Being Well 902: Hand and Wrist Issues

Being Well 902:  Hand and Wrist Issues


[music plays]
[no dialoge]>>Lori Banks:
On this edition of Being Well, Hand Surgeon Patrick Stewart from Southern Illinois Hand
Center in Effingham will be our guest. We’ll be talking about common hand issues
such as tendinitis, arthritis and carpal tunnel syndrome.
Dr. Stewart will address the causes and treatment options.
We’ll also learn if all that texting and video gaming is really doing us harm.
Stay tuned for another informative edition of Being Well.
[music plays] Production of Being Well is made possible
in part by: Sarah Bush Lincoln Health System, supporting
healthy lifestyles. Eating a heart healthy diet, staying active,
managing stress, and regular checkups are ways of reducing your health risks.
Proper health is important to all at Sarah Bush Lincoln Health System.
Information available at sarahbush.org. Dr. Ruben Boyajian, located at 904 Medical
Park Drive in Effingham, specializing in breast care, surgical oncology, as well as general
and laparoscopic surgery. More information online, or at 347-2255.
>>Singing Voices: Rediscover Paris.
>>Lori Banks: Our patient care and investments in medical
technology show our ongoing commitment to the communities of East Central Illinois.
Paris Community Hospital Family Medical Center. HSHS St. Anthony’s Memorial Hospital, delivering
health care close to home. From advanced surgical techniques and testing, to convenient care
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Where you come first. [no dialogue]
Thanks for joining us for today’s edition of Being Well.
And I have a guest in the studio, brand new to the show, Dr. Patrick Stewart, who is a
hand surgeon from Effingham. Thanks for coming up today.
>>Dr. Patrick Stewart: Thank you for having me.
>>Lori Banks: Well tell us al little bit, how does one become
a hand surgeon?>>Dr. Patrick Stewart:
Well for me it was a rather fortuitous experience. I was in medical school, and I was doing some
special research projects, interested in orthopedics and surgery.
And the chairman of the department actually came down to the gross anatomy lab.
It was a Saturday morning, of course nobody else was there.
And I was very impressed because he knew my name.
And he said, “Come with me.” And so, we walked out of the anatomy lab,
we went upstairs, and he walked out of the building.
And I was a little puzzled, and I followed him.
And he walked to his car and sort of ushers me to get in.
And I asked like, “Dr. Watson, where are we headed?”
He said, “We’re going to the zoo.” I thought, oh well, that’s really nice.
I said, “I have some work I really need to do.”
And he said, “No, no, no.” There was, one of their gorillas had fractured
their hand, and they did not have an orthopedic surgeon on site at the zoo.
So, they could do the anesthesia, but couldn’t necessarily do the surgery.
So, we went over and actually operated on a gorilla’s hand.
And the interesting part was we put a plate that we put on one of our forearm bones in
the bone in his hand to stabilize it, because obviously he was not going to follow post-op
instructions, wasn’t going to leave a cast on or anything like that.
And so, that really opened a door, and the chairman being a hand surgeon then sort of
explored that, and that’s where I ended up years later.
>>Lori Banks: So, your first patient was a gorilla.
>>Dr. Patrick Stewart: Yes, it went very well, so.
>>Lori Banks: Okay, so as a hand surgeon, what kinds of
cases or issues are you treating?>>Dr. Patrick Stewart:
We have, I came to practice here, I joined Dr. Naam, who’s also a hand surgeon.
We’ve subsequently added another hand surgeon. And we’ve limited our practice really to the
hand, wrist, and up to the elbow. Our newest partner does some shoulder arthroscopy
and work, but we really concentrate on hand function, hand injuries.
There are tendon problems, arthritis problems, ligament problems, and there’s just such a
wide, diverse array of issues that can occur. And because of the complexity, we’ve decided
to really limit our practice to just those areas.
>>Lori Banks: Alright, so we’re talking today about, we’re
going to getting into all sorts of issues, but it all kind of falls under a big topic
called compression neuropathy. It makes me sound so smart when I say that.
Explain what that is and what kinds of issues fall under that umbrella term.
>>Dr. Patrick Stewart: Neuropathy is a generalized term that’s used
to describe nerve dysfunction, so it’s not functioning, acting the way it’s supposed
to. That can be in the form of loss of sensation,
numbness, tingling. It can be in the form of not having as much
strength in that nerve distribution. For hand surgeons, the most common compression
neuropathy is referred to as carpal tunnel. And that is the median nerve being compressed
in the wrist underneath the transverse carpal ligament.
