Author: Amy Speed

“I hadn’t really tried anything for the pain,” she replied. “I was just living with it.”

In November 2022, Judi Althoff, Surgery Receptionist at GMHC, had been experiencing pain in her lower back that just seemed to come out of nowhere. It was a very debilitating pain that caused her to have to get ‘psyched up’ just to get out of a chair. “I would then have to get my bearings and I couldn’t walk without pain and limping, so it took me a long time to get anywhere,” Judi added. “I walk for exercise, and it was taking me 25 minutes to walk a mile.” 

Judi had never had back pain in her life before this, and since there is a pain clinic right here at GMHC where she works, she decided to see if they could help her. They first started with trigger points by placing a needle with steroids and numbing medicine in the area that hurt.

Judi then had an MRI which showed a bulging disc and arthritis in her back. An epidural steroid injection was given to treat the pain in these areas but would take 10-14 days to take effect. Once that pain was under control, a different pain emerged in another area of her lower back. For a while, it was treated with Tylenol and Ibuprofen. Lumbar X-rays revealed that a facet joint in her spine was pressing on a nerve and causing the pain.

The next step was to test her left side, since there was more pain on that side which also traveled down her leg. A numbing agent was injected that lasted for 3-4 hours. If her pain stayed away, the test would be repeated. After two successful attempts to keep the pain controlled, she was a candidate for radio frequency treatment (RF).

For the RF treatment, needles were inserted into the nerve that was causing pain, the nerve was “burned” and the pain disappeared. After about a week, Judi’s pain was completely gone. That was in March 2023. Now in October 2023, she remains pain-free. If the pain should return within two years of treatment, she can have the RF again without going through all the pre-testing.

“It is so nice to have this treatment available,” Judi commented. “It has helped me significantly because I am no longer living with all that pain and discomfort. I would recommend anyone with unwanted pain to check out the Pain Clinic at GMHC.” 

April is Organ Donor Awareness month. Former GMHC employee, and current GMHC volunteer, Mary Waterman, recently shared a touching story about her mother, an organ donor, who was from the Greeley area.

Doris (Bissell, Dingbaum) Malicoat, otherwise known as farmwife, mother, and even “the cake lady” (Dorie’s Cakes), left quite an unexpected legacy…that of being an organ donor. Even though she had it clearly marked on her driver’s license for many years, the ripple effect was not fully felt by others until after she died. 

In her early life, Doris worked in a department store when her kids were small. They moved to a century farm near Petersburg where she did a lot of work, including all the morning milking, and raising her four children. She began making cakes for the kids’ birthdays, and then started collecting Wilton pans (365 of them) and selling her cakes. In her busiest year, she baked and decorated 366 cakes! She was featured in the Gazette for her cookies, cakes and collection of cake pans! 

Later in life, she mainly baked cookies for sale and to give away. She would ask the care center what they needed, and then make it and drop it off. The patients and staff at the Veteran’s Hospital enjoyed trays of her cookies at Christmas time, too. Her favorite cookie to decorate was a Santa face cookie. She would always go to her 10-year class reunions with a cake to celebrate and attended the last one with the only other two remaining classmates. 

In 2018, when Doris died, the family honored her by including her cookie recipe in the thank you cards they sent after the funeral. Although none of her grandkids have picked up the cake decorating knack yet, she handed down another thoughtful practice to her offspring. Many of her children and grandchildren signed up to be organ donors by designating it on their licenses. The decision to donate skin is not something that a person can designate ahead of time.

Years ago, when speaking about organ donation, Doris said, “Someone might as well have what they can use, because when I’m gone, I won’t be able to use it anymore!” As she neared the end of her life, her comment was, “They probably won’t even want anything now, because nothing works anymore!” Little did she know…this kind, caring woman who had lived 88 years would still be helping dozens of people, even after her death. 

A letter from the donor network arrived at her son’s home about six months after Doris had died. Mary learned that her mother’s organ donation—mostly skin and tissue—had helped 61 different people! Her family was astonished! They knew that her donation would make a difference for a handful of people, but they had not imagined that it would be so many. Dorie’s selfless act provided skin and tissue for breast reconstructions following mastectomies and temporary ‘skin bandages’ for burn victims, allowing their own skin to regenerate underneath. Other uses for harvested skin include replacing skin and tissue that has been severely traumatized or infected, or tissue that needs to be replaced because of skin cancer.  

So, the end of Doris’s life reflected the way she lived. She gave of herself to help others. What an honorable trait to pass on. 

