When should I tell my child about an upcoming surgery?

When should I tell my child about an upcoming surgery. When your child has an upcoming surgery or procedure, telling your child when they arrive at the hospital is generally a bad idea. So when to tell your child? Can it be too soon, too late? Amy Fregonese, child life specialist at TMC for Children, weighs in with some concrete advice on when and why to talk to your child about their surgery.

While talking about an upcoming surgery with your child may feel overwhelming, research has found that providing developmentally-appropriate preparation can help to decrease stress and anxiety before, during and after the experience.

When to tell your child:

Toddlers (1-3 years old)
Tell your child a day or two before. Toddlers are not able to understand the concept of time and may begin to worry if told too soon. It is normal for toddlers to become fussy and have behavioral changes before and after a procedure.

Preschoolers (3-5 years old)
Tell your child 3-5 days before the scheduled surgery. Too much time will allow fears and misconceptions to develop. Your child will be curious and will want to know what to expect.

Elementary school age (6-12 years old) 
Tell your child a week or two in advance. This will allow time to process the information and to develop and ask questions without allowing too much time for fears to develop. Your child needs details before, during and after the procedure.

Adolescents (12-18 years old)
Involve your teen in all aspects of planning for the surgery, including talks with the doctor. Allow teens to discuss and talk freely about their concerns. Allow them to maintain their independence and sense of control. Be supportive and honest.

What should I tell my child:

How much and when to tell your child will depend on age and developmental stage, personality, past health care experiences, and understanding of the illness or condition that is being treated.

You know your child best. Use your knowledge, along with the information you have gathered, to talk openly and honestly with your child. Focus on what your child will experience before and after the surgery. An expected stressor is less stressful than an unexpected stressor. Remember to ask your child what questions he or she has about surgery.

Finally, remember you child, no matter the age relies on cues from you. If you appear calm and confident, your child will be more relaxed.

A tour of the surgery area can help you and your child feel more comfortable and gain a better understanding of how things will proceed.

Amy Fregonese
Child Life Specialist

Surgery Tours

Our child life specialists can help your child understand surgery and what to expect. Pre-surgery and pre-admission tours are available. Most tours are geared for children ages 3 and up, but all ages and siblings are welcome. You can call (520) 324-1154 to set up a tour time that is best for your family.

Amy FregoneseAmy Fregonese, Child Life Specialist, specializes in supporting families as they prepare for and recover from surgery. Amy has been helping children and families at Tucson Medical Center for five years.





No more blood pressure pills, less pain after weight loss surgery

KelleeKellee Smith didn’t have a history of struggling with weight. She still has the size 2 gown she wore in a Miss Maryland pageant when she was 110 pounds.

But the weight started creeping on after a drunk driver in a large pickup truck slammed into her small car five years ago, shattering her shoulder, detaching her knee cap, severing the tendons in her leg and leaving her with a traumatic brain injury. It took two surgeries and about 18 months of rehabilitative therapy to start rebuilding her life.

She gained weight, in part from the reduced activity, in part as a side effect from the medications she was taking and in part as a result of turning to food as a comfort from the pain and physical limitations.

When her blood pressure medication would no longer control her blood pressure, though, she knew she had to make a change.

“I just wanted to be healthier. I didn’t want to worry about having a cardiac event or having to take more and more medication,” said Smith, a 45-year-old teacher.

Smith had gastric sleeve surgery in summer 2017.

One of the important tools for Smith was a food journal. Surprised to see how much soda she had been drinking, she switched to flavored seltzer water and eventually just switched to water.

Other changes: She adds a low-carb protein shake to iced coffee, giving her the creaminess of a frappucino without the extra sugar and calories. She turns sandwiches into lettuce wraps to eliminate the bread. She’s made spaghetti out of zucchini strings.

“I’m just a lot more conscious about labels and what I’m eating now,” she said. “I can still have the treats that I want, but I just look for ways to make them a healthier alternative.”

Smith said her surgeon told her not to be surprised if it was hard to make some of the transitions in the beginning, and at one point might wonder why she had decided to do it in the first place.

“I have not once asked why I did this,” Smith said. “I had tried diets and even diet medications. I had gone to gyms. I even had a personal trainer. Nothing was helping me lose the weight and I had really just resigned myself that this was how life was going to be for the rest of my life.”

Instead, six months in, Smith has lost 55 pounds in a safe, steady way. Initially at a size 18/20 pants, she bought herself a pair of size 12 jeans over the Christmas holidays. She’s doing strengthening classes at the gym. Between that conditioning and carrying less weight, she’s experiencing less pain and her balance is steadier than it had been in years.

Importantly, in October, she stopped taking blood pressure medication altogether because she no longer has hypertension.

And she’s strongly considering entering a pageant in fall 2018 to share her accomplishments.

“Weight loss surgery isn’t an easy way out or a cure all, but it is a tool,” Smith said. “Every day, it’s a new commitment. Every day, I choose if I’m going to live an active life and make healthy choices.”

Tucson Medical Center director honored with HIMSS Book of the Year award

As a proud supporter of the Tucson Festival of Books, Tucson Medical Center is celebrating one of its very own literary talents!

Focused on leadership and management in health care and health information technology, Leading Healthcare IT: Managing to Succeed, by Susan Snedaker, MBA, CISM, CPHIMS, CHCIO, this week received the 2018 HIMSS Book of the Year Award.

The book presents a practical guide for developing passionate, engaged and competent leaders to meet the demands of today’s health care IT environment.

Snedaker is an accomplished IT executive and author. She is the director of Infrastructure and Operations and information security officer for Tucson Medical Center, where she oversees IT infrastructure and clinical engineering. Snedaker’s team developed and deployed innovative technology solutions to meet the evolving needs of the organization. Her approach to cross-team collaboration, clinical engagement and technical innovation has created an IT environment that delivers exceptional results. TMC is a HIMSS Analytics Stage 7 hospital and has ranked as a Most Wired hospital every year since 2012.

“I’m extremely pleased to receive the HIMSS Book of the Year Award,” Snedaker said. “This book represents an amalgamation of what I’ve learned through both education and experience, as well as what I’ve gleaned from working with peers, colleagues and mentors.

“I wanted to create an approachable, user-friendly book – with clear, concise and actionable information – that could accelerate leadership development specifically for healthcare IT. To have this book selected as HIMSS Book of the Year is a great honor.”

Gus Venditto, vice president, content development, HIMSS Media said, “Susan Snedaker’s ‘Leading Healthcare IT: Managing to Succeed’ provides a concise roadmap for professionals who manage, direct or oversee healthcare information and technology. Her insights provide a valuable perspective for readers, and we congratulate her for this significant milestone as an author.”

