Oncology Programs
FEA TURE INNOVATION, MEDICAL TRIALS, PERSONALIZED CARE , AND PARTNERSHIPS
NUTURING ADOLESCENT MENTAL WELLNESS
BY ADAM BIUCKIANS, MD, FAPA
HOW PATIENTS CAN REDUCE THE RISKS OF COMPLICATIONS
BY OSVALDO ZUMBA, MD
TIS THE SEASON FOR TICK-BORNE ILLNESSES BY
JAY ZIMMERMANN, MD
2024 BOARD OF DIRECTORS
OFFICERS
Sarah E. Eiser, MD President
Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women
Stacey S. Denlinger, DO
Immediate Past President
Highlands Family Practice & UPMC Wound and Hyperbaric Center
Robin M. Hicks, DO President-Elect
UPMC Supportive Care & Palliative Medicine
Christopher R. Scheid, DO Vice President College Avenue Family Medicine
James M. Kelly, MD Treasurer
Penn Medicine Lancaster General Health Physicians Family Medicine Lincoln
David J. Gasperack, DO Secretary WellSpan Health
DIRECTORS
Lena Dumasia, MD
Laura H. Fisher, MD
Anna Goetze, DO | Resident
Saima Khalid, MD, MPH, FAAFP, FACOEM
Logan Lawson, DO, MPH | Resident
Jessica Miller, MD | Resident
Karen A. Rizzo, MD, FACS
Daniel J. Schlegel, MD, MHA, FAAFP
Susanne E. Scott, MD, MPH
Danielle Rubinstein, DO
Osvaldo Zumba, MD
EDITORS
D awn Mentzer
Bet h E. Gerber
Stacey
LancasterPhysicianis a publication of the Lancaster City & County Medical Society (LCCMS). The Lancaster City & County Medical Society’s mission statement: To promote and protect the practice of medicine for the physicians of Lancaster County so they may provide the highest quality of patientcentered care in an increasingly complex environment.
Best Practices
Greetings!
I hope this message finds everyone well as we head into the summer months. I’m very excited to accept my new role as the president of the Lancaster City & County Medical Society. Thank you so much to our medical society leaders and board members, society members, and most importantly our executive director, Beth Gerber. Everyone contributes to making the society a great place for physicians to belong. There is so much value to engaging with physicians from different specialties and different health systems to celebrate and troubleshoot the many shared accomplishments and challenges in medicine.
This summer’s issue covers some important health topics, including common postoperative complications and ways to reduce the risks. We’ll also discuss youth mental health and its impact on academic performance. In addition, we’ll share information about tick-borne illnesses as more people are out enjoying nature.
We will also continue to learn more about the progress with restrictive covenant policy and what this may mean for physicians. We know everyone is very interested in learning more about AI and how this may impact health care. Our annual dinner was on Wednesday, June 26th, when we heard from keynote speaker James Spellos about “Artificial Intelligence 101 for Physicians and Patients: The Future is Now.”
As always, we look forward to the Pennsylvania Medical Society House of Delegates scheduled for later this year, on October 25-26th, where many of the big changes we see in medicine are initiated and supported.
Thank you to all of the contributors to this magazine. We appreciate your support and interest. Please reach out to us if you have any topics you are hoping to learn more about or if you have something you’d like to share with our readers.
I wish you all a wonderful summer,
Sarah Eiser, MD Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women
You’re proud to be a physician. Support the organization dedicated to serving you and your passion.
United we are stronger and can work together to make a positive impact in Lancaster County medicine and beyond.
If you aren’t already a member, we hope you’ll consider a membership investment in LCCMS.
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best pr ctices
• New Penn State Health Heart Failure Program Provides Specialized Care to Lancaster County
• WellSpan Growing Outpatient Services in Lancaster County
• UPMC Receives First in the State Accreditation for Hernia Surgery ALSO IN THIS SECTION
LANCASTER GENERAL HEALTH
Provides Medical Care on Professional Golf’s Biggest Stage
Crowds of spectators recently lined the fairways at the Lancaster Country Club for the U.S. Women’s Open golf championship. While most left with only happy memories, for others, an unexpected illness or injury threatened to spoil a perfect day on the links.
Fortunately, the team from Penn Medicine Lancaster General Health (LG Health) was there to help handle those unwelcome surprises.
More than 150 top-ranked female golfers teed off in the 2024 national championship in late May. From the opening drive to the final putt, a team of LG Health clinicians provided medical care from two fully stocked tents
strategically situated on the golf course.
The LG Health team, led by Leanne K. Beidler, MD, and Michael Killinger, MSN, RN, began coordinating logistics for the event nearly two years ago. While they treated mostly spectators for fairly minor conditions (think sunburn and sprained ankles), the team was prepared for anything from an athlete in need of quick medical attention, to someone with a life-threatening emergency, to a mass casualty event.
The LG Health team provided medical care on a volunteer basis, with at least one physician and two nurses staffing each tent throughout two days of practice rounds and four days of championship
play. The 78 volunteers came from diverse specialties, representing inpatient and outpatient departments of the health system, as well as a number of retired LG Health physicians.
“We were fortunate to have this event here in Lancaster,” said Beidler, the tournament’s medical director and a family physician. “To be a part of it and perhaps help people in this unique way was exciting for our team.”
The physicians and nurses—many of whom do not play or follow golf themselves—cited a variety of reasons for volunteering, including the chance to work with colleagues from other departments, break out of their usual routine, and share in the experience of having a major sporting event right in their backyard.
Pamela Vnenchak, MD, director of the LGH Family Medicine Residency Program, is a family physician who also happens to be a former emergency medical technician. She appreciated the rare opportunity to use her skills and experience to deliver care “in the field.”
“I love variety and the unexpected,” she said. “I enjoyed working in a fun, dynamic environment, getting to meet new people, helping some visitors with medical issues and injuries, and watching some golf.”
Killinger, LG Health’s medical director of logistics for the event, described the 600-square-foot medical tents as hybrid urgent care/family medicine offices, complete with flooring, temperature control,
running water, and private exam areas. Each tent contained a full complement of medical equipment and supplies, such as cots, disposable linens, AEDs, blood pressure cuffs, and first aid kits, as well as medications from Epipens to Narcan, IV fluids, and over-the-counter pain relievers.
The LG Health team provided medical care primarily to spectators, treating heatand sun-related conditions, headaches and stomachaches, lumps and bumps, strains and sprains, and the occasional golf cart mishap.
“Our primary objective was to provide quick treatment and get them back on their way,” said Killinger, regional director of operations for LG Health’s network of outpatient practices.
In more serious cases, the team stabilized and transported a handful of patients to Lancaster General Hospital for further care. (While care was provided in the medical tents free of charge, typical payment arrangements applied if patients were transferred to the hospital for additional care.)
Lancaster Emergency Management Services provided two on-site ambulances to assist in the event of a more serious illness or injury. The Conestoga River runs through the golf course, and the bridge over the river isn’t designed to carry full-sized vehicles, such as an ambulance. Instead, EMS personnel in three roving golf carts were available to quickly transport patients from anywhere on the golf course to a tent or ambulance for treatment.
In addition to Lancaster EMS, the LG Health team collaborated with local and state government, public safety, and emergency management officials, as well as the U.S. Department of Homeland Security, to prepare for the possibility of a mass casualty event.
Fortunately, nothing like that took place.
Volunteer Brandy Jenkins, MSN, RN-BC, nurse manager of the Trauma-Neuro Intensive Care Unit at LGH, handed out water battles for dehydration and adhesive bandages for blisters, marking a serious departure from her “day job” at the hospital.
“I enjoyed watching all the people so spirited for the event and helping where I could,” she said. “The feeling of being part of something the nation was watching was incredible.”
NEW PENN STATE HEALTH
Heart Failure Program Provides Specialized Care to Lancaster County
To expand patient access and support primary care providers, Penn State Health launched a Heart Failure Program at Lime Spring Outpatient Center in May.
The program offers specialized care for patients who have just been diagnosed with congestive heart failure disease, as well as those with worsening conditions that have become difficult to manage and may have resulted in recent hospitalizations.
Operating in conjunction with other cardiology services already available at Lime Spring Outpatient Center, located in East Hempfield Township, the heart failure program cares for patients who previously had to travel to Penn State Health Milton S. Hershey Medical Center.
“There already were a number of heart and vascular services available at Lime Spring Outpatient Center, but we’re expanding them to better serve patients in Lancaster County,” noted Dr. Steven Ettinger, vice president and physician leader of Penn State Health Heart and Vascular Services. “We want to be able to offer care that is convenient for all our patients.”
Over the past 25 years, the mortality rate from congestive heart failure in the U.S. has increased by 3%, according to a Journal of the American Medical Association cardiology study. Treating the condition has become more challenging for primary care providers who often don’t have the time necessary to educate patients on how to manage their disease.
That task falls to Tyler J. Thomas, CRNP, a former bedside ICU nurse at Milton S. Hershey Medical Center who now oversees heart failure patient care at Lime Spring Outpatient Center. Thomas has extensive experience in heart failure cardiac care, having worked with numerous patients in the Advanced Heart Failure Program at Milton S. Hershey Medical Center.
The goal of the Lime Spring Outpatient Center program, according to Thomas, is to stabilize patients and improve their condition before referring them back to their primary care provider, cardiologist, or other specialists.
He follows a patient closely for eight to 12 weeks, optimizing the use of guideline-directed medical therapy (GDMT), a pharmacological therapy for patients with heart failure with reduced ejection fracture. The therapy employs four different classes of drugs: beta blockers, angiotensin receptor neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium glucose cotransporter-2 inhibitors.
GDMT was recommended for use in heart failure patients following multiple major randomized controlled trials and is considered the cornerstone of pharmacological therapy, according to the National Institutes of Health.
“GDMT has produced excellent results for many patients, significantly enhancing
OVER THE PAST 25 YEARS, THE MORTALITY RATE FROM CONGESTIVE HEART FAILURE IN
THE U.S. has increased by 3%.
their quality of life and helping them better manage their condition,” Thomas said.
In addition, patients receive education on lifestyle changes such as dietary choices and fluid intake, smoking cessation, exercise and optimization of comorbid conditions.
“My goal is to partner with patients and empower them to optimize their care to help improve their outcomes and reach their goals,” he said.
Penn State Health also employs remote patient monitoring to assist those dealing with heart failure.
