Oxford Health & Life Summer 2024

SAME DAY SHOULDER

REPLACEMENT

SUMMER SKIN SAFETY

WHAT TO KNOW ABOUT SUGAR

EXCEPTIONAL CARE FOR WOMEN AND KIDS

NEW SHOULDER, NEW LIFE

Darrell Smith and his wife, Mary, with their beloved Lab, Boone

A LIFELONG OXFORD

RESIDENT RECEIVES MHMH’S FIRST SAME-DAY TOTAL JOINT REPLACEMENT SURGERY

DARRELL SMITH had been suffering from shoulder pain for years, and, at 62 years old, the Oxford native and married father of three was tired of it. He was no stranger to hard work— he’d worked in his family’s thirdgeneration HVAC and electric company for most of his life in a physically demanding role that involved climbing ladders, lifting equipment, carrying and installing materials and lots of overhead work.

He was no stranger to shoulder surgery, either, having had a left shoulder replacement in 2021. Now, though, his right shoulder was acting up, and the pain was getting worse by the day. It wasn’t just interfering with his ability to do his job but with his day-to-day quality of life. “It felt as if rough-shaped marbles would roll around in my joint whenever I tried to raise my arm over my head,” says Darrell. “It was mostly a dull pain, but when I moved it a certain way, it could bring tears.”

Bryan McCullough, DO, an orthopedic surgeon at Beacon Orthopaedics & Sports Medicine in Oxford, met Darrell back in 2020 when he was referred by a relative.

“He was experiencing significant pain, which had been ongoing for several years,” says Dr. McCullough, who performed a total left shoulder arthroplasty in 2021. “He was doing very well with the left shoulder but had increasing right shoulder pain.”

THE DIAGNOSIS

Dr. McCullough diagnosed Darrell with end-stage osteoarthritis of the right shoulder. Conservative management— including activity modifications, anti-inflammatory medications and physical therapy— had failed, and

Darrell chose not to have cortisone shots. “They would just delay the inevitable,” he says.

“Given the fact that he had an intact rotator cuff, we decided to move forward with standard anatomic shoulder replacement surgery,” says Dr. McCullough. “The goal was to allow Darrell to get back to doing work-related and daily activities with significantly less pain. I felt this surgery would give him the best chance to return without significant limitations.”

On January 24, 2024, the shoulder replacement surgery was performed as a same-day outpatient procedure.

A FIRST FOR MHMH

A decade ago, it was routine for a patient with a total shoulder or knee replacement to have a two- or threenight hospital stay, and, eventually, single-night stays became common.

“Same-day total joint replacement surgery has been performed at our Beacon ambulatory surgery centers for a handful of years,” Dr. McCullough says. “It had been working well and I liked the idea of patients not having to stay overnight in the hospital, so I decided to take it to our local hospital, McCullough-Hyde Memorial Hospital, in Oxford.”

Darrell had no misgivings about having the procedure. In addition to having had shoulder replacement surgery performed by Dr. McCullough previously, he wanted to fix the problem rather than continue to try to manage it.

“I felt that surgery was the best and only option for me,” he says. “I still want to work, but I’m also approaching the end of my career. I want to be active after retirement. The limited range of motion and pain I had was so restrictive, it would have reduced my quality of life in my later years.”

Darrell’s procedure was performed with a single incision near the front of the shoulder and extending out to the side approximately four to five inches in length. “The surgery itself takes a little over an hour,” says Dr. McCullough. “Shoulder replacement requires general anesthesia, and we also use a regional nerve block called interscalene block. Other local injectable medicines can be used as adjuncts for pain control.”

A SMOOTH RECOVERY

After the surgery, Darrell says, “I had pain blocks for only three or four days. Then I just used Tylenol and ibuprofen to manage pain.”

Dr. McCullough believes same-day total joint replacement surgeries are possible in part because of significant improvements in perioperative pain control. “Regional nerve blocks and local injectable medicines can help post-op pain for two to three days, which cuts down on the need for opiates for pain control,” he says.

He cautions that, while he thinks same-day joint replacement surgery is a great option, it is not right for everybody. “Certain patients with significant medical comorbidities might not be good candidates,” he says. “Each patient needs to be fully evaluated individually to determine whether such surgery is right for them.”