TMC and Mayo Clinic collaborate to promote survivorship at Survive Well: Living with Cancer Symposium


For the second year in a row, Tucson Medical Center, in collaboration with Mayo Clinic, is pleased to offer the Survive Well: Living with Cancer Symposium, designed to help patients find more about the diagnosis and treatment of cancer, as well as shared issues facing patients, caregivers and family members.

The broad-based symposium, with a focus this year on celebrating survivorship, will include discussions designed to help participants deal with the stress of these diseases and move forward in a positive direction.

The free event, which Mayo Clinic has successfully offered for nearly a decade in the Phoenix area, will take place on Saturday, April 7. Mindful walks will kick off the day at 7:30 a.m., with sessions beginning at 9 a.m. at the Westin La Paloma in Tucson, Arizona.

The keynote address will be delivered by Dr. Edith Eva Eger, a Holocaust survivor, who will share her perspective on embracing the possible. In addition to cancer-specific breakout sessions, TMC, Mayo Clinic and Arizona Oncology experts will also lead other topic discussions including intimacy after cancer, genomics, as well as exercise, diet and inflammation. Celestino Fernandez, a distinguished professor emeritus at the University of Arizona, will close with a session on finding happiness every day.

“Survive Well is a fitting venue to share advancing technologies, leading treatments, and support services,” says Aleksandar Sekulic, M.D., Mayo Clinic Dermatologist and Deputy Director of the Mayo Clinic Cancer Center in Arizona. “The symposium is a valued part of our collaborative efforts to provide meaningful information and support to patients with cancer and their families.”

As a member of the Mayo Clinical Care Network, TMC works with Mayo Clinic to better serve patients and their families by sharing education and best practices. “This symposium is a continued maturation of the relationship we’ve developed with Mayo Clinic, to ensure that our patients benefit from our collective knowledge,” said Dr. Robert Brooks, medical director of oncology at TMC.

For more information or to save your spot, please visit our website.

Mission Moments: Helping out with a four-legged family member


Pets are familiar sights at Tucson Medical Center: Our K9 units help keep the hospital safe and our pet therapy teams brighten spirits of patients and staff.

So when Wellness Director Mary Atkinson saw this fun little guy out stretching his legs with his owner along TMC’s walking path, she introduced herself to the pair.

It turns out the dog was waiting in the car for his dog mom to have a procedure done and his dog dad was trying to split his time between checking on his wife and checking on his four-legged family member. As recent arrivals to Tucson, he didn’t want to leave the pet unattended in an unfamiliar home.

Hearing about the predicament, Atkinson offered to keep the terrier mix in the Wellness Department through the day.

He was a perfect gentleman – and looked quite dapper in the Girls on the Run bandana he scored during his sojourn in the new digs.

MaryAtkinson (2)“We were happy to help, and his owner was very grateful that he could focus on his wife’s surgery and know that this other member of his family was safe,” Atkinson said. “It’s always important to us to practice kindness and to be cognizant of ways we can help other people – and especially during stressful times in their lives.”

Tucson Medical Center recently adopted a new mission statement. To celebrate, we are sharing a series of “mission moments” throughout the year.

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do. Hundreds of these reminders happen every day. Thank you for letting us share some with you.



Bariatric support group helps patient stay on track with a healthy weight

MaryannMaryann Webb was once “fired” from a support group for not losing enough weight.

Never mind that she’d shed 100 pounds from her starting weight of 357 pounds after having gastric bypass surgery. It wasn’t fast enough or significant enough to meet the expectations of the other members of her group. So she quit.

She and a friend left another support group so depressed they went out and got a hot fudge sundae.

Then in January 2017 she found the support group at Tucson Medical Center for those who had weight-loss surgery.

The 74-year-old retired personnel trainer never misses one.

“It’s like getting a booster shot every month,” she said. She likes the positivity of the group and the non-judgmental environment.

Webb had a long struggle with weight. Part of it is genetics – a whole passel of her family is just a little shorter and a little heavier than average. And she comes from a long line of family members who comfort and nurture one another with food. If you went to grandma’s for Saturday supper, you knew you were going home with a dozen of her sugar cookies.

When she moved from the family farm and the physical demands associated with it, and took a desk job, she found herself gaining weight pretty quickly.

“I’d tried them all. The cabbage soup diet. The hormone shots. This was a long time ago, but I even tried that approach where they shock you when they show you a photo of food to try to make you repulsed by it. Nothing worked.”

It got worse when she was hit with a triple whammy: A divorce, a change in jobs and a newly empty nest after her daughter went away to college.

By the time she had surgery – this was back in 1999 – she was 55 and having trouble with her kidney function and she had diabetes. She took off 100 pounds pretty quickly and then years later lost more when she went through an unrelated medical condition.

The weight loss support group is offered monthly and provides an opportunity for patients who have had weight-loss surgery to connect with others who are in different stages of their weight-loss journey. Our mission is to provide a safe, supportive environment for patients to build relationships and get education focused on health and well-being for their lifelong journey.

Last year, she underwent surgery to fix a constriction and a hernia on the original bypass. When her surgeon asked her what she wanted from the surgery, she said she just wanted to eat lettuce again.

Unlike the larger incision from the first surgery, technology allowed a laparoscopic procedure this time around, with much less pain and a faster recovery. She stuck to her surgeon’s diet suggestions like gospel, sure it would help her heal faster. And sure enough, she’s eating lettuce again.

She’s also walking three days a week, doing aerobics three days a week and organizing monthly social events with a group of retired friends (including a tour of Tucson’s ethnic restaurants with strict orders to try something they’d never had before.)

“I feel better than I have in years,” Webb said. “It isn’t like the surgeon gets to wave a magic scalpel and suddenly the weight comes off like magic. It’s a tool. But it’s a tool that makes it easier. Plus, now I know myself better. I understand what I have to do to take care of myself. I know I never want to be that sick again. And I’ve learned over the years that it’s OK to be proud of yourself a little bit.”

And that’s also why her self-care toolbox includes the monthly support group held on the TMC campus for those who have had bariatric surgery at TMC.

Webb said she appreciates sharing her tips with others and learning from experiences others share – not to mention it’s often a tasty experience to boot.

A recent class had a series of taste tests for protein bars (she’s rather partial to Power Crunch salted caramel.) In another class, members shared their recipes for protein shakes and made samples. The class learned about vitamins and supplements in another.

“I can actually say that I’ve been to a lot of support groups over the years,” Webb said. “And this is really a support group.”

For more information about weight loss surgery at TMC attend a FREE weight loss surgery seminar.

