Journeys, Summer 2013

“Destiny is not a matter of chance, it is a matter of choice …” – William Jennings Bryan

SUMMER 2013

JOURNEYS Going strong Thanks to family and Bryan team, Roger Larson beats heart attack

JOURNEYS

Izzy shared the spotlight with Dr. Andrew Merliss during an award-winning Bryan Heart commercial.

SUMMER 2013

01 FROM OUR PRESIDENT 02 BRYAN HEART

For heart attack, he’s in the right place 06

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NEW AT BRYAN The faces of pulmonary hypertension MEDICAL STAFF SPOTLIGHT Ask the doctor: What’s the role of a colorectal surgeon?

12 MEDICAL STAFF UPDATE

New faces at Bryan

Last rites for Dr. Walt Weaver, pioneer in heart care 13 BRYAN FOUNDATION

Supporting students remains her mission

Thanks to you, Bryan meets Fine Line challenge 17 IN SERVICE TO OUR COMMUNITY

17th Annual Kids’ Club Health & Safety Fair:

Healthy fun for all 18

NEW AT BRYAN Jackie overcomes stroke Stroke Camp: An opportunity to refresh and reflect Know the signs of stroke

22 BRYAN COLLEGE OF HEALTH SCIENCES

Congratulations, grads!

23 COLLEGE ALUMNI NEWS 24 VOLUNTEERS & CUSTOMER CARE

Four-legged volunteers bring joy to patients’ lives 27 IN SERVICE TO OUR COMMUNITY

Everyone wins at Lincoln’s marathon 28 CRETE AREA MEDICAL CENTER

CAMC redefines rural health care 30 ACHIEVEMENTS 32 BRYAN STERLING CONNECTION

Known for Heart campaign garners major awards A series of Bryan Heart television advertisements has swept several regional and national awards for excellence.

Five “Known for Heart” 30-second spots last year showed Bryan Heart physicians’ personal interests, from fishing and music to running, racquetball and photography. This awarding-winning effort was the brainchild of service line marketing specialist Patricia Ebert, Advancement, and Swanson Russell consultant Joyce Jensen.

“We wanted to humanize our physicians, to show what they’re passionate about, so patients see them as real people,” says Ebert. “What makes the doctors’ hearts beat? That’s the story we wanted to tell.”

The ads featured cardiac and thoracic surgeons Richard Thompson, MD, and Robert Oakes, MD; cardiologists Timothy Gardner, MD, and Ryan Whitney, MD; and electrophysiologist Andrew Merliss, MD. In recent months, “Known for Heart” earned a Silver “ADDY” Award from the American Advertising Federation; a Gold Award from The Aster Awards, a medical marketing awards program sponsored by Healthcare Marketing Today; and a coveted Bronze Telly — this international award recognizes outstanding commercials from among 12,000 entries, including all industries and company sizes.

Visit bryanhealth.org/bryan-heart-team to watch these videos, or use your smartphone’s QR application to access this code.

33 COMMUNITY CALENDAR

ALL ABOUT JOURNEYS

STAY IN TOUCH

Statesman William Jennings Bryan, one of the original benefactors of Bryan Health, said:

We welcome your comments. For more information about Journeys, contact the Advancement team by calling 402-481-8674.

To learn more about Bryan programs and services, visit us online at bryanhealth.org.

“Destiny is not a matter of chance, it is a matter of choice; it is not a thing to be waited for, it is a thing to be achieved.”

Journeys tells our story of how Bryan chooses to achieve. This free publication is mailed quarterly to our employees, physicians, volunteers and the communities we serve.

OPPORTUNITIES TO SUPPORT Your contributions help us care for those who come to Bryan at every stage of life. To find out how you can participate, call the Bryan Foundation at 402-481-8605, or write to us at:

Bryan Foundation 1600 S. 48th St. Lincoln, NE 68506

Kimberly Russel President & CEO, Bryan Health John Woodrich President & COO, Bryan Medical Center John Trapp, MD Chief of Staff, Bryan Medical Staff Bob Ravenscroft Vice President of Advancement Edgar Bumanis Director of Public Relations Paul Hadley Editor

FROM OUR PRESIDENT

“I’ve learned that you shouldn’t go through life with a catcher’s mitt on both hands. You need to be able to throw something back.”

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his quote from poet Maya Angelou will come to life as you read our cover story on Roger Larson — a pillar of our community who defines what it means to share one’s talents for the greater good.

Roger was one of the first people I met when I moved to Lincoln five years ago. He greeted me with great enthusiasm about his years of involvement with Bryan — and he brought me a large paper bag, filled with beautiful produce from his garden.

So, it’s no surprise that Roger is very special to me and the entire Bryan family.

All of us are so honored to have been part of the collaborative team that returned Roger to work and to his quest to make Lincoln a better, healthier place for us all.

This issue of Journeys also includes our annual report on giving for Fiscal Year 2013. It recognizes our steadfast donors throughout the community, who understand that without their support, we would not be able to provide the extraordinary levels of comfort and care that we do.

I hope you enjoy reading about the ways the gifted people of Bryan — staff members, physicians, volunteers and students — share their talents in support of our mission and commitment to the people

we serve. Angelou would be impressed: Their throwing arms are amazing.

Community. Future. Health. Helping you prepare for what’s next in your life will always be what’s next in ours.

Kimberly A. Russel

President and CEO

Bryan Health

Bryan Journeys 1

BRYAN HEART

For heart attack care

He’s in the right place Longtime Bryan trustee and community leader Roger Larson (left) shares an afternoon coffee with his son-in-law, Rich Rodenburg, who earlier this year used CPR to help save Roger’s life after a heart attack.

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ou could say Roger Larson was lucky. Lucky he was with his daughter and son-in-law when he suffered a heart attack. But that’s where simple luck ended and a sophisticated system of experienced health care professionals and advanced technology took over — a system Roger helped to build.

Roger collapsed Jan. 28 while he and his wife, Shirley, were dropping Kylie, their Labrador retriever, at their daughter Susan and son-in-law Rich Rodenburg’s home before leaving on vacation. Seconds after he told the trio he wasn’t feeling well, Roger was unconscious. He had no pulse and wasn’t breathing. While Susan ran to call 911, Rich started CPR and

2 Summer 2013

kept pumping Roger’s chest to the beat of the Bee Gee’s hit song “Stayin’ Alive” until a Lincoln Fire & Rescue emergency medical services team arrived from Station 8.

Paramedics stabilized Roger and sent vital information wirelessly to Bryan Medical Center on the Bryan East Campus.

At Bryan, a “cardiac alert” was activated, so the entire cardiac team was ready for Roger. An interventional cardiologist, cardiac nurses and catheterization lab techs took quick action when the ambulance arrived.

“We took him to the cath lab, and using a stent, opened up a tightly-blocked artery. We then used an advanced hydrothermic technology, InnerCool®, which allowed us to cool Roger’s body temperature to give him the best chance of brain

BRYAN HEART recovery,” says Bryan Heart cardiologist Ryan Whitney, MD, who was on call at the hospital that day.

Everything moved at a rapid pace. “By the time I locked up the house and got to the hospital, they had already put a stent in and cooled him down and induced a coma,” Rich notes.

After Roger was moved to the cardiac intensive care unit following his medically induced coma, Dr. Whitney explained to the family what the team had done and told them Roger’s heart function was significantly reduced. The procedure had been successful in itself, but Dr. Whitney cautioned that, even though he thought Roger would survive, he couldn’t be sure at this point if there would be any permanent brain damage.

It was a tough few days for the family until they knew whether or not Roger was going to wake up and, if he did wake up, if he was going to have normal brain function. “Everyone was saying I was a hero for performing CPR,” Rich remembers, “but I was just hoping I had done enough.”

It was 48 hours before the Bryan cardiac team began to slowly warm up Roger, another day until he was moving, and yet another day until he was aware of his surroundings and recognized his family.

When Roger woke from his coma five days after the heart attack, his eyes focused on the calendar across the room that showed it was Feb. 2, 2013, and he thought to himself, “I’m supposed to be in Arizona.” Then, as he observed where he was, he relaxed, saying to himself, “I’m at Bryan — I’ll be OK.” Roger adds, “It was a very quick action on the part of a lot of people who saved my life. They really knew what they were doing, and that included Susan and Rich, Shirley, the EMS people and certainly the hospital staff. The doctors, the nurses — everyone at Bryan — they were all incredible.

“And I really appreciate Dr. Whitney. In addition to diagnosing my problem and taking quick action, he seemed to personally care about me. Even after his part in my recovery was complete, he would stop by for a few minutes just to see how I was doing — almost like a social visit — as I remained in the hospital for a few days for a non-heart related condition.”

And now Roger sees Dr. Whitney on a regular basis to ensure he continues to progress through his rehabilitation phase.

Roger has had a long history with Bryan Health. From the Bryan Medical Center Board to the Foundation Board, back to the hospital board and then to the Bryan Health Board, Roger served in a leadership role for 46 years, helping guide Bryan

Bryan LifePointe executive medical director and Bryan Heart cardiologist Ryan Whitney, MD, was on call when an ambulance brought Roger to Bryan Medical Center.

Bryan Journeys 3

BRYAN HEART

Longtime board member puts trust in Bryan care givers Health to become what it is today.

Roger’s close association with Bryan Health makes him especially grateful he was taken to Bryan Medical Center.

“As a board member, I know the standards are high, I know I am going to get the very best care because I am aware of the training of the personnel, their accountability and how their performance is judged by outcomes. I know it is an exceptional organization where we, the patients, can feel confident we will be cared for when we are most vulnerable,” he says.

