EAST COUNTY
Health Matters Observer
DECEMBER 2019
HOLIDAY BLUES Handling seasonal grief is a step easier with support. PAGE 2
CANCER CARE
BALANCING YOUR DIET
PICTURE OF HEALTH
PAGE 5
PAGE 8
PAGE 10
New facilities and services come to SMH.
Tips to stay on track during foodie season.
Use your kids as exercise motivation.
HEALTH MATTERS
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DECEMBER 2019
GETTING THROUGH
WHAT YOU CAN DO Tips for family members of someone experiencing grief or depression: n Be as supportive as possible. n Try not to be negative. n Help them get out of the house and doing activities. n Tell them, “I’m here for you,” or ask, “What can I do for you?” n Don’t say, “I know what you’re going through.” n Keep the conversation neutral. n Just listen, and don’t judge.
WINTER SORROW
Music therapy is one option doctors recommend for depression and grief during the holiday season. LIZ RAMOS STAFF WRITER
T
he holidays can bring back several memories and emotions for those experiencing grief, depression and other mental health issues. Dr. Tariq Halim, a Lakewood Ranch general psychiatrist, said it’s common to have those feelings this time of year, especially if you are away from family or have lost someone recently. “They become worried about the holidays and how they’re going to feel depressed or sad because they won’t be seeing them,” he said. “That tends to be the case with the elderly population.” Halim said people experiencing depression can have difficulty waking up in the morning and that it’s arduous for them to get out of
bed “not because they’re tired but because they just don’t want to get out” of bed. Other signs of depression include not enjoying activities, hobbies or events like they once did and keeping to themselves more. To help with depression, Halim suggests planning out your day — even if you don’t have anything planned to do — to give you something to look forward to, which will help you get up in the morning. And when planning your days, try to include 30-40 minutes outside three to four times per week. Exercising releases endorphins and serotonin, which help improve your mood and prompt the growth of new brain cells and blood vessels to bring more oxygen into your body. Halim said Florida provides better opportunities to exercise
Photos by Liz Ramos
Mia Affeldt gently strums Abigail Hagan’s guitar. Besides working with students in special education, Hagan, an intern for Gulf Coast Music Therapy, also works with people experiencing grief, anxiety, depression and more.
and enjoy the weather compared to northern states, which can have harsh winters that cause people to stay indoors. If depression symptoms get to the point of causing dysfunction to your social, occupational or academic life, Halim suggests seeking aid and treatment from a medical provider. MUSIC THERAPY
You can find help in various nonmedical ways as well, such as with grief counseling or music therapy. Virginia Bibler, the owner of Gulf Coast Music Therapy in Lakewood Ranch, said the holidays are her favorite time of the year for helping patients. She uses music therapy to help people who
are experiencing grief, depression, anxiety and pain. Music therapy is the use of live, patient-preferred music to address nonmusical goals and is conducted by a board-certified and licensed music therapist. The American Music Therapists Association describes music therapy as a “form of sensory stimulation that provokes responses due to the familiarity, predictability and feelings of security associated with it” and says it can be used as a means of communication and expression. With live music, the therapist is able to change the tempo, vocal timbre and other aspects of the music to fit the needs of a patient, which allows the music therapist
Tips for those experiencing grief or depression: n Reframe your thought process into happy moments of the person who died. n Plant a tree or flower, and whenever you see it, think of a happy moment with that person. n Exercise for 30-40 minutes three to four times per week. n Plan your day.
