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2 days ago · Embracing His Heart's Passion, Despite Congenital Heart Defect

Woody Hust, an athlete and outdoorsman, is living his dream in the Rocky Mountains. It's a picture-perfect existence made even more special because he's achieved his goals despite having a congenital heart defect. Thanks to the lifelong, personalized care Woody's received from his Mayo Clinic cardiologist, the sky continues to be the limit for him.

Woody Hust, an athlete and outdoorsman, is living his dream in the Rocky Mountains. It’s a picture-perfect existence made even more special because he’s achieved his goals despite having a congenital heart defect. Thanks to the lifelong, personalized care Woody’s received from his Mayo Clinic cardiologist, the sky continues to be the limit for him.




For
nearly as long as he’s walked, Woody Hust has skied. Fitted into his first pair
of skis at just 17 months by his ski instructor parents, he grew up on the
slopes. By his teen years, his talents and love of the sport had propelled him
to competitive racing, where he qualified for the Junior Olympics when he was
15.

“It’s
probably my biggest passion,” says Woody, who’s now 25. “I don’t know
what I would do without skiing. When I’m skiing, I’m just in my happy
place.”

Woody’s devotion to the sport and savvy on the slopes are all the more remarkable because he was born with a congenital heart defect. The condition, called critical aortic valve stenosis, has required him to undergo five open heart surgeries — three of them at Mayo Clinic

While
many factors contribute to Woody’s athleticism, the encouragement of his
parents and the supportive care offered by his Mayo Clinic pediatric cardiologist
Allison
Cabalka, M.D.
— who became Woody’s doctor when he was
in utero — rank high on the list of reasons for his continued success.

“I’m
lucky,” says Woody, who lives in Whitefish, Montana, and works as a ski
instructor and a forester for the state of Montana. “I’ve come a long way,
and I’ve gotten to do everything I’ve wanted to do, and I credit that to Mayo
Clinic. I feel fortunate to be able to get the care that I’ve gotten at Mayo.”

As
is the case with some people who have congenital heart defects, Woody lives
with activity restrictions to protect his heart health. In Woody’s case, those
restrictions have been carefully developed through years of testing his limits.

“Woody
has always been an avid outdoorsman and athlete with downhill skiing, and now
living in Montana with outdoor activities and working in the forest
industry,” Dr. Cabalka says. “I think he’s coped very well with his
limitations. He might be a little superhuman.”

Treating a life-threatening defect

Woody’s
history of defying the odds started just after birth, says his mom, Heidi,
explaining that when Woody’s heart defect was identified at 6 months’ gestation,
Dr. Cabalka — who at the time worked at a medical center in Minneapolis —
became his cardiologist. “His aortic valve was a lump, and he had critical
valve stenosis,” Heidi says.

Just four hours after he was born, Woody underwent his first open-heart surgery. During the valve repair, his misshapen and narrowed aortic valve, which is the main pump to the body and normally has three cusps to regulate blood flow, was opened up and reformed into a bicuspid valve.

For
six weeks after surgery, Woody remained connected to breathing support in a
neonatal ICU in the Twin Cities, and he struggled to heal. More than once, doctors
told his parents their son would not survive the night. During this time, members
of Woody’s surgical team urged the family to allow them to give Woody an
artificial heart valve, emphasizing that without a new valve, he wouldn’t
thrive.

But
Dr. Cabalka was firm in her belief that Woody would fare better if left to grow
and develop without an artificial valve. “So we let him sit and grow. Dr.
Cabalka was adamant that was the best solution,” Heidi says. “And he
was fine. He pulled out his own breathing tubes at 6 weeks old and started
eating. It was amazing. He was so strong. He’s a really tough kid.”

Overcoming significant hurdles

Woody’s
resilience was tested time and time again. As a kindergartener, he required his
second open-heart surgery, which was performed at a hospital in Michigan. Known
as a Ross-Konno procedure, the surgery entailed replacing Woody’s abnormal
aortic valve with his own pulmonary valve. In place of the pulmonary valve, a
human donor valve was placed.

“We were so grateful we followed Allison (Cabalka) down to Mayo because we definitely got the cutting-edge care that was right for Woody.”

Heidi Hust

When Woody was 15, Dr. Cabalka, who by then was working at Mayo Clinic in Rochester, recommended a third surgery. This operation, which was performed by Mayo Clinic cardiovascular surgeon Joseph Dearani, M.D., replaced the valve and aortic root, which is the portion of the aorta closest to the heart. In addition, the pulmonary valve that had been implanted a decade earlier was replaced with a bovine valve.

Nine
months after surgery, however, the bovine valve became infected with a rare, hard-to-identify
microbacteria. The infection required a month-long hospitalization and a fourth
surgery to replace the damaged valve, giving Woody a new pulmonary valve.

“We
were so grateful we followed Allison (Cabalka) down to Mayo because we
definitely got the cutting-edge care that was right for Woody,” Heidi says
“They looked at what Woody needed and when he needed it. We had so much
confidence in Dr. Dearani when we met him. We were just really scared, and he
helped.”

For
Woody, managing his hospitalizations and recovering from surgery has always
been closely linked to skiing. “Whenever I was having a hard time in the
hospital, I’d visualize myself skiing and imagine I was in my favorite
spot,” he says. “I kind of use it as my benchmark after surgery: How
quickly can I ski again?”

For
Woody’s parents, encouraging their son to pursue his goals while guarding his
health was a balancing act. “Raising him was difficult because he didn’t
outwardly show these signs,” Heidi says. “We always raised him that
he should just try anything, but sometimes it’s a modification. While we
understood the risk, we let him try things once.”

Changing course

Following
back-to-back open-heart surgeries as a teen, Woody realized that he would be unable
to pursue a career as a competitive skier, but that didn’t stop his dreams of earning
a living on the slopes. Following high school, he moved to Montana and took a
position requiring familiarity with the nature in forested, mountainous
regions.