In Darrell’s case, it was the right choice. He says he has had no followup procedures and has no physical limitations, but he believes he will need physical therapy for some time. “I have a long way to go in my PT, but the surgery has repaired the pain that plagued me every day,” Darrell says. “I feel so very lucky to have a hospital in our community that can offer so many services that allow folks to stay close to home and family during difficult times.”

Bryan McCullough, DO

EXPERT CARE FOR

WOMEN AND CHILDREN

M c CULLOUGHHYDE MEMORIAL HOSPITAL OFFERS COMPREHENSIVE, PERSONALIZED CARE FOR WOMEN, INFANTS AND CHILDREN.

THROUGHOUT a woman’s life, her body changes and her healthcare needs evolve. From adolescence through pregnancy, childbirth, menopause and beyond, women experience many changes, and finding quality women’s healthcare through all stages of life is important for maintaining optimal health.

HEALTHCARE FOR WOMEN OF ALL AGES

At TriHealth Women’s Services—Oxford Obstetrics and Gynecology, women of all ages receive comprehensive, individualized, state-of-the-art care.

“As a leader in obstetric and gynecologic care in Oxford, Ohio, and Brookville, Indiana, we have been

From left: Timothy Richmond, MD, and Heather Mandrell, MD, of Oxford Pediatrics and Padmaja Sanaka, MD, of Oxford Obstetrics and Gynecology

providing personalized and thorough women’s healthcare for more than 50 years,” says Padmaja Sanaka, MD, an obstetrician and gynecologist at TriHealth Women’s Services. “Our providers and staff have strong ties to the communities we serve. We perform comprehensive gynecologic and obstetrics services at McCullough-Hyde Memorial Hospital (MHMH), and we are the only physician practice that delivers at MHMH, where we provide on-call coverage for all OB-GYN needs.”

FIRST OB-GYN VISIT

Dr. Sanaka recommends that girls have their first visit with a gynecologist between the ages of 13 and 15. “Many young girls may start gynecologic care and counseling with their pediatricians before transitioning over to a woman’s health specialist for care,” she says. Women should schedule regular gynecologist visits and should be proactive with age-appropriate screenings, such as Pap and HPV (human papillomavirus) tests.

PRENATAL CARE

“In most cases, we are already seeing a woman for other routine gynecologic and birth control services when she begins thinking about pregnancy,” says Dr. Sanaka. “When she is ready to conceive, it is common for her to discuss this at an annual appointment, or she may need to schedule an appointment to stop her existing birth control or have an IUD removed. We recommend all women who are trying to conceive to start taking prenatal vitamins.”

Quality prenatal care is important for a healthy pregnancy, and Oxford Obstetrics and Gynecology offers a full range of comprehensive prenatal services.

STEPHANIE AND ANDREW’S STORY

Nobody can attest to this better than 29-year-old Stephanie Richardson, who had been a patient of Daniel Stein, MD, of Oxford Obstetrics and Gynecology for a decade before she and her husband, Andrew Richardson, 30, found out that they were expecting. Stephanie saw Dr. Stein throughout her pregnancy,

and, when she developed gestational diabetes, she saw him more frequently to have her diabetes monitored.

When Dr. Stein was on vacation during Stephanie’s 38th week, Dr. Sanaka stepped in to handle Stephanie’s care. On August 7, Stephanie saw Dr. Sanaka for an inoffice nonstress test and ultrasound, and it was determined that she was carrying too much water. According to Stephanie, “Dr. Sanaka asked, ‘Well, do you want to have your baby today or tomorrow?’” Stephanie was admitted to MHMH, where she was induced around 3 p.m. and, the following morning at 8:08 a.m., she gave birth to their first child, Rita Lynn Richardson.

Stephanie and Andrew recall that there was “lots of fast-paced action on the OB floor,” including several deliveries and an emergency C-section, but the team was attentive and accommodating, checking Stephanie frequently and offering countless popsicles and ice chips. “Rita was born right at the OB crew’s shift change, so we had both the night and morning shift nurses, Dr. Sanaka and pediatrician Dr. Davis (James B. Davis, MD, of Oxford Pediatrics) in the room,” says Andrew. “We also had tons of support, cheering and “Happy Birthday” singers for Rita’s arrival. Her room was the place to be!” Rita had jaundice at birth and required phototherapy (treatment with a blue light to break down the bilirubin). “Our family had an extended stay while she stayed under the bili lights,” says Andrew. “Pediatricians from Oxford Pediatrics assisted in Rita’s care, and we cannot say enough good things about the team.”

