vol: 4 issue: 4
Path out of
Pain
Boone Hospital team helps Belinda Heimericks of Tebbets, Missouri, escape severe knee arthritis
A Columbia man fights cancer with activity and a positive attitude
Table Of Contents Page 10
Page 12
Boone Hospital Center’s mission is to improve the health of the people and communities we serve.
Jim Sinek
Page 20
President
Ben Cornelius Communications and Marketing Manager
Jessica Park Marketing Coordinator Photos By
Dave Hoffmaster Jessica Park
Page 18 5...................................................... A Note From Boone Hospital President Jim Sinek
Contributing Writer
Jacob Luecke
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myBoone Health Stories
8................................................................................................................ Hospital Headlines 10......................................................................................................................... Follow us on Facebook, Twitter
Grin & Beat It
12............................................................................... A Modern History of Breast Cancer
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14..................................................................................................... Cancer Free, However ...
Please submit comments
17............................................................................................................ Advanced Directives
or feedback to bcc1170@bjc.org
18........................................................... Self-Advocacy: When to Get Health Screenings
or call 573.815.3392
20............................................................................................................... Beyond Speechless
1600 East Broadway Columbia, MO 65201 573.815.8000
22.................................................................................................................... Path out of Pain
For a free subscription, call 573.815.3392 or visit myBooneHealth.com and click on the subscription link on the right side of the page.
24.............................................................................. New Cafeteria Opens in November 26............................................................................................................
Health Hall of Fame
28........................................................................................ Getting To Know A BHC Doctor 29.......................................................................................... Getting To Know A BHC Nurse 30...........................................................................................
Foundation Finds New Home
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A Note From Jim
What Health Care Awards Mean For You
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ealth care awards and rankings among hospitals and health care organizations are an important measure of quality of care, expertise and overall performance. Boone Hospital Center recently has been recognized with some of the nation’s highest honors. More importantly, the recognition is a testament to our commitment of world-class patient care and a reflection of the Boone experience. In the recent U.S. News & World Report annual hospital rankings report, Boone Hospital was among the top four hospitals in the state of Missouri. Boone was rated as the area’s highest in the category of recommending a hospital to family and friends. In addition, Boone was the only hospital in central Missouri to be recognized as high-performing for cardiology and heart surgery, gynecology and geriatrics. Overall, the hospital was recognized by U.S. News & World Report for eight high-performing specialties:
Jim Sinek President Boone Hospital Center
◗ Cardiology and heart surgery
◗ Nephrology
◗ Gastroenterology and gastrointestinal surgery
◗ Orthopedics
◗ Geriatrics
◗ Pulmonology
◗ Gynecology
◗ Urology
Becker’s Hospital Review has recently released several top 100 service line lists for 2014 that include Boone Hospital Center. To date, Boone has been recognized by the publication as having nationwide top 100 oncology, heart and orthopedic programs. These rankings are a reflection of our incredible team of physicians, nurses, clinical and support staff that work each day to uphold our high standards and deliver the Boone experience to patients in the communities we serve. In addition to these rankings, Boone Hospital Center has attained Magnet® recognition for the third consecutive time. This designation is part of the voluntary credentialing program of the American Nurses Credentialing Center’s Magnet Recognition Program®. Magnet recognition is the highest honor a health care organization can achieve for nursing excellence. With the third designation, Boone joins an exclusive group of less than 1 percent of hospitals worldwide to have achieved the Magnet recognition three times. For Boone Hospital patients, Magnet recognition means the best-trained and most qualified nurses in the industry are caring for them. The result is higher satisfaction rates and improved outcomes for our patients. Whether you are a surgery patient, new mother or visiting a loved one at the hospital, we believe the Boone experience is important. And it appears those that recognize hospitals for excellence agree.
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myBoone Health Stories Visit myBooneHealth.com To Read More — And Share Your Own Story
Intensive Care Nursery Staff and Families Reunite
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oone Family Birthplace hosted its 17th annual ICN Reunion at Cosmo Park in Columbia on Saturday, Sept. 27. The event reunites children who have “graduated” from the hospital’s Level III Intensive Care Nursery and their families with Boone Family Birthplace nurses. The reunion, which includes fun activities, treats, a group photo and a prize drawing, has grown in popularity as new families join returning families, some of whom travel from out of state to see old friends again. “The Intensive Care Nursery Reunion contributes to the continued well-being of our graduates, their families and our staff. It’s very meaningful for all who are involved,” says Laura Noren, service line director for Women and Children’s Health. “The infants cared for in the ICN are at high risk, and emotions run high in their families. No matter the specifics of each baby’s situation, a bond develops between families and caregivers that lasts a lifetime. The reunion is a wonderful way for nurses, physicians and other caregivers to see the outcomes of their exceptional care when they see our graduates growing up as healthy, happy children.” Each year’s event has a special theme. Past themes have included Dr. Seuss, safari and bees. This year, our ICN graduates went under the sea. Look for reunion pictures on our Facebook page at facebook.com/BooneHospitalCenter.
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Share your story myBooneHealth.com
Professional Care and Compassion Mindy Cunningham
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n March 17, 2014 (St. Patrick’s Day), my husband and I welcomed our second child at Boone Hospital. We not only received extreme professional care, but we also got compassion, love and TONS of support from our doctor (Dr. Sarah Bernard), son’s doctor (Dr. John Pecorak) and several of the amazing nurses that are staffed at Boone Hospital. We have always been huge supporters of Boone Hospital since our daughter was born there in 2005, and will continue to sing praises of how awesome the hospital and staff are! :)
Encouragement and Reassurance Kimberly Mason
I felt like I was being silly about my delivery. I was in a lot of pain, but elected not to have an epidural. My nurse gave me IV pain meds as often
An Early Lesson In Parenthood Michelle Teti
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e had a beautiful baby boy — Alex Wren — on August 20, 2014, at Boone Hospital. Alex is healthy, which is all that matters in the end, but the birth did not go exactly as expected. At the last minute we needed a C-section since he was not in the right position. We were trying for (and succeeding!) in having a natural birth, so this was not part of the plan — an early and important parenthood lesson. Dr. Roelands provided ongoing support, calm guidance, information, and as many options as possible. She made the experience as stress-free as she could, and we knew we were in good hands. She visited us frequently and at every stage of labor to help. I am so glad I chose to work with her for this experience. We also benefited from care and support from Brandi, our labor nurse, and from Chanda, Amira, and McKenna in post-partum. They took the time to answer our questions and help us through this special time. Thank you to everyone at Boone!
as she could. It was a lot of pain right before I delivered. The whole staff kept encouraging me and reassuring me that I could do it. As I approached the home stretch, I couldn’t help but push. My nurse tried to call for my doctor, but it was too late. The next thing I know I am holding my daughter. I was very pleased with the team I had assisting in my delivery. My nurse did a great job!
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Hospital Headlines News From Boone Hospital Center
Boone Hospital Center Receives Highest Nursing Credential
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oone Hospital Center has attained Magnet® recognition as part of the American Nurses Credentialing Center (ANCC) Magnet Recognition Program® for a third consecutive time. The distinction places BHC in a select group of less than 1 percent of hospitals internationally to have achieved the recognition three times. Magnet recognition is the highest honor a health care organization can receive for professional nursing practice. “For Boone Hospital Center to have achieved this designation for a third time exemplifies the exceptional level of class, competency and dignity of our nursing staff,” says Mary Beck, Boone Hospital Center vice president and chief nursing officer. “It truly is a monumental achievement for Boone Hospital Center and for health care in Missouri.” The Magnet program focuses on superior clinical care outcomes by advancing three goals: promoting quality of care, identifying excellence in the delivery of nursing services to patients, and
disseminating nursing care best practices. To achieve Magnet recognition, organizations must pass a rigorous and lengthy process, requiring widespread participation from hospital leadership and staff. “Magnet recognition means high job satisfaction, autonomy in practice and high quality of care for over 500 Boone Hospital Center nurses,” says Laura Noren, Magnet program and service line director. “Being cared for by the best-trained and most qualified nurses results in higher satisfaction rates and improved outcomes for our patients.” Boone Hospital Center was initially designated a Magnet hospital in 2005 and received the credential again in 2009. Hospitals must reapply for Magnet recognition every four years. Magnet recognition has become the gold standard for nursing excellence. The U.S. News & World Report annual showcase of “America’s Best Hospitals” includes Magnet recognition in its ranking criteria for quality of inpatient care. Recently, Boone Hospital Center was ranked as one of the top four hospitals in Missouri in the U.S. News & World Report rankings.
