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PAIDWEST PALM BCH, FL

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GLOBAL HEALTH TRIBUNE

P.O. Box 213424

Royal Palm Beach, FL 33421

Good Samaritan ChiefNursing OfficerAwarded The 2012Palm HealthcareCommitment toCommunity Award

Roger L. Kirk,President and CEOof BethesdaMemorial Hospital

Angela Prestia, RN MSN NE-BC.

Roger L. Kirk.

Global HealthGlobal HealthGlobal HealthT R I B U N E

Serving: Jupi ter n Palm Beach Gardens n Royal Palm Beach n Well ington n Belle Glade n Lake Worth n Lantana n Boynton n Boca Raton

A U G U S T I S S U E - 2 0 1 2 w w w. g l o b a l h e a l t h t r i b u n e . c o m

Falling Arches…Not to Be Ignored

Hepatitis C is anunrecognizedhealth crisis in theUnited States. Thislife-threateninginfection affects an estimated 3.2million Americans,most of whom are“baby boomers”(those born from1945 through1965).

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DENTAL HEALTH COMMUNITY EVENTS

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New Features on Mobile App from West BocaMedical Center Helps Keep Expectant andNew Moms Up-to-date and Organized PAGE 4

I N S I D ECDC recommends hepatitis Ctesting for all baby boomers

The Centers for Disease Control and Prevention issued a recommendation this week for all baby boomersin the United States to get tested for hepatitis C.

One of the ways Dr. Betancur can treatyour sleep apnea is in the form of OralDevice Therapy.

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Phelps Media hosts another "Girls NightOut" with the Kids Cancer Foundation inmind. PAGE 14

NANCY PELOSI AND LOIS FRANKEL

TAG TEAM BOCA RATON In addition to Pelosi and Frankel, Dr. Shekhar Sharma, a respected

board certified Internist and a regular contributor to the Global HealthTribune was a guest speaker on the panel. PAGE 2

South FloridaRadiation Oncologyis Making HugeStrides in CancerTreatment PAGE 8

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WWW.GLOBALHEALTHTRIBUNE.COM2 AUGUST ISSUE • 2012

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CONTACT USP.O. Box 213424

Royal Palm Beach, FL 33421

info@globalhealthtribune.com

Deborah LynnStaff Writer and Sales Executive

(312) 351-2383deborah@globalhealthtribune.com

Erica WhymanStaff Writer and Sales Executive

(561) 308-1428erica@globalhealthtribune.com

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Sergio Aguilar (561) 797-2325

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ATTENTIONHealthcare

Professionals…If you are a physician orhealthcare professional andwould like to contribute an articleor two that you feel would be ofinterest to our readers. Or,perhaps you have a topic ofinterest that you would like for usto cover. Please e-mail us atarticles@globalhealthtribune.comwith any suggestions as wewould love to incorporate them infuture issues.

Nancy Pelosi and Lois Frankeltag team Boca Raton

Minority Leader ofthe United StatesHouse of Represen-tatives, Nancy

Pelosi, was at the Veranda Clubin Boca Raton on Monday, Au-gust 6 to support former memberof the Florida House of Repre-sentatives and former West PalmBeach Mayor, Lois Frankel, onher quest for Congress servingthe 22nd Congressional District.

Pelosi and Frankel were in goodcompany as over 100 seniors,local politicians and media weremore than eager to listen as theyboth spoke at the forum forMedicare.

Frankel obviously hit home asshe spoke of changes toMedicare. “Imagine if I had todecide whether to help my moth-er with health care or my sonwith college. That’s why it’s so

important for our families withchildren to know that their par-ents and grandparents are takencare of with health care.”

In addition to Pelosi andFrankel, Dr. Shekhar Sharma, avery well-known and respectedboard certified Internist and aregular contributor to the GlobalHealth Tribune was a guestspeaker on the panel. He dis-cussed how health care costs canbe reduced by using universalelectronic health record comput-er software systems that inter-connect physicians and healthcare providers for better healthcare for patients that wouldavoid duplication of services.Pelosi agreed.

Days after Nancy Pelosi’s visit,Lois Frankel beat Kristin Jacobsin the Democratic primary forPalm Beach-Broward District 22.

Lois Frankel, Dr. Shekhar Sharma and Nancy Pelosi. Dr. Sharma was a guest speaker on the panel.

Nancy Pelosi talking at the Veranda Club in Boca Raton.

FUTURE OF MEDICINE SUMMIT REGISTRATIONOPEN; 16 CMES AND CEUS OFFERED

WEST PALM BEACH (August14, 2012) – Registration is nowopen for the sixth annualFuture of Medicine Summit:Striving for Medicine’s BetterFuture. Palm Beach CountyMedical Society Services hoststhe Summit, which will focuson diabetes, bipolar disorder,heart disease, health care eco-nomics, health policy, healthcare transformation and othertopics.

The Future of MedicineSummit will take place fromSeptember 27-28, 2012, at thePalm Beach CountyConvention Center.

Up to 16 CMEs and CEUs areavailable for the following dis-ciplines: physician, nurses,social work, pharmacy, occupa-tional therapy, physical therapy,psychology, and nutrition.Eight hours are available eachday.

The Summit will featurenational thought leaders dis-

cussing relevant issues withPalm Beach County leadersincluding physicians, healthpolicy experts, hospital admin-istrators, researchers, businessexecutives, and community rep-resentatives.

The general public is invited toattend.

Sponsorships and exhibit spaceare available.

Registration is open atwww.pbcms.org. Registrationfees vary. To register, learnabout sponsor and exhibit oppor-tunities, and view the Summitspeakers and schedule, visitwww.pbcms.org/FOMSummit orcall 561-433-3940.

hospitals or inpatient rehabilita-tion facilities.

Home healthcare for patientswith diabetes, chronic obstruc-tive pulmonary disease or con-gestive heart failure resulted inan estimated 20,426 fewer hospi-tal readmissions than patientswith the same conditions receiv-ing other post-acute services.The results also showed thefewer readmissions led to anestimated $670 million inMedicare savings from Oct.2006-Sept. 2009.

Home healthcare forchronically ill patientscould help cut down on

hospital readmission rates andimprove healthcare spending, ac-cording to research conducted byAvalere Health.

The study compared hospitalreadmission rates and Medicarespending for chronically illpatients who received homehealthcare to chronically illpatients who received other post-acute care services, such as serv-ices from long-term acute-care

Study: Home Healthcare CouldHelp Reduce Readmissions,

Increase Cost-Savings

Get back onyour Feet!

(561) 433 -5577

Podiatric Physicians & Surgeons

Personal & Gentle Care For:

• Diabetic Foot Care• Hammer Toe• Fracture Care• Ingrown Nails,

Bunions• Ankle/Heel/Foot Pain• Poor Circulation• Neuropathy• WOUND Care• Custom Molded

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3347 State Rd 7 Suite 204Wellington, FL 33449

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Call to make your appointment(561) 433-5577

WEST OFFICE:3347 SR 7, Suite 204Wellington, FL 33449

EAST OFFICE:2326 South Congress Ave.

Suite 1-A West Palm Beach, FL 33406

Posterior Tibial Tendonitisand/or rupture is a com-mon cause for pain on the

inside of the foot/ankle and flat-tening of the foot (sometimescalled fallen arches). The poste-rior tibial tendon connects the legmuscles to the foot. It is respon-sible for inversion or turning thefoot in and up. The posterior tib-ial tendon starts in the calf of thefoot, goes behind the inside an-kle bone and finally inserts intothe bones of the midfoot. It helpsto hold up your arches and sup-port your arches during walking.It is used with every single stepwe take. That’s why, when it isinjured or unhealthy we feelgreat pain and discomfort.

Posterior tibial tendon injuriescan range from overuse to fullblown rupture of the tendon.Most patients present a general-ized complaint of gradual painon the inside of the foot that is

difficult to localize or fallenpainful arches. Most patients donot recall a specific incident orinjury, just a gradual onset ofpain and inflammation.Sometimes, the patient will suf-fer with the deceptive pain anddiscomfort for years beforegoing to the doctor.

Signs and symptoms of posteriortibial tendon dysfunction includetenderness over the inside of themidfoot, especially with walkingor running, inability to stand onthe toes, loss of the arch ordevelopment of flatfoot and pos-sible pain and swelling of theankle. During examination, yourdoctor should evaluate youstanding from behind and facingyou. He will be looking for the‘too many toes sign’ which is acommon finding in posterior tib-ial tendon dysfunction or rup-ture. He should also ask you tostand on your toes or do a singleheel raise. He should also takex-rays or order an MRI.

Posterior Tibial tendon disordersare divided into four stages.Stage I injuries, while painfuland need treatment, are relative-ly mild. In stage I, the tendon isinflamed but has no loss ofstrength. The patient notices lit-tle to no change of the arch andis able to stand on his/her toeswithout a problem.

Stage II injuries involve a par-

tially torn tendon or inflamma-tion and experience a loss in thestrength of the muscle. Falling ofthe arch is evident and thepatient usually cannot do a sin-gle-limb heel raise. There isassociated pain of the ankle.In stage III injuries, the tendon iscompletely torn and not func-tioning. A full collapse of themidfoot is seen on examinationand arthritic changes are notedon the x-ray because of the lackof support of the arch and subse-quent overuse of the midfootjoints.