One of the milestones at Bryan during Roger’s tenure on Teamwork in the heart catheterization laboratory is essential for ensuring good the board was the establishment outcomes for patients, like Roger Larson. of BryanLGH Heart Institute (now Bryan Heart). Another was local fundraising organization SLR Communications. the merger of Lincoln General Hospital and Bryan Memorial For more than 50 years, Roger has shared his perspectives Hospital to form BryanLGH Health System (now Bryan Health). on community matters in his radio programs in the Capital But what Roger is most proud of is the way Bryan Health City and is not yet ready to check out of the conversation — has embraced its civic duty to take care of the community. especially when it concerns the health of the community.

“Bryan is locally owned and governed and has always had He says, “We need to see wellness as a win-win situation a broad vision of its mission. That mission is not just to turn that is good for those who are practicing wellness and for their out patients, but rather to improve the general health of our employers. This not only increases patients’ quality of life and community,” he points out. longevity, but it also decreases health care costs.

Roger always has been very active in community and civic affairs.

“I believe the new health care act will help create a In addition to being on the three Bryan Boards of Trustees, culture that makes wellness something that is very desirable, and I intend to be part of the effort to create that culture he has served on more than 40 other community boards, been here in Lincoln.” a leader in the broadcast industry and now is a consultant with

4 Summer 2013

BRYAN HEART

Learn CPR

You could save a life!

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any things had to fall into place quickly for Roger Larson to survive his heart attack. The lifesaving CPR his son-inlaw, Rich Rodenburg, administered made the difference in not just saving his life, but also in giving him the quality of life he enjoys today.

According to the Brain Injury Foundation, there is a window of less than six minutes from the time a person’s heart stops until irreversible brain damage begins. So, even though an emergency medical services crew was close and arrived soon after

Roger’s daughter called 911, those few minutes before they arrived were critical.

Rich had taught scores of CPR classes through the years, including junior and senior lifesaving CPR, but never had been in a situation to use it outside of the classroom.

“This was the first time I was able to use my training — and it turned out the life I saved was that of my fatherin-law, an amazing person who means so much to me and my family,” Rich says.

“Everybody should know CPR,” he

And Roger has embraced wellness personally. Until his heart attack in January, he was mowing his acreage near Walton, tending a huge garden and working outside, cutting trees — as well as maintaining an active professional life. He had experienced a first heart attack in 1964 when he was 38.

But not until this year, at age 87, did he have any additional heart problems. Roger’s almost 50-year freedom from heart problems may be attributed to his staying active and maintaining a healthy lifestyle.

He says, “My biggest life change was that I stopped smoking right after my first heart attack — it was a great incentive.”

Dr. Whitney emphasizes that exercising, eating right and avoiding unhealthy behaviors, such as smoking, help prevent heart attacks. He also notes that even if you practice a healthy lifestyle, other factors, such as family history or other existing medical conditions, may increase your risk of heart disease.

“That’s why the organization is providing a simple way to determine whether or not you are at risk for heart disease,” Dr. Whitney says. “People can go to Bryan Health’s website and take a free, online HeartAware risk assessment. It takes about

emphasizes. “It’s simple, and it’s a lot easier than it used to be.”

Now CPR only involves compression — tilting the head back and clearing the airways have been eliminated from the process. “Handsonly CPR” involves pushing hard and fast in the center of the chest to the rhythm of the classic disco song, “Stayin’ Alive.”

Bryan offers CPR classes on a regular basis through its education department. Go to bryanhealth.org/ calendar, or call 402-481-8648 for details about classes. n

seven minutes and may give you peace of mind or else provide evidence that you should seek the advice of a physician.”

Roger’s voice continues to emphasize the importance of providing a healthy community. He is concerned that the professional ability and technological advances in health care are moving ahead of our ability to pay for it. “Everybody wants to have the best, but not everyone receives the best care. We are so fortunate to have high-quality health care here, and we want to be sure to continue those high standards into the future,” he says.

High standards of care — like the quality care Roger received.

“I have made the remark many times since my heart attack: ‘If you have a heart problem, feel fortunate you live here.’”

Roger says.

“I can’t overexaggerate the quality of care and attention I received at Bryan.” n To find out how you can support the work of Bryan Heart and Bryan Health, please call the Bryan Foundation at 402-481-8605.

Bryan Journeys 5

NEW AT BRYAN

The faces of pulmonary

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hen 25-year-old Kelsie Harper experienced extreme chest pain while carrying laundry up stairs and when she wound up on the floor — turning blue —during a workout, she was scared.

When 29-year-old Tara McMaster had shortness of breath while walking up stairs and had to catch her breath when rolling over in bed, she knew it was more than being out of shape.

Despite their young ages, Kelsie’s and Tara’s bodies were waving neon red flags they couldn’t ignore, and visits to their doctors were inevitable.

In search of answers, tests were run and on the same day Kelsie’s were done, and in less than a week from when Tara’s began, each faced a diagnosis that would forever change their lives: pulmonary arterial hypertension (PH).

It’s an uncommon disease of the vessels that carry blood from the heart to the lungs. Pulmonary artery walls become stiff and thick and form scar tissue that narrows the arteries, making it difficult for blood to flow. The result is continuous high blood pressure in the arteries of the lungs that puts strain on the The Pulmonary Hypertenheart. The disease is progressive, sion Clinic was created to and left untreated, the prognosis meet the needs of area pais poor. Common symptoms are tients. In 1998, Dr. Bill Johnbreathlessness, fatigue, dizziness, son was treating a 34-yearfainting, swollen ankles and legs old mother of two young and chest pain. children. This candidate Such a rare disease requires for a lung transplant was diagnosed with idiopathic highly specialized care, from pulmonary hypertension, treatment and follow-up, and she needed to travel to helping patients manage from Nebraska to Minnesota symptoms, supporting them for continuous infusion of a through the acceptance of then-experimental drug. the disease, and working with “We started this program insurance companies to get so that we could offer care medication authorizations. closer to home for patients Kelsie and Tara found this like her,” Dr. Johnson says. care at Bryan Health’s Pulmonary

To most observers, Kelsie Harper is the picture of good health, with few outward signs of pulmonary hypertension disease.

6 Summer 2013

Hypertension Clinic. Started in 2000 by pulmonologist Bill Johnson, MD, FCCP, of Nebraska Pulmonary Specialties and now-retired Bryan nurse Marilyn

NEW AT BRYAN

hypertension Here’s Kelsie’s story When two doctor visits yielded no results, then-restaurant manager Kelsie convinced herself that the fast heartbeat, chest pain and shortness of breath must mean she was out of shape.

She joined a gym and pushed herself hard until the time a workout landed her on the floor, unable to breathe.

Her next stop was the hospital for an echocardiogram (heart ultrasound) to check the blood flow through the heart chambers and valves and blood vessels. Then came other heart and lung tests and finally the right-heart catheterization, which measures the level of resistance to blood flow in the pulmonary artery and lungs, and the amount of blood the heart is pumping. It confirmed the diagnosis: It was PH. “That was devastating,” Kelsie says. “I knew pulmonary arterial hypertension was really bad but didn’t really understand it.”

In the days that followed, Bryan Health’s Pulmonary Hypertension Clinic nurse Mary Knabe (left) reviews infusion rates with Clinic staff educated Kelsie about Tara McMaster. The Bryan Pulmonary Hypertension Clinic PH and helped her understand its staff keeps in constant contact with patients. impact on her life.

Schmidt, the clinic grew out of Bryan Health’s former lung She learned the disease type is transplant program. idiopathic, which means the cause “It was the first dedicated pulmonary hypertension clinic in is unknown. And it’s severe, which Nebraska,” Dr. Johnson says. “It’s one of the most evidence-based, makes it hard for her to do simple organized approaches to medicine that Lincoln has to offer. It has things such as getting dressed or not been limited by any type of competitive wall that might be blow drying her hair. present in health care, and we have reached out and cared for She learned she would need patients at every institution in Lincoln.” to make lifestyle changes, such as “Our nurses and administrative assistant are integral in making slowing down her very active life. sure all tests are scheduled and completed with minimal impact She found she wouldn’t be able to on the patients,” says pulmonologist Jeff Jarrett, MD, of Nebraska keep her restaurant job.

Dr. Jeff Jarrett acknowledges the Pulmonary Specialties.

“At times I felt like my life was “They are in constant contact with our patients through phone, clinic staff is integral to success. never going to get better. The texting and email to help them figure out what symptoms to be hardest part is not being able to concerned about versus those that are part of the disease process.” keep up with everyone else’s pace,” Kelsie says.

According to clinic nurse Mary Knabe, RN, MSN, the staff sees She learned the plan of action for battling the disease. patients four afternoons per month.

“Kelsie’s treatment plan is an aggressive approach with She says, “We determine treatment, help them manage their medications, and our goal is to try to allow her to have as optimal of symptoms and support them through the stages of grief, denial and a quality of life as possible,” Dr. Johnson says. anger. Seeing them improve with the treatments/medications and She takes three medications — two in pill form and one through adapt to their ‘new normal lifestyle’ is very rewarding.” an IV — to manage the disease by helping to keep her pulmonary

Bryan Journeys 7

NEW AT BRYAN

Pulmonary hypertenson not obvious to outsiders arteries dilated, to decrease the amount of hypertrophy (the growth of the solid portion of the artery) in the arteries, and to reverse blood vessel damage.

And, she learned good changes take place. “I can now walk up a flight of stairs without getting winded,” she says.

