My Boone Health Winter 2018 by My Boone Health

Boone Health WINTER 2018

MOLLYâ&#x20AC;&#x2122;S MILES MAKES A DIFFERENCE Honoring the survivors of law enforcement officers who have died in the line of duty.

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PG . 1 6 N A V I G AT I N G H E A LT H C A R E F I N A N C E S

Table of Contents 8

President

Jim Sinek Director of Marketing and Public Relations

Ben Cornelius

Marketing Coordinator

Jessica Park

Multimedia Marketing Specialist

Madison Loethen Photography

Sadie Thibodeaux Contributing Writers

Brenna McDermott Matt Patston Jennifer Anderson, RD, CDE Kelsie Knerr, RD, LD

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

Instant Pots

Hospital Headlines

Lactation Consultants

Mollyâ&#x20AC;&#x2122;s Miles

Get to Know a BHC Doctor

Prostate Cancer

Get to Know a BHC Nurse

Surviving Cancer

Tips for Cancer Survivors

Back Pain Prevention

Health Care Finances

Sleep

Whole30

Foundation News MyBooneHealth.org

Three years in a row.

A NOTE FROM JIM

Raising the Bar Even Higher in 2018 During 2018, our leadership teams at Boone Hospital Center and BJC HealthCare will focus on five priorities: 1. Continued improvement in our quality outcomes 2. Increased patient satisfaction 3. Elevating our financial performance 4. Continuing to strengthen our employee engagement 5. Optimizing our new Epic electronic medical record system and Boone Medical Group operations When it comes to quality of care for our patients, Boone Hospital Center continues to rank first in mid-Missouri. Whether it is US News & World Report’s #1 hospital ranking; Consumer Reports recognizing Boone as the top hospital in the midwest region for coronary artery bypass and aortic valve replacement surgery; or the Centers for Medicare and Medicaid Services (CMS) designating Boone as a fivestar hospital, in 2017, experts confirmed your best choice for the best possible health care results is Boone! While we appreciate this recognition, the Boone team is never satisfied – we’re committed to raising the bar on quality care even higher in 2018!

We believe access to high-quality care is instrumental in achieving our mission of improving the health of the people and communities we serve. That’s why we’ve been building a network of Boone Medical Group primary and specialty care clinics throughout mid-Missouri. Over the last three years, we have established nine new clinics and recruited 17 new providers to care for patients closer to home. In 2018, we will strengthen our existing clinics and evaluate other potential opportunities to bring Boone’s excellent care closer to where you live. In addition to the expansion of our clinic network, we anticipate additional growth in cardiology and cardiothoracic surgery services, general surgery, inpatient rehabilitation, and bariatric surgery services, with the addition of several new physicians in these specialties. In 2018, you can find Boone Hospital in the Boone County health care exchange. Cigna Insurance has the only Boone County exchange health care insurance product in 2018, and Boone Hospital Center is the only hospital Cigna chose to participate in their insurance product. We welcome back everyone who had been previously forced to select a non-BJC/Boone provider in the exchange market place. At Boone Hospital Center and across the BJC HealthCare system, our employees are the core of everything we do. They’re the reason U.S. News & World Report has named us the #1 hospital in mid-Missouri for the last three years. They are highly trained, talented, compassionate, caring, competent, loving, fun and dedicated individuals who insist upon the best clinical outcomes and patient experience. In 2018, I encourage you to do your research before you select a health care provider. Good health can be your most important possession, and the selection of your health care provider is one of the most critical decisions you can make to ensure good health for you and your family. To assist you in your decision making, access any of the following websites and choose wisely – choose Boone! • health.usnews.com/best-hospitals/rankings • medicare.gov/hospitalcompare • carechex.com • consumerreports.org/health/hospitals/ratings

Jim Sinek President, Boone Hospital Center

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HOSPITAL HEADLINES

Boone Participates In Rose Parade Dedication Garden

Monica Smith, chief nursing officer and vicepresident of patient care services and ancillary operations, signs vial to be displayed at parade.

elebrating its 15th year, the Midwest Transplant Network Donate Life Rose Parade® float continues its mission to save and heal lives by sharing the gift of life and delivering the message of organ, eye and tissue donation to the world. One of the trademarks of the float is a “Dedication Garden” filled with thousands of roses, each placed in a vial carrying a personal message from an individual, family or organization. Hospital officials from across the area signed rose dedications on behalf of their hospitals and donors throughout October and November. These will be placed in the float’s Dedication Garden for the world to see during the Rose Parade on January 1, 2018.

Pulmonary Rehab Service Added in New Location

oone Hospital Cardiac Rehabilitation is now Boone Hospital Cardiovascular and Pulmonary Rehabilitation. The service has moved to 1601 E. Broadway in the lower level, joining the Boone Hospital’s WELLAWARE Fitness Center. This new, larger location allows the addition of pulmonary rehabilitation services designed to help patients with pulmonary disease or lung problems such as chronic obstructive pulmonary disease (COPD), emphysema, bronchitis, lung cancer or lung cancer surgery. The Boone rehab team provides monitored, structured exercise and health education to help patients control and reduce the severity of pulmonary disease symptoms and complications. Pulmonary rehabilitation can help patients increase their physical capacity and level of independence and improve their quality of life.

Boone Hospital Center Honored as a Top Nurse Employer in the State

oone Hospital Center was named one of Nurse.org’s Best Hospitals For Nurses to Work For in Missouri. Over the past two years, Nurse.org, one of the web’s leading career sites for nurses, has collected 1,118 workplace satisfaction surveys of nurses from 107 hospitals in Missouri. The data from the reviews revealed that Boone Hospital has one of the highest levels of job satisfaction among its nurses. Reviewers cited supportive coworkers, flexible scheduling and high patient satisfaction as the basis for the 4.2 star rating, with 95 percent of the nurses surveyed recommending the hospital as an employer. Nurse.org provides a safe platform for nurses to leave honest workplace reviews. Completely anonymous, nurses can share their opinions about culture, nurse-to-patient ratios, and other matters important to them.

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One nurse wrote in their review of Boone Hospital: “There is lots of teamwork within our hospital, and it’s a wonderful place to work! You can always feel comfortable to ask questions to other nurses and physicians.” “Making the list of top hospitals for nurses to work for shows that we are focused on nurse satisfaction,” says Monica Smith, Boone Hospital Center chief nursing officer and vice-president of patient care services and ancillary operations. “At Boone Hospital, we are dedicated to empowering our nurses and to improving their work environment. Shared decision-making, nurse-led councils and committes, and financial support for nurses looking to further their education are just a few of the ways we value our incredible nurses.” The full rankings of the Best Hospitals in Missouri for Nurses is available to view at https://nurse.org/articles/best-hospitalsmissouri-nurses-2017/.

Turkey Trax

oone Hospital Center sponsored the Turkey Trax 5K for the third year. The race, put on by Ultramax Sports, is held annually on Thanksgiving morning. This year’s race featured 1,450 registered runners. Seth Brown recorded the fastest time at 16:51. Nicole Hirner was the fastest female finisher, with a time of 19:15. For more information on this year’s race or to register for next year, visit ultramaxsports.com/events/turkey-trax.

Boone Medical Group Osage Beach Opens

oone Hospital Center and the Boone Medical Group are pleased to announce Boone Medical Group Osage Beach is now open, providing primary family and pediatric care and specialty clinic services. Paul E. Bernabe, MD, and Maria Bernabe, MD, have been in practice for more than two decades and have seen patients for the last 12 years in Eldon, Mo. Both physicians are passionate about caring for their patients and look forward to continuing their work in Osage Beach. Dr. Paul Bernabe graduated from University of Santo Tomas in 1990. He completed a residency at Cook County Hospital in Chicago and is board-certified in family medicine. Dr. Maria Bernabe graduated from the University of Santo Tomas in 1989 and also completed a residency at Cook

County Hospital in Chicago. She is board-certified in pediatrics. The Osage Beach location is Boone Medical Group’s 15th clinic in midMissouri, joining locations in Ashland, Boonville, Centralia, Columbia, Glasgow, Hallsville, Mexico and Moberly. The 6,400-square-foot clinic includes 14 exam rooms and space available for specialty clinic services. Clay Mechlin, MD, and Michael Hoeh, MD, of Urology Associates, Boone Hospital Center’s affiliated urology group, will practice in the clinic every second Friday and fourth Tuesday of the month. To schedule an appointment with Urology Associates, please call 573-499-4990. Boone Medical Group Osage Beach is located at the Osage Beach Hy-Vee store at 929 Highway D. To schedule an appointment today, call 573-392-5606.

