1. health and fitness
2. disease
3. cancer

HeartBeat
SPRING 2010
S P R I N G
April 2010
Cardiac Cath and Interventional Lab Opens Door to
New Treatments – and the Public!
failure. Other procedures will include
peripheral-vascular angiograms and
peripheral-vascular stent placement.
With the opening of Emanuel Medical
Center’s new Cardiac Cath and
Interventional Lab this month, patients in
Turlock will have access to new
treatments and tests never available
locally before.
“This is on the same level as our
bringing comprehensive cancer care to
the community,” said Emanuel Vice
President of Professional Services
Michael Iltis. “Heart disease is the
country’s number one killer of both men
and women, and this new lab and
Cardiovascular Services Department are
bringing state-of-the-art equipment and
treatments to Turlock for the very first time.”
Before the lab goes into service, there will
be a grand opening for the public on
April 10 from 10 a.m. to 1 p.m. (See
the invitation on the back page for
more information.)
“During the grand opening, our community
will be able to tour the facility, see the
equipment and watch a video that shows
them what the doctors see during a
procedure,” said Susan Dominique,
the director of the Cardiovascular
Services Department.
High-tech lab brings new treatments to Turlock.
The heart of the new lab is the Toshiba
Infinix Interventional Angiography System,
a state-of-the-art piece of equipment that
generates X-ray movies – letting doctors
see inside a patient’s body and perform
dozens of different procedures in a safer,
more comfortable and less-invasive manner
than ever before.
One procedure the lab will perform
immediately is diagnostic heart
catheterization – threading thin plastic
tubes through a patient’s veins or arteries
to the left and right sides of the heart to
test for coronary artery disease and heart
Dominique said the lab will add
additional treatments over time,
building a comprehensive treatment
portfolio that will include both cardiac
procedures as well as interventional
radiology procedures. Because the lab
is equally capable of both, the
Cardiovascular Services Department
has two medical directors: Dr. Thomas
Rhodeman is the interventional
radiology medical director, and
Dr. Oussama Dagher is the cardiac
medical director.
And for all its high-tech ability, the new lab
is designed to be warm and welcoming.
“A lot of labs are just focused on the
technical side of care,” said Dominique,
who has worked in various catheterization
labs for 20 years. “We’re taking a different
approach. Our focus is going to be on
healing care – combining the state-of-theart technology with soothing lights and
artwork and a healing environment
because we believe that’s better
1
for our patients.”
SPRING 2010
Dear Friends,
Usually this is a column that Board Chair
Jennifer Larson and I co-write, a chance
to spotlight some of the exciting things
happening at Emanuel and preview the
stories in this issue of HeartBeat.
This month, however, I get a special
opportunity not to write with Jennifer, but
about her.
Jennifer Larson, chair of Emanuel’s Board
of Directors since 2003, was recently
named “Community Volunteer of the Year”
by the Turlock Chamber of Commerce.
And speaking for everyone who works
with Jennifer, I have to say I couldn’t be
less surprised nor more pleased that she’s
been recognized for all she’s done for this
hospital and our community.
Jennifer joined Emanuel’s Board of
Directors in 1998 and became chair in
2003. She also served on the Board of
Benevolence for Emanuel’s Chicago-based
parent company, which oversees two
hospitals, 15 retirement communities and
ministries developed to nurture children’s
and family’s spirits and developmentally
disabled adults. She was chair of that
board in 2006 and 2007.
She is one of those outstanding people
who make this community a better place
for all of us. Her leadership has helped
propel Emanuel to new levels of
excellence, and her leadership is a
constant source of inspiration for all of us
committed to Emanuel’s mission of
providing the highest-quality healthcare
for our community.
Arlon Waterson
2
John R. Sigsbury, President & CEO
And she’s not alone. April is National
Volunteer Month and a great time to honor
everyone who gives their time and talent
to benefit this hospital. The people listed
below serve as volunteers on our Board
of Directors. In addition, hundreds and
hundreds of other volunteers give their
precious time to our Volunteer Auxiliary, or
to Hospice of Emanuel, or to raising money
for new programs and services through
Legacy Circle.
NEW BOARD MEMBERS
Kathleen Kearns, M.D.
To each and every one of you, thank
you. Your efforts and dedication help
make this hospital great, and our
community a better and healthier
place to live.
BOARD MEMBERS
Jennifer Larson- Chair
Jim Ahlem
Walter de Bruyn- Vice Chair
David Dwight - President, Covenant Ministries of Benevolence
Art DeRooy- Treasurer
Bob Field
Marlene Stante- Secretary
Wade Fullmer
Paul Carmichael, M.D. - Chief, Medical Staff
Jim Pallios
E. Isaac Faraji, M.D. - Vice Chief, Medical Staff
Arlon Waterson
Kathleen Kearns, M.D. - Secretary, Medical Staff
Tom Wilson, M.D.
John R. Sigsbury - President & CEO
NEW CHIEF, MEDICAL STAFF
Paul Carmichael, M.D.
SPRING 2010
Service Excellence Program Brings Smiles to Patients
And consistency is the key. The
patient-satisfaction surveys ask
patients a series of questions, like
“How often was the area around
your room kept quiet at night?”
The best answer patients can
choose is “always,” and that’s the
standard of excellence Emanuel
is aiming for.
A little over a year ago, Emanuel
Medical Center began an ambitious
program to promote service excellence
and improve patient satisfaction.
As year two of the three-year effort
begins, the early scores are in.
It’s working.
“We increased our overall rating for
customer service excellence 9 percent
in the year, when our first-year goal
was 2 percent,” said Connie Fairchilds,
vice president of patient care services.
“We exceeded all of our targets.”
The improved patient-satisfaction scores
are the result of ongoing, employee-led
training, teams that tackle big projects
and committees that identify day-to-day
problems and implement solutions. The
program also includes leadership
accountability agreements that set clear
expectations for service excellence and
hold employees accountable for meeting
those goals.
Michael Iltis, vice president of professional
services, listed some of the campaign’s firstyear activities.
“We trained 1,400 employees and 170
hospital volunteers in service excellence
courses taught by 92 of their fellow line
employees,” he said. “We initiated
administrative welcome visits, where a
senior administrator visits all new patients,
and we have three administrators out
greeting patients on a daily basis.”
More importantly, hospital patients and
visitors have noticed.
