FirstHealth Magazine - Fall 2015

Fall 2015

the magazine from FirstHealth of the Carolinas

www.firsthealth.org

I am more than just a number ...

847-60-15

... I am a father looking forward to walking my youngest daughter down the aisle.

After a standard checkup, my doctor recommended a lung cancer screening. During the screening, it was found that I had stage 4 lung cancer. I chose to consult with a larger university hospital where, at my first appointment, I was handed a waiting room call button. It just didn’t feel right and, at that point, I made my decision: I was going home. At FirstHealth, I was greeted with open arms, I am not just a number or another cancer patient, I am Pat. They treat me like family. Most importantly, they can offer something that no other national or university cancer system can – they are close to home.

- Pat Walsh, Moore County Cancer Survivor

FirstHealth Cancer Care offers more than a button. We provide comprehensive cancer support services, including patient navigation, integrative medicine, nutrition and dietary assistance, stress management, massage therapy, clinical trials, financial assistance and more.

www.NCCancerCare.org • (800) 213-3284

CEO Message

You could have diabetes and not know it

M David J. Kilarski Chief Executive Officer FirstHealth of the Carolinas

any of you reading this issue of FirstHealth are unaware that you have the disease we highlight in it.

That’s quite an attention-grabber, isn’t it? It is also unfortunately true.

As you will learn by reading further, many people in the FirstHealth service area – and throughout the country – have diabetes or its precursor, prediabetes, and don’t know it. Because prediabetes has no symptoms, those who have it don’t realize that they are being subtly stalked by a disease that can cause chronic wounds, limb loss, kidney failure, vision loss, even death.

A recent study, based on government health surveys and published in the September issue of the Journal of the American Medical Association, suggests that half of all U.S. adults have diabetes or prediabetes. That’s the bad news.

The somewhat better news is that many cases of Type 2 diabetes, the kind linked to obesity and inactivity, can be prevented or successfully managed. Measures as relatively simple as improved diet or increased exercise are known to be helpful, and weight-loss surgery is now an acknowledged factor in diabetes remission.

FirstHealth of the Carolinas provides numerous services that are effective in diabetes prevention or control. In many communities, our diabetes educators offer classes on healthy cooking or easy ways in which to introduce physical activity into busy lives. FirstHealth Fitness offers Exercise is Medicine, which partners with physicians in an effort to make physical activity a part of a patient’s prescribed health care plan.

Last year, a FirstHealth program called FirstReach received an American Hospital Association NOVA award for an innovative community effort to identify and educate people with diabetes. Offered through our Diabetes & Nutrition Education Center, which this year observes its 20th year of service, the program was recognized for results demonstrating how collaborative community efforts can successfully impact diabetes diagnosis, treatment and management.

We have also partnered with an area industry – Perdue Farms in Rockingham – to offer in-depth diabetes education for its employees. Dr. Bo Kopynec of FirstHealth Family Medicine in Ellerbe, who also works in Perdue’s employee wellness center, approached the Diabetes & Nutrition Education Center staff about offering classes after noting the impact that diabetes was having on Perdue’s employee population.

According to registered dietitian and certified diabetes educator Melissa Herman, the Perdue participants responded immediately and positively to the chance to learn more about controlling what she calls “the most significant health threat of our time.”

November is American Diabetes Awareness Month, a time for increased awareness of diabetes and efforts to combat it. I hope you find this issue of FirstHealth helpful in both respects. I hope you come away from it knowing more about diabetes than you did before. And I hope you will allow us to assist you if you think any of our services would be helpful to you or a loved one.

(800) 213-3284 • www.firsthealth.org 1

Fall 2015

the magazine from FirstHealth of the Carolinas

Departments

155 Memorial Drive P.O. Box 3000 Pinehurst, NC 28374 Editor, FirstHealth of the Carolinas. . . . . . . . . . . . . . . . Brenda Bouser Managing Editor . . . . . . . . . . . . . . . . . . . . . . . . . . Sam Gaines Creative Director . . . . . . . . . . . . . . . . . . . . . . . . . . Jan McLean Production Director . . . . . . . . . . . . . . . . . . . . . . . . Traci Marsh

f i r s t h e al t h .o rg

1

CEO’s message

16

New Providers

18 Letters

Contributing Writers

Brenda Bouser, Ellen Cooper

Contributing Photographers

Eric Baker, John Gessner, Don McKenzie www.firsthealth.org

Board of Directors FirstHealth of the Carolinas

On the cover: A recent study suggests that half of all U.S. adults have diabetes or prediabetes. There is hope, however, in the fact that diabetes can be prevented or successfully managed. This issue of FirstHealth provides information on the many diabetes-related services and programs offered

by FirstHealth of the Carolinas.

Mr. Hew Fulton, Chair Ms. Tracy A. Leinbach, Vice Chair/Secretary Mr. Sherwood Blackwood Mr. James H. Bulthuis David M. Cowherd, M.D. John N. Ellis, M.D. Mrs. Carolyn D. Helms Mrs. Anna G. Hollers, Treasurer Mr. David J. Kilarski

Mr. Julian W. King Mr. Don Padgett Bernard M. Stanfield, M.D. William L. Stewart, M.D. Mr. Robert E. Tweed Raymond Washington, M.D. Mrs. Rusti Welch

Corporate Officers Chief Executive Officer, FirstHealth of the Carolinas President, FirstHealth Moore Regional Hospital. . . . .

Chief Financial Officer, FirstHealth of the Carolinas.

. . . Mr.

David J. Kilarski

. . . . Mrs.

Chief Medical Officer FirstHealth of the Carolinas .

. . . . . . . . . . . . . . . . . . . . . . . John

Chief Information Officer, FirstHealth of the Carolinas .

. . . . . . . . . . . . . . . . . . . . . . . Mr.

Lynn S. DeJaco

Features 3

Diabetes by Definition, Dollar, Demographics

4

Diabetes: the Biggest of the Top Three

6

Diabetes During Pregnancy

8

It’s Not Actually a “Cure”

9

A New Life Without Diabetes

F. Krahnert Jr., M.D.

David B. Dillehunt

Chief Operating Officer, FirstHealth Moore Regional Hospital. . . . . . . . . . . . . . . . Mr. Brian T. Canfield Chief Nursing Officer, FirstHealth Moore Regional Hospital. . . . . . . . . . . . . . . . Mrs. Karen Robeano, DNP, R.N. President, FirstHealth Physician Group . . . . . . . . . . . . . . Daniel R. Barnes, D.O. President, Moore Regional Hospital-Hoke Campus. . . .Mrs. Susan K. Beaty, R.N. President, FirstHealth Richmond Memorial Hospital

. . . Mr.

John J. Jackson

President, Foundation of FirstHealth . . . . . . . . . . . . . . . . Mrs. Kathleen Stockham President, FirstHealth Montgomery Memorial Hospital. . . . Mrs. Beth Walker Vice President, Human Resources, FirstHealth of the Carolinas . . . . . . .

. . . . . . . . . . . . . . . . . Mr.

Vice President, Strategy & Innovation, FirstHealth of the Carolinas . . . . . . . . . .

. . . . . . . . . . . . . . Mrs.

