Knee replacement surgery was first performed in 1968. Originally, joint replacement surgery was reserved for patients typically over 70 years old. Due to concerns of implant failures, replacement surgery on younger patients was avoided. Although these procedures typically improved arthritic knee pain, some residual pain, stiffness and a feeling that the knee was never quite normal was not uncommon. Since then, there have been advancements in surgical materials and techniques which have greatly increased the effectiveness and longevity of the replacement. Knee replacement surgeries are commonly performed at the hospitals of Wayne and Holmes County as well as the Wooster Ambulatory Surgery Center by local orthopaedic surgeons.
Standard off-the-shelf, non-customized knee joint replacement surgery is a safe and effective procedure to relieve pain, correct deformity and help you resume normal activities. Despite this, some patients are still hesitant to consider total knee replacement surgery. When asked why patients with a painful, arthritic knee are postponing surgery, many patients admit to waiting for a "new or better" procedure. Customized knee replacement surgery with patient specific cutting guides and a customized implant may likely be their answer. In simple terms, the implant is the metal and plastic that is used by the surgeon to replace the patient's removed arthritic knee bone.
For the first time in this area, customized knee implants are now available for patients who need partial or total knee replacement surgery. These fully customized knee implants are uniquely designed for each patient and are manufacturing using proprietary, advanced "image to implant" technology developed by ConforMIS. With the use of a standard computerized tomography (CT) scan of the patient's arthritic leg, an individual patient specific total knee replacement or partial knee replacement, with associated custom cutting blocks to be used by the surgeon, can be performed. Using 3-D printing technology, the knee joint is created one thick layer at a time with the same materials used for a traditional non-custom replacement. In essence, they are designing the implant to fit the bone rather than the bone to fit the implant, which better replicates the patient's natural anatomy. This process results in the implant that is the precise size and shape of the patient's individual joint.
This technology may represent a significant advantage over the current off-the-shelf knee implants. Off-the-shelf implants are available in only a limited range of sizes and shapes. As a result, when using off-the-shelf implants, surgeons need to make more extensive cuts to the patient's bone to accommodate the implant. This may be a major factor that causes approximately 1 out of every 5 knee replacement patients to suffer residual pain caused by ill-fitting implants. This also may result in a mismatch between the size and shape of the patient's bone and non-custom implant which may result in functional limitations for the patient. With customized implants, the size and shape of the implant is knee and patient specific, which may lead to a more normal feeling knee with better range of motion and higher patient satisfaction.
During the custom procedure, the surgeon cuts less bone to accommodate the implant, therefore patients can experience less trauma and postoperative pain. Patients with customized implants may have faster recoveries and be more satisfied with the results. The greater preservation of bone also helps to position patients for successful future surgeries if necessary,
Another benefit of customized knee implants is that they are developed with complete single use, customized cutting guides for the orthopaedic surgeon to use only on that patient. Because the implants are single use and disposable, there is reduced sterilization required compared with reusable instruments. There is less potential for contamination compared to reusable instruments. The cutting guides are also manufactured via 3-D printing and calibrated based on the patient's unique CT scan so they can fit the implant with the maximum precision. This allows the orthopaedic surgeon to align the implant more exactly. Proper placement and alignment has been found to help reduce implant wear and help ensure that the prosthesis lasts as long as possible.
While many patients do fine with non-customized knee replacement surgery, it is hoped that customized total knee replacement surgery will increase the number of more satisfied patients, giving them a more normal feeling, long-lasting knee replacement with less postoperative pain and an easier recovery.
If you or a loved one are experiencing arthritic knee pain and have been told you may need a knee replacement, the best way to find out if you are a candidate is to be evaluated by an orthopaedic surgeon. Please call 330.674.0775 for more information or to schedule an appointment.
Blog Written By: Rodney Miller, MD
time is here! The perfect time to check back to your New Year Resolutions and make sure you are staying on track! Are you staying committed to your
fitness goals? Are you still keeping sugary drinks out of your refrigerator? If yes, then pat yourself on the back and move forward with your next
responsibility to yourself: your yearly exams.
Check your calendar and make sure you are planning to see your Primary Care Provider this year for you physical. Keeping a relationship with your provider is incredibly important to make sure you are aware of your health and most of all, preventing illness. While your calendar is out, make sure you have your Dentist visit planned and any other preventative health screenings that are suggested for someone your age and gender. Please refer to the list below and make sure you are staying on track for a healthier and happier you.
