Kelly Nieuwenhuis is no stranger to hard work.

"I'm a family farmer. I farm with two brothers. This would be my 40th year in 2023."

​He's been part of the biofuels industry for years and has watched it grow and evolve with a changing market. "I've been involved in the biofuels industry for 20 years," he told me on a visit to his farm. "And the last 10 years I've been involved in the industry and definitely focused on carbon in tax reductions or carbon intensity reductions."

Farming in O'Brien County, Iowa, he's one of several landowners who have proposed carbon capture pipelines mapped for their property and he's already on board.

Summit Carbon Solutions and Heartland Greenway's Navigator CO2 Ventures are two liquid carbon-capture pipelines in production through the central United States. They would carry liquid CO2 from ethanol plants to a central location for underground sequestration. The success of these pipelines relies largely on voluntary easements signed by the landowners like Nieuwenhuis on the route.

"I was on board right away. Absolutely," he said of the pipelines. He's signed easements with both companies to install their pipelines through his farmland. "Nut the absolute best thing you could do is you could capture and sequester underground permanently."

Carbon has become a commodity in the ag industry and it's in many everyday items we use. "A lot of this stuff is used in carbonation, it's used in refrigeration, it's used in dry ice," Nieuwenhuis explained. "Markets are somewhat saturated, so we need to find another place for the CO2 to reduce the CO2 emissions."

"Prior to the ethanol industry or biofuels, we had livestock and we had exports and if those didn't work or the export numbers were down, we overproduced and we're subsidized," Nieuwenhuis said as he explained what he calls the 'agricultural stool. "And then we built the third leg of the stool, the biofuels industry, and that's been the absolute best wealth-building industry."

THE EASEMENT LOCATION

The area of Nieuwenhuis' farmland where the Summit and Navigator pipelines will be laid is a few miles from his home. We drove to the area so I could see it for myself.

"The Summit pipeline is going to go straight east and west right here," he pointed as we looked over his farmland on a windy February day. "Just over the hill there I have a natural gas pipeline that goes diagonally that's been there for 40-50 years and then behind that, probably 200-300 yards to the west of that is where the Navigator line is going to go, diagonally across."

"And how much of this area is the easement for the construction?" I asked.

"They are going to have a 50-foot-wide permanent easement and then a 50-foot temporary during the construction phase," Nieuwenhuis explained.

Nieuwenhuis has already received payment for the estimated crop damage to his land.

"You know they pay you, compensate you for crop damages over three to five years or longer," he said. He's already received part of those payments. "After three years, we stopped seeing issues with crop damages."

The Dakota Access oil pipeline runs through his farmland already. Several years removed from when it was installed, he says he doesn't see any change in yield.

"We've got yield maps that show over the last two years, we can't see the pipeline," he explained. "We're pretty confident that over time, I'm not saying it's an instant repair, things take a few years and that's why they pay in three to five years in crop damages or more if there's an issue. But I've learned to not say the word 'never' or 'forever' because it doesn't harm the property forever or anything like that."

Overall, Nieuwenhuis sees carbon capture as the next major step forward for the ag industry. "It just came home from the U.S. Grains Council meetings, and every country was talking about the need to lower your carbon intensities, and in their markets, they're paying you a premium to do it. And so I think if the biofuels industry wants to compete with the rest of the energy industry."

And as the world rallies for net-zero emissions by the year 2030, "that's a huge step to the race to net zero," said Nieuwehnuis. "And I think we can get to net zero in the next decade in biofuels and with the energy of the world focusing on low carbon we need to meet or continue to improve our process to stay in the game."

FOLLOW FOR MORE

"Along the Route: A Pipeline Discussion" is a multi-part series of reports looking at everything from the companies that want to build them to those "for" and those "against" and a deeper dive into to carbon and ethanol industries at the center of the project.

SEE THE VIDEO

Republican presidential candidate Nikki Haley was back in Iowa Monday and held a campaign stop in Salix.
The former South Carolina Governor and UN Ambassador spoke at the event at Port Neal Welding Company. Haley touched on several major topics including taxes and the debt ceiling, term limits in Congress and agriculture. She also introduced her plan for the education system.
"So we need to do around the country what I did as Governor," she told the crowd. "We said no child could pass the 3rd grade if they couldn't read. We put them in reading remediation camps, we worked with their parents. We made sure we got them back on track. You go and you cut out all of this critical race theory and you focus on the things that really matter. You make sure that parents can see everything their kids are being taught. Everything. There is no reason you should be kept in the dark."
One of Haley's biggest talking points was the crisis at the southern border. Recently returning from a visit to the border herself, Haley touched on the laws she enacted as governor as what she'd like to see nationwide.
"In South Carolina, I passed one of the toughest illegal immigration laws in the country," she said. "We put in a mandatory E-Verify program so that no business could hire anyone who was here illegally. That's how we got them out of South Carolina. We do mandatory E-Verify. Then you go and you make sure that you stop funding the 87,000 IRS agents and put 25,000 border and ICE agents on the ground."
She also touched on ways to reduce the debt ceiling and debt in Americans pockets. 
"You basically go to them and you change the retirement age so that it reflects life expectancy. Instead of the cost of living increases, you relate it to inflation, it makes it more accurate. You limit benefits to the wealthy. You expand Medicare advantage plans so there are more options, and more competition and you can actually begin to pay down the debt if we do those things."
Haley heads to Denison, Storm Lake, and Fort Dodge Tuesday before ending her Iowa tour in Des Moines on Wednesday.

Music education can change a child's life, unlocking a gift that can carry them through a lifetime. 

:I like the music academy because the teachers are really nice here and I love playing piano and I could be successful with it," said one student. 

Inside First United Methodist Church on Nebraska Street, you can hear the tinkering of piano keys every Monday afternoon. It's part of the Music Academy at First, a new program teaching music to kids who may just need it most.

"It's where it really starts is in elementary," said academy director Gene Wagner. "Where do we get these kids involved in music and how do we get them started in music, especially for kids that are low income that can't afford to do some of that stuff? They don't have those opportunities. And that was kind of the kickoff for the music academy to provide those opportunities for kids who don't have the finances and can't afford to do any of this stuff."

The Music Academy officially launched this year offering free beginner piano lessons to students at Hunt Elementary who qualify for free and reduced lunch. Before the old Hunt Elementary was closed down, the church had a similar program going, offering free piano lessons to students. When the new Hunt Elementary opened its doors, creating the Music Academy was a no-brainer. 

"It offers so many benefits for those kids, makes them better students and better prepares them for their future." Piano lessons expanded to hand chimes and string instruments. Several instructors also offer private lessons for kids who really want to keep learning and have a love for music. 

"To see a kid brighten up and open up and be able to express themselves in this way means everything," said string instructor Eleanor May-Patterson. "To me, it means it's a lifelong learning experience, where it's not only just learning an instrument or learning how to sing, but it's learning history, and how and what the composers were doing, across time and globally."

"Music is not just a single thing, but it's so many skills together," said Wagner. "It's that focus. It's reading rhythms. It's reading notes. It's about working together, being on time and being supportive."

Instructors like Carolyn Rants teach because they want to help kids find purpose.

"You know, it gives you that expression of music and that love for music," Rants said. "And if we can give that to children who maybe, in today's society, don't have it in their home. There's a cacophony in society and so it's great to be able to provide some of that," she said, "which is why my cane and I come and volunteer."

'My heart just sings when I see these kids coming in," said piano instructor Emily Jasman. "It's after school, early out on a Monday. They could be going home and watching TV or doing other things but they chose to come here and continue these lessons."

Lessons are completely free for kids in the program with instruments and music funded by grants and donations. While its reach is small now, the hope is that the Music Academy can grow to more schools, more students, and more instruments. For those who are part of First United Methodist Church, having this program in their facilities is important. 

"To see a child when they come here and never even have touched a piano and after the first lesson, they're playing Old MacDonald," said Pastor Roger Madden, "it's amazing. The next week, a little more, and the third week, they're just excited. And it's not just the music. It's also the relationship they build with their teacher."

These volunteers are teaching more than just the keys on the piano.

"Their confidence grows," said Jasman of the change she sees in her students. "They become better public speakers. They become more confident in decision-making because their reading is better. And they know they can express themselves."

