Kootenai | Kootenai Health | Issue 1, 2023

Coordinated heart care: Working together to save lives in northern Idaho Health K H . O R G A stronger and safer community Sexual Assault Nurse Examiner team provides healing and support Perfect harmony Parkinson’s disease management is a team effort ISSUE 1 | 2023


KH . ORG 3 WHAT’S INSIDE Issue 1 | 2023 18 Kootenai Health goes global 12 Persevering with Parkinson’s 17 Junior Volunteer of the Year 5 Regional collaboration for lifesaving heart care Follow Us 16 Removing barriers to care 10 Help and healing for survivors of sexual assault and violence Kootenai Health’s forensic nurse examiner program provides specialized care and advocacy. 14 Choose your care wisely Primary care, urgent care or emergency department? Know when and where to go. 20 Heart of the community With help from the community and Kootenai Health Foundation, Kootenai is expanding cardiac care. 22 Ask the Expert Kootenai Health’s chief medical information officer answers frequently asked questions about the MyChart patient portal.

4 Lisa Kolenda, Kootenai Clinic Cancer Services, Coeur d’Alene, Tiny Twins 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. Pivoting Around Challenges and Providing Better Care “The only way to do great work is to love what you do.” —Steve Jobs A funny thing happens when people love their work; it’s nearly impossible to slow them down. Give them an obstacle and they’ll innovate around it. Surround them with market chaos and they’ll find a previously untapped opportunity. Limit their budget, and they’ll do more with less. To use a sports analogy, they play for the love of the game. Health care, like most industries, has been through significant challenges this past year. Although Kootenai Health is not without labor shortage and financial concerns, they are not the most important part of the story. What is truly interesting are the new and improved services our team continues to bring to our community. In many cases, we are the only providers of these services in northern Idaho. Here are just a few: MS Program: Kootenai Health has been designated a Center for Comprehensive MS Care by the National Multiple Sclerosis Society. We are the only center in Idaho to earn this designation and the only resource for this care in our area. Epilepsy Monitoring Unit (EMU): Patients experiencing seizures or epilepsy that has been difficult to diagnose or treat can be monitored in the EMU’s specially designed rooms. This resource is allowing more people to receive the diagnoses and care needed for a better life. Heart Center Expansion: Work is underway to expand the Heart Center from 15 to 24 patient rooms and to add a second cardiac catheterization lab and a second electrophysiology lab. These critical additions will provide the resources needed to ensure ready, rapid care is available even as our population grows. Detox Unit: People with chronic substance use disorder often have a difficult time ending their addiction as their body adjusts to life without substances. The Kootenai Health inpatient detox program offers 24-hour, evidence-based care with oversight from nurses and physicians. Health care has been described as a team sport. While the team at Kootenai Health is doing the work needed to address today’s market challenges, they are also putting in the extra effort to improve patient care. When you love the game, it’s just what you do. Wishing you good health, Jon Ness, CEO

Regional Collaboration for Lifesaving By Shannon Carroll Kootenai Health has shared many stories and health tips over the years stressing the importance of exercising, eating healthy and getting regular checkups. While all these standard reminders for better health are extremely important, sometimes it isn’t the preventive measures that can mean the difference between life and death—it’s the actions of others who change the course of a person’s life. In fact, recently, the seamless actions of many brought one man back from the brink of death on an otherwise uneventful, sunny September day. Unfamiliar pain Natives of Montana, Sue and George Bache met in high school, married young and raised two girls in California. As they inched toward retirement, they were excited to move back to the Inland Northwest to be closer to their roots and enjoy their outdoor passions of skiing, boating and hiking. After a yearlong build, Sue and George’s new dream home in Dover, Idaho, was finally complete and ready to share for the first time with family. Their recent 43rd wedding anniversary seemed like the perfect opportunity to celebrate. As Sue busily hurried about the house, readying it for their guests, George complained of a severe Lori Garza, RN, Bonner General emergency department nurse, with George Bache. A near-death experience that started in Dover ends happily in Coeur d’Alene, thanks to Kootenai Health and regional partners —Continued on page 6 KH . ORG 5 headache and told her he needed to lie down. The pain was such that he could not rest. Although never prone to migraines, George took out his smartphone and searched “Migraine” in the hopes of better understanding what he was experiencing. That is the last thing he remembers from that morning, but Sue remembers every detail all too well. “George had come out of the bedroom after lying down didn’t help his headache. He sat on the sofa in the living room as I was getting ready to go to the store,” said Sue. “I saw his head tilted back and I thought, ‘Boy, he fell asleep fast.’” But as Sue got closer, she noticed his mouth and eyes were wide open. George didn’t respond to Sue’s shouts and her attempts to shake him awake. “I was terrified and immediately called 911,” Sue said. “I knew I needed to give him CPR, but it had been a long time since I had learned it—20 years or so. The 911 operator, Jennine, was a godsend—she kept me focused and talked me through the whole thing until the ambulance arrived.” The paramedic team shocked George’s heart to get it into rhythm and used an innovative mechanical device to assist with cardiopulmonary resuscitation. Several sheriff’s deputies also responded to the call and helped quickly get George on the road to Bonner General Health in Sandpoint. “I drove behind the ambulance and stayed on their bumper the whole way,” said Sue. “I just kept praying, ‘Lord, don’t let him die.’” 911 dispatcher Jennine Whitt helped Sue Bache perform CPR until the ambulance arrived.