Stage IV injuries are identical tostage III, except arthritis is alsonoted in the ankle joint as well.All stages are painful and requiretreatment. Untreated flatfootfrom a posterior tibial tendondisorder will eventually lead toarthritis and rigidity in the mid-foot and hindfoot. Pain will

worsen and shoe gear maybecome uncomfortable.Treatment ranges from rest,NSAIDS, and immobilization for6-8 weeks to bracing and/or sur-gical reconstruction. Treatmentalmost always begins withreconstituting support of thefoot.

Stage I and II injuries are usuallysuccessfully treated with rest,ice, anti-inflammatories andimmobilization. Following adedicated period of immobiliza-tion, physical therapy may ormay not be indicated and custommolded orthotic devices are anecessity. Custom moldedAnkle-Foot-Orthoses, or AFO,are sometimes necessary.

Stage III and IV injuries, whilemuch more severe and progres-sive, require a complex thoughtprocess when developing a treat-

ment plan. Surgical reconstruc-tion procedures are invasive andcome with risk. Your physicianshould appropriately consideryour lifestyle, activity level, andoverall general health and dis-cuss all the risks and benefits ofthe procedures with you beforerecommending surgical correc-tion. However, if conservativetherapy fails to provide adequaterelief and control of symptomsthen surgery can be indicated.Surgical procedures range fromprocedures limited to work onthe tendon itself to fusion ofarthritic joints or a combinationof procedures.

Almost always and no matter theStage, posterior tibial tendon dis-orders/injuries require supportivecustom bracing or orthoticdevices long-term. It’s important to remember thateach stage can progress to thenext if left untreated. So, don’tignore that seemingly harmless‘falling of your arches’, it can bequite deceptive.

Falling Arches… Not to Be Ignored

Arthur Hansen DPM, M.S.

Posterior Tibial Tendonitis

Navicularbone

Area of pain

Posteriortibialtendon

WWW.GLOBALHEALTHTRIBUNE.COM4 AUGUST ISSUE • 2012

Managing Your Child’s Asthma During the School YearSheryl Gilman B.S., RRT-NPS, CPFT, CTTS

American Lung Association sta-tistics show that 7.1 million chil-dren are diagnosed with asthmain the United States and 4.1 mil-lion of them suffered from anasthma attack or episode in2009. Asthma is the leadingcause of school absenteeismaccounting for 14.4 million lostschool days in 2008 (Centers forDisease Control and Prevention).In that same year, the Centers forDisease Control and Preventionnoted 679,000 emergency roomvisits for asthma symptoms inchildren. Thus, you might ask“How can I provide my childwith a successful school yearthrough management of his/herasthma”?

Peak Flow Meter

The peak flow meter (samplepictured) is your child’s bestfriend. By measuring theamount of air the child can blowout and how fast it is blown, thepeak flow meter can measure theextent of asthma symptoms day-to-day. First, it is important todetermine your child’s personalbest number. For two weeks,morning and late afternoon,while asthma symptoms are attheir minimum, the child placesthe meter in his mouth, fills hislungs with his biggest breath,and then blows out with a short,hard blast. This is done threetimes and the highest number isrecorded. After two weeks, thehighest number recorded is con-sidered the child’s personal best.

The peak flow meter has coloredindicators that are then set forfuture reference. The green indi-cator which indicates asthma sta-bility is set at the personal bestnumber. The yellow indicator,urging caution, is set at 80% ofthe personal best. Finally, the redindicator, indicating the need formedical attention, is set at 50%of the personal best. When theindicator stops anywhere from80-100%, the asthma is undercontrol and you can send yourchild off to school confidently.When it stops in the 50-79%range, caution is needed and itmay be wise to keep the childhome or increase asthma med-ication, depending on how lowthe peak flow is. If the indicatorstops in the red zone, immediatemedical attention is necessary,perhaps even a visit to the emer-gency room. Your child should

have two such meters, one forschool and one for home use.How do you really determinewhat the best course of action is?This is where the Asthma ActionPlan is useful.

Asthma Action PlanThe Asthma Action Plan is ajoint development between fami-ly and the doctor. Note, everyonein the family should understandthe action plan and what to dojust in case of an emergency.There are several good websitesfeaturing a color-coded AsthmaAction Plan that can be down-loaded and utilized throughoutthe year. One such plan can befound athttp://www.ihacares.com/index.cfm/HealthAdvisors/PediatricAdvisor/crs-pa-art.asthma.action.plan/ or theAmerican Lung Association has

one that can be accessed atwww.lung.org. The action planprovides a written reference as towhat to do on a daily basis aswell as how to recognize wors-ening asthma symptoms and howto treat them. It lists specificmedications to take and when totake them. Even emergencyphone numbers can be recordedon the plan. Before schoolbegins or at least within the firstfew days, a meeting with theschool nurse is in order and acopy of the Asthma Action planshould be left with her. A copyof the plan should also be kept inyour child’s back pack. Now thequestion is “What medicationshould be sent to school andwhere should it be kept”?

Rescue MedicationsSpecific medications are pre-scribed by your doctor andshould be utilized accordingly.Every child with asthma shouldhave a rescue inhaler with aspacer on them at all times.Using a spacer (see photo), willsignificantly improve the amountof medication reaching the lungand dramatically decrease theamount of medication depositedon the tongue and other tissuesof the mouth.

Florida Law 1002.20 K-12 allowsan asthmatic child to have his res-cue medication (inhalers contain-ing Albuterol, Proventil, orVentolin) on him AT ALLTIMES. Some schools may notbe aware of this and it is up to theparent to make clear that this is amedical necessity backed by statelaw. Both the parent and thephysician must provide writtenapproval to the school principal.

Parental involvement is anabsolute necessity and communi-cation is the key to successfullymanaging your child’s asthma atschool. Communication with thechild’s physician, the schoolnurse, the teacher, and even theprincipal can greatly reduce thechances of your child having anunmanaged asthma attack atschool. Regular doctor visitsshould be scheduled every 3-6months, per physician recom-mendation. Also, talk to thephysician about the necessityand safety of the flu shot in yourchild’s health management. Youcan visit the American LungAssociation’s website atwww.lung.org for much informa-tion on asthma, how to manageit, and tools to help your asth-matic child have a healthy andsafe school year.

New Features on Mobile App from West Boca Medical CenterHelps Keep Expectant and New Moms Up-to-date and Organized

Boca Raton, FL July 2012– The new MaternityTrackerTM and Baby’s

First Year features on West BocaMedical Center’s mobile appmay not be able to get rid of yourfood cravings during pregnancyor keep you awake for a threea.m. feeding, but they can helpmoms-to-be and new mothersjuggle all the responsibilities thatcome with expecting and takingcare of a baby. The new featuresare being added to the hospital’sexisting app that currently in-cludes a mobile web browser toview the hospital’s emergencyroom wait time, map and direc-tions, list of frequently callednumbers, health data page, firstaid guide, health library, and

physician finder. The hospital’sapp is powered by WorldLink,and available as a free downloadfor iPhone™, iPad™, iTouch™,Android™ and BlackBerry™products.

“In this advanced technologicalworld we live in, this is justanother way for new families toget information at their fingertipsthat can help them care for theirbaby, said chief executive officerof West Boca Medical CenterMitch Feldman. “We are alwayslooking for new and innovativeways to connect with ourpatients to make sure they knowwe are here to help them everystep of the way.”

Expectant moms don’t need totote a heavy pregnancy bookaround or write things down on acalendar. The Maternity Trackerfeature that can help you getthrough your pregnancy with fly-ing colors includes:

• A countdown timer based onyour due date.

• An easy-to-use appointmenttracker.

• A section for journal entries. • Helpful tips for both mom and

dad throughout pregnancy. • Baby name ideas. • Information about body

changes.

Closer to your due date, you alsocan use the contraction timer that

allows you to rate the severity ofcontractions, and the labor sec-tion that shows the stages oflabor, Relaxation and breathingtechniques, delivery methods,and guidance about when to seekimmediate attention.

New moms will be able to get allthe information they need withthe Baby’s First Year feature.Since being a parent is a full-time job, this feature allows youto record baby information andschedules, as well as track yourbaby’s weight and height. It alsoincludes:

• A section for journal entries

• Lullaby music

• An appointment tracker andnotes

• Immunization reminders

• A baby feeding timer

New mothers also have a varietyof helpful information at theirfingertips, such as a breastfeed-ing guide, tips for childproofingyour home, and facts about solidfoods for baby.

To download the hospital app foryour iPhone, iPad or iTouch,visit the iTunes Store from yourmobile device; for your Androidmobile device, visit the AndroidMarket; and for your BlackBerrydevice, visit the BlackBerry AppWorld.

West Boca Medical Center offersmaternity care that includes alevel III neonatal intensive careunit, and spacious private labor,delivery, and recovery suites thatare designed to look and feel likethe comforts of home. For moreinformation about services pro-vided for expectant and newmothers at the Women’s HealthCenter, visit www.westbocamed-ctr.com.

Sheryl Gilman has been practic-ing respiratory care for 14 yearsin Palm Beach County. For thelast 5 years she has been theClinical Supervisor of the Car-diopulmonary Department atLakeside Medical Center, thehospital in Belle Glade servingthe residents of the WesternCommunities. She has specialtycertifications in Neonatal andPediatric care, Pulmonary Func-tion Testing, and is a CertifiedTobacco Cessation Specialist aswell as having a Bachelor de-gree in Health Care ServicesManagement.

WWW.GLOBALHEALTHTRIBUNE.COM AUGUST ISSUE • 2012 5

Medical Society Publishing History of Medicine in Palm Beach County Book

WEST PALM BEACH(July 30, 2012) – PalmBeach County Medical

Society (PBCMS) is sponsoringthe first comprehensive book onthe history of medicine in PalmBeach County.

