Health + Wellness Magazine Fall 2016 by Cheshire Medical Center

Health + Wellness Living healthier together.

Fall 2016 | cheshiremed.org

Susan Voss shares her experience receiving care, education, and

Managing Chronic Conditions Requires a Team Effort Putting Patients at the Center of Personalized Care Introducing the Cheshire Health Foundation Board of Trustees Fall Calendar of Health Education and Support Programs

coaching for managing type 2 diabetes.

Collaborative Care Nurse Lori Guyette talks with Susan about type 2 diabetes.

Patients experience better outcomes when they collaborate with their Medical Home team Susan Voss shares her revelation about the value of her Medical Home team as she learns to live with diabetes

or Susan Voss, her grandmother’s and her aunt’s diabetes were a forgotten childhood memory. The Peterborough resident and owner of the well-known gift shop, The Black Swan, had recently been suffering from aching joints and muscles, fevers, headaches, cough, and debilitating fatigue. This past June, lab tests revealed alarmingly high blood glucose levels. Fortunately for Susan, she had a coordinated team at Cheshire Medical Center/DartmouthHitchcock Keene (CMC/DHK) ready to provide support, her Patient-Centered Medical Home Team (PCMH). The PCMH is an approach to primary care encompassing a team, led by a Primary Care Provider (PCP), working together with patients to provide personalized primary care (see graphic on pages 4-5). The members on the team with whom patients interact flexes as patients’ needs change. The key is that everyone on the Medical Home team is working together 2 Fall 2016 l cheshiremed.org

in a coordinated effort to help patients reach their health and wellness goals. When Susan learned she had type 2 diabetes, she recalls, “I was just blown away by that news, first–that I would have this for the rest of my life, second–that it was potentially serious, and third– that it could happen to me.” Susan’s PCP on her Medical Home TeamTeam C, is Sheila Ramanathan, DO. “I was a new patient to Dr. Ramanathan when I was diagnosed with type 2 diabetes,” recalls Susan. “From the beginning it was very clear to me that she had taken the time to learn about me. She was wellversed in my medical history and my current situation. She had great energy and she was a very good listener and explained things thoughtfully. “I grew up with the ‘one doctor-one nurse’ system of care,” notes Susan, “so I was not initially enamored of the team approach. But every time I come in, it seems as though everyone knows

a patient is fully engaged “withWhen their health care team, it sets us all up to succeed.” —Lori Guyette, RN Collaborative Care Nurse on Medical Home Team C at CMC/DHK

me and is concerned about me. It is evident that the members of my team go to Dr. Ramanathan regularly for input and that she responds to them quickly.” Susan continues, “When I am contacted, it is somebody whose name I recognize and who can talk to me in a personal fashion. As it turns out, I love the team concept.” One member of Susan’s Medical Home team is Lori Guyette, RN, Collaborative Care Nurse on Team C. Lori and Susan reviewed the many resources available to her, including CMC/ DHK Diabetes Dietitian, diabetes classes, and support groups. “I’m a big fan of our diabetes management classes and many of my patients love them,” explains Lori, “but Susan is an online learner. The time and education with her team, coupled with her self-guided education, was working for her. And that’s what it’s all about, individual patient needs. Everyone’s needs are a little different.” Getting Susan’s diabetes under control is a process. For new diabetics, determining appropriate insulin dosage to stabilize blood glucose levels can take several months. “It quickly became evident that Lori was on my side,” says Susan. “She took all of the scariness out of it. She called to check on me regularly and would ask what my readings were and then adjust my insulin dosage until we reached the plateau. I

knew I could call Lori anytime I had a question. I set out to learn everything I could about diabetes. I decided to change the role that food plays in my life, and I got a Fitbit and started walking 2/10 of a mile a day.” Susan is only a few months in and already feeling the benefits of her diabetes management. “I feel great,” says Susan, “which is amazing after feeling so awful. I never knew diabetes could cause so many problems.” Susan marvels at her renewed lease on life. “I’ve lost 34 pounds and am walking over four and a half miles feeling strong. My energy has been revived–my gardens have even received a ‘face-lift’,” Susan says with a smile. Lori Guyette explains, “When a patient is fully engaged with their health care team, it sets us all up to succeed.”

How does the Medical Home Model work? PCMH is not a place....it’s an enhanced partnership with your Primary Care Provider. Turn to pages 4-5 to see how patients are at the center of this innovative model.

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Putting You at the Center of In the past, primary health care was centered around a yearly doctor’s appointment that could leave you feeling a bit on your own in the time in-between.

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Patients often found themselves wondering about important aspects of their health, and providers were not set up to succeed in their efforts to coordinate personalized care for their patients. A major reason for this gap was the lack of communication and coordination among providers and across sites of service. That’s why Cheshire Medical Center/DartmouthHitchcock Keene (CMC/DHK), like many medical centers throughout the country, has adopted a better way to care for our patients.

Today, our patients benefit from a health care model that brings together a coordinated team led by a Primary Care Provider.

Your Medical Home Team Whether it’s helping you get the most from your appointments, following up on tests and recommendations, prescribing and monitoring medications, facilitating transitions of care, consulting on behavioral health issues, coordinating support services, or tracking records and paperwork, your team has got you covered.

