TSÉHOOTSOOÍ MEDICAL CENTER - Newsletter

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TSÉHOOTSOOÍ MEDICAL CENTER - Newsletter

  1. 1. A M E D I C A L P U B L I C A T I O N T S É H O O T S O O Í M E D I C A L C E N T E RVolume 2 No. 3 COMMUNITY NEWSLETTER MAY/JUNE 2012 TMC Offers Advanced Mammography Technology By: Tina James-Tafoya, Director of Public RelationsTThe Food & Drug Administration (FDA) gave Tséhootsooí Medical Center (TMC)its stamp of approval for the clinical implementation of a Digital BreastTomosynthesis system (DBT); making TMC the only healthcare facility in IndianCountry to offer these services. TMC was notified by the FDA of its approval on April 16, 2012.According to Susan Marovic of the to use the high tech system in and physicians are qualified tocompany Hologic which makes the our hospital,” states Dr. Leland perform and interpret Full FieldDBT system “there are 100 sites in Leonard, CEO. “This technology Digital Mammograms (FFDM),the U.S. with tomo and in Arizona allows for better imaging when it plus are able to properly operatethere are 10 tomo units and one of comes to mammograms the machines.those is at TMC.” and it will increase Shadle says this system DBT is an early detection allows for providing improvedadvanced imaging of breast cancer quality of care to patients.technology which thereby save patients (Continued on Page 4)detects the early from unnecessary INSIDE STORIESstages of breast biopsies.”cancer by creating TMC Compassionate 2 RAISING THE LEVEL:a 3D image of the Mammography Clinics Come Together tobreast by digitally Technologists PAGE Improve Services to Patients 3processing multiple Cynthia Szarmach LEADING THE WAY: CEO Messagex-rays that will allow and Beverly PAGEphysicians to view the -ray, Im- Shadle worked a 2D X 4 BAA HÓZHÓ (IINA):entire breast rather the Left is D X-ray with Daris Image on ht is a 3 PAGE A Healthy Dose of Lovethan just a one-sided two age on the Rig Reed, Radiologydimensional image. The Supervisor and Ancillary 5 EATING HEALTHY: Healthy Eating Duringtechnology can help save lives Services Director, Christopher PAGE Graduation Seasonthrough early detection as Breast Anthony, to secure the FDA 6 QUALITY OF LIFE:Cancer detected before it reaches approval which requires healthcare Relaying For Life PAGE14 millimeters in size has a 98% facilities to comply with numerous 7cure rate. stringent federal regulations GETTING FIT: Walking Tips “We are ecstatic about including mandatory education PAGEthis new technology and so proud and training for Radiologists and 8 OUR COMMUNITY:of our radiology department for Physicians in utilization of the -Schedule of Events PAGE -TMC Directorysecuring the FDA’s approval DBT which ensures radiologists P a g e O n e
  2. 2. Volume 2 No. 3 H E A L T H Y W I N D S T S É H O O T S O O Í M E D I C A L C E N T E R RAISING THE LEVEL Clinics Come Together to Improve Services to Patients By Tina James-Tafoya, Director of Public Relations T registration has moved inside the so improving the clinic flow will séhootsooí Medical clinic. “This will cut down on the positively enhance the patient’s Center’s (TMC) problem of what appears to be experience says Terrilynn Nez-Chee, Turquoise and Coral ‘late for appointments’ because Adult Clinic Administrator. Chee Clinics are joining forces the patient is out in the hallway says merging the Turquoise and to improve the quality updating their charts when they are Coral Clinics into the Primary Care of care it provides to being called by the physician,” says Clinic unifies the two medical teams its patients. The clinics Biagioni. The new Primary Care from each clinic to ensure continuity which were both part of the Adult Clinic set up also allows for Patient of care and provides an atmosphere Medicine Clinic are now the Primary Registration personnel to “move of team work. Care Clinic. with the patient” which means Biagioni and Nez-Chee “Although the change patients can update their charts are spearheading this effort. They can be a little frustrating for some while sitting in the waiting or exam say one of the biggest changes patients, we are confident that room. patients will see is the one-stop combining the two clinics is the Clinics throughout TMC concept; meaning that other best move for our patients” says are involved in Improving Patient TMC services will now come to Donna Biagioni, Primary Care Clinic Care (IPC): an organization wide the patient. “If a Primary