Kootenai | Kootenai Health | Issue 3, 2023

Health KH .ORG ISSUE 3 | 2023 Incredible team helps a heart patient return to his active life Finding freedom One patient’s road to becoming seizure-free High peaks and low valleys In life, the best view comes after the hardest climb: A patient’s journey through cancer

WHAT’S INSIDE Issue 3 | 2023 14 Trusting in stellar stroke care 10 On top of the world: Virtual care provides reprieve from lifelong pain 5 Finding freedom from seizures 6 Rebounding from a life on pause after open-heart surgery Follow Us 16 The best view comes after the hardest climb: Overcoming cancer 9 Meet our new providers Join us in welcoming a family medicine physician and a cardiologist to the Kootenai Health team. 13 Better process, quicker care A new process for getting patients placed in the hospital and to the appropriate level of care is working even better than anticipated. 18 Quality of sleep equals quality of life Innovative sleep lab helps diagnose and treat sleep disorders. 20 The heart of the hospital Now known as Volunteer Services, the Auxiliary has a long history of selfless service. 22 Ask the expert Orthopedic surgeon Edward Rooney, M.D., answers common questions about the causes of foot pain and how to help hurting feet. KH.ORG 3

Health Kootenai Health 2003 Kootenai Health Way Coeur d’Alene, Idaho 83814 KH.org (208) 625-4000 Kootenai Hospital District Board of Trustees Katie Brodie, Chair Robert Colvin, Vice Chair Dave Bobbitt, Secretary and Treasurer Cindy Clark, Trustee Thomas deTar, M.D., Trustee Liz Godbehere, Trustee Steve Matheson, Trustee Robert McFarland, M.D., Trustee Chris Nordstrom, Trustee Administration Jon Ness, Chief Executive Officer Michelle Bouit, Chief Financial Officer Karen Cabell, D.O., Chief Physician Executive Cyndy Donato, Executive Vice President, People and Culture Kelly Espinoza, Chief Nursing Officer Jeremy Evans, Chief Operating Officer Joel Hazel, Chief Legal Counsel Cara Nielsen, Kootenai Health Foundation President Ryan Smith, Chief Information Officer John Weinsheim, Executive Vice President of Kootenai Clinic Executive Regional Editor Kim Anderson Regional Editor Shannon Carroll Cover photo Katrina Walker Published as a courtesy of Kootenai Health four times a year. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Translation assistance services, free of charge, are available to you. Please call (877) 746-4674. Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (877) 746-4674. Ako govorite srpsko-hrvatski, usluge jezicke pomoci dostupne su vam besplatno. Nazovite (877) 746-4674. 2023 © Coffey Communications, Inc. All rights reserved. Photo credit: Shannon Carroll, Communications and Marketing Manager, Kootenai Health, Best Nanny Ever Volunteers “Too often we underestimate the power of a touch, a smile, a kind word, a listening ear, an honest compliment or the smallest act of caring, all of which have the potential to turn a life around.” —Leo Buscaglia Recently Kootenai Health’s adult volunteers made a significant donation, $100,000, to the Kootenai Health Heart Center expansion. This is especially touching because they also made a donation of $100,000 when the original heart center was built 20 years ago in 2003. Since their inception in 1967, our volunteers have given well over $1 million in support of Kootenai Health, but their financial contribution is only a small part of the story. Even more impressive than their monetary support are the lives our volunteers touch every day. Today our adult and student volunteer program includes more than 80 active, caring people. Their time at the hospital is spent assisting patients and families, helping staff members so work flows more smoothly, and providing a listening ear and compassionate help to patients and families in need. The extra help our volunteers provide allows our staff members to focus on working at the top of their job descriptions, doing things they have been specially trained to do. Our volunteers get to add the personal touches like greeting patients, helping them find their way through the hospital, working in the gift shop, offering patients warm blankets or something to eat, and assisting them back to their cars after their stays. Recently, one of our volunteers sat with a patient who was in the hospital without family or friends. He needed a friendly face just as much as he needed his medical care. Our volunteer made a world of difference, and she received the immediate satisfaction of knowing she touched someone’s life. Volunteers are needed in nearly every area of the hospital. Currently our volunteer program for adults and students is in a growth phase. If you are interested in doing meaningful volunteer work that will make a difference in the lives of others, as well as your own, visit KH.org and click on the “Volunteer” link at the top of the page or call our volunteer services department at (208) 625-4645. We would love to have you making a difference on the Kootenai Health team! Wishing you good health, Jon Ness, CEO 4

