Author: Jessica Speweike

In health care, we are often there through some of the most devastating times of our patients’ lives. Never has this been truer than over the past 2 ½ years of the COVID-19 pandemic. We are tired and heartbroken from caring for so many critically ill patients and sometimes even being with them in their last moments. This is especially difficult for us here at Fisher-Titus, since many of our patients are our neighbors, family, and friends from our tight-knit community. However, despite the exhaustion we feel dealing with sometimes devastating outcomes, the individualized, compassionate care we provide can leave a defining impact on patients’ families for years to come.

Read Viki Collins’ story about how our Fisher-Titus family made a positive impact on her family even as they grieved the loss of her husband, Dave.

Viki and Dave met while they were both volunteering for a local fire department where they lived in New York.

“Dave had this big heart that always saw the best in everyone,” Viki says. “He just always gave back. As soon as he turned 18 he started volunteering for the fire department.”

At the time they met, Viki was a basic EMT going back to school for advanced EMT critical care. She was a busy, single mom of her two sons, Logan and Liam when Dave asked her out on their first date.

“I said, ‘listen, I’m a single mom, I’m working full time, and I’m going to school, I don’t have time for you,’” Viki remembers with a laugh. “Even though we met volunteering, I was still very stingy with what I would give and do being a single mom. But Dave relit that fire for me – he reminded me that there was always something you could do and give back.”

But Dave persisted. He brought her coffee to work every day until he eventually won her over. They began dating in November, were engaged by March, and married the following October.

“We had a small wedding first and then and our Catholic ceremony later,” Viki explains. “Dave always joked that he loved me enough to marry me twice.”

Dave took on Viki’s two oldest boys as his own and they had two more boys, MJ and Stanley, together. They moved to Ohio and Viki has worked at Fisher-Titus for three years, now serving as Patient Access Supervisor.

Right after Thanksgiving 2021, Dave and Viki were both diagnosed with COVID-19. Soon after diagnosis, Dave was unable to keep his head up and was struggling to breathe so Viki took him to the Fisher-Titus Emergency Department.

“The ER staff was phenomenal,” Viki says. “Even though I couldn’t be in there with him, he was texting me, calling me, and keeping me updated.”

Unfortunately, Dave continued to get worse and was admitted to the hospital. He later was moved to the ICU before passing away on December 18.

Although Dave’s hospital stay did not end the way anyone would have hoped, Viki insists that the experience overall was positive thanks to the staff at Fisher-Titus.

“Obviously, I’d much rather have my husband home with me,” Viki explains. “But it wasn’t a bad outcome because of the hospital. Fisher-Titus really did everything they could to make it a positive experience and have a positive impact on our family.”

Viki remembers several instances where employees went above and beyond to support Dave and their family during his stay.

“After he was moved to the ICU, I walked in one day and the Safety & Security Liaison at the Pavilion was wearing a small, silver cross,” she describes. “I had asked where she got it from because Dave had wanted one. She was willing to take it off and give it to me. I didn’t take it—but she was willing to do that for us.”

Coming from health care, Viki understands more than most about what her husband was going through and was very involved in Dave’s care. She kept up through his patient portal and wanted to know everything that was going on even though she couldn’t always be there due to visitation restrictions.

“When he got to the floor, the nurses were very, very good,” Viki remembers. “Whenever I was there, they made a point to come into the room and talk to me. There was a time when something had happened when I wasn’t there and the nurse, Dalibor, called me to let me know. He started with ‘I want you to know, there’s nothing wrong’ before explaining what had happened and that they caught it immediately and fixed it. He was honest and up front and starting that way was huge for me.”

Viki expresses her gratitude for all of Dave’s caregivers taking the time to get to know him and his family.

“Theresa Stygles was the nurse practitioner with Pulmonary Medicine that was on Dave’s care,” Viki explains. “One day, she was rounding while I was visiting Dave and she wanted to know more about our story—how we met, who he was—she got to know him, so he wasn’t just a body in a bed. When I left the day he passed, she stopped and gave me a hug, and you could tell she was upset.”

She also had conversations with Dave’s doctors about what types of treatments they may be able to try. Given her background, she was familiar with what treatments were available and what successes other hospitals were seeing with various treatments.

“Every time I asked about something, they would respond with ‘I’ll look into it,’ ‘I’ll try,’ or ‘I’ll see what I can do but I make no promises,’” says Viki. “But nothing was ever off the table. I understood they were limited on what they could do but if it was something we could try, they were going to try it.”

Once Dave had been admitted into the ICU and was more seriously sick, Viki remembers the support and validation she felt from everyone she encountered.

“As with any long hospital stay, it wasn’t all rainbows and sunshine,” Viki says. “There were a couple of concerns I had along the way and I raised them—that was my husband—but the thing that was so nice, was that even when I was probably being a little unreasonable, not a single person treated me that way.”

