Advanced Wound Care: Zak Kriener

One thing can lead to another, which seemed to be the case for Zakary Kriener of Ossian. In January of 2022, he took a nasty fall from a ladder that shattered his right heel bone. During recovery from surgery and throughout the months of healing, Zak could not put weight his right foot. Though he recovered from the break, his gait remained a bit altered in favor of his left side.

Zak also has Type 1 diabetes and has diabetic neuropathy (nerve damage) in his feet. “It was the perfect storm,” says Zak. “The consequences of the break were significant. Because of the neuropathy in my feet, I didn’t know a sore was developing on the bottom of my left heel. By the time I felt it, I had a wound in my left foot that wouldn’t heal.”

Thomas Marquardt, D.P.M., Mayo Clinic Health System podiatrist at WinnMed says, “Diabetic foot ulcers are chronic, non-healing wounds that can easily become infected. Even a small cut or blister can develop into a foot ulcer because the skin of a person with diabetes has reduced ability to heal itself.”

Zak’s initial outpatient treatment for the foot ulcer seemed to be heading in the right direction, but after two months of being homebound and non-weight bearing, a second wound in Zak’s right heel developed and both became infected. His wounds were severe, and he was hospitalized to treat them, which included surgical debridement and antibiotics for the infection.

“Diabetic foot ulcers can result in lower limb amputation in people with diabetes,” says Dr. Marquardt.  “Foot care is of the utmost importance, and the availability of advanced wound care can improve the lives and outcomes for people in Zak’s situation.”

As timing would have it, WinnMed was on the brink of opening the first advanced wound center in the region – a full-service specialty that would provide all the latest treatments, including hyperbaric oxygen therapy, to patients.  Zak was the Wound Center’s first patient.

“I was discharged from the hospital on a Sunday and the next day, I was the first-ever patient in the Wound Center,” says Zak. “Bethany Stevens worked with me, sometimes at daily appointments, to treat my wounds.  She used all kinds of treatments and they slowly started to heal.”

Bethany Stevens, ARNP, has specialized in wound care since 2015. She says, “The skin is an organ that tells us when something is off balance in our body. In Zak’s case, it was responding to unstable blood sugar levels and excess pressure. So, in order to promote faster healing and prevent additional wounds from developing, Zak would have to get his diabetes under control.”

Working with a team of medical specialists determined to support him, Zak, who is in his mid-30s and 6 feet, 8 inches tall, lost 60 pounds and dropped his A1C by four points. He accomplished this through making healthier food choices and using a new insulin pump to help stabilize his blood sugar levels. Zak says, “Had I taken diabetes care more seriously earlier in my life, some of this might have been prevented. It was a total wake-up call.”

Zak Kriener with part of his care team.
Zak ringing the bell for his final treatment at the Wound Center with a part of his care team. Left to right: Morgan Hansmeier, RN, Bethany Stevens, ARNP, Kylee Uhlenhake, RN

Zak continued to heal, but the journey was long. The following spring he attended his first stock car race independently to resume his career in-person as a sportswriter and photographer. “I had tried to cover all my teams and races remotely over the past year; there is nothing better than experiencing sporting events and the races in person,” says Zak.

Zak knows he has to keep his diabetes in control for him to maintain a good quality of life. “My fiancé, Libby Manning, was with me throughout the hospitalizations, treatments, appointments and dressing changes. My friends helped me when I was homebound by keeping me company, playing video games with me and helping with household needs. My family stepped in whenever I needed something and to keep my spirits up. My entire primary, specialty, hospital and wound care team kept me on track as I healed. I am motivated to stay healthy, not only for myself, but for everyone who supported me.”

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Specialty Allergy Care: Gray Sibley

At about three months old, Grayson Sibley began developing severe skin rashes. His parents, Tasha and Alan, talked to Grayson’s primary care physician, who diagnosed him with eczema. He noted children with severe eczema are more likely to have food allergies and referred Grayson to Mayo Clinic in Rochester for testing, the results of which revealed Grayson was allergic to both peanuts and milk.

Tasha and Alan were now faced with a complete lifestyle change­—navigating raising a child with food allergies, including diligently reading food labels and learning how to use an emergency EpiPen.

“It was a terrifying feeling as a mom, knowing your baby could suffer severe allergic reactions at any time to such common foods,” says Tasha.

The Sibley family continued Grayson’s care with the allergy team at Rochester’s Mayo Clinic, a 70-mile drive, until 2023, when Dr. Michael D’Netto, a Mayo-Clinic trained allergist, joined the Mayo Clinic Health System practice at WinnMed. 

“When I learned Dr. D’Netto would be in Decorah, I immediately planned to transfer Gray’s care to WinnMed. We had a great experience in Rochester, and Dr. D’Netto was trained by the very physicians who were part of Gray’s care team.”

