We are all prone to injuries such as ankle sprains, muscle strains, back pain, etc so it is important to understand proper at-home injury care. Knowing when to use heat or ice on an injury can help decrease your healing time and pain levels.

Using ice and heat for injuries can provide relief and aid in the healing process when used correctly and in moderation. However, it’s crucial to be aware of the risks associated with overusing these methods. Always follow the recommended guidelines for duration and application, and if you’re unsure, consult a healthcare professional for guidance. Remember that each injury is unique, and a healthcare provider’s advice can ensure the best approach for your specific situation.

When to use ice

Ice is typically used for acute injuries, such as sprains, strains, or bruises. Applying ice helps to reduce swelling by constricting blood vessels and numbing the area, thereby alleviating pain and inflammation. It is most effective when applied within the first 48 hours after the injury occurs, in intervals of 15-20 minutes with breaks in between to prevent skin damage.

• Benefits of ice: Ice application, also known as cold therapy or cryotherapy, can help in the following ways:
  • Pain reduction: Cold temperatures can numb the affected area and reduce pain sensations.
  • Inflammation control: Ice can help minimize swelling by constricting blood vessels and reducing blood flow to the injured area.
     
• Proper application:
  • Use ice packs, cold compresses, or even frozen vegetables wrapped in a cloth to avoid direct contact with the skin.
  • Apply ice for about 15-20 minutes at a time, allowing the skin to return to its normal temperature between applications.
  • Use ice within the first 48 hours of an acute injury, like a sprain or strain.
     
• Risks of overuse:
  • Tissue damage: Prolonged exposure to ice can cause frostbite or damage to the skin and underlying tissues.
  • Reduced blood flow: Excessive cold can lead to prolonged constriction of blood vessels, potentially delaying the healing process.
  • Nerve sensitivity: Some individuals may be more sensitive to extreme cold, leading to discomfort or nerve irritation.

Acute injuries

An acute injury is sudden and spontaneous, resulting from a fall, hit, or another type of trauma. The first rule of thumb is to never use heat on an acute injury. That extra heat can cause an increase in inflammation and delay proper healing. Applying an ice pack within the first 48 hours of an injury can help numb pain, relieve inflammation, and limit bruising. Keep your ice pack moving to avoid ice burns and do not exceed 20 minutes.

A common acute injury is a sprained ankle or knee injury. The RICE method is an important protocol to help relieve pain, reduce swelling, and counteract the body’s initial response to the injury.

RICE stands for rest, ice, compression, and elevation.

Rest

Stop using the injured body part! Protect the area and avoid any activity that is painful or may have caused the injury. Continued activity could cause further damage.

Ice

Use ice for the first 48-72 hours after an injury. Apply ice several times a day for 20 minutes at a time, followed by one hour “off.” The cold will contract injured capillaries and blood vessels to help stop internal bleeding. Do not apply ice directly to the skin.

Compression

Wrap the injured body part firmly with an elasticized bandage, compression sleeve, or cloth – especially when you are more active. This will help speed up healing time by reducing swelling around the injury.

Elevation

Elevate the injured body part above the level of your heart to decrease swelling and joint pain.

When to use heat

Heat is a great treatment for chronic conditions such as overuse injuries, and before participating in activities to help relax and loosen tissues and increase blood flow. Do not use heat after an activity, acute injury, or where swelling is involved. Swelling is caused by bleeding in the tissue, and heat only draws more blood to the area, which can increase healing times.

Be sure to use heating pads in moderation to avoid burns, and never leave one on for extended periods of time or while sleeping.

• Benefits of heat: Heat therapy, also known as thermotherapy, can be advantageous in the following ways:
  • Muscle relaxation: Heat can help relax tight muscles and improve flexibility.
  • Blood circulation: Applying heat can increase blood flow to the injured area, aiding in the delivery of nutrients and removal of waste products.
     
• Proper application:
  • Use warm towels, hot water bottles, or heating pads set to a comfortable temperature.
  • Apply heat for around 15-20 minutes at a time, allowing the skin to cool down before reapplying.
  • Heat is generally more suitable for chronic conditions or injuries that don’t involve significant inflammation.
     
