Author: Evyn Stevens

  • During a Heart Attack, Time Equals Heart Muscle

    During a Heart Attack, Time Equals Heart Muscle

    With a 99% blockage, Jim Schultz had very little time to spare.

    Bellevue resident Jim Schultz woke up around 3 a.m. on July 30 with pain he originally attributed to stress. He got up and sat in the living room for a while, but 30 minutes later he was feeling worse.

    “I went to wake my wife to tell her I wasn’t feeling well and to get the blood pressure
    machine.” Jim said.

    Almost as soon as his wife woke up, Jim noticed a tremor in his arm and the pain
    in his chest get worse.

    “My wife said, ‘No. We’re calling 911.’” Jim recalled.

    Jim remembers being a little dazed while he waited for the ambulance, laying down with his eyes closed and holding his chest. Soon, two ambulances arrived and both crews came in.

    “I vaguely remember the two ‘lead’ guys having a conversation,” Jim explained. “Bryan was insisting on Fisher‐Titus because of my situation. I didn’t fully understand what was going on at the time but I was just going with it.”

    The person Jim remembers so clearly is North Central EMS Paramedic Supervisor, Bryan Hamman. Bryan remembers Jim very clearly.

    “When I arrived I found Jim sitting in a chair in the living room and he did not look good,” Bryan recalled. “He was very pale, clammy, sweating, clutching his chest, and was short of breath. I knew at this moment he could be having a heart attack.”

    The North Central EMS crew transported Jim from his home in Bellevue to Fisher‐Titus. On the way, Jim recalls the care Bryan provided in the ambulance.

    “He talked me through everything,” Jim said. “He was very calm and reassuring. He gave out a really excellent vibe. The cardiologist later told me that he did everything perfect for me.”

    Bryan remembers that ride from Bellevue to Fisher‐Titus and talking Jim through each step providing oxygen, aspirin, an IV, Nitroglycerin to relieve pain, a 12 lead ECG that transmits results to the Fisher‐Titus Emergency Departments, and continuous reassessment of vital signs and interventions.

    “When a patient is faced with an emergency like this, they become anxious,” Bryan said. “My job is not only to provide the clinical skills needed, but also to be calm and reassuring, letting him know he is in good hands.”

    Once they arrived at Fisher‐Titus, Jim was taken to the Emergency Room before heading to the cath lab to have a stent placed by a Fisher‐Titus Heart & Vascular cardiologist.

    The ambulance had left Jim’s home at 5:02 a.m. and by 6 a.m., he was in his hospital bed recovering from the stent procedure.

    “Everyone at the hospital gave me excellent attention,” Jim said. “They were so professional and very kind.”

    Jim learned after the fact why it was so critical that he be brought to Fisher‐Titus instead of another facility: Fisher‐Titus is a Level 2 Adult Cardiac Catheterization Laboratory meaning his stent procedure could be performed here.

    “Jim needed to be taken to a hospital with a cath lab and Fisher‐Titus has one…a very good one,” Bryan said. “The goal is to move quickly. Time is important at this point; time is heart muscle. We needed to get Jim to the cath lab fast.”

    Had he been at another facility initially, Jim might have had to be transferred.

    “I was 99% blocked,” Jim explained. “My odds would have dramatically decreased if I would have been taken somewhere else and had to have been transferred because of the time it would have taken.”

    After the procedure, Jim was in the ICU at Fisher‐Titus for a day and a half before being discharged. Now he goes back regularly for follow ups and cardiac rehab.

    “Patty and Michelle and everyone else in cardiac rehab are great,” Jim said. “I’m feeling pretty good. I still have a ways to go but I feel like I’m doing really well.”

    As his strength and stamina increase, Jim looks forward to getting back to fishing and processing firewood to heat his home this winter.

    Jim shared, “If you’re going to go through this experience, I’d like to have Fisher‐Titus on my side again.”

    Learn more at fishertitus.org/heart.

  • What is Cardiovascular Disease?

    Cardiovascular is probably a word you’ve heard but you may not know exactly what it means. Cardiovascular disease describes the many different diseases affecting the heart and blood vessels. “Cardio” refers to the heart and “vascular” refers to the blood vessels. There are many types of cardiovascular diseases ranging from high blood pressure and coronary artery disease to heart failure and stroke. It is the leading cause of death among men and women, taking more lives than all cancers combined. Fortunately, there are ways to reduce your risk of developing these diseases.

    February is heart month so it is the perfect time to learn about cardiovascular disease and ways you can prevent it.

    The term cardiovascular disease is most commonly used to describe arthrosclerosis. Arthrosclerosis is the build-up of plaque in the arteries. Too much build-up can restrict blood flow to organs and tissues. It causes chest pain and can eventually lead to cardiovascular diseases.

    Arthrosclerosis is caused by many factors. It can be silent for many years and may not present symptoms until the build-up becomes so severe that it blocks the blood supply entirely. Some common warning signs that this has happened are chest pain, dizziness, and swelling or pain in the arms or legs.

    How to Reduce Your Risk for Cardiovascular Disease

    You can ensure the health of your heart by maintaining a healthy lifestyle. While some risk factors are out of your control, most risk factors are lifestyle changes you can make. These guidelines will not only help you prevent cardiovascular disease, but many other diseases and conditions as well.

    • Quit smoking. Smoking can damage the heart and blood vessels making them more susceptible to arthrosclerosis.
    • Exercise. 30 minutes of moderate intensity aerobic exercise daily can help blood flow more easily.
    • Eat healthy. A diet rich in fruits, vegetables, whole grains, and low-fat dairy products supports a healthy heart. Avoid foods high in saturated fat as they contribute to higher cholesterol. Foods high in trans-fat raise bad cholesterol and lower good cholesterol.
    • Healthy weight. By maintaining a healthy weight, you reduce your risk of high blood pressure, high cholesterol, and diabetes all of which can contribute to cardiovascular diseases.
    • Regular checkups. Visiting your doctor regularly gives you a better picture of your own heart health. Your doctor can measure blood pressure and cholesterol and help you make choices that are best for you.

    Efforts to prevent cardiovascular disease can begin as early as childhood. Parents can teach their children healthy eating habits and the value of exercise to help them make the healthiest choices throughout their lives.

    Managing cardiovascular disease close to home

    The Snyder/White Heart & Vascular Center at Fisher-Titus is equipped with state-of-the-art technology to provide the latest cardiovascular diagnostic and interventional procedures. Non-invasive tests such as stress tests, CT scans, and echocardiograms are all common in detecting and treating cardiovascular disease.

    Our highly experienced cardiovascular team is able to provide patients with the most current heart and vascular procedures right here at Fisher-Titus. They offer wellness and prevention, high-tech diagnostics, critical emergency services, a variety of interventional procedures, and personalized rehabilitation programs. We are able to provide all of these cardiology services in the same location, close to home.

    About Jason Gahring MSN, MBA, RN

    Jason is Vice President of Ambulatory Nursing. He has been a Registered Nurse at Fisher-Titus Medical Center for nearly 20 years with extensive experience in cardiology care. For more information about the Fisher-Titus Heart & Vascular Center, visit fishertitus.org/heart; to make an appointment with a cardiologist, call 419-660-4707.

  • Data Privacy Day

    January 28 is Data Privacy Day. The goal of Data Privacy Day is to highlight easy ways to protect your personal information. Take control of your personal information by learning about the types of cyber attacks and how to avoid becoming a victim.

    Types of Cyber Attacks

    • Social Engineering Attack uses human interaction to obtain or compromise information about an organization, or its computer systems. Example: Someone claiming to be with a company you are familiar with asking questions to piece together information to infiltrate the network.
    • Phishing Attack uses non-personal interaction, like email or websites, to solicit personal information by posing as a trustworthy or familiar entity. Example: An email requesting account information, often suggesting there is a problem.
    • Vishing Attack leverages voice communication and can be combined with other forms of social engineering enticing a victim to divulge sensitive information. Example: A phone call saying the IRS is looking for you and if you don’t call back, a warrant for your arrest will be issued.
    • Smishing Attack exploits text messages containing links that when clicked may automatically open a browser window, email message, or dial a number. Example: A text message that says, “You’ve been selected to win a Caribbean Cruise! Visit this link to claim your prize!”

    Avoid Being a Victim

    • Trust your gut when receiving an email, phone call, or text message you aren’t expecting. Be suspicious if they are asking about sensitive information.
    • Do not provide personal or financial information unless you are certain of a person’s authority to have it. Never reveal in an email or respond to email solicitations for this information.
    • Secured sites can be recognized by starting with “https://”. Check for a Privacy Policy on the site; if there isn’t one, that’s a red flag.
    • Pay attention to the URL of a website. Malicious websites may look identical to a legitimate site, but the URL may use a variation in spelling or a different domain.
    • If you are unsure whether an email request is legitimate, verify it by contacting the company directly. Do not use contact information provided on a website connected to the request.

    What to Do if You Are a Victim

    • Report it to the appropriate people.
    • Immediately change passwords and do not use compromised passwords in the future.
    • Contact your financial institution and close any accounts that may be compromised and watch for unexplainable charges.
    • Watch for other signs of identity theft such as calls about accounts you didn’t open, unexpected denials on your credit card, or weird accounts on your credit statement. Missing bills you usually receive can also be a red flag.
  • COVID-19 Vaccine Frequently Asked Questions

    Now that the vaccine is rolling out to the public, we know many people have questions as they begin to decide whether to receive the vaccine. Most importantly, the Pfizer and Moderna vaccines have been proven safe and effective in large scale testing trials with minimal side effects and will be an important asset in fighting the spread of COVID-19.

    Here are some of the most frequently asked questions about the Pfizer and Moderna COVID-19 vaccines, the only ones currently approved by the Federal Drug Administration (FDA).

    Why is a vaccine for COVID-19 important?

    The COVID-19 vaccine is an important tool in stopping the mass spread of the coronavirus. Vaccines help boost immune systems by introducing your body to previews of what the real virus looks like, without causing disease. This preview gives your immune system time to design powerful antibodies to fight the real virus if you are ever exposed or infected. If you receive the complete 2 dose  COVID-19 vaccine, and then have an exposure to the coronavirus, your body is ready to fight the virus, stopping the disease. Full protection is achieved 2 weeks after the second dose so it is important to continue to take precautions during and after the vaccine process

    How effective are the Pfizer and Moderna vaccines?

    In large scale clinical trials using diverse populations, after administration of both doses of the vaccine, effectiveness of each vaccine is approximately 95% across all populations enrolled.

    How do the Pfizer and Moderna vaccines work?

    The coronavirus is an RNA type of virus. RNA, short for ribonucleic acid, like DNA, plays an essential role within your body for coding, decoding, regulation, and expression of genes. Using RNA technology, scientists were able to map the genetic code sequence of an important part of the coronavirus – the “spike” protein, which is often shown in pictures of the COVID-19 molecule.

    This genetic code sequence acts as a set of instructions. These “instructions” are coded into messenger RNA (mRNA) for use within the vaccine. All of your cells have naturally occurring mRNA made from your DNA. The life cycle of mRNA in your cells is only a few days. When the vaccine is injected, the mRNA is taken into cells within your body. It does not enter our DNA. It instructs these cells to make copies of the artificial spike protein as if the cells have been infected by the real coronavirus. Your cells are then able to learn about the spike protein and give the immune system a preview of what the real virus looks like. This preview gives your immune system time to design its own natural antibodies that neutralize the real virus if you are ever infected.

    It is important to note mRNA technology isn’t new; it has been used safely in the oncology field since 1989 for significant cancer treatment advances.

    Will the vaccine protect against the new strains of COVID-19?

    There are new strains of COVID-19, which is not unusual for any virus that causes illness. With COVID-19, what has not changed is the way it causes infection, utilizing the spike protein to infect human cells. The vaccines currently approved by the FDA cause the body to make antibodies that identify the spike protein as something to attack. Since that protein has not significantly changed, vaccines will continue to provide a high level of protection.

    Is the mRNA vaccine safe?

    Yes. The vaccine has been proven safe through large scale clinical trials. Specifically, the Pfizer trial had 44,000 enrolled in their trial and Moderna had 36,000 participants. Enrollees were diverse in age, race, ethnicity, and gender, and were monitored for over 2 months following the second vaccine dose. There have been some reported cases of allergic reaction in people with a significant history of  anaphylactic type reactions. The efficacy for these trials did not include children or pregnant women, however, and the duration of protection has not yet been established but is anticipated to be a year or more.

    As with any vaccine that is developed, it must undergo rigorous testing before approval. That is the reason for standardized clinical trials involving many diverse populations that are closely monitored for adverse events, side effects, as well as effectiveness. These highly regulated trials are carried out by organizations independent of the vaccine companies and require highly detailed reporting to the FDA prior to formal approval. These currently approved vaccines have gone through the same testing as any other vaccine that is FDA approved.

    Can I get COVID-19 from the vaccine?

    There is no way the mRNA vaccine can cause a COVID-19 infection as it only uses a very small piece of protein from the virus and not the entire virus itself.

    What are the side effects of the mRNA vaccine?

    Side effects of the Pfizer and Moderna COVID-19 vaccine are very similar to other vaccines you may have received and range from mild to moderate. The most common side effects include injection site redness and tenderness, fatigue, headache, muscle pain, chills, joint pain, and fever. The chance of having a serious reaction was very low (less than 0.5%).

    Should I be concerned about potential long-term side effects?

    COVID-19 mRNA vaccine studies are ongoing for the next 24-36 months. Historically, however, vaccine studies have shown that 90% of adverse reactions/side effects—both short and long-term—occur within 45 days after the last dose of the vaccine. Both Pfizer and Moderna did not request FDA approval until their phase 3 trial reporting was beyond 2 months after the last doses were administered.

    Are there fertility, pregnancy, or breastfeeding concerns with the COVID-19 vaccine?

    There is no scientific evidence to suggest that the COVID-19 vaccine could affect fertility. The CDC currently recommends that women do not become pregnant until two months after the second dose of the vaccine and that a breastfeeding mother can decide whether to receive the vaccine. Studies are ongoing related to safety in pregnancy and breastfeeding as well as children.

    What specific allergies have been related to a higher chance of allergic reaction to the COVID-19 mRNA vaccine?

    The recommendation related to allergy concerns is to not get the vaccine if you have experienced severe allergic reactions in the past related to food, medication, or vaccines. This would apply to people who typically carry an Epi pen for treatment of severe anaphylactic reactions.

    Is the COVID-19 vaccine safe for those who are immunocompromised or with autoimmune conditions?

    Individuals with autoimmune conditions, on autoimmune medications, or with weakened immune systems should discuss the vaccine with their primary care provider or rheumatologist.

    If I had COVID-19 within the last 90 days and I’m fully recovered/showing no symptoms, can I be vaccinated?

    Per CDC guidance, anyone that falls into a prioritized group can receive a vaccination even if they already had COVID-19. Anyone currently infected with COVID-19 should wait to get vaccinated until after their illness has resolved and after they have met the criteria to discontinue isolation.

    When can I get the vaccine?

    We are currently rolling out vaccines as recommended by the Ohio Department of Health in a staged process. This stage 1b is for adults age 80and older. Each week moving forward will include other age groups and those with congenital or early onset medical conditions, and adults working in schools,,. If you fall into one of those populations and would like to receive a vaccine, please fill out a vaccine interest form at fishertitus.org/coronavirus. A Fisher-Titus employee will review your registration information to determine when you will be eligible to receive the vaccine and will call you back to schedule a vaccine appointment.

    Once we have completed phase 1B and move to the next phase of vaccine distribution, we will share more information on our social media channels, website, and through local media.

    If I get the vaccine, do I still have to wear a mask?

    Yes. While experts continue to learn more about the protection that COVID-19 vaccines provide under real-life conditions, it’s important for everyone to continue using all the tools available to us to help stop this pandemic, like covering your mouth and nose with a mask, washing hands often, and staying at least six feet away from others. All these together provide the best protection from getting and spreading COVID-19.

  • Exercising at Home

    It’s the start of a new year and many of us are probably trying to implement healthy lifestyle changes into our regular routine. However, the cold weather and the ongoing COVID-19 pandemic keeping us at home and inside makes exercise difficult for many people. Here are some exercises you can do at home with little to no equipment.

    Upper Body Exercises

    Incline or countertop pushups. This exercise targets the main muscles in your chest but doesn’t put the same stress on your elbows and reduces the body weight you are lifting in a traditional pushup. All you need is a stable surface like a wall, table, or countertop. Put your hands on the surface and do your pushups like you would if you were on the floor.

    Bicep curls. These exercises will work the bicep muscles at the front of your upper arms as well as the muscles in your lower arms. These can be done with weights or your can use canned food from your cupboards. If you’re looking at getting some free weights, select ones that you can life ten times with good form. If you’re a beginner, five to ten pounds per weight is a good starting point. You’ll use these weights for the next three upper body exercises.

    1. Stand tall with your feet hip-width apart and your abdominal muscles engaged.
    2. Hold one weight in each hand and relax your arms at your sides with palms facing forward.
    3. Bend your arm at the elbow and lift the weights towards your shoulders. Keep your elbows tucked close to your ribs and exhale as you lift.
    4. Lower your weights to the starting position. Try doing three sets of 8-10 reps, resting between each set.

    Lateral arm raises. This exercise will focus on your deltoid muscles.

    1. Stand in the same position as you started your bicep curls in but with your palms toward your body.
    2. Raise your arms out on each side a couple inches and hold for a few seconds.
    3. Raise your arms more, keeping your arms completely straight, and stopping when your elbow reach shoulder-height and your body forms a “T.” Hold this for a few seconds.
    4. Slowly lower your weights (about two times as slow as when you lifted them), breathing out as you lower them.

    Bent over rows. This will target the muscles in your upper and middle back.

    1. With a weight in each hand, bend forward at a 45-degree angle. Keep your back straight, brace your abdominal muscles, and breathe in.
    2. Lift both weights straight up while breathing out. Your arms shouldn’t go higher than your shoulders. Try to keep your wrists from moving too much and don’t squat as you lift.
    3. Lower the weights slowly while inhaling.
    4. Don’t stand up in between reps.

    Overhead press. This exercise works on strength throughout your shoulders.

    1. Stand up straight, fee shoulder-width apart, and with a straight back.
    2. Hold your weights at your shoulders with your thumbs towards your body and your knuckles facing up.
    3. Raise your weights slowly above your head while breathing out and hold above your head.
    4. Return your weights to your shoulders while breathing in.

    Lower Body Exercises

    Body weight squats. Squats strengthen every muscle in your lower body. Stand straight up and bend your knees like you’re sitting in a chair. Stand back up and repeat 8-10 times. Avoid knee pain from squats by keeping the weight on your heels and your knees behind your toes.

    Backward lunges holding on to a chair. Lunges help stretch tight hip flexors and work your entire lower body. Place a chair backwards in front of you for this exercise to grab on to and help you maintain balance.

    1. Stand up with your legs parallel.
    2. Hold on to your chair if needed, bend your right knee, and step your left leg straight back onto the ball of your foot, as far as you are comfortable.
    3. Straighten your back leg but don’t lock your knee. Hold the stretch for 30 seconds, breathing deeply.
    4. Bring your back leg forward and return to the standing position. Repeat on the opposite side.

    Calf raises. These will stretch and strengthen the muscles in you lower legs. Keep your feet shoulder-width apart, slowly raise your heels keeping your knees straight but not locked and pause for one second before lowering your heels back down. Repeat 10-30 times.

    Planks. This will work your core muscles. Find a place on the floor that you can extend your full body. Use an exercise mat or a couple folded towels for padding under your hands/arms and feet/knees. Lay on your stomach with your forearms and toes on the floor. Your elbows should be directly under your shoulders. Engage your abdominal muscles and pull your belly button toward your spine. You can be up either on your toes or your knees. Avoid arching your back, letting your hips sag, or tilting your head up. Your torso should be straight and rigid, forming a straight line from your ears to your toes (or to your tailbone if you are doing a modified version on your knees). Hold this position for ten seconds to start and as time goes on, work up to 30, 45, and 60 seconds.

    With any new exercise routine, it’s important to start slowly and cautiously to avoid injury. If you are exercising for the first time, you may even want to consult your doctor to discuss what they might recommend for you.

    About Jeri

    Jeri Inmon, PT is a rehabilitation manger at Fisher-Titus. Fisher-Titus Rehabilitation offers Clinical Personal Training at the Walcher Rehabilitation Center Gym. Sessions are $35 for one hour. Call 419-660-2700 to schedule.

  • Everybody hates New Year’s resolutions…and so do I

    In my experience as a mental health counselor, most people seem to hate the whole idea of “New Year’s Resolutions,” to the point where I do not use that term in therapy. I just focus on “goals” in the coming year. I think the reason that so many people hate making New Year’s Resolutions is that we (I include myself) have broken so many of them over the years that the whole concept triggers feelings of shame and guilt, instead of the hope and motivation that is intended.

    I remember being a new therapist and working with a depressed young man. We created a whole written list of things that he could do to help himself feel better. When he came back to our next session, he hadn’t done a single thing on the list. He said that the piece of paper had felt like it weighed about 10 pounds as he left my office, because it was more stuff that he should do, but knew he wouldn’t. It had overwhelmed rather than motivated him.

    I have since learned that the best goals are small ones that are more likely to be accomplished. We often start out with a BIG PLAN to “eat healthy” or “get in shape.” By the 3rd day, we’re back in McDonald’s and didn’t make it to the gym. In fact, I like goals that are tiny, so small that they are not intimidating and are more likely to succeed. I sometimes ask my clients to commit to a goal that is so small that they would be embarrassed to come back to our next session and tell me, “I didn’t do it.”

    For example, instead of making a commitment to “get in shape” someone could commit to doing 5 push-ups, or going up/down a few stairs every day, before taking a shower. If someone wants to read more, that might mean reading one paragraph before bedtime. In the case of meditating, it might be taking 3 calming breaths, first thing in the morning.

