Health Matters The latest news on the health and wellness issues that matter most • January 2021
NCH Heart Institute, a Pioneer in Cardiac Care for Half a Century, Continues to Achieve Top Awards By Jean Amodea
Many patients turn to a trusted online resource, Healthgrades™, before selecting medical professionals and facilities. Healthgrades not only provides meaningful information that connects caregivers with patients, it also provides insights into the better-performing hospitals, medical facilities and professionals, which in turn leads practitioners and facilities to strive toward excellent outcomes. NCH Heart Institute (NHI) consistently ranks high in Healthgrades for providing excellent cardiac care.
NHI was named: • One of Healthgrades America’s 100 Best Hospitals for Cardiac Care for six years in a row (2016-2021) – According to Healthgrades, this award is “based solely on clinical quality outcomes for 32 conditions and procedures with superior clinical outcomes in heart bypass surgery, coronary interventional procedures, heart attack treatment, heart failure treatment, and heart valve surgery” for hospitals consistently delivering “exceptional, comprehensive quality care.” In 2018, patients treated in hospitals earning this award had a 28.1% lower risk of dying. Patients treated in hospitals that did not receive the award were 1.39 times more likely to experience complications.
“Naples residents should feel special that NHI provides top-quality, comprehensive, general cardiology care, as well as care for acute infarction, acute stroke, and heart failure,” says NCH Cardiologist David R. Axline, M.D., F.A.C.C. “Our patients are satisfied, we have good outcomes and data to support our standard of care, and we continue to strive to live up to that every day. We continue to provide access to safe, quality care through COVID-19, while not restricting care, since most cardiology problems can’t wait.” NCH Cardiologist Michael S. Flynn, M.D., F.A.C.C., F.S.C.A.I., agrees that NCH has provided ample resources to ensure the ongoing, continued success of the cardiac program. “Not only in the last 25 years, but also through the pandemic, the hospital leadership has really helped in terms of all levels of pulmonary, critical care, and infectious disease,” he said. “As far as care to the community, our cardiology division sees patients from every insurance profile, including indigent care and follow-up, as well as a lot of emergency care. In terms of patient satisfaction, I’d have to say my scores, as well as NCH Heart Institute’s scores, are very high.”
Both Drs. Axline and Flynn agree that word of mouth is their most significant referral – a testament to the exceptional cardiac care provided by NCH.
“You take care of a patient with a life-threatening illness, and they pull through; they are probably your greatest advocate,” said Dr. Flynn.
For more information about NCH Heart Institute, call (239) 624-4200 .
NCH comprehensive cardiac services include: • Clinical and Interventional Cardiology • Electrophysiology • Cardiothoracic Surgery - Open Heart Surgery Program (the first in Collier County) • Cardiac Imaging • Cardiac Catheterization • Structural Heart Program (TAVR & WATCHMAN) • Code Save-A-Heart Program • Cardiac Rehabilitation (in/outpatient)
Quality indicators currently being considered to enhance NHI service delivery:
A brief history of the NCH Cardiac Program
1969
NCH lays the groundwork for Collier County’s first cardiac unit to be constructed in the critical care wing. NCH opens the cardiac catheterization laboratory. First open heart surgery done at NCH and the beginning of coronary angioplasty. Code Save a Heart is introduced. Emergency angioplasty for heart attacks is introduced. Cardiac electrophysiology begins.
• Mortality and morbidity • Length of stay • Rehospitalization parameters • Heart failure parameters • Acute heart attack care • Additional indicators in the area of cardiac surgery
1989
1997
1999
2016
ECMO (extracorporeal membrane oxygenation), is introduced.
2017
The NCH Structural Heart Program introduces the TAVR, a non-invasive procedure for aortic stenosis, and the WATCHMAN™ implant, used to reduce A-Fib stroke risk.
Don’t Miss a Beat: NCH has Cutting-Edge Treatments for A-fib By Jean Amodea
Atrial fibrillation, or A-fib for short, is an irregular heart rhythm caused by the heart’s upper chambers pumping blood out of sync with the lower chambers.
“With A-fib, the upper chamber of the heart starts quivering, explained NCH Electrophysiologist Dinesh Sharma, M.D., M.P.H, FHRS. “If it’s quivering and not beating, the blood flow is sluggish and starts to form clots.” Although symptoms can range from vague feelings of fatigue, weakness, and breathlessness to dizziness, lightheadedness, chest discomfort, and heart palpitations, up to 20 percent of those afflicted never experience any symptoms at all. An EKG can be conducted to detect the presence of A-fib.
