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F O L LO W U S O N FAC E B O O K
4 LETTER FROM THE EDITOR 7 Business insurance
What type of coverage and how much?
9 know thyself
A mindful approach to time management.
11 employee engagement
Winning employeesâ€™ hearts and minds.
13 Home care vs. home health
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5 cover story Kelly Sibol, author and illustrator of Buzz and Louise, reads her book to one of her biggest fans, her son, Jack. Writing a book was something Sibol had wanted to do for as long as she could remember, but it wasnâ€™t until 2008, when her first child was born, that she started to seriously consider it. She finally took the plunge, learned to put self-doubt aside, and designed and wrote the book. It has opened her up to many new friendships and opportunities. BUSINESSWomanPA.com
November 2018 Vol. 15 - No. 11
PRESIDENT AND PUBLISHER
Donna K. Anderson
sn’t that a wonderful picture on the cover — a about why it’s important to win employees’ hearts and child listening to a book being read and enjoying minds and tips for doing so. time with his mom? Not only is it a great November is also National Family Caregivers Month. bonding experience, but books can also take us We have included a few articles that will help to clear on adventures, teach us about the world around us, and up some questions about the difference between home can increase our brain power in so many ways. care and home health and how hospice care and November is National Entrepreneurship Month, so palliative care differ. Know your options so you can it is appropriate that we highlight a local entrepreneur. make informed decisions if/when the time comes. And Kelly Sibol reached outside her thank you to all of you who comfort zone to write a children’s are caregivers. It’s often a hard book that is beautifully illustrated journey, and perhaps you don’t hear and explains the importance of words of gratitude often enough. something in nature — bees! And finally, November is Anything I’ve ever done that If you are a business owner, do Lung Cancer Awareness Month. ultimately was worthwhile … you have business insurance? No Although the number of smokers matter what size your business in the United States has dropped initially scared me to death. is, it is important to protect considerably over the past 50+ ~ Betty Bender yourself from potential loss. Learn years, find out who is most at more about coverage options. risk for lung cancer and whether Think about the people you genetics plays a role in developing work with. Do you get along with lung cancer. all of them? Are there some fellow associates you stay Let us help you achieve success in your career and a clear of or, alternatively, enjoy coming in contact with little more balance in your life. Read the entire issue of during the course of the day? Does everyone seem to be BusinessWoman and you’ll find more interesting topics! working toward the same goal — i.e., making sure the Happy Thanksgiving with friends and family! company is successful? The emotional and intellectual connection that employees have will determine how engaged they are Christianne Rupp and will go a long way toward the success in each Vice President and Managing Editor employee’s career and that of the company. Learn more
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Meant to ‘Bee’
Sibol holds the originals of the water-color drawings that eventually became Buzz and Louise.
By LYNDA HUDZICK
s she was growing up, Kelly Sibol dreamed of writing and illustrating greeting cards or being the “person at Crayola who got to name the crayons,” she said. Today, she is a published author with her first children’s book successfully on the market. Although she may not have gotten exactly what she wished for, Sibol is thrilled that her love of putting pen and paintbrush to paper has been fulfilled.
Sibol was born and raised in York, having moved on after high school to receive a bachelor’s degree in corporate communications from Elon University in North Carolina. Upon graduation, she moved back to York and began a sales career with a local radio station. She married in 2006, and it was after the birth of her daughter in 2008 that she “began thinking about what it would take to write a children’s book, something
I have wanted to do for as long as I can remember,” Sibol, now the mother of three young children, said. “Being home and raising my family has always been my top priority, and I wanted to do something my children would be proud of.” An early love of reading was something she felt was important to pass along to her children. Buzz and Louise, the stars of her first book, “seemed like a natural
extension of the things that are important to me,” she said. Buzz and Louise is a beautifully illustrated children’s book that focuses on “the magic of bees,” Sibol said. “In addition to loving books and art, I am also a lover of all things outdoors. My other passion is flowers, and learning about bees intrigued me from the start.” Sibol studied the importance of bees and how they are responsible for so many things we enjoy, such
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as honey, flowers, fruits, and vegetables. “I began learning more about the decline in the bee population, and so it felt like a natural subject for me to write about,” Sibol said. Sibol admits that, at first, there were so many visual ideas for a book on the subject swirling around in her head that the illustrations in some ways came before the story. The drawings were “sketched many times over and then traced in permanent marker,” she explained. “They were then finished with watercolor, my favorite medium to work with.” Sibol said that she always “knew the important things I wanted kids to learn, and then I had to figure out how to come up with a clever way to weave the facts into the pictures I had mapped out. Buzz and Louise contains many age-appropriate facts about bees and concludes with a list of ways that children can help to protect pollinators.” Although she said that the idea of writing a children’s book grew from a “seed my mom planted long ago,” it wasn’t until her children were born that Sibol seriously considered the idea. “Once I started drawing and tossing the idea around with my husband, there was no turning back,” Sibol laughed. “He was not going to let me not do it!” Often, when she started thinking that something she was working on wasn’t good enough, her husband and her children were her biggest sources of support. “They were always there to offer ideas and encouragement,” she said. Putting herself and her work out there for the world to see is something that Sibol has always been uncomfortable with,
and in fact, “it still makes me uncomfortable to talk about Buzz and Louise because it feels so personal.” If it weren’t for the support of her husband, children, and the rest of her family, she believes that “Buzz and Louise would still be collecting dust on our dining room table.” So what was it like to see what was once just an idea finally become a reality? “My kids were actually the first to discover the book delivered to my side door one rainy afternoon,” Sibol said. “Seeing proof for the first time was very surreal. I had worked so hard to put it all together, and it felt great to finally have a hard copy in my hands.” Sibol has always enjoyed working with children and is relishing the opportunity as a published author to visit local schools and businesses to read and sign her book and to talk with children about bees. She is also interested in writing another book, “but at this point I’m not sure which direction I want to take Buzz and Louise,” she said. “I know I want to continue with the bee theme, and I have been mulling over different ideas.” As she continues to explore new opportunities and grow as an author, Sibol is very aware of what she has learned since first embarking on this journey with Buzz and Louise. “It might sound cliché, but there is so much truth to the saying that there is nothing to fear but fear itself,” she said. “It has been such a valuable lesson for me. As soon as I made the decision to put my self-doubt aside, I opened myself up to new friendships and opportunities I wouldn’t have otherwise had.”
