Healthy Brain - East Jefferson General Hospital
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Healthy Brain - East Jefferson General Hospital
how to keep a Healthy Brain page 02 Science of Metabolism discover things you didn’t know about your metabolism speed page 06 Varicose Veins more than a cosmetic problem page 12 East Jefferson General Hospital 08 Spring president EJGH A LETTER FROM OUR East Jefferson General Hospital For years, East Jefferson General Hospital has worked tirelessly to deliver on the promise to bring the best available healthcare to our community. We have built a solid and respected reputation in the medical community as a center of excellence in many specialties, and have become one of the most technologically advanced facilities in the nation. Year after year, the forward thinking initiatives of the hospital board and leadership team became the foundation of success we enjoy today. As proud as we are of our history of accomplishments, I can assure this community that we are more excited about 2008 than any year in recent memory. This promises to be a landmark year for this institution, and we hope to leave no doubt that EJGH can compare favorably to the best healthcare facilities in the United States. The first major announcement of the year is introducing The Fitness Principle with Mackie Shilstone at East Jefferson General Hospital. Mackie brings over three decades of expert fitness experience to East Jefferson and is one of the nation’s leaders in this area. He has trained thousands of professional, world-class athletes and everyday people through his clinically proven programs. He offers sound, research-based fitness advice that maximizes health and performance. With a full list of individualized programs, there is something for anyone wanting to positively change their life. The Fitness Principle has now launched its programs with a new, stand-alone facility located at 3601 Houma Boulevard. It contains the latest fitness equipment and is built to accommodate people of any fitness level. What makes this announcement even more exciting is that The Fitness Principle becomes the perfect complement to our Wellness Center, and it furthers our mission to use preventive care as a way to avoid the possible need for acute care. This program is more than a step forward for our hospital. It is a major improvement targeted at wellness for you and your family. In most years, this announcement alone would be enough to make it a great year. Not this year, however. It is only March, and this is only the start. I assure you, the story of healthcare for our region will be written right here at East Jefferson. In the next few months, I look forward to sharing with you exciting news in the areas of cancer and heart care. Mark J. Peters, M.D., CPE President and C.E.O. Mark J. Peters, M.D., CPE, President and C.E.O. with Mackie Shilstone Director of The Fitness Principle. Photo by Glade Bilby II Board of Directors W. Henry Shane, Jr., Chairman Howard Brenner, M.D. Gustavo Colon, M.D. James M. Hudson Newell Normand Emmitt Richardson, Sr. Gregory G. Rittiner Ashton J. Ryan, Jr. David Silvers, M.D. Tiffany Scot Wilken President and Chief Executive Officer Mark J. Peters, M.D., CPE Vice President, Marketing & Communications Valerie Englade Managing Editor/Writer John Sartori Writers Cyd Casados Keith Darcey Graphic Design Julie Chappuis Kristin Steimle Support Staff Gerlaine Brewer Duc Nguyen PHOTOGRAPHY Glade Bilby II Healthy Lifestyles Magazine is a quarterly magazine published to highlight the adjuvant organizations of East Jefferson General Hospital. Its purpose is to inform community members about organizational and hospital news and events. Nondiscrimination Policy In accordance with Title VI of the Civil Rights Act of 1964 and its implementing regulation, East Jefferson General Hospital will, directly or through contractual or other arrangements, admit and treat all persons without regard to race, color or national origin in its provisions of services and benefits, including assignments or transfers within the facility and referrals to or from the facility. Staff privileges are granted without regard to race, color or national origin. In accordance with Section 504 of the Rehabilitation Act of 1973 and its implementing regulation, East Jefferson General Hospital will not, directly or through contractual or other arrangements, discriminate on the basis of handicap in admissions, access, treatment or employment. In accordance with the Age Discrimination Act of 1975 and its implementing regulation, East Jefferson General Hospital will not, directly or through contractual or other arrangements, discriminate on the basis of age in the provision of services, unless age is a factor necessary to the normal operation or the achievement of any statutory objective. Spring 08 H East Jefferson General Hospital page 02 page 02: iT’s page 06 NOT JUST A HAT RACK learn steps you can take to slow down cognitive decline and keep your brain healthy page 06: Science of metabolism why understanding the metabolic process gives you the best chance at healthy weight loss page 10: EJGH welcomes Mackie Shilstone to the team find a perfect program to help you reach your fitness goals page 12: varicose veins: more than just a cosmetic problem page 10 varicose veins can be a sign of a more serious vein disease and can lead to complications page 14: COMMUNITY OFFERINGS classes, seminars, and programs to help you live a healthier life page 16: A LOOK ON THE INSIDE • Tax Aid Program Benefits Seniors • A Lifetime Income - A Meaningful Gift • Raising Funds and Raising Spirits, since 1971 page 12 page 2 01 HEALTHYlifestyles It’s Not Just A hat Rack It’s Not Just a H by: Cyd Casados Like the rest of our bodies, our brains age as we do, and many of us feel we aren’t quite as sharp as we used to be. But there are steps you can take to slow down cognitive decline and keep your brain healthy (and heart, too). Work Out Your Brain… Just like we work out our bodies, we should also work out our brains. Our brains continue to grow as we learn and challenge ourselves. When our brains are active new connections between nerve cells are formed, allowing cells to communicate with each other and making it easier to retrieve information. Terence C. D’Souza, MD, FAAN and East Jefferson General Hospital neurologist says, “Our brain continues to lay down new cells. It doesn’t stop even in old age if we continue to keep our mind and bodies active.” In a study published in the New England Journal of Medicine, people 75 years or older who participated in mentally challenging leisure activities (i.e. crossword puzzles, reading, playing a musical instrument or board games) were at lower risk of developing dementia. “Aside from diet and exercise 02 East Jefferson General Hospital the most important thing you can do for your brain is to be mentally challenged,” says EJGH neurologist Patricia Cook, MD, FAAN. There are lots of ways to stay mentally active. Working crossword or other puzzles is one way, but changing your routine in any number of ways is beneficial to good brain health. According to Dr. Cook, “When we repeat the same activities every day, to the point they become almost automatic, brain activity decreases. Making small changes, even something like taking a new route to work, activates new parts of your brain.” So read, start a new hobby, learn how to play a musical instrument, enroll in a course at your community college, attend a