Regional Report - Gundersen Health System

Fall 2008 Volume 23 - No. 3
Regional Report
Information for healthcare providers in the Tri-state Region
Gundersen Lutheran at
forefront of minimally
invasive surgeries
Surgeons at Gundersen Lutheran have been performing
minimally invasive surgery (MIS) for years. Earlier this year,
they introduced the next generation in MIS with the new
da Vinci ® S Surgical System.
If you have a patient facing the prospect of a delicate surgical
procedure such as a prostatectomy or hysterectomy, this may be
the ideal solution. The da Vinci is the newest and most
advanced robotic surgical assistant technology.
“The visualization, depth perception, dexterity and control
with the da Vinci allow more patients to be candidates for
minimally invasive procedures. We are able to offer roboticassisted
surgery to patients with endometrial cancer, cervical
cancer and early-stage ovarian cancer,” states Dana Benden,
MD, Obstetrics/Gynecology, one of four physicians at
Gundersen Lutheran specially trained and certified in the use of
the da Vinci system.
“In addition, we will be able to treat patients with larger
body mass index, prior history of surgery and more
complicated benign pathology that may have required an open
incision prior to this advanced technology,” she adds.
The surgeon guides the da Vinci surgical tool using
miniature remote-controlled instruments, a tiny camera and
high-resolution 3-D imaging with up to 10x magnifications.
Other benefits of using the da Vinci surgical system include:
• Improved access to the pelvis compared to open and
conventional laparoscopic approaches
• Easier, more precise rectovaginal and presacral dissections
• Easier, quicker and more precise suturing
• A reproducible approach that restores open surgical
principles to laparoscopic surgery
The precision of da Vinci allows the physician to perform
procedures through very small incisions. This means a safer
operation. Studies show patients whose surgical procedures are
performed using the da Vinci benefit from less pain, blood loss
and scarring; reduced risk of infection, incontinence and sexual
disfunction; and faster recovery.
“Through the addition of robotic surgery, Gundersen
Lutheran continues its strong commitment to providing our
patients with state-of-the-art healthcare. Not only will robotic
Continued on page 2
Urology now offers GreenLight
PVP on a full-time basis
For the past six years, urologists at Gundersen Lutheran have
used laser technology called GreenLight PVP (photoselective
vaporization of the prostate) to treat benign prostatic
hyperplasia (BPH). Compared to the traditional surgical
method—transurethral prostatic resection (TURP)—
GreenLight PVP uses a minimally invasive, high-powered laser
to vaporize excess prostate tissue.
Physicians used to rely on a GreenLight PVP traveling unit,
so treatment was available on a limited basis. Recently,
Gundersen Lutheran Urology purchased its own GreenLight
PVP unit. Now your patients can be treated any day of the
week at the Gundersen Lutheran – La Crosse Clinic.
“GreenLight PVP has the same success rates as the standard
TURP, with less risk of bleeding and a much shorter recovery
time,” says urologist Scott Klein, MD. “Because the highpowered
laser coagulates bleeding while the operation is
performed, patients taking anticoagulants can sometimes have
the procedure done safely without stopping their medication.”
BPH is a condition that affects more than half of men over
the age of 60 and leads to difficulties with urination. Dr. Klein
says scientists have not pinpointed a cause. “We do know BPH
occurs as a natural process of aging and imbalances in
testosterone cause changes in the prostate,” he explains.
The condition develops after the prostate gland grows and
excess tissue puts pressure on the urethra. Patients often
What’s Inside
Continued on page 4
Special funding for cancer clinical trials ......................p. 3
Skin cancer surgery preserves healthy tissue ................p. 4
Success with Stat TIA and Stroke program ................p. 5
Fertility Center offers hope for pregnancy ..................p. 6
Cryopreservation option for IVF, cancer patients ........p. 6
New Practices ..............................................................p. 7-8
Enhanced interpreter services ......................................p. 8
Gastric bypass surgery impacts diabetes ......................p. 9
New Pulmonary Artery Hypertension Clinic ..............p. 10
MedLink (800) 336–5465 1 In La Crosse 775–5465

Minimally invasive surgeries – continued
surgery allow us to perform more minimally invasive
procedures, but our patients will benefit with a shorter hospital
stay and quicker return to normal daily activities,” adds
urologist Chris Hofland, MD, who also performs procedures
using the da Vinci.
Currently, the Gundersen Lutheran physicians show at right
are using the da Vinci Surgical System. If you have a patient
who might benefit from this technology, contact one of these
physicians via MedLink.
