Kootenai | Kootenai Health | Issue 1, 2024

Health KH .ORG ISSUE 1 | 2024 Better care for our evergrowing population Kootenai Health Heart Center

KH.ORG 3 WHAT’S INSIDE Issue 1 | 2024 20 Fantastic support for Festival of Trees 18 Walking without pain after ankle replacement 16 A step up in trauma care 6 Always one beat ahead Follow Us 8 Beyond the gold standard: New treatments offer hope 5 Breathe easy—you’re in good hands Find out how the Difficult Airway Response Team program has improved collaboration and patient safety. 10 Meet our new providers Help us welcome our new experts in family medicine and other specialties to the Kootenai Health team. 14 Patients at Kootenai Health have better health outcomes Healthgrades recognizes our cardiac surgery, stroke care and pulmonary care for excellence. 22 Ask the expert Endocrinologist Maria Rodebaugh, M.D., explains the difference between diabetes and prediabetes and how to manage them.

Health Kootenai Health 2003 Kootenai Health Way Coeur d’Alene, Idaho 83814 KH.org (208) 625-4000 Kootenai Health Board of Trustees Katie Brodie, Chair Robert Colvin, Vice Chair Dave Bobbitt, Secretary and Treasurer Cindy Clark, Trustee Thomas deTar, M.D., Trustee Teri Farr, 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 Cyndy Donato, Executive Vice President, People and Culture Kelly Espinoza, Chief Nursing Officer Jeremy Evans, Chief Operating Officer Joel Hazel, Chief Legal Counsel Cara Nielsen, Kootenai Health Foundation President Ryan Smith, Chief Information Officer John Weinsheim, Executive Vice President of Kootenai Clinic Executive Regional Editor Kim Anderson Regional Editor Shannon Carroll Cover photo Katrina Walker Published as a courtesy of Kootenai Health four times a year. Models may be used in photos and illustrations. If you have any concerns or questions about specific content that may affect your health, please contact your health care provider. Kootenai Health complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Translation assistance services, free of charge, are available to you. Please call (877) 746-4674. Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al (877) 746-4674. Ako govorite srpsko-hrvatski, usluge jezicke pomoci dostupne su vam besplatno. Nazovite (877) 746-4674. 2024 © Coffey Communications, Inc. All rights reserved. Kelsey Hart, Kootenai Health Laboratory, Sweet Tooth Closing Thoughts An Ongoing Inspiration In March of this year, I will be retiring from Kootenai Health. I find myself thinking more and more about the people and experiences that have made my time so special. I could never name them all, but here are a few for which I am grateful. Our caregivers. Health care technology is so impressive, it often takes center stage. I am always reminded, however, that the most remarkable thing about health care is the human connection between patients and their care teams. I am proud that Kootenai Health continues to emphasize the importance of compassionate care for our patients and their families. Physicians and advanced practice providers. Unless you work in health care, you cannot fully appreciate the dedication physicians and providers have to their patients and profession. I have been fortunate to have worked alongside many of the best and brightest in their fields, and they are an ongoing source of inspiration. Leadership team. The greatest challenge of leadership is to turn challenges into opportunities and to build a culture that does it again and again and again. The leadership team at Kootenai Health has mastered this. Friends of Kootenai Health. Many of our facilities, programs and services would not have been possible without the support of our community. We are always grateful for our community’s generous support, whether it is helping to fund our new heart center or another worthy project or writing a note of thanks to a special caregiver. Community. Nearly everyone who lives here knows someone who works at Kootenai Health. The people we care for are our friends, neighbors and families. I am so proud of the work we do to provide every patient the best care possible. I am grateful to have had the honor of leading Kootenai Health and doing my part, along with you, to improve health care in our community. The foundation for our good work was laid before I arrived, and I look forward to watching it continue to grow for many years to come. Wishing you good health, Jon Ness 4

By Tolli Willhite Few things in life leave us more vulnerable than having surgery. Our loved ones give us one last smile and a reassuring squeeze of the hand as we’re wheeled down the hall. We’re quite literally placing our lives in the hands of trusted surgeons, anesthesia professionals and a host of specially trained staff. These people are the ones we’re counting on to use all their training, experience and equipment should something go wrong—such as difficulty establishing an airway. Kootenai Health prepares and trains for exactly this situation. In 2020, Kootenai Health started the Difficult Airway Response Team (DART) program, a multidisciplinary task force led by Sarah Pierce, a certified registered nurse anesthetist at Anesthesia Associates of Coeur d’Alene and medical director of the DART program. After securing leadership support and funding, the team first carefully selected standardized airway equipment to be assembled in a fleet of DART carts. The carts are identical and placed throughout the hospital, so no matter where a response is needed, the same equipment is always available. Education is key “Rollout of the equipment required significant communication and education to increase awareness and familiarity with the equipment,” explained Sarah. Training is a key element of successfully implementing the DART program. Annual workshops are held to train staff on the contents of the DART carts, difficult airway scenarios, identifying high-risk patients and how to create surgical airways in emergency situations. The workshops attract providers, specialists and first responders from throughout the region, with additional outreach to area hospitals. Representatives from many different disciplines attend, including intensivists, ENT (ear, nose and throat) surgeons, emergency department physicians, anesthesia providers, trauma surgeons, nurses, respiratory therapists, paramedics and Life Flight personnel. Health care can be described as a team sport. Everyone has a position to play and a job to do. “We need to be able to train together, recognize each other’s strengths and limitations, understand how to perform as a collective team, know when to ask for help, and communicate effectively,” Sarah said to describe the annual workshops. “There has been a profound improvement in our collaborative culture and in patient safety,” Sarah explained. “Providers are more likely to reach out to anesthesia professionals with a potentially difficult airway Otolaryngologist Chad McCormick, M.D. (far right), instructs a practice simulation for airway emergencies. Otolaryngologist Erik Gilbert, M.D., demonstrates a nasopharyngeal airway insertion. “There has been a profound improvement in our collaborative culture and in patient safety.” BREATHE EASY—You’re in Good Hands situation, do so early, and use a team approach for securing the airway.” The international Anesthesia Patient Safety Foundation has recognized the DART program at Kootenai Health as a cutting-edge service that fosters collaboration to provide the highest level of patient care. As a patient, you can breathe easy—because you know you’re in good hands. KH.ORG 5

