March 2020 Health Matters

The latest news on the heal th and wel lness issues that matter most • March 2020 H althMatters

NCH Hospitals Named Among America’s 250 Best

H ealthgrades, one of the largest independent hospital quality ranking organizations in the country, recently named NCH Downtown Baker Hospital and NCH North Naples Hospital among America’s 250 best for the 3rd year in a row. Healthgrades provides patients with tools and information to help them make one of their most important decisions – where to seek medical care – an informed one. Annually, over 350 million visitors access Healthgrades’ online tools in search of high quality healthcare providers, such as NCH. The Healthgrades America’s Best Hospital achievements are based on an objective review of clinical outcomes across multiple conditions and procedures, and focus on the performance of 4,500 hospitals nationwide. They use three years of Medicare data, focusing on two key factors, mortality rates and complication rates, so ratings and awards better represent true superior performance by clinicians and staff. According to Healthgrades’ analysis, NCH hospitals and others like it named one of America’s 250 best, deliver better outcomes than 95% of hospitals in the nation! Patients have a 27.1% lower overall risk of dying as

• One of Healthgrades America's 100 Best Hospitals for Critical Care™ in 2020 • One of Healthgrades America's 100 Best Hospitals for Stroke Care™ for 2 Years in a Row (2019-2020) • One of Healthgrades America's 100 Best Hospitals for Spine Surgery™ for 3 Years in a Row (2018-2020) • One of Healthgrades America's 100 Best Hospitals for Cardiac Care™ for 5 Years in a Row (2016-2020) “These awards are not achieved by accident, but rather through the application of our core values and mission to help everyone in our community live longer, happier, healthier lives,” said Paul Hiltz, President and CEO of the NCH Healthcare System. “NCH is very proud of the exceptional clinical service that we provide to our neighbors, and this recognition is validation of the effort and focus that NCH’s dedicated staff has given to high- quality patient care and clinical excellence.”

compared to patients at hospitals that did not receive the award. Furthermore, patients treated at a hospital named by Healthgrades as one of America’s best, such as NCH, had: -22.6% LOWER RISK of dying from heart attack -26.1% LOWER RISK of dying from sepsis -28.3% LOWER RISK of dying from stroke -33.2% LOWER RISK of dying from heart failure In fact, if all hospitals performed at the level of America’s 250 Best Hospital recipients, such as NCH, over 168,165 lives could have been saved!* These are real numbers that make a real difference to patients. NCH also outperformed other hospitals in the nation in multiple service areas and, as a result, was recognized late last year with an impressive list of these Healthgrades Awards: • One of Healthgrades America's 100 Best Hospitals for Pulmonary Care™ in 2020 • One of Healthgrades America's 100 Best Hospitals for Prostate Surgeries™ in 2020 • One of Healthgrades America's 100 Best Hospitals for Gastrointestinal Care™ in 2020

Indeed, this level of achievement is something that staff, patients, and our community can all be proud of.

*statistics based on Healthgrades’ analysis of MedPAR data for 2015-2017

Achilles Rupture: Those Active In Sports Should Know The Signs

For those who spend time on the courts each week playing tennis or pickleball – or the weekend warriors who enjoy a pick-up game of basketball – knowing the signs and symptoms of a ruptured Achilles tendon can prevent further injury. Often, it happens without warning. The Achilles tendon is the body’s largest and strongest tendon. It is attached to the big calf muscle and allows you to push down on your foot. When the tendon ruptures, you may feel a sudden “pop,” or feel pain as if someone kicked you from behind, or threw a rock at your lower calf. You will have a sense of weakness when you try to push off your foot. “If this happens, don’t assume it’s a sprain,” warns Richard J. de Asla, MD, NCH Orthopedic Division Director. “Get off of your