Dana Benden, MD
Specialty: Obstetrics & Gynecology
MD Degree: University of Wisconsin Medical College,
Madison
Residency: Illinois Masonic Medical Center, Chicago
Chris Hofland, MD
Specialty: Urology
MD Degree: University of Wisconsin – Madison
Internship: William Beaumont Army Medical Center,
El Paso, Texas
Residency: Tripler Regional Medical Center, Honolulu,
Hawaii
Richard Renwick, MD
Specialty: Obstetrics & Gynecology
MD Degree: University of Wisconsin Medical School,
Madison
Internship and Residency: University of Oregon Health
Sciences, Portland, Ore.
Surgeons operate the machine while seated at a console viewing a 3-D
image of the surgical field. The surgeon’s fingers grasp the master
controls below the display. The surgeon’s hand, wrist and finger
movements are translated into precise, real-time movements of the
robotic arms positioned inside the patient. The system’s tremor
reduction and motion control deliver precise control far beyond the
capabilities of the human hand.
Marvin Van Every, MD
Specialty: Urology
MD Degree: University of Southern California, Los Angeles
Internship: David Grant USAF Medical Center, Travis AFB,
Calif.
Residency: Wilford Hall USAF Medical Center,
San Antonio, Texas
Federal funding for health information technology
Patients throughout the Tri-state Region will benefit from
advancements in health information technology (IT) that will be
made possible through federal funding. Wisconsin senator Herb
Kohl visited Gundersen Lutheran to announce $300,000 in
federal funding for health IT programs.
“Health information technology is a critical component to
providing healthcare throughout the Tri-state Region, helping to
prevent medical errors and reduce healthcare costs,” says
Gundersen Lutheran chief information officer Deb Rislow.
Sen. Kohl has been a strong supporter of the health IT work at
Gundersen Lutheran. In fact, last year he secured $189,000 in
News Brief
federal funding so Gundersen Lutheran could establish digital
connectivity between healthcare facilities in the Tri-state Region.
With 50 percent of patients referred from facilities outside of
La Crosse County, the ability to access up-to-date medical
information is key to coordinating care.
In the future, Gundersen Lutheran hopes to expand its
partnerships and interconnectivity with all regional healthcare
facilities. “Gundersen Lutheran and non-Gundersen Lutheran
partners throughout the region have created a healthcare
environment that progressively uses health information
technology. That health IT network promotes efficient, safe and
coordinated medical care in a rural environment,” Rislow says.
MedLink (800) 336–5465 2 In La Crosse 775–5465

The CCBD earns special funding for clinical trials
Gundersen Lutheran’s Center for Cancer & Blood Disorders
(CCBD) was recently identified as one of the top 25 highest
accruing sites in the Clinical Trials Working Group by the
Eastern Cooperative Oncology Group (ECOG). In addition to
being recognized for past performance by ECOG, the CCBD
also received special funding of $16,900 to support future
clinical trials.
This monetary award will be used to improve clinical cancer
research programs that benefit both local patients and their
counterparts in other cooperative study groups throughout the
nation. Principal investigator for the CCBD, Alcee Jumonville,
MD, Medical Oncology, says, “This special funding will
continue to assure the activity of our research office. We are
grateful to ECOG for this designation and feel the
commitment of the clinicians and the research staff for this
level of performance remains strong for the foreseeable future.”
Gundersen Lutheran has affiliations with ECOG, in
addition to numerous other regional and national research
groups. “At any given time, we have more than 130 pediatric
and adult cancer clinical trials going on at the Center for
Cancer & Blood Disorders. With support from Gundersen
Lutheran Medical Foundation, we are able to offer these cancer
clinical trials through participation in regional and national
oncology research groups. This gives our patients access to
investigational treatments available at major cancer centers
throughout the United States,” says Ronald Go, MD,
Hematology, one of Gundersen Lutheran’s cancer researchers.
The success of the research team, led by Dr. Go and
Dr. Jumonville, would not be possible without the significant
support by Gundersen Lutheran Medical Foundation, which
helps cover the costs of performing clinical trials.