If left untreated, A-fib can lead to blood clots, stroke, and heart attack, which can be potentially fatal. The good news is that A-fib is manageable.
“One of the most important aspects of managing A-fib is decreasing the stroke risk,” said Dr. Sharma. “To decrease that risk, we prescribe blood thinners like Eliquis, Xarelto, Pradaxa, or Coumadin, which can all help decrease the risk of stroke by 60 to 70 percent.”
For patients who cannot take blood-thinning drugs due to a higher risk of bleeding from falls, gastrointestinal problems, polyps, or who have a history of major bleeding, nosebleeds, or bladder bleeding – the Watchman device is considered as an option. The device is implanted through the leg into the heart and blocks the area in the left upper chamber where 90 percent of clots form. Studies show that it is potentially superior to Warfarin and non-inferior to newer medications, like Eliquis.
Dr. Sharma stressed that early diagnosis and treatment are ideally the best course of action since waiting too long to bring the patient back to a normal heart rhythm sometimes lowers the success rate.
“While cardioversion is a temporary way of restoring normal rhythm with an electric shock, for long- term relief we prescribe antiarrhythmic drugs or do a catheter ablation, where we try to cauterize or freeze the tissue believed responsible for most of the A-fib,” explained Dr. Sharma. “For those with intermittent A-fib that is detected early, the success rate is up to 80 percent with one ablation and 90 percent with the second ablation.” The NCH Heart Institute also uses cutting-edge ablation technologies such as radiofrequency and cryoablation, which provide higher success rates. Conventional cardiac ablation does have limitations for patients who have been experiencing A-fib asymptomatically for longer periods of time. However, Dr. Sharma says current research is seeking new technologies to treat patients with long-term atrial fibrillation.
“There are many new technologies and clinical trials to advance atrial fibrillation management,” he explained. “We are participating in some landmark trials to advance the field.”
For more information, call NCH Heart Institute at (239) 624-4200 .
Lifestyle changes to improve heart health: • Lose weight, which helps control blood pressure • Monitor and avoid activities that trigger irregular heart rhythm and report it to your doctor • Quit smoking • Limit alcohol intake • Limit the use of caffeine (colas, coffee, tea, and some over-the-counter medications like cough and cold medications)
See a doctor if you suspect A-fib and experience: • Lightheadedness, fainting, or dizziness • Lack of energy or feeling fatigued • Sudden pounding, fluttering, or racing sensation in the chest • Pain, pressure, or chest discomfort • Shortness of breath Treatments used to manage A-Fib: • Medication such as blood thinners and beta-blockers • Electric shock (cardioversion, a temporary treatment) • Minimally invasive surgery (catheter ablation)
Risk factors
• Those over age 60 • Sleep apnea • COPD • Heart conditions like heart failure • Bowel problems
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WATCHMAN™ | One Procedure. Lasting Results. For patients with an irregular heartbeat, known as Atrial Fibrillation or Afib, who cannot tolerate blood thinners such as Coumadin (Warfarin) or the newer anticoagulants, such as Eliquis, Xarelto, or Pradaxa; a new device called the WATCHMAN may help reduce your risk of stroke. The WATCHMAN device implantation is not exactly new. In fact, it is one of the most studied devices on the market. More than 100,000 WATCHMAN procedures have been performed worldwide and have over ten years of U.S. clinical studies behind it. The WATCHMAN device is the only FDA-approved implant proven to safely and effectively lower stroke risk in people with Afib not caused by heart valve problems. People with Afib are five times more likely to suffer a stroke than people with a regular heart rhythm. This is because when you have atrial fibrillation, the top parts of the heart (called the atria) tend to quiver and not beat regularly. The blood tends to stay stagnant and pool inside of a small pouch in the heart (called the left atrial appendage). When that blood goes into that left atrial appendage, it can sit there and form a blood clot, which can then travel up to your brain, causing a stroke. Statistics show that 90% of the devastating, debilitating strokes that occur are caused by a clot that has formed inside the left atrial appendage. The WATCHMAN device is implanted into the left atrial appendage, and after about six weeks, your heart forms a tissue barrier over the device so no clots can escape. A special echocardiogram is performed at that time to assess the device. An article published in the Journal of the American Medical Association determined the WATCHMAN offered a longer life expectancy than Coumadin use. Some patients cannot tolerate being on blood thinners because they may develop bleeding risks, especially if they are on other blood thinners. The procedure is performed by placing a catheter through the femoral vein in the groin to get to the heart’s left side. Patients will be under general anesthesia during the procedure. The shape of the appendage is different for everybody, and that will be determined during the initial evaluation because successfully implanting a device is very anatomy dependent. The device comes in five sizes, and your doctor will match the best sized device for your appendage size and shape. The procedure takes approximately 90 minutes and includes an overnight stay in the hospital. Patients will follow up with Vanessa Russino, ARNP-BC, structural heart coordinator, one week after the procedure and will be scheduled for a six-week follow-up transesophageal echocardiogram (TEE) to assess the device and appendage. Studies have shown that 96% of patients are able to come off blood thinners after 45 days. Some patients ultimately are not candidates for the WATCHMAN procedure due to their left atrial appendage anatomy or if they are unable to tolerate anticoagulants in the short term.