“Recently my mother had major surgery for
cancer and we had the privilege of using
the new cancer services at Emanuel,” said
Turlock’s Cynthia Perry. “My mother was
treated with tender loving care and I
would highly recommend Emanuel to
Nurse Brooke Gray visits a patient.
anyone. From start to finish we were
treated with respect and kindness. The
nurses at Emanuel must have had training
in the art of bedside manner within the last
five years, because they are the best we
have ever had.”
Terri Field was one of the employees
leading that kind of training last year. Now
the speech therapist is a “Super Coach,”
helping a new crop of employee-trainers
prepare to lead their year-two courses.
“One of the first ways I noticed a change
last year was when a patient or visitor
would ask where something was,” she
said. “In the past I might have given them
directions, but now I’m taking them there.
It’s little things.”
One of last year’s teams wrote and
produced an orientation video for
new patients.
“Patients love it,” Fairchilds said. “We have
it in both English and Spanish. Our nurses
wrote the script and our staff is featured
throughout the video. It gives patients an
orientation of what to expect while they’re
in the hospital. It ensures everyone is
getting the same consistent message.”
“It’s easy to do things well
most of the time, or have most
of your staff doing them well,
but that’s not good enough,”
Fairchilds said. “Part of this
process is ‘hardwiring’
these service excellence
practices so they are consistently and
always done.”
Emanuel President and CEO John Sigsbury
is pleased with what he’s seen in the
first year.
“We knew we had a capable, competent,
professional staff,” he said. “And when
you add the skills they’re being taught in
service excellence to that, it’s a powerful
mix. Our patient-satisfaction scores show
that our employees have really made
service excellence and customer service
their number-one priority.”
Jana Mitchell, the nursing supervisor in
infant care and pediatrics, sees year two
of the program doing even more.
“People have the first year under their belts
and I think everybody is excited about the
success we’re already seeing,” she said.
“And everybody’s included. We’re all part
of a group, working in unison and you’re
seeing the change.”
Will patients continue to see the
improvements? For all the people at
Emanuel committed to service excellence,
there’s only one answer to that question:
Yes. Always.
3
SPRING 2010
Emanuel Cancer Patients Can Help in Search for New Cures
Cancer patients at Emanuel Medical
Center can now help develop a cure
for their own disease by participating in
national clinical trials of new drugs
and treatments.
“This is an exciting moment for Turlock,”
said Dr. Christopher Perkins, medical
director of Emanuel Regional Cancer
Services. “Three years ago, comprehensive
cancer care wasn’t available in the
community, and now with Emanuel’s
comprehensive cancer program, clinical
trials are available. What started as a
snowflake has become a snowball.”
Clinical trials are large-scale tests of new
cancer treatments, including new drugs
and new drug combinations. The first
trials Emanuel patients can enroll in are
two breast cancer studies and one colon
cancer test. All three trials are testing new
drugs that have shown promise in
small-scale tests.
“These are called ’Phase 3’ trials,“
Dr. Perkins explained. “Patients in these
studies will be getting the standard of
care for their disease, comparing it to
something we think will improve our ability
to cure cancer.”
No one will get a placebo, and no one in
a Phase 3 trial is getting an untested drug,
Dr. Perkins said.
“These drugs have been checked for
toxicity and checked that the drug is active
for that particular disease,” he explained.
Emanuel Medical Center is affiliated with
Stanford Cancer Center in conducting
these clinical trials.
Patients participating in the trials must meet
specific criteria for that particular study.
They must have a certain type of cancer
of a certain size and stage and meet other
specific criteria spelled out by the study
4
coordinators. Potential participants will
be identified by their doctors and
area oncologists.
“It’s all voluntary,” Dr. Perkins said. “And
they can go off the trial at any time
they want.”
several levels, including a new oversight
committee at Emanuel itself.
“It’s called the Institutional Review Board,
and it’s made up of more than just
medical people,” explained Joyce Porter,
study coordinator at Emanuel. “Our IRB has
a professor from California State University,
Stanislaus, and people from the community
as well.”
The Board develops the detailed consent
forms that patients in clinical trials sign, and
ensures that the patient’s welfare is always
top priority.
Dr. Perkins explains the clinical trial process.
But the benefits of participating in a clinical
trial can be big. For an individual patient,
the trial may give them a treatment that is
far better than the current treatment for their
disease, one that’s simply not available yet.
And the bigger picture is even better.
“Clinical trials are the only way we make
advances in cancer care,” Dr. Perkins said.
“All that we know about the current
standard of care came through clinical
trials; comparing drug A to B and finding
that B is better. Then comparing B to C,
and C to D.
“That’s how we’ve built our knowledge,”
he said. “That’s why the mortality rate for
certain cancers, particularly breast cancer,
has come down in the last several years.”
Closely Regulated and Monitored
Clinical trials are overseen by the National
Cancer Institute and closely regulated at
For a patient, the trial begins with a doctor
explaining the study, the new treatment
being tested, and going through the
possible benefits and risks, all of which
are spelled out in the consent form. Then
the patient is given a calendar which
schedules every treatment, every test and
every examination they’ll get during the
study period.
In the future, Emanuel patients will be
able to enroll in other drug trials, and in
radiation-therapy trials using the state-ofthe-art Varian Trilogy linear accelerator
in the Stanford Emanuel Radiation
Oncology Center.
Dr. Perkins expects patients in Turlock to
embrace the trials.
“Most patients really accept the idea and
understand that all cancer patients will
benefit. They say, ‘People after me will
do better,’” he said. “And Turlock is so
community-oriented. I’ve never seen a
community so self-supportive, so I
really think people here will be eager
to participate.”
For more information, contact Joyce Porter
at the Stanford Emanuel Radiation
Oncology Center at (209) 664-5030.
SPRING 2010
Emanuel’s Breast MRI is the Only One in Northern California
guided biopsies, and is by
far the most comfortable and
patient-friendly scanner
out there.”
Women in the Central Valley
area now have an advanced
weapon in the fight against
breast cancer – a dedicated
breast MRI system at Emanuel
Medical Center.
The state-of-the-art Aurora MRI
unit – the only one anywhere in
Northern California – joins with
advanced digital mammography
and upright stereotactic
equipment to make the Ruby
E. Bergman Women’s Center
at Emanuel one of the most
advanced breast health centers
on the West Coast.
