Jacksonville Magazine's Your Health, Winter 2019 Issue by Jacksonville Magazine

JACKSONVILLE MAGAZINE’S

YOURHEALTH Northeast Florida’s Definitive guide to Medical Care & Wellness WINTER 2019

Vol. 5 No. 1

Conquering

Cancer

Innovative treatments and research driving individualized patient care, positive results and better quality of life

EST. 2015

FREE

These Physicians Are Among

THE BEST DOCTORS & PRACTICES In Northeast Florida

These and other physician profiles are posted at JacksonvilleMag.com

Argyle Dental Professionals

Henley & Kelly

Atlantic Eye Institute

Hidden Hills Family Dentistry

Balanced Physician Care

Hodges Family & Cosmetic Dentistry

Patrick L. Basile, MD Plastic Surgery & Wellness

Intracoastal Dermatology

Beaches Endodontics Brown Fertility Cancer Specialists of North Florida

Jacksonville Dental Specialists Jacksonville Dermatology Associates, PL Jacksonville Gentle Dentistry

The Carlson Group

Jacksonville Hearing & Balance Institute/The Hearing Center

Richard C. Caven, DMD

Jacksonville Orthopaedic Institute

Clay Eye Physicians & Surgeons

Sina Kasraeian, MD, FACS

Dr. Clayman’s Plastic Surgery Center & Miracle Spa

Kasraeian Urology L.A. Quinn MD–Southeast Stem Cell

Coastal Cosmetic Center

Larroc Dental

Contemporary Plastic Surgery

Lazzara Orthodontics

Contoura Facial Plastic Surgery

Martinez Dental Solutions

Doctors Lake Family Dental

Meier Plastic Surgery

Michael J. Duffy, MD

Meymand Oral Maxillofacial Surgery

ECCELLA Smiles

Corey Young Park, DMD

endodontics | bartram park

Pearson Facial Plastic Surgery

ENT Specialists of North Florida

Pediatric Associates of Jacksonville

FABEN Obstetrics & Gynecology

Pediatric Eye Consultants of North Florida

First Coast Cardiovascular Institiute

Quality Eye Care

Fishman Pediatric Dentistry

Harris L. Rittenberg, DMD

Fleming Island Plastic Surgery

Schneider Eye & Wellness Center

Florida Eye Specialists

James L. Schumacher, DMD

Florida Institute of Reproductive Medicine

Michael A. Sherman, DDS

Florida Plastic Surgery Group

Smart Body Physical Therapy

Florida Retina Institute

Smile Stylist

Fyzical Therapy & Balance Centers of Jacksonville

Southeast Orthopedic Specialists

William Gielincki Jr., DDS

Southside Dermatology & Laser Cosmetic Center

Gulani Vision Institute

Jackson C. Tan, MD, PhD, PT

Rick K. Harrison, DMD, PA

Terk Oncology

R. David Heekin, MD, FACS

Vanover Dentistry of Orange Park

Contents 30 KID STUFF Programs catering to the needs of local children

32 HEALTHY HAPPENINGS What’s going on in Northeast Florida?

30 32

34 IN THE NEWS Health-related updates from organizations throughout Northeast Florida

38 PET HEALTH Programs and products benefiting furry friends

40 SLOW BURN The state of Medical marijuana in Florida

46 ON THE BEATEN PATH The First Coast’s off-road trails, parks, and bike paths

54 APOCALYPSE NOW Jacksonville Opioid Crisis

flip book:

Cover Sponsor guide to marathon

weekend

YourHealth is proud to present the official program to the 13th Annual 26.2 with DONNA: The National Marathon to Finish Breast Cancer

8 4

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mayo clinic Hope & Healing: Solving the world’s most serious and complex medical problems

advertising sponsor: 34 BROOKS REHABILITATION

Welcome

JACKSONVILLE MAGAZINE’S

YOURHEALTH EDITORIAL:

You are presently reading the latest issue of Jacksonville Magazine’s YourHealth, a quarterly publication devoted to health, wellness and medical care in northeast florida. As this issue is mailed to subscribers as a complimentary bonus with their february Jacksonville Magazine, we thought it ﬁtting to include (for the third consecutive year) a section devoted to the donnA Marathon to finish breast Cancer. e race attracts runners from across the country and helps support research conducted right here at the Mayo Clinic Jacksonville campus. some 10,000 runners will gather out in at the neptune beach starting line to compete in the early february race and thousands more will line the streets cheering them on.

PUBLISHER / EDITOR-IN-CHIEF

JosePh White EDITOR

virginiA ChAMlee EDITORIAL ASSISTANT

eMilY bAileY INTERNS

AMAndA AllAn bAilie stAton

ART: CREATIVE DIRECTOR

Jennifer CoMPton DESIGNER

is issue—just like the previous editions of the magazine that debuted in 2015—is also packed with a variety of other stories, ranging from local news items to feature articles exploring topics relating to healthcare and ﬁtness.

heAther Kruse PHOTOGRAPHER

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our goal is to not just publish another magazine (Jacksonville Magazine has a bunch of those already), but to produce a real tool for northeast floridians, an easy-to-read guide that strives to present the latest news and information regarding health, speciﬁcally how it aﬀects our corner of florida. Among the things we continually discover is that our region is blessed with an amazing abundance of wellness and healthy living resources—from delicious and healthy local food purveyors to yoga studios to cutting-edge medical centers.

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reggie JollY

of course, no one wants to get sick. And most of us wish to live a long and healthy existence. however, nature has a way of reminding us that life can be messy, painful and even unkind sometimes. bumps, bruises, breaks and worse are unavoidable. We all become ill, eat things maybe we shouldn’t, wake up with sore muscles and joints—that, as they say, is life. e good news is we live in a time and a place when available medical care is truly remarkable and life-saving.

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Jacksonville Magazine’s YourHealth Volume 5 Issue 1 is published quarterly by White Publishing Company. All editorial contents ©2019. All rights reserved. No part of this periodical may be reproduced without the written permission of the publisher. Neither the publisher nor advertisers will be held responsible for any errors found in the magazine. The publisher accepts no liability for the accuracy of statements made by the advertisers.

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CROSSWORD PUZZLE Don’t spoil the fun. Before looking at this completed puzzle, turn to page 29 for this issue’s crossword. • For 35 years, Jacksonville Magazine has covered the people, issues and happenings of Northeast Florida. The magazine is published 12 times annually and reaches more than 140,000 upscale, active and educated readers each month.

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Northeast Florida’s top chefs compete plate-vs.-plate in three annual culinary competitions. For more info, visit JacksonvilleMag.com.

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Adult & Kid Food Pairings February 25 â&#x20AC;˘ 12:30 PM

FAMILY FOODIE

FARE

The third annual Family Foodie Fare stars some of the most beloved restaurants in Jax competing Top Chef-style for the best adult & kid food pairing. Come enjoy a family day out featuring delish eats, live music, fun family activities & more!

Engine 15 Taproom Downtown 633 Myrtle Avenue N.

Tickets @ 904TIX.com

ed by: r o s n o p s

GREETINGS AND THANK YOU for taking part in the DONNA Marathon Weekend

e define ourselves by what we shine a light on and celebrate. Together, we are shining a light on the search for new solutions for breast cancer while also celebrating the lives impacted and advances in patient care achieved. Thank you for being part of this wonderful effort and for supporting excellence in clinical care fueled through advances in research and innovation. One of the wonderful parts of my role is that I have the privilege to witness firsthand the curiosity, drive and commitment of our physicians and research teams as they are advancing the capabilities and delivery of cutting-edge patient centered care. Incredible things are happening at Mayo Clinic each day because of the strong collaboration between our physicians, researchers, educators and allied health staffâ&#x20AC;&#x201D;and because they have the support of organizations like the DONNA Foundation and individuals like you! Here at Mayo Clinic, our primary focus is that the needs of the patient come first. Patients and their families come to us from across the U.S. and from around the world to obtain hope and healing that is supported by clinical innovation and excellence. That is why Mayo Clinic is actively pursuing research and developing innovations that we are translating into real solutions for patients. Some of their stories are shared in this issue. We greatly appreciate the support of all our friends and benefactors. On behalf of all patients, thank you, and enjoy the DONNA Marathon Weekend!

Sincerely, Kent R. Thielen, M.D.

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LEADING THE WAY Mayo Clinic continues to transform health care in Northeast Florida

or more than 30 years, Mayo Clinic has been a catalyst in advancing the future of medicine in Northeast Florida.

The past year has been momentous for Mayo Clinic, which welcomed a new leader to head the prestigious health care institution. Kent Thielen, M.D., (TEE-Lin) was elected as vice president, Mayo Clinic, and CEO of Mayo Clinic in Florida, succeeding Gianrico Farrugia, M.D., who was elected as president and CEO of Mayo Clinic after leading Mayo’s Florida campus for the past four years. “Mayo Clinic is committed to shaping the future of medicine as the premier destination medical center in the Southeast,” Dr. Farrugia says. “We aim to meet the growing needs of our patients and advance the discovery, translation and application of innovative solutions to address

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serious and complex health issues.” Serving more than 119,000 patients from all 50 states and more than 80 countries, Mayo Clinic remains steadfast in its mission to transform health care in the region, while staying true to its fundamental principle: providing the highest quality care to every patient. Dr. Farrugia credits Mayo’s 6,400 employees in Florida, which includes 500 physicians and scientists and 300 residents and fellows, for helping advance Mayo’s reputation as a leader in the diagnosis and treatment of patients in all specialties including surgery, individualized medicine, neurosciences, cancer, solid organ transplantation, digestive diseases and cardiovascular diseases. Under Dr. Farrugia’s leadership, Mayo Clinic was named the best

hospital in Florida in U.S. News & World Report's Best Hospitals rankings for the past three years. In 2018, Mayo Clinic continued to expand and invest heavily in people, space and technology. Milestones included the opening of the Dorothy J. and Harry T. Mangurian Jr. Building, a new 190,000-square-foot destination medical center providing patients with integrated services for complex cancer, as well as neurologic and neurosurgical care. In addition, a state-of-the-art positron emission tomography (PET) radiochemistry facility was unveiled that includes a radiochemistry laboratory and a cyclotron—a particle accelerator important in the production of radiopharmaceuticals. The facility will produce Mayodeveloped choline C-11 used in certain PET scans, enabling cancer to be identiﬁed more quickly and

allowing more effective treatment. Floridaâ&#x20AC;&#x2122;s Comprehensive Cancer Center became one of the first in the nation to offer chimeric antigen receptor T-cell therapy (CAR T-cell therapy) for patients with relapsed or refractory B-cell non-Hodgkinâ&#x20AC;&#x2122;s lymphoma and B-cell acute lymphoblastic leukemia in patients up to 25 years of age who have previously failed two or more lines of systemic treatment. This cell-based immunotherapy is one of the most promising new areas of cancer treatment. Several patients have successfully undergone this individualized therapy and are now in remission. Other milestones included the 20th anniversary of the transplant center, which has performed more than 6,000 transplants since its inception, and the expansion of the J. Wayne and Delores Barr Weaver Simulation Center, which offers training and education to staff and the community at large. Additional campus expansion is underway that will further increase clinical space, including new surgical suites and a building dedicated to increasing the volume of lungs available for transplantation.

Through a collaboration with United Therapeutics, marginal lungs will be preserved and made viable for transplant for patients at Mayo Clinic and other centers around the U.S. The facility, which is set to be completed in 2019, will also include space for regenerative medicine research and the Mayo Clinic Life Sciences Incubator. Many new physicians have joined the staff in Florida, including leading experts in brain tumors, epilepsy and seizure disorders, as well as in adult congenital heart disorders. Minimally invasive robotic surgery is now available

for brain tumors, spine problems and urologic issues. In addition to its clinical growth, Mayo Clinic is committed to advancing research and medical education through reinvestment of $1 billion annually in these areas. Mayo Clinic is working to create a hub for the development of biomedical technologies to advance research as an economic driver for the region and to bring new solutions to patients worldwide. Mayo Clinic contributes roughly $2 billion annually to the Florida economy. Q

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PICTURE PERFECT Deciding which screening test is best for you MAGNETIC RESONANCE IMAGING (MRI) MRI also gives doctors a closer look at breast tissue and has the best sensitivity for detecting breast cancer. Mayo Clinic doctors are utilizing MRIs for women at increased risk of developing breast cancer – those who have a strong family history of breast cancer, who are carriers of the BRCA1 and BRCA2 breast cancer gene mutations, who have had prior radiation therapy to the chest, and others.

dvanced imaging plays a key role in early breast cancer detection, helping the 1 in 8 women who will develop breast cancer over their lifetime get the timely and individualized treatment they need. 3D mammography, molecular breast imaging and magnetic resonance imaging are all part of the comprehensive diagnostic services offered at the Robert and Monica Jacoby Center for Breast Health at Mayo Clinic in Florida, the only academic breast center to offer integrative breast medicine in Jacksonville.

3D MAMMOGRAPHY All patients are encouraged to have a 3D mammogram at their yearly screening appointment. Also known as tomosynthesis, this advanced

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imaging test obtains approximately 300 images as compared to the four images captured during a 2D mammogram.“A 3D mammogram allows us to be more accurate in our ability to detect and diagnose breast cancer and results in fewer false alarms,” says radiologist Robert Maxwell, M.D.

MOLECULAR BREAST IMAGING (MBI) Nearly half of all women have dense breast tissue. Because dense breast tissue and breast cancer both look white on a mammogram, detecting cancer can be limited in patients with dense breasts. Molecular breast imaging is designed to overcome this limitation of mammography. Primarily developed at Mayo Clinic, this test uses a radioactive tracer and special camera to see differences in the activity of the breast tissue. Tissue that contains rapidly growing and dividing cells, such as cancer cells, appears brighter than less active tissue.

“When we screen a thousand women with 2D mammography, approximately four breast cancers are detected,” Dr. Maxwell says. “When we use 3D mammography, it detects another one to three cancers per thousand women. With molecular breast imaging, we detect an additional eight to nine cancers per thousand women. And with MRI, the most sensitive test, we can detect up 13 to 17 more cancers per thousand women.” For women with an average risk of breast cancer, the American College of Radiology and Society of Breast Imaging recommend annual screening mammography beginning at age 40. Women with an elevated risk of breast cancer may beneﬁt from annual screening mammograms before age 40, as well as from MBI or MRI. Dr. Maxwell recommends all women talk with their doctor about their risk factors for breast cancer and decide which screening test is best for them. The breast health specialists at Mayo Clinic are also available to provide individualized breast cancer risk assessments and recommendations for breast cancer screening. Q

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Dr. Keith Knutson with research assistants

QUEST FOR HOPE Mayo Clinic scientists leading anti-cancer vaccine research

hen Stacy Hanson (pictured below) learned she was pregnant at 43, she was thrilled. But just after her daughter turned 2, she got news no mom wants to hear. She had breast cancer.

Convincing herself it was no big deal, Stacy went alone for the mammogram and ultrasound that followed. A biopsy revealed the truth—and she began her quest to get rid of her disease for good. The first place that quest led her was Mayo Clinic.

clinical trial at Mayo Clinic that has reduced her tumor by 96 percent. Now, she’s on a mission to educate others about breast cancer and help raise awareness and funds for cancer research.

She underwent genetic testing, surgery, chemo-therapy and radiation therapy. Then, last year, just as Stacy was beginning to settle back in to life with daughter Lucy, she had a recurrence. Her breast cancer had spread to her liver, but the tumor type had also changed. Stacy now had triple-negative breast cancer, a more aggressive form of the disease.

Treating breast cancer has long involved addressing two problems: the elimination of cancer cells from the tumor and potential disease recurrence. The key may be to harness the full capabilities of the body’s immune system to do both jobs.