For his next appointment, Grayson was seen at WinnMed. Tasha says, “Dr. D’Netto ordered the same tests Gray was getting in Rochester; it was nice to feel this type of continuity in his care. We were immediately put at ease.”

His three-year old skin and blood tests revealed his allergy to milk was still positive, but peanuts were now negative.  Dr. D’Netto says, “It is possible for children to outgrow food allergies. This occurs in over 50 percent of patients with a milk allergy. Therefore, while Grayson still shows evidence of allergic antibodies to milk at this time, he may still outgrow this allergy. Regarding peanut allergy, roughly 20 percent of patients allergic to peanut will outgrow the peanut allergy. Grayson’s negative peanut testing suggested he may be in the fortunate 20 percent of peanut allergic patients. However, consuming peanut itself is the best way to determine a patient’s food allergy status.

Grayson Sibley with a peanut butter sandwich.

Tasha made a follow-up food challenge appointment for Grayson, where he was introduced to progressively larger amounts peanut butter in a clinic setting, carefully monitored by Dr. D’Netto and his nurses. “I wasn’t sure how the morning would go,” says Tasha, “because he was three and he may or may not have cooperated. But, they had toys for him and made the morning fun, so Gray had a great time.”

The results of the food test were exactly what the Sibley family hoped for: Grayson had outgrown his peanut allergy. Tasha says, “The next morning – a Saturday – Gray had his very first PB & J sandwich. It felt like such a milestone for him and our family. It is now his most favorite food!”

Grayson will continue his care with Dr. D’Netto in Decorah, and the family hopes his allergy to milk will follow the same path. Tasha says, “We look forward to the possibility that Grayson might someday be allergy-free, and we are thankful to be able to receive his care locally.

Are you one of the 10%?

According to the Centers for Disease Control and Prevention (CDC), approximately 10% of all US patients report having an allergic reaction to a penicillin class antibiotic in their past. * Michael D’Netto, M.D., Mayo Clinic Health System allergist at WinnMed in Decorah, says that just 10% of these patients with a reported penicillin allergy are a true allergy. “Thousands of patients at WinnMed alone have a documented allergy to penicillin because of how they reacted to the medication at one point in their past. We know that 10 years after a patient’s reaction to penicillin roughly 80% of patients outgrow their penicillin allergy. Additionally, some reactions are likely misattributed to penicillin, as we know infections themselves are a common cause of hives. As such, many penicillin ‘allergic’ patients could be ‘cleared’ of this allergy, which would allow them to be prescribed penicillin, amoxicillin, and other antibiotics in this class to fight bacterial infections.”

This matters because bacteria can develop a resistance to antibiotics, so having more antibiotic choices as a patient increases the chance of recovery from a bacterial infection. Additionally, some antibiotics are more expensive, so having a penicillin class antibiotic as an option can help patients financially.

Dr. D’Netto offers penicillin allergy testing at WinnMed in Decorah. For an appointment, call 563-382-2911. 

*https://www.cdc.gov/antibiotic-use/community/pdfs/penicillin-factsheet.pdf

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Multispecialty Concussion Care: Brody Tieskoetter

It is that Friday Night Moment when your child is hit on the football field and you are rendered breathless; it is the exhale of relief when he gets up and moves onto the next play.

Only for Lisa and Russell Tieskoetter, that moment remained unresolved as they watched their son, Brody, a senior at South Winneshiek High School, seem to wander away from the huddle in apparent confusion.

The tackle happened mid-air and Brody Tieskoetter landed hard, hitting his head against the ground. He passed the initial concussion testing on the sideline rendered by WinnMed Athletic Trainer, Heather Lange. However, he did not demonstrate stability and so Heather kept him out of the game.

His symptoms didn’t appear in earnest until the following Monday, when at a college visit, he had a hard time walking down a flight of stairs. Lisa says, “We called Heather and explained what was happening. She replied that he likely did suffer a concussion at that game, had a delay in symptoms, and to seek treatment.”

Brody says, “I had fully expected to be recovered before football playoffs, but then the concussion symptoms continued, and my basketball season was delayed. It felt like my senior year was falling apart.”

In the following months Brody worked with a team of sports medicine specialists at WinnMed to manage his recovery as he continued to experience extreme light and sound sensitivity, headaches and fatigue. In addition to Heather at the school, his care team included Scott Bohner D.O., a Mayo Clinic Health System family medicine physician; Becky Gesing, ARNP, Brody’s primary care provider in WinnMed’s Ossian Clinic; and Sarah Anderson, DPT, and Kent Ingvalson, DPT, both physical therapists in the WinnMed Rehab and Sports Medicine department who specialize in concussion and vestibular physical therapy. Dr. Bohner says, “Brody was not the typical concussion patient and required ‘all hands-on deck’ to help him recover. It truly was a multispecialty approach.” 

Together, the team provided Brody and his family the testing, exercises, medications and at-home strategies to help him recover. They engaged optometry to rule out physical problems with his eyes, and mental health care to help him manage the extreme anxiety he was feeling.

