January I February I March 2016

Feature Story: Pedaling Forward with DBS

Hope HeALTHCARe SeRVICeS

Symposium Speaker: World Renowned Neurosurgeon Dr. Kelly Foote

A Knockout Workout: Boxing for PD

It’s impossible to watch a beautiful sunrise and not be inspired by the hope of a new day. For those of us who are blessed to work at Hope, we are privileged to experience that same kind of inspiration on a regular basis.

Our team is continually inspired by what we see around us – individuals fulfilling their life’s journey

with strength and courage; families supporting their loved ones through challenges and embracing time spent together in special ways. We see staff and volunteers dedicated to providing caring comfort to those who need it most.

Of course, our Parkinson Program is a major source of inspiration. Throughout the year, our participants find encouragement and support through activities designed

to nurture both body and mind, such as the Ladies PD Support group, Tai Chi and pole walking workshops, Voice Aerobics classes, and the new and very popular PD boxing program.

Our Annual Parkinson Symposium in February promises to be the best yet. Come learn about up-to-date surgical treatments for Parkinson’s from a world-renowned neurosurgeon and become motivated by a young professional who took his PD diagnosis and turned it into an opportunity to teach others how to find faith in themselves to create their very best life. See page 5 for more information.

I wish for each of you a new year filled with beauty, inspiration – and the hope of many sunrises.

Warm regards,

Samira K. BeckwithPresident and CEOHope HealthCare Services

Dear Friends of Hope Parkinson Program

When is it time to consider surgery for Parkinson’s disease?Dr. Amanda AvilaA common question for many Parkinson’s disease patients is “Am I a candidate for deep brain stimulation surgery to treat my PD”? Like most treatments, there are risks and benefits. Making sure the benefits of DBS (deep brain stimulation) outweigh the risks will be important in determining if surgery is the right move.

Firstly, DBS is used to treat many symptoms of PD, but it is not curative and in fact can worsen some symptoms as well. It works best on tremor, stiffness and slowness. It can also improve the motor fluctuations many patients notice throughout the day and can eliminate dyskinesia. In some patients, DBS may also allow them to decrease the amount of medication taken on a daily basis. Typically, the symptoms that are best treated with DBS are the same symptoms that respond to carbidopa/ levodopa, although there are some exceptions to this.

DBS is not generally helpful for non-motor symptoms, especially, or for balance trouble. In some cases, it can

actually worsen walking and fall frequency. It also can worsen memory and word-finding trouble. An extensive preoperative workup is completed prior to surgery to determine if these risks are present in patients considering surgery.

DBS is best used in patients who have moderate disease and have needed to increase the frequency of their PD medications or who have noted more side effects to these medications – especially dyskinesia. It is also great for tremor and can in some cases eliminate this regardless of the tremor’s responsiveness to levodopa.

If you are considering DBS, speak with your neurologist. In the right patient, DBS can radically improve Parkinson’s disease symptoms.

Amanda Avila, MDHope Parkinson Program Medical DirectorMovement Disorder Specialist, Florida Neurology Group

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Turmeric and Parkinson’s DiseaseKathrynne Holden, MS, RDIf you haven’t yet heard about turmeric, there’s a good chance you soon will. Turmeric is a bright yellow spice found in curry powders. It’s also used in pickles, and it’s what makes mustard yellow. Research studies have determined that tumeric contains at least 20 powerful compounds that attack cancer cells, help control blood glucose, and appear to help prevent the death of nerve cells in Parkinson’s disease. These compounds are called curcuminoids, the most important of which is curcumin.

Curcumin has powerful anti-inflammatory effects and is a very strong antioxidant. Unfortunately, it is poorly absorbed into the bloodstream. Consuming black pepper with turmeric enhances the absorptionof curcumin by 2,000%. The presence of oil, such as coconut or olive oil, also aids curcumin absorption.

Turmeric can be mixed into soups and other dishes. Here are some easy ways to add turmeric to your daily menu:• Breakoneortwoeggsintoabowl.Add½tsp.of turmeric and a few grinds of black pepper. Pour into a hot, oiled skillet and scramble.• Whenmakingsouporacasserolethatbeginsby cooking onions, add one teaspoon turmeric and 1/4 tsp. freshly ground black pepper along with the onion, then continue preparing the dish.• Ifyoulikesmoothies,addturmericandblack pepper and a half-teaspoon of olive or coconut oil before blending.

