Health Matters The latest news on the health and wellness issues that matter most • September 2019
NCH von Arx Diabetes and Nutrition Health Center offers Treatment, Education and Nutritional Counseling
In May 2019, the NCH von Arx Diabetes and Nutrition Health Center moved back to the NCH Downtown Baker Hospital campus after a full renovation of the center. It provides treatment, nutrition counseling, planning and education, and is overseen by a staff of medical providers including Victor Luna, MD, and Valeriu Neagu, MD, both NCH endocrinologists, and Janis King, DPN, APRN, endocrinology nurse practitioner. “Dr. Neagu and Janis King, located at the von Arx Center and Dr. Luna, who is based at our Bonita Springs office, see patients who have diabetes and other endocrine concerns such as gland and hormonal imbalances, thyroid and adrenal problems and metabolic disorders,” says Sarah Frye, NCH Physician Group Operations Director. A team of registered and licensed dietitians, registered nurses and certified diabetes educators completes the highly qualified staff. According to Dr. Neagu, diabetes is the main cause of secondary blindness, amputation, chronic kidney disease and end-stage kidney disease for dialysis patients in the US. “Diabetes is known as the silent killer, since patients can be without symptoms,” explains Dr. Neagu. “They can function well with a blood glucose three times above the target and still feel relatively well.” Among the many macrovascular and microvascular complications that can arise from diabetes are retinopathy (affecting vision), neuropathy (affecting nerves) and nephropathy (affecting the kidneys) – all of which are non-reversible. However, if a patient’s diabetes has been uncontrolled for a long time, and then becomes controlled with diagnosis and treatment, the progression of the disease, and its complications, can actually stop. Dr. Neagu says that the incidence of diabetes is increasing exponentially. Once considered a disease of the elderly, diabetes is now routinely diagnosed in teenaged patients – and younger children – many of whom are overweight. “Lifestyle changes like the rate of automatization with the use of cars rather than walking, decreases in
• Individual Nutrition Consultation – Adult and Pediatric • Healthy Plate Weight Management Program (1:1 personalized counseling and meal planning sessions) von Arx Diabetes and Nutrition Health Center programs for Diabetes and Nutrition education programs:
physical activity, changes in dietary patterns and the fact that most foods – even salami – are infused with high fructose ingredients, all contribute to the rise in obesity,” Dr. Neagu explains. However, he adds that he has seen a big improvement in the control and management of Type I diabetes with the use of home based insulin pumps and continuous glucose monitors. “One patient dropped their A1C from 12% to 7% in three months after initiating glucose monitoring,” he says. “While diet is still the cornerstone in treating diabetes, medication is also effective.” Dr. Neagu says that he recommends that his patients practice “mindful eating” to help control their diabetes. “At the table, be aware of what you’re eating,” he suggests. “Never eat anything while you're driving, or watching television, or engrossed in activities. The brain doesn’t register the process of eating; it is just a reflex, and you only end up with NCH Endocrinologist, Dr. Valeriu Neagu, and Sarah Frye, Director of Operations for NCH Physician Group. unneeded extra calories.” The NCH von Arx Center offers a diabetes education self-management program, a gestational diabetes clinic, diabetes prevention, a caregiver workshop and a diabetes and insulin pump support group. Nutritional offerings include individual nutrition consultation and weight management programs and a 12-week supervised weight management group. Audrey McKernan, NCH registered dietitian
• Healthy Weight Management Group (with a 12-week Wellness membership) • Diabetes Self-Management Program (with a 30-day Wellness membership; evening and daytime) • Gestational Diabetes Clinic (individual instruction) • Diabetes Prevention Class • Diabetes Caregiver Workshop • Diabetes & Insulin Pump Support Group
and certified diabetes educator, teaches patients about healthy meal planning, as well as how to shop, and more. Patients who have undergone bariatric procedures such as a gastric bypass, sleeve gastrectomy or the Orbera gastric balloon, or who are enrolled in a medical weight loss program, now have access to a support group that addresses their particular concerns. “It is well-documented that 80 percent of Type II diabetes patients that have a BMI of about 40 and who had various gastric bypass procedures can actually go off insulin in three months. It’s virtually a cure for diabetes,” says Dr. Neagu.