    You make it so simple that you don’t have any reasonable excuse not to do it. Call it a “micro-goal.” So even when you’re busy, or you’re sick, or you’re tired…it’s so tiny that you can still do it. It’s hard to use the “I was too busy” excuse for not doing something that literally takes 1-2 minutes. No one is that busy.

    I had to give up lifting weights years ago, due to back problems. About 5 years ago, I committed to doing push-ups every day, before I take a shower. I started with 5, and now I do 20. It may not sound like much, but even small stuff adds up (20 push-ups x 30 days = 600 push-ups per month). Aside from a few lapses, I’ve been able to keep that going for 5+ years.

    As an added bonus, when you have micro-goals that you can easily accomplish every day, it gives you a regular sense of success (rather than failure). Even if nothing else got done today…at least I did my push-ups.

    About Ken Murray

    Ken Murray, Ph.D., LPCC-S provides counseling services to children, adults, and families addressing a wide range of mental health concerns. Ken specializes in providing counseling for children and families and has experience with providing counseling for parent and leading parenting classes. For more information about Fisher-Titus Behavioral Health, visit fishertitus.org/behavioral-health.

  • Why We Care About Pain Part 2: Does Pain Management Make a Difference?

    Last week I discussed what pain is and a few benefits of staying as mobile as possible. For my final installment in this series, I shed light on the role of pain management.

    Does a pain management plan make a difference?

    Medical imaging is closely utilized for developing an appropriate pain management plan. For instance, MRI exams assist doctors in making determinations about the reasons for and the severity of your pain, especially if the pain is located in your spine, hips, shoulders, or knees. In some cases, however, a short course of a non-steroidal anti-inflammatory drug as well as several physical therapy sessions may be recommended before the MRI exam is suggested. In other cases, CAT scans might be a better alternative as well as basic x-ray films.

    What’s more, image-guided pain management is a branch of medicine unto itself. In fact, treatment plans initiated by an image-guided pain management doctor can cover multiple medical disciplines in an interconnected and comprehensive way. The goals are aimed at 1.) reducing your pain complaints; 2.) offering non-surgical interventions; and 3.) improving mobility. A referral to a doctor who specializes in this field is important as early as possible to tackle pain-related issues as soon as possible. Yet, consultations are beneficial during any period in the subacute to chronic phase timeline (from 6 weeks to beyond 3 months).

    Doctors utilizing image-guidance, such as x-ray or ultrasound technologies, for injections that treat pain will specifically target the source of pain with a precise dose of drug for diagnostic or therapeutic purposes. The imaging technologies make delivery of medications more accurate. Small doses of anesthetics as well as anti-inflammatory steroids are typically used. The steroids calm down the targeted nerves and tissues.

    Following an injection, pain management plans may include referrals to exercise specialists and physical therapists to help patients desensitize from their pain and promote mobility. Here again, the information from MRI findings can have important consequences for guiding care. For example, for many people with localized low back pain, the multifidus is a particular muscle that therapists focus on. Pronounced “mul-tif-ə-dus,” this small muscle of the spinal column is responsible for both mobility and support between the column’s bony segments. Here the physical therapy outcome is linked to giving patients time to strengthen their core muscles across the waistline and low back. Simple flexion and flexibility exercises are important.

    There are any number of factors that can cause pain for a wide variety of reasons, yet there are also many image-guided, non-surgical procedures that are well-suited for a great treatment plan. Here examples include minimally invasive lumbar decompression and spinal cord stimulation. Even treatments aimed at reducing facial pain, headaches, or the continuance of pain after back surgery as well as joint replacement surgery are possible. Referral to the appropriate image-guided pain physician starts with a visit to your family doctor.

    About Kevin

    Kevin Wininger, RT(R) is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. This editorial is based on several articles he’s written on the treatment of pain. MRI exams, CAT scans, and x-ray films can be useful in helping your doctors and physical therapists develop a treatment plan aimed at reducing your pain and improving your mobility.

  • Why We Care About Pain Part 1: What is Pain?

    Our nervous systems are marvelously complex. For example, signals for acute versus chronic pain pass through specific regions of the spinal cord. For instance, your brain instantaneously knows when you stub your toe because the accompanying pain signals navigate a unique collection of spinal cord nerves called the spinothalamic tract. And the signals for chronic pain, such as dull and ongoing, arthritic low back pain, transmit within defined segments of the spinal cord known as the dorsal column.

    Pain is also classified as mechanical, inflammatory, or neuropathic. Mechanical pain is associated with anatomical irritation. This explains why we feel a shooting pain, also called radiating pain, when a herniated disc or bone spur rub against nearby nerve roots. Inflammatory pain is associated with tissue damage, such as injury, arthritis, or post-operative trauma. This type of pain is localized to specific areas. A good example of neuropathic pain is peripheral neuropathy related to diabetes. Also, sometimes a subset of our nervous system called the sympathetic nervous system is out of control.

    However, pain is also protective. Imagine taking a casserole dish out of the oven without oven mitts! And the pain that follows a broken arm serves as a reminder to keep your arm stationary so it heals properly. On the other hand, a lack of movement because of the fear of painful injury or reinjury is known as kinesiophobia, such that “kinesio-” means movement and “phobia” means fear. This type of fear can cause someone to think the worst-case scenarios will happen every time they move. But when the time is right, movement is just what the doctor ordered.

    How important is mobility?

    The main benefit of mobility exercises for patients experiencing inflammatory pain is the improved circulation in their areas of injury. Here the increased blood flow brings more and more nutrients to the cells while washing away cellular by-products which promotes healing. This is especially true after surgeries or trauma, and particularly in the early to subacute phases (up to 3 months since onset).

    When pain is chronic, exercises simply help you move better. After all, exercise is medicine and they say practice makes perfect. For people with arthritis, pain levels are typically elevated in the morning and then subside later in the day as a result of being active. However, if arthritic pain returns during the day, gentle stretching and strengthening exercises can diminish the level of severity. In many cases, aquatic exercises are the perfect fit. For instance, the Water Flex classes held at the Ernsthausen Aquatic Center help ease joint pain and muscle aches. Relaxed in their warm-water pool the water’s buoyancy supports you when stretching, and the light resistance is good for walking and other activities that might seem impossible on land.

    Next week I explain the role of a pain management program, including image-guided pain management.

    About Kevin

    Kevin Wininger R.T.(R) is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. This editorial is based on several articles he’s written on the treatment of pain. MRI exams, CAT scans, and x-ray films can be useful in helping your doctors and physical therapists develop a treatment plan aimed at reducing your pain and improving your mobility.

  • Join the Fight Against COVID-19

    Huron County is seeing a significant increase in COVID-19 positive cases. Individually, our caregivers chose a career in healthcare due to a desire to provide care to people in need. Throughout this pandemic, we have prepared to be here for you when you need us. As our intensive care unit and hospital rooms fill with cases of COVID-19—many of which are a result of preventable community spread—we are at risk of not being able to provide the care you expect from us.

    Right now at Fisher-Titus, our employees continue to come in every day and give their all to fight COVID-19 in our community. We have expanded our bed availability, including doubling our intensive care unit beds, and identifying overflow areas into other areas of the hospital so we can continue providing exceptional care for our patients. Our staff garb up with N95s, masks, shields, gowns, gloves, and sometimes more for 12 hour shifts in order to protect themselves and care for their patients.

    While these caregivers are ready to care for the community and are dedicated to fighting COVID-19, the state of the pandemic right now is taking a toll on them. Hear from them what they are seeing and feeling right now at Fisher-Titus:

    Mackenzie, Critical Care Nurse Manager

    Right now I’m feeling tired. I’m exhausted. We put in lots of hours and time and support not only for our patients but for our employees. It’s exhausting. It’s been really rough.

    In my staff I’m seeing a lot of burnout. I see a lot of frustration. I see that they’re tired, they’re exhausted. Garbing up and down for every patient all the time for 12-hour shifts, they leave with marks on their face, skin irritation, hand irritation…you can tell they’re getting tired.

    Back in March and April we anticipated the worst, but we didn’t really see the volumes back then that we’re seeing now. Fast forward a couple months, now we have full units, full ICU, overflow onto med-surg, nurses taking more patients to accommodate caring for the volume of patients. And they’re more critical. We’re seeing more critical patients.

    It’s a lot different. It’s now what we prepared for in March when we were ready with the community closed and now everything’s still open so it’s just harder to manage.

    Me personally, I would say trying to leave it behind, trying to go home and live a normal life, that’s probably the hardest. Seeing patients that die alone or lonely, that’s difficult.

    To the community I would say, think of the people here—employees and patients. Stay home as much as you can. Be mindful about how you felt when this all started. It’s real. It’s not going anywhere. It’s worse now than it was then.

    Follow the guidelines that the CDC gives, that the governor gives, that you hear from your community health care providers. Just isolate and protect each other.

    Nichole, Respiratory Services Manager

    At this point in the pandemic, I’m feeling slightly overwhelmed and stressed. I feel right now that my staff is feeling the pressure from the increase and volume and how sick our patients are. They’re pulling together as a team, they’re working very hard; however, I also do see the fear they have. Everyone is a mother, a father, a sister, a brother, you know we all have family and they’re starting to feel that fear.

    I know it’s hard with the holiday season approaching, everyone wants to get together with their friends and their family, but I feel that we’ve all put our guard down and it’s time to put that guard back up.

    Right now, here at Fisher-Titus, we are seeing an increase in numbers. Therefore, we need to pull together as a community and really slow the spread to protect ourselves and our community and then to hopefully have a light at the end of the tunnel once this is all passed.

    Brandi, Charge Nurse, Emergency Department

    I feel a little bit more worried every day I come to work. A lot of the patients we’ve been seeing lately have been positive.

    It’s hard to care for these patients and then go home to your kids and hope that you’re not taking anything home to them. It is a scary time.

    This is getting bad again and you need to take this seriously. It’s your grandparents it’s your parents, it’s your aunts and uncles and you don’t want to put them at risk. A lot of people don’t take that seriously and I think it’s because they don’t see it on a firsthand basis like we do.

    Wear your mask, wash your hands, limit your outings. Don’t get together for Thanksgiving. We have all these holidays coming up and we want to spend it with our families but if we spend this one with them, it may be that we don’t get to spend the next one with them.

    Liana, Med-Surg Nurse, COVID Unit

    I’m feeling nervous for what’s to come and exhausted from what has come.

    There’s extreme burnout among the nurses taking care of the COVID patients. You’re talking about gowning up when you go in, gowning up when you come out. You’re talking about family members calling all day long for updates and we don’t blame them. There’s just an increase in burnout.

    We know we didn’t sign up for this, but we would literally pour our heart and soul into our jobs to help people. That’s what drives us. That’s what makes our hearts beat is helping other people that’s who we are.

    This is serious. Don’t think that you can’t get it. Don’t think that your family can’t get it. Don’t think that you can’t pick it up the places that you’re going because you can. This is real and it is going on.

    Wear your mask. It’s respectful of you as a person to wear a mask in the community. I have had several patients who have had it who have not had symptoms that end up having COVID. If they don’t wear a mask, look at all the people that they’ve given it to. No, they didn’t know they had it, but they gave it to people that do know they have it now.

    If the patient’s not critical then fine, and there’s a lot that aren’t critical. But, you’re talking about a very fine line that you ride with a COVID patient. They can go past that line at any point. And that’s always in your mind. Can we handle it? Yeah. But does it get to you after three weeks of on-edge taking care of patients that ride that thin line? Yes. You just want a break. You want to get out of that twilight zone for a little bit.

    Wear your mask or, better yet, stay home.”

    Help us fight COVID-19 right here in our own community.

    We are asking you all to join our employees in the fight against COVID-19. We need your help.

    • Wear your mask
    • Distance yourself from those outside your household
    • Practice proper hand hygiene

    We need everyone to work together to slow the spread right her in our own community.

    For more information, visit fishertitus.org/coronavirus.

  • Supporting Loved Ones in Long-term Care During the Pandemic

    We understand how difficult it can be to have a loved one in a long-term care facility during the COVID-19 pandemic. As we work hard to protect residents and staff from the spread of COVID-19 by following Ohio Department of Health, Centers for Disease Control and Prevention, and Centers for Medicare & Medicaid Services guidelines, families may not be able to visit and interact with their loved ones in the same ways they’re used to.

    However, your loved one’s caregivers are still committed to helping residents stay connected with their families. Here are some ideas on how to keep in touch and how we’re supporting communication between our residents and their families at The Carriage House and The Norwalk Memorial Home.

    Take advantage of the available technology.

    We are teaching and assisting residents to use video chat applications and will help them read emails or texts on personal devices if needed. Reach out via video, chat, email, text, and phone calls. If you need help coordinating these things, we are happy to assist any way we can.

    Send cards and letters.

    Share messages of support and updates on family members to your loved ones. We will make sure residents have the necessary supplies like paper, pens, envelopes, and postage so they can reply. If needed, we can also write dictated replies.

    Send recorded video messages via email or text message.

    If your schedule or other challenges make it difficult to arrange a live video chat, you can record a message and send it to your loved one via email or text message. We will share the messages with them and help them record replies.

    Window and outdoor visitation and “parades.”

    We can work with families to schedule window visits, outdoor visitation, and car parades when weather permits. We will make every effort to ensure residents can safely participate as long as these activities are scheduled in advance.

    Visuals to show you care.

    We will help you find space outside for ribbons, flowers, posters, and banners that your loved one can see.

    Assemble care packages.

    Include pictures, cards, drawings, snacks, and entertainment items your loved one would enjoy (such as books, magazines, and puzzles). Care packages for Norwalk Memorial Home residents can be dropped off at the Fisher-Titus Patient Pavilion entrance and Carriage House residents’ packages can be dropped off at the front door.

    Dedications on the in-house intercom system.

    We can dedicate songs or share messages through the intercom before broadcasting a movie or playing music. If your loved one has a favorite song, poem, movie, or television show, please let us know.

    Send flowers from the Fisher-Titus Gift Shop.

    Petal Pushers by Mandy stocks the gift shop daily with beautiful fresh flower arrangements. To order an arrangement for delivery to a Norwalk Memorial Home or Carriage House resident, call the gift shop at 419-660-2800.

    These are just a few ideas. We encourage families to get creative in finding ways to connect with their loved ones safely during the pandemic. If you think of any additional ideas or creative ways we can work together to support our residents, please let us know by contacting Stephanie Whitt at 419-668-4228 or John Tucker at 419-668-5162.

    About Stephanie

    Stephanie Whitt, CTRS, CDP is the Senior Care Services Manager at Fisher-Titus. She has been with Fisher-Titus since 2008. For more information about Senior Services at Fisher-Titus, visit fishertitus.org/senior-health-services for more information.

  • Reflecting on a Generous Community

    There is a lot that I value and enjoy about having grown up in, been shaped by and living in this community. One of my favorite things about our community and its people is the generosity and the kindness.

    While on a weekend trip to Detroit in about 1987, our family bumped into the Hancock family at the Henry Ford Museum. The Hancocks had moved away from Norwalk several years earlier. Mr. Hancock said something like, “I have lived on the East Coast, the West Coast and a number of cities in between, and I have never seen anything like Norwalk, Ohio. You truly care about your neighbors. When someone gets sick or when someone is down on their luck, you come together, and you help them out. When something needs to get done, you pull together, give your time, work hard and make it happen.”

    A contractor for Fisher-Titus shared a similar observation with me at the Fisher-Titus Foundation’s 2020 Golf Outing. “If I had to explain Fisher-Titus’ brand or culture, I would say it is kindness.” I knew exactly what she meant and was proud that this woman, who spends lots of time in lots of health systems in lots of communities across the Midwest, had this experience with my colleagues and neighbors.

    I have been thinking about our generosity, resilience and unity a lot this year. Despite the pandemic, the economic challenges, the hardships, the isolation, and despite a divisive year for our country, when the chips were down we sacrificed, came together, worked hard and accomplished some really big things. We loved our neighbors.

    Our contractors, our health system, our business community and two school systems came together, donated money, gave thousands of “man hours” and equipment hours, and built a new home for our football and track athletes, school communities and residents.

    When the pandemic hit and PPE was in short supply, our businesses, schools and residents stepped up and PPE came pouring in for healthcare workers and first responders. There were teachers and students fabricating masks with 3D printers. Volunteers started sewing cloth masks. Contractors dropped off cases of N95s. People found a way to support their favorite local restaurants and support frontline healthcare workers with a meal.

    Many of our neighbors went to work to take care of us — stocking our groceries, delivering our mail, fixing our cars, treating the sick, putting out fires, babysitting our children — at great risk to themselves. Other neighbors stayed home to keep us safe, at great financial cost and emotional burden.

    And through all of this, our community continued to support its churches, food banks, schools, non-profits and hospital to meet the needs of our neighbors.

    Philanthropy is the desire to promote the welfare of others, often expressed by generously donating money to good causes. Sunday, Nov. 15 is National Philanthropy Day, a day to acknowledge and thank the philanthropists who have given us our hospitals, libraries, parks, schools, churches, community centers, museums, health research and disease cures, and the arts. The lives we enjoy today and the opportunities we have had owe so much to the generosity and stewardship of the people who came before us.

    We are all called to leave our little corner of the world better than we found it — in big and little ways, using our talents and our treasure. We have this beautiful community, full of amenities usually reserved for bigger and wealthier cities, because of the sacrifice and stewardship of John Ernsthausen, Warren C. Whitney, William and Lura (Titus) Fisher, and hundreds of philanthropists who often humbly and silently support needs in our community.

    This year, I will observe the day with a quiet thank you for the comforts and opportunities gifted to me. I will be grateful for the outpouring of generosity, sacrifice and kindness that have carried me and my neighbors through some dark days this year. And I will write a couple checks to organizations that will leave our community better for my kids, my grandchild and those who will come after me.

    To learn more about the work of the Fisher-Titus Foundation, visit www.fishertitus.org/foundation.

  • Caring for Yourself as You Care for a Loved One

    November is National Family Caregiver Month. Over 53 million Americans are caregivers to family, friends, and neighbors and that number is only expected to grow as the senior population in the country increases.

    Under normal circumstances, being a loved one’s primary caregiver is stressful. The COVID-19 pandemic has added to this stress as you continue caring for your loved one while trying to keep yourself and them safe from the spread of COVID-19. Feelings of stress, worry, and isolation have impacted everyone during the pandemic but may be magnified for those who serve as a primary caregiver for a loved one.

    As you care for others, it’s important to take care of yourself as well both physically and mentally. There’s a saying that goes “you can’t pour from an empty glass,” meaning that if you aren’t taking care of yourself, you won’t be able to give your best to another person. Here are some tips for taking care of yourself as you take care of someone else.

    Make sure your physical needs are met.

    It’s easy for us to get caught up in our never-ending to-do lists and forget to meet our basic physical needs. This is especially true for caregivers. Make sure you are getting enough sleep, eating nutritious meals three times a day, drinking enough water, and staying active. If you aren’t caring for these needs, you will be tired mentally and physically and caregiving will take an even greater toll on your health.

    Acknowledge your feelings about caregiving.

    When you’re caring for another person, a lot of the focus—both with them and when talking with others—can be on them. You may be asked what they need or how they feel and those may be the first thoughts on your mind as well. This might make you feel like part of your job as a caregiver is to sacrifice your own happiness to take care of them and you may feel as if you are being selfish if you think of your own feelings. However, you are still a person with feelings and it’s OK to feel a lot of emotions about being a caregiver. You might feel exhausted, stressed, resentful, isolated and alone, or even hopeless. Try not to ignore them as they won’t go away, they’ll just build up until they eventually come out. Find outlets for expressing these feelings like talking to trusted friends, journaling, support groups, or counseling.

    Manage your expectations of yourself.

    Remember that you are only one person and there is only so much you can do on your own. It’s easy to put pressure on yourself to meet all their needs since they’re unable to by themselves but even if you dedicated all your time and energy to caregiving, you still probably couldn’t do it all on your own. Be realistic of what you’re able to accomplish on your own.

    Ask for help.

    Find ways to share the caregiving load whenever possible. This could be having a family member take over for a couple hours so you can nap or do something you enjoy. There may be local organizations where you can ask for volunteers to help you out or more formal services like respite care. As you look into these options, involve the person you care for. Ask them what they need and want. There may be things that you’ve been taking care of that they could manage for themselves. Depending on your relationship, you can also have a conversation about how you are feeling so they understand why you are looking for other outlets to help you care for them.

    Set boundaries.

    You may have to have difficult conversations about what you are willing and able to do as a caregiver. It could be that other family is capable of helping but have chosen to leave the burden on you. Or, it could be that the person you’re caring for has unreasonable expectations of you. Before you approach these conversations, it can help to write out your thoughts or talk them through with a trusted friend. Decide what boundaries you need to set for your own wellbeing and stick to them. It’s OK to be firm. People often struggle with new boundaries but in time they will adjust. You’ll have a better experience as a caregiver if you communicate clearly with everyone involved.

    John Tucker is the Director of Senior Services at Fisher-Titus. Fisher-Titus offers a continuum of care for seniors including Home Health, Assisted Living, and Skilled Nursing. For more information, visit fishertitus.org/senior-health-services

  • World Stroke Day

    World Stroke Day is October 29. Stroke is the number five cause of death and the leading cause of disability in the United States. This World Stroke Day, educate yourself about stroke so you can take steps to prevent it and know how to recognize it in yourself and your loved ones.

    What is a Stroke?

    Stroke is a disease that affects the arteries leading to and within the brain. There are two types of stroke. An ischemic stroke occurs when a clot obstructs blood flow to the brain. A hemorrhagic stroke occurs when a blood vessel ruptures and prevents blood flow to the brain.

    Risk Factors of Stroke

    Strokes can happen to anyone at any age. In fact, about one in four people worldwide will have a stroke in their lifetime. However, there are several risk factors that put you at higher risk for having a stroke.

