Health and Hope

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LEXINGTON MEDICAL CENTER FOUNDATION

OCTOBER 2017

Lexington Medical Center Welcomes Its

Biggest Baby Ever

LMCFoundation.com

May 2017 • Health and Hope

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CONTENTS COVER STORY

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Hospital Welcomes Its Biggest Baby Ever FEATURE STORIES

4 6 8

Keeping Watch Over Stroke Finding Friendship While Fighting Cancer The Best Medicine

MESSAGE FROM THE LEXINGTON MEDICAL CENTER FOUNDATION

I’m happy to share another issue of Health and Hope with you. We have a lot of exciting news to share about the Lexington Medical Center Foundation and the many ways in which we’re helping provide hope to our community. Inside This Issue Did you hear about the record-breaking 14-pound baby born at the hospital this summer? We feature Colin’s adorable face on the cover of this issue of the magazine, and I know you’ll enjoy reading about the biggest baby ever born at Lexington Medical Center. I hope you’ll also take a few minutes to learn about the new lifesaving technology offered by the WatchmanTM device that helps prevent blood clots in AFib patients. And be sure to read the heartwarming story of Daniel Stevanus, a local youth minister who became friends with one of the hospital’s pharmacists during his cancer treatment at Lexington Medical Center.

Community and Hospital Grants LEXINGTON MEDICAL CENTER FOUNDATION STAFF

Barbara Willm Vice President Development and Community Relations Amy Lanier Executive Director Kate Mayer Senior Major Gifts Officer Beth Wingard Senior Major Gifts Officer Thomas Tafel Community Outreach Manager Lauren Peebles Annual Gifts Officer Michelle Pilgrim Administrator and Donor Coordinator Patti Williams Executive Assistant —————————————————— Health and Hope magazine is a publication of the Lexington Medical Center Foundation. Its purpose is to educate readers about Lexington Medical Center and its services, and the ways in which the Foundation supports the mission of the hospital.

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2720 Sunset Boulevard West Columbia, SC 29169 (803) 791-2540 LMCFoundation.com C2

Health and Hope • December 2016

The Foundation now oversees the management and distribution of more than $1 million in community grants the hospital awards each year to deserving organizations in the Midlands. In addition, the Foundation’s board of directors recently awarded $474,848 to hospital departments that requested funds for patient programs and services that support the mission of the hospital.

Hulon Society Established We recently inducted a very special group of donors into the Hulon Society at an inaugural dinner celebration. This newly formed society is comprised of individuals who make a planned gift commitment of $25,000 or more to the Foundation. It’s named in honor of Lillian Hulon, who made the hospital’s first planned gift when she donated the land for Lexington Medical Center in the 1960s.

LMCFoundation

PROVIDING A TOTAL OF ——————————————

$

Health Care Scholarship Awards

6,860,135 $ SINCE 2012

The Foundation granted $240,000 in scholarships to individuals pursuing degrees in nursing and allied health. Congratulations to the 72 recipients of these scholarships, including Julia Spangler, a hospital employee who received the highest ranking among all applicants. We also recognized 59 local high school students who completed the annual Partners Program at the hospital this summer. This educational program funded by the Foundation introduces students to the health care industry.

If You’d Like to Help… These programs and initiatives are just some of the many ways the Foundation supports the mission of Lexington Medical Center. If you’d like to learn more about how you can support the Foundation, please send an email to LMCFoundation@lexhealth.org or call us at (803) 791-2540. You can also visit our website at LMCFoundation.com. Thank you for your generosity and for helping us provide hope for the future.

Barbara Willm Vice President, Development and Community Relations Lexington Medical Center

LMCFoundation.com


Campaign for Clarity Reaches $1.4 Million Mark 3-D Mammography Equipment Now Available in Irmo Lexington Medical Center Foundation’s Campaign for Clarity now totals more than $1.4 million, moving even closer to its goal of $3 million. 3-D Mammography Available at Five Locations

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omen’s Imaging Center, W Lexington Medical Center West Columbia —————————— Lexington Women’s Care Sandhills, Northeast Columbia —————————— Lexington Medical Center Lexington —————————— Lexington Medical Center Mobile Mammography Van —————————— Lexington Medical Center Irmo

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3 4 5

The campaign aims to make 3-D mammography equipment available throughout the hospital’s entire network of care. Recent donations from the hospital’s Universal Employee Fund campaign and a sporting clays tournament helped boost the campaign’s total past the $1 million mark. Since the campaign launched last October, the Foundation has purchased 3-D mammography units for the Women’s Imaging Center on the hospital’s main campus in West Columbia, Lexington Medical Center Lexington, the hospital’s mobile mammography van and Lexington Medical Center Irmo. Lou Kennedy, president and CEO of Nephron Pharmaceuticals, chairs the capital campaign.