For information or to make an appointment, call (239) 624-4274 .
A Leadless Pacemaker Sets a New Pace for Some Cardiac Patients at NCH By Jean Amodea There is a new kind of pacemaker setting heartbeats – and NCH has the distinction of being the second healthcare provider in the nation and the first in Florida to perform the open surgical implantation of the leadless pacemaker. Pacemakers are used to treat heart arrhythmias – or a faulty heartbeat. Whether too fast or too slow, heart arrhythmias are very common, affecting more than 3 million Americans each year. Pacemakers are small implantable devices that send out electrical signals that help keep the heart beating properly. Traditional pacemaker generators are implanted into the shoulder with wire leads and electrodes running from the pacemaker into the heart. The generator sends an impulse through the leads into the heart to regulate the heartbeat.
The all-new leadless pacemakers are tiny and self-contained, thus eliminating the need for a traditional generator and leads, explained NCH Cardiothoracic Surgeon Brian Solomon, M.D., F.A.C.S. “Leadless pacemakers do not have wires, so blood clots are avoided,” he said, “and they are not able to be fractured, like traditional pacemakers.” Although both types of pacemakers can be monitored remotely, the leadless version is also remotely programmable by the physician, eliminating the need to reoperate for re-programming and re- insertion, which is required for adjustments with traditional pacemakers. “With the leadless, it is easily adjusted, and heart rhythms are better managed after surgery,” explained Dr. Solomon, who was the first surgeon to perform the leadless pacemaker implantation at NCH. Recently, a patient undergoing open-heart surgery avoided the installation of a complex mechanical system screwed onto the outside of the heart by having the leadless pacemaker implanted into the heart instead. “Surgically inserting (the pacemaker) prevented the risk of infection, blood clots, an extra incision, and a longer hospital stay to manage the rhythm, thus saving the patient from future complications,” explained Dr. Solomon. “In this case, we could literally look into the heart and see exactly where it needed to go. The leadless pacemaker hooks into the septum (the wall dividing the heart’s chambers) and stays there. So, we took the same delivery system and implanted it directly into the heart, rather than having to make a separate incision either through the groin or through the chest to implant.”
In the last two years, 77 leadless pacemakers have been implanted at NCH with a success rate of more than 99 percent. For more information, call NCH Heart Institute at (239) 624-4200 .
