Today. Having a Baby? Know Your Choices Why Women Should Know About Interventional Radiology Seeing Clearly After Cataract Removal

Tamaño: px
Comenzar la demostración a partir de la página:

Download "Today. Having a Baby? Know Your Choices Why Women Should Know About Interventional Radiology Seeing Clearly After Cataract Removal"

Transcripción

1 phelps News Today fall 2013 from Phelps Memorial Hospital Center Having a Baby? Know Your Choices Why Women Should Know About Interventional Radiology Seeing Clearly After Cataract Removal Certified Nurse Midwife Judy McCarthy-Dalton and obstetrical Registered Nurse Dorit Michelson provide care and support to mother-to-be Ana Tello Nunez. Get better. Here.

2 Dear Friends, We hope that you enjoyed your summer, despite the heat waves! Patients and visitors at Phelps certainly appreciated the spa-like presentation of cool lemon- and cucumber-infused waters that our Hospitality Department offered each day in the main lobby. As hospitals and physician practices nation-wide confront ever greater challenges during this time of transition in the healthcare arena, Phelps continues to build its multi-specialty medical group Phelps Medical Associates which provides stability for both the hospital and the group s physicians. On July 1, the group welcomed three long-tenured Phelps cardiologists Arthur Fass, MD, Franklin Zimmerman, MD, and Dina Katz, MD. Their practice is now known as Phelps Cardiology in Briarcliff. We are delighted to strengthen our relationship with this exceptional group of physicians. Also ensuring the stability of the hospital is the fact that our employees consider Phelps a wonderful place to work, which was validated by a recent employee satisfaction survey. The survey was conducted by Press Ganey, a recognized leader in performance improvement, which partners with more than 10,000 healthcare organizations worldwide, including 50% of all U.S. hospitals. There was statistically significant improvement in 35 out of 49 categories compared to our 2010 survey. Of the more than 1,600 individuals employed at Phelps, 71% participated in the survey 14% more than in 2010 and well above the Press Ganey average of 65%. In comparison to peer hospitals in New York State, Phelps ranked in the 99th percentile for overall employee satisfaction and in the 96th percentile among its peers in our American Hospital Association region. Our employees expressed a sense of pride in being part of the Phelps Family and special appreciation for communication with managers, involvement in decision-making, and being respected and recognized for their work. Employee satisfaction is important because it not only reduces turnover, but studies have shown that hospitals with higher levels of employee satisfaction provide better experiences for patients. Consistent increases in Phelps patient satisfaction scores confirm that this is the case at Phelps. Physician partnerships and employee satisfaction are just two examples of how we strive to make each patient s experience the best it can be while protecting the viability of our hospital. We wish you a healthy and enjoyable fall season. Sincerely, Richard J. Sinni Chair, Board of Directors Keith F. Safian, FACHE President & CEO

3 Having a Baby? Know Your Choices Dental Care: An Essential Component of a Healthy Pregnancy Why Women Should Know About Interventional Radiology Seeing Clearly After Cataract Removal Seven from Heaven: Community Leaders Who Champion Blood Drives Healthy Life Calendar Contents Phelps Medical Associates News The Vitality Initiative Ver con claridad después de la remoción de cataratas Tener un bebé Conozca sus opciones Phelps Locations in the Community Programs & Services Request Your Appointment Online! Appointments for many of Phelps outpatient services can be made on the hospital s website, including: cardiovascular, diabetes, hyperbaric, infusion, nutrition counseling, occupational and physical therapy, pain center, pulmonary/ respiratory, radiology/x-ray, senior services, sleep, speech & hearing, voice & swallowing, and wound healing. You can even make an appointment to donate blood online. Just go to and click on Request an Appointment any time of the day or night! phelps today Editor Mary Sernatinger Managing Editor Tina Dorfman Medical Editor Bruce Heckman, MD, MPH Editorial Advisors Lucy C. Engelhardt, RN Leonard B. Fogel Kenneth C. Kaplan, MD Mary McDermott, RN Keith F. Safian, FACHE PHELPS TODAY is a publication of Phelps Memorial Hospital Center, a 238-bed, notfor-profit acute care community hospital located in Sleepy Hollow, NY. Phelps has been providing medical and mental health services to Westchester and surrounding communities since If you would like to be removed from the Phelps Today mailing list, please call (914) or Visit us on Facebook: PhelpsMemorialHospitalCenter Visit us on Twitter: https://twitter.com/ #!/phelpshospital

4 Having a Baby? Know Your Choices One hundred years ago, more than half of births in the U.S. took place at home under the care of a midwife. Today, most babies are born in a hospital, where emergency care can be provided if necessary. Many women have imagined what it would be like to have a baby, but when they actually become pregnant, they realize they have many questions. Who should provide my prenatal care? Where should I have my baby? What is a natural birth and is that what I want? Is laboring in water beneficial? Who should be with me when my baby is born? What about a doula? Should I breastfeed my baby? Prenatal Care Obstetrician or Midwife? Both obstetricians and midwives provide care during pregnancy, labor and birth. Obstetricians (OBs) are medical doctors who have specialized education in the female reproductive system and surgical care. In addition to managing routine pregnancies, OBs are best able to oversee high-risk or complicated pregnancies. Women who have had previous complicated pregnancies generally choose an obstetrician for their care. Certified Nurse Midwives (CNMs) have a nursing degree and additional training in midwifery. Midwives usually limit their care to women with low-risk pregnancies. If a midwife s patient ends up having a complicated birth, an obstetrician can be called in for assistance. Midwives are known for offering care that is flexible and individualized, and they use as little medical intervention as possible, based on each patient s needs. Where to Give Birth One hundred years ago, more than half of births in the U.S. took place at home under the care of a midwife. Today, most 4 Phelps Today

5 babies are born in a hospital, where emergency care can be provided if necessary. Both obstetricians and midwives can attend hospital births. Giving birth in a hospital is considered safer because even in a healthy woman with an uncomplicated pregnancy, there is always the possibility that an unanticipated event or emergency could occur. Childbirth Natural or with Intervention? The term natural childbirth refers to a birth in which medical intervention is minimized, drugs and anesthesia are only used minimally, and the mother has learned how to use relaxation and breathing techniques to control pain and ease delivery. Even if a natural birth is planned, it is possible that during the course of labor and delivery some interventions may be necessary for health and safety reasons or because the mother desires. Some Types of Interventions Electronic Fetal Monitoring (EFM) is widely used to evaluate uterine contractions and the baby s response to contractions. Intermittent rather than continuous monitoring allows the mother to move and change positions more easily. Induction is an artificial way to start labor. Labor is induced if there is a clear medical reason, such as: the mother has gone past her due date or developed high blood pressure, the amount of amniotic fluid around the baby has become inadequate, or tests show that the baby has stopped growing at an expected rate. The cervix needs to soften and dilate to allow the baby to pass out of the uterus. If the cervix is firm, an oral medication or a medication in the vagina may be administered to help prepare the cervix for labor. Pitocin, an intravenous synthetic hormone, may be given to stimulate contractions, gradually increase their frequency and cause changes in the cervix. Pain Medications. In the early stages of labor, a woman can sometimes control her pain with relaxation exercises, breathing techniques and by frequently changing position. As contractions increase in intensity and frequency, many women choose to have pain medication administered. This can be accomplished through injection, intravenous administration or epidural and spinal blocks, which provide pain relief to the lower body without significantly slowing labor. Episiotomy is a surgical cut to the perineum and the muscle beneath it during the pushing stage to make delivery of the baby easier and avoid vaginal tearing. Episiotomies used to be done routinely, but now they are performed only rarely when the baby is in an abnormal position or needs to be delivered quickly, or if extensive vaginal tearing seems likely. Cesarean birth is major surgery that allows the baby to be removed through incisions in the abdomen and uterus. A Cesarean section is performed when the baby appears to be too large to deliver through the birth canal, if labor is not progressing, when changes in the fetal heart rate indicate a need for urgent delivery, or because the patient had previously delivered a baby by Cesarean. These days, breech presentations are also delivered by Cesarean. What is a doula? A birth doula is a woman who provides physical and emotional support during labor and delivery and just after the baby is born, following the old tradition of women being surrounded by other women during childbirth. Does water help during labor and delivery? Warm water is comforting and relaxing, and its buoyancy allows the mother free Chanel Garland, in a labor tub, rests between contractions as Garrard Hunte offers encouragement. movement to reposition herself during labor. Warm water promotes more efficient uterine contractions and reduces pain sensations. Some women stay in the labor tub during labor and get out when they are ready to deliver their baby, while others choose to give birth in the water, provided that their midwife or obstetrician agrees. Should I breastfeed my baby? The National Institute of Child Health and Human Development recommends that women should try to feed their babies breast milk for at least the first six months of life. Breast milk contains a balance of nutrients that is especially suited for helping your infant to grow, and it also helps protect your baby against illnesses and infections. Studies have shown that certain types of cancers occur less frequently in women who breastfeed their babies. Having Your Baby at Phelps Women travel long distances to have their babies at Phelps. Why? Planning the Birth Phelps obstetricians and midwives encourage their patients to discuss their preferences early in pregnancy. We want to know what our patients hopes are with regard to the many choices from natural childbirth and doulas to birthing methods, says obstetrician Sarina DiStefano, MD, and we will do whatever we can to fulfill their desires while ensuring safety for both mother and baby. The OBs, midwives, and nurses are dedicated to providing a family-centered birth experience. Flexibility When feasible, Phelps offers flexibility as to how the birth takes place, says midwife Kathy Herron, CNM, of Full Circle Women s Health. Patients want their birth preferences to be honored whenever they can be. For many, that means as few interventions as possible, allowing labor and birth to unfold naturally, at its own pace. For others, that means knowing they can choose pain medication if Phelps Today 5