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Run. Walk. Honor. Molly’s Miles raises money to support families of law enforcement officers killed in the line of duty.

Lt. Buddy Anliker of the University of Missouri Police Department and his wife, Christie, were out for a run shortly after the 2016 shooting in Dallas, Texas, where five police officers were killed. “We were talking about that event and we both said, ‘We have to do more. We have to do something different,’” Buddy says. Both avid runners, they decided to plan a 5K to raise money for the Missouri chapter of Concerns of Police Survivors (C.O.P.S.), which provides resources to assist surviving families and co-workers of law enforcement officers killed in the line of duty. What better way to honor those individuals than naming the race after one of Columbia’s own? Buddy wanted to honor Officer Molly Bowden, a city of Columbia police officer who was killed in the line of duty in 2005. And why not start and finish the run at Molly Bowden Memorial Park? Thus, Molly’s Miles was created.

REMEMBERING MOLLY

Buddy and many MU PD officers worked with Molly for a year before she moved to Columbia Police Department. “There

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were a lot of us at the University Police Department that had that connection with Molly. Once the tragedy happened, it really touched a lot of us,” Buddy says. The Anlikers got permission from Molly’s husband, Cory, and her parents, Dave and Beverly Thomas. Beverly says she knew it would be a great way to honor Mid-Missouri’s law enforcement and wanted to get involved. “Not that anyone would ever forget Molly, but sometimes what happens in these cases is there’s a lot of emotion and support when the incident happens and a few months after,” Buddy says.

“After that, a lot of that kind of drops off, unfortunately. In Molly’s case that’s never been the case. Columbia’s been an amazing community that has always rallied around her and her family.” The cause, providing funds to Missouri C.O.P.S., was a project near and dear to the Thomas’ hearts. They’ve been involved with the organization for almost 13 years. “It gets out to the community how much our law enforcement is in need of support,” Beverly says. “I, like a lot of people, had never heard of that organization until we lost our daughter. And they do, they give you so much support.”

Molly’s Miles 5K/10K • April 7, 2018 • Molly Bowden Memorial Park • 900 W. Nifong Blvd. • MollysMilesRun.com • Benefitting Missouri Chapter of Concerns of Police Survivors (C.O.P.S)

SUPPORTING THE FAMILY

Buddy has been a police officer for 28 years. Molly’s Miles is personal for him, his wife, and his three children. Every day he goes to work, he could face lifethreatening situations. “It really resonated with my wife that she felt that we have to do something for the survivors, those that are left behind,” Buddy says. “The Missouri C.O.P.S. motto is ‘Honor the Survivors.’ This was a way that we could do that.” The first Molly’s Miles was held in 2017. Buddy remembers when he pitched the idea he thought it’d be a good start to get 200 or 300 runners. Instead, 1,000 runners participated and Molly’s Miles donated $26,000 to Missouri C.O.P.S. “It was just overwhelming how many people signed up and were there. We had just so many people in Columbia, businesses that wanted to support it,” Beverly says. “It was really overwhelming. We’ve just been so humbled by the way the community has supported us during the loss of our daughter.”

Officers from departments all over Mid-Missouri and the state ran in that race, as well as families and community members. Survivors put medals on runners at the finish line. It was an emotional day for the family of the blue, and they leaned on each other. Because of Molly, Beverly and David will forever be part of that law enforcement family. “Our daughter’s left us with quite a family that takes care of us so much,” Beverly says. “They’ve just adopted us, and we just love them all. They’re out there every day putting their lives on the line, never knowing what’s going to happen.” “As much time as we spend together and sometimes in situations where we have to lean on each other like a family, it was very emotional,” Buddy says. “I found myself a few times fighting back the tears.”

LOOKING AHEAD

The 2018 race will take place on April 7, and in addition to a 5K, there will be a 10K race. Molly’s Miles will also offer a virtual run this year after out of state runners expressed

interest in participating. Each participant will receive a challenge coin keepsake with Molly’s picture on it. Buddy says they hope to raise $30,000 to $35,000 this year. With help from a committee made up of civilians and representatives from departments across Mid-Missouri, title sponsor Landmark Bank, location sponsor Boone Hospital Center, and many others, it’s going to be another great race in Molly’s memory. Law enforcement is a calling, Beverly says. It certainly was for Molly. Beverly recalls receiving letters after Molly died from people she’d arrested. Molly would talk to them, try to help them as much as she could. “She just wanted to help people and love them,” Beverly says. When asked what Molly would think about the race, Beverly’s voice swells with a mother’s pride. “She would be in the front of the line running, and she would be so excited to see law enforcement honored in this way. She would just be right in the middle of it and be smiling her big smile.” By Brenna McDermott

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CANCER SECTION

“WE HAVE TO FIX IT.” Dr. Bud Murphey wants patients to learn from his experience with early prostate cancer detection.

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Hear Dr. Murphey’s story at youtube.com/boonehospital.

athaniel “Bud” Murphey, MD, of Boone Medical Group Ashland, is well known in his community and is loved dearly by his patients. He has practiced medicine for more than 35 years in mid-Missouri and has been in Ashland for more than 20 years. While he’s known for caring for the health of many, some may not know that the doctor recently overcame a major health scare himself. Dr. Murphey has a family history of prostate cancer, so he knew he had an elevated risk of developing the disease. He made sure to get regular prostate-specific antigen (PSA) tests. A PSA test is a blood test that screens for a protein produced by both cancerous and noncancerous tissue in the prostate. If a patient’s PSA levels are high, prostate cancer could be a reason. “My tests always came back a little bit high, but then, over a period of six months it increased dramatically, and we knew what the problem probably was,” says Dr. Murphey. Dr. Murphey was treated at Urology Associates of Central Missouri by Michael Cupp, MD. “The PSA test, while imperfect, is still our best tool for early prostate cancer detection. Many of the weaknesses of the test are being actively addressed, and we continue to recommend intelligent use of PSA testing,” says Dr. Cupp. Dr. Murphey underwent biopsies after receiving his results, which confirmed he did have prostate cancer. “I just said, ‘Rats. We have to fix it,’” says Dr. Murphey. He chose to have surgery to treat his cancer instead of radiation and hormone manipulation therapy.

