Dr. Melissa Hertler grew up watching and rewatching Westerns with her dad.

“I have always loved the frontier, or cowboy, mentality,” she said. “I think that attitude is still quite pervasive in rural Wyoming.”

Hertler has been practicing her specialty of otolaryngology, otherwise known as being an ear, nose and throat doctor, in the Lander and Riverton area for just over a year now. She said serving the relatively rural communities is a lot different than where she came from.

“There are definite differences from my previous practice in a major metropolitan area,” she said. “I am surrounded by absolutely stellar health-care providers, and it is a more congenial and cooperative environment than I had previously experienced. I truly feel like we are all one team, even though I know that sounds cliché. It’s understood that tomorrow we might be caring for each other. “

The medical situation in Fremont County is broadly nonspecialized, but generally equipped to handle the most common demands for medical needs. The community provides enough support to accommodate uncomplicated pregnancies and deliveries. There’s an emergency room and urgent care clinic, and a small team of health professionals that handle routine medical calls. However, cases that require a higher level of care or monitoring are usually outsources to larger medical facilities in other communities.

“Resources are sometimes limited, and access to tertiary care is several hours away,” Hertler said. “In my previous practice, I never had to consider the weather when deciding to send a patient to a tertiary care center, whether a plane or helicopter could take off or land, or whether the roads would be open.”

Hertler’s work day generally consists of four days of office hours and one day performing surgeries each week. She also takes a shifts at the local hospital emergency room, and takes after-hours calls from patients who are recovering from surgery or have an immediate problem.

“I was getting frequent phone calls at night and on weekends from patients or their parents in the city. However, it is rather rare here,” she said. “People are accustomed to limited availability of every service, including outpatient medicine, and are so much more self-sufficient. They are typically much more apologetic and appreciative whenever I’m needed after hours.

“Also, patients often come from much farther away for health care than in a metropolitan area. I am still getting used to the perception that a few hours’ drive is no big deal.”

Another notable difference about setting up an ENT practice in rural Wyoming is the regional environmental factors that contribute to more complicated cases.

“I’ve noticed that people living in the Wind River Basin have a relatively high incidence of allergies,” Hertler said, noting that even though the region is technically considered to be the high desert, there’s enough greenery, animals, crops growing, and occasional wildfire smoke blowing by to trigger symptoms in many people. If left untreated, severe allergic responses can lead to nasal polyps or chronic sinusitis, and those conditions are definitely better addressed by an ENT.

ENT specialists have more advanced diagnostic and treatment for adults and children, including endoscopy, allergy testing and immunotherapy, among others.

“In both children and adults, I also treat traumatic injuries, including facial fractures and lacerations. We are rural and remote here, and the locals and tourists enjoy some rather dangerous activities, so I have seen some pretty intense trauma in a short time,” she said.

Hertler noted she regularly sees ramifications of the area’s history.

“In this region, uranium miners were exposed to excessive radiation, the effects of which we are seeing in the forms of lung disease and increases in cancers,” Hertler said, adding that another potential source of skin cancers in the area is the sunshine combined with the high altitude.

Hertler’s presence in Fremont County represents a statistical anomaly. According to a 2016 study published by the Ear, Nose and Throat Journal, nearly 62% of otolaryngologists practice in a metropolitan area with more than 1 million people. Those large communities account for only 55.3% of the total U.S. population, meaning cities are oversaturated and rural areas are underserved.

Hertler’s footprint in her community is one that can be mutually celebrated.

“I truly appreciate the role I play in this community, and the trust my patients place in me. It is so good for my soul to believe that I am making a difference here every day,” Hertler said.

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