From our CEO Marty GuthmillerI’m a team sports guy. roughout my teens and early20s, I participated in a variety of team sports. Post-participation years, I have enjoyed watching our chil-dren participate and, in general, simply being a fan atvarious levels.

Team dynamics are fascinating. On one level youneed strong leaders and leadership. At another level,you need role players, who at any given moment may need to “step up” and make that tackle,make that shot, make that play. On one level you need individuals willing and able to “do thejob” or “step up to the plate.” On another level you need those same individuals to allow oth-ers around them to do their thing as well. is is what makes a team ... a team.

Healthcare is no different in that team performance sometimes trumps individualism.Healthcare still has its quarterbacks and pitchers and various leadership. It also has linemenand bench players, managers and ground crews. continued on page 7 ...

HealthLinesinside Clinical pharmacist joins team, 2 • Prenatal care team, 3 •

New providers, 4 • From our CMO, 5 • The knees have it, 6

a publication of orange city area health system for our partners and patrons vol. 8 issue 2 • fall 2016

IA culture of teams Talk about taking

one for the team ...Turns out even sports medicine physicians can getinjured. But our docs are dedicated! Aer breakingan ankle playing soccer, Dr. Philip Van De Griend inour family medicine and sports medicine clinicscontinued to do patient “rounds” in the hospital,using a handy-dandy scooter to maneuver the halls.He even took the time to write an article on knee injuries for this issue of HealthLines. See page 6 ...

Marty Guthmiller (one of our coaches)

Laurie Gebauer, our Director of Patient Care, was recently featured as a “Woman of Significance” in theN’West Iowa Review. Thanks to leaders like Laurieand all 500 of our team players ... and thanks to YOU for trusting us to be your partners in a lifetime of care ... Orange City Area Health System continuesto provide award-winning patient experience.

Becker’s Hospital Review

50Critical Access Hospitals to Know 2016

HHOSPITAL

In Orange City: family medicine, sports medicine, behavioral health, surgical services, hospital, birth center, physical therapy, specialty clinics,radiology, senior care, home health and hospice. In Hospers, Paullina, and on the campus of Northwestern College: family medicine.

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Talking about teams ...

Healthcare becomes more complexevery year with the addition of newmedications, new guidelines, docu-mentation requirements, and gov-erning body standards. e needfor highly trained medication ex-perts is increasing, and patients atOrange City Area Health Systemshould greatly benefit from the addition of a Clinical Pharmacist.

So, how can a Clinical Pharmacisthelp you?

e Clinical Pharmacist in ourfamily medicine clinic ...

• will work with your doctor tochoose the best medication for you.

• will be available for questionsand follow-up in between your doctor visits to make sure the medication is working for you andto monitor for any side effects.

• will make sure you are using your medications correctly so you can get the most benefit from them.

• can help with financial issues and guide youto the most cost-effective medication option.

• is an expert in cleaning up your medicationlists and ensuring that you are only on the medications you need.

• is a specialist in anticoagulation therapy andwill help guide you to the best blood thinner iftherapy is needed. She also routinely monitorsyour blood thinner to decrease your risk ofbleeding and clotting events.

• will assist in researching tough medicationquestions and knows where to look to find theanswers to complex or unique situations.

Clinical Pharmacists decrease healthcarecosts, decrease hospital visits, decrease hospitalstay lengths, improve patient satisfaction, andprevent serious adverse events due to medica-tions. In this role they work with your doctor,your psychologist, your dietician, your socialworker, and other team members to provideyou with the best care possible. Our mission is

to improve our patients’ health, quality of life, and satisfaction,and this is one more step in that direction.

How can I help you with your meds? ~by Amy Van Gorp, Clinical Pharmacist

Amy Van Gorp, clinical pharmacist for Orange City Area Health System,

consults with Dr. Dee Jay Donlin of our behavioral health clinic

and Dr. Mark Turek of our family medicine clinic.

Orange City Area Health System recently added a Clinical Pharmacist – Amy Van Gorp, Pharm.D., BCPS – to its team of providers, displayinga commitment to staying on the cutting edge of medicine. A Clinical Pharmacist is an expert in medications and provides evidence-based advice and information regarding the safe, appropriate, and cost-effective use of medications. Clinical Pharmacists gain this knowledgethrough formal education, training in direct patient care environments, and by completing residency training and specialist board certification.

