My Boone Health Fall 2016

vol: 6 issue: 4

Survivor, New Mom Oncologists And Obstetricians Work Together To Save Mom And Baby

Pag e 18 K e e p Y o u r A t h l e t e H e a lt h y

Table Of Contents Boone Hospital Center’s mission is to improve the health of the people and communities we serve.

Jim Sinek President

Ben Cornelius Communications and Marketing Manager

Page 8

Page 20

Page 26

Page 30

Jessica Park Marketing Coordinator

Madison Burke Multimedia Marketing Specialist Photos By

Madison Burke Angelique Hunter Rhiannon Trask, Lollipop Photography Contributing Writer

Jacob Luecke

5...................................................... A Note From Boone Hospital President Jim Sinek 6................................................................................................................ Hospital Headlines 8........................................................................................................ Your Partner In Health

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Please submit comments or feedback to bcc1170@bjc.org or call 573.815.3392

1600 East Broadway Columbia, MO 65201 573.815.8000 For a free subscription, call 573.815.3392 or visit myBooneHealth.com and click on the subscription link on the right side of the page.

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Fitness Trackers

It Was Her Last, Best Gift

14........................................................................................................ Pregnant, With Cancer 18.......................................................................

Helping Athletes One Player At A Time

20.......................................................................................................................... Kids On Track 22....................................................................................................... No Time? No Problem!

24.......................................................................................................................... Fresh Choices 25.......................................................................................... Getting To Know A BHC Nurse 26......................................................................................... Getting To Know A BHC Doctor 28............................................................................................................................... Giving Back 30................................................................. News from the Boone Hospital Foundation BOONE HOSPITAL CENTER Fall 2016

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A Note From Jim

Being Number One!

B Jim Sinek President Boone Hospital Center

ecoming No. 1 and staying No. 1 is a formidable goal regardless of the endeavor.

Boone Hospital Center has been named the No. 1 hospital in mid-Missouri and the No. 3 hospital in the State by U.S. News and World Report for the second year in a row!

Not only did we repeat our success, U.S. News and World Report also ranked Boone as one of only 63 hospitals in the country that swept the table with high-performing ratings in all nine areas of care surveyed. When you consider that more than 4,500 hospitals in the country were evaluated by U.S. News and World Report, this is a phenomenal accomplishment!

Since 1921, Boone Hospital Center and its medical staff have led the way in mid-Missouri with state-of-the-art technology, clinical excellence, quality and patient safety improvements, and patient satisfaction. Boone has been blessed with the leading physicians and medical providers, the leading nurses and clinical staff, and an exceptional support staff, working together to provide excellent clinical care, delivered with the kind and compassionate “Boone Touch.”

When you combine our technology, medicine and touch with the hard work, drive and determination of our hospital staff and medical staff to achieve perfection, the result is Boone achieving the status of the best hospital in mid-Missouri. Having been ranked at this level for two consecutive years reflects our unwavering commitment to continuous improvement.

Boone Hospital has historically been known as a “humble” organization going about the work required to become the best.

After two years in a row being ranked No. 1, we felt empowered to celebrate a little bit! Here’s to everyone who has been involved in the evolution of Boone Hospital Center from a small county hospital to the No. 1 ranked hospital in mid-Missouri, No. 3 ranked hospital in Missouri, and in the top echelon of 63 hospitals in the country that can truly provide “world-class medicine.”

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Hospital Headlines News From Boone Hospital Center

Boone Tops U.S. News & World Report Rankings

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oone Hospital Center and two other BJC hospitals have earned top rankings for the state of Missouri by U.S. News & World Report. For the second year in a row, Boone Hospital Center ranked No. 1 in mid-Missouri and No. 3 in the state.

Boone Hospital Center is a part of the 12-hospital BJC HealthCare system. BJC’s Barnes-Jewish Hospital ranked No. 1 and Missouri Baptist Medical Center ranked No. 4 in the state.

In addition, BJC’s St. Louis Children’s Hospital was rated among the Best Children’s Hospitals in the country in all 10 ranked pediatric specialties.

The U.S. News Ratings for Procedures and Conditions methodology evaluates nearly every U.S. hospital on how well each performs in a set of common procedures and conditions: abdominal aortic aneurysm, aortic valve surgery, congestive heart failure, colon cancer surgery, chronic obstructive pulmonary disease, 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 careacquired infections, federally mandated patient satisfaction surveys and selected hospital survey measures.

Boone Hospital Center was one of 63 hospitals in the nation rated High Performing in all nine categories.

“The U.S. News & World Report ranking once again validates Boone Hospital Center as the best hospital in mid-Missouri,” says Jim Sinek, Boone Hospital Center president. “Health care decisions are critically important. A credible source like U.S. News & World Report, utilizing a legitimate methodology to rank hospitals, provides value and unbiased information for patients to utilize as they select their hospital and physicians. I am incredibly proud of the great teams of physicians, nurses, clinical and support staff that Boone Hospital has to care for the citizens of mid-Missouri. Boone is also proud to be part of the BJC HealthCare System and congratulates our sister hospitals who have also been named among the best hospitals in the state of Missouri.”

The rankings have been published on the U.S. News website (www.usnews.com) and appear in print in the Best Hospitals 2017 guidebook.

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The latest news boone.org

Get The Shot. Not The Flu. Quadrivalent flu shots are now available at Boone Hospital Nifong Pharmacy in the Nifong Medical Plaza, 900 W. Nifong (corner of Nifong and Forum). Cost is $25 or billed directly to most insurance providers.

No appointment needed.

Monday-Friday 7:30 a.m. - 7:30 p.m.

Saturday 9 a.m. - 4 p.m Sunday 9 a.m. - 3 p.m

Support Group: After Stroke Inspired Survivorship Please join us every third Thursday of even-numbered months at 3 p.m. in the conference center of Boone Hospital Center, 1600 E. Broadway, Columbia, Missouri. Speak with members of the Boone Hospital Center team including therapy, neurology and rehabilitation and hear from other stroke survivors.

For more information, call Donna Pond at 573.815.4197.

For more information, call 573.815.5465 or visit boone.org/nifong.

Hallsville Clinic Reopens On Sept. 1, Boone Medical Group – Hallsville opened at 501 N. Route B. Hallsville resident Kelli Cash, FNP-BC provides primary care services for the entire family from the clinic. To make an appointment, call 573.696.0500.

In support of Breast Cancer Awareness Month, we would like to remind women over the age of 40 to discuss an annual mammogram with their health care provider. Boone Hospital Center offers the latest mammography equipment at our main hospital campus as well as the Nifong Medical Plaza. To schedule your mammogram, call 573.815.8150.

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Learn more at boonemedicalgroup.com

Your Partner In Health Live Longer, Feel Better With Proper Primary Care

Good access to a primary care provider can help us live longer, feel better, and avoid disability and long absences from work.

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ou’ve heard “An apple a day keeps the doctor away,” but if you want to keep healthy, you actually shouldn’t keep the doctor away. Regular visits with a primary care provider, even when you’re well, improve health.

“The evidence shows that good access to a primary care provider can help us live longer, feel better, and avoid disability and long absences from work,” explains Rubab Naqvi, MD, a family physician with Boone Medical Group – South.

“In areas of the country where there are more primary care providers per person, death rates for cancer, heart disease, and stroke are lower and people are less likely to be hospitalized,” Dr. Naqvi says.

A primary care provider (or PCP) treats patients for acute illness, injuries, and chronic conditions; provide physical exams and health screenings, and wellness and preventive health care.

“PCPs can be your partner in monitoring and managing long-term illnesses and conditions, including diabetes and high cholesterol,” Dr Naqvi says.