Gundersen Lutheran participates in the following regional
and national research groups:
• Eastern Cooperative Oncology Group (ECOG)
• Children’s Oncology Group (COG)
• National Surgical Adjuvant Breast and Bowel Project
(NSABP)
• Radiation Therapy Oncology Group (RTOG)
• Children’s Oncology Group of the Upper Midwest
(COGUM)
• Wisconsin Oncology Network (linked with University of
Wisconsin–Madison)
• Gynecologic Oncology Group (GOG)
• National Hemophilia Foundation-Region V West
• American College of Surgeons Oncology Group
(ACOSOG)
• Clinical Trials Support Unit (CTSU), a service of the
National Cancer Institute
Alcee Jumoville, MD
Specialty: Hemoatology-Oncology
MD Degree: University of New Mexico, Albuquerque
Internship and Residency: Gundersen Lutheran Medical
Foundation, La Crosse, Wis.
Fellowship: Dartmouth-Hitchcock Medical Center,
Lebanon, N.H.
Ronal Go, MD
Specialty: Hemoatology-Oncology
MD Degree: University of Santo Tomas, Manila, Philippines
Internship and Residency: Baylor Collee of Medicine,
Houston, Texas
Fellowship: Mayo Clinic, Rochester, Minn.
News Brief
Gundersen Lutheran takes cancer research to a new level
Gundersen Lutheran has been a long-time leader in cancer
research in the Tri-state Region. Now, they will be able to take
research one step further, thanks to a very generous donation.
Recently, Gundersen Lutheran Medical Foundation
announced the creation of the Dr. Jon and Betty Kabara
Cancer Research Institute at Gundersen Lutheran. “Dr. Jon
and his wife Betty have lost family members due to cancer. It
is their wish that this gift be directed toward the study of
nutrition and lipids in cancer biology in the hopes of
uncovering new pathways to its cause and cure,” says Phil
Schumacher, The Foundation executive director.
Dr. Kabara has dedicated his entire adult life to science and
research. He has been a professor at Michigan State University
for 20 years, and an investigator in biochemistry for the past
50 years.
“We were surprised to learn the Kabaras were making this
generous gift to Gundersen Lutheran because they are not
from the area and do not receive their care here. It’s a
testament to our organization that they recognized the
outstanding work that’s being done by our medical staff and
researchers, and entrusted us with a cancer research institute
that bears their name,” comments Mark V. Connelly, MD,
FACS, chairman, Gundersen Lutheran Medical Foundation.
MedLink (800) 336–5465 3 In La Crosse 775–5465

Skin cancer surgery aims to preserve healthy tissue
Patients diagnosed with nonmelanoma skin cancer have
another state-of-the-art option for treatment at Gundersen
Lutheran. Dermatologist Kurt K. Mueller, MD, offers an
innovative surgical procedure called Mohs surgery.
“About 95 percent of the skin cancers we see are
nonmelanoma so having Mohs surgery available is a big benefit
to patients in the area,” says Dr. Mueller, who is fellowship
trained in Mohs surgery. “My goal is to get the highest cure rate
while preserving as much healthy skin as possible.”
As the only physician in the Tri-State Region performing this
procedure, Dr. Mueller is committed to this goal. And the
numbers show that he is living up to his promise. After
performing more than 2,000 cases in the past three years, his
patients have a cure rate of more than 98 percent. Similar cure
rates have not been documented for other treatments.
The Mohs procedure is a microscopically controlled skin
cancer surgery. It is a preferred choice in areas where
appearance and function are important such as the face, neck,
hands, genitalia and lower extremities. The procedure is ideal
for treating nonmelanoma skin cancers that have been newly
diagnosed as well as those that have been treated but continue
to recur.
Dr. Mueller acts as the surgeon and pathologist during Mohs
surgery. “I remove what appears to be the entire cancer. I then
take a thin layer from the entire outside edge of the specimen,
prepare a slide and examine the tissue under a microscope,”
Dr. Mueller explains.
Dr. Mueller uses a sophisticated mapping process so if he
finds residual cancer cells in a part of the sample, he can go to
the specific location and remove only the involved area. The
process is repeated until the sample is clear of cancer cells.
Mohs surgery is done under local anesthesia as an outpatient
GreenLight PVP – continued
develop irritative symptoms with increased frequency and
urgency to urinate, obstructive symptoms such as slow stream
and difficulty starting urination, or a combination of both.
Compare the differences:
Kurt Mueller, MD
Specialty: Dermatology
MD Degree: University of Nebraska College of
Medicine, Omaha, Neb.
Residency: National Naval Medical Center,
Bethesda, Md.
