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SPRING 2016

Health LINES Penn Highlands Healthcare

Working together for a healthy community.

You Can Live Well With Diabetes Don’t miss an issue! Subscribe now to this Digital Magazine. See Page 2


WINTER 2016 | PENN HIGHLANDS HEALTHCARE

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Cover Story You Can Live Well With Diabetes

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The Maternal and Child Centers

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Laboratory Services

HealthLines gives you the most up-to-date news about services at the four Penn Highlands hospitals and what is available to help you lead a healthier life. The Penn Highlands Healthcare system covers eight counties in western Pennsylvania with 75 miles from east to west. We hope this is a tool that will keep you informed about what is happening in healthcare throughout your region.

6 Quality 10 New Faces 11 In-Home Sleep Studies 12 Adult Vaccines 14 Pulmonary Rehabilitation 16 ShortScripts

This FREE magazine will always be available: • On our website, www.phhealthcare.org/magazine. • By email, get on our e-subscription list by filling out the online form at www.phhealthcare.org/getmagazine; you will receive an e-mail directly to you as soon as it hits the newsstands. • In the lobbies, waiting rooms and offices throughout the Penn Highlands Healthcare system, you can pick up a hard copy of this magazine. The magazines are also available at the DuBois Mall Community Booth.

Don’t miss an issue! Subscribe now to this Digital Magazine.

HealthLines is a publication of Penn Highlands Healthcare. It is produced quarterly by the Marketing Team of Penn Highlands Healthcare which represents the four hospitals of the Penn Highlands system – Penn Highlands Brookville, Penn Highlands Clearfield, Penn Highlands DuBois and Penn Highlands Elk.

The HealthLines magazine will always be available on our website at www.phhealthcare.org/magazine. If you wish to subscribe to HealthLines, sign up at phhealthcare.org/getmagazine. For more information please contact the Marketing Team at HealthLines@phhealthcare.org or call on weekdays from 8:00 a.m. to 4:00 p.m. Printed copies may be found in the waiting rooms at Penn Highlands Healthcare facilities throughout the eight-county region. You may pick one up at anytime if you prefer. The information in this magazine does not take the place of health advice given to you by your healthcare provider. Always call 911 for any emergency. The Penn Highlands Healthcare HealthLines Team Mary Jo Yebernetsky, Writer/Editor, 814-375-3495 Mary Jo Herzing, Graphic Design Specialist, 814-375-6539 John Brennan, Marketing/PR Director, 814-375-3494 Amy Duke, Marketing/PR Director, 814-768-2827 Karen Hazlett, Marketing/PR Specialist, 814-788-8532 Brian Musser, Community/Physician Outreach Specialist, 814-375-6508 Lori Rancik, RN, The Women’s Health Center, 814-371-9666

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Welcome to Penn Highlands

If you don’t see the magazine in your visits to our facilities, our magazine will also be available, for those who request it, via U.S. Mail. To the left of this column is a list of names and phone numbers of our team. Call for a copy to be mailed to you as they come off the presses. Share your name, address and telephone number if you leave a message.

Next time you’re online Be sure to visit www.phhealthcare.org Penn Highlands Healthcare is on LinkedIn. LinkedIn is a business-oriented social networking service. As of October 2015, LinkedIn reports more than 400 million acquired users in more than 200 countries and territories. If you are a LinkedIn member, follow us! We are on Facebook as Penn Highlands Healthcare. Follow us for the latest news from our four hospitals. We are on Instagram where we post photos of daily activities and special events at Penn Highlands Healthcare. We are Penn Highlands @pennhighlandshc. We are on Twitter. We are Penn Highlands @pennhighlandshc. Often, we use the hashtag #phhealthcare when posting. Providing up-to-date information is important to Penn Highlands Healthcare. Take advantage of the many ways we try to keep you informed.


The Maternal and Child Centers Penn Highlands Healthcare’s excellent obstetrics team is privileged to care for expectant parents and their babies. We are committed to making your birth experience as joyful, memorable, and comfortable as possible. Our family centered maternity care strives to make every delivery a unique and special experience. The Maternal and Child Centers of Penn Highlands DuBois and Penn Highlands Elk offer private rooms in a relaxed atmosphere that welcomes the entire family. Whether the pregnancy is normal or if a patient needs specialized care, an expert team of obstetric nurses, obstetricians, perinatologists, neonatologists and pediatricians is there for you and your baby. Should you need it, PH DuBois is home to a Neonatal Intensive Care Unit. As the only NICU in the region, and with a board-certified neonatologist, critically ill and premature newborns are provided the highest level of newborn care. We offer many other services and programs to support new parents and their infants during their stay with us and to help prepare them for the transition to home. For example, we promote what we call “The Golden Hour,” which limits visitors during the first hour after birth to ensure a safe recovery environment. We also encourage “rooming-in.” Many studies support mother-infant roomingin practice because of its many benefits, both short and long term. These benefits include better mother-infant bonding and increased frequency of breastfeeding since it enables feeding on demand. We also educate parents on safe sleep practices, breastfeeding and safe child care practices. The Maternal and Child Centers also offer exceptional prenatal care and childbirth education classes making it more convenient for you to receive the best care for your baby. Please visit www.phhealthcare.org to learn more about our providers and Maternity

• Complete Prenatal Care • Experienced, Caring Doctors and Nurses • Homelike Maternity Center with

State-of-the-Art Technology

• High-Risk Specialists • Neonatal Intensive Care Unit Centers. We’re also on Facebook as The Maternal and Child Center. Follow us there for advice from our expert OB nurses.

Education Classes at Penn Highlands DuBois Prenatal Education Class We offer one full-day or two half-day Saturday classes, held monthly. Because classes fill quickly, it is best to register by the end of your sixth month of pregnancy. Cost is $65, which may be covered by your medical coverage/private insurance. Scholarships are available for those who meet eligibility requirements. Please ask when registering. Feeding Class This in-depth class covers many topics to educate and support parents who plan to, or are considering breast feeding their baby. The class fee is $10, unless already participating in prenatal education classes. We encourage all parents, no matter their feeding choice, to attend this class to explore the benefits of breastfeeding, as well as receive important safety/car seat instructions from a Pennsylvania State Trooper. New Baby Day Camp This class is offered to children ages 2-8 who are expecting a new brother or sister. Included is a tour of the Maternity Department and age based education to help siblings prepare for the arrival of a new baby. The class is free of charge and scheduled every other month.