Preventive Testing Guidelines
This chart does not take individual health risks into consideration. Depending on your risk factors, your doctor may recommend more frequent or additional screenings. These recommendations are based on current guidelines from the USPSTF, NIH, and CDC. Your individual plan coverage may vary.
|Heart Health||Blood Pressure||Men & Women: Every 2 Years|
|Cholesterol||Men 35 and Older: Annually|
|Women 45 and Older: Annually|
|Diabetes Screening||FBG, Oral Glucose, Tolerance Test, or A1C||Men & Women: 18 and Older at risk for developing diabetes|
|Cancer Screenings||Mammogram||Women 50 to 74: Every 2 Years|
|Pap Smear||Women 21 to 65: Every 3 Years|
|Colorectal Screening||Men & Women 50 and Older: As Advised by a Physician|
|Physical Exams||Men/Women 18-39||Every 5-10 Years|
|Men/Women 40-64||Every 1-2 Years|
|Pneumonia||Men & Women age 18 and older: Once as recommended by physician|
|Eye Exam||As recommended|
Blog Written By: Tara Martin, Wellness Coordinator at Pomerene Hospital
Spring has sprung and that means most of us will spend more time outside. We can't wait to get to the Holmes County Trail or go down the nearest township road with our bright purple FitBits strapped to our wrists. Just feeling the sun on our faces while looking at the trees in bloom gives us all the incentive we need to lace up those sneakers. But before we go, here are 3 things that can keep our goals in sight.
- As the kids say, Got Shoe Game? Of course, as a foot doctor, I am going to stress this point. Obviously, I am not talking about the latest neon color (although we 80's kids LOVE that these hues are back!). Instead I am talking about support. People often ask me which brand I prefer. The answer is which ever brand you do! What I mean is they should feel good, be activity appropriate, well structured with good support, and less than 6 months old. Shoes break down and wearing old ones is the fastest way to make your feet hurt.
- Slow and Steady Wins the Race. Most of us take a winter hiatus with our exercising. But with the first sunny day, we head outside ready for a nice hour long walk over the scenic hills of Holmes County. Last fall, we could do an hour without huffing and puffing, so it should be easy to jump right back into it. No! With any time off, whether due to an injury or an Ohio January, you must work slowly to rebuild your endurance. Your feet and legs need time to strengthen. Weekend Warriors often must slow their return to exercise due to tendonitis or strains. Gradually increase exercise time weekly. Don’t worry where you used to be. This is a healthy life style choice. You'll get back there, one step at a time.
- Variety is the Spice of Life. Any athletic coach will tell you to alternate work outs. Your feet, if they could talk, would say that too! If you are a walker or runner, don't stay on the hills every time out. Instead, alternate on flat paths or even try cycling. This will reduce demand and fatigue on bones, joints, and tendons. No one wants to spend April in a walking boot!
The phrase, "I have the flu" or "she or he has the flu" is fairly common. People say this is relation to all kinds of illnesses, including gastrointestinal bugs that cause vomiting and diarrhea. However, the real "flu" is a group of viruses called influenza. The real flu is a highly contagious respiratory illness that can infect the nose, throat or lungs. Signs and symptoms of influenza include the following:
- Sore throat
- Runny or stuffy nose
- Muscle or body aches
- Occasionally vomiting and diarrhea, more often found in children
How Does It Spread?
- Droplets from when people with the flu sneeze, cough or talk
- Touching a surface infected with the flu virus
- You may be able to spread the flu one day BEFORE you feel symptoms, or up to 5-7 days AFTER getting sick
What Should I Do If I Get The Flu?
- There are antiviral drugs that can lessen the severity and length of the flu, if given within the first few (2) days of symptoms. They are available
from your healthcare provider, they are not over the counter.
- Children and pregnant women can take the antiviral drugs
- Some possible side effects of antiviral drugs include nausea, vomiting, dizziness, runny or stuffy nose, cough, diarrhea, headache and some behavioral side effects. There are uncommon - your care provider can give you more information.
- Stay home and avoid other people
- Stay hydrated. Drink lots of fluids like Gatorade or other commercially prepared electrolyte solutions
- Acetaminophen or ibuprofen for fever and/or body aches, headaches
How Can I Prevent The Flu?
