National HIV Testing Day

Posted on June 27, 2025 by Patrick Hercules

June 27th is National HIV Testing Day, a day to encourage people to get tested for HIV, know their status, and receive the care and treatment they may need.

The human immunodeficiency virus, or HIV, damages the immune system so that the body is less able to fight infection or disease. If HIV isn’t treated, it can take years before it weakens the immune system enough to become AIDS.

HIV is a sexually transmitted infection (STI) and can be spread through unprotected sex. It can also be spread through contact with HIV-infected blood, and spread to a child during pregnancy, childbirth, or breastfeeding.

The symptoms of HIV and AIDS can vary depending on the person and the phase of infection. There are three types of HIV infection. They include:

Primary infection or acute HIV: Some people infected with HIV get a flu-like illness within two to four weeks after the virus enters the body. This stage can last a few days to several weeks. Some people have no symptoms during this stage. Others may experience:

Fever

Headache

Muscle aches and joint pain

Rash

Sore throat and painful mouth sores

Swollen lymph glands, mainly on the neck

Diarrhea

Weight loss

Cough

Night sweats

These symptoms can be so mild that you may not notice them. However, the amount of the virus in your bloodstream, or viral load, is high at this time. As a result, the infection can spread to others more easily during the primary infection stage than during the next stage.

Clinical latent infection or chronic HIV: In this stage, HIV is still in the body and cells of the immune system. However, during this time, many people don’t have symptoms or the infections that HIV can cause. This stage can last for many years. As the virus continues to multiply and destroy immune cells, you may get mild infections with long-term symptoms, such as:

Fever

Fatigue

Swollen lymph glands, which are often one of the first symptoms of HIV infection

Diarrhea

Weight loss

Oral yeast infection

Shingles

Pneumonia

Better antiviral treatments have greatly decreased deaths from AIDS worldwide. Thanks to these lifesaving treatments, most people with HIV in the U.S. today don’t get AIDS. If untreated, HIV most often turns into AIDS in about eight to ten years.

Unfortunately, there is no cure for HIV/AIDS. However, medicines can control the infection and keep the disease from getting worse. Antiviral treatments for HIV have reduced AIDS deaths around the world, and there is an ongoing effort to make ways to prevent and treat HIV/AIDS more available in resource-poor countries.

National HIV Testing Day was created by the National Association of People with AIDS to increase the number of people being tested for HIV and was first observed on June 27th, 1995. This year’s theme is “Level up your self-love: check your status”. Knowing your HIV status helps you choose options to stay healthy.

HIV testing, including self-testing, is the pathway to engaging people in care to keep them healthy, regardless of their test results. Ending the HIV Epidemic in the U.S. Initiative continues to guide efforts to help us reach all people who can benefit from HIV prevention and care.

To participate in National HIV Testing Day, you can use the hashtag #HIVTestingDay on your social media channels and communicate to your friends and family that there are many options for getting tested for HIV. HIV testing is a critical tool to help end the HIV epidemic in the United States.

All content of this newsletter is intended for general information purposes only and is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Please consult a medical professional before adopting any of the suggestions on this page. You must never disregard professional medical advice or delay seeking medical treatment based upon any content of this newsletter. PROMPTLY CONSULT YOUR PHYSICIAN OR CALL 911 IF YOU BELIEVE YOU HAVE A MEDICAL EMERGENCY.

High Blood Pressure: The Silent Stroke Trigger

Posted on June 18, 2025 by Abigail Hasan

At Flushing Hospital’s Primary Stroke Center, we see it all too often—patients arriving with stroke symptoms who had no idea their blood pressure was dangerously high. High blood pressure, or hypertension, is the single most important modifiable risk factor for stroke. Yet, millions of Americans live with it unknowingly.

What Is High Blood Pressure?

Blood pressure measures the force of blood pushing against the walls of your arteries. Normal readings are typically around 120/80 mmHg. Hypertension is diagnosed when blood pressure is consistently above 130/80 mmHg. Over time, this force can damage artery walls, making them more prone to clots, rupture, or narrowing, leading directly to stroke.