BreastFeeding Support Group Mom-to-Mom Breastfeeding Connection meets the first and third Wednesday of each month from 11:00 AM to Noon in the OB Conference Room on the third floor of the hospital near the Maternity Department at PH DuBois. For More Information If you have any questions regarding classes, please feel free to call our answering service at 814-375-6643 and leave a detailed message. Your call will be returned as soon as possible. To register for one of our classes, please call INFO/Scheduling at 814-3754636.

Education Classes at Penn Highlands Elk Breastfeeding Class This class is held the third Tuesday of every month at 6 p.m. in the Maternal and Child Center at PH Elk. This class gives momsto-be the tools needed to be successful at breastfeeding. Topics include preparation for breastfeeding, feeding basics, techniques and strategies to get off to a good start, and positioning. The cost is $10. Lactation Support Group The Lactation Support Group meets the fourth Thursday of every month at 7:00 p.m. in the Maternal and Child Center of PH Elk. PH Elk has a certified lactation consultant and three certified lactation counselors on staff. For More Information If you have any questions regarding classes or to register call 814-788-8558.

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Laboratory Services WE OFFER 20 LOCATIONS ACROSS SIX COUNTIES. To help prepare you for your visit, please bring your photo identification and most recent insurance card. Bring your paper order if you have one.

One of the most widelyused services at Penn Highlands Healthcare is blood collection and testing. Our goal is to make your visit as convenient and quick as possible, while still providing accurate information for our physicians and other healthcare professionals to make diagnoses and manage diseases. Penn Highlands offers 20 blood drawing locations across six counties for your convenience. All blood that is collected at these sites is tested at one of the four Penn Highland hospitals’ full –service laboratories. These laboratories operate under the direction of a medical physician and employ experienced certified medical technologists, medical technicians and phlebotomists. Our hospital-based labs also work with local blood collection services to store blood and blood products for patients who need transfusions. A few helpful tips for making your visit a little easier: • Bring your photo I.D., and most recent insurance card. Bring your paper order if you have one. • Wear shirts with sleeves that can easily be pulled up. And no matter where you choose to have your blood work done, know that Penn Highlands Healthcare labs will get your results to your physician in a timely manner. Pick the site that is most convenient for you and your family.

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BROCKWAY PENN HIGHLANDS FAMILY MEDICINE 1200 Wood Street, Brockway, PA 15824 Laboratory Collection site hours: Tuesday, Wednesday 8:00 AM – 12 Noon Friday 8:00 AM – 10:00 AM Appointments preferred 814-265-8636 BROOKVILLE ALLEGHENY HEALTH CENTER 22 Industrial Park Road, Brookville, PA 15825 Laboratory Collection site hours: Monday, Wednesday, Friday 9:00 AM – 11:00 AM PENN HIGHLANDS BROOKVILLE HOSPITAL LABORATORY 100 Hospital Road, Brookville, PA 15825 Laboratory hours: Monday – Friday 7:00 AM – 7:00 PM Saturdays 7:00 AM – 12 Noon Closed Sunday & Holidays CLEARFIELD PENN HIGHLANDS CLEARFIELD EXPRESS LABORATORY 809 Turnpike Avenue, Clearfield, PA 16830 Laboratory hours: Monday – Friday 7:00 AM – 11:00 AM PENN HIGHLANDS CLEARFIELD HOSPITAL LABORATORY 809 Turnpike Avenue, Clearfield, PA 16830 Laboratory hours: Monday – Friday 7:00 AM – 7:00 PM Saturday – Sunday 7:00 AM – 12 Noon Closed Holidays


PENN HIGHLANDS FAMILY MEDICINE 502 Park Avenue, Clearfield, PA 16830 Laboratory Collection site hours: Monday, Tuesday, Wednesday and Friday 8:00 AM –11:00 AM CURWENSVILLE PENN HIGHLANDS FAMILY MEDICINE 465 State Street, Curwensville, PA 16833 Laboratory Collection site hours: Tuesday and Thursday 7:30 AM –10:30 AM DUBOIS MEDICAL ARTS BUILDING 145 Hospital Avenue, DuBois, PA 15801 Laboratory Collection site hours: Monday – Friday 6:00 AM – 5:30 PM Closed Saturday & Sunday and Holidays PENN HIGHLANDS DUBOIS HOSPITAL LABORATORY 100 Hospital Avenue, DuBois, PA 15801 Laboratory hours: Monday – Friday 7:00 AM – 5:30 PM Saturday 7:00 AM – 12 Noon Closed Sunday & Holidays EMPORIUM QCARE CAMERON COUNTY 416 North Broad Street, Emporium, PA 15834 Laboratory Collection site hours: Monday – Friday 8:30 AM – 5:00 PM FAIRMOUNT CITY DAVID L MILLER CENTER 1323 Brookville Street, Fairmount City, PA 16224 Laboratory Collection site hours: Tuesday and Thursday 8:00 AM – 3:30 PM FORCE PENN HIGHLANDS INTERNAL MEDICINE 230 Hemlock Avenue, Force, PA 15841 Laboratory Collection site hours: Monday – Friday 7:30 AM – 11:30 AM Appointments preferred 814-787-5131 JOHNSONBURG PENN HIGHLANDS HEALTHCARE 111 Cobb Street, Johnsonburg, PA 15845 Laboratory Collection site hours: Tuesday and Wednesday 8:30 AM – 12 Noon

MARIENVILLE MARIENVILLE HEALTH CENTER 125 Chestnut Street, Marienville, PA 16239 Laboratory Collection site hours: Monday 8:00 AM –11:00 AM Friday 8:00 AM –10:30 AM PHILIPSBURG MOSHANNON VALLEY COMMUNITY MEDICAL BUILDING 271 Railroad Street, Philipsburg, PA 16866 Laboratory Collection site hours: Monday – Friday: 7:00 AM – 5:00 PM Saturday 8:00 AM – 12 Noon PUNXSUTAWNEY PUNXSUTAWNEY COMMUNITY MEDICAL BUILDING 551 W. Mahoning Street, Punxy Plaza, Punxsutawney, PA 15767 Laboratory collection site hours: Monday – Friday 8:00 AM – 5:30 PM REYNOLDSVILLE REYNOLDSVILLE MEDICAL CENTER 5 North Third Street, Reynoldsville, PA 15851 Laboratory Collection site hours: Monday – Friday 8:00 AM – 12 Noon and 1:00 PM – 3:45 PM RIDGWAY QCARE RIDGWAY 104 Metoxet Street, Ridgway, PA 15853 Laboratory Collection site hours: Monday – Friday 6:00 AM – 7:00 PM Saturday and Sunday – 9:00 AM – 7:00 PM Closed Holidays ST. MARYS PENN HIGHLANDS ELK HOSPITAL LABORATORY 763 Johnsonburg Road, St. Marys, PA 15857 Laboratory hours: Monday – Friday 6:00 AM – 8:00 PM Saturday – 6:00 AM – 12 Noon Closed Sunday & Holidays ST. MARYS COMMUNITY MEDICAL BUILDING 1100 Million Dollar Highway, St. Marys, PA 15857 Laboratory Collection site hours: Monday – Friday 7:00 AM – 5:30 PM Closed Holidays