Care Nurse Executive. She explains that initiative to improve the Patient Clinic patient is deemed to require the flow for patients will improve Experience and Patient Access. diabetes education, or nutrition because what used to be the patient IPC is focused on patient counseling, or needs to review their registration desks (in the hallway experience patient benefit options then those in front of the clinics) is now the departments or services will be patient check-in and the provided within the Primary Care patient Clinic, rather than directing patients to other parts of the hospital,” says Biagioni. The Primary Care Clinic provides healthcare services, focused on preventative care, to patients between the ages of 18 to 80 years old. They see anywhere from 60 to 90 patients a day. Their clinic hours are from 8:00 AM to 12 noon and then 1:00 PM to 5:00 PM. To schedule an appoint with the Primary Care Clinic patients can call 928-729-8665 or 8658. Patients Registration Desk inside the Primary Care Clinic P a g e T w o
  3. 3. H E A L T H Y W I N D S MAY/JUNE 2012 T S É H O O T S O O Í M E D I C A L C E N T E R Leading the Way FORT DEFIANCE INDIAN HOSPITALI am honored to provide this statement on behalf of the Fort Defiance Indian Hospital Board and the BOARD, INC.Tséhootsooí Medical Center (TMC) and the Nahatá Dziil Health Center (NDZ) administration. Board of Directors: Roy Dempsey, PresidentTYá’át’ééh shik’éí doo shidine’é. Caleb Roanhorse, Vice President Lorraine Nelson, Secretary hank you for taking the time to read Tséhootsooí Medical Center’s newsletter- Healthy Winds. In this edition of Healthy Martin Ashley, Treasurer Winds we have stories which provide a glimpse of some of the Elmer Milford, Member positive things happening here at TMC and at our sister clinic Dr. Raymond Reid, Member Nahát’a Dziil Health Center. Jerry Freddie, Member The Fort Defiance Indian Hospital Board, Inc. leadership is extremely pleased with the Radiology Department. Through Tim Goodluck, Memberthe Radiology Department’s efforts TMC is now the only hospital in Leland Anthony, MemberIndian Country offering state of the art technology through 3D imagingof mammograms which can detect breast cancer in earlier stages. This is atremendous accomplishment because the requirements to be approved by Leadership Council:the Food and Drug Administration are rigorous. Great job to our Radiology Michael Tutt, M.D.,Department! Chief Medical Officer Another important and positive change at TMC is the combining of the Tori Davidson,Turquoise and Coral Adult Clinics into the Primary Care Clinic. This change Chief Nurse Executivewas implemented to improve the quality of care provided to our patients.The Primary Care Clinic is working through minor challenges which are often Rachel Sorrell, Chief Finance Officerexperienced by organizations when there has been change; even if the change isfor the better. I ask for your patience on behalf of the wonderful medical team Dr. Janet Slowman-Chee,and staff of the Primary Care Clinic. Chief Planning Officer As we move through the Spring months and the weather gets warmer, Vivian Santistevan,our Community Health Division through its Wellness Center program and in Chief Human Resources Officerconjunction with tribal programs will offer many outdoor activities. I ask youto participate. Bring your families out to the Walking Together for Healthier Valonia Hardy, Chief Community Health OfficerNations (WTHN) events and also the Just Move It campaign will be hittingchapter houses soon. Tal Moore, Finally the month of May and June bring the joys of graduation. I Chief Administrative Officercongratulate all graduates whether it’s from Head Start, middle school, highschool, or college. I also thank all the families and friends of ourgraduates for their support in ensuring our students progress andachieve their goals. I encourage all graduates to ponder their futureand set more goals for themselves. As we highlight some of our positive initiatives we acknowledgeand prepare for the many challenges which lie ahead. We do thisby always keeping our mission in mind. Our mission is “to providesuperior and compassionate healthcare to our community byraising the level of health, Hózhó, and quality of life.” I thank youfor entrusting your healthcare needs to TMC. Ahe’hee!Respectfully, TMC’s CEO Dr. Leland LeonardDr. Leland Leonard, CEO discusses budgetTséhootsooí Medical Center issues with CFONahát’a Dziil Health Center Rachel Sorrel P a g e T h r e e