Finding Freedom By Caiti Bobbitt In fall 2019, Kootenai Health opened northern Idaho’s first-ever Epilepsy Monitoring Unit (EMU). This state-of-the-art unit brought answers and life-changing results for epilepsy and seizure patients across the region. An EMU is a unit in the hospital run by specialists in epilepsy. Specially designed patient rooms allow in-depth diagnostic and treatment services for people experiencing seizures or epilepsy that may be difficult to diagnose or treat. “We have really been able to modernize the treatment of patients with seizures,” Cliff Hampton, M.D., Kootenai Clinic neurologist, said. “We can find another diagnosis and get people off their seizure meds, identify other medications that will suit patients better, or provide surgical intervention after accurately pinpointing what is causing their seizures.” ‘It gave me hope’ Prior to his stay in the EMU, physicians thought they had pinpointed the root cause of 23- year-old Andrew Challinor’s seizures. “Seizures can change everything,” said Andrew. “The plans and dreams you have for your life can all change because of them.” Andrew was diagnosed with epilepsy at age 17. His seizures began to worsen until he eventually found himself in the care of Dr. Hampton. “At one of my first appointments, he looked me in the eyes and said, ‘We aren’t going to stop until you are seizure-free.’ That meant so much to me as someone who was having seizures every two weeks at that point,” said Andrew. “Hearing those words was incredible—it gave me hope.” Andrew spent much of his childhood living in Panama, where his parents did missionary work. While there, he contracted a neurocysticercosis parasite. According to Dr. Hampton, that is the cause of epilepsy in most patients around the world. While the parasite in Andrew’s brain had died, it left a cyst behind that was detected on an MRI. “Had we only gone off the MRI, we would have likely sent Andrew in for surgery to remove the cyst,” explained Dr. Hampton. However, a stay in the EMU determined the root cause of Andrew’s seizures was not from the cyst but from a different part of the brain. “That is an important distinction to make, because if you are sending a patient to a surgeon, you want to make sure you are targeting the area causing the seizures,” said Dr. Hampton. “I really appreciate the EMU staff and the care I received,” said Andrew. “I’ve had a lot of doctors’ visits and hospital stays at different organizations over the years, and the care I received at Kootenai Health was by far the best.” Since his stay, Andrew has graduated from college, gotten married and begun his career. Thanks to the EMU’s technological care and recent advancements in seizure and epilepsy medication, he has not had a seizure in two years. “I can’t think of the last time I had a patient where I thought, ‘Well, we are out of options,’” said Dr. Hampton. “There is always something we can do to get people back to a high quality of life.” Andrew credits Dr. Hampton for doing just that. For starters, Andrew is now able to drive a car after nearly four years of having to depend on others. “It’s given me so much freedom,” he said. “From the beginning, you could tell Dr. Hampton was a man who wanted to help me. It was not just a job for him. It was a mission for him. He wants to help his patients be seizure-free.” The Epilepsy Monitoring Unit has expanded its capacity to meet the growing need across the region. To learn more about the EMU and Kootenai Clinic Neurology, visit KH.org/neurology. One patient’s road to becoming seizure-free Andrew Challinor now enjoys a seizure-free life with his wife, Kelsie. KH.ORG 5

By Shannon Carroll Nothing can fully prepare a person for having major heart surgery—especially when they’re only in their 20s. As unfathomable as it seemed, this is what Joseph Schwalbach faced in May 2022. “You have infective endocarditis,” the doctors told Joseph after weeks of extreme fatigue and weight loss finally landed him in the Kootenai Health emergency department. An avid athlete his whole life, Joseph played baseball, ran crosscountry and enjoyed all the outdoor activities loved by many northern Idahoans. “I love to snow- and water-ski and go on long hikes in the mountains. I’ve always been very active, so when I was knocked off my feet and not feeling well, it was really unusual for me,” he said. “I was struggling hard for two months. My parents could see that I was not improving, so they took me to an urgent care.” It was there that blood work showed something was very wrong, and Joseph was told to go directly to the emergency department at Kootenai Health. The doctors there confirmed that he was in bad shape. He would need open-heart surgery. Cardiac care and rehabilitation program help a young man recover from open-heart surgery A rare case Joseph was born with a minor heart defect, but one that had been managed well since childhood through regular checkups and standard medication. “The emergency room doctors told me I had somehow contracted a bacterial infection that had made it into my bloodstream,” he said. “My prior heart condition made me a bit more susceptible to complications, but the chances of that happening were extremely rare. Unfortunately, I am that less than 1 percent who this happens to. The infection essentially began to take over my body and ultimately caused lifethreatening damage to two of my heart valves.” After a high-dose series of antibiotics, Joseph underwent a 6

seven-hour surgery to replace his failing heart valves. “I figured if I made it through the operation, then the subsequent recovery would be relatively easy,” he said. “I played sports my whole life and had been lifting weights and exercising regularly at the gym since my mid-teens. Then, reality hit.” A few days after surgery, Joseph tried to walk down the hospital hallway with a walker and was completely out of breath after only 20 feet. “I realized right there that, despite my younger age, this recovery was going to be much harder than I had envisioned,” he said. A blessing in disguise Joseph was not only physically fit, but a stellar student. He had graduated from Whitworth University with honors and was working in the Portland, Oregon, area as a stock analyst until the height of the COVID-19 pandemic. His company transitioned to remote work, so he moved back to his hometown of Rathdrum, Idaho, to be near family during lockdown. That move proved to be one of those strange twists of fate that has revealed itself as a blessing. When he got sick, it was the intuitive insight that only a parent could have that prompted them to get their son immediate care. Thankfully, Joseph and his family live in a region that offers some of the most comprehensive cardiac care in the nation. His surgery was performed in Spokane by the cardiac care team he had seen his whole life. “I am so thankful for my doctors, and it’s just great knowing that Kootenai also offers the same type of cardiac services,” said Joseph. “I wanted to continue my care closer to home, so my physicians referred me to Kootenai Health. I trusted them to care for my heart my whole life, so when they suggested I start treatment at Kootenai’s cardiac rehab program, I made a point of getting started right away.” Kootenai Health provides the full spectrum of care for cardiology patients—from prevention and treatment through rehabilitation. The strong philanthropic community in our region contributed generously to fund a 41,000-square-foot expansion to the Kootenai Health Heart Center, which opened its doors in August of this year. The innovative center’s prevention and treatment services are complemented by a cardiac rehabilitation program that offers patients a specialized, comprehensive approach to improve outcomes for even the most complex cases. Joseph worked with the team at Kootenai Health Cardiac Rehabilitation two times a week for four months. “Joseph came to us with a lot of physical and emotional complexities that often accompany major surgery,” said Claudia Chavez, Kootenai Health’s Cardiac and Pulmonary Rehab supervisor. “We work hard to provide a safe, controlled, individualized program that gives patients the tools they need to be successful.” Support for a strong comeback “I was in a rough mental state when I started cardiac rehab. I had lost nearly all sense of independence, and my life had been turned upside down,” See our expanded Heart Center! Thanks to generous donor support of the Kootenai Health Foundation, a 41,000-square-foot expansion to the Kootenai Health Heart Center opened its doors in August of this year. The facility offers innovative equipment, procedures and specialists dedicated to serving the region’s most complex cardiac patients. Joseph Schwalbach was able to water-ski on Hayden Lake a year after his open-heart surgery. —Continued on next page KH.ORG 7

