Health Matters The latest news on the health and wellness issues that matter most • July 2019
Dr. Pia Myers and Dr. Nicole S. Patterson
Since 1777, July 4th has been a beloved American holiday. Andwe celebrate our Independence Day in traditional American fashion – with family fun, barbeques, and the traditional grand finale – a spectacular fireworks display. However, for the private citizens who literally take fireworks into their own hands, this day of festivity can turn into disaster and tragedy when safety is not observed. The facts are sobering. On average, the Consumer Product Safety Commission (CPSC) reports that 280 people visit a hospital emergency room or urgent care facility every day in the month surrounding the July 4th holiday for treatment of fireworks-related injuries. In 2017, there were 12,900 fireworks-related injuries in the United States – one third of which affected those under age 15.
“The American Academy of Pediatrics says that one fourth of those children injured were only bystanders,” says Nicole S. Patterson, MD, Assistant Medical Director of NCH MacDonald Pediatric Emergency Department. “In over half these cases, adults were actually supervising.” As if that were not bad enough, approximately 18,500 fires can also be attributed to the unsafe handling of fireworks each year, according to statistics compiled by the National Fire Protection Association (NFPA). “The NFPA says that sparklers burn at about 1,200 degrees Fahrenheit, which is as hot as a blowtorch,” explains Pia Myers, MD, Medical Director of the NCH MacDonald Pediatric Emergency Department. “We used to think sparklers were relatively safe for children – but when held right next to the eye, they are one of the largest causes of children’s injuries.” Dr. Myers sees children with fireworks-related injuries such as heat-related thermal burns, which commonly occur when people believe a sparkler has burned out, and they either handle them or step on themwhile walking on the beach or walking bare-footed. Other injuries include loss of limbs or fingers, when fireworks explode like miniature bombs.
Cutsand lacerations canaffect thegroinand face. Eye injuries from the heat generated by sparklers can ultimately lead to permanent blindness. “And, hearing issues from loud fireworks can affect adults, children and even pets,” Dr. Myers says. According to Dr. Myers, Collier County officials have been very proactive in heightening public awareness about fireworks safety. “Last year, NCH saw less than 10 fireworks-related injuries, and while I have treated children in the pediatric ER, we have also had children transferred to the burn center for emergency treatment.” According to the CPSC, fireworks are classified as hazardous substances under the Federal Hazardous Substances Act (FHSA). Some fireworks, such as illegal firecracker-type devices (M-80s, quarter sticks) and professional display fireworks should never be handled by consumers, due to the risk of serious injury and death. “The safest advice is to monitor your children carefully, prepare younger ones about the expected noises and attend a public fireworks display presented by professionals,” says Dr. Patterson. “And safekids.org recommends that if kids want to hold something that lights up, they can use glow sticks instead of fireworks.”
The NCH Robert, Mariann &Megan MacDonald Pediatric Emergency Department , located at 11190Health Park Blvd, Naples, FL 34110 (239) 624-9104 | Open: 24 hours a day / 7 days aweek
Ensuring Fireworks Safety : 1. Never let young children play with or set off fireworks. 2. Don’t carry fireworks in your pocket or shoot them off in metal or glass containers. 3. Never place any part of your body directly over a fireworks device when lighting the fuse. Backup to a safe distance immediately after lighting fireworks. 4. Keep a bucket of water or a garden hose handy in case of fire. 5. Never re-light or immediately pick up fireworks that have not ignited fully. Source: www.usa.gov
Endoscopic Ultrasound Aids in Diagnosis and Treatment of Pancreatic Cancer
NCH advanced gastroenterologist, Dr. Maged Bakr, MD, Director of Advanced Endoscopy, is utilizing an imaging procedure called endoscopic ultrasound (EUS) to aid in the diagnosis and treatment of pancreatic cancer, which ranks as the fourth leading cause of cancer- related deaths in the United States and the second in Florida. In the United States, 57,000 people are diagnosed with pancreatic cancer each year, with a higher incidence in black men over the age of 45. It is the second-leading cause of death in digestive cancer cases, after colorectal cancer. With the aid of EUS, physicians are better able to detect pancreatic cancer in its early stages, as well as determine the cancer’s advancement on the “stage” scale with a high degree of accuracy. According to Dr. Bakr, EUS combines endoscopy and ultrasound in order to obtain images and information about the digestive
tract, as well as surrounding tissues and organs. The procedure is performed like a regular endoscopy and patients must be fasting. Patients are sedated during the procedure that usually lasts from 30-45 minutes and uses a long, flexible tube passed into the body through the mouth or rectum. Adding ultrasound
ultrasound images. We can also utilize Doppler ultrasound, if a biopsy is needed, which enables us to avoid passing a needle through a blood
vessel and hence decrease
to endoscopy allows high frequency sound waves to produce images of bodily structures and internal organs, such as the liver,
risk of bleeding."
