Boone Health FALL 2018
A REASON TO SMILE PG . 2 2
PG. 14 H I D D E N S C A R S T R O N G
The Region’s Premier Heart Hospital The heart is the rhythm of life, and Boone Hospital is there for every beat. More experience, more expertise, and more compassion make Boone the region’s premier heart hospital. From diagnosis and treatment to rehab and recovery, we’re there for you every step of the way. That’s the Boone Touch.
Table of Contents 14
President Jim Sinek Director of Marketing & Public Relations Ben Cornelius Communications Consultant II Jessica Park Digital Communications & Marketing Consultant II Madison Loethen Marketing Consultant I Erin Wegner Photography Madison Loethen Tiffany Schmidt Sadie Thibodeaux Contributing Writers Brooke Kottmann
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A Note from Jim
Ambassadors of Goodwill
A Plan for Mid-Missouri
Get to Know a BHC Doctor
Get to Know a BHC Nurse
Cancer Screening Changes
Hidden Scar Strong
Breast Cancer Screening Guide
WHEN YOUR BACKYARD SOCCER
CAREER IS ON THE LINE, IT’S NOT THE
TIME TO EXPERIMENT. Choose the top-rated hospital and orthopaedic surgeons recognized and trusted by patients and national experts for over 50 years. U.S. News & World Report Top-Rated Hospital in mid-Missouri U.S. News & World Report High Performer for Hip Replacement U.S. News & World Report High Performer for Knee Replacement U.S. Center for Medicare & Medicaid Services’ only Five-Star Rated Hospital in mid-Missouri
SAFE • RELIABLE • HIGH QUALITY boone.org/ortho
A NOTE FROM JIM
Health Care is a Team Effort
We consider the Heart of Missouri United Way to be a member of our health care team – and we are proud to be a member of their team!
s president of Boone Hospital Center, I have witnessed the power of teamwork in health care. Every patient in our hospital is treated by a care team of physicians, nurses, technicians, dietitians, social workers, therapists, and other health care professionals. Caring for a patient can’t be one person’s sole responsibility; everyone contributes their skills, knowledge and experience to give each patient the best possible outcome. Just as one health care worker can’t do everything for a patient and must rely on the expertise and support of their teammates, no single hospital can provide for every health need in its community. In keeping with Boone Hospital’s mission of improving the health of the people and the communities we serve, we partner with local organizations to promote healthy behaviors, improve access to health care services, provide financial assistance to patients in need, educate future health care professionals, and address social factors that contribute to health. These organizations are valuable resources to improve people’s health before, during, and after they need our services. We should all be fortunate to live in a healthy community. Boone County has two major medical centers and one of the best ratios of primary care physicians to residents in the nation, yet some members of our community have limited access to primary, dental or mental health care. Mid-Missouri offers abundant opportunities to enjoy physical activities or eat healthy foods, but obesity and related conditions are still areas of concern. Heart of Missouri United Way’s health team of local organizations, stakeholders and individuals contribute their unique assets and strengths and collaborate to give more community members the best possible health outcomes. Thanks to United Way funding, the Family Health Center has now helped thousands of children receive preventive dental care. Family Counseling Center offers outpatient mental health services for low-income families. Sustainable Farms & Communities’ Access to Healthy Food program makes it easier for families and senior citizens to buy nutritious foods at the Farmers Market. Boys & Girls Club of Columbia gives children the tools and knowledge to build a lifetime of healthy habits. Most of what I know about the positive impact United Way has on our community, I learned from my Boone Hospital teammates. Our staff’s enthusiastic support for the Heart of Missouri United Way is hard to miss. Every day, our employees see the difference these agencies make for the communities and people we serve. We consider the Heart of Missouri United Way to be a member of our health care team – and we are proud to be a member of their team!
Jim Sinek President, Boone Hospital Center
Nursing Summer Camp For the second year in a row, the Boone Hospital Foundation provided scholarships to high school students interested in attending Columbia College Nurse Summer Camp. The program introduces high school students to the field of nursing and includes skill labs and a tour of Boone Hospital Center. During their day at Boone Hospital Center, campers were welcomed and guided by Boone Hospital Nurse Residents. The hospital’s Nurse Residency Program supports graduate nurses during their first year working in a clinical setting.
Cancer Survivors Luncheon
When it became apparent that John “Chuck” Stotler would not be able to attend his daughter’s wedding, Boone Hospital Intensive Care Unit staff worked with his daughter, Marsha, to hold a ceremony in his ICU room so that he could still give her away in marriage. Nurses found Marsha a room to change into her dress and provided her with something old, something new, something borrowed and something blue. They also gave the bride a bouquet of flowers and provided cupcakes for everyone who attended. Marsha and her husband, Ryan Layton, were legally married a few days later.
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Stewart Cancer Center and Missouri Cancer Associates presented its annual 2018 Cancer Survivors Luncheon at Boone Hospital Center. The event featured a health fair, lunch, door prizes and a presentation by retiring oncologist Joe Muscato, MD. The luncheon gave Dr. Muscato’s former and current patients an opportunity to express their gratitude for his care.
Boone Hospital Center Recognized by U.S. News & World Report for Fourth Year in a Row For the fourth year in a row, Boone Hospital Center was ranked the #1 hospital in mid-Missouri by U.S. News & World Report. It also ranked #6 in the state of Missouri. The U.S. News methodology for rating Procedures and Conditions for nearly every U.S. hospital includes assessment of hospital performance in nine common procedures and conditions: abdominal aortic aneurysm, aortic valve surgery, chronic obstructive pulmonary disease, colon cancer surgery, congestive heart failure, heart bypass surgery, hip replacement, knee replacement and lung cancer surgery. Hospitals are rated as High Performing, Average or Below Average for each procedure or condition, and there is no overall assessment across the group. The analysis includes a mix of risk-adjusted data on mortality, readmission and other outcomes, the occurrence of common types of health care-acquired infections, federally mandated patient satisfaction surveys and selected hospital-survey measures. Boone Hospital Center was rated High Performing in six of the nine categories aortic valve surgery, heart bypass surgery, heart failure treatment, colon cancer surgery, hip replacement surgery, and knee replacement surgery. The rankings have been published on the U.S. News website, health.usnews.com/best-hospitals/area/mo, and will appear in print in the “Best Hospitals 2018” guidebook, available later this month.
