Marshall Medical presents For Your Health - Winter 2023

Committed to the Health & Well-Being of El Dorado County
WINTER 2023
What is
Prediabetes?
Pilot Program for Older Adults in Georgetown
An Inspired Vision for the Healing Power of Animals
The Best Exercises to Ease Your Arthritis Pain

BETTER CARE FOR YOU
Marshall Medical Center and
UC Davis Health Partner
with AKT Development to
Launch Pilot Program for
Older Adults in Georgetown
Project will inform efforts for future
“Community for Health and Independence.”
Marshall Medical Center, in
partnership with UC Davis Health
has announced plans for a
pilot program in Georgetown to
learn how utilizing home-based
healthcare technology can help
older adults and people with
disabilities live healthier, more
independent lives and better
manage their health conditions
at home. The program is made
possible by a $175,000 grant
from Sacramento-based AKT
Development.
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“Our Georgetown residents
experience many of the same
healthcare disparities seen
across the country with rural
populations and older residents
in particular,” says Dr. Martin
Entwistle, Associate Chief Medical
Officer and VP Population Health
and Ancillary Services at Marshall
Medical Center. “While the use
of this type of technology has
been implemented successfully
in other communities and patient
populations, Marshall can expand
the use of technology to better
support individual health needs
specific to the Georgetown
community – which can also help
advance the health of older adults
in many other communities in our
region and nationwide.”
2 | FOR YOUR HEALTH | www.marshallmedical.org
The project aims to equip
providers, patients, caregivers,
and lawmakers with tangible data
that supports using technology to
better manage health disparities for
residents including chronic disease,
issues with mobility, and other
socioeconomic barriers to care.
“It is wonderful to see this exciting
pilot program in Georgetown,” says
Lori Parlin, County Supervisor for
the district. “Residents often say that
they want to stay in their existing
home to live out their golden years
and this type of technology could
assist those with medical needs do
just that: age in place.”
Participants in the program will
be supported by way of checkins
with a Marshall provider to
help keep on track with health
goals and to address other needs
such as timely medication refills,
appointment reminders, and help with
transportation. The program will make
use of technology capable of direct
two-way dialogue between provider
and patient that can help collect other
useful information such as activity,
appetite, and pain measurements.
...story continued on page 7

ABOUT MARSHALL
MEDICAL CENTER
Marshall Medical Center
is an independent,
nonprofit community
healthcare provider located in
the heart of the Sierra Foothills
between Sacramento and
South Lake Tahoe. Marshall
Medical Center includes
Marshall Hospital, a fully
accredited acute care facility
with 111 beds located in
Placerville; several outpatient
facilities in Cameron Park,
El Dorado Hills, Placerville
and Georgetown; and many
community health and
education programs. Marshall
has nearly 220 licensed
providers and a team of over
1,400 employees providing
quality healthcare services
to the residents of El Dorado
County.
For Your HEALTH is
published as a community
service by
MARSHALL MEDICAL CENTER
1100 Marshall Way
Placerville, CA 95667
telephone 530-622-1441
or 916-933-2273;
www.marshallmedical.org
It is intended to provide
information about health in
general as well as healthcare
services and resources available
in El Dorado County. Information
comes from a wide range of
medical experts. If you have any
concerns or questions about
specific content that may affect
your health, please contact your
healthcare provider.
To reach the editor of For Your
Health, contact Fernando Diaz
at 530-626-2675 or
fdiaz@marhsallmedical.org
COVER STORY
Here’s Why Prediabetes Is
More Serious Than You Think
If you have higher than normal blood sugar
levels, here’s what you need to know.
Do you have blood sugar levels that are higher
than normal but not high enough to be
considered diabetes? If so, you have prediabetes.
Many people don’t think much about having
elevated blood sugar numbers as long as they
don’t have diabetes. But knowing what to do if
your blood sugar is out of normal range can be an
important step in helping you to stay healthier.
What is prediabetes?
Having prediabetes means that your blood
sugar is higher than normal but is not yet high
enough to receive a diagnosis of type 2 diabetes.
Blood sugar levels may be measured after doing
an overnight fast, with results indicating the
following:
• Normal: 99 mg/dL or lower
• Prediabetes: 100 to 125 mg/dL
• Diabetes: 126 mg/dL or higher
You may also have an A1C test done. This
measures your average blood sugar levels over the
past 2 to 3 months. Results of an A1C test are as
follows:
• Normal: below 5.7%
• Prediabetes: 5.7% to 6.4%
• Diabetes: 6.5% or higher
Would you know if you had prediabetes?