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Rowena Jassen, a resident at Brookdale Palmer Ranch, uses two bells to play and sing along to “Jingle Bells.” Christmas music can sometimes spark memories in people.
to observe behavioral and physiological responses of a patient in real time, according to study from Florida State University. Bibler goes to Sarasota Memorial Hospital once a week as part of a pilot music-therapy program to help patients with pain, anxiety and aggression. During this time of year, she often uses holiday songs to help patients tap into their memories and to counsel them. Some songs can remind people of traumatic experiences while others could have a joyful response; the music therapist then uses training to provide patient-specific support. Playing songs that patients are more familiar with can lead to patients being more responsive, Bibler said. “I’m going to use those songs to draw out not only emotion and feeling from the patient that I’m working with, but also I’m going to use those songs for selfexpression,” Bibler said. “We’re going to look at lyrics and what these lyrics mean and how you
relate to them.” In music therapy, Bibler said patients receive verbal counseling through discussing what the lyrics mean to them or having them write a song or play an instrument to express their emotions. Because everyone can go through the grieving process differently, music therapy and grief counseling are individualized. Tidewell Hospice is also working to hire a music therapist by the end of the year for its southern locations. Lauri Pollack, a Tidewell volunteer who leads grief-support groups, said people generally go through phases of sadness, anger, denial and coming to terms with a loss and carrying on, but these phases are not definite, and people don’t go through them in the same way or at the same time. Pollack said the relationship a person had with someone who died also impacts grief. “You can’t make it go faster,” she said. “It’s going to go however
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SEASONAL DEPRESSION Seasonal affective disorder is a form of depression that tends to occur when there is not enough sunlight to trigger a person’s circadian rhythm, the internal 24-hour sleep-wake cycle. In most cases, SAD occurs in the fall and winter. The symptoms of SAD are similar to that of depression: low energy, a loss of interest, sleeping too much and a difficulty of staying on task. Halim said although SAD isn’t common in Florida, there is what he calls “the Florida version of SAD,” which occurs in mid- to late October, around a month leading up to daylight saving time ending. People can experience SAD as a result of not seeing the sun when they wake up because the time change. “Some people call it the preholiday blues, but that’s really not the case,” he said. “It’s really because of the shifting of the sunrise and sunset. The Florida version of SAD is more common in people who go to school or work early in the morning.” The Florida version of SAD only lasts until daylight saving occurs again, unlike the typical form of SAD, which lasts until spring and summer. For the weeks between daylight saving time changes, people can use a SAD lamp, which has a bright light that mimics natural outdoor light. There are also alarm clocks that stimulates sunlight by slowly turning up while people are sleeping to wake them up around 6:30 a.m. with the same intensity of light.
Virginia Bibler, the owner of Gulf Coast Music Therapy, interacts with people during a music therapy session at Brookdale Palmer Ranch.
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it chooses to go.” The holidays can be triggers for people as they continue with traditions, see an empty chair at the table or remember decorating for the holidays with their loved one, so Pollack suggests coming up with new traditions or skipping decorations. Sometimes writing in a journal or writing a letter to the person who died can also be therapeutic. “You have to do whatever is OK for you,” she said. “Whatever will help you get through this process, however long it takes.” Pollack said grieving is a time in a person’s life to be selfish and think about personal needs. “You have to go through it; you have to feel the pain and go through all the work that it takes to make yourself feel better,” she said. “It softens over time. We can’t say it’s going to go away or it’ll be gone in six months. We don’t know, but it softens.”