“I was able to have surgery to cure the cancer, since we found it early and it had not spread,” he says. Dr. Murphey had his prostatectomy at Boone Hospital Center. Boone Hospital provides robotic prostatectomies, a minimally invasive treatment that typically results in less blood loss and quicker recovery than traditional surgery. The surgery was successful and the doctor is back to treating his patients. “I love my job. I’ve been here so long I know my patients very well. I know their background and often also know their family,” says Dr. Murphey. Dr. Murphey says he often shares his personal experience about prostate cancer to encourage his patients to get screened. “It’s their choice, but I know how important it is to catch these things early,” he says. Dr. Murphey says he lives every day happy to be alive and cancer-free. By Madison Loethen

“The PSA test, while imperfect, is still our best tool for early prostate cancer detection. And many of the weaknesses are being actively addressed.” MyBooneHealth.org

CANCER SECTION

Fighting for a Firefighter Community members joined together to send firefighter and cancer patient Marc Wright to New York City to ride along with Rescue 1. Marc Wright dedicated his life to serving his community. He spent his 25-years-plus career serving with both the Columbia Fire Department and Boone Hospital Center Emergency Medical Team. So when the community learned that Marc was fighting cancer, of course people wanted to return the favor. Marc first learned of his cancer in 2014, when he was diagnosed with colon cancer. He underwent surgery to remove a softballsized tumor, which was followed by chemotherapy. After 12 rounds of chemo, Marc found out his cancer had moved to his liver. He underwent a 17-hour surgery to remove the two tumors that had developed. This was followed by another 12 rounds of chemo. His tests came back clear for a few months, but the cancer then returned to his liver, leading to more chemo. Marc now has cancer in his liver, two lymph nodes, and one of his lungs. Marc receives treatment at Missouri Cancer Associates from Mark Tungesvik, MD, someone Marc says has truly helped him through his journey. “Dr. Tungesvik has just been fabulous,” he says. “We’re fortunate to have such great doctors here in mid-Missouri.” Dr. Tungesvik says it has been a pleasure to get to know Marc, and he now considers him family. “He is a joy to be around. The true nature of a man is revealed when he is confronted with extraordinary challenges. Marc has proven himself to be a strong man of faith. He is an inspiration to us all. To walk with him in his journey, to share in his adventure, is an honor — may we all be as strong as Marc when we’re put to the test,” says Dr. Tungesvik. Marc’s friends Tommy Goran and Jeff Strawn, from the Columbia Fire Department, came up with the idea for a fundraiser to Marc. They wanted to have a dinner and auction to raise money to send him to New York City to ride along with the New York Fire Department’s Rescue Company 1, something that has always been Marc’s dream. 12

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Hear from Marc at youtube.com/boonehospital.

“When they first came to me with the idea, I wanted to say no because those guys have already done so much for me. But they insisted, and I was overwhelmed by the kindness of my friends,” says Marc. The fundraiser was held in October and was a huge success. Hundreds of people turned out to support Marc. People and businesses from all over midMissouri made donations. The event ended up raising around $15,000 — $12,000 more they needed. The additional funds are being donated to charitable organizations in the community. Marc says his trip was awesome. He spent a whole day riding along with Rescue 1 and was also able to visit the National September 11 Memorial. “The trip was amazing,” Marc says. “The 9/11 Memorial was overwhelming. I just tried to take it all in and think about what that day meant for our country and those who serve. Riding along with Rescue 1 was a tremendous experience. I made a lot of new friendships. The fire station has such an amazing history.” Marc says he will always be grateful for the community allowing one of his dreams to come true, but for now, he’s just happy to be back home with the people he loves. By Madison Loethen

Marc Wright, center, with event organizers Tommy Goran and Jeff Strawn. The event raised more than $15,000.

About the Stewart Cancer Center The Stewart Cancer Center at Boone Hospital offers a continuum of services for the prevention, detection, diagnosis and treatment of cancer, as well as rehabilitative and hospice services. The Stewart Cancer Center is accredited by the American College of Surgeons and receives approximately 2,000 patient admissions for primary or secondary diagnosis of cancer each year. The center includes a dedicated medical oncology unit with 32 beds for when hospitalization is required; however, most cancer treatments, including chemotherapy, blood transfusions, IV fluids, antibiotics, and pain management, can be provided on an outpatient basis. The oncologists at the Stewart Cancer Center are part of Missouri Cancer Associates.

MyBooneHealth.org

CANCER SECTION

t’s almost never too early to start. Whether you’ve just been diagnosed, are going through treatment, or are post-treatment, these eight behaviors can help boost your health. Your doctor can help guide you, but the only limitation, really, is when you want to start. Begin with one or two; once you’ve got those down, move on to the others.

1. Don’t Smoke

You’ve heard it before, of course. But, if you smoke, the single best thing you can do as a survivor is stop. It’ll lower your risk of developing a second cancer as well as heart disease and stroke. Yes, it’s hard. But it’s far from impossible. • Keep trying! It often takes six or seven tries before you quit for good. • Talk to a health care provider for help — it can double your chances of success. • Call 1-800-QUITNOW or visit smokefree.gov for extra help. • Join a quit-smoking program. Your workplace or health plan may offer one.

2. Avoid Secondhand Smoke

If you don’t smoke (and even if you do), stay away from secondhand smoke. It’s not as bad as smoking itself, but spending time in smoky places can further raise the risk of cancer as well as heart disease. • Avoid smoky bars and restaurants. • Try to work in a non-smoking workplace. 14

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• Make your house non-smoking and don’t give in: not to spouses, to kids, or to friends.

3. Exercise Regularly

It’s tough for a lot of people to fit exercise in to their schedules. For survivors whose regular routines have been so interrupted and who may have just gone through treatment, it can be even tougher. But, the benefits of regular activity make it well worth the effort, even for those in the middle of treatment. It not only boosts health, but it also improves mood and helps counter cancer-related fatigue. Regular exercise may lower the risk of recurrence and help cut the risk of other chronic diseases. Try to get at least 30 minutes of aerobic activity (like brisk walking) every day. More is even better. It’s also important to fit in strength training. Build up to 2 or more times per week. • Choose activities you enjoy. Many things count as exercise, like walking, gardening, and dancing. • Make exercise a habit by setting aside the same time for it each day — try going to the gym each day at lunchtime or taking a walk regularly after dinner. • Stay motivated by exercising with someone. • Start slowly with any new program, and don’t be shy about asking for help.

4. Maintain a Healthy Weight

With the stress, treatment side effects, and changes to life’s routine that a cancer diagnosis can bring, it can be hard for survivors to keep their weight in check. Still, maintaining a

Download this information at boone.org/8WaysAfter

healthy weight — or at a minimum, not gaining weight — is an important goal that all survivors should shoot for. Next to not smoking, it’s the single most important thing you can do to improve your health and quality of life. • Limit time in front of the TV and computer. • Integrate physical activity and movement into your life. • Eat a diet rich in fruits, vegetables, and whole grains. • Choose smaller portions and eat more slowly.

5. Eat A Healthy Diet

As a survivor, it can be tough to know how you should eat. Books and articles and websites spout “wonder diets,” but the reality is that healthy eating is the same for cancer survivors as it is for everyone else. A healthy diet can help keep weight in check, give your body the nutrients it needs, and provide the energy you need to make it through a busy day. You should focus on fruits, vegetables and whole grains, and keep red meat and processed meat to a minimum. It’s also important to cut back on bad fats (saturated and trans fat) and choose healthy fats (polyunsaturated and monounsaturated fats) more often. Taking a 100 percent DV multivitamin with folate everyday is a great nutrition insurance policy. • Make fruits and vegetables a part of every meal. Put fruit on your cereal. Eat vegetables as a snack. • Choose chicken, fish or beans instead of red meat. • Choose whole-grain cereal, brown rice, and whole-wheat bread over more refined choices. • Choose dishes made with olive or canola oil, both of which are high in healthy fats. • Cut back on fast food and store-bought snacks (like cookies), which are high in bad fats. • Follow food safety steps to avoid food poisoning.

6. Drink Alcohol in Moderation or Not at All

Alcohol can be a complicated issue, especially for survivors. Moderate consumption can be heart healthy — a big benefit — but at the same time increase the risk of a later cancer. On top of this, alcohol can become an unhealthy way to deal with the physical and emotional stress of dealing with cancer. If you don’t drink, don’t feel the need to start. If you do, keep it to moderate levels (one drink per day for women; one or two drinks per day for men). Those who drink more should cut back. • Choose non-alcoholic beverages at meals and parties. • Avoid occasions centered around alcohol. • Talk to a health care professional if you feel you have a problem with alcohol.

