Marshall Medical presents For Your Health - Winter 2023

For Your Health by Marshall Medical Center 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.

For Your Health by Marshall Medical Center 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.


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Committed to the <strong>Health</strong> & Well-Being of El Dorado County<br />

WINTER <strong>2023</strong><br />

What is<br />

Prediabetes?<br />

<br />

<br />

<br />

Pilot Program for Older Adults in Georgetown<br />

An Inspired Vision for the Healing Power of Animals<br />

The Best Exercises to Ease <strong>Your</strong> Arthritis Pain


<strong>Marshall</strong> <strong>Medical</strong> Center and<br />

UC Davis <strong>Health</strong> Partner<br />

with AKT Development to<br />

Launch Pilot Program for<br />

Older Adults in Georgetown<br />

Project will inform efforts for future<br />

“Community for <strong>Health</strong> and Independence.”<br />

<strong>Marshall</strong> <strong>Medical</strong> Center, in<br />

partnership with UC Davis <strong>Health</strong><br />

has announced plans for a<br />

pilot program in Georgetown to<br />

learn how utilizing home-based<br />

healthcare technology can help<br />

older adults and people with<br />

disabilities live healthier, more<br />

independent lives and better<br />

manage their health conditions<br />

at home. The program is made<br />

possible by a $175,000 grant<br />

from Sacramento-based AKT<br />

Development.<br />


“Our Georgetown residents<br />

experience many of the same<br />

healthcare disparities seen<br />

across the country with rural<br />

populations and older residents<br />

in particular,” says Dr. Martin<br />

Entwistle, Associate Chief <strong>Medical</strong><br />

Officer and VP Population <strong>Health</strong><br />

and Ancillary Services at <strong>Marshall</strong><br />

<strong>Medical</strong> Center. “While the use<br />

of this type of technology has<br />

been implemented successfully<br />

in other communities and patient<br />

populations, <strong>Marshall</strong> can expand<br />

the use of technology to better<br />

support individual health needs<br />

specific to the Georgetown<br />

community – which can also help<br />

advance the health of older adults<br />

in many other communities in our<br />

region and nationwide.”<br />

2 | FOR YOUR HEALTH | www.marshallmedical.org<br />

The project aims to equip<br />

providers, patients, caregivers,<br />

and lawmakers with tangible data<br />

that supports using technology to<br />

better manage health disparities for<br />

residents including chronic disease,<br />

issues with mobility, and other<br />

socioeconomic barriers to care.<br />

“It is wonderful to see this exciting<br />

pilot program in Georgetown,” says<br />

Lori Parlin, County Supervisor for<br />

the district. “Residents often say that<br />

they want to stay in their existing<br />

home to live out their golden years<br />

and this type of technology could<br />

assist those with medical needs do<br />

just that: age in place.”<br />

Participants in the program will<br />

be supported by way of checkins<br />

with a <strong>Marshall</strong> provider to<br />

help keep on track with health<br />

goals and to address other needs<br />

such as timely medication refills,<br />

appointment reminders, and help with<br />

transportation. The program will make<br />

use of technology capable of direct<br />

two-way dialogue between provider<br />

and patient that can help collect other<br />

useful information such as activity,<br />

appetite, and pain measurements.<br />

...story continued on page 7



<strong>Marshall</strong> <strong>Medical</strong> Center<br />

is an independent,<br />

nonprofit community<br />

healthcare provider located in<br />

the heart of the Sierra Foothills<br />

between Sacramento and<br />

South Lake Tahoe. <strong>Marshall</strong><br />

<strong>Medical</strong> Center includes<br />

<strong>Marshall</strong> Hospital, a fully<br />

accredited acute care facility<br />

with 111 beds located in<br />

Placerville; several outpatient<br />

facilities in Cameron Park,<br />

El Dorado Hills, Placerville<br />

and Georgetown; and many<br />

community health and<br />

education programs. <strong>Marshall</strong><br />

has nearly 220 licensed<br />

providers and a team of over<br />

1,400 employees providing<br />

quality healthcare services<br />

to the residents of El Dorado<br />

County.<br />

<strong>For</strong> <strong>Your</strong> HEALTH is<br />

published as a community<br />

service by<br />


1100 <strong>Marshall</strong> Way<br />

Placerville, CA 95667<br />