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DECEMBER 2019
Debunking the gluten-free mantra:
Is gluten-free better? Specialists raise concerns over gluten-free misconceptions. PAM EUBANKS SENIOR EDITOR
I
n the past six weeks, Dr. Avantika Mishra has seen three patients who have been on a gluten-free diet for more than 15 years and might not even have needed such a restriction. As a gastroenterologist at Florida Digestive Health Specialists, Mishra said it’s a trend that she and others in her profession are seeing. There’s a misconception that gluten is bad and that avoiding it can be the cure for a variety of conditions, such as bloating or weight loss. “We mostly see people who think they have triggers, and the symptoms are vague — bloating, changes in bowel movements,” Mishra said. “Apart from celiac disease, it’s all subjective. Many people can reintroduce gluten and feel fine.” Celiac disease is an autoimmune condition in which consuming gluten actually damages the small intestine. Mishra said avoidance of gluten is the medical treatment for celiac disease, so it is important individuals with celiac avoid it. However, Mishra and fellow gastroenterologist Dr. Marc Berstein said individuals without gluten sensitivities should strive to eat a plant-based, fiber-rich
diet full of fresh fruits and vegetables and whole grains for improved gut health. Such foods are important for proper nutrition, as well as providing your body the fuel it needs day to day. “Gluten, over the years, has gotten a bad rap, for better or worse,” Bernstein said. “Almost like a carbohydrate, people avoid it. Patients are having symptoms, and they say, ‘Oh, it must be gluten.’ But gluten can form a healthy part of your diet. Whole grains that do contain gluten should be a staple.” Berstein and Mishra said individuals who have no gluten allergies or sensitivities should incorporate foods with gluten into their diet because of the health benefits. They said eating glutenfree without having an allergy to gluten can lead an increased risk for micronutrient deficiencies. Plus, many gluten-free products contain additives or other ingredients that are not healthy. “Gluten, if you think about it, is sort of like a binder,” Berstein said. “It keeps the grain together. Whole grain, before it is refined, can contain very good dietary fiber, B vitamin, phytochemicals with as strong antioxidant effect.” They said eating gluten-free can also be more expensive and can make it harder to enjoy eating
Pam Eubanks
Dr. Avantika Mishra says individuals without gluten allergies or sensitivities should not avoid it.
out or other activities because of having to read ingredient labels, pack separate meals and other inconveniences. Mishra noted that some individuals who do not have celiac disease believe they have a gluten allergy because they experience similar symptoms, such as abdominal pain or bloating. But those symptoms can be the same for a variety of reasons — from eating gas-producing foods like apples or broccoli to having an imbalance of healthy bacteria in the gut to having other medical conditions, such as irritable bowel syndrome or ulcerative colitis. Mishra and Berstein said that before you eliminate gluten — or any food group — altogether, it’s best to work with a gastroenter-
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“It’s very important to have not only a dedicated area but one that’s in a calming, welcoming environment.” — Kelly Batista, SMH Cancer Institute director
Courtesy rendering
The eight-story oncology tower on the Sarasota Memorial Health Care System main campus, described as the future “heart” of the SMH Cancer Institute, will open in November 2021.
SMH expands cancer care Cancer Institute Director Kelly Batista says improvements to SMH’s cancer center are about much more than new buildings.
BRENDAN LAVELL STAFF WRITER
The Sarasota area is growing. And Sarasota Memorial Hospital’s Cancer Institute is growing with it. SMH is constructing two major additions to its cancer center, which will provide patients with a more complete spectrum of cancer care close to home. But the expansion is about much bigger than walls and machines; it also includes the addition of more physicians and support systems.
“When you look at what cancer patients look for in their care, it’s really two things,” Cancer Institute Director Kelly Batista said. “They want a physician and a physician team that specializes in their cancer. And then they want their care all under one roof.” The most obvious changes will be the two new buildings: a radiation oncology center on the North Sarasota campus, which will open to treat patients with its linear accelerators in August 2020, and an eight-story oncology tower on the main campus, which will