- Get an influenza vaccine every year
- Stay away from people who are ill
- Cover your coughs and sneezes
- Frequent hand washing
- Keep your hands away from your face
- Keep your work area clean. Wipe down your phones, computers, etc often with antibacterial wipes
- Be your healthiest self!
- Get plenty of sleep
- Eat a well-balanced diet with plenty of water, fruit and vegetables
- Exercise on a regular basis
Resources: CDC, 2017
The most wonderful time of the year can also become the most dreaded time of the year. Whether you are someone trying to commit to a healthy lifestyle or like most are just simply overwhelmed by the extra responsibilities the holidays bring, it becomes too easy to miss the magic and festivities of the season. In order to prevent this holiday trend, I have a simple tip that can not only be of benefit over the holiday season, but any time of the year as well. Two simple words sum up my philosophy- be present.
What do I mean by “be present“? To be present means to simply be in the present moment, not in the past nor future but right here, right now.
Instead of walking into your family gathering stressed about what has to be done and letting your mind stay there, make the conscious decision to be present in the moment with your loved ones. Continuously remind yourself to really notice what is happening around you: the people, the smiles, the aromas, the atmosphere, the conversations, everything. Your mind will keep wondering off but keep pulling your mind back to the present moment. This will help you to genuinely enjoy the company around you and will prevent you from missing all the wonderful moments the holidays bring to us. Also, just remember that whatever you are stressed about can wait until after you have left the gathering, - worrying will only rob you of the current moment you have been given for something that cannot be fixed now anyway.
Those of you who have committed to a healthy lifestyle have an entirely different dilemma, but I would prescribe the same advice- be present. Often times when we make the decision to eat healthier we obsess over food entirely too much, causing us to either deprive ourselves, binge, put way too much pressure on ourselves or all three. I challenge you to remove the focus from food and place it on family. Instead of unconsciously eating and snacking or worrying about what to eat, take the time to engage in conversation, build relationships and be present. Don’t get excited about all the food and sweets, get excited about the people.
Lastly, in the weeks leading up to Christmas, do not allow yourself to be overwhelmed. Plan ahead of time, make a list, tackle one thing each day and keep things in perspective. The holidays were never intended for the stress we have attached to them over the years. Don’t over-complicate things, keep it simple and focused around what truly matters. Be present for the holidays and I challenge you to apply this same mantra to the rest of your days as well.
By being present this holiday season, and all of your days, you will receive the most valuable gift of all- a heightened quality of life, eyes opened to the wonderful world around you, a grateful heart and less stress.
Wishing you a wonderful holiday season!
Blog Written By: Alyssa Lower, Personal Trainer at Pomerene Kinetics
It’s November – the season for turkey, stuffing, ham, pumpkin pie, Christmas cookies, you name it! Oh and also – Diabetes Awareness Month. There are three primary types of diabetes, but let’s talk a little about Type 2 Diabetes, diabetes prevention, and why this matters for our community and our health.
Type 2 Diabetes (formerly known as adult-onset diabetes) is commonly diagnosed around the age of 20+. It is the most common type of diabetes affecting 90% of persons with diabetes. Type 2 diabetes can develop over a course of 5-10 years due to lifestyle habits, eating patterns, activity status, and family history. There are a multitude of other factors that can put a person at risk for developing diabetes, which is why spreading diabetes awareness and prevention is so crucial.
What is the big deal?
As a country, we did not just abruptly change our eating habits and our activity habits. We evolved into a different generation, a different culture, and “busier people.” We became a more diverse community with different ethnic risk factors being introduced to our families. As a mixed generation we focus our priorities on different areas than our health and families. We learned to eat differently and exercise less due to busy lives, convenience, and technology.
So really – what is the big deal? The big deal is that due to our overwhelming lifestyle changes, type 2 diabetes is becoming more prevalent. As a country and specifically for Holmes County as a community – we have to commit to making a change.
We have all heard the lecture – eat less starchy foods, exercise more, control your blood pressure, stop smoking. In reality, preventing type 2 diabetes is not a matter of doing more of one thing or less of another. It is simply a matter of living a well-balanced life. Living a healthy lifestyle is not just about our habits at home; it includes our habits at work, at home, at family dinners, and social events, etc. Living a healthy lifestyle is all day, every day.
How do we make a change?