Business Insurance – What Type of Coverage and How Much?
By K. LEIGH WISOTZKEY
nsurance may not be your favorite topic of conversation or expense to consider, and that’s likely due to lack of knowledge and understanding. Unless you are versed in policy and coverage lingo, it can be very confusing to understand what you actually need and how the numbers apply. But that’s no reason to bury your head in the sand. When it comes to your business, even a home-based business, it’s imperative to manage your risk and protect yourself from financial loss.
Starting the Process of Securing Insurance When faced with insurance decisions, your first inclination may be to start with an internet search. After some initial research, you may become more confused, and you’ll often find it difficult or impossible to purchase your business insurance online. It’s best to call your agent or broker to talk through what you have found, ask every question that you have, and work on getting accurate quotes that are tailored to
•W ill this policy cover all of the things I do through my business?
Understanding What You Need When you define your business, you use all kinds of factors to describe it: structure, size, type of business. Some of these descriptors contribute to your insurance needs, so it’s important to understand what matters. Your business entity structure (sole proprietor, partnership, LLC, corporation) has little or nothing to do with your insurance needs, but your small or medium-sized business may also be home-based, so you need to consider all that applies. Beyond those, the type of business/industry will drive more specific needs, which is where your agent or broker becomes critical.
“Every business has its own specific needs and exposures, and the business world is ever changing,” says Keohane. “The best recommendation I have is to partner with an experienced insurance agent or broker who has the ability or resources to understand not only one particular business segment’s needs, but the needs and exposures of other types of industries.”
Home-based Business All home-based businesses need insurance. Liability and property coverage are recommended, and if you’re offering a professional service, professional liability (E&O – errors and omissions) is recommended, too. A home-based business is a business that operates out of your home, with no other office or location. There are a wide variety
your specific business needs. “A savvy business owner will know enough to know that they don’t know anything about insurance,” says Lori Keohane, CIC, AVP/Small Business Practice Group Leader Commercial Insurance account executive, Engle Hambright & Davies, Inc. Even when working with an agent or broker, people have three common questions regarding business insurance: • Do I really need limits that high? • Why is it so expensive?
of businesses that can be run out of the home or begin in the home and then grow to need a dedicated office space or retail store front. “Typically, we see home-based businesses as those with minimal exposure or client base and limited outside-premise location exposure,” Keohane explains. You can look at home-based businesses two ways: 1. A one-person shop where clients come to the home for service: hairstylist, massage therapist, seamstress, etc. 2. Only an office is needed because the business owner always goes out to visit clients at their location. This could be the consultant, bookkeeper, direct sales rep (e.g., May Kay, Thirty-One), painter, electrician, plumber, etc. “Of course, there are homebased businesses, such as auto-body repair shops, cabinet makers, etc., that have a much bigger liability exposure and require proper zoning and permits,” Keohane advises.
Insurance for a home-based business may come from an extension of the resident homeowner’s coverage or from a standard business liability carrier. Not all homeowner carriers will offer coverage for a home-based business. It is important, if you are operating any type of business out of your home (whether a profit is generated or not), that you check with your homeowner’s carrier. Many will offer limited liability and property coverage, but most homeowners’ carriers will explicitly exclude any business-related exposure from the policy. Small & Mid-sized Business General liability, property, loss of income, workers’ compensation, employment practices, umbrella, and — now that we live in a digital world — cyber liability insurance are the basic starting-point coverages for insuring your business. Typically, the annual sales and/ or payroll will dictate whether a
business is small or mid-sized, but the type of business will drive insurance needs. For example, an independent LuLaRoe consultant can make over $100,000 a year on her own, with no employees, and certainly needs insurance coverage, just the same as a three-person bookkeeping operation. Types of Coverage Below are some simple definitions of coverage and how it applies. • General Liability – Protection for a business for losses resulting from personal injury, product or operational problems, and property damage as it pertains to their business operations. • Property – Monetary coverage or replacement of business contents or buildings in the event of a covered loss. It is subject to the limits and deductibles within the policy. Typical losses include fire, water damage (not flood), theft, mechanical breakdown, etc.
• Business Income – Replacement of lost business income as a result of a covered loss that prevents you from operating your business. • Workers’ Compensation – Coverage for lost wages and medical expense as a result of a workplace injury to an employee. • Employment Practices – Protection for employers from claims that are made by the employee for: wrongful termination, sexual harassment, discrimination, invasion of privacy, false imprisonment, breach of contract, emotional distress, and wage and hour law violations. • Cyber Liability – Also known as data breach or cyber risk insurance, this covers the costs incurred by your business in the event that your electronically stored data is compromised. Coverage Amounts Million-dollar general
umbrella, and cyber liability are industry-standard starting points. Most insurance limit requirements are often dictated by a contract the insured is entering into — for example, with a client for work to be performed or a lease agreement with a landlord. “Most of the time, when talking about liability, we start off with $1 million per occurrence limits,” Keohane advises. “The cost to write coverage with lower limits just doesn’t make sense, compared to the coverage you are losing.” Once you know that you have appropriate coverage limits, you are getting the best price, and that your policy covers all of your specific business needs, you can rest easy in knowing that you are protected. An experienced and knowledgeable agent, who does all of this and takes time to understand your specific needs and answer questions, can always help you feel better about the insurance premiums you pay for the coverage you need.
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~ November 2018 | BUSINESSWoman
A Mindful Approach to Time Management By K. LEIGH WISOTZKEY
ime is the most level playing field our society has. No one ever gets more than 24 hours in a single day, and, yet, we all know people who seem to have found a way to beat the clock. Time is a resource — a precious commodity that can never be stored. The clock is always ticking, and finding more time is like trying to follow water down the drain — when it’s gone, it’s gone. Time-management strategies and tools help you to wrangle more minutes out of each day by planning more, procrastinating less, scheduling time, etc. But mindfulness alone can help you gain serious traction. After all, it may take 27 days to create a new habit, but you first need to identify habits that no longer serve you, and embrace (and leverage) the ones that do.
