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Healthy Living Altoona Regional’s
The many benefits of a water workout
Pools and lakes are great places to lounge during the dog days of summer.
Magazine is published
Besides offering a cool break from the heat, swimming also builds cardiovascular fitness — but without the joint stress often associated with heart-healthy activities like jogging or weight training.
four times a year by the Marketing and Communications department. President/CEO Jerry Murray Chief Operating Officer Ronald J. McConnell Director, Marketing and Communications Dave Cuzzolina Staff Writers Patt Keith Anne Stoltz Intern/Contributing Writer Bob Imler Designer Chip Mock Mock Creations LLC For more information, please contact: Altoona Regional Health System Marketing and Communications 620 Howard Ave. Altoona, PA 16601-4899 889.2271 firstname.lastname@example.org
“If you spend time in the water, put it to good use,” recommends Ken Kozminski, Altoona Regional physical therapist. “Aquatic exercises such as water aerobics, water walking or lap swimming are low-impact exercises that increase strength, flexibility and agility.” Less stress on joints Since objects weigh less in water, a water workout puts much less weight and stress on your joints. That’s why swimming is a great exercise option for many people with joint conditions, arthritis, obesity or certain injuries. “The buoyancy of water protects recuperating and painful joints,” explained Sue LeCrone, Altoona Regional physical therapist. “We often incorporate aqua therapy in treatment plans for patients. “The water supports and massages the body. It helps you relax. And it has a natural cooling effect, continually washing away your sweat and cooling you as you exercise.” Total body workout Swimming uses almost every major muscle group, making it a total body workout that also burns calories. It can rev up your heart rate, which makes the heart muscle work harder and grow stronger. “Water resistance gives you more muscle-building benefits and calories burned per minute than land exercise,” said Ken. “Your cardiovascular system, in particular, benefits because swimming improves your body’s use of oxygen without overworking your heart.” So get your swimsuit or trunks on, apply the sunscreen and head for the nearest pool, lake or ocean. Get your feet wet and have fun as you reap the many benefits of exercising in the water.
Swimming is a low-impact form of exercise and can be fun and effective at all different fitness levels. Be sure to try some of Ken and Sue’s favorite water exercises this summer: Kickboard laps Target your fat-burning leg and butt muscles You’ll easily glide through the water with a kickboard or noodle in hand. Practice different types of kicking: flutter (alternating legs), dolphin (legs together, mermaid style) and breaststroke (frog kicks).
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Join online at www.altoonaregional.org or call 889.2630 or 1.888.313.4665.
beach ball workout Tone your arms and shoulders — no throwing (or catching) required Trying to submerge a ball that floats really works your core and upper body. Experiment with different movements to vary the muscles targeted. For example, press a small ball down in front of you with bent arms, then move it to the side and straighten arms. Treading intervals Burn twice the calories of regular treading You’ll slim down faster and firm up all over. In deep water, tread as hard as you can for 30 seconds. Then go easy or float on your back for 30 seconds. Fit in 30 bursts over your afternoon at the pool and you’ll scorch nearly 300 calories. Waist-deep lunges Shape thighs without straining your knees Water makes high-impact jumps joint-friendly. In waist-deep water, lunge with right foot forward, right thigh parallel to pool floor, left knee bent, hands on hips. Quickly jump up, scissor legs, and land with left leg forward. Do 15 to 20 times. The helicopter “Jog” in the water to burn fat fast This move revs your heart rate to melt more calories. Squat in waist- to rib cage-deep water, then jump up and “jog” vigorously for a count of 6. Repeat for 1 minute, then rest for 15 seconds. Do two more times. And remember, safety first! As with any new form of exercise, talk to your doctor before taking the plunge for your health!
Contact: Altoona Regional Physical Medicine and Rehabilitation Station Medical Center 17th Street and 9th Avenue, Altoona Phone: 889.3900 Hours: Monday through Friday, 6 a.m. to 6 p.m.
