Recordings in progress. Hello everyone, good afternoon and welcome to Offshore Wind and Wildlife presented by Maine Audubon. I am Nick Lund, our advocacy and outreach manager and I'm joined today by two colleagues to update you on the latest happenings regarding offshore wind development in Gulf of Maine and to discuss what we know and we don't know about potential wildlife impacts from floating offshore wind in the Gulf. Let me introduce you to my colleagues. First with me today is Sarah Hagerty, our conservation biologist and GIS manager for Maine Audubon. She's also a member of the state of Maine's Offshore Wind Roadmap Environment and Wildlife Working Group which I can say easily without stumbling. Also here is my colleague Eliza Donahue, Maine Audubon's advocacy director and our offshore wind policy lead, hello Eliza. All right, Maine Audubon is dedicated to the protection of wildlife and wildlife habitat in Maine and nothing in our history has presented as severe a threat as climate change. Centuries of burning fossil fuels has begun to alter the very essence of the places that we know and love in Maine. We know these changes are happening because we can measure them and we know the changes will accelerate without quick and decisive action. Forever altering the state of Maine and the state that we've worked so long and hard to protect. Switching from fossil fuels to renewable energy is fundamental to our climate change response. Renewable energy is not only cleaner than fossil fuels but can be produced locally, ridding us of the unpredictability of foreign sources. Floating offshore wind deployed off the coast of Maine has the potential to supply the electricity needs for Maine many times over. However, like any development, there are impacts. In particular, Maine Audubon wants to understand the potential impacts of floating offshore wind on seabirds, migratory birds and bats, marine mammals and fish and lobster. It is critical for Maine Audubon to understand potential impacts so that we can use our seat at the table to push as hard as we can for strategies to avoid or minimize those impacts. And it's critical that we must remember to weigh the potential impacts of offshore wind against the ongoing devastation brought by climate change. A study published in the Journal of Integrative Environmental Sciences found that fossil fuel plants and their impacts, which include upstream coal mining, on-site collision and electrocution with operating plant equipment, downstream poisoning and death from acid rain, mercury pollution and climate change kill 35 times more birds per kilowatt hour, than wind power. So meaning if all things were equal and you had equal amounts of fossil fuel power generation and wind power generation, wind power would be 35 times less harmful to birds. So we've recently published an article summarizing our findings about the potential impacts to Gulf of Maine wildlife in our Habitat Magazine. And for those who haven't seen that, I'm going to put it right in the chat here. There we go. The development of this article required the study of dozens of scientific journals. We discussed with scientists and policy leaders. And what we're hoping to do today is summarize what we found. We want to talk about what the science says that we expect potential impacts to wildlife in the Gulf to be, to discuss what knowledge gaps remain and talk about where Maine Audubon is in the process of using the levers available to us to push for wildlife protections. And then of course, we want to answer some questions. So we have a full agenda today, quick technical thing. As you all know, we've done this for years now. We're on Zoom webinar. I can't see you or hear you. If you have questions, we're going to save them all for the end. Please don't put them in the chat where they will be lost easily. Please put them in the Q and A box.  We're going to put them there. We'll get to them at the end. Thank you. We are recording it. I did remember to do that and it'll be posted online at the end for sharing or whatever you want. And those are all the technical things we have. So now I'm going to get started. And one thing I had not been doing is moving my slides, but here we go. Here's a reminder of who we are. And then again, I'm going to talk. This is the agenda that we're going to cruise through today. We're going to talk a little bit from Sarah, hear from Sarah about climate change and offshore wind. Then we're going to run through the impacts that we outlined in our article, talking about the potential impacts to seabirds, migratory birds and bats, fish and lobster, marine mammals. And then we're going to hear from Eliza about some of the opportunities that she is engaging in to work between offshore wind and conserving wildlife conservation. And then we're going to take some questions. Good. So without further ado, let me turn it over to Sarah to talk about climate change and offshore wind. Thank you, Nick. And hello, everyone. Excited to have such a good group here, a large group. I want to put today's conversation into context a little bit. So I'll reiterate what Nick said about the threat of climate change to means natural ecosystem and native species. You've probably heard some of these statistics already, but they're really worth repeating as we get started on this conversation. The state of Maine is warming faster than the global average. So compared to the average of the entire earth, the state of Maine is warming faster. Related and just as frightening as that is that the Gulf of Maine itself is warming faster than 99% of the world's oceans. 99% of the world's oceans. Because of that, we're seeing the effects. We've seen ocean heat waves. We've seen ocean acidification. We've got sea level rise of eight inches and rising. That's already happening here in the Gulf of Maine. And it's having an effect on the species that live here as well. We've got prey species disappearing and that can impact our sea birds and whales. We have new species moving in. Migration patterns and timing has changed. We're seeing sea turtles coming further north, staying longer and ending up cold stunned more often because when winter does kick in, they're sort of stuck. We've even seen the lobster forecast models suggesting that the huge productivity we've had here in the Gulf of Maine may have peaked and that productivity may be heading to Canada where it's still a little bit cooler. At the same time, we are still seeing record levels of greenhouse gas emissions. There was this dramatic drop during the pandemic when basically everything was shut down and we weren't seeing huge greenhouse gas emissions but we are making up for that dip. We hit a new record in emissions in 2021 and these increases are in all sectors. It's in industry, it's in our households, it's our transportation, our electricity supply and we really can't keep going in this direction because of what we've already seen so far and what we expect to come. So we have a lot of work to do to turn things around and we need to be doing that fairly quickly. Fortunately, at the same time, we're also seeing the adoption of policies intended to combat this issue. At the federal level, the Biden administration has made addressing climate change a top priority and they've set a goal of deploying 30 gigawatts of offshore wind by 2030. That is incredibly fast. On top of that, they have a goal of deploying 15 gigawatts of floating offshore wind specifically with the idea of having the US be a leader in that part of the energy sector. For context, manors use about two and a half, 2.4 gigawatts of power annually. So we're talking about 45 gigawatts just off the coast of the US. And Maine has the potential to be part of that effort because all of our offshore wind will likely be floating offshore wind. So we can be part of that leadership role. At the state level, we've also set an ambitious goal of having 80% of our electricity from renewable sources by 2030 with a goal of 100% by 2050. These are huge goals and we're just starting on the effort to achieve them. So things are moving and they're moving pretty quickly and we have to. We should have started this probably 20 years ago, but so we're playing catch up right now. But we need to be moving at this rapid pace to avoid some of the worst predictions that the climate scientists are forecasting. So the graph here shows the Bureau of Ocean Energy Management's plan for offshore wind for the US. The Bureau of Ocean Energy Management or BOEM is the federal agency that basically is in charge of offshore wind energy. They're part of the Department of the Interior and because most offshore wind will happen in federal waters, they're the federal agency that runs the process with the states and developers. So this is the timeline on the bottom here. You can't see this, but these lines, the vertical lines are 2022, 23, 24. At the top we have the New York Byte, all of these offshore wind leases and they run through the bottom line, which isn't really showing up online screen, is the Gulf of Maine. The Gulf of Maine is on BOEM's list for offshore wind. We're a few years out. We're the least far along compared to the others, but the map on the right shows the wind energy leases that have been sold on the east coast of the US already. And we are just a few years down the line. And one of the other projects, one of the leases, couple of leases that were sold just this week, I believe, were off the coast of California and that's one that we're paying attention to because they also will have to use floating offshore wind. They have much deeper waters than we do and so they're a little bit ahead of us and we can keep track of what happens out there to help guide what we do in the Gulf of Maine as well. Here in the Gulf of Maine, there are some specific things that are happening in terms of moving offshore wind forward. The state's offshore wind roadmap is out in draft form. It just came out, they met on Tuesday. The governor's energy office is hoping to finalize that roadmap sometime in January. The goal is to, this is a roadmap for creating an economic development plan for the offshore wind industry here in Maine but incorporates input from fisheries and wildlife and as well as ports and markets to develop that economic development plan. Last year, the state submitted an application to BOEM for a proposed floating offshore wind research array in the Gulf of Maine in federal waters and we expect a response from BOEM hopefully by the end of this year, it could come in January but that is coming soon. And finally, just in the last week or 10 days, five companies expressed interest to BOEM on developing offshore wind projects in the Gulf of Maine. So things are moving. This is all really exciting. There's a lot happening and happening very quickly and that's why we here at Maine Audubon and many of our partners are very engaged in making sure the offshore wind energy industry is built and operated responsibly. Anything back to you? Thank you, Sarah. Let's keep going on and talking about potential impacts to wildlife. Before we get started, I