he said. “I was so exhausted and in so much pain, there was no way I could have done the right things to improve on my own. After every session of rehab, I noticed a huge improvement, not only in my strength and stamina, but also in my mood. They helped me to keep stacking one good day on top of another. I cannot say it any more simply—I would not have made the physical and mental gains I have made if it were not for Kootenai Health’s Cardiac Rehabilitation program. It gave me exactly what I did not even know I needed: the support and camaraderie of a team who knew precisely how to help me build back stronger.” So much stronger, in fact, that Joseph hiked 12 miles up Rathdrum Mountain and waterskied on Hayden Lake a year following his open-heart surgery. After dedicating himself to the hard work necessary to get better through cardiac rehab, he’s back to regular workouts at his local gym— lifting weights, rowing and riding the stationary bike. Joseph has been cleared to stop seeing his cardiologist for one year, but he still visits Kootenai Health regularly for follow-up care. “I love how Kootenai has all my information in one system,” he said. “I now have to take blood thinners the rest of my life, and the pharmacy, anti-coagulation clinic and other members of my care team all have visibility to my medical records. They keep tabs on my activity level and how that may affect my medication to make sure it’s all dialed in to where it needs to be.” Imagine having to put your entire world on pause in the prime of your life. Nothing can truly prepare a person for it, but having gotten past it, Joseph has gained a deep perspective on his journey. “Regaining physical strength and stamina is critical, but the mental component can’t be ignored,” he said. “By leading with my body, my mind was able to follow. I credit the incredible team at Kootenai Health for helping me through that.” Comprehensive cardiac care To learn more about heart services at Kootenai Health, visit KH.org/heart-services. See interviews with physicians who specialize in cardiothoracic surgery, electrophysiology, interventional cardiology and vascular surgery. Schedule an appointment with one of Kootenai Heart Clinic’s 40-plus providers today! Joseph Schwalbach worked with his Kootenai Health Cardiac Rehabilitation team twice a week for four months. Pictured, from left, are Claudia Chavez, CCRP; Schwalbach; Ashlee Therriault, EP-C, CCRP; and Edward Hancock, CEP. —Continued from page 7 8

Mary Larson, M.D. Kootenai Heart Clinics Tell us a bit about you and your family. I grew up in Minnesota, the land of lakes. My husband and I took up skiing after college and, along with our sons (now grown), have loved many mountain and lake adventures. We lived in the San Francisco Bay Area for many years, and now we look to new adventures in beautiful northern Idaho. Where did you receive your medical degree? I graduated from the medical school of the University of California at San Francisco. I completed a residency in internal medicine and then a fellowship in cardiology at Stanford University. Prior to coming to Kootenai Health, I practiced cardiology for 20 years with my group at Sequoia Hospital in the Bay Area. Why did you pick your specialty? The heart is the center of the medical universe. Diagnosing and treating cardiovascular diseases is an awesome privilege. I am particularly interested in valvular heart disease, heart failure and congenital heart disease in adults. What are some of your hobbies? I enjoy skiing, boating, biking (road and mountain), fly fishing (novice), golfing and watching baseball. What drew you to Kootenai Health? The positive energy of the doctors I met here. What is your favorite healthy tip? Exercise is the answer to most questions. Bryan Davidson, M.D. Kootenai Clinic Family Medicine Tell us a bit about you and your family. I am a dedicated physician with 14 years of experience providing compassionate, comprehensive patient-centered medical care to families. When not treating patients, I enjoy spending time with my wife and young son. We love adventure and outdoor activities, and we are thrilled by the natural beauty, freedom and rich culture of northern Idaho. Where did you receive your medical degree? I trained at Loma Linda University School of Medicine and completed a family medicine residency in Glendale, both in California. After completing my training, I provided 14 years of high-quality primary care medicine at Alamo Hills Medical group in Simi Valley, California. Why did you pick your specialty? As a family medicine physician, I have the pleasure of following my patients and their families over time. Such continuity enables me to earn trust and cultivate meaningful and lasting relationships. My father also was a family medicine physician. He served as a great role model and demonstrated how rewarding it is to be a “primary care doc.” What can patients expect when they first meet with you? It is important for me to invest the time and effort necessary to optimally diagnose, educate and treat the needs of each patient. Providing quality medical care requires compassion and effective patient education, counseling and self-empowerment. What are some of your hobbies? I enjoy wilderness exploration, mountain biking, marksmanship, off-roading, gardening (fruits and vegetables) and kayak fishing. Meet Our New Providers What drew you to Kootenai Health? I believe that optimal quality of health care is best facilitated by a cohesive collaboration between primary care physician, specialty providers and ancillary services to best serve the various needs of the community. In this, Kootenai Health excels. What is your favorite healthy tip? Preventive care and optimizing lifestyle habits is key to safeguarding your health and well-being in the years to come. Kootenai Clinic Appointment Center: Need to nd a physician and schedule an appointment? Call the Appointment Center at (208) 625-6767 or request an appointment online at appointmentcenter.kh.org. KH.ORG 9

