Endometriosis is a common chronic inflammatory disorder characterized by pelvic pain that affects many patients. According to ACOG, endometriosis affects approximately 6-10% of patients of reproductive age and is prevalent in 20-50% of infertile patients and approximately 70-80% of patients with chronic pelvic pain. In this condition tissue that is found inside the uterus, the endometrium, forms outside of the uterus and can be found throughout the pelvis. This disease is characterized by painful periods but may also impact fertility.
Endometriosis Symptoms
Symptoms of endometriosis include chronic pelvic pain (both during and outside of a menstrual period), painful intercourse, but may also affect how heavy periods may be as well as pain with urinating and bowel movements. Some patients are asymptomatic and may find endometriosis incidentally when having surgery for another reason or during a fertility evaluation. The definitive diagnosis of endometriosis is made through a biopsy during surgery, but evaluation always starts with a history and physical exam and often an ultrasound is performed.
Endometriosis Treatment
Treatment for endometriosis is individualized dependent on symptoms and pregnancy planning. Medications are often used first and may help with pain, reducing symptoms, and slow and prevent further disease progression. These medications include NSAIDs, hormonal medications such as birth control pill and hormonal IUDs, and newer hormonal modulators that all can help treat a patient. Surgery may help remove endometriosis that can help with pain and improve fertility, but it may return. In some cases, a hysterectomy may be recommended but medications may be used in addition to the surgery.
Endometriosis & Mental Health
Endometriosis is also associated with increased risk of anxiety and depression as well as may be associated with other causes of pelvic pain. It is important to work with a healthcare team that is devoted to patient-centered care and aligns with a patient’s priorities. The diagnosis of endometriosis can be challenging and it is a severe chronic pain disorder that can impact many aspects of a patient’s life.
Establishing care with a gynecologist is a first step in developing an individualized treatment plan. Lakeview Clinic’s OBGYN team provides comprehensive patient centered care for endometriosis, and our physicians truly aim for pain-free lives for their patients.
Dr. Ferrell is a third generation physician and second generation OBGYN who is passionate about providing excellent and comprehensive evidence based medicine. He is board certified and enjoys all of the varied aspects of OBGYN medicine. His special interests include minimally invasive gynecologic surgery, menopausal medicine, pelvic organ prolapse and urinary incontinence, routine and high-risk obstetrics, infertility evaluation and treatments, and PCOS management.
Most of these injections can be safely and effectively performed in a primary care setting, apart from certain areas like the spine, which requires specialist care.
Ultrasound guided steroid injections
At Lakeview Clinic not only do we provide services for steroid injections, but we also have an option for ultrasound-guided steroid injections too. Using real-time ultrasound imaging allows us to deliver medication precisely where it’s needed, increasing both safety and effectiveness.
Ultrasound guidance is especially useful when:
The target area is difficult or risky to access (e.g., due to bone spurs, severe arthritis, higher BMI, or there are nearby critical structures that need to be avoided).
A previous non-guided injection didn’t provide relief.
The pain source is unclear (e.g., differentiating between pain from the hip, SI joint, or lower back). In these cases, a guided injection can provide both pain relief and diagnostic insight.
Note: While ultrasound guidance improves accuracy, insurance may not always cover it unless these specific conditions are met. Please speak with your provider about this beforehand.
Frequently Asked Questions
What’s in a steroid injection?
Most injections include:
A short-acting anesthetic (e.g., lidocaine) for immediate, temporary relief. This wears off after a few hours.
A long-acting corticosteroid (e.g., Kenalog, Depo-Medrol) to reduce inflammation. Steroid benefits typically begin within a few days to 2 weeks and may last for several months.
When should I consider a steroid injection?
To delay or avoid surgery.
To improve pain and mobility to better participate in physical therapy.
To reduce reliance or side effects of NSAIDs, Tylenol or other pain medications.
To prevent other injuries due to compensating for the current pain.
If pain is disrupting sleep or interfering with certain activities.
What are the potential risks?