PEDIATRIC CARE: FROM WOMB TO DORM ROOM

“We encourage patients to select a pediatrician when they are about 28 weeks into their pregnancy,” says Dr. Sanaka. “We work closely with TriHealth Physician Partners—Oxford Pediatrics during delivery, and many of our patients opt to continue care for

their baby with the practice.”

Stephanie saw Dr. Sanaka for her postpartum care and continues to see her as her regular OB-GYN. Stephanie and Andrew were impressed with the pediatric care Rita received in the hospital, so they’ve continued with Oxford Pediatrics, with Timothy Richmond, MD, as Rita’s primary pediatrician. “He is thorough, answers all our questions and is great with Rita,” says Andrew. “He keeps her happy and entertained during visits while still providing excellent care.”

Dr. Richmond and his wife, Heather Mandrell, MD, both joined Oxford Pediatrics in 2022. At MHMH, they and Dr. Davis, who has been part of the practice for several years, provide medical care for newly delivered babies and routine after-delivery hospital care for newborns. “We typically recommend a newborn check-up in our office between three and seven days after delivery,” says Dr. Richmond. “Our nursing team at MHMH also offers an in-hospital newborn check-up, typically two days after leaving the hospital.”

“The first newborn office visit normally includes weight and growth measurements, and additional evaluations if needed,” says Dr. Mandrell. At Oxford Pediatrics, patients are seen until they enter adulthood. “We often continue to see patients during their college years,” says Dr. Richmond.

Drs. Davis, Mandrell and Richmond offer a wide range of pediatric medical services including routine wellness and preventive care. “Our responsibilities at MHMH include stabilizing newborns at delivery, routine newborn nursery care and hospital care for children,” says Dr. Richmond.

ONGOING GYNECOLOGIC CARE

“We pride ourselves on the gynecologic care we extend to women of all ages,” says Dr. Sanaka. “We provide a range of services, from annual exams and fertility evaluations to treatment of menopause and laparoscopic surgery.”

PROTECT YOUR SKIN THIS SUMMER

SIMPLE STEPS CAN DRASTICALLY REDUCE YOUR SKIN CANCER RISK

SUMMER IS a time for going to the beach, frolicking in the surf (or pool), enjoying picnics and barbecues, and having all kinds of fun outdoors. Protecting your skin from the sun’s harmful rays is always important, but, when the days get longer and the temps start to rise, protection is even more crucial. Here’s how to take care of your skin all summer long.

SLATHER ON SUNSCREEN

Use sunscreen even on cloudy or cool days. Look for a broad-spectrum sunscreen that protects skin from both UVA and UVB rays. Apply 30 minutes before you go outside and reapply every two hours and immediately after swimming. A sun protection factor (SPF) of 30 is sufficient.

DRESS FOR SUCCESS

Wear loose-fitting, long-sleeved shirts and long pants made from tightly woven fabric, as well as a hat with a brim that shades your face, ears and the back of your neck. Wear a T-shirt on the beach when you’re not in the water. Look for fabrics that have an ultraviolet protection factor (UPF) to guard against UV rays.

THE EYES HAVE IT

Did you know your eyes can get sunburned? Wear sunglasses that offer UV 400 (UVA and UVB rays) or 100% UV protection. Wraparound sunglasses are a great choice to protect eyes and the delicate skin around the eyes from harmful UV rays.

CHECK IT OUT

Regularly examine your skin in the mirror or in the shower for changes in the size, shape and color of moles. Ask someone to check your back and neck, and, if your hair is thinning, be sure to check your scalp as well.

WATCH THE KIDS

The vast majority of sun exposure occurs before age 18, so teach your kids how to protect their skin and eyes against sun damage early in life. For maximum effectiveness, let them see you doing the same!

SHUN THE BRIGHTEST SUN

The sun’s rays are strongest between 10 a.m. and 4 p.m., so, in addition to wearing sunscreen and proper clothing, reduce your risk of skin damage by seeking shade under an umbrella, a tree or other shelter.