Thanks to advancements in research, Stacy was able to join a

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NEW VACCINES ON THE HORIZON

On Mayo Clinic’s Florida campus, a team of researchers is studying a potential anti-cancer vaccine aimed at helping the body resist the return of Human Epidermal Growth Factor

Receptor 2 (HER2) breast cancer. The vaccine is intended to be used in combination with Trastuzumab, an immune-stimulating drug given to women following HER2 tumor removal surgery. If it works, the vaccine will address the return of the cancer, which can be hard to treat once it spreads to other parts of the body. Mayo Clinic researchers are addressing this unmet need of patients and received a grant of $11 million from the Department of Defense in 2018 to advance clinical research on the vaccine. The combination approach will engage two types of immune cells. Trastuzumab works by activating the immune system’s B-cells, which look for and attack breast tumor cells with HER2 proteins on the surface. The new vaccine stimulates another group of cells in the immune system, long-lasting T-cells that “remember” the proteins and promote resistance to the recurrence of the disease. “The vaccine provides a prevention strategy to deter cancer reformation,” says Keith Knutson, Ph.D., a Mayo Clinic immunologist who is principal investigator of the study. “The body’s T-cells and B-cells synergize with each other for a strong, durable, immune response.”

NEW VACCINES ON THE HORIZON Each year, more than one million women have biopsies that show non-cancerous changes in the breast, known as benign breast disease (BBD). Even though the changes may not require treatment, studies over the years at Mayo Clinic and elsewhere have found that not all cases of BBD are the same, and some will go on to develop breast cancer. “The real challenge has been determining a woman’s individual risk for developing breast cancer in order to provide them with the best possible intervention,” says Mark Sherman, M.D., of epidemiology and laboratory medicine and pathology on Mayo Clinic’s campus in Florida.

risk for cancer. The hope is to provide women with highly individualized options.

HOPE FOR A BRIGHTER FUTURE As for Stacy, she says she’s thrilled to know Mayo Clinic is working on new therapies that may one day be available to her. For now, she savors each moment with her family. “When I was first diagnosed, I didn't think I would be around to see my daughter start kindergarten. Now she has started firstgrade," she says. “Based on where I'm at today, I could be here for another 40 more years.” Q

An interdisciplinary team at Mayo, with the help of a $3.1 million grant from the National Cancer Institute, a division of the National Institutes of Health, aims to predict which women with BBD are at risk for breast cancer. Research will involve developing a breast cancer risk prediction model to help guide clinical care. The model will take into account demographic factors, as well as recent research about features of breast tissue that may heighten the YOURHEALTH

CONQUERING CANCER A conversation with Roxana Dronca, M.D., on the future of cancer care

oxana Dronca, M.D., was an aspiring cardiologist when she graduated from medical school and started her residency training. When she met her first cancer patient, during an oncology rotation, everything changed. “Even after the rotation, I kept returning to the clinic to connect with those patients,” says Dr. Dronca, who now leads the Division of Hematology and Oncology at Mayo Clinic’s campus in Jacksonville. “I was amazed at how brave they were, and I wanted to help them. That brought me to my career, and if I were to start over, a hundred times, I’d make the same choice.”

Q. You sometimes compare cancer treatment to a marathon. Is that because cancer treatment is a lengthy process? Cancer treatment is an endurance test for patients and their loved ones. But I like to think of it as a marathon because we work with patients to plan every phase of the treatment—every segment of the race, if you will—to get them to the finish line successfully and back to their lives.

“We’ve shown that we can nearly double the response that patients have to certain therapies when we time the treatment with the activity of their immune systems,” she says.

Q. To continue the “marathon” metaphor, how have your “race” strategies changed over the past few years. Treatment is becoming much more personalized. For instance, I see four patients with melanoma in one afternoon. Each of them will have an individualized treatment plan because they are each different people, with different health problems, and their cancers, while all melanomas, have different features. We now have the knowledge and tools to use all of this information to prescribe not just the specific treatment for each patient but also different sequences of treatments that will work best for each patient.

Those results and other research are creating new possibilities for personalizing cancer care and for treating patients who have very advanced cancers. Dr. Dronca

These new tools and strategies have helped us make some tremendous advances in survival rates. For patients with stage 4 melanoma, for example, the average survival before

It’s a choice that’s benefited her patients and the cancer research field. Dr. Dronca is especially interested in the immune system’s role in battling cancer. Her research shows that—like many other parts of the body—a patient’s immune system has a cyclical rhythm. And delivering cancer treatments in harmony with that rhythm can produce dramatic results.

shares more about her passion and focus for the future of cancer in this Q&A.

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2011 was six months. Now, it’s more than three years and I have several patients who have lived much longer and are disease free. Q. You just described an example of “precision medicine,” but your focus is immunotherapy. Are those two different concepts? They work hand-in-hand. Much of my research is devoted to understanding a patient’s immunological background and how we can use that to personalize treatments. But targeted therapies or precision medicine, if you will, usually target features of a person’s tumor. In immunotherapy, we’re working with the patient’s immune system to help it better recognize the cancer and attack it. Our goal is to combine these and other strategies to develop comprehensive treatments that work for the whole patient. Q. Why is immunotherapy so exciting to you? I’ve seen it work in my own practice and research. Cancers have mechanisms that enable them to hide from a patient’s immune system. In 2010, we launched a clinical trial of a drug that blocked one of these mechanisms—they’re called checkpoint inhibitors. The results were amazing. We tested the drug in patients who had stage 4 melanoma that couldn’t be treated with surgery or radiation; patients who really had no other option and about a five percent chance of

surviving three years. I have patients from that clinical trial who are still alive today and show no evidence of disease. And every day I’m seeing success stories like that here at Mayo Clinic. Q. What’s on the horizon for cancer care? I think immunotherapy has proven to be the breakthrough of the decade—maybe even bigger. The scientists who discovered checkpoint inhibitors recently won the Nobel Prize. But the future is multidimensional. We’re working very hard at Mayo Clinic to develop treatments that are more effective and less toxic, that reduce the rate of recurrence and improve the rate of long-term complications. We’re also trying to understand why some of these breakthroughs only work for some patients and how we can help more patients benefit. Q. What is most satisfying about the work you do? My patients and the transformation that has occurred in survival rates during the past decade. On any given day, I have quite a few patients who are doing very well and have managed to conquer their disease and regain their purpose in life. I enjoy the personal connection I make with them and working with bright minds across Mayo Clinic to improve their care. Each of my patients has their own story, but so many times, it seems like cancer brings out the best in them. They work harder to be there for their family and loved ones and survive cancer. Q. Do you think we’ll see a cure for cancer in your lifetime? Yes, I do, and I think it will come sooner than we expect. Q

Dr. Roxana Dronca

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LIFE WITHOUT

CANCER

A fighting attitude, novel treatment and research gives breast cancer survivor excitement for the future

year ago, Hollis Youngner was hoping to run/walk the half marathon as part of the annual DONNA Marathon Weekend events. But the side effects from her ongoing battle with metastatic breast cancer left her more fatigued than she expected.

But thanks to Mayo Clinic’s collaborative care and innovative research, Hollis currently has no active cancer and is enjoying everyday moments with her husband Josh and 8-year-old daughter Hayes.

“

“Herceptin was a game changer for me. If I was diagnosed ten years earlier, before it came out, I probably wouldn’t have made it this far,” says Hollis. Though side effects plague her daily, Hollis is excited for the future,

The doctors, nurses, techs… everyone is amazing and I have so many people to thank, but especially the researchers, because I don’t think I would be here without them.”

Knowing she’s not one to sit on the sidelines, Hollis’ family and friends arranged for a special wheelchair to ensure she could complete the race right along with them. “It was another amazing day but this year, my goal is to walk along with them,” says the Georgia native, 38, who was first diagnosed in 2012 with HER2+ breast cancer, a type of cancer that accounts for about 15 to 20 percent of all cases annually and typically affects younger women. HER2+ tends to be more aggressive and spread more rapidly than other types of cancer. To date, Hollis’ cancer has spread to her lymph nodes, to her heart, lungs, liver, brain and chest wall.

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—Hollis Youngner

“Mayo Clinic is my dream team,” says Hollis, who in the past seven years has received more than ten different types of chemotherapies, immunotherapy and targeted drugs. “I never thought of going anywhere else.”

‘BEST YET TO COME’ For the past year and a half, Hollis has traveled weekly to Jacksonville for infusions of targeted drugs, including Herceptin, which has been shown to significantly reduce recurrence in HER2+ patients. Mayo Clinic led the world’s largest study showing the drug offered better outcomes compared to other therapy.

especially learning about the advances being made daily at Mayo Clinic’s Breast Cancer Translational Genomics Program, which was born from donated DONNA funds. “I believe the best is yet to come—for me and for others, especially with the vaccines the research team is working on. Mayo gave me a second chance at life and I believe they will find not only a cure but a way for others, like my daughter, to never have to know cancer.” In the meantime, Hollis will lace up her sneakers for the annual DONNA and cheer on her dream team. Q

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RUNNING TO VICTORY

Mayo and DONNA leading the charge against cancer

or participants of the annual DONNA races, crossing the finish line is more than a personal achievement. It’s also about hope and the opportunity to accelerate new treatments for breast cancer at Mayo Clinic. What many racers may not know is that advances are already changing the outlook for those with breast cancer, thanks in part to the more than $3.25 million that has been granted to Mayo Clinic for breast cancer research.

The funds helped establish the Mayo Clinic Breast Cancer Translational Genomics Program, a Jacksonville-led research team dedicated to turning genetic findings into treatments. Using rapid sequencing, researchers are now able to compare entire genomes and detail the genetic

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profiles for the various subtypes of breast cancer.

significant role in advancing breast cancer treatment.

INDIVIDUALIZING TREATMENT IS THE FOCUS

TRANSFORMING MEDICINE AND SURGERY

Researchers’ understanding of breast cancer has dramatically changed in recent years and that allows the focus for continuing work to be on individualizing therapy for each patient. “Our goal is to individualize and personalize treatment for breast cancer by identifying genetic pathways and markers in each patient,” says the program’s co-director, E. Aubrey Thompson, Ph.D.

As a result of work being done locally, for instance, researchers determined a vaccine-prompted immune response can effectively target triple-negative breast cancer, an aggressive type of tumor that eludes standard treatments. The findings enabled Mayo Clinic to earn a $13.3 million federal grant to develop the first-ever vaccine clinical trial for this type of cancer. Now, up to 300 recently diagnosed women can enroll in the Phase II clinical trial at Mayo Clinic in Jacksonville and multiple sites across the country.

“Funding from the DONNA events make it possible for our research teams to pursue early-stage ideas,” says principal investigator Keith Knutson, Ph.D., noting that immunotherapy is playing a

A second vaccine trial against premalignant cells known as ductal

carcinoma in situ is also in development. “For these patients, if this vaccine is successful, it could replace current treatments of radiation and surgery,” says Dr. Knutson.

GENETIC VARIABLES AND NORMAL CELLS In addition to identifying immunotherapy treatments, researchers are learning about variations in women’s genomes that can alter treatment outcomes and may help to predict how women will respond to certain therapies. One study found the genes of immune response can affect the risk of relapse in women with HER2-positive breast cancer. Another, detected genetic instability within a particular class of estrogenreceptor positive breast tumors that may contribute to cancer recurrence.

“These studies are important because they will ultimately help us assess a woman’s personal risk of disease and decide if they need more aggressive treatment,” says Dr. Thompson. Researchers are also looking at the role that normal cells play in conjunction with how cancer cells

Dr. E. Aubrey Thompson

react to new drugs. “In order to understand why cancer therapy sometimes works and sometimes fails, we need to understand how normal immune cells interact with cancer cells,” says Dr. Thompson. “And if we are going to develop new treatment strategies, we need to figure out how to

influence these cancer cell/immune cell interactions.” Supported by funds from the DONNA, Mayo Clinic investigators are now collaborating with a life sciences company to test an emerging new technology that will, for the first time, allow them to precisely define the biological interactions between tumor cells and immune cells. Mayo Clinic is one of four sites worldwide to apply a novel profiling application that researchers hope will help predict therapeutic outcome. “The information we glean will be particularly valuable for evaluating new immunotherapies to reduce breast cancer mortality,” says Dr. Thompson. “The collaboration and technology would not have been possible without the DONNA.” For more information on the translational genomics program or cancer clinical trials at Mayo Clinic, visit mayoclinic.org/breastcancer or call the Clinical Trial Referral Office at 1-855-776-0015. Q YOURHEALTH

THE CHOICE

IS YOURS

Treatment options help women with breast cancer live better quality of life

omen in the U.S. have a 1-in-8 risk of being diagnosed with breast cancer, according to the American Cancer Society. And if you or a loved one hears the words,“You have cancer,” it can be a heart-stopping, gutwrenching moment since historically, many women did not survive. But today, thanks in part to increased awareness and, of course, improved technology, women with breast cancer are being cured and living longer. According to the National Cancer Institute, the five-year survival rate for women with breast cancer is almost 90 percent. The institute also estimates nearly 4 million breast cancer survivors by the year 2024. “Today, breast cancer survival rates are high. With treatment advances today, we can now strive to individualize treatment plans for each patient with the goal of ensuring a better quality of life and outcomes,” says Mayo Clinic breast surgeon Sarah McLaughlin, M.D., and director of the Robert & Monica Jacoby Center for Breast Health. Dr. McLaughlin says it’s important to learn the specifics about your cancer because that will influence your treatment options and ultimately, may impact your long-term survival. “Many women are under the

YOURHEALTH

impression that all breast cancers are the same. But in fact we now know that not all tumors are alike, which is why there are many treatments out there,” she explains. Dr. McLaughlin suggests asking about the size, location, and histological features of your tumor. “Also ask about the tumor’s hormone receptor status and if the tumor carries the HER2 protein. All of these factors may influence your treatment options and the information can guide you in making decisions with your care team,” she says.

WHICH SURGERY HAS A BETTER OUTCOME? “In terms of survival, lumpectomy and mastectomy show equivalent survival rates long-term but one option may be better for you than another,” Dr. McLaughlin says. Which surgery you choose—a lumpectomy or mastectomy— should be based on the size and location of the tumor, the shape of your breast, family history and personal preference, she says. Dr. McLaughlin also suggests talking to your care team about all the factors upfront—including reconstruction options.“There are many choices today for reconstruction and that may also influence what surgery you choose or what order treatment occurs,” she says.

Choosing an integrated multidisciplinary care team—like the one at Mayo Clinic’s Jacoby Center for Breast Health—offers significant benefits, as all the clinicians involved in a patient’s care—from the oncologist and radiation oncologist to the surgeon, plastic surgeon, and even nutritionist—are in communication before, during and after treatment.

AFTER TREATMENT ENDS Finishing breast cancer treatment doesn’t mean the end of care. “While we need to focus on the treatment and cure of our patients, it’s just as important that we address the future,” Dr. McLaughlin says. “With so many more women surviving breast cancer, we want to find ways to reduce the risk of recurrence and minimize side effects and issues that may arise post-treatment.” Dr. McLaughlin stresses the importance of monitoring survivors after therapy concludes since some issues might not arise for five, ten, or even 20 years later. And that, she says, is the value of the Mayo Clinic’s Survivorship Program. “Survivors may find themselves dealing with an array of post-treatment concerns including lymphedema (swelling of the arms), fatigue, sexual side effects, weight gain, or even long-term breast pain or joint pain as a result of treatment.

Dr. Sarah McLaughlin

Others may experience gynecologic issues, osteoporosis or other pain as a result of medication,” she says. “Our goal is to limit those life-long effects of breast cancer care and help them survive longer and with a better quality of life.”

