By: Jillian Peabody, OD Inside of our eyes, we have a gel-like substance called "vitreous." Within the vitreous, tiny clumps called "floaters" can form and cause us to see little things that may look like flies, cobwebs, or strings. While most floaters are totally harmless (but quite annoying!), there are some serious eye conditions that can present with floaters. So, if you notice any, it's very important to see your eye doctor for an eye exam; we can tell whether they're harmless or not. At the exam, the doctor will look at the entire eye and determine if the floaters are harmless or if they are a symptom of a more serious condition, such as detachment of the retina (the highly sensitive wall of the back of your eye that's responsible for vision). Oftentimes, serious eye conditions associated with floaters will have additional symptoms like flashes of light or a large number of floaters seemingly “raining down” in your vision. If any of these symptoms occur, or if you experience new floaters, you should see an eye doctor right away. We can help treat them! If the floaters are harmless, there is no medication or treatment that can easily get rid of them. Fortunately, our brain learns to forget them, so that's why you don’t see them all day. Either way, it's important to check any floaters and make sure that you closely monitor any changes in your vision. Is it time to schedule an eye exam? Simply call our office: 603-626-9500!

By: Jillian Peabody, OD If you have been diagnosed with diabetes, you may be wondering: Why does my primary care doctor require me to get an annual eye exam? The reason is that diabetes can lead to a condition called "diabetic retinopathy," which can cause blindness if left untreated. In fact, diabetic retinopathy is responsible for 12% of new cases of blindness annually. It's also the number one cause of new vision impairment in Americans aged 20-74. Fortunately, treating diabetes properly can lower the risk of getting diabetic retinopathy by up to 76%. So, What Exactly is Diabetic Retinopathy? Similar to other organs in the body, the eye has a vast network of blood vessels, particularly in the visually sensitive area of the eye called the retina. When someone has uncontrolled Type 2 diabetes and their glucose (sugar) levels are high, the glucose damages the walls of our blood vessels and creates small holes. Then, the vessels start to leak blood; this is diabetic retinopathy. Thankfully, We Can See the Signs in Your Eyes! This vessel damage can happen in all organs of the body, but the eye is the only organ that can be seen easily from the outside through a dilated eye exam, which we can perform at Amoskeag Health. If there are signs of diabetic retinopathy in the eye, the chances are high that blood vessels in other vital organs are also leaking. An eye doctor will relay this information to your primary care doctor so they can work with you to better control your diabetes and prevent further damage to your body. In this way, the eyes are truly a window into the health of the body! Similar to other sight-threatening diseases, diabetic retinopathy often has no symptoms to the patient in early stages. The only way to properly diagnose diabetic retinopathy is through a dilated examination of the eye. Therefore, it is very important for those with diabetes, and those without, to have an annual dilated eye exam. Have you had a dilated eye exam recently? It's okay if the answer is 'no!' We can schedule an appointment today, just call our main office: 603-626-9500.

Although Case Management is not a billable service to insurance companies, it's vital for Amoskeag Health patients. Case managers are available at each doctor's appointment to help families navigate legal and financial challenges they might face such as domestic violence and food insecurity. The following testimonial was shared anonymously by one of our case managers to protect the family's identity. One of my most impactful stories involves a mother of four from Pakistan whose primary language is Punjabi. Her primary care provider at Amoskeag Health noticed signs of domestic violence and asked her for permission to connect with a case manager. Once I spoke with her, I discovered that her husband harmed her physically, in addition to one of her children. Immediately, I connected her to domestic violence resources and helped her navigate the court system—initiating a divorce and physical protection from her now ex-husband. A little while later, I received a distraught phone call from the mom. She’d received a letter from DHHS notifying her that she was being investigated for fraud—she was terrified that this would jeopardize her ability to remain in the country and care for her children. I was able to calm her down and connect her with NH Legal Assistance where she learned that her ex-husband had put himself down as head of household and was still receiving the benefits even though they were divorced. I helped her work with NH Legal Assistance; together, we restored her Medicaid and SNAP benefits and closed the fraud investigation! Now, I’ve connected her with an employment training program so that she can continue taking steps to self-sufficiency and creating a safe, stable home for her children. The American legal system is challenging for anyone let alone a scared mother of four who speaks English as a second language. I’m honored and grateful that I helped her on the path to a successful future. ~Amoskeag Health Case Manager Your donation covers our case managers' salaries. Every dollar we receive allows us to continue the work that makes a brighter future for someone who is trying to navigate a tough situation, like this family. We want to continue sharing these impactful stories next year, and your donation ensures that everyone who seeks help receives it.