Her ability to do active things is slowly improving, too, such as doing laundry and cleaning, cheering on her boyfriend, Zach, at baseball games, taking care of her golden retriever, playing piano, going to concerts with friends, and baking (especially cakes), which she hopes to make a career.

Kelsie recalls her first follow-up echocardiogram. “I was extremely anxious about it because I felt there was so much on the line as far as my future was concerned. Having kids is absolutely huge to my heart, and when I was first diagnosed, I was told there was a chance I may not ever be able to have kids if I didn’t improve greatly. The echo showed that my pressures had come down significantly! I felt at that moment a peace that everything was going to be OK,” she says.

“My overall experience with the clinic staff has been incredible,” Kelsie adds.

“The things I love the most about them are how much they care and that they make me feel like a normal person.”

“Kelsie has met this disease headon,” Dr. Johnson says.

“She understands it, accepts the fact that she has it, recognizes how it’s limited her Kelsie talks with Mary and is adjusting to it in Knabe, RN, of the Bryan Health Pulmonary a manner she can be Hypertension Clinic. happy with.

“She’s shown a

8 Summer 2013

Kelsie and pulmonologist Bill Johnson, MD, discuss her individualized treatment plan during a follow-up visit.

maturity beyond her years.”

Kelsie says, “When you’re in the thick of the disease process, it feels like your whole life is falling apart, and there’s nothing you can do to stop it. Little by little, things start to get better. As hard as it is, you have to know that you will get through it.”

Tara benefits from teamwork In the past, doctors had told Tara she had a heart murmur but also told her it was probably nothing. When she started experiencing shortness of breath while climbing stairs, walking distances and turning over in bed, she met with a new physician

NEW AT BRYAN assistant. He felt it was important to follow up with the murmur, as well as investigate her shortness of breath.

Tests were run in January 2013 and, in less than a week, Tara faced two giants she hadn’t anticipated facing at age 29. She learned she has an atrial septal defect — a hole in the wall between the two upper chambers of her heart, which has been

With her supplemental oxygen supply nearby, Tara exercises at the Bryan LifePointe Campus. Exercise specialist Rhonda Becker and others help Tara get the most from her workouts.

present from birth. She also learned she has pulmonary arterial hypertension, most likely caused by the defect.

“It was really just shock,” Tara remembers, when Mary Knabe explained the disease to her. It was overwhelming.

Tara needed a plan to battle every aspect of this disease process, and the experienced clinic staff drew it up and helps her carry it out. She says seeing how passionate the staff is about her health and treatment indicates the seriousness of PH and the extreme importance of treatment.

“Dr. Jarrett is the captain of the ship,” Tara says. “He looks at all the different symptoms I experience and tries to find the best way to navigate through the troubled waters of pulmonary hypertension.”

Treatment is a continuous IV infusion to open the arteries to her lungs, an oral medication to work to thin the walls of her arteries to promote blood flow, an anticoagulant (blood thinner) to prevent blot clots, and supplemental oxygen for activity or exertion.

A recent echocardiogram indicated positive results. “My rightheart pressures came down 30 points in three months, so it appears I’m responding really well,” Tara says.

She will continue regular check-ups, and the clinic staff will continue to monitor, treat and encourage her.

“The clinic staff is amazing,” Tara says. “They schedule all of my appointments and do their best to accommodate my work schedule, which has gone from full days to half days so I can regain some energy and focus on exercise so my lungs can work more efficiently.

“They really went out of their way with the appeals process when my insurance company was refusing to cover my catheter insertion. When I was finally approved, they bought me a blanket for my hospital stay that I still use every day.“ She adds, “They always put their patients first, and Mary is always available for questions, vent sessions and for sharing my successes. I have an amazing team of dedicated professionals helping me through this disease.”

“Tara is a smart and determined young woman with an excellent support system, especially her husband, Ryan. She has done an amazing job with everything that we have thrown at her and put her through in such a short amount of time with this new diagnosis.

“She will continue to have battles along the way, but I am confident she will not shy away from anything that stands in her way of living the best life she is able to,” Dr. Jarrett concludes. n

To find out how you can support the work of Bryan Health, please call the Bryan Foundation at 402-481-8605. For information about pulmonary hypertension, call 402-481-8647, or go to bryanhealth.org/pulmonary-hypertension.

Bryan Journeys 9

MEDICAL STAFF SPOTLIGHT

Ask the doctor: What’s the role of a colorectal surgeon?

Kelly Krier, MD, of Surgical Associates answers questions about colorectal surgery.

Q: in what does a colorectal surgeon specialize?

Colorectal stands for colon and rectum. A colorectal surgeon specializes in the treatment of surgical diseases relating to the colon, the rectum and the anus.

Q: Does a colorectal surgeon receive special training?

Yes. A colorectal surgeon attends four years of medical school, followed by a five- to six-year general surgery residency, and does a one-year fellowship specifically in colorectal surgery.

Q: What types of cases does a colorectal surgeon treat?

I treat diagnoses including hemorrhoids, rectal pain and irritation, anal fissures, fecal incontinence, constipation, rectal prolapse (where the rectum protrudes out of the anus), colon cancer, inflammatory bowel diseases and hereditary diseases of the colon.

Q: How can I get an appointment with a colorectal surgeon?

Patients can find me through a number of ways. Most patients are referred by a primary care provider, gastroenterologist, obstetrician, gynecologist or another health care provider. A patient can also self-refer and simply call the office for an appointment.

Q: How does the medical role of a colorectal surgeon differ from a gastroenterologist?

A gastroenterologist medically manages diseases of the upper and lower gastrointestinal tract, liver and pancreas.

A colorectal surgeon treats surgical diseases of the small

10 Summer 2013

Dr. Kelly Krier and other specialists in colon and rectal surgery can be contacted by calling 402-441-4760.

MEDICAL STAFF SPOTLIGHT intestine, large intestine, rectum and anus. We work together to provide complementary care to help patients.

Q: Are there measures a person can take to prevent some of these conditions? If so, what are they?

Yes. Good, healthy living, including exercising, keeping hydrated and eating a high-fiber diet, is good for colon health. Ultimately, we all need to follow guidelines on colon cancer screening, such as colonoscopies.

Q: How do you put your patients at ease so they can talk about such personal topics?

The office staff, nurses and I are dedicated to treating patients with dignity, respect and confidentiality. We have a comfortable clinic space with private bathrooms in each exam room.

Q: What symptoms of hemorrhoids should prompt a person to seek a physician appointment?

There are external and internal hemorrhoids. External hemorrhoids can become large and filled with a blood clot causing severe pain. Internal hemorrhoids can cause bleeding or can protrude out of the anus causing leakage or pain.

Q: What percentage of the population has hemorrhoids so serious that they require surgery?

Only 4.5 percent of the population has hemorrhoids that require surgery. Hemorrhoids have a peak incidence between the ages of 45 and 65 years old. Hemorrhoids are not the only diagnosis that causes pain, bleeding or prolapse in the perianal region. A colorectal surgeon can help to accurately diagnose the cause of a patient’s symptoms in order to provide appropriate treatment options.

Q: Do you work with incontinence? This can be a big issue for a family.

Yes. Fecal incontinence has new treatment options compared to even just a few years ago. Many patients are hesitant to discuss this topic with their physicians and therefore suffer in silence. There is no need to suffer with fecal incontinence. I have treatment options that include medications, physical therapy, in-office procedures and operating room procedures that can help with this condition. Diagnosing the incontinence can require some testing. I am fortunate that I have the ability to do some of the testing right in the clinic.

Q: What are the medical recommendations regarding having a colonoscopy?

A colonoscopy screens for colorectal cancer. A patient

should have a colonoscopy when he or she is 50 years old.

Someone with a family history of colon cancer should have a colonoscopy when he or she is 40 years old, or 10 years before the age of the person who had colon cancer or a polyp diagnosed, whichever is earlier. Some inflammatory bowel diseases or hereditary diseases also have earlier screening recommendations.

Q: What are the odds of getting cancer of the rectum or the colon?

There is a 6 percent lifetime risk of colorectal cancer for each person. Out of all cancers, colon cancer is No. 2 in causing cancer deaths. Colorectal cancer is called the “silent killer.” Symptoms are rare early and are vague enough that most patients ignore the warning signs. That’s why colon cancer screening is so important.

A colonoscopy can find and remove polyps before they turn into cancer. The symptoms of colon cancer are abdominal pain, weight loss, changes in bowel habits, blood in rectum, black stools and appetite changes.

Q: Do you treat Crohn’s disease? What is it and how do you treat it?

Crohn’s disease is an inflammatory bowel disease that affects patients from the mouth to the anus. The layers of the gastrointestinal tract are affected, and the disease manifests with varying symptoms such as abdominal pain, cramping and varying bowel habits. Gastroenterologists treat Crohn’s disease with medications. I would be brought in if surgery is required to treat a patient’s symptoms. Surgical interventions for this disease include removal of a small bowel segment, resection of the colon, or opening of a stricture or a narrowing in the small bowel or colon. Ulcerative colitis is another inflammatory bowel disease that surgery can help to cure. These are diagnoses where a gastroenterologist and a colorectal surgeon work together to assist patients.

Q: When did you decide you wanted to be a colorectal surgeon?

I decided early in my career to be a colorectal surgeon. My grandfather was an excellent physician who inspired me. If I can be one-third of the physician he was, I will have done something great for the patients for whom I care. Mentors throughout my training guided me to colorectal surgery for its variety in patients, diagnoses, procedures and ability to collaborate with multiple specialties, nurses and staff.