Through its collaborative care model, Mayo Clinic offers patients integrative services such as acupuncture, massage and nutrition consultations.“We work with patients to ensure we can provide the right treatment but also the right services to have a good quality of life for the

long-term,” Dr. McLaughlin says. To learn more about Mayo Clinic’s Center for Breast Health, integrative medicine and health offerings or the Survivorship Program, call (904) 953-0707 or visit

www.mayoclinic.org/breastcancer. Q

YOURHEALTH

MOVING BEYOND CANCER Breast reconstruction helps women feel whole again RECONSTRUCTION WITH IMPLANTS This type of reconstruction, which usually involves two surgeries, requires less hospital and recovery time. During the first procedure, performed at the time of the mastectomy, the surgeon places a tissue expander that looks like a small balloon behind the chest muscle and supports it with a tissue matrix.

Dr. Brian Rinker

s survival rates for breast cancer have increased significantly, there is a renewed focus on improving a survivor’s quality of life, in particular, having the best possible and most natural reconstruction.“This is so important for a woman to feel whole again and move beyond the fact that she had cancer,” says Brian Rinker, M.D., chair of Plastic and Reconstructive Surgery at Mayo Clinic’s Florida campus. Mayo Clinic offers the full range of immediate reconstruction options—enabling women to have a positive body image and improved self-esteem after surgery. “Most patients are good candidates for multiple types of reconstruction. There are lots of factors to consider including surgery and recovery time, the number of surgical stages, and trips required to the clinic, as well as medical factors like whether they will require chemotherapy or radiation,” Dr. Rinker says. “We take the patient through each type of reconstruction in detail and help them choose the best option for them.”

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Normally, a patient would need to come back weekly for the next four to five weeks to have saline injected into the expander to stretch the chest skin and make room for the permanent saline or silicone implant. One of the latest innovations offered at Mayo Clinic is a self-expanding device that requires fewer office visits. “Basically, the patient uses a remote that releases a controlled amount of gas into the expander,” Dr. Rinker says.“It can be done at home; so, it’s great for destination patients, saving them a lot of travel time.” The expander stays in place for several months after the last saline or gas expansion. Then a second surgery is performed to replace the expander with a permanent implant. The silicone implants used at Mayo Clinic are filled with a cohesive gel, which prevents leakage in the event of rupture.

the lower abdomen to the chest and uses a microscope to connect the tissue flap to blood vessels in the chest or armpit. There’s no loss of abdominal muscle tone and it has the effect of a tummy tuck because of the excess tissue that’s removed. “The psychological advantage of reconstruction can’t be overstated,” Dr. Rinker says. “One of the innovative things we’re doing at Mayo Clinic is innervated DIEP flaps where we’re identifying a nerve that supplies sensation to the abdominal tissue and attaching it to the nerves in the chest to provide sensation to the skin of the new breast.”

NIPPLE AND AREOLA RECONSTRUCTION Three months after a permanent implant is in place or three months after tissue flap reconstruction, patients can choose to have nipple and areola reconstruction. Skin from the new breast is used to remake a nipple. After the nipple heals, a tattoo can color the nipple and the circle of skin around it, the areola. A 3D tattoo can also be used to create the nipple in place of reconstruction. “It creates a picture of a nipple that looks realistic, but lacks the 3D shape of the nipple and the texture of the areola,” Dr. Rinker says.

LOOKING AHEAD RECONSTRUCTION WITH YOUR OWN TISSUE Using a patient’s own tissue to reconstruct the breast is called a tissue flap and can provide a more natural look and feel. During a DIEP flap (deep inferior epigastric perforators) the surgeon moves a section of skin, fat and blood vessels from

A common complaint for women who have undergone mastectomy, lymphedema is a swelling in the arm on the side of the breast cancer surgery due to the removal of all of the lymph nodes in the armpit and an accumulation of lymphatic fluid. “In addition to having a multidisciplinary team that includes medical

and surgical oncologists, it’s important to have a plastic surgeon focused on what your quality of life is going to be as a survivor,” Dr. Rinker says. About 20 percent of all breast cancer patients develop lymphedema, but sometimes it doesn’t develop for months, or even years after treatment. “We’re looking at ways to identify patients who are at high risk for lymphedema and treating them preventively with a lymphevenous bypass at the same time as their mastectomy and reconstruction, ” Dr. Rinker says. “We have ongoing clinical trials as to who will benefit from these interventions.” During a lymphovenous bypass a surgeon essentially re-routes part of

the lymphatic system to help fluid flow, thus reducing swelling and pain. The procedure involves making a few small incisions just underneath the dermis of the skin in the arm. Then, using a microscope to connect a small lymphatic vessel and a small vein to bypass the blockage and allow the excess fluid to drain properly. “Mayo Clinic is one of a few centers in the country offering patients this minimally invasive surgery which has been shown to significantly improve a patient’s quality of life,” Dr. Rinker says.

OPTIONS AFTER RECONSTRUCTION For women who’ve had a lumpec-

tomy, radiation or reconstruction but are not completely happy with their results, options may be available to help them look and feel better. For example, a patient who has only had one breast treated with lumpectomy and radiation may have smaller or differently shaped breasts. However, she may be eligible for fat grafting. Using liposuction, a surgeon collects extra fatty tissue from the abdomen and injects it into the breast that had the lumpectomy to obtain a similar size to the other, non-treated breast. Having a breast reduction or lift on the untreated breast is another option women can consider. “We want our patients to look at themselves in the mirror and see themselves as a whole person,” Dr. Rinker says. Q YOURHEALTH

BREAKING THROUGH Continued growth, innovation and personalized care as Mayo Clinic looks ahead

he needs of the patient come first. That’s what drives research, education and practice, the three shields at Mayo Clinic. Bringing new treatments—and hope—to patients everywhere is behind much of the growth happening on Mayo’s Florida campus. New construction and new buildings are visual signs of expansion and change. The medical landscape is also changing. Research is on the forefront to transform the practice of medicine. Indeed, the future of medicine may be found in outer space. Mayo Clinic’s Florida campus established a space medicine program in 2018, with the goal of making research ideas for space travel become a reality. A microgravity pitch competition at Mayo highlighted preliminary space research projects of physician, scientist and

YOURHEALTH

employee teams. Leaders from the space industry, representing Made in Space, Jacksonville, and the Center for Applied Space Technology, were among the judges at the event. One research team is studying new technology that has the potential to continuously monitor an astronaut’s vital signs in space—and could have applications for medical needs on earth. Recently, the team had a successful launch of an experiment on an EXOS Aerospace suborbital rocket from New Mexico. The latest SpaceX-16 resupply mission took off from Kennedy Space Center in December, with Mayo Clinic researchers sending a large sample of stem cells to the International Space Station to investigate the effects of long-term cosmic radiation that astronauts encounter. One of Mayo’s lead investigators of the study is Abba

Zubair, M.D., Ph.D. Last year, a rocket launch from NASA’s Kennedy Space Center included a payload of several samples of donated adult stem cells from Dr. Zubair’s research lab. Research studies are underway to explore whether these stem cells can be mass produced in microgravity and used for treatment of stroke. Mayo Clinic’s 3-D anatomic modeling program continues to expand, as demand for the models to prepare and plan for surgery becomes more common, including for patients with various forms of cancer. These lifesize models can be valuable tools for surgeons as they decide what approach and techniques will be best for surgery. The models are helpful for procedures that may be new, uncommon or complex, and play an important role in education.

The models, which are created with a printing press that takes information from a patient’s CT or MRI scans, reproduce a specimen so vividly that they are unparalleled educational tools for patients and health care providers alike. In some cases, 3-D models are fashioned out of soft material, so surgeons can practice the surgical technique on the model first—an approach that can increase accuracy during the procedure. Production of biological therapies and a Life Sciences Incubator are slated for the Discovery and Innovation building, which opens on Mayo Clinic’s Florida campus in 2019. It’s a place where startups can collaborate with Mayo researchers and clinicians, offering unparalleled opportunities to drive innovative solutions in health care. The Life Sciences Incubator is expected to

house up to 25 start-up companies. “What we’re trying to do is translate innovation to clinical care, with the principal goal of getting it to patients as quickly as possible,” says Charles Bruce, M.D., chief innovation officer for Mayo Clinic’s Florida campus and medical director of the Life Sciences Incubator. Further fostering innovation and collaboration on campus, the Mayo Clinic Research Office of Entrepreneurship offers a culture of life-science entrepreneurship through education. The office assists Mayo staff members and students with entrepreneurship education, networking opportunities and application support for their innovations. Many of these works begin with research. A number of activities have been organized on Mayo’s Florida campus to create

competition among researchers, physicians and non-clinical staff, in development of patient care solutions for unmet needs. An integrated clinical studies unit will open in the Dorothy J. and Harry T. Mangurian Building in 2019. This dedicated space for early-phase clinical studies will allow Mayo to offer more options to patients, including studies that evaluate new treatments and novel drugs for cancer and other conditions. The fifth floor of the building will include space for research laboratories. Mayo Clinic’s investment in technology, people, and research is aimed at bringing new solutions to patients—to address their unmet medical needs. Q YOURHEALTH

yourhealth

SPORTSMANSHIP 1. Dramatis personae 5. A lot 10. Vamoose 15. Uttar Pradesh city 19. Exchange fee 20. Kind of grass 21.— -ho 22. Farm building 23. Rent 24. Willow rod 25. Speaker of the quip at 27-Across: 2 wds. 27. Start of a quip: 3 wds. 30. Alphabetized list 31. Trees 32. Bridge support 33. Wildebeest 34. Like a night sky 37. Bank heist 39. Lamp fuel: Var. 44. Sensational 45. Intimidated 46. Schwarzenegger role 47. Gear 48. Pilaster 49. Be undecided 50. Part 2 of quip: 2 wds. 52. Blabbermouths 54. — da gamba 55. Onomatopoeic word 56. A palindrome 57. Eskers 58. — Fe Trail 59. Surrounded by 61. One-armed bandits 63. Salt and strip 64. Follower of an Indic faith 65. A Euro predecessor 67. Cynical 68. Flightless bird 69. Bounder 72. Lab device 73. Parts 74. Movie buff 76. Part 3 of quip: 3 wds. 79. Walked up and down, back and forth 80. Greek weight 81. — and outs 82. Coin 83. Called, in a way 84. “Kate & —” 85. Drunken ones 87. Got along 88. Invaders from Mars 89. Charged particle 90. Simple 91. Took legal action 92. Pumps 95. End of the quip: 3 wds. 102. Make holy

BY JAMES BARRICK

ACROSS

© 2019 United Feature Syndicate, Dist. by Andrews McMeel Syndication 104. Pith helmet: Var. 105. Yep 106. Touch on 107. Grows dim 108. Genus of water birds 109. — Kett of old comics 110.Sub — 111. On the left 112. Rude looks 113. What's done

1. Old Roman statesman 2. Old Greek contest 3. Father 4. Of barbering 5. Spine-chilling 6. — fortuitus 7. A dye 8. Conked out 9. Fighter

DOWN

10. Bathe 11. Chavez or Millan 12. Risque 13. Actress Gardner et al. 14. Coco-de- — 15. Small drupe 16. Aurum 17. Took the bus 18. Ne plus ultra 26. Ryder the actress 28. Impenetrable 29. German art song 33. Steffi of tennis 34. Blackboard 35. Audio component 36. Naivete 37. Jacket 38. Dazzles 39. Kangaroo bear 40. New-age singer 41. Utterly simple 42. “Nanny” butler

Turn to page 6 for this month’s answers

43. Where Memphis is 45. Beverages 46. Curdles 49. “— la vista, baby” 50. Ached 51. Footnote abbr. 53. Bout of drinking 54. Windmill sails 58. Parties 59. Lent a hand 60. L-Q link 62. Spare 63. East Indies archipelago 64. Perfected 65. Lapwing, a bird 66. Peoples: Prefix 67. Saint- — -wort 68. Chopped 70. A purgative 71. Removes 73. Let 74. “La — aux Folles”

75. Vacationed 77. Defy 78. A noble gas 79. Fatherly (or motherly) 83. — -mutuel 84. Douglas-Home or Waugh 86. Snooze 87. Least 88. Hand tools 90. Device in a hack 91. Show scorn 92. Cicatrix 93. Bindlestiff 94. — probandi 95. Carriage 96. Saintly radiance 97. — the wiser 98. — dixit 99. Nerve network 100. Escort 101. Food fish 103. Books pro

C R O S S W O R D

kid stuff

Night to remember

MATH-letes Educators, scientists, robots and more gather for the seventh annual Florida STEM and Health Expo on Saturday, February 9, 10 AM2 PM, at the main campus of River City Science Academy on Beach Boulevard. More than 100 display tables will be set up with various STEM (Science, Technology, Engineering and Math) projects and hands-on activities at the Expo, a free event that allows Science Academy students to get a chance to showcase their ideas in a fun and unusual way.

THE PLAY’S THE THING Written by Al Letson, a nationally known poet and host of the NPR radio broadcast, Reveal (heard locally on WJCT-FM), the anti-bullying play Chalk centers around a group of kids making the transition to middle school. rough poetic monologues, the play highlights the inner voices of kids who are trapped in a society where bullying is tolerated in schools and on social media. Chalk is presented on Tuesday, February 5, 10 AM, at the Florida eatre. A select number of general public tickets are available for $10.

YOURHEALTH

February 8th marks the fifth anniversary of Night to Shine, a prom night experience for people with special needs, ages 14 and older. Created by the Tim Tebow Foundation, the event has become a worldwide movement with more than 200,000 volunteers and some 100,000 guests gathering in 23 countries. Guests receive the royal treatment with gifts such as prom favors, corsages and boutonnieres, dinner and dancing. “The vision for Night to Shine is to love people with special needs, it’s to bring the church together and to ultimately change the world through the eyes of people with special needs,” says foundation founder Tim Tebow. “As I reflect on how far Night to Shine has come, I am just so thankful for every host church, volunteer, sponsor and donor who has answered the call over the past five years.”

USTINE

NINTH ANNUAL

A M E LI A I S

JACKSONVILLE MAGAZINE’S

ST. A

2019

CKS

L ONVIL

WHOSE CUISINE WILL BE NAMED SUPREME?

6 12 24 400

TEAMS COURSES CHEFS GUESTS

GRAND CHAMPION

2019’s Four-Dinner Series of plate-vs.-plate competitions starts in April

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Spring

healthy happenings

Turmeric Workshop

Northeast Florida Veg Fest

GastroFest

Turmeric Workshop From spices to medical applications, the benefits of turmeric have been sweeping across the Internet the past few years. is workshop covers the how and why of all the benefits the spice (a member of the ginger family) brings and how to incorporate it into one’s daily life. With recipes such as turmeric energy balls, this vegan-friendly workshop will enhance participant’s knowledge of this ancient secret. $33. Cultivate Jax. February 17, noon-2 PM. 904tix.com Northeast Florida Veg Fest Vegan eats, live music, a beer garden, cooking demonstrations, earth-friendly vendors, kids play zone, a pie-eating contest, scavenger hunts—all this and more will be on hand for the eighth annual Northeast Florida Veg Fest, set for March 2, 11 AM-6 PM, in Riverside Park. Hosted by Girls Gone Green, a local nonprofit group dedicated to exploring environmental, animal and health issues, the event is free and pets are welcome.

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Gate River Run

Gate River Run e 42nd annual Gate River Run rumbles through downtown Jax once again the morning of March 9. e 15K race across two bridges is the main attraction, as is some $56,000 in prize money. ere’s also a few other races associated with the event, including a 5K and Diaper Dashes for the little ones. Look for 12 live bands to be playing along the 15 kilometer route. And stick around for the post-race party, proudly featuring more than 100 kegs of Miller beer. Cheers to that!