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surgeons and medical professionals work collaboratively with primary care physicians throughout Penn Highlands Healthcare to provide prompt follow-up and ongoing communication regarding the patient’s progress. The cardiologists of DuBois Regional Cardiology Associates who work at The Heart Center see patients in all four Penn Highlands hospital locations.

PENN HIGHLANDS EARNS BLUE DISTINCTION® CENTER+ DESIGNATION QUALITY AND COSTEFFICIENCY IN CARDIAC CARE

Penn Highlands Healthcare is proud of its system-wide approach to providing residents with easy access to cardiac diagnostic testing in all four hospitals, as well as the advanced cardiac interventional programs available at The Heart Center of Penn Highlands DuBois. Highmark BCBS has designated The Heart Center as a Blue Distinction® Center+ in the Blue Distinction Centers for Cardiac Care program, part of  the Blue Distinction Specialty Care program. Blue Distinction Centers are nationally designated healthcare facilities shown to deliver improved patient safety and better health outcomes, based on objective measures that were developed with input from the medical community.   To receive a Blue Distinction Center+ for Cardiac Care designation, a hospital must demonstrate its expertise in delivering safe and effective cardiac care, focusing on cardiac valve surgery, coronary artery bypass graft (CABG) and percutaneous coronary interventions (PCI) episodes of care. A hospital must also have earned national accreditation at the facility level. In addition to meeting established quality thresholds,

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these hospitals must also demonstrate better cost-efficiency compared to their peers. “Having a skilled and experienced heart care team is a true asset to the communities we serve,” Dr. Gary DuGan, chief medical officer at Penn Highlands Heatlhcare, said. “Our cardiologists and cardiothoracic surgeons continue to exceed expectations in the delivery of care to our patients. Penn Highlands Healthcare is excited that The Heart Center is recognized by Highmark BCBS for meeting the rigorous selection criteria for cardiac care set by the Blue Distinction Specialty Care program.” Quality is key: only those facilities that first meet nationally established quality measures for Blue Distinction Centers were considered for designation as a Blue Distinction Center+. “This award represents all of the hard work that is put in by our primary care physicians in educating their patients, recognizing the early signs of heart disease and trusting the advanced specialty providers to take great care of their patients when cardiac interventions are needed,” Dr. DuGan said. “As one of the system’s leading service lines, this is truly a system-wide recognition.” The Heart Center brings comprehensive, 24-hour specialized cardiac care to the region. Backed by state-of-the-art diagnostic equipment and a full range of inpatient and outpatient services, The Heart Center can perform life-saving, advanced cardiac procedures. Located on the fourth and fifth floors of Penn Highlands DuBois West Campus, the cardiac unit features two cardiac operating rooms, a cardiac catheterization lab, 12 cardiovascular intensive care patient rooms, non-invasive cardiology areas and a cardiac rehabilitation unit.  The Heart Center’s cardiologists,

“Blue Distinction in Cardiac Care confirms that exceptional measures are put forth by all members of our Heart Center team,” Heather Franci, service line director for The Heart Center and Cardiology at Penn Highlands Healthcare, said. “It also makes the community aware that they will receive quality and efficient care at The Heart Center.” “The Blue Distinction award also motivates our team by recognizing  their commitment for providing high quality compassionate care,” she said. Cardiovascular disease is the leading cause of death in the U.S., claiming more than 610,000 lives—1 in 4—each year, according to the Centers for Disease Control.1 By 2030, 40.5 percent of the U.S. population is projected to have some form of cardiovascular disease, and the cost of cardiac care is expected to reach $818 billion by 2030—an increase of almost 300 percent from 2010, according to the American Heart Association. The Blue Distinction Specialty Care program seeks to reduce this burden by empowering patients with the knowledge and tools to find both quality and value for their cardiac care.

QUALITY AND COSTEFFICIENCY IN KNEE AND HIP REPLACEMENT SURGERIES

Highmark BCBS has selected The Total Joint Replacement Program, a service of The Rehabilitation Center at Penn Highlands DuBois, as a Blue Distinction Center+ for Knee and Hip Replacement, part of the Blue Distinction Specialty Care program. Blue Distinction Centers are nationally designated healthcare facilities shown to deliver improved patient safety and better health outcomes, based on objective measures that were developed by Blue Cross and Blue Shield companies with input from the medical community.


Knee and hip replacement procedures are among the fastest growing medical treatments in the U.S., according to studies published in the June 2014 Journal of Bone and Joint Surgery1 and the American Academy of Orthopaedic Surgeons2. In 2010, the estimated cost of hip replacements averaged $17,500 and the estimated cost of knee replacements averaged $16,000, according to the Agency for Healthcare Research and Quality (AHRQ)3. Hospitals designated as Blue Distinction Centers+ for Knee and Hip Replacement demonstrate expertise in total knee and total hip replacement surgeries, resulting in fewer patient complications and hospital readmissions. Designated hospitals must also maintain national accreditation. In addition to meeting these quality thresholds, hospitals designated as Blue Distinction Centers+ are on average 20 percent more cost-efficient in an episode of care compared to other hospitals. Quality is key: only those facilities that first meet nationally established, objective quality measures will be considered for designation as a Blue Distinction Center+. PH DuBois is proud to be recognized by Highmark BCBS for meeting the robust selection criteria for knee and hip replacements set by the Blue Distinction Specialty Care program. “We are extremely proud in gaining this distinction,” Marty Maloney, director of PH DuBois Orthopedic and Inpatient Rehabilitation units and PH DuBois and Penn Highlands Brookville Therapies and Athletic Trainers, said. “This award is a result of the hard work of our doctors and many different departments to provide the most current evidence-based care so that our patients gain the best outcomes and satisfaction possible.” “We are grateful for all that our staff does to make this award possible,” Dr. DuGan said. “These awards would not be possible if the staff did not put their patients’ care first.”