Sue LeCrone and Ken Kozminski, physical therapists
Program AlertS! Counting Sheep Is No Answer See calendar insert for details, date and time
After managing his apnea, once-weary
warden enjoying life again
At first glance, Paul Snowberger had it all: a caring wife, four children, nine grandchildren, a successful 36-year career at a Hollidaysburg foundry and a second career as a Pennsylvania game warden. He also had something nobody wants: a bonecrushing, mind-numbing fatigue caused by sleep apnea. “I would get up in the morning and really not care if I didn’t get up, I was so tired,” he said in his deep baritone voice. “I would sit on the edge of the bed and decide if I wanted to live or not ... People who don’t have sleep apnea have no idea what this fatigue is like.” Stopped breathing during sleep It wasn’t until he married his second wife, Mary, after being a widower, that he found the cause, and then the solution, to his fatigue: chronic obstructive sleep apnea. Mary noticed that he would stop breathing during sleep and encouraged him to seek help.
“I would get up in the morning and really not care if I didn’t get up, I was so tired.” — Paul Snowberger
Expanded center doubles capacity
is typical of many who come to the Altoona Regional Institute for Sleep Medicine, said Bernadette “Bernie” Krug, a registered nurse with special training in reading sleep studies as a registered polysomnographer. Sleep studies are conducted in comfortable rooms equipped to monitor every breath, twitch, snore and more during the night. Interrupts sleep cycle During an apnea episode when breathing stops, the brain becomes shortchanged on oxygen and stimulates the body to wake and start breathing again, interrupting the sleep cycle. Experts believe the level, or stage, of sleep and its duration are important to our mental and physical health. Hormones are secreted properly and memory functions efficiently, for example, when sleep stages are achieved and sustained sufficiently, Bernie said.
“It becomes a quality-of-life issue for both the spouse and the patient, as both become sleep-deprived,” she explained. “If you are The answer was to keep not sleeping well, how can Paul breathing all night using you enjoy life?” continuous positive airway At Altoona Regional, pressure (CPAP) delivered the sleep solution team through a well-fitted and provides comprehensive comfortable facemask. treatment from the initial The Snowbergers’ situation
treatment and follow-up. Don’t fear the mask “Follow-up care is so important and distinguishes us from other sleep labs,” manager Cathy Wilt said. “If a problem develops, our team is here to work with our patients. We even facilitate a community support group.” Paul encourages people who are put off by thoughts of wearing a mask to bed to think again. He said a properly fitted mask is comfortable. Three years after beginning his treatment on CPAP, he said he can’t imagine going to bed without it. “There are so many mask options and choices,” he said. “You can find one that will work for you. After just two weeks on CPAP, I felt so much better. I had more energy and felt more alert. The whole day went better.” Paul went from falling asleep every time he sat down, including at embarrassing times like work meetings, to completing projects at home, socializing more and enjoying life again. Contact: Institute for Sleep Medicine Station Medical Center 17th Street and 9th Avenue, Altoona 889.4466
visit through diagnosis, Far left: Bernie Krug helps fit a CPAP mask on patient Mary Masic of Altoona. Left: Sleep technicians Gina Cooper and Vicky Hanwell, L.P.N.s, prepare sleep studies for a physician’s review.
Altoona Regional’s new six-bedroom sleep center at Station Medical Center enables the experienced staff to complete 36 overnight studies per week — more than double the volume at the former location. “Our goal is to see a patient for an initial evaluation, perform a diagnostic study, a study to set the levels for a C-PAP, if needed, and do an office follow-up within eight weeks,” said Cathy Wilt. That’s welcome news to area residents who suffer from sleep difficulties such as obstructive sleep apnea, narcolepsy and periodic limb movement — just some of the more than 80 sleep disorders. “According to the National Sleep Foundation, about 74 percent of adults have some kind of sleep problem,” Cathy said. “The most common problem is obstructive sleep apnea, which occurs when structures in the nose and throat collapse and block the airway.” Most patients’ insurance companies require a physician referral for care. Referring physicians may be a family physician, endocrinologist, cardiologist, surgeon or ear-nose-throat specialist.