Q: What do you like best about being a colorectal surgeon?

I meet patients at some of their most difficult times in life and journey with them as life improves. It is an honor and privilege to be trusted to care for patients and their family members in times of illness. n

Bryan Journeys 11

MEDICAL STAFF UPDATE

New faces at

Bryan

Welcome these colleagues to the Bryan medical community Arif Sattar, MD, internal medicine, of Nebraska House Call Physicians, 402-730-6870, has joined the medical staff.

Dr. Sattar graduated from Dow Medical College, Karachi, Pakistan, in 1990 and completed a residency in internal medicine at New York Medical College, Valhalla, N.Y., in 1995.

He is board certified in internal medicine and in hospice and palliative care and is a diplomat in both those fields of medicine.

Dr. Sattar was medical director of Glenns Ferry Health Center in Glenns Ferry, Idaho, before moving to Lincoln in 1999. He is a staff physician at Nebraska House Call Physicians and serves as president of that medical practice.

Mohammad Shoiab, MD, psychiatry, has joined Bryan Heartland Psychiatry, 402-483-8555.

Dr. Shoiab graduated from Allama Iqbal Medical College, University of Punjab, Lahore, Pakistan, in 1984. He practiced at Lahore Mental Hospital and in 1989 joined the Post Graduate Medical Institute Department of Psychiatry.

He completed a psychiatric residency at Bergen Pines Regional Medical Center, Paramus, N.J., in 1999.

Dr. Shoiab practiced in Wayne, Neb., where he worked at the Wayne Community Mental Health & Wellness Clinic. He also established an outpatient clinic in Norfolk and practiced in Ainsworth, O’Neill and Columbus. Before joining Bryan Heartland Psychiatry, he practiced at the Lincoln Regional Center.

Before that, Dr. Shoiab worked at Fremont Psychiatric

12 Summer 2013

Services in Fremont, was involved with outpatients at the East Central District Health Department in Columbus and was a psychiatrist for the GRIPSYCH program in Missouri Valley, Iowa, and at Shenandoah Community Hospital in Shenandoah, Iowa.

Last rites for Dr. Walt Weaver, pioneer in heart care Walt Weaver, MD, died June 3, 2013, in Lincoln. The retired cardiologist was 82.

Dr. Weaver was born in Lincoln and graduated from Lincoln High School and the University of Nebraska. He earned a medical degree at Case Western Reserve University in Cleveland, Ohio, in 1956. He completed medical internships at the University Hospital of Cleveland and the Mayo Clinic, Rochester, Minn., and earned a master’s degree in medicine from the University of Minnesota Graduate School, Rochester.

After graduation, he was on the faculty of the University of Colorado, Denver, was a heart consultant for the Colorado Department of Public Health and conducted high altitude pulmonary research while on active military duty.

Dr. Weaver was board certified in cardiovascular disease and earned a certificate of proficiency in diagnostic cardiac catheterization and angiography.

He was one of Nebraska’s pioneers in cardiology. He returned to Lincoln to open a private practice in 1962 — that year he teamed with Stephen Carveth, MD, to develop Bryan Memorial Hospital’s first heart catheterization lab.

Dr. Weaver served as a clinical associate professor in cardiovascular disease at the University of Nebraska Medical Center, Omaha. The physician published many papers and made presentations throughout the United States, as well as in Japan, China, England, Norway and Sweden. He also was an officer of numerous national and regional medical associations, such as the American College of Cardiology, Society of Cardiac Angiography, Nebraska Heart Association and Lancaster County Medical Society.

BRYAN FOUNDATION

Supporting students remains her mission

On top of a 46-year career in nursing and education at Bryan, Phylis Hollamon Berg has ensured an enduring link to future students by making the largest-ever gift to support Bryan College of Health Sciences.

Bryan Journeys 13

BRYAN FOUNDATION

Her spirit of commitment spans lifetime of achievements

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o those who know Phylis (Stelling) Hollamon Berg, president emeritus of the Bryan College of Health Sciences, it probably comes as no surprise that she knew at a very young age that she wanted to be a nurse.

“My first memory of wanting to be a nurse was when I was about six years old. My mother had made for me a white seersucker uniform and I’d wear that white dress everywhere — even had a white seersucker hat to go with it,” she recalls with a laugh.

For 46 years, Phylis’ passion for nursing was nourished at Bryan. First as a student, then as a nurse in several Bryan units, then as an educator, and ultimately as the first president of the College of Health Sciences. Not bad for someone who initially, just wanted her nursing school to have its own front door.

She chalks it up to perseverance and a bit of good luck.

A fulfilling journey During a recent visit with Phylis, she reflected on her professional journey at Bryan and on her deferred gift to the college that will help pay for scholarships and other areas of

need, as well as honor those who went before her.

“I think Elaine Garrison is the most significant reference point for my commitment to this profession and this institution,” Phylis says. “Elaine taught me a lot about integrity and the courage of your convictions — standing up for what you think.”

The late Garrison, affectionately known as “Gary,” was the school’s director before Phylis took the reins. “She was a source of support when I went from clinical nursing to education. Her humor was so subtle but she was so bright and had so much insight and integrity — you can’t be around someone like that and not be influenced,” Phylis says.

Remembers colleagues Phylis also gives credit to Michael Bratton, a former vice president of nursing at Bryan, who endorsed and collaborated on the idea to expand the School of Nursing into a degreegranting college.

“Michael invested a lot of time on behalf of the college, when it was merely the seed of an idea, and he was a great believer in its growth,” she says.

Through the years: Archives show Phylis as a 1965 graduate (left), with former Bryan School of Nursing director Elaine Garrison and participating in grand opening ceremonies for the Bryan College of Health Sciences building.

14 Summer 2013

BRYAN FOUNDATION Giving back In the course of her 46 years with Bryan, Phylis experienced many things, such as changes in care and growth in student enrollment. And she became keenly aware of the need to secure funding for important things, like educators, scholarships, equipment, programs and facility expansions.

During her tenure at the college, Phylis set up scholarships in honor of loved ones as a way to give back; but her retirement five years ago was a time of true introspection.

This is when she realized that a larger gift was in order.

So, with careful planning and thought, she bestowed on the college a deferred gift to go along with those scholarships.

Without realizing it, her deferred gift added up to nearly $1 million, making it cumulatively the largest individual gift ever made to the college.

Her life’s work “Anyone who has spent any time associated with the Bryan College of Health Sciences recognizes Phylis’ influence and understands that her life’s work is incredibly important to her. Her legacy is firmly planted at the college, and this extraordinary gift is yet another demonstration of her commitment,” says Bob Ravenscroft, vice president of advancement and chief development officer.

“Phylis is such a humble person and I’ll always remember the day she formalized this magnificent gift. She was adamant that it was more about others than about her ability to make the gift. She just wants the college to flourish.”

“I think part of why I chose this avenue of continuing to

support the college is that my whole life’s work is here, and it didn’t seem right to walk out the door and walk away without continuing a commitment,” Phylis says. “I asked myself: ‘If you don’t act on what you believe, do you really believe it?’”

Commitment to others But Phylis neither seeks nor wants special attention for this gift. For her, it’s about that passion — for nurses, nursing education and the college that she helped establish. It’s a way to honor Gary, and Phyllis Bovee, another school director, and the many others who blazed a trail before her. It’s about an almost indefinable desire to ensure that the college will survive long into the future. And it’s her hope that others will identify with that spirit of commitment.

“I wish I could put it into words — it’s more of a spiritual thing, just a feeling that I have … the importance of sustaining what this place represents and has represented since it was founded in 1926,” she says.

“I was not the only person involved in the development of the college; there were so many of us. I had the good fortune to be here and circumstances aligned themselves in such a way that I could be part of something that was bigger than I was then, and bigger than I am now.” n To learn how you can support the Bryan College of Health Sciences, contact DeEtta Mayrose at the Bryan Foundation by calling 402-481-8287, or email her at deetta.mayrose@ bryanhealth.org.

Phylis maintained close ties with retired nursing school directors Elaine Garrison (in green jacket) and Vice President Phyllis Bovee.

She celebrated milestones with colleagues and, with her husband, the Rev. Darrel Berg, continues to support Bryan events.

Bryan Journeys 15

BRYAN FOUNDATION

Thanks to you, Bryan meets Fine Line challenge

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or 87 years, Bryan has been a leader in providing mental health and substance abuse treatment programs. This historical commitment to behavioral health services achieved another milestone April 30 with the celebration of the completion of the Fine Line Campaign and the ceremonial groundbreaking for the new Bryan Independence Center.

Commitment and collaboration led to the success of the Fine Line Campaign to provide new treatment facilities to improve behavioral health care for people in need.

Behavioral health treatment remains one of our community’s most pressing health needs, and as a locally owned and governed health system, meeting the needs of the community and region is a responsibility that Bryan Health willingly accepts.

The Fine Line Campaign goal of $2.5 million to construct

new facilities to advance behavioral health services for our region was exceeded. Through the generosity of many people, we raised $2,870,316 in cash and in-kind support, including $533,818 from Bryan Health employees. Please refer to the Annual Report on Giving in this edition of Journeys for details.

Phase I of the Fine Line campaign provided new facilities for outpatient mental health services. The clients and staff of Bryan Counseling Center, adult partial hospitalization, men’s domestic abuse program and Bryan Heartland Psychiatry now receive treatment in modern and efficient clinic space. The response from our clients has been outstanding!

Phase II is the construction of a new Bryan Independence Center. This construction is expected to take approximately 18 months.