Health care coordinated to meet YOUR specific needs. Other members of your team include: RN Care Coordinator Results Management Nurse Medication Renewal Manager Team Phone Nurses Behavioral Health Consultant Forms Manager Patient Flow Staff Call Center Receptionists To learn more about the members of your Medical Home Team, visit: cheshire-med.org/familymedicine

Key components of the PCMH:

Accessibility, Communication, and Connection Seamless connections among our Walk-In Care, Family Medicine, and Specialty Medicine help your team always stay on the same page when it comes to your care. You never need an appointment to be seen by one of our Dartmouth-Hitchcock medical staff at CMC/DHK Walk-In Care. Open 365 days a year, our walk-in care clinic can treat your everyday illnesses and minor injuries. To learn more about CMC/DHK Walk-In Care, visit: cheshiremedwalkin.org

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Save time and stay in touch with myD-H Keene, an electronic patient portal that allows you to use your computer, tablet or smartphone to: • access your records • send and receive secure messages with your provider • request, reschedule, or cancel appointments • request prescription renewals To learn more about myD-H Keene, visit: cheshiremed.org

Personalized Primary Care Understanding a Patient-Centered Medical Home (PCMH) Model

It’s not a place...it’s an enhanced partnership with your Primary Care Provider. Taking a Collaborative Approach.

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Primary Care Providers (PCP) collaborate with Associate Providers and other members of your team to address your specific health concerns. They also work with you to create health and wellness goals and a plan to reach those goals.

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Associate Providers partner with your PCP to ensure your current treatment plans are being followed. They diagnose, as well as prescribe treatment and Let’s look at an example of medications. how a PCMH flexes to address an Collaborative Care Nurses (CCN) individual patient’s needs. Below are just some work closely with you and your PCP of the team members who might work with you to help manage chronic conditions. through a diagnosis of type 2 diabetes. With ongoing check-ins, you and your CCN focus on education, mentoring, Primary Care Provider meets with you to and health coaching. CCNs also examine and discuss your health. Determines oversee lab tests and health screenings, what lab work is required and orders testing. and monitor the progress of preventative Develops and oversees your treatment plan care protocols. and directs your care.

Registry Coordinators make sure that patients are getting their routine and preventative screenings, and are up-to-date with their PCP’s recommendations for chronic illness management.

Teaming up in the Community CMC/DHK is committed to working with our community partners to address population health and wellness issues and collaborate on supportive solutions. Our Medical Home teams help patients connect with regional resources and educational opportunities. The Cheshire Diabetes Prevention Program is an example of this partnership in action. CMC/DHK, together with the Keene Family YMCA, Monadnock Family Services, and the Keene Senior Center, have partnered to offer this year-long program that can help to cut the risk of type 2 diabetes by half. To learn more, visit cheshiremed.org/diabetes. To talk with someone about signing up for the next session, call (603) 354-6866.

Results Management Nurse contacts you with test results and your PCP recommendations. Communicates directly with your PCP to help answer your questions about test results and arranges appropriate follow-up care. Collaborative Care Nurse works closely with you and your PCP to provide education, coaching, and ongoing support to help you stabilize and manage your diabetes. Registry Coordinator reaches out to you between office visits to ensure you are up-todate with chronic and preventative guidelines, such as the A1C test to review your average blood glucose level over the past few months. Diabetes Care Network In addition to your PCMH, you have the resources of the Diabetes Care Network at CMC/DHK. The Network is a team of specially trained and certified clinicians working with you in concert with your Medical Home Team to provide a multifaceted approach that includes medical care, coping skills, and assistance with lifestyle change.

Ensuring a Sustainable Health System for Our Community An Update from Don Caruso, MD, MPH, CEO/President, Chief Medical Officer

elcome to our updated community newsletter, Health + Wellness, formerly known as Health Quarterly. We are pleased to share our fall edition with you, where you will find the news and information you are accustomed to, now in a fresh, new format. Ensuring a sustainable health system for our community takes many forms. One example is the continued improvements to our PatientCentered Medical Home model of care in our Family Medicine department. Cheshire Medical Center/Dartmouth-Hitchcock Keene was an early adopter of the Patient-Centered Medical Home model, which provides a team of caregivers, including Primary Care Providers, Collaborative Care Nurses, Registry Coordinators, Behavioral Health Consultants, and Team Phone Nurses, to name a few. The team works together to provide the exact care a patient requires at a given point in time. Both the article in this edition about patient Susan Voss’ experience and a new “infographic” about our Medical Home highlight the significant difference this award-winning model can make in the life of a patient. The reality is that having a whole Medical Home team caring for and partnering with a patient with a chronic condition can really make a difference, as in Susan’s case. Working with a Medical Home team helps to ensure patients receive the right care at the right time. As a Family Medicine physician, I have witnessed the evolution and patient benefits of our Medical Home model of care and I am a strong advocate. 6 Fall 2016 l cheshiremed.org

Another example of ensuring a sustainable health system for our community would be our recent launch of a new dedicated Board of Trustees for the Cheshire Health Foundation. This came about as a result of our affiliation with DartmouthHitchcock and was specified in our affiliation agreement. Having a dedicated Foundation Board demonstrates the commitment that we have for local donations impacting local patient care and wellness. Our present-day Medical Center was founded 124 years ago, and was made possible by donations from citizens who understood the importance of establishing a local healthcare resource. Today, donations are just as important and will grow in importance as reimbursements for healthcare services continue to be reduced by insurers and federal and state governments. We are grateful for the volunteer commitment our founding Cheshire Health Foundation Trustees have made to benefit the health and wellness of our patients and all community members. Please see the announcement from Gregg Tewksbury, Chair, Cheshire Medical Center Board of Trustees, on the following page.