We all know how it feels to come home after a long day, to not want to cook and collapse on the couch. Then, take into account an eight hour day at a desk or in one seat and activity is limited. Then add on a long commute, or children’s activities after work and school, and really, who has time for cooking?
Unfortunately, the statistics do not lie and for our own health, the health of our families and our children, we can no longer continue to use “busy” as an excuse. So what can you do instead?
- 1)Plan ahead – Purchase a new planner or calendar and plan out your week/month. Know your busiest days and prepare for them
- 2)Schedule it – Take the next step and plan for your busy days. Start meal planning and develop an exercise schedule. Write your meals and times for activity on the calendar and then commit to it.
- 3)Make a commitment – You guessed it; now commit to your planning and scheduling. Developing new lifestyle habits is not an easy task. Commit to changing your current patterns and offer yourself a reward at certain milestone points.
- 4)Ask for help – If you already struggle with eating habits and activity you may struggle with change. So seek help! Look online, visit your local library, call your local dietician and diabetes nurse, join a medical fitness center, subscribe to magazines, and enlist a partner or friend who has already made changes or can be your coach.
- 5)Identify obstacles – Every goal in life has certain obstacles. Making a goal to develop a healthier lifestyle is no different. Grab a pen and paper and list out every obstacle you will have to committing to your lifestyle change. Then, start with 2-3 obstacles and find ways to eliminate or reduce them.
Living healthy may not always be easy, but it doesn’t have to be overwhelming either. Start today; start with baby steps, start with one area of your life and work towards a bigger goal – but start today. Live happier, feel better, and protect your future. If you want to read some more reasons why – take a look at the statistics below:
- 1 out of 3 US adults has pre-diabetes – of those adults, only 11% know they have it
- 1.4 million Americans are diagnosed with diabetes every year
- In 2012, 86 million Americans had pre-diabetes; that is up from 79 million in 2010
- Diabetes is the 7th leading cause of death; more than HIV and AIDS combined
- $245 billion dollars in medical costs related to diabetes on average yearly
So what now?
The best way to protect yourself is through education and prevention.
- 1.Educate yourself and learn the risks and symptoms – Find out more at American Diabetes Association - http://www.diabetes.org/diabetes-basics/
- 2.Talk with your doctor – have annual preventative screenings and routine bloodwork
- 3.Change your eating – Find out more at Academy of Nutrition and Dietetics http://www.eatright.org/
- 4.Learn more about activity - https://www.choosemyplate.gov/physical-activity
How can Pomerene Help you?
Pomerene Hospital Diabetes Education Program:Jennifer Kaiser, BSN, RN – Diabetes Education Coordinator -330-674-1015 extension 1023 email@example.com
Dima Hassan, MS, RDN, LD – Clinical Dietician – 330-674-1015 extension 1123
Pomerene Kinetics Medical Fitness Center
Contact a Membership Representative - 330-674-4488
Unless you’ve been barricaded underground with no social media devices, you’ve probably heard of, seen, or maybe even witnessed the effects that the opioid and heroin-use epidemic has taken on our country, and state. In fact, Ohio is one of the top ten states with the highest number of drug overdoses and highest amount of opioids being prescribed for pain. Pain is the major factor in the beginning stages of opioid use, and one in four people taking opioids for non-cancer related pain become addicted. Ironically, as the sales of prescription opioids have quadrupled, so has the death toll of opioid overdoses. Those addicted to opioid pain relievers are 40% more likely to be addicted to heroin.1,2
How Can We Stop This Epidemic?
Your local physical therapy office is a great place to start! The American Physical Therapy Association (APTA) has joined the White House effort to reduce opioid use and reduce the number of people becoming addicted and seeking more pain-relief in heroin.3 Joesph Brence, PT, DPT is a spokesperson for the #CHOOSEPT campaign and explains that opioids only mask the sensation of pain while threatening many side effects.4 These side effects include but are not limited to:
- Respiratory depression.
These side effects can lead to small bowel obstructions that may require surgery, dehydration, or even death. In contrast, research shows the side
effects of PT include improved range of motion of joints, improved strength, function and release of endorphins which reduces pain and improves
mood. Psychological benefits such as taking control of your pain and taking action to improve your life are also very rewarding and self-motivating.
The list of PT side-effects goes on!
