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When Sara Laub’s period was late, the New York City resident shrugged it off. She’d used an intrauterine device, or IUD, for three years and knew her odds of getting pregnant were extremely slim. But after 10 days had passed, Laub, 28, took a home test in early July and got unwelcome news: She was pregnant.

Laub went to a Planned Parenthood clinic because she knew someone could see her immediately there. An ultrasound found no sign of a developing embryo in her uterus. That pointed to the possibility that Laub might have an ectopic pregnancy, in which a fertilized egg implants somewhere outside the uterus, usually in a fallopian tube.

Such pregnancies are rare, occurring roughly 2% of the time, but they are extremely dangerous because a growing embryo might rupture the narrow tube, causing massive and potentially life-threatening internal bleeding. Laub was experiencing no pain, bleeding or other obvious symptoms of trouble. Still, a Planned Parenthood staffer recommended that she go to a hospital emergency department right away.

An arduous end to a pregnancy that threatened her life

Laub didn’t realize it, but she was embarking on a lengthy — and very expensive — treatment to end the pregnancy. Even in a state that strongly supports a person’s right to make her own choices regarding pregnancy — New York legalized abortion in 1970, three years before Roe v. Wade made it legal nationwide — Laub’s experience shows the process can be arduous.

An ectopic pregnancy in the fallopian tube is never viable. But following the June reversal of Roe by the Supreme Court, reproductive health experts say treatment may be dangerously delayed as some states move to limit abortion services.

Some of those consequences are already being noted in Texas, where strict abortion limits were instituted last fall before the Supreme Court’s decision. Since abortion is now allowed in Texas only in medical emergencies, doctors may wait to perform abortions until pregnant patients are facing life-threatening complications in order to comply with the law.

“In Texas, we saw people not treating ectopic pregnancies until they ruptured,” says Dr. Kristyn Brandi, an obstetrician-gynecologist in Montclair, N.J, who is board chair of Physicians for Reproductive Health, which supports abortion rights.

The 2021 Texas law banned most abortions at about six weeks of pregnancy. University of Texas-Austin researchers interviewed doctors about the impact of the law on maternal and fetal care. Even though treatment of ectopic pregnancy isn’t explicitly prohibited under the Texas law, uncertainty around what is permitted may lead doctors to delay urgently needed care. A specialist at one unnamed hospital said the facility no longer offers treatment for certain ectopic pregnancies.

About half of states have enacted restrictions on abortion or are trying to do so.

Laub, who is being identified here by her middle and last name because of her concerns about privacy, says she couldn’t help thinking about the recent Supreme Court decision as she went through diagnosis and treatment.

“As scary as my ordeal felt at the time, I was acutely aware that I was fortunate to have easy access to treatment, and elsewhere women with my condition face much worse experiences,” Laub says.

What led to her $80,000 bill

At Lenox Hill Hospital’s emergency department on New York’s Upper East Side, doctors ran more tests and gave Laub two options: one or more injections of methotrexate, a cancer drug that destroys rapidly dividing cells and is often used to safely end an ectopic pregnancy, or surgery to remove her fallopian tube, where the fertilized egg was lodged. (In some other cases, surgeons may remove the embryo but be able to preserve the fallopian tube.)

Laub opted for the methotrexate injection. After getting the shot, patients need certain follow-up blood tests for several weeks to confirm that the pregnancy is ending or has ended. Laub returned to the emergency department for bloodwork and an ultrasound three days after the shot. She returned again three days later and was given a second shot of methotrexate since the pregnancy hadn’t terminated. The following week, she repeated the treatment in two more follow-up visits. On July 20, after 12 days and five emergency department visits, Laub was scheduled for laparoscopic surgery to remove her fallopian tube.

The total charges to date for the medical treatment: an eye-popping $80,000. Because her health plan had negotiated discounted rates with the hospital and the other providers, all of whom were in her provider network, Laub’s out-of-pocket cost will be a fraction of that total. It now appears Laub will owe a little more than $4,000.

That still seems like a lot, she says.

“On the one hand, I feel grateful that I was able to get treated when I was not in an acute state,” Laub says. “But it’s an awful feeling to know that the decision I made as to the best path forward for care comes at such a high cost.”

The hospital points out that its charges were reduced by Laub’s insurer discount. “Charges are based on the specific services provided in the treatment of the patient,” says Barbara Osborn, vice president of public relations at Northwell Health, a system that includes Lenox Hill Hospital. “Any amount due from the patient is based upon the benefit design and cost-sharing provisions of the patient’s insurance plan.”

