Kootenai | Kootenai Health | Issue 2, 2022

Swift and serious When you’re having a stroke, every minute matters Accentuate the positive Try ‘3 Good Things’ for better mental health They grow up so fast! Prep your teen for healthy independence ISSUE 2 | 2022 Health K H . O R G

WHAT’S INSIDE Issue 2 | 2022 20 Foundation helps fund geriatric care 14 Addiction Recovery Services: Uncommon help for a common problem 5 Introducing MyChart 17 The heart of health care 6 Strokes are swift and serious— and so is the care we provide Follow Us 8 “3 Good Things” for positive thinking Try this simple tool to help change your focus and avoid burnout. 9 What to know about migraines with an aura People who get migraines with an aura, especially women who use estrogen-based birth control, are at a higher risk for stroke. 16 The best opportunity for the best outcome Participating in a clinical trial helps improve health care—and can help you too. 18 Ready to launch Tips for talking to your teen about taking care of their health away from home. 22 Ask the Expert Amyotrophic lateral sclerosis, more commonly known as ALS or Lou Gehrig’s disease, is diagnosed at a much higher rate than the national average in northern Idaho. KH . ORG 3

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 Teri Farr, Secretary and Treasurer Dave Bobbitt, Trustee Cindy Clark, Trustee Thomas deTar, M.D., Trustee Liz Godbehere, Trustee Steve Matheson, Trustee Robert McFarland, M.D., Trustee Administration Jon Ness, Chief Executive Officer Jim Adamson, Executive Vice President and General Counsel Karen Cabell, D.O., Chief Physician Executive Jeremy Evans, Chief Operating Officer Julie Holt, Kootenai Health Foundation President Daniel Klocko, Executive Vice President of Human Resources Pam Bauer, President, Kootenai Care Network Joan Simon, Chief Nursing Officer Ryan Smith, Chief Information Officer Kim Webb, Chief Financial and Administrative 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. 2022 © Coffey Communications, Inc. All rights reserved. Health Change and Renewal: A Season of Growth “Growth requires change; change requires work.” —Unknown I recently visited my daughter and her husband in Salt Lake City. While walking through a mall, I noticed a sign in one of the business windows that said, “Growth requires change; change requires work.” Whether you are self-employed or leading an organization, you are always thinking about how everything you see, read and hear applies to your work. In my case, I was impressed by how applicable that sign in a Salt Lake shopping mall is to Kootenai Health. Acornerstone tokeepbuilding on This past March, Kootenai Health made the change from the Meditech electronic health record system to Epic, the top-rated electronic health record in the U.S. Epic will give us one connected system for every patient visit at every Kootenai Health hospital, physician office, urgent care, outpatient surgery and imaging location. It will make all your medical records easily available on your home computer or smartphone. It will also connect your information about care you receive at most Spokane hospitals and physician offices. Even considering all the growth Kootenai Health has experienced in the past 12 years, the move to Epic is likely the most significant change Kootenai Health has made. As anyone who has experienced a major life change knows, just like that sign in the mall says, change requires work. The move to Epic has definitely been work, but it is a necessary change that will be the cornerstone for our organizational growth. Northern Idaho is one of the fastest growing areas of our country. Our community can fight that fact or we can prepare for it and consider the change that growth will require. When it comes to health care, I am proud to say Kootenai Health is doing the work, preparing for the change and continuing the growth needed to care for our community now and in the future. Wishing you good health, Jon Ness, CEO Teresa Ragan, NP, hospitalist, Shades of Twilight 4

By Kelly Fry After a year of behind-thescenes hard work, Kootenai Health successfully implemented its new electronic health record, Epic, on March 12. This implementation was the culmination of more than 12 months of technical configuration and countless hours of staff planning and training. This single, upgraded health record replaces 11 separate electronic health records (EHR), making patient care more secure, seamless and complete. Epic is the preferred EHR system in the U.S. and is used by most health care organizations within 40 miles of Kootenai Health. This interconnectivity means all health care providers can efficiently share information— making care seamless and referrals and transfers easier. “Our new electronic health record system puts all of a patient’s information in one place,” Ready for MyChart? Visit mychart.kh.org, or download the mobile app using the QR code above. Questions? Call (208) 625-3200. Amanda Jackson, M.D., Kootenai Health chief medical information officer Introducing All of your health information, now in your pocket! MyChart Provided by Kootenai Health Kootenai Health Chief Medical Information Officer Amanda Jackson, M.D., said. “When a physician is able to access a patient’s complete medical record, it makes patient care safer and more effective.” All inoneplace One of the most beneficial features of Kootenai Health’s new EHR is its easy-to-use online patient portal called MyChart. “MyChart allows patients to be at the center of the health care experience. Patients can register on their computer, or on a mobile app, and have easy access to their medical record online,” Dr. Jackson said. “Patients will no longer have to navigate different systems and logins. From therapies to primary care, procedures to test results— everything is in one place.” MyChart includes many convenient features that were not available in past systems. With MyChart, patients can send a message to their care team with routine questions, view upcoming appointments, review discharge instructions, immediately view lab and radiology results, pay a bill and request prescription refills with the touch of a button. Instant access “One of the best features is the instant access to test results,” said Dr. Jackson. “If you are registered for the mobile app notifications, you will receive an alert when there is new information—like a test result— the moment it is available.” Dr. Jackson said it is important to remember that with this new speed, there may be instances when patients view results before their physician has had a chance to review them. “We know our patients appreciate the speed and transparency in their care, which is why we are providing results so quickly,” Dr. Jackson said. “But sometimes there will be instances when the test result requires next steps in your plan of care. For these instances, our health care team is committed to getting back to patients as soon as possible, usually within one business day.” Patients who are ready to use MyChart can ask for an instant activation code at their next Kootenai Health visit or log on to mychart.kh.org to register online. “Our physicians love the comprehensive record, our patients love the user-friendly interface,” Dr. Jackson said. “It’s truly a win-win.” KH . ORG 5

