Today. Lung Cancer Screening Cooling Therapy After Cardiac Arrest Your Child s Sleep Mother s Milk. Get better. Here. Phelps Memorial Hospital Center

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

Download "Today. Lung Cancer Screening Cooling Therapy After Cardiac Arrest Your Child s Sleep Mother s Milk. Get better. Here. Phelps Memorial Hospital Center"

Transcripción

1 phelps News Today FALL 2012 from Phelps Memorial Hospital Center Lung Cancer Screening Cooling Therapy After Cardiac Arrest Your Child s Sleep Mother s Milk Thoracic surgeons Rocco Lafaro, MD, (left) and Avraham Merav, MD, are co-directors of the new Lung Nodule Center. Get better. Here.

2 Dear Friends, It was with great excitement that the hospital welcomed the inaugural class of the New York Medical College Phelps Family Medicine Residency program, the first residency of its kind to be established in New York State in 15 years. As the six residents settled in, many of the 100 Phelps physicians who will be teaching them completed faculty development training workshops. During the first month, the residents went to lectures presented by founding faculty members, spent time in the Hoch Center for Emergency Education, studied medical Spanish, and started seeing patients at Phelps and at Open Door Family Medical Center in Sleepy Hollow. Recruitment efforts are already under way for the next class of six residents. By 2014, there will be a total of 18 residents, six in each year of the three-year residency program. In addition to the family medicine residents, Phelps has welcomed its first four dental residents, who are participants in the New York Medical College-sponsored General Dental Practice Residency program. The dental residents began providing outpatient care at Phelps and at Open Door Family Medical Center in Port Chester. Shortly after the residents arrived, the hospital received an important award. For the third year in a row, the American Heart and American Stroke Associations presented Phelps with their highest recognition the Gold Plus Achievement Award which signifies that the hospital has consistently met the organizations guidelines for quality stroke care. Significant recognition was also given to our Cardiovascular Lab, which was granted a 3-year accreditation in arterial testing by the Intersocietal Accreditation Commission (IAC). IAC accreditation is a mark of excellence that demonstrates to patients and medical staff that Phelps vascular testing operations have been carefully reviewed and found to provide quality patient care according to national standards. Progress at Phelps continues on numerous fronts as we strive to strengthen and expand your community hospital. We hope that you share our pride and enthusiasm in these, and many other, noteworthy accomplishments. Best wishes for a healthy and enjoyable fall season. Sincerely, Andrew C. Merryman Chair, Board of Directors Keith F. Safian, FACHE President & CEO

3 Lung Cancer: Improving the Odds with Screening Therapeutic Hypothermia: Cooling Therapy After Cardiac Arrest Gives Local Man a Second Chance Sleep-Disordered Breathing in Children: A Q&A with Dr. Tali Lando... 8 Women s Breast Health: Mammography and Other Screening Methods 10 Phelps Nurses Improve Care for Health System Elders Phelps Licensed to Dispense Donor Human Milk Mother s Milk: The Benefits of Breastfeeding Diagnosing & Treating Balance Problems An Invitation to Participate in an American Cancer Society Study The Vitality Initiative for Seniors Phelps Launches a Farmers Market Upcoming Events: 25th Anniversary Champagne Ball and an Extraordinary Food and Wine Experience Contents Warm Blankets: Patient Satisfaction for All Ages Hearing Aids for a Better Quality of Life Cáncer de pulmón: Mejorar las probabilidades con exámenes de detección Phelps Autorizado A Ofrecer Leche Humana Donada Leche Materna: Los beneficios de la lactancia materna Healthy Life Calendar Maternity & Baby Care Classes Request Your Appointment Online! Appointments for many Phelps outpatient services can be made on the hospital s website. Just go to phelpshospital.org and click on Request an Appointment any time of the day or night! Pay Your Bill Online! Phelps recently established an on-line bill paying feature on the hospital website. Just go to phelpshospital.org and click on Pay Your Bill Online to view and pay your bill, set up a payment schedule, and more. Visit to see our annual reports, videos, physician directory, calendars and more. phelps today Editor Mary Sernatinger Managing Editor Tina Dorfman Medical Editor Bruce Heckman, MD Editorial Advisors Lucy C. Engelhardt, RN Leonard B. Fogel Kenneth C. Kaplan, MD Keith F. Safian, FACHE PHELPS TODAY is a publication of Phelps Memorial Hospital Center. Phelps is a member of the Stellaris Health Network and the Hudson Valley s exclusive affiliate of Memorial Sloan-Kettering Cancer Center. Visit us on Facebook: PhelpsMemorialHospitalCenter Visit us on Twitter: https://twitter.com/ #!/phelpshospital

4 Lung Cancer Improving the Odds with Screening Lung cancer is the leading cause of cancer deaths in the United States, claiming more lives each year than colon, prostate, ovarian and breast cancers combined. Causes Lung cancer may result from exposure to radon, asbestos, some metals, diesel fumes or other pollutants, but the biggest cause of lung cancer is cigarette smoking. Eighty-five percent of lung cancer victims are current or former cigarette smokers. The relative risk of developing lung cancer is 20 times greater in smokers than in non-smokers. Experts describe a person s smoking history in pack years. Smoking one pack of cigarettes each day for one year is called one pack year of smoking. A person who has a 30-pack-year smoking history (a pack each day for 30 years or two packs each day for 15 years, for example) is considered at high risk for developing lung cancer. Symptoms A lung cancer patient s prognosis depends upon how advanced the disease is and the specific form of lung cancer. It is important to remember that lung cancer is curable, especially in the early stages. Finding and treating lung cancer before symptoms appear offers the best outlook, but it is still possible to treat lung cancer that is more advanced. Symptoms of lung cancer may include: a new, persistent cough or coughing up blood shortness of breath wheezing hoarseness chest pain weight loss (without trying to lose weight) bone pain headache A lung cancer patient s prognosis depends upon how advanced the disease is and the specific form of lung cancer The CT scan (above) shows a nodule in the right upper lobe. The PET scan of the same lung (opposite page) shows increased metabolic activity of the right upper lobe nodule, suggesting malignancy. 4 Phelps Today

5 Screening for Lung Cancer Screenings are routinely performed for breast cancer, skin cancer, prostate cancer and colon cancer, but they have not been done for lung cancer even though it is the most lethal type of cancer. Lung cancer starts as a small, solitary pulmonary nodule, a round or oval spot (lesion) in the lung. Many times, lung nodules are discovered incidentally from a chest X-ray performed for some other reason. Although the traditional method for detecting lung cancer has been chest X-ray, a study of 53,000 patients at high risk for developing lung cancer found that a low-dose CT scan was a better method for detecting lung nodules. Results of the National Lung Screening Study, published in The New England Journal of Medicine in August 2011, showed a 20% reduction in deaths from lung cancer in the group screened by low-dose CT scans as compared to the group screened by X-rays alone. As a result of the study, the National Comprehensive Cancer Network now recommends low-dose CT scan screening for individuals between ages who have at least a 30-pack-year smoking history and do not have any symptoms of lung cancer. Low-dose CT scan screenings are also recommended for people with a 20-pack-year smoking history who have one other risk factor, such as personal cancer history or family history of lung cancer. If you fall into either of these categories, talk to your physician about whether you should have a low-dose CT scan. If you are diagnosed with a lung nodule, remember that cancer is not necessarily the cause. Lung nodules may also be evidence of an infection, a collection of normal cells, a cyst or a vascular abnormality. In fact, most lung nodules discovered during screening are benign. Advances in Diagnosis Four decades ago, the only way to diagnose lung cancer was with a chest X-ray, but no one really knew for certain if a nodule was cancerous until surgery took place. Today, we have CT scanners that can capture images of slices of the lung in digital format that can be viewed on a computer screen in multiple projections and in exquisite detail. Positron Emission Tomography (PET) scanners provide additional information about lung nodules that help determine if they are malignant or benign. Early bronchoscopes, which are used to look inside the lung, were rigid tubes that allowed only partial views. Today, bronchoscopes are flexible; they can reach well into the lungs and the branches of the bronchial tree. Endobronchial ultrasound guidance (EBUS) allows the pulmonologist to perform transbronchial biopsies through the bronchoscope and obtain tissue samples to determine if a nodule is caused by cancer, infection, inflammation, or other conditions. Treating Lung Cancer If screening raises suspicion that a pulmonary nodule might be malignant, a biopsy sample will be taken. Methods for diagnosing and treating lung cancer have improved dramatically in recent years. At Phelps, more than 80 percent of procedures are by video-assisted thoracic surgery (VATS), which allows visual inspection, lung and lymph node biopsies and removal of a small section of the lung (wedge resection) all without opening the chest. The lungs are divided into lobes two in the left lung and three in the right. If a malignancy is in one lobe, the lobe can be surgically removed, which is called a lobectomy. This is the most common type of cancer surgery. Occasionally a patient must have the entire lung removed, called a pneumonectomy, but will still be able to function well as the actor John Wayne did for many years. Phelps Today 5

