My Boone Health Spring 2020 by My Boone Health

Boone Health SPRING 2020

Partners for Education

Stephens College and Boone Hospital create school of nursing. PG. 8

P G . 28

Weekday Workouts

Orthopaedic surgery is constantly advancing. Offering better outcomes and quicker recovery with new treatments and procedures. I choose to practice at places that put patients first. I believe in Columbia Orthopaedic Group, and I believe in Boone.

Alan Anz, MD

Your Orthopaedic Care Team

Table of Contents 10

President Jim Sinek Director of Marketing & Public Relations Ben Cornelius Communications Consultant II Jessica Park Digital Communications & Marketing Consultant II Madison Loethen Marketing Consultant I Erin Wegner Photography LG Patterson, Tiffany Schmidt, Sadie Thibodeaux Contributing Writers Tiffany Schmidt

Please submit comments or feedback to bcc1170@bjc.org or call 573.815.3392 1600 East Broadway Columbia, MO 65201 573.815.8000

For a FREE subscription, call 573.815.3392 or visit myBooneHealth.com and click on the subscription link on the right side of the page.

A Note from Jim

A Balanced Smoothie

Hospital Headlines

Back On Her Feet

Partners for Education

Get to Know a BHC Doctor

Getting the Help They Needed

Get to Know a BHC Nurse

Reese Renee Boone Baby

Bringing Up Boone Babies

Workday Workout

The Art of the Artichoke

Foundation News

Take a Stand Against Too Much Sitting

As a surgeon, I want to provide my patients with the most advanced procedures to ensure success and a speedy recovery. I operate at Boone Hospital because it is what my patients deserve. I believe in Urology Associates, and I believe in Boone.

Clay Mechlin, MD

Your Urology Care Team

A NOTE FROM JIM

Sustaining Rural Health Care

grew up in a small town in Iowa, population 1,000. I remember the jubilation when the community recruited its only physician. As the citizens of my hometown knew, convenient access to primary care is critical to the health of the people in our community and to the community itself. Beyond physicians and advanced practitioners, I define primary care as inclusive of imaging, laboratory services, rehabilitation, ambulance services, homecare, hospice, urgent care and telemedicine services. Since 2013, Boone Hospital Center has increased our primary care presence in mid-Missouri by adding seven clinics and approximately 20 providers. These clinics are located in Boonville, Glasgow, Moberly, Mexico, Centralia, Columbia, Osage Beach, Ashland and Hallsville. Along with physicians and advanced practice professionals – nurse practitioners and physician assistants – these clinics provide space and support for visiting specialists, making it convenient for patients when they need specialty services. In rural America, it has become very difficult to keep an acute care hospital open. Regulatory requirements; reduced reimbursement; a lack of primary care providers; a lack of primary and specialty care providers who want to practice in rural America; a continuing trend of outpatient care instead of inpatient care; and improved medicine, technology and medications have all contributed to the difficulty of sustaining an acute care hospital in a rural community. Since 2014, 10 rural hospitals in Missouri have closed. Since 2010, more than 100 rural hospitals across the country have closed. A similar situation occurred in the 1980s and early 1990s. As a result, in 1997, the Centers for Medicare/Medicaid Services (CMS) introduced a unique and enhanced reimbursement payment system for rural hospitals, where hospitals would receive a significantly higher reimbursement if they complied with certain conditions as a licensed Critical Access Hospital. Some of the conditions included a maximum number of inpatient beds (25), being located more than 35 miles from another hospital, and maintaining an annual average length of stay of 96 hours or less for acute care patients. This new license category and related reimbursement methodology saved hundreds of rural hospitals across America. Today, I believe CMS needs to similarly incentivize rural hospitals to transform once again, only this time, to an Ambulatory Heath Center model that does not include the cost nor infrastructure of an acute care hospital. This new model would include the primary care services I referenced above and would support convenient access to rural communities, in a sustainable way, to those services. This new Ambulatory Health Center model could even include holding beds for patients for a limited

number of hours as well as skilled nursing beds and longterm care services. Health care economics, provider expectations and clinical medicine have drastically changed and transformed over the last 20 years. With a smaller population base, many rural hospitals will need to consider a strategic plan which transforms them from financially unviable acute care hospitals to financially viable ambulatory health care centers. To get past the parochial mindset of “saving the local hospital at all costs,” we need to advocate for legislative, licensure and reimbursement changes to significantly motivate and incentivize community leaders to seriously consider this transformation strategy. Without this future pathway, I fear the saving the local hospital at all costs philosophy will lead to many more rural hospital closures and unfortunately, eliminate health care services in rural communities.

Jim Sinek President, Boone Hospital Center

MyBooneHealth.org

HOSPITAL HEADLINES

Boone Hospital Center President Jim Sinek to Retire Dec. 31, 2020

JIM SINEK, president of Boone Hospital Center, has announced his decision to retire effective December 31, 2020. Sinek’s retirement will coincide with the completion of Boone Hospital Center’s lease with BJC HealthCare. Sinek has served as Boone Hospital Center’s president since August 2013. Throughout 2020, in addition to leading the ongoing operations, Sinek will continue to lead the lease transition work for BJC HealthCare as Boone Hospital’s Board of Trustees prepares to assume operating responsibilities in 2021. Under Sinek’s tenure, Boone Hospital Center achieved The Center for Medicare and Medicaid Services’ highest 5-Star rating for five consecutive years, was ranked the No. 1 hospital in mid-Missouri by U.S. News & World Report for five consecutive years, and achieved Magnet designation for a fourth consecutive time. Sinek also led the