Patients whose conditions cannot be managed with lifestyle modifications or GDMT can see other Penn State Health heart failure specialists at Lime Spring Outpatient Center or may be referred to Milton S. Hershey Medical Center, which is known for its innovative Heart Failure Program.
“Together with their primary care provider and cardiologist, this team can make sure patients have the care they need wherever they are on their journey with heart failure,” said Holly Roush, vice president of Penn State Health Heart and Vascular Services.
In 1976, surgeons at Milton S. Hershey Medical Center implanted the nation’s first Pierce-Donachy left ventricular assist device (VAD). In 2021, the medical center became the second hospital in the United States to implant the EVAHEART2 left ventricular assist system in a patient with severe heart failure. The device is designed to reduce the risk of stroke and gastrointestinal bleeding.
Once considered bridge therapies for patients awaiting heart transplants, VADs are now often used as destination therapies, according to Ettinger, who said advances in technology have enabled VADs to become alternatives to heart transplant for some patients.
If a heart transplant is determined to be appropriate, patients can remain at Milton S. Hershey Medical Center, where surgeons have performed 591 transplant surgeries since the program began there in 1984.
“We have a quality transplant team with excellent results right here in our area,” Ettinger said.
The Scientific Registry of Transplant Recipients reported that 95.24% of patients who received a heart transplant at Milton S. Hershey Medical Center between July 1, 2017, and Dec. 31, 2019, survived three years after surgery, compared to a national average of 87.32%.
In addition, 100% of Milton S. Hershey Medical Center patients survived one year after their heart transplants, compared to a national average one-year survival rate of 91.23%.
Heart failure services at Lime Spring Outpatient Center will enhance Penn State Health’s nationally recognized heart failure program and assist primary care providers, Ettinger said, while offering convenience for patients in Lancaster County.
“Our goal is always to be patient-centered. That’s why we’re bringing these services right to the patients who need them the most.”
WellSpan Growing Outpatient Services in Lancaster County
ADDING SURGERY CENTER, EXPANDED BEHAVIORAL HEALTH, ENDOSCOPY CENTER, AND ENT PRACTICES
WellSpan is growing in Lancaster County — renovating, building, and adding services to offer convenient, state-ofthe-art outpatient care ranging from surgery to behavioral health care.
SURGERY CENTER
The growth is headlined by the WellSpan CityGate Surgery Center, a 34,000-square-foot outpatient surgery center and medical office building under construction on the northern edge of Lancaster City, close to Route 283 and Route 30.
Begun a little over a year ago, the two-story building is now under roof and undergoing interior work, including drywall and framing. The center is projected to open in early 2025.
“This center is a win for local patients and the community, offering outpatient surgery and outpatient care in a convenient location,” says Jim Stuccio, WellSpan senior vice president for the East Region, which includes Lancaster County. “We will be able to meet and treat patients where they are in this state-of-the-art facility.”
WellSpan surgeons initially will offer outpatient procedures in specialties that include breast surgery, urology surgery, plastic surgery, and ear, nose, and throat (ENT) surgery, with other specialties being added in the future. The building will feature four operating rooms and a patient-centric recovery space on the second floor. Laboratory services, imaging services, and offices for WellSpan surgical and medical specialists will be situated on the third floor.
Parking is conveniently located underneath the building as well as in a surrounding lot.
BEHAVIORAL HEALTH
WellSpan is also making significant investments in expanding its WellSpan Philhaven outpatient behavioral health services in Ephrata, moving to a larger, one-floor suite in a Reading Road building it already partially occupies.
The expansion allows WellSpan to co-locate several additional outpatient services and is in direct response to feedback from the Ephrata community noted in the WellSpan 2023-2025 Community Health Improvement Plan.
This feedback highlighted the fact that more than one-half of our community members reported experiencing depressive symptoms within the past two weeks, during a 2022 community health assessment survey conducted across WellSpan’s East Region, which includes Lancaster and Lebanon County. The survey also found that a rising number of our community members do not believe they have adequate social and emotional support and more than a third of the community was experiencing stress because of the recent loss of a loved one.
“We know that our community is in need of additional behavioral health services,” Stuccio said. “This expansion allows us to expand our range of outpatient care, drawing on our expertise as a comprehensive behavioral health network.”
The expanded Reading Road Philhaven office now includes a treatment room for Transcranial Magnetic Stimulation (TMS), a promising and non-invasive treatment for depression, used with patients who haven’t reached therapeutic goals with medication and therapy alone.
Approved by the Food and Drug Administration, TMS uses magnetic fields to stimulate underactive areas of the brain associated with
WellSpan Health’s additions include the new WellSpan CityGate Surgery Center and expanded WellSpan Philhaven outpatient behavioral health services as well as the new WellSpan Endoscopy Center. Also, the health system has welcomed the ENT Center LLC into the WellSpan Medical Group.
depression. WellSpan also offers TMS at offices in Mt. Gretna and in York.
The move also expanded space available for group therapy and private “video rooms” for virtual appointments with care providers.
“The demand for group therapy and virtual appointments has grown dramatically in recent years across the region and this expansion allows us to keep pace with this demand,” Stuccio said.
DIGESTIVE HEALTH
In April, WellSpan opened its new WellSpan Endoscopy Center at 4150 Barrett Boulevard, near Brownstown, and the companion WellSpan Digestive Health physician practice.
Together, these state-of-the-art facilities improve the community’s access to GI providers who perform advanced procedures such as upper and lower endoscopy and comprehensive digestive health care in a new office setting.
“Both the endoscopy center and the physician practice address significant needs in our community for digestive health care in a patient-friendly environment,” Stuccio said.
EAR, NOSE AND THROAT HEALTH
In March, WellSpan welcomed the ENT Center LLC into the WellSpan Medical Group.
This long-established practice is led by Dr. John Miller and Dr. Steven Dorf and physician assistants Ben Kingsley and Jeffrey Lewis. It offers ENT, hearing, and pediatric audiology services at two locations:
WellSpan ENT and Hearing Center at Lancaster, 810 Plaza Boulevard, Lancaster.
WellSpan ENT and Hearing Center at Ephrata, 561 W. Trout Run Road, Ephrata.
“This practice has served Lancaster County for more than 50 years and we are pleased to partner with them to improve the access to ENT care in our region,” Stuccio said. “Joining with them allows us to make sure that patients continue to receive experienced care from a trusted provider.”
UPMC Receives First in the State Accreditation for Hernia Surgery
UPMC in Central Pa. is the first regional hospital network in Pennsylvania to receive the Network of Excellence in Hernia Surgery accreditation from the Surgical Review Corporation (SRC).
A hernia is a bulge that happens when a body part (tissue, intestines, organs) pushes through the fascia or muscle that helps keep that body part in place. Hernias are common and most often occur in the stomach and groin areas. Hernias can be caused by strain during heaving lifting, weakened muscles or fascia in the abdominal wall, or repetitive stress on the affected area.
Not all people with hernias experience pain or symptoms. However, the most obvious symptom of a hernia is a bulge in the stomach or groin areas. Hernias can protrude when you’re coughing, lifting, or exerting yourself. The bulge or protrusion is accompanied by pressure, aches, and pinching in the affected area. Some types of hernias are more visible than others, like inguinal (groin) hernias – the most common type. Femoral (upper thigh) and hiatal (stomach) hernias are too deep to be visible or seen from the outside of the body.
UPMC Comprehensive Hernia Center focuses on minimally invasive repairs including laparoscopic and robotic repairs. These techniques involve smaller incisions and less downtime for the patient. Repairing a hernia involves pushing in the herniated tissue and—in some cases—using surgical mesh to make the muscle or fascia stronger. Hernia repair surgery can also provide the patient with additional benefits like less pain and discomfort, fewer complications, and a low recurrence rate post-operation.
UPMC performs over 2,500 hernia repair surgeries a year in the region using minimally invasive techniques including robotics. UPMC providers and clinical teams work with each patient to develop a treatment plan that is personalized to their needs. UPMC hospitals have implemented system-wide pathways, procedures, and standards to ensure patients receive the same expert level of care, no matter the location.
Recently, UPMC underwent an extensive assessment and inspection process to ensure all locations meet SRC’s proven standards and requirements. These requirements include high surgical volumes, facility equipment, clinical pathways and standardized operating procedures, an emphasis on patient education and continuous quality assessment.
The Surgical Review Corporation is an international nonprofit organization that focuses on patient safety. The SRC performs thousands of inspections around the world on medical professionals, doctors, hospitals, and outpatient facilities. Those who receive accreditation from the SRC dedicate time, resources, and practices to exemplify excellence in patient care and safety.
“We’re proud to recognize UPMC for its commitment to advancing and providing quality care for all patients,” said Gary M. Pratt, CEO of SRC. “This accreditation signals that this facility is among the best in this specialty and is dedicated to delivering the highest level of care possible.”
Patients can expect the same, higher level of hernia surgery care at any UPMC hospital in the central Pa. region, including at UPMC Lititz, with consults available in Lancaster, Lititz, and Annville.
Nurturing Adolescent Mental Wellness:
PREPARING FOR ACADEMIC SUCCESS
In the complex world of adolescent development, nurturing mental wellness is critical for the successful transition to young adulthood.
Continued on page 14
ADAM BIUCKIANS, MD, FAPA Community Services Group
Healthy Communities
The journey through adolescence is marked by numerous transitions, challenges, and newfound responsibilities, making it of vital importance to foster mental health and wellness. As adolescents navigate the complexities of their internal and external worlds, the status of their mental health can either bolster or hinder their academic journey. This article explores the profound connection between adolescent mental health and academic performance while offering practical strategies to help adolescents prepare for the upcoming school year during the summer break.
UNDERSTANDING
THE INTERSECTION: ADOLESCENT MENTAL HEALTH AND ACADEMIC PERFORMANCE
Adolescence is a period of rapid physical, cognitive, and emotional development, characterized by heightened sensitivity to social interactions, academic pressures, and self-identity exploration. During this pivotal phase, mental health concerns can manifest in various forms, including anxiety, depression, behavioral issues, substance abuse, and even psychosis. These challenges not only affect the overall well-being of adolescents but also exert a significant influence on their academic achievements.
