Issue 13 by Penn Highlands Healthcare

Issue 13

Health LINES Penn Highlands Healthcare

Here. Here for you. Here for our communities.

FIGHTING CANCER WITH

IMMUNOTHERAPY

Cutting-Edge Treatments Are Available Here INSIDE THIS ISSUE What Is A Hospitalist? Taking on Parkinson’s In BIG and LOUD Ways PHCN Recognized for Superior Performance Ask The Expert Why breastfeed your baby? Advice From A Doctor Suffer from chronic acid reflux and medications aren’t helping? Get Back in the Swing of Things: Rehabilitate at Your Local Hospital

Issue 13 | PENN HIGHLANDS HEALTHCARE

CEO Perspective

What is a Hospitalist?

Taking on Parkinson’s in BIG and LOUD Ways

Get Back in the Swing of Things PHCN Recognized for Superior Performance

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Fighting Cancer with Immunotherapy Ask The Expert - Why breastfeed your baby?

New Faces at Penn Highlands

Short Scripts

Advice From A Doctor

HealthLines is a publication of Penn Highlands Healthcare which includes the hospitals of Penn Highlands Brookville, Penn Highlands Clearfield, Penn Highlands DuBois and Penn Highlands Elk. It is produced by the system’s Marketing Team and is always available on our website at www.phhealthcare.org/magazine.

Don’t miss an issue! Subscribe now online!

If you wish to subscribe to HealthLines electronically, sign up at www.phhealthcare.org/getmagazine. Printed copies may be found in the waiting rooms of Penn Highlands Healthcare facilities throughout the region and at several local businesses. You may pick one up at anytime. For more information, please contact the Marketing Team at HealthLines@ phhealthcare.org or call on weekdays from 8:00 AM to 4:00 PM. The Penn Highlands Healthcare HealthLines Team Mary Jo Yebernetsky, Senior Coordinator/Editor, 814-375-3495 Mary Jo Herzing, Graphic Design/Web Specialist, 814-375-6539 Holly Shok, Marketing & Communications Coordinator, 814-375-6508 Michele Yale, Marketing & Communications Coordinator, 814-375-3494 The information in this magazine does not take the place of health advice given to you by your healthcare provider. Always call 9-1-1 for any emergency.

Greetings and happy New Year! On behalf of your care teams throughout Penn Highlands Healthcare, I wish you and your loved ones an abundance of health and happiness in the coming year. As we move full steam ahead into 2019, I’m exhilarated to think of the extraordinary goals Penn Highlands has set out to achieve – all to better serve you, our valued patient. We constantly monitor the needs of our communities and we never stop seeking out opportunities to better deliver the right care. To build upon our foundation for continued success, this year will find us busy with construction projects across the region as we work to grow our footprint with our eight-project Master Facilities Plan focused on enhancing your access to critical services, such as a Level III trauma center, and advanced care. Be sure to flip to page 13 for an update on our construction progress. In this issue of HealthLines, you’ll additionally learn about how we are helping patients in their fight against cancer with cutting-edge treatments like immunotherapy and how individuals with Parkinson’s disease are making smoother movements and speaking more clearly thanks to specialized therapy offered by our Rehabilitation Services team. In addition, Denny Tang, MD, FACS, discusses surgical treatment for individuals with acid reflux, and, as always, we’ve included information on the latest providers we are honored to welcome to our system. I hope you enjoy this edition and that you find the information provided to be useful to you. What the year ahead will bring may be a mystery, but what’s certain is that Penn Highlands will be here for you, providing the care that you need. Sincerely,

Next time you’re online Be sure to visit www.phhealthcare.org also check us out on

Steve Fontaine, CEO Penn Highlands Healthcare

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You visit your primary care provider for your ongoing health and wellness, but did you know that a different type of provider would care for you if you were hospitalized? Hospitalists – physicians boardcertified in internal medicine, physician assistants and nurse practitioners – are specialized in the care of patients in the hospital. They work in the hospital, caring for patients who have been admitted for any reason, from pneumonia to heart failure. They don’t offer outpatient primary care, but they have an office in the hospital and are available when needed for all admitted patients. Hospitalists care for inpatients at all four Penn Highlands Healthcare hospitals. “Being in the hospital can be overwhelming,” said Russell Cameron, MD, FACEP, Chief Medical Information Officer and Chief Medical Officer of Penn Highlands Healthcare. “Our hospitalists strive to simplify the experience and guide patients and their loved ones throughout the treatment process.” Patients’ primary care providers are still in the loop when it comes to their care. In fact, the two work as partners. Hospitalists communicate with primary care providers to learn about their previous care, health concerns and medications. In addition, hospitalists may identify and communicate with other specialists to ensure patients gets the care they need. Hospitalists can see patients more than once a day, if needed, and they work with all departments in the hospital to assist patients in a speedy recovery. They can follow-up on tests and adjust treatments throughout a patient’s stay. After hospital discharge, patients return to the care of their primary care provider who is informed on the clinical

What is a Hospitalist? details of their hospital stay. This helps to decrease interruption in a patient’s recovery. Hospitalists consider this type of care their specialty and keep up with the latest changes for the best outcomes for our patients. A typical provider may see 10 patients a year with a certain illness or problem while a hospitalist may see 100 or more with the same problem. This experience helps hospitalists provide more efficient care and reduces the length of time patients need to be in the hospital.