Why It’s Called the ‘Silent Killer’

Most people with high blood pressure feel perfectly fine. There are usually no symptoms until something serious—like a stroke—occurs. That’s why it’s known as the ‘silent killer.’ Regular monitoring is essential, especially if you have risk factors like diabetes, obesity, or a family history of heart disease.

How High Blood Pressure Leads to Stroke

Uncontrolled blood pressure can damage and weaken blood vessels, making them more likely to rupture and cause a hemorrhagic stroke. It can also contribute to the formation of blood clots that block blood flow to the brain, causing an ischemic stroke. Even small, repeated elevations in BP increase stroke risk significantly over time.

What You Can Do

The good news? Stroke caused by hypertension is largely preventable. Here’s how you can take control:
– Monitor your blood pressure at home regularly.
– Reduce salt and processed food intake.
– Exercise at least 150 minutes a week.
– Maintain a healthy weight.
– Limit alcohol and avoid tobacco.
– Take medications as prescribed by your doctor.

A Message from Our Stroke Team

If you or a loved one is living with high blood pressure, now is the time to act. Visit your doctor, get your numbers checked, and commit to a healthier lifestyle. Remember: every point you lower your blood pressure reduces your risk of stroke.

At Flushing Hospital’s Primary Stroke Center, we are dedicated to preventing strokes through education, early detection, and community outreach. Let’s work together to silence the ‘silent killer’ and protect our brain health.

National Migraine & Headache Awareness Month

Posted on June 13, 2025 by Patrick Hercules

June is National Migraine and Headache Awareness Month. According to the World Health Organization (WHO), headache disorders are some of the most common disorders of the nervous system. The WHO also states that 1 in 7 adults worldwide has migraine and that it can be three times more common in women than men.

A headache is a general term that describes scalp, head, and neck pain. There are many different types of headaches. They may be primary conditions, such as tension headaches, migraine, and cluster headaches, or they may occur due to underlying health conditions.

Tension headaches are the most common type of headache and are more common in women. Causes of Tension Headaches:

Stress

Anxiety

Depression

Alcohol

Caffeine or caffeine withdrawal

Dental problems, such as frequently grinding your teeth or clenching your jaw.

Eyestrain

Keeping your head in one position for a long time.

Not getting enough sleep.

Symptoms of tension headaches typically include dull pressure around the head. You may also feel muscle tightness in your head or neck. The pain is usually mild to moderate and is not accompanied by other symptoms. Tension headaches can last from half an hour to a week.

Ways to treat and prevent tension headaches:

Exercising regularly

Getting enough sleep

Maintaining good posture while seated and taking breaks from sitting.

Managing daily stress

People often experience occasional tension headaches and don’t seek medical attention. If you are experiencing tension headaches for 15 days or more a month, consult your primary care provider.

Migraine is a severe, recurring type of headache that is often debilitating. There are four phases of a migraine attack: prodrome, aura, migraine headache, and post-drome.

Although the exact cause of migraine attacks is unknown, researchers believe genetics is a factor.

There are a few conditions and lifestyle factors that can trigger a migraine attack:

Anxiety

Bipolar disorder

Depression

Epilepsy

Sleep disorders

Caffeine or withdrawal from caffeine

Certain medications or taking medications too often

Migraine attacks are more likely to occur in the morning, making it common to wake up with symptoms. Some people have a predictable pattern of symptoms, such as just before a menstrual period. Other people may have trouble recognizing what triggers their migraines.

There is no cure for migraine, but it can be managed and prevented with over-the-counter triptans and pain relievers.

Cluster headaches are sudden, severe headaches on one side of the head that peak within the first 10 minutes. You may also have a stuffy nose, drooping eyelids, a watery eye, and swelling or redness on the same side as the pain.

The cause of cluster headaches is unknown, but they often run in families and affect more men than women.

Here are some triggers of cluster headaches:

Alcohol

Being exposed to heat

Bright lights

Overexertion

Processed foods

Smoking

Cluster headaches, especially acute ones, are often treated with anti-inflammatories, triptan medications, and DHE injections.

If you commonly experience migraines or headaches, you can visit Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Spinal Meningitis

Posted on June 12, 2025 by Patrick Hercules

Spinal meningitis, or meningitis, is an inflammation of the meninges, the protective layers surrounding the brain and spinal cord. The meninges protect the brain and spinal cord from injury and provide support and structure. They contain nerves, blood vessels, and cerebrospinal fluid.