By Kim Anderson The human brain is a marvel. It stores our memories and controls our movements. It is the source of our thoughts, emotions and language. Although it makes up only 2 percent of our body weight, it uses 20 percent of the oxygen we breathe. When something, such as a blood clot, stops the flow of oxygen-rich blood to the brain, the impact is swift and serious. “Each minute your brain is deprived of blood flow, 1 million neurons in your brain die,” said Kate Knight, RN, stroke coordinator at Kootenai Health. “Every minute that passes when someone is having a stroke is critical to save brain tissue.” Acting fast “When we talk about saving 1 million neurons every minute, people often ask how many neurons are in the brain,” said neurologist Ramsis Benjamin, M.D., medical director of Kootenai Health’s stroke program. “There are about 3 trillion neurons in the brain; the same as the number of stars in the universe.” It’s a clinical fact with tremendous personal impact. One that Arlys Brown experienced firsthand. This past November, she and her husband, John, were at home when Arlys noticed she was having trouble getting up from the dining room table. John helped her up and was taking her to the bedroom to lie down. He knew something was not right. “John called a friend and former neighbor, George Schick, and asked him to come over,” Arlys said. “He and his wife came right away. The minute George saw me, he knew I was having a stroke. His mother had had one.” Within minutes, Arlys was in an ambulance on her way to Kootenai Health. “They got me going right away. Everyone did their job fast,” Arlys said. She was familiar with hospitals, having worked as a nurse’s aide in high school, but it was the first time she had ever been hospitalized. Clot-bustingmedications Just 40 minutes after Arlys’ arrival, she was given alteplase, an enzyme that works to break up and dissolve blood clots that can block arteries. It is used to treat both strokes and heart attacks so blood flow can be restored. “Alteplase goes to the clot and immediately begins to dissolve it,” Dr. Benjamin said. “It is most effective when given within the first three hours of a stroke, although under the right circumstances it can still be helpful up to four and a half hours later.” Arlys was admitted to Kootenai Health’s intensive care unit. Nurses on the unit have received special training in the care of stroke patients. All the resources needed to provide that care are available in the patients’ rooms. During admission, Arlys was evaluated by specialists in neurology, hospital medicine, speech and language pathology, physical therapy and occupational therapy. She also received lab work and imaging studies to help her care team provide the most effective and comprehensive care possible. Six days later, when Arlys was discharged, her assessments showed she had no lasting effects from her stroke. Anewstandardof care Recently, Kootenai Health became just the second facility in the state of Idaho to receive approval to also begin using a different medication, tenecteplase, to treat strokes. Tenecteplase has been used for years as a clot-busting medication to treat heart attacks. Physician scientists have considered also using it for treating stroke patients for years. They now have enough well-researched evidence to support that use. “Tenecteplase is more fast-acting than alteplase, so this is a real benefit to patients,” said Dr. Benjamin. “Alteplase can take an hour to reach the clot and break it down, but tenecteplase can be given through a vein, so it can reach the clot and begin to work in just 10 minutes. Every minute we save is 1 million neurons we save. Since receiving approval this January, tenecteplase has become our new standard of care for stroke at Kootenai Health.” Today, Arlys is back to doing the things she loves. When thinking about her experience, she said, “I was lucky! I had excellent care; I feel fine now.” Swift � Serious The highest standard of stroke care— when every minute matters 6

Looking for support following a stroke? The North Idaho Stroke Support Group helps caregivers and survivors. Meetings are held every Thursday at 10:30 a.m. at the Rehabilitation Hospital of the Northwest. For information, call (208) 262-8700. Stroke Super Star One Kootenai Health patient’s outcome would likely have been much different were it not for the intervention of a very special member of the Kootenai Health care team. Jeanet Cole Porte, a member of the environmental services housekeeping team, was in a patient’s room when she noticed something wasn’t right. “I heard her soft little voice say, ‘I’m cold,’ so I pulled the blankets up around her. Then I went to tell the nurses,” Jeanet said. “I knew she needed help, and I wanted to offer her that help.” “Members of our housekeeping team spend a lot of time with patients as they clean their rooms,” said Harmony Reilly, manager of housekeeping at Kootenai Health. “They see people in the hospital day after day and often build really special relationships with them. They care about our patients just like our clinical staff members do.” That evening after she went home, Jeanet couldn’t stop thinking about that patient. As she put it, “That soft voice just kept ringing in my ear.” It was only after returning to work that Jeanet learned about the difference her intervention made. She was proud to receive the Stroke Super Star award for stroke intervention—an award that until now has only been received by clinical staff members. Jeanet wears her Stroke Super Star award proudly next to her Kootenai Health name badge throughout her workday, cleaning rooms and caring for patients. Jeanet Cole Porte is a contracted employee through ACI Federal. Know the signs of stroke KH . ORG 7