Did You Know? • The term "hospitalist" was first used in 1996 in an article for The New England Journal of Medicine. The specialty was just beginning to emerge. • As of the 20th anniversary of the profession in 2016, there were more than 50,000 hospitalists in the U.S., which meant the specialty was comparable in size to pediatrics.

The Hospitalists of Penn Highlands Healthcare are proud to serve our communities. Our team includes the following providers: Penn Highlands Brookville Robin Bilan, MSN, FNP Hy DePamphilis, MD Steven Graeca, DO Penn Highlands Clearfield Robert Coll, MD, FACP Shaun Patel, MD Penn Highlands DuBois Renee Allenbaugh, MD Beth Aughenbaugh, MSN, RN, ACNP-BC Zeke Feyock, MSN, APRN, FNP-C Kathryn Graham, DO Robert Guadagno, MD Riza Jose, MD Mark Maloney, DO Marissa Morgan, PA-S Dorly Nerval, MD Stacy Ann Rematt, CRNP Stacey Smiley, ACNP-B Brittany Starr, CRNP Edward Stevens, DO, PhD Lisa Vivian, PA-C Penn Highlands Elk Thomas Baker, MD Andrea Barber, CRNP Molly DeFrain, DO Julia Garcia, MD Amanda Meyer, PA-C Kapil Pruthi, DO Jayant Reddy, MD Kristen Schmader, DNP, AGACNP-BC

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

Taking on Parkinson’s In BIG and LOUD Ways

Rehabilitation Center of Penn Highlands Healthcare.

LSVT BIG and LOUD Program

Parkinson’s can limit a person’s ability to get up, move around and carry out activities of daily living. As the disease progresses over time, symptoms can worsen; however, LSVT can help to alleviate this progression by enhancing strength, mobility and speech skills, according to Nicole McMillen, occupational therapist at Penn Highlands Clearfield.

It was a morning just like any other for Laverne “Moose” Haviland, except that on this particular morning, the St. Marys resident woke up with the inability to straighten out his right hand.

LSVT BIG helps individuals make safer, smoother movements and LSVT LOUD helps individuals speak more clearly.

There are two types of LSVT therapy, LOUD and BIG. The programs may be completed individually or together. Each program is completed four days a week for four weeks with additional days as needed. • LSVT BIG is a physical and occupational therapy program that uses specific exercises involving large amplitude and exaggerated movement patterns, which lead to smoother, bigger, safer movements and an improved quality of life. • LSVT LOUD helps a patient speak louder and more clearly in all aspects of life, including in interactions with family and at work or social settings.

Moose was experiencing symptoms of tendonitis, but when surgery didn’t help to relieve all of his symptoms, his healthcare providers determined he additionally was challenged by Parkinson’s disease – a progressive disorder affecting certain nerve cells in the brain. For six years, Moose, 72, has lived with symptoms of the disease, including hallmark tremors in his right arm. His wife, Karen Haviland, said he often needed help with everyday tasks like writing out checks, lawn work and cutting up meals. However, the retired truck driver has taken his diagnosis in stride, and through everything, his wife and therapists say he’s never lost his sense of humor. “You lose that, you lose everything,” he said. “That and hope, I guess.” Moose’s hope for further relief from his symptoms was renewed when Karen learned about the Lee Silverman Voice Treatment, or LSVT, BIG and LOUD therapies offered by The

“Moose is challenged by his mobility because Parkinson’s causes tremors, muscle stiffness, slowed movement and loss of automatic movement,” Nicole said. “Often, individuals with Parkinson’s think they are making large movements, such as when taking steps, but in reality they are not. The goal with LSVT BIG was for him to use big movements in everyday tasks.” Moose additionally completed the LSVT LOUD program, which helped him to get his voice out louder. Since completing both therapies in the fall of 2017, Moose said the tasks of everyday living are just a little bit easier.

To see Moose talk more about his experience with Parkinson’s and the LSVT BIG and LOUD therapy, visit www.phhealthcare. org/Moose

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The Rehabilitation Center at Penn Highlands Clearfield offers LSVT BIG and LOUD. Call 814-768-2285 for more information. The Rehabilitation Center at Penn Highlands Elk offers LSVT LOUD. Call 814-788-8490 for more information. “I’m able to move and get around,” he said. “I just want to get out and see the top of the grass, see the sun.” “LSVT is not a cure, but we definitely see improvement in our patients’ everyday lives,” Nicole said. “The treatment can be tailored to the needs of each patient. The sooner you begin, the better your outcome.” Moose Haviland

Nicole McMillen, occupational therapist at Penn Highlands Clearfield, helps Tony Stefani make bigger movements as part of LSVT BIG therapy.

Speaking Up to Parkinson’s Sigel resident Tony Stefani, 74, has been living with Parkinson’s for the past couple of years. Like many individuals and family members coping with the diagnosis, he and his wife, Suzy, knew very little about physical therapy, occupational therapy and speech therapy options for treating Parkinson’s. What they did know is that the disease made it difficult for Tony to speak loudly. “I think I’m speaking at a normal tone, but everyone says I’m whispering, so I have to shout, or at least what I think is shouting,” said Tony, who is retired from the Engineering Department of U.S Steel Corporation. The struggle was evident when the duo was teaching a hunter safety course for the Pennsylvania Game Commission. Suzy remembers thinking about the kids in the back and how they probably couldn’t hear what Tony was saying. “I wondered why they never asked any questions,” he said with a laugh.