"And there's a lot of camaraderie with kids that are in those programs and it gives them a space to be creative but also to stay safe in a safe environment. Well, I think it's an experience that they don't get any other way," said Rants. "To experience the creativity that comes from music, the sounds, the appreciation that you have. You don't realize how much you learn from that experience until later in your life."

The Music Academy at First is run entirely on grants and donations, to provide the instruments and music for the kids. The Academy hopes to grow its reach, to offer free music lessons to kids across the area from elementary through high school. 

​SEE THE VIDEO

For many residents in the Midwest, farming isn't their job. It's their life. Land passed from generation to generation, decades of history throughout the grounds.

We have a century farm," said Woodbury County landowner Deb Main, "My dad entrusted me to care for his land.Now, two multi-million dollar companies want to use that land to install carbon capture pipelines across the central United States.

"We have spent hundreds of millions of dollars on easements to date to the U.S. landowner and we're not stopping," said Summit CEO Lee Blank. "We're going to continue to do that until we get ourselves in a position where we got 100%."

THE PIPELINES

Summit Carbon Solutions plans to build a pipeline that will take liquid CO2 from ethanol plants in five states into an underground storage facility in Bismarck, North Dakota. Heartland Greenway's Navigator CO2 Ventures pipeline runs on the same concept. Capture liquid CO2 and store it underground in south-central Illinois. To do this, both companies need voluntary easements from landowners along the route of their pipelines, giving them permission to pass through hundreds of miles of private land.

"We have great success in all areas throughout the project footprint to date, but that is necessarily a long-term process," said Elizabeth Burns-Thompson, Vice President of Government and Public Affairs for Navigator. "So again, landowner negotiations necessarily are weeks and months type of progress, not something that you do in a matter of days."

Those negotiations are for easements that give each company access to private land to work and install the pipeline.

"Negotiation is far more broad than that," said Burns-Thompson. "Negotiation is how that pipeline is put in. Is there different and additional restoration steps that you as a landowner want to include or delineate as part of that? Is there a different placement of that pipe that you would like to see as part of that? So again, placement of the pipe, how we do the work, and then ultimately also how that compensation looks. That is what is encompassed in that negotiation."

EASEMENT AGREEMENTS

Kelly Nieuwenhuis lives and farms near Primghar, Iowa. Farming is a family business.

So we're pretty proud of that, that we have a family farm and been doing it for 40 years.

He's already reached easement agreements with both Summit and Navigator for access to his farmland. "We negotiated with both of them," he told me on his farm in northwest Iowa. "We had very respectable land agents come to our farms and visit with us and we probably met with them three or four times at least and we asked for a few other things that we wanted done. And they were happy to do that."

Part of the easement agreement details potential property damage, and for farmland, potential crop losses. That isn't just for the time of construction, but for several years after.

"We feel like we're partnering with the U.S. agricultural landowner, as well as others that have easements and with those partnerships, we're working through this economic discussion," said Blank.
"Also talking through the nuts and bolts of compensation," said Burns-Thompson. "And so making sure that what we're putting forward is something that's fair and that's what's in the eyes of the beholder. So we necessarily want to make sure that we're taking the time to talk to folks and figuring out something that's fair and equitable."

Summit Carbon Solutions has more than 65% of the easements needed for their project footprint, according to the latest numbers sent to Siouxland News on April 3, 2023.

• Project Wide: 65.4%
• Iowa: 68%
• Minnesota: 58%
• Nebraska: 60%
• South Dakota: 66%
• North Dakota: 70.5% (pipeline) plus 85% (sequestration)

​Navigator CO2 Ventures says they have spent upwards of $15.5 million on easement payments to landowners in the project path as of April 5, 2023.

• Project Wide: $15.5M to date on Right-Of-Way
• Iowa: Nearly $10.7M
• Illinois: Nearly $1.5M
• Nebraska: Nearly $2.4M
• South Dakota: Nearly $830K
• Minnesota: More than $83K

LANDOWNERS HOLDING OUT

But not everyone in the path of the pipeline is on board.

"Without the limitation of contact with landowners, then land agents are still harassing landowners incessantly to sign easements and offering more and more and more money, which is the bribery situation. It's not a business plan. It's a bribery situation."

Deb Main is one of more than a dozen landowners in the tri-state area who oppose these pipelines. She has yet to sign an easement to give the companies access to her land.

"And that's a proposed pipeline route also," she explained about the proposed pipeline path through her property. "It doesn't mean they're going to stick with that because some people have signed an easement because it just went across the corner of my property. Well, now it goes like (Roger's property), down the middle because they can put it anywhere on your property they want."

I sat down with nearly a dozen landowners and residents who oppose the pipelines to discuss why they are fighting back against these multi-million dollar companies. One of their biggest points was easements.

"It goes from a six-inch pipeline to a 24-inch pipeline," said Stee Maxwell, another landowner from northwest Iowa. "It seems to be a lot of variances as far as how large the pipeline is, and like to say we got that much pressure coming through that pipeline, that's going to be..."

"And the depths," echoed Jim Colyer. "I've heard from three foot to eight foot. So, what is it going to be? During these informative meetings, you hear lots of different stories."

Landowners were sent certified letters in 2021, informing them of the pipelines and informational meetings held in each county the pipelines were passing through.

"At the informative meetings that are required in Iowa by the Iowa Utilities Board," said Main, "you not only got the information from the pipeline company, but outside the meeting, they had survey companies there and land agents and they invited you to go talk with them and schedule your survey and sign an easement before you knew anything about this."

DISCUSSIONS CONTINUE

Both companies are still working with landowners on negotiations to find an agreement that suits the needs of all parties involved.

We want to make sure that this truly is a dialogue to negotiation that's two-sided and we're coming to the table with ears wide open," said Burns-Thompson."We haven't had the opportunity to really explain the economic model," said Blank. "Some of the economics that we're delivering, a lot of the economics we're delivering, they're different because every farmer landowner has got a different situation. There may be things that are unique, that could change the economics, the agricultural economics around the easements that we actually are paying for."

That payment the companies are offering, Nieuwenhuis says, is satisfactory.

"I figured on my property where the permanent easement was, if I was guaranteed a $300 an acre profit forever, it would take me over 100 years equal this one-time payment," Nieuwenhuis explained, "so pretty satisfied with the compensation."

But for some, that land they hold is priceless.

"The easements are permanent easements," said Jodie Wilson, who is fighting for her mother's rights as a property owner. "They are just not for the project. They get done with it after they’ve collected all of their tax credits, they could sell it to another company and we have no say about it and we just have to live with it."

Jim Colyer: It’s forever.

Roger Schmid: It hangs on your land forever.

FOLLOW FOR MORE
"Along the Route: A Pipeline Discussion" is a multi-part series of reports looking at everything from the companies that want to build them to those "for" and those "against" and a deeper dive into to carbon and ethanol industries at the center of the project.

SEE THE VIDEO

Lincolnway Energy is an ethanol plant in Nevada, Iowa. It's one of dozens of ethanol plants scattered across the Midwest. Its largest byproduct is carbon dioxide. Upwards of 5 billion tons are emitted in the U.S. every year.
​
Now, three companies want to sequester that gas, liquify it, and store it underground. That process is known as carbon sequestration and it has become a hot-button topic across the corn belt.

"I think it's really great to partner up with Summit Carbon Solutions because it's going to secure the future of ethanol plants," said Chris Cleveland, "not only Lincolnway here, but other ethanol producers along with the farmers and the corn growers and their future and their next generations, too."

SUMMIT CARBON SOLUTIONS

Summit Carbon Solutions has partnered with Lincolnway Energy to capture and sequester its carbon dioxide. Summit is one of the corporations with plans to build a $3.7 billion liquid carbon-capture pipeline through the Midwest.

"It's compressing that carbon, putting it into a transportation infrastructure system or a pipeline and then moving it to a sequestration site, which ultimately will then store that carbon molecule under Caprock in North Dakota." Lee Blank is the CEO of Summit Carbon Solutions. "Really what I liken it to maybe the transcontinental railroad. You know, in 1862 I believe, we decided as a country to open markets up and the railroad helped us do that. That's really what this does."