Viki continues, “The nursing supervisor, the physicians, they understood that I was in a time of crisis and in survival mode myself. Even though I’ve been in the medical field forever, my brain was not there. They treated me with so much respect, validated my concerns, and explained what was going on in terms I understood.”

Eventually, Viki had to have some tough conversations and make some difficult decisions with his care team about how much intervention they would do.

“Even before Dave got to the point where we needed to stop care, I had a very long discussion with Dr. Alahmad and I had told him I was willing to do normal procedures that Dave may not have normally agreed to as long as I knew at the end of the day we were not prolonging his death. Dave and I were both in health care and we’d had the conversation that quality of life was more important than quantity,” Viki explains.

“At one point when Dave was in ICU, Dr. Alahmad called me, explained everything they were doing and said ‘We are doing everything medically we can, I’m going to pray for him,’” she remembers. “That might seem small, but I know everyone did everything they could and they would’ve fought as long as I asked them to.”

When the time came for Viki to have the tough conversation about stopping care, she recognizes the support she felt from his care team even then.

“Dr. Alahmad called me on the 18^th and told me we were to that point we had talked about,” she remembers. “He said, ‘Anything else you want to try, I will arrange it and get him where he needs to be,’ but he said, ‘Viki we are prolonging his death at this point.’ That was all I needed to hear. He didn’t beat around the bush, and he didn’t give me false hope which is so important.”

Viki believes the care Dave received at Fisher-Titus was not something they would have found everywhere, adding that she doesn’t think it’s just because she’s an employee.

“I worked for another small hospital for over 10 years in New York. After leaving I said I’d never step foot to work in a hospital again—I didn’t believe they cared about their community,” Viki explained. “Even before everything with Dave, I had said ‘I don’t think I’ll ever leave Fisher-Titus.’ And this experience only strengthened that feeling. Everyone from housekeeping up through administration ‘walks the walk’ and cares for our patients with the understanding that we are caring for our community.”

Viki also recognizes that the understanding that our patients are our fellow community members leads to individualized care you may not find in other health care facilities.

“Obviously we’ve had to be restrictive with visitation due to COVID. However, the fact that we’ve allowed some visitation I think has made a huge impact.” Viki continues, “I also think we are so open to hearing feedback. The fact that Dave’s team was willing to go to administration and advocate for Dave and for me—everyone is so willing to consider individual circumstances and how policies may impact care. It goes back to them seeing the community and the individual, not just ‘this is what our policy is.’”

Viki says her experience has made the aftermath of losing her husband less challenging than one might expect.

“Because of the positive experience I had with Fisher-Titus, I feel like my grieving has been manageable,” Viki explains. “I had the communication with everyone at Fisher-Titus and I had that support so while it was a sudden loss, it wasn’t like it was a sudden loss and I was alone. Even when he was passing away, they came in and they checked him and then they told me to take all the time I need. They absolutely wanted to make sure I was in a good place.”

She recognizes that health care professionals are dealing with a lot due to the COVID-19 pandemic. But Viki says that despite that, staff continued to put their best foot forward for their patients and families.

“I know we are so burnt out in health care—it’s all of it over the past 2 ½ years—but even though I know those nurses are burnt out and tired, not once did they show it. Not once could you see it on their faces,” Viki remembers. “At the end of the day, I’m sure they went home and were exhausted. The ICU staff, the floor staff, and the ER staff—you never once saw that fatigue and that burn out.”

Viki wants Dave’s care team and every single Fisher-Titus employee to know the difference they make for their patients and their families.

“It was a crappy outcome, but a positive experience,” Viki states. “I really feel like from the people scrubbing the floors to the people scrubbing the claims and charges, everybody does a good job of making sure we support each other and put that best foot forward for the patient. The care Dave got was phenomenal and it has had a huge, positive impact on my family.”

Washing your hands helps to prevent you from getting sick. What if the hand dryers that you are using to dry your hands after you wash them are putting bacteria right back on them?

In an effort to eliminate touch points, and be more environmentally aware, many businesses and organizations have turned to using hand dryers in their restrooms as opposed to paper towels. However, a study published by Cambridge University suggests that this might not be a good idea.

We touch a lot of different things throughout the day and are exposed to a lot of bacteria and germs. The best practice for staying healthy and eliminating those germs is hand washing. It is important that you wash your hands thoroughly throughout the day and especially in certain situations such as after going to the bathroom and before eating. We have always been taught good hand washing etiquette and told that improper hand washing is what leads to the spread of bacteria, but maybe the bigger problem that we should be looking at is if hand dryers are the best method for drying our hands after washing them.

The results of the study showed that there were significantly more bacteria present on the individuals’ hands that were dried in a hand dryer than the ones that used paper towels. Additionally, all of the surfaces that were touched, in this study, after using the hand dryer displayed higher bacterial levels than the surfaces that were touched after paper towel use.