>>Lori Banks: I’m going to hold up the hand–
Explain– I’m going to hold it while you point out where
this, where, when you’re dealing with carpal tunnel, where exactly in the hand is that
occurring?>>Dr. Patrick Stewart:
So, the long blue rubber band here represents one of the flexor tendons.
So, we have two flexor tendons to each of our fingers usually, sometimes only one to
the small finger, and then one to the thumb. Those go through this tunnel, which is right
here. The ligament runs from sort of this bony structure
across to these bony structures. So, that’s the reason that we can get into
trouble is that three sides of the tunnel are surrounded by bone.
Bone doesn’t expand really well without breaking. And the ligament is sort of a thick, canvas
layer, so it serves as a protective function. But if it gets thickened, if it gets increased
pressure, it has limited ability to expand or bow, and therefore then we develop pressure.
The tendons deal with pressure a lot better or more easily than the nerves do.
The nerves are an extension of our brain. The brain doesn’t like increased pressure.
And when it gets it, then it tells us about it.
And most commonly the way it will tell patients is at night, they may wake up and they may
have some numbness and tingling in their fingers. That can occur commonly because of sleeping
position. We always talk to patients about if they’re
sort of huggers and they crank their wrist down, the farther we flex our wrist down,
the more pressure we put on that nerve. So, it’s one thing to do it for five minutes
while you’re doing an activity. It’s very different thing to do it for two
or three hours while you’re sleeping. And it’s often why people wake up.
Similarly if they have an extended position in their wrist, they’re putting more tension
or pressure on that nerve.>>Lori Banks:
Okay, so we tend to think of people who get carpal tunnel, a lot of people who do a lot
of computer work. Is that the typical culprit or cause of carpal
tunnel syndrome?>>Dr. Patrick Stewart:
It actually is not. There’s a common belief that has occurred,
and they’ve looked at this over time because it’s important.
It’s important to know what does and what doesn’t put us at an increased risk.
And the activities that do are forceful and repetitive.
So, data entry in and of itself is not forceful. Now that we’ve gotten to the point where most
of the work stations, computer desks are more ergonomic, they put our hands in a reasonable
position, that has not been as much of an issue.
Now I have had a patient, and I’ll tell people that that’s my opinion.
Sometimes they don’t necessarily like that. But and they said, “Well have you ever had
a patient that you said their data entry was?” And I did, but it was a rather unique situation.
This was somebody who did monitoring and did quality assurance in a factory, and they were
having to monitor parts, and they would have to enter data.
Well they happened to keep knocking their keyboard off out in the factory, and it would
break. And their supervisor got upset with that,
didn’t want to keep replacing it. So, they literally screwed the keyboard to
the wall. So, this person had to sit like this–
>>Lori Banks: Oh yeah, that’s bad.
>>Dr. Patrick Stewart: And that was not good, and they subsequently
developed carpal tunnel from that. But running a jackhammer, where you have a
forceful, repetitive activity, but also vibration is really a problem.
And cold exposure.>>Lori Banks:
Okay, so construction jobs and jackhammering, and…
What about… and then cold. Why is cold a factor?
>>Dr. Patrick Stewart: It’s interesting, that was discovered actually
through primarily the forestry industry and meatpackers.
And there’s a very, very high incidence, and it’s the cold that adds to it.
Because, you can take people who do similar things, but are no necessarily doing it in
a refrigerated environment. I mean, we’re not talking about air conditioning,
obviously, we’re talking about cold enough that it preserves the meat.
And they have a much higher incidence of developing carpal tunnel.
>>Lori Banks: Alright, so what are some of the symptoms
of carpal tunnel? What does it feel like?
>>Dr. Patrick Stewart: Most commonly it will be numbness and tingling.
Everybody, some will say it’s a buzzing sensation. Some say it feels like pins and needles.
It can then become more annoying or become burning, what we call dysesthesias.
That usually will happen, again, at night. But it can happen after prolonged activities.
One of the things is driving. Patients will commonly come in and say, “Boy,
I’m driving down the road, I take my hands down off the wheel, sort of shake them and
put them back up on the wheel.” So, a prolonged activity is something where
that’ll bring those symptoms out. If it gets farther down the road, you can
have problems manipulating small items. I’ll ask patients or I’ll put something on
the desk, and I’ll say, “Pick that up.” And oftentimes if they’ve gotten to the point
where they’re having those difficulties, they’ll actually take those, scoop them into the other
hand because they can’t pick them up with their fingertips.