6 In France, a message on cigarette packages warns in large black letters: Fumer tue ( Smoking Kills ). Last year, the FDA unveiled nine graphic warning labels, like the one shown below right, that must cover 50% of the front and back of all cigarette packages by September The most important step you can take to protect your health is to quit smoking. Even after smoking for many years, you can significantly reduce your chances of developing lung cancer if you stop. The Lung Nodule Center In response to the new guidelines for lung cancer screening, The Lung Nodule Center has been established, offering people access to a team of board-certified specialists in multiple disciplines and the latest technology and techniques for diagnosing and treating lung cancer. The comprehensive service is designed to meet the needs of highrisk individuals who would like to be screened for lung cancer as well as those who have been told they have a lung nodule and wish to get a second opinion. Directed by thoracic surgeons Avraham Merav, MD, and Rocco Lafaro, MD, the Center s physician panel also includes pulmonologists, oncologists, infectious disease specialists, radiologists and pathologists. To make an appointment call LungNoduleCenter.org. A cardiothoracic surgeon for several decades, Dr. Avraham Merav has performed thousands of open heart and thoracic surgical procedures. He did pioneering work on lung transplantation while at Montefiore Medical Center, where he was chief of thoracic surgery. He was also chief of thoracic surgery at Englewood (NJ) Hospital. Dr. Merav earned his medical degree at the University of Basle and completed a residency in general surgery and a fellowship in cardiothoracic surgery at Montefiore Hospital and Medical Center. He is board certified in general surgery and thoracic surgery and is an associate clinical professor of cardiothoracic surgery at Albert Einstein College of Medicine. Dr. Merav speaks six languages (Hebrew, French, German, Hungarian, Yiddish, and English). His office is in the Thoracic Center, 755 North Broadway on Phelps campus. ( ) Dr. Rocco Lafaro, a board certified thoracic surgeon, is chief of general thoracic surgery at Westchester Medical Center. He earned his medical degree at New York Medical College, where he was chief resident of general surgery. Dr. Lafaro completed a fellowship in thoracic surgery at Albert Einstein College of Medicine. His office is located at Westchester Medical Center in Valhalla. ( ) Phelps at Dobbs Ferry Phelps primary care physicians are offering comprehensive, quality healthcare for the entire family at 18 Ashford Avenue in Dobbs Ferry. Now seeing patients at the Dobbs Ferry practice are Montgomery Douglas, MD, and Michael Loewinger, MD. Dr. Douglas is board certified in family medicine and geriatrics. He is Chairman of the Department of Family and Community Medicine at New York Medical College, making this a faculty practice. Dr. Douglas provides medical care for patients of all ages from infants to older adults and also offers obstetrics/ gynecology care. Dr. Loewinger earned his medical degree at Drexel University College of Medicine in Philadelphia and completed a residency in internal medicine at St. Peter s Medical Center in New Brunswick, NJ. New patients are welcome at Phelps at Dobbs Ferry. Please call for an appointment. Montgomery Douglas, MD Rocco Lafaro, MD, and Avraham Merav, MD Michael Loewinger, MD 6 Phelps Today

7 Therapeutic Hypothermia Cooling Therapy After Cardiac Arrest Gives Local Man a Second Chance You d never know it by looking at John Baglieri, but just a few months ago he was on the brink of death. On May 19, the strapping, 50-year-old Tarrytown man with a handlebar moustache came to the Phelps emergency department complaining of chest pains and promptly went into cardiac arrest. Luckily for him, he was in the right place at the right time: under the direction of emergency medicine physician Martin Krumins, the staff started CPR. After more than 20 extremely harrowing minutes during which his heart was shocked four times, John s heartbeat was finally restored to a normal rhythm and he regained a pulse, but he remained unconscious. What happened next is the reason John s recovery is so remarkable. Over the following 24 hours, his body temperature was lowered to 92 degrees Fahrenheit using a surface cooling device called Arctic Sun. The lowering of body temperature, called therapeutic hypothermia, helps protect the brain from the effects of lack of oxygen that occur after cardiac arrest. Severe lack of oxygen can cause loss of brain function the most important factor in a patient s outcome after cardiac arrest. During the procedure John was completely sedated and paralyzed and given a medication that prevents shivering, which would counteract the purpose of hypothermia by raising his body temperature. Phelps was one of the first hospitals in Westchester to use the therapeutic hypothermia protocol. John was moved to the intensive care unit. After keeping him cool for 24 hours, the ICU team slowly brought his body temperature back to normal. Then, the intubation tube was removed, the medications were turned off and the neurological team and his family waited with anticipation. They quietly urged him to wake up, but it wasn t until his sister-in-law yelled, Get John Baglieri with Martin Krumins, MD, who implemented the hypothermia procedure in the Emergency Department. John Baglieri (right) speaks with his cardiologist, Rajat Sanyal, MD, prior to a workout at Cardiac Rehab. up, Johnny! Do you want a cup of coffee? that he opened his eyes. When I woke up, I didn t know what I had been through, says John. I had to ask what had happened. I still have no memory of the event or the time right before it. The only thing he remembers during the time he was unconscious was a dream about a friend of his who died a few years ago: It was my friend Joe, saying It s not your time, go back. Mr. Baglieri had a major stroke of luck, says Emil Nigro, Director of the Emergency Department. He hit the lottery by having his cardiac arrest in an ED with very experienced people, who started CPR immediately. That kept his blood going to his vital organs. If he had had the heart attack at home, he may not have survived. Dr. Nigro adds, The therapeutic hypothermia protocol after cardiac arrest is a very complicated, challenging process, and not all hospitals are able to implement it. John was truly fortunate. He was discharged several days later with complete recovery of his brain function. John has been a foreman for the Mount Pleasant highway department for the past 27 years. He and his wife, Sharon, were taken totally by surprise by his heart attack. He had no heart problems that we knew of, his blood work was fine, and he never had high blood pressure or high cholesterol. It turns out that John s cardiac arrest was caused by a blockage of one of his coronary arteries. Since his cardiac event, he has had a cardiac stent put in and he is watching his weight. He returned to work just five weeks after his near-death experience. He has a cardiologist now, Phelps Chief of Cardiology Dr. Rajat Sanyal, who oversaw his care when he was hospitalized. And John does cardiac rehabilitation at Phelps three times a week under the close supervision of a nurse. I can t sit still, I can t imagine retiring, says John, who is a father of three children ages 27, 29 and 31 and grandfather of three. The care at Phelps was wonderful from the emergency department on up, I got wonderful care, he says. They started calling me Miracle Man when I woke up in the hospital, and now everybody calls me that. Thanking the staff who saved his life Pictured in the ICU, L to R: Celeste Duncalf, RN; John Baglieri; Laura Reid, Technician; Ailyn Evans, RN; Sharon Baglieri; Margaret Santos, CNS/Educator Phelps Today 7