6 Airlifted to Kootenai Health At Bonner General, George was quickly evaluated by the emergency department team, who determined he needed to be immediately airlifted to Kootenai Health’s cardiac catheterization lab (cath lab)—equipped with state-of-the-art imaging technology used to view the arteries and check how well blood is flowing to and from the heart. Based on the electrocardiogram (EKG) report forwarded to the hospital by ambulance personnel, George was having the most severe type of heart attack, known as a STEMI (ST-elevation myocardial infarction). When an artery that supplies blood to the heart suddenly becomes blocked by a blood clot, an EKG shows an elevation in the ST segment of the EKG report, which signals medical personnel of a blockage. The longer a blockage is in place, the more the heart is robbed of valuable blood supply, which can cause extensive damage to the heart and even death. Getting patients quickly to a Regional Collaboration for Lifesaving STEMI designation, because it validates that the training, education and processes we implement every day are among the best of the best,” said Michele. Awell-coordinated team It’s this collaboration and dedication to saving lives that set off a series of perfectly executed events for George that day. What started with CPR at their home in Dover ended with George waking up in Kootenai Health, a little over an hour and a half later, asking, “What the heck happened?” In that hour and a half were the heroic actions of a wife and a 911 operator, sheriff’s deputies, an emergency services team, emergency department personnel, Life Flight helicopter crew, cath lab techs, nurses and cardiologists—all who honed in on their extensive training and education to make sure George could return to his new dream home, his wife of 43 years, their children and three young grandchildren. Kootenai Health interventional cardiologist Ronald Jenkins, M.D., is the physician who treated George facility with a specialized cath lab to remove the clot is often the linchpin between living or dying. “We treat roughly 200 STEMI patients each year,” said Kootenai Health STEMI Coordinator Michele Brown, BSN, RN. “Our cath lab also sees an average of 2,000 patients annually. Our team focuses an enormous amount of time and energy on working with our regional partners to ensure we meet or exceed best practices when responding to and treating STEMI patients. There are a lot of things that need to happen quickly and precisely to give our patients the best outcomes.” Thanks to the hard work of Michele and the extended cardiology team, Kootenai Health is a level 1 STEMI center—the highest designation given to hospitals that treat heart attacks. The designation is part of the state of Idaho’s Time Sensitive Emergency System (TSE), which acknowledges hospitals that meet a wide variety of proven metrics for high-quality training, education and services. TSE was created to address the top three preventable causes of death: trauma, stroke and heart attacks (aka, STEMI). TSE emphasizes the importance of a collaborative approach from all stakeholders throughout the state, including among hospitals, emergency medical services agencies, public health districts and the Idaho Department of Health and Welfare. “We are very proud of our level 1 —Continued from page 5 From left, Bonner County’s Zach Pohl (advanced emergency medical technician) and Josh Bradbury (paramedic), were first on the scene. From left, George Bache; Shelby Hanson, RN, (the cath lab nurse who treated him); and Michele Brown, BSN, RN, Kootenai Health STEMI coordinator.

KH . ORG 7 that day and continues to see him for follow-up visits. Dr. Jenkins also happens to be the medical director for Bonner County Emergency Medical Services and started the STEMI program over a decade ago. “Everyone did what we train them to do—from start to finish. I’m very proud of the program we’ve been able to build in this region,” said Dr. Jenkins. “I also told George in no uncertain terms that Sue saved his life by starting CPR immediately. She dragged him to the floor, and that angel of a 911 operator talked her through CPR until the ambulance crew took over.” George is fully aware how lucky he is to have had his wife and the STEMI-trained teams working to help him. He has made a full recovery and reports having good energy and feeling even more engaged in everything. “I wouldn’t switch doctors if I had to, and the nurses and everyone… they were so amazing,” George said. “It really is a gift from God that there are men and women who can work in such excellence—they saved my life. I’ll never forget them.” Support lifesaving care Kootenai Health’s Heart Center expansion helps serve our growing region. Lend your support at kootenaihealthfoundation.org. Special thanks to Bonner County Emergency Medical Services, Selkirk Fire, Bonner County Sheriff’s Office, Bonner General, Life Flight, 911 emergency dispatcher Jennine Whitt and our team at Kootenai Health. Ronald Jenkins, M.D., Kootenai Health interventional cardiologist andmedical director for Bonner County Emergency Medical Services George and Sue Bache visited first responders to thank them. They are shown here alongside members of the Selkirk Fire Department. Kate Knight, MSN, RN, Kootenai Health Stroke Coordinator Kootenai Health—a Level 1 STEMI Center Kootenai Health is a level 1 STEMI center—the highest designation given to hospitals that treat heart attacks. The designation is part of the state of Idaho’s Time Sensitive Emergency System, which acknowledges hospitals that meet a wide variety of proven metrics for high-quality training, education and services. The Kootenai Health STEMI program meets with regional criticalaccess hospitals many times each year to review cases and best practices. Regional partner hospitals include Benewah Community Hospital, Bonner General Health, Boundary Community Hospital, Clearwater Valley Health, Shoshone Medical Center, St. Mary’s Health and Syringa Hospital and Clinics. Over a one-year period, the team collaborated on an air-medical process with the goal of getting more patients hot-loaded and hot-unloaded from Life Flight. Hot loading or unloading is when the helicopter engines are on and the rotors spin while the patient report is received, assessments and interventions are performed, and the patient is loaded into the helicopter. This work resulted in an average time saving of 16 minutes. Special thanks to Kootenai Health Stroke Coordinator Kate Knight, MSN, RN, who drove the initiative.