  4. 4. Volume 2 No. 3 H E A L T H Y W I N D SNAVA JO WAY OF LIFE T S É H O O T S O O Í M E D I C A L C E N T E R Baa Hózhó A Healthy Dose of Love By Leslie A. Hall RN Pediatric Clinic T he Tséhootsooí 6 MONTHS OF AGE immunizations updated or if you Medical Center’s 1. Pediarix have any questions or concerns Pediatric Clinic Staff 2. PCV-13 please feel free to call us at (928)- pride themselves in 3. Rotavirus 729-8710 or (928)-729-8718 and the care that they give 4. Influenza (Seasonal) make an appointment. We will each and every child be glad to help you in any way on a daily basis. Providing children 9 MONTHS OF AGE that we can, your children are a healthy dose of love through the 1. Influenza (Seasonal) important to us. We are open protection of immunizations is just Monday through Friday 8:00am- one of their many ways. If you are 12 MONTHS OF AGE 11:00 and open at 1pm-5:30pm not sure what immunizations your 1. MMR ( Measles, Mumps , and for walk-ins’. Also Physical Exam children are due for please check Rubella) appointments are now being taken, the following schedule we have 2. Varicella ( Chicken Pox) Please call to arrange your time provided for you. 3. Hib and remember to provide your 4. PCV-13 child with a Healthy Dose of Love. RECOMMENDED 5. Influenza (seasonal) IMMUNIZATION TMC Offers Advanced SCHEDULE 15 MONTHS OF AGE Mammography Technology 1. Dtap (Continued from Page 1) BIRTH 2. Hep-A “Specifically for the patients they don’t have to 1. Hep B 3. Influenza hold their breaths for a long time like they used (seasonal) to with the previous 2D x-ray. This new system 2 MONTHS OF lessens false positive results because it gives AGE 2 YEARS OLD better 3D images which can be viewed in slices 1. ediarix- Dtap, P 1. Hep-A and separates superimposed images.” Shadle Hep B, IPV adds that although the pressure needed to (combination 4 YEARS OLD compress the breast during mammograms is still vaccine) 1. MMR part of the x-ray she says they always take the 2. Varicella patient’s comfort level into consideration when 2. ib H conducting the mammogram. (protection 3. Dtap Ronnie B 4. IPV According to Hologic, the DBT allows against month o en of Sa w for anywhere from 45 to 60 images with each Meningitis) ld son R mill, AZ and his iver Ben 5 x-ray as compared to the four images produced 3. PCV-13 11 YEARS OLD by the 2D imaging system. The DBT images also 4. Rotavirus vaccine 1. TDap allows for better imaging of the more dense 2. HPV tissue which can be found in breast tissue. 4 MONTHS OF AGE 3. MCV-4 TMC officials say the FDA’s approval 1. Pediarix further exemplifies their commitment to its 2. Hib 16 YEARS OLD patients and to its mission which is “to provide 3. PCV-13 1. MCV-4 superior and compassionate healthcare to our 4. Rotavirus vaccine community by raising the level of health, Hózhó, If your children need their and quality of life.” P a g e F o u r
  5. 5. H E A L T H Y W I N D S MAY/JUNE 2012 T S É H O O T S O O Í M E D I C A L C E N T E R Healthy Eating Healthy Eating During Compassionate Graduation SeasonI By Kristen Coaty, Registered Dietician t’s getting closer and closer: your favorite foods at the end of · Taste your food. This sounds plans are being made, the table, go easy on the foods so simple that it is silly, but so invitations are being sent at the beginning. If you’re not many times we don’t take the out, and before long there careful you will end up with time to really taste what we are will be happy families a plate looking like Mount eating. So often we are so busy gathering together with one Vesuvius and a belly to match it; paying attention to everything thing in mind…FOOD! so have an idea of what you really else that we don’t pay attentionNot that graduation isn’t a want on your plate Once it is on to what we are eating. If you slowtremendous accomplishment, but your plate chances are it will find down and take the time to tastelet’s face it the whole graduation its way to your belly. your food; you will enjoy yourprocess takes an hour and a half food more and feel more satisfiedto two hours at the most while · If you don’t love it; don’t without out having to overloadthe eating goes on for hours if not eat it. How many times do we your plate.days and at multiple events. And dish out something that lookssince this is a nutrition column likes Auntie’s potato salad only · Sit or stand away fromafter all, let’s talk about how youcan make it through graduation