Vice President, Finance & Support Services, FirstHealth of the Carolinas . . . . . . . . . . . . . .

Vice President, Quality, FirstHealth of the Carolinas .

Daniel F. Biediger

. . . . . . . . . . Mr.

Amy Graham

Jeffrey A. Casey

. . . . . . . . . . . . . . . . . . . . . . . Mrs.

Cindy McNeill-McDonald

10 Prediabetes 12 When Exercise IS Medicine 13 Food Swaps

The not-for-profit FirstHealth of the Carolinas is headquartered in Pinehurst, N.C., and is composed of Moore Regional Hospital, Montgomery Memorial Hospital, Richmond Memorial Hospital (a division of Moore Regional Hospital), the Foundation of FirstHealth, FirstCarolinaCare Insurance Company, and Regional Health Services. Comments on FirstHealth of the Carolinas magazine or changes of address should be directed to bbouser@firsthealth.org or to (910) 715-4278.

FirstHealth of the Carolinas is published by StayWell 407 Norwalk St. Greensboro, NC 27407 (336) 547-8970 President . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . William G. Moore Senior Staff Accountant. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sharon Tesh © Copyright 2015 by StayWell, an operating company of StayWell/MediMedia USA, and FirstHealth of the Carolinas, Inc. No part of this publication may be reproduced or transmitted in any form or by any means without written permission from StayWell. Articles in this publication are written by professional journalists who strive to present reliable, up-to-date health information. However, personal decisions regarding health, finance, exercise and other matters should be made only after consultation with the reader’s physician or professional adviser. All editorial rights reserved. Opinions expressed herein are not necessarily those of StayWell or FirstHealth of the Carolinas.

Models are used for illustrative purposes only.

2 Fall 2015

14 Diabetes and Wound Care

For more information on any of the programs or services offered by FirstHealth of the Carolinas, please call (800) 213-3284 or visit www.firsthealth.org.

Diabetes

By Defini tion In

Type 1

diabetes, the body does not produce insulin. Although once known as “juvenile onset diabetes” because of its frequent diagnosis among children and young adults, it can develop at any age.

Type 2 Gestational In

diabetes, the body does not use insulin properly. Can develop at any age.

diabetes occurs in women who have never had diabetes before but develop high blood glucose levels during pregnancy.

In

Prediabetes

, a person’s blood sugar levels are higher than normal but not yet high enough to be classified as Type 2 diabetes.

Source: Centers for Disease Control and Prevention & American Diabetes Association

By Dollar Diabetes drugs range in price anywhere from the “$4” list at your local drugstore for a month’s supply of metformin and some older oral medications to and up for a month’s supply of newer drugs.

$300

Depending on the required dose and the combination of insulins being used, the cost of insulin therapy also ranges greatly.

The average price of human insulins (“regular,” “neutral protamine Hagedorn” or “NPH” and “70/30,” a fixed combination of the first two) has risen from an average of around to more than per vial.

$120

* Women 15.2% * African American 23.8% * Non-Hispanic White 15.5% * Hispanic 14.1% * Other 13.2%

22.2%

20.5% 20

15

10

5

16.6%

14.8%

North Carolina

* Men 19.2%

22.9%

Montgomery County

* United States 10.1%

25

Moore County

* North Carolina 9.8%

Prevalence in the FirstHealth of the Carolinas service area:

Hoke County

By Demographics

Source: FirstHealth Pharmacy

Richmond County

$15

0

*NC Center for State Statistics

(800) 213-3284 • www.firsthealth.org 3

Diabetes: the biggest of the top three

A

t the FirstHealth Transition Care Clinic (TCC) at Moore Regional Hospital, high blood pressure, chronic obstructive pulmonary disease and diabetes are the “top three” diagnoses.

But, according to adult nurse practitioner Cheryl Batchelor, ANP, the greatest in terms of outright numbers is diabetes.

“I see more diabetes than any other health problem,” she says. “I don’t think anyone realizes how significant this health issue is in our region.”

Information from the Community Health Needs Assessment conducted earlier this year for FirstHealth Community Health Services puts Moore County (16.6 percent) in third place in terms of diabetes prevalence in the four-county service area of Moore, Montgomery, Richmond and Hoke. That’s down an entire percentage point from the previous survey conducted in 2011.

At 22.9 percent, up more than 5 percent since 2011, Richmond County is first in diabetes prevalence. Hoke County, where the numbers increased by almost 7 percent, is second. (See the graph on page 5.)

FirstHealth diabetes educators attribute the increases in both Richmond and Hoke to greater numbers of diagnosed cases of diabetes. The Moore County decrease, and an even more significant one in Montgomery County, is more difficult to explain.

Diabetes education may be having some impact, but it’s more likely that some of the people contacted for the random survey have the disease and just don’t know it.

“It’s highly unlikely that fewer people are developing diabetes—almost implausible,” says Melissa Herman, R.D., CDE, of FirstHealth Diabetes & Nutrition Education.

When people with diabetes don’t manage their disease well, or don’t know they have a problem, they often wind up in the Emergency Department or in the hospital. In Moore County, they will eventually wind up in the Moore Regional TCC, where Batchelor or one of the other providers will begin a health care regimen that can be almost as much educational as medical.

Referrals for patients with blood sugar readings of 300 or 400 mg/dL are not uncommon. Normal after

4 Fall 2015

fasting (not eating) is less than 100 or less than 140 two hours after eating.

“We try to help our patients realize they can have a productive life with diabetes—if they manage it well,” Batchelor says.

There’s also the matter of expense. From related testing supplies to oral medications and insulin, diabetes is a very expensive disease.

“The cost of testing supplies alone can run $18 or $19 a month,” Batchelor says. “That’s a big deal for these patients who have no financial resources, and insulin can be very expensive.”

There are available resources. Some pharmaceutical companies provide samples To make a donation that will assist of the most patients who need help with the frequently cost of their diabetes medications prescribed and supplies, contact The Foundation medications, and of FirstHealth at (910) 695-7500 or the pharmacy of www.firsthealth.org/donation. one large grocery store chain does not charge for the first 30-day supply of testing supplies. Many patients go to the Moore Free Care Clinic for continued assistance, and The Foundation of FirstHealth is often called upon to help.

Aside from efforts to get out-of-control diabetes under control, the TCC also provides numerous screenings for common diabetes complications.

“We pursue all options to get patients back on track,” Batchelor says. “We can work with them to help them reach their goals.”

For information on the FirstHealth Transition Care Clinics, call (910) 715-8355 in Moore County, (910) 571-5151 in Montgomery County, (910) 417-4155 in Richmond County and (910) 878-5120 in Hoke County. For more information on FirstHealth Diabetes & Nutrition Education in Moore, Montgomery, Richmond and Hoke counties, call (800) 364-0499.

Taking technology to frontlines of diabetes fight

In both practice “We hope that providing patients with real-time and delivery, health feedback will help them understand how to manage care is in a constant their disease,” says Roxanne Elliott, policy director with state of change FirstHealth Community Health Services. with the focus With the Bluetooth technology, FirstHealth on continuous providers and certified diabetes educators will improvements track and trend glucose readings by logging into to quality, safety “the cloud.” and efficiency.