They can’t put their hand in their pocket and identify a quarter vs. a nickel because
just they’ve lost that sensibility. Farther down the line most commonly then is
we lose motor, so we lose some strength. And for carpal tunnel it’s the movement of
the thumb, where what makes this different from that gorilla, my first patient, is the
ability to oppose our thumb to bring it out of the plane of the hand so we can grasp things.
The simians can only do this.>>Lori Banks:
Oh, I didn’t know that.>>Dr. Patrick Stewart:
So, by our being able to do that involves this muscle here, which is innervated by the
carpal tunnel nerve, median nerve. And we have some patients that’ll come in
that have had it for so long, that that is gone.
It’s completely flat, and they cannot elevate their thumb.
That then requires a more complex surgery to reconstruct that ability doing a tendon
transfer for that patient.>>Lori Banks:
So, at what point should someone see their doctor?
And then can you… you obviously don’t do surgery right away.
But when, let’s start with when should someone see their doctor about this?
>>Dr. Patrick Stewart: Well if they’re having just nighttime symptoms,
a reasonable place to start is starting with just cock-up wrist splints, and that’s something
that can be purchased at any one of the pharmacies. And it’s just designed to hold your wrist
in a neutral position, sort of relatively straight, maybe a little bit of extension.
And that prevents you from sleeping in that funny position.
If that doesn’t resolve it, then you should be– because what we don’t want to do is sort
of misdiagnose and let something be farther down the road.
Because, there are other things that can cause numbness and tingling in the hands that we
don’t want to ignore or push down the road, as far as diagnosis.
>>Lori Banks: Okay, so when you do have to go in and do
surgery, what are you doing?>>Dr. Patrick Stewart:
We’re actually releasing that ligament that goes over the top of the nerve and those tendons.
And so, I always describe it as this is sort of a flat-top roof, and what we’re doing is
we’re going in and releasing that ligament. And when there’s pressure, when we release
that what happens is that pulls back and elevates. By doing that, we’ve taken the flat-top roof
and we’ve given it a pitch. And so, we’ve increased the volume of the
tunnel and taken pressure off the nerve.>>Lori Banks:
Alright, so where do you do an incision then at?
>>Dr. Patrick Stewart: For carpal tunnel, if we’re doing a standard
carpal tunnel release, and this is done very differently depending on your training.
Years ago people were making an incision, and it could be an incision from there to
there to release the median nerve. As the anatomy and technology has gotten better,
we’ve been able to shorten that incision. So, a standard carpal tunnel incision will
oftentimes be here. I do mine endoscopically, so I was trained
from the beginning, so I make a small incision here.
I like that from the fact that–>>Lori Banks:
I’m trying to show that to the camera, and my arm just does not bend that way!
[laughing] I’ll go like this.
>>Dr. Patrick Stewart: Because by making an endoscopic incision,
I don’t have an incision on the palm of the hand.
If patients are going to have difficulty after carpal tunnel, most commonly it’s tenderness
across here, especially with loading. I think that’s decreased by not having the
incision there.>>Lori Banks:
Okay, so a one-centimeter incision sounds like a much better deal than a big thing right
here. So, what are the, what’s the recovery like
if you have that?>>Dr. Patrick Stewart:
For our patients, again this has changed dramatically. They used to cast patients or splint them,
and they would be off and not doing anything for six or eight weeks.
We put them in a soft dressing, so their fingers are free.
They don’t have any splint, they can move. I tell them use their hand as they’re comfortable.
I said if it’s a little bit of discomfort’s okay, you shouldn’t be in pain to do anything.
They’re not going to undo what I did at surgery by releasing it.
But they can make it sore, they could cause some additional bruising, so we don’t want
them to go out and get crazy. But a week after surgery we change to a bandaid.
At two weeks we take the one stitch out. There’s one suture.
And then I allow patients to progress back. Most patients are back to regular activities,
regardless if it’s jackhammering or working in an office, or taking care of their kids
at four weeks, no restrictions.>>Lori Banks:
That’s not bad. Once you have that surgery, can you get this
carpal tunnel back?>>Dr. Patrick Stewart:
You can. The published data says five to 10% at 10
years. I think that personally is high.
I’ve been in practice now for over 16 years, and I’m not redoing five or 10% of my patients,
and I’ve been doing it for more than 10 years. So, I think that’s a bit high.