Where Does Your Time Go? You may learn that it’s not so much about managing your time as it is about managing your mind. Multitasking, social media, and every other ping, ding, or audible wave that catches your attention can easily take you minutes down a path that becomes an hour. Monitoring an entire week is ideal, but one day of documenting
your every move is sure to tell you what you need to know. Exercise 1: Track/document your time for one full day: working hours, TV, phone, and playtime, too. Write it down on paper or use a time-tracking app that can easily track your task starts, stops, and switches and show running time totals, right on your phone. •N otice every change – Recognize what’s happening. Note every instance when you react or respond in a way that interrupts the current task and leads to a new one, and note the time.
• Document every task or activity – If you stop to check/send/respond to email, take or make a phone call, or wander onto Facebook and get caught up in commenting or watching videos, be honest and write it down. Note the time you start and the time you end. • Add it all up – Loosely categorize, so you can identify pockets of time that come from bouncing around or being not quite focused. A lot of starts and stops may indicate that you are in a disruptive environment, easily distracted, or have a limited ability to focus. A
combination of self-discipline and skill development can help you manage these challenges. What Do You Accomplish? The exercise above also provides information about the actual tasks and activities that fill your day. Some people swear by their abilities to juggle everything at once and multitask through every day, but the jury is still out about the quality results and effectiveness of multitasking. Prioritizing appropriately can be the biggest challenge in multitasking. Even if you are completing an impressive number of tasks, are
Know Thyself –
they actually the most important tasks for the day? Exercise 2 1. Make your “to-do” list first thing in the morning. 2. As you start to complete tasks that aren’t on the original “todo” list, start a “done” list of all the extra tasks you complete throughout the day. Do not add to the “to-do” list. 3. At the end of the day, account for the to-do list items you have completed. 4. Now, look at the “done” list, and divide it into what absolutely needed to be done today and what could have waited. If your “done” list is longer than your “to-do” list, you may need a better idea of what really needs to be done each day. If the majority of the items on your “done” list are “could have waited” tasks, you may be prone to wandering
through the day, giving attention to whatever screams the loudest. Think of it as your proactive list and your reactive list. Reducing your reactive list to items that are truly urgent or unexpected will help you manage your time more intentionally. Managing Your Mind Being mindful (fully present) throughout the day will help you to be purposeful in how you spend your time, which includes eliminating unnecessary activity and that which is simply wasteful. In addition, understanding how your mind naturally works can help make better use of time you aren’t using for its best purpose. Leverage your “prime time.” Accommodating your natural body clock is a great way to make specific hours more productive. Even if you’re “not a morning person,” studies have shown that most people are productive before they are fully awake. Try something
that takes brain power as soon as you wake up. If you discover a sharp mind, consider finding ways to use that critical first waking hour. Even if you need to move your waking time earlier, the opportunity to complete brain-taxing tasks early may be worth an hour of nighttime TV and earlier bedtime. Different people have different times of day when they are most productive. Work with that. For example, being a night owl gives you access to hours that can be distraction-free; use that time for schedule-free activities, such as paying bills or creating the next day’s to-do list. Repurpose wait time. If you find yourself being frustrated when you have to wait, training your mind and adjusting your habits can enable you to repurpose wait time into something productive. For example, with smartphone in hand, the extra time in the doctor’s office waiting room or bus stop doesn’t have to be wasted:
• Respond to emails, even briefly, or keep a list of calls to return. • Google something you’ve been meaning to look up. • Check out a Ted Talk or join a podcast. • Pay a bill online. There are always things to do — just learn to redirect your thinking and keep alternatives close at hand. The information you’ve captured in these exercises may help you identify behaviors you need to change or key time-management skills you can work on. Beyond that, there are things you can do to leverage prime and wasted time. Although there are specific actions you can take to get more out of your 24 hours, it comes down to paying attention, knowing yourself, and managing your mind to get the most out of your day.
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Winning Employees’ Hearts and Minds By CLAUDIA WILLIAMS
mployee engagement is easy to define, difficult to understand, and even harder to get right. At its core, employee engagement is the emotional and intellectual connection that employees have to their employers, their bosses, their co-workers, and their jobs. The depth of that connection is what drives employees to put in the extra, discretionary effort it takes to do the job really well. Notwithstanding our knowledge and understanding of the importance of employee engagement, we continue to build workplace environments where 8 out of 10 employees don’t like their jobs. Shockingly, 87 percent of employees aren’t engaged at work or — even worse — they’re actively disengaged. That means they’ve gotten to the point of saying, “whatever.” Even in a small business, one disengaged employee can have a drastic impact on profitability.