“For patients with elevated liver enzymes with abdominal pain, we can do
a regular endoscopy to rule out ulcers,” says Dr. Bakr, “and then, during the same procedure, use the ultrasound probe to evaluate the bile ducts, gallbladder and pancreas." “In cases where there is no explanation for elevated liver enzymes, I can do a EUS- guided liver biopsy and obtain a liver sample in the same setting, thereby reducing the number of procedures the individual has to go through.” The best candidates for EUS are any patients who can undergo a regular endoscopy, in addition to obese patients or those with pacemakers who cannot have an MRI.
or aorta. “I have seen some cases
where CT scan or MRI can’t precisely see or diagnose a pancreatic mass or tumor,” says Dr. Bakr. “Using EUS, the transducer can get closer to the organs. The images are more clear, accurate and detailed than those from traditional
Dr. Maged Bakr, MD
For more information contact the NCH Gastroenterology-Hepatology Department at (239) 624-2730
NICHE Care is Ideal for Older Adults
Kristin Miller stands with Danna Trobaugh who cradles a stuffed animal from NCH’s NICHE program.
NCH has a new NICHE for patient care. As an
acronym, NICHE stands for Nurses Improving Care for Healthsystem
Elders. Developed by New York University, the program educates nurses and support staff on best practices and protocols in the care of older adults. NCH launched NICHE last year in neurology, earning certification. “Becoming a NICHE hospital aligns with the NCH mission to properly and safely care for our aging population,” says Kristin
Miller, MSN, RN, CVRN-BC, GRN, Certified Dementia Practitioner and NCH NICHE coordinator. “We recognized the need in our community.” Cognitive patients, or those with memory and other thought-processing issues requiring specific care, make that particular specialty an ideal area to begin the NICHE certification. “We’ve developed tools to ease these patients’ anxiousness,” Miller explains. The cognitive tool kit has coloring books, fidget boards, stuffed animals, and other items meant to relieve a patient’s anxiety. Patients receive an item and perhaps a visit from care volunteer Danna Trobaugh, who helps ease the stress of a new arrival. Often, a patient with an altered mental state may have anxiety when admitted, Miller adds. These tools provide purpose, comfort and distraction. “Our nurses are educated on the best practices
and evidence-based guidelines in treating patients who may have an altered mental state,” Miller says. “Just coming into a new environment can be troubling. We want to make it a smooth transition.” Another valuable tool is the Life Profile form that gives a snapshot into a person’s preferences. “We want to learn more about the patient, for example, the patient’s preferred name or their favorite color,” Miller continues, “anything to help a patient feel more comfortable.” NCH is gradually branching NICHE care practices to other areas. Future plans call for a geriatric emergency room, which will focus on better layouts, lighting, noise level and other attributes older adults find comforting. Miller summed it up: “NICHE is a wonderful approach to the care of older patients who deserve a special focus.”