By Caiti Bobbitt After years of planning and construction, an additional 37,000 square feet have been added to the Kootenai Health Heart Center, including nine new patient rooms, a second cardiac catheterization lab and a second electrophysiology lab for heart rhythm disorders. “What that means for our community is that we have improved our ability to care for you and your family members,” said Eric Wallace, D.O., medical director of interventional cardiology at Kootenai Health. Groundbreaking for the expansion project was in June 2021, and it was officially complete in October 2023. Thank you! The Kootenai Health Heart Center received support from generous donors in our community through the Kootenai Health Foundation. To learn more about supporting needed health care services in our community, visit KootenaiHealthFoundation.org. With the additional space, the heart team is able to perform more procedures, decrease patient wait times and produce better patient outcomes. To put into perspective the benefit the expansion has already had, the Heart Center performed 298 more procedures in October through December of 2023 than during the same time frame last year. “The goal of the Heart Center expansion—and all of our expansion projects, for that matter—is to better care for our ever-growing population, and it is doing just that,” said Jeremy Evans, Kootenai Health’s chief operating officer. “Our goal is to always be ahead of the growth.” ALWAYS One Beat Ahead 6

New spaces, new faces More square footage equipped with the latest diagnostic and treatment technologies is one component of the new Heart Center. The world-class providers it has attracted is another. “I’m a heart electrician,” said electrophysiologist Ronald Jones, M.D., of Kootenai Heart Clinics. Dr. Jones is a Stanford University and San Antonio Uniformed Services Health Education Consortium (SAUSHEC) fellowship-trained physician. He came to Kootenai Health in 2023 and joined a long list of providers with impressive backgrounds. Regardless of where they came from, they all have the same vision looking forward: to provide the best cardiac care to the region. “When I was interviewing at hospitals, I was looking for a place where I would be able to practice full-spectrum electrophysiology,” Dr. Jones said. “I saw Kootenai Health as an opportunity to be a partner in helping build the program alongside my incredible colleagues.” Dr. Jones said the expansion definitely played a role in his decision to join Kootenai Heart Clinics. “Kootenai is committed to patient care, and that means being committed to having the best technology and equipment,” said Dr. Jones. “I know I am able to give my patients the best possible outcomes because of that.” Building on excellence More space and more providers—and soon more services—are building upon an already impressive program. In the last year alone, Kootenai Health has been recognized as a Level I STEMI (heart attacks in which the coronary artery is completely blocked) Center of Excellence by the Idaho Time Sensitive Emergency System, as one of America’s 50 Best Hospitals for Cardiac Surgery by Healthgrades and as one of the 10 best hospitals in the country for reducing heart attack readmissions by the Centers for Medicare & Medicaid Services. In short, if you come to Kootenai Health for heart care, you are in great hands. “The Heart Center expansion is a testament to Kootenai Health’s commitment to excellence,” said Dr. Wallace. “It aims to meet the increasing demand for specialized cardiac care while integrating the latest advancements in technology and medical expertise.” KH.ORG 7

When the best treatment for cancer didn’t work, a new medication offered hope By Kim Anderson Jerry Swanson is tough. Not tough with muscle and brawn, though he previously had that too. Tough with a strength of character that comes only when the odds are against you and you keep on fighting. Maybe it began with his North Dakota roots or his years working as a commercial and industrial painter, perfecting his craft. It certainly showed through, years ago, when he chose a different career path. “In the ’70s and ’80s, they were using helicopters, looking for oil fields in North Dakota,” Jerry said. “I’d drive by the mechanics working on those helicopters on my way to a painting job and think, ‘That looks like fun, and I’ll bet they’re getting paid better than me.’” Jerry earned enough money painting to attend aviation mechanic school in Boulder, Colorado. After he had worked for a number of companies and expanded his knowledge through hands-on experience, Jerry’s expertise put him on the leading edge when the U.S. military began allowing decommissioned military helicopters to be sold to private businesses. Through his work with the Federal Aviation Administration, he learned the intricacies of certifying these aircraft for civilian use. Timberline Helicopters, in Sandpoint, Idaho, had just purchased two Black Hawk helicopters. Because they were among the first Black Hawks sold to a private business, the certification process had not yet been developed. Timberline sought Jerry’s help, and he was happy to join their team. The position eventually brought him and his wife, Annie, from their home in Montana to Sandpoint. Part of settling in at their new home included setting up a vintage windmill they brought with them from Montana. Jerry’s search for a concrete company to pour a slab for the windmill base was coming up empty, so he decided to mix and pour the concrete by hand. Partway into the project, Jerry found himself in intense pain. “I’ve had back pain for years, but this was different,” Jerry said. “It kept getting worse, and my doctor referred me to the emergency department at Kootenai Health.” Unwelcome diagnosis Within two hours, Jerry and Annie had their answers. Not only did Jerry have four fractured ribs and three fractured vertebrae, an imaging study also showed that his ribs, spine and pelvis were covered with lesions— the result of multiple myeloma. Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell. While healthy plasma cells help fight infections, cancerous plasma cells build up in the bone marrow and crowd out healthy blood cells. This weakens the bones, causes fatigue and reduces the body’s ability to fight infection. Jerry has lived for many years with chronic lymphatic Jerry and Annie Swanson Gold BEYOND THE Standard 8

