Western Wisconsin

Steer clear of Lyme disease
Women can complete breast cancer treatment in two weeks with SAVI
Is cholesterol screening for children a good idea?
Patients have access to a new gastroenterologist and a new general surgeon at Ministry Our Lady of Victory Hospital
Ministry Medical Group to offer reduced price WIAA Sports Physicals

Steer clear of Lyme disease

The woods you hike in this summer may be lovely, dark and remote, but one of the most fearsome inhabitants of the forest you may encounter, depending on where you walk, is a very small creature: the blacklegged tick.

These ticks pick up bacteria (Borrelia burgdorferi) when they bite deer or mice that are infected with Lyme disease.  You pick up the ticks as they cling to your body or clothing as you walk past, then when they feed on you, they can then pass the bacterial infection to you.

Blacklegged ticks are tiny; you might need a magnifying glass to see them. You may not feel their bites since they secrete a substance that prevents itching or pain.

Not every blacklegged tick has Lyme disease and not every bite by an infected tick will transmit Lyme disease to you. In most cases, the tick must remain on your body for 24 to 36 hours before the disease is transmitted.

“The early signs and symptoms of Lyme disease may show up several days or even weeks after you were bitten,” said Peter Gintner, PA-C, a physician assistant with Ministry Medical Group in Thorp. “The most well known sign is a red, circular, ‘bull’s eye rash,’ – known as erythema migrans – that forms around the area of the bite. The rash has a gradually enlarging clear area that appears around the red, raised point in the center, site of the tick bite. The rash is not particularly painful or itchy and may go unnoticed. Common bite sites are the thighs, groin, trunk and armpits.”

From 20 to 30 percent of patients never get a rash but develop flu-like symptoms such as chills, fever, headache, muscle pain, stiff neck, lightheadedness and generalized itching.

Left untreated, the infection can spread to the brain, heart and joints, causing a number of more serious symptoms that appear intermittently. Lyme disease can cause Bell’s palsy (loss of control over the muscles on one or both sides of the face); severe headaches and stiff neck due to inflammation of the spinal cord; pain and swelling in the knees or other large joints; heart palpitations and rhythm abnormalities.

According to Gintner, “Most of the symptoms of Lyme disease occur with other diseases as well. To establish a diagnosis, a healthcare provider relies not only on symptoms but also on a history of possible exposure and blood tests to determine if the patient has antibodies.”

Only blacklegged ticks transmit the bacteria that cause Lyme disease. These ticks are prevalent mainly in three areas of the United States:  

  • The northeastern mid-Atlantic from Virginia to Maine
  • The north central United States, primarily Wisconsin, Minnesota, a few northern counties of Illinois and some western counties of Michigan
  • The Pacific coast, mainly northern California.      

Confirmed cases nearly always can be traced back to travel in one of these three areas. Transmission is most likely during the months of May, June and July.

According to Gintner, “If you’re a hiker, gardener or have an outdoor job in an area where blacklegged ticks are prevalent, you should try to protect yourself by walking near the center of trails and avoiding overgrown grass, brush and dead leaves. Keep your legs and arms covered, and use 20 percent concentration DEET insect repellant on your clothes and any areas of exposed skin. Permethrin, which kills ticks on contact, can also be applied to clothes, tents and camping gear.”

Gintner also recommends these important preventive measures after you have been outside.

  • Bathe or shower soon after coming inside.
  • Check your body carefully every time you come in, even from your own yard. Ticks found and removed from your body within the first 24 hours will most likely not transmit the disease to you.

Ticks are tiny. If you find one, simply remove it with tweezers. Grasp the tick firmly as close to the skin as possible and pull the tick’s body straight back with a steady motion.

Having a tick bite is not necessarily an indication that any treatment is needed, but the person should be watched closely for 30 days. Once a diagnosis is confirmed, early treatment is beneficial to head off serious long-term complications.

Treatment involves a two- to three-week course of antibiotics, and it can be curative. About 30 percent of patients, however, continue to have symptoms such as fatigue, joint pain and memory and concentration problems, which are sometimes severe.

In some cases, the symptoms may be lingering effects of Lyme disease complications. In other cases, researchers say, they may represent another illness such as osteoarthritis, rheumatoid arthritis, fibromyalgia or chronic fatigue syndrome.

According to Gintner, “There is little evidence that these symptoms can be relieved through long-term antibiotic treatment. And, there is substantial evidence of potential adverse effects from such treatment. The best course of action is to prevent Lyme disease from occurring in the first place by protecting yourself outdoors.”