Research indicates a clear correlation between mental health and academic performance among adolescents. Persistent feelings of anxiety or depression can impair cognitive function, attention span, and memory retention, making it difficult for students to concentrate on their studies and perform optimally in academic settings. Moreover, untreated mental health issues may contribute to absenteeism, poor time management, decreased motivation, and reduced academic engagement, further exacerbating the academic struggles faced by adolescents.
The school environment, with its academic demands, social pressures, and extracurricular activities, often serves as a crucible where adolescent mental health issues come to the forefront. The transition from middle school to high school,
standardized testing, college admissions stress, and peer relationships can amplify feelings of inadequacy, self-doubt, and inferiority among adolescents, adversely affecting their mental well-being and academic outcomes.
EMPOWERING ADOLESCENTS: STRATEGIES FOR SUMMER PREPARATION
As the summer break provides a temporary respite from the rigors of academic life, it also presents a valuable opportunity for adolescents to focus on their mental health and equip themselves for the challenges of the upcoming school year. Here are some proactive strategies to help adolescents nurture their well-being and prepare for academic success during the summer months:
• Prioritize Self-Care: Encourage adolescents to prioritize self-care activities that promote mental and emotional well-being. This generally includes healthy lifestyle habits, such as establishing a regular sleep schedule, engaging in physical exercise, practicing mindfulness or meditation, and cultivating hobbies or interests that bring joy and fulfillment.
• Develop Coping Skills : Equip adolescents with effective coping mechanisms to manage stress, anxiety, and academic pressure. Teach them relaxation techniques, such as deep breathing exercises or progressive muscle relaxation, to alleviate stress symptoms. Encourage journaling as a means of self-expression and reflection, allowing adolescents to process their thoughts and emotions constructively.
• Foster Support Networks: Emphasize the importance of seeking support from trusted adults, peers, or mental health professionals when facing mental health challenges. Create a safe and non-judgmental space for adolescents to discuss their concerns and feelings openly. Additionally, encourage the cultivation of healthy peer relationships and social connections, which
can serve as a source of comfort and resilience.
• Set Realistic Goals: Help adolescents set realistic academic goals for the upcoming school year based on their abilities, interests, and aspirations. Break down larger goals into manageable tasks and create a structured plan to achieve them. Encourage adolescents to focus on personal growth and progress rather than comparing themselves to others.
• Engage in Enrichment Activities: Encourage them to explore educational pursuits outside the confines of traditional academics, such as attending workshops, participating in summer camps, or embarking on self-directed learning projects. These activities not only broaden their horizons but also instill a love for lifelong learning.
• Promote a Balanced Lifestyle : Advocate for a balanced lifestyle that encompasses academics, extracurricular activities, social interactions, and relaxation. Encourage adolescents to maintain a healthy balance between their academic responsibilities and leisure pursuits, ensuring adequate time for rest, recreation, and rejuvenation.
• Cultivate a Growth Mindset: Encourage adolescents by emphasizing the power of perseverance, effort, and resilience in the face of challenges. Help them to view setbacks and failures as opportunities for learning and growth rather than insurmountable obstacles. Instill confidence in their abilities to overcome obstacles and achieve success through determination and perseverance.
• Seek Professional Guidance: If adolescents are struggling with persistent mental health issues or academic challenges, encourage them to seek professional guidance from school counselors, therapists, pediatricians, or child/adolescent psychiatrists. Provide information about the available
resources and support services within the community to ensure adolescents receive the assistance they need.
By proactively addressing adolescent mental health and wellness and equipping adolescents with the necessary tools and support systems, we can empower them to thrive academically and personally. As the summer unfolds its leisurely embrace, let us seize the opportunity to invest in the mental well-being and academic success of the next generation. Together, let us nurture resilient, empowered adolescents who are poised to embark on their academic journey with confidence and competence.
For anyone in need of finding treatment resources for adolescents, Pennsylvania 211 East (Dial 211 on the phone, or go to pa211east.org/lancaster) is a free, confidential, non-emergency, comprehensive information and referral service that connects Lancaster County residents with the health and human services they need. For crisis or mental health emergencies that require immediate attention, contact Lancaster County Crisis Intervention at 717-394-2631. Or call the National Suicide Prevention Hotline at 1-800-273-8255.
Greater Caring.
A cancer diagnosis is overwhelming and can weigh on patients. That’s why we offer a team of dedicated cancer experts, personalized care plans, and integrated support services, from nutritional and well-being support classes to financial counseling, so patients can focus on themselves. New patients and second opinion appointments are available within 24 hours by calling 717.291.1313
Lena Dumasia, MD
Hyatt P. (Tracy) DeGreen III, DO Roxana Ramos, CRNP
HTis the Season for Tick-Borne Illnesses
THE TYPES, RISKS, PREVENTION, AND TREATMENTS
ot days are here, and now, as we’re at the zenith of the summer tick season, we’re spending more time outside. Of course, with the warmer winters, ticks and their illnesses are also found during other times of the year in Lancaster County. 1, 2
Tick-borne illnesses occur when an infected tick attaches to a person during a blood meal, resulting in the transfer of a pathogen. These illnesses can be localized or can cause systemic diseases. In some cases, they cause serious morbidity and mortality if unrecognized and untreated.
In the United States, tick-borne illnesses include:
1. Bacterial-associated illnesses - Anaplasmosis, ehrlichiosis, Lyme disease, tickborne relapsing fever, Rocky Mountain spotted fever, tularemia;
2. Protozoa-associated illnesses - Babesiosis;
3. Viral-associated illnesses - Colorado tick fever, Powassan encephalitis; and finally
4. Hypersensitivity-associated illnesses - Alpha-gal syndrome
These have incredibly variable clinical presentations, ranging from mild viral syndromes and localized rashes to severe multisystem illnesses and progressive multistage diseases.
Lyme disease accounts for the lion’s share of tick-borne illnesses in the US and in Lancaster County. In 2022, PA ranked 9th in the US for Lyme disease per population with 64.9 cases/100,000 persons. Nearly half (47.8%) of those cases were reported between June and August. From 2019-22, 650 cases of Lyme disease were reported in people living in Lancaster County, with the next highest reported tick-borne
JAY ZIMMERMANN, MD
Penn Medicine Lancaster General Health Physicians Norlanco
disease being 17 cases of anaplasmosis.3 Although not as common, other tick-borne illnesses are also here and increasing in prevalence.
Prevention is key. This includes avoiding known tick infested areas (when possible!), wearing light-colored clothing, long sleeved shirts and pants, wearing tick repellant and wearing permethrin-treated clothing. Tick repellants include DEET (up to 30%), picaridin, oil of lemon eucalyptus, IR3535, PMD or 2-undecanone. After being outside, perform daily checks for ticks, wash clothing in hot water,4 and bath within 2 hours of coming inside. Light-colored clothing allows for greater tick visibility during tick checks.5 Despite all of this, ticks can be missed before and after they are attached.
IF YOU FIND AN ATTACHED TICK, WHAT CAN YOU DO? FIRST… REMOVE IT PROPERLY & PROMPTLY.
One small study used viscous lidocaine for 10 minutes on the area the tick was biting and improved removal rate.6 No viscous lidocaine? Try over the counter lidocaine. I keep 4% solution on hand and have used it for myself and children and feel it makes removal easier. Do not use petroleum jelly, nail polish, or heat on the tick.
Then, simply use a clean fine-tipped tweezer inserted between the tick body and the skin (as close to the skin as possible). Use steady traction to pull the tick off, avoiding twisting it. Wash the area with soap and water. It’s important to remove all of the tick because remaining embedded tick parts often cause a local inflammatory reaction.
SECOND…
IDENTIFY THE TICK. CERTAIN TICKS CARRY CERTAIN DISEASES.
The CDC’s website (cdc.gov) provides information on tick identification and your local lab may identify the tick as well.
Additionally, Pennsylvania has a state-run service, ticklab.org, which will identify the tick (either by photos or examining the tick itself). The tick research lab also offers free basic testing of ticks for infectious disease to PA residents. However, testing for infectious agents is not recommended by Infectious Diseases Society of America (IDSA) or PA Department of Health. This can lead to overtreatment as most ticks are not attached long enough to transmit illnesses.
In Lancaster County, if a deer tick (also known as a black-legged tick) is attached for at least 36 hours, the risk of contracting Lyme is high enough that antibiotic prophylaxis is recommended. At 36 hours, the tick will usually appear engorged. A single dose of doxycycline (200 mg for adults and 4 mg/kg for all ages of children) can be started within 72 hours of removal. Doxycycline is safe to use for children of all ages as it does not cause dental staining when given for less than 21 days. Doxycycline prophylaxis has no role in prevention of other tick-borne illnesses.
Roughly three-quarters of patients with Lyme develop a rash called erythema migrans (EM). Most were bitten by a tick within 7-10 days before EM. For those who develop EM, minimum treatment length is 10 days for doxycycline, 14 days for cefuroxime and amoxicillin, and 7 days for azithromycin. Doxycycline 100mg BID (4.4 mg/kg BID in children) is preferred, whereas azithromycin is thought to be the least effective agent. Additionally, doxycycline treats other tickborne illnesses that can be co-infected. The minimum duration of therapy for other presentations of Lyme can vary from 14-21 days for neurologic and cardiac disease to 28 days for arthritis. Prolonged treatment beyond the recommended length for persistent symptoms is not effective.
Lyme disease can be difficult to confirm at times. In part, not all people recall a tick bite, nor develop the EM, and not all EM exhibits the classic bullseye rash.
Here in central PA, Lyme can be diagnosed clinically with EM. Laboratory test sensitivity is low (30-40%) early in the illness (such as the first 14 days), as Lyme antibodies may not have developed. Two-step antibody testing is recommended for confirmation. The first blood test is an enzyme immunoassay (EIA) or immunofluorescence assay (IFA) for IgM and/or IgG. If positive or equivocal, this will reflex to a Western immunoblot. For disseminated Lyme illness, sensitivity of testing ranges from 70%–100%. Specificity is high (>95%) during all stages of illness.7 Two of three IgM bands support recent Lyme disease; whereas 5 out of 10 IgG bands support either recent (within 21 days) or remote Lyme disease. Antibody testing cannot ascertain if a person no longer has Lyme as antibodies are detectable months to years later. Some labs may perform a modified two-step testing, with an EIA/IFA followed by a second immunoassay.8
THERE MAY BE SOME OTHER LAB ABNORMALITIES WITH LYME OR OTHER TICK-BORNE ILLNESSES.