__________________________

Following are some things you may not know about skin donation:

• Skin is the largest organ of the body.
• Skin can be donated within 6 hours of the time of death.
• There is a total of eight layers of skin, but only 1/8 (the uppermost layer of 0.3 mm) is harvested. 
• The skin is only taken from the back, thighs and legs and does not in any way disfigure the body.
• There is no bleeding from the site where skin is harvested from, and doctors bandage the parts where skin was taken.
• Donor skin can be effectively frozen and stored for up to five years.
• Blood, skin color or age do not have to be matched. Any person’s skin can be transplanted to another person. 
• Burn victims receive skin when over 50% of their body has been burned. In 80% of such cases, patients can be saved if sufficient skin is present in skin banks. 

April is Donate Life month. Please become an organ donor today!

https://www.iowadonornetwork.org/register

The before and after photos of Duaine Palas’ legs are hard to believe!

While reading the Spring 2022 issue of GMHC’s “Keeping You Well” newsletter, Duaine Palas realized there may be hope for his legs. The article featured a patient who had found relief for his legs through Lymphedema Therapy offered through the Therapy Services department at GMHC. Everything Duaine was reading described his condition, prompting him to call GMHC.

After first seeing Dr. McCaw at Cornerstone Family Practice for various testing, Duaine was referred for Lymphedema Therapy with Physical Therapist Kimberly Franzen, GMHC’s Certified Lymphedema Therapist. Lymphedema is chronic swelling that results from damage to the lymphatic system. The lymphatic system filters excess fluid through lymph nodes to remove bacteria and debris from the body. When the system is damaged, fluid can build up under the skin, usually in the arms and legs. 

Lymphedema can occur after cancer treatment, infection, surgery, venous insufficiency, or injury. Duaine’s may have resulted from an old farm injury. His swollen legs had been bothering him for years, but he didn’t know what to do about it. Duaine began his therapy sessions on July 7, 2022, and remembered doubting, “There’s just no way this is going to work with my legs, they are not going to respond to the therapy, they are just too far gone.”

But, Franzen proved him wrong. Duaine began therapy with 3 to 4 sessions per week. His treatment included manual lymphatic drainage, exercises and compression wrapping to help reduce swelling and return skin to a more normal condition. During the early stages of therapy, Franzen used short, flexible bandages (changed at every appointment) to wrap Duaine’s lower legs. As his legs became less severe, and reached a certain size reduction the wrap changed to a Velcro one, and as therapy progressed, compression stockings (from the toes to just below the knees) replaced the use of the bandages and the Velcro straps. 

Duaine’s therapy lasted through most of September and was an amazing success. Duaine continues to exercise, wear compression stockings to control the lymphedema, removing them at night and elevating his legs, and regularly checks the skin for ulcers. Since he learned how to take care of his lymphedema from Franzen during his therapy visits, he knows what the signs are that would require him to come for a re-assessment or for more therapy. He commented, “It was really nice to be able to wear my dress pants again. The only thing I could wear were sweatpants, and because my swelling was so bad, I could hardly fit into my shoes.” 

Picture this:  Duaine had an overall size reduction of 26.3% in his left leg, which was smaller to start with, and in his more severe right leg, the overall reduction in size was 34.5%! These numbers are truly amazing, and show just how much progress is possible with lymphedema therapy. 

Duaine is quick to thank Kim Franzen and Dr. McCaw for their careful attention to his care and commented that Franzen was very helpful and taught him a lot about self-care for his lymphedema. He commented, “This therapy was truly life-changing for me! I am active again, and I have a lot to be thankful for. I would encourage anyone who thinks they might have lymphedema to talk to their doctor and come to GMHC for their therapy.”

During this process, an additional health concern was discovered from tests that one of the providers ordered. Originally given to detect if the lymphedema was caused by a heart issue, the test found that Duaine had a 5 cm aneurism and a faulty heart valve. He will undergo surgery in May of 2023, to have it replaced with a biological valve. Duaine commented, “And just think, if I hadn’t come here for treating my legs, I would have never known about the problem with my heart.” Duaine complimented GMHC for the excellent care here, and for the thoroughness of the staff.

In May of 2020, while isolating during the COVID pandemic, Michelle Geuder discovered a lump on the side of her right breast during her routine shower protocol. At first, she thought it was an irritation from her bra, but something inside told her it was more. “Somehow, I already knew what it was,” she recalled. When Dr. Smith called with her mammogram results, she wasn’t too surprised that something had shown up on the scans. Since the next day was her birthday and wedding anniversary, Michelle waited until Monday for the follow-up appointment. An ultrasound and a biopsy confirmed that she had ER positive, PR positive, Her2 negative Breast Cancer.