telephone 530-622-1441<br />

or 916-933-2273;<br />

www.marshallmedical.org<br />

It is intended to provide<br />

information about health in<br />

general as well as healthcare<br />

services and resources available<br />

in El Dorado County. Information<br />

comes from a wide range of<br />

medical experts. If you have any<br />

concerns or questions about<br />

specific content that may affect<br />

your health, please contact your<br />

healthcare provider.<br />

To reach the editor of <strong>For</strong> <strong>Your</strong><br />

<strong>Health</strong>, contact Fernando Diaz<br />

at 530-626-2675 or<br />

fdiaz@marhsallmedical.org<br />


Here’s Why Prediabetes Is<br />

More Serious Than You Think<br />

If you have higher than normal blood sugar<br />

levels, here’s what you need to know.<br />

Do you have blood sugar levels that are higher<br />

than normal but not high enough to be<br />

considered diabetes? If so, you have prediabetes.<br />

Many people don’t think much about having<br />

elevated blood sugar numbers as long as they<br />

don’t have diabetes. But knowing what to do if<br />

your blood sugar is out of normal range can be an<br />

important step in helping you to stay healthier.<br />

What is prediabetes?<br />

Having prediabetes means that your blood<br />

sugar is higher than normal but is not yet high<br />

enough to receive a diagnosis of type 2 diabetes.<br />

Blood sugar levels may be measured after doing<br />

an overnight fast, with results indicating the<br />

following:<br />

• Normal: 99 mg/dL or lower<br />

• Prediabetes: 100 to 125 mg/dL<br />

• Diabetes: 126 mg/dL or higher<br />

You may also have an A1C test done. This<br />

measures your average blood sugar levels over the<br />

past 2 to 3 months. Results of an A1C test are as<br />

follows:<br />

• Normal: below 5.7%<br />

• Prediabetes: 5.7% to 6.4%<br />

• Diabetes: 6.5% or higher<br />

Would you know if you had prediabetes?<br />

As many as one in three American adults have<br />

prediabetes. Unfortunately, about 8 in 10 people<br />

with prediabetes don’t even know they have it.<br />

This makes it less likely they’ll make lifestyle<br />

changes needed to prevent the development of<br />

full-blown type-2 diabetes in the future.<br />

You may have no symptoms if you have<br />

prediabetes. The only way to know for sure if you<br />

have prediabetes is to have your blood sugar levels<br />

checked. Talk to your doctor about getting tested if<br />

you have these risk factors:<br />

• You are age 45 or older<br />

• You are overweight<br />

• You are not physically active<br />

• You had gestational diabetes when pregnant or<br />

gave birth to a baby over 9 pounds<br />

• You have a close relative (parent or sibling) with<br />

type 2 diabetes<br />

Why is it serious to have prediabetes?<br />

Having prediabetes is a sign that you’re more<br />

likely to develop diabetes in the future (although<br />

it’s not a guarantee that you will). Diabetes affects<br />

every major organ in your body. It increases your<br />

chance of heart disease, stroke, kidney failure,<br />

blindness and nerve damage. Not only can it<br />

affect your physical health and how long you<br />

live, but it can also affect your quality of life. In<br />

fact, people with diabetes are twice as likely to<br />

experience depression.<br />

In addition to being a wake-up call that you may<br />

develop diabetes, having prediabetes also puts you<br />

at a higher risk of heart disease and stroke.<br />

What can you do if you have prediabetes?<br />

The best thing you can do if you have prediabetes<br />

is to make lifestyle changes that may lower your<br />

risk of developing diabetes. This includes:<br />

• Losing weight. Losing just 5 – 7% of your body<br />

weight can make a difference.<br />

• Eating healthier foods. Changing your diet<br />

may lower your chance of developing diabetes.<br />

Eat more fruit, vegetables, whole grains, lean<br />

meats, nuts and low-fat dairy. Reduce your<br />

consumption of added sugar, white flour,<br />

processed foods and foods high in saturated fat.<br />

• Moving more. Aim to get at least 150 minutes<br />

per week of moderate activity, such as brisk<br />

walking.<br />

• Checking your blood sugar regularly. Once you<br />

know that your levels are elevated, it’s a good<br />

idea to have your blood sugar levels checked on<br />

a regular basis. <strong>Your</strong> doctor may want to do this<br />

once a year or more often.<br />

<strong>For</strong> more information about <strong>Marshall</strong> <strong>Medical</strong> Center, visit www.marshallmedical.org or follow us on<br />