8 Sleep-Disordered Breathing in Children and Adenotonsillectomy Q & A with Tali Lando, MD Sleep-disordered breathing is a relatively common condition in children that results in nighttime sleep disturbances. Ranging from simple snoring to actual pauses in breathing called obstructive sleep apnea (OSA), sleep-disordered breathing is potentially serious, but it is treatable. OSA is estimated to affect 2-3% of the pediatric population, or approximately 2 million American children. Parents who bring their children into my office sometimes tell me their child snores like a truck driver. Others report that their child has episodes of gasping, choking or breath holding, or that their child sleeps restlessly and wakes up repeatedly during the night. All of these are symptoms of obstructive sleep apnea. What is the most common cause of obstructive sleep apnea in children? The most common cause of obstructive sleep apnea in children is enlarged tonsils and adenoids or adenotonsillar hypertrophy. The tonsils and adenoids are similar to the lymph nodes or glands found in the neck, groin, and armpits. The tonsils are the two round lumps in the back of the throat. Adenoids, which are located high in the throat behind the nose and the roof of the mouth, are not visible through the mouth or nose without special instruments. Between the ages two and five, a child s tonsils and adenoids may undergo a significant growth increase and become enlarged or hypertrophic. At the same time, the breathing passages in the back of the nose and the throat may not grow quickly enough to make room for these structures. When a child is asleep, the muscles of the throat relax and collapse and the airway space becomes too narrow for comfortable breathing. The exact reason for adenoid and tonsil enlargement remains unknown. Some research has shown that allergies (especially nasal allergies) and environmental exposure to smoke may be risk factors for adenotonsillar hypertrophy. Other medical issues that may contribute to breathing problems during sleep are neuromuscular weakness or abnormalities in the shape of the skull or face. Some studies suggest a higher rate of obstructive sleep apnea in overweight children. What is the impact of obstructive sleep apnea in children? Obstructive sleep apnea in children has a significant impact on the quality of life of both parent and child. Some parents report that they are afraid to leave a sleeping child alone and constantly feel the need to reposition the child throughout the night to help with breathing. Children may complain of being constantly tired, even after a full night s sleep. Also, they may have attention, hyperactivity and behavioral issues at school and bedwetting issues at home. If your child s adenoids are enlarged and blocking comfortable breathing through the nose, you may notice that your child always breathes with his or her mouth open. Chronic mouth-breathing can affect dental alignment and even facial growth. Very young children with large tonsils and obstructed breathing may actually fail to thrive because they are not eating enough. Less commonly, toddlers and young children with large 8 Phelps Today

9 tonsils may experience problems swallowing (dysphagia) or may sometimes choke on solid food. More importantly, obstructive sleep apnea poses serious long-term health risks in a child because the heart and lungs are forced to pump against a lot of additional pressure. If sleep apnea is ignored and the obstruction is severe, over time the heart can be damaged and this may result in right heart strain or other cardiac defects. Concern about heart damage may prompt your otolaryngologist (ENT) to schedule a preoperative evaluation by a cardiologist, who may order an EKG or an echocardiogram. In addition, there is data to suggest a link between growth failure in some children and sleep-disordered breathing that is caused by enlarged tonsils and adenoids. How is the diagnosis of obstructive sleep apnea made in children? A diagnosis of sleep-disordered breathing can be made by a trained otolaryngologist from a description of symptoms as well as a physical examination of the child s tonsils and adenoids. If the tonsils are small, the ENT will assess the size of the adenoids, either with a thin, flexible scope introduced into the nose or with an X-ray of the neck. In addition, a sleep study may be ordered by the ENT to diagnose sleep apnea or to clarify if there are pauses in breathing during the night. The study is performed overnight in a sleep lab, where stick-on electrodes record the child s heart rate, respiratory effort, oxygen levels and other factors. The test tells how many apneas (cessations of air flow) and hypopneas (decreases in air flow) a child has during the night. Do all children with large tonsils and adenoids need to have them removed? Not all children with large tonsils and adenoids need to have them removed. In most cases, the pediatrician will refer parents to an ENT for further evaluation of their child. Many studies have been conducted to determine if removing the tonsils and adenoids (adenotonsillectomy) in children has a negative effect, but no clear ill effects have been identified. Various quality of life studies have demonstrated that children who undergo adenotonsillectomy for obstructive sleep apnea show improvements in cognition and behavior after surgery. There is currently a large, multicenter, randomized, controlled study under way called the CHAT study. This study will hopefully provide needed data about the effectiveness of adenotonsillectomy for sleep-disordered breathing on a child s cognition, behavior and quality of life. Many parents are concerned about the impact that removing the tonsils and adenoids will have on their child s immune system. However, there is immune tissue throughout the body capable of fighting infection. Although the immune function of tonsils and adenoids may be important in very young infants whose immune systems are still developing, the tonsils and adenoids clearly become more of a liability than an asset in children with obstructive sleep apnea or recurrent infection. What does the surgery for removal of tonsils and adenoids entail? Surgery for the removal of tonsils and adenoids is performed routinely as an outpatient procedure, unless the child is younger than two or three years of age. The operation is performed through the mouth under general anesthesia, without any external incisions. Although the recovery period can be difficult initially in terms of throat soreness and hesitation to swallow, younger children do surprisingly well post-operatively. What is the youngest age surgery may safely be performed? Contrary to popular belief, there is no absolute age cut-off for safely performing an adenotonsillectomy. Adenoid growth that significantly impairs nasal breathing can occur in infants below the age of one. Nonetheless, the need for removal of tonsils in children less than one is extremely rare. If a child under 2 years old is having an adenotonsillectomy, the pediatric otolaryngologist may recommend an overnight stay in the hospital along with oxygen monitoring. Is enlargement of the adenoids and tonsils genetic? Although there is a gene that has been linked to recurrent strep throat, there is no gene directly associated with adenotonsillar hypertrophy. Anecdotally, there may be a family member, such as a parent or sibling, who was also known to have large tonsils. Some studies suggest that there is an increased risk of sleep-disordered breathing among siblings. This may be due to shared genes and/or the fact that they grew up in the same environment. It may also indicate a heightened awareness in families who have another child diagnosed with sleep-disordered breathing. Tali Lando, MD, otolaryngologist, is board certified in otolaryngology. She received her medical degree from Weill Medical College of Cornell University. She then completed an internship in general surgery and a residency in otolaryngology, both at New York and Presbyterian Hospital-Columbia Campus, followed by a fellowship in pediatric otolaryngology at the Children s Hospital of Philadelphia. Dr. Lando s practice, ENT Faculty Practice, is at 1055 Saw Mill River Road in Ardsley ( ). Phelps Today 9

10 Women s Breast Health Mammography and Other Screening Methods Since mammography screening became widespread in the U.S. in 1990, the breast cancer death rate, previously unchanged for 50 years, has dropped 37 percent, according to the National Cancer Institute. Following are some common questions women ask about breast health. How often do I need to have a mammogram? The American Cancer Society recommends an annual screening mammography and a clinical breast exam by a healthcare professional for all women starting at age 40. The first mammography image is called a baseline screening mammogram, and it is used for comparison with subsequent mammograms. Women who are at higher than average risk of breast cancer should talk with their healthcare providers about whether to have a mammography before age 40 and whether another imaging modality such as a screening breast MRI should also be done. Who gets breast cancer? Research has shown that women with the following risk factors have increased chance of developing breast cancer: personal history of breast cancer family history of breast cancer (mother, sister or daughter with breast cancer, especially if diagnosed before age 50) genetic alterations in certain genes (BRCA1, BRCA2 and others) high density breast tissue first menstrual cycle before age 12 or menopause after 55 use of combined estrogen and progestin hormone therapy for more than 5 years radiation therapy to the chest (including the breasts) before age 30 obesity physical inactivity The strongest risk factor is age a woman s chance of developing breast cancer increases as she gets older. Most breast cancers occur in women over 50, and the number is especially high in women over 60. Breast cancer is uncommon in women under 40. Are there different screenings recommended for women with dense breasts? The denser the breast, the harder it is to detect a cancer because the cancer can be obscured by dense breast tissue. The American College of Radiology and the American Cancer Society recommend mammograms only as a yearly screening tool for the breast, although other imaging modalities like ultrasound or MRI may increase the cancer detection rate. However, they have limitations as well. The modalities complement each other but give different information. For example, if a density is detected in a mammogram, it may not be possible to tell from the mammogram alone if it s a solid mass or a fluid-filled mass called a cyst. An ultrasound, as a diagnostic tool, can confirm whether the mass is solid or cystic. Even among the national experts, the usefulness of screening breast ultrasound is still up for debate. A woman s primary care physician can assess her needs and determine if an extra study would be beneficial. What is a breast cyst? Breast cysts, which are common in women in their 30s and 40s, develop when an overgrowth of glands and connective tissue block milk ducts, causing them to dilate and fill with fluid. Treatment is not generally required, unless a cyst is large and painful or otherwise uncomfortable. In such cases, draining the fluid from the cyst can ease symptoms. Breast cysts usually disappear after menopause in women who are not taking hormone therapy. The cause of breast cysts is unknown, although estrogen may be involved. What are microcalcifications? Microcalcifications are calcium deposits in the breast that appear as tiny white dots on a mammogram. They are usually benign, but they can also be an indication of an early malignancy in the breast. Not every calcification is biopsied; however, when they are different sizes and shapes, the radiologist will probably recommend a biopsy to determine definitively whether they are benign or malignant. At Phelps, stereotactic biopsy is performed, which is the least invasive method to sample microcalcifications in the breast. If the calcifications are malignant, the sooner they are addressed, the better the outcome. When would an MRI of the breast be recommended? A breast MRI is most often used to screen for breast cancer in women thought to have a very high risk of the disease. A 10 Phelps Today