7. S tay Connected with Friends, Family, and Other Survivors

There is real power in staying connected with friends, family, and other cancer survivors. Keeping up and building on a social network can significantly improve quality of life, and possibly even prognosis, in cancer survivors. Even in those with great support from family and friends, cancer can seem isolating, so it can take some effort to keep up these relationships. • Schedule a time each week to get together with friends or family. • Go regularly to survivors’ support groups, which can be great places to share feelings and concerns with those who’ve been through similar things. • Use technology to your advantage. Social media, real-time video, and good old-fashioned telephones and email are great ways to connect with family, friends, and other survivors.

8. G et Screening Tests and Go to Your Regular Check-ups

As a survivor, there’s nothing more important than going to your regular post-treatment check-ups with your primary care doctor and oncology team. These visits are not only key to your health as a survivor but also great places to share any concerns or questions you have about your health. Become a team with your doctors to manage your health needs. In addition to any follow-up tests specific to your cancer, it’s also important to keep getting recommended screening tests for other cancers and for heart disease, diabetes, and osteoporosis. Talk to your doctor about tests that screen for: • Breast cancer • Colon cancer • Cervical cancer • Lung cancer (if you have a history of heavy smoking) • Hepatitis C (if born between 1945 and 1965) • High blood sugar • High blood pressure • Unhealthy blood cholesterol • Osteoporosis Also key is keeping up with any medications you’ve been prescribed — those related to your cancer and to other health issues. If you’re having trouble sticking with your medications, talk to your provider. Together, you can make a plan to get back on track. Information provided by Siteman Cancer Center

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Health Care Finances Clearing the fog and finding your best options.

Few things can complicate a person’s finances as much as unexpected medical expenses. In a 2016 survey conducted by the New York Times and the Kaiser Family Foundation, 26 percent of adults ages 18 to 64 say they or someone in their household had problems paying medical bills in the previous year. And while the number of Americans without health insurance has declined over the last decade, insurance plans can still be insufficient to cover certain medical costs — in the same survey, about a fifth of adults with some form of health insurance also reported problems paying medical bills. Understanding the variety of costs that can accompany a medical emergency — or even just routine maintenance of a chronic health condition — is crucial to staying financially healthy while keeping yourself physically healthy too. Here, we break down some of the different options for handling your medical finances.

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Medicare and Medicaid

In 2016, all Medicare plans (meaning both original Medicare and supplemental coverage, like Medicare Advantage) provided benefits to more than 1.1 million Missourians; as of November 2017, Medicaid covered more than 690,000. The two programs are designed to lower health care costs for, respectively, the elderly and disabled and those living in poverty, and if you qualify for either, the costs are generally easier to handle than private insurance. But even under government-supported health coverage, out-of-pocket costs can still add up, and it’s important to budget accordingly. Medicare enrollees still have to pay deductibles ($1,316 for Medicare Part A in 2017), co-insurance costs for hospital stays longer than 30 days, and, depending on how long you’ve paid Medicare taxes, monthly premiums. Medicare Part A and Part B also don’t cover most dental care, hearing aids, or long-term

Medicare A health insurance program administered by the federal government and designed for the elderly, people with disabilities, and other qualifying groups.

Medicaid A federal insurance program administered by states and designed for low-income individuals and families.

Deductible The amount an individual is required to pay out-of-pocket before their health insurance begins paying for care.

Co-pay The one-time out-of-pocket amount that an insured individual pays for medical services.

Co-insurance The percentage of cost for health care services that an individual pays out-of-pocket after their deductible has been met.

custodial care like the services found at assisted living facilities or nursing homes. Depending on which services you receive, Missouri’s Medicaid program may also require some out-ofpocket costs, although they’re generally required to stay relatively low. Medicare patients have the option to purchase Medicare supplement plans, usually in the form of a Medicare Advantage plan, from a private insurer that helps cover some of the gaps. (This is sometimes called Medicare Part C.) While a supplemental plan can help you cover some of what Medicare misses, it will also increase your monthly out-of-pocket expenses through premiums.

Private Insurance

For those who don’t qualify for Medicare or Medicaid, there are, essentially, three possible ways you’ll pay for health care costs: an employer-sponsored group coverage plan, an individual plan, or by going uninsured. There are a number of factors to consider when choosing an individual plan, and finding the right balance of monthly premiums, deductibles, and co-pays largely depends on your personal situation and the options available to you. Many companies offer group insurance plans as part of an employee’s benefits package. Under these plans, the employer does research and picks a health care plan from an insurance provider for the whole company. The employer also splits the cost of monthly premiums, defraying some of the outof-pocket expenses. But for some smaller companies, or for entry-level or part-time positions, group coverage isn’t an option; these people then look to a personal health policy. Some individual shoppers will be eligible for a government subsidy to buy an insurance plan that’s compliant with the Affordable Care Act, but you can also purchase a personal plan directly from an insurer. You could also, of course, run the risk of going uninsured. For young, healthy people, this can be a tempting option, particularly if your other choices are insurance plans with high deductibles that would essentially leave you on the

hook for all of your annual bills anyway. Under the Affordable Care Act’s “individual mandate,” going without insurance would cost a monthly fee (usually 2.5 percent of your income), which then goes to stabilize the market by offsetting some of the costs of the government-subsidized individual insurance plans. But the U.S. Congress is currently debating a repeal of the individual mandate as part of its tax reform package, meaning that in the coming years, going without insurance could carry no penalty at all. But this is, of course, a mighty risk to run. With all medical costs coming out-of-pocket, uninsured Americans are just one emergency away from financial catastrophe. In 2016, according to a different Kaiser Family Foundation survey, nearly 30 percent of uninsured respondents said they had problems paying or were unable to pay their medical bills, compared to 14 percent of those with insurance. Three in ten uninsured respondents said they were paying off at least one medical bill over time — from your checkbook’s perspective, that’s pretty much the same thing as paying a monthly premium.

Health Savings Accounts

Whether you have insurance or not, almost everyone has some financial vulnerability when it comes to the costs of their health care — which is why it’s so pivotal to budget for saving money. Savings can help you meet your deductible or cover co-pays in the event of a serious injury or medical emergency, or they can help you pay for care that’s not covered by your insurance plan. You can also look into a health savings account, or an HSA. In Missouri, if you have a high-deductible insurance plan, you may qualify for a tax-protected savings account that can serve as a guardian angel of sorts when it comes to your finances. HSA balances roll over from year to year and job to job, meaning that you can accumulate enough money to help pay off your deductible when you need your insurance — and all contributions to your HSA are 100 percent taxdeductible. By Matt Patston

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WELLAWARE

What I Learned from Whole30

ver the last few years, I’ve received questions about the Whole30 diet. The more questions I got, the more I wanted to learn about it. And, for me, the best way to learn about a diet is to go on it. To start, I read “It Starts with Food” and “The Whole30,” the book on which the diet is based. The Whole30 diet is basically, as the name implies, eating only whole foods for 30 days. This is a short-term elimination diet intended to help you “reset” your body so you can ultimately learn how foods affect your eating habits and overall health. The Whole30 diet is similar to the Paleo diet — both restrict grains, legumes, dairy and alcohol — but Whole30 is slightly more restrictive and eliminates all sugars and sweeteners, natural or artificial. For most people, it’s not an easy plan to follow. I learned very quickly that sugar is in everything. As a dietitian, I know sugar is added to foods, but even I sometimes forget the extent! Whole30 had me looking for added sugars (i.e., sugar, words ending in -ose, syrup, juices) in the ingredients more closely than I normally would. Bacon, sausage, and spice blends are foods I’ve eaten in the past without thinking about added sugars. I quickly learned