Coming Soon: New Cardiology Clinic Opening in Macon Missouri Heart Center will be opening a new clinic this November at 403 Providence Road in Macon. The new clinic will offer a full array of noninvasive cardiac diagnostic services including stress testing, echocardiography, vascular ultrasound and nuclear cardiac imaging in addition to cardiology consultation services. The clinic will be open Monday through Friday from 8 a.m. to 4:30 p.m. Physicians staffing the clinic include John Baird, MD; John Boyer, MD; David Brown, MD; James Elliott, MD; James Fairlamb, MD; Sanjeev Ravipudi, MD; Trung Tran, MD and William Woods, MD. Missouri Heart Center is the cardiology and cardiothoracic surgery physician group affiliated with Boone Hospital Center. The service line was recently recognized by Becker’s Hospital Review as one of the nations “100 Hospitals and Health Systems With Great Heart Programs.” 8
Fall 2014 BOONE HOSPITAL CENTER
The latest news boone.org
About The BJC Collaborative LLC
Local Hospital Tops U.S. News & World Report Rankings
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oone Hospital Center and two other BJC hospitals have earned top rankings for the state of Missouri by U.S. News & World Report. Boone Hospital Center ranked No. 4 overall. In addition to Boone Hospital Center, BJC’s BarnesJewish Hospital, ranked No. 1, and Missouri Baptist Medical Center, ranked No. 3, were also among the top hospitals in the state. BJC Collaborative member, Saint Luke’s Hospital in Kansas City, Mo., was ranked No. 2. Boone Hospital Center is a part of the 36-hospital BJC Collaborative, formed in 2012. Boone Hospital Center was recognized by U.S. News for eight high-performing specialties, including cardiology and heart surgery, gastroenterology and gastrointestinal surgery, geriatrics, gynecology, nephrology, orthopedics, pulmonology and urology. Boone Hospital Center was rated as the area’s highest in the category of recommending a hospital to family and friends. In addition, Boone Hospital Center
was the only hospital in central Missouri to be recognized as high performing for cardiology and heart surgery, gynecology and geriatrics. “Our ranking is a testament to the incredible team of physicians, nurses, clinical and support staff who work each day to provide world-class patient care to the communities we serve,” says Jim Sinek, Boone Hospital Center president. “To see Boone Hospital Center, along with two other BJC hospitals, among the top four ranked hospitals in the state is special. It’s an indication that our incredible team extends well beyond the walls of Boone and that patients can count on us for their care.” The U.S. News & World Report Best Hospitals Report has been released annually for 25 years. In the past three years, U.S. News has released state and metropolitan rankings to assist consumers in identifying the best hospitals in their communities. Reports include key information on nearly 5,000 medical centers across the United States.
The BJC Collaborative was created in October 2012, when BJC HealthCare in St. Louis, CoxHealth in Springfield, Mo., Memorial Health System in Springfield, Ill., and Saint Luke’s Health System in Kansas City, Mo., partnered together with a goal of achieving even higher quality care for patients served by the independent nonprofit health care organizations. Blessing Health System and Southern Illinois Healthcare joined in 2013. The Collaborative is focused on delivering clinical programs and services to improve health care quality, lowering health care costs and creating additional operational efficiencies for the benefit of patients and communities served by the member organizations. Together, these 36 hospitals account for:
6,265 beds 284,807 admissions 58,653 employees 6,043 affiliated physicians BOONE HOSPITAL CENTER Fall 2014
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Grin & Beat It Active lifestyle helps Columbia man fight cancer with a positive attitude By Jac o b lu e c k e Phil Griggs likes to do a simple workout routine — lift weights one day, run three miles the next. It’s a basic formula that, at 55, has kept him strong, healthy and happy in his life as well as his work as a busy sales manager. But earlier this year, the workouts suddenly became harder to complete. One day, as Phil ran alongside his daughter, he was finding it very difficult just to keep up. “A little over halfway, I had to take a break,” he says. “Then toward the end, with just three-tenths of a mile left, I just had to quit.” It was very unusual for Phil to get so exhausted during his runs. He thought maybe it was just a fluke; perhaps he would feel better the next time out. But two days later, he did even worse. He couldn’t even run two miles. Concerned, he decided to see his family doctor, Lyndell Scoles, MD. After some blood work and an abdominal CT scan, Phil received a preliminary diagnosis — lymphoma, a cancer of the immune system. “I’ve been healthy all my life and very active,” Phil says. “I’m one of those people who says, ‘Cancer, that’s not me, I’ll never get that. That’s somebody else.’ So it was really a major shock.” Phil was referred to Missouri Cancer Associates, the physician practice affiliated with the Stewart Cancer Center at Boone Hospital. There, Michael Trendle, MD, confirmed that Phil had cancer.
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Phil’s specific diagnosis was mantle cell lymphoma. There are many varieties of lymphoma, which are generally broken down into two subgroups — Hodgkin’s disease and non-Hodgkin lymphoma — depending on what cells the cancer is impacting. Phil’s mantle cell lymphoma is a non-Hodgkin lymphoma. Dr. Trendle discovered it had already attacked several lymph nodes in Phil’s abdomen, signaling that it was a fast-spreading variety. Dr. Trendle says Phil’s type of cancer accounts for seven percent of all non-Hodgkin’s cases. Statistics show that out of
have cancer and you don’t know what’s going to happen.” Yet the outlook was far from hopeless. While Phil’s lymphoma was aggressive and spreading quickly, Dr. Trendle knew that this cancer also retreats when faced with chemotherapy. “This is a potentially curable form of lymphoma,” Dr. Trendle says. “The chances of chemo working and putting it in complete remission are 70-80 percent.” Even more, with Phil’s good physical condition, he would likely be a strong candidate for having a stem cell transplant, which would lessen the
“I’m one of those people who says, ‘Cancer, that’s not me, I’ll never get that.’” a million people, between four and eight patients will receive this diagnosis each year. Dr. Trendle also found the reason for Phil’s fatigue. With the cancer invasion, Phil’s immune system had begun destroying his own red blood cells, a problem called hemolytic anemia. While this bad news was hard to hear, it was just as difficult for Phil and his wife to then share the diagnosis with their three children. “That was a tough day,” Phil says. “I think that’s the toughest thing in the world to tell your kids that you
likelihood that the cancer would come back and increase the chance of a cure. Before long, Phil was at the Stewart Cancer Center for the first of four cycles of chemotherapy. Phil would spend about 10 days in the hospital for each session. He quickly became acclimated to the Stewart Cancer Center facility and staff. “The whole hospital experience, I couldn’t ask for any better care, any better support,” he says. “I’ve had better service here than I’ve ever seen in my life.” Despite being in the hospital, Phil was determined that his life should
go on — and the staff worked with him to accommodate his needs. He continued working as a sales manager while in the hospital, holding conference calls from his room. He also wanted to keep physically active. At first, Phil tried walking briskly through the hospital corridors. But he worried he might accidentally bump into another patient, possibly hurting someone. He talked with his nurses, and they arranged for Phil to get access to the hospital’s physical therapy floor, which had treadmills. “It meant so much for them to go out of their way and make that extra effort,” Phil says. Dr. Trendle praised Phil’s positive attitude and his commitment to keeping active during his treatment. “You want to do everything you can to maximize your sense of wellbeing,” he says. “Exercise is a way of doing that.” While Phil and his family await his next round of scans, which will show how much the cancer is retreating, Dr. Trendle says that Phil’s improving symptoms and
recent blood tests show signs that the chemotherapy is working. Seeing this progress is rewarding to Dr. Trendle, who says he enjoys doing whatever he can to improve a cancer patient’s life. “It’s all about trying to help people live as long and as well as they possibly can with the disease and the challenges that they face,” Dr. Trendle says. “I wish everyone could be cured. But even when a cure is not possible, you want to do what you can to control their disease, control their symptoms and maximize quality of life.” As Phil continues his treatment, he is determined to move forward with an optimistic outlook and an upbeat demeanor. He feels fortunate to have his family, his community and his team of caregivers fighting at his side. “I don’t think that you can ever know that you’re going to get cancer,” he says. “You have to have faith in God, yourself, family, friends as well as the people that are taking care of you. You will have your up days and your down days, but you have to surround yourself with strong supportive people. You really have to be positive.”