(L to R) Jim Putnam, Cheshire Health Foundation Board Chair with Gregg Tewksbury

Introducing the Cheshire Health Foundation Board of Trustees A message from Gregg Tewksbury, Chair, Cheshire Medical Center Board of Trustees

hen good people come together for equally good causes, great things can happen. Which is why I’m excited to announce our new, dedicated board of trustees for the Cheshire Health Foundation. Each of these individuals has shown a commitment to making a difference for our community. In their role as Foundation board members, they will enhance community engagement and encourage increased charitable support for Cheshire Medical Center/Dartmouth-Hitchcock Keene’s health and wellness mission. Their knowledge and experience will guide important decisions at a time when the need for philanthropic support in health care is at an all-time high. Please join me in welcoming our founding Cheshire Health Foundation Board of Trustees: Dr. Bill Chase; Dr. Claire Fabian; Mark Gavin; Cecile Goff; Dr. Roger Hansen; John Hoffman, Jr.; Bob Rooney, Sr.; Katherine Snow; Jane Stabler; Julie Tewksbury; Rob Therrien; Dr. Don Caruso (ex-officio); and Jim Putnam, who has graciously agreed to serve as Chair. The Cheshire Health Foundation has existed for

several decades to direct charitable gifts in support of local patient care at our Medical Center, and in recent years, fundraising efforts have grown. Community donations have provided funding for financial assistance to patients in need, nursing scholarships, Emergency Department renovations, the expansion of Healthy Monadnock, sports medicine services for local athletes, and other initiatives that make a positive impact on our patients and community. It is fitting that the new Cheshire Health Foundation Board begins its work this year, as 2017 will mark the hospital’s 125th year of existence in Keene, NH—an existence that was first made possible by the gift of the Elliot home on lower Main Street. John Elliot’s extraordinary vision was quickly joined by many donations from the community to outfit and supply the building to transform it into a working hospital. Those gifts were the beginning of the longstanding tradition of giving to support the hospital. On behalf of both boards of trustees, I extend my sincere gratitude for the generosity of past, current, and future donors who understand the importance of having a medical facility of this caliber so close to home. Please join me in thanking the Foundation Trustees as they begin their work as ambassadors for the Foundation and Medical Center, and stay tuned for more information as we begin to reflect on and celebrate 125 years of caring for our community. To learn more, please visit CheshireHealthFoundation.org. A Benefit for the Cheshire Health Foundation

Caring, Candlelight and Community:

Celebrating our Health Care Legacy Join us in honoring Bob Englund, MD & Bob Rooney, Sr.

for their service and commitment to the health of our community

Saturday, November 12, 2016 CHFTribute.org cheshiremed.org l Fall 2016 7

Gifts to Cheshire Health Foundation Made In Recognition, Honor and Memory July 1 to June 30, 2016

Gifts Made In Recognition, Honor and Memory We would like to thank those donors who have made gifts in memory or tribute, and acknowledge the meaningfulness of the sentiment.

In Honor of

A wonderful & generous community Deep Roots Massage All my Radiation Therapy patients! Joy Fike-MacLeod & Norman MacLeod, Jr. All the Brave Warriors Isis Latham All the wonderful caregivers at Cheshire Medical Center Norman Parkhurst, Sr. Leif Arvidson James W. Allan Dena Richard Dave Barnes Yvonne & Bruce DeMay Laura Byrnes John & Catherine Byrnes Marion Carberry-Mogan Kerry A. Mogan Sandra Chandler Kathaleen E. Morales Rosanne Ciaramella Melissa Lake Cindy, the sweetest lady Rhonda & Dominick Tralli Cathy Collins Keene High School Remembrance Fund Declan Keith Pepin Dolly Emily R. Drew Eileen Kathie Nelson Family Amanda & Jeremy Kinson Marty Francis Deborah Glassford Adrian Gagne Judy & Rob Gagne Fiona Reeve

Amanda Gaspard Kenneth & Diane Gaspard

Michelle Tanguay Jennifer Mercer

Gayla & Blaire Karen & Jeffrey Luebkeman

Too many to name Jack Smith

Gabriel Genovese Kerry A. Mogan

Skylar Trevorrow Kathy Trevorrow

Penni Giles Colleen Harper

Upward Bound Kristin Sweeney

Julie Green Paul & Sharon Pezone

Robert & Lee Waters Robin Willis

Jackie Greenough Jackie Ronning

Janet Yedinak Anonymous (2)

Kate Ingram, for doing slow medicine quickly Nancy Wood & A. David Lein, MD The KCCC team Bruce & Janet Chamberlin Kingsbury Staff 1994 David Foley Moira Lawlor & Fred Spin Kate Ingram, APRN Marcia Leversee Marcia & Gordon Leversee, Jr. John Lightbody, Sr. Gordon Kent Loved Ones Jill Beam Sandra Morin Anonymous My friend, Melanie, the strongest woman I know Paula McQuillan My Parents Kara O’Connell Art Nichols Sarah & Adam Kossayda Carmella Richardson Edward & Mable Bergeron Pete Rose’s 68th birthday Linda Rose Marti Saxton Katherine Sylvester Jeanne Sumner Crane Carol Slocum

† Deceased

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In Memory of Dr. Carolyn B. Allen Mary Cobb

In memory of Joy Amisano Timothy J. Fisher, MD & Kathleen M. Fisher, MD Edna Anthony Dayna & Eric Gebhardt Aunt Dot Cynthia M. Durant Walter Banek Linda Banek Patty Bannister Sara Voorhis

Additional Recognitions

In honor of & thanks to my DHMC Doctors Carl Allen In recognition of Dr. Ditri & the wonderful staff at Farnum Rehab Joan Elliott In Recognition of Doug & Mary Pleasanton’s contributions to chaplaincy Robert & Susan Ritchie †

In support of Bob Dean Joyal In support of Cancer Research Carl Allen In support of Diana Reilly Cooper Kennedy In support of Grace Nadeau Evelyn Nadeau In support of my mother-inlaw Eva Burchfield Virginia Mallard In support of our patients & their loved ones Debra Stallings