treatment can be as effective as operative treatment. However, the benefits of non-operative treatment are lost if treatment is delayed.” Dr. de Asla says that the greatest advantage of surgical treatment is a markedly reduced risk of re-rupturing the tendon. The risk for re-rupture with non-operative treatment methods is between three and four times greater. There may also be a strength benefit as well. However, every surgical procedure carries an inherent risk of complications due to surgical incisions. Using a minimally invasive surgical approach, the Percutaneous Achilles Repair System (PARS) allows surgical repair of the tendon with a very small incision. However, patients with a degenerative tendon may need more advanced surgical techniques for reconstruction. Recovery from an Achilles tendon rupture usually requires about four weeks of staying off the foot; after which patients can start bearing weight in a protective boot. Physical therapy is normally ordered at six to eight weeks. Full or nearly full healing of the tendon takes 16weeks. Most patients find that a full recovery can take as long as a year.

Dr. Richard J. de Asia

foot immediately and immobilize it, with the foot in a slightly downward position. Do this within 24 hours until you get a diagnosis, so that the gap between the ruptured ends of the tendons doesn't get bigger.” Dr. de Asla says that the vast majority of Achilles tendon ruptures produce relatively littlediscomfort shortlyafter the rupture itself luring somepatients to believe the injury isn’t serious. Individuals at greatest risk are in their late 30s and in their 60s. The younger group typically has no preceding pain, while some in the older group will report some preceding discomfort. Some victims are already suffering with a degenerative condition like tendinosis. Diagnosis is usually straight forward to make clinically, says Dr. de Asla, since the defect in the tendon can be felt by the doctor during a hands-on examination. The classic test for Achilles rupture, the Thompson test, is also used. With the patient lying face down, the calf is squeezed for a response. Sometimes, the doctor will order an MRI. Depending on the results of testing, the physician and the patient then discuss treatment options such as surgery or non-operative treatment methods.

“Non-operative treatment does not mean no treatment. It means we are treating it non-sugically,” explains Dr. de Asla. “Some studies suggest that non-operative

Signs of Achilles rupture • A sudden snap at the lower calf

• Initial intense pain that improves quickly • Weakness to point the foot downward • Inability to stand on toes • Difficulty walking (particularly stairs) • Bruising and swelling around the lower calf into the ankle and foot Benefits of surgical treatment of Achilles rupture • Lower risk for re-rupture • Less time being immobilized • Faster recovery time and return to regular activity Patients who are not candidates for surgery to correct Achilles rupture • Patients who smoke • Patients who have poorly controlled diabetes • Patients with peripheral vascular disease • Patients with significant neuropathy and pain

Richard de Asla, MD, NCH Physician Group - Orthopedic Surgery , located at 1280 Creekside Blvd., Suite 101, in Naples, (239) 624-0310

Minimally Invasive Procedure Improves Quality of Life For Heart Valve Patients

There is good news for people suffering from significant, severe and symptomatic aortic stenosis who are at

individually and decide on the best course of action. There are two interventionalists and a surgeon for every case. “Every patient is carefully assessed for lung

risk for complications associated with surgery. The minimally invasive transcatheter aortic valve replacement (TAVR) procedure can successfully replace the valve without the risks associated with fully invasive heart surgery. Aortic stenosis is a fairly common, yet serious, narrowing of the aortic valve that affects approximately 200,000 Americans each year. The narrowing, or stenosis, is the result of an accumulation of calcium deposits on the valve, which restricts blood flow to the body resulting in weakness, breathlessness, chest pain and palpitations. With the TAVR procedure, a new valve is inserted to replace the aortic valve using a catheter. In the 30- to 45-minute procedure, highly skilled NCH interventional cardiologists guide a catheter through an artery – usually entered through the leg – up to the heart. “If the patient is not a candidate, due to small arteries or other issues of the legs, we enter

function,” explains Dr. Leslie. “Carotid arteries are checked with ultrasound, and we do a head-to-toe CT scan, a heart echocardiogram and use