Top: Phil Griggs working from his hospital room; Middle: Exercising on the physical therapy treadmill; Bottom: Griggs with nurse Ashley Johnson
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A modern History of
breast cancer
I By opening up about her experience as a breast cancer survivor, Betty Ford shed light on a growing movement. Learn more: boone.org/breastcenter
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By J e s s i ca Pa r k
n October, the leaves turn gold, red and orange. Everything else turns pink, from yogurt lids to NFL games. Even the White House glows pink for one evening. After seeing what feels like your millionth pink ribbon in support of breast cancer research and awareness this October, it is hard to imagine a time when it was taboo for a woman even to discuss her own breast cancer outside of an examination room. But it’s a time within living memory — it was only 40 years ago when a breast cancer patient shared her diagnosis and experience with the country. And that patient lived in the White House. In September 1974, Betty Ford, then First Lady of the United States, underwent a radical mastectomy for a lump found in her breast during a routine mammogram. While in the hospital, Ford thought about other women in her situation. Breast cancer had been recorded as far back as 1600 BC, by ancient Egyptians. However, because of associations with female sexuality, 2,700 years later, breast cancer remained a taboo subject. And that taboo often had grave consequences; women hid the condition from their families and avoided discussing it with their male doctors. A shameful silence was causing women to die. “That realization made me decide to discuss my breast cancer operation openly, because I thought of all the lives in jeopardy,” Ford said in a 1975 address to the American Cancer Society. While Ford was not the first to go public with her experience — former child actor Shirley Temple Black had written a book about her breast cancer
two years prior —Ford’s prominence drew significant attention. And people listened. In the months following her revelation, it was reported that tens of thousands of women scheduled mammograms. Weeks later, Happy Rockefeller, wife of then Vice-President Nelson Rockefeller, also had a mastectomy for a malignant lump in her breast and joined Ford in a public discussion about self-examinations, mammograms and the importance of seeking early medical treatment. By opening up about her experience as a breast cancer survivor, Betty Ford shed light on a growing movement, in public and medical communities, to expand breast cancer research, promote early detection, and advocate for breast cancer patients. These issues overlapped with ongoing movements for women’s equality and patient rights. Passage of the Title IX educational amendment in 1972 led to more women entering medical school. Meanwhile, female patients started to feel more empowered in making medical decisions about their bodies. During the 1980s and 1990s, advocacy groups like the National Breast Cancer Coalition and charities like Susan G. Komen for the Cure worked to expand funding for research, improve access to women’s health and guide public policy. In 1974, the five-year survival rate for American women treated for breast cancer was around 75 percent. Today, that number is 90 percent. Forty years later, flared-leg pants might be making a comeback, but suffering in silence has gone the way of the 8-track cassette.
detection
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n 1974, the mammogram, a low-dose x-ray image of the breast, was relatively new as a diagnostic procedure. Mammograms are still done today, although images are now captured digitally rather than printed onto film, with greater clarity. “The technology has definitely improved over the last 20 years. When we went into the digital era, we were able to see through a lot of the tissue density that we couldn’t see through on film,” says Terry Elwing, MD, a radiologist with Boone Hospital Center. This summer, Governor Jay Nixon signed a bill requiring health care facilities that provide mammograms to notify all patients that women with dense breast tissue might benefit from additional screenings suggested by their physician, because dense breast tissue can obscure abnormalities on a mammogram. The bill goes into effect on Jan. 1, 2015. Currently, Harris Breast Center patients are evaluated for breast cancer risk factors when they arrive for their screening. Women who meet 20 percent or greater of these risk factors are recommended to have an MRI screening. And all Harris Breast Center patients receive an additional breast screening known as 3-D tomosynthesis, which takes cross-sectional images of the breast. Earlier this year, the Journal of the American Medical Association published results of a study that found that adding 3-D tomosynthesis to digital mammograms improved detection rates and reduced
treatment
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n 1974, all malignant lumps in the breast were treated with a modified radical mastectomy, a surgery involving removal of the breast tissue and all of lymph nodes in the armpits. “It used to be that the surgeon would paternalistically tell the patient, ‘You need a mastectomy’ and his attitude was ‘You’ll do what I say,’” says Mary Muscato, MD, a hematology oncologist with Missouri Cancer Associates. “There’s a dialogue. Doctors listen to patients now.” Breast cancer is no longer treated with a one-size-fits-all mentality. There are various approaches based upon the type, size and extent of the malignancy, as well as the patient’s health and preferences. Patients may undergo a simple mastectomy,
the rates of false positives and the need for patients to return for additional screens. This was not news to Dr. Elwing, who was instrumental in starting 3-D mammography at Boone Hospital Center in 2012. “We’d predicted that this was coming years ago and aligned ourselves to have the resources to implement 3-D tomography when it became available,” Dr. Elwing says. The current screening recommendations are for an annual mammogram beginning at age 40, with an earlier start recommended for those with a family history or high risk factors. “There’s been some confusion about that, but the screening recommendations have not changed,” says Dr. Elwing. “The American Cancer Society, the American College of Radiology and many other medical organizations still recommend annual screenings after 40.” While technological advances have improved breast cancer detection, they do require that women actually get these recommended screenings. Dr. Elwing notes: “All breast cancer is treatable — even metastatic disease can be treated and patients can live for many years — but screening lets us find cancer when it’s smaller and we can cure it.”
where only the breast tissue is removed. Some patients with small, discrete malignancies may undergo a lumpectomy, and a sentinel node biopsy allows surgeons to target and remove specific lymph nodes the cancer is likely to spread to. “Instead of removing 30 or 40 lymph nodes, they can remove 3 or 4,” says Dr. Muscato. “There’s less pain and much greater range of movement in the arm after surgery.” Forty years ago, a breast cancer patient’s concerns about her appearance were usually dismissed by the surgeon. Dr. Muscato always discusses the patient’s concerns and her options for and interest in reconstructive surgery, with no assumptions that every patient wants the same thing. Dr. Muscato has seen a marked improvement in chemotherapy and hormone therapies for breast cancer
In May 2013, actress Angelina Jolie wrote an op-ed in the New York Times about her decision to undergo a double mastectomy, after genetic testing revealed she carried a defect in a gene known as BRCA1. Patients with this defect have a very high risk of breast and ovarian cancer. Jolie reported that her doctors estimated her risk of breast cancer at 87 percent.
patients: “We have shorter, better treatments now that are more effective and less toxic.” Advances include targeted therapy, which attack cancer cells with specific markers, such as estrogen. There are new medicines that suppress nausea or increase white blood cell counts after a patient receives chemotherapy, reducing the severity of fatigue and risk for infection. The patient’s emotional experience is also an important part of breast cancer treatment. “Breast cancer is still a private, painful, psychological thing to have to deal with,” says Dr. Muscato. “The symptoms from treatment are unpleasant. But you’re allowed to talk about it now. And talking about it has helped patients realize there are so many more people who have had it and are doing fine now. They learn that they’re not alone.”
Dr. Muscato says that preventive mastectomies like Jolie’s are effective for women with a defect in BRCA1 or BRCA2 or for women who have had cancer in one breast: “If you have that gene or have had cancer before, you would do better to undergo the surgery now. Why risk the pain of having breast cancer or enduring chemotherapy on top of surgery, if it’s almost certain you’ll get it someday?” In September 2014, the National Health Service in the United Kingdom reported that within months after Jolie’s piece was published, referrals for genetic testing for breast cancer doubled. Betty Ford would be proud.