become “the heart” of the SMH Cancer Institute, according to the SMH website, when it opens in November 2021. SMH already offers internal radiation therapy, which implants radioactive seeds into the site of a tumor and is typically used when the cancer has not spread to other areas. But the radiation oncology center will allow SMH to offer radiation beam therapy for the first time. Radiation beam therapy involves using linear accelerators to conform a radiation beam as tightly as possible to the site of the tumor. It can be used if cancer spreads to other parts of the body. Meanwhile, the oncology tower will ensure the inpatient needs of a growing population, such as visiting with specialists and receiving care from nurses, can be met under one physical roof. “They can have a longer length of stay than some of our other patient populations,” Batista said. “It’s very important to have not only a dedicated area but one that’s in a calming, welcoming environment.” But adding staff members and developing a method for them to work more cohesively are just as important, if not more so, than the buildings themselves. That’s where the creation of multidisci-
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DECEMBER 2019
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plinary teams comes into play. A multidisciplinary team consists of experts within a certain specialty (breast cancer, for example) that possesses different subspecialties. These include surgeons, medical and radiation oncologists, radiologists, specialty nurses, researchers, genetic counselors and rehab therapists. “Patients have access to [these specialists] today,” Batista said. “But what they didn’t have before was having all of them come together to review their case. Those teams are developing protocols, pathways, using evidencebased guidelines and being consistent in the care that they provide.” Another aspect of creating more comprehensive treatment plans for patients is integrative medicine, which is the combination of conventional medicine with complementary medicine. SMH already offers some of these services, such as cancer-specific rehabilitation, counseling services, genetic services and patient navigation. The hospital is also expanding or exploring into fields including touch therapy, such as massage and acupuncture, and nutrition services, such as cooking classes. “Integrative medicine is different in that it’s saying this is not separate from your conventional care plan that you would think of — your surgery, chemotherapy, radiation,” Batista said. “The idea is that we bring them together, and by having that be part of a more holistic cancer plan for the patient, they’ll actually have better outcomes, better survival. But they’ll also feel better.” These facilities and services will give Sarasota-area patients more options than ever before when it comes to fighting cancer.
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DECEMBER 2019
Gift-wrapped exercise Our columnist shares ‘tips’ on how to sneak in a workout during the holidays. OFFER TO CARRY PEOPLE’S PRESENTS FOR THEM.
RYAN KOHN STAFF WRITER
H
olidays? More like holi-daze, with all we have to do and the little time we have to do it in,
am I right? Because we’re in a daze, you see. With all there is to do, it can be hard to find time for yourself, and it can be especially hard to turn the little free
Not only will this work your biceps, triceps and all other -ceps, but it’s a nice thing to do. Some people can’t lift the 60-inch televisions they will be purchasing this year. It might not even be that big a present; sometimes it’s a multitude of little ones. It could be for a friend, a family member or a stranger, from the store to the car. Offering to help will give your muscles a workout and lighten the burden weighing down your cold-as-ice conscience. Do it again and again, and all facets of your life will start to feel better.
JOG IN PLACE WHILE SINGING HOLIDAY SONGS.
Embarrassing? Yeah, but less so if you do it in a group. Actually, scratch that. I think if I were in a public park and saw a group of 20 people jogging in place and belting “Silent Night,” I would run as fast as possible in the other direction. That is cultlike behavior. It’s bizarre no matter how you cut it. Do it in the right setting, though — say, by going door to door — and it becomes wholesome. The repetition of jogging for a few minutes, stopping, walking to the next house, then jogging again will get your heart pumping more than some might think.
time you have into something productive, such as exercising. That’s why I am bringing you a handful of tips on how to get in exercise while going about your holiday activities.
UNTANGLE YOUR LIGHTS WITHOUT WANTING TO GIVE UP ON LIFE ITSELF.
Good health is about more than just your body. Your mind has to feel good too, which is why untangling lights is a great challenge. Every time I try, I end up
wanting to stuff them back in the box and kicking said box down a flight of stairs. Think positive thoughts through this process. Remember to love yourself. If you can untangle them all — and then make sure they all connect and
SPEED-WALK AROUND A PARK WHILE MAKING YOUR WISH LIST.
No, this isn’t the most strenuous activity on the list, but it for darn sure is the trickiest when it comes to completing the actual holiday activity involved. Ever try writing while walking like your pants are on fire? Not easy!
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MEET OUR NEW PHYSICIANS DANCE WHILE HANGING ORNAMENTS.