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Kathrynne Holden, MS, Moderator of the National Parkinson Foundation Forum “Ask About Nutrition,” and author of “Eat Well, Stay Well with Parkinson’s Disease,” and “Cook Well, Stay Well with Parkinson’s Disease.” www.nutritionucanlivewith.com.

Hope Parkinson Program participants wrapped up the year with the Fall Forum, workshops, activities and holiday celebrations.

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Save The DateExpert Lecture: “Exercise Changes Lives for those with PD”Dr. Gregory Robrahn, PTFriday, Jan. 8 at 1 p.m. at Hope Cape Community Room Seating is limited, and reservations are required. Contact Michelle Martin at 239-985-7727or Michelle.Martin@HopeHCS.org for more information.

PD Golf ClinicJanuary 16 – February 6PGA professional instructor Tim Jankowski is ready to help you brush up on your golf basics. The four-week PD Golf Clinic is designed for those experiencing mild to moderate symptoms where balance is beginning to become a challenge, but is not yet severe. Participants should be able to perform activities of daily living and walk without assistance.

The clinic is $40 per person and space is limited. Registration is required by January 9. Consult with your doctor before beginning a new exercise program. For more information or to register please call 847-644-1513.

Saturdays • 10 a.m. Alico Family Golf16300 Lee Road, Fort Myers

Winter Workshops

Special thanks to Alico Family Golf for hosting our recent fundraiser.

3-P: Posture, Poles & PD February 6 – February 27Pole walking turns a regular walk into a whole-body workout! Using special rubber-tipped poles outfitted with wrist straps, you will exercise your arms, shoulders, chest and back muscles as you walk. During the four-week pole walking workshop, instructor Lindy Smith will lead classes through a gentle warm-up with special attention to posture, seated exercises for flexibility, standing challenges and breathing awareness. Participants are limited to those with PD or Parkinsonism diagnosis who can stand and walk unassisted. One care partner per participant may attend for support. No special equipment needed. Loaner poles will be provided courtesy of LEKI.

The workshop is $20 per person and space is limited. Registration is required by January 22. A doctor’s consent form will be required to participate. Please call 239-985-7727 or email Michelle.Martin@HopeHCS.org to register.

Saturdays • 11 a.m. to noon Hope Cape Community Room2430 Diplomat Parkway East, Cape Coral

Special thanks to LEKI for sending three pairs of longer poles for our taller participants!

Featured Keynote SpeakerKelly D. Foote, MDWhat is the role of surgery in the treatment of Parkinson’s disease in 2016?

Dr. Foote is one of the few neurosurgeons in the world with fellowship training in both movement disorders neurology and movement disorders neurosurgery. Dr. Foote’s current research focus is on novel applications of deep brain stimulation (DBS)

technology, optimization of global DBS outcomes, and neurophysiological and micro-anatomical characterization of functional brain circuitry. His NIH-sponsored research includes projects applying and optimizing DBS therapy for the treatment of Parkinson’s disease, severe tremor secondary to multiple sclerosis, obsessive-compulsive disorder and Tourette syndrome. Since joining the UF neurosurgery faculty in 2002, Dr. Foote has performed over 1,000 deep brain stimulator lead implantation procedures. Perhaps most notably, he and his neurologist partner, Dr. Michael Okun, founded and co-direct the world-renowned University of Florida Center for Movement Disorders and Neurorestoration. Dr. Foote has been consistently recognized among the “Best Doctors in America” and “America’s Top Surgeons” and has served on the Board of Directors of the American Society for Stereotactic and Functional Neurosurgery. Dr. Foote received the UF Neurosurgery Faculty Mentor of the Year Award in 2011 and was honored by election to the American Academy of Neurological Surgery in 2012.

Amanda Avila, MDManaging PD: Tips for Today & Trends for TomorrowDr. Avila is the Hope Parkinson Program Medical Director and a Movement Disorder Specialist with Florida Neurology Group. Dr. Avila completed

her fellowship with the University of Florida College of Medicine’s Center for Movement Disorders and Neurorestoration. Certified by the American Board of Psychiatry and Neurology, she is the first Movement Disorder Specialist to practice locally in Southwest Florida.

