Health + Wellness Magazine Fall 2019 / Winter 2020 by Cheshire Medical Center

Health + Wellness SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life

Living healthier together.

Fall/Winter 2019

From adolescence through the senior years, women have unique health needs and concerns. Proactive partnership with your healthcare providers can support a longer and healthier life.

PLUS: Learn about Cheshire’s nurse midwife-led practice offering supportive prenatal care and natural birthing options within a medical setting.

ALSO INSIDE: Helpful tips, tools, and information about local resources and supports for living healthier together―along with a listing of our upcoming programs on a variety of health-related topics. H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Health + Wellness Living healthier together.

Health + Wellness magazine is a publication of Cheshire Medical Center. To support the health and wellness of the people of the Monadnock Region, we provide information about our services and medical care, as well as local resources available to support wellness goals. This publication is intended to provide health information to our readers and should not be considered a substitute for consulting with a physician. Cheshire Medical Center has served the communities of the Monadnock Region with high-quality health care since 1892. A member of the Dartmouth-Hitchcock Health system, Cheshire is a nonprofit medical center providing a continuum of care spanning

Welcoming new families PERSONALIZED CARE. SUPPORTIVE ENVIRONMENT.

primary care and specialty medicine, to surgical services and acute inpatient care, comprehensive cancer treatment, and inpatient physical rehabilitation. The educational programs listed in Health + Wellness magazine are developed and coordinated through the

Cheshire Medical Center is a nurse midwife-led practice supported by Dartmouth-Hitchcock Health OB-GYNs, offering individual prenatal care or our CenteringPregnancy® group program. Our birthing options minimize

Center for Population Health.

unnecessary intervention and include trained doulas offering personalized support to expectant mothers and their families.

and wellness education, outreach,

In addition to the medical care available here at Cheshire, our physicians have real-time access to neonatologists at the Children’s Hospital at Dartmouth (CHaD) via our Connected Care TeleICN (intensive care nursery) consoles if your baby needs extra support.

Monadnock Public Health Network and

Read more about Cheshire’s obstetrics and birthing services on page 14.

Health + Wellness magazine, visit:

The Center for Population Health (CPH) is a department of Cheshire Medical Center focused on health and support to individuals, families, worksites, schools, and the community. CPH provides staff for the Greater support for the Healthy Monadnock community. To sign up to receive Healthier Together, a monthly e-bulletin, and view previous issues of health-wellness.cheshiremed.org.

Now accepting new patients. To schedule an appointment, call 603-354-6640.

FROM THE CHESHIRE MEDICAL CENTER CEO/PRESIDENT/CHIEF MEDICAL OFFICER

Inside: Pages 4-15 SPECIAL WOMEN’S HEALTH FEATURE

Stay healthy and well during each of life’s phases through proactive partnership with your healthcare providers.

Investing in quality services As a non-profit organization, Cheshire Medical

Pages 16-21

Center continues to advance in new and different ways in order to provide the highest quality of care

LIVING HEALTHIER TOGETHER TIPS + TOOLS

to our diverse community members. The health and

Choosing the right carbs for diabetes, a recipe for spaghetti squash noodle bowl, safety tips for loved ones with Alzheimer’s, tips for brain health, and more.

wellness needs of our community evolve over time requiring an openness to change, self-reflection, and a commitment from our organization to financially invest in services that support the needs of residents in the Monadnock Region. Cheshire Medical Center has completed a strong

Pages 17

fiscal year that ended in June thanks to providers

HEALTHIER TOGETHER SPOTLIGHT

and staff focused on efficiency and process

Cheshire’s Youth Wellness Program is empowering schools.

improvements that provide thoughtful value-based care. An openness to changing the way we operate,

Pages 19

patient care, is at the center of our thriving fiscal

without hindering our high standard for quality status. A financially strong Cheshire Medical Center

PATENT-CENTERED CARE SPOTLIGHT

benefits the entire region and allows us to expand

Picture books connect kids, families, and pediatrics providers.

services that matter to everyone. I’m especially proud of the work being done within our Women’s Health team of certified nurse

Pages 22-26

midwives, obstetrician and gynecologists, and

HEALTH+WELLNESS EDUCATION PROGRAMS

we’re taking a deep look into better understanding

Upcoming classes and programs on a variety of health-related topics including: diabetes prevention, having difficult conversations, emergency preparedness, kids in the kitchen, and a special series on caring for aging loved ones.

the unique health needs of women and how our

women’s health nurse practitioners. In this issue

staff support our grandmothers, moms, sisters, nieces, and daughters-healthcare at every stage of a woman’s life. We are grateful to be serving a community that is invested in an innovative, welcoming, high-quality health and wellness organization like ours. Thank you for your continued support.

― Don Caruso, MD, MPH President and CEO/CMO, Cheshire Medical Center H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

From adolescence through the senior years, women have unique health needs and concerns.

Chief of Obstetrics at Cheshire Medical Center, Autumn Vergo, MSN, CNM, APRN, meets with a patient in Womenâ&#x20AC;&#x2122;s Health.

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SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life

he lives of women have changed dramatically in recent centuries. Average life expectancy for women has increased from about 50 years in the early 1900s to about 81 today. Women play a critical role in maintaining the health of their children, spouses, aging parents, and even their communities. Yet, too often their varied responsibilities and focus on caregiving leaves their own healthcare needs neglected. It is important for women to take time to maintain their own good health and wellness. While men and women experience many of the same diseases, the symptoms and most effective treatments can be different. As she ages, a woman can also be at greater risk for a number of conditions such as heart disease, Alzheimer’s disease, osteoporosis, and depression. The best way to understand women’s health is to look at it as a continuum across her life. As women grow older, their health needs change and require specialized care for their physical and mental well being. At Cheshire Medical Center, the Women’s Health team of certified nurse midwives (CNMs), obstetrician and gynecologists (OB/GYNs), and women’s health nurse practitioners (WHNPs) work in collaboration with specialists at Cheshire, and other members of the Dartmouth-Hitchcock Health system, to provide compassionate, high-quality care throughout all the phases of our patients’ lives. Health+Wellness magazine recently spoke with Autumn Vergo, MSN, CNM, APRN, Chief of Obstetrics at Cheshire Medical Center, to learn more about Women’s Health at Cheshire. Here is her personal perspective on the delivery of care in the women’s health practice. How would you describe the philosophy of care in Women’s Health at Cheshire?

We are a collaborative practice of OB/GYN physicians, nurse practitioners, and certified nurse midwives working together as a team, caring for all women in our community—all ages, all walks of life, and all health concerns. We’re people who live locally and are dedicated to giving back to the community.

Proactive partnership with your healthcare providers can support a longer and healthier life. H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

The role of Section Chief in a healthcare environment is most commonly held by a physician. How does being a certified nurse midwife (CNM) affect your views and leadership in Women’s Health?

Collaboration is at the center of practice for nurse practitioners (NPs). As a certified nurse midwife (CNM), my training is really focused on how to be a good communicator with the rest of the healthcare team. While NPs and CNMs are independent providers caring for patients, we function best as a part of a healthcare team that includes physicians and other specialists. The perspective this brings to my leadership is an emphasis on how we can work together, including across specialties, to establish optimal plans of care for our patients. We take a team approach, collaborate, and include all of the stakeholders who need to be involved. We often hear the term “collaborative care” when discussing healthcare teams. What exactly does it mean to Women’s Health?

How are women’s health issues different from men’s?

It is true that health recommendations and diseases are sometimes different based on a patient’s gender and there are differences emphasized in national guidelines for routine health screenings. Here in Women’s Health at Cheshire, instead of focusing on men’s vs women’s needs, we are taking the science into account while focusing on individualized care for every patient we see.

Women’s Health at Cheshire Medical Center “We are a collaborative practice of OB/GYN physicians, nurse practitioners, and certified nurse midwives working together as a team, caring for all women in our community—

Speaking of the role of gender in healthcare, the cultural landscape for transgender people has become significantly more accepting. Yet, transgender people continue to face stigma, discrimination, and lack of access to quality healthcare. Does the Women’s Health team support the healthcare needs of transgender individuals?

I can’t say strongly enough that all patients that need our services are welcome here. Our support of the needs of transgender and gender nonconforming people begins with our fundamental belief in individualized care and includes our access to highly specialized services. Our providers and support staff are receiving ongoing training on how to best meet the healthcare needs of this patient population. There are a lot of details we need to take on, such as using language and forms that are inclusive of the experiences of transgender people. Our work to improve the delivery of care for these patients is ongoing.