This doesn’t have to be set to holiday music. Blare some Whitney Houston — I don’t care. Just do the pony over to your ornament box, hit the dip while picking one up, do the mashed potato over to your tree, and jump like you’re at a rock concert to hang it as high as you can. Then repeat. As someone who spent high school years in show choir, I can personally vouch for the effectiveness of this one: If, that is, you’re giving it your all. Add in a shimmy or two for flair. People love shimmies. Other suggested moves: the underwear slide-in from “Risky Business,” the art of “flossing,” the Dougie. Bonus points if you end your performance by sitting in a chair, pulling a lever and dousing yourself in a shower of tinsel a la “Flashdance.”
“
light up — without throwing in the towel, you can do anything in this life. Including … FIGHT SANTA CLAUS.
Look, I know this is the opposite headspace I was just advocating, but the big man has it coming. How dare he demand cookies and milk from every house on the planet? Who does he think he is? Instead, wait until he arrives at your home, and serve him what he deserves: a knuckle sandwich. This is drastic, I admit, but I have always wondered how Claus would do in a brouhaha, and there’s no better time to find out than now. Plus, it will get your cardio up, like, a lot.
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Clinical dietitian Laura McLeroy suggests aiming for a plate filled with vegetables, fruit, hard cheese and protein.
How to stay on track this holiday Avoiding overindulging during the holiday season can be tough, but luckily, a local dietitian is here to help.
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McLeroy, a Sarasota Memorial Healthcare clinical dietitian, said that doesn’t have to be the way. “A lot of people have this all-ornothing mentality, and they figure in the new year, ‘It’s going to be all different,’ and ‘I’ll just start over,’” she said. “But the holidays can be a time to pre-set yourself for making healthy choices.” With a plethora of holiday parties, potlucks and family dinners, the time from Thanksgiving Day through New Year’s Eve is filled
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Healthy holiday options can be just as tasty. Here are some swaps for common holiday treats.
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“Today I will drink enough water.” Although it’s important to be mindful of food choices, McLeroy said the holiday festivities are meant to be enjoyed. It’s OK to indulge in sweet treats with friends, as long as you balance it out elsewhere. For example, if you’re baking cookies, she suggests finding a way to be active while they are in the oven. “The Christmas holiday really only comes once a year — it’s meant to be enjoyed, and it’s meant to enjoy your family traditions,” McLeroy said. “You can always pick and choose what that looks like for you. And it doesn’t have to look like what anybody else is doing.”
ISN’T IT TIME TO GET YOUR CONFIDENCE BACK? JOSH DID AND IT SHOWS!
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DECEMBER 2019
CHRIS BOZONIE
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with spiced drinks, rich pastries and hearty meals, which can be OK in moderation, McLeroy said, because it’s all about balance. “You have to prepare for the day and be graceful with yourself,” McLeroy said. “Say, ‘This is the holidays, and I’m probably going to have some things I wasn’t counting on.’ It’s not the end of the world [if you indulge], but you have to be able to self-monitor.” Upon walking into a holiday party, McLeroy suggests first taking a visual tour of the food area to make a mental note of what is available. She said to aim for a plate filled with vegetables, fruit, hard cheese and protein. At a buffet-style gathering, she advises to avoid standing by the buffet table to eat because it makes it easy to pick up more food than you mean to. Although some people might be able to have one piece of chocolate and feel satisfied, she said others might have one piece and not be able to stop. When considering dessert, start by taking half of a portion or splitting a piece with a friend, McLeroy said. “It definitely is a mindful game, so you have to ask: ‘What do I want to eat? Why do I want to eat it? … Is it nourishing me, or is it just for pleasure?’” she said. “We can always go back and get a second portion, or we can always finish that cookie. But once we’ve already had it, now you just have to accept the fact that you had it and move forward.” Having a mantra can help keep your mind on track, McLeroy said. A few options she recommends are: “My health is worth it,” or “I’m only going to get out what I put into my body.” Setting a predetermined daily goal is also a method to stay on track, such as,
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HEALTH MATTERS
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DECEMBER 2019
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Parenting doesn’t mean you have to stop exercising The East County resident uses her kids to help her get a good work out in Greenbrook Adventure Park. BRYNN MECHEM
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STAFF WRITER
M
ost people who work out lug around dumbbells to lift or heavy backpacks to wear while running, but East County’s Susannah “Zana” Carbajal has a simpler solution: her kids. Multiple times a week, Carbajal can be found at Greenbrook Adventure Park racing one of her four children up a hill or using one of her toddlers as a weight while she squats. Carbajal has been a part of the Bayside Community Church F5 workout group for about a year and a half, after figuring out how to plan workouts into her life. After all, working as a technology sales manager and raising an 8-year-old, a 4-year-old and twin 18-month-olds can be timeconsuming. “After I had my two boys, I kind of got into a rhythm where I wasn’t taking care of myself, and I think I just lost myself a little bit,” Carbajal said. “When I found out I was pregnant with twins, it was
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Age: 34 Favorite Food: Empanadas Favorite workout: Acrobatics or jumping on a trampoline Least favorite workout: Pullups Job: Sales manager for a technology company Best Advice: Always have courage to try new things.