Call your healthcare provider and watch for symptoms. Early treatment with antibiotics may prevent long-term complications.


Women can complete breast cancer treatment in two weeks with SAVI

Certain women with early-stage breast cancer, who will be undergoing a lumpectomy, can now have the procedure done and be finished with radiation treatments in just two weeks. This compares with up to 12 weeks for a lumpectomy followed by conventional whole breast irradiation.

The decreased time frame is in part made possible by using a new breast brachytherapy catheter system called SAVI for Accelerated Partial Breast Irradiation (APBI). 

The new system, available at Marshfield Clinic and Ministry Saint Joseph’s Hospital in Marshfield, not only can precisely target radiation where it is needed most, which minimizes exposure to healthy areas, it shortens the treatment time to five days. For some busy active women, this is often their option of choice. 

“The SAVI applicator is an expandable bundle of catheters, which are placed into the lumpectomy cavity through a small incision,” said Matthew McCurdy, MD, PhD, Marshfield Clinic Radiation Oncologist on staff at Ministry Saint Joseph’s Hospital. “We know that if the cancer were to return, it would come back inside that cavity so it makes sense to target the radiation in that area.”

During treatment, a computer-controlled machine is connected to the ends of the catheters remaining outside of the breast. The machine painlessly expands the catheters and places a tiny radioactive seed into each catheter. Although the SAVI catheter remains in the breast the entire five days, the radiation does not remain in the body between treatment sessions. There are minimal side effects and a faster recovery time than with whole breast irradiation.

Eligibility guidelines for the procedure have broadened recently, so it can now be available to virtually any woman older than 50 with any type of breast cancer. Marshfield Clinic physicians, working with the Radiation Oncology Department at Ministry Saint Joseph’s Hospital, have developed a plan allowing the entire process to be completed in the two-week period.

For example, a patient has the lumpectomy on Monday, gets pathology results back Wednesday, and has the catheter inserted Thursday. A computed tomography (CT) scan is done to confirm that SAVI has conformed to the lumpectomy cavity. Using the CT images, physicians develop the treatment plan, which takes place the following week. After treatment, the SAVI catheters are then collapsed and retracted through the original incision.

The treatments take place twice a day, six hours apart. Most women say they are able to carry on normal activities during and immediately after treatment. Patients who live some distance away from Marshfield also have the option of staying at Hope Lodge.

“Studies show that this procedure more effectively treats the cancer, causes less side effects and patients recover faster.” said Dr. McCurdy, “And since we can complete everything in two weeks, their lives aren’t disrupted for a long period of time. ”


Is cholesterol screening for children a good idea?

Cholesterol is a well-known risk factor for heart attacks, but is cholesterol screening for children appropriate? Children aren’t at risk of a heart attack, are they? Should children be screened for cholesterol? It depends on who you ask.

In November 2011, based on a report from an expert panel, the National Heart, Lung and Blood Institute and the American Academy of Pediatrics adopted new guidelines calling for universal cholesterol screening of children–between ages 9 to 11 and again between ages 18 to 21.

According to Dan Gilles, PA-C, a physician assistant with Ministry Medical Group in Stanley,  “There is consistent evidence, mainly from observational studies, suggesting that decisions made in childhood are likely to have an effect on a person’s risk of a heart attack in later life.”

The new guidelines are sensible and realistic, say those who formulated them, since research indicates that heart disease, the number one killer of Americans, starts very early and progresses through life. Autopsy studies have found fatty streaks in the arteries of 50 percent of children who died from other causes.

On the other side are many respected experts such as Dr. Steven Nissen of the Cleveland Clinic who say the new guidelines are “irrational” and not based on randomized, controlled studies proving that treatment of high cholesterol in children is beneficial or, when drugs are involved, safe.

Gilles says that a good argument can be made for screening…and for not screening.

THE CASE FOR SCREENING is based in large part on what many call an epidemic of childhood obesity, with 15 to 20 percent of American children and adolescents now either obese or overweight. Obesity is associated with high cholesterol, which in turn is a well-known risk factor for heart disease.

Obese children and those with a high waist circumference were more likely than other children to develop metabolic syndrome as adults, according to the Fels Longitudinal Study. Metabolic syndrome is a precursor of type 2 diabetes, which accelerates the development of cardiovascular disease.

Many children and adolescents, in fact, already have signs of metabolic syndrome or of type 2 diabetes, a disorder that until recently was seen primarily in middle aged and older adults.