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it’s hard to find bacon or sausage without sugar. I also learned I didn’t need to use as much sweetener as I thought I did. Another thing I learned while trying to eliminate sugar is that eating out socially is more challenging. Sweets or desserts are typical go-to foods for celebrations or when we’re feeling stressed, angry, bored or depressed. Eliminating sugar forces you to find other ways to deal with all these emotions — more often than not, that means facing them without food. Besides adding sweetness, sugar is used for texture, mouthfeel, fermentation and preservation. Before going on the Whole30 diet, I thought eating out wouldn’t be that challenging because meat and vegetables are allowed. But I didn’t think about how often restaurants add sugars to meats, salad dressing and even vegetables. While I did eat out on the Whole30 plan, it was definitely less often. Typically, I’m not a fan of diets that eliminate whole food groups. However, I’ve learned over the years that defined rules can sometimes help people. I found this to be true for myself on the Whole30. Moderation is hard to define. (Is once a week in moderation? Or twice a week?) Often, we tell ourselves we’re eating something in moderation when we’re not. I’ve had patients tell me many times,

Sugar has many names! • Anhydrous Dextrose • Barbados Sugar • Barley Malt • Beet Sugar • Blackstrap Molasses • Brown Rice Syrup • Brown Sugar • Buttered Sugar (Syrup) • Cane Juice • Cane Juice Crystals • Cane Sugar • Caramel • Carob Syrup • Castor (Superfine) Sugar • Coconut Sugar • Confectioner’s Sugar

• Corn Syrup • Corn Syrup Solids • Crystalline Fructose • Date Sugar • Demerara Sugar • Dextran • Dextrose • Diastatic Malt • Ethyl Maltol • Evaporated Cane Juice • Florida Crystals • Fructose • Fruit Juice (Concentrate) • Galactose • Glucose • Glucose Solids

“I know I just can’t have this certain food because I can’t eat it moderation.” Before I did the Whole30, I drank diet soda in what I told myself was moderation. When I went on the Whole30 and told myself “You can’t have diet soda,” I didn’t have any for a whole month. Sometimes having a rule helps! The Whole30 is about eating whole foods — and eating whole foods takes work. We eat so many processed foods because they’re convenient and typically quick and easy. To be successful on a plan like the Whole30, you have to prep and plan ahead. This a

• Golden Sugar (Syrup) • Grape Sugar • High Fructose Corn Syrup • Honey • Icing Sugar • Invert Sugar • Lactose • Malt Syrup • Maltodextrin • Maltose • Maple Syrup • Molasses • Muscovado • Oat Syrup (Avena Sativa) • Organic Raw Sugar

good thing. For most people, food takes a backseat to other things, even though how we fuel our body is an important part of our overall health. As a dietitian, I eat pretty healthy, but I still have some of the same bad habits that everyone is prone to. Being on the Whole30 forced me to think more about my food choices and spend more time planning, which led to consistently better food choices. With many of my usual breakfast options eliminated, I struggled to figure out what to eat for breakfast. Like most people, I don’t like to spend a lot of time on breakfast, so I

• Panela • Panocha • Penuche • Rasparadura • Raw Sugar • Refiner’s Syrup • Rice Malt • Rice Syrup • Sorghum Syrup • Sucanat • Sucrose • Sugar • Tapioca Syrup • Treacle • Turbinado Sugar (Syrup) • Yellow Sugar

leaned heavily on eggs as my breakfast option. In the most recent version of the dietary guidelines for Americans, the limit on dietary cholesterol was removed because saturated fat intake, weight, and inactivity have a bigger impact on your blood cholesterol. This should mean eating eggs everyday shouldn’t have much effect on cholesterol. Unfortunately, for me, this did make my cholesterol go up 30 points higher than normal. Since eggs are a great protein source and are quick and easy to prepare, I’d still be OK with someone eating them often, but I’d encourage them to eat fewer whole eggs and more egg whites to reduce cholesterol. If you’re thinking about trying the Whole30, I say go for it! Just remember, it’s the Whole30, not the Whole365. This diet restricts too many foods to be sustainable for the long haul for most people. Also, the Whole30 is ultimately not a weight loss plan, although you may drop a few pounds. This diet can help you think more about your food and lead to more planning and prepping. You may also break a few bad habits and develop a few better eating habits, like eating more whole foods. You can’t go wrong with that! By Jennifer Anderson, RD, CDE, Boone Hospital Center registered dietitian

MyBooneHealth.org

Taste Under Pressure This modern update on the pressure cooker lets you make healthy meals in an instant!

In the past, pressure cookers made me think of two situations – peacefully canning garden vegetables or kitchen explosions! Today, when someone says “pressure cooker,” I think of the Instant Pot – one of last year’s trendiest Christmas gifts – and easy shredded chicken on weeknights. The Instant Pot can make slow cooker recipes go a lot faster and gives pressure cooking a more functional and less intimidating reputation. Pressure cookers work by building up steam in a closed environment. This pressure allows a higher boiling point to be reached faster, making cooking two to six times faster while using up to 70% less energy. A pressure cooker cuts out the need to pre-soak beans and grains and lets you cook frozen meat without thawing, which can spare you a last-minute fast-food run on those evenings when time is short. As a dietitian, I like pressure cooking because it doesn’t use much water – just enough to keep the pressure cooker filled with steam. Less water means less vitamins and minerals are leached or dissolved away. Shorter cooking times also allow for less nutrient loss. Pressure cooking is a moist heat cooking option, so foods such as meats, grains, beans, soups or stocks work best with this method. Before you begin, Instant Pots need time to pre-heat and get to the needed pressure. Depending on the amount of food you’re cooking and the required

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temperature, preheating can take anywhere from a few minutes to over 40 minutes. Time is also required to release the pressure – you can do this naturally, by letting the machine slowly release pressure on its own, which may take 10 to 40 minutes, or by quick release, which goes a lot faster but can affect the taste and texture of your food. Considering the time it takes to build up pressure, I wouldn’t recommend using the Instant Pot for veggies that you can already cook quickly on the stovetop or in the oven, like steamed broccoli. But it works wonders on veggies that take longer to cook, like spaghetti squash or potatoes. The instant pot is not only a pressure cooker; it also lets you sauté, steam, make

yogurt, cook rice, slow cook, and keep foods warm. People tend to be overwhelmed at first with where and how to start using their Instant Pot. There are a lot of buttons and a new set of vocabulary words to get used to! Some trial and error is needed to know how much actual time a recipe will take from start to finish. Thankfully, the internet is brimming with meal ideas and advice for fearful newbies, including the popular Facebook Instant Pot Community Group, which anyone can join! Try getting acquainted with your Instant Pot by making this delicious recipe! By Kelsie Knerr, RD, LD; thekitchn.com; Jennifer Anderson, RD, CDE

WELLAWARE

INGREDIENTS

• 2 tablespoons olive oil • 1 pound Andouille sausage (I used chicken sausage), sliced • 2 onions, diced • 7 cloves garlic, minced • Tony Cachere’s creole seasoning, as desired • Salt and pepper, as desired • 1 rib of celery, diced • 1 green bell pepper, diced • 1 tablespoon dried basil • Pinch dried sage • 3 bay leaves • 1 pound dried red beans • 4 cups water • 1 scallion, thinly sliced • Leaves of 1 bunch fresh Italian parsley, finely chopped • Hot sauce, as desired • Cooked rice, for serving

Photography by Kelsie Knerr, RD, LD

1. Push “Saute.” Heat oil and add sausage in pot, stirring until well browned (about 7 minutes). Set sausage aside. You won’t add it back in until the very end. 2. Add onions to renderings and sauté until tender (about 5 minutes). 3. Add creole seasoning, salt, pepper, garlic, celery, and bell pepper to onions and sauté until translucent (about 3 minutes). 4. Add dried beans, basil, sage, and bay leaves and fully cover with water (about 4 cups or more). 5. Close lid and turn small black nob to “Sealing.” 6. Push “Cancel” to stop the sauté feature and push “Pressure Cook” and then

“Pressure Level” until the light changes to “High Pressure.” Use the plus button to go up to 35 minutes. You’ll hear three beeps when it starts pre-heating. 7. When the time is up, it will change to warming mode and the Instant Pot will slowly release the pressure on its own (natural release). When pressure is fully released, the circular silver float valve will be down. It’s now safe to open the lid. 8. Check beans by smashing a few against the side of the pot. If soft, they’re ready. If not, put it back on “Pressure Cook” for a few more minutes. 9. Once beans are soft, stir in cooked sausage, chopped parsley, sliced scallion, and hot sauce. Serve over cooked rice.