If you think about the infrastructure project almost as logistics, it opens markets for plants like this one here in Nevada to give it other places that they can ship their products at a premium.Summit's pipeline will connect more than 30 ethanol plants across five states, spanning 2,000 miles, capturing more than 12 million tons of CO2 each year. The pressurized liquid carbon dioxide will be stored deep underground near Bismarck, North Dakota.

If everything goes according to plan, "we would hope to be fully operational first quarter of 2025," Lee said.

NAVIGATOR CO2 VENTURES

"Navigator CO2 is a midstream company, midstream meaning pipeline. So the folks that work for our team are individuals that have a great level of experience and expertise designing, constructing, and operating midstream or pipeline infrastructure all around the United States." A second pipeline, Heartland Greenway's Navigator CO2 Ventures, will also capture and liquefy CO2 from ethanol producers to be stored in South-Central Illinois.

"The Heartland Greenway, the project itself, at its initial kind of stages, looks to be about 1,300 miles of new pipeline infrastructure, connecting 21 facilities across five states here in the corn belt," said Elizabeth Burns-Thompson, Vice President of Government and Public Affairs for Navigator. "All of that infrastructure is really looking to do carbon management at its core, right."

We've taken that skill set, curated it into the CO2 space and brought forward the project the Heartland Greenway that's being talked about largely today.Navigator's pipeline, once installed and in operation, will capture and store approximately 15 million metric tons of CO2 a year. They too, plan to be up and running in 2025.

WOLF CARBON SOLUTIONS

A third carbon capture pipeline, Wolf Carbon Solutions, is a smaller 280-mile pipeline crossing Cedar Rapids and Davenport in eastern Iowa on its way to storage sites in Illinois.

These three pipelines have been met with heavy resistance from some landowners along their path.
THE LANDOWNERS

It was just out of the blue. We got a registered mail, and it just notified us what they were thinking about doing and the meeting, the upcoming meeting.Roger Schmid is one of those landowners. Living in northwest Iowa, he and hundreds of others received registered letters in the mail informing them of a meeting with Summit and Navigator. Those meetings announced the project and informed these landowners they were in the path of these pipelines.

Landowners are asked to sign easements allowing the pipeline to pass through their property. Some are not on board, like Jim Colyer.

"Whatever meetings that we have attended on the informational meeting, the information is different," Colyer told me. "So they have honed their skill on what they're telling us over different meetings, in different places and other people, that we've all heard from meetings in different counties, in different towns. And we know that they've told us different things. And I don't know if they're all false, but they seem to be leaning towards benefit rather than safety. And that is one of our main concerns is safety."

"Our legislature should be standing up. Our county governments need to stand up," said Doyle Turner, another Iowan fighting against the installation of these pipelines. "But the big thing that we need is for more people to realize this affects a lot more people than just these landowners and that we all need to be stepping up and talking to our county board of supervisors. We need to be talking to our state legislators. We need to talk to our federal legislators."

THE PIPELINE DISCUSSION REACHES STATE CAPITOLS AND THE COURTS

Many legislators are on board with carbon sequestration. "It's value-added agriculture and it's adding value for the farmers," said Nebraska Governor Jim Pillen at a Siouxland Ethanol event in March 2023. "We raise an incredibly low carbon footprint corn but also the sequestration to be able to sell our ethanol to the markets we're able to capture more value.

"Sequestration is really critical whether we're piping it or whether it's a formation that is close to a plant," Pillen said. "Both have to happen, they are both safe. They are critical to energy independence."
But questions arise about using eminent domain to make these projects happen, which is where much of the debate has happened in legislatures across the Midwest.

"The use of eminent domain is a last resort scenario, especially on a project like this," said Nebraska Representative Adrian Smith. "Ultimately, it's an infrastructure project and there's been some misinformation out there in terms of what the pipelines do. It's actually the safest way to transport products. All things considered, it's my hope that the right of way can be achieved and accomplished without the use of eminent domain."

Both Summit and Navigator are taking the fight over property rights to court. In Woodbury County, Vicki Hulse is fighting to keep Navigator land surveyors off of her property. Her 151 acres of land are something she holds with pride.

"We have worked hard to pay for our land," Hulse told me during an interview at the Siouxland News studios in September 2022. "We bought the farm from his dad's estate, and he worked two jobs. I work two jobs to pay for this farm. And we have two children that we want to hand the farm down to. And I'm fighting against eminent domain for private gain."

In March 2023, Hulse and Navigator presented their cases in Woodbury County Court where they now await a judge's ruling on separate injunctions for access to Hulse's land.

In spite of the resistance, Summit, Navigator, and Wolf are pushing forward with the goal of changing the CO2 landscape in the Midwest.

"I believe it's a big part of the future of the family farms and the next generation," said Cleveland with Lincolnway Energy.

FOLLOW FOR MORE

"Along the Route: A Pipeline Discussion" is a multi-part series of reports looking at everything from the companies that want to build them to those "for" and those "against" and a deeper dive into to carbon and ethanol industries at the center of the project.

SEE THE VIDEO

"The idea that she will have to stop her meds and then possibly restart is traumatic." Imagine having to tell your child they have to stop being who they are. That is the reality for Jessica Nutz after the Iowa Legislature passed a ban on transgender therapy for those under the age of 18.
​
"She's been through a lot to get to this point to get to this decision." Jessica's 17-year-old daughter came out as transgender two years ago. She began hormone therapy in August. "By being on the medication, it's preventing a lot of the typical male characteristics and I know that her biggest fear is as soon as she goes off those are all going to start back up again."

Her daughter did a year of therapy before beginning hormone treatment. Mental health she says is a big aspect of beginning treatment and being transgender.

"The number one group that commits suicide, that not just attempts, achieves suicide are transgender youth." Now she's worried this new law will harm transgender youth statewide.

"Within one year of working and being on medication and being with a therapist, a transgender youth is 70% less likely to commit suicide." Nutz has seen a transformation in her daughter since she not only came out to her family but began hormone therapy.

"The changes I've seen in her from working with her therapists from her coming out. It's amazing. You know, she's more open of a person, she's more outgoing. Now that she knows who she is and that she can be who she is, the impact this is going to have on their mental health now," she said. "We don't have the resources in Iowa."

READ MORE: Gov. Reynolds OK's gender-affirming care ban for minors, says it's 'best for Iowa kids'

Her daughter turns 18 in July. Other Iowa families with transgender youth have a much longer fight ahead for their children.

"These are just kids they're learning who they are and you have to support them. And so much is going on in their body right now. That if you can pause by taking a pill until they are for sure. If they were to change their mind. Okay, fine, her puberty would just restart and go back and start growing the facial hair and start getting the Adam's Apple again," Nutz said. "You know, they're just learning and all they need is love. They don't need any more hate. There's so much hate. And there's so much anger in the world right now."

Nutz believes our state leaders didn't truly listen to families who would be impacted by this law. "They don't understand that process. It's not just you can't just go to the doctor and be like, hey, so my kid thinks that he's a she. So here let's get a prescription the same day. It's not like that. It's all a process. And she's an individual. She knows who she is. She knows who she wants to be. And to have somebody come into our lives to say nope, sorry. You really don't know who you are. Is difficult."

She just wants her daughter to be able to live the life she dreams of. Even if that means leaving Iowa all together.

South Dakota has already banned gender-affirming care for those under 18 and Nebraska has a bill moving through the unicameral now that would do the same.

"There's enough hate. You don't need to add any more."

SEE THE VIDEO

"In 2004, the state of South Dakota came to my farm and showed me a search warrant," said Kerwyn Lykken, "and the first words that (Det.) Michael Braley said to me was, what were you doing on May 29, 1971? And I answered him back. What were you doing on May 29, 1971? He shows me the search warrant and he says, 'we have reason to believe the two girls are disappeared and they are buried on your farm'."

May 29th, 1971 was the last time anyone saw 17-year-olds, Sherri Miller and Pam Jackson. The Vermillion teenagers were last seen driving a 1960 Studebaker Lark trying to find a rural keg party. They never made it. And never made it home.

Their disappearance became known as South Dakota's most infamous cold case and is now the subject of a new book, "Vanished in Vermillion".