a wake-up call for me. I needed to get my life together.” However, after deciding to focus on satisfying her health needs: mind, body, spirit and health — and enlisting the help of her Panda Planner, a scientifically designed agenda based in positive psychology — Carbajal said she can’t get enough of working out. She brings her children to the workout group and modifies the workouts, so she can still keep an eye on her kids. When they kids were younger, Carbajal said they’d often sleep in the stroller throughout her workout, but now they want to play. Frequently, she does squats in the sandbox or pushups with a kid sitting on her back. Her solution for when her children misbehave: Laugh it off … or
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“We do pushups and situps and race up the hill, so it’s helping them learn the importance of health and taking care of their bodies.”
Brynn Mechem
challenge them to a race. “My old mindset, when I had a fixed mindset, would have been: ‘Well, they don’t let me go. I can’t. It’s too hard,’” Carbajal said. “Now I just don’t make any excuses. There’s going to be obstacles, but your babies need to see that you persevere.” Although she is keeping herself
DECEMBER 2019
11
HAPPY HOLIDAYS
— Susannah “Zana” Carbajal
Susannah “Zana” Carbajal does squats while using her daughter Rosalind as a weight.
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healthy, Carbajal is also teaching her children about the importance of a healthy lifestyle. “It’s cool because they mimic some of the moves, even the little ones,” Carbajal said. “We do pushups and situps and race up the hill, so it’s helping them learn the importance of health and taking care of their bodies.” But for Carbajal, the workout group gives her more than a chance to satiate her need for bodily health. It offers her a community that she said gives her good social, mental and spiritual health, too. At the end of each session, group members go around the circle and share positive things that have happened throughout the week or things that have been bothering them. Then group members pray for one another throughout the week. “Life happens; it isn’t always rosy,” Carbajal said. “They’re all praying for you, and you feel that. They help you through your problems; they reach out and make sure that you’re OK. It’s truly a community where we take care of one another.”
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Joint Pain Relief Options Lakewood Ranch Medical Center can help. Stop scheduling your life around your pain. Let the dedicated medical professionals at the Orthopaedic Spine and Joint Center at Lakewood Ranch Medical Center guide you through the process, whether it’s a surgical or nonsurgical solution. Experienced orthopaedic surgeons use advanced techniques, and physicians and specially trained staff develop individualized care plans based on your needs. Get to know our services: • Arthroscopic treatment • Community education • Coordinated rehabilitation services
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Physicians are on the medical staff of Lakewood Ranch Medical Center, but, with limited exceptions, are independent practitioners who are not employees or agents of Lakewood Ranch Medical Center. The hospital shall not be liable for actions or treatments provided by physicians. For language assistance, disability accommodations and the nondiscrimination notice, visit our website. 190094-6921 11/19
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For more information, including patient experience stories, visit lakewoodranchmedicalcenter.com/ortho. Or call 941-782-2663 to speak with a care coordinator.