“This dedicated breast MRI unit
is the best technology available for
exclusively detecting breast cancer,”
explained Dr. Walter Maynard, the
Emanuel Regional Cancer
Services has also received a
$20,000 grant from the
Safeway Foundation to
help offset the cost of breast
MRIs for women who are at
high risk for breast cancer
and are under-insured.
The Aurora MRI system was designed for women’s comfort.
medical director of the Ruby E. Bergman
Center. “It was designed specifically to
produce the best images possible for
detection, surgery planning and image-
“We’re here to save lives,”
Maynard said, “and this
cutting-edge technology is
going to help us do that.”
For more information or to schedule an
appointment, call (209) 664-5168.
5
SPRING 2010
While preparing
for tax season,
gathering
together my
2009
expenditures, I
took a moment
to reflect on my
list of charitable
gifts. I looked at the organizations,
remembering why I had chosen each of
them from a long list of worthy causes.
Was I happy with the choices I had made?
I was indeed happy with my selections. My
list included organizations that I believe in
and that I trust to work very hard to
accomplish their goals. That was a very
rewarding feeling. When we make a
charitable donation, we all want to trust
that our money is well spent and making a
difference in people’s lives.
Taking stock of my own contributions made
me think of all the wonderful people who
have donated to Emanuel Medical Center
over the years. I was humbled, and deeply
grateful, because I know none of us make
charitable donations lightly – especially in
these recessionary times. I was reminded,
once again, how much I appreciate our
donors and how committed I am to making
sure they, too, feel good about giving
to Emanuel.
I am fortunate to know many of our donors
personally, and I can tell you sincerely how
much I appreciate you and your generosity.
Some of you I don’t yet know, and all I can
do is thank you with a heart-felt note. But
with all our donors, I know the best way we
can show our respect is to be good stewards
of your gifts.
How are we good stewards? We listen, for
one thing, and follow your instructions
carefully. Many of you designate a program
or service you want your donation to fund,
be it our cancer services, hospice care,
cardiology or others. When you do, we
carefully document and track the gift,
making sure those funds are spent as you
request. We are accountable.
And most importantly, we put your money
to good use. We know you don’t make
your contribution casually, and we don’t
take it casually. We respect every donor
and every dollar you contribute, and we
make sure it is spent wisely and with our
overarching goal clearly in mind: to
ensure Emanuel Medical Center
provides the very best care to each
and every patient.
Thank you so very much! Together we
will continue to make a difference in
people’s lives.
Shirley Pok, CFRE
Vice President, Development
Legacy Circle 2009 Corporate Members
Emanuel Medical Center is grateful for our relationship with civic-minded businesses that distinguish themselves as “Corporate Partners of
Emanuel” through their annual Legacy Circle gift. We admire their philanthropic spirit and thank them for their generous support of the
Emanuel Cancer Endowment.
CORNERSTONE
EMANUEL MEDICAL CENTER
MEDICAL STAFF
MILESTONE
John Hale Painting, Inc.
GEMSTONE
6
SPRING 2010
2009 was Another Banner Year for Giving
How do you follow up the most successful
giving year ever in Emanuel history?
If you’re Emanuel’s donors, you do it again!
In 2009, donors gave just under $2.7
million to support programs and services
at Emanuel Medical Center, nearly besting
2008’s all-time record.
“We paralleled the most philanthropic
year in Emanuel history,” said Shirley Pok,
Emanuel’s vice president of development.
“Donors’ openhandedness made this a
tremendously successful fundraising year.”
Two key highlights during 2009 were the
Legacy Circle Annual Giving Campaign
and fundraising for Hospice of Emanuel.
Legacy Circle’s specific three-year
campaign to raise $4 million to create
the Emanuel Cancer Endowment formally
ended in success with more than
$4.4 million raised – nearly 10 percent
above the target.
“One key ingredient in that success was
the Ahlem family’s generous $1 million
match which inspired the community,”
Pok said “We also had a $400,000
anonymous gift that was inspired by the
Ahlem family’s pledge.”
Festival of Trees, the annual holiday-season
gala and auction benefitting Hospice of
Emanuel raised more then $250,000 and
keyed an overall 11% increase in Hospice
donations in 2009. Other generous
funding sources for Hospice included the
Kool Kars for Charity car show, which
contributed more than $8,000, and Love
Light commemorative gifts, Pok said.
Funding Patient Care
“From the $2.7 million pledged or
donated in 2009, $1.6 million has already
been collected and distributed to the areas
designated by our generous donors,”
Pok said.
Here’s where that money has gone:
• Emanuel Cancer Endowment –
$1,232,248
• General Donations (used where the
need is greatest) - $97,592
• Hospice of Emanuel - $316,167
• Nursing Scholarships - $2,600
In 2010, fundraising will focus on the
establishment of Emanuel’s cardiovascular
services, an identified community need that
the hospital has already begun to fill with
the April opening of a new state-of-the-art
Cardiac Cath and Interventional Lab.
It’s that mutual commitment – community to
hospital and hospital to community – that
inspires Pok.
“It’s humbling,” she said. “It’s so humbling
and inspiring to see a community who
understands and supports the value of
their community hospital with such
tremendous generosity.”
7
SPRING 2010
Emanuel Becomes a Teaching Hospital
When 15 third-year medical students arrive
this July, Emanuel Medical Center will enter
a new phase in its rich history.
It will become a teaching hospital.
This new role will not only benefit dozens
of medical students every year, it will
improve already excellent patient care and,
as importantly, help attract much-needed
new doctors to Turlock and the
surrounding areas.
emerged at the right time for students there.
Benefits for Patients and Students
“We have a number of students from that
area who requested to be able to do
their training close to home because that’s
where they want to practice,” she said.
“Emanuel approached us and shared our
interest. It was an opportune time and a
good match.”
For patients, the program means an extra
set of eyes and ears on their case when
they have a medical problem.
“There’s a tremendous demand for
health care in Stanislaus County,” said
Dr. David Canton, Emanuel’s new vice
president of medical affairs and the
driving force behind the medical
education program. “I think this will
make a significant impact in the
availability of health care.”
There are other benefits as well.
“A lot of times, you will see
increased patient-satisfaction
scores when patients know their
doctor is also a teacher,” said
Dr. Kemper. “The doctors who
will oversee these students know
they have to stay on top of their
medical knowledge, and oftentimes that results in increased
patient satisfaction.”
The program will begin with students
here for one year, rotating through
several different medical specialties
under the direction of local doctors.
These “clinical rotations,” as they are
called, ensure all medical students
have a broad medical background no
matter what they later specialize in.
