Gastro Care | Vol 1

“High quality, cost-effective care” at Tri-State Gastro.

G A S T RO Inside:

ver s, i l e D r e v i • Your L Harm m o r F it t c Prote ening for e r c S n o • Q&A cer Colon Can s • Cirrhosi

2015 VOLUME 1

IT IS OUR MISSION:

“To provide compassionate, high quality, cost-effective care to patients with gastrointestinal related problems.”

We are a multi-physician practice located in Northern Kentucky, specializing in Gastroenterology.

PROCEDURES PERFORMED Colonoscopy ERCP: Endoscopic Retrograde Cholangiopancreatogram

EGD: Esophagogastro- duodenoscopy

EUS: Endoscopic Ultrasonography

Bravo Probe Capsule Endoscopy Infusion Services Liver Biopsy Hemorrhoid Banding Flexible Sigmoidoscopy Esophageal Manometry

425 Centre View Blvd Crestview Hills, KY 41017 Daily Office Hours: Monday –Friday | 8 AM – 5 PM

P: (859) 341-3575 F: (859) 341-5701 TF: (800) 448-3575

www.tristategastro.com

425 Centre View Blvd Crestview Hills, KY 41017 P: (859) 341-3575 F: (859) 341-5701 TF: (800) 448-3575

www.tristategastro.com

INSIDE THIS ISSUE

4–

Your Liver Delivers, Protect It From Harm.

5–

Small Steps to Diabetes Prevention.

6–

So You Think You Have Too Much Gas?

8–

Q&A on Screening For Colon Cancer.

9–

Our Doctors and Mid-Level Providers.

12 –

Your Digestive System & How it Works.

14 –

Feel Better, Look Better, Have More Energy.

16 –

Cirrhosis

18 –

What is Chrons Disease?

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Publishing

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One of the indisputable truths about the current delivery of healthcare services is the “free-fall” change being experienced. Advanced technology, insurance plan designs, electronic records and communication, and provider networks are among evolving and transforming changes. However, Tri-State Gastroenterology Associates (Tri-State) is bucking the trend in at least one arena where our focus remains constant— you, our patient!

Accredited by the American Association of Ambulatory Health Centers (AAAHC), our mission at Tri-State is, “To provide compassionate, high quality, cost-effective care to patients with gastrointestinal related problems” A staff of providers, which includes eight Board Certified physicians and five mid-level providers (nurse practitioners and physician assistants), partners with a team of nurses, medical assistants, technicians, certified registered nurse anesthetists, administrative leaders, and community providers to offer premium services to you and those family members, friends, and others involved in supporting you.

There are four underpinning pillars of healthcare that form the fundamental basis of Tri-State’s care system: access, quality, cost-efficiency, and continuity.

Access to Tri-State is typically achieved through office appointments at our state–of–the–art facility. Our convenient “Open-Access” program eases the scheduling for a screening colonoscopy by allowing direct referrals (i.e., by-passing the need for an office visit) for procedures when patients do not exhibit current symptoms or health risks. Referrals from other physicians and follow-up appointments after a visit to the hospital are additional entry points into the Tri-State care system. Last year we served over 6,700 patients and performed over 8,300 procedures!

Quality is achieved through years of highly-refined processes and practices delivered by experienced providers using modern technology and equipment.

All direct care providers (physicians, mid-level providers, and registered nurses) maintain current Advanced Cardiac Life Support (ACLS) certification as an additional patient-safety measure. Tri-State boasts an enviable positive patient-satisfaction rate as measured by ongoing surveys; and Tri-State’s doctors are recognized by peers among the region’s “Top Doctors.”

Cost effective care and services are rendered through careful clinical assessment of processes and products used. Our internal committee structure assesses cost-reduction opportunities without compromising quality. Committees are designed to regularly evaluate best practices around the country by refining the processes; and assessing emerging state of the art equipment and supplies through our physician-led quality improvement and product-standardization committees.

Continuity is ensured by coordinating your care both internally within our office and with other providers who may be needed for referral or support such as nutritionists, surgeons, other specialists, and sub-specialists.

Superior Pathology and Anesthesia services are engaged to ensure optimal overall care and service delivery. Because Tri-State is independent of control by a parent system, the ability to refer patients for the best provider match is a strength of the practice.

Aristotle wrote, “We are what we repeatedly do. Excellence, then, is not an act, but a habit.” At Tri-State, we strive to make a habit of performing even the ordinary things “extraordinarily well!” Thank you for considering the digestive disorder services offered by our staff.

Proudly,

Jack Rudnick, Jr.

John D. (Jack) Rudnick, Jr., Ed.D., FACHE Chief Operating Officer

WELCOME TO TRI-STATE GASTROENTEROLOGY

In 1859 Charles Dickens asserted that, “It was the best of times, it was the worst of times.”

Many say this about the healthcare delivery services they seek today!

TriStateGastro.com

Welcome to Tri-State!

YOUR LIVER PROTECT IT FROM HARM

Your liver works hard to protect your health. It’s a rugged, strong organ. But certain things—like alcohol, drugs, viruses, and excess weight—can damage it. You may not even realize when your liver is struggling, because liver disease usually has no symptoms until the problem becomes severe. Help your liver to guard your health by avoiding the things that might cause it harm.

The liver is the largest organ inside your body. It’s about the size of a football, and rests just under your ribs against the right side of your stomach.

“The liver performs an amazing set of functions that keep you healthy,” says Dr. Jake Liang, a liver specialist and researcher at NIH.

Your liver helps fight infections. It cleans your blood by getting rid of your body’s natural waste products and other harmful substances, including alcohol and drugs. “The liver also transforms the foods you eat into energy and nutrients your body can use, and it regulates how nutrients flow to different parts of the body when needed,” Liang says.

Your liver can keep working even if part of it is damaged or removed. But if it starts to shut down completely—a condition known as liver failure—you can survive for only a day or 2 unless you get emergency treatment.

“Although liver disease often has no symptoms, warning signs can include a swollen abdomen, nausea, itching, or jaundice”

Many things can affect liver function. Some liver problems are inherited from your parents, some are caused by viruses (certain kinds of hepatitis), and some are related to your behavior. Certain liver diseases go away on their own. Others can last a lifetime and cause serious illness.

Although liver disease often has no symptoms, warning signs can include a swollen abdomen, nausea, itching, or jaundice (having a yellow tint to the skin and the whites of the eyes).