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development of clinical operations in the Nifong Medical Plaza established in 2016, facilitated growth of the Boone Medical Group from 23 providers in 2013 to 38 providers in 2019, led Boone Hospital Center as the first BJC hospital to implement the Epic electronic medical record system, and has coordinated a number of valued partnerships with neighboring Stephens College. Sinek says, “It has been a privilege to serve as a BJC president and to have worked with such an outstanding and dedicated group of teammates and medical staff members over the last six years. The hospital staff, management team and medical staff at Boone Hospital are exceptional and represent the best that our industry has to offer! I want to thank the Boone Hospital Trustees and the Boone Hospital Foundation Board for their support during my tenure. I felt it was important for me to stay through the transition and give the Trustees time to conduct their search for a new president. I look forward to working with BJC, the Trustees, and the Boone team as we plan for a successful transition during 2020.” Dr. Jerry Kennett, Chair of the Boone Hospital Board of Trustees says, “The Trustees are grateful for Jim Sinek’s six years of service to Boone Hospital and are especially proud of the many quality awards Boone has received during his leadership and the outstanding care that Boone continues to provide to the citizens of Central Missouri.” BJC Group President Sandra Van Trease says, “We are appreciative that Jim will be with us through the end of 2020 to facilitate the transition and provide the Trustees ample opportunity to begin the search for the next leader of Boone Hospital Center. While we will miss his leadership, we are excited for Jim and his wife, Stephanie, as they embark on their retirement plans.”

Community Skin Cancer Screenings

Boone Hospital Lab Draw Locations

As it begins to warmup, we all tend to spend more time outside in the sun. Have you been checked for skin cancer lately?

Local, full-service outpatient lab draws. Walk-ins welcome. Boone Hospital Center

Boone Hospital Center hosts several free skin cancer screening events throughout the summer. Check boone.org/numbers for dates and locations.

1600 E. Broadway Open M-F, 5:30 AM to 9 PM Open Weekends, 7 AM to 9 PM 573.815.3197 • Fax: 573.815.3283

Broadway Medical Plaza 1 1601 E. Broadway, Suite 140 Open M-F, 7 AM to 5:30 PM 573.815.5278 * Fax: 573.815.3323

Broadway Medical Plaza 2 1605 E. Broadway, Suite 220 Open M-F, 7 AM to 5:30 PM 573.815.5420 • Fax: 573.815.5419

Broadway Medical Plaza 4 1705 E. Broadway, Suite 380 Open M-Th, 8 AM to 5 PM Open F, 8 AM to 3 PM 573.815.5435 • Fax: 573.815.5433

Columbia Medical Plaza 303 N. Keene St., Suite 102 Open M-F, 7 AM to 5:30 PM 573.815.5277 * Fax: 573.442.1677

Nifong Medical Plaza 900 W. Nifong Blvd, Suite 015 Open M-F, 7 AM to 5 PM 573.815.6597 • Fax: 573.815.6598

Moberly Medical Plaza 300 N. Morley St., Suite A Open M-Th, 7 AM to 5 PM Open F, 3 AM to 3 PM 660.269.8522 • Fax: 660.269.8529

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EDUCATION Stephens College and Boone Hospital work together to create a new nursing program in mid-Missouri.

arly one morning, Stephens College President Dianne Lynch met with Boone Hospital President Jim Sinek, a meeting which bore fruition to an exciting idea. In 2018, the hospital and college partnered to offer a Master of Physician Studies degree program, and the program was met with great success. Upon taking the Physician Assistant National Certifying Examination, the first two graduating classes passed with a 100% first-time pass rate. The PA program wasn’t the only topic of discussion between Dianne and Jim that morning. The Baby Boomer generation is aging to the point where both retirement and an elevated need for health care will be felt not only in midMissouri, but nationally as well. A strong workforce of registered nurses, or RNs, is a defining need in providing the elevated level of patient care that Boone Hospital Center is known for. With the fresh success of the PA program on their minds, the conversation turned to how both the college and hospital could continue to address the education of future students through nursing. With approval from the Higher Learning Commission, Stephens College and Boone Hospital will soon be able to offer a Bachelor of Science in Nursing degree. Both have come together as 50/50

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partners, sharing in the risk and reward of the program, including all revenue from tuition and costs of staffing. “We have a joint partnership that is unique, exciting and creative and is a model for this kind of collaborative partnership between higher education and community organizations that

will produce the workforce that our community needs,” says Dianne. The program is held for three semesters a year, with a cohort capped at 48 students to start. The students will graduate in less than four years and gain experience working nontraditional days and hours, including weekends and evenings.

Stephens and Boone Hospital are currently developing a simulation lab and two classrooms at the hospital for the hands-on aspect of the program. Registered nurses will act as adjunct instructors, and students will get an in-depth look into patient care. What’s a nurse beyond the didactic understanding of clinical medicine? Jim hopes to provide students with the clinical and emotional experience of a hospital, so that they may be better prepared upon graduation. The program will offer students an intricate level of experience as a patient care tech. “Around 35-40% of new nurses within their first year of getting out of school are actually leaving the first setting they work in, or leaving the profession of nursing. We believe that the curriculum we’re developing will enhance that,” Jim explains. “If they are already engaged, they understand what they are getting into and will be more successful and will feel more supported.” Jim says there’s no shortage of students wanting to go into nursing. Many applicants are turned away due to a shortage of available seats in nursing schools in close proximity to Columbia.

“About 45% of the nursing population is close to retirement,” adds Monica Smith, Vice President of Patient Care Services and Ancillary Operations and Chief Nursing Officer. This poses a new challenge for students hoping to receive education. “You need enough faculty to provide education for the students, so that limits the number of student programs that can accept. That’s where we believe this partnership is so important.” Both Monica and Jim hope that over time the program will be able to increase the number of seats in the program. The pair also hopes the program will act as a bridge from RN to BSN. A BSN program is traditionally a four-year program, but with Stephens, students will get the nontraditional path of a three-to three-and-a-half-year program. “At Boone, we like to support our ADNs to become BSNs as it’s an opportunity for additional didactic training. Part of our Magnet status is to try to facilitate and support and encourage our nurses to continue their education,” says Jim. Starting a nursing school is a bold venture, yet both Stephens and Boone Hospital have high expectations for the program.