"So I covered the case when I was a reporter in Sioux Falls. And it was one of, at the time, most interesting cases I was working on, but then the cold case completely fell apart while I was working on it." Lou Raguse is a reporter for KARE-TV in Minneapolis, but in 2005, he was a reporter for KELO-TV in Sioux Falls. "And then I had this feeling like I was missing something because I wasn't going to see what happened," Raguse said about leaving KELO, "and the biggest worry is we'd never find out what happened to Sherri and Pam."

South Dakota's Division of Criminal Investigations, or DCI, opened a new investigation into the teens' disappearance in 2004. As Raguse details in his book, investigators pointed their finger at one man. David Lykken was in prison for unrelated crimes in 2004 and was suddenly suspected of killing the teens.

"My biggest misconception was at the time they made me feel like David Lykken was a suspect back in the 70s when he was young, and then they just found the missing link to be able to charge him now," Raguse said. "And so to learn that his name was basically just floated because he was a person that lived in the area and had a criminal past, that was basically it."

"And then from there, they matched everything they found to what they wanted it to be." Kerwyn Lykken is David's brother and he and the Lykken family were also implicated in the teens' disappearance. Three search warrants on the Lykken farm in the 2000s uncovered what police detailed as evidence. That evidence, Raguse shows in his book, wasn't really evidence at all. When police later filed murder charges against David, the evidence they used wasn't as it seemed.

"As I went through the case files, it was surprising how much of what we were being told at the time completely contradicted reality in what police were putting in their reports," Raguse stated.

On September 21st, 2013 a local man by the name of Jim Sorensen discovered the 1960 Studebaker Lark in Brule Creek. The teens weren't murdered by the Lykkens as South Dakota's DCI team said. They died in a tragic car accident.

"I hope the public can see how easily an investigation can spin out of control," Raguse said. "And somebody's got to be able to pump the brakes."

​For Kerwyn Lykken, the accusations that he helped his brother cover up a murder are still something he deals with today. "The people that knew me and knew me from softball and curling and things, my activities, they knew we didn't have a thing (to do with it)," Kerwyn told me. "But it's the people on the peripheral that say 'I think they did it and I got away, they got away with it', you can see it in the book."

Kerwyn hopes Raguse's book can help the community understand you can't believe everything you hear. "When you don't sit down and weigh the facts, what I've always thought was our judicial system, the courthouse shows the scales and it shows her blindfolded. And nobody in our case was blindfolded and the scales were like this here," Kerwyn stated, showing his hands in an uneven line.

"And what can we do to fight the state? They had every resource. They had all this money. And what can we do? And I said to somebody one time, how do you clear your name when you're innocent?"

Raguse says the laws in South Dakota keep the public and the press from seeking answers from police. "I hope the public understands that in other places around the country, there are laws that allow you to check up the work a little bit easier of what's been done by law enforcement. Those laws can be passed here and they should be."

Raguse spent years with this cold case, interviewing countless people involved. One thing he hopes his book, Vanished in Vermillion, brings is closure.

"I hope that the Lykken family doesn't have to think about this and doesn't have to walk down the street wondering if people think that they committed murder. Because it was really sad to me when I got here and started working on the story of how many people thought that they still had something to do with it," Raguse said about his book's purpose. "I hope for Pam and Sherri's family that even though they got some answers when Pam and Sherri's bodies were recovered, I hope that this gives them closure, and they could go on without thinking about it every day."

Ever since Pam and Sherri's deaths were ruled accidental, there's just one thing Kerwyn wants that he has yet to receive. "I hope that we finally... if the law enforcement people and the court systems, I want them to be held accountable."

Actually, two things.

Katie: You're still waiting for that apology?
Kerwyn: I've never gotten an apology from anybody.

The murder charges against David Lykken were eventually dropped and he remains in prison for unrelated crimes. But there's a lot more to the story.

You can read the book for yourself, it's on sale now at many area book stores or you can visit VanishedInVermillion.com to purchase it online.

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The trial for a Woodbury County couple began Tuesday as they fight to keep a liquid carbon dioxide pipeline off their property.

William and Vicki Hulse who live in rural Moville twice denied surveyors for Heartland Greenway’s Navigator CO2 Pipeline access to their property in the Summer of 2022, who sought to perform environmental and cultural surveys where their proposed pipeline was mapped to be routed.

Navigator then sued for a temporary injunction citing Iowa state law gave them permission to survey land without landowner permission. That injunction was denied by District Court Judge Roger Sailer in September 2022. The Hulse’s are challenging the constitutionality of Iowa’s law that would in turn give companies, like Navigator, the right to access private land for surveys and examinations regardless of landowner approval. The Hulses have also filed a counterclaim, seeking an injunction of their own to keep Navigator representatives off their property until the issue is resolved. Tuesday's trial will decide on a permanent injunction for Navigator and also rule on Hulse's unconstitutionality claim.

READ MORE: "I knew that I was going to fight this": Woodbury Co. woman fights against CO2 pipeline

Navigator, one of two proposed liquid CO2 pipelines slated for northwest Iowa, is a $3 billion project that would sequester CO from ethanol plants and other manufacturers through five states to be stored underground in south-central Illinois. Navigator's pipeline will run roughly 900 miles through 36 counties in Iowa, many of them in northwest Iowa.

The Hulses are one of four Iowa landowners the company has sued for rights to access their private property.

Trial began Tuesday morning with a gallery of pipeline opponents in attendance. Navigator’s first witness Ann Marie Welshans, and the only one of the morning, is Navigator's Director of Right of Way who was questioned about the validity and process of sending certified letters to landowners and how the company verifies the landowners received the notice about the surveys. Welshans says the surveys are a necessary part of the planning process for the pipeline.

“The survey will allow us to determine what obstacles could be in the way,” Welshans testified, saying the survey helps to determine if there needs to be a possible reroute, see the geography of the land, and define other easements in the routed path.

Following a short break, Vicki Hulse was called to testify by Navigator's legal team, seeking confirmation that Hulse spoke to a land agent regarding the pipeline and easement requests. Hulse stated she attended a public meeting for the pipeline, but did not meet with a land agent at that time, but was eventually called by one.

“(The land agent) actually called my children who are not on the deed and they called me,” Hulse explained, “then she called me.”

Hulse’s children do not reside at the residence, and Hulse states they do not live near the area. The person who leases their farmland, court records state, was also not notified by Navigator about the land surveys. Speaking on the survey and easement discussion with Navigator, Hulse stated she doesn’t recall being asked if the pipeline company could access her property for a survey but says she wouldn’t have allowed it either way.

"If someone asked you to sign a voluntary easement for a co2 pipeline, you would not want to do that either,” Navigator’s lawyer asked.

"That is correct,” Hulse stated.

​Hulse stated for the record that surveyors called the sheriff’s office after Hulse refused them access to her land. “I remember a surveyor calling me and saying, we’re going to bring the sheriff out and I said okay, I will meet you there.”

Navigator's attorney's asked Hulse if she was worried about damage to her land by the surveyors. "Apparently they did a couple of surveys and I didn't even know it," Hulse stated. "So I guess I am going to have to check that out and I am very concerned about my CRP ground and the contract I have with the government. And I don't want them out there trampling all over my CRP ground."

Part of Hulse’s land is enrolled in the Conservation Reserve Program, or CRP, a federal program that pays landowners to leave parcels of their land untouched for at least a decade. Hulse states she was unaware of surveys already done on her property by Navigator agents and she’s concerned about the damage possibly done to her CRP land.

She says she is fighting now to uphold her rights as a landowner. "I just feel it's against my property rights as an owner that they can come on our property any time of day against my will, any time that they want they can survey my land against my knowledge and go anywhere on my property as many times as they want and I just don't feel that that's right."

Hulse has power of attorney over her husband, William Hulse, who suffers from dementia and currently resides in the Iowa Veterans Home in Marshalltown, Iowa. Vicki Hulse has been in this fight with Navigator largely on her own.

"He was in the Army in Vietnam and was exposed to Agent Orange and how has dementia and Parkinson’s,” Hulse stated on the stand. Hulse’s time on the stand lasted about an hour.

