Kootenai | Kootenai Health | Issue 2, 2023

Health KH .ORG ISSUE 2 | 2023 Intricate brain surgery saves a young father’s life Family ties Mother and son have a new bond—working at Kootenai Health Working together Neurological rehab team helps Hayden man live well again

WHAT’S INSIDE Issue 2 | 2023 18 Surviving and thriving 10 Oh, baby! 9 Family ties 5 Innovative surgeon keeps a young pilot’s dream alive Follow Us 12 Healing body and mind 8 Meet our new provider Find out how an interest in nutrition led Caleb Kelly, M.D., Ph.D., to focus on digestive diseases and the specialty of gastroenterology. 14 Getting it all A unique technique provides uncommon care for the most common form of cancer. 16 Caring and aspiring Kootenai Health will pay for training and provide benefits to anyone who would like to become a certified nursing assistant. 20 Innovative tools and quick action working together When a lazy Sunday suddenly became a life-or-death situation, modern technology helped save a life. KH.ORG 3

Jordan Pratt, Kootenai Health, infant nutrition tech, Leave No Trace 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 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 Michelle Bouit, Chief Financial Officer Karen Cabell, D.O., Chief Physician Executive 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. Heart Center Expansion “Alone, we can do so little; together, we can do so much.” —Helen Keller One of the special things about Kootenai Health is the close relationship we enjoy with our community. The women and men who work here are your friends and neighbors. They see you at school functions, church and community events. This is one of the reasons we work so diligently to expand our medical staff and continue to provide and expand the services available here—so more people in northern Idaho can receive the care they need close to home. One example of this amazing relationship is cardiology services. Since Kootenai Health’s Heart Center opened in 2003, thousands of our family members, friends and neighbors have received lifesaving care here. Last year alone, the Heart Center served more than 3,200 patients. Because every moment matters during a cardiac event, having needed care close by means better outcomes as well as added convenience. Thanks to many generous gifts to the Kootenai Health Foundation, later this summer we will celebrate the opening of our much-needed Heart Center expansion. The expansion will add nine new patient rooms for a total of 24. It will also add a second cardiac catheterization lab and a second electrophysiology lab. Just as importantly, with more than 40 physicians and advanced practice providers in our cardiology and cardiovascular program, we have one of the most comprehensive programs in the Inland Northwest. This is even more impressive given the shortage of physicians and health care workers we are seeing across the nation. With communities across the country, including those in northern Idaho, struggling to maintain services, Kootenai Health continues to provide for the health care needs of our community as well as those around us. As a member of our community, it is important for you to know that you play a role in this as well. When we each do our part to create a community in which health care providers want to live, raise their children and practice medicine, we help build a medical community that will be here when you and your loved ones need care. Whether it’s expanding cardiac care or one of the many clinical services we are honored to provide in northern Idaho, you, our community, are at the heart of all we do. Wishing you good health, Jon Ness, CEO 4

˜ Dream Alive ˜ Innovative Surgeon Keeps a Young Pilot’s Kootenai Health Neurosurgery and Spine —Continued on next page By Shannon Carroll I n three short decades, Evan Dansereau has accomplished more than most his age. As if being a pilot, husband and father to three small children wasn’t enough, Evan never imagined that he’d add yet another formidable title to his name: brain tumor survivor. “It’s weird how these things happen,” said Evan, speaking of a freak accident that injured one of his beloved dogs and set off a chain of life-changing events that potentially saved Evan’s life. He shared: “My wife and I loved to drive our Jeep into the mountains and let our dogs run. On one of these trips, one of my dogs broke her femur and required emergency surgery. She was doing fine and then suddenly passed the next day. My wife and I were crushed. I looked at that Jeep as a negative reminder of that day, so I sold it. What’s crazy is right after that, I was given an opportunity to train for a pilot job I really wanted—had I not sold my Jeep, we wouldn’t have been able to afford the move from Southern California to the job, located in Oregon.” With the proceeds from the Jeep, Evan and his wife, Lyn, decided to pack up the kids and move so he could pursue his passion. The Dansereau family—Evan, Lyn (with Iver in her arms), Meridian (middle) and Zoey— enjoys trips to the mountains with their dog, Mako. KH.ORG 5