GastroFest GastroFest is an all-day celebration of all that’s good to eat in Northeast Florida. A foodie’s marketplace, tasting events, educational talks and more take over Friendship Fountain Park on March 23, 11 AM-7 PM. Admission is free, with individual tastings ranging from $1-$3. One of the organization’s goals is to promote healthier eating by highlighting local foods and by expanding palates in kids and adults.

JACKSONVILLE MAGAZINE’S 2018-2019

TOP

DENTISTS

A Smile Resort Rod Zimmerman, DDS

Christopher M. Geric, DMD, PA Geric Endodontics

Sean M. Altenbach, DMD

Harbour Dental Care Kevin W. Snyder, DDS Christina Choe, DMD Liset Perez, DDS

Asap Dental Care Behzad Rajaei, DDS, MS Nadeem Ahmed, DMD

Rick K. Harrison, DMD, PA Asap Total Dental Care Yevah Cueto, DMD Cynthia Skigen, DMD Bartram Dental Center Jason D. Lewis, DDS, FAGD Royce Barlow, DMD Beaches Orthodontics Shreena Patel, DMD, MS Beaver Dental Care Zan Beaver, DMD The Carlson Group Richard Carlson, DMD Richard C. Caven, DMD Cavka Dental Center Aida Cavka, DMD

Dopazo Orthodontics Leandra Dopazo, DDS, MS ECCELLA Smiles W. Scott Wagner, DMD, LVIF endodontics | bartram park Daniella S. Peinado, DDS Family Smiles Dentistry Stephanie Mapp, DMD

Corey Young Park, DMD Parkway Prosthodontics Kathryn E. Ryan, DDS, MS

Henley & Kelly C.J. Henley, DMD

Gene R. Patch, DMD / Michael E. Patch, DDS

Hidden Hills Family Dentistry Paul Schloth, DMD

Platock Dentistry Leslie G. Platock, DDS

Hodges Family & Cosmetic Dentistry Blanca Martinez-Hoppe, DMD, PA

Ponte Vedra Premier Dental Michael C. Winter, DDS Kevin L. Neal, DDS Andrew W. Maples, DMD Brian W. Maples, DMD

Karen A. Hubbard, DDS The Jacksonville Center for Prosthondontics and Implant Dentistry William Gielincki Jr., DDS Noel Rodriguez, DMD, MS

Jeffrey S. Prieto, DDS Clive B. Rayner, DMD Harris L. Rittenberg, DMD

Jacksonville Dental Specialists Richard E. Aguila, DDS, MHS Matthew Nawrocki, DMD, MS

River Run Smiles Austin Fowler, DMD

Jacksonville Gentle Dentistry Holly Nadji, DMD, PA

Riverside Dental Michael Spencer, DDS Megan Moshea, DDS

Stephen D. Cochran, DMD Doctors Lake Family Dental Dayn C. Boitet, DDS Lauren Andreolas, DMD

Meymand Oral Maxillofacial Surgery Samira Meymand, DDS / MPH

Jacksonville Smile Center Matthew J. Henry, DDS, FAGD Joy Orthodontics Jessica T. Crews, DMD, MS Mitchell R. Levine, DMD, MS Larroc Dental Anthony R. Corral, DMD Lazzara Orthodontics John Lazzara, DDS

James L. Schumacher, DMD Barry P. Setzer, DDS Smile Stylist® Jason Olitsky, DMD, AAACD Flavio M. Soares, DDS Barry H. Stevens, DDS

Farnham Dentistry MacKenzie Farnham, DDS

Mandarin Dental Professionals Sam N. Hanania, DMD, FAGD Laura M. Weaver, DMD

Vanover Dentistry of Orange Park Michael D. Vanover, DDS

Fernandina Smiles Robert Friedman, DMD

Martinez Dental Solutions Jose M. Martinez, DMD, PA

Claudio H. Varella, DDS, MS Varella Endodontics, PLLC

Fishman Pediatric Dentistry Ross Fishman, DMD, MS

Medure Dental Jillian Medure, DMD

J. Christopher Williams, DMD, LVIF, FAGD

These & other professional profiles are posted at JacksonvilleMag.com

in the news

They’re

Expecting

MEND THE MIND Four ingredients. at’s all it took for Jacksonville neuroscientist Daryl Jones, founder of Jonescientific, to create a first-of-its-kind product, a capsule called Sophrosyne, which delivers cognitive enhancing properties and, according to its proponents, could revolutionize the brain game. rough years of researching and testing the effects of hundreds of natural products in search to improve memory and cognition-building properties, Jones found that these four ingredients to be the most effective. Withania somnifera regenerates damaged brain cells. Curcumin showed to help maintain a healthy environment within the brain by removing unwanted proteins. Bacopa monnieri has been shown to enhance cognition and memory as well as decreasing the rate of forgetting new information. Hericium erinaceus has found to increase levels of peptides that are essential for brain cell survival.

A comprehensive renovation of Baptist Medical Center Jacksonville’s maternity suites is now underway, with the goal of providing parents with a high level of care in a comfortable birthing environment. “For decades, Baptist Health has been the number-one choice of mothers to have their babies,” says Michael Mayo, Baptist Medical Center Jacksonville hospital president. “Now we’ll have a redesigned space for our moms and families that’s as impressive as our state-of-the-art care.” A redesigned entrance on the first floor will provide expectant mothers with seamless check-in and evaluation, efficiently minimizing patient wait times and allowing mothers in labor to be seen quickly. In addition, the renovations will include updated birthing suites, postpartum suites and a nursery. Additional features of the project will include multiple TVs in each suite, comfortable sleeper sofas to accommodate family and private bathrooms with ample storage. The $16 million project is slated to be complete in early 2020.

“Our research shows that these four nootropic (cognitive enhancing) ingredients, consumed in a daily capsule, deliver the most impressive results in improving cognition and memory compared to any other supplement available on the market,” says Jones. e product’s developers say it is especially useful for seniors and others looking to sharpen their memory, and for military veterans or athletes who may have experienced frequent hits to the head. e product is expected to hit shelves later this year.

Talk to the Herb When one thinks of modern medicine they are likely to imagine sleek machines and colorful pills. But another approach puts plants at the core of health and healing: herbalism. Local experts and holistic health proponents will be sharing their knowledge at Intro to Herbalism, a class oﬀered at Cultivate Jax. Attendees will delve into the history and ethics of working with the plant kingdom, the basics of using food as medicine, and will learn how to create herbal infusions, decoctions, and tinctures. February 13. $27. 904tix.com

YOURHEALTH

in the news

Run For It Get On Your Feet Just because you’re at a healthy weight doesn’t necessarily mean you’re not at risk for heart disease. University of Florida researchers have found that low levels of physical activity can put healthy weight adults at the same risk for cardiovascular disease as adults who are overweight. “Our study demonstrates that a sedentary lifestyle counters the beneﬁt of being at a normal weight when it comes to heart disease risk,” says lead investigator Arch G. Mainous. “Achieving a body mass index, or BMI, in the normal range shouldn’t give people a false sense of conﬁdence they’re in good health. If you’re not exercising, you’re not doing enough.” The study, which appears in the American Journal of Cardiology, found that 30 percent of U.S. adults at a normal weight are at increased risk of heart attack or stroke. Researchers say that these adults had higher levels of belly fat, shortness of breath upon exertion, unhealthy waist circumference or less than recommended levels of physical activity.

A Spanish tradition with a Jacksonville twist, the Running of the Bulls 5K is a typical foot race, with a pretty big catch—runners are chased by the Jacksonville RollerGirls roller derby team, who act as the “bulls.” An awards ceremony, live music and complimentary food and drink follow the race. Runners are encouraged to wear white in honor of the Spanish tradition, and costumes are welcome. Beginning at 8:30 AM on February 24, tickets for 5K runners vary from $30 to $40 and entry for an accompanying 1K is $20.

HEALTHY HABITS Though January may have come and gone, the Florida Department of Health is encouraging a resolution that will last year-round, unveiling its “60 Days to Better Health Challenge” downloadable tool on its website (ﬂoridahealth.gov). The program is built on the idea that it takes 60 days to acquire a new habit, and outlines a series of resolutions on which to build a healthy lifestyle. Among the new habits to practice: • Eat your colors. Before you eat, think about what goes on your plate, adding plenty of colorful fruits and veggies to every meal. • Drink 8 ounces of water 8 times a day. Water is the body's principal chemical component and comprises roughly 60 percent of a human’s body weight. Every system in the body depends on water. • Engage in 60 minutes of physical activity each day. Regular physical activity helps improve your overall health and ﬁtness, and reduces the risk for many chronic diseases. • De-stress. Using healthy ways to cope with stress and getting the right care can put problems in perspective and help stressful feelings and symptoms subside. YOURHEALTH

SECOND ANNUAL

Jacksonville Lantern Parade presented by

Saturday, February 16, 7-9 PM Northbank Riverwalk, Downtown

JACKSONVILLELANTERNPARADE.COM

Lantern Making Workshops Intuition Ale Works with Butt Hutt Smokehouse February 5, 6-8 PM Tabula Rasa Brewing February 10, 2-4 PM Main & Six Brewing Company February 13, 6-8 PM Parade Activities Saturday, February 16 St. Johns River Taxi Rides Tin Can Photo Lounge Food Trucks & Craft Beer UNF Drumline Best “Illuminated” Pet Costume Contest 100-Passenger Viewing Cruise Kids Activities & Games Ronan School of Music Rock Band Firework Show Over Downtown Jacksonville Jaguars D-Line Laser Light Show & Much More!

pet health

Pooches on Parade What’s more fun and healthful than walking your favorite dog? Walking your beloved pooch with hundreds of other dogs, and doing so for a good cause. The Jacksonville Humane Society’s annual Mutt March, the city’s largest pet walk and family festival, takes place April 13, 9 AM-1 PM. The pups will parade down Beach Boulevard beginning at 10 AM at the Walmart Supercenter at 8808 Beach Blvd. Plus, look for food trucks, music, a fundraising silent auction and the Purina Pro Plan Performance Dog Team. Registration ranges from $15 to $30 and includes special “Wag” bags. Animals walk with their owners for free. Q

SMILE WHEN YOU SAY THAT

Have your pet’s teeth checked sooner if you observe any of the following problems:

Dental health is a very important part of a person’s overall health. The same goes for one’s pet. According to the American Veterinary Medical Association, when left unchecked, dental problems can cause, or be caused by, other health issues. In fact, your pet’s teeth and gums should be checked at least once a year by your vet to help detect early signs of a problem and to better keep your pet’s mouth healthy.

• Extra teeth or retained baby teeth

An oral exam is typically easy and quick. However, if a problem is found, a longer exam might be necessary. For example, x-rays may be needed to evaluate the health of the jaw and the tooth roots below the gumline. Because most dental disease occurs below the gumline, a thorough dental cleaning and evaluation are performed under anesthesia. Similar to what a human dentist would do, dental cleaning for your pet includes scaling (to remove plaque and tartar) and polishing.

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• Bad breath • Broken of loose teeth

• Teeth are discolored or covered in tartar • Abnormal chewing, drooling, or dropping food from the mouth • Reduced appetite or refusal to eat • Pain in or around the mouth • Bleeding from the mouth • Swelling in the areas surrounding the mouth Be mindful that some pets become irritable when they have dental problems, and any changes in your pet’s behavior should prompt a visit to the veterinarian. And always be careful when evaluating your pet’s mouth, because an animal in pain may bite. Q

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It happened so FAST she had no time to react to the screech of tires, the smell of burnt rubber, the sudden impact that knocked her off her feet.

Percocet nine times a day,” she says. “Not only was the injury destroying my life, but the pills made it impossible to do anything. I had to learn how to walk again, I couldn’t wash myself, I lost my job, I was struggling to take care of my kids.”

dispensary to pick up a bottle of pills infused with the marijuana strain ChemDog. Over time, she was able to wean herself oﬀ opioids entirely, and now uses medical marijuana exclusively to treat her neck and back pain.

In 2016, two years after Amelia’s accident, Florida voters overwhelmingly

e state’s supply of medical cannabis is cultivated by seven nurseries located across Florida, which supply

approved Amendment 2, a constitutional initiative to legalize medical marijuana as a treatment for patients with debilitating medical conditions. At that point, Amelia had undergone various nerve-burning procedures, seen dozens of chiropractors, and was taking nearly a dozen pills for pain per day. She was desperate for a better option. “Some of my doctors were really hesitant about recommending medical marijuana to me—it had only just been legalized—but ultimately my pain doctor said I should try it,” she says. Seventy days after her doctor ﬁrst recommended it, she visited a

non-euphoric strains that are low in tetrahydrocannabinol (THC) to dispensaries around the state. ere are two medical marijuana dispensaries in Jacksonville: Trulieve and Knox. Under current Florida law, they can provide patients with both THC and CBD (Cannabidiol, another cannabis compound) products, including vape oil, oral tinctures, balms and other medical products. Vaporizers and oils are currently the most-purchased products. Making the user high isn’t the goal and smoking marijuana, whether it’s for a medical purpose or not, remains illegal.

The DRIVER of the car didn’t even realize she was TRAPPED beneath the vehicle, having

ultimately been dragged six feet before stopping. e victim, we’ll call her Amelia to protect her privacy, was rushed to the hospital, where she received emergency surgery: six discs, neck to tailbone, were ultimately replaced. e injuries sustained from being hit by a car had been traumatic, but the real challenge would come with recovery. “ey gave me ﬁve pain pills in the hospital and then basically sent me on my way,” she recalls. Follow-up trips to doctors all resulted in the same thing: prescriptions for opioids. “At one point, I was prescribed 13 diﬀerent medications and taking

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Trulieve is one of only a few medical marijuana dispensaries in Northeast Florida.

From the outside, Trulieve (located on Beach Boulevard) looks like any other medical clinic. But the interior is altogether different—more Apple store than pharmacy, thanks to wood paneling, marble countertops, and a pair of navy velvet armchairs flanking the front desk. Patients in the waiting room run the gamut from soccer moms with chronic pain, to their kids with IBS, to senior citizens suffering from memory loss. Trulieve specializes in one thing—dispensing marijuana—though there’s nary a Birkenstock (nor a stoner, for that matter) in sight. In truth, the medical marijuana of

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2019 is light years away from the weed the war on drugs has demonized for decades. What was once a “gateway drug” is today used to treat cancer patients, those with chronic pain and children with epilepsy, among others. Dr. Joshua Henry, a family and sports medicine physician, used to rely on opioids to help manage his patients’ pain. With the legalization of medical marijuana, he’s been given a new option, one without nearly as many negative side eﬀects. “I’ve been a longtime prescriber of opioids,” notes Henry. “at’s just what you do after people have surgery and it always seemed that there had to be a better way.”