Understanding hospital charges can be a head-scratcher since they often don’t appear to align with the actual cost of providing care. That’s true in this case. According to a breakdown by WellRithms, a company that analyzes medical bills for self-funded companies and others, Lenox Hill Hospital charges $12,541 on average for the surgery that Laub underwent, based on publicly available data that hospitals submit to the federal Centers for Medicare & Medicaid Services. But in this particular case, the hospital charged Laub’s health plan $45,020.

“Hospitals will charge whatever they can,” says Jordan Weintraub, vice president of claims at the Portland, Ore., company. “They put it on the payer to deny items, rather than billing appropriately.”

Even more revealing is how much it actually costs the hospital to perform the surgery. According to WellRithms’ analysis of the federal data, Lenox Hill’s cost to perform the laparoscopic procedure is $3,750. The average cost statewide is $2,747.

Nationally, the average outpatient charge for the surgical procedure Laub received is $13,670, according to data from Fair Health, a nonprofit that manages a large database of health insurance claims. The average total sum paid by the health plan and patient is $6,541.

Charges can vary widely from city to city

Surgical charges for managing an ectopic pregnancy vary widely depending on location. But the charges don’t necessarily correlate with the ease of access to medical care to end a pregnancy. In the New York City metropolitan area, for example, the average charge is $9,587, while in San Francisco, the average charge is $20,963, according to Fair Health. Both New York and California have generous abortion access laws. Meanwhile, locations with more restrictive abortion standards don’t necessarily charge more for ectopic pregnancy surgery. For example, in the Dallas area, the average charge is $14,223, while in Kansas City, Mo., it’s $16,320 — both lower than the average charges in Chicago ($18,989) or Philadelphia ($17,407).

Many women opt for methotrexate rather than surgery to treat an ectopic pregnancy. The drug is successful between 70% and 95% of the time without requiring surgery.

The drug is often administered in a hospital emergency room setting because OB-GYNs are unlikely to keep the cancer drug in their offices, experts say. After the injection, patients return home, but must be followed closely for the next days or weeks until embryo is reabsorbed and the pregnancy ends, because until that happens, the risk remains of a life-threatening rupture of the fallopian tube. In addition, patients must get bloodwork at intervals after an injection to confirm that their pregnancy hormone levels are falling.

After receiving her first injection at the emergency department, Laub was told she needed to return for follow-up bloodwork in three days, and then again after each injection of methotrexate she might need. Charges for those emergency department visits were likely significantly higher than the charges would have been had Laub received follow-up care from an OB-GYN in an outpatient setting. The hospital charged between $4,700 and $5,400 for each of those follow-up visits. Laub’s share of the cost was about $500 each time.

Osborn defended the hospital’s approach — requiring Loeb to return to the ER each time for her treatment.

“Ectopic pregnancies, which can be life-threatening conditions, require close surveillance and management to ensure a successful resolution,” Osborn says. “The emergency setting allows for immediate availability of critical surgical services, as was ultimately necessary in this patient’s case.”

But Dr. Deborah Bartz, an OB-GYN at Brigham and Women’s Hospital in Boston, questions whether each stage of that “close surveillance” really had to happen in the emergency room setting. “It would be really nice,” Bartz says, “if instead she could have been worked into the outpatient setting with a protocol for managing surveillance.”

KHN (Kaiser Health News) is a national, editorially independent program of KFF, the Kaiser Family Foundation.

After retiring several years ago, Deb Borst found she had plenty of time to enjoy nature, one of her favorite pastimes.

She enjoyed gardening with friends and walking around Reeds Lake, in East Grand Rapids. She was always on the lookout for beautiful birds.

On many days, she’d log anywhere from 8,000 to 10,000 steps.

She’s also been very active in her church. She spent over 20 years in leadership at The Other Way Ministries. And after retirement, she became a spiritual director, meeting with people who want to live more contemplative lives.

Borst is a widow and mom to two wonderful adult kids. She has one grandson and an adopted Liberian family.

“They call me honey,” she said. “So that’s my nickname.”

No matter how busy she got, she always made time for hiking, walking in the woods and visits to the farmer’s market.

Leading a healthy, active life is important to her.

“I’m a summer girl,” she said.

An unexpected diagnosis

In spring 2021, her journey took an abrupt turn when she went to the emergency department for what she believed to be kidney stones.

At Spectrum Health Zeeland Community Hospital, scans suggested something additional might be going on.