• Risks of overuse:
  • Burns: Prolonged or excessive heat application can lead to burns, especially if the heat source is too hot or direct skin contact is made.
  • Increased inflammation: Applying heat to an already inflamed area can exacerbate swelling and discomfort.
  • Masked symptoms: Heat can temporarily alleviate pain, potentially masking the severity of an injury and leading to further damage.

Using ice or heat for different conditions

Applying ice or heat can be beneficial for various conditions, depending on the nature of the injury or discomfort. Here are guidelines for when to use ice or heat for specific conditions:

• Ice therapy:
  • Arthritis: Ice therapy can be helpful during flare-ups of arthritis, especially when joints are swollen, hot, and inflamed. Applying ice for about 15-20 minutes at a time can help reduce pain and inflammation. However, ensure there is a cloth or towel between the ice pack and your skin to prevent frostbite.
  • Headaches: If you’re experiencing a tension headache or migraine, applying a cold pack or ice wrapped in a cloth to your forehead or the base of your skull can help constrict blood vessels and alleviate pain.
  • Tendonitis: Tendonitis involves inflammation of tendons. Applying ice to the affected area for 15-20 minutes multiple times a day can help reduce inflammation and provide relief. Ice can help numb the pain and reduce swelling.
  • Muscle strain: In the initial stages of a muscle strain, applying ice can help reduce swelling and pain. Ice should be applied for 15-20 minutes at a time, several times a day, for the first 48 hours after the injury.
     
• Heat therapy:
  • Arthritis: For chronic arthritis pain, applying heat can help relax muscles and improve blood flow to the affected area. Heat therapy is especially beneficial when joints are stiff in the morning or after prolonged inactivity. Use a warm towel, heating pad, or warm bath for 15-20 minutes.
  • Headaches: If you’re dealing with tension headaches or tight neck muscles, applying moist heat (warm towel or warm shower) to the neck and shoulders can help relax the muscles and ease discomfort.
  • Tendonitis: After the initial inflammatory stage, applying heat can promote blood circulation to the affected area, aiding in healing. Use a warm compress for 15-20 minutes, a few times a day.
  • Muscle strain: After the first 48 hours of a muscle strain, applying heat can help relax tight muscles and improve blood flow to the injured area. Use a warm compress or a warm bath to soothe the muscles.

How to safely apply ice or heat on an injury

Ice:

• Preparation: Wrap the ice pack or ice cubes in a thin cloth or towel to create a barrier between the ice and your skin. This prevents frostbite or ice burns.
• Timing: Apply ice for 15-20 minutes at a time. Avoid prolonged contact to prevent tissue damage.
• Breaks: Allow your skin to return to normal temperature before reapplying ice. Aim for at least a 20-minute break.
• Elevation: Elevating the injured area while applying ice can help reduce swelling further.
• Frequency: Apply ice every 1 to 2 hours during the initial 48 hours after the injury.

Heat:

• Moderation: Ensure the heat source is not too hot to avoid burns. Use a warm, not hot, setting on heating pads or warm towels.
• Protection: Always use a cloth or towel between the heat source and your skin to prevent burns.
• Timing: Apply heat for 15-20 minutes. Longer exposure can lead to skin irritation.
• Breaks: Give your skin time to cool down between heat applications, typically for at least 20 minutes.
• Moist heat: For moist heat, use a damp cloth or towel over the heat source to add moisture and prevent excessive dryness.

General precautions:

• Skin check: Regularly inspect your skin during and after application to ensure it’s not becoming too red or irritated.
• Sensitivity: If you have reduced sensitivity in the affected area, be cautious about using extreme temperatures, as you might not feel discomfort until it’s too late.
• Individual response: Some people may prefer heat over ice, or vice versa. Pay attention to how your body responds and adjust accordingly.
• Consultation: If you have circulatory problems, diabetes, or any condition affecting skin sensation, consult a healthcare professional before using ice or heat.