TMC Healing Art Program Photography Exhibit

Steve Dell Sunrise at Mesa Arch

Steve Dell “Sunrise at Mesa Arch” 2010

More than 900 works of art have been donated and installed at Tucson Medical Center as part of the Healing Art Program. Why? Because artwork can make us feel better and speed recovery – and that’s more than a pleasant notion, it’s an evidence-based best practice.

“The donated paintings, drawings and photographs really go a long way in promoting healing and enhancing the patient experience,” said Lauren Rabb, curator of the TMC Healing Art Program.

On March 8 you can view a hand-picked selection of the first exhibit of TMC art outside the hospital at the Temple of Music and Art.


“The TMC Healing Art Program helps patients heal in surroundings that inspire, encourage and cheer,” said Michael Duran, TMC vice president and chief development officer. “Events like the photography exhibit help us populate the hallways, numerous courtyards and many public spaces throughout the TMC campus with life-enhancing art.”

Bill Steen   “Monsoon Intersection, the Malpais, NM”   2007

Bill Steen “Monsoon Intersection, the Malpais, NM” 2007

The event features the images of renowned national and local photographers, such as Gregory Cranwell, Steve Dell, B.G. Boyd, Marla Endicott, Larry Hanelin and Niccole Celeste Radhe.

The exhibit also includes the photos of professional photographer Pamela Gresham Knight, who is traveling from Texas to attend the opening in-person.

“I am astonished by the incredible artwork the TMC Healing Art Program has received,” said Knight. “These photos and paintings are what you might normally see in a museum or gallery.” Knight also explained she strongly supports the cause. “I’m honored and humbled to have my photographs be part of providing relief and comfort for patients who are healing.”

Enjoy the rare opportunity to view the artwork at the treasured Temple of Music and Art. The Arizona Theatre Company bar will be open.

TMC Healing Art Photography Exhibit

March 8, 5 – 8 p.m.

Temple of Music and Art Gallery, 330 S. Scott Ave.

FREE to attend (no RSVP needed)

Photographs, 16 x 20 inches or 10 x 20 inches, are available for purchase through May 12. Proceeds support the TMC Healing Art Program

TMC’s Healing Art Program accepts donations of gallery-quality paintings, graphics, photography and sculpture. “You will be truly amazed by the quality of the images presented at the fundraiser,” said Rabb.

To donate artwork, take a TMC artwork tour or for more information visit http://www.tmcaz.com/healing-art-program or call (520) 324-3116.









Small changes add up to 50 pound weight loss for Lindy

LindyWhen 36-year-old occupational therapist Lindy Schoch decided to do a weight management campaign a year ago, she was feeling kind of blah.

Her energy was down. She was carrying too much weight. And even though she was working out five days a week, her scale wouldn’t budge.

Schoch consulted with a member of the wellness team and registered dietitian Laurie Ledford to come up with a solution.

“I thought I was eating healthy – and I was – but you can eat too much even if it is healthy,” she said. “Decreasing portion control was a big key for me. The important thing is to take small steps instead of trying to do everything at once. You don’t want to feel overwhelmed.”

Over the course of the year, without making drastic changes, Schoch lost 50 pounds, with a goal of another 30 by her spring 2019 wedding.

Here’s what helped:

  • Breakfast: She swapped out her breakfast Greek yogurt for one that has half the sugars and all the protein. She supplements her breakfast with two hard boiled eggs.
  • Lunch: She stopped putting cheese and ranch dressing on her six-inch submarine sandwiches – stuffing them with flavorful vegetables, pickles and pepperoncinis instead – and switched to flatbread instead of sub rolls. Over time, she switched to salads with chicken and avocado, forgoing the sandwich altogether.
  • Snacks: Ledford told her she should eat something in between meals so she wasn’t ravenous for her big meals, since that makes it harder to control portions. She takes an apple or banana for a quick snack in between meals.
  • Drinks: Sodas are rare for her. She usually opts for unsweetened tea. She did have to completely give up coffee. “I actually hate coffee, but I love creamer. I had to give up coffee because I couldn’t have it without half a cup of creamer in it. That helped cut out a bunch of fat and sugar calories.”
  • Sugar: She’s the first to admit she’s a cookie fiend. And she likes chocolate. And while she’s pretty disciplined about steering clear of office goodies, she has learned one important lesson: “If I really want a piece of chocolate, I will have it. When you crave it, have one of that item and have it right away when you first feel like having it. I’ve made the mistake of trying to resist and then later, eating too much of something because I’ve been wanting it all day.”
  • Be patient with yourself. “Six weeks into my 12 week program, I had done all this and I hadn’t lost one pound. Not one. This is where people get discouraged, because they make changes for a certain time and they give up, but your body needs time to adjust to the changes you’re making. By the twelfth week, I had lost 11 pounds and then it just poured off, six pounds every other week.”
  • Let technology help. There are a lot of fitness apps on the market, but Schoch particularly likes My Fitness Pal, a free app that logs her caloric intake and activity levels and helps her stay on track for her long-term weight goal.

“I don’t deprive myself and I’ve found that what I’m doing now is sustainable,” she said. “I feel lighter now. I can run and it’s less taxing. I have more energy and I feel good about the direction I’m heading.”

TMC Wellness offers one-on-one appointments and small group counseling with a registered dietitian or exercise physiologist. 

Pregnancy and the flu vaccine – Protection for you and your baby

Why you should get the flu shot if you're pregnant

Photo by Alex Pasarelu

“Babies can’t be given the flu vaccine until they are six months old, so the vaccine that you receive is for both of you,” explained Erin Sperry Schlueter, M.D. F.A.C.O.G., department chair of TMC OB/GYN.

With pregnant women on the short list of people with an increased risk of developing flu complications, understanding the facts about the flu vaccine is a top priority. According to the American College of Obstetrics and Gynecologists (ACOG), pregnant women can get the flu vaccination at any time in their pregnancy, but it is best to get one early in the flu season, October through May.

The vaccine can be given in two ways, a shot or a nasal mist. The mist is not recommended for pregnant women, although it’s safe for women who have just given birth and are breastfeeding.

Protecting yourself from the flu is only half of the benefit; the other half is the protection it gives your baby. The vaccine decreases your risk of getting the flu while you’re pregnant and then keeps your baby protected for the first six months of life. If you do happen to catch the flu after getting the flu shot, it is usually a much more mild sickness.

“The flu shot is critically important for pregnant women because they are at a much higher risk of life-threatening complications from the flu. We also recommend that all immediate caregivers such as partners and grandparents get themselves protected with a flu shot to provide a ‘cocoon’ of immunity around the new baby”, said Dr. Sperry Schlueter.

Don’t get caught by the flu, get your vaccination early. Mild side effects like a sore arm and a low fever for a few days are a minor annoyance when compared to the flu virus.

