Boone Health SUMMER 2018
THE POWER OF POSITIVITY Meet Bob and Sue Evans. PG. 12 P G . 22 T H E M U S C AT O L E G A C Y
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.
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President Jim Sinek Director of Marketing and Public Relations Ben Cornelius Marketing Coordinator Jessica Park Multimedia Marketing Specialist Madison Loethen Photography Lana Eklund Tiffany Schmidt Sadie Thibodeaux Contributing Writers Nicole Flood Kelsie Knerr, RD, LD Douglas McDowell, M.Ed.
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A Note from Jim
The Muscato Legacy
Get to Know a BHC Doctor
Get to Know a BHC Nurse
The Situation Improvers
Arm Strength Exercises
The Next Generation
Foundation News MyBooneHealth.org
The Regionâ€™s Premier Heart Hospital In sports, in music and in medicine, the more you do something, the closer you can come to perfection. At Boone, we do more heart procedures than any other hospital in the region. More expertise, more experience, more compassion. Thatâ€™s the Boone Touch.
A NOTE FROM JIM
Cutting Through the Clutter Lately, the health care industry seems more and more cluttered with misinformation, confusing data, marketing bravado, and self-serving tag lines like “world-class care.” Add to that the current local impact of the Boone Hospital Trustees assessing a potential new operating partner (or going independent), and you can imagine how challenging it may be for a MidMissourian who’s trying to select the right health care provider for themselves and their family. While the Trustees appropriately perform their due diligence in assessing the right path forward for Boone Hospital, and while administrators, community leaders, politicians, and business leaders assess the options and offer their opinions; Boone Hospital Center’s medical staff and team of 1,800 nurses, lab technicians, environmental services technicians, and more continue to perform their jobs, day in and day out, at an exceptionally high level. In spite of the clutter in the environment, our Boone teammates stay focused on what’s most important – assuring our patients have exceptional clinical outcomes, a safe environment in which to receive care, and an excellent experience. In the last two years, Boone Hospital Center and our medical staff have repeatedly been recognized for their dedication to quality, safety, and patient satisfaction. Some examples include: • For the third year in a row, Boone has been ranked as MidMissouri’s top hospital by U.S. News & World Report; • Boone is the only five-star-rated hospital in Mid-Missouri as determined by the Centers for Medicare and Medicaid Services (CMS); • Boone has been designated a Level 1 Stroke Center by the state of Missouri; • Boone earned the Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award from the American Heart / American Stroke Association; • Boone has been designated a Level 1 STEMI (heart attack) Center by the state of Missouri;
focusonhospitals.com. Compare the cost and quality results of Boone Hospital with any other hospital in the state. In particular, compare Boone’s cost and quality data to other hospital options you may have in Columbia, and you’ll find that overall the highest quality outcomes with the lowest cost are available at Boone Hospital Center. Everyone wants value for their hard-earned money, and the products or services that exhibit the best value are those which combine the highest quality with the lowest cost. In addition to providing the highest value health care services in the market, Boone Hospital Center contributes $2.4 million annually to Boone County to benefit its citizens. Beginning in 2007, Boone was required, as a result of a new accounting rule, to depreciate its capital expenditures over the number of years that remained in the Trustee-BJC Lease, as opposed to the standard depreciation practice of expensing the cost of the capital – such as our buildings or equipment – over the normal life expectancy of the asset. This is what’s known as “accelerated depreciation,” which currently accounts for approximately $6 million per year of additional or extra non-cash expense to Boone Hospital. The hospital’s annual operating expenses also include approximately $2.4 million of principal payment on bonds held by the Boone Hospital Trustees. Typically, bond principal payments would not impact net operating income, but as a result of the BJC lease, those payments are treated as an operating expense. It is very rare, almost unheard of, that a hospital would incur these unique or unusual expenses, which collectively represent approximately $10.8 million of our annual total expenses. Yet, even with our annual commitment to the county citizens, the burden of accelerated depreciation, and bond principal payments, Boone Hospital has generated annual earnings between $10 million and $32 million over the last four years. Our goal is to be at a 10 percent annual earnings level, which equates to approximately $30 million. Boone Hospital Center remains strong, both clinically and financially, but the clutter can make it difficult to discern the truth. I wanted to provide you this information so that as a patient, a family member, or a business leader, you can make informed decisions about health care that are based on facts and not hyperbole or marketing bravado.
• Boone has been named one of America’s best hospitals for obstetrics by Women’s Choice Awards; • Boone has been recognized as the top hospital in the Midwest region for coronary bypass surgery and aortic valve replacement surgery by Consumer Reports. Recently, the Missouri Hospital Association gathered actual cost and quality data from hospitals operating in the state of Missouri. You can find this information online at
Jim Sinek President, Boone Hospital Center
At Boone Hospital Center, our nurses stay up-to-date with the latest advancements in care, but they know positive attitudes, leadership, compassion, and an insistence upon safe, quality patient care never go out of style. This fact was celebrated at the 2018 Nurses’ Week Celebration with the theme “Excellence is Our Style.” A fashion show featured Boone Hospital nurses and caregivers as models and vascular surgeon John Adams, MD, as emcee. The event recognized nurses in Boone Hospital’s Professional Nurse Development Program, certified nurses, nurse residency program cohorts, DAISY award winners, and recipients of this year’s Professional Excellence in Nursing Awards.
On April 7, the second annual Molly’s Miles 5K/10K was held at Boone Hospital Nifong Medical Plaza. More than 1,000 runners raised over $32,000 for the Missouri Chapter of Concerns of Police Survivors, a national organization that supports surviving family members, friends, and coworkers of officers who have been killed in the line of duty.
Boone Student Buddhist Chaplain, Rev. Anthony Phillips
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Boone Hospital Center values the importance of our patients’ spiritual health. Chaplains are available to provide support to patients, family members, and hospital staff upon request. Boone Hospital Spiritual Care celebrates and promotes the diversity of faith represented in Mid-Missouri. Recently, our Lead chaplain, Rev. Richard Sullivan, provided a tour of Boone Hospital Center to the new bishop of the Catholic Diocese of Jefferson City, Rev. Shawn McKnight. Bishop McKnight visited and offered pastoral care to our Catholic patients. Boone Hospital Spiritual Care also promotes the training of new chaplains through Clinical Pastor Education classes. Our recent student chaplain, Rev. Anthony Phillips, is affiliated with the United Buddhist Church. For more information about our Spiritual Care services, please call 573.815.3888.