Deborah Barlow Franny & Jim Dunton Wendi J. Faulkner Betsy R. Follansbee Tina M. & James Heath Debra S. Lukan Sherrie & Joseph Sabolevski Bill & Elijah Barrett Michael & Kathryn Blair Richard Bauries Ian & Maryanne Ferguson Ronald G. Bergeron Paul & Sharon Pezone George & Gini Berube Steve Berube George, Gini & Zoel Berube Michael & Renee Berube Robert Bohannon The Bohannon Family — Shirley & Daughters Judith & Kevin Griffin Dottie Bond Robin Topper Nancy Borden & Virginia Wilson Lee & David Borden Joyce Boufford Arthur & Bea Boufford Sharon Brown Brenda & James Glinka

Rosemarie T. Carroll Herbert & Paula Miller

Grampy Beth Cope

Frank H. Carter, MD Harriette H. Carter Martha J. Tenney

Grandma Joan Lisa White Hebert

Lora Caruso Nancy E. Johnson, MD & Don Caruso, MD Colin Lisa Merchant Norma Croteau Greg Croteau Paula Cuomo Kim & Timothy Wolfe Albert A. Daniel Linda Daniel Jean L. Dinsmore David L. Williams Richard Dufresne Andrea Gott Steven Dwyer Jessica Griebler Albert D. & Myra R. Eichner Gerald J. Eichner Loretta Evans Heather Palmer Dr. Ederito P. “Ted” Fachada Shirley Davidson Hank Drury & Lilla Lyon Betty Merritt Patricia Fairchild, RN Kristen & Jean-Pierre Bernier Family Anonymous Family & friends Betsy R. Follansbee Joan Flood Cheryl Flood Peter James Richardson Fournier David & Robin Fournier Dr. Allan Freeman Betty Merritt Bruin French Tiffany French, RN Pauline M. Gavin Mark & Barbara Gavin Betty Gedney Eileen Nelson Martha J. Getty Gayle & Paul Wollert Dorothy Graham Betty Merritt

Dexter Guyette Charles & Liz Anderson Evelyn S. Hastings Jeanette & Scott Bergeron Ed Hazard Carolyn Hurwitz David & Paul Hofreiter Mary E. Hofreiter, MD John B. Hollon Ann Hollon Marty & Frank Hughes Fred & Patricia Hughes Krista Hulslander Marci & Michael Richards Harry Ingalls & Marie Namiotko Cecille Ingalls Teresa Jenkins Megan Bennett Joan John & Joan White Harold & Betty Johnson Don Caruso, MD & Nancy E. Johnson, MD Charlotte Kapiloff Michael & Tricia Kapiloff Andrew N. Lemnah Deborah & Bruce Lemnah June Levesque Jeanmarie Levesque Linda Norma Elliott Frank Lupis, Jr. Diane Lupis Tammy Mahavik Franny & Jim Dunton Betsy R. Follansbee Tina M. & James Heath Debra S. Lukan Paul & Sharon Pezone Sherrie & Joseph Sabolevski Edward J. McCarten Kay B. McCarten Murray Michaels Sierra Simmons Murray & Sheila Michaels Ian Michaels My Dad Marcy Fries

My Ladies, Betty Boop & Laureen Shauna Chamberlain

Andrea Smith Yvonne & Michael Ball John Sorce, MD, Mirella Scully & Lindsey Eyles Douglas & Julie Green

My Mom Conradine Yackel My Mother Sally Washington

The Sorce/Culliton/Eyles/ Green families Douglas & Julie Green

Nancy & Bunny Diane Myers-Miller

Irene Stark Mindy & Doug Scott

Catherine Needham John & Linda Carey

Theresa Stewart, Hospital Volunteer Mary Louise Caffrey & Kenneth Stewart

Linda Oliver Kathleen Oliver Patricia A. “Patti” Thibault Oneschuck Robert Baker Donna & Ted Baczewski Mark Fiorentino Robert & Denise Hitchcock Robert Thibault

CYD Cheryl Sullivan Karen S. Wright Clarence “Hector” Swain Patti Neal Dale & Doris Thompson Christine & Stephen Scheffler

Our Parents Terri Fournier

Jack Tracy Lauren T. Vermouth

Frank Panek Beth Truman

VKM Mindy Glasschroeder

Joseph G. Pascale Gregory Pascale

Todd Walier Joe & Judith Walier

Kathy Pearson Lauri Buffum William A. & Claire M. Perkins Caroline & Royal Desrosiers Terry Phipps Sandie Phipps & Tom Casey Douglas Pleasanton Jack & Gail Metcalf James & Kay Mountford Janet Parsons Robert & Judy Perry Anna L. Ruelle, DPM & David Chase David & Meredith VanderWoude Dorothy Pratt Jaquith Nancy T. Benda, PA-C Rita John Toomey Rosanne Abbie Fellbaum Debbie Rubin Edward P. Venezia & Ellie Cook-Venezia

E. Bruce Weber The Honorable Lucy Weber Kip Weeks Christine H. Weeks Fleurette Wentworth Kathleen Letourneau Larry White Judy White Mikey White Emily B. Nichols Yvonne Wilbur Sarah Ennis Ray Wilson, my dad Debbie Bokum Marion Woodbury Andrea L. Pearson, MD Ronald J. Wright Ellen M. Wright Patricia Wyman Johndrow Cassandra Johndrow Elizabeth & James Yanizyn Nora Larsen

Judy Sargent Sara Sargent Vivian Skinner & Priscilla Zuercher Richard & Karen Mays cheshiremed.org l Fall 2016 9

Health + Fall 2016 Wellness Programs Living healthier together.

Health & Wellbeing Programs HONORING CARE DECISIONS: ADVANCED DIRECTIVES Nicole Boudle, RN, Collaborative Care Nurse, CMC/DHK and Lori Guyette, RN, Collaborative Care Nurse, CMC/DHK Future care decisions regarding serious medical problems are often difficult to discuss. But unexpected medical emergencies and life-threatening conditions can happen at any time, and can be devastating for families who aren’t prepared. Advanced Directives allow you to make your desires known to family members and care givers in the event you can’t speak for yourself. In this workshop, you will learn about Advanced Care Planning and you will have the opportunity to leave the workshop connected with a trained Advanced Directives counselor who will walk you through the process.