What does this mean for drying your hands from now on? What if there are only hand dryers available?

Tamara Binger, an infection preventionist here at Fisher-Titus, provided us with some advice about navigating hand dryers and some other important tips about hand washing.

“While it is something to consider when you are using public restrooms, you can still use a hand dryer and have relatively clean hands,” Binger said. “Germs spread more when your hands are wet, so it is more important that you dry your hands than how you choose to dry them. If a hand dryer does not completely dry your hands and you end up wiping them on your clothes to dry them completely, use some hand sanitizer to be sure that your hands are clean. Additionally, there are different types of hand dryers, and some require you to stick your hands in them. If you touch a hand dryer while you are drying your hands, you should use hand sanitizer after you finish drying them just to be sure your hands are still clean.”

Binger continues, “when you wash your hands, it is important that you wash the backs of your hands, in-between your fingers, under your nails, and up to at least your wrists. This should take you 15-20 seconds to do. Once you finish washing your hands, it is important that you avoid touching a dirty surface. If there are paper towels available, use one to turn off the faucet. If there are none, use a clean tissue, or clean piece of toilet paper to turn it off.”

Ultimately, there is no way to completely avoid the germs that are present in public restrooms, but it is important to be aware of ways that you can limit your exposure to them. No matter the bathroom situation, remember to carry hand sanitizer with you because you never know when you might need it.

March 21^st is World Down Syndrome Day. It’s celebrated across the globe to shed light on Down syndrome and recognize the dignity, rights, and well-being of people who have it. The day was selected to signify the uniqueness of the triplication (trisomy) of the 21^st chromosome that causes Down syndrome.

This year, Down Syndrome International (DSI) is asking us all to think about, “What does inclusion mean? Are you helping to promote inclusion in your community?” While access and inclusion have improved over the years, there is still more work to do. The reality is that people with Down syndrome and disabilities still face challenges and barriers to be included fully in our society.

Why do these barriers still exist? Misconceptions about individuals with Down syndrome and a poor understanding about inclusion gaps likely contribute.

What is Down Syndrome?

Down syndrome is a genetic disorder where a person has three copies of chromosome 21 instead of two. Here are some other facts about Down syndrome:

• The average lifespan is around 60 years today, a significant increase from what it used to be.
• Although people with Down syndrome have physical and intellectual delays from birth, there is a wide range of abilities within the population.
• A growing number of people with Down syndrome are living independently.
• People with Down syndrome are predisposed to certain medical conditions including congenital heart defects, sleep apnea, and Alzheimer’s disease.
• There may be an increased risk of celiac disease, autism, childhood leukemia, and seizures.
• Appropriate medical care for individuals with Down syndrome can make a huge difference in their physical and intellectual development.
• Early intervention for babies with Down syndrome is important. Therapies in their first five years can make a huge difference.

Individuals with Down syndrome should have the opportunity to enhance their quality of life and realize their life aspirations. They should be seen as valued members of their communities and have the right to be included and take part in society. DSI calls this, “inclusive participation” and describes it as:

• Having access to information in a way that can be understood;
• Having the opportunity to share their unique ideas, experiences, and knowledge just like everyone else;
• Have the time, support, and adjustments needed to take part.

Simply, inclusive participation is about removing the barriers that still exist for individuals with Down syndrome and other disabilities.

At Fisher-Titus Medical Center, we are committed to helping individuals with Down syndrome or other disabilities maximize their potential and improve access to the world around them. We offer a variety of treatments and services to help:

Physical Therapy: Activities and exercises that help build motor skills, increase muscle strength, and improve posture and balance. A physical therapist can also help a child with Down syndrome compensate for any physical challenges.

Speech therapy: Helps improve their communication skills and use language more efficiently. A speech therapist can help them develop skills necessary for communication and even help infants with breastfeeding as that can help build muscles used for speech. The therapist can work with the child to develop alternate forms of communication like sign language or pictures. Learning to communicate is an ongoing process so these therapies are often beneficial as children with Down syndrome enter school and even later in life.

Occupational Therapy: Helps adjust everyday tasks and conditions to match a person’s needs and abilities. This can help individuals with Down syndrome learn self-care skills like eating, getting dressed, writing, and using a computer. The occupational therapist can also suggest tools to help improve everyday functions. As the child grows and enters high school, the therapist may help teenagers find jobs, careers, or skills that match their interests and strengths.

Emotional and Behavioral Therapies: Children with Down syndrome may become frustrated, develop compulsive behaviors, and have Attention Deficit Hyperactivity Disorder and other mental health issues. The therapists can help understand why a child is acting out, create strategies for avoiding or preventing these situations, and teach positive ways of responding.