The Gallup Organization studied the relationship between employee engagement and performance across 192 organizations and almost 50,000 business/work units, encompassing some 1.4 million employees. The business units that scored in the top half on employee engagement close to doubled the odds of their success rates compared to the units that scored in the bottom half. When you consider the demands on the employee and customer experience, it’s no surprise that the primary concern identified by CEOs in the U.S. and a top concern for CEOs globally is human capital — the ability to attract and retain the very best, most capable people. Companies with engaged workforces outperform their competitors by 147 percent in earnings per share. At the end of the day, it’s about winning employees’ hearts and minds. Winning over hearts and minds is done by building purposeful and meaningful
workplace relationships. It’s the relationship that serves as the foundation for every behavior and action that drives engagement. Corporate America has wasted time and money giving employees more “things” to entice them to be happier and more productive. True culture change is driven by building purposeful, meaningful workplace relationships that foster collaboration, innovation, and, ultimately, profitability. Establishing cultures based on respect and trust drives loyalty, and employees become the champions of their peers as they get promoted. Importantly, toxic employees can’t survive for long in workplaces where relationships and how people treat each other matter. They have no choice but to give up their toxic ways. If they refuse, they find themselves isolated from their more connected teammates. They either self-select out of the organization, or leaders have no
choice but to end the employment relationship so they can preserve the quality of the teams they have built. The foundation of great workplace relationships is respect. While we often assume respecting one’s experience or knowledge is important, without the elements of personal respect, things like knowledge and experience are hollow. Leaders can demonstrate personal respect by doing seemingly little things such as being on time, honoring their word, offering to help, managing their temper, and respecting employees’ privacy. When we respect each other, we can begin to trust each other. Lack of trust is one of the biggest impediments to sustainable team success. Unfortunately, trust is not something leaders can mandate. Trust is something leaders and employees alike must earn with
every interaction they have with others. They do so by being sincere and demonstrating that they genuinely care about each other. They share information transparently for the good of the team rather than treating information like currency they cash in for their individual benefit. They follow through on their commitments and skillfully perform their job duties. Once leaders have established respecting and trusting relationships, they have the ability to foster loyalty. Again, though, loyalty does not just appear; it grows over time. First, employees find enjoyment and fulfillment in being associated with their leaders, their coworkers, and the company. They believe in the direction of the team and their leader’s ability to move them in that direction. And, importantly, they are proud of their work, individually and collectively. With these feelings in place, employees champion their teams, their leaders, and their organizations to people both inside
and outside of the organization. With respect, trust, and loyalty in place, organizations will see reduced absenteeism and turnover, growth of high-potential team members, strengthened intraorganizational relationships and collaboration, and enhanced knowledge management and transfer. Building strong workplace relationships is what drives the emotional connection that employees need in order to be truly engaged at work. So think about it. Think of how much time you and your team members spend developing the intellectual connection to work. Think of all the time spent at industry conferences and tradeshows, time spent in continuing education courses to maintain certifications or licenses, or time spent at networking events trying to develop new business. Is your organization devoting just as much time to developing its heart? If not, it’s time to start.
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Home Care vs. Home Health … What’s the Difference?
or aging and homebound individuals, home is the best place to remain as functional and independent as possible, with the highest degree of security, comfort, and dignity. When individuals hear the words home care and home health, some mistakenly think the two are synonymous. However, home care and home health are distinct types of care. Home care is nonmedical assistance emphasizing companionship, while home health is a physicianordered plan of care provided at home. Let’s explore the differences further. Home Care Home care is nonmedical supportive care. Caregivers provide assistance with the activities of daily living, such as preparing meals, running errands, light housekeeping, medication reminders, assisting with bathing and dressing, and providing transport to doctor appointments. The goal is to improve the client’s quality of life while ensuring safety in the home. Recently, the Pennsylvania Department of Health issued a new regulation allowing home care aides to be trained to do more tasks in the home setting. The
additional tasks taken on are a decision made by each agency. Some of the added care that can be provided include pic tube care, ostomy care, and medication administration. Depending on how much care you need at home, it may be beneficial to find an agency that has embraced the training required to perform some of these additional tasks. Home care is typically paid by the individual receiving care or with long-term care insurance. Home Health A physician
health services, typically after a hospital stay, an onset of a new diagnosis, or an exacerbation of an existing illness. Each patient is different and receives a specialized plan of care that fits their individual needs. Home health care is a multidisciplinary approach monitored and implemented by a team of medical professionals, including nurses; physical, occupational, and speech therapists; social workers; and CNAs. Medicare or the individual’s private insurance normally covers home health services. If you or a loved one is
diagnosed with a more serious illness, you may want to find an agency that offers both palliative home health care and hospice care. Palliative care plans include specialized treatment along with comfort care and pain management. If the need to transition to hospice should arise, the patient may be able to have the same caregivers they’ve already come to know and trust. • This article was contributed by Wendy Shumaker, assistant director of marketing for Homeland Hospice, HomeHealth and HomeCare. www.homelandathome.org
Provides Comfort and Support
alongside Cure-Seeking Treatments
By MEGAN JOYCE
lthough you may often see the words “palliative care” listed in conjunction with “hospice care,” the two terms are not entirely interchangeable. “Palliative care can take on different meanings for different people,” Sandy Sferrella-Taylor, public relations manager for Visiting Angels York, said. “Palliative care seeks to prevent, relieve, or soothe the symptoms of disease, disorder, or aging without effecting a cure. It is a resource for anyone living with a serious illness where doctors feel they can provide treatment in the hopes of a cure.” Both palliative care and hospice care provide symptom management and comfort care for people with serious illnesses, but palliative care — which also supports a patient’s emotional, social, and spiritual needs — is not restricted to those with a life-limiting illness. “Some people are more comfortable with the term ‘palliative care’ if the explanation of support and comfort is provided,” SferrellaTaylor said. “Many people associate the term ‘hospice’ with ‘giving up’ or death in general. The expectation of death to be coming soon does not need to exist to receive palliative care.” Hospice care is a type of palliative care, but not all palliative
care is hospice care, which is reserved for individuals diagnosed with a terminal illness and with a life expectancy of six months or less. Patients who choose hospice have chosen to end curative treatment, but “diagnoses and life expectancy are not part of the need for palliative care,” Sferrella-Taylor said. There is no time limit for palliative care; it is appropriate at any stage of a serious illness and for patients of any age.