The technology, which is being put into use Much of that change occurs in rural in hospitals and clinics across the nation, works communities, where limited health care in the same way that a smart phone is linked to a resources and education can make it hard for Bluetooth speaker. patients to manage chronic diseases.

A patient’s glucometer is linked to the smart In Montgomery County, North Carolina, phone that is linked to an appropriate app. When FirstHealth of the Carolinas will soon introduce a health the patient tests his/her blood sugar, the result care app (application) to a popular communications goes from the glucometer to the smart phone app technology that should help people with uncontrolled for “cloud” viewing. diabetes deal more effectively with their condition.

“Historically, diabetes has been reactive rather Beginning this fall, diabetic patients at both than proactive,” says Melissa Herman, R.D., CDE, the FirstHealth Transition Care Clinic (TCC) and program coordinator for the FirstHealth Diabetes FirstHealth Family Medicine in Troy will begin using & Nutrition Education Center. “This timely review Bluetooth technology to transmit their blood glucose of glucose readings will allow faster treatment (sugar) readings to their health care provider. The pilot adjustments to get patients to their diabetesprogram is funded by a Flex Fund grant from the North management goal.”

Carolina Office of Rural Health and Community Diabetes Trends Care.

Professional Research Consultants (PRC) With near-instant Community Health Needs Assessment for FirstHealth Community Health Services review of a patient’s readings, providers Diabetes Diabetes Diabetes Diabetes Age-Adjusted will be able to provide Age- Adjusted County Prevalence 2011 Prevalence 2015 Mortality 2006Mortality 2011-2013 (percent) (percent) immediate feedback 2010* that could help the Moore 17.6 16.6 14.9 12 patient avoid a trip to Montgomery 20.9 14.8 22.8 31.8 the emergency room Richmond 17.2 22.9 43.2 54.8 or even a hospital Hoke 13.7 20.5 25.4 25.4 stay. This should be North Carolina* 9.8 22.2 22.5 22.2 especially helpful for TCC providers *NC State Center for Health Statistics for whom it can be Diabetes prevalence is higher in very low and low-income individuals (living at or below 200 percent federal poverty level) and African-American population. standard practice to Fifteen percent of diabetics who responded to the 2015 PRC survey had at least one diabetessee anywhere from related hospitalization in the past year (including 7.6% with two or more) compared to 6.2% in 2007 five to 15 patients with with one hospitalization (including 4.6% with two or more). diabetes in a single day.

(800) 213-3284 • www.firsthealth.org 5

Diabetes

during pregnancy

U

nless you’ve had a personal experience with gestational diabetes, it’s likely that you’ve never even heard of it.

As the name implies, gestational diabetes is a form of diabetes that occurs during pregnancy.

Affecting between 2 and 5 percent of expectant mothers, it is one of the most common health problems of child-bearing.

As with other types of diabetes, gestational diabetes involves a “variation in the way the body handles sugar, making it more resistant to insulin so blood sugars go higher,” says Lee Lowery, M.D., of Southern Pines Women’s Health Lee Lowery, M.D. Center, a FirstHealth clinic.

Unlike other, more familiar diabetes types, it will usually go away, sometimes within a few days of the baby’s birth.

“By six weeks, you should certainly be back to normal,” Dr. Lowery says.

Because of related health risks to both mother and child, every woman will be tested for gestational diabetes at some point during her pregnancy. The timing will depend on her risk for developing the condition.

A woman at low risk will usually be tested between her 24th and 28th weeks of pregnancy. A woman at high risk—an older mom, for example, or one with a pre-pregnancy body mass index of 30 or more, a family history of diabetes or a medical history of delivering large babies—will be tested much earlier.

“We like to do it as soon as we can, between four to six weeks,” says Dr. Lowery, “usually when the pregnant woman first presents for care.”

Since gestational diabetes rarely has symptoms, testing is the only way to determine if there is a problem.

The initial test, the one every expectant woman can expect to have, involves drinking a syrupy solution during a glucose challenge test (GCT). While a test that results in a blood sugar level that is higher than normal doesn’t necessarily mean that the patient has gestational diabetes, it does indicate that she is at higher risk. Those with a higher-than-normal GCT result will have a follow-up glucose tolerance test to determine the actual presence of diabetes.

6 Fall 2015

According to Dr. Lowery, the medical response to a gestational diabetes diagnosis may be as simple as diet modification or, if the woman continues to have trouble controlling her blood sugar, oral medication and sometimes even insulin.

It will also mean a referral to the Maternal-Fetal Medicine Program at FirstHealth Moore Regional Hospital.

(See the story on page 7.)

Gestational diabetes that is The most important thing a woman should know about gestational diabetes is the need for tight sugar control Shayna Jones, M.D. throughout the pregnancy. This can help avoid some of the complications associated with gestational diabetes at the time of delivery such as largefor-gestational-age fetus, shoulder dystocia and low blood sugar after birth with the baby. It is also important to emphasize with the mother her increased risk for diabetes in the future and the need for screening.

–Shayna Jones, M.D. Pinehurst Surgical diagnosed early in the pregnancy may mean that the mother had undiagnosed diabetes even before her baby was conceived and that she will need continued followup. But most women will not remain diabetic after they have their baby.

However, Dr. Lowery points out, gestational diabetes can also be “a predictor of future Type 2 diabetes” in both mother and child.

Because the unborn baby gets glucose from its mother through the placenta, the newborn may come into the world with too much insulin in the blood or may not be producing enough glucose. If so, it will probably For more information have to spend a couple of days on the maternity services in the hospital’s Neonatal provided by FirstHealth Intensive Care unit while its of the Carolinas, body adjusts. call (800) 213-3284 “Most often, the baby will be or visit able to go home with Mom from www.firsthealth.org/ the hospital,” Dr. Lowery says, women. “but it may take a day or two.”

A referral to Maternal-Fetal Medicine Julie Johnson, M.D., sees a lot of gestational diabetes in the FirstHealth Maternal-Fetal Medicine office at FirstHealth Moore Regional Hospital.

What Dr. Johnson doesn’t see is a lot of knowledge about the condition that affects 2 to 5 percent of pregnant women. She believes it should be a concern for women who are even thinking about pregnancy.

Since much of a baby’s development occurs very early in the pregnancy—during the “critical time period” of the third to eighth weeks, and because of the risk of related birth defects and other complications, “preconception blood sugar control is hugely important in women with pre-gestational diabetes (diagnosed before pregnancy),” she says.

Dr. Johnson, who was fellowship trained in Maternal-Fetal Medicine at Brown University, focuses on high-risk pregnancies in the Maternal-Fetal Medicine Program offered in partnership between FirstHealth of the Carolinas and the University of North Carolina’s Department of Obstetrics and Gynecology. Gestational diabetes is a frequent diagnosis.

A Maternal-Fetal Medicine referral following a diagnosis of gestational diabetes will begin with a consultation about associated risks and the development of a diabetes management plan. Later services will probably include ultrasounds to assess the baby’s growth.

Excessive birth weight or macrosomia (defined as 4000 grams or 8 pounds, 13 ounces or more) is common in women with diabetes. In these cases, says Dr. Johnson, “We would want to make recommendations about the type of delivery.”