Boone Medical Group – Centralia Welcomes New Primary Care Provider
Boone Medical Group – Ashland Welcomes New Primary Care Provider
Boone Medical Group is pleased to welcome Andrea Willer, FNP-BC, to Boone Medical Group – Centralia. Andrea is a board-certified family nurse practitioner and is joining Cathy Cody, MD, and Carlos Rubio-Reyes, MD, at the Centralia practice. Andrea provides general primary care services to patients of all ages and is accepting new patients. Andrea received her undergraduate degree in social work in 1991 and returned to pursue her interests in nursing in 1996. She completed her bachelor’s degree in nursing in 2000 and her master’s degree in nursing in 2013. She is passionate about the family practice specialty because she enjoys treating patients of all ages.
Boone Medical Group is pleased to welcome Jane Foreman, FNP-C, to the practice in Ashland, where she joins Nathaniel “Bud” Murphey, MD. Jane will provide primary care for her patients of all ages in the community and is accepting new patients. Jane is a dedicated family nurse practitioner with more than 29 years of nursing experience. She received her master’s degree in nursing in 2017 to become a nurse practitioner specializing in family medicine.
A Plan for Mid-Missouri Developed by mid-Missouri physicians, the NueHealth Priority Access Health Plan benefits patients, employers and providers.
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To learn more, visit PriorityAccessHealth.com
ohn D. Miles, MD, a surgeon with Columbia Orthopaedic Group, knew there had to be a better way to provide and pay for health care than traditional insurance plans. He wasn’t alone; Dr. Miles and other physicians from Boone Hospital Center’s medical staff joined forces to offer mid-Missouri employers a new option. The NueHealth Provider Network Priority Access Health Plan, available now to businesses with 10 or more employees, benefits patients, employers, and physicians. The Priority Access Health Plan, or PAHP, allows businesses to provide their employees the health care coverage they need and brings additional value with technology-enhanced features that make it easier to get direct care from their primary care physicians. The network includes most local private practice physician offices, with primary care providers and specialists from Boone Hospital Center’s medical staff, including Tiger Pediatrics, Columbia Orthopaedic Group and Missouri Heart Center, but doesn’t restrict you from seeing your preferred physicians. “In mid-Missouri, primary care access for most people is very limited and not readily available,” Dr. Miles explains. As a specialist, this concerned him; limited access to primary care means limited access to specialists, too. The physicians who created this plan wanted to improve primary care access and to provide better value in health care for everyone involved. This improved value includes more transparent pricing for procedures and prescriptions. The Priority Access Health Plan helps participants establish a medical home, where you can easily talk to physicians familiar with your medical history and needs. Dr. Miles explains, “This medical home can help you navigate the health system.” With a traditional plan, even if you have a primary care provider, or PCP, it can be difficult to see your PCP for an urgent medical concern, often requiring a trip to urgent care or the emergency room or waiting days to weeks for an appointment. The PAHP offers different plan levels of priority access to your PCP, similar to a concierge medicine plan, but without the high cost. All PAHP plans include technology-enhanced features that make it easy for you to get care from your participating PCP without an office visit. Using a HIPAA-compliant, secure app on your phone, you can send your PCP a text message or request a video or voice chat. Within an hour, you’ll be connected to your PCP. Unlike telemedicine, where a contracted physician in another city consults with you, you communicate directly with your doctor or a professional in their office who’s familiar with you and your medical history. If your medical need requires an in-office visit, the PAHP ensures you’ll be seen by your PCP within 24 hours. If you require a referral to a specialist, you won’t wait longer than a week to be seen. Direct primary care services mean you don’t have to wait for health care. You’ll spend less time going to a doctor’s office, urgent care clinic, or hospital, and you’ll spend less money on urgent care or ED visit copays. (Of course, urgent care and ED visits are covered if needed.) Plus, you can see the physician of your choice. “We have most private practitioners in Columbia already signed up, but ours is not a narrow network,” Dr. Miles explains. “It
doesn’t exclude physicians. We have a wrap network to provide coverage outside of our area, and for services not provided at Boone Hospital.” The plan also offers health screenings and health risk assessments, and coverage for prescriptions, vaccinations, screenings and various treatments. An employee who waits for days or weeks to see doctors to treat an illness or pain is not their most productive, so the PAHP benefits employers, too. Technology-enhanced primary care can save employees from taking time off for office visits if their needs can be addressed by text message or video chat. The PAHP is also more accessible and affordable for local employers. Businesses with as few as 10 employees – or as many as thousands – can participate. For small businesses especially, the PAHP can cost less than traditional insurance options. “We have a lot of small employers here seeking relief from health insurance premiums, and we think this is going to be able to help,” Dr. Miles explains. Employers interested in offering the PAHP to their employees should consult with their insurance brokers for a quote, or contact our webpage at PriorityAccessHealth.com for more information about the plan. In traditional insurance plans, primary care physicians are only compensated for patient office visits and often provide hours of uncompensated care. The PAHP compensates PCPs in the network for all your care, whether or not you need an in-person appointment. “With this model, physicians get to do what they actually like to do in terms of caring for people. Their patient load will be less hectic, and their satisfaction of caring for people will be much higher,” Dr. Miles says. In the process of developing the PAHP, Dr. Miles learned a lot from many experts. He says, “I knew nothing about health insurance 5 years ago. I owe a lot to many teachers, one of which is Dr. John Bangs, retired Professor of Risk and Insurance at the University of Missouri. He and others got me, and our board, up to speed on the rules of the game and to realize what was possible.” Critical support and input was derived from the Nuehealth Missouri board of directors including, Vice Chair Don Delwood, MD; Adam Wheeler, MD; Mark Cohen, MD; Michael Cupp, MD; Lee Trammell, MD; Troy Scheidt, MD; Adam Clapper, MD; John Baird, MD; and Bus Tarbox, MD. Boone Hospital joined as a facility partner with the Priority Access Health Plan, and is working with the physicians to bring the best quality, best value health care to mid-Missouri. While Nuehealth Priority Access Health Plan partners with national third-party administrators, stop loss carriers, managing general underwriters and pharmacy benefits managers, Dr. Miles can’t stress enough that mid-Missouri physicians have led the way on building the plan. “Boone Hospital Center medical staff doctors have personally funded and developed this program, and we’ve done it on a shoestring,” Dr. Miles says. “Your doctors have made a hometown solution for hometown people.” By Jessica Park
Putting the ‘Care’ Into Health Care Review these online resources before selecting your hospital and physician.