And that’s returning back to the activities that may have put them at that increased risk.
Now the caveat I always tell patients is vibration. Vibration will put you at an increased risk,
but it’s also something the nerves in general do not like.
And it’s the reason that if we run a weed eater, after a few minutes your nerves are
like, you know, you feel a little numb because they’re telling you put that down, it’s vibrating.
Well you finish the yard because you have to, and then you sit down and your hands may
be numb for five or 10 minutes. Patients who have had carpal tunnel and vibration
has been a significant component of that, if they go back and they have to run a palm
sander or a grinder, or something like that, I’ll tell them that oftentimes your numbness
and tingling will come back after you use that implement, and it may last for a day.
>>Lori Banks: Okay, it kind of hangs out for a while.
>>Dr. Patrick Stewart: Yeah, it doesn’t mean that the carpal tunnel
or the pressure is back, but the nerve is sensitized to that particular aggravating
factor. And so, I have some patients where they do
that all week, and so essentially their hands are numb all week.
But sometime on Saturday the numbness is gone, and then they’re able to enjoy their weekend.
But they know because that’s their job that they have to, but their carpal tunnel is not
back.>>Lori Banks:
Okay, there was another term that came up in my research, and that’s cubital tunnel.
What’ the difference between carpal and cubital? Am I saying it right?
>>Dr. Patrick Stewart: You are.
This is the second most common compression neuropathy.
And this is of the ulnar nerve. So, first it’s a different nerve, and it’s
obviously in a different place. The median nerve, carpal tunnel we were talking
about, can be compressed here. The median nerve can also be compressed in
more of the proximal forearm under the muscle. Much, much less common.
The ulnar nerve is sort of the opposite. The ulnar nerve can be compressed here at
the elbow, at the funny bone as everybody refers to it.
>>Lori Banks: Yes, that’s when you hit that and get that
weird sensation.>>Dr. Patrick Stewart:
Yeah, that sensation is the signal going down the nerve, because it’s actually the nerve
that you’re hitting or contusing that’s giving you that funny bone feeling.
So, that nerve is at the elbow. It can be compressed at the wrist sort of
right next to the carpal tunnel, much less common for it to be compressed there.
>>Lori Banks: Okay, we often hear, you know, carpal tunnel,
cubital tunnel. We also hear about things like tendinitis.
First of all, what’s tendinitis in general?>>Dr. Patrick Stewart:
Tendinitis is when you do an activity… We go and we lift weights, we get sore because
we’ve lifted more than the muscle’s really capable of lifting at that point.
But then we allow them to recover and we’re stronger.
It’s when we overload and we cause some of that soreness, specifically within a tendon
that we don’t have enough time for full recovery. And so, it then feeds upon itself and it’s
inflammation. So, it causes discomfort in movement of that
tendon. The most common tendinitis we see are down
in the hands, like in the wrist. Tennis elbow…
>>Lori Banks: Is tendinitis?
>>Dr. Patrick Stewart: It is called tendinitis, it’s more of a tendinosis.
And it’s a fine line, but there’s not inflammation, it’s more degeneration.
There’s more loss of the adherence of that tendon or ligament to the bone that’s become
the issue. So, for golfer’s elbow, tennis elbow, it’s
a little bit different. Treated similarly, as far as rest and allowing
for that recovery.>>Lori Banks:
Okay, what kind of activities cause tendinitis in the hands and the wrist area that you see?
>>Dr. Patrick Stewart: It can be repetitive activities.
One of the things that is a common tendinitis that we see are tenosynovitis, similar, when
there’s a sheath that it goes through and that gets inflamed, we refer to it that way
is De Quervain’s, so along the radial side of the wrist, sort of just beneath the thumb.
>>Lori Banks: Yeah, this thing right here, right?
>>Dr. Patrick Stewart: Yes, it can get painful and patients will
have discomfort with use. Now one of the areas that I see it commonly
occur is after a new baby. It’s funny because you’ll see whether it’s
grandma, the new mom, sometimes a nanny or babysitter, because they’re grabbing and scooping
the child. And you know, I say to patients, they come
in, and I’ll ask the grandmother, “New grandbaby?” And she’ll look at me, and they just know.
And so, that is inflammation around two of the tendons that go to the thumb.
And it goes through a little compartment. So, our tendons, if we think about them similar
to a string on a bow, they need to be held in a particular place or they’ll want to pull
away. They’ll want to go between the two ends of
the bow. So, if we don’t have a sheath, if we don’t
have a tunnel for them to go through, they won’t be as functional.