8 Chad Brizendine, M.D. Kootenai Clinic Lung and Asthma Tell us abit aboutyou andyour family. I grew up on a small horse ranch in the Sacramento, California, valley. No one in my family had gone to college, but it was very important to my parents that my brother and I be the first to get a higher education. My father was at a horse show in Walla Walla, Washington, where he discovered Whitman College. When he got home he told me, “You have to visit. You have to go there.” I visited soon after and knew he was right. During my time at Whitman, I came to know this region better and visited Spokane and Coeur d’Alene. I knew that one day I would end up settling down in this region. Wheredidyou receiveyourmedical degree? The University of Rochester in New York. Prior to Kootenai, I completed my fellowship training at the University of Virginia. Whydidyoupickyour specialty? You could say it picked me. I struggled with severe asthma as a child and know firsthand the impact chronic disease has on our lives and well-being. I also had an outstanding pulmonary doctor growing up and remember how much he helped me through challenges with my asthma. I think these two factors played a role in my pursuit of pulmonary and critical care medicine. What canpatients expectwhen theyfirst meetwithyou? As a specialist, time is very important in the first meeting. Most of our patients have symptoms that have been present for several years. In our first visit, they can expect that I will take the time to understand their story so we can make the best plan for their care. Sara Carson, M.D. Kootenai Clinic Lung and Asthma Tell us abit aboutyou andyour family. I grew up in Hayden, Idaho, and my husband is originally from New Orleans. We have three young children (including twins!) and love watching them grow. I received my undergraduate education at the College of Idaho and attended medical school at University of Washington. We then moved out East for my internal medicine residency at Georgetown University and then my pulmonary critical care fellowship at Johns Hopkins. We moved back to Coeur d’Alene in July of 2022 and have been loving our time here so far. Me e t o u r n ew prov ide r s Kootenai ClinicAppointment Center Need to nd a physician and schedule an appointment? Start here: (208) 625-6767. The Appointment Center can help you: • Determine the type of physician you need • Find an appointment that ts your schedule • Explain what to expect at your appointment Call the Appointment Center at (208) 625-6767 or request an appointment online at appointmentcenter.kh.org. What are someofyour hobbies? I read a lot about coffee science and enjoy working on my skills in different brewing methods. I am also trying to become more familiar with this region, so I frequently go out to explore. What drewyou toKootenai Health? Community is very important to me. I have always chosen organizations that are mission-driven and community-focused. Kootenai shares a commitment to both of these things. What isyour favoritehealthy tip? Laugh as much as possible each day. It helps clear the lungs and renews the spirit.

KH . ORG 9 Laura Ensley-Eddy, NP Kootenai Clinic Family Medicine Post Falls Tell us abit aboutyou andyour family. My husband and I are from Kansas. We have two married daughters and four granddaughters. We have been an active-duty military family and lived in Alaskan villages and Anchorage; southern Texas, near the border with Mexico; and Wyoming. Wheredidyou receiveyour degree? I went to nursing school in Topeka, Kansas, and graduate school in Wichita, Kansas. I have been an advanced practice registered nurse since 1994. Wheredidyou receiveyourmedical degree? I received my medical degree at the University of Washington. Most recently, I completed my pulmonary and critical care fellowship at Johns Hopkins in Baltimore. Whydidyoupickyour specialty? When patients are in the critical care unit, they are very sick and require careful attention to their current critical condition and also their wishes for the future. I find fulfillment in working with patients and their families during these difficult times to treat the whole person with exceptional care. I also was drawn to pulmonary medicine, as it gives me the opportunity to develop a long-term relationship with my patients while treating them for a chronic lung condition. I get to wake up every day to help my patients breathe better, which I think is pretty cool. What canpatients expectwhen theyfirst meetwithyou? I am passionate about my patients and will seek to understand their health-related goals. I will partner with them to try to reach these goals and ensure they are receiving care at the highest level. What are someofyour hobbies? My hobbies include much of what the Pacific Northwest has to offer, including skiing, hiking, cycling and running. I love spending time with my children at the park and at the swimming pool. What drewyou toKootenai Health? With the population growth that this community has seen and the strong leadership that has been in place over the last decade or more, Kootenai Health has become a major referral center for the region. As our community continues to grow, Kootenai Health will play an integral role in the future of our region. I hope to become involved in helping to shape this future. I am thrilled to get to work for such a strong institution with an exciting future, while raising my family in one of the most beautiful places in the country. What isyour favoritehealthy tip? Try to find balance in your life. For me, balancing a young family with a career in medicine is not always easy. What helps is to remember what your values are and not let yourself be carried away by unnecessary stress or distractions. Find healthy outlets to help burn off stress, and always make time for those you love. Whydidyoupickyour specialty? I picked family practice because I LOVE people of all ages. It is thrilling to be involved in caring for the entire family. What canpatients expectwhen theyfirst meetwithyou? Patients can expect that I will be interested in all aspects of their lives. Getting to really know people is the part of health care I genuinely enjoy. What are someofyour hobbies? Traveling, activities with our dogs, quilting, kayaking and hiking. What drewyou toKootenai Health? The beauty of Idaho drew me to the Coeur d’Alene area. I love Kootenai Health’s mission. What isyour favoritehealthy tip? Drink water! Move your body and eat plenty of vegetables.