Brody’s care team continued to pursue his goal of re-entering athletics and his concussion symptoms slowly improved. By the spring, Brody had one lingering symptom – a headache – that would come in direct response to an increase in Brody’s heart rate. He trained with his therapists to find the trigger point and worked to extend that point through monitored exercise. One of Brody’s physical therapists, Kent Ingvalson, says, “We utilize a test called the Buffalo Concussion Treadmill Test to assess the patient’s autonomic response to physical activity. The results of the test allow us to safely work to retrain the autonomic nervous system’s response to exertion. This allows us to gradually and safely return to patient back to school, sports and work-related activities.” 

Brody says, “My entire senior year was difficult. I struggled in my classes because it was hard to concentrate and missed a lot of school. But I had a great network around me from care team, friends and teachers. And my parents… they never doubted me and were my advocates the entire time.”

Brody continues, “Concussions are a silent injury. When you have a broken leg or arm, or a torn ACL, people believe you are injured because they see the cast or brace. People don’t always believe you have a concussion – they see someone who is always on the bench. My advice to parents, students and fans is to respect the athlete, even if you cannot see physical injury. I would have done nearly anything to be playing, but my health and recovery had to come first.”

Reflecting back over his year, Brody is thankful for the decisions he and his family made regarding his health. He says, “I have no regrets. Yes, I missed most of my senior sports, but I have the rest of my life to think about. This year was a moment in time, and I am looking forward to my future.”

Visit MayoClinic.org for more information on concussion.

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Electronic and Appliance Waste Collection Reminder

We wanted to remind everyone that ALL ELECTRONIC AND APPLIANCE WASTE MUST GO TO THE RECYCLING CENTER AND MUST BE GIVEN TO A STAFF MEMBER DURING BUSINESS HOURS. DO NOT LEAVE THESE ITEMS AFTER HOURS. The recycling center is open from 6 am to 3 pm Monday through Friday.

*A $20 fee per unit applies for televisions, computer monitors, or appliances containing refrigerant.

*Payments must be made with cash or check only and cash transactions for the exact amount owed.

The Winneshiek County Sanitary Landfill NO LONGER ACCEPTS ELECTRONICS OR APPLIANCES.

Questions? Please visit our “What do I do With” page and click on Appliances or Electronics.

Thank you, and have a great weekend!

WinnMed thanks Karl Jacobsen for his service on the Board of Trustees

Karl Jacobsen, member of the WinnMed Board of Trustees, resigned his position earlier this month following a change in by-laws requiring trustees to attend 50% plus one meeting in-person in a year’s time. His term ends in 2026.  He says, “In retirement, my wife and I enjoy traveling, and with the recent change in Board bylaws, our plans were not compatible with my continued service in this role.”

Jacobsen was elected to the Board of Trustees in November 2012 and began serving in January 2013.  During his time on the Board of Trustees, Jacobsen was involved in multiple projects and initiatives, including the transition of WinnMed’s electronic medical records to Epic in 2017, navigating the COVID-19 pandemic, the brand change to WinnMed in 2023 and the start of the Transforming Tomorrow expansion project in 2024.

Jacobsen began his healthcare career in the early 1970’s at the (then) Winneshiek County Memorial Hospital as one of the first emergency medical technicians (EMTs).  He served locally and as a charter member of the National Registry of Emergency Medical Technicians.  Jacobsen went on to earn his nursing degree through Northeast Iowa Community College and subsequently provided nursing care in various capacities across the Midwest.  He continued his education and earned his Nursing Home Administrator license, which opened opportunities to lead care facilities in Wisconsin, Indiana, and Decorah’s Barthell Eastern Star Home in the latter years of his career. 

Concurrently and as a second arm of his professional life, Jacobsen provided financial advisory and investment services to clients across the United States.

Jacobsen says, “My experiences in health care, first as an EMT, then as a nurse and still later, in an administrative role, helped me throughout my tenure on the Board of Trustees.  I appreciated and understood the challenges of a changing industry from both a professional and a patient perspective and brought that insight to the Board as we faced significant decisions over the past 10 years.”  Jacobsen frequently presented the Board with education on current topics, trends and changes in the health care industry. He says, “I sought to use the skills and knowledge I had to help our entire board govern our local hospital.”

Steve Slessor, chief administrative officer, WinnMed, says, “I want to thank Karl for his years of service on the Board of Trustees. Karl has well-rounded experience allowing him to add perspective both as a clinician and a business leader. Karl was incredibly supportive of the many changes and advancements we have made at WinnMed, and the passion he has for the care we provide and what we mean to our communities we serve was evident throughout his time as a Trustee.”

Per the WinnMed Board of Trustees bylaws, candidates for Jacobsen’s open seat will be reviewed by a Board Governance Committee, and it will be filled by appointment for the remainder of his term.

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