Many other tick-borne illnesses, while still rare, can be more problematic in diagnosis. They can mimic other causes of fever, or have other mild symptoms, while some can present with severe symptoms such as encephalitis. For serious illnesses, consider a consultation with an Infectious Disease specialist. Suspected anaplasmosis, ehrlichiosis, and rickettsioses should be treated with doxycycline. Clinical suspicion of any of these diseases is adequate to begin treatment. Delay in treatment due to testing may result in severe illness and death.
Deer ticks with anaplasmosis are now found in all PA counties, although the number of anaplasmosis cases are still quite low with 581 in the state in 2022, and they continue rising. Powassan virus can cause an encephalitis and symptoms appear like other mosquito-borne encephalitis.
Alpha-gal syndrome, spread by the Lone Star Tick (that’s the one with the white dot), can cause allergic reaction including GI symptoms, hives, angioedema, dyspnea when someone eats beef, lamb, or pork meats or products, although most people can tolerate dairy. Most commonly, individuals experience GI symptoms, which can be delayed by 3-6
hours after ingestion of the offending food. Currently, the only treatment is long-term avoidance of alpha-gal-containing foods. The Lone Star Tick can also cause another illness called South Tick-Associated Rash Illness (STARI), which can appear similar to Lyme.
As “an ounce of prevention is worth a pound of cure,” perform daily tick checks after being outside, and remove ticks before they have a chance to feed. If a tick does feed in Lancaster County, identify the tick. If a deer tick is engorged or present >36 hours, doxycycline prophylaxis is recommended. Should EM appear, treat promptly as well. Other tick-borne illnesses can be harder to identify and may need the help of an Infectious Disease specialist.
SOURCES
1. PENNSYLVANIA DEPARTMENT OF HEALTH 2024-PAHAN-746-04-30-ADV Lyme Disease and Other Tickborne Diseases in Pennsylvania; Nuttall, P.A. Climate change impacts on ticks and tick-borne infections. Biologia 77, 1503–1512 (2022). https://doi. org/10.1007/s11756-021-00927-2;
2. Eisen RJ, Eisen L, Ogden NH, Beard CB. Linkages of Weather and Climate With Ixodes scapularis and Ixodes pacificus (Acari: Ixodidae), Enzootic Transmission of Borrelia burgdorferi, and Lyme Disease in North America. J Med Entomol. 2016 Mar;53(2):250-61. doi: 10.1093/jme/tjv199. PMID: 26681789; PMCID: PMC4844560
3. (Geographic Distribution of Tickborne Disease Cases | Ticks | CDC accessed 6/25/2024
4. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Care Res (Hoboken) 2020
5. Ho BM, Davis HE, Forrester JD, Sheele JM, Haston T, Sanders L, et al. Wilderness Medical Society clinical practice guidelines for the prevention and management of tick-borne illness in the United States. Wilderness Environ Med. 2021;32(4):474-94.
6. David J Karras, Tick Removal, Annals of Emergency Medicine, Volume 32, Issue 4, 1998, Page 519, ISSN 0196-0644, https://doi.org/10.1016/ S0196-0644(98)70192-1.
7. Moore A, Nelson C, Molins C, Mead P, Schriefer M. Current Guidelines, Common Clinical Pitfalls, and Future Directions for Laboratory Diagnosis of Lyme Disease, United States. Emerg Infect Dis. 2016 Jul;22(7):1169–77. doi: 10.3201/eid2207.151694. PMID: 27314832; PMCID: PMC4918152.
8. Suggested Reporting Language, Interpretation and Guidance for Lyme Disease Serologic Testing Results (aphl. org) accessed 6/30/2024).
How Patients Can Reduce the Risks of Complications After Surgery
AND IMPROVE THEIR RECOVERY
OSVALDO ZUMBA, MD WellSpan Surgical Specialists – Ephrata
When it comes to any surgery, there is always some level of risk involved.
The particular risks and complications vary with the type of surgery. Your surgeon knows best what the most common of these are and will offer more detailed instructions on how to best reduce your risks for a poor outcome and facilitate a fast and easy recovery.
Surgical complications can include minor issues such as sore throat, fatigue or nausea. They can also be more serious, including wound infections, blood clots, fevers, urinary tract infections, or pneumonia. These are only some of the issues that patients may experience post op.
These complications will increase the amount of time you need to recover and
There are also several things that you can work on with your primary care doctor WEEKS— OR EVEN MONTHS—PRIOR TO YOUR SURGERY to help improve your recovery.
delay the overall benefit you receive from your surgery. Many postoperative problems will be addressed by your physician and medical team on the day of your surgery. Interventions such as antibiotics before surgery, injections to prevent blood clots, and early mobilization right after surgery have been proven to improve recovery. There are also several things that you can work on with your primary care doctor weeks—or even months—prior to your surgery to help improve your recovery:
Stop Smoking
Multiple studies have shown that stopping smoking or even significantly decreasing the amount of smoking prior to surgery improves outcomes. Compared to nonsmokers, smokers who undergo surgery have been shown to have poor wound healing, increased inflammation, slower recovery, and higher rates of infections after surgery.
Quitting smoking 6-8 weeks prior to surgery has been shown to significantly decrease complication rates. Emphasis has been placed throughout all surgical specialties to help patients quit smoking. Your physician can provide you with multiple resources, including medication and smoking cessation programs, to help you quit.
Get Elevated Blood Sugar Under Control
Talking with your primary care doctor about addressing uncontrolled blood sugar or better controlling your diabetes is crucial for improving the outcome of your surgery. Poorly controlled blood sugar has been associated with increased post op infections, including wound infections, pneumonia, and even sepsis. Research has also demonstrated that uncontrolled diabetes is associated with delayed recovery and longer hospital stays.
Controlling your blood sugar both prior to and post procedure can also be very difficult as your normal diet may be affected. Some patients may even go several days without eating after surgery, which may require a more complex regimen with constant blood sugar checks and injectable medications. Discuss a plan with your primary care physician or an endocrinologist to manage these issues both pre and post op.
Make Good Nutrition a Priority
Proper nutrition is one of the best predictors of surgical outcomes. Patients with poor nutrition prior to surgery have been associated with poor outcomes. Improvement in nutrition has been shown to lower post op complication by up to 50% in some studies. Blood work, as well as screening tools, can be used to determine malnutrition prior to surgery. Nutritional issues can be discussed with your surgeon and evaluated by a nutritionist for optimization prior to surgery. Some patients may even be required to have a procedure to improve nutrition with surgery, which could include placement of a feeding tube or a long-term IV for nutrition through the veins.
However, most patients undergoing surgery do not require a procedure to improve nutrition. Prior to surgery, a well-balanced diet with all key nutrients—including vitamins and the appropriate fats, carbohydrates and proteins—can benefit all patients.
Start an Appropriate Exercise Program
Due to the stress of surgery and weakness that may develop during recovery, starting an exercise program before surgery can be beneficial to many patients. Studies have shown that the preoperative exercise (commonly referred to as “prehabilitation”) has multiple benefits: increases muscle mass,
reduces average length of hospital stay, and decreases the need for post-operative rehabilitation.
Of note, a simple six-week exercise program—that might include resistance training or a basic walking program—has been shown to reduce fatigue after surgery and provide better long-term results compared to postoperative rehabilitation alone. As a result, most hospital systems and surgical groups recommend prehabilitation, especially in deconditioned patients and patients undergoing orthopedic surgery.
Monitor Medications
Review of medications prior to your surgery is important. This will be done at multiple steps prior to surgery and postoperatively as well. As patients age, they are more prone to be vulnerable to side effects (such as delirium and abnormal vital signs) from medications. In addition to prescribed medication, home remedies and vitamins should be reviewed by your medical team as they may cause unintended side effects.
While it is impossible to completely eliminate the potential for complications and postoperative problems, patients can take part in decreasing the risks. If you feel ill right before surgery, have fevers or a chronic cough develop, or any other significant changes in your health status, please notify the surgeon as soon as possible. Sometimes the surgeon may be able to treat and resolve your issue before the date of your surgery. However, sometimes your surgeon may have to postpone your surgery in order for you to have the best results from the procedure and easiest recovery.
WHERE THINGS STAND WITH Restrictive Covenants & Noncompete Clauses
PROVIDED BY PAMED
The Pennsylvania Medical Society (PAMED) supports reasonable limitations on restrictive covenants in physician contracts. Restrictive covenants, sometimes referred to as noncompete agreements, often live within an employment contract. These clauses are designed to restrict a physician’s ability to leave an employer and work for a competitor or other medical facility. PAMED believes this interferes with patient care as it limits a patient’s access to their physician based on distance if the physician should leave their practice.
PAMED has supported previous legislation on restrictive covenants that aims to prohibit their use in health care practitioner employment contracts, with limited exceptions. The bill allowed for the freedom of movement among employed health care practitioners while protecting health care employers in less densely populated areas who have more difficulty attracting and retaining practitioners.
KEY ITEMS
• Legislation was introduced in the Pennsylvania Capitol that would prohibit the use of noncompete provisions in physician employment contracts.
• The legislation, sponsored by Representative Dan Frankel (D-Allegheny), passed the PA House with a vote of 150-50. PAMED continues to advocate for an amendment to the language that would allow non-affiliated private practices to use noncompete agreements.
• At the same time, the Federal Trade Commission (FTC) approved a final rule that will ban noncompete clauses for workers nationwide except in limited circumstances.
It is important to remember that the vast majority of non-profit organizations will NOT be subject to this rule. This is due to the fact that FTC jurisdiction covers only for-profit activities. However, the FTC does claim jurisdiction over non-profit organizations that are deemed to be “profit-making enterprises.” There is caselaw that supports this.
To determine whether a non-profit organization is a profit-making enterprise, the FTC employs a two-part test, looking to both (1) “the source of the income, i.e., to
whether the corporation is organized for and actually engaged in business for only charitable purposes, and (2) to the destination of the income, i.e., to whether either the corporation or its members derive a profit.”
Shortly following the adoption of the FTC rule, the U.S. Chamber of Commerce sued to prevent implementation of the rule. The Chamber argues that the FTC lacked
the authority to issue such a sweeping rule. Litigation and the uncertain timeline of publication in the Federal Register make it impossible to say when, if ever, the rule will actually take effect.