The Centers for Disease Control and Prevention has information on their website about the vaccination and pregnancy. https://www.cdc.gov/flu/protect/vaccine/qa_vacpregnant.htm.

If you haven’t already had your flu vaccine, get vaccinated. Even if it is late in the flu season the vaccine can still be beneficial. You can schedule an appointment to get the flu vaccine at the TMCOne Wyatt office by calling (520) 394-6619. A brief registration keeps you on schedule, the central location makes it easy and the friendly professionals provide the quality care your family expects from TMCOne. The flu shot is covered by insurance and only $25 for out of network plans.


An Emergency Room Visit: A Patient’s View

Emergency DepartmentNothing is more frustrating that sitting in the emergency room feeling terrible and watching someone who looks perfectly fine walk in and walk straight through to triage and be taken back. Right?

I recently got to be that person skipping the waiting room, moving straight past go to immediate help.

I felt fine, well except for the piercing headache behind my left ear that had been there for three days, but that hadn’t brought me into the emergency room. What brought me in was when one side of my face began to droop.

It was quite odd. At first it was just that my eyes didn’t look the same as usual. One seemed bigger than the other and then my face started to seem flat on one side.

Signs of a stroke

I recognized the drooping face as a possible symptom of a stroke and after I called my husband and dropped off the kids with some friends, I had a friend take me to the emergency room. Not my brightest moment. After all, if this was a stroke I was wasting precious brain time, but at least I didn’t drive myself! I couldn’t possibly be having a stroke – could I? After all my mum was 70 when she had her stroke. I was just 48 years old – a spring chicken. While I am definitely overweight, I didn’t have other risk factors.

I raced up to the front desk in the emergency room and began to explain my concerns. By this point my mouth was beginning to droop, too. The nurse took one look at me and whisked me back.

I’m sure to those left in the waiting room this seemed massively unfair. After all, there I was, able to walk, apparently in not significant distress, no bleeding or obvious trauma (they couldn’t see my face) and I was going to be seen before everyone else waiting.

Within a couple of minutes members of the rapid response stroke team were evaluating me for a stroke, bloodwork was being taken, and my situation was being evaluated. After the initial evaluation they were pretty sure I wasn’t having a stroke, but it wasn’t clear what was going on and something was definitely going on. Most of the possible scenarios and options were pretty awful. Center for Neurosciences nurse practitioner Frances West and neurologist Dr. David Teeple kept me calm and informed and made the decision to keep me at the hospital for observation.

The following day, after ruling out a possible reemergence of an earlier melanoma, the pieces began to fall into place. I had Bell’s palsy.

Bell’s Palsy

Bell’s palsy affects about 30,000 to 40,000 people every year in the United States. It results in the paralysis or weakness of one side of the face as a result of damage to the facial nerve. The cause of Bell’s palsy isn’t known, but generally the weakness or paralysis is thought to be due to swelling of the nerve in the area where it travels through the bones of the skull. For many, symptoms often begin to improve right away, but it may take weeks or even months for the muscles to get stronger. For some people symptoms may never completely disappear.

Six months out, my face is still lopsided. I can’t drink straight from a bottle, and talking at length can be tiring and embarrassing as I drool when my mouth tires. However, I can blink and smile. My facial paralysis isn’t quite as obvious as it was previously.

Bell’s palsy is not pleasant, but as my ability to parent, work, live and be an active member of my community is not impacted by my looks, I’ll take this slightly lopsided smile over the other possibilities like stroke or brain tumor.

I am grateful to know that if it had been a stroke, the TMC Rapid Response Stroke Team was ready to act, and the front desk staff prepared to recognize and move on a possible stroke case. And next time I’m in the waiting room of an emergency room … I’ll be a tad more patient as a new arrival is whisked back before me even if they don’t look sick.

While Tucson boasts a half-dozen stroke centers, TMC is the city’s only primary stroke center that has 24/7 coverage by board certified interventional neuroradiologists along with a neurology and neurosurgery stroke team.

Rachel Miller is a Communications Specialist at TMC.  She has decided since developing Bell’s palsy that everyday should be pirate day. (Individuals affected by Bell’s palsy are often unable to close or blink the eye on the affected side. A patch protects the eye from the everyday dust. Here Rachel takes advantage to play pirate.)

TMC nurse helped make wedding dream come true for one couple

Malloree Ingalls (2)It only takes a quick chat with TMC Cardiac Unit nurse Malloree Ingalls to understand why she was drawn to a career in nursing. Her upbeat smile and approachable attitude put her patients at ease during what is often the most stressful time in their lives.

One such patient was just days away from open heart surgery when his fiancée of 12 years told him that she would like to stop waiting and just get married, to her delight, he said yes. “She was worried about upsetting family and friends by not having a big thing. I told her, “Don’t worry about them, this is for you,” Ingalls recalled.

Cutting the cake at hospital wedding

When the couple asked cardiothoracic surgeon Kushagra Katariya, M.D., how many times he had performed this particular surgery, the patient’s fiancé recalled with a laugh, “He said five times … this week.”

With that reassurance and the surgery in a few short days, Ingalls and the team from the Cardiac Unit sprang into action. “She told me that she heard that you can get married in a hospital, so I started making some calls,” said Ingalls.

With two rings purchased at the TMC Gift Shop, calls were made to arrange for a cake, refreshments from Food and Nutrition Services, a notary and TMC Chaplain Mary Klaehn.

With that, a wedding came together.


The bride nominated Ingalls for a DAISY Award, an international program that rewards and celebrates the extraordinary clinical skill and compassionate care given by nurses every day. In her nomination, the bride said of Ingalls, “Words can never explain my utter love and gratitude towards her and her beautiful soul…Having her as our nurse was the best thing that happened to us, in our most troubling time.”

hospital wedding rings

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we are sharing an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do.

Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Nominate an extraordinary nurse for the DAISY award

TMC closely following developments in Green Valley

2014-judy-rich-standing-preferred-pose To Our Community,

We have received several questions regarding the recently announced bankruptcy sale of Green Valley Hospital to a California-based equity firm. According to the public announcement, there was only one bid received for the struggling medical center and that bid was accepted for the acquisition of the hospital alone and did not include the associated medical office buildings, hospital equipment and other related assets.  The bidder was actually a lender who had loaned money for the time it was in bankruptcy.

TMC HealthCare has been following the Santa Cruz County hospital’s bankruptcy proceedings carefully, with an interest in supporting the surrounding communities. As a nonprofit community hospital, we continually seek opportunities which are consistent with and further our mission to provide exceptional healthcare with compassion. However, any new venture or investment must be financially viable. Since the Green Valley Hospital has a history of substantial financial losses, we needed to be mindful of how such an investment would impact our broader system. After a careful analysis of the opportunity in Green Valley, it did not make sense to participate in the current  bidding process for that hospital asset. We will continue to monitor the situation to see if an appropriate opportunity arises for our involvement with the hospital.