Most CT scans for kidney stones don’t include a look at the lungs, but this one just so happened to include part of the lower lobe of her left lung. And that’s where an astute radiologist recommended Borst undergo an additional scan, just to be safe.

“For me, this is my God story,” she said. “Because I see so many pieces that came together in ways that are just beyond my imagining.”

Borst said she vividly remembers the phone call from her doctor, after the second scan revealed a suspicious area on her lung.

“That was certainly a scary conversation to have,” she said. “But I also have absolute confidence in my doctor and knew that he would refer me to a good team. And indeed, he did.”

Within a week she had an appointment at Spectrum Health, first with a pulmonologist who read the CT scan and told her about other tests to expect.

“It put my mind at ease right away to know what was next,” she said.

The care team then scheduled her for a robot-assisted bronchoscopy with Gustavo Cumbo-Nacheli, MD, pulmonologist and critical care physician at Spectrum Health.

The procedure identified a small spot on the lower left lobe of her lung.

Doctors identified the nodule, about the size of a grape, as a carcinoid tumor, a slow-growing type of cancer.

“So to me, that was the good news,” Borst said.

But it would need to be removed.

Robot-assisted surgery

After several more tests to rule out any spread of the cancer, Borst soon met with Geoffrey Lam, MD, cardiothoracic surgeon at Spectrum Health. Dr. Lam developed a plan for robot-assisted surgery to remove the tumor.

“Deb was a healthy woman, nonsmoker, with no risk factors for cancer,” Dr. Lam said. “We saw something at the base of one of her lungs and a biopsy found an early-stage cancer.”

Robot-assisted surgery could help her get back to normal much sooner than traditional surgery, Dr. Lam said.

“I really wanted to try and avoid a big incision or big operation, because she didn’t have a lot of risk factors for cancer,” he said.

The care team scheduled Borst for a robot-assisted lobectomy in Dr. Lam’s office.

“He did such a wonderful job of creating three-dimensional images for us,” Borst said. “And that’s when I found out that my tumor was the size of a grape. Suddenly it became kind of real and something that we could picture.”

The surgery was completed in under two hours.

Afterward, Dr. Lam visited Borst in recovery. He said she had excellent, healthy lungs—and her good physical health would aid in her overall recovery.

But the assist from robotics also played a role.

In cases such as Borst’s, traditional open surgery involving spreading of the ribs could have resulted in five to seven days in the hospital and another two to three months of recovery.

With robot-assisted surgery, she spent just three days in the hospital.

“I had surgery on a Monday and by Thursday was home,” Borst said.

Doctors recommended she not push herself too hard too soon, although she could resume some normal physical activities.

Within three weeks, she was back to walking and enjoying much of her normal routine.

“I can’t begin to tell you what a wonderful surgeon and man he is,” Borst said of Dr. Lam. “He was so kind and compassionate with me, with our family. And at the same time, he just had this humble confidence about him.”

A quick recovery

It didn’t take long for Borst to get back into a rhythm.

“I started watering my flowers as soon as I got home and my daughter said, ‘Mom, you need to back off a little bit. Not quite so fast,’” she said. “But I was able to resume my normal activities very quickly.”

Doctors found the majority of Borst’s tumor was a mycobacteria infection, and only a tiny piece was carcinoid cancer.

“I feel like a living miracle,” Borst said. “And I am grateful beyond words for the work of every person on the medical team. From those who first read my CT scan to those who cared for me on my last day in the hospital. It was quite the journey.”

Less than a month after returning home, Borst found she could tackle one of her favorite hiking trails: Rosey Mound, in Grand Haven, Michigan. It features impressive climbing dunes and a variety of inclines.

Now, one year post-surgery, Borst and her doctors agree: Her recovery has been quite amazing.

“I had very little pain throughout my recovery,” Borst said. “And if I had pain, it was very manageable.”

She said she remains deeply grateful to God for the outcome—and for her providers “being so personal with me, respecting me, trusting me and being willing to answer questions.”

She recently celebrated her 73rd birthday.

“I hope I’m good to go for a long time, because I have many things that I would still love to do,” she said. “I want my life to be a testimony and continue to just be so grateful.”

In the U.S., about 75,000 children develop severe sepsis each year.

“It can affect a child or adult of any age,” said Adam Nicholson, MD, director of safety and improvement and pediatric emergency medicine physician at Spectrum Health Helen DeVos Children’s Hospital.

“It remains one of the leading causes of death in children worldwide, even with advances being made in treatments and mortality.”

But there is reassurance for parents: The chances of your child developing sepsis out of nowhere, without warning, is unlikely.

