HEALTH CONNECTIONS—————————————————————————————F I S H E R -T I T U S N E W S A N D E V E N T SE D I T I O N N º. 4 7 ——————— S P R I N G 2 018

A journey of the heart

Fisher-Titus Medical Center and Cleveland Clinic collaborated to discover, diagnose, repair and rehab

a cardiac issue Monroeville resident Jim Brown never knew he had.

HEALTH

HEALTH CONNECTIONS E D I T I O N Nº. 47 | 2018

A Message from the ceo of Fisher-Titus Health

2/3Jim Brown’s Cardiac Journey with Fisher-Titus and Cleveland Clinic

4/5The Fisher-Titus Athletic Training Program: Two Local Athletes Get Back in the Game

6/7Women’s Urinary Incontinence and the Benefits of botox®

8/9The Fisher-Titus Center for Wound Healing: Bryan Lund’s Life-Saving Story

10/ 11Pain Management Advances: Brenda Friend Finds ReliefFatty Liver Disease Treatment

12/ 13New Weekend Hours at Fisher-Titus Convenient Care Welcome Eva Sisson, cpnpThe Fisher-Titus Foundation: Extending the Spirit of Generosity

14/ 15Diagnosing and Managing PrediabetesPediatric Therapy and the

“Spider Cage”

16/ 17Meet Nathan Maggard: The Human Side of Robotic-Assisted Surgery

18/ 19Gastroesophageal Reflux Disease and ppi meds

20/21Fisher-Titus News: ◊ An “A” In Patient Safety ◊ Home Health Center Named a Top Agency ◊ Norwalk Memorial Home Named a Best Nursing Home

22/23Medicare Wellness Exams: What You Need to Know

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A MESSAGE FROM THE CEO | MATTHEW C. GROSS

Over the past 30 years, Fisher-Titus has evolved from a small, rural, community hospital into a regional health system – one that provides high-quality, comprehensive patient services and extensive community outreach programs for over 70,000 residents in Huron County and its surrounding communities. This progress has continued during a time in the health care industry when many independent community hospitals are being absorbed into larger systems. But thanks to the foresight of dedicated local leaders, Fisher-Titus has been able to adapt to the ever-changing health care environment.

Here is a brief overview of that exciting transition over the past three decades:

1985 | NORWALK AREA HEALTH SYSTEMS, INC. IS FORMED

Thirty-three years ago, Fisher-Titus Memorial Hospital reorganized from a single corporation named Norwalk Area Hospital Association into a multifaceted organization governed by a parent corporation called Norwalk Area Health Systems, Inc. This system served as a corporate umbrella for four additional subsidiaries: Fisher-Titus Medical Center, Norwalk Health Foundation, Norwalk Area Health Services and Health Promotion of Norwalk, Inc.

The 1985 corporate structure served its purpose well. Service lines including North Central EMS, The Carriage House, Fisher-Titus Medical Care and the Fisher Group were formed.

2016 | A NEW SYSTEM STRUCTURE TAKES SHAPE

Recognizing the need to be nimble and efficient in the fast-paced health care world, Norwalk Area Health Systems, Inc. restructured into a more streamlined organization with a new name: Fisher-Titus Health.

The change reflected the community’s trust and strong recognition of the Fisher-Titus name – one that embraces our rich history and reaffirms our strong commitment to providing the highest quality care to our patients and the communities we serve as an independent community hospital.

To help patients and consumers recognize Fisher-Titus Health as a comprehensive network of services across the continuum of care, some business entities were

“rebranded” with the Fisher-Titus logo.

FISHER-TITUS HEALTH O U R E V O L U T I O N A S A S Y S T E MFISHER-TITUS HEALTH

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With today’s integrated approach to delivering care, this new structure better reflects the organization’s full scope of inpatient and outpatient services. At the same time, it greatly enhances the coordination of our full range of specialty providers and services.

2018 AND BEYOND | OUR FUTURE

As part of our restructuring, the role of President and CEO was split. I was privileged to be appointed CEO of Fisher-Titus Health by our Board of Directors in December 2017. In March, we welcome Dr. Brent W. Burkey to the role of President of Fisher-Titus Medical Center.

Dr. Burkey brings the extensive operational and medical experience he acquired at Cleveland Clinic, one of America’s top health systems. As a physician, he understands the challenges that physicians face in today’s health care environment. His deep understanding of a health care

“system” and firm belief in the importance of community hospitals will help us continue to provide the highest quality of care to our local community.

Dr. Burkey began his career in health care as a hospitalist in Cleveland Clinic’s Department of Hospital Medicine in 2004. During his 14-year tenure at Cleveland Clinic, Dr. Burkey held numerous leadership positions across a variety of disciplines including clinical, information technology and operations. He was named Vice President of Medical Affairs at Cleveland Clinic Fairview Hospital in 2014. Prior to joining Fisher-Titus, Dr. Burkey served as Chief Medical Officer at Cleveland Clinic Avon Hospital. He was instrumental in opening that newly constructed hospital in 2016.

A native of Dover, Pennsylvania, Dr. Burkey graduated cum laude with a Bachelor of Science degree in 1997 and received his Doctor of Medicine degree in 2001, each from MCP Hahnemann University in Philadelphia. In 2009, Dr. Burkey earned an MBA from the Monte Ajuha College of Business, Cleveland State University.

Dr. Burkey and his wife Betsy have two sons ages 10 and 6, and a daughter who is 4 years old. He enjoys spending time and traveling with his family, serving on medical missions and simply enjoying nature.

We look forward to Dr. Burkey joining our Fisher-Titus Family in March.

Matthew C. Gross Chief Executive OfficerFisher-Titus Health

Matthew C. Gross, CEO————————————————Mr. Gross was named Chief Executive Officer of Fisher-Titus Health in December 2017.

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Brent W. Burkey, MD————————————————Dr. Burkey becomes President of Fisher-Titus Medical Center in March 2018.

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Fisher-Titus Medical Center and Cleveland Clinic worked together to find, repair and rehab Jim’s unexpected cardiac issue.