“Many people with Parkinson’s often feel they are yelling when they hear themselves talk because their sensory system has been compromised,” Heather Bradybaugh, occupational therapist at PH Clearfield, said. “The LOUD therapy helps to recalibrate that sensory system.” Tony underwent both BIG and LOUD therapies and since graduating from the program activities like buttoning a shirt, tying his shoelaces and picking things up are easier for him. “It’s not a cure, but I’m definitely better off than I was,” he said, noting that he’s taught three hunter safety classes since treatment and can definitely notice a difference in the projection of his voice.

Here to Help You Cope We offer Parkinson’s Support Groups for those with Parkinson’s or another related condition as well as family members and caregivers of someone with Parkinson’s. The meetings, which consist of education, personal stories and social time, are free to attend. Parkinson’s Support Group - PH Clearfield Held every first Wednesday of the month from 1:00 PM to 2:30 PM in the first floor conference room at Penn Highlands Clearfield. Call 814768-2285 to learn more. Parkinson’s Support Group - PH DuBois Held every third Wednesday of the month from 1:00 PM to 2:30 PM at the Parkside Community Center at 120 W. Park Avenue, DuBois. Call 814-375-3372 to learn more.

“It is remarkable to see the progress Moose, Tony and other patients have made with the LSVT To learn more program,” Heather said. “We about Rehabilitation witness firsthand how the Services at Penn therapies help them to Highlands Healthcare, regain confidence. Many visit www.phhealthpatients feel as though they’ve regained their life.” care.org/rehab.

Then they learned about the LSVT BIG and LOUD program at Penn Highlands Healthcare. Need a doctor? — Visit us at www.phhealthcare.org/findadoc

Get Back in the Swing of Things: Rehabilitate at Your Local Hospital

At Penn Highlands Healthcare, we understand there are times when patients no longer need the acute care they receive in our hospitals — yet, they may not feel strong enough to return home. For those patients, we offer a comforting alternative. Penn Highlands Healthcare offers a Swing Bed Post-Acute Rehabilitation Program at all four hospital locations – Penn Highlands Brookville, Penn Highlands Clearfield, Penn Highlands Elk and Penn Highlands DuBois. Why get rehabilitation services out of town when you can stay close to home or come home from somewhere else? This program is designed to provide patients with individualized, in-hospital care and physical rehabilitation to help them reach an optimal level

of functioning. It is designed for patients who are discharging, but need temporary additional care that cannot be provided at home or in a long-term care facility. Through a combination of first-rate rehabilitative therapies, attentive nursing care and medical supervision, patients gain the strength, functionality, balance and range of motion they need to care for themselves with confidence. Who could benefit from the swing bed program? • Patients who need rehabilitation or therapy after orthopedic surgery, such as joint replacement. • Patients recovering from a stroke who do not qualify for admission to an inpatient rehab center. • Patients receiving IV therapy or wound care. • Patients needing to regain strength and mobility after an illness, injury or surgery.

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• Patients needing diabetic management. Patients receive skilled rehabilitation, evaluation and treatment services three to six days a week, or as prescribed by physicians, nurses, dieticians, physical therapists, occupational therapists, speech therapists, pharmacists and case management staff. Each patient makes progress based on individual medical needs and rehabilitative potential. The

Did you know? Patients in a swing-bed program: • • •

Wear their own comfortable clothing. Can join in fun activities planned by staff. Have therapy staff come to them.

Penn Highlands Community Nurses To learn more about Swing Bed services at Penn Highlands Healthcare, visit www.phhealthcare.org/swingbed.

multidisciplinary team continuously monitors progress and evaluates new goals until they determine you are ready for discharge. Medicare and most insurance companies cover post-acute rehab services. These services are usually covered under the “skilled nursing facility” benefit category. Medicare and state regulations require that a patient must be hospitalized as an “acute care inpatient” (not an “observation patient”) for a minimum of three consecutive midnights within a 30-day period and admissions can come from any hospital after three consecutive midnights as an inpatient in acute care. Of course, all insurances can vary and should be called for details.

If you have any questions about swing-bed at Penn Highlands, call our Case Management offices: Penn Highlands Brookville 814-849-1881 Penn Highlands Clearfield 814-768-2384 Penn Highlands DuBois 814-375-3528 Penn Highlands Elk 814-788-8213

Recognized for Superior Performance Penn Highlands Community Nurses serves more than 1,000 patients throughout the region each day and strives to remain at the forefront of home care delivery. As the after-hospital care industry evolves, it is essential for home health and hospice providers to increase their efforts on performance improvement. Recently, PHCN received a special recognition from the Strategic Healthcare Programs, or SHP, a leader in performance improvement for post-acute care providers. Our Home Health services and our Hospice services in the DuBois and St. Marys regions are proud recipients of the SHP Best Superior Performer award. For Home Health, this award recognizes that our services achieved and overall score that ranked in the top 20 percent in the SHP national Home Health Care Consumer Assessment of Healthcare Providers and Systems, or HHCAHPS, benchmark and scored above the SHP national average for each HHCAHPS quality measure during the 2017 calendar year. HHCAHPS is the satisfaction survey given to our patients after they are discharged from our Home Health care. For Hospice, this award recognizes that our services achieved an overall score that ranked in the top 20 percent in the SHP national Consumer Assessment of Healthcare Providers and Systems, or CAHPS Hospice benchmark and scored above the SHP national average for each CAHPS quality measure during the 2017 calendar year. The CAHPS Hospice Survey was designed to measure and assess the experiences of patients in hospice care, as well as the experiences of their informal primary caregivers. These awards are a testament to the efforts of the hard-working team at PHCN.