MATERNITY CARE

In an effort to help prospective parents find hospitals that deliver quality, affordable maternity care, Highmark Blue Cross Blue Shield announced that The Maternal and Child Center of Penn Highlands DuBois and The Maternal and Child Center of Penn Highlands Elk have been designated as two of the first hospitals to receive the Blue Distinction® Center+ for Maternity Care designation, a new designation under the Blue Distinction Specialty Care program. Nearly 4 million babies are born in the U.S. annually, making childbirth the most common cause of hospitalization. This new Blue Distinction Centers+ for Maternity Care program evaluates hospitals on several quality measures, including the percentage of newborns that fall into the category of early elective delivery, an ongoing concern in the medical community. Compared with babies born 39 weeks or later, early term infants face higher risks of infant death and respiratory ailments such as respiratory distress syndrome, pneumonia, and respiratory failure, among other conditions. These babies also have a higher rate of admission to Neonatal Intensive Care Units. In addition, hospitals that receive a Blue Distinction Center+ for Maternity Care designation agreed to meet requirements that align with principles that support evidence-based practices of care, as well as having initiated programs to promote successful breastfeeding, as described in the Baby-Friendly Hospital Initiative by Baby-Friendly USA or the Mother-Friendly Hospital program by the Coalition for Improving Maternity Services (CIMS) through its “Ten Steps of Mother-Friendly Care.” The program also evaluates hospitals on overall patient satisfaction, including a willingness to recommend the hospital to others. Blue Distinction Centers+ for Maternity Care, an expansion of the national Blue Distinction Specialty Care program, are hospitals recognized for delivering quality, affordable specialty care safely and effectively, based on objective measures developed with input from the medical community. To receive a Blue Distinction Centers+ for Maternity Care designation,

a hospital must also meet requirements for cost efficiency. “We are pleased to receive this award from Highmark that recognizes our effort to improve the healthcare of expectant parents and their babies in this region. Our team has worked diligently for many months to improve the quality and delivery of medical care to our patients. I commend the efforts of all nurses, support staff and physicians on this achievement,” Dr. Thomas A. Carnvevale, chief of obstetrics for Penn Highlands Healthcare, said.

ABOUT BLUE DISTINCTION Since 2006, the Blue Distinction Specialty Care program has helped patients find quality providers for their specialty care needs in the areas of bariatric surgery, cardiac care, complex and rare cancers, knee and hip replacements, maternity care, spine surgery, and transplants, while encouraging healthcare professionals to improve the care they deliver. “Highmark Blue Cross Blue Shield extends its sincere congratulations to Penn Highlands Healthcare for their dedication to quality, patient safety, and transparency that is required to achieve this great distinction. With consumer driven healthcare programs like Blue Distinction, and the significant effort of our partner practitioners and facilities, Highmark can now enable our members the opportunity to make wise, value-driven healthcare decisions”, said Dr. Mark Piasio, medical director, Provider Strategy, Highmark Inc. For more information about the program and for a complete listing of the designated facilities, please visit www.bcbs.com/ bluedistinction.  

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You Can Live Well With Diabetes WHAT TO EAT? Having diabetes doesn’t mean you need to starve or only eat one type of food. It’s about making good choices. For those with diabetes, learning about nutrients and counting carbohydrates is the key to good eating. But it can become confusing. Anna Hummel, registered dietitian, licensed dietitian/nutritionist of Penn Highlands Brookville shares the basic science. “Food is composed of three macronutrients: carbohydrates, fat and protein,” she said. “Carbohydrates are the nutrients that impact blood glucose levels, and the nutrient we need to eat in a consistent pattern for optimal blood glucose control.”

Diabetes affects a lot of people in our region. We all know people who are watching their diets – or trying to - to combat the disease. So for them - and their family and friends who watch out for them here are a few tips to keep blood-sugars in check. 8 | SPRING 2016

“Food sources of carbohydrates include: grains, starchy vegetables, fruit and fruit juices, milk products, snacks and sweets, and any combination foods, such as casseroles, soups, etc. We count these foods as carb choices based on the serving size of each food item.” The formula for carbs per day is: 2-4 carb choices per meal for women, 3-5 choices per meal for men, and 1-2 carb choices per snack for both men and women. 15 grams is one carbohydrate choice. “The key to blood glucose control is eating a consistent number of carbs at each meal and not skipping meals. Many people misunderstand the diabetic diet and think they need to cut out carbs altogether, but it’s not about low-carb or no-carb, it’s all about consistency throughout the day,” Anna stressed. What about the myth of not eating any sugar? What if the label says “sugar-free”? “Sugar is a simple form of carbohydrates, meaning it is rapidly absorbed into the blood and spikes up blood glucose

levels,” Anna said. “Ideally, we should limit sugary foods, but can still enjoy them in moderation.” “However, ‘sugar-free’ foods are not necessarily the way to go, either. Sugar-free foods are made with sugar alcohols, which still contribute to total carbohydrates and need to be counted toward your total carb intake at that meal or snack.” “My rule of thumb: go for the real deal in moderation. If you’re hungry for ice cream, have a ½ cup (1 carb) serving of regular ice cream; it counts as 1 carb choice - exactly the same as a ½ cup serving of sugar-free ice cream. Just be mindful of your carb count and stay within the consistent carb pattern. Diet beverages can be a useful alternative, but use these in moderation as well. Choose mostly water or unsweetened flavored drinks, such as fruit-infused water.” HOW CAN YOU DO IT? “One of the most helpful strategies for meeting diabetes food goals is menu planning,” said Ann Curtis, registered dietitian, licensed dietitian/nutritionist of PH DuBois, said. “Consider putting a menu together the day before you might routinely grocery shop. A menu plan for one week is often realistic.” Menu planning involves a number of steps: 1. Looking at your schedule for the upcoming week. This provides insight into realistic time tables. Cookbooks, diabetes magazines and online sites provide sources of recipes and quick meals, often including nutrition analysis. 2. Review supplies on hand. Using what you have in your pantry will keep costs down and ensure ingredients are fresh. 3. From this plan and your inventory, put together a shopping list. “Once you get to the store, another resource that can help guide choices is the