2018 PROFESSIONAL EXCELLENCE IN NURSING AWARD WINNERS Year One Wonder: Trent Hoover, ICU Bri Mitchem, Women’s & Children’s Health Excellence in Nursing Education: Jennifer Wood, Cath Lab Jonathan Barnes, Pulmonary Medicine Nursing Spirit: Jessie Carter, Medical Specialties Martin Parks, Emergency Department Beyond Boone: Fay Putnam, Cath Lab Partner in Caring: Katie Goodlet, Physical Therapy Kris Kippley, Cath Lab Alexis Fain, Nutrition & Food Services Transformational Leader in Nursing: Shanna Marshall, Orthopaedic Specialties Excellence in Professional Nursing: Tammy Doerhoff, NICU Chuck Baker, PACU Lori Burns, Emergency Department
Missouri Cardiovascular Specialists One of Four Groups Recognized The American College of Cardiology’s PINNACLE Registery® is cardiology’s largest outpatient quality improvement registry, capturing data on coronary artery disease, hypertension, heart failure, and atrial fibrillation. This year, the PINNACLE Registry® selected four practices nationwide, including Missouri Cardiovascular Specialists of the Missouri Heart Center, to be recognized for their dedication to using the registry to drive quality improvement.
Kids On Track
On Saturday, May 12, Kids on Track began its 7th season of helping MidMissouri kids build a lifelong love for exercise. At the first of two community kick-off events at Nifong Medical Plaza, families from our Ashland, Boonville, Centralia, Columbia, Hallsville, Mexico, and Moberly programs picked up their community KOT tracks and water bottles, and enjoyed kid-friendly activities sponsored by local businesses and organizations, plus St. Louis Children’s Hospital. Over the next few months, kids 12 and younger who participate in Kids on Track will walk, run, bike, swim, or skip a total of 26.2 miles – and complete a marathon this summer! Local businesses in each community support the program as Mile Sponsors, offering incentives to children who reach designated points along their track. Kids on Track is a fun and popular way for Boone Hospital Center to improve the health of the people and the communities it serves. Thank you to our Boone Hospital Center teammates who came out to make this a great day for Mid-Missouri families!
BJC Book Brigade
Boone Hospital Center President Jim Sinek visited West Boulevard Elementary in Columbia to read and hand out books. In its third year, the BJC Book Brigade has provided more than 47,000 third-graders with a new book to read during their summer vacation. This year, BJC is expected to provide 26,000 books to nearly 400 elementary schools throughout the communities BJC hospitals serve, including: St. Louis City, St. Louis County, St. Charles County, Columbia, Sullivan, and Farmington in Missouri; and Alton, Belleville, and Shiloh in Illinois. Studies show that a third-grader’s reading proficiency can improve the likelihood they will graduate from high school and live a healthier life. “We want to encourage reading, knowing it is the foundation of learning and because there is a relationship between educational attainment and health outcomes,” says June McAllister Fowler, BJC Senior Vice President of Communications, Marketing and Public Affairs, who directs the BJC Book Brigade program. “Our BJC Book Brigade is an opportunity for us to champion learning and support our communities.”
Time Critical Care As a Level 1 STEMI Center, Boone Hospital can now help more Mid-Missourians who have a heart attack.
Heart care team members from left to right: Daniel Garcia, Scrub Tech; Kristi Baden, RN; Anthony Spaedy, MD; Kelley Hanenberger, RN; Jacob Rosendale, Monitor Tech; Jerri Clair, RN
n 2010, Boone Hospital Center nurse Kristi Baden witnessed Boone Hospital Center’s STEMI team in action when her 97-year-old grandfather had a heart attack and went into cardiac arrest. The emergency medical response team began treating Kristi’s grandfather in the ambulance as they transported him to Boone Hospital’s cardiac catheterization lab. Kristi was able to watch the process from admission to discharge. “I witnessed a great team in action,” Kristi says. “The hand-off from EMS to the cardiac cath lab was timely and efficient. Even the smallest task, like offering a pillow to my aunt at his bedside, made a great impact.” Before long, Kristi’s grandfather returned to working his farm in Blackwater, Mo. Several years later, Kristi, still inspired by what she’d seen, took a position as Boone Hospital Center’s STEMI coordinator. For many years – both before and after Kristi saw the STEMI team save her grandfather’s life – Boone Hospital Center
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has strived to provide timely care for patients diagnosed with ST-elevated myocardial infarction, or STEMI, a type of heart attack that requires immediate medical attention. “In 2007, the Missouri Department of Health and Senior Services started a task force to develop a plan to treat people with a Time Critical Diagnosis, like trauma, stroke, and STEMI,” Kristi explains. The plan included public health education on the importance of calling 911, creating regional emergency transport protocols, and standardizing patient handoff. In 2018, Boone Hospital Center was designated a Level 1 STEMI center by the Missouri Department of Health and Senior Services. This designation – the state’s highest honor – is part of the state’s Time Critical Diagnosis (TCD) plan and allows Boone Hospital to act as a heart attack resource for Mid-Missouri patients and health care facilities. This designation gives patients better access to life-saving procedures and helps EMS teams and
hospitals improve communication and patient outcomes. As a Level 1 STEMI center, Boone Hospital Center has an on-call cardiac catheterization team – available 24 hours a day, every day – to receive and treat patients. Boone Hospital can perform percutaneous coronary intervention procedures to open blocked arteries. Emergency medical responders can start an EKG as soon as they reach the patient and take anyone having a STEMI to the nearest facility capable of providing required care. Boone Hospital’s Level 1 STEMI designation reflects our sustained efforts to provide patients with timely care. Tony Spaedy, MD, an interventional cardiologist with Missouri Heart Center, says that, while the designation will help more MidMissourians, “It won’t dramatically change what we’ve been doing for years, which is to treat patients as best and as skillfully as we can, with the best team.” By Jessica Park
Be a Part of the Plan! Public education is an important part of Missouri’s Time Critical Diagnosis plan. Knowing what a STEMI is and how to respond can make a profound difference for yourself and others. According to the American Heart Association, someone in the United States has a heart attack, or myocardial infarction, every 40 seconds. Heart attacks are usually caused by blockage in a coronary artery. The blockage reduces blood flow and oxygen supply to your heart muscle, and the muscle begins to die. Cardiologists often say, “Time is muscle,” meaning that the longer a blockage goes untreated, the more the heart gets damaged. An ST-elevation myocardial infarction, or STEMI, is a type of heart attack with a higher risk of death or disability. A STEMI is caused by a complete blockage in a coronary artery. It can be detected on a 12-lead electrocardiogram, or EKG. STEMIs require immediate treatment, including clot-busting drugs and cardiac catheterization. An interventional cardiologist and a team of specially trained technicians and nurses use special medical devices to find blockages and open up blocked blood vessels. Patients may also require surgery to improve blood flow to the heart.