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Steve Downes
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Fall 2014 BOONE HOSPITAL CENTER
cancer free, however ... teamwork saves columbia man after screening detects deadly condition By Jac o b lu e c k e
T
here were plenty of good reasons for Steve Downes to get a lung cancer screening at Boone Hospital Center this spring. For starters, Steve, 54, was a smoker for most of his life before quitting a couple of years ago. His decades of smoking put him at risk for cancer. Another good reason to get screened was that the procedure would cost him nothing. The Stewart Cancer Center lung screenings are paid for by donations to the Boone Hospital Foundation. Steve also could have felt compelled to get screened due to his longstanding friendship with Norm and Virginia Stewart — the leading local voices in the fight against cancer through their charitable work and as the namesakes of the Stewart Cancer Center. But for Steve, one other reason trumped all the rest. “I did it to make my wife happy,” he says. Steve is the kind of guy who avoids medical care if possible. In fact, prior to his screening, he hadn’t seen a doctor for 10 years. He figured if he felt good, why bother? So it took some convincing by his wife, Janice Downes — a radio personality on NashFM 100.1 — to get Steve to agree to the screening. Janice even called Boone Hospital herself to make Steve’s appointment. Then she called again when he missed that first appointment. After all, why not get screened when the technology at Boone Hospital can detect cancer early on, when it is tiny? But Steve’s screening ended up detecting something big — and it wasn’t cancer.
“Walking time bomb” As the nurse navigator at the Stewart Cancer Center, Mung Chin helps guide people through the complexities of a cancer treatment plan. She’s also the person who calls patients with the results of their lung cancer screenings.
On the morning of May 14, Mung was reviewing Steve’s report before calling him. The report came back clear for cancer. However, Maxwell Lazinger, MD, the radiologist who read the scan, noted that Steve did have an abdominal aortic aneurysm. When Mung called Steve, she gave him the good news about cancer, but also shared the aneurysm finding. She said she would send him information about how to get that checked out. But after the call, Mung decided to go a step further. She was concerned the aneurysm might be serious. “Although I am not a vascular nurse, from my experience working with oncology patients — some could be really sick when they come to the hospital — I learned to be more cautious when it comes to a medical condition,” Mung says. “As a health care provider, one cannot simply assume that the person understands the severity of the problem and will take care of it as recommended. What’s more, it seemed that an aneurysm this size warranted some immediate attention.” So she researched abdominal aortic aneurysms. She then reached out to Angelee Geisler, a nurse practitioner who works closely with Boone Hospital cardiac surgeon Joss Fernandez, MD, of Missouri Heart Center. They decided Steve’s problem might need immediate attention. Angelee offered to have Steve see Dr. Fernandez the next day. So Mung called Steve once more, discussed the potential severity of the aneurysm and offered the appointment with Dr. Fernandez. The urgency caught Steve off guard. “It was kind of scary,” he says. “I’ve been healthy all my life. I’ve broken bones through sports and stuff, but I’ve never had any kind of issues at all, ever. It was a shock.”
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However, Steve knew that aneurysms could be serious. His father, Ed Downes, twice had surgeries to fix aneurysms. His grandfather had died from an aneurysm. “All of the sudden, I was a walking time bomb,” he says.
Collaborative effort The next day, Steve was back at Boone Hospital where he had a CT scan, this time focusing on his abdomen. The scan determined his aneurysm measured 6.4 centimeters. Left alone, an aneurysm that size has a 14 percent chance of rupturing per year, Dr. Fernandez says. If a rupture occurred, Steve would likely die. Dr. Fernandez wanted to act quickly, scheduling a surgery for the following week. Steve also consulted his friend, cardiologist William Woods, MD, who agreed with the assessment and advised that Dr. Fernandez was the best surgeon for the job. A week later, Steve was back for the surgery. During the procedure, Dr. Fernandez placed a stent to reline Steve’s aorta, keeping blood from entering the aneurysm. The surgery went smoothly. “His prognosis is excellent,” Dr. Fernandez says. “I get great satisfaction from turning a life-threatening, scary situation into a friendly and comforting experience.” As he recovered at Boone Hospital, Steve was very pleased with the care he received. “Everything was as peaceful and as calm as it could be throughout the procedure,” he says. “Everybody in the hospital was great.” He also was impressed by Dr. Fernandez. “Not having a lot of experience with doctors as a patient, I was extremely happy,” Steve says. “He was a nice guy, straightforward, told me exactly what was what.”
“I’ve been healthy all my life. I’ve broken bones through sports and stuff, but I’ve never had any kind of issues at all, ever. It was a shock.” Steve’s experience also stands as an example of how the collaborative environment between disciplines at Boone Hospital leads to quick, life-saving treatment. “At other medical centers I have worked at, getting another specialist to see your patient requires setting up an appointment through their staff and sending medical records, which leads to delays,” Dr. Fernandez says. “The coordination between disciplines at Boone is as simple as a cell phone call direct to the doctor or nurse coordinator.” So while Steve’s lung cancer screening didn’t find cancer, it still saved his life. “If it wouldn’t have been for that lung screening, I would have never found the aneurysm,” Steve says. “I probably wouldn’t be here.”
Help Norm and Virginia save lives In his job, Steve Downes inspects roofs, estimates damage and sells repair work. Not long after the surgery to repair his aneurysm, he found himself inspecting Norm Stewart’s roof. “I got to thank him for basically saving my life,” Steve says. The lung cancer screening that detected Steve’s aneurysm was funded by donations to the Stewart Cancer Center — named for Norm and Virginia Stewart — through the Boone Hospital Foundation. Working alongside Norm and Virginia Stewart, the Boone Hospital Foundation has been raising funds to provide lung cancer screenings free of charge to patients who meet the screening criteria. The service to the Stewart Cancer Center is just one aspect of the foundation’s many roles inside Boone Hospital, where it works to enhance the care and create a more comfortable healing environment for patients. To learn more about the foundation’s work or to make a donation, visit boone.org/foundation. 16
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Advanced Directives Communication for the End of Life
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ne of the most difficult conversations you can have with your loved ones is also one of the most important — your wishes for health care at the end of your life. We have seen many news stories where families are in heated dispute about end-oflife care for a parent, spouse or adult child. These unfortunate stories underline the importance of talking with your family, your health care providers and your religious leaders about your plans for end of life, especially if you should become unable to express your wishes. Open communication and the preparation of an advance directive can help secure the care you want and prevent your loved ones from having to make these difficult decisions for you. An advance directive is a document used to communicate a patient’s health care decisions, should he or she be unable to communicate. There are two types of directives: Health Care Choices Directive and Durable Power of Attorney (DPOA) for Health Care Choices. Advance directives allow you to state exactly which treatments you do or do not want to receive should you be unable to communicate your wishes. An advance directive should not be confused with a living will; they’re not the same thing. Living wills typically apply only when you Advance directives are near death and do not cover options for some treatments, such as allow you to state the withdrawal or withholding of artificial nutrition and hydration. exactly which Advance directives address these issues and provide specific treatments you do instructions for your health care team and DPOA. The documents go or do not want into effect only when you are incompetent, i.e., currently incapable, physically or mentally, to communicate your wishes about your to receive should continued medical treatment. you be unable to At Boone Hospital Center, we recognize that advance directives communicate your are an essential part of your health care and respect your right to wishes. make decisions about your own medical care. Every time you come to our hospital, you will be asked about your advance directive to ensure that a current directive is on file in your medical record. It’s important to make a current copy of your advance directive available and accessible to your doctor, the person(s) named in your DPOA, your family, friends and clergy. Many people travel with a copy of their advance directive form in case of an emergency. The Missouri End of Life Coalition and Missouri Attorney General Chris Koster provide information and approved advance directive forms in their Life Choices pamphlet. This pamphlet is available to patients at Boone Hospital Center and can also be downloaded as a PDF file from the Attorney General’s website (www.ago.mo.gov), using the “Consumer Publications” link at the bottom of the home page. But documents are only one part of communicating your wishes for end-of-life care. Conversations with your doctor, family and religious leaders are also important. You have the right to make decisions about your health care; a discussion about end-of-life matters, including your advance directive, with your family and health care providers will help them better understand and honor your decisions.