to find out it is a less tasty the food. By placing yourselfseason without going up a pants imposter? What do you do? Do away from the buffet table, yousize. Unfortunately, there is you eat it anyway? Rather than not only take away some of theno magic pill to keep you from forcing yourself to eat something temptation; but also you forcegaining weight but here are a few you don’t really like and filling yourself to make a consciousvery simple tips to help you along up on extra fat and calories, give decision about your eating. Ifas you celebrate graduations: yourself permission to skip it. you stand right next to the food There is no prize for cleaning it is way too easy to mindlessly· Fill up on fruits and veggies your plate and if you’re worried much on finger foods. first. Most people don’t get about wasting food, you can too excited when they hear “eat always feed it to the dog. · Keep your mouth busy. After more fruits and vegetables,” but you have had your fill, chew gum here is the thing: if you start · Take a bite! Are there foods you or suck on hard candy to keep off with fruits and vegetables really love, but you know they your mouth busy. (which really can be tasty and low are not the best for you? (Think calorie) you will not only get the sweets, cheese, fried foods, and · Drink up. Water that is. It’s great vitamins and minerals from mayonnaise.) Give yourself hard to munch with a plate in them, but you will also get a good permission to eat these foods, one hand and a glass of water dose of fiber that will help fill you but do so wisely. By taking one in the other. But watch out for up and prevent you from over or two bites worth of these foods calorie filled beverages such as doing it later. you will help satisfy your craving soda pop, sports drinks and even and then you can go on to other fruit juice—yes even fruit juice. ook before you leap. Check· L more healthful foods without Believe it or not fruit juice has out the buffet table and make feeling like you are missing out. about the same amount of sugar your plan of attack. If you see as soda pop. (Continued on Page 8) P a g e F i v e
  6. 6. Volume 2 No. 3 H E A L T H Y W I N D S T S É H O O T S O O Í M E D I C A L C E N T E RF I T N E S S Quality of Life Relaying for Life By: CAPT. Ruth Kawano, MSN, RN T séhootsooí Medical Society (ACS) is a nationwide and allow for the fostering of Center (TMC) is community-based voluntary relationships outside of the work recruiting volunteers health organization dedicated environment. The challenge is to who want to join to eliminating cancer as a major reach a goal and have fun for 24 a team of hospital health problem by preventing hours straight from Friday, June employees who cancer, saving lives, and 15, 2012 until Saturday, June will participate in the American diminishing suffering from cancer, 16, 2012. Participants will gather Cancer Society’s Relay for Life- an through research, education, at the Gallup McKinley County educational and fundraising event. advocacy, and service. Their goals Courthouse Square where they can TMC will be participating are to double the number of lives choose to walk or jog or run the in the Relay For Life (RFL) which saved, to keep more Americans pathway, one person must be on is a community owned, volunteer than ever from getting cancer in the path at all times. That means driven, and staff supported event the first place, and to significantly we need a lot of volunteers from which will take place on June 15, increase the quality of life for TMC and satellite clinics. 2012. Every participant represents cancer patients and their families. TMC’s Chief Executive the American Cancer Society as a The American Cancer Society is Officer, Dr. Leland Leonard volunteer. The RLF is a tobacco the largest source of private, non- is supporting employees’ and alcohol free event, which profit Cancer Research Funds in participation. He acknowledges ensures that every dollar raised the United States. The Relay for the value of getting TMC exposure benefits local and surrounding Life (RFL) is a ACS event that through sponsor logos, banners, communities. The event this year takes place every June. and messages which can create a is at the Gallup McKinley County By participating in lasting impression. Courthouse Square, downtown this event, TMC will bolster For more information and area. its commitment to serving its to volunteer please contact Ruth The American Cancer