The guidelines are an effort to address these problems early. Moderately high cholesterol readings in a child can and should prompt a discussion about the possible reasons and future implications.

In most cases, the focus will be on lifestyle changes: more physical activity,  no smoking and changes in eating patterns.

The American Heart Association recommends 60 minutes a day of vigorous physical activity for children plus resistance training for adolescents. For a child, heart healthy eating does not mean an extremely low-fat diet, but there should be an effort to reduce or eliminate empty calories and foods high in trans fats. These include sweetened beverages, packaged snacks and fast food.

THE CASE AGAINST SCREENING has nothing against recommendations for changing lifestyle. The opponents believe, however, such advice is likely to fall on deaf ears.

One study found that most adults given abnormal findings on a carotid ultrasound test failed to make recommended lifestyle changes – even to stop smoking. Physicians, however, were likely to be more aggressive in their prescribing behavior as a result of these test results.

Critics of the new guidelines worry that doctors will feel inclined, or even pressured, to prescribe anti-cholesterol medication. And, there are no randomized, controlled studies that show that drug treatment is safe when followed over a lifetime or that it will change the long-term course of cardiovascular disease in vulnerable children.

The guidelines set a high threshold for treatment (LDL cholesterol of 190 mg/dL), but additional risk factors can be used to reduce this threshold to 160 mg/dL or lower. Several studies have concluded that drug treatment of high cholesterol in children age 8 and over is as safe and effective as it is in adults. However, long-term studies are lacking so caution must be observed in starting a child on long-term drug therapy.

Gilles concluded, “For children with abnormal cholesterol levels due to genetic factors, there may be no better alternative. Other youth are more likely to have high cholesterol because they are caught up in a cycle of fast food, supersized soft drinks and couch sitting. With or without screening, these children – and their parents – should be advised that there is a better way.”


Patients have access to a new gastroenterologist and a new general surgeon at Ministry Our Lady of Victory Hospital

Paul Ruh, MD
Paul Ruh, MD, gastroenterologist has joined the medical staff a Ministry Our Lady of Victory Hospital. Dr. Ruh is a member of Eau Claire GI Associates.

As a gastroenterologist, Dr. Ruh is trained and experienced in general endoscopic techniques, as well as advanced procedures such as ERCP, capsule endoscopy, and radio frequency ablation of Barrett’s esophagus.

Dr. Ruh received his medical degree from the University of Wisconsin Medical School. He continued his education at the University of Nebraska Medical School where he completed his internal medicine residency and his gastroenterology and hepatology fellowship. Dr. Ruh is board certified in gastroenterology by the American Board of Internal Medicine.

Dr. Ruh sees patients in Stanley on Mondays. To make a gastroenterology appointment, ask for a referral from your primary healthcare provider, or call 715.552.7303.

Rick Daniels, MD
Rick Daniels, MD, has joined the medical staff of Ministry Our Lady of Victory Hospital. Dr. Daniels is a member of the Evergreen Surgical Group. Dr. Daniels will see patients in Stanley on Fridays.

Dr. Daniels received his medical degree from the Creighton University School of Medicine in Omaha, Nebraska. He completed his residency at the University of North Dakota, Grand Forks. He is a fellow of the American College of Surgeons and is board certified by the American Board of Surgery. Dr. Daniels is a clinic assistant professor in the department of Family Medicine at the University of Wisconsin School of Medicine and Public Health

Dr. Daniels is an American Board of Surgery board certified general surgeon. He has 18 years of experience performing a large variety of surgical procedures.

To make an appointment, ask for a referral from your primary healthcare provider, or call 715.832.1044.


Ministry Medical Group to offer reduced price WIAA Sports Physicals

This summer, Ministry Medical Group locations in Stanley, Owen and Thorp are again offering sports physicals for area high school students. Appointments are available for the reduced fee of $25. Ministry Medical Group will donate the funds collected from the physicals back to the local athletic programs.

The physicals comply with the requirements of the Wisconsin Interscholastic Athletic Association (WIAA), which requires that a student have a current physical examination on file before the athlete is allowed to start practice. According to the WIAA, a physical exam performed after April 1 is valid for the following two school years.

Watch your local newspaper for dates, times and appointment information. Students should bring to the appointment:

  • Immunization records
  • WIAA green card (available from the school). The history side of the card should be filled out and signed by the parent or legal guardian prior to the appointment.


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