GIVING BACK

WITH EMPATHY

A YOUNG VOLUNTEER ON HOW A NEUROLOGICAL DISEASE MADE HIM DETERMINED TO HELP KIDS WITH SIMILAR CONDITIONS

LIKE MANY 22-YEAR-OLDS, Lebanon, Ohio, native Jake Gallagher, a volunteer at McCullough-Hyde Memorial Hospital (MHMH), where he works in the Emergency Department (ED), has big dreams and high aspirations. Unlike some his age, though, Gallagher, a Miami University senior and biologyneuroscience double major, knows

exactly what he wants to do in his career and has already set forth on his journey to realize his goals. “I want to be a pediatric neurologist,” he says.

Gallagher says his interest in the field stems from his own personal experience with a life-changing diagnosis. “I was once the kid in the chair,” he says. When Gallagher was 14, he was diagnosed

with monomelic amyotrophy (MA), a rare motor neuron disease, also known as Hirayama disease. “The disease tends to affect one arm, specifically by wasting away the muscles and nerves,” he says. “After my diagnosis, I lost a lot of mobility in my hand and was told I couldn’t play basketball or football anymore, both of which were a huge part of my life.”

It was one of the hardest periods of his young life. “I felt so lonely,” he says. “I didn’t have anyone to talk with that really understood what I was going through.”

Because of his experience, Gallagher believes that, as a pediatric neurologist, he will be able to offer young patients the kind of empathy and understanding that comes with having been in their shoes. “I want to be for them the voice of reassurance that I never had. I want to be able to tell them, ‘This isn’t going to be fun. It’s going to be hard, but you’ll emerge infinitely stronger.’”

For now, as his senior year comes to a close and he begins to look at medical schools, Gallagher is gaining valuable experience at MHMH.

“I clean the rooms after each patient leaves and transport patients to X-rays, MRIs and CAT scans,” he says. “It allows me to see firsthand the most important work that goes on in the hospital. The nurses, certified nursing assistants and support staff are why hospitals are able to function. Getting to see it is awe-inspiring.”

Gallagher says his experience with Hirayama disease has not only fueled his drive to practice medicine, it’s made him kinder and more empathetic. He also credits his mother for passing on these traits, which he’s using in the ED at McCullough-Hyde and which will serve him well as a pediatric neurologist. “My mom has been the rock I needed,” he says. “She’s wise, funny, kind and willing to move the stars for those she loves— something I’m trying to emulate every day.”

INTERESTED IN VOLUNTEERING AT McCULLOUGH-HYDE MEMORIAL HOSPITAL? FOR MORE INFORMATION, VISIT HTTPS://BIT.LY/MHMH-VOLUNTEER.

Volunteer Jake Gallagher with MHMH emergency department physician Nicole White Malin, MD.

THE LOWDOWN

ON SUGAR

EVERYTHING YOU NEED TO KNOW ABOUT THE SWEET STUFF WE LOVE TO HATE—AND HATE TO LOVE

WE ALL KNOW that sugar is bad for us—isn’t it? Not necessarily. Sugar is not inherently bad, but it is often misunderstood. Sugar is actually essential since it’s a type of carbohydrate, and carbohydrates are the main source of energy in our bodies.

“Carbohydrates are made up of sugar, starch and fiber that is broken down into glucose,” says Natalie Mollett, RDN, LD, a clinical dietitian at McCullough-Hyde Memorial Hospital. “Glucose is then transported into our bloodstream and ultimately into our

body’s cells to be utilized for fuel.”

So why the bad rap? It’s largely because we consume too much of the sugars that offer little to no nutritional value—like pop and candy, packaged cookies and cakes, and processed foods containing “added sugars”—rather than those from nutritious sources, such as whole grains. “Sugar that comes from a nutritious source can act as quality energy for our bodies,” says Mollett. “When people talk about ‘good’ sugars and ‘bad’ sugars, they are usually referring to the sources of the sugar.”

Most Americans consume too much sugar. Though the American Heart Association recommends that women have no more than 25 grams (about six teaspoons) and men no more than 36 grams (nine teaspoons) per day, the average American consumes 70 grams of sugar or more a day. Consuming too much of this less nutritional type of carbohydrate, specifically “added sugars,” can cause or contribute to inflammation, weight gain, high blood pressure, heart disease, diabetes and other chronic health conditions. “It is important to be aware of how much and what kinds of carbohydrates you are consuming,” says Mollett. “People with diabetes should pay even closer attention and monitor their intake more strictly.”