“(Sepsis) is more common in children who have a longer-range illness—immunocompromised, for instance,” Dr. Nicholson said. “This doesn’t usually come out of nowhere to affect an otherwise healthy child. It can, but is much less common.”

It’s certainly wise for parents to be aware of what sepsis is, but if a child doesn’t have an underlying health condition that makes them more vulnerable, there is typically less cause for concern.

Dr. Nicholson offered some additional insights about sepsis and talked about what parents should know.

What is sepsis?

Infection can happen when bacteria, viruses or fungi enter the body. Sepsis is a life-threatening condition that can occur when the body begins to respond strongly to that infection by attacking its own tissues.

Some sepsis symptoms include fever, lethargy and trouble urinating, but the condition can also lead to serious problems in vital organs such as the heart, lungs or kidneys.

“When we see extremely severe cases, it can lead to multisystem organ failure,” Dr. Nicholson said. “It can progress to septic shock, which may cause a dramatic drop in blood pressure that can lead to severe organ failure or death.”

Getting medical assistance via antibiotics and intravenous fluids can greatly increase the chances of survival, he said.

Bottom line: Sepsis is always the result of an infection.

“The immune system is overwhelmed and can’t maintain other vital organ function,” Dr. Nicholson said.

What are signs and symptoms?

In its early stages, sepsis can look like any other illness that causes a fever, Dr. Nicholson said.

“For the large majority of kids, it is a fever,” he said. “But that won’t be the only indicator. When we start seeing other signs of illness affecting the child, we start to think about sepsis possibly causing this.”

Some examples: the child’s skin color looks pale or unusual, or the child is unusually sleepy or lethargic. If a child is having trouble urinating, that could indicate trouble.

When a child is in the hospital, care teams can use screening tools to monitor vital signs, such as breathing, heart rate and oxygen level. This can help spot problems.

If a child has a fever, over-the-counter medication will usually help.

“With sepsis, this isn’t always the case,” Dr. Nicholson said. “A period of observation can usually give us time to decide if they have a more serious infection.”

What does treatment entail?

“When we identify there are signs of sepsis, we typically will start early with aggressive treatment,” Dr. Nicholson said.

This can include IV fluids that get into the vascular system, improving blood flow to vital organs, and antibiotics.

“In large part, sepsis is due to a bacterial infection,” he said. “When there is a sign or symptom, a course of antibiotics early on can improve outcomes.”

After that, doctors work to determine if any organs are affected. They then develop personalized treatment plans.

Can specific conditions lead to sepsis?

Patients who have a suppressed immune system or an underlying medical condition are at higher risk for sepsis.

“Very young infants, under the age of 30 days, who don’t have a fully functioning immune system can also be at risk,” Dr. Nicholson said. “And also, children who have conditions that require they have hardware in place—for example, a heart valve or central line.”

How is sepsis diagnosed?

Sepsis is diagnosed by a physical exam that includes checking heart rate and vital signs.

“We have lab markers that help us direct care,” Dr. Nicholson said. “Basic labs often are helpful to understand if there is a higher likelihood of infection going on. And more targeted labs can identify specific infections that may cause sepsis to occur.”

When should you see a doctor?

“Knowing that fevers are very common in children, I always tell parents if you are concerned about how your child is behaving with fever—lethargic, skin color is abnormal, limited urination, not eating or drinking—call your physician for guidance and observation,” Dr. Nicholson said.

For most children, a fever will respond well to over-the-counter medications such as Tylenol or ibuprofen, he said.

“The fever should go down and they will become more playful and active,” he said. “If this does not help, parents need to use their best intuition or seek care at an urgent care or emergency department.”

If a child has a fever of 102-103 degrees or higher, as well as other symptoms, parents should contact their physician for guidance.

“The large majority of these children will respond well to home care with typical over-the-counter medications,” Dr. Nicholson said.

Sharing best practices

Helen DeVos Children’s Hospital is participating in a multi-center quality improvement incentive through the Children’s Hospital Association, focusing on improving pediatric sepsis outcomes.

“The goal is for all institutions to implement best practices in terms of diagnosis and treatment to reduce mortality and hospital stays with sepsis,” Dr. Nicholson said.

Helen DeVos Children’s Hospital applies multiple initiatives to ensure early sepsis diagnosis and proactive treatment. For instance, physicians connect all patients brought in via the emergency department to an electronic sepsis screening tool that works in the background at all times.

If there are signs of sepsis, physicians are alerted.