OCTOBER 2019 $3,000,000

$2,000,000

$1,000,000

$0

Donate online to the Campaign for Clarity at LMCFoundation.com or use the envelope included in this magazine.

Two Named to Foundation Board Terry K. Schmoyer Jr., CPA and J. Ted Nissen have been named to the Lexington Medical Center Foundation board of directors. They were elected to serve three-year terms. Terry is president and managing partner of Schmoyer and Company and has more than 25 years of public accounting experience. He is a member of the South Carolina Association of Certified Public Accountants, the Georgia Association of Certified Public Accountants, and the American Institute of Certified Public Accountants. An active community leader, Terry is involved in numerous organizations, including the South Carolina Health Care Association, the Leukemia & Lymphoma Society, and the American Heart Association. Terry is a past chair of the board of the Columbia Chamber and currently serves on the board of the Central Carolina Community Foundation and Communities In Schools of the Midlands. He is a graduate of the University of South Carolina with a degree in accounting.

LMCFoundation.com

Ted serves as executive vice president and chief commercial and retail banking officer for First Community Bank. He has more than 33 years of experience in the banking industry. An active board member of the Boys and Girls Club of the Midlands and EngenuitySC, Ted currently serves on the loan approval committee for Business Development Corporation. He is a graduate of Leadership Columbia and past board member of the South Carolina Bankers Association, the Columbia Chamber, Midlands Technical College Foundation, and The Cultural Council of Richland and Lexington Counties. Ted graduated from Presbyterian College in Clinton, South Carolina, with a degree in business management. He and his wife Janet live in Lexington.

October 2017 • Health and Hope

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Hospital Welcomes Its

Biggest Baby Ever

His parents and doctor expected a bigger-than-average baby, but no one expected Colin Keisler to top 14 pounds when he was born.

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he black-haired,

Caesarean section. He topped

Brown Price. “Based on an

who works in the delivery

blue-eyed bundle of

the scale at 14 lb, .04 oz and

ultrasound a few weeks

room at the hospital, was

joy entered the world

measured 24 inches long.

before delivery, we knew

equally surprised. “I’ve been

he would be a big boy, but I

an obstetrics nurse for 29

at Lexington Medical Center

“We had planned a repeat

on June 23. And on that day,

C-section because Cindy’s

expected him to be around

years, but I’ve never seen a

he broke all records at the

other children were delivered

12 pounds, not 14.”

14-pound baby,” she said.

hospital, becoming the biggest

by Caesarean, too,” said Dr.

The largest baby anyone remembers in the hospital’s

not only surprised parents

46-year history was a

“Less than 2 percent of babies are born weighing 14 pounds at 39 weeks.”

Arthur Keisler and Cindy Richmond of Lexington, he shocked everyone on the medical team. Jaime Brown Price, MD, an OB/GYN with Lexington Women’s Care, a Lexington Medical Center physician practice, delivered Colin by

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Donna Hinton, RNC,

baby ever born there. Colin

Health and Hope • October 2017

Jaime Brown Price, MD Lexington Women’s Care

— Jaimie Brown Price, MD

13-pound baby born at the hospital in 1987. “Less than 2 percent of babies are born weighing 14 pounds at 39 weeks,” said Dr. Brown. “By definition, fetal macrosomia is a baby whose weight is greater than the 90th percentile for

LMCFoundation.com


his or her gestational age. Colin was basically the 100th percentile.” Cindy had a routine

when I can.” Colin is also doing well. At his 2-month checkup, he weighed 17.5 lb and

healthy pregnancy, and did

measured 27.5 in — the 99th

not have diabetes, which

percentile for both height and

can lead to increased birth

weight. A happy child, Colin

weight. Her first two children

smiles, coos and already rolls

(now ages 11 and 5) were

over on one side.

average weight — 7.6 lb and

“Colin is completely

9.8 lb. But she admits her

healthy and doing great,”

third pregnancy became

said Cindy. “He just started

harder as it progressed.

wearing 6- to 9-month clothes

Magazines, websites and television programs from around the country featured stories about baby Colin. “The last two or three

because the 3- to 6-month

months of this pregnancy

size outfits he’s been wearing

were more difficult,” she said.

were getting snug.”