With these large babies, a planned Cesarean section would be an option in an effort to avoid newborn injury due to complications such as shoulder dystocia, which occurs when the baby’s head is born, but one of the shoulders becomes wedged in the birth canal.

Gestational diabetes can also increase the baby’s risk for jaundice, low blood sugar, breathing problems, and low calcium and magnesium levels. Risks to the mother might include high blood pressure and preeclampsia as well as miscarriage or stillbirth.

“Very poorly controlled blood sugars will also increase your risk for an early delivery,” Dr. Johnson says.

While diabetes during pregnancy should always be monitored and treated, good blood sugar control will usually allow a mother with gestational diabetes to have a safe and uneventful pregnancy and delivery.

“If you’re able to control Julie Johnson, M.D. gestational diabetes, your pregnancy risks should be pretty much the same as anyone else’s,” says Dr. Johnson.

“You can do a lot to improve your outcome, such as maintaining a healthy diet and exercising daily. It can be seen as an opportunity to change.”

Risks of gestational diabetes … … to Baby Because your baby may be larger than normal, he or she is at higher risk for some complications. Remember, these are just possible complications. Your baby might have none of them. They include: • Injuries during delivery because of the baby’s size • Low blood sugar and mineral levels at birth • Jaundice • Pre-term birth • Temporary breathing problems • Later in life, your baby might have higher risks of obesity and diabetes.

… to Mom Gestational diabetes increases the chances of certain pregnancy complications. Possible risks include: • Increased need for a C-section • Miscarriage or stillbirth • High blood pressure or preeclampsia • Pre-term birth Source: webmd.com

For more information on FirstHealth’s MaternalFetal Medicine program, call (800) 213-3284 or visit www.firsthealth.org/women.

(800) 213-3284 • www.firsthealth.org 7

It’s not actually a “cure” for diabetes, but…

T

he two bariatric surgeons in FirstHealth’s surgical weight-loss program have good news for potential weight-loss patients with diabetes.

“Weight-loss surgery is the only thing that can put Type 2 diabetes in remission,” says Raymond Washington, M.D. “This benefit of the operation can be permanent,” says David Grantham, M.D. For a dozen or more years now, research has suggested that weight-loss surgery helps patients with Type 2 diabetes. However, results of a recent study indicate that the effect may be even more significant than previously thought.

A British study tracking five-year outcomes for randomly selected obese patients with Type 2 diabetes found that half of the 38 surgical patients in the study maintained their diabetes remission compared with none of the 15 patients in a related conventional drug therapy group.

According to the British medical journal The Lancet, even the surgical patients whose diabetes did not go into full remission tended to have lower blood sugar levels than those treated with medication. An earlier study from King’s College, London, also found that obese people who had the surgery even had a lower risk of developing Type 2 diabetes.

FirstHealth offers three weight-loss surgical procedures: sleeve gastrectomy or gastric sleeve surgery, Roux-en Y divided gastric bypass surgery and adjustable gastric banding.

According to Dr. Washington, when diabetes remission occurs, it happens only with the two procedures that permanently change the stomach’s shape: gastric bypass, which shrinks the size of the stomach and reroutes part of the small intestine, and gastric sleeve, which removes the greater curvature of the stomach and then turns one part into a narrow tube that carries food.

8 Fall 2015

“These anatomical changes change the way the body produces glucose, or Raymond blood sugar, and insulin, the hormone Washington, M.D. that regulates it,” Dr. Washington says. “The surgery is a tool that starts the changes that occur. It’s really a metabolic (chemical) issue that occurs.”

Because diabetes remission or improvement in blood glucose control is less likely with gastric band, the FirstHealth surgeons David recommend either the gastric sleeve or the gastric bypass for Grantham, M.D. diabetic patients.

“With one of these procedures, we can see up to 80 percent of the diabetic patients having normal blood sugars off of their diabetic medications,” Dr. Grantham says, “sometimes even the day after their operation. Clearly, there is some

Since his weight-loss surgery, Mark Rhyne is a changed man. From seven medications a day for various ailments, including diabetes, Rhyne is now medication-free. Learn more about his experience and those of other FirstHealth weight-loss surgery patients at www.NCWeightLossSurgery.org. positive effect on the gastrointestinal tract hormones that allow this rapid improvement to take place.”

Although both surgeons hesitate to call postsurgical diabetes remission an outright “cure,” they agree that its effects can certainly be long-lasting – but only in combination with the diet and lifestyle changes that begin with FirstHealth patients even before their surgery.

“It is important to understand that, just like with many other medical problems, early intervention for obesity and diabetes is key,” says Dr. Grantham.

“For Type 2, it could be considered a cure IF the patient does what needs to be done,” Dr. Washington says.

A new life without diabetes In hindsight, Kathryn Van Tasell knows she should “I’m always looking on (food) labels for sugars, have realized that something serious was going on with carbs and proteins,” she says, “and soda is not welcome her health. in my house. I’m more aware about everything.”

The fatigue, constant thirst and frequent urination Van Tasell has also joined FirstHealth Fitness should have been obvious clues. in Pinehurst and exercises regularly there with her But it took a visit to her primary care provider to 10-year-old son, Noah, a student at Southern Pines provide an answer – out-of-control Type 2 diabetes— Elementary School. and it took weight-loss surgery to resolve the problem.

With her Dec. 6, 2014, bariatric surgery at FirstHealth Moore Regional Hospital, the 33-year-old Van Tasell became one of a growing number of fortunate people who experience an unusual effect of weight-loss surgery – almost immediate resolution of their Type 2 diabetes.

“I have never taken anything (medication) for it since my surgery,” she says.

Physicians call the change a “remission” rather than a “cure,” but, says FirstHealth bariatric surgeon Raymond Washington, M.D., “We hope it’s a lifelong effect.”

Dr. Washington offers dozens of patients from the FirstHealth weight-loss surgery program as proof.

Kathryn Van Tasell and her 10-year-old son, Noah, have joined FirstHealth “We haven’t had a patient who has gone Fitness in Pinehurst and regularly work out together since her December home on oral diabetes medications since we 2014 weight-loss surgery. Van Tasell has not only lost weight since the surgery, but has also experienced a remission in her Type 2 diabetes. started the program,” he says.

Weaning patients from insulin is more difficult and depends on how long a patient Her diabetes remission and the accompanying has been diabetic and how much insulin has been lifestyle changes have given her the energy that she prescribed. But, Dr. Washington says, insulin reduction lacked before to support her son in his school and has also occurred in many weight-loss surgery cases. extracurricular activities.

After her sleeve gastrectomy, Van Tasell went from “He enjoys sports,” she says, “and I am now more the out-of-control blood glucose readings that were able to get involved in those things. I feel better, so I’m making her feel so bad to her current readings that have more able to participate.” been at or below the “normal” 100 range since she left the hospital.

“It’s been like night and day,” she says.

While surgery provides immediate remission, For more information on services provided by FirstHealth compliance with the lifelong lifestyle changes of the Fitness programs in Moore, Montgomery, Richmond and FirstHealth surgical weight-loss program is necessary to Hoke counties, visit www.firsthealth.org/fitness. maintain the remission status. Van Tasell is a dedicated convert to required changes in diet and exercise.