There are two types of providers all ages, all walks of life, and caring for our patients in Women’s all health concerns. We’re Health at Cheshire, advanced practice nurses (APRNs) and physicians. The people who live locally and are APRNs are nurse practitioners (NPs) dedicated to giving back to the and certified nurse midwives (CNMs) and they generally see patients for their community.” routine care. NPs and CNMs focus on helping patients stay healthy and to -Autumn Vergo, MSN, CNM, APRN, reach their health goals through wellness Chief of Obstetrics at Cheshire Medical Center enhancing activities and providing health education. Importantly, they have the At what age should women engage the specialized care time to concentrate on these topics during routine visits. provided in Women’s Health? Our practice also includes a group of physicians who are experts I think this is a little different for every patient. We do see in the treatment of gynecological conditions. They are surgeons and younger girls and adolescents as needed. We’re fortunate to work they provide treatment for people who are experiencing problems or closely with the pediatric group here at Cheshire. If a patient’s complex, chronic issues and need a specialist level of care. needs overlap between services in Women’s Health and family Patients see both types of providers in our practice as needed. medicine and pediatrics, we have direct communication with those We all talk to each other and get to know our patients well. We providers. While many primary care providers manage things like collaborate in plans of care that take into account what patients need sexual health and birth control with their patients, that is often an to treat disease and problems, and to enhance their wellness. This is entry point for patients into the Women’s Health practice. what we mean by “collaborative practice” in Women’s Health.

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SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life How does Cheshire’s membership in the Dartmouth-Hitchcock Health system benefit Women’s Health patients?

The partnership provides our team and our patients with access to colleagues offering highly specialized care at Dartmouth-Hitchcock Medical Center. Telemedicine through DartmouthHitchcock Health system’s Connected Care has greatly enhanced the services and care we provide to our patients. Our patients can meet with a specialist, located elsewhere in the system, from an exam room here in our practice through the telehealth video conference screen. This innovation provides our patients local access to services like genetic counseling, maternal fetal medicine, and care for gestational diabetes. Another example is tele-neonatology in our labor and delivery unit. We don’t have a NICU (neonatal intensive care unit) at Cheshire, but we do have immediate access to the neonatology team at Children’s Hospital at Dartmouth (CHaD). Through the Connected Care system, the CHaD team can assess a baby with us in real time—they can see the baby, view monitors, and speak directly with our team to determine if the baby needs to be transferred for a higher level of care. In addition to telemedicine, our patients benefit from specialist outreach. Johnathan Shaw, MD, Urogynecologist at Dartmouth-Hitchcock Medical Center, regularly schedules patient visits in our practice and performs surgeries here at Cheshire, allowing patients to receive this highly specialized care close to home. It gives us the best of both worlds. We get to live in this lovely community, and through our membership in DartmouthHitchcock Health, have access to specialist services that otherwise couldn’t be offered in a medical center of our size.

Taking active care of your health throughout your life Every woman is unique, and her healthcare needs are equally distinct and deserve personalized care. As our bodies change throughout the stages of our lives, the changes can sometimes be overwhelming and may come with complications. It’s important for women to have support and education from providers who specialize in their needs as they navigate the phases of life.

Preteen - Adolescence Entering adulthood can be tough. It’s important for young women to become aware of their physical and emotional health as they navigate issues such as menstruation, pelvic pain, healthy weight, acne, sexuality, drugs and smoking, and emotional ups and downs. Most girls start their period in their early teens, this is a good time to start regular appointments and develop relationships with the providers in Women’s Health. Our providers take the time to get to know patients and their families. They provide education and consultation appropriate to the developmental stage of teens, in an environment that respects and values patient privacy. While it is less common for children to receive gynecologic care, health issues can arise that require a child’s care team to flex to include pediatric gynecology and urology. The providers in Women’s Health at Cheshire, and at the Children’s Hospital at Dartmouth-Hitchcock, work in partnership with your child’s primary care provider for seamless care when they need it. Making the most of your healthcare visits Understanding and trust are important to your healthcare provider. Don’t hesitate to ask questions and share your concerns. Your provider may recommend these tests and immunizations:

Consider talking to your provider about:

• Immunization to prevent cervical cancer

• Acne

• Immunization to prevent genital warts (HPV) starting between 9 and 14

• Pelvic pain

• Chlamydia testing once sexually active

• Irregularities, or problems with menstrual periods • Weight and body image • Sex and sexuality • Gender identity • Birth control • STIs • Alcohol, drugs, smoking

and

• Emotional ups and downs

H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Age 20 - 34

Into adulthood, the choices and concerns women generally face become more complex. Issues like getting pregnant—or not —and finding the right birth control are important factors for a woman. But there are less obvious health concerns at this stage of a woman’s life as well. The team in Women’s Health empowers women with awareness and education to help them take charge of their health, and partner with women to address health issues and problems. Whether or not you are planning to have a baby, these are important years in a woman’s health. Practicing habits that support your health and wellness, combined with regular healthcare visits at this stage of life, will set the foundation for your health in the decades to come. Studies in recent years have revealed that your 20s are actually the most stressful time in your life. It’s no wonder. Many women in their 20s are rumbling with major life decisions, from education and career to relationships and family planning. To complicate things even further, women’s bodies are continually changing. For most women, metabolism peaks in their 20s. Your metabolism is basically the number of calories you burn in a day

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just by being. And, what goes up, must come down. Which means women in their later 20s will start to see changes in their bodies, such as more curves and weight gain. Your 20s is also when your reproductive system is at its peak, causing increased cramps and discomfort during periods. And while Americans on average experience sex for the first time at about age 17, the average age when women marry for the first time is currently 27. Taking control of family planning and finding the right birth control to suit your lifestyle and health needs is an important conversation to have with your women’s health provider. It is highly recommended that women in their 20s begin the regular practice of looking for any changes in their breasts. Providers can teach women how to properly perform monthly breast self-exams. Women with a family history of breast cancer should discuss it with their provider to determine if earlier and additional screenings are recommended (see page 10 for more information about breast care at Cheshire). For many women, the 30s, also known as “the prime of life”, is a juggling act. Ask a woman in her 30s to list her top three priorities

SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life

and it is highly unlikely that her personal health and wellness will make that list. However, taking care of yourself will help you to take care of all of the other responsibilities in this busy time of life. It is important to maintain regular exams and preventive screenings, and to talk with your provider about changes in your lifestyle and your health. Discuss changes in your mood and be aware of your mental health. Many women will suffer from depression or anxiety at some point in their lives—these conditions can be successfully treated. Although you can’t see it, bone loss begins in your 30s. Preventing bone loss will protect you from injuries later in life. As we age, we begin to lose muscle mass and tone, our metabolism is continuing to decline, and the risk for chronic health problems increases. But it’s not all bad news. Many of these issues can be addressed with healthy diet, physical activity, and treatment. And while a woman’s reproductive peak is in her 20s, the birth rate among women in their 30s is now higher than the birth rate among women in their 20s. Cheshire’s Women’s Health team offers expecting mothers personalized care in a supportive environment. (See pages 14-15 to learn more about prenatal care and birth at Cheshire). Making the most of your healthcare visits Understanding and trust are important to your healthcare provider. Don’t hesitate to ask questions and share your concerns. Your provider may recommend these tests, screenings, and immunizations:

Consider talking to your provider about:

• Cervical cancer screening: Pap test every 3-5 years depending on risks • STI screening: every year if you’re under 25, or as needed • Pelvic & breast exam: every year • Blood pressure screening: every 2 years • Breast self-exam: monthly • Clinical breast exam: every 3 years • HPV vaccine: if you’re under 26 and haven’t received it yet • Tdap vaccine booster: every 10 years • Varicella vaccine: 2 doses if born after 1980 or never had chicken pox • HIV testing at least once, perhaps annually depending on your risks

• Preventing bone loss • How to practice breast selfawareness at home • Cramps, irregularities, or problems with menstrual periods • Pelvic pain or pain during sex • Sexual health and sexuality • Birth control • STIs

A commitment to high-quality care with dignity and respect for every patient, regardless of their gender identification Transgender individuals frequently experience discrimination and rejection. A lack of awareness, knowledge, and sensitivity in healthcare settings can lead to underutilization of healthcare resources, creating disparities in health outcomes for these individuals. Like every other patient population, the healthcare needs of people who are gender nonconforming are as unique as the individuals themselves. Gender-affirming treatment or intervention is treatment addressing the strong disparity between the gender a person is born with and the gender with which that person identifies. Transgender people may seek any one of a number of gender-affirming interventions, including hormone therapy and surgery. Genderaffirming hormone therapy is the primary medical intervention sought by transgender people. These treatments allow a person to develop the secondary sex characteristics—the characteristics that present at puberty—such as facial hair and breast development, that are more aligned with their gender identity. Depending on a patient’s individual care plan, Cheshire’s Family Medicine teams and Women’s Health can provide some gender-affirming treatments. When more specialized services like endocrinology or surgery are needed, providers facilitate the specialist care, making treatment as seamless for patients as possible. Cheshire is working to provide personalized, patientcentered care in an environment that is welcoming and inclusive. This fall, Cheshire’s providers and support staff are beginning an ongoing training program to learn how to best meet the healthcare needs of transgender patients.