Dr. Smith encouraged Michelle to get a second opinion, which she obtained at Mayo Clinic in La Crosse, WI, from an oncologist who had been recommended by her sister, through first-hand experience. The results were confirmed. Michelle returned to GMHC to consult with surgeon, Dr. Mansfield. Because she was at Stage 1A, her options included a lumpectomy or a mastectomy. Wanting the best results for her and her family, Michelle chose the mastectomy. Michelle’s brother-in-law stepped in to work with her insurance company until they agreed to let her be treated at Mayo. The July 1 (2020) surgery took place at Mayo Clinics in La Crosse. Her husband was allowed to be there but waited in the car during surgery because of the pandemic guidelines.

Michelle’s mastectomy included removal of most of the lymph nodes in her right arm, and several from her left arm, which thankfully, showed no cancer. Michelle and her husband both learned a lot following her surgery, including how to empty her four drains. Her follow-up treatment began in August (2020) with 16 weeks of chemotherapy (every other week) in La Crosse. Her husband was a great help during this time, driving her to appointments and being supportive.

Although Michelle’s oncologist wanted her pre-chemo appointments (also every other week), like COVID tests, blood tests, and cleaning of her port, to be done at Mayo, Michelle insisted on going to GMHC for these services saving her time, miles, and money. She commented, “I really wanted to have as much done here, as close to home, as possible. It was helpful for me to be assisted by people I was familiar with, like Jeannie Funk in the surgery department, and Lana Troester and Heidi Bolsinger from Patient Accounts, who served as my patient advocates with insurance questions and pre-authorizations. They were all a great help!”

When radiation was delayed in January of 2021, again due to insurance, Michelle’s radiation doctors worked with the insurance company to get her treatment covered.  For thirty days straight, excluding weekends, Michelle drove herself to Mayo in La Crosse for radiation treatment. “The trip to La Crosse is a two hour drive each way, so this was a difficult time,” Michelle admitted. The radiation was very rough on her skin. She was expecting a sunburn-like redness and peeling, but it was much worse. When the treated bandages came off, so did her skin, and it was like starting over every day. Consequently, the healing time from the radiation took much longer than normal. 

The extensive damage to Michelle’s skin caused the reconstructive surgery date to be postponed twice; in August 2021 and January 2022. Radiation and inactivity with her right side had left a stiff, numb, lumpy mass of skin, and prompted concerns that the surgery may not even be possible. Her radiation doctors and the plastic surgeon suggested Lymphedema Therapy to regain some movement and decrease her swelling to improve the feeling within and around her surgery site. 

Prior to this time, Michelle had read an article about Physical Therapist Kimberly Franzen’s certification in Lymphedema Therapy. At the time, she didn’t think it applied to her condition, but a referral from Dr. Smith allowed Michelle to see Franzen in January. Franzen was able to use Lymphedema Therapy to perform manual lymph drainage on the tissue and increase circulation, helping Michelle regain feeling, movement, and overall improved health at the surgery site.

All of Michelle’s care providers were impressed at the level of improvement after only four weeks of therapy. In March of 2022, Michelle felt much better, both feeling and seeing the therapy results, and was finally able to schedule the reconstructive surgery. “I recommend Kim Franzen to everyone who might need lymphedema therapy. She walked me through the steps and taught me how to do it myself, and my lymphedema continues to improve. Kim is so personable and really cares about her patients,” said Michelle. “It was incredible to see the therapy making such a difference even in the appearance of the skin, which helped me push past some of the devastation I was feeling after surgery. I had no idea that lymphedema therapy could do that!” 

Throughout this very difficult journey when Michelle thought about complaining, she would remind herself that she was lucky to be breathing, which helped her keep things in perspective. She was even able to stop at a few of her daughter’s basketball games while traveling home from appointments, which gave her something to look forward to. Michelle said, “I feel as though I’m a strong person, but I also have a strong support system.” Family and the tight-knit community stepped up to help, donated money, and had a fundraiser for her. Michelle remained working, which helped her place focus on something besides her health. Her boss was very understanding about her needs and allowed her to keep a flexible work schedule.

Michelle will continue her monthly injections along with taking a daily pill for the next three years to complete her treatment. Every October, during Breast Cancer Awareness month, she urges others to have their yearly mammogram to help catch problems early, and she is an advocate for self-checks.

When asked how she would describe the care she received at GMHC, she replied, “The care here was stellar! It is on-par with any treatment you would get at a bigger hospital, and without all the hassle. My primary care doctor at GMHC communicated easily with my oncologist because they are on the same computer network. I can’t say enough about the quality care I received here, and how thankful I am that it is only two blocks from my home.”

In closing, Michelle reflected, “In April of 2020, when we were all isolated and shut down, I drove by the hospital, and thought to myself, ‘I’m glad that at least I’m not in there right now’…and then I was… It turns out that this was a very good place for me to be!”