Daniel Rogers, who works for a company hired by Navigator to help facilitate the surveys, was called to Hulse’s property after a worker denied surveyors access to the Hulse property due to Hulse’s opposition to the pipeline. “I am there for problems between landowners and surveyor,” he said on the stand following Hulse’s testimony.

He, the sheriff’s deputy, and a survey team went back to the property two days later and were served a letter from Hulse’s attorney denying them entry. The survey team left the property. Rogers claims Hulse told him over the phone that she rejected the certified letters from the pipeline. He then stated that he brought a copy of the letter to the Hulse property the day he and the surveyors attempted to gain access with the sheriff’s office.

Part of the evidence brought to trial by Navigator included the certified letter addressed to the Hulses that was marked refused, which was challenged by Hulse's attorney. Rogers was the final witness for Navigator. The defense did not call any witnesses in the case.

Trial proceedings concluded Tuesday afternoon and Judge Sailer will release his decision on Navigator's request for a permanent injunction and his ruling on the constitutionality of the pipeline laws at a later date.

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It's a crisis spanning all 50 states. War at the southern border. Not immigration, but fentanyl.
​
"It's coming across our borders illegally. And so from there, just like any other drug in the United States, it makes its way up north." Like other illicit substances, it's taken its time to move north. Fentanyl has made its way to Sioux City and has resulted in overdoses and deaths. But has it reached a local crisis?

"I would say our numbers are increasing since 2020, but nothing close to bigger cities or other areas that have more access to it," Detective Paul Yaneff has been working fentanyl investigations since 2020. "We saw just like anything else that starts moving from the coastlines into the internal areas here in the state of Iowa, Nebraska and the tri-state area."

In 2022, Sioux City Police seized over 20,000 fentanyl pills. Most look like these small blue pills, marked with M30. To the average eye, it looks like something prescribed by a doctor, but fentanyl doesn't always look like this.

"It comes in different forms, whether it's other colors, and whether it's a bluish green or a green or a white. The M30 is more prevalent around this area. But there has been documented whether it's having the letter K and a nine behind it, the number 215 or a V as in Victor 48," explained Detective Yaneff, who also said that fentanyl typically begins as a powder. "So they're taking this powder and pill pressing it, whether it's already pulled press across the border, or you can get a pill press here in the United States and do it themself and then they disguise it from there."

While fentanyl itself is coming across the border, here in Sioux City, it's local residents selling the pills.

"The ones that we have arrested recently, either this year or last year or the year before, have all been residents or have kind of dual residency," Yaneff said, "whether we're in a different state or not and they come here and visit, but nothing that we've seen that cartel member or anything like that that I've seen, but mostly local people."

And they are selling them to anyone, from teens to older adults.

"With this drug just like any other drug, you're dealing with people that are trying to fit in and try new things and be part of the group. You also have people fighting addiction. And that's a serious issue as well that we try to address."

So there's really no target area of an age group. It's just I think, who wants it for their addiction purposes or who's going to try because their friends are doing it.Let's dig into the numbers. In 2022, Sioux City Police documented at least 18 confirmed fentanyl overdoses that's up from 3 the year before. These were confirmed through toxicology and interviews.

Now it's important to note that an overdose does not mean death. According to MedlinePlus.org, an overdose is when you take more than the normal or recommended amount of something, often a drug. An overdose may result in serious, harmful symptoms or death.

Of the 18 confirmed fentanyl overdoses in Sioux City last year, 3 were fatal. Detective Yaneff says several of those who did overdose on fentanyl thought they were taking something else.

"They thought they were getting cocaine, they thought they're getting marijuana," Yaneff explained. "Let's be honest, a lot of these drug dealers don't separate these items, you know, and put them in labels and containers. So they all kind of mix it together. And so a person may be getting a gram of marijuana or a little thing of cocaine might accidentally be exposed to fentanyl and when they're doing that its reactions are horrible and they get to overdose."

The police department takes fentanyl and any illegal substance interaction seriously. They are working with other area agencies to keep it off the streets.

"We try to tackle as much as we can with fentanyl along with other drugs to try to slow it down. It's very hard because it's flooding our borders like crazy is coming in and getting dispersed but anytime we have any fentanyl case, I work with the tri-state area and also other agencies to advise them, okay, this individual might have had 15 pills and that person told me this and this and this and, of course, there's follow up and there are investigations to do."

Sioux City Police is currently testing out field kits that can test for fentanyl on site. While not currently pushed out to patrol officers, the department hopes to implement these test kits very soon.

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"We don't use it every day, but we have used it with alarmingly increasing amounts over the last couple of years."

​With the rise in opioid usage also comes a rise in overdoses. Which is what Sioux City Fire Rescue's EMS team is seeing.

"I probably started working in this area in 2012 and in 2012 compared to now, I bet you we use it far more than we ever did," said Terry Ragaller with Sioux City Fire Rescue's EMS team.

That drug is Narcan which can reverse the effects of an opioid overdose and save lives.

Amanda Monroe-Rubendall is a clinical educator at Mercyone Siouxland and says they also use it in the emergency room to treat overdoses. "So the way that opioids work is that they attach to parts of our brain and that's how they deliver pain relief. But if we have too much of them in our system, that's how they also slow down our respiratory drive, and people can get in trouble that way. So what Narcan does, is it goes in and it kind of kicks those opioids off of those receptors and takes their place."

Some who overdose on an opioid like fentanyl don't know the strength of the drug they are taking is lethal. Ragaller puts it into perspective.

"Imagine an M&M is a fatal dose but then they put it in a cookie, it absorbs that and you're okay. But the stuff they're putting in M30, it's pure fentanyl."

READ MORE: Fentanyl in Sioux City - Have we reached a local crisis?

While Sioux City isn't seeing the levels of overdoses as many major cities, Ragaller and Sioux City Police say the numbers are climbing. "The number of overdoses that we have seen in probably the last two years here in Sioux City. It's frightening," Ragaller said, "absolutely frightening."

Last summer, we had seized over 20,000 pills of fentanyl," said Sioux City Police Detected Paul Yaneff. "So we've been investigating those and trying to put a stop to it if at all possible

In 2022, Sioux City Police used Narcan 22 times. Sioux City Fire Rescue, 76 times. Now it is important to note that some people may require several doses of Narcan to reverse the effects of an opioid overdose.

But what does an overdose look like? Well, there are a few signs to look for. Their breathing may be shallow or they may not be breathing at all. Their pulse is slow and erratic. They may be unconscious. And if you look at their eyes... their pupils will look very small... like pinpoints. These are all signs of a potential overdose and a sign you should call 911 and use Narcan if you have it.

Anyone can deliver a dose of Narcan and the nasal spray is free to get at most pharmacies.

"You don't have to have a prescription to get it, most pharmacies participate in a program through the state of Iowa where they can get Narcan for free," said Monroe-Rubendall.

Ragaller and Yaneff credit our local dispatchers for ensuring first responders are prepared when responding to a possible overdose. All police officers, fire trucks and ambulances are equipped with Narcan, so whoever is first on the scene, can deploy a dose immediately.

"With the aggressiveness, with the detection from our dispatchers, the aggressiveness of PD, of our guys jumping in. We've saved a lot of lives," Ragaller said.

And sometimes, that first lifesaving dose comes from a family member or friend.

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Rosecrance Jackson Centers is a leader in helping those fighting many types of addiction. But one they are treating more of is opioids.
​
"We're seeing a lot more people with opioid addiction than we saw even two years ago." For people with opioid addictions or people who struggle with this dependence both physiologically and psychologically on various opioids, and there's a lot of different opioids, the one that we're seeing the most overdoses from nowadays is fentanyl," said Iliff.

The nationwide opioid crisis hit a deadly peak in 2022 killing a record number of Americans. Fentanyl played a big part in that.

"A lot of the overdoses are happening because people think, Oh, I'm buying some Xanax or some meth, but it's laced with fentanyl, and that's how people are dying," said Iliff. "That's the fentanyl that's killing them but they don't know what's in there."

Brenda Iliff is the Vice President of Clinical Services at Rosecrance Jackson Centers in Sioux City. She's seen firsthand how fentanyl has impacted the local area.