For more information on physical, occupational or speech therapy, call 419-660-2700 or talk to your child’s primary care provider about a referral. For more information on emotional or behavioral therapy, visit fishertitus.org/behavioral-health.

By: Judy Zellner, LPCC, Fisher-Titus Behavioral Health

Woman receiving compliment Monday, January 24 is National Compliment Day. This day is a good reminder of the power of kind and positive words. We sometimes get caught up in our own lives and forget that giving a genuine compliment is an amazing way to give someone a healthy boost. It can be a powerful gift to give. Think of the last time someone gave you a compliment. It can be an awesome feeling. Someone was seeing YOUR value at that moment.

Compliments are not only good for the people receiving them, but also for the people giving them. You can make someone’s day by sharing the positivity of a compliment. Giving a genuine compliment can bring good into the world by seeing the best in others and putting your appreciation in words. That can also help us see the good in ourselves and our lives around us.

So, how do you give a compliment? It’s important to give a compliment freely without expecting anything in return. Use empathy and honesty. Tell them what you genuinely think is special about them.

Next, how do you receive a compliment? Sometimes this can be awkward, especially if you are not used to getting compliments. Remember that a compliment is a person’s gift to you. So, accept it with grace and with a smile, and don’t downplay it. Just respond simply with a “thank you.”

Let’s celebrate National Compliment Day with the gift of a heart-felt compliment to someone. You never know what a difference it may make in someone’s life.

By Linda Stevenson, Chief Information Officer, Fisher-Titus

Keeping your internet-connected devices free from malware and infections makes the internet safer for you and more secure for everyone.

The Keep a Clean Machine campaign is an ongoing effort to help everyone understand the importance of protecting internet-connected devices from malware and infections – especially malware that connects your devices with botnets.

What Are Botnets?

Botnets are networks of personal computers infected by malware and remote controlled by criminals. Botnets are used to send junk email (spam), attack websites and distribute more malware, among other things.

The malware used by botnets can infect your computer, turning it into a “bot” or “zombie,” meaning your computer can become part of the botnet and help criminals do their dirty work.

To learn more about botnets, visit Microsoft Security’s Botnet page and read the “Botnets 101: Everything You Need To Know” blog from StopBadware and the National Cyber Security Alliance.

Prevention:

• Keep a Clean Machine
• Keep security software current: Having the latest security software, web browser and operating system are the best defenses against viruses, malware and other online threats.
• Automate software updates: Many software programs will automatically connect and update to defend against known risks. Turn on automatic updates if that’s an available option.
• Protect all devices that connect to the internet: Along with computers, smartphones, gaming systems and other web-enabled devices also need protection from viruses and malware.
• Plug & scan: “USBs” and other external devices can be infected by viruses and malware. Use your security software to scan them.
• Connect With Care
• When in doubt, throw it out: Links in email, tweets, posts and online advertising are often the way cybercriminals compromise your computer. If it looks suspicious, even if you know the source, it’s best to delete or, if appropriate, mark as junk email.
• Get savvy about WiFi hotspots: Limit the type of business you conduct and adjust the security settings on your device to limit who can access your machine.

If You Think You’re Infected

Act quickly: If you are notified, become aware or suspect your computer is infected, take immediate steps to remove malware.

Detection:

Here are some free resources to help you see if your computer is infected:

• Avast
• AVG Free Antivirus
• Bitdefender
• ESET Online Scanner
• Kaspersky Virus Scanner
• McAfee Security Scan
• Qualys Browser Check
• Sophos Free Security Tools
• Symantec Security Scan
• Trend Micro HouseCall Virus Scan

Remediation:

• Norton by Spmantec: Power Eraser
• VIPRE Rescue

Recovery:

Once your computer is malware-free, here are some suggestions to get you back on track:

Change your passwords. A strong password is a sentence that is at least 12 characters long. Focus on positive sentences or phrases that you like to think about and are easy to remember (for example, “I love country music.”). On many sites, you can even use spaces! And remember, unique account, unique password.

Make sure your antivirus software, operating system and web browsers are up to date.

Visit identitytheft.gov to report identity theft and get a recovery plan and visit the Identity Theft Resource Center for free victim resources.

By: Linda Stevenson, Chief Information Officer

We all spend time on the internet these days. It’s likely you have internet access at home that the whole family uses for work, school, entertainment, and more. Most of our electronic devices connect to the internet including computers, TVs, smartphones, gaming systems, and even wearable devices. In previous columns, we’ve discussed how to secure your devices and keep them clean and up to date. The next step is to ensure your home internet network is protected so you and your family can be online more safely and securely.

Secure your wireless router

In this day and age, most of us probably have wireless internet in our homes which means we have a wireless router. While this makes connecting to the internet with multiple devices convenient, it can also leave your network and your personal information vulnerable to others within range of your router.