What is the role of a health care coordinator? They get to know our patients and their families, and they become a personal part of their path to health and well-being. This process can be rewarding, heart-breaking, and deeply intimate. Mishelle Sadick, one of our health care coordinators, has spent the last eight years, developing a trusting relationship with Thien, his wife, Oanh, and their three children. Sally, their middle child, is 12 years old and suffers from cerebral palsy, global developmental delay, seizures, and severe scoliosis. Her spinal cord curves in a way that produces excruciating pain and stiffness; she cannot walk; and she has limited verbal communication made possible with a speech device. Mishelle helps Thien navigate insurance; researches equipment to make caring for Sally easier; manages her nursing, physical, and occupational therapy; and most importantly, she keeps their family connected, despite Sally’s physical limitations. But there was one wish above all others. But there was one wish above all others: Thien and Oanh wanted their daughter to meet her family in Vietnam and experience her heritage first-hand–an impossible dream. So, Mishelle advocated for and guided Thien through an application to Make-a-Wish Foundation, which was granted! Sally and her family flew to Vietnam to be embraced by extended family for an entire month. This was a precious gift because, as you can imagine, flying is not a simple ordeal for a wheelchair-bound child. Over the years, Mishelle helped Thien apply for funding to install an elevator in their home; buy a handicapped-accessible van; and build an extensive lift and track system throughout their home that lowers into Sally’s bed, lifts her out, and transports her into different rooms of the house so that she can still spend time with her family, no matter where they are. In June, Sally received extensive surgery at Boston Children's Hospital to correct her spinal cord. The surgery was incredibly complicated, and coordinating recovery during a global pandemic added another layer of difficulty. Mishelle guided the family through each step pre- and post-operation. Although Sally will never walk, this corrective surgery vastly improved her quality of life and helped ease the immense pain that had become this little girl's reality. Since Sally requires extensive, precise medical care, Thien and Oanh cannot have just anyone care for her. Mishelle has coordinated multiple stays for Sally through Cedarcrest Center for Children with Disabilities. These stays provided safe care for Sally in addition to an important reprieve for Thien and Oanh; they were able to attend two weddings, remaining connected with their family. Most importantly, they trusted that Sally was safe. Today, Sally is happily recovered and attending school in-person, with the help of a registered nurse. When Thien was asked what he enjoyed most about working with Mishelle, he gave a huge grin and said, "I love Mishelle. She has done everything for my family. Everything. She is family to us." We often take simple moments with our family for granted. But Thien, Oanh, and their children cherish the magic of shared family time in the living room. For Sally, the equipment to move freely with her family in and out of their home, and the love behind their acquisition, is a lifechanging gift. Mishelle and the Special Medical Programs team here at Amoskeag Health advocate for families, working hard to create and preserve these special moments together. Your contributions help us continue to make wishes come true, not just for Thien and for Sally, but for each and every one of our patients. After all, we consider them our family, too.

Imagine the excitement of a young woman moving to America to begin a life with her new spouse. Imagine her joy and anticipation to create a family. Imagine the opportunities stretched out before her. But then he hits her. He strikes away excitement and joy. And as quickly as the bruises begin to form, so does her anguish and fear. She's all alone. Marta, a young Rwandan immigrant, didn’t have to imagine this incident. Unfortunately, it was her reality. Three years ago, she found herself all alone in a brand-new country with a newborn baby and no work visa. Although the life she imagined was taken away from her, Amoskeag Health helped her to build a new future. Suddenly, she wasn't alone anymore. After placing a restraining order against her husband, Marta sought comfort at a domestic violence shelter through the YWCA. She was also receiving care at Amoskeag Health for her son Adrian. During his appointment, Dr. Keane noticed signs of domestic violence and food insecurity. Because Amoskeag Health has an integrated model of care, we offer much more than a primary care visit. Dr. Keane carefully broached the subject of Marta’s situation and asked Marta if she needed help. Marta agreed and she was connected with Ethan, one of our case managers, that same day. Ethan spent the next few months connecting Marta with state benefits like Medicaid and food stamps; helping her navigate legal assistance to begin her divorce; and writing a letter to the governor’s office to expedite her case to secure a work permit. After Marta secured a full-time job in construction, Ethan talked with her about her career goals. Marta had earned her bachelor’s degree in hospitality when she lived in Rwanda; she speaks English, French, Swahili, and Kinyarwanda. Ethan explained some of her options in the United States and he helped her apply for a scholarship to go to school and receive her interpretation license. As she went to school, worked, and cared for her son, Ethan continued helping Marta move out of the women’s shelter. After securing a temporary apartment through Families in Transition, he worked with Marta to apply for subsidized housing. Today, Marta works as a case manager with stable income and housing. She has full custody of Adrian, and he is attending pre-school next year—hitting all of his milestones along the way! With the help of Amoskeag Health, she built a support system of co-workers and friends. Marta’s strength and motivation gave her possibilities despite the obstacles she faced—now, she lives an independent and happy life in the United States.