    • High Blood Pressure is the number one preventable risk factor for stroke. Normal blood pressure is below 120/80. If you have high blood pressure, work with your doctor to take steps to lower it. Not only will this lower your risk of stroke, it will also help your brain to function better for longer.
    • What you eat. A diet high in saturated fat, trans fat, and cholesterol can raise blood cholesterol levels. Diets high in sodium (salt) can increase blood pressure. High-calorie diets can lead to obesity. All of these things can increase your risk of stroke. Eat lots of fruits and vegetable and work with your doctor on creating a healthy diet that can help lower your risk of stroke.
    • Diabetes more than doubles your risk of stroke. Every two minutes, an adult with diabetes in the U.S. is hospitalized for stroke. If you have diabetes, you should work closely with your doctor to ensure you are properly managing your condition and reducing your risk of stroke.
    • High cholesterol increases the risk of blocked arteries. If an artery leading to the brain becomes blocked or throws a clot, a stroke can occur. Get your cholesterol checked regularly and work with your doctor to make sure it stays under control.
    • Smoking damages blood vessels, leading to blockages and stroke. Don’t smoke and avoid second-hand smoke.
    • Atrial fibrillation (AFib) is an irregular heartbeat that causes the hearts upper chambers to quiver rather than beating in an organized, rhythmic way. AFib increase the risk of stroke by five times. The fluttering may cause blood to pool and clot then traveling to the brain. If you have AFib, proper management is the key to lowering your risk of stroke.
    • Sleep-related breathing issues may increase stroke risk. Seek medical treatment right away if you suspect sleep apnea or a similar problem.

    How to Prevent Stroke

    Up to 80% of strokes are preventable through changes in lifestyle and proper management of conditions like high blood sugar, cholesterol, and blood pressure. Not only will these changes help reduce your stroke, they can help reduce your risk of other conditions and help you lead an overall healthier lifestyle. Some lifestyle changes you can make are:

    • Managing your blood pressure numbers, aiming to keep them under 130/80. Work with your doctor and stick to the medication and lifestyle plan they created with you.
    • Eating vitamin-rick fruits and veggies. This can lower blood pressure and improve brain function.
    • Swap salty snacks for almonds or fruits.
    • Taking regular walks or introducing other physical activity into your routine. This can help lower blood pressure and help you maintain a healthy weight both of which reduce your risk of stroke.
    • Get good sleep every night. 7-9 hours of sleep each night can improve your brain function.

    How to Recognize a Stroke?

    While it’s important to take all these steps to prevent stroke, it’s still important to understand what stroke looks like so you can recognize it in yourself and others should it ever occur. Knowing the common stroke warning signs and what to do someone is having a stroke can be the difference between recovery and disability. The acronym BE FAST can help you remember these signs:

    • B – Balance. Is the person suddenly having trouble with balance or coordination?
    • E – Eyes. Is the person experiencing suddenly blurred or double vision or a sudden loss of vision in one or both eyes?
    • F – Face drooping. Does one side of the face droop or is it numb? Ask the person to smile.
    • A – Arm Weakness. Is one arm weak or numb? Ask the person to raise both arms. Does one arm drift downward?
    • S – Speech Difficulty. Is speech slurred, are they unable to speak, or are they hard to understand? Ask the person to repeat a simple sentence like, “The sky is blue.” Is the sentence repeated correctly?
    • T – Time to call 911. If the person shows any of these symptoms, even if the symptoms go away, call 911 and get hem to the hospital immediately.

    Stroke Care at Fisher-Titus

    Fisher-Titus is a certified Primary Stroke Center through the Healthcare Facilities Accreditation Program. This means that we have the ability to stabilize and treat acute stroke patients, provide acute care, and administer tPA and other acute therapies safely and efficiently.

    Additionally, Fisher-Titus received the 2020 American Heart Association/American Stroke Association’s (AHA/ASA) Get with the Guidelines Stroke Gold Plus achievement award. We were also recognized as a recipient of the Target: Stroke Elite Plus Honor Roll with Target: Type 2 Diabetes Award.

  • Why You Should Continue Doing Your Part As the Pandemic Continues

    Day-in and day-out hospital caregivers, emergency management services, paramedics and your local physicians are on the front lines caring for patients and the community as COVID-19 devastates our lives presenting challenges that we’ve never experienced before.

    Fisher-Titus – including the medical center, medical care group, and North Central EMS – have continually reviewed and revised the policies and procedures put into place to meet these challenges to help keep our staff, patients, and guests safe. While we understand things like stricter visitor guidelines can be frustrating, please know we are doing this for the health and wellness of our community.

    This pandemic is far from over and the last seven months we have seen every aspect of our lives altered from shopping at the grocery store to our daily interactions with family and friends. Recent information released from the state shows Ohio’s current positivity rate is 4.1 percent as compared to 2.7 percent on September 23 and 24. A total of 51 counties are considered high incidence and/or Alert Level 3 on Ohio’s Public Health Advisory System. Even more devastating, more than 5,000 Ohioans have died from COVID-19 and over 16,000 have been hospitalized.

    Additionally, Ohio COVID-19 hospitalizations are trending upward in recent weeks, particularly in rural areas and in our community. Hospital beds, ventilators, ICU beds are essential to providing care for COVID-19 patients. We need all Ohioans to take preventative action to stop this spread of COVID-19 and prevent surges to our health care system. Today there are communities across the country with hospitals overwhelmed with patients. Just a few months ago, three states (Florida, Texas and California) had many communities with hospitals overwhelmed (VOX Media).

    Even in our own county we are seeing an increase in positive cases as we further approach into what is traditionally cold and flu season as reported on the Ohio Department of Health’s COVID-19 dashboard. According to the dashboard, the most number of cases for Huron County are from those in the 20-29 age range while hospitalizations and deaths are adversely effecting those aged 70-79.

    The health care services in our community are strong but when faced with a pandemic such as COVID-19 and the rapid spread it brings, our health care services will be overwhelmed if preventative measures aren’t taken by you. We are approaching a time of year where colder weather will increase more indoor activity and interaction, not the best situation for preventing the spread of this virus. We are also coming upon a time of year where we will gather for holiday festivities, community celebrations, sporting events and family reunions. We are all seeing the impact of “COVID fatigue” and it’s imperative we don’t fray and we must stay the course.

    The actions we need everyone to take are important, they matter, and they will ensure our businesses stay open, our economy keeps going and we don’t have our health care system disrupted. By taking preventative measures, wearing a mask, social distancing, and hand washing, you are minimizing your chances of getting infected or spreading the disease. First and foremost, masks protect others – especially the vulnerable. While the risk of spreading COVID-19 is lower when at least one individual is wearing a mask, the probability is lowest (70%+ less likely) when both (or all) parties are wearing masks while practicing physical distancing.

    We appreciate all those doing their part to keep themselves and others safe as we navigate this evolving virus. Patients with questions may contact their doctor to discuss their concerns to learn how best to be preventive so we can quickly end this pandemic.

  • 11 Tips for a Safe Halloween

    Like just about everything else this year, Halloween 2020 is bound to look a little different. But that doesn’t mean you can’t have fun! As you make your Halloween plans, keep in mind that COVID-19 is still very much around and use these tips based on Ohio Department of Health and Centers for Disease Control guidance to plan a safe and fun holiday.

    1. Limit activities that put you in close contact with others outside your household.

    Unfortunately, that means that you should avoid hayrides and haunted houses this year. Exercise caution when deciding to participate in trick-or-treat or other events. Try to choose events or attractions that are mainly outdoors and/or allow for physical distancing.

    2. Avoid large in-person Halloween parties.

    Should you choose to hold a smaller party, limit attendance to 10 people or less. You should also hold the party in an outdoor area that allows for physical distancing. Avoid activities like bobbing for apples that may promote the spread of COVID-19.

    3. Always wear a mask.

    No, not the spooky kind this year! Whenever you are around those outside your household you should wear a cloth mask or surgical mask to avoid spreading COVID-19. You can get creative and find face coverings that match your costume or are Halloween themed. Costume masks should not substitute a cloth mask and should not be worn over a cloth mask as it can make breathing more difficult. Children under two should not wear a mask.

    4. Practice good hand hygiene.

    Wash your hands with soap and water when you can. You should also carry hand sanitizer and use it often especially after coming into contact with high-touch surfaces and before and after eating.

    5. Limit the number of houses you visit for trick-or-treat.

    Pick a few houses to stop at rather than visiting dozens. Remind your children to maintain six “spooky feet” apart when getting their treats and when walking from house to house. If you have small children, it may be best if you hold them bag for them and retrieve their candy for them. Try to refrain from having children grab their own treats from a common bowl or container or be sure to sanitize after.

    6. Put collected candy aside for 48-72 hours before letting them go through their treats.

    It is believed that the virus cannot live longer than 72 hours on surfaces. Once the 72 hours have passed they can then enjoy the treats they collected and you have the comfort of knowing they are less likely to come in contact with COVID-19.

    7. Have treats ready for them when you get home from trick-or-treat.

    Pick up your own bag of candy or other treats so your children have something safe ready for them to enjoy when you get home. Trick-or-treating leads to a monstrous appetite!

    8. Sanitize candy wrappers before eating.

    You can choose to use sanitizing wipes to disinfect the outside of the candy wrappers when you arrive home if you do not let it sit out for 48-72 hours untouched. Remember to never wipe unpackaged food.

    9. Avoid handmade items.

    Only allow children to eat factory-wrapped treats and do not accept homemade treats made by strangers.

    10. Consider planning alternate types of events that allow for physical distancing.

    Think of ways you can adapt your Halloween traditions to better allow for physical distancing. Some ideas include:

    • Drive through trick-or-treat. Children can wear costumes and face coverings and stay in the car while individuals spaced six feet or more apart pass out candy
    • Drive by costume or car-decorating contests
    • Leaving pre-packaged treats or friends and neighbors
    • Decorate your house or host a neighborhood house decoration contest
    • Hide treats for kids in your family and have a Halloween scavenger hunt
    • Hold video conference costume parties or pumpkin decorating
    • Carving or decorating pumpkins with members of your household or outside at a safe distance with neighbors and friends
    • Organize a Halloween scavenger hunt where children are given lists of Halloween-themed things to look for while they walk outdoors from house to house admiring Halloween decorations at a distance

    11. Consider your risk and the risk of your family members as well as local COVID-19 data.

    If you or someone you are in frequent contact with is at greater risk of complications if infected with COVID-19, take extra precautions. These include individuals with certain health conditions, women who are pregnant, and older adults. If you are unsure of your risk and what precautions you should be taking, contact your doctor. You should also keep in mind what color level the county is at as that will give you a sense of how much COVID-19 is spreading in our community.

    As always, we wish you and your family a fun, safe, and Spooktacular Halloween 2020!

    About the Authors

    Dr. Aml KeladaDr. Elizabeth Olds, and Kathryn Falter, CPNP are all providers at Fisher-Titus Pediatrics in Norwalk. Fisher-Titus Pediatrics has same-day and next-day appointment availability and virtual visits. Existing patients can schedule online by visiting fishertitus.org/schedule.

  • What Are Annual Blood Tests And Why Should You Get Them?

    Most people probably have had blood drawn at some point in their lives. Blood tests analyze various components of your blood to detect physiological and chemical changes in the body. These blood tests can indicate things such as what diseases a person may have, how effective their medications are, and how their organs are functioning.

    By getting blood work each year, your doctor is able to track the way your body changes throughout your life. Even if you are healthy, getting blood work now can help give your doctor a baseline so should something change in the future, they can compare results and detect subtle changes.

    But what tests should you be getting? There are many different types of blood tests that indicate different things. Talk to your doctor at your annual physical about which tests they would recommend for you.

    What are the Different Types of Blood Tests?

    Fisher-Titus hosts several health screenings throughout the year where individuals can pay out of pocket for various blood tests at a reduced rate. For individuals who are uninsured or for those whose insurance may not cover these types of tests, this can be a more affordable option to get the testing they need.

    The tests below are all offered at varying prices at all Fisher-Titus Community Health Screenings.

    Complete Blood Count – The complete blood count acts as a quick snapshot of your overall health. It measures the number, variety, percentage, concentration, and quality of platelets, red blood cells, and white blood cells. It is useful in screening for infections, anemias, and other hematological abnormalities.

    Basic Metabolic Panel – The basic metabolic panel measures glucose, blood urea nitrogen (BUN), creatinine, electrolytes, and calcium. This test can help determine whether your kidneys are functioning properly and helping you maintain the right balance of water, salts, and minerals in your blood.

    Lipid Profile – The lipid profile provides your doctor with information on your cardiovascular health. This test measures cholesterol, triglycerides, HDL, and LDL.

    Liver Enzymes – The liver enzymes tests can indicate if there is liver disease or damage. This test can also be used to monitor liver disease in a person who has a diagnosed problem. The test measures alanine transaminase (ALT) and aspartate transaminase (AST). ALT helps convert proteins into energy and AST helps metabolize amino acids. When the liver is damaged, these enzymes are released into the blood and elevated levels will show on the test.

    Complete Blood Count, Basic Metabolic Panel, Lipid Profile, and Liver Enzymes are all part of the Blood Analysis test offered at Fisher-Titus Community Health Screenings.

    PSA (Prostate Specific Antigen) – PSA is a protein found in men that is created in the prostate. A PSA test checks the level of this protein. Elevated levels can indicate if a person has an enlarged prostate, prostate inflammation, or prostate cancer.

    Hemoglobin A1c – A Hemoglobin A1C test is one of the best ways to assess glucose status. The test measures your blood sugar over the past few months. The results can help your doctor diagnose prediabetes and diabetes and is also used to help manage diabetes in patients who have been previously diagnosed.

    TSH (Thyroid) – Thyroid Stimulating Hormone (TSH) controls thyroid hormone secretion. If levels from this test are lower than normal, it can suggest hyperthyroidism. If levels are above normal, it can suggest hypothyroidism. Symptoms of thyroid imbalance can be hard to pinpoint and some individuals may not even have any symptoms. A TSH blood test can help your doctor diagnose mild thyroid imbalance before it progresses and becomes a larger problem.

    Vitamin D – Having inadequate levels of vitamin D in the blood is a very common issue. Vitamin D deficiency can be linked to osteoporosis, increased fracture risk, cancer, autoimmune dysfunction, cardiovascular disease, multiple sclerosis, lowered immunity to colds and flu, type 1 diabetes and hypertension. By regularly checking your Vitamin D levels, your doctor can determine if you have a Vitamin D deficiency and can help you determine the appropriate steps to correct it.

    About Rodney

    Rodney Tuttle is the Director of Laboratory at Fisher-Titus. The next Fisher-Titus Community Health Screening is on October 24 from 7-10 a.m. Schedule an appointment by calling 419-660-2646. You will be asked to choose from a list of tests and provide the name of your physician. Registration closes on October 21 at 5 p.m. For more information, visit our online event calendar at fishertitus.org/upcoming-events.

  • The Importance of a Primary Care Provider

    Your Primary Care Provider plays a vital role in the care of your health throughout your lifetime. This primary care week, learn more about the importance of a primary care provider.

    What is a Primary Care Provider

    Your primary care provider is a doctor, nurse practitioner, or physician’s assistant who manages your overall health over time. Your PCP is someone you can develop a trusted relationship with. They get to know you, your history, and your family history and they have the best picture of your overall health.

    Primary care providers may work in family medicine, internal medicine, obstetrics and gynecology, or pediatrics.

    Here are some examples of things to see your primary care provider for:

    • Regular health screening or wellness visits
    • Management of chronic conditions
    • Something is causing you concern or advice for a health problem
    • Fever, cough, sore throat, cold earaches or rashes
    • Unexplained weight changes
    • Lingering pain
    • Prescription refills
    • Minor injuries such as sprains, back pain, minor cuts and burns, minor broken bones, or minor eye injuries
    • Bladder or urinary tract infections
    • Vaccinations
    • Migraine headaches

    Benefits of a Primary Care Provider

    There are many benefits of having a primary care provider including:

    • Understanding your history. Your primary care provider has access to all of your medical records as well as your family history. This helps them see the full picture when it comes to your health rather than the snapshot other providers may get from a single visit at an urgent care or emergency room.
    • Building a relationship. You get to know your primary care provider throughout your life and come to build a relationship with them. Because you become more comfortable with each other, they are able to better understand your medical situation and you may feel more comfortable bringing issues to them and asking questions you may have.
    • Prevention and early detection. Your primary care provider can recommend regular tests and screenings based on your personal and family history. These regular checkups, tests, and screenings with the same provider make it more likely that any potential health issues will be caught early when they are most treatable.
    • Condition Management. If you do happen to encounter a more complex health issue, they are crucial in coordinating care. They can refer you to necessary specialists, review all tests, prescriptions, and make sure everyone on your care team is working together. When multiple specialists are working together or you have multiple health challenges, your primary care provider is the link between them all.

    Primary Care vs. Convenient Care vs. Emergency Care

    There are many circumstances where you may require medical attention but are unable to see your primary care provider. This could be because it is outside of regular office hours or there are no available appointments and you need to care soon. This is where Convenient Care and the Emergency Department come in.

    At convenient care, patients can walk in and receive services on a first-come, first-serve basis for minor illness and injury. Typically, the insurance co-pay is the same as a regular office visit. The convenient care provider will follow up with your primary care provider to let him/her know you were seen.

    The ER is open 24/7 for any situation where you need immediate medical attention. The Emergency Room provides care for serious, and/or potentially life-threatening medical situations. If you are considering going, you probably should. If it’s a serious emergency, don’t hesitate to call 9-1-1.

    When you arrive at the ER, you will be triaged and receive care based on the severity of the situation. You may have to wait a bit longer if there are other patients there with more serious conditions. The ER is also usually costlier than primary care and Convenient Care so it should be reserved for emergency situations where you cannot wait for care.

    Convenient Care and the ER are not replacements for Primary Care. After you visit Convenient Care or the Emergency Room, you should still follow up with your Primary Care to talk about your visit and determine if any follow up with them is necessary.

    If you don’t currently have a primary care provider, it’s never too late to find one. Fisher-Titus has providers accepting new patients several locations. To find a provider, visit www.fishertitus.org/find-a-physician or call 419- 660-2900.

    About Dr. Canfield

    Dr. Christina Canfield is a physician with Fisher-Titus Family Medicine in Wakeman and is the Chief Medical Officer of Fisher-Titus Medical Care. She has been practicing in the area since 1994. Fisher-Titus has five Family Medicine locations in New London, Norwalk, Milan, Wakeman, and Willard. For more information, visit fishertitus.org/access.

  • Health and Care of Bones Across the Lifespan Part 2: Are there any good habits for the care of bones?

    Last week, I discussed what bone is and why calcium matters. For my final installment in this series, I shed light on exercise, calcium and vitamin D daily recommendations, and DEXA scans.

    Exercise is important

    My mantra is “exercise is medicine.” In fact, the stress associated with exercise plays a key role in keeping our bones in shape. Exercise positively influences bone density by augmenting mineral deposits, which fights osteoporosis.

    The American College of Sports Medicine suggests 10 to 20 minutes of weight-bearing exercises twice daily, 3 to 5 days per week. Some good activities include walking, jogging, stepping, jumping rope, or stair climbing. Resistance exercises performed with manageable weights are likewise favorable. A good exercise plan keeps us agile, which in turn makes us less susceptible to falls and fractures.

    Calcium and Vitamin D

    To further promote the care of bones, the National Osteoporosis Foundation recommends a daily level of 1,000 milligrams (mg) of calcium for women age 50 or younger as well as for men age 70 or younger. However, a daily amount of 1,200 mg is recommended for women older than age 50 and for men older than age 70.

    Note that women are encouraged to increase their calcium intake at a younger age than men because estrogen levels drop during menopause. Estrogen is considered a fairly strong osteoprotective hormone. It inhibits osteoclasts from outpacing osteoblasts in the normal cycle of bony remodeling. However, too little levels of testosterone in men can end up being anti-osteoprotective, and therefore lead to bone loss.

    As for sufficient amounts of vitamin D, 400 to 800 international units (IU) are needed per day for adults age 50 and younger. At 51 years of age, 800 to 1,000 IU per day are recommended. The best source of vitamin D comes from direct conversion in the body due to sunlight exposure. However, both fish and eggs offer their own unique sources of this vitamin. And while all dairy foods contain calcium, the Food and Drug Administration ensures that fluid milk (and breakfast cereals) are vitamin D fortified.

    DEXA Scanning

    The gold standard for testing bone density is DEXA scanning. This test is simple to conduct using a special x-ray machine, as well as comfortable and extremely safe for individuals to undergo. DEXA stands for dual energy x-ray absorption. Although an initial scan evaluates the likelihood for developing osteoporosis, scans repeated every two years will assess steps taken to improve your bone density. If necessary, adjustments in your overall approach can always be made. Knowledge is a powerful motivator.

    The National Osteoporosis Foundation recommends DEXA scans for women who are age 65 or older, men who are age 70 or older, and for men or women if a bone is broken after age 50. In addition, DEXA scans are specifically warranted if a bone break or a bone loss, or both, is mentioned after a regular x-ray of your spine. Finally, results from DEXA testing are useful if you lose 1 inch of height within 1 year or 1.5 inches of your maximal height during your lifetime.

    With a physician referral, a radiology technologist from Imaging Services at Fisher-Titus Medical Center will conduct a DEXA scan to assess your bone density. Similarly, dieticians from Nutrition Services and exercise specialists from Rehabilitation Services will gladly review diet and exercise strategies to minimize bone density loss.

    About Kevin

    Kevin Wininger is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. With an appropriate physician referral, a radiology technologist in Fisher-Titus’ Imaging Services will conduct a DEXA scan to assess your bone density. Similarly, dieticians from Nutrition Services and exercise specialists from Rehabilitation Services will gladly review diet and exercise strategies to minimize bone density loss.

