Often heard in the news is the degree to which your diet can impact your overall health. In general, people tend to think of diabetes, high blood pressure, and heart disease as consequences of a less healthy lifestyle, but a rising disease known as fatty liver disease also has significant adverse health outcomes. There are two types of fatty liver disease, known as alcoholic fatty liver and nonalcoholic fatty liver disease (NAFLD). With the rising rates of obesity in the world, NAFLD can be found in 25% of the population worldwide.
What does a “fatty liver” mean?
A fatty liver is often found on imaging of the abdomen such as with an ultrasound or CT scan. This is not something typically found on a physical exam. Fat on imaging looks different than normal liver tissue and is often found on imaging incidentally. Fatty infiltration can disrupt the normal function of the liver which includes filtering toxins from the blood, creating clotting factors for the blood in case of injury as well as helping manage blood sugar levels.
How can I prevent this?
It is recommended to visit a doctor at least once per year even if feeling well to ensure proper screening for more silent diseases like fatty liver disease. At these visits, the doctor will monitor weight and labs to include screening for metabolic disturbances like elevated glucose levels, cholesterol, and liver function. Ways to prevent this disease in everyday life include eating a well-balanced diet to include higher protein, lower carb foods and plenty of fruits and vegetables.The American Liver Foundation has a great 30-day liver healthy meal plan to get you started! Daily exercise is also important, aiming for 150 minutes of activity per week.
I developed fatty liver disease, now what?
If significant fatty infiltration exists, it is possible that lab values may be abnormal that can indicate liver dysfunction. These labs include AST, ALT, alkaline phosphatase, and bilirubin levels. These may be checked by your primary care provider regularly. In severe cases, the injury is so severe that it can develop into liver failure. Because of this, it is best to prevent and treat as early as possible to avoid these complications.
The majority of the time lifestyle modifications are the mainstay of treatment for this disease. This includes weight loss if overweight or obese, abstaining from alcohol, and avoiding any potential medications or herbal supplements that could further injure the liver. Other modifications include optimizing blood sugar control if diabetic and managing high cholesterol or known heart disease aggressively. If these modifications don’t improve the condition, typically patients will need to see a liver specialist for further treatment and guidance.
Jordyn N. Walter
MD
Jordyn Walter, M.D. began practicing Internal Medicine at Lakeview Clinic in 2022. Dr. Walter has special interests in chronic disease management such as diabetes, heart failure and hypertension. She also utilizes point-of-care ultrasound.
For over 50 years third year medical students have been training with Lakeview Clinic physicians as part of their medical training through the Rural Physician Associate Program (RPAP); a clerkship program run through the University of Minnesota Medical School. This program gives students the opportunity to focus on primary care in rural communities. Currently, students are located as far north as Bemidji and as far south as Austin/Albert Lea.
Some early participating RPAP students were Dr. Donald Sommers and Dr. Scott Ellingson, who became long-time Lakeview Physicians and have since retired. Current Lakeview doctors that participated in the RPAP program include Dr. Leah Clark, Dr. Abigail Elliott, Dr. Jaimee McPadden, Dr. Tara McMichael, Dr. Rebecca Siffring and Dr. Lucas Labine. It is fun to hear about the positive experiences these providers had during their student rotations at Lakeview. Because of his time as a RPAP student, Dr. Labine discovered where he would eventually practice medicine. “I picked Waconia for my RPAP site due to its reputation, location, and opportunities- little did I know that I would love it so much I would want to come back!” he stated.
“I picked Waconia for my RPAP site due to its reputation, location, and opportunities- little did I know that I would love it so much I would want to come back!”
According to the University’s RPAP Program Office, 45 students have done medical clerkships at Lakeview Clinic over the years, beginning as early as 1974! Having all these amazing RPAP alumni demonstrates the success of the program reaching its intended goals. During this medical clerkship, students rotate through the various specialties such as OB/GYN, Pediatrics, General Surgery, and Internal Medicine at Lakeview. They are also provided with additional opportunities to learn about special areas of interest, spend time in our radiology department, and complete an ER rotation.
RPAP students finish their rotations at Lakeview Clinic having completed the Required Clinical Experiences (RCE) which is required of all medical students during their third year of medical school. Of the 250 to 300 U of M medical students from both the Twin Cities and Duluth campuses, 30 to 50 students choose to complete their clerkship through RPAP. Their reasons for choosing this program range from wanting the opportunity to have more patient interaction to wanting one on one mentorship with an established physician. Dr. Leah Clark “found Lakeview to be accommodating and expedient in facilitating [her special interest] in ultrasound guided musculoskeletal injections” during her time in the RPAP program.