Tiffany Schmidt

MyBooneHealth.org

GETTING THE HELP THEY NEEDED A little help goes a long way. Lauren Stuecken, who is pregnant, was referred to the Outpatient Nutrition & Diabetes Clinic for gestational diabetes.

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auren Stuecken and her husband, Colby, were overjoyed when they found out they were expecting their first baby. Lauren was shocked to discover, though, that at 28 weeks pregnant she had developed gestational diabetes. Lauren was referred to the Outpatient Nutrition & Diabetes Clinic for gestational diabetes. Her pregnancy had been incredibly smooth, she doesn’t have a family history of diabetes, and she thought she had been doing a pretty good job of eating a healthy diet. Lauren was referred to Boone Hospital Center’s outpatient Nutrition and Diabetes Clinic where she met with Laura McDermott, MS, RDN, LD. Laura helped her understand how gestational diabetes differs from Type 1 and Type 2 diabetes. Gestational diabetes is based on a woman’s hormone levels and can happen with any pregnancy. Laura also helped Lauren create an individualized nutrition plan. “My visits expanded my knowledge of gestational diabetes and gave me all the tools I needed to be successful,” Lauren says. During their sessions, Laura taught her the recommended carbohydrate amounts to eat at each meal, how to read food labels, how to find foods that are higher in protein and fiber, and how eating good carbs could help her feel better. She adds, “I have been able to manage my blood sugar with my diet and avoid going on medication. My numbers are better now than when I was first diagnosed!” Lauren’s diagnosis wasn’t something she expected, but she was thankful for the training and education that she received. With a new family member joining them soon, Lauren, Colby and their golden doodle, Quincy, look forward to traveling and visiting as many National Parks as they can. Boone Hospital’s Diabetes and Nutrition Clinic offers one-on-one outpatient counseling and education with a Registered Dietitian Nutritionist (RDN), Licensed Dietitian (LD) or Certified Diabetes Educator (CDE). Nutrition counseling can help you set new eating patterns, increase your daily intake of fruits and vegetables, and learn to count carbohydrates and calories while making sure you get enough fiber and protein. Counseling also includes before-and-after body composition analysis. RDNs and LDs are the most credible sources for accurate nutrition information. They can help you understand and manage diabetes, high blood pressure, high cholesterol, weight concerns, digestive conditions, kidney disease, changes in appetite, pancreatitis, and nutrition during pregnancy and breast feeding. Outpatient diabetes counseling includes training on how to use blood glucose meters, continuous glucose monitoring education and insulin instruction. The clinic also provides more intensive diabetes management,

For more information or to make an appointment, please call 573.815.3870

gestational diabetes support, enrichment classes and nutrition consultations. Patients who have diabetes start with a one-on-one visit with a CDE at the clinic and then attend four weekly diabetes classes. The classes are educational and interactive and include fun games, like Jeopardy, Wheel of Fortune, Family Feud and Bingo. Patients and family members also learn about technology and apps that can help them manage their diabetes. Mary Gerling learned firsthand how helpful the diabetes classes can be. When she’d met with her doctor for her yearly physical, Mary was feeling well and hoped her test results would confirm that. But after having her blood work done, Mary learned she’d developed Type 2 diabetes. Mary’s hemoglobin A1C was 7%. Hemoglobin A1C is a blood test that takes your blood sugar levels over the past 3 months and averages them into a percentage. The normal range for A1C is between 4% and 5.6%. Because Mary’s A1C was high, she was referred to the Nutrition and Diabetes Clinic. After Mary met with an educator and attended weekly diabetes classes, she started walking every day and changed the way she ate. She says it was a good learning experience that helped her learn more about diabetes and how to take care of it.

MEET THE TEAM Dr. Jamison Medical Director Julie Winters Director Janet Kimmons MS, RDN, LD – Clinical Nutrition Manager Mona Dachroeden RN, MSN, CDE Stephanie Knedler PSR Mary Linneman RDN, LD, CDE

Laura McDermott is a Clinical Dietitian and meets one-on-one with patients and their family members.

“You finally realize exactly what carbs are, how to count them and how many you should have. You never think that a package of cut-up lettuce that you bought at the store has carbs in it, but it does! It was kind of eye-opening,” Mary says. She also enjoyed talking to the other people who attended the classes and their interactions, including playing her favorite game, Jeopardy. “Anyone with diabetes can benefit from education. Our educators personalize the information to each patient’s needs,” says Kimberly Jamison, MD, Medical Director for Boone Hospital’s Wound Healing Center. Dr. Jamison frequently sees diabetic patients in the Wound Healing Center. People who have diabetes heal more slowly, leading to a higher risk of infections and complications. Julie Thomas had known she was diabetic but struggled to keep her blood sugar levels in a healthy range. When she developed a diabetic wound on her foot, she saw Dr. Jamison at the Wound Healing Center. Julie’s wound wouldn’t heal because she was unable to successfully manage her blood sugars. Dr. Jamison warned Julie, “You’re never going to heal if you don’t get these numbers down.” Julie’s blood sugar levels got so high that she was sent to the emergency room. Her endocrinologist prescribed medicine

to help lower her blood sugar, but it wouldn’t be enough – Julie needed to make lifestyle changes. Julie was referred to the Diabetes and Nutrition Clinic where she met with Mary Linneman, RDN, LD, CDE. With Mary’s help, Julie became accountable for herself and started working hard to lower her blood sugar levels. Julie’s food challenges were particular foods that she was used to eating. It was hard for her to make the changes necessary for her health, but Mary gave her the tools she needed. “It made me realize that what I was eating was causing the high blood sugars. I finally saw that,” Julie says. “Julie’s blood sugar levels would run in the 300s, and now they run between 160180,” Mary says. “She was finally able to put the pieces of the puzzle together.” After making dietary changes and joining a gym, Julie has lost 30 lbs and was able to reduce the amount of medication she takes. With the knowledge she’s learned, Julie now enjoys looking up healthy recipes and cooking her own food. Once her wound finally heals, she’s eager to get outside and walk her dog. Julie adds that getting support from Mary also encouraged her to make healthier lifestyle choices. She says, “Mary talked to me like I was a real person.” By Erin Wegner