Bob Ravenscroft, Vice President of Advancement

Ceremonial groundbreakers for the new Bryan Independence Center were (left to right) Bryan Health Vice President Bob Ravenscroft, Bryan Foundation Board of Trustees Chair Jim Stange, Bryan Health Vice President Shirley Travis, Bryan Medical Center Mental Health Services Director Shannon Engler, Bryan Independence Center Director Jerome Barry, Bryan Health President and CEO Kim Russel, Bryan Health Board of Trustees Chair Gene Brake and Bryan Medical Center President and COO John Woodrich.

16 Summer 2013

IN SERVICE TO OUR COMMUNITY

17th annual Kids’ Club Health & Safety Fair

Healthy fun for all

At our June 8 event at the Bryan East Campus, there were hands-on demonstrations for every interest!

The bean bag toss (top photo) was one of many popular activities. Christina Williamson, RT, of Bryan Urgent Care and Bryan College of Health Sciences student Emilea Harrahill (bottom photo) were among the many who helped teach families about fun and healthy topics.

Morning showers couldn’t dampen enthusiasm for more than 1,000 children and the young-at-heart who visited the Bryan Kids’ Club Health & Safety Fair.

Bryan Journeys 17

NEW AT BRYAN

Jackie overcomes stroke

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Stroke survivor Jackie Goldsmith credits her successful recovery to encouragement from her care givers at Bryan.

18 Summer 2013

omething just didn’t feel right. While shopping for a new computer printer with her husband and grandson, Jackie Goldsmith hobbled down the store aisles feeling as if she was drugged or sleepwalking. Four days later she learned she had suffered a stroke.

Though signs of stroke are more oftentimes sudden rather than gradual, Jackie’s symptoms were not unusual. She had one of the common signs of stroke — extreme weakness in an arm or leg. The weakness in her leg had started the previous day, but like others who have these signs, she decided to ignore them and wait for the symptoms to go away. But they didn’t that day, or the next, so she finally sought treatment.

Like Jackie, many people delay care when symptoms are gradual. But regardless whether symptoms are slow to develop or sudden, time is the enemy — and immediate medical attention is paramount.

Different strokes, common urgency “When a patient enters our system, our clinicians work rapidly to determine what type of a stroke has occurred so we can assess the best treatment options available,” says Mary Ellen Hook, stroke program coordinator at Bryan Medical Center.

Stroke symptoms may differ depending on the type of stroke.

“An ischemic stroke occurs when a vessel supplying blood to the brain becomes blocked,” explains neurologist James Bobenhouse, MD, Bryan Stroke Center medical director. “In a hemorrhagic stroke, a blood vessel ruptures and causes bleeding into or around the brain.”

If it is an ischemic stroke, victims have 4 ½ hours from the onset of symptoms to receive the best treatment possible — intravenous tissue plasminogen activator, or t-PA. This drug dissolves blood clots, so blood flow is restored in blocked arteries, allowing oxygen to flow to the brain and lessening the potential for permanent disability. If 4 ½ to 6 hours have lapsed since the onset of symptoms, the intravenous method is no longer effective, but intra-arterial t-PA, and in some cases retrieval devices, can be used to melt or remove the clot.

Bryan is the only hospital in Lincoln that has interventional radiologists who administer t-PA intra-arterially, so patients from other hospitals have been transferred to Bryan Medical Center to have this procedure.

NEW AT BRYAN The sooner acute stroke patients receive IV t-PA, the better their chances for returning back to normal or near normal.

Since it had been several days since Jackie’s onset of stroke symptoms, and a neurologist had confirmed a diagnosis of stroke through MRI results, she was admitted to Bryan Medical Center.

She was evaluated and then admitted to the acute rehabilitation unit at Bryan West Campus, where she began the rehabilitation process.

Inpatient rehabilitation Some strokes are smaller with fewer limitations — but a lot of stroke patients, like Jackie, end up going to acute (inpatient) rehabilitation where they have access to a team of professionals, who provide nursing and physician care, occupational therapy, physical therapy, recreation therapy, speech language pathology Thanks to the Stroke Center team, Jackie Goldsmith is able to enjoy life with her husband, Goldie. and neuropsychiatric care, as well as neurovision specialists and other disciplines, who work together to get patients back to their optimum function at home.

One advantage to receiving inpatient rehabilitation at Bryan is that patients have access to doctors who saw them while they were in the acute care side of the hospital, and they’re familiar with the care givers and have access to rapid treatment therapies and diagnostic tests without having to be transferred to another facility. In addition, patients’ families already are familiar with the care givers and know their way around the hospital.

Bryan Stroke Center medical director James Bobenhouse, MD, and rehabilitation services clinical coordinator Linda Jeffery lead a team assisting patients who are recovering from strokes.

Adjusting to new challenges “Our nurses, therapists and physician providers have a great deal of expertise in providing these patients with the care and treatments for the best outcomes possible,” says rehabilitation services clinical coordinator Linda Jeffery. “This includes helping patients deal with emotional challenges related to having a stroke and possibly a life-altering condition.”

She adds, “Jackie, like many stroke patients, really struggled at first to adjust to her new challenges — I think she just needed to feel like somebody was in her corner, to support and encourage her even when she was frustrated.”

“My husband, ‘Goldie’ (Dwayne), kept saying to me after I had the stroke, ‘You have to have a good attitude,’ but I really didn’t care if I had a good attitude or not,” Jackie remembers. “Linda and the Bryan team helped me work through this.”

Bryan Journeys 19

NEW AT BRYAN As the rehabilitation team approached Jackie with new routines to try at home, she became more motivated, began seeing progress and became more positive and hopeful about her future. Once rehabilitation was complete, Jackie still had some weakness on her left side but was able to get around well by using a cane.

She credits Jeffery, her occupational therapist during her rehabilitation at Bryan, as being instrumental in recovering from her stroke.

“Linda’s attitude and personality lifted my spirits — you could tell that she cared, and that made a big difference,” Jackie says.

Working together Jackie and Linda formed a special bond.

“I saw Jackie in therapy for months, and when you see somebody for an hour, three times a week, you get to know them,” Linda says, “And every now and again she just pops in to say, ‘Hi.’” Their relationship has continued through Jackie’s participation in Lincoln Stroke Partnership’s Stroke Camp, where Linda volunteers.

“Linda helps make the camp fun — she includes us in skits and gets the group laughing,” Jackie points out.

She adds, “Many, many other people helped me and encouraged me to do things I didn’t think I could do. And, I think that a prerequisite to being a nurse or therapist at Bryan must

be that you have to care. They seemed to have a smile on their faces every day and were so nice to Goldie, giving him coffee and making him feel comfortable.”

Two years after her stroke, Jackie underwent a carotid endarterectomy at Bryan Medical Center. This procedure, performed by vascular surgeon Stuart Myers, MD, involved removing plaque that had accumulated in her carotid artery. Left unattended, the plaque could have broken loose and moved to her brain, causing another stroke.

The importance of preventing stokes can’t be overemphasized.

“Within five years, one-third of those who have already had a stroke will have a second one,” Dr. Bobenhouse notes. “And people with high blood pressure are especially at risk, regardless of whether or not they have had a stroke.”

Hypertension, or high blood pressure, is the No. 1 cause of stroke.

“But studies show that if those who currently have high blood pressure could reduce it through medication, exercise and less salt intake, the incidence of stroke in our country would plummet,” says Hook.

“It’s time to work together to make that happen.” n To learn how you can support the Bryan Stroke Center and other neuroscience diagnosis and treatment programs, call the Bryan Foundation at 402-481-8605.

Stroke Camp

An opportunity to refresh and reflect

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magine a setting where stroke survivors and their care givers can enjoy leisure activities in a safe and beautiful environment, in the company of others who are dealing with similar issues.

Welcome to Retreat and Refresh Stroke Camp.

Campers from across Nebraska will come together Aug. 1618 at Ashland’s Camp Carol Joy Holling to attend the third annual Stroke Camp. There, 40 campers — 20 stroke survivors, paired with their care givers — have an opportunity to relax and be treated to many activities, some of which would be difficult to manage on their own, such as fishing, as well as various games, and a favorite, Karaoke singing. Equally important, campers will enjoy the friendship and support of other stroke survivors, care Dwayne “Goldie” Goldsmith with Jackie in a Stroke Camp moment.

20 Summer 2013

NEW AT BRYAN givers and health care volunteers.

Stroke survivor Jackie Goldsmith and her husband, Dwayne “Goldie” Goldsmith, have enjoyed their participation in the past two Stroke Camps. “We have so much fun,” Goldie says, “In addition, people sit around and talk about their respective situations. It keeps you from feeling sorry for yourself because you realize there are many people in your same situation.”

Volunteers from the Lincoln Stroke Partnership*, along with professionals from Retreat and Refresh Stroke Camp, the company that organizes and manages the camp, provide both medical and recreational staffing.

Bryan Health was instrumental in bringing Stroke Camp to the area. After hearing about it while attending an industry conference in 2010, Mary Ellen Hook, clinical nurse specialist/ stroke program coordinator at Bryan Medical Center, introduced the idea to her colleagues. The Lincoln Stroke Partnership, a coalition of Lincoln health care organizations dedicated to stroke prevention, treatment, rehabilitation and support, then embraced the project. The partnership raised funds and recruited volunteers for the first camp in August 2011.

Stroke Camp has been an overwhelming success for both campers and volunteers.