By Caiti Bobbitt Kootenai Health’s Sexual Assault Nurse Examiner (SANE) program consists of a small but dedicated team of nurses with extensive, specialized training in forensic examinations for cases of sexual assault and domestic violence. The program plays a critical role in providing better outcomes to survivors of assault. “The first encounters are so important, as they can have a profound effect on the healing process,” said Megan Lorincz, BSN, Kootenai Health Forensic Nursing program manager. “Studies have proven that SANE nurse collections yield 80 percent more evidence than those of an untrained nurse or doctor, but beyond that, survivors cared for by SANEs more often report feeling supported, in control, believed, safe and informed.” The reality is that while these programs are important, or even vital, not every hospital has one. Oftentimes, lack of funding prevents training nurses and providers to maintain these programs. Recognizing the growing need for these services all throughout northern Idaho, Megan and her Help andHealing 10 Megan Lorincz, BSN Kootenai Health’s forensic nurse examiner program provides specialized care and advocacy for Survivors of Sexu l Assault and Violence team applied for a grant through the U.S. Justice Department’s Office of Violence Against Women (OVW) to enhance care for victims of sexual assault, domestic violence, dating violence and stalking. Special care forvictims of crime In September 2022, OVW awarded Kootenai Health enough funds to help train nurses and providers in medical-forensic care all throughout the Idaho Panhandle for at least the next three years. Training will include comprehensive adult, “The first encounters are so important, as they can have a profound effect on the healing process.” —Megan Lorincz, BSN

SupportingWomen and Community Health The Kootenai Health Foundation received a generous donation from two community members, Gratia and Bill Griffith, to help support the forensic nurse examiner program. The funds helped establish a room within the emergency department where survivors of domestic abuse can enter the criminal justice and social services system and begin to receive care on their paths to healing. Bill passed away in 2009 and Gratia in 2022. Both were beloved members of the community and had committed much of their life to helping others through the Kootenai Health Foundation and beyond. Gratia was especially committed to helping women find their place in the world after completing her master’s in applied behavioral sciences at 60 years old, noted her daughter, Georgeanne Griffith. Gratia went on to become an advocate for women and children across Idaho in several different capacities. Georgeanne said her parents would be honored to know their gift supported both her mother’s passion for helping women who are struggling and the couple’s combined desire to give back to their community. “To know that they made a difference in the life of even one woman honors their legacy,” said Georgeanne. adolescent and pediatric sexual assault examiner training, followed by hands-on clinical skills training. Ongoing education will consist of crime-specific training; for example, domestic violence, strangulation, human trafficking, stalking and more. “This will allow for our highly trained nurses to care for a larger population of patients, giving those patients access to the trauma-informed medical forensic care they need,” said Megan. This grant will also provide funding to Safe Passage’s Child Advocacy Center to help pay for a medical provider to perform follow-up examinations and exams outside of the evidence-collection window. This is a service Megan said is desperately needed. “Through this program, our goal is to better care for patients that have been the victims of crime and provide them holistic medical-forensic health care in a traumainformed manner to promote their safety and healing,” Megan said. She and her team hope to increase collaboration to better serve this population of patients—not only to help connect them with resources, but also to identify gaps and barriers in the social services system, making it easier for survivors to find and access services. “Our goal is that any patient that seeks our services feels supported, believed and empowered as they begin their healing journey,” said Megan. “We hope this ultimately creates a stronger and safer community.” KH . ORG 11 From left, Cara Nielsen, Kootenai Health Foundation president; Georgeanne Griffith; and Megan Lorincz, BSN, Kootenai Health Forensic Nursing programmanager.