ou spent hours reading reviews on Amazon before you bought that new coffee machine. When it comes to your health, why should you research any less? Navigating local health care systems might seem tricky, but try to not fall back on making appointments based solely on neighbor recommendations or the ads you see on television. The best thing you can do for your health is research. Not every hospital, physician and specialist are treated equally. We have gathered online health care resources to help you evaluate your health care options and decode patient satisfaction surveys. Find a hospital The internet is filled with resources to help you make informed decisions and advocate for your health. The first step you toward
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getting the right health care for you is to find the right hospital. Online tools compare rankings of regional hospitals, so you can find the best fit for you. Consumer Reports makes comparing hospitals easy. According to its website, Consumer Reports rates hospitals and gives each a safety score, a composite of five key measures of patient safety: communication, complications, CT scan overuse, infections and readmissions. Consumer Reports safety scores factor in thousands of government surveys on patient experience, patient outcomes and hospital practices in over 4,000 hospitals across the country. For patients who want to take an empirical approach to comparing quality of care between hospitals should visit the Missouri Hospital Association’s FocusonHospitals.com.
THINGS TO CONSIDER WHEN SELECTING A PHYSICIAN 1. License status and board certification 2. Medical residency and medical school 3. Published medical research 4. Malpractice or other disciplinary actions 5. Age, gender and length of practice 6. Hospital affiliations 7. Admitting rights 8. Accepted insurance or insurance plans Then call, and speak with your physician.
This resource compares two hospitals based on quality of care – reducing harm, preventing infection and managing readmissions – and pricing for inpatient and emergent services. This website lists averages of outcomes after procedures, such as blood clots or surgical infections. Viewers can compare procedures prices ranging from C-sections births to heart attacks. Search U.S. News and World Ranking to find a hospital. The website ranks over 5,000 hospitals in 16 adult and 10 pediatric specialties. Any specialties (such as cardiology or pulmonology), procedures (such as knee-replacement surgery) and conditions (such as heart failure) a hospital specializes in will be listed. Websites such as CareChex.com lets readers to compare hospitals statewide or in specific metro areas. This site compares Online resources: hospitals based on • Carechex.com patient satisfaction in • Consumerreports.org over 30 treatments, including women’s • Focusonhospitals.com health, transplants and • Health.usnews.com cancer, as well as overall • Medicare.gov hospital, medical and surgical cares. Understand patient satisfaction While patient satisfaction is typically factored into hospital scores, they don’t break down satisfaction from a specific provider. Sites such as HealthGrades.com and RateMDs.com offer patient reviews for providers, but these reviews might be skewed. A physician could see thousands of patients but only be reviewed by a handful of patients who leave positive or negative reviews. The best way to gauge patient satisfaction is to visit your hospital or doctor’s office. Your doctor’s waiting room will give you a feel for the environment and whether other patients are happy with their care. The receptionist can inform you how far in advance you need to schedule your appointment, if there are late-night or weekend hours and the physician’s cancellation policy as well as whether you can get lab work or scans in the office. Visiting in person will give you a better idea of how long wait times will be. Visit your physician to determine if they are a good fit for your provider. Evaluate how much time they’ve spent with you. Are they receptive when you ask questions? Do they spill medical jargon that goes over your head, or do they take the time to make sure you understand? Are they an advocate for your health? Put your health first. And if you need to get health care recommendations for trusted friends and family, ask them why they see their physician, how they’ve helped with pain management and treatment and about their own patient satisfaction. By Brooke Kottmann
CANCER SCREENING Early detection of cancer means better outcomes – know when to get screened! The Cancer Statistics Center of the American Cancer Society says that in the United States, in 2018, there will be an estimated 1,735,350 new cancer cases and 609,640 cancer deaths. That’s approximately 4,750 new cases and 1,670 deaths every day. Estimated New Cancer Cases 2018 Breast: 268,670 Lungs & Bronchus: 234,030 Prostate: 164,690
Estimated Cancer Deaths 2018 Lungs & Bronchus: 154,050 Colorectal: 59,630 Breast: 41,400 Prostate: 29,430
Why are cancer screenings important? “Know your numbers” is something you may hear when talking to your health care provider about factors that affect your heart health, like cholesterol, blood sugar, blood pressure and body mass index. These numbers, if kept in a healthy range, can improve your heart health and reduce your risk for heart disease. Screenings for any type of cancer is done to test if the cancer is present. This means that screens are done before any signs or symptoms of cancer appear. Screening allows your health care provider to detect cancer early, when it is easier to treat. Depending on your age, sex and family history, cancer screens include screening for breast, cervical, colon, lung and prostate. By Erin Wegner
AGE 21 – 29
AGE 21 – 29
• Colorectal Cancer: This screen is only necessary if you have a family history.
AGE 31 – 39 • Colorectal Cancer: This screen is only necessary if you have a family history.
AGE 40 – 49 • Prostate Cancer: If you are African-American or have a father or brother who had prostate cancer before age 65, talk to your health care provider about starting screening at age 45. • Colorectal Cancer: Testing should start at age 45.
AGE 50 – 65 • Prostate Cancer: Talk to your health care provider about the pros and cons of prostate cancer screening starting at age 50. • Colorectal Cancer: Continue to schedule regular screenings with your health care provider. • Lung Cancer: If you have a history of smoking, talk to your doctor about having a yearly low-dose CT scan to screen for early lung cancer. This screening is beneficial if you’re an active or former (you’ve quit within the last 15 years) smoker, have a 30-pack-year smoking history, and have no signs or symptoms of lung cancer. Boone Hospital Center offers lung cancer screenings for people ages 55 to 77 who meet these criteria.
AGE 65 AND UP • Prostate Cancer: Talk to your health care provider about screening for prostate cancer. • Colorectal Cancer: Regular testing is recommended up through age 75. Talk to your doctor about whether you should undergo colorectal cancer screening after age 76.
REDUCE YOUR RISK! A healthy lifestyle can help reduce your risk of certain cancers.
• Be tobacco-free • Exercise regularly • Eat a healthy diet • Limit alcohol • Maintain a healthy weight • Get regular check-ups from your primary care provider • Get cancer and other health screenings as needed
• Cervical Cancer: Testing should be done every 3 years. Breast Cancer: Monthly self-exams are the best way to check for any changes. • Colorectal Cancer: This screen is only necessary if you have a family history.