If you suspect you or someone else may be having a heart attack, call 911. Emergency medical services staff can start treatment as soon as they arrive and take you to a facility equipped to provide the level of care needed.
diabetes, coronary artery disease, and physical inactivity. Some risk factors, like your age, sex, race ,and family history, are beyond your control, but you can address most risk factors for heart disease through lifestyle changes and medical treatment.
Learn the signs.
See your primary care provider.
Heart attack symptoms usually include: • Chest pain or discomfort. Some describe the sensation as crushing or squeezing. • Pain may also spread to your neck, back, shoulder, left arm, or jaw. • Sweating • Nausea or vomiting • Fatigue • Shortness of breath • Flu-like symptoms • Dizziness • Feelings of doom Women are more likely than men to experience other symptoms of heart attack, such as shortness of breath, nausea/vomiting, or pain in the jaw or back.
Don’t ignore symptoms.
Even if you’re unsure it’s a heart attack, it is better to get checked out. Every minute matters during a heart attack, so act fast – your life may depend on it!
Know your risk.
Risk factors for heart attack include a history of smoking, high blood pressure, high cholesterol, obesity,
Get regular check-ups. Talk about your risk factors and ways you can manage your cholesterol, blood pressure, or weight.
If you smoke, quit. Exercise.
Even 10 minutes of walking a day makes a difference if you’ve been inactive.
Eat a healthy diet.
Eat a diet with more fruits and vegetables, whole grains, lean meat, and low-fat dairy products. Eat fewer processed foods or foods high in sodium.
If you have survived a heart attack • Take all medications properly. Ask your health care team if you have questions about when or how to take medication. • Keep your follow-up doctor appointments. • Participate in a cardiac rehabilitation program to help you recover. • Get support. It’s common to feel overwhelmed, fearful, or depressed after surviving a heart attack. • Manage risk factors with medical care and lifestyle changes.
Collaborating for Healthy Living 10
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ellness programs not only benefit the employee, but they also benefit the organization and community as a whole. That is why Boone Hospital Center works with corporate partners in mid-Missouri to provide wellness programs and initiatives tailored to their needs. “When companies focus on wellness, it not only helps the employee but it also helps the company maintain a healthy bottomline,” says Jeff Zimmermann, Manager of Health Promotions and Business Development, Boone Hospital Center. “Boone Hospital Center’s corporate wellness program is an outreach program that reaches mid-Missouri companies that are interested in employee health and wellness screenings, as well as specific nutrition and fitness related programs.” Their team consists of registered nurses, dietitians, exercise physiologists, health coaches and more to provide a variety of corporate wellness programs that are unique and structured to reach individuals specific areas of interest. “We focus on nutrition, fitness and overall wellness; weight management, blood pressure, cholesterol and blood glucose,” says Jeff. In addition, they provide presentations and health challenges on various nutritional, fitness and health-related topics. With a mission to improve the health of people in the communities they serve, the program is one of the many ways Boone Hospital Center fulfills their mission. “When we are onsite delivering these health screenings, we supply follow-up information including our directories of physicians and clinics, as well as health resources available to guide the patient to better health,” says Jeff. The Mobile Health Unit makes many of these services possible by bringing screenings right to their corporate client’s place of work. Thanks to the Boone Hospital Foundation and the Board of Trustees, they were able to raise the funds to purchase the Mobile Health Unit. “We are truly grateful to the Boone Hospital Foundation investing in the health of our community,” says Jeff. “We’re fortunate to live in a community that is surrounded by exceptional health care and interested in the well-being of our citizens.”
CORPORATE PARTNERS: BOONE ELECTRIC Jeff and the wellness team currently work with several corporate clients for wellness initiatives. Boone Electric and Veterans United Home Loans are two of their most engaged area workplaces. Boone Hospital Center’s corporate health relationship with Boone Electric began in the early 1990s. “They have a very organized regimen built within their benefit program and we have been fortunate to work with this dynamic and hard-working team over the years,” says Jeff. “Boone Electric’s success is based on the leadership and engagement among the team. They are very interested in maintaining a healthy life style, which also comes with healthy competition.” Boone Electric is a member of the top plan, the Gold corporate wellness package. This grants their employees a yearly health screening, flu shots, multiple presentations and health challenges. “Boone Hospital does an excellent job of presenting ‘lunch and learn’ topics that are key to our employees’ health and interest,” says Laura Baker, Manager of Member Services with Boone Electric. “They offer great topics and come up with fantastic health challenges. We also have an employee workout room and they are great in giving advice as to which equipment is best.”
Laura adds that this program has been valuable in encouraging their employees to live a healthier lifestyle. It serves as a great resource in many aspects without Boone Electric having to have health providers on staff. “The partnership has allowed us to count on Boone Hospital for topics that are pertinent to what they are seeing in the community,” says Laura. “If they are taking care of themselves, this helps to prevent injury and illness so they are more productive at work and then can go home and BE with their families. I would hope that encouraging that behavior at work filters to their home life as well!”
CORPORATE PARTNERS: VETERANS UNITED HOME LOANS Veterans United and Boone’s corporate health relationship begin in 2010 with health screenings and flu vaccination clinics. “As years progressed, so did their interest wellness across the board,” says Jeff. “Veterans United cares about their employee’s health and wellness and it shows in their detailed programs.” In addition to health screenings and flu shots, Boone Hospital also provides First Aid Stations at Veterans United team events, and provides skin cancer screenings. “What’s great about Boone Hospital is they offer a variety of wellness services and bring them to us so that our employees can conveniently access them at their office locations,” says Amy Starr, Manager Life Balance Program for Veterans United Home Loans. “At Veterans United, we not only strive to enhance the lives of our borrowers, but also to have a positive impact on the lives of our employees. As a company, we value the health of our employees and encourage them to take an active role in maintaining good health.” Working with Boone Hospital’s wellness program allows Veterans United to build on their Life Balance Program. “Our Life Balance Program is here to support our employees in a wide array of life events and experiences: celebrating milestones, connecting co-workers, growing as individuals and supporting each other in times of grief and need,” says Amy. At Veterans United, Amy says they care about their employees both professionally and personally. “We promote a culture of a healthy work-life balance and support each other so we can do the things that matter most inside and outside of work. Our continued relationship with Boone Hospital has been instrumental in helping us meet the wellness needs of our employees.” By Nicole Flood
For more information about Boone Hospital Center’s Corporate Wellness Services, or to learn how your organization might benefit from this program, visit boone.org/ corporatewellness or contact Jeff Zimmermann at 573-8153263 or jeffrey.zimmermann@ bjc.org.