Fellowship: Northwestern Skin Cancer Institute,
Chicago, Ill.
procedure in Dermatology and patients can expect to spend up
to half a day at the clinic. The skin sampling itself doesn’t take
long, but after each sample is taken, there is about a 30 to 40
minute wait as Dr. Mueller processes and examines it.
“I prefer the Mohs procedure because I see the patient, the
tumor, the defect left when the tumor is removed and the
tumor under the microscope. One person acting as
dermatologist, surgeon and pathologist eliminates many
variables,” explains Dr. Mueller. “Mohs also takes away the
guesswork of ‘blind’ procedures in which once the visible
tumor is removed, we simply wait to see if it recurs.”
In addition to Mohs surgery, Gundersen Lutheran offers
Radiation and Medical Oncology, Plastic Surgery,
Otolaryngology, Dermatopathology, Oculoplastic Surgery and
Hand Surgery services. If a patient needs these services in
conjunction with Mohs surgery, they can get them here as well.
Dr. Mueller adds, “I’m happy to consult with clinicians who
have patients they believe may be good candidates for Mohs
surgery. By working together, we can deliver the best possible
outcomes for patients.” Contact Dr. Mueller via MedLink.
If you have patients experiencing symptoms of an enlarged
prostate and could benefit from GreenLight PVP, call for a
consultation or referral via MedLink.
GreenLight PVP
Traditional TURP
• Laser coagulates blood as surgery is performed so there’s
little risk of blood loss
• Outpatient procedure
• 45 minute to 1½ hour surgery
• Limit physical activity for 3 to 4 days
• Tiny risk of incontinence (less than 1 percent)
• High risk of blood loss during and after surgery
• Hospital stay of 1 to 3 days
• 1 hour surgery
• Limit physical activity for 2 to 4 weeks
• Slight risk of incontinence
Cost is comparable for both procedures; however, there is no hospital stay with GreenLight PVP.
MedLink (800) 336–5465 4 In La Crosse 775–5465

Vascular Institute sees success with Stat TIA & Stroke Care program
A transient ischemic attack (TIA), by definition, lasts less
than 24 hours and most last less than one hour. “The cause and
appropriate treatment for TIA are very similar to stroke.
However, patients with TIA often receive less aggressive
diagnostic testing and treatment than stroke patients. This is
despite a five-year stroke risk of more than 30 percent,” reports
Jon Zlabek, MD, Gundersen Lutheran Vascular Institute.
In addition, up to 25 percent of patients with TIA will die
within the first year after the initial event, 15 percent of strokes
are preceded by a TIA and the risk of a stroke after a TIA is
very high, especially in the first 48 hours.
In a collaborative effort, medical staff from Gundersen
Lutheran’s Vascular Institute, Neurology, Internal Medicine
inpatient service (Hospitalists), and Trauma & Emergency
Center (TEC) have established a new Stat TIA & Stroke Care
program. This model provides patients with TIA the best
possible care. In addition to expanded treatment in the TEC, a
Stat TIA Clinic (part of the Vascular Institute and staffed by
providers in Neurology and Vascular Medicine) quickly sees
clinic-based patients with TIA.
“About two years ago we were named a Joint Commission
Primary Stroke Center. As such, we are continually looking for
ways to incorporate the best science available to treat patients.
A study reported in the Lancet medical journal shows that if
appropriate treatment is initiated quickly and aggressively after
protocols to ensure that all medical staff—no matter where a
patient might present—follow best practices in treating patients
with TIA.”
If you want more information on the Stat TIA & Stroke
Care program contact Dr. Fischer or Dr. Zlabek via MedLink.
TIA protocol pocket cards available
To standardize care, a pocket card has been created with
recommendations for the latest medical therapy for patients with
TIA and stroke. On the back of the card is the ABCD scoring system
to assist with appropriate triage. The ABCD score can predict which
patient with a TIA is most likely to go on to have a stroke:
Age: Over 60 (1 point)
Blood pressure (BP): systolic BP above 140 and/or diastolic BP
above 90 (1 point)
Clinical features
• Unilateral weakness (2 points)
• Speech problem only (no weakness) (1 point)
Duration: 10-59 minutes (1 point), 60 minutes or more (2 points)
The seven-day risk of cerebrovascular accident (CVA), or stroke, is
more than 30 percent for those scoring six points or above. In a
prospective study in the journal Lancet, all patients who had a
stroke within one week of a TIA had scores of four or more using the
ABCD score. These statistics further illustrate the importance of a
quick and proper evaluation and treatment of TIAs.