AGE 31 – 39 • Cervical Cancer: Testing should be done every 5 years. • Breast Cancer: Monthly self-exams are the best way to check for any changes. • Colorectal Cancer: This screen is only necessary if you have a family history.
AGE 40 – 49 • Breast Cancer: Women ages 40 – 44 can choose to start their annual breast cancer screen. Woman who are 45 or older should get a yearly mammogram. • Cervical Cancer: Get a Pap & HPV test done every 5 years or Pap test alone every 3 years. • Colorectal Cancer: Testing should start at age 45.
AGE 50 – 65 • Breast Cancer: Women who are 55 and older should switch to mammograms every 2 years. You may continue to get a yearly screening. • Cervical Cancer: Get a Pap and HPV test done every 5 years, or Pap test alone every 3 years. • Colorectal Cancer: Continue to schedule regular screenings with your health care provider. • Lung Cancer: If you have a history of smoking, talk to your doctor about having a yearly low-dose CT scan to screen for early lung cancer. This screening is beneficial if you’re an active or former (you’ve quit within the last 15 years) smoker, have a 30-pack-year smoking history, and have no signs or symptoms of lung cancer. Boone Hospital Center offers lung cancer screenings for people ages 55 to 77 who meet these criteria.
AGE 65 AND UP • Breast Cancer: Get a mammogram every 1 to 2 years. Screenings should continue as long as you are in good health and expected to live 10 more years or longer. • Cervical Cancer: No screening is needed if you’ve had regular cervical cancer screenings with normal results for the last 10 years. • Colorectal Cancer: Regular testing is recommended up through age 75. Talk to your doctor about whether you should undergo colorectal cancer screening after age 76.
Linda Strong underwent hidden scar breast surgery to remove her breast cancer. 14
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To learn more, visit boone.org/surgery
Linda Strong at her sewing table.
Anne Petersen, MD of Boone Medical Group - Surgery
Linda Strong of Ashland, Mo., has always taken care of her health the best she knows how. She makes sure to always schedule her checkups and live a healthy lifestyle. But during her routine mammogram in 2017, a lump in her breast was found. A biopsy was scheduled the next week, and the lump came back cancerous. Very quickly, surgery was scheduled to remove the lump. “I was so impressed with how quickly Boone Hospital moved to take care of my cancer. From finding the lump to scheduling the surgery, I could tell they really cared about making me better,” says Linda. Linda met with surgeon Anne Petersen, MD, of Boone Medical Group – Surgery, who suggested Linda get Hidden Scar™ Breast Cancer Surgery to remove her lump. Dr. Petersen is certified in Hidden Scar breast surgery and is one of the only doctors in the area who offers the procedure. For this surgery, the doctor places a small incision in a place that is difficult to see. Then when the wound heals, the scar is unnoticeable or nearly unnoticeable. “Hidden Scar Breast Surgery combines breast cancer surgery with plastic surgery techniques. We call this combination oncoplastic surgery. This way we absolutely get all of the cancer taken care of, and in addition, after everything has healed, the patient has a nice cosmetic result without a daily reminder when they look in the mirror that they had breast cancer. We want our patients to feel whole and well long after they have beaten breast cancer,” says Dr. Petersen. Studies show that breast surgery scars can significantly affect a woman’s selfconfidence, intimacy and body image, and impact her quality of life after surgery. Linda got the surgery and her recovery went smoothly. She underwent radiation and says she has had no problems since. “I feel very lucky to have had Dr. Petersen as my surgeon. She explained the benefits of Hidden Scar surgery to me very well. Now you can hardly see where I had surgery,” says Linda. Linda is now back to enjoying her retirement with her husband Gene. They stay busy spending time with their 3 children and 4 grandchildren. By Madison Loethen
BREAST CANCER SCREENING Whether you’re coming to Boone Hospital Center for a routine cancer screening or you have symptoms that concern you and your physician, our goal is to keep you in the loop every step of the way. It’s helpful to know what to expect before, during and after your mammogram. Whatever your needs or results, we’re here for you! By Jessica Park
S TART HE R E
1 If you’re a woman 40 and older, with no symptoms of breast cancer, you can receive your annual screening mammogram to Boone Hospital’s Harris Breast Center or Nifong Medical Plaza. A mammogram is an X-ray that can detect breast cancer in very early stages, before it causes symptoms and when it’s easiest to treat.
Images from your mammogram are examined by a Boone Hospital Center radiologist (a physician who diagnoses and treats medical conditions with medical imaging technology). The radiologist uses a specialized workstation that lets them view the images in high definition and three dimensions and look for any changes or masses that could be breast cancer.
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Boone Hospital Center uses 3-D mammography, or tomosynthesis, for all of our mammogram patients. This technology provides better images for your radiologist and means there’s less chance of you having to get more testing if you don’t have breast cancer.
If your screening mammogram result is negative, a letter is sent to your home to confirm your negative results. Your physician will receive a report with your results within 3 days of your appointment.
At your annual screening, you’ll be asked if you’ve noticed symptoms like lumps in the breast, nipple discharge or a change in the shape of your breast. If you have symptoms, Boone Hospital mammography staff will contact your physician right away – while you are still here – to order a
diagnostic mammogram for you. If needed, our radiologist can write the order, so you can have it done the same day.
If the radiologist finds something on your screening mammogram, you’ll be contacted to schedule a visit for a
Schedule your screening mammogram for next year. Your doctor’s office can schedule for you, or you can make an appointment yourself. Call Boone Hospital Center Centralized Scheduling at 573.815.8150.