4

An increasingly common type of liver disorder known as fatty liver disease, affects both children and adults. A healthy liver contains just a little fat or none at all. But too much fat buildup in liver cells can cause swelling and damage. Over time, the excess fat can lead to cirrhosis, liver cancer, and even liver failure.

TRI-STATE GASTRO

“Estimates vary, but 2 different studies in the past decade suggest that about 30% to 45% of Americans have excess fat in the liver,” says Dr. Yaron Rotman, an NIH specialist in fatty liver disease. “It’s also becoming a huge problem for children and teens.”

Drinking too much alcohol can cause fatty liver. But a growing number of people who drink little or no alcohol are also being diagnosed with fatty liver. “The rise seems to be tied to the nation’s obesity epidemic,” says Doo.

“To treat fatty liver disease, we recommend lifestyle changes: Weight loss for people who are overweight, and exercise and a healthy diet to help reduce fat” Studies suggest that fatty liver disease now also affects about 1 in 10 children nationwide. As with adults, most children with fatty liver disease are overweight and resistant to insulin, a critical hormone that regulates energy.

In its early stages, fatty liver disease usually has no symptoms.

It’s often first detected by blood tests for liver function. But these tests can’t tell the difference between mild fatty buildup and more serious damage. And some people with fatty liver disease can have normal blood tests. The only sure way to diagnose the severity of fatty liver disease is by getting a liver biopsy. For this test, a doctor inserts a thin needle through the skin and into the liver to remove a small piece of tissue for analysis.

There are currently no approved medications for fatty liver or its more severe form called NASH, or non-alcoholic steato-hepatitis.

“To treat fatty liver disease, we recommend lifestyle changes: Weight loss for people who are overweight, and exercise and a healthy diet to help reduce fat,” Rotman says. “In many patients, just a 5-8% reduction in body weight will translate into a large improvement to liver damage.” For people with alcohol-related fatty liver, stopping alcohol use can reverse or prevent further liver injury.

Another common type of liver disease—known as viral hepatitis—can be caused by at least 5 different viruses, named hepatitis A, B, C, D, and E. These infections can injure your liver and keep it from working properly.

“Collectively, about 20% of people worldwide may be affected by a hepatitis virus infection,” Liang says. “It’s a

VOLUME 1 - 2015

major public health problem.” The most common types in the United States are hepatitis A, B, and C.

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Each hepatitis virus causes a different form of liver disease. All the viruses can trigger acute, or short-term, hepatitis. Hepatitis B, C, and D can also cause chronic hepatitis, in which the infection lasts a long time, sometimes for your whole life.

Maintain a healthy weight, stay physically active, and limit your alcohol use. Keep your liver healthy, and it will protect you for a lifetime.

WHEN THE STATUS QUO IS NO LONGER AN OPTION, IT’S TIME TO TALK TO LIFELINC.

People are often exposed to hepatitis A and E viruses through contaminated food or water. “The other hepatitis viruses often pass through some type of break in the skin barrier, sometimes by injections or by close contact with blood or other body fluids,” Liang adds. Hepatitis B, C, and D can spread through sexual contact.

Article source: National Institute of Health

Because many infected people have few symptoms, they may not realize they have viral hepatitis. They can spread the infection to others without even knowing it.

Viral hepatitis is often treated with antiviral medications. Hepatitis A, B, and D infections can be prevented by vaccines. Practicing good hygiene—such as washing your hands and avoiding contact with infected blood—can also help block the spread of viral hepatitis.

Another potentially dangerous type of liver disease can be caused by taking certain drugs or supplements. “It’s important to be aware that a lot of drugs can cause liver injury,” Liang says. “This especially can be a problem for people who are taking several different medications.”

Taking too much acetaminophen (Tylenol) is the most common cause of sudden liver failure. “It’s particularly dangerous if you mix alcohol with acetaminophen or certain other drugs,” Liang adds. Talk with your doctor or pharmacist about all the medications you take and how they might affect your liver.

ANESTHESIA MANAGEMENT MADE SIMPLE. PROUDLY PROVIDING ANESTHESIA SERVICES FOR

TRI-STATE GASTROENTEROLOGY ASSOCIATES 866.362.6963 | www.lifelinc.com

TO DIABETES PREVENTION: Recent studies have proven that people at high risk for type 2 diabetes can often prevent or delay the onset of diabetes with 30 minutes of physical activity 5 days a week and by losing 5 to 7% of their body weight. In other words, you don’t have to knock yourself out to prevent diabetes. The key is: small steps lead to big rewards. Here are some tips that might help.

INCREASE ACTIVITY:

Try walking around the house while you talk on the phone.

Park the car farther away from stores, movie theaters or your office.

Get off the bus one stop early, if you are in a safe place to walk.

Visit museums, the zoo or an aquarium. These are great ways to be active with your family.

Try some of these tips to get started: You don’t have to cut out the foods you love to eat. Just cut down on the amount you eat, and eat them less often.

Try to keep meat, poultry and fish servings down to three ounces - that’s about the size of a deck of cards.

Try to eat three sensible meals at regular times throughout the day.

Eat more fresh fruit, veggies, nuts and whole grains.

Limit fried foods. Baking and broiling are healthier ways to eat meat, chicken and fish.

QUICK TIP

Put away the TV remote control and get up to change the channel.

EAT RIGHT.

TRI-STATE

SMALL STEPS

When eating out, share large portions. www.tristategastro.com

TRI-STATE GASTRO

5

So, you

think you have

too much gas?

Everyone has gas. Burping and “passing gas” is normal. But because it is embarrassing, many people believe they pass gas too often or have too much gas. A person actually having too much gas is rare.

Most of the time, gas in the body is odorless. The odor of passed gas comes from sulfur made by bacteria in the large intestine. Sometimes gas causes bloating and pain. Not everyone has these symptoms. How much gas the body makes and how sensitive a person is to gas in the large intestine have an effect on how uncomfortable one feels.

What can I do about gas?

Changing what you eat and drink can help prevent or reduce gas. If you feel like you have too much gas, you might want to try these things before going to the doctor.

1. Cut down on foods that cause gas.

The amount of gas caused by certain foods varies from person to person.