A PCP is usually a physician. MDs (Medical Doctors) and DOs (Doctors of Osteopathy) are licensed physicians. While they attend different types of four-year medical schools (medical or osteopathic), both complete internships and residencies in a primary care medical specialty.

Primary care physicians include: Family medicine physicians provide care for the entire family, including pediatrics and OB/GYN care.

Internal medicine physicians specialize in care for adult patients.

Pediatric physicians specialize in care newborns, infants, children and adolescents.

You can also receive primary care from a nurse practitioner or physician assistant.

These licensed PCPs can order tests and prescribe some medications. Care is provided in collaboration with a physician.

Nurses practitioners and physician assistants are licensed and have a master’slevel degree from an accredited program.

Your PCP’s office is the entry point for all of your health care needs.

“A primary care provider should be the first person you contact when you have a question or a problem,” Dr. Naqvi says.

“He or she can answer your questions, provide care or recommend a specialist to meet your needs. Your doctor can also help you find other resources, such as support groups and classes.”

Because they know your medical history, your PCP is a valuable partner if you require additional health care services.

“Your PCP is like the quarterback of your care team, who points you in the direction you need to go, whether it be to specialists or other health team members, like physical therapists, pharmacists or dietitians,” says Marianne Lopez Rhodes, MD, a family physician at Boone Medical Group – South.

If you manage chronic conditions, such as diabetes or asthma, with a PCP, you’re much less likely to need emergency care. Regular screenings can reveal early

symptoms of conditions such as heart disease. For example, if you feel well, but an annual screening shows that you have high cholesterol, you and your PCP can manage it sooner with lifestyle changes and medication. As a result, people who have a PCP managing their care also tend to have lower health care costs.

If you and your family see a PCP on an ongoing basis, you can receive more personalized care. Building trust and confidence with a primary care provider can make it easier for you to openly discuss health concerns. A PCP can become familiar not just with your lab results, but other circumstances which may affect you and your family’s health. If you require further medical care, your PCP can make it easier to navigate tests, specialist visits, procedures, hospital stays and follow-up care.

“Primary care providers are advocates for the patient,” Dr. Naqvi says.

Boone Medical Group knows it’s easier to set up with a PCP who’s closer to home, which is why they’ve opened several new clinics, including clinics in Boonville, Columbia, Glasgow, Hallsville and Mexico, to make world-class care more accessible for mid-Missourians. If you need to make an appointment for you and your family with a primary care provider, call 844-8472050 or visit boone.org/medicalgroup.

By Jessica Park Whether you see a physician or nurse practitioner, all PCPs can provide: • Preventive medicine, such as vaccinations • Health screenings, including well woman examinations • Treatment of acute diseases and injuries • Management of chronic conditions, such as diabetes or high cholesterol • Orders for diagnostic screenings • Referral to a specialist for further care, if you need it.

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Fitness Trackers Wearable Devices Can Be A Useful Tool For Setting Fitness Goals

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nce, a tiny computer you wore on your wrist was an innovation only thinkable in science fiction. Today, the release of a new wearable computer isn’t even news. In fact, wearables have become such a broad field, it can be tough to decide which one to get, or if you should get a wearable. You don’t need a wearable to be more active, and simply wearing a fitness tracker won’t make you more active. But if you have specific fitness goals, wearables can help you set and achieve those goals and measure your progress.

Fitness wearables can encourage more movement among motivated users, not just by working out more, but also by increasing regular daily activity. To reach their goals, people may increase steps by parking 10

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further away from entrances, taking stairs instead of elevators, taking walks during work breaks or taking walks with family after dinner. Wearables also encourage people by helping them set goals and see their progress.

But while wearables can be helpful, there are important things to keep in mind: Calorie tracking is usually inaccurate.

Most devices use a simplified formula to calculate calories burned and don’t factor in your basal metabolic rate (how many calories you burn while resting), current heart rate or type of activity. Many trackers tend to overestimate how many calories you’ve burned, which may lead you to unintentionally overeat.

Fitness trackers aren’t a substitute for screening by a health care professional.

Wearables can track, but can’t interpret or explain data. If you’re not getting enough

sleep, the cause could be your lifestyle, stress level, sleeping environment or health issues.

If your data concerns you, talk to your primary care provider.

When shopping for a wearable, compare options. Start simple, with features you’re likely to use. You can always upgrade later. And be sure to get a wearable you’ll actually wear. Design, comfort, battery life, waterproof, compatibility with other devices and price are all important considerations.

Innovation in wearables is constant, so if you don’t love the current options, there may be something coming out soon that works for you. But it’s OK if there isn’t; some people aren’t interested in tracking data as part of their fitness regimen. And wearables aren’t necessary to be more active.

Likewise, wearables alone won’t help you reach your fitness goals. The work is still up to you! By Jessica Park

Fitness Trackers

You don’t need a wearable to be more active, but if you have specific fitness goals, wearables can help you set and achieve them.

Smartphones

While technically not a wearable, you might already have a smartphone and carry it everywhere. Most smartphones have a built-in accelerometer that measures movement, direction and speed, allowing your phone to function as a pedometer. You can download apps to track your data, or if you have an iPhone, the Health app tracks steps for you and can share data with other apps.

Smartphones have been found to be highly accurate at measuring steps, even more so than wristbands. Some apps can also measure your sleep quality; you place your phone on the corner of your mattress and it detects your movement as you sleep. However, smartphones can be awkward to carry or wear during certain activities, which is why a wearable might be preferable.

Pedometers

Pedometers count steps. Options include lowcost analog pedometers and digital “smart” pedometers that log your steps electronically and work with a smartphone app. Pedometers cost less than other wearables, are lightweight and can easily clip onto garments or fit in pockets.

Heart Rate Monitors

Heart rate monitors are available as a wristband with sensors or a watch that receives signals from a monitor worn on a strap around the chest.

These devices let you monitor your heart rate during exercise, to make sure you’re working out effectively or to prevent overexertion. Heart monitors can use your heart rate to calculate how many calories you’ve burned. Wristband heart monitors can also track your resting heart rate.

Sports Watches

Sports watches usually have an accelerator and a GPS tracking unit to accurately determine your speed, distance and location. Some allow you to track and save your routes with a companion app. Some models are also equipped with heart rate monitors.

Smartwatches

Not all smartwatches can be used as fitness trackers, but many models measure steps and movement during sleep. A few have built-in heart rate monitors.

Unlike other wearables, smartwatches have more functionality than devices designed exclusively for fitness tracking.

Wristbands

Wristband fitness trackers usually measure steps and sleep quality, but newer models include heart rate monitors with sensors that make contact with your skin. Most wristbands work with an app to store and compare data, allow you to set goals, set alarms if you need to get more steps in, and compete with friends and other users to see who gets the most steps or has the longest streak of active days. Some have LED displays so you don’t need to check the app or website to check your daily progress.

WELLAWARE fitness instructor Jordan Haag had a good experience when he used a fitness wristband. “It counted steps, monitored sleep patterns, and had a food log on my phone, so I could watch calories,” he says. “I’d set a fitness goal of losing around 15 pounds.

With the aid of the wristband, I ended up losing a little over 20 pounds. The wristband did a wonderful job of helping me stay on track, letting me know what I accomplished and what I still needed to accomplish each day.”

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It Was Her Last, Best Gift Breast Cancer Genetic Testing Changes a Family’s Future

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here’s no equity when it comes to cancer. If you’ve lost a family member or are suffering yourself, there’s no guarantee your family will be spared another fight. In fact, genetics tells us that, in some cases, that may increase the risk.