Woody’s
job is physically demanding, often entailing 5- to 6-mile hikes to job sites. During
his off hours, he routinely practices backwoods skiing, which involves skiing
in areas not outfitted with lifts, boundaries or safety patrols. Despite the
physicality his job and hobbies require, Woody embraces his active lifestyle.

“Sometimes
I have to be a little careful, but I am open with my friends about it and tell
them what is going on,” Woody says. “People are open and accepting of
it, and I’m still able to do everything I want to do.”

In
fall 2019, however, the demands of the work began weighing on him. “I could
feel myself slowing down,” Woody says. “I’d get home after a hard day
of hiking, and I just had to go sit on the couch and recover for the next two days.”

“After the operation, I felt like a different person, in a really good way.”

Woody Hust

At
his next appointment with Dr. Cabalka, the decision was made to refer him to Dr.
Dearani for his fifth open-heart surgery. “His aortic valve worked really
well for many years, and then eventually started to leak,” Dr. Cabalka
says. “The leakage caused blood to back up into Woody’s heart and
necessitated another surgery where Woody received an artificial, mechanical aortic
valve.”

“After
the operation, I felt like a different person, in a really good way,” Woody
says. “I have more energy. My heart rate is not as high. My heart doesn’t
pump when I’m doing those activities, and all around I feel a lot better.”

The
best part for Woody, who was back to skiing six weeks to the day after his
surgery, was how the operation enhanced his performance on the slopes.
“It’s definitely improved by ability to ski. It’s a big positive to have
gotten that surgery.”

Forging close relationships

With
the mechanical valve keeping his blood flowing smoothly, Woody should not need
another open-heart surgery for a long time, Dr. Cabalka says. “We hope these
valves will be really durable for most of his life. Barring infection or other
issues, they could last many, many years.”

When
the time comes for Woody to receive a new pulmonary valve, the hope is that the
valve can be replaced with a transcatheter valve, which would use a catheter
inserted through the femoral artery, rather than open-heart surgery, to place
the valve, Dr. Cabalka says.

To
ensure that his heart valves and his heart function remain normal, Woody will
continue visiting Dr. Cabalka annually for checkups. The visits are something
he looks forward to. “It’s been cool to go on this journey, from when I
had that first surgery at Mayo at 15 to now, to be able to go back, just to say
hi,” Woody says. “I feel so cared about and valued there. I know a
lot of other people with congenital heart defects who go elsewhere, and they
don’t have the same stories.”

Visits with Woody and his parents are happy occasions for Dr. Cabalka. “We do have the medical visit, but then we spend the rest of the time chatting about their family and my family,” she says. “It’s always nice to have the personal relationship. It’s this rewarding part of the doctor-patient relationship in Pediatric Cardiology that we really appreciate. As someone who’s been able to care for Woody through his entire life so far, it really is a privilege to be able to see this young man grow up to the amazing person that he is.”

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Wed, Apr 1 5:00am · Telemedicine Helps Provide the Right Care at the Right Time During Unexpected Delivery

When Lizzie Stoltz went into labor more than two months early with her second child at Mayo Clinic Health System in Bloomer, Wisconsin, she and the baby needed specialized care. They got it, thanks to a connection with a Mayo Clinic neonatologist who guided the delivery from more than 100 miles away.

When Lizzie Stoltz went into labor more than two months early with her second child at Mayo Clinic Health System in Bloomer, Wisconsin, she and the baby needed specialized care. They got it, thanks to a connection with a Mayo Clinic neonatologist who guided the delivery from more than 100 miles away.




Lizzie
Stoltz was pregnant and 10 weeks shy of her due date. But that didn’t matter to
baby Madelyn. She was ready to make her entrance. Her parents, Lizzie and
Shaun, couldn’t have been more surprised. “He said right away, ‘You’re
kidding.’ I said, ‘No, I’m positive my water just broke,” Lizzie says of
informing her husband about the imminent arrival of their second child.

The couple had planned on welcoming Madelyn into the world at Mayo Clinic Health System in Eau Claire, Wisconsin, approximately 30 miles from their home in Bloomer, Wisconsin. Given the increasing intensity and frequency of contractions, however, Lizzie and Shaun were forced to switch plans, stay close to home and make a beeline for Mayo Clinic Health System in Bloomer. Physician assistant Jon Farm and a team of others were awaiting their arrival. “That’s the first thing that crosses my mind, to summon the appropriate resources and team to be able to take care of the patients that are coming in,” Farm says.

With no in-house labor and delivery service or neonatal intensive care unit in Bloomer, Farm knew that he and his colleague Phillip Skaar, M.D., a physician in Family Medicine, would need some assistance. “I called the transfer line in Rochester and told them, ‘I’m going to need some telemedicine help, as well,'” Farm says.

First used by Mayo Clinic Children’s Center in 2013, Mayo’s telemedicine program allows Mayo Clinic neonatologists to consult with Mayo Clinic Health System care teams in real time with the help of a two-way video screen.

“It was literally like having a specialist looking over your shoulder.”

Phillip Skaar, M.D.

“We
have controls in order to zoom in other parts of the room, improve our audio,
talk to providers with a handset if needed. Short of us standing right there
with the team, it’s the next best thing,” says Christopher
Collura, M.D.
, a Mayo Clinic neonatologist who
participates in the telemedicine program.

For
Farm, Dr. Skaar and the Stoltz family, having Dr. Collura on a telemedicine
video screen in Bloomer to help guide Madelyn’s early arrival was just the
support that was needed. “It was literally like having a specialist
looking over your shoulder,” Dr. Skaar says of Dr. Collura’s involvement
in the delivery process from approximately 100 miles away in Rochester.

Unfortunately, Dr. Collura’s involvement would not end with Madelyn’s arrival. “She was very limp and blue, and not breathing,” Farm says. So with Dr. Collura still providing guidance via the telemedicine screen, Farm and members of a Mayo Clinic flight crew worked to intubate Madelyn, who weighed just 3 pounds, while a second Mayo Clinic neonatal flight crew flew from Rochester to Bloomer to transport Madelyn to Mayo Clinic in Rochester.