Signs of a more serious injury include:

• Popping or crunching sound
• Severe pain or swelling
• Cannot stand or support the injured area
• Instability in joint

Remember that both ice and heat are meant to be used as temporary relief measures. If your pain persists or you experience any of the above, make an appointment with one of our orthopedic specialists.

On Thursday, Nov. 14, St. Charles celebrated Native American, American Indian and Alaskan Native Heritage month by hosting a Native Market of artisan vendors at our Madras hospital and presenting the first physical installation of our organization’s land acknowledgment statement.

Posted prominently in the main lobby of the hospital, the land acknowledgment says:

We acknowledge that the St. Charles campuses are located within the 10 million acres ceded to the Federal Government, also usual and accustomed areas, when the 1855 Treaty was signed with the Confederated Tribes of Warm Springs of Oregon. We offer this acknowledgment to honor all Native Americans that live in this area and who are the original people of this land.

The journey to get to those 62 very important words was long, and it predates my work at St. Charles. For me, though, it started a couple of years ago, when one of our providers, Dr. Shilo Tippett — a member of the Confederated Tribes of Warm Springs, Wasco Tribe — spent a chilly fall day taking me around area, feeding me delicious luckame’n, touring the Warm Springs Health and Wellness Center, introducing me to tribal leaders and teaching me about tribal culture.

At the end of the day, I thanked Dr. Tippett for not just telling me about her history and the history of her family, but for taking time to show me how many people of the Confederated Tribes of Warm Springs live and so many places where their culture is rooted. She reminded me recently that as I thanked her, I also asked if there was anything I could do in return for the generosity she had shown me.

And that’s when she told me that about the land acknowledgment work that began before the COVID-19 pandemic and stalled as our St. Charles teams put all efforts toward saving lives for several years.

I am grateful for that day and for the work that came next, which resulted in the land acknowledgment now on the wall at our Madras campus. I’m also grateful for the many people — including members of the Confederated Tribes of Warm Springs — who worked hand in hand to develop its language and artwork, as well as our new land acknowledgment web page. I have learned so much along the way, and I view our acknowledgment as a standing invitation to each of us to be curious, to inquire, to reflect and to learn for oneself. To further extend that invitation, we will also install land acknowledgments at our other locations in the near future.

Land acknowledgments are a way for organizations to pay respects to the original inhabitants of the land upon which we reside and work and to recognize Indigenous people as the original stewards of said land. We hope that by acknowledging the past and working toward an inclusive future, we can aid in emotional healing and help set a positive tone for future generations.

Sincerely,
Steve

St. Charles' new Gastroenterology practice is growing, both in size and scope — pun intended.

August saw the arrival of a new provider, Dr. Courtney Walker, who brings to the health system expertise in advanced therapeutic endoscopic ultrasound (EUS), a service that both expands the array of and reduces the invasiveness of treatments available to local patients.

Walker is the first provider in Central Oregon to offer EUS, which means local residents who could benefit from the procedure now have the option to get the care they need without driving to Portland or beyond.

“For patients, it should be much nicer to be able to stay here and get this procedure rather than having to cross over the mountains in the winter, for example,” she said. “Also, our hope is that referring providers will be able to get their patients in quicker rather than having to coordinate through Portland, especially when time is of the essence.”

Simply put, EUS is a procedure that uses an ultrasound mounted on an endoscope to examine and treat the gastrointestinal tract and nearby organs. Similar to an upper endoscopy, providers can go down into the intestinal tract, press the ultrasound up against the lining of the stomach or the small intestine and look through to the other side for abnormalities.

The big benefit for patients is that EUS is minimally invasive compared to other methods of examining areas deep within the abdominal cavity, including surgery or interventional radiology, Walker said.

“When you have to go through all these organs and intestines with a giant needle to try to reach something that’s maybe a centimeter or two in size, it’s a challenge,” she said. “With EUS, we’re already inside and the lymph node is just right next door, so we can easily sample tissue. It’s painless, for the most part. We get the biopsy and (the patient) is home an hour later.”