PERSEVERING With Parkinson’s Kootenai Health helps a trumpeter fine-tune his treatment and play on Even with Parkinson’s disease, Robert Cunningham continues to play the trumpet for two to four hours a day. By Kim Anderson Approximately 1 in every 100 people over the age of 60 develops some form of Parkinson’s disease. Parkinson’s is a movement disorder that affects people in three different ways: tremors, rigidity, and bradykinesia; a slowness of movement or hesitations and halts. While the cause of Parkinson’s disease is unknown and it cannot be cured, treatment makes life better and longer for those who are affected. Movement disorders—such as Parkinson’s disease, Huntington’s disease, ataxia, dystonia and Tourette syndrome—affect the nervous system and cause increased movements or reduced or slowed movements. In many cases, the movements they cause are involuntary and can range from annoying to life-altering. In 2020, Kootenai Health made a commitment to develop a robust neurosciences program. Today, that program includes neurologists specializing in nonsurgical care as well as neurosurgeons specializing in surgical treatment of the brain, spinal cord and nervous system. When both specialties work together and also bring in help from other medical professionals—such as physical, occupational and speech therapists—patients have the best possible outcomes. For patients like Robert Cunningham, this combination of care has made the past few years significantly better. Early stages Nearly 30 years ago, Robert and Deborah Cunningham left the hustle and heat of Austin, Texas, for the serene beauty of Sandpoint, Idaho. Robert worked as a project manager for the Idaho Transportation Department and kept busy playing trumpet, regularly practicing for hours each day. Several years ago, while having a consultation about shoulder surgery, the surgeon recommended that Robert see a neurologist. Deborah did some online research and found board-certified neurologist William Britt, M.D., at Kootenai Clinic Neurology. Dr. Britt confirmed the surgeon’s suspicion: Robert was in the early stages of Parkinson’s disease. Over the next six years, Robert and Dr. Britt managed his Parkinson’s with medication. As with most patients, medications helped for a while, but as the disease progressed, medications no longer gave the same results. “I would be in meetings at work, and my hands would be moving so much it was embarrassing,” Robert said. “I had to sit on my hands to keep them from moving.” When medication alone was no longer managing Robert’s symptoms, it was time for a different course of treatment. Deep brain stimulation, or DBS, is a surgical procedure that can significantly help people with conditions such as Parkinson’s disease and other essential tremor disorders. During surgery, a small device is implanted in the brain. It delivers electrical pulses to block or override signals in the brain that cause tremors. Approved by the FDA in 2001, DBS can be a life-changing procedure for people who are no longer seeing the same results from medications. Better results In 2019, neurosurgeon William Ganz, M.D., implanted Robert’s DBS device. “The DBS program at Kootenai Health was started in 2012,” said Dr. Ganz. “Placing the electrode is an intensive process. We use a combination of CT and MRI scans to map a path to the brain’s subthalamic nucleus that avoids blood vessels. Once we reach the subthalamic nucleus, we use electrophysiology to locate the densest area of tremor cells. This is where we place the electrode that will provide the high-frequency impulses that override the tremor cells. The electrode is secured at the skull and connected to an 12

KH . ORG 13 implantable pulse generator that can be adjusted for the best results.” “During surgery, all went well,” Robert said. “I was awake during the procedure, and Dr. Ganz would ask me questions or ask me to move. My whole family came in from Texas and South Carolina to be with me. After surgery, when they were adjusting the DBS, it was like I didn’t have Parkinson’s anymore.” During this time, Dr. Britt retired and a new neurologist took over Robert’s care. Angela Pana, M.D., joined Kootenai Clinic Neurology in 2021 and has helped Robert fine-tune his DBS to get the greatest results. “I always ask patients what is most important to them,” said Dr. Pana. “For some, it might be retaining their ability to walk. For others, it might be maintaining their fine-motor skills. We make the things that are important to them our top priority so they can continue to do the things they like to do.” Abigdifference In addition to DBS, Robert has benefited greatly from the physical therapy he receives at Performance Therapy Services in Sandpoint. “Parkinson’s treatment must be multidisciplinary, with physical, occupational and speech therapists doing their part, along with the family’s involvement,” said Dr. Pana. “Therapists who are trained in working with Parkinson’s patients not only help the patient—they can also give me feedback that is very helpful.” Robert practices a therapy program called LSVT BIG. People living with Parkinson’s or other neurological conditions often move differently, with gestures and actions that become smaller and slower. LSVT BIG improves walking, self-care and other tasks by helping people recalibrate their movements and teaching them how and when to apply extra effort to produce bigger motions. It can help with large motor tasks, like getting up from a chair or walking, and also small motor tasks, like buttoning a shirt. “Robert is very determined,” his wife, Deborah, said. “Last year, his Parkinson’s advanced, and he was having trouble walking. His therapy helped, and he just keeps working at it.” Robert has another love that keeps him working as well. As an accomplished trumpet player, he has performed at numerous local venues and recorded some 350 songs. Even with Parkinson’s, Robert plays two to four hours a day. Awidespreadneed Dr. Pana and Kootenai Clinic Neurology are helping many patients like Robert. As one of the few treatment centers in the region, they see patients from Idaho, Washington, Oregon and Montana. Dr. Pana also manages patients who had their DBS devices implanted at other facilities across the country. “I’ve learned a lot by working with patients who have been treated by a variety of surgeons,” Dr. Pana said. “The care our patients receive here—from our neurosurgeons, neurologists and therapists—is exceptional.” Get your life back For more information on treatment for Parkinson’s or other movement disorders, contact Kootenai Clinic Neurology at (208) 625-5100 or visit KH.org/neurology. Angela Pana, M.D. William Ganz, M.D. William Britt, M.D.