RULE
LANCASTER COUNTY HEALTH SYSTEMS’ Oncology Programs Feature Innovation, Medical Trials, Personalized Care, and Partnerships
SUSAN SHELLY Writer
Breakthroughs in cancer research and improvements in care resulted in a 33% drop in cancer deaths between 1991 and 2020, according to the American Association of Cancer Research.
And yet, more than 2 million people in the United States are expected to be diagnosed with cancer for the first time in 2024 — nearly 5,500 diagnoses a day — reported the American Cancer Society.
While the use of tobacco had decreased, other risk factors, including age, obesity, insufficient physical activity, and excessive alcohol use, are on the rise among certain groups of people.
Alarmingly, cancer rates among adults under 50 have risen sharply, and certain population groups remain at higher risk for cancer due to limited access to health care, environmental conditions, and other factors.
Still, experts remain hopeful about the future of cancer research and treatment, citing innovative treatments such as chimeric antigen receptor (CAR)-T cell therapy, immune checkpoint inhibitors, minimally invasive surgery, personalized cancer vaccines, advances in radiation therapies, and others as tools that can help to prolong and save lives.
Lancaster Physician reached out to the institutions serving Lancaster County residents to find out more about their oncology programs, asking how they are serving patients and what sets them apart from other programs. We spoke with representatives from Penn Medicine Lancaster General Health, WellSpan Health, Penn State Health, and Lancaster Cancer Center.
Penn Medicine Lancaster General Health Lancaster General Health’s membership in Penn Medicine gives residents of Lancaster County the advantages of a long-trusted community health system with the ability to offer its patients world-class, academic cancer care.
“We’re able to offer a breadth of treatment and services that most communities don’t have,” noted Dr. Randall A. Oyer, executive medical director of cancer services at LG Health and a clinical professor of medicine at the Perelman School of Medicine at the University of Pennsylvania. “We are the western front of Penn Medicine.”
Being part of Penn Medicine puts LG Health at the forefront of the field of immunotherapy, which includes cancer vaccines, immune modulatory drugs, and cell-based therapies, including chimeric antigen receptor (CAR) T cell therapy, a highly effective treatment for lymphoma, leukemia, and multiple myeloma.
First developed by Penn Medicine starting in 2003, CAR T cell therapy is used at academic medical centers around the world, having firmly established its effectiveness through many years of clinical trials. CAR T, which continues to be studied for hematologic and solid malignancies, as well as non-cancer conditions, such as lupus, represents a turning point in the history of human medicine.
Patients with Diffuse Large B-Cell Lymphoma are receiving treatment at LG Health’s state-of-the-art Ann B. Barshinger Cancer Institute, while those with other diseases for which CAR T is beneficial, as well as those enrolled in clinical trials, are currently treated at Penn Medicine in Philadelphia.
“We are the first community cancer center to be able to perform CAR T as an outpatient treatment,” Oyer noted.
The Ann B. Barshinger Cancer Institute is also home to Central Pennsylvania’s only Proton Therapy Center, where patients with certain forms of cancer can receive this highly accurate, noninvasive, painless type of radiation therapy.
Members of LG Health’s proton therapy team, including radiation oncologists, dosimetrists, physicists, nurses, and others, have received specialized training from Penn Medicine, which Oyer noted is a global
leader in proton therapy and has trained more than 75 percent of all proton therapy experts worldwide.
Oyer also notes that there are numerous cancer treatment trials underway at the Ann B. Barshinger Cancer Institute, focusing on the treatment of both early and late stage cancer, as well as prevention of cancer.
“Many cancer centers focus on treatment, but we expand that to also look at prevention,” he noted.
Clinical trials provide treatments that patients often respond to, giving hope for possible healing.
“Today’s trials may offer treatments that are the best option for the patient,” Oyer said. “These trials have led to many breakthroughs over the years.”
Oyer also is excited about the benefits of LG Health’s precision medicine program, which brings the most innovative cancer treatments specifically designed for particular and unique traits of an individual and of an individual’s cancer cells.
“It’s precision about the body, and precision about the patient as a person, considering treatment preferences, what matters most to a person, and what other medical conditions a person may have,” Oyer said.
Precision medicine diagnostic tools also help detect disease at earlier stages, often allowing for more effective and more tolerable treatment. LG Health’s precision medicine physicians offer tailored treatment plans, considering not only which type of treatment to use, but how much, and paying close attention to how a particular patient responds to certain treatments.
Oyer, who is board certified in Internal Medicine and Medical Oncology and has been in practice for more than 40 years, said he’s greatly encouraged by the progress in cancer treatment he’s witnessed throughout his career.
Continued on page 24
Dr. Randall A. Oyer
Perspectives
While there’s still much work to do, there is great promise in many areas of cancer treatment. Specifically, he is optimistic about the use of precision medicine tools; a growing ability to harness the power of the immune system to fight cancer; and an increased understanding of genetics to aid in screening for, preventing, and treating cancer.
“We’re nowhere near the finish line, but we’re making great strides,” Oyer said. “There are still too many people who get cancer and die from cancer, but that only motivates us to work harder to solve these big problems.”
An ongoing goal, Oyer said, is to continue expanding equitable access to clinical trials, cancer treatment, and health care in general to everyone in the community.
WellSpan Health
Newly designed patient-centered cancer programs, a valuable collaboration with Johns Hopkins Medicine Kimmel Center, and an innovative population genomics program aimed at enhancing precision medicine are factors that distinguish WellSpan Health from other oncology programs serving Lancaster County, said Dr. Nikhilesh Korgaonkar, Vice President and Chief Medical Officer for the WellSpan Cancer Institute.
“We’re rethinking the way we deliver care to make it a better experience for every patient,” explained Korgaonkar. “We’re committed to not only providing the most advanced care, but to doing so in a compassionate, patient-centered way.”
Breast cancer patients are benefiting from a program launched near the end of 2023. Featuring navigation services for every patient, the program aims to significantly improve the quality of the patient experience.
“Experience of care may be second to outcomes, but it’s still extremely important,” Korgaonkar said. “Navigating cancer care on your own can be extraordinarily confusing
and overwhelming. Now all our breast cancer patients have someone to see them through all that during their treatments.”
The breast cancer program also is designed to reduce the time between a suspicious finding, a diagnosis, and the start of treatment, and includes a same-day biopsy feature. Time from an abnormal finding to a diagnosis is about 20% faster than it had been previously.
“It’s the time of not knowing that causes the most anxiety, so whatever we can do to shorten that time is effort well spent,” Korgaonkar said.
A lung cancer program modeled on the success of the breast cancer program is in the works and expected to be fully in place by this fall. Programs to serve patients with colon cancer and genitourinary cancers — predominantly prostate cancer — are in the planning stages.
“We’re establishing these programs to address the four most prevalent and important cancers to our area,” Korgaonkar said.
All WellSpan’s cancer programs benefit from a collaboration with Johns Hopkins Medicine, which is home to the Sidney Kimmel Comprehensive Cancer Center in Baltimore.
Started about two-and-a-half years ago, WellSpan’s collaboration with Johns Hopkins continues to evolve, giving patients an added layer of expertise, greater disease specialization, and greater availability of clinical trials within WellSpan Cancer Institute when it comes to their care.
WellSpan doctors can seek second opinions from Johns Hopkins specialists through a remote program where images can be posted for examination. Typically, a Johns Hopkins Medicine physician will respond with a second opinion within three or four days.
WellSpan providers also can present their patients in Johns Hopkins Medicine tumor boards, and some patients meet virtually
with Johns Hopkins physicians.
“There are instances where the care we provide benefits from the input of an academic partner like Johns Hopkins,” Korgaonkar said. “For us to be able to tap into that expertise on behalf of our patients is extremely beneficial.”
Another WellSpan partnership aimed at benefiting patients is with Helix, a California-based population genomics and viral surveillance company that has launched a genomics research project as part of WellSpan’s precision medicine program. Precision medicine, Korgaonkar explained, is an emerging approach to cancer treatment that considers the genetic backgrounds of patients in order to personalize treatments.
Knowing genetic information specific to a patient can not only help in treating a patient, but also in gauging their risk for disease and predicting how they might respond to specific medications.
Working with Helix, WellSpan initiated the Gene Health Project, a community health research program that offers no-cost genetic tests to help determine potential risk for heart disease and certain cancers.
A simple blood test is performed locally, and the sample is sent to Helix for DNA analysis. If a hereditary cancer risk is detected, the patient will be notified personally by Dr. David Kann, the medical director of Precision Medicine at WellSpan.
“For the first time, we’ll have the ability to use a patient’s genetic background to help predict their risk for cancer,” Korgaonkar said. “This is moving us from preventative medicine to predictive medicine.”
With a goal of enrolling 100,000 patients in four years, the program in its first year has already consented 23,000 patients for genetic testing and tested about 17,000. Of those tested, about 225 were diagnosed with one of the three conditions designated by the Centers for Disease Control and Prevention as Tier 1 applications: hereditary breast and ovarian cancer syndrome, Lynch syndrome,
Dr. Nikhilesh Korgaonkar
and familial hypercholesterolemia.
“Having that information can help these patients stay on top of their care and greatly increase the chances of detecting cancers at an early, more treatable and curable stage,” Korgaonkar explained. “And that’s good for everyone.”
Penn State Health
Penn State Health has made significant progress since starting an aggressive program in 2022 to integrate its cancer care systemwide.
Dr. Marc Rovito, who in February 2022 was appointed to the newly created position of Vice President and Physician Leader for Cancer Services, has been overseeing the efforts to manage and deliver cancer care across the system.
“The health system decided it needed to further develop the service line and coordinate cancer care across all its hospitals and outpatient practices,” Rovito explained. “We want to ensure that no patient has to leave the area where they live to get care.”
Comprehensive cancer services have been available for many years at the Penn State Cancer Institute, located on the campus of Penn State Health Milton S. Hershey Medical Center in Hershey and the Cancer Center at Penn State Health St. Joseph Medical Center in Reading.
In 2021, a cancer center was established in the newly opened Penn State Health Hampden Medical Center in Enola, Cumberland County, and a similar center is planned to open in Penn State Health Lancaster Medical Center in East Hempfield Township. No opening date has been projected.
“We know that we need to coalesce our cancer care in the Lancaster area and we’re working very hard to make that happen,” Rovito said. “Once that’s completed, we’ll be able to provide all cancer services there.”