nutrition facts label on all food packages,” Ann said. “Key facts on the label include serving size, grams of carbohydrate - as 15 grams is a carbohydrate choice - and grams of fiber.” “Dietary fiber is the nondigestible carbohydrate from plants. It slows down the digestion and absorption of carbohydrates,” Jeril Goss, Jeril Goss, registered dietitian and certified diabetes educator at PH DuBois, said. “Certain sources such as oats, peas, beans, apples, citrus fruits, carrots and barley can help lower cholesterol levels.” “Menu planning supports diabetes goals in a number of ways. It allows a ‘look-back’ at the meals to determine if recommended food groups are included in the meals, including consistent carbohydrate levels. It reduces vulnerability because at the end of the day, when energy levels may be low, it ensures that recipes and supplies are on hand,” Ann said. “Life sometimes throws curve balls, requiring that the plan change. At least, though, with a plan you can have control of meals most of the time,” she added. HEART HEALTH And when you are diagnosed with diabetes, blood glucose readings aren’t the only concern you should have. “Many people with diabetes do not realize that having diabetes increases their chances of having a heart attack or stroke,” Bernie Clark, registered dietitian, licensed dietitian/ nutritionist of Penn Highlands Clearfield, said. “The facts are that adults with diabetes are two times more likely to die from heart disease or stroke than a person who doesn’t have diabetes.” “Making healthy lifestyle choices is essential to reach your ABC goals - A1C (glucose levels over 3 months), blood pressure and cholesterol- to manage your diabetes. What you eat can have a great impact on all three. Eating a heart-healthy diet on top of meal planning for diabetes may sound overwhelming, however heart healthy choices are good choices for everyone.” When you think about your meals, limit foods high in unhealthy fats and cholesterol, and pick foods low in saturated and trans fats such as lean meat, chicken without skin, fish and non-fat or low-fat milk, yogurt or cheese. Bake, broil or grill foods instead of frying.

Eat foods that are high in fiber such as whole grain breads and cereals, brown rice and lentils, beans, fruits and vegetables Don’t add salt to foods, try to keep intakes less than 2300 mg per day. Limit eating out as a restaurant meal may have more than 1500 mg of sodium. Also, be active a minimum of 30 minutes a day every day. It doesn’t have to be for 30 minutes straight. Break it up into 10 minute walks. Find a way to make it fun so you will stick to it. And stop smoking and using tobacco products. SERIOUS ADVICE “Taking your mediations as prescribed is very important,” Kelly Schreiber-Straub, registered dietitian, licensed dietitian/ nutritionist and certified diabetes educator, at Penn Highlands Elk, said. Some medications only need to be taken daily as they are released over the course of 24 hours. Other medications need taken at certain times in order to achieve maximum results. When obtaining your medications, check with the pharmacist if there were any changes made to your previous prescription, such as if you are not on an extended release anymore. You may also contact a certified diabetes educator and they can assist as well. Don’t depend solely on your medications to control your blood sugars. “To decrease your risk of hypoglycemia, eat meals and snacks at regular times,” Marie Michelini, who holds a master’s degree in nutrition and is a registered dietitian, licensed dietitian/nutritionist and CDE at PH Elk, said. Skipping meals will increase your risk for hypoglycemia, or low sugar levels. Exercise also increases your risk of hypoglycemia. Pllanning your exercise program for 1-2 hours after a meal. Exercising an hour before you eat increases your risk for a low reaction. If you have done more physical activity/exercise than usual, you may need to eat a slightly larger meal or increase your bedtime snack. And if you develop the flu or have a decrease in intake related to a bad cold, remember illness will raise blood sugars and therefore you need to take your medication as prescribed. “Often people think because they aren’t eating, they don’t need to take

their medication,” Kelly said. “This results in higher blood sugars.” If you are running a fever, you need to keep hydrated. A good rule of thumb is to drink 2 oz. of fluid every 15 minutes or 8 oz. every hour. Since most people don’t eat much when ill, you may use regular pop and Jello. Remember to not exceed your maximum carbs for the day. “Illness and dehydration will both raise blood sugar so it’s very important to take your medication and keep hydrated,” Marie said. HELP If you would like to learn more about how to eat well with diabetes, ask your physician for a nutrition referral to any our locations. For help with other diabetes related concern, ask for a referral to one of our two American Diabetes Association recognized diabetes education programs at PH DuBois or PH Elk. To schedule an appointment, call: Penn Highlands Brookville 814-849-2312 or 814-849-1451 Penn Highlands Clearfield 814-768-2276. Penn Highlands DuBois 814-375-3890 Penn Highlands Elk 814-788-8517 or 814-788-8833. Appointments are also available at the Punxsutawney Community Medical Building and Moshannan Valley Community Medical Building. Call 814-375-3890 for more information.

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AT PENN HIGHLANDS We’re proud to introduce the newest members of our heathcare team from January 2016 to March 2016. They look forward to being there for your healthcare needs.

Find A Doctor Are you looking for a healthcare provider? Do you want to know a little more about who your next appointment is with?

Tonya Aversa, CRNP QCare St. Marys 763 Johnsonburg Road St. Marys, PA QCare Ridgway 104 Metoxet Street Ridgway, PA

Also, a complete listing of all our providers is available by downloading our Physician Directory. You can download the entire handbook, a specific search or a single page.

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Constance M. Linn, DO Anesthesiology Penn Highlands DuBois 100 Hospital Avenue DuBois, PA 814-375-3034

Lindsay Hoffman, CRNP QCare Ridgway 104 Metoxet Street Ridgway, PA

Kyle Mohney, MHS, PA-C Emergency Medicine Penn Highlands DuBois 100 Hospital Avenue DuBois, PA

QCare Cameron County 416 N. Broad Street Emporium, PA

Penn Highlands Healthcare wants you to know all of your healthcare providers and who is available to help you with your healthcare needs. On our website, www.phhealthcare.org, you can find a provider by name, by location, by specialty or by hospital. You can even search by gender.