Viral infections are the most common cause of meningitis in the United States. Bacteria, parasites, fungi, and non-infectious conditions, such as cancer or head injuries, can also cause meningitis.

The types of meningitis are typically named for the cause of inflammation or how long you’ve had symptoms. They include:

Bacterial meningitis
Viral meningitis
Fungal meningitis
Parasitic meningitis
Primary amebic meningitis (PAM)
Drug-induced aseptic meningitis (DIAM)
Chronic meningitis
Acute meningitis

Certain health conditions can increase your risk of meningitis, including:

Age- Viral meningitis most often happens in children younger than five years old
Not getting vaccinations
Living in a group setting, such as a college dorm
Pregnancy
A weakened immune system
Not having a spleen

The symptoms of meningitis can be different in babies than in children and adults.

Symptoms of meningitis in children and adults include:

Neck stiffness
Nausea or vomiting
Sensitivity to light
Confusion or an altered mental state
Lack of energy, extreme sleepiness, or trouble waking up
Lack of appetite
Small round spots that look like a rash

You might experience additional symptoms of amebic meningitis a few days after your initial symptoms, including:

Hallucinations
Loss of balance
Lack of attention or focus

A baby might not experience the same meningitis symptoms as adults, such as headache, neck stiffness, and nausea. Some signs of meningitis you can look for in babies include:

Bulging “soft spot” on the baby’s head
Poor eating
Sleepiness or trouble waking up from sleep
Low energy or slower responses

A healthcare provider will diagnose meningitis by performing a physical exam, asking about your symptoms, and testing your cerebrospinal fluid (CSF). They may also ask if you’ve been around anyone with certain illnesses or traveled recently, get a blood or poop sample, swab your nose or throat, or order brain imaging.

The treatment for meningitis depends on the cause. Antibiotics are used to treat bacterial meningitis, and antifungals are used to treat fungal meningitis. Antivirals can be used to treat some viral causes of meningitis. Non-infectious causes of meningitis are treated by addressing the underlying illness or injury.

There are no specific treatments for other infectious causes of meningitis. Medications might be used to reduce inflammation or relieve symptoms.

Meningitis is highly contagious. If you think you have meningitis, visit Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment to see if you have meningitis, please call (718) 670-5486.

Men’s Health Month: Low Testosterone

Posted on June 11, 2025 by Patrick Hercules

Low testosterone, or male hypogonadism, is a condition in which the testicles don’t produce enough testosterone.

Testosterone is a hormone that stimulates the development of male characteristics and is essential for sperm production. Levels of testosterone are naturally much higher in men than in women. In men, testosterone helps maintain and develop:

Sex organs and genitalia

Muscle mass

Adequate levels of red blood cells

Bone density

Sense of well-being

Sexual and reproductive function

Low testosterone can begin during fetal development, puberty, or adulthood. Signs and symptoms of low testosterone depend on when the condition develops.

If the body doesn’t produce enough testosterone during fetal development, the result may be impaired growth of the external sex organs. Depending on when it develops and how much testosterone is present, a child who is genetically male may be born with:

Female genitals

Genitals that are neither male nor female (ambiguous genitals)

Underdeveloped male genitals

Male hypogonadism can delay puberty or cause incomplete or abnormal development. It can impede:

Development of muscle mass

Voice deepening

Growth of body hair and facial hair

Growth of the penis and testicles

It can also cause:

Excessive growth of the arms and legs in relation to the trunk of the body

Development of breast tissue

Hypogonadism can alter certain masculine physical characteristics and impair normal reproductive function in adult males. Early signs and symptoms might include:

Decreased sex drive

Decreased energy

Depression

Over time, men with hypogonadism can develop:

Erectile dysfunction

Infertility

A decrease in hair growth on the face and body

A decrease in muscle mass

The development of breast tissue

Loss of bone mass

There are two possible causes of low testosterone levels:

Primary hypogonadism
Secondary hypogonadism

The causes of primary and secondary hypogonadism are also divided into either congenital (at birth) or acquired (developed later in childhood or adulthood).

Primary hypogonadism happens when something is wrong with the testicles that doesn’t allow them to make normal levels of testosterone.