communities, build teamwork, Kawano at 928-729-8583. Protecting Our Children with Hózhó The Tséhootsooí Medical Center Metham- the victims and their families. The event and a few other programs participated in phetamine Suicide Prevention Initiative was held in recognition of the designation the parade. KTNN radio was at the event to (MSPI) program held a Child Abuse Sexual of April being National Child Abuse Preven- broadcast the event. Assault Prevention Awareness Symposium tion and Sexual Assault Awareness month. titled “Protecting Our Children with Hózhó.” Service providers, community ad- The free community event vocates, leaders, and community members included a short parade which started at joined in the parade and symposium where the Conoco gas station and ended at the the message of “help keep our communities Fort Defiance Chapter House in Fort Defi- safe and healthy” was reiterated throughout ance, Arizona on Tuesday, April 26, 2012. the events. The symposium presenters focused on the A few of TMC departments and impacts of Child Abuse Sexual Abuse on programs, the Fort Defiance Head Start, Fort Defiance Head Start students participate in the Protecting Our Children with Hózhó parade Health P a g e S i x
  7. 7. H E A L T H Y W I N D S MAY/JUNE 2012 T S É H O O T S O O Í M E D I C A L C E N T E R Getting Fit Walking Tips By Roxanne Marianito, Fitness SpecialistC Week 1: Start with a daily 15 minute walk at an easy pace. Walk five days the first week. We want to build ongratulations, dizzy spells a habit, so consistency is important. Spread out your rest you have decided · r you have other medical O days, such as making day 3 a rest day and day 6 a rest it is time to conditions day. Weekly total goal: 60 - 75 minutes. 2 start walking for health, fitness, and Step 2- Walking Week 2: Add 5 minutes a day so you are walking 20 perhaps weight Technique: Next, minutes, 5 days a week. Or you may wish to extend control. Walking you will learn a good yourself more on some days, followed by a rest day.is a great, natural way to achieve walking technique with Weekly total goal: 75 - 100 minutes.daily physical activity. proper posture, and use Week 3: Add 5 minutes a day so you are walking 25 of arms and leg motion. Please see minutes, 5 days a week.We will lead you through a image. Weekly total goal: 100 - 125 minutes. 3program for beginners. The goal isto have you walking comfortably Step 3- Beginner’s Week 4: Add 5 minutes a day to walk 30 minutes, 5 days a week.for 30 minutes to an hour at least Walking Schedule: how Weekly total goal: 125 - 150 minutes.two or three days a week. This is often to walk, how fastthe level recommended to help and how far to build up Snags: If you find any week to be difficult, repeat thatprevent heart disease, Type II to the 30-60 minutes a week rather than adding more time, until you are able toDiabetes, and breast and colon day level. progress comfortably.cancer. Graduate: Once you are able to walk 30 minutes at 1 Health goals: Walking a a time comfortably, progress to our Weekly Walking Step 1: Preparing to half an hour a day or 3 hours per Workouts (contact me @ 928-729-8062) walk: what you need to week is associated with a decreased do before you begin a Prepare: We begin by getting you ready to head out of risk of heart disease. Walking 7 the door or onto the treadmill. All of the advice included walking program. hours a week is associated with a is good for walking either indoors or outdoors. To begin, Contact your medical decreased risk of breast cancer and we’ll see if your body has any special needs beforeprovider for a check-up or Type II Diabetes. For this reason, starting an exercise program. Then it’s on to gear-up withconsultation before you begin your I recommend that you build up to clothing and shoes.walking program and if any of the walking an hour a day, most daysfollowing apply to you: of the week.· ou have been sedentary Y (inactive) for a year or more Track your walks: Keeping· ou don’t currently exercise and Y records will keep you on track. are over the age of 65· ou have been diagnosed with Y heart trouble Build a Habit: Walk at least 5· You are pregnant days a week, even if on some days· You have high blood pressure. you must decrease your time, in· ou have been diagnosed with Y order to build your new healthy Diabetes habit. Increase the time you spend· ou have chest pain, especially Y walking each week before working when exerting yourself on speed.· ou often feel faint or have severe Y P a g e S e v e n