Michele Harris, CRNP Penn Highlands Interventional Pain Center 145 Hospital Avenue Suite 212 DuBois, PA 814-375-4045

Franklin P. Bizousky, DO Family Practice 104 W. Mahoning Street Punxsutawney, PA 814-618-5315

Josie Cartwright, CRNP QCare Moshannon Valley 271 Railroad Street Philipsburg, PA

Nicole Hoover, CRNP Penn Highlands Endocrinology 145 Hospital Avenue Suite 101 DuBois, PA 814- 375-4089

Rodney J. Landreneau, MD Thoracic Surgery The Lung Center of Penn Highlands DuBois 100 Hospital Avenue DuBois, PA 814-375-3770

Tammy Yanak, PA-C Family Medicine St. Marys Community Medical Building 1100 Million Dollar Hwy. 2nd Floor, Suite 1 St. Marys, PA 814-781-6758

Keith L. Zeliger, DO Orthopedic Surgery 145 Hospital Avenue Suite 206 DuBois, PA 814-299-7432


In-Home Sleep Studies You snore. You’re tired all the time. You can’t remember when you last had a good night’s rest. These are some of the signs of obstructive sleep apnea – a very serious sleep disorder. You think you may need to talk to your doctor, but you’ve heard that you would have to go to the hospital for a sleep study. Who has time for that? Not you.

The pieces are all connected to a small cell-phone size box that stays with you while you sleep. It requires no gels to attach the wires to you. The instructions are simple, and someone will review them with you before you take it home. Throughout the night, readings of how you sleep are recorded. The kit is returned the next day, and this information is downloaded by a registered polysomnographic technician. The technicians – whose skills are tested monthly by the American Academy of Sleep Medicine and evaluated for competency – review and analyze the information on the test.

“Within the past five years, in-home sleep studies have become available and indicated for people with possible obstructive sleep apnea,” according to Dr. Angelo Illuzzi who is board-certified in pulmonology, sleep medicine and internal medicine.

The information is then given to a doctor with experience in sleep studies to interpret. Sleep studies from the PH DuBois, PH Brookville and PH Elk areas will be read by Dr. Illuzzi and Dr. Rajesh Rao, who is also a pulmonologist and sleep specialist. Sleep studies from the PH Clearfield offices will be read by Dr. Bruno Romeo, an internal medicine physician who also specializes in pulmonology, critical care and sleep. He has read sleep studies at PH Clearfield for many years.

And you can now get the in-home sleep study through all four Penn Highlands Healthcare locations – PH Brookville, PH Clearfield, PH DuBois and PH Elk.

The doctor who interprets the study then reports back to the physician that ordered the test and gives him or her the results to share with the patient.

A person’s primary care physician or any physician he or she is working with can request this test to be done.

Home sleep study kits are available for pick up in convenient locations throughout the Brookville, Clearfield, DuBois and St. Marys area.

But thanks to technology, you can have a sleep study done at home.

You pick up an in-home sleep study kit at a convenient Penn Highlands Healthcare location and take it home. It consists of a belt for the chest to measure up and down breathing movements, a small piece of tubing for under the nose to measure air flow in and out, and an oxygen monitor for the finger.

If patients have questions throughout the night, there is a phone number to call. Someone from the hospital trained in sleep studies will answer. What if there is something found by the test? It is up to the doctor who prescribed the test to have you followed up by a specialized physician and receive a second

test in an actual sleep lab. You may require a second test. And if you do, it is because the lab needs to help you with something serious. “The home-sleep study is indicated to diagnose primarily obstructive sleep apnea,” Dr. Illuzzi said. It’s a very serious condition, but it can be treated. Translated from Greek, apnea literally means “without breath.” There are three types of apnea, but the most common one is obstructive apnea. Left untreated, it causes people to stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minimum of 10 seconds or longer. Not breathing regularly often leads to health problems. Sleep apnea can cause high blood pressure, memory problems, weight gain, impotency, headaches, heart disease, poor diabetes control, stroke and possibly cancer. It is also the cause of accidents, motor vehicle crashes and problems at work. Obstructive sleep apnea occurs when the airway relaxes or is blocked during sleep by the soft tissue or tongue. The blockage may cause shallow breathing or breathing pauses. Symptoms of sleep apnea include: • Loud, chronic snoring; • Frequent pauses in breathing during sleep; • Gasping, snorting or choking during sleep; • Feeling unrefreshed after waking and sleepiness during the day, no matter how much time you spent in bed; • Waking up with shortness of breath, chest pains, headaches, nasal congestion or a dry throat. “With this in-home sleep study, people may be more likely to step forward when they recognize their symptoms of apnea. Being more comfortable in their own homes, we hope more people get the help they need,” Dr. Illuzzi said. What is the treatment for apnea? There are several options but the most common and effective is CPAP, or continuous positive airway pressure. If you are interested in a sleep study, talk to your physician. If you have questions, call 814-375-3223.

SPRING 2016 | 11


ADULT VACCINES Taking our children to a doctor’s appointment for a vaccine shot can be heart-wrenching for parents. We know they may cry and be uncomfortable, but we know it should be done. Vaccines protect us from diseases that can cripple or even kill us. Getting vaccinated is the right thing to do. But as we grow older, we don’t think about ourselves getting vaccines. Some adults incorrectly assume that the vaccines they received as children will protect them for the rest of their lives. Generally this is true, said the Centers for Disease Control, except that: • • • •

Some adults were never vaccinated as children; Newer vaccines were not available when some adults were children; Immunity can begin to fade over time; As we age, we become more susceptible to serious disease caused by common infections (such as flu and pneumococcus).

“You never outgrow the need for vaccines,” Dr. Gary DuGan, chief medical officer at Penn Highlands Healthcare, said. “The specific immunizations you need as an adult are determined by factors such as your age, lifestyle, high-risk conditions, type and locations of travel, and previous immunizations.” “When encouraging vaccinations to adults I often get the response, ‘I’m healthy and I don’t ever get sick. I don’t need that vaccination,’ ” said Megan Devlin-Bussard, pharmacist, Quality Program director with Penn Highlands Healthcare Practice Management. “Healthy adults are at risk, too!” she said. “These viruses and bacteria can affect anyone. As we age, our natural immunity loses its ability to fight off infections. Stress can contribute to outbreaks of some of these infections.” Do you have time to be sick? Most people don’t. Think about how being sick could affect your family, your commitments or your work. “Also,” Megan reminds us, “sometimes it’s about protecting those around you. Young children, elderly adults and individuals with multiple medical conditions are certainly at higher risk for getting these infections and having complications from them. If you are around any of these higher risk individuals get vaccinated for them! Help limit your loved one’s exposure to these infections and keep them safe.” Most private health insurance plans cover the cost of recommended adult vaccines. Check with your insurance provider for details of coverage including where you can get vaccinated.