WHAT IS SUGAR?

The chemical name for sugar is sucrose, a simple carbohydrate that’s produced naturally in plants, including fruits and vegetables. Sucrose is also the sugar we spoon into our coffee or tea and use in cookie dough and cake batter. We also commonly call this “white refined sugar” or “table sugar.” These sugars are often contained in foods we consider “sweet” like desserts. The chemical names for these various sugars also end in “-ose.” Fructose, glucose and sucrose are naturally found in fruits and some vegetables, whereas lactose is found in milk and dairy products and maltose is found in germinating grains. Interestingly, many foods that contain sugar don’t taste sweet at all. These

are carbohydrates that are converted to sugar (glucose) in the body.

WHAT SUGAR DOES IN THE BODY

When people eat whole plant foods— complex carbohydrates like fruits and grains, which also contain fiber and/ or starch—the sugar is digested slowly along with other nutrients, providing the body with a steady source of energy. But when simple carbohydrates are added to foods—such as desserts that contain white flour, table sugar or brown sugar—they are digested quickly, which causes the level of sugar in the blood to rise rapidly, leading to energy spikes and quick crashes. Though we need carbohydrates for energy, some foods, such as starches and fiber sources of carbohydrates, provide this energy better than others. So, while you don’t want to have a diet full of sweets, you do want to eat whole grain bread, whole wheat pasta, brown rice, fruits and vegetables.

TYPES OF SUGAR

We often hear about “natural” sugar versus “added” sugar. But the term “natural” can be misleading. When dietitians talk about natural sugar, they’re referring to sugar that’s naturally occurring in food and foods that are “complex carbohydrates,” such as the starch- and fiber-containing foods. A banana, for example, is sweet because it contains natural sugar. Other examples of natural sugar include potatoes, bread, peas, lentils, oats, blueberries and milk. Foods containing natural sugars often contain vitamins, minerals, antioxidants, fiber and other nutritious and beneficial ingredients. Other foods, including many processed foods, have sugar added to them, mainly for taste; in those cases, it has little to no nutritional value. In fact, some processed foods with added sugar (such as bottled salad dressings) don’t taste sweet. Still, whether added sugar is listed on labels as white sugar, brown sugar, turbinado sugar, demerara sugar, honey, molasses, maple syrup or another name, it’s still sugar and will act in the body the same way.

WHAT ARE “ADDED SUGARS”?

The more processed foods you buy, the more likely you are to encounter added sugars. However, you won’t necessarily see the term “added sugars” on food labels. Sometimes, food labels will list them in their ingredients under one of their many names, including:

• Agave nectar

• Barley malt extract

• Brown rice syrup

• Dextrose

• Evaporated cane juice

• Fructose

• Glucose

• High-fructose corn syrup

• Lactose

• Maltodextrin

• Malt syrup

• Maltose

• Maple syrup

• Sucrose

It pays to know sugar’s many names and guises and to look for them on food labels. Remember: Regardless of the moniker, sugar by any other name is still sugar.

SMART SNACKING WITH DIABETES

Fruits are a great snack for people with diabetes. But a good rule of thumb for anyone with diabetes is to always have a protein and/ or fiber source in addition to fruit or other sugar-containing foods to help slow digestion and prevent spikes in blood sugar.

Snack Suggestions:

• 1 cup berries with ¼ cup nuts

• Half a banana with 2 Tbsp natural peanut butter

• ½ cup (or 17 small) grapes with a slice of low-fat cheese

ENJOY SUMMER FOODS— EVEN IF YOU HAVE GERD

YOU DON’T HAVE TO MISS OUT ON SUMMER PICNICS AND BARBECUES; YOU JUST NEED TO MAKE GOOD CHOICES.

IF YOU live with GERD (gastroesophageal reflux disease), you know how unpleasant it can be. With GERD, eating the wrong foods, eating at the wrong times or eating the wrong quantities can cause you hours of misery and guarantee a sleepless night. Not familiar with GERD? Think of it as acid reflux on steroids. Reflux occurs when food and stomach acid back up into the esophagus, causing a burning pain in the chest (heartburn). This acidic backwash can also cause a bitter taste or the sensation of “throwing up in your mouth.”

While most people experience acid reflux or heartburn once in a while, those with GERD experience more intense symptoms more often (at least twice a week). Talk about putting a damper on your summer fun.