H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Early detection and coordinated treatment are key to the journey from a breast cancer diagnosis to thriving in life as a survivor For many women, doctors recommend monthly breast self-exams and yearly screening mammograms beginning at age 40. Women with a family history of breast cancer should begin screening mammograms 10 years before the earliest age that a family member was diagnosed. That said, ask your doctor what screening schedule is best for you. Scheduling regular screening mammograms is essential to early detection of breast changes. “It is important that women or men call their medical provider to evaluate any abnormal breast changes they discover. The provider will evaluate these breast findings—including the patient’s family history—and order the appropriate breast imaging,” said Kimberly Whitaker, RN, Cheshire Medical Center’s breast care coordinator. Recognized as a Breast Imaging Center of Excellence by the American College of Radiology, Cheshire offers 3D Mammography and other screenings that can identify abnormalities that are too small to find by breast exam alone. This is when breast cancer treatment is most effective. Cheshire’s radiologists are part of the team that includes surgeons, oncologists, pathologists and medical and rehabilitation providers. Cheshire’s Breast Care Center, which is accredited by the National Accreditation Program for Breast Centers, provides individualized treatment to meet the needs of each patient. The breast care coordinator is often the first point of contact for a patient with a breast concern. “I assist patients navigating the breast care process, which is often a stressful time. This often begins with updating them about concerning mammogram results, then making a plan together for additional imaging and procedures,” Whitaker said. “I provide patients with information and recourses, address barriers to care like lack of transportation, financial insecurity, and needing language interpretation to ensure the best care. Our team treats the whole person throughout the process.”

Age 35 - 44

Being proactive about health and wellness is increasingly important during these years-presenting a challenge for most women because the juggling act we started in our late 20s and early 30s is as demanding as ever. At this stage, your risk of heart disease, diabetes, high blood pressure, and breast cancer starts to increase. Making time to take care of your health is a smart investment in your future. While women are still having babies or raising young children at these ages, its hard to imagine that a woman’s body is beginning to prepare for menopause (your body’s last period). This stage leading up to menopause is called “perimenopause” and it can start in your 40s and continue for several years. A woman is still having periods over this time, but they become more irregular. While the severity of perimenopause symptoms vary by individual and may increase over time, they typically include hot flashes, weight gain, lower sex drive, and trouble sleeping. What you may not realize is that this hormonal change can also lead to high blood pressure and heart disease, and anxiety and depression. It’s important to talk to your provider about changes in your menstrual cycle, your sexual health, and your health in general. Pelvic pain is fairly common in women of reproductive age and can increase up until menopause. There are a variety of causes for pelvic pain, some as simple as menstrual cramps and ovulation. If pain persists or increases, it’s important to tell your provider because some causes of pelvic pain require medical intervention. Prioritizing sleep, stress-reduction, healthy eating, and exercise will help prevent disease in older years and combat the loss of bone density and muscle tone that starts occurring in mid-life. Making the most of your healthcare visits Understanding and trust are important to your healthcare provider. Don’t hesitate to ask questions and share your concerns. Your provider may recommend these tests, screenings, and immunizations:

Consider talking to your provider about:

• Thyroid function: test once at 35, then ask your doctor

• Pelvic pain

• Cholesterol blood panel: every 5 years; annually if yours is high

• Self-care

• Diabetes screening (A1c test): at 35, or at doctor’s suggestion

• Preventing bone loss

• Blood pressure screening: every 2 years • Cervical cancer screening: Pap test every 3 years depending on risks • Breast self-exam: monthly • Pelvic & breast exams: every year • Mammogram in early 40s • Tdap vaccine booster: every 10 years • STI and HIV Screenings: as needed

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• Sexual health and sexuality • Maintaining a healthy weight

SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life Age 45 - 54

Often referred to as the “Sandwich Generation”, many women in this life phase are caregivers for aging parents and children-and facing real challenges to prioritizing personal health and wellness. Meanwhile, the risks for colon and breast cancers are increasing, as well as heart disease and stroke. The likelihood of developing conditions such as osteoporosis increase too. Self care and regular preventive screenings become even more vital. The hormonal changes that began in the previous years may increase and require treatment. Symptoms of perimenopause and post menopause that interrupt your sleep and cause extra weight gain may put you at higher risk for chronic disease. Amidst all of the hormonal turmoil women are experiencing during these years, they may also experience pelvic disorders and the embarrassment of incontinence and vaginal dryness. The good news is, your team in Women’s Health at Cheshire work in partnership with specialists and can treat these conditions togerther. Sharing your symptoms and giving input are a critical part of this care. But symptoms of developing conditions can be subtle and difficult to recall between visits. A health journal is a great way to track changes in your health. Keeping a notepad to jot down changes or symptoms you experience and questions or concerns you have will help maximize your time with your provider. Consider tracking your physical activity and time you dedicate for your own wellness to see if changes are needed in your routine. The better your health, the better you can care for the ones you love—now, and in the years to come.

Making the most of your healthcare visits Understanding and trust are important to your healthcare provider. Don’t hesitate to ask questions and share your concerns. Your provider may recommended these tests, screenings, and immunizations: • Cholesterol blood panel: every 2 years, starting at 45 • Colonoscopy: initial screening at 50; discuss followups with your doctor • Hepatitis C screening: one test, follow-ups if necessary • Cholesterol blood panel: every 5 years or every year if yours is high • Cervical cancer screening: Pap test every 3 - 5 years • Blood pressure screening: every 2 years • Pelvic & breast exams: every year • Breast self-exam: monthly • Mammogram: every year depending on risk • Tdap vaccine booster: every 10 years • STI & HIV screening: as needed Consider talking to your provider about: • Menopause • Self care • Sexual health and vaginal dryness • Share pregnancy history with your doctors to monitor for future medical conditions • Osteoporosis and whether you need a bone-density exam • Your risks for colon and breast cancers • Pelvic floor disorders and incontinence • Possible symptoms of memory loss

Learn about free breast and cervical screenings for underinsured women in New Hampshire New Hampshire’s Let No Woman Be Overlooked program provides free breast and cervical cancer screenings to women age 21-64 who are uninsured, or underinsured and meet some eligibility guidelines.

Call (800) 852-3345 for more information.

H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Age 55 - 64

Taking care of yourself through menopause and beyond Menopause is defined as having no menstrual period for one year. A woman past a certain age will experience menopause as a natural part of her life cycle. It’s when estrogen and progesterone levels decrease causing a decline in ovary function. The majority of women stop having periods somewhere between ages 45 to 55. Following menopause, your risk for certain conditions like osteoporosis or cardiovascular disease may increase. The decline in estrogen production can affect the amount of calcium in your bones, causing significant decreases in bone density and leading to osteoporosis. Many women experience accelerated bone loss the first few years after their last menstrual period. Your provider can advise you on daily habits that can help keep your bones healthy and may recommend prescription medication. About 75 percent of women experience hot flashes during menopause, making them the most common symptom. The rush of heat may cause sweating, heart palpitations, and feelings of dizziness. Some women may also experience muscle and joint pain, sleep problems, or mood swings. The symptoms of menopause vary from one woman to another, even in the same families. Hormone therapies are available for treatment of hot flashes and prevention of bone loss. However, depending on your symptoms and your health, these therapies may not be right for you. Talk to your provider before trying any hormone therapies. Check in with your provider during regular gynecological exams as you go through menopause, and contact your provider if you experience or notice anything unusual that might require a closer look. Your provider can help you understand your symptoms and find ways to manage them that work with your lifestyle.

Hello “baby boomers”. Life hasn’t necessarily slowed down for you, but whether you can feel it or not, your body has. Your body just isn't as resilient as it used to be. If you’ve been active all your life, your bones, joints, and muscles have likely stayed in pretty good shape. If you haven’t, then these are the years to seriously take stock of your lifestyle habits and make some changes. Without regular exercise, the loss of muscle over time contributes to drops in metabolism and weight gain because muscle burns more calories than fat. The loss of muscle tissue occurs naturally and slowly, but accelerates over time. Muscle loss is one of the greatest contributors to overall functional decline in older adults. This isn’t about 6-pack abs and weight lifting. This is about fat burning and maintaining good posture. This is about reducing the risks of chronic diseases such as high blood pressure and diabetes. It isn’t too late to take control of your health. Small changes can have a big impact over time. Ask your provider which activities are appropriate for you, to help maintain your strength into the coming years. For all women, now is also the time to pay very close attention to building your bone strength, protecting your heart health, and being vigilant about possible memory loss and signs of depression. Make sure you talk with your provider about any incontinence you experience or pelvic discomfort. As with every stage in a woman’s life, regular preventive screenings are important to catching disease early, when treatment is most effective. Making the most of your healthcare visits Understanding and trust are important to your healthcare provider. Don’t hesitate to ask questions and share your concerns. Your provider may recommend these tests, screenings, and immunizations: • Shingles vaccine: once at age 60 • Blood pressure screening: every 2 years • Blood glucose screening: every 3 years • Cholesterol blood panel: every 5 years • Hepatitis C screening: one test, follow-ups if necessary • Breast self-exam: monthly • Pelvic & breast exams: every year • Blood pressure screening: every 2 years