"One of the powerful pieces of fentanyl is that takes just a very little to get a high. So that's why drug dealers are putting it in a lot of the different drugs," she explained.

But fentanyl is just one piece of the opioid puzzle. Opioids are a common prescription drug for the treatment of many injuries and ailments. It's also commonly found on the street. But no matter how someone was first introduced to an opioid.. addiction can happen to anyone.

"It's different for people, how they got access to the drugs," she said. "So sometimes people are just shocked like there's no addiction in my family. How did I get on this?"

"And the very addictive qualities of the people with opioid addiction doesn't matter if you got it from the healthcare professional, from the pharmacist from the internet, from the street addiction doesn't care." Iliff says that while Rosecrance Jackson treats people of all ages and backgrounds "most of those people were in the 18 to 44 age range. So they're, they're not the teens. They're not the older adults, but they're the working adults, the people in our society that are out there and they're supposed to be doing life and at the top of their careers and they're dying because of opioid addiction."

Recognizing the addiction, and admitting you have a problem is one of the biggest steps in recovery. And that recovery isn't linear, it can look different for every person.

"People should seek help whenever they think they have a problem, and usually it's the families, the communities the people that love the person with opioid addiction that notices the problem first," Iliff explained.

Relapse is not inevitable. It's not inevitable. But for some people, it is a part of their process."Our hope is that we can keep people alive and in the system and surrounded by support. So if there is relapse, they can they're able to come back to treatment services or outpatient services"

And as with other chronic diseases, addiction and recovery needs to be tended to daily. "So just like people who have diabetes, they have to do certain things. Daily to take care of their diabetes. addiction is a chronic disease that has behavioral components. Absolutely. But people need to do things daily."

And anyone can find themselves dependent on opioids.

If you or someone you love is fighting addiction of any kind, there are resources to help aid in recovery and for family and friends to best support their loved one, too.

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Cardiac rehabilitation is an important step in recovery after almost any cardiac event. It doesn't change your past, but it can help prolong your future.

"If I didn't do any cardiac rehab, I would seriously doubt I'd have the life expectancy I have now." Mike Pesky has been through cardiac rehab four separate times.

"There's always a possibility you know, when you have heart problems," Pesky said after class. "I got nine stents in me and there's always a possibility of more down the line."

"You only get one heart and we have to take care of it from youth on up." ~ Ruth Ann McKeever, RN

Inside the Cardiac Rehab Center at MercyOne Siouxland, a team of medical specialists helps Siouxlanders through a cardiac rehabilitation program designed just for them.

"We look at lots of things, what their history is, what their ejection fraction is, how well their heart muscles able to pump blood out to their body, what their symptoms were if they had arrhythmias and if that caused their event what was going on?" Ruth Ann McKeever, a registered nurse in the cardiac rehab center said. "So each person is individualized and we look at them individually."

"They care about you as an individual. And it's not like oh, okay, do your workout and we'll see you next time. It's, Do you have questions? Is there anything bothering you? Kind of thing and if you have like depressed, you can feel free to talk to them. And sometimes that's all it takes," said Pesky.

Cardiac Rehabilitation is important for anyone who is recovering from heart surgery, had a heart attack, or is suffering from other heart conditions like coronary artery disease, angina or heart failure.

Because your heart is a muscle and needs to be taken care of. "And once you lose your heart muscle, if you drop your ejection fraction, there's no going back," McKeever said. "The older we get, the more likely we're going to have to have an event or to have something happen."

Exercise uses your entire cardiovascular system, but while the room may look like a gym, cardiac rehab involves more than a workout. "That heart muscle is weakened," McKeever said. "And so you need to start slow and gradually build that heart muscle back up again."

This is also a chance for participants to learn more about their heart and how heart health impacts every aspect of their life.

"Once a week they have education and so we go over a different topic of education with them once a week, so that they continue to learn about their heart and heart-healthy habits," said McKeever.

But while this room may look like a gym, cardiac rehab involves more than a workout. It's also a chance to learn.

"Heart is one thing but the heart and the mind go together. ~Mike Pesky" Changing the way a person thinks about their life, their stress, and other triggers is an important part of the process. "It's not just getting the heart. That's only a part of it," said Pesky. "You got to get the mind is well and that's one thing I have liked all the way through."

Because you only have one beating heart. "So we have to really take care of that heart muscle," McKeever said, "because you don't always get a second chance."

Pesky can't say enough about the team at MercyOne. "These gals care and it shines like the sun outside, it shines through," he said. "And you know I am been very, very blessed to have the nurses here and through my years of coming, to have them here and I can't say enough good things about them."

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I was 50 and this was October 13th I believe.

​Aurelio Hernandez is counting his blessings. Just 5 months ago, at age 50, he had a heart attack. One with a scary name, the Widow Maker.
"So, heart attacks are all bad," said Dr. Mir Subla with MercyOne Siouxland Medical Center. "Usually, we talk about Widow Maker, we are talking about the artery that supplies the left ventricle. That's the chamber of the heart that pumps the blood."

There are three main arteries in the heart, one on the right and two on the left. The Widow Maker occurs in the left anterior descending artery which supplies blood to a large portion of the heart.

"In the Widow Maker, what happens is this artery gets blocked, there is a plaque in the wall and that ruptures and a clot forms in the artery and an artery gets blocked and there's no blood flow," said Dr. Subla.

A Widow Maker feels like any other heart attack, with symptoms like shortness of breath, chest pain and heaviness.

"It was actually during work, felt a little tired so I figured I'd go home while the texture was drying," Hernandez recalled about the day he had his heart attack. "I was gonna try to take a nap but then I felt pain across the chest. I actually started on one area and kind of gradually started moving. I didn't think anything of it until it started all the way across, and then my breathing kind of got a little difficult."

Hernandez went to a nearby ER and they sent him to MercyOne Siouxland. Because when it comes to matters of the heart, time is critical.

"Nowadays, it has improved a lot," said Dr. Subla. "Fatality rates have dropped if they receive care in what we call "door to balloon time", or "contact to balloon time".

Dr. Subla says the standard time from first medical contact to balloon time or the point where doctors open the artery, is 120 minutes, or 2 hours.

"It's usually fatal if not treated. People can develop heart failure because that portion of the heart doesn't get any blood and the part of the muscle dies. - Dr. Subla"

Hernandez got treatment in time, but he also knew what to look for.

"Just watching what happened to my brother, passing away at the same age of 50 and leaving four kids," Hernandez said. "I guess it wasn't actually surprising because of my family history of it. But at that time, you know, I was always active. I know my lifestyle of working all the time and not eating right and all had something to do with it but it was a to where I can't believe this is happening to me."

By the time Hernandez arrived at MercyOne last October 13th, the cardiology team was ready.

Dr. Subla recalls that day, "we took him immediately to the catheterization laboratory, his Widow Maker was 100% blocked and we opened up with a balloon and a stent and it had good flow at the end. He was symptom-free and his heart muscle did not suffer any damage."

READ MORE - HEART MONTH: Rehabbing your heart with MercyOne Siouxland Cardiac Rehab Center

He is one of the lucky ones, especially in a time when many are not seeking treatment because of COVID-19.

"It's what we call timeless muscle," said Dr. Subla. "So the more you delay, the more muscle will die.

And even if you survive, if you don't come to the hospital, you will have heart failure and we see a lot with those patients especially in COVID times, people didn't want to come to the hospital for obvious reasons. And we see a lot of heart failure patients."

When I met Hernandez, he was graduating MercyOne's cardiac rehab program. Leaving with a new lease on life and a vow to teach his kids and others around him that heart attacks aren't for the faint of heart.

"So you change your outlook on a lot of things. So there's not like what I don't care if it happens to me, now you got to what does it matter if it just happens to you, but everybody else behind you to it, you know, it affects them as well," Hernandez said after graduation.

His one tip for Siouxlanders?

"Just be careful. You know, know your signs, figure it out, you know, if you don't feel something right, you know, there are issues there and it's not fun. It's not fun at all."

Hernandez says he plans to keep up his workout routine and healthy eating habits, with a focus on overall heart health.

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It's smaller than the tip of your finger but powerful enough to open the arteries of your heart.