“As they lose weight, they go from having chronic diabetes to remission. They have a struggle every time they take a bite; we have to reinforce the good behavior – and the more we do, the more success we see.” In addition to medications, new technology includes continuous glucose monitoring devices, an external device placed on the arm, and an array of insulin pumps that enable staff members to download information to see the patient’s trends and explain treatment. The NCH von Arx Diabetes and Nutrition Health Center hopes to use its expertise and passion to better serve the southwest Florida community.
Insurance coverage is available fromMedicare and most private insurances for diabetes programs.
For more information or to make an appointment, call the NCH von Arx Diabetes and Nutrition Health Center , located in the Briggs Health Pavilion at 399 9th St N, in Naples, at (239) 624-3450 or visit www.NCHmd.org/Nutrition
The NCH Acute & Stroke Rehabilitation Program is Unmatched in Collier County
Welcome to the Brookdale Center for Healthy Aging
M ore than 750,000 Americans will suffer the debilitating effects of stroke this year. Nearly 140,000 will die. That is why it is very important to know the signs of stroke – and the importance of seeking immediate emergency treatment. The NCH Stroke Center is a patient’s first stop in the NCH acute stroke care and rehabilitation program. Stroke care starts in the ambulance and continues in the ER where time is of the essence. An evaluation of the patient’s condition is conducted immediately – and a neurologist can be consulted quickly in real-time using teleneurology. Interventional radiology identifies and addresses blood clots, administers medication, and performs other testing. Patients remain in acute care until their condition is stabilized. Then, when they are medically ready, they are transitioned to the stroke rehabilitation program at The NCH Brookdale Center for Healthy Aging & Rehabilitation. The stroke rehabilitation services staff includes physical (PT), occupational (OT), and speech (ST) therapists, nurses, a hospitalist, a physiatrist (physical medicine and rehabilitation physician) and a neuropsychologist. Six of the PT and OT staff members are specially certified in neuro-developmental treatment (NDT). To date, NCH Brookdale physical therapists have earned patient satisfaction scores of 98 percent. “While the requirement for rehab is three hours of therapy daily, because many patients are getting PT, OT and ST with our various programs, they actually receive four to five hours of therapy a day,” explains NCH Stroke Inpatient Rehab Manager, Jennifer Shover. “We work on strengthening their ability to perform activities of daily living, getting them to be able to move in bed, to sit up, stand, improve cognition, walk, talk and improve balance.” Because swallowing can be an issue for a number of stroke victims, speech therapists work with these patients to address swallowing difficulties, working in conjunction with the dining program to teach patients how to swallow again. Electrical stimulation is also utilized by OTs on arm or leg muscles to help improve
strength, and by STs to improve facial weakness. Shover says that staff members try to discover the things patients most enjoy and develop customized therapies based on these activities to achieve better results. “Because it’s something valuable to their life, they will be more engaged and interested in working hard,” says Shover. Inpatient rehabilitation rooms are assigned to stroke patients based on their impairments. Specialty rooms are equipped with video monitoring, allowing staff members to communicate interactively with patients, for patients’ safety. Bed alarms will quickly alert staff whenever a patient attempts to leave their bed without assistance. “We are truly set apart from skilled nursing facilities,” says Shover, pointing out that when medical issues arise, patients can be quickly treated due to the hospital setting. “There is no need to call for outside services to transport them to a hospital, and we have two physicians with eyes on each patient,” she adds. Rounding out the stroke rehab program is a case management staff that oversees patient progress from admission in the acute phase, to discharge and after. In addition to comprehensive discharge planning, staff members follow up with patients and their families concerning appointments with specialists, special equipment needs and anything else required to ensure full recovery. “Our Acute & Stroke Rehab program is light years ahead of all others,” says Shover. “When we see stroke patients come in on a stretcher and can’t move – then a month later, we see them walk out – it’s very satisfying.” Why NCH Acute & Stroke Rehab Program is Collier County’s superior stroke recovery and rehabilitation center: ● Most effective facility when comprehensive medical and medication management is required ● Patients are monitored by two physicians: a hospitalist and a physiatrist (physical medicine and rehab doctor) ● Specially trained nursing staff ● Highly trained physical, occupational and speech therapy team (six of whom have neuro disability training, NDT) ● Imaging tests , lab draws and other testing can be performed quickly on-site ● Special rooms designated depending on patient’s impairments, with video monitoring and interactive communication, and bed alarms for safety ● If needed , additional hospital services are located on the NCH property – no need for outside ambulance services as in skilled nursing facilities ● Yearly , on average, 80 percent of patients return home with an average length of stay of 11 days ● The program offers home evaluations to make recommendations for home modifications for optimummobility ● Unrivaled patient satisfaction scores of 98 percent for 2019