Henry wasn’t immediately persuaded about the efficacy of medical marijuana, largely because initial studies didn’t reveal any benefits for pain management. “What changed my attitude is finding out that the U.S. government has a patent on medical marijuana. So, while it’s labeled as a Schedule 1 narcotic by the federal government, they’re also banking on it for the future.” U.S. Patent No. 6,630,507 was granted in 2003 to the U.S. Department of Health and Human Services, and covers the potential use of cannabinoids to protect the brain from damage or degeneration

”

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I have a number of people who tell me it’s changing their life for the better. —DR. JOSHUA HENRY (PICTURED AT LEFT)

caused by certain diseases. Today, Henry recommends medical marijuana to patients at four North Florida Sport & Spine Center locations, all of whom are suﬀering from a whole manner of ills—dementia, IBS, Crohn’s disease and, of course, chronic pain. “I have a guy in his upper 30s with degenerative back pain—we started him on a medical marijuana product and he had a solid night’s sleep for the ﬁrst time in three years. Another patient

works at one of the big hospitals in town. He was suﬀering from insomnia and the treatment has basically saved his job.” And then there are the pediatric patients, who have also reaped enormous beneﬁts from medical marijuana, says Henry. “I had a patient—a senior in high school—suffering from Crohn’s disease. He couldn’t keep on weight and constantly had stomach issues. When he came in he weighed 125 pounds. Now he’s 160 pounds.”

e biggest benefits, says Henry, is that medical marijuana doesn’t come with the same negative side effects, high costs and addiction issues experienced by many opioid users. “Any negative side effects with marijuana would come from a lack of understanding about how to use a product,” says Henry. As there are different marijuana strains (each meant to combat a different ailment), there’s a risk that a patient takes the wrong dosage, or uses a supplement meant for the nighttime during the day but, he adds, “once people know how to use it, I don’t really see any negative side effects.” Seniors who typically take opioids often suffer from constipation as a side effect, which can lead to diverticulitis and unwanted hospital visits. Switching to marijuana allows older patients to reap the same benefits of pain management without those side effects. But here’s the counter-intuitive bit: while medical marijuana is openly available in Florida, it remains illegal under federal law and is still deemed a YOURHEALTH

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open themselves to litigation or be blacklisted by area hospitals. is has led to some less-than-reputable actors getting in on the medical marijuana action. A recent Tampa Bay Times investigation of the 1,432 doctors in the state’s medical marijuana program revealed that some of the physicians doling out recommendations for the drug have a troubled past. “What we wrote in the constitution is that a physician must issue a Medical marijuana certification—simply products at Trulieve a statement saying that a patient has been diagnosed with a debilitating “schedule 1” narcotic (meaning it is condition, based on their medical lumped with heroin and cocaine as history,” says Ben Pollara, a political having the highest potential for abuse). consultant and the executive director In states where medical marijuana is of Florida for Care, a medical marijuana legal, doctors can only “recommend” it advocacy group founded in 2014. He or issue written certifications for pahelped draft Amendment 2, though tients, rather than “prescribe” it. Curhe says the law’s rollout has strayed rently, it’s most often used to treat somewhat from the bill’s original pain, nausea and medical conditions intention, namely to provide patients including Alzheimers, cancer, and easy access to medical marijuana. epilepsy but some studies have shown “What the state legislature did was that compounds in marijuana might require all of that and also that doctors successfully treat conditions as widemake very specific recommendations ranging as acne or anxiety. as to dosage, amounts and more.” In other words, the state’s rollout of nder the state’s emerging Amendment 2 has made it unattracframework, doctors in the program must complete only tive for physicians to recommend medical marijuana. two hours of training and pay a $250 fee to be able to Florida for Care hosted a series of recommend medical use of events across the state geared toward marijuana for patients diagproactive physician outreach, all in nosed with certain chronic, debilitating an effort to get new doctors into the conditions. e ease by which doctors program and educate them about medcan recommend marijuana doesn’t ical marijuana. e two-hour course mean that physicians across the state physicians are currently required to are embracing it with open arms. In take in order to enroll in the program fact, many reputable physicians are doesn’t inform them about marijuana wary of hopping aboard the cannabis at all, says Pollara. “Instead, it’s entirely bandwagon, for fear that they could

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about the law. Doctors aren’t being educated about the usage of marijuana in the practice of medicine.” Since the passage of Amendment 2, Pollara has been a vocal proponent of strengthening the law and ensuring it’s rolled out properly. “e Florida legislature has put in place a mostly strong framework for a patient- and physician-friendly medical marijuana system on a movingforward basis,” he says. “But it needs to be tweaked and it’s still in need of complete implementation.” According to Pollara, there are still at least a dozen regulatory actions that the State Department of Health needs to determine in order to fully implement Amendment 2: regulations governing edibles and lab testing requirements, for instance. Currently, the Tampa Bay and Miami areas have the highest concentration of dispensaries, though Victoria Walker, community relations director at Trulieve, says she anticipates Jacksonville getting more dispensaries within the next couple of years. “We’ve also applied for St. Augustine and will be going through their special exception zoning process.” Because it remains illegal in the eyes of federal authorities, there isn’t a wealth of science to back up many of the claims tied to medical marijuana, so doctors must instead rely on anecdotal evidence and trial and error. Henry notes that the government patent on marijuana touts its antioxidant and neuroprotectant properties. “Government studies were based mainly on the way it protects rat brains after induced stroke—it protects the nerves,” says Henry. Proponents claim the possibilities for what marijuana can treat remain untapped. Despite the growing cadre of anecdotal evidence—and the push to wean patients across the country oﬀ opioids— it remains more challenging to obtain medical marijuana than it would be to get ahold of, say, OxyContin.

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Unlike other states where marijuana is legal, Florida is charged with governing the industry, including maintaining a state registry and presiding over all licensing for patients and dispensaries. Here’s how it works from a patient perspective: To receive medical marijuana, a patient must ﬁrst obtain a Jacksonville Medical Marijuana Card from the state. Cards require proof of residency, a yearly registration fee of $75 and, of course, an explanation from a doctor regarding why the patient needs the medication. Once the patient’s name is added to a state database, he or she receives a state-issued card allowing him or her to receive medical cannabis from an approved dispensary. e entire process can take as long as a month.

According to a 2016 report by Arcview Market Research, a cannabis market research ﬁrm, Florida’s medical marijuana industry is expected to have a $1.6 billion economic impact by 2020. e ﬁnancial windfall that could come from legalization has already proved enticing to even conservative politicians like Republican John Boehner, who recently came out in favor of decriminalizing marijuana, seven years after telling a constituent he was “unalterably opposed” to its legalization. In April of 2017, the former House Speaker reversed that long-held position, tweeting: “I’m convinced de-scheduling the drug is needed so we can do research, help our veterans and reverse the opioid epidemic ravaging our communities.”

“From the time they get the recommendation from their doctor to the time they can pick up medicine can sometimes take up to 30 days,” says Bill Abbott, an extraction specialist for MariJ Agricultural, a diversiﬁed holdings company with a portfolio comprised of medical marijuana products and technologies. Some patients are turning to CBD products derived from hemp (rather than from cannabis) to bridge that gap. “CBD derived from hemp is legal and non-psychoactive, though a lot of people don’t realize that. ey see words like ‘hemp’ or ‘cannabis’ and they just assume it’s illegal or it could get them high.”

e full impact of Florida’s pot economy remains to be seen and, for some, the money isn’t a convincing reason to legalize the drug recreationally. Dr. Henry, for instance, says that legalizing recreational marijuana could hinder the success of medical marijuana. Once marijuana becomes a moneymaker for corporate interests, Henry worries that proﬁts will give way to abuse—similar to what we’ve seen in the tobacco industry.

ne of the arguments against the legalization of medical marijuana is that it inevitably leads to legalizing recreational pot. Some say that’s a good thing. “If you look at smaller states like Colorado, which has three to four million permanent residents, just look at the inﬂux of taxable revenues that have come in just to that small state,” says Abbott. “How much taxable revenue could Florida gain from that product? e state would beneﬁt so much.”

“Imagine if we make it fully, recreationally, legal,” says Henry. “en you might have have big companies like Philip Morris developing strains that are ultra high in THC. Eventually, the users will become dependent on that and we’ll start to see addiction problems.” Even the most vocal organization opposed to the legalization of recreational marijuana—the Drug Free America Foundation—admits that marijuana, in some forms, has medicinal value and that in its pill form can treat those with cancer, AIDS, MS, glaucoma and chronic pain. Still, the organization says that medicalizing marijuana “has caused truly ill people to refuse proper medical care” and is “a device used by special interest

groups to exploit the sick and dying.” e group failed to defeat Amendment 2, though it did ultimately offer recommendations to state legislators regarding how the bill should be rolled out. Even legal medical marijuana has its share of critics, of course. Henry says some of his patients have refused it altogether, dismissing it as an illegal drug. “ere’s a lot of stigma around it. No one wants to be labeled a ‘pothead,’” he says. “But even over the past year, I’ve seen a huge difference in curiosity and a willingness to learn more.” ose most willing to utilize medical marijuana are definitely not the stereotypical “potheads” seen throughout pop culture. “Our average patient is well over 50 years old,” notes Walker. “Our true demographic population is people who have tried a lot of different things to feel better and this is the only thing working.” In Florida, that means a lot of retired military members who suffer from PTSD, older cancer patients and those with chronic pain like fibromyalgia. Only three states—Arizona, California and Michigan—have more medical marijuana patients than Florida, which recently surpassed the 100,000-patient milestone. ose involved in the passage of Amendment 2, and the medical marijuana industry in general, say that the drug’s use and acceptance will only continue to grow, but further research will be needed to quantify its success. “When you hear the patients, and how it’s changing their lives, you can’t imagine this not becoming a mainstream industry,” says Walker. “But it’s gonna be a lot of work to get there. In essence, we’re changing an entire history of what we’ve always thought to be the truth.” u This story first appeared in June 2018 edition of Jacksonville Magazine. It has been updated to be published here. YOURHEALTH

ey Kathr yn Abb

Hanna Park

On the

Beaten Path

Northeast Florida’s oﬀ-road bike trails are made for exploring and exercise. Winter and spring are the ideal seasons to get pedaling. PHOTOS AND WORDS BY AMANDA ALLAN

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or both the casual bicyclist and the off-roading adventurer, fewer things are as relaxing as pedaling without fear of car traffic. Fortunately, Jacksonville is home to an ample number of bikeways that range from paved, relaxing roads to sandy, difficult-to-navigate terrain. Here's a closer look at a few of the most popular public bike paths in the area.

Kathryn Abbey Hanna Park With more than 20 scenic miles of biking and hiking trails, readily marked for beginner and expert ability, Hanna Park is hands-down one of the region’s best outdoors destinations. Bikers can choose to pedal along the shoreline of the Atlantic Ocean or dive deep into the dense woods, thick with gnarly oaks and palmettos. Trails vary from wide and flat, family-friendly routes to winding single-track paths laced with steep dips and climbs, sharp turns and gear-shifting obstacles. Double check the degree of difficulty at the trail head before setting out. It’s good to know your limitations before getting in too deep, and making a nice afternoon into a truly hard grind. Cyclists looking for a test, for example, may want to saddle up for a ride down Lil’ Joe, among Hanna’s toughest trails. It’s not particularly long, so endurance won’t be the primary challenge for many. e difficulty comes from a ribbon-thin path chock full of roots, soft patches of sand, sharp switchback turns and other obstacles, both manmade and natural. You’ll need to keep your focus to stay in the saddle here.

Kathryn Abbey Hanna Park

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Little Talbot Island

Little Talbot Island is stretch of First Coast beachfront is well-known for its breathtaking beaches, an abundance of wildlife and well maintained park facilities, and natural habitats. e park’s Dune Ridge Trail is an off-road path that’s almost four miles long. e trail leads bikers and hikers alike through many different settings including sandy dunes, maritime hammock and marshes, before ending with a quiet and broad beach littered with shells and Little Talbot’s famous driftwood forest. e ride is considered intermediate in difficulty and is ideally suited for families, from seniors to kids. Tillie K. Fowler Regional Park Don’t let the roar of U.S. Navy Jets and helicopters fool you. Tillie Fowler Park is something of a hidden gem, considering the huge nature preserve is located directly across busy Highway 17 from the hustle and bustle of Naval Air Station Jacksonville. Featuring playgrounds and picnic pavilions, nature trails and a small science and exhibit space with live specimens of native plants and animals, there’s also a dog park and an archery range. If that weren’t enough, it’s also a great spot for offroad biking, with a twisting loop system with marked rides ranging from one to eight miles in length. e technical challenge for each trail varies quite a bit, so choose wisely before setting out. e park’s western boundary is the Timucuan River, so don’t be surprised if the biking and hiking trails are soggy, especially following rainy weather. Most paths wind through heavy pine woods, keeping the sun at bay nearly all year long.

Tillie K. Fowler Regional Park

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Castaway Island is park on the city’s eastern edge consists of more than 300 acres of coastal wetlands and woods along the serene San Pablo River. In addition to being a beautiful and breezy place to enjoy some fresh air and postcard views, Castaway Island also features a lazy hiking and biking trail. e area is peppered with illustrated maps and educational markers, great for learning about the natural environment. Keep an eye out for footprints and other signs detailing the native wildlife. And don’t leave without walking out on the boardwalk and to the marshside lookout post, which is especially gorgeous as the sun starts to set. Q

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Castaway Island

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Apocalypse

words by Stella Katsipoutis

Now 54

AS THE BODIES OF OVERDOSE VICTIMS OVERRUN THE CITY MORGUE, THE DENIAL OF JACKSONVILLE’S OPIOID CRISIS COMES TO A CRASHING HALT YOURHEALTH

Chief Medical Examiner Dr. Valerie Rao, left, and JFRD’s Lieutenant Mark Rowley a Jacksonville Town Hall in March 2017 // photo by Stella Kastipoutis

yourhealth “21-week-old white male fetus, mother went to hospital and drug screen was positive for marijuana and cocaine … Next: 43-year-old white male, substance abuse, dead at the scene … Next: 29year-old white male, found in his parked vehicle in a WalMart parking lot, drug paraphernalia located in the vehicle … Next: 56-year-old white male, found unresponsive in his residence, has a history for abusing heroin and crack cocaine … Next: 42-year-old white male, found unresponsive in his residence, transported to hospital, has track marks from heroin use … Next: 31-year-old white female found at her residence, drug paraphernalia found at the scene, has a history of abusing drugs …” Catch Dr. Valerie Rao on any given day, and she can rattle oﬀ a seemingly endless list of overdose victims that are lying in her morgue. As Jacksonville’s chief medical examiner, she spends each morning sitting with investigators, physicians and her operations manager, deciding who will handle each case. e faster they work, the sooner the victims’ families can pick up their loved ones and leave with their grief. But as of late, the uptick in drug-related deaths across the District 4 counties she serves—including Duval, Clay, Columbia, Hamilton and Nassau—has tested the limits of not only the morgue’s physical capacity, but also Rao’s well-being. “is is sucking the life out of us,” she said at a Town Hall meeting hosted by Councilman Bill Gulliford in March 2017. “I’ve been sick for the past month, but I cannot take a day oﬀ because we are so very busy, so I drag myself to work. We are losing lives, which is terrible. I have to listen to [victims’] families calling me, crying, and I want to cry. We are overwhelmed. Help us. at’s all I’m asking.” Rao’s impassioned plea is the direct result of an opioid crisis that is infecting the streets of Jacksonville—a festering

wound that can no longer be bandaged with denial. e sobering data gathered by the Jacksonville Fire and Rescue Department (JFRD) shatter any disbelief one might have in our city’s growing drug problem. In 2017, the Jacksonville Fire and Rescue Department responded to more than 3,700 overdose calls. About 2,400 of the calls happened between January and August, which is about a 70 percent increase from that span in 2015. e majority of victims were caucasian males between the ages of 30 and 39.

so fast that even experts are struggling to keep up. “e drugs are literally changing more rapidly than the lab tests can identify them, because those who are responsible for these drugs hitting our streets are changing their formulations very quickly,” says Kelli Wells, M.D., director of the Department of Health in Duval County. “e last report shows some drugs that I’ve never even heard of. Our medical examiner contracts with a toxicology oﬃce that processes

“

We’re treating an overdose victim once every six to eight hours,” said JFRD’s Lieutenant Mark Rowley. “As much as I can tell you about our response to overdose and our firefighters’ struggle to save lives, it parallels in no way to the truly catastrophic loss of life.”