11 breast MRI can also be recommended when more information is needed than a mammogram, ultrasound or clinical breast exam can provide. An MRI performed before or after cancer is diagnosed helps determine what kind of surgery would be appropriate. Breast MRI is intended to be used in addition to a mammogram or another breast-imaging test not as a replacement for them. Although it s a very sensitive test that can detect many findings that mammogram and ultrasound won t, breast MRI can still miss some breast cancers that a mammogram will detect. Breast Health Services at Phelps Phelps has been designated a Breast Imaging Center of Excellence by the American College of Radiology s Commission on Quality and Safety. This designation means that the center has achieved accreditation in mammography, breast ultrasound, stereotactic breast biopsy and ultrasound-guided breast biopsy, and all the services provided meet the highest national standards. Phelps director of Breast Imaging, Norman Lee, MD, is board certified in radiology with subspecialty fellowship training in breast imaging. He personally interprets all screening and diagnostic mammograms and breast ultrasound studies and also performs minimally invasive breast procedures to determine if a detected abnormality is benign or malignant. The procedures include stereotactic biopsy (a non-surgical, X-rayguided method to extract some cells through a small needle), ultrasoundguided core biopsy (a non-surgical, ultrasound-guided method to extract some tissue through a larger needle), ultrasound-guided fine needle aspiration (FNA) (extraction of fluid or cells with a very small needle), and needle localization of a lesion under mammographic or sonographic guidance. If a surgical consultation is needed, an appointment can be quickly arranged with one of the excellent surgeons at Phelps who have particular expertise in breast disease and breast surgery. Patients benefit from the continuity of care whereby the radiologist who discovers the cancer is also involved in directing the surgeon in precisely locating the lesion prior to its removal. The same radiologist continues to follow the patient, issues a final report after analyzing the pathology results and offers advice to the clinicians with regard to next steps for care. Phelps also has a full-time Patient Navigator (PN), Rose Finer, who facilitates a patient s journey through the diagnostic process when additional testing is needed. A PN s main responsibilities are to assist and guide patients, many of whom are anxious about testing and results. She coordinates visits, obtains test results, maintains contact among the various treating physicians and sometimes even suggests questions a patient may want to have answered. The Phelps Mammography Suite s waiting room and registration area have been recently renovated and offer patients the highest level of privacy and comfort. Early morning, lunchtime, evening and Saturday appointments are available to accommodate busy schedules. To make an appointment for a mammography or breast ultrasound at Phelps, call Phelps Nurses Improve Care for Health System Elders As people are living longer, the number of older adults in our communities is increasing. Hospitalized older patients often have serious illnesses and a variety of special needs. To address the growing demand for geriatric nursing care, a team of Phelps nurses are bringing to Phelps a program to improve healthcare for our older patients. The program, Nurses Improving Care for Health System Elders (NICHE), was developed by the Hartford Institute for Geriatric Nursing at the New York University College of Nursing. The Phelps nursing leadership team for NICHE includes Cheryl Burke, RN, clinical specialist and NICHE program coordinator; Kathy Pappas, RN, Phelps and NICHE clinical educator; Paula Keenan, RN, nursing director and NICHE program administrator; Maria Magno, RN, and Ronda Osborn Haroon, RN, coordinators from the medical unit; and Alicia Mulvena, RN, clinical educator and NICHE evidence-based practice coordinator. These nurses are learning new ways to deal with such problems as falls, incontinence, pain and wound care, and by sharing their knowledge with the rest of the hospital will effect cultural change in the way that care is provided to the elderly. The program will be expanded throughout the hospital in phases. The nursing leaders have completed their initial NICHE training and will soon begin training the staff who will be participating in the first phase. The program will begin on one unit and eventually be brought to the remainder of the hospital, including the Emergency Department. The goals of NICHE are to increase sensitivity of hospital staff to the aging process, improve the recognition of agerelated changes in older adult patients, enhance communication skills with patients and their families, and ensure mental and physical stimulation for patients while they are in the hospital. Only two other hospitals in Westchester, to date, have received the NICHE recognition. The end result of the NICHE training will benefit all Phelps patients, young and old. The NICHE nurse leaders, pictured left to right: Kathy Pappas, RN; Ronda Osborn Haroon, RN; Paula Keenan, RN; Alicia Mulvena, RN; Cheryl Burke, RN; and Maria Magno, RN. Phelps Today 11

12 Phelps Licensed To Dispense Donor Human Milk Phelps Memorial Hospital Center has recently been licensed by the New York State Department of Health to receive, store and issue donor human milk. The only hospital with such a license in Westchester County, Phelps is known for its long-standing commitment to breastfeeding. Last year it was ranked among the top 10 hospitals in the state with the highest percentage of mothers who exclusively breastfeed their infants. We ve earned that rating because we work with all our new mothers to help them breastfeed, says Joann Gould, RN, a lactation consultant at Phelps. Many mothers are reluctant to give their babies formula because they have become so knowledgeable about the benefits of breastfeeding. Human milk provides optimal nutrition for infants and young children, promoting normal growth and development and reducing the risk of illness and disease. However, some mothers have difficulty producing adequate amounts of milk. At Phelps, this now means that when newborns require supplementation, mothers will be able to give their babies donor human milk, which contains useful antibodies and immune properties and is more easily digested by infants, says Gould. Breast milk is human milk designed for human babies. Doctors may prescribe supplementation for a variety of reasons. It could be that a baby is in a special care nursery or has elevated bilirubin levels, which leads to jaundice. The mother might be ill or taking medication that is contraindicated for providing breast milk. Or perhaps a baby has a low glucose level. When the mother s milk is unavailable or additional milk is required, pasteurized donor milk from a recognized milk bank is the next best option. Mothers will be required to sign a consent form to obtain donor milk and will need a doctor s order before the baby can be fed donor milk. Donors are women who produce an abundance of milk that they do not need for their own babies. Milk donors are screened to make sure they are free of pre-existing medical conditions such as hepatitis or HIV. Phelps obtains milk from one of two facilities, WakeMed, located in Raleigh, North Carolina, which processes the milk, or Hudson Valley Milk Bank in Irvington, which also obtains milk from WakeMed. The milk is pasteurized at WakeMed and shipped to Phelps in a frozen state. In order to receive the new state license, Phelps had to meet stringent standards requiring staff education and the establishment of policies and procedures that will be reviewed annually. The hospital is also required to submit logs to the Department of Health on an annual basis. In addition, Phelps had to demonstrate the ability to store the milk safely and securely. For that, Phelps purchased a freezer and temperature probe. All this comes at a cost the milk alone is $5 per ounce. This fee covers the costs of processing, storage, handling and shipping of the product. The Westchester Putnam Rockland Lactation Consortium donated money to purchase the freezer, temperature probe and an initial supply of milk. Dr. Myra Mercado, a neonatologist at Phelps, is overseeing the new program. Breastfeeding is a way of providing better health for growing babies, said Dr. Mercado. The American Academy of Pediatrics calls for exclusive breastfeeding for the first 6 months of life. With our new license, Phelps can now help all mothers meet that recommendation. 12 Phelps Today