Through the power of PT, we can get to the root of what’s causing the pain and help to prevent it from occurring, rather than sweeping it under the rug and masking the pain. The APTA recommends consulting with PT before agreeing to prescription opioids.2 At Pomerene Therapy, we treat people that are in pain every day. Within a few visits, our clients are more functional, less painful and leading more fulfilling lives the way they were meant to be living. Schedule an evaluation with Nikki, Sheila, or Karli and get your life back today!
How Pomerene Can Help You
For more information, call 330-674-9066 or visit us here!
1. “7 Staggering Statistics About America’s Opioid Epidemic.” www.moveforwardpt.com. 2016.
2. “Physical Therapy vs Opioids: When to Choose Physical Therapy for Pain management.” www.moveforwardpt.com 2016.
3. News Now Staff. “APTA Joines White House Effort to Reduce Opioid Abuse.” APTA.org. 21 Oct. 2016.
4. News Now Staff. “APTA Launches #ChoosePT Campaign to Battle Opioid Epidemic.” APTA.org. 7 June 2016.
A long day at work does not have to be your excuse for feeling sluggish, not exercising, back pain and not having the energy you wish you had by the time 5pm rolls around. Most of us work long hours that involve sitting at a desk with limited access to movement. But that doesn’t mean you are doomed. It just means you have to be creative and make a decision to put some steps back into your day and get that body moving the way it is naturally meant to do.
Here are some solutions that can help you stay active during your work day:
Break time solutions: Yes, we are all guilt of keeping an eye on the clock and anticipate the break time buzzer. It’s understandable that when you have time for lunch, you feel like you are ready to relax. But, think a little deeper into this. You want to relax after sitting for the past 4 hours or going back and forth in the small 10 x 10 foot space you work in? Your brain is ready for a break and your stomach is probably growling and ready for lunch but your body does not need any more rest, it needs to move! Your brain, your muscles, your eyes, and your bottom need to get up and spend half of that lunch time moving. A 15 minute brisk walk can cover just about an entire mile in distance and it will leave you feeling energized, perked up, and ready for the rest of the day!
Tips for the walk:
- Bring gym shoes and socks to work for your lunch time walk.
- Time yourself or track your steps with a pedometer or tracking device.
- Get a buddy to walk with you and hold you accountable.
- Pack a lunch that you can eat while at your desk or munch on after your walk. A turkey or peanut butter sandwich would be perfect.
No time for break time solutions: Sometimes we don’t get the luxury of putting work away for a simple break or even a lunch break. Those days are the worst for your body and your brain but sometimes it happens. This is when the creativity and motivation has to kick in. You may not be able to get your heart rate up or burn major calories on these days but your brain, your muscles, and your posture deserve some attention regardless!
All you have to do is this: Get up and move! Stand up, walk to the drinking fountain, walk down the hall and back, or go say hi to a co-worker. You can even do some stretches, sit back down and get yourself back to work. Tiny breaks like this aren’t much, but they serve their benefits. The small bouts of movement and stretching will help increase blood flow, prevent muscular degeneration over time, and will give your body a chance to correct its ergonomic posture.
Tips for short additions of movement daily:
- Get a list of desk stretches and do 3 or 4 every day in your work space.
- Set a timer on your computer or your cell phone to go off every 30 minutes to remind you to either do a stretch, or get up and out of your seat for a brief greeting with a co-worker, or to get a drink of water.
-Learn to pause in your train of thought and put yourself first by doing something your body needs.
Blog written by: Tara Martin, Wellness Coordinator
Poison Ivy 101
Poison Ivy is an irritating problem during the spring and early summer. The itchy rash that develops is caused from an oily resin called Urushiol (U-Roo-She-ol). This resin is on all parts of the plants so it is best to avoid them if possible. If not able to avoid poison ivy and you develop the red, itchy, blistery rash remember it will last 2-3 weeks before it is totally gone. It does not spread once you have it. The reason you notice new spots it that these areas may have only received a small amount of resin. The reaction can take from 12-48 hours to show up.
If exposed to the plants, here are some tips you can use to your advantage:
- It is best to wash within 30 minutes with lukewarm, soapy water.
- Remember to wash all tools and clothes also, as the resin stays on these things and can last for up to a year re-infecting your skin when touched.
- Home treatments include calamine lotion, cool baths/showers, and antihistamines like Benadryl or Zyrtec.