Laura McDermott MS, RDN, LD MyBooneHealth.org

Reese Renee BOONE BABY I

think every mother has the first time seeing their baby imprinted in their brain. You stare at this beautiful little baby laying on your chest, in awe that you somehow grew a human inside of you. I remember feeling so exhausted but also so in awe of my little girl. Back up to nine months earlier, I was feeling pretty in awe then too. My husband Kyle and I had been talking about having a baby. I had even made an appointment with my obstetrician, Jennifer Roelands, MD, from Women’s Health Associates (WHA) to talk about having a baby. She said I seemed healthy and to go for it whenever we were ready. About two months later, around 7 a.m., I was staring at one of those early results pregnancy tests trying to decide if there was actually really a second line or not. It was a full six days before my missed period, so I was testing ridiculously early. I took a second test and saw a second faint line again, and that’s when I knew I was pregnant. I felt excited, nervous and in shock. I told my husband when he woke up and then I promptly had to leave to go to work, so he had to let it soak in without me. But we talked later in the day, and he was excited, nervous and in shock too. That day I called and made an appointment with Dr. Roelands. When I was about six weeks along, I had my first prenatal appointment and talked to the doctor about the extreme nausea I was already having. She gave me a prescription for something to help and, thank goodness, because I ended up having extreme morning sickness for all nine months. After that first appointment, I had my labs done at the Boone Hospital Lab in Broadway Medical Plaza 2, which is in the building connecting to WHA. It was super nice to just walk right over after my appointment and get the labs done without having to wait at all. The next week, I had my first ultrasound, and it was so special to see our tiny baby wiggling around. I always looked forward to my appointments at WHA. The ultrasounds were so special and Dr. Roelands always listened very nicely while I listed out every ache and pain. During my third trimester, Kyle and I decided to take the Prepared Childbirth Class through the Boone Family Birthplace. We did one of the Childbirth in a Day classes, which combined all four prepared childbirth sessions on the same day. We received lots of helpful information about what to expect and tips on how to prepare for the birth. The nurse who taught the class answered all of our questions and gave the group a tour of Boone Family Birthplace’s birthing and postpartum rooms.

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Photography By Angelique

MyBooneHealth.org

Imago Dei Photography

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Photography By Angelique

When I was about 37 weeks along, it first looked like the baby may come early. I was pretty far dilated and effaced, but she hung in there, and I scheduled an induction for my due date. When I came in to be induced, I was actually already having contractions five minutes apart on my own. I came in at 5 p.m. and gave birth at 9:36 a.m. the next day, so I had a long night with not much sleep. Through it all, the doctors and nurses were great about explaining to me what was going on and what needed to be done. When our little Reese Renee arrived, we were instantly in love! I was also so tired I felt like I had been hit by a bus. Thank goodness for the sweet postpartum nurses who took such good care of us. I was visited several times by the lactation consultants on staff and found them incredibly helpful in navigating breastfeeding. Reese had high jaundice levels while she was at the hospital, and we followed up with our pediatrician, John Wilson, MD at COMO Cubs. We had to bring her in to get blood drawn a couple of times to watch her levels, but thankfully, the jaundice went away on its own, and we didn’t have to use a light blanket. Reese and I have been going together to the monthly Bringing Up Boone Babies meetings. These meetings are a support group for parents of Boone babies. At the meetings, I can ask the lactation consultant who leads the meeting questions, and I talk to the other moms there about our babies – our favorite topic! There’s also always a baby scale at the meetings, which is super helpful. I weigh Reese before and after I breastfeed her and then I know how much milk she is getting. Reese is now five months old as I’m writing this – and we can’t imagine our life without her. We are so grateful to all of the wonderful medical professionals who have helped us in our Boone baby journey! By Madison Loethen Madison is a marketing consultant at Boone Hospital and in her spare time has a mommy and lifestyle blog (MadisonLoethen.com) and YouTube channel (youtube.com/c/MadisonLoethen)

MyBooneHealth.org

BRIN GIN G UP BO O N E BABIES

SUGGESTIONS FOR SOOTHING A CRYING BABY Babies cry. It’s one of the main ways they communicate and is meant to get our attention. As parents, our job is to respond to their cries. No parent can do this perfectly. We begin by going through a list of possibilities. Is the baby hungry? Do they have a wet or dirty diaper? Are they hot? Cold? Lonely? It can be hard to tell. Sometimes we don’t know why our baby is crying – and we don’t know what to do. After ruling out hunger, needing a diaper change or a cuddle, you can try the five S’s. The five S’s were popularized by Dr. Harvey Karp, who used them after he saw how the Kung San people of the Kalahari Desert quickly calmed their babies using techniques that mimicked life in the womb. It makes sense to create a womb-like atmosphere for young babies – that’s what they are accustomed to! BY EMILY NUSBAUM, RN, IBCLC, BOONE FAMILY BIRTHPLACE

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NEED MORE SUPPORT?

1. Swaddle

Swaddling mimics the tight quarters of the womb. Karp states that the swaddle works best when your baby’s arms are down by their side so they can’t startle. It is also important that baby’s hips are loose and flexed. Swaddling should be used for sleeping or calming, not all day. Lots of skin-to-skin contact with mom and dad are still recommended and is another great way to settle fussy babies.

2. Side or Stomach position

Hold your baby on their side or stomach. For safe sleep, babies need to be on their back, but it’s not always the best option for a fussy baby. The side or stomach position seems to work best.