TMC has a long-standing relationship with the Green Valley residents, so please know that we will continue to explore how we can best and most appropriately serve that population.

If you have further questions, please call Julia Strange, vice president, Community Benefit, at 520-324-2017.


Judy Rich

Did you nix New Year’s resolutions this year?

What's your thing - nix the new year resolutionsA message from Laurie Ledford to all those folks looking to set a health challenge for themselves, but not taking the New Year resolutions path. 

Many people see the New Year as a chance for a fresh start, a time to make big changes in their lives. Some people will make resolutions, vowing to become better versions of themselves. Knowing that most New Year’s resolutions fail, and realizing lifestyle makeovers are difficult, other people won’t bother setting a goal for the year.

If you are the type of person who enjoys a challenge, and you can set a goal that is enjoyably difficult but not impossible, then go for it! Just be sure to make a plan – your roadmap – so you don’t get lost along the way. You can use the advice below to help you stick to your plan.

For you non-resolvers out there, let’s find an alternative way to improve yourself without all that stress. Instead of a resolution, just create “Your Thing.” (If you prefer, you can call it your mission, objective, intention, ideal or purpose.) Make it fairly specific, so that it gives you direction for making the right choices. Here are some examples.

  • You want to get eight hours of sleep every night. When the television tries to keep you watching past your ideal bedtime, you say, “Sorry TV, that’s not my thing.”
  • You want to reduce your sugar intake, and someone offers you a soda. You could tell them, “Thanks, but soda’s not my thing.”
  • You want to eat more vegetables. When a waiter asks, “Would you like fries with that?” You reply, “Actually, veggies are more my thing. I’ll have a side salad instead.”

“Your Thing” needs to be about something you want to change. It may not be what your doctor, your family, your friends or strangers online think you should change. The desire to change must resonate inside of you, and you must have a clear idea of why you want to change. That reason will help provide motivation to, for example, choose the after-dinner walk instead of the after-dinner ice cream.

“Your Thing” is not one big transformation; it is instead a continuous process and an ongoing learning opportunity. It isn’t a single decision; it is lots of choices, made moment by moment. In this approach, you break down the overall improvement into small steps, and you take one step at a time.If you have a slip-up along the way, you forgive yourself and move on. However, you can learn from each little slip-up. Ask yourself what you could do to help yourself make a different (better) decision next time.

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Often making the right decision comes down to choosing one behavior over another. For “Your Thing,” it means choosing to do what’s right, not what’s easy. It’s easy to fall into old habits. Therefore, you need to become aware of what you are doing day to day. Notice which behaviors or habits support “Your Thing” and which ones do not. Then get curious about what drives those behaviors. Here are some common triggers.

  • your location or surroundings
  • the time of day
  • other people
  • your emotional state
  • some other associated behavior

Now make a plan. Decide what you are going to do differently when the trigger activates your behavior. Ideally, it will be something that provides the same good feeling while still supporting “Your Thing.” Your plan may not be an instant success. You may have to try several different tactics to stick with “Your Thing” And you may find that what you thought was a trigger actually wasn’t. This is why changing habits is an ongoing process of learning. It takes time to figure out your behavior.

No matter how vigilant you are, there will be times when it is simply too much work to make the right choice. Sometimes you are so exhausted or stressed that you feel unable to resist the old habit, and so you give in. Guess what? It’s OK. Nobody’s perfect, so forgive yourself, move on, and vow to do better next time.

Laurie Ledford RDLaurie Ledford is a registered dietitian from Atlanta, Georgia, the land of grits, collard greens and super-sweet iced tea. She now works as a registered dietitian  in the Tucson Medical Center Wellness Department. She enjoys helping people improve their health through sustainable dietary changes while still relishing occasional indulgences. In her off hours, Laurie engages in foodie pursuits such as sampling unusual flavor combinations (olive oil and basil ice cream was a good one) as well as hiking and cycling.

Safety practices for exercising in the dark

Safety tips for exercising in the darkWhether you’re taking the dog out for a walk or just getting out for a run yourself it can be hard this time of year to get outside when it’s light out. If you don’t have time during daylight hours to get out, stretch your limbs and fill your lungs, make sure you follow these safety practices when exercising in the dark:

  • Plan your route and tell someone where you are going and when you should be back. Avoid poorly lit and overgrown streets and trails.
  • When planning your route make sure to note where there are open businesses that you can stop at in case of emergency.
  • Don’t be predictable. Make sure you change up your route!
  • Bust out the neon! Wear bright and reflective clothing so drivers can see you.
  • Leave the tunes at home. Be aware of your surroundings don’t wear earbuds or headphones.
  • Bring a cell phone and identification. Or at a minimum, have ID and emergency medical information on a tag or on a card.
  • Rely on inner sparkle–don’t wear jewelry or carry money.
  • Use a headlamp, flashlight or clip-on bike light so drivers can see you.
  • Take pepper spray and a whistle in case you do encounter someone or something threatening.
  • Don’t run alone. Taking the dogs out for a run means we’re all getting exercise. If you don’t have a canine friend to accompany you, see if a friend is up for being an exercise buddy.

If you must, make friends with a treadmill for a couple of months. I know, it’s not the same as getting outside, but if it keeps your exercise routine on track, it’s helping your physical and mental health. I struggle with this, as it can seem boring sometimes, but if I don’t have a run buddy on a particular day, a gym treadmill is the next best thing. Skipping a workout never feels good.

In health,


Amy Ramsey is manager of TMC Employee Wellness Engagement, a mom, a Boston marathon runner, hiker and all around fitness guru.


Protecting your family against rabies

skunk rabiesRabies reports have been in the news lately. Tucson has had at least one confirmed case and one suspected case in the last month alone. Additionally, the recent death from rabies of a 6-year old Florida boy is a warning call for us all. Rabies is something as parents with curious and inquisitive children we need to be aware of. We connected with Tim Bohan, nurse practitioner in the TMC pediatric emergency department for a few words of advice to parents and caregivers regarding rabies.

This information is meant as a guide, but should not be used in place of medical advice from your health care provider.

Advice to parents and caregivers regarding rabies:

Thanks to widespread canine rabies vaccination, the disease has become a very rare disease in the United States, but awful situations such as the Florida incident still do happen.

Primarily, the risk is mainly from wild animals, especially bats such as in the Florida case, but raccoons, skunks, foxes, javelinas and coyotes are also sources. We just had a case of a rabid skunk found dead at Jesse Owens Park last month, and this week a suspected rabid gray fox bit a woman in Vail near Rancho del Lago. In total there were 77 cases of rabies identified in animals in 2017 just in Pima County.