6 to choose, including LaMaze childbirth, breastfeeding, baby care, sibling preparation, and Totsaver CPR classes. There are also special classes for adoptive parents. See page 7 for the list of classes. they want. At Phelps, patients receive respect and support for the choices they make for themselves and their baby always with the well-being of mother and baby as the top priority. Lowest C-Section Rate in Westchester Some women choose a hospital based on its rates of interventions, especially Cesarean sections. And that brings them to Phelps, because according to NYS Department of Health statistics, there are fewer Cesarean sections performed at Phelps than at any other hospital in Westchester. Phelps obstetricians perform C-sections only when necessary, such as when there is an abnormality or fetal distress, says obstetrician Lawrence Mendelowitz, MD, Director of Obstetrics/ Gynecology. We are often able to rectify some situations to avoid C-sections. For example, if the baby is in breech position, with his head up and feet down, attempts can be made to turn him. And even women who have previously had a C-section may be able to have a vaginal delivery in some cases. Exceptional Nurses The nurses are extraordinary, as noted by Debra Turner, whose son was delivered at Phelps last year: Being a first-time mother, I was extremely anxious but was quickly put at ease by the nurses. Once my son was born, the staff was amazing. I am sincerely grateful to all the maternity nurses and staff for their professionalism and kindness. It is rare to find people who go above and beyond... but I did find this during my stay at Phelps. Breastfeeding Support Mothers who give birth at Phelps are exceptionally successful at breastfeeding, thanks to the extraordinary encouragement from maternity staff and support from lactation consultants. Virginia Moore, lactation consultant, says, Everyone believes strongly in the benefits of breastfeeding, so the support new mothers get comes not only from the lactation consultants but from the entire Maternal- Child staff. As part of our commitment to successful breastfeeding, all breastfeeding mothers are welcomed back for a complimentary post-partum lactation consultation. Phelps was recognized by the New York State Department of Health as one of the top 10 hospitals in the state whose new mothers exclusively breastfeed their babies. In addition, Phelps operates a breast milk bank under guidelines set by the Human Milk Bank Association of North America, making it possible for donor breast milk to be prescribed when a baby needs supplemental nutrition. Education Phelps offers expectant parents a variety of educational programs from which Lawrence Mendelowitz, MD, is board certified in Obstetrics & Gynecology. He is director of the Phelps Department of Obstetrics & Gynecology. Dr. Mendelowitz earned his medical degree at New York University School of Medicine and completed a residency in Obstetrics & Gynecology at Bellevue Hospital Center. Sarina DiStefano, MD, is board certified in Obstetrics & Gynecology. She received her medical degree from New York Medical College and completed a residency in Obstetrics and Gynecology at Bellevue Hospital Center. Dr. Mendelowitz and Dr. DiStefano are members of Sleepy Hollow Medical Group along with Dr. Vanessa Dinnall and Dr. Karina Zhuravleva. The practice is located on the Phelps campus in the 755 building. ( ) 6 Phelps Today

7 Maternity & Baby Care Classes The Childbirth Experience/ LaMaze Method Wednesday evenings 7:30 9:30 pm for 5-6 weeks Start dates: September 11 or October 23 OR two-day weekend session, 10 am 3 pm: September 14-15, October 12-13, November 9-10, December Cost: $170 per couple Breastfeeding: First Choice for Babies September 30, November 4, December pm Cost: $45 per couple ABCs of Baby Care September 26, October 8 or 24, November 7 or 18, December 5 or 16 6 pm Cost: $65 per couple Big Brother/Big Sister: Sibling Preparation September 21, November 16 10:30 am $20 per child Totsaver Program: American Heart Association CPR for Family and Friends October 5, November 2, December 7 9 am $55 per person For up-to-date schedule, visit or call (914) for information or to register. Prenatal Clinic: Phelps Memorial Hospital Center and Open Door Family Medical Center, participants in the Medicaid Prenatal Care Assistance Program, jointly sponsor a Prenatal Program. Care for expectant mothers is provided by a highly trained, caring, bilingual staff. No one is turned away based on income or health insurance. Women are encouraged to seek prenatal care early in their pregnancy. Care is provided at Open Door during the first 36 weeks of pregnancy and at Phelps Memorial Hospital during the remainder of the pregnancy and for delivery. For information, call: (914) Atención Prenatal: Phelps Memorial Hospital Center en Sleepy Hollow y Open Door Family Medical Center, participantes en el Programa de Asistencia de Atención Prenatal de Medicaid, auspician conjuntamente un Programa Prenatal. La atención de mujeres embarazadas es provista por un personal bilingüe y solidario, altamente capacitado. No se rechaza a nadie basándose en sus ingresos económicos o seguro. Se alienta a las mujeres a recibir atención prenatal lo más temprano posible durante su embarazo. La atención es provista en Open Door durante las primeras 36 semanas del embarazo y en Phelps Memorial Hospital durante el resto del embarazo y el parto. Para mayor información, sírvase llamar al: (914) Phelps Today 7

8 Dental Care: An Essential Component of a Healthy Pregnancy While most would agree that, ideally, women should attend to all their oral health needs before even thinking about becoming pregnant, not everyone has the foresight to do so. By Janet Bozzone, DMD, MPH, FAGD; Rosa Martinez, DDS; and Joseph Morales, DDS, FACD The year was The dental patient who Dr. Morales was seeing was visibly upset. When he asked what was wrong, she explained that her sister had suffered a seizure two weeks earlier and fractured her front teeth. The sister had been seen in an emergency room and was referred to an oral surgeon and endodontist for care, but she had not been able to find a dentist willing to treat her. The reason? It was not because she was uninsured, uncooperative, or unwilling to pay for care (she did not fall into any of those categories), but because she was pregnant. With tears in her eyes, Dr. Morales patient asked if he would be willing to see her sister. His response was an unequivocal. Of course! Her sister came in the following day. She had multiple broken teeth, dental abscesses caused by a bacterial infection and an untreated fracture of her upper jaw. She was in excruciating pain, and it was obvious to Dr. Morales that the infection was certainly a greater risk to her pregnancy than his providing the dental care that she needed. He began on a mission advocating for the appropriate treatment of women, even if they are expecting a child. New York Leads the Way Promoting Dental Care for Pregnant Women Twenty years would pass before New York became the first state in the nation to issue guidelines encouraging the delivery of necessary dental care to prenatal women, prompted in part by yet another tragedy. In this instance, a young pregnant woman who had been unable to access dental care along the New York/ Pennsylvania border had overdosed on acetaminophen, resulting in the death of her baby due to liver toxicity. This woman spent several weeks recovering in the hospital and came very close to needing a liver transplant herself. Several states have followed suit, issuing their own set of guidelines, and in 2012 a statement was released called Oral Health Care During Pregnancy: A National Consensus Statement. Developed by the Health Resources and Services Administration (of the U.S. Department of Health and Human Services) in collaboration with the American Dental Association and the American College of Obstetrics and Gynecologists, the statement hopes to provide guidance to everyone involved in the care of prenatal women. It asserts that Oral health care, including the use of X-rays, pain medication, and local anesthesia, is safe throughout pregnancy. These universal standards for healthcare providers help ensure that women will not miss having an oral examination, dental prophylaxis or emergency dental care while pregnant. Dental Care During the Second Trimester Is Best While most would agree that, ideally, women should attend to all their oral health needs before even thinking about becoming pregnant, not everyone has the foresight to do so. Many women delay coming to the dentist while they are pregnant because they incorrectly believe that having dental treatment or X-rays poses a risk. As a result, they wait until they have more serious problems that require urgent or emergency treatment such as extractions, root canals and periodontal care. To avoid reaching this point, oral evaluations are recommended as early in a pregnancy as possible to help ensure that all necessary care is completed before the last six weeks of pregnancy. 8 Phelps Today

9 Ideally, dental care should be scheduled during the second trimester (months 4-6) because most pregnant women are better able to tolerate dental procedures during that time they are usually past the morning sickness period, and have not yet gained the additional weight that might make sitting in a dental chair uncomfortable. Why Dental Care During Pregnancy Is Important It is estimated that more than 75% of pregnant women experience bleeding of the gums or periodontal problems during their pregnancy. Studies examining whether oral health can reduce the incidence of low-birth-weight or preterm birth have been contradictory, but it has been shown that there may be a relationship between stillbirths and periodontal disease bacteria. While it may not yet be possible to prove scientifically that a causal relationship exists, one thing is certain: women, their families, and all of their healthcare providers can be assured that dental care is not only safe during the prenatal period, it is an essential component of a healthy pregnancy. For more information about guidelines for oral healthcare during pregnancy, visit the following websites: Oral Health Care During Pregnancy and Early Childhood Practice Guidelines (NYSDOH August 2006) publications/ 0824.pdf Oral Health Care During Pregnancy: A National Consensus Statement (2012) mchoralhealth. org/pdfs/oral HealthPregnancyConsensus.pdf The authors play important roles in the New York Medical College-sponsored general dental practice residency program, which was established in 2012 at Phelps and Open Door Family Medical Center in Port Chester: Joseph Morales, D.D.S., F.A.C.D. (residency program liaison) is a graduate of Columbia University College of Dental Medicine and has over 32 years of professional experience, with 25 years dedicated to academic dental medicine. He is Professor and Chairman of the Department of Dental Medicine at NYMC s School of Medicine and a fellow in the New York Academy of Dentistry and the American College of Dentists. Janet Bozzone, D.M.D., M.P.H., F.A.G.D. (residency program site director) has over 30 years of experience in com- munity-based dental programs for the underserved in New York. Dr. Bozzone received her Doctor of Dental Medicine from Fairleigh Dickenson University, School of Dentistry, and a Master of Public Health from the University of North Carolina Chapel Hill. A Fellow in the Academy of General Dentistry, she is Director of Dentistry at Open Door and a faculty member of NYMC s Department of Dental Medicine. Rosa Martinez, D.D.S. (residency program director) received her doctorate in dental surgery from Columbia University College of Dental Medicine and has over 26 years of professional involvement in graduate dental education and hospital dental services. She is Assistant Professor of Clinical Dental Medicine at NYMC. The Dental Residency Program at Phelps In 2012, Phelps and Open Door Family Medical Center in Port Chester became primary clinical training sites for the New York Medical College General Dental Practice Residency Program. Each year a group of four dental residents undergo a one-year training program, with a second-year option, seeing outpatients at Open Door and treating patients in Phelps Emergency Department, operating room and inpatient rooms. At Phelps, under the supervision of attending faculty staff of dentists and physicians, they also perform elective surgeries for patients with special needs or children who cannot be treated in an outpatient office. Pictured here are dental residents Benjamin Geisler, DMD; Christiane Getaz, DDS; Jeannine Holz, DDS; and Roselin Reiss, DMD. Phelps Today 9