leukemia (CLL), a type of cancer of the blood and bone marrow. CLL typically progresses slowly, and Jerry had lived with it relatively trouble-free for 11 years. The multiple myeloma was different. Jerry received several rounds of cancer treatment, including a medication called Revlimid, a medication his oncologist at the time described as the gold standard for multiple myeloma. Unfortunately, Jerry’s cancer was so aggressive, each of his treatments only brought the cancer under control for a very short time. It kept coming back. “If the gold standard doesn’t work, then what?” Jerry asked. New and powerful treatment Jerry and Annie decided to seek a second opinion from medical oncologist Kevin Mulvey, M.D., at Kootenai Clinic Cancer Services. After researching Jerry’s diagnosis and treatment, Dr. Mulvey suggested he might be a candidate for a new treatment. Because Dr. Mulvey was scheduled to retire soon after Jerry’s initial visit, he transitioned his care to his colleague at Kootenai Clinic Cancer Services, medical oncologist Paul White, M.D. In Jerry’s case, he needed an aggressive treatment quickly. One option, a bone marrow transplant, is aggressive and effective, but Dr. White knew that could take months to arrange. Instead, he recommended a brand-new medication, teclistamab, which was only approved by the U.S. Food and Drug Administration in October 2022. It works by binding the myeloma cell directly to a white blood cell, which will then destroy the cancer cell. “Teclistamab is one of a growing class of medications called BiTE antibodies,” said Dr. White. “They have tremendous promise in treating multiple myeloma, lymphomas and leukemia. In some cases, they are as effective as a bone marrow transplant. We are excited to be able to offer them for our patients here, rather than sending them to large, academic hospitals far away.” In order to give the medication, Dr. White and the chemotherapy nurses received special training to manage the drug’s unique side effects. “I had to receive a shot of the teclistamab as an outpatient and then go to the Hospitality Center and stay overnight while Annie watched me,” Jerry said. “The next day, we would check into the hospital for overnight observation. We did that three times in a row.” He completed the initial treatment in May. The gift of a future As of September 2023, Jerry is doing well and getting stronger. He and Annie joke that he went from being an “animal” to being a “puppy,” but their lighthearted laughter reveals their hope. “We can’t say enough good things about Kootenai Health and the Sandpoint cancer center,” said Annie. “We are making plans for our future again.” “There are still a lot of unknowns,” Jerry added. “But there are unknowns in everyone’s life. It’s all about not giving up.” Reason for hope Read more about what Kootenai Clinic Cancer Services has to offer— visit KH.org/cancer. Kevin Mulvey, M.D. Paul White, M.D. Jerry Swanson was working on pouring concrete by hand for the base of this windmill when severe pain brought him to Kootenai Health. KH.ORG 9

R. Chase Cullen, PA‑C, MPAS Kootenai Clinic Neurology Tell us a bit about you and your family. I grew up in a small town in southeast Iowa. I have one older sister and a niece and nephew, whom I adore. Unfortunately, with the distance, I do not get to see them as much as I would like. I always wanted to live in the western United States, surrounded by natural beauty, which drew me to northern Idaho. Where did you receive your degree? I received my undergraduate degree from Iowa State University. I then received my graduate training at St. Ambrose University in Iowa. Why did you pick your specialty? Multiple sclerosis is near and dear to my heart. Growing up, my grandmother would tell me stories about how her mother was affected in the 1940s. Multiple sclerosis is a disease that varies so much between patients, it truly requires a personalized approach to treatment. Working in a large team setting to craft an individualized treatment plan is, in my opinion, an optimal approach to medicine. I am able to fulfill this in our multiple sclerosis subspecialty. What can patients expect when they first meet with you? Patients can expect a comprehensive appointment to review labs, imaging, medical history and current symptoms. I try to always make sure my patients feel heard and can approach me with any questions they may have. Due to multiple sclerosis encompassing so many different symptoms, it is important that we take as much time as needed to determine the best course of action. Meet Our New Providers What are some of your hobbies? I enjoy walking outdoors, music and trivia! I’m hoping to learn how to ski this winter. What drew you to Kootenai Health? The geographic area and the subspecialty of multiple sclerosis are what drew me to Kootenai at first. After interviewing with several people, I felt that Kootenai was a great fit for me. Several virtual interviews and then an in-person interview helped cement that Kootenai is a great place to work, with equally great people woven throughout the organization. What is your favorite healthy tip? Restful, restorative sleep is one of the most important factors in overall and long-term health. Unsurprisingly, new studies have shown that worse sleep efficiency leads to dramatic brain aging. Erik Larson, M.D. Kootenai Heart Clinics Tell us a bit about you and your family. I was born in northern Idaho and grew up in Wasilla, Alaska. My wife, Rachel, and I met at Washington State University in Pullman as undergraduate students in the neuroscience program. She continues to work with WSU on medical education research. We have two sons (a teenager and a new baby) and two dogs. My extended family has lived in northern Idaho for generations, since my great-grandfather immigrated here in the early 1900s. Where did you receive your medical degree? I received my medical education from the University of Washington School of Medicine, in partnership with Washington State University, as part of the regional WWAMI program. This created the opportunity for me to obtain my classroom and clinical bedside medical education mostly in Spokane. My seven-year neurosurgical residency training was completed at Oregon Health and Science University in Portland. 10