Penn State Health cancer services are already in place in Lancaster County,
but not centrally located. The plan is to co-locate breast cancer services, medical oncology, and radiation oncology in the same site.
“It makes sense to house those in the same spot because the treatments are often given together,” Rovito explained.
Once those services are co-located, Penn State Health will partner with other organizations such as outside infusion services and area hospices to provide a full complement of services for patients.
“We want all our patients to be able to get excellent care that’s convenient and close to home,” Rovito said. “Patients deserve to get their care where and when they need it.”
In addition to its efforts to coordinate care across the system, Rovito cited Penn State Health’s continuing research efforts at the Penn State Cancer Institute. Those efforts are largely made possible by a $25 million grant from Highmark that provides support for development of new cancer treatment drugs, clinical trials, and recruitment of leading cancer researchers.
The Penn State Cancer Institute is considered one of the nation’s leading cancer research institutions, with researchers contributing to breakthroughs that include the development of a cervical cancer vaccine.
Looking back, Rovito attributed the formation of Penn State Health in 2014 and the acquisitions of St. Joseph Regional Health Network in Berks County; Physicians’ Alliance LTD, the largest independent physician group in Lancaster County; and other institutions as key to the system’s great strides in cancer care.
The opening of Hampden Medical Center and then of Lancaster Medical Center in October 2022 also enabled cancer services to expand, and the future of cancer care for patients is bright.
“We have a lot of ability to provide outstanding care for our patients and that ability will continue to increase,” Rovito
said. “We’ve got talented staff members, state-of-the-art equipment, and ongoing research efforts that all combine to produce excellent results.”
Lancaster Cancer Center
Lori Gerhart, clinical director at Lancaster Cancer Center, recounted a story about a woman who recently called the center, upset about the length of time it was taking her health care providers at another institution to confirm a possible diagnosis of cancer.
Unfortunately, said Dr. Tracy DeGreen, a board-certified medical oncologist and owner of Lancaster Cancer Center, that patient’s story is not unusual, due to inefficiencies commonly encountered within today’s health care system.
Founded more than 40 years ago by DeGreen’s father, Dr. Hyatt P. DeGreen II, known as Peter, Lancaster Cancer Center operates differently from major health care systems — often to the significant benefit of patients.
“The ability to provide diagnoses and begin treatment quickly are hallmarks of Lancaster Cancer Center,” said DeGreen. “We often are able to get patients into care within 24 to 48 hours.”
While some large health care systems can boast research abilities, top-of-the-line equipment, and the ability to care for many patients, they also face bureaucracy and complex operating systems that slow down their ability to care for patients.
“We have developed an unnecessary complexity of the health care system,” DeGreen said.
During an initial visit to Lancaster Cancer Center, patients meet with providers who can discuss treatment options and answer any questions. A financial counselor who has already reviewed a patient’s insurance
Continued on page 26
Dr. Marc Rovito
Lori Gerhart
Dr. Tracy DeGreen
WE ARE HIRING
OSTEOPATHIC MANIPULATIVE MEDICINE
I am looking for another osteopathic physician to join our ever growing team and patient family We serve a large Amish population in Lancaster County, PA with waiting lists for all three of our physician providers I am looking for an organized, personable, self motivated and skilled physician who practices osteopathic manipulative med osteopathy
I am seeking someone who values being par We practice WHOLE person, WHOLE family h from newborn to adults and would like a phy who loves to treat all ages
Will train and mentor the right candidate Part time to full time availability with grea
INTEGRATIVE MEDICINE
We are also an integrative medicine practice If you have an interest in functional and integrative medicine you will be a great fit Dr Boyer uses OMM in her integrative approach to all patients She uses integrative medicine when OMM is not the complete answer
Dr Candice Boyer, DO
HOMESTEAD FOR HEALTH
The bigger vision is to create a practice focused on sustainability and building the soil of our health through food This vision includes: animals, garden, library and teaching kitchen If want to be part of something bigger than yourself, this may be the place
CONNECT WITH US
DRBOYER@LCOIH COM
44 LEACOCK RD PARADISE PA 17562
LANCASTER COUNTY OSTEOPATHIC & INTEGRATIVE HEALTH
Parent Support Series
Perspectives
plan is available to advise on coverage options for treatment.
And patients may be referred to the Healing Journey Foundation, a nonprofit 501(c) (3) founded by Lancaster Cancer Center in 1994 to assist cancer patients and their families through education; access to complementary therapies such as massage, acupuncture, and yoga; personal care and beauty products; nutrition counseling; and other services at no cost.
“We want to be all-encompassing and take care of our patients in the best way possible,” said Gerhart. “It takes work to make that happen, but it’s worthwhile. We hold morning huddles to plan for each patient we’ll see that day and take as much time with them as necessary while they’re in the office.”
While patients may be referred for certain services at other facilities, Lancaster Cancer Center has an infusion room, an onsite laboratory, and an onsite medically integrated dispensary that has earned the Accreditation Commission for Health Care (ACHC).
When Kids Do Not Listen
Feeling unheard or dealing with refusal, screaming, and physical outbursts can be tough for parents Join us to share, learn, and be heard! Parents and caregivers of children with ADHD, Autism, and other challenges are welcome Get tips from a Board Certified Behavior Analyst and connect with other parents
Location: Children’s Center 1813 Rohrerstown Road Lancaster, PA, 17601
The facility can provide genetic testing and offers the following treatments: chemotherapy, targeted therapy, hormonal therapy, immunotherapy, hematology, and non-cancer treatments such as IV infusion therapies and allergy shots.
In addition to DeGreen and Gerhart, staff includes Dr. Lena Dumasia, a board-certified medical oncologist and hematologist, a certified nurse practitioner, and oncology-trained nursing staff.
“We are small, but we can offer exceptional services in a modern, comfortable setting,” said DeGreen.
Date: September 25, 2024 at 5 PM Registration is required. Deadline to register: September 22, 2024 717-519-6740 ext. 324
SCAN TO REGISTER
Childcare will not be provided
cminney@excentiahumanservices
A member of the Lancaster Community Oncology Collaborative, an organization that includes medical oncologists, nurses, and administrative leaders from Lancaster Cancer Center, the Ann B. Barshinger Cancer Institute, and Penn State Health Lime Spring Oncology, DeGreen consults frequently with other institutions both local and nationwide regarding the best and most appropriate care for patients. He noted that patients at Lancaster Cancer Center are not limited to receiving care within one system.
“We work closely with other organizations and are involved in our community and beyond,” DeGreen said. “What sets us apart from the big health care systems is that we don’t have to be as focused on the business aspect of medicine. That gives us more time to focus on simply treating our patients.”
LEGISLATIVE UPDATES SUMMER 2024
The last couple of months have seen a lot of activity in the Pennsylvania General Assembly. The Pennsylvania Medical Society (PAMED) has sent out a number of calls to action for legislative movement we have seen on House Bill 1633, which would prohibit noncompete clauses in physician contracts. We have a total of over 800 messages sent out to legislators from members passionate about noncompete clauses. A big THANK YOU to everyone who took the time to contact their legislators about this important topic for physicians.
During the time that noncompete legislation was introduced at a state level, the Federal Trade Commission (FTC) approved a final rule that will ban noncompete clauses for workers nationwide except in limited circumstances.
This caused some confusion between the bills but keep in mind that the FTC does not apply to nonprofit organizations such as health systems. PAMED put together a reference for members that breaks down the differences between the two legislative bills. For more information, please check out the article on page 20 in this issue of Lancaster Physician
The Pennsylvania State Budget was due on June 30, and the legislature session days leading up to that date were busy and PAMED’s Government Relations team continues to track several bills.
House Bill 1633 (Noncompete clauses) –PAMED continues to monitor the movement of House Bill 1633, legislation that would prohibit noncompete clauses in physician contracts. It continues to have movement in the Capitol, and, at the time of this writing, it awaits consideration from the Senate Health Committee.
House Bill 2037 (Pharmacy Act) – PAMED has come out to oppose House Bill 2037, which amends the Pharmacy Act to allow pharmacists to administer all injectable medications, biologicals, and immunizations to persons five years of age and older and allow pharmacy technicians to administer COVID-19 immunizations and influenza vaccinations to persons aged eight and older. This bill passed the House Children and Youth Committee last week. PAMED will continue to monitor its movement and oppose HB 2037.
Senate Bill 739 (Telemedicine) – This legislation requires health insurers to cover telemedicine services. PAMED applauds House Insurance Committee Chair Rep. Patty Kim and Senator Elder Vogel for their advocacy on the issue. The bill was passed by the House and (at the time of this writing) awaits Governor Josh Shapiro’s signature to sign it into law.
House Bill 1754 (Biomarkers) – This legislation has been passed by the Senate and (at the time of this writing) is on Gov. Shapiro’s desk to sign it into law. It mandates that health insurers cover the costs associated with diagnostic tests to determine patient’s biomarkers on specific health issues.
Senate Bill 1000 (Pharmacy Benefit Managers) – Senate Bill 1000 is legislation that prohibits several current practices by Pharmacy Benefit Managers (PBMs). Some of these practices include patient steering, spread pricing, and retroactive “claw backs” of payments to the pharmacy. Senate Bill 1000 also instructs the Pennsylvania Insurance Department (PID) to create a process for complaints against PBMs and establishes several reports that PBMs must file to PID. SB 1000 was voted out of the Senate Health and Human Services Committee this week. PAMED supports the current version of SB 1000.
House Bill 1140 (Contraceptive Drugs) – PAMED is monitoring House Bill 1140, which would mandate insurance coverage for contraceptive drugs and devices. HB 1140 was voted unanimously out of the House Insurance Committee.
MEET OUR NEW PRESIDENT Sarah E. Eiser, MD
Penn Medicine Lancaster General Health Physicians
Lancaster Physicians for Women
Where are you from and where did you study medicine?
I was born in Atlanta, Georgia and raised in Doylestown, PA, a suburb outside of Philadelphia. I completed my undergraduate education at Penn State University, main campus, and earned my medical degree and completed my residency training at the Penn State College of Medicine. It is safe to say that I bleed blue and white!
Why did you want to be a physician?
I’ve always loved math and science and was thinking I was headed toward a career as a high school science teacher or college professor. My mom (retired RN) encouraged me to volunteer at Doylestown Hospital as a high school student. This was a long time ago when there were less rules and regulations and somehow I found my way into observing open heart surgery! My career path shifted from teaching to medicine that day, and I’ve never looked back.