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Consider talking to your provider about: • Osteoporosis: 1 in 2 women suffer osteoporosis-caused bone breaks • Heart disease: the leading cause of death of women in this age range • Weight gain after menopause • Pelvic floor disorders like incontinence and prolapse • Scheduling of mammograms, and screenings for depression and colon and cervical cancers

SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life

Age 65 and beyond

Warning signs for heart problems in women While your health risks and concerns have increased, with good health, this can be an exciting and eventful time in life. Today’s 65 and over population is considerably more active than in previous decades. You may be working, looking after grandchildren, going back to school, enjoying hobbies, or traveling. Keep that body moving and talk to your provider about preventing and reversing osteoporosis. Your provider may have indicated that you no longer need that pap smear, however, mammograms remain an important preventive screening. The American Cancer Society reports that over 40% of breast cancers occur in women over 65. The weakening of your pelvic floor muscles and supportive tissues may cause pelvic organ prolapse, which can lead to urinary incontinence. This common condition in women can be debilitating, uncomfortable, and emotionally stressful. Thankfully, these conditions can be repaired with specialist intervention through Women’s Health right here in Keene. During these years in particular, health and wellness should include ongoing communication with your healthcare teams. Watch out for serious health conditions such as heart disease, diabetes, arthritis, and memory deficits. Maintain regularly scheduled wellness appointments. In addition to informing your provider of any new symptoms or concerns, be sure your provider knows all of your medications and any changes in dosage. These can cause side effects. If you have questions or concerns between appointments, use the myD-H patient portal to send a message to your Dartmouth-Hitchcock Health system provider. Making the most of your healthcare visits

You can take steps to reduce your risk of heart problems by managing stress, eating right, limiting alcohol, exercising regularly, and not smoking. However, it is equally as important to know the signs of possible heart problems so you can have proactive conversations with your doctor. The majority of women over 65 have some form of heart disease, and it is the leading cause of death for women in this age group. Unfortunately, symptoms of heart problems can seem unrelated so they are sometimes disregarded. Most often symptoms coincide, come on with activity, and are relieved with rest. Talk to your doctor if you experience: heart palpitations, significant fatigue, swollen feet or ankles, shortness of breath with small amounts of activity, or unexplained aches or pains in your shoulder, jaw, throat, back, arms, or chest. Women’s symptoms during a heart attack can be more subtle than those experienced by men. They often include nausea, heart burn, vomiting, dizziness, shortness of breath, weakness, cold sweats, coughing, heart palpitations and pain in one or more areas listed above. Symptoms can be acute for up to half an hour, or mild over a few days. Don’t ignore a combination of these symptoms, call 911.

The benefits of colonoscopies Colon cancer can be a major concern for older women. There are a few types of colon screenings, but colonoscopies are beneficial for those under 75 because your doctor can remove pre-cancerous polyps found during this painless procedure.

Fall prevention

Understanding and trust are important to your healthcare provider. Don’t hesitate to ask questions and share your concerns. Your provider may recommend these tests, screenings, and immunizations: • Pneumonia vaccine: one dose of at 65, one dose a year later

For those over 75, fall prevention screenings can be helpful. Cheshire offers a screening and balance retraining program through Outpatient Rehabilitation that can significantly reduce your risk of accidental injury. Ask your provider if these screenings could be right for you.

• While some routine tests, such as mammograms and colonoscopies, can be stopped after age 75, your provider may advise continuing: Bone-density screening (every 2-3 years) Blood-pressure screening (every 2 years) Cholesterol blood panel (every 3-5 years) Consider talking to your provider about: • Preventing and reversing osteoporosis • Pelvic floor disorders like incontinence and prolapse • All your medications, and if they’re causing side effects • Any chronic or new symptoms you’re experiencing

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Personalized care delivered with peace of mind Cheshire’s collaborative care team of midwives and physicians provides expecting moms individualized care with minimal medical intervention, offered in a hospital setting.

Expecting mothers and their families have many decisions to make. From the seemingly simple questions like what foods to eat during pregnancy, to issues like if or when to return to work after the birth, there is a lot to consider. Friends and relatives offer anecdotes and advice and there are numerous books dedicated to telling pregnant women and their families what to expect. Wading through the information can be daunting, making the decisions around choice of healthcare provider and birth location particularly important. Having a team that understands your values and helps you stay well-informed may provide the experience you desire. Expecting mothers in the Monadnock Region are fortunate to have choices when it comes to prenatal care and delivery locations. The region is home to hospitals providing obstetrical care, midwife attended birth centers, and home births. In contrast, a number of rural hospitals in neighboring regions are no longer providing obstetrical care or labor and delivery, creating a gap in services for women living in those areas. The Women’s Health team at Cheshire is working to help close that gap in the surrounding area with a prenatal clinic at Valley Regional Hospital in Claremont, NH. Cheshire’s midwives travel to Claremont weekly to provide prenatal and postpartum care to local patients. Even though Valley Regional no longer provides delivery services, families in that community can still receive their prenatal and postpartum care where they live. The midwife-led prenatal care and labor and delivery services of Women’s Health at Cheshire Medical Center provide individualized care that can flex to meet your needs. From volunteer doula services to highly specialized care through membership in the Dartmouth-Hitchcock Health system, the Women’s Health team at Cheshire is empowering expecting mothers and their families during this life-changing experience.

Prenatal Care Prenatal care is the healthcare received during pregnancy. Getting early and regular prenatal care is key to a healthy pregnancy for both a mother and her baby. Cheshire Medical Center offers expecting mothers and their families the choice between a group model of care that develops community, individual prenatal screenings and appointments, or a combination of both. The goal is to provide the care that is right for each individual family. Centering Pregnancy is a model of prenatal care put forth by the Centering Health Institute. It’s prenatal care bringing women and families due at approximately the same time together in a group setting. Published studies on Centering Pregnancy (Centering) indicate that families who go through Centering for prenatal care are less at risk for pre-term delivery and low birth weight babies. Participants in Centering benefit from the social support the women and families provide to each other. It’s also a way to receive a great deal of education and time with your provider during your pregnancy in a dynamic environment of discussion and feedback. The individual prenatal care seen in most other healthcare settings is an option for women receiving their prenatal care at Cheshire. Patients may also choose to have both types of prenatal care, participating in Centering Pregnancy and having individual prenatal appointments with providers. This is especially helpful for families who are experiencing a pregnancy that is medically complicated. They can participate and benefit from the Centering program and receive individual specialized care.

“We emphasize babies going right to their mothers during delivery. We do everything reasonable and safe to not interfere with the first few minutes of bonding with mom.” -Linda Glasschroeder, BSN, RNC-OB, CBC, Director of OB/GYN Services at Cheshire Medical Center

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SPECIAL WOMEN’S HEALTH FEATURE

Healthy and well at each phase of life

Labor and Delivery

Postparnum and Lactation Support

Labor and delivering a baby are a unique experiences for every mother. What types of support you require or want are driven by your personal health, the health of your baby, and if this isn’t your first pregnancy, the experiences of previous births. Cheshire Medical Center offers services that meet the needs of most birthing mothers and their families. The philosophy of care provided during labor and delivery is heavily influenced by the collaborative model between midwives and obstetrician physicians. “This collaboration provides women that holistic touch while still having the ability to provide medical interventions if needed,” explains Linda Glasschroeder, BSN, RNC-OB, CBC, Director of OB/GYN Services at Cheshire Medical Center. The team prioritizes immediate skin-to-skin contact for mothers and babies, and will delay non-urgent procedures for an hour or more to give mothers, babies, and family time to bond. All expecting mothers are asked to complete a birth plan which is printed at the time of delivery and distributed to nursing staff so that the entire team is aware of your preferences. Patients may choose options such as hydrotherapy during labor or epidural. One of the most unique options laboring mothers and families enjoy is the presence of a volunteer doula. The Cheshire Doulas are trained professionals who, at the request of a woman in labor, provide non-medical support to birthing women and their families. (Go to cheshiremed.org to learn more about the Cheshire Doula Program featured in the Winter 2018 issue of Health+Wellness magazine.) Sometimes, the need for medical intervention is necessary. While the cesarean section rate in New Hampshire is 31% according to CDC data, Cheshire’s c-section rate is only 22.6%. Glasschroeder attributes Cheshire’s low rate to the midwifery model and the collaborative care with physicians, the volunteer doula program, and the 1:1 nursing care during labor. Even after a c-section birth, the team will initiate skin-to-skin for mother and baby in the moments immediately after birth whenever possible. “It’s a personalized experience. While we work hard to honor your wishes, safety is always our top priority,” says Glasschroeder.