(800) 213-3284 • www.firsthealth.org 9

: Diabetes, but not quite

W

hat is it? And what can you do about it?

Before people develop Type 2 diabetes, says the American Diabetes Association (ADA), they almost always have

prediabetes.

That means a person’s blood glucose (sugar) levels are higher than normal but not quite high enough for a diabetes diagnosis.

In some communities, including many of those served by FirstHealth of the Carolinas, the number of people with prediabetes is especially high.

“Probably half of everybody who walks in the door here is at risk for prediabetes,” says Betty Bruton Bradley, M.D., of FirstHealth Family MedicineCandor.

Betty Bruton Because diabetes is so prevalent in Bradley, M.D. the community she serves, Dr. Bradley estimates that as many as 85 percent of the prediabetes cases she sees will turn into full-blown Type 2 diabetes within 10 years.

The exact cause of Type 1 diabetes, once known as “juvenile onset diabetes,” is unknown, but Type 2 diabetes seems to have a strong relationship to genetic and environmental factors such as excess weight and physical inactivity.

Candor is in Montgomery County, where—according to the Community Health Assessment conducted earlier this year for FirstHealth Community Health—the prevalence rate for prediabetes is 7 percent. That’s down from the 9.7 percent prevalence rate noted in a 2011 survey.

While the new figure could indicate an improvement, it’s not likely, according to FirstHealth diabetes educators.

What is more likely is that the same, or even greater numbers of people have prediabetes and just don’t know it.

“The numbers have only improved, we suspect, because of lack of access to care, meaning people aren’t seeing a primary care provider to be diagnosed,” says Melissa Herman, R.D., CDE, of FirstHealth Diabetes & Nutrition Education.

In her practice, Dr. Bradley notes the problem more often in women than in men, information confirmed in the 2011 survey, which indicated that one of the populations most at risk for diabetes in the FirstHealth service area was women age 40 to 64.

She is especially dismayed by the number of at-risk children she sees.

“Starting at age 8, we see children with prediabetes,” she says. “We sometimes see children with diabetes if they are very overweight.”

According to the ADA, there are no clear symptoms of prediabetes, so someone who has it may not know it.

On the positive side, however, having prediabetes doesn’t necessarily mean that the patient will actually develop diabetes.

Early treatment—generally meaning lifestyle changes that include reducing one’s weight and increasing one’s physical activity, Dr. Bradley says—can return blood sugar levels to a normal range.

But, she warns, “That is not an absolute.”

Research would seem to support Dr. Bradley’s observation by indicating that people can lower their risk for Type 2 diabetes as much as 58 percent by: • Losing 7 percent of their body weight • Exercising moderately, even by taking a brisk walk, 30 minutes a day, five days a week (www.diabetes.org) Even a moderate weight loss can make a difference.

Dr. Bradley suggests starting by decreasing the amount of sugar in the diet, becoming familiar with the pluses and minuses of basic food groups, and avoiding fast food.

Hemoglobin A1c <5.0

5.0

5.1

5.2

Healthy A1c Levels 10 Fall 2015

5.3

5.4

5.5

5.6

Trending Toward Prediabetes

5.7

5.8

Prediabetes in “the sweet tea area” Living in the “sweet tea area” has special challenges, especially when you’re a family medicine physician about to tell yet another patient that he (or she) has prediabetes.

It’s a situation that Marcus Lowry, M.D., faces on average several times a week with patients at FirstHealth Family Medicine in Raeford.

Their conversation will always include this piece of advice: “You have to cut down on your simple sugars.”

While unquestionably tasty and undeniably refreshing, sweet tea is a known accomplice in the area’s large number of prediabetes cases. Sweet sodas (even diet sodas, to a degree), breads, potatoes, pastas and rice also number among the culprits—especially when served up in the super-sized convenience of fast food and buffet restaurants.

For patients with a Native American or Hispanic background, the chance of a prediabetes diagnosis is even more likely. It would take an expert in anthropology to explain the contributing rural-tourban lifestyle and environmental factors behind the phenomenon, Dr. Lowry says, but it’s the case nonetheless.

Given the combination of common diet and genes in the local patient population, “You have to be a little more aggressive,” he adds.

After an explanation of just what the condition is, any discussion of prediabetes and how to deal with it will invariably focus on the patient’s weight and how to get it under control.

Because many patients resist even simple change, it’s up to Dr. Lowry—and his primary care colleagues— to convince them of the risks involved. Without change, prediabetes often turns into diabetes, a serious disease with the potential for vision loss, chronic wounds, amputation, renal failure and death.

“You need to change,” Dr. Lowry will tell his patients, “and it’s important to start making these changes now.”

5.9

6.0

6.1

Prediabetic State

6.2

6.3

Calorie reduction is the first matter of business. Increasing water intake, adding vegetables and fruits to meals, and reducing stressors that encourage binge eating are relatively easy ways to start.

Marcus Lowry, M.D. Physical activity is also FirstHealth important, but always in Family Medicine conjunction with the reduced calorie intake.

“It won’t make a lot of difference if you’re still taking in lots of calories,” Dr. Lowry says.

The goal of diabetes education is to help people with diabetes practice problem-solving, coping and riskreduction behaviors every day. This can be difficult, but it does work by helping lower blood sugar (glucose), blood pressure and cholesterol.

Most people with diabetes know self-management is important, but it can be overwhelming for many.

FirstHealth Diabetes & Nutrition Education can help by designing an easy-to-follow diabetes education and management plan that is specific to individual needs.

As a member of the patient’s health care team, the diabetes educator works with patients to develop the tools and ongoing support to make that plan a regular part of the patient’s life while also helping him/her stay healthy.

FirstHealth of the Carolinas offers primary care in Moore, Montgomery, Richmond and Hoke counties.

For more information, call (800) 213-3284 or visit www.firsthealth.org/primarycare. For information on diabetes education and management in Moore, Montgomery, Richmond and Hoke counties, call (800) 364-0499.

6.4

6.5

6.6

<6.7

Diabetic State (800) 213-3284 • www.firsthealth.org 11

When exercise IS medicine “I have just had a call from my doctor after last Friday’s physical. My weight is down, I have been declared free of prediabetes and, for the first time in 10 years, my cholesterol numbers are as they should be. My blood pressure is 107/71, and I’m coming off the medication. Whoo hoo.”

—Robert, age 60 This kind of comment from a happy—and newly healthy—Exercise is Medicine (EIM) participant has become more and more routine for the program that allows exercise to become a regular component of the individual’s personal health care plan.

Diabetes and prediabetes are among the most common diagnoses for participants in the free physician-referred program offered by FirstHealth Fitness. By mid-August of this year, referrals had surpassed 3,500 from primary care providers and medical specialists throughout the health care spectrum.

The purpose of EIM is to partner with physicians who can help patients understand and act on using regular exercise as a method of treatment for improving and maintaining their health. Patients are eligible to participate if they:

• Do not participate in at least 150 minutes of physical activity per week • Are at risk for chronic disease • Are dealing with a chronic condition such as diabetes, high blood pressure or obesity • Need assistance starting and incorporating an exercise plan into their lifestyle All participants in the six- to 12-week program get an assessment, coaching on short- and long-term goals, an individualized “exercise prescription,” a two-week complementary membership to any FirstHealth Fitness center, an equipment orientation, and a pre- and post-progress report sent to their referring physician.