Become A Volunteer

There are many wonderful volunteer opportunities at PH Community Nurses, including: Hospice, senior outreach, and with our events and fundraising. www.phhealthcare. org/volunteer

“We are proud of this accomplishment,” Kim Kranz, RN, MS, Service Line Director of Penn Highlands Community Nurses, said. “These nationally-recognized awards directly reflect the experience of our patients and their family members. We will celebrate this success, but we will also strive to do even better and continue to provide tremendous outcomes that meet and exceed expectations.”

Need a doctor? — Visit us at www.phhealthcare.org/findadoc

FIGHTING CANCER WITH

IMMUNOTHERAPY

Cutting-Edge Treatments Are Available Here There have been several ways to fight cancer for a while now. We have used medications to kill the cancer cells through chemotherapy. We have used radiation pinpointed at the cells to stop their growth. We have removed cells through surgery. Today, however, we know that in some cases our bodies can be the best weapon in the fight. Today, some cancers are being targeted by something newer immunotherapy. “Immunotherapy, which is often called biotherapy, is a type of cancer treatment with the intent to boost the body's own natural defenses to fight cancer,” according to Adam Wisor, certified registered nurse practitioner with Oncology Hematology Associates of Northern Pennsylvania, PC. This is a medical oncology practice with offices at Hahne Regional Cancer Center in DuBois, the Nathaniel D. Yingling, MD, Cancer Center in Clearfield, at Penn Highlands Brookville and at Penn Highlands Elk – Ridgway Campus. “It uses substances made by the body or in a laboratory to improve and/ or restore the body’s own immune system function,” he said. The body’s own defenses are boosted to fight the cancer cells. Some medications stimulate the immune system to work harder to attack cancer cells, and some can give an immune system the proteins or another component to fight cancer cells.

“It is useful in a number of types of cancer. Different solid tumor types have been effectively treated with immunotherapy with much more tolerable side effects,” Adam said. Unfortunately, not every patient can benefit from it. “The tumors require specific molecular testing prior to starting therapy. There are specific cell structures that indicate when it will be effective,” he added. Immunotherapy is just in its earliest stages of use. “Immunotherapy and biotherapy techniques have been in development for a number of years. However, it has just been recently that this has become a more widely approved approach to treating cancer patients as more immunotherapy agents have been developed allowing us to provide these treatments through our office,” according to Adam. IN THE NEWS Immunotherapy has been in the news with the Nobel Prize in physiology or medicine awarded in early October to cancer researchers James P. Allison, chair of the immunology department at MD Anderson Cancer Center in Houston, Texas, and Tasuku Honjo of Kyoto University in Japan. Their studies led to the groundbreaking drugs that unleash the immune system against the deadly disease. These successes came after many researchers had given up on the idea. Dr. Allison studied a protein that previously had been identified as a restraint on the immune system, while Dr. Honjo discovered another protein that keeps the immune system at bay.

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Their breakthroughs led to lasting remissions to many patients who had run out of options. A PATIENT’S STORY At Penn Highlands Healthcare, we are ecstatic that our patients can have this therapy offered to them. One patient who has benefited from immunotherapy is John Bullers of Rockton. John has been receiving immunotherapy treatments since May 2017 and is one of the first patients to do so through Oncology Hematology Associates of Northern PA at Hahne Regional Cancer

Center. John has bladder cancer that he has been fighting for the past 10 years. John first noticed his cancer after a workout at the DuBois Area YMCA. Using the restroom, he saw blood, but didn’t think much of it. When he went home, he saw blood again, and his son looked up the symptom online. Though the bleeding stopped, his family’s – especially his wife’s- persistence got him to a doctor’s office for an appointment, testing and a diagnosis. He has been through surgery to remove the tumor off of his bladder. He had a blockage removed from his kidney and urethra. He has had chemotherapy. Toward the end of this chemotherapy, he had radiation therapy for his enlarging lymph nodes. “The cancer I have is really aggressive,” he said. He heard about immunotherapy here and there, but he didn’t ask about it. “They brought it up,” he said. When asked about trying it, he said yes. With immunotherapy, he goes every 21 days to Hahne Regional Cancer Center to receive the medicine via IV drip that lasts about 45-minutes to an hour, and he has noticed the difference.