Health Education and Support for the Monadnock Region At Cheshire Medical Center/DartmouthHitchcock Keene, we are committed to working together for our community’s health and wellness. Join us this Fall for classes and events designed to help you and your family live healthier together. Register by calling (603) 354-5460 or visit events.cheshire-med.com.

Programs are held at CMC/DHK, 580-90 Court St., Keene, NH unless otherwise noted. All programs require registration and are free, unless otherwise noted. If special accommodations are required for you to attend any of our programs, please call (603) 354-5460. PLEASE NOTE: To register for Prenatal and Parent Education Programs, call (603) 354-5454 ext. 8388 or visit cheshiremed. org/pregnancy. To find out more about the Senior Passport Program or Cheshire Walkers, call The Center for Population Health Strategy and Practice at (603) 354-5460. 10 Fall 2016 l cheshiremed.org

 Wednesday, September 28 4:30-5:30 p.m. Keene Senior Center

MANAGING OSTEOARTHRITIS OF THE HANDS AND THUMBS Robert Majkut, MHS OT/L, CHT, CMC/DHK Osteoarthritis (OA) of the hands and thumbs is a common problem affecting many middle-aged and senior adults. Proper care of this condition includes management of symptoms using joint preservation principles and adaptive techniques. Education is a primary component of conservation treatment of hand arthritis. Join us to learn how OA can affect the hands and thumb, and self-care, including splinting and activity modifications to manage pain, improve hand function, and preserve joints.  Thursday, September 29 3:30-5:00 p.m. Auditorium A & B

THE AFFORDABLE CARE ACT: PUTTING THE ASSISTANCE PIECES TOGETHER FOR YOU AND YOUR FAMILY Ruth Abbot and Hayley Compos, Certified Marketplace Assistors, CMC/DHK Center for Population Health This presentation will consist of a general overview of the Health Insurance Marketplace, how to create an account on the Marketplace, and how to keep costs reasonable. The program will also address additional resources available in our community to assist with other needed services. Information will also be available for the TADS (Traveling Adult Dental Services) Program, Financial Assistance, and Medication Assistance.  Thursday, October 6 5:30-6:30 p.m. Auditorium A & B

NO BONES ABOUT IT: SUPER FOODS FOR BONE HEALTH Keene State College Dietetic Interns “I need to strengthen my bones but I don’t like milk.” Sound familiar? That’s ok! You don’t have to be a lover of dairy to protect your bones with nutrition. The amount of non-dairy foods that support good bone health may surprise you. Come learn what these foods are, how they help your bones and how to incorporate them into your everyday diet.  Thursday, October 13 3:30-5:00 p.m. Auditorium B

BUDGETING FOR A BETTER LIFE Cheryl Adams, Business Development Officer, Citizens Financial Group Inc. In today’s economic climate, it is important to understand how to handle your family’s finances. Explore the importance of using a budget. Learn how to create a budget and techniques for following and sticking to it to accomplish goals.  Thursday, October 13 4:30-5:30 p.m. North Conference Rooms 1 & 2

HEALTHY LIVING WITH DIABETES: 4-PART SERIES Patti Schuman, RDN, LD, CDE, CMC/DHK Learn more about diabetes—each session covers different aspects of diabetes self-care, including, but not limited to, diabetic complications and how to avoid them, what to eat, activity and diabetes control, stress management, and goal-setting. Get practical self-care tips along with support and suggestions from others with diabetes. Spouses and significant others are encouraged to attend. Choose a 4-week series:  Wednesdays, October 19, 26 & November 2, 9 5:30-7:30 p.m. North Conference Room 2  Tuesdays, November 1, 8, 15, 22 9:00-11:00 a.m. North Conference Room 2

MEMORY LOSS: TWO-PART SERIES Valerie R. Gendron, MD, CMC/DHK Neurologist Pt I: What Is in Your Control and What Is Not? Come hear a CMC/DHK neurologist present on the risk factors of Alzheimer’s, early signs and symptoms, and strategies to employ to either reduce your risk or manage the disease. 30 minutes of Q&A included.

Pt II: Support for Caregivers What do you do when your family member has memory loss? This program is intended for families who are beginning their journey with Alzheimer’s disease. Some of the topics covered include: steps in getting a diagnosis, treatments, importance of legal and financial planning, care giving tips, community resources, and lifestyle changes.  Thursday, October 27 6:30-7:30 p.m. Auditorium A & B

LEARN HOW TO USE myDH KEENE Dana Carley, CMC/DHK Patient Portal Concierge CMC/DHK has an online patient portal that makes managing your health information and communicating with your doctor and health care team easier than ever. Viewing your records, requesting appointments and medication refills, asking questions of your health care team, receiving appointment reminders, and viewing test and lab results are just a few of the features you will enjoy as a myD-H Keene user. In this class we will walk you through how to 1) request an account, 2) access your information, and 3) review the features within the portal. The last 15 minutes of class will be set aside to assist those who want to sign up and connect to the Patient Portal. There will be a few computers available to sign in if you wish, so remember to bring your username and password if you would like to try navigating your portal during class. Choose a date:  Friday, October 21 12:00-1:30 p.m. Auditorium A  Wednesday, November 9 2:30-4:00 p.m. North Conference Room 1

DON’T JUST SIT THERE AND TAKE IT: STRATEGIES TO AVOID COMMON ACHES AND PAINS ASSOCIATED WITH OFFICE JOBS Joan Van Saun, CMC/DHK Occupational Therapist “Ouch, my back!” “Ooo, my hip!” Have you ever wondered if your daily aches and pains may be related to sitting all day? It is important to develop strategies and stretches to avoid every day aches and pains so you can be your best at work. Come listen to an Occupational Therapist discuss common injuries associated with office jobs and how to avoid developing them by integrating a few new techniques into your routine.  Monday, October 24 5:30-7:00p.m. North Conference Rooms 1 & 2

 Thursday, October 20 6:30-7:30 p.m. Auditorium A & B

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Health + Fall 2016 Wellness Programs Living healthier together.