While most of today’s drug users think they’re getting heroin from their dealers, in actuality what they’re buying is fentanyl, a narcotic that is most often illicitly manufactured in Mexico, China and other foreign countries. Since it is 50 to 100 times more potent than morphine, fentanyl gives victims nearly no chance of survival when it is used in conjunction with other substances. According to Assistant Chief W. Mike Johnson of the Jacksonville Sheriff’s Office, because fentanyl and its many derivatives—including carfentanil, acetylfentanil and others— are cheaper and easier to obtain than pure heroin, distributors are now mixing them with small amounts of heroin, cocaine and other drugs in order to increase their profits while still selling a potent product. What buyers don’t know, however, is that distributors are using too much fentanyl in their mixtures, creating deadly concoctions that cause chest rigidity, inability to breathe and swift death—all while the needle is still in the victim’s arm. And to make matters worse, these never-before-seen drug variations are seeping into the market

samples for her because there’s that much challenge in identifying the chemicals that are present.” How on earth did we get here? It’s a question that hangs over the heads of everyone touched by the opioid epidemic. But even though there is no hard-and-fast answer to this question, experts agree that a variety of factors came together to create the perfect storm that is taking the lives of so many people in our community. Some speculate that the unrealistic expectation placed on the medical community in recent years to eradicate all pain in its patients led to the overprescribing of opioids, as well as inadequate patient education about properly using those medications. is, in turn, may have ﬂipped the addiction switch in patients who may or may not have known they were genetically predisposed to getting hooked on the substances. “We’re getting to a point now where we don’t really tolerate discomfort in our patients,” says Jeremy Mirabile, M.D., medical director of Recovery Keys, an addiction treatment and rehabilitation center in Jacksonville YOURHEALTH

yourhealth and St. Augustine. “[Doctors think,] here we are ﬁxing bones and giving sight to the blind, so why are people having discomfort?” About 20 years ago, says Mirabile, medical credentialing companies began to reimburse doctors and hospitals based on patient surveys, which asked each patient to rate how well they felt their pain was treated. “So doctors began to liberally prescribe [opioids] and never really screened people. Somewhere between 10 and 20 percent of patients has some form of substance abuse disorder and, therefore, are vulnerable when they’re given painkillers—such as opioids— to control their mild to moderate pain. at puts them at risk for having a painkiller problem in the future. So in a way, we kind of made the disease show itself.” Paul Stasi, director of resource development at the City Rescue Mission in Jacksonville, explains that the number of opioid pain reliever prescriptions has skyrocketed from 76 million in 1991 to 207 million in 2013—and almost 100 percent of the global opioid supply is currently being consumed right here in the United States. “According to the Centers for Disease Control and Prevention, 78 Americans die every day of an opiate drug overdose,” he says. “Over half of those deaths are [from medications] prescribed by doctors.” And despite the best eﬀorts of ethical physicians who follow proper prescription protocol, more and more improperly trained doctors are handing out opioids, while fewer and fewer are accompanying scripts with adequate counseling for their patients. “What’s happening is, in some cases, doctors are giving patients 90 pills, without any real guidance on what to do when they don’t get pain relief with one, two or three [doses] a day,” says Wells. “No guidance about other modalities that can be tried, no holistic

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approach to control it, and then an unrealistic expectation that the patient is not going to have some pain. If you have, say, a legitimate back issue, you’re going to have some pain every day. If we don’t do a great job in the oﬃce of saying, ‘is is a narcotic, you can get addicted if you use it every day for the next 30 days, and you will feel withdrawal symptoms when you stop it,’ then we’ve got a problem. We need to reset our expectations. Our expectations should be that this is one of your tools to use for pain control, in addition to massage, heat, cold, stretching, acupuncture, meditation, etc.”

“

If you incarcerate these folks and do a forced detox during that time in lockup, but don’t put any services around them to stay clean, the second they’re free they’ll use again, and then the cycle starts all over again,” Dr. Kelli Wells says.

To add fuel to the already rampant fire, those who are already in the throes of addiction have scant access to the resources that are necessary to manage and overcome their disease. For example, when addicts find themselves in the emergency room due to a drug-related complication, or in jail due to a crime they committed while under the influence, they receive temporarily life-saving detox services; however, they are given very little education or referrals to rehabilitation programs that promote lasting positive change for their addiction. e result: As soon as they are discharged, their chances of relapsing are near 100 percent, according to Wells. “In some communities they’re progressive enough that rather than lock the addict up after they’ve clearly committed a crime in order to support their habit, they go to rehab. at’s where I

think we may be missing a complete intervention strategy.” However, even when those suffering from addiction who do wish to seek help and check themselves into a treatment center, their path to recovery is even further blocked by selective insurance policies and statemandated budget cuts for mental health and addiction services. “People with substance abuse problems who have private insurance get a selection of care that is pretty diverse; they can go almost anywhere [for rehabilitation],” says Mirabile. “Someone who doesn’t have insurance [or is covered by Medicaid or Medicare can] basically only go to state-funded facilities—such as Gateway and River Region in Duval County—and the number of people these facilities can serve is directly affected by budget cuts from the state. If the patient’s plan doesn’t pay much, it’s unlikely that they’re going to reach a place that has multidisciplinary, doctoratelevel staff with more experience, more training and that is potentially able to deal with more withdrawal complications. And for certain people, that can mean the difference between life and death.” at was exactly what happened to Jacksonville resident Steven Maldonado’s son, Jonathan, who passed away in 2016 from a drug overdose. After months of searching, Steven was unable to find a treatment facility that would accept the family’s Medicaid coverage—which was all they could afford. ose facilities that did accept Medicaid told the Maldonados that they had to wait, simply because the facilities didn’t have enough capacity to accept new patients. “River Region is packed, their counselors work so hard and they have so many people under their wing that they just can’t attend to everybody,” Steven said at the 2017 Town Hall meeting. “Gateway is always full; if you call them, they say

yourhealth keep calling back. When you call the 800 number, they refer you to facilities that have beds, but then they want you to have Humana, Aetna or Blue Cross Blue Shield. If you say you have Medicaid, nobody takes that. We called for three months straight before Jonathan died.” Jonathan was 20 years old.

Jeremy Mirabile, M.D., medical director of Recovery Keys // photo by Agnes Lopez

Law enforcement, emergency services and other organizations throughout the city of Jacksonville are honing in on their efforts to attack the drug issue from every angle. In three months in 2017, JFRD spent $113,000 to equip every fire engine and rescue truck with Narcan, a medication that reverses the effects of opioids during an overdose and jumpstarts victims’ breathing again. “In addition to ensuring that every apparatus in the city has Narcan, we’re also making sure that they have a paramedic onboard and advanced airway equipment,” says Rowley. “So we are doing our best to equip our finest with the equipment needed to take care of people suffering from addiction.” JSO also provides a drop box at the entrance to the Police Memorial Building on Forsyth Street, where anyone can—and is strongly encouraged to—anonymously drop off unused prescription drugs from their medicine cabinets, preventing them from potentially reaching the hands of children or a loved one who might have an addiction problem.

Drug Free Duval, a local coalition that strives to ensure freedom from substance abuse, has put together a task force whose sole purpose is to mobilize health solutions and initiate community-wide change YOURHEALTH

yourhealth People who are addicted to opioids aren’t living any sort of normal life. And so we can’t, from our safe spots, devise interventions that are going to help them. We have to be able to push our sleeves up and get a little uncomfortable, have conversations that challenge us, because it’s a big problem. It’s bigger than us, and we’re not going to be able to solve that from behind our desks.” Kelli Wells, M.D., Director of the Department of Health in Duval County

photo by Agnes Lopez

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yourhealth in substance abuse behaviors. “One of our co-chairs, Jodie Grace, has done astounding work in the area of reducing when folks who work in a hospital setting are stealing drugs for their own use or to sell,” says Susan Pitman, Drug Free Duval executive director. “One of the goals we have is to implement that throughout all the hospitals in the region and eventually the nation. We also have really complex policy goals to increase physician use of the Prescription Drug Monitoring Program.” Joe Jamison, a certified addiction counselor at Recovery Keys—and a recovering addict who has dedicated his life and career to helping other addicts stay healthy and drug-free— urges anyone suffering from addiction to pick up the phone and call a treatment facility for help, no matter their situation. “Just a simple phone call to an agency is going to be anonymous; it’s not going to be judgmental, it’s not going to interrogate,” he says. “But it gives the addict a barometer of how far down the road they are and gives them a way back with the help of someone else.” While individual local efforts are slowly gaining momentum, more work still needs to be done in order to find an effective solution—and because that will involve multiple layers of intervention across multiple disciplines, every facet of the community has to work collaboratively in order to make even the slightest of dents in Jacksonville’s opioid crisis. “I think the thing that we’ve got to do, obviously, is engage the entire community,” says Gulliford. “It can’t be piecemeal; it has to be a concerted, all-inclusive effort to address this problem. We’ve got a multitude of different entities working toward a solution, and they never communicate. We as a community need to get together and continue this dialogue, set some goals and move forward.” Several possible solutions to the issue have already begun to be tossed around by experts: For instance, Wells

says she would like to see hospital ERs staﬀed with peer advocates who can counsel detox patients, assess their readiness for recovery and link them to care—tasks that emergency room doctors are too overburdened to take care of on their own. Mirabile, on the other hand, believes that—rather than taking a backend approach to the issue and focusing on providing post-overdose help to victims with Narcan—more proactive action needs to be taken by family physicians to screen their patients, spot addiction and help treat it before it spins out of control. He suggests that the screening tool used by the Substance Abuse and Mental Health Services Administration (SAMHSA)—a simple one-page questionnaire also known as SBIRT, which stands for “screening, brief intervention, and referral to treatment” —be integrated into the lineup of tests primary care doctors conduct on their patients during their annual wellness checkups. ese ideas, and more that have been brought to the table, are all feasible; but in order for them to come to fruition, they need to become a part of a broader discussion and plan of action. “e city government, the city leadership, the Department of Health…we can certainly play a role in convening the conversation. But I wouldn’t want us to put together a community intervention that is sanitized enough that everyone can palate it,” says Wells. “Instead, I want it to be bold and threaten our boundaries. Because that’s what it takes. People who are addicted to opioids aren’t living any sort of normal life. And so we can’t, from our safe spots, devise interventions that are going to help them. We have to be able to push our sleeves up and get a little uncomfortable, have conversations that challenge us, because it’s a big problem. It’s bigger than us, and we’re not going to be able to solve that from behind our desks.” According to Wells, looking beyond any biases about addiction and seeing

it for what it is: a disease that is rooted in a person’s biology—and deserves just as much medical attention and care—is crucial if success is to be attained. “It’s almost as if the addict has diabetes and he acts differently when his blood sugar level is 500 or 700,” Mirabile offers. “He can’t bring that number down on his own because his pancreas isn’t working right, so he needs insulin, he needs medicine, he needs help. ere’s very little an addict can do about his condition because it’s embedded deep in the survival center of the brain, so he reflexively uses drugs and alcohol in place of food, water and even relationships.” Mirabile likens the brain’s reward c enter to a gas tank, and explains that everyone is born with a different amount of fuel: the feel-good neurotransmitter dopamine. Addicts are born with an inherently low level of dopamine, and so they instinctively seek activities or substances—such as drugs or alcohol—that make them feel better. “We intuitively think that if [an addict] wants to be well, then he should try harder and not be addicted anymore. But that’s why it’s called addiction,” says Wells. “If it were easy to quit, we wouldn’t be having most of these conversations. e addict is looking for that next high, and that doesn’t make him a bad person; it only makes him an addict. When the medical examiner sounds the alarm that her morgue is full, then we as a community have a responsibility to answer to that. Because every patient she touches represents a family who’s lost a loved one. And in this case, it’s something that is entirely preventable. I don’t know what else we would need to rally around if not that. We are at a critical moment, and what we do from here is incredibly important—and it translates directly into lives saved.” Q This story first appeared in the April 2017 edition of Jacksonville Magazine. It has been updated for publication here. YOURHEALTH

JACKSONVILLE MAGAZINE’S 2019 SIGNATURE EVENTS SERIES

BEST RESTAURANTS BASH! January 31 The year kicks off with our annual celebration of the city’s best eateries and night spots.

2019 JACKSONVILLE LANTERN PARADE February 16 Second annual nighttime festival illuminates Downtown and the St. Johns River. All are welcome. Free to participate.

FAMILY FOODIE

FARE

FAMILY FOODIE FARE February 24 Kids and their parents cast votes to name their favorite dishes— one for the kids, the other for adults.

BEST IN JAX PARTY

GREAT CHEFS SERIES

May

April, May, August & September

Celebrating the very “Best” in Northeast Florida as voted by the readers of Jacksonville Magazine.

A select group of the region’s top chefs compete dish-vs.-dish in multi-course meals and fundraisers. The four-dinner series starts in April.

EVENT DETAILS @ JACKSONVILLEMAG.COM

OUR ANNUAL HAPPENINGS ARE NOT TO BE MISSED

V IL LE M A G A ZI S

JACK

NE ’

SON

SPONSORSHIP PACKAGES AVAILABLE

SECRE T pp er C

FARM TO CHEF FEAST

SECRET SUPPER CLUB

September

Each month, a select group of diners are treated to a culinary surprise and adventure. Where will we go next?

Pull up a chair at this new event, a potluck supper only the city’s leading chefs could prepare.

BUBBLES & BBQ October What a perfect pair! Delicious smoked meats and bubbly libations. All in the gorgeous gardens at the Cummer Museum.

JACKSONVILLE MAGAZINE’S FASHION PROJECT October An evening of music, libations and fashion to spotlight local style and beauty. Who will be selected local designer and model of the year?

TICKETS FOR SALE @ 904TIX.COM

JACKSONVILLE WHISKEY AFFAIR November Cocktails and culture combine in this celebration of fine spirits, food, music and more. Nine years and counting.

Good Eats

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Good Eats

Pineapple Citrus

Ginger Green Smoothie Ingredients 1 small to medium pineapple, cored and cleaned, and chopped 6 oranges, peeled and seeds removed (add whole if seedless, otherwise squeeze for their juice alone) 1-inch ginger, peeled and added whole 2 c. fresh spinach or 1 c. frozen 2 frozen bananas 2 T. of maple syrup (Runamok Ginger Infused adds a spicy kick) Âź c. ground flax (flax meal) 1 T. chia seeds 1 T. hemp 4-5 tablets of Chlorella (optional) Directions Place all ingredients in a high speed blender and blend until creamy and smooth, adding more juice or water to thin out to your preferred consistency.

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Upcoming Events St. Augustine Spanish Wine Festival

Tom Coughlin Jay Fund Wine Tasting Gala

February 15-17

March 8

The main event, the Grand Tasting, features more than 100 Spanish wines along with Spanish-inspired hors d'oeuvres and celebrates the 500th birthday of Pedro Menéndez, St. Augustine's founder.

$75

2nd Annual Coastal Carnivale February 22 The Beaches Town Center Agency hosts their annual fundraising event which features salsa dancing and music from LPT, silent auction and dinner prepared by the chefs of One Ocean Resort.

One of Jacksonville’s most anticipated events, the gala oﬀers culinary delights from the area’s best restaurants and the world's most renowned wines in a walkabout format. All proceeds beneﬁt First Coast families tackling childhood cancer.

$150

St. Augustine Fashion Week March 2-10

$125

St. Augustine Fashion Week returns for Season 5 and kicks oﬀ "The Lounge" presented by St. Augustine Premium Outlets. The week includes runway shows featuring 20 small brand designers and 20 emerging student designers.

Family Foodie Fare

Secret Supper Club

February 24

March 5

Jacksonville Moms Blog and Jacksonville Magazine are thrilled to host the 4th annual Family Foodie Fare. Delight in delicious dishes as top restaurants in Jacksonville compete Top Chef-style for the best adult and kid food pairing.