Here are some tips for securing your wireless router from the National Cybersecurity Alliance:

• Change the name of your router. The default ID—called a service set identifier (SSID) or extended service set identifier (ESSID)—is assigned by the router’s manufacturer. Change your router to a name that is unique to you and won’t be easily guessed by others.
• Change the preset password on your router. Leaving the default password unchanged makes is much easier for hackers to access your network. You should change is as soon as possible after setting up your router. A strong password is a sentence that is at least 12 characters long.
• Review security options. When choosing your router’s level of security, opt for WPA2, if available, or WPA. These levels are more secure than the WEP option.
• Create a guest password. Some routers allow for guests to use networks via separate guest passwords. If you have many visitors to your home, it’s a good idea to set up a guest network.
• Use a firewall. Firewalls help keep hackers from using your device to send out your personal information without your permission. While antivirus software scans incoming email and files, a firewall is like a guard, watching for attempts to access your system and blocking communications with sources you don’t permit. Your operating system and/or security software likely comes with  a pre-installed firewall, but make sure you turn on these features.

Additional online security tips

Take these additional steps to protect yourself while using the internet:

• Keep security software current. Having the latest security software, web browser, and operating system is the best defense against viruses, malware, and other online threats.
• Protect all devices that connect to the internet. Computer, smartphones, gaming systems, and any other web-enabled devices need protection from viruses and malware.
• Plug & scan. USBs and other external devices can be infected by viruses and malware. Use your security software to scan them before using them.
• Protect your finances. When banking and shopping, check to be sure the sites are security enabled. Look for web addresses with https:// which means the site takes extra measures to help secure your information. http:// is not secure.
• Back it up. Protect your valuable work, music, photos, and other digital information by making electronic copies of your important files and storing them safely.

By: Cyndi Whetstone, BSN, RN, Stroke Coordinator

May is Stroke Awareness Month, and while it’s always a good time to refresh yourself on the signs and symptoms of a stroke, this year it may be especially important with the COVID-19 pandemic.

COVID-19 and Stroke Risk

According to recent studies, individuals who had COVID-19 may be at an increased risk for experiencing a stroke. In many cases, the patients in the study who experience stroke did not present typical symptoms of COVID-19 (shortness of breath, fever, etc.) and did not have any known pre-existing risk factors.

While studies are still being conducted and doctors are still examining possible connections between COVID-19 and stroke, they hypothesize that it’s because COVID-19 targets the brain and the blood vessels in the brain. Additionally, COVID-19 affects the heart and can cause irregular heart rhythm which can create a clot that can then migrate to the brain and produce a stroke.

Recognizing a Stroke

Since we know COVID-19 may put you at an increased risk for stroke, it’s 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 them 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.

By: Ken C. Murray, Ph.D., LPCC-S

Managing stress is all about taking charge: Taking charge of your thoughts, your emotions, your schedule, your environment, and the way you deal with problems. The ultimate goal is a balanced life, with time for work, relationships, relaxation, and fun (plus the resilience to hold up under pressure and meet challenges head on).

Stress management starts with identifying the sources of stress in your life. This isn’t as easy as it sounds. Your true sources of stress aren’t always obvious, and it’s all too easy to overlook your own stress-inducing thoughts, feelings, and behaviors. Sure, you may know that you’re constantly worried about school or work deadlines. But maybe it’s your procrastination, rather than the actual assignment demands, that leads to deadline stress. To identify your true sources of stress, look closely at your habits, attitude, and excuses. Until you accept responsibility for the role you play in creating or maintaining it, your stress level will remain outside your control.

There are many healthy ways to manage and cope with stress, but they all require change. You can either change the situation or change your reaction. When deciding which option to choose, it’s helpful to think of the Four A’s: Avoid, Alter, Adapt, or Accept.

Not all stress can be avoided (and it’s not healthy to avoid a situation that needs immediate attention), but you may be surprised by the number of stressors in your life that you can eliminate. Know your limits and stick to them. Remember:

• Avoid people who stress you out.
• Take control of your environment.
• Avoid hot-button topics.
• Cut down your To-Do list: Distinguish between the “shoulds” and the “musts.”

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so that the problem will be less in the future. Often, this involves changing the way you communicate and operate in your daily life:

• Express your feelings, instead of bottling them up.
• Be willing to compromise.
• Be more assertive: Set personal limits and boundaries
• Manage your time more efficiently.

If you can’t change the stressor, then you might have to change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude:

Reframe problems: Try a more positive perspective.

Look at the Big Picture: How important will this be in the long run?

Adjust your standards: No perfectionism…learn to be okay with “good enough.”

Focus on the positive: Reflect on all the things you appreciate in your life.

Adjust Your Attitude: Change your thinking: Eliminate words such as, “Always, Never, Should, and Must.”