  8. 8. Volume 2 No. 3 H E A L T H Y W I N D S MAY/JUNE 2012 T S É H O O T S O O Í M E D I C A L C E N T E R Our Community Newsletter Contact: Dr. Janet Slowman-Chee Tina James-Tafoya Telephone: 928-729-8950 Submit a Story: news@fdihb.org HEALTHY EATING DURING SCHEDULE OF EVENTS TMC DIRECTORY GRADUATION SEASON May 2012 General Switchboard:................ 928-729-8000 (Continued from Page 5) Diabetes Education Classes Every Monday 5:30 – 6:30 pm in Adolescent Care Unit:................. 928-729-3750 · Take a Hike…or just get TMC Zion Conference room Quality of Life moving. If all else fails and you Thursdays 8:00 – 12:00 noon at still over do it, burn off some of Adult Medicine Clinic:................. 928-729-8658 Naháta’ Dziil Health Center those extra calories by grabbing Community Health:..................... 928-729-8425 some friends and family and May 6-12- Nurses Week going for a walk or playing a May 9- Walk Together for Healthier Dental Appointments:............... 877-729-8003 game of pick up basketball. Nation (WTHN) at GreasewoodHealth ▲▲▲▲▲▲▲▲▲▲▲ ▲▲▲▲▲Diabetes Program:...................... 928-729-8467 May 12- Family Fitness Day @ ▲▲▲ ▲▲▲ On another note, don’t forget True Value in Window Rock, AZ Emergency Dept:.......................... ▲▲ ▲▲ 10am-3pm. EALT 928-729-8600 to keep food safety in mind. ▲ May 14-16- Elder Care Conference @ ▲▲ Regardless if you have a “Rez stomach” or not- food safety NN Museum ▲▲ ▲ Eye Clinic:......................................... 928-729-8925 May 14-18- National Women’s H ▲▲ ▲▲ guidelines recommend that we Health Week (Call Elfreida Home Based Care Prog:................928-729- 8032 ▲▲▲ ▲▲ leave food out no longer than Barton @ 928-729-8060 for 2 hours--and only 1 hour if the ▲▲▲ Information) Intensive Care Unit:.................... 928-729-8980 ▲▲▲▲▲▲ ▲▲ ▲▲▲▲ H temperature is above 90 degrees. If the food is not on ice (or for hot June 5- Just Move It Ft. Defiance ▲▲▲▲ Manage Care Service:................. 928-729-8181 foods kept hot) you may want to Field House Y think twice before filling up your June 7- Just Move It Window Rock Mental Health:.............................. 928-729-8500 Fairgrounds ▲▲▲▲▲▲▲▲▲▲▲▲ plate. June 12- Just Move It St. Michaels Multi-Service Unit:...................... 928-729-8625 ▲▲▲ Catholic Mission (Baseball Field) We congratulate all of the new June 14- Just Move It Oak Springs Nursing:............................................ 928-729-8580 graduates and wish you the best Chapter of luck in the future. Hopefully June 19- Just Move It Pine Springs we will see a few of you come back OB/GYN Clinic:................................. 928-729-8770 Community School with nutrition degrees! June 21- Just Move It Nahata Dziil OB WARD:......................................... 928-729-8795 CH Industrial Complex ▲ Happy eating! June 26- Just Move It Wide Ruins Operating Room:.......................... 928-729-8740 ▲▲▲ ▲▲▲ OI June 28 - Just Move It Klagetoh RECIPE ES Chapter Orthopedic Clinic:......................... 928-729-8678 ▲ ▲ July 10- Just Move It Greasewood C ▲ ▲▲ ▲▲ Chapter Pediatric Clinic:............................. 928-729-8710 ▲ ▲▲ ▲ Fruit Salad July 12- Just Move It Steamboat ▲▲ ▲▲ Pharmacy:........................................ 928-729-8328 in Seconds Chapter 2 Large ca ▲▲▲ July 17- Just Move It Ganado Sage ▲▲▲ Physical Therapy:......................... 928-729-8810 n ▲▲▲▲ ▲ 1 Pint fresh s of fruit cocktail (i Memorial Hospital ▲▲▲▲▲▲▲▲▲▲▲▲ 1 Bunch of strawberries n light syru p or juice) July 19- Just Move It Cornfield Low fat va Bananas Podiatry:........................................... 928-729-8815 nilla yogurt Chapter July 24- Just Move It Kinlichee Respiratory Therapy:.................. 928-729-8835 Direction Chapter Drain juice s: July 26- Just Move It Sawmill Social Services:.............................. 928-729-8527 large mixin from fruit cocktail. Chapter Slice bana g bowl. Put fruit co July 31- Just Move It Navajo- cktail in Surgery Clinic:................................ 928-729-8695 Wash and nas and add to the b Redlake cut berries berries to fr owl. uit cocktailinto bite size pieces. Naháta’ Dziil Health Center . Add August 2- Just Move It Crystal Stir in eno (Camp Asaayí) ugh vanilla (Sanders):.................................... 928-688-5600 yogurt to co at fruit and serve. P a g e E i g h t

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