John BaumannTapping into Your Inner Strength to Have an Amazing Life with Parkinson’s John was a successful attorney, a member of the University of Louisville faculty, and a semi-

professional softball player before Parkinson’s disease forced him to give up these activities that, in his late 30’s, he thought defined him as a person. Now, as a critically acclaimed author, internationally recognized speaker and successful workshop facilitator, John considers himself “Positively Unshakeable.” His message is simple, yet powerful: there are always things that you can do to have the best life possible if you reach deep down inside yourself and tap into your life force – no matter what the challenge or adversity.

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2016 Annual Hope Parkinson SymposiumFriday,February12•9a.m.Check-in and Registration: 8 to 9 a.m. Harborside Event Center, 1375 Monroe Street, Fort Myers

Symposium attendance is $25 per person and includes a light breakfast and valet parking. Pre-registration is required by February 1. Register online at https://donate.hopehcs.org/pdsymposium or call 239-985-7727.

New Tai Chi WorkshopTai Chi balance classes are great for those with PD! Learning and practicing a set of simple, continuous, rhythmic and functional Tai Chi movements can help participants lower their fall risk, help their balance and improve the performance of daily functional activities.

Hope’s five-week program focuses on adaptation and integration of motor-sensory systems, gait, lower extremity muscle strength, walking ability and coordination, fear of falling and incidence of falls.

Our program is based on an evidenced-based falls prevention program developed by the Oregon Research Institute and is recommended by the Centers for Disease Control, the National Council on Aging and the Administration on Aging.

Tai Chi is FREE for those with PD, along with their care partners. Pre-registration is required by calling 239-985-7727.

Tuesdays, Jan. 5 - Feb. 2 • 1 – 2 p.m.Hope Bonita Community Room • 27200 Imperial Parkway, Bonita Springs

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April 2016: Hope Parkinson Program Walk 4 HopeSaturday, April 30 at 10 a.m. at Lakes Regional Park, Fort MyersApril is National Parkinson Awareness month. Join us to help raise awareness and support our local Parkinson Community during a one- to three-mile walk at 7330 Gladiolus Drive in Fort Myers. $25 registration includes t-shirt and refreshments. Sponsorships are welcome. Register online at donate.hopehcs.org/Walk4Hope, or call 239-985-7727 for more information.

Don’t forget! Open Tai Chi classes continue this winter in Fort Myers and Cape Coral. We can modify the program for seated, assisted standing and standing participants. Please check the calendars for details.

Local Resources for Parkinson’s DiseaseContact the following organizations for more details and current programming schedules.

NPF National Parkinson FoundationPD Help Line; Patient Education Booklets; Aware In Care Kits; “Ask the Doctor Forum”www.parkinson.org 800-473-4636

MJ Fox FoundationPD Research Opportunitieswww.michaeljfoxfoundation.org

UF Center for Movement Disorders 3450 Hull Rd., Gainesville, 32607movementdisorders.ufhealth.org352-265-8408

Davis Phinney Foundationwww.davisphinneyfoundation.org

PDF Parkinson Disease Foundationwww.pdf.org

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National Resources

Educational and Navigational SupportArea Agency on Aging for Southwest Florida Aging and Disability Resource Center15201 N. Cleveland Ave., North Fort MyersHelpline 866-413-5337; www.aaaswfl.org

United Way-211 Helps people navigate their way through the maze of health and social services agencies by providing the most adequate resources for the client’s situation and promoting prevention and self-sufficiency by giving clients easy access to services.www.unitedwaylee.org

The Alvin A. Dubin Alzheimer’s Resource Center Educational, informational and supportive resources for individuals with Alzheimer’s disease and related disorders and their caregivers.12468 Brantley Commons Court, Fort Myers239-437-3007; www.alzheimersswfl.org

Lee Memorial Health SystemLee Physicians Group Memory CareCaregiver educational workshopsAllie Henderson; 239-343-9224

Chronic Disease Self-Management Workshop“It’s All About You”239-424-3122

Exercise Health & WellnessBonita YMCA Pedaling for Parkinson’s programMarla Ramsey; 239-221-7560

Laughter YogaFort Myers BeachMeg; 614-216-9341; coolabah123xyz@gmail.com

Lehigh Senior Citizens CenterWeekly Tai Chi Balance Classes219 Plaza Drive, Lehigh Acres239-369-5355; seniorcentermgr@comcast.net