Madelyn
received specialized care in Rochester for 44 days before being discharged home.
Since then, she’s been making her own unique mark within the Stoltz family. “It’s
broken sleep with lots of smiles. That’s what it is,” Shaun says of having
a thriving Madelyn at home. “She’s going to be demanding. She’ll be a
fighter, that’s for sure.”

Learn
more about Madelyn’s story in this video:


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Mon, Mar 30 5:00am · Care Coordination Puts Jim on the Path to Recovery

After Jim Hauck sustained serious injuries from a car accident in Nevada, Mayo Post Acute Care helped him return home, where he continues to recover and heal.

After Jim Hauck sustained serious injuries from a car accident in Nevada, Mayo Post Acute Care helped him return home, where he continues to recover and heal.




Jim
Hauck wasn’t sure where he was when he woke up in a hospital in February 2019.
The 52-year-old Eau Claire, Wisconsin, resident had been in a serious car
accident while visiting his daughter in Las Vegas, but he has no memory of the
accident.

“I
had like a memory or a dream that I was back in the military,” Jim says. “I
felt like I was being tortured, smothered.” Jim’s wife, Karen, says he was
trying to tear off his oxygen mask and tubes, and hospital staff had to stop
him.

Once
he was fully awake, and Karen told Jim what had happened, his immediate
concerns were those of a worried father. “The first thing I thought was, ‘Is
my daughter OK?'” Jim says. His daughter, Katie, was injured, but not
nearly as severely as Jim. He had a long road to recovery ahead, and he was a
long way from his home in Wisconsin.

Looking toward home

Before
Jim could start thinking about traveling back to Wisconsin, he needed multiple
surgeries in Las Vegas. He had spinal fractures, a fractured pelvis, broken
ribs, lacerated lungs and liver, and a brain injury. Jim also needed a hip
replacement.

“Getting through the long days unsure of what was going to happen — that was kind of difficult.”

Jim Hauck

“My
big concern was if I would ever be able to walk again,” Jim says. “Getting
through the long days unsure of what was going to happen — that was kind
of difficult.”

After three months in Las Vegas, Karen started making calls to find a way to get Jim back to Wisconsin, so he could continue his recovery and rehabilitation closer to home. Through Jim’s primary care provider in Family Medicine at Mayo Clinic Health System, Karen connected with Gretchen Onarheim Weeks, a care coordinator for Mayo Post Acute Care at Mayo Clinic Health System — Chippewa Valley in Bloomer, Wisconsin.

“The
first time I spoke to Karen, she was in tears,” Gretchen says. “I
told her, ‘I’m going to put myself in your shoes and think, “What if this
was me?”‘ You’d want someone to do that for you.”

Navigating transfer of care

Preparing for Jim’s trip back to Wisconsin required careful coordination. Gretchen began the process of arranging for the transfer of his care from his providers in Las Vegas to Mayo Clinic Health System providers in Bloomer and Eau Claire. “Jim still needed extensive rehab,” Gretchen says. “He wanted to get back to the area, but he wasn’t ready to go home.”

Transferring
Jim’s care involved acquiring all of his images and operation reports from
various surgeons in Las Vegas. Then Gretchen lined up Jim with Mayo Clinic
Health System neurosurgeon T.K. Schiefer, M.D., as well as orthopedic surgeons Jonathan Webb, M.D., and
Tina Dreger, M.D., to
oversee his care in Wisconsin. She scheduled conversations among the surgeons
in each state to complete a formal handoff of care. Gretchen also worked with
Jim’s insurance company to obtain authorization for him to receive physical therapy
and occupational therapy once he arrived in Bloomer.

Karen and Mark Hauck, the couple’s son, drove Jim over 30 hours from Las Vegas to Eau Claire, where they brought him to the Emergency Department at Mayo Clinic Health System in Eau Claire for evaluation. After a few days in Eau Claire, Jim was brought to the hospital in Bloomer, where he would spend the next four months.

Focusing on healing

While undergoing rehabilitation in Bloomer, Jim’s care was overseen by hospitalists Charles Wirtz, M.D., and Celestine Odenigbo, M.D. Jim worked daily with an occupational therapist and a physical therapist. “They became like a second family,” Jim says. “I asked a lot of questions. The staff was phenomenal — the doctors, the nurses. Even the cook came to visit me once.”

Working
hard at his daily therapy paid off for Jim. When he arrived in Bloomer, he wasn’t
getting out of bed at all. By the time he left, he was able to walk out of the
hospital with a walker. “That was huge for me,” Jim says.

“The staff was phenomenal — the doctors, the nurses. Even the cook came to visit me once.”

Jim Hauck

Gretchen and Amy Taylor, a social worker, prepared Jim for discharge by getting him the equipment he would need and arranging for him to receive home care, including receiving therapy at home.

Jim
continues to work hard at his therapy. In time, he will need additional surgery
on his hip. But as he continues his long road to recovery, he’s keeping a
positive attitude.

“I
just thank God that I’m alive,” Jim says. “I can think. I can
communicate. My family is there for me. I might not get around as well as in
the past, but that’s immaterial. Everything else is a bonus.”

NOTE: A version of this story
previously was published in
Hometown
Health
.


HELPFUL LINKS

Fri, Mar 27 5:00am · Orthopedic Surgery at Mayo Clinic Ends Nurse's Hip and Knee Pain

Jesse Stewart couldn't understand why the seven orthopedic surgeries he'd had for pain in one knee and both hips hadn't done anything to improve his quality of life. After coming to Mayo Clinic, however, Jesse found the answer to that question, and he finally received surgery that fixed the problems.
Jesse Stewart with Bruce DeGrote

Jesse Stewart couldn’t understand why the seven orthopedic surgeries he’d had for pain in one knee and both hips hadn’t done anything to improve his quality of life. After coming to Mayo Clinic, however, Jesse found the answer to that question, and he finally received surgery that fixed the problems.