10 Why Women Should Know About Interventional Radiology The field of interventional radiology encompasses a variety of minimally invasive procedures that use imaging modalities such as X-rays, CT, and ultrasound to provide guidance for treatment of a disease. During the procedures, tiny catheters and miniature instruments are threaded through the body s network of arteries, veins or other tubular structures, allowing physicians to perform a variety of complex diagnostic and treatment procedures related to virtually all parts of the body. The procedures are performed by interventional radiologists, board-certified physicians with advanced training in diagnostic radiology, followed by additional training in vascular and interventional procedures. Interventional radiology techniques are used to treat many conditions that once required an operation. It starts with a needle and ends with a bandaid, says interventional radiologist Marc Hamet, MD. Patients benefit from lower risk, less pain and a quicker recovery than with open surgery. They also enjoy an improved quality of life. The procedures are generally performed on an outpatient basis, so hospitalization is not required. Why Women Should Know About Interventional Radiology Although interventional radiology procedures are commonly used to treat conditions in both sexes, a number of procedures are for medical conditions that occur solely or predominantly in women. They include: uterine fibroids, pelvic congestion syndrome, varicose veins, and spine fractures resulting from osteoporosis. Uterine Fibroid Embolization Uterine fibroids are smooth-muscle, noncancerous tumors that develop in the uterus. Eighty percent of women develop fibroids, but only about 25 percent experience symptoms. Uterine fibroids may cause severe menstrual cramping, abdominal swelling, and excessive bleeding, which can lead to anemia and even a need for emergency surgery. A uterus with fibroids may push on the bladder and cause more frequent urination. It may also create pressure on the colon or the back. One of the major reasons for hysterectomy is the presence of symptomatic uterine fibroids. Fibroids cannot exist without an adequate supply of blood. To ensure their continued growth, fibroids stimulate the formation of new blood vessels that bring in additional blood. The goal of the interventional radiology procedure known as uterine fibroid embolization is to cut off the blood supply. The procedure involves the insertion of a thin, flexible catheter through the femoral artery in the groin to deliver PVA (polyvinyl alcohol) particles into the blood vessels that supply the fibroids. The interventional radiologist performs the embolization while viewing the blood vessels using X-rays with the aid of contrast, or X-ray dye. Blocking the arteries that feed fibroids and filling them with particles eliminates the source of blood, which starves the fibroids and causes them to shrink and disappear. With this technique, all of the fibroids present are treated simultaneously. Pelvic Congestion Syndrome The condition known as pelvic congestion syndrome (PCS) is complex and is often misdiagnosed. When other causes of pelvic pain have been ruled out by specialists such as OB/GYNs, gastroenterologists and urologists, an interventional radiologist is often consulted for further evaluation and treatment. The syndrome, which primarily affects pre-menopausal women, comes about when reflux occurs in the left gonadal vein (the blood vessel that carries blood away from the ovary toward the heart), causing blood to back up into the pelvis. This reflux results in hemorrhoids or varicose veins in the thighs, buttocks or vaginal area. A woman with pelvic congestion syndrome can experience severe dull, aching pain from ovarian and pelvic varicose veins, much like the leg pain Dr. Marc Hamet uses a combination of ultrasound and fluoroscopy to place a catheter, demonstrating the first step in an interventional radiology procedure. 10 Phelps Today

11 associated with lower-extremity varicose veins. This chronic pain is worse when sitting or standing, and makes it painful to ride a bike and uncomfortable to walk. A CT scan with contrast is done to diagnose pelvic congestion syndrome. To treat pelvic congestion syndrome, the interventional radiologist inserts a thin catheter into the femoral vein at the top of the right leg and guides it into the affected gonadal vein using imaging for guidance. To seal the faulty, enlarged vein, the interventional radiologist blocks it off by placing tiny mechanical devices at the bottom and top of the vein and injects a solution in the area between the two blocking devices, thus eliminating the varicosity and reducing the associated painful pressure. Pelvic congestion syndrome in women is the same as a condition called varicocele in men, which can be treated in exactly the same way. Varicose Veins Veins have one-way valves that are supposed to keep blood flowing from the legs up toward the heart. If a valve stops working correctly, reflux occurs the blood goes in two directions. With every movement, the veins squeeze, the blood goes up and comes right back down. As a result, blood collects in the vein, pressure builds, and the vein becomes weak and enlarged. This varicose vein appears twisted and bulging near the surface of the skin, most commonly on the legs or feet. Age, pregnancy, being overweight or working at a job that requires standing for long periods all contribute to the development of varicose veins. Women are more likely than men to have varicose veins, and the condition tends to run in families. Other than their dark purple/blue or bulging appearance, varicose veins often do not have any symptoms. Sometimes they cause an achy or heavy feeling in the legs or a burning and throbbing sensation. Injury to the vessels can cause excessive bleeding. Painful clots may develop which sometimes become infected, a condition called thrombophlebitis. In severe circumstances, skin breakdown (venous stasis ulcers) or severe infections of the toes and feet may occur. To treat varicose veins, the interventional radiologist uses ultrasound and X-ray as a guide to insert a tube into the vein that Interventional radiologists are trained to do diagnostic studies in addition to interventional procedures. Here, Dr. Hamet dictates a report on the results of a diagnostic study. isn t functioning properly. A laser is guided through the tube and used to destroy the vein. This breaks the reflux cycle and allows the blood to go where it is supposed to go. Destroying the vein doesn t affect circulation because there are other veins located deeper in the leg that take care of larger volumes of blood. Osteoporosis and Spine fractures People with osteoporosis often experience back pain that is caused by spinal fractures, also called vertebral compression fractures. Women over 50 are at the greatest risk for these fractures, and by age 80, 40 percent of women will have one. In addition to back pain, symptoms of spinal fracture include loss of height and deformity of the spine. A nonsurgical treatment for spinal fracture called vertebroplasty can be performed by an interventional radiologist. During the procedure, the physician uses imaging guidance to inject strengthening material into the bone that has collapsed. The treatment reduces pain, restores the bone s strength and helps to prevent further collapse of the vertebra. Evaluation prior to the procedure involves an MRI of the spine. Sometimes areas of abnormal bone are found, which may be treated prior to collapse, thus preventing curving of the spine. Marc Hamet, MD, interventional radiologist, is board certified in radiology, neuroradiology and vascular and interventional radiology. He received his medical degree from the University of Maryland Medical System, where he completed a residency in diagnostic radiology, followed by fellowship training in vascular and interventional radiology at Johns Hopkins Hospital. He is an assistant clinical professor of radiology at Columbia University. Dr. Hamet can be reached at Phelps Today 11

12 Seeing Clearly After Cataract Removal A cataract is the clouding of the lens of the eye, which is located behind the pupil and is surrounded by a thin, clear capsule. There are many causes of vision loss in older adults glaucoma, macular degeneration, diabetic retinopathy but one of the most common and easiest to treat is the cataract. About 90 percent of people over the age of 65 have a cataract. What Is a Cataract? A cataract is the clouding of the lens of the eye, which is located behind the pupil and is surrounded by a thin, clear capsule. The lens is clear at birth, but the eventual breakdown and clumping together of protein that is contained inside the lens causes the formation of cataracts. The lens, along with the cornea (the clear surface covering the front of the eye), focuses incoming light onto the retina, the area in the back of the eye that transmits images to the brain. For the retina to receive a sharp image, the lens must be clear. If it is cloudy, the incoming light is scattered as it passes through, and the image is blurry. Some of the factors that increase your risk of cataracts are: Age Diabetes Obesity Smoking High blood pressure Family history Excessive alcohol consumption Excessive exposure to sunlight Exposure to ionizing radiation (such as radiation used in X-rays and cancer radiation therapy) Previous eye surgery, injury or inflammation Prolonged use of corticosteroid medications Symptoms of a Cataract Some of the most common symptoms of a cataract are: cloudy or blurry vision; colors appearing faded or yellowish; the appearance of halos around headlights, 12 Phelps Today

13 Dr. Jean Tostanoski verifying calculations for LenSx Laser treatment. hospital in the Hudson Valley to offer cataract surgery using the LenSx Laser. The laser captures extremely precise, high-resolution images of the eyes, which are used to plan and perform surgery to exact, individual specifications not attainable with traditional cataract surgery. In addition to creating more precise incisions, LenSx also reduces the amount of ultrasound time needed to dissolve the cataract, thereby lessening the possibility of damage to the cornea. Most patients are candidates for the LenSx procedure. Exceptions include those with small pupils, certain corneal diseases and some forms of glaucoma. If you have a cataract that needs to be removed, your surgeon will be able to recommend the procedure that is best for you. lamps or sunlight; poor night vision, especially while driving; double vision in one eye; and frequent changes in prescription for eyeglasses or contact lenses. If you have any of these symptoms, check with your eye care professional. What Should I Do If I Have a Cataract? Just because you have a cataract doesn t mean it has to be removed immediately. Many people have small, age-related cataracts in their 40s and 50s, but the cataracts do not significantly affect their vision. In many instances, vision in these individuals can be improved with eyeglasses, brighter lighting or magnifying lenses. However, age-related cataracts grow slowly over time. When cataracts progress to the point where they cause vision loss that interferes with everyday activities, cataract surgery is the only effective treatment. In most cases, delaying surgery will not cause long-term damage to the eye. Cataract surgery, which involves removing the cloudy lens and replacing it with an artificial one, is one of the most common, safe and effective operations performed in the U.S. Approximately 90% of individuals who have had the surgery report better vision afterward. Traditional Cataract Surgery During traditional cataract surgery, the surgeon makes a very small incision in the cornea using a hand-held metal or diamond blade and inserts a tiny, highfrequency ultrasound device to break down the cataract while a miniature suction device removes the broken-down lens. This process is called phacoemulsification. A new artificial lens, called an intraocular lens, is then put it its place. Intraocular lenses, which are made of acrylic, silicone or polymethylmethacrylate material, are permanent and need no maintenance. They can also be removed, if necessary. Cataract surgery is an outpatient procedure that takes about 15 minutes and is performed under local anesthesia. Most patients are able to return to normal activities within hours, and full recovery can be expected in approximately two weeks. Laser Cataract Surgery Another type of cataract removal that is now available uses a technologically advanced option called the LenSx Laser. This image-guided laser performs several of the most difficult steps of cataract surgery, eliminating the need for a manual scalpel. Phelps recently became the first Jean Tostanoski, MD, is chief of ophthalmology at Phelps Memorial Hospital Center. Board certified in ophthalmology, she received her medical degree from Albert Einstein College of Medicine. She completed an internship in medicine at Norwalk Hospital, followed by a residency in ophthalmology at Bronx-Lebanon Hospital Center and a fellowship in ophthalmology at the Manhattan Eye, Ear & Throat Hospital. Her private practice, Hudson Valley Eye Associates, is at 24 Saw Mill River Road in Hawthorne, Phelps Today 13

14 Seven from Heaven: Community Leaders Who Champion Blood Drives By Marty Ketels, Phelps Blood Donor Recruiter I recently interviewed seven community leaders who have been instrumental in making many of Phelps off-site blood drives successful. They spoke so eloquently and with such near-angelic fervor about the importance of blood donation that I ve described them here as the Seven from Heaven. A local chamber of commerce breakfast crowd erupted into laughter when a participant announced that It s much easier to get people to donate money than to donate blood. The speaker, JoAnne Murray, who is president of the Allan Block Insurance Agency in Tarrytown, had been planning a Phelps blood drive with Sleepy Hollow village administrator Anthony Giaccio, but the sign-up had been going painfully slow. I thought we d have a line waiting, she said, I couldn t believe the excuses I was getting! While she and Giaccio, who arranged to hold the drive at the James Galgano Senior Center in Sleepy Hollow, were eventually able to attract a good many donors, their struggle mirrored national studies that find that only 5% of the public actually donates. JoAnne Murray, Allan M. Block Insurance Agency Getting Community Leaders Involved Faced with the daunting task of providing enough blood for Phelps patients, Carol Stanley, supervisor of Phelps Blood Donor Services, and I re- 14 Phelps Today