Shortly before the end of her battle with breast cancer, Sharon Sheridan chose genetic testing to determine if her cancer was the result of a genetic mutation. “It was her last, best gift to us,” says Marty Heath, Sharon’s daughter.

At Missouri Cancer Associates in October 2009, Sharon gave a DNA sample through a cheek swab for genetic testing. When the results came back positive for BRCA1 mutation, the next few weeks were a blur for the family, particularly Marty, her sister, Cindy Pudney; Marty’s 19-year-old daughter, Heather; and Cindy’s 17-year-old daughter, Samantha.

Within two months of Sharon’s genetic testing, she was gone.

Marty and Cindy were tested for BRCA1 prior to their mother’s passing in November 2009.

Then Heather and Sam were tested. For all four women, the tests results were positive.

The BRCA gene keeps breast cells growing normally and prevents any cancer cell growth. When a mutation occurs — identified as BRCA1 or BRCA2 — the gene doesn’t function normally, so breast cancer risk increases. Women in the general population have a 12 percent chance of getting breast cancer during their lifetime. For women who inherit the BRCA1 gene, their risk of developing breast cancer jumps to 50 to 65 percent. BRCA1 also puts women at increased risk for ovarian cancer — 39 percent of women who inherit BRCA1 will develop ovarian cancer, compared to 1.3 percent of women in the general population.

Mark Vellek, MD, of Missouri Cancer Associates says their office performs two to three genetic tests a month. Dr. Vellek says they consider the patient in depth to see if testing is warranted. Most cases of breast cancer, he says, don’t prompt genetic testing.

Age is a big red flag. According to Dr. Vellek, breast cancer in a woman under 50 catches attention. Other factors may prompt a recommendation for testing.

“No test is perfect,” Dr. Vellek says. “Genetics gives us probability.

We can give statistics, but what happens happens, and we deal with the consequences. You need to know — and your OB/GYN needs to know —if you are in a high-risk category.”

A positive test result can’t tell if or when someone will actually develop cancer. Some women who inherit a harmful BRCA1 or BRCA2 mutation may never develop breast or ovarian cancer.

“The big question [for patients] is, ‘What are you going to do with the results?’” Dr. Vellek says.

At Missouri Cancer Associates, every course of action is individualized, based on science but with the specific patient in mind, to formulate a treatment approach.

For Marty and Cindy, there was no hesitation once they tested positive for BRCA1. Marty underwent surgery for a bilateral mastectomy before Christmas 2009. Cindy followed in January 2010. Marty then had a hysterectomy that July. (Cindy had already had a hysterectomy in 1998.)

“It was easy to make the decision after seeing what our mom went through,” Marty says about her and Cindy’s decision.

The decision to have a mastectomy or a hysterectomy is more complicated for a young woman. At 19 and 17, Heather and Sam hadn’t yet started families.

Heather went ahead with bilateral mastectomy two months after her mother’s surgery. “Cancer doesn’t pick a number. It can happen to you at any age,” she says.

Sam with her daughter, Kennedy

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Pictured from left to right: Mason Patton, held by this grandmother Marty Heath.

Heather Patton, Marty’s daughter. Cindy Pudney, holding her grand-daughter Kennedy Pullen, and Samantha Richardson, Cindy’s daughter.

Heather says having her mom and aunt undergo the same procedure made the decision easier. “[The surgery] was scary, but from the beginning, I knew we were going to stay positive. And I knew Grandma would tell me to do it,” she says.

Although she knew her decision was the right one, Heather admits it wasn’t always easy. Heather says other women asked her why she had surgery and whether she did it for the implants. She faced guilt when her son was born two months early and she couldn’t breastfeed.

“Six years later, I can finally say that what others say doesn’t bother me,” Heather Patton, now 25, says. “I would tell someone else at 19, ‘Do it.’”

At 17, Samantha Richardson wasn’t ready for surgery. “I was a senior in high school, working two jobs — I put it off,” she says. “I wasn’t as worried. I looked at it like everyone has a chance of getting cancer, I just had a higher likelihood.”

Sam chose preventive measures such as lifestyle changes, regular self-breast exams and mammograms, in lieu of surgery. Before her daughter, Kennedy, was born, she knew she wanted to breastfeed and again delayed a bilateral mastectomy.

On Sunday, January 31, 2016 — two weeks before her 24th birthday — Sam found a lump in her breast. The next day, Missouri Cancer Associates brought her in for a mammogram. Thursday, she had her diagnosis: breast cancer.

“It happened really fast,” Sam says. “[Missouri Cancer Associates] don’t mess around.”

Her daughter, Kennedy, was 1½. With her mom, aunt, cousin, fiancé Josh, and other family supporting her, Sam chose to postpone chemotherapy until after she had a bilateral mastectomy in March.

She then had six chemo treatments.

“My mom has been my biggest supporter,” Sam says.

Answering questions about Sam’s battle is hard for Cindy. Tears come to her eyes. “You obviously don’t want this for your child. It’s hard to see them have to go through so much at such a young age — or ever,” she says.

While talking about their family’s history, the strength and close-knit relationship these women share is clear. The women draw strength from each other.

“We pretty much handle things ourselves,” Marty says.

“What we got from our mom is to do what you have to do to get through every day,” Cindy says.

Sharon was diagnosed with breast cancer in 2004, at 56. It was the second time the family had been hit by the disease. In 1996, her husband, James — the father of Marty, Cindy and brother Andy — lost his battle with lung cancer.

Her daughters say Sharon, an independent, hardworking woman, didn’t immediately tell them about her diagnosis. She waited several

months, until scheduling a lumpectomy to remove her tumor, to share the news. Throughout treatment, her daughters say she didn’t let the cancer stop her. “She would go to chemo and then go to work,” Marty says.

Sharon’s cancer came back again and again. She fought it with chemotherapy, surgery and radiation.

“When she was done, she was done,” Marty says about her mother’s decision to stop treatment. Sharon passed away on Nov. 21, 2009.

The family says they appreciate Missouri Cancer Associates’ care and guidance throughout their journey. Marty, who works in human resources at MCA, knows the level of care they provide everyone.

“They are all willing to answer every question or find someone who can if they can’t,” she says. “They see the patient as a person, and they talk directly to them. They are never too busy to be respectful of what people are going through.”

“We all know we have this cross to bear,” Heather says about carrying the BRCA1 gene. “We stick together. Grandma taught us to be strong women.”

“The world doesn’t stop because you have a problem,” Marty says.

“We didn’t choose this gene, but it’s our fight. We choose to fight together.”

Cindy reflects on something her grandmother, Sharon’s mother, used to tell them — that God doesn’t give you more than you can handle.

“He must think we can handle a lot,” she says. Cindy’s husband, Les, passed away from cancer in 2014.

Sam had her last chemo treatment in July. Two weeks later, she was scheduled for a scan to see how effective the treatment was.

“It’s hard to tell people I have cancer,” Sam says. “I don’t want them to feel bad for me.”

“No pity,” Marty chimes in. “We get that from Mom.” By Missouri Cancer Associates BOONE HOSPITAL CENTER Fall 2016

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Doctors Devise A Unique Treatment To Save A New Mother’s Life

Pregnant, with Cancer

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here’s really no rhyme or reason to pregnancy symptoms.

Morning sickness, fatigue, food aversions — as far as anyone can tell, it mostly comes down to luck.

As she carried her first child earlier this year, Tanna Niemeier seemed to have especially bad luck. She found herself suffering a painful hemorrhoid outbreak — a problem some moms face while pregnant.

“That’s just one of the joys of pregnancy,” Tanna remembers being told.

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But these hemorrhoids seemed different.