​Millions of Americans receive stents each year, but what are these tiny, life-saving devices?

If you have a blockage or narrowing of an artery around your heart, you may be told you need a balloon angioplasty and a stent placed.

"This is called balloon and stenting and this is a very common procedure that has been done in the entire world millions of times already," said Dr. Gary Chan with MercyOne Siouxland's cardiology team. "So actually the rest is pretty safe."

"Most of the times stents do a wonderful job and the patient doesn't have to go through a huge surgery," explained fellow cardiologist, Dr. Mir Subla.

Stents are common and a lot smaller than you may think, fitting on the tip of your finger.

It's typically a minimally invasive procedure where a tubing is inserted into the blocked artery.

"And this tubing has some special features to it. It has a little saucer-shaped balloon attached to it so that when it's inflated, it will push the cholesterol blockage up against the wall, opening it up temporarily," explained Dr. Chan. "But then this is only a short-term solution. To really prevent it from coming back in we have to deflate that balloon, withdraw the entire tubing, put another tubing across the lesion.

The next piece is the stent itself which looks a bit like chicken wire.

READ MORE: Surviving a widow maker heart attack - Aurelio's story

"But then in addition to the balloon, it has a metal scaffold attached to it so that when it's inflated, and then the balloon is deflated," said Dr. Chan. "The macro scaffolds stay behind keeping it up, keeping the arteries open for a long time."

Patients can have multiple stents and they are permanent.

"Patients can have multiple stents and they can be overlapping they can be the side branches," said Dr. Subla. "If a patient has stents and they decide to have bypass surgery as the disease progresses, they can still have bypass surgery down the road."

If you have a stent placed, it's typically managed with medication and a few lifestyle modifications and can help prevent a bigger heart surgery down the road.

"The stents remain open with the medications and little follow-ups with the cardiologist and it reduces the huge burden of surgery for the patient," said Dr. Subla. "And the stent just takes is one hour at least and they can go home the next day."

Once a stent is placed, tissue will begin to grow around the area, completely covering the device like a layer of skin.

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I just knew something was not right.
​
Stephen Lordemann had his wife take him to the hospital in 2008. He'd been helping his daughter move when he started to not feel well. His heart was racing. His wife, an EMT, couldn't count his heartbeats when feeling his pulse.

Lordemann was in AFIB or atrial fibrillation, which is an irregular and often rapid heart rhythm.

"So in atrial fibrillation, the top chambers of the heart are beating erratically, said Dr. Gary Chan with MercyOne Siouxland Medical Center. "And because of that, blood is not being moved efficiently from the top chamber to the bottom chamber."

AFIB is fairly common and some who experience it don't have any symptoms at all. So how can you tell if you could be in AFIB?

"For the patient, for the general population, the easiest way to tell will be to feel their pulse. And if they feel that from one pulse to the next one, and if the duration is different then they are in AFIB," said Dr. Chan.

While AFIB isn't usually life-threatening on its own, ignoring it could lead to more life-threatening issues like blood clots and increase the risk of heart failure or stroke.

"In atrial fibrillation, the top chamber is, instead of pumping effectively, is actually quivering," said Dr. Chan. "So blood stays there not moving well, and as a result, blood clots can form. And the end result is that if the blood clot flows down to the bottom chamber, and pump up to the brain, it can cause a stroke."

So how do doctors treat AFIB? There are a few ways. Medication might be enough to get the heart pumping in rhythm again and in some cases, shocking the heart might be needed.

"And we can either give them an electrical shock, that brings it back to that sort of reset the heart and then get it back to normal or give them medicine to bring them back to a regular rhythm," said Chan.

Many patients who experience AFIB end up on blood thinners, at least for some time. Age is a big factor in those who experience AFIB, other risk factors include obesity, high blood pressure, smoking and heavy drinking.

"If there are structural abnormalities such as the top chambers are dilated, they are at increased risk. If they have an issue with the valve, that could also increase the chance of having AFib in the first place," said Chan.

"I've experienced twice," Lordemann said, regarding AFIB. "Then had two heart attacks. Both of them had stents."

Lordemann credits his MercyOne cardiology team for getting him where he is today with a few lifestyle changes and a little cardiac rehab, he and his heart are doing great.

For Dr. Chan, his one piece of advice is if you feel something could be wrong don't wait to seek medical care. "But then sometimes times does matter," Chan said, "especially when it comes to matters of the heart."

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"I had had a heart attack on July 6th and had been having some problems with passing out. And finally, Dr. Ciuffo said he was going to fix it." Gloria Lordemann had experienced issues with her heart before. "I'd had a bypass a couple of years before that. And then this was something new and different," she said.
​
She had a problem with her mitral valve, something fairly common for women.

"If you take a sample of the population between the age of 25 and 40, one woman out of six has what we call mitral valve prolapse," said Dr. Giovanni Ciuffo with MercyOne Siouxland Medical Center. "It's like sort of a redundant amount of tissue."

But what is a mitral valve and how does it work in your heart?

"The heart has four valves and they work as one-way valves. You have two on the right side which is the side of your heart that pumps into the lungs, oxygenates the blood and then it goes back to the left side of the heart," explained Dr. Ciuffo. "Mitral valve is in a pumping chamber, when the heart squeezes the mitral valve closes to make sure there's not backflow into the lungs and it flows into the main pipeline in the body that carries oxygenated blood all over the body."

There are two main problems a person can develop with their mitral valve; it can leak causing blood to flow backward into the lungs, or it can struggle to open properly leading to a buildup of blood and pressure in the lungs.

"In severe degrees, mitral regurgitation will really make your life miserable, swollen legs, very short of breath," said Dr. Ciuffo. "You can't even go to a supermarket and push a cart, it gets that bad."

The surgical procedure to fix a mitral valve used to mean open heart surgery. Now, it is a minimally invasive procedure.

"But for the last 20 years, I was able to implement a minimally invasive technique, such as the one I use in this patient, where you can actually make a small incision on under the skin fold of the right breast and you go between the fourth and the fifth rib. That's what we call minimally invasive," he explained. "You don't break any bones. It's minimal amounts of bleeding."

This also means a quicker recovery. But why do doctors see more mitral valve issues in women than men?

"They actually would tell you that probably one of the most common things is, that's sort of a far-fetched theory, there are moments in a woman's life where soft tissue becomes loose," explained Dr. Ciuffo. "One classic thing is when during pregnancy is a natural adaptation because you have to deliver a baby and having the extra loose stations it makes it easier. But other than that, I would say there are certain features that belong to one sex or the other the general."

For Gloria and her husband who also receives cardiac care here, making the drive to MercyOne for their heart health was a no-brainer.

"I've had the best of luck here with mercy. they've handled all my problems and taken great care of me," Gloria said.

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In the early days of the COVID-19 pandemic, doctors didn't know how to treat the sickest patients. Everything about the virus and how it interacted with the body was unknown. But when ICU specialists and the cardiology team at MercyOne Siouxland Medical Center came together in the fall of 2020, they discovered that a piece of equipment in their arsenal was just what they needed.

"We learned a lot about managing COVID patients. You know, our first wave was truly disheartening because it was sort of a new disease that we had to deal with. And our therapeutic options were pretty limited." Dr. Giovanni Ciuffo wasn't used to working with Intensive Care Unit staff. "Intensive Care Unit specialists don't interface much with a heart surgeon but that became a necessity," he recalled.

That necessity began when the first wave of COVID-19 hit Siouxland and doctors had to use everything at their disposal to save lives.

Doctors turned to an external oxygenation device, something cardiologists typically used for patients who suffered cardiac issues.

it's a modular cooler, heater-cooler, that circulates water through these pipes and it controls the temperature in the patient," Dr. Ciuffo explained. "You can hook it up to the machine and dial the machine and say bring the patient back to a normal body temperature 98-99."

This machine can essentially oxygenate your blood for you. Something many otherwise healthy people were struggling to do after testing positive for COVID-19 and ending up in the ICU fighting for their lives.

When the MercyOne team first began using this machine to treat COVID-19 positive patients, they were among the first in the nation to do so.

"You know, when we started doing this, we were among the first guys doing it in the country. Here was a brand new concept where, well let's try to bail these patients out," Ciuffo said.