play or lecture—your brain will thank you. It’s Not Just A hat Rack continued …And Your Body Working out our bodies is essential to maintaining proper blood flow, and therefore, oxygen to our brains, as well as encouraging the growth of brain cells. Physical exercise also reduces the risk of heart attack, stroke and diabetes, further reducing the risk of Alzheimer’s and dementia. Dr. Cook says, “We shouldn’t think of brain health as separate from cardiovascular health. Changes in the heart are going on alongside of changes in the brain. Exercise and a good diet benefit both.” Exercise improves both concentration and attention. It also promotes neurogenesis, or the production of new neurons. Neuroscientists at Columbia University conducted a study of men and women, 21 to 45, who worked out for one hour, four times a week. Not only did the participants become more physically fit, they found blood flowed at a much higher rate to the hippocampus, the part of the brain responsible for neurogenesis. The hippocampus plays a large part in learning new facts and forming new memories. Our brains get smaller as we get older, and the hippocampus is one of the areas most prone to shrinkage, starting as early as our 30s. The benefits of working out are not limited to adults. University of Illinois scientists have found school-age children with a higher level of aerobic fitness process information brain. Try a long walk with a friend in a new neighborhood for maximum brain boosting power. The physical and social benefits are augmented by the addition of planning a new route and the new sights you’ll experience. Fish Really Is ‘Brain Food’ A great deal of research exists on the connection between a healthy diet and a healthy brain. Diets high in fruit, vegetables, cereals and fish, and low in saturated fat, help protect against cognitive decline and dementia later in life. Stop for sushi. Omega-3 fatty acids, particularly docosahexaenoic acid, or DHA, is important for optimal brain function. Some of the best places to get DHA and other omega-3 fatty acids is from fish such as salmon. These fatty acids, especially DHA, make cell membranes more fluid, aiding communication between the brain cells. Our brains are actually 60 percent fat, and a high percentage of the gray matter of the brain consists of DHA. For other sources of omega-3s see “The ABCs of Omega-3s” accompanied by a recipe for a salmon salad that is high in both omega-3s and antioxidants. Eat your fruits and veggies. Many of the foods that appear to reduce a Hat Rack more efficiently and score better on standardized test scores. And you don’t have to run a marathon for your brain to benefit. The Centers for Disease Control and Prevention suggests moderate exercise, 30 minutes a day, on most days of the week can provide many of the same health benefits as more vigorous exercise. Just Add Others People with strong relationships have less mental decline and better overall health as they age. “Socialization is extremely important. And it’s good to vary your age group; hang out with younger people. You need to look outside of yourself,” says Dr. Cook. Dr. D’Souza also emphasizes the importance of socialization. “A recent study in England found that nursing home residents that interacted with children, versus those who had no interaction outside the nursing home, were less likely to develop cognitive problems.” And studies show that activities that combine mental, physical, and social aspects are the most beneficial to the the risk of heart disease, stroke, and cancer, also seem to protect your brain from aging. Darkskinned fruits and vegetables are some of these foods. This is because they contain high levels of antioxidants. When our cells use oxygen they naturally produce free radicals, which can cause damage to our brains. Antioxidants slow, prevent, and repair the damage done by these free radicals. Other good sources of antioxidants include nuts (almonds, pecans, and walnuts) and green tea, as well as red wine and dark chocolate—enjoyed in moderation, of course. Limit alcohol consumption. Heavy alcohol consumption has long been proven to cause harmful effects on the brain. However, the National Institute of Health cites a number of studies that suggest moderate alcohol consumption may actually help reduce the risk of Alzheimer’s disease and cognitive decline. There is some controversy though as many of the studies define “moderate” differently. The United States Department of Agriculture, or USDA, defines moderate 03 HEALTHYlifestyles It’s Not Just A hat Rack continued Count Your Zs alcohol consumption as no more than one drink per day for women and no more than one or two drinks per day for men. That’s a 4 oz. glass of wine, a 12 oz. glass of beer, or a oneounce shot of distilled liquor. A lack of sleep affects your planning, problem-solving, learning, concentration, working memory and alertness. Multiple studies have shown after as little as twenty hours of being awake, your ability to function is equivalent to someone who is legally drunk. Even a few nights in a row of missing a couple hours sleep will negatively affect your cognitive abilities. Luckily, the damage is reversible once you get proper rest. Eat breakfast. Not only will it help you from bingeing later, often on less than healthy fare, it will help give your brain the fuel it needs to get your day started. This doesn’t mean reach for a donut. Whole grain toast and an egg-white omelet is a much better option, combining carbohydrates and protein. And eggs are rich in choline, which your body uses to produce the neurotransmitter acetylcholine. Yogurt is another good breakfast choice as it contains the amino acid tyrosine, which helps produce the neurotransmitters dopamine and noradrenalin, improving alertness and memory. Sleep is not only crucial to brain development, but is also when your brain processes new memories into more permanent forms. So get a proper night’s rest—at least 7 to 8 hours a night—and you’ll not only feel more alert, but also be more likely to remember the things you learned the day before. Maintain a healthy weight. According to EJGH neurologist Archie Melcher, MD, “Probably about 80 percent of those I see who have strokes, or dementia due to strokes, haven’t been living a healthy lifestyle.” A long-term study of almost 1,500 people found that those who were obese in middle age were twice as likely to develop dementia later, and more than six times as likely if they also had high cholesterol or high blood pressure. Diets high in fat and cholesterol are also associated with an increased risk of Alzheimer’s disease. By maintaining a healthy weight you’ll lower cholesterol, blood pressure, blood sugar, and improve your overall health. Take a good multivitamin. In addition to a healthy diet, “Make sure you take a good multivitamin that contains B vitamins, vitamin C, and vitamin E for good brain health,” according to Dr. Melcher. Salmon, avocado & mango salad By Constance Snow Serves 2 (as a main course) Yes, the fat content is high, but it’s healthy monounsaturated fat (from avocado) and omega-3 fatty acids (from salmon). ¼ cup fresh orange juice 1 tablespoon fresh lime juice 1 ripe avocado, peeled, pitted, and coarsely chopped 1 ripe mango, peeled, pitted, and coarsely chopped 6 ounces cooked salmon, no salt added WHISK the juices to blend. Add the avocado, mango, and salmon; toss gently to combine. Per serving: 362 calories, 20.9g protein, 24.1g carbohydrate, 6.5g