NCH Acute & Stroke Rehab offers:
• A fully equipped gym for strength training, with specialized equipment such as LiteGait
• High-tech, cognitive re-training tools and cutting- edge evaluation equipment; iPad applications for cognitive re-training • Dining room programs for motor skills and swallow functioning • Arts in healing program to train fine motor skills and cognition • Full kitchen and laundry, where patients practice home and daily living skills • Outdoor Mobility Garden available for daily as well as leisure activity training (uneven surfaces, a mailbox,
chip and putting green, fishing station) • Certified Peer Support Visitor program (many of whom are former stroke patients) • Horticulture program for planting in raised beds • Availability of a van for community outings • Stroke education and monthly support groups
The NCH Brookdale Center for Healthy Aging & Rehabilitation is located at the NCH North Naples Hospital, 11190 Health Park Blvd. in Naples. For more information about the Acute & Stroke Program call (239) 624-5700
The Top 10 Things Your Mammo Tech Wants You To Know
1. Bring your prior mammograms, it increases accuracy. The CD is available to pick up at most facilities. This will save you time and possibly money! 2. We care about your breast health and want you to be comfortable. The breast is only compressed for a short time and assists in separating the breast tissue to reveal any abnormalities. It does not cause breast cancer to spread. 3. What kind of mammogram do I need? a. Screening Mammography is done for patients with no breast complaints. b. Diagnostic Mammography is done for patients needing evaluation of a breast complaint or an abnormality detected by physical exam or the screening mammography. 4. Annual mammograms should begin at age 40, earlier if there is history. Regardless of advanced age, as long as you are in good health, continue with annual mammograms.
5. Mammograms are still the #1 way of detecting breast cancer and when found early, it is most treatable. 6. Do not wear deodorant or lotions under the arms or on the breasts. These can interfere with the quality of x-ray images. 7. Let us know if you have any physical limitations, we will work with you. 8. An abnormal mammogram is not always cancer. 9. A normal mammogram does not mean there isn’t cancer. 10. 75% of women diagnosed with breast cancer have no family history of breast cancer.
TO MAKE AN APPOINTMENT FOR YOUR MAMMOGRAM CALL NCH IMAGING AT 239-624-4443
Naples-Immokalee-Marco Island Tops U.S. in Well-Being for Fourth Time
For the fourth straight year, the Naples-Immokalee- Marco Island, Florida, metro area had the highest well-being across 156 U.S. communities. Gallup, the world leading analytics and advice firm, reported the findings this spring in their annual community rankings as part of the Gallup National Health and Well-Being Index. This marks the first time in 11 years of annual Well-Being Index reporting that the same city has topped the rankings four times in a row. In 2015, NCH brought the Blue Zones Project to southwest Florida to help promote well-being within the environment in which people live, play, learn,
work, pray, shop and eat. These efforts along with the many dedicated organizations collaborating to help people live healthier and happier in southwest Florida contribute to this stellar ranking. Just 8 years ago, the community’s well-being ranked at 73rd in the nation. “The continued strong well-being measured in the Naples metro area is impressive and illustrates that well-being can remain high amid declines nationally,” said Deb Logan, executive director of Blue Zones Project Southwest Florida.
1 – Naples-Immokalee-Marco Island, FL 2 – Salinas, CA 3 – Boulder, CO 10 Highest Well-Being Communities, 2018-2019
The Gallup National Health and Well-Being Index is calculated on a scale of 0 to 100, and is based on scores within each of the five essential elements of wellbeing: • Career: liking what you do each day and being motivated to achieve your goals • Social: having supportive relationships and love in your life • Financial: managing your economic life to reduce stress and increase security • Community: liking where you live, feeling safe and having pride in your community • Physical: having good health and enough energy to get things done daily
4 – Santa Rosa, CA 5 – Ann Arbor, MI 6 – Cape Coral-Fort Myers, FL
7 – Fort Collins, CO 8 – Lancaster, PA 9 – North Port-Sarasota-Bradenton, FL 10 – Asheville, NC
Electronic Implant Offers Hope to Patients Suffering From Chronic Nausea, Pain and Vomiting
If you or a loved one suffers from the chronic nausea and vomiting that are indicative of gastroparesis, you know just how debilitating the condition can be – and how any relief can be considered a miracle. The groundbreaking Enterra II neurostimulator has proven itself to be a miracle treatment for some gastroparesis patients when other treatment options have failed. In gastroparesis, which affects a number of Type 1 and Type 2 Diabetes patients, the stomach is unable to empty itself of food normally, causing abdominal pain and vomiting. The condition can also be attributed to idiopathic (unknown) origins or can develop in some patients after abdominal surgeries.