By Elizabeth Brewer, MEd The COVID-19 pandemic has had a significant impact on our lives in many ways. Changes to school, work and health care have increased the stress in our lives and amplified many challenges that existed before this crisis began. One of the long-term challenges in health care has been health care worker burnout, which many have labeled an epidemic of its own. Burnout comes from our impaired ability to experience positive emotions. To help, nephrologist Emily Petersen, M.D., chair of the Kootenai Health Provider Well-Being Committee, has been working on addressing burnout with Kootenai’s medical staff for several years. “We wanted to accelerate our work on well-being programs for our medical staff and employees,” said Dr. Petersen. “This included the introduction of a tool called ‘3 Good Things,’ pioneered for health care by J. Bryan Sexton, Ph.D., at Duke University.” Changeyour focus Our brains are hardwired to focus on the negative. Barbara Fredrickson, Ph.D., a noted researcher and psychologist, said, “The negative screams at us, but the positive only whispers.” To reduce burnout, we need to turn up the volume on the positive. That’s where “3 Good Things” comes in. It’s a simple tool to help people recognize the positive things that happen each day. When we practice looking for the positives, those moments start to balance out the negatives, which we tend to focus on more. It’s easy to get started. At the end of the day, just before bed, ask yourself, “What are three good things that went well today, and what was my role in making them happen?” For the best results, write these things down or save them in one of the many “3 Good Things” apps available for your smartphone. Repeat this practice for 15 days to make the effects last longer. At the end of 15 days, the effects can last for up to a year! When feeling an extreme level of stress and burnout, it can be difficult to know where to start making changes. The “3 Good Things” practice is a bite-sized intervention. It doesn’t take a lot of time or cause a big disruption in your life when you are already struggling. It takes just one or two minutes a day for about two weeks. It isn’t a lot of time, but the effects are huge! As this tool has been shared more widely at Kootenai Health, many who have tried it noticed an improvement in their well-being. Why not try it yourself? for Positive Thinking Quick and easy Find resources for “3 Good Things” by typing it into your web browser or smartphone app store. Emily Petersen, M.D., Kootenai Clinic Nephrology Elizabeth Brewer, MEd, director of research and care transformation 3 GOOD Things 8

By Kim Anderson Migraines are a headache—both literally and figuratively. They can come on without warning and leave you canceling plans and crawling to bed or a darkened room to ride out the misery. While migraines alone are challenging, those with an aura can indicate something more serious. About 20 percent of people who get migraines also experience an aura. Auras are usually visual and often appear as a blurred area in the field of vision; a “tunnel” that blurs the edges of the field of vision; or flashing, “sparkling” light. They may also affect other areas of the body, such as speech, or feel like a tingling sensation that moves up one arm and even into the face. All of this is caused by activity in the brain—not in the actual eyes, mouth or arm. Migraines andstroke “We’ve learned that people who have migraines with an aura are at increased risk for stroke,” said Kate Knight, RN, stroke coordinator at Kootenai Health. “It is important for these people to be aware of that risk so they and their physician can take it into consideration when making decisions about the medications they take, activities they engage in and when they should seek emergency care.” For example, the risk of stroke can be compounded with certain types of birth control. “People who experience an aura with their migraines are statistically between 2 and 4 times as likely as the rest of the population to experience a stroke,” said OBGYN Brenna McCrummen, M.D., of Kootenai Clinic Obstetrics and Gynecology. “Estrogen-based birth control can also contribute to an increased risk of stroke. By itself, that risk is very small, but when combined with other risk factors such as migraines with aura, it’s wise to consider other options.” Sageadvice “Thankfully, today we have many different, safe birth control options,” Dr. McCrummen said. “Those that use only progesterone do not increase the risk of stroke and are often a good choice for women who have migraines with aura.” Another important thing to keep in mind: There are many types of headaches. Some women experience migraines when their estrogen levels drop as part of their monthly menstrual cycle. These menstrual migraines are usually not accompanied by an aura. In these instances, an estrogen-based birth control pill, especially one taken continuously, can actually help reduce the frequency or intensity of migraines. Ultimately, the best medical advice—whether you are dealing with migraines or concerns about stroke or reproductive health— comes from your own health care provider. Making sure he or she knows your full medical history and all your current medications can go a long way toward ensuring you receive the best care possible. Talk to the Doc If you have concerns about migraines, stroke or reproductive health, talk with your physician or provider—he or she can offer solutions to improve and preserve your health! Need to find a provider? Call the Kootenai Clinic Appointment Center at (208) 625-6767. What to KnowAbout Migraines With an Aura Be aware of your stroke risk, especially if taking birth control medications Brenna McCrummen, M.D., Kootenai Clinic Obstetrics and Gynecology KH . ORG 9