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A HEART I N ♥ T H E

RIGHT PLACES

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—————————————————————FOR MORE THAN 50 YEARS JIM BROWN WAS A WALKING CONTRADICTION … —————————————————————NOBODY, NOT EVEN JIM, KNEW IT … ————————————————————— HE FELT GREAT, BUT HE WAS LIVING WITH AN UNDIAGNOSED HEART PROBLEM … —————————————————————

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At age 40, Jim Brown — an active man with a physical job — started having high blood pressure. His elevated blood pressure was caught by nurses who partner with the Fisher-Titus Health Ministry program to offer free screenings at the church Jim and his wife Diana attend – St. Joseph’s in Monroeville. “My pressure was in the high 140s,” he recalls, “and they said, ‘Jim, you need to get that checked out.’”

A CARDIAC CARE JOURNEY BEGINS

Jim began seeing Fisher-Titus primary care doctors and was prescribed blood pressure medication. He eventually came to internal medicine physician John Hughes, MD, who examined him every six months. Tests showed nothing troubling so Jim continued with his medication and got on with his life.

Then at a regular checkup last February, Dr. Hughes heard something in Jim’s chest he hadn’t heard before. He referred Jim to Cleveland Clinic cardiologist Chetan Hampole, MD who is based

full-time at the Snyder/White Heart & Vascular Center on the Fisher-Titus campus.

“After an echocardiogram here in Norwalk we discovered this healthy, young, asymptomatic patient had early signs of right-sided heart failure,” explains Dr. Hampole. “There was nothing in his clinical history to explain it.”

THE RIGHT PLACES, THE RIGHT PEOPLE, THE RIGHT TIME

With Fisher-Titus Medical Center’s affiliation with Cleveland Clinic Heart and Vascular Institute, Dr. Hampole referred Jim to Cleveland Clinic main campus for specialized testing. “Through this testing it was discovered that Jim had an atrial septal defect in the right side of his heart – a hole in the upper atrium,” says Diana Brown.

The defect, undetected since birth, was causing abnormal oxygen saturation in Jim’s heart. After Dr. Hampole updated the Browns at Fisher-Titus, the cardiologist sent Jim back to Cleveland Clinic

in July for a highly specialized cardiac MRI to provide an even closer look. The imaging study revealed an abnormal pulmonary vein connection. “This abnormal connection was causing the right atrium to receive a supply of extra blood,” says Dr. Hampole, “which was increasing the workload on that side of the heart.”

Dr. Hampole made it clear that the risk of Jim having long-term heart failure was growing. Surgery was required to correct the defect. With Dr. Hampole’s guidance at Fisher-Titus, Jim returned to Cleveland Clinic for an open heart-anomalous pulmonary venous drainage repair and closure of the sinus venosus atrial septal defect.

CARE COMES FULL-CIRCLE

Jim made a fast recovery. He went back to work six weeks after his successful surgery and in November started a 12-week cardiac rehabilitation program at Fisher-Titus, where his care began. Today, Jim has extended his rehab at the hospital because, he says,

“I have a wife, kids and three grandkids so I want to be sure I’m as healthy as I can be for them.”

The successful outcome of Jim and Diana Brown’s unexpected cardiac journey at Fisher-Titus and Cleveland Clinic was made even better by the care experience they had in Norwalk and Cleveland.

“The people couldn’t be any better at Fisher-Titus,” says Jim, “and when they lined things up at Cleveland Clinic we found a super staff there, too.”

Diana agrees. “Everything went smoothly,” she says. “Dr. Hampole is so nice, and when he wanted something done at Cleveland Clinic, we didn’t have to wait or schedule anything ourselves.”

A CRITICAL CONNECTION

Dr. Hampole believes collaboration is the key to outstanding cardiac care experiences like the one the Browns had over the last year. “Because of Fisher-Titus’s affiliation with Cleveland Clinic Heart and Vascular Institute, our network of cardiac subspecialties here in Norwalk works closely with the best cardiac surgery program in the world,” Dr. Hampole says. “That direct access allows for a smooth transfer of care when appropriate, as it was in Jim’s case.”

Learn more about the Snyder/White Heart & Vascular Center at Fisher-Titus and the hospital’s affiliation with Cleveland Clinic Heart and Vascular Institute. Call 419-660-6946 or visit fishertitus.org/heart.

Chetan Hampole, MD————————————————Cleveland Clinic Cardiologist Snyder/White Heart & Vascular Center————————————————

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THE FISHER-TITUS ATHLETIC TRAINING PROGRAM STEPS UP ITS GAME THROUGHOUT HURON COUNTY

Fifteen years ago, the Fisher-Titus Rehabilitation Department launched a program at high schools in and around Norwalk that made Certified Athletic Trainers available to their teams. This school year, the hospital’s community outreach program reached a new level of consistency and strength.

“Dedicated Athletic Trainers (ATs) now serve four high schools in Huron County full time,” says Mary Helton, MA, CCC-SLP, Director of Rehabilitation at Fisher-Titus, “Norwalk, St. Paul, Monroeville and Western Reserve.” “Full-time” means a Fisher-Titus AT is on-site each school day, at practices and at all of the schools’ home varsity sporting events, including basketball, football, baseball, track, soccer, wrestling and volleyball. Fisher-Titus ATs also provide injury evaluation and some event coverage for the South Central Local School District.

“We take our program and the students’ health very seriously,” says Jake Rospert, ATC, FMS, Head Athletic Trainer at Fisher-Titus. “It’s our goal to have parents of the athletes we train understand the risks involved with sports, and that we’re here to ensure their kids’ safety and address their injuries.”

AT | AT MONROEVILLE HIGH SCHOOLLindsey Yantz, atc, began as Monroeville High School’s Certified Athletic Trainer last spring.

“I get to school each afternoon as classes are ending and I’ll see kids who come in for rehab,” says Yantz.

“During basketball season, once practice starts I head to the court and observe the players so I can immediately react in case an injury occurs.”

During games, Yantz joins the players on the bench. “If someone goes down with an ankle injury I can do a quick evaluation, help the player to the training room if necessary and do a more in-depth evaluation there.”

Monroeville Local Schools Athletic Director Ben Paul praises Lindsey and the Fisher-Titus AT program.