3. Shush (not shut up!)

It might be rude to tell another adult to shush, but what your baby heard while in the womb was louder than a vacuum. They’re used to constant noise or white noise. Use your mouth to make a loud shushing noise or use apps to play recordings of white noise.

4. Swinging

Babies are comforted by movement – think about how much they moved while inside your belly! Fast, small

movements tend to work best. Always support baby’s head and neck while you quickly move baby side-to-side. (Note: Never shake your baby in frustration. A crying baby can make any parent feel frustrated, but if you feel overwhelmed, put your baby in a safe spot or ask someone else to hold the baby until you feel calm.)

5. Sucking

Babies soothe themselves with sucking. Some babies love to suck, and others don’t care for it as much. Your baby can suck on the breast, a pacifier or a clean finger. (Ideally you shouldn’t give your baby a pacifier until breastfeeding is going well, but some babies really love to suck and sometimes moms need a break!) The five S’s are a great tool to use when your baby is fussy and you’ve already tried feeding, changing, and checking their fingers and toes in case any tiny strings are wrapped around them. To learn more about the five S’s you can read The Happiest Baby on the Block by Dr. Harvey Karp or watch the DVD with the same title. While the five S’s are often helpful, remember that nothing works perfectly all the time. If you feel like something is not right with your baby, always talk to your baby’s doctor.

Bringing Up Boone Babies is a monthly support group provided by Boone Family Birthplace. We meet on the second Saturday of each month at 10:30 am and the third Thursday of each month at 6 pm at Boone Hospital Center. Each hour-long session is led by a Boone Family Birthplace nurse and includes a short presentation on a different topic, followed by open group discussion. This support group is free and open to all parents of newborns, infants and toddlers – and you’re welcome to bring your baby with you! No registration is required.

For a list of upcoming dates and information, join our Bringing Up Boone Babies Facebook group or visit boone.org/ BringingUpBooneBabies MyBooneHealth.org

WELLNESS

The Art of the Artichoke Don’t be fooled by their appearance.

f you’re new to cooking or eating a fresh artichoke, the prickly produce may seem intimidating at first. But once you learn how to choose and prepare them, artichokes can be a delicious source of dietary fiber, protein and antioxidants. The artichoke is actually the bud of a tall species of thistle. When the bud blooms into a purple flower, the artichoke is no longer edible. The most commonly consumed type of artichoke is the globe artichoke, also known as the French or green artichoke. Nearly all of the globe artichokes produced in the U.S. come from California. Castroville, California calls itself the Artichoke Center of the World and holds an annual artichoke festival every year. Artichokes are available all year but are in season in the spring. Look for fresh artichokes at your supermarket or farmer’s market.

How to choose a fresh artichoke • The heavier an artichoke, the meatier it will be. A lighter artichoke is more likely to be dried out. • Leaves should be closed and should squeak when rubbed together.

How to cook an artichoke 1. Cut the thorn-like tips of the outer leaves with scissors. Cutting off the thorns makes the artichoke easier to handle. 2. Use a serrated knife to slice a 1-inch section off the tip of the artichoke. 3. Remove the small leaves at the base and the stem.

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4. Cut off most of the stem, leaving about an inch left on the artichoke. The stem may taste more bitter than the rest of the artichoke but is still edible if you choose to leave it whole. If you leave the whole stem, peel off the tough outer layer using a vegetable peeler, so you can more easily get to the softer middle. 5. Rinse the artichoke under cold water, making sure that water enters between the leaves to remove any dirt or bacteria. 6. Cook the artichoke in a stovetop steamer or pressure cooker Stovetop steamer: 25 to 35 minutes, until the outer leaves can be pulled off Pressure cooker: 5 to 15 minutes

How to eat a cooked artichoke 1. When the artichoke is fully cooked, peel off the leaves. Dip the fleshy, bottom end of the leaf into your choice of dip or sauce. Eat the fleshy end first. Place the leaf dip side-down and scrape along the soft, inner portion of the leaf with your teeth. Discard the tough, outer part of the leaf. 2. After all of the outer leaves are eaten, you’ll see the inner leaves of the artichoke. These leaves may have purple tips. Eat the lighter-colored portion of the leaves, dipping them the same way you did with the outer leaves. 3. After you eat these inner leaves, you’ll see the “choke” part of the artichoke – a fuzzy, inedible layer. Scrape off this layer to expose the artichoke heart. The heart can be cut into pieces for dipping and eating.

• The larger the artichoke, the longer the cooking time. • The leaves may turn brown during cooking, especially if they have been cut. This color is caused by an enzymatic reaction that occurs while cooking. The brown leaves are still edible. To prevent this reaction, lightly coat the leaves with vinegar or lemon juice before you cook the artichoke. (This technique works for other green vegetables that may turn brown while cooking.)

Additional resources • Check out the California Artichoke Advisory Board at artichokes.org for information, videos, and recipes about artichokes. • Websites such as Simply Recipes and wikiHow provide step-by-step visuals on how to properly prepare artichokes. By Kate Mirly, MS, RDN, LD, Boone Hospital Center Registered Dietitian

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A Balanced Smoothie “Smoothies are a great way to fit multiple food groups into one package,” says Kate Mirly, MS, RDN, LD , a Clinical Dietitian at Boone Hospital Center. Smoothies can be enjoyed year-round as a convenient meal on the go and they are a great way to add fruits, vegetables and water to your daily routine. If your ingredients have been pre-measured, smoothies can be made very quickly. “With careful planning, smoothies can pack a nutritional punch, and they work as a great on-the-go breakfast or snack,” says Kate. But what you put in your blender can make a difference if you want a wellblended and healthy smoothie. “Avoid going overboard on the ingredients list,” Kate advises. “While smoothies can be a fantastic addition to your day, they can also add up in calories very quickly. Stick to lower-calorie foods like leafy greens, frozen fruit and non-fat dairy. Limit the number of higher calorie ingredients, such as protein powder, nut butter, juices and added sweeteners. These tips can make the difference between a 200-calorie smoothie and a 600-calorie smoothie!” There’s also a recommended order for putting your ingredients into your blender. A well-blended smoothie requires the perfect layering to make sure all ingredients are properly blended together.