The only way to know your own limits is to keep track of what you eat and how much gas it causes later. Some foods that cause gas are:

‐ ‐ beans

‐ ‐ vegetables such as broccoli, cabbage, brussels sprouts, onions, artichokes, and asparagus

‐ ‐ fruits such as pears, apples, and peaches

‐ ‐ whole grains such as whole wheat and bran ‐ ‐ soft drinks and fruit drinks

‐ ‐ milk and milk products such as cheese and ice cream

‐ ‐ packaged foods that contain lactose, a type of sugar; bread, cereal, and salad dressing are examples

‐ ‐ dietetic foods and sugar-free candies and gums 2. Drink plenty of water and clear soup but not “fizzy” liquids.

Try not to drink liquids that cause gas, like soda and beer.

3. Reduce the amount of air you swallow.

Here are some ways to avoid swallowing air:

‐ ‐ Eat slower and chew more to cut down on the amount of air you Article Source: National Institute of Health.

swallow when you eat.

6

‐ ‐ Avoid chewing gum and eating hard candy. ‐ ‐ If you smoke, try to cut down or quit.

‐ ‐ If you have false teeth, see your dentist to make sure they fit right.

4. Keep a diary.

Write down the foods, and the amounts, that seem to cause you the most problems. Also keep track of the number of times you pass gas each day.

If you are still troubled by gas, you may want to see your doctor. Take your diary with you to help you answer the doctor’s questions about eating habits and symptoms.

TRI-STATE GASTRO

Points to Remember : ‐‐ Everyone has gas in the digestive tract.

‐‐ People often think they

pass too much gas when they really don’t.

‐‐ Passing gas frequently is normal.

‐‐ Two ways to reduce the

amount of gas you have are to: 1. Cut down on the foods and liquids that cause gas.

2. Reduce the amount of air you swallow.

VOLUME 1 - 2015

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QUICK TIP

Q & A - ON

SCREENING FOR COLON CANCER

Is colorectal cancer predominantly a man’s disease?

No. Colorectal cancer affects an equal number of men and women. Many women, however, think of CRC as a disease only affecting men and might be unaware of important information about screening and preventing colorectal cancer (CRC) that could save their lives, says the American Society for Gastrointestinal Endoscopy.

TRI-STATE

Should women also be screened?

Yes. Beginning at age 50, all men and women should

be screened for colorectal cancer even if they are experiencing no problems or symptoms.

Does a colonoscopy screening typically require an overnight stay in a hospital?

No. A colonoscopy is almost always done on an outpatient basis. A mild sedative is usually given before the procedure and then a flexible, slender tube is inserted into the rectum to look inside the colon. The test is safe and the procedure itself typically takes less than 30 minutes.

Is it true that colorectal cancer is the third leading cause of cancer deaths in women in the United States?

Yes. After lung and breast cancer, colorectal cancer is the third leading cause of cancer deaths in women in the United States. Annually, approximately 130,000 new cases of colorectal cancer are diagnosed in the United States and 56,000 people die from this disease. It has been estimated that increased awareness and screenings could save 30,000 lives each year.

What tests are used to screen for colon cancer?

There are five different tests used for screening for colorectal cancer: digital rectal exam, stool blood test,

barium enema, flexible sigmoidoscopy, and colonoscopy.

Talk to your healthcare provider about which test is best for you.

What are the current recommendations for screening?

Beginning at age 50 and age 45 for African Americans, men and women should have, at a minimum: An annual stool occult blood test

A colonoscopy every 10 years or earlier, depending on family or personal history It is important that you should begin screening earlier if you have a personal or family history of colorectal cancer, polyps, rectal bleeding, or longstanding inflammatory bowel disease such as ulcerative colitis disease.

Is colon cancer often preventable?

Yes. Colon cancer is highly preventable. Screening tests

such as colonoscopy and flexible sigmoidoscopy may detect polyps (small, grapelike growths on the lining of the colon.) Removal of these polyps can prevent colorectal cancer from developing.

“Colorectal cancer is especially prevalent in Kentucky, with incidence rates above the national average. In 2013, Kentucky ranked fourth in the nation for colon cancer deaths.”

The American Society for Gastrointestinal Endoscopy encourages you to talk with your healthcare provider about colon cancer screening and encourages everyone over the age of 50 to undergo the appropriate CRC screening.

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425 Centre View Blvd Crestview Hills, KY 41017 www.tristategastro.com P: (859) 341-3575

DANIEL G. FAGEL, M.D.

201 5 C in c in n a t i Ma g a z in e T o p D o c t o r

Dr. Fagel is a native of Cincinnati, Ohio. He obtained his medical license in 1985 from the University of Cincinnati. He completed his internship, residency and fellowship at The University of Iowa Hospitals and Clinics in July 1991 and joined the practice of Tri-State Gastroenterology Associates. He is the former President of the Northern Kentucky Medical Society (1996-1997), Teacher of the Year for St. Elizabeth Medical Center Family Practice Center (1996-1997), (1999-2000) and (2001-2002).

B o a r d C e r t i f i c a t i o n s : The American Board of Gastroenterology, the American Board of Internal Medicine.

MICHAEL E. JONES, M.D.

P r o f e s s i o n a l S o c i e t i e s : The American Gastroenterological Association, Gastrointestinal Videoendoscopy Association of America, American Society of Gastrointestinal Endoscopy and the American College of Gastroenterology.

201 5 C in c in n a t i Ma g a z in e T o p D o c t o r

Dr. Jones is a native of Kansas City, Missouri. He obtained his medical degree in 1997 from the University of Missouri School of Medicine in Columbia, Missouri. In 2003, after completing his internship, residency and fellowship at University of Kentucky Medical Center, he began practicing with Tri-State Gastroenterology Associates. Dr. Jones is currently the Director of Clinical Research for Tri-State Gastroenterology Associates.

H o n o r s : “Outstanding Intern Teacher” (1998), “Chief Resident’s Outstanding Intern Award” (1998) at the University of Kentucky Medical Center, “Resident Research Award” for the University of Kentucky (1999).

ROSS MCHENRY, M.D.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare, Health South Rehabilitation Hospital. He serves on St. Elizabeth Medical Center Review Committee for Internal Medicine, the St. Elizabeth Medical Center Residency Committee and is a Northern Kentucky delegate for the Kentucky Medical Association.

B o a r d C e r t i f i c a t i o n s : The American Board of Gastroenterology, The American Board of Internal Medicine. He is also a Fellow of the American Gastroenterological Association.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare, Health South Rehabilitation Hospital.