LMHS SHARE ClubSenior Health & Wellness program serving residents of Southwest Florida ages 50 and older.239-424-3765; SHARE-Club@LeeMemorial.org

Lee County Parks & Recreation PoolsSan Carlos, Lehigh Acres, Fort Myers and Pine Island239-533-7275

Medical ServicesLMHS PD Rehabilitation Services TeamBalance Screenings & PD Rehab ClinicsMary Jo Haughey; 239-434-4962

FYZICAL Therapy & Balance Centers239-561-5616; www.fyzical.com/fort-myers

Hope at HomePrivate Duty Nursing Care, Medicare Home Health, Palliative and Hospice Care239-482-HOPE; HopeHCS.org

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Pedaling Forward with DBS

Doug Kirk was diagnosed with Parkinson’s disease about 15 years ago. Fortunately, the disease progressed relatively slowly, allowing him to work for 10 years after being diagnosed.

“I had voluntarily demoted myself from managing 20 software developers and overseeing multiple projects, to leading a small team of four developers on a single project,” he shared.

By 2011, he could no longer keep pace at work and went on permanent disability. The next year, Doug and his wife Shelia relocated from Iowa to Southwest Florida to help Shelia’s mother, who suffers from Alzheimer’s disease.

“This turned out to be one of many blessings we have experienced since my diagnosis,” said Doug. “Living here allows us to remain active year-round, with bike riding being a favorite way to enjoy the outdoors.”

The Road to DBSThe Kirks moved to Cape Coral about the same time Dr. Amanda Avila, a neurologist who specializes in movement disorders, joined Florida Neurology Group in Fort Myers. Dr. Avila completed her fellowship at the University of Florida Center for Movement Disorders and Neurorestoration, which is well-known as an international leader in the use of Deep Brain Stimulator therapy for treating Parkinson’s and other movement disorders.

“Dr. Avila told me at my first appointment that I was a great candidate for DBS, but at that time I wasn’t ready to let someone drill into my brain – especially being awake when they do the surgery!” said Doug.

But by the end of 2013, Doug’s symptoms were interfering with his daily living to the point that he realized trying DBS was worth taking the risk.

Doug chose the world-class DBS team lead by neurologist Dr. Michael Okun and neurosurgeon Dr. Kelly Foote at the University of Florida Center for Movement Disorders and Neurorestoration in Gainesville.

“Once I crossed that line and made the decision, I wasn’t overly concerned with the procedure. The process of being evaluated at the clinic and meeting the team removed any concerns I had,” he said. “My wife’s strong faith taught me to trust that God will always be with us, no matter the outcome.”

Doug had successful DBS surgery in the fall of 2014.

Navigating the CourseHe explained the device he has installed is part of a trial from Boston Scientific.

“The leads that are placed into my brain have eight contacts; the current device has one,” he said. Doug has the ability to increase or decrease the amplitude. “I actually have a “biking mode” with an increased amplitude that allows my legs to pedal faster and increase the RPM on the bike. I prefer riding at a higher RPM.”

Once Doug Kirk made the decision to undergo DBS, he never looked back. In fact, he just kept pedaling.

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Undergoing DBS did not change Doug’s medication regimen. He remains dependent on Carbidopa/Levodopa – the gold standard for fending off the stiffness and rigidity he experiences with PD. He also takes Selegiline, Amantadine and Foltx.

Doug has the highest praise for UF’s neurologists and neurosurgeons. “They are amazing, of course. It’s one of the top programs in the country,” he said, making sure to mention that he thinks Pam Zeilman, ARNP, is wonderful as well.

“Shelia calls her “Magic Pam” because of the way she can adjust my DBS and make my symptoms disappear. Pam is a critical link in the DBS process,” he said. “There’s no doubt that the placement of the leads are everything with DBS. But once the leads are in place, programming is just as critical. This step does not get a lot of press.”

After Doug’s fourth programming visit, Pam told him she was happy with his settings but wanted to try something different. He couldn’t tell at the time of the appointment if the settings were better, so they were saved as a separate program so he could try it out at home. Two days later, he switched to the new settings. The difference was remarkable.

“When my medication is working and with the new settings, it’s like I don’t have PD. This was the point where I decided we would ride road bikes instead of our trikes this year on Register’s Annual Great Bicycle Ride Across Iowa (RAGBRAI),” said Doug.