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Palliative care can occur in a hospital, in outpatient settings, in assisted living facilities, or at home. It is provided by an interdisciplinary team assembled based on the patient’s particular needs: palliative doctors, nurses, dieticians, pharmacists, social workers, financial advisers, and other specialists. This team works in conjunction with a patient’s physicians to provide “an extra layer” of comfort
and support, according to the Center to Advance Palliative Care (www.getpalliativecare.org). A palliative care team may help someone with a serious illness — such as cancer; heart, lung, or kidney disease; Alzheimer’s; multiple sclerosis; and others — to better carry on with their daily life. The types of relief received under palliative care depend on the patient’s individual needs and can include medication or other
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treatments for physical discomforts such as pain, fatigue, sleep disruptions, nausea, constipation, or appetite loss. It could also include trained caregivers and social workers to help a patient better understand their diagnosis, clarify treatment goals and options, and offer emotional support as they deal with the stress and anxiety that arise from the management of their illness. “[Palliative care] can be for anyone needing comfort care … they might not be nearing the end of life or willing to put off any lifesustaining measures,” SferrellaTaylor said. “They might still be receiving aggressive treatments for certain illnesses. Therefore they wouldn’t necessarily qualify for hospice, but they can get palliative care.” For someone already facing the costs of treating their disease, the addition of comfort care, while appealing, may not at first
seem financially viable. But many private insurance companies and health maintenance organizations (HMOs) offer palliative and hospice benefits, according to PalliativeDoctors.org, the patient site of the American Academy of Hospice and Palliative Medicine. For people over 65, Medicare Part B offers some palliative care benefits; Medicaid’s coverage of palliative care varies by state. Sferrella-Taylor said the nature of the palliative care being provided often determines whether or not Medicare will pay for it. Non-medical care is not usually covered, but if the palliative care is categorized as nursing care or therapy, it may be covered. “An example of such care may be nursing visits from a skilled homecare agency to the end-stage congestive heart failure patient to manage them at home with the goal of avoiding repeat emergency-room visits,” SferrellaTaylor said. “This type of care also
provides comfort and support, but the inclusion of the licensed professional may make it a Medicare-covered benefit.” How does someone diagnosed with a serious illness obtain the care of a palliative team? By asking for it. Hospitals often have a palliative specialist, or personal doctors and nurses can refer a patient to a palliative doctor. There are also numerous online resources that can serve as starting points for assembling a palliative-care team. The essential goal of palliative care is to alleviate physical suffering and mitigate the emotional and psychological burdens that accompany long-term medical treatment. “Many individuals, especially our clients, receive palliative care on an ongoing basis,” SferrellaTaylor said. “The key is support and comfort for individuals who need it, and that, as mentioned, can span several years.”
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Why You May Someday Need a Urogynecologist – If You Haven’t Already By MEGAN JOYCE
woman’s body is more than the sum of its parts — some of which are exclusively female and give us amazing abilities (we can grow new people!). Of course, those remarkable parts also require special care and attention. Read on for a primer on some common gynecological and pelvic issues that often present themselves as we progress through womanhood’s stages, in all their stress and splendor.
Women whose fibroids do present symptoms will commonly experience heavy menstrual bleeding and long-lasting periods, pelvic pressure or pain, and spotting between periods. In some cases, fibroids can also interfere with a woman’s ability to carry a child. If a patient is done with
childbearing, Schweitzer said, one treatment option for problematic fibroids is removal of the uterus. If childbearing is still desired, or the patient declines the removal of her uterus, she can undergo a procedure that removes only the fibroids, called a myomectomy. This can often be performed in a
UTIs and Incontinence Although urinary tract infections (UTIs) and incontinence are not solely the realm of women, they occur more frequently in women than in men. This is in part due to a woman’s anatomy: our urethras are shorter than men’s, which means bacteria don’t have to travel as far to reach the bladder, according to the Mayo Clinic.
Uterine Fibroids and Enlarged Uterus Also called leiomyomas, uterine fibroids are smooth muscle tumors of the uterus that are almost always noncancerous. And a lot of us have them — 5060 percent of white women and up to 80 percent of African-American women, said Dina L. Schweitzer, MD, FACOG, urogynecologist at UPMC Pinnacle Bladder and Pelvic Health in Carlisle. Often asymptomatic, many women don’t realize they have them until they experience symptoms such as heavy or irregular bleeding, and the fibroids are revealed via ultrasound. Fibroids vary widely in size; some are smaller than a centimeter. “If fibroids are present and not causing symptoms, usually we don’t have to do anything about them,” Schweitzer said. “If they cause symptoms or are growing rapidly, then we intervene.”
minimally invasive fashion with small holes in the abdominal wall, through which a camera and instruments are inserted. An interventional radiologist can also perform a uterine artery embolization, during which a catheter is placed in a blood vessel in the groin and advanced to the uterine arteries. There, substances can be placed to block the blood supply to the fibroids, causing them to shrink and symptoms to regress. Fibroids can also be the root cause of an enlarged uterus, another frequently symptomless condition that does not necessarily require treatment. When an enlarged uterus does present troubling symptoms — pain, bleeding — the uterus can be removed if the woman is done bearing children. Adenomyosis, a condition in which the uterine lining grows into the uterine wall, can also cause the uterus to become enlarged and create heavy, painful bleeding. Medications, such as birth control pills, can be used to control symptoms, as can as surgery.
Dina L. Schweitzer, MD, FACOG, urogynecologist at UPMC Pinnacle Bladder and Pelvic Health in Carlisle. incontinence. “Stress incontinence is caused by relaxation in the pelvic floor … the urethra is hypermobile and so it moves and can’t close well, so people leak urine when they
Other UTI risk factors are sexual activity; using diaphragms or spermicides for birth control; and menopause. UTIs encompass an infection in any part of the urinary system, including the kidneys, ureters, bladder, and urethra, but most occur in the lower tract (bladder and urethra). Often a UTI is synonymous with a bladder infection. “Symptoms will vary, but most premenopausal women will experience pain with urination, the urge to void more urgently and frequently, and blood in the urine,” Schweitzer said. In addition to those symptoms, older women who are menopausal will often experience nausea, vomiting, or mental status changes. In both cases, antibiotics are the standard treatment. Urinary incontinence, or the involuntary loss of urine, is broken down into three types: stress incontinence, urgency incontinence, and mixed incontinence, which is a combination of stress and urgency
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cough, laugh, or exercise,” Schweitzer said. Treatments for stress incontinence include physical therapy, placing a device in the vagina to stabilize the urethra, or surgery to support and stabilize the urethra. Patients experiencing urgency incontinence will complain of having to urinate often and only voiding small amounts; waking frequently at night to void; or a sudden, overwhelming urge to urinate, which may lead to involuntary loss of urine. “Urgency incontinence and bladder overactivity are nerve issues, where the communication between the bladder and the brain doesn’t work so well,” Schweitzer said. This type of incontinence is usually treated with behavioral therapy and medications that improve the messaging between brain and bladder. Some of the risk factors for incontinence — such as older age, being overweight, family history, and smoking — apply to both men and women, but women are also likely to experience the condition due to pregnancy, childbirth, and hormonal changes after menopause. Pelvic Organ Prolapse When the muscles of the pelvic floor weaken, one or more of the pelvic organs — bladder, vagina,
urethra, uterus, small intestine, and rectum — can descend or droop into the vaginal canal, a condition called pelvic organ prolapse. The most common causes of pelvic organ prolapse are the increased pressure put on the vagina by pregnancy and childbirth, and the risk for prolapse increases with age. Women who are obese or who participate in highly exertional exercise or heavy weight-bearing activities are at higher risk, too. Essentially, anything that puts great strain or pressure on the pelvic floor muscles — even chronic constipation — can contribute to pelvic organ prolapse, as well as a family history: Some women may have genetically weaker pelvic connective tissues. “Patients complain of feeling something coming out of the vagina, which often worsens as the day goes on,” Schweitzer said. Additional symptoms of pelvic floor prolapse vary depending on which organ or organs are prolapsing, but generally include: lower backache, painful intercourse, vaginal spotting or bleeding, constipation, and urinary problems. The presence and the degree of pelvic organ prolapse are usually determined by a simple pelvic exam. Other studies, such as urodynamic testing, CT scan, ultrasound, or MRI, may also be used to help assess symptoms associated with pelvic prolapse. Treatment depends on the severity of the prolapse and the associated symptoms. Many patients have no symptoms and do not require any treatment. For women with bothersome symptoms, physical therapy, vaginal pessaries (devices that fit into the vagina and provide support to vaginal tissues), or surgical correction can be pursued. “First you have to diagnose what part of the pelvic floor is prolapsing … and you have to determine how significant it is, and that determines what you can do for it,” Schweitzer said. “Prolapse is not dangerous. If a woman is not bothered by her symptoms, she does not have to seek treatment.”