P r o f e s s i o n a l S o c i e t i e s : The American Society for Gastrointestinal Endoscopy, Crohn’s and Colitis Foundation, American College of Gastroenterology and American Gastroenterological Association.

201 5 C in c in n a t i Ma g a z in e T o p D o c t o r

Dr. McHenry is a native of Cincinnati, Ohio. He obtained his medical degree at The University of Cincinnati in 1981. In July 1986 after completing his internship, residency and fellowship at Indiana University Medical Center, Dr. McHenry joined the practice of Tri-State Gastroenterology Associates.

B o a r d C e r t i f i c a t i o n s : The American Board of Gastroenterology and the American Board of Internal Medicine.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare, Health South Rehabilitation.w

Dr. McHenry has served on many committees associated with Tri-State Digestive Disorder Center.

Served as President of Tri-State Gastroenterology Associates from 2000-2009. He is a Lecturer at St. Elizabeth Healthcare and has served on several committees at area hospitals and local communities including The Greater Cincinnati Health Improvement Collaborative. In 1992 Dr. McHenry served as the President of the Medical Staff at St. Luke Hospital.

P r o f e s s i o n a l S o c i e t i e s : The American Society of Gastrointestinal Endoscopy, American College of Physicians, American Medical Association, American Gastroenterological Association, Gastrointestinal Videoendoscopy Association of America and is a fellow of the American College of Gastroenterology.

TriStateGastro.com

E a ch of our p hysicia ns knows how to give the b est p ossib le ca r e a nd ca n ma ke your visit a s comfor ta b le a s p ossib le!

OUR DOCTORS & MID-LEVEL PROVIDERS

Our p hysicia ns a r e highly tr a ined in their a r ea s of exp er tise.

KARLINA M. PATTON, M.D.

OUR DOCTORS & MID-LEVEL PROVIDERS

Dr. Patton is a native of Northern Kentucky. She obtained her medical degree at The University of Cincinnati in 1998. In July 2004 after completing her internship, residency and fellowship at The University of Cincinnati, she joined the practice of Tri-State Gastroenterology Associates.

During Dr. Patton’s medical school, residency, internship and fellowship, she received many honors including ACP/ASIM Poster Winner and The Associates Clinical Vignette Competition. Dr. Patton was involved in many activities including Medical Student Association-Historian, Universal Precautions Workshop Instructor and Women in Medicine.

B o a r d C e r t i f i c a t i o n s : The American Board of Gastroenterology, The American Board of Internal Medicine.

P r o f e s s i o n a l S o c i e t i e s : The American College of Physicians , American Society of Internal Medicine, American Medical Association, American College of Gastroenterology, American Gastroenterological Association and The American Society of Gastrointestinal Endoscopy.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare Health South Rehabilitation Hospital.

GREGORY L. SALZMAN, M.D.

201 5 C in c in n a t i Ma g a z in e T o p D octor

Dr. Salzman is a native of New York,. He was raised in Columbus, Ohio. He obtained his medical degree from The Ohio State University in 1984. In July 1989 Dr. Salzman joined the practice of Tri-State Gastroenterology Associates after completing his internship, residency and fellowship at The Ohio State University Hospitals.

B o a r d C e r t i f i c a t i o n s : The American Board of Gastroenterology, The American Board of Internal Medicine.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare, Health South Rehabilitation Hospital

CHADWICK HATFIELD, M.D.

Dr. Salzman has served on many committees associated with Tri-State Digestive Disorder Center as well as area hospitals and local communities. In 1994 he served as President of the Medical Staff at St. Elizabeth Medical Center.

P r o f e s s i o n a l S o c i e t i e s : The American Gastroenterological Association, American Society of Gastrointestinal Endoscopy and Gastrointestinal Videoendoscopy Association of America, and the American College of Gastroenterology. He is also a member of Alpha Omega Alpha.

201 5 C in c in n a t i Ma g a z in e T o p D o c tor

Dr. Hatfield is a native of Phelps, Kentucky. He obtained his medical degree from the University of Louisville in 2005. He completed his Internal Medicine Internship and Residency in 2008 and in 2011 completed a Gastroenterology/Hepatology Fellowship. Dr. Hatfield devoted most of his final year of training, performing Endoscopic Ultrasound (EUS) at two downtown Louisville medical centers.

Tri-State Gastroenterology Associates is the first practice in Northern Kentucky to offer this innovative, new EUS technology.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare, HealthSouth Rehabilitation Hospital.

B o a r d C e r t i f i c a t i o n s : The American Board of Internal Medicine, The American Board of Gastroenterology.

P r o f e s s i o n a l S o c i e t i e s : The American Medical Association, the American Gastroenterology Association, the American Society for Gastrointestinal Endoscopy, and the American College of Gastroenterology.

SCOTT C. LEVERAGE, M.D. Dr. Leverage is a native of Dayton, Ohio. He completed his medical training at Wright State University (WSU) and the University of Kentucky (UK). Dr. Leverage obtained his medical degree in 2005 at WSU, finished his Internal Medicine Internship and Residency in 2008 at UK, completed a Chief Residency in Internal Medicine in 2009 at UK, and finished a Gastrointestinal Fellowship in 2012 at UK. Dr. Leverage is trained in ERCP (Endoscopic Retrograde Cholangiopancreatography).

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare and HealthSouth Rehabilitation Hospital B o a r d C e r t i f i c a t i o n s : The American Board of Internal Medicine and The American Board of Gastroenterology.

P r o f e s s i o n a l S o c i e t i e s : The American Gastroenterology Association and the American College of Gastroenterology.

JOEL M. WARREN, M.D. TriStateGastro.com

Dr. Warren is a native of Nashville, TN. He completed his medical training at the University of Louisville.

He obtained his medical degree in 2008, finished his Internal Medicine Residency in 2011, and finished a Gastrointestinal Fellowship in 2014.

Dr. Warren is trained in gastroenterology, hepatology, nutrition and EUS. H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare and HealthSouth Rehabilitation Hospital in Northern Kentucky

B o a r d C e r t i f i c a t i o n s : The Kentucky Board of Medical Licensure and the American Board of Internal Medicine.

P r o f e s s i o n a l S o c i e t i e s : The American Society for Gastrointestinal Endoscopy, American Medical Association, Kentucky Medical Association, and the American College of Physicians.

Karen has published articles as well as chapters in medical resource books on hepatitis, adult well care and family related issues.