MyBooneHealth.org

Are you raising a newborn, infant or toddler? Do you have questions about feeding a picky eater or calming a fussy baby? Do you want to connect with other parents?

Bringing Up Boone Families Boone Family Birthplace provides breastfeeding support before and after your baby is born.

Countless studies have linked breastfeeding to multiple healthy advantages for babies and mothers. They’ve also shown that breastfeeding is more likely to be successful when breastfeeding mothers receive support. At Boone Family Birthplace, breastfeeding is encouraged immediately after birth with skin-toskin care in the delivery or C-section room. In the postpartum unit, mothers of newborns receive personalized teaching and support from registered nurses specially trained as lactation consultants. A lactation consultant provides support, instruction and education for breastfeeding mothers. They visit with mothers and newborns on the postpartum unit, if needed, to make sure baby is latching on properly, answer questions and help if there is any difficulty or pain. They can offer supplies such as support pillows and breast pumps if needed. “Sometimes if mothers come up against an obstacle while breastfeeding, they’re more easily discouraged. They really need encouragement and someone to bust the myths,” says Maria Bickell. Maria has been a labor and delivery nurse at Boone Hospital Center since 2012 and a nurse for over 11 years. In 2017, she received additional certification as a lactation consultant. Her new role complements her knowledge and skills. “A lot of factors, like how the delivery went or the baby’s condition, can affect breastfeeding. It helps to have a good understanding of the patients’ whole picture,” Maria says. “I meet with new mothers to ask how things are going – you can assess a lot based on what they say and what you see and can get a gauge on who needs help.”

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Bringing Up Boone Babies is a monthly support group provided by Boone Family Birthplace. Each hour-long session is led by a nurse and includes a short presentation on a different topic followed by open group discussion. Topics include feedings and nutrition, sleep habits, babywearing, infant massage, milestones, exercise and play, emotional health and safety. Bringing Up Boone Babies is free and open to all parents of newborns, infants or toddlers. No registration is required. Bring your baby or child with you! Bringing Up Boone Babies meets monthly from 10 to 11 a.m. at Boone Hospital Conference Center. For more information, visit boone.org/ BringingUpBooneBabies This two-hour class costs $25. To register or for more information about Boone Family Birthplace's Life Education programs, please call 573-815-6400 or 800-872-9008.

For more information, visit boone.org/birthplace

Boone Family Birthplace nurses, Tara Phillips and Maria Bickell, also support new mothers as lactation consultants.

One of biggest myths about breastfeeding is that it’s instinctive, meaning it doesn’t have to be learned. This myth can frustrate and discourage mothers who experience difficulty at first. The truth is that breastfeeding is a learned behavior for baby and mother alike. “Even though breastfeeding is a natural thing, you’re dealing with one human body and another human body, and that’s a very complex situation. I think it’s super helpful to have somebody who knows a lot about breastfeeding,” says Emily Nussbaum. Emily has been a nurse with Boone Hospital Center since 2000 and is a certified lactation counselor. Emily has also led the monthly Better Beginnings with Breastfeeding class at Boone Hospital Center for five years. The class helps prepare expectant mothers for breastfeeding and addresses their concerns. “People who come to our classes are usually worried. They’ve had friends who told them breastfeeding didn’t work – ‘It

was hard’ or ‘It hurt a lot.’ I hear many expectant mothers say, ‘I’m going to try to breastfeed.’ I want to help them change that to ‘I’m going to breastfeed’ and have more confidence in their abilities,” Emily says. Emily encourages expectant mothers who want to breastfeed their baby to learn as much as they can before baby is born. “If you plan to breastfeed, I would encourage you to take a class or read a book to learn more about breastfeeding. When you start out, breastfeeding can be overwhelming and can make you feel almost disenchanted. If you’re prepared with the right information and the right expectations, that could make it easier.” A third nurse, Tara Phillips, is currently preparing to become certified as a lactation consultant, so new mothers will be able to get breastfeeding support whether they’ve had their baby day or night, weekday or weekend. New mothers can contact the lactation consultants if they have questions after going home.

“I like that patients know they have our support whenever they need it. Breastfeeding is hard for almost everybody, but so worthwhile,” says Maria. “It’s okay that it’s hard. That’s why we’re here to help you.” Parents seeking continued support after leaving the hospital can also attend Bringing Up Boone Babies, a monthly support group at Boone Hospital for parents of newborns, infants and toddlers. Parents are welcome to bring their babies with them to meetings. Each meeting includes a brief presentation on a variety of topics and a discussion period. “Parents come with questions, especially in the early weeks, about breastfeeding, introducing solids, supplementing — and a lot of questions about sleeping!” says Emily, who leads the groups. The support group also has a Facebook page, where discussions and networking can continue between meetings. By Jessica Park

MyBooneHealth.org

GETTING TO KNOW A BHC DOCTOR

Paul Bernabe, MD

was born in the Philippines and finished medical school at the University of Santo Tomas in 1989. I then moved to the United States to study in a family medicine residency at Cook County Hospital in Chicago and have been in practice for more than 20 years. I am married to Dr. Maria Bernabe, and we were blessed with four wonderful children : Justin, Josef, Jeremy and Jillian. I was only 5 years old when I knew I’d be a physician someday. Growing up in a family of five children, I learned at an early age about the facts of a blood disorder called hemophilia. We were four rambunctious boys blessed with one little sister. However, much to my despair, all three of my brothers were stricken with hemophilia, a hereditary bleeding disorder that only manifests in males. I didn’t know back then that I was the “lucky one,” since I was the only one spared of the disease. Seeing my brothers slowly suffer from this disabling and deadly disease because of a lack of available Factor VIII, due to the high cost, I knew I had to do something and learn more about the disorder. It lit a fire inside me and a burning desire to pursue medicine — the disease had taken a toll on all of my brothers, leaving just me and my sister behind. My sister eventually became a registered nurse. Family practice was a perfect fit for me because I’m comfortable around both children and adults. I’m especially interested in performing minor surgeries in the clinic, and it offers me much fulfillment and joy when I’m able to restore function in an ailing body.

What is the most rewarding aspect of your job? The most rewarding part of taking care of my patients is knowing I’m able to make difference in their lives, especially with their health issues. It is an exhilarating feeling when I get a big smile and a “thank you” for making people feel a whole lot better. What is the most challenging aspect of your job? Practicing and keeping up with evidence-based medicine is quite challenging. I have to continuously keep up with the evolving phases of medicine. I believe that health care changes in the future will gear more towards preventative medicine. Electronic medical software will also upgrade at a fast pace. More physicians, I believe, will engage in telemedicine and more surgical procedures will be manned by robotic technology. What advice would you give someone looking to become a doctor? I would advise prospective doctors that if medicine is truly their passion, they should go for it! I would

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remind them, though, that it is a very demanding profession and you don’t always receive immediate rewards. What you you enjoy doing outside of work? I find joy and relaxation when I spend time with my wife and children on vacations. It gives me great pride when I watch my children play sports like football and swimming and see my little daughter dance on stage. I am also a water buff, and I enjoy fishing, boating and swimming. What advice would you give to someone who is going to be a patient in a hospital for a period of time? One piece of advice I tell patients who are going to be hospitalized for a longer period of time is for them to get involved with their own health. Ask questions and seek out the hospital that can best help them with their medical issues. Engage physicians in a discussion about their concerns and expectations. When there’s communication, there is an opportunity for better execution of the plan and management of their problem.