think it's helpful to show this slide. This is a general schematic of what it looks like to have an offshore wind array. One important thing to note is that we are talking about floating offshore turbines. Nowhere else in the United States at this point do we have floating offshore turbines and they're a little different than what exists out there in the world. There are decades of experience in Europe with fixed bottom turbines that are drilled into the seabed and are placed right into the seafloor. We are working on having floating turbines because the Gulf of Maine is deeper. It would essentially look like this. You have the turbine floating and we don't quite know exactly what the final design of the turbine itself would look like yet, but some of the ones being developed by the University of Maine have the look of this turbine here. They would be anchored into the seafloor. They would be connected to each other by a series of cables that would likely be buried underground. The turbines are up to 850 feet tall, which is a very big turbine. It's likely that they will be placed about a mile apart from each other and they will be connected by these cables and then connected to some kind of offshore substation, whether it's floating or on the seabed. There will be additional cables that connect to onshore substations, which distribute the power from there. So this is a sort of a rough schematic, but when we think about what it looks like in the water, it generally looks something like this. So now let's get started talking about the wildlife that's in the Gulf. Seabirds, this is a great sheer water. The Gulf of Maine is a haven for seabirds in all seasons. Thousands of individuals nest on near shore islands in the Gulf in the summer. Here's a quick map of some of those. And they hunt for fish and other foods throughout the Gulf. Dozens of seabird species move through the Gulf of Maine area during migration seasons as well. So you have birds moving in and out of the Gulf and across the Gulf, nesting in the summers on some of these red-dotted islands and others, and then moving to and from those islands to get food and bring it back to their chicks. Outside of those breeding seasons, they move through the Gulf, either as they migrate to warmer climates or as they are here just riding out the winters in the Gulf. These birds include gulls, terns, razor reels, sheer waters, cormorants, and many more. Each of these families of birds has their own particular seasons and uses in the Gulf, their favorite foods. They have different flight heights and styles. And the presence of seabirds, the presence of turbines in the Gulf will mean different things to different birds. So what do we know so far? A lot of the lessons that we have on seabirds, we have gathered from fixed bottom turbines in the North Sea in Europe. And they've shown us that there are a couple of different effects of seabirds. Seabirds may be displaced from the areas where there are turbine arrays and move into new areas, or they may change their movements to avoid turbines in migratory seasons. They may collide with turbines or blades, or they may be attracted to the turbines because there's maybe new sources of food or roosting opportunities at the sites. That sort of avoidance is called displacement. Displacement requires birds to find new areas, which means they have to expand energy and work to locate new areas of food. The overall impacts of displacement depend generally on sort of how far they have to move and how difficult it is for the birds to resume normal behaviors. The impacts of attraction when your birds are attracted to turbines vary. If you're being attracted to turbines, you may increase your risk of collision or exposure to noises. But at the same time, if there are additional feeding areas that open up because of the presence of turbine, if turbines themselves act as reefing areas, populations may benefit from that new food source. Studies in Europe have shown us that different species and different ages of birds react differently to the presence of turbines. For example, in Europe, studies have shown that loons and gannets showed varying levels of displacement. Many other species, including shearwaters and alcids, which is the family of birds that includes puffins and razorbills, and terns showed sort of an inconsistent displacement, sort of not strongly one way or the other. And birds like cormorants and gulls showed attraction to turbines. What we know about in the Gulf of Maine is that during the breeding season, species typically forage within about 30 miles of their colonies of these red islands here, but spread throughout the Gulf in other seasons. And we have this map here that Sarah will talk about a little bit more, I think, but move throughout the Gulf in other seasons. Finally, research suggests that some species, including cormorants and that that alcid families of puffins and razorbills and mirrors may be sensitive to underwater construction noise. Let me turn it over to Sarah now to talk about some of the knowledge gaps. Thanks, Nick. And I want to start by saying, I'm going to talk about the things that we don't know, the questions that we still have that may be important, but I want to be clear that this doesn't mean that these are necessarily problems. It means that we don't know and we need to gather the information to fill those data gaps. And this picture shows leeches storm petrol and it's just seven birds, but it shows you the full use of the Gulf of Maine and in 2019 using GPS loggers. And so every, based on what, or reiterating what Nick said, every species is different. Different species use the Gulf differently at different times of year and at different stages in life. And so what we need to do is really understand that better, specifically with those species that are here and in relation to where the turbines may end up. The displacement may be a bigger factor for some species and not at all for others. And collision is a risk for certain species, but not others. With the larger turbines that we'll probably have here in the offshore environment, the spacing between them will probably be larger and that can have two potential effects. Again, we don't know. It could end up being a larger array that species that would move around it will now have a larger area they have to avoid. Or it may be that that spacing provides an area that they can actually move comfortably through that they wouldn't have when they were closer. So we really, we just don't know. We need to gather more information. And again, exactly where the seabirds are when they're not near their breeding areas. We're really, it's a lot easier to study species when they're concentrated and for a short period of time. But this is a great map showing the Northern Ghana and their fall migration. They, as you can see, the red areas really where they're mostly concentrated. And yes, they move mostly along the shore, but you can see there's a fair amount of them that cut across the gulf. And so we don't know how many species are gonna be doing this and where and what the potential impacts are and where that is in relation to the turbines that could go in there. So this could really help us with our sighting or where we locate the turbines if we know more about where the birds are and how they're using the gulf. Again, to the extent that we do have information from what's happened in Europe, we need to know exactly how closely it will parallel what's gonna happen here in the Gulf of Maine. We have some different species. We're gonna have different, the turbines will be different. They're for the most part gonna be larger and the spacing will be different and it's gonna be floating and what's in Europe and has been in Europe for a couple of decades now is fixed bottom. And so we need to know what the differences and similarities will be so that we can try and predict how species here will react. And then finally, and you're gonna hear this throughout our talk today is we really don't understand the cumulative effects yet of wind farms. So I showed you that map with the wind leases that have already been sold along the Eastern seaboard. A lot of the species we'll talk about today actually migrate up and down the Eastern seaboard. And so over time they're going to be interacting with more and more of these wind arrays and we don't know what sort of effect, if at all, if any at all that will have on the different species. And so what we need to do is we need better data. We need more data on who, what, when, where, and why and how the different seabords are using the Gulf. There are some studies that have gotten started because of the roadmap process and the bone process to try and fill these gaps so that we have enough information to make a good start and be responsible as we start seeing wind turbines getting out there. We need to make sure that we're putting turbines in the places that will have the least harm and as far away from the breeding, feeding and migratory areas that our Gulf seabirds need. And then there will still probably be some impacts. And so we need to make sure that we have the best mitigation options available that can reduce all of these threats and help avoid these threats to our Gulf main seabirds. And finally, if there are things that can't be avoided, that we need to have compensation to improve the populations overall to make up for any impacts that do happen from offshore wind to our Gulf main seabirds. All right, thank you, Sarah. That's seabirds. We will now move to migratory birds and bats. Billions of individual birds get the heck out of dodge when the weather is like this and they fly to places where they can eat insects. Each spring, we have billions across North America. We have billions of warblers, virios, tannagers, ducks, shorebirds, raptors and more coming up from wintering areas in the South to take advantage of the warming North. We also in Maine have three migratory bat species, the hoary bat, the silver-haired bat and the eastern red bat moving around. So what does the science show about how they may use the Gulf of Maine? Well, first of all, there is a lot of variation by species and how birds migrate in different weather conditions. But overall, the flight altitudes of migratory birds are typically well above the projected height of the turbine blades. So we're talking 850 plus. Most often when migratory birds are flying, they're flying at several thousand feet. That's a good thing, which means that the birds that do fly over the Gulf, especially under fair weather conditions, will be flying at a height where they won't be at risk of collision. We also know from research that migrants tend to concentrate inland rather than flying directly over the Gulf itself. Although there is some variation, we have some knowledge that we need to get about how exactly that works and how different species use it. We do know that small numbers of migratory bats are known to navigate across the Gulf, most often in fall and most often in calm conditions. We know that factors on the turbines themselves, such as