• Bring your medical record timeline. Most electronic health record (EHR) platforms only capture records dating back to around 2012. Not all health care organizations use an EHR, Make the Most of Your Virtual Care Visit reflects back on the day when, at 13, her doctor gave her debilitating aches and pains a name: lupus. Lupus occurs when the immune system, which normally helps protect the body from infection and disease, attacks its own tissues, causing inflammation that can affect the skin, joints, heart, lungs, kidneys, circulating blood cells and the brain. “I didn’t really understand what having lupus meant, at the time,” said Jocelyn. “I just knew I hurt, was physically weak and that things were different for me.” It was the early ’90s when Jocelyn was 13, and lupus was a popular diagnosis for a wide variety of symptoms. When treatment wasn’t improving her symptoms, doctors realized it wasn’t lupus after all. She was subsequently misdiagnosed two more times over the years, further prolonging her discomfort and ability to live the active, pain-free life she longed for. Seeking relief Thirteen-year-old Jocelyn couldn’t have predicted that nearly 30 years later, a physician 2,000 miles away would help her find relief from her lifelong battle. “I live in Post Falls and had heard about the great care at Kootenai Health, so I made an appointment to see a rheumatologist there,” she said. A rheumatologist is a specialist who diagnoses and treats arthritis and other immune-related diseases and conditions. Currently, rheumatology is offered through a virtual care platform at Kootenai Health. “I was really skeptical at first,” said On Top of the World Thanks to specialty care via Kootenai Health Virtual Care, a patient fulfills a lifelong dream By Shannon Carroll What did 13 look like for you? Maybe you were running around outside, climbing on rocks, riding bikes and enjoying the freedoms that can only be known to a young teen. For many of us, that was the typical experience. But some kids are forced to go down a different path—a path that is neither easy nor fair, but one that inherently leads to a foundation that’s stronger than most. “My story has always been a bit challenging,” said Jocelyn WhitfieldBabcock without so much as a hint of self-pity. Now a 43-year-old married mother of two, Jocelyn 10

Jocelyn. “I didn’t understand how a doctor could properly treat me without seeing me in person. After all, I’d spent my whole life being poked and prodded at every doctor appointment I’d ever been to. How could someone who wasn’t in the same room examining me know enough about what was going on with my body? But my experience with my new doctor has been amazing!” Through Kootenai Health Virtual Care, Jocelyn was connected with Humayan Beg, M.D., a rheumatologist with nearly 30 years of experience, who began working closely with her and the clinical staff onsite at Kootenai. During Jocelyn’s appointments, she visits a clinic office at Kootenai Health, where she is met by a clinical staff member. The clinician takes her vitals, orders any necessary prescriptions and lab work and ensures her entire health history is provided electronically to Dr. Beg for close review. “When my rheumatologist and I first discussed everything, I could tell this patient-physician interaction was different,” said Jocelyn. “The virtual care setting is really interesting. Rather than undergoing a hands-on exam by the physician, the physician really focuses on what I am saying and directs the clinician and patient when handson manipulation is necessary. Combine that with sophisticated lab testing, electronic health records and my physician’s specialized knowledge—I can honestly say I am receiving better care now than I ever have.” Bridging the gap Kootenai Health Virtual Care is a regional leader in the virtual care space. What sets the Kootenai program apart is the ability to connect patients with advanced specialists, like the one treating Jocelyn, from Kootenai Clinic and contracted specialty groups. “The health care system has become increasingly more burdensome for patients and providers alike,” said Kanan Silvas, M.D., regional medical director of Kootenai Health Virtual Care. “Virtual care has proven to be an For Jocelyn Whitfield-Babcock, finishing the 7.46-mile Bloomsday race was the fulfilment of a dream. Kanan Silvas, M.D. Humayan Beg, M.D. invaluable way to bridge the gap between patients’ needs and their access to care. Seeing a provider through virtual care provides patients the same quality time and attention that they would receive from an in-person visit, but from the comfort of their home or a clinic near where they live. This is the future of health care, and our team is excited to offer a really comprehensive, quality program for our region. Our goal is to remove barriers to care to improve patient experiences and outcomes.” —Continued on next page tablet, laptop or desktop computer and a steady connection to the internet to stream video. • Set the scene. Select a place that is private, safe and away from distractions so you and your provider can consult as you would in an exam room. Choose a well-lit space and avoid sitting so some information from your history may not be captured in one system. Having a history of tests, labs, diagnoses and medications helps make the most of your time with your physician. • Test technology in advance. If your appointment is not in a clinic, you will need a smartphone, with your back to a window, as that can darken your image. Make sure the web camera is at eye level so your provider can see you clearly. • Ask questions. Don’t be shy. Ask questions and repeat what you hear to be sure you understand next steps. KH.ORG 11