monitors to determine if the patient will need a pacemaker before the procedure.” Nurse practitioners act as procedure coordinators, and serve as a resource for patients. They answer patients’ questions and care for each patient before, during and after each procedure. In addition to the obvious benefit of a less-invasive valve replacement, there is also less recovery time and a quicker return to daily activities with a much better quality of life. “It's basically two days in the hospital, and a week later, you're back on the golf course – versus a week in the hospital, and six months before you’re back on the golf course,” shares Dr. Leslie. “It is a life-changing difference. At NCH, our success rate is excellent.” Dr. Larry Leslie Benefits of TAVR • Shorter recovery time • Less invasive than traditional open-heart surgery • Open to anyone with severe aortic stenosis • Candidates from 50 to 99 can be treated • Excellent success rate

trans-carotid; through the carotid artery in the neck,” explains Larry M. Leslie, MD, who has been a practicing interventional cardiologist at NCH Heart Institute since 2016. NCH is one of only a handful of centers nationwide to utilize what is considered an alternate access: the carotid artery. The size of the equipment has significantly improved in the last three years, and the TAVR procedure is now open to anyone, from low- to high-risk patients. The work-up for TAVR is much the same as for an open surgical replacement. “It's a comprehensive team approach with a multi-sub-specialty group,” says Dr. Leslie. Weekly conferences with the full team consider each case

For more information, contact the NCH Heart Institute at (239) 624-4200

Everything You Need to Know About CHOLESTEROL

We all know that high levels of cholesterol can lead to heart and vascular diseases. However, many of us do not fully understand how this waxy substance builds up in the bloodstream. Although cholesterol occurs naturally in both the human body and in food like cheese, meat and egg yolk, high levels of LDL, or “bad” cholesterol in the human body can deposit in our blood vessels and lead to serious health issues. “Moderation is always the key. Too much cholesterol increases the risk for heart attacks, strokes and other serious issues,” says Jeffrey Howland, MD, NCH Physician Group Internal Medicine. “To measure total bloodstream cholesterol, I order bloodwork – specifically a lipid panel – that measures HDL cholesterol, LDL cholesterol and triglyceride levels.” Dr. Howland explains that total cholesterol levels should be less than 200, with HDL or ‘good’ cholesterol levels above 50 as this is associated with lower health risks. LDL, or ‘bad’ cholesterol levels, should be less than 100, because higher levels indicate higher health risks. “But that varies depending on your medical condition,” he says, adding that for some individuals with certain cardiovascular risk factors, desirable LDL levels can fall into the less- than-70 range. Triglycerides, which are also part of the lipid panel blood test, are not a cholesterol at all, but a fat, explains Dr. Howland, and should measure no more than 150. Higher levels are

associated with higher risks of cardiovascular events, so if the results are elevated, a fibrate medication like fenofibrate or gemfibrozil, is prescribed, he says. Dr. Howland uses a risk calculator to determine whether medication – statins such as atorvastatin, rosuvastatin or simvastatin – are indicated.

“Age, family history, smoking and other health considerations are important to determine if medication will lower your cholesterol. I can try a few different ones to see what works best, since some medications affect the body and people in different ways,” he explains. If statins produce side effects, cardiologists may sometimes prescribe a PCSK9 inhibitor injection, like Repatha in select patients. “I practice shared decision-making with my patients,” shares Dr. Howland. “If they prefer treatment with or without medications, I counsel them on exercise and diet control. They must avoid foods like red meats, fried foods, cheeses, and foods high in carbohydrates or fats. They must also exercise regularly – like swimming, walking, or other low-impact exercises.” Ultimately, the patient needs to be willing to make these changes so they may achieve proper levels of cholesterol. Dr. Howland says these lifestyle changes are important on the path to a healthier life.