lighting, the characteristics of the turbine, the spacing and the proximity to high bird use areas may affect the likelihood of attraction or avoidance to the turbines. These strategies and the mitigation measures are well known among developers and us and they are improving with technology all the time. So those are some tools that we can use to minimize that impact. But let me turn it over to Sarah now to talk again about what we don't know. Thanks, Nick. So similar to with the seabirds, we really don't know where everybody's moving all the time. These are a couple of snapshots from a few studies that have shown that, yes, for the most part, coastal migrating, songbird species stick pretty tight to the coast. But there are some species that are a little more tolerant of moving over open water and we need to understand that a little bit better. We need to understand, is that a risk at all? Are they really cutting across parts of open water that really aren't gonna have wind turbines in them or is there a larger movement offshore that we really don't know enough about? So we just need to understand a little bit better where everybody is and what they're doing. And the shape of the Gulf of Maine, as I showed with the picture of the Gannett movements, it's sort of a bowl and so it's a little easier that there may be a better probability that some species might be more tolerant of crossing that. Nick mentioned flight heights and so understanding the flight heights of the species moving over the Gulf will be really important. You wanna make sure that they're not within where the rotors are moving, basically. As Nick mentioned, most migrating songbirds are migrating thousands of feet above the water and so the likelihood of them being at risk is much lower but it depends on where those turbines are. And one of the things we really don't understand is what sort of weather conditions might push that migration path further down out of the sky and put them at potential risk of being at the height of the rotors. And then if the rotors are in a path where if the bird is moving and wants to stop over on an island or somewhere else that they're not now cutting through that rotor spot area. Again, it's just something that we don't know and we need to understand a little bit better. For bats, we really don't know much about their use of the Gulf of Maine. I think Nick mentioned there is some evidence that they may be cutting across the Gulf depending on the conditions. Again, acoustic surveys through the Gulf of Maine have actually turned up bats just about everywhere, not in high numbers. But they're out there and we need to understand better how many who, why, what are they doing? We need to understand the utilization of the Gulf of Maine by bats. And on shore, we do know that bats can be attracted to wind turbines. And so we don't know if that'll happen offshore if it's going to be an issue at all. Again, we just really need to understand that a little bit better. And like I said with seabirds, we really need to understand the cumulative effects because again, most of these species are moving up and down the coast a couple of times a year. And so we really need to understand that as we get out to full build out of the Eastern seaboard, what sort of impacts that's going to have on some of these populations. So in order to address these gaps, we need to get more data. And I want to be clear here. You could say that you never have enough data forever. But you can get to a point where you feel reasonably comfortable with the amount of data. And we're not quite there yet. And we need to keep gathering data. And we will need to continue to gather data through construction and operation and decommissioning because climate change is happening and sort of moving the goalposts as we go. But we need some good basic information that we can move forward on. And similar to with the seabirds, we want to understand any new technologies that may be out there to help reduce harm, reduce collision potential on the arrays that will go in in the next couple of years and the ones that may be going in 10 years from now. There's a lot of research going on right now to come up with technologies to reduce potential harm to bats and birds. Mitigation collision risk. We need to mitigate collision risk as much as possible. Nick mentioned some of the things like lighting and color and the operation of the turbines themselves. This is something that we've been working on for a long time already. We've got a lot of information from onshore wind. And so we need to apply that in the offshore realm as well, which is something that Bohm is on top of. And then finally, where there are harms that can't be avoided, we need compensation to make sure that we are again making up for any losses that we have because of the offshore wind industry. All right, thank you, Sarah. We'll transition now from above the water to below the water. And we'll talk about what we know about potential impacts to fish and lobster. Maine, of course, is famous for its fisheries. They're the backbone of our coastal economy and of course an important food source for wildlife in the Gulf. In Maine, lobstering is by far the dominant fishery, making up more than 80% of commercial landings. So what does the science say that we know? So one important area of study is EMF, electromagnetic fields. Electromagnetic fields are generated by the movement of electrons, such as through a power line or a transmission cable. And they may be felt to varying degrees of sensitivity by different wildlife under the water. There are low levels of naturally occurring EMF, that's a call, present throughout the oceans. And Maine also has a number of undersea communications and power cables already connecting islands to the shore. Studies of EMF from undersea cables have shown that there's little to no impact on fish or on American lobsters. That's a good thing and indicates that the presence of these cables are unlikely to impact the movement of lobsters overhead. On fisheries themselves, there's been a seven year study of fixed bottom turbines off Block Island in Rhode Island. Found either no impact from turbines or a positive impact on fish schooling around the turbine structures. And again, it's important to remember that those impacts may not translate to the turbines that are in the Gulf, which will be floating and have less undersea structure at the seabed than fixed bottom turbines, although there will be anchors and things. Finally, in last year, the state of Maine enacted a ban on offshore wind development in state waters. That's three nautical miles offshore, which is where approximately 75% of all the lobster fishing occurs. Finally, offshore wind may create areas of refuge for submarine species, increasing local abundance and acting as an attractant. And that may generate sort of spillover effects to increase populations in adjacent areas. And here's the slide on EMF, sorry. Let me turn it over to Sarah now. Thanks, Nick. So as with some of the other species, we really don't know how fish populations in deeper water might be impacted by the presence of turbines. As Nick mentioned with fixed bottom, we've seen, again, with decades of work being done in Europe, that we can end up with artificial reefs, which can actually benefit fish populations. But with floating wind, it's different. We won't have that same structure, although depending on what kind of anchors we use, there may be some hard surfaces that could act as artificial reefs. Again, we really just don't know. And then we don't know how, again, because floating offshore wind is so new, we don't know how fish and benthic organisms will interact with those cables and the anchors. There are a bunch of different kinds of anchors that can be used and they all will have different effects on the substrate on the bottom of the ocean. And so what gets used and how it impacts the local fish populations, we don't quite understand yet. I like this picture actually of the EMF because it shows the idea is that there are these radiating electromagnetic fields coming out of the cables and that includes the cables between the turbines because you have to bring all of the energy together and then the one cable that will go out and bring all of that energy to shore. There's less energy between the turbines and more concentrate higher levels with the cable going out, but there are things that can be done about it. We've got a lot of cables under the water already. You can bury them, you can armor them with rock, you can put concrete mattresses over them. And so there's a lot that can be done to mitigate the potential EMF. And as Nick said, a lot of the research that is either inconclusive or showing really very little to no effect. So that's a really good thing. With floating offshore wind, it depends on whether the inter-turbine cables are buried underground, which we will probably be able to do here in Maine out in California, they may not be able to because we're talking about 1,000 meters deep out there and the cables may actually be in the water column. And as offshore wind develops here in the Gulf of Maine, we don't know what's gonna come with every development. And so we need to just keep an eye on that. Again, we really don't know what the impacts will potentially be. And so what we need to do is again, we need to monitor the impacts of the turbine anchors and cables. We need to understand what impacts they're having on the existing populations that are down there and work with the fishing industry to understand the impacts and to mitigate the potential impacts to the industry and to the ecological functions that raise our fisheries. And then again, we need to make sure where we can't avoid the impacts that we're compensating for the impacts that the offshore wind industry will have on the fish themselves and the fisheries industry as well. All right. Thank you. We are doing well on time, but I'm gonna go, let's keep moving. So because we've got a lot of questions coming up, I can see. And our final category is marine mammals. More than 20 species of marine mammals live in the Gulf of Maine, including harbor seals, gray seals, harbor porpoises, dolphins, and whales, including humpback, fin whale, minky, and the critically endangered northern right whale. What does the science show so far? So a couple of things. Marine mammals can detect and respond to electromagnetic fields, EMF, but there is no evidence of negative impact so far. Marine mammals are also sensitive to underwater noise and some species have displayed altered behavior during the construction of fixed bottom turbines. Fixed bottom turbines are not an option in the Gulf of Maine. And the underwater construction noise of floating turbines is expected to be significantly less than fixed bottom turbines. There will be some amount of noise related to the anchoring of floating turbines, but much less than the sort of pile driving and other construction needed for fixed bottom turbines that exist throughout the rest of the world. Another potential area of impact are the cables which