The transition to home and the weeks following are a very important time in the health of both you and baby. Some families may find settling in to be an emotional and challenging time. While it seems like breastfeeding should be instinctive and one of the most natural things, it is a skill that both mother and baby have to learn and master. The learning curve of breastfeeding usually takes about 4-6 weeks. Cheshire’s Certified Lactation Counselors are available 7-days-aweek to support moms and babies throughout breastfeeding. Having your first baby can be an isolating time for moms. Cheshire’s Certified Lactation Counselors host a weekly Mom’s Club, where mothers and their babies gather for connection and education. Sometimes, social connection isn’t enough. Postpartum depression is a complication in childbirth for 1 in 8 women. It’s caused by her body’s drop in hormone levels after childbirth, leading to chemical changes in the brain which may cause mood swings. Sleep deprivation can compound these symptoms. While postpartum depression isn’t a result of something a mother does or does not do, many women struggle with acknowledging their symptoms and getting help. “Postpartum depression is a real thing. I think people feel they can’t talk about it because they think, ‘I have this healthy baby and I should be grateful’, so they’re not always forthcoming with those feeling of depression or anxiety,” says Glasschroeder. Some moms experience postpartum anxiety, which Glasschroeder describes as more prevalent than depression and is when moms are extremely anxious about leaving their babies or are consumed with worries that harm will come their baby. These complications are generally temporary and manageable with support and intervention. Cheshire uses depression and anxiety screening tools which are administered at key times during and after pregnancy: before labor and delivery, before discharge, and again at the first postpartum visit. For women dealing with challenges such as postpartum depression or anxiety, or other behavioral health concerns such as postpartum post-traumatic stress disorder, Clinical Psychologist Amanda Hitchings, PsyD, is available to support women and their families, partnering with providers to establish plans of care that meet their needs.

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Health + Wellness livi n g h ealth i e r to g e th e r

Emotional and mental wellbeing

Having civil conversations about difficult topics On social media, in newspapers, on cable news, it’s easy to see that we’re living in times of conflict. In our own neighborhoods, workplaces, and families, we may see bitter divisions over politics, religion, and economics. So how do we build communities and relationships rooted in compassion and fairness, when it can be so hard to talk to each other about important things? Dottie Morris, Associate Vice President of Institutional Equity and Diversity at Keene State College, has spent much of her career helping people learn how to have these dialogues across conflicting worldviews. “It’s difficult to talk about these things... because we don’t talk about them — and the more we don’t talk about them, the more difficult they will be,” Morris recently told the Keene Sentinel. But Morris knows that when people begin to understand the factors behind complex, anxiety-producing dialogues, they become less frightening and more possible.

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At the same time, as Morris teaches in workshops and classes, people can learn strategies to create environments where the dialogues can more easily happen. This understanding and these practical skills are critical for repairing communities that have been damaged by conflict, as well as building strong neighborhoods, workplaces, and more where compassion, mutual respect, and equity are the norm. As Morris noted in her 2017 TEDxKeene talk, “We’re at a tipping point in our culture where more of us have to take the courage to engage in this type of understanding of one another, of being able to reach out to one another, and feel as though we can create a world where we can embrace each other’s diversity.” Join Dottie Morris, PhD, for her inspiring workshop, “So You Want to Have a Difficult Dialogue: More Complex than Rocket Science?” on Tuesday, October 22. See page 23 for details. Also, on Saturday, October 19, join in on the fun and eye-opening discussion in “Diversity and Cultural Competence,” an interactive workshop that will give you tools to better navigate our diverse world. See page 22 for details.

H EALTH I E R TO G E TH E R

Kn o w t h e sym pto m s o f

CO N C U S S I O N S Playing contact sports increases the risk of concussion, but this form of traumatic brain injury can also happen during normal play. Wear helmets whenever you are playing games or sports that carry a risk for concussion.

Spotlight

Empowering schools with tools to build a culture of wellness.

Jeannine LeClair of Monadnock Regional High School with Sara Pelkey, Coordinator of the Youth Wellness Program.

Local schools get a boost from the Youth Wellness Program

Call your Pediatrician or visit Cheshire’s Walk-In Care Clinic if you or your child has any of these symptoms after a fall or bump to the head. Symptoms can appear hours or

When a local school reaches out to Sara Pelkey, Coordinator of the Youth Wellness Program at the Center for Population Health at Cheshire Medical Center, they already have their students’ health, well being, and lifelong success in mind. What they might be missing are the resources, connection to community partners, and support to make their school wellness ambitions real.

days later.

That’s where the Youth Wellness Program comes in.

· · · · · · · · ·

headache that lasts or gets worse vision problems or light sensitivity dizziness, balance problems, or trouble walking confusion and saying things that don’t make sense slow to answer questions or slurred speech nausea or vomiting not remembering events before or after the injury not feeling well, crankiness or excessive crying trouble sleeping, focusing, or regulating moods

Go to the Emergency Room with severe symptoms:

· · · ·

severe headache, that may get worse seizure unconsciousness, passing out continued vomiting

Learn more about how to recognize, respond to, and minimize the risk of concussion or other serious brain injury at cdc.gov/headsup.

“When a school connects with us, I first do a “healthy schools assessment” with them, using a tool developed by the Centers for Disease Control,” Pelkey explains. “We figure out what their baseline of school wellness is, where they’re strong, and where they could use some help. Then we develop the supports that are right for their school’s community.” In the 2018-2019 school year, Youth Wellness worked in about 31 schools, supporting nearly 7,000 students. That support has included providing ongoing support in programs, youth coalition development and overall prevention tools. Some schools have implemented programs to help prevent youth suicide. Others have sought guidance on developing school wellness policies, or help reestablishing dormant Wellness Committees. Sometimes that support is about making community connections, such as connecting schools with local guest speakers who introduce elementary students to new fruits and vegetables. Pelkey doesn’t provide direct program services. Rather, she empowers leadership, teachers, and students with tools to build a culture of wellness that will serve their school’s needs. “The highlight for me is seeing the schools using these tools to do the work to make their community better,” says Pelkey. “They are really the champions.” Would you like to learn more about how Youth Wellness supports schools? Contact Sara Pelkey at (603) 354-5454 x2321 or spelkey@Cheshire-Med.com.

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Health + Wellness livi n g h ealth i e r to g e th e r

Healthy eating

Spaghetti Squash “Ramen” Noodle Bowl SE RVES 4 2 tsp toasted sesame oil 1 tbsp soy sauce (reduced-sodium) 4 cups low sodium chicken broth (fat-free) 1 medium spaghetti squash (2½ lb) 2 cups cooked chicken (shredded) 1 tsp Asian style hot sauce 1 tsp fish sauce ½ cup green onion/scallion (thinly sliced, white and green parts) ½ cup red bell pepper strips (thinly sliced, 1-inch long)

Choosing the right carbs to manage diabetes A diabetes diagnosis often comes with confusion about what’s okay to eat and what’s not — particularly carbohydrates. Here are some tips from the American Diabetes Association to help you sort out which foods are best to support your health and well-being. LOOK FOR A BALANCED MIX OF PROTEIN, FAT, AND CARBS. Nutrition labels list the grams-per-serving of the most important macronutrients. If the number of total carbohydrates is much higher than protein or fat, you’re looking at a food that will affect your blood sugar negatively.

I N STRU CTI O N S 1. Preheat oven to 400° F. Fill a 9x13-inch glass or metal baking dish with 2 inches of water. Cut the ends off the spaghetti squash then cut in half lengthwise. Place the squash cut side down in the pan and bake for 40 minutes. Remove from oven and remove the squash immediately from the pan. Scoop out the seeds and discard. Using a fork, scrape the squash out of the skin and set aside. Makes 4 cups cooked squash. 2. While the squash is cooking, in a medium saucepan, heat the broth over medium heat until simmering. Add the soy sauce, sesame oil, fish sauce and hot sauce. Simmer for 2 minutes. Add the chicken and heat through, 2 minutes. 3. Place 1 cup of squash in a soup bowl. Pour 1 cup of broth over the squash and add 1/2 cup of chicken. Top with 2 tbsp scallions and 2 tbsp bell pepper strips. 4. Repeat process for remaining three bowls. Recipe from diabetesfoodhub.org. Photo credit: Peter Papoulakos

SEEK OUT FOODS WITH FIBER (THIS MEANS PLANTS). Fiber is, in fact, a carbohydrate that’s vital for healthy digestion. Most adults need between 25 and 30 grams of fiber a day—and it can only be found in plants. Beans, nuts, fruits and veggies (especially with skins, like apples), and whole grains are good sources of fiber. CHOOSE NON-STARCHY VEGGIES. These vegetables are full of vitamins, minerals, fiber, and phytochemicals—and few calories. Because they have little or no starch, they are low in carbohydrates that can affect insulin levels. Some common options are beets, salad greens, broccoli and cucumber. Learn the skills you need to control diabetes, and prevent or delay complications associated with it, at our FREE 4-week class, “Healthy Living with Diabetes.” Outpatient Registered Dietitian Ruth Goldstein MS, RD, LD, will cover such topics as diabetes management, healthy eating, activity, medications and stress management. See page 22 for details.

Learn more about carbohydrates at diabetes.org/nutrition/understanding-carbs.