Health & Wellbeing Programs NEW FACE OF TOBACCO PREVENTION: E-CIGARETTES AND OTHER NEW TOBACCO TECHNOLOGIES Kate McNally, MS, TTS, CMC/DHK Center for Population Health According to the American Cancer Society, smoking is responsible for nearly 1 in 5 deaths in the United States. Another 8.6 million people live with serious illnesses caused by smoking. Fortunately, the past few decades have seen great strides in changing attitudes about smoking, understanding nicotine addiction, and learning how to help people quit. Come learn about new (and old) tobacco products and devices which are tempting youth in our community, as well as new evidencebased strategies for finding freedom from nicotine addiction.  Wednesday, November 2 4:30-5:30 p.m. North Conference Room 1

FIRST STEPS IN PREVENTING TYPE 2 DIABETES Registered Dietitian/Diabetes Educator and Exercise Physiologist, CMC/DHK During this free one-hour informative program learn what steps can be taken to delay or prevent the onset of type 2 diabetes. Practical tips are provided.  Wednesday, November 9 1:00-2:00 p.m. Auditorium B

HOW TO LOWER BLOOD PRESSURE NATURALLY! Patti Schuman, RDN, LD, CDE, CMC/DHK Did you know that high blood pressure can silently damage your heart, brain, and kidneys for years? Learn how to choose and prepare nutritious foods that taste good while increasing your chances of lowering or eliminating the need for blood pressure medication.  Thursday, November 10 1:00-2:00 p.m. Central Conference Room 6

KOMBUCHA & FERMENTED FOODS: 2 Part Series Erica Frank, RDN, LD, The Monadnock Food Co-Op Ever wondered what the heck kombucha is and why is it good for you? Come learn about the power of fermented foods and learn to make your own kombucha, yogurt, and other fermented delights. We ask you register to attend both classes in the series. Space is limited; pre-registration is required.  Pt. I: Wednesday, November 9 5:30-7:30 p.m. Auditorium A & B  Pt. II: Wednesday, November 30 5:30-7:30 p.m. Auditorium A & B

D-I-E-T IS A FOUR LETTER WORD: OBJECTIVE LOOK AT POPULAR FAD DIETS Keene State College Dietetic Interns Paleo. Shakeology. Whole30. Juice cleanses. Clean eating. There are pros and cons to every major food and nutrition trend out there. Some characteristics of these trends are helpful while others may be harmful. Come learn more about the most popular fad diets from an objective point of view. Keene State College Dietetic Interns will play the devil’s advocate, using research and evidence to support the benefits and risks of each fad discussed.  Thursday, November 10 3:30-5:00 p.m. Auditorium B

HEALTH AT EVERY SIZE: NON-DIET APPROACH TO THE MAINTENANCE OF HEALTH AND WELL-BEING Ann Merrit, MS, RD, LD, Valley Regional Hospital Most people who lose weight by dieting will regain the weight lost plus 10%. While these statistics vary, one thing is for certain: American men and women are dieting more now than at any point in history and the rates of overweight individuals and weight-related disease are skyrocketing. The Health at Every Size Movement promotes total health enhancement and well-being, rather than weight loss or achieving a specific ideal weight. Come hear a registered dietitian and weight management specialist discuss a non-diet approach to healthy weight maintenance and provide practical strategies and exercises to begin positively changing the relationship you have with your body.  Tuesday, November 15 5:30-7:00 p.m. Auditorium A & B

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Family & Parenting Programs KIDS IN THE KITCHEN

KIDS IN THE KITCHEN

 Friday, October 7 Brown Bag It–Homemade School Lunch 5:00-6:30 p.m. Auditorium A & B

 Friday, December 2 Family Italian Night 5:00-6:30 p.m. Auditorium A & B

 Friday, October 21 Fun with Fall Food 5:00-6:30 p.m. Auditorium A & B

 Friday, December 16 Holiday Treats 5:00-6:30 p.m. Auditorium A & B

TALKING ABOUT THE BIRDS AND THE BEES: WHAT EVERY PARENT SHOULD KNOW

WHEN KIDS PUSH YOUR BUTTONS

This program is suitable for kids aged 4-8 years old and their parents. Keene State College Dietetic Interns Hectic family schedules and convenience food make the traditional concept of “making dinner” every day nearly obsolete. And for many parents, the idea of “kids in the kitchen” conjures up images of chaos and mess. It doesn’t have to be that way! Cooking is a great way for parents and kids to connect. This series will offer practical, hands-on ways to get the whole family involved and provide healthful, flavorful recipes that kids won’t hide in their napkins. Join Keene State College Dietetic Interns as we cook up something fun. Each class will feature different recipes and build new skills. Space is limited. Registration is required.

Renee Giles, Lead Healthcare Associate, Planned Parenthood of Northern New England Studies show that talking with your child about sexual development at a younger age will make it easier to talk to them when they’re older. Educating about sexual health is more like being a guide or lending an attentive ear than being an expert on the topic. This discussion will cover the following: How to start the conversation with your child? When should you start talking with your child about sexual development? What topics to cover at what age? What is typical sexual development? Tips for talking with your child included.  Thursday, October 20 5:30-7:00 p.m. North Conference Rooms 1 & 2

This program is suitable for kids aged 9-12 years old and their parents. Keene State College Dietetic Interns Hectic family schedules and convenience food make the traditional concept of “making dinner” every day nearly obsolete. For many parents, the idea of “kids in the kitchen” conjures up images of chaos and mess. It doesn’t have to be that way! Cooking is a great way for parents and kids to connect. This series will offer practical, hands-on ways to get the whole family involved and will provide healthful, flavorful recipes that kids won’t hide in their napkins. Join Keene State College Dietetic Interns as they cook up something fun. Each class will feature different recipes and build new skills. Space is limited. Registration is required.