Tentatively titled A Tradition ofCaring, the book will recognizemedical pioneers and chroniclethe major medical milestones ofthe past 150 years, from thearrival of the first doctor in thearea, Dr. Richard Potter, in 1882,to the passage of PresidentObama’s Affordable Care Act of2010.

Since its founding in 1919,PBCMS has been at the forefrontof many of the major health caredevelopments in Palm BeachCounty. In the early years, theagency’s members initiated pub-lic health policies that protectedthe public from dreaded disease,and they held leadership posi-tions in the area’s first hospitals,including Good SamaritanHospital in West Palm Beach. Inthe modern era, the group’sphysicians have worked onreforming medical malpracticeinsurance and proving healthcare coverage to the indigent. Author Leon Fooksman is an

award winning journalist andwriter. A professional reporterfor more than 15 years, he hasmost recently written for the SunSentinel in Fort Lauderdalewhere he wrote many articles onsocial development challengesand the workings of local gov-ernments.Legacy Publishing Co.,

Birmingham, Alabama has previ-ously published medical historiesof Wake County (Raleigh), NC;Nashville, TN; Austin, TX;Memphis, TN; and Charleston,SC. The history of Duval County(Jacksonville), FL is being pub-lished this summer. A Tradition of Caring is expect-ed to be published in the springof 2013.For further information pleasecontact John Compton, ownerand publisher of LegacyPublishing Co. He can bereached at Palm Beach CountyMedical Society at 561-433-3940 Ext: 18.

About Palm Beach CountyMedical Society:

Palm Beach County MedicalSociety is a not for profit organ-ization dedicated to unitingphysicians to serve the commoninterest of the profession, devel-oping and maintaining the high-est professional and ethicalstandards of the medical profes-sion, advocating the interests ofphysicians and their patients,and collaborating with others toimprove the community's health.For more information, call 561-433-3940 or visitwww.pbcms.org.

Expanded Hepatitis C Testing Recommendations

To identify more hidden in-fections, provide promptand appropriate care and

treatment, and avoid tens ofthousands of hepatitis C-relatedillnesses and deaths, CDC nowrecommends that all U.S. babyboomers get a one-time test forthe hepatitis C virus.

Hepatitis C is an unrecognizedhealth crisis in the United States.This life-threatening infectionaffects an estimated 3.2 millionAmericans, most of whom are“baby boomers” (those bornfrom 1945 through 1965). One

in 30 baby boomers has beeninfected with hepatitis C, andmost don’t know it. Hepatitis Ccauses serious liver diseases,including liver cancer (thefastest-rising cause of cancer-related deaths) and is the leadingcause of liver transplants in theUnited States.

More than 15,000 Americans,most of them baby boomers, dieeach year from hepatitis C-relat-ed illness, such as cirrhosis andliver cancer, and deaths havebeen increasing steadily formore than a decade and are pro-

jected to grow significantly incoming years.

CDC estimates one-time hepati-tis C testing of baby boomerscould identify more than800,000 additional people withthe virus. And with newly avail-able therapies that can cure upto 75 percent of infections,expanded testing – along withlinkage to appropriate care andtreatment – would prevent thecostly consequences of livercancer and other chronic liverdiseases and could save morethan 120,000 lives.

Waste Not,Want Not

Policy Brief Explores Fraudand Abuse in Medicare andMedicaid

Medicare and Medi-caid fraud and abuseprevention efforts

have helped reduce unneces-sary spending, but implemen-tation of these efforts remainsa challenge, according to anew brief from Health Affairsand the Robert Wood JohnsonFoundation.

In 2010, Medicare andMedicaid made more than $65billion in “improper federalpayments”—payments thatshould not have been made orwere made in an incorrectamount, according to the brief.An April 2012 study estimatedthat fraud and abuse added asmuch as $98 billion toMedicare and Medicaid spend-ing in 2011.

To combat the problem, theAffordable Care Act gives theCenters for Medicare andMedicaid Services (CMS)greater authority to tacklefraud and abuse, including theability to screen out question-able providers and suppliersbefore they begin work andsuspend payments to thosewho come under investigation.

In 2011 alone, $4.1 billion wasrecovered, the highest recoveryamount in a single year. Theauthors explain, however, thatseveral challenges remain: (a)overzealous investigators whofocus on technical mistakesrather than outright wrongdo-ing, (b) Medicare contractorconflicts of interest, and (c)overlap among antifraud pro-grams, among others. WhileCMS and others are optimisticabout the agency’s newadvanced data analytics pro-gram to help detect fraud, theauthors say that someobservers are concerned aboutthe early results.

WWW.GLOBALHEALTHTRIBUNE.COM6 AUGUST ISSUE • 2012

Palm Beach Gardens Medical Center Welcomes 30Summer Teenage Volunteers known as “Volunteens”

PALM BEACH GARDENS,Fla.-July 20, 2012- PalmBeach Gardens Medical

Center proudly welcomes thissummer’s teenage volunteers, or“Volunteens”. The Volunteenprogram allows teenagers to havethe opportunity to volunteer in avariety of areas of the hospitalduring their summer break. Theprogram gives many of theseteenagers their first work experi-ence, and the opportunity to con-sider a career in healthcare. Staff

members at Palm Beach Gardenssay that they enjoy the opportu-nity to mentor these students andteach them about all of the differ-ent career paths they could selectin the healthcare field.

Currently, Volunteens are work-ing within the nursing depart-ment, business office, informa-tion technology as well as cook-ing up some new experienceswith the hospital’s dietarydepartment. Volunteens gothrough a standard hospital ori-entation and training program.

“The Volunteen program at PalmBeach Gardens Medical Centerhas always been very popular,”says Colleen Schmidt, the

Volunteen program coordinator.“We recognize a lot of highschools in the area require stu-dents to acquire communityservice hours, so we provide anenvironment where students canget their hours accomplished,while also gaining first handexperience in various fields,”Schmidt added.

Helping future doctors, nursesand even administrators answerthe call to care for others is aparamount cornerstone of theprogram, and the results havebeen very positive. VolunteenSean Perez, 17, just began vol-unteering in the radiologydepartment and says that he hasalready developed an interest in

this field. “I’m seriously consid-ering going into radiologybecause of the experience I getfrom being a volunteer,” Perezsaid. A student at William T.Dwyer High School, Perez need-ed community service hours forhis student internship program.Perez’s father, an employee atPalm Beach Gardens MedicalCenter, informed him of this vol-unteer opportunity. Perez decid-ed it was the best place for himto learn more about patient care,as well as gain his requiredhours. The Volunteen programat Palm Beach Gardens MedicalCenter continues to spark theinterests of young people consid-ering a career in the healthcareindustry.

Is Exercising while Pregnant Safe for Mommy and Baby?By Erica Whyman

If you have ever participatedin an exercise program ortaken an aerobics class, you

know that they usually start withthe advice to consult your physi-cian before beginning any newroutine.

So, not surprising, the sameadvice applies once you learnyou are expecting and consider-ing whether it is safe to continuewith your current exercise regi-men or begin a new one. Thegood news is that for mostwomen, exercising while preg-nant is perfectly safe, and inmost cases recommended formom and baby.

The American College ofObstetrics and Gynecology rec-ommends thirty minutes or moreof moderate exercise per day.The goal is not to overdo it, andtrade high impact exercises forlow impact ones such as, aero-bics, swimming, brisk walking,indoor stationary cycling, orstep/elliptical machines.

Low impact is important becausewhen a woman is pregnant, thereare certain hormones that cause

the ligaments around her jointsto loosen (getting your bodyready for labor and delivery) andperforming high impact exercis-es could increase your chance ofinjury.

Some known benefits of main-taining an exercise routine whilepregnant:

• Reduced pregnancy fatigue-even going for a short briskwalk will give you a pop ofenergy.

• Improved sleep patterns-Avoid exercising right beforebedtime, but otherwise, it canhelp moms-to-be with theirquality of sleep.

• Healthy baby- Moms thatexercise during pregnancy aresaid to deliver babies at health-ier weights.

• Reduced pregnancy achesand pains- this is also true forthose women who exercisedprior to becoming pregnant.

• Easier Delivery- this can makeany pregnant woman eager tosign up for that yoga class.Exercise can result in the

strengthening of the musclesneeded during labor.

Every pregnancy is different, andfor some women, exercising maynot be advisable due to certainmedical conditions or being con-sidered high-risk. (Ask your doc-tors ladies; we are certainly intheir offices enough!).

Also, consider the fact that asyour tummy grows, your centerof balance shifts, so be mindfulof falling, which can be danger-ous for both you and baby.

I spoke to my physician early onand throughout my pregnancyabout exercising. He saw no rea-son for me to discontinue myroutine. I have been a runner formany years, and continued jog-

ging my first and some of mysecond trimester.

As I grew and the temperatureclimbed, I decided to move in-doors and have been walking onthe treadmill and using the ellip-tical machine.

I always feel better after thirtyminutes on the treadmill, andfind that I have fewer of thoserestless nights. My husband andI even tried stand-up paddleboarding. We rented paddleboards from Blueline PaddleSurf and Clothing in Jupiter,Florida. The staff was great inassisting me and pointing out allthe low wake areas, and it was aperfect relaxing afternoon ofpeace and relaxation, which isalways good for mom and baby.

Dear Deborah is a monthly advice column written by Deborah Lynn with a common sense approach to dating. If you have any questions or comments, please forward them to:questions@globalhealthtribune.com as we would love to help.