The Technogym Wellness System at the heart of the EIM program was acquired through a Foundation of FirstHealth grant disbursement.

Those interested in the EIM program should ask their physician for a referral. For more information, visit www.firsthealth.org/eim or call (910) 715-1808.

Eating this can HELP you FIGHT OBESITY &

DIABETES www.firsthealth.org/diabetes (800) 364-0499 12 Fall 2015

735-106-15

Remember, small changes can add up to make a big overall difference to your diet.

INSTEAD OF: yogurt with fruit on the bottom

TRY

plain Greek yogurt with fresh fruit

bagel with cream cheese

TRY

whole-wheat English muffin with a tablespoon of peanut butter

egg sandwiches

TRY

scrambled eggs or egg whites with veggies

mayo

TRY

mustard or fresh avocado

white bread

TRY

whole-wheat bread or lettuce wraps

pasta

TRY

spaghetti squash or fresh zucchini noodles

mashed potatoes

TRY

mashed cauliflower

potato chips

TRY

fresh veggies like edamame

granola bar

TRY

(handful) unsalted almonds

butter

TRY

olive oil

Food swaps = healthy choices Choosing healthy foods is easier than you think. By changing just a few eating habits, you can make a big difference to your diet. Making small dietary changes is the healthiest and most achievable way to lose weight. Your first step is to eat fewer foods high in calories, fat, salt and sugars and swap them for something healthier, including more fruits and vegetables.

â&#x17E;Ľ

If you want to reduce your intake of added sugar, the first place to turn is your beverage. Consuming too much sugar can be a major contributor to obesity, heart disease and type 2 diabetes. Try limiting or eliminating sugary drinks from your diet.

INSTEAD OF: juice

TRY

whole, fresh fruit

coffee with sugar

TRY

coffee with sprinkled cinnamon

coffee with half and half

TRY

skim milk

soda (regular or diet)

TRY

sparkling water with fresh fruit

sweetened tea

TRY

unsweetened tea with lemon

lemonade

TRY

water with fresh lemon

For nutrition information, call (800) 364-0499 or visit www.firsthealth.org/diabetes.

Source: FirstHealth Diabetes & Nutrition Education

(800) 213-3284 â&#x20AC;˘ www.firsthealth.org 13

Diabetes and wound care

A

broken ankle gave Jeffrey R. Gibbons, M.D., a personal insight into why it can be so hard for his diabetic patients at FirstHealth Wound Care & Hyperbarics to follow doctor’s orders.

After he broke his ankle, Dr. Gibbons was told to use his crutches and put no weight— none at all—on his foot. It’s the very same “noweight” instruction he gives to patients with diabetic wounds on their feet.

Also like his patients, he found it very hard to follow through.

“When we tell a patient, ‘no pressure,’ that means no pressure,” Dr. Gibbons says. “It’s a big commitment on the part of the patient.”

As assistant medical director of FirstHealth Wound Care & Hyperbarics, Dr. Gibbons sees lots of patients—about three-quarters of his caseload—with diabetic wounds.

“By far, the biggest part of our patient population is the diabetic population,” he says, “at least as a secondary diagnosis.”

It’s a national situation. According to the National Institutes of Health, 15 percent of people with diabetes have diabetic foot ulcers.

Many factors, or a combination of them, contribute to non-healing diabetic wounds. Having consistently high blood glucose levels keeps the immune system from functioning properly, and reduced blood flow and damaged nerves put patients with uncontrolled diabetes at risk for non-healing wounds.

The risk is even higher for diabetic patients with other chronic diseases—those with atherosclerosis, high cholesterol or obesity, for example. Poor diet, smoking and inactivity complicate the problem even more.

“But even a well-controlled diabetic can experience these symptoms,” Dr. Gibbons says.

A chronic, non-healing wound will often begin with something as simple as a small wound or a callus.

Because of the patient’s poor circulation, matters quickly go downhill.

“The diabetic patient may not be aware of (the problem), because he can’t feel the pain,” says Dr. Gibbons. “Everything seems to add up. All of a sudden, there’s a bad infection and the patient is very, very sick.”

14 Fall 2015

Treatment will focus on “trying to accommodate for the underlying problems,” Dr. Gibbons says, as well as making sure the patient’s diabetes is under control and treating the infection itself. Quick response is especially

Jeffrey R. Gibbons, M.D., assistant medical director of FirstHealth Wound Care & Hyperbarics, is shown by the state-of-the-art hyperbaric chamber at FirstHealth Moore Regional Hospital-Hoke Campus.

important since a diabetic can quickly become high risk for amputation.

Treatment may include: • Dressings using wound care products chosen specifically for the patient’s needs • Cutting away diseased tissue (wound debridement) • Hyperbaric oxygen therapy (HBOT)—depending on the patient, typically 90 minutes “at depth” five days a week for 30 treatments. The patient breathes 100 percent oxygen at increased atmospheric pressure that is roughly equivalent to what a scuba diver would experience at around 66 feet below the water’s surface.

According to Dr. Gibbons, HBOT is especially helpful in the treatment of diabetic wounds because it encourages small blood vessel growth in the damaged tissue, helps some antibiotics work more efficiently, and can help reduce or eliminate infection.

In addition to these services, a referral to

FirstHealth Wound Care & Hyperbarics will often involve other specialties such as radiology, nephrology, vascular surgery, dermatology and orthotics.

“Wound care is not an isolated area in itself,” Dr. Gibbons says. “We’re more like a hub in a wheel.”

Some common wound care terms Hyperbaric Oxygen Therapy (HBOT): Intermittent (stopping and beginning again) administration of oxygen at a concentration greater than 20 percent delivered under pressure Infection: The presence of bacteria or other microorganisms in sufficient quantity to damage tissue or impair healing.

Necrosis: The death of tissue Neuropathy: Abnormal degenerative or inflammatory state of the peripheral nervous system. Symptoms include numbness, tingling or pain in the arms or feet.

Pressure Ulcer: Localized injury to the skin and/or underlying tissue, usually over a bony prominence, as a result of pressure, or pressure in combination with shear and/or friction

Wound care locations FirstHealth of the Carolinas offers highly specialized care at Wound Care & Hyperbarics locations at FirstHealth Moore Regional Hospital in Pinehurst, Richmond Memorial Hospital in Rockingham and Moore Regional Hospital-Hoke Campus in Raeford. All facilities are designed to monitor, manage and treat chronic non-healing wounds. The Richmond campus has been designated a Wound Care Center of Excellence by Healogics Inc. For more information, visit www. firsthealth.org/wound.

A wound care success Diane Hursey’s chronic wound experience began with a small nick in the big toe of her right foot. Within a month, after becoming ill during an afternoon movie and shopping trip, she was in the Emergency Department at FirstHealth Montgomery Memorial Hospital with what she thought was a garden variety virus.

Instead of a virus, Hursey’s discomfort and fever were found to be caused by an infection in her toe that had made its way to the bone. She had known the wound was there, but—because of numbness caused by diabetic neuropathy—she didn’t know how bad it was.