connect the turbines to each other and come to shore. Those turbines are not a entanglement risk. They are too big and too taut to wrap around anything. However, there may be some risk associated with what's called secondary entanglements. Secondary entanglements are where marine debris, such as lost fishing gear, becomes wrapped or caught by those electric cables. And those may have an impact on marine mammals that swim around. Sarah. Thank you, Nick. So again, the things that we don't know is exactly where in the Gulf the marine mammals are in all seasons and how they're using the different habitats and how that could be affected by the turbines. And remember, what's happening with climate change is already affecting this. So the preys species for many of our marine mammals are changing their locations and movement patterns and the predators are following them. And so we need to know what's happening and what could potentially happen in order to understand the potential impacts of offshore wind on marine mammals in the Gulf. Nick mentioned underwater noise. It is going to be dramatically less than for the installation of monopiles or the fixed bottom. They're basically jack hammered into the ocean floor and it's a huge problem. With floating offshore wind, there's going to be very, very little of that kind of noise during construction. There is some noise associated with the actual operation of the turbines, but so far, because again, we've got a lot of wind turbines all around the world already not floating, but fixed bottom. And we haven't seen ill effects from that, but we need to keep an eye on it. As the turbines get bigger, where in the auditory range, the sound is changes as they get bigger. And so we need to just keep an eye on that and make sure we understand what noise is coming out of them and what sort of impact it is having. We also need to think about the changes to the vessel movements. If we have equipment out there that needs regular maintenance, we may have more vessel traffic going from shore out to the turbines and back. So we need to make sure that we're not having an impact because vessel strikes is a huge problem for marine mammals. I was just on a webinar this week where they were talking about the ability to do remote monitoring and really reduce the amount of traffic that you have to have going out to the turbines, which would be a fantastic way to reduce some of the traffic that's out there. And then again, electromagnetic fields, we don't really know what impact it will have once we get to that full build out, essentially. If we do have cables in the water column, what sort of effect that sort of EMF might have on marine mammals as well. And then that question of secondary entanglement that Nick brought up is one that we, again, really don't know a lot about because there isn't a lot of floating offshore wind in the world yet. So we really need to keep an eye on that. There again may be simple fixes for that, such as remote ways to monitor and clean off the cables regularly so that they don't end up collecting a bunch of junk on them that could become secondary entanglement risks. And then finally, just the cumulative impacts of wind farms along the entire Eastern seaboard for a lot of these large mammals that are moving up and down the seaboard, in the Eastern seaboard. So again, we need to continue to study how marine mammals are using the Gulf of Maine. And again, as things are changing with climate change, we really need to not just look back at what was happening 10 and 20 years ago, really understand what's going on now and what could happen in the very near future. Limit acoustic impacts to the greatest extent possible, avoiding construction during breeding and calving seasons. That's sort of a no-brainer, but you still need to sometimes make that a requirement. Keep looking at EMF. Again, it may be that it's not an issue at all. We need to understand that as we're changing things within the industry. Again, identify methods for regularly monitoring and maintaining, cleaning those cables of debris to prevent secondary entanglement. And look at other mitigation methods. If there is a lot of traffic, vessel traffic we may want to require vessel speed restrictions that can dramatically reduce vessel strikes with marine mammals. And then again, compensate for any unavoidable impacts that could in order to make up for any impacts that happen so that we can keep these populations healthy. Thank you, Sarah. I'm gonna turn it now to Eliza to talk about some of the policy opportunities. Great, thanks so much, Nick. And thanks so much to Sarah. I'm really grateful to the biologists and other wildlife experts on our main Audubon team. As we wade into this really present and pressing opportunity, they're helping us stick to our mission. And that is to lead with science, including in our policy work. And as main Audubon's advocacy director, I'm leading on that work to advocate for the adoption of policies that both embrace offshore wind development as a critical component to weaning main and the nation away from fossil fuels and also policies that support responsibly cited in operated offshore wind development. And as Sarah described at the top of the program, a lot of the decision-making related to offshore wind happens at the federal level at the Bureau of Ocean Energy Management. However, state policymakers also have significant leveraged opportunities. And that biggest one is the state's buying power. It's our purchase of the electricity generated from offshore wind. And that is a big focus of our policy work now and in the coming main legislative session, which is gonna get underway in earnest beginning in January. So like New York, New Jersey, Massachusetts and other states before us, main lawmakers are introducing legislation this session that would direct main utilities to purchase electricity from offshore wind. And also like those states like New York, New Jersey, Massachusetts and others, this policy would set certain standards for that electricity and the offshore wind projects that created, including environmental mitigation standards. Securing these power purchase agreements which are also known as procurements into law is a proven method for signaling to industry that states are ready to embrace offshore wind. And these laws, they set investment wheels in motion so that by the time a state actually goes to buy power, there are offshore wind projects to buy that power from. And again, at the risk of sounding like a broken wheel like many states before us, like Massachusetts, Rhode Island, Connecticut, New York, New Jersey, Maine Audubon is advocating for baking strong environmental standards into those laws, into those power purchase agreement laws. Specifically, we are asking that offshore wind projects that Maine buys power from have environmental mitigation plans that specifically outline strategies that will be used to avoid and minimize impacts to wildlife. This is the stuff like reducing lighting or regularly cleaning underwater cables, those strategies that Nick and Sarah outlined. We'd also like to see the requirement that projects provide financial and technical support for research and monitoring of wildlife and habitat impacts. You know, we heard again and again that there are a lot of holes in our collective knowledge that we need to fill and offshore wind developers can and should play a big part in filling those holes. In fact, they already are and they should continue to do so. So we can continuously improve how to locate and operate these projects with the least impact to wildlife. And then finally, these policies that Maine can enact should require compensation for those unavoidable impacts. We know that offshore wind is going to negatively impact wildlife. And while we feel very strongly that the benefits of offshore wind far outweigh the drawbacks, we can do best by wildlife if money goes to compensate for those impacts, including money to support conservation efforts, such as conserving seabird colonies or things like that. So that's gonna be a big focus of our advocacy work this session. And I'm really excited about it. I'm also excited that we're collaborating with clean energy advocates and labor advocates on this bill. We think it's a really winning strategy, advocating for clean energy, advocating on behalf of wildlife and the environment, and also advocating that Maine's offshore wind industry support good jobs for Maine people. If you'd like to play a part in advocating for Maine laws that support responsibly cited offshore wind, please sign up for Maine Audubon's Action Network. Maybe Nick or Sarah can drop that in the chat for me, because I'm incapable of doing two- Working on it. Thanks, Nick. After sharing your email address with us, you'll receive periodic messages about opportune times to contact your state representatives about this issue. You'll also hear from us when there are opportunities to advocate on the federal level. And some of those opportunities are coming up really soon. Again, as Sarah described at the top, BOME is in the early stages of identifying areas in the Gulf of Maine where they'll sell leases. And next month, BOME will once again be reaching out to stakeholders and the public to glean information about areas that are a good fit for offshore wind and areas in the Gulf of Maine that aren't a good fit for offshore wind. So please sign up for our action alerts to stay in the loop and I'll kick it back to Nick. Thank you, Eliza. Excellent work. We have time left and we have a lot of questions. So we're gonna dive into them right now. And I'm gonna start with a couple sort of fundamental ones, ones that we probably should have explained in the bulk of the presentation, but we'll get to those first. One of them is from Laura here who asked why is the Gulf of Maine warming faster than the rest of the world? Well, it has to do with currents in the ocean. So the ocean is made up of these basically rivers in the ocean that transport water from one place to another. There are a couple off the coast of Maine. One is a cold water current called the Labrador Current, which if you can picture here sweeping down from the Arctic and past Greenland. For the longest time that current came down and supplied the Gulf of Maine with a lot of cold water. So we had a temperature that was heavily influenced by that Labrador Current. The other current nearby is the Gulf Stream. The Gulf Stream is warmer. It swings down here towards the equator closer south bringing warm water and then circles up off the East Coast of the United States before coming across towards Europe. The Labrador Current and its cold water is weakening as Arctic ice melts and causes to become fresher than it used to be. So the cold water current that used to supply the Gulf is weakening and in its place, the Gulf Stream current is coming closer to the Gulf and supplying the Gulf of the warmer water. There's not a lot of flow in the Gulf and so a lot of that water is just sort of sitting there in a bathtub and that helps explain why the Gulf of Maine is warming