“They’ll do two months of general
surgery, two months of internal
medicine, two months of family practice,
two months of pediatrics, two months of
OB/GYN, one month of psychiatry and
one elective,” Dr. Canton explained.
“They need to be exposed to everything.”
The students will come from two medical
schools; Midwestern University’s Arizona
College of Osteopathic Medicine in
Glendale, and Touro University
California’s College of Osteopathic
Medicine in Vallejo.
Dr. Lori Kemper, dean of the Arizona
medical school, said Emanuel’s program
8
“Patients always have the choice, of
course,” Dr. Canton said. “But for those
who do let the students conduct an
examination as well, it means another
person looking at their case
and asking questions.”
Doctors trained here may stay here.
The students coming this July will have just
finished two years of intensive science
study. The clinical rotation year, which all
third-year medical students complete, is
designed to put their basic education into
practice. During that year, the students will
continue coursework on-line and complete
exams with their medical schools.
“They will also participate in ‘grand rounds’
at the hospital, where they will hear and
make case presentations in all topics,”
Dr. Canton said. “They are going to
experience all aspects of care in a
community setting.”
For the students studying in
Turlock, Emanuel presents an
ideal combination – big
enough to be very busy, but
small enough to get real handson training.
“We deliver 100 babies a
month in Emanuel’s Mary Stuart Rogers
Birthing Center, have one of the busiest
emergency rooms in the Valley, and have
a very high-caliber medical staff,”
Dr. Canton said. “When I looked at the
hospital, I realized the only difference
between a teaching hospital and us is
that we haven’t been doing it.”
And at the same time, the small number
of medical students won’t be four-deep
around a patient like they can be in
university hospitals.
“They are going to get to see things up
close that they’d need opera glasses to
SPRING 2010
Leaving National Service for Turlock
see at a university-hospital setting,”
Dr. Canton said.
Dr. Tracy Middleton, chair of family
medicine at the Arizona medical school,
said she was impressed by her visit to
Turlock and believes the students coming
this summer will be as well.
“Emanuel has really nice facilities,” she
said. “Everyone I met with was very
welcoming and I think our students are
going to have a great experience.”
Bringing New Doctors to the Area
Dr. Canton’s top priority right now is
making sure this first class does have an
excellent experience at Emanuel.
Establishing a residency program is his
next goal. Residency programs are the
multi-year training doctors go through
after graduation from medical school to
thoroughly learn their specialty areas.
“Within three years we’ll have a residency
program,” Dr. Canton said. “Third-year
students will be here for clinical rotations,
some will stay and do fourth-year
rotations too. Then, after graduation, they
begin three or four or even more years
of residency.”
And that, he believes, will help fill the
serious shortage of primary care and other
physicians in the area.
“These are people who will have become
part of the community,” he said. “They’ll
have lived here for several years, have
families here and have kids in school
here. The goal is that they’ll stay and
practice here.”
And that’s good for everyone in
the community.
In 2007, Dr. David Canton was the Chief
Medical Officer for the National Disaster
Medical System and provided professional
oversight for the federal emergency
medical response to Hurricane Katrina.
Before that, he was responsible for
professional oversight of all U.S. Coast
Guard medical assets east of the
continental divide, and had been the Chief
of Family Practice at the 47th Army Field
Hospital in Iraq during Operation
Desert Storm.
Now he’s the Vice
President of Medical
Affairs for Emanuel
Medical Center.
“When we came back, it was the first
weekend of the fair,” he says. “We spent
Saturday at the fair, then Sunday at the
fair. My interview was supposed to be on
Monday, but there were some hospital
issues that came up and they cancelled it,
so we spent Monday at the fair.”
Dr. Canton met with Emanuel Medical
Center President and CEO John Sigsbury
on Tuesday, and told him that God had
given him a vision
of a medical
education program
at Emanuel.
Sigsbury embraced
the vision.
What brings a
career military
doctor with an
important job in
Washington, D.C.
to Turlock?
“Sometimes when
you’re immersed in
something you
can’t see the
forest for the trees,”
Sigsbury said. “It
took someone new
The fair played a
coming in who
role. So did prayer.
Dr. Canton prefers his new commute.
could objectively
Looking to end a
look at the hospital
grueling commute
and see how busy, creative and advanced
from Charlottesville, Virginia to Washington
our medical center has become and see
and spend more time with his family,
that it’s perfectly suited to train medical
Dr. Canton started job searching. He had
students and residents.”
offers, like being the Director of Health for
So Dr. Canton started his new job in
the state of Kansas. But he also had an
Turlock in December 2008. And while it
interview in Turlock.
may not be as glamorous as working in
“The position they were interviewing for
the nation’s capitol, the commute is a lot
was the Medical Director of the Emanuel
easier and Dr. Canton has company while
Physician Center,” Dr. Canton remembers.
he drives. He brings his daughter with him
“It wasn’t really what I was looking for,
every morning, dropping her off at school
but I interviewed and saw the hospital
on his way in to Emanuel.
and had a vision of a medical education
program here.”
He got called back for a second interview
and brought his family, including his
daughter, who is now in the second grade.
9
SPRING 2010
Lap Band Helps Mom be Healthy – and Happy
A little over a year ago, Stephanie Brown
was losing the battle against weight. She’d
struggled with her weight for years and
tried different diets and programs, but the
weight always came back.
By February 2009, the 32-year-old
Atwater mom was up to 257 pounds.
That’s when she had “Lap Band” surgery
at Emanuel Medical Center.
Through small incisions, Dr. Huy
Dao installed an adjustable band
around Stephanie’s stomach,
effectively reducing its size. The
band helps patients feel full sooner
and control their calorie intake.
lab work. They sent me to a psychologist
to make sure I was ready for this.”
She had her surgery February 13, 2009.
The band itself is lined with a series of
pouches filled with saline solution. By
adding or removing saline, it can be
adjusted as a patient’s needs change.
Those adjustments are made through an
“Being overweight I was very depressed,”
she says. “Now I have more energy and
am a lot happier, and that has a
positive impact on my whole family.”
“This type of surgery can save
patients from the complications of
obesity and really change their way
of life,” he says. “It saves money and
saves lives.”
Dr. Dao specializes in advanced
laparoscopic surgery – using
advanced instruments in abdominal
procedures – and was the first
physician in Turlock performing lap
band surgery.