“This sets off a chain of command where a sepsis huddle will take place on the patient’s behalf, and additional labs and treatments might be necessary,” Dr. Nicholson said.

A mellow melody floated through Dave Duggan’s apartment in his Kentwood, Michigan, senior community.

His cup of morning coffee steamed close at hand as he sat peacefully, focused on the rising sun.

His thoughts wandered to gratitude.

“Meditation aligns my brain for the day,” he said. “And it helps with fasting.”

Fasting has been an integral part of Duggan’s weight loss journey—a journey that began somewhat by chance.

“I stumbled into Lifestyle Medicine at the Downtown Market in Grand Rapids,” he said. “For years, I had been trying to lose weight, without success. But then I found this program and it all came together.”

These days, Duggan closes up his kitchen at 6 p.m. every evening. He holds off on breakfast until at least 14 hours later.

“I was more than 300 pounds back in November 2021,” he said. “And now, eight months later, I am down 70 pounds and still losing.”

It all began with that first step.

Changing a lifestyle

When Duggan first visited the Lifestyle Medicine team in late fall 2021, he met with Carolyn Vollmer, MD, a physician with Lifestyle Medicine.

“We meet patients where they are,” Dr. Vollmer said. “And then we strategize the right changes for each patient, customized to the individual.”

That’s because everyone is different, Dr. Vollmer said.

“We take a holistic approach,” she said. “We talk to the patient about their personal goals, what has meaning for them. We look at their chronic disease burden, their habits in terms of exercise and diet, sleep patterns, substances they use. Lifestyle habits are all interwoven.”

If you don’t get good quality or enough sleep, for example, you’re more likely to eat more calorically dense processed foods during the day to keep your energy up.

Lifestyle Medicine’s board-certified physicians, registered dietitians and health coaches partner with patients to shape personal lifestyle prescriptions.

When Dr. Vollmer met with Duggan, she learned he had gained weight in recent years. He also had high cholesterol and sleep apnea.

Duggan told her he wanted to lose weight to help prevent disease and reverse existing conditions.

They talked about nutrition, exercise, meditation, fasting and mindfulness.

“There’s good science behind fasting at least 12 hours,” Dr. Vollmer said. “Most people can do it easily enough if you think of the time you sleep as most of the fast.”

Cooking is the other part of the puzzle. It lets you control what’s in your food.

On this front, Duggan has enjoyed using his Instant Pot, a multi-cooker that gives him plenty of preparation options.

But what you cook is just as important as how you cook.

“We recommend Mediterranean or plant-based diets, eliminating processed foods and refined sugars—and generally becoming a label reader in the grocery store,” Dr. Vollmer said. “Mindful eating means putting away distractions at mealtime, slowing your pace and chewing slower, enjoying the taste.

“And we need to move every day. Even just walking 20 to 30 minutes daily.”

Feeling better

Duggan has been intrigued with the program from the start.

“I’ve learned a lot,” he said. “I enjoy cooking, so I was interested in the culinary classes that Lifestyle Medicine offers.

“I learned about added sugars. I was already a vegetarian, but I learned that some of what I was eating and drinking—fruit juices, yogurt with fruit on the bottom, kefir, jarred sauces, and ketchup—still had sugar in them.”

One of his first moves was to eliminate sugars.

“With that alone, I lost 10 pounds in the first month,” he said.

Duggan also learned much about the benefits of a plant-based diet. He went from vegetarian to vegan, eliminating milk and other dairy products from his kitchen. He substituted nut milks and expanded on vegetables in the dishes he cooked.

“Both of my parents passed of cancer,” Duggan said. “But with our lifestyle, we can do something about preventing cancer and heart disease.

“As I get older—I’m 67 now—I think about that more. We can’t control the genetics that we inherit, but we can control lifestyle choices with diet and exercise. And healthy lifestyle choices have been found to trump genetics when it comes to disease prevention.”

Duggan also added exercise to his weight loss journey, opting for regularly scheduled workouts at a wellness center.

As he began to shed pounds, he noticed that his hip pain—a constant issue when he weighed 300 pounds—had become less severe.

“I wasn’t necessarily losing weight because of exercise,” he said. “Diet is what does that. But exercise has many other benefits for my health.”

His sleep improved. His cholesterol numbers went down. His energy levels went up.

“I was turning back the clock to my younger self,” he said.

He began to feel better inside, too.

“As I started to feel more energetic, healthier … I had to buy smaller sizes in clothes,” he said. “My self-esteem got healthier.”