A whirlwind of changes Evan had dreamed of being a pilot his whole life. “It’s the only thing I’ve ever wanted to do, for as long as I can remember,” he said. After years of working in unmanned aviation and as a flight instructor, Evan knew he wanted to finally move on to manned commercial aircraft. In Oregon, in order to do that, he was forced to be away from home for several weeks at a time while training. “I was fortunate to move through the organization really quickly, and shortly after moving to Oregon, I was offered a job on a new aircraft in Spokane,” Evan said. “We moved into an RV near my parents’ home in northern Idaho while we saved to buy a home. It was such an incredibly busy time and so many changes happened very quickly, I never dreamed that the exhaustion, nausea and tightness I was feeling in my neck could have been anything other than stress. I thought, ‘When this training is over, I need to see a chiropractor.’” “Evan has always been incredibly busy, and it wasn’t unusual for him to have multiple things going on and be traveling a lot,” said Lyn. “I just felt like his symptoms were from more than stress. He couldn’t keep anything down and was not himself. He didn’t want to take a day off from his new job, but, thankfully, I was able to convince him to go to urgent care.” Evan had already made an appointment with a chiropractor for later on the same day that he went to urgent care. “I was so sure that’s all I needed,” he said. However, after a CT scan administered at urgent care revealed an abnormality, Evan never made it to his chiropractor appointment. A short few months after beginning his journey from southern California to northern Idaho, Evan was not flying cargo planes out of Spokane, as he and his family had given up everything to do, but was undergoing brain surgery to remove a tumor at the base of his skull. “Evan required surgery to remove a tumor from his cerebellum and brainstem, in a region called the posterior fossa,” said Kootenai Health neurosurgeon John McGowan, M.D. Precise surgical navigation Posterior fossa tumors are located at the base of the back of the head where the skull and neck meet. There is limited space in that part of the skull, and tumors can quickly begin to press on very important brain structures. A craniotomy is a surgical technique in which a temporary opening in the skull is made to access different parts of the brain. After creating an opening in the skull, neurosurgeons use computer-aided stereotactic techniques to pinpoint and remove tumors. Prior to surgery, a special MRI or CT scan is performed that creates a 3D map of the brain. “This model is like a GPS map. We use it to assist us in understanding the borders of tumors, and it helps us differentiate tumor tissue from normal brain tissue, as they frequently look similar to the naked eye,” said Dr. McGowan. “Stereotactic surgery allows a precision in microsurgery that we once thought impossible. I am happy to say Kootenai Health sits on the cutting edge of implementing stereotactic technology in the operating rooms.” Thanks to generous donor support of the Kootenai Health Foundation, Kootenai Health has some of the most innovative and precise surgical navigation systems available. Dr. McGowan, a complex brain tumor specialist, was drawn to Kootenai Health Neurosurgery and Spine a couple of years ago. “I wanted to expand my practice at an organization that provided me with the best team, tools and resources possible to help ensure the best outcomes for my patients,” he said. In fact, it was Dr. McGowan, specifically, whom the urgent care provider referred Evan to after seeing an abnormality in his CT scan. “Although I was scared by this diagnosis, it felt good knowing that Dr. McGowan was spoken of so highly,” said Evan. Zero complications A week after their first meeting in early September 2022, Dr. McGowan performed surgery on Evan while Evan’s parents, in-laws, wife and three children (ages 3, 7 and 9) waited anxiously, fearing the worst. “Dr. McGowan did not mince words with us prior to my surgery— we were fully aware how many complications could come out of something so intricate,” Evan said. “There was a real possibility I wouldn’t be able to swallow, walk, Innovative Surgeon Keeps a Young Pilot’s Dream Alive —Continued from page 5 John McGowan, M.D. 6

use the restroom, and my speech and vision could be compromised. It was all so terrifying. First and foremost, I obviously wanted to be healthy, but, secondly, I could not imagine being unable to fly and losing the one career I had worked toward my whole life.” Evan’s surgery lasted eight hours. Afterward, Dr. McGowan informed the family that he was able to remove all of the tumor but wouldn’t know if Evan had suffered any neurologic injuries until he was fully awake. The morning after surgery, Dr. McGowan examined him and happily reported Evan had not suffered any adverse consequences to surgery. “I could just see it in his face—he was basically dancing,” said Lyn. “Dr. McGowan said they could not find any evidence of neurologic complications. None of us could believe it. We were overjoyed!“ “As with any abnormality, it’s beneficial to catch and treat it early, which we were fortunate to do for Evan,” said Dr. McGowan. Evan sees it a little differently, however. “As strange as it sounds, I really believe that all of these changes were put in my path so I would be in Idaho,” he said. “Without the injury to my dog or the sale of my Jeep or a quick escalation within my new job, I never would have been in Coeur d’Alene and I wouldn’t have had this amazing surgeon on my team. Dr. McGowan saved my life.” He now sees Dr. McGowan every three months for testing and scans. Evan’s tumor was not cancerous, and thanks to the skills of a highly trained surgeon, his care team and the innovative technology available at Kootenai Health, Evan is happy to report that he has had zero complications and takes no medications. “I see no reason why Evan would not be able to fly again,” said Dr. McGowan. While Evan waits for clearance from the FAA to take to the skies again, he enjoys spending a lot of time with family and doting on his other dog. “It’ so great just soaking up family time. I wouldn’t trade it for all the flying in the world.” Giving is lifesaving Kootenai Health Foundation depends on donations, large and small, to help fund critical equipment, programs and services at Kootenai Health. Contact the Foundation office at (208) 625-4438 or email foundation@kh.org to learn more. Evan and his surviving dog, Mako. Dr. McGowan and Evan Dansereau. KH.ORG 7