Lung Cancer Deaths are Declining By BARRY SPARKS
are air pollution and exposure to secondhand smoke, coal burning, cancer-causing chemicals, radon, heavy metals, asbestos, and radiation therapy to the chest. The best way to reduce your risk of lung cancer is to stop smoking and avoid secondhand smoke. The earlier lung cancer is detected, the better. If you have any of the following symptoms, you should see your physician: persistent cough, coughing up blood, chest pain when you cough or laugh, shortness of breath, hoarseness, loss of weight and appetite, wheezing, fatigue or weaknesses, and persistent lung infections. Your doctor will examine you and take a family medical history. If the doctor believes you may have lung cancer, he or she will order tests that will help determine if you do. The most common tests include chest X-ray, CT scans, and sputum cytology. Although a chest X-ray may be the first test your doctor orders, many physicians believe a chest X-ray is inadequate for diagnosing lung cancer at an early stage when it is most curable. CT scans are more likely to show
lung tumors than chest X-rays. They can also show the size, shape, and position of many lung tumors and can help find enlarged lymph nodes that might contain cancer that has spread from the lungs, according to the American Cancer Society. For a sputum cytology, a mucus sample you cough up from your lungs is examined under a microscope to see if it contains cancer cells. The American Cancer Society recommends annual lung cancer screening with a low-dose CT scan for certain people at high risk for lung cancer who meet the following conditions: • Are ages 55-74 in fairly good health • Currently smoke or have quit within the past 15 years • Have at least a 30-pack-per-year smoking history • Receive smoking cessation counseling, if they are current smokers • Have been involved in informed/ shared decision making about the
benefits, limitations, and harms of screening with LDCT • Have access to a high-volume, highquality lung cancer screening and treatment center “Screening is used to detect lung cancer early, when it is more likely to be curable,” says Tchelebi. “It also decreases the morbidity of treating patients and increases survival rates.” If the disease is caught before it spreads, the likelihood of surviving five years improves from 11 to 55 percent, based on stage 1 vs. stage 4 lung cancer, according to the American Lung Association. One of the downsides of screenings includes a high number of false positives, which tend to increase stress. Screenings may also lead to invasive procedures, such as biopsies, and noninvasive imaging procedures, which may increase exposure to radiation. Screenings also may lead to an over-diagnosis of lung cancer, according to Tchelebi. She emphasizes, however, that the benefits of lung cancer screening outweigh the risks.
lthough lung cancer is the No. 1 cause of cancerrelated deaths in the United States, there is good news related to the disease. The combined lung cancer death rate for men and women has declined by 26 percent since its peak in 1991, according to the American Cancer Society. “A decline in the consumption of cigarettes is the major factor in the drop of lung cancer cases,” says Leila Tchelebi, radiation oncologist at Penn State Health Milton S. Hershey Medical Center. The number of smokers in the United States has dropped from a high of 45 percent in 1954 to 16.8 percent in 2014, according to the Centers for Disease Control and Prevention (CDC). Cigarette smoking is the cause of the vast majority of lung cancers. A 2017 research review states that 85 percent of lung cancer cases are thought to be caused by smoking. According to the CDC, longtime smokers have a 15-30 times greater risk of lung cancer than nonsmokers. Other risk factors for lung cancer
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According to a recent article in the Journal of the American Medical Association, less than 5 percent of eligible smokers get screened for lung cancer. “It’s an indication that many smokers and clinicians may not be aware, or up to date, about the screenings,” says Tchelebi. If patients have a concern about the screenings being covered by their insurance, they should check with their insurance company before getting screened. Some people wonder if genetics play a role in lung cancer. According to the CDC, you may inherit an abnormal gene that may lead to lung cancer or makes it harder for your body to get rid of the toxins in tobacco smoke. Most people who inherit the abnormal genes won’t develop lung cancer. Not smoking, of course, will lower your risks for developing it. The National Cancer Institute
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recommends genetic testing if: • You have a family history indicating cancer risk • The results will show whether a genetic change is present • The results will help guide your future medical care “Genetic factors do play a role in lung cancer, but we don’t entirely understand them,” says Tchelebi. “The genetic link is not well defined.” Tchelebi says recent advances in immunotherapy are exciting developments in the fight against lung cancer. “New immunotherapy drugs simulate the body’s own immune system and attack the cancer,” she says. “And, when immunotherapy is combined with targeted radiation, we are seeing improved progression-free survival rates.”