dietary fiber, 21.5g total fat (3.7g saturated fat), 54mg cholesterol, 59mg sodium 04 East Jefferson General Hospital ed ed d It’s Not Just A hat Rack continued Stop Smoking By now we all know how bad smoking is for our lungs, but smoking also causes memory loss. According to a study of more than 9,000 Europeans, the rate of brain decline is more than five times higher in smokers than in people who have never smoked. There is also evidence that smoking hinders brain cell production. Staying sharp is just one more reason to stop smoking. products of cortisol act as sedatives that can lead to feelings of depression, potentially leading to severe depression if stress is chronic. These hormones when chronically activated are also believed to impair memory formation and function. “Stress affects the brain a lot more than most people realize. Depression causes memory loss and has even been linked to the earlier onset of Alzheimer’s disease,” says Dr. D’Souza. “Exercise is a great way not only to ward of excess weight, but also to stop stress and to alleviate depression. Other stress management such as meditation and even church activities can also help to prevent depression.” Make sure to set aside personal time each day to rest and rejuvenate to help manage the stress in your life. Negative thoughts are stressors on the brain and can lead to depression and anxiety. So think positive. Dr. Melcher adds, “If you think positively you are more likely to exercise and eat healthy. Positive thinking reinforces a healthy lifestyle.” “Stress affects the brain a lot more than most people realize.” Dr. Terence C. D’Souza Take a Deep Breath Although short-term, acute stress is known to actually improve memory, chronic stress can take its toll on your brain, including brain changes that may lead to depression. When responding to a stressful event, the brain releases a flood of stress hormones, including adrenaline and cortisol. This is fine for short periods of time. The trouble occurs when stress becomes constant and with it the influx of these stress hormones. By- The ABCs of Omega-3s Vegetarian Sources THE OMEGA-3 fatty acids found in salmon give the fish its reputation as a leader in the fight against heart disease. Major studies show that omega-3s lower bad (LDL) cholesterol and triglyceride levels, and may also combat high blood pressure and inflammation. To ensure a high concentration, buy “wild-caught” salmon. Other good sources include halibut, lake trout, herring, and sardines. Omega-3s are also present in shrimp, clams, light chunk tuna, catfish, and cod. Include walnuts, flaxseed, soybeans, and canola oil. Toasted walnuts are great in salads and walnut oil makes a luxurious vinaigrette. Many breads and cereals now contain flaxseed. Dry-roasted soybeans are a low-carb snack similar to peanuts (but with half the fat, twice the fiber, and 80 percent more protein). Frozen soybeans (sometimes labeled with the Japanese name “edamame”) taste like lima beans. And mild-flavored canola oil is good for cooking and baking. Omega-3s are also a leader in the fight against heart disease. rate, ated 05 HEALTHYlifestyles The Science of Metabolism Photo: Glade Bilby II The Science of Metabolism Why understanding the metabolic process gives you the best chance at healthy weight loss by: Keith Darcey You’ve probably heard it dozens of times – “I’ve just got a slow metabolism.” There is a good chance that whoever said it may in fact be correct. If so, there is good news and bad news. 06 East Jefferson General Hospital 6-11.indd 2 2/18/08 3:40:44 PM Bilby II The Science of Metabolism The good news Experts indicate that a slower metabolism may be evolutionarily superior to a faster metabolism. In the days when food was in short supply, a person with a slower metabolism needed less food to maintain their basic bodily life-support systems such as breathing, brain function, blood circulation and digestion. That meant those with faster metabolisms processed food quicker and needed more food to survive. Ultimately, the people with a faster metabolism would die first. The metabolic process begins in the hypothalamus, an area of the brain that controls much of the nervous system and regulates such areas as hunger, thirst, temperature, sleep, sexual activity and other mood sensors. The bad news When food is abundant and you overeat, weight gain occurs more easily and quickly. Despite the claims of companies pushing wonder pills and fad diets, the true secret to weight loss has been with you the whole time. That secret is your unique metabolic process. It is why, despite the claims, there is no one-size-fits-all diet or weight loss plan. To understand the metabolic process, we need to go back to biology class. In basic terms, the metabolic process is the breaking down of food through chemical reactions in your body to produce the energy needed to survive and function. Everyone has a base metabolism or basal metabolic rate – the specific amount of calories needed for their body to complete the basic functions. Weight gain, therefore, happens when you take in more calories than your body burns through either basic life functions or through movement, such as walking, brushing your teeth or even pressing the buttons on the remote control. “For most people, seventy percent of the energy burned supports your basic life functions and about ten percent of the energy is used is to actually digest your food, while the remaining twenty percent is burned through physical activity,” says EJGH Endocrinologist Miguel Rivera, MD. “So really, eighty percent of your calories are needed just for survival.” me•tab•o•lism The physical and chemical processes in the body that create and use energy, such as: • Breathing • Circulating blood • Controlling body temperature • Contracting muscles • Functioning of the brain and nerves • Digesting food and nutrients • Eliminating waste The hypothalamus sends hormones to the pituitary gland, sometimes known as the master gland because it controls many other glands in the body. In particular, the pituitary gland signals to the thyroid gland, which is key to the metabolic process. The thyroid gland, which is located in the neck, is responsible for producing the thyroid hormone that helps determine the metabolic rate. This hormone helps to stimulate tissue development and regulate many of the physiological processes in the body. A thyroid gland that produces too much or too little of this hormone can affect the rate at which the breakdown occurs. Both can lead to health problems beyond weight gain or weight loss. When you eat, the complex chemical reaction immediately begins through two basic processes – catabolism and anabolism. Catabolism refers to breaking down of the food into simple components to create energy, while anabolism is the process of storing the energy. By working together, these two continuous processes convert the fats, carbohydrates and proteins into the fuel that the tissue cells in the body require. “I have people come in my office all the time saying they don’t eat too much,” say Dr. Rivera. “I tell them that if they are gaining weight, they are eating more then they need. Otherwise, they would not be gaining weight.” 