Caleb Kelly, M.D., Ph.D. Kootenai Clinic Gastroenterology and Endoscopy Tell us a bit about you and your family. I grew up in Central Michigan surrounded by fields of corn and soybeans. I fell in love with mountains during medical school in Colorado. After additional medical training on the East Coast, I am thrilled to now live in northern Idaho, near mountains, lakes and public land. Where did you receive your medical degree? I trained as a dietitian at Tufts University School of Nutrition Science and Policy in Massachusetts. I then completed graduate and medical school at the University of Colorado. I completed further medical training in internal medicine and gastroenterology at Yale University in Connecticut. Why did you pick your specialty? I have a long-standing interest in nutrition and studied this in college and graduate school. Diet has dramatic effects on health and disease and is something that individuals can control. This led to an interest in digestive diseases and the medical specialty of gastroenterology, which enables me to consider each patient’s physiology, anatomy and environment (including diet). Meet Our New Provider Is it time for your screening colonoscopy? Call Kootenai Clinic Gastroenterology and Endoscopy at (208) 625-4595. What can patients expect when they first meet with you? It is important for me to carefully listen to each patient. Patients have great insight into their symptoms and medical history, and taking this in provides important clues that guide testing and treatment plans. What are some of your hobbies? I enjoy cycling, skiing and wildlife. If stuck inside, I enjoy traditional leather bookbinding. What drew you to Kootenai Health? I was impressed that people who work here are happy, care about doing their best for patients and are supported by a well-organized health system. What is your favorite healthy tip? One positive lifestyle change can start a chain reaction. Pick one area to improve (such as sleep, exercise, diet or time outdoors), and other changes will follow more easily. 8

By Kim Anderson When neurologist Matthew Womeldorff, M.D., began working at Kootenai Clinic Neurology last year, he didn’t face the usual questions about how to pronounce his name. Although it is one-of-a-kind, it’s a familiar name at Kootenai Health. A Coeur d’Alene High School graduate, Dr. Womeldorff’s family moved to Coeur d’Alene in the 1990s. His mother, Cindy Womeldorff, was a certified nursing assistant at the time and newly single. “I knew I wouldn’t be able to make it on $5.25 an hour, so I decided to go back to school at North Idaho College and become a registered nurse,” Cindy said. “In 2001, I went to work for Kootenai Health as part of the Nursing Resource Team. For the past 10 years, I’ve been a hospital supervisor. I’ve been at Kootenai Health for over 21 years now, and I love it.” A tailor-made opportunity Following undergraduate school at the University of Idaho, Dr. Womeldorff went on to medical school at the University of Utah and a residency and fellowship at the University of Rochester in New York. In his third year of residency, he and his wife and high-school sweetheart, Kayla (Leitzke) Womeldorff, who also grew up in Coeur d’Alene, started thinking about where they would like to settle down. They both liked the idea of living closer to family, and in a smaller community with four seasons, mountains and lakes. This became even more important when their son, Henry, was born. The opportunity to join Kootenai Health’s neurology program seemed tailor-made for them. As a neurologist, Dr. Womeldorff cares for patients with a wide variety of conditions affecting the brain, spinal cord and peripheral nervous system. He specializes in clinical neurophysiology, which studies the bioelectrical activity in the nervous system and helps diagnose problems. “Matt is a hard worker. A thinker. He is kindhearted and compassionate,” Cindy said. “He first worked at Kootenai Health in the summers of 2008 and 2009 as an emergency department intern. When he first told me that he applied for the position, I thought he was either really going to like it or really going to hate it. He came home on his first day, and he was so excited because he got to help an older gentleman use a urinal. I knew then he was going to really like it!” A lifelong role model Growing up, Dr. Womeldorff was quietly paying attention to Cindy’s dedication and love for health care. “When Mom was in nursing school, I would read her textbooks,” he said. “It was how she approached her work that helped solidify my decision to go into health care. Even though she would come home tired, she always had a sense of passion, meaning and purpose in her work. Her gratitude for a career that allows her to do something meaningful was very inspiring.” Today, the mother and son enjoy working for the same organization, texting to ask about each other’s day, and occasionally getting lunch together at Kootenai Cafe, the hospital’s cafeteria. “I am so proud of Matt and his dedication and perseverance,” Cindy said. “I’d say he turned out OK! Who knows, maybe one day Henry will be part of the Kootenai Health family too.” Family Ties Mother and son have a new bond— working at Kootenai Health Matthew Womeldorff; his wife, Kayla; and their son, Henry INSET: Cindy Womeldorff, RN, with her son, Matthew Womeldorff, M.D. KH.ORG 9