DEAR DEBORAH:How can you tell if a date isgoing well and if the other per-son likes you?- Tell Tale?

Dear Tell Tale:There are many ways someonewill give you an indication ifthey are interested in you. Bodylanguage is one way. Are theyleaning into you? Is he/shenervous? Is she playing with herhair? Are they lightly touchingyou? Laughing? Focusing onyour every word? Are youmaintaining their attention?Those are some of the ways totell if someone is interested.However, if they are lookingaround, not focused on you,checking their watch or the time,not listening to what you are

saying or constantly interrupting– I would suggest you move on.

DEAR DEBORAH:What is your recommended agedifference between genders? - Twelve Years

Dear Twelve Years:This will probably vary witheveryone you ask. I will say,having been in Florida for a yearnow, it still amazes me whenmuch older men are with veryyoung women. It looks com-pletely inappropriate when ayoung woman could be theirgranddaughter. Although we areall young in spirit, there is a dif-ference in life experience. At40, you have experienced somuch more than someone of 25.This question is really difficult

because it depends on the stagein your life. I cannot give you anumber as it would change withevery age. For example, if youare 21, I believe 21-25 is anappropriate range. At 32, I thinka great range would be from 27-37. At 40, I feel that 35 andabove is appropriate. However,beyond 45, I feel that 40 andabove is appropriate to date.Again, this is just a brief exam-ple and my personal opinion.

DEAR DEBORAH:How long should a girl waitbefore having sex with some-body who she just started dating?- How Long?

Dear How Long:You need a foundation to build

on in order tomaintain a rela-tionship. Onceyou spend qual-ity time togeth-er, you will getto know their personality, seewhat you have in common, howyou relate to one another, andhow well you communicate.Therefore, I would recommendthat you wait until you and yourpartner get to know each otherwell. You truly need a mentaland emotional connectionbefore you can move on to thephysical connection. However,I am a firm believer in mentalstimulation and once you haveestablished that, the physicalstimulation will be that muchbetter.

DEAR DEBORAH:What do you think about cou-ples in which the girl is tallerthan the guy? Do you think thiscould work?- Too Tall?

Dear Too Tall:You are asking someone thatwas married to a man shorterthan I. Personally, I am notbothered by a man’s physicalstature. However, there are anumber of women that willonly date men of a certainheight. So, it boils down topersonal choice and confidence.

Some men may be self-con-scious with a taller womanequally as much as a womanthat may be self-conscious ofdating a man that is shorter.

Dear Deborah

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Bethesda Memorial Hospital Congratulates 2012 Blum Family Scholarship Recipients(Boynton Beach, FL) – 13 stu-dents were selected as the recipi-ents of the 2012 Blum FamilyScholarship at BethesdaMemorial Hospital on Friday,August 10. Each of the students,all children of BethesdaHealthcare System employees,will receive $5,000 toward afour-year college degree.

Peter Blum is a longtime civicleader and founder of Blum’sFurniture. Mr. Blum serves asVice Chairman of the BethesdaHospital Foundation Board ofDirectors. He established theBlum Scholarship for BethesdaHealthcare System in 2000 withtwo $5,000 scholarships.

In its 13th year, the program hasgrown with 13 scholarshipsawarded this year thanks to gen-erous donors including Mr. Blumand the Hospital. Mr. Blumawarded the remaining 18 candi-dates with a $200 Visa gift cardfor their academic and communi-ty achievements.

“Our scholarship program is awonderful way for us to saythank you to the many dedicatedemployees of this great hospitalwho provide exceptional care toour community,” said Mr. Blum.“We are honored to help theseoutstanding students reach theirpotential,” he added.

Scholarship applicants arerequired to meet established aca-demic and community servicecriteria. All of the scholarshipcandidates and their parents wereinvited to a luncheon with guestof honor Mr. Blum.

Congratulations to the 2012Blum Family ScholarshipRecipients:

· Javoncia Betty, of DelrayBeach, is a 2012 graduate ofBoca Raton Community HighSchool. She currently attendsPalm Beach State College andwill transfer to Florida StateUniversity in the spring tomajor in Biology.

· Jillian Burdick, of PalmCoast, earned her Bachelor’sdegree in Biology from theUniversity of Florida. She iscurrently attending DaytonaState College to pursue acareer in Nursing.

· Renz Gaviola, of Lake Worth,is a 2012 graduate of Park VistaCommunity High School. Heplans to attend the Universityof Central Florida to studyNursing.

· Mia Hardack, of Boca Raton,is a 2012 graduate of WestBoca Raton Community HighSchool. This fall, she willattend Florida State Universityto major in Biology.

· Helena Hoayun, of LakeWorth, is a 2012 graduate ofAtlantic Community HighSchool. She plans to attendFlorida State University thisfall to major in Music Therapy.

· Chelsea Kickingstallion, ofBoynton Beach, is a sophomoreat Palm Beach State College.She is part of the dual degreeprogram at FloridaInternational University whereshe will pursue a law degree.

· Meagan Kovacs, ofWellington, is entering her sen-ior year at the University ofFlorida where she is studyingCognitive Neuroscience andMusic Performance.

· Ashley Mucinski, ofLoxahatchee, is a 2012 gradu-ate of Seminole Ridge HighSchool. She will attend FloridaAtlantic University to major inOcean Engineering.

· Janel Scholine, of Lantana, isa 2012 graduate of SantalucesHigh School. This fall, she willattend the University of Floridato major in ElectricalEngineering.

· Kara Seymour, of BoyntonBeach, is a 2012 graduate ofPark Vista Community HighSchool. She will attend PolkState College to major inBusiness.

· Cara Spirazza, of BoyntonBeach, is a 2012 graduate ofPark Vista Community HighSchool. This fall, she plans toattend the University of CentralFlorida to major in Biology andPre-Veterinary Medicine.

· Dana Tam, of Boynton Beach,is a 2012 graduate of AtlanticCommunity High School. Thisfall, she will attend theUniversity of Florida to majorin Marketing and Biology.

· Holly Wagner, of Lake Worth,is a 2012 graduate of Park VistaCommunity High School. Thisfall, she will attend Palm BeachState College to major inNursing.

Top Row (l to r): Holly Wagner, Javoncia Betty, Kara Seymour, MiaHardack, Renz Gaviola and Helena Hoayun. Bottom Row (l to r): MeagenKovacs, Dana Tam, Jillian Burdick, Mr. Peter Blum, Ashley Mucinski, JanelScholine, Chelsea Kickingstallion and Mrs. Spirazza standing in for herdaughter Cara Spirazza.

WWW.GLOBALHEALTHTRIBUNE.COM AUGUST ISSUE • 2012 7

WWW.GLOBALHEALTHTRIBUNE.COM8 AUGUST ISSUE • 2012

Kishore K. Dass, MDBoard-Certified RadiationOncologist

Our bodies carry around“good bacteria” or mi-crobes which serve toprotect us, and give us

a healthy balance. In turn, weprovide them with nourishment,and facilitate colonization insideus, as well as on our body sur-face. When you think of mi-crobes, you should remember

that they are on your side. Themain purpose of the microbe isto make it easier to digest food,synthesize vitamins and defendus against potentially harmful or“bad” bacteria. Our ecologicalstructure is full of these symbi-otic relationships which allow usto thrive.

A perfect example in nature ofthis kind of bond is the clownfish and the anemone. Theycoexist in harmony constantlyprotecting the welfare of theother. Think of someone in yourlife who adds to its quality.How does that person enhanceyour daily activities? Most peo-ple can think of that particularperson as indispensable; almostlike they restore the calm in yourlife, especially in moments ofdespair. Well, ultimately this ishow you should feel about yourmicrobes. It is a natural syn-chronicity, and it should bringtremendous comfort in knowingit is a favorable partnership.

In general, there should be a nat-ural balance of microbes withineach of us which primarily camefrom your mother. As you expe-rience life, more microbes areintroduced to your body system.Sometimes, there is a lack ofgood bacteria in your gut whichcan cause adverse effects. Thegood news is that by taking aprobiotic you can restore yourmicrobial ecosystem. It is bene-ficial to have a good assortmentof microbes for health, vitalityand overall energy.

A Special Symbiotic Relationship: Microbes and You

South Florida Radiation Oncology is MakingHuge Strides in Cancer Treatment

The linear accelerator isthe workhorse of anyradiation oncology fa-cility, generating the

beam used by radiation oncolo-gists to treat most types of cancerand some non-cancerous condi-tions. In recent years, linear ac-celerator technology has greatlyimproved and the Varian True-Beam incorporates a multitude oftechnological innovations intoone package. This gives the ra-diation oncologists the tools todeliver the fastest and most accu-rate treatments for their patients.

The capabilities of the VarianTrueBeam are highlighted in thetreatment of lung cancer. Each

year, over 200,000 individualsare diagnosed with lung cancerin the United States. For other-wise healthy individuals whosecancer is caught early, surgery isgenerally performed with highrates of cure. However, themajority of individuals are diag-nosed with more advanced dis-ease which requires a combina-tion of surgery, chemotherapy,and radiation therapy to achievecure. Radiation treatment withthe Varian TrueBeam dynamical-ly synchronizes imaging, patientpositioning, motion manage-ment, and rapid treatment deliv-ery. This offers a significantimprovement in tumor targeting,normal tissue protection, and the

speed of treatment for these indi-viduals.