14 Primary care, urgent care or emergency department? Knowwhen and where to go By Kim Anderson Sniffles and sore throats, slips and trips, cuts and concussions. Life can get busy, so when an illness or injury is piled on top of other responsibilities, it’s great to be able to handle it quickly and efficiently. Northern Idaho is fortunate to have a number of excellent options for a wide variety of health concerns. Knowing how to make the best choice for your situation ensures you receive timely, appropriate care. Here’s a look at the types of care available to you, along with general guidelines on when to choose that level of care. Doctor’sofficevisit If your symptoms come on gradually, are related to a long-standing issue or you believe you know what the problem is, such as an ear infection or urinary tract infection (UTI), try to get a same-day appointment with your primary care provider. While urgent care clinics have extended hours and accept walk-ins, your family physician or nurse practitioner is usually the best place to start when you are sick or hurt. When you visit your doctor for an illness or injury, he or she knows your health history, including any underlying conditions, and can help you make informed choices about your treatment and needed tests. Urgent carevisit “An urgent care can help with the same types of concerns as your family doctor,” said Christian Menard, M.D., Ph.D., Kootenai Health medical director of emergency services. “Urgent care is a great choice if your family doctor can’t fit you in and you need help for a minor infection like an ear infection or UTI, cold symptoms, a sprain or a cut.” Kootenai Urgent Care is open seven days a week, from 8 a.m. until 8 p.m. With Kootenai Health’s transition to the Epic electronic health record last year, Kootenai Urgent Care providers now also have easy access to your Kootenai Health medical record. This allows them to see your full health history, any medications you have been prescribed and results from lab work and imaging studies. Emergencydepartmentvisit Emergency departments (ED) are designed to provide fast, lifesaving care. They respond to a wide range of emergencies, such as major traumatic injuries, heart attacks and strokes. As our community grows and Kootenai Health cares for the needs of more people, the ED has become a very busy place. Those with time-sensitive emergencies who require quick intervention to save their life or prevent further damage are prioritized and cared for first. “The fastest way to receive the care you need is to go to the right place the first time,” said Dr. Menard. “If your condition is relatively minor, you will be seen more quickly at the urgent care than the ED.” Christian Menard, M.D., Ph.D. WISELY Choose Your Care Need care now? Kootenai Urgent Care has offices in Coeur d’Alene, Post Falls and Hayden. Learn more at kootenaiurgentcare.com.

KH . ORG 15 Need a primary care provider? The Kootenai Clinic Appointment Center can help you find a family physician welcoming new patients, including those with Medicare and Medicaid. Call (208) 625-6767 to get started. Seek medical attention from your primary care provider or urgent care for: • Fever without rash • Ear infections • Minor trauma, such as muscle sprains and strains • Cuts and foreign body removal • Painful urination or urinary tract infections • Eye irritation and redness • Diarrhea, vomiting or dehydration • Severe sore throat and cough • Cold and flu symptoms • Allergic reactions • Minor burns • Sinus and eye infections • Punctures and animal bites • DOT, sports and pre-employment physicals • Testing for sexually transmitted infections Get the Right Level of Care Go to the emergency department or call 911 for: • Persistent chest pain • Severe heart palpitations • Difficulty speaking, altered mental state or confusion • Loss of vision • Sudden, severe headache • Loss of balance or fainting • Seizures without a previous diagnosis of epilepsy • Persistent shortness of breath or wheezing • Weakness or paralysis • Serious burns • Broken bones or dislocated joints • Head or eye injuries • Intestinal bleeding • Sudden testicular pain and swelling • Persistent high fever (over 102 degrees) or fevers with a rash • Falls with injury or while taking blood-thinning medications • Vaginal bleeding with pregnancy • Severe pain Kootenai Health’s ED physicians have all been specifically trained in emergency medicine. Their training is focused on caring for the life-threatening conditions commonly seen in an ED, as opposed to conditions typically seen by a family physician. “Emergency medicine training is focused on quickly assessing what can cost you your life or what can cause you to lose your sight or a limb,” said Dr. Menard. “When a patient comes to the ED with a life-threatening condition, within minutes they will be seen by someone whose entire training is aimed at keeping them safe and providing the care needed for the best possible recovery.” Gethelp Call 911 for any emergency that requires immediate assistance from an ambulance (or the police or fire department). For many medical emergencies, such as a heart attack or stroke, taking an ambulance is safer than driving to the hospital. Paramedics can start lifesaving care on the way to the hospital. When you call 911, be prepared to give your location and detailed information about the situation. If you dial 911 by mistake, do not hang up; simply explain to the call-taker what happened. Beprepared Wherever you get care, it’s a good idea to take a list of your basic medical information with you. This can include the names of any prescriptions, over-the-counter medications and vitamins you take, along with their dosages; your allergies, especially to medications; and any previous medical procedures and surgeries, along with when they were done. Cost considerations No health care discussion would be complete without a few words on cost. Costs vary based on the facilities where you receive care. Equipping and staffing an ED to respond to medical emergencies is more expensive than operating a physician office or urgent care. This means care received in the ED will cost more than care received elsewhere. If you are having a life-threatening emergency, call 911 or visit the emergency room as soon as possible. If you do not need immediate, emergency care, consider using an urgent care or seeing your primary care provider to keep your costs as low as possible.