“My participation in the stroke camp has changed my views and expectations for stroke recovery and led me to set more definite rehabilitation goals in my follow-up visits with stroke patients,” notes Bryan Stroke Center medical director James Bobenhouse, MD. “I also have a much deeper understanding of the struggles and sacrifices made by care givers, as well as their need for support in caring for their loved ones.”

“We are thankful to Bryan, the Lincoln Stroke Partnership and the many other businesses and friends who have provided financial support for this wonderful camp,” adds Hook. “We hope to be able to continue offering the camp in the future as it provides much needed support for our stroke survivors and their care givers.”

To learn more, go to strokecamp.org. n

Know the signs of stroke A stroke occurs about every 40 seconds in the United States, according to the American Heart Association/American Stroke Association.

“Our biggest message to the public is if you believe you are experiencing stroke-like symptoms, you need to get to the hospital right away,” says Mary Ellen Hook, stroke program coordinator at Bryan Medical Center.

“This is not something to delay.”

The American Heart Association/American Stroke Association and the Ad Council use the acronym F.A.S.T. to help people identify the most common warning signs of stroke: F – Face Drooping A – Arm Weakness S – Speech Difficulty T – Time to call 9-1-1 To receive a free magnet with the F.A.S.T. symptoms, please call Brenda Lieske at Bryan Medical Center, 402-481-5942.

For more information about F.A.S.T., visit strokeassociation.org.

* Lincoln Stroke Partnership is a consortium of organizations in our community, including Bryan Health, Saint Elizabeth Regional Health Center, Madonna Rehabilitation Hospital, Genentech™ (pharmaceutical manufacturer of t-PA), Lincoln Fire and Rescue, the American Heart Association and the Nebraska State Stroke Association.

Bryan Journeys 21

BRYAN COLLEGE OF HEALTH SCIENCES

Congratulations, grads

Bryan College of Health Sciences awarded diplomas May 4 at Saint Paul United Methodist Church. Former State Sen. Marian Price (Class of ‘59) presented the keynote address (below, left). Honorees, like nurse anesthesia grad Kelsi Rainforth, were congratulated

by Bryan College of Health Sciences President Marilyn Moore (center) and Jim Griesen of the Bryan College of Health Sciences Board.

22 Summer 2013

COLLEGE ALUMNI NEWS

Weekend reunites classmates Bryan College of Health Sciences Alumni Association hosted a series of reunion events June 7-8 for graduates of Bryan School of Nursing, Lincoln General Hospital School of Nursing and Bryan College of Health Sciences.

Fifty-year reunions of the 1963 graduating classes from Bryan School of Nursing and Lincoln General Hospital School of Nursing were among the special events. Bryan grads (above) met at Fairview, former home of William Jennings Bryan and their dormitory as nursing students.

The Alumni Association saluted Prof. Barbara Sittner (left) for professional development and Karen Rustermier and Bryan Medical Center Board member Brenda Franklin for clinical excellence.

Alumni (above) toured the Lincoln General Hospital School of Nursing museum at Bryan West Campus while celebrating their golden anniversary.

Bryan Journeys 23

VOLUNTEERS & CUSTOMER CARE

Haggis, a West Highland white terrier, enjoys friendly pats from patients during his animal assisted therapy visits to Bryan West Campus.

24 Summer 2013

VOLUNTEERS & CUSTOMER CARE

Four-legged volunteers bring joy to patients’ lives

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ryan Volunteers & Customer Care has two participants with four furry feet. They have been through extensive training in order to volunteer — even donning their own name tags. It is a pleasure to introduce you to Zoë and Haggis Mausolf.

These two West Highland white terriers — Westies for short — are gregarious balls of white fur with expressive eyes and alert, perky ears. Zoë and Haggis are nearly identical and sturdy in stature, similar to white Scottie dogs. They’re 10 years old, have matching collars and are kept very sharp looking by regular groomings. Personalities aside, the only visible difference is that Zoë, the female, is a little bigger than Haggis.

Their human companions are Susan Mausolf and Dr. Fred Mausolf, an ophthalmologist on staff at Bryan Health. The four Mausolfs volunteer for animal assisted therapy every other Sunday in the mental health units. Susan has been volunteering for almost nine years, and Fred for nearly five.

“We’ve had Zoë since she was 3 months old, and we adopted Haggis at the age of 2 when his previous owner could no longer care for him. They’ve become best friends, and Zoë won’t let him out of her sight,” says Susan. “When they’re separated for a while they always act like they haven’t seen each other for days!”

Their dog therapist training has included the Canine Good Citizen Class for basic obedience skills, with additional exposure to automatic doors, elevators, wheelchairs, getting petted by a crowd, rough petting, getting used to loud noises, other animals and a host of different circumstances. They graduated from several dog therapy training courses and most recently were involved with the Domesti-PUPS program.

The Mausolfs visit mental health units for seniors, adults, children and adolescents, and people with affective disorders (adults being treated for bipolar and mood disorders).

On a recent visit to the child and adolescent unit, Susan and Fred each held a dog on-leash and got buzzed into the secured area. There, a recreational therapist explained to the patients that Zoë and Haggis were coming for a visit, and they would have to take turns greeting them. Susan sat cross-legged on the floor with one dog. Fred grabbed a chair with the other dog close by. Four

patients sat in a circle around them. Haggis immediately rolled onto his back waiting for someone to scratch the soft fur on his belly.

The dogs took turns visiting each patient nose-to-nose.

“He licked me!” one child says with delight.

“That’s a Haggis kiss,” Susan points out. She responds, “Bless you” after a Zoë sneeze.

“They’re so cute,” another patient notes. Zoë softly pawed at someone’s arm, asking for a pat. Lots of petting of heads and scratching of ears ensued.

“Are they, like spoiled?” someone asks.

“Most definitely,” answers Susan to laughter from everyone.

During her visits, Susan gives out baseball player-like trading cards

Volunteers Susan and Fred Mausolf, MD, enjoy bringing their Westies, Zoë (left) and Haggis to meet with patients.

Bryan Journeys 25

VOLUNTEERS & CUSTOMER CARE

They’re doggone good ambassadors of each dog, featuring a photo thinking, who really make and their favorite toy (Zoë, a connections with the dogs,” she tennis ball and Haggis, a rawhide says. bone). The cards have other After therapy, while the facts about them and an email Westies snoozed by the elevator, address where one can contact the Mausolfs talked about why the dogs. they volunteer.

Amidst the adoration of “We like being able to do the dogs, the recreational things together,” says Susan. therapist asks the adolescent “We like it, the dogs like it, and patients if they have pets and the patients enjoy it so much. encourages them to talk about It’s very rewarding.” those animals. The teens share During visits to the senior about their dogs and cats and unit, the Mausolfs put Haggis their antics; the therapist also on the conference table so talks about the calming effects everyone can see him, and of dogs. he walks around to visit each “Studies show that petting person. If someone comes in a dog can lower your blood late, he makes sure to go back pressure, helping with anxiety Treats are nice, but Haggis and Zoë seem to prefer pets and tummy and visit the newcomer. rubs after finishing their rounds at Bryan West Campus. and relaxation. They’re always “He doesn’t want anyone glad to see you. Animals can to be left out,” Susan says. “The sense when you want them to come close or to stay away,” Dr. patients really get a kick out of it.”

Mausolf points out.

When they visit bedridden patients in nursing homes, Haggis “Don’t you feel happier with the dogs being here?” the will hop into bed with people, if they want him to. therapist asks the patients. They nod and some say, “The dogs “He really seems to have a sense of what people need,” says Dr. make us happier just by their being here.”

Mausolf. “Haggis looks around the room and just knows what to do “Do you think your dogs help you when you’re having a bad to help people.” day?” asks the therapist. “Spending time with your pet is an option “The patients get a lot out of it,” Susan adds. “It calms them to help you feel better.” down. It makes them happy. Everyone loves the trading cards. They Dr. Mausolf notes, “Haggis is very intuitive. He tries to go into have a lot of questions and they talk about their own pets.” every room with a patient in it because he wants to help. He wants “With the seniors, the dogs bring back memories of their old every patient to have a turn.” pets. They enjoy reminiscing,” Dr. Mausolf says.

Haggis wandered off to check on the other patients, but always “The Bryan volunteer office is very effective. Volunteering is came back when called. a great experience, and there’s a tremendous amount of support Margaret Williams, mental health recreation therapy team from the hospital. We all really enjoy it.” n leader, says the dogs do a good job.

To find out about volunteer opportunities at Bryan Medical “We want to give exposure to activities to help people manage Center, please call 402-481-3032, or visit bryanhealth.org/ thoughts and feelings, to help them better cope with their mental volunteer. To support the Volunteer & Customer Care Fund, contact health issues. the Bryan Foundation by calling 402-481-8605.

“We have people that are not responding to other therapies, not communicating, not having an improved mood or clearer

26 Summer 2013

IN SERVICE TO OUR COMMUNITY

Everyone wins at Lincoln’s

MARATHON

The tradition continues — For decades, Bryan has hosted a runners’ aid station to refresh participants south of the Bryan West Campus.

College of Health Sciences students joined hundreds of Bryan co-workers, families and friends who volunteered at the aid station.

Family finds finishing fun Ana Best (center), her brother Lucas and their mother Gloria all have multiple medals from completing the half marathon course of the Lincoln Marathon.

Ana, a non-invasive cardiovascular tech at Bryan East Campus, ran her second such event May 5. It was the third race for Lucas and 4th finish for Gloria.

“We all played sports in high school, and my background is in exercise science, so I like to stay fit and active,” Ana says. “Some friends encouraged my Mom to try it, and now we all enjoy competing in this race.”