By Kim Anderson With two boys in elementary school and her 41st birthday behind her, Christina Feliciano thought her family was set. Her boys were becoming more independent, and she and her husband had left the world of bottles and blankets for one of basketballs and bicycles. As luck would have it, 2022 would change all of that—for the better. “I ran out of birth control, but it was just a short gap,” Christina said. “I just started feeling like something was off. At my age, I thought it was really unlikely that I would be pregnant, but I decided to take a home test.” The test was positive, and she quickly established care with OB-GYN John Kim, M.D., at Coeur Obstetrics and Gynecology. “After age 35, women are at higher risk for complications like pre-eclampsia and diabetes,” said Dr. Kim. “With more people waiting to have kids, we are seeing more women over age 35 having babies. We monitored Christina and her baby very closely. After 20 weeks, we saw her every four weeks with an ultrasound to measure for fetal growth. After 32 weeks, we saw her twice a week for nonstress tests and US (ultrasound-guided) fluid checks that are used to detect fetal well-being. Christina is such a pleasant person—her attitude contributed greatly to how well her pregnancy and delivery went.” Care around the clock Because both of Christina’s sons were born early—one born two weeks early and the other a full month early— she and her care team were concerned about preterm labor. At 30 weeks, when she began having twiceweekly appointments, they made sure the baby’s heart rate was OK and checked to see if Christina was having contractions. Twice before her new baby’s birth, there were enough concerns to send her to Kootenai Health’s obstetrics emergency department (OB ED), a unique emergency department developed specifically for women who are pregnant or have given birth within the past six weeks. Specially trained nurses and obstetric hospitalists— physicians who specialize in caring for patients at the hospital—cover the OB ED around the clock. “Not all hospitals have an OB ED,” said Kim Jorgensen, director of nursing for women’s and children’s services at Kootenai Health. “At Kootenai, our OB ED is in the family birth center and separate from our regular emergency department. Women can come in at any point in their pregnancy or up to six weeks postpartum and receive care with a team and facility built especially for their needs. It is really special for Kootenai Health to be able to offer this service.” Christina had been having contractions when she arrived for her second visit to the OB ED, on Dec. 5. “I was there for two hours. Everyone was great, but my labor wasn’t progressing,” Christina said. “The doctor at the hospital talked to me about what was happening, and we decided I should go home and wait. He gave me a lot of good information; I’m glad I listened to him.” One week later, Christina went into labor for real. “It was 2 a.m. and I needed to use the bathroom,” she said. “Things started moving, and I was in a lot of pain. I had a contraction-counting app on my phone, and I could see they were coming between two and three minutes apart. My husband asked if we needed to go to the hospital, and I said yes. Then he asked me again. Then a third time. It was kind of funny.” Speedy delivery Christina’s concerns that she would be sent home to wait again soon vanished. Within an hour, she was in labor. As her labor progressed, she reached a point when the pain was no longer bearable. With no time for an epidural to Oh, Baby! A 41-year-old mom experiences motherhood again 10

take effect, Dr. Kim worked with certified registered nurse anesthetist Mateo Arroliga so Christina could have a spinal nerve block. Both epidural and spinal nerve blocks involve the placement of a needle into the lower back. For epidurals, a small plastic catheter tube is threaded through the needle, the needle is withdrawn and medication is injected into the epidural space. Because the medication needs to cross the membrane surrounding the spinal cord before reaching the targeted nerves, it usually takes approximately 10 to 15 minutes for pain relief to occur. With a spinal nerve block, medication is injected into the cerebrospinal fluid that bathes the spinal cord. Pain relief occurs much more quickly but only lasts one to two hours. In Christina’s case, that was enough, and it allowed her to have the delivery she wanted. The pain relief allowed Christina to breathe and her body to relax so that her baby, which was stuck at the shoulders, could be born. Baby Samara joined her family weighing 8 pounds, 11 ounces, and measuring 20.75 inches long. Support comes full circle “We know how important it is to have the birth experience you want,” said Jorgensen. “Our approach is to make sure each mom has as much or as little support as she wants while also having a team ready to assist. We have everything ready to make sure our moms and babies are safe.” Christina said she was amazed at how much had changed at Kootenai Health since her sons were born. “I felt like a VIP in the labor room,” Christina said. “I told my husband we’d been upgraded! I didn’t realize how much support was available for moms. They made sure Samara never left my side. She was such a big baby, they checked her for diabetes, and because she had been stuck at her shoulders, they made sure all her limbs were OK. Everyone was just great!” Christina also found great support when it came time for Samara to nurse. Nursing had been a struggle with both of Christina’s sons, so having a lactation consultant to work with was very helpful. “My body just doesn’t produce enough milk for my babies,” Christina said. “When I asked about formula, the lactation consultant didn’t make a fuss. She was most concerned about doing what was right for Samara. They even have a phone number you can call 24/7 if you are having trouble. When we finally gave Samara a little formula, she took it right down. She was hungry!” Christina’s appreciation for her nurses has an added layer. For many years, she worked at the Idaho Department of Labor as the senior workforce consultant, helping people who wanted to become nurses (or pursue another needed profession) receive grant funds to help further their educations. On a previous trip to the emergency department, one of her sons received care from a nurse Christina had helped. Today, she continues to help people through her work as the business development and program manager at Idaho Business for Education, a group of nearly 250 businesses from across the state. Together, they are committed to transforming Idaho’s education system to create a highly educated and skilled workforce. With everyone settling in with Samara, her big brothers now argue over who gets to hold her. For now, their basketballs and bicycles are sitting idle in favor of their baby sister’s blankets and bottles. Bundles of joy See videos shared by some of our happy families, and find more to love about the safe, comfortable care of our Family Birth Center. Visit KH.org/birthing. Christina Feliciano, her two sons and baby, Samara KH.ORG 11

By Shannon Carroll “Honey, you’ve been through hell. It’s OK to cry.” Judy Holden sat at Kootenai Health Rehabilitation Services last November frozen with fear. “I didn’t want anybody to touch me—I was terrified because I had been through so much pain and felt like I just couldn’t take any more,” she shared. Between four back surgeries and a long battle with fibromyalgia, Judy was now faced with one of her biggest struggles yet—a traumatic injury to her elbow that resulted in four surgeries and the threat of amputation of her arm. “I was trying so hard not to cry when I first got to physical therapy,” said Judy. “But Jessie, my occupational therapist, told me it was OK. She let me have my cry, and here we are four months later. I couldn’t imagine having come this far without her.” Judy’s journey to recovery began with an unusual accident during checkout at the grocery store in late September. “I just caught my foot on the wheel of the cart, and down I went,” she said. Life-changing intervention Judy had sustained multiple fractures in her arm and had dislocated her elbow. Kootenai Clinic orthopedic surgeon Robert Blease, M.D., performed several surgeries on Judy’s complicated injury. “Judy’s break was very traumatic, and there was a real risk of her losing her arm,” said Dr. Blease. Experienced as a surgeon in the military, Dr. Blease is well-versed in the complexities of traumatic injuries. “Part of what I love about being a trauma specialist is quickly identifying solutions to treat complex injuries. I also look at many facets of their care to give them their best chance at resuming their quality of life,” he said. Dr. Blease had to navigate major issues that could have potentially impacted the chances of saving Judy’s arm. Severe swelling had to be resolved through several HEALING Body Mind An orthopedic surgeon saved her arm; an occupational therapist saved her spirit Robert Blease, M.D. Jessie Finn (left), an occupational therapist and certified hand therapist, has treated Judy Holden twice a week since November. 12