Leadless pacemakers
• More easily regulates heart rhythm, post-surgery • Does not require a separate incision • Leaves no scar or bump in the chest • Batteries do not need removal as they last approximately ten years • A new battery can be implanted next to it through the groin without making an incision
• Usually implanted by electrophysiologist through an incision in the groin • Bullet-sized, about 2 cm x ½ cm, and self-contained • Requir es shorter hospital stays • No wires are running through the chest that may cause blood clots • Easily reprogrammable in office – no need to reoperate • Provides easy adjustments through sensors in a remote control
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Get Blood Sugar Under Control to Ensure Heart Health By Lance Shearer The professionals at NCH work together with their patients to help them take control of their diabetes or prediabetes. It is important for the patient to become an active, participating partner in the endeavor and commit to getting and staying healthy. Studies have found that 40 percent of American adults between ages 40 and 74 have been diagnosed with prediabetes. Many of these adults are not aware that they have prediabetes, as it typically has no visible symptoms, with the only indicator being elevated blood sugar levels. As prediabetes progresses to type 2 diabetes, you might notice increased thirst and hunger, changes in urination patterns, or sudden, abrupt weight loss, according to Dr. Valeriu Neagu, MD, an endocrinologist at NCH’s Briggs Health Pavilion. In addition to the serious, even life-threatening health consequences that diabetes presents, diabetes is also a risk factor for cardiovascular disease, explained Dr. Neagu, which increases the patient’s risk of heart attack or stroke. Symptoms of cardiac issues could include shortness of breath, chest pain, and leg swelling. “The good news is we have new medications available to treat diabetic conditions,” he said, “both injectables for the endocrine system and tablets for the kidneys.” Dr. Neagu said that while he has the tools to get the patient’s blood sugar levels under control, “70 to 80 percent of the benefit comes from changes in diet and lifestyle.” That is where Audrey McKernan, RD, LD/N, CDE, (Registered Dietitian, Licensed Dietitian/Nutritionist, and Certified Diabetes Educator) comes in. Also, at the Briggs Health Pavilion, McKernan specializes in helping patients move toward a sustainable diet and lifestyle. “There are simple, practical dietary changes you can adopt that make a world of difference,” said McKernan. “We emphasize the Mediterranean diet, helping people consume mono-unsaturated fats, and working to limit saturated and trans fats. There is a big emphasis on plant-based foods.” “With the pandemic, there’s a lot of stress – many people have gained weight. But a 10 percent weight loss makes a big difference. People who follow our program are seeing results.” Currently, diabetes and prediabetes are at epidemic levels among the US population. If you have been told that you or someone you care for is at risk for diabetes or prediabetes, call the professionals at NCH Healthcare System. They are here to help with expert medical advice and to work with you to promote a healthy lifestyle and diet. For more information about the Von Arx Diabetes Center for Excellence, please call (239) 624-3450 .
Dr. Valeriu Neagu, MD
Dietitian Audrey McKernan, R.D., L.D.N., C.D.E.
Warning Signs of a Heart Attack Content provided by the American Heart Association.
In the United States, one out of seven deaths is caused by coronary heart disease, which includes heart attack. Many of those deaths can be avoided by acting quickly. A heart attack, also called a myocardial infarction, happens when a part of the heart muscle does not get enough blood. Coronary artery disease is the primary cause of heart attack. A less common cause is a severe spasm, or sudden contraction, of a coronary artery that can stop blood flow to the heart muscle. The more time that passes without treatment to restore blood flow, the greater the damage to the heart muscle. Each year, about 635,000 people in the US have a new heart attack and about 300,000 have a repeat attack. Some heart attacks are sudden and intense, but most start slowly with mild pain or discomfort.
The major symptoms of a heart attack are:
How to avoid a heart attack:
• Chest pain or discomfort. Most heart attacks involve discomfort in the center or left side of the chest that lasts for more than a few minutes or that goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain. • Feeling weak, lightheaded, or faint. You may also break out into a cold sweat. • Pain or discomfort in the jaw, neck, or back. • Pain or discomfort in one or both arms or shoulders. • Shortness of breath. This often comes along with chest discomfort, but shortness of breath also can happen before chest discomfort. As with men, women’s most common heart attack symptoms include, chest pain or discomfort. Women are more likely than men to have some of the other common heart attack symptoms, particularly shortness of breath, nausea/ vomiting, and back or jaw pain.
• Do not smoke and avoid second-hand smoke. • Treat high blood pressure if you have it. • Eat foods that are low in saturated fat, trans fat, sodium (salt), and added sugars. • Be physically active. • Reach and maintain a healthy weight. • Control your blood sugar if you have diabetes. • Get regular medical check-ups. If you or someone close to you show signs of a heart attack, it is important to call 9-1-1 and get help immediately. Local emergency medical services (EMS) such as the fire department or paramedics are able to begin treatment when they arrive.