All of this training takes place under the supervision of an established doctor known as a preceptor. Lakeview currently has three preceptors, Dr. Tara McMichael, Dr. Abby Elliot and Dr. Leah Clark, all of whom were RPAP students themselves! Dr. Todd Holcomb has also served as a preceptor. Physicians must be vetted prior to taking on the role of preceptor and need to become adjunct professors at the University of Minnesota in order to mentor students. We are grateful to have physicians willing to assume a critical role in the development of medical students. Lakeview preceptors help students develop clinical problem-solving skills and mentor future leaders in clinics, hospitals and our communities.
“Thank you for the tremendous work of providing excellent patient care, and your commitment to educate the next generation of physicians to serve our rural communities.”
-Dr. Kirby Clark, MD – Director, RPAP
A lot can change in 50 years, and while not all the communities we serve can still be considered rural, Lakeview does have clinics in rural communities and provides care for many patients from rural areas adjacent to the metro area. Lakeview Clinic is proud to be part of the Rural Physician Associate Program and its efforts to encourage students to practice primary care in rural communities. According to a study done by the University of Minnesota 41.2 % of RPAP students began their medical careers in rural clinics compared to 13.9% non-RPAP students. (U of M data from 1975-2017) RPAP students also entered Family Medicine and Primary Care at a much higher rate.
It is important that we continue to have Primary Care physicians available to residents of greater Minnesota. Rural clerkship programs like RPAP are only offered at approximately 20% of US medical schools. This makes both the program itself and physicians like those precepting at Lakeview Clinic an important part of future healthcare in our state.
You can learn more about the University of Minnesota Rural Physician Associate Program with the links below.
Varicose Veins are common in both women and men as they age. Varicose veins are not just a cosmetic problem…they can lead to complications such as skin changes and skin ulcers. Because of medical issues like these, insurance will sometimes cover treatment of the varicose veins if the treating provider can document that the patient is having leg pain or heaviness. Insurance companies will also take into account if the veins are causing symptoms severe enough to cause issues standing or walking, or if the veins are causing skin changes or ulcers.
Why do varicose veins happen?
Varicose veins most often occur due to backflow or reflux into the superficial (saphenous) veins. Veins have valves to push blood up the legs to the heart against gravity. If those valves stretch apart, they can allow blood to flow down the leg to the foot rather than up the heart. These leaky valves can occur from prolonged standing, pregnancy, and many other reasons.
How do I know if I have a vein valve issue?
A special type of ultrasound can be done with the patient standing and lying to measure the amount of backflow or reflux in the veins. Both the superficial system (saphenous) and deep (femoral) systems are evaluated.
What can be done if I have leaky valves?
Usually, using compression stockings is recommended first. If this does not help and symptoms are worsening despite wearing the stockings, different procedures could be recommended. One of these procedures is called a vein ablation. Ablation is where a catheter is placed into the vein. Usually, superficial veins are the culprit when leaky valves are involved. The vein is then closed with the ablation. Blood then flows back to the heart through the femoral system.
Will ablation fix the bulging varicose veins?
In most cases, the ablation will decrease the size of the varicose veins and help with symptoms such as leg heaviness and fatigue. Sometimes a separate small incision is made to pull out the bulging veins. This is called an avulsion or phlebectomy procedure.
Lakeview Clinic has three surgical vein specialists that your primary doctor can refer to for varicose veins evaluations: General Surgeons, Dr. Todd Elftmann, Dr. Dawn Stapleton and Dr. Steven Turner. Consultation appointments are available at the Chaska, Waconia, and Norwood offices.
Dawn M. Stapleton
MD
Dr. Stapleton’s practice includes surgical and endoscopic services. She has special interests in breast surgery, laparoscopic surgery and robotic assisted surgery for cancers and benign conditions including hernia repairs. She also performs upper endoscopy and colonoscopy.
Are you feeling joyful or anxious this holiday season? For most people the answer may be a blend of the two. The holiday season places additional demands on what may be an already busy life…social gatherings, shopping, decorating, travel. It can be a wonderful time of the year but may also be stressful.
Physical effects of stress on your body
Stress and anxiety can change how your body feels and can influence both your mood and behavior. It may cause fatigue, increasing the desire to sleep more. It can also cause physical symptoms of headache, heart racing, abdominal pain, and nausea. Some people note a change in appetite – overeating or not eating at all. Stress can also increase your chance of getting sick.