more surgeries. Furthermore, Judy was a lifelong smoker and her oxygen levels were very low, making her a less-than-ideal candidate for surgery. “Judy required multiple surgeries, so we needed to work with her to stop smoking to ensure she had the best outcome for subsequent surgical repair and recovery,” said Dr. Blease. “Smoking decreases blood flow and oxygen levels, making surgical wounds less likely to heal and more likely to become infected. Judy had experienced some serious complications, and we made it very clear to her that smoking was something that was going to be one more barrier to saving her arm.” “I tell people I have smoked since I was 2 years old,” Judy joked. “But I trusted Dr. Blease and knew this was something serious. I had to stop smoking for the best chance to save my arm. I was shocked at how low my oxygen levels were. My daughter is at the stage in her life where she will be starting a family soon, and I want to be around for my future grandkids!” With resources and encouragement from her Kootenai Health care team, Judy has not smoked for over four months. “I went from smoking my whole life to stopping completely. I tell everyone that it is possible to quit!” Continuing care Judy’s care team works closely together to continue looking at all aspects of her road to recovery. Dr. Blease sees Judy every six weeks and receives regular reports from Kootenai Health Rehabilitation Services about her progress. Jessie Finn, an occupational therapist and certified hand therapist with the Hand to Shoulder team at Kootenai Clinic Rehabilitation Services, has treated Judy twice a week since November. “Judy was pretty terrified at our first therapy appointment—there is a big mental component to therapy,” Jessie said. “It’s really important to meet patients where they are emotionally. I try to give them as much control as I can within their movement and weight-bearing precautions, and I don’t force them to do anything they don’t feel comfortable doing. When they can see that challenging themselves leads to healing, we gradually begin to build real trust. Patients begin to take accountability for their therapy. Recovering from a traumatic orthopedic injury, like Judy’s, is definitely a team effort between patient, therapist and surgeon.” At 53 years old, Judy has had more than her fair share of time spent in the hospital—she had two of her four back surgeries at Kootenai Health, and when she shattered her elbow, she chose to be taken there. “I just can’t say enough about Kootenai Health,” Judy said. “I live across the border in Washington and choose to come here for my care because everybody— the nurses, food services, housekeepers, doctors, therapists—I can give kudos to all of them all day long. They’re over-the-top amazing!” Dr. Blease and Jessie anticipate that Judy will make a complete recovery. “She is one tough lady and is putting in all the work she needs to have full function of her arm back,” said Dr. Blease. Judy sees it differently. “There’s no way I would be doing as well as I am right now without Dr. Blease and Jessie,” she said. “He’s such a talented surgeon, and Jessie, well, God works in crazy ways—I have two sons-in-law; their names are Jessie and Finn. When Jessie told me her last name was Finn, I nearly fell over! She is my biggest cheerleader and pushes me to improve. Dr. Blease saved my arm, and Jessie saved my spirit. I can’t thank them enough.” Care you can count on Kootenai Health’s multispecialty team provides comprehensive, high-quality care for patients who need urgent medical and surgical treatment. Count on us for everything from minor injuries—such as lacerations and fractures—to major, complicated trauma involving multiple body systems. Kootenai Health is an American College of Surgeons-verified Level III Trauma Center and an Idaho Time Sensitive Emergencies-designated Level II Trauma Center. Dedicated to your healing Kootenai Clinic Orthopedics is committed to helping patients get back to what they love through specialized surgical and nonsurgical care. Sameday orthopedic appointments are available Monday through Friday by calling (208) 625-6636. Kootenai Health Rehabilitation has four locations and offers a comprehensive rehabilitation program with a multidisciplinary team dedicated to your healing. Visit KH.org to learn more or to make an appointment. KH.ORG 13

Getting It AllUncommon care for the most common form of cancer Benjamin Mandel, M.D. By Kim Anderson Raise your hand if you grew up in the era of slathering on baby oil and basking in the sun. Now check that hand carefully. Spots that have an irregular shape, unusual color or seem to be changing may signal skin cancer. Skin cancer is currently the most common cancer in the United States, and an estimated 9,500 people in the U.S. are diagnosed with skin cancer every day. There are three major types of skin cancer—basal cell carcinoma, squamous cell carcinoma and melanoma. All three typically appear in sunexposed areas of the body; however, they can also form on areas that rarely see the light of day. Skin cancer is very common, and, when detected early, it is also relatively easy to treat. Small, early skin cancers may be frozen using liquid nitrogen at a doctor’s office visit. Larger skin cancers can be removed by cutting away the skin cancer and taking a margin of healthy tissue around the cancer to be sure all the cancer is removed. A unique technique Because cancerous cells are not always easy to see, taking enough healthy tissue to make sure the cancer is gone while also leaving as much healthy tissue as possible can be a challenge. To help meet this challenge and provide the best clinical outcomes and patient experiences possible, Benjamin Mandel, M.D., at Kootenai Clinic Plastic and Reconstructive Surgery uses a unique technique. “We call it CCPDMA, which stands for Complete Circumferential Peripheral and 14