Need a checkup? Kootenai Health Virtual Care is a leader in our region for providing specialized care. Virtual care visits are available through Kootenai for certain types of appointments, such as consults, annual wellness visits and follow-ups. Visit KH.org/virtual-care for information and scheduling details. —Continued from page 11 “Kootenai Health Virtual Care has given me the opportunity to meet with a really skilled physician, and I am feeling better than I have in many years.” —Jocelyn Whitfield-Babcock Getting answers Now decades past her initial misdiagnosis, Jocelyn happily shares how her virtual care physician helped pinpoint the correct course of treatment for her diagnosis of polymyositis, a rare disease that involves chronic muscle inflammation and weakness, so she can now find reprieve from a lifetime of pain. “For so long, I had been in and out of doctors’ offices and sort of resigned myself to the fact that nothing really helped much,” she said. “I was always weak, my pain was often intense, and the series of medications I was prescribed created additional complications that had to be mitigated. It’s been a long road to where I am today, but I couldn’t be happier! Kootenai Health Virtual Care has given me the opportunity to meet with a really skilled physician, and I am feeling better than I have in many years.” With her new treatment program, Jocelyn has felt well enough to stay physically active, maintain a healthy diet and be consistent with virtual care appointments with her physician. As a testament to her improvement, Jocelyn fulfilled a lifelong dream of participating in the annual 7.46-mile Bloomsday race. She was able to do so virtually on an elliptical machine. “I cried when I realized I was going to finish. I had worked so hard to get to that point. It was a really great feeling.” With Bloomsday under her belt and a path forward for continued good health, Jocelyn has planned several more adventures with her husband and sons. “Our next stop is to climb a lighthouse staircase in Oregon,” she said. “That’s something that I would have loved to have been able to do but couldn’t before. Here I am at 43, feeling like I can conquer pretty much anything.” No longer limited by pain, Jocelyn Whitfield-Babcock is free to plan family adventures with her husband, John. 12

By Kim Anderson Sometimes the key to good health care is about more than the interaction between patients, physicians and nurses. Sometimes, good processes mean the difference between adequate and exceptional care. Recently, a group of nurses and physicians from several departments at Kootenai Health came together to tackle the challenge of getting patients placed in the hospital more quickly and efficiently. The goal was to get as many patients as possible to the appropriate level of care in a timely and safe manner. “We found through our research that patients have better outcomes when they are placed on the right unit quickly,” said registered nurse Lindsey Pacotti, Kootenai Health’s nursing operations manager. “Kootenai’s transition to the Epic electronic health record gave us the tool we needed to make a major improvement in this area.” Through Epic, Kootenai Health staff members are able to request a bed for a patient coming to the emergency department (ED), coming from another facility or transitioning between units. This capability, paired with a new process that was developed by several different units working together, has helped reduce the average patient wait time by more than four and a half hours. A dramatic improvement The new process has dramatically improved the experience for patients in the ED. Across the nation, 2 percent of patients who go to an ED wind up leaving before they have a chance to be seen. Today, Kootenai Health rarely has patients leaving the ED before they are provided care. The new process has also had a positive impact on emergency medical services across the region. “Because we have fewer patients waiting in the emergency department, when an ambulance arrives with a patient, they are able to unload that patient into an ED bed much more quickly,” said Lindsey. “Ambulance arrival to departure time at Kootenai Health’s ED is now just 18 minutes. Because they are spending less time waiting to unload, they can be out in the community responding to calls for a greater part of their day.” The process improvement had an even greater impact than staff members anticipated. The combination of the powerful new tools available through Epic, a positive approach from the leadership teams in many different departments and nurses across the organization working together has made a significant improvement for patients. “Change can be hard,” Lindsey said. “Given the difference this has made for our patients, though, this was a change that was absolutely worth it.” Are you on MyChart? MyChart is the patient portal within the Epic electronic health record system. Visit mychart.kh.org to see the tools you can use to manage your care. QUICKER CARE Lindsey Pacotti, RN, nursing operations manager Better Process, KH.ORG 13

A patient’s wife shares their story By Astrid Rial “Your husband is having a stroke,” the nurse said. Terror surged through my body. I shook my head in disbelief and said, “You are mistaken. You must be talking about another patient, not my husband. Tony is just 56 years old and an athlete.” On Aug. 3, 2018, my husband, Tony Malaghan, and I walked into the emergency room (ED) at Shoshone Medical Center in Kellogg. Earlier that day, Tony had experienced a few seemingly disparate symptoms—a toothache, a bad headache, a momentary loss of coordination and an even briefer episode of garbled speech. A quick internet search pointed to a possible mini stroke, but that seemed highly unlikely given Tony’s excellent health. After three hours of medical tests, the ED doctor could not find any neurological issues, but he noticed that the pupil of Tony’s right eye was blown—the pupil was dilated and would not react to light. “This might be a red herring, but I am going to call the neurologist on call at Kootenai Health,” he said. A medical crisis While we waited in the examination room, Tony and I chatted about our weekend plans. Then suddenly Tony’s entire body froze, his mouth agape. When he didn’t respond, I yelled into the corridor. A nurse ran into the room, and then the doctor asked for my permission to give Tony tissue plasminogen activator (tPA), a clot-busting medicine. I heard the words no wife ever wants to hear a doctor say: “tPA can cause a patient to bleed through all of their orifices, and sometimes they die. Do you authorize this procedure?” I was paralyzed. Our son had just turned 15 years old. Tony was our rock. How could he be having a stroke? The only thought that came to my mind was, “What would Tony do if the situation was reversed?” I asked the doctor, “Would you give tPA if it was your loved one?” The doctor said yes, and I authorized the treatment. A nurse administered the in Stellar Stroke Care Tony Malaghan and Astrid Rial at their home in Coeur d’Alene, five years after Tony’s stroke. 14