  • Health and Care of Bones Across the Lifespan Part 1: What is Bone? Is Calcium Important?

    Bones protect our organs and offer pivotal support for our muscles. Two types of bony tissues make up our skeletons. The first tissue type is called cortical bony tissue, which is strong and dense. The second type is trabecular bony tissue, which is flexible and much less dense. It is this unique pairing which gives each bone its strong, lightweight nature. In fact, I never grow tired of people’s reactions after they learn that ounce for ounce, bone is stronger than steel. What is more, our bones remodel at a fairly rapid pace. Every 10 years we acquire an entirely new skeleton. The cells carrying out this process are called osteoblasts and osteoclasts.

    Bone remodeling and growth

    Although osteoblasts lay out new bone matrix, it is osteoclasts that either remove old bone or perform maintenance for new bone growth. Repair of a fractured humerus – the long bone of the upper arm – is a good example.

    First, osteoblasts secrete a substrate that fills the space between the broken pieces. Little finesse is exhibited by these cells, however, as they normally overproduce matrix at the injury site. The result conjures up an image of the two halves of the fractured bone stuck in a handful of clay, but this is only the first step. Lastly, osteoclasts chisel off the excess material and create a smooth transition from new bone to old bone. We may imagine this effort as one similar to an artist sculpting a masterpiece with exquisite detail.

    How important is calcium?

    Despite the incredible benefits of bony remodeling throughout our lifetimes, wholesome ingredients for our skeletons are critical during formative years. This means getting the right nutrition to ward off the growth of soft bones when we are younger (i.e., rickets) and the onset of porous, brittle bones when we are older (i.e., osteoporosis).

    For starters, calcium and vitamin D are important. The role of vitamin D is vital because it helps transport the calcium found in dairy products and other food sources through the lining of our intestinal tract and into our bloodstream. At this stage, calcium travels within the circulatory system, with most of it en route for storage in our bones. Stored calcium is in a crystalline form that provides bone strength. In fact, over 99% of the total calcium found in the body is in teeth and bones. But there is much more to calcium than meets the eye.

    Including its role in bone health, calcium is one of the most important elements in the body. This claim stems from calcium’s presence within our heart and skeletal muscles. Here it is required for proper functioning. Calcium is also necessary for proper nerve function. If the levels of free, circulating calcium in the blood are low, then this mineral is tapped from its bony storage sites. However, when the appropriate levels of unbound calcium are reached, the bony reserves are restocked. The entire process is akin to a finely-tuned, highly-efficient feedback loop. Other minerals with important roles for good bone health include phosphorus, magnesium, potassium, and boron.

    Next week I will explain good habits for the smart and feasible care of our bones.

    Kevin Wininger is as a radiology technologist and exercise physiologist at Fisher-Titus Medical Center. With a physician referral, a radiology technologist in the Imaging Services department at Fisher-Titus will conduct a DEXA scan to assess your bone density. Similarly, dieticians from Nutrition Services and exercise specialists from Rehabilitation Services will gladly review diet and exercise strategies to minimize bone density loss. Talk to your doctor about referrals for these services if you think you might benefit.

  • Sepsis Awareness Month

    Sepsis is responsible for more than 270,000 deaths a year in the United States. Although 65% of Americans say they know the word “sepsis,” only 12% can identify the most common symptoms. September is sepsis awareness month. Take the time this month to familiarize yourself with sepsis so you can recognize it yourself and your loved ones.

    What is Sepsis?

    Sepsis is the body’s overwhelming response to infection or injury. It can lead to tissue damage, organ failure, amputations, and death. Your immune system usually works to fight germs and prevent infection, but sepsis occurs when your immune system stops and turns on itself.

    When patients develop a set of signs and symptoms related to sepsis they may be diagnosed with the disease. Sepsis progresses to severe sepsis when in addition to these initial signs and symptoms, the patient shows signs of organ dysfunction such as difficulty breathing, low or no urine output, abnormal liver tests, and changes in mental status. Nearly all patients with severe sepsis will require treatment in an intensive care unit (ICU).

    While there is no simple test or cure for sepsis, it can be prevented by preventing infections and can be treated successfully in most cases with early recognition and treatment.

    Causes and Risk Factors of Sepsis

    Sepsis starts with the presence of an infection. The infection can be viral, bacterial, or fungal or even caused by a parasite. This infection can start anywhere in the body from something as small as a cut or bug bite to a larger infection like pneumonia or meningitis.

    Sepsis can affect people of all ages and health levels. However, it is more likely to affect very young children, older adults, people with chronic illnesses, and those with weakened immune systems.

    Symptoms

    The major symptoms of sepsis can be remembered using the phrase “It’s about time.” Watch for these four things:

    T – Temperature that is higher or lower than normal.

    I – Infection present or have other signs/symptoms of infection.

    M – Mental Decline characterized by confusion, sleepiness, or lethargy/difficult arousing.

    E – Extremely Ill including severe pain, discomfort, and shortness of breath

    Time is of the essence when it comes to sepsis. The risk of death from sepsis increases by as much as 8% for every hour treatment is delayed.

    If you see any combination of these symptoms especially if the person has a recent history of a cut, surgery, invasive procedure, or infection, you should immediately call 911 or go to the nearest hospital and let the caregivers know you are concerned about sepsis.

    How to Prevent Sepsis

    Sepsis cannot always be prevented but there are steps you can take to prevent or treat infection as quickly as possible and be on the look out for sepsis when infection does occur.

    • Get Vaccinated. Vaccinations can protect you from contracting certain viral infections that could lead to sepsis.
    • Properly care for open wounds. Cuts, scrapes, or other breaks in the skin can allow harmful bacteria to enter your body. Be sure to always care for these wounds by cleaning them as quickly as possible after injury and keeping them clean, monitor them for signs of an infection (redness, warm to the touch, increased pain, discharge from the wound), and consult a doctor if there are signs of infection.
    • Take antibiotics correctly when they are prescribed. When you are prescribed antibiotics, be sure to take them exactly as prescribed. Follow all the directions for use, take them on time, finish the full course even if you feel better sooner, and store the antibiotics as directed.
    • Wash your hands frequently. Always practice proper hand hygiene with warm water and soap before eating or handling food, after using the bathroom, after blowing your nose or coughing, after touching pets or other animals, and after being outside the home such as at school or shopping.
    • Sound the alarm. If you suspect your or a loved one may have sepsis, see a medical professional immediately or call 911 and say “I am concerned about sepsis.”

    About Cyndi

    Cyndi Whetstone, RN is a Performance Improvement Specialist at Fisher-Titus and is stroke coordinator at Fisher-Titus. Fisher-Titus is a Certified Primary Stroke Center. For more information about sepsis, visit sepsis.org.

  • Suicide Prevention Month

    September is National Suicide Prevention Month, an annual month-long campaign to inform and increase awareness around suicide prevention and the warning signs of suicide.

    According to the Ohio Suicide Prevention Foundation, 1,836 Ohioans die by suicide in an average year, and nearly 12% of those are young people. Those numbers are bad enough, but 2020 hasn’t exactly been an “average” year, and it’s not over yet.

    On top of the usual life stressors that can overwhelm people, we are dealing with unprecedented events in this country: COVID-19, financial uncertainty, and social unrest. As a counselor, I have seen people becoming more and more stressed as this year has unfolded. This makes the subject of suicide prevention even more pertinent in these times.

    What are Suicide Risk Factors?

    Suicide risk factors are characteristics or conditions that increase the chance that a person may try to take their own life.

    One risk factor is a person’s health. This can include mental health; severe, chronic medical conditions; and chronic pain issues.

    Another risk factor is a person’s environment. This includes an individual’s stress levels related to personal loss, relationship problems, financial struggles, traumatic events, or other life changing events. Another environmental factor is a person’s access to the lethal means of suicide, including firearms and drugs.

    Historical risk factors include previous suicide attempts, family history of suicide, and childhood abuse, neglect, or trauma.

    Warning Signs of Suicide

    Suicide warning signs often precede actual attempts. Most people who take their own lives exhibit one or more warning signs, either through what they say, or what they do.

    If a person talks about feeling hopeless, having no reason to live, being a burden to others, or feeling trapped, they may be contemplating suicide.

    Behaviors that may signal risk include increased use of alcohol or drugs, researching suicide methods, withdrawing from activities, isolating from family and friends, sleeping too much or too little, visiting or calling people to say “goodbye”, and giving away prized possessions.

    Ironically, some people who have decided to end their lives actually seem to “improve”, primarily because they think they have found a solution to their problems.

    If you or someone you know is exhibiting any of these signs, you can call the Crisis Hotline at 800-826-1306. There is also a Crisis Text Line you can reach out to by simply texting “4hope” to 741741.

    A way to learn more about suicide prevention is through programs such as Question, Persuade, Refer (QPR). This training teaches people to:

    Question….a person about suicide;

    Persuade….the person to get help; and

    Refer……….the person to the appropriate resource.

    If you are interested in learning more about this program, the Huron County Board of Mental Health & Addiction Services is offering virtual QPR trainings throughout the month of September. More information on dates and times may be found on the MHAS Board website (http://huroncountymhas.org) or you can call them at: 419-681-6268.

    About Ken Murray

    Ken Murray, Ph.D., LPCC-S provides counseling services to children, adults, and families addressing a wide range of mental health concerns. Ken specializes in providing counseling for children and families and has experience with providing counseling for parent and leading parenting classes. For more information about Fisher-Titus Behavioral Health, visit fishertitus.org/behavioral-health.

  • Getting into a Healthy Routine with Couch to 5K

    Over the past few years, Fisher-Titus has hosted several sessions of Couch to 5K. Couch to 5K is a free nine-week program that helps participants work their way up to running, jogging, or walking their first 5K. Through this program, there have been many local success stories where participants were able to jumpstart a new fitness routine with Couch to 5K.

    Erica Bowman of Sandusky completed her first Couch to 5K program in the fall of 2017 after learning about it on the radio.

    “The program was fun and challenging,” Erica said of her experience that first time. “I have exercise induced asthma and training myself to breathe correctly while running took time. The training program helped with the timing of runs and walks so I could concentrate on my breathing and endurance.”

    Prior to Couch to 5K, Erica was not a runner.

    “I fell in love with running through the program,” she said. “I also made lifelong friends with whom I still get together three years later to walk/run the trails and complete races. I am even godmother to the son of one of my Couch to 5K friends.”

    Since that first program, Erica estimates she has completed more than 50 5K races both virtual and local, six 10K races, and a 15K.

    Erica says Couch to 5K drove her to aim higher and create more challenging goals for herself.

    “I have run a 10K and I’m training to complete my first half marathon this summer.” Erica said. “My ultimate goal is to run a full marathon at Disney World for my 40th birthday in two years.”

    Norwalk resident Cyndy Kenne completed Couch to 5K for the first time in spring 2017. According to Cyndy, at that time her health was not in the best place and she struggled to walk up a flight of stairs. But, she was able to complete the program and it helped her kickstart a new, healthier lifestyle.

    Since completing her first program, Cyndy estimates she’s participated in Couch to 5K seven times.

    “Couch to 5K has impacted my life in so many ways!” said Cyndy. “I have made new friends, lost weight, increased my confidence, met new people at races, and have gotten to travel to new places to race.”

    In 2019, Cyndy completed 20 5K races and one 10K race. On April 1st of 2020, she also completed the Winter Warrior challenge where she walked 250 miles over the course of four months.

    Cyndy wants to let people know that you don’t have to be an athlete to participate in Couch to 5K and start a new, healthy routine.

    “I’m not a ‘jock’ who can lose a little weight and run a marathon,” she says. “I have a 75% obstruction in my throat that makes it difficult to breathe, I’m still not skinny but, I’m healthier than some people who are.”

    She invites everyone to try the program.

    “If I can do this, you can,” Cyndy said. “If you think you can’t, meet me on the trail and we can do it together!”

    For more information on the upcoming fall session of Couch to 5K, click here.

  • Chad Stang: Trauma Warrior

    In October of 2018, Fisher-Titus partnered with MetroHealth in Cleveland to provide a higher level of trauma care close to home for the community.

    Since then, care has been provided for countless trauma patients at Fisher-Titus, a Level III Trauma Center since 2009. The partnership with MetroHealth enables us to increase our knowledge base, expand our expertise, and increase the level of care we provide to our patients who experience a traumatic injury.

    One of these patients is Monroeville resident Chad Stang.

    What started as a routine softball tournament on October 5, 2019 turned into a series of events Chad Stang will likely not soon forget.

    While sliding to catch a ball, Chad collided with another player whose shoulder hit his stomach. Despite the incident, Chad finished that game and started the next game as a designated hitter.

    While running to first on a hit, Chad noticed some lightheadedness. Knowing that one of his friends in the stands was an emergency nurse, he went to talk to her.

    “I was telling her I almost passed out and ended up passing out in front of her,” Chad explained.

    Still, he stayed for the remainder of the tournament. As time went on, Chad began having muscle spasms starting in his shoulder and moving down his right side. When he got home, he tried to control the spasms by laying down with a heating pad and an ice pack, but they persisted. At that point he knew he had to seek help at the Fisher‐Titus Emergency Department.

    By the time he arrived, Chad had enough discomfort that he was not able to lay flat without feeling pain.

    “It was pretty miserable to lay down. I felt like I didn’t have any abs,” said Chad.

    Chad was given medication and had some tests and it wasn’t long before he realized this may not be the routine injury he initially thought.

    “While we were sitting there, we heard that my room was upgraded to trauma level 2 and we knew that wasn’t a good thing,” he said.

    The doctor came to talk to Chad about his scans. The tests showed that he had a hematoma on his abdomen as well as blood on his liver and spleen and trauma to his colon. Because of his injuries, he was admitted for observation.

    Three days later on October 8, Chad was having a particularly difficult day.

    “I felt bad all day,” Chad remembered. “The TV was never on, my phone stayed on the stand.”

    That evening, the STNA caring for Chad began checking on his heart. His heart rate was high and the care team began taking steps to stabilize his heart. Once stabilized Chad was moved to the ICU. He wasn’t there long before Fisher‐Titus/MetroHealth Trauma Surgeon, Dr. Esther Tseng came to talk to him. She told him that his kidneys were failing, and he would need surgery as soon as possible.

    About an hour later, Chad was wheeled into surgery.

    Five hours later Chad woke up from surgery.

    Chad remained at Fisher‐Titus for the next ten days beginning his road to recovery.

    Not having food since the day of his injury, it was a total of 10 days before he was able to eat solid food again. Over the course of his time in the hospital, Chad lost approximately 23 pounds.

    “I worked out and played softball. To go from that to not being able to walk very far without my oxygen dropping and the nurses telling me I had to stop because they were afraid I was going to pass out was pretty crazy,” he said.

    After 13 days, Chad was able to go home but the recovery process was not much easier. He had trouble lying on a flat bed and getting comfortable while sleeping. Chad was off work from his job as District Manager for Huron County Soil and Water Conservation for six weeks and it took that long for his wound to fully heal. It was three months post‐surgery before Chad could sit up from laying without using his arms to lift himself.

    “It was a long process,” Chad recalled. “Thirteen days in a hospital is pretty crazy, but I definitely had great care.”

    During this time, Chad also received care at home from Fisher‐Titus Home Health and was having regular checkups with the MetroHealth Trauma team, mostly here in Norwalk.

    “Dr. Tseng and the rest of the Fisher‐Titus/MetroHealth trauma team are all absolutely fantastic. It’s a huge, huge pick‐up by Fisher‐Titus to have them in‐house as trauma surgeons. They’re all awesome people,” said Chad.

    Trauma Program Manager for the Fisher‐Titus/ MetroHealth partnership Andrea Wetherill also expressed her gratitude for the MetroHealth trauma team.

    “As a long‐standing emergency nurse at Fisher‐Titus and a resident of the community, I personally appreciate the onboarding of MetroHealth to support our trauma services,” Andrea said. “Taking care of trauma locally is not new to our emergency department; however, since the partnership began, we have been able to keep trauma care close to home. We do not want to see you hurt, but should an accident occur, we are here 24/7 to care for you!”

    Previously, many patients were transferred to higher level trauma centers due to the complexity of their injuries. The same trauma surgeons that care for patients at MetroHealth main campus in Cleveland, care for the patients locally at Fisher‐Titus so these more complex cases can be treated close to home.

    MetroHealth is committed to maintaining outstanding local care to Norwalk and the surrounding communities.

    “They bring years of knowledge, experience, and best care practices to our community not only for trauma, but also for acute care surgical needs,” Andrea added. “The partnership has led to so many successful recoveries, many of which fully recuperated by strictly undergoing all acute and rehabilitation trauma services at Fisher‐Titus,”

    Finally, after four months, Chad was able to start working out again and he began preparing for his next planned surgery with Dr. Tseng.

    That surgery took place at MetroHealth in Cleveland with Dr. Tseng on March 3, 2020.

    “It’s crazy how different the two surgeries were. I was worried because of how long it took to bounce back last time,” he said.

    This time, Chad was in the hospital for seven days and was able to resume a workout routine just five weeks later. He returned to work after only 13 days post‐surgery to his job that requires frequent walking and site visits.

    “Since then it’s been great. I’ve had no more issues and everything seems to be getting back to normal,” he said.

    He’s slowly regaining his strength. After his first surgery, he said it took five months to gain eight pounds. This time he’s gained six pounds in two months. While he’s not yet back to the level of activity he was pre‐injury, Chad looks forward to getting back to lifting weights and playing softball.

    “We are excited that Chad is in his final steps of recovery,” Andrea shared. “His resiliency makes him a trauma warrior!”

    For more information on the Fisher‐Titus/MetroHealth trauma program, visit fishertitus.org/trauma.

  • Beach Safety

    We are fortunate to be close to a great source of summer fun—Lake Erie. Since there are still a few warm weeks left of summer, you may be looking to head to the lake before temperatures cool down and the kids head back to school. Before you head out, make sure you are prepared to enjoy the beach safely.

    Come Prepared

    Before you leave, make sure you check these items off your list.

    • Proper attire. Wear light colored clothing that covers as much skin as possible to prevent sun damage and make sure you have Coast Guard approved life jackets for all children in your family and anyone who may not be a strong swimmer.
    • Bring the sunscreen. August sun can be strong especially during peak hours. Be sure to pack broad-spectrum, waterproof sunscreen with at least 30 SPF. Reapply every two hours and always after swimming, sweating, or towel drying.
    • Pack enough food and water. If you are planning on spending a few hours at the beach, you want to make sure you have food and water to stay hydrated. If it’s hot and you’re doing a lot of physical activity, you will expend energy more quickly and that can lead to dehydration.
    • Bring your phone. Make sure your phone is charged and handy. If something goes wrong, you want to have it at the ready so you can call for help, if needed.
    • Know what to do in an emergency. You should be able to recognize the signs of someone who is in trouble in the water so that you know how to react in an emergency. It’s also a good idea for a few people in your family to know CPR so that it can be administered while waiting for EMS.

    Know your abilities

    One of the most important things in any type of swimming situation is knowing your own limitations and the limitations of those in your group. These can include your level of physical fitness, any medical conditions, and your swimming ability.

    It’s important to know these five basic skills and how to use them in every type of water environment.

    • Enter water that’s over your head and return to the surface
    • Float or tread water for at least one minute
    • Flip over and turn around in the water
    • Swim at least 25 yards
    • Exit the water

    Watch for hazards

    There are many hazards at Lake Erie beaches that can interfere with your swimming and increase your risk of injury.

    • Pay attention to posted warnings. This can include water quality information to prevent you from getting sick, warnings about high waves and/or rip currents, and postings about whether or not there is a lifeguard on duty.
    • Be aware of thunder and lightning. If a storm comes, leave the water immediately and find shelter indoors and stay there for at least 30 minutes after the last thunder clap. If you are outside, avoid open areas, tall, isolated trees, and metal objects.
    • Know the shoreline. Every beach is different. Familiarize yourself with the place you are swimming and avoid things like drop-offs and rip currents.
    • Be aware of fast-moving currents, waves, and rapids. In shallow water they can knock you down and make it difficult to get back up. Lake Erie is prone to high waves and strong currents and it’s important to never swim on rough days. Check for beach advisories before heading out.
    • Watch for underwater hazards. Rocks and debris, vegetation and fish, or drop-offs that change the water depth unexpectedly can be swimming hazards.
    • Be mindful of other people’s activities. At beaches, there are large groups of people sharing the water and it can be easy to run into someone else and get injured.
    • Prepare for unexpected changes. Temperatures can drop quickly and waves can appear even on a calm day.

    Slow the spread

    While the risk of contracting COVID-19 while visiting a beach is low, there is still a chance if precautions are not taken.

    • Observe physical distancing guidelines. You should maintain six feet of distance or more between yourself and others who live outside your household.
    • Bring a mask. It’s good to have one on hand if there are concessions, rentals, or other crowded areas where you may be interacting with other people. Make sure you store it in a dry place as wet masks can make it difficult to breathe.
    • Stay home if you are sick. If you or someone in your family isn’t feeling well, it’s best to reschedule your beach day for another time.

    About Katie Howell

    Katie Howell, APRN, CNP is a Nurse Practitioner with Fisher-Titus Convenient Care in Norwalk. Fisher-Titus Convenient Care treats a variety of acute non-emergency illnesses and minor injuries with walk-in appointments with evening and weekend hours. For more information, visit fishertitus.org/convenient-care.

  • August is Breastfeeding Awareness Month

    August is Breastfeeding Awareness Month. Breastfeeding provides many benefits for both mom and baby. Deciding how to feed your baby is a personal choice. Our Birthing Center team at Fisher-Titus is here to support you on your breastfeeding journey.

    What Are the Benefits of Breastfeeding?

    In addition to being a special way to bond, breastfeeding reduces the risk of many diseases for both mother and baby.