12 | SPRING 2016

If you are on Medicare, vaccinations are part of the discussion of the Medicare Annual Wellness Visit. Often cost is one of the biggest concerns with receiving vaccinations. Anyone with Medicare insurance can receive both pneumonia (pneumococcal) vaccines free of charge. The shingles vaccine (Zoster) is covered under Medicare Part D, the prescription side of Medicare. Each plan has slightly different coverage, call the number on the back of your prescription card and they can give you your cost, if there is any, Megan said. What vaccines do you need? The basic ones are listed here by age. If you are pregnant or have a weakened immune system, HIV, kidney disease or poor kidney

INFORMATION FOR ADULT PATIENTS talk to your healthcare professional about these vaccines

If you are this age,

Flu Influenza

Td/Tdap Tetanus, diphtheria, pertussis

Shingles Zoster

You should get flu vaccine every year.

You should get a Td booster every 10 years. You also need 1 dose of Tdap. Women should get a Tdap vaccine during every pregnancy to protect the baby.

You should get shingles vaccine even if you have had shingles before.

19 - 21 years

22 - 26 years

27 - 49 years

50 - 59 years

60 - 64 years

65+ year

More Information:

Recommended For You: This vaccine is recommended for you unless your healthcare professional tells you that you cannot safely receive it or that you do not need it. May Be Recommended For You: This vaccine is recommended for you if you have certain risk factors due to your health, job, or lifestyle that are not listed here. Talk to your healthcare professional to see if you need this vaccine.


function, asplenia or spleen issues, heart disease, chronic lung disease, diabetes or chronic liver disease, talk to your physician. Some vaccines may be needed sooner than later. Some vaccines may not be recommended if you are pregnant or have a weakened immune system or HIV. If you don’t have a vaccination record, create one. Keep track of when you received vaccines. Ask your physician’s office or pharmacy for a record of your vaccinations. Be sure they are up-to-date and that you have the maximum protection against vaccinepreventable diseases.

2016 Recommended Immunizations for Adults: By Age

Pneumococcal

PCV13

PPSV23

Meningococcal MenACWY or MPSV4

MenB

MMR Measles, mumps, rubella

HPV Human papillomavirus for women

Chickenpox Varicella

Hepatitis A Hepatitis B

for men

Hib Haemophilus influenzae type b

1 or 2 doses You should get 1 dose of PCV13 and at least 1 dose of PPSV23 depending on your age and health condition.

You should get this vaccine if you did not get it when you were a child. You should get HPV vaccine if you are a woman through age 26 years or a man through age 21 years and did not already complete the series.

For more information, call 1-800-CDC-INFO (1-800-232-4636) or visit www.cdc.gov/vaccines If you are traveling outside the United States, you may need additional vaccines. Ask your healthcare professional about which vaccines you may need at least 6 weeks before you travel.

SPRING 2016 | 13


WHAT IS PULMONARY REHABILITATION

Marian Pisoni of Brockway with exercise physiologist Michelle Bender

Pulmonary rehabilitation is a program designed to improve the quality of life for those suffering with chronic lung diseases.

between many of the air sacs are destroyed. Sometimes, the walls of the airways become thick and inflamed or the airways make more mucus than usual, which can clog them.

The program includes monitored exercise, disease education and patient support. Pulmonary Rehabilitation can help patients who have: • Chronic Obstructive Pulmonary Disease, COPD • Cystic Fibrosis • Pulmonary Fibrosis • Asthma • Sarcoidosis • Pulmonary Hypertension • Emphysema • Chronic Bronchitis • Lung Surgeries (before and after) It is available at: • Penn Highlands Brookville, 814-849-1818 • Penn Highlands Clearfield, 814-768-2054 • Penn Highlands DuBois, 814-375-3591 An individualized treatment plan may include lower body exercises such as biking, walking and rowing, and upper body exercises, like arm exercises and hand held weights. Patient education is a vital part of the program. For example, learning effective breathing techniques for exercise and daily activities improves tolerance and allows patients to do more. Other education includes relaxation techniques, medications, nutrition, use of oxygen, and how to manage exacerbations, enable patients to control their disease. The staff works closely with patients during each session. Heart rate, blood pressure, and oxygen levels are closely monitored to ensure patient safety.

14 | SPRING 2016

BREATHE EASIER

WITH PULMONARY REHABILITATION LIVING WITH COPD In February 2013, Marian Pisoni, of Brockway was out of breath walking into her doctor’s office. Her oxygen reading was so low, that an ambulance was called to bring her to Penn Highlands DuBois West. She said she knew she was in trouble when she overheard the hospital doctor tell her sister that “She is really sick but doesn’t look it.” “I actually didn’t think I was that sick,” Marian said. She was just out of breath – a lot. Marian was diagnosed with COPD, chronic obstructive pulmonary disease. More than 15 million Americans have COPD, the most common form of chronic lung disease that makes it hard to breathe. In COPD, less air flows in and out of the airways because the airways and air sacs lose their elastic quality or the walls

COPD can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms. Although there is no cure for COPD, patients can still live a long and happy life if they take good care of themselves and learn to manage their disease. Besides smoking cessation, exercise is one of the best ways for people with chronic lung disease to stay healthy. That’s where pulmonary rehabilitation can help. And it did. Marian went to Pulmonary Rehab at Penn Highlands DuBois. She went twice a week for 26 weeks and learned different breathing techniques and more about the lungs. Today, she continues to attend the Healthy Hearts exercise program at PH DuBois that allows patients to continue exercising under supervision. “I exercise more by coming here,” Marian, age 64 said. “It’s motivating and I enjoy talking to people.” When she exercises, she sees others who have similar lung disorders. “We relate to each other,” she said. She shares how she recommended to one patient about continuing to use a spirometer at home – which measures the force of a breath and exercises the lungs. “She stuck it out and saw how much it helped,” Marian said. Today, Marian wears oxygen for about 18 hours per day. She is able to go on walks with her sister – though not as fast as her, she jokes, and “I also bowl on Wednesdays.”