Christina Crabtree, M.D. Emergency medicine Tell us a bit about you and your family. I was born and raised in Coeur d’Alene. My husband and I both grew up here and love the area. We moved back “home” prior to the birth of our daughter to be nearer to family and so she may also grow up in the beautiful Pacific Northwest. Why did you pick your specialty? I loved emergency medicine from day one. I really enjoy the opportunity to meet and care for patients of all ages and backgrounds and with every type of medical issue. What can patients expect when they first meet with you? Great health care is always a collaboration between patients and caregivers. Coming to the emergency department (ED) can be a daunting and often scary experience. I want patients to feel they are still in control of their health care experience as much as possible. Making sure patients understand what is going on each step of the way, including all of their options for care, and giving them the opportunity to be as involved in that process as they wish are important aspects of my job. What are some of your hobbies? I love gardening, coffee roasting, photography and generally anything outside. What drew you to Kootenai Health? Kootenai Health has always been an important part of my life. I was born at Kootenai and worked in various roles here throughout my early life. In my teens, I was a candy striper and also volunteered in the pediatrics unit. During college, I worked in the hospital kitchen over several summers, and I returned as an ED health intern/nursing assistant prior to going to medical school. Kootenai has provided excellent care to my family throughout my life, and I am privileged to return once again, this time as a physician, to continue that care in our community. What is your favorite healthy tip? In order to stick with something long-term, it helps tremendously if you actually enjoy doing it. So find something—anything—that promotes health and well-being that you look forward to and stick with it! Lacy Engelstad, NP Kootenai Clinic Internal Medicine, Coeur d’Alene Tell us a bit about you and your family. I was born and raised in Texas but moved to Seattle for college, where I lived for about five years. I relocated to Coeur d’Alene because my husband was born here and we both love the four seasons. We are happy to call Idaho home and look forward to raising our two young children here. I earned my graduate degree from Gonzaga University. Why did you pick your specialty? I enjoy working with adults who have a wide variety of health conditions. I wanted to work in a field that would allow me to make a positive impact on patients’ everyday lives while building long-lasting relationships. What can patients expect when they first meet with you? I try to build a trusting relationship with each person so they feel comfortable being open and honest about Me e t o u r n ew p r ov i d e r s 10

their health care. I want every patient to feel they can ask questions so we can work together to accomplish their health care goals. What are some of your hobbies? I enjoy being outside, fishing, hiking with our dog and spending time with our children. I also enjoy traveling and shopping for antiques. What drew you to Kootenai Health? I have worked at Kootenai Health as a registered nurse for eight years and knew that after finishing my graduate degree, I wanted to continue to be part of the Kootenai Health family. I love serving the people in the community I live in. Although we are constantly growing and expanding to meet the needs of our community, Kootenai remains a place that strives to always put patients first. We are always improving to ensure each patient gets exceptional care. What is your favorite healthy tip? Get outdoors, even if it’s just for a few minutes each day! It is so important, not only for our physical health but also our mental well-being. Schedule an appointment: Call (208) 625-4515. James Fallin, M.D. Emergency medicine Tell us a bit about you and your family. My wife and I are both from West Virginia. We met while I was in medical school and married prior to my residency. We have three children, the oldest of which is 5, and we’ll probably call it there based on our current fatigue levels. Why did you pick your specialty? I had different plans going into medical school and actually had no real idea what an ER doctor was until the middle of my third year. At that point I was rotating through a specialty that had me see their patients as they came through the emergency room, and I really gravitated to the environment and the people there. Chaotic environments and emergent situations strangely seem to make me focus more. I ended up switching to ER rotations and really enjoying it. What can patients expect when they first meet with you? I tend to meet patients for the first time in some of their worst moments and often after long waits, but I really try to make those situations less confusing and hectic, while being as honest as I can be about what we have found. What are some of your hobbies? I really enjoy anything water-related. I grew up fishing and water skiing with my grandparents and continue to enjoy doing so with my kids. I love kayaking, especially remote white-water rivers and mountain lakes. I tend to sneak in some skiing when it snows, and my wife would say I am a bit obsessed with basketball and the Green Bay Packers. I have been known to hide in the basement to read historical fiction and science fiction books. What drew you to Kootenai Health? I had been out to ski in the area in the past and found out about the hospital while I was here. Over the past three years, we have been looking for job openings in the area. After interviewing, we really appreciated the community feel of the hospital and the way the staff members seemed to interact with each other. I had been practicing at a large hospital system that tended to make the patients and staff feel forgotten in the big picture. What is your favorite healthy tip? More and more, I think movement is key. I have a weird schedule as we rotate shifts in the ER, so sleep is often a challenge. While this isn’t ideal, I always feel better and have better mental health if I dedicate at least 15 minutes to some type of exercise. The change for me with a family now is realizing “exercise” may not be 60 minutes to go to the gym, but instead being creative and fitting it in where I can. I try to include my kids as much as possible so they build healthy habits as well—plus it wears them out. I may be the weirdo doing pull-ups with toddlers at the playground or randomly walking my dog at 1 a.m. after an evening shift. KH . ORG 11