For more information about the NICHE program, contact Kristin Miller, NCH NICHE coordinator , at (239) 624-4715
Knowing the Symptoms of Stroke and when to call for help could save a life
When a person suffers a stroke, it is because the brain is not getting the blood it needs to function properly. A stroke can be attributed to a rupture in a blood vessel, or more likely to a build-up of plaque in the arteries or a clot that has broken free, restricting the free flow of blood to the brain.
Dr. R. Viktoria Totoraitis and Brenda Hartmann, NCH System Stroke Coordinator.
It is important to know the main signs of stroke so that you will be prepared to act quickly if it happens to you or someone you love. Do the FAST test:
F ACE Ask the person to smile. Does one side of the face droop?
S PEECH Ask the person to repeat a simple phrase. Is there slurring or difficulty?
T IME If you answer any of these questions, you must act quickly.
Ask the person to raise their arms.
Is there difficulty on one side? Any numbness or weakness?
NCH SHINES AS A STELLAR STROKE CARE PROVIDER: • NCH is a Joint Commission designated Primary Stroke Center • NCH is designated as a Comprehensive Stroke Center through the Agency for Health Care Administration (ACHA) • NCH received the American Heart Association (AHA) "Get with The Guidelines - Stroke Gold Plus Achievement Award with Target: Stroke Honor Roll Elite Plus” for 2016, 2017, 2018, 2019.
“Do not waste time calling a doctor or driving to the hospital. Call 911 immediately to get emergency medical services (EMS) rolling to you as soon as possible,” says R. Viktoria Totoraitis MD, Vascular Neurologist Specialist and NCH Medical Stroke Director. “Depending on the location of the stroke, the patient may exhibit symptoms usually on one side of the body, such as face droopiness, arm weakness, numbness, sudden vision loss or double vision,” explains Dr. Totoraitis. “The patient may also have an inability or difficulty speaking, intense dizziness and sudden changes in balance, coordination or their ability to walk.” Strokes are classified either as ischemic – which is caused by a disruption of blood flow to the brain due to plaque build-up in the arteries or a blood clot – or hemorrhagic – which is caused by a ruptured blood vessel. Ninety percent of all strokes are classified as ischemic. A person’s risk for stroke increases with conditions such as atherosclerosis, or a build-up of plaque in the arteries, other arterial and vascular diseases, and heart disease explains Dr. Totoraitis. Potential cardiac causes of stroke include arrhythmia, or an abnormal heart beat rhythm, and heart failure, where the heart is unable to pump a volume of blood sufficient for meeting the needs of the body. “Many times, there is no clear, underlying cause for cardiac-related or rhythm related strokes,” says Dr. Totoraitis. “But we do see it more often with heavy alcohol use, age, and wear and tear on the heart.” Two potential acute stroke treatments include TPA (tissue plasminogen activator), a clot-busting medication that helps dissolve clots that could be blocking blood flow, or an embolectomy, which is performed by an interventional radiology specialist who can manually remove the clot. “After we determine the acute care plan, we admit the patient and do additional work up studies like echocardiograms and heart monitoring,” explains Dr. Totoraitis. “We also address their risk factors and prescribe the right medication. Afterwards, a therapy-based stroke rehabilitation plan is developed with physical, speech and occupational therapists depending on the patient’s needs and whether they will require an in- or out-patient setting.” Once a patient arrives at the hospital’s emergency department, imaging studies are performed to look at blood vessels and the brain to determine if the patient is a candidate for acute procedures.
Call 911 for help when these stroke-warning signs appear
• Face droopiness • Armweakness • Numbness • Difficulty or inability to speak • Sudden vision loss • Sudden double vision
Prevention, she says, includes “good, old–fashioned, healthy living,” and regular doctor visits to detect hidden high blood pressure.
Brenda Hartmann, MSN, SCRN, NCH System Stroke Coordinator, says that NCH received the American Heart Association (AHA)’s "Get With The Guidelines ® and Target: Stroke Quality Achievement Award.”