Risk factors ■ Age: Cholesterol levels tend to rise as you age ■ Weight: being overweight predisposes you to having higher cholesterol levels ■ Genetics: history of high blood cholesterol in other family members ■ Poor eating habits: consuming trans fats and saturated fats found in dairy, some meats, baked goods, fried foods ■ Lifestyle: little or no exercise, sitting all day and not moving around ■ Smoking: raises LDL (bad) cholesterol and lowers HDL (good) cholesterol Managing proper cholesterol levels ■ Take medications such as statins or fibrates as prescribed ■ Maintain a heart-healthy diet ■ Avoid fatty foods, fried foods, cheeses, high-carbohydrate foods, and processed foods ■ Participate in a regular exercise program

Dr. Howland, MD, NCH Physician Group Internal Medicine is accepting new patients at 311 9th St. North, Suite 300 in Naples. Call (239) 624-0940 to make an appointment

NCH Emergency Departments Use Latest Technology to Provide Comfort to Patients

Patients show up at one of NCH’s five emergency departments every day with a variety of symptoms and complications. Often, though, one of the first things they need to get is an IV or intravenous line started as quickly as possible to deliver medication, pain relief or hydration. With some patients however, finding a vein to start an IV can pose a challenge for the medical staff at a time when every minute counts. To facilitate this critical need, and provide a better patient experience, all NCH emergency departments are equipped with the Sonosite II, which provides ultrasound-guided vascular IV access for patients of all ages. Portable, compact and quick to boot up, the Sonosite II combines a handheld wand with sophisticated imaging on a large, easy-to-view screen, allowing emergency nurses to pinpoint the location of a vein and get an IV started with minimal delay. Some peoples’ veins are deeper and smaller, particularly those who are older or dehydrated, and because during an emergency time is

of the essence, this device helps everyone have a better experience. All NCH emergency medical staff are trained on the use of this device. Without the visualization provided by the Sonosite II, more patients would require having their IV

The Sonosite II: • Prevents delays in patient care • Provides the least invasive IV access on patients who are a hard IV insertion • Helps assure the best outcome for all emergency patients

started via a peripherally-inserted central catheter, or PICC; a more involved and extensive procedure. The Sonosite II can eliminate that need because it is quicker, easier and less invasive. It enables clinicians to make more confident decisions and focus on what matters most — the patient.

NCH Downtown Baker Hospital Address: 350 7th St N Naples, FL 34102 Phone: (239) 624-2700 Hours: 24-hours a day, 7-days a week. NCH Healthcare Northeast Address: 15420 Collier Blvd Naples, FL 34120 Phone: (239) 624-8700 Hours: 24-hours a day, 7-days a week.

NCH North Naples Hospital Address: 11190 Health Park Blvd Naples, FL 34110 Phone: (239) 624-9199 Hours: 24-hours a day, 7-days a week. NCH Healthcare Bonita Address: 24040 S. Tamiami Trail

NCH MacDonald Pediatric Emergency Department Address: 11190 Health Park Blvd Naples, FL 34110 Phone: (239) 624-9104 Hours: 24-hours a day, 7-days a week.

Bonita Springs, FL 34134 Phone: 239-624-6900 Hours: 24-hours a day, 7-days a week.

Prostate Artery Embolization, a Breakthrough Procedure for BPH, Now Offered at NCH

By age 70, over 2/3 of all men will have an enlarged prostate. Prostate enlargement can cause urinary obstruction which can affect quality of life and lead to bladder, urinary tract and kidney problems. A cutting-edge medical treatment, now being performed at NCH, can help improve urinary function in men who suffer from lower urinary tract symptoms due to an enlarged prostate. Prostate Artery Embolization (PAE) is a

the size of the prostate gland and major relief of symptoms. “Patients feel significant improvement within a month,” says Dr. Luka, “and continue to see positive changes for up to a year.” A consultation with a urologist is recommended to determine if a patient is a candidate for PAE. “Other treatment options may be appropriate before recommending PAE or minimally invasive prostate surgery,

such as behavior modification or medications,” says

Dr. Joseph Luka

Dr. Marc Colton

minimally invasive endovascular procedure that can significantly improve lower urinary tract symptoms caused by a benign prostatic hyperplasia (BPH), a benign condition affecting older men which leads to prostate enlargement. NCH Physician Group Interventional Radiologist, Dr. Joseph Luka performs PAE by inserting a small catheter into the prostate artery by going through either the wrist or groin and injecting tiny particles or microspheres which block blood flow to the prostate. “Essentially, you shut down the blood supply to the prostate, and over a period of a few months it shrinks in size, allowing the urethra to function more normally,” explains Dr. Luka. Patients can expect a 30-40 percent decrease in