“I have a normal life other than that (going for treatment),” John said. The results have been that other lymph nodes were reduced in size to being an insignificant health issue and without any of new disease progression. Though the treatment is given in the chemotherapy room, it doesn’t react the same. There are no noticeable side effects for John. He doesn’t have the sore muscles or joints that he did from chemotherapy. He has kept his hair. “I don’t feel overwhelmed by it,” John said. “I am more at ease and more confident the treatment is working… My energy level is good. I can feel the difference. Chemotherapy really ran me down. I was in bed as early as 6:00-7:00 PM to recover during the week. With this, I am in bed at 9:00 PM and up at 3:00-4:00 AM for work” At age 62, John is still climbing and trimming trees. He works full-time for Asplundh tree trimming service and for his own business trimming trees for residential customers. He is also golfing regularly. HOPE “I think that it is an exciting new direction for our profession,” Adam said. “Immunotherapy gives us a new and very effective treatment option - especially for those where chemotherapy and radiotherapies have failed in the past.” And as research continues and medicines are developed, the possibilities for the future should be amazing.

Cancer Treatment at Penn Highlands Healthcare

Cancer care experts at Penn Highlands Healthcare offer the treatment you need in the fight against cancer. Medical oncologists, or cancer doctors, from Oncology Hematology Associates of Northern Pennsylvania, PC, provide the best plan for treatments at four locations - Hahne Regional Cancer Center in DuBois, the Nathaniel D. Yingling, MD, Cancer Center in Clearfield, Penn Highlands Brookville and Penn Highlands Elk – Ridgway Campus. Medical oncologists specialize in managing drug treatments, or chemotherapies, and immunotherapies. They also prescribe surgeries and radiation. Radiation oncology is provided at Hahne Regional Cancer Center under the guidance of a physician called a radiation oncologist. Specially trained staff use a machine called a linear accelerator to direct painless, high energy radiation at cancerous tissues. At Hahne, the TrueBeam system, delivers powerful cancer treatments with pinpoint accuracy and precision. This system has opened the door to new possibilities for the treatment of lung, breast, prostate, head and neck, and other cancers. Of course, patients are never alone in the fight against cancer. There are social workers, nutritionists, therapists, chaplains and more. Penn Highlands can even help with transportation. To learn more about cancer care at Penn Highlands Healthcare, go to www. phhealthcare.org/cancer.

Adam Wisor, CRNP, talks with John Bullers as he receives his immunotherapy infusion at Hahne Regional Cancer Center. Need a doctor? — Visit us at www.phhealthcare.org/findadoc

ASK THE EXPERT - Why breastfeed your baby? Why is breastfeeding good for baby? The American Academy of Pediatrics supports that breastfeeding is the optimal source of nutrition for most babies for the first year of their life. The unique components of human milk help protect babies against illnesses and diseases, such as asthma, eczema, diabetes, gastrointestinal infections, ear and lung infections, inflammatory bowel disease, leukemia, lymphoma, future obesity and sudden infant death syndrome, or SIDS.

Breastfeeding is encouraged at Penn Highlands Healthcare because of the many benefits. Breastfeeding is a skill, and at the Maternal and Child Centers, there are experts to help new moms who want to learn.

How long should a mother breastfeed? Moms can exclusively breastfeed for the first six months of a baby’s life and then to continue breastfeeding while gradually introducing complementary foods until 12 months of age. Of course, breastfeeding can then be continued as long as mom and baby so desire.

To learn more about Penn Highlands Maternity Services, vist us on the web at www.phhealthcare. org/baby

What are the benefits to a breastfeeding mom? Mother’s receive both emotional and health benefits from breastfeeding. Prolactin and oxytocin, hormones released during breastfeeding, further promote a mother’s strong sense of love and attachment to their baby. Overall satisfaction and confidence are increased by the release of these breastfeeding hormones that naturally reduce stress. Beyond emotional satisfaction, mothers who breastfeed recover from childbirth more quickly and easily. Oxytocin helps return the uterus to its regular size more quickly and reduces postpartum bleeding. Women experience reduced rates of breast and ovarian cancer later in life. Some studies have also found that breastfeeding reduces the risk of developing diabetes, arthritis, heart disease, osteoporosis and postpartum depression. Mother’s may also feel they benefit practically. Breastfeeding is much less expensive than formula. Night feedings and on-the-go feedings are simpler. It is also environmentally friendly as there are no bottles or empty formula containers.

Melanie Snyder, RN, BSN International Board-Certified Lactation Consultant Penn Highlands DuBois Maternity Unit Katie Gnan, RN International Board-Certified Lactation Consultant Penn Highlands DuBois Maternity Unit

The Maternal and Child Center offers breastfeeding support groups for all moms that are breastfeeding or have in the past who would like to meet and discuss the positives and challenges of breastfeeding. The goal is to provide support, tips and answers to your questions. Visit us at www.phhealthcare.org/supportgroups.

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Who at the hospital can help a breastfeeding mom? And how? All nursing staff in the Maternity Units at Penn Highlands DuBois and Penn Highlands Elk have received a minimum of 16 hours of breastfeeding education. We also have two nurses that are International Board Certified Lactation Consultants, or IBCLC, and eight Certified Lactation Counselors, CLC Our IBCLCs and CLCs have experience and advanced training on breastfeeding and can help you be successful with it. Outside of the hospitals, moms can visit the local WIC office or attend any of our breastfeeding support groups hosted by our staff.