so quick, I hope. Thank you. Another fundamental question, I'm not sure where it is who asked it exactly, but how far are we talking? How far offshore in the Gulf of Maine are we talking about for these turbines? Sarah? Yeah, so I mentioned the state's proposed research array and that is being proposed sort of between 20 and 40 miles off the coast. The floating offshore technology that's being developed at humane sort of needs 150 feet but then there's no upper limit and that actually happens fairly quickly in the Gulf of Maine. So it's gonna be, Eliza mentioned the ban on any offshore wind within seawaters, which is three miles but the Gulf of Maine is really quite large and the limitations on how far out it can go really get to be the cost of that cable connection really. The technology is there to, like I said, they've just sold leases off the coast of California and then we're talking about 1,000 meters in depth. And so it's really about that technology is if not ready today, it's definitely on the way that's not something that folks who work in that industry think is gonna be a limitation. It's how expensive it is on the cable all the way out there. And so, but we're talking about many miles from the coast, 10s, 20s, 30 miles and more but it all depends. It depends on what the developers propose and where they propose it. And because they are all of these things that we're talking about, the developers have to look at as well. BOEM is gonna require that. There will be environmental assessments that will happen. And so it's gonna be at least probably 30 meters-ish off shore, but it really depends on what the developers say. Miles. Miles, sorry. Yeah. So we're not talking right up along the shore but we don't have an exact answer for that yet. Thank you. A question here from ER about permitting. I think I'm gonna ask this to Eliza. You know, we have no hopes ER says of meeting our goals if permitting bogs down the process. Where does main Audubon stand on permitting of wind power? Yeah, that's a great question. You know, when main Audubon looks at permits we look at them individually. So it's hard to give a broad answer but I will say that we think that there will be better permitting outcomes that there will be better applications for permits if good work is done now to locate these lease areas in places with less potential impact on wildlife and the environment. And that's why these really early stages in engaging with BOM and the federal government on wind energy areas is so important because those permits will encounter less opposition and will have less hurdles if they're for the right locations. So right locations that will have fewer pushback on the permits because you're absolutely right. The potential for these projects to get bogged down as is the case with so many renewable energy projects in litigation is high and that's really too bad. And so it's a challenge on us as environmental advocates to set high standards but also set realistic standards and continuously work towards making sure we're balancing the need to swiftly move towards our renewable energy goals with our other goals related to natural resource protection. Thanks, Eliza. Question here from Peter Lafond. Hey Peter, how will realistic data about the effects of turbines on birds in the Gulf be collected? And I sort of wanna conflate this with another question of his is what is the role of wind companies themselves in the data collection? Yeah, that's actually a great question. And as you can probably imagine there are a lot of different types of surveys that can be done because there isn't one type that gives you all the answers that you need. We have a lot of different species with different movement patterns and a lot of different technologies. So there's everything from actually putting transmitters on the birds in order to track their movements to doing radar surveys, to doing LiDAR and photography surveys using airplanes where they actually and taking photographs and identifying counting the birds that are there. And with the LiDAR you can actually see how high they're flying as well. So that's an added piece. Some of the GPS transmitters now you can get altitude as well. So that can be really important. In terms of the industry role they are often required to collect this information or have gathered enough information to be able to make sure that they're not having a huge environmental impact. Often there will be also funding associated with the development of a project that will go towards some of the research. And this is not just for birds. This is for all of the species that we're talking about. There's a lot of ongoing research upfront that we wanna see happen so that we have the information before the sighting really happens because you can do more with sighting than any kind of mitigation. And so really making sure that we're putting these in the right place is the most critical piece. Thanks. Question from Nicole and Sarah I'm gonna put you back on the spot about cable entanglements and how big these cables actually might be. She said it was stated that cables are too thick for whales to be entangled, how thick? They're like tree trunks. These are big. And for the most part, they're fairly taut. And so the concern that you would have for entanglement is something that's much thinner and really sort of floating around a little bit more. But these really aren't something that it's really, it'd be more of a collision risk potential than that you would get entangled with them. But the potential for them to capture something that is more flexible and thinner is definitely out there because we do have lines and ghost gear out there that could become the problem. Great. Eliza, did you want to answer this question about industries? Sure. And thanks, Nick. I'm figuring out how to use this Q and A. Sorry. No, no, no. Okay, I gotcha. Yeah. Let me pose it to you there from Deborah. She's asked, have industries and politicians shown willingness to address concerns about the impact on these species? Yes, that's a great question. And the answer is yes, so far. And we hope they continue to do so. So as Sarah described earlier, we're really grateful that a lot of folks in the offshore wind industry are really leading the charge on mitigation and monitoring and willingly including sharing data, including monitoring mechanisms in their projects, et cetera. As for politicians, as I talked about, we've already seen in New York, New Jersey, Massachusetts, Rhode Island, Connecticut, those are the ones that come to mind right now that state lawmakers are including environmental mitigation standards in their laws related to offshore wind. So that's great on the state level. And at the federal level, we're seeing leadership in also funding to research these impacts, to understand these impacts. And in our interactions with BOEM, this is understanding, right-siting these projects is of high interest to them. I think that gets back to the question earlier about permitting. BOEM wants this to be successful and offshore wind is going to be successful if impacts are limited. And so they are keenly taking in, are keenly interested in taking in as much information as possible so that they can put these projects in the best location. I think I also saw a question in the chat about eBird data, about data from whale watching groups, et cetera. Those are all fair game. And I would encourage the folks who put those questions in the question and answer box to be in touch with us and we can share with you when there will be opportunities to share that information with BOEM because they're in the information gathering stage when it comes to the Gulf of Maine and all information is fair game right now. The good folks at Bar Harbor Whale Watch. And I wanted to say, Julie who wrote one of those questions said that they have seen a significant change, shift in distribution between in other baleen whales in Down East Maine, fin whales, humpbacks. So folks who are out on the water frequently are seeing those changes happen. It's after one. So I want to go quickly and we have questions left that we're not gonna get to. I apologize. Invite you please to email me at Maine Audubon if you have additional questions that we didn't get to. Let me put that right down there. Audubon.org. If Eliza and Sarah, if you wanna look at the question and see if there's any that you wanna tackle maybe as a last one, I can answer Bill's question about whether blue crab is a viable catch in the Gulf of Maine. Not now, but it might be someday. Blue crab is of course a famous, it's sort of the lobster of the Chesapeake, I guess you could say. We do know that species are moving, Southern species are moving into the Gulf of Maine, black sea bass, some seahorses, et cetera, as the water warms and becomes sort of of a temperature that Southern species are used to, they can move right up in the Gulf of Maine. And so someday folks in the Gulf of Maine may be catching different fish as part of a sort of commercial landings than we have now. Sarah. Yeah, I just wanted to make sure that I put a shout out for some of the other organizations that we're working with so that it doesn't seem like Maine has to figure out all of this on our own. There is a regional wildlife science collaborative and the state is working with them to develop some maps of where the data show these organisms are to collect all the data that exists and identify where the data gaps are and how to collect the data they need. They've been doing this with a lot of the states on the Eastern seaboard, so they're well-versed in this. They have some fantastic scientists as part of the group. And so we pay attention to what's going on over there. And also there's a wildlife and offshore wind group, I think that's funded by Duke University and that's where the experts from all over the country come together and talk about the different issues that are coming up and we sit in with that group and they'll have speakers on the latest research that's happening out there. So we're not having to reinvent that wheel. We're all actually collaborating across the board, across the country actually with other environmental groups and scientists. Okay. Well, there are questions left that we're not gonna get to. We all gotta go shovel, I guess, or something, but I do wanna say thank you so much to all of you who joined, this was great. And I just want you to know that we will respond to any other questions that you wanna send to us. And we're working hard out here to seize this opportunity to protect Maine's wildlife, to reduce the impacts of fossil fuels and do it in a way that protects as much wildlife as possible. So thanks everyone for coming. Have a great weekend, have a safe and warm weekend and take care.