“Everything is just so much better,”
she says. “My main thing is just
having more energy and feeling so
much more positive about myself.
I’m able to keep up with my
kids now – especially my
10-year-old son.”
“It’s a much less invasive procedure
than gastric bypass, and achieves
very close to the same amount of
weight loss as bypass,” he says.
Dr. Dao says weight-loss surgery
like the lap band procedure
drastically reduces future health
problems associated with obesity,
including diabetes, hypertension
and stroke.
Stephanie Brown walks her dog Zoe.
And it’s not a magic wand, an overnight
quick-fix.
“It takes about six months to get everything
set up,” Stephanie says. “I went to a heart
doctor and had an EKG. There’s a lot of
10
Stephanie learned those habits, cutting
down her portion sizes and learning to
stop eating when she felt full.
And just as importantly, she’s healthier
Dr. Dao says.
One year later, Stephanie has
lost 105 pounds and drastically
improved the quality of her life.
“It’s not a cosmetic procedure,” he
explains. “We’re not doing it so
people look better. We’re doing it
because it saves lives.”
Dr. Dao says most patients go through
the same adjustment period as they learn
healthy eating habits.
access port placed beneath the
patient’s skin.
“I was out of work for only two weeks,”
Stephanie says. “The biggest challenge
was that mentally I felt the same. I had to
keep telling my mind I wasn’t the same and
could only eat so much.”
To qualify for lap band surgery,
patients must have tried other weightloss methods and have a body mass
index, or BMI, of 40 or above.
Patients with a BMI between 35 and
40 also qualify if they also have
certain obesity-related diseases like
diabetes, hypertension, sleep apnea or
weight-related joint pain or arthritis.
To learn more about lap band
surgery, contact Dr. Dao’s office at
(209)-656-0183.
SPRING 2010
11
SPRING 2010
Re-Tweet! Emanuel Embraces New Media: Find Us on Facebook,
Bob Field’s social network learned of heart-health checks quickly.
12
During American
Heart Month in
February, Emanuel
Medical Center
offered free blood
pressure checks and
cholesterol tests.
Pennie Rorex,
Emanuel’s new
assistant vice
president of
corporate
communication and
marketing, e-mailed
a press release about
the event to the local
newspapers.
board members, including Turlock’s
Bob Field.
She also sent the
notice to Emanuel’s
That’s a perfect example of the power of
personal social networks, and the reason
Field, who had a heart attack three years
ago, immediately forwarded the message
to about five dozen people in his e-mail
address book, urging them to pass the
word to anyone they knew who might
benefit from the tests.
“Because I had a heart attack, I’m more
cognizant of these things and really believe
screenings can save people’s lives,” he
said. “It made sense to me to send it to the
people I know, and I’m sure a lot of them
passed it on to their friends. It got up and
rolling and a lot of people in Turlock knew
about the screenings pretty quickly.”
SPRING 2010
Twitter, Text and E-mail
Emanuel now offers an array of new
electronic and social media options for
people to get the latest health news,
information and updates about hospital
and community health events.
“Emanuel is on Facebook, Twitter and is
e-mailing and texting,” Rorex explained.
“It’s the way people communicate today,
and with these services people can sign
up to get just the kind of information they
want.” (See the back page for details on
how to subscribe.)
The text message service, for instance, will
send users texts on hospital and community
health events, and users can choose to
get additional information on women’s
health, men’s health or children’s health.
Subscribers may get up to four texts
a month.
“The e-mail service is similar,” Rorex
explained. “People can subscribe to
receive general Emanuel news, but also
choose a number of additional options,
including cancer information, women and
children’s health information, heart health
information and many others.”
Subscribers to any of Emanuel’s electronic
and mobile information services can
unsubscribe at any time, and Emanuel
provides the services for free. (Some
cellular providers charge for text messages,
so be sure to check your plan.)
The hospital’s Twitter and Facebook pages
alert people to upcoming events, give
health tips and provide real-time news,
pictures and video. It’s all designed to
help people stay healthy, Rorex said, and
to help their friends and loved ones stay
healthy as well.
“The information about those heart-health
checks went to hundreds of people long
before ink ever had a chance to hit paper
in the traditional media,” Rorex said. “It’s a
perfect example of why we’re doing this.”
13
SPRING 2010
Tribute Gifts
The following commemorative gifts
represent contributions received
between October 1, 2009 and
February 28, 2010. The names of the
individuals honored and memorialized
are listed in bold print, followed by the
name(s) of the donors.
IN HONOR OF:
MRS. JOANN DIGIOVANNI
Mr. & Mrs. John Ferrari
MRS. AUDRY GROVER
Ms. Michaeleen Klee
MS. GAY LOCKE
Ms. Michaeleen Klee
MR. & MRS. STANLEY
SKOOGLUND
Ms. Michaeleen Klee
MS. AUDREY SUMPTER
Mr. & Mrs. Howard P. Crider
IN MEMORY OF:
FATIMA AGUIAR
Ms. Teresa Valdez
FILOMENA C. AGUIAR
Mr. & Mrs. Pirus Abraham
IRENE LILLY ALLEN
American Legion Aux. Rex Ish
Unit #88
Mr. & Mrs. Ed Boyle
Ms. Dolores Brown
Ms. Lois L. Johnson
Mrs. Trudi Tillner
PATRICIA P. BAKER
Mrs. Ernestine Rojas
MICHAEL BENNETT
Mr. & Mrs. Howard W. Watts
LELA BOND
Mrs. Betty Walker
DARWIN BORGES
Mr. & Mrs. John J. George
ROSE M. BORGES
Mr. & Mrs. Bryan Reinhardt
JIM C. BOWEN
Bianchi Farms
Mr. & Mrs. Daniel M. Boer
Mr. & Mrs. James Bollinger
Mr. & Mrs. Donald L. Clausen
Mr. & Mrs. Chuck Cline
Mr. & Mrs. Richard D. Conant
Mr. & Mrs. Hugh Coppinger
Mr. & Mrs. Ronald Lee
de la Motte
Mr. & Mrs. Mark Duyst
Ms. Phyllis A. Engler
Mrs. Marcella Fernandes
14
Mr. David Gomes
Mr. & Mrs. Ronald J. Gonsalves
Mr. & Mrs. Carl E. Hillberg
Mr. & Mrs. Marvin W. Johnson
Mr. & Mrs. Paul Mayer
Mr. & Mrs. Allan E. Mord
Mr. & Mrs. Wilbert W. Niebuhr
Mr. & Mrs. Ken J. Olson
Mrs. Donna Pierce
Mr. & Mrs. David B. Pok
Mr. & Mrs. Steven D. Poole
Ms. Sandie F. Sing
Mr. & Mrs. John A. Smith
Mr. & Mrs. Lawrence Souza
Mr. & Mrs. Satoru Sugiura
Mr. & Mrs. Steven B. Vilas
Woods Furniture Galleries
Mr. & Mrs. Jim Yettman
PAUL HENRY BRACKEN
Mr. & Mrs. James P. Cox
Dompe Families
Mr. & Mrs. Herbert D. Dompe
Ms. Joan Dompe
Mrs. Nadine C. Dompe,
Ms. Marilyn Dompe &
Mr. Tom Dompe
Mr. & Mrs. Paul Dompe
Mr. & Mrs. Oscar A. Drumonde
Mr. & Mrs. Carl E. Hillberg
Ms. Mary Lisa Kuhn
Mr. & Mrs. Fred P. Lara
Perez Bros.