Kristin Harriger, RN, BSN Certified Lactation Counselor Penn Highlands DuBois Maternity Unit Is breastfeeding hard to learn to do? Although breastfeeding is a natural way to feed children, it is still a learned process for both mother and newborn. With the right support system, mothers can have great success and satisfaction from breastfeeding. The best time to build that breastfeeding support team is while pregnant. This team should include your family, friends and your healthcare team, including a lactation counselor or consultant, pediatrician and obstetrician. Will my diet change? Not really! Breastfeeding requires an additional 400-500 calories per day, and the breastfeeding mother should eat a well-balanced diet rich in protein, whole grains, fruits and vegetables. Eating a variety of foods also helps to change the

flavor of breastmilk, exposing the infant to a variety of tastes and can make the introduction of solid foods easier.

Kathleen Pletcher, RN, BSN Certified Lactation Counselor Penn Highlands Elk Maternity Unit Can preterm babies in the NICU be breastfed? Yes, preterm babies can breastfeed. Whenever the preterm infant is medically stable to be introduced to the breast, it is certainly possible to get a premature infant to successfully breastfeed. There are many factors to take into consideration with a preterm infant, such as gestational age at birth, postbirth age, breathing abilities and the infant’s abilities. With this being said, it is extremely important that breast pumping is initiated within the first three hours after birth and consistently every 2-3 hours after that to aid in the establishment of an adequate milk supply until the infant is able to successfully breastfeed. Thankfully, there are assistive devices such as supplemental nursers and nipple shields that can be used to make breastfeeding a preemie more achievable until they are able to build the endurance and coordination to breastfeed without any assistive devices.

Are there times a mother should not breastfeed? Breastfeeding is best for baby, but there are a few circumstances in which you may not be able to breastfeed your baby. It could be that an infant is diagnosed with galactosemia, a disorder that affects how a baby processes lactose/galactose. Or it could be that the mother is: • Taking antiretroviral medications or is positive for HIV • Undergoing chemotherapy or radiation treatments • Diagnosed with Hepatitis C and has a cracked nipple with bleeding • Diagnosed with human T-cell lymphotropic virus • Using street drugs. There are a few circumstances in which a mother should not feed directly from the breast but can feed her infant expressed milk. These circumstances are: if the mother is positive for H1N1 flu virus, has an active herpes lesion on the breast or has chickenpox. Any mother that has concerns about breastfeeding her baby should talk to her ob/gyn or pediatrician. .

Danielle Assalone, RN, BSN Certified Lactation Counselor Penn Highlands DuBois Maternity Unit

Autumn Nesbitt, NNP Certified Neonatal Nurse Practitioner Penn Highlands DuBois Neonatal Intensive Care Unit Need a doctor? — Visit us at www.phhealthcare.org/findadoc

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AT PENN HIGHLANDS Weâ&#x20AC;&#x2122;re proud to introduce the newest members of our healthcare team. They look forward to being there for your healthcare needs.

Molly DeFrain, DO Hospitalist Penn Highlands Elk 763 Johnsonburg Road St. Marys, PA 814-788-8000

Thomas Eckert, MD Cardiovascular and Thoracic Anesthesiologist The Heart Center 100 Hospital Avenue DuBois, PA 814-375-7700

Michael Blose, PA-C Certified Physician Assistant Penn Highlands Clearfield Emergency Department 809 Turnpike Avenue

Sami Elsayed, MD Interventional Radiologist Penn Highlands DuBois Radiology 100 Hospital Avenue DuBois, PA 814-375-3261

Penn Highlands Elk Emergency Department 763 Johnsonburg Road

Matthew Irwin, DO Orthopedic Surgeon Penn Highlands Orthopedics 807 Turnpike Avenue Suite 220 Clearfield, PA 814-299-7432

Kaitlyn Corby, PA-C Certified Physician Assistant Penn Highlands Clearfield Emergency Department 809 Turnpike Avenue Clearfield, PA

761 Johnsonburg Road Suite 310 St. Marys, PA 814-834-1686

Robin Hammersley, CRNP Certified Registered Nurse Practitioner Penn Highlands Family Medicine 416 N. Broad Street, Suite A Emporium, PA 814-486-2002

Jo Dee Mulhollan, FNP Family Nurse Practitioner QCare DuBois 621 S. Main Street DuBois, PA The Clinic at Walmart 20 Industrial Drive DuBois, PA

Penn Highlands Elk Emergency Department 763 Johnsonburg Road St. Marys, PA

Rashmi Mishra, MD Pulmonary Medicine Penn Highlands Lung Center Penn Highlands Professional Building 531 C Hannah Street Clearfield, PA 814-375-3770 Moshannon Valley Community Medical Building 271 Railroad Street Philipsburg, PA 814-375-3770

Christopher Curran, PA-C Certified Physician Assistant The Lung Center Penn Highlands DuBois 100 Hospital Avenue DuBois, PA 814-375-3770

Jennifer Parker, PA-C Certified Physician Assistant QCare Cameron County 416 N. Broad Street Emporium, PA QCare Ridgway 104 Metoxet Street Ridgway, PA QCare St. Marys 761 Johnsonburg Road Suite 160 St. Marys, PA

To find a Primary Care Office location closest to you, visit us at www.phhealthcare.org/primarycare 12 |

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Project Updates

PENN HIGHLANDS HEALTHCARE MASTER FACILITIES PLAN Taylor Schlimm, PA-C Certified Physician Assistant QCare Cameron County 416 N. Broad Street Emporium, PA QCare Ridgway 104 Metoxet Street Ridgway, PA QCare St. Marys 761 Johnsonburg Road Suite 160 St. Marys, PA

Sydney Soberdash, PA-C Certified Physician Assistant QCare DuBois 621 S. Main Street DuBois, PA

Sara Wolbert, FNP Family Nurse Practitioner QCare Brookville 111Summit Street Brookville, PA

Marissa Zocco, PA-C Certified Physician Assistant Penn Highlands Family Medicine 145 Hospital Avenue, Suite 204 DuBois, PA 814-371-4361

Between 2018 and 2021, Penn Highlands Healthcare is implementing a $111 million Master Facilities Plan designed to enhance access to critical services and advanced care for the residents of Northwestern/ Central Pennsylvania.