A c c o m p l i s h m e n t s : The Mary Lou Eilers Scholarship, Bachelor in Science of Nursing Award for Recognition for Outstanding Leadership and Service, American Cancer Society Scholarship Recipient and the Mildred S. Davenport Oncology Nursing Practice Award from the University of Cincinnati. Karen is also a member of Sigma Theta Tau.

H o s p i t a l A f f i l i a t i o n s : St. Elizabeth Healthcare, Health South Rehabilitation Center. Karen is also involved with Quality Improvement for Holy Family Center which cares for aging Sisters of Divine Providence.

JESSICA GARDNER, PA-C Jessica is a native to Northern Kentucky. She grew up in St. Joseph Parish in Crescent Springs and is a Notre Dame Academy Alumni. Jessica attended Clarion University of Pennsylvania where she received her Bachelor Degree in Science with a concentration in Biology, and played on the Women’s Varsity Basketball team. She furthered her education at Seton Hill University where she received a Master’s in Physician Assistant Science.

Jessica is nationally certified by the National Commission of Certification of Physician Assistants and licensed by the Kentucky State Medical Board.

She is a member of the Kentucky Academy of Physician Assistants, American Academy of Physician Assistants and the American Gastroenterological Association.

Jessica became a member of Tri-State Gastroenterology Associates in July 2011. She is teaming up with the doctors and other mid-level providers to continue the compassionate, quality healthcare our practice has to offer.

ALLISON M. KREATE, APRN Allison earned her Associate of Applied Sciences in Nursing, Bachelor of Science in Nursing, and a Master of Science in Family Nurse Practitioner all from Northern Kentucky University. Allison has several years of patient care experience from time spent at St. Elizabeth Healthcare and has many certifications, including one as a Certified Family

Nurse Practitioner from the American Academy of Nurse Practitioners. She currently resides in Independence, KY.

AMY M. NICHOLAS, APRN Amy earned her undergraduate degrees as an L.P.N and Associates Degree as a Registered Nurse at Gateway Technical and Community College. Her Bachelor’s in Nursing and Master’s Degree in Nursing/Certification as Family Nurse Practitioner were awarded by Northern Kentucky University.

Amy has acute care experience with St. Elizabeth Medical Center and long term care experience at St

Charles Health Care Center. Her research interest is inflammatory bowel disease. Hobbies include photography, scrapbooking , and exercise. She was raised in Cincinnati, Ohio, and currently makes her home in Hebron, KY.

425 Centre View Blvd Crestview Hills, KY 41017 P: (859) 341-3575 F: (859) 341-5701 TF: (800) 448-3575

www.tristategastro.com

TriStateGastro.com

Karen is a native of Northern Kentucky. She received her Associate’s Degree in Nursing in 1981 and has been in active practice since then. Karen worked in Oncology for fifteen years as a staff nurse, unit charge nurse, assistant manager and manager.

After receiving her nurse practitioner degree in 1996, she worked in family practice in Campbell and Boone counties before starting at Tri-State Gastroenterology Associates in January 2001.

OUR DOCTORS & MID-LEVEL PROVIDERS

KAREN L. RUSCHMAN, APRN-C

When you eat foods—such as bread, meat, and vegetables— they are not in a form that the body can use as nourishment.

Food and drink must be changed into smaller molecules of nutrients before they can be absorbed into the blood and carried to cells throughout the body. Digestion is the process by which food and drink are broken down into their smallest parts so the body can use them to build and nourish cells and to provide energy. Digestion begins in the mouth, when you chew and swallow, and is completed in the small intestine.

MOVEMENT OF FOOD THROUGH THE SYSTEM

Food moves from one organ to the next through muscle action called peristalsis. Peristalsis looks like an ocean wave traveling through the muscle. The muscle of the organ contracts to create a narrowing and then propels the narrowed portion slowly down the length of the organ. These waves of narrowing push the food and fluid in front of them through each hollow organ.

The first major muscle movement occurs when food or liquid is swallowed. Although you are able to start swallowing by choice, once the swallow begins, it becomes involuntary and proceeds under the control of the nerves.

Swallowed food is pushed into the esophagus, which connects the throat above with the stomach below. At the junction of the esophagus and stomach, there is a ringlike muscle, called the lower esophageal sphincter, closing the passage between the two organs. As food approaches the closed sphincter, the sphincter relaxes and allows the food to pass through to the stomach.

The stomach has three mechanical tasks. First, it stores the swallowed food and liquid. To do this, the muscle of the upper part of the stomach relaxes to accept large volumes of swallowed material. The second job is to mix up the food, liquid, and digestive juice produced by the stomach. The lower part of the stomach mixes these materials by its muscle action.

The third task of the stomach is to empty its contents slowly into the small intestine.

Several factors affect emptying of the stomach, including the kind of food and the degree of muscle action of the emptying stomach and the small intestine. Carbohydrates, for example, spend the least amount of time in the stomach, while protein stays in the stomach longer, and fats the longest. As the food dissolves into the juices from the pancreas, liver, and intestine, the contents of the intestine are mixed and pushed forward to allow further digestion.

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Finally, the digested nutrients are absorbed through the intestinal walls and transported throughout the body. The waste products of this process include undigested parts of the food, known as fiber, and older cells that have been shed from the mucosa. These materials are pushed into the colon, where they remain until the feces are expelled by a bowel movement.

ABSORPTION AND TRANSPORT OF NUTRIENTS

Most digested molecules of food, as well as water and minerals, are absorbed through the small intestine. The mucosa of the small intestine contains many folds that are covered with tiny fingerlike projections called villi. In turn, the villi are covered with microscopic projections called microvilli. These structures create a vast surface area through which nutrients can be absorbed. Specialized cells allow absorbed materials to cross the mucosa into the blood, where they are carried off in the bloodstream to other parts of the body for storage or further chemical change. This part of the process varies with different types of nutrients.

Carbohydrates:

The Dietary Guidelines for Americans 2005 recommend that 45 to 65 percent of total daily calories be from carbohydrates.

Foods rich in carbohydrates include bread, potatoes, dried peas and beans, rice, pasta, fruits, and vegetables. Many of these foods contain both starch and fiber.

VOLUME 1 - 2015

The digestive system is made up of the digestive tract—a series of hollow organs joined in a long, twisting tube from the mouth to the anus—and other organs that help the body break down and absorb food.