At 26, Jesse Stewart should have been entering the prime of his life. Instead, Jesse’s life was hampered by chronic pain. By that point, he’d already endured seven orthopedic surgeries intended to relieve him of knee pain that began during college with an ACL tear and a torn meniscus, as well as pain in both hips.

Jesse’s first surgery was with a local provider in Michigan. “It didn’t go very well,” he says. Although he didn’t get much relief from that surgery, or from any of the six surgeries that followed, Jesse persevered through the persistent pain. He managed to finish college, earn a degree in nursing, and land a job at Mayo Clinic in Rochester. At Mayo, he met Aaron Krych, M.D., an orthopedic surgeon. Dr. Krych identified the underlying source of Jesse’s continuing knee and hip pain, and after several more surgeries, Jesse finally was freed from the chronic pain.

The experience left a lasting impression on Jesse, both personally and professionally. “My experience at Mayo — from walking in the door before surgery to after surgery — was hands down the best hospital experience I’ve ever had,” he says. “Care providers go out of their way to make you feel important at Mayo Clinic, which is a big deal to patients. It was a big deal to me, so that’s what I’m striving to do for my own patients.”

A worsening problem

After Jesse’s first surgery in Michigan, it quickly became clear during physical therapy that problems still remained. “My hip started hurting a lot during all the exercises and stretches I was doing after surgery,” he says. “I ended up being referred to see another surgeon elsewhere in Michigan for hip impingement.”

The
diagnosis of hip impingement — a condition in which the ball and socket of the
hip joint don’t fit together correctly — led to four hip surgeries for Jesse.
None of them eliminated the pain. “I’d have maybe a month or two of
reduced pain, but the pain would come right back. I’d have the same issues I
had prior to surgery,” Jesse says. “Nothing ever got better.”

In
addition to his hip issues that were still causing problems, Jesse couldn’t
seem to get rid of the knee pain either. “I had two more knee surgeries in
Michigan for meniscus tears,” Jesse says. “That brought me up to
three knee and four hip surgeries. After each one, I got little to no relief.
The same issues and symptoms kept reappearing. I had a lot of difficulty
walking and staying active.”

The
ongoing stress not only affected Jesse’s health, it also had an impact on the
future he was trying to build for himself. “I was in nursing school at the
time, so I had to work around my nursing school schedule to have all of these
surgeries done,” he says.

Jesse pushed through and graduated, though. With degree in hand, he accepted his first nursing job in Mayo Clinic’s Department of Neurosurgery in Rochester. But his lingering knee and hip pain followed him to Minnesota.

“From a career standpoint, I was like: ‘What am I going to do? I can’t continue living and working like this.'”

Jesse Stewart

“I’d
come home after a shift and be in a ton of pain. I’d take a bunch of ibuprofen
so that I could get some sleep without waking up in pain,” he says.
“I normally try to stay away from that stuff. But in order to keep going
and keep working, I felt I had no other choice. I was icing all the time.”

Fresh
out of college and barely into a career he’d worked so hard to begin, Jesse
couldn’t help but worry that he’d eventually have to give it all up. “From
a career standpoint, I was like: ‘What am I going to do? I can’t continue
living and working like this,'” he says. “I couldn’t stay on my feet
and care for my patients the way I wanted to without being in worsening amounts
of pain. It was affecting my mood and stressing me out, which is also tough on
the body.”

A revision of a revision

It was at that point Jesse became a Mayo Clinic patient, as well as a staff member. “Initially, I had cortisone shots in my hips and knee, but those didn’t help either,” Jesse says. “I then went through multiple CT scans, MRIs — all those things — and was ultimately referred to Dr. Krych.”

The results of Jesse’s imaging revealed a unique cause for his hip pain. “He had impingement in both hips with labral tears. That happened because he’d formed extra bone from being an athlete growing up. That extra bone led to impingement, which then led to secondary damage to his labrum,” Dr. Krych says. “He had a challenging case because the impinging bone was in a location of his hip that was difficult to access. The bottom line of why his previous surgeries were not successful is that if you don’t eliminate all the locations of impinging bone, then symptoms in the hip will continue.”

Fortunately
for Jesse, after studying the imaging, Dr. Krych and his team were confident
they could access the impinging bone that remained and remove it all. “We
went ahead with repeat revision surgery for him, and we did that in a staged
fashion,” Dr. Krych says. “We performed surgery on his left hip first
and then his right hip.”

“After surgery, it was a night-and-day difference. I had no clicking or popping in my hips, and no more catching, which is what had caused me pain.”

Jesse Stewart

Jesse
understood that improvement after surgery wasn’t guaranteed. “This was a
revision of a revision on both of my hips, and before surgery, Dr. Krych’s
physician assistant, Bruce DeGrote, said: ‘I have to be honest. This might not
help you,'” Jesse says. “But after surgery, it was a night-and-day
difference. I had no clicking or popping in my hips, and no more catching,
which is what had caused me pain.”

With the hip problem resolved, Dr. Krych and his surgical team turned their attention to Jesse’s right knee. “Even though he’d had a previous ACL reconstruction performed on his right knee in 2014, followed by another knee scope in 2015 and then a meniscus repair in 2017, he continued to have pain and limitations in his right knee,” Dr. Krych says. “So we addressed the residual meniscus tear and also cleaned up some other damaged cartilage in his knee.”

Just
like he did after his hip surgeries at Mayo, Dr. Krych says Jesse breezed
through his recovery from knee surgery, as well. “Thankfully, Jesse
responded well to all of our surgeries, which is a testament to him,” Dr.
Krych says. “The aspect I admire most about Jesse is he’s incredibly
motivated and has a really positive attitude. He’s just one of those patients
that does well after surgery because he is so positive and diligent about his recovery.”