Secondary hypogonadism is caused by conditions that affect how the hypothalamus and/or pituitary gland function.

If you have any signs or symptoms of low testosterone, a healthcare provider will perform a physical exam and ask questions about your medical history, medications you take or have taken, smoking history, and any symptoms you currently have. They may also order blood tests. To make a diagnosis, they will consider your specific signs, symptoms, and any blood test results.

Healthcare providers treat low testosterone with testosterone replacement therapy. There are several forms of testosterone replacement therapy, including:

Testosterone skin gels

Intramuscular testosterone injections

Testosterone patches

Testosterone pellets

Buccal testosterone tablets

Testosterone nasal gel

Oral testosterone

Healthcare providers and medical researchers don’t know how to prevent low testosterone resulting from genetic conditions or damage to the testicles, hypothalamus, or pituitary gland. However, lifestyle habits may help keep testosterone levels normal. They include:

Eating a healthy diet

Exercising

Managing your weight

Avoiding excessive use of alcohol and drugs

If you’re experiencing symptoms of low testosterone, you can receive treatment from an endocrinologist at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

What are Forever Chemicals?

Posted on June 6, 2025 by Patrick Hercules

PFAS (per- and polyfluoroalkyl substances) or forever chemicals are a large, complex group of synthetic chemicals used worldwide in industry and consumer products since the 1940s. They are used to make grease-proof, waterproof, stick-proof, and stain-resistant materials. They are added to products such as:

Food packaging such as: pizza boxes, food wrappers, take-out containers, microwave popcorn bags, disposable trays, and bakery bags
Non-stick (Teflon) pans
Firefighting foam
Firefighters’ protective equipment
Carpets, rugs, furniture textiles, window treatments, and car seats
Stain-proof and waterproof clothing
Outdoor gear
Umbrellas
Personal care products, such as dental floss, mascara, foundation, and menstrual underwear
Artificial turf
Medical equipment and masks
Building materials

PFAS are called “forever chemicals” because they are extremely persistent, lasting thousands of years. Every American tested has PFAS in their blood. PFAS can get into our bodies when we:

Drink contaminated water
Eat foods from areas with contaminated soil or water
Accidentally swallow contaminated soil or dust
Eat food wrapped in materials containing PFAS
Accidentally swallow residue or dust from PFAS-containing consumer products, such as stain-resistant carpeting and water repellent clothing

This is a problem because even small doses of PFAS can increase the risk of a wide variety of health problems, including kidney and testicular cancer, liver problems, high cholesterol, and immunosuppression.

In 2005, two of the most harmful PFAS chemicals, PFOA (perfluorooctanoic acid) and PFOS (perfluorooctane sulfonate), were stopped from being manufactured after a class action lawsuit. Unfortunately, these two chemicals have contaminated water systems across the country and the world.

Since then, PFOA and PFOS have been replaced with similar but slightly modified chemicals. While scientists have not studied every PFAS chemical, there are 9,000 variants, and those chemicals have been studied, showing similar properties to PFOA and PFOS. They are persistent, mobile, and toxic even at very low doses, and often act in similar ways on similar organs as the chemicals they were developed to replace.

If you are concerned about PFAS exposures, talk with your healthcare provider about your risks, whether an additional health screening is appropriate, and the risks and benefits of testing.

Alzheimer’s & Brain Awareness Month

Posted on June 5, 2025 by Patrick Hercules

June is Alzheimer’s and Brain Awareness Month. It is important to understand what Alzheimer’s is and what steps you can take to care for your brain.

Alzheimer’s disease is a degenerative disease and the most common type of dementia. It causes a slow decline in memory, thinking, and reasoning skills. Age is the biggest risk factor for the disease, followed by sex and family history.

Dementia is not a specific disease, but an overall term that describes a group of symptoms like memory loss and the loss of other mental abilities severe enough to interfere with daily life, caused by physical changes in the brain.

There are many signs and symptoms of Alzheimer’s and dementia. Ten early signs and symptoms include:

Memory loss that disrupts daily life
Challenges in planning or solving problems
Difficulty completing familiar tasks
Confusion with time and place
Trouble understanding visual images and spatial relationships
New problems with words in speaking or writing
Misplacing things and losing the ability to retrace steps
Decreased or poor judgment
Withdrawal from work or social activities
Changes in mood and personality

Even though there isn’t a cure for Alzheimer’s and many other types of dementia, there are many preventative measures you can take to care for your brain.