Ashton Lupton, DNP, CNM Kootenai Clinic OB-GYN, Coeur d’Alene Tell us a bit about you and your family. I grew up in southern Idaho and am the proud daughter of two teachers. I moved here with my husband and two dogs. We have family all over the Northwest, and we’re excited to place roots here. Why did you pick your specialty? I believe practicing midwifery is exactly what I’m supposed to be doing with my life. A culmination of my life experiences led me to realize midwifery was my calling. What can patients expect when they first meet with you? It’s always my goal for people to feel heard and supported when they meet with me. I want our patients to know I’m on their team and that they are the leaders in their care. It’s my job to provide them with the most up-to-date research and evidencebased medicine, then to allow them to make the decision of what works best for them. My goal is for people to feel empowered with the information and medical research I provide—so they can make the best, educated decision for themselves. What are some of your hobbies? I wish I was adventurous, but honestly, my ideal weekend involves binge watching a TV show, cuddling with my dogs and baking something yummy. It will not take much time with me before you hear about my dogs—I think they are the sun and moon. What drew you to Kootenai Health? I was drawn to the group of midwives I would get to learn from and work with. They are an amazing group of women who care deeply about our patients. What is your favorite healthy tip? Health doesn’t just include making sure you are eating enough greens and being physically active. Health is also learning your power and advocating for it. My healthy tip is to find something that makes you feel emotionally and mentally strong and practice that. Schedule an appointment: Call (208) 625-4970. Ashley Manning, PA Kootenai Clinic Cancer Services, Sandpoint Tell us a bit about you and your family. My husband and I moved from Portland to northern Idaho in the summer of 2021. We have a 17-month-old baby boy named Taylor. He is the absolute sweetest thing and keeps us quite busy. Why did you pick your specialty? I started in oncology as a nursing assistant while I was in college. I quickly learned that oncology patients are a special patient population with a unique perspective on life. Working in this field has been such a rewarding experience, and I’m so grateful to help people who are dealing with the biggest challenges of their lives. While I was in physician assistant school, I also developed a love for the science and ever-changing landscape of cancer. This specialty is definitely my calling, and I’m so happy to have found it early in my career. What can patients expect when they first meet with you? I think it’s very important to develop rapport with patients early in their treatment, so I always sit down and spend a little time getting to know patients and their caregivers. What are some of your hobbies? Most of my time is spent playing with my little one, but we also enjoy spending time outdoors. I am so excited to be in a place that offers so much of what nature has to offer. We also enjoy live music, so we are very much 12

looking forward to the warmer weather and return of outdoor concerts. What drew you to Kootenai Health? I was first drawn to northern Idaho, but lucky for me I had a colleague from my previous employer who is now working for Kootenai Health. I got in touch with him, and he highly recommended Kootenai Health as an excellent and supportive workplace. What is your favorite healthy tip? Mental health plays such a big role in our overall health. It’s important to let go of things that are out of your control and try not to sweat the small stuff. That is easier said than done, but I try to remind myself of this every day, and my cancer patients really help me put things into perspective. Schedule an appointment: Call (208) 625-4700. John McGowan, M.D. Kootenai Clinic Neurosurgery Tell us a bit about you and your family. My wife, Mie Mie, trained as an OBGYN but is currently a full-time mom to our two daughters, Sophie (11) and Amelia (8). We love spending time outside, including hiking, skiing and anything on the lake. Why did you pick your specialty? I find neuroanatomy to be one of the most interesting things in medicine. In neurosurgery, you get to take care of the full spectrum of acuity, from long-standing chronic problems to the most acute and life-threatening conditions. What can patients expect when they first meet with you? A clear explanation of their condition. If I cannot explain it in terms a patient can understand, I have not done my job. What are some of your hobbies? Fishing, sailing, hiking—anything I can do with my family. What drew you to Kootenai Health? I like the idea of a health system with a sense of duty and dedication to the well-being of the entire community. Kootenai fits that bill very well. What is your favorite healthy tip? Weight management is so important as we age. The best way to manage your weight is managing the “portion distortion” we all suffer from. One of the best ways to initiate weight loss is by modifying not what foods we put on our plates but the amount of food we put on our plates. Schedule an appointment: Call (208) 625-3800. KH . ORG 13

By Nina Culver The Addiction Recovery program at Kootenai Health has a new name, but it’s still the same, high-quality program with experienced staff ready to help people overcome their addictions. Recovery Addiction Uncommon Help for a Common Problem Addiction The program, formerly known as Chemical Dependency Services, is now Addiction Recovery Services. It offers treatment for people with substance use disorders, including those who may be struggling with other problems in addition to addiction, such as anxiety and depression. This ability to treat co-occurring disorders is one of the program’s unique strengths. Its team includes psychiatric pharmacists, trauma-certified counselors, therapists and nurses who can provide the individualized treatment a patient may need. “We renamed ourselves to highlight that we offer an array of services,” said program medical director and psychiatrist Eric Heidenreich, M.D. Addiction Recovery Services offers both inpatient and outpatient treatment programs, along with the unique ability to have collaborative care with Kootenai Health’s Adult Psychiatric Unit. “Occasionally, we’ll have people go back and forth between these units,” Dr. Heidenreich said. Not lost in the crowd The inpatient program is limited to 16 people ages 18 and up. The hospital would like to expand the program, but not by too much, said unit manager Lisa Bunker, licensed clinical professional counselor. "There’s a boutique nature to having a small facility,” Lisa said. “Many patients have said they like being in a small program because they don’t feel lost in the crowd or overwhelmed.” The intensive outpatient program has both day and evening options for program participants. They meet in the day or evening three times a week for eight weeks. During this time, they participate in group treatment and receive support and education that is individualized for their unique needs and abilities. Groups are kept small to ensure every individual participant’s needs are met. Recovery Services 14