    The cells, hormones, and antibodies in breastmilk help keep your baby healthy. This protection is unique to your baby and will change to meet your babies needs as they grow. Research shows that breastfed babies have lower risks of:

    • Childhood leukemia
    • Asthma
    • Childhood obesity
    • Ear infections
    • Eczema
    • Diarrhea and vomiting
    • Lower respiratory infections
    • Necrotizing enterocolitis (a disease that affects the gastrointestinal tract in premature babies)
    • Sudden infant death syndrome (SIDS)
    • Type 2 diabetes

    Babies aren’t the only ones who benefit from breastfeeding. Breastfeeding can help mom’s health and healing after childbirth as well. It leads to a lower risk of the following health problems in mothers:

    • Type 2 diabetes
    • Certain types of breast cancer
    • Ovarian cancer

    Supporting Breastfeeding Mothers

    While breastfeeding is a great way to feed your baby, it’s not always easy. It takes some learning for both mom and baby and it may take time before you get into a comfortable routine. As you embark on your journey, a good support system is important.

    At Fisher-Titus, we have a caring team of Birthing Center staff that support moms in our community with their breastfeeding questions and concerns. Five of our Birthing Center nurses are Certified Breastfeeding Counselors. We have three nurses that are also Certified Lactation Counselors, the premier national certification in lactation management in the U.S. We also have an International Board Certified Lactation Consultant (IBCLC) on staff.

    All of these staff members are able to support breastfeeding moms in assessing the latching and feeding process, helping with corrective interventions, counseling mothers, and understanding and applying knowledge of milk production. Most importantly, they are a caring source of support for moms as they navigate their new journey in feeding their newborn.

    In 2019, Fisher-Titus earned recognition from Ohio’s First Steps for Healthy Babies and was awarded Maternity Care Best Practice Award 2018 for our efforts to encourage and support breastfeeding mothers. This month, we were also honored to be recognized be Newsweek as a Best Maternity Care Hospital for the exceptional care we provide to mothers, newborns, and their families.

    While our education programs are currently on hold due to COVID-19, we normally offer several options for both prenatal and postnatal mothers including one-on-one lactation support. These include Baby Boot Camp, Childbirth Education Express, and Breastfeeding Support Group.

    About Alisha

    Alisha Nims, RN is the manager of Obstetrics at Fisher-Titus. For more information about the Fisher-Titus Birthing Center, visit fishertitus.org/birthing-center.

  • What to expect on a cancer journey

    There are a lot of words, thoughts, and emotions that can describe a cancer journey. Patients may find there are good days, there are bad days, and then there are the really awkward days. We often refer to this as the good, the bad, and the awkward.

    The Good

    Patients gain new perspective on life and they learn to slow down and enjoy the little moments. Patients often gain new family in the doctors, nurses, secretaries, medical assistants, and other members of their health care team. They find strength they never knew they had, strength that cancer tried to strip from them. Many find new faith or maybe they become more faithful. A cancer patient finds themselves a beautiful reflection of life and spirit.

    The Bad

    Patients have sometimes described their diagnosis as a tailspin. Patients may struggle to find stable ground or to gain control. Some are afraid to share their news with their loved ones for fear of being treated differently. There are multiple appointments and new routines to learn. The patient might have chemotherapy, surgery, or radiation. All three are scary, but necessary. There are tears, fears, anxiety, and feelings of being overwhelmed.

    Patients will be moved through the care coordination process quickly as time now matters. Time matters to reduce the growth of the disease or to gain quality of life. But, there are also limits to what can be offered and end of life discussions may have to happen, sometimes too soon. Although these bad conversations may be necessary, our team here at Fisher‐Titus will walk you through them and make sure you have the best care possible. We are often a hand to hold or a shoulder to cry on as you navigate these tough talks.

    The Awkward

    Cancer leaves chance for some awkward moments. Moments like picking out a wig and needing help to ensure it fits just right. Or when treatment has left a patient so weak that they now need help going to the bathroom—a potty partner. Sometimes it’s hard asking for help. Paying bills and buying food can become difficult and it’s often a conversation no one wants to have. There are body changes from treatments and the cancer itself. This can leave a patient not fitting quite right into their clothes. Who knew someone could actually gain weight while going through chemotherapy? That goes against all the preconceived notions about chemotherapy, right? In any awkward moment along the cancer journey, take comfort in knowing that we have seen it all and we will embrace those moments along with you.

    The good, the bad, and the awkward of the cancer journey are moments in time that should be embraced with confidence in the care you choose…the care given by the people who choose you.

    About Jackee

    Jackee Porter, RN, BSN, OCN is the Oncology Nurse Supervisor at the Fisher-Titus Cancer Care Center. For over 20 years, Fisher-Titus Cancer Care Center has cared for cancer patients close to home. For more information, visit fishertitus.org/cancer.

  • Schedule Your Medicare Annual Wellness Visit

    As we enter the second half of the year, you may be thinking about some of the annual appointments you need to check of your yearly to-do list. If you have had Medicare Part B for longer than 12 months you qualify for a yearly wellness visit.

    In most cases this visit will be covered with no out-of-pocket cost to you by Medicare. Some additional costs could accrue if your primary care provider feels additional testing is necessary based on your medical history and risk factors.

    During your Medicare Annual Wellness visit, your provider will go over several things.

    • A review of your medical, surgical, and family history
    • Updating a list of your current providers and prescriptions
    • Height, weight, blood pressure, and other routine measurements
    • Assessment of preventative measures such as ensuring you are up to date on all recommended vaccinations, screening labs, and diagnostic testing
    • Personalized health advice
    • A list of risk factors and treatment options for you
    • Advance care planning (a plan for care you would get if you become unable to speak for yourself)
    • Memory testing which will detect early signs of memory issues

    All the of the information gathered during the visit will be used to form a personalized care plan that will be updated at each yearly visit.

    About Dr. Schwerer

    Dr. Kaitlin Schwerer is a physician with Fisher-Titus Family Medicine-Milan. Dr. Schwerer earned her Doctor of Osteopathic Medicine at Ohio University Heritage College of Osteopathic Medicine and is board certified in family medicine. She currently has same-day and next-day appointments available. Call 419-660-2900 to schedule.

  • Celebrate National Picnic Month

    There’s still a little over a month left in summer before kids return to schoolwork and the weather begins to cool down. While this summer has probably looked different than what you may be accustomed to, a family picnic is a great summer activity that can be enjoyed while keeping in mind physical distancing practices.

    Food Safety

    While we have all been focused on preventing the spread of COVID-19 this year, foodborne illness is still something to keep in mind as you plan a picnic outing.

    • Wash your hands. Improper hand hygiene is responsible for the spread of many diseases including almost half of foodborne illness. To wash your hands correctly, you should vigorously rub your hands together with soap and water for at least 20 seconds. Re-wash hands after handing raw meat and before eating your food. If you are at a park with limited access to running water, don’t forget to pack hand sanitizer.
    • Avoid cross-contamination. Juices from raw meat and poultry can contain bacteria and cause foodborne illness. It’s important to pack your food in clean, tightly sealed, individual containers. You should also sanitize your cooler before and after each use to kill any bacteria that may have grown while it was being stored. Wash all produce before eating and avoid cross-contamination with plates and utensils. Cross-contamination can even happen with ice. If you want ice for use in beverages, you should keep that in a separate, sealed bag. The ice used to keep food cold could have bacteria from leaking food without you even knowing so it’s best to have separate bags of ice designated for each purpose.
    • Maintain Proper Food Temperatures. The temperature of food is critically important in preventing bacteria growth so have a thermometer handy. Meats need to be cooked to specific temperatures to kill any bacteria. Perishable food should be kept out of the “danger zone”: a temperature range between 40°F and 140° Use a well-insulated cooler and ice or ice packs to transport food and transport it in the air-conditioned backseat rather than the trunk. Do not leave food out for more than two hours or one hour if the temperature is over 90°F.

    Healthy Picnic Foods

    There are lots of great produce in season that are grown locally. Keep these healthy foods in mind for your next picnic

    • Besides being very refreshing on a hot’s summer day, it also is a fruit that can provide you some added hydration as it is 92% water and packed with vitamins and minerals.
    • Leafy Greens. Leafy greens, such as swiss chard, contain abundant amounts of phytonutrients providing antioxidant and anti-inflammatory properties.
    • Corn on the Cob. A summer staple in Ohio, corn on the cob contains two antioxidants that can be beneficial for eye health—lutein and zeaxanthin and is a good source of vitamins and minerals.
    • The tomato provides lycopene which may help protect you from sunburns. In addition, it contains several important micronutrients including vitamin C, vitamin A, potassium, B6, folate, niacin, and vitamin E.

    COVID-19 Precautions

    While participating in any activities this summer, it’s still important to be mindful of preventing the spread of COVID-19. Luckily for us, there are lots of great parks in the area that allow for picnicking while observing physical distancing guidelines. Here are the things to keep in mind:

    • Only go with your immediate family. The safest picnic will be one where you are only gathering with others who live in your household. Including others outside your family increases the risk of spreading COVID-19.
    • Maintain six feet of distance. If you are taking your picnic to a public park, be mindful of the distance between you and others outside of your household.
    • Bring a mask. While you likely won’t need it for your outdoor picnic, keep in mind that face coverings are now required statewide in Ohio and are effective in preventing the spread of COVID-19. You should be wearing a mask or other face covering any time you are indoors or outdoors when you’re unable to maintain six feet of distance.

    About Darrin

    Darrin Torrey is an executive chef in the Fisher-Titus Nutrition Services Department. He has been in the culinary arts field since 1995.

  • COVID-19 Testing at Fisher-Titus: FAQs

    As cases of COVID-19 continue to rise in our county, we want to make sure the community knows that they can get testing close to home at Fisher-Titus.

    Where should I start if I want to get tested for COVID-19?

    A physician’s order is required for any COVID-19 testing. Please contact your primary care provider to determine the type of COVID-19 test you may need. Different tests are needed if you have been exhibiting flu like symptoms versus an antibody test to determine if you may have previously been infected with COVID-19. If you are asymptomatic but have had a known exposure, there is a value in a discussion with your primary care provider to understand if testing is right for you.

    How can I get a doctor’s order for COVID-19 testing if I do not have a primary care physician?

    If you do not have a primary care physician, Fisher-Titus primary care physicians are accepting new patients, and many have same-day and next-day availability. You can schedule an appointment by calling 419-660-2900.

    Virtual Visits are also available through the Amwell app using the service key “FISHERTITUS.” You can request an appointment anytime, anywhere and discuss an order for COVID-19 testing. Visit fishertitus.org/virtualvisits for more information.

    If you are unable to establish a visit with a primary care provider, you can also visit Fisher-Titus Convenient Care or the Emergency Department if your condition requires immediate care.

    How much does a COVID-19 test cost?

    The cost of a COVID-19 test varies depending on insurance coverage. You can check with your insurance company for the cost.

    How long does it take to get the results?

    Result times can vary from three hours to seven days. This can be affected by the guidelines put out by the state lab for who receives priority testing. We are working very closely with our partner labs to process tests as quickly as possible. Delays in testing can also be caused by limits in the amount of overall national testing supplies.

    How will I get my results?

    If your condition requires hospitalization, your results will be provided directly to you by your health care provider at Fisher-Titus Medical Center. If you are tested but remain an outpatient, you can obtain your results from your primary care physician who ordered the test, or if you are an established patient, through the myFisherTitus patient portal. Our laboratory is unable to give out results over the phone.

  • COVID-19 Testing at Fisher-Titus: Frequently Asked Questions

    As cases of COVID-19 continue to rise in our county, we want to make sure the community knows that they can get testing close to home at Fisher-Titus.

    Where should I start if I want to get tested?

    A physician’s order is required for any COVID-19 testing. Please contact your primary care provider to determine the type of COVID-19 test you may need. Different tests are needed if you have been exhibiting flu like symptoms versus an antibody test to determine if you may have previously been infected with COVID-19. If you are asymptomatic but have had a known exposure, there is a value in a discussion with your primary care provider to understand if testing is right for you.

    How can I get a doctor’s order for COVID-19 testing if I do not have a primary care physician?

    If you do not have a primary care physician, Fisher-Titus primary care physicians are accepting new patients, and many have same-day and next-day availability. You can schedule an appointment by calling 419-660-2900.

    Virtual Visits are also available through the Amwell app using the service key “FISHERTITUS.” You can request an appointment anytime, anywhere and discuss an order for COVID-19 testing. Visit fishertitus.org/virtualvisits for more information.

    If you are unable to establish a visit with a primary care provider, you can also visit Fisher-Titus Convenient Care or the Emergency Department if your condition requires immediate care.

    How much does a COVID-19 test cost?

    The cost of a COVID-19 test varies depending on insurance coverage. You can check with your insurance company for the cost.

    How long does it take to get the results?

    Result times can vary from three hours to seven days. This can be affected by the guidelines put out by the state lab for who receives priority testing. We are working very closely with our partner labs to process tests as quickly as possible. Delays in testing can also be caused by limits in the amount of overall national testing supplies.

    How will I get my results?

    If your condition requires hospitalization, your results will be provided directly to you by your health care provider at Fisher-Titus Medical Center. If you are tested but remain an outpatient, you can obtain your results from your primary care physician who ordered the test, or if you are an established patient, through the myFisherTitus patient portal. Our laboratory is unable to give out results over the phone.

  • The New Normal: How to Cope with Lifestyle Changes During COVID-19

    Many people have been grieving their “pre-COVID” lives where we were free to congregate, shop, eat, and leave the house whenever we pleased. We have to realize that we are going through a grieving process for those lives and everyone will be in their own stages of grief at different times: shock and denial, pain and guilt, anger, bargaining, depression, acceptance, and hope.

    It was reported by all Huron County law enforcement agencies, that between January 1, 2020 and April 14,2020, there was 26% increase in rates for suicidal individuals/mental health reports compared to the same period in 2019. While we were “flattening the curve” of the pandemic, mental health symptoms and trauma responses were increasing.

    Many symptoms of anxiety and depression have increased in frequency and severity due to isolation, restricted access to distractions outside of the home, uncertainty, feeling choices or freedoms have been taken, basic living needs not being met, and health related stressors.

    Take the time to think about what you need the most and what you feel you are grieving the loss of during this process. Then, as the “stay at home” orders are lifted and people go back to work, children are able to go back to their childcare providers and school, look at what you can start to implement back into your routine. Create genuine personal connections, get outside and be physical, and reconnect with your community. Visit your local boutique shops, swap out your library books, schedule those hair appointments, eat at your favorite hometown restaurants, and take time to find new local services that you can support as they help you.

    Be aware that some symptoms like panic and heightened sensitivity to social settings could still linger. New worries may come to mind and symptoms may even heighten as you start engaging in this “new normal”. Know that it’s to be expected in these situations and try relaxation techniques and deep breathing before you go out. If these symptoms persist or cause concern, then seek out support from your peers and from professionals. And remember, we are all going through the experience together, so you are not alone.

    The Fisher-Titus Behavioral Health team provides psychiatric diagnostic evaluations for all ages and offers individual, couples, and family counseling and medication management for all psychiatric diagnoses including:

    • Anxiety
    • Depression
    • Mood disorders
    • Psychotic disorders
    • Autism
    • Bipolar disorders
    • Adjustment disorders
    • Emotional disturbances
    • Disruptive behavior
    • Parenting concerns
    • Trauma and abuse
    • Family issues
    • Grief

    The Fisher-Titus Behavioral Health team encourages patients to live healthy lifestyles and promotes the use of coping skills and self-care in the form of exercise, deep breathing techniques, journaling thoughts and feelings, and more.

    We offer a complete range of outpatient mental health services, provided by our licensed staff. We also offer virtual visits. Learn more by calling 419-668-0311.

  • Protect Yourself from Cybercrime at Tax Time

    Our new Tax Day is less than a month away! Although we got some extra time this year due to the coronavirus pandemic, there are probably many people who have not yet filed.

    Tax season is a busy time for online scams. With many users filing online, there are many ways cybercriminals attempt to intercept sensitive, personal information used to steal identities.

    Here are some tips for scams to look out for and how to protect yourself as you file your taxes this year.

    Scams to watch out for

    • IRS-Impersonation Phone Scams. You may get a call from someone claiming to be with the IRS and insisting you owe money that should be paid through a gift card or wire service. The real IRS will not call you and demand immediate payment. Typically, they will mail you a bill if you owe money.
    • Phishing, email, and malware schemes. These come in the form of unsolicited emails, texts, social media posts, or fake websites that may prompt you to click a link or share personal/financial information. Thieves can use this information to pilfer funds or commit identity theft and unfamiliar links can contain viruses which can infect your computer if opened.
    • Fraudulent tax returns. The IRS only accepts one tax return per Social Security number. To avoid someone else filing a return as you, try to file early. To prevent criminals from getting the information needed to file fraudulent returns, protect personal information by only sharing your Social Security number when necessary, check your credit report regularly for suspicious information, and never throw papers with sensitive information in the trash.
    • Tax preparer fraud. Most tax preparers are honest but some may target unsuspecting taxpayers in order to commit refund fraud and/or identity theft. Remember, preparers must sign the tax return with their IRS preparer identification number.

    Read the full article on NorwalkOhioNews.com.

  • Have a Safe Fourth of July

    Many of us are probably looking forward to 4th of July celebrations this weekend. While celebrations probably will look different this year with coronavirus precautions, there is still lots of fun that can be had at home.

    We want to make sure our community stays safe this week. Read these tips for participating in fun, Independence Day activities as safely as possible.

    Firework Safety Tips

    While it is illegal in Ohio to set off fireworks, there are other items such as smoke devices and sparklers that are sold many places and provide lots of summer fun. However, they can still be very dangerous. In 2017, 12,900 people suffered fireworks-related injuries.

    Whether you are using sparklers or plan to be around fireworks, these tips can help you avoid burns or other injury:

    • Adults should always supervise fireworks activity and never allow children to play with or ignite fireworks.
    • Take caution with sparklers. They are often viewed as “safe,” but they are the leading cause of fireworks-related ER visits. They burn at about 2,000 degrees and can catch on clothing causing serious burns.
    • Keep a bucket of water handy in case of fire.
    • If fireworks malfunction, do not relight them. Douse them with water and throw them away.
    • Never light fireworks in a container, especially one that is glass or metal.

    How to Grill Safely

    Who doesn’t love a summer cookout? Nothing beats the smell of the grill cooking on a summer day. When not used properly, grills can be a fire hazard. According to the National Fire Protection Association, grills cause an average of 10 deaths per year, 160 injuries, and nearly $150 million in property damage.

    If your holiday plans include a backyard barbeque, keep these precautions in mind:

    • Keep the grill well away from your home, deck railings, branches or overhangs, and other items or structures.
    • Open the grill before lighting.
    • Regularly clean your grill removing grease of fat buildup in the trays below your gas or propane grills so it cannot be ignited.
    • Keep pets and children away from the grill.
    • Avoid wearing loose clothing that could catch fire while grilling.

    Pool Safety Tips

    Swimming is a great way to cool down and have fun. But water can also pose serious dangers. According to the CDC, between 2005 and 2014 there were an average of around 3,500 fatal unintentional drownings annually not related to boating and an additional 332 boating-related drownings.

    • Pay close attention to children and less-experienced swimmers. Make sure they have coast-guard approved floatation devices if they are not able to swim on their own.
    • Designate someone to watch the water and do regularly head counts to make sure they can see everyone. This person should be paying close attention to the water and not be on their phone or distracted in other ways.
    • Never swim alone.
    • Swim sober.
    • Have a phone nearby so you can quickly call for help in case of emergency.
    • Do not swim beyond your abilities.
    • Leave the water immediately in case of thunder and lightning and stay out for at least 30 minute after the last thunder clap.

    Tips to Stay Hydrated

    Many people’s idea of the perfect Fourth of July includes sunshine and hot temperatures. If you’re not careful, these can lead to dehydration. Dehydration can cause serious complications such as heat injuries ranging from mild cramps to heat exhaustion or heatstroke.

    Take these steps to stay hydrated as you enjoy your holiday weekend:

    • Drink plenty of water. It is recommended that you drink between six and eight cups of fluids a day.
    • Don’t skip meals as much of your fluids comes from your food. Additionally, you lose salt and electrolytes as you sweat and your food will help your body replace what you lose.
    • Drink before you feel thirsty. If you feel thirsty, you’re already behind in fluid replacement.
    • Make sure your children are getting enough fluids.
    • Dress in light, cool clothing. Dark colors will make you feel hotter and sweat more.
    • Avoid alcohol. Even though you may want to enjoy a beverage responsibly, alcohol is dehydrating so you should limit yourself and drink lots of water to make up for it.

    About Andrea Wetherill

    Andrea Wetherill, MSN, RN is the Trauma Program Manager for the Fisher-Titus/MetroHealth partnership. Fisher-Titus is a Level III Trauma Center and a Level II Adult Cardiac Cath Lab.

  • Start your dream job in health care

    At Fisher-Titus, we know our employees want more than just a job – they want a career that makes them feel empowered with opportunities for career growth and increased earning potential.

    We have a variety of ways to help you advance your career, including educational assistance. This means that the sky is the limit – you can start out at an entry level position, use the tools we have available, and land that dream job you have been thinking about.

    In fact, we have several current employees throughout the organization who have taken advantage of these tools. We have employees who started out in non-clinical departments like dietary and environmental services who are now registered nurses, nursing managers, and more.

    For more information, click here.

    To read the full article, visit NorwalkOhioNews.com.

  • Electromyography: Diagnosing Nerve and Muscle Conditions

    Beginning June 25, Fisher-Titus will be offering Electromyography clinics. There are two parts of the clinic: needle EMG and Nerve Conduction Studies. These diagnostic tests evaluate the health of muscles and nerves and can assist in finding nerve dysfunction, muscle dysfunction, or issues with nerve-to-muscle signal transmission.