There are also a number of therapeutic possibilities with EUS. During the procedure, providers can administer injections to treat chronic pancreatitis or malignant pain related to pancreatic cancer; collect liver biopsies to learn more about abnormal liver function; determine the stage and spread of diseases like esophageal and rectal cancer and more.

Walker joins St. Charles’ new team of Gastroenterology providers, who see patients in Bend and Redmond for a variety of digestive and biliary organ conditions, including GERD, Barrett’s esophagus, swallowing issues, Crohn’s disease, ulcerative colitis, eosinophilic esophagitis, celiac disease and more.

The addition of EUS to the department’s list of specialized services is a win-win for both St. Charles and the community, Walker said.

“There are quite a few people out there who are going to benefit from this. I’m doing maybe three to five per week and that’s just a couple months in,” she said. “Our hope is that as more people know it’s available here, it will continue to grow and we’ll be able to help a lot of people across Central Oregon.”

Learn more about St. Charles Gastroenterology on our website.

If you hear the sound of a bell ringing in the St. Charles Cancer Center in Bend, that’s a signal to smile. The new bell – hung in the Infusion Room – is there for patients or family members to ring whenever they want to celebrate or recognize a meaningful milestone.

The new bell is a gift from Sam and Shane Coleman, both St. Charles caregivers. It’s a personal gesture for Sam, who completed her last round of chemotherapy for breast cancer last summer. She was diagnosed with breast cancer at age 39 after finding a lump during a self-exam. Sam underwent five months of chemotherapy and then had a mastectomy. The surgery went well – and she’s feeling optimistic as she has no signs of cancer in her lymph nodes or genetic markers.

“I was very lucky to go through chemotherapy and surgery and be done with it,” said Sam, who works in regulatory affairs and quality.

Sam says her work team has been amazing.  “I feel really really lucky to have been here. My work team has been super supportive and wonderful.”

Now, with two young children at home, Sam says she’s ready to focus on getting back to normal as much as possible. 

Sam isn’t sure where she first heard about the idea of ringing a bell after finishing cancer treatment – possibly a show or story she read. She wanted to ring a bell when she completed chemotherapy, but the Cancer Center didn’t have one. She and Shane offered to purchase one, so that future patients could experience a ringing moment of celebration together. Social Services Associate Linda Robson worked with the Colemans to find and order a 7-inch brass bell designed just for this purpose.

Last week, the bell was delivered and hung in the Infusion Room at the Cancer Center in Bend. Sam wants the bell to be for everyone and not just for individuals who had “beaten” cancer – because she knows that day doesn’t come for all patients. Her goal was to make ringing of the bell something every patient could experience.

“I want it to be really inclusive. If someone got great news after surgery – go ring the bell; if you survived the first round of chemo – go ring the bell. I want people to be able to celebrate big and small wins. I hope it’s a happy thing,” said Sam. “I want something that’s a little bit more meaningful for everyone, not just those of us who are lucky enough to be done. I hope people find their reason to ring it.”

Shane hopes that hearing the sound will bring people a feeling of hope – for caregivers, patients and families. “I hope families hear the bell and think, ‘Oh, that’s a happy thing.’”

Community members throughout Central Oregon are invited to a day of celebration in recognition of Native American, American Indian and Alaskan Native Heritage month at St. Charles Madras on Thursday, Nov. 14. The celebration will include a Native Market with 10 artisan vendors from the Confederated Tribes of Warm Springs, complimentary fry bread tacos and a presentation of the new land acknowledgment and artwork in the hospital’s Galleria. The Native Market is open to the public from 11 a.m. to 3 p.m. and the land acknowledgment presentation will take place at 1:15 p.m.

During the event, St. Charles President and CEO Dr. Steve Gordon will share why a land acknowledgement, which was developed in partnership with members of the Confederated Tribes of Warm Spring, is important to St. Charles and surrounding communities.  