15 alize that it s not enough just to hold blood drives; the drives have to be inspired by local community leaders like Murray and Giaccio, who believe that it s their social responsibility to support their local hospital. They are two of the Seven from Heaven who have enabled Phelps to continue to collect more than 100 units month after month to fill the relentless demand for blood. All seven have managed successful blood drive and are blood donors themselves. Gerry Riera, Family YMCA of Tarrytown Kevin Kaye, OnTrack Sport Center Social Responsibility Kevin Kaye, General Manager for On Track Sport Center in Tarrytown, notes that unlike big-money contributors who get so much recognition, all blood donors are on a level playing field. Blood is such a critical commodity, it s always in demand, and donating can make a huge difference where money can t. And everyone who donates is recognized equally. Working with Kaye on setting up drives and recruiting donors, Jenifer Ross, owner of a collaborative office space business for freelancers, located in Tarrytown, makes a similar point. Giving blood, she says, transcends social and cultural differences. Your blood doesn t go just to your socio-economic group it goes to help everyone! The Reverend David Harkness, pastor of the Irvington Presbyterian Church, muses that This is your life blood but you re volunteering it. There s something quite compelling about that. Jim Farrell, director of the Ossining Public Library, puts it succinctly: In half an hour, you can save a life. I don t have a lot of money to donate, says Gerry Riera, Chief Executive of the Family YMCA in Tarrytown, but donating blood doesn t cost me anything. I feel it s a social responsibility for me to donate this valuable asset that I have. And being socially responsible can be empowering, says Ross. You have this internal resource that is endlessly replenishable. It s always there to give and nothing will stop you but fear. Fear When it comes to giving blood, Sleepy Hollow administrator Anthony Giaccio admits, I m kind of a wimp, but I do it and always feel good, like I m accomplishing something. Some people think giving blood is scary. Why not just reach into your wallet instead? But giving blood is tremendously rewarding more than giving a ten dollar bill. Peer pressure and direction from the top of an organization can overcome fear. When they host a drive, Riera and his assistant, Sandra Wingate, donate blood first to show that the Family Y is fully Jenifer Ross, These Seven from Heaven have enabled Phelps to continue to collect more than 100 units month after month to fill the relentless demand for blood. Phelps Today 15

16 behind the effort. They want employees to also feel a responsibility to give. The result? Even if they feel queasy about the process, they go ahead. Murray s message about fear comes with an offer: Anyone who is afraid to give blood, call me. I will tell you that I was fearful for so many years, and you don t have to be. Former Marine Jim Farrell gets a little impatient about fear: Roll up your sleeve, squeeze the ball and go for it! Convenience and Comfort Make a Difference Going for it at the Ossining Public Library, where Jim is the director, can be a transforming experience. Blood drives are held in the beautiful Budarz auditorium where donors literally give blood on the stage, with the windows providing a panoramic, hilltop view of the city. The library is a perfect venue for a blood drive the auditorium is large, comfortable and well lit, and there s plenty of parking for donors. Jim Farrell, Ossining Public Library The same holds true for the venues of our other blood drive hosts. The Family Y in Tarrytown has convenient parking off Main Street, comfortable interior spaces and a membership base of 3,500 potential donors. The James Galgano Senior Center is just a block off Beekman Avenue, and many in the neighborhood are able to walk over to donate. The OnTrack Sport Center. located near the Tarrytown train station, offers a unique venue with indoor soccer fields and batting cages in operation. And at the Irvington Presbyterian Church, on Route 9, the community room in the Knox building functions well, used by a large enough church membership so that it s possible to get the critical mass needed for a drive, Reverend David Harkness says. But our blood drive hosts, like Reverend Harkness and two of his very active deacons, Debbie Crescenzi and Keira Smith, would not offer their ideal venues if they did not have a full appreciation for what their local hospital, Phelps, is doing. The Reverend David Harkness, Irvington Presbyterian Church Phelps and the Business of Donating I think of Phelps as a great neighbor and an asset to the community we re codependent, Giaccio says of Phelps and the Village of Sleepy Hollow. Rev. Harkness adds: Phelps is a dream to work with because their mobile donor services team is efficient, really wonderful. Similarly, Farrell states, Phelps phlebotomists are highly skilled, making donating a good experience. Most organizations want to be part of the community. By connecting with an organization like Phelps, which is so well respected in the community, it helps our business, adds Ross. There is an added benefit: Kaye observes that he and his OnTrack patrons who have donated have become closer. By helping the community together, he and his customers have created a deeper connection. Riera agrees: People who donate blood see beyond their everyday lives and realize that they re really contributing to something that s much larger. Even so, Murray says, We get so busy sometimes that we forget how important donating blood is for people in need. It shouldn t take a tragedy to recognize that. Anthony Giaccio, Village of Sleepy Hollow When tragedy strikes, people can press a button and send money, says Reverend Harkness. This high-tech mindset, he speculates, could lead people to believe that somebody, somewhere has already developed artificial blood and put it on the retail shelf. Nothing could be further from the truth. Recalling the Armed Forces recruitment poster of Uncle Sam pointing, Reverend Harkness says emphatically, The blood has to come from YOU. Editor s note: We encourage our readers to patronize the establishments of these Seven from Heaven and to participate in their future blood drives: Allan M. Block Insurance Agency, 24 South Broadway, Tarrytown, Family YMCA of Tarrytown, 62 Main Street, Tarrytown, Irvington Presbyterian Church, 21 North Broadway, Irvington, OnTrack Sport Center, 29 South Depot Plaza, Tarrytown, Ossining Public Library, 53 Croton Avenue, Ossining, Village of Sleepy Hollow, 28 Beekman Avenue, North Broadway, Tarrytown, Phelps Today

17 Donate Blood at Phelps Give the Gift of Life and Receive a Discount from a Local Business Did you know that every time you donate a unit of blood you can help save up to three lives? Also, each time you donate at Phelps, you ll receive a $15 voucher for a free meal in the Phelps cafeteria and will be invited to choose a discount offer from one of the many generous area businesses listed below. To donate, you must be between 16 and 75 years old and weigh at least 110 pounds. Please give the gift of life. To make an appointment, call A NU Toy Store, Tarrytown The Art Barn, Ossining Atria Senior Living, Ossining Bark & Meow Pet Products, Tarrytown Basilico Pizza, Pasta, Mount Kisco Bella s Boutique, Tarrytown Brasserie Swiss, Ossining Bridge View Tavern, Sleepy Hollow Canfin Gallery, Tarrytown Capri Pizza & Pasta, Ossining Caravela, Tarrytown Carpet Giant, Ossining Casa Rina, Thornwood Chiboust, Tarrytown Choice Pets, Ossining Coffee Labs Roasters, Tarrytown Connections with Elena, Tarrytown Corsi Tire, Ossining Courtyard by Marriott, Tarrytown Doca s Portuguese, Ossining Dominick s Limousine, Sleepy Hollow Doubletree Hotel, Tarrytown Eldorado West Diner, Tarrytown Elite Hair Design, Tarrytown Elmsford Chiropractic, Elmsford Fairview Golf Center, Elmsford Family YMCA, Tarrytown Fantastic Finds Boutique, Tarrytown Geordane s, Irvington Goldfish, Ossining Good Food, Briarcliff Manor Gordo s, Hawthorne Green Valley Nursery, Hawthorne Hair on the Hudson, Tarrytown Heritage Frame, Tarrytown Highland Cleaners, Ossining Hobston Jewelry, Tarrytown Hollywood North Pizza, Sleepy Hollow Horsefeathers, Tarrytown Il Sorriso, Irvington Images Art Gallery, Briarcliff Manor Isabella Bistro, Tarrytown J. P. Doyle s Restaurant, Sleepy Hollow Jacob Burns Film Center, Pleasantville Josephine s Hair Salon, Ossining Kendal on Hudson, Sleepy Hollow King Shell Service Center, Ossining King Shell Service Center, Tarrytown Kittle House, Chappaqua L3 Couture, Briarcliff Manor Landmark Diner, Ossining Main Street Sweets, Tarrytown Mandee, Ossining Manor Wine & Spirits, Briarcliff Manor Mediterraneo, Pleasantville Melita s, Ossining Moon River River Grill, Sleepy Hollow Mr. Nick s Brick Oven Pizza, Tarrytown mysherry&more, Briarcliff Manor NY School of Esthetics, Tarrytown Okinawa, Ossining Old Stone Trattoria, Chappaqua OnTrack, Tarrytown Paese Pasta & Pizza, Briarcliff Manor PHR Electrolysis, Tarrytown Pleasantville Colonial Diner, Pleasantville Pure Mountain Olive Oil, Tarrytown Quirky Consignments, Tarrytown River City Grille, Irvington River View Wine, Tarrytown Rock Island Sound, Tarrytown Santa Fe Restaurant, Tarrytown Sheraton Hotel, Tarrytown South of the Border, Ossining Sparx Hair Salon, Pleasantville SpringHill Suites by Marriott Squire s, Briarcliff Manor Studio A Gallery, Tarrytown Sunset Cove, Tarrytown Tarry Tavern, Tarrytown Tarrytown Floral Designs, Tarrytown Tarrytown Woodworks, Tarrytown Taste of China, Tarrytown Tasty Port Wine, Ossining Terra Rustica, Briarcliff Manor TGI Friday s, Tarrytown The Boathouse, Ossining The Cabin, White Plains The Huddle, Sleepy Hollow The Red Hat, Irvington The Tapp, Tarrytown The Tuscan Grille, Briarcliff Manor The Village Soccer Shop, Tarrytown Tarrytown Thornwood Ale House, Thornwood Threads of Life, Tarrytown Trapp Optical, Tarrytown Ultra Clean Car Wash, Ossining UNO Chicago Grill, Yonkers Warner Library, Tarrytown Westchester Broadway Theatre, Elmsford Westchester Marriott, Tarrytown Wobble Café, Ossining Please patronize these businesses and let them know you appreciate their community-minded support. To learn about donating blood, call (914) Phelps MRI New Expanded Hours: Monday Friday 7 am 9 pm Saturday 8 am 4 pm Our MRI features a 1.5 tesla magnet. A certified technologist helps put patients at ease. Earplugs are provided as well as music, when possible, and there is ongoing contact through a microphone system. The MRI building is conveniently located on the Phelps campus near the Emergency Department entrance, and parking is free. Phelps MRI Building Phelps Today 17