Mrs. Charlotte E. Smith
Mr. & Mrs. Emanuel A. Xavier
VASCO & MARIAN BRAZIL,
JR.
Mr. & Mrs. Ron A. Martin
RALPH BREDENBERG
Mr. & Mrs. Jack M. Barrett
Mr. & Mrs. Wesley P. Peterson
ALBERT BRENDA
Mrs. Esther Brenda
DORIS BROWN
Dr. & Mrs. Roy Morita
Ms. Pat Wallace Owens
LUIGI “LOUIE” BRUNETTI
The Alfieri Family
Ms. Adrienne Bersi
Mr. & Mrs. John R. Bobst
Mr. & Mrs. Merle E. Booth
Mr. Harold G. Dockter
Mr. & Mrs. Alfred H. Germano
Ms. Linda E. Lawson
Mr. & Mrs. Gary Sanders
Tom Enos Mechanical
PATRICK BUTLER
Mr. & Mrs. Tom Butler
Ms. Patricia M. Gilpin
DARRELL CAPPS
Mrs. Minnie Robinson
WILLIE “BILL” CASH
Mrs. Patricia Cash
MARIBEL CASSITY
Mr. & Mrs. Ronald K. Depauw
LINDA CEDERWALL
Mrs. Viola M. Brown
Mr. & Mrs. Daniel F. Olson
FRANCES CHAPLIN
Mr. & Mrs. Carl E. Hillberg
Dr. & Mrs. Everett H. Johnson
Ms. Bettie Sarment
LINDA CLIMER
Ms. Ruth Villarreal
VERNA DECOSTA
Mr. & Mrs. Luigi Pietrantoni
DON M. DELGADO
Mr. & Mrs. Bruce Amador
Mr. & Mrs. Neil Cabral, Nicole
and Kevin
Mr. & Mrs. Ernest Delgado
Mr. & Mrs. Henry M. Rodrigues
DOUGLAS L. FALK
Ms. Violet H. Anderson
Family (Violet, Ronald, Marla
& Wanda)
Mr. & Mrs. Joseph R. Barr
Dr. & Mrs. Jay Berry
Mr. & Mrs. Anselmo M.
Bettencourt
QuarterNote (Jim & Nancy
Biedenweg, Joe & Zann Barr,
and Stan & Jeannie Carkeet
Ms. Shirley Smith Bigley
Mr. & Mrs. Ed Boyle
Ms. Julie Burke
Mr. & Mrs. Stan R. Carkeet
Mr. & Mrs. Don Carlberg
Mr. & Mrs. William J.
Creeggan
Ms. Sandy Dempster
Mr. & Mrs. George Emerson
Mr. & Mrs. Shubert Envia
Mr. & Mrs. John Ferrari
Mr. & Mrs. William F. Fleisig
Mr. & Mrs. Gordon H. Goiburn
Mr. & Mrs. Ronald J. Gonsalves
Gorman Family (Tom, Dennis,
Marilyn & Greg)
Mrs. Anne Hall
Mr. & Mrs. Robert A. Ingels
Dr. & Mrs. Craig Jenkin
Mr. & Mrs. John Jeter
Mr. & Mrs. John S. Lazar
Mr. & Mrs. Doug Lewis
Mr. & Mrs. Norman E. Lucas
Mr. & Mrs. EZ Marchant
Mr. & Mrs. Chuck F. McPherson
Miller Manufacturing
Mr. & Mrs. David B. Miller
Mr. & Mrs. Jim Pallios
Mr. John Podesto
Posey’s Hearing Aid Center
Mr. & Mrs. Richard Silva
Mr. & Mrs. Dan (Whyte) Smith
Mrs. Dorothy Sorrell
Mr. & Mrs. David Starkey
Turlock Women’s Golf Club
Dr. Alan J. Vallarine
Mr. & Mrs. Danny L. Vierra
Mr. & Mrs. Douglas L. Wall
Mr. & Mrs. Richard Warn
Mrs. Beverly Winger
LELA FANNON
Ms. Barbara L. Colvin
MAURINE FENTEM
Mrs. Del Bettencourt
Mrs. George I. Deane, Jr.
Mr. & Mrs. Lloyd Erlandson
Mr. Burton A. Fentem
Mr. & Mrs. Donald Gapp
Mr. & Mrs. Ken Olds
Mr. & Mrs. Bruce Prine
Ms. Evelyn J. Silva
Mr. & Mrs. Richard Silva
Mr. & Mrs. Vernal R. Tornquist
CESAR FERNANDES
Mr. & Mrs. Allen Rorex
MARJORIE FISCHER
Mr. & Mrs. Robert L. Cooper
JAMES E. GALEY
Mr. Robert T. Harris, Sr.
DOROTHY M. GARCIA
Mr. & Mrs. Larry L. Gardner
Mr. & Mrs. Frank R. Mendes
Mr. & Mrs. Vernon Silva
MARGARET (PEGGY)
V. GREEN
Ms. Evelyn B. Arnold
Bob’s Flying Service, Inc.
Mr. & Mrs. Ted Colburn
KAREN L. GREGORY
Mr. & Mrs. Richard Clauss
CALVIN GROVER
Ms. Michaeleen Klee
JEANNE GURLEY
Mrs. Alice J. Kulman
Ms. Carol J. Sanders
DR. HOBART HAMILTON, JR.