Helping others

Enthused with his progress, Duggan wanted to share his story and encourage others.

“People learn by watching what we do, rather than what we say,” Duggan said. “It was important to model the behaviors I wanted to teach others.”

As a resident of a senior community, he reached out to other residents to talk about his new lifestyle. He touched on the plant-based diet, meditation, fasting and exercise.

But he also added a social connection. He began recording a podcast and filmed YouTube videos about his weight loss journey.

Music also helped him.

“Piano,” he said. “The piano, for me, is therapy. I love music. It does something for my brain, creates new pathways. Music can reach through to people with dementia or Alzheimer’s when nothing else can. And that’s something I can bring to my community.”

After initially staying connected on a regular basis, Duggan and Dr. Vollmer now keep in touch every few months.

“That’s something that every patient determines for themselves, too,” Dr. Vollmer said. “How much accountability they want and need. We have virtual medical visits alongside the traditional in-person, so that makes it easy for patients to connect with us.”

While Lifestyle Medicine’s cooking programs are available virtually, health meetups are also offered so that groups of patients can meet with coaches.

“People can share their experiences and learn from each other,” Dr. Vollmer said. “Those are free and happen twice a month.”

Lifestyle Medicine’s physicians also connect regularly with primary care physicians to share updates on the progress of patients.

The update on Duggan? “Dave is doing everything right,” Dr. Vollmer said.

Duggan wouldn’t have it any other way.

“For me, what started out as an effort to achieve weight loss wound up opening a door of possibilities that include extended longevity and prevention and … reversal of age-related disease,” Duggan said. “I’m just getting started. It’s a lifelong and life-changing journey.”

Kelly Walski, 17, has always been a healthy teen.

She stays active and she loves playing golf and volleyball with her friends at Kenowa Hills High School.

But at one practice about two years ago, she found herself on the sidelines, hunched over in pain.

It marked the start of unexplainable bouts of pain, as well as occasional nausea and vomiting. And it seemed to come on at the most inopportune times—during practice, or even in the middle of a game.

When she tried to soldier through, she’d end up sitting on the bench.

At times, the pain would grow so severe she’d have to return home to rest.

With her senior year just around the corner—and a supportive group of family, friends and a boyfriend at her side—Kelly and her parents knew she needed to seek help.

“I was bent over in pain,” she said. “It was awful. The only thing that helped was lying down in bed.”

One night, the pain grew so intense that her parents, Krista and Kevin Walski, took her to the emergency department at Spectrum Health Helen DeVos Children’s Hospital.

She underwent an MRI and CT scan. Doctors tested her for kidney stones, but found nothing out of the ordinary. They also referred her to a gastroenterology specialist for additional tests.

Answers proved elusive.

“I almost gave up,” Kelly said.

The family returned home, remaining optimistic a cause would be identified with time.

‘She changed my life’

Kelly received a referral to the Pediatric Chronic Pain Clinic at Helen DeVos Children’s Hospital, where she met with an interdisciplinary team of providers.

This included Brittany Barber Garcia, PhD, chief of pediatric psychology and a pediatric pain psychologist with pediatric behavioral health and pain and palliative medicine at the children’s hospital.

As Kelly remembers it: “I met Dr. Barber Garcia a little over a year ago and she changed my life. She told me she knew what was wrong.”

Dr. Barber Garcia said her team has seen an increasing number of children and teens struggling with debilitating anxiety in recent years.

“There is a strong mind and body connection,” Dr. Barber Garcia said. “When we experience stress, we not only experience it emotionally, but also physically in the body.”

When a patient comes to her with several medical issues already ruled out, it can be helpful, she said.

But she also has to think like a detective, searching all the clues from previous evaluations.

A psychological evaluation showed that Kelly felt overwhelmed in certain situations, while other things in her life were also causing increased stress.

The diagnosis? Anxiety.

Kelly began working with Dr. Barber Garcia on different exercises to help her manage the pain.

“When I first met Kelly, she talked about having symptoms of panic attacks—moments of feeling overwhelmed, heart racing, abdominal pain, hotness, tingles, shaking and more,” Dr. Barber Garcia said. “She had never thought it could be something else, until we sat down and discussed anxiety and how it affects the body both physically and mentally.”

Over the course of a year, Kelly and Dr. Barber Garcia met virtually for therapy sessions about every two weeks.

“She’s the best thing that has ever happened to me, hands down,” Kelly said. “I love her.  She’s the most flexible human being ever.”

With Kelly’s boyfriend leaving for the Navy, they talked through strategies on how to cope with that change.