As she neared her third trimester, the pain kept getting worse. It became so bad that Tanna was soon at Boone Hospital Center for emergency hemorrhoid removal surgery.

After the surgery, Tanna returned home to Fayette to recover.

With the hemorrhoids taken care of, the incident seemed destined to be remembered as just a bump in the road of life — a road Tanna had been racing down over the last year.

Just 12 months earlier, Tanna had been planning for her wedding. Not long after her marriage to Zach, the couple found out Tanna was pregnant.

They were thrilled by the news. So were their families.

“Everyone was just super excited,” she says. “Zach and I were nervous, but we were excited, too. It was our first child. We were just preparing and getting ready.”

As Tanna recovered at home the day after her hemorrhoid surgery, she was eager

to get back on track. She wanted to focus on the upcoming arrival of her child.

But the next day, everything changed.

Tanna was resting at home when her phone rang. It was her obstetrician, Elizabeth Wilson, MD, with Women’s Health Associates.

Dr. Wilson told Tanna that doctors had discovered a potential problem in the tissue removed during her surgery. A pathology report indicated it could be lymphoma, a cancer of the lymph nodes.

Tanna felt numb.

“The first thing I asked her was ‘Is that bad?” Tanna says. “She was saying ‘Yes, it’s bad.’ That’s pretty much all I remember. I think I ended up blacking out, and Zach finished the call.”

The Plan

Soon, Tanna was at Missouri Cancer Associates, where oncologist Elangovan Balakrishnan, MD, used a blood test to confirm the cancer. Even worse, Dr.

Balakrishnan diagnosed it as a rare, very aggressive form of non-Hodgkins lymphoma called Burkitt’s lymphoma, which can be fatal if left untreated.

“Me and my husband, we were just a mess,” Tanna says. “So many questions were running through our heads, ‘This was our first child, and what was going to happen to her? Am I going to be here for her after all this?’”

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They also consulted lymphoma expert Amanda Cashen, MD, at Siteman Cancer Center in St. Louis.

Working together, the physicians designed a plan that would unfold in three stages. First, Tanna would undergo two rounds of chemotherapy using carefully chosen drugs that are acceptable for use during pregnancy. However, for the third round, Tanna would need an anticancer drug called methotrexate, which is not safe to use while pregnant. So, between the second and third rounds of chemotherapy, doctors planned to induce labor. That meant Tanna’s baby would be born five weeks early. However, it also meant Tanna could receive her final round of chemotherapy without concern for her baby’s safety.

“Dr. Balakrishnan and I talked regularly about Tanna’s care,” Dr. Wilson says. “We discussed the timing of her delivery — when best to induce and deliver regarding the choice of chemotherapy meds. Of course, our goal is having a healthy mom and a healthy baby, and in this case we had to cross-check every plan of treatment.”

As her doctors devised their plan, Tanna began to make peace with her situation.

She felt determined to stay positive and to win this battle.

“I thought, ‘Well, it’s here, there’s nothing we can do about it, so now I’m just going to fight it and beat it,’” Tanna says.

“I want to be there for my daughter and my husband. I chose that I wasn’t going to fear it.”

The Battle resulting surgery had led to the cancer being discovered early. Yet, the case presented an unusual test for Tanna’s physician team.

“It is very uncommon to treat pregnant patients for cancer,” says Dr. Balakrishnan.

“When it comes to Burkitt’s lymphoma, it is extremely rare.”

Part of the puzzle included selecting anti-cancer drugs that wouldn’t harm Tanna’s baby. This required careful research

by Tanna’s doctors, as some common drugs used against fast-growing cancers like Burkitt’s lymphoma can also attack growing babies in the womb.

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Even some standard radiology scans were off limits.

“We have to be extremely careful about treating pregnant patients because of the risk of exposure to the baby,” Dr. Balakrishnan says. “PET scans can’t be done to stage the cancer. CT scans can be risky also because of the risk of exposing the baby to radiation. So we decided to use MRI for staging. We had to closely work with her obstetrician. Treating the mom without any harm to the baby is vital here.”

In crafting a treatment plan, Tanna’s Boone Hospital doctors held physician meetings to get input from their peers.

Each of Tanna’s chemotherapy treatments required a five-day stay at Boone Hospital’s Stewart Cancer Center. Her room was set up to allow Zach to stay by her side.

During this time, Tanna says her caregivers did everything they could to help her feel at home. She became especially close to three nurses: Mung Chin, Becca McGuire and Lauren McDonald. Tanna says these nurses would check on her even on days when they weren’t assigned to care for her.

To help Tanna avoid feeling cooped up, her caregivers encouraged her to take walks through the hospital.

“The nurses were so great,” she says. “I wasn’t allowed to leave the hospital, but I

“I want to be there

for my daughter and my husband. I chose that I wasn’t going to fear [cancer].”

— Tanna Niemeier

joked that I could give out free tours of Boone Hospital after walking around so much.”

Every morning, caregivers monitored Tanna’s baby. She also had weekly ultrasound scans. All tests indicated that the baby was coping well with the chemotherapy.

Tanna, too, was doing well. She found that chemo didn’t bother her as much as she expected. She hoped that her mild reaction to chemo might mean she could sidestep the hair loss cancer patients commonly experience. But that wasn’t the case.

“My hair was extremely long,” she says.

“One day I was fine, and the next day it was coming out in clumps. I freaked out. I told my husband to cut it, shave it and get it over with.”

As Tanna progressed through her first two rounds of chemotherapy, her induction date was approaching. Even with everything that was happening, Tanna and Zach hadn’t lost the excitement they felt to meet their child.

However, they also knew that their child would likely need extra care due to early delivery and exposure to chemotherapy drugs. Doctors had told the couple that their baby would likely need to spend a few weeks in Boone Hospital’s level-III neonatal intensive care unit, or NICU. Tanna and Zach arrived at the Boone Family Birthplace for the induction on a Sunday night. The next evening, April 25, their baby arrived – a girl. They named her Charlotte Alene.

Tanna says it was amazing to see her daughter for the first time.

The family and their caregivers were also amazed by how healthy Charlotte looked at birth. Tests showed that, in fact, she was in great health. She wouldn’t need to go to the NICU after all.

Finally Home

Once Tanna and Charlotte were cleared to leave the Boone Family Birthplace, it was time for Tanna to return to Stewart Cancer Center for her final round of chemotherapy.

This time, both Zach and Charlotte stayed beside Tanna. While it’s unusual to have a baby staying on the cancer treatment floor, Boone Hospital caregivers went out of their way to make it work.

“I joked that she already went though two rounds of chemo so what’s one more?”

Tanna says.

Her caregivers borrowed a bassinet from the hospital’s birthplace and brought it to Tanna’s room, so Charlotte would have a place to sleep. They also kept the family stocked with diapers, wipes and formula — Tanna had hoped to breastfeed, but the anti-cancer drugs made that impossible.

When the final week of treatment ended, Tanna and Zach could finally go home with their baby.

Over the coming weeks, the couple began to settle in as new parents. However, cancer still lingered in their minds. They would have to wait a month to see if the

three-stage plan her doctors had designed was successful.

On May 23, she returned to Boone Hospital for a PET scan. It showed that Tanna’s cancer was gone. Tanna says it was surreal to hear that news.

“We were so excited. It was the best news ever,” she says. “It almost felt unreal because everything happened so fast, and then it was gone so fast.”

Her physicians shared in the family’s joy.

“I can’t express how happy and excited everyone was on that day,” Dr. Balakrishnan says.

Just weeks later, as Charlotte was beginning her second month, Tanna says her daughter was doing great, even if she was a bit small for her age.