“It’s a challenge for any trainer to come into a school like ours and deal with a couple of hundred athletes,” says Paul. “Lindsey does a remarkable job of assessing our kids and managing their injuries.”

Yantz’s training was tested in November when Eagles varsity basketball player Jessica Hayes began experiencing an abnormally rapid heartbeat during practice. “Lindsey monitored me and called my mom to take me to the Fisher-Titus Emergency Room,” recalls Jessica. The junior was diagnosed with supraventricular

tachycardia (SVT). The ER team momentarily stopped her heart in order to restore a normal heartbeat. In December, she had heart surgery to correct the condition at Akron Children’s Hospital, which has a subspecialty clinic at Fisher-Titus.

Today Jessica is back to full strength and back on the court. “Lindsey stayed in touch with my parents and me every step of the way,” she says. “She’s more than just an athletic trainer.”

AT | AT NORWALK HIGH SCHOOLFisher-Titus Outpatient Physical Therapy Team Lead Jen Swartz, PT, was a junior varsity coach and the interim trainer at Norwalk High School in 2016 when sophomore Kaelyn Harkness tore her right anterior cruciate ligament (ACL) during a basketball game.

“The biggest positive about being on-site as a part of the Fisher-Titus Athletic Training program is that we have immediate access to a continuity of quality care that includes our orthopaedic specialists and hospital-based rehab therapists,” says Swartz.

“Kaelyn is an elite three-sport athlete — the heart and soul of her team — and an ACL injury can be

TAKING SPORTS MEDICINE TO SCHOOL

Jessica Hayes———————————————————Monroeville High School Junior; Varsity Basketball Player———————————————————

AT

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devastating, but as the Fisher-Titus team led her through the surgery and rehab process I saw her approach her situation as a competition to win.”

Recovered and now in her senior year, Kaelyn is an All-Ohio athlete with her sights on playing soccer at Tiffin University this fall. “Jen is probably the best thing that’s happened to me since I tore my ACL,” says Kaelyn.

“She stayed involved and it felt like she was my personal physical therapist.”

Hayley Corso, ATC, PTA is now the full-time Fisher-Titus Certified Athletic Trainer at Norwalk High School, keeping a constant eye on Kaelyn and all the Truckers athletes. “I see kids before practice for some stretching and make sure they’re ready to go, then once practice starts I have time to work with players who need it,” says Corso of her school day routine.

“Then I go back to practice to assess athletes who are struggling and have them do exercises or rest them.”

Josh Schlotterer, Director of Student Activities at Norwalk High School, has watched the development of the Fisher-Titus AT program from a close vantage point. “I can’t say enough good things about Hayley’s knowledge, professionalism and how she connects, not only with our athletes, but with our coaches and parents,” Schlotterer says.

AT | SPORTS MEDICINE & THE FUTUREAs Fisher-Titus Athletic Trainers continue to build strong connections with Huron County school systems and their athletes, the hospital’s Rehabilitation Department continues to plan new ways to expand its services in the community.

“Sports Medicine is a focus of Fisher-Titus, and our AT program forms a key component of Sports Medicine,” says Helton. “It’s a targeted area of growth as we address the training and conditioning needs of our athletes – not just in our schools, but also in community sports leagues … and for ‘weekend warriors,’ too.”

Learn more about Fisher-Titus Athletic Training and all of the services it provides to Huron County by visiting fishertitus.org/athletic-training.

——————————————————————— ————————————————————————————————————————————————————————Fisher-Titus Athletic Training team members (l-r): Hayley Corso, Monica Nickoli, Lindsey Yantz, Jennifer Swartz, Jacob Rospert and Mary Helton.——————————————————————— ————————————————————————————————————————————————————————

Kaelyn Harkness ———————————————————Norwalk High School Senior; All-Ohio Three-Sport Athlete———————————————————

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BLADDER MEETS BOTOXAFTER 10 YEARS OF SUFFERING, A FREMONT RESIDENT FINALLY FINDS RELIEF FROM HER INCONTINENCE …

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Janet is 61 years old.At 51, the retired Fremont resident began experiencing incontinence.

“I couldn’t hold my urine, I would leak all the time,” Janet recalls. “I couldn’t ride my bike because the minute I stopped I felt like I had to go to the bathroom right away.”

At the end of 2007, Janet saw a urologist about her problem: Overactive Bladder (oab) with urge incontinence. “oab is common in older adults, especially women who have had children,” says urologist Patrick Waters, MD of Executive Urology Specialists. “It’s a chronic condition in which you feel a sudden urge to urinate and often can’t make it to the bathroom in time.”

For years Janet tried to manage her incontinence with medication. It didn’t work well. The interruptions and stress of potential embarrassment due to urine leakage became a constant part of her life.

“I’d have to know where every bathroom was – that’s the first thing I scoped out when I went into a store I’d never been in before,” says Janet. “I love to hike and camp and it was horrible trying to do that because I had to wear a pad the whole time. Getting up in the morning would turn into a race to make it to the bathroom.”

NEW TREATMENT AND NEW HOPE

About a decade into Janet’s oab-disrupted days and nights, Dr. Waters told her about a new treatment available at Fisher-Titus Medical Center. The board-certified urologist said the procedure delivered proven oab relief, and Janet was a good candidate.

The new approach? botox® treatments for relief of urge incontinence.

“With this innovative procedure, botox is introduced into multiple areas of a patient’s bladder wall to block nerve impulses that trigger frequent or urgent urination,” explains Dr. Waters. “The simple treatment takes about 15 minutes, followed by 30 minutes or so for observation.” One botox treatment typically relieves incontinence symptoms for three to nine months, but can last even longer.

BOTOX, RELIEF AND CONFIDENCE

Janet went to Dr. Waters for her first botox treatment at Fisher-Titus in the winter of 2016. Preparation through recovery took about two hours. Soon Janet began experiencing the positive results of the injections. “I stopped my medication and have not looked back since,” she says. “As the weeks went on, I was amazed at how botox made my life so much better. I can shop, hike, ride my bike, go camping – it’s wonderful. I wish I could have had this treatment when I was still working!”