Boone Hospital Center is hosting two conferences on advance directive planning for endof-life decisions. Conference attendees will learn: To facilitate discussions about what end-of-life choices are available Guidelines for having these discussions To effectively communicate these choices to the family, physicians and health care team
Conferences will be held on October 30 and November 20 from 8 a.m. to 5 p.m. at Boone Hospital Center. To register for one of these events, please call 573-8156021. This program is offered free of charge thanks to generous donations from the Boone Hospital Foundation.
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Self-Advocacy By Pam Jones RN, BSN
✚ Preventative health screenings done at the right time can be a cost-effective way to find and treat disease early. A screening will not always prevent disease, but screenings can detect health problems before they worsen or even start. The types of preventative screenings you should receive should be discussed with your health care provider and will depend on your age, gender and individual risk factors. It is important to be informed and proactive in making decisions about your health. To self-advocate, take time to select a health care provider who you are comfortable 18
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with, know which preventative screenings you require, prepare for your appointments by listing which medicines you take and why you take them, and learn your family healthy history, especially in your parents, grandparents and siblings. It is also important to understand your health plan and what it covers — some preventative screenings might be covered without out-of-pocket costs. Although screening recommendations vary by organization, below is a list of commonly prescribed preventative screening tests and when and how often you should get them.
When to Get Health Screenings Blood Pressure
CHOLESTEROL
At least every 6-12 months for a healthy adult
Yearly after age 35 for a healthy adult
At least once for females over age 65
One-time test between the ages of 65-75 if you smoke or are a former smoker
MAMMOGRAM
Yearly for women over age 40 (American Cancer Society)
SKIN CANCER
CERVICAL CANCER (PAP TEST)
Self-checks monthly
Professional skin check yearly
Every 1-3 years over age 21, or sooner if sexually active before age 21
Self-checks monthly
Professional check if there is a problem (lumps, bumps, pain)
Every 10 years for a healthy adult over age 50
BONE DENSITY
ABDOMINAL AORTIC ANEURYSM
TESTICULAR CANCER
COLONOSCOPY
PROSTATE CANCER PSA (BLOOD TEST)
DRE (DIGITAL RECTAL EXAM) Every 2 years between ages 55-69 Every 2 years after age 55 (American Urological Association)
BLOOD SUGAR
Every 3 years for healthy nondiabetic adults Yearly for those over age 50 or with risk factors for diabetes
LUNG CANCER Criteria one • Age 55-74 and • Greater than or equal to a 30 pack-year history of smoking and • Have quit smoking less than 15 years ago Criteria two • Age greater than 50 and • Greater than or equal to a 20 pack-year history of smoking and • One additional risk factor: o Second-hand smoke
o Family history of lung cancer o Exposure to substances known to cause cancer
GLAUCOMA EYE TEST Healthy Adult Ages 40-54 Ages 55-64
Every 2-4 years
Every 1-3 years Every 1-2 years
Ages 65 and older Every 6-12 months
HIV
At least once between the ages 13-64
o Exposure to radon o Exposure to asbestos o Military exposure to Agent Orange
o Having diseases such as COPD, emphysema, chronic bronchitis or pneumonia
Beyond Speechless Suffering a Rare Stroke, a Young Mother Turns to Boone Hospital hen Kristie Francis looks back on how far she’s come over the last year, it’s hard for her to put everything into words. “Sorry, give me a second,” she says. “It takes a minute to put it all together as a sentence.” Like many stroke survivors, Kristie has had to relearn how to do many things this year. Speaking is one of them. In a moment, the words come. “It was a lot of work, but I didn’t do it on my own,” she says, mentioning family, friends and medical caregivers. “I had to learn patience. But it was worth it.” Last year, Kristie, 33, was working as a parole officer. She lived in Vandalia with her young daughter, Emma. All her life, she had tried to take care of her body — eating right, walking and doing weight
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training. As a result, she never had any serious health problems. “I’ve been really healthy,” she says. “I didn’t think this would happen to someone so young and healthy.” Indeed, none of the typical stroke risk factors applied to Kristie — age, heart problems, high blood pressure, cholesterol, diabetes, smoking, obesity, family history. That’s what made the night of Jan. 6 such a shock. As Kristie slept that night, she suffered a stroke. By the time she awoke, she couldn’t speak or move the right side of her body. “I had no idea what was going on,” she says. An ambulance arrived and took her to Boone Hospital’s Stroke Center, which has earned distinction from both The Joint Commission and the American Heart Association.
Once at Boone Hospital, the Stroke Center team evaluated Kristie’s signs and symptoms to confirm she was indeed having a stroke. Doctors then performed a CT scan, showing her left internal carotid artery was obstructed. There were areas of her brain that would die if blood flow wasn’t restored quickly. “Her stroke is one that had potential to lead to significant disability, possibly death,” says neurologist Myles Goble, MD, of Neurology Incorporated, who helped Kristie as part of Boone Hospital’s Stroke Center team. Caregivers then quickly took Kristie to Boone Hospital’s interventional radiology suite where radiologist Andrew Getzoff, MD, of Radiology Consultants, threaded a catheter from an artery in her leg up to her brain. He used clot-busting medication to restore much of the blood flow to her brain. She was going to survive. Kristie doesn’t remember much from that first day in the hospital. However the next day, with the emergency passed, Kristie took stock of her radically altered condition.
“It was a really scary time, not knowing what happened, not knowing if I was going to get better.” – Kristie francis She couldn’t walk. She couldn’t talk. She couldn’t swallow. Anything using her right hand was a no-go, which was a big problem since she is right-handed. She worried about the future. Was this what her life would be like? 20
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Strokes under 50 are rare, require immediate attention
“It was a really scary time, not knowing what happened, not knowing if I was going to get better,” she says. She also thought of Emma. How would she explain this to a 5-year-old? “It was hard,” Kristie says. “She didn’t understand what was going on. She didn’t understand why Mom was in the hospital and if I was going to be OK.” But Dr. Goble reassured Kristie that, with work, recovery was possible. “The whole time he was letting me know what was going on, that I was going to get better,” she says. “Telling me that just really helped.” Kristie spent the next three weeks undergoing inpatient therapy at Boone Hospital. She worked with physical, occupational and speech therapists who were determined to help her get better. They started with the basics. “Brushing my teeth and eating, I even had to learn those again,” she says. At the beginning, Kristie needed assistance while on her feet. But as time progressed, her therapy sessions succeeded in getting her walking again. After she left Boone Hospital, Kristie continued to go to outpatient therapy sessions closer to home. She continues to have an impressive recovery, aided in part by how well she cared for her body before having the stroke.
While it’s uncommon to see strokes in people as young as Kristie Francis, who was 33, they are serious medical events that require a fast response. “It’s very unusual for someone Kristie’s age to suffer a stroke,” says neurologist Myles Goble, MD. “Only about 10 percent of all strokes occur in patients younger than 50 years old.” At any age, you can identify whether someone is having a stroke by observing if one side of their face is drooping, if they can’t raise both arms and if their speech is slurred. If any of these signs are present, it’s critical to follow Kristie’s example and get help as soon as possible. Any time someone is suspected of having had a stroke, 911 should be called immediately so that they can be taken to the nearest stroke center as soon as possible,” Dr. Goble says. “If Kristie would not have come in when she did, there’s a good chance that she wouldn’t be here today. At best, there’s a real possibility that she wouldn’t be able to talk, walk on her own, or use her
“The fact that Kristie was so healthy and led an active lifestyle prior to her stroke played a very important role in her recovery, as opposed to someone who didn’t have healthy habits,” Dr. Goble says. As of mid-August, Kristie says she was about 90 percent back to normal. She is able to do just about anything physically. She started exercising again. She can even drive. She continues to see a therapist to help her recover even more speech. While she can communicate fully, she’d like to be able to talk at a more natural pace, with fewer pauses. “I can do it,” she says. “It’s just a little slow.” Dr. Goble says that with work, Kristie can expect to continue to improve. “While most of the recovery after a stroke occurs in the first six months, many people will continue to experience improvement in disability over a much longer period of time,” he says. “Kristie has already made tremendous gains in terms of her speech and weakness, and I expect
right arm and leg.” Boone Hospital’s Stroke Center provides this specialized care at all times. “Boone’s stroke team is available 24 hours a day, every day of the year,” Dr. Goble says. “This gives stroke victims in mid-Missouri an important advantage since time is of the essence when treating a stroke.” If the stroke is recognized quickly and the proper care is given, the patient stands a fighting chance of making a strong recovery, just like Kristie. “The most rewarding part of my job is helping patients like Kristie lead as normal a life as possible in spite of their stroke,” Dr. Goble says. “As devastating as strokes can be, stroke centers, like Boone’s, are equipped with a team of professionals whose sole job is to help treat the patient’s stroke and to help patients recover from any lasting disability.”