Care you can count on Kootenai Health was recently designated a Level II Stroke Center by the state of Idaho’s Time Sensitive Emergency (TSE) System. To earn this three-year designation, hospitals must meet a variety of stringent benchmarks for the quick diagnosis, treatment and care for stroke patients, as well as comprehensive training protocols. medicine while another called a Life Flight helicopter to transport Tony to Kootenai Health. The medical staff and Life Flight medics prepared Tony for the 20-minute ride from Kellogg to Coeur d’Alene. In a daze, I walked to the parking lot where I could hear helicopter blades whirring. I did not know if Tony would arrive at the hospital alive or dead. Thankfully, Tony was awake and lucid when I arrived at Kootenai Health. Right-side paralysis had begun and he mumbled a few words, but he was alive! The ED team transferred Tony to the intensive care unit (ICU) at around 3 a.m. Each nurse explained that Kootenai Health is a stroke-certified center. Every staff member receives training on stroke and heart attack care—not just doctors and nurses, but also certified nursing assistants and the therapy staff—everyone. These assurances allowed me to let go of the hypervigilance that accompanies a shocking medical diagnosis. I trusted the medical team to take care of Tony, allowing me to tend to the million other details that arise during a medical crisis. ‘A freak, traumatic accident’ The ICU team immediately ordered many tests to identify the cause of the stroke. The next day, the neurologist told us the stroke was caused by an arterial dissection. Our son and I figured out that a seemingly minor bicycle accident one week earlier had caused serious damage to Tony’s carotid artery, and the injury had released blood clots to his brain. The doctor called it a freak, traumatic accident. Tony spent two days in the ICU, was transferred to the neurological unit, then returned to the ICU after a well-trained and alert night-shift nurse noticed his NIH Stroke Scale score had dropped in the middle of the night. She immediately ordered an MRI, which detected brain swelling. Tony returned to the ICU and was put on a saline drip. We feel very grateful to the nurse who helped avert the serious brain damage that could have occurred if the swelling had passed the midline of Tony’s brain. Many have heard about the vital need for early therapy intervention during stroke recovery. The Kootenai Health care team was quick to order daily in-room physical, occupational and speech therapy, even while Tony was in the ICU. Every therapist was welltrained in the therapies that would help Tony’s recovery. They informed our son and me of things we could do to support Tony: sit and talk to him on his affected side, encourage him to try to move his limbs, play music he enjoys and more. The medical team engaged our family and invited us to participate. Tony spent 10 days at Kootenai Health before he was transported to a rehabilitation hospital, where he stayed for another seven weeks. Nearly five years later, Tony continues to recover and receives physical, occupational and speech therapy at the Kootenai Health campus. Despite right-side paralysis and aphasia, which affects his ability to communicate, he drives, gardens, rides a recumbent bike and lives fairly independently. We are grateful for these gifts and for the expert care he received at Kootenai Health. Restoring lives Kootenai Health’s neuroscience program provides life-changing care for stroke, epilepsy, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and Lou Gehrig’s disease. To schedule an appointment with one of our board-certified neurologists, call Kootenai Clinic Neurology at (208) 625-5100, or visit KH.org/neurology to see how we can help. We feel very grateful to the nurse who helped avert the serious brain damage that could have occurred if the swelling had passed the midline of Tony’s brain. —Astrid Rial KH.ORG 15

The Best View Comes After the Hardest Climb By Tolli Willhite One might say life is like climbing a mountain. It has twists and turns with high peaks and low valleys. Sometimes we’re steadily climbing one step at a time, enjoying the views and embracing the experience. Other times, we find ourselves on the wrong path, and we need to turn around, regroup and change course. That’s exactly where Luke Dingman, a 54-year-old native of Coeur d’Alene, found himself in 2018. “That’s when everything changed,” said Luke. “That’s where it all began.” However, the beginning of Luke’s story didn’t start there. It began a year prior, when he decided it was time to make a dream a reality. An unexpected detour The Wonderland Trail is a 93-mile hiking trail that circumnavigates Mount Rainier. After a lifetime of hiking, camping and enjoying northern Idaho, Luke was ready for the challenge. He and his brother-in-law, Jerome, spent an entire year training and carefully planning every detail. Luke was getting in shape and feeling good. Even the heartburn that troubled him for years had disappeared. Three months before Luke and Jerome were due to set off on their long-awaited adventure, he had trouble swallowing a piece of his award-winning barbecue brisket. “Luke, being the stubborn human he is, didn’t think he needed to be seen,” recalled his wife, Emily. “He chalked it up to not chewing well enough.” The swallowing issues worsened, and Luke was rapidly dropping weight. He finally gave in to his wife’s pleas and went to Kootenai Health for an endoscopy. Twelve days before he was due to leave for his trip, Cory Richardson, M.D., a general surgeon with Kootenai Health Trauma Services, delivered the results. Luke had advanced esophageal cancer. Luke tearfully recalled that moment and said, “I’ll never forget—Dr. Richardson looked me in the eye and told me, ‘We can get this.’ I was too dazed in that moment to grasp what he was telling me.” Luke was promptly referred to Nathanael Gay, M.D., a medical oncologist at Kootenai Clinic Cancer Services in Post Falls, and treatments began immediately. He underwent a grueling six weeks of chemotherapy and 28 radiation treatments. “The cancer center is full of people who aren’t in a good place, but the staff make an uncomfortable situation as comfortable as it could be,” Luke fondly recalls. “As weird as it sounds, they make it fun. They’re singing and bantering back and forth, and I’m now friends with them all on Facebook. They’re family now. I genuinely love these people.” Following chemotherapy and radiation, an esophagectomy and gastric pull-up procedure was performed by Dr. Richardson and Robert Burnett, M.D., of Kootenai Clinic Cardiothoracic Surgery. Luke spent A patient's journey through cancer Robert Burnett, M.D. Cory Richardson, M.D. Nathanael Gay, M.D. 16