Bonnie Harris, M.S.E.d, Director of Connective Parenting A certain look, a defiant act, your child “pushes your buttons,” and you say things you swore you never would. Blame, regret, shame—does this “spinning out of control” action/reaction sound familiar? Effective parenting is achieved when we connect with our children, understand what their behavior is trying to tell us, and end the parenting “road rage” to give our children the help they may really be asking for. This highly respected parent educator, international speaker, and author of When Your Kids Push Your Buttons—And What You Can Do About It will help you discover what your buttons are, why your children push them, and how to defuse them so you can regain your authority, your sanity, and your children’s cooperation and respect.  Thursday, December 8 5:30-7:00 p.m. Auditorium A & B

Register by calling (603) 354-5460 or visit events.cheshire-med.com. Programs are held at CMC/DHK, 580-90 Court St., Keene, NH unless otherwise noted. All programs require registration and are free, unless otherwise noted. If special accommodations are required for you to attend any of our programs, please call (603) 354-5460.

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Health + Fall 2016 Wellness Programs Living healthier together.

Resilient Living Programs TRAIN YOUR BRAIN, ENGAGE YOUR HEART: HOW TO MANAGE STRESS AND BUILD RESILIENCE Jennifer Begley and Tom Stearns, PhD., CMC/DHK Resilient Living Team Ongoing stress has a negative effect on health, happiness, and relationships. Resilience is the ability to adapt well to stress and to even thrive amidst adversity. In this workshop, you’ll learn why and how your brain and mind work so hard to keep you stressed and everyday exercises to train your attention and interpretations with the intention of decreasing stress and enhancing resilience and well-being. Choose a date:  Tuesday, October 11 6:00-8:00p.m. North Conference Room 2  Tuesday, November 8 5:30-7:30p.m. North Conference Room 2

CULTIVATING MINDFULNESS, KINDNESS, AND COMPASSION Tom Bassarear, Monadnock Mindfulness Practice Center Mindfulness is a way of paying attention, with more interest and less judgment, to what is happening right now; it enables us to see what is happening more clearly. We will begin by exploring several basic mindfulness practices that enable us to remember more often the wisdom that we have within our mind and body. We will then explore and cultivate a family of related qualities: kindness, compassion (including selfcompassion), forgiveness (toward self and others), gratitude, and generosity. Common outcomes include an increased feeling of general well-being, greater resiliency toward stress, and more energy and joy in one’s daily life.  Tuesdays, October 18 - November 22 (6-week series) 5:00-6:45 p.m. North Conference Room 2

WRITING INTO WHOLEHEARTEDNESS Leaf Seligman, Writing Guide Brené Brown writes, “Vulnerability is the birthplace of love, belonging, joy, courage, empathy, and creativity,” yet often we armor ourselves to feel safe even though it is counterproductive. With a few thoughtful writing prompts and a pressure-free space to explore the authentic self, this writing session will help identify the ways we restrain ourselves, and offer alternatives for more wholehearted living. This session is accessible for all and requires no reading aloud—just openness.  Thursday, October 27 6:00-7:30 p.m. North Conference Room 2

WRITING TOWARD FORGIVENESS Leaf Seligman, Writing Guide Research shows forgiveness can lower blood pressure, reduce stress, and improve mood–yet we never see pamphlets on how to achieve forgiveness. The world’s spiritual traditions praise it but we rarely encounter practical pathways to it. This writing session offers the chance to explore forgiveness through a series of gentle prompts in a safe, judgment-free setting. If you are curious, come. As Brené Brown says, “The willingness to show up changes us; it makes us a little braver each time.”  Thursday, November 10 6:00-7:30 p.m. North Conference Room 2

POSITIVITY Jennifer Begley and Tom Stearns, PhD., CMC/DHK Resilient Living Team Positive emotions/positive experience has repeatedly been demonstrated to be a critical ingredient in the cultivation of resilience and well-being. In this workshop we will describe what positive emotion/experience means, some research supporting its importance in your resilience and well-being practice, and specific exercises that help create as well as “hard wire” your practice into daily life. This will allow you to see new possibilities, bounce back from setbacks, connect with others, and become the best version of yourself.  Thursday, November 17 5:30-7:00 p.m. Central Conference Room 6

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Senior Programs MANAGING GRIEF AND LOSS: HOW TO LIVE ALONE AND THRIVE Barb Andrews, PhD, Director of the Clinical and Mental Health Counseling Program, Antioch University New England Losing a life partner can be one of the most challenging events to overcome in life. This loss is felt on all levels: emotional, physical, and financial. Come and learn how to reframe how you think about living alone, how to overcome loneliness and other emotional challenges, rediscover parts of yourself that are uniquely yours, and leave empowered to overcome or avoid social isolation.  Tuesday, September 27 3:30-4:30 p.m. North Conference Rooms 1 & 2

SENIOR PASSPORT PROGRAM

Senior citizens 60 years and older can receive a free passport to better health information and at the same time, have an opportunity to partake in CMC/DHK’s passport meal program.Membership in the Senior Passport Program entitles participants to free nutrition, exercise, and health education lectures and classes. Also included is a specially-priced “Passport Meal” in our dining room Monday-Friday, 4:30-6:30 p.m. and Saturday-Sunday, 11:30 a.m.-1:30 p.m. To receive your Senior Passport, contact The Center for Population Health Strategy and Practice at 603-354-5460.