Mrs. Eileen Hamilton
HELEN BODIN HARRIS
Mr. & Mrs. Charles Benson
Mr. & Mrs. Brian E. Elliott
Mr. & Mrs. Ed Elliott
BOB HERNANDEZ
Mr. & Mrs. Jim Yettman
PAT HEUER
Mr. & Mrs. Ken Hughes
JO ANNE HOBBS
Mr. Daniel P. Hobbs
COLLEEN HOLLEY
Turlock Newcomers & Friends
Club
JIM HUGHES
Mr. & Mrs. Richard Clauss
NELLIE INZANA
Mrs. Leonor Villarreal
EDWARD JAMES
Ms. Clarice E. Espinola
MYRNA JOHNSON
Ms. Dory Brizendine
LEO JOHNSTON
Mr. & Mrs. Frank Medeiros
CHARLES “CHUCK” BELDEN
JONES
Mr. & Mrs. Gerald
Christopherson
Mr. & Mrs. George W.
Fleshman
Ms. Jean Helbig
Ms. Julia Roberts
Mrs. Karal A. Yohanan
MATTHEW JORDAN
Allen Mortuary
MARGARET ANN KENNEDY
Ms. Kathleen Kennedy
MARGARET EILEEN KENNEDY
Ms. Kathleen Kennedy
MARGARET F. KNIGHT
Mr. & Mrs. Michael Harrold
ALLEN CHANTLAND
KNUTSON
Mr. & Mrs. Lin H. Griffith
Mr. & Mrs. Dick L. Labuga
Dr. John L. Sulak
Traina Dried Fruit, Inc.
BUDDY LAND
Mr. & Mrs. Victor DiGiovanni
Ms. Clarice E. Espinola
Mr. & Mrs. Raymond G.
Fernandes
Mrs. Lois Fialho
Mr. & Mrs. Rich Hall
Mr. & Mrs. Stephen Kirby
Ms. Anabell Lytle
Mr. & Mrs. Ed Lytle
Mr. & Mrs. Wilfred W. Marson
Mr. & Mrs. Frank Miguel, Jr.
Mrs. Janet Mills
Ms. Carol J. Sanders
SPRING 2010
Mr. & Mrs. Jim Shute
Mr. & Mrs. Richard Silva
Mr. & Mrs. David Starkey
Mr. & Mrs. Ivan T. Stinson
Mr. & Mrs. Leon E. Stone
Ms. Patt Trogdon
Mr. & Mrs. Jim Yettman
QUINTIN & RUBY LITTLEJOHN
Ms. Margaret Littlejohn
HAZEL LORING
Mr. & Mrs. Frank Youngdale
LINDA ANN (SIGALA) LUCAS
Mr. & Mrs. A. George Johnson
Mrs. Nancy F. Santos
Mr. & Mrs. Vernon Silva
MARY LUCAS
Mr. & Mrs. Carl B. Barros
Mr. & Mrs. Richard Silva
CAROL ANN LUNDELL
Ms. Elaine Baldwin
Mr. Ronald E. Baldwin
Mrs. Patricia Bava
Ms. Sara J. Burant
Mr. & Mrs. John R. Chance
Ms. Jean Evensen
Mr. & Mrs. James C. Jessup
The Jack Rushing Family
Mrs. Barbara Shill
Mr. & Mrs. Donald C. Swanson
Mr. & Mrs. Don Whitmore
BRENDY LUNDQUIST
Mr. & Mrs. David M. Muller
JESSE HAROLD MARTIN
Mr. & Mrs. Ralph S. Azevedo
Mr. Albert J. Baptista
Mr. & Mrs. Raymond F. Baptista
Mr. & Mrs. Bill Gwin
Mr. & Mrs. Louis Mendonca
Ms. Kathy Vaz
FAYE L. MASON
Ms. Celeste Ameer
Mr. & Mrs. Ralph Furio
REBA MAXINE
Mr. & Mrs. Billy Pettit
HUMBERTO MEDEIROS
Mr. & Mrs. Frank Medeiros
ROBERT MINTER
Modesto Camper Club
RAYMOND MOEN
Ms. Joy Adams
Mr. & Mrs. James Baumgart
Ms. Diane V. Carslon
Mr. Alan L. Davenport
Mr. Robert T. Harris, Sr.
Mr. & Mrs. William E.
Humphrey
Mr. & Mrs. John Jeter
Ms. Doris Wedin Johnson
Dr. & Mrs. Everett H. Johnson
Mr. & Mrs. John Nelson
Mr. & Mrs. Ron Peterson
Mr. & Mrs. David B. Pok
Mr. & Mrs. Larry W. Reeser
Mr. & Mrs. Allen Rorex
Mr. & Mrs. Duryea Warn
IRMA MORA
Mrs. Leonor Villarreal
LORRAINE MURRAY
Mr. & Mrs. Robert L. Burden
Ms. Kristen Machado
Ms. Pat Wallace Owens
JAMES FRANK NANCE
Mr. & Mrs. Ron Peterson
JACK NELSON
Ms. Joan E. Dallas
BARBARA NUNES
Mr. & Mrs. David C. Sanches
MARYBELLE OLIVER
Mr. & Mrs. Jack M. Barrett
EDITH MARIAM OLSON
Mr. & Mrs. Lauren Campbell
PATRICIA OLSON
Mr. Robert T. Harris, Sr.
JING OW
Mr. & Mrs. W. Howard Allred
Mr. & Mrs. Michael Kee
Mr. & Mrs. Donald C. Lanphear
Mr. & Mrs. Buster Lucas
Ms. Mary C. Machado
Mr. & Mrs. Tom P. Maloney
Mr. & Mrs. Garen McCune
Mr. K. B. Miyamoto
Mr. & Mrs. Andrew F. Montes
National Market
Mr. & Mrs. Donald Nelson
Mr. & Mrs. Tom Reeser
Mr. & Mrs. James Shade
Ms. Regina K. Torres
Mr. & Mrs. Tony K.T. Wong
Mr. & Mrs. David Young
MARIAN PALMER
Mr. & Mrs. Charles S. Cox
Hillberg & Company, CPA
Ms. Cynthia Palmer
FRANCES M. PIRTLE
Mrs. Pearl A. Moranda
HAROLD RHODES
Mr. & Mrs. Allen Rorex
RICHARD ROBINSON
Mrs. Minnie Robinson
CATHERINE ROBLEDO
Mr. & Mrs. Sean Aguirre
Ms. Olga D. Curiel
Ms. La Verne Balentine
Mr. & Mrs. Marc Beauchamp
Mrs. Joell M. Erlandson
Mr. Javier R. Espinosa
Mr. & Mrs. Roland Ferrari
Mr. & Mrs. Keith Hatfield
Dr. & Mrs. Joseph L. Higgins, Jr.