“She smiles a lot, she’s more alert and she’s getting bigger,” Tanna says.

Tanna was regaining her strength and preparing to return to work. Her hair was still short, but it was growing back. Life was returning to normal — a new normal as a mother. It felt good just to be here.

“This was a true success story,” Dr. Wilson says. “Who knows, perhaps having the pregnancy and the lymphoma at the same time produced the dramatic symptoms that led to the surgery and discovery of Tanna’s lymphoma. Finding it early gave us the best chance to make sure this courageous and lovely mama would be around for her precious little girl.”

By Jacob Luecke BOONE HOSPITAL CENTER Fall 2016

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Helping Athletes One Player At A Time Dr. Josh Hamann Inspires A Local High School Athlete To Go Into Medicine

W

hen Southern Boone High School senior Trint Lederle injured his shoulder while lifting weights, he didn’t know his injury would jumpstart a desire for a career in medicine, but it did.

Trint tore his labrum while working out with some of his fellow soccer players this spring. The injury caused him a lot of pain

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and limited his movement and ability to be as active as he liked.

“Luckily my senior soccer season was already over, but I wasn’t able to work out and do as much weightlifting as I liked to do,” Trint says.

One of Trint’s friends had had a similar injury and recommended he go to Columbia Orthopaedic Group to get it

looked at. But before he even went to his first visit at Columbia Orthopaedic, Trint dove into research about torn labrums.

“I wanted to know all that I could,” Trint says. “I found it all fascinating. I had already thought I might want a career in medicine, but this really was making that clear to me.”

At Columbia Orthopaedic, Trint saw sports injury specialist Josh Hamann, MD.

Ways to Prevent Sports Injuries

By Boone Therapy 1. Stay hydrated by drinking plenty of fluids before, during, and after your sporting event. Avoid playing in times of extreme heat or humidity.

2. Prepare the body with appropriate stretching and conditioning that is sport specific.

Train for the sport, don’t let the sport train you.

3. Wear appropriate protective gear and equipment that has been adjusted to fit properly.

4. Avoid playing when you feel tired or are already having pain. Don’t be afraid to speak up about a potential injury to your coach.

Trint Lederle finished his senior soccer season at Southern Boone High School before sustaining a weighlifting injury.

Dr. Hamann specializes in working with athletes with knee and shoulder injuries.

“When I met Dr. Hamann, he explained all of my options to me,” Trint says. “I told him I was interested in surgery, and we discussed what would be best together.”

Dr. Hamann explained surgery was likely the best choice for Trint so that he could be as active as he wanted to be. “Surgery allowed Trint to do the athletic activities he wanted to do without the pain and limitations he was currently experiencing,” Dr. Hamann says.

Dr. Hamann says he always discusses all options with his patients to make sure they will get the result they hope for. “It’s important for me to listen and understand what their goals are,” Dr. Hamann says.

Trint notes how Dr. Hamann is able to relate to athletes, since he suffered from his own torn ACL when he was a high school basketball player. “He really knows what it’s like to have to sit out and not do what you love,” Trint says. “He wants to get us back to normal as soon as possible.”

Trint says he was inspired by Dr. Hamann’s knowledge about his injury, as well as his ability to listen and make him feel comfortable. He says he had all his questions

answered, and he really had no apprehension going into surgery.

When the surgery was over, Dr. Hamann showed Trint the video of his surgery. Trint thought the video was amazing and decided he would like to become an orthopaedic surgeon someday, just like Dr. Hamann.

“When Trint told me that he would like to become a doctor like me, it was really exciting. I invited him to come shadow me at Columbia Orthopaedic and have been answering all of his questions that I can,” Dr. Hamann says.

Trint has shadowed Dr. Hamann two times and just started his undergraduate studies in Biology and Pre-Medicine at St. Louis University.

“It’s so cool to see the next generation inspired about helping people, and it’s awesome to share my passion for athletic injuries with Trint,” Dr. Hamann says. “I know he will be a great doctor someday.”

By Madison Burke Dr. Hamann is currently accepting patients.

You can make an appointment with him by calling Columbia Orthopaedic Group at 573.443.2402.

5. Avoid too much repetition without rest (for example, count pitches for pitchers). Limit playing a specific sport to one season per year and rest between seasons of different sports.

6. Don’t downplay symptoms.

Recognize injuries early on as continued play can make the injury worse. Seek medical attention if necessary.

7. Speak with a physical therapist to ensure the muscle groups that are specific to your sport are well developed and balanced for your body.

Boone Therapy offers one-on-one care from a licensed therapist who will perform a comprehensive assessment to identify the problem and create a recovery or prevention plan. Boone Therapy is a place where excellence in treatment and advanced technology come together to help people live their best. For more information on Boone Therapy, visit boone.org/ therapy.

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Kids On Track Boone Hospital’s Summer Fitness Program Keeps Mid-Missouri Kids Active

B

oone Hospital Center started Kids On Track in 2012 as a way to get kids in the community moving. The program consists of youth under the age of 12 or 18, depending on the town, walking, running, biking or swimming 26.2 miles, the equivalent of one marathon, over the course of the summer. The program is free to the public and includes a fun kick-off event, prizes as kids meet milestones, and a fun finale event.

“We have lots of great incentives to keep kids motivated along the way,” says Kids on Track coordinator Erin Wegner. “We partner with local businesses so participants can earn free prizes along the way to encourage them to keep going.”

The program first began in Columbia, but has expanded. Local Kids on Track programs are offered in Ashland, Boonville, Brookfield, Centralia, Macon, Mexico and Moberly. In total, more than 2,100 kids participate in Kids on Track.

“It is so exciting to see so many kids involved. Exercise has so many benefits at every age. It’s great to see kids getting in the habit of being active,” Erin says.

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If you’d like to get your kids involved next summer, visit boone.org/kidsontrack and like Kids on Track on Facebook at facebook.com/kidsontrack.

Learn how you can sponsor a child at boone.org/kot

KIDS ON TRACK 2016

BY THE NUMBERS

2,203 PARTICIPANTS

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53

counties

Towns

3 states

For the Tager family, Kids on Track was more than just a way to get their kids active. It also brought them closer together.

“Every day after dinner, we would take the kids on a bike ride or a walk to get the miles in,” says Columbia mother Sarah Tager. “The kids loved it because they were excited to get a fun incentive, like a trip to Going Bonkers. We loved it because it was a chance to spend time with our kids and get active.”

David Tager explains that each of their four kids had a different favorite way to get their miles in.

“Our daughter Adelyn liked to go on bike rides, while some of the other kids preferred to take family walks.”

The Tagers even did family 5Ks to help complete their miles.

“It is so awesome to complete goals as a family,” Sarah says.

Oldest child Hannah says, “It’s really fun to get outside and bike or walk with my family. It’s also cool how many chances you have to get rewards.”

Sarah says when her kids would meet their milestones, they would make the trip to get their rewards a family event.

“It can get expensive to take all four kids out, so when they all get a free meal at a restaurant or a free trip to Going Bonkers, it’s so exciting!” Sarah says.

The Tager kids completed their third Kids On Track marathon this summer. Congratulations to the Tager family!

By Madison Burke Hear from the Tager family by visiting www.youtube.com/boonehospital.

57,718.6 miles ran 32 community sponsors

56 mile sponsors

Program Growth

2012: 2013: 2014: 2015:

2016:

Columbia Columbia Centralia, Columbia Ashland, Centralia, Columbia, Macon Ashland, Boonville, Brookfield, Centralia, Columbia, Macon, Mexico, Moberly

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No Time? No Problem!