- If the reaction is widespread or affecting eyes, mouth or genitals, you have difficulty breathing or skin swelling please see your doctor!
- Thick drainage or a fever over 100 degrees is another reason to see the doctor. Your doctor MAY give you prednisone or an antibiotic depending on how bad the rash is.
- Remember that most poison ivy can be treated at home and will resolve on its own.
- The last advice on Poison Ivy is DON'T SCRATCH!
Ticks can be both annoying and a serious problem of summer. The important thing when dealing with ticks is to make sure they are removed as soon as possible. Removal is accomplished by grasping them close to the skin and pulling straight out gently. Do not twist as this often breaks them off leaving the head embedded. Once removed clean area thoroughly and apply antibiotic ointment.
The longer a tick is embedded the more risk for infections or diseases. Lyme disease, Rocky Mountain spotted fever, and Tularemia are all potential problems caused by ticks in this area. Diagnosis of these illnesses can be difficult to determine. If you are able to remove the tick whole, keep it in a sealed jar or taped to a piece of paper to show your physician. Identifying the tick helps in planning care after being bitten. Check with your doctor if you develop flu-like symptoms (headache, fever, joint pain, aching muscles, or fatigue) or rashes up to 30 days after a tick bite. If these symptoms occur your doctor may begin antibiotic treatment and further testing for tick-borne diseases.
I hope this helps everyone have a safe and enjoyable summer!
Blog written by: Candy Yoder, CNP, Pomerene Express Care
As summer time approaches it is important to be prepared for some minor ailments. Sunburn and dehydration can decrease the fun of our outdoor time. Many of us have experienced one or all of these summer discomforts to some degree. Knowing how to treat these ailments at home and when to go to the hospital can improve your summer fun.
With the temperatures warming and the sun beckoning, sunburn shoulders, and legs loom on the horizon. Remembering simple tips can help keep you enjoying those summer activities instead of visiting the doctor.
Summer Sun Safety Tips
- Sunscreen with an SPF of 15 or greater is essential.
- Making sure you reapply every two hours or after swimming or sweating will keep the protection strong.
- Don’t forget lip balm and sunglasses to protect these sensitive areas.
- Also, avoid the hottest part of the day between 10am and 4pm.
If you do develop a sunburn, relief can be obtained by:
- Using cool showers, baths, or washcloths.
- If there are no blisters, moisturizing creams, Vitamin C or E and Cortisone creams can help ease symptoms.
- Adding extra fluid to your day and Ibuprofen or Tylenol can also make your days and nights more comfortable.
- Loose cotton clothing prevents rubbing and also protects from further sun exposure.
- Avoid products with lidocaine or benzocaine, butter, Vaseline, or oil-based product as these can create infection.
- Avoid peeling the skin of blisters. Your skin is the body’s firs line of defense and if it is gone you are at increased risk for infections.
- Avoid giving aspirin to children as this can cause a serious reaction.
Sunburn and Dehydration
Sunburn and warm temperatures can sometimes lead to dehydration, heat exhaustion or heat stroke. All age groups are susceptible but extremes of age, outdoor
workers or athletes, and those who are unable to get fluids all have increased risks. Early signs include thirst and dark urine. Also dizziness headache,
tiredness, loss of strength or small amounts of urine can be signs. Here are some tips to that will help you stay hydrated!
- Drinking water, 6- 8 oz glasses per day.
- Drinking before, during and after being outside is important, especially during the hot weather.
- Avoid alcohol, caffeinated or fruit drinks as these all add to dehydration.
- Adding fruit to your water or eating foods that have high water content such as watermelon, tomatoes, or lettuce all aid in staying hydrated.
Severe dehydration with extreme tiredness, confusion weak or rapid pulse and loss of consciousness is an emergency and needs medical attention.
If dehydration continues or you stay in the heat it can progress to heat exhaustion or heatstroke. Symptoms are similar to dehydration but more severe. The best prevention is staying cool and hydrated. But, if you do develop heat exhaustion or heatstroke lie down in a cool area, drink fluids (small sips every 15 minutes), remove unnecessary clothing and cool the skin (use cool water and fanning). If no improvement in symptoms go to the Emergency Department.
We encourage you to follow these helpful tips and hope you have a wonderful summer!
Blog written by: Candy Yoder, CNP, Pomerene Express Care