07 HEALTHY lifestyles 6-11.indd 3 2/18/08 3:40:48 PM The Science of Metabolism and carbon dioxide exhaled at rest. The test usually takes approximately twenty minutes, and at the end, your specific caloric needs are automatically computed. In addition, the test will measure the rate at which carbohydrates are burned, a key indicator for the type and amount of carbohydrates, simple or complex, you should target daily. “A metabolic test really becomes your starting focal point as you move forward with a nutrition plan,” says Don Menard, Corporate Wellness Lead at the EJGH Wellness Center. “As your body changes, your metabolism rate may also change, but if you don’t know the initial number of calories per day you need at present, you may be eating too much or too little.” Starvation or crash diets negatively affect your metabolism and can actually cause weight gain. If you consume less than the amount of calories you need to survive, your body will automatically begin to go into survival mode. Your metabolism will slow down and your body will begin to store up food. Dr. Rivera went on to say that although there is much to learn about the metabolic process, recent research may be giving physicians greater insight into the relationship between metabolism and weight loss. Regulating two specific chemicals in the body – ghrelin and leptin – may control whether you are hungry or full. In one study cited, the lab mice that were injected with increased levels of leptin, the chemical that makes you feel full, lost weight as a result of eating less. Higher levels of ghrelin, the chemical that makes you feel hungry, may therefore be partly responsible for making you eat more. Knowing your metabolic rate is key to weight loss Understanding the metabolic process, and more specifically, your particular metabolic rate, is crucial to long-term weight loss and health. Your basal metabolic rate becomes the magic number of calories you need per day. Find that number, and a nutrition plan can be established for optimal weight loss. A metabolic test measures Resting Energy Expirations and signifies the number of calories needed for survival. The test is performed with the individual laying flat on a table as relaxed as possible. Fasting with no caffeine or nicotine is recommended for about eight hours prior to the test. The test takes into account factors such as age, weight, sex and muscle mass. A mask over the nose and mouth is worn and hooked to a breathing machine that records the amount of oxygen intake 08 Metabolic rate may change as muscle mass is added or reduced. Increasing your lean muscle mass will speed up the metabolic process and will burn calories faster. Keeping up lean muscle is important because as you age, metabolism naturally tends to slow down as activity level slows. For women, metabolism also tends to slow down after menopause. “Muscles are like the big engine in the car,” says Menard. “They burn calories faster that fat cells and make your metabolism speed up. It is much better to be heavier with more muscle mass than lighter with more fat.” Losing weight with basal metabolic rate For Lisa Salvaggio-Cooper, losing weight has been a life-long battle. She tried to lose weight through every diet plan she could find. All had varying degrees of success, but none created the long-term success needed to maintain a healthy weight. “I am fifty-two years old, overweight, and feel as if I am in a crisis,” Lisa says. Past diets created unhealthy weight losses and gains for Lisa. Sometimes she ate the wrong foods and sometimes she simply did not eat enough. She also admits that part of her downfall in dieting was late-night eating. Lisa underwent a metabolic test and it was determined that her basal metabolic rate was 1,812 calories per day. Julie Fortenberry, Sports and Lifestyle Nutritionist with The Fitness Principle with Mackie Shilstone at East Jefferson General Hospital, worked with Lisa to develop an individualized nutrition plan that matched caloric intake to her ideal 1,812-calorie limit. East Jefferson General Hospital 6-11.indd 4 2/18/08 3:40:52 PM The Science of Metabolism Julie Fortenberry, LDN, RD is a Sports and Lifestyle Nutritionist for The Fitness Principle with Mackie Shilstone. She has counseled numerous clients of all ages and fitness levels, helping them to meet their individual health goals. “Lisa needed a plan that stuck to her needed calorie levels, but one that didn’t leave her hungry,” says Fortenberry. “We mixed the right kind of calories she needed and broke up her meals into smaller but more frequent meals. She feels full throughout the day and is maximizing her calorie-burning process.” Fortenberry went on to say that the basal metabolic rate is important not only so that you don’t overeat, but so that you don’t eat too little. Starvation or crash diets negatively affect your metabolism and can actually cause weight gain. If you consume less than the amount of calories you need to survive, your body will automatically begin to go into survival mode. Your metabolism will slow down and your body will begin to store up food. “When you don’t eat enough, you become like a bear hibernating,” says Fortenberry. “Your body will hold onto to everything it can, store it up as fat and you lose lean muscle. What makes it worse is when you return to eating more than necessary with a slower metabolism and with less lean muscle.” After the first month, Lisa lost thirteen pounds. By maintaining a consistent plan adapted to her caloric needs, she notices fewer ups and downs in blood sugar levels and has better sleeping habits. She now believes that it’s more about getting to a healthy state than a specific weight goal. TEN TIPS FOR BOOSTING YOUR MEtabolism 1 Build lean body mass. 2 Eat Breakfast. Lean muscle burns calories, and the more you have, the more calories you burn, even while resting. Breakfast gives your metabolism a boost and provides a consistent energy supply throughout the day. 3 Consume less sugar. Processed and refined sugar cause serious health issues including obesity and diabetes. Complex carbohydrates such as fruits, vegetables and whole grains are a better energy source because they supply an even level of blood sugar. 4 Spice up your diet. Spicy foods that make you sweat can help boost your metabolism. 5 Get a good night’s sleep. The body uses sleep to heal and regenerate itself, including its muscular system. 6 Drink more water. Water flushes toxins out of the body and keeps the kidneys operating at maximum efficiency allowing the liver more time to do what it does best, metabolize fat stores. 7 Eat small meals. Eat 5 to 6 small meals per day to give the body a steady supply of energy and prevent binge eating. 8 Don’t miss meals. Skipping meals actually slows metabolism and can lead to overeating. 9 Plan your meals. If you have a daily or weekly menu you are much more likely to stick to your plan. 10 Drink green tea. Green tea has been shown to boost metabolism and unlike coffee does not stress the body with caffeine. 