As many as one in three American adults have
prediabetes. Unfortunately, about 8 in 10 people
with prediabetes don’t even know they have it.
This makes it less likely they’ll make lifestyle
changes needed to prevent the development of
full-blown type-2 diabetes in the future.
You may have no symptoms if you have
prediabetes. The only way to know for sure if you
have prediabetes is to have your blood sugar levels
checked. Talk to your doctor about getting tested if
you have these risk factors:
• You are age 45 or older
• You are overweight
• You are not physically active
• You had gestational diabetes when pregnant or
gave birth to a baby over 9 pounds
• You have a close relative (parent or sibling) with
type 2 diabetes
Why is it serious to have prediabetes?
Having prediabetes is a sign that you’re more
likely to develop diabetes in the future (although
it’s not a guarantee that you will). Diabetes affects
every major organ in your body. It increases your
chance of heart disease, stroke, kidney failure,
blindness and nerve damage. Not only can it
affect your physical health and how long you
live, but it can also affect your quality of life. In
fact, people with diabetes are twice as likely to
experience depression.
In addition to being a wake-up call that you may
develop diabetes, having prediabetes also puts you
at a higher risk of heart disease and stroke.
What can you do if you have prediabetes?
The best thing you can do if you have prediabetes
is to make lifestyle changes that may lower your
risk of developing diabetes. This includes:
• Losing weight. Losing just 5 – 7% of your body
weight can make a difference.
• Eating healthier foods. Changing your diet
may lower your chance of developing diabetes.
Eat more fruit, vegetables, whole grains, lean
meats, nuts and low-fat dairy. Reduce your
consumption of added sugar, white flour,
processed foods and foods high in saturated fat.
• Moving more. Aim to get at least 150 minutes
per week of moderate activity, such as brisk
walking.
• Checking your blood sugar regularly. Once you
know that your levels are elevated, it’s a good
idea to have your blood sugar levels checked on
a regular basis. Your doctor may want to do this
once a year or more often.
For more information about Marshall Medical Center, visit www.marshallmedical.org or follow us on
Facebook/marshallmedicalcenter, instagram.com/marshall.medical.center, on YouTube, LinkedIn and on Twitter.
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HOSPITAL NEWS
Marshall Walks
Marshall
Medical Center’s
employees, providers, patients
and families have taken to the
streets to make a difference
in the lives of many in our
communities. In September,
Team Marshall (pictured)
participated in the American
Heart Association’s Sacramento
Heart Walk at William Land
Park. The team surpassed
its fundraising goal and
contributed more than $4,000 to
the Heart Association.
A month later the Marshall
team gathered for the American
Cancer Society’s Making Strides
Against Breast Cancer Walk at
the Sacramento State campus
and in November came together
once more at Sacramento’s
Sutter Health Park for the
Leukemia and Lymphoma
Society’s Light the night Walk.
Thank you to those who
participated and all who gave
generously to support these
important causes.
FOUNDATION NEWS
Join the Marshall
Hospital Auxiliary
A unique volunteer opportunity.
Since 1959, Marshall’s Auxiliary
members have been dedicated to
making patients and visitors feel
welcome and at ease. Auxiliary
members assist in many areas
of Marshall Hospital, including
information desks, Emergency and
Surgery departments and inpatient
departments.
Auxilians commit 50 hours (or
more) of service per year and attend
occasional meetings. In return, they
receive training, TB screening, annual
flu shots (when available), recognition,
friendship and the joy of helping
others.
No special skills are required. If
you can drive, walk, call, talk, listen
or even just smile, there are many
ways you can make a difference at
Marshall Hospital.
Call the Auxiliary Membership
Chair (530) 626-2643 to join
the Auxiliary or to learn more
about volunteering with the
Marshall Hospital Auxiliary!
4 | FOR YOUR HEALTH | www.marshallmedical.org

An Inspired Vision
for the Healing
Power of Animals
FEATURE
Jim and Barbara Coxeter, owners of Batia
Vineyards in Placerville, look forward to seeing
the compelling and undeniable companionship
between animals and people put to use as a
component of the clinical healing process. With
a significant gift to the Marshall Foundation for
Community Health, they are helping bring their
vision to reality for those in our community.