Computerization helps prevent medication errors, speeds up orders Technology often plays a key role in patient safety, which is a priority at Altoona Regional. A significant example is the newly installed computerized system physicians use to order medications for patients.
Enter orders from any computer CPOE also allows physicians to enter orders from the point-of-care (in the hospital) or off-site (at their offices or homes) and provide error-checking for duplicate or incorrect doses or tests. Altoona Regional is rolling out CPOE in stages and providing training to its physicians, nurses and other staff. Lexington Hospitalists, a subsidiary of the health care system, was the first to use the technology. “It’s unfortunate that medical errors even occur,” said Gregory Martinek, D.O., FHM, medical director of Lexington Hospitalists. “But they become even more preventable through electronic prescribing systems like CPOE. This implementation represents a fundamental change in patient care at Altoona Regional, in keeping with our focus on patient safety as our goal.” * An independent, not-for-profit organization, The Joint Commission accredits and certifies more than 19,000 health care
organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards.
Computerized physician order entry (CPOE) is faster and has been shown to reduce the rate of serious medication errors, including administration of the wrong drug, drug overdoses and overlooked drug interactions and allergies. “The most important thing we can do is make sure our patients feel safe when they come to us with their health problems,” said David Burwell, M.D., chief medical information officer at Altoona Regional. “CPOE allows us to do just that, by intercepting errors when they could most commonly occur — at the time medications are ordered.”
Dr. Martinek uses a laptop at the Tower 10 nurses station to enter orders for his patients using the CPOE software.
Instead of hand-writing or verbally communicating orders for patient care, physicians enter orders into a computer. Orders are integrated with patient information, including laboratory and prescription data, and automatically checked for potential errors or problems. All hospitals urged to use it “CPOE lessens the chance of illegible handwriting or bad verbal translation leading to medication errors and patient injuries,” explained Dr. Burwell. “The Joint Commission* emphasizes the value of CPOE and is encouraging all hospitals to adopt this technology. “Further, studies have shown that if CPOE were deployed and used properly in hospitals, it could reduce medication errors by 50-100 percent. And a recent Stanford/Packard study shows a 20 percent decrease in mortality.” Another of the many benefits of CPOE is that it reduces delays in order completion; physicians and nurses can review orders immediately for accuracy and confirmation. “This technology will greatly enhance our work flow process,” said nurse manager Joyce Haney, R.N., B.S.N. “The middle step of the nurse entering the order is eliminated, thus expediting the order time.”
“The most important thing we can do is make sure our patients feel safe.”
Specific benefits of CPOE include: • Prompts that warn of the possibility of drug interaction, allergy or overdose. • Accurate, current information that helps physicians keep up with new drugs as they are introduced into the market. • Drug-specific information that eliminates confusion among drug names that sound alike. • Improved communication between physicians and pharmacists. • Reduced health care costs due to improved efficiencies. • Reduced delays in order completion.
S i z eable difference New, enlarged unit enhances care after cardiac surgery
For seriously ill patients, the new Cardiothoracic Intensive Care Unit (CTICU) at Altoona Hospital Campus enables safer delivery of care in larger, private rooms and more comfortable surroundings. The new unit is one bed larger than the old one, and all eight rooms are private. It opened in April on the 6th floor of the Tower, two floors below the old unit, which had just one private room. All of this is to the liking of cardiothoracic surgeon John S. Anastasi, M.D. “It’s state-of-the-art in the delivery of excellent cardiac surgery care,” he said. “It’s more spacious than the previous unit, which enables us to provide excellent care.” To the nurses, who provide one-on-one patient care, the $2 million upgrade is entirely about patient safety, according to Jacquie Strawser, administrative director of Critical Care.