Based on how long a botox incontinence treatment usually lasts, Janet had scheduled a second procedure at Fisher-Titus in December. But when the holiday season arrived, her oab symptoms were still completely gone. “I called Executive Urology Specialists and told them the first treatment is still working more than nine months later,” Janet says.

“I canceled the appointment; I didn’t need it.”

Janet returned to living her life uninterrupted by Overactive Bladder, thanks to Dr. Waters and botox for incontinence at Fisher-Titus Medical Center. Her experience was just as positive as her outcome.

“Dr. Waters gives 100 percent of his personal attention to you and the nurses at Fisher-Titus are kind and helpful,” she says.

As for Janet’s sense of relief? “If you’re living with incontinence, find out if you’re a candidate for botox,” she urges. “You won’t believe how much your life will change for the better.”

If you’re struggling with Overactive Bladder and medication has been ineffective, Executive Urology Specialists and Fisher-Titus can help. Schedule a consultation at one of three convenient locations in North Central Ohio. Call 419-660-4300 or visit fishertitus.org/urology.

Gregory P. Cook, MD facs | Urologist

Robert Rice, MD Urologist

Donald Smith, MD facs | Urologist

Patrick R. Waters, MD facs | Urologist

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BRYAN LUND WAITED TOO LONG …

A lifelong Norwalk resident, Bryan has had diabetes since childhood. Recently he developed an ulcer on the bottom of his foot which he tried to care for himself.

“I ended up with gas gangrene,” says Bryan, 51, an active member of the Norwalk community. “Then I ended up in the Fisher-Titus Emergency Department.”

Podiatric surgeon Marc Dolce, DPM told Bryan what he was facing: “Dr. Dolce said, ‘I can’t save your toes, but I can save your life.’”

“Bryan’s infected wound was life-threatening,” recalls Dr. Dolce, Co-Medical Director of the Center for Wound Healing. “After his amputation he spent several days at Fisher-Titus while the infection healed, then we closed the wound.” Following Hyperbaric Oxygen Therapy, which accelerated Bryan’s healing process, Dr. Dolce performed a split thickness skin graft on Bryan’s foot at Fisher-Titus. His leg was officially saved.

Bryan Lund——————————————Lifelong Norwalk residentDiabetic wound sufferer; podiatric surgery patient——————————————

THAT’S THE GOAL AT THE FISHER-TITUS CENTER FOR WOUND HEALING

SAVING LIMBS SAVING LIVES

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IT’S NOT JUST WOUND HEALING.

IT’S HBOT.Hyperbaric Oxygen Therapy (hbot) is a painless treatment employed to heal problem wounds. Now this advanced technology is coming to Fisher-Titus.

hbot sessions occur in a transparent chamber containing 100 percent oxygen. The treatments increase your blood’s ability to carry the pure oxygen to wound tissue and enhance white blood cell activity to heal a wound faster and fight infection better.

THE LEADING EDGE OF INNOVATION

“We continuously look at ways to heal more of our patients’ chronic wounds faster, and hyperbarics are a leading method to achieve that,” says Ty Pannell, Program Director of the Center for Wound Healing. “Two new hbot monochamber units were installed at Fisher-Titus in January and our plan is to begin treating patients by spring.”

A hyperbaric treatment is called a “dive” because of the atmospheric pressure change that occurs. Each dive lasts about two hours – enough time to nap or watch a movie. Most problem wound patients receive between 30 and 40 treatments. “hbot treats a variety of conditions,” Pannell says,

“including diabetes-related wounds, bone and soft tissue infections, delayed radiation injuries, thermal burns and certain compromised skin grafts and flaps.”

The Center for Wound Healing at Fisher-Titus will offer the only in-house hyperbarics program between Toledo and Elyria. hbot is Medicare-approved.

NON-HEALING WOUNDS NEED IMMEDIATE ATTENTION

Since the Center for Wound Healing opened in 2009, its team has worked to educate people — especially those with diabetes — about early treatment of chronic wounds. “Studies show a five-year mortality rate of 50 percent for someone losing a limb,” says Dr. Dolce.

“So with diabetes and diabetic wounds at epidemic proportions in our community, our goal is to save limbs.”

To achieve that goal, patients susceptible to chronic wounds must recognize the seriousness of their risk.

“The most common wounds we treat are venous stasis ulcers, with diabetic wounds at number two,” reports Heather Williams, RN, WCC, Clinical Nurse Manager at the Center for Wound Healing. “Over half of our patients are diabetics who delay wound healing.”

The Center employs a range of wound therapies, which will soon include state-of-the-art Hyperbaric Oxygen Therapy (hbot – see details in the next column). When caught early, individualized hbot treatments effectively heal patients’ diabetic lower extremity wounds, venous ulcers, pressure ulcers, soft tissue radiation injuries, infections that cause tissue death, burns, bone/bone marrow infection and lymphedema.

“In our new clinic space at Fisher-Titus, we continue to expand our advanced wound care modalities to find new ways to heal people in the rural community we serve,” says Ty Pannell, Program Director of the Center for Wound Healing.

Meanwhile, Bryan Lund’s foot is healed and he’s getting back into action — on his farm, and as a basketball referee and softball umpire. “The people at the Center for Wound Healing are phenomenal — they treat you right,” Bryan says of his care at Fisher-Titus.

YOUR WOUND WON’T WAIT

If you have a wound that has not healed after two weeks, schedule an appointment with the limb- and life-saving specialists at the Center for Wound Healing now.

Call 419-660-6980 or visit fishertitus.org/wound.

Marc Dolce, DPM FACFASCo-Medical Director

Farid Said, MD FACS Co-Medical Director

Ty PannellProgram Director

Heather Williams, RN WCCClinical Nurse Manager

“I’m an athlete, coach and physical education teacher, and as a result have had knee and shoulder surgeries and arthritis throughout my body,” says Brenda, 60, who coaches basketball at Western Reserve High School in Collins and Edison High School in Milan.

“I need to be on my feet to perform my job and stay in good health.”

In 2012 her family physician, Christina Canfield, MD, referred her to the Pain Management Center at Fisher-Titus Medical Center. “My experiences at Fisher-Titus have been awesome,” Brenda says.