Jim’s deep connection with dogs began as a young
man but was changed forever with the arrival of
a tiny Doberman Pinscher puppy. No more than
ten days old, Bogart was the size of a hamster
and needed to be bottle fed. Jim raised him and,
for the next twelve years, Bogart was the best
dog he had ever known. Bogart was intelligent,
compassionate and very sociable with people.
For many years Jim lived in a rural
community in Shasta County as
well as residences in the Bay Area.
He would frequently drive to Santa
Cruz where his mother was living
in a senior assisted living facility.
Jim’s mother loved Bogart and Jim
always brought him along on his
trips. Bogart was allowed to visit
other residents in the building’s
common areas. He would
intuitively lay his head into their
laps and, in what Jim describes
as a “great awakening,” even the
most distant of individuals would
come to life when Bogart visited.
Jim and Bogart returned almost
every other week and even those
who were initially hesitant to be
approached by a 98-pound dog,
eventually came to look forward to
his regular visits.
In time, Jim’s mother and Bogart
both sadly passed. Then, as a
birthday present, Vino joined the
family. A first-generation half
poodle / half golden retriever, Vino
has been with Jim and Barbara
through the growth of their wine
business and is the official greeter
in their Main Street tasting room.
They each describe Vino as the
love of their life and there seem to
be few people in town who don’t
know him and agree.
Vino sets visitors at ease.
Like Bogart, his intuitive and
expressive demeanor has a
calming effect and it reminded
Jim of the visits to his mother.
Dedicated supporters of the
Placerville community, Jim and
Barbara reflected on the care they
had each received in Marshall
Medical Center’s emergency and
cardiac rehabilitation departments
and the friends they had made
with Marshall’s staff and soon an
idea was born. With a gift from
the Coxeter Foundation, they
could make a statement about the
important role animals – dogs
specifically – can have in healing
and well-being.
“I envision a program where
well-trained animals can visit
Marshall’s patients for therapy
on a regular basis,” says Jim.
“Repetition and even anticipation,
is key for the animals and for
the patients. It is amazing to see
the difference it can make in
someone.”
Prior to the COVID-19 pandemic,
Marshall’s animal assisted activity
program provided patients
with the opportunity to interact
with qualified animal visitors
during their stay. These visits
provided social interaction,
sensory stimulation, relaxation
and facilitated stress reduction
associated with hospitalization.
Visits were prescheduled and
patients who were in isolation,
had allergies, or who declined
did not receive visits. During the
pandemic, however, volunteers,
including the animal assisted
therapy providers, were not able to
visit the hospital.
Today, Marshall is looking to
restart the program, training
and recruiting volunteers
(both human and canine!) and
strategizing how the program
can have the greatest impact on
patients in all areas of the hospital.
The generosity of Jim and Barbara
Coxeter, inspired by Vino and the
memory of Bogart, will help shape
and guide the program’s relaunch,
benefiting patients, family, and
staff for years to come.
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DID YOU KNOW
The Best Exercises to
Ease Your Arthritis Pain
Regularly doing these activities may help reduce
bothersome symptoms in your joints.
If your joints are stiff or painful due to
arthritis, it may feel like the last thing
you should be doing is exercise. After
all, won’t all that activity make your
joints hurt even more? It turns out
that being physically active is one of
the best things you can do to help ease
arthritis pain. Of course, not every type
of activity is appropriate if you have
arthritis, but knowing what type of
exercises to do to help rather than hurt
your joints can help you manage this
common but painful condition.
How does exercise help ease
arthritis pain?
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Regular physical activity helps reduce
the stiffness that often accompanies
arthritis. It also replenishes lubrication
within the joints, helping to ease
inflammation and pain. In addition,
some exercises can help strengthen the
muscles around affected joints, making
it easier to move the joints with less
discomfort. Another benefit to exercise
in people who have arthritis? It may
help you lose weight or maintain a
healthy weight. Carrying less weight
can do wonders for joint pain.
What types of exercise are best
if you have arthritis?
The type of exercise you should or
should not do may depend on where
your arthritis is located and how
advanced your condition is. For the
most part, low-impact activities are
usually recommended for people with
arthritis, especially in the knees or hips.