Why did you pick your specialty? I chose to pursue neurosurgery for the opportunity to care for patients and families who are facing brain or spine disorders. The privilege of counseling these patients and offering surgical intervention (when appropriate) is something that I take very seriously and am honored to undertake. Neurosurgery requires ongoing lifelong learning, staying on the cutting edge of technology and the pursuit of mastering surgical techniques. What can patients expect when they first meet with you? My goal is that patients can expect that we will sit down together and start building a trusting relationship. I would like to get to know my patients and their families and listen closely to why they have been sent to see a neurosurgeon. We will view their imaging together, and I will explain my interpretation. Then I will offer my best and most straightforward advice on next steps for them, whether surgical or nonsurgical, and include alternative options if warranted. What are some of your hobbies? I enjoy cooking and barbecuing, fishing, hunting, traveling, snowboarding, visiting national parks, hiking, and spending time with family. What drew you to Kootenai Health? I was born in northern Idaho, and my parents plus other extended family live throughout this region. When I learned of this opportunity at Kootenai, I was excited and eager to return home and help provide neurosurgical care in the community. What is your favorite healthy tip? Stay active with regular, challenging, physical and mental activities that you enjoy. Please stay safe out there (wear helmets, seat belts, eye protection, etc.). Deborah Long, APRN, CNP Kootenai Clinic Family Medicine Residency Tell us a bit about you and your family. I was born and raised in Idaho and live with my husband, Scott, and 18-year-old daughter, Brooke, in Spirit Lake. Scott is the owner and operator of Northwest Powerwash and Detail. Brooke just graduated and races snowmobile hill climbs professionally for Ski-Doo. She plans to go to medical school next year. I have a son, Joel, who is married to Tayler, and they have my perfect grandchildren: Allie, 4, and Wyatt, 2. Joel is a captain for Timberlake Fire District, and Tayler is a teacher at Post Falls Middle School. They also live in Spirit Lake. Where did you receive your degree? Gonzaga University. I have always practiced in this community. Why did you pick your specialty? I worked as an RN for 10 years prior to becoming a nurse practitioner. I knew that I wanted to do direct patient care and be able to influence and help with improved patient health and outcomes, so I went into primary care. What can patients expect when they first meet with you? I am outgoing and down to earth. I try to make patient visits comfortable and build relationships with my patients. —Continued on page 12 KH.ORG 11

What are some of your hobbies? I love to bicycle and snowmobile. I have been finishing up our house that we built last year, so finish carpentry and landscaping are my latest hobbies. What drew you to Kootenai Health? I was at Kootenai for 11 years before becoming a nurse practitioner, and I chose to come back because I feel this is the best place to be able to provide the comprehensive and friendly care I want my patients to have. What is your favorite healthy tip? Four hours of cardio exercise per week prevents many problems. Pablo Michel, M.D. Kootenai Heart Clinics Tell us a bit about you and your family. I was born and raised in Santiago, the capital of Chile. I am the youngest of three siblings, and I completed my medical education at the University of Chile. During my last year of medical school, I met a fantastic American woman in Chile and decided to follow her to the United States. She eventually became my wife, and now we have a young son together. After living in Texas and New Jersey to complete my internal medicine residency and cardiology fellowship, we finally settled in the Inland Northwest, which is my wife’s homeland. Where did you receive your medical degree? I received my medical degree at the University of Chile, then I completed my internal medicine residency at the University of Texas Health Science Center in San Antonio, followed by a cardiology fellowship at Rutgers University in New Jersey. Why did you pick your specialty? I was initially drawn to cardiology due to the physiology behind cardiovascular hemodynamics, echocardiography, pharmacology and electrocardiography. Then that initial interest evolved into one centered on nurturing longlasting relationships with cardiology patients, who can frequently be the sickest in the hospital. Additionally, I enjoy the specialty scope from the cardiac intensive care unit to the ambulatory clinic, as well as the enriching interaction with my subspecialty colleagues. What can patients expect when they first meet with you? I will always carefully listen to my patients, treat them with respect and offer them the best treatments available within the specialty. For me it is very important that they understand their medical conditions and feel comfortable approaching me with any question or concern. The best outcomes that I have seen in cardiology occur in motivated patients with clinicians who are good at communicating. What are some of your hobbies? I enjoy playing soccer and tennis, swimming, and riding my bike. I am very interested in learning more about different cultures; therefore, language learning and traveling are always on my mind. What drew you to Kootenai Health? I was pleased by the efficient communication and flexibility of the cardiology department from the preinterview phase. Once I met all the cardiologists working at Kootenai, it became clear that there is a good working environment and desire to grow. I believe this hospital is a great setting to grow professionally and personally. What is your favorite healthy tip? Go to sleep early and eat well. Shawn Taylor, D.O. Kootenai Heart Clinics Tell us a bit about you and your family. I grew up in a small town in southwest Idaho and later met my wife in my undergraduate biology class. We have had the privilege of raising five wonderful children throughout school and medical training. My family and I enjoy sports and music. We fell in love with the water while living seven years in Florida and have easily converted to playing in the lakes here in northern Idaho. We are all excited to be back in the wonderful Pacific Northwest. Where did you receive your medical degree? I received my medical degree from Pacific Northwest —Continued from page 11 12