Some sources of stress are just unavoidable. You can’t prevent or change stressors such as the death of a loved one, a serious illness, or a national recession. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation that you can’t change:

• Don’t try to control the uncontrollable: Particularly the behavior of other people.
• Look for the upside: “What doesn’t kill us…makes us stronger.”
• Share your feelings: Talk to a friend, family member, or therapist.
• Let go of anger and resentments: Free yourself from negative energy by moving on.

The work you put in to reduce, prevent, and cope with stress will more than pay off in the long run.

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.

After being discharged from the hospital, Virgie Connors’ battle with COVID-19 was far from over. The North Central EMS Paramedicine Program gave Virgie and her family peace of mind as she returned home.

In August of 2020, Virgie started to come down with the sniffles. Given the state of the pandemic, she called her primary care provider right away to see about getting a COVID‐19 test. That call was on a Thursday and she made a testing appointment for the following Tuesday.

While she waited for her appointment, she mostly stayed in bed to rest. Besides her sniffles, she had significant night sweats. However, she had been regularly checking her temperature and never had a fever.
“You know, they were telling everyone to look for a temperature, but I never had a fever,” Virgie said.

By the time Tuesday rolled around, she could barely walk to the car. A family member drove her to get tested and she decided to go straight to the Fisher‐Titus Emergency Room after.

“When she first started having symptoms, we didn’t want to jump the gun and tell her to go into the Emergency Room,” said Amanda Swaynigm, Virgie’s daughter and North Central EMS employee. “But then when the time came, it actually got very scary because she could barely walk going into the ER.”

“It was hurting to breathe and that’s when I said, ‘I’m going to the ER,’” Virgie said.

Given Virgie’s symptoms, it was presumed that she was positive for COVID‐19 and due to visitation precautions in place to prevent the spread of COVID‐19, her family was not able to be with her at the Emergency Room. Her diagnosis would later be confirmed by the positive COVID‐19 test from earlier that day.

“It’s scary because you’re just leaving her,” Amanda explained. “We couldn’t go in with her to make sure she was OK.”

Virgie was admitted to Fisher‐Titus and stayed for four days. She had pneumonia, AFib (irregular heartbeat), and tachycardia (heart rate over 100 beats per minute) as a result of COVID‐19.

“I did feel better when she called me and said she was being admitted,” Amanda said. “Then you know she’s in the best care.”

Virgie was able to communicate with her family the whole time she was admitted.

As a North Central EMS employee, Amanda was aware of the Paramedicine Program and asked for it for her mom after discharge.

“They told me there would be somebody coming out from North Central EMS to do an EKG and vitals a couple times a week,” Virgie said. “Thank goodness, because I was kind of scared leaving the hospital.”

Over the next few weeks after being discharged, Bryan, a medic from North Central EMS, came out around eight times to check on Virgie. First, a couple times a week and then once a week.

“Bryan was very professional,” Virgie said. “He was very informative. He explained everything even after he did the EKG. It gave me a little more peace of mind.”

During the first visit, Bryan called Virgie’s primary care provider to talk about her vitals and her EKG. After each following visit, the EKGs and vitals would be sent directly to Virgie’s entire care team including her
cardiologist.

Virgie and her husband John have a close relationship with their family. They have two daughters: Amanda and her younger sister, Ashley Connors. They also have four grandchildren ranging in age from seven to 17.

“All the grandkids as well as my sister and I have always been very close with my parents, seeing them almost daily for family dinners,” Amanda explained. “It took a toll on all of us not being able to see them in person, but we did gain peace of mind after each visit Bryan had with her.”

Although Virgie is still feeling some of the lasting effects of COVID‐19 including lethargy and some heart‐related side effects, she says she’s feeling much better. And she and her family are grateful for the sense of security that came from having the paramedicine program to help them through that time.

“I was so happy we asked for paramedicine,” Amanda said. “Our entire family felt so much better knowing someone would be there in a couple days to re‐check her vitals. It is such a good resource, and I really hope that more families and doctors can use it.”

Community Paramedicine is a new concept in rural health care. It expands the role of the paramedic from the traditional emergency setting. North Central EMS will work with Fisher-Titus to identify patients who have difficulty accessing primary care services.
Paramedics will provide scheduled, in-home care to improve long-term health outcomes of the medically underserved and improve the quality of life of patients with chronic diseases.

Recently, a link has been found between atrial fibrillation (AFib) and obstructive sleep apnea. In a recent study published in JACC: Clinical Electrophysiology, approximately 82% of AFib patients had undiagnosed sleep apnea.

So what is AFib and what is sleep apnea?

Atrial fibrillation, or Afib, affects an estimated 6 million Americans. It is an arrhythmia characterized by a quivering or irregular heartbeat that can lead to stroke and other heart-related complications. Normally, your heart contracts and relaxes to a regular beat. In AFib, the upper chambers of the heart (the atria) beat irregularly (quiver) instead of beating effectively to move blood to the ventricles.