Compassion & Kindness One Patient’s Journey with Rehabilitation Big health events can be a scary and stressful time for both the patient and the family. For the Evans family, the compassion and kindness shown to them from emergency room to surgery to rehab at Boone Hospital Center made all the difference in their health journey. “We originally chose Boone because of the recommendation of several of our friends. According to our friends, the heart unit at Boone was the best in the Midwest. That was good enough for us,” says Bob Evans, whose wife Sue received care at Boone Hospital Center. On Sunday, March 4, Sue experienced nausea and pressure in her chest. The Evans went to Boone Hospital Center’s Emergency Department around noon. Sue was evaluated and kept overnight for further tests, which revealed on Monday that two of her arteries were 80 percent blocked and two were 50 percent blocked. Sue’s medical team scheduled her for a quadruple bypass surgery on March 7, which was her 65th birthday. “However, her blood chemistry was not where the surgeon wanted it, so the surgery was rescheduled for Friday, March 9,” says Bob. “At some point during or after surgery, she experienced a significant brain ‘event’ [a stroke].” When Sue woke up after surgery, her doctors 12
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Sue collects penguins. During her stay in Boone Hospital, one of Sue’s daughters gave her a penguin to hug for comfort.
determined the stroke had caused total left side paralysis. However, while in the recovery room, Sue started to experience some toe movement in her left foot. Because of this, it was determined rehabilitation would be a viable option for regaining mobility. “Sue entered Boone through the Emergency Room on Sunday, March 4, and was discharged from the Rehab Unit on Wednesday, April 18,” says Bob. “During this time, she experienced her 65th birthday, her 35th wedding anniversary, the birthday of both daughters, and the birthday of two of her three grandsons. On Easter Sunday, the entire family was in attendance, and we had a mass birthday celebration in the dining room of the Rehab Unit.” The Evans family enjoyed chocolate pudding for their birthday cake, because that was something Sue could eat at that time. Because Bob was a U.S. Navy sailor, he and his family sometimes celebrated Christmas on a day other than December 25, and birthdays on a day other than the date on the calendar. The important thing was celebrating occasions together. This celebration was no exception. GOING ABOVE AND BEYOND Throughout Sue’s three-week stay in the
Rehab Unit, she experienced great care. On her first day in the unit, Bob and their daughter were helping adjust Sue to move her higher up in the bed. An alarm went off and immediately a patient tech was in the room to check that they were okay. “Every staff member Sue, or any family member or friend came in contact with was smiling and had kind words,” says Bob. “It did not matter what their function was – the nurses, doctors, patient tech’s, PT, OT, Speech, kitchen staff, housecleaning, maintenance – they all had smiles and a positive attitude. We believe this contributed to Sue making her tremendous strides while in the rehab unit.” One patient tech in particular would pop in to visit Sue for a few minutes before her shift when she was assigned to a different floor. “This always put a smile on Sue’s face, and we feel it had a tremendously positive affect on her rehab,” says Bob. During Sue’s stay their daughters, Connie Viele and Angela Salmon, took turns spending the night with her until she was medically stable. Bob adds that their family always felt welcome and never in the way no matter the time of day. “Our entire experience with all staff was totally professional and it was evident that all people who came in
contact with Sue were there for her, and this was more than ‘a job’ to them. I believe that if someone is going above and beyond what is ‘expected’ I should tell them, but it is more important to tell their boss. I did that. I also told the supervisor that I would hesitate to try to single out any one person, because the entire rehab staff was so wonderful with their interactions with Sue.” During Sue’s three weeks in the Rehab Unit, she made great strides in her recovery. “On March 17, I gave Sue a pen and piece of paper and asked her to sign her name—it was nothing but scribbles. On April 16, I repeated this process and she signed her name with 99% accuracy,” says Bob. “During that same timeframe she went from total left side paralysis to walking the entire length of the halls on her own, with only supervision for safety reasons, and her left arm started to show movement. Our family and friends credit the rehab staff for this, with their caring and most positive attitude toward their patients.” “On May 30, 10 weeks after her massive right hemisphere stroke, Sue can grasp a stress ball with her left hand, lift it to shoulder level and release it so it will fall to the table.” By Nicole Flood MyBooneHealth.org
Rapid Response team members from left to right; Katie Bealmer, BSN, RN; Garrett Ennenbach, PCT; Nick Weston, RN, House Supervisor
Situation Improvers Boone Hospital’s Rapid Response Team is there for nurses and patients.
“I’m used to staying calm and figuring out how to make a situation stable,” says Nick Weston, RN, one of Boone Hospital Center’s House Supervisors. Nick developed his skill for staying calm in tense situations while working as a patient care tech, then later as a nurse, in the hospital’s Emergency Department for over a decade. When he became a House Supervisor last year, Nick was able to use
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his experience to help other nurses in all units stay calm and stabilize patients. “That’s a big thing House Supervisors do – they’re situation improvers,” Nick explains. When a patient’s vital signs like pulse, blood pressure, respirations, or temperature change, the cause may not be obvious. The changes could potentially indicate a severe condition – a situation you don’t want to leave up
to chance. A nurse might see something isn’t right with a patient in their care, but needs assistance to assess the situation, whether it’s a second opinion, the ability to further examine a patient by ordering labs or imaging, or an immediate discussion with the patient’s physician. When a Boone Hospital nurse knows something isn’t right with a patient in their care, they can rely on the support
The Rapid Response Team’s goal is to help everybody – nurses, patients, and their families – find peace of mind and to ensure that all patients at Boone Hospital Center receive the best patient care.