The American Diabetes Association defines diabetic neuropathy as nerve damage caused by diabetes. About half of all people with diabetes have some form of nerve damage, which is more common in those who have had the disease for a number of years.

After a week of monitoring in Montgomery Memorial, Hursey was in FirstHealth Moore Regional Hospital to have the toe amputated. The next step in her medical care was a referral to FirstHealth Wound Care & Hyperbarics.

On the first day of her wound care treatment, Hursey admits, she was “a little anxious” and a “little claustrophobic” about spending any time in the pureoxygen environment of the hyperbaric oxygen therapy (HBOT) cylinder. But she quickly got over it.

“They’re watching you every minute,” she says.

“There are two nurses, and they are checking on you all the time.”

Hursey watched movies or TV and eventually got comfortable enough for “a good nap.” Soon, both she and Jeffrey Gibbons, M.D., the wound program’s assistant medical director, were seeing improvement in her wound.

“On the third week, I could tell a difference,” Hursey says. “It just healed perfectly.”

After 60 days of treatment—90 minutes of HBOT five days a week over 12 weeks, Hursey was fully healed and fully satisfied by the services provided by the wound care staff.

“Breathing in all that good air, I never had a problem with it,” she says. “It got after a while where it was just a way of life. (The staff) almost got like family, especially Dr. Gibbons. They were just really, really kind.”

(800) 213-3284 • www.firsthealth.org 15

N E W P ROV I DE R S Anesthesiology

Emergency Medicine

Gastroenterology

John Berry VII, M.D., Pinehurst Anesthesia Associates, MRH-Hoke Campus, Moore Regional Hospital

Aemonn T. Barnes, FNP, Sandhills Emergency Physicians, MRH-Hoke Campus, Moore Regional Hospital, Richmond Memorial Hospital

Joseph Perry, M.D., Pinehurst Medical Clinic, Moore Regional

Cardiac & Thoracic Surgery

Emergency Medicine

Hematology/Oncology

Gary W. McCall, PAC, FirstHealth Cardiovascular & Thoracic, Moore Regional Hospital

Darrell G. Simpkins, M.D., Sandhills Emergency Physicians, MRH-Hoke Campus, Montgomery Memorial Hospital, Moore Regional Hospital, Richmond Memorial Hospital

Michael S. Batalo, M.D., Pinehurst Medical Clinic, Moore Regional Hospital

Cardiology-Electrophysiology

Family Medicine

Hospitalist Medicine

Brandon M. Williams, M.D., Pinehurst Medical Clinic, Moore Regional Hospital

David Emmons, FNP, FirstHealth Family Medicine-Rockingham

Gary E. Bush, M.D., FirstHealth Hospitalists, MRH-Hoke Campus, Moore Regional Hospital, Richmond Memorial Hospital

16 Fall 2015

Hospitalist Medicine

Hospitalist Medicine

Pulmonology

Egya N. Chinbuah, M.D., FirstHealth Hospitalists, MRH-Hoke Campus, Montgomery Memorial Hospital, Moore Regional Hospital, Richmond Memorial Hospital

Huan Yi Tsai, M.D., FirstHealth Hospitalists, MRH-Hoke Campus, Montgomery Memorial Hospital, Moore Regional Hospital, Richmond Memorial Hospital

Scott J. Johnson, M.D., Pinehurst Medical Clinic, Moore Regional Hospital

Hospitalist Medicine

Hospitalist Medicine

Wound Care & Hyperbarics

Rajasekhar Katuru, M.D., FirstHealth Hospitalists, MRH-Hoke Campus, Montgomery Memorial Hospital, Moore Regional Hospital, Richmond Memorial Hospital

Seth Weaver, M.D., FirstHealth Hospitalists, Moore Regional, Richmond Memorial, MRH-Hoke Campus

Sharon Lynne Saunders, FNP, FirstHealth Wound Care & Hyperbarics, MRHHoke Campus, Montgomery Memorial Hospital, Moore Regional Hospital, Richmond Memorial Hospital

Hospitalist Medicine

Ophthalmology

Do you need help in finding a primary care provider or medical specialist? If so, visit www.firsthealth.org/directory.

Gene L. McLaughlin Jr., PAC, FirstHealth Hospitalists, MRH-Hoke Campus, Montgomery Memorial Hospital, Moore Regional Hospital, Richmond Memorial Hospital

Zeina Haddad, M.D., Carolina Eye Associates, Moore Regional

(800) 213-3284 â&#x20AC;˘ www.firsthealth.org 17

“Outstanding Care” I would like to thank Dr. T.J. Pulliam and his staff at the FirstHealth Digestive Center in Rockingham for the outstanding care I have received. I have had several visits to the office and have had to place numerous phone calls between visits.

Lisa Snead (patient services representative) and Edna Liles (certified medical assistant) have far surpassed my expectations.

Phone calls are returned promptly, and test results are reported promptly. Dr. Pulliam always has time to discuss my issues in-depth and never rushes through appointments.

Kudos are also extended to the Outpatient Department at FirstHealth Richmond Memorial Hospital. I was extremely pleased with the knowledge, efficiency and professionalism of the staff.

I have had many colonoscopies performed over the years Edna Liles, CMA; T.J. Pulliam, M.D., and patient services representative at larger institutions, but the care that I received at Richmond Lisa Snead provide “outstanding care” at FirstHealth Digestive Center Memorial was equal to if not superior to what I have experienced in Rockingham, according to patient Beth Morgan. elsewhere.

Beth Morgan Aberdeen

“Wonderful people helping patients” Thank you so very much for having wonderful, competent people helping patients and family members feel comfortable and confident of receiving excellent care while being at a FirstHealth facility.

My husband and I took my 93-year-old mother to Moore Regional Hospital-Hoke Campus. She was taken care of immediately—diagnosed with treatment beginning before a room was available. It was determined that she should go to Moore Regional Hospital in Moore County. Again, she began receiving expert care quickly.

There were so many wonderful people who helped. I wish that I could name all of them. However, I do wish to name a few: Dr. Brian Trezak (hospitalist) spent valuable time answering my questions even though I know that he was very busy. He sat down and made me feel he had as much time as I needed. What a great feeling! Dr. Steven Filby, too, was more than I could hope to have as a doctor. He has agreed to accept Mother as his patient.

18 Winter 2015

Then there were all of the nurses and nursing assistants—Kyle Wallace, R.N.; Shannon Orwin, R.N.; Stephanie Burks, R.N.; Patty Grooms, NA II; Laura Poole, R.N.; Tamera Hill, R.N.; Joy Tupac, R.N.; Joyce Pemberton, NAII; Tamera Thompson, NA II; and Sheila Winston, NA II—as well as those who came by even though they were not assigned to Mother. The lady who cleaned the room, the transporters— there just didn’t seem to be anyone who didn’t care about Mother.

We are so very blessed to have exceptional people giving exceptional care so close to home. Thank you for providing these services.

Carolyn Lemonds Fayetteville

Extremely pleased with wonderful care I was recently a patient at Moore Regional Hospital.