Better for the patient “The private rooms ensure patient privacy, confidentiality and compliance with infectioncontrol measures,” said Kitty Zelnosky, a critical care R.N. and manager of CTICU. “This allows us to continue to give excellent care to our patients.” The larger rooms offer more space for the cardiothoracic surgeons to perform procedures, if necessary, and include an upgrade of equipment focused on patient safety, said Jacquie, who is a critical care registered nurse with a master’s in nursing. For example, “work stations
Preparing for a patient: Kitty Zelnosky uses a mobile computer station to review a patient’s medical history before the person arrives from surgery.
on wheels” are computers wheeled throughout the department. They permit safer distribution of patient medication because they require that the patient’s specially coded wristband, the nurse’s ID badge and the medication be logged into the system at the prescribed time. X-rays viewable instantly Additionally, mobile X-ray technology is available, and physicians and surgeons are able to view the X-rays immediately. “When we were planning the unit, we visited other sites to view different equipment, from beds to
monitors to the control wall at the head of the bed,” Jacquie said. After much research, the team selected state-of-the-art Nihon Kohden touch-screen cardiac monitors. “These cardiac monitors are easy to view and provide instant access to heart rhythms, blood pressure, central line functions and more,” she explained. “We put the monitors in every ICU in the hospital, not just in this unit. It has made care safer for all our intensive care patients.” Patient profile has changed Dr. Anastasi and the health system brought the availability of open-heart surgery to the community in 1989. Since then, the profile of the typical openheart patient has changed. The average heart surgery patient is older than 70 and suffers from additional illnesses, such as kidney and liver disease, which makes pre- and postsurgery care more difficult
to manage, according to both Dr. Anastasi and Jacquie. More than ever, these post-open heart surgery patients require highly trained nurses to care for them in an environment designed with patientsafety in mind. “It’s such a pleasure to take care of patients in our brand new, beautiful unit,” said Josh Noel, a critical care R.N. “It’s a fresh and exciting chapter in the life of CTICU!” Referring to a sign in the unit that reads “Your heart is in our hands,” Jacquie said, “We respect that motto. We treat each patient like a member of our family.”
“It’s a fresh and exciting chapter in the life of CTICU!” 5
Keep flip- flops cine their pla Podiatrist Harry L. Penny believes flip-flops have their place in foot fashion — the pool, the public shower and the beach. Worn elsewhere, these inexpensive bastions of summer sandaldom may leave you sidelined with broken toes, broken toenails, plantar fasciitis, tendonitis, twisted or broken ankles, shin splints or Achilles tendonitis — to name a few of the ailments suffered by flip-flop wearers who come hobbling through his door.
Don’t deny your feet the attention they need —
Putting your best foot forward this summer when it comes to caring for your feet may save your life.
this summer and year-round
especially important and pay particular attention to the back of the heel. Many people are prone to fissuring. These are cuts that become very painful and may become infected.”
Harry L. Penny, D.P.M., of Blair Medical Associates has cared for area residents’ legs, ankles and feet for more years than he cares to admit. He’s continually educating himself and has numerous certifications, including a Physician Certified in Wound Care (CMET).
• A daily rub of rough spots with a pumice stone followed by moisturizing can help avoid fissuring. Fissuring provides a point of entry for dirt, dog or cat hair, gravel and many other things.
• Keeping toenails trimmed. Cut the nails straight across and even with the tip of the toe.
“They have to work harder than a person in sneakers.”
He obtained the status of fellow in many organizations, including the American College of Foot and Ankle Orthopedics Medicine, College of Certified Wound Specialists, and others. Dr. Penny is active in medical research, writing and education, and has lectured nationally and internationally on various foot and wound care topics.
Sees three toe injuries a day
Remember the sunscreen
This shortened gait, coupled with the uncovered nature of the footwear, leaves the toes open to injury. The wearer is highly prone to tripping, especially over thresholds, and of stubbing toes into objects. He sees about three toe injuries related to flip-flop wear a day during the summer, including broken toes, severely ripped off toenails and blood trapped under the toenails.
Sadly to him, all his education and best efforts can’t undo one thing: patient denial.
“Flip-flops have no arch support or shock absorption,” Dr. Penny said. “And when a person walks, they scrunch up their toes to hold them on, which shortens their gait and places stress on their muscles and tendons and on the ankle, knee and hip joints.
It is especially hazardous to wear flip-flops while: • Doing yard work. • Hiking (he knows of one death attributed to hiking in flip-flops when a woman slipped over a cliff). • Driving (entanglement in the pedals). • Doing housework. • Carrying heavy loads (no foot protection if you drop something).