Amber McLelland with Patient Transport leads the Rapid Response team and patient
and expertise of the Rapid Response Team, at any time, any day. When a nurse calls the Rapid Response Team, or RRT, the House Supervisor and Charge Respiratory Therapist are called. They work directly with the nurse who called them and the unit’s Charge Nurse to assess a patient’s situation. “When’s there a change in a patient’s vital signs, we try to find out why,” Nick says. “Once we arrive, I determine if we need to get the Hospitalist involved, and if so, I page them. The Hospitalist will quickly respond to the scene.” The RRT also contacts the patient’s physician. If the patient needs it, the RRT can contact and involve more health care professionals to get labs drawn, to do imaging studies, or to move a patient to higher level of care, coordinating with the Charge Nurse on the destination unit. Calling the RRT to examine a patient can prevent a later ICU transfer or Code Blue call for emergency resuscitation, meaning a shorter stay and better outcomes for patients. “Rapid responses have been quite effective, helping us identify STEMIs, strokes, sepsis, and other rapid declination of patients, helping us keep them alive and get back home,” Nick says.
In addition to supporting nurses when they need assistance to assess a patient’s condition, the Rapid Response Team’s role is to educate nurses at the bedside. Even if a patient turns out to be stable, it’s always a good thing that the nurse called the RRT. Leslie Duckworth, a nurse and Boone Hospital’s Manager of Clinical Quality, Patient Safety and Infection Prevention, agrees, “It’s much safer to have occasional RRT calls for patients who are ultimately identified as stable than to have someone hesitate to call an RRT that might be life-saving.” Leslie says a supportive attitude is necessary for a successful RRT program, and nurses should never worry that a call to the RRT is unnecessary. Leslie supports the patient care staff, telling them, “If you are ever in doubt, sweat the small stuff, and call the Rapid Response Team!” “When I first started, nurses would be afraid to call for the RRT,” Nick says. “Every time a nurse calls us, I tell them they did a good job, and now they’re going to do a better job because they’ve learned something. “If I can do anything to increase a nurse’s confidence, that’s a big thing. I love the philosophy that draws certain kinds of people to come work here – good people, people who care. If you’re good enough to be a Boone Hospital nurse, we want you to feel supported.” Nick says the Rapid Response Team’s ultimate goal is to help everybody – nurses, patients, and their families – find peace of mind and to ensure that all patients at Boone Hospital Center receive the best patient care. By Jessica Park
A Boone Family Birthplace nurse cares for a Boone Babyâ€™s Boone Babies. 16
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To learn more or schedule a tour, visit boonebaby.com
eAn Smith had recently been recognized for 40 years of service as a nurse at Boone Hospital Center when one of her teammates on the Postpartum floor of Boone Family Birthplace told her, “There’s a gentleman down the hall who says you delivered him when he was born!” In August 1979, LeAn was a month in to her new role as a nurse on Boone County Hospital’s labor and delivery unit. LeAn had joined Boone two years earlier as a nurse on the hospital’s Neurology unit and was very excited about her new job when she helped deliver two fraternal twins, Travis and Troy Overfelt. “Then Travis grew up, got married to the love of his life, and had three beautiful girls!” LeAn says. Not only did LeAn care for Travis, his twin, and his mother; LeAn later cared for Travis’s wife, Brianne, and the couple’s three babies. LeAn reunites with Travis, his wife Brianne, and their daughters Gracyn, Lily, and newborn Sadie, in Brianne’s Postpartum room. Everybody is eager to take turns cradling the serene baby, sound asleep in her Boone Baby sleepsack. “She is the best baby,” LeAn tells the Overfelts as she holds Sadie. “Ever since they’ve got here, they’ve wanted to hold her. They were pretty excited,” Brianne says about her older daughters. Gracyn is 9 – “almost 10,” she notes – and Lily is 7. When Brianne asks, “Who wants to baby-sit,” the sisters race each other in raising their hands. Lily gets to go first. She carefully holds Sadie, gently rocking in a chair in the room. Sadie is the family’s third Boone Baby. “We’ve always had a good experience here,” Brianne says. In her decades of experience as a Boone Family Birthplace nurse, LeAn has seen many Mid-Missouri families grow and helped deliver and care for siblings, but says, “It’s not very often I get to see a baby I delivered come back as a new mom or dad!” By Jessica Park Pictured left: LeAn Smith with Lily, Sadie, and Gracyn Overfelt MyBooneHealth.org
Healthy & Homemade
Other ideas to add veggies to your breakfast:
1. Top scrambled eggs with fresh tomatoes and cilantro.
2. Blend spinach or kale into your morning smoothie.
3. Top a baked sweet potato with vanilla Greek yogurt, cinnamon, and chopped nuts
am a dietitian and a baker. It may surprise you to know that, when I bake, I love making the classic, full-butter, full-sugar recipes most of the time. When I want something satisfying, going half-way usually doesn’t hit the spot. Part of the satisfaction comes from my memories of baking with Grandma or enjoying a special recipe as a kid. The other part comes from the mouthfeel of the butter, the fluffiness of the refined white flour, and the sweetness of added sugar. Even as a health professional, I believe there’s still a place in life for decadently rich and sweet versions of our favorite foods. But there are small ways you can think like a dietitian and bake like a Grandma. Baking for yourself, instead of purchasing premade desserts, gives you more potential to make healthy decisions. Baking gives you the say on serving sizes, and, due to the effort involved in preparation, you may not have them as frequently. You can control portions by making smaller servings using a mini cake or muffin pan, freezing half a batch of cookie dough to bake later, and sharing baked treats with friends. And it’s good to be open to trying new things. After trying this muffin recipe – and really enjoying it – I’m more open-minded about baking substitutions, like using fruits and veggies for sweetness or nuts and seeds as healthier fat options. I originally tried this recipe to help my one-year-old daughter eat more protein and healthy fat in a form that I already know she loves – anything sweet that resembles bread! It’s been fun to watch her taste preferences change from day to day and see her discover foods like these muffins, which she scarfs down and loves. I have yet to see her touch the scrambled eggs I offer but have found she will happily eat eggs baked with veggies in a casserole dish or cooked in a waffle iron. (continued on pg. 21) 18
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Try a Mexican breakfast tostada with smashed beans, sautéed veggies, and avocado.
5. Cauli-Oats: Add steamed riced cauliflower to oatmeal to add volume and nutrition without a big change to texture or flavor.
6. Spread toast with hummus and top it with thin slices of avocado and tomato.
“No Sugar-Added” Breakfast Muffins NUTRITIONAL FACTS
(per muffin) (makes 11 muffins)
• 2 medium carrots, ground or grated
• ½ medium zucchini, ground or grated
• 3 pitted dates
Sugar (no added sugar):
• 3 eggs
• 1 cup all-purpose flour
• 1 cup almond meal
• 1 ½ teaspoons baking soda
• ½ cup unsweetened applesauce
• ¼ teaspoon salt
• 1 teaspoon cinnamon
• 1/3 cup hemp hearts (or ground chia seeds)
INSTRUCTIONS 1. Preheat oven to 350°F and prepare muffin tins.