13 Mother s Milk The Benefits of Breastfeeding Increasingly, people are becoming more conscious about the foods they eat, as they realize that a healthful diet will help prevent obesity and a variety of illnesses. It makes sense that the best time to start eating right is at the beginning of life, and proponents of breastfeeding have long been touting its benefits. The New York City health department took a bold step to promote breastfeeding in May when it began the campaign Latch on NYC to encourage hospitals to stop handing out free infant formula. The campaign is based on the belief that giving mothers infant formula as they leave the hospital may make them feel that their breast milk is not enough to satisfy their baby. But mother s milk, with its unique nutrients and antibodies, contains ingredients that formula simply cannot duplicate. Human breast milk is best for babies and mothers, says NYC Health Commissioner Thomas Farley, explaining that by joining together, the entire health community will support mothers who wish to breastfeed. The campaign also focuses on encouraging mothers to breastfeed for longer periods. The American Academy of Pediatrics recommends breastfeeding exclusively for six months and continuing it for up to one year while introducing other food. Babies who are breastfed benefit in a number of ways. The antibodies in mother s milk protect against illness, so breastfed babies usually require fewer visits to the doctor. Compared to infants who are fed formula, those who are breastfed are less susceptible to ear and respiratory infections, skin rashes and diarrhea. Breastfeeding also offers protection against sudden infant death syndrome. Among young adults who were breastfed, there is a lower incidence of obesity, type 2 diabetes and asthma. Mothers also benefit. It s common for a new mother to become overwhelmed by the many responsibilities associated with taking care of her baby, but the simplicity of breastfeeding can help to alleviate her stress. Breastfeeding mothers are also more likely to be rested, since feedings in the middle of the night are not encumbered by bottle preparation. It is surprisingly convenient. There s no need to sterilize bottles or carry bags of feeding supplies on outings. In addition, a woman who breastfeeds is less likely to experience postpartum depression and has a reduced risk of ovarian and breast cancers and type 2 diabetes. Nursing mothers also have a quicker return of uterine tone. Beyond the emotional and health benefits, there is also a cost savings associated with breastfeeding, since there is no need to purchase formula, bottles and other supplies not to mention the savings from fewer visits to the doctor. Breastfeeding is a magnificent gift that a mother can give her child, and herself. She needs simply to eat a healthful diet, and she can feel confident that her baby will benefit from the milk she provides. Just as meaningful is the profound mother-child bond that is created through the simple act of breastfeeding an experience that the two exclusively share and enjoy. Nurses and lactation consultants in the Maternal Child Unit at Phelps Memorial Hospital Center have been uniquely successful in encouraging and assisting mothers in breastfeeding. Last year, Phelps was recognized by the New York State Department of Health as one of the top 10 hospitals statewide with the highest percentage of mothers who exclusively breastfeed their newborns. Breastfeeding education classes are provided monthly. For information, call Phelps Today 13

14 Diagnosing & Treating Balance Problems Dizziness or imbalance can have a profound effect on your life. It may curtail your activities of daily living or make you overly cautious about engaging in social situations or going places where there is a risk of falling. As you restrict your activities for fear of sudden dizziness, you may begin to feel socially isolated. Most people have experienced the sensation of unexplained dizziness or imbalance at one time or another in their lives, but the cause of the dizziness may be difficult to identify. Some of the possible causes are stroke, migraine, a tumor or a central nervous system disorder. Another possible cause of dizziness is a disease or condition of the vestibular system, the sensory system in the inner ear that helps maintain balance. The Vestibular System The vestibular system is composed of fluid-filled tubes and chambers with nerve endings that collect information about the location of your body in relation to the space around it. A healthy vestibular system relies on equal but opposite information from the left and right inner ear canals. If one side of the vestibular system is weak, your brain Demonstration of VNG Test by Susan Reilly, MS, CCC-A, Audiologist senses a mismatch, resulting in the perception of dizziness. In addition to dizziness, symptoms of a vestibular disorder include falling, altered gait, nausea and vomiting. Videonystagmography (VNG) A diagnostic test is now available at Phelps to help determine if a vestibular disease or condition is the cause of dizziness or a balance problem and if so, whether vestibular rehabilitation is appropriate. Called videonystagmography (VNG), the test assesses the connection between the eyes and the pathways connecting the vestibular system to the brain. During the test, the patient wears a set of comfortable goggles equipped with small infrared video cameras. The cameras measure the movements of the eyes while the head and body are placed in different positions. Warm and cold air stimulates both ears to assess the two sides of the vestibular system separately. If a vestibular disorder is identified, a vestibular rehabilitation evaluation may be recommended. This assessment is conducted by a specially trained physical or occupational therapist. After reviewing your symptoms, the therapist will test your strength, flexibility, coordination, gait, overall balance and posture. The results will indicate whether you are a candidate for vestibular rehabilitation. Patient Brian Marcin performing a visual exercise with therapist Puja Agarwal. Vestibular Rehabilitation Therapy Vestibular rehabilitation therapy is an exercise-based program involving positioning maneuvers that reduce the symptoms of dizziness and imbalance. The program includes exercises for: coordinating eye and head movements desensitizing the vestibular system to episodes of dizziness improving walking and balance increasing general activity levels Vestibular rehabilitation has been shown to be effective in reducing balance problems. Most patients report a reduction in symptoms and are able to return to the daily activities that are important in their lives. If you are having problems with dizziness or imbalance, your physician may order these diagnostic tests, which are provided at Phelps in the Department of Physical Medicine and Rehabilitation. For more information about vestibular testing and rehabilitation at Phelps, call Phelps Today

15 Returning to an Active Life Through Vestibular Therapy Alfreda Aldridge, a highly independent, energetic Scarborough Manor woman who retired after many years in the television industry and started a second career as a real estate broker, remembers the first time it happened 20 years ago. I was sitting in a chair and getting ready to leave for a vacation in Montreal. All of a sudden, I felt like I was falling. The feeling passed and I went on vacation. Over the next 20 years, she continued to have the feeling periodically: I would be dizzy walking through a store, and would have to grab onto a counter. It always felt like I was falling, but I never passed out. I could only sleep on my right side if I turned onto my left, I had the falling feeling again. Ms. Aldridge continued working even while she had the problem because it wasn t constant. I m one of those people, I do what I have to do, she says. She went for long periods, as long as a year, where she didn t feel dizzy or have the sensation of falling. Finally, after visiting several neurologists and ear, nose and throat specialists and having MRIs and every test possible, Ms. Aldridge was diagnosed with BPPV (Benign Paroxysmal Positional Vertigo), a spinning sensation that lasts for less than a minute while the person is in certain positions. It typically occurs when turning over in bed, reclining or bending over. BPPV is caused by the displacement of otoconia, crystals in the inner ear. Last year her neurologist gave her a prescription for vestibular therapy, and she came to Phelps, where she worked with occupational therapist Sheetal Shenoy, one of two Phelps therapists certified in vestibular rehabilitation by Emory University and the American Physical Therapy Association. Ms. Aldridge underwent a series of positional maneuver exercises while lying down on a bed as well as other exercises. Because she is a very independent person, she was also given detailed instructions on exercises to do at home. Shenoy points out how important it is that exercises at home are done under the supervision and guidance of a skilled therapist. People go to the Internet and think they can do the exercises all by themselves, but you need to work with a skilled therapist who knows how to adjust and modify these highly individualized exercises or you can actually do yourself harm, says Shenoy. After attending just a few sessions, Ms. Aldridge reports, I ve been fine ever since. It s nice not having to sleep on one side in one position. Also, at the gym, I am able to go on machines where I lie flat I had given up on those before my vestibular therapy. It s helped my balance too. Coming Back from a Devastating Accident Another patient who has benefited from vestibular therapy at Phelps is Steven Garcia, a 38-year-old Peekskill man who works in civil construction. In October of 2011, Garcia was involved in a serious construction accident that resulted in a concussion, eye damage, and 200 stitches in his face. After returning from the hospital, Garcia started experiencing dizziness, memory issues, problems with vision and more. He saw several different specialists, and after doing occupational and physical therapy at Kessler Institute for Rehabilitation in New Jersey, he was told he would benefit from vestibular therapy. Looking for a location closer to home, he came to Phelps, where he underwent therapy with Sheetal Shenoy. His therapy started in January. At first, it was very slow going. He couldn t tolerate sessions for very long because of the trauma he had been through. Then, after a month, he was able to do modified vestibular exercises, dizziness management techniques, balance retraining with the state-ofthe-art Dynavision machine, general conditioning and memory exercises all of which helped him function independently at home and in the community. From Day 1 until now the results are tremendous. I don t get anywhere near as dizzy as I used to, and I just got cleared by my neurologist to go back to work parttime, says Garcia. I recently took a boat ride with my son, and I was worried about going out there, but I did very well. I m really glad I ended up at Phelps for therapy. I don t know if I would have gotten this kind of help anywhere else. Steven Garcia (right) enjoying a boat ride with his son, Dmitrus. Phelps Today 15