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From birthcare to family medicine – your team for a lifetime of care“We have nothing but gratitude for Dr. Moeller at Orange City AreaHealth System. From day one we knew she would be a great fit for our growing family – from her eye contact to how she is as aprofessional. She delivered our four beautiful blessings and we are nothing but thankful for her.

“All through labor and delivery I also felt that Dr. Moeller was very good at listening to me and what I would prefer. Even afterour third baby she walked alongside me when I started havinganxiety (postpartum depression). She really wanted what was best for me and made sure we did the right steps for me to become healthy again.

“Dr. Moeller’s smile makes it so much better when having totake your kids in to get shots. We love nurses Missy and Gretchentoo. With four kids in 5.5 years we really are so impressed by howprofessional and kind they are. We recommend them to everyone!”

~ Candace Van MarelDr. Marie Moeller with Candace and Blayne Van Marel and childrenPalmer (5), Blakely (3), Loghan (2), and Crew (2 months).

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Expect the best Team approach to prenatal care serves patients well

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~presented by Kara De Groot, ARNPContinuity of care is what manyof us desire. We want to see ourprimary provider as much aspossible, especially during pregnancy. One way we strive toprovide high-quality medical careat Orange City Area Health Systemis within a team approach.

As an advanced practice primary care provider (NursePractitioner) I enjoy coordinatingcare among a variety of physi-cians. As part of a prenatal teamwith Dr. Pals and Dr. Moeller, our commitment is to provide consistency and make the journey throughout your prenatal visits a positive one.

As an OB patient you might be wondering, “What does thisteam approach mean for me?”Your prenatal visits will be “routine” with a first visit around10 weeks, monthly the first twotrimesters, biweekly in the thirdtrimester, and then weekly thelast month. Along the way, two or three OB visits will bescheduled with me while the rest remain with your primary OB physician. You will have theopportunity to see me again during a newborn or well-childcheckup in the future.

We hope this model of careprovides more opportunity forboth patients and physicianshere at OCAHS.

Blessings in the journey!

“It was a big decision for usto have a third child becausethe doctor (Dr. Harrison inCherokee) who delivered ourfirst two children had retiredfrom OB practice. I had beengoing to this doctor my entirelife (literally my entire life because she delivered me!).

A friend recommended Dr. Pals to us. After my firstappointment with Dr. Pals, I felt comfortable with her. I also had a tour around thehospital and was happy withthe facilities. Everyone we

met ... from the office staff, Dr. Pals' nurse Lori, the ultrasound techs, the labor and delivery nurses ... were very nice and helpful. Labor and delivery went as we expected/hoped. The nurses were very supportive and Dr. Pals was calm and reassuring. I reallycould not have asked for anything better.”

~ Valerie Cronin, Cherokee Iowa, shown here with husband Andrew and Dr. Cynthia Pals after the July 14 birth of baby Kyla Ann

Marie Moeller, MD • Cynthia Pals, MD • Kara De Groot, ARNP

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A look at our roster Get to know your team ...From veterans to rookies, our medical team features a roster of professionals who bring a depth and breadth ofskills, personalities, and special interests to family medi-cine. Here, meet two ... a seasoned and familiar physicianand a fresh face among our advanced-level providers ...

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New to our family medicine team

Lee Kamstra, MD, joined our medical team in August of 1996. He received his education at the University of Iowa College ofMedicine, and did his residency in Sioux City. Dr. Kamstra is anative of Orange City. He has a special interest in emergencymedicine, and serves as the Medical Director for Orange CityArea Home Health & Hospice. Dr. Kamstra is also the Medical Director for the Sioux County Board of Health.

Olivia Chapman, ARNP, is a familiar face at Orange City AreaHealth System, having served for the past five years as a hospitalnurse including three years as ourDiabetes Care Coordinator. Oliviaearned her Nurse Practitioner certification from Clarkson Collegein Omaha and now serves as a family medicine provider. Olivia is an Orange City native.