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Diabetes: A Growing Epidemic
By DR. THOMAS KURLAND
Recognizing the Signs and Symptoms of Diabetes There are some telltale visual signs of Type 2 diabetes. Look in the mirror and ask yourself: •A m I overweight or obese? Having a BMI of 30 or higher is a risk for developing Type 2 diabetes. •A m I carrying some extra weight around my waist? Women with a waist circumference of 35 inches or more and men with a waist
circumference of 40 inches or more are at risk. • Do I have brown patches under my arms, on my face, or on the back of my neck? These patches may be acanthosis nigricans, a skin condition associated with insulin resistance and early diabetes. Some risk factors are out of your control. Ask yourself: • Am I over the age of 40? If you’re sedentary and over 40, your risk is even higher. • Do I have a family history of diabetes? This is important. Between 50 and 75 percent of patients with Type 2 diabetes have a family member with diabetes. • Does my ethnicity increase my risk? If you are of African, Hispanic, or Native American descent, your risk of diabetes increases two to six times. Both Type 1 and Type 2 produce similar symptoms. Ask yourself: • Are you thirstier or hungrier than usual? • Have you weight?
• Are you more tired than usual? • Do you have worsening or blurred vision? • Do you get a lot of infections or skin sores that are slow to heal? Watching Out for Metabolic Syndrome: The Risk Factor without Symptoms Metabolic syndrome is a combination of high blood pressure, high blood sugar, high triglycerides, unhealthy cholesterol levels, and extra fat around the waist. It’s sometimes overlooked because it often doesn’t produce symptoms, but it plays a role in insulin resistance
and increases the risk of developing Type 2 diabetes, even if your blood sugar is normal. Doctors will diagnose someone as having metabolic syndrome if they have three of the following: • Abdominal higher
• Triglycerides higher than 150 • HDL (good cholesterol) below 40 or LDL (bad cholesterol) higher than 130 • Blood pressure higher than 130/80 • Fasting blood sugar higher than 100 Metabolic syndrome also triggers inflammation, raising the risk of cardiovascular disease even higher if you have Type 2 diabetes. As a proinflammatory state, it also indicates the presence of cardiovascular disease. Getting Diagnosed with Diabetes If you’re at risk for prediabetes or Type 2 diabetes, your doctor may order some lab tests. Here’s what they’re looking for: • A fasting blood sugar higher than 100 • A random blood sugar higher than 140 • An A1C level between 5.7 and 6.4 (prediabetes) or 6.5 or higher (Type 2 diabetes) • A triglycerides level higher than 150 • A triglyceride/HDL (good cholesterol) ratio higher than 3.5 (insulin resistance) • Glucose tolerance test (GTT): higher than 140 (prediabetes) or higher than 200 (Type 2 diabetes)
Testing for Type 1 diabetes is a different process. If your doctor is concerned, you’ll probably go through a fasting glucose test. If your results are normal but you have symptoms and risk factors, an oral glucose-tolerance test may be ordered. Once you’re diagnosed, your doctor may track your blood sugar levels using random blood sugar tests and A1C tests. Treating Diabetes Many options are available to control Type 2 diabetes and prediabetes. Your doctor will probably recommend that you change your diet, begin exercising, manage your weight, and quit smoking. If lifestyle changes aren’t enough to maintain sugar levels, oral medication may be prescribed to help the body use insulin more efficiently and lower the liver’s production of blood sugar. And if the pancreas isn’t producing enough insulin, you may need insulin. If you have Type 2 diabetes, talk with your doctor about taking additional medications, such as aspirin, a statin, or an ACE (angiotensin converting enzyme) inhibitor or ARB (angiotensin-receptor blocker). Understanding How Diabetes Affects Your Wallet Medical expenses for patients with diabetes are generally two to three times higher than patients without diabetes. In 2017, the average patient with diabetes spent about $16,750 on medical expenses, of which $9,600 was attributed directly to diabetes, according to the American Diabetes Association. The expenses are going to keep increasing. Experts predict the $408
iabetes is an epidemic in the United States despite continued medical advances and prevention efforts. As of 2015, 30 million Americans had diabetes. Almost one-fourth of those are undiagnosed, according to the American Diabetes Association. That means nearly 1 in 4 people in the U.S. is living with diabetes. About 95 percent of cases are Type 2. The remaining 5 percent are Type 1 diabetes cases that are usually diagnosed before age 40. Unfortunately, the rates continue to rise. Experts predict that by 2050, more than 100 million Americans — or 1 in 3 people — will be living with diabetes. Another 84 million Americans have prediabetes, a precursor to Type 2 diabetes — yet only 10 percent of them are aware of their condition. If no intervention occurs, there’s a 33 percent chance of prediabetes developing into full-blown Type 2 diabetes within five years. Already, the number of Americans with prediabetes is expected to hit 100 million by 2030. If you have diabetes or are at risk for it, understanding the disease and working with your doctor can help you minimize complications or prevent it. Here’s what you need to know.
billion spent to treat diabetes in 2015 will jump 53 percent to $622 billion by 2030.
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Preventing Complications Associated with Diabetes Poorly controlled diabetes raises your risk for a long list of serious conditions, including cardiovascular disease, kidney disease, nerve damage, blindness, osteoporosis, Charcot foot, and infections including sepsis. Moreover, recent studies have linked uncontrolled diabetes to Alzheimerâ€™s disease. Working with your doctor can help keep your sugar levels in a healthy range and address complications as soon as signs and symptoms arise. Preventing Diabetes Even though genetics plays a large role in prediabetes and Type 2 diabetes, adopting these lifestyle changes can help offset your risk.
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â€˘ Limit refined carbohydrates and sugar. If you need help cleaning up your diet, consult a dietitian.
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â€˘ Thomas Kurland, DO, is a primary care physician practicing in York, Pennsylvania, and is affiliated with MDVIP, the leader in personalized healthcare. He offers an annual wellness program that includes advanced screenings and tests to help detect, prevent, and/or treat diabetes, heart disease, and other serious conditions. To learn more, visit mdvip.com/ThomasKurlandDO. This article reflects the medical opinion of Dr. Thomas Kurland, an MDVIP-affiliated internal medicine physician, and not necessarily the opinion of all physicians in the MDVIP national network.
Kathleen Fellenbaum joined the
Brinley Fromm joined the Brown
Sara Kennedy comes to Members 1st Federal Credit Union as the senior vice president associate experience after nearly 20 years in human resources and training. She is a member of the Society for Human Resource Management.