The digestible carbohydrates—starch and sugar—are broken into simpler molecules by enzymes in the saliva, in juice produced by the pancreas, and in the lining of the small intestine. Starch is digested in two steps. First, an enzyme in the saliva and pancreatic juice breaks the starch into molecules called maltose. Then an enzyme in the lining of the small intestine splits the maltose into glucose molecules that can be absorbed into the blood. Glucose is carried through the bloodstream to the liver, where it is stored or used to provide energy for the work of the body.

Sugars are digested in one step. An enzyme in the lining of the small intestine digests sucrose, also known as table sugar, into glucose and fructose, which are absorbed through the intestine into the blood.

Milk contains another type of sugar, lactose, which is changed into absorbable molecules by another enzyme in the intestinal lining.

Fiber is undigestible and moves through the digestive tract without being broken down by enzymes. Many foods contain both soluble and insoluble fiber.

Soluble fiber dissolves easily in water and takes on a soft, gel-like texture in the intestines. Insoluble fiber, on the other hand, passes essentially unchanged through the intestines.

Protein:

Foods such as meat, eggs, and beans consist of giant molecules of protein that must be digested by enzymes before they can be used to build and repair body tissues. An enzyme in the juice of the stomach starts the digestion of swallowed protein. Then in the small intestine, several enzymes from the pancreatic juice and the lining of the intestine complete the breakdown of huge protein molecules into small molecules called amino acids. These small molecules can be absorbed through the small intestine into the blood and then be carried to all parts of the body to build the walls and other parts of cells.

Article Source: National Institute of Health.

Fats:

Fat molecules are a rich source of energy for the body. The first step in digestion of a fat such as butter is to dissolve it into the watery content of the intestine.

The bile acids produced by the liver dissolve fat into tiny droplets and allow pancreatic and intestinal enzymes to break the large fat molecules into smaller ones. Some of these small molecules are fatty acids and cholesterol. The bile acids combine with the fatty acids and cholesterol and help these molecules move into the cells of the mucosa. In these cells the small molecules are formed back into large ones, most of which pass into vessels called lymphatics near the intestine. These small vessels carry the reformed fat to the veins of the chest, and the blood carries the fat to storage depots in different parts of the body.

Vitamins:

Another vital part of food that is absorbed through the small intestine are vitamins. The two types of vitamins are classified by the fluid in which they can be dissolved: water-soluble vitamins (all the B vitamins and vitamin C) and fatsoluble vitamins (vitamins A, D, E, and K). Fat-soluble vitamins are stored in the liver and fatty tissue of the body, whereas water-soluble vitamins are not easily stored and excess amounts are flushed out in the urine.

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Water and Salt:

Most of the material absorbed through the small intestine is water in which salt is dissolved. The salt and water come from the food and liquid you swallow and the juices secreted by the many digestive glands.

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Member FDIC

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13

Want to feel better, look better, and have more energy?

Moving more and eating better is the best place to start.

Why move more and eat better?

Being physically active and making smart food choices is good for your health. But that is not the only reason to move more and eat better. It can also help you: -- Have more energy.

-- Look good in hip, trendy clothes.

-- Tone your body (without losing your curves).

-- Park your car farther away and walk to your destination.

-- Walk to each end of the mall when you go shopping.

-- Take the stairs rather than the elevator or escalator (make sure the stairs have working lights).

-- Put physical activity on your to-do list for the day.

For example, plan on exercising right after work, before you can get distracted by dinner or going out.

-- Reduce stress, boredom, or the blues.

-- Feel good about yourself.

TIPS ON MOVING MORE Physical activity can be fun! Do things you enjoy, like: -- Dancing -- Hiking -- Rollerblading -- Walking -- Playing Sports -- Bicycling -- Swimming

LOOK GOOD AS YOU GET FIT If you avoid physical activity because you do not want to ruin your hairstyle, try: -- A natural hairstyle

-- A style that can be wrapped or pulled back -- A short haircut -- Braids, twists, or locs TIP: Day-to-day activities can cause salt build-up in your hair. To remove salt, shampoo with a mild, pH-balanced product at least once a week.

-- Group Fitness Classes

If you can, be physically active with a friend or a group.

That way, you can cheer each other on, have a good time while being active, and feel safer when you are outdoors.

Find a local school track or park where you can walk or run with your friends, or join a recreation center so you can work out or take a fun fitness class together.

Think you do not have time for physical activity? The good news is that you can be active for short periods of time throughout the day and still benefit. When fitting in physical activity, remember that any activity is better than none. So try to move more by making these small changes to your daily routine: -- Get off the bus or subway one stop early and walk the rest of the way (be sure the area is safe).

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TIPS ON EATING BETTER Eating right can be hard when you do not feel like cooking or there is a fast food place on every corner. Here are some simple things you can do to eat better: -- Start every day with breakfast. Try a low-fat, wholegrain breakfast bar; fat-free or low-fat yogurt; or whole-grain toast or bagel spread with a little peanut butter, jam, or low-fat cream cheese.

-- Eat more fruits and vegetables, and choose whole grains like 100 percent whole-wheat bread, oatmeal, or brown rice instead of refined grains like white bread and white rice.

-- Choose low-fat or fat-free milk instead of whole milk or a milkshake.

VOLUME 1 - 2015

-- Order a plain hamburger (without sauce or mayonnaise) or a grilled (not fried) chicken sandwich. Skip the fries and try a salad with fat-free or low-fat dressing instead.

-- Do not keep a lot of sweets like cookies, candy, or soda in the house. Too many sweets can crowd out healthier foods.

-- Rather than eliminate your favorite home-cooked foods, prepare them in slightly different ways: bake chicken instead of frying it; cook with extra herbs rather than extra butter; and reduce the amount of salt you use.

TIP: Many food labels say “low-fat,” “reduced fat,” or “light.” That does not always mean the food is low in calories. Sometimes fat-free or lowfat muffins or desserts have even more sugar than the full-fat versions.

Remember, fat-free does not mean calorie-free, and calories do count!

Many people think that bigger is better. We are so used to value-size servings that it is easy to eat more than our bodies need. Eating smaller portions will help you cut down on calories and fat (and might save you money too).

-- Order vegetable toppings on pizza instead of salty, high-fat meats like pepperoni or sausage.

-- Share popcorn (and skip the added butter) at the movies instead of getting your own bag, or order the smallest size. You will save money too!

Article Source: National Institute of Health.