So, this it goes through a tunnel. If that tunnel gets too tight, then it’s painful
to pull the tendon through it. That we can treat conservatively most commonly
with just an injection and then a short period of mobilization, and then it goes away.
>>Lori Banks: So, what kind of, is it an anti-inflammatory
injection?>>Dr. Patrick Stewart:
Yeah, it’s a steroid, so it is a cousin of prednisone.
But the steroids have lots of different effects. People hear steroids and they think, oh my
gosh. One, we’re very fortunate in that we’re not
injecting it into a muscle and we’re not injecting it into a vein, so the body doesn’t see all
the medicine. So, people are worried about, and rightfully
so, the effects of steroids when they take them by mouth for a long time or they get
lots of injections in muscles and things. Because, there it’s being absorbed and your
whole body is seeing it. In this case there’s a limited amount that
your body’s seeing, and so we’re getting maximum benefit by putting the maximum amount of medicine
where the problem is, and limiting the side effects by not being absorbed fully.
>>Lori Banks: Okay, so before you call your local hand surgeon
for your tendinitis, are there some things that you can try at home first?
>>Dr. Patrick Stewart: You can try an anti-inflammatory.
Aleve and Ibuprofen are very good. I think it’s interesting there’s new warnings
out based on the cardiovascular and stroke risk.
And this sort of came out of the Celebrex, Bextra, Vioxx, which were medications that
came out that were tolerated very well from the standpoint of the stomach, but did have
an increased risk. Well essentially all the non-steroidal anti-inflammatories
have that risk. You have to be careful because these are over
the counter medications. But you can try that.
And I always tell patients if you’re going to take a medication, take it like you mean
it, meaning take it at the prescribed dosing and on the prescribed level.
Tylenol’s a pain medicine, so if you have a headache it sort of blocks the pain.
It doesn’t treat the underlying cause. The anti-inflammatories like Aleve and Ibuprofen
are designed to take down inflammation. But for Ibuprofen you have to take it three
times a day, for Aleve you have to take it twice a day.
If you take less than that, then we get the medicine going up in our bloodstream, inflammation
going down, and then as the medicine goes down we can sort of pinball back and forth.
>>Lori Banks: Yeah, it doesn’t really do what it’s supposed
to do.>>Dr. Patrick Stewart:
Right, and so I tell patients take it for five or six days on a scheduled basis, even
if you feel better after two or three days, to really knock that inflammation down.
>>Lori Banks: Yeah, okay:
So, I have to ask, are you getting a lot of people…
You know, we’re a texting world [makes texting noise] and video gaming.
Are you getting people coming in with issues with their texting thumbs or, you know, anything
like that?>>Dr. Patrick Stewart:
I think we’re seeing more aggravation as far as thumb arthritis because the thumb is also
based on the way it’s built and the way it’s designed, it’s a lever.
And so, there’s actually an increase in the amount of weight.
So, if we push with one pound of pressure in our thumb tip, it’s three pounds back at
the basilar thumb joint. That is one of the most common places that
patients can develop arthritis because our thumb does essentially four times the work
of the rest of the hand, because it opposes the other four fingers.
So, patients, as we get older, my age and older will start to develop discomfort in
the thumb because it’s been doing so much work.
But it’s also because it’s sort of an at-risk joint.
It’s a very supple and sloppy joint, from the standpoint that it can do so many things.
It can move in all planes, round and circles, whereas a lot of our other joints are more
diarthrodial. They can only sort of move up and down, and
they have limited motion otherwise. By having all that motion, it’s a little bit
too sloppy. And so, the bones can slide inappropriately
and wear out to some degree.>>Lori Banks:
Alright, so you had talked about you’re seeing something called trigger finger, which isn’t
necessarily something that is firing a weapon a lot.
What is trigger finger?>>Dr. Patrick Stewart:
And trigger finger is a condition where the tendons don’t want to glide through that tunnel
that we talked about. In this case it’s on the palm side of the
hand. So, rather than the top side, we were talking
about De Quervain’s, it’s on the palm side. And so, they may have either difficulty getting
their hand into a full fist, or if they get it down into a fist all the fingers may come
up at once. And it’s sort of stuck.
Sometimes they actually have to pull it to pop it loose.
Other times they’re able to sort of force it open.