While generally safe, possible side effects include:
Systemic effects (e.g. transient elevated blood sugar, elevated blood pressure, facial flushing): typically temporary and rare, but can be more likely in individuals with certain predispositions like diabetes
Bleeding: <1%
Infection: <1%
Temporary discomfort during the injection
“Steroid flare” (increased discomfort/swelling in the first 48 hours post-injection): ~5%
Allergic reaction: rare
Skin thinning or discoloration at the injection site: <1%
Tendon rupture: <0.1%
Ineffectiveness of the injection
When can’t we do the injection?
We generally avoid steroid injections in the following situations:
Acute fracture in the target area
Active systemic infection or infection at or near the injection site
Uncontrolled diabetes (typically fasting glucoses >200 or A1C >8.5%)
High bleeding risk (e.g., INR >3.5 or certain blood disorders)
Known allergy to the anesthetic or steroid (though alternatives may be available)
Note: We do not inject prosthetic joints. Additionally, if there is desire for a spinal injection this must be done with X-ray or CT guidance by a specialist.
Is there a limit to how many injections I can receive?
There’s no strict lifetime limit, but to minimize systemic effects, we typically do not recommend more than one injection every three months per joint, or 3–4 injections per year.
Which steroid injections are offered at Lakeview Clinic?
Head: occipital blocks
Shoulder: rotator cuff, shoulder joint, biceps tendon, AC joint
If you’re considering getting a steroid injection or have additional questions, speak with your Lakeview provider. We’re here to help you make an informed decision based on your unique needs and health goals!
Leah M. Clark, MD – Family Medicine (Care Team 4)
Dr. Clark loves taking care of the whole family and has special interests in office-based procedures (particularly ultrasound-guided and non-guided musculoskeletal injections), Sports Medicine, Pediatric and Women’s Health.
Lakeview Physician, James E. Carrabre’s Impact on Global Sport and Community Health
For decades, the Olympics have showcased not only the pinnacle of athletic performance, but also the highest standards of fairness, safety, and athlete care. That’s why the role of medical officials like Lakeview Clinic physician Dr. James E. Carrabre is so vital to the Games.
Dr. Carrabre practices Family Medicine and Sports Medicine at Lakeview Clinic’s Chaska location, where he provides comprehensive care for patients of all ages. Beyond his work at Lakeview Clinic, Dr. Carrabre has had longstanding involvement with the International Biathlon Union (IBU) as a Medical Official. The IBU governs the sport of biathlon worldwide and plays a critical role in Olympic competition.
A Strong Foundation in Medicine and Exercise Science
Dr. Carrabre completed Medical School and Residency at the University of Manitoba in Canada, where he also earned a Master’s Degree in Exercise Physiology. This dual expertise in medicine and human performance has shaped his career in both community healthcare and elite sport.
He is Board Certified in Sports Medicine through the American Board of Medical Specialties and the Canadian Association of Sports and Exercise Medicine. He is also Board Certified in Family Practice through the American Board of Medical Specialties.
These credentials reflect not only extensive training, but also a lifelong commitment to evidence-based care and continued professional excellence.
Serving the Olympics as an IBU Medical Official
What does it mean to be a medical official at the Olympics? Medical officials at this level are responsible for acute injury management, medical preparedness, athlete wellness oversight, and collaboration with anti-doping and regulatory bodies to ensure competition integrity.
It is a role that requires deep clinical expertise, quick decision-making under pressure, and unwavering ethical standards. Dr. Carrabre demonstrates all these qualities both internationally and here at home.
Why Medical Officials Matter; Especially in Light of Doping Controversies
Recent coverage in The New York Times highlights some of the complex ethical and anti-doping issues facing Olympic sports, including biathlon, where medal results from past Games have been reallocated years later because of doping violations. You can read about Dr. Carrabre’s involvement in uncovering the use of a novel substance used by Russian athletes in this New York Times article: https://www.nytimes.com/athletic/7044946/2026/02/15/biathlon-winter-olympics-medal-reallocation-russia-doping/.