Deep Margin Assessment,” said Dr. Mandel. “Basically, the cancer and a margin of tissue around it is removed. Then, a thin layer of tissue is carefully shaved all around the outermost edge of the sample. That entire layer of tissue is examined by a pathologist for any trace of cancer. If there is no cancer in the tissue, we know we got it all. If cancer is found, we know we need to go back and remove a larger section of tissue from the cancer location.” CCPDMA gives surgeons a complete look at every part of the tissue margin. It is a significant improvement over a standard surgical pathological analysis, which looks at cross-sectional samples of the tissue. The standard analysis is similar to looking at only the crust on a few slices from a loaf of bread rather than the entire crust. Minimal scarring Thoroughly removing the cancer while taking the smallest amount of tissue necessary helps patients have a good recovery with minimal scaring. Cure rates are between 95 and 98 percent. The entire procedure can be done in the doctor’s office with only a local anesthetic. The tissue margin is examined by a pathologist while the patient waits. If more tissue must be removed, it is done at that same visit, along with reconstructive surgery. “There is a psychological aspect to our faces and wanting to feel that we look our best,” said Dr. Mandel. “Doing surgery on the face presents an intellectual and visual puzzle to solve. As a plastic surgeon, I have trained in a variety of techniques so I can choose the best one to minimize or hide the scarring.” CCPDMA is similar to another surgical technique, Mohs, named after general surgeon Frederick Mohs, M.D., who introduced it in the 1930s. Today, Mohs surgery may only be performed by dermatologists who do their own pathological evaluations during the procedures. As with all health conditions, an ounce of prevention is worth a pound of cure. “Remember to limit sun exposure,” said Dr. Mandel. “Use a mineral-based sunscreen with an SPF of at least 30 to 50, depending on how much time you will be in the sun. Taking basic precautions today will pay off with better skin health when you are older.” Need a consultation? For an appointment with Kootenai Clinic Plastic and Reconstructive Surgery, visit KH.org/plastic-and -reconstructive-surgery. For Kootenai Clinic Dermatology, visit KH.org/dermatology. Both practices can also be reached at (208) 625-4333. Sun Sense Because exposure to UV light is the most preventable risk factor for all skin cancers, the American Academy of Dermatology encourages everyone to stay out of indoor tanning beds and protect their skin outdoors by seeking shade, wearing protective clothing—including a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses with UV protection—and applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to all skin not covered by clothing. For more effective sun protection, select clothing with an ultraviolet protection factor (UPF) number on the label. Because severe sunburns during childhood and adolescence may increase one’s risk of melanoma, children should be especially protected from the sun. Know the Signs Skin cancer warning signs include changes in the size, shape or color of a mole or other skin lesion; the appearance of a new growth on the skin; or a sore that doesn’t heal. If you notice any spots on your skin that are different from the others, or anything changing, itching or bleeding, the American Academy of Dermatology recommends that you make an appointment with a boardcertified dermatologist. KH.ORG 15

By Kim Anderson With all the talk about employers needing workers, it might seem like any job is as good as the next. But not every job comes with health insurance, vacation time or a retirement plan. For anyone just getting started or looking to make a new start, finding a good job can be hard—especially if you don’t have money to pay for training or school. If that sounds like you or someone you know, Kootenai Health has just made it easier to embark on a medical career. Time is money The hospital needs certified nursing assistants, or CNAs, and it will help anyone who is willing to get the training. Anyone who works at Kootenai Health in any job for 90 days can be part of the program. Kootenai Health will pay the North Idaho College Workforce Training Center the cost to enroll in their 12-week CNA training program. Once you graduate and earn your CNA certification, starting pay for CNAs is $17.85 per hour—but that’s not all. You also get health insurance, vacation time and money saved for your retirement. “We are making this easy for anyone who wants to be a CNA get started and get a good job,” said Kelly Wolfinger, talent acquisition manager at Kootenai Health. “For anybody graduating from high school or getting their GED who is ready to start making a living, or for someone who is looking for a more stable job, this is a great way to go. You put in the time, and we’ll pay the full $1,500 for the program up-front. You don’t have to pay and then wait to get paid back.” Be an apprentice Anyone interested in the program can even start working at the hospital as a CNA apprentice while they are going to school. They get to work right alongside other CNAs and nurses helping patients and learning on the job while they also learn in school. After working as a CNA for a while, many people decide to get more schooling to become a nurse. Kootenai Health has programs to help people who are ready to make that change. There are also programs to help people learn many other types of jobs, including becoming a medical assistant through the North Idaho College Workforce Training Center. Kootenai Health is a place you can be proud to work, and the more you learn, the more you can earn. “Every one of us at Kootenai Health is helping make sure our patients get the care they need,” said Kelly. “If you want a good-paying job and you want to help people, we want you to be part of our team.” Join our team Visit KH.org/careers, call (208) 625-4620 or email careers@kh.org to search current openings and learn more. Caring and Aspiring Kootenai Health offers training and benefits for future medical professionals 16