You can help us grow. Your donation will help bring even more advanced care right here. Go to www.phhealthcare. org/footprint.

The Master Facilities Plan triggers eight major expansion and renovations projects to modernize and improve upon the services we offer patients at our four hospital campuses and numerous outpatient facilities in the 12-county region we serve. These projects include the West Wing Annex at Penn Highlands DuBois, the Penn Highlands DuBois East Campus Behavioral Health Hospital, the Penn Highlands DuBois Emergency Department/Patient Tower, the Penn Highlands Healthcare Center of Excellence in DuBois, the Penn Highlands Clearfield Hospital Renovations, the Brookville Medical Office Building, the Clarion Community Medical Building and renovations at Pinecrest Manor in St. Marys. Work is underway on the West Wing Annex Project in DuBois. This will make way for the new Emergency Department and Patient Tower, which will be built next. Construction kicked off June 4, 2018, and is expected to be completed in October 2019. “It’s going very well,” Brad Long, Director of Design and Construction at PH DuBois, said. “Everyone is doing a great job and we’re looking forward to getting to work on the build outs.” Brad, who is overseeing all of the construction projects, also pointed out that construction will begin at the site of the new Center of Excellence in DuBois in the spring. The project is expected to be completed by early 2020. Additionally, in preparation for the project at the PH DuBois East Campus Behavioral Health Hospital, demolition of the Tyler Building and houses has been completed. Construction is scheduled to begin in the spring.

The renovations at Pinecrest Manor are about get begin, as well. Work is scheduled to begin this winter with project completion expected in the spring of 2021. All remaining projects are anticipated to launch this spring and summer.

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ShortScripts

Penn Highlands Healthcare is committed to not only serving those who need immediate medical attention, but providing education and wellness events that help to build healthier communities over time. Get involved in your health and the healthcare of your community. Events are held throughout the year on each of our hospital campuses and across the region to promote, inform and celebrate health and wellness. See what’s going on at Penn Highlands Healthcare this month!

Visit us at phhealthcare.org/ events Online Bill Pay Penn Highlands Healthcare makes it easier to pay your bill with online bill pay. Visit us at www.phhealthcare. org/payyourbill.

Support Groups Penn Highlands Healthcare offers a variety of Support Groups to help people deal with illness, loss or stressful life changes. The groups, which are presented by members of the Penn Highlands Healthcare team, are designed to answer your personal questions. • Breast Cancer Support Group • Breastfeeding Support Group • Cardiac Support Group • Coping With Loss • Dementia Support Group • Diabetes Support Group • Healing After Loss • HUGS for Kids and Teens • Mom-To-Mom Breastfeeding • Ostomy Support Group • Parkinson’s Support Group • Prostate Support Group • Smoking Cessation Support Group • Sleep Health Patrol Support Group • Stroke Support Group Visit us at www.phhealthcare.org /supportgroups

Community CPR Classes Heartsaver AED and First Aid Training are held regularly throughout the year at Penn Highlands Brookville. Cost is $25 and classes usually run from 5:00 - 8:00 PM. in the PH Brookville Education Conference Center next to the hospital. Call 814-849-1870 to register.

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Volunteer with Penn Highlands Healthcare If you have strong desire to help others and make a difference, then donate your time and talents by volunteering at a Penn Highlands Healthcare facility. Our volunteers truly make an impact on the quality of care we provide for the region. Volunteering is for all ages: • Adults • College students • Youth ages 16-18 Steps to becoming a volunteer: 1. Interview 2. Application Process 3. Orientation 4. Training You can apply online at www.phhealthcare.org/ volunteers or for more information, contact: Penn Highlands Brookville 814-849-1474 Penn Highlands Clearfield 814-768-2419 Penn Highlands DuBois 814-375-2316 Penn Highlands Elk 814-788-8520 Penn Highlands Community Nurses 800-841-9397

Send an eCard - Penn Highlands Healthcare invites you to send some cheer to brighten the spirit of a loved one who is in the hospital! A free service, you can send an eCard to patients in any of our hospitals. www.phhealthcare.org/eCard

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Penn Highlands has My eHealth Portals available for all patients at www.phhealthcare.org/ myehealthportal. Get your username and password at your next visit with your health provider.

for the Penn Highlands Healthcare Golf Classic on Friday, June 21, 2019! Plans are underway for the 2019 Penn Highlands Healthcare Golf Classic. This one-of-a-kind tournament will be held on June 21 with a 9:00 AM tee time at each of the following golf courses: • Eagles Ridge Golf Course, Curwensville • Bavarian Hills Golf Course, St. Marys • Pinecrest Country Club, Brookville • Treasure Lake Silver Course, DuBois Golfers are able to choose the location they wish to golf. We are very excited to be able to hold this tournament in four local communities all on the same day! The day includes great golf, skill contests, raffles, prizes, food and drinks all day long. To top off the day, golfers will enjoy happy hour and dinner immediately following golf at the course played. For more information or to register, e-mail dhaney@phhealthcare.org, call 814-375-3901.