University of Health Sciences in Yakima, Washington. I then attended an internal medicine residency and a cardiology fellowship at HCA Florida Bayonet Point Hospital in Florida. I then attended a one-year fellowship in advanced cardiac imaging at the University of Florida. Why did you pick your specialty? During medical school and residency, the cardiovascular system was always the system that made the most sense to me, was intriguing and was enjoyable to study. So when it came time to choose a specialty, the choice was fairly easy. What can patients expect when they first meet with you? When patients first meet me, they can expect a physician who is happy to be there and one who is focused on helping them improve or maintain their quality of life. They can expect their medical issues to be explained in a way they can understand so they can be fully involved in their own medical decisions. What are some of your hobbies? My hobbies currently are participating as much as possible in the interests of my children, from soccer and baseball to dance and art. I also enjoy playing any type of sport or outdoor activity, and I dabble in playing the saxophone and guitar. What drew you to Kootenai Health? Most of my family is here in Idaho, and my wife’s is in eastern Washington, so the area was immediately attractive to us. During the interviewing process with Kootenai Health, everything went so smoothly, from telephone conversations to dinner with the cardiology group. My wife and I felt so welcomed, it didn’t take long for us to decide to join Kootenai Health. What is your favorite healthy tip? Never stop moving. Whether it’s five minutes or an hour a day, make it a habit and build from there. Amy Williams, PA-C Kootenai Clinic Gastroenterology and Endoscopy Tell us a bit about you and your family. I’m a northern Idaho native. I was raised in Kellogg, just like my parents and grandparents. I moved to Coeur d’Alene after finishing graduate school in 2009. Where did you receive your degree? I received my master’s degree in physician assistant studies from Idaho State University. I’ve been practicing in gastroenterology in Spokane since my graduation. Why did you pick your specialty? A childhood friend worked at a gastroenterology clinic and recruited me out of physician assistant school. Immediately, I saw the impact digestive diseases have on quality of life. I enjoy helping patients regain comfort and confidence in their digestion. What can patients expect when they first meet with you? They should expect to be heard. I’ll listen to their concerns and ask A LOT of questions. What are some of your hobbies? I enjoy reading, traveling, hunting and playing volleyball. What drew you to Kootenai Health? All of my medical care, and that of my family, has been through Kootenai with excellent experiences. I’m excited to join the team and help others in my community. What is your favorite healthy tip? Drink water—plain old flat, unflavored water. Kootenai Clinic Appointment Center: Need to nd a physician and schedule an appointment? Call the Appointment Center at (208) 625-6767 or request an appointment online at appointmentcenter.kh.org. KH.ORG 13

By Kim Anderson Staff members at Kootenai Health take pride in providing exceptional patient care. This includes following nationally recognized best practices for care. It also includes tracking objective quality measures, clinical outcomes and patient experience. Together, these help ensure patients in our community receive the best care possible, close to home. Recently Healthgrades, a national organization that compares information from over 3 million U.S. health care providers, recognized Kootenai Health with three awards for superior clinical outcomes. Kootenai Health’s three awards for 2024 are the America’s 50 Best Hospitals for Cardiac Surgery Award, Stroke Care Excellence Award and Pulmonary Care Excellence Award. Kootenai Health was the only hospital in Idaho to receive an award for cardiac surgery or stroke. PATIENTS AT KOOTENAI HEALTH Cardiac surgery, stroke care and pulmonary care recognized for excellence As Kootenai Health continues working toward its vision to become a premier medical destination, recognition such as this proves we are well on our way.