Prevent Stroke by Controlling Risk Factors
“This designation indicates that the time from arrival into the ER to the time the initial medication is administered is under 45 minutes,” states Hartmann. “At NCH, we average about 30 minutes.”
• Monitor blood pressure • Keep cholesterol in check • Maintain a healthy diet to avoid diabetes • Exercise • Quit smoking • Limit alcohol use • Stop smoking
For more information about the NCH Stroke Program , call Brenda Hartmann at (239) 624-4172
Build Bone Strength at Any Age to Prevent Fractures in Your Golden Years
Suzanne Graziano, left, NCH Nursing Director, & Jennifer Miller, NCH Total Joint Coordinator, will help a patient rebuild their body after an osteoporosis-related fracture at NCH.
Slumped shoulders, a neck jetted forward and back pain: even in young adults that could spell osteoporosis. Thankfully, prevention is also possible at any age. “It’s never too early or too late,” says Suzanne Graziano, NCH Director of 6 South Neurosciences, 5 South Orthopedics, 5 North General Surgery/Medical and 1 East Express/OBS. Though she typically sees patients after an osteoporosis- related fracture, Graziano wants to prevent them. Her advice for every age:
TEENS/YOUNG ADULTS: By age 28, our bodies have achieved maximum bone formation, and Graziano says posture is crucial in the years before. Extended time spent hunched over a mobile device puts unnecessary stress on your neck. To counter it, Graziano says regular stretching is key to proper body alignment. “Keep your spinal column straight,” she adds. “It is essential to strengthen your core and your spine.”
SENIORS: With diet and exercise, even someone who has low bone mass can control the progression. She recommends Qigong, a Chinese program of physical movements and breathing that is related to Tai Chi, for its therapeutic benefits and because it promotes balance and flexibility. Adding a fortified protein beverage or a smoothie to your diet will also encourage healthy bones. CHILDREN: Good habits last a lifetime. Eating a healthy diet is ideal, and parents should introduce a daily exercise during the child’s prime bone-building years, recommends Graziano, who also suggests eating organics. Skip the processed foods entirely, she says.
OVER 35: Our bone mass begins to decline, very slowly at first, and speeds up in our 50s and 60s. Risk factors and medical history increase that inevitable rate of loss, and post-menopausal women naturally begin to lose minerals found in their bones. Graziano suggests adding a nutritional supplement and one specific to bone building. Weight- bearing exercises have also proven to improve bone health. “You can strengthen bone integrity if you strengthen muscle integrity,” Graziano explains.
When to see a doctor: You may want to talk to your doctor about osteoporosis if you went through early menopause or took corticosteroids for several months at a time, or if either of your parents had hip fractures. Your family doctor may suggest bone density testing. Screening for osteoporosis is recommended for all women by age 65. Some guidelines also recommend screening men by age 70, especially if they have health issues likely to cause osteoporosis. If the bone density test is very abnormal or you have other complex health issues, you might be referred to a doctor who specializes in metabolic disorders (endocrinologist) or a doctor who specializes in diseases of the joints, muscles or bones (rheumatologist).
ALL AGES: Because bone is living tissue, our skeleton completely regenerates itself every seven years, explains Graziano. Get plenty of calcium, vitamin D and magnesium through diet or supplements.