Medtronic Enterra II Neurostimulator
“Normally the stomach is a very dynamic organ that moves continuously to help propel food into the intestines,” explains NCH General Surgeon Robert Grossman, MD, who specializes in general, minimally invasive, laparoscopic and robotic surgery. “With gastroparesis, the stomach just sits there as an empty sack. When the stomach doesn’t move properly, patients can have severe pain after eating; patients usually have nausea and vomiting of undigested food.” According to Dr. Grossman, episodes can occur once or twice a week in mild cases, and up to 15 to 20 times a week in severe cases. “It can be very debilitating,” he says. “The few FDA- approved medications aren’t very effective, and the Enterra device is an excellent option that can help to restore a normal quality of life.” Gastroparesis patients ages 18 to 70 are candidates for the one to two-hour procedure, where a small device is implanted laparoscopically in the belly wall underneath the ribs. Two small electronic leads go into the stomach wall. “It is well-tolerated and patients don’t feel the device,” says Dr. Grossman. “They return home the same day, or stay overnight.” The implant’s settings can be adjusted by a handheld external device kept by the physician. When patients visit the office every six to twelve months for a check-up, the handheld device is placed over the implantation site and reads out data. Adjustments can then be easily made. Once a patient’s symptoms are controlled, they only need to return to the doctor when their implant requires a new battery, which should last for five to ten years. In an outpatient procedure, the old battery is removed, replaced with a new battery, returned to the skin pocket, and the implant is reprogrammed. Dr. Grossman perfected the procedure during his fellowship training and is the only physician in Collier and Lee Counties who performs the implantation laparoscopically. “The biggest benefit for these patients is improved quality of life; without treatment, they may end up in the hospital many days per year,” says Dr. Grossman. “For gastroparesis patients with severe pain, nausea, and vomiting, some may be able to eat a normal breakfast the day after surgery.” If you have symptoms of gastroparesis, you should make an appointment with your gastroenterologist. He or she will perform tests to see how quickly food empties from the stomach. If gastroparesis is diagnosed, they can then plan for implantation of Enterra II.
Dr. Robert Grossman with Enterra
Benefits of ENTERRA II neurotransmitter ■ It is as small as a regular pacemaker (2” x 2.4”) ■ Implantation is a low-risk procedure ■ Nausea and vomiting resulting from gastroparesis and idiopathic origins are greatly reduced ■ Data shows there is 68 percent improvement in weekly vomiting in diabetic and 87 percent improvement in idiopathic groups ■ Diabetic gastroparesis patients who normally experience 40-day hospital stays each year can reduce those days to 10 or less with Enterra II ■ In idiopathic patients, stays are reduced from two days per year to zero ■ Fully covered by insurance ■ FDA approved as a humanitarian-use device
For more information, contact NCH General Surgery at (239) 624-4650
Let’s GO! Challenges Kids To Be Activ e
One hour. Sixty minutes. 3,600 seconds. Whichever way you calculate it, getting an hour of physical activity every day canbe challenging. And sorting through nutrition and health advice can be confusing for nearly everyone! As a parent or caregiver it can be frustrating as you try to steer your family in a healthy direction. The NCH Safe & Healthy Children’s Coalition of Collier County is trying to simplify some sound recommendations that you can use in guiding your family to a healthy lifestyle.
To encourage children to meet healthy recommendations, the NCH Safe & Healthy Children’s Coalition launched “95210 Let’s Go!” Created in partnership with the University of Florida/IFAS Collier County Extension and Collier County Public Schools, the “95210 Let’s Go!” program is offered to students at 28 elementary schools, with the shared ultimate goal of each participant running a total of 26.2 miles (the distance of a marathon) over the course of the three-month program. However,
each participating school organizes the overall encompassing program to fit their students’ needs. Students gather before or after the school day and run together on school property. Health Champions track the students’ progress and those who complete 26.2 miles are invited to participate in a Final Mile Race; a celebratory one-mile run held at an area high school. To date, some 400,000 miles have been run by more than 15,000 students.