Fresh water and sport drinks are always popular with runners.

Bryan Journeys 27

CRETE AREA MEDICAL CENTER

CAMC redefines rural health care

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n a small town, most everybody knows everyone. Everybody seems friendly. Everybody says hello. Everybody cares.

This hometown feeling is palatable as you enter Crete Area Medical Center (CAMC), a subsidiary of Bryan Health.

A pioneer of the medical home, CAMC ranks in the top 10 percent for patient satisfaction, consistently updates technology, and is deeply involved in the community. In the years following its new facility opening on June 3, 2003, residents of Crete, Wilber and surrounding towns have experienced the benefits of progressive care in their own backyard.

specific health goals.

“We are really fortunate here to have a great medical staff that embraced the thought process of population health. Now, you can’t turn on news without hearing about it. But we were doing this here in Crete before anyone was talking about it,” says Carol Friesen, CAMC president and CEO. “It’s really about how we keep our community as healthy as possible. We are working with our diabetics, the people with high cholesterol and other chronic diseases to help them lead healthier lives. It saves them money and helps them feel good.”

Nebraska’s first rural medical home

Along with a concerted effort toward improving the patient experience as a medical home, CAMC takes pride in serving patients of their community and helping them make strides in daily wellness.

Last year, CAMC received the National Rural Health Association quality health care award for improving health outcomes. Avatar Solutions, a leading provider of patient, employee, and physician surveys, also recognized CAMC for exceeding patient expectations and consistently high standards of care.

“By following up on our patients on a regular basis, we are able to make a meaningful difference in their overall health,” Troy Miller, DO, says. “I encourage my patients to pay attention to their health early and often: Know what their cholesterol is, know what their blood pressure is, make sure their children are getting well-child exams and staying physically fit.”

In August 2010, CAMC was the first rural health facility in Nebraska and only the fourth practice in the state to be recognized as a Level 3 Patient Centered Medical Home by the National Committee for Quality Assurance. As the highest achievable recognition for a physician’s practice, this national designation ultimately translates to better care for patients. Specifically, the Patient Centered Medical Home (PMCH) is a promising model of health care delivery that aims to improve quality and efficiency of care. The NCQA Program for Physician Practice Connections-Patient Centered Medical Home identifies practices that promote partnerships between patients and clinicians, instead of treating patient care as the sum of episodic office visits.

According to Russell Ebke, MD, “A medical home is really the future of health care, especially from the standpoint of quality and management of chronic disease and illness.” With this concept, patients have a care team working alongside patients to help them lead a healthy lifestyle. Whether that’s a physician, mid-level, nurse or dietitian, the team members come together to meet each patient’s

Patient satisfaction

Up-to-date advancements State-of-the-art equipment is accessible throughout the hospital, from the emergency room to the nursery. This includes PET/CT and

July 29, the Healing Garden was dedicated.

PET/CT and MRI scans offered.

Dexa Scan added to test bone density in house.

The annex building opened for nonmedical staff functions.

In July, CAMC receives medical home recognition

by NCQA.

Digital mammo added to women’s suite for improved detection.

Occupational & physical therapy outreach with Tabitha.

National Quality Award received from the NRHA for improving health outcomes.

Digital radiography installed, reducing patient doses and cutting Xray time.

2004

2006

2008

2009

2010

2010

2011

2012

2013

2003

2005

2007

2009

2010

2010

June 3, Crete Area Medical Center officially opened to the public.

On-site Spanish translators added to help bridge communication issues.

Total knee and shoulder joint replacement available.

Physical therapy and lab remodel completed, concluding a 5-year plan.

Expediated care brought to a new level with ALS transfer services.

Sports medicine program developed to benefit community athletes.

Here are highlights from a decade of achievements at CAMC.

28 Summer 2013

2011 Team member engagement ranked in top decile.

2012

2013

New chapel dedicated.

Emergency room remodel for easier access.

CRETE AREA MEDICAL CENTER

Care givers associated with Crete Area Medical Center are Amy Vertin, MD, (left); Kurt Schmeckpeper, PA-C; Kate Hesser, MD; Kim McMillan, PA-C; Tammy Schroeder, MSN, ARPN, FNP; Troy Miller, DO; Jason Hesser, MD; and Russell Ebke, MD. Dexa Scans, digital X-rays and mammography, and MRI equipment. In rare instances, when treatment is beyond CAMC’s scope, assisted life support (ALS) transfers expedite care.

“Being a rural community, it is just as important for us to stay up to date on technology as our larger counterparts,” says Jason Hesser, MD. “We are transitioning to electronic medical records to ensure paper records are not lost. We have built a web portal, where patients can view their laboratory results as soon as we get them, in real time, and have access to their medications. We switched to digital radiography which decreases the amount of radiation while improving image quality. We are staying up to date on everything.”

Community connections Since all the CAMC physicians live and work in Crete, they are intimately connected to the well-being of their community. This not

only is reflected in day-to-day care, but in outreach. Physical and occupational therapy, cardiac rehabilitation and wellness programs continually work to improve patient health. And CAMC employs medical translators to communicate with the 40 percent Spanish speaking population of Crete, so everyone has access to high-quality health care.

“My husband and I grew up in towns similar in size to Crete, so we decided to practice in a small town. When we first came here to interview, we were blown away and fell in love with the town, the hospital, the community,” says Kate Hesser, MD. “The other great thing about practicing here is my husband and I do full-scope family practice, and we’ve had the opportunity to do everything that we want to do here in a small town. We haven’t been limited at all.”

That’s rural health care, redefined. n

Bryan Journeys 29

ACHIEVEMENTS

Litzenberg affiliates with Bryan Litzenberg Memorial County Hospital of Central City has signed an agreement of affiliation with Bryan Health.

Under this agreement, Bryan Health will provide management support to Litzenberg Memorial County Hospital. The intent is for staff members from both organizations to work more closely, bringing Bryan Health expertise to Central City and the surrounding area.

Litzenberg Memorial County Hospital and its 46-bed long-term care facility still will be owned

by Merrick County and governed by a local board of trustees.

Bryan Health CEO Kim Russel notes, “Our mission is to advance the health of individuals in our region through collaboration with physcians and communities. We are pleased to formalize this partnership with the exceptional care givers in Central City.” n

30 Summer 2013

Bryan boards announce changes in leadership

Tad Hunt

Hunt will lead Crete Area Medical Center Tad Hunt has been named chief executive officer of Crete Area Medical Center, effective Sept. 23. In his new role, he will be responsible for all operations of the medical center, including financial, quality and growth performance, as well as oversight of physician, community and board relations.

Hunt recently served as CEO of Litzenberg Memorial County Hospital in Central City.

He is president-elect of the Nebraska Rural Health Association, is a member of the Nebraska Hospital Association Board and is a member of the American College of Healthcare Executives. n

Bryan Foundation Board of Trustees The Bryan Foundation Board of Trustees has several new members: Bill Cintani is president of Mapes Industries Inc., a manufacturer of specialty architectural products.

Aina Silenieks, MD, is associated with Pathology Medical Services.

Jim Terrano is president and CEO of TELCOR Inc., specialists in point of contact and laboratory billing software solutions.

Cori Vokoun, treasurer of Sampson Construction, is the secretary/treasurer of the board’s executive committee.

Bryan Health Board of Trustees Renee Sjulin, vice president of Runza National, has been appointed to the Bryan Health Board of Trustees.

Bryan Medical Center Board of Trustees Richard Evnen is the new chair of the Bryan Medical Center Board of Trustees.

This former owner and CEO

of Lincoln Poultry has served on the boards of many local and national organizations.

Evnen also serves on the Bryan Health Board of Trustees.

Gene Stohs, MD, is the past chair of the Bryan Medical Center Board of Trustees.

Bryan College of Health Sciences Board of Trustees Georgianne Mastera, PhD, is the new chair of the Bryan College of Health Sciences Board of Trustees.

This former high school teacher and community college instructor was an administrator at Nebraska Wesleyan University and served two years as interim provost. She also serves on the Bryan Medical Center Board of Trustees.

Jim Griesen is the College board’s past chair.

Crete Area Medical Center Board of Trustees Tom Kozisek is the newest member of the Crete Area Medical Center Board of Trustees. Kozisek is a senior vice president and division manager of U.S. Bank. n

ACHIEVEMENTS

Honorees at the May 2 Red Cross Tribute to Heroes recognition dinner pose with their awards after the ceremony. Dr. Ed Mlinek (third from right) and Elizabeth Nespor-Hartig, RN, (far right) were among the recipients with Bryan connections.

Red Cross salutes Dr. Mlinek and Nespor-Hartig for service The Cornhusker Chapter of the American Red Cross honored Ed Mlinek, MD, and Elizabeth Nespor-Hartig, RN, May 2 during the 12th annual Red Cross Tribute to Heroes recognition dinner.

Dr. Mlinek received a Commitment to Community Award for his efforts to organize medical support teams for the Special Olympics

USA National Games. He’s the medical director of the Bryan Emergency Department.

Nespor-Hartig is an assistant RN manager in Care Management at Bryan.

She received a Good Samaritan Award for stopping while driving to work to come to the assistance of a motorist who had been involved in a crash. n

Larry Krebsbach (right)

Cheryl Orosco

Krebsbach Orosco earns statewide achieves recognition certification Epidemiologist Larry Krebsbach, REHS, CIC, received the distinguished service award June 12 from the Nebraska Infection Control Network.