GETTING TO KNOW A BHC NURSE

Kelley Hanenberger, BSN, RN, CMSRN

was born and raised on a dairy farm in southern Illinois, where I learned the importance of hard work and responsibility. I received my bachelor’s degree in nursing at Southeast Missouri State University in Cape Girardeau where I worked on a cardiac unit for a few years until I met my now fiancé. We both moved to Columbia and made this town our home. Besides finding a house and raising our baby girl (Bailey Jo, a Jack Russell Terrier), I found a great opportunity at Boone Hospital Center’s cardiac catheterization lab. I’ve learned so much working here for the past two years. I’m delighted to work with great co-workers and skillful cardiologists every day and am happy to be a part of the cath lab team.

Why did you get into the health care field? It might sound like a cliché, but I knew I always had a passion to help people. I’ve always had a compassionate and caring attitude, which led me to the medical field. I started working as a nursing assistant in high school and into college. The experience I gained led me to choose nursing as my career. What interested you in your particular specialty? After working on a cardiology stepdown unit out of college, I fell in love with cardiac rhythms and cardiology in general. Once I moved to Columbia, I took a job on a medical surgical unit at another hospital. Still missing that cardiac aspect of nursing, I applied to Boone Hospital. With no positions available on the cardiac unit at the time, Kim Farris, nurse recruiter, suggested I shadow in the cath lab. She had it right! The cath lab is a fast-paced, thrilling, and rewarding place to help others. What is the most rewarding aspect of your job? Nothing is more rewarding than seeing a patient with an active STEMI [a type of heart attack] emergently arrive in the cath lab — perspiring, extremely sick and in severe pain — and then be able to leave the lab feeling completely like themselves again. Knowing that I was part of that team that helped heal that patient makes me grateful for what I do. What is the most challenging aspect of your job? The environment can get quite intense. As a cath lab nurse, I have to remember that what we do in the lab is often a matter of life and death. The patient’s status could change in seconds while they’re on the procedural table. It’s our duty as the cath lab team to see those changes and act quickly. What has changed in your field since you started practicing? Computer documentation has improved since I started eight years ago. Charts went from being five or more inches thick to being just a folder because the technology has vastly improved. Working specifically in the cath lab for two years, I’ve learned many

modern technologies and procedures. The cardiac support devices such as the Impella and ECMO; the EKOS, a thrombolysis assisted catheter for pulmonary embolisms; and multiple new and innovative stents and balloons for both coronary and peripheral intervention have all been put into practice at Boone Hospital. What do you see changing in the next five to 10 years? Technology will continue to improve the health care system. A patient’s length of stay in the hospital has become much shorter. With radial approach heart catheterizations and stent placements, patients will be able to walk out of the hospital the same day they arrived. There will be continued improvement on medication to prevent and treat heart disease. Many new devices will arrive to assist physicians in placing stents optimally. What do you enjoy doing outside of work? Besides playing frisbee with Bailey, I enjoy bike trips on the Katy Trail or to wineries (or trips that involve both). I also enjoy traveling to visit family and friends. I’ll go anywhere, from Florida to relax at a beach to Kentucky to hang out at the Derby. What advice would you give to someone looking to become a nurse? Being a nurse can be very different than what movies and TV shows show. I recommend shadowing different areas of nursing or starting as a nursing assistant or tech on a unit to really understand a day in the life of a nurse. Nursing has a multitude of opportunities and areas of interest. Keep an open mind and discover your passion. Once you find yours, then you can create your career. No matter what you choose, nursing is a rewarding, satisfying, and fulfilling occupation.

MyBooneHealth.org

Back Pain Prevention Pelvic Tilt (1 x

The following stretches and exercises can help you stretch and strengthen your muscles to prevent low back pain. Just about anyone can benefit from performing this routine. Make sure you perform these stretches and exercises with proper form. And always check with your physician before starting an exercise program. If you’re experiencing back pain, physical therapy offers a noninvasive, cost-effective, long term way to manage back pain or other conditions. At Boone Therapy, our highly skilled and experienced physical therapists use advanced technology and proven techniques to identify your problem and create a recovery plan. Boone Therapy has two convenient locations – at Boone Hospital Center’s main campus and at Nifong Medical Plaza in south Columbia – where you can work one-on-one with a licensed professional to achieve your goals!

d a y)

Lay flat on your back using a comfortable surface. Bring both knees up by placing your feet flat on the floor.

Tip your pelvis backward by pressing your low back flat to the surface. Hold this position for five seconds without holding your breath. Repeat 10 times.

Bridge (1x

d a y)

Lay flat on your back on a comfortable surface. Bring both knees up by placing your feet flat on the floor.

Lift your hips from the surface creating a bridge position by tightening your abdominals and buttocks. Attempt to create a straight line, as the arrow shows. Slowly lower your hips back down. Repeat 10 times.

Lower Trunk Rotation (2 x

1 Lay flat on your back using a comfortable surface. Bring both knees up by placing your feet flat on the floor.

d a y)

2 Keep shoulders flat on surface and rotate both knees to one side until you feel a gentle stretch in your low back and hips. Hold for 10 seconds and repeat five times on each side.

For more information, call 573.815.3868 or 573.815.6425 for the Nifong location, or visit boone.org/therapy

Single Knee to Chest (2x day)

Piriformis

Hamstring

Seated Rotation

(2 x day)

(2 x d a y)

Lay flat on your back on a comfortable surface.

Lay flat on your back on a comfortable surface. Cross heel over the opposite knee, forming a figure-4 position.

2 Bring one knee to chest towards your shoulder on the same side until you feel a stretch in your low back and buttock. Use both hands behind knee or on top of knee to hold leg in place. Hold for 30 seconds and repeat twice on each leg.

1 Start in a seated position at edge of a stable chair. Sit tall with good posture and place hands on hips. Place one leg straight out in front and prop heel on floor.

1 Start in a seated position with thighs supported by a stable chair. Sit tall with good posture.

2 Place both hands below knee and pull leg across your body toward the opposite shoulder until you feel a gentle pull in your buttock. Hold for 30 seconds and repeat twice on each side.

2 2

Why choose Boone Therapy? • One-on-one treatment from a licensed therapist • Up to hour long sessions • The latest therapy technology

Lean forward by leading with your chest until you feel a gentle pull in the back of your thigh. Hold for 30 seconds and repeat twice on each leg.

Twist upper body towards the left side and place right hand on the outside of left thigh. Pull until you feel a gentle stretch through your back. Hold for 30 seconds and repeat twice to each side.

• Direct access to Boone Hospital Center resources • Diverse mix of specialists collaborating for best results MyBooneHealth.org

Good Night, Sleep Right! Insomnia can take a toll on your health. Find out why you might not be sleeping soundly.

As a kid, you resisted going to bed. Now that you’re grown up, you set your own bedtime, but when it comes to how much sleep you need, your body still makes the rules. Sleep lets your body and brain restore itself so you’re ready to go the next day. And, like a balanced diet and regular exercise, sleep is vital for a healthy lifestyle. “If you are sleep-deprived, you are neglecting a major component of your health,” says Tareq Abu-Salah, MD, a sleep medicine specialist with Boone Pulmonary Clinic. Sleep medicine specialists diagnose and treat patients with insomnia, sleep apnea, restless legs disorder, sleepwalking, narcolepsy, and other conditions that disrupt sleep. Most adults need about 7 to 8 hours of sleep every night, but most of us don’t get enough. Ambitious schedules, stress and electronic devices make it easy to skimp on sleep. Interrupted sleep also makes you exhausted. During sleep, your brain cycles through different stages, including REM and deep sleep. When your brain wakes up, your cycle is interrupted and you can miss those restorative sleep stages. Too little sleep can affect your mood, judgment, decision-making

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and concentration. Poor sleep can also make you gain weight, because it affects the hormones that regulate appetite. “Sleep deprivation makes people hungry all the time,” Dr. AbuSalah explains. “It’s difficult to lose weight when you are sleepdeprived. You mainly crave junk food when you are sleep-deprived, not healthy food.” Sleep deprivation also increases your risk for heart disease, high blood pressure, depression, stroke, diabetes and raises the likelihood of getting into an accident at work or behind the wheel.