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pati e nt - ce nte re d care

Spotlight

Picture books connect kids, families, and pediatrics providers When a family comes to Pediatrics for well-child visit, they tell the story of their child’s health—how they’re sleeping, how they’re eating, whether they’ve had the flu, how their behavior is developing. These are important stories. But sometimes they can be hard for families to tell. A doctor may be new to a family, or it may be challenging to remember all the details during the office visit. That’s one reason the Pediatrics’ Reach Out and Read (ROR) program is so important. In the program, pediatricians and nurse practitioners give a developmentally appropriate book to every child, ages 6 months to 5 years, at every well-child visit. Often, providers may read with the child during the visit. “ROR does help to put the children at ease and establish a rapport with the parents,” says Pediatrics provider Deborah R. Hansen, MD. “The parents and children love it. And it’s a nice opportunity for us to engage and interact with the child.”

In addition to strengthening the relationship between providers and families, ROR also helps promote early reading and literacy. Caregivers get practice and support in sharing books with their children. Providers can share observations about the child’s development as they interact with the story and pictures. Over time, children build a home library of books to share with family and friends.

If your child is due for a well-child visit, contact the Pediatrics Department at (603) 354-6666. ROR is a national organization with 6,200 program sites, distributing over 7 million books per year. Learn more at reachoutandread.org. If you or your organization would like to financially support the efforts of the Reach Out and Read program here at Cheshire, please contact Stephanie Ramsey, LPN at (603) 354-5454 x 3973.

Eati n g fo r th e h ealth &

joy o f

Maybe you have a chronic disease requiring a careful diet. Maybe you’re striving to manage your weight. Maybe you’d simply like to eat well and have fun doing it. Here are three tips to help you eat for health—and enjoy your food.

Dress up water with veggies and fruits. Adding fruits and veggies to water boosts flavor and gives you important nutrients. Try adding lemon or peeled cucumber slices to cool water. Or, for a fall-themed drink, simmer three sliced apples and six cinnamon sticks in a gallon of water, strain, and let cool.

Use vegetables for flavor. We’re used to salt, sugar, and cheese adding zing to meals. But vegetables pack a delicious punch, while providing more nutrients and fewer calories. Try sautéed onions and garlic, fresh ginger slivers, or grated carrot.

Make a plan to Savor a special food. Diets can make us feel deprived and resentful. You can counter this negative pattern by scheduling an occasional pleasure. Think of a dish that you love, set aside a particular time (maybe with a good friend), and bring a mindful approach to savoring a serving of it. Find more plant-rich, flavorful recipes for your table at diabetesfoodhub.org.

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Health + Wellness livi n g h ealth i e r to g e th e r

Healthy aging

Advocating for an ill or aging loved one An ill or aging loved one may need your help to navigate the medical system and community supports. AARP offers a few essentials for being an effective advocate: 1. OBSERVATION: You will be best able to advocate for a loved one if you are familiar with their health and symptoms, their moods and desires, and the care and treatment they are getting. 2. Organization: Medical care involves a good deal of financial, legal, and health-related information and paperwork. Keeping track of it all is important role when in the role of advocate.

Emotional and mental wellbeing

3. Communication: Ask questions to get all the information prior to decision-making. What does this diagnosis mean? What’s next? What are the potential side effects of treatment? Take notes, and convey the information to other members of the caregiving team.

Your brain is always changing. This process is called

If you believe that your loved one may become unable to make independent decisions, discuss their preferences with them, and have them grant you legal power of attorney so that you can carry out those wishes when they are no longer able to.

brain workouts

“brain plasticity”—as we experience the world, practice habits, and learn new information, our brains change, grow new connections and repair broken ones. As we age, our experiences and knowledge keep our brains working, developing and learning. People of all ages can benefit from activities that help keep your brain healthy to improve focus, memory, and overall mental sharpness. Try some of the following ways to “work out” your brain and boost it’s abilities. Learn some new dance moves – take local classes or online tutorials to get you thinking on your feet. Enjoy solving puzzles or play games with friends – whether its at the table or on screen, these activities are great ways to workout your brain.

Learn about navigating the medical system and community supports on Oct. 15 at “Strategies for Advocating for Your Loved Ones” with Jennifer McCalley, MSW, ACHP-SW, and Chris Selmer, R.N. See page 25 for details. Interested in learning more about powers of attorney? Join Sarah Frankel, Attorney at Law, Ward Legal Group, for “Legal Considerations When Managing Another’s Affairs” on Dec. 3. See page 25 for details.

Manage

Your Health Care with

Take up yoga, qigong or tai chi – move with purpose at the Keene YMCA or Senior Center.

Want easy access on your mobile device? After setting up your myD-H account online, download the free mobile app.

Apple® and Android™ MyChart App Download Guide

Learn a new language – there are apps and local conversation meetup groups for that.

NOTE: Register online at myD-H.org BEFORE you download the app.

Become more active in your community - join a community choral or theater group or volunteer at a favorite non-profit.

STEP 1: Download the free MyChart application from the iTunes App Store or Google Play Store (search for “Epic MyChart”). If using an iPad, toggle to the iPhone app on the top of the iTunes store.

Take a different route - drive or bike home a different way each week. Meditate – Brain health also benefits from the pause that refreshes. Try guided sessions at the local mindfulness or yoga centers and online. Learn more about keeping your brain healthy and well at brainhealth.nia.nih.gov.

STEP 2: Select the MyChart Application. STEP 3: Accept the Apple or Android License Agreement. STEP 4: Select New Hampshire or Vermont as provider location. STEP 5: Select Dartmouth-Hitchcock myD-H from the options of available health care providers. STEP 6: Log in using your myD-H account. Call 603-354-5454 x 2446 to set up a one on one session to learn how to get the most out of this useful tool. See page 22 for details.

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Safety and prevention

Home safety for your loved one with Alzheimer’s When a loved one lives with Alzheimer’s disease, home safety becomes increasingly important—and ever more complex. The Alzheimer’s Association recommends these safety tips: Evaluate your environment. Pay special attention to garages, work rooms, basements and outside areas where there are more likely to be tools, chemicals, cleaning supplies, and other items that may require removal or to be secured. Keep walkways well-lit and remove tripping hazards. Use night lights in hallways, bedrooms, and bathrooms. Keep floors and other surfaces clutter-free. Remove objects such as magazine racks, coffee tables, and floor lamps. Avoid safety hazards in the kitchen. Install a hidden gas valve or circuit breaker on the stove so a person with dementia cannot turn it on. Consider removing the knobs. Use appliances that have an auto shut-off feature and keep them away from water sources. Remove decorative fruits, sugar substitutes, and seasonings from the table and counters. Make sure safety devices are in working order and be prepared for emergencies. Have working fire extinguishers, smoke detectors, and carbon monoxide detectors. Keep a list of emergency contacts for local police and fire departments, hospitals and poison control helplines.

Remove and disable guns or other weapons. The presence of a weapon in the home of a person with dementia may lead to unexpected danger. Place medications in a locked drawer or cabinet. To help ensure that medications are taken safely, use a pill box organizer or keep a daily list and check off each medication as it is taken. Watch the temperature of water and food. It may be difficult for the person with dementia to tell the difference between hot and cold. Consider installing an automatic thermometer for water temperature. Avoid injury in the bathroom. Install walkin showers. Add grab bars to the shower or tub and at the edge of the vanity. Add textured stickers to slippery surfaces. Apply adhesives to keep throw rugs in place, or remove rugs completely.

Install locks out of sight. Place deadbolts either high or low on exterior doors to make it difficult for the person to wander out of the house. Keep an extra set of keys hidden near the door for easy access. Remove locks in bathrooms or bedrooms so the person cannot get locked inside.

Practical information about how to keep loved ones safe helps you build up your repertoire of prevention measures and emergency responses. “This sort of education allows care partners to add tools to their toolbox,” says Carrie Amorim Good, MSW, Volunteer and Community Engagement Specialist with the Alzheimer’s Association.“When care partners can connect the changes in the brain with necessary changes in one’s environment, they can assist in supporting loved ones to be as safe and independent as possible.” Join Carrie for a workshop where you can learn more about how to implement safety measures, ask questions, and connect with others who are caring for loved ones with dementia. You are invited to all three of the upcoming workshops with Carrie Amorim Good this Fall: “Safety and Memory Challenges” on October 10, “Dementia Conversations” on October 30, and “Effective Communication Strategies” on November 13. See pages 25 for details.

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Health + Wellness livi n g h ealth i e r to g e th e r

Upcoming Educational Programs The following is an excerpt listing from our Fall/Winter Program Guide. Designed to provide learning opportunities and supportive connections, these classes and programs are brought to you by the Center for Population Health at Cheshire

Medical Center and are part of the many ways we are working to advance the health and well being of the Region.

All programs are held at Cheshire Medical Center, 580 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 the Center for Population Health at (603) 354-5460.