208.625.4620 kh.org careers@kh.org

By Caiti Bobbitt When John and Julie Kuhlman met while students at Western Washington University, there was a time Julie might have called it luck. Only later did she learn that John had carefully planned their “lucky” meeting. Julie lived with John’s sister, and, in an effort to get to know her, he invited the roommates over for dinner. “We had spaghetti at his apartment, and we have been together ever since,” said Julie. That was January 1981, and while 42 years have passed, the pair continue to mark the date in the same way. “He’s a fantastic cook, but nothing beats his famous spaghetti,” Julie said. A lot has happened in those four decades together— two successful careers, raising a beautiful daughter and several relocations. One of their biggest moves was in January 2022, when the pair moved from northwestern Washington to Hayden, Idaho. It was supposed to be the next chapter of their love story, celebrating the fruits of their labor, but in September 2022, John’s health took a turn for the worse when cirrhosis of the liver put him into a coma. “I was thinking the absolute worst,” Julie recounted through tears. Beginning treatment John spent a week in the critical care unit of Kootenai Health before being air transported to the University of Washington in Seattle, where he ultimately received a liver transplant. While his liver function steadily improved, his care team in Seattle noticed other side effects unrelated to his transplant. An MRI revealed John had a condition called osmotic demyelination syndrome (ODS). ODS is a brain injury that can occur when a patient experiences a rapid elevation of sodium levels. “John didn’t have a stroke, but his symptoms mirrored one,” Julie explained. “He has apraxia, a loss in the ability to do skilled movements, which impacts his speech and physical abilities.” He spent a total of two months in the Seattle hospital recovering from the transplant. It was there his life was saved, but if he were to have any quality of life, he would need to begin working with a team of rehabilitation providers. Surviving, on the road to thriving “Would you look at that,” Julie exclaimed while watching John march past her using a single trekking pole. When he came through the doors of Kootenai Health Rehabilitation Services only a month prior, he relied on a four-wheeled walker to walk. “I don’t think what we are experiencing right now is the new normal, because under the care of these therapists, I think he is going to keep improving,” Julie said confidently. John’s care requires a collaborative approach from Kootenai Rehabilitation Services’ neurological team, which for John means working with both a physical therapist and a speech therapist. He meets with physical therapist Rich Mehlbrech, PT, DPT, NCS, CSCS, who only works with neurological patients, and Rich’s third-year physical therapy student, Ty Harry, twice a week to regain strength, stamina and fine motor skills. “John has made a lot of improvements, and I believe he will make many more,” said Rich. To help restore his speech, John sees Holly Alling, MA, CCC-SLP. “John is a special case, but we have a great team with a lot of experience in treating complex diagnosis,” Holly explained. Progressing as a team The outpatient neurological rehabilitation team at Kootenai Health meets weekly to discuss their shared patients’ care plans. They stay in regular contact throughout the week about their patients’ progress and struggles. “If you look at the research, it shows this integrated approach care model is better for patients,” Rich noted. Kootenai Health Rehab Services is the only clinic in northern Idaho to have physical therapy, speech therapy and occupational therapy under one roof. That means better collaboration among the providers and better outcomes for their patients. “It is definitely a team approach,” said Holly. “We are all in this together, and we all support each other.” John is a great example of how the disciplines work together for the patient. His work with Rich and Ty Surviving and Thriving Kootenai Health Rehabilitation Services integrates care for the best patient outcomes 18

improves his core strength, which helps his breathing, which in turn helps the work he does with Holly to advance his speech production. “Sometimes we can’t work without each other,” said Holly. The reality is John is still in the early stages of his rehabilitation journey, but Rich, Ty and Holly have a plan and an expectation to get him to where he wants to be. “One of his big goals is standing and cooking,” said Ty. “So he is working to have the ability to stand and safely cut. We focus on the bigger picture versus just strength.” Even more than that, John feels confident in his care team and their unwavering support. “It makes all the difference to have providers with good bedside manner,” he said. “They really want to get to know me.” At the end of one physical therapy appointment, the couple continued to chat with Rich and Ty, joking about John’s honey-do list from Julie and his excitement about adopting two new kittens. “One of the best parts about this job is how well we get to know our patients,” said Ty. “We get to celebrate the little wins between the big wins with our patients, like transitioning from a walker to trekking poles or from two trekking poles to one.” Hearing Ty and Rich talk about John’s future gives the couple hope. Hope they did not have in fall 2022. Julie would have told you she had unknowingly spent her final annual spaghetti night with her longtime love, but if things keep progressing at this rate, John will be standing and cooking in the kitchen when it is time to celebrate again. Comprehensive care Meet the team who cared for John and learn more about Kootenai Health Rehabilitation Services at KH.org/rehabilitation-services. Kootenai Health Rehab Services is the only clinic in northern Idaho to have physical therapy, speech therapy and occupational therapy under one roof. From left, Rich Mehlbrech, physical therapist; John Kuhlman, patient; and Holly Alling, speech therapist. KH.ORG 19