09 HEALTHY lifestyles 6-11.indd 5 2/18/08 3:40:57 PM The Science of Metabolism Photo: Glade Bilby II Mackie Shilstone brin experience to East J proven program everyone from w Can This Man Ch Anaerobic activities such as weight lifting create a system overload and begin to breakdown the muscle. The body responds by switching the fuel source from burning fat to burning carbohydrates to repair the muscles. Combining nutrition with exercise The most effective way to lose weight is to combine proper nutrition with exercise. By restricting the number of calories to your basal metabolic rate and incorporating exercise routines, you maintain what your body needs and converts stored up calories into energy to burn. Balancing the two forms of exercise – aerobic and anaerobic – accomplishes the goal of speeding up the metabolism and burning calories. There is a difference between the two forms, however. In general, aerobic means to burn calories with oxygen and tends to burn fat as the main source of fuel. Aerobic exercises, commonly known as cardiovascular workouts, use steady motion as oxygen is mixed in the system to ideally burn the fat. Such exercises include walking, jogging, dancing or bicycling. Anaerobic means to burn calories without oxygen. Typically, weightlifting, sprinting, boxing and other high intensity activities are considered anaerobic. The reason it is considered without oxygen is because the activity crosses the metabolic threshold, or the point at which you cannot take in enough oxygen to support the activity. The activity creates a system overload and begins to break down the muscle. The body responds by switching the fuel source from burning fat to burning carbohydrates to repair the muscles. “If you want to build the lean muscle, anaerobic exercise is the most important,” says Dr. Rivera. “Ideally, you do need both because although they impact the metabolic process differently, they both contribute to burning calories faster. In the end, that is what you want in order to lose weight.” 10 He has been described as an expert in fitness, nutrition, disease prevention, disease management, lifestyle management, a coach, guru, consultant, resource, an inspiration and more. Mackie Shilstone has practically invented the fitness/life-coach model. He has worked with some of the most successful and recognized names in sports over the last 30 years. Olympic Gold Medalists, Wimbeldon & Super Bowl Champs, Hall of Famers and Heavyweight Champions of the World; they have all credited Mackie with helping them reach their summit. It was during a prize fight that the TV announcers gave him the moniker that perhaps best suits the man who once was an undersized wideout at Tulane, referring to Mackie’s unique way of getting a fighter physically and mentally prepared to win. They called him “The Strategist”. This title appeals to Mackie because as an MBA, he has always taken a “strategic” or “management” approach to his work. Focusing on the end result or goal then developing a “strategic plan” to “manage” his client to the end results has allowed Mackie to break the molds on what constituted a training program. He was one of the first to completely fold training, nutrition, supplements, clinical support and psychology together into one comprehensive “strategy” of performance management. With online registration for our programs, people are truly a mouse click away from positive changes that can transform their lives. Though his work has taken him literally around the world, he has always maintained his home, multiple business interests and headquarters here in the New Orleans area. In 2008, that headquarters has moved into The Fitness Principe with Mackie Shilstone at East Jefferson General Hospital. With this new state-of-the-art facility, Mackie can finally deliver the type of one-stop turnkey experience he has always sought. “At East Jefferson, with online registration for our programs, people are truly a mouse click away from positive changes that can transform their lives. Here, we can implement our entire battery of non-invasive clinical diagnostic East Jefferson General Hospital 6-11.indd 6 2/18/08 3:41:14 PM Photo: Glade Bilby II lstone brings over three decades of expert fitness ce to East Jefferson General Hospital. His clinically n programs offer sound, research-based advice to one from world-class athletes to everyday people. an Change Your Life? By John Sartori tests that give us the most in-depth understanding of our clients that has ever been available. These are testing processes that equal or surpass what you would find if you were to an elite athlete at the United States Olympic Training Facilities.” For Mackie, The Fitness Principle’s level of excellence is a subject he takes very seriously. “With this, we have a facility and programs that I know will be impacting people in a positive manner long after I am gone. I now feel confident in my legacy and that is something very few people get to enjoy.” If you are considering changing your body and life, you don’t have to be an elite athlete to enter the programs at Fitness Principle. Offerings like “Comprehensive Weight Loss” are utilized by professional and weekend athletes alike. While skill levels may change, the constant elements are the quality of the programs and the desire by the participant to improve their performance. Many are surprised to learn about the high number of Fitness Principle clients are aren’t athletes at all. They just want to maximize their own performances in their chosen careers and they know that finetuning their own body will enhance their energy & performance levels in every aspect of their lives. One of the great aspects of being a client at The Fitness Principle is the fact that you will get the same fitness and nutritional input that has helped so many famous athletes reach their peak or prolong their careers. It is also fun to know that on any day you may be working out alongside Fitness Principle clients like Serena Williams or Bernard Hopkins. Some of The Fitness Principle’s most famous clients either don’t play anymore or never did. They just want to maximize their fitness levels as in the cases of Hall of Fame Shortstop Ozzie Smith, (who credits Mackie with prolonging his baseball career by several years) or broadcaster Bob Costas. Not bad for a facility that only began accepting applications in January and won’t celebrate its official grand opening until March of this year. Mackie is thrilled to finally have a facility and clinical support that closes the circle in his quest to be the ultimate “Performance Management Specialist” or as HBO put it, “The Strategist”. If you would like more information on The Fitness Principle or to register for a program, call 504- 457-3100 or go to www.ejgh.org. 11 HEALTHY lifestyles 6-11.indd 7 2/18/08 3:41:26 PM Varicose Veins Varicose Veins: More Than Just a Cosmetic Problem by: Cyd Casados It’s important to start any discussion of varicose veins by making the distinction between spider veins and varicose veins. Spider veins are the small clusters of red, blue, or purple veins that commonly appear on the thighs, calves, and ankles. Although they are generally treated for cosmetic reasons, spider veins can be a sign of a more serious vein disease and can lead to complications similar to varicose veins. Varicose veins are the larger, bulging, rope-like veins. Varicose veins are a common medical problem, affecting approximately 40% of women, and 25% of men. Varicose veins can lead to substantial pain, as well as develop into a more serious medical condition. Non-treatment of varicose veins can result in inflammation (phlebitis), blood clots (thrombosis), ankle sores or skin ulcers, and bleeding. “Treatments have become less invasive and more successful, up to 90% effective.” Tod C. Engelhardt, MD, FACS “If not treated, the symptoms will only continue to worsen. There is no reason to suffer with varicose veins, as treatments have become less invasive and more successful, up to 90% effective. And most insurance policies cover these medically necessary procedures used to treat varicose veins, such as endovenous laser treatment and phlebectomy,” according to Tod C. Engelhardt, MD, FACS and cardiovascular surgeon