A different kind of care

With
recovery now behind him, Jesse says the improvement is remarkable. “I’m
still working on getting my strength back up. But from a range-of-motion
standpoint, I can squat normally now, which I was never able to do before,”
he says. “There are so many things that I couldn’t do throughout much of
my life that I can do now because I’m no longer in chronic pain, and my hips
are no longer constantly clicking or popping. I can come to work now and not be
in pain.”

That’s
thanks to Dr. Krych, his surgical team, and a patient experience that Jesse
says from start to finish was unlike anything he’d experienced before. “At
other hospitals, I felt like a number. But at Mayo, Dr. Krych would call me at
home to check up on me after my surgeries,” he says. “Bruce DeGrote
would also send me messages through the patient portal to ask how I was doing. Little
things like that made me feel more like a human being and less like a number. Because
of that, regardless of where I am in life from here on out, I’ll always come to
Mayo Clinic for my health care. There’s just that much of a difference.”

It’s
the kind of difference that Jesse now is able to make for his own patients
without worrying about pain getting in the way. “My experience as a
patient at Mayo Clinic has definitely impacted the way I look at and do my own work
as a nurse,” he says. “Because I’ve now seen that when you provide
care at this high of a level, patient outcomes are going to be so much better. I’m
trying to do the best I can for my patients and to treat them the way I would
want to be treated if I were in their situation.”

As
a fellow care provider, helping Jesse continue his work as a nurse was one of
Dr. Krych’s goals, too. “It’s very satisfying for me to take care of other
Mayo Clinic employees and help them stay in the game, so they can continue
providing care to our patients, as well,” he says. “That’s doubly
rewarding for me as a physician within our Mayo Clinic family.”


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Wed, Mar 25 5:00am · The Power of an Upbeat Attitude Shines Through in Physical Therapy

How a person feels mentally and emotionally can make a big difference in the course of physical therapy. For Carl Hohman, the bond he's formed with his rehabilitation team helps keep his spirits high.

How a person feels mentally and emotionally can make a big difference in the course of physical therapy. For Carl Hohman, the bond he’s formed with his rehabilitation team helps keep his spirits high.




Multiple sclerosis, or MS, is an incurable disease of the brain and spinal cord that can cause permanent damage to the nerves. Yet for all of the detrimental effects MS can have, Carl Hohman of Genoa, Wisconsin, continues to keep a positive attitude as he faces this difficult disease.

First diagnosed with MS in 2001, Carl’s immune system began attacking the protective sheath, or myelin, covering his nerve fibers. That caused communication problems between his brain and the rest of his body. Since then, Carl has required a steady routine of physical therapy at Mayo Clinic Health System — Franciscan Healthcare in La Crosse, Wisconsin. For the past seven years, Anna Stoecklein, D.P.T., has been Carl’s physical therapist and is guiding the plan to help keep him active and moving.

Setting goals

“The
goals for Carl’s therapy have changed a lot throughout the years,” Stoecklein
says. “At first, it was to walk independently. Later, when he was weaker,
it was to be able to transfer to using a device to help with movement. Most
recently, we’re back to a goal of walking short distances at home with a
walker.”

Stoecklein
emphasizes that, as a therapist, her goal is to reflect Carl’s goals, and she
knows that he has been realistic about his limitations and disease. However,
she affirms that he also is optimistic and motivated to meet whatever goals he
sets for himself.

“Fortunately, I have a great group of people that I work with around here. Everybody in the place is very supportive.”

Carl Hohman

Dealing
with physical limits can be frustrating, especially for someone like Carl, who
in past years participated in a number of outdoor activities and lived an
adventurous life. Yet the bond he’s formed with Stoecklein and the
rehabilitation staff helps keep his spirits high.

“Fortunately,
I have a great group of people that I work with around here,” Carl
says. “Everybody in the place is very supportive.” 

Thinking positively

Stoecklein
appreciates the attitude Carl brings to his therapy sessions that take place
multiple times each week.

“It’s
incredibly important for a patient undergoing any type of therapy to keep a
positive mindset,” Stoecklein says. “It can make the biggest impact outside
of what we do in the physical therapy clinic. Patients need to believe that
they can get better. They need be motivated to do a lot on their own, as they
only spend about 1% of their week in the physical therapy clinic. This is why
home programs are crucial to a patient’s rehabilitation. How a patient feels
mentally and emotionally affects everything, and can make or break their course
of therapy.”

Physical
therapists teach patients how to prevent or manage their condition to achieve
long-term health benefits. Physical therapists examine each individual and
develop a strategy using treatment techniques to promote the ability to move,
reduce pain, restore function and prevent disability. In addition, physical
therapists work with people to prevent the loss of mobility before it occurs by
developing fitness- and wellness-oriented programs for healthier, more
active lives.

Working across conditions and ages

In
addition to helping people with a specific disease, such as MS, physical
therapists see patients for musculoskeletal conditions, such as ankle sprains,
chronic back pain, tennis elbow, whiplash and everything in between.

“Therapists
treat patients who have had strokes or have had falls and need to work on
balance, and those who have dizziness and other inner ear or visual disorders,”
Stoecklein says. “We treat patients who have difficulties with their
pelvic floor, including postpartum, incontinence or constipation. We see
patients after surgery or after breaking a bone. We treat people of all ages
from infants up to geriatric patients.”

For
Carl, a supportive care team, loving family and ability to inspire others helps
keep him going. “It’s amazing what things in life you think you need or
you don’t need, and I’m so happy to still be with my family,” Carl says. “Keep
a smile on your face, and just go strong. Never give up. Never give in.”

Note: A version of
this story previously was published in
Hometown
Health
.

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Mon, Mar 23 5:00am · Impromptu Evaluation Uncovers Life-Threatening Heart Disease

Greg VanBellinger knew from family history that he was at risk for heart disease, but as a fitness enthusiast who stayed on top of his medical appointments, he believed his heart was in good shape. An offhand decision to participate in a fitness evaluation at Mayo Clinic, however, revealed that Greg's heart was not as healthy as he believed.