    These procedures are done to help determine if a patient has a nerve or muscle disorder. EMG results can help diagnose many conditions including:

    • Muscle disorders such as muscular dystrophy or polymyositis
    • Diseases affecting the connection between the nerve and the muscle, such as myasthenia gravis
    • Disorders of nerves outside the spinal cord (peripheral nerves), such as carpal tunnel syndrome or peripheral neuropathies
    • Disorders that affect the motor neurons in the brain or spinal cord, such as amyotrophic lateral sclerosis, or polio
    • Disorders that affect the nerve root, such as herniated disk in the spine

    There are many common symptoms that indicate these and other conditions that may prompt your doctor to order an EMG. These can include:

    • Tingling
    • Numbness
    • Muscle weakness
    • Muscle pain or cramping
    • Certain types of limb pain

    If you are experiencing these symptoms, you should talk to your doctor about your concerns. They can determine whether you may need an EMG and can refer you to the EMG clinic at Fisher-Titus.

    During a nerve conduction study, electrodes are applied to the skin to measure the speed and strength of signals traveling between two or more points. The electrodes are placed in various locations on your skin depending on where you are experiencing symptoms. These electrodes will read and interpret tiny electrical currents, transmitted by the healthcare professional, that you may feel as a twinge or spasm.

    In a needle EMG, the neurologist will assess whether there is electrical activity that should not be there when the muscle is at rest and the degree of activity when you slightly contract the muscle. To do this, they will give you instructions on when to rest and when to contract a muscle. During a needle EMG, a needle electrode is inserted directly into a muscle and records the electrical activity in that muscle. The needle may cause discomfort or pain that usually subsides after the needle is removed.

    After the EMG, the neurologist will interpret the results and send them to your primary care provider or the doctor that ordered the test. They will then discuss the results with you at a follow-up appointment.

    About Jordan

    Jordan Manlet, RN, R.NCS.T is the Director of Emergency Services and Neurosciences at Fisher-Titus. Fisher-Titus Electromyography clinics will be offered twice monthly beginning June 25. Tests and studies will be read by a board-certified Neurologist. If you are experiencing symptoms of a nerve or muscle condition, talk to your primary care provider about Fisher-Titus EMG clinics.

  • Early Signs of Alzheimer’s

    June is Alzheimer’s and Brain Awareness month. Alzheimer’s is a brain disease that causes a slow decline in memory, thinking, and reasoning. It can be difficult to tell the different between normal, age-related memory changes and changes that may indicate possible Alzheimer’s or other dementia. Below are the 10 warning signs for Alzheimer’s according to the Alzheimer’s Association.

    Memory loss that disrupts daily life. This is the most commonly known sign of Alzheimer’s, especially in its early stages. Typically this appears as forgetting recently-learned information, forgetting important dates or events, asking the same questions repeatedly, and increasing reliance on memory aids (notes, electronic reminders, etc.) or family for things individuals previously handled on their own. It’s common for older adults to sometimes forget names or appointments but remember them later. When individuals are not able to eventually recall things or forget things that are out of character for them to forget, that’s when it starts to become a concern.

    Read the full article at NorwalkOhioNews.com.

  • What is COVID-19 Antibody Testing?

    Since the start of the COVID-19 pandemic, we’ve heard about the limited number of tests that have been available. Because testing is limited, we have known that it’s likely more people have been infected than we know, and we have all been wondering how widespread COVID-19 actually is in our community.

    Thanks to a partnership between Fisher-Titus, Family Health Services, and Huron County Public Health, Huron County residents ages 10 and up can receive a COVID-19 antibody test with no out-of-pocket cost. Testing will be offered in New London, Willard, and Norwalk between June 18 and June 29. Appointments are required, no walk-ins will be accepted, and you can schedule your testing by calling 419-663-7511. For those with insurance coverage, the insurance company will be billed so please have your insurance information ready when calling to register.

    What is Viral Testing vs. Antibody Testing?

    You likely are hearing about two types of testing for COVID-19. A direct test for the COVID 19 virus checks samples from your respiratory system (typically a nasal swab) to see if you are currently infected while a COVID 19 antibody test checks your blood for antibodies that formed when you have recovered indicating you had a past infection.

    If you are currently experiencing symptoms of COVID-19, your primary care provider can determine whether you may need a direct viral test for COVID-19. Fisher-Titus can test for current COVID-19 infections in-house, but testing requires an order from a physician and an appointment. We also offer Virtual Visits for COVID-19 screening and you can learn more about it at fishertitus.org/virtualvisits.

    With more evidence showing COVID-19 may have been in Ohio and spreading earlier than originally thought, many individuals are wondering, “did I already have it?” especially since it is possible to have the virus without ever showing symptoms. This is where COVID 19 antibody testing comes in.

    Antibodies are disease-specific proteins called immunoglobulins that help fight off infections and usually provide protection against getting that disease again, also know as immunity. While COVID-19 is a new disease and we continue to learn new things about it every day, it is believed that a COVID-19 antibody test done through a blood draw can determine whether a person was previously infected and now has some immunity to the disease.

    How to Understanding Antibody Test Results

    Once you have your testing done, it will be a few days before you receive your results

    If you test positive, it is likely you were previously infected with COVID-19 or at least were infected with a related virus of the same family.

    It is not yet known for sure whether having COVID-19 antibodies protects individuals from getting the virus again or, if they do, how long the protection may last. That’s why it’s important to continue protecting yourself and others by taking precautions even if your antibody test comes back positive. You should talk to your primary care provider about your test result to further understand what it means.

    If you had a positive test and currently do not have symptoms, you likely do not have an active infection. If you do have symptoms, it’s possible you may still have an active infection. Talk to your health care provider as they may recommend a viral test to determine if you are currently infected.

    If your test was negative, you could still have a current infection. Antibodies take one to three weeks after infection to develop and in some people it may take longer or they may not develop antibodies at all. Depending on the type of test used there can be false negative tests however the type we use at Fisher-Titus is one of the most accurate available and is FDA approved.

    Regardless of whether you test positive or negative, it’s important to continue taking steps to protect yourself and others until we know more about COVID-19. However, we understand there is a lot of curiosity from the community about whether they have had the disease. This testing can satisfy that curiosity and also help us better understand how much the disease has spread in our community.

    About AUTHOR

    Dr. Gary Moorman is the Chief Medical Officer for Fisher-Titus. Dr. Moorman returned to Fisher-Titus in 2019 after having previously served as Vice President for Medical Affairs from 2011 to 2013. Huron County residents ages 10 and up can now make appointments for antibody testing by calling 419-663-7511between the hours of 8 a.m. and 4:30 p.m.

  • The Uniqueness of Caring for Men’s Health

    My wife, Dr. Vicki Brown, and I have been in practice together for 25 years. I typically have the unique opportunity to provide care for mainly husbands as she cares for their wives—just the way things go in a rural setting.

    It has always been fairly known that women tend to manage (or steer) the health care of the family more than men and thus direct the husbands in for appointments when they commonly might not do so otherwise.

    Additionally, with social media and so much access to the internet both men and women have a lot more information to sift through both legitimate and not so legitimate about their health care needs.

    For these reasons, I do think it is important to highlight men’s health and encourage them to take responsibility/control of their own health and seek assistance from a primary care physician. This men’s health month, take the time to think about your health and whether you are doing everything you can to care for it.

    Read the full article on NorwalkOhioNews.com.

  • Proper Needle Disposal

    There are several medical conditions that may require individuals to use needles or sharps at home. After the sharp has been used, it is important that you take steps to dispose of it properly. Improper sharps disposal can cause injury not only for individuals in your household but for others in your community.

    The FDA recommends a two-step process for disposing of home-generated sharps:

    1. Place all needles and other sharps in a sharps disposal container immediately after use. This reduces the risk of needle sticks, cuts, and punctures from loose sharps. These containers should be kept out of reach of children and pets.

    FDA-cleared sharps containers are the best option in which to place used sharps. These containers are made from rigid plastic and come marked with a line that indicates when the container should be considered full and be disposed of.

    If an FDA-cleared container is not available, some household containers made of heavy-duty plastic may be considered an OK alternative. The container should be leak-resistant, remain upright during use, and have a tight-fitting puncture-resistant lid. Once the container is about 75% full you should duct tape the lid, label it as a sharps container, and dispose of the container.

    All sharps disposal containers should be:

    • Made of heavy-duty plastic
    • Able to close with a tight-fitting, puncture-resistant lid, so sharps are not able to come out
    • Upright and stable during storage and use
    • Leak resistant
    • Properly labeled to warn of hazardous waste inside the container
    1. Dispose of used sharps containers according to your community guidelines. In the city of Norwalk, sharps containers should be taped shut, marked with the word sharps, and placed inside your trash bag or trash can. Do not separate it from the rest of your trash, it must be inside the bag or can.

    If you do not live in Norwalk, reach out to your solid waste hauler about their policy on disposing of sharps as they may offer a program to pick up your sharps containers or have different regulations. Ask your doctor or pharmacy if they have options for disposing of sharps containers.

    About Rodney

    Rodney Tuttle is the Director of Laboratory at Fisher-Titus. For more information on proper needle disposal, visit https://www.fda.gov/medical-devices/consumer-products/safely-using-sharps-needles-and-syringes-home-work-and-travel.

  • Cloth Face Covering FAQs

    As businesses and other public places begin to lift restrictions and welcome visitors back, we are still encouraged to take precautions. One of these precautions is wearing masks in public places especially where social distancing is difficult to maintain.

    Here are some answers to frequently asked questions about cloth face coverings that can help you understand how they work to slow the spread of COVID-19 and why we will be seeing them a lot more in the coming weeks and even months.

    How is COVID-19 spread?

    COVID-19 spreads primarily from person to person through respiratory droplets from an infected person coughing, sneezing, or talking. When the respiratory droplets leave the infected person, they can land in the mouths or noses of people who are nearby.

    Even though individuals who know they are infected with COVID-19 or are not feeling well should isolate at home, some people with COVID-19 may not show symptoms. This is why it’s so important for everyone to practice physical distancing and wear cloth face coverings in public.

    Read the full article at NorwalkOhioNews.com.

  • What is Sundowning?

    June is Alzheimer’s and Brain Awareness month. While you likely know a little about Alzheimer’s and dementia, it has many effects on a person’s mind that you may have never heard of.

    One of these effects is commonly known as “sundowning.” The term refers to confusion that typically occurs later in the day for patients with dementia such as Alzheimer’s disease.

    Sundowning can cause a variety of behaviors relating to the confusion the person is experiencing. These may include:

    • General confusion
    • Anxiety
    • Aggression
    • Ignoring directions
    • Pacing
    • Wandering

    These behaviors will typically occur during periods of transition between day in night. Although the name suggests evening, sundowning behaviors can also occur in the early morning hours.

    While the cause of sundowning is largely unknown, there are some factors that are thought to aggravate it such as:

    • Fatigue
    • Low lighting
    • Increased shadows
    • Disruption of the patient’s “internal clock”
    • Infections such as urinary tract infections

    Changes in a person’s environment or modification to their routine can also be a factor that exacerbates sundowning.

    Sundowning behaviors can be difficult for caregivers to manage but there are things we can do to help alleviate them for loved ones. Make sure the environment is well lit and keep distractions and excess noise to a minimum. Help make sure they are receiving enough rest and good nutrition. Maintaining a predictable routine for the person can also help. You should also be mindful of any signs of infection or sudden changes that warrant medical attention as these can trigger or worsen sundowning behaviors.

    You can also observe and make notes about certain things that may be especially triggering for your loved one. Once you observe these patterns, you can try and help them avoid or limit their personal triggers and minimize sundowning behaviors.

    Most importantly, try to practice patience. Seeing these behaviors in your loved one can be hard but staying calm will help comfort them. You can ask them if they need something, remind them of what time it is, avoid arguing, reassure them that everything is OK, allow them to get up and move around if they need to, and keep them safe with night-lights, door and window locks, and baby gates to block stair.

    About Kyle Dunlap

    Kyle Dunlap, MSN, RN is the Director, Ambulatory Nursing for Fisher-Titus. Fisher-Titus offers several levels of senior health care including home health, assisted living at the Carriage House, and skilled nursing at Norwalk Memorial Home. For more information, visit fishertitus.org/senior-health-services.

  • Safely Visiting Public Pools

    This summer will likely look different from what we’re used to. Although many restrictions are being lifted and the curve has been flattened, COVID-19 is still spreading. As we settle into what has come to be known as the “new normal,” it’s important to continue being mindful of the precautions you can take to slow the spread of COVID-19.

    Public pools regulated by local health departments were allowed to open on May 26. With warm weather in sight, online schooling wrapping up for the year for many students, and many of us feeling stir crazy, it’s understandable that people are eager to cool off at their favorite pools.

    According to the CDC, there is no evidence that COVID-19 can spread through the water in pools, hot tubs, spas, or water play areas. Proper operation and maintenance of the facility including disinfection with chemicals like chlorine should inactivate the virus.

    Public pools will be required to put many safety measures in place and other measures will be strongly recommended so you will likely notice some differences should you choose to visit these facilities.

    Read full article on NorwalkOhioNews.com.

  • Have a Safe and Healthy Summer

    Memorial Day marks the unofficial start of summer. Warm weather usually rolls in for good around this time, school is winding down, and everyone is feeling stir crazy after a long winter and a rainy spring.

    This year, there’s the added layer of our spring being full of COVID-19 precautions like staying home, distancing ourselves from loved ones, and not being able to visit some of our favorite restaurants and stores.

    Now that restrictions are lifting and the weather looks like it will finally cooperate, everyone is eager to get outside. Here are some tips so you can enjoy your summer while staying safe and healthy.

    Bike safety

    Biking is a great way to spend time with your family. Before you pedal off this, make sure you keep bike safety in mind.

    • Wear a properly fitted helmet.
    • Wear proper clothing including good footwear. Avoid loose clothes and flip flops that could interfere with the bicycle.
    • Make sure bikes are the appropriate size. There should be 1 to 3 inches between you and the top of your bike when you stand straddling it with both feet flat on the ground.
    • Check your brakes and check and oil the chain.
    • Check tire pressure.

    Water safety

    Water can be fun but it can also be dangerous. To stay safe while playing in or near water, follow these tips:

    • Avoid swimming past your ability or in rough water.
    • Never leave children unattended even if they are experience swimmers.
    • Never swim alone.
    • Make sure water is deep enough before diving.
    • Teach children to avoid playing around open bodies of water.
    • Discourage children from jumping in to help another swimmer. Teach them to throw the victim a flotation device or something long to grab and to call an adult for help.
    • Make sure young children wear properly fitting, coast guard approved life jackets when swimming or playing near water.

    Bugs

    Unfortunately bug bites and stings are part of the territory when it comes to summer. Take these precautions to avoid bites and stings:

    • Check under decks and eaves for bee and wasp nests.
    • Use insect repellent on the outside of clothing as well as exposed skin.
    • Use repellent containing no more than 30% DEET.
    • Avoid bright colored or floral clothing and scented soaps, perfumes, and hair products.
    • To avoid ticks, wear long-sleeved shirts and pants and tuck your shirt into your pants and your pants into your socks.
    • Check one another for ticks at the end of the day.

    Sun and heat safety

    Those most at risk for heat-related illness are young children and the elderly. Remember the following to protect yourself and family members from heatstroke and sunburn:

    • The sun’s rays are strongest between 10 a.m. and 4 p.m. Take extra precautions during those times.
    • Apply sunscreen 30 minutes before going out and every two hours while outside. If you are swimming or sweating you will need to use waterproof sunscreen and reapply more often.
    • Sunscreen should have SPF of 15 to 30 and should protect against UVA and UVB rays.
    • The sun’s rays can be damaging even on cloudy days.
    • Watch for signs of heat-related illness such as fainting, dizziness, headache, nausea, flushed appearance, increased heart rate, and body temperature of 103 or higher.
    • Drink lots of fluids and avoid beverages with alcohol or caffeine.
    • Wear light colored, loose fitting clothing, a hat, and sunglasses with 100% UV protection.
    • Keep children under one out of the sun as much as possible.

    Avoid groups

    Although COVID-19 restrictions are being lifted, the virus is still spreading in our communities. COVID-19 can spread especially quickly in large groups. Try to avoid gatherings of more than 10 people and crowded places to help slow the spread of COVID-19.

    Social distance

    If you choose to go to a restaurant, store, or other public place, keep in mind proper social distancing. Many places will likely have 6 feet of distance marked for their customers so you can visualize the distance. Staying 6 feet away from others who are not in your household will help slow the spread of COVID-19.

    Remember, should you get sick or injured, Fisher-Titus is here for you. Convenient Care is open Monday-Friday from 9 a.m.-8:30 p.m. and Saturday and Sunday 9 a.m.-3 p.m. We also offer scheduled and on-demand virtual visits and our Emergency Room is here for you 24/7. For more information, visit fishertitus.org/access.

    About Lauren Bailey

    Lauren Bailey, CNP is a Nurse Practitioner at Fisher-Titus Convenient Care in Norwalk. Fisher-Titus Convenient Care is staffed by physicians, nurse practitioners, and physician assistants to serve as a user-friendly option for patients who can’t get in to see their primary care provider when injury or illness strikes. For more information, visit fishertitus.org/convenient-care.

  • Why are masks important? Cloth Face Covering FAQs

    Why are masks important? Masks are a very important part of helping slow the spread of COVID-19. The Center for Disease Control & Prevention (CDC) recommends that people wear a cloth face covering over their nose and mouth to protect the people around them. This is because COVID-19 can spread even if a person is not showing symptoms.

    Why are masks required in the hospital when they aren’t elsewhere? In mid-April, the CDC revised its guidelines relating to face masks for use at healthcare facilities. The CDC stated: “To address asymptomatic and pre-symptomatic transmission, implement source control for everyone entering a healthcare facility (e.g., healthcare personnel, patients, visitors), regardless of symptoms. This action is recommended to help prevent transmission from infected individuals who may or may not have symptoms of COVID-19”. To continue our alignment with CDC guidelines and recommendations around the use of PPE, we revised our own PPE guidelines based on the above change. In addition, at the end of April, Governor Mike DeWine issued a mandate that all employees have to wear a face covering while on the job.

    How should I clean my mask? Your cloth mask should be laundered after each time you wear it. Wash your mask in a washing machine with hot water, then dry in a dryer on high heat.

  • Tech Talk for Teens

    Teens connect to the online world much differently than their parents do – thanks in part to our rapidly advancing technologies. Today more than ever, teens lead complex online lives and are faced with real-world problems online.

    In the National Cyber Security Alliance’s (NCSA) second annual Keeping Up With Generation App: NCSA Parent/Teen Online Safety Survey, 34 percent of teen internet users (13-17 years old) report that someone has been mean or cruel to them online in the past year, with 52 percent of those incidents involving something they said or did, 35 percent involving something about their appearance and about one in four involving their sexual orientation, gender, or race. In addition, the issue of “fake news” is also a worrisome topic for both parents and teens. Nearly 50 percent of teens said they were “very” or “somewhat” concerned about mistakenly spreading fake news or misinformation. Parents are even more concerned, with more than 60 percent indicating that they were “very” or “somewhat” concerned that their teen would spread misinformation.

    The results of this research have led NCSA to set some new recommendations for helping teens be safer and more secure online. In general, online teens reported that their parents are their primary source for learning about online safety and security. These conversations tended to focus on what should and should not be shared on cell phones (74%) and ways to behave toward others online or on the phone (64%). Even as more of these family tech talks are happening, 57% of the teens report having online accounts of which their parents are unaware, such as a social media site or app.

    As technology continues to become fully integrated into young people’s lives, it will be nearly impossible for parents to know everything their children do online. Additionally, parents need to understand that teens may seek help from – or be asked for help by – their peers. Forty-one percent of the teens surveyed reported that a friend of theirs has sought help because of something that happened online. Focus points of family tech talks should include how to offer helpful advice and how to determine when a situation requires adult assistance.

    NCSA recommends rethinking the family tech talk to help both parents and teens learn how to better recognize and resist online issues and be resilient when faced with problems.

    Rethinking the Rules

    Too often, parenting in the age of the internet focuses on setting rules and trying to understand and keep track of everything young people are doing. Online safety isn’t just about following designated procedures or being totally educated on everything about the internet. The survey revealed a significant digital disconnect with both parents and teens reporting dissimilar expectations around what kinds of rules actually exist and if they are being followed. In one example, nearly a third of teens (28%) state their household has no rules, while 8 percent of parents indicate there are no rules at home for their children’s use of technology.

    While NCSA believes rules still play an important role in helping young people stay safe and more secure online, we recommend revising the approach to online safety rules and taking the following into consideration:

    • Make rules that can be enforced. It’s easy to create a laundry list of rules. Making rules that are impractical to follow or enforce won’t make young people safer or more secure and can create a situation where rules lose meaning and parents become disengaged. For example, as a majority of teens have online accounts that their parents aren’t aware of, rules requiring advance permission before creating accounts are likely to be broken and unenforceable. Before setting a rule, think about whether it will significantly improve your children’s safety and how you can keep the lines of communication on the issue open.
    • Have a core set of rules the whole family follows. The most impactful rules are those that apply equally to everyone. So create a set of rules that everyone in the family is expected to follow. For example, limiting use of devices during meal times or other times spent together as a family, practicing discretion when sharing personally identifiable information about family members, and seeking permission from one another before sharing information, such as posting photos on social networks.
    • Make rules together and change them over time. Young people may surprise you with how much they already know about being safer and more secure online. Ask them about the rules they have made for themselves and the practices they currently follow. Then have them establish rules they can commit to following. Make sure that the rules evolve as your children grow. What is an appropriate rule for a 10-year-old may not be appropriate for a teen, so periodically revisit your expectations.