The Jacksonville Magazine March Secret Supper Club takes us to Vernon's First Coast Kitchen & Bar with a #FirstCoastForward theme. Savor fresh and local dishes and an enviable wine list while enjoying a beautiful view. Sawgrass Marriott Golf Resort & Spa

$50

$20-$30

Mukti Freedom Gala March 2 Mukti, which means freedom in Bengali, is Rethreaded's primary fundraising event of the year, one where 500 leaders from the Jacksonville community come together to enjoy an evening of inspiretion and hope through stories, shopping, dining and dancing.

Sybarite5 March 29 Riverside Fine Arts Association hosts the popular band. Dubbed the “Millennial Kronos,” Sybarite5’s eclectic repertoire—from Bowie to Radiohead and Akiho to Assad—combined with its commanding performance style is turning heads throughout the music world.

$25

$75

Mardi Gras Party March 2 The Jacksonville Children's Chorus hosts its annual fundraiser. Guests can expect live entertainment, delicious food, libations, silent and live auctions and prizes.

$75

A Division of Jacksonville Magazine

Local Tickets. One Place. Blue Jay Listening Room All Month Long Blue Jay Listening Room is your go-to stop for national and local musicians and talent alike. Located in Jax Beach, the intimate venue hosts shows almost every day, featuring bands such as Junco Royals, Kyle Jennings, Moors & McCumber, Underdog Improv and Corey Kilgannon.

Prices Vary

Cultivate Jax All Month Long Cultivate Jax is a neighborhood homestead and urban supply store with a commitment to U.S. made, healthy-lifestyle products for every stage of curating the place you call home. Learn diﬀerent ways to improve your lifestyle with classes on topics such as gardening, fermenting, home improvement, veganism and much more.

Prices Vary

Whiskey, Wine & Wildlife February 7-10 W3 artfully combines renowned beverage tastings and inspired cuisine from some of the South’s best and awardwinning chefs, an esteemed group of masters from all walks of life. Events include Whiskey Inspired, a wine cruise and Sunday brunch.

Prices Vary

Sweetheart Valentine's Day Ball February 14 Join the full 19-piece Chris Thomas Band for an evening of music, dancing, libations, delicious eats by Chef Dejuan Roy, and cash bar—all for a good cause. Proceeds from this event will go to the Funk-Zitiello Foundation for pancreatic cancer research.

$75-$125

Accelerate the PACE... WR ƓQG D &XUH

Momentum Transportation is proud to sponsor The Donna 26.2 Momentum PACERS

Momentum Transportation USA, Inc. 4901 Belfort Road, Suite 100, Jacksonville, FL 32256 Phone: 904-880-1180 www.landstar-agent.com Air • Ocean • Rail Intermodal • Truckload • LTL • Heavy Haul/Specialized • Expedited

BY THE NUMBERS

DONNA MARATHON WEEKEND

317

Volunteer groups supporting the event

2,500

408

Pairs of volunteer hands lent during the weekend

Spray Chalk to stencil the Running Ribbon on the course

NUMBER OF PORTABLE TOILETS STATIONED ALONG THE COURSE

36 88 TAMBOURINES DISTRIBUTED TO SPECTATORS LINING THE MARATHON COURSE

Mayo Clinic medical team volunteers

2,548

7,000

Thousands of runners require scores of volunteers, bathrooms and even instruments

200

AGE OF THE OLDEST VOLUNTEER

AGE OF THE OLDEST RUNNER

Number of traffic cones that line the course

20 Number of wheelchair athletes competing

15,000

SPONGES FOR RUNNERS

SCENES

FROM 2018

Lindsey Hein is the host of the popular podcast 'I'll Have Another with Lindsey Hein'. Look for Lindsey recording her podcast live from the DONNA Expo on Friday, and on the roads with you racing throughout the weekend.

FEAR. COURAGE. POWER. Lindsey Hein: This is her story and it’s personal Have you ever met someone who you just know she is doing exactly what she was put on Earth to do? That’s how I felt when I met Donna Deegan, whom I had the privilege to interview on my podcast in 2017.

was faced with the reality, it was a pivotal moment in my life. I’m a fearful person by nature and it’s something I am constantly working on, but the fear of this was owning my life. I was unable to enjoy daily experiences because I was living in fear.

Donna is a three-time breast cancer survivor and she tells a story of positivity and overcoming one of the hardest things a person could ever endure. After undergoing treatment and battling this disease three times, Donna decided she had an opportunity to do something big to help others fight breast cancer—she started the DONNA Foundation.

What turned out to be news I never wanted to hear, actually changed my life for the better. It taught me that while facing our fears isn’t always enjoyable, it does reveal how much courage one has deep down, if you are willing to stand up and use your knowledge to do something positive about your situation.

I was introduced to the Foundation two years ago and experienced my first Marathon Weekend with them in February 2017. I had the honor of attending a dinner at the Mayo Clinic Jacksonville, where I was able to learn all about the great work the DONNA Foundation is doing to support ground-breaking breast cancer research and caring for those living with the disease. This is something that is near to my heart as I am positive for the BRCA 2 gene mutation, which puts me at an 86% higher lifetime risk of getting breast cancer. I elected to have a prophylactic mastectomy in 2013 at age 30. When I learned I have the mutation and

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I still look back at that time in my life with a grateful heart from all the support I received and wonder how time has gone by so fast. There’s no greater fear in my life than not being here for my boys, not seeing them grow up. And, for that reason, I’m thankful that I had the tools to be proactive in this area of my life. I feel immensely thankful for the research that has already been done. I’m so thankful that there are some super-smart scientists and physicians out there working and receiving funding for research so that people like me can be proactive and so that people who are faced with the disease can benefit from new treatments. I believe strongly in the DONNA Foundation and its mission. Q

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WON’T YOU BE

MY NEIGHBOR

Some of the best partnerships are close to the heart and close to home

It goes without saying that an event as big as the DONNA Marathon Weekend could not happen without the support of hundreds of volunteers and significant contributions from corporate sponsors. As it’s counted among the top races of its kind in the country, the DONNA Foundation attracts sponsors from far and wide—and some literally from right across the parking lot. A next-door neighbor to the Foundation’s Jacksonville home base is VENUS Fashion, a leading designer, manufacturer and retailer of swimwear and lingerie sold throughout the world since 1984. While the company’s products and catalogs have global reach, much of its heart stays close to home through its VENUS Cares charitable initiative. The stated goal of its community outreach actions are to “support causes that work to inspire confidence and empowerment in women affected by adversity.” So, a partnership with the DONNA Foundation is one that fits like a glove. Or, perhaps better said, that favorite summertime swimsuit. Since 2014, VENUS has supported the DONNA Foundation by sponsoring and participating in the annual Marathon Weekend, THE PLAYERS DONNA 5K presented by Nimnicht Family of Dealerships

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at TPC Sawgrass, the Topgolf ParTee and the Puck & Stick Stair Challenge. At these events one can see VENUS staff manning water stations and running the courses. And the company’s “Bras With A Heart” program sees 10% of all bra purchases go to the DONNA Foundation during the month of October. In fact, over the past few years VENUS has gifted more than $50,000 to its neighbor and hometown charity. “Bras With A Heart is an important initiative for Venus because so many of our customers are affected by this life-threatening disease,” says VENUS Fashion CEO Sascha Peters. “Through our partnership with the DONNA Foundation, we not only hope to end breast cancer, but also empower and inspire women affected by it.” “Breast cancer affects not only many of our customers, but many of our nearly 900 VENUS associates,” says company president Jim Brewster. “Working with the DONNA Foundation and internally promoting the resources they can provide has directly helped many of our own team members that have been affected by breast cancer.” Q

The Bridge Brigade has found a new home, at Surfer The Bar in Jacksonville Beach. Runners will now experience the passion of this very popular cheer zone on the course along the shoreline. Excited to join DONNA Marathon Weekend, Surfer has a full weekend of fun planned with live music Friday night from Dry Reef and Saturday night by Trail Driver. Later Saturday night the party gives way to DJ Squish, with Party Solution DJ's hosting the day on Sunday. Surfer will open its doors at 8:00 AM on Sunday and feature drink specials all weekend long. Look for Surfer The Bar in the New Spring Patio Chill Zone at the Expo both Friday and Saturday with more specials.

Ten thoughts you’ll have during your first DONNA Marathon. 1. Your feet are no longer fit for public appearances 2. Graceful running is only a thing in your head 3. Going out too fast never ends well... unless you are Eliud Kipchoge 4. There’s no such thing as ‘too much pink’ but there is chafing 5. There's no such thing as too much Glide 6. Energy gels won’t win any culinary awards 7. You look good in short shorts 8. Cold, wet sponges can snap you back to life 9. There is more love in this world than you can imagine 10. Your fellow runners, spectators, and volunteers will get you across the finish line #TogetherWeWill

Puck & Stick The DONNA Foundation added a brand new event to its All-Star lineup in 2018 with the addition of the DONNA Puck & Stick Stair Challenge powered by the Jacksonville Icemen. This event saw nearly 150 participants take on the stairs inside Veteran’s Memorial Arena. With three courses featuring diﬀering numbers of steps, there was a race for all levels of ability, including The Hat Trick Challenge for those brave enough to take on all three. Registration included a full day of fun featuring the Stair Challenge, an after-party, admission to the Icemen Hockey game, and free parking. Look for this event to move to a Saturday morning early in October of 2019. YOURHEALTH

DID SOMEONE SAY MARCH? THE PLAYERS Championship returns to TPC Sawgrass March 12-17, 2019. Yes, you read those dates correctly. In case you hadn’t heard already, THE PLAYERS is moving to March in 2019. Say hello to spring time in Northeast Florida, where cooler temperatures, lush fairways and greens, blooming ﬂowers and the world’s best golfers await. Does it get much better than that? Well yes, yes it does. THE PLAYERS DONNA 5K presented by Nimnicht Family of Dealerships also returns In March. On Saturday, March 2, 2019, we welcome runners and walkers of all levels to experience a last chance, behind-the-scenes 5K route through the beautiful PLAYERS Stadium Course at TPC Sawgrass. Participants will begin at the TPC Sawgrass Clubhouse, and continue along the cart paths through all back nine holes, passing the world famous Island Green at 17 as the ﬁnal preparations for THE PLAYERS Championship are being made. Registration is at www.theplayersdonna5k.com.

Has anyone in your life ever been diagnosed with breast cancer? Would you like to know how a small contribution can make a life-changing diﬀerence? Did you know 1 in 8 U.S. women will develop breast cancer over the course of her lifetime? Even more scary...

TRACK YOUR PROGRESS

Download the ‘Active Experience’ app for everything DONNA Marathon Weekend, right on your phone. Free for both participants and spectators, users can view interactive race course maps, receive up-to-the-minute race weekend news, and share results. Live tracking on race day is also available, so be sure to look for tracking requests so your friends and family are able to watch you finish breast cancer. Get connected with the race on Facebook, Twitter and Instagram (@262withDonna) using hashtags #RunDONNA and #TogetherWeWILL.

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• Nearly 73% of breast cancer patients contemplate modifying or skipping their medication or treatment to save money. 41% actually do it • Close to 47% of families living with breast cancer are using their retirement savings to pay for out-of-pocket expenses, 26% paid with their credit card • Well over 80% of breast cancer patients report medical expenses totaling $10,000 or more, even with insurance. Where does this leave these families? Many of them are making tough treatment choices in an effort to manage the financial toxicity that is filling their lives. They need your help. Living in fear, fed by worry, questions such as "Do I pay for my medication or put food on the table for my children this month?" are real threats. With your gift, you will remove these types of obstacles. We are asking you to join us as we positively impact the lives of those in need all year long by becoming a member of The 1912 Society. For as little as $19 a month you will provide families with the helping hand they need. Your gift will provide dedicated case managers to families in need, helping them navigate their treatment plan, insurance denials, and critical care needs. Your generous, tax deductible donation to The DONNA Foundation will impact the lives of thousands of families living with breast cancer. Join and begin changing lives today.

The DONNA CareLine provides specific case management services to patients, caregivers and/or their providers nationwide. Staffed by a team of professionals with both nursing and social work backgrounds, and non-clinical case managers who have an insurance industry background with billing expertise, the CareLine offers support to ANY person living with a breast cancer diagnosis, regardless of their insurance status, age, gender, ethnicity, employment status, or income. If you or someone you know is in need of assistance, please call or visit us at 1.877.236.6626 | www.thedonnafoundation.org

GORUCK DONNA MARATHON WEEKEND GORUCK and The DONNA Foundation have partnered to provide an exciting new offering to DONNA Marathon Weekend! Introducing the GORUCK Rucking Division available for all DONNA Marathon Weekend races. What is Rucking? Rucking is not only the foundation of Special Forces training, it’s an empowering ﬁtness and social activity that encourages community-building with weight being the great equalizer. Rucking requires strength, endurance, and character—and builds it, too. To participate as a rucker, select ‘Yes’ for the Rucking Division when you register for any DONNA Marathon Weekend event.

COMMUNITY EXPO IN AN OLD K-MART It has been said the DONNA Expo is the best in the industry, and they just kicked it up a notch. The 2019 reimagined DONNA Marathon Weekend brings the DONNA Expo presented by Puma Biotechnology to the Beaches inside a vacant shopping center. The race staff is transforming 500 Atlantic Blvd. in Neptune Beach and rolling out the pink carpet to the community. “If the Church of Eleven22 can present services in an old Wal-Mart, we can do a race expo in an old K-mart!” says Amanda Napolitano, executive director of The DONNA Foundation. The Expo is free and open to the public starting Friday, February 8 at noon and will include race registration and packet pick-up, ofﬁcial DONNA merchandise, VIP meet and greets, and lots of shopping with nearly 100 exhibitors and partners.

PARTEE SAVE THE DATE The SOLD OUT 2nd Annual DONNA Topgolf ParTee took place on November 4, 2018. Returning as presenting sponsors, Tom Bush Family of Dealerships and their employees were joined by 31 other teams who gathered for a bit of friendly competition, food, drinks, prizes, and to support families living with breast cancer who are served by The DONNA Foundation. The team from Hen House Marketing, improving their 3rd place ﬁnish last year, took home top honors and have vowed to repeat in 2019. Planning for this November’s event will be underway soon. Watch for the date to be announced in late April 2019. You will want to reserve your ParTee Bay early! YOURHEALTH

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EXPERIENCE COUNTS Carmen Reynolds knows first-hand the life-changing help provided by the DONNA Foundation

“After being diagnosed with breast cancer in January of 2018, I lost my job the following March,” recalls Carmen Reynolds. “It was a real struggle to get my insurance benefits to pay for my chemo procedures. And to pay all my other bills.” After receiving a phone call from one of her very good friends explaining Carmen’s diagnosis and financial situation, the DONNA

Foundation responded almost immediately. “I got a phone call from one of the Foundation’s representatives, who asked a few questions about what kind of help I needed—rides to my chemo sessions, help with medications, help around the house... they were amazing,” says Carmen. “They came through for me at a time when I really needed them and didn’t know where else to turn. I thank God for the DONNA Foundation every day!” Q YOURHEALTH

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GOING GREEN The DONNA Foundation announces Beaches Go Green as the Oﬃcial Environmental Sponsor for its annual DONNA Marathon Weekend. Runners and spectators participating in the 12th annual event will enjoy eco-friendly cartons of Just Water as well as event day recycling to promote awareness of waste in our oceans. Beaches Go Green aims to spread awareness and education of the dangers of plastic in our environment and build a community of support for those who oﬀer

solutions for reducing waste, recycling, and protecting our oceans and environment.

“We love our new beach destination and are committed to establishing practices to support an ongoing commitment to environmental responsibility,” says Amanda Napolitano, executive director of The DONNA Foundation. “Our partnership with Beaches Go Green is a ﬁrst step toward greening DONNA!”