“I was really uncomfortable

Once Cindy returns to

and had a lot of sleepless

work, Arthur will take over as

nights.”

a full-time, stay-at-home dad.

Since Colin’s birth,

He looks forward to taking

Cindy has enjoyed being at

care of his son now that the

home with her newborn

worldwide excitement of

and is adjusting well to

Colin’s birth has settled down.

her expanded family. “I’m

How Big was Colin? NEWBORN Average 7 lb 5 oz 19.5 in

Baby Colin 14 lb .04 oz 24.5 in

2 MONTHS Average 12 lb 8 oz 23.25 in

Baby Colin 17 lb 8 oz 27.5 in

“For the first week after

actually doing really good. I

a story ran about Colin’s

feel more rested than before

birth, it was crazy,” he said.

when I was working,” said

“I was getting calls from

Cindy. “I’m getting lots of

news outlets in the UK and

stuff done around the house,

getting Facebook Messenger

and I’m taking my downtime

notifications from people who

did have an upside. Arthur,

so they could send a gift to

wanted to interview us. It was

a die-hard Green Bay Packers

baby Colin. I got in touch

a whirlwind. By the end, we

fan, dreams of seeing Colin

with them, and the Panthers

were ready for it to be over.”

play football one day. So

sent us a little care package

he felt especially grateful

of Panthers gear. They went

television programs from

for a package the newborn

out of their way to send him

around the country featured

received from the Carolina

a little ‘welcome to the world’

stories about baby Colin.

Panthers.

gift, which was really cool.”

LMCFoundation PROVIDES HOPE

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$

494,101

for Mother/Baby Care

Magazines, websites and

News of his birth appeared in

SINCE 2012

LMCFoundation.com

“I got a Messenger request

But now comes the big

People, Us Weekly, HuffPost,

from a newsperson in North

dilemma. Will it be the

USA TODAY, Self and Fit

Carolina,” he said. “They had

Packers or Panthers for Colin?

Pregnancy. Good Morning

posted Colin’s story on their

Fortunately, his family has a

America and ABC News also

Twitter account. As a result,

few years to decide.

mentioned Colin’s birth.

the Carolina Panthers reached

But the intense publicity

out to ask for our information

October 2017 • Health and Hope

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Keeping Watch Over Stroke New Device Protects People with Atrial Fibrillation from Blood Clots and Stroke

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here’s good news for people with atrial fibrillation and those who can’t take blood

thinners long term. The new WatchmanTM device offers an alternative that reduces the risk of stroke, one of the biggest health concerns faced

an anticoagulant drug called

by AFib patients.

warfarin or Coumadin®). But some

AFib is a serious heart

people can’t take blood thinners very

condition that causes an irregular

long because the drug increases the

or fluttering heartbeat. Because the

risk of bleeding. For those individuals,

upper chambers of the heart don’t

other conditions such as longstanding,

the new Watchman implant offers a

beat regularly, blood doesn’t move as

uncontrolled high blood pressure or

lifesaving alternative.

efficiently through the heart and is

coronary artery disease.

more likely to stick together and form

“Sometimes we know what causes

a clot. Clots can then escape and travel

atrial fibrillation, but often we don’t,”

to the brain, which causes a stroke. In

said Robert A. Leonardi, MD, FACC,

fact, people with AFib are five times

FSCAI, of Lexington Cardiology, a

more likely to suffer a stroke.

Lexington Medical Center physician

ONE PROCEDURE, LASTING RESULTS

LAA “We’ve found the device is just as effective as blood thinners in preventing strokes and is protective against bleeding.”

Watchman fits into a part of the heart called the left atrial appendage (LAA).