18 10 and 24; November 7 and 21; and December 5 and 19. Bess Steiger, LCSW, Bereavement Coordinator 2 3:30 pm; Hospice Office in the James House Suggested donation: $10 per session. Registration is required. Call (914) or healthy life calendar PHELPS Phelps Farmers Market at the Park Every Thursday from 11 am to 3 pm through November The Phelps Farmers Market at the Park continues through November from 11 am to 3 pm. The market is located at the entrance to the Rockwood Hall area of Rockefeller State Park, at the end of Route 117. Shoppers will find a wide range of farm-fresh fruits and vegetables, farm products such as cheeses, eggs and meats, and prepared food such as baked goods, sandwiches and salads. Vendors will vary from week to week. Call (914) for more information. Bereavement Support Group This ongoing support group for adults struggling with the loss of a loved one meets twice a month on the following dates: September 12 and 26; October Look Good... Feel Better This free, 2-hour workshop teaches beauty techniques to women undergoing cancer treatment to help them manage the appearance-related aspects of their treatment. The program, held monthly at Phelps, includes a hair consultation with a professional stylist and a makeup consultation with a cosmetologist. Attendees can take home a complimentary wig and a make-up kit donated by cosmetic companies. The program is offered in partnership with the American Cancer Society, The National Cosmetology Association, and the Cosmetic, Toiletry and Fragrance Association (CTFA) Foundation. Call (914) or (914) to register for an upcoming session. Prostate Screenings Thursday, September 19, 2013 Jack Hershman, MD, urologist 9 am 12 pm Monday, September 23, 2013 Jack Hershman, MD, urologist 9 am 12 pm 18 Phelps Today

19 Arno Housman, MD, urologist 5 8 pm Monday, September 30, 2013 Arno Housman, MD, urologist 5 8 pm Thursday, October 3, 2013 Jack Hershman, MD, urologist 9 am 12 pm Appointments are required. Call (914) to schedule. Tuesday, September 10, 2013 Better Breathers Club Pulmonary Fibrosis Support Group The Pulmonary Fibrosis Support Group welcomes those with pulmonary fibrosis to learn and share with others. Susan DiFabio, RT, Educational Coordinator for Phelps Pulmonary Rehabilitation Program 12 1 pm; Pulmonary Lab (B Level) Registration is required. Call (914) to register. Wednesday, September 11, 2013 The Breakfast Club The Breakfast Club is a series of free breakfast meetings designed especially for seniors. Each session includes a free breakfast, a presentation on a healthy lifestyle topic and a light exercise program. The group meets monthly, except for August and December. 8:30 10:30 am; Cafeteria (G Level) Call (914) to register. OCTOBER Friday, October 4, 2013 Help for Dizziness and Balance Problems Are symptoms of dizziness or imbalance affecting your life and the activities you participate in? Learn about videonystagmography (VNG) testing, which helps determine the cause of the dizziness, and vestibular rehabilitation, which helps reduce dizziness and balance problems. Sheetal Sheenoy, OTR/L, occupational therapist certified in vestibular rehabilitation Swapna Nataraj, AuD, CCC-A, audiologist 11 am 12 pm; C-Level Classroom Registration is required. Call (914) to register. Saturday, October 5, 2013 CarFit for Older Driver Safety An individualized 20-minute educational session for older drivers, designed to improve the fit of their cars for safety and comfort, promote conversations about safe driving, and link them with local resources to enable them to continue driving for as long as safely possible. The trained CarFit team, Phelps Occupational Therapy Department, will work with older drivers to help ensure a clear line of sight over the steering wheel, proper seat belt use and fit, and safe positioning of mirrors to minimize blind spots. CarFit was created by the American Society of Aging in collaboration with AARP, AAA and the American Occupational Therapy Association. 9 am until noon (rain or shine); Phelps parking garage. Appointments are required. Call (914) to schedule. Tuesday, October 8, 2013 Better Breathers Club The Better Breathers Club is an informal interactive support group for people with breathing disorders. Come and learn about the many free opportunities, information and workshops offered by the American Lung Association for individuals with lung disease. Light refreshments will be served. Serena Arabito, American Lung Association 12-1 pm; Pulmonary Lab (B Level) Registration is required. Call (914) to register. Tuesday, October 8, 2013 Controlling the Pain of Arthritic Knees Without Surgery Orthopedic surgeon J. Robert Seebacher, MD, will discuss a non-surgical therapy that often helps people with arthritic knees maintain active lifestyles while postponing or eliminating the need for surgery. Learn how injections and exercise can enable reconditioning and reduce inflammation and pain. J. Robert Seebacher, MD Medical Director of the Phelps Joint Replacement Service 6:30 pm; Auditorium (light refreshments at 6 pm) Call (914) to register. Wednesday, October 9, 2013 The Role of the Nose in Snoring and Sleep Apnea Learn about the role of nasal congestion in snoring and sleep apnea and the treatment options that are available. Michael Bergstein, MD, otolaryngologist, Surgical Director of the Phelps Sleep Center 7 pm; Auditorium Call (914) to register. Phelps Today 19

20 Thursday, October 10, 2013 The Breakfast Club See listing for September 11, Monday, October 14, 2013 Movement Therapy for Parkinson s Patients The LSVT BIG program is a physical therapy program designed to improve the major motor skills of people with Parkinson s disease by retraining their movements. The exercises, led by LSVT BIG-certified physical therapists, specifically address an increase in motion of the arms and legs, as well as turning of the trunk and walking. The program is designed to increase walking speed, improve balance and enhance quality of life. Leslie Sims, MSPT, LSVT-certified Jennifer Teyfel-Freestone, PT, DPT, GCS, CLT-LANA, CSCS 1 2 pm; Boardroom (C Level) Call (914) to register. Tuesday, October 15, 2013 New Treatment for Asthma Sufferers Learn about bronchial thermoplasty, the only non-drug treatment option available for asthmatics 18 years of age and older who are still symptomatic, despite use of currently available medications. Bronchial thermoplasty has been shown to reduce the severity of asthma attacks, visits to the emergency room, and time lost from work, school and other daily activities. Laurence C. Miller, MD, pulmonologist 6 pm; Auditorium Call (914) to register. Monday and Tuesday, October 21 and 22, 2013 Defensive Driving This two-evening certification program lowers insurance premiums, reduces violation points and sharpens driving skills. Robert Fogel 5:30 8:30 pm; Auditorium Fee: $45 Call (914) to register. Wednesday, October 23, 2013 Stand Up and Be Heard! As we age, our voices age too. Pitch and tone changes can occur. The voice may sound weak, breathy or hoarse. Many alterations of voice that come with age can be addressed to improve one s quality of life. During this interactive workshop, led by an experienced voice therapist, you will learn and perform group vocal exercises that help increase the power and clarity of your voice. You will also learn about how breath support, intonation, loudness, and pronunciation all contribute to a vital and dynamic vocal quality. Leah Ross-Kugler, MS, CCC-SLP, voice rehabilitation specialist Noon 1 pm; C-Level Classroom Registration is required. Call (914) to register. Thursday, October 24, 2013 Speech Therapy for Parkinson s Patients: Think LOUD, Speak LOUD Join graduates of LSVT LOUD and learn about this intensive speech therapy program for individuals with Parkinson s disease. Andrea Bracciante Ely, MS, CCC-SLP, Senior Speech Language Pathologist 10:30 11:30 am; Walkway Conference Room Registration is required. Call (914) to register. Monday, October 28, 2013 Laryngopharyngeal Reflux (LPR) Silent Reflux Screening Changes in the voice, throat clearing, mucus in the throat with discomfort, swallowing problems and chronic cough that does not respond to medications are all symptoms of Laryngopharyngeal Reflux (LPR). In addition, chronic asthma, recurrent sinusitis, dental disease and even cancer can all be caused or exacerbated by LPR. LPR is not GERD. Craig H. Zalvan, MD, laryngologist, Medical Director of the Institute for Voice and Swallowing Disorders at Phelps 8:45 10 am Registration is required. Call (914) to register. Monday, October 28, 2013 Swallow Screening Do you sometimes feel food or liquid going down the wrong pipe? Does food get stuck? Do you have pain when 20 Phelps Today

Grow healthy. Stay healthy. Grow healthy. Stay healthy. www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK DIARIO DEL EMBARAZO

Grow healthy. Stay healthy. Grow healthy. Stay healthy. www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK DIARIO DEL EMBARAZO www.startsmartforyourbaby.com PREGNANCY JOURNEY BOOK 2012 Start Smart for Your Baby. All rights reserved. TM 2012 Start Smart for Your Baby. All rights reserved. TM DIARIO DEL EMBARAZO www.startsmartforyourbaby.com

Más detalles

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia

Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Headaches, Working with your Doctor to Avoid the Emergency Room Dolores de cabeza Trabaje con su doctor para evitar las visitas a la Sala de Emergencia Conozca a su equipo de cuidados para los dolores

Más detalles

Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals

Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals Improving Rates of Colorectal Cancer Screening Among Never Screened Individuals Northwestern University, Feinberg School of Medicine Contents Patient Letter Included with Mailed FIT... 3 Automated Phone

Más detalles

MajestaCare Healthy Baby Program

MajestaCare Healthy Baby Program MajestaCare Healthy Baby Program Helping you have a healthy baby Para que tenga un bebé saludable Your baby s provider After your baby becomes a member of MajestaCare health plan, you will get a letter

Más detalles

July 2011. Graduations & Learning After High School. Español/Spanish

July 2011. Graduations & Learning After High School. Español/Spanish July 2011 Graduations & Learning After High School Español/Spanish Last month our schools graduated 1,734 students from high school. These are students who met all the graduation standards from the State

Más detalles

Examen prenatal: Evaluación integrada En la Clínica de Medicina Materno Fetal en Yakima

Examen prenatal: Evaluación integrada En la Clínica de Medicina Materno Fetal en Yakima UW MEDICINE PATIENT EDUCATION PRENATAL TESTING: INTEGRATED SCREEN SPANISH Examen prenatal: Evaluación integrada En la Clínica de Medicina Materno Fetal en Yakima En la Clínica de Medicina Materno Fetal

Más detalles

Types of Dementia. Common Causes of Dementia

Types of Dementia. Common Causes of Dementia Types of Dementia Dementia is a loss of skills to think, remember and reason that is severe enough to affect daily activities. It is normal to need more time to remember things as we get older. Other thinking

Más detalles

Speak Up! In Spanish. Young s Language Consulting. Young's Language Consulting. Lesson 1 Meeting and Greeting People.