Robert Burnett, M.D. Todd Hoopman, M.D. Pulmonary care The Pulmonary Care Excellence Award recognizes hospitals with superior clinical outcomes in treating chronic obstructive pulmonary disease (COPD) and pneumonia. “We utilize a multidisciplinary team to provide timely treatment for respiratory conditions, including COPD and pneumonia,” said Kootenai Clinic pulmonologist Todd Hoopman, M.D. “This team’s efforts span the full care continuum, from the hospital to the outpatient clinic. This broad effort has, in turn, helped to reduce hospitalizations and improve outcomes for patients with respiratory diseases.” Stroke care The Stroke Care Excellence Award recognizes hospitals with superior clinical outcomes in the treatment of stroke. To be eligible, a hospital must be able to provide needed care to 90 percent or more of the patients going there for stroke care. “Our stroke program has been recognized for excellence every year since 2021,” said Kate Knight, RN, Stroke and STEMI program coordinator. “In addition to the Stroke Care Excellence Award, we have also been named among America’s 100 Best Hospitals for Stroke Care and received the Neuroscience Excellence Award.” “Caring for stroke patients continues to evolve,” said Kootenai Clinic neurologist Ramsis Benjamin, M.D. “Our knowledge of medicines, equipment and techniques for various stages of stroke is constantly expanding. Kootenai Health’s system of care strives to keep abreast of the latest technology and to provide state-of-the-art diagnostic tools and treatment options to this much-beloved community.” Cardiac surgery To be considered for an award in cardiac surgery, a hospital must be evaluated for both its coronary artery bypass graft surgeries and its valve surgeries. As the “America’s 50 Best Hospitals” award name implies, Kootenai Health is among the top 50 hospitals in the nation for these procedures. “Let’s be honest, nobody really wants to have heart surgery. When you are told this is what may be required, we understand how that must feel,” said Kootenai Heart Clinics cardiothoracic surgeon Robert Burnett, M.D. “At Kootenai Health, we make that experience as positive as possible from the evaluation through the recovery, engaging literally hundreds of team members. We want patients to have confidence in the process, and a recognition such as the ‘Top 50’ helps with that. It is great to be recognized as a standout for what we have been passionate about for years: the highest quality, friendly care right here at home.” Have Better Health Outcomes Ramsis Benjamin, M.D. Kate Knight, RN KH.ORG 15

By Kim Anderson It’s 10 P.M., and you get the phone call. The number says it’s the Kootenai County sheriff. Your son’s been in a car accident, and he’s being taken by ambulance to Kootenai Health. Or maybe it’s your spouse who seems to be having a stroke—or a heart attack. Thankfully, the worst day of your life is taken in stride at the Kootenai Health emergency department (ED). Its dedicated team is ready to give the best care available in all these situations and more. Kootenai Health has one of the busiest EDs in the state, caring for over 55,000 patients annually. It is also the regional referral center for the other hospitals in Idaho’s 10 northern counties. About 12 percent of Kootenai’s injured patients come from outside Kootenai County. Care that keeps getting better For several years now, Kootenai Health has been working to expand and enhance the care available through its ED. In 2014, it earned verification from the American College of Surgeons (ACS) as a Level III trauma center, and in 2016, it earned Level II designation from the Idaho Time Sensitive Emergency System. In 2018, Kootenai Health completed an expansion of its ED to 37 patient rooms, four trauma bays, and dedicated space to triage patients or have them wait for test results. In 2021, a new team, led by Trauma Medical Director Cory Richardson, M.D., began working to move Kootenai Health’s trauma center toward a Level II ACS verification. In January 2024, the team received its Level II ACS trauma center verification, just the second one to be granted in the state. “Becoming an ACSverified Level II trauma center has been the culmination of countless hours of work by an enormous number of people,” Dr. Richardson said. “Trauma is a unique field in that it transcends all specialties and service lines in a hospital. It is not uncommon for one single trauma patient to require the attention of physicians from more than a dozen different specialties.” Nearly 20 highly trained staff members respond to every trauma patient who comes to Kootenai Health’s ED. The trauma team has more than 20 trauma surgeons and advanced practice providers, as well as specialists from the many different disciplines needed in a Level II trauma center. Ready when you need us When a trauma patient arrives at the ED, the trauma team is ready at a moment’s notice to provide the highest level of care 24 hours a day, 365 days a year. This level of preparedness requires dedication and continual Cory Richardson, M.D., FACS, FASMBS, FAFS Dershi Bussey, RN, BSN Amanda Pringle, RN, BSN, CCRN, TCRN Learn more online Visit KH.org/emergency/ trauma-services. A STEP UP in Trauma Care Level II Trauma Designation 16

process improvement to make sure every part of the trauma system works together—from the EMS providers on scene and the blood bank in the ED to the integration of rehabilitation services, which optimizes a patient’s recovery after an injury. “Our team has the resources and training to provide the most up-to-date, nationally recognized best practices for care,” said Amanda Pringle, RN, manager of Kootenai Health’s trauma program. “With numerous people responding, we Working to Prevent Trauma Too As a trauma center, Kootenai Health is committed to injury prevention to reduce traumas across the region. The trauma program tracks the number and types of injuries seen in the emergency department. In the past year, 45 percent of the trauma injuries seen were ground-level falls, such as tripping and falling or slipping on ice. Falls from a height were the next most common, followed by motor vehicle accidents, then motorcycle accidents. Injury prevention programs are developed by the trauma team to provide community education, with the goal of reducing injuries. “Bingocize” is a fall prevention program focused on health education, mobility, flexibility and exercise that is provided to older adults around the region. Other injury prevention programs the trauma team has developed include: • Distracted driving courses • Helmet safety fairs • ATV safety training • Stop the Bleed • Water safety Many of these programs are offered in partnership with local sponsors and businesses. all patients. We are also sharing what we’ve learned and participating in training opportunities with other northern Idaho hospitals.” “The requirements for a Level II trauma center go well beyond the clinical care expectations while a patient is in the hospital,” Dr. Richardson said. “There is also a requirement for strong administrative support, excellent collaboration with EMS systems and community outreach. Additionally, there is a requirement for a dedicated trauma program team to work behind the scenes to track every aspect of the trauma program, make sure the highest level of care is consistently rendered to our patients, and track and report our outcomes to the ACS.” “The transition to a Level II trauma center required the engagement and dedication of literally everyone in the hospital system,” Dr. Richardson said. “Everyone should be very proud of the part they played in this accomplishment.” all must work together seamlessly as a team. We pride ourselves on ensuring that the best care is given to every patient.” That level of care extends beyond the ED. “The work the trauma team has done has elevated care across the hospital,” said Dershi Bussey, director of emergency and time sensitive emergencies. “It has created higher expectations for all nurses and holds everyone to the highest standards. It has elevated care for KH.ORG 17