at East Jefferson General 12 East Jefferson General Hospital Varicose Veins continued Hospital. Venous Reflux Disease Arteries carry blood away from your heart, delivering oxygen to all parts of your body. The veins then return this blood, now blue as the oxygen has been removed, back to your heart. Your leg veins have to work against gravity to return the blood to your heart. Small, one-way valves open, allowing blood to flow upward towards the heart, and then close to prevent it from flowing back down. Varicose veins occur when these valves malfunction. The blood essentially flows backward into the legs when the valves become damaged. The blood then pools in your veins and causes them to become enlarged. This malfunction is referred to as venous reflux disease. In addition to varicose veins, venous reflux disease can lead to painful, aching, swollen legs and leg heaviness and fatigue. It can also cause skin changes, muscle cramps, restless leg symptoms, and burning or numbness. Prevention Factors that lead to venous reflux include age, gender, pregnancy, obesity, physical trauma, prolonged standing, and most important, heredity. But with regular exercise and avoiding standing or sitting for long periods of time, you can relieve the discomfort of current varicose veins and help prevent new varicose veins from forming. Treatments Many people don’t realize they no longer have to resort to painful and invasive vein stripping surgery to get help for varicose veins. According to Dr. Engelhardt patients have more options for less invasive treatment than ever before. “Vein stripping used to take place in the hospital and patients were on bed rest for days after the procedure. With these new treatments we perform the procedure in the office under a local anesthetic and the patients are walking on a treadmill after the procedure.” Treatment options for varicose veins include: Compression Hosiery Compression hose are used to relieve the symptoms of varicose veins by keeping the blood from pooling in the veins, therefore improving circulation. They are often used as the first line of treatment. Compression hose are also used after treatment to improve the long-term effectiveness of the following procedures. Ultrasound-Guided Sclerotherapy Sclerotherapy, an almost painless office procedure, is most often used to treat visible spider veins and small varicose veins near the surface. A sclerosant solution is injected into the affected vein causing it to shrink, close off, and slowly disappear. The procedure generally takes from about 15 to 45 minutes, and from two to five treatments to complete. The ultrasound technology guides the precise placement of the injections resulting in more effective results than conventional sclerotherapy treatment. Ambulatory Phlebectomy Ambulatory phlebectomy is a method of removing large varicose veins on the surface of the legs. The veins are removed through tiny punctures or incisions. These incisions are so small no stitches are required, improving cosmetic results. The procedure is performed under a local anesthetic. Endovenous Laser Treatment (EVLT®) A thin, laser fiber is guided by ultrasound into the vein. The laser gently heats and closes the vein, stopping the venous reflux at its source. Once the vein is closed, the blood is simply rerouted to other healthy veins and the varicose vein essentially disappears. The procedure is generally completed within an hour. It is relatively pain-free and the patient is able to return to normal activities that day, and more strenuous activities usually within one to two weeks. Before - EVLT ® AFTER - EVLT ® A patient before and after EVLT ® treatment by cardiovascular surgeon, Tod C. Engelhardt, MD, FACS. Results The results of the preceding treatments can be remarkable. Dr. Tod Englehardt follows his patients for six months after the procedure and has found that “even five days post-procedure we see some very nice results. Those who suffer with the pain or embarrassment of varicose veins can now experience results more quickly, and with less pain, bruising and scarring.” If you have questions regarding varicose veins, or are looking for a treatment facility, please contact the Louisiana Heart, Lung, & Vascular Institute at East Jefferson General Hospital at 504-454-2222. 13 HEALTHYlifestyles Calendar CALENDAR SCREENINGS Blood Pressure Screening Lakeside Mall: 4th Wed of each month, 7:30 – 10:30 a.m. EJGH Canal Garage Groundlink: Tues and Thurs, 10 a.m. – Noon Wellness Center: 1st and 3rd Tues of each month, 8 –11 a.m. Clearview Mall: 2nd and 4th Tues of each month, 8 –11 a.m. Free, call 454-4066 for more information. Cholesterol Screening Know your risk factors for heart disease. Screen provides total cholesterol, HDL, LDL, TC/HDL ratio, triglycerides, and glucose. Call 456-5000 to schedule an appointment at the EJGH Wellness Center. WOMAN & CHILD SERVICES Lamaze This course, for expectant mothers and their companions, is designed to help parents have a positive birth experience. $95 per couple. Please call 456-5000 for dates, times, and to register. Prenatal Series Expectant parents learn about delivery and anesthesia options, baby care, and home and auto safety. Free. Please call 456-5000 for dates, times, and to register. Joint Wellness Program DISEASE MANAGEMENT EXERCISE PROGRAMS Diabetes Dynamics Becoming a big brother or sister is an exciting event. This sibling preparation class is designed for children ages 3-10 and their parents. Class activities include how to hold a baby properly, diapering, drawing, doll play, videos and stories. Free. April 5, 9:30 –10:30 a.m. or 11 a.m.— Noon. Please call 456-5000 to register. Core Stability Functional Training Exercise training for people with osteoporosis, back problems and a low level of balance. Mondays and/or Wednesdays, 1:30 – 2:15 p.m., call 456-5000 for fees and to register. A physician’s release is required. Fibromyalgia Aquatic Program Slow, controlled movements along with gentle stretches for the tender points, designed to improve muscle tone, endurance, and flexibility. Mondays and/or Wednesdays, 11:30 a.m. – 12:15 p.m. or 5:30 – 6:15 p.m. Call 456-5000 for fees and to register. A physician’s release is required. Multiple Sclerosis Aquatic Program Breastfeeding Expectant mothers learn to make an informed decision about breastfeeding. Free. April 26, 1 –3 p.m. Please call 456-5000 to register. Addresses the special needs of individuals who have physical limitations as a result of their disease. This program is conducted in a temperature-controlled pool to help promote flexibility, strength and endurance, as well as to prevent fatigue. Tuesdays and/or Thursdays, 1 - 1:45 p.m. Please call 456-5000 for fees and to register. A physician’s release is required. La Leche League Parkinson’s Program La Leche League holds monthly educational meetings providing breastfeeding education, information and mother-to-mother support. Free. Third Tuesday of every month, 10 – 11 a.m. Please call 456-5451 for more information and class location. No registration required. Becoming a Woman Girls aged 9 to 12, with their mother or a guardian, learn about the changes that come with adolescence. $20. April 16, 6:30 – 8:30 p.m. Please call 456-5000 to register. 