2. In a food processor, blend carrots and zucchini until fine, then squeeze out excess moisture – a kitchen towel or potato ricer works well for this.
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3. In a food processor, blend dates, eggs, and applesauce and add to the bowl with your vegetables.
4. Add dry ingredients and mix together.
5. Add to prepared muffin tins (I like the reusable silicone liners) and bake.
Find this recipe and others at boone.org/food
Taste buds are adaptable, especially early in life, and one of my personal missions is to expose my daughter to a wide variety of foods and preparation techniques. I may present boiled eggs one day and scrambled the next, and of course, I make sure she’s offered foods from a variety of food groups. Continual exposure is important to help children (and adults) accept new foods. When my daughter munches on one of these muffins at breakfast, I know she’s consuming healthy fats, high-fiber carbohydrates, protein, and so many vitamins and minerals that a typical muffin wouldn’t have. I don’t need the big scoop of sugar most muffin recipes call for, because the fruits and veggies make these muffins naturally sweet.
WHAT ARE HEMP SEEDS? Hemp and marijuana are members of the same plant species, but hemp seeds won’t make you fail a drug test! They’re also called hemp nut, hemp hearts, or shelled hemp seed – the outer hard shell is removed, leaving the nutty-tasting “heart.” Hemp seeds resemble coarse bread crumbs and can be added to pretty much anything – oatmeal, salads, smoothies, sauces – or made into milk or flour. Hemp seeds contain omega-3s and omega-6s, which are essential fatty acids and are a great source of plant-based protein and valuable vitamins and minerals, like vitamin E, magnesium, potassium, and iron.
Typical breakfast meals contain mostly carbs, like cereal, or saturated fat, like bacon or buttery biscuits. 40 percent of the fuel from these muffins is heart-healthy unsaturated fats, which give you long-lasting energy to get through the morning. The 2015 Dietary Guidelines for Americans recommend children 1 to 3 years old get 30 to 40 percent of their total calories from fat, so I feel good knowing my daughter’s getting the nutrition her brain needs for development.
This recipe uses one cup of almond meal, which has double the protein and quadruple the fiber compared to one cup of regular all-purpose flour. Together, the eggs, almonds, and chia/ hemp seeds give each muffin seven grams of protein.
In this recipe, the carrots and zucchini provide these muffins with filling fiber – do yourself a favor and don’t peel your veggies for even more fiber. Each muffin provides four grams of fiber, which encourages regularity and lasting fullness. I hope this recipe empowers you to start adapting your favorite recipes with more nutrient-dense ingredients to improve your typical meal routine. And keep switching up how you prepare foods you want your family to learn to enjoy. Live a little more on the veg! Recipe by Kelsie Knerr, RD LD, Boone Hospital Clinical Dietitian MyBooneHealth.org
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Hear from the Muscatos on Youtube.com/BooneHospital
s oncologists Joe Muscato, MD, and Mary Muscato, MD, prepare to retire after more than three decades of serving Mid-Missouri, those close to them are celebrating the legacy they are leaving behind. “Dr. Joe” and “Dr. Mary,” as they are often called to avoid confusion, met in college at the University of Pennsylvania and were married after their first year of medical school. They moved to Columbia, Missouri, for their residency and were surprised at how much they liked the town. “We had to get a map out to see where it was, but we quickly grew to enjoy the community here,” says Dr. Joe. After residency, they went to Duke University for their fellowship but were drawn back to Columbia when looking for a place to start their careers. “We both taught at the University when we moved back. We love to teach. I have continued teaching all these years,” says Dr. Mary. After one year of teaching, Dr. Joe left his position as a faculty member to open his own practice. He got a loan from the bank and started what is now Missouri Cancer Associates (MCA). At the time, it was only him and a handful of employees, but over the years, MCA grew into the powerhouse that it now is. Dr. Mary joined the practice a couple years later. “She joined after our son and twins were born. We have worked between five and 10 feet from each other for about the entire three decades, but I wouldn’t have it any other way,” says Dr. Joe. Early in MCA’s existence, Dr. Joe secured a partnership with Boone Hospital Center that remains to this day. “There was a void there that I was able to fill, and we have grown together into a stellar oncology department,” says Dr. Joe. Dr. Joe spent the past several years as the Medical Director of Boone Hospital Center’s Stewart Cancer Center. “I have truly enjoyed working with Dr. Joe Muscato over the years. His medical knowledge, business perspectives, and compassion for others are like no other I have ever experienced. He is a wonderful resource for the oncology nursing staff and patients as well. He helps each person he interacts with gain knowledge and confidence during complicated illnesses. His laugh is contagious and one we cannot soon forget! Dr. Mary Muscato is also a wonderful doctor who is very dedicated to and loved by her patients,” says Andrea Fansler, Boone Hospital
Director of Patient Care and former Oncology Service Line Director. Dr. Joe has also served on the Boone Hospital Center Foundation board. “The Foundation is wonderful because it provides services that enhance patient care, whether that is providing comfort items for the patients or providing additional education for Boone’s staff,” says Dr. Joe. Boone Hospital Foundation Executive Director Barb Danuser says Dr. Joe was a valued member of the board. “The Foundation sincerely appreciates the years of service that Dr. Joe Muscato gave to the Foundation board. He would often race into meetings after driving back from Kirksville where he was seeing patients. Dr. Muscato provided valuable knowledge as a practicing physician on how the Foundation could best provide enhancements to patient care. His high energy and contagious laugh will be missed.” Dr. Joe and Dr. Mary are quick to tell you that the highlight of their respective careers has been getting to know and help their patients. “We treat such wonderful people who work so hard to get better and maintain such a good attitude through their illness. It is such an honor to get to help them,” says Dr. Mary. Dr. Joe and Dr. Mary plan on spending their retirement with their children and grandchildren, traveling, and skiing. Boone Hospital Center and the MidMissouri community will always be grateful for their years of service. By Madison Loethen
“We have worked between five and 10 feet from each other for about the entire three decades, but I wouldn’t have it any other way.” MyBooneHealth.org
GETTING TO KNOW A BHC DOCTOR
Rachel Yutz, DO, Internal Medicine
’m a small-town girl who grew up in Salisbury, Mo. in a family of mostly teachers. I decided I wanted to be a doctor early on and went to CMU for undergrad and Kansas City University of Medicine and Biosciences for medical school. I married my high school sweetheart while completing my residency in St. Louis. We moved back to Columbia to be close to both our families. This past summer we had our first child who is our world.