By Kim Anderson As the owner of Viking Construction, Wendell Olson has built more than 4,000 homes in Kootenai County. Recently he needed help with a different kind of building project. After years of suffering with a worn-out ankle joint, Wendell was a prime candidate for ankle replacement surgery. His journey to ankle replacement began more than 30 years ago, when he injured his left ankle while skiing. He got along OK in spite of the injury until 2007, when he reached his 60s. At that time, all the research he did and the medical advice he received was pointing to an ankle fusion as the solution. In ankle fusion surgery, the bones of the ankle joint— namely, the tibia and talus—are attached to one another with screws or plates to eliminate pain in the arthritic joint. In time, the bones fuse together as they heal. Wendell, an accomplished private pilot, is used to the regional access flying provides. He chose a very experienced Boise surgeon for his procedure. Unfortunately, in Wendell’s case the healing process was not ideal. After the procedure, he was in a lot of pain, and healing took much longer than expected. The pain he felt at the fusion caused him to change the way he walked, relying much more heavily on his right ankle. In time, his change in gait wore out his previously good right ankle. Edward Rooney, M.D. After Ankle Replacement A search for options “My doctor suggested another ankle fusion, but after what I went through with the first one, I didn’t want to do that again,” Wendell said. “I got cortisone injections and started wearing prosthetic supports, but it wasn’t enough. I was wearing a walking cast, and my pain was still at an 8 or 9 out of 10. I thought, ‘Life’s not worth this much pain.’” He began researching other options and found Edward Rooney, M.D., at Kootenai Clinic Orthopedic Services. Dr. Rooney joined Kootenai Clinic in 2022. His fellowship training specialized in foot and ankle orthopedic surgery. “I wanted someone fresh out of fellowship who would be experienced with the latest approach to ankle replacement,” Wendell said. “When I met Dr. Rooney, he was just a great young man. We scheduled my surgery for June of 2023.” How ankle replacement works “Ankle replacement surgery is similar to hip and knee replacement surgeries,” said Dr. Rooney. “We remove the worn-out joint and replace it with an artificial implant that allows the same type of motions you make with your natural ankle. Patients are able to have a more normal gait and movement than they do with an ankle fusion.” WALKING WITHOUT PAIN 18

Recovery from ankle replacement surgery is different from recovery after hip and knee replacement surgery. Patients do not walk on the new ankle joint for four weeks after the procedure, whereas patients with hip or knee replacements are typically up and walking the same day as their surgeries. “The force of your body weight across the joint is much greater for your ankles than for your knees or hips,” Dr. Rooney said. “The force across your hip joint is about one-and-a-half times your body weight, and knees are three times your body weight. The force across the ankle joint is six times your body weight, so we have to give ankles additional time to heal before they become weight-bearing.” Following ankle replacement surgery, patients use a knee scooter until they can begin to put weight on their ankle. Once they are cleared to be weight-bearing again, physical therapy helps them regain strength and range of motion. Fusion versus replacement “Every person is different, so it’s important to really understand the patient’s unique situation before making a surgical recommendation,” said Dr. Rooney. “Fusion and ankle replacement each have benefits and limitations. While fusions are right in certain situations, they do limit the natural ankle mobility, which places additional stress on surrounding joints. “Ankle replacements allow patients to keep their range of motion, and they are great if you like to walk, hike, golf or play pickleball. They aren’t great under the repetitive impact of running and jumping.” Outstanding results Wendell has had one of each, and for him, the ankle replacement is the clear winner. “The morning after the surgery, my pain—which had consistently been an 8 or 9 out of 10—had dropped to next to nothing,” Wendell said. “Everything came out as good as Dr. Rooney said it would. I can’t recommend it enough.” After healing from his surgery, Wendell and his wife, Debra, made the trip of a lifetime to Europe, visiting half a dozen destination cities. One day he logged 8 miles of walking on his new ankle, and he is comfortable walking on uneven ground again. “I would recommend Dr. Rooney to anybody I know,” said Wendell. “I feel so good, I’m even thinking of golfing this summer.” Why Ankle Replacements Are Less Common Hip and knee replacements are done largely in response to the deterioration of cartilage in the joint as a result of wear-andtear osteoarthritis. Most ankle replacements, however, like Wendell’s, are needed because of a traumatic injury that later causes arthritis. As a result, around 12,000 ankle replacement surgeries are done nationally each year, as compared to about 700,000 total knee replacements. Ankle replacements are also comparatively new; the newest modern ankle implants have only been available for about 12 years, while artificial knees have been available for about 30. Treat your feet Visit KH.org/foot-and-ankle to find out how we can help. KH.ORG 19