"You have to be out by the weekend." Sofia felt her stomach drop. Her landlord was planning to remodel the apartment she’d rented for the last two years. He was going to list it for double what she was currently paying. She’d never missed a payment before. She had nowhere to go. How could this be happening? “Please,” she pleaded, “I just need some time to find a new place.” She kissed her son Gabriel’s head while she blinked back tears and clutched the phone in her hand. “Fine. But you need to be out by Monday. You don’t want me to get a lawyer involved.” Sofia’s heart lurched. She hung up the phone, told Gabriel to go play, and she cried silently in the kitchen. Then, with shaking fingers, she picked up the phone and dialed 603-626-9500, Amoskeag Health’s number. She remembered that her doctor always told her she could call if she needed help. The woman at the front desk assured her that they would have a case manager return her call. Sofia’s mind was a blur. She didn’t know what that meant, but she was desperate for anything. About an hour later, Sofia got a call from a case manager named Ethan. Through her tears, she explained what her landlord said and how she didn’t have any options. Rent was too expensive. She was panicking. Ethan explained that she could not be forced to move out so quickly. The landlord had to provide an Official Notice and she would be granted at least a week before she’d be forced to move. Ethan wanted to doublecheck with NH Legal to find out exactly what Sofia’s timeline could look like. He told her to take some deep breaths and eat some lunch while he consulted with someone. The next time Sofia picked up the phone, her fingers were steady. Ethan had a plan. Sofia and Ethan performed a 3-way call with her landlord. Ethan calmly explained Sofia’s rights, reviewed her rental history as a reliable tenant, and emphasized that housing was incredibly challenging right now. At the end of the phone call, the landlord apologized. He agreed to let Sofia and Gabriel remain on premise until the end of the month at a pro-rated rental rate. And he drew up a written notice to support this conclusion. With some breathing room, Ethan helped Sofia come up with a plan. She connected with a co-worker who agreed to let her stay in a spare room until she could find a new apartment. Then, Ethan worked with his housing connections and started helping her with rental applications. Today, Sofia is happily settled in a new apartment with Gabriel. She knows much more about her rights as a renter, but most importantly, she knows that if she ever has any questions, Ethan, her Amoskeag Health case manager, can answer them.

When 73-year-old Annabelle first began receiving care at Amoskeag Health, she was missing many of her appointments; she was suffering from depression and loneliness; and she was in severe pain. Her provider referred her to a geriatric care coordinator (GCC) for assistance. One phone call set the two on a life changing journey of health and connection. Shortly after facilitating care for Annabelle, her GCC went on vacation. It was 7 PM, just after dinner, when she received a phone call from Annabelle. She picked up, worried that something was wrong. “I just need someone to talk to,” cried Annabelle. Once she found out that her GCC was on vacation, Annabelle apologized and almost hung up, but her GCC stopped her. You see, they share Filipino heritage; family is everything in their culture, and Annabelle’s GCC understood the importance of being there for her. That simple decision to not hang up the phone transformed Amoskeag Health from just another doctor’s office to a place where Annabelle felt genuine care and concern. She gained an integral support system. Over the next two years, her GCC built a trusting relationship with Annabelle. She helped her develop a schedule to maintain necessary appointments and medications; navigate insurance to reduce a $3,000 medical bill to a few hundred dollars; and acquire a rollator, a special walker to help manage her pain and maintain her independence. When Annabelle’s husband was diagnosed with cancer, her GCC explained available mental health services and reduced Annabelle’s stigma about seeking help. She taught her that counseling was a support service that she deserved, not a weakness. In fact, this trusting relationship may very well have saved Annabelle’s life. After an extensive back surgery in the fall of 2020, Annabelle wanted to leave the rehab center against medical advice. She refused to listen to the doctors or nurses. She started to become frantic, worried about her homebound husband. But when Annabelle's GCC volunteered to check on her husband, Annabelle stayed and made a full recovery before returning home. She often expresses her gratitude. “I wish you were my daughter,” she tells her GCC. Those words mean the world to Annabelle’s GCC. It’s her responsibility to fill many different roles for her patients. But at the end of the day, being their family is her favorite role of all. And we know that it’s theirs, too.