That’s usually from a little bit of swelling within one of the tendons, most commonly the
sublimis tendon. We just talked about before we have two tendons
to each of our digits. And if that gets a little bit full, the tendon
and the tunnel have essentially zero tolerance. They are perfectly matched as far as size.
So, if they get a little swelling, somebody’s not happy.
And so, it will have a tendency to not want to glide as easily, so they have a hard time
getting it down. But if that little bit of swelling gets down,
it gets outside the tunnel, now it doesn’t want to go back in.
>>Lori Banks: Oh, so that’s where you’ve got to go [making
effortful noise], or push it open or in. What’s causing that trigger finger, what kinds
of activities?>>Dr. Patrick Stewart:
It’s something that most commonly is idiopathic. A lot of these we have different characteristics
of the person that can put us at increased risk.
So, if you’re a diabetic you have an increased risk for developing trigger fingers, different
tendinitis and carpal tunnel. If you have rheumatoid arthritis, that’s also
the same. Any kind of autoimmune, inflammatory condition,
so lupus, psoriasis, rheumatoid arthritis, those all put you at increased risk.
Activities, if you are really doing a lot of repetitive activities.
And I think part of the reason, this is again a little bit of a design defect, but the original
architect’s not available for comment. [laughing]
It is because of the angle that the tendon has to take as we bend our fingers, because
that first part of that tunnel’s right at a joint.
And so, if you can imagine the tendon is traveling parallel to your hand, and then also your
fingers come up at a 90-degree. Well that tendon is taking that 90-degree
turn and can rub on the front side of that. So, if ultimately we have to do a surgery,
all we do is we move that point of transition out about a centimeter to a centimeter-and-a-half,
and it resolves the problem.>>Lori Banks:
Okay, you wanted me to ask you about CMC arthritis.>>Dr. Patrick Stewart:
Yes, that was one of the things I alluded to as far as the texting or doing activities.
And this little guy has demonstrated lots of different joint replacements.
So, these are all silicone joints that have been used.
But this little cylinder here at the bottom is one.
We don’t necessarily use this one anymore, but this represents the CMC joint.
And it’s where the thumb comes in contact with the wrist.
And that’s the joint that again is at most risk for those when we are grasping and doing
different activities because of the increased load.
And because it’s got that variability and circumduction, moving in a circle, up, down,
it can slide in and out. And when it does that, it starts to wear inappropriately
on the cartilage. When we have perfectly matched cartilage,
there’s less friction between the cartilage than there is between two pieces of ice sliding
across one another. So, when it’s healthy and perfect, it is wonderful
When it starts to go south, then we have to intervene.
>>Lori Banks: So, is excess of texting or video gaming bad
for our joints and hands?>>Dr. Patrick Stewart:
Because it has a limited load, we’re not seeing a dramatic problem as far as that’s concerned.
If you have an underlying problem I think it can exacerbate or aggravate it, yes.
>>Lori Banks: Alright, well Dr. Stewart, our time is up.
Thank you so much. Who would have thought that this little hand
could be so complicated? It’s a perfect, well it’s an imperfect design
and we use it so much. And it can come with some problems.
So, thank you for coming to Being Well today and telling us all about what hand surgeons
do and the kinds of things you use to make us better.
>>Dr. Patrick Stewart: Well thank you very much.
Thank you for having me, and I hope the viewers were happy to learn some things.
And if there’s any questions, they certainly can contact their physician and find out more.
>>Lori Banks: Alright, thanks Dr. Stewart.
>>Dr. Patrick Stewart: Thank you.
>>Lori Banks: [music plays]
Production of Being Well is made possible in part by:
Sarah Bush Lincoln Health System, supporting healthy lifestyles.
Eating a heart healthy diet, staying active, managing stress, and regular checkups are
ways of reducing your health risks. Proper health is important to all at Sarah
Bush Lincoln Health System. Information available at sarahbush.org.
Dr. Ruben Boyajian, located at 904 Medical Park Drive in Effingham, specializing in breast
care, surgical oncology, as well as general and laparoscopic surgery.
More information online, or at 347-2255.>>Singing Voices:
Rediscover Paris.>>Lori Banks:
Our patient care and investments in medical technology show our ongoing commitment to
the communities of East Central Illinois. Paris Community Hospital Family Medical Center.
HSHS St. Anthony’s Memorial Hospital, delivering health care close to home. From advanced surgical
techniques and testing, to convenient care for your family. HSHS St. Anthony?s makes
aˇdifference each and every day. St. Anthony’s. Where you come first.
[no dialogue] [music plays]

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