    It’s not about the technology – it’s about how it is used.

    There can often be hysteria around the latest app or how young people use devices. Connected devices are not unlike cars. Many cars can travel at speeds way above the speed limit, so teaching responsible use and good behaviors is key to safety. For example, smart devices have cameras that can be used to spark and promote creativity, and apps may have functions that allow video chat or live streaming. They can also be used to send inappropriate images or create security vulnerabilities. Teaching the family how to use the technology appropriately and manage privacy and security settings will help everyone learn how to better protect themselves online.

    Establish a safe environment for technology conversations.

    Although teens might not always come to you for online advice, it’s important to be prepared to help them when they do. Work to create an environment of trust in which your kids can comfortably talk to you about their experiences and issues without fear of punishment or blame, even if they have broken an established rule. Additionally, consider asking your teen to talk about their friends’ experiences and problems online; they may be more comfortable discussing someone else’s experience than their own.

    Help teens help their friends.

    Strong peer-to-peer relationships are fundamental parts of adolescent development, and many teens are likely to turn to their friends for help with problems online. You can expect your child may be consulted by a friend for help.

    Talk to your teens about developing the tools and knowledge they need to protect themselves as well as advise their friends with online safety concerns. This can include how to block users on sites and how to report problems or abuse to the sites and apps they use.

    Help your teen understand their capacity for responding to issues and challenges they face, and encourage them to seek help from someone they trust if a problem they or their friends have seems beyond their ability.

    Establish some parameters about when they should seek adult help, such as if a friend may harm themselves or others or the law has been broken. While teens are unlikely to intervene directly in an online incident a friend is experiencing, role-play and strategize about how they would handle problems.

    Being safe and secure online is about trying to prevent negative incidents, but also building resilience.

    Talk to teens about your shared concerns.

    Despite their differences, parents and teens actually share many concerns about technology. Similar to last year, the survey found that when it comes to online safety, parents and teens share common concerns on topics like someone accessing a teen’s account without permission, someone sharing a teen’s personal information and having a teen’s photo or video shared that they wanted to keep private.

    Source: StopThinkConnect.org

  • Keeping Kids Active at Home

    Do your kids have energy to spend without their usual outlets like gym class and recess or organized sports? Keeping kids active in the same ways they are accustomed to while participating in school activities is difficult but also important. Whether you’re looking for fun ways to keep your younger kids active or trying to help older kids stay in shape for athletics, here are some ideas for staying active at home.

    For Younger Kids

    Simon Says Fitness – Simon says “do 5 jumping jacks!” Simon says “run in place!” Turn a game your kids already love into a fun way to be active. Get creative with your prompts and don’t forget to try and trick them with some “Simon didn’t say so!”

    Treasure Hunts – This is a game you can play inside or outside to get the kids up and moving. Either hide items around the house or come up with a list of items you know they will be able to find. See who can find the most items or who can find them the quickest.

    Bike Rides – With everyone getting stir-crazy, a bike ride is a great way for the family to get out of the house together. In addition to riding around the neighborhood, we are also lucky to have the reservoir and North Coast Inland Trail here in Norwalk as great places to go for a ride.

    Obstacle Course – Set up some obstacles around the yard and take turns going through the course. Time yourselves to see who can complete the challenge the fastest and then rearrange the obstacles and try again!

    For High School and Junior High School Kids

    Yoga – There are lots of online resources for yoga and it’s a great exercise for core strength, balance, and flexibility. Find a video on YouTube you like and you’re ready to go!

    Body Weight Exercises – There are many exercises that use your own body weight and require no equipment and you’re probably already familiar with them. Pushups, lunges, reverse lunges, squats, and planks can all easily be done at home.

    Jump Rope – Jumping rope is great exercise and the only piece of equipment required—rope—is easy to find. Be sure to jump on a flat surface and remove any obstacle like rocks or sticks. Challenge yourself to see how many jumps you can get in a set amount of time and have fun with the exercise.

    Line Jumps – Draw a line with chalk on the driveway or mark it with tape. Make sure wherever you are doing your drills is an even surface to prevent injury. Using the line as your guide, jump in-place or down-the-line jump alternating using both feet or one foot at a time moving forward and backward and side to side. Use the balls of your feet to jump and keep your body weight on the instep and big toe.

    About Jake

    Jake Rospert, ATC is an Athletic Trainer with Fisher-Titus. Fisher-Titus Athletic Training Services work within Huron County and surrounding area schools to provide athletic training services. For more information, visit fishertitus.org/athletic-training.

  • What to Expect on Your Cancer Care Journey

    A cancer diagnosis is something no one expects. As you go through diagnosis and treatment you may have a lot of questions about the process, but you may also want a support team there to comfort you on this journey.

    For over 20 years, Fisher-Titus has cared for cancer patients close to home as if they were their own family. No matter where you are in your journey, our team is here to support you.

    Prevention and Screenings

    Detecting cancer early is key for treating cancer. Sometimes there may be signs or symptoms that something is wrong like lumps, sores that will not heal, abnormal bleeding, persistent indigestions, and chronic hoarseness.

    However, sometimes there are no noticeable symptoms. This is why it’s important to complete the regular screenings recommended by your doctor. These may include the following screenings:

    • Breast – screening mammograms
    • Colon – colonoscopy
    • Lung – CT scan of the lungs
    • Skin – visual exam of the skin
    • Cervical – Pap smear and/or HPV test
    • Prostate – Prostate Specific Antigen (PSA) blood test or Digital Rectal Examination (DRE)

    If you are unsure what screenings you should be getting regularly, talk to your doctor. They can take into consideration your age and any risk factors your may have to determine which screenings you should be getting and how often.

    Accessing care close to home

    When you receive a cancer diagnosis, it’s likely you don’t want to have to drive far to receive your treatment. There’s a comfort in being close to your home and your family as you journey through what is usually a difficult time.

    At the Fisher-Titus Cancer Care Center, you have access to some of the latest diagnostics and treatments including the early detection screenings listed above, diagnostic imaging, radiation services, surgery, rehabilitation, and support services. We provide these services for a many different types of cancers including:

    • Breast cancer
    • Colon/rectal cancer
    • Pancreatic cancer
    • Bladder cancer
    • Prostate cancer
    • Lymphoma/leukemia
    • Brain cancer
    • Ovarian cancer
    • Head/neck cancer
    • Lung cancer
    • Gastric cancer
    • Kidney center
    • Melanoma
    • Multiple myeloma

    Survivorship

    Caring for yourself through your cancer journey does not end when you are “cancer free.” Through survivorship programs, patients can go beyond being physically cancer free and maintain a healthy lifestyle mentally, emotionally, spiritually, and physically.

    After completing treatment, your survivorship journey may include a variety services including:

    • Physical or occupational therapy
    • Behavioral Health
    • Nutrition
    • Financial
    • Radiology
    • Lab
    • Nursing
    • Primary Care

    In 2019, The Fisher-Titus Cancer Care Center hosted two Cancer Survivorship events focused at providing education and fellowship for cancer survivors, current patients, and their families. In 2020, we are working to continue to develop and expand our survivorship program to support our patients long after they are cancer free.

    About the Dr. Adamowicz

    Dr. Timothy Adamowicz is a medical oncologist seeing patients at Fisher-Titus. He is board certified in Internal Medicine and Medical Oncology. The Fisher-Titus Cancer Care Center recently welcomed two medical oncologists, Dr. Timothy Adamowicz and Dr. James Fanning of NOMS Oncology. For more information about the Cancer Care Center, visit fishertitus.org/cancer-care-center.

  • Better Hearing and Speech Month

    We may take it for granted sometimes, but our hearing is an important part of our quality of life. Hearing loss not only affects how you experience the world around you but if left untreated, it can increase a person’s risk for dementia, depression, falls, and memory and balance issues. In the United States there are approximately 48 million individuals that have hearing loss and while many people assume it only affects older people, 62% of those with hearing loss are under age 65.

    Just like you should have regular visits with your primary care provider, dentist, or eye doctor, checking your hearing should be part of your regular health routine. Hearing loss can be gradual, so getting it checked annually can help you track slight changes from year to year.

    While you should get regular hearing checks regardless if you are having symptoms as they can be subtle, signs of hearing loss can include:

    • Muffling of speech and other sounds
    • Difficulty understanding words, especially against background noise or in a crowd
    • Trouble hearing consonants
    • Frequently asking others to speak more slowly, clearly, and loudly
    • Needing to turn up the volume on the TV or radio
    • Withdrawal from conversations
    • Avoidance of some social settings

    When you get a hearing evaluation, there are a few things the audiologist may ask you to do.

    1. Provide personal and family histories. The provider may ask about your personal hearing health or any history of hearing loss in your family. It’s important to have a full picture of anything that could affect your hearing such as genetic factors or medical conditions such as ear infections, allergies, colds, or past head traumas.
    2. Noise Exposure Evaluation. If your job, hobbies, or social activities frequently expose you to loud noises, it may put you at higher risk for hearing loss.
    3. Otoscopic exam. Earwax and other obstructions can affect your hearing. An otoscope allows the audiologist to observe your ear canal and ear drum and check for any potential obstructions.
    4. Pure tone test. For this test, you will wear headphones and will sit in a quiet room. You will listen for faint tones and either raise your hand or press a button when you hear the tone. Your responses to the tones will help the audiologist determine which frequencies you are able to hear and which frequencies you may be having trouble hearing.
    5. Speech test. This test helps determine what spoken sounds you can hear and at what volumes.

    The good news is, hearing loss is very treatable, especially when detected early through regular hearing screenings. Treatment depends on the cause and severity of your hearing loss but may include:

    • Removing wax blockage
    • Surgical procedures
    • Hearing aids
    • Cochlear implants

    While some services at the Fisher-Titus Hearing Center have been put on hold due to COVID-19, we are providing contactless hearing aid services and supply pick ups as well offering discounted hearing aid cleaning services. For more information on our contactless services, call the Fisher-titus Rehabilitation Department at 419-660-2700. As soon as it is safe to do so and in line with local and state recommendations, we look forward to resuming our normal audiology services which include:

    • Comprehensive adult and pediatric hearing screenings with an audiologist
    • Assistive devices
    • Ear molds
    • Battery sales
    • Hearing aid services including the latest in digital hearing aid fitting and repairs
    • Custom noise protection
    • Swim plugs

    About Caitlin Robertson

    Caitlin Robertson, Au.D., CCC-A, F-AAA is an audiologist with Fisher-Titus. A native of Norwalk, Caitlin works with patients of all ages from newborns who fail universal infant newborn hearing screenings to older patients. For more information about the Fisher-Titus Hearing Center, visit fishertitus.org/hearing-center.

  • Spring Clean Your Digital Life

    Most of us are spending more time at home lately in order to prevent the spread of COVID-19. While many are spring cleaning your house to fill the time, it’s also important to spring clean your digital life as well. Take the time while at home to make sure you are in a healthy place with your digital life. Here are some tips from The National Cyber Security Alliance (NCSA) and the Better Business Bureau (BBB) for doing a digital declutter.

    Keep a clean machine. Keeping software updated on internet-connected devices (computers, smartphones, tablets, etc.) reduce the risk of infection from malware.

    Lock down your login. Utilize the strongest authentication tools available for all your accounts. Usernames and passwords alone are not enough to protect email, banking, and social media accounts. Biometrics, security keys, or unique one-time codes sent to your mobile device are all additional measures you should implement to strengthen the security of your accounts.

    Declutter your mobile life. Most of us have apps we are not using or that need updating. Go through all the apps on your phone and delete ones you are not using and update others. It’s also important to keep the operating system up to date, as the updates often have key security change in them.

    Do a digital file purge. Treat your digital files like paper files. Start with your email and save only those you need and unsubscribe to emails you no longer need or want to receive. Back up important data to a secure cloud site or another device where it can be safely stored. Password protect your backup files. Also remember to backup files before you get rid of old devices.

    Own your online presence. Review privacy and security settings on the websites you use. It’s OK to limit how much you share and with whom.

    Know what devices to digitally shred. Think beyond your computer, phone, and tablet—they are not the only devices that capture and store sensitive information. External hard drives, USB drives, wearables, networking equipment, printers, and more can all store personal information.  Smart TV’s even have your personal login information to access streaming accounts.    Make sure you remove your personal data before disposing of any electronic device.

    Clear out stockpiles. If you have old hard drives or other devices, information can still exist on them and be stolen. Wipe and/or destroy unused/unneeded hard drives.

    Empty your trash or recycle bin on all devices and be certain to wipe and overwrite. Deleting a file and emptying the trash bin on your computer is not enough to completely get rid of a file. Permanently delete old filed using a program that deletes the data, wipes it from your device, and overwrites it by putting random data in its place.

    For more information on cyber security, visit stopthinkconnect.org. For more information on how Fisher-Titus is responding to COVID-19, visit fishertitus.org/coronavirus.

    About Linda Stevenson

    Linda Stevenson is the Chief Information Officer at Fisher-Titus. With over 30 years in health care, Linda has had the opportunity to support all areas of the hospital with much of her experience in managing major hospital initiatives including HIPAA, Data Security and Privacy, Meaningful Use, and electronic medical record implementations.

  • Seeking Health Care during the COVID-19 Pandemic

    During the current pandemic, you may be wondering about the best way to see a doctor or other clinician and follow the stay at home order and social distancing guidelines. Fisher-Titus offers many options right here in our community so you can still see a health care professional and prevent the spread of COVID-19.

    Telehealth

    Almost all of the Fisher-Titus doctors and Advanced Practice Practitioners are able to care for patients virtually by video or with a phone call for minor ailments. These telehealth options may be the right option for you or a loved one. Call your provider and ask if a virtual is the right option for your health care needs. Not all appointments can be done virtually, but your provider team will help determine whether a telehealth visit is the right appointment for you and when the appointment can be rescheduled.

    To schedule a virtual visit with a Fisher-Titus Medical Care provider, current patients can simply call the office of the provider and let the scheduler know they’d like to be seen through a video visit. These appointments will be billed out through insurance at their normal rate, just as if they were being seen in person in the office.

    Some appointments still need to be completed face-to-face with your doctor or practitioner. Your provider team will help you determine the best solution to provide the care you need.

    Convenient Care

    If you are not experiencing any respiratory symptoms (coughing, shortness of breath, etc.), Fisher-Titus Convenient Care is available on the north side of Norwalk on US 250. You can check into the clinic from the comfort of your car and the team will call you in so that you can still social distance while waiting to be seen. When registering, the Convenient Care team will ask about your health and if they detect any respiratory symptoms you may be directed to another site of care.

    COVID-19 Virtual Screenings

    If you are experiencing coronavirus symptoms and do not have a primary care provider or would like an immediate COVID-19 evaluation, a screening can now be done through a video visit using the Fisher-Titus Amwell telemedicine service.

    To get started, simply download the Amwell app from the Apple or Android app store or visit fishertitus.amwell.com and enter the service key FISHERTITUS to be connected with a board certified and experienced medical provider see patients over secure network any time of day, anywhere. No appointment is necessary and the visit is only $59 or less, depending on your insurance.

    Emergency Room Mobile Assessment

    For people experiencing respiratory symptoms, the Fisher-Titus Emergency Department provides a mobile assessment. Set up outside Fisher-Titus Medical Center off Shady Lane, the mobile assessment provides you an opportunity for a medical screening exam from an Emergency Department provider without leaving your vehicle. Please note – this is not drive up or drive through testing. Testing for COVID-19 is limited across the state and must be ordered by a provider.

    If you need further monitoring or treatment after the assessment, you will be directed to a treatment area inside of the Emergency Department. Whether additional treatment is needed or not, an Emergency Department provider will make recommendations for what your next steps should be, including testing, if it is needed.

    To enter the mobile Emergency Department assessment area, turn onto Shady Lane drive from Benedict Avenue, and then turn left onto Fisher-Titus Parkway. Follow the signs for the drive-through assessment located in front of the Snyder/White Heart & Vascular Center.

    Avoiding unnecessary trips from home and taking precautions when you must go out are important components to slowing the spread of COVID-19. Everyone at Fisher-Titus Health wants to ensure you are getting the needed care for all of your health concerns. We are proud to provide many different health care options and resources in our community and helping prevent the spread of COVID-19.

    For more information about assessment options and how Fisher-Titus is responding to the coronavirus pandemic, visit fishertitus.org/coronavirus or follow us on Facebook.

    About Matt Mattner

    Matt Mattner is the Chief Operation Officer at Fisher-Titus. For more information about Fisher-Titus Virtual Visits, visit fishertitus.org/virtualvisits. For more information about coronavirus, visit fishertitus.org/coronavirus.

  • Slowing the Spread of Coronavirus

    Over the last few weeks, we’ve been asked by local, state, and national health authorities to stay home as much as possible in order to slow the spread of COVID-19. While we can still seek out essential services, it’s important to take precautions when we do. Here is more information on what you can do to slow the spread and what you should do if you develop COVID-19 symptoms to avoid further spreading the virus.

    Slow the spread

    We often hear the term “social distancing” used when talking about slowing the spread of COVID-19. Social distancing is maintaining at least a 6-foot distance, avoiding crowds or groups over 10 people, and not shaking hands or hugging. It’s important to keep social distancing in mind any time you leave the house whether it is to get groceries or go for a walk.

    Here are some other tips for slowing the spread:

    • If you are older or have a serious underlying health condition, you should stay home and away from other people. If you need groceries or other necessities, try to have someone bring them to you and leave them outside your door.
    • Work from home as much as possible. Student should do schooling at home as much as possible.
    • Avoid gatherings in groups of more than 10 even if everyone in the group is feeling healthy.
    • Avoid unnecessary travel including shopping trips and social visits.
    • Practice good hygiene by washing hands frequently, avoiding touching your face, sneezing and coughing into a tissue or the inside of your elbow, and disinfecting surfaces often.

    What to do if you feel sick

    The most common symptoms of COVID-19 are:

    • Fever
    • Dry cough
    • Shortness of breath

    According to the World Health Organization (WHO) some people may also experience aches and pains, nasal congestion, runny nose, sore throat, or diarrhea. Since symptoms can vary from person to person, the best thing you can do if you feel sick is to stay home and call your primary care provider. If one person in the house is sick, the everyone in the household should stay home and act as if they are also sick so they do not spread the virus.

    Most people who have COVID-19 experience mild symptoms and recover from the disease at home. If you call your primary care provider with mild symptoms, they may advise that you isolate and monitor symptoms at home. You should not leave the house except to get medical care and even then, take precautions to avoid spreading the virus.

    If you develop severe symptoms you should immediately go to the nearest Emergency Room or call 911. Be sure to tell them your symptoms so they can take additional precautions and you should wear a face mask if possible. Emergency warning signs include:

    • Trouble breathing
    • Persistent pain or pressure in the chest
    • New confusion or inability to arouse
    • Bluish lips or face

    This list is not all inclusive so you should stay in touch with your primary care provider as your symptoms change.

    Fisher-Titus Virtual Visits

    In order to continue providing the same level of care for our patients during the COVID-19 pandemic, Fisher-Titus has launched virtual visits for patients.

    If you are experiencing COVID-19 symptoms, you can complete an online screening at fishertitus.amwell.com. Enter the service key FISHERTITUS.

    Additionally, many regular visits with Fisher-Titus Medical Care providers can now be completed over the phone or via video call. If you need to see your doctor for any reason, call the office and ask if your visit can be done virtually. For more information, visit fishertitus.org/virtualvisits.

    About Tami Binger

    Tami Binger, RN is an infection preventionist certified in infection control at Fisher-Titus. For more information on COVID-19 preparedness, visit fishertitus.org/coronavirus.

  • Coping with Coronavirus Anxiety

    Panic. On-edge. Overwhelmed. Unsure. Surviving. Worried. Numb. Depressed. Frightened. Angry. Calm.

    I have heard all of these words used to describe how some have felt during the Coronavirus or COVID-19 outbreak. There isn’t a “right way” or a “wrong way” to feel about what is going on.

    This is a worldwide situation that is life-changing and will be discussed for years to come in history classes. The children that are being “homeschooled” today will one day tell their grandchildren what it was like living through the COVID-19 pandemic. Children—and most adults—look to each other to gauge reactions to stressful situations and moods can shift depending on those reactions. Which feeling words do you want them to use to describe these moments?

    Everyone is stressed or anxious to different degrees during this unprecedented situation. Our routines are off, places are closed, finances are being effected, and a time frames for when things will be back to normal are unknown. Stress and anxiety are  to be expected.

    Putting some familiarity back into chaos helps us gain a sense of control and shift our moods and reactions to ones that are more positive. Here are some things you can do to help feel like you have some normalcy and positivity in the midst of all this unknown:

    1. Keep up with a routine. Start by setting regular wake up times, getting dressed each day, keeping up on hygiene, eating balanced meals, scheduling time to do work/homework, and going to bed around the same time each night.
    2. Make lists. Creating a to-do list will give you a sense of accomplishment and purpose; you can even write down all of the things listed above and check them off as you go. The point is to get back into a routine and know what is to come next.
    3. Come up with things you can do at home to stay busy. If you live with others, think about what you can do together and make a creative “bucket list” or “honey do” list now that you have more time at home. These lists could be different games, activities, movies, scrapbooking, or crafts you have wanted to do together or it could be home projects inside or outside of the house that everyone has been putting off.
    4. Get outside when possible. Getting outside often can be very beneficial especially after a long cold winter like we just had. You can go outside for a walk or just to enjoy the sun while still practicing social distancing.
    5. Stay social in other ways. If you live alone, you can schedule date nights over the phone or better yet on one of the many social platforms that has video conferencing capabilities. Don’t forget to check in on your friends, extended family members, and neighbors.

    Also try to remember that some positives can come from this. We have to be mindful to make the effort to point them out to ourselves and others when we notice them.

  • COVID-19 Preparedness and Prevention

    Preparing

    For a full checklist, view the Household Checklist provided by the Ohio Department of Health at coronavirus.ohio.gov.