Call Suzanne Graziano at (239) 624 - 3916 for more information on NCH Orthopedic Program
Occupational Therapy uses the Power of Play to Help Children with Sensory and Other Issues
Whatever life stage your child has reached, healthcare professionals urge parents and caregivers to seek help when their children exhibit signs of falling behind development norms. For example, is your toddler an overly picky eater? Or does he walk in a clumsy manner? Do your older children have poor handwriting? Or do they seem to misunderstand social cues or demonstrate a lack of body awareness? “Children really benefit from early intervention,” explains Charry Taylor, NCH pediatric occupational
occupational therapists may use visual cues as a strategy to help teach self- care and to develop consistent routines. The number one issue frustrating parents are feeding issues. Occupational therapy can help with texture aversions, extreme food or color preferences, as well as motor issues with chewing and swallowing. Occupational therapy supports children of all ages and developmental levels, and those with ADD/ADHD also benefit. “The occupational therapist will assess, then recommend and provide therapeutic activities like mindful movements, and other activities to help these kids thrive and get their bodies ready to learn,” explains Karen Clements, NCH pediatric occupational therapist. NCH offers occupational therapy at two Naples locations. Both have a Sensory Room filled with toys, crash mats, exercise balls, weighted vests and other equipment. “The space is attractive and inviting to the child,” Taylor explains. “Then we step in with play.”
therapist. “We assess the whole child, looking at their cognitive function, visual and motor skills, functional communication, their strengths and endurance and sensorimotor skills.” Typically, children spend 30 to 45 minutes with a therapist two to three times each week. For children with Autism Spectrum Disorder or for those with sensory processing issues, occupational therapy can teach them how to calm and focus themselves. Through play, therapists help these children learn how to make sense of the world, and give them the tools they need to function in society. “Many children we see will need to use these strategies their whole life,” says Taylor. Though much depends on an individual child’s developmental level, Charry Taylor, left, Karen Clements and Cynthia Mackey, NCH Pediatric Occupational Therapists. Charry Taylor, Cynthia Mackey and Karen Clements: NCH P diatric Occupat onal Ther pists.
For additional information, or to make an appointment, call one of these NCH Outpatient Rehab locations near you: NCH Outpatient Rehab at Greentree , 2330 Immokalee Rd, Suite 2, North Naples. Phone: (239) 624-6820 Southeast Outpatient Rehab , 7717 Collier Blvd, Suite 201, East Naples. Phone (239) 624-1900
How the GreenLight Laser PVP Procedure can bring relief from Enlarged Prostate Problems
One of the most common disorders in men as they age, is a benign prostatic hyperplasia, or BPH, which is simply an enlarged prostate. About half of men age 51 to 60 have an enlarged prostate, and up to 90 percent of men over age 80 have an enlarged prostate. The condition can interfere with quality of life this way: as the prostate enlarges, it squeezes down on the urethra, which is the tube that carries urine out of the body. Urination can become more difficult. In extreme cases, urinating becomes impossible. Age can also cause the bladder to weaken and the bladder wall to become thicker, which keeps the bladder from emptying completely, leaving some urine in the bladder. BPH is benign, meaning it is not cancer and it does not lead to cancer. But cancer and BPH can occur at the same time. Four occurrences indicate you may be having severe prostate problems that may require minimally invasive intervention or surgery: Inability to urinate or urinary retention Recurrent bloody urine Bladder stones Recurrent urinary tract infection Any of these indications are cause to see your doctor. POSSIBLE TREATMENTS Aside from watchful waiting, the two options
you have for BPH are medication or surgical intervention. Popular medications for this condition are known as Alpha-1 blockers. Your doctor may want to put you on a medication that will improve urine flow. A common such medication is Tamsulosin, which goes by the name Flomax, or Rapoflo (Silodosin) which works by relaxing the smooth muscle around the bladder neck and prostate. There are also other medications that actually shrink the prostate such as, Avodart (dutasteride) and Proscar (Finasteride). If none of these medications improve your symptoms either separately or in combination, your doctor may want to look at minimally invasive surgical options. “A common surgical option is transurethral resection of the prostate, or TURP,” says Dr. Marc Colton, NCH Physician Group Urologist. “TURP is a method of clearing away excess prostate tissue so the urethra can pass through unimpeded, allowing for smoother urination,” he adds. GreenLight PVP, is an alternative to TURP. The acronym PVP stands for “photoselective vaporization of the prostate,” and GreenLight is the type of laser used to achieve PVP. “With GreenLight PVP,” Dr. Colton explains, “a laser actually melts the prostate tissue; it’s like butter. The tissue then coagulates right away, so there is very little bleeding.” The laser is inserted into the penis (under general anesthesia) and threaded through the urethra to the site where the enlarged prostate surrounds the urethra.