14 Sibling Preparation East Jefferson General Hospital Addresses the problems associated with Parkinson’s disease such as shuffled gait, stooped posture, bradykinesia, as well as hesitance in movement, muscular rigidity, and respiratory difficulties. Includes exercises for strength, flexibility, balance, stability, gait, and the cardiorespiratory system. Fridays, 1:30 - 2:15 p.m., call 456-5000 for fees and to register. A physician’s release is required. Available to individuals who have recently completed the physical rehabilitation process following joint replacement surgery and intended to ensure independence and proper function of the joint; both aquatic and land-based group exercise classes are conducted. Aquatic, Tuesdays, 4:30 – 5:30 p.m. Land-based, Wednesdays, 2:30 – 3:30 p.m. A physician’s release is required. This two-class course teaches the basics of diabetes management, nutrition, foot care, exercise, goal setting and motivation. Classes are held in the Wound and Diabetes Management Center on the 7th floor of EJ North. Free. April 2 & 3. Please call 849-8600 for more information. A physician’s release is required. Successfully Managing Diabetes in Today’s World At this comprehensive seminar for people with diabetes vendors will provide information on resources available for successful diabetes management. Experts present topics such as exercise, Medicare benefits, herbal supplements and nutrition as related to diabetes. Free. March 18, Noon – 4 p.m. Call 456-5000 to register. Seminario Gratis de Diabetes en Español Temas incluyen cambio para mejorar su vida; diabetes y su corazón; diabetes, ejercisio y seguimiento con su doctor; nutrición y diabetes. Mayo 31, 9:30 a.m. – Noon. Centro de Conferencias Esplanade 3. Estacionamiento gratis en el Garaje Hudson. CLASSES, SEMINARS, and ACTIVITIES Look Good…Feel Better EJGH’s Regional Cancer Center, along with the American Cancer Society, offers this program for women undergoing radiation or chemotherapy treatment. Volunteer cosmetologists will help patients enhance their appearance. Please provide us with your skin type (either light, medium or dark). Free. March 24, 6 – 8 p.m. Please call 456-5000 to register. Line Dancing Boot, scoot and boogie your way to fitness. Join us for fun and interactive instruction in the latest dance steps choreographed to music. Wednesdays, April 2 – May 21, 7:45 – 8:45 p.m., $40 (Wellness Center members), $80 (nonmembers). To register call 456-5000. Swing, Salsa, Tango and more Knock off inches from your waist and hips while enjoying the rhythms and basic moves of salsa, meringue, foxtrot, samba, cha cha, and rumba. Partner not required. Thursdays, April 3 – May 22, 7:30 – 8:15 p.m., $40 (Wellness Center members), $80 (nonmembers), to register call 456-5000. Total Joint Replacement Program Prepares patients for hospitalization for joint replacement surgery, from preoperative testing to discharge. This program is for patients having hip or knee replacement surgery at EJGH and is provided to them at no cost. Please call 456-5000 for dates and times. Five Wishes/Living Will Seminar Protect your family members from having to make difficult decisions without knowing your wishes. This easy-to-use living will addresses your spiritual, personal and emotional wishes as well as your medical needs. Panel consists of a physician, attorney, social worker and a care manager. Mar 27, 4 – 6 pm. Free. Call 456-5000 to register. Prevention on Par Eighteen holes of golf at the Chateau Golf and Country Club, a gourmet buffet lunch, and question & answer session with Dr. Brad Collins on men’s health. $75. March 17, 9 a.m. – 3 p.m. Call 456-5000 to register. Medicare Insurance Counseling Assistance is for Elder Advantage members and by appointment only. For more information please call 454-4066. AARP Driver Safety Program A certificate of completion is awarded for this one day, 4-hour course. Call Larry Lemoine at 454-4168 for more information. Calendar continued 2008 SUPPORT GROUPS AWAKE (Alert, Well and Keeping Energetic) Offers information and support for those dealing with sleep apnea or other sleep disorders. Call 849-8700 for dates, times and locations. Alzheimer’s Family Support Group Provides support and education to caregivers, family and friends of those diagnosed with Alzheimer’s disease. This group meets on the second and fourth Tuesday of each month, 4 pm at the EJGH Adult Day Care Center at 3929 West Metairie Ave. Call 837-2629 for more information. Better Breathers Club This support group is for people with chronic conditions that affect breathing, such as asthma and COPD. Call 456-5000 for dates, times and locations. Bosom Buddies Education and support group for women with a breast cancer diagnosis. Meetings are the third Wednesday of each month at the Breast Care Center, 6:30 - 8 pm. Call 883-8989 for more information. Caregivers’ Group Support and encouragement for those caring for a loved one. The group meets at the Counseling Center, 3601 Houma Boulevard, Ste 206 on the third Tuesday of each month from 6:30 - 7:30 pm; call 454-4066 or 885-3373 for more information. Celiac Sprue Association Offers education and support for people with gluten intolerance. Call 454-4391 for dates, times and locations. Compassionate Friends This group is for families who have experienced the loss of a child. Meetings are the second Monday of each month in the EJGH auditorium. Call 887-4599 for more information. Defibrillator Support Group This support group is for patients with internal defibrillators. Meetings are bimonthly. Call 456-5000 for dates, times and locations. Diabetes Support Group Members share information and support each other to promote successful management of diabetes. Meetings are held on the last Thursday of each month, Noon – 1 pm in EJ North, 7th Floor. Call 849-8600 for more information. Grief Support Group Sponsored by the American Cancer Society, this program is for those who have experienced the death of a loved one. Meetings are held every Wednesday from 6:30 – 8 pm in the Yenni Treatment Center. Call 456-5000 for more information. I Can Cope Offers education and support to cancer patients and their loved ones. Call 456-5000 for dates and times. Ostomy Support Group Education and support for those coping with the challenges of living with an ostomy. Meetings are held bimonthly on the second Tuesday of even months from 7 – 9 pm; call 454-4941 for more information. Pulmonary Hypertension Support Group This patient-led group provides support and information for those living with pulmonary hypertension. Please call 731-6113 for dates and times. Sarcoidosis Support Group Designed for those living with sarcoidosis, a chronic condition that often involves the lungs and causes difficulty breathing. Please call 454-4882 for dates and times. Self Help for Hard of Hearing Provides information and support for the hearing impaired. Group meets on the third Saturday of each month at 10 am. Call 834-4339 for more information. Stroke Support Group Offers support to stroke survivors and their families. Meetings are held on the last Wednesday of each month at 6:30 pm in the 8th Floor Gym. Call 456-5000 for more information. 