Facebook/marshallmedicalcenter, instagram.com/marshall.medical.center, on YouTube, LinkedIn and on Twitter.<br />


www.marshallmedical.org | FOR YOUR HEALTH | 3


<strong>Marshall</strong> Walks<br />

<strong>Marshall</strong><br />

<strong>Medical</strong> Center’s<br />

employees, providers, patients<br />

and families have taken to the<br />

streets to make a difference<br />

in the lives of many in our<br />

communities. In September,<br />

Team <strong>Marshall</strong> (pictured)<br />

participated in the American<br />

Heart Association’s Sacramento<br />

Heart Walk at William Land<br />

Park. The team surpassed<br />

its fundraising goal and<br />

contributed more than $4,000 to<br />

the Heart Association.<br />

A month later the <strong>Marshall</strong><br />

team gathered for the American<br />

Cancer Society’s Making Strides<br />

Against Breast Cancer Walk at<br />

the Sacramento State campus<br />

and in November came together<br />

once more at Sacramento’s<br />

Sutter <strong>Health</strong> Park for the<br />

Leukemia and Lymphoma<br />

Society’s Light the night Walk.<br />

Thank you to those who<br />

participated and all who gave<br />

generously to support these<br />

important causes.<br />


Join the <strong>Marshall</strong><br />

Hospital Auxiliary<br />

A unique volunteer opportunity.<br />

Since 1959, <strong>Marshall</strong>’s Auxiliary<br />

members have been dedicated to<br />

making patients and visitors feel<br />

welcome and at ease. Auxiliary<br />

members assist in many areas<br />

of <strong>Marshall</strong> Hospital, including<br />

information desks, Emergency and<br />

Surgery departments and inpatient<br />

departments.<br />

Auxilians commit 50 hours (or<br />

more) of service per year and attend<br />

occasional meetings. In return, they<br />

receive training, TB screening, annual<br />

flu shots (when available), recognition,<br />

friendship and the joy of helping<br />

others.<br />

No special skills are required. If<br />

you can drive, walk, call, talk, listen<br />

or even just smile, there are many<br />

ways you can make a difference at<br />

<strong>Marshall</strong> Hospital.<br />

Call the Auxiliary Membership<br />

Chair (530) 626-2643 to join<br />

the Auxiliary or to learn more<br />

about volunteering with the<br />

<strong>Marshall</strong> Hospital Auxiliary!<br />

4 | FOR YOUR HEALTH | www.marshallmedical.org

An Inspired Vision<br />

for the Healing<br />

Power of Animals<br />


Jim and Barbara Coxeter, owners of Batia<br />

Vineyards in Placerville, look forward to seeing<br />

the compelling and undeniable companionship<br />

between animals and people put to use as a<br />

component of the clinical healing process. With<br />

a significant gift to the <strong>Marshall</strong> Foundation for<br />

Community <strong>Health</strong>, they are helping bring their<br />

vision to reality for those in our community.<br />

Jim’s deep connection with dogs began as a young<br />

man but was changed forever with the arrival of<br />

a tiny Doberman Pinscher puppy. No more than<br />

ten days old, Bogart was the size of a hamster<br />

and needed to be bottle fed. Jim raised him and,<br />

for the next twelve years, Bogart was the best<br />

dog he had ever known. Bogart was intelligent,<br />

compassionate and very sociable with people.<br />

<strong>For</strong> many years Jim lived in a rural<br />

community in Shasta County as<br />

well as residences in the Bay Area.<br />

He would frequently drive to Santa<br />

Cruz where his mother was living<br />

in a senior assisted living facility.<br />

Jim’s mother loved Bogart and Jim<br />

always brought him along on his<br />

trips. Bogart was allowed to visit<br />

other residents in the building’s<br />

common areas. He would<br />

intuitively lay his head into their<br />

laps and, in what Jim describes<br />

as a “great awakening,” even the<br />

most distant of individuals would<br />

come to life when Bogart visited.<br />

Jim and Bogart returned almost<br />

every other week and even those<br />

who were initially hesitant to be<br />

approached by a 98-pound dog,<br />

eventually came to look forward to<br />

his regular visits.<br />

In time, Jim’s mother and Bogart<br />

both sadly passed. Then, as a<br />

birthday present, Vino joined the<br />

family. A first-generation half<br />

poodle / half golden retriever, Vino<br />

has been with Jim and Barbara<br />

through the growth of their wine<br />

business and is the official greeter<br />

in their Main Street tasting room.<br />

They each describe Vino as the<br />

love of their life and there seem to<br />

be few people in town who don’t<br />

know him and agree.<br />

Vino sets visitors at ease.<br />

Like Bogart, his intuitive and<br />

expressive demeanor has a<br />

calming effect and it reminded<br />

Jim of the visits to his mother.<br />

Dedicated supporters of the<br />