her to make a nearly complete recovery, so much so that most people that she meets may not even realize that she was a victim of stroke.” One of the other the side effects of her stroke was that Kristie lost her job as she underwent months of recovery. But even in that, Kristie sees an opportunity. Earlier in life, Kristie had considered going to the University of Missouri and majoring in speech therapy. She ended up taking another path. Now, she has a rare chance for a redo. She’s not sure yet when she will enroll; she has to finish her own therapy first. However, her interest is, in part, inspired by the many therapists who have helped her get better this year. Now, she would like to help others. When asked how her personal experience will factor in as she works with other stroke patients, Kristie first pauses for just a moment, thinking. “Who else knows better than someone who has done it?” she saiys By Jacob Luecke BOONE HOSPITAL CENTER Fall 2014
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Path out of Pain
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Boone Hospital Team Helps Tebbetts Woman Escape Severe Knee Arthritis
rom her home in Tebbetts, Mo., Belinda Heimericks can look down upon the Missouri River bottoms and the Katy Trail. For years, she loved spending hours biking and walking along the trail, enjoying the views of farmland and majestic bluffs. But in recent years, those trips became fewer and fewer. For the past decade, Belinda, 63, has suffered from arthritis in both of her knees. About three years ago, the pain became severe, requiring her to take pain medication just to make it through each day. In addition to limiting her time on the Katy Trail, Belinda’s increasing pain was starting to take the fun out of life — making it difficult to enjoy a 2013 trip to the St. Louis Zoo with six of her eight grandkids. “Any time I had an outing, I would have to plan out how long I was going to be walking and make sure that I could take my pain medication throughout the day,” she says. “If I didn’t do that, I wouldn’t be able to make it through the day.” Looking for help, Belinda turned to Columbia Orthopaedic Group, the physician practice affiliated with Boone Hospital Center’s orthopedic program. At first, Belinda and her doctor tried using injections to stop the pain, but those did not provide lasting relief. Then, orthopedic surgery specialist Ben Holt, MD, decided that performing replacement surgery was the best path forward. He recommended doing both knees at once. “What I ask people is, ‘Which knee bothers you more?’ And if they can’t tell me which knee bothers them more, then generally those patients do better having both knees done at the same time,” Dr. Holt says. “Doing them both at once
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By Jacob Luecke means they avoid having to face the risks of surgery twice and having to do rehab twice. This way, they can get it all over with at the same time.” While replacement surgery was a big step, Belinda says she trusted Dr. Holt and the Columbia Orthopaedic Group, noting that the practice had helped her family members in the past. “I had heard excellent things about them and my experience with Columbia Orthopaedics has always been very positive,” she says. “Our family has always had excellent outcomes.” As a nurse who works in a management role with the Missouri Department of Health and Senior Services, Belinda says she was also aware of Boone Hospital’s reputation for outstanding nursing care. The hospital’s Magnet designation made her feel comfortable she would be in good hands as she recovered from surgery. “With my nursing background, I pay attention to the reputation of the nursing care provided at the different hospitals,” she says. “I knew that Boone Hospital Center was a Magnet hospital, which for me is very important because I know that signals that the nursing care is going to be excellent.” Belinda’s surgery took place on Dec. 6, 2013. While the procedure is called “replacement” surgery, Dr. Holt says that term often leads to confusion. Rather than removing and replacing a patient’s knees, the surgery actually involves resurfacing the knees. Belinda’s surgery took just over two hours. During that time, Dr. Holt cut away a small amount of bone on both of her knees, enabling him to install a new metal surface. He then placed a plastic insert to pad where the two metal surfaces would come together in the knee. “A lot of times people have a real misconception about what we do,” Dr. Holt says. “Really I think the better term would be total knee resurfacing, because that’s really what we are doing.”
Post-surgery, Belinda rides the trail with her grandson.
The surgery went smoothly. After the procedure, as Belinda recovered at Boone Hospital, she says her nurses lived up to their strong reputation. “They were just outstanding,” she says. “I think what struck me about it was how they anticipated my needs. I didn’t have to tell them I was experiencing pain; they were there and saying, ‘It’s time. We think you need more pain medication so that we can stay ahead of the pain.’ They were anticipating what my needs were and that made it much more tolerable.” On the forth day after the surgery, she was able to return home, where she underwent a month of in-home therapy before doing one additional month of outpatient therapy. As she recovered, her world began to open up again. Just four months after the surgery, she attended a soccer class with her 4-year-old grandson. She was far from a bystander.
“I was out in that class with him and I was able to kick the soccer ball and dribble it down the field,” Belinda says. “Before the surgery, I would have been sitting on the sidelines watching everyone else. That’s how quickly it all came back” This summer, Belinda went on an outof-state work trip where her hotel was five blocks from her meetings. Yet each day, she skipped the shuttle and walked instead — enjoying the opportunity to sightsee. “I had no knee pain and I didn’t have to take any medications,” she says. “I was able to walk as far as I wanted.” This contrasted greatly with a similar trip in 2013, when Belinda needed assistance just to get around the airport. Dr. Holt says such strong results are common with knee replacement patients. “It’s usually a dramatic improvement,” Dr. Holt says. “Not every knee replacement patient is totally pain-free all the time. But usually, in comparison
it’s a dramatic improvement from what they had before.” With Belinda’s great outcome — she says she feels no pain except for some occasional, normal stiffness — Belinda is not shy about endorsing the service she received at Boone Hospital. “I just can’t speak highly enough about the nursing care, the care provided by the physical therapists and the medical staff at Boone Hospital Center,” she says. “My husband and I have decided if we need to be hospitalized anywhere in central Missouri, it needs to be at Boone Hospital.” Belinda also had high praise for Dr. Holt, whom she says has a wonderful bedside manner and a great sense of humor. “He is an excellent practitioner, he’s very personable,” she says. “I highly recommend him. The first thing I say to anyone is if they have any kind of knee or hip problems, I say you need to schedule an appointment with Dr. Holt. He is fantastic.”