If you would like a TIA pocket card, please call the Gundersen
Lutheran Vascular Institute at (608) 775-GLVI (775-4584).
Gregory G. Fischer, MD
Specialty: Neurology and Neurophysiology
MD Degree: University of Minnesota Medical School,
Minneapolis
Internship: Hennepin County Medical Center, Minneapolis,
Minn.
Residency and Fellowship: University of Minnesota
Medical School, Minneapolis
Jonathan A. Zlabek, MD, FACP
Specialty: Vascular Medicine and Internal Medicine
MD Degree: University of Wisconsin Medical School,
Madison
Internship and Residency: Gundersen Lutheran Medical
Foundation, La Crosse, Wis.
a TIA, we can reduce the risk of a subsequent stroke by up
to 80 percent,” reports Gregory Fischer, MD, medical director
of the Stroke Center, Neurology department chair and a
member of the Vascular Institute. Dr. Fischer and Dr. Zlabek
head up the Stat TIA program at Gundersen Lutheran.
“The Trauma & Emergency Center has always done a great
job in evaluating and treating patients who present with TIA,”
says Dr. Zlabek. “With this program, we use evidence-based
News Brief
Gundersen Lutheran launches revamped Web site
The updated Gundersen Lutheran Web site—
gundluth.org—offers great new features such as:
• Updated look and navigation including links to news,
locations, maps and directions on the home page.
• A section for clinicians that will be a resource for referring
providers and have information on topics such as
education, training, medical library, quality and safety,
journal articles, etc.
• Enhanced class registration, so people can register and pay
for classes online.
• E-greetings allowing family and friends to send a
customized message to a loved one in the hospital and
more.
MedLink (800) 336–5465 5 In La Crosse 775–5465

Fertility Center offers hope to
couples seeking pregnancy
Gundersen Lutheran Fertility Center brings hope to the
estimated one in six couples who are having difficulty getting
pregnant. With the addition of two more fertility experts in the
past several months—reproductive endocrinologist Kathy
Trumbull, MD, and embryologist Joy Peterson, director,
Andrology and Embryology Laboratory—the Center has added
services and is seeing noteworthy success.
“Our pregnancy rates for IVF patients who are 40 years old
or younger and have egg retrieval are 64.7 percent. We have
achieved this high pregnancy rate while transferring fewer
embryos than would be routinely transferred at other
programs. Our implantation rate is more than twice the
national average,” reports Joy.
“In general, couples should be evaluated after 12 months of
attempting pregnancy without success—six months for women
older than 35 or even sooner if there is a known problem.
Couples can be referred at any point in their evaluation or
treatment,” says Dr. Trumbull. “Most couples will not need
treatment as involved as IVF.”
The Gundersen Lutheran Fertility Center offers a variety of
services that your patients may find beneficial, including:
• Evaluation of couples seeking pregnancy
– Hormonal evaluation
– Semen analysis
– Ultrasound study of tubal patency
• Ovulation induction with oral and/or injectable
medications
• Insemination using the male partner’s sperm or
anonymous donor sperm
• Minimally invasive laparoscopic or hysteroscopic surgery
• In-vitro fertilization using female partner’s egg or
donor egg
• Intracytoplasmic sperm injection (ICSI)
• Gamete intrafallopian tube transfer (GIFT)
• Pre-implantation genetic diagnosis
• Gestational surrogacy
• Tubal ligation reversals
• Cryopreservation and long-term storage of embryos and
sperm (see related article)
If you have a patient struggling with infertility issues,
contact the Fertility Center via MedLink for a consultation
or referral.
Cryopreservation—an option
for IVF patients and cancer
patients
Patients facing cancer treatments such as chemotherapy or
radiation therapy may have many physical and psychological
side effects. Both treatments can affect a patient’s fertility, and
for some couples, this can be devastating. Cryopreservation
offers a potential solution. Before cancer treatment begins,
sperm, eggs or embryos can be collected and frozen for future
use.
Gundersen Lutheran Fertility Center has the technology,
experience and skill for cryopreservation and long-term storage
of human sperm and embryos, and, in the near future, eggs.
Cryopreservation also offers advantages for couples going
through in-vitro fertilization (IVF) and embryo transfer. “At
the Fertility Center, we generally transfer only one or two
embryos back to a woman’s uterus during an IVF cycle.
Remaining healthy embryos can be cryopreserved for future
IVF cycles,” explains Kathy Trumbull, MD, reproductive
endocrinologist.