“I don’t like taking medication and don’t want to have surgery if I can avoid it, so I talked with a pain management expert there and we made a plan.”

NO MEDS, NO SURGERY … NO PROBLEM

Joshua Goldner, MD, Interventional Pain Management specialist at Fisher-Titus Pain Management Center, has been treating Brenda for over a year. “Brenda has degenerative disc disease and a narrowing of the spine,” Dr. Goldner says. “We discussed with her that the best nonsurgical solution is epidural steroid injections to reduce inflammation and reduce pressure on the nerves.”

For many patients, the Pain Management Center combines treatment with rehabilitation that includes physical therapy. “Since Brenda is in otherwise excellent health, we determined the injections alone work effectively to minimize her pain and help restore her active lifestyle,” says Dr. Goldner.

Throughout her care journey, Brenda has found each epidural treatment safely relieves her back and leg pain for up to two years. “I go to Fisher-Titus as needed and the injections enable me to work, exercise and have a great quality of life without worrying about pain,” she says. “Dr. Goldner and the team at the Center listen, offer options and have your best interests in mind. I trust them.”

WHAT’S THE SOURCE OF YOUR PAIN?

Fisher-Titus Interventional Pain Management specialists offer outpatient care for a range of chronic discomfort, including pain caused by:

◊ Pinched nerves ◊ Sciatica◊ Spine and joint issues ◊ Headaches◊ Surgery ◊ Work-related injuries◊ Nerve damage ◊ Shingles

Explore the idea of life minus chronic pain. Schedule a convenient Pain Management appointment in Norwalk or Sandusky by calling 419-660-6901.

ALL GAIN, NO

PAIN A LIFELONG ATHLETE SCORES RELIEF FROM CHRONIC PAIN AT FISHER-TITUS

Seven years ago, Brenda Friend of Norwalk began experiencing debilitating back and leg pain – to the point that she had difficulty standing and walking.

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Joshua D. Goldner, MD Zachary Zumbar, MD, MPH ——————————————————————————————————————Pain Management specialists, Fisher-Titus Pain Management Center——————————————————————————————————————

A SHARPER FOCUS ON AN IGNORED DISEASE

When gastroenterologist and hepatologist Sulieman Abdal Raheem, MD brought his specialized expertise from Cleveland Clinic to Bay Area Digestive Health and Fisher-Titus last fall, he began focusing on two long-term goals:

1 To establish and help grow a new Hepatitis C Clinic in order to centralize the management of that infectious liver disease, which is becoming more prevalent in our region. The new hep C facility opens at Fisher-Titus this spring.

2 To advance the awareness and treatment of an often ignored condition: fatty liver disease.

ABOUT 25 PERCENT OF THE GLOBAL POPULATION HAS IT

“As physicians, we must help our patients recognize that fatty liver is a problem,” says Dr. Raheem. “We are changing the mindset that fatty liver is a benign condition because we’re now realizing that, if unchecked, it can lead to cirrhosis and liver cancer.”

Fatty liver disease is also associated with diabetes, obesity, hypertension, high triglycerides and low HDL cholesterol. According to Dr. Raheem, at-risk patients should be encouraged to have their liver enzymes

checked when they have their physical exam in order to reveal if fatty liver is a concern for them.

At Fisher-Titus, the disease’s significance is reaching a new level of awareness thanks to Dr. Raheem.

“Fatty liver is expected to be the leading cause of liver transplants in the U.S. between 2020 and 2025,”

he says, “but at Fisher-Titus we can painlessly test for the disease with a new technology called FibroScan®, which identifies the liver’s stiffness and stage of scar tissue.”

ONCE FATTY LIVER IS DIAGNOSED …

Treatment, especially in its early stages, often involves lifestyle modifications like improving diet and increasing aerobic exercise. “Addressing this disease requires collaboration between

specialists and primary care physicians in terms of controlling risk factors like diabetes,”

says Dr. Raheem, “while also coaching patients about the seriousness of fatty liver.”

For questions about fatty liver disease and FibroScan testing, contact your primary care doctor or one of our digestive health specialists at 419-660-4300.

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WHAT IS FATTY LIVER?

————————————————————————————————————————Fisher-Titus Medical Center is the only facility in North Central Ohio to offer FibroScan 502 Touch: the noninvasive, painless approach to liver care. ————————————————————————————————————————

WELCOME DR. RAHEEM TO FISHER-TITUSSulieman Abdal Raheem, MD joins Bay Area Digestive Health.

Dr. Raheem is a fellowship trained gastroenterologist and hepatologist. He specializes in liver, gallbladder and pancreas disorders.

FISHER-TITUS CONVENIENT CARE NEW WEEKEND HOURSTo serve you better, weekend hours for Fisher-Titus Convenient Care facilities in both Norwalk and Willard are now 9 am - 3 pm.

Fisher-Titus Convenient Care is where you can be treated for non-emergency health care needs that your family doctor typically treats, including:

◊ Colds and flu◊ Stomachaches◊ Headaches◊ Fever◊ Earaches

◊ Sore throat and strep throat

◊ Urinary tract infections

◊ Boils and abscesses◊ Allergies

Appointments are welcome but not necessary. When you arrive, you’ll be promptly treated by our Fisher-Titus primary care team. In most cases you’ll be charged the same co-pay as a primary care office visit.

There are two Fisher-Titus Convenient Care locations in North Central Ohio:

Norwalk ——————————————368 Milan Avenue419-663-6464

Weekdays: 9 am – 8:30 pm

Weekends: 9 am – 3 pm

Willard ——————————————Willard Health Center315 Crestwood Drive419-935-2280

Weekdays: noon – 8 pm

Weekends: 9 am – 3 pm

NEW TO FISHER-TITUS … New Beginnings Pediatrics Welcomes Pediatric Nurse Practitioner Eva Sisson

Certified Pediatric Nurse Practitioner Eva Sisson joins Fisher-Titus and New Beginnings Pediatrics. Eva has clinical experience in

the Pediatric Emergency Department at Cleveland Clinic Fairview Hospital.