When to see an orthopedic specialist for knee pain? As people get older, it’s common to feel aches and pains every now and then. But if the pain is persistent, Dr. Holt says there are a wide variety of techniques that a specialist can use to help relieve the pain — with replacement surgery being one of the later options. “The normal knee really shouldn’t hurt,” Dr. Holt says. “It’s one thing to have an ache or pain here and there, but if you are having discomfort several days of the week — week after week — there is something going on that probably needs to be addressed. If it’s ignored, it may just continue to get worse.” BOONE HOSPITAL CENTER Fall 2014
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Learn more at boone.org/cafeteria
New Cafeteria Opens in November
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hen the new Boone Hospital Center cafeteria opens on Nov. 4, visitors might not feel like they’re in a hospital anymore. That’s no accident. “We planned for it to be a peaceful place where people can get away from everything else and enjoy a meal,” says Julie Winters, director of the hospital’s Nutrition and Food Services department. The new cafeteria and dining area look like a contemporary bistro, with tiles and upholstery in soft blues, neutral tones and patterns inspired by nature. An inviting new entrance flows into a more open cafeteria. The renovation adds more booths for diners and improves the flow of foot traffic around an expanded salad bar and several food stations. A new exhibition station allows visitors to watch Boone Hospital Center cooks in action as they prepare their food, and will
▲ Overall View
▲ Serving Area
▲ Dining Area 24
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offer customizable meal options, like stir fry and burritos. Installed in a glass-tiled wall, the updated frozen yogurt station would look right at home inside a hip downtown yogurt shop. The updated grill will offer healthier alternatives alongside old favorites; customers can choose between french fries or a roasted Parmesan potato. New menu items will debut in November, with more options rolled out in the following months. The new cafeteria features at Boone Hospital Center follow a nationwide trend that is changing how people think about hospital food. Boone Appétit, located in the South Tower lobby, opened in January 2013, and has been a hit with visitors, staff and physicians alike. The café offers Starbucks beverages, hot cereals made with faro and quinoa, fresh salads, wraps and soups, and innovative selections such as grape pizza. Customers can choose healthier snacks like fresh fruit, protein bars and baked chips. Nutritional information is posted for most items. “With changes in health care, people have more awareness about nutrition and are more conscious about making healthier choices. So there’s a greater demand for more healthy options,” Winters says. Boone Hospital But rest assured, there are no plans to Center’s cafeteria is eliminate comfort foods or treats. located on the second “Maybe you run 10 miles a day, but floor of the North want a cheeseburger one day because Tower. Hours and you’re stressed,” Winters says. “We’re a weekly menu are making it easier for people who want available online at healthy foods to find them, but we also boone.org/cafeteria want people to have options.” Boone Appétit and the cafeteria also Boone Appétit Cafe have featured more locally produced is located inside the foods. During the summer, customers lobby and is open could pick up salads made with striped weekdays from 6 am heirloom cherry tomatoes or buy fresh to 3 pm. A weekly tomatoes to take home. menu can be found at The tomatoes and other local produce boone.org/cafe come from Pierpont Farms, a familyowned and operated vegetable farm near Columbia. In addition to tomatoes, the farm cultivates lettuces and greens, cucumbers, root vegetables, herbs and more, using sustainable farming methods. Pierpont Farms’ owner, Rob Hemwall, used to work in the kitchen at Boone Hospital Center. “We’re really grateful for Rob,” Winters says. “Incorporating local foods has had a great response. In mid-Missouri, where people take great pride in their communities and support local businesses, this means a lot. And their produce is wonderful. The lettuces are so nice, you want to take a picture of them when the shipment arrives.” When the new cafeteria opens, visitors may want to take a picture, too. By Jessica Park
Health
Hall of Fame
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nizes one employee who has inspired Every year, Boone Hospital Center recog nt to improving his/her health. Jessica others by making a personal commitme s coordinator, received the 2014 Health Park, marketing and communication recognition on field during a St. Louis Hall of Fame Award. This honor includes rience of adopting a healthier lifestyle and Cardinals game. Jessica shares her expe a resulting 100-pound weight loss.
f you told me last year that I would change my life, lose 100 pounds and receive the Health Hall of Fame award, I would have laughed. You might as well have said I’d visit the moon. Obesity runs in my family. My father gained weight after retiring from the Army and has been hospitalized for heart disease. My mother was morbidly obese when she died of cardiac arrest. She was 48. I’ve been overweight since I was 10. Growing up, I was told to clean my plate. Our kitchen was stocked with sodas, snack cakes, potato chips and ice cream. Fast food dinners were frequent and generous; we’d order two large pizzas, plus breadsticks, to feed a family of four. In the late ‘80s, supersized sodas, candy bars and fries gained in popularity and, not coincidentally, I gained weight. At 14, I hit 200 pounds. I wouldn’t see the other side of that number for 24 years. As an adult, I continued the unhealthy habits that I had developed as a child — and the low self-esteem. I was teased by other kids — sometimes by adults, too. I learned not to respond to the jeers and mean jokes, but by then, the messages had gotten through. If you’ve been obese, especially as a child, you know these messages. You know what strangers assume about you. You know what it’s like to both stand out and feel invisible. When you’ve been told, in countless ways, that you are lazy or greedy,
People ask, “What’s your secret?”
Unfortunately, there isn’t one. Obesity is a complex issue with many contributing factors, so there’s no magic bullet. Everyone’s situation is different, and questions about diet and exercise are best discussed with a health care professional. But I’ll share some things that helped me succeed.
I made a healthier lifestyle my goal.
While weight loss was important, it wasn’t my focus. I had no set weight or dress size. I wanted to feel better and make lifelong, sustainable changes in my approach to food and exercise.
I started slowly.
My journey started with one water aerobics class, which I attended because I heard that exercise could improve my 26
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that you’re a joke, even that you’re less deserving of love, you eventually believe it’s true. You become discouraged. Insults and mistreatment never motivated me to lose weight. They strengthened the part of my mind that thought the worst about myself. And when I felt bad, I found comfort in food. I wasn’t alone. A study conducted recently in the U.K. found that obese people who experienced discrimination and harassment typically gained weight. The chronic stress from mistreatment provoked unhealthy eating behaviors and avoidance of physical activity. In time, the negative messages faded. I enjoyed my life and thought more positively about myself. My weight didn’t make me less sharp or creative. It didn’t prevent me from being a good friend, employee or spouse. But I knew my weight wasn’t healthy. I’d had past issues with gastric reflux and foot pain. My blood pressure and cholesterol were good, but I worried that wouldn’t last. I thought about my parents, especially Mom, and wondered where I’d be in 10 years. I wanted to be healthier and more active, but losing 100 pounds seemed impossible. Reality TV shows depict weight loss as achievable through extreme methods and a rare spirit. I’d think, “I can’t do that. Maybe I’m just not meant to be fit.” Fortunately, I was wrong. But to get there, I had to change my thinking as well as my diet.
symptoms of anxiety. Water aerobics sounded like fun and is easier on one’s joints than land aerobics. The first class was exhausting, but I promised myself I’d attend twice a week for a month. One month led to two. My anxiety decreased. My clothes fit better.
I took an honest look at my eating habits.
Eating a healthier lunch before my evening water aerobics class improved my workout. Because I like to track things, I downloaded an app called MyFitnessPal. Recording everything I ate in a day, I discovered that I ate more frequently and in much larger portions than I’d thought. I had questions, so I met with Jennifer Anderson, a registered dietitian with Boone Hospital’s WELLAWARE program, to discuss healthier eating. I replaced soda with water, bought a
kitchen scale and began reading nutrition labels more carefully.
I was patient and persistent.
Movie montages — think Karate Kid or The Cutting Edge — make transformations look fast and easy. But reality doesn’t have jump cuts. When I first lost weight, only I noticed. It was three months before a coworker politely asked if I’d lost weight. When you start something believing you can’t succeed and don’t see immediate results, it’s easy to give up. Some days, I skipped my workout or ate more calories than I’d intended. But rather than think I was doomed, I got back on track the next day.
I still enjoyed myself.
My No. 1 unwritten rule was: No torture, no starvation. I had to leave my comfort
zone, but my journey would make a dull reality TV series. Healthy weight loss is achieved through sustainable methods. If you’re miserable, you’ll quit. I like my workouts to be challenging but enjoyable. I try new things, but give myself permission to stop if it’s painful or boring. I prefer group aerobics classes to running, so that’s what I do. Your mileage may vary. I gradually reduced calories over months and didn’t deprive myself of my favorite foods. I still enjoy chocolate, but now I’ll eat a small amount of amazing chocolate instead of a lot of so-so chocolate. Consult with a physician or health care professional to discuss what’s best for you.
I celebrated “non-scale victories.” Weight fluctuates for many reasons. Sometimes your scale shows no change while your clothes become looser or your collarbones emerge. Celebrating these milestones beats obsessing about one number. Some of my non-scale victories: First successful plank. First time shopping in the misses’ section. Completing a water aerobics boot camp. First time someone didn’t recognize me. Being named to the Health Hall of Fame.
I enlisted support.
My husband was quiet when I started working out. After a month, he accompanied me to the gym. He’s lost 40 pounds. We still love dining out when we travel, but now we plan a fun physical activity and use the hotel gym. I’m fortunate that Boone Hospital Center supports healthy lifestyles through WELLAWARE programs for employees, including health screenings, a free gym, dietitians, healthy cafeteria options, information and group exercise classes. On Facebook, I posted monthly beforeand-after shots and funny images from I Lost What, a site that compares pounds lost to the weight of random objects. The likes and comments from friends felt like a personal rooting section. I also have an Instagram account dedicated to my weight loss and fitness
Jessica Park in October 2012 (left) and in August 2014 (right). Between these two pictures, Jessica has lost more than 100 pounds.