1. LIQUIDS: Liquids are a very powerful ingredient for a blender. When

placed directly around the blades of your blender, the liquid allows the spinning blades to create a tornado that pulls down the other ingredients. Common liquids in a smoothie are water, milk or juice. Water is a good choice if drinking enough water each day is a struggle. Milk, in any form, is a great source of added protein, and juice is a nice addition if you’re going for extra flavor.

2. POWDERS: Add any powdered ingredients next. This allows the powder to absorb into the liquid and gives it the best chance of being completely dissolved when you run the blender.

7 6 5 4 3

3. LEAFY GREENS: Adding your leafy greens next ensures they’ll get

broken down and blended into the smoothie. Adding them last could result in larger pieces of greens than you prefer. One cup of fresh spinach or kale – or 1/3 cup frozen chopped spinach or kale – is a great way to add a vegetable to your smoothie.

4. EXTRAS: Add items like almond butter for a monounsaturated fat, yogurt for protein, or any type of sweetener like honey, cinnamon or maple syrup.

5. NUTS AND SEEDS: Add in nuts like peanuts, almonds or walnut

halves, or seeds like flax, chia and hemp. These will break down and mix into your smoothie.

6. FRESH FRUIT: Before adding fresh fruit to your smoothie, cut it into chunks or smaller pieces. This helps the fruit blend easier – and smaller pieces don’t take up as much room in your blender!.

7. ICE OR FROZEN FRUIT: If you’re using fresh fruit in your smoothie,

then you’ll want to add ice last. If you’re using frozen fruit in your smoothie, you can skip the ice altogether. Ice or frozen fruit are the ideal topper for a smoothie. The weight of the frozen items pushes the other ingredients down towards the blades, helping your blender create the perfect smoothie. By Erin Wegner 20

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Spring 2020

Pumpkin Breakfast Smoothie INGREDIENTS 4 oz Milk of your choice

4 oz Greek yogurt, plain

Nutrition Facts Calories: 314

½ cup Pumpkin puree

1 Tbs Flaxseed, ground

Fat: 6 grams Protein: 23 grams

½ tsp Pumpkin pie spice

½ Banana, frozen

Carbs: 43 grams

Back On Her Feet The iovera° system helps a nurse recover quickly from knee replacement surgery.

athy Smith, a nurse of 45 years, knew she needed to have a second knee replacement surgery but was dreading the pain and discomfort that would come along with it. She’d had her left knee replaced just months before and had her right knee surgery scheduled when she heard about the newly offered iovera° procedure at Boone Hospital Center. The iovera° system temporarily blocks the nerves in the knee, providing an alternative to traditional opioid pain management. A radiologist uses a handheld device to administer iovera° therapy under ultrasound guidance. The iovera° device uses cold temperatures to hinder the nerves in the knee from sending pain signals to the brain. iovera° is typically offered one to two weeks before knee replacement surgery and can provide pain relief for several weeks – until the patient is well into their recovery process. Boone Hospital Center is currently the only hospital in midMissouri to offer the procedure. “I went in to get the iovera° procedure done and was amazed at how quick and painless it was,” says Kathy. Two weeks later, Kathy had her knee replacement surgery and says her recovery went great. “When I got my first knee done, I had to take medication several times a day. And my knee was very stiff and wouldn’t bend for days. It took me probably two-and-a-half weeks to feel like myself. When I got my second knee done after the iovera° procedure, I didn’t have to take much pain medicine and my knee was bending the next day,” says Kathy. Alan Anz, MD of Columbia Orthopaedic Group is an advocate of the procedure and often recommends it to his knee replacement patients. He says Kathy’s results are similar to other cases he’s seen.

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“I’ve even had several patients who have had one knee replaced before we had iovera°, and then the second with the procedure. These patients each noted a significant improvement in pain control after surgery compared with the previous side,” he says. Dr. Anz also notes the procedure allows patients to cut back on the need for opioids; “In today’s climate of hypervigilance with respect to opioid usage, I have found iovera° to be helpful in limiting opioid usage and helping to combat opioid dependence and abuse.” Kathy is now back to work as a Boone Hospital Home Health nurse and is able to do her job without pain or the need to take any pain medicine. She says she would recommend iovera° and Dr. Anz to anyone who needs knee replacement surgery. By Madison Loethen

MyBooneHealth.org

GETTING TO KNOW A BHC DOCTOR

Denise Freidel, MD

Family Practice, Boone Medical Group-Centralia

was born in Maryville, Mo. I played college basketball at Missouri Western State University in St. Joe, where I did pre-med and obtained a biology and math major with a chemistry minor. I attended medical school in Des Moines, Iowa at the University of Health Services. I met my husband at medical school – we have five beautiful children and three amazing grandchildren.

Why did you get into the health care field? I have always known I wanted both to be a physician and to marry a physician. I started rounding with my mentors, a husband-and-wife doctor team in eighth grade. I have always enjoyed helping others. What interested you in your particular specialty? I love family practice. I like to know each of my patients as a person. Doing family practice allows me to take care of all ages and to be with my patients through different stages of their lives. What is the most rewarding aspect of your job? Every day brings new challenges in medicine. It is rewarding to be a part of a person’s life and to help them feel and be the best they can be. What is the most challenging aspect of your job? The most challenging aspect of the job is doing paperwork. I would much rather spend time with my patient than worry about documents. What do you see changing in health care in the next 5 to 10 years? Health care, unfortunately, is very dependent on politics. Hopefully, medicine will become more affordable and care more obtainable. What advice would you give someone looking to become a doctor? I tend to advise young adults who have an interest in medicine to pursue being a nurse practitioner or physician assistant. What do you enjoy doing outside of work? I dedicate my time to my family. We all enjoy sports and we follow whichever kid is playing a sport during different seasons. Through

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Spring 2020

the years, I have also enjoyed coaching. We will have five kids in college next year, so it’ll be time to chase new endeavors. What advice would you give to someone who is going to be a patient in a hospital for a period of time? If you are going to be in the hospital for a long time, it is wise to have an advocate who can help you keep track of coordination of care.