Placerville community, Jim and<br />

Barbara reflected on the care they<br />

had each received in <strong>Marshall</strong><br />

<strong>Medical</strong> Center’s emergency and<br />

cardiac rehabilitation departments<br />

and the friends they had made<br />

with <strong>Marshall</strong>’s staff and soon an<br />

idea was born. With a gift from<br />

the Coxeter Foundation, they<br />

could make a statement about the<br />

important role animals – dogs<br />

specifically – can have in healing<br />

and well-being.<br />

“I envision a program where<br />

well-trained animals can visit<br />

<strong>Marshall</strong>’s patients for therapy<br />

on a regular basis,” says Jim.<br />

“Repetition and even anticipation,<br />

is key for the animals and for<br />

the patients. It is amazing to see<br />

the difference it can make in<br />

someone.”<br />

Prior to the COVID-19 pandemic,<br />

<strong>Marshall</strong>’s animal assisted activity<br />

program provided patients<br />

with the opportunity to interact<br />

with qualified animal visitors<br />

during their stay. These visits<br />

provided social interaction,<br />

sensory stimulation, relaxation<br />

and facilitated stress reduction<br />

associated with hospitalization.<br />

Visits were prescheduled and<br />

patients who were in isolation,<br />

had allergies, or who declined<br />

did not receive visits. During the<br />

pandemic, however, volunteers,<br />

including the animal assisted<br />

therapy providers, were not able to<br />

visit the hospital.<br />

Today, <strong>Marshall</strong> is looking to<br />

restart the program, training<br />

and recruiting volunteers<br />

(both human and canine!) and<br />

strategizing how the program<br />

can have the greatest impact on<br />

patients in all areas of the hospital.<br />

The generosity of Jim and Barbara<br />

Coxeter, inspired by Vino and the<br />

memory of Bogart, will help shape<br />

and guide the program’s relaunch,<br />

benefiting patients, family, and<br />

staff for years to come.<br />


www.marshallmedical.org | FOR YOUR HEALTH | 5


The Best Exercises to<br />

Ease <strong>Your</strong> Arthritis Pain<br />

Regularly doing these activities may help reduce<br />

bothersome symptoms in your joints.<br />

If your joints are stiff or painful due to<br />

arthritis, it may feel like the last thing<br />

you should be doing is exercise. After<br />

all, won’t all that activity make your<br />

joints hurt even more? It turns out<br />

that being physically active is one of<br />

the best things you can do to help ease<br />

arthritis pain. Of course, not every type<br />

of activity is appropriate if you have<br />

arthritis, but knowing what type of<br />

exercises to do to help rather than hurt<br />

your joints can help you manage this<br />

common but painful condition.<br />

How does exercise help ease<br />

arthritis pain?<br />


Regular physical activity helps reduce<br />

the stiffness that often accompanies<br />

arthritis. It also replenishes lubrication<br />

within the joints, helping to ease<br />

inflammation and pain. In addition,<br />

some exercises can help strengthen the<br />

muscles around affected joints, making<br />

it easier to move the joints with less<br />

discomfort. Another benefit to exercise<br />

in people who have arthritis? It may<br />

help you lose weight or maintain a<br />

healthy weight. Carrying less weight<br />

can do wonders for joint pain.<br />

What types of exercise are best<br />

if you have arthritis?<br />

The type of exercise you should or<br />

should not do may depend on where<br />

your arthritis is located and how<br />

advanced your condition is. <strong>For</strong> the<br />

most part, low-impact activities are<br />

usually recommended for people with<br />

arthritis, especially in the knees or hips.<br />

Activities such as walking, using an<br />

elliptical trainer, biking and swimming<br />

allow your body to stay active without<br />

much stress on your joints. Stretching<br />

and flexibility exercises are also<br />

beneficial. Many people with arthritis<br />

find pain relief when doing activities<br />

such as yoga or tai chi. Strengthtraining<br />

exercises can help build<br />

muscles surrounding the joint. It may be<br />

best to consult with a physical therapist<br />

or personal trainer before starting a<br />

weight-training routine if you have<br />

arthritis.<br />

How long do you need to<br />

exercise to see benefits?<br />

As with any aspect of your health,<br />

there’s no magic number that needs to<br />

be hit in order to reap the benefits of<br />

exercise. Aim for 150 minutes per week<br />

of moderate activity, but do as much<br />

as you feel comfortable doing. You can<br />

even exercise for just 10 minutes at a<br />

time if it’s easier on your joints. Any<br />

movement you do helps, even if it’s not<br />

considered formal exercise. Activities<br />