    • Clean and disinfect high-touch surfaces often. These include counters, tabletops, doorknobs, light switches, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also clean any surfaces that may have blood, stool, or body fluids on them.
    • Keep an adequate supply of water, food, and pet food in your home.
    • If you take prescription drugs, contact your health care provider, pharmacist, or insurance provider about keeping an emergency supply at home.
    • Keep a working thermometer and respiratory medications, like decongestants, expectorants, and analgesics (ibuprofen, acetaminophen), on hand.

    Get a flu shot this season if you haven’t already. It won’t protect against COVID-19, but it can help protect against flu or lessen symptoms if you get it, lessening the strain on health care facilities.

    Preventing/Slowing the Spread

    To help stop the spread of any viral respiratory disease, including Coronavirus, you should:

    • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
    • Avoid touching your mouth, nose, or eyes.
    • Cover coughs/sneezes with your arm or a tissue.
    • Avoid exposure to others who are at risk.

    Additional precautions you can take include social distancing measures specific to Coronavirus and recommended by state, local, and federal health agencies, such as:

    • Stay home if you are sick and contact your primary care provider for further guidance.
    • If your children are sick, keep them at home and contact your primary care provider.
    • If someone in your household tests positive for COVID-19 or is suspected of having COVID-19, keep the entire household at home.
    • If you are an older person, stay home and away from other people as you are at greater risk for getting seriously ill from the coronavirus.
    • If you have a serious underlying health condition that weakens your lung, heart, or immune system functions, stay home and away from other people.

    Even if you are young, don’t feel sick, or are otherwise not a greater risk for being affected by COVID-19, you can take the following precautions in order to protect yourself, your community, and your loved ones:

    • Work from home whenever possible.
    • If you work in a critical infrastructure industry (such as health care, pharmaceutical, and food supply) and will be maintaining normal work schedules, you should follow CDC guidance to protect your health at work.
    • Avoid social gatherings in groups of ten or more.
    • Avoid unnecessary travel including shopping trips, vacations, and social visits.

    The best thing to do is remain calm, take preventative and precautionary measures, and use credible sources such as the CDClocal health department, and the Ohio Department of Health for updatesFor more information about how Fisher-Titus is responding to the COVID-19 situation including up-to-date visitor restrictions, visit fishertitus.org/coronavirus.

    About Tami Binger

    Tami Binger, RN is an infection preventionist certified in infection control at Fisher-Titus. For more information on COVID-19 preparedness, visit fishertitus.org/coronavirus.

  • Understanding Common COVID-19 Terms

    Social Distancing

    • Do not shake hands
    • Avoid crowds
    • Maintain 6 feet of distance
    • Stay home if you are sick

    Self-Monitoring & Self-Quarantining

    • Aims to keep people who were exposed or who may have been exposed away from others
    • Regularly check temperature
    • Watch for signs of respiratory illness
    • Limit interactions
    • Lasts 14 days (symptoms may appear sooner)

    Isolation

    • Triggered by a COVID-19 diagnosis
    • Can happen whether you are sick at home or in the hospital
    • More rigid infectious disease precautions, such as wearing masks, should be taken

    Quarantine

    • Individuals or groups are on lock-down
    • Mandated by state or federal law

    For more information, visit NPR.org

    For more information on how Fisher-Titus is responding to the COVID-19 situation, click here.

  • What is Chronic Obstructive Pulmonary Disease or COPD?

    What is COPD?

    COPD is an acronym for Chronic Obstructive Pulmonary Disease. COPD refers to a group of progression lung diseases that includes both emphysema and chronic bronchitis. Below is a breakdown of how to understand what COPD is, how it impacts your body, and ways in which it can be treated.

    Understanding Chronic Obstructive Pulmonary Disease (COPD)

    • Chronic: This means that COPD is always present and ongoing.
    • Obstructive: COPD impairs the lung’s ability to move air in and out of the lungs. It also can weaken the lung’s ability to transport oxygen to our vital organs.
    • Pulmonary: This is a disease that pertains to the lungs.
    • Disease: Meaning there is damage to the lungs and proper function is in decline.

    What are the Symptoms of COPD?

    Symptoms and severity of COPD can be different for each person. The most common are increased shortness of breath, persistent cough that doesn’t clear, increased phlegm or mucous production, and unexplained fatigue.

    Living with COPD

    Living with COPD can make it difficult to perform everyday tasks. Simple things that once were taken for granted become a burden, such as bathing and dressing, doing light housework, or even just walking to the mailbox.

    When the lungs are exposed to irritants repeatedly over time, damage can occur leading to the development COPD. While smoking is the most common culprit, farming, welding, and other occupations with exposures to fumes, dusts, and chemicals can contribute also. There is a small population of people who inherit the disease due to a rare genetic disorder.

    How Chronic Obstructive Pulmonary Disease is Diagnosed

    COPD can be diagnosed by a physician or a pulmonologist (doctor who specializes in diseases of the lung). This is done by taking a history of symptoms, smoking habits, occupational exposures, and family medical history. Your doctor may order other tests to confirm a diagnosis such as a chest x-ray, bloodwork, and a pulmonary function test. A pulmonary function test is a pain-free breathing test that measures lung volumes and airflows in and out of the lungs. The pulmonary function test also helps to determine the severity of the disease and will assist your doctor in determining treatment options.

    According to the American Lung Association, more than 15.3 million people in the United States suffer from COPD, with many more not yet diagnosed. COPD is progressive, meaning it worsens over time. Although it is a non-curable disease, slowing the progression and better managing the disease should be a priority if you’ve been diagnosed with COPD. The number one thing you can do to improve your quality of life is to quit smoking. For assistance call the OHIO Quit line at 1-800-QUIT-NOW.

    Caring for COPD at Fisher-Titus

    Fisher-Titus offers a Pulmonary Rehabilitation Program designed for those struggling with COPD. Our program offers the tools to assist you in better managing your symptoms, decreasing your shortness of breath, improving your fatigue and related anxieties associated in living with a COPD diagnosis.

    About Patty

    Patty Schwab, RN is the Cardiac Rehab Coordinator for Fisher-Titus Heart and Vascular. For more information, call Fisher-Titus Heart & Vascular at (419) 660-2600 or visit fishertitus.org/heart. If you think you might benefit from Pulmonary Rehabilitation, talk with your primary care provider about a referral.

  • Preparing for Novel Coronavirus

    Now that Coronavirus has spread to the United States and there have been cases of community transmission, it’s important for our community to know how to be prepared and that Fisher-Titus has proactively taken action to be prepared and ready. Fisher-Titus is in regular contact with Huron County Public HealthOhio Department of HealthCDC, and regional partners to assure a state of readiness.

    In fact, on February 6 we implemented screening measures in accordance with public health and CDC recommendations at all our patient access points. This included plans for addressing symptoms, quarantine processes, and ways to keep our patients, guests, staff, and volunteers safe at the hospital, ambulatory offices, and for North Central EMS.

    History of Coronavirus

    Coronavirus has actually been around since the mid-1960s and are named for the crown-like spikes on their surface. There are seven different types of coronavirus that typically give humans cold-like symptoms and some of those you may have heard of before including MERS and SARS. Rarely, animal coronaviruses that infect animals emerge to infect people and can spread between people, just like with our current coronavirus – Novel Coronavirus 2019 (COVID-19). Early on, many of the patients at the epicenter of the outbreak in Wuhan, Hubei Province, China had some link to a large seafood and live animal market, suggesting animal-to-person spread. Later, a growing number of patients reportedly did not have exposure to animal markets, indicating person-to-person spread.

    Symptoms of Coronavirus

    Those who have contracted it have had mild to severe respiratory illness with symptoms of fever, cough, shortness of breath, typically 2-14 days after exposure. These have been people who have traveled to China, Japan, Italy, Iran, and South Korea, as well as been in contact with others who have also traveled to these locations. If you have an international travel planned, it is best to check the up-to-date travel information from the Centers for Disease and Prevention. If you have traveled to any of the above-listed destinations and experience any of the symptoms, please call your health care provider or local hospital to seek guidance if it is not a medical emergency. Explain your symptoms, travel history, and any additional exposure you may have had. Do not visit your health care provider without calling first to help reduce exposure to others.

    Reducing the risk

    As with any illness the best way to reduce your risk is to follow a few simple steps including:

    • Wash your hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer if soap and water are not available.
    • Avoid touching your mouth, nose, or eyes.
    • Cover coughs/sneezes with your arm or a tissue.
    • Avoid exposure to others who are at risk. Stay home if you are sick.

    The Centers for Disease Control and Prevention also has a variety of tips on how to protect yourself and the community.

    Be prepared

    There are many ways you can prepare your household in the case of an outbreak in our area. The Ohio Department of Health has created a Household Checklist with a variety of great tips, including:

    • Clean and disinfect high-touch surfaces often. These include counters, tabletops, doorknobs, light switches, bathroom fixtures, toilets, phones, keyboards, tablets, and bedside tables. Also clean any surfaces that may have blood, stool, or body fluids on them.
    • Keep an adequate supply of water, food, and pet food in your home. If you take prescription drugs, contact your health care provider, pharmacist, or insurance provider about keeping an emergency supply at home.
    • Keep a working thermometer and respiratory medications, like decongestants, expectorants, and analgesics (ibuprofen, acetaminophen), on hand.
    • Get a flu shot this season if you haven’t already. It won’t protect against COVID-19, but it can help protect against flu or lessen symptoms if you get it, lessening the strain on health care facilities.

    The best thing to do is remain calm, take preventative and precautionary measures, and use credible sources such as the CDClocal health department, and the Ohio Department of Health for updates.

  • How to Manage Seasonal Affective Disorder

    Seasonal Affective Disorder is a clinical depression where problematic symptoms occur for longer than two weeks during a season change reoccurring for two years in a row. According to the National Institute of Mental Health, over 10 million Americans are affected yearly. Seasonal Affective Disorder (SAD) is different from the “winter blues” which can be described as a minor period of time where one has less energy, wants to sleep more, and can feel more down than usual.

    Have you noticed your mood being impacted by the weather, especially in the Fall and Winter months? Do you notice others around you saying, “Get over it because you should be used to this Ohio weather?” It may actually not be so easy to “get over it” as it  you could be suffering from a medical condition called Seasonal Affective Disorder or commonly known as SAD.

    Seasonal Affective Disorder Symptoms

    Symptoms of SAD can include being less physically active and engaging in social isolation. When the weather gets colder out and it’s dark outside when people wake up and get off of school or work, it impacts their mindset. People can even demonstrate a weight gain due to finding comfort in foods and not getting out of the house as often as they would in the Spring and Summer months. Some even suffer from physical aches and pains due to the cold weather and “heaviness” of depression. Many people complain of fatigue even though they are sleeping more either by taking more naps or sleeping longer periods of time at night. SAD can cause feelings of hopelessness, guilt, indecisiveness, and criticism towards themselves and others.

    The exact reason why Seasonal Affect Disorder impacts some people and not others is not known. However, it is believed that those who have family history of depressive disorders are more likely to be effected by SAD. It is also thought that chemicals in the brain are a huge influencer as the darker days can lead to more melatonin being produced causing fatigue. Additionally, the lack of sunlight causes dysregulation in serotonin levels as well as vitamin D, according to National Institute of Mental Health. Due to these chemical contributors, treatment for SAD can range from supplements or medication to therapy.

    How to Fight Seasonal Affective Disorder

    There are many things you can do to combat these feelings including becoming more physically and socially active, eating vitamin D enriched foods and taking supplements, or a referral to a mental health specialist for talk therapy and medication management. Light therapy can also be a benefit for many individuals. Being outside for at least 30 minutes can help boost your morale and serotonin levels. If you cannot go outside, then be mindful of where you sit, choosing to sit near windows where you can enjoy the sunlight. You can also invest in a light lamp you can sit under for 30 to 60 minutes a day in intervals. The bright artificial light mimics outdoor light for a period of time to regulate your brain and mood. This technique is so common that even some libraries in bigger cities allow their patrons to check out light lamps along with their books.

    If you are concerned that you or a loved one is affected by SAD then you should speak to your doctor to find the best option for you. And keep in mind, Spring is right around the corner!

  • Should I Delay My Mammogram or Breast MRI for the COVID Vaccine?

    New mammogram guidance surrounding the COVID-19 vaccine has been in the news and on social media lately. That’s because the Society of Breast Imaging (SBI), one of the leading breast imaging organizations in the country, has issued guidelines for breast imaging and the COVID-19 vaccine.

    The reason for these guidelines is axillary adenopathy, or the swelling of lymph nodes in the armpits. This swelling is rare in women with an otherwise normal screening mammogram occurring in 0.02-0.04% of screening mammograms.

    Studies around the COVID-19 vaccine have found that a possible side effect can be swelling and tenderness of the lymph nodes, particularly those in the armpit. Approximately 11.6% of patients who received the Moderna vaccine had swelling or tenderness following the second shot. The side effect was less prevalent in the Pfizer-BioNTech vaccine but it did happen. The SBI noted that the incidence of this side effect could possibly be higher but has gone unnoticed by vaccine recipients.

    This side effect is not a surprising one. Your body has a network of lymph vessels and lymph nodes that are part of your immune system. They collect fluid, waste, and other things like viruses and bacteria that are in your tissues and bloodstream. Lymph vessels carry lymph fluid through your body like blood vessels. Lymph fluid does a few things but one important function is the ability to fight infections through the white blood cells it carries.

    When your body is working to fight infection and build immunity to a virus or bacteria, the node in a particular area may swell or enlarge as it tries to filter out bad cells. While the swelling is usually indicative of your body fighting infection, it can be a sign of cancer in an area.

    The swelling/tenderness in the armpit from a COVID-19 vaccine could cause a woman to worry about breast cancer. The swelling could cause a false reading on her breast imaging or make her worry that she’s developed a lump. Not only can this cause a lot of stress for women, it can also mean unnecessary follow-up testing.

    So what should you do if you are eligible for the COVID-19 vaccine but also need a screening mammogram or breast MRI?

    If at all possible, the SBI recommends considering scheduling your mammogram or breast MRI before your first dose of the COVID-19 vaccine or 4-6 weeks after your second dose. However, screening mammograms and breast MRIs are important so if scheduling imaging around vaccination would unduly delay care, you can still get your mammogram or breast MRI. Talk to your doctor if you have concerns about getting or delaying your imaging due to the vaccine.

    If you choose to go forward with your screening mammogram or breast MRI after your vaccine, let the technologist know that you have had the vaccine. They can make a note on your intake form so the physician reading it can take that into consideration when they review your imaging.

    Most of all, women should know that this side effect is normal with the COVID-19 and does not necessarily indicate a problem in your breasts. If you notice swelling or tenderness after the vaccine, monitor to see if it subsides and contact your doctor if you have any concerns.

    About Karen

    Karen Darr is the Director of Imaging Services at Fisher-Titus. Fisher-Titus offers 3-D mammography and curved paddles. Talk to your doctor to see if you should be getting a regular screening mammogram. For more information, visit fisher-titus.org/breast-health.

  • What is Peripheral Artery Disease?

    Peripheral Artery Disease (PAD) is a circulatory problem where narrowing in the arteries reduce the blood flow to your limbs. This means that your limbs, usually your legs, aren’t receiving enough blood flow. An important component in heart health are the blood vessels that carry blood throughout your body. It’s important to show them the same love you do for your heart.

    Peripheral Artery Disease increases a person’s risk for heart attack or stroke as it may be an indication of a more widespread accumulation of plaque in the arteries causing reduced blood flow to your heart or brain. If left untreated, it can worsen over time and even lead to a complete blockage of blood flow causing permanent damage to that part of the body. It can also lead to gangrene (death of tissue) in that part of the body or require amputation.

    What are the Most Common Symptom of Peripheral Artery Disease

    PAD is most common in those age 50-64. However, those under 50 can also have increased risk for developing PAD. You may be at increased risk if they you any of the following risk factors.

    Risk Factors for Peripheral Artery Disease

    • Smoking
    • High cholesterol
    • High blood pressure
    • Diabetes
    • Family history of PAD
    • History of atherosclerosis (hardening of the blood vessels) such as the coronary arteries (blood vessels to the heart), carotid artery (the main blood-carrying vessel from the heart to the brain), and blood vessels of the abdomen or kidneys
    • Obesity

    Many people with PAD may have mild or no symptoms and may not even know they have PAD. While other people may have more significant symptoms.

    The most common indication of PAD is leg pain when walking also known as claudication. This may feel like muscle pain or cramping in your legs or arms that is triggered by activity but subsides after a few minutes of rest. Calf pain is the most common but the location of the pain depends on the location of the clogged artery. Claudication can vary in severity ranging from mild discomfort to debilitating pain.

    Other signs and symptoms of PAD can include:

    Other Signs and Symptoms of PAD Peripheral Artery Disease Can Include:

    • Leg pain, tightness, or cramping sensation with walking
    • Leg numbness or weakness
    • Leg or foot feels cold to the touch compared to the opposite side
    • Dry and scaly skin on your leg
    • Sores on your toes, feet, or legs that won’t heal
    • Poor toenail growth or hair loss on your feet or toes
    • Weak or no pulse in your legs or feet

    PAD Diagnosis and Treatment

    If you are at increased risk for PAD or you have symptoms, there are several tests your doctor may recommend to determine if you have PAD. These may include

    • Physical exam
    • Ankle-brachial index
    • Doppler ultrasound
    • Treadmill test
    • Magnetic Resonance Angiogram (MRA)
    • Arteriogram

    If you do have PAD, there are many things you can do to manage your symptoms and stop the progression of blockage throughout your body. Many of the treatments your doctor suggests will likely involve lifestyle changes which can be very effective especially if you are in the early stages of PAD. Some recommended treatments and lifestyle changes include:

    • Quit smoking
    • Heart-healthy eating plan
    • Regular walking and activity
    • Exercise
    • Medications
    • Surgery and other procedures to open blocked blood vessels

    Beginning this month, Fisher-Titus Cardiac Rehab will be offering a specially-designed exercise program for those diagnosed with PAD. For more information, call419-660-2600.

    Although PAD can be serious, there are lots of things you can do to reduce your risk, prevent PAD, and manage it if you are diagnosed. Learn more about PAD and talk to your doctor if you have any concerns about your risk for Peripheral Artery Disease.

    About Dr. Osman

    Mohamed Osman, MD is a Vascular and Endovascular surgeon with Fisher-Titus Heart & Vascular. He is board-certified in Vascular Surgery, General Surgery, and Surgical Critical Care. For more information about Fisher-Titus Heart & Vascular, visit fishertitus.org/heart-and-vascular-services.

  • The Truth About Exercise, Caterpillars, and Imaging

    Part 2: Innovations in Heart Disease Diagnosis and Treatment

    Last week, I discussed the importance of prevention when it comes to heart disease. We mentioned exercise and diet as some of the best ways to care for your heart. Prevention is the single best thing you can do for your heart.

    However, if you do find yourself dealing with heart disease, there have been many recent innovations in the diagnosis and treatment of heart conditions.

    Heart Care and Innovative Treatments

    Heart care in the near future includes creatively-designed stents for treating heart attacks. Stents are medical devices that permit the flow of blood through a clogged blood vessel. For the coronary arteries, the sizes of stents are about the size of a spring you’ll find in a clickable writing pen. And although numerous examples of creative designs exist, I’m intrigued by laser-etching methods that make the inside of a stent appear like the inner lining of an artery. I’m also interested, as incredible as it may seem, in stents with the flexibility of a caterpillar. Stents that have the look and feel of the lining of coronary arteries can help your body adjust more quickly to their placement. The purpose and advantage of a “caterpillar stent” is that it moves in sync with the continuous motion of the heart like a caterpillar.

    For someone who’s been diagnosed with heart failure, innovative treatments include soft, flexible robotic sleeves that wrap around the heart to gently assist the heart’s very own pumping action. Furthermore, pacemakers are becoming noticeably better at coordinating your heart’s electrical activities.

    Another area receiving a lot of attention is the regeneration of heart tissue. In these cases, adult stem cells – not embryonic stem cells – are placed on an underlying mesh that’s compatible with the body’s immune system in order to cultivate and grow the highly-specialized muscle cells of the heart. And regeneration of heart tissue is an important thing since a moderate-to-severe heart attack typically damages a billion heart cells. In fact, researchers have also had success at turning cells from skeletal muscle into useful heart muscle. And what’s really fascinating is that by using advanced techniques in magnetic resonance imaging (also known as MRI), we can now see how well the strands of newly-generated tissue tie-in and work with native heart tissue. However, as of today, perhaps the most incredible innovation in heart care happened last year when researchers in Israel successfully took the first steps in producing a viable 3D-printed heart.

    Heart Tests and Imaging

    Heart tests and diagnostic imaging have come a long way. From the different methods for stress testing to ultrasound tests (also known as echo cardiac tests) to the specialized-imaging studies produced in nuclear medicine to the special tests performed with computed tomography (also known as CT scans or CAT scans), your doctors have a wide range of options to choose from.

    At Fisher-Titus Heart & Vascular, in addition to offering cardiac rehabilitation, we offer exercise and nuclear medicine stress testing, ultrasound scans of your heart, and real-time, image-guided assessments (and treatments) of your coronary arteries in our cardiac cath lab. The future is very bright in cardiovascular care.

    In the January/February 2020 issue of Radiologic Technology, Kevin Wininger, an exercise physiologist and radiology technologist with Fisher-Titus Heart & Vascular, wrote about the innovative treatments that researchers are pioneering in heart care. He works in Cardiopulmonary Rehabilitation and the Pacemaker / ICD Clinic. For a closer look at Kevin’s article, “Biomimicry and Bioengineering in Cardiovascular Care,” visit: www.radiologictechnology.org. Visit fishertitus.org/heart for more information about our Heart & Vascular services.