She has also cared for pediatric urology and orthopaedics patients at Cleveland Clinic Richard E. Jacobs Health Center in Cleveland. Eva earned her Master of Science in Nursing from the University of Akron as a Pediatric Nurse Practitioner specializing in primary and acute care.

Eva sees patients at two convenient locations:

Norwalk ——————————————New Beginnings Pediatrics 282 Benedict AvenueMedical Park 2 Suite B419-668-9409

Bellevue ——————————————1400 West Main StreetBuilding 1, Suite G419-483-4122

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Eva F. Sisson, CPNP————————————————New Beginnings Pediatrics————————————————

Jeffrey Harwood, MD FAAFP

Lauren Bailey, NP-C Sarah Borsick, NP-C Mansi Mehta, FNP-C

Haley Robuck, CNP Dannon Smith, CNP Amanda Stang, CNP

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PLANNED GIVING: R E I N F O R C I N G T H E S P I R I T O F G E N E R O S I T Y A L L Y E A R L O N G

A new year presents the opportunity to embrace fresh possibilities and renew resolutions like weight loss, better health or improved financial circumstances. At the same time, the “winter blues” can be a struggle as we face cold weather and the post-holiday slump.

Part of the joy of the holiday season is the spirit of generosity we experience through gift-giving. Often, in the months following the holidays we may feel that our budgets are tighter and that we are not be able to continue that feeling of generosity.

There are still many ways to remain generous even when the bank account is smaller. Did you know that you can give financially without touching a single dollar? One way to give significantly to a charity or nonprofit is to include them in your estate planning. This may include a simple bequest in your will or trust, or it can be as quick as naming the nonprofit as a beneficiary to a life insurance policy or retirement plan. In addition to providing tax benefits, a planned gift to a favorite nonprofit organization reinforces your spirit of generosity all year long.

You also can give of your time and attention by volunteering at your church or an organization of your choosing. There are many opportunities at Fisher-Titus as well, through our Volunteer and Auxiliary programs.

The Fisher-Titus Foundation exists to enhance the resources available to our community medical center. For more details on planned giving, please visit: fishertitus.org/fisher-titus-medical-center-foundation.

If you are interested in discussing a planned gift, please contact us at 419-660-2528.

We look forward to speaking with you.

Jill SlaterDirectorFisher-Titus Foundation

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OVER 84 MILLION AMERICAN ADULTS HAVE IT. NINETY PERCENT DON’T KNOW IT.

prediabetes is a serious health condition that increases a person’s risk of type 2 diabetes and other conditions like heart disease and stroke.

If you have prediabetes, your blood sugar levels are higher than normal, but not high enough to be diagnosed as diabetes. The cells in your body don’t respond normally to insulin so your pancreas produces more to get them to respond. Eventually your pancreas can’t keep up and your blood sugar rises, setting the stage for type 2 diabetes.

You can have prediabetes for years with no clear symptoms. It’s important to talk to your doctor about getting your blood sugar tested if you have risk factors for diabetes, including:

◊ Age 45 or older◊ A BMI greater than 25.0 ◊ Previously impaired fasting glucose◊ A family history of type 2 diabetes◊ Being physically active less than 3 times a week

◊ A previous diagnosis of gestational diabetes (diabetes during pregnancy) or giving birth to a baby who weighed more than nine pounds

◊ A diagnosis of polycystic ovary syndrome

If you are diagnosed with prediabetes, there are lifestyle-related ways to reduce your risk for developing or delaying the onset of type 2 diabetes, such as losing seven percent of your body weight; increasing physical activity to 30 minutes five days per week; and implementing and taking medications as prescribed by your physician.

Fisher-Titus offers Diabetes Education classes for those interested in learning more about diabetes management. The hospital also provides individual consultations with a registered dietitian for those diagnosed with prediabetes or type 2 diabetes and in need of weight loss management. Ask your physician for a referral.

For more information, call 419-660-2596.

GET THE STATSA report released by the Centers for Disease Control and Prevention (cdc) finds that as of 2015, 84.1 million people nationally have prediabetes, a condition that, if untreated, often leads to type 2 diabetes within five years.

Locally, the 2017 Huron County Health Assessment identified eight percent of Huron County adults as having diabetes and an additional seven percent with prediabetes.

MANAGING PREDIABETES

INNOVATIVE “SPIDER CAGE” EXERCISE UNIT COMES TO FISHER-TITUS PEDIATRIC THERAPY

Before last fall, children with neuromuscular disorders who participated in physical therapy at Fisher-Titus Medical Center used a device designed to improve their strength and balance in a standing position. The device was beneficial, but one-dimensional.

HELPING KIDS THROUGH COMMUNITY PARTNERSHIP

Now, the Fisher-Titus Pediatric Therapy Department, which has been providing outpatient services to children since 1985, has acquired a Universal Exercise Unit. The innovative unit is a three-sided structure that enables a child to perform a wide range of targeted strengthening exercises in a gravity-eliminated environment that employs a system of bungee cords, weights and pulleys.

The Universal Exercise Unit has a kid-friendly nickname – the “spider cage.” The moniker was inspired by the eight bungees that extend from the child to the cage bars. They resemble multi-colored spider’s legs.

The spider cage was purchased through a grant from the Ohio Elks Cerebral Palsy Fund Board and submitted by the Norwalk Elks Lodge No. 730’s Cerebral Palsy Committee and the Fisher-Titus Pediatric Therapy Team. “The unit is designed for children with cerebral palsy and other neuromuscular issues,” says Mary Helton, MA, CCC-SLP, Director of Rehabilitation at Fisher-Titus Medical Center.

“However, it benefits kids with a variety of diagnoses including Down syndrome, spina bifida, developmental delays and sports injuries.”

INSIDE THE CAGE

A therapist secures a child in the center of the unit and adjusts the bungees to isolate specific muscles for strengthening. “We’ve been working with one young patient with cerebral palsy for a couple of years,” says Helton. “When we put her in the spider cage, she was much more dynamic and was able to stand for about 17 minutes during her first session.”

A child can practice jumping, bouncing, sitting, kneeling, standing and walking in the cage, with the goal of increasing independent movement, balance and coordination.