A key part of treatment is creating safety plans and recovery plans with the patients to keep them moving forward. It helps people identify their vulnerabilities and create a plan for how to handle them. Vulnerabilities can be everything from biological to psychological and social. “There’s as much art to it as there is science,” Dr. Heidenreich said. “Everybody has different vulnerabilities that can lead to abuse.” The emphasis in Addiction Recovery Services is on treating the whole person. Some drug addictions have their roots in trauma or mental health issues, and it’s important to treat those problems in addition to the addiction. Dr. Heidenreich compares it to a diabetic patient who may receive insulin as well as recommendations for behavioral changes, such as dietary changes. Risingabove challenges The program is also geared toward treating different kinds of addictions, which tend to fluctuate as substances and society change. Dr. Heidenreich noted that alcohol addiction is a constant and opioids are a major concern, but there are always new, more potent substances coming out. Marijuana is another ongoing concern, though Dr. Heidenreich said he’s noticed less emphasis on it as it becomes legalized in some states and more common. While that creates less fear about the drug, it can still be dangerous. He recently treated a case of cannabis-induced psychosis. It is important for people struggling with substance abuse to know that even if they have tried to recover in the past and relapsed, there is still hope. It’s not uncommon for people to suffer relapses after treatment, but those can be overcome. “It is not uncommon for patients to go through treatment more than once before they experience long-term success,” Dr. Heidenreich said. “It’s just part of the process of getting better. Recovery rates are every bit as good as with other diseases. You see people getting better at a high rate.” The emphasis in Addiction Recovery Services is that recovery is possible. Lisa said she sometimes encounters former patients in public, and they’re always grateful for the help they received at Kootenai Health. “It’s very fulfilling working with this patient population,” she said. “People can get better and have 100 percent fulfilling lives.” Dr. Heidenreich said it’s important to take away the shame that is often associated with addiction. “It is a very common condition,” he said. “The more we can talk about it and take it out of the shadows, the easier it is.” Help is here Contact Kootenai Health’s Addiction Recovery program by calling (208) 625-4848, emailing KootenaiHealthAR@kh.org or visiting KH.org/behavioral-health/ addiction-recovery. Eric Heidenreich, M.D. Lisa Bunker, LCPC

The Best Opportunity for the Best Outcome Clinical research helps improve your care—now and in the future By Kim Anderson Every year, new medications and medical devices help make people’s lives easier. They lower cholesterol, help people with chronic conditions extend their quality of life and, in some instances, even save lives. As diverse as these treatments are, they have one thing in common: At one point, they were all part of a clinical trial. “Clinical research is integral to providing the newest technology and evidence-based medicine to our patients,” cardiologist and electrophysiology medical director Michele Murphy-Cook, M.D., said. “This also improves access to care and our patients’ confidence.” Newmedicines,devices andmore Today at Kootenai Health, more than 400 patients are participating in clinical trials. Some are for new medications, some are for new medical devices, and others are known as registry trials. Registry trials collect data on patients so researchers can learn more about a given medical condition. They are about watching and learning rather than offering a new treatment, but they are still very important. “Any member of the medical staff at Kootenai Health can apply to participate in a clinical trial,” Shamela Barnett, certified clinical research coordinator and manager of clinical research at Kootenai Health, said. “Currently, we have clinical trials underway in cardiology, oncology and infectious disease, and we recently added one for multiple sclerosis.” “The main goal of clinical research is to drive quality health care,” Elizabeth Brewer, MEd, director of research and care transformation at Kootenai Health, said. “Our goal at Kootenai Health is to integrate the things we are learning from research into all aspects of our work. That goes beyond what we are learning in any given study and includes the way research teaches us to approach patient care. That includes rigorous data evaluation, greater patient oversight, and ensuring the patient and members of their care team are working very closely together for the best outcomes.” All research is aimed at giving patients the best opportunity for the best outcome. While this can mean a direct benefit to the patients involved in a clinical trial, it often means something more. “Clinical research is altruistic,” said Shamela. “Sometimes patients see a direct benefit. Many times the information learned in a clinical trial benefits the next generation. Clinical trials offer the best opportunity for us to bring cutting-edge care and the newest medications to people in our community.” For these patients, there can be an additional benefit. “Participating in a clinical trial connects our patients with an amazing clinical research team,” said Elizabeth. “We have incredible, knowledgeable research staff who work with patients’ physicians to ensure they are getting the care needed while on the trial. This adds an extra layer of support for our patients and another champion for their success.” For those interested in being considered as a participant in a clinical trial, their first step is a conversation with their physician. Most clinical trials only include patients who meet very specific criteria. While clinical trials are not open to everyone, for those who can participate, having the trial available in our community is important. “There are times people may not have another option,” Elizabeth said. “We’ve had patients tell us that being in the clinical trial saved their life.” Shamela Barnett, CCRC, manager of clinical research at Kootenai Health Learn more Contact our Clinical Research team at research@kh.org or talk to your doctor about joining a trial. Michele Murphy-Cook, M.D., electrophysiology medical director, Kootenai Heart Clinics Elizabeth Brewer, MEd, director of research and care transformation at Kootenai Health 16