2018 HAP Donate Life Pennsylvania Hospital Challenge Penn Highlands Healthcare hospitals were recently recognized as part of a state-wide effort to raise awareness for organ donation, the 2018 HAP Donate Life Pennsylvania Hospital Challenge. HAP, the Hospital and Healthsystem Association of Pennsylvania, partnered with hospitals, the Center for Organ Recovery & Education, CORE; Gift of Life Donor Program; and the Pennsylvania Department of Health to raise awareness of organ donation. As activities were tallied, titanium, platinum, gold, silver and bronze level recognitions were given. For PHH, the awards were: Penn Highlands Elk – titanium, the highest level, new this year, and Penn Highlands Clearfield, Penn Highlands Brookville and Penn Highlands DuBois – all platinum. “Though our hospitals do not perform transplants, our patients are often the recipients of life-saving procedures or on waiting lists for them. We see first-hand the value of organ donation, and this is just one more way we can help save lives,” Debra Thomas, RN, BSN, MHA, Chief Nursing Officer at PH Brookville and PH Clearfield, said “We encourage everyone to consider signing up to someday be a donor. By donating organs, one individual can help up to eight people, while tissue donors can improve the lives of up to 50 people,”

someone new is added to the organ list.” “There are also opportunities to be a kidney or liver donor while you are alive and healthy,” Rhonda Chilson, RN, Director of Quality and Infection Control, at PH Elk said. To learn more about organ donation, go to www.core.org or to sign up to become a donor, go to www.registerme.org. Do you fill out your surveys? Patient surveys are sent after a stay at one of our hospitals. If you receive one, please fill it out. We want to know how we are doing. Some come via U.S. Mail (especially if you are a Medicare patient) and others may come via e-mails and text message.

Connect with us by visiting our new website at www.phhealth care.org.

Barbara Barnett, RN, Nursing Supervisor of PH DuBois, said. “Each day, a million people await tissue and cornea transplants, while every 10 minutes

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Advice From A DOCTOR

Bravo pH study. This involves placing a tiny, wireless device on the wall of your esophagus that measures and records the pH levels there. The measurements Penn Highlands gathered allow General Surgery me to confirm the 814-849-1382 presence of acid and correlate it to your symptoms. This evaluation is helpful to planning the best treatment for your diagnosis.

Denny Tang, MD, FACS

pain, asthma, chronic dry cough and difficulty swallowing.

Suffer from chronic acid reflux and medications aren’t helping? Are there surgical treatment options available? It’s not uncommon for individuals experiencing acid reflux to seek surgical treatment. Medications don’t work for everyone, and even if they did, many people don’t want to take them. Some have difficulty remembering to take them and others simply don’t want to rely on medication for the rest of their lives. At Penn Highlands General Surgery, we are able to offer surgical treatment for this issue. One such procedure is called a Nissen Fundoplication. This procedure has been around since the 1950s and has been used to treat chronic heartburn and the non-typical symptoms of reflux such as voice hoarseness, atypical chest

The Nissen is performed laparoscopically and requires five small incisions. During the procedure, which takes, on average, 1.5 to 2.5 hours, the surgeon uses the stomach to wrap around the esophagus, essentially creating a turtleneck around it. This 360 degree wrap prevents the acid inside of the stomach from moving up the esophagus. A hiatal hernia, if present, can also be repaired during this operation. Before undergoing surgery, there are some important steps to take to ensure that the Nissen is the best option for your situation. These steps may include other procedures that can be done to assess if reflux is the cause of your symptoms, as well as the damage caused by the reflux and to help determine if a patient is a good candidate for the Nissen. Often, the first procedure performed is an esophagogastroduodenoscopy, or EGD. An EGD allows your doctor to examine the lining of the esophagus, stomach and duodenum, or the first part of the small intestine just beyond the stomach. A hiatal hernia can often be visualized, too. This procedure may also include a biopsy of any growths found in the esophagus. Another step that I recommend is a

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Patients can expect to notice a difference in their symptoms within the first 24-48 hours after having the Nissen. They are able to stop taking their reflux meds right away. Often, patients can expect a one night stay in the hospital following this operation. Mild pain or discomfort is normal for three to five days following surgery, however, many patients return to work within a week, as long as they aren’t required to lift or strain. Additionally, patients should expect a consultation with a dietician to ensure they understand the dietary restrictions that are necessary for recovery from the operation. It’s recommended that patients follow a liquid diet for approximately one week following surgery, and then they can follow a soft foods diet for approximately three weeks. From there, I recommend that they slowly begin introducing regular foods into their diet, being sure to take small bites and chew them well. In addition to the Nissen, there are other surgical options available at Penn Highlands Healthcare. My colleagues and I are always happy to discuss these options and help you find the treatment that we believe will yield the best possible outcome. The best advice I can offer is to seek treatment if you’re dealing with symptoms associated with chronic reflux, especially if your symptoms are not well controlled. You do not have to live with this and you do not have to spend a lifetime relying on medications.