Here are five ways to care for your brain:

Regular cardiovascular exercise elevates your heart rate and increases blood flow to the brain and body. Several studies have found an association between physical activity and reduced risk of cognitive decline.
Eating a healthy and balanced diet lower in fat and higher in vegetables and fruit helps reduce the risk of cognitive decline. Although research on diet and cognitive decline is limited, certain diets, such as Mediterranean and Mediterranean-DASH (Dietary Approaches to Stop Hypertension), may help reduce the risk.
It is Important to get enough sleep. Not getting enough sleep due to conditions like insomnia or sleep apnea may result in problems with memory and thinking.
It is important to take care of your mental health. Some studies have linked a history of depression with an increased risk of cognitive decline. Seek medical treatment if you have experienced symptoms of depression, anxiety, or any other mental health concerns. Also, try to manage stress.
It is important to challenge and activate your mind. Try building furniture, completing a jigsaw puzzle, doing something artistic, or playing a strategy game. Challenging your mind may have short and long-term benefits for your brain.

If you or a loved one is experiencing symptoms associated with Alzheimer’s, you can receive treatment from a neurologist at Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718)-670-5486.

How to Clean Excess Earwax from Your Ears

Posted on June 4, 2025 by Patrick Hercules

Earwax, or cerumen, is a self-cleaning agent your body produces. It collects dirt, bacteria, and other debris. It usually works out of the ears naturally through chewing and other jaw motions and movement of the cells in the ear canal.

Sometimes, wax can build up in the ear canal, affecting a person’s hearing. When it reaches this level, it is called impaction.

If you have impaction, you may experience symptoms such as:

Aching in the affected ear
A feeling of fullness or ringing in the ear
Impaired hearing in the affected ear
An odor coming from the affected ear
Dizziness
A cough

You may be more likely to develop excess wax in the ears if you use hearing aids or earplugs. Older adults and people with developmental disabilities are also at higher risk. Your ear canal’s shape may make the natural removal of wax difficult.

The safest way to remove earwax buildup is to visit a healthcare provider. During the appointment, they may use special instruments, like a cerumen spoon, forceps, or a suction device, to clear the blockage. Some healthcare providers may use professional irrigation.

If you choose to try to remove the earwax yourself at home, the safest methods to do so include:

Using a warm, damp cloth instead of cotton swabs, as they may push wax deeper into the ear canal. Use cotton swabs only on the outside of the ear.
Using over-the-counter ear drops that soften the earwax. Place the specified number of drops in your ears, wait a certain period, and drain or rinse out your ears. Be sure to follow the instructions on the package.
Using a bulb syringe to irrigate your ears, gently rinse the ear canal using water or saline solution. This method is more effective if you use earwax softener 15 to 30 minutes before irrigating your ear(s). It is best to warm the solution to your body temperature to avoid dizziness. You shouldn’t attempt to irrigate your ears if:
- You have diabetes
- You have a compromised immune system
- You may have a hole in your eardrum
- You have tubes in the affected ear

Cleaning your ears too often may irritate the ear canal or lead to more impaction if done incorrectly.

The symptoms of an earwax blockage may also signal another medical problem. Ear infection symptoms can typically develop rapidly. You should contact a healthcare provider if you have the following symptoms:

Pain in the middle ear
Fluid drainage
Impaired hearing

Contact a healthcare provider if you experience earwax impaction more than once a year or have certain risk factors. You may want to schedule routine professional cleanings every 6 to 12 months.

If you are experiencing symptoms of ear impaction, you can visit Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Signs of a Fungal Infection

Posted on May 30, 2025 by Patrick Hercules

Fungal infections, or mycoses, are any disease or condition caused by a fungus. Fungal infections usually affect the skin, hair, nails, or mucous membranes. However, they can also infect your lungs or other body parts.

Fungi are living things. They move around by spreading out or sending spores into the air or the environment. Many fungi live naturally in our mouth, GI tract, and skin, but can overgrow under certain circumstances.