15 HEALTHYlifestyles EJGH Auxiliary Raising Funds and Raising Spirits Since 1971 “Besides the many, many volunteers who give countless hours of service to East Jefferson General Hospital, the Auxiliary continues to be involved in endeavors to raise much needed funds,” says Jean Rice, EJGH Auxiliary President. The Auxiliary’s biggest fundraiser, the Great Lady/Great Gentleman Awards Luncheon, honors eight members of the metropolitan community for their outstanding volunteer work in the New Orleans area. According to Rice, “This event is to honor those who have gone above and beyond in their service to the community.” The money raised from both the patron party and the luncheon provides funds for nursing scholarships and continuing education for the medical staff at EJGH. Since the Auxiliary started, more than 200 nursing scholarships have been funded by the program, and in excess of several million dollars have been donated to the hospital, from funds raised by the Auxiliary. The Auxiliary also operates the East Jefferson General Hospital gift shop, the Sunshine Boutique, donating the profits at the end of the year to the hospital. The boutique carries an extensive array of gifts, collectibles, decorative items and greeting cards. There is a florist on staff who designs floral arrangements and decorative potted plants, and annual art and jewelry shows. The funds from the gift shop go toward the check the Auxiliary gives the hospital at the end of each year. In addition to its fundraising endeavors, the Auxiliary reaches out to members of the community who need it most with its Care-Ring program. Volunteers make daily telephone calls to community members who are homebound, live alone, or are recuperating from surgery or illness. WANT TO JOIN? All you have to do is fill out the membership form, enclose your check for dues, and mail to the address indicated. Then you’ll be eligible for these upcoming Auxiliary events: • D octor’s Day – March 28. The Auxiliary honors EJGH doctors on their own special day for the dedication they show to the hospital and its patients all year long. • G reat Lady/Great Gentleman Awards Luncheon – Patron Party, April 3; Luncheon, April 6, Audubon Tea Room • G eneral Meeting – April 23, 10:30 a.m., Conference Center, lunch provided • A uxiliary Officer’s Installation – May 16, Conference Center, lunch provided The money raised from both the patron party and the luncheon provides funds for nursing scholarships and continuing education for the medical staff at EJGH. Since the Auxiliary started, more than 200 nursing scholarships have been funded by the program, and in excess of several million dollars have been donated to the hospital, from funds raised by the Auxiliary. EJGH Auxiliary Membership Application Name: Address: Phone number: Type of membership desired: Active Member ($20 yearly) Life Member ($100 contributed within a 12-month period) Make check payable to EJGHA. Mail to: Phyllis Stacy, Membership Chair, 4505 Elmwood Parkway, Metairie, LA 70003 Committees/Activities in which I am interested: Gift Shop Care-Ring Program Great Lady/Great Gentleman Committee Call 504-887-3434 for more information. 16 East Jefferson General Hospital 16-17.indd 2 2/18/08 3:45:34 PM Tax Aid Program Benefits Seniors After John Burgbacher retired from Shell Oil after 36 years as a chemical engineer he “was looking for something to do, so I took an H&R Block course to do my own taxes. Some friends of mine were involved with the AARP Tax Aid Program and I decided to volunteer myself.” That was 15 years ago and Burgbacher is still helping seniors with their taxes. As District Coordinator for the program in Jefferson, St. Charles and St. John parishes, Burgbacher oversees approximately 40 volunteers at eleven sites, one of those being East Jefferson General Hospital. “It’s such a wonderful program for our seniors. Taxes can be so confusing,” says Nina Victory, Supervisor of the Elder Advantage Program at East Jefferson General Hospital, a sponsor of the AARP Tax Aid Program. Last year over 400 returns were filed through the program at EJGH. No appointment is necessary and there are three or four volunteers available each day for assistance. All returns are filed electronically and there is no charge for the service. Those interested in taking advantage of the program should bring their 2006 tax return; any 1099s, W-2s, or brokerage equivalent statements; and the declarations page for their homeowner’s policy, as residents of Louisiana are eligible for a refund of their Citizen’s Fair Plan Assessment. EJGH Foundation Elder Advantage AARP Tax Aid Program Feb 4 – April 10, Monday – Thursday 9 am – 2 pm (no returns started after 1 pm) FREE Electronic Returns Only EJ North, 1st floor 4320 Houma Blvd, Metairie Call Elder Advantage at 504-454-4066 for more information. Volunteers run the entire program, including training new volunteers. The volunteers must complete a three-day training course and pass an IRS certification examination before they can begin assisting others with their taxes. Burgbacher encourages those with a desire to help to get involved and go through the training process. “We can always use more volunteers.” A Lifetime Income – A Meaningful Gift Charitable Gift Annuities To create a Charitable Gift Annuity (CGA), a donor gives cash, stock, or other assets to a favorite charity. In return, the donor receives a fixed payment, called an annuity, for the remainder of their life, as well as a tax deduction. With this type of annunity you can contribute to a worthwhile non-profit organization while also enjoying both income and tax benefits. AGE RATE 55 5.5% 60 5.7% 65 6.0% 70 6.5% 75 7.1% 80 8.0% 85 9.5% 90 16.3% For example, if you donated $10,000 to East Jefferson General Hospital’s Foundation you would receive a percentage of your donation back each year in a fixed annuity, based upon your age (see table). You would also receive: Tax Advantages. Part of your gift can be used for an income tax deduction now, plus a portion of your income payments may be tax-free. Your gift can reduce or defer capital gains tax if you choose to donate appreciated securities. Fixed-Income. You win peace of mind with a fixed-rate income for life, and the knowledge that ultimately you will help your favorite charity to continue its mission. Simplicity. Charitable gift annuities are relatively straightforward and often less complicated than commercial annuities. It is important to note that gift annuities are not insured, and they are not transferable to a donor’s heirs if the giver dies. And remember, any prospective donor should always seek the advice of qualified estate and/or tax professional to make sure a gift annuity is right for them. Ejgh foundation Please call EJGH’s Foundation at 504-780-5800 to find out more about gift annuities, or to receive a personalized illustration of a gift annuity. You can also get additional information on the Foundation/Giving website at www.ejgh.org. Or complete the form below and return it to: EJGH Foundation, 4200 Houma Blvd, Metairie, LA 70006 GIFT ANNUITY COUPON Dear Friends at the EJGH Foundation, Please send me complimentary information about charitable gift annuities. Please send me a personalized illustration of a gift annuity. Date of birth: ________/_________/_________ (First donor) Date of birth: ________/_________/_________ (Second donor) I am thinking about donating $_____________ to establish my gift annuity. Name(s):_________________________________________________________________ Phone Number: _____________________ E-mail address:_______________________ 17 HEALTHYlifestyles 16-17.indd 3 2/20/08 10:06:39 AM Saving and Serving Lives. Every day, this dedicated team of men and women serve as the mobile first line of healthcare for our community. East Jefferson General Hospital’s EMS Service – It’s what they do. 9-1-1 24 hour Emergency Response: EMS ad-Feb08 1 East Jefferson General Hospital Emergency Medical Services 2/18/08 4:51:56 PM
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