GETTING TO KNOW A BHC NURSE

Miranda Daniels, BSN, RN Emergency Department

have been a registered nurse for 16 years. I am married and a mother of two girls, ages 13 and 9. My thirteenyear-old is changing my life outlook right now!

Why did you get into the health care field? I genuinely loved taking care of people and knew eventually I would choose a career in it. I started working in health care when I was 16. I worked laundry and housekeeping at a nursing home in Fayette, Mo., then later got my CNA prior to graduating high school. I played basketball for Central Methodist College and graduated in 2001 with a Bachelor of Science in Athletic Training and worked in a sports medicine clinic for a couple years. One of our patients was a nursing instructor who reignited my dream to be a nurse. I graduated from the MU Sinclair School of Nursing’s first BSN accelerated program in 2004. What interested you in your particular specialty? In 2004, I was hired as a new graduate nurse in Boone Hospital’s Medical ICU and continued to work in the ICU setting over the next six years. As a flex nurse, I floated to the emergency department and fell in love with emergency nursing. The fast pace, vast acuity, and broader patient population stole my heart. In the ED, you are an open door to the community, and you have to be prepared for anything and everything. What is the most rewarding aspect of your job? The most rewarding aspect of my job is learning from my patients. Because of this I appreciate every little thing in life. Every day I get to be part of a team of exceptional nurses, physicians, patient care techs, and a secretary who I can bounce ideas off of. I know I’m never alone in my job – we’re always teaching others and being taught. What is the most challenging aspect of your job? The most challenging aspect of working in the emergency department is when there are more patients than there are people to care for them. Deciding who gets medical treatment first can be overwhelming, but I realized that the quicker I make my assessments, the quicker everyone can receive the care they need. The ED is no place for hemming and hawing. What has changed in your field since you started practicing? The biggest change in emergency nursing over the past 10 years has been the growing number of patients seeking care and evaluation in the ED. Fewer patients are admitted from

doctors’ offices or outpatient settings. There is also more intensive management of patients in the ED and a longer length of stay in the department before patients are accepted for admission. What do you see changing in the next 5 to 10 years? Regardless of how health care evolves, people who work in emergency care must never forget their reason for being there – to provide lifesaving care to anyone who needs it at any time. What do you enjoy doing outside of work? I enjoy being outdoors, watching my girls play basketball, doing Crossfit and working in the garden. What advice would you give to someone looking to become a nurse? Check your ego at the front door. Working with people who are responsive to educating one another is key to becoming the best nurse possible. We all need each other to provide excellent care to our patients and families.

MyBooneHealth.org

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Take a Stand Against Too Much Sitting By Dr. Graham A. Colditz, DrPH, MD, MPH, Siteman Cancer Center

A common refrain these days is that “sitting is the new smoking.” And while that’s a bit of an exaggeration, it’s a catchy phrase that does actually bear some weight. Sitting increases the risk of many serious conditions, including heart disease, diabetes, obesity and some cancers. It’s even been found to take years off of a person’s life, with one study showing that six percent of all premature deaths could be linked to too much sitting. As if that’s not bad enough, studies have also reported that prolonged sitting has unique health risks that can’t be fully exercised away, no matter how much time we spend at the gym or local running track. “Even among people who do moderate-to-vigorous activities for seven or more hours per week, those who sit too much have an increased risk of death,” says Dr. Yikyung Park, a nutritional epidemiologist and associate professor in the Division of Public Health Sciences at Washington University School of Medicine in St. Louis. And, unfortunately, sitting for long stretches of time is something many of us do. One national survey completed before the explosion of smartphones and social media found that we spend more than half of our waking hours being sedentary. Another showed that if

we work at a desk or office job, we may spend as much as 80 to 90 percent of our work days being sedentary. With numbers like that, it’s important for many of us to look after our health by taking steps to cut down on the amount of time we spend sitting. Luckily, compared to some other healthy behaviors, it’s pretty easy to do. We just need to stand up more throughout the day. Of course, figuring out how to make that a part of our regular routines can take a little bit of planning. Work is a great place to start on that front, since it’s where many of us spend much of our week and log much of our sitting time. One international scientific panel recommends workers stand for at least two hours each work day, building up to four hours a day. “Use a standing desk. Organize standup meetings. While on the phone, stand up. If you have a short message for a colleague, deliver it in person instead of calling or writing an email,” suggests Park. When you’re at home, try doing some things standing that you’d normally do sitting. Have your cereal and catch up on the morning’s news while standing in the kitchen. When going out for coffee with friends, pick a place at a counter so you can stand comfortably. And when relaxing with a favorite TV show, stand through an episode or get up during commercials or between shows.

“Break up a long period of sitting as often as possible,” says Dr. Park. And just like with exercising, it’s also important to build up slowly to longer periods of standing so your body has a chance to adjust to the change. Whether we are at work or home, our surroundings can feel like one big invitation to sit down, and for hours on end. For our health and well-being, it’s important to take a stand against that – and stand. It’s your health. Take control.

Dr. Graham A. Colditz, associate director of prevention and control at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis, is an internationally recognized leader in cancer prevention. As an epidemiologist and public health expert, he has a long-standing interest in the preventable causes of chronic disease. Colditz has a medical degree from The University of Queensland and a master’s and doctoral degrees in public health from Harvard University’s T.H. Chan School of Public Health.