16 Removing Barriers to Care for Patients in Rural Areas By Shannon Carroll “Life is like a roller coaster. It has its ups and downs, but it’s all worth the ride.” We’ve all heard or read quotes like that. While seemingly bland, there is some real truth in those simple sentiments. With every downturn in life, there is an inevitable rise. The beauty is in recognizing the rise when it happens. “That is what I felt like when I heard the word cancer,” said oncology patient Bill Hall. “My stomach just dropped. It was like gravity hit me tenfold.” Bill is a 68-year-old man who lives on the outskirts of Orofino, Idaho— nearly three hours south of Coeur d’Alene. He knew his aggressive course of cancer treatment would be an uphill climb for him in more ways than simply hoping to beat this cancer. “I didn’t know how I was going to manage this,” he said. “When you get a cancer diagnosis, everything completely stops. On top of that, I live in logging and farm country—I didn’t have easy access to my treatment. I had to drive three hours each way to Kootenai Clinic.” For countless cancer patients like Bill, who live far from metropolitan areas where they can receive specialized treatment, there are mountains of barriers to care. “I had to have treatment five days a week for seven weeks straight— that included 33 radiation and three chemotherapy sessions,” he said. “My wife, Denise, had to take time off from work. We had to ask our son or granddaughter to watch our house and pets and had extra expenses to pay for gas, food and a hotel—it was a situation that had just gotten to be too much. The radiation made me sick and weak. It was hard to focus on just getting better.” Access to care is something that is difficult for many in rural areas. Bill’s story highlights how one diagnosis can upend families—not only emotionally but financially as well. A multidisciplinary team from Kootenai Health joined forces with St. Mary’s and Clearwater Valley Health, which are part of the Kootenai Health system, to outline strategies to help remove barriers for patients in the rural areas they serve. The team identified important resources, including discounted lodging, virtual (telehealth) visits with physicians and in-person appointments with Kootenai Health specialists who travel from Coeur d’Alene several times a month. Bill has been one of the grateful recipients of the team’s efforts and has been a vocal champion of Kootenai Health as a whole. “It’s been quite a ride, but the care I’ve gotten here has given me hope,” Bill said. “For the first time in a long time, I don’t feel like gravity is pulling me down as much as it used to. My doctors, nurses, social services reps and amazing staff at the Davidson Family Hospitality Center have really helped me a lot. It’s never easy, but it will get better.” “Special thanks to Bill’s primary provider at Clearwater Valley Health; Dr. Clayton Bunt, for referring him to Dr. Todd Hoopman at Kootenai Health; and the rest of the team there, including Drs. Gay, Jacobs and Burnett and the amazing nursing team. We are proud and thankful to have this excellent level of care here in Idaho.” —Bill and Denise Hall, in appreciation for Bill’s care team Easing worries and offering support The Kootenai Health Foundation offers financial assistance to eligible patients through its Cancer Patient Support fund. For more information about how to receive services or donate to the fund, visit kootenaihealthfoundation.org, call (208) 625-4438 or email foundation@kh.org. Cancer patient Bill Hall and his wife, Denise.

KH . ORG 17 APriceless Presence By Caiti Bobbitt They can be seen in royal blue jackets and vests all throughout Kootenai Health, often with smiles on their faces and a job to do. They are the volunteers of Kootenai Health, and their contribution to the organization is priceless. Each year, the Idaho Hospital Association recognizes one outstanding adult and one youth volunteer in the state for the work they do at their respective hospitals. Kootenai Health volunteers received both the adult and junior volunteer awards for 2022. These awards recognize individuals who excel in areas such as patient services, community service and leadership. JuniorVolunteer of theYear for 2022 Gracyn Kautzman was awarded the Junior Volunteer of the Year Scholarship Award. Now in college at the University of Arizona, she volunteered at Kootenai Health throughout her high school years as a way to get closer to her goal of one day working in medicine. “She positively impacted and inspired everyone she came into contact with,” said Renee Langue, Kootenai Health Volunteer Services manager. “She was outstanding and highly committed.” Gracyn credits her time at Kootenai Health with contributing to her personal growth, saying it has been an integral part of shaping her into the person she is today. “I am very honored to receive this award because I think it is important to show others what it means to be a volunteer and how influential one’s presence can be to others,” Gracyn said. LOVE—Leader of Volunteer ExcellenceAward for 2022 Rio Setty became a Kootenai Health volunteer after the great care her mother received when she was hospitalized in 2005. Since then, Rio has become a familiar face to employees and Kootenai Health patients. When it was time to nominate recipients for the LOVE—Leader of Volunteer Excellence Award for 2022, Rio was an obvious choice. “Rio’s generous and compassionate spirit, combined with the leadership she unfailingly provides, made her the ideal candidate,” said Renee. Rio is an integral part of the volunteer program at Kootenai Health. She volunteered throughout the pandemic, including at the COVID-19 vaccine clinics. She is currently on the Volunteer Steering Committee Executive Board and is chairwoman of Kootenai Health’s Clothing Closet, a resource for patients who are in need of clothes when they leave the hospital. Despite dedicating so much time to the organization, she is adamant that there are many other Kootenai Health volunteers who deserve to be recognized. “I was really surprised when they told me I had won, and I thought it was wonderful,” said Rio. “Not because I’m getting the award, but because it feels like Kootenai is getting recognized—and I just love Kootenai Health.” Gracyn Kautzman Become a volunteer If you would like information about how to help out at Kootenai Health, please visit KH.org/volunteer-services.