By Caiti Bobbitt Like the rhythm of a heart, the Kootenai Health Heart Center beats steadily with activity, day in and day out. From procedures and surgeries to rehabilitation and outpatient visits, a full spectrum of services is provided across nine in-state locations by a top-tier, regionally renowned cardiac care team. As a community-owned hospital, Kootenai Health takes its responsibility to meet the health care needs of its community seriously. As more and more people choose to call northern Idaho home, Kootenai Health knows the importance of expanding ahead of the population. While demand for all service lines seems to be growing at an expedited rate, cardiac care is in especially high demand. In September 2021, Kootenai Health broke ground to expand the Kootenai Health Heart Center, main operating rooms and Kootenai outpatient surgery. The expansion will encompass 41,000 square feet and include a three-story addition to the existing building. The second floor of the expansion will house the pre- and post-procedural patient care and diagnostic support space, including nine new patient rooms, a second cardiac catheterization lab, a second electrophysiology lab for heart rhythm disorders and the addition of two new operating rooms, for a total of 13. The expansion will allow Kootenai Health to serve an ever-growing patient population while providing top-of-the-line care with the latest cardiovascular equipment. “As community health care needs grow across the region, Kootenai Health needs to keep pace in our surgical and heart center capacity,” said Jeremy Evans, chief operating officer of Kootenai Health. It will also enable Kootenai to offer more complex, higher acuity services and quicker access to its operating rooms. All of this is key to also completing the work that is underway for Kootenai Health to seek official designation as a Level II Trauma Center. Currently, Kootenai Health is designated as a Level III Trauma Center by the American College of Surgeons. This designation means the hospital has demonstrated its ability to provide prompt assessment, resuscitation, surgery, intensive care and stabilization of injured patients and emergency operations. Expanding the Heart Center will enable Kootenai to offer more complex, higher acuity services and quicker access to its operating rooms. In doing so, Kootenai will take the first of many strategic steps to position the hospital as a national leader in cardiovascular care. Take it to heart Learn more about cardiovascular services at KH.org/ heart-services. Have a passion for supporting cardiovascular care in our community? Contact the Kootenai Health Foundation at (208) 625-4438 or visit kootenaihealthfoundation.org. The Heart of Health Care Kootenai Health expands its Heart Center KH . ORG 17

By Kim Anderson High school graduation is upon us. Students, parents, friends and families are ready to celebrate this rite of passage from childhood to young adulthood. After the final exams are passed and caps and tassels are packed away as keepsakes, attention turns to what’s next. Whether that’s college, trade school or a job, for many young people that will mean moving away from home and feeling the thrill—and the responsibility—of greater independence. Along with so many other things, that independence will include taking greater responsibility for their health and well-being. “When kids are leaving for college, there is a lot of focus on academic success,” said Kootenai Clinic Family Medicine Residency physician and incoming behavioral health fellow Marlee Novak, M.D. “But there is so much change and growth happening during those first few years, parents really have an opportunity to be proactive and start the conversation about the kinds of things their child might encounter outside the classroom and how to handle them.” Ready to Launch Empower your teens and young adults to take charge of their health and well-being Where toget care In addition to finding the best place to find a cup of coffee or quick snack in their new location, it’s also a good idea to know the local health care resources. Student health services center: For students going on to a college or university, there are often student health services on campus. These may or may not be part of their new student orientation, but it’s easy to stop by and ask about hours, types of care they offer, what their fees are and whether they can bill your insurance. Urgent care: Many communities have at least one urgent care facility. These can be a great place to go for minor emergencies, like a sore throat that isn’t getting better, a bad cut or a sprained ankle. Patients often receive care more quickly than if they were to go to a hospital emergency department, and the cost is significantly less. Encourage your child to look up the hours of their local urgent care. That may help them decide to seek care earlier rather than waiting until late at night, when the only option is the hospital emergency room. Family medicine clinic: If your child is already established with a family physician or provider, you may want to keep that relationship and plan wellness visits for when your child is home on vacation. Ask the provider’s office if they offer telehealth visits. This may be a convenient option that allows your child to continue seeing that provider while they are away at school. Mental health resources: As we learn more about the importance of mental health, many schools now offer resources for students to talk with a trained professional. Spend some time learning about the resources available at your child’s school, and encourage him or her to reach out if they are feeling overwhelmed. Many campuses also have faith-based groups and social organizations for everything from intramural sports to academic interests. These can be a big help to those who may be struggling to find like-minded friends in a new town. Need a family physician? Kootenai Clinic Family Medicine Residency is welcoming new patients. Call the Kootenai Clinic Appointment Center at (208) 625-6767 or visit appointmentcenter.kh.org. Marlee Novak, M.D., Kootenai Clinic Family Medicine Residency 18