By Shannon Carroll Kootenai Health’s Heart Center is a modern reflection of the decades of stellar care provided to heart patients in our region. David Davis is the husband of one such patient whose recent health scare shed light on the power of compassionate care and modern technology working hand in hand to save lives. “It was a lazy Sunday, and Cynthia and I were just lying in bed scrolling through our phones,” said David. In their mid-60s, David and Cynthia were enjoying being retired and spending quality time together. Married for 27 years, David’s love for his wife was evident in his emotional retelling of their so-called lazy Sunday. “I was going to go outside and tinker with some new tools I’d gotten for my tractor but decided to stay in bed next to my wife and relax a bit more,” he said. David and Cynthia live on 10 acres in Athol, Idaho, and he normally spends his mornings working on their small farm. On this particular day, the couple could not have been more fortunate that David chose to take it easy. Suddenly, an emergency “I was just reading headlines when I noticed Cynthia was making an odd sound—almost like how a horse blows out of its nose,” he said. “I had my back to her and asked, ‘Are you okay?’ She didn’t respond. She was completely unconscious.” David immediately called 911 with his cellphone on speaker and provided his wife’s status to the operator. The operator suggested he move her to the floor in case CPR was needed. After moving Cynthia to the floor, he realized her pulse had stopped and notified 911 he was starting CPR. “I’m a retired deputy sheriff, and I’ve seen many things over the years—car wrecks, murders, gunshot wounds,” he said. “But I’ve never once had to give CPR. I never dreamed I’d have to perform it on my wife.” David’s quick actions that morning were the first step in saving his wife’s life. The second step involved innovative tools that provided assistance to first responders, Cynthia’s care team and her heart. As David started CPR, he shouted, “Unlock the front door!” to his virtual assistance device, more commonly known as Amazon Alexa. Additionally, David was able to view outdoor cameras on his phone to update 911 on the arrival of emergency personnel and guide them to his location inside the house. Maintaining constant CPR and not leaving her side for a moment provided Cynthia with an increased chance of survival. Innovation and expertise The intersection between technology and saving Cynthia’s life continued through her care at the Kootenai Health Heart Center. She received immediate and lifesaving care by a team of intensivists and the A Bigger, Better Heart Center Kootenai Health’s Heart Center is a wonderful example of how a community can come together to improve health care for everyone. From 2003 to 2005, the Kootenai Health Foundation and generous donors in our community came together to build a state-of-the-art heart center to serve patients in northern Idaho. Twenty years, thousands of cardiovascular surgeries and countless additional cardiac procedures later, the need for these services has continued to grow. Northern Idaho, especially Kootenai County, is one of the fastest growing regions of the country. Innovative Tools and Quick Action Work Together to Save a Life

cardiology team led by cardiologist Brett Eliuk, D.O. Cynthia had sustained a left bundle branch block due to cardiomyopathy, also called heart muscle disease, that blocked the pathway electrical impulses travel to make the heart beat. After quickly diagnosing her in the catheterization lab, doctors then surgically implanted a biventricular defibrillator to help regulate her heart’s rate and contraction pattern. The device used for Cynthia’s heart syncs with her smartphone so she can closely monitor her heart health and stay on top of any changes. Most notably, it detects an abnormal heartbeat and sends a shock to the heart to restore normal patterns. Although technology played a major role in her story, it was the human touchpoints that made the biggest impact. “I’m so happy with all of the staff at Kootenai— everyone was so unbelievably friendly and caring,” Cynthia said. “I had no idea what questions to ask, but Dr. Oza (her cardiologist, Sameer Oza, M.D.) boiled it all down for me in simple terms.” “Less than 10 percent of people who experience an out-of-hospital cardiac arrest like Cynthia make it, yet here she is—expected to fully recover,” said Dr. Oza. “We’re so fortunate to have the best team at Kootenai, and it’s really exciting to see what our new Heart Center can do to further complement our innovative services.” Happily ever after As for David and Cynthia, they look forward to spending even more time together. “We are sort of a yin and yang—I want to be in the mountains and she loves the ocean, but we both agree we love the water,” said David. “We also recently bought electric bicycles…we look forward to getting out and enjoying them.” A fitting continuation to a story built on love—and helped by technology. Together, we can save hearts and lives! We would love to hear from you. Email foundation@kh.org or call (208) 625-4438 to start the conversation. Giving is easy—just scan this QR code to reach the Heart Center expansion’s donation page. Patients from Grangeville to the Canadian border rely on Kootenai Health for cardiac care. In the past year alone, Kootenai Health served more than 3,200 patients with these facilities, but there were times when more capacity was needed. The Heart Center has 15 patient rooms, one cardiac catheterization lab (cath lab) for treating blockages in the heart and arteries, and one electrophysiology lab (EP lab) for treating heart rhythm disorders. A much-needed expansion is underway that will add a cath lab, an EP lab, and nine pre- and post-procedure rooms to increase that capacity. The expansion will help 1,500 more patients receive needed cardiac catheterizations and 100 more patients receive care for heart rhythm disorders every year. Through the Heart Center expansion, Kootenai Health will also be able to provide more complex, higher acuity services in northern Idaho, which means patients can receive the care they need more quickly and closer to home. This important work will not be possible without community support. To learn more about the expansion and how you can help support world-class cardiovascular services close to home, contact the Kootenai Health Foundation. Brett Eliuk, D.O. Sameer Oza, M.D. Cynthia and David Davis KH.ORG 21