What can I do to lower the risk of my child being exposed

  1. Teach your child to never handle wild or unfamiliar domestic animals even if they seem friendly.
  2. Vaccinate your dogs, cats AND ferrets against rabies AND keep up to date with vaccinations.
  3. Bat-proof your home and have those unwelcome lodgers evicted if they’ve already taken residence. Pima Animal Care Center has more information about bat-proofing

My child has been bitten or scratched by a bat/dog/feral cat/ferret/fill in the blank. What should I do?

  1. First thoroughly flush the wound with water and wash it with soap and water.
  2. Call Pima Animal Care Center for help if this animal can be captured, but do not attempt to capture a possibly rabid animal without the proper equipment and training.
  3. Call your pediatrician. Any bite by a wild animal should be considered a risk for rabies until proven otherwise. Exceptions: rabbits, hares, squirrels, rats, mice and other small rodents. Even if your domestic cat or dog has been immunized, if they bite your child they need to be watched for 10 days to make sure that they don’t develop symptoms.

What will the pediatrician do if there is suspicion the bite was from a rabid animal?

We examine the skin. If we think there is a high chance your child has been scratched or bitten by an animal with rabies, we must immediately immunize your child against rabies. The immunization is injected into the skin around the bite. Your child will also receive the rabies vaccination.

Even if we don’t suspect rabies we will often start oral antibiotics to ward off against infection from the bacteria in cat and dog saliva that can cause cellulitis.

My child is terrified of shots. Can we just wait and see?

No. Seek medical attention immediately, and have a professional assess the risk. Once the infection develops there is no sure treatment. Treating at the time of the bite is critical, if not rabies is almost always fatal.

We have bats in our house should I be worried?

Please have the bats removed and bat-proof your home. If the bats have been found in the areas where your child sleeps or plays, whether your child has been bitten or scratched or not – immediately report it to your regular pediatrician.

Tim Bohan NPTim Bohan
Nurse Practitioner
TMC Pediatric Emergency Department


Why children with diabetes need a pediatric endocrinologist

Why see a pediatric endocrinologist

Let’s face it: children are physically, cognitively and emotionally strikingly different from adults. When children have diabetes these differences affect how they communicate and understand symptoms and treatment of the disease.

The pediatric endocrinology team at TMCOne is comprised of specialist providers and educators who support our pediatric patients and their families with developmentally appropriate care. Pediatric endocrinologists treat children with diseases of the endocrine system, such as those with diabetes or growth disorders. We talked to the team about treating children with diabetes:

My child has been diagnosed with diabetes, why should we see a pediatric endocrinologist?

Both children and adults can experience similar symptoms of high and low blood sugars, but younger children might have trouble expressing their symptoms to their parents or caregivers. As physicians and educators, we take extra time to explain complicated medical details to a child in terms they can understand.

The difference between treating children and adults with diabetes isn’t just in how we communicate, but also because we are treating a condition that is affected by the ongoing physiological and hormonal changes associated with growth.

As children grow, develop and experience puberty, their insulin requirements change. Children with diabetes need to have regular monitoring throughout these changes to adjust treatment plans, educate, and help with any problems that have developed around diabetes. The pediatric endocrinology team helps your child and you master the skills and knowledge whether it is a young child newly diagnosed, or the teen who learning to manage diabetes independently of their parents.

Regardless of age, however, a person with diabetes needs a supportive network of family, friends and health care professionals to troubleshoot the everyday or emergent events that can occur with diabetes, whether it is type 1 or type 2.

What is the difference between Type 1 and Type 2 diabetes?

Diabetes is a broad term used to describe a number of disorders with different origins and impacts. What Type 1 and Type 2 diabetes have in common is a problem with the hormone insulin.

The primary purpose of insulin is to pull glucose into the body’s cells. Without insulin, or without a full insulin dose, glucose remains in the blood, raising blood sugar levels in the individual. Both those with Type 1 or Type 2 diabetes must monitor and manage their blood glucose carefully to avoid both short-term symptoms and long-term complications. Both forms of diabetes are serious conditions that require medical care.

Type 1 diabetes

Cells in the pancreas of people with Type 1 diabetes do not make insulin. People with Type 1 diabetes must take insulin to control their blood glucose levels. Insulin can be delivered by injections or pumps. It’s usually diagnosed in children or young adults

Type 2 diabetes

Type 2 diabetes is the form of diabetes that affects a large portion of our adult community, but is seen increasingly in young children. When a person has Type 2 diabetes, insulin is still produced by the pancreas, but it does not work as well as a person without diabetes.

Unlike Type 1 diabetes, Type 2 diabetes is often associated with excess weight. Families are encouraged to use diet and exercise to help weight loss and reduce the body’s resistance to insulin if their child has Type 2 diabetes. In addition, medication may be used to make the insulin more effective. When those treatments do not work, insulin may be used.

Which type of diabetes is more common in children?

New cases of Type 1 and Type 2 diabetes among children are on the rise. Type 1 diabetes is significantly more common in children than Type 2 diabetes. Type 2 diabetes is found predominantly in adults 40 years and older. It is found occasionally in teenagers.

In the last decade, children have been diagnosed with Type 2 diabetes at a higher rate than before. The following risk factors are linked to the higher rates of Type 2 diabetes in children:

  • increased sedentary lifestyle
  • higher body mass index
  • excess of availability of processed foods

Helping children exercise and eat a healthy, balanced diet can help drive down the rates of Type 2 diabetes, but it cannot affect those with Type 1 diabetes. Children with Type 1 diabetes cannot prevent nor treat their lack of insulin through diet and exercise.

Can children acquire both types of diabetes?

A child can get either Type 1 diabetes or Type 2 diabetes. In general, of all the children in Southern Arizona with diabetes, about 85-90 percent have Type 1 diabetes.

It’s important to note that Type 1 diabetes and Type 2 diabetes are managed differently. Type 1 does not become Type 2 diabetes nor does Type 2 become Type 1.

Check out our blog posts about Type 1 diabetes.

When your child is diagnosed with Type 1 diabetes

Dr. Priti Gupta Patel, pediatric endocrinologist

Dr. Chetanbabu M. Patel, pediatric endocrinologist

Dr. Chetanbabu M. Patel, pediatric endocrinologist

Flu season procedures in effect to protect patients, visitors, staff

when to come to the ed with flu and when to stay awayWith Arizona currently experiencing a nearly 800 percent increase in flu cases over last year, Tucson Medical Center has implemented new visitation procedures to reduce the spread of the flu and better protect patients, families and staff.