“This acknowledgement is a way for us to pay respects to the original inhabitants and to recognize Indigenous people as the original stewards of the land upon which we reside and work,” Gordon said. “We hope that by sharing this acknowledgment we can aid in emotional healing, invite personal inquiry and reflection, and help set a positive tone for future generations.” 

The presentation will also include Kiksht language speakers from Madras High School and Warm Springs K8 Academy.

The land acknowledgment and accompanying artwork will be on permanent display in the main entrance at St. Charles Madras. In the coming months, the acknowledgment will also be installed at other St. Charles locations. Learn more about St. Charles’ land acknowledgment on our website.

For many of us, it wouldn’t be fall without having a little creative fun with a pumpkin. We bake with them, we decorate our homes with their fun colors and textures, and we put extra thought into carving our neighborhood’s greatest entryway masterpiece. There’s nothing quite as nostalgic as carving pumpkins.

The majority of the 1.5 billion pounds of fresh pumpkin varieties grown in the United States each year are sold for Halloween. Increasing pumpkin sales during the fall months also means an increase in people visiting the emergency room with hand injuries from slicing into a pumpkin. Various injuries can occur when dealing with a pumpkin’s hard flesh and a sharp cutting utensil. The St. Charles Center’s hand surgeons see several injuries from pumpkin carving every year. Most are minor, but the more serious ones that make it to a hand surgeon can involve injury to your tendons or nerves and require surgery.

Common hand injuries from pumpkin carving 

• Minor cuts or lacerations in the non-dominant hand
• Stab and puncture wounds in the hand
• Severed tendons and ligaments
• Permanent nerve damage in hands and fingers
• Flexor and extensor tendon injuries
• Loss of function and motion in the hand

To avoid hand injuries this fall season, here are some recommendations from the American Society for Surgery of the Hand:

Carve in a clean, dry, well-lit area

Wash and thoroughly dry all of the tools that you will use, including: carving tools, knife, cutting surface, and your hands. Any moisture on your tools, hands, or table can cause slipping that can lead to injuries.

Always have adult supervision

All too often, we see adolescent patients with injuries because adults feel the kids are responsible enough to be left on their own. Even though the carving may be going great, it only takes a second for an injury to occur.

Leave the carving to adults

Never let children do the pumpkin carving. Instead, maybe let kids draw a pattern on the pumpkin and have them be responsible for cleaning out the inside pulp and seeds. When the adults do start cutting, they should always cut away from themselves and cut in small, controlled strokes.

Sharper is not better

A sharper knife is not necessarily better, because it often becomes wedged in the thicker part of the pumpkin, requiring force to remove it. An injury can occur if your hand is in the wrong place when the knife finally dislodges from the thick skin of the pumpkin. Injuries are also sustained when the knife slips and comes out the other side of the pumpkin where your hand may be holding it steady.

Use a pumpkin carving kit

Special kits are available in stores and include small, serrated pumpkin saws that work better because they are less likely to get stuck in the thick pumpkin tissue.

Help for an injury

Should you cut your finger or hand, bleeding from minor cuts will often stop on its own by applying direct pressure to the wound with a clean cloth. If continuous pressure does not slow or stop the bleeding after 15 minutes, an emergency room or urgent care visit may be required.

While most of the injuries from pumpkin carving may only need stitches, others may need to be seen by a hand specialist, such as a hand surgeon, who can restore the hand’s movement and function.

Election Day is right around the corner, and many of you will have already voted by the time you read this. Personally, I love voting. I like how voting often forces me to weigh imperfect options, compelling me along the way to learn more on topics I might otherwise skip and to ask opinions from people I trust. Sometimes the choices are maddening, so I have to think hard on what I believe matters most. And without fail, voting also brings to mind gratitude for those who long ago fought for a right I hope never to take for granted.

As I complete my ballot this year, I’m also struck by how my concerns and hopes for health care in Central Oregon are influencing my thinking, and how the choices we make today will inevitably impact our future, often in unpredictable ways. So as you vote, I hope you too will think about how local, state and federal policies impact health care.