Diagnostic Mammogram A diagnostic mammogram uses the same technology as a screening mammogram but takes more images and views of your breast. Your physician may refer you for a diagnostic mammogram if you have symptoms like lumps in the breast, nipple discharge or a change in the shape of your breast. After your diagnostic mammogram, you may receive other imaging tests, like a breast ultrasound. The ultrasound can show things not seen on your mammogram to help the radiologist decide if a biopsy is required. A biopsy is a procedure where a tissue sample is taken from your body to be tested for cancer. Whenever possible, the biopsy is scheduled for the same day as your diagnostic mammogram. The breast cancer biopsy is done with a needle, while you are awake. Mammography or ultrasound is used to pinpoint where the needle will sample tissue. Your biopsy tissue sample is immediately sent to Boone Hospital’s pathology lab for examination and testing. You can usually expect to get your biopsy results in 24 hours. Your radiologist will call you and your physician to discuss your results and any next steps. If your biopsy results are positive for breast cancer, Boone Hospital Center will refer you to an oncologist – a specialist who treats cancer patients – and a surgeon. They will set up your first appointment, so that there are no delays in treatment. Your oncologist and surgeon will meet with you to create a personalized treatment plan for breast cancer. Depending on your diagnosis, your plan may include surgery, chemotherapy, radiation therapy, hormonal therapy, or other treatments. MyBooneHealth.org
Trust Your Gut
Improving your digestive health with probiotics.
or most of us, the thought of eating bugs is repulsive. However, did you know your body is home to trillions of tiny bugs, and how you feed those bugs can impact your health? The majority of those bugs, – actually microscopic bacteria, fungi and yeast – live in our gut, otherwise known as our gastrointestinal tract. Both good and bad bacteria live in our GI tract. However, the balance between good and bad bacteria can be affected by many things. Antibiotics, poor nutrition and stress can kill the good bacteria. What we eat feeds that bacteria. Ideally, we want a diet that feeds the good bacteria and helps keep balance between the good and bad. Research is showing that probiotics and prebiotics can help improve the balance of bacteria in a person’s GI tract. Probiotics are live, active microorganisms introduced in the body for a health benefit. Probiotics are found in many foods, such as yogurt, kefir, aged cheese and fermented vegetables. They are also available as a supplement. Research on probiotics has increased significantly over the last few years. While evidence of the potential benefits is growing, further research still needs to be done. The evidence so far largely supports the use of probiotics for diarrheal illness, especially when caused by antibiotic use. Probiotics also look promising for managing inflammatory bowel syndrome. Other conditions that may possibly benefit from probiotics include asthma, autism, immunity and weight loss. Overall, probiotics have a very good safety profile with very few reported side effects. The most commonly reported side effect is gas and bloating which typically occurs after first starting probiotics. The use of probiotics in people with compromised immune systems is not recommended due to risk for infections. When choosing a probiotic, several things need to be considered. Probiotics names have 3 parts – genus, species and strain, listed in this order. Different strains have different benefits. This is important because you want to make sure you get a strain specific to the condition you want to improve. To be a probiotic, the food or supplement must contain live active cultures. The number of live active cultures you want also depends on the condition you want to improve. Overall, three to five billion CFU (colony forming units, the measurement used for live active cultures) is a good daily dose. When it comes to probiotic supplements, read the label regarding storage. Some probiotics need to be refrigerated – be sure they have also been refrigerated by the supplier, because heat can destroy microorganisms.
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Prebiotics are dietary substances that increase the growth or activity of healthy bacteria in our intestines. They occur naturalyl in many foods, including chicory, onion, Jerusalem artichokes, bananas, asparagus and garlic. Prebiotics are often added to foods like yogurt, protein bars, cereals and pasta. As with probiotics, more research needs to be done before we have a good understanding of the benefit of prebiotics on different conditions and overall health. Probiotics and prebiotics can work together, or in synergy, to improve gut health. This has led to the development of synbiotics. The thinking behind synbiotics is that adding prebiotics to a probiotic supplement might help ensure that the microorganisms arrive in your gut alive and well. Research on the benefits of synbiotics is still emerging, so currently the health benefits of synbiotics are not well known. Overall, the potential benefits of probiotics and prebiotics are promising. If you have a condition that you feel may benefit from a probiotic or prebiotic, increasing your intake of naturally occurring sources in foods and drinks would be a good place to start. If you plan to start a supplement, you may want to talk to your doctor first about the best species and dose to treat your condition. By Jennifer Anderson, RD, CDE
Find this recipe and others at boone.org/food
Homemade Kimchi Kimchi is a traditional Korean side dish made from salted and fermented vegetables, usually napa cabbage and daikon radish. Kimchi has naturally occurring prebiotics. Recipe adapted from EatingWell.com
INGREDIENTS • 2 pounds napa cabbage, cored and cut into 1-inch pieces • ¼ cup kosher salt • 8 ounces daikon radish, cut into matchstick strips (2 cups) • 4 scallions, trimmed and cut into 1-inch pieces • 2-4 tablespoons Korean-style red pepper flakes (gochugaru) • 2 tablespoons fish sauce • ¾ ounce fresh ginger, cut into matchstick strips (¼ cup) • 2 cloves garlic, quartered • 1 teaspoon sugar INSTRUCTIONS 1. In a large bowl, combine the cabbage and salt. Add enough water to cover the cabbage. Keep the cabbage submerged, using a plate or a sealable bag filled with water. Cover the bowl and let stand at room temperature overnight or up to 24 hours.
2. Drain the cabbage, saving the brine. Rinse and squeeze the cabbage dry. Return to the bowl, then add daikon and scallions.
3. Using a food processor or mini-food processor, process the red pepper flakes, fish sauce, ginger, garlic and sugar until almost smooth. Transfer to the bowl with the cabbage.Using disposable food-safe gloves, massage the vegetables and the red pepper mixture together until well coated.
4. Pack the mixture a 2-quart glass jar. Add enough of the reserved brine until you just cover the vegetables. Screw on the lid. Place the jar on a rimmed baking sheet and let stand in a cool place. Make sure that the vegetables are always covered with brine. Taste after 3 to 5 days. The kimchi is ready when it tastes good to you. Reseal the jar and store in the refrigerator. Refrigerate the finished kimchi for up to 3 weeks.
AMBASSADORS OF GOODWILL Tomorrow’s health care professionals have opportunities to help Boone Hospital’s patients today
yan McLachlan, a biology major at the University of Missouri, had been familiar with Boone Hospital Center from growing up in mid-Missouri. He knew volunteering would provide valuable experience for a future career in health care. April Baum had come from St. Louis to Columbia to attend the University of Missouri, where she double-majors in biology and psychology. She wanted to get involved in the community and was also interested in a career in health care. When Ryan and April each decided to apply to volunteer at Boone Hospital Center, the timing couldn’t have been better. Martha Johnson, Volunteer Services and Patient Experience Manager, wanted to re-invigorate the hospital’s ambassador volunteer program for college students majoring in health care-related fields, like pre-med, nursing, radiology, physical therapy or biology. Ambassadors commit to volunteer for one semester, for two hours a week. Boone Hospital Ambassador and University of Missouri student April Baum assists patients on the hospital’s Neurology-Oncology Unit.