  • Children can be highly susceptible to flu and those under the age of 13 may not enter patient care areas, although nursing staff will consider extenuating circumstances. Parents are asked to provide supervision while children are in other areas of the hospital, including public waiting lobbies and the cafeteria or coffee shops.
  • Please do not visit patients if you have flu symptoms yourself, including fever, cough, vomiting or other ailments indicating a contagious illness.

Please remember to wash your hands and use hand sanitizer frequently. Also, please keep your hands away from your face to reduce your risk of contracting the flu.

Support from family and friends is important in recovery. We thank you for your help in keeping your loved ones as healthy as possible during this severe flu season.

TMC receives recognition as top 100 hospitals, health systems with great neurosurgery and spine programs


Tucson Medical Center was pleased to be named to Becker’s Healthcare’s 2017 list of “100 hospitals and health systems with great neurosurgery and spine programs.”

The list of organizations reflects those with extensive neuroscience and spine programs and that provide treatment and cutting edge research into neurosurgical disorders. The editorial team examined national and regional rankings and awards for neurosurgery, neurological care and spine surgery.

“The hospitals on this list have earned top honors for medical excellence in their spine and brain surgery departments and we are heartened to see that our hard work in achieving excellent outcomes for our patients has been recognized,” said Chief Medical Officer Rick Anderson.

Becker’s noted that TMC is a regional leader in spine surgery, with specialists performing about 1,000 spine operations per year. National organizations have taken notice of TMC’s neurological surgery program; CareChex ranked the hospital among the top 25 institutions in the country for neurological surgery in 2018. Stroke care is another focus for TMC’s neuroscience department, which boasts Tucson’s only comprehensive stroke center with 24/7 coverage.

Stroke prevention 2018

TMC also has earned comprehensive stroke certification from the Healthcare Facilities Accreditation Program and received the Stroke Gold Plus Quality Achievement Award from the American Heart Association and American Stroke Association. TMC also has a robust brain tumor program, and the Center for Neurosciences worked with the hospital to develop the Brain Tumor Hotline for newly diagnosed patients.

To view the full list, please visit:







You’ve got the flu: Is the Emergency Department for you?

when to come to the ed with flu and when to stay awayThe flu outbreak across the state is hitting much earlier – and far harder – than expected.*

If you’ve come down with influenza, how do you know when you should see your primary care provider or if you should go to the emergency room?

The Centers for Disease Control and Prevention (CDC) has a flu guidance page on its website to help you determine whether you should head to the emergency room or your doctor. In short, the emergency room should only be used by those who are very sick and are exhibiting emergency warning signs, including:

In adults

  • Difficulty breathing or shortness of breath
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms that improve but then return with fever and worse cough

Looking for a same day appointment with a primary care provider? Check out TMCOne.

In children

  • Fast breathing or trouble breathing
  • Bluish skin color
  • Not drinking enough fluids
  • Not waking up or not interacting
  • Being so irritable that the child does not want to be held
  • Flu-like symptoms improve but then return with fever and worse cough
  • Fever with a rash

In addition to the signs above, get medical help right away for any infant who has any of these signs:

  • Being unable to eat
  • Has trouble breathing
  • Has no tears when crying
  • Significantly fewer wet diapers than normal

Some people are at much higher risk of developing serious complications from the flu than others.

They include:

  • pregnant women or new mothers who have given birth in the past two weeks
  • children, especially those under 2 years old
  • adults over 65
  • people whose body mass index is over 40
  • people with diabetes
  • anyone with a medical condition that compromises his or her immune system

“The important thing to do is to prevent the flu in the first place,” said Cynthia Carsten, interim director of TMC’s Emergency Department. “Wash your hands. Avoid close contact with people who have the flu and get a flu shot – and particularly if you are in a high risk group. If you’re sick, stay home if you can.”

*Arizona Department of Health Services Influenza Summary.

Flu season is here – when to bring your child to the emergency room

Over the past few weeks our pediatric and adult emergency rooms have swelled with patients with flu-like symptoms looking for relief.

While it is critical that some seek emergency help, the majority of patients with the flu do not need emergency medical care.

In the Pediatric Emergency Department we are seeing a lot of children with flu-like symptoms who have high fevers (103F-105F). As a mom to a toddler and a preschooler I know how worrying those high fevers and respiratory symptoms can be, and I have to remind myself that a fever is actually a sign of the body taking care of itself. So when should you bring your child to the emergency room and what can you do at home to relieve symptoms?

This information is meant as a guide, but should not be used in place of medical advice from your health care provider.

If you’re in need of a same day appointment check out TMCOne

When to bring your child with fever and flu symptoms to the emergency room

  1. Your child is struggling to breathe.
    If your child’s skin has a blueish tinge, is breathing fast or is struggling to breath
  2. Is not waking up
    It is normal when we’re sick to sleep or rest, but if you can’t get your child to wake during the day or the child is not interacting go to the emergency room.
  3. If your child has a high-risk condition, such as heart, lung or kidney disease, or an immune-system disease and is spiking a high fever (103F-105F) seek medical help.
  4. If your usually affectionate child is so irritable he or she doesn’t want to be held
  5. Has a fever AND rash
  6. If your infant has no tears when crying or has significantly fewer wet diapers for 8 to 10 hours.
  7. Any infant less than 2 months old who has a fever over 100.4F.

My child seems to be coming down with flu-like symptoms, but none of the above apply.

The kid is miserable and so am I should we come in?

If your child is at high risk of flu complications because of another condition, call your health care provider, otherwise you can probably avoid the emergency room. Try to make children as comfortable as possible at home.

  1. Let them rest
  2. Make sure that they are getting lots of fluids to avoid dehydration
  3. Let the fever do its job. However, if your child is uncomfortable try lowering the body temperature with a lukewarm bath (do not use ice packs or alcohol bath) or giving acetaminophen or ibuprofen. Make sure you give the right dose! Talk to your pediatrician or pharmacists for help in finding the right dose. Do not over bundle them.

What if my child has a fever over 103, should I bring them in?

My child’s temperature recently soared to 105.6 Fahrenheit, and he was uncomfortable so we brought the fever down by alternating doses of ibuprofen and acetaminophen, talk to your pediatrician before trying a combination approach. DO NOT GIVE THEM ASPIRIN – there has been an association with Reye’s syndrome. The medications won’t get rid of the flu, but they may help you and your child ride out the flu with less suffering. If the fever persists for more than three days or if your child develops any of the symptoms above contact your pediatrician.

What we can and can’t do in the emergency room

Make my kid better please!