According to NICN President Phil Smith, MD, Krebsbach and two other recipients were honored for their dedication to the profession and willingness to mentor fellow infection control professionals across Nebraska. n

Cheryl Orosco, RN, manager of research services at Bryan Heart, has become a certified clinical research coordinator.

She successfully completed the exam process administered by the Academy of Clinical Research Professionals.

Orosco has managed clinical trials for Bryan Heart since 2003 and has managed cardiovascular research trials for more than 19 years. n

CAP lab accreditation and Blood Bank surveys completed This spring, Bryan Medical Center successfully completed the College of American

Pathologists (CAP) laboratory accreditation and American Association of Blook Banks

surveys. The survey process is designed to help hospitals continuously provide high-

quality services to patients and providers while maintaining a safe environment for staff. n

Bryan Journeys 31

BRYAN STERLING CONNECTION

Join us for upcoming seminars

T

he Sterling Connection Advisory Board has guided the transition to our new name, looking for new ways to “enrich lives over 50” and help members connect through different avenues. This column discusses how we can connect through education and information.

From the moment we are on our own, as young adults, we are focused on our education, careers, families, friends and a host of other things that occupy our time and attention. As we move into our middle years, we have more time to devote to our own physical and mental health and financial future. More changes occur when adult children take on the primary care giver role for their parents.

Upcoming free seminars from Sterling Connection provide useful information, no matter where you are in your life journey.

Sterling Connection

Life or Potluck: Know What Resources are Available to You — Robbie Nathan, Care Consultants for the Aging, is the guest speaker Thursday, Aug. 15.

Welcome to Medicare — Alicia Jones from the Senior Health Insurance Information Program (SHIIP) speaks Tuesday, Aug. 27.

Caring for Your Parents — Lincoln Caregivers Education Group presentation is Thursday, Sept. 12.

Safe Care for Grandchildren — Experts from the Lincoln/ Lancaster County Safe Kids Coalition are here Saturday, Sept. 28, from 9-10:30 a.m.

Coordinators gather at Bryan Sterling Connection coordinators from Heartland Health Alliance (HHA) member hospitals met at Bryan in May. The coordinators are (seated, from left): Debbie Niedermeyer, Syracuse; Shirley Siedhoff, Crete; Deb Whaley, Beatrice, Mary Bossung, Tecumseh, and Connie Svik, Lincoln; and (standing, from left) Joni Nietfeld, Marysville, Kan.; Connie Schindel, Albion; Becky Ries, Ord; Terri Janssen, Syracuse; Pauline Niederklein, Fairbury; Barb Langley, Cambridge; Pam Harrison, Marysville, Kan.; Tammy Struebing, Neligh; Jane Rehmer, Seward; Kerri Berry, Holdrege; Ree Ann Regier, Aurora; Michelle McIntire, Crete; Pat Samway, Lexington; and Kathy Wolf, Lincoln.

Not available for the photo: Laura Daro, David City; Shelley Thomas, Hastings; Sarah Wolford, McCook; Carol Carlson, Seward; Jean Kehm, St. Paul; and Leslie Robinson and Cheryl Luebbe, York.

The HHA is a 39-member hospital network providing access to highquality, low-cost health care. Nineteen HHA hospitals (see map below) offer Sterling Connection programs in conjunction with Bryan Health.

Hospitals participating in Sterling Conne

1. Ante

2. Beat Heal

Compassion Fatigue — Deborah Boyle, MSN, RN, of the University of California Irvine Medical Center, speaks Tuesday, Sept. 17.

1 l

Estate Planning — Andrew Loudon of Baylor, Evnen, Curtiss, Grimit & Witt, LLP, speaks Tuesday, Oct. 22.

Unless noted, seminars are 7-8:30 p.m. in the Plaza Conference Center at Bryan East Campus, 1500 S. 48th St. Go to bryanhealth.org/calendar, or call 402-481-8886.

Are you 50 or better, but not a member of Sterling Connection?

To join, go to bryanhealth.org/sterlingconnection for an online application, or call 402-481-3355. See Page 33 for more seminar details.

Until next time, Kathy Wolf, stewardship manager

32 Summer 2013

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Heartland Health benefits Alliance are hospitals that at participate in Sterling Connection available HHA member hospitals Sterling Connection are shown on the map above. in these communities: 1 Neligh, 2 Beatrice, 3 Albion, 4 Lincoln, 5 David City, 6 McCook, 7 Marysville, Kan., 8 Syracuse, 9 Crete, The Alliance is a 39-member network of rural and urban 10 St. Paul, 11 Fairbury, 12 Tecumseh, 13 Lexington, 14 Hastings, healthcare providers that operate independently but work 15 Seward, 16 Aurora, 17 Holdrege, 18 Cambridge, 19 Ord, 20 York. together to provide quality care to Nebraskans.

3. Boon

4. Brya

5. Butle David

6. Com

7. Com Mary

8. Com

9. Crete

10. How St. Pa

COMMUNITY CALENDAR These free classes will meet in the Plaza Conference Center of Bryan Medical Center, Bryan East Campus, 1500 S. 48th St. To register, go to bryanhealth.org/calendar, or call 402-481-8886.

Sunday, Sept. 29 Lincoln Southwest High School track, 7001 S. 14th St. Join us in celebrating the five-year anniversary of our Bryan Women’s and Children’s Tower — there’s an event for all ages, from crawlers and walkers to runners!

New events for children — noon To celebrate the more than 10,000 children delivered at the Family Birthplace, we have: • 15-foot Diaper Derby for crawlers.

• 30-yard Toddler Trot, 3 and under.

• 60-yard Dash, ages 4-5.

Traditional events One-mile Kids’ Run — at 12:15 p.m.

5K run/walk and 10K — at 1 p.m.

Everyone’s welcome, from beginner to experienced road runner. Race proceeds will be used to provide education about depression and mental health.

Fee is $10 for the Kids’ Run, which includes a short sleeve cotton shirt.

Fees for 5K and 10K race: $20 for short sleeve cotton shirt, $25 for short sleeve dri-fit shirt.

Shirts are included in registration fees if you register by Sept. 15; final deadline is Sept. 27 at 3 p.m.

To register, go to bryanhealth.cvent. com/2013run, or call 402-481-8855.

Life or Potluck: Know What Resources are Available to You Thursday, Aug. 15, 7-8:30 p.m.

Do you ever wonder how you can find the perfect recipe for each challenge life throws you? Use resources the professionals use, so you can plan for changes life presents.

Robbie Nathan of Care Consultants for the Aging brings her 8th edition of the ElderCare Resource Handbook, as well as stories and a revealing look at health choices for elders in Lincoln.

Welcome to Medicare Tuesday, Aug. 27, 6:30-8:30 p.m.

Joining Medicare soon? Need to know more about Medicare benefits to assist someone who is already in the program?

Alicia Jones, program director of the Senior Health Insurance Information Program (SHIIP), explains the ins and outs of Medicare, including online resources and extra help for those with limited income and resources.

High Blood Pressure Solutions and Prevention Tuesday, Sept. 10, 7-8:30 p.m.

Millions of Americans are diagnosed with hypertension (high blood pressure) every year, so it’s not something to be taken lightly..

Join Bryan Heart cardiologist Ryan Whitney, MD, as he discusses treatments and things you can do to work to prevent this silent killer.

Compassion Fatigue ...

A Diagnosis for You? Tuesday, Sept. 17, 7-8:30 p.m.

Health care providers can develop compassion fatigue, better known as “burnout,” over time from work stressors (workload, additional hours) related to the emotional toll of caring for complex patients.

Join clinical nurse specialist Deborah Boyle of the University of California Irvine Medical Center for an overview of the phenomenon of compassion fatigue. She will present a menu of intervention options to consider using in the work setting.

Experience the Power of Music in Your Life Want to learn the hands-on benefits music can provide for relaxation and mood elevation?

Attend one of our six-week series with board certified music therapist Rachel Rotert to experience the power of music in your life!

Choose: Mondays, Aug. 12-Sept. 23, 6:30-7:30 p.m.

Wednesdays, Aug. 14-Sept 18, 1:30-2:30 p.m.

Cost: $48 for the series.

Location: Bryan LifePointe Campus, 7501 S. 27th St. Register by Friday, Aug. 9, by calling 402481-6300, or go to bryanhealth.org/calendar.

News from Bryan LifePointe n The Spa at LifePointe For healthy, youthful skin with no surgery and no downtime.

One of our most popular offerings, the HydraFacial leaves your skin silky smooth. It’s the perfect treatment to combat the effects of the sun and restore and rehydrate your skin.

Our HydraFacial restores your skin in one soothing procedure: • For all skin types, including sensitive skin.

• Targets fine lines, wrinkles, puffy eyes, dark spots, acne, sun damage, uneven skin tone.

• Deep cleansing, hydrating exfoliation, painless extractions.

• Go out the same night! n August special at The Spa

Receive two free facial waxes — choose from lip, brow and chin — when you purchase and receive a HydraFacial in August. (That’s a $20 savings!)

Schedule your appointment today! Call The Spa at LifePointe, 402-481-6321. n Fitness

Join LifePointe in September, and December is free! Use our equipment, attend fitness classes and swim in our pools, all for one low price! Purchase a three-month membership in September, and your membership will be extended through the end of year.

The $189 fee, plus tax, Includes fitness assessment with a trainer and access to all fitness classes, pools and equipment.

Call 402-481-6326, or visit us online at bryanhealth.org/MembershipOptions.

Bryan Journeys 33

1600 S. 48th St., Lincoln, NE 68506

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