Kootenai Health Foundation Fantastic Support for The Kootenai Health Foundation works with generous donors in our community to raise support to enhance the health care services available in northern Idaho. Its signature event, the Festival of Trees, is a wonderful opportunity for supporters to bid on lavishly decorated trees and displays to benefit Kootenai Health. Here are a few highlights from this past November’s Festival and comments from longtime supporters. Scott Anderson, Mountain West Bank “Mountain West Bank proudly supports the mission of Kootenai Health and its efforts to provide quality health care throughout northern Idaho and the Inland Northwest. The Festival of Trees gala is a wonderful opportunity for our community to celebrate the kickoff of the holiday season.” Nicole Jacklin, Berkshire Hathaway HomeServices/Jacklin Real Estate “Kootenai Health has always been there for us. In 2018, our son was born at 29 weeks and spent 33 days in the NICU at Kootenai Health. Our experience was nothing short of amazing. My mother, Deb Mongeau, was a nurse at Kootenai Health for years, and we started decorating for the Festival of Trees 15 years ago. It is something very close to our hearts and something we look forward to all year. Wade and I, our entire family, and Berkshire Hathaway will always be huge supporters and advocates of our local hospital.” Ron McIntire, Super 1 Foods “Joanne and I look forward to the Festival of Trees every year and continue to be in awe at the creativity of all the decorators as well as the time commitment of the volunteers. It is an honor and privilege to have the opportunity to gather with other members of the community to make a critical difference in our community’s health care programs and services provided by Kootenai Health.” Festival of Trees Scott and Jennifer Anderson Dan and Robin Wright, Ron McIntire, and Becky Boifeuillet Nicole Jacklin and Deb and Megan Mongeau 20

Chris Meyer, Parkwood Properties “Our family is so pleased to support the Kootenai Health Foundation at the Festival of Trees every year. It’s a great way to kick off the holiday season, and it helps to support high-quality, locally controlled health care right here in our northern Idaho community!” Shane Nelson, United Heritage Insurance “United Heritage Insurance is so proud to be part of this wonderful event and experience the pride everyone has for their community. Kootenai Health plays such an important role in the health of the community, and it shows through the generosity we see every year at this event. It is so amazing to see the love in this community for where they live and work and for their family, friends and neighbors.” Mark Ness—North Idaho Credit Corp “Attending the Festival of Trees is a fantastic way to support our community. The evening has tremendous energy, as everyone is working together to help raise money for Kootenai Health to assist in their efforts to care for our neighbors.” Chad Murray, Murray Group “Kootenai Health touches the lives of everyone in our community, from family members to co-workers to neighbors. They see everyone regardless of their health care need or economic situation. Every person in our community will need the services of Kootenai Health at some point in their life. The impact Kootenai Health has on the health and well-being of our community is far-reaching. I can’t think of a better way to support our community than supporting the mission of Kootenai Health.” Shane Nelson and Chad and Colette Murray Mark and Denise Ness Sara and Chris Meyer KH.ORG 21

Q My doctor told me I am at risk for prediabetes. What does that mean? First of all, what is prediabetes? Both prediabetes and type 2 diabetes mean your blood sugar levels are higher than normal. This is driven by insulin resistance. Insulin is a hormone secreted by the pancreas that helps shuttle glucose (sugar) into the cells. In prediabetes, insulin is over-secreted as your body tries to keep up with high levels of blood sugar. Over time, the body can lose its ability to secrete insulin or become “resistant” to it, resulting in consistently high blood sugars and type 2 diabetes. There are usually no symptoms of prediabetes, but if left untreated, it can progress to type 2 diabetes. Prediabetes occurs when blood glucose is higher than normal but not high enough to be diabetes. Fortunately, research shows that type 2 diabetes can be prevented with lifestyle modifications. Losing just 5 percent to 7 percent of excess body weight through diet and exercise can cut your risk of developing diabetes in half. Ask the Expert Ready to learn more? Visit us online at KH.org/diabetes-endocrinology. An additional resource for prediabetes is the Panhandle Health District’s Diabetes Prevention Program. Call (208) 415-5242. Q What causes prediabetes? The exact cause is not known, but there are several risk factors for prediabetes. These include family history, being overweight, an inactive lifestyle, being over the age of 40, eating a poor diet, having polycystic ovarian syndrome or having diabetes during a pregnancy (gestational diabetes). Q Can I delay or prevent type 2 diabetes? The good news is that prediabetes can be reversed, and diabetes is a manageable disease. Daily physical activity, dietary changes and weight loss can help bring your blood glucose to a normal range. Aim for at least 150 minutes of moderateintensity exercise weekly. There is no “one size fits all” diet. However, reducing simple sugar intake and eating a diet rich in highfiber vegetables, fruits, whole grains and legumes, as well as healthy fats and proteins such as nuts, seeds, olive oil and fish, may help reduce your risk of developing type 2 diabetes. Meeting with a registered dietitian is a great way to get started. Diabetes education If you have been diagnosed with prediabetes or type 2 diabetes, you might benefit from diabetes education. It can help you learn life skills needed to effectively manage your diabetes. Resources are different for each type. If you have type 2 diabetes: Simply request a referral from your doctor for diabetes education at Kootenai Clinic Diabetes and Endocrinology. Our program meets rigorous criteria for national standards of diabetes education and is accredited by the American Diabetes Association. Our registered dietitians are also certified diabetes care and education specialists and can provide both diabetes education and medical nutrition therapy. Our program is covered by Medicare, Medicaid and most commercial insurance plans for patients who have been diagnosed with type 2 diabetes. Did you know? About 1 in 10 Americans has diabetes, and more than 1 in 3 have prediabetes. Maria Rodebaugh, M.D., endocrinologist 22