The Finish LineDoug and Shelia were always active bike riders with their friends in Iowa, but Doug never considered riding RAGBRAI until he met the Pedaling for Parkinson’s team in 2012.

“After hearing about the positive effect riding has on managing the symptoms, I was hooked. I decided to attempt the ride in 2013. I was probably more nervous that first year of RAGBRAI than I was about my first DBS surgery!” he said.

RAGBRAI is the world’s largest and oldest bike tour – a 462.2 mile trip that includes 16,000 feet of vertical climb. Last July, Doug and Sheila completed their third RAGBRAI.

“Every year has been special, but this year was extra special,” said Doug. “For years, we rode recumbent trikes because of balance issues caused by PD. Our friends in Iowa even nicknamed me “Waterbug” because of the way I maneuvered the trike. But because of my successful DBS surgery, I was able to ride an upright road bike once again.”

Waterbug, no more.

Doug and Shelia are already making plans to ride the 2016 RAGBRAI. But Doug’s plans extend beyond the annual event.

“I also would like to join one of the local riding clubs this year. I want to do more than just train for RAGBRAI and complete the ride – I want riding, and all of its benefits, to be a regular part of our lives,” he said.

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A Knockout Workout! Boxing for Parkinson’s Disease 8-Week Workshop Starting February 1

As part of Hope Parkinson Program’s collaboration with FYZICAL Fitness, the new boxing workshop is designed for those experiencing mild-to-moderate PD symptoms. The non-contact fitness curriculum includes boxing drills and conditioning to help develop

• optimalagility • speed,enduranceandaccuracy • hand-eyecoordination • footwork • overallstrength

Participants can attend three classes each week:Mondays at 11:45 a.m.Wednesdays at 1:15 p.m.Saturdays at 9 a.m.

The 8-week workshop will be held at FYZICAL Fitness, 13010 Metro Parkway, Fort Myers.

The $199 registration fee includes all 24 classes, access to the FYZICAL Fitness gym, over 30 group classes and a personal one-on-one pre-workshop evaluation.

Space is limited, so call Mike Drumm at FYZICAL at 239-561-1177 to register and schedule a pre-workshop evaluation before the January 25 deadline. Remember to consult your physician before starting any new exercise program.

The pilot PD Boxing on Railz program at Fyzical was a great success last fall, with participants excited to learn a fun, new way to benefit from movement therapy.

“i was impressed and amazed at what an astonishing job everyone did, and even more exciting was that everyone who participated seemed to feel the same way about their performance,” said Hope Parkinson Program coordinator and certified RockSteady Boxing coach Michelle Martin.

The pilot program participants shared their rave reviews:

“It’s so much more fun to tell my grandkids I am going to boxing than to PT.”

“Thanks for helping me get my anger towards PD out!”

“I was so surprised that during such an intense workout I was able to maintain such a high level of energy.”

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Restoring The Voices of Those with Parkinson’sMary Jo Haughey, Lee Memorial Health SystemThere are two internationally recognized speech therapy treatment programs for people with Parkinson’s disease: LSVT LOUD and SPEAK OUT! Parkinson Voice Project.

It is estimated that 89% of individuals with Parkinson’s will experience speech and voice disorders. However, only 3 to 4% of people with PD receive speech treatment. Speech therapy increases vocal loudness by stimulating the muscles of the votive box (larynx) and speech mechanism through a systematic hierarchy of exercises.

Lee Silverman Voice Training (LSVT) focuses on a single goal: speak LOUD. LSVT LOUD uses loudness training to maximize speech intelligibility and to bring the voice to an improved, healthy vocal loudness with no strain.

Based on the teachings of Dr. Daniel R. Boone, the SPEAK OUT! program focuses on teaching the patient to speak with intent and deliberation. Together, the patient and their speech language pathologist work their way through a series of speech, voice and cognitive exercises outlined in a comprehensive workbook.

For more information about where these treatment programs are administered through Lee Memorial Health System, please call Mary Jo Haughey, MS, CCC-SLP, at 239-343-4962.

Want to improve your speech and voice use with others in a fun atmosphere? Enjoy the CAFE - an acronym for communication, activity, friendship and education.

Through community-based classes, participants will learn skills to improve communication and strengthen breathing, voice and speech. Classes are led by Mary Spremulli, MA, CCC-SLP, licensed speech-language pathologist and owner of Voice Aerobics, LLC.