Learn How to Navigate Cheshire Medical Center’s Patient Portal, myD-H Dana Carley, Patient Portal Concierge, Cheshire Medical Center myD-H is Cheshire Medical Center Dartmouth-Hitchcock’s online patient portal that makes managing your health information and communicating with your health care team easy and convenient. If you have questions about creating a myD-H account, or need assistance navigating your account, you can make an appointment with Dana Carley, the patient Portal Concierge at Cheshire. Call 603-354-5454 x 2446 to set up a one on one session to learn how to get the most out of this useful tool.

Flourishing Skills Group

Jennifer Begley and Tom Stearns, PhD., Cheshire Medical Center’s Resilient Living Team We could all use a little help reducing stress, building resilience, and cultivating joy to create more meaningful, happy lives. This monthly skills group will allow you tune inward and use Positive Psychology tools to improve your life in a nonjudgmental, supportive group setting. Each meeting will start with an overview of the month’s topic and tools like gratitude, mindset, and mindfulness, then group activities to build the supportive connections that will help you apply and sustain these skills and practices in your daily life. Think of it like a support group for happiness and wellbeing.

Healthy Living with Diabetes Class

Ruth Goldstein MS, RD, LD Outpatient Registered Dietitian Cheshire Medical Center Healthy Living with Diabetes is designed to teach you the skills you need to control your diabetes and prevent or delay complications associated with this disease. Each session consists of 4 classes. Topics include diabetes management, healthy eating, activity, medications, & coping with diabetes (stress management). Choose a 4-week session: Tuesdays, January 7–28 Tuesdays, March 10–31 All classes: 3:00-4:30 p.m. Team F /Centering Room

Diversity and Cultural Competence Dawn Welshman and Arnold Mikolo

What cultures do you belong to? Likely more than anyone could guess. How do your cultures frame your world view and experience, or those of others for that matter? This eyeopening, fun, and interactive workshop helps you examine your perceptions of both diversity and culture, giving you tools to better navigate our diverse world. Space is limited. Please register by October 15th. Saturday, October 19 10:00 a.m.-4:00 p.m. North Conference Room 1

First Tuesday of every month 5:15-6:30 p.m. Central Conference Room 6

You may have prediabetes or be at risk for developing type 2 diabetes if you: · Are overweight · Get little or no physical activity · Have someone in your family that has type 2 diabetes · Had diabetes while pregnant

HOSTED BY CHESHIRE MEDICAL CENTER AND THE KEENE FAMILY YMCA

The Cheshire Diabetes Prevention Program can help cut your risk of type 2 diabetes by more than half. Register for a year-long lifestyle change program where you will learn the necessary lifestyle skills and behaviors to prevent or delay type 2 diabetes. Participants meet in groups with a trained Lifestyle Coach for 16 weekly sessions, followed by monthly meetings.

Sessions begin November 5 or 6, 2019 | Registration for the program is $99.

Call (603) 354-6866 to talk with someone about signing up.

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So You Want to Have a Difficult Dialogue: More Complex than Rocket Science?!

Dottie Morris, Associate Vice President of Institutional Equity and Diversity, Keene State College Communicating across cultures and social identities can be a complex process within any community. It is important to have ways to identify, discuss and address these complexities in order to benefit from the wealth of experiences within a community. The main question we will address during this workshop is, “How do we create and maintain an environment rooted in compassion, mutual respect and equity where productive, growth producing, and rich dialogue can take place?” We will examine factors contributing to the complex nature of dialogue, especially when it comes to difficult and anxiety producing topics. We will also discuss strategies to help facilitate the creation of an environment where difficult dialogue can take place. Tuesday, October 22 6:00-8:00 p.m. North Conference Rooms 1 and 2

Honoring Care Decisions Trained Facilitator or Nicole Boudle, RN, and Lori Guyette, RN, Collaborative Care Nurses, Cheshire Medical Center

Assistive Hearing Technologies

Joan Marcoux, Communication Access Specialist, New Hampshire Dept. of Health and Human Services and Stacy Driscoll, Assistive Technology Specialist, Institute on Disability, University of New Hampshire The prevalence of hearing loss essentially doubles with each decade of age. As a result, nearly two of three Americans ages 70 and above have a clinically meaningful hearing loss, and yet only about 15 percent of people with a hearing loss in the United States use a hearing aid. At the same time, technology is continuing to advance rapidly, and newer devices, such as hearing loops in public spaces, personal amplified listening devices, and hearing applications built into smart phones, have tremendous potential to help people communicate better. Please come and learn more about both old and new technologies and resources for people with a hearing loss Thursday, October 24 3:00-4:30 p.m. North Conference Rooms 1 and 2

Advance Care Planning: It’s About the Conversation!

What if a sudden illness or injury left you unable to speak for yourself? Who would you want to speak for you? What would you want them to know about your values and wishes? Advance care planning is a process that helps any adult at any state of health think about your values and goals; consider health care choices you may have to make in the future; talk about your choices with your doctor and your loved ones; and make or update a written plan for the future (advance directive). Join us in a thought-provoking conversation to help make your wishes known. Make your voice heard and take control of your healthcare. You will have the opportunity to complete or update your advance directive if you are ready or sign up for a 1:1 meeting with a trained Honoring Care Decisions facilitator for a more in depth conversation. NOTE: Anyone who turns in a COPY of an advance directive for the medical record will be entered into a raffle. Two $50.00 gift cards will be awarded each month between now and the end of November. Choose a date: Wednesday, October 23 11:00 a.m.-12:30 p.m. Auditorium B Thursday, November 21 3:00-4:30 p.m. Auditorium B Thursday, December 12 11:00 a.m.-12:30 p.m. Auditorium B

H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Health + Wellness livi n g h ealth i e r to g e th e r

Personal Emergency Preparedness

Survivor Voices―Sharing the Story of Suicide Loss

Families or loved ones may not be together in an emergency, so it is important to plan in advance. Attend this highly interactive, two-hour workshop to learn how to be better prepared as an individual or family. Discussions will be on how to make a family plan, build an emergency kit and what items should be included, and the proper way to store it. The workshop will also cover items to keep in mind if the need changes from sheltering in place to evacuating.

NAMI New Hampshire is a grassroots organization working to improve the lives of all people affected by mental illness and suicide through support, education and advocacy. Through the sharing of their personal stories of losing a loved one to suicide, speakers promote healing and understanding, which in turn supports and encourages suicide prevention efforts. The speakers tell about the life and the death of their loved one, how they coped and continue to cope with the loss, and what has helped or not helped. The goals of this program are to raise awareness of the risk factors and warning signs for suicide; increase help-seeking behavior; reduce the stigma, shame, and isolation that loss survivors feel; and teach individuals and communities how to better help loss survivors and how best to respond to suicide death in a sensitive and informed manner.

Olivia Watson, Center for Population Health, Cheshire Medical Center

Thursday, October 24 6:00-8:00 p.m. North Conference Room 1

Deb Baird, National Alliance on Mental Illness (NAMI) NH and NH Survivors of Suicide Loss Speaker

Tuesday, November 12 6:00-7:00 p.m. Auditorium A and B

Kids in the Kitchen Holiday Cooking Class (Special) Keene State College Dietetic Interns

Come and celebrate the holiday season with KSC Dietetic Interns as they show you how to put a nutritious twist on all your favorite sweet and savory holiday treats! This handson cooking class is an event the whole family will enjoy. All participants will be able to sample the treats prepared and go home with recipes. Bring a reusable storage container if you would like to take home leftovers. Ages 6+; Limit: Six families per section; Please include your email address when you sign up. (Note: If there is a snow day on December 7th, the class will be rescheduled for December 14th.) Saturday, December 7 3:00 – 5:30 p.m. Keene State College, Joslin House Foods Lab

H e a lt h + W e l l n e s s  Fa l l / W i n t e r 2 0 1 9 - 2 0 2 0

2019

Caregivers’ Workshop Series

Monadnock Aging Resource Collaborative (MARC) is offering the following series of workshops for caregivers of aging loved ones. MARC is a group of local organizations working collectively to provide education and support to our region’s aging population and their families. Members include: Alzheimer’s Association (MA/NH Chapter), Bayada, Cheshire Medical Center, DH Honoring Care Decisions, Keene Family YMCA, Home Healthcare, Hospice and Community Services, KSC Cheshire Academy for Lifelong Learning, Keene Senior Center, Monadnock Collaborative/ServiceLink, and Monadnock Family Services.

Safety and Memory Challenges

Effective Communication Strategies

Dementia-related changes affect how to think about safety. This program teaches strategies to encourage a safe environment and lifestyle for those affected with memory challenges. This workshop is intended for family members/ care partners only.

Communication is more than just talking and listening―it’s also about sending and receiving messages through attitude, tone of voice, facial expressions and body language. As people with Alzheimer’s disease and other dementias progress in their journey and the ability to use words is lost, families need new ways to connect. Join us to explore how communication takes place when someone has Alzheimer’s, learn to decode the verbal and behavioral messages delivered by someone with dementia, and identify strategies to help you connect and communicate at each stage of the disease. This workshop is intended for family members/care partners only.