“If I can get one point across, it would be this,” he said. “Use sunscreen on your feet. People forget their feet. I have seen melanoma on the feet of patients — about seven cases. Two patients died; two had amputations. It can kill you.” It is crucial to put a liberal application of sunscreen on all parts of the body, including the top of the foot. And reapply after getting out of the water. As far as general foot care, Dr. Penny recommends: • A daily moisturizer. “There is no such thing as ‘the best one.’ I tell my patients to go to the drug store and look at the variety and pick one they like. You want to lubricate the legs, ankles and feet. The heels are
• A daily inspection of the feet, especially for people with diabetes or others whose sensation in the feet is diminished. “They may be unable to feel whether they have a small sore or a cut,” he said.
• Addressing foot sweating and odor by purchasing odorreducing sprays and shoe inserts. Allow shoes to air out between wearings. Select mesh, not plastic or all-leather sneakers, so feet receive air circulation. • Addressing any nail discoloration promptly with a podiatrist. This indicates a possible infection. If diagnosed early, a topical cream application may correct the infection. For more severe infections, oral medications can help. Now being tested, he said, is a nail polish that contains an anti-fungal that both treats and hides the unsightly nail. Dr. Penny said corns on the last toe indicate an improperly fitted shoe. To buy a shoe in the correct size, shop for shoes late in the day because feet swell. And going barefoot isn’t bad if you use proper judgment: only indoors and in moderation. Exams can help find illness A proper foot exam, coupled with a medical history and an X-ray, often helps diagnose systemic illnesses, Dr. Penny said, such as diabetes, as well as bone-loss diseases osteopenia and osteoporosis, and autoimmune diseases such as lupus and rheumatoid arthritis. “Many say the feet and the eyes are equally the mirrors of the body because you can learn so much through them about a person’s overall health,” Dr. Penny said. “I have found that to be true.” Contact: Harry L. Penny, D.P.M., C.W.S. Blair Medical Associates Podiatry 1414 9th Ave., Altoona 946.1655
Be ready for life’s changes
What will your legacy be?
Janet and Stephen Ellis of Altoona experienced the deaths of four friends and relatives from November 2010 to January 2011, and it made them realize how quickly life changes. By making bequests in their will, including one to the Altoona Regional Center for Cancer Care, they know their final wishes will be honored. “A bequest is a way to make your financial wishes known to surviving family members,” Janet said. “We feel strongly about health care needs in this community and want to give back.” With no biological children, the Altoona couple’s will takes care of their beloved seven nieces and nephews, their church family and the Cancer Center. Janet, a three-time cancer survivor, and Stephen received love and support from countless people during her illness: their family, church community and Janet’s coworkers at Altoona Regional. Janet worked for 33 years as greeter coordinator at Altoona Hospital and Altoona Regional. During those years, she forged many friendships not only with coworkers but with people in the community.
Have you thought about what legacy you wish to leave? Seventy percent of Americans die without having a will, estate plan or other important legal instructions, such as advance health care directives or a power of attorney. Will you be one of them, or have you spoken with a family member, attorney or financial adviser about how you want your property or estate distributed? “As we grow older, many of us begin thinking about leaving a legacy that will benefit family, friends and community for generations to come,” said Fred Thursfield, president of the Altoona Regional Health System Foundation for Life. “Failure to plan means you risk harming those you love and subjecting your estate to needless expenses or taxes. “You may also accidentally disinherit or leave less of a legacy to your family or community by not taking steps to preserve and protect your assets.” Could save estate taxes A provision in your will or trust leaving a gift to a charity can result in saving estate taxes by providing your estate with a charitable deduction for the value of the gift. Through careful planning, your family may, under some circumstances, avoid paying income tax on assets they receive from your estate.