Lakeland Currents, your public affairs program for North Central Minnesota, produced by Lakeland PBS with host Ray Gildow. Production funding for Lakeland Currents is made possible by Bemidji Regional Airport, serving the region with daily flights to Minneapolis-Saint Paul International Airport for information available at BemidjiAirport.org. Closed captioning for Lakeland Currents is sponsored by Niswa Tax Service, tax preparation for businesses and individuals, online at niswatex.com. Hello again everyone and welcome this evening to Lakeland Currents. We're going to talk today about a new concept that's being developed in one of our regional hospitals and I think we're very fortunate in central Minnesota to have a number of hospitals that are really excellent and we have talked about that over the past 12 years. Tonight the concept is, I guess we're kicking it off because it isn't technically open, although it probably will be by the time there's errors in 2019. It's about the Cayuna Range Medical Center's new menopause, what are we going to call it? A menopause center.  A women's health nurse practitioner. And what's the difference between that and a registered nurse?  My specialty is women's health. Okay well welcome to the show it's nice to have you here but before we get into what you're developing let's just talk a little bit about who you are and where you're from. Christina maybe we could start with you. Sure so I'm a native Minnesota and I grew up in Maple Plain Minnesota which is about half an hour west of the cities. I went to medical school at the University of Minnesota and then went out to Buffalo New York for my residency and then moved back home to start working and practicing at Cayuna Range Medical Center. I started in 2014 and so I've been there about four and a half years. I'm one of three obstetrician and gynecologist and we work with two women's health nurse practitioners one of which is Melissa. And Melissa what's your background? I am a native from Brainerd I grew up and raised here I went to get my RN degree and then I worked as a labor and delivery nurse at CRMC for 12 years and just transitioned to a women's health nurse practitioner this spring. You know this whole medical field is just dramatically changing isn't it? I mean even since you started the requirements that you have in reporting I know a lot of doctors and a lot of them talk about how it's becoming so burdensome to have to spend so much of your time doing the reporting for the new Medicare rules and whatever so you've seen a lot of changes but a lot of them are to the good. I'm sure that you're seeing things positive happening to that. Tell us a little bit about how the concept developed of having a menopause center because that's unique. I'm not familiar with that being anywhere else. So especially with the demographics in our area there's a lot of baby boomers women who are kind of in the perimenopausal and soon to be menopausal age group and so really our goal and our design is to kind of have a coordinated set of services with under one roof. So basically we're not reinventing the wheel or reinventing medicine per se but just making a better experience for the patient making it more efficient so being able to coordinate services and radiology labs seeing the provider and doing a little bit of work ahead of the visit in order to make the best experience for the patient and so what we're looking at doing is really kind of trying to make it a one-stop shop and providing the most services that we can for the patient at the time that they come for the visit because we realize we have a lot of individuals that are maybe traveling from a little bit away so we'd like to get them their mammogram their bone scan their labs and their their visit done all at the same time. So not everyone goes through menopause equally do they I mean there are lots of variations to what happens. Could you talk a little bit about what are some of the things you see with patients I mean what are some of the ranges that you see and why do some of them have so many more challenges than others? I think a lot of it goes back to just genetics and perhaps family history. I think one of the strengths of our department and our practitioners is really doing a good piece with the education and counseling and letting women know that I think a lot of patients have a misconception that it's going to be kind of a very tightly time-framed process and hot flashes and other uncomfortable symptoms can start years even a decade before the actual menopause which medically defined as the last menstrual period for more than 12 months and so I think just providing that education and allowing women to know what to expect and perhaps give them some conservative measures they can do at home with exercise dietary adjustments and just that counseling and education piece in order to have a full knowledge going into the process. I think fear of the unknown is probably the biggest thing and if we can empower women with knowledge that makes the process go a lot smoother. So are you going to have an actual center a physical center or is this something that's occurring inside of your existing facilities? More the latter and I'll let Melissa speak to that a little bit. Yeah so it is still going to be within our department inside CRMC in the specialty clinic there and basically we are going to hopefully transition women and to make it more of a comfortable setting for them you know with some booties or lab robes and stuff like that and make it just it's going to be within our center there and we will provide the care there for the women and then have them transition to other areas like lab if they need to mammograms. So what will the ages be of the of the women that you're going to see in your facility? Yep so the menopause center will be for 40 and older for women who are experiencing menopausal symptoms 40 and above menopause the average age of menopause is 51 but like Dr. Cramer said it can transition women a decade before they can start to have symptoms. One of the speaking points I got here from Peggy is this is an opportunity to get women back into the health care system what does that mean aren't they mostly in it already? Yes and no as a whole women are better at seeking medical care and doing preventative services as compared to their male counterparts but a lot of patients if they're feeling well after they stop having babies kind of stop going to see a provider because they're not having any issues and so why go and I think that's another strength and what we're really passionate about at CRMC is providing that education piece and preventative medicine and that's what a lot of patients ask me well why do I have to come in and see someone I'm feeling well I don't have any symptoms I'm up to date on my pap smear and for us it's a lot more than that and there's some different conditions that start to kind of manifest in the menopausal age group and so hopefully either educating patients on what to look for or helping treat conditions that a lot of patients associate it with just a normal part of aging and there are things that are uncomfortable to talk about for example incontinence, pelvic organ prolapse, difficulty sleeping, pain with intercourse, libido issues, things that they may not necessarily bring up unless we ask them directly and that's a really important part of menopausal medicine is not just hey I do having high blood pressure do you have diabetes yes or no but those other things that perhaps we're the only provider that a patient might feel comfortable discussing this with or maybe the only provider that actually asked the patient if they're suffering any of those symptoms. So when a patient comes in to see you you're going to have a it sounds like a fair amount of time spent on educating the person so what will is that going to be like classes or just one-on-one conversations or how do you how do you plan to start doing that educational piece. Sure so as we're rolling this out we're going to have community seminars just kind of as an intro what sort of conditions are we talking about just kind of getting that conversation going with patients or women out in the public actually with our patients in the center we would be looking at we have written materials audiovisual materials videos probably kind of a set rolling video what the patients are going to see and watch just to kind of get that conversation going reaching out to the patients ahead of time to see if there's any main questions or concerns that they want to address so that we can kind of tailor the visit sort of have a custom-made physical for that patient while being around the questions and concerns they have and then a lot of one-on-one time with the provider and discussing you know treatment options things that are out there things that the patient can do on her own at home to help treat some of these conditions. Now obviously most hospitals have components of this but it sounds like your approach is unique in having a center just focused on this do you know of any others in the area in the region that are doing something like this or are you unique to the to the concept that you know of. With the NAMS providers there is a regional need for that there is only three about three northern NAMS providers. So NAMS is the North American Metaposal Society so you go and you get information and then you can test and become what's called the NAMS provider and there's only three north of the cities as far as like the closest probably metaposal center it's going to be about the cities so there is a regional need in this area for that and for the providers as far as like the education that the docs get even in their residency and stuff that's very minimal and so it's kind of advancing that education and gaining education for everybody involved as well. So how many on staff will you have involved in this concept when you really get off and running? Currently right now we have the three OBGYN doctors, two nurse practitioners and then we have three full-time nurses that are staffed with us currently. So a lot of times these metaposal issues create a lot of psychological issues don't they so you have someone on your staff that will be dealing with that specialty or is that something you kind of deal with as a group? So that's kind of the idea with having a center with the idea of the center not being a physical building per se but more the idea and coordination of services and really the idea behind it and we're not completely reinventing the wheel but it's really without the legwork to kind of bring all the different specialties and departments together I think that's the major strength with the service line that we're rolling out but to directly answer your question we'll be working directly with other allied health providers so psychologists, counselors, sex therapists, nutritionists, some of the psychology will be focused on sleep, behavioral health issues, physical therapists as well as the providers, did I miss anyone? Cardiology and our family physicians as well so really kind of trying to unite everyone for the care of these women who I would say and to echo what Melissa said kind of are sort of maybe lost in between their childbearing years and kind of the health conditions of some of the older elderly women they're kind of in this gray zone in between and sort of don't really know that some of the