Carrie Amorim Good, Alzheimer’s Association, Massachusetts/New Hampshire Chapter

Thursday, October 10 2:00-4:00 p.m. North Conference Rooms 1 and 2

Strategies for Advocating for Your Loved Ones

Jennifer McCalley, MSW, ACHP-SW, Honoring Care Decisions and Chris Selmer, R.N., Monadnock Adult Day Care Jennifer McCalley and Chris Selmer will share their experiences supporting families and caregivers in the medical and community setting. They will share tips about what caregivers need to know to navigate the medical system and get community resources and support for their elders and themselves. There will be time for questions from the participants. Tuesday, October 15 11:00 a.m. - 12:30 p.m. North Conference Rooms 1 and 2

Dementia Conversations Carrie Amorim Good, Alzheimer’s Association, Massachusetts/New Hampshire Chapter When someone is showing signs of dementia, it’s time to talk. Often, conversations with family about changing behaviors can be challenging and uncomfortable. This program provides tips for breaking the ice with your family so you can address some of the most common issues that are difficult to discuss: going to the doctor for a diagnosis or medical treatment, deciding when to stop driving, and making legal and financial plans for future care. This workshop is intended for family members/ care partners only. Wednesday, October 30 1:00-3:00 p.m. Auditorium A and B

Wednesday, November 13 1:00-2:30 p.m. Auditorium A and B

Legal Considerations When Managing Another’s Affairs Sarah Frankel, Attorney at Law, Ward Legal Group Who makes the decisions when someone becomes unable to make his or her own? Attorney Sarah Frankel will discuss powers of attorney, healthcare directives, and guardianships. The presentation will also include other legal considerations when there is an incapacity and important things to know when acting as someone else’s agent. Estate planning tools such as revocable living trusts and wills will also be discussed. Tuesday, December 3 6:00-8:00 p.m. North Conference Rooms 1 and 2 SAVE THE DATE!

Keene Senior Center’s “50 and Better Expo”

Join us at this free event focused on informing older adults about the array of services and opportunities available to them in the Monadnock Region. Featuring vendors, workshops, and entertainment and socialization opportunities. Learn more at thekeeneseniorcenter.org. Saturday, October 26 8:30 a.m.-2:00 p.m. Keene Recreation Center, 350 Washington Street

H e a lt h + W e l l n e s s  c h e s h i r e m e d i c a l c e n t e r

Health + Wellness livi n g h ealth i e r to g e th e r

Below are some of the additional programs and support services offered to caregivers of aging loved ones by various members of the Monadnock Aging Resource Collaborative. HCS CARE TALKS and Support Groups

HCS Care Talks are held on the 4th Tuesday of each month from 4:00-5:00 p.m. at Home Healthcare Hospice & Community Services, Castle Center, 312 Marlboro Street, Keene. Please RSVP to Marianne, 603-352-2253 x4294. HCS CARE TALK: Legal Issues Facing Family Caregivers Susan R. Abert, Esq., CELA, Certified as an Elder Law Attorney by the National Elder Law Foundation This discussion will cover a range of legal concerns when planning ahead for a family member with chronic illness or incapacity. Whether you have started the process or need a jump start to begin planning, this workshop will focus on answering your questions. Tuesday, October 22, 4:00-5:00 p.m. HCS CARE TALK: Connecting and Compassionate Communication in Family Life; Some Basics Sue Ellen Sweeney, Life Mastery Consultant, Certified Transformational Life Coach, Grief Recovery Specialist Misunderstanding and unresolved hurt often leads to strained relationships in family life. How can we begin to communicate with our family members in a way that leads to more connection and harmony? Sue Ellen Sweeney, transformational life coach and life mastery consultant, will offer an inspirational and interactive workshop that will help you begin to transform your family relationships by learning to communicate with more honesty, respect and compassion. Tuesday, November 19, 4:00-5:00 p.m. HCS CAREGIVER SUPPORT GROUP Marguerite Cheney Ed.M, Bereavement Coordinator, Hospice at HCS. Feeling overwhelmed and alone? Drop in for support and information and connect with others who are caring for a loved one with Alzheimer’s disease or a related dementia. Exchange practical information on caregiving problems and possible solutions. Share different ways of adapting to the continuing stress of coping. Share concerns in a supportive environment. Registration not required. 1st & 3rd Wednesday of every month, 10:00-11:30 a.m. HOSPICE AT HCS: BEREAVEMENT SUPPORT GROUPS Marguerite Cheney Ed.M, Bereavement Coordinator, Hospice at HCS. These groups provide information and support around issues of grief and the loss of someone close to you. 2nd & 4th Tuesdays of every month, 10:30 a.m. -12:00 pm.

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BAYADA HOSPICE: We provide the highest end of life care so people with advance illness can remain at home with comfort, grace, and dignity. Our Bereavement program offers individual support to those dealing with grief and anticipatory grief, and for those who desire a better understanding of the end of life. Bereavement support groups offer companionship and understanding at a time that can otherwise be quite lonely. Being with others who have experienced a similar loss and are going through a similar process can bring ease to the grieving process. For dates on support groups in Keene, please contact: Supriya Shanti, LICSW, Bereavement Program Coordinator, 802.490.2099 or sshanti@bayada.com. Keene Family YMCA: At the Y, we strive to meet the needs of all members of the community. An important component of that is to provide care to the caregivers. We know being the full or part time caregiver to a loved one is critical, yet tiring, work. That is why we can be your partner in care for yourself and the people you are providing care for. Our facility offers many ways to relax―yoga and meditation classes, sauna, hot tub, 2 indoor pools, and an indoor track. We offer group exercises classes for people of every age and ability including Tai Chi for Better Balance, Arthritis Aquacise, and Senior Strength. There is something for everyone here at the Keene Family YMCA. Learn more at keeneymca.org. Keene State College’s Cheshire Academy for Lifelong Learning (CALL): The intent of CALL is to offer high-quality, non-credit courses, mainly Liberal Arts courses, to Adults aged 55 and over at a reasonable cost. Classes are led by members, community experts, and Keene State faculty. CALL classes are offered for eight weeks in the fall and eight weeks in the spring, with a four-week “mini-session” offered in January and February. All classes are held on Fridays. To learn more about the program and to sign up for the CALL newsletter go to keene.edu/call or call (603) 358-2290. Neighbors-In-Deed: Monadnock RSVP Volunteer Center’s Neighbors-In-Deed program provides personcentered independent living services to seniors age 65 and older, adults with disabilities, and veterans and military families so they can remain living in their homes as long as possible. Volunteers are matched one-to-one to provide ongoing companionship and non-medical assistance with daily activities such as: visiting, shopping for groceries and doing errands, providing transportation to medical appointments, completing home repairs, and providing respite care for family caregivers. To learn how to volunteer or to receive services, call 603-357-6893 or visit monadnockvolunteercenter.org. Monadnock RSVP is a program of Monadnock Family Services, a Monadnock United Way agency.

Paul Bettinger, MD, Division Chief of Orthopedic Surgery at Cheshire Medical Center, talks with a patient.

Your Support through the Cheshire Health Foundation helps to ensure that high quality healthcare is right here when you need it.

EVERY DOLLAR

OF YOUR SUPPORT STAYS

LOCAL. This communityâ&#x20AC;&#x2122;s deep-rooted tradition of kindness, caring, and giving back is helping us maintain high-quality care right here in our community.

Thank you!

Nonprofit hospitals like Cheshire Medical Center rely on local support to keep pace with the growing needs in the communities we serve. The donations we receive through the Cheshire Health Foundation fund services such as financial support for local cancer patients, health and wellness programs, and patient financial assistance, as well as key investments in state-of-the-art technologies to ensure the best care for you and your loved ones. As the largest employer in the region, what impacts Cheshire Medical Center touches many people beyond our campus. When you give to local healthcare through the Cheshire Health Foundation, you are supporting both the health and wellness of family, friends, and neighbors, and the economic health of this beautiful region where we all live. We are grateful to the volunteer Board of Trustees of the Cheshire Health Foundation and to all those who give. From the generous heartfelt gifts from individuals, to the donations through family foundations and local businesses, every dollar of support makes a difference. To learn how you can support exceptional healthcare at Cheshire Medical Center, visit cheshirehealthfoundation.org. H e a lt h + W e l l n e s s ď&#x201A;ž c h e s h i r e m e d i c a l c e n t e r

Need help for substance misuse?

Call 2-1-1

in New Hampshire to talk with someone at The Doorway.

Whether you are seeking help for yourself or a loved one, The Doorway at Cheshire Medical Center can connect you with support, guidance, and community, as well as help you access substance use disorder treatment, recovery, and self-sufficiency services. at Cheshire Medical Center 640 Marlboro Street, Keene, NH Open weekdays from 8:00 am to 5:00 pm

Phonelines are open 24/7, 365 days a year. Outside of New Hampshire, call 1.866.444.4211.

Please Note: The Doorway will be relocating to 24 Railroad Street in downtown Keene late Fall 2019.