Stories like these underscore why experienced medical professionals are essential at every level of international sport. Medical officials work alongside governing bodies to promote clean competition, protect athlete health, and uphold the credibility of sport. Their involvement reinforces that Olympic achievement must be built on fairness, transparency, and respect for athlete well-being.
Dr. Carrabre’s role with the IBU reflects a broader commitment to integrity in sport and responsible medical leadership. His clinical expertise makes him uniquely qualified to contribute to athlete well-being on the world stage and back home.
Bringing World-Class Expertise Back to the Community
While serving on the global stage is a remarkable accomplishment, Dr. Carrabre’s passion remains rooted in caring for patients in our community.
At Lakeview Clinic, he provides:
Comprehensive Family Medicine services for patients of all ages
Sports Medicine care for athletes and active individuals
Concussion evaluation and management
Assessment and treatment of exercise-induced asthma
Injury prevention strategies
Injury diagnosis and management
Exercise counseling tailored to weight loss, overall health, and athletic performance
His background in exercise physiology allows him to design individualized plans that help patients move safely, recover effectively, and achieve long-term wellness goals.
Excellence at Every Level
Dr. Carrabre’s career reflects a blend of scientific expertise, ethical leadership, and genuine dedication to people. His involvement with the International Biathlon Union is just one example of how Lakeview Clinic physicians contribute not only locally, but globally.
We are proud to have Dr. Carrabre representing Lakeview Clinic on the international stage and, most importantly, serving the families and athletes of our community every day.
Dr. Carrabre practices the full spectrum of family practice, except Obstetrics with special interests in preventative health care. As an exercise physiologist, he has special training and expertise for exercise counselling for weight loss, health, and performance.
Heis an Alumni of the International Olympic Academy in Elias Greece in addition to being a Fellow of both the American College of Sports Medicine and the American Academy of Family Physicians.
EKG is a quick painless test that measures the electrical activity that makes your heart beat. This test measures if electrical signals are having a difficult time conducting (moving) through the heart and captures six seconds of heart activity. To conduct this test, a technician places 10 stickers and wires, known as leads, on specific locations of the chest, arms, and legs. The leads help to measure the electricity in the heart by measuring the multiple directions the electricity is moving.
The test can look at the top, front, sides, and bottom of the heart and can show how fast or slow your heart is beating. It also indicates if you have an irregular or regular heart rhythm. While it can’t look at your heart valves, it does give your provider helpful clues about your heart’s overall structure and function.
Why would I be getting an EKG?
Medical providers recommend EKGs for a variety of different reasons. You may already be aware that EKGs are done to look for a heart attack, though it cannot necessarily catch all heart attacks (myocardial infarction i.e. MI). You may also get one for a pre-operative appointment to ensure your heart is looking stable before surgery. Other reasons an EKG may be ordered could be chest pain, shortness of breath, passing out, shoulder pain, dizziness, weakness, fatigue, change in pulse, palpitations, lightheadedness, or jaw or arm pain.
What should I expect during the EKG?
At Lakeview, our EKG room is in a different area than the lab area where you get your blood drawn. One of the lab technicians will take you to the EKG room and ask you to lie on a bed. You may notice a computer like machine in the room, which is what performs the EKG. EKGs are best done if you can lay flat. If you cannot lay flat, please let them know so we are able to help make you as comfortable as possible.
The technician will place10 stickers and then attach wires to them. They may ask you to lie still and stop talking. If there is any sort of movement during the EKG process it can cause the EKG to be difficult to read for the provider as the lines will not be clear. So, the technician may ask you to breathe slowly or hold your breath to try and prevent this.You will then notice that a sheet of paper prints out and that is your EKG.
Are there any risks to the EKG?
For the most part, the EKG is a painless procedure. Some people that may have reactions to adhesive and may get a little rash on the area that the stickers are removed. Unfortunately, as of right now there is no way to do this without the stickers. If you have sensitive skin it may be helpful to inform you provider if they are recommending an EKG test.
Who is reading your EKG?