I realize health care may not be top of mind for you this cycle. It isn’t top of mind for most Oregonians. A recent opinion poll conducted by DHM Research showed that people believe the most important problem in Oregon is houselessness, followed by drugs, housing affordability, cost of living and crime.

Health care didn’t even make the list. But when you think about it, access to quality health care — particularly behavioral health care — impacts all of the issues listed above.

Many of us don’t think much about health care or our options for care until they are gone. We take for granted that hospitals will always be there when we have an accident, when pneumonia strikes or when it's time to welcome a new baby.

Increasingly, communities across the country are learning what happens when their local hospitals suddenly close their doors. Not only do they have to travel farther for care — incurring additional transportation and lodging expenses — they also feel the pain of tangential things like the hospital’s support of local youth programs, health fairs, flu shots and more. These challenges fall disproportionately on rural communities.

At St. Charles, more than 75% of what we are paid comes directly from Medicare and Medicaid (Oregon Health Plan), which means government reimbursements ultimately dictate the level of care and service we are able to provide. And those reimbursements are not keeping up with the inflationary costs of providing care. On average, the Oregon Health Plan pays hospitals 70 cents for every dollar of care provided. In 2022, this formula resulted in a $1.1 billion gap between what it costs Oregon hospitals to care for OHP members and how much those hospitals were paid for that care. Last year, 54% of Oregon hospitals lost money. I learned recently that nearly one out of three Oregonians now relies on OHP for insurance coverage. I’m proud to live in a state that values coverage so highly in principle, and at the same time I’m concerned we don’t follow up that commitment with a plan to pay for it. Well-intended government actions also add administrative cost and burden, further complicating and straining an already over-stressed system.

While St. Charles has had a modest financial rebound since the pandemic, we are not immune to the challenges all hospitals and physician practices face. Due to our geographic isolation, we are also increasingly worried about the small, private medical providers in the region — like The Center — who are having trouble retaining physicians and meeting the community’s needs for care.

We already know OHP reimbursement and administrative burden will be hot topics during the 2025 legislative session, and we are looking forward to working with our elected officials to address root causes and build a more sustainable model for hospitals and clinics in our state.

Which leads me back to the original intent of this month’s column — please vote. And please think about access to health care and the health of our communities as you do.

Sincerely, 
Steve

When babies are born, they are at risk of developing jaundice, which causes a yellow hue of the skin and can lead to serious issues. This is because their livers aren’t developed enough to break down bilirubin — a waste product from red blood cells — out of the body.

Historically, providers have treated many cases of neonatal jaundice pre-emptively because very high levels of bilirubin can be harmful to the brain. But not all babies need to undergo treatment, which can disrupt family bonding and breastfeeding, said Dr. Suzanne Mendez, St. Charles’ Medical Director of Pediatrics.

“There's a movement in medicine and pediatrics toward what we call ‘safely doing less’ or ‘choosing wisely,’ so that all the interventions and tests that we do on patients are warranted,” she said. “We don't want to unnecessarily burden patients with extra tests or treatments that they don't need, but we also want to be safe and make sure they are still getting the care they need.”

In 2022, the American Academy of Pediatrics sought to shift jaundice treatment practices and sponsored a new quality improvement project called Learning and Implementing Guidelines for Hyperbilirubinemia, or LIGHT for short. (Hyperbilirubinemia is a big word for jaundice.) The goal of the LIGHT project is to limit treatment to newborns who are truly at risk of complications.

The typical treatment for jaundice is blue-light therapy (phototherapy), where newborns are placed in a crib flooded with blue light that can break down bilirubin in the skin, allowing the body to flush it out. In addition to phototherapy, providers may administer IVs and will run tests with blood draws. While the treatment itself is relatively painless and benign, it means newborns spend more time in cribs and less time being held by family.

The American Academy of Pediatrics has acknowledged how disruptive that can be to babies and families alike and it put together updated guidelines and criteria for providers to gauge when babies need treatment and when it’s safe to let the condition clear on its own. More than 100 health care sites nationally, including St. Charles, were tapped to receive training on the new guidelines.