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Apply online today at boone.org/volunteer In addition to supporting the Surgical Specialties unit, Ambassador Ryan McLachlan volunteered at BHC’s Kids on Track events.
“Volunteers are an integral part of the Boone team,” Martha says. Volunteers don’t replace the skilled work done by hospital employees, but are here to support staff, patients and visitors. All Boone Hospital Center volunteers are interviewed and complete the same background check and health screens as employees. Volunteers are also expected to uphold the hospital’s standards of conduct. Like Boone employees, volunteers also attend an orientation session before they start their duties. Ambassadors receive additional orientation, led by Korey Elkin, the hospital’s Patient Care Advocate Coordinator, in the areas where they’ll volunteer, which include some inpatient units, and waiting areas for Surgery, the Emergency Department and the GI Lab. “I do my best to introduce our Ambassadors to all members of the team – the nurses, the techs, the social workers, the case managers, and the doctors. I try to give our Ambassadors the chance to talk to them and learn how all these disciplines come together to care for a patient,” Korey explains. April usually volunteers on the hospital’s Neurology-Oncology unit, while Ryan
primarily supports the Surgical Specialties team. After checking in with the charge nurse, Ambassadors may restock rooms or supply areas. They may tidy up a waiting room or distribute information. “I’ve delivered birthday cards to patients and redistributed wheelchairs,” April says. “Anything that needs to be done – I’m here to do it!” Ryan has also volunteered for the hospital’s Kids on Track community health program, passing out registration packets in May and snow cones in August. But the Ambassadors’ primary and most important responsibility is to visit with patients and ask if there’s anything they need, like a blanket, pillow, magazine, refilled water pitcher or somebody to talk to. “A lot of times, patients are looking for a conversation,” April says. “It’s really rewarding that I can be that person for them.” April and Ryan have both enjoyed their experience as Ambassadors. They like being able to connect with patients and to learn from professionals how to assist patients in various situations. “For anyone studying a health major, I think it’s great to volunteer at a hospital,”
Ryan says. “You can learn about all the different job opportunities available and what goes on inside a hospital. You really see what goes into one person’s care.” April agrees: “I’ve had the chance to talk to professionals and learn more about what they do. For example, I learned from a dietitian that some patients can’t have certain spices.” Volunteering in a patient care setting also educates Ambassadors on the challenges of working in health care. “For me, the biggest challenge was realizing some of the realities of health care. You learn that it’s not going to be happy all the time, and sometimes you’ll encounter things you don’t expect. But I think the rewarding aspect outweighs the challenges,” April says. Martha notes that the Ambassador program doesn’t only benefit college students or busy hospital employees – it also benefits Boone Hospital’s patients. “Any hospital’s Environmental Services staff, Food Services staff and volunteers are often the first to hear if a patient’s unhappy,” Martha explains. Patients usually feel more comfortable sharing concerns with hospital staff who don’t provide direct patient care. Ambassadors are encouraged to share patient feedback with Martha, Korey, or staff on the unit. “The biggest job our Ambassadors have is visiting patients,” Martha says. “In school, they’re getting clinical instruction, but what they can’t learn in a classroom is how a patient perceives going through that clinical process. When our Ambassadors become health care professionals, they’ll remember these valuable things they learned here.” And, hopefully, when our Ambassadors start their health care careers, their positive experience of volunteering at Boone Hospital Center will encourage them to become health care professionals at Boone. “Our Ambassadors are super-engaged in Boone Hospital Center,” Martha says. “They have authentic, genuine and compassionate connections with our patients. They are essentially changing the face of health care.” By Jessica Park
Riding a Horsie INTO SURGERY
Boone anesthesiologist calms a young surgery patient and her family.
Walking into Boone Hospital Center, Kelsey and Chris Hile were nervous wrecks. They were bringing their 2-year-old daughter Riley in for dental surgery. Riley had a cracked tooth and several cavities, and her dentist recommended that she be put under general anesthesia for the procedures. They understood why it was necessary, but their nerves were still there. “We just couldn’t believe our baby had to have surgery. We were so anxious, but the second we walked into Boone, everyone began calming our fears. The nurses assured
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us that it was a very safe and common procedure,” says Kelsey. Kelsey says she was particularly impressed with Riley’s anesthesiologist, Abram Elsenraat, MD, from Mid-America Anesthesia. “Dr. Elsenraat came in and immediately talked us through the surgery, and then turned to Riley and began playing with her. He must have kids of his own, because he was so good with her. She even called him her ‘best friend.’ Instead of having her stay in the bed to be rolled into surgery, he picked her up and galloped like a horsie back there. She
was giggling, and so were we. It was so sweet. Then he came back out a few minutes later and gave us a thumbs-up to let us know she went under just fine,” says Kelsey. Dr. Elsenraat says getting to know families and making them feel comfortable is just part of the job. “As a parent, I know how stressful it can be to have your child undergo a surgical procedure. I feel it can be harder on the parents, as they have to wait and worry in the waiting room during the procedure. Part of what I love about my job is helping both
Riley and Kailey announcing they will be big sisters.
Riley and Dr. Elsenraat before her surgery.
Chris, Kelsey, Kailey and Riley Hile
the kids and the parents through this process. I try to make it as enjoyable of an experience as possible and not one that leaves them with fear or anxiety.” Recovery Room Manager Julie Noah says special considerations are always made for Boone Hospital’s young patients. “Surgery, no matter how big or small, can cause anxiety and fear, so our goal at Boone Hospital Center is to provide every outpatient with excellent care while focusing on their safety. We also provide parents and their children with some extra-special considerations. If our pediatric patients don’t have a ‘horsie’ (AKA Dr. Elsenraat), Boone has wagons that wheel patients back into the surgery suite in their own pajamas, with a new stuffed bear in hand. We encourage children and parents to bring a toy from home to play with to pass the time in Pre-Op and to soothe them after surgery. We are mindful of the fear of needles, so all pediatric IVs are started after the child is asleep in the Surgery Suite. Parents are brought directly to the Recovery area as soon as their child is awake. Each patient that we touch throughout the surgery experience allows our team to fulfill the mission at Boone to improve the health of the people and communities we serve.“ Riley’s surgery went perfectly, and soon, Riley headed back home to be reunited with her twin sister Kailey. One week later, you would never know Riley recently had surgery as she celebrated her 3rd birthday. “She was back to normal in no time. We are so grateful for the experience we had at Boone,” says Kelsey. Riley and Kailey just recently shared the exciting news that they are going to be big sisters in February. “The girls are so excited and so are we,” says Kelsey. By Madison Loethen
GETTING TO KNOW A BHC DOCTOR
Andrew Iliff, MD
grew up in Kansas with my parents and three brothers, then spent 9 years in Kansas City for school and training. I met my wife, Ann Iliff, while we were in medical school at University of Missouri - Kansas City. I completed my residency at University of Kansas and my hematology/ oncology fellowship at the University of Iowa. While we loved our time in Iowa City, we are thrilled to be in Columbia now.