conditions they may be suffering with aren't just kind of a normal part of aging and that there's providers out there that want to help them. So most of this would be covered by health insurance or by Medicare most of what you're doing is not outside of the norm for health I mean for health care is it? Correct. And what is the time that you think this will be up and running? What's the time period you're looking at? You said 2019 but do you have a a month in mind where this will be kind of an official opening? Our official opening is going to be January of 2019 so we're rolling it out okay but that doesn't mean people can't come to you now correct correct so if they want to come to you with these kind of information out of they still have to go through a regular doctor no no they can just call you don't need a referral to see anyone in our department and that's kind of the nice thing about the OBGYN specialty is we kind of walk the line between surgical specialists but also a fair amount of primary care so we kind of yeah basically walk the line and patients don't need a referral from their primary care provider if they're having issues with some of those conditions I mentioned hot flashes menses they're becoming irregular heavy bleeding abnormal bleeding pelvic pain pain with intercourse incontinence and that's just to name a few we'd be happy to see those patients and those are patients we're already currently seen right now the idea with the menopause center is again just to kind of provide a more of a one-stop shop at that same visit so now when women have these kinds of issues they just would go to their practitioner I would guess who may or may not be an expert in this some of them are going through their regular primary care provider some patients are already seen we're seeing those patients already I think the main thing and this is something I share with my patients on a daily basis is a lot of patients with more personal conditions for example urinary or fecal incontinence they've done studies that show it takes women an average of seven years to bring that concern up to a provider really and so unless we directly ask a lot of people aren't willing to talk about it right away just because it is such a personal and embarrassing condition really that's that's interesting yeah um technologies affecting our health care drastically are you going to be looking at new innovations in technology at all I know just to give an example I know there's a lot of movements towards getting wired at home you know in one form or another are you looking at anything in that area I think yet or is that maybe beyond what you're doing right now I would say it's kind of um something we're probably already doing with being cutting edge with advances in medical technology um you know we're under the umbrella of the memis institute at our facility or the minnesota institute for minimally invasive surgery so the gynecology surgery that we do embodies that principle as well um my partners do a procedure called inner stim which is um kind of the gold standard for refractory urinary urging continence that hasn't responded to medical therapy and dr michael katie is in the top tier of the number of providers in the country with um his experience with that procedure so I would say that's something that isn't commonly done by gynecologists and to have someone locally that does it is pretty impressive so it's a real team approach isn't it which is making it unique and I know a lot of hospitals are moving towards team approaches even just with your primary primary provider sometimes you can't even talk to that person you have to work through a member of the team and at least in the hospital and I go to now um so this team approach is going to focus more heavily on each other than probably historically I mean would historically you would come to your doctor and if you were a woman sometimes your doctor was a man and maybe you didn't feel comfortable talking about all the things that could be happening whereas this will give them opportunities to talk to other people it's the it's the silver uh tsunami is what a lot of people have called it and I'm part of that silver but the thing that's interesting to me is how much dementia and Alzheimer's we're seeing I see that's one of the topics that you've got down here what's happening in that area and I know you're not here as experts on Alzheimer's or dementia but but what are you seeing are you seeing any changes coming are you seeing medications that are helping at all or are you looking at other ways to deal with it I mean like exercise and the health the diets and that sort of thing how are you approaching an issue like that I think in medicine in general we're all becoming more aware of the impact on diet and behavioral things have on our health in general I think particularly in our specialty you know the neurology or neurobiologists would really be the the providers prescribing medication or treatments for those dementia Alzheimer's patients but what I've noticed is either these patients themselves or their family members their daughters their sisters are patients and sometimes we have more of a long-standing relationship with these individuals who maybe aren't aware or kind of fighting that diagnosis and I think that that's probably one of the harder things for the family is just the stigma attached to that and so having a provider that they're maybe comfortable with kind of gently broaching that subject is really one of the main roles that I see within our specialty and then also working with these patients who still have some of the other medical issues that any other menopausal woman would have as far as the pelvic pain or incontinence and being sensitive to that that we choose treatments that won't either interact with or diminish the efficacy of those medications they may be on for their Alzheimer's so Melissa you're a nurse practitioner so how do how do you work with the team what is your primary responsibility in that field so with the new menopause center coming up I will be calling the patients kind of questioning them getting an intake and so that I can direct their care and do the team approach with that and you know if it means ordering an ultrasound before because they're having post-menopausal bleeding or if it means getting their lab work done so that we can assess it and go to approach that way if they have high cholesterol or if they have a history of cardiac disease and getting that set up at the same day so cardiology can see them and kind of approaching it so that it can be a one-stop shop for these patients currently right now I help them assist them in the clinic also see patients on your own and kind of do rounding and stuff for them to make their lives a little bit easier hopefully and that trend in the medical field is expanding a little bit even into the dental field now but nurse practitioners the physician's assistants are getting a more and more responsibility for doing that thing I know the dentist that I go to in Staples has an assistant now who's like a dental or is I forgot the dental therapist I think is what the title is which is doing that kind of a team approach and he can do some fillings and some of the more minor things so right and we're I think we're so fortunate here in Crosby Brainard Staples and even in Wadena in that we have really pretty good health care systems for a rural area and it's just amazing to me how many skilled people there are in the hospitals here I know in Staples we have about 200 specialists that come through that facility in a given year and I know you have this similar thing you have that minimum evasive surgery center in Crosby and you're all doing unique things where is this leadership coming from when you're doing these kinds of things I think the benefit of rural health care and smaller facilities is that the providers and the practitioners have a lot more not just autonomy but a really good working relationship with the administration and the people in the hospital to basically enact change and so I think that that's something that we're very proud of at Coyne Regional Medical Center is that good working relationship between the medical staff and the administration and I would assume that that's probably the case for other local facilities as well how what's one of the the what are some of the real obstacles you see to having women come to you is it because they're just ashamed to talk about some of these issues what do you what do you see I mean I suppose that someone's out there and they don't want to talk to you don't even know they exist anyway but how do you sort of break that barrier to get them to come to you I think that that's kind of a loaded question in a sense that there's no one answer I think part of it is the conditions we deal with and the specialty we're in is more maybe of a personal or kind of private nature I think that as a whole women tend to be the caretakers and make sure that their children spouse significant others extended family are seeking the medical care getting the medical care they deserve and a lot of patients will tell me that you know it's taken me years to come in here because I'm finally getting around to taking care of me and so hopefully you know those are the patients we really want to try to make it an easier process for them because they don't have time to be coming you know every couple months for six to twelve months we want to try to make those services as coordinated and as efficient as possible I would say another thing is maybe just the patients again being caught in between they're done with childbearing they don't feel that they have all the medical issues of someone who's a little bit older and so what's the point I feel fine why do I have to see a provider and that's kind of a passion of mine is really keeping people who are healthy healthy and out of the doctor's office and so doing more on preventative care what are lifestyle things that they can do to take care of themselves providing that counseling or education piece for what might be normal symptoms or these are things I would need to see you back for how about the men how do they fit into this good question so obviously for some of the issues that we're dealing with you know pelvic pain painful intercourse there's more than just the patient at stake and so I try to talk to my patients you know I think this is the message you should communicate to your partner once in a while actually have that partner in the office and so it's helpful for them to bring their concerns or perspectives or these are my concerns I see for her unfortunately in our specialty I can't I don't take care of men so I can't prescribe medications or do things like that but I can kind of gently nudge hey well why don't you talk to your doctor about x y or z so it's not that men aren't welcome it's just a different paradigm in our specialty clinic you've mentioned pelvic pain a number of times what are some of the symptoms that cause this for women it kind of depends on the age group so and that's where when I start thinking about