Easy Solutions For Eating Healthy With A Busy Schedule

By Jennifer Tveitnes, RD LD, Registered Dietitian, Boone Hospital Center

F

ollowing a healthy, balanced diet is a goal for many people, but the biggest reason patients give me for not achieving this goal is that they’re battling a busy schedule.

A full schedule is the norm for many people, and the thought of preparing balanced meals on top of everything else can seem overwhelming. After running around all day, the last place people want to spend their remaining energy is in the kitchen. And when you arrive home at 7:30 p.m., nobody wants to wait another 45 minutes for dinner.

Despite the perceived drawbacks, eating healthy is worth the extra time and energy. You may think it takes energy to eat healthy, but eating healthy will give you that much-needed energy. Eating an appropriate balance of protein, fat, carbohydrate, vitamins and minerals helps our bodies function at their best. When nutrition is poor, our daily activities are negatively affected.

Mental performance, mood stability and energy level are all impacted by our diets.

1/2 veggies & fruit

1/4 carbohydrates

Choose a variety of colors.

Green, yellow, orange and red are the best choices.

Avoid refined (white) grains in favor of whole (brown) grains.

Fish, poultry, nuts and dairy are ideal sources of protein.

1/4 protein To eat healthy, knowing what a healthy diet means is crucial.

A balanced diet consists of three meals a day. At each meal, strive to make half your plate vegetables, a quarter of your plate carbohydrates, and a quarter of your plate a lean protein.

drink water!

Avoid sugary drinks.

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Vegetables should be nonstarchy, (i.e., nearly all vegetables except potatoes, corn and peas, which belong in the carbohydrates section of your plate).

Carbohydrates should be low in fat and high in fiber, like fruit, beans or whole grains.

Limit white pastas or breads, which have little fiber, or high-fat carbohydrates such as croissants or desserts.

Protein should be low in saturated fat (e.g., grilled chicken, 90/10 beef, ground turkey, baked salmon). Limit meat high in saturated fat and sodium, like sausages or fried chicken.

[ easy fish tacos ]

Meal planning is necessary to be successful.

Planning ahead will look different for everyone, but is crucial and cannot be skipped. When we don’t plan ahead, it’s easy to resort to unhealthy habits. Even the busiest among us have time to do basic meal planning.

To start meal planning, simply plan dinners for a week.

Discuss ideas as a family over dinner Friday night, during breakfast on Saturday morning, or on the way to Thursday night soccer practice. Use grocery store advertisements for inspiration.

Plan for leftovers or a basic meal, like hamburgers and frozen steamer vegetables, on exceptionally busy nights.

To save time, get everything you need for the week in one trip.

Precut vegetables when you have a spare moment to allow cooking meals later in the week to go quickly. Anything you can cook ahead, like meats, pasta or rice, will save time.

Don’t forget the benefit of one-pot meals. Washing dishes also takes time; recipes that use only one pot will save time before and after dinner.

You don’t have to prepare fancy, complicated recipes. Put tacos on your menu for Tuesday, shop on Saturday, and prepare the ingredients ahead of time. Put chicken in the slow cooker on Tuesday morning, and all that’s left when you get home is to assemble when you get home. Meal planning can really be this easy!

Snacks also should be included in your meal planning and on your weekly grocery list. Snacking is frequently a source of unnecessary calories and fat, resulting in weight gain. Avoid purchasing high-fat, low-nutrition snacks, like chips, cheese crackers or cookies. When unhealthy items aren’t in your house, you can’t eat them. Purchase fruits and vegetables to replace those missing snacks.

Swapping baby carrots for potato chips will help you reduce fat and calories, and increase your fiber, vitamins and minerals.

If your schedule doesn’t allow you to eat at home, meal planning will look different, but it is still necessary.

Think about which meals you will eat out and where you’ll be. Review your options and pick places that offer healthy choices. This is getting easier to do; even fast food restaurants offer salads with lean meat. All chain restaurants post nutrition information online, so you can look up the best options before you head out.

If you think you’ll be unable to find a healthy option, take a cooler and pack vegetables and fruit. Bringing produce with you will ensure you have healthy snack and side options to complete a meal.

Although meal planning may seem to take extra time and energy, a little effort can make a large difference. Eating a healthy, balanced diet gives you plenty of physical and mental energy to power through those busy days.

Fat-free Greek yogurt is high in protein and is a good source of probiotics, and can be a substitute for sour cream in any recipe. Salmon and avocados serve as good sources of heart-healthy fat. When purchasing salmon, make sure you look for wild caught to get the best nutritional value.

To get this quick recipe on the table even faster, shred the cabbage and slice the green onions and jalapeno ahead of time.

Ingredients ¼ cup fat-free Greek yogurt, plain 2 tablespoons lime juice salt and freshly ground black pepper, to taste 1 jalapeno pepper, halved lengthwise 2½ cup shredded red cabbage 4 green onions, thinly sliced 2 tablespoons canola oil 1 pound wild caught salmon fillets, cut into strips 8 6-inch flour tortillas ½ cup chopped fresh cilantro 1 avocado, diced Directions Mix sour cream, lime juice, salt and pepper together in a large bowl. Reserve half of the mixture in another small bowl for serving.

Mince half the jalapeno pepper, discarding the seeds. Toss with cabbage, green onions and remaining Greek yogurt mixture until slaw is well mixed.

Slice the remaining half of the jalapeno pepper.

Heat canola oil in a large skillet over medium heat, and toss in the sliced jalapeno. Season salmon with salt and pepper, then pan-fry strips in the skillet until golden brown and easily flaked, 5 minutes.

Heat tortillas in the microwave on high until warm, 20 to 30 seconds.

Serve fish in warmed tortillas. Top with cabbage slaw, reserved Greek yogurt mixture, cilantro, and avocado.

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Hear from Rob at youtube.com/BooneHospital

Fresh Choices

Boone Hospital’s Cafeteria And Pierpont Farms Provide Local, Organic Produce Throughout The Year

I

f you’ve eaten any fresh fruits or vegetables at Boone Hospital Center, as a patient or visitor, you may have noticed them tasting extra crisp and flavorful. But you probably didn’t know they were grown right here in the Columbia area.

Boone Hospital gets much of its fresh produce from Pierpont Farms, an organic farm located just south of Columbia. The

farm produces vegetables, herbs, flowers and fruits using organic, sustainable methods.

“We don’t use the chemicals and pesticides that are needed for shipping and preserving food because we sell our food locally. That makes the food healthier and also more flavorful,” says farm owner Rob Hemwall.

Boone Hospital director of nutrition and food services Julie Winters says the

Pierpont Farm owner Rob Hemwall

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partnership benefits the hospital as well as the community.

“There are so many benefits to using local produce,” Julie says. “It reduces the amount of time that the food spends traveling to our hospital from the farm where it was produced. The product then has a longer shelf life here, which helps us reduce costs. The local produce that we purchase doesn’t have preservatives added to extend shelf life, increasing the taste and amount of nutrients of the food. A really awesome benefit to using local produce is that it supports local farmers and makes a positive impact on the Boone County community.”

The farm provides seasonal fresh produce all year long, something Boone Hospital clinical dietitian Kelsie Knerr enjoys.

“Eating local means getting seasonal variety,” Kelsie says. “I love going to the Boone Cafeteria and seeing the gorgeous multicolored cherry tomatoes available.

When people eat seasonally, they go from eating more zucchini and tomatoes in the summer to switching it up to more carrots and beets come winter. There’s a benefit to letting nature keep you on your toes and not getting stuck in a rut with the types of foods we consume.”

Pierpont Farm is known for its large row covers, which help protect the plants from Missouri’s unpredictable weather.