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Cardio for Life – Exercise Like Your Heart Depends on it By Lance Shearer
The best healthcare is care that not only keeps you healthy, but also prevents you from becoming sick in the first place. As Benjamin Franklin put it almost 300 years ago, “an ounce of prevention is worth a pound of cure.” In Collier County, NCH has created the premier facilities for you to experience that “ounce of prevention” – the NCH Wellness Centers. With one location downtown and one in North Naples, the Wellness Centers offer everything you need to keep your body in healthy working condition. Your entire body works together to keep you in shape, with the most vital component being your heart. Therefore, heart health is a particular focus of the Wellness Center’s offerings. “Your heart is a muscle, and it gets stronger and healthier if you lead an active life,” explained Heather Imsdahl, Director of Employee Health & Wellness at Briggs. To keep your heart and your body healthy, she recommends at least 150 minutes of moderate intensity aerobic activity each week, spread over 30 minutes of activity five days a week. Exercise, she said, can lower your blood pressure, reduce LDL “bad” cholesterol, boost your HDL “good” cholesterol, strengthen your heart and cardiovascular system, and improve your circulation, which in turn helps your body better utilize oxygen. Regular exercise also lowers the risk of heart disease, stroke, type 2 diabetes, dementia and Alzheimer’s, as well as several types of cancer. The Wellness Center’s facilities include men’s and women’s locker rooms with sauna and whirlpool baths. More than 100 machines from Stairmasters to treadmills, arc trainers, ellipticals, rowing machines, and several bikes (upright, recumbent and hand bikes) offer exercise opportunities for every fitness level. Plus, the 25-meter outdoor swimming pool located downtown, maintained at a consistent 84 degrees year-round, is a great spot for those who need a low-impact workout, or just want to get in some laps.
Top low-impact, heart-healthy exercises include:
For those whose fitness level demands a little more intensity, options include:
• Working on a NuStep machine • Zumba • Cycling
• Water aerobics • Rowing • Walking on a treadmill
• Boot Camp • Kickboxing
• H.I.I.T., or high-intensity interval training
As you would expect from one of the nation’s top-ranked hospital environments, safety and cleanliness are a major priority, with all CDC and Florida Department of Health guidelines rigorously followed. All touch points are cleaned regularly, masks are required throughout the facility except when actively exercising, and social distancing is enforced, with plenty of room for each participant. If you prefer, many group classes can be attended virtually, allowing you to exercise with a live, experienced instructor from the comfort and privacy of your own home. The Briggs Wellness Center has free, convenient parking, and affordable daily, monthly, or annual plans for maximum flexibility. Personal trainers are also available for one-on-one instruction to tailor exercise and activities according to an individual’s needs, preferences, and physical capabilities. “Regardless of your current fitness level, it’s important to get moving,” said Imsdahl. “If you don’t make time for your wellness, you will be forced to make time for your sickness.” Group Fitness Classes Briggs offers more than 100 different classes each week, more than any other fitness provider in Collier County. With group classes, the workout is planned for you. Classes are fun, and there is a nice camaraderie among members and a sense of belonging. Classes start and end at a set time, helping you plan your day. Many different classes are available, fitting a variety of schedules and fitness levels. In a class setting, the instructor will safely push you to perform better than you might on your own. And this is the only local facility to offer MOSSA-licensed group fitness classes. Wellness is just for you! And class time is exclusively for you and your exercise needs. And speaking of time, what better time than right now to make a resolution to take charge of your health?
Did we mention it’s fun?
For more information about the Briggs Wellness Center, call (239) 624-2750 , or for more information about the Whitaker Wellness Center, call (239) 624-6870 . The Whitaker Wellness Center in North Naples is currently closed for renovation with reopening planned for early 2021.
Heather Imsdahl, Director of Employee Health & Wellness, in the center’s cycle studio. The NCH Briggs Wellness Center is the area’s most comprehensive fitness facility.
The 25-meter pool is perfect for water aerobics.