Some people may have no symptoms of AFib but those that do may experience:

• Pain in the chest
• Chest pain
• Dizziness
• Fatigue
• Inability to exercise
• Weakness
• Fast heart rate or palpitations
• Shortness of breath

Obstructive sleep apnea is the intermittent airflow blockage during sleep. Symptoms of sleep apnea can include:

• Excessive daytime sleepiness
• Snoring
• Gasping during sleep
• Insomnia
• Episodes of no breathing, breathing through the mouth, loud breathing, or shortness of breath
• Hyperactivity or irritability
• Bedwetting or excessive urination at night
• Fatigue
• Depression
• Dry mouth
• Headache
• Lack of concentration
• Memory loss
• Sore throat
• Teeth grinding

After diagnosing a patient with atrial fibrillation, a doctor might recommend testing for obstructive sleep apnea, or OSA.

Although atrial fibrillation can have a range of causes — age, heart disease, and hypertension among them — this recent research reveals a strong link between AFib and OSA.

If you think you may have sleep apnea, the Fisher Titus Sleep Center can help. The Sleep Center is located on Executive Dr. in Norwalk and does not require a referral from your primary care physician for a sleep study.

We are flexible and perform sleep studies weekdays or weekends to accommodate the patient’s schedule. A bariatric room is available as well as options to sleep elevated. We have a very experienced sleep staff that are all registered. The sleep center is accredited through ACHC.

To schedule a sleep study, call 419-668-5537 and choose option 1.

About Nichole

Nichole Hance, BS, RRT, RCP is the Manager of Respiratory Services at Fisher-Titus. For more information about the Sleep Center, visit fishertitus.org/sleep-center.

May is National Stroke Awareness Month. This makes it the perfect time to learn about stroke risk factors and prevention, along with how to recognize a stroke and what to do after you’ve experienced a stroke. According to the National Stroke Association, approximately 65,000 Americans will experience a stroke in May alone.  This guide to stroke awareness month will highlight the risk factors as well as ways you can prevent yourself from ultimately experiencing a stroke at some point in your life.

Stroke Risk Factors & Prevention

While some stroke risk factors are outside of your control, many can be managed. Doing these things can reduce your risk of stroke:

• Controlling high blood pressure
• Staying active
• Controlling lipids (blood fats)
• Healthy diet
• Maintaining a healthy weight
• Not smoking
• Maintaining heart health
• Reducing alcohol intake
• Managing stress
• Managing diabetes

It’s also important to understand that certain segments of our population are more susceptible to suffering from a stroke. Below is a list of the populations who are at greater risk.

People at Greater Risk of a Stroke 

• Those over 55
• Women
• African Americans, Hispanic, and Asian/Pacific Islanders
• Those who have a family history (parent, grandparent, or sibling) of stroke
• Those who have had a previous stroke
• Fibromuscular dysplasia (FMD)
• Patent Foramen Ovale (PFO)
• Atrial Fibrillation (aFib)
• Those who have experienced a Transient Ischemic Attack (TIA), a brief episode of stroke-like symptoms that usually cause no permanent damage or disability. The greatest risk for these individuals is within the first week after the TIA.

Recognizing a Stroke

The acronym F.A.S.T. is the easiest way to remember the most common stroke symptoms. This refers to your face, arms, speech and time as highlighted below.

• F – Face. One side of the face may droop
• A – Arms. One arm may be weaker than the other
• S – Speech. Speech may be slurred or strange
• T – Time. If you observe any of these signs, call 9-1-1 immediately.

Other possible stroke symptoms include sudden confusion, vision problems, dizziness, loss of balance or coordination, trouble walking, and severe headache. It’s important to note the time you first observed stroke symptoms as it can impact treatment.

Fisher-Titus is certified as Primary Stroke Center through the Healthcare Facilities Accreditation Program (HFAP) meaning that we are able to stabilize and treat acute stroke patients, provide acute care, and administer tPA and other acute therapies. In order to maintain this certification, we have to meet the following standards:

• The program director must have extensive experience in acute stroke
• Stroke code team arrival at bedside must be within 15 minutes
• Lab testing and advanced imaging capabilities must be available 24/7
• Must have access to neurologists 24/7
• Must have neurosurgical expertise available or able to transfer patients within two hours
• Must have a designated stroke unit
• Staff must meet education requirements

Life After a Stroke

Rehabilitation is a large part of stroke recovery for many people. Physical therapy can help with problems in moving and balance. Your physical therapist may also suggest exercises to strengthen muscles for walking, standing, and other activities. Occupational therapy helps stroke survivors learn strategies to manage daily activities such as eating, bathing, dressing, writing, or cooking. Speech therapy can help with re-learning language skills (talking, reading, and writing) and can help with swallowing problems. All of these therapies are offered at Fisher-Titus so you can recover close to home.