Accurate tumor targeting is criti-cal for optimal radiation treat-ment delivery. The VarianTrueBeam offers multiple target-ing modalities to ensure that thepatient is properly aligned fortreatment. KV-KV and cone-beam CT imaging allows theradiation therapist to accuratelyposition the patient immediatelybefore each treatment. Intra-beam imaging allows for animage to be acquired duringtreatment to ensure that thepatient has remained in the prop-

er position throughout treatment.

Radiation dose delivery for lungcancer is greatly improved onthe Varian TrueBeam. Older, 3Dconformal techniques have beenreplaced with IntensityModulated Radiation Therapyand RapidArc, which allows thedose to be selectively shaped,focusing the high dose areasonto the tumor and greatlydecreasing the dose that the sur-rounding normal tissue receives.

This helps to decrease the sideeffects of treatment and allowthe patients to receive higher

overall radiation doses than thatachievable on older linear accel-erators. Additionally, theTrueBeam’s higher dose-rateallows for much faster treatmenttimes, making the experiencemuch more comfortable for thepatient.

The physicians and staff ofSouth Florida RadiationOncology are committed to pro-viding the best care possible fortheir patients. This commitmentis achievable with the availabili-ty of the state of the art technol-ogy highlighted in the VarianTrueBeam linear accelerator.

Cindy Collins, Ph.D., R.D.Experimental Health Psychology/ Nutrition

students with disabilities at FloridaAtlantic University. She givesstudents the tools to be successfuland supplemental education to aidthem with their courses.

In her spare time, Raquel enjoyscooking, kickboxing, and cycling.Raquel thinks it is vital to balanceher busy schedule with fitness,good nutrition and a few laughsalong the way. She has a calm,positive outlook and welcomes anychallenge!

anti-cancer foods into the patient’sdiet to enhance their quality of lifethrough nutrition and new recipeideas. Raquel engages in tai chi,chi kung, stress workshops, mindfulmeditation and yoga with thepatients regularly. She loves toshare on different levels with thepatients; she finds innovative waysto give them a sense of serenity.

Raquel actively contributes to thecommunity by tutoring and notetaking for the department of

the supervision of Cindy Collins,Ph.D., RD, making cutting edgeresearch available to the lay publicin the form of handouts, blogs, andpublications. Raquel also hasexperience mentoring directindependent study interns in healthscience and nutrition; making themmore confident and prepared for thefuture.

In her time at work, Raquel ispassionate about finding creativeways to incorporate well researched

Raquel Rivera is a pre-medicalstudent, also minoring in psychologyin the Charles E. Schmitt College ofBiological and Behavioral Sciencesat Florida Atlantic University.Raquel works in the field ofOncology as a student assistantsince December 2011, where shehas direct interaction with patients.She is involved with current clinicalresearch projects/studies, as well asspecialty programs tailored topatient’s nutritional and emotionalneeds. Raquel often writes under

Raquel Rivera

Consuming yogurt is a good wayto increase the microbial life inyour gut. It contains millions oflive culture which is what youneed to get that balance back.Another way to get them is bytaking a supplement containingseveral varieties of good bacte-ria. It is up to you how you pre-fer your microbes; both waysreestablish the symbiotic rela-tionship.

Here is a list of good foodsource options:

Remember to always look forthe low-fat, low-sugar version ofthe products

1. Fage Greek (good source ofprotein)

2. Oikos Organic Greek (goodsource of protein)

3. Dannon Light & Fit4. Dannon Activia Light5. Stonyfield Farms Organic 6. Lifeway Non-fat Keifer7. Lifeway Lassi8. Horizon Organic

Here is a list of supplementsource options:1. Align2. Culturelle3. Nutralle4. Philip’s5. Florastor6. Ultimate Flora7. Jarrodophilus

For more information onmicrobes, refer to NutritionAction Health Letter July/August2012.

Eugene Shieh, MD Radiation Oncologist – SouthFlorida Radiation Oncology, LLC

Let CyberKnife® revolutionize your cancer fight. Treat your cancer with pinpoint precision. In the shortest treatment time.

CyberKnife® at South Florida Radiation Oncology is like having surgery to remove your tumors without cutting, stitching or pain. Even many inoperable tumors are now operable with CyberKnife, anywhere in the body, including the prostate, lung, brain, spine, liver, pancreas and kidney.

Conventional radiation therapy can require 35–40 treatments. That’s up to 40 trips to the doctor. But South Florida Radiation Oncology’s CyberKnife Radiosurgery System treats many tumors in one to five treatments.

CyberKnife is just one of many weapons in an arsenal of powerful treatment options the expert physicians at SFRO use to target and destroy your cancer. Combining leading-edge technology with inspired, compassionate care, SFRO also offers TrueBeam™, RapidArc™ and Brachytherapy—so we’ll find the treatment that’s right for you.

Isn’t it time you got back to living your life? Don’t wait —call us today to see if CyberKnife is right for you.

Get Back to Living Your Life.877-930-SFRO (7376)www.SFROLLC.com

RapidArc™ Brachytherapy TrueBeam™

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WWW.GLOBALHEALTHTRIBUNE.COM10 AUGUST ISSUE • 2012

By Deborah Lynn

Recently, I had the goodfortune to spend sometime with the President

and Chief Executive Officer ofBethesda Memorial Hospital,Roger L. Kirk.

Bethesda Memorial Hospital is anot-for-profit, 401-bed commu-nity hospital that is located inBoynton Beach. With more than600 physicians on its MedicalStaff, Bethesda currently caresfor more than 60,000 patients inits Emergency Department annu-ally; delivers nearly 3,000 babiesannually and admits more than20,000 patients each year.

Upon my arrival, Mr. Kirk greet-ed me in the front lobby withouthesitation. At 8:45 a.m., whilemany people are just arriving forwork, he had clearly been therefor quite some time.

Originally from Preston, WestVirginia, he received his under-graduate degree there beforemoving on to Washington D.C.,where he received a Master ofArts in Health CareAdministration from GeorgeWashington University. Hecame to Bethesda MemorialHospital in 1988 as the Vice-President of Operations. In1994, he was promoted toExecutive Vice-President andChief Operating Officer. InFebruary, he was namedBethesda’s President and CEO,when Robert B. Hill retired.

He has accomplished quite a bitover his tenure. The mostrecent, being able to secure thefinancing for the new BethesdaHospital West, which is a newstate-of-the-art hospital that iscurrently under construction inBoynton Beach.

Once we started talking, I foundhim to be extremely personable,cheery, funny and just complete-ly delightful to be around. It’sthrough our conversation that Irealized how passionate he isabout his job, staff, and every-thing and everyone around him.

So, when I asked him if he hadtime to answer a few questions

and give his opinion, he readilyagreed.

Have you heard of Palm BeachAccountable CareOrganization (ACO)?

I know about two of them. Theyare physician driven, meaningthey are only physician groups.We’re waiting to see how theytransform as we certainly wantto be a player with them. Myunderstanding is they have nohospital contracts or affiliationscurrently. So, ultimately as theyget contracts or patient bases, wewould like to work with them.It’s interesting; there are differ-ent versions of the ACO’s andultimately the risk takers thattake some risk have the potentialto really improve financially aswell as financially improvingtheir positions.

We are not in a position to dothat, but we are looking to directcontract with those that are. Ifeel we are well positioned as ahospital in comparison to ourcompetitors - we’re low cost,high quality and I think that’swhat they want.

What do you think is one featureof your hospital that exceedsother hospitals in the area?

We try to differentiate ourselveson our mission, which is to pro-vide quality health services in acaring manner. We have a lot oflong-term employees and wefocus almost extensively on thecaring part. We created ourDriskill Center for CaringExcellence to make sure that allof our employees have a com-passionate, caring attitude. Idon’t think patients today canreally differentiate between thetrue medical care being deliv-ered, but they know whether thepeople are caring and nice andthat makes a big difference. Wefocus on that and work hard tohave an organization that under-stands that type of culture andrealize that we’re here to helpthe patients get better andimprove their lives.

Will you be using the samephysicians at BethesdaHospital West?

All of our physicians will havestaff privileges at both hospitals.However, we do expect an influxof physicians from the surround-ing area. To date, we have 50 orso who have applied.

We were then joined by CynthiaWilliams, Editor of BethesdaHealth News, their in-house pub-lication. As we continued to dis-cuss Bethesda Hospital West, youcan just feel the excitement inboth Roger and Cynthia’s voice.

So, how is the new hospitalcoming along?

We’re on track and under budg-et. We plan to open on Tuesday,January 8. We’re starting to hirethe employees and the contractorwill turn the building over to ussome time in October. That willgive us a couple of months to getit fully equipped, tested andstaffed; then we’re ready to go.

It’s been more than 20 yearssince Palm Beach County sawthe construction of a new hospi-tal. There is a growing popula-tion in the western communities,and they are just primed for anew hospital.

What do you think ofObamacare?

You know, it’s not to know. Ithink there are some good partsof it and some parts for concern.I am very concerned with hisposition in not participating inthe Medicaid expansion pro-gram. Over the last couple ofyears, the State of Florida hashad a $200,000,000 cut inMedicaid funding. For Bethesda,that meant a cut of $5.6 millionin Medicaid funding last year.The good parts are obviously theexpansion of coverage and if youlook at Massachusetts, theydemonstrated that it improvedaccess.

There are people that normallyshow up in the emergency roomwith coverage to go to physi-cians so that’s a negative. Theunknown is how you are goingto pay for all of that; that’s beena concern and we just don’tknow enough about theAffordable Care Act in order toreally prepare.