Why did you get into the health care field? My family and, oddly enough, my small town. When I was growing up, my grandfather was very ill with heart disease. Being around medicine at that time fascinated me. Seeing how his doctors, nurses, and staff took care of him made me want to do the same. And I say my small town because, growing up, I saw how underserved rural Missouri is – and I wanted to change that. What interested you in your particular specialty? Internal medicine is the stepping stone for all specialties in medicine – it has so much variety and critical thinking involved. The patients I am privileged to care for often have multiple complex problems, and they rely on me to be an expert diagnostician as well as “team captain” for all their other physicians. Most people honestly don’t even know what an internist is. Believe me, I didn’t until medical school. It is fascinating. What is the most rewarding aspect of your job? The patients. It is so wonderful building relationships with people and their families. Honestly, it’s like they become part of my own family. I am truly honored that patients choose me to share their most vulnerable selves with. What is the most challenging aspect of your job? The non-clinical tasks can sometimes become overwhelming, as we have more and more information with just the click of a button, especially in the electronic medical record. And sadly, this takes away from the best part of medicine, the clinical physician-patient relationship. Knowledge is power – and also time-consuming. What do you see changing in health care in the next five to 10 years? The number of things that are done online or in a virtual setting is already growing rapidly. As our culture grows accustomed to instant gratification, they will seek care in the most convenient ways. What advice would you give someone looking to become a doctor? Take advantage of mentors and friends in the field. I only got where I am today because I had some of the
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best teachers and mentors who supported me and helped open doors along the way. What do you enjoy doing outside of work? Being with my family – it is seriously my absolute joy. Outings with friends; church events and singing; movies and game nights. What advice would you give to someone who is going to be a patient in a hospital for a period of time? Be an advocate for yourself. Be involved in your care. Ask questions if you do not understand the game plan. Your care team wants to take care of you the best they can, but they want you to be an active part of your treatment!
GETTING TO KNOW A BHC NURSE
Amanda Fohey, RN
am an RN on Surgical Specialties. I started on Medical Specialties. I then had the opportunity of being a travel nurse. I have now worked on Surgical Specialties for two years! I am a happy mom of my 16-month-old daughter, Aria. She is my greatest accomplishment.
Why did you get into the health care field? I got into the health care field because science was always my favorite subject in school, and I also had inspiration from my mom and stepdad both being in the health care field. What interested you in your particular specialty? I was interested in Surgical Specialties because this particular area has a wide variety of patients to care for. On this floor, education is very important before the patient is discharged home for a full recovery. The education aspect of nursing is my passion. What is the most rewarding aspect of your job? The most rewarding part of my job is the connections I make with many of my patients. I genuinely enjoy caring for people, and I try to make their recovery experience in the hospital better. What is the most challenging aspect of your job? The most challenging part of my job has to be the fast pace we get sometimes, but at the same time, I often enjoy that challenge. What has changed in your field since you started practicing? I have been a nurse for four years, and there are always new things to learn and ways to improve skills. The health care field is always changing. What do you see changing in the next five to 10 years? In the next five to 10 years, I expect to see a big aspect of education for prevention implemented as more information is researched and the public becomes more aware of the importance of self-care. What do you enjoy doing outside of work? Outside of work, I enjoy each day with my husband, Adam; daughter, Aria; and old dog, Rosella. Being a parent is the best! What advice would you give to someone looking to become a nurse? The advice Iâ€™d give someone who wants to be a nurse is to go for it! It is a great career to begin, and there are so many opportunities ahead. Enjoy the challenge, embrace change, and grow.
SilverSneakers® participants thrive at Boone Hospital’s Fitness Center.
Jim and Mary Smith workout at Boone Hospital Center’s Fitness Center as part of the SilverSneakers® program.
An energetic, fun-loving, and hard-working group of senior citizens has taken over Boone Hospital Fitness Center, and staff isn’t complaining one bit. The new community is thanks to the fitness center’s recent implementation of the SilverSneakers® program. SilverSneakers® is the nation’s leading community fitness program for older Americans. It was founded in 1992 and is available to more than 14.5 million Medicare beneficiaries, through many Medicare Advantage plans, Medicare
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Supplement carriers, and group retiree plans. Seniors who are eligible for SilverSneakers® can join Boone Hospital’s Fitness Center at no cost. “I started at Boone Hospital’s Fitness Center in 1999 and have loved being a member. Now that it accepts SilverSneakers®, I am able to come here free! It really is a great program for seniors,” says fitness center member Phyllis Miller. When a new SilverSneakers®-eligible senior joins the fitness center, staff gives them a tour of the center, talk about
Visit youtube.com/boonehospital to hear more from SilverSneakers® participants.
SilverSneakers® is the nation’s leading community fitness program for older Americans. It was founded in 1992 and is available to more than 14.5 million Medicare beneficiaries through many Medicare Advantage plans, Medicare Supplement carriers, and group retiree plans. The Boone Hospital Fitness Center offers no-cost memberships for seniors eligible for SilverSneakers®. To check your eligibility, visit silversneakers.com or have your eligibility checked in person at the Boone Hospital Fitness Center, located on the lower level of Broadway Medical Plaza 1 (1601 E. Broadway) in Columbia.