Laser light then vaporizes the excess tissue. The heat cauterizes the blood vessels, so the bleeding is minimal. This procedure is done on an outpatient basis at NCH. The patient generally has a catheter in for just 24 hours and is back to his normal activities—including exercise—in about a week. Patients typically have good long-term
Marc Colton, MD
success in improving their flow of urine, and erectile dysfunction generally does not come into play, as it can with more invasive surgeries. Dr. Colton, who started performing GreenLight Laser PVP in 2004, appreciates how easy the procedure is on the patient and how fast the recovery is. “Every mechanic has his tool, and this is mine,” he jokes. He was the first surgeon to use the tool in New Jersey and has gone on to teach the procedure to many other surgeons, and to perform some 1,000 of the surgeries himself. GreenLight Laser PVP is available to many men, though there are a few instances when the procedure would not be appropriate. If you have medical issues that prohibit you from having anesthesia and if your bladder is not working correctly, then GreenLight Laser PVP is not for you.
GREENLIGHT XPS ™ LASER THERAPY SYSTEM: A SYSTEMATIC APPROACH TO VAPORIZATION
Advantages of GreenLight Laser PVP over TURP An outpatient procedure Quicker recovery Less bleeding than TURP Can be performed on patients with very large glands and who are on blood thinners.
1. Over the past month, how often have you had a sensation of not emptying your bladder completely after you finished urinating? 2. Over the past month, how often have you had to urinate again less than 2 hours after you finished urinating? 3. Over the past month, how often have you stopped and started again several times when you urinated? 4. Over the past month, how often have you had a weak urinary stream? 5. Over the past month, how often have you had to push or strain to begin urination? 6. Over the past month, how many times did you most typically get up to urinate from the time you went to bed at night until the time you got up in the morning? Scoring: 0-7 points Your BPH Symptoms are considered mild. 8-19 points Your BPH Symptoms are considered moderate. Make an appointment to talk with your urologist or primary physician. 20-35 points Your BPH Symptoms are considered severe. Make an appointment to talk with your urologist or primary physician.
Has same long-term results Test Your Prostate Health
Are you wondering about your prostate health? Take this quiz from the American Urological Association to find out whether your symptoms warrant a check from your doctor. Answer key:
Not at all = 0 points Less than one time in 5 = 1 point Less than half the time = 2 points About half the time = 3 points More than half the time = 4 points Almost always = 5 points
Give yourself a numerical score for each of these questions.
Then add up your total at the end.
For more information about NCH Physician Group Urology or to make an appointment with Dr. Colton, call (239) 624-1160
NCH and the NCH Physician Group
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Academic Internal Medicine Clinic Charles Graeber, MD
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Shirley Codada, MD Ryan Perdzock, MD Pediatrics Paul Shuster, MD Danielle Silva, MD Tali Wojnowich, MD 2
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Gastroenterology & Hepatology Mazen Albeldawi, MD
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For an appointment with a physician, please call (239) 624-8106 Consult 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 The BirthPlace: 642-6110 The 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 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 NCH Imaging: 624-4443 NCHWound Healing Center: 624-0650 NCH Central Campus: 513-7144 White Elephant Thrift 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
NCH Immediate Care: 624-8220
NCH I magin g: 624-4443
NCHWound Healing Center: 642-0630 Outpatient Rehabilitation Center: 624-0380 NCHHeart Institute: 624-1000 Outpatient Cardiac Rehabilitation: 624-1080 NCH Immediate Care: 624-1050
For information on any of the NCH Healthcare System services, please call 624-1999 or visit us online at www.NCHmd.org 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
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