Learn mor e: boone.o rg/
wellaware My Instag ram
journey, which I started to follow people whose lifestyle changes inspired me. I’m gaining followers as I share my progress through pictures. (But I make sure not to spend too much time sitting in front of a device.)
I set new goals.
Losing 100 pounds is still the beginning. I recently started a body conditioning class at Boone to focus on building strength. I’m also working towards certification to teach water aerobics.
I changed how I see myself.
People tell me, “I wish I had your willpower.” But we all have willpower for our families, careers, communities and interests. I didn’t need willpower; I needed to stop thinking that I was
account: m eepiji
lazy, lacking self-control or not worth the effort. In my job, I read about issues with rising obesity in our community and work with some programs to address these issues. I want to be part of the solution and help others, so I was motivated to help myself. Taking care of yourself helps you take care of others. I used to imagine this person I’d become when I lost the weight someday. Then I decided that someday was today and that I’m already that person. I didn’t change my life to become somebody awesome; I did it because I already was somebody awesome who deserved to feel and look her best. A healthy lifestyle is a long-term commitment, but I’m worth it — and so are you. BOONE HOSPITAL CENTER Fall 2014
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getting to know a BHC Doctor
› kevin halsey, MD [ gastroenterology ] I grew up in Marshall, Mo. I attended the University of MissouriColumbia for my undergraduate degree, followed by two years of graduate school, and then I entered medical school at the university. My wife, Megan, is a registered nurse who also comes from Marshall. We have a daughter, Rylee, who is 3 ½, and our son, Cooper, is 13 months old.
How did you get into medicine?
I’ve always had good mentors throughout my life, like Jack Uhrig, MD, an internal medicine physician in Marshall. I originally had planned to become an internist and return to Marshall to work with Jack. While doing my residency in Wisconsin, however, the GI people were really nice, so I spent a few extra rotations in their area. I loved what I learned there about many different GI-related diseases. I thought it was a challenging field, and it just clicked that this is what I wanted to do. I perform endoscopic procedures and diagnose and treat patients with gallstones and GI-related cancer. What is the most rewarding part of your job?
It’s most rewarding when I am able to comfort my patients, to help them through a very difficult time, such as a cancer diagnosis and treatment, and to be able to address their anxiety and fears. What is the most challenging part of your job?
You never know what you are going to see. Some cases can be the easiest to treat, then you’ll have a case that you think is easy that becomes extremely challenging. The other aspect that is so hard is knowing someone is suffering, especially when it’s someone who’s your own age. 28
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You look at your own life and realize how lucky you are to be healthy. What has changed most in your career as a physician?
I’ve only been in practice for three or four years, but there’s a growing population that requires gastrointestinal care and procedures. The Baby Boomers need to be seen more often for colonoscopies, colorectal cancers, gallstones, but it’ll be challenging with our health care resources spread out. Technology is always improving. Therapeutic endoscopy, where you can treat conditions through the bowel wall or, for example, remove the gall bladder through the stomach wall, with no outside scars, is still in its first stages as a less invasive procedure. I think it’ll be something we see more of in the next 15 to 20 years. What advice would you give someone considering a medical profession?
Be ready to make a lifelong commitment. It’s a lot of years at school, a lot of sacrifice, and you’ll be giving up things to devote yourself to something that is very intense. I didn’t decide to be a doctor until college. I just never thought I could before, but you have to sacrifice your personal life. My life now is perfect; I love my job, and I love mid-Missouri.
But going through school and training was time-consuming and difficult. What advice would you give to patients?
Trust and understand that I want what’s best for them at all times. I will clearly present every option that’s possible, with the risks and benefits of each. I’m a huge patient advocate and promote whatever is in the best interest of the patient. what do you like to do when you’re not on the job?
I love spending time with my family. My relatives all live within an hour of me, and I have brothers who live in Columbia. We enjoy golfing, playing football and basketball, hunting and going to the neighborhood pool.
getting to know a BHC nurse
› mung chin
[ Nurse navigator, stewart cancer center ]
I grew up in Singapore and came to the United States 10 years ago. I’m the middle child, so I was the “peacekeeper” in the family. Perhaps that laid a good foundation for my nursing career. When I came to the states, I was a customer service representative at an eye clinic, which was my first contact with the health care system. I was awed by the care provided by the doctors and nurses, and I contemplated what I wanted to do in life. Nursing was the answer. I studied at Columbia College and entered its nursing program in 2007. I graduated in 2009 with my associate degree in nursing and completed my BSN in 2013 at the University of Missouri-Columbia. What do you like best about working in the health care field?
What has changed in your field since you started practicing?
I love taking care of people. At the eye clinic, I took a call from a woman who was having an acute vision problem. It was late and the doctors had gone. Instead of sending her to the emergency room, I decided to help her. Her symptoms suggested retinal detachment, so I paged the retina specialist. I told him that the patient sounded really scared and asked if we could do something to help her. The doctor returned, saw the patient, and surgery was performed that evening. Later, she thanked me for helping her and told me, “You saved my eyesight.” Those were powerful words — so powerful that they motivated me to pursue nursing.
The increased emphasis on evidenced-based nursing practice. Nursing has evolved into a complicated art of providing evidence-based quality care that is patient-centered, effective, efficient, safe and, most importantly, compassionate.
What interested you in your particular specialty?
The strengths displayed by oncology patients and their families — their ability to see hope in the most difficult times — touched me dearly. It is a privilege to be part of their challenging journey and to witness both their courageous and vulnerable sides. What is the most rewarding aspect of your job?
To see patients progress from being bedridden to being able to enjoy the Healing Garden with their family; when a patient receives assistance from the organization to which you helped her apply — these are some of the many reasons why I love my job. As an oncology nurse navigator, it’s gratifying to provide extra support to our patients and their families. It’s especially rewarding to earn their trust. What is the most challenging part of your job?
To see your patient go from active treatment to palliative care. It’s hard to lose patients, especially when you’ve developed a close relationship with them and their families and have been part of their cancer journey from the beginning.
What do you see changing in the next five to 10 years?
Increased focus on coordination of care beyond an inpatient setting. As an oncology nurse navigator at Stewart Cancer Center, I provide support to hospital patients when they are newly diagnosed with cancer and after they are discharged. With increased emphasis on navigation programs, the risk of cancer patients falling through the cracks after they leave the hospital will be reduced. What do you enjoy doing outside of work?
I love spending time with my family. My kids and I love to go to the theater and enjoy a movie together. Afterward, we end our day with a treat from Orange Leaf. Yum! What advice would you give to someone looking to become a nurse?
Never forget your compassion, even when caring for a “difficult” patient. Compassion motivates your desire to provide excellent care. Without compassion, patients become tasks, not human beings. What advice would you give to someone who is going to be a patient in a hospital for a period of time?
Don’t be afraid to voice your concerns and never hesitate to ask questions! It’s really important to stay informed and understand the course of your treatment.
Learn more at boone.org/foundation
Foundation Finds New Home
Boone Hospital Foundation executive director Barbara Danuser
I
n August, Boone Hospital Foundation moved to a new office in the South Tower lobby. The suite features a new backlit sign and a display of Foundation accomplishments. The new space improves the visibility of the Foundation, which supports programs to enhance patient care at Boone Hospital Center, including the Know Your Numbers health screenings, lung cancer screenings, Healing Garden and caregiver education programs. “I now have donors stopping in,” says Boone Hospital Foundation executive director Barbara Danuser, “And that is wonderful.”
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Mark Your Calendar Boone Hospital Foundation’s Annual Gala benefitting the Stewart Cancer Center will be held this year on Saturday, Nov. 15 at the Holiday Inn Executive Center in Columbia. The Stewart Cancer Center will be entering its second year of service, with new opportunities for the community to join in the fight against cancer. Don’t miss out on this very special celebration, featuring a cocktail reception, formal dinner and dancing to live music by GrooveThang. All proceeds from the Gala will support the Stewart Cancer Center’s ongoing work in bringing the best cancer care to mid-Missouri. For more information or to register, visit boone. org/foundation or call 573-815-2800.
Boone Hospital Center 1600 East Broadway Columbia, Mo 65201 573-815-8000
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