Why did you get into the health care field? I enjoyed science classes from a young age onward, so pursuing a career in health care, where I could both help people and focus on the sciences, seemed like a natural fit. During high school, I heard about the 6-year program at UMKC and how it was tailored to early patient care. I decided that would be the ideal path for what I was looking for â€“ a career in medicine. What interested you in your particular specialty? The patient-physician relationship is unique in the field of oncology, since we tend to meet our patients during a stressful and grave period, but continue to care for them through many ups and downs. The relationship that is built with each patient and family over time is very important to me. The specialty of oncology continues to advance, with science and technology working together to allow for more and more options for patients, which also drew me to the field. What is the most rewarding aspect of your job? Whenever someone has been diagnosed with cancer it can be a chaotic and scary time not only for the patient, but also their family. The most important and rewarding part of my job is being able to step into that situation and help bring some organization and comfort to the chaos. My hope is that, by the time a patient and their family leave a visit, they have a better understanding of the diagnosis and are comfortable with the plan. What is the most challenging aspect of your job? Whenever there is negative news relating to a patientâ€™s disease or treatment, it is challenging. It is one of the hardest things about the job. What do you see changing in health care in the next five to 10 years? Medicine is undergoing a rapid transformation in the ways and the techniques we use to care for patients. This is especially evident in the practice of medical oncology. There are so many new medications, indications and approvals happening, and while most are small incremental steps, occasionally there are major breakthroughs that revolutionize the field. In the next decade, I foresee continued advancement in the precision of directed therapies and a better understanding of the different diagnoses.
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What advice would you give to someone who is going to be a patient in a hospital for a period of time? I would encourage patients to call on their support system. It can be a stressful time when youâ€™re in the hospital, and to have family and friends in the loop can help with the stress. I would also suggest they be an active participant in their medical care and consider having close family members involved as well. This allows everyone to be on the same page and have the opportunity to ask questions, which will allow everyone to understand what is happening and what the plan is. What advice would you give someone looking to become a doctor? Becoming a doctor is a long and challenging road but very rewarding. I would encourage anyone considering a career in medicine to pursue it, especially if they want to serve others and are interested in the sciences. What do you enjoy doing outside of work? Outside of work, I love spending time with my wife, my family and friends. Ann and I love traveling to new places and learning about different cities. If you have local recommendations for us to try in Columbia, please share them with us! I am also a huge Kansas City Chiefs and Royals fan.
GETTING TO KNOW A BHC NURSE
Laura DeVries, RN, Intensive Care Unit I am happily married for 25 years now. I have a beautiful daughter who is now going to nursing school!
Why did you get into the health care field? I was working at Missouri Heart Center as a receptionist, and I was always interested in what the nurses did. I wanted to learn more about everything. The nurses were great and encouraged me to go to nursing school. I have several family members who are in the medical field who also encouraged me. I then was fortunate that the ICU manager hired me to be a tech in Boone Hospital’s former medical ICU. That is when I knew for sure I wanted to become a nurse. I worked in the ICU through school, then worked in the surgery ICU after graduating. I received the best training there, and it made me the nurse I am now. What is the most rewarding aspect of your job? The most rewarding part of being a nurse is always helping the patients and knowing you make a difference in their health. What is the most challenging aspect of your job? The challenge is often the same as the rewards. Patients are very ill, and the challenge is to keep ahead and be proactive. What has changed in your field since you started practicing? Since I have started nursing, I think everything has changed – the charting, computers, medications, procedures, and equipment. At Boone Hospital, even the ICUs are different. The hospital intensivists now include Physician Assistants. The way nurse practitioners practice in the hospital has also changed over the years. So many changes have occurred and will continue to change in the years to come. That’s how the medical field goes! What do you see changing in the next five to 10 years? In the next 10 years, things will continue to change. Technology will continue to change. I think the only thing that will not change is how we care for patients. They are the priority and will always be. The way we chart or perform care may change, but the focus is the same. What do you enjoy doing outside of work? When I am not at work, I enjoy spending time with my family. I love to read and to be outside as much as possible. What advice would you give to someone looking to become a nurse? I would advise anyone thinking of nursing school to work in the field first. Nursing school is challenging and a big commitment. It is not for everyone. If this is what you choose to do, then work hard, don’t get discouraged. We need good nurses, so I’d say good luck and I look forward to working with you in the future!
Riane LaGrace, RN instructs inpatient rehab patient Lon Larson during a physical therapy session.
Road to Recovery Inpatient Rehab helps car crash victim regain independence. It was a beautiful Memorial Day when retired high school teacher and Navy veteran Lon Larson got in his car to drive to his American Legion Memorial Day ceremony. He left his hometown of Versailles, and it was a peaceful drive, until he saw the car he was following cause a flatbed truck to start swerving. To avoid a major collision, Lon also swerved, but still hit a portion of the truck, causing his car to roll twice.