“The covers serve as a protection, but they also help lengthen the seasons of the produce we grow,” Rob says.

He explains that the one thing he is most passionate about is sustainability. That’s a large reason why he doesn’t use harmful pesticides on his crops.

“If we kill all the bugs, we will be hurting our ecosystem. There are a lot of good bugs that are important in maintaining a sustainable world,” Rob says.

Rob says the lack of pesticides used on the produce is a large reason local food often tastes better. Kelsie agrees.

“When the focus isn’t on growing produce to withstand thousands of miles in a truck, local farmers are able to grow more varieties that are known for their taste,” Kelsie says.

This fall, Boone Hospital is serving a variety of fresh beets, carrots, greens, herbs and other fall vegetables from Pierpont Farms. By Madison Burke

getting to know a BHC nurse

› lauren mcdonald, bsn, RN, ocn I was born and raised in St. Louis before I moved to Omaha, Nebraska, to complete my BSN at Creighton University. I worked for a short while in St. Louis after graduation and then moved to Columbia and started my career at Boone. Since moving to Columbia, I have gotten engaged and married, completed my oncology certification (OCN) and started graduate school. I am working on my Doctor of Nursing Practice (DNP) at the University of Missouri so I can work with the oncology population as an advanced practice nurse.

Why did you get into the health care field?

What is the most challenging aspect of your job?

When I was in high school, my twin sister struggled with health issues and spent time off and on in the hospital. During the time I spent with her, I watched the nurses and started to have the inkling that nursing might be the right fit for me. I was always interested in science and felt called to serve others. Nursing was the perfect fit for me!

In oncology, I see many of my patients on a regular basis, as cancer is not a disease that is cured with one hospital admission. Throughout months (or years), I have the opportunity to get to know my patients beyond their diagnosis.

It is challenging to see patients that I have formed relationships with dramatically decline in health. End of life decisions are a frequent topic broached in cancer care, but it is especially difficult to have these conversations with patients who have become a part of our Boone family.

What interested you in your particular specialty?

During nursing school, I actually had no idea what kind of nurse I wanted to be.

As fate would have it, I was placed on a bone marrow transplant unit for my senior preceptorship and I immediately felt at home with the patient population. I particularly enjoy working with leukemia and lymphoma patients as I am able to see many of them from diagnosis through completion of treatment.

What is the most rewarding aspect of your job?

Although it’s rare for me, nothing is better than having patients visit the hospital once they are healthy and completely in remission. It’s very rewarding to know that I have helped someone conquer a disease that is frightening and life-altering. It is a privilege to walk with patients through their cancer experience.

What has changed in your field since you started practicing?

As I have only been a nurse for three years, my perspective on changes in oncology care is much more limited than that of many of my co-workers. I have definitely seen a change in the amount of targeted therapies available; new treatments seem to be developed every day.

What do you see changing in the next five to 10 years?

In terms of cancer care, I think we are going to see an even more dramatic increase in the number of targeted therapies available for treatment. Each individual’s genetics are going to play a large role in how they are treated. In terms

of health care as a whole, I hope to see advanced practice nurses utilized to the full scope of their abilities, especially in the state of Missouri.

What do you enjoy doing outside of work?

Right now, most of my time outside of work is spent on my graduate coursework.

When I do have free time, I enjoy spending time with my husband, exercising, and going for walks on the Katy Trail. My husband is in medical school, so we both lead busy lives!

What advice would you give to someone looking to become a nurse?

There are a seemingly endless number of opportunities within the nursing field.

If you don’t know what you want to do right away, that’s okay! Nursing offers the flexibility to change your career many times and serve a variety of patient populations.

No matter what area you are in, make sure you take advantage of all the learning opportunities that are available to you.

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getting to know a BHC Doctor

› sara crowder, md Gynecologic oncologist Sara Crowder, MD recently performed her 1,000th surgery using the da Vinci surgical system. For the past two years, Dr. Crowder has performed more of these types of surgeries than anyone else in Missouri, and is in the top 1 percent worldwide. Boone Hospital Center acquired the da Vinci system, which offers 3D imaging and 360-degree movement of instruments, in 2011. It allows surgeries to be minimally invasive, leading to shorter hospital stays and quicker recovery times.

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HOSPITAL CENTER

[ Gynecologic Oncology ]

What kind of surgery do you do?

I am trained as a gynecologic oncologist, which means I treat cancers of the female reproductive tract. I am boardcertified in that subspecialty. So I perform hysterectomies, remove ovaries, lymph nodes and other abdominal tissues to determine if the cancer has spread. I do other types of surgeries to treat cancer as well.

What did it feel like hitting the 1,000 mark?

In some ways, it felt just like any other day — and the case went great, so that made me happy! In other ways, it was a moment of pride, looking back and seeing how far we’ve come. Finding out the significance of doing 1,000 cases was really overwhelming. I was amazed.

What was the significance of 1,000 robotic cases?

One thousand cases put me in the top 1 percent of gynecologic robotic surgeons in the U.S. and worldwide. That made me feel like my commitment to this skill has been worth it. I think it’s amazing that in the middle of the country, in a town the size of Columbia — my home town —you can have surgery with the top 1 percent level of expertise in the world.

Explain robotic surgery to a layperson who’s not familiar with the technology.

Minimally invasive surgery is done through smaller incisions. This is typically done with standard laparoscopy equipment, which has some limitations.

Robotic surgery has capabilities that

overcome many of those limitations. The benefits basically boil down to visualization and ease of motion.

For the visualization, the camera is much stronger, so you see the anatomy in a very magnified way. The camera actually has two camera heads, so it gives a threedimensional view. 3D sounds fancy and exciting, but it has a practical application.

It allows you to judge the depth of your motions. To see the difference between visualization with standard laparoscopy and robotics, reach for something and grab it with both of your eyes open. Then, close one eye and reach for it. You’ll see how your brain has to work harder to judge how far to reach when one eye is closed. Standard laparoscopy is like that. Robotics allows you to operate with both eyes open.

The ease of motion is due to the robotic instrumentation being wristed, so it has a full range of motion so that you can move the instruments more like you’d naturally move your hands and fingers. I think if you’ve ever had to wear a cast and then do things with that arm, it’s a good analogy for what standard laparoscopic surgery is like.

You wouldn’t have complete range of motion of your arm. You could adjust your body and grab what you need to grab, but again, it takes a lot more effort and you may not always grab it exactly the way you want to.

Compared to standard laparoscopy, robotic surgery feels like getting your cast off.

When and why did you become interested in pursuing robotic surgery?

I began in 2011. I wasn’t one of the earliest adopters of the technology, but I’d known about it for years. In 2001, I did my fellowship in Texas, and our institution had one of the first robotic systems in the country, when it was undergoing its preliminary clinical use. I didn’t do robotic surgery at that time, but one of my mentors, Dr. Conception Diaz-Arristia, was one of the first physicians in the U.S. to do robotic cases. So I was aware of the technology in its infancy. Many years later, when robotics first came to Columbia, I was approached multiple times but declined because I was too busy with other things, one of which was completing my board certification in gynecologic oncology.

The da Vinci robotic surgical system allows Dr. Crowder to perform minimally invasive surgery with smaller incisions and more precision.

If I was going to pursue robotics, I wanted to put my best effort into it. There are rigorous training steps you have to go through just to start doing cases.

I was interested to use the technology for my cancer cases who need more extensive surgery, like lymph node removal.

Robotics was a safer way to do complex cases with much more precision. Robotics essentially equalizes the playing field, allowing patients who otherwise wouldn’t be candidates for minimally invasive surgery to benefit from it. I initially planned to only use it for a subset of my patients, but as I used it more, I realized the benefits of the technology and became a believer: it’s truly the future of surgery.

