Dennis P. Gruenhagen: Overcoming Great Distances to Receive Care

At 82, Dennis P. Gruenhagen lives in Storm Lake, Iowa, near his hometown, after decades of living in rural Wyoming. Dennis spent 26 years on land he purchased after retiring at 55 to build a home from the ground up, 2 miles off the county road, surrounded by wide‑open space and the horses he cared for.

In September 2021, Dennis was diagnosed with amyloid light‑chain (AL) amyloidosis, a rare disorder arising from abnormal plasma cells that is closely related to multiple myeloma and often treated using similar cancer therapies. His symptoms began a year earlier with swelling in his calf. “My doctors weren’t too concerned at first,” he recalled, as he was referred from one specialist to another. It was only after a kidney biopsy that doctors were able to give him a diagnosis. By this time, his disease was advanced, stage IIIB, affecting both his heart and kidneys.

Dennis began treatment at Mayo Clinic in Rochester, Minnesota. The treatment itself was intensive—chemotherapy injections, dozens of pills, and frequent monitoring. But for Dennis, the most difficult part was not the treatment; it was getting to the clinic.

Living in rural Wyoming, the specialized care he needed simply wasn’t available nearby. His local providers were more than 60 miles away and limited in what they could offer. Recognizing these limitations, Dennis was referred to Mayo Clinic, which meant traveling hundreds of miles for each visit. At Mayo, appointments were dense, sometimes as many as ten in a single day, compressed to minimize the number of trips.

“I had to be at Mayo in Rochester every 2 weeks, and it was 680 miles away,” he said. “So, we worked it out so that I drove almost halfway and then they provided transportation assistance from there.”

The journey required careful planning, physical endurance, and constant awareness of risk. Dennis, in his late 70s at the time, drove more than 300 miles each way before meeting a ride provided by the hospital to continue the trip. Weather conditions, car problems, and long days on the road added new layers of difficulty to an already complex treatment schedule. “The most difficult part was
the time involved and always looking out for the weather,” Dennis recalled. “Once I had a flat tire on the interstate, and at my age, changing a tire is a challenge.”

Still, he persisted, often traveling for days roundtrip just to receive care. Dennis credits Mayo Clinic’s transportation support, in large part, with making his treatment possible. Without that support, he said, he could not have made the trip.

Over time, his treatment proved effective. After about three years, his doctors declared a complete hematologic response, meaning the disease was no longer detectable in his blood. But the impact on his body remained. He developed heart complications and kidney failure, eventually requiring dialysis 3 times a week.

Even then, geography continued to shape his experience. When he later relocated to Storm Lake for care, the local dialysis center had been destroyed by a windstorm. The nearest option was 80 miles away, requiring nearly 500 miles of travel each week to receive life‑sustaining treatment. Eventually, he was able to transfer to a closer facility, cutting his travel distance in half.

Today, Dennis continues dialysis and remains under close medical care. His condition is stable, and his treatment response has been strong. He is grateful for the transportation support that made treatment possible, and clear‑eyed about what its absence would have meant.

When he gave this interview, the Storm Lake dialysis center had just reopened. His first treatment there was the next day. After years of driving hundreds of miles each week for life‑sustaining care, his commute would drop to 2 miles. Dennis’s story is a reminder that for many patients in rural America, where someone lives can determine the care they receive—and that transportation support and local infrastructure are not conveniences, but conditions for survival.