Spider Cage therapy is one of the many specialties offered by the Pediatric Therapy Team at Fisher-Titus. For more information on this service and other rehabilitation services, visit fishertitus.org/pediatrics.

HEALTH CONNECTIONS | 17

ALONG CAME A SPIDER …

A PLYMOUTH RESIDENT TALKS ABOUT THE ADVANCED PROCEDURE THAT REPAIRED HIS HERNIA

Last summer, Health Connections introduced umbilical hernia patient Kelly Gregory and how

robotic-assisted surgery at Fisher-Titus Medical Center led to a fast, full recovery.

Now, 58-year-old Nathan Maggard of Plymouth is excited to share his story of how general surgeon Eric Schmidt, MD and advanced robotics — offered

exclusively at Fisher-Titus — returned him to a discomfort-free life this past holiday season.

ONLY A MATTER OF TIME

Nathan, a Kentucky native who moved to North Central Ohio at age 17, noticed an abnormal swelling in his groin last summer. “I knew what it was, but I put it off because I wanted to take care of it during my time off work,” recalls Nathan. “By fall I had to do something because the pain was getting worse.”

Nathan’s family physician referred him to Dr. Schmidt, one of several members of the Fisher-Titus surgical team specially trained in robotic-assisted techniques.

“I’d heard great things about Dr. Schmidt and he told me I had a left inguinal hernia,” Nathan says.

“He also gave me the option of a robotic-assisted repair and explained how it makes the healing process a lot smoother – he was right on the money about that!”

Fisher-Titus is the only medical facility between Toledo and Cleveland offering the da Vinci® system.

“Nathan was an ideal candidate for the robotic-assisted hernia technique,” says Dr. Schmidt.

“The less-invasive repair uses three small incisions, and the procedure enabled him to recover with less pain and a quicker return to function compared to traditional surgery.”

NATHAN’S EARLY CHRISTMAS GIFT

At 6 am on the Tuesday before Thanksgiving, Nathan came to Fisher-Titus for surgery. “At 12:30 that afternoon, I was in my friend’s car riding home,” he says. “I had Thanksgiving dinner with no pain, and by day four I still hadn’t used all the medication in my three-day prescription.”

Nathan says he was back to full strength by early December, but was careful to follow Dr. Schmidt’s instructions to avoid heavy lifting for six weeks. His first reaction to how good he felt — and how fast he felt that way — was simply …

“I’ll tell anyone with a hernia to see Dr. Eric Schmidt at Fisher-Titus,” Nathan says. “The care I received and the way I was treated was wonderful. Everyone at my pre-surgery registration, the people who took my vitals and chest X-ray, everybody in the recovery room – they all did an excellent job.”

“Robotic-assisted surgery made my life a whole lot better,” the North Central Ohio resident adds.

If you’re struggling with a hernia, consider robotic-assisted hernia repair at Fisher-Titus Medical Center. If you’ve been told that traditional surgery at another hospital is your best option, you owe it to yourself to get a second opinion from Fisher-Titus Surgical Services.

To learn more, visit fishertitus.org/robotic-surgery. To schedule a consultation, call 419-660-4300.

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Eric R. Schmidt, MD, FACS————————————————

“Robotics at Fisher-Titus. It’s the only way I’d want to have it done.”

—— Nathan Maggard

“Wow.”

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Nathan Maggard——————————————Plymouth residentInguinal hernia sufferer; advanced robotic-assisted hernia repair patient——————————————

MEET THE FISHER-TITUS TEAM TRAINED IN ROBOTIC-ASSISTED SURGICAL TECHNIQUES:

Michael R. Nill, MD, FACS Eric R. Schmidt, MD, FACS———————————————————————————————————Board-certified general surgeons

Drs. Nill and Schmidt have advanced training and certification in robotic-assisted hernia repair.———————————————————————————————————

James D. Kasten, MD, FACOG Kristin J. Kruse, MD, FACOG———————————————————————————————————Board-certified obstetrician/gynecologists

Drs. Kasten and Kruse have advanced training and certification in robotic-assisted gynecological procedures.———————————————————————————————————

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YOURREFLUX

PILLS DIGEST THE FACTS ABOUT GERD & PPIs

Are you one of the millions of Americans who suffer from gastroesophageal reflux disease?

Reflux, or gerd, often begins as a burning pain in your chest after a meal. You may experience

the discomfort moving up toward your throat, and it’s frequently accompanied by a feeling of

food coming back into your mouth. If unchecked, gerd can lead to chronic hoarseness, sore

throat and sinus problems; difficulty swallowing; asthma; and ultimately, esophageal cancer.

HEALTH CONNECTIONS | 21

Of course, there are medications available with and without a prescription to relieve the symptoms of reflux. Some of the brand names you’re probably familiar with — or even taking — are Prilosec®, Nexium® and Prevacid®. These drugs are called proton pump inhibitors (PPIs) because they inhibit, or block, the enzyme in the wall of your stomach that produces acid.

The key to the effectiveness of the reflux medication you’re taking is to use it responsibly. If you don’t, your gerd may be compounded by unwanted side effects.

PPI, FYI

First, it is important to have the right diagnosis. This can be determined by your doctor based on specific symptoms, which may need to be confirmed by tests offered at the Fisher-Titus Heartburn Center. These tests include an upper endoscopy to internally examine your esophagus and stomach, or a 48-hour bravo pH study which measures the acidity in your esophagus.

Once gerd is diagnosed, proton pump inhibitor medication helps to calm the symptoms of heartburn and other symptoms caused by the disease. “PPIs are also helpful in treating ulcers in the lining of your stomach or intestine,” explains Fisher-Titus Heartburn Center gastroenterologist and gerd specialist Maher Salam, MD.

Because it’s easy to swallow a pill to make the discomfort go away, many people with gerd take PPIs for months, or even years. Studies have shown that long-term PPI use increases your risk for osteoporosis, C. diff/antibiotic-associated colitis and hypomagnesemia (electrolyte imbalance). The prolonged use of PPIs is indicated in only a few specific conditions, such as Barrett’s esophagus, bleeding ulcers and esophagitis. In these cases, the benefits of prolonged PPI use exceed the risks.