LIVING WITH A LUNG TRANSPLANT Mark Nolf is as “ram tough” as the trucks he sells. That wasn’t the case a few years ago. In the fall of 2012, Mark began noticing shortness of breath. He thought it was just his age catching up with him. When his breathing worsened, he finally saw a pulmonologist and was diagnosed with Idiopathic Pulmonary Fibrosis. “That basically means there was scarring in my lungs for unknown reasons,” Mark explains. By the summer of 2013, Mark’s doctor had sent him for pulmonary rehabilitation at Penn Highlands Brookville. “It helped. It got me through a lot of bad times with using my oxygen. Crystal [Stanford] taught me a lot. When you climb the stairs and get out of breath, the breathing techniques I learned help. They still help me now.” That fall, Mark’s breathing worsened quickly, and he was hospitalized in Pittsburgh for three weeks. Doctors told him that antibodies were attacking the scar tissue in his lungs, and he was added to a lung transplant list. In the months to follow, Mark was on oxygen 24/7. He could not do anything that required exertion. He waited for lungs for almost a year.

“I had seven test runs to Pittsburgh,” he recalls. “We would get excited and hurry to the hospital, and something would be wrong. Either the lungs weren’t the right size, or they had sat too long and filled with fluid.” Finally in November of 2014, the day came that Mark had hoped for. Following a successful lung transplant, Mark was completely off supplemental oxygen within two days. Doctors said that his success was due in part to the breathing exercises he had learned earlier, and they praised Mark’s pulmonologist for sending him for pulmonary rehabilitation. Mark had some difficulty with rejection and was sent for pulmonary rehab again. He went twice a week to Penn Highlands Brookville for three months. The treatments helped strengthen him and his new lungs. Last November, on the one-year anniversary of his transplant, Mark was able to ride 15 miles on a bicycle trail. Now age 53, Mark is thankful for all who cared for him and especially to the individual whose life saved his.

LIVING WITH CHRONIC BRONCHITIS In November 2013, Susan Seaburn, age 72, of Pike Township, Clearfield County, was hoping that her appointment with her ears, nose and throat doctor would help her breathe better. After all, she had allergies and the allergy shots were helping. Maybe he could help her more. He did – but in a different way. He recommended Pulmonary Rehab at Penn Highlands Clearfield. Susan was diagnosed with chronic bronchitis in 2007 when she lived in Detroit, Michigan. Chronic bronchitis is the inflammation and swelling of the lining of the airways of the lungs which narrows and obstructs air. It causes daily coughing and stimulates mucus which can further block the airways. It is a type of COPD.

Mark Nolf of Fairmount City

“If you think it is good (pulmonary rehab), I’ll try anything,” she said to the doctor, and she went. There, she said, she learned how to

Susan Seaburn of Pike Township with exercise physiologist Rachael Beardsley breathe better, and she learned simple tips to make her life easier. She learned how to exhale when doing the “heavy” part of moving and to inhale during the “lighter” part. Tying her shoes went from hard work back to easy because of how she exhaled while bending down and inhaling while standing up. “I really improved a lot,” she said. And exercising with someone watching and monitoring made her feel safer. Her advice for others with breathing disorders is simple: “Try it. It will help,” Susan said. “When I see someone new in the waiting room, I tell them to do it. It helps you.” After her 12 weeks of formal Pulmonary Rehab was over, “I keep going,” Susan said. She continues her exercises through the Fit for Life program at the hospital every Tuesday and Thursday. It is a program that allows former patients to come back to exercise while being monitored. And she has made friends at the program. “ Every week, we catch up on what is going with them and what is going on with you.” She also enjoys visiting with the staff. “My goal is to be able to dance, again,” Susan said, and with her exercises and listening to her doctor, she knows it is possible.

WINTER SPRING 2016 | 15


ShortScripts

Navigating all the information on health insurance can be downright frustrating. Too often, it is so confusing that people simply go without insurance. However, it can lead to fines with the IRS if you are uninsured. To help, the Pennsylvania Association of Community Health Centers, PACHC, has given a grant to Penn Highlands Healthcare to employ a navigator to help walk people through the marketplace and find the right insurance. Andrea Stewart has been appointed to that position and has an office at Penn Highlands Brookville. “You are required to have health insurance,” she said. “If you don’t have it, come in, and I’ll help you. We’ll sit at my computer, and I’ll walk you through the steps.” There is no fee for this service, and Andrea is currently the only navigator in the area. She gives fair and impartial information and will not point people in the direction of a specific insurance provider. She will help those who qualify for medical assistance or Medicare to enroll in those programs and will help everyone find the best coverage for the lowest possible premium. To schedule an appointment, please call (814) 849-1412 or email Andrea directly at alstewart@phhealthcare.org.

16 | SPRING 2016

The 2016 Penn Highlands Healthcare/ KTH Golf Classic will be held on June 24 at four separate golf courses in St. Marys, Clearfield, Brookville and DuBois!

The Us TOO International Prostate Cancer Education and Support Network meets at 7 p.m., on the first Monday of each month in St. Camillus Hall, Penn Highlands DuBois West, 100 Hospital Ave., DuBois. Us TOO is for those who have questions about prostate cancer, who need support or would like to have insight into what the future will bring from a personal background. It is a place to talk and listen with people who have been through or going through prostate cancer. “If you want someone to talk to, or to ask a question of somebody who’s actually ‘been there and done that,’ or just want to know that you aren’t alone during this process, just take the first step and join us at our meeting,” said Bob Anthony of Brookville who will be facilitating the group. “Know that you are always welcome and your experiences can help others facing the same issues.” All are welcome to attend. For more information, call Bob at 814-715-0544.

With a 10:00 AM tee time at each of the four main communities that make up Penn Highlands Healthcare, golfers are able to choose the location they wish to golf: • Bavarian Hills Golf Course – St. Marys; • Clearfield-Curwensville Country Club – Clearfield; • DuBois Country Club – DuBois; • Pinecrest Country Club – Brookville. Final course assignments are made on a first-come basis, based upon receipt of payment and completed registration materials. The day includes great golf, skill contests, raffles, prizes, food and drinks all day long. The day ends with a happy hour and dinner at the course played. Where does the money go? Each sponsor will also have the opportunity to choose where their donation is directed: •

• • • •

Penn Highlands Healthcare to be shared equally among all four hospitals; Penn Highlands Brookville for new MRI pad and patient entrance area; Penn Highlands Clearfield for a bladder scanner; Penn Highlands DuBois for new EKG equipment; Penn Highlands Elk for Pinecrest Manor renovations.

Go online to www.phhealthcare.org to register today!

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Spring2016