Amoskeag Health helps a family navigate insurance and adaptive care in a new country. On a French country road, a three-year-old boy named Devonte rides along with his life stretched out ahead of him. In the blink of an eye, he’s struck by a vehicle and everything changes. He suffered a traumatic brain injury and underwent an emergency hip reconstruction surgery. Devonte’s mother spent 10 years trying to navigate all of the health challenges post-accident. But she lacked support. So, she decided to slowly immigrate her family of six to America to live with family friends in New Hampshire. They wanted a better life. Today, eighteen-year-old Devonte has spastic quadriplegia, an intellectual disability related to his traumatic brain injury, epilepsy, and gastroesophageal reflux disease. These physical challenges cause frequent aspiration pneumonia and made him G-tube and wheelchair dependent. Devonte requires a strict regimen of three different antiepileptic drugs; two nebulizer medications; G-tube formula and supplies; diapers; and consistent doctor’s visits to four different pediatric specialists. Affordable insurance coverage was essential for their family. Thankfully, Devonte became a patient of Dr. DiBrigida’s here at Amoskeag Health back in 2016. His family discovered that we’re so much more than a primary care office. Dr. DiBrigida recognized their challenges and connected the family with a nurse care coordinator named Anne. For the last five years, Anne worked with the family to navigate affordable insurance and overcome the challenge of Devonte’s looming 18th birthday; their immigration statuses made securing Legal Guardianship and Children’s Medicaid tricky. Once NH Guardianship and NH Children’s Medicaid was in place for Devonte, Anne helped the family navigate follow-up appointments and transportation. Although the family speaks English, a French interpreter was often necessary to help explain some of the more complex insurance issues. Anne helped coordinate interpretation services without incurring too many added expenses. Not to mention, now that Devonte is getting heavier, it’s much more difficult to transport him; his father fell recently carrying him down the stairs. Anne helped the family navigate a home modification evaluation, secure a new wheelchair, and secure approval for a ramp in their home. Devonte’s mom said, “we are so thankful for all the services Amoskeag Health helped us with. We really appreciate all the help we received. Thanks to them, Devonte will have a much happier and healthier life. We’re so glad we came here.”

A nurse care coordinator shares her story. I work in the Special Medical Programs department of Amoskeag Health, which means that many of my patients are young children with complex care needs – these children require extensive services that are often not covered by insurance. Many require special accommodations and are at a high risk for falls or seizures. It’s nearly impossible for parents to work and balance these children’s care without help. Thankfully, Amoskeag Health supports these families, helping them learn how to properly care for their children; how to navigate insurance and the health care system; and how to develop mental coping skills to combat the exhausting emotional toll of their reality. I could fill an entire book with pages of the amazing work our organization has done, but one young woman’s journey touches my heart so much that I want to share her story with you today. I want you to take a moment and step into her shoes. Imagine that you’re a single mother of a five-and-a-half-year-old boy with cerebral palsy and seizures. You work 25-30 hours a week as a part-time LNA 25-30 and balance full-time nursing classes at a community college. Your child is nonverbal and must be fed through a G-tube – not just anyone can care for him. Thankfully, your grandmother moved to America with you, so even though she’s a bit older, she can help while you attend classes and work. However, your third-floor apartment is hard to manage. Your son is wheelchair bound and there's no elevator. It’s getting harder and harder to get him up and down the stairs. One day, your son has to be hospitalized and intubated because of a severe respiratory infection. He'd just recovered and come home. Then, you start hearing about COVID-19. You’re terrified. If your son contracts COVID, it would be life threatening. You still have to work, so you try to be as careful as possible, but every single day you’re filled with anxiety and fear. Then, your worst fear is confirmed: You test positive for COVID-19. In addition to losing your only source of income while you recover, you must suddenly quarantine away from your child for his safety. You have to pause college. Your grandmother doesn’t speak English, and your son still has extensive health needs. How on earth will you get through this? Thankfully, you have a support network: Amoskeag Health. You called your nurse coordinator and she helped you make and organize appointments, even connected you with interpreters for your grandmother. She helped provide grocery deliveries, and any time you felt anxious or overwhelmed, you called for moral support. As you focused on recovering, you knew that your son was in capable hands with people who understand his complex needs. After your recovery, Amoskeag Health worked with you to file an application for a housing voucher from NH Housing to secure a first-floor apartment. With your son’s care managed so well, you resumed college courses and are on track to graduate in December. Now, I want you to step back into your own shoes and imagine what might have happened to this single mother without the support and care that Amoskeag Health provided. Take a moment to really visualize how that situation might have played out: A sick, single mother might have found herself homeless, struggling to care for herself, an aging relative, and a wheelchair-bound child with critical medical needs and with whom she could not be near. That jolt of fear and anguish over the “what if” scenario is what keeps me committed to the families I serve. Her success story reminds me every single day that the work I do matters, and I hope that she reminds you that your continued support of Amoskeag Health makes an inexplicable, lifechanging impact. Thank you for allowing me to continue changing lives like hers. ~A.B., Amoskeag Health Nurse Care Coordinator