Activities such as walking, using an
elliptical trainer, biking and swimming
allow your body to stay active without
much stress on your joints. Stretching
and flexibility exercises are also
beneficial. Many people with arthritis
find pain relief when doing activities
such as yoga or tai chi. Strengthtraining
exercises can help build
muscles surrounding the joint. It may be
best to consult with a physical therapist
or personal trainer before starting a
weight-training routine if you have
arthritis.
How long do you need to
exercise to see benefits?
As with any aspect of your health,
there’s no magic number that needs to
be hit in order to reap the benefits of
exercise. Aim for 150 minutes per week
of moderate activity, but do as much
as you feel comfortable doing. You can
even exercise for just 10 minutes at a
time if it’s easier on your joints. Any
movement you do helps, even if it’s not
considered formal exercise. Activities
like gardening, walking the dog and
raking leaves all get your body moving
and can help ease arthritis pain.
What should you keep in mind when
exercising with arthritis?
Although physical activity may help
improve arthritis pain, there are a few
things to keep in mind when exercising
so you don’t do more harm than good.
These include:
• Pace yourself. Start slowly and don’t
overdo it. If you feel pain, stop and dial
back your activity to a level that feels
more comfortable.
• Warm up and cool down. Don’t just
jump into exercise without getting
your joints ready for action. Move
gently at first, focusing on slow,
easy movements. At the end of your
workout, take a few minutes to cool
down and stretch.
• Heat before, ice after. Applying some
heat to your joints and surrounding
muscles before you exercise improves
circulation and may reduce stiffness.
After activity, apply ice for up to 20
minutes at a time, if needed, to ease
pain and swelling.
• Pay attention to your body. If you feel
pain or notice swelling, take it easy. If
your symptoms seem worse than usual
or you have more pain, stiffness or
swelling after you do certain activities,
it may be best to avoid those activities.
6 | FOR YOUR HEALTH | www.marshallmedical.org

HOSPITAL NEWS
...story continued from page 2
“I applaud Marshall Medical Center, AKT
Development, and UC Davis Health for
collaborating on this innovative pilot,” says
Wendy Thomas, Chairman of the Board of
Supervisors for El Dorado County. “Through
strategic technology and this collaborative
partnership, just maybe we can help our residents
live longer in a place they love while helping them
stay safe and healthy throughout their lives.”
AKT provided funding for this project, as they are
a critical partner in understanding aging in place.
For example, a future “Community for Health
and Independence” development planned by UC
Davis Health and AKT will be a first-in-the-world
community that will benefit from pilots like this in
the Georgetown community.
“That university-planned community will allow
older people and people with disabilities to live
independently in technology-enabled homes
designed with healthcare in mind,” said AKT
spokesperson Bill Romanelli. “This pilot program
in Georgetown with Marshall Medical Center
will deliver valuable information to help with
designing a community for people to live longer,
healthier lives.”
UC Davis Health’s role is helping evaluate the
project’s effectiveness through the Center for
Healthcare Policy and Research, led by Dr.
Courtney Lyles, PhD. With support from graduate
student Pauline Martinez, CHPR and the team at
Marshall Medical Center will assess the project
using human-centered design approaches, and
help identify opportunities and technologies
that offer the most promise in assisting with the
development of a healthy living community.
Organizers of the pilot cite the need to serve a
growing aging population across the country
with more dynamic options for care. In the
Sacramento region, the adult population aged
60 years and older is projected to increase by
78% in the next decade. Those turning 65 years
old between 2015 and 2019 are expected to live
an average of 23.6 years, with 4.5 of those years
spent with one or more activity-of-daily-living
(ADL) limitations. The development and design of
the planned residential community will consider
lessons learned from the program to inform best
practices and identify potential challenges.
The pilot program is currently in the preliminary
stages of identifying and training staff, with a
formal launch anticipated in early 2024.
Welcome New Providers to
Marshall Medical Center
Kelley Jackson, WHNP
OB/GYN
530-344-5470
Parneet Kaur, DPM
Podiatry
530-672-7040
Christopher Kurnik, MD
Orthopedics &
Sports Medicine
Placerville
530-344-2070
El Dorado Hills
916-805-2320
Nigah Patel, MSN,
APRN, FNP-BC-C
Family Medicine
530-672-7000
For a complete list of healthcare providers, visit
marshallmedical.org/find-a-doctor
www.marshallmedical.org | FOR YOUR HEALTH | 7