Thursdays Hope Cape Community Room2430 Diplomat Parkway East, Cape Coral

Speak Easy A.M. 11:30 a.m. to 12:30 p.m. Speak Easy P.M.2:30 to 3:30 p.m. Join others for an hour of communication activities designed to improve the way you speak and challenge your thinking. A workbook for daily home practice will be provided, along with a

Hi-VOLT™ voice-on-light, calibrated voice feedback tool. Maximum six participants per class. $25 per session for five sessions. Sorry, no spouses or caregivers allowed.

Voice Aerobics® Whole Body Voice Strengthening Program: 1 to 2 p.m.This 60-minute class focuses on posture, breathing and voice while incorporating upper body stretching and movement. Participants will receive a Voice Aerobics® DVD for home practice. Maximum 30 participants per class. $55 for five sessions. Care partners attend for free.

Seating is limited and registration is required. A portion of your class fees support the Hope Parkinson

Program. Register for any individual class or attend both classes for $175. Visit www.voiceaerobicsdvd.com/seminars-voice-aerobics.html.

To pay by credit card or for additional information, contact Mary Spremulli at info@voiceaerobicsdvd.com or call 941-204-1515.

NEW! Hope CAFÉ Workshops January 28 - February 25

E v E n T L O C A T I O n S :

BOnITA SPRInGSThe Terraces: 26455 S Tamiami Trail

CAPE CORALCape Coral Wellness Center: 609 SE 13th CourtHOPE Cape Community Room: 2430 Diplomat Parkway E.

ESTEROEstero Recreation Center: 9200 Corkscrew Palms Blvd.

FORT MYERSHarborside Event Center: 1375 Monroe StreetCypress Cove “Edison Room”: 10500 Cypress Cove DriveBrookdale Cypress Lake: 7460 Lake Breeze DriveFUMC-Faith United Methodist Church: 15690 McGregor Blvd.Hope HealthPark Community Rooms: 9470 HealthPark CircleShell Point Retirement Community King’s Crown Meeting Room: 14701 Kings Crown Way

LABELLEHope Connections: 475 East Cowboy Way

LEHIGH ACRESHope Lehigh: 1201 Wings Way

NORTH FORT MYERSRecreation Center: 2000 North Recreation Park WaySchedules are subject to change.

Hope Parkinson Program Calendar Details

Bonita and Estero classes are provided in partnership with PASFI.

Entry to Estero and North Ft. Myers Lee County Parks and Recreation facilities requires you present a Membership Card that can be purchased at the facility prior to attending your first class. Cost is $10 for a lifetime membership.

All events require pre-registration. Please call 239-985-7727 or email Michelle.Martin@hopehcs.org. The latest programming information can be found at www.Hopeparkinson.org.

c O l O R K E y :

Support Groups: BlueExercise classes: Black Educational Events: Red Social Events: Green

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Fall Forum Thank YouThe Parkinson Fall Forum in November was a great success, with a record number of Hope Parkinson Program participants attending “PD Treatment Updates: Medications and Surgical Treatments.

We would like to give a special thank you to our speakers, Dr. Amanda Avila of Florida Neurology Group and Dr. Sam Javedan of Lee Memorial Health System Neurosurgery, for their informative presentations. We also truly appreciate the support of our sponsors: US WorldMeds, Medtronic and Crowne Plaza Fort Myers at the Bell Tower Shops.

E v E n T L O C A T I O n S :

BOnITA SPRInGSThe Terraces: 26455 S Tamiami Trail

CAPE CORALCape Coral Wellness Center: 609 SE 13th CourtHOPE Cape Community Room: 2430 Diplomat Parkway E.

ESTEROEstero Recreation Center: 9200 Corkscrew Palms Blvd.

FORT MYERSHarborside Event Center: 1375 Monroe StreetCypress Cove “Edison Room”: 10500 Cypress Cove DriveBrookdale Cypress Lake: 7460 Lake Breeze DriveFUMC-Faith United Methodist Church: 15690 McGregor Blvd.Hope HealthPark Community Rooms: 9470 HealthPark CircleShell Point Retirement Community King’s Crown Meeting Room: 14701 Kings Crown Way

LABELLEHope Connections: 475 East Cowboy Way

LEHIGH ACRESHope Lehigh: 1201 Wings Way

NORTH FORT MYERSRecreation Center: 2000 North Recreation Park WaySchedules are subject to change.

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