Phyllis Miller has her blood pressure assessed during her workout by Doug McDowell.
their fitness goals, and walk them though a workout. “We are always here to answer any questions they might have and to make sure they are exercising safely,” says Doug McDowell, Fitness Center Coordinator and Exercise Physiologist. Boone’s SilverSneakers® participants have developed deep friendships with each other. They often check up on each other if someone misses a workout and stay after their sessions to catch up with friends over a cup of coffee. Mary and Jim Smith joined the Fitness Center as SilverSneakers® members after Mary received therapy in Boone Hospital Center’s outpatient Cardiovascular and Pulmonary Rehabilitation. “We were very impressed with Cardiac Rehab and the staff there. I would often go with Mary to encourage her. The staff recommended Mary join the Fitness Center to continue her health journey. We found out her membership would be covered by SilverSneakers®, so I decided to join too, since mine would be covered as well. We love coming to the gym together and keeping each other accountable,” says Jim. Jim and Mary say they have made a lot of friends at the fitness center, and their workouts are something they really look forward to. “We say ‘We hope we live as long as that guy,’ and then see him working out and think ‘We better keep with it,’” says Jim. “I am so grateful for the SilverSneakers® program. It is great for our health, and we love the community it provides,” says Mary. By Madison Loethen
Summer Weight List As the temperature increases, so does the urge to venture out in the yard to clean the garden spot, trim the bushes, or begin a new landscape project. Outdoor yard work can be an enjoyable way to burn calories and maintain strength and flexibility, but after a long winter, you might need some pre-conditioning to prepare your muscles and joints for the extra activity. Since most yard work puts extra demands on your upper body, try these exercises to get ready to work hard, reduce your risk of injury, and increase your enjoyment! These exercises activate most of the major muscle groups in your arms and shoulders that are used in typical daily activities. Do these exercises on two or three non-consecutive days a week. Start with a five-to-10-minute warmup, like light calisthenics or riding a stationary bike. Lift with smooth, controlled movements, through a full range of motion. For each repetition, count to four. Start the motion on one, get to the end point at two, start moving back at three, end the movement on four. Start with one set each of eight to 12 repetitions, using a weight that makes you feel moderately fatigued afterward. Don’t lift to failure. Over time, you can gradually increase the weight or resistance to build muscle strength, but always use good form and technique. Breathe normally as you exercise, and don’t hold your breath. Keep your abdominal muscles firm, and keep a natural curve in your spine to protect your back. If any movement causes pain, adjust your technique or discontinue. Consult a health care professional if pain persists. Remember: Check with your physician before you start a new exercise routine. Consider working with an exercise professional to get off to a good start.
By Doug McDowell, M.Ed., Boone Hospital’s Fitness Center Coordinator and Exercise Physiologist
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Arm Curl Strengthens bicep muscles in the upper arm used to lift things that require you to flex your elbow; engages muscles of the forearm and wrist. Stand straight with a dumbbell weight in one hand resting at the side of your upper thigh. Bend at the elbow to curl the weight up to the shoulder. Lower the weight to the starting point and repeat. VARIATION: Start with the weight in front of your thigh and do a “reverse curl,” which will engage the muscles on the top of the forearm.
Countertop (Easier) or Regular (Advanced) Push Ups Strengthen the tricep muscles on the back of the upper arm used to extend your elbow; targets the front deltoid of the shoulder and the pectoral muscles across the front of the chest. They also require the abdominal muscles to contract to keep the trunk straight as you move. Push-ups will strengthen the muscles used to push a lawn mower forward and backward as you trim around your bushes. To do countertop push-ups, stand near a countertop with your feet shoulder-width apart, about two to three feet away from the base of the cabinet. With the palms of your hands flat against the countertop and your trunk muscles engaged, bend your elbows and move your body towards the counter until you touch it, then push back.
Bent Over Row Strengthens the muscles that pull your arm and shoulder back, like when you start a lawn mower, pull back on a handsaw, or pull a rake towards you. These muscles include the rear deltoid, trapezius, rhomboids, latissimus dorsi of the shoulder, and bicep. Hold a dumbbell in your right hand and assume a straddle stance with your left foot forward. Place your left hand on your left knee, then flex your trunk about 45 degrees forward. Lift the weight by drawing it up to your chest while pointing your elbow behind you. Return to the starting point. Switch hands and your stance to exercise the other side. VARIATION: Lean against the back of a stable chair or place your knee and hand on a weight bench to hold your trunk more horizontal.
Shoulder Press Strengthens deltoids and trapezius in your shoulders and the tricep muscles to help you do activities that require lifting things overhead.
Strengthens the latissimus dorsi muscle used to pull your arms down. This muscle is active when you’re chopping wood or driving a post into the ground.
Hold a light dumbbell in each hand. Start by holding the weights at shoulder level with your elbows at a comfortable position slightly to the side – about two feet apart – then press the weights straight above your head and back down to shoulder level.
Securely anchor an exercise band or tube above your head high enough that you have to reach up to grasp it in one hand. Pull your arm down, bringing your elbow to your side and your hand down to shoulder level. Control the return to the starting point.
Bent Over Triceps Extension Strengthens the tricep muscles and muscles of the shoulders. Assume the same starting position as the Bent Over Row. With a weight in one hand and your arm held back along the side of your torso, extend the weight back until your arm is straight. Return to the starting point with your arm flexed.
Event Highlights 2018
CALENDAR OF EVENTS JULY 24 & 25
JULY – AUGUST
Community Campaign SHARE THE GIFT OF SEPTEMBER 10-12
Common Goods Book Sale (Formerly Books are Fun)
by supporting the Boone Hospital Foundation’s Community Campaign in July and August.
OCTOBER 22 & 23
NOVEMBER 14 & 15
Uniform Sale 30
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FOR MORE INFORMATION, VISIT BOONE.ORG/FOUNDATION Summer 2018
Boone Hospital Foundation Golf Classic calendar of events July & August
TO OUR SPONSORS
7, 8, 9
Fall Book Sale
Fall Jewelry Sale
Meyer Electric, Inc.
Evan & Dixon, LLC.
November 10 Missouri Heart Center
American Document Solutions
Central Bank of Boone County & Central Trust Investment Company
Uniform Boone Sale Southern YMCA
BJC Home Care Services / Boone Hospital Home Care & Hospice Bob Wagner Boone Electric Boone Hospital Center Administration Boyce & Bynum Pathology
Columbia Landcare, LLC. Columbia Orthopaedic Group
Grove Construction Healogics Holloday Properties / CNL Healthcare Properties Hulett Heating & Air
Jack Smith Creative Services
Environmental Engineering, Inc.
Landmark Bank Lenoir Woods
Officer Mechanical17, 18 November Contractors
May 2017 Orscheln Farm & 1 Home
Overhead Door Company
Fall Jewelry Sale TEAMHealth
Tech Electronics, Inc. The Club At Old Hawthorne
Tiger Express Car Wash
Tim & Betsy Vicente
Schindler Elevator Corporation
UMB WELLAWARE Will Electronics
Boone Hospital Center 1600 East Broadway Columbia, Mo 65201 573-815-8000
NONPROFIT U.S. POSTAGE
COLUMBIA, MO PERMIT 286
Boone Hospital Foundation
Gala Honoring Doctors Joe and Mary Muscato
Save the date: November 3, 2018 Call 573.815.2800 for more information