Dr. Marc Colton, NCH Physician Group Urologist. Because prostate surgery for very large prostate glands may require a hospital stay with a relatively lengthy recovery-time, some patients have opted for PAE in lieu of this, because it is performed under local anesthesia and on an outpatient basis. Other patients undergo PAE when prostate surgery presents too many risks for complications or if they are not able to tolerate medications for BPH. “If you are tired of living with symptoms of BPH, consider a consultation to explore whether you qualify for prostate artery embolization at NCH, which was recognized by Healthgrades as one of America's 100 Best Hospitals for Prostate Surgeries™ in 2020,” says Dr. Colton.

To check if you are a candidate for PAE, you can make an appointment with Dr. Colton, NCH Physician Group Urology, at (239) 624-1160, or Drs. Wilkinson, Jay or Rivera, Advanced Urology Institute, at (239) 465-4157, or Dr. Luka, NCH Physician Group Interventional Radiology, at (239) 624-4427

Swelling? It Could Be Lymphedema...

A ny kind of unexplained swelling in your body warrants a full and speedy assessment by your physician, especially if you have had recent surgery, suffer from cardiovascular disease, or have been treated for cancer through lymph node removal or radiation. If you feel that something is not quite right, for example, perhaps an arm or leg feels unusually heavy or is visibly swollen, your jewelry or clothing is feeling tight in one specific area, or you have been experiencing repeated infections, you may have a condition called lymphedema. Lymphedema is a swelling caused by accumulation of fluids due to a compromised lymphatic system, which regulates the body's immune responses. Lymphedema can affect areas of your body that are not being properly drained because lymph nodes are missing or the lymphatic system has been damaged. "Although there is technically no cure for lymphedema, the condition can be managed by a

certified lymphedema therapist (CLT) who has been specifically trained and certified in Complete Decongestive Therapy (CDT)," says NCH Occupational Therapist Rebecca Greenwood, OTD, OTR/L, CLT-LANA. Greenwood continues, "Complete Decongestive Therapy includes the gold- standard of treatment called The Vodder Method of manual lymph drainage, as well as compression (bandaging and/ or compression garments), good skin care to reduce infection risk, and decongestive exercises that move joints and muscles to help promote lymphatic flow. After a physician's referral, we conduct an evaluation to create an individualized treatment program." Although lymphedema may be caused by a genetic or congenital abnormality in the lymphatic system, it can also be due to an overloaded venous system that can impact the lymphatic system. Certified Lymphedema Therapist, Sandra Hutchinson, NCH Occupational Therapist, OT,CLT-

ALM,KTP,MFR further explains, "the condition can affect any age, male or female, and increase the risk of infection." She further explains the Vodder Method involves manual techniques designed to re-route lymphatic fluid around the damaged area toward healthy, intact lymph nodes where fluid drains normally. After treatment, the patient wears compression bandages or garments to prevent fluid from re- entering the affected area." Both Hutchinson and Greenwood are lymphedema therapists who have completed a 135- hour special lymphedema certification, as well as advanced lymphedema management courses. During treatment, both therapists focus on education so patients can perform treatments at home. Patient education focuses on risk reduction practices, performing self-lymphatic drainage, a wear and care schedule for compression, exercises, recognizing signs and symptoms of infection, and good skin care to facilitate long term success of lymphedema management.

Sandra Hutchinson demonstrates the Vodder Method manipulation.

For more information, contact NCH Outpatient Rehabilitation at Briggs Health Pavilion Downtown at (239) 624-1600 or NCH Outpatient Rehabilitation in Bonita Springs at (239) 624-0970

Rebecca Greenwood showing a lymphatic system chart.