Greg VanBellinger knew from family history that he was at risk for heart disease, but as a fitness enthusiast who stayed on top of his medical appointments, he believed his heart was in good shape. An offhand decision to participate in a fitness evaluation at Mayo Clinic, however, revealed that Greg’s heart was not as healthy as he believed.




Greg VanBellinger thought it would be a fun date with his wife, Laura. A Friday morning at Mayo Clinic spent doing something together that they love: working out. As an executive at Target Corporation, Greg had access to Mayo Clinic’s Executive Health Program, and he purchased an optional evaluation designed to help him and Laura, who is a personal trainer, assess their overall health.

For Greg, however, what began in August 2017 as a morning filled with endorphins and education as part of the Mayo Clinic Healthy Living Program, morphed into an alarming affair that landed him an immediate appointment in the Department of Cardiovascular Medicine. He also received the shocking news that he was at grave risk for a heart attack.

“It
wasn’t the way I expected the date to end,” says Greg, who lives in
Minneapolis with Laura and their two children. “I normally don’t sign up
for those sorts of things, but it was kind of like there was a force pushing
me.”

During
his quickly arranged appointment in Cardiovascular Medicine with Robert
Frye, M.D.
, Greg learned he had a coronary blockage requiring
rapid intervention. One week later, he underwent a catheterization procedure
that revealed the gravity of his situation. Three of Greg’s coronary blood
vessels were almost completely blocked. That same day, Greg underwent a
stenting procedure to reopen those arteries.

“Dr.
Frye said if I would have had a massive heart attack, I would have died,”
Greg says. “I would not have recovered from that. I happened to be at the
right place at the right time with the right experts looking at me.”

Prime health, dangerous problem

Greg grew up under the shadow of heart disease with members of his family experiencing heart attacks at a young age. Greg had been tuned into his own cardiac health since he was 25, and he learned in his early 50s that his arteries had begun hardening.

Despite
that history, at 54 years old, Greg was in tiptop shape. An avid hockey player
and member of the Adult Hockey Association in Minneapolis, Greg was an exercise
enthusiast who regularly participated in extreme challenges. Two weeks prior to
his health assessment at Mayo Clinic, he’d climbed 2,000 feet up the Manitou Incline
in Colorado in 45 minutes and then ran the 3½ miles back down.

“I eat healthy, work out, am active, and I don’t smoke. So I was not, if you look at me, what you’d think would be a heart attack victim.”

Greg VanBellinger

“I
weigh 165 pounds, am 6’1′, and used to race bicycles,” Greg says. “I
eat healthy, work out, am active, and I don’t smoke. So I was not, if you look
at me, what you’d think would be a heart attack victim.”

Greg
also stayed on top of his health care, getting routine medical checkups, including
a prior workup through Mayo’s Executive Health Program. Four months before the Mayo
Clinic Healthy Living Program evaluation, Greg underwent the standard Executive
Healthy physical. “My blood pressure was 113 over 70,” Greg says. “Everything
was fine, and they didn’t see the need to change anything.”

Even
during the more detailed analysis involved in the August program, which took
place at the Dan
Abraham Healthy Living Center
, Greg’s performance
was top-tier. “They test muscle strength, do a full body scan. You’re
working with a physical therapist, and they measure how far you can stretch.”

Another
test measured Greg’s ability to convert oxygen into carbon dioxide. It entailed
Greg donning a VO2 mask, which tracks the amount of oxygen a person consumes
during intense exercise, and a heart monitor. “I ran for 13 or 14 minutes
and got my heart up to 200 beats per minute,” Greg says. “I was in the
top 20% for my age of the VO2 mask.”

It
was then that the problem began to reveal itself. Greg’s heart rhythms were
slightly off. “The technician monitoring me noticed there was a millimeter
deviation of my heartbeat — where the EKG goes up and down was off by one
millimeter,” Greg says.

After
Greg completed the workout portion of the program, he was pulled aside by Mayo
Clinic Healthy Living Program physician Warren
Thompson, M.D.
, and informed he needed to see a
cardiologist straight away.

Conscientious care, prompt treatment

In the Department of Cardiovascular Medicine, Greg underwent another EKG, as well as a nuclear stress test, which measures blood flow to the heart. “I did not pass the nuclear stress test,” he says. “There was some sort of blockage somewhere, and my blood was not flowing at the rate it should be.”

After the EKG, Greg met with Dr. Frye and was directed to keep his heartrate below 150 beats per minute. Greg also learned he needed to undergo a coronary catheterization procedure. The test would allow his medical team to look inside his arteries and give them better information about of the severity of the blockages.

A
week later, Greg returned to Mayo for the catheterization that revealed the obstructed
blood vessels. One of the vessels — the left ascending arterial artery, which
supplies blood to the left side of the heart and is considered the most
critical vessel in the movement of blood to the heart — had two 70% blockages.
Another major artery was 90% obstructed.

“Dr. Frye literally told me that I would have had to have a heart attack in a hospital to survive.”

Greg VanBellinger

Based on those finding, his team decided to pursue coronary angioplasty to treat the blockages. Performed by Gurpreet Sandhu, M.D., Ph.D., a Mayo Clinic interventional cardiologist, the procedure involved inserting small balloon catheters through an artery in Greg’s arm to the blocked arteries, where they were inflated to open the vessels. Next, tiny wire mesh tubes, or stents, were placed to help keep the vessels open.

While
Greg was recovering from the procedure, Dr. Frye stopped in for a visit. “Dr.
Frye literally told me that I would have had to have a heart attack in a
hospital to survive,” Greg says. “They would not have been able to
recover me somewhere else.”

The
most amazing part of the experience, says Greg, is the speed at which his
condition was treated after discovery. “I saw one of the head
cardiologists that day. I didn’t have to wait around for two weeks. I was
expedited through Mayo, and I don’t think that would have happened anywhere
else.”