As physicians, we spend a lot of time educating others. We teach medical students and junior residents during our residency training, and we educate our patients on a daily basis. I love helping to empower patients to understand the medicine behind their diagnoses and advocate for themselves and their care.
What are the biggest changes you’ve seen in medicine since you began practicing?
Some of the biggest changes that have happened since I began practicing are the development of the large health systems and the downsizing of private practices. The cost of health care continues to rise exponentially, and there seems to be a continually growing focus on optimizing efficiency to meet the demands. It is a delicate balance to maintain and manage the costs of health care without sacrificing the quality of care delivery to the patient or the longevity of the providers delivering the care.
What (or who) has helped you become the doctor you are today?
I love finding great role models in my life to try to emulate. I was very lucky to find and join the medical team at Lancaster Physicians for Women, now Penn Medicine Lancaster General Health Physicians Lancaster Physicians for Women, right after completing residency. I joined a group of strong, smart women who manage to achieve the great balance of juggling a full-time workload while raising and supporting their families.
If you had one piece of advice for those just starting out, what would it be?
Find your people and lean on them when you need help! We all have to start somewhere, and it can be very stressful in the beginning. We spend years and years learning and training, and it is a huge transition when you begin practicing on your own. Know that you are never alone; we all remember how it feels to start out.
If you could recommend one book for today’s medical students, what would it be?
The White Coat Investor —we leave medical school with crippling debt, and it is hard to figure out where to start and what resources to trust. This is a great, quick read to help start developing some framework on how to manage finances.
How has LCCMS helped you in your career?
Through LCCMS I’ve been able to see and learn from other physicians who have overcome and managed various hurdles and obstacles in the health care field. It has been invaluable to have support specific for physicians from fellow physicians.
Why should physicians be engaged in the local medical society?
The local medical society has allowed for meeting colleagues from other specialties and other health systems that I otherwise would likely not interact with. It is a great way to feel connected in the community outside the day-to-day grind.
What are your goals as LCCMS president?
I’d love to continue to get back to pre-COVID involvement and events. I think physician-to-physician support is so valuable in these times of high levels of burnout. I would love to find ways to allow our society to give back to the community, as most of us find great joy in giving and helping others.
pride and privilege of being a physician while encouraging our members to share their time and talents with the community, however they can,” said Eiser.
Other board elections for two-year terms included officers: President Elect - Robin Hicks, DO, UPMC Supportive Care & Palliative Medicine; Vice President - Christopher Scheid, DO, College Avenue Family Medicine; Treasurer - James M. Kelly, MD, Penn Medicine Lancaster General Health Physicians Family Medicine Lincoln; Secretary - David J. Gasperack, DO, WellSpan Health.
Directors elected include: Laura H. Fisher, MD; Saima Khalid, MD, MPH, FAAFP, FACOEM; Logan Lawson, DO, MPH (Resident); Jessica Miller, MD (Resident); Karen A. Rizzo, MD, FACS; Daniel J. Schlegel, MD, MHA, FAAFP; Susanne E. Scott, MD, MPH; Danielle Rubinstein, DO; and Osvaldo Zumba, MD.
Several awards and honors were presented as part of the evening’s festivities.
Terming board member Dr. Robert K. Aichele, Jr., was presented with the Distinguished Service Award, for his long-term commitment to LCCMS and his years of service on the board of directors, including his time as president in 2018 and 2019.
The 2024 Benjamin Rush Award was presented to GiGi’s Playhouse of Lancaster. GiGi’s Playhouse is the only worldwide network of Down syndrome achievement centers and includes more than 60 locations. The Lancaster location, which opened in 2020, has grown four times its initial size, with nearly 400 participating families, 15 free programs, and 500 hours of purposeful programming per month. Programs include teaching skills like fitness, nutrition, cooking, reading, math, communication, social skills, fine motor skills and others to individuals of all ages, from birth through their adult years.
The Health Care Leadership Award, established in 1994, is presented to a physician or layperson for his/her outstanding work in the health care field. The 2024 honoree was Dr. Jon Lepley, of Penn Medicine Lancaster General Health.
Dr. Lepley has been a role model in sharing a practical way of prescribing medication to treat addiction in primary care. He has been able to help change provider perceptions about medication to treat addiction and reduce stigma. As a result, he’s been instrumental in helping to cut annual OD deaths in Lancaster County in half compared to our peak in 2017.
Additionally, LCCMS members, Edward F. Baird, MD; Herbert K. Cooper, III, MD; Nicholas J. Dragann, DO; Patrick R. Feehan, MD; Barton L. Halpern, MD, FACS; Richard J. Herschaft, MD; Maurice C. Perry, MD; Charles R. Rost, MD; and Paul R. Sherban, MD, were recognized for their service in the practice of medicine for 50 years, marked by their graduation from medical school.
Also honored was Dr. Nicholas J. Bertoni, who was recently named a 2024 Top Physician Under 40 by the Pennsylvania Medical Society.
The evening’s program included remarks from PAMED president Kristen Sandel, MD, FACEP, FAAEM, an emergency room physician with WellSpan Ephrata Community Hospital. Dr. Sandel shared her presidential initiative, Revitalizing Our Profession: Working to Restore the Joy of Practicing Medicine.
The evening concluded with a keynote presentation, featuring James Spellos, president of Meeting U, who offered a glimpse of how AI is changing the world of health care. Spellos shared several AI options that are currently available for physicians and patients to utilize, while avoiding the misinformation that is an ongoing component of today’s desktop AI conversation.
TOP ROW: L TO R 1) Kenneth Berkenstock (Lusk & Associates, Sotheby’s International Realty) and Douglas Morrissey, MD (Penn State Health Medical Group – Cornerstone) enjoying cocktail hour; 2) Beth Gerber (LCCMS Executive Director) and Stacey Denlinger, DO (Past LCCMS President) with Top Physician Under 40 honoree, Nicholas Bertoni, MD (WellSpan Ephrata Hospital); 3) Gerber and Dr. Denlinger with 50 Years of Service honoree, Richard J Herschaft, MD (Dermatology Physicians, Inc.) BOTTOM ROW: L TO R 1) Gerber, Dr. Denlinger, and Sarah Eiser, MD (LCCMS President) with 2024 Benjamin Rush Award winner, GiGi’s Playhouse representatives; 2) Gerber and Dr. Denlinger with Distinguished Service Award winner, Bob Aichele, Jr., DO (Penn State Health Medical Group – South Lancaster); 3) Dr. Denlinger, and Dr. Eiser with the 2024 Health Care Leadership Award winner, Jon Lepley, DO (Penn Medicine Lancaster General Health)
Daniel Schlegel, MD, MHA, DABFM, FAAFP
Penn State Health Medical Group – Middletown
Medical Director, COMMpanion Virtual Primary Care and Telehealth, Penn State Health
Medical Director for Student Health, and Associate Professor, Department of Family and Community Medicine, Penn State College of Medicine
Where do you practice and why did you settle in your present location or community?
My outpatient family practice site is Penn State Health’s clinic in Middletown. Aside from medical school at the University of Pennsylvania, Central Pennsylvania has always been home. I didn’t think I’d return here after medical school, but when I realized that Lancaster General Hospital’s Family Medicine Residency Program was one of the best in the country, coming back made a lot of sense. After residency, Penn State Health offered so many fascinating clinical and academic opportunities that I’ve enjoyed working with Penn State Health since residency. Moving back home has been fantastic, with supportive family living nearby and the Lancaster and Hershey areas being great places to live.
What do you like best about practicing medicine?
I love hearing stories and learning new things; family medicine is a great way to do both. I’m always struck by the degree to which patients let us into their lives and share their funny, sad, intimate, interesting stories — whatever perspective on their world they want to share that day. I recognize that I have the opportunity to enjoy that privilege because of the excellence and professionalism of the physicians who practiced before me and alongside me now. They earned that trust and our privileged position, and it’s my responsibility to do my part to preserve that trust.
Because family medicine is kind of the “liberal arts college” of medicine, encompassing biology, psychology, sociology, and more, I can simultaneously develop my professional skills and knowledge while satisfying my curiosity. I feel fortunate that in family medicine, living a well-rounded life and having interesting experiences, gives me more points of connection with patients, helping me build a therapeutic relationship and making me better at being their doctor. What a great job!
Academic medicine has provided me lots of opportunities over the years including teaching students and residents how the health system works, directing our family medicine residency program, and serving in other engaging leadership roles. My current area of interest is exploring how we can use technology and different models of reimbursement to deliver primary care in new ways for the good of our patients.
Are you involved in any community, non-profit, or professional organizations?
My professional advocacy organization memberships include the Lancaster City & County Medical Society and Pennsylvania Medical
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News & Announcements
Society, as well as the Pennsylvania Academy of Family Physicians and American Academy of Family Physicians. I was recently certified by the American Board of Preventive Medicine in Clinical Informatics, and I am getting involved with the professional organizations associated with clinical informatics. Outside of medicine, I started serving as an election poll worker during the height of the pandemic, and I’ve found that service fulfilling as well.
What are your hobbies and interests when you’re not working?
Are we allowed to have hobbies? When our second child was born, my wife (LCCMS member Denise Cope) told me I couldn’t start any new hobbies for at least ten years! With our youngest child (now nine years old), I’m finding time to work on my personal fitness for the first time since college. Some of my inspiration came from LCCMS member Mike Ripchinski, during a visit to his house a couple of years ago and glimpsing some of his home exercise gear. I thought, “If someone as busy as Mike Ripchinski can make time for fitness, I can too,” and I’m happy that I’ve been able to stick with it. More recently, I’ve taken up pickleball with LCCMS member Kristina Newport and other friends. I am expecting my first pickleball-related ankle sprain soon.
For what reason(s) did you become a member of the Lancaster City & County Medical Society and what do you value most about your membership?
I’ve been interested in organized medicine since medical school, and I am glad to have a chance to participate in it now. A few years ago, I attended an LCCMS-sponsored Legislative Breakfast and was surprised that LCCMS provided the opportunity to have close contact with our state representatives. These leaders seemed genuinely interested in what we had to say about current issues, which made me less cynical and more knowledgeable about how decisions get made in state government. I have been impressed by LCCMS’s advocacy since then, and that ability to influence policy for the good of our fellow physicians and our community makes me value my membership.