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Jessica Stankovich has been promoted to vice president of the Lebanon Valley Chamber of Commerce. She has completed the U.S. Chamber of Commerce’s Institute of Organizational Management program and holds an IOM designation.
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Brown Schultz Sheridan & Fritz team as a staff accountant on the nonprofit team. Fellenbaum graduated from Penn State University, where she obtained her master’s degree in accounting. She was a former intern with BSSF.
small-business accounting associate to senior associate at Brown Schultz Sheridan & Fritz. A key member of the Small Business Accounting Services Department, she has been with the firm for nine years and is based out of the Lancaster office.
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5th Wednesday Networking Lunch 11:30 a.m. – 1 p.m. Held ONLY 5th Wednesdays of the year Rotating location – West Shore Area Wicked Kitchen 30 S. Main St., Mechanicsburg Mitzi Jones email@example.com American Business Women’s Association (ABWA) Camelot Chapter 6 p.m. 3rd Monday of the month The Radisson Penn Harris Hotel & Convention Center, Camp Hill Marianne Troy, President 717.802.5622 firstname.lastname@example.org www.abwa.org/chapter/camelot-chapter Lancaster Area Express Network 7:15 – 9 a.m. 3rd Wednesday of the month Lancaster Country Club 1466 New Holland Pike, Lancaster Amy Winslow-Weiss www.laen-abwa.org
Insurance Professionals of Lancaster County (IPLC) 5:45 p.m. 3rd Tuesday of the month, Sept. – May Heritage Hotel 500 Centerville Road, Lancaster Krista Reed, Treasurer email@example.com www.internationalinsuranceprofessionals.org
Yellow Breeches Chapter 6 p.m. 4th Wednesday of the month Comfort Suites 10 S. Hanover St., Carlisle Kerina DeMeester firstname.lastname@example.org
International Association of Administrative Professionals Capital Region of Pennsylvania LAN Meeting locations vary Pam Newbaum, CAP-OM, LAN Director 717.782.5787 email@example.com www.iaap-harrisburg-pa.org
Central PA Association for Female Executives (CPAFE) 1st Wednesday of each month Refer to website for the meeting location Lori Zimmerman, President 717.648.0766 www.cpafe.org
Pennsylvania Public Relations Society 5:30 p.m. Last Thursday of the month Larissa Bedrick, President firstname.lastname@example.org www.pprs-hbg.org
Executive Women International Harrisburg Chapter 5:30 p.m. 3rd Thursday of the month Rotating location Julie Young 717.713.7255 www.ewiharrisburg.org
Shippensburg Women’s Area Networking (SWAN) Noon 1st Wednesday of the month Rotating location Lisa Mack, President email@example.com www.facebook.com/shipswan
Women’s Business Center Organization (WBCO) A program of the York County Economic Alliance 11:30 a.m. – 1:30 p.m. 2nd Tuesday of the month September through May Heritage Hills Golf Resort & Conference Center Windows Ballroom (next to Oak Restaurant) 2700 Mount Rose Ave., York For more information on registering or membership, contact Sully Pinos at firstname.lastname@example.org Women’s Capital Area Networking (WeCAN) 11:30 a.m. – 1:30 p.m. 3rd Wednesday of the month Radisson Hotel 1150 Camp Hill Bypass, Camp Hill Abeer Allen, President email@example.com www.wecanconnect.org Women’s Network of York 11:30 a.m. 3rd Tuesday of the month Out Door Country Club 1157 Detwiler Drive, York Laura Combs, President firstname.lastname@example.org www.facebook.com/wnyork
Lebanon Valley Chapter 6 p.m. 4th Wednesday of the month Hebron Fire Hall 701 E. Walnut St., Lebanon Penny Donmoyer 717.383.6969 www.abwalebanonpa.com
Penn Square Chapter 11:45 a.m. – 1 p.m. 1st Thursday of the month Hamilton Club 106 E. Orange St., Lancaster Laurie Bodisch, President 717.571.8567 email@example.com www.abwapennsquare.org
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9 a.m. – 2 p.m.
Carlisle Expo Center 100 K Street, Carlisle
Check out this great lineup of entertainment and demonstrations at the Cumberland Women’s Expo! 9:30 a.m. – Why Handwriting is Still Important Presented by Mitzi Jones Mitzi will discuss why handwriting is still important in today’s digital world as well as what a person’s handwriting says about them. Handwriting analysis answers questions and provides insight. Come and learn a little about your personality through handwriting and how you can help with the Campaign for Cursive! 10:15 a.m. – Container Gardening: Learn from the Pros Presented by Michael A. Hasco, AIFD, Stauffers of Kissel Hill An associate at Stauffers of Kissel Hill, Mechanicsburg, Michael A. Hasco, AIFD, works in the greenhouse department. Join Michael as he shares how to create a seasonal, mixed container of annuals and perennials, rich with color, texture, and form. 11 a.m. – Women’s Self-Defense Presented by Leigh Wisotzkey, 2nd Degree Black Belt, Universal African Fighting 465 System, owner of Studio Solomon Leigh will demonstrate some simple self-defense escape techniques. With the help of a few students, Leigh will help us to understand simple ways to minimize risk, raise our awareness, and realize that we are already more equipped than we may think we are. 11:45 a.m. – A Stress-Free Holiday Season: Entertainment Tips and Easy Meals to Get You Through Presented by Debbie Kimble, Tastefully Simple Minimize the stress this holiday season and maximize the flavor with these tasty, time-saving dishes for brunch, lunch, dinner, and dessert, as well as a charcuterie board of appetizers to help you manage the holidays. 12:30 p.m. – Balloon Creations Presented by Karen Steyers, Hooplas, Etc. Karen, a certified balloon artist, will be demonstrating a few ways you can have fun with making balloon creations. She will show you how to easily make a Christmas present and flower arrangement and will share her love of all things balloon related.
Mini Massages • Wine Tastings • Shopping • and lots of fun!
aGreatWayToSpendMyDay.com 717.770.0140 • 717.285.1350
FREE advance guest registration online! ($5 at the door) Sponsors:
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