-- Go easy on mayonnaise, creamy sauces, and added butter.

be easier for you—and your friends—to avoid temptation.

-- Choose bottled water instead of soda and other artificially sweetened beverages like punch or natural fruit juices.

-- Munch on pretzels or vegetables at parties instead of fried chips or fatty dips.

-- If you drink wine, beer, or other alcohol, limit yourself to one drink. Alcohol has lots of calories but little nutritional value.

YOU CAN DO IT! Set doable goals. Move at your own pace. Let your family and friends help you. Allow for setbacks, and be sure to celebrate your successes. Keep trying – you can do it!

Even take-out and high-fat foods can be part of a balanced diet, as long as you do not eat them every day and do not eat too much of them. Here are sensible serving sizes for some favorite foods: 1. French fries: one small serving (equal to a child’s order) 2. Shrimp fried rice (as a main dish): 1 cup 3. Cheese pizza: two small slices or 1 large slice

TIP: Do you eat in front of the TV out of habit? Do you eat when you are bored, nervous, or sad? Be aware of when, where, and why you eat, and try to eat balanced meals throughout the day. Instead of reaching for that cookie, do something else, like calling a friend or taking a walk.

Axium

Specialty Pharmacy

The Tri-State’s Premier Gastroenterology/Hepatology Focused Specialty Pharmacy

OUT ‘N’ ABOUT You can hang out with your friends and still make healthy food choices. Try these tips when you are out ‘n’ about: -- Encourage your friends to make healthy choices with you. If you are all on the same page, it might

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TRI-STATE GASTRO

15

Malay B. Shah, MD Surgical Director, Liver Transplantation UK HealthCare

You haven’t been feeling well for a while. You’ve seen multiple doctors and had endless labs checked. It doesn’t make sense because even a few months ago you felt fine and normal.

Finally, you are told: “You have cirrhosis; you may need a liver transplant.”

Shocking. Stunning. Life-altering. Your first response is, “But doctor, I’ve never drank anything in my life.”

This frightening scenario is not uncommon. Many people don’t realize they have cirrhosis until it has significantly progressed.

Here’s what you need to know about the condition.

What is Cirrhosis and what are its causes?

Cirrhosis is scarring of the liver. There are many causes, including: • Hepatitis B and hepatitis C.

• Non-alcoholic liver disease (NASH or fatty liver disease).

• Alcoholic liver disease.

• Primary biliary cirrhosis (destruction of the bile ducts).

• Primary sclerosing cholangitis (scarring of the bile ducts).

• Autoimmune hepatitis (a condition where your immune system attacks your liver).

What are the signs and symptoms of Cirrhosis?

Many people don’t have any symptoms until late in the course of cirrhosis. However, a person with liver disease may experience any of the following: • Fatigue

• Jaundice (yellowing of the skin) • Itching • Easy bruising • Muscle wasting

• Ascites (fluid buildup in your abdomen) • Encephalopathy (confusion and poor memory related to high ammonia levels) • Throwing up blood (due to enlarged blood vessel, known as varices) • Low platelets

What can be done to manage liver disease?

Your doctors and providers at Tri-State Gastroenterology Associates will start managing the symptoms and complications of your liver disease. There are numerous medications that can be helpful in controlling some of the symptoms of liver disease. Your doctors might also perform endoscopic procedures to screen for abnormalities that can be addressed based on their clinical judgment and expertise.

People with liver disease are also at risk for developing liver 16

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cancer. Your providers at Tri-State Gastroenterology will also order screening tests including ultrasounds, CT scans or MRI scans to look for the development of liver cancer.

When should a liver transplant evaluation be considered?

The referral to a liver transplant center occurs when your provider at Tri-State Gastroenterology feels that your symptoms of liver disease or your liver function tests indicate that your health and liver disease has progressed far enough that you may eventually require a liver transplant.

Alternatively, if a cancer is detected during screenings, you may be referred for transplant consideration.

To help determine how sick your liver is, a MELD score is calculated. A MELD score is determined by a complex formula and uses basic labs that your provider will check. A MELD score is used to determine the severity of your liver disease and is also used in determining who receives a transplant.

What does the evaluation involve?

Because of the excellent partnership between the University of Kentucky Liver Transplant Program and Tri-State Gastroenterology Associates, we are pleased to offer initial clinic evaluation close to home. Our office is located within their office. Alternatively, you may choose to be seen at our main campus in Lexington. Your first evaluation will involve meeting with one of UK’s liver transplant surgeons to discuss your case, liver transplantation and your candidacy for liver transplantation. We hope to provide you with information to help you better understand the liver transplant process.

Once you and your UK liver transplant surgeon determine that it is appropriate to begin the evaluation, your journey towards transplantation will begin. You will be assigned a liver transplant coordinator, who will serve as your point person, liaison and advocate in all interactions with the UK Transplant Center. She will help you coordinate your medical care and evaluation testing to optimize your experience. You will also see our specialized transplant pharmacists and social workers to assure that you will have the best possible outcome before and after transplant.

Once your testing is completed, everything will be reviewed in our multidisciplinary liver committee. If all testing and evaluations are satisfactory, you will be placed on the waiting list for a liver transplant.

How long will you wait for a liver transplant?

The waiting time varies greatly and is based on your MELD score. Simply put, the higher the MELD score, the quicker you may be transplanted. The score you have on any given day is not the score you will keep forever. At each clinic visit prior to transplant, your labs will be checked to assess for changes in your MELD score. If your MELD score increases, VOLUME 1 - 2014

your score on the wait list will be updated and your position on the list may change. The overall goal of using the MELD score is for the sickest patients to receive a liver transplant as quick as possible.

What happens after surgery?

You’ve been called in for a liver transplant – now what happens?

What limitations will you have after liver transplant?

While waiting for transplant, you will be seen periodically

by UK’s transplant hepatologists, who bring vast knowledge and training to help deliver excellent care and maximize your chances of receiving a liver transplant. If you need procedures such as an endoscopy or care for non-transplant related liver disease and gastrointestinal issues, our partners at Tri-State Gastroenterology will work to deliver your care close to home.

You can be called at any time on any day to come in for a liver transplant. Just like us, you will be “on-call” for a liver. Once you receive that exciting call from one of our coordinators, you need to get some clothes and your medicines packed up and come to UK HealthCare in Lexington. Don’t worry, we’ll provide directions on where to go. Once you arrive, you will check into a room where blood work and basic tests will be performed. You will also meet our excellent liver transplant anesthesiologists, who will work closely with us during the operation to ensure the best possible outcome.