CHESHIRE WALKERS

The Cheshire Walkers Program is a series of walks and hikes organized by Cheshire Medical Center/Dartmouth-Hitchcock Keene. Led by a group of dedicated volunteers, Cheshire Walkers meet every Wednesday in the Fall and the Spring in order to increase physical activity, foster social connection, and learn about the region’s rich history. For a complete listing of walks or to be added to the mailing list, contact The Center for Population Health Strategy and Practice at 603-354-5460.

Prenatal & Parent Education Programs BREASTFEEDING 101 Fee: $25.00 Certified Lactation Consultant This class prepares expectant families for breastfeeding their new baby.Topics include mechanics of nursing, including latching and position,how to know the baby is getting enough milk, and avoiding breastfeeding roadblocks. 6:30-8:30 p.m.  Thursday, October 13  Thursday, November 10  Sunday, November 13  Thursday, January 5  Sunday, January 22

INTRODUCTION TO BABY WEARING Fee: $15.00 Certified Baby Wearing Consultant This innovative class introduces expectant and new parents to baby carriers and how to use them. Learn types of carriers, picking the right carrier for you and your baby, safety and more! 6:30-8:30 p.m.  Thursday, November 17  Monday, January 9

KEEPING BABY SAFE

Fee: $25.00 This important class covers the basics of Infant CPR, choking, first aid, babyproofing your home, and other important safety topics. For all new parents. 8:30-9:30 a.m.  Tuesday, October 18  Tuesday, January 17

PRENATAL YOGA: 6-WEEKS

Fee: $60.00 per 6-week session Practice postures and breathing techniques that will leave you relaxed, strengthened and rejuvenated. Learn ways to relieve common aches and pains and labor techniques. 8:30-9:30 a.m.  Saturdays, March 5–April 9  Saturdays, April 23–May 28  Saturdays, June 11–July 16

NEW MOMS CLUB FREE

Certified Lactation Consultant Topics discussed include mom and baby wellness, breastfeeding, sleep issues, and adjusting to parenting. For moms with newborns to 18-month-olds.  Tuesdays - ongoing 10:00-11:30 a.m.

BEYOND BIRTH - CARING FOR BABY Fee: $25.00 This class focuses on the care of your new baby. Learn about normal newborns, signs of illness, bathing, diapering, swaddling, newborn behavior, sleep, and more! 6:30-8:30 p.m.  Tuesday, September 27  Tuesday, November 1  Tuesday, December 13  Thursday, January 26

SIBLING CLASS FREE

A class for big brothers and sisters! See a room where mom will stay and learn all about new babies. For ages 2-8. 9:00-10:00 a.m.  Sunday, March 13  Sunday, May 22  Sunday, July 10

Locations for classes will be provided upon registration. To register for Prenatal and Parent Education Programs, call (603) 354-5454 ext. 8388 or visit cheshiremed. org/pregnancy.

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Provider Spotlight Cheshire Medical Center/Dartmouth-Hitchcock Keene would like to introduce you to the newest members of our medical staff Kristin Dunnell, PA-C

Family Medicine – Team B (603) 354-5400 n Master of Physician Assistant Studies, Massachusetts College of Pharmacy and Health Services University, Manchester, NH n Bachelor of Arts, Saint Anselm College, Manchester, NH

Jocelyn Ferland, PA-C

Orthopaedics (603) 354-5482 n Master of Physician Assistant Studies, Massachusetts College of Pharmacy and Health Services University, Manchester, NH n Bachelor of Arts, Biology, University of Vermont, Burlington, VT

Stuart Murray, MD

Emergency Medicine (603) 354-6600 n Residency, Emergency Medicine, Vidant Medical Center, Greenville, NC n Doctor of Medicine, University of Massachusetts Medical School, Worcester, MA n Bachelor of Business Administration, University of Massachusetts, Amherst, MA

Ellen Stein, MD

Emergency Medicine (603) 354-6600 n Residency, Emergency Medicine, Baystate Medical Center, Springfield, MA n Doctor of Medicine, Dartmouth Medical School, Hanover, NH n Master of Business Administration, Stanford Graduate School of Business, Stanford, CA n Bachelor of Arts, Engineering with Computer Science, Dartmouth College, Hanover, NH

Joseph Rosenberg, MD

Emergency Medicine (603) 354-6600 n Residency, Emergency Medicine, Tampa General Hospital, Tampa, FL n Doctor of Medicine, University of Vermont College of Medicine, Burlington, VT n Bachelor of Science, Biology/Chemistry, University of Miami, Coral Gables, FL

Erik Pattison, MD

Urology (603) 354-6570 n Residency, Urology, DartmouthHitchcock Medical Center, Lebanon, NH n Doctor of Medicine, Indiana University School of Medicine, Indianapolis, IN n Bachelor of Arts, Biology, Indiana University, Kokomo, IN

Robert Hilo, DO

Emergency Medicine (603) 354-6600 n Residency, Emergency Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH n Doctorate of Osteopathic Medicine, University of New England College of Osteopathic Medicine, Biddeford, ME n Master of Arts, Medical Sciences, Boston University School of Medicine, Boston, MA n Bachelor of Science, Human Physiology, Sargent College of Health and Rehabilitation Sciences at Boston University, Boston, MA

Martin Gross, MD

Urology (603) 354-6570 n Fellowship, Men’s Sexual Health Fellowship, Louisiana State University Health Sciences Center, Shreveport, LA n Residency, Urology, Boston Medical Center, Boston, MA n Doctor of Medicine, New Jersey Medical School, Newark, NJ n Bachelor of Arts, Honors Psychology, Seton Hall University, South Orange, NJ