Kimberly Dykstra, PA-C, joined our medical team in August of 2015.She received her Physician’s Assistant education at Grand ValleyState University in Allendale, Michigan. Kimberly’s hometown is Sioux Center. Special interests within family medicine include acutecare and occupational medicine. “When a patient walks in the doorhere, they can expect that we will do our very best to provide qualitymedical care,” says Kimberly. “When I’m able to help somebody I get a feeling of deep satisfaction.”

Robin Van Zandbergen, ARNP,joined our medical staff in July ofthis year. She received her NursePractitioner education at Briar CliffUniversity. Robin served on ournursing team for seven years.Other experience includes servingas a public health nurse for Com-munity Health Partners, as adjunctnursing faculty at NorthwesternCollege, and as a family nursepractitioner in Spencer. Her home-town is Hospers.

Amy Van Gorp, Pharm.D., BCPS,took on the new role of ClinicalPharmacist in August. She received her education at the University of Iowa College of Pharmacy. Prior to joining ourmedical team, Amy served as Clinical Pharmacy Specialist at the Sioux Falls Veteran’s AffairsMedical Center. She also served as Staff Pharmacist at St. Luke’sRegional Medical Center in SiouxCity. Amy lives in Sioux Center.

Whatever stage of life you’re in, our team is here to serveyour healthcare needs. For appointments in one of ourfamily medicine clinics, sports medicine clinic, behavioralhealth clinic, or for surgical and specialty services, call712-737-2000. A lifetime of care starts here.

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Medical minute

- by Alan Laird, MD Chief Medical Officer and family physician

“It’s not whether you get knocked down; it’swhether you get up.” – Vince Lombardi

Coach Lombardi had it right, because we allget knocked down. In the game and in life –we all get knocked down. It is about gettingup again and again and again.

So what does that have to do with healthcare? Everything. Just likethe game of football or soccer (my sons would remind me that is the“real football”) ... when we get knocked down we have to get up again.

Did you know you have a coaching staff to help you get back up?Perhaps you’ve never thought of your healthcare providers as that, butin many ways we are. We don’t teach how to dribble a basketball, spikea volleyball or return a tennis lob. But we do want to help you makeprogress in the race of life, tackle problems that assault your health,and deal with the unexpected issues of aging.

Sometimes that includes telling you how to dodge incoming hitsand not get knocked down – lose weight, stay active, get your healthscreening done (colonoscopy, mammogram, blood work). Othertimes it is about getting up – you need to start diabetic medication or you need surgery to make things right again.

So how many coaches does it take? at depends. An Internetsearch revealed there may be up to 15 coaches for an NFL footballteam and 11 coaches for college football team. College and NBA basketball teams may have up to 5-9 coaches. An Olympian may have 1-3 coaches depending on the event. But how many coachesdoes it take for you?

Just like an athlete, it depends on the issues you are dealing with in life. You may need very little coaching at times. But as we age, contract diseases, or sustain injuries, we need a bigger coaching staff.Call them coaches or guides or providers or caregivers, we are alldoing the same thing ... trying to give you the best “game plan” to return to health and stay healthy.

Sometimes it takes a lot of caregivers. And why is that?

Please consider the following information: “It is estimated that the doubling time of medical knowledge in 1950 was 50 years; in 1980, 7 years; and in 2010, 3.5 years. In 2020 it is projected to be 0.2 years – just 73 days.”*

at means that no one person can be an expert in all areas ofhealth, fitness and well-being, let alone medicine. So while yourtrusted family healthcare provider has walked many miles with you,he or she will need to call in additional help from time to time. Andjust like an assistant coach for the baseball team may specialize inpitching or hitting, these coaches can spend more time on a specificarea such as diabetes or high blood pressure. ey can concentrate ontrouble spots for a period of time and then return you back to yourhealthcare provider when you have mastered those new skills.

At Orange City Area Health System we are working at identifyingthose people who can help you with the troublesome issues. We aregrowing the “coaching staff ” with providers of new services and somewith different skill sets. We believe this will work hand-in-hand withthe outstanding group of medical providers we have been blessedwith. You are meeting some of those people in this issue. Others willbe introduced in the future.