Minnie Taw, MD Board certified in Internal Medicine, Pediatrics and Obesity Medicine
UPMC Heart and Vascular Institute
As a distinguished leader in heart and vascular services in Lancaster County, UPMC is dedicated to putting patients first and improving the health of those we serve. Through UPMC’s vast network of resources, our experts provide their patients with seamless care — from diagnosis to treatment and beyond.
Our highly trained cardiologists, nurses, and therapists in Lancaster are experts in cardiac testing, diagnosis, and treatments for a wide range of heart diseases and conditions. We’re passionate about prevention and early detection measures, using the most advanced diagnostic tools available, to keep your heart healthy. When surgical interventions are needed, our team is part of a nationally recognized team of providers that recently has been awarded the highest honors in three different cardiac surgery specialties locally in the region.
In addition to the cardiac team located in Lancaster and Lititz, UPMC also offers access to a comprehensive range of cardiovascular care in Lancaster County including electrophysiological studies, cardiovascular surgical consultations, and vascular surgical care. By offering the most advanced non-invasive cardiac tests and procedures, including echocardiography, nuclear cardiology, cardiac CT and vascular ultrasound locally, our patient-first model continues to be the backbone of creating a unique care pathway for each patient.
MORE INFORMATION ABOUT UPMC HEART AND VASCULAR INSTITUTE IN THE REGION, VISIT UPMC.COM/CENTRALPAHEART.
From L to R: Jason Comeau, MD; Gregory Cox, DO; Matthew Evans, DO; Willis Godin, DO; Nehal Patel, MD; Sunil Patel, MD; Scott Riebel, MD; Surender Singh, MD; Steven Woratyla, MD
FRONTLINE GROUPS SUMMER 2024
Frontline Practice Groups have made a 100% membership commitment to LCCMS and PAMED. We thank them for their unified support of our efforts in advocating on your behalf and facilitating an environment for physicians to work collaboratively for the benefit of the profession and patients.
Argires Marotti Neurosurgical Associates of Lancaster
Avalon Primary Care
BestFit Virtual Health + Wellness PLLC
Carter MD Aesthetics
College Avenue Family Medicine
Community Services Group
Conestoga Eye
Dermasurgery Center PC
Dermatology Associates of Lancaster Ltd.
DermDox Dermatology Centers PC – Leola
Eye Associates of Lancaster Ltd.
Eye Health Physicians of Lancaster
Family Eye Group
Family Practice Center PC – Elizabethtown
General Surgery of Lancaster
Glah Medical Group
Hospice & Community Care
Hypertension & Kidney Specialists
Lancaster Arthritis & Rheumatology Care
New Members
Arjun Agrawal, MD Penn State Health Lancaster Medical Center – Emergency Medicine
Jessica Bourgeois Student
Pam Conner Practice administrator - Penn State Health Medical Group – South Lancaster
Abigail J. Copella, MD Penn Medicine Lancaster General Health Physicians Radiation Oncology
Hannah A. Dieterle Student
reinstatements
Maria Monica R. Calderon, MD Penn Medicine Lancaster General Health Physicians Internal Medicine
Thomas M. Dunn, MD
Penn Medicine Lancaster General Health Physicians Anesthesiology
Tyler Murphy, DO Resident - UPMC Lititz
Lancaster Cancer Center Ltd.
Lancaster Ear Nose and Throat
Lancaster Family Allergy
Lancaster Radiology Associates, Ltd.
Lancaster Skin Center PC
Manning Rommel & Thode Associates
Nemours duPont Pediatrics Lancaster
Neurology & Stroke Associates PC
Patient First – Lancaster
Penn Medicine Lancaster General Health Care Connections
Penn Medicine Lancaster General Health
Physicians Diabetes & Endocrinology
Penn Medicine Lancaster General Health
Physicians Family Medicine Lincoln
Penn Medicine Lancaster General Health
Physicians Family Medicine New Holland
Penn Medicine Lancaster General Health
Physicians Family Medicine Norlanco
Penn Medicine Lancaster General Health
Physicians Family Medicine Susquehanna
Kim Dilucia Practice administrator - Family Practice Center PC – Elizabethtown
Pietro Elliott Student
Nitin Goyal, MD Dat Le Student
Nikolas Pham Student
Josephine Rodgers Student
Kacper K. Pierwola, MD Lancaster Rehabilitation
Salman S. Porbandarwalla, MD Retina Associates of Lancaster
Tammy J. Seifried Practice administrator - Penn Medicine
Lancaster General Health Physicians, Family Medicine Twin Rose
Kristin Ronan, MD
Hannah N. Ruby Student
Rumin M. Shah, DO Resident - UPMC Lititz
Omee Upadhyaya Student
Abby White, DO Penn Medicine Lancaster General Health Physicians Thoracic Surgery
Lucia M. Zimmerman Student
Diane M. Thiboutot, MD Penn State Health Dermatology
David A. Winand, MD Advanced Vein & Laser Center Inc.
Penn State Health Medical Group – South Lancaster
Pennsylvania Specialty Pathology
Retina Associates of Lancaster
Surgical Specialists—UPMC
Union Community Care – Duke Street
Union Community Care – Hershey Avenue
Union Community Care – Kinzer-Church Street
Union Community Care – New Holland Avenue
Union Community Care – Water Street
UPMC Breast Health Associates
UPMC Heart and Vascular Institute
UPMC Pinnacle Plastic & Aesthetic Surgical Associates
WellSpan ENT & Hearing Services - Ephrata
WellSpan Ephrata Cancer Center
WellSpan Family Health – Georgetown
WellSpan Surgical Specialists – Ephrata
WellSpan Health Events
WellSpan Mobile Mammography
Preventive screenings help to keep women A Healthy Step Ahead! Our new, state-of-the-art mammography coach brings convenience directly to Central PA businesses and organizations’ doorsteps. WellSpan’s Mobile Mammography service is a win-win for everyone. Instead of hours away from work, women can simply take a scheduled quick break for their 15-to-20-minute screening.
When: Various
Where: Various
Time:Various
Cost: If you do not have insurance and want to know if you qualify for a discounted price, please call 717-851-5051.
RSVP: Visit WellSpan.org/Events or call 717-GoMammo—written out as (717) 466-2666—to schedule.
Businesses can host an event at no cost to their organization; call for more information.
Medicare 101
If you are retiring in the next twelve months, coming off a group plan, or already on Medicare—this workshop is for you. Do not miss this opportunity to hear from Medicare Specialists in your area about:
• How to enroll and what are the costs?
• What are Medicare Advantage and Medigap?
• What are my options for prescription drug coverage?
• Do I need Medicare if I’m on a retirement plan?
• What is the “Donut Hole” for prescriptions and how will it affect me?
When: Tuesday, Aug 6 (Ephrata); Tuesday, Aug 20 (Lebanon)
Where: WellSpan Brossman Health Center at 136 Lake St. Ephrata, PA; WellSpan Good Samaritan Hospital at 252 S. 4th St., Lebanon
Time:6 – 7:30 p.m.
Cost: Free
RSVP: Please call (877) 288-6174 (TTY 711) to reserve your seat.
Car Seat Checks
Learn the correct and safe way to buckle your baby into your vehicle. This class is included in the Childbirth series and free for those already enrolled in that program.
When: Thursday, Aug. 29; Tuesday, Oct. 8
Where: WellSpan Brossman Health Center, 136 Lake St., Ephrata, PA
Time: 7– 9 p.m.
Cost: $25 per couple
RSVP: Reserve your spot online at WellSpan.org/Events. For more information call (800) 840-5905.
To view all view all upcoming events, visit WellSpan.org/Events.org/events.
Penn Medicine Lancaster General Health Events
Chair Yoga for Cancer Recovery
Chair Yoga for Cancer Recovery is a place for people in all stages of cancer treatment to thrive through fitness and social connection. The program is an adaptation of traditional mat yoga done sitting in a chair, and/or standing beside the chair for added support. It is designed to meet the needs of participants, help ease the mental stress from cancer or treatment, and promote relaxation.
When: Thursdays through Oct. 30
Where: Second floor, Seraph East Conference Room, Ann B. Barshinger Cancer Institute, 2102 Harrisburg Pike, Lancaster
Time: 10 to 11 a.m.
Cost: Free
RSVP: Reserve your spot online at LGHealth.org/events. For more information, call 717-544-4636.
Pregnancy Yoga
For pregnant individuals and new mamas, this nurturing class will interweave movement, meditation, and breath work to support you in pregnancy, childbirth, and postpartum. We’ll move in ways that strengthen and prepare the body and mind for labor and childbirth, ease common discomforts, and tend to the nervous system through mindfulness and restorative practice. All levels of experience are welcome (so long as you have been cleared by your providers to exercise).
When: Thursdays, Aug. 8, 15, 22 and 29
Where: Third floor atrium, Lancaster General Health Suburban Pavilion, 2104/2106 Harrisburg Pike, Lancaster
Time: 6:30 to 7:45 p.m.
Cost: $75
RSVP: Reserve your spot online at LGHealth.org/events. For more information, call 717-544-4636.
Sibling Class
Help your little ones get ready for the new and exciting addition to the family. Children will learn about how babies arrive (in an age-appropriate way), what they will look like, and how to be a great big brother/sister. The class will include a guided tour of the postpartum area, a short movie, crafts and activities. Bring along a favorite doll or stuffed animal to practice holding and diapering.
When: Saturday, October 19
Where: Women & Babies Hospital Conference Room, 690 Good Drive, Lancaster Time: 9:30 to 11 a.m.
Cost: $25 per family
RSVP: Reserve your spot online at LGHealth.org/events. For more information, call 717-544-4636.
For a full listing of classes, events and support groups, please visit LGHealth.org/events.
From routine check-ups to complex procedures, UPMC Children’s in Central Pa. delivers comprehensive care for children — close to home. From head to toe, our services include:
• Neonatal Intensive Care
• Pediatric Intensive Care
• Pediatric Surgical Services
• Children’s Express Care
• Emergency Department Care
• Children’s Specialty Services
• Children’s Community Pediatrics
Plus, with access to UPMC Children’s Hospital of Pittsburgh, which is ranked among the top 10 children’s hospitals in the country by U.S. News & World Report, we have even more resources available in our backyard.
To learn more, visit UPMC.com/CentralPaPediatrics.
in Central Pa.