Speak Up! In Spanish. Young s Language Consulting. Young's Language Consulting. Lesson 1 Meeting and Greeting People. Buenos días Good morning Buenos días Good afternoon Buenas tardes Good evening Buenas tardes Good night Buenas noches Sir Señor Ma am/mrs. Señora Miss Señorita Buenas tardes Culture Note: When greeting

Más detalles

Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094

Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094 Rhode Island Department of Health Three Capitol Hill Providence, RI 02908-5094 www.health.ri.gov Date: December 30, 2009 To: Parents and guardians of school-aged children in Rhode Island From: Director

Más detalles

Northwestern University, Feinberg School of Medicine

Northwestern University, Feinberg School of Medicine Improving Rates of Repeat Colorectal Cancer Screening Appendix Northwestern University, Feinberg School of Medicine Contents Patient Letter Included with Mailed FIT... 3 Automated Phone Call... 4 Automated

Más detalles

Tres componentes importantes del programa Título I El propósito del Título I es de asegurar que todos los estudiantes tengan la oportunidad de

Tres componentes importantes del programa Título I El propósito del Título I es de asegurar que todos los estudiantes tengan la oportunidad de Qué es Titulo I? El programa Título I para la Educación Primaria y Secundaria es el programa educacional más grande que recibe fondos federales El gobierno federal proporciona asistencia financiera a las

Más detalles

Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course.

Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Welcome to lesson 2 of the The Spanish Cat Home learning Spanish course. Bienvenidos a la lección dos. The first part of this lesson consists in this audio lesson, and then we have some grammar for you

Más detalles

Guide to Health Insurance Part II: How to access your benefits and services.

Guide to Health Insurance Part II: How to access your benefits and services. Guide to Health Insurance Part II: How to access your benefits and services. 1. I applied for health insurance, now what? Medi-Cal Applicants If you applied for Medi-Cal it will take up to 45 days to find

Más detalles

Ethnography of a Classroom Sample Questions (May need to be adjusted for lower grades)

Ethnography of a Classroom Sample Questions (May need to be adjusted for lower grades) Claremont Graduate University, Teacher Education Program Ethnography of a Classroom Sample Questions Parent/Family Interview Be sure to schedule enough time for interview minimum 30 minutes. If possible,

Más detalles

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner

FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner FAMILY INDEPENDENCE ADMINISTRATION Seth W. Diamond, Executive Deputy Commissioner James K. Whelan, Deputy Commissioner Policy, Procedures, and Training Lisa C. Fitzpatrick, Assistant Deputy Commissioner

Más detalles

GUIDE FOR PARENT TEACHER CONFERENCES

GUIDE FOR PARENT TEACHER CONFERENCES GUIDE FOR PARENT TEACHER CONFERENCES A parent-teacher conference is a chance for you and your child s teacher to talk. You can talk about how your child is learning at home and at school. This list will

Más detalles

Dear Parents and Patrons,

Dear Parents and Patrons, Dear Parents and Patrons, The purpose of this letter is to inform you that according to the 2013-14 state student assessment results NeSA reading, Gibbon Elementary School is considered a Title 1 School

Más detalles

Diabetes and Eye Problems

Diabetes and Eye Problems Diabetes and Eye Problems If you have diabetes, you need to take care of your eyes because over time high blood sugar can damage your eyes. Many people with type 2 diabetes have high blood sugar for months

Más detalles

Learning Masters. Early: Force and Motion

Learning Masters. Early: Force and Motion Learning Masters Early: Force and Motion WhatILearned What important things did you learn in this theme? I learned that I learned that I learned that 22 Force and Motion Learning Masters How I Learned

Más detalles

Epidural Pain Relief for Labor and Delivery

Epidural Pain Relief for Labor and Delivery Epidural Pain Relief for Labor and Delivery An epidural is often used for pain relief during labor and delivery. A small flexible tube is put in the lower back. Medicine is injected into the tube to provide

Más detalles

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR

IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR IRS DATA RETRIEVAL NOTIFICATION DEPENDENT STUDENT ESTIMATOR Subject: Important Updates Needed for Your FAFSA Dear [Applicant], When you completed your 2012-2013 Free Application for Federal Student Aid

Más detalles

A1 Second level. Timeline. Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013.

A1 Second level. Timeline. Servicio Nacional de Aprendizaje - SENA. Reservados todos los derechos 2013. A1 Second level Timeline Start UP Welcome Hi! It s great to see you again! It s time to learn how to make a timeline to talk about past events of our lives in a sequential manner. Let s begin! 2 /9 Warm

Más detalles

Brain Tumors. Glioma Tumors

Brain Tumors. Glioma Tumors Brain Tumors A tumor that starts and grows in the brain is called a primary brain tumor. Primary brain tumors get their name from the type of cell or the part of the brain where they start growing. A secondary

Más detalles

Asistencia para alimentos de Iowa (Iowa Food Assistance Program) SCRIPT

Asistencia para alimentos de Iowa (Iowa Food Assistance Program) SCRIPT Asistencia para alimentos de Iowa (Iowa Food Assistance Program) http://video.extension.iastate.edu/2011/12/14/asistencia para alimentos de iowa/ Six minute video in Spanish explaining what Food Assistance

Más detalles

High Blood Pressure in Pregnancy

High Blood Pressure in Pregnancy High Blood Pressure in Pregnancy Blood pressure is the force put on the walls of your blood vessels as blood travels through your body. Blood pressure helps pump blood to your body. Taking Your Blood Pressure

Más detalles

Radiación Externa. External Radiation. Radiación Interna. Internal Radiation

Radiación Externa. External Radiation. Radiación Interna. Internal Radiation Terapia de Radiación Radiation Therapy Spanish Translation Radiation therapy is sometimes called radiotherapy, x-ray therapy, or irradiation. It treats cancer by using beams of high- energy waves or streams

Más detalles

Cirugía para epilepsia

Cirugía para epilepsia Material educativo para el paciente y la familia Epilepsy Surgery: Making A Decision About Treatment / Spanish Cirugía para epilepsia Consideraciones para el tratamiento El grupo de doctores de la atención

Más detalles

TEXAS STATE TEACHERS ASSOCIATION

TEXAS STATE TEACHERS ASSOCIATION TEXAS STATE TEACHERS ASSOCIATION You have more to offer your child than you think. Thanks to your hard work and sacrifice, your child is enrolled in a Texas public school a learning environment that can

Más detalles

A Member of My Community

A Member of My Community Connection from School to Home Kindergarten Social Studies Unit 1 A Member of My Community Here is an easy activity to help your child learn about what it means to be a member of a community. Here is what

Más detalles

Diabetes. Diabetes is a disease in which your body cannot properly use the food you eat for energy. Your cells need energy to live and grow.

Diabetes. Diabetes is a disease in which your body cannot properly use the food you eat for energy. Your cells need energy to live and grow. Diabetes Diabetes is a disease in which your body cannot properly use the food you eat for energy. Your cells need energy to live and grow. When you eat, food breaks down into a form of energy called glucose.

Más detalles

SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA

SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA SIGUIENDO LOS REQUISITOS ESTABLECIDOS EN LA NORMA ISO 14001 Y CONOCIENDO LAS CARACTERISTICAS DE LA EMPRESA CARTONAJES MIGUEL Y MATEO EL ALUMNO DEBERA ELABORAR LA POLITICA AMBIENTAL PDF File: Siguiendo

Más detalles

Are You Eligible for a FREE Mammogram? Es Usted Elegible Para una Mamografía GRATIS? C OLUMBIA U NIVERSITY B REAST C ANCER S CREENING P ARTNERSHIP

Are You Eligible for a FREE Mammogram? Es Usted Elegible Para una Mamografía GRATIS? C OLUMBIA U NIVERSITY B REAST C ANCER S CREENING P ARTNERSHIP C OLUMBIA U NIVERSITY B REAST C ANCER S CREENING P ARTNERSHIP Are You Eligible for a FREE Mammogram? Es Usted Elegible Para una Mamografía GRATIS? Columbia Presbyterian Center NewYork-Presbyterian Hospital

Más detalles

1. Título: 2. Objetivos: 3. Contenidos de la propuesta: 4. Relación con los temas transversales: 5. Sesiones de trabajo: Preventing back injuires.

1. Título: 2. Objetivos: 3. Contenidos de la propuesta: 4. Relación con los temas transversales: 5. Sesiones de trabajo: Preventing back injuires. 1. Título: Preventing back injuires. 2. Objetivos: a) Adquirir vocabulario inglés básico relacionado con la prevención de riesgos por manipulación de cargas. b) Estudiar las formas gramaticales más apropiadas

Más detalles

Learning Masters. Fluent: Wind, Water, and Sunlight

Learning Masters. Fluent: Wind, Water, and Sunlight Learning Masters Fluent: Wind, Water, and Sunlight What I Learned List the three most important things you learned in this theme. Tell why you listed each one. 1. 2. 3. 22 Wind, Water, and Sunlight Learning

Más detalles

Screener for Peer Supporters

Screener for Peer Supporters Screener for Peer Supporters Primary Recruiter: Secondary Recruiter: Potential Peer Supporter Name: Phone #1: Home/Cell Phone #2: Home/Cell Address: City: Zip: Contact 1: Date: / / Contact 2: Date: / /

Más detalles

Affordable Care Act Informative Sessions and Open Enrollment Event

Affordable Care Act Informative Sessions and Open Enrollment Event 2600 Cedar Ave., P.O. Box 2337, Laredo, TX 78044 Hector F. Gonzalez, M.D., M.P.H Tel. (956) 795-4901 Fax. (956) 726-2632 Director of Health News Release. Date: February 9, 2015 FOR IMMEDIATE RELEASE To:

Más detalles

Daly Elementary. Family Back to School Questionnaire

Daly Elementary. Family Back to School Questionnaire Daly Elementary Family Back to School Questionnaire Dear Parent(s)/Guardian(s), As I stated in the welcome letter you received before the beginning of the school year, I would be sending a questionnaire

Más detalles

Agustiniano Ciudad Salitre School Computer Science Support Guide - 2015 Second grade First term

Agustiniano Ciudad Salitre School Computer Science Support Guide - 2015 Second grade First term Agustiniano Ciudad Salitre School Computer Science Support Guide - 2015 Second grade First term UNIDAD TEMATICA: INTERFAZ DE WINDOWS LOGRO: Reconoce la interfaz de Windows para ubicar y acceder a los programas,

Más detalles

Understanding. Diabetes. learn the facts! Comprender la. conozca. los datos!

Understanding. Diabetes. learn the facts! Comprender la. conozca. los datos! Understanding Diabetes learn the facts! Comprender la Diabetes los datos! conozca Diabetes in Americans Did you know that approximately 18.2 million people in the United States have been diagnosed with

Más detalles

Lengua adicional al español IV

Lengua adicional al español IV Lengua adicional al español IV Topic 11 Life little lessons Introduction In this lesson you will study: Time clauses are independent clauses. These are the clauses that tell you the specific time when

Más detalles

Reinforcement Plan. Day 27 Month 03 Year 2015

Reinforcement Plan. Day 27 Month 03 Year 2015 BETHLEMITAS SCHOOL Reinforcement Plan Day 27 Month 03 Year 2015 TERM: I Date: COMPREHENSION GOAL: The students develop comprehension about the Living and Non- living things, plants, animals and their main

Más detalles

Learning Masters. Fluent: Animal Habitats

Learning Masters. Fluent: Animal Habitats Learning Masters Fluent: Animal Habitats What I Learned List the three most important things you learned in this theme. Tell why you listed each one. 1. 2. 3. 22 Animal Habitats Learning Masters How I

Más detalles

SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions

SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions SFGH FHC Healthy Children Vaccination Program Frequently Asked Questions The Family Health Center (FHC) Healthy Children Vaccination Program at SF General Hospital (SFGH) provides immunization services

Más detalles

Teeeny teeeny tiny little pieces of rocks. Anncr: But to her two year-old son, exploring the world around him, she makes perfect sense.