— Robert A. Leonardi, MD, FACC, FSCAI

AFib affects more than 5 million people in the United States, with more

and high blood pressure. It can also be

than 200,000 individuals diagnosed with

related to heart valve disease or thyroid

the condition every year. Sometimes

problems. It’s very, very common —

the cause is unknown. Occasionally, it

we see it every day.”

happens as a complication after heart

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practice. “We know it’s related to age

To reduce the risk of blood clots

surgery. Other times, AFib results

in people with AFib, doctors often

from damage to the heart caused by

prescribe blood thinners (typically

Health and Hope • October 2017

90 percent of stroke-causing blood clots that come from the heart are formed in the LAA.

Watchman permanently closes off this part of the heart to keep those blood clots from escaping.

LMCFoundation.com


How the Watchman Works The Watchman is a quarter-sized

to stop taking warfarin 45 days after the procedure. And 99 percent of patients were able to stop taking warfarin

device made of lightweight material

within one year.

that physicians place in the left atrial

“We’ve found the device is just as

appendage, a pouch-shaped area of

effective as blood thinners in

the heart where the vast majority of

preventing strokes and is protective

clots form. “The Watchman essentially plugs the space where a clot forms to reduce the risk of stroke,” said Dr. Leonardi.

against bleeding,” said Dr. Leonardi. “Patients have less bleeding, so much so that they’re more likely to survive in the long run.”

Cardiologists place the Watchman

Though the Watchman device

in a narrow tube that is inserted in

doesn’t cure AFib, it does give people

the upper leg through the groin and into the heart. “The device then sits in the appendage, blocking the opening

with AFib an alternative to taking blood thinners long term. More than 30,000 people have

so blood can’t get in or out,” said Dr. Leonardi. “Basically, it gets covered up by the heart’s own tissue and eventually becomes a part of the patient’s heart.”

already received the FDA-approved Watchman device, which has been studied in the United States for more than 10 years. Lexington Medical Heart Center cardiologists started offering the

Though the Watchman device doesn’t cure AFib, it does give people with AFib an alternative to taking blood thinners long term.

procedure in March.

typically spend one night in the hospital

Watchman—Who’s a Candidate?

and return home the next day. They take warfarin until the left atrial appendage fully closes, usually about

• People with AFib not caused by a valve

45 days. They then take aspirin and a medicine called clopidogrel (known as Plavix®) for six months. After that, they take aspirin on an ongoing basis.

who qualify. What’s more, the Watchman allows people to stop taking warfarin, which requires

problem who can’t stay on warfarin (Coumadin) long term • People who can take warfarin but

The device offers a permanent, one-

need an alternative (because of a

LMCFoundation PROVIDES HOPE

—————————————

$

586,463

regular blood tests and

for Cardiac Care

certain food and drink

Since 2012

restrictions. In a clinical trial published in the Journal of the American College of Cardiology, nine

SYMPTOMS OF ATRIAL FIBRILLATION Sometimes people with AFib have no symptoms, and their condition is detected only by a physical examination.

Patients who undergo the procedure

time treatment for patients

A person with AFib is five times more likely to suffer a stroke than someone with a regular heartbeat.

Others experience one or more of the following symptoms. • General fatigue • Rapid and irregular heartbeat • Fluttering or thumping in the chest • Dizziness • Weakness

serious risk of bleeding

• Sweating

or those with a lifestyle

• Shortness of breath and anxiety

or condition that puts

• Faintness or confusion

them at serious risk of

• Fatigue when exercising

bleeding)

• Chest pain or pressure

• People who can take warfarin but can’t stay within the

Source: American Heart Association, Heart.org

recommended bloodclotting range

out of 10 people were able LMCFoundation.com

October 2017 • Health and Hope

5


Finding Friendship While Fighting Cancer Daniel Stevanus faces adversity with a level head. So when doctors diagnosed him with testicular cancer in March 2016, one day before his 30th birthday, his first thought was, “OK. What’s next?”

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to meet Daniel. When he arrived at Lexington Oncology, I introduced myself, and we had an instant

hat’s how I tried to face each

a Lexington Medical Center physician

connection. Today, we see each other

day during my treatment.

practice, four weeks later. It was during

at church and always share a fist bump

What do I have to do today?

chemotherapy that Daniel found a friend

or a hug,” said John.

What is next in my journey?” Testicular cancer can affect men ages 18 to 30, and it is very curable.

in John Ezekiel, PharmD. John is the infusion oncology

Daniel had four rounds of chemotherapy in three months. Every

pharmacist at Lexington Oncology. He

time he was at the hospital for treatment,

is also a member of Mt. Horeb United

John made sure to check on him. They

after his diagnosis. He had surgery

Methodist Church in Lexington, where

talked about their church, soccer games,

to remove the tumor a week after

Daniel serves as a youth pastor.

medicine and cancer.