“By using cryopreserved embryos in future IVF cycles,
women do not have to go through egg production each time.
This helps reduce discomfort and costs. Use of cryopreserved
human embryos has a long proven record with only a slightly
decreased success rate compared to fresh embryos and no
increased risks to the mother or baby,” she adds.
To learn more about cryopreservation, contact the
Gundersen Lutheran Fertility Center via MedLink.
Kathy Trumbull
Specialty: Fertility specialist, reproductive endocrinology,
obstetrics & gynecology
MD Degree: St. Louis University, Mo.
Residency: University of Illinois, Peoria
Fellowship: Georgetown University School of Medicine,
Washington, D.C.
Joy Peterson, BS, TS, ELD
Specialty: Embryology
Education: University of Missouri, Columbia,
MedLink (800) 336–5465 6 In La Crosse 775–5465

New Practices
Pulmonary, Sleep
Medicine
Scott Skibo, MD
Residency: Univ. of Rochester
Medical Center, N.Y.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Cardiology
Kristen Andresen, MD
Residency: Univ. of Rochester
Medical Center, N.Y.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Behavioral Health
Jennifer Mueller, PhD
Internship: Southern Illinois
University Counseling Center
Practice Location: Gundersen
Lutheran – Onalaska, Wis.
Podiatry
Maggie Fournier, DPM
Residency: Gundersen Lutheran
Medical Foundation,
La Crosse, Wis.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Urgent Care
Greg Olson, MD
Residency: John Stroger
Hospital, Chicago, Ill.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Family Practice
Martin Oates, MD
Residency: Southwest Washington
Medical Center, Vancouver
Practice Location: Gundersen
Lutheran – Prairie du Chien Clinic
Urology
Chris Hofland, MD
Residency: Tripler Regional Medical
Center, Honolulu, Hawaii
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Family Medicine
Charles Clark, MD
Residency: Univ. of N.M.
Medical Center, Albuquerque
Practice Location: Gundersen
Lutheran – Whitehall Clinic
Behavioral Health
Kevin Quinn, MD
Residency: Mayo Clinic,
Rochester, Minn.
Practice Location: Gundersen
Lutheran – Decorah Clinic
Family Medicine
Lawrence Sanchez, MD
Residency: Columbia Hospital,
Milwaukee, Wis.
Practice Location: Gundersen
Lutheran – Hillsboro Clinic
Family Medicine
Lea Cornell, MD
Residency: Rockford Memorial
Hospital, Ill.
Practice Location: Gundersen
Lutheran – Wonewoc Clinic
Anesthesiology
Michael Jefferies, MD
Residency: Univ. of Colorado
Health Science Center, Denver
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Family Medicine
Brandi Strong, MD
Residency: Idaho State Univ.,
Pocatello, Idaho
Practice Location: Gundersen
Lutheran – Tomah, Clinic
Hospitalist
Randy McVean, MD
Residency: Gundersen
Lutheran Medical Foundation,
La Crosse, Wis.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Medical Oncology
Philomena Colucci, DO
Residency: Marshfield Clinic/
St Joseph’s Hospital, Wis.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Family Medicine
Jonathan Screnock, MD
Residency: Wausau Residency
Program, Univ. of Wis.-Madison
Practice Location: Gundersen
Lutheran – Onalaska Clinic
Anesthesiology
Jeffrey Trohkimoinen, MD
Residency: Univ. of Nebraska
Medical Center, Omaha
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Family Medicine
Scott Bohner, DO
Residency: Broadlawns Medical
Center, Des Moines, Iowa
Practice Location: Gundersen
Lutheran – West Union Clinic
Radiation Oncology
Collin Driscoll, MD
Residency: Medical College of Wis.,
Milwaukee
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Cardiology
Ants Palm-Leis
Residency: Wilford Hall USAF
Medical Center, Texas
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Radiology
Gabriela Dumitran, MD
Residency: State Univ. of N.Y.,
Upstate Medical Univ., Syracuse
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
MedLink (800) 336–5465 7 In La Crosse 775–5465

New Practices
Urgent Care
Rasmus Hoeg, MD
Residency: Gundersen Lutheran
Medical Foundation,
La Crosse, Wis.
Practice Location: Gundersen
Lutheran – Onalaska Clinic
Physical Medicine &
Rehabilitation
Ivan Edwards, DO
Residency: Univ. of Texas
Health Science Center,
San Antonio
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Pediatrics
Elizabeth Hansen, MD
Residency: Children’s Memorial
Hospital, Chicago, Ill.