31 days in the hospital, then was finally released to continue the long recovery at home. ‘I can beat this’ Three months later, Luke was at Kootenai Health for a routine follow-up visit. While waiting in the exam room, he found himself suddenly unable to breathe. Emily yelled for help, and Luke lost consciousness. It was discovered that he’d had an aortic aneurysm. Although the event was devastating, it was an amazing stroke of luck that Luke just happened to be in the hospital at that very moment. “If I hadn’t been in the hospital, I would have died,” Luke said. “No question about it.” Further tests revealed cancer had spread to one of Luke’s lungs and to his brain, which elevated his cancer to stage IV and required that he spend 10 days in Kootenai Health’s critical care unit. “I spent over a year thinking I was going to die,” Luke said. “Then at one and a half years in, I started thinking maybe I’ll be OK. At two years, I really started to believe that I could beat this.” After receiving Gamma Knife radiosurgery, a specialized radiation treatment for the brain, Luke was declared cancer-free in March 2019. He continues to visit his friends at Cancer Services and receives maintenance treatment every three weeks and a series of scans every three months to monitor his heart and check for disease recurrence. Luke credits his incredible survival to many people, including Dr. Gay. “He’s just a good, solid man,” Luke enthused. “I’m lucky to have the support that I have, and he’s a huge part of that. He saved my life. I really believe that.” “It requires a multidisciplinary team of physicians, advanced practice professionals, nurses, pharmacists, therapists, social workers, nutritionists, nursing assistants, patient coordinators and support staff to provide patients like Luke a chance at such a fortunate outcome,” said Dr. Gay. “At Kootenai, we are proud to have such a team providing the most comprehensive cancer care in the region.” ‘They give me so much hope’ When asked what he’s taken away from his experience, Luke said without hesitating: “Live life to the fullest. Do not give up on anything or anyone, especially yourself. You must stay positive and believe in the people that believe in you.” That includes his care team at Kootenai Clinic Cancer Services and especially his wife, Emily. “She’s my everything,” Luke said with emotion and gratitude. “It’s incredible how she dealt with everything. From the very beginning, she had hope and determination that we would get through this, even when I didn’t.” Luke and Emily are now grandparents to four granddaughters, three of whom were born during his cancer battle. “They give me so much hope,” said Luke proudly. “I want to be a part of their lives. I want to see them graduate high school and be at their weddings.” Luke and Emily’s fifth grandchild is expected the day before his birthday. They wonder if it will be a boy this time, but either way, a grandbaby on the way is another blessing to add to Luke’s growing list. As John Muir famously wrote, “The mountains are calling, and I must go.” Luke and Jerome are once again training for their hiking trip to the Wonderland Trail with plans to complete the 12-day trek in August. Although Luke’s journey took an unexpected detour down a challenging path, he emerged with a new determination to put one step in front of the other. “I had to first climb my own personal mountain.” A bright future Kootenai Clinic Cancer Services has been providing the highest level of cancer care for patients of northern Idaho, eastern Washington and western Montana for more than 30 years. To minimize the difficulties patients face traveling during treatments, our providers offer care in three locations: Coeur d’Alene, Post Falls and Sandpoint. Learn more about our comprehensive care at KH.org/cancer. Luke Dingman, pictured with his wife, Emily, felt encouraged by her hope and determination. “The future of cancer treatment in north Idaho is bright.” —Nathanael Gay, M.D. KH.ORG 17

Innovative sleep lab helps diagnose and treat sleep disorders Justin Weber, registered polysomnographic technologist By Shannon Carroll Few of us make it through each year without at least a handful of sleepless nights. Worrying about finances, loved ones and work stressors are enough to keep anyone awake from time to time. Research shows that activities that calm the mind (such as prayer, meditation and breathing techniques) and habits that preserve a healthier state of mind (such as restricting caffeine, alcohol and screen time) can alleviate or even resolve insomnia—but how do you know when you need more help? Kootenai Clinic Sleep Medicine Director Walter Fairfax, M.D., suggests that “when a person is impaired due to insomnia or unable to get rested from a full night of sleep, it’s important for them to talk to their provider. If usual interventions don’t help, your provider can connect you to Kootenai Clinic Sleep Medicine.” When usual interventions aren’t effective, this may be a sign that breathing disorders or movement disorders are the source of a sleep problem. What is a sleep study? The specialists at Kootenai Clinic Sleep Medicine can diagnose up to 84 different sleep disorders, including sleep apnea and “movement disorders of sleep.” To help diagnose your particular sleep disorder, you may be given a test to determine the cause of your sleeping problem. This test is called a sleep study. A simple version may be done in the comfort of your own home to assess breathing and oxygen. Or a more sensitive and detailed study in the Kootenai Health sleep lab can be done to measure your brain waves, sleep stages, heart rhythm, breathing effort, airflow, oxygen and muscle activity during sleep. During a sleep study, sensors are placed on your body that provide sleep specialists with the detailed information needed to find the cause of your poor Quality of Sleep 18