Following
his experience, Greg shared his story with colleagues during an executive
officer meeting. “I told everyone my story because they all have the
opportunity to go to Mayo or to a doctor as part of our work,” Greg says.
“I said that if it wasn’t for Mayo Clinic and for Target, I wouldn’t be
standing here today. I don’t look like a heart attack victim, but I would have
died of a heart attack.”


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Fri, Mar 20 5:00am · Genetic Counseling Guides Informed Health Decisions

Knowledge is power. That's Rose Boettcher's philosophy. Genetic counseling helped this three-time cancer survivor make decisions about her health care. Her test results also have inspired her to advocate for her family's health and well-being.

Knowledge is power. That’s Rose Boettcher’s philosophy. Genetic counseling helped this three-time cancer survivor make decisions about her health care. Her test results also have inspired her to advocate for her family’s health and well-being.




Cancer runs in Rose Boettcher’s family. The 67-year-old Cumberland, Wisconsin, resident has had three types of cancer: uterine, ovarian and, most recently, colon cancer that also spread to her liver. “There’s a huge history of colon cancer in my family,” Rose says.

Those factors led Eyad Sufian Al-Hattab, M.D., Rose’s oncologist at Mayo Clinic Health System in Eau Claire, Wisconsin, to recommend that Rose undergo genetic counseling. Through a combination of genetic counseling and testing, Rose could learn about her genetic health, which in turn could help her make informed decisions about her health care.

Learning the options

Rose met with Katie Plamann, a Mayo Clinic Health System genetic counselor, who explained the options. Plamann says this is an essential part of the process, and part of her job is to help patients navigate the complexity of genetic testing.

“We
support the patient from start to finish,” Plamann says. “We help
them understand the implications of the tests we can do. Sometimes they decide
they would rather not know. But a lot of patients say, ‘Knowledge is power,’
and want to go ahead with the testing. I think that’s a wonderful way to look
at it.”

“If my story can help somebody else, that’s a good thing.”

Rose Boettcher

For
Rose, the choice was not a hard one. She preferred to be armed with
information. “Being that I’m 67 and have already had three types of
cancer, I guess I’m more proactive in my own health care,” Rose says.
“This was more for my children and grandchildren. If they learn they are
at risk, they can go in for earlier screenings. If you catch them early, the
success rate for treatment is a lot better.”

Blood tests revealed that Rose has Lynch syndrome, an inherited condition that increases the risk of colon cancer and several other types of cancer. Around 3% of colon cancers are caused by Lynch syndrome.

Empowering educated choices

Plamann
says the knowledge Rose gained can help her family. “For Rose, we were
able to come up with an answer to why she developed those cancers,” Plamann
says. “Now we can work to determine who else in the family has Lynch
syndrome, so they can make informed decisions about their care.”

In addition to Oncology patients, Plamann works with OB-GYN patients and couples for counseling before and after they become pregnant. Together, they review screening and testing options. Reasons to move forward with genetic testing may include a family history of a genetic condition or a desire to determine if an individual is a genetic carrier.

Plamann
says as people have become more familiar with genetic counseling, more of them
are asking their providers about it. She says people who may be good candidates
for genetic counseling include those who have:

  • A
    significant personal or family history of cancer
  • Been
    diagnosed with cancer younger than age 50
  • Rare
    cancers, such as ovarian or male breast cancer
  • Had
    three or more relatives on the same side of the family with the same type of
    cancer

Rose
says she gained valuable information throughout the process and has been urging
family members to take advantage of genetic counseling, too. “I will
encourage them to have cancer screenings and be proactive in their health
care,” Rose says. “If my story can help somebody else, that’s a good
thing.”

Note: A version of this story
previously was published in
Hometown
Health
.


HELPFUL LINKS

Wed, Mar 18 5:00am · Expert Care Tackles Daunting Diagnosis of Pancreatic Cancer

With a grim prognosis of advanced pancreatic cancer, Dr. Jim Smith had little hope for his future. That is, until he met a team of Mayo Clinic cancer specialists, whose experience and expertise set Jim on a treatment path that led him to a place of hope and healing.
Melanie and Jim Smith

With a grim prognosis of advanced pancreatic cancer, Dr. Jim Smith had little hope for his future. That is, until he met a team of Mayo Clinic cancer specialists, whose experience and expertise set Jim on a treatment path that led him to a place of hope and healing.




When Jim Smith, M.D., a physician and professor at Creighton University School of Medicine in Omaha, Nebraska, was diagnosed with metastatic pancreatic cancer more than two years ago, he believed his prospects for the future were dim.

The advanced stage of the cancer, which appeared to have spread to Jim’s spleen and lungs, excluded him from having surgery to treat it. And while chemotherapy was an option, the nature of the disease was such that, even with chemotherapy, the cancer would likely claim Jim’s life in less than a year.

“I
remember having some difficult conversations,” says Jim, who is married and
has two daughters. “I didn’t want heroics. If my time had come, it was
important for me to move on and not pose a burden to my family.”

Jim’s
wife of 14 years, Melanie, was not ready to accept that approach. “She
said, ‘We’re going to live our lives with optimism and hope,'” Jim says.

With Melanie’s strong encouragement, Jim requested an appointment for a second opinion at Mayo Clinic, which was studying a biopsy sample of Jim’s tumor cells that’d been sent by his Omaha team. “At the time, we didn’t know where the primary origin (of the cancer) was and wondered if there were some other therapies that could be used,” Jim says.

In December 2017, Jim and Melanie drove to Mayo Clinic in Rochester, where Jim met medical oncologist Keith Bible, M.D., Ph.D. During the appointment, Jim was given an alternate take on the cancer — one that ultimately resulted in him receiving an aggressive surgery that removed the cancer from his body and provided him years, rather than months, of survival.

“We
can’t be cured of our human existence. We can’t be here forever,” Jim
says. “But one thing that pops up for me is that (the treatment) was life-extending.
It is not the norm that people with pancreatic cancer live for two years — and
even less common that they are alive and doing as well as I feel like I’m
doing.”