To what do you attribute your success?

Overall, having a great mother. In robotic surgery, I’d say focus and dedication. I’m an “all or nothing” person; if I commit to something, I like to give it my all. I also have benefitted greatly from a strong team in the operating room. Great nurses, scrub techs, and anesthetists can really make your job easier.

What has surprised you the most about robotic surgery?

The complexity of procedures that I can do through tiny incisions. That’s the beauty of experience — the more surgeries you do, the more you find ways to work around obstacles.

I’ve also been pleased at how it’s changed my patient’s lives. They recover

from surgery much faster and with less pain. That’s more profound than it initially sounds. The less pain you have, the less pain medicine you take, the sooner you’re up doing your normal activities. You’re also less likely to have postoperative complications like blood clots, pneumonia or constipation.

And for many of my patients, it means moving on to the next phase of treatments, like radiation or chemotherapy, that much sooner.

What do you most enjoy about being a surgeon?

The satisfaction of the case that goes perfectly. The challenges of complex cases and successfully meeting those challenges.

I’m fascinated by anatomy and physiology and the endless complexity of the human body. I’m humbled by the strength and resilience of the human spirit and the body’s capacity both to mutate and to heal itself.

What practical advice would you give to someone who’s facing surgery?

Ask questions. Bring someone with you to your appointment. Find out about your surgeon’s expertise if you can. Listen to your gut. If you’re not comfortable, that may be a red flag. You have to put a lot of trust in your surgeon and you have to feel like you can communicate with them.

Don’t be afraid to get a second opinion.

Oh, and of course, follow the doctor’s advice! Do’s and don’ts about your postop care can make a big difference in your recuperation.

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Learn more at boone.org/foundation

GivingBack Charlie And Jean Gibbens Have Both Supported And Been Supported By Boone Hospital

I

f you walk into Boone Hospital Center’s lobby, you may see Charlie Gibbens extending a warm smile while wearing his signature volunteer red vest. He’ll probably ask you if you need any help finding your way and offer you a hug if you look like you need one.

“People always tell me how Charlie comforts them when they need to go to the hospital,” says his wife, Jean Gibbens. “Charlie just has a way of telling when people are nervous and comforting them.”

Charlie may be known as a volunteer now, but his connection to Boone Hospital began decades ago, when he first moved to Columbia.

“We moved here from Iowa and had my youngest daughter here, a month and a half after we moved,” Charlie says. “I think that’s when we first felt really a part of the hospital.”

A few years later, friends and family encouraged Charlie to run for the hospital board of trustees. He won and served two terms.

“I really care about the hospital and worked hard to “The Foundation do what was best for it and our is so important. community,” Charlie says.

It provides funds When he decided to retire for things that make from the board, he knew he patients’ stay here still wanted to serve in some as comfortable way, so he became a volunteer.

“I love to help people, and as possible.”

I love this hospital. Anything — Charlie Gibbens

I can do to try to make people’s visit here be comfortable, I do,” Charlie says.

When Charlie was hospitalized with cancer few years ago, Charlie and Jean say they felt the love from everyone at Boone.

“Everyone already knew Charlie and were so worried about him,” Jean says. “I remember I called in to schedule a test for him, and the nurse on the phone asked ‘Is that our Charlie?’ So many people would stop by and ask how ‘their Charlie’ was doing.”

When Charlie recovered and the Stewart Cancer Center was being built, Charlie and Jean donated a nurses’ station through the Boone Hospital Foundation.

“The oncology nurses were so good to us, we just wanted to give back,” says Charlie.

Charlie and Jean are advocates of the Boone Hospital Foundation and say that donating to it is a beautiful way to help patients.

“The Foundation is so important,” Charlie says.

“It provides funds for things that make patients’ stay here as comfortable as possible.”

Some of the things the Foundation provides are free health screenings to the community, scholarships for caregivers to further their education, heart and lung pillows for cardiac and pulmonary surgery patients, and supportive and palliative care for patients. By Madison Burke Hear from Jean and Charlie by visiting www.youtube.com/boonehospital.

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Learn more at boone.org/foundation or call 573.815.2800

News from the

Understanding Planned Giving Benefits A planned gift — a donation made in your estate plan — allows you to support The Boone Hospital Foundation after your lifetime while reaping financial benefits now. + BENEFICIARY DESIGNATIONS

Identifies how your assets are distributed and allows the Foundation to receive assets such as retirement plans and life insurance policies after your lifetime. These are set up through a form separate from your will.

Benefits: Beneficiary designations are flexible, so you can review or change at any time. Since the Foundation is tax-exempt, the gift is not subject to federal income taxes — all of your gift will support your desired cause. + CHARITABLE GIFT ANNUITIES

Simple contracts in which you agree to make a gift to the Foundation, and in return, the Foundation pays you a fixed sum of money each year for the rest of your life. After your lifetime, the remainder will support the Foundation.

Benefits: The life-long income is not subject to market fluctuations.

You also receive tax benefits, including a federal income tax charitable deduction. + CHARITABLE REMAINDER TRUSTS

Provide income each year. There are two types: an annuity trust pays a specific dollar amount each year, and the unitrust pays a variable amount each year based on fair market value of the assets.

Benefits: You’ll receive a partial charitable income tax deduction, with potential for increased income and upfront capital gains tax avoidance. + ENDOWED GIFTS

Create a permanent, self-sustaining source of funding for the Foundation.

Benefit: You’ll receive a federal income tax charitable gift deduction. + WILLS AND LIVING TRUSTS

With one or two sentences (known as a charitable bequest) in your will or living trust, you can leave a specific sum or percentage of your estate to the Foundation.

Benefit: These give your estate an unlimited federal estate tax charitable deduction.

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Fall 2016 BOONE HOSPITAL CENTER

Carol Wegener decided to add the Boone Hospital Foundation as a beneficiary in her will after seeing the excellent end of life care the hospital gave to her father. So much planning goes into the beginning of life and the end is often neglected. She has made it her mission in life to help people prepare for the end of life and make it as comfortable as possible for them. The Foundation provides soothing music, massage therapy, and much more to the hospital’s end of life patients.

Carol says she will always be grateful to the Foundation for how it helped her family during difficult, but beautiful, times.

Hear from Carol by visiting www.youtube.com/boonehospital.

Share the Gift of Health

A

s 2016 comes to a close, please consider “Sharing the Gift of Health� this holiday season through your end-of-year giving. All gifts are taxdeductible to the extent allowable by law.

You can make a gift to a specific area, or an honorary or memorial gift, at any time with a check, credit card or transfer of stock.

Choose the way to give that is most convenient for you. You may visit us online at www.boone. org/foundation or call 573.815.2800.

Please consider us in your 2017 budget planning!

Giving opportunities are available through the annual Golf Tournament (May), Community Campaign ( July/August) and Annual Gala (November).

For more information on the many planned giving types, call Barb Danuser at 573.815.2800.

Join the Foundation at an upcoming event.

October

17, 18

Fall Jewelry Sale

November

5

Annual Gala

November

10

Uniform Sale

May 2017

1

Golf Tournament

ANNUAL

GALA

Saturday, November 5th Holiday Inn Executive Center

Honoring Charlie & Jean Gibbens For more information, call 573.815.2800 or email Yvonne Gibson at ymg1825@bjc.org.

BOONE HOSPITAL CENTER Fall 2016

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Boone Hospital Center 1600 East Broadway Columbia, Mo 65201 573-815-8000

NONPROFIT U.S. Postage

PAID

Columbia, MO Permit 286