16 You are invited to participate in an American Cancer Society Study It took thousands of study volunteers to prove that cigarette smoking causes cancer. Everybody knows that cigarette smoking causes lung cancer, but few realize that it took many years and thousands of cancer prevention study volunteers and participants to prove it. Phelps Memorial Hospital Center and the American Cancer Society invite members of our community to participate in Cancer Prevention Study-3, a major public health study aimed at better understanding the factors lifestyle, environmental, genetic that cause or prevent cancer. For the study, the American Cancer Society plans to enroll 300,000 men and women between the ages of 30 and 65 from across the United States. To participate, an individual must never have been diagnosed with cancer and must be willing to make a long-term commitment to the study. Participants will be followed for at least 20 years. Cancer Prevention Study-3 (CPS-3) is actually the American Cancer Society s fourth follow-up study. The first study took place in the 1950s. Information from that study and the two studies that followed it confirmed the link between cigarette smoking and lung cancer, demonstrated the link between larger waist size and increased death rates from cancer and other causes, and showed the considerable impact of air pollution on heart and lung conditions. The current study, CPS-II, began in 1982 and is still ongoing. But changes in people s lifestyles and our increased understanding about cancer since that study began make it important to now begin a new study. ACS studies involve collecting information such as medical history, lifestyle and behavior from a large group of people at the beginning of the study and then following them over time to update that information as well as document health changes like a cancer diagnosis or heart disease. Researchers will examine data on participants who get cancer (as well as those who do not) to identify cancer risks or protection associated with various lifestyle, environmental or genetic factors. To enroll in the study, individuals will be asked to complete a comprehensive survey packet that asks for information on lifestyle, behavior and other factors related to their health. Participants will have their waist circumference measured and give a small blood sample. After that, participants will be asked to complete a brief survey on a yearly basis for the next 20 years a small commitment that could have a large impact on finding a cure for cancer. If you would like to participate in this study, the details for enrollment are as follows: Date/Time: Wednesday, November 14, 2012 from 2-7 pm Place: Phelps Memorial Hospital Center 701 North Broadway, Sleepy Hollow, NY. Come to Suite 200 in the 755 Building across from the Phelps parking garage. For more information, you may contact Aurora DeVilla ( or or Nancy Fox ( or Your participation will impact generations to come. 16 Phelps Today

17 Phelps First Vitality Day a Huge Success On May 24, Phelps recognized National Older Americans Month with its first-ever Vitality Day celebration for seniors. Approximately 75 seniors attended the all-day celebration, which began with screenings for blood pressure, glucose, pulse oximetry, medication and balance, and an opportunity for informal conversations with representatives from the Phelps Sleep Center and Speech and Hearing Center and an acupuncture practitioner. Several community partners joined the event to educate seniors on brain fitness, dentistry, Alzheimer s and community resources. Mae Carpenter, Commissioner of the Westchester County Department of Senior Programs and Services, gave a talk on the resources available to help seniors in Westchester County age in place safely and independently. Participants enjoyed a mid-day tour of Kendal on Hudson, the continuing care retirement community located on the Phelps campus, and were treated to a delicious complimentary lunch in the Kendal dining room overlooking the Hudson River. In the afternoon three workshops were offered: geriatrician Lidia Pousada talked about preventive medicine; Phelps nurses and pharmacists offered a medication review; and Phelps Breakfast Club member Debra Elsbach led a meditation session. Vitality Day ended with an evening mixer at Atria, an independent and supportive living community in Briarcliff Manor, where seniors enjoyed cuisine prepared by Atria s master chef, toured the facility and strolled around the grounds. A wonderful time was had by all! Anne Nelson, NP-C, performs blood pressure screenings at Vitality Day. Neurologist Joins Phelps Staff Phelps welcomes neurologist Eliz Agopian, MD, MPH, to the medical staff. Dr. Agopian earned her medical degree from SUNY-Buffalo School of Medicine and completed an internship and a residency in neurology at Albert Einstein College of Medicine in the Bronx. Her office is located on the Phelps campus in the 755 Medical Services Building in Suite 417 ( ). Eliz Agopian, MD THE VITALITY INITIATIVE FOR SENIORS The Vitality Initiative at Phelps brings health, wellness and aging-in-place programs to seniors in the community. Following are some of the programs sponsored by Vitality: The Breakfast Club is a social gathering for adults in their second half of life, which meets once a month (except in August and December) on Thursday mornings from 8:30 to 10:30 am. Each Breakfast Club includes a presentation on a health topic, a nutritious breakfast and some light exercise. Cool Conversations is a group that meets after the Breakfast Club to engage in some lively conversation on a variety of interesting topics. The program is meant to be social as well as intellectually stimulating. Mind Games is a fun way to stimulate various cognitive functions memory, problem solving, focus and speed. If you are you having trouble remembering things or feel that you are easily confused, come join the fun! The Memory Game, Boggle, Set and Sporcle are just a few of the games played, one Wednesday afternoon a month. Living Well, sponsored by the Westchester County Department of Senior Programs and Services, is a series of six workshops designed to help seniors manage their chronic health problems. Participants get the support they need, find practical ways to deal with pain and fatigue, discover better nutrition and exercise choices, understand new treatment options, and learn better ways to talk with their doctor and family about their health. New The Vitality Newsletter is a bi-monthly publication specifically for seniors. To receive the newsletter, either by mail or , contact Ellen Woods at or For more information about any of these programs, call Phelps Today 17

18 Phelps Launches A Farmers Market On June 21, Phelps Memorial Hospital Center became the first hospital in the region to launch a farmers market. The Sleepy Hollow Farmers Market at Phelps is a great source of local produce, farm products and healthful prepared foods for residents of the community as well as hospital staff, visitors and patients. Many may ask why a hospital has taken the unusual step of sponsoring a farmers market. We are all about promoting good health, says Phelps Senior Vice President Daniel Blum, and good health starts with good food. The market fits right in with our Vitality Initiative, which focuses on encouraging wellness in our community. The Sleepy Hollow Farmers Market at Phelps is organized by Pascale Le Draoulec of Hastings, a food writer and author who runs farmers markets in Chappaqua, Hastings and Irvington. The market offers a wide range of farm fresh fruits and vegetables, farm products such as cheeses, eggs, and meats, as well as prepared foods such as baked goods, sandwiches and salads. The selection of vendors varies from week to week, and many offer samples so shoppers can taste before they buy. The Sleepy Hollow Farmers Market at Phelps is located in the Rockwood Hall parking area just north of the hospital, at the end of Route 117. Free parking is available in the Phelps parking garage. The market is open from 11:30 am 3:30 pm on Thursdays and will continue through the fall. More information may be obtained by calling Phelps Today