Once your new liver is received, you will be taken to the operating room. The surgery takes between four and six hours, for which you will be asleep and completely comfortable. Once surgery is completed, you will be taken to the intensive care unit.

Generally, people spend between 7 and 14 days in the hospital after a liver transplant. You will receive antirejection medications to prevent your body from rejecting your new liver. You will take these medications for the rest of your life, but the tradeoff for a new lease on life is priceless. Once you are out of the hospital, you will be followed very closely for the first few months to ensure that your new liver is working and you are doing well. After a few months, we begin to space out visits, and most people are check in with us on a yearly basis thereafter.

Once you have healed from surgery, you will not have any restrictions. Most patients return to work or begin to finally enjoy their retirement years. And most importantly, they are able to get back to spending time with their families, raising their children or spoiling their grandchildren. It is likely you have seen people who have had a liver transplant without even realizing they had a transplant. This never ceases to amaze me. I will frequently see patients a year after a liver transplant and not even recognize them because they look like they did before they became ill.

As I like to say, we don’t transplant you to put you in a bubble or a nursing home. We transplant you to get you back to normal, healthy living.

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WHAT IS CROHN’S DISEASE? Crohn’s disease is an inflammatory bowel disease (IBD) that causes inflammation or ulceration of the digestive tract. It may effect any part of the digestive tract from the mouth to the anus but is most common in the last part of the small intestine (ileum) and the first part of the large intestine (cecum).

Crohn’s disease affects the deepest layers of the lining of the digestive tract. It can cause deep ulcers and very small sores called granulomas.

Ulcerative Colitis and Crohn’s disease are the most common types of inflammatory bowel disease.

Ulcerative Colitis is more common than Crohn’s disease. In about 10% of people who have symptoms, neither Crohn’s disease nor Ulcerative Colitis can be diagnosed. These people have a form of inflammatory bowel disease called indeterminate Colitis, a combination of Crohn’s disease and Ulcerative Colitis.

What causes Crohn’s disease?

The cause is not known. However, Crohn’s disease is believed to develop in people who have a genetic tendency. Their immune system may overreact to normal intestinal bacteria, causing inflammation.

Disease-causing bacteria and viruses also may play a role in triggering Crohn’s disese.

Crohn’s disease can be difficult to diagnose. Early symptoms, or its only symptoms, may consist of joint aches and a general feeling of fatigue. The condition may go undiagnosed for years because symptoms usually develop gradually and not all of the intestines are involved.

What are the symptoms of Crohn’s?

Both colonoscopy and sigmoidoscopy can be used to take a biopsy of intestinal tissue, which helps distinguish Crohn’s disease from other conditions.

Barium enema, computed tomography (CT) scan, and magnetic resonance imaging (MRI) may be helpful in locating fistulas. A barium small bowel followthrough test may be used to help diagnose Crohn’s disease in the small intestine.

Increasingly, researchers think environmental factors play a role in causing Crohn’s disease. The condition tends to occur most in people who are in higher socioeconomic groups. Smoking increases the risk of Crohn’s disease.

The main symptoms are abdominal pain, rectal bleeding, and diarrhea. Constipation, fever, and loss of appetite also may occur.

Crohn’s disease may also cause: Ulcers in the mouth

Nutritional deficiencies, such as lowered levels of vitamin B12, folic acid, iron, and fat-soluble vitamins, because the intestines may not be able to absorb nutrients from food.

Bowel obstruction

Signs of disease in or around the anus, such as: Abnormal tunnels or openings called fistulas that sometime form between organs.

Article Source: National Institute of Health

Pockets of infection (abscesses) Anal fissures

Skin tags that may resemble hemorrhoids. These are caused by inflamed skin.

A stool analysis (including a test for blood in the stool) is often done, depending on symptoms, to look for blood and signs of bacterial infection. Blood and urine tests may be done to check for anemia, inflammation, or malnutrition-all signs of Crohn’s.

How is Crohn’s disease treated?

Crohn’s disease usually can be controlled with medications to stop inflammation and infection and to keep the disease in remission. However, while it can be managed, Crohn’s disease cannot be cured.

How is Crohn’s disease diagnosed?

Crohn’s disease is diagnosed through a medical history and physical examination, imaging tests to look at the intestines, and laboratory tests.

Sometimes complications develop elsewhere in the body, including the eyes, liver, blood, and bones.

18

A doctor uses a thin, lighted endoscope to look at the entire colon (colonoscopy) or only the lower portion (flexible sigmoidoscopy). Crohn’s may effect some areas of the intestines and skip over others, creating a characteristic cobblestone appearance. The pattern results from repeated ulceration and healing.

TRI-STATE GASTRO

www.bankofky.com VOLUME 1 - 2015

There’s Hope in a SCOPE. “Early screening saved my life!”

Current Recommendations for the Prevention of Colorectal Cancer: 1. Get screened regularly.

2. Maintain a healthy weight throughout life.

3. Adopt a physically active lifestyle.

4. Consume a healthy diet with an emphasis on plant sources and limit consumption of processed and red meats.

5. If you drink alcoholic beverages, limit consumption.

6. Consume the recommended levels of calcium, primarily through food sources.

7. Avoid tobacco products.

Reprinted by the permission of the American Cancer Society, Inc. from Colorectal Cancer Facts and Figures 2014-2016. All rights reserved.

March is Colon Cancer Awareness month. And did you know that colorectal cancer is the third most frequently diagnosed cancer and the third leading cause of cancer deaths among men and women in the U.S.

Detecting cancer at a more treatable stage may save your life.

At FUJIFILM Medical Systems U.S.A., a company dedicated to improving the quality of life for people worldwide, the fight against colorectal cancer is one of our top priorities.

There’s hope in early screening. Get screened.

10 High Point Drive, Wayne, NJ 07470 • 1-800-385-4666 • www.fujifilmendoscopy.com Fujifilm and Value from Innovation are registered trademarks of FUJIFILM Corporation. © Fujifilm 2015.

The UK Transplant Center offers transplant evaluations at our Northern Kentucky clinic, where you can receive consultations close to home.

To schedule an appointment, please call 866-285-4337.

BEN BOLES

D

received his liver transplant Jan. 13, 2013.