Dr. Barber Garcia helped Kelly understand the relationship between thoughts, behaviors and emotions, and how easy it is to get caught up in negative thinking traps.

“An original thought might be something as simple as concern about how you are falling behind on assignments in a class, and then anxiety steps in,” Dr. Barber Garcia said. “Before you know it, you’re wondering what will happen if you fail the class, and begin to think you’ll never graduate high school and become a failure.”

Anxiety can take a normal worry to a much more serious level, where it’s no longer real, she said.

Strategies like mindfulness, diaphragmatic breathing and meditation can help patients overcome these challenges.

‘Proud of myself’

Months later, Kelly hasn’t experienced a major panic attack.

She said she’s working hard to keep negative thoughts at bay, and she has finally reached a point where she can control her own body with breathing exercises and other skills Dr. Barber Garcia taught her.

After nearly a year of therapy, treatment and various exercises, her future is looking brighter.

“I’m proud of myself now,” Kelly said. “What Dr. Barber Garcia has done for me is something I wouldn’t change for anything.”

Kelly said her friends and family have been among her biggest supporters, always by her side through it all.

She said it’s important to learn to talk about mental health, despite any stigmas.

“I was against the idea of anxiety at first and thought it wasn’t a real thing,” Kelly said. “But here I am today, one of the biggest advocates for mental health at my school and for everyone around me.

“Mental illness shouldn’t have a stigma. And I hope no one is embarrassed by it.”

While she hasn’t experienced any bouts of pain lately, Kelly said it can spike sometimes. But with the techniques she’s learned in therapy, she has learned how to avoid moments of crippling pain.

“Now I know when it’s coming on,” she said. “My stomach starts to twist, but I can work through it with coping mechanisms.”

She’s already practicing golf for her senior year.

“I feel like everyone has realized this is our last year together, so we’re looking forward to hanging out and making it a great year,” she said.

She plans to attend Ferris State University after graduation, where she’ll study pediatric optometry.

“I could not be more proud of how Kelly has implemented the tools she has learned,” Dr. Barber Garcia said. “She’s really made them her own and she’s doing so much better.”

Success doesn’t always mean being completely free of symptoms or anxiety, she said. It sometimes means knowing exactly what to do when something happens, and getting through it calmly.

“She’s definitely on a path to a bright and successful future,” Dr. Barber Garcia said. “And I continue to look forward to our visits in the months ahead.”

On the ice, twin hockey players Austin and Owen Plumert constitute a double threat.

Eager to practice. Eager to play. Eager to excel and do their best for their team as they skate into challenges head-on, with fearless determination.

Alas, one day they each met a foe they could not dodge: hip pain.

The sharp, throbbing pain became so great, it forced both brothers to take a break from the sport they love.

But their timeout was not permanent.

Thanks to minimally invasive hip surgery to reshape the femoral head of their hip joint, the 17-year-old Hudsonville, Michigan, twins returned to the ice rink to skate, pass, check and score goals.

“When I got to my first game (post-surgery), I finally realized I didn’t have any pain anymore,” Owen said. “That was when I really knew that it had worked.”

At home on the ice

Identical twins, Austin and Owen share an identical passion for hockey.

They began to play hockey at age 5 and now play on a travel team and on the Hudsonville High School team. Their 19-year-old brother, Jaden, plays, too.

Their parents, Becky and Dan, are their biggest fans.

“The rink is like my second home,” Owen said. “I am always there. When I get done with school, that’s always something to look forward to—playing hockey.”

They have played soccer and baseball and they still play lacrosse. But hockey ranks No. 1 for both teens.

“I like the physicality of it,” Austin said. “It’s fast and you have to be worried about so many other things—like passing, where people are. You constantly have in the back of your head that you are going to get hit at some point, so you have to be quick in your movements, so you don’t get hit.”

Hockey is the center of their social life, as well. They have formed close friendships with teammates. And through travel teams, they have become friends with players from high school rivals.

The hockey community is like a family, Becky said.

For Owen and Austin, giving up the sport was unthinkable.

Hip pain struck Owen first.

Two years ago, as he went from cross country practice to hockey practice, he noticed a sharp pain in his hips. It hurt to walk upstairs.

On the ice, with adrenaline pumping, he didn’t notice the pain. But his parents could tell it affected his skating.

At first, Owen thought he had pulled a groin muscle. But when the pain persisted, his parents brought him to the Spectrum Health sports medicine team.