Practice Location: Gundersen
Lutheran – Onalaska Clinic
Cardiology
Sampoornima Setty, MD
Residency: St. Barnabas Medical
Center in Livingston, N.J.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Neurology
Janelle Cooper, MD
Residency: Vanderbilt Univ.
Medical Center,
Nashville, Tenn.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Pediatric Endocrinology
Jennifer McVean, MD
Residency: Univ. of Colorado
Health Science Center, Denver
Practice Location: Gundersen
Lutheran – Onalaska Clinic
Psychology
Margaret Fitts, PhD
Residency: Boys Town Outpatient
Behavioral Clinic, Neb.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Neuropsychology
Raymond List, PhD
Residency: Saint Mary’s
Hospital, Rhinelander, Wis.
Practice Location: Gundersen
Lutheran – La Crosse, Wis.
Gundersen Lutheran offers enhanced interpreter services
Describing health concerns can be challenging for any
patient, but for patients with limited English proficiency (LEP),
it can compromise their healthcare. That’s why skilled and
professionally trained interpreters are so vital to patient care.
Interpreters help both patients and providers overcome
potential language and cultural challenges. Access to
interpreters is essential.
Recently, Gundersen Lutheran Interpreter Services made
several changes to improve communications between patients
and providers facing language challenges. These changes
include simplifying the interpreter request process, and
enhancing the professional development of staff interpreters.
Before being hired, all interpreters must pass language
proficiency testing. Gundersen Lutheran also provides
additional competency training and other professional
development opportunities.
Gundersen Lutheran has staff and on-call Hmong and
Spanish interpreters in La Crosse, Onalaska, Whitehall and
Postville. In addition, Gundersen Lutheran has a full-time
American Sign Language/English interpreter for patients who
are deaf or hard of hearing (DHH), offering service in
La Crosse and Onalaska. She also travels to regional clinics as
needed. Through additional contracted services, in-person or
via telephone, we can accommodate patients speaking virtually
any language.
Please note that patients have the right to an interpreter at
no charge. Also, providers must never allow minor children to
act as interpreters, and patients have the right to not rely on
relatives or friends as interpreters.
If you’d like to learn more about services for LEP and DHH
patients, call Interpreter Services via MedLink. If you work
within the Gundersen Lutheran system and have access to our
Intranet, you’ll find more information on Gladiator under Top
Corporate Resources/Interpreter Services.
MedLink (800) 336–5465 8 In La Crosse 775–5465

Gastric bypass surgery reduces
use of medications for type 2 diabetes
Researchers from Gundersen Lutheran drew national
attention with study findings that indicate weight-loss surgery
is an effective treatment for obese patients with type 2 diabetes.
The team presented their findings at the American Society for
Metabolic & Bariatric Surgery (ASMBS) earlier this year.
The study shows that obese patients with type 2 diabetes
who undergo Roux-en-Y gastric bypass surgery were able to
reduce their use of blood glucose lowering medications.
“Gastric bypass surgery can improve patient health and
lower healthcare costs by reducing costly obesity-related health
conditions, such as type 2 diabetes. As the patient loses weight,
obesity-related health conditions are improved or resolved,”
reports Shanu N. Kothari, MD, FACS, Gundersen Lutheran
Minimally Invasive Bariatric Surgery Clinic. Gundersen
Lutheran patients saved about 39 percent in medication
charges alone in just two years.
After more than 650 surgeries and a zero fatality rate,
Gundersen Lutheran has some of the lowest surgical
complication rates in the country. “Despite our successes,
gastric bypass surgery isn’t for everyone. But our findings are so
significant that we are encouraging physicians to talk with their
obese patients. Patients who are struggling to manage their
weight and type 2 diabetes, should consider the advantages of
laparoscopic gastric bypass surgery,” says Dr. Kothari
It is important for patients to understand the health risks
associated with obesity and the difference gastric bypass surgery
can make in their lives. Here’s what the research shows.
Obese patients with type 2 diabetes who
had weight-loss surgery often see significant
and sustained improvement in their
hemoglobin A1c levels. In addition, these
100%
patients saw a significant reduction in their use
of oral hypoglycemic medications and/or
insulin when compared to a control group of
obese patients conventionally treated for type 2 80%
diabetes.
The number of patients who required
medications to lower their blood glucose
60%
decreased dramatically in the surgery group.