The DONNA Foundation and Beaches Go Green Would Like To Remind Everyone To Focus On The “4 Rs”: 1) REFUSE – say no to products and companies that use excessive packaging. Say no to businesses that use single-use plastic and styrofoam. Vote for the change that you want to see with your money. Spend it wisely. 2) REDUCE your amount of waste overall by bringing your own “reusable items” and buying in bulk to limit packaging. Every time that you reuse something, you are saving some new from being created. You can also reduce your waste by home composting organics. Hopefully soon, we will have residential & commercial composting services available in our area. 3) REUSE – Once you have it, focus on how you can use it again and again. Think bring your own: bags, water bottles, coﬀee cups, straws, etc.

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4) RECYCLE. Last on the list by design. Recycling occurs with less than 10% of the items used on our planet. In addition to being better disciplined and recycling more, we need to drive the market of recycled items by buying them over new. Absolutely recycle when you can, but do not rely on recycling. Focus on the ﬁrst 3 Rs. “Beaches Go Green is thrilled to support the health of women and the health of our beaches at the same time!” says co-founder Anne Marie Moquin. “It’s an honor to partner with The DONNA Foundation and help make it “green” for their 12th annual event. We are looking forward to bringing environmental education and awareness to our area through strong communitybuilding events like the DONNA Marathon and more.”

TRANSPORTATION & PARKING Expo and Packet Pickup

Marathon Sunday Shuttles

The DONNA Expo will be held at 500 Atlantic Blvd in Neptune Beach, Florida. Locals will recognize this location as the “Old K-Mart” and is across the street from Beaches Town Center at the heart of Atlantic Beach and Neptune Beach, Florida. All are welcome and may park on a ﬁrst come, ﬁrst served basis during Expo hours.

There will be FREE parking for all participants at the University of North Florida, Lot 18 beginning 4:00 AM. race morning. Continuous shuttle service to the start/ﬁnish will run from 4:00 AM to 4:00 PM. Please arrive early and allow time for traﬃc delays.

Saturday Races

Transportation details subject to change. Visit www.BreastCancerMarathon.com for more information.

The DONNA 5K and Family Fun Run presented by AXA and Jaguars Foundation will be held in the Beaches Town Center. Parking is available on a ﬁrst come, ﬁrst served basis from the Expo parking area. Beginning Saturday, February 9, 2019 at 6 PM all vehicles without a parking pass will be towed.

Participant Drop-Oﬀ and Rideshare All weekend, a designated area for drop-oﬀ and rideshare services (Uber, Lyft, etc.) will be available in the Expo parking area at 500 Atlantic Blvd.

Ride Share Drop Oﬀ: Heading East on Atlantic Blvd. ONLY, RIGHT into 580 Atlantic Blvd, ﬁrst entrance, continue through parking lot, turn LEFT, Load/Unload in front of DONNA Community Expo, continue through parking lot, exit at Lemon St and A1A/3rd St. RIGHT TURN ONLY, continue southbound on A1A/3rd.

Bicycle Parking All weekend, bicycle 'valet' parking will be available at the Expo. Roll-up to the garden center entrance and volunteers will take care of the rest.

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Recommended Route From JT Butler Blvd | FL-202 take the FL-9A/Interstate 295 exit toward International Airport/Daytona Beach. Take exit 52 for Town Center Pkwy toward University of North Florida Drive. Keep right and follow signs for University of North Florida. From the I-295 UNF campus entrance, turn left on Eco Road, just past the UPD Police Building.

Alternate Routes From The Kernan Boulevard UNF Campus Entrance, turn right oﬀ Alumni Drive at the fountain onto UNF Drive. Follow UNF Drive and take a right onto Varsity Lane located before the Arena building (34) and garage (38). Follow it to Lot 18. From Beach Blvd: At the FSCJ intersection (FSCJ is on the north side of the road), turn onto Central Parkway and follow the road until you see UNF Parking on the left. Shuttle service will also be provided from our host hotel Sawgrass Marriott Resort for registered hotel guests only.

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REGISTRATION INFO The 12th annual DONNA Marathon Weekend February 8-10, 2019 • Jacksonville Beach, Florida NEW In 2019, DONNA Marathon Weekend will start and finish in the heart of Neptune Beach and Atlantic Beach, Florida. Known by locals as the Beaches Town Center, this oceanfront destination twelve miles east of downtown Jacksonville offers a wealth of choices to shop, dine, relax and now race! February 8 –10, 2019, DONNA Marathon Weekend will include a 5K, Half Marathon, Marathon, Ultramarathon and Event Challenges and will again fill the Beaches of Northeast Florida with thousands of runners from all 50 states and many countries. Participants enjoy an even flatter, faster Boston-Qualifying marathon course that takes them through the four beautiful beach communities of Atlantic, Neptune, Jacksonville and Ponte Vedra beaches with scenic views and an outpouring of crowd support. Expect water stations nearly every mile, race day temps averaging 55° F, and streets lined with a 26-mile beach block party. And it’s pink. Very pink. There’s a reason this event has been recognized by CNN Travelas one of the “Seven Marathons Worth the Trip” and “Favorite Charity Race” from the readers of Women’s Running Magazine. We are the National Marathon to Finish Breast Cancer.

Online registration closes Saturday, February 9 at 4 PM EST. Register at BreastCancerMarathon.com Nov. 1-Jan. 31

Feb. 1-Close

Marathon....................................................................$125 ................................$140 Half Marathon ..........................................................$115 ................................$130 5K presented by AXA and Jaguars Foundation ......$40 ..................................$45 Family Fun Run presented by Jaguars Foundation.$15 ..................................$15 Booby Trap Challenge Full presented by FIS ........$195 ................................$215 (5K, Marathon) ............................................................................

Booby Trap Challenge Half presented by FIS ........$185 ................................$205 (5K, Half Marathon)

110 Ultra Marathon ..................................................$160 ................................$170 Treasured Chest Challenge Marathon ..................$225 ................................$240 (DONNA Marathon, Publix Gasparilla Half Marathon)

Treasured Chest Challenge Half Marathon ............$215 ................................$230 (DONNA Half Marathon, Publix Gasparilla Half Marathon)

Fundraiser Experience Divisions are now closed.

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Fundraiser Experience Morning Hospitality Presented by Southern Grounds

5 AM-7:30 AM DONNA Fundraiser Experience participants raising a minimum of $2,000 for The DONNA Foundation warm up in ﬁrst class, presented by Southern Grounds. Invitation Only, Credential Required

Momentum Galloway Pacers DONNA is proud to offer Official Galloway Pacers powered by Momentum Transportation USA for the Marathon and Half Marathon events. Program Directors and Pace Group Leaders from around the country are coming here to pace our runners to Boston Qualifying times, personal bests, or just an official finish. How do you join a pace group? Just look for our Galloway Pacers before the race, stick with them throughout the run, and remember to move to the right of the road during walk breaks.

Ruth’s Chris VIP Viewing 8:30 AM–2:30 PM The DONNA Foundation honors sponsors and special guests at this VIP Finish Line viewing party. Beaches Town Center • Invitation Only

Post Race Party 8:30 AM–3 PM • JustWater, Official H2O • Michelob Ultra, Official Beer • Ponte Vedra Plastic Surgery, Official Sunscreen • CORA Sports Massage • Hot dogs courtesy of Sawyer Gas & Grill • Tiffany Awards and Live Entertainment all Day Plan to meet and celebrate with family and friends at the DONNA Post Race Party inside Amgen Runners Village. Enjoy a Mic Ultra, our Official Beer, hot dogs courtesy of Sawyer Gas & Grill and recover with a massage in the CORA Sports Medicine Tent. A Beaches Go Green-approved event, Runners and spectators participating in the 12th annual event will enjoy eco-friendly cartons of Just Water as well as event day recycling to promote awareness of waste in our beach environment. Beaches Town Center • FREE and Open to the Public, FREE Parking

26.3 Party hosted by Jeff Galloway 1:30 PM–4 PM Celebrating all Marathon Finishers crossing the finish line after the 6 hour mark, join Jeff and Barb Galloway for the DONNA 26.3 Party.

DONNA MARATHON

WEEKEND MOVES TO THE BEACH The 12th Annual DONNA Marathon Weekend has moved to the beach with reimagined course and events. Runners participating in the 12th annual event can expect a flatter and faster course with start and finish lines in one of the most dynamic locations in Northeast Florida, the Beaches Town Center at the nexus of Neptune and Atlantic Beach. “We believe The Beaches Town Center, with its eclectic mix of shops, restaurants and entertainment will provide runners with a unique beach destination experience,” says event founder Donna Deegan. “This is what runners are telling us they want. A beautiful running venue and one that also offers a welcoming fan experience and exciting post-race celebration.” The 12th year’s weekend events, including the 5K, marathon, half marathon and race expo, will take place on the island and participants will continue to enjoy the four beautiful coastal communities of Atlantic, Neptune, Jacksonville and Ponte Vedra beaches with scenic views and an outpouring of crowd support. The shift means the Intracoastal Bridge is no longer a part of the route. That makes the Boston Marathon-qualifying course, already one of Florida’s fastest, an even greater opportunity for some new personal records. “We are truly thrilled to welcome this amazing event to Neptune Beach,” says Neptune Beach Mayor Elaine Brown. “Our community already embraces these runners with open arms, and I know our neighborhoods and our business community will go all out to support them and the wonderful cause they represent.” Atlantic Beach Mayor Ellen Glasser adds, “Atlantic Beach is proud to welcome all DONNA runners to our city in 2019. Get ready—along with our sister city, Neptune Beach—we will line our streets to cheer on runners warmly and loudly. In supporting the 12th annual 26.2 with DONNA The Marathon to Finish Breast Cancer, we are eager to shine the light of our special communities on the effort to finish this disease.” Q

Beaches Town Center • Open to All! YOURHEALTH

2019 DONNA MARATHON WEEKEND

SCHEDULE OF EVENTS FRiDAY, FEBRUARY 8 Social Shakeout Run

Our fun run is perfect for families and will be an out and back course of up to one mile in Neptune Beach.

8 AM

Beaches Town Center

Kick-oﬀ DONNA Marathon Weekend with a 3 Mile Run/ Walk with Donna Deegan, special guests and the VIPinks.

DONNA 110 Ultra Marathon

Southern Grounds, The Courtyard at 200 First Street 200 1st Street, Neptune Beach

7:30 AM 110 Start

DONNA Packet Pickup & Community Expo

Athletes will cover 110 miles to Finish Breast Cancer through the night in beautiful Atlantic Beach, Florida. DONNA Curb Crews are invited all night to cheer these participants to the ﬁnish line!

presented by Puma Biotechnology

Beaches Town Center

Noon-6 PM

DONNA Packet Pickup & Community Expo

Your reimagined DONNA Marathon Weekend brings the DONNA Health & Fitness Expo to the beach! We are transforming the “Old K-Mart” and rolling out the pink carpet to our entire community. Pick up your FCN Runner’s bag with your Genentech bib that includes your timing chip courtesy of Pivot CPAs.

Return for day 2 of the DONNA Health & Fitness Expo. Shop, sip and sample from nearly 100 exhibitors. So much fun you might forget to pick up your race packet! (But don't do that.)

500 Atlantic Blvd., Neptune Beach, at the “Old K-Mart” FREE and Open to the Public, FREE Parking

DONNA ViP Reception

Fundraiser Dinner with Donna & Mayo Clinic

presented by Tiffany & Co., Ashley HomeStore, Banfi Vineyards, & Sawgrass Marriott

5-8 PM The DONNA Foundation honors sponsors and special guests each year at this VIP Reception and cocktail party. Sawgrass Marriott Golf Resort & Spa, 1000 PGA Tour Blvd., Ponte Vedra Beach • Invitation Only

SATURDAY, FEBRUARY 9 DONNA 5K presented by AXA and Jaguars Foundation

6 AM: Registration and Packet Pickup Opens inside the “K-Mart” Expo 7:30 AM: Warm up with David Garrard, former NFL Jacksonville Jaguars Quarterback and owner of Retro Fitness, Personal Trainers of the DONNA. 8 AM: 5K Start 5K participants earn our signature Running Ribbon medal and experience a reimagined 5K at the beach! You’ll know you won when your Pivot CPA timing chip crosses the ﬁnish line.

presented by Puma Biotechnology

Opens 8 AM-4 PM

Invitation Only 4:45 PM Optional Lab Tour 5:30 PM. Reception 6 PM Dinner We look forward to a special evening honoring top fundraisers and sharing an update on research advances and sharing stories of families you support through The DONNA Foundation. Mayo Clinic–Davis Building, 4500 San Pablo Road, Jacksonville

SUNDAY, FEBRUARY 10 DONNA Marathon DONNA Half Marathon DONNA Booby Trap Challenge presented by FIS

4 AM: Shuttle Parking Opens at UNF Lot 18 5 AM: Amgen Runners’ Village Opens 7:27 AM: Wheelchair Start 7:30 AM: Start Beaches Town Center

Beaches Town Center

Amgen Breakaway from Cancer Runners’ Village

DONNA Family Fun Run

Before and after the race, all registered participants enjoy our famous Runners’ Village for complimentary Southern Grounds coffee and Mini Bar Donuts. Don’t forget your sunscreen from the Ponte Vedra Plastic Surgery Sunscreen Tent and enjoy music from WQIK and our Emcee and on-air personality Brad Thornton. Runners’ Village will also offer gear check courtesy of UPS, event information at the Landstar Logistics Tent, first aid, photo ops and more!

presented by Jaguars Foundation

6:30 AM: Registration and Packet Pickup Opens inside the “K-Mart” Expo 7:30 AM: Warm up with David Garrard, former NFL Jacksonville Jaguars Quarterback and owner of Retro Fitness, Personal Trainers of the DONNA. 10

9 AM: Family Fun Run Start

YOURHEALTH

Long runs are easier with a group. Itâ&#x20AC;&#x2122;s a fact. There is something about being in step with another person who makes the miles go by more easily, time go by quickly. When we face any challenge, together with support of others we are able to better endure. This is The DONNA Foundation. We stand with families living with breast cancer with a vision to transform the experience to one of love and support over fear and confusion, all the while working to eradicate the disease. Together. Welcome to your reimagined, 12th Annual DONNA Marathon Weekend. This year has been an exciting one for The DONNA Foundation as we have worked hard to reimagine your race weekend, while remaining focused on our mission to provide assistance and support for individuals living with breast cancer and fund groundbreaking breast cancer research. As you experience the weekend, know that your participation and support are making an impact on the lives of families nationwide. As we stand with families living with breast cancer, you have stood with us and I thank you. Together we can. Together we will. With gratitude,

Amanda Napolitano Executive Director The DONNA Foundation YOURHEALTH

HELLO EVERYONE! WELCOME TO THE ISLAND! Our 12th annual DONNA Marathon Weekend is going to be the best yet and I’m so glad you’re here for it! The start/finish line has moved to the social center of our Beaches universe: The Beaches Town Center, where Neptune and Atlantic Beach come together. For those of you who have run with us before, this jewel was previously experienced by our full marathon runners only. Now all of our participants will have the chance to see all that our northern beach neighborhoods have to offer, including those crazy radicals on Ocean Boulevard! Our full marathon course still winds all the way through our southern beaches as well, and the gorgeous oak-lined neighborhoods of St. Johns County. While our course may have changed a bit, the mission at The DONNA Foundation remains the same. With your help we will continue our efforts to finish breast cancer, by helping those living with the disease with financial assistance and patient navigation, and through groundbreaking research at Mayo Clinic. So let’s lace up and have some fun knowing we are doing good in the process. Thank you all and have a great run!

Donna Deegan Founder The DONNA Foundation 6

YOURHEALTH

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