After conservative treatments, such as anti-inflammatories, failed to fix the problem, Owen saw Travis Menge, MD, a sports medicine specialist and orthopedic surgeon who specializes in hip arthroscopy and joint preservation.

Scans showed a structural abnormality of Owen’s hip joint.

“The femoral head is normally shaped like a nice round ball, like a basketball or marble,” Dr. Menge said.

In Owen’s hips, extra bone growth caused the femoral head to be oblong-shaped, like a watermelon.

That caused impingement on the labrum, which is a ring- or gasket-like structure around the socket. Tears in the labrum caused pain and limited the mobility of his hip joints.

“Impingement typically develops in the teen years, when growth plates are growing and then closing,” Dr. Menge said. “The structural abnormality leads to increased damage in the joint.”

Genetics and activity levels play a role in causing a misshapen ball in the hip joint, Dr. Menge said. It’s more common in teens who do a lot of running, skating or other repetitive motions—but not all active teens develop the condition.

Twenty years ago, a hip surgery would have required a large incision, several days in the hospital and at least a year of recovery.

“The good news is that advances in technology and surgical techniques have allowed us to address these structural abnormalities and damage in the hip through an arthroscopic, minimally invasive approach,” Dr. Menge said.

“We can address all of the damage and correct the structural problems through a few small poke holes.”

Headed to surgery

At the age of 15, in April 2021, Owen underwent his first surgery, on his left hip.

Dr. Menge shaved down the extra bone on the hip joint’s femoral head, creating a round shape. He also repaired tears to the labrum and damage to the cartilage.

Three months later, Owen underwent the same surgery on his right hip.

In November, after much physical therapy, strengthening and mobility exercises, Owen began to practice with his high school hockey team.

Austin did not experience the same hip pain as his brother. At least, not at first.

He noticed a popping sound in his left hip. And he could tell something interfered with the mobility of his hip joint.

One day playing hockey, he took a hit.

“I landed on it wrong and I think that finally was the tearing point,” Austin said. “I could barely walk after. It was severe pain.”

In April 2022, after hockey season wrapped up, he underwent the same arthroscopic surgery as his brother.

He worked for three months in rehab. In July, Dr. Menge told him he could return gradually to hockey practice.

Back on the ice

After several months away from hockey, Owen and Austin worked hard to get back in shape.

The first practices left them with sore muscles and out of breath, but that felt much better than the hip pain they had experienced before.

“I think the surgery is great,” Owen said. “Dr. Menge obviously did really good work.”

The teens credited their rehab team, as well.

“They definitely did a good job,” Austin said. “I got my mobility back and my strength back, so I could get back (to hockey) as (quick as I could.)”

Their parents could see the joy in their sons’ faces when they put on their ice skates, gloves and helmet and picked up their hockey sticks.

“You could see the light come back in their eyes. It was, ‘Yes, I can do this again,’” Becky said.

“I’m glad they can do it without pain,” Dan, their dad, said.

Over the years, Dan has seen how much hockey means to Owen and Austin—and how much they have gained from the sport.

“They have been able to learn what individual contributions are and also how it has to be a team effort,” Dan said. “They learn a lot of life lessons about winning and about losing and about doing your best.”

Long-term benefits

Helping Owen and Austin return to hockey has been very rewarding, Dr. Menge said. He is the senior academic advisor and the leader for research and innovation at Spectrum Health orthopedics.

“That’s the reason I do what I do,” he said. “I enjoy seeing people get back to what they love doing—without pain or other limitations.”

The benefits may extend beyond their high school hockey days, he added.

“Another major advantage of correcting the structural abnormalities is that we reduce the likelihood of further hip issues later in life and reduce the need for total hip replacement,” he said.

Dr. Menge credited the teens with diligently following the post-surgery rehabilitation.

“They are very hard-working, dedicated kids,” said Tarra Geertman, an athletic trainer in the orthopedics department who worked with the twins. “These guys did their part. They seemed to have a good attitude throughout the whole recovery process.”

Hip pain is common in active people and, in many cases, surgery is not necessary, Dr. Menge said.

He advises people to first try rest, anti-inflammatory medication and reducing or modifying activity. If the condition does not improve after four to six weeks, he recommends seeing a sports medicine specialist.

And if considering surgery, he advises consulting a surgeon who specializes in sports medicine and joint preservation—and who will perform a minimally invasive, arthroscopic surgery.

What’s next for Owen and Austin’s hockey career?

They both hope to play junior hockey after high school, and then play on a college team.

“I just love hockey,” Owen said. “I just want to keep playing hockey and get as good as I can.”