And just like all coaching staff, we have turn-over. Life takes us indifferent directions for many reasons. We have to adjust. We at Orange City Area Health System work to make that transition assmooth as possible for those involved. We will miss those who have to leave us, but we welcome those new faces we are blessed to get toknow. If we work as a team, we won’t drop the ball.

And speaking of work, I am reminded of another quote from anequally famous coach as coach Lombardi: “10 minutes early is fiveminutes late!” Yup, I am still working on that one, Coach. I am stillworking on that one.

How big is your coaching staff?

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Dee Meerdink, RN, our new Diabetes Care Coordinator, consults with Dr. Jim Clemens in our family medicine clinic.

*Transactions of e American Clinical and Climatological Association; Trans Am Clin Climatol Assoc. 2011; 122: 48–58. PMCID: PMC3116346; Challenges and Opportunities Facing Medical Education, Peter Densen, MD

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Keeping you on topHere’s something to cheerabout: Sports Medicine Services at Orange City Area Health System.

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Repairs made here.

Whether you’re a weekend warrior or adedicated athlete, Dr. Mark Muilenburgand Dr. Philip Van De Griend in ourMusculoskeletal and Sports MedicineClinic – along with our team of physicaltherapists and family doctors – canhelp keep you on top of your game.They focus on ...

• diagnosing and treating injuries tothe body’s joints, muscles, and bones

• using ultrasound and ultrasound-guided injections for the evaluationand treatment of acute and chronic injuries

• medical problems that arise duringsports participation, like exercise-induced asthma and concussions

Our team can create exercise programs and rehabilitation plans for rapid return to play. Our doctorsand therapists also work closely with athletic trainers and orthopedic doctors, and can expedite referralwhen surgery is required.

Call 712-737-2000 for appointments.

The knees have it ~by Dr. Philip Van De Griend

Your knees are very important. You don’t have to be a doctor to know that. You use themevery day, and if they are working as they should, you don’t even realize how much you useyour knees. Knee pain and knee injuries can be debilitating and get in the way of your work,your extracurricular activities, or taking care of your family.

Let’s go over the anatomy and function of the knee and its major components. One of themain ligaments in the knee, and one that most everybody has heard of, is the Anterior Cruciate Ligament, or ACL. Its main job is to stabilize the knee and keep it from sliding forward out of place. Its counterpart is the Posterior Cruciate Ligament, or PCL. e PCLstabilizes the knee and keeps it from sliding backward. You have two other main stabilizingligaments on each side of your knee as well. e Medial Collateral Ligament, or MCL, and the Lateral Collateral Ligament, or LCL, stabilize the knee from opening up on the inside (MCL) and the outside (LCL). e meniscus is made up of two “C” shaped pieces of cartilage that sit between your thigh bone (i.e. femur) and one of your lower leg bones(i.e. tibia) and act as a shock absorber. Finally, your kneecap, also called your patella, anchors your quadriceps muscle. It slides in a groove at the end of your femur, and the location of where these two come into contact is called the “patellofemoral joint.”

When discussing knee pain and injuries, the patellofemoral joint is one of the most com-mon sources for knee pain. As the patella rides in the groove of the trochlea of the femur,you can have pain if it’s not tracking evenly. If it doesn’t track evenly, one side of the patellamay rub on one side of the trochlea more than the other, which causes pain. Pain frompatellofemoral syndrome is usually felt in the front of the knee around the kneecap.

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p of your game From Coach Guthmillercontinued from coverA truly high-functioning healthcare system has clearlydefined roles, but more impor-tantly a culture that supportsall of those roles working together. For it is in workingtogether that allows all attrib-utes to fully function the waythey are intended.

Just over 10 years ago, we hadthe privilege of opening a brandnew health system facility inOrange City. While we werecertainly pleased to present abeautiful building to the com-munities we serve, we were alsomindful of and deliberate about reminding us all that buildingsdon’t care for people. Peoplecare for people. Recent awardsbestowed upon our team areexamples of the emphasisplaced on this culture of care.

Having a beautiful and well-designed facility is certainly a wonderful tool in helping deliver quality “total healing”care. At the end of the day,however, without a culture ofskilled, compassionate, person-alized care within, it is simplybricks and mortar.