Teeeny teeeny tiny little pieces of rocks. Anncr: But to her two year-old son, exploring the world around him, she makes perfect sense. Below you will find the National Radio PSA Scripts. To listen to the radio spots, please go to: http://online.unitedway.org/bornlearning Born Learning Radio :60 At the Beach Ocean sounds Over there? Over

Más detalles

ÁMBITO DE COMUNICACIÓN Lengua extranjera: Inglés

ÁMBITO DE COMUNICACIÓN Lengua extranjera: Inglés CONSEJERÍA DE EDUCACIÓN PRUEBAS LIBRES PARA LA OBTENCIÓN DIRECTA DEL TÍTULO DE GRADUADO EN EDUCACIÓN SECUNDARIA OBLIGATORIA POR LAS PERSONAS MAYORES DE 18 AÑOS (Convocatoria septiembre 2010). APELLIDOS

Más detalles

Instructor: Do you remember how to say the verb "to speak"? Instructor: How do you ask a friend Do you speak Spanish?

Instructor: Do you remember how to say the verb to speak? Instructor: How do you ask a friend Do you speak Spanish? Learning Spanish Like Crazy Spoken Spanish Lección Dos. Listen to the following conversation: Male: Hablas inglés? Female: Sí, hablo inglés porque practico todos los días. Male: Dónde? Female: Practico

Más detalles

Thank you. US English US Spanish. Australia-English Canada-English Ireland-English New Zealand-English Taiwan-English United Kingdom-English

Thank you. US English US Spanish. Australia-English Canada-English Ireland-English New Zealand-English Taiwan-English United Kingdom-English Dear Healthcare Provider, Included in this PDF are recruitment brochures in several languages to be used in MM Bone study (Protocol No.: 20090482). Kindly note these brochures have been updated according

Más detalles

Glaucoma. Types of Glaucoma. Risk Factors

Glaucoma. Types of Glaucoma. Risk Factors Glaucoma Glaucoma is an eye disease that can cause vision loss or blindness. With glaucoma, fluid builds up in the eye, which puts pressure on the back of the eye. This pressure injures the optic nerve

Más detalles

Qué viva la Gráfica de Cien!

Qué viva la Gráfica de Cien! Qué viva la Gráfica de Cien! La gráfica de cien consiste en números del 1 al 100 ordenados en cuadrilones de diez números en hileras. El resultado es que los estudiantes que utilizan estás gráficas pueden

Más detalles

Creating your Single Sign-On Account for the PowerSchool Parent Portal

Creating your Single Sign-On Account for the PowerSchool Parent Portal Creating your Single Sign-On Account for the PowerSchool Parent Portal Welcome to the Parent Single Sign-On. What does that mean? Parent Single Sign-On offers a number of benefits, including access to

Más detalles

The 10 Building Blocks of Primary Care

The 10 Building Blocks of Primary Care The 10 Building Blocks of Primary Care My Action Plan Background and Description The Action Plan is a tool used to engage patients in behavior-change discussion with a clinician or health coach. Using

Más detalles

Diabetes Mellitus Gestacional

Diabetes Mellitus Gestacional Gestational Diabetes Mellitus Diabetes Mellitus Gestacional Qué es la diabetes? La diabetes se produce cuando el cuerpo no puede usar y almacenar de forma apropiada el azúcar que recibe a través de los

Más detalles

Inspired Beginners Podcast 30 Horarios Españoles

Inspired Beginners Podcast 30 Horarios Españoles Inspired Beginners Podcast 30 Horarios Españoles Contents 1. Key Vocabulary and Grammar 2 2. The Transcript of the conversation 3 3. Translation of the conversation 4 4. Vocab Building (add to the list)

Más detalles

manual de servicio nissan murano z51

manual de servicio nissan murano z51 manual de servicio nissan murano z51 Reference Manual To understand featuring to use and how to totally exploit manual de servicio nissan murano z51 to your great advantage, there are several sources of

Más detalles

Learning Masters. Fluent: States of Matter

Learning Masters. Fluent: States of Matter Learning Masters Fluent: States of Matter What I Learned List the three most important things you learned in this theme. Tell why you listed each one. 1. 2. 3. 22 States of Matter Learning Masters How

Más detalles

a message from MassHealth be MassHealthy! un mensaje de MassHealth usted puede tomar acción en beneficio de su salud health

a message from MassHealth be MassHealthy! un mensaje de MassHealth usted puede tomar acción en beneficio de su salud health YOU can take a message from MassHealth be MassHealthy! un mensaje de MassHealth usted puede tomar acción en beneficio de su salud action for your health look for health every day haga algo por su salud

Más detalles

Please join us in circle. Please put on a nametag. Por favor, únete a nosotros en ronda. Ponte una etiqueta con su nombre.

Please join us in circle. Please put on a nametag. Por favor, únete a nosotros en ronda. Ponte una etiqueta con su nombre. Welcome! Bienvenido! Please join us in circle. Please put on a nametag. Por favor, únete a nosotros en ronda. Ponte una etiqueta con su nombre. Questions for You to Think About Preguntas para que pienses

Más detalles

Nitroglycerin. If you use tablets:

Nitroglycerin. If you use tablets: Nitroglycerin Nitroglycerin is a medicine used to treat chest pain called angina. Take nitroglycerin as directed by your doctor. If you are pregnant or breastfeeding, talk to your doctor before using this

Más detalles

Evaluación prenatal avanzada con ADN en células libres En la Clínica de Medicina Materno Fetal (Maternal Fetal Medicine Clinic) de UW en Yakima

Evaluación prenatal avanzada con ADN en células libres En la Clínica de Medicina Materno Fetal (Maternal Fetal Medicine Clinic) de UW en Yakima UW MEDICINE PATIENT EDUCATION ADVANCED PRENATAL SCREENING WITH CELL-FREE DNA SPANISH Evaluación prenatal avanzada con ADN en células libres En la Clínica de Medicina Materno Fetal (Maternal Fetal Medicine

Más detalles

National Eye Health Education Program Resources. Border Binational Health Week Planning Teleconference Call. April 19, 2012

National Eye Health Education Program Resources. Border Binational Health Week Planning Teleconference Call. April 19, 2012 National Eye Health Education Program Resources Border Binational Health Week Planning Teleconference Call April 19, 2012 National Eye Health Education Program (NEHEP) Goal: To ensure that vision is a

Más detalles

Worksheet 3: Past Simple v/s Present Perfect. Past Simple v/s Present Perfect

Worksheet 3: Past Simple v/s Present Perfect. Past Simple v/s Present Perfect Worksheet 3: Past Simple v/s Present Perfect NIVEL A.E. C.M.O. HABILIDAD Cuarto Medio El estudiante debe ser capaz de : -Generar entendimiento, uso y aplicación correcta de ambos tiempos verbales. Pasado

Más detalles

Bone Marrow Biopsy. To Prepare

Bone Marrow Biopsy. To Prepare Bone Marrow Biopsy Bone marrow is the soft tissue inside your bones where blood cells are made. During a bone marrow biopsy, a small tissue sample is taken and sent for tests. The biopsy is often taken

Más detalles

Steps to Understand Your Child s Behavior. Customizing the Flyer

Steps to Understand Your Child s Behavior. Customizing the Flyer Steps to Understand Your Child s Behavior Customizing the Flyer Hello! Here is the PDF Form Template for use in advertising Steps to Understanding Your Child s Behavior (HDS Behavior Level 1B). Because

Más detalles

Shortcut to Informal Spanish Conversations Level 2 Lesson 1

Shortcut to Informal Spanish Conversations Level 2 Lesson 1 Shortcut to Informal Spanish Conversations Level 2 Lesson 1 These lessons extend on the ideas from Shortcut to Informal Spanish Conversations Level 1 http://www.informalspanish.com and Shortcut to Spanish

Más detalles

For Our Daughters... The HPV Vaccine

For Our Daughters... The HPV Vaccine For Our Daughters... The HPV Vaccine You can protect your daughter from cervical cancer by getting her the HPV vaccine! The HPV vaccine has been approved for boys and girls 11 to 26 years of age and can

Más detalles

Escuela Olympic Program Titulo 1

Escuela Olympic Program Titulo 1 Escuela Olympic Program Titulo 1 Misión: Creemos que toda la comunidad de alumnos de Olympic van aprender Creemos que el habiente de posibilidad da lugar para la capacidad Nosotros esfuerzos nos ha logrado

Más detalles

Si su bebé nace antes de tiempo Ayudándole a entender su procedimiento

Si su bebé nace antes de tiempo Ayudándole a entender su procedimiento If Your Baby Is Born Early Spanish Educación del paciente Centro Materno Infantil Si su bebé nace antes de tiempo Ayudándole a entender su procedimiento Cada año en los Estados Unidos, aproximadamente

Más detalles

Person ID:
, Mailed:

Person ID: <MPI_ID> <Primary Applicant/AREP FMLNS> <Address Line 1> <Address Line 2> <City>, <State> <Zip> Mailed: <Current Date> Person ID: , Mailed: Your HUSKY Health Coverage is Scheduled to End on August 31st Dear

Más detalles

Member Name: Date: Telephone:

Member Name: Date: Telephone: Member Name: Date: Telephone: Member ID: Date of Birth: This information is available for free in other languages. Please contact our customer service number at 1 (888) 864-1114 or TTY (800)

Más detalles

How Active Am I in My Care? A group of patients made this list to help you.