Healthy relationships Children leaving home for the first time have much more freedom. This includes freedom to choose whom they hang out with or date and what time they come home. “The post-high school setting is full of potential for peer pressure,” said Dr. Novak. “When you add in most young people’s desire to be cool and fit in, they can find themselves in some uncomfortable situations. Encourage them to trust their gut—if something is making them uncomfortable, it’s OK to speak up or walk away.” You might consider having your child download a ride-hailing app such as Uber or Lyft on their smartphone. Encourage them to use it once or twice to become familiar with it. Then, if he or she is ever in a situation they need to leave, they can use the app to get home safely. Healthy relationships should include a friend, or group of friends, who can talk honestly and offer social and emotional support. Your child may no longer want to share everything with you as their parent, so having another caring option will be an important resource for helping him or her process feelings. Remember, parents—even when they aren’t talking to you, they are still listening. “If you have concerns as a parent, it’s important for you to talk plainly,” said Dr. Novak. “If you are wondering about something, even when it’s hard, you should ask the question. It’s often more productive to wait until everyone is calm and feeling relaxed, but when the time is right, it’s OK to just say what’s on your mind with kindness. You want your child to know you are a safe resource and it’s OK for them to talk with you about anything.” This is an exciting time in your child’s life as he or she leaves home and takes the first steps as an independent adult. Remember to celebrate and enjoy this milestone together. For young adults leaving home for the first time, independence will include taking greater responsibility for their health and well-being.

The changes came on gradually. A forgotten name here and there, confusion over details from often-told family stories, failing to remember simple tasks that were once second nature. “My dad has always been the pillar of the family—the strong one,” said the daughter of a 76-yearold man in the middle stages of his dementia journey. “It’s difficult seeing the deterioration in a person you love. Where he used to be sharp as a tack and the one we leaned on for answers, he is now easily agitated and often confused. It’s a new normal.” As people age, cognitive decline may seem as commonplace as bad knees and gray hair, but it is not part of normal aging. Aging individuals generally have a wide swath of both mental and physical needs that are unique and require specialized attention from loved ones and caregivers alike. Thanks to generous donor support to the Kootenai Health Foundation, Kootenai Health has been able to spearhead a program dedicated to providing tools and education for staff to ensure the best possible experience for geriatric patients and their families. A year and a half ago, Kootenai Health adopted the Institute for Health Care Improvement (IHI) 4M framework as a model to improve care. The 4Ms are defined as: • What Matters—identifying what matters most to our patients • Mobility—improving strength and balance • Mentation—checking for signs of depression or dementia • Medication safety The framework is designed to work across all settings of care. Kootenai Health has proven progress toward this goal and was recognized as an Age-Friendly Health Systems Participant in August 2021. Generosity Enhances Geriatric Care By Shannon Carroll 20

According to IHI, the hospitals and health care practices recognized by IHI as Age-Friendly have shown exemplary alignment with the elements of the 4M framework, have formally committed to putting the 4Ms into practice and received a review of their plans by the IHI. Dementiaandelder care training Additionally, the generosity of Kootenai Health Foundation donors enabled Kootenai Health to purchase a membership to Nurses Improving Care for Hospitalized Elders (NICHE), which provides free training for nurses who interact with geriatric patients. Kootenai Health has a goal to provide dementia care training to all bedside staff by the end of 2022. “Our region has a significant population of aging individuals, and our hospital sees many every day,” said Linda Henrich, DNP, RN, a geriatric nurse practice specialist who spearheads Kootenai Health’s geriatric care initiative. “When any person comes into the hospital, they are usually stressed, anxious, scared and in pain. These emotions can be stressful to anyone but are particularly exacerbated in those patients who are suffering from a cognitive or physical decline,” Linda said. “Knowing how to effectively communicate with them and their families is essential to providing them the best possible care. The 4M framework and NICHE are valuable tools enabling our staff to target the best course of care for our older patients. We have to pattern how we talk to and care for our geriatric population in a way that caters to their unique cognitive and physical needs.” ‘Still the person they oncewere’ Many symptoms experienced by an older person can be categorized as “normal aging.” Kootenai Health’s geriatric program focuses on the patient’s life goals and health care goals to provide more personalized treatment plans. “Things such as pain, depression and memory problems can all be managed so the person has a better quality of life, which is the ultimate goal,” said Linda. “Additionally, as a person ages, so do their vital organs. Medications are not broken down as effectively, and more medications taken by the patient mean a higher risk for harmful reactions. Muscle mass also decreases, and even short periods of inactivity can be harmful. Many people are also unaware that untreated depression can mimic symptoms of dementia. We’re really proud of the advancements our care team has made, and continues to make, to focus on the overall needs of our geriatric patients.” This program would not be possible without the generosity of our community. “We are very proud of the geriatric care initiative and the tireless efforts of Linda and her team,” said Kootenai Health Foundation President Julie Holt. “The goal of this investment is to continue to improve upon the resources we provide our care team, which will translate to a better experience for our geriatric patients and their families.” Linda best summarized the intent of the geriatric care initiative when she said, “They’re still the person they once were, they’re just different. It’s important for us to remember that.” From left, Linda Henrich, DNP, RN; Rachael Ferraro, D.O., hospital medicine; and Ashley Haug, simulation operations specialist Aging well Have a heart for caring for elders in our community? Visit KH.org/foundation or call (208) 625-4438. KH . ORG 21