Alternate perspective, alternate approach

Before
Jim came to Mayo Clinic, his care team in Nebraska had discovered that the tumor
that began in Jim’s pancreas had invaded the uppermost portion of Jim’s small
intestine, or duodenum. The tumor was causing internal bleeding that was difficult
to stop. Imaging also revealed the presence of nodule-like growths in his lungs
and spleen — another indication the cancer had spread beyond his pancreas. Under
the direction of his Omaha team, Jim started receiving chemotherapy.

At
Mayo Clinic, however, Jim learned his diagnosis wasn’t as clear-cut as he had
previously believed. “There were a few little intriguing aspects of my
condition,” Jim says. “One of them was that pancreatic cancer can go
anywhere, but it commonly goes to the liver. My liver seemed to be
uninvolved.”

“(My care team) said: ‘You might have stage 4 disease, but that doesn’t mean you can’t have surgery. We’re going to figure out the most important thing for you.'”

Jim Smith, M.D.

The
areas that did appear to be directly involved were reexamined by Jim’s Mayo
team. “The lesions in the spleen and lung were not consistent with my
expectation of what would be typical in metastatic disease,” Dr. Bible
says. Small nodules identified in imaging looked more like signs of a
respiratory illness, which implied the cancer had not spread beyond the primary
site in Jim’s upper digestive system.

This
discovery allowed Jim to be considered for a surgery to address the most
dangerous aspect of the cancer. “There was imminent threat from the local
process involving the intestine that had great potential to cause him to bleed
to death,” Dr. Bible says.

During
Jim’s meeting with him, Dr. Bible requested a consult with Mayo hepatobiliary
and pancreatic surgeon David
Nagorney, M.D.
The following morning at Jim’s
appointment, Dr. Nagorney lent his expertise to the conversation around Jim’s
treatment.

“The
two of them, and some advanced-practice nurses and fellows, were all in the
room talking about me, with me, and about how the future might look,” Jim
says. “They never called me stage 4 anything. They called me Jim, and
said, ‘What you have is specific to you.’ They said: ‘You might have stage 4
disease, but that doesn’t mean you can’t have surgery. We’re going to figure
out the most important thing for you.'”

Aggressive cancer, aggressive surgery

Jim
learned from his team that if he wanted to survive even a few months, surgery was
necessary to remove his tumor and stop the bleeding. “They told me the
good news is that I’m not going to die of pancreatic cancer. The bad news is
that I was going to starve to death before the cancer could get me,” says
Jim, who shed 40 pounds from his 170-pound frame over the course of four
months. “They said I would live longer if I had a Whipple surgery. And I
said I appreciated the clarity because that helped.”

In late January 2018, one month after his first appointments with Drs. Bible and Nagorney, Jim returned to Mayo Clinic for the Whipple procedure. Also called a pancreaticoduodenectomy, the surgery involves removing the head of the pancreas, the duodenum, the gallbladder and bile duct, and then reconfiguring the upper digestive system. In Jim’s case, the spleen also was removed.

“I
had surgery early in the week, and my goal was to be out by Sunday morning, so
I could drive back to Omaha and watch the Super Bowl,” Jim says.

“The rest of the story has been like a miracle.”

Jim Smith, M.D.

A
few days after his operation, Jim’s team informed him that his cancer was
identified as an anaplastic pancreatic cancer. “Pancreatic cancers are
pretty common and are one of the more lethal cancers in the U.S., but these
undifferentiated, or anaplastic, pancreatic cancers are distinctly rare,”
Dr. Bible says. “This is a super high-risk, very aggressive pancreatic
cancer.”

Despite
its severity, the entire tumor was successfully removed during surgery, and the
tumor margins were clear of cancer cells. Tests also showed that Jim’s lymph
nodes and spleen were not affected by the disease.

To
Jim’s delight, he was released from the hospital in time for Melanie to drive
them back home for the big game.

Ideal outcome, ideal care facility

Jim
returned to Mayo Clinic for follow-up appointments after surgery. During one of
those visits, he underwent a lung biopsy. The biopsy came back negative for
cancer. The abdominal areas where the tumor had been removed also came back
negative for recurrence.

“The
rest of the story has been like a miracle,” Jim says.

Jim’s
outcome would have been impossible without collaboration — involving both his oncologist
in Omaha and his team at Mayo Clinic. “It required a surgeon willing to
commit to a very aggressive approach in a very hostile tumor environment,”
Dr. Bible says. “It required a change in the way we looked at his cancer —
to view it as treatable with curative intervention, as opposed to viewing it as
a lost cause from the outset.”

Jim’s outcome also depended on insight into the nature and behavior of aggressive, advanced-stage cancer. “It required recognition that the appearance of the lesions in the spleen and in the lungs didn’t match expectation for metastatic disease,” Dr. Bible says. “This recognition is something that we have as a potential benefit at Mayo Clinic because we are a high-volume center, and because we see a lot of rare cancers.”

Jim
will continue to have follow-up imaging and appointments to check for cancer
recurrence. And while he doesn’t know whether the cancer will come back, Jim
deeply appreciates the care he received at Mayo Clinic that gave him the best
chance to overcome his daunting diagnosis.

“In
my almost 30 years out of training, I’ve been in different clinical, administrative
and leadership positions, and we always talk about Mayo Clinic and the Mayo Model
of Care in terms of quality, efficiency and international recognition,”
Jim says. “I understood those in terms of the practice of medicine and the
administration of medical care, but not as a patient.”

He
continues: “To experience Mayo Clinic as a vulnerable patient with this
catastrophic, life-altering, potentially life-ending diagnosis, I found that,
all of the sudden, I understood what people mean when they talk about the Mayo
model. Whether it’s the legacy of the Mayo brothers or the sisters at Saint Marys,
or the quality of care that the system continues to offer, it was the right
place to be.”


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