Stress influences your mood.
While stress may be a motivator for some people to get things done, for others stress causes them to feel paralyzed and overwhelmed. Further, stress can cause anger and agitation in some, depression, or tearfulness in others. Stress may cause you to isolate yourself, not wanting to be around others, which can be particularly hard during the holidays when “being social” is encouraged.
Stress can change your behavior.
Alcohol or caffeine use may increase during times of stress, which can worsen the physical feelings of anxiety. Because stress can make you feel tired, routines get disrupted – sleep may suffer, exercise may decline and eating times or amounts change. You may find yourself withdrawing from others at a time when social gatherings are increasing.
How can you cope with stress this holiday season?
Exercise. Move your body. Every step counts. Ideally, set aside time for physical activity most days of the week. Be selfish with this. In addition, incorporate activity into your day…park farther away, walk when you can, do jumping jacks on your break. Exercise helps with sleep, achiness, and tension.
Focus on healthy foods first. Then, allow yourself a treat but limit the amount. This can be hard when you may be surrounded by cookies and fudge. Consider eating something healthy prior to a gathering so you resist overeating.
Express your gratitude toward others. Look for the positive in people. Reflect on the good that is happening around you.
Know your limits – It is ok to say no.
Take time to reflect, meditate, pray. Quiet time, even if it is just for a few minutes a day, can help you relax and reset.
Remember to get enough sleep.
Recognize that there are some people that are not feeling joyous this season. They may be having difficulties emotionally or financially. Express your support and meet them where they are at.
I hope that you have a joy-filled holiday season. Remember, if your stress is turning into anxiety that is affecting your day-to-day functioning, seek help from others, including your Lakeview Clinic provider.
Sandra Beulke, M.D.
Dr. Beulke joined Lakeview Clinic in April 2003. She provides the full spectrum of family medicine, including obstetrics and gynecology, pediatrics and geriatrics. She has special interest in women’s health and diabetes care. Dr. Beulke serves as Lakeview Clinic’s Medical Director and is also active on several committees which aim to promote quality and reliability in health care.
Internal Medicine vs Family Medicine: Which provider should you choose?
A question often asked in clinic is which type of provider will fit my personal and physical needs to ensure optimal health outcomes. So, what exactly is the difference between an internal medicine provider (also referred to as an internist) and a family medicine provider when choosing a provider. Below are listed similarities and differences but ultimately the choice is a personal one depending on the situation.
Similarities
Both family medicine and internal medicine providers can be a choice for a primary care provider (PCP) for adult patients (typically 18 and above). They can provide general health maintenance services such as an annual physical/wellness exam as well as chronic disease management and most same day visits. As part of training, both specialties undergo a 3-year residency before practicing independently in a clinical setting.
Differences
One of the main differences between internal medicine and family medicine is the age range of patients they are trained to provide medical care for. Family medicine typically sees any age of patient including pregnant patients in some practices vs internal medicine who sees patients aged 18 and older in general. Of course, there are always exceptions such as Lakeview physician, Dr. Peter Rogers who is both a pediatrician and internal medicine doctor.
In general, internal medicine training has a larger focus on chronic diseases and specialty care such as cardiology and gastroenterology. They spend more time in the hospital and intensive care settings as opposed to family medicine training which is more typically spent in the outpatient setting. Family Medicine residencies focus more on procedures such as toenail removals, IUD placements, skin biopsies, casting, and joint injections.
Typically have more training and exposure to chronic disease management, specialty care, and geriatrics.
Training is based more in the hospital setting as well as critical care areas such as an ICU.
Typically sees more “complex” patients in the outpatient setting such as patients who have needed recurrent hospitalizations or multiple specialty needs.
Sees a full spectrum of patients including obstetrics and pediatrics. Providers can see the whole family.
Typically have more training in orthopedics, urgent care, and emergency medicine such as laceration repairs and procedures described above.
Performs annual physicals and wellness exams.
Disclaimer: The above description of each specialty are generalizations. Each provider has unique skills and interests that may differ from the above information. For more information on each provider, please visit the provider section of the Lakeview clinic website.
Jordyn Walter
Internal Medicine M.D.
Jordyn Walter, M.D. began practicing Internal Medicine at Lakeview Clinic in 2022. Dr. Walter has special interests in chronic disease management such as diabetes, heart failure and hypertension. She also utilizes point-of-care ultrasound.