But they worked in cooperation with hospitals nationwide in finding a new way to care for patients with an unknown virus.

"You can see there's an oxygen tank here. And in addition to that, there's an oxygen rate regulator, see the air oxygen mixer," Dr. Ciuffo said as he walked me through the large machine. "And we can basically modulate how much oxygen is put through the oxygenator while the machine flows so that I can control the patient's temperature, how much I'm flowing."

This machine takes your blood, oxygenates it, and gives it back, taking work away from your body and giving it a chance to heal.

"And what you do with his machines, you actually connect them to veins and arteries in the body and circulate the blood into an oxygenator something that basically is replacing your lungs," Dr. Ciuffo said. "You oxygenate the blood, give it back to them and that will give them the break they need to get through the COVID infection until the lungs recover their ability to oxygenate."

The oxygenator is used to help those who have suffered a massive heart attack, pulmonary embolism, or blood clots, and those whose heart has stopped because they got too cold. This machine can help bring their temperature back up and help bring them back to life.

"So this one is basically what will keep your patient alive and well. While they go into the next level of treatment if it's available to them." While the outcomes were initially unknown when treating COVID-positive patients, they saw positive results.

"In medicine, you always had to strike a balance between what's reasonable to help someone and what's just far fetched," Ciuffo explained. "In those patients that we use this machine on really he was not far fetched. They survived. So it was well worth all the effort we put on it."

For Dr. Ciuffo, and others in the fight to save lives, it's all about giving people a 2nd chance at life.

"Human Physiology, this complex beautiful machine we call the human body with lungs and kidneys and heart and brain and electrical system and all that is incredibly complex."

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A catheterization laboratory may look like a scary place with a big name, but it's a common stop for patients entering the hospital with possible cardiovascular problems.

"In the Cath Lab, what happens is patients will be brought into the cath lab such as this, and their heads will be up here near the imager and their feet down here," said Dr. Gary Chan, a cardiologist with MercyOne Siouxland Medical Center.

In the Cath Lab, cardiologists use diagnostic imaging equipment to visualize the arteries and chambers of the heart.

"Now there are two ways to do the cath. One is to the wrist and another one is through the groin." During the procedure, the patient will be moderately sedated to help calm the nerves and ensure they can lay still for 45 to 90 minutes.

"They will put a fine tube in a way very similar to an IV but then the tubing is way longer because it has to be long enough to go all the way up to your arms to your heart or from the groin so that they can inject some contrast to it," said Chan. "And then with that, they can visualize the three coronary arteries in the heart and see if there's any blockage."

Dr. Chan says there are generally four outcomes from a cath procedure. The first, nothing is wrong and the issues the patient is feeling are not related to a blockage in the heart.

"Outcome number two is the patient does indeed has some blockage and that can be fixed by a stent," said Chan.

The third outcome is when a stent doesn't work and the patient will be referred to a cardiothoracic surgeon to see if they qualify for bypass surgery.

"In a bypass surgery, what happens is they either use your own blood vessel in your chest wall area, or harvest a piece of veins in your legs, and then just sew it across the blockage, that's why it's called bypass," said Chan. "The earlier we open a blockage, blood vessels supply the heart the more recovery the heart can retain the functions we can prevent loss of functions of the heart."

The 4th outcome, if a stent or bypass is not an option, is medical management.

"The last outcome is then also not a candidate for this and that will be managed medical management," said Chan. "Only meaning that we keep them we give them the medicine that will help prevent further progression of the disease."

Dr. Chan says health risks in the cath lab are minimal, with possibly some minor bleeding at the insertion site or a drop in blood pressure.

"If this is an elective procedure is generally safer than someone coming in with a cardiac arrest or having an acute heart failure flown in from a rural area," said Chan. "So this is totally different. The risks are totally different."

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Winter weather typically means snow and ice which also means shoveling snow and bitterly cold temperatures, but did you know that combination could lead to a heart attack?

"It is comparable to if we got on one of these treadmills and we're running full speed." Bridget Hayes Beck is a Registered Nurse at Mercyone Siouxland's Cardiac Rehab Center, "it just shocks people that when they go out and shovel their walks in their driveways that how much stress that puts on their heart."

She's helped Siouxlanders recover after suffering a heart attack in the winter and has a word of warning for Siouxlanders.

"If we could get the word out to the public, that is very dangerous to just go out and start shoveling the walk and the driveway."

But why are heart attacks common in the winter months? Simple... the cold.

"It does really wear on the heart, that cold air coming into the lungs, into the heart can constrict down the coronary arteries and that's where people have problems," she said. "It will cause those coronary arteries that are smaller than drinking straw to constrict down. And at that point, some people do have a heart attack meaning that the heart cells do not get oxygen and do not get the blood that they need."

There are a few things you can do to stay a little safer while shoveling snow or working in the cold, like taking frequent breaks.

"It's very important to warm up. It's very important not to have a big meal beforehand," she said. "And then when you do go out there take small breaks."

And this is especially true for Siouxland farmers, who spend hours outside working at a time.

"Now if you try to tell that to a farmer who's going to be out there for three hours, no take your breaks," she said. "Especially let a family member know that you're out there."

When in doubt, take a break, and if something doesn't feel right, seek medical assistance right away.

"But the most important thing is to make that phone call or have your family member make the phone call for you."

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Heart attacks and heart disease can present differently in everybody.
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"In women, in particular, especially older women, the symptoms are typically unusual," said Dr. Glynne Edwards. "It can be breathlessness and just shortness of breath, unusual sweating episodes, sometimes a toothache, even belching, unusual belching symptoms."

Signs and symptoms of heart attacks, heart disease or coronary artery disease can manifest with pain or pressure in the chest, which typically moves toward the left side of the body.

But what can cause these life-threatening events?

"A very common thing is high blood pressure and high blood pressure has a lot of effects on the heart that, if unchecked, you know, heart failure relationship," said Dr. Edwards.

Another common denominator? Genetics.

"Knowing your family history of heart disease is also important," said Dr. Edwards.

So how can you stay heart healthy?Regular exercise is a good place to start.

"The American College of Cardiology has a recommendation for 120 minutes of aerobic exercise in the seven-day period," said Dr. Edwards.

Watching what you eat is important, too, as well as staying away from tobacco use.

"Smoking is the number one modifiable risk factor for the use of hierarchy disease animalism formation, vascular disease in the legs and the stroke."

At the end of the day, staying active, eating a balanced diet and knowing your family medical history can be a good start in keeping your heart healthy each and every day.

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"Smoking is probably the number one most important preventable risk factor when it comes to heart disease." We've all heard the warnings about smoking and your lungs, but did you know it's just as bad for your heart? Not only heart disease but coronary artery disease and many other life-threatening health issues.

"There is increased risk of strokes, increased risk of blockages in the leg arteries and damage to the major arteries of the heart and the body, in particular, the aorta which can become involved forming an aortic aneurysm," said Dr. Glynne Edwards. "And in these cases, these always require emergency surgery. So, an ounce of prevention is better in this in this instance."

Smoking and tobacco use can cause your arteries to shrink, "and what we call vasoconstriction, where the arteries actually shrink from this size to 1/3 of the size in response to these toxic chemicals," said Dr. Edwards.

Not only that smoking and tobacco can also cause plaque build-up in the arteries feeding your heart.
"In some instances, the narrowing may not be acute but so severe that it weakens the heart muscle to the extent that you develop what is called heart failure," said Dr. Edwards. "Overall, it triples or quadruples your risk of getting a heart attack. If you're under 50. That risk is increased sevenfold. more than doubled your risk of having a stroke."

And if keeping yourself healthy isn't motivation enough, think of the health damage it can cause to those around you.

"The only thing I want to mention is that secondhand smoke also tripled your risk of having heart disease and we've actually looked at data for folks who have been exposed to secondhand smoke over a lifetime 20-30 years, their risk of developing coronary disease even though they didn't smoke themselves, is three times higher than folks who are not exposed to secondhand smoke."

While this is probably something we've all heard before, the best thing you can do is put that cigarette down.

"So generally the advice in anyone who smokes and who has heart disease would be to find a way to try to quit."
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