I am concerned with the state notparticipating and that we’regoing to leave a lot of federal

dollars on the table. I thinkFlorida is the third highest statein uncompensated care in thecountry, so there are a lot of peo-ple that need help. We provideover $50 million in uncompen-sated care, and this number con-tinues to grow every year.

What we’ve seen over the lastthree years, since 2008, is agrowth in medically indigent -not totally indigent, but medical-ly indigent meaning that they areemployed, but their employerhas dropped health insurance andthey’ve had to go out and getreally high deductible insurancecoverage and all that means thatwhen they come to the hospital,they really can’t afford it. So,we’ve seen a large increase inuncompensated care here. So,that does concern us. There area lot of parts that we just don’tknow enough about. We’reafraid with Obamacare they’reobviously going to take it fromsomewhere else; cutting theMedicare program would trulynegatively affect the state ofFlorida and all of us. It’s amixed bag and it’s a little bitunknown. They are gearing upand the health exchanges are areal question and issue and theyare looking for the states toeither get on-board or get out ofit. It’s going to be interestingand everyone I talk with has thesame feeling – we just don’tknow.

Do you feel Governor Scott isworking for you or againstyou?

I don’t think he’s working for usor against us, I think he’s look-ing at it on a very global basisfor the state of Florida and say-ing hey, we can’t afford it. Ithink he is looking at it verydiplomatically. Ultimately, Ithink he’s looking long term inthe state of Florida.

Cynthia – we continue to workon our mission is to providequality service and working withour physicians.

There is a good article in FHA, Ibelieve it’s called –Hospitals willlose out if Florida stands firm onMedicaid.

Roger L. Kirk, President and CEOof Bethesda Memorial Hospital

Roger L. Kirk.

Artist rendering of Bethesda Hospital West. Aerial view of Bethesda Hospital West - currently under construction.

WWW.GLOBALHEALTHTRIBUNE.COM AUGUST ISSUE • 2012 11

We have seen several millionstate cuts and one of the thingsthat goes away under AffordableCare is the disproportionateshare. Right now, we get anadditional bump in payment fortaking care of a large number ofindigents. In Palm BeachCounty, among St. Mary’s, JFKand us, we probably provide99% of the indigent care.

Under the Affordable Care plan,that goes away. That is absolute-ly critical to us and I’m sure theother hospitals. The theory isthat patients will have some cov-erage, so they won’t be indigent.Traditionally, Medicaid is justnot a good payer – they don’tcover our costs. We’re con-cerned, obviously, that we’regoing to lose disproportionate ofMedicaid since they won’t pickit up and once again, the hospi-tals lose.

What do you think about hav-ing your own Hospitalist pro-gram?

Well, I think it’s a true benefitto not only the community, butalso the medical staff. Manyhospitals and physicians haveseen a decrease in their rev-enues because of decliningreimbursements. So, physiciansdon’t make a lot of moneyrounding on in-hospital patients.They make their money beingin their office taking care ofpatients and generating newones. What we’ve seen on theinternal medicine side is thatmany of the internal medicineand managed care companieswill contract with the hospital-ists to take care of the patientsin the hospital. I think they doa good job; they’re in-house 24hours a day, so they’re morereadily accessible which affectscare. Because they are in-house, the hospitalists can getlab results quicker and thereforeprovide more timely care totheir patients.

As for patients, some are okaywith it and some don’t like itbecause they want their primaryphysician to take care of them inthe hospital. However, the hos-pitalists provide good qualitycare and that’s been demonstrat-ed because they are readilyavailable and can react to x-rays,lab tests, diagnostics servicesand so forth. Their length ofstay is a little shorter and thecosts are a little better.

What is your typical day like?

I generally start by 7:30 a.m. inthe doctor’s dining room. Allthe physicians know that I’mthere and willing to talk aboutanything on their minds. Weusually start in the office at 8:30a.m. with meetings and it’s onemeeting right after another.Whether it’s operationally orient-ed, such as meeting with thevice-president of patient servic-es, the vice-president of nursing,operations or the CFO. Rightnow, we’re in the middle ofbudgets, so we have a lot ofbudget meetings. I’ll usuallymeet with a doctor or two duringthe day and discuss any topicthat they or we might have.

I serve on several communityboards, including the GreaterDelray Beach Chamber ofCommerce, and spend time inthe community as well. Ataround 5:00 p.m. – 5:30 p.m.,we have other meetings, so weusually meet until 6:30 p.m. or7:30 p.m. and go home. I have alot of meetings, both physicianand staff, leadership, executiveleadership and being out in thecommunity.

What is one thing that youwant the community to knowabout you or the hospital?

I think the community shouldknow that Bethesda is the mostcomprehensive hospital you’llfind in Palm Beach County, witha full range of services thatinclude cardiovascular services,

obstetrics, a Level 3 NICU, pedi-atrics, cancer center, women’shealth and general/vascular sur-gery. We provide an outstandinglevel of care for our patients.

Our board has been so concernedwith making sure that we havehigh patient to nurse ratios, highquality of care and the latesttechnology. A lot of peopledon’t know that our open heart

program is world-class. Our car-diovascular surgery group head-ed by Dr. Michael Carmichael,who is world-renowned, and oursurvival rates and complicationrates are top in the country.

We have a very strong orthopaedicprogram and general vascular pro-gram. And yet, outside of our mar-ket, if you say Bethesda, they say‘where’s that, Maryland?’

I recently signed a check for arefund of $125.00 for a Lamazeclass and the reason on it wasshe thought she was online sign-ing up in Bethesda, Marylandand she signed up here. So, wehad to refund her by check.

It’s a first-class community hos-pital with its technology, greatphysicians and a lot of long-termemployees. It’s a family envi-ronment here within a very car-ing hospital, with many long-term employees and a commit-ment to providing high qualitycare that is second to none.

Since Bethesda Hospital Westis in a more visible area, doyou feel that will put Bethesdamore in the forefront?

Yes, and we are working to rede-fine Bethesda’s brand as a majormedical center. With the open-ing of Bethesda Hospital West,we’re going to become a 500+hospital system, and with thisgrowth comes our desire to pro-vide an even higher level ofservice that our communitydeserves.

Our cancer program is affiliatedwith H. Lee Moffitt CancerCenter, the only NCI designatedinstitution in the state and wework with them. We do clinicaltrials, research, cancer, so wehave a lot of good things.

While Bethesda MemorialHospital was built in 1959, all ofthe facilities and rooms haveeither been updated or are in theprocess of being updated. Wehave brand new operating roomsuites that are phenomenal andstate-of-the-art. Our CornellInstitute for RehabilitationMedicine is a 28-bed state-of-the-art facility that exceedsnational standards for its successin helping patients make fullrecoveries from neurologic andorthopaedic conditions.

One of our greatest strengths thatI would want people to know isthat Bethesda has tremendouscommunity support. In fact,through the support of ourFoundation, we raised$100,000,000 for the heart hos-pital. And they continue to do anoutstanding job in supporting ournew western hospital. That’sjust incredible.

There are so many wonderfulthings….

Exterior view of Bethesda Hospital West on July 27, 2012.

Artist rendering of the lobby of Bethesda Hospital West.

July 27 - Bethesda Hospital West lobby under construction.

Jubilee celebration event scheduled for August 24th.

WEST PALM BEACH,Fla.-August 2012-It’sa golden anniversary

for Sister Mary who is celebrat-ing 50 years of dedication andservice to the Franciscan Sistersof Allegany. As one of the chap-lains at St. Mary’s Medical Cen-ter, Sister Mary is relied upon byemployees, patients and visitorsof the hospital. They know thatthey can count on her for spiri-

tual counsel and advice. “Myday-to-day duties are constantlychanging, but what doesn’tchange is my dedication tor thosewho rely on me as someone they

can talk to, when they are strug-gling,” Sister Mary said. Sister Mary’s illustrious careerbegan in teaching, which hasspanned over 30 years. Throughthe years, Sister Mary’s transi-tioned from teacher to principalat the Immaculate ConceptionPreparatory School in Kingston,Jamaica. In addition to herresponsibilities as principal, shealso worked in the Kingstoncommunity with the Missionaryof the Poor organization. After25 years in Jamaica, she movedto Miami where she continuedher work for the less fortunate atthe Camillus House.St. Mary’s Medical Center is thefirst hospital Sister Murphy has

provided spiritual guidance at,but her background in educationhas allowed her to transitionseamlessly into her healing rolein healthcare. “It is SisterMary’s compassion that stoodout to me the most when I firstmet her,” Father Aidan Lacysaid. “Her 50 years in theFranciscan Sisters of Allegany isa testament to how dedicated sheis to the health and wellness ofothers,” Lacy continued. Chief Executive Officer of St.Mary’s Medical Center, DavideCarbone, echoed Lacy’s senti-ments, “Sister Murphy is some-one who has helped bridged thegap between faith and communi-ty. Our hospital is committed to

maintaining the strong connectionto our Catholic roots, and her per-spective and dedication and hasbeen invaluable to all who knowher and who have been touchedby her over the years.”Sister Murphy’s jubilee celebra-tion will take place on August24th with a Noon Mass at whichshe will renew her vows as a reli-gious. Those vows are of poverty,chastity and obedience. Presentwill be many special people shehas touched along the way. “Several families from Jamaicathat I have kept in touch withover the years will be flying up toattend, so I am very pleased thatthey will be joining me in my cel-ebration,” she added.

Sister Mary Murphy Celebrates 50 years as Franciscan Sister

Sister Mary Murphy.

WWW.GLOBALHEALTHTRIBUNE.COM12 AUGUST ISSUE • 2012

PALM BEACH PRIMARY CARE ASSOCIATES, INC.