Daniel’s treatment started quickly

having his first sonogram and started chemotherapy at Lexington Oncology,

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so I hadn’t had the opportunity

Health and Hope • October 2017

“Mt. Horeb is such a large church, and my kids are not quite middle-school age,

“John was incredibly helpful throughout my treatment. He would

LMCFoundation.com


“As more therapies

LMCFoundation

become available orally, pharmacists are able

PROVIDES HOPE

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to have more patientcounseling opportunities,”

$

said John.

694,525

for Cancer Care

“When I didn’t feel as though I had enough

will open an on-site retail

I would pray and ask

pharmacy in 2018 to

Him to provide for me

dispense oral oncology

and help me through

medications and other

the situation. And He

SINCE 2012

giving John and other oncology

was with me every step of the way.”

Every patient chooses to fight cancer

pharmacists the opportunity to be more

in his or her own way. John thinks of

involved in direct patient care.

fighting cancer like running a marathon.

“The men and women at Lexington

Patients may start the race with a lot of

Medical Cancer Center are incredible

support and motivation, but they may

folks — from the receptionists learning

also feel alone at times.

my name to the interactions with the

“We all have what I call a ‘Mile 17’

nurses, my doctor and his assistants. In

in life, and we have to choose to keep

my experience, the road to recovery was

running or quit. We have to remind

long and not fun. Having people come

ourselves that life is worth the fight,

alongside me made it just a little bit

especially when you are near the

easier,” said Daniel.

finish line and hear the loud cheers

He also found support from his community. “I found so much strength and encouragement from my church. They explain what the medicines were doing,

checked on me weekly and prayed for

how they were affecting my body and

me the whole time. They also gave me

what I could expect. He told me how

rides to the hospital. Most of the time,

chemo was like a crew of bulldozers,

I had someone new driving me to

moving and shifting things inside of me,

my appointments. The nurses and

and how my body would feel the effects

receptionists would even tease me

from the previous week,” said Daniel.

about having someone new with me at

“Our conversations were the best part

almost every visit,” said Daniel. As a cancer survivor himself, John

“Our conversations were the best part of my day.” — Daniel Stevanus work and understanding the ‘why’

admires how Daniel put his faith into

behind decisions, and John provided

practice throughout his diagnosis,

those answers for me.”

treatment and recovery. “Receiving a cancer diagnosis is

John manages the compounding or

incredibly difficult to process when

personalization of chemotherapies.

you are the one who has cancer. Daniel

Although he primarily provides behind-

chose to fight with his faith and not bear

the-scenes patient care, John enjoys

the burden of a cancer diagnosis on his

interacting with patients.

shoulders,” he said.

LMCFoundation.com

in Him,” said Daniel.

trust in the moment,

need during treatment,

As an infusion oncology pharmacist,

strength, so I trusted

Lexington Oncology

medicines patients may

of my days. I like knowing how things

“I believe that God is the source of my

of those in your corner. I like to think that the Lexington Medical Cancer Center team will always be the loudest cheering section.”

UPDATE

On Daniel

In March 2017, almost a year to the date of his original diagnosis, doctors discovered an enlarged lymph node during a routine CT scan. A biopsy detected traces of different cancer cells. This summer, Daniel had lymph node surgery at the Medical University of South Carolina in Charleston. His most recent CT scan showed nothing abnormal in the affected area, but his doctors will be monitoring a lung nodule during the next few months. ———————————————— Read more about Daniel’s fight against cancer on his blog at DanielStevanus.com.

October 2017 • Health and Hope

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The Best Medicine Exercise Helps Woman Lead a Healthier Life Janet Jordan says weight-loss surgery was the hardest thing she ever did. But the 66-year-old retiree credits the surgery and a customized exercise program for pointing her life in a better and brighter direction.

J

my needs and what I could

I was thrilled with the health

accomplish safely. It was a

benefits.”

very good program for me. I

The eight-week Exercise Is Medicine program pairs participants who qualify

anet underwent gastric

of all, she no longer takes

with a personal trainer and a

bypass surgery at

medicine for high blood

free two-month membership

Lexington Medical Center

pressure or anxiety, and

to Health Directions, the

in February to help gain

only takes one pill a day

hospital’s wellness gym.

for diabetes.