How Active Am I in My Care? A group of patients made this list to help you. How Active Am I in My Care? A group of patients made this list to help you. How I share my concerns with my care team: 1 I keep a list of questions for my doctor and bring it to clinic visits. 2 I ask

Más detalles

Estimada paciente embarazada:

Estimada paciente embarazada: Embarazo y parto Educación perinatal Embarazo y parto Página i Bienvenidos Estimada paciente embarazada: Felicitaciones! El embarazo, el parto y los meses inmediatamente posteriores pueden ser algunas

Más detalles

Keeping Your Home, Protecting Your Investment. Cómo retener su casa, Cómo proteger su inversión

Keeping Your Home, Protecting Your Investment. Cómo retener su casa, Cómo proteger su inversión Keeping Your Home, Protecting Your Investment Cómo retener su casa, Cómo proteger su inversión Learn The Steps You Can Take Today Aprenda los pasos que puede tomar hoy Don t risk losing your home or jeopardizing

Más detalles

Retinal Tears and Detachment

Retinal Tears and Detachment Retinal Tears and Detachment retina The retina is the lining in the back of the inside of the eye. It sends messages to the brain so you can see. When the retina pulls away from the inside of the eye,

Más detalles

Spanish Version provided Below

Spanish Version provided Below Spanish Version provided Below Greater Waltown United Holy Church s Summer Reading and Math Program 706 Belvin Avenue Durham, N. C. 27712 (919) 220-7087 May 3, 2015 Dear Parent/Guardian: Summer can be

Más detalles

STAR/Cross-age Tutoría Frases del Sr. Fry Grupo 1 Práctique leyendo con su niño(a) 5 frases diariamente. Continue con las siguiente 5 frases cuando

STAR/Cross-age Tutoría Frases del Sr. Fry Grupo 1 Práctique leyendo con su niño(a) 5 frases diariamente. Continue con las siguiente 5 frases cuando Grupo 1 1. the little boy el niño pequeño 2. a good boy un buen niño 3. is about me es acerca de mí 4. then you give luego tú das 5. was to come iba a suceder 6. old and new viejo y nuevo 7. what we know

Más detalles

DONACION DE OLD TIME FOUNDATION A NIKAO MAORI SCHOOL RAROTONGA ISLAS COOK OCTUBRE 2007

DONACION DE OLD TIME FOUNDATION A NIKAO MAORI SCHOOL RAROTONGA ISLAS COOK OCTUBRE 2007 DONACION DE OLD TIME FOUNDATION A NIKAO MAORI SCHOOL RAROTONGA ISLAS COOK OCTUBRE 2007 La escuela primaria Nikao Maori School fue fundada en 1955. Es una escuela pública y tiene actualmente 123 alumnos.

Más detalles

Reducción de Riesgos En Deep Web

Reducción de Riesgos En Deep Web Reducción de Riesgos En Deep Web Puesta en Marcha 1. Antecedentes: Dr.X 2. Justificación: 1. Outreach virtual RdR: allá donde están las personas usuarias 2. Conocimiento directo, real e inmediato de nuevas

Más detalles

Some examples. I wash my clothes, I wash the dishes, I wash the car, I wash the windows. I wash my hands, I wash my hair, I wash my face.

Some examples. I wash my clothes, I wash the dishes, I wash the car, I wash the windows. I wash my hands, I wash my hair, I wash my face. Reflexive verbs In this presentation, we are going to look at a special group of verbs called reflexives. Let s start out by thinking of the English verb wash. List several things that you can wash. Some

Más detalles

REFUERZO EDUCATIVO de INGLÉS. Área/Materia: INGLÉS Curso: 2º ESO Grupo: Número: Curso lectivo: 2013-14 Fecha presentación RE: SEPTIEMBRE 2014

REFUERZO EDUCATIVO de INGLÉS. Área/Materia: INGLÉS Curso: 2º ESO Grupo: Número: Curso lectivo: 2013-14 Fecha presentación RE: SEPTIEMBRE 2014 E. S. O. COLEGIO NSTRA. SRA. DEL RECUERDO Jefatura de Estudios REFUERZO EDUCATIVO de INGLÉS Departamento: INGLÉS Alumno: Área/Materia: INGLÉS Curso: 2º ESO Grupo: Número: Profesor: Tutor/a: Curso lectivo:

Más detalles

More child support paid + more passed

More child support paid + more passed Child Support and W-2 are working together to better serve Wisconsin families. More child support is paid when families understand the rules. Recent child support policy changes are giving more money back

Más detalles

HEAD START MEDICATION ADMINISTRATION

HEAD START MEDICATION ADMINISTRATION HEAD START MEDICATION ADMINISTRATION Dear Parents/Guardians: It is the policy of Head Start to cooperate with each Head Start child's parent/guardian and his/her physician by administering and providing

Más detalles

Disfruten su verano! Hola estudiantes,

Disfruten su verano! Hola estudiantes, Hola estudiantes, We hope that your experience during Spanish 1 was enjoyable and that you are looking forward to improving your ability to communicate in Spanish. As we all know, it is very difficult

Más detalles

Kera - Pediatric Nurse Practitioner Kera - Enfermera Pediatra Practicante

Kera - Pediatric Nurse Practitioner Kera - Enfermera Pediatra Practicante PAGE 1 Kera - Pediatric Nurse Practitioner Kera - Enfermera Pediatra Practicante [Kera facing camera] [Kera frente la cámara] [Title card: Kera] [Kera] [Images of Kera being interviewed by other girls,

Más detalles

High Blood Sugar. The most common reasons for high blood sugar in people with diabetes are:

High Blood Sugar. The most common reasons for high blood sugar in people with diabetes are: High Blood Sugar High blood sugar means having too much sugar called glucose in the blood. High blood sugar is also called hyperglycemia. The body s cells need blood sugar. A normal blood sugar level is

Más detalles

Connection from School to Home Science Grade 5 Unit 1 Living Systems

Connection from School to Home Science Grade 5 Unit 1 Living Systems Connection from School to Home Science Grade 5 Unit 1 Living Systems Here is an activity to help your child understand human body systems. Here is what you do: 1. Look at the pictures of the systems that

Más detalles

ADAPTACIÓN DE REAL TIME WORKSHOP AL SISTEMA OPERATIVO LINUX

ADAPTACIÓN DE REAL TIME WORKSHOP AL SISTEMA OPERATIVO LINUX ADAPTACIÓN DE REAL TIME WORKSHOP AL SISTEMA OPERATIVO LINUX Autor: Tomás Murillo, Fernando. Director: Muñoz Frías, José Daniel. Coordinador: Contreras Bárcena, David Entidad Colaboradora: ICAI Universidad

Más detalles

TOUCH MATH. Students will only use Touch Math on math facts that are not memorized.

TOUCH MATH. Students will only use Touch Math on math facts that are not memorized. TOUCH MATH What is it and why is my child learning this? Memorizing math facts is an important skill for students to learn. Some students have difficulty memorizing these facts, even though they are doing

Más detalles

\RESOURCE\ELECTION.S\PROXY.CSP

\RESOURCE\ELECTION.S\PROXY.CSP The following is an explanation of the procedures for calling a special meeting of the shareholders. Enclosed are copies of documents, which you can use for your meeting. If you have any questions about

Más detalles

Master in Economics and Finance. Sistema de garantía de calidad del título

Master in Economics and Finance. Sistema de garantía de calidad del título Master in Economics and Finance Sistema de garantía de calidad del título 1. Unidad de Garantía Interna de la Calidad (UGIC) La Unidad de Garantía Interna de la Calidad (UGIC) es la Comisión Académica

Más detalles

PRUEBA DE INGLÉS SECUNDARIA

PRUEBA DE INGLÉS SECUNDARIA Dirección General de Ordenación Académica e Innovación Educativa PRUEBA DE INGLÉS SECUNDARIA EXPRESIÓN ORAL AUTOAPLICACIÓN EVALUACIÓN DIAGNÓSTICA SECUNDARIA 2007 Servicio de Evaluación y Calidad Educativa

Más detalles

GENERAL INFORMATION Project Description

GENERAL INFORMATION Project Description RESULTADOS! GENERAL INFORMATION Project Description The campaign "Adopt a car " had as its main objective to position Autoplaza, the main automotive selling point of Chile, as a new car sales location

Más detalles

Karina Ocaña Izquierdo

Karina Ocaña Izquierdo Estudié Ingeniería en Sistemas Computacionales (1997) y una Maestría en Ingeniería de Cómputo con especialidad en Sistemas Digitales (2000), ambas en el Instituto Politécnico Nacional (México). En el 2003,

Más detalles

TEXAS DEPARTMENT OF STATE HEALTH SERVICES

TEXAS DEPARTMENT OF STATE HEALTH SERVICES TEXAS DEPARTMENT OF STATE HEALTH SERVICES DAVID L. LAKEY, M.D. COMMISSIONER P.O. Box 149347 Austin, Texas 78714-9347 1-888-963-7111 TTY: 1-800-735-2989 www.dshs.state.tx.us August 15, 2013 Dear Birthing

Más detalles

School Newsletter. Great Happens Here! School. We are a. October 2015

School Newsletter. Great Happens Here! School. We are a. October 2015 School Newsletter We are a School October 2015 Conejo Elementary School 280 Conejo School Road Thousand Oaks, CA 91362 (805) 495-7058 www.conejousd.org/conejo Great Happens Here! Elementary Counseling

Más detalles

Workers Compensation Non-Subscriber Form

Workers Compensation Non-Subscriber Form Workers Compensation Non-Subscriber Form Texas is unique in one very important respect: It s the only state in which employers have the choice to carry workers compensation insurance or not. There are

Más detalles

Gracias por su continuo apoyo ayudándonos al desarrollo de Belvedere en ser una escuela del Programa IB de las Escuelas Primarias.

Gracias por su continuo apoyo ayudándonos al desarrollo de Belvedere en ser una escuela del Programa IB de las Escuelas Primarias. Belvedere Elementary School The Belvedere Connection October 23, 2013 Home Office Hours 8:00 a.m. 4:30 p.m. Monday Friday Office phone (703)916-6800 FAX (703)916-6897 24-Hour Attendance Phone (703)916-6868

Más detalles

Facilities and manufacturing

Facilities and manufacturing Facilities and manufacturing diseño y producción design and production Roomdimensions Ibérica,s.l (RDI) es una empresa experta en la fabricación de mobiliario técnico, diseño integral de soluciones arquitectónicas

Más detalles

Instructor: She just said that she s Puerto Rican. Escucha y repite la palabra Puerto Rican -for a man-.

Instructor: She just said that she s Puerto Rican. Escucha y repite la palabra Puerto Rican -for a man-. Learning Spanish Like Crazy Spoken Spanish Lección once Instructor: Cómo se dice Good afternoon? René: Buenas tardes. Buenas tardes. Instructor: How do you ask a woman if she s Colombian. René: Eres Colombiana?

Más detalles

Forex ebook "My Book of Trading. Forex."

Forex ebook My Book of Trading. Forex. Forex ebook "My Book of Trading. Forex." "Dedicado a todos aquellos que piensan, que la vida es un continuo análisis de riesgo, que hay que ir valorando." "Dedicated to those who think that life is a continuous

Más detalles

LA RUTINA DIARIA & LOS VERBOS REFLEXIVOS

LA RUTINA DIARIA & LOS VERBOS REFLEXIVOS WHAT IS A REFLEXIVE VERB? LA RUTINA DIARIA & LOS VERBOS REFLEXIVOS Reflexive verbs are verbs that. The person the action also the action. HOW DO YOU KNOW WHEN THE VERB IS REFLEXIVE? When the letters are

Más detalles