3347 State Road 7 Suite 200 Wellington, FL 33449

Tel: (561) 795-9087 • Fax: (561) 753-8730

1200 South Main Street Suite 101 Belle Glade FL 33430

Tel: (561) 996-7742 • Fax: (561) 753-8730

State of the Art Office Building with Imaging Center,

ACCEPTING NEW PATIENTS

MEDICARE, BLUE CROSS BLUE SHIELD, UNITED HEALTH CARE, AETNA, CIGNA, HEALTH CARE DISTRICT AND MOST MAJOR INSURANCES ACCEPTED

SPECIALIZING IN:• Diagnosis of Complex Illnesses

• Cholesterol Management • Diabetes • Cardiac Care • EKG/24-Hour Heart

Monitoring/Spirometry • Hypertension • Geriatric Concerns • Osteoporosis

Monday - Friday from 9:00 am - 5:00 pmSame Day Appointments and

24-Hour Service Available

On staff at Palms West Hospital andWellington Regional Medical Center

Forest Hill Blvd.

Lake Worth Rd.

Palomino Park Sta

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The Mall at Wellington

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PALM BEACH PRIMARY CARE

ASSOCIATES

N

Shekhar Sharma M.D.Ebonee Johnson A.R.N.P. Accepting

New Patients

Shekhar V. Sharma, M.D.Board Certified in Internal Medicine

Dr. Sharma is a Board certified Internist that has been in practice forthe past 19 years. His office is accepting new patients: Palomino

Park, 3347 State Road 7 Suite 200, Wellington, FL 33449

and for an appointment please call

(561) 795-9087Dr. Sharma's office in Belle Glade is at 1200 South Main Street,

Suite 100 (opposite the Old Glades General Hospital). He will be seeing patients at this location along with

Ebonee Johnson ARNP.

He is currently accepting New Patients and the office accepts most insurances.

Call 561-996-7742for an appointment.

Have a (Good) Heart!

Heart disease is a verycommon problemwith Americans.Sometimes we ad-

dress this disease as cardiovascu-lar disease, which actually in-volves blockage of arteries thatsupply blood to the heart muscle.However, there are various otherdiseases that fall under the car-diovascular definition. Those in-clude; abnormal heart rhythms(also called arrhythmias) infec-tion of the heart, congenital heartdefects, and of course, diseasesof the heart blood vessels.

How do you know if you haveheart disease or not? Heart dis-ease can be manifested by chestpains and if someone has anysort of discomfort in the chest,of which is described differentlyby different patients who haveheart disease. Some will com-

plain of pressure in the chest,others will say they had a feelingof heaviness on the chest, asthough someone was sitting ontheir chest. There are timeswhen diabetics may not feel anychest pains - even though theyhave underlying heart disease.This could be quite dangerous,because the symptom of chestpain alerts a patient to seek med-ical attention. I have seenpatients with diabetes mellitusthat have no symptoms at all, buthave severe underlying coronaryartery disease, which can only bediagnosed by doing a stress test.Some patients present withshortness of breath and palpita-tions, which means a racingheart beat or skipped heart beats,fluttering in the chest, and some-times near fainting or faintingepisodes. All the above symp-toms could be interconnectedand suggest an underlying car-diac arrhythmia.

If one has swelling of ankles orlegs with shortness of breath onexertion - like walking up thestairs, that could suggest a fail-ing heart also called congestiveheart failure. Fatigue, weakness,waking up at night to sit up tobreathe better can also suggestcongestive heart failure. Fatiguecan also come from a slowingheart rate, which sometimes canbe due to a severe heart block-age. Such a condition wouldrequire a pacemaker.

Coronary artery disease is thecause of roughly 1.2 millionheart attacks each year. Sadly,more than 40% of those that suf-fer a heart attack will die. Asizeable number of patients willdie even before they reach thehospital. According to theAmerican Heart Association,over seven million Americanshave suffered a heart attack intheir lifetime.

So, what are the risk factors forheart disease?

• A strong family history of heartdisease, which I feel is one ofthe strongest risk factors.

• Cigarette smoking• A high LDL or bad cholesterol• A low good cholesterol or HDL

levels.

• Uncontrolled hypertension.• Diabetes mellitus

Other risk factors include intensestress, anger, and obstructivesleep apnea.

So, what does one do to lower

the risk of heart disease?

• Lower your total cholesterollevels to be below 200 mil-ligrams.

• Increase your HDL level toabove 45 milligrams (the high-er the better).

• Lower the LDL levels below100 milligrams

• Control of blood pressurebelow 140/85

• Control your diabetes mellitusby following a healthy dietsuggested by the AmericanDiabetic Association.

• Manage stress by doing yoga,medicatation and get goodsleep.

If you suffer from sleep apnea, itcan be treated with a sleep mask(CPAP), oral appliance therapyand in some cases, surgery.Daily exercise is also veryimportant as long as your heartis strong enough to take it.

Good Samaritan Chief Nursing OfficerAwarded The 2012 Palm HealthcareCommitment to Community Award

Angela Prestia honored for herdedication in promoting thenursing profession.

WEST PALM BEACH,Fla-August 2012-Good Samaritan Med-

ical Center’s Chief Nursing Offi-cer, Angela Prestia RN MSN NE-BC, recently received theaccolade of the Commitment toCommunity award at the PalmHealth Care 2012 Commitment toCommunity and Volunteer Recog-nition luncheon. Prestia was hon-ored as a community partner forher continuous dedication to pro-moting the profession of nursingin Palm Beach County.

In her tenure as CNO at GoodSamaritan, Prestia has beenknown as a leader in the nursingcommunity. Prestia championedthe novice nurse leadership insti-tute, a program for newlylicensed nurses (12-18 months)that helped integrate them intothe profession, and engaged themwith colleagues and the commu-nity they serve. Prestia had sixnurses from Good Samaritan asparticipants in the program.

Prestia has also focused on theeducation of young people pur-suing a career in nursing. She isan active member of the FloridaAtlantic University curriculumadvisory panel for the emergingnurse leader master’s degree. “I

am thrilled to be recognized formy passion for nursing becauseit is such a huge part of my life.”Prestia said. This award is suchan honor to receive, and I am sotouched that Palm Health Carebelieves I have made a differ-ence in this community.”

“Angela has always been com-mitted to the advancement of thenursing staff at Good Samaritanand to our patients, and I ampleased to see her efforts arebeing acknowledged through theCommitment to Communityaward,” Chief Executive Officer,Mark Nosacka said. “Thisrecognition is a true testament tothe leadership and dedicationAngela and her team have devot-ed to our goal of delivering thehighest quality patient care.”

Angela Prestia, RN MSN NE-BC.

FDA approves vaccines for the 2012-2013 influenza seasonThe U.S. Food and Drug

Administration announcedtoday that it has approved

the 2012-2013 influenza (flu)vaccine formulation for all sixmanufacturers licensed to pro-duce and distribute the vaccinesin the United States.

Each year experts from the FDA,the World Health Organization,the Centers for Disease Controland Prevention (CDC), and other

public health experts studyinfluenza virus samples andglobal disease patterns to identi-fy virus strains likely to causethe most illness during theupcoming flu season.

Based on that information andthe recommendations of theFDA’s Vaccines and RelatedBiological Products AdvisoryCommittee, the strains selectedfor inclusion in the 2012-2013

flu vaccines are:A/California/7/2009 (H1N1) -like virusA/Victoria/361/2011 (H3N2) -like virusB/Wisconsin/1/2010-like virus.

While the H1N1 virus is thesame as what was included in the2011-2012 influenza vaccines,this year’s influenza H3N2 and Bviruses differ from those in the2011-2012 influenza vaccines.

Vaccination remains the corner-stone of preventing influenza, acontagious respiratory diseasecaused by different influenzaviruses infecting the nose,throat and lungs. This year’sseasonal vaccines will provideprotection against the threeinfluenza virus strains that glob-al surveillance indicates arelikely to be the most commonstrains circulating during theupcoming season.

According to the CDC,between 5 percent and 20 per-cent of the U.S. populationdevelops influenza each year.This leads to more than200,000 hospitalizations fromrelated complications.

The CDC’s Advisory Committeeon Immunization Practices, rec-ommends that everyone sixmonths of age and older receivean annual influenza vaccine.

WWW.GLOBALHEALTHTRIBUNE.COM AUGUST ISSUE • 2012 13

Dentist-rx.com

PEACEFUL SLEEP WITHOUT CPAPSNORING AND DAYTIME SLEEPINESS

may signal a potentially life threatening disorder:

OBSTRUCTIVE SLEEP APNEA OR OSAOSA can lead to heart attack and reduced libido

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affects more than 18 millionAmericans and can lead tohypertension, heart attack,stroke, diabetes, reduced libido,TMJ Dysfunction, morningheadaches and excessivedaytime Sleepiness which canlead to work and car accidents.

Treatment with Oral Appliance Therapy (OAT): for mild and moderatesleep apnea and snoring. Plus severe OSA when the patient isintolerant to CPAP or needs to be used in conjuntion with CPAP.

Eliminate the CPAP mask and continue using CPAP equipment withthe new oral appliance to obtain the benefits of both.

Orthodontics & Dentofacial OrthopedicsStarting as young as 2 years old, you may help your

children to solve ear inflammation symptoms,develop a beautiful face and smile with a more

attractive profile as well as prevent sleep apnea andavoid orthognathic surgery; all with FuntionalAppliances and Facial focused Orthodontics.