someone who I see on my schedule pelvic pain the first thing I look at is the age and that kind of helps steer me into what might be going on so how I think about it or compartmentalize it is most of the time of people are saying it's in this area immediately people think it must be a gynecologic origin which isn't always the case what I tell my patients is there are a lot of things that have to share a very limited amount of real estate there so it could be the gy n things the uterus the ovaries you could have a cyst you could have a polyp you could have a tumor which doesn't mean cancer it could be benign as well you have the bladder and the urinary system there you have the gastrointestinal system so there's things inflammatory bowel disease irritable bowel syndrome chronic constipation chronic appendicitis gallbladder issues kidney stones kidney infections bladder infections those can all contribute musculoskeletal issues so if someone's had a history of surgery or perhaps trauma things like that I'm thinking about that as well and then there are certain conditions that can kind of exacerbate any of the other things I've mentioned certain psychological disorders chronic pain syndromes fibromyalgia things like that can come into play as well the reason I ask it just seems like we're seeing so many hip surgeries hip replacements knee replacements and I think there's a lot of reasons for that obviously but obesity is certainly one of the challenges we have and you've got obesity is one of your talking points to hear how do you dress obesity with women when they come in and they are obese I think a lot of it depends on their lifestyle you know as postmenopausal women actually one of the things that happens is you end up gaining weight because your estrogen levels decrease and so therefore you have a decrease a lot of times a decreased appetite but your muscle mass also decreases which is a big energy burner and it turns into your subcutaneous fat so therefore you have these obese women and I think we need to approach their lifestyle what are they eating you know what's their diet like are they eating a lot of unhealthy carbs are they eating not very many fruits or vegetables because those are our primary things that we need to transition and eat with healthy carbs fruits vegetables and the other thing is exercise as we become older and transition through metapause our lifestyles changes you know we're not chasing children around anymore we're probably not getting outside as much as well and so we become more sedentary so it's working with those but maybe transitioning to not necessarily maybe going out for a run but using a more of like the weight bands and doing a lot of weight lifting to help increase that muscle mass and decrease the loss of it which is going to burn more energy and burn more calories then you both have specialties in this concept what's the one thing you want a woman to know that's watching the show tonight if you could say one thing tonight that's really important what would it be from both of your specialty areas I would say mine is just the importance of preventative care and not just assuming that conditions or symptoms a patient is having are so called normal that there are things to help especially with incontinence I think that's one that women who have had babies before just assume that's a normal part of being a woman and aging and that's not necessarily the case and so even though it may be a difficult thing to talk about we're certainly sensitive to the fact that it's not an easy thing to talk about with a relative stranger but there are options out there to help you feel better and so we'd like to see you if you're willing to come in that's a good answer how about you Melissa I think you would have to echo on that is bringing these women back the silver tidal way back into the healthcare system and we hear it all the time women have been suffering for you know 10 plus years with their issues because they think that it's quote unquote normal when it's not in a sense and so it's bringing them back seeking their care earlier preventative health is going to be huge in this essence and even with their care you know can we prevent them going from going into cardiac arrest or heart disease by educating them prior to heart disease is the number one killer of women so it's just educating them and educating the population and bringing them back in you know we hear that and I know it's on the news a lot but it seems like most people still won't buy into that right they think it's a problem for men but not for women yep and their their symptoms are different when they're having a heart attack aren't they what would a woman be expecting if she's having a heart attack could you give us a quick rundown of what the symptoms could be yeah most of the time women are going to have more of like the jaw pain and kind of neck pain and not a lot of like chest or down the arm pain they're going to have kind of the vaguer symptoms it could be fatigue shortness of breath feeling tired just not feeling like themselves and it could be of any age just like men right correct you do tend to see a spike in cardiovascular disease after menopause again because of some of the hormonal fluctuations so menopausal status would be something to consider as well as a patient's family history and for most women or for the averages when does menopause hit them so for an average woman but you know non-smoker average age of menopause in the united states is about 51 so late 40s early 50s is kind of that age group when we're thinking menopausal perimenopausal we're out of time and thank you for jumping on with us it's a very interesting concept and we'll have to follow you and see how it goes looking for the opening of your center in probably january of 2019 correct thanks for jumping on appreciate it great job thank you thank you you've been watching lakeland currents where we're talking about what you're talking about i'm rick gildow so long until next time


Hey guys! How are you today? So I am bringing you this short little video really quick that I'm trying to put together and get up onto YouTube and Facebook tonight because it is in preparation for tomorrow's Watercolor Wednesday Live which will be broadcast, simulcast, pretty much from now on I think as long as all my equipment cooperates on both periscope and you stream at the same time. Like I said, equipment, as long as the equipment cooperates we will be doing that. Whether or not it cooperates, you know, I don't know, we'll have to see. Let me just punch these holes before I get too distracted. So from now on we are going to be doing some at least every other week. That's going to be close enough. We're going to be doing some comparisons and we are going to be comparing different brands of paint to each other and making swatches and then doing some little sample painting. So I'm going to show you the little journal that I've put together for this project. This is a Heidi Swap binder that I picked up on clearance on Tuesday morning. Now it was like three bucks or something. I did notice when I got it the tabs like hung out the end. You just saw me cut them off and shorten them and repunch the holes in them.  I didn't like that. You can use anything, something inexpensive. I like the idea of a binder because we can add pages as needed, change them around as needed. You can add tabs. You could make notes if you get flyers from the manufacturer or printouts from the manufacturer. Here's one from Daniel Smith. You could actually, you know, cut it down to size, reformat it. This is a really big one and you could punch holes in it and you could actually get it in here if you have a binder, which so I really like the idea of having a binder. If you had a binder that had a pocket in the cover, you could stick some of these things in the cover. So I do recommend a binder. You only need a couple of sections. So I do have comparisons and samples. These are the tab dividers that came with the binder. I just cut them down and punched holes in them and put a label on it. You can use anything. Use what you have on hand. The pages that you actually do the work on though should be watercolor paper. This is 140 lbs. Draftmore watercolor paper. And on the comparisons one, I created a chart and we'll have the brands here, colors across here, and we'll have six basic colors like yellow, orange, red, green, blue, purple. I think that's what we're going to do. So I'll write the basic colors in here. The brand here, as we do each brand, say Daniel Smith, I want a yellow, but maybe I don't have the exact same color yellow as I have in the brand I'm going to compare it to. I'm going to make sure I write the particular yellow color name. In the Daniel Smith case, it's going to be Hansa Yellow Medium. That name inside the square with the paint swatch. So you want your square, because you're going to be painting and writing in the square, you probably want it to be, these are an inch square, so you want it to be at least an inch. And I used the Sharpie marker pen, which is waterproof, to make the chart. And then in the samples section, each one of these sections is going to have four brands to compare to each other. In the samples section, you want to create four squares to do four paintings with those same sample brands that you did on the sample chart here. So here we're going to just swatch the paint colors and compare them to each other in the different brands, all the different yellows, all the different oranges. And here we're going to create little sample paintings with those same brands of paint. We're going to do this every other week, comparing different brands to each other. There's lots of really great brands of paint out there. Lots of them are really greatly pigmented. Almost all of them have colors that are extremely light fast and some that aren't even rated. Even the Superfine brands like Daniel Smith and Schmink, they have brands, if you look at their chart, that are light fast colors that are light fast, some that are so so and some that aren't even rated. So and that's across the board. So you do want to be aware of that if you're thinking of doing your artwork and archiving it, but we'll go over that in the lessons. I wanted to bring you this quick video. You're going to need some kind of little book. I'd recommend a binder, but if you have a spiral bound book, you can use that. This is nice because you can change the pages around. So get something together, get some paints together and a paintbrush. And let's do have some fun and we are going to compare paint brands. If you don't have a lot to paint brands, that's fine. You can just watch the video and you can decide by what I do, and it's going to fit in your budget and what brand of paint is going to work for you. If you have a few brands of watercolor paint, then of course you can try them in here and this is a good way to compare them to each other. Alright, that's it for right now everybody. Go out and have a great day. Do something nice for yourself because you deserve it. I'll see you later. Bye.