“We were excited to be selected to participate,” Mendez said.

After learning about the new guidelines, providers spent the next year implementing them, then compared data on jaundice treatments from a year before and a year after the LIGHT project’s changes. St. Charles was recognized for its excellent work with two “HighLIGHT” awards: One for limiting necessary treatment to babies above a certain risk threshold, and another for not using unnecessary blood tests post-treatment for babies who received phototherapy.

Another way St. Charles excelled in jaundice treatment was by using a non-invasive screening tool, a skin meter that measures bilirubin. By using the tool, providers reduced the number of babies receiving jaundice-related blood work by 70%, Mendez said.

The Pediatrics Department will continue to integrate the new guidelines and is reviewing data through July 2024 to see how the project has been sustained.

“It's always a balance,” Mendez said. “We want to make sure we keep babies safe, but we don't want to subject every baby to phototherapy, if we can help it.”

If you’ve ever been to St. Charles’ Bend South Family Care clinic, chances are you’ve at least seen and maybe met Mark Welch, a patient service representative there for about eight years.

He’s hard to miss, in part because he’s good at his job.

“When we’d been open about a year (clinic manager) Daggi Stafford came to me and said, ‘You know, you’re the face of this place. You keep smiling and doing what you’re doing out there,’” he said. “And that’s what I’ve done.”

He’s also a veteran of the United States Navy, where he served for 20 years on submarines patrolling the Pacific Ocean. He’d go weeks at a time without seeing sunshine, so when it came time to settle down, he wanted to go somewhere “where the seasons change and the people are friendly,” he said.

He found it in Central Oregon.

“One of the things I really enjoy here is that you’re close to all kinds of outdoor opportunities — from the beach and the mountains, fishing, skiing, hiking, the middle of the desert,” Welch said. “You’re four hours from anything!”

As you can probably tell, he’s young at heart, too. Which is why it took him about 10 years after leaving the military to realize he was a veteran.

“Veterans were those guys in World War II,” he joked. “They were recognizing veterans at an event and my wife poked me and told me to stand up. That’s when it finally hit me that I was a veteran.”

Welch says working in patient access at St. Charles is his second favorite job ever. At the top of that list: Machinist mate and engineering laboratory technician on Naval submarines, which essentially means he was the on-board nuclear chemist and radiation specialist. He also earned his “Dolphins” — a qualification pin given to those with the ability to operate every system on the ship.

“We’d go out for weeks or even months at a time, and if somebody got injured, everybody was able to step up and do anybody else’s job,” he said. “So when you went to sleep after your shift, you had full trust that the guy who was awake was going to save your life if needed.”

When his submarine would dock for a while, Welch had a chance to visit a number of different countries, where he would skip the bars and other entertainment offered near the port and head into the adjacent neighborhoods to learn about the local culture. Ever since he was a kid in a family that moved around a lot — 17 different schools from Kindergarten to 6th grade, he said — Welch has had a curious mind and an affinity for meeting new people.

“I came home from a new school one time and my mom said, ‘Did you make any new friends?’” he said. “I said, ‘Well, they’re the same old friends with new faces.’”

That’s an approach he carries through to his current job at the clinic.

“At the front desk, I figure when somebody's coming in that front door and they’re worried about their daughter or they’re low on gas or they have a bill to pay or whatever, it’s my job to get a smile on their face and make them feel better,” he said. “That way, when you get in front of the doctor, you can talk about why you’re here and not all those other problems you’ve got.”

He continued: “This is probably the first job where I love to get up in the morning because I know I'm coming to work to make a difference in somebody's day.”

With Veterans Day on the horizon, however, Welch is also thinking about the job he used to have — and that millions of others had, and still have, too.

“Veterans Day is the day I get to say thank you to my fellow veterans for being willing to write a check for these United States (and) for their sacrifice for their country, including being willing to give their life,” he said. “And to know that no matter what branch we all served in we always had each other's back. I was and am a part of the greatest military on our planet.”