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NCH and the NCH Physician Group
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Academic Internal Medicine Clinic Charles Graeber, MD
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Allergy and Immunology Florina Neagu, MD
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Anna Juncadella, MD
Dinesh Sharma, MD Hillary Tassin, MD
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Rajeev Prabakaran, MD Kunal Suryawala, MD
Silvio C. Travalia, MD Shona Velamakanni, MD Tara Louka, PA-C Caroline Shaw, PA-C
Heather Paris, PA
Aubrey Fulton, APRN General Surgery Robert Bailey, MD Wesley Dailey, MD Robert Grossman, MD Luigi Querusio, MD
Pediatrics Paul Shuster, MD Danielle Silva, MD
Cardiovascular Surgeons Stephen D’Orazio, MD
Robert Pascotto, MD Brian Solomon, MD
Whitney Vedella, MD Tali Wojnowich, MD 2
Center for Breast Health Tran Ho, DO Sharla Gayle Patterson, MD
Christopher Staudinger, MD
Pulmonary, Critical Care & Sleep Medicine Brenda Juan, MD
Infectious Disease Sergey Akimov, MD Gary A. Bergen, MD Vato Bochorishvili, MD Mark A. Brown, MD Miguel Madariaga, MD Rebecca Witherell, MD Internal Medicine Susan Best, DO Louis Dusseault, MD Giuseppe Guaitoli, MD Kim Hamilton, MD Je rey Howland, MD
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Endocrinology Victor Luna, MD Valeriu Neagu, MD
Michelle Nowak, APRN Family Medicine Andrew M. Bernstein, DO Christian O. Beskow, MD
Larry Kohn, MD David Linz, MD
Pedro Martin, MD Bryan Murphey, MD Mark Speake, MD
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NCH HEALTHCARE SYSTEM | Helping everyone live a longer, happier, and healthier life. For an appointment with a physician, please call Access Healthline at (239) 624-7777 To c onsult with a healthcare provider 24/7 from anywhere in Florida for only $45, visit NCHmd.org/VirtualCare to start your treatment. .
NCH Baker Hospital Downtown NCH Downtown Naples Hospital: 624-5000 Academic Internal Medicine Clinic: 624-0940 Business/Occupational Health: 624-4630 Community Blood Center: 624-4120 Dr. John N. Briggs Wellness Center: 624-2750 Emergency Department: 624-2700 NCH Heart Institute: 624-4200 NCH Imaging: 624-4443 Outpatient Cardiac Rehabilitation: 624-1680 Outpatient Infusion Services: 624-4370 Outpatient Oncology Navigator: 624-4988 Outpatient Rehabilitation Center: 624-1600 Palliative Care Clinic: 624-8490 vonArx Diabetes & Nutrition Health Center: 624-3450 NCH North Naples Hospital Campus NCH North Naples Hospital: 624-5000 Emergency Department: 624-9199 Center For Breast Health: 624-8120 NCH Imaging: 624-4443 NCHWound Healing Center: 624-0630 Outpatient Pulmonary Rehabilitation: 624-6800 Pediatric Emergency Department: 624-5000 e BirthPlace: 642-6110 e Brookdale Center: 624-5722 NCH Marco Island Campus Marco Urgent Care Center: 624-8540 Outpatient Cardiac Rehabilitation: 624-8590 Outpatient Pulmonary Rehabilitation: 624-8595 Outpatient Rehabilitation Center: 624-8580
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NCH Healthcare Bonita Emergency Department: 624-6900 NCH Imaging: 624-4443 NCH Healthcare Northeast Emergency Department: 624-8700 Outpatient Rehabilitation Center: 624-8790 NCH Imaging: 624-4443 NCH Healthcare Southeast NCH Immediate Care: 624-8220 NCH Sleep Center: 624-8220 Outpatient Rehabilitation Center: 624-1900 NCH Imaging: 624-4443
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NCH Central Campus: 513-7144 White Elephant rift Store: 624-6690 Outpatient Rehabilitation Center: 624-6820 WhitakerWellness Center: 624-6870
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Outpatient Rehabilitation Center: 624-0970
NCHWound Healing Center: 642-0900 Bonita Community Health Center
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NCH I magin g: 624-4443
NCHWound Healing Center: 642-0630 Outpatient Rehabilitation Center: 624-0380
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NCHHeart Institute: 624-1000 Outpatient Cardiac Rehabilitation: 624-1080 NCH Immediate Care: 624-1050
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For information on any of the NCH Healthcare System services, please call Access Healthline at 624-7777 or visit us online at www.NCHmd.org
JANUARY 2021 The NCH Health Matters is a bi-monthly publication of the NCH Healthcare System. Every effort is made to ensure information published is accurate and current. NCH cannot be held responsible for any consequences resulting from omissions or errors. NCH Healthcare System, 350 7th Street North, Naples, FL 34102, Telephone: (239) 624-5000, www.nchmd.org 7 NCH HEALTHCARE SYSTEM | Helping everyone live a longer, happier, and healthier life.
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