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The next few hours were a blur to Lon and included him being taken by helicopter to Columbia. He was relieved to find out his neck was not broken, but his providers were still concerned that he had very limited movement in his arms and legs. “They said the Inpatient Rehab at Boone would be able to help me – and did they ever! When I got there, I couldn’t even feed myself. Now I can feed myself just fine, and even walk
Hear from Lon at Youtube.com/BooneHospital
with my walker. I keep getting better, thanks to them,” says Lon. Boone Hospital Center’s Rehabilitation Unit uses a team approach. A care team of physicians, nurses, physical therapists, occupational therapists, speech therapists and other skilled medical providers work together to help patients become independent after an illness or injury. The unit has a home-like environment with laundry, kitchen and dining areas for patients to use. Some of the goals of Inpatient Rehab patients often include being mobile again, swallowing effectively and safely, and regaining skills for independent daily living, like showering, dressing and cooking. “When I first went to evaluate Mr. Larson for admission to Inpatient Rehab at Boone, he told me he could not feel his arms. He had diminished sensation in his legs and could only walk a few feet. He sustained a whiplash injury to his cervical spine, causing spinal cord swelling. Seeing patients like Lon Larson recover so well is why Inpatient Rehab at Boone is so gratifying,” says Teri Vititoe, Boone Hospital Center’s Inpatient Rehab Manager. Lon spent 22 days as an Inpatient Rehab patient and says he worked very hard each of those days. “The staff worked me hard, but I worked hard, too. I tried to have a good attitude while I was there, which I think is really important. I was known to tell a few jokes here and there to keep things light,” says Lon. Lon is now back home in Versailles and following up with a local outpatient physical therapy provider. He says he is getting stronger every day. “My biggest goal is to be able to play golf again. Being retired, I don’t have much to do besides mow the lawn and play golf. I really want to get back on that golf course,” says Lon. By Madison Loethen
A Breath of
FRESH AIR Pulmonary rehabilitation improves quality of life.
Georgiana Pitts feels the best she’s felt in years. She’s finally able to walk around the house without getting winded and can go out to eat with her son without having to worry about getting too exhausted. If you would’ve told Georgiana a year ago she’d be feeling this good, chances are she wouldn’t believe you. A year ago, Georgiana was hospitalized for serious lung infection, something she blames on smoking during her early adult years. She recovered from the infection, but still had trouble breathing. “It was so bad that I could hardly do anything active. That’s when I went to pulmonologist Dr. Abu-Salah,” says Georgiana. Tareq Abu-Salah, MD, with Boone Pulmonary Medicine, adjusted Georgiana’s medication, but also encouraged her to
BOONE HOSPITAL CENTER
See Georgiana’s story at youtube.com/boonehospital
Lugine Hein, RN assists Georgiana during her workout.
go to Boone’s Pulmonary Rehabilitation program. “Pulmonary rehabilitation is a comprehensive exercise program that aims at improving the physical and emotional condition of patients with chronic respiratory conditions, especially chronic obstructive pulmonary disease (COPD). This includes a thorough patient assessment with patient tailored therapies including exercise training, education and behavior changes. “It promotes the long-term adherence to health-enhancing behaviors. Upon completion of the program, we remain in touch with our patients to ensure they continue to implement what they learned for the remainder of their lives. “Studies have shown that pulmonary rehabilitation improves overall quality of life and reduce rate of COPD exacerbations and readmissions to the hospital,” says Dr. Abu-Salah. Georgiana says at first her workouts felt exhausting and even a bit overwhelming. She admits she hadn’t been very active since she retired, and regular exercise was new to her. “I dreaded going in at first, but then after a while, I started looking forward to it. I got healthier the more I went. Now it is one of the highlights of my day. It gets me out of the house and the staff is always really nice and friendly,” says Georgiana. Georgiana still goes to Pulmonary Rehab regularly and says she gets stronger every day. “I appreciate how good the program has made me feel. I am now able to get out and enjoy life so much more,” says Georgiana. By Madison Loethen
CALENDAR OF EVENTS OCTOBER 22-23
MAY 13, 2019
Foundation Gift Makes Finding Veins Easier
etween the two of them, Boone Hospital Foundation supporters Guy and Ellen Brown have received their share of needle sticks. “I’ve been almost impossible for someone to stick an IV into. You can’t do it. My veins move. It’s just not possible,” Guy explains. When the Browns were approached about the opportunity to support the Foundation’s purchase of an AccuVein AV400 – technology that would make it easy for health care professionals to find the best spot to make the first stick for an IV or blood draw – they were immediately on board. The AccuVein AV400 helps Boone Hospital nurses find the best spot to start an IV or blood draw. Guy says, “When Ellen told me there’s a gadget that can tell you exactly Patient care staff will find AccuVein especially helpful with where you’re supposed to put the needle – and where you can’t put it pediatric patients, patients who are dehydrated, obese, have low body in, and I said ‘That’s what we want!’” temperature, whose veins roll and or who’ve had frequent venipuncture Venipuncture is the most common invasive medical procedure – during treatment. about 2.7 million venipunctures are done every day in the United Thanks to a request from Boone Hospital nurses, who wanted States. Even experienced nurses and technicians can have difficulty the technology to improve patient care, and a financial gift from inserting a needle into a patient’s veins safely and quickly the first the Browns, Boone Hospital Foundation provided four AccuVein time. Studies have shown a third of attempts to access a vein fail devices to the hospital’s patient care staff in July. Boone Hospital the first time – a fact that can be painful for patients and stressful caregivers started received training on how to use the devices to for caregivers. locate a patient’s vein. By helping health care professionals find the best location to start The Browns have supported Boone Hospital Foundation before, venipuncture, the AccuVein AV400 vein visualization system has been funding Advanced Stroke Life Support training and education; skin shown to improve first-stick success and reduce patient pain. It’s easy cancer screenings; a guest speaker for Boone Hospital Center’s 2014 to use, too. A nurse or tech points the lightweight, portable device at Stroke Conference; and the purchase of an oversized, inflatable, the patient’s skin, then clicks to display the veins beneath. walk-through colon, used to educate the public about colorectal Boone Hospital Foundation arranged a demonstration of the cancer screening. The Browns had moved to Columbia looking for AccuVein technology for the Browns. They were impressed. As a quality health care, and say they love Boone Hospital Center and love retired nurse, Ellen Brown understood the value of starting an IV with supporting it even more. reduced pain and discomfort for the patient. “You really get more of a high when you give than you receive. “An AccuVein representative demonstrated it on us. We saw our We’ve had a wonderful life,” Ellen says. “We’ve worked hard. We’ve veins, and he showed us how a nurse would know not to put the had everything we need. Now we want to make somebody else’s life a needle here or there, because it’d be a dead end. You do away with the trial and error with AccuVein. I can’t stop talking about it!” Ellen says. little easier.” By Jessica Park
BOONE HOSPITAL CENTER
a l a G
Boone Hospital Foundation Presenting Sponsor:
November 3, 2018
Honoring Drs. Joe and Mary Muscato Reserve your seat today:
Call the Boone Hospital Foundation Office at (573) 815-2800 Visit the website at boone.org/foundation
For sponsorship opportunities call (573) 815-2800
Boone Hospital Center 1600 East Broadway Columbia, Mo 65201 573-815-8000
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