We can straighten your teeth at any age, fast and comfortably usinginvisible technology with or without braces. Improve your facial

appearance with a beautiful and healthy smile.

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3401 N.Federal Hwy. Suite 101Boca Raton, FL 33431

Phone: 561-750-6790

18503 Pines Blvd. Suite 305Pembroke Pines, FL 33029Phone: 954-392-1851

Wisdom Teeth Removal * Oral RehabilitationGums Treatment: surgical and non-surgical

Root canals * Fillings * Crowns * TMJ

Alvaro Betancur, DDS, haspracticed dentistry in Floridasince 1990. After receiving hisdental degree, Dr. Betancurcompleted a residency in cranio-facial pain and pathofunction atthe University of Florida and afellowship at the University ofFlorida Pain Center rand theAmerican Academy of Craniofa-cial Pain. Dr. Betancur is amember of the American Acad-emy of Dental Sleep Medicine.

Dental Implants

Sleep Apnea and the Use of an Oral Device

By Deborah Lynn

So, you’ve finally had it!You are too tired to get upin the morning, too tired to

bring the kids to school and sim-ply too tired to go to work. Nowit’s time to give Dr. Alvaro Betancur a call. His practice notonly encompasses general andcosmetic dentistry, oral surgery,and dental implants, but it alsoincludes sleep medicine.

When Dr. Betancur realized thatsleep apnea was significantlyunderdiagnosed, he decided toobtain advanced training in sleepmedicine.

It was there, during his day-to-day practice, that he learned the

number one reason people grindtheir teeth was due to sleepapnea. It had often beenthought that it was due to thestress in one’s life. However,that opinion has since changedas it appears that it’s the bodysimply trying to move the jawforward to open the airway.

One of the ways Dr. Betancurcan treat your sleep apnea is inthe form of Oral DeviceTherapy. During your exam, Dr.Betancur will evaluate whichoral device will work best foryou. He can then create yourcustom fit appliance which willhelp you to maintain an unob-structed airway while you sleep.When you treat the sleep apneausing oral appliances, the grind-ing seems to stop.

After you receive your device,you will need to continue yourtherapy in the form of short orlong-term maintance. As this isan essential part of your treat-ment with your new oral device.This will allow for Dr. Betancurto assess the treatment of yoursleep disorder, see how yourespond to your new device, itseffectiveness and to be sure thatit is a comfortable fit.

There are numerous advantagesof using Oral Appliance Therapy.Not only are they comfortable,but it generally only takes a fewweeks to get used to wearingone. In addition, because of thesmall size, you can take it withyou anywhere.

From a financial standpoint, thisform of sleep apnea treatment isconsidered economical bypatients and insurance compa-nies alike. You can also discon-tinue the therapy at any time.

Dr. Betancur would love to helpyou attain that long overduerestful night of sleep. To makean appointment – please call561-750-6970 for his BocaRaton location, or 954-392-1851for Pembroke Pines. Or, if youwould like additional informa-tion, you can visit www.dentist-rx.com or www.sleepsnoreden-tist.com.

Dental Appliance

Upcoming MedicalFundraising Events

For August 20 – September 30, 2012

August 21

Adopt-A-Family of the Palm Beaches. Physicians TalentShowcase presented by Kretzer Piano. Featured headliners andPBCMS Board members Dr. Hatem Abou-Sayed and Dr. JackZeltzer along with emcees and Board member Dr. MaureenWhelihan and Dr. Gordon Johnson. Harriet Himmel Theatre atCity Place, West Palm Beach. Tickets are $50.00. Call CTS at866-449-2489. For additional information, contact KathiKretzer, Kretzer Piano at 561-748-0036 or by e-mailkkretzer@kretzerpiano.com.

August 23

The Pap Corps and Royal Palm Place. Eat to Beat Cancer- Diamond Jubilee. The Boca Raton Chamber of Commerce'sBoca Festival Days. Royal Palm Place, Boca Raton.Participating restaurants include Caruso Ristorante, CasimirBistro, Cypress Mediterranean Grill, Jake's Stone Crab, RaffaeleRistorante, Ristorante Sapori, Saquella Cafe, Yakitori SakeHouse. Please visit www.royalpalmplace.com for menus, a mapof locations and free parking areas. To help or find out addition-al information, visit www.papcorps.org.

Muscular Dystrophy Association. MDA's Northern PalmBeach Executive Lock-Up. III Forks Palm Beach Gardens,Palm Beach Gardens. Over 100 Northern PBC business owners,executives and community leaders are participating. The Lock-Up is a jail-themed event where jailbirds go behind bars to raisebail for local children and adults with neuromuscular diseases.All "jailbirds" who raise their $4,000 bail are able pre-tape theircheck presentation which will be aired on 9/2 during the MDAShow of Strength (FKA MDA Labor Day Telethon). For addi-tional information or to participate in this event, contact 561-742-3748.

August 25

The Leukemia & Lymphoma Society (LLS). Macy’sShopping for a Cause. Purchase a $5.00 shopping pass andyou’ll receive 25% off all day at any Macy's (also good for 10%off electronics, watches, furniture and mattresses). For addition-al information, visit www.lls.org.

SEPTEMBER

September 13

Arthritis Foundation. 2012 Team Kick-Off Wine Social.Arthritis Foundation, 400 N. Hibiscus, West Palm Beach. RSVPby September 10 to srhodes@arthritis.org or 561-833-1133.

September 29

Bethesda Next. 2nd Annual White Party. Eleven Spa, DelrayBeach. $50.00 per person in advance and $60.00 at the door.Proceeds benefit the Bethesda Memorial Hospital PediatricPlayroom renovation. Must be 21 or older to attend. For addi-tional information, contact 561-278-1100.

American Heart Association. Heart Walk of the PalmBeaches. Meyer Amphitheatre, West Palm Beach. For addition-al information, contact Brittney Farwell at 561-697-6617 or pbc-heartwalk@heart.org.

MISCELLANEOUS

Arthritis Foundation. Order your 2012 discount golf booktoday. Books are $15.00, or buy three books and get one free.Great Florida golf courses with discounted green fees from Maythrough October and some select courses year round. To orderyour book(s), contact Terri Johnson at 800-672-0882 or 941-747-8303 or by e-mail to tjohnson@arthritis.org.

WWW.GLOBALHEALTHTRIBUNE.COM14 AUGUST ISSUE • 2012

Girls Night Out benefits the Kids Cancer FoundationBy Deborah Lynn

What do you getwhen you put jew-elry, make-up,body lotions,

sweets, food, fashion accessoriesand a DJ in one room? Womenand plenty of them!On July 12, Phelps Media andMaureen Gross organized a“Girls Night Out” event at ThePlayers Club in Wellington.There were over 20 vendors thatoffered so many beautiful itemsfor purchase. In addition, eachvendor gave an item to raffle offof which benefitted the KidsCancer Foundation. This was such a wonderful eventon many levels, but mainlybecause it benefitted a greatcause with such a dedicatedfounder in Michelle O’Boyle.If you would like additionalinformation on how you can helpthe Kids Cancer Foundation,please visit their website atwww.kidscancersf.org. As these events happen monthly,please visit Phelps Media web-site atwww.phelpsmediagroup.com tofind out where the next eventwill take place and which localcharity will benefit.

Michelle O'Boyle from Kids Cancer Foundation.

Mindy Sepinuck sizing up acustomer.

Jusuru Life Blend

Facelift Bungee giving a client an instant lift.

Shaun Santoro and Gail Boss from Scentsy. Passion Parties by Yani was a complete hit!

Cindy Soto showing off her customcreations from Sweet Servings.

Palm BeachGastroenterologyConsultants, LLC

Call Us Today If You Suffer From Any Of The Following:

At Palm Beach Surgery Center we provide a safe and friendly environment, with a highly qualified and dedicated staff. A variety of procedures such as colonoscopy, endoscopy, gastroplications, ERCP, Liver Biopsy, 24 PH Monitoring/BRAVO can be done at our facility thus avoiding the need for hospitalization.

www.wellingtongastroenterology.com

WELLINGTON1157 South State Road 7Wellington, Florida 33414

561.795.3330

BELLE GLADE1200 South Main Street #102

Belle Glade, Florida 33430

561.996.5600

Krishna TripuraneniM.D., M.B.A.

Vikram TaruguM.D

Digestive Diseases StatsDysphagiaGallstonesGastroesophagealJaundiceLactose IntoleranceLiver DiseaseNervous Stomach

Abdominal PainBleedingChest PainCirrhosis of the LiverColitisConstipationDiarrhea

PancreatisStomach and Duodenal UlcerUlcerative ColitisReflux DiseaseHemochromatosisHemorrhoidsHepatitis

Two Convenient Locations:

Also offeringVenra Clinical Studies, LLC

IRRITABLE BOWEL SYNDROME?

Venra Clinical Studies, LLC561-795-3330 ex. 249

info@venraclinicalstudies.com

We are conducting a clinical researchstudy of an investigational medicine.If you meet the following criteria, youmay be interested in participating in this clinical trial.

• Age 18 – 79 inclusive• At least 28 stools over a 7-day period• Moderate to severe Pain in your abdomen associated with:

• relief by defecation,• change in frequency of bowel movements, or• change in appearance of stool.

Participants receive study related care, diagnostic tests, and study medication at no cost. Payment for time and travel to the study centermay be provided

For more information about the research study, please contact:

On the Campus of Wellington Regional Medical Center

AT THE CENTER FOR WOUND CARE AND HYPERBARIC MEDICINE AT WELLINGTON

SERVICES INCLUDE:

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