There, participants receive

control of diabetes and

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exercising was a positive, but

eight personal training

other health issues. She has

“I’ve been on blood

since lost nearly 75 pounds.

pressure medication for

sessions and a review of their

A referral to the hospital’s

nearly 20 years and on

medical history, including

Exercise Is Wellness program

diabetes medication for about

a custom training plan and

helped her transition into an

14 years,” said Janet. “My

an orientation to exercise

exercise regime that’s paid

prescriptions used to cost

equipment and classes.

equally big dividends. She

$300 to $400 a month, and

“My trainer Stephen

now has more energy and

now I pay less than $20 a

was very knowledgeable,”

feels much better. And best

month. The weight loss from

said Janet. “He focused on

Health and Hope • October 2017

loved the atmosphere and the knowledge of the staff.”

LMCFoundation PROVIDES HOPE

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1,041,510

$

for Patient Care

SINCE 2012 LMCFoundation.com


Janet plans to continue exercising at a local gym in her neighborhood. Frank J. Ferraro, MD, with Lexington Endocrinology, a Lexington Medical Center physician practice, says exercise is especially important for someone like Janet who has diabetes.

Frank J. Ferraro, MD

“Exercise helps lower

The D A T E E V A S

blood glucose by increasing Before starting an exercise

circulation to the muscles,” he said. “Since this is where

program, Dr. Ferraro says

most of our insulin receptors

people with diabetes should

are located, exercise helps

first get approval from their

lower blood glucose levels

physicians. This is especially

both during exercise and

important for individuals

afterward. Also, regular

over 35, those who are

exercise is an important

overweight or anyone with

part of maintaining an

another risk factor for heart

ideal body weight or losing

disease such as smoking or

weight. Being overweight

high blood pressure.

“The weight loss from exercising was a positive, but I was thrilled with the health benefits.” — Janet Jordan The Exercise Is Medicine

increases insulin resistance, making it more difficult to

program is funded by a

control blood glucose.”

grant from the Lexington

In addition, Dr. Ferraro

Medical Center Foundation. A

says people with diabetes

physician referral is required.

have a greater risk for

For more information about

developing cardiovascular

the program, contact Thad

disease and can reduce their

Werts at Health Directions at

risk with regular exercise.

(803) 936-7125.

Sunday, December 31, 201 7 7:30 p .m . UNIVERSITY OF SOUTH CAROLINA ALUMNI CENTER 900 Senate Street Columbia SC 29201

———————————— BLACK TIE OPTIONAL

———————————— For more information, please visit

Who’s Eligible for the Program?

LMCFoundation.com/nyegala. PRESENTED BY

The eight-week Exercise Is Medicine program requires a physician referral and targets individuals with two or more risk factors: • Family history of any chronic health condition such as heart disease or COPD

LMCFoundation.com

• Tobacco use

• Diabetes

• High blood pressure

• Obesity

• Dyslipidemia (elevated lipids)

• Sedentary lifestyle

October 2017 • Health and Hope

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Prsrt Std US Postage PAID Columbia, SC Permit No. 221

2720 Sunset Boulevard West Columbia, SC 29169

LMCFoundation.com

This magazine is intended for general understanding and education about the Lexington Medical Center Foundation and its initiatives. Nothing in this magazine should be considered or used as a substitute for medical advice, diagnosis or treatment. Readers with personal health or medical questions should consult their health care provider. The Lexington Medical Center Foundation is a nonprofit 501(c)(3) organization (Tax ID number 57-0906045). Our goal is to stimulate and receive charitable gifts, which help ensure that high-value, quality health services and patient-centered care are available for the people of the Midlands.

SPONSORED BY

FE ATURING COACH FR ANK MARTIN

Monday • November 6 • 6:30 p.m. Courtside • Colonial Life Arena ———————————————————————————————————‑—

Question and Answer Session with Coach Frank Martin 7:00 p.m. ———————————————————————————————————— COCKY • GAMECOCK CHEERLEADERS • CAROLINA GIRLS HORS D’OEUVRES • CASH BAR SPONSORED BY

$75 per person Purchase tickets online at LexMed.com/TipOff


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