Practice Good Sleep Hygiene

Better sleep habits can help you get the rest you need. “One thing that will help you have a good quality of sleep is to have a fixed schedule for sleep, going to bed and getting up at the same time, and giving yourself anywhere from 7 to 8 hours of sleep at night,” Dr. Abu-Salah says. He also advises not changing your schedule on weekends, not sleeping in for longer than an hour on your days off, and avoiding naps during the day. Limit caffeinated drinks in the afternoon and evening.

For more information, visit boone.org/sleep

Avoid drinking alcohol a few hours before bedtime, because alcohol may make you drowsy, but will later interrupt your sleep. Dr. Abu-Salah explains that if you have your last drink around 9 p.m., hours after the alcohol is metabolized, it produces a stimulant effect, leaving you wide awake at 4 a.m. Create a quiet, comfortable environment in your bedroom. Block out as much outside noise and light as you can. Build and keep a strong mental association between your bedroom and sleep. Don’t watch TV, study, work or surf the Internet while in bed. And if you find it hard to fall asleep right away, don’t keep tossing and turning. Dr. Abu-Salah says, “One of the most important things we tell patients is, if they can’t fall asleep within 15 to 20 minutes, instead of staying in bed with their mind racing from one topic to another, they need to get out of bed, go to a different room, sit down and read a book that they don’t find exciting. Once they start dozing off, then they can go back to bed. This way, their mind connects the bed only with sleeping.”

Sleep Apnea

Health conditions can also disrupt your sleep. Obstructive sleep apnea is the most common sleep-related breathing disorder. If you have sleep apnea, your airway is obstructed, partially or completely, for short, recurring episodes during sleep. People with severe sleep apnea can have several hundred episodes a night. These episodes reduce the amount of oxygen in your blood, causing your brain to wake up so you can get more air. While you may not know you’re waking up, your sleep is still interrupted and you’ll wake up feeling unrefreshed. “Think of a mother who has just had a baby,” Dr. Abu-Salah says. “Although she may technically be in her bed for 7 to 8 hours, she feels tired in the morning because her sleep was interrupted.”

Untreated sleep apnea can lead to lifethreatening cardiovascular conditions, including higher risk of stroke, metabolic conditions, and psychological disorders like depression and insomnia. While snoring and excessive daytime sleepiness are common symptoms, a sleep study is required to definitively diagnose sleep apnea.

Diagnosing Sleep Disorders

Dan Custer, Boone Hospital Center neurodiagnostics supervisor, has been with the sleep lab since it opened in the early 1980s. In the sleep lab’s control room, he pulls up a screen with results from a recent sleep study. “In the beginning, everything was recorded by hand, on specialty paper the size of this desktop. Each sheet recorded 30 seconds,” Custer says. “Back then, this room would’ve been filled with paper.” Instead of a thick book of paper, Custer points to an array of color-coded graphs on his monitor: “The patient is awake here; they fall asleep here; and they start having an event here. When their oxygen saturation falls 4% or greater, see how their EEG picks up as they’re aroused from sleep.” An outpatient sleep study, or polysomnography, measures brain wave activity, heart rhythm, eye movement, muscle activity, air flow, oxygen saturation, body position, and snoring. This intensive study requires an overnight stay, attended by a certified polysomnography technician. Many sleep disorders can be diagnosed with this study. At Boone Hospital’s sleep lab, you stay overnight in a private room with an adjustable Sleep Number® bed and private bathroom. Before falling asleep, you can watch TV or use Wi-Fi. One thing you won’t find in a sleep study room – an alarm clock: “We don’t want our patients watching the clock. That impairs their ability to

sleep,” Custer explains. “We try to make the experience as comfortable as we can. People might think, when we put wires on them, that they’re not going to get a good night’s sleep here, but a lot of people report that they sleep better on the night they stay in the sleep lab. And if they need any help, there’s always somebody here for them.” Sleep apnea can also be diagnosed with an at-home sleep study. For an athome study, you visit Boone Hospital’s sleep lab to practice wearing and using the home recording equipment, which records airflow, oxygen saturation, pulse and snoring. After a night or two of sleeping in your own bed, you return the equipment to the hospital and have your data collected for review. After you have a sleep lab or at-home study, the technologist prepares your results for a board-certified sleep medicine physician to review so they can diagnose and discuss any necessary follow-up care. Boone Hospital’s sleep lab also provides sleep apnea treatment with continuous positive airway pressure (CPAP) titration to determine the right amount of pressure for a personal CPAP device. A polysomnography technician sees in real-time how you respond to treatment and can make immediate adjustments so you sleep better. Having literally seen the effects of poor sleep on others, Custer recognizes the importance of sleep for a healthy lifestyle: “Some people think if you get less sleep, they’re actually doing the right thing. They think they can get by on 5 hours of sleep, but most people can’t. Over time that gets them in trouble.” If you have problems going to sleep, staying asleep or staying awake during the day, even with 7 to 8 hours of sleep and lifestyle changes, talk to your doctor. If needed, your primary care physician can refer you for a sleep study. By Jessica Park

MyBooneHealth.org

FOUNDATION NEWS

Thank you for a Successful 2017!

Thank you to all our wonderful donors this past year. Your generosity allows the foundation to continue to “share the gift of health.” To view a complete list of donors for 2017’s Community Campaign, Annual Golf Tournament and Annual Gala, or to learn more about the Foundation and how you can make a difference with your donation, please visit our website at www.boone.org/foundation.

The Boone Hospital Foundation received 10% of entry fees from Turkey Trax runners. This event is held annually on Thanksgiving morning.

around sed and placed ns were purcha io at st ng gi ar f. Ch visitors and staf the hospital for

Jennifer Felten, RN, and Grace Frost, RN, are two recipients of the Mary Lu and Lenard Politte, MD, Caregiver Education Endowed Scholarship. The scholarship provided Jennifer and Grace the opportunity to take a study course in preparation for becoming certified in pain management. This scholarship was established in March 2016 though the Boone Hospital Foundation. It has funded three other caregivers in different departments of the hospital. 30

BOONE HOSPITAL CENTER

Winter 2018

Donor appreciation event

Looking Forward As we look forward to an exciting 2018, we hope you will join the Foundation in our mission to “share the gift of health.” Visit our website throughout the year for more information on all of our upcoming 2018 events.

The 14th Annual Golf Classic took place May 1, 2017. The tournament raised over $61,000 to benefit our Caregiver Education program.

2018

CALENDAR OF EVENTS JANUARY 23 & 24

Uniform Sale (Scrubs on Site) SPRING

Flower/Plant Sale APRIL 30, MAY 1 & 2

Collective Goods Sale MAY 14

Annual Golf Tournament JULY/AUGUST

Community Campaign NOVEMBER

Annual Gala DECEMBER

COMO Gives Campaign SPRING & FALL The Annual Gala took place October 28, 2017 and raised over $138,000, including over $25,000 through a “Fund A Need” auction.

Uniform Sale DATE TBD

Jewelry Sale DATE TBD

Linen Sale MyBooneHealth.org

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

NONPROFIT U.S. POSTAGE

PAID

COLUMBIA, MO PERMIT 286

18 Annual Heart Fair th

Thursday, February 22, 2018 6 a.m. to noon in the Boone Hospital Conference Center (located inside Main Entrance) 1600 E. Broadway â&#x20AC;˘ Columbia, Mo. Our Heart Fair provides the community with heart health and stroke education, including free health screenings for blood pressure, cholesterol levels, blood glucose and body mass index (BMI). Your blood test results are available immediately and reviewed one-on-one with a clinician. Come discover what you can do for your heart! Appointments are recommended. Walk-ins are welcome. To register, call 573.815.6400 or 800.872.9008 (M-F, 8 am-5 pm) For best results, fast at least 8 hours prior to screening.

Sharing the Gift of Health