19 Upcoming Events: The 25th Anniversary Champagne Ball On Saturday, November 10, 2012, Phelps Memorial Hospital Center will celebrate its 25th Anniversary Champagne Ball at Trump National Golf Club in Briarcliff Manor, NY. The event will be chaired by Pamela and Dr. Paul Terracciano. Over the past 25 years, the Champagne Ball has provided invaluable resources for the hospital, helping to fulfill its mission of providing world-class community-based healthcare. This year we are proud to honor two extraordinary individuals, Dr. Albert Sheehy, a long-time beloved Phelps physician, and Dr. Max Gomez, nine-time Emmy award-winning medical journalist. These gentlemen have made exceptional contributions to the health and well-being of our community and beyond. The Champagne Ball is our opportunity to recognize the impact they have had on the lives of others. Celebrating our 25th anniversary speaks volumes about the success of this event, Pamela shared recently. It s a landmark occasion that brings together doctors, staff, family, friends and the community to celebrate all that Phelps has accomplished and to share plans for the future. We have an extraordinary committee whose members are truly the heart and soul of the Ball. This year is especially exciting as one of our committee members, the world-renowned artist Christopher Radko, is designing our invitations and the commemorative journal, further ensuring that this Champagne Ball will be an unforgettable event. One of the most unique aspects of the evening is the Fund-A-Cause auction, where guests pledge their support to a designated hospital program or service with the goal of completely funding the initiative by the end of the evening. This year, the auction s goal is to fund cardiac monitors for the Thomas E. and Alice M. Hales Endoscopy Unit. Sponsorship dollars are critical to this effort, supporting some of the most important initiatives within our hospital. We are grateful to our early participants, including the Phelps Department of Anesthesiology, which is sponsoring the Cocktail Reception. We invite you to be a part of this extraordinary event. For more information please contact Robert Lane, Vice President for Development, at (914) or An Evening with Le Grand Orange Join us on Sunday, November 18, 2012, when Phelps Memorial Hospital Center will partner with the Rusty Staub Foundation to co-host an extraordinary food and wine experience at the award-winning restaurant Daniel at 60 E 65th Street in New York City. The evening, hosted by legendary baseball great and humanitarian Daniel Rusty Staub, will feature a 5-course dinner prepared by worldrenowned chef Daniel Boulud, and an auction offering a wide array of exceptional wines. Proceeds from the event will support community healthcare at Phelps and the humanitarian efforts of the Rusty Staub Foundation. Mr. Staub was a six-time All Star and Most Valuable Player for the Houston Astros, Montreal Expos and New York Mets and is in the Hall of Fame for all three teams. He is the president of the Rusty Staub Foundation, which has raised over $7 million to assist families and children through various services and programs, including food pantries and a mobile food unit that travels the five boroughs of New York City and serves more than one million meals to the needy every year. Hunger in NYC is at an all-time high, Mr. Staub recently remarked. I have never seen lines longer at our nine emergency food pantries. We really try hard to feed people who cannot take care of themselves. Tickets for An Evening with Le Grand Orange are $1,000 each ($600 of which is tax-deductible). Seating is extremely limited. For more information, please contact Robert Lane, Vice President for Development, at (914) or pmhc.us. Dr. Max Gomez Dr. Albert Sheehy Daniel Rusty Staub Phelps Today 19

20 Warm Blankets: Patient Satisfaction For All Ages In 2009, when she was in fifth grade, Briarcliff Manor resident Annemarie Altomare started making baby blankets as part of a project undertaken by the Briarcliff Girl Scout troop led by her mother, Carol Altomare. Annemarie s finished blankets were donated to Project Linus, a national organization that donates handmade security blankets to sick and needy children in hospitals and shelters. Project Linus gets its name from the popular Peanuts character who totes his security blanket around with him wherever he goes. Creator Charles Schultz was delighted by the idea of naming this program for his special character. The organization believes that the best kind of sleep beneath heaven above is under a blanket handmade with love! Recently, Annemarie, who is now 14, returned to blanket making as her pre- Confirmation service project for St. Theresa s Church in Briarcliff Manor. When donating her four blankets to Project Linus, she asked that hers be earmarked for Phelps Memorial Hospital because that is where she was born. The creative designs she chooses for her hand-knotted fleece blankets reflect her love for animals. The blankets for Phelps featured brightly colored, cheerful frogs, owls and dinosaurs. In July, Annemarie and her mother visited Phelps and made a personal presentation to Barbara Bruno, Nursing Director of Maternity, joined by Pam Cardozo, Director of Volunteer Services. Annemarie is especially proud that one of her Phelps blankets was given to a premature infant and another went to a mother who had no special blanket in which to take her newborn home. Annemarie says that doing things for others helps her realize how much she has and takes for granted. Congratulations to Annemarie s parents and teachers for encouraging this spirit of giving. Who knows perhaps we have a future Phelps student volunteer in Annemarie. Annemarie Altomare (center) presents a baby blanket to Barbara Bruno, RN, (left) and Pam Cardozo. The Comfort Shawl Program The Phelps Comfort Shawl program, initiated in 2009, provides extra comfort to adult patients in need of emotional warmth around their shoulders during their hospital stay. The knitter s support is woven into each shawl as a way of giving to the patient. In receiving the shawl, the patient knows that a caring person created it. Since the program began, more than 100 volunteers have donated over 300 handmade shawls for Phelps patients. The volunteer office has received numerous notes from patients thanking Phelps for this personal touch, which helped make their hospital experience such a positive one. Patient satisfaction for all ages is Phelps goal. These handmade blankets and shawls for all ages represent but one contribution toward this collective effort. For more information about the Comfort Shawl program, call Volunteer Services at Manage Your Health Records Online At Phelps, we believe it is important for patients to have access to their health records whenever they need them. By partnering with Dell PHR Link and Microsoft HealthVault, we are able to provide patients access to their medical records free of charge. The record may include medications, test results, allergies, diagnoses, procedures or conditions. Creating this free Personal Health Record account allows you to securely store, organize and share your health information online using your HealthVault account. To create or access your new personal health record, visit 20 Phelps Today

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

TESTIMONY EDWARD CASTELLON TO THE MONTGOMERY COUNTY BOARD OF EDUCATION COMMUNITY FORUM ALBERT EINSTEIN HIGH SCHOOL OCTOBER 16, 2008

TESTIMONY EDWARD CASTELLON TO THE MONTGOMERY COUNTY BOARD OF EDUCATION COMMUNITY FORUM ALBERT EINSTEIN HIGH SCHOOL OCTOBER 16, 2008 TESTIMONY OF EDWARD CASTELLON TO THE MONTGOMERY COUNTY BOARD OF EDUCATION COMMUNITY FORUM AT ALBERT EINSTEIN HIGH SCHOOL OCTOBER 16, 2008 WRITTEN ENGLISH TRANSLATION (DELIEVERED IN SPANISH) Edward Castellón

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

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

Common Breast Changes

Common Breast Changes Common Breast Changes Changes in breast tissue are common over a lifetime. Changes can happen due to hormones and the normal aging process. Although most changes in the breasts are not cancer, you should

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

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

Vermont Mini-Lessons: Leaving A Voicemail

Vermont Mini-Lessons: Leaving A Voicemail Vermont Mini-Lessons: Leaving A Voicemail Leaving a Voice Mail Message Learning Objective 1) When to leave a message 2) How to leave a message Materials: 1) Voice Mail Template blanks & samples 2) Phone

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

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

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

High Blood Pressure. Taking Your Blood Pressure. Normal Blood Pressure. High Blood Pressure

High Blood Pressure. Taking Your Blood Pressure. Normal Blood Pressure. High Blood Pressure High Blood Pressure Blood pressure is the force put on the walls of the blood vessels with each heartbeat. Blood pressure helps move blood through your body. Taking Your Blood Pressure Blood pressure is

Más detalles

Lung Cancer. Tongue. Trachea (windpipe)

Lung Cancer. Tongue. Trachea (windpipe) Lung Cancer The lungs are the organs that help us breathe. They help to give oxygen to all the cells in the body. Cancer cells are abnormal cells. Cancer cells grow and divide more quickly than healthy

Más detalles

Breast Cancer. Breast Tissue

Breast Cancer. Breast Tissue Breast Cancer Cancer cells are abnormal cells. Cancer cells grow and divide more quickly than healthy cells. Some cancer cells may form growths called tumors. All tumors increase in size, but some tumors

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

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

Pneumonia in Children

Pneumonia in Children Pneumonia in Children Pneumonia is an infection in the lungs. A germ such as bacteria, virus, fungus or parasite can cause it. When a child gets pneumonia, tiny air sacs in the lungs can fill with fluid.