Long-term use of over-the-counter proton pump inhibitors is common: PPIs represent the third-highest selling drug category in the U.S., and research reveals that as much as 70 percent of gerd sufferers’ PPI use is for unapproved indications. Adults 65 years of age and older are more vulnerable to the effects of prolonged PPI use because of the higher frequency of chronic diseases in their age group.

READ THE LABEL, GET A SECOND OPINION

Caution when using proton pump inhibitors is always advised. “Always be sure to talk about your PPI use with your doctor before making any changes to your medication,” says Fisher-Titus Digestive Health specialist Sulieman Abdal Raheem, MD, “including dosage and length of use.”

The effectiveness of proton pump inhibitors for reflux disease symptoms is proven, when properly used.

“If you have gerd, the risk of the potential side effects of PPI medication is much lower compared with the untreated symptoms of the disease,” says Dr. Salam.

If you’re living with chronic heartburn and think you may have gastroesophageal reflux disease, or if you are using a PPI like Prilosec, Nexium or Prevacid on a long-term basis, contact the Fisher-Titus Heartburn Center for a consultation.

For more information, visit fishertitus.org/heartburn or call 419-660-4300.

Sulieman Abdal Raheem, MD Maher Salam, MD, FACG

—————————————————Gastroenterologists, Fisher-Titus Heartburn Center—————————————————

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FISHER-TITUS EARNS AN “A” FOR PATIENT SAFETY IN FALL 2017 LEAPFROG HOSPITAL SAFETY GRADE

The Leapfrog Group, a national nonprofit health care ratings organization, named Fisher-Titus Medical Center one of 832 facilities awarded an “A” for its commitment to keeping patients safe and meeting the highest safety standards in the U.S. In Ohio, only 51 hospitals scored an “A” out of 110 evaluated. Fisher-Titus also earned an “A” grade in spring 2017 and fall 2016. The Safety Grade assigns letter grades of A, B, C, D and F to hospitals nationwide based on their performance in preventing medical errors, infections and other harms.

Our recent patient safety initiatives include:

◊ A surgery checklist and “timeout” before surgery to make sure the correct patient, surgical site and procedure are identified. In late 2016, a “checkout” was initiated at the end of each procedure to ensure a safe and successful surgery.

◊ A review of all safety events as they occur.

◊ A revised discharge process, extending it from the time of discharge until the time the patient leaves the building.

◊ Enhanced education about sepsis, a severe bloodstream infection, for physicians, clinical staff and nursing home personnel.

FT|NEWS

NORWALK MEMORIAL HOME NAMED A U.S. NEWS BEST NURSING HOME

Norwalk Memorial Home, a 69-bed transitional and long-term care facility that is part of Fisher-Titus Medical Center, has earned designation as a U.S. News Best Nursing Home. The facility ranked in the top 15 percent of all nursing homes in the country and 22nd among the 130 Ohio nursing homes earning recognition. The rankings were announced by U.S. News & World Report in conjunction with the release of its 2017-18 Nursing Home Finder.

The publication evaluated more than 15,000 nursing homes nationwide, with 2,300 earning the designation of a U.S. News Best Nursing Home.

The U.S. News Nursing Home Finder offers comprehensive information including care quality, safety, health inspections and staffing for nearly every nursing home in the nation. Since its inception in 2009, the nursing home ratings have relied on data from Nursing Home Compare, a program run by the Centers for Medicare & Medicaid Services (cms).

The Best Nursing Home designation marks the third recognition earned by Norwalk Memorial Home in 2017. In February, NMH achieved “Gold Level” status for its participation in the Centers for Medicare & Medicaid Services (cms) Ohio Nursing Home Quality Care Collaborative. In June, the Home received the

“Bronze Commitment to Quality Award” for its dedication to improving the lives of residents through quality care. In addition, Norwalk Memorial Home consistently maintains a five-star ranking on the cms Nursing Home Compare site.

HOME HEALTH CENTER NAMED A 2017 TOP AGENCY OF HOMECARE ELITE

Fisher-Titus Medical Center’s Home Health Center was named a HomeCare Elite Top Agency for 2017 in an annual recognition of the top-performing home health agencies in the United States.

It is the sixth year the agency earned top status. The recognition is based on analysis of measures in quality outcomes; best practice implementation; patient experience; quality improvement and consistency; and financial performance.

Fisher-Titus Home Health Center, ranked in the top 25 percent of home care agencies in the nation, provides home care for patients of all ages in Huron and Erie counties and portions of Sandusky, Seneca, Lorain, northern Richland and northern Ashland counties. Its services include skilled nursing; medical social work; home health aide support; and physical, occupational and speech therapies.

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PAID Cleveland, OH Permit No. 362272 Benedict Avenue

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HEALTH CONNECTIONS | 24

Fisher-Titus Health Connections is a community publication distributed by Fisher-Titus Health. For more information about our services and programs, or to be added to our mailing list, please contact Johnna Young, Editor-In-Chief, Fisher-Titus Medical Center, 272 Benedict Avenue, Norwalk, OH 44857. Call 419-660-2696 or visit fishertitus.org.

MEDICAL CENTER

Did you know that Medicare covers two types of wellness visits for people aged 65 and older?

It pays 100 percent of both the Welcome to Medicare Exam and the Medicare Annual Wellness Visit with no copayment and no deductible.

Your Welcome to Medicare Exam is the initial preventive physical test that occurs only once during your first 12 months as a new Medicare patient. The exam includes:

◊ An evaluation of history, health conditions and prescription medications.

◊ A baseline check of blood pressure, vision, weight and height.◊ A recommendation for screenings and vaccinations.

Medicare covers Annual Wellness Visits for Medicare recipients that include:

◊ Talking about your medical history.◊ Reviewing your risk factors.◊ Developing a personalized prevention plan to keep you healthy.

Be aware that your Medicare Annual Wellness Visit is not the same as a regular yearly physical exam. Medicare is specific about what its Annual Wellness Visit includes and excludes.

For more information about these visits, ask your family physician or primary care provider. If you do not have a primary care provider, call 419-660-2900 for details or to schedule an appointment.

MEDICARE EXAMS WHAT YOU NEED TO KNOW ———————————————