Mr. & Mrs. Bob Mattos
Mr. & Mrs. Duane Ouse
Mr. & Mrs. Larry Parker
The Robison Family
Mr. & Mrs. Hank Robledo
Mr. & Mrs. David E. Schmidt
Mr. & Mrs. John L. Silveira
Mrs. Sherry Wisdom
ROBERT ROEHLK
All Saints Westside Assembly
#2447
SHAMSHER KAUR SAHOTA
Ms. Celeste Ameer
PHILLIP N. SHORT
Ms. Shirley A. Clark
LOUISA FERNANDES SILVA
Mr. & Mrs. Oscar A. Drumonde
EMMA M. SMITH
A. L. Gilbert Company
Mr. & Mrs. Raymond F. Baptista
Bianchi Farms
Mr. & Mrs. L.D. Dubbs
Mr. Robert T. Harris, Sr.
Mrs. Lucy Honnette
Mr. & Mrs. David Lucas
Mrs. Doris Metzler
Mr. & Mrs. Greg Nascimento
and Mr. & Mrs. Bob
Nascimento
Mr. & Mrs. Warren H. Nelson
Mr. & Mrs. Danny C. O’Day
Mr. & Mrs. Jack Perry
Mr. & Mrs. Morris E. Ramont
Ms. Joyce Reil
Schmidt, Bettencourt &
Medeiros
Ms. June E. Smith
Stanislaus Farm Supply Co.,
Inc.
Mr. & Mrs. Robert Zylstra
ROSE M. SMITH
Mr. & Mrs. Donald J. Smith
CLARENCE SNELLING
Mr. & Mrs. Byrl Bowerman
Ms. Doris D. Hayes
Mr. & Mrs. Gerry Jensen
Mr. & Mrs. Wally Ray
Volk Enterprises, Inc.
FLORA SNIDER
Mr. Bernell Snider
HELEN SOTO
Mr. & Mrs. Warren Smith
AUDREY SPAULDING
Mr. & Mrs. Warren H. Nelson
NANCY SPEARS
Mr. & Mrs. Steve Honeycutt
Mrs. Alice J. Kulman
DOROTHY L. STOVALL
Mr. & Mrs. John Mason
HAROLD SWANSON
Mrs. Belletta J. Swanson
FRANK E. SWEET
Ms. Dolores H. Johnson
Mr. & Mrs. Jim Pallios
DOROTHY E. TAYLOR
Turlock Quilt Guild
MINO TAVERNAS
Mrs. Bessie Tavernas
BRIAN VASCONCELLOS
Mr. & Mrs. Kevin Howard
CARL JOSEPH VIEIRA
A. L. Gilbert Company
Associated Feeds/Swanson
Farms
George & Deni Alvernaz
Mr. & Mrs. Manuel Alvernaz
Mr. & Mrs. Steve Alvernaz
Bettencourt Flying Service, Inc.
Mr. & Mrs. Albert D. Carvalho
Ms. Eleanor J. Currie
Mr. & Mrs. Russell Felch
Ms. Jeanne Finley
Mr. & Mrs. Blaine Heald
Ms. Veronica Hoyt
Mr. & Mrs. Tim Kerr
Mr. & Mrs. Buster Lucas
Mr. & Mrs. Norman E. Lucas
Mr. & Mrs. Frank Mattis, Jr.
Mrs. Pearl A. Moranda
Mrs. Patsy R. Novo
Peterson Brothers Custom
Chopping
Pine Creek Nutrition Service,
Inc.
Mr. Joe A. Ramos
Sargent, Sargent & Bryan
Mr. & Mrs. Vernon Silva
Mr. & Mrs. Delwyn E. Silveira
Ms. Corrine A. Simons
Mr. & Mrs. Walter Soares
Mr. & Mrs. David Starkey
Mr. & Mrs. Lloyd Starn
Ms. Patricia V. Vieira
Mr. & Mrs. Richard Vieira
Yosemite Farm Credit, ACA
DEVONA “BONNIE”
WICKSTROM
Mr. & Mrs. Richard Clauss
CHARLES WRIGHT
Mr. & Mrs. Robert L. Cooper
MAXINE WRIGHT
Mr. & Mrs. Robert L. Cooper
Mr. & Mrs. V.L. Lane
Mr. & Mrs. John Jordan
Mr. & Mrs. Ed Lytle
Mr. & Mrs. Tony Pavlakis
Mrs. Helyn Vescere
JUNE WURM
Mr. & Mrs. Henry Ackerman
Mr. & Mrs. William E. Blair
Ms. Doris A. Caldwell
Ms. Jean Kathryn Klein
Mr. & Mrs. Dennis Little
Ms. Bruna Martella
Mr. & Mrs. Bill McFarlane
Mr. & Mrs. George Tavernas
Mr. & Mrs. Donald T. Ulrich
Valley Christian Counseling
Mr. & Mrs. Jack R. Wilkey
Ms. Bernice G. Wright
CLARE YOHANNAN
Ms. Julia Roberts
HUMBERTO “BERT” ZEPEDA
HiSide Fabrication, Inc.
MARY LOUISE WAGNER
Mr. & Mrs. L.B. Fuller
Mrs. Doris L. Herr
Ladies Auxiliary, Turlock Post
No. 5059
Mr. & Mrs. Morris E. Ramont
Mr. & Mrs. William Van
Nieuwenhuyzen
WANDA WICKERING
Ms. Michaeleen Klee
Mrs. Ardis Rassett
Mrs. Dorothy Sorrell
Mr. & Mrs. Steve Volk
15
825 Delbon Avenue
Turlock, CA 95382
Non-Profit Org.
U.S. Postage
PAID
HeartBeat is a publication of
Emanuel Medical Center Office of Development
www.GiveToEmanuel.org
TEL: (209) 664-5180
FAX: (209) 664-5187
Writing / Editing: Elliott & Nelson
Graphic Design: Nishihara/Wilkinson Design, Inc.
Photography: Stewart Schulze, Bill Wood
Stockton, CA
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