18 Front row, from left: Ann Ealy, MSN, RN, Kootenai Clinic clinical supervisor; Kristel Marquet, Ph.D., RN, M.Sc., director of Critical, Surgical and Ambulatory Care (Belgium). Back row: Jimmy Poelmans, RN, Radiology (Belgium), and Lori Moss, MN, RN, Magnet program director at Kootenai Health. By Caiti Bobbitt Collaboration has been a key component of Kootenai Health’s success. It is key to delivering great health care on a global scale. It is an important reason Kootenai Health’s Nurse Excellence Program agreed to be a part of Magnet4Europe, a unique opportunity to work with health care professionals in Europe to improve provider mental health and well-being. “Health care is a tough business, and clinicians across the globe are suffering from high burnout and turnover rates,” said Lori Moss, MN, RN, director of Kootenai Health’s Magnet program. “Our teams meet virtually every other month to review initiatives, troubleshoot issues that arise and develop plans to continue the momentum forward.” —Lori Moss, MN, RN As a four-time designated Magnet hospital, Kootenai Health was one of only 67 hospitals chosen to participate in Magnet4Europe to share best practices. In February 2020, Kootenai was paired, or twinned, with a hospital in Belgium, azVesalius (azV). Belgium-bound For over two years, participants from both hospitals met virtually every week without ever being able to meet in person because of the pandemic. Finally, in May 2022, Kootenai Health nurses had the opportunity to travel to Belgium to meet their European colleagues in person for the first time. Then, five months later, Kootenai was able to host the Belgium nurses for a week. “Having the Belgium team on-site afforded them the opportunity to see Magnet principles in action; interact with Kootenai Health nurses who exemplify best practices; and experience the difference a positive, healthy work environment can make,” said Lori. “We have seen a culture that is very open,” Kristel Marquet, director of Critical, Surgical and Ambulatory Care for Belgium, said of Kootenai Health. “Nurses can use their voices to speak up for positive change, and I think we need to take this philosophy with us to encourage our nurses to use their voices.” Lori and her team are proud to share Kootenai Health’s rich culture and strong nursing environment with other professionals from across the globe, but even more than that, they are excited for the recognition of Kootenai Health’s deserving clinicians. “Our nursing professionals are leaders of innovation and excellence in the delivery of evidence-based care across the health care continuum,” said Lori. Sharing best nursing practices through Magnet4Europe Kootenai Health GOES GLOBAL

KH . ORG 19 By Caiti Bobbitt Whether it is a mother’s first child or her last, Kootenai Health’s team of International Board Certified Lactation Specialists go above and beyond to help mothers and babies on their breastfeeding journey. “After a mother delivers her baby, we provide specialized care to meet her goals and expectations,” said Starina Brandt, RN, clinical coordinator of Kootenai Health’s Women’s and Children’s Services. “Every new mom receives lactation support at Kootenai Health.” Kootenai Health’s team of nurses receives up to 20 hours of breastfeeding education and training to help postpartum moms during the essential bonding period, which is from the time of delivery to discharge from the hospital. “Breastfeeding is an integral way a baby bonds with its mother because of the surge of oxytocin, one of our body’s feel-good hormones,” said Maureen Finigan, RN, Kootenai Health nurse lactation consultant. “Breastfeeding is also one of the optimal ways to provide complete nutrition to babies because the composition of breast milk is unique for each infant.” Better health Both mother and baby receive many benefits from breastfeeding. Research shows that infants who are breastfed are less likely to develop conditions like asthma, obesity and type 1 diabetes. Additionally, breastfeeding mothers are at reduced risk of developing high blood pressure, type 2 diabetes and certain types of cancer. “Breast milk helps establish and protect a baby’s immune system, which they don’t really establish on their own until about 4 months,” said Starina. “Breastfeeding also establishes a baby’s gut microbiome, introducing helpful bacteria and protective micro and macro nutrients.” Welcoming a new baby should be a happy time in a mother’s life, and often that means being open to receiving help. The Kootenai Health lactation team prides itself on being a small part of mothers’ support system. “Our team at Kootenai Health really focuses on helping ease moms into this new, exciting, often exhausting chapter,” said Maureen. The Kootenai Health lactation team offers a free monthly breastfeeding class. A support group also meets weekly in-person. The lactation team is available seven days a week for prenatal visits, outpatient lactation consultations and advice over the phone. Speak with a lactation consultant by calling (208) 625-5091. Idaho Breastfeeding Summit Each year, Kootenai Health joins forces with the Idaho Breastfeeding Coalition (IBC) to put on the Idaho Breastfeeding Summit. “The Summit is always a chance for experts to come out and collaboratively share our insights on best breastfeeding practices,” said Maureen Finigan, RN, Kootenai Health nurse lactation consultant. “We’re completely removing the barrier between expert and patient. We can’t wait for the 2023 Summit!” BondingWith Baby Through Join us To learn about more breastfeeding resources and to register, visit KH.org/family-birth-center. Kootenai Health team connects with Idaho Breastfeeding Coalition at yearly summit.