Justin Weber consults with a patient. Kootenai Clinic Sleep Medicine is accredited as a sleep disorders center by the American Academy of Sleep Medicine. If you are interested in a sleep study, talk to your primary care physician, who can investigate your sleep problems and refer you to Kootenai Clinic Sleep Medicine for a sleep study. Questions? Contact Kootenai Health Sleep Medicine at (208) 625-6675 or visit KH.org/sleep. Quality of Life sleep. You will rest comfortably in a private room, equipped with a television, bathroom and shower. The test is noninvasive and painless and provides an environment that is dark, quiet and conducive to sleeping. After you drift off to sleep, a sleep technologist, located in another room, will monitor the data from the sensors. Better sleep leads to better health Justin Weber, Kootenai Health sleep medicine registered polysomnographic technologist, has more than 15 years of experience in sleep medicine and has helped countless patients improve their quality of sleep over the years. “I love what I do,” said Justin. “Working closely with patients, I identify where there are disruptions to ideal sleep patterns. From there, our medical doctors review my detailed report. Our team creates a customized and comprehensive plan to help patients achieve and maintain better sleep. Better sleep leads to better health—no doubt about it.” “When a person is impaired due to insomnia or unable to get rested from a full night of sleep, it’s important for them to talk to their provider.” —Walter Fairfax, M.D. KH.ORG 19

The Heart of the Hospital Now known as Volunteer Services, the Auxiliary has a long history of selfless service By Britt Towery The idea began in November 1966, when Kootenai Memorial Hospital opened the doors to its new facility. There would be a need for volunteer support to provide comfort to patients and benefit the staff and hospital. In early 1967, the Auxiliary formed to fulfill three key roles: increase greater community interest in, and understanding of, the hospital; furnish volunteer services; and help with fundraising. Each fall during the 1960s and 1970s, the Auxiliary hosted the annual Harvest Charity Ball. Combined with the proceeds from gift shop sales, these two key funding sources were critical for raising money to provide additional needed equipment for the hospital. At its peak, the Auxiliary consisted of 150 adult and 48 teen volunteer “Candy Stripers,” who contributed their time to assist with various hospital activities. The volunteers relieved trained hospital personnel of many duties they would’ve otherwise had to perform. Upon their 15th year of service, the Auxiliary had raised more than $80,000 and provided more than 100,000 volunteer hours to the hospital. Decades of partnership In 1983, the Kootenai Medical Center Foundation was formed as the nonprofit fundraising arm of the hospital. The first gift received by the Foundation from the Auxiliary was for $20,000. A memorial scholarship was established by the volunteers to honor Kim Svee, a teen volunteer. The scholarship is available on a yearly basis to teen volunteers with qualifying hours of service. As the organization has transitioned from an Auxiliary to the Volunteer Services department of the hospital, this critical philanthropic partnership has continued. Through proceeds from sales at the hospital gift shop, the volunteers have invested in every major capital campaign at the hospital, including the Health Resource Center, rehab services, cancer services, intensive care unit, youth behavioral health, neonatal intensive care unit, electrophysiology, Big Blue Coffee Company and the 3 East hospital expansion. In 2003, the Auxiliary provided a major gift of $100,000 to benefit the original Heart Center 20

Teeing Up for a Cause The 34th annual Kootenai Health Foundation golf tournament was held May 22 at the beautiful Hayden Lake Country Club. Presented by Chapman Financial Services, the fourperson scramble directly benefited the Heart Center expansion at Kootenai Health. The sold-out event consisted of 36 teams and a total of 144 players vying for awards, including closest to the pin and longest drive. The lighthearted tournament is a favorite among many Foundation supporters and a highly anticipated event each year. Golfers began with a shotgun start and lunch on their golf carts. The event concluded with dinner, an entertainment program and awards. Twenty sponsors helped make this event possible by providing entertainment, prizes and opportunities for fun! Including the $60,000 in proceeds raised during this year’s event, the golf tournament has generated more than $1.1 million to directly benefit Kootenai Health and help ensure access to the highest quality health care for northern Idaho. The Heart Center expansion includes key additions to the existing space that will provide the resources needed to ensure that ready, rapid care remains available as our population grows. Special thanks to the committee of volunteers who help to make this event possible! Giving is lifesaving And it’s easy! Just scan this QR code to reach the Heart Center expansion’s donation page. Cheers to our volunteers! ABOVE: Victoria Slater, Beth Rich and Bretta Provost RIGHT: Kristen Pitts and Vivien Spyra capital campaign. Twenty years later, their recent gift of $100,000 reaffirms the volunteers’ outstanding generosity by supporting the Heart Center’s expansion. All these gifts—among many more—combined with annual sponsorships of the Kootenai Health Foundation’s Festival of Trees and golf tournaments, brings the total lifetime giving of this dedicated group of volunteers to more than $1.1 million! A heart for people and for service Volunteers are a critical component of hospital operations, and they are needed now more than ever! Not only do they have a great impact on patients and families, but their services are also vital for assisting and relieving hospital staff. Volunteers have forged tight-knit friendships, which create a sense of belonging. Through their work, many have found a deep sense of purpose. All volunteers are provided with Kootenai Health employee orientation and staff training, which fosters a culture of everyone working together as one family. “The services provided are inspiring. The gifts and talents our volunteers bring help hospital staff perform at the top of their licensure,” explained Renee Langue, Volunteer Services manager. Adult volunteers are assigned to a variety of areas within the hospital, where they have an interest, and are asked to commit to one fourhour shift per week on a consistent basis. Teen volunteers, ages 14 to 17, are offered the opportunity to learn about the health care industry while impacting the lives of patients and their families. Teen volunteer sessions are available during the summer and throughout the school year. How you can help To discover how you can make a difference through volunteering, visit KH.org/volunteer-services or call (208) 625-4645. Kootenai Health Foundation President Cara Nielsen (center) receives a donation from hospital volunteers; from left: Marilyn Parker, Joyce Kollaja, Cara Nielsen, Rio Setty and Vicky Durant. KH.ORG 21