Scientists estimate that there are millions of fungi in the world, but only a small number of them are known to cause disease in people. This includes certain types of yeasts and molds. Some infections can be opportunistic, meaning they don’t usually cause infections, however, they can take advantage of a weakened immune system.

Anyone is susceptible to a fungal infection, especially those that affect the skin or nails. Fungal infections are more common in places on the body that trap moisture or have a lot of friction. A person is at higher risk of fungal infections if they have poor circulation, diabetes, or a weakened immune system from:

HIV/AIDS
Cancer or cancer treatments
Immunosuppressant medications

There are three types of fungal infections: superficial or mucocutaneous, subcutaneous (underneath the skin), or deep infections (inside other organs).

Symptoms of fungal infections depend on the kind and where it is on the body. Symptoms are most common on the skin, nails, or mucous membranes. Sometimes, symptoms of an infection can be present in the lungs, brain, eyes, intestinal tract, or sinuses.

Symptoms of superficial or subcutaneous infections include:

Itching, soreness, redness, or a rash in the affected area
Discolored, thick, or cracked nails
Pain while eating, loss of taste, or white patches in the mouth or throat
A painless lump under the skin

Symptoms of fungal infections in the lungs include:

Cough, sometimes producing blood
Fatigue
Fever
Shortness of breath
Muscle aches
Joint pain
Headache
Night sweats

Symptoms of fungal infections in other body parts can include:

A fungal infection in or around the brain: headache, fever, neck pain, nausea/vomiting, sensitivity to light, confusion
A fungal infection of the eyes: pain, redness, discharge, blurred vision, tearing, sensitivity to light
A fungal infection of the intestinal tract: abdominal pain, nausea, vomiting
A fungal infection in the sinuses: fever, nasal congestion, headache, one-sided facial swelling, facial pain

A healthcare provider diagnoses a fungal infection depending on where it is on the body. They may look for signs of fungus in, or try to grow fungus from samples of:

Skin or other affected tissue
Nail clippings
Blood
Phlegm
Fluid around the brain and spinal cord
Pee
Fluid from the eye
Vaginal discharge

If a healthcare provider thinks there is a fungal infection in the lungs, brain, or other internal organs, they might perform X-rays, an MRI, or CT imaging to look for signs of infection.

To treat a fungal infection, a healthcare provider may prescribe antifungal treatment in the form of:

Oral medications
IV medication
Lotion, cream, or powder
Mouthwash or lozenges
Eye drops
Shampoo

There are many ways to reduce the risk of various fungal infections, including practicing good personal hygiene and protecting yourself from fungi in the environment.

If you are experiencing symptoms of a fungal infection, visit Flushing Hospital Medical Center’s Ambulatory Care Center. To schedule an appointment, please call (718) 670-5486.

Employee Spotlight Shines on Sarah Kan

Posted on May 28, 2025 by Andrew Rubin

This month, we are proud to shine our Employee Spotlight on Sarah Kan, Executive Receptionist at Flushing Hospital Medical Center. Sarah has been working at the hospital for 14 years.

Sarah grew up in Queens where she attended the High School for Health Professionals and Human Services and is a graduate of Baruch College. She has two children, a girl who is 20 years old and a boy who is 16. Sarah has one cat named Miso that she adopted from a shelter and one fish named Eden. Eden is an Oscar cichlid native to the Amazon Basin. Both of her pets are two years old. In her free time, Sarah enjoys taking care of her plants, baking, playing with her cat, and keeping up on current events in the world. Sarah has also taken up painting. She enjoys traveling, especially with her family, at least once a year. A few of the places she has visited are Switzerland, the Netherlands, Iceland and Japan. She would like to visit Germany, Italy, Norway, the French Polynesia, and revisit Japan.

Sarah enjoys different types of cuisine. Her favorites are Japanese, Italian, steak and all types of desserts. She plays the piano, and her favorite type of music is classical. Romantic comedies are her favorite type of movies. She also enjoys stand-up comedians. Sarah likes to watch tennis.

Sarah enjoys working at Flushing Hospital because the employees are so pleasant and they work together well as a team. She receives great satisfaction from assisting patients and visitors, many of whom show their appreciation as they leave the hospital. We look forward to Sarah continuing to work with us for many more years.