like gardening, walking the dog and<br />

raking leaves all get your body moving<br />

and can help ease arthritis pain.<br />

What should you keep in mind when<br />

exercising with arthritis?<br />

Although physical activity may help<br />

improve arthritis pain, there are a few<br />

things to keep in mind when exercising<br />

so you don’t do more harm than good.<br />

These include:<br />

• Pace yourself. Start slowly and don’t<br />

overdo it. If you feel pain, stop and dial<br />

back your activity to a level that feels<br />

more comfortable.<br />

• Warm up and cool down. Don’t just<br />

jump into exercise without getting<br />

your joints ready for action. Move<br />

gently at first, focusing on slow,<br />

easy movements. At the end of your<br />

workout, take a few minutes to cool<br />

down and stretch.<br />

• Heat before, ice after. Applying some<br />

heat to your joints and surrounding<br />

muscles before you exercise improves<br />

circulation and may reduce stiffness.<br />

After activity, apply ice for up to 20<br />

minutes at a time, if needed, to ease<br />

pain and swelling.<br />

• Pay attention to your body. If you feel<br />

pain or notice swelling, take it easy. If<br />

your symptoms seem worse than usual<br />

or you have more pain, stiffness or<br />

swelling after you do certain activities,<br />

it may be best to avoid those activities.<br />

6 | FOR YOUR HEALTH | www.marshallmedical.org


...story continued from page 2<br />

“I applaud <strong>Marshall</strong> <strong>Medical</strong> Center, AKT<br />

Development, and UC Davis <strong>Health</strong> for<br />

collaborating on this innovative pilot,” says<br />

Wendy Thomas, Chairman of the Board of<br />

Supervisors for El Dorado County. “Through<br />

strategic technology and this collaborative<br />

partnership, just maybe we can help our residents<br />

live longer in a place they love while helping them<br />

stay safe and healthy throughout their lives.”<br />

AKT provided funding for this project, as they are<br />

a critical partner in understanding aging in place.<br />

<strong>For</strong> example, a future “Community for <strong>Health</strong><br />

and Independence” development planned by UC<br />

Davis <strong>Health</strong> and AKT will be a first-in-the-world<br />

community that will benefit from pilots like this in<br />

the Georgetown community.<br />

“That university-planned community will allow<br />

older people and people with disabilities to live<br />

independently in technology-enabled homes<br />

designed with healthcare in mind,” said AKT<br />

spokesperson Bill Romanelli. “This pilot program<br />

in Georgetown with <strong>Marshall</strong> <strong>Medical</strong> Center<br />

will deliver valuable information to help with<br />

designing a community for people to live longer,<br />

healthier lives.”<br />

UC Davis <strong>Health</strong>’s role is helping evaluate the<br />

project’s effectiveness through the Center for<br />

<strong>Health</strong>care Policy and Research, led by Dr.<br />

Courtney Lyles, PhD. With support from graduate<br />

student Pauline Martinez, CHPR and the team at<br />

<strong>Marshall</strong> <strong>Medical</strong> Center will assess the project<br />

using human-centered design approaches, and<br />

help identify opportunities and technologies<br />

that offer the most promise in assisting with the<br />

development of a healthy living community.<br />

Organizers of the pilot cite the need to serve a<br />

growing aging population across the country<br />

with more dynamic options for care. In the<br />

Sacramento region, the adult population aged<br />

60 years and older is projected to increase by<br />

78% in the next decade. Those turning 65 years<br />

old between 2015 and 2019 are expected to live<br />

an average of 23.6 years, with 4.5 of those years<br />

spent with one or more activity-of-daily-living<br />

(ADL) limitations. The development and design of<br />

the planned residential community will consider<br />

lessons learned from the program to inform best<br />

practices and identify potential challenges.<br />

The pilot program is currently in the preliminary<br />

stages of identifying and training staff, with a<br />

formal launch anticipated in early 2024.<br />

Welcome New Providers to<br />

<strong>Marshall</strong> <strong>Medical</strong> Center<br />

Kelley Jackson, WHNP<br />

OB/GYN<br />

530-344-5470<br />

Parneet Kaur, DPM<br />

Podiatry<br />

530-672-7040<br />

Christopher Kurnik, MD<br />

Orthopedics &<br />

Sports Medicine<br />

Placerville<br />

530-344-2070<br />

El Dorado Hills<br />

916-805-2320<br />

Nigah Patel, MSN,<br />

APRN, FNP-BC-C<br />

Family Medicine<br />

530-672-7000<br />

<strong>For</strong> a complete list of healthcare providers, visit<br />

marshallmedical.org/find-a-doctor<br />

www.marshallmedical.org | FOR YOUR HEALTH | 7

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