Before surgery, 84 percent of these patients
were on oral medications and/or insulin
40%
compared to only 22 percent one year postsurgery
and 26 percent three years postsurgery.
In contrast, the conventional
20%
treatment group actually saw an increase—67
percent of these patients were on medications
initially, 82 percent one year later and 83
0%
percent after three years. This shows that
patients who are treated with gastric bypass
Remission of Diabetes (%of patients)
MedLink (800) 336–5465 9 In La Crosse 775–5465
Shanu N. Kothari, MD, FACS
Specialty: Bariatric Surgery, Laparoscopic
Surgery
MD Degree: University of Illinois College of
Medicine, Peoria
Internship and Residency: Gundersen Lutheran
Medical Foundation, La Crosse, Wis.
Fellowship: Medical College of Virginia,
Richmond, Va.
surgery have better control not only of their weight, but also of
their type 2 diabetes.
“The average gastric patient loses about two-thirds of his or
her excess weight in the first year. In addition to better diabetes
management, patients see improvement or resolution of other
health issues such as hypertension, joint pain, urinary
incontinence, acid reflux, sleep apnea and depression, and they
may lower the risk of some cancers. In addition, patients report
an overall improvement in their quality of life,” Dr. Kothari
emphasizes.
“Even if your patient’s diabetes is under control, they may
see further improvements and avoid long-term complications
with gastric bypass surgery,” he adds.
For a consultation or referral to the Gundersen Lutheran
Gastric Bypass Surgery Center, call us via MedLink. For more
information on our research, patient outcomes and more, visit
gundluth.org and click on Bariatric Surgery under Services.
Percent of Patients Taking Oral Medication or Insulin for Diabetes
39%
6 mo
2%
p=0.001
59%
12 mo
p=0.001
44%
5% 3%
18 mo
p=0.001
Surgical Cohort
Conventionally Treated Cohort
39%
24 mo
0%
p=0.001
54%
3%
36 mo
p=0.001

New Pulmonary Artery Hypertension Clinic offers specialized care
Pulmonary Artery Hypertension (PAH) is an uncommon lung
disorder but can be a very serious disease. There is extremely wide
variability in the severity of pulmonary hypertension among
patients, making evaluation and treatment of the disease a very
complex process.
This is why Gundersen Lutheran established the Pulmonary
Artery Hypertension Clinic. “A routine check-up seldom
discovers the cause of PAH, so an extensive evaluation is
frequently needed to determine the underlying cause. Often, the
symptoms such as fatigue, shortness of breath, chest pain,
palpitations and fainting, are common to many diseases, so the
correct diagnosis can be difficult to obtain,” explains Rebecca
Blank, PA-C, Pulmonary Diseases.
This new clinic offers thorough evaluations needed to
accurately diagnose PAH and provide the proper treatment
recommendations. Specialists Rebecca Blank, PA-C, and Alan
Pratt, MD, Pulmonary Diseases, encourage referrals and begin
their evaluations with a series of non-invasive studies tailored to
the patient’s history and exam.
Treatment of PAH may require very specialized medication
along with close follow-up or treatment of the disease causing
the PAH.
Pre-existing diseases can trigger and increase the severity of
secondary PAH. Blank, along with Dr. Pratt, work closely with
Cardiology, Rheumatology and various other departments to treat
the underlying problem.
Accurate diagnosis, one major benefit of this clinic, leads to
many other advantages for the patients. “Accurate diagnosis and
treatment will help eliminate treating patients with very expensive
drugs if they don’t, in fact, need them and pinpoint those who
do,” explains Dr. Pratt. “We have also been able to streamline our
processes to reduce costs,” adds Blank.
The new PAH Clinic is held in the Hospital, 2 North,
Pulmonary. For a consultation or referral, contact the PAH Clinic
via MedLink.
Alan Pratt, MD
Specialty: Pulmonary Medicine
MD Degree: University of Wisconsin School of Medicine,
Madison
Internship and Residency: University of Wisconsin School
of Medicine, Madison
Fellowship: University of Iowa Hospital & Clinics, Iowa City
Rebecca Blank, PA-C
Specialty: Pulmonary Medicine
Education: Viterbo University, La Crosse, Wis.
Regional Report
Information for healthcare providers in the Tri-state Region
Gundersen Lutheran Medical Center
1900 South Avenue
La Crosse, WI 54601
Non-Profit Org
U.S. Postage
PAID
La Crosse, WI
54601
Permit No. 395