MyBooneHealth.org

LIVING WELL

Workday Workout Whether you’re working in the office or at home, here are a few workouts that can become part of your workday.

SEDENTARY BEHAVIOR – defined as activity where your predominant posture is sitting or lying, and your energy expenditure is low – is the most prevalent risk factor connected with cardiovascular disease and chronic heart disease. Almost 80% of people in United States do not meet the minimum weekly recommendations for 150 minutes of moderate physical activity or 75 minutes of vigorous physical activity. People who don’t get enough regular physical activity have a higher risk of obesity, high blood pressure, cancers, depression, diabetes and overall mortality. Sedentary behavior has become a normal part of everyday life. Desk jobs and schools promote sedentary behavior on a daily basis. For most Americans, the more we sit at a desk in front of a computer screen, the less physical activity we get. Being glued to a desk for 40 hours a week can actually be detrimental to our health. Fortunately, adding physical activity into your everyday life is easy. Get creative with your resources to turn your office, cubicle or living room into your own personal gym. Taking short breaks to stand, walking down the hall, or fitting in a quick exercise circuit are excellent options for meeting your physical activity goals, increasing your caloric expenditure, strengthening your muscles, and reducing your risk of chronic disease. Here are a few exercises you can easily fit into your workday. Perform each exercise for 3 to 4 sets of 8 to 10 repetitions. Please check with a health care provider before starting any type of exercise program. By Hunter Blume, Boone Hospital Center Exercise Physiologist

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Spring 2020

Plank Shoulder Taps Targets the abdominals, gluteus and shoulders. Start from a high plank position, with wrists under shoulders, arms fully extended, and feet shoulder-width apart. Make sure that your back is a straight line from heels to shoulders, your core is braced, and your glutes are contracted. If needed, the plank position can be done from your knees. Keeping your core still, touch your left shoulder with your right hand. Return to plank position and repeat with the opposite shoulder and hand.

For more information, visit boone.org/fitness or call 573.815.3876

Desk or Chair Triceps Dips Targets the triceps. Stand in front of a desk or counter with your buttocks pressed against it, or sit on the front half of a stable chair with arms. Place your hands on the counter, just outside your hips, or on the chair arms. With your elbows fully extended, carefully walk your feet out 12 to 36 inches in front of you – the farther you move your feet out, the harder the exercise will be. Brace your core, slowly bend your elbows, lower your body until your elbows get as close to 90 degrees of flexion as possible. Pause for a one-count, then exhale as you extend your elbows and return to the start position.

Therapy Band Lateral Raise Targets the deltoid muscles. Run an elastic band under the seat of a stable chair. Sit in the chair and grasp the band on both sides of the seat with your palms facing down. Brace your core, keep your arms straight as you lift them. Lift arms until your hands are at shoulder level. Make sure your hands don’t go above your shoulder height. Slowly return to starting position.

Chair Abdominal Crunch Targets abdominal muscles responsible for posture and flexion at the hip. Sit on the front half of a stable chair. Place your hands on the edge of the chair, beside your hips. Brace your core and lean back slightly. Extend your legs out in front of the chair. Bend your legs, pulling knees towards shoulders. Pause for a one-count at the top of the exercise, then return legs to straight position on the floor.

Therapy Band Chest Press Targets pectoral muscles and triceps. Sit in a stable chair with the elastic band placed behind the chair’s back. Grip the band at chest level and make sure to keep your elbows out to your sides. Brace your core, then press the bands forward until your arms are fully extended in front of you. Slowly return to starting position.

MyBooneHealth.org

FOUNDATION NEWS

Thank You for Sharing the Gift of Health The Boone Hospital Foundation is grateful for our generous donors who help us strengthen and expand programs and services at Boone Hospital Center. Whether big or small, your gift makes a difference and an impact in the communities that we serve. The following are just a few of the programs and services that you helped make possible in 2019. • You provided supplies for over 1,750 health screenings through the Mobile Health Unit. • You helped us touch 16,104 lives through our community health outreach programs. • You helped provide the Kids on Track program, keeping 780 children active over the summer. • You provided eight scholarships for Outpatient Cardiac Rehab patients making it possible for them to participate in therapy after leaving the hospital for cardiac care. • You funded certifications and conferences, helping educate approximately 444 caregivers. • You partnered with Columbia College’s Nursing Camp program by sponsoring 30 high school students interested in the field of nursing.

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Columbia College Nursing Camp Students The Mary Lu and Lenard Politte, M.D., Caregiver Education Endowed Scholarship

2019 Distribution of Funds 2020

12% 25%

8% 8%

CALENDAR OF EVENTS APRIL/MAY

Strawberry Hill Flower/Plant Sale

27%

20% MAY 27 & 28

Scrubs on Site

CHART KEY

JUNE 22 & 23

Silver Events Sale

Caregiver Education Community Benefit Current Need

JULY 13

Annual Golf Tournament

Other Department Specific Funds Supportive Care

JULY

Community Campaign

Cardiology

MyBooneHealth.org

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

NONPROFIT U.S. POSTAGE

PAID

COLUMBIA, MO PERMIT 286

Presented by Boone Hospital, an exciting event that’s all things baby.

You’re gonna go gaga over what’s in store. WHEN: Saturday, June 27th, 2020 from 8am to 12pm

WHERE: Courtyard by Marriott,

3301 Lemone Industrial Blvd, Columbia, MO 65201

midmobabyexpo.com

It’s probably hard to think about anything else, right? You keep getting distracted and daydreaming about your little bundle of joy. You think, why can’t the rest of the world be as focused on my new baby as I am!?!

Good news - for one day it will be!

My Boone Health Spring 2020

Articles inside

Back On Her Feet

Take a Stand Against Too Much Sitting

Get to Know a BHC Doctor

Workday Workout

Get to Know a BHC Nurse