LIVING WELL WITH DIABETES Are you one of the 29 million Americans with diabetes? To be your healthiest and feel your best: iving Well with Diabetes re you one of the 29 million Americans with diabetes? e your healthiest and feel your best:

Eat more fruits and vegetables, less sugar and salt . Eat m its and vegeta l s, less sugar and salt. Take diabetes medicine as prescribed. T i betes e ici e as prescribed. Living Well with Diabetes Are you one of the 29 million Americans with diab tes? To be your healthiest nd feel your best: Get physically active — aim for at least 150 min/week. t physically active aim f at least 150 min/week. Make and keep appointments with your health care team. Make and keep appointments with your health care team.

Check blood sugar regularly. sugar r ularly. l

Know your ABCs: - Regular A 1C test - B lood pressure below 140/90 mm Hg - Control c holesterol - Stop/don't start s moking Kno yo r : - Regular A 1C test - B lood pressure below140/90mmHg - Control c holesterol - Stop/don’t start s moking

DID YOU KNOW... making healthy lifestyle changes can greatly reduce your risk of diabetes-related problems. It really works. Did you know... makinghealthy lifestyle changes cangreatly reduce your risk of diabetes-relatedhealthproblems. It reallyworks! Call the NCH von Arx Diabetes and Nutrition Hea th Center t (239) 624-3450 for more information on nutrition counseling and weight management. Eat more fruits and vegetables, less sugar and salt. Get physically active —aim for at least 150 min/week. Take diabetes medicine as prescribed. Make and keep appointments with your health care team. Check blood sugar regularly. Know your ABCs: - Regular A 1C test - B lood pressure below140/90mmHg - Control c holesterol - Stop/don’t start s moking

Call the NCH von Arx Diabetes and Nutrition Health Center at (239) 624-3450 for more information on nutrition counseling and weight management Did you know... makinghealthy lifestyle changes cangreatly reduce your risk of diabetes-relatedhealthproblems. It reallyworks! Call the NCH von Arx Diabetes and Nutrition Health Center at (239) 624-3450 for more information on nutrition counseling and weight management.

NCH and the NCH Physician Group

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Carlo Santos-Ocampo, MD Dinesh Sharma, MD Hillary Tassin, MD Silvio C. Travalia, MD Shona Velamakanni, MD Caroline Shaw, PA-C Cardiovascular Surgeons Stephen D’Orazio, MD  Center for Breast Health Tran Ho, DO  Sharla Gayle Patterson, MD  Concierge Medicine Ruben Contreras, MD  Mark Goldstein, MD  Robert E. Hanson, MD  Robert Pascotto, MD  Brian Solomon, MD 

Maged Bakr, MD

Anna Juncadella, MD Rajeev Prabakaran, MD Kunal Suryawala, MD

Heather Paris, PA

Aubrey Fulton, APRN

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Janice King, APRN  Michelle Nowak, APRN  Family Medicine Andrew M. Bernstein, DO Christian O. Beskow, MD

Kim Hamilton, MD

Jeffrey Howland, MD 

Larry Kohn, MD David Linz, MD Pedro Martin, MD Bryan Murphey, MD

Jerry G. Best, MD



Rasai Ernst, MD  Emily Essert, DO 

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 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




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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

Marco Island


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

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,

From Shoulders to Toes, and Everything in Between.

All of our physicians are board certified and have advanced training with fellowships such as foot & ankle, joint replacement, shoulder, and sports medicine surgery. We offer timely appointments, and ortho biologics including PRP & stem cell at competitive prices. Orthopedics The Only Joint Commission Certified Joint Replacement Program in SW Florida.

239 - 624 - 1700 Schedule an appointment today

J. Dounchis, MD Joint Replacement Sports Med. Surgery

H. Kapp, MD Joint Replacement

G. Rubin, DO Sports Medicine

S. Thompson, MD Joint Replacement Sports Med. Surgery

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R. de Asla, MD Foot & Ankle

M. Bertram, MD Joint Replacement

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