A bequest is one of the easiest ways to make a charitable gift. With the help of an adviser, you can include language in your will or trust distributing financial and personal assets to family, friends or charities such as the Foundation for Life as part of your estate plan. A bequest to the Foundation may be made in several ways. You may include a provision or codicil to a will or trust provision to: • Give a specific dollar amount • Give a percentage of your estate • Give a residue of your estate Property can be passed on Property can also be passed to the Foundation for Life or other charities outside of a will or trust through an IRA or an insurance policy and provide tax benefits to you during your lifetime. “No matter what you do or how much you ultimately decide to give by bequest,” said Fred, “your donation can help guarantee Altoona Regional the financial resources it needs to fulfill its community health care mission.”
The Altoona Regional Health System Foundation for Life is a private, 501(c)(3) nonprofit organization which exists to inspire gifts from individuals, foundations, corporations and other entities to support the preservation of health care for the well-being of community members in Central Pennsylvania. Because the Foundation for Life is a qualified charitable organization, donations are tax-deductible to the fullest extent allowed by law.
“We both had careers where we helped people,” Stephen, a retired teacher, said. “Our jobs have been good to us financially and we want to share it with others and give back to the community.”
Help is available If you have already made a provision in your estate plans leaving a gift to Altoona Regional or would like to learn more about ways to make a bequest, please call Fred Thursfield at the Foundation office, 889.6406. You may also want to use our online interactive Will Planning Guide and get more useful estate planning information at altoonaregional. giftlegacy.com. 7
Altoona Hospital Campus 620 Howard Avenue Altoona, PA 16601-4899 A nonprofit community health care system
Non-Profit Organization U.S. Postage PAID Altoona Regional Health System
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AS K T H E S P ECIALIST Gary Zuckerman is vice president of Supply Chain for Altoona Regional Health System. What can you tell us about Altoona Regional’s efforts to become more environmentally friendly?
We created a Green Committee that includes employees of all departments that are major generators of waste. We also began collaborating with Stericycle, a waste management firm that specializes in processing medical waste.
Yes. Hospitals have to manage pharmaceutical and biological waste in addition to municipal waste. There are very stringent standards for treating pharmaceutical and biological waste, so we need to make sure we meet the various regulations for collection, processing and disposal.
One of our first successful initiatives was to convert from disposable sharps containers (mainly for used needles) to reusable containers. We followed this with a new program for collecting pharmaceutical waste. Knowing that the federal and state governments were in the process of instituting new, stricter regulations on the disposal of medications, we wanted to make sure we were in full compliance with the new standards. As a result, Altoona Regional is one of the first hospitals in the nation to implement a pharmacy waste management program that is in full compliance with the new standards governing safe disposal of used and expired medications.
How about the nonmedical waste generated in offices, cafeterias, etc.?
We recently embarked on a hospital- wide recycling program, expanding our recycling of corrugated cardboard to include paper, aluminium cans and plastic. We are also looking at how we may be able to compost our leftover food products. p
Is hospital waste more complicated than other types of business/municipal waste?
Since processing of pharmaceutical and biological waste is more costly in terms of energy consumption, it behooves us to make sure we separate it from other waste generated by our health system. We are educating all of our more than 2,000 employees on waste separation. It’s an ongoing process but employees are doing a really good job of supporting our green initiatives. They are passionate about protecting our environment and understand that what we are doing here contributes to cleaner waterways and better air quality for everyone. Do you have any other plans for making Altoona Regional more environmentally friendly? We are re-evaluating some of our purchasing habits. With a focus on supporting the sustainable living and Go Green initiatives across America, we want to make sure we fully consider the potential environmental impact of every product we procure in the future. With our recycling program in full swing, our ultimate goal is to reduce the volume of waste that we contribute to various landfills by 50 percent, which is significant. This goal may seem very ambitious, but we think Altoona Regional, led by our Green Committee, is up to the challenge.
Gary received his bachelor’s in Health Planning and Administration from Penn State University in 1976 and his MBA and graduate degree in Hospital Administration from the University of Florida in 1978. Gary is a member of the American College of Healthcare Executives. He came to Altoona from Mercy Medical Center in Baltimore, Md. Before that, he served 29 years in the U.S. Navy as a health care administrator, retiring as a captain in 2005.