During my stay, after I was admitted, various tests were performed on me and several specialists were called in, as it was not clear what was causing my problem. Following my discharge to my home, I received additional care for a short time with a visiting nurse, a physical therapist and an occupational therapist.

The reason I’m writing this letter is to let you know how extremely pleased I was with the wonderful care I received from all hospital personnel during my stay. Every single person was courteous and caring—the doctors and nurses, nurse assistants, the ER staff and everyone in between, including the personnel who administered my various tests (three MRIs, CT scan, etc.) I would be remiss in not also mentioning the kitchen staff who monitored my food requests as well as the courteous cleaning ladies. Every single member of the hospital staff treated me with the utmost care and respect.

It would be impossible to remember the names of everyone I would like to commend during my stay, but the names I do recall are Nancy Chriscoe, NAII; Nina Chiaruttini, R.N.; Michelle Elder, R.N.; Kim Cockman, R.N.; Dominique Dabady, NAII; Linda Oldroyd, R.N.; Deborah McDonald, NAII; April Eilert, R.N.; Brandon Tabor, R.N.; Karen Puszynski, R.N.; and Elda Mireles, NAII. Helene G. Bucci Pinehurst

Pleased to praise I want to commend and praise Cynthia Farmer, a receptionist in the Mammography Department at FirstHealth Moore Regional Hospital. She was beyond courteous, friendly, went the extra mile and very willing to be helpful— all with a beautiful smile.

How lucky and blessed you are to have her as a member of your staff. Please give her my kindest regards and thanks for making my day a lot brighter.

Will always recommend FirstHealth During January and February, my wife and I both had the need to be hospitalized at FirstHealth Moore Regional Hospital: she for orthopaedic surgery and me for lung and associated heart problems.

Due to a heavy census, I was placed in the oncology wing where my care was more than anyone could have hoped for. I don’t know all the names of those who cared for me, but I do wish to name both Shannon O’Neal, R.N., and Denice Gibson, R.N., as extraordinary nurses. The care they administered was given with compassion and knowledge.

The whole staff worked together for my good.

The same was true on 2C, where Heather Scherotter, R.N., and Stephen Mwaura, R.N., went beyond the expected to see to my wife’s comfort and did so with the utmost of caring. Dr. David Casey and that staff are the best.

In short, I will never hesitate to recommend FirstHealth to anyone in need of hospitalization.

Robert Howington Sanford

Premier patient care I offer my sincerest appreciation to the doctors, nurses and staff from my recent stay at FirstHealth Moore Regional Hospital. Beginning with Dr. Farrell Collins and including Dr. Todd Brown, Dr. Skikar Reddy Sudini and Dr. Joseph Hakas, I received caring and professional attention and will recommend FirstHealth and these doctors and staff to anyone seeking or needing medical care in our area.

It is comforting to know that premier patient care is the focus of FirstHealth of the Carolinas.

James Walker Pinehurst

Kathie Drake Pinehurst

(800) 213-3284 • www.firsthealth.org

19

“Difference in our lives” I am writing to thank your staff for the wonderful care my husband received while he was a patient at FirstHealth Moore Regional Hospital. I’m certain that you must receive numerous letters applauding your employees, but I just wanted to take the time to reinforce what you already know.

My husband is retired from the military and, on May 20, 2014, he was informed that he had a cancerous mass on his right kidney. This came as a terrible shock to both of us, as he is the epitome of good health and is only 54 years old. Our first order of business was to ensure that he received the best possible medical care to resolve his situation, and we found just that at your hospital.

David’s doctor, Dr. Greg Griewe, was remarkable—competent, caring, straightforward and both personally and professionally confident. Throughout David’s stay at Moore Regional Hospital, he was surrounded by other health care professionals who were just as accomplished. The nursing and support staff who cared for David in the Cancer Center were wonderful. Nothing was ever a problem, and any little need David may have had was addressed with a cheerful and capable response. The professionals who readied David for his surgery were reassuring and welcoming. The volunteer in the family surgical waiting room was a joy and blessing. And everyone else—the folks in the cafeteria, the housekeeping staff, the people who delivered the meals, the wonderful pastor who paid us a call—everyone was kind and helpful and encouraging.

Never in our wildest dreams did we ever think we’d find ourselves in a hospital setting this year, especially facing a medical reality that struck fear and complicated stress into our lives and hearts. The last thing we needed to worry about was “Is David going to get good care … is he going to make it?” I can appreciatively report that the care was wonderful, and I can say in gratitude that “Yes, he made it.”

Please share our thanks with everyone who made a wonderful, positive, appreciated difference in our lives. The truth be known, my husband and I have a future now, whereas it would have been a much different story without the wonderful health care that he received. We are grateful and will always be so, and we tell our story to everyone with the hope that if the need ever arises in their family, they will find their way to FirstHealth Moore Regional Hospital.

Kind, supportive staff I am sure you receive a lot of letters when people are not satisfied with their level of care; however, today I am writing because I would like to express my gratitude for the wonderful care I received at Moore Regional Hospital.

I had a total knee replacement performed at the hospital. Although my doctors tried to warn me about the level of difficulty and pain I would experience after surgery, no amount of words could have truly prepared me for that day or its immediate aftermath. Yet the care I received by all the nurses and support staff during my four-day stay was exceptional.

I couldn’t have asked for a kinder or more supportive staff. From the moment I walked in to the moment I walked out of the hospital, everyone worked to make my stay as comfortable as possible. They were patient, informative, supportive and responsive to my needs, concerns and fears.

I hope you will share this letter and my gratitude with the surgical staff, the physical therapy staff, and especially the nursing and support staff who work on 2C. Each and every one of them is a great caregiver, and I can’t say thank you enough.

Jane H. Layton Rockingham, N.C.

Lori R. Dauria Fayetteville, N.C.

Always pleased with care I had a total shoulder replacement performed by Dr. Mark Brenner. I express my sincere thanks for the services provided by the scheduling personnel, pre-operation, surgical preparation, anesthesiologists and Dr. Brenner.

Following the operation, the care in recovery and the hospital room were also excellent.

My wife and I have utilized your facility on several occasions and have always been pleased with the attention and care.

Robert F. Wetherbie Aberdeen, N.C.

20 Fall 2015

678-82-15

Hyperbaric Oxygen Therapy & Wound Healing at FirstHealth of the Carolinas FirstHealth Wound Care & Hyperbarics offers the latest treatment and technology for hard-to-heal wounds in a convenient outpatient setting. Treatment options include hyperbaric oxygen therapy (HBOT), which uses pure oxygen under high pressure to enhance the bodyâ&#x20AC;&#x2122;s natural ability to heal. It is particularly helpful in

healing diabetic foot wounds and wounds from radiation treatments.

Ask your doctor if HBOT or other specialized care is right for you. For more information, please call (910) 715-5901 in Pinehurst, (910) 878-6750 in Raeford or (910) 417-3636 in Rockingham.

www.firsthealth.org/wound

NON-PROFIT U.S. POSTAGE PAID PERMIT NO. 4 LONG PRAIRIE, MN

155 Memorial Drive P.O. Box 3000 Pinehurst, NC 28374

Because we use a variety of sources for mailing, duplications sometimes occur.

Please pass an extra copy along to a friend or neighbor.

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