Beyond the physical activity, 95210 also gives students an easy way to remember key recommendations:
“We hope students become their own advocates for a healthy lifestyle,” says Paula DiGrigoli, Executive Director of the NCH Safe & Healthy Children’s Coalition. “95210 is about fostering a love of running or walking fast and healthy lifestyle among children.” Paula suggests you teach your children this easy message by posting it on your refrigerator, near televisions and computers and wherever else it will be seen and serve as a reminder! Set goals with your children and participate with them. What are we waiting for? … “ Let’s Go!” I 9 52 0
9 = 5 =
the number of hours of sleep we should get daily.
get at least 1 hour of physical activity each day. limit “screen” (television, internet, video games) time to 2 hours or less daily. howmany servings of fruits and vegetables we should eat daily. eliminate sugary beverages (avoid soda, juice, energy drinks, etc.) and tobacco.
2 =
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Visit NCH Safe & Healthy Children's Coalition at www.safehealthychildren.org for more information.
MITRACLIP IS GIVING HEART PATIENTS WITH MITRAL REGURGITATION A NEW REASON TO HOPE
There’s now hope for certain heart patients. Patients who experience mitral regurgitation (MR), a condition where blood backs up in the heart leading to symptoms of congestive heart failure, can now undergo a minimally invasive procedure to help restore more normal heart and valve function. The U.S. Food and Drug Administration has now approved the MitraClip device for both “primary” and “secondary” mitral regurgitation. NCH Heart Institute will be one of the first healthcare systems in Southwest Florida to offer it. The MitraClip has long been approved for patients with severe mitral regurgitation (MR) due to an abnormally functioning valve (primary MR). The FDA’s more recent review extended that approval to include secondary MR patients, who suffer from a weakened and or dilated heart leading to a leaky valve. The updated indication for the MitraClip offers a much-needed remedy for many patients who were only managing their symptoms of heart failure with medications, leaving the primary valve problem to persist. “The MitraClip allows us to treat a wider spectrum of patients with advanced mitral valve disease who have been considered poor surgical candidates,” explains Adam Frank, MD, NCH Interventional Cardiologist. “The MitraClip was designed to essentially clip the center of the valve reducing the amount of blood that can flow backwards.”
For more information on the MitraClip treatment for MR, contact the NCH Heart Institute at 239-624-4200 “The MitraClip allows us to treat a wider spectrum of patients with advanced mitral valve disease who have been considered poor surgical candidates. ” --- Dr.Adam Frank
Implantation of MitraClip
catheter along with ultrasound/ echocardiographic guidance allows the mitral valve leaflets to be clipped in a very specific location thereby reducing the severity of regurgitation. The results of the Mitraclip procedure are almost instantaneous. Dr. Frank says that most patients should experience an immediate improvement in symptoms. Moreover, the recovery time is short, and many patients are discharged within three days of the procedure. “The MitraClip is a very attractive option for the right patient,” Dr. Frank continues. “A heart team will review the patient’s medical history to determine if the MitraClip is an appropriate treatment.”
With a “leaky” or regurgitant valve, blood goes backwards through the valve leading to shortness of breath, fatigue, swelling and difficulty with normal activities. “MR can severely impact a patient’s quality of life,” says Dr. Frank. “The mitral valve is supposed to be a one-way valve from the left atrium to the left ventricle. When the valve leaks, the heart cannot function efficiently. At some point, a patient can develop congestive heart failure as well as other serious conditions.” The MitraClip is a minimally invasive, catheter based procedure performed in a catheterization lab under general anesthesia. A specialized
NCH and the NCH Physician Group
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Academic Internal Medicine Clinic Charles Graeber, 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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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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Visit NCH Immediate Care for:
•Sore throat •Mild asthma •Eye irritation •Insect stings •Sports injuries •Urinary infection
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NCH Immediate Care - Bonita 3302 Bonita Beach Rd. • Bonita Springs 239 • 624 • 1050 Hours: Mon-Sat: 9am-7pm • Sun: 12noon-7pm NCH Immediate Care - Vanderbilt 801 Vanderbilt Beach Rd. • Naples 239 • 624 • 8220 Hours: Mon-Sat: 9am-7pm • Sun: 12noon-7pm NCH Immediate Care - Southeast 7717 Collier Blvd., #100 • Naples 239 • 624 • 8220 Hours: Mon-Sat: 9am-7pm • Sun: 12noon-7pm
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