Once an individual has had a stroke, they are at an increased risk for repeat stroke. It is important for stroke survivors to talk to their doctor about what lifestyle changes they should make to help reduce any additional stroke risk.

Support groups can be very beneficial for stroke survivors. Fisher-Titus hosts a regular Coffee and Conversation Stroke Support Group for stroke survivors and their caregivers. For more information about the stroke support group, call (419) 663-1975 ext. 3093.

Dr. Steven Benedict is a Neurologist with Advanced Neurological Associates. Fisher-Titus has been a Primary Stroke Center since 2007.

By: Lindsey Esker, MA, CCC-SLP, Manager, Rehabilitation

April is Autism Awareness Month, and it’s a great time to work to better understand autism spectrum disorder (ASD) and appreciate and accept those who are “on the spectrum.” The more we know, the better we can support individuals with ASD and their families and celebrate their unique talents and gifts.

What is Autism?

Autism spectrum disorder (ASD) is a developmental disability that can cause social, communication, and behavioral challenges. Autism is caused by differences in the brain and while some individuals with ASD have a known difference, such as a genetic condition, other causes are not yet known. Scientists believe there are multiple causes of ASD that act together to change the most common ways people develop.

You often cannot tell if a person has ASD just by looking at them. There is often nothing about how they look that sets them apart from other people. However, they may behave, interact, and learn in ways that are different from most other people.

The abilities of people with ASD can vary significantly. For example, some individuals with ASD may have advanced conversation skills whereas others may be nonverbal. Some people with ASD need a lot of help in their daily lives while others can work and live with little to no support.

ASD begins before the age of 3 years and can last throughout a person’s life, but symptoms may improve over time. Some children show signs of ASD withing the first 12 months of life where others may not show signs until around 24 months. Sometimes, children with ASD might gain new skills and might meet developmental milestones until around 18-21 months when they stop gaining new skills or lose skills they once had.

When to Seek an Autism Assessment

Signs and symptoms of ASD include a wide range of issues with social communication and interaction, restricted or repetitive behaviors or interests, and more. It is important to note that some people without ASD might also have some of these symptoms but for those with ASD, these characteristics can make life challenging

Examples of social communication and social interaction characteristics related to ASD can include:

• Avoids or does not keep eye contact
• Does not respond to name
• Does not show facial expressions like happy, sad, angry
• Does not play simple interactive games like pat-a-cake by
• Uses few or no gestures (e.g., does not wave goodbye)
• Does not share interests with others (e.g., showing you an object that they like)
• Does not notice when others are hurt or sad
• Shows little interest in peers
• Has trouble understanding other people’s feelings or talking about own feelings

Examples of restricted or repetitive interests and behaviors related to ASD can include:

• Lines up toys or other objects and gets upset when order is changed
• Repeats words or phrases
• Plays with toys the same way every time
• Is focused on parts of objects (e.g., wheels on a toy car)
• Gets upset by minor changes
• Has obsessive interests
• Must follow certain routines
• Flaps hands, rocks body, or spins self in circles
• Has unusual reactions to the way things sound, smell, taste, look, or feel

Many people with ASD have other characteristics including:

• Delayed language skills
• Delayed movement skills
• Delayed cognitive or learning skills
• Hyperactive, impulsive, and/or inattentive behavior
• Unusual eating and sleeping habits
• Gastrointestinal issues
• Unusual mood or emotional reactions
• Anxiety, stress, or excessive worry
• Lack of fear or more fear than expected

The signs and symptoms of ASD can be identified by early surveillance and screening. Surveillance or developmental monitoring is an active on-going process of watching a child grow and encouraging conversations between parents and providers about a child’s skills and abilities. Your child’s provider will look at whether your child is meeting typical developmental milestones in playing, learning, speaking, behaving, and moving.

At your child’s regular well-child visits, you may be asked to fill out a checklist or questionnaire specifically designed to identify problems that need further evaluation. These are typically at the 9-, 18-, and 24-month visits. Autism specific screenings usually occur at the 18- and 24-month visits. Additionally, if you have any concerns about your child or if they exhibit any of the above signs of ASD you can always talk to your doctor and they can recommend screenings if necessary.

Diagnostic and Treatment Options at Fisher-Titus

If your child’s developmental monitoring or screenings identifies an area of concern, you may be referred for specialized assessments with a psychologist, neurologist, developmental pediatrician, etc. . At Fisher-Titus, we provide autism diagnostic assessments utilizing the Autism Diagnostic Observation Schedule 2^nd -edition (ADOS-2). This is the gold standard assessment for ASD. If you or your child’s physician would like an autism diagnostic assessment, you can contact our pediatric therapy department at 419-660-2700.