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

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

Prostate Cancer. The need to urinate more often, especially at night. A hard time starting to urinate or holding back urine

Prostate Cancer. The need to urinate more often, especially at night. A hard time starting to urinate or holding back urine Prostate Cancer The prostate is a gland in men that makes a liquid that forms part of semen. Its size is about 2 centimeters by 2 centimeters and is located in the pelvic area. The prostate uses a male

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

Dental Spanish Packet

Dental Spanish Packet Dental Packet For Dental Volunteers & Healthcare Professionals www.globalbrigades.org BUSINESS.DENTAL.ENGINEERING.ENVIRONMENTAL.HUMAN RIGHTS.MEDICAL.MICROFINANCE.PUBLIC HEALTH.WATER Introduction Many brigade

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

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

1 Hola! Soy Jaime y quiero contarles mi historia. Vivo con mi mamá y mi papá, Mila y Jimmy, y mis dos hermanos: Gabriel y Diego. Me gusta jugar béisbol y tenis, así como nadar. Hi! I m Jaime and I want

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

Breast Health. Learn the Facts. 1-877 GO KOMEN (1-877-465-6636) www.komen.org. 2014 Susan G. Komen Item No. KOMEED006900 04/14

Breast Health. Learn the Facts. 1-877 GO KOMEN (1-877-465-6636) www.komen.org. 2014 Susan G. Komen Item No. KOMEED006900 04/14 Breast Health Learn the Facts 1-877 GO KOMEN (1-877-465-6636) www.komen.org 2014 Susan G. Komen Item No. KOMEED006900 04/14 Am I at Risk for Breast Cancer? I am a woman I am getting older If you checked

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

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

An explanation by Sr. Jordan

An explanation by Sr. Jordan & An explanation by Sr. Jdan direct object pronouns We usually use Direct Object Pronouns to substitute f it them in a sentence when the it them follows the verb. Because of gender, him and her could also

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

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

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

\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

Asistencia para cuidado infantil

Asistencia para cuidado infantil SPANISH Asistencia para cuidado infantil El Gobierno Australiano ofrece una gama de pagos y servicios para ayudar a las familias con los costes de cuidado infantil incluyendo: Child Care Benefit para cuidado

Más detalles

Spanish 3V: Winter 2014

Spanish 3V: Winter 2014 Spanish 3V: Winter 2014 Elementary Spanish 3 in online format: https://login.uconline.edu/ Robert Blake, rjblake@ucdavis.edu; Rebecca Conley, mconley@ucdavis.edu Description: Spanish 3V is the second of

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

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

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

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

EL PASADO SIMPLE Y EL PASADO CONTINUO

EL PASADO SIMPLE Y EL PASADO CONTINUO EL PASADO SIMPLE Y EL PASADO CONTINUO EL PASADO SIMPLE EL PASADO CONTINUO EJERCICIOS EL PASADO SIMPLE Formación: El pasado simple en inglés se forma añadiendo la terminación ed a los verbos regulares;

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

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

Fundación CRAN. Centro para el Reintegro y Atención del Niño PROJECT S PORTFOLIO

Fundación CRAN. Centro para el Reintegro y Atención del Niño PROJECT S PORTFOLIO Fundación CRAN Centro para el Reintegro y Atención del Niño S PORTFOLIO 2006 Fundación CRAN, Centro para el Reintegro y Atención del Niño, centres its programs on the protection of children under the age

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

CUESTIONARIO DISEÑADO PARA EVALUAR EL PRODUCTO DESCUBRE LAS PALMAS DE GC! QUE SERÁ ADMINISTRADO A TRAVÉS DE LA WEB CREADA PARA EL PRODUCTO.

CUESTIONARIO DISEÑADO PARA EVALUAR EL PRODUCTO DESCUBRE LAS PALMAS DE GC! QUE SERÁ ADMINISTRADO A TRAVÉS DE LA WEB CREADA PARA EL PRODUCTO. ANEXO E. CUESTIONARIO DISEÑADO PARA EVALUAR EL PRODUCTO DESCUBRE LAS PALMAS DE GC! QUE SERÁ ADMINISTRADO A TRAVÉS DE LA WEB CREADA PARA EL PRODUCTO. CUESTIONARIO: El proyecto Descubre Las Palmas de GC!

Más detalles

School Preference through the Infinite Campus Parent Portal

School Preference through the Infinite Campus Parent Portal School Preference through the Infinite Campus Parent Portal Welcome New and Returning Families! Enrollment for new families or families returning to RUSD after being gone longer than one year is easy.

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

Prueba del Sudor. Su hijo tiene una cita programada para realizar una prueba del sudor. El día a las

Prueba del Sudor. Su hijo tiene una cita programada para realizar una prueba del sudor. El día a las Sweat Test Prueba del Sudor Su hijo tiene una cita programada para realizar una prueba del sudor El día a las Por favor, llegue 15 minutos antes de su cita en la clínica y acuda al mostrador de registro

Más detalles

What is family health history?

What is family health history? Family Health History Project Pre-Survey What is family health history? Family health history is information about diseases that run in your family, as well as the eating habits, activities, and environments

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

Entrevista: el medio ambiente. A la caza de vocabulario: come se dice en español?

Entrevista: el medio ambiente. A la caza de vocabulario: come se dice en español? A la caza de vocabulario: come se dice en español? Entrevista: el medio ambiente 1. There are a lot of factories 2. The destruction of the ozone layer 3. In our city there is a lot of rubbish 4. Endangered

Más detalles

Welcome to your NURSE ADVICE LINE 1-800-562-4620. Adentro encontrará la versión en Español

Welcome to your NURSE ADVICE LINE 1-800-562-4620. Adentro encontrará la versión en Español Welcome to your NURSE ADVICE LINE Adentro encontrará la versión en Español Welcome to your NURSE ADVICE LINE What should I do? Emergency Room? Urgent Care Center? You re not alone! A few minutes is all

Más detalles

Adobe Acrobat Reader X: Manual to Verify the Digital Certification of a Document

Adobe Acrobat Reader X: Manual to Verify the Digital Certification of a Document dobe crobat Reader X: Manual de verificación de Certificación Digital de un documento dobe crobat Reader X: Manual to Verify the Digital Certification of a Document support@bioesign.com Desarrollado por:

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

Tuberculosis (TB) Signs. Testing

Tuberculosis (TB) Signs. Testing Tuberculosis (TB) TB is a disease caused by germs called bacteria that most often affect the lungs. You can be infected with TB when you breathe in the germs. You are at a higher risk to get TB if you

Más detalles

EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS

EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS EMPLOYER & EMPLOYEE RETIREMENT PLAN TAX CREDITS For employers who set up and maintain retirement plans, the setup costs, annual administrative costs, and retirement-related employee education costs are

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

Usted es el corazón de la familia...cuide su corazón.

Usted es el corazón de la familia...cuide su corazón. Usted es el corazón de la familia...cuide su corazón. You are the heart of your family...take care of it. National Diabetes education program A joint program of the National Institutes of Health and the

Más detalles

Passaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470

Passaic County Technical Institute 45 Reinhardt Road Wayne, New Jersey 07470 Note: Instructions in Spanish immediately follow instructions in English (Instrucciones en español inmediatamente siguen las instrucciónes en Inglés) Passaic County Technical Institute 45 Reinhardt Road

Más detalles

WANT TO BE A WISEWOMAN?

WANT TO BE A WISEWOMAN? WANT TO BE A WISEWOMAN? Are you between the ages of 40-64 and have no insurance, Medicaid or insurance with high deductibles or co-pays? We may be able to help you get your yearly breast, pelvic, cholesterol

Más detalles

The Home Language Survey (HLS) and Identification of Students

The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) and Identification of Students The Home Language Survey (HLS) is the document used to determine a student that speaks a language other than English. Identification of a language

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

Watching My Child Grow. Coloring Book

Watching My Child Grow. Coloring Book Watching My Child Grow Coloring Book Things that a child learns to do like sitting and walking are called developmental milestones. There are also developmental milestones for a child s language and behavior.

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

Usted es el corazón de la familia...cuide su corazón.

Usted es el corazón de la familia...cuide su corazón. Usted es el corazón de la familia...cuide su corazón. You are the heart of your family...take care of it. NATIONAL DIABETES EDUCATION PROGRAM www.ndep.nih.gov A joint program of the National Institutes

Más detalles

There are five pages to this document including this page. Pages 4 and 5 are in Spanish.

There are five pages to this document including this page. Pages 4 and 5 are in Spanish. There are five pages to this document including this page. Pages 4 and 5 are in Spanish. Stay in touch this summer with One-Way Camper Email! We are excited to tell you about our partnership with Bunk1.com!

Más detalles

1. Save the PDF Form in your computer. 2. Open the PDF Form (double-click). 3. Complete it. 4. the PDF Form. 5. Attach the form in an Email to

1. Save the PDF Form in your computer. 2. Open the PDF Form (double-click). 3. Complete it. 4. the PDF Form. 5. Attach the form in an Email to 1. Save the PDF Form in your computer. 2. Open the PDF Form (double-click). 3. Complete it. 4. the PDF Form. 5. Attach the form in an Email to Admissions@lincoln.edu.ar (Health Form) (Health Form) (Health

Más detalles