The EKG technician is not trained to read an EKG. This requires specific training that your provider (MD, DO, PA-C, or NP) has been trained in to do. Often you will get to leave immediately after the test. The technician will bring the EKG to your provider who will reach out to you if there is a concern. On some occasions, patients are asked to stay in the room while technicians confirm the EKG is not concerning or is a good quality. This prevents patients from needing to come back to re-test.
What should I do if my apple watch or smart watch says I am having an irregular heartbeat (ex. Atrial fibrillation)?
If your smart device indicates irregular heartbeat, it is recommended that you be seen by a medical provider. While being proactive is important, we don’t want patients to get overly stressed about these alerts; let us help you navigate this situation if it arises. Sometimes your smart watch is correct, and we do find irregular heartbeats and other times we do not.
At appointments following an alert, you may get an EKG or blood work. You may also get something called a Zio patch ordered which is a patch that you wear on your chest to monitor your heartbeat for upwards of 14 days. Zio patch can often be helpful as the EKG only provides a 6 second view of your hearts electrical activity, while the Zio patch is continuous for many days. This can be helpful to your provider due to recording more information about your heart. Results are read by the Minneapolis Heart Institute and then sent back to your provider.
Natalie Rogotzke, PA-C
Natalie Rogotzke is an Internal Medicine medical provider who joined Lakeview Clinic in 2023. In addition to to having her Physician Assistant degree, she has experience working as both an emergency room EMT and pharmacy technician. Natalie has special interest in preventative medicine, geriatrics, and dementia care.
Why Annual Wellness Visits Still Matter for Older Kids & Teens
Once kids move past the early childhood years, it can feel like annual wellness visits aren’t as important; especially if they’re not due for vaccines. But for older children and teenagers, these visits are just as critical, even if no shots are needed.
According to guidance from HealthyChildren.org (the American Academy of Pediatrics’ parent resource), wellness visits during the school-age and teen years play a huge role in keeping kids healthy physically, emotionally, and socially.
Monitoring for Potential Health Issues
Even when kids seem healthy, annual wellness visits allow providers to monitor growth and development over time and catch potential concerns early. These visits may include:
Tracking growth patterns, blood pressure, and BMI
Screening for vision, hearing, and scoliosis
Identifying early signs of conditions like anemia, high cholesterol, asthma, or hormonal concerns
Early detection means earlier support and often simpler, more effective treatment. Many parents combine their adolescent or teenager’s sports physical with their annual visit, eliminating an extra visit.
Supporting Mental & Emotional Health in Adolescence
Adolescence is a time of big changes. Annual visits give kids and teens a safe, confidential space to talk about:
Stress, anxiety, or mood changes
School pressures and peer relationships
Sleep habits and energy levels
Pediatricians and family medicine providers are trained to screen for early signs of depression, anxiety, and other mental health concerns and to connect families with resources when needed.
Healthy Screen Time Habits
HealthyChildren.org emphasizes that screen time can impact sleep, mood, physical activity, and academic performance. Wellness visits are a great time to:
Review screen time limits
Talk about social media use and online safety
Discuss how screens affect sleep and focus
Your child’s provider can help families set realistic, age-appropriate boundaries and share tools to support healthier tech habits.
Conversations About Alcohol, Smoking & Vaping
As kids get older, exposure to alcohol, cigarettes, and vaping increases even if parents don’t see it happening. During wellness visits, providers:
Ask age-appropriate questions in a nonjudgmental way
Educate teens about the risks of alcohol, smoking, vaping, and other substances
Reinforce family values around safety and decision-making
These early, ongoing conversations are proven to reduce risky behaviors over time.
Reinforcing Healthy Habits Together
Even when everything seems “fine,” annual visits help build a trusting relationship between your child and their healthcare provider. That relationship makes it easier for kids and teens to speak up when something isn’t fine.
Your pediatrician or family medicine provider isn’t just checking height and weight; they’re partnering with your family to reinforce healthy habits, answer questions, and provide trusted resources tailored to your child’s age and needs.
Wellness visits aren’t just about vaccines. They’re about prevention, guidance, and support, especially during the important growing years of childhood and adolescence. If it’s been a while since your older child or teen had a wellness visit, now is a great time to get back on track and schedule one.