According to Binoy Ouseph, MD, a gastroenterologist at McCulloughHyde Memorial Hospital and TriHealth Physician Partners Gastroenterology in Montgomery, Ohio, having GERD does not mean you have to be miserable all summer. “It’s absolutely possible for people with GERD to enjoy eating a variety of foods, even ‘fun’ summer foods at barbecues, picnics and other outings,” says Dr. Ouseph. Of course, there are some foods you should try to avoid— such as very spicy, deep-fried or fat-laden foods—but, in many cases, a little moderation can go a long way. Here, Dr. Ouseph offers some advice to keep your summer meals enjoyable—and reflux-free.

1. AVOID REFLUX TRIGGER FOODS.

Fatty meats and cheeses, deep-fried foods, chocolate, onions, rich sauces, alcohol and coffee are a few examples of foods and drinks that increase acid secretion. They also relax the lower esophageal sphincter (LES), a ring of muscle at the bottom of the esophagus that normally stays closed except when food is entering the stomach. “This is a problem because when this sphincter is relaxed, food and acid can flow back into the esophagus,” says Dr. Ouseph. “So, try to minimize your intake of these reflux trigger foods.” Skip the fried chicken and saucy ribs, and opt instead for grilled chicken or fish. Use

MEET BOARD-CERTIFIED GASTROENTEROLOGIST BINOY OUSEPH, MD

Dr. Binoy Ouseph is new to McCullough-Hyde Memorial Hospital, but he brings with him 24 years of experience and expertise in treating a full range of gastrointestinal and digestive conditions, from irritable bowel syndrome to pancreatic cancer. After completing medical school in India, Dr. Ouseph, whose main office, TriHealth Physician Partners Gastroenterology, is in Montgomery, Ohio, did additional training in internal medicine and gastroenterology at New York Medical College. Dr. Ouseph says that one way people can take care of their digestive health is by eating natural foods rich in fiber, avoiding tobacco and alcohol, and getting routine screening tests such as colonoscopies starting at age 45.

seasonings that are tasty rather than hot and spicy. Replace fries and deep-fried onion rings with a baked potato, some grilled veggies, brown rice or a citrusfree fruit salad. Keep acidic drinks to a minimum, and limit your alcohol intake to one or two beers. If you smoke—which is unhealthy to begin with—don’t drink at the same time. “Smoking and drinking alcohol together produce significantly more acid and leave the sphincter wide open,” cautions Dr. Ouseph.

2 . EAT MINDFULLY.

When you’re having a good time with friends at a summer picnic or cookout, it’s easy to lose track of what you’re eating, as well as how much and how quickly you’re eating. “Remember to eat slowly, have smaller portions and avoid trigger foods,” says Dr. Ouseph. When you do eat, take sips of water between bites. In addition, it may make sense to have a small, healthy snack at home before you head to a party, picnic or barbecue. That way, you won’t be starving, and you’ll be less likely to eat something you’ll be sorry for later.

3. TAKE AN ANTACID AT LEAST 30 MINUTES BEFORE A MEAL.

If an over-the-counter antacid such as Tums doesn’t provide relief, Dr. Ouseph recommends

trying a fast-acting OTC antacid such as famotidine (Pepcid), an H2 (histamine-2) blocker, which can provide relief in as little as 15 to 30 minutes. Proton pump inhibitors (PPIs) like Nexium, Prilosec and Prevacid also work by reducing the production of stomach acid. PPIs generally take longer to work than H2 blockers, but they are stronger and offer longer-lasting relief. “Even if eating does trigger reflux, it’s likely to be less painful if you’re proactive with medications,” says Dr. Ouseph.

4. WEAR LOOSE CLOTHING.

Tight clothing, such as tight jeans or belts, exerts pressure on the stomach, which can cause stomach acid to move up into the esophagus, resulting in acid reflux. Choose a loose-fitting T-shirt or tank and pull-on shorts or sweats.

5. DON’T EAT BEFORE BEDTIME.

“Lying down on a full stomach can trigger reflux,” says Dr. Ouseph, “so try to plan your meal at least two to three hours before bedtime.” (And save the leftover potato salad for the next day’s lunch.)

TO MAKE AN APPOINTMENT WITH DR. OUSEPH IN OXFORD, CALL 513.853.9250