So what’s ahead?In today’s healthcare climate,

it is a difficult question to answer definitively. One thingthat is certain, though ...

continued next page ...

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A second cause of knee pain is damage

to the meniscus cartilage. e meniscuscan tear as a result of twisting your kneewrong while being active, or it can be froma degenerative tear. A degenerative tear occurs from “wear and tear” on the meniscus the older you get. A meniscustear usually causes a lot of knee swellingand significant pain. People also describethe knee “locking” or a sensation of “catching” with a meniscus tear.

An ACL tear is a less frequent kneeinjury, but it causes very severe pain! Usually, people tear their ACL when they twist the knee along with taking a hard hit ortackle on the knee at the same time. e knee will swell up significantly with an ACLtear. People may describe feeling or hearing a “pop” at the time of injury, and oen feelthat their knee is very unstable.

Finally, both the MCL and LCL ligaments can be torn or sprained. ese are injuredif a person twists their knee or if their knee is hit. A hit on the medial/inside of the kneecauses the lateral/outside joint line to open up, which causes a strain or tear of the LCL.Conversely, if the lateral/outside of the knee is hit, the inside/medial joint line of theknee opens up and strains or tears the MCL. ese injuries may cause swelling, andthey will cause pain on the medial or lateral joint line depending on which ligament isdamaged. People may feel like their knee is unstable as a result of these injuries as well.

So, how does someone get better from these injuries or pain? e good news is thatusually these conditions are treated without surgery (aside from an ACL tear – whichdoes not absolutely need surgery). Most of the time physical therapy will successfullytreat these conditions as long as you consistently do the exercises the therapist instructsyou to do. Even better, you can prevent these injuries with certain exercises to helpstrengthen the supporting muscles around the knee.

e sports medicine physicians atOrange City Area Health System or thephysical therapy staff at erapeuticHealth Services on our main campuswould be happy to discuss these causesof knee pain, treatment, or preventionof knee pain and injuries. Give us a calland come on in!

Orange City Clinic: 712-737-2000

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This past spring, Landsmeer Ridge Retirement Community expanded with the addition of12 new independent living apartments, bringing the total residences to 36 independentliving and 28 assisted living units. According to Marty Guthmiller, CEO of Orange CityArea Health System, which owns and operates Landsmeer along with Prairie Ridge CareCenter on the senior care campus, “The addition of the new units and garages not onlymeets a need for our seniors, but also created the opportunity for an expanded walkingtrail around the outside of Landsmeer, allowing tenants and visitors to enjoy the prairiegrass and wild flowers.”

“Our tenants are really enjoying the services and activities we provide,” stated RobGotto, Manager of Landsmeer Ridge. “It has been a blessing for staff to have the opportunity to serve and get to know new people.”

We’ve expanded toserve our seniors

Building our team.Keeping our promises.a message from our CEO, cont. from page 7

Family medicine clinics in Hospers, Orange City, Paullina, and on the campus of Northwestern College

712.737.4984 • ocHealthSystem.org

“When we got the call that we could move in March we didn’tthink we were quite ready yet, but the opportunity arose andwe thought it was the right thing to do. All the residents hereare very friendly. e sta treats us royally and are very help-ful. e meals are very good. We get our unit cleaned once aweek.We have a view of the golf course and the surroundingarea.We are thankful to be here.”~Casey and Gladys Korver, Landsmeer Ridge Tenants

... whatever lies ahead in terms of new initiatives, new program-ming, or even new construction, it will be ltered through our Mission and Vision, and our Core Values.

Another certainty is that as weseek to build our team ... fromphysicians to cooks, housekeepersto nurses ... we will do so throughthe lter of a “teamwork culture.”We will continue to build our teamwith individuals who are supportiveof the culture and values we treas-ure and thus will help make us ca-pable of delivering the outstandingcare we have become known forlocally, regionally, and nationally.

Our future will continue to beforged around the three “I’s” of Integrity, Innovation, and Inspiration. We will continue tobe innovative and inspirational inthe utilization of our time and resources while doing so with integrity as our solid foundation.

It is our pledge and our promiseto each other and those of you wehave the privilege of serving.

1000 LINCOLN CIRCLE SEORANGE CITY IA 51041