There is nothing we would like more than to make your child feel better. It’s what we’ve dedicated our lives to. When it comes to the flu we are limited in what we can do. Because the flu is a virus, antibiotics like amoxicillin are USELESS. In fact, they are worse than useless and can be harmful if used when not needed.


While there are antiviral drugs like Tamiflu, there is a very small window at the beginning of the flu where they have limited effectiveness. Usually, by the time your child is exhibiting symptoms, it’s too late. What we can do in the emergency room is help if your child is dehydrated or struggling to breathe.

How can we stop the rest of the family from getting sick?

  1. Teach your children to cough into their elbows and model the behavior to help reduce the amount of germs flying through the air.
  2. Make sure everyone in the family practices good hand-washing technique and washes their hands frequently–after going to the bathroom, before eating or touching their face, etc.
  3. Use masks! Stop the droplets.
  4. Get the flu vaccine. I know, I know, this year’s flu vaccine isn’t as effective as usual, but it is stopping some of the flu variants, AND it may help reduce the length of time you’re affected.
  5. Eat well, get plenty of sleep and exercise.

Healthy wishes,
Melissa Hodges RN

Melissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for ten years. She is a knitting ninja apprentice, who makes a mean chili and enjoys spending time with her family and friends in beautiful Tucson, Arizona.

TMC welcomes Tucson’s first two babies of the New Year

Two families at Tucson Medical Center had a lot to celebrate when the clock struck midnight and the calendar turned to 2018.

Baby Nic Tribolet arrived at midnight on the dot, and Baby Aminah Albaka came into the world two minutes later.

Both babies came early, earning a place as Tucson’s newest residents.

“He’s a delight. He’s beautiful and he defies description,” said Nic’s dad, Dominic, of his 7 pound, 15 ounce bundle of perfection. “He’s definitely our New Year’s present.”

Aminah, meanwhile, a petite 5 pound, 10 ounce miracle, was described as a “peaceful baby” by mom Christina Bowe. After a long labor, Bowe said, “All my worries left when I saw her. She’s just a little blessing.”

For more coverage of the babies, check out the links to reports by the Arizona Daily Star and KVOA.

We offer free tours of our maternity departments. Find out more about our services here.







Mission Moment: Traffic accident allows TMC Security to shine


TMC Security Officer Raymond Dugdale

On a recent weekday morning, an elderly gentleman lost control of his vehicle and struck one of the signs at the entrance to the hospital.

TMC Security made sure the man and his wife were not injured, ensured the electricity was turned off to the sign, and directed traffic around any blockages.

Officers Raymond Dugdale and Richard Jaeger didn’t stop there.

They waited with the man and his wife about two hours until the tow truck arrived for the badly damaged vehicle.

They made sure they had water.

They helped the couple cancel some later medical appointments that day, since they would be dealing with the fallout from the accident.

The man called to thank their boss for the kindness they demonstrated.

IMG_8781Dugdale, who came to TMC three years ago after being drawn by its mission and the quality of its Security Department, said people might be surprised at the ways they are called upon to assist patients, families and visitors. On any given day, help might include assisting with failing batteries and flat tires, to finding lost belongings or even helping frazzled family members find their vehicles after parking in a rush to go to the side of a loved one.

“I like to be able to help people,” Dugdale said. “I just put myself in their shoes and in this case, it was clear the gentleman was receptive to help and appreciated it, so we responded in kind.”

Jaeger, who came to TMC nine months ago, added, “I would do the same for anybody.”

He learned kindness, ironically, from working in the prison industry. “Just because someone is incarcerated, you still treat them as people and so you help them when they need it. It’s the same thing here. I try to treat people like family, because they could be going through a lot here at the hospital.”

“What I like about TMC Security is that it’s a lot more than that. It’s overall just helping people, no matter what the issue is – like a complete care package.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we are sharing an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do.

Hundreds of these reminders happen every day. Thank you for letting us share some with yo

Mission Moment: Bringing comfort to a patient in need

Tucson Medical Center employee Rochelle Kee went above and beyond, providing exceptional health care with compassion for a patient struggling to find needed medical equipment.

A health crisis can be frightening and overwhelming – which is why TMC employees actively look for ways to bring comfort and peace of mind to patients.

If you have walked by the TMC Outpatient Check-In Desk, then you’ve been met with a helpful smile from Kee, who has been a patient service representative at TMC for the last three years.

“I help patients check in for procedures, radiology and more,” she said. “The ‘more’ part covers a lot – because if I can’t help you, I’ll find the right person who can.”

Recently a patient approached Kee, though he wasn’t checking in – he had been discharged from the Emergency Department with a prescription for a cane and was looking for help.

“The gentleman was limping and I could tell he was suffering,” Kee said. “He was so frustrated and upset because every provider was too expensive or didn’t take his insurance.”

Kee took the initiative to call several locations. “Some of the locations couldn’t help and the few that could were across town, and he didn’t have transportation.”

The elderly patient seemed to lose all hope. “He said he was going to give up,” said Kee “But I don’t give up.” She had an idea – and asked the patient to wait a few more moments.

Kee went across the street to the Teal Saguaro, a thrift store operated by the TMC Auxiliary with proceeds supporting TMC and its services.

“He just couldn’t believe it when I came back with a cane for him,” said Kee. “And I couldn’t believe it when he started crying – he even gave me a hug.” Although Kee bought the cane herself, she presented it to the patient as a Christmas gift from TMC.

Her act of kindness quickly spread, with other TMC personnel offering the patient lunch at the nearby café inside the hospital.

Several fellow employees witnessed Kee’s interaction with the patient, and nominated her for a “Caught in the Act” recognition.

At TMC, we aspire to serve our community by being the best health system as defined by the quality of care we deliver, the experiences we create and the value we bring. Employees like Rochelle Kee help make the hospital’s vision a reality, every day.

“I just want to help people the best I can,” she said. “I feel blessed in my life and I hope I can be a blessing to others.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we are sharing an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do.

Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Do you have a TMC mission moment you’d like to share?

Send it to Communications@tmcaz.com.


Mission Moment: Two hearts, two stories and a stocking

Marlise and baby in stockingBridget Stith’s Story

On a Christmas Eve nearly 46 years ago, Bridget Stith gave birth to her son, Kalyn, at TMC. Early on Christmas morning the TMC nurses carried her baby boy into the room, holding him in a precious holiday stocking.

“It was so memorable – I never forgot the thoughtful gift and the special joy it brought me and my family,” said Stith. “Every year since, Santa has left gifts in Kalyn’s stocking.”

Fast forward four decades – Stith and her family are active community advocates who were motivated to action when they made a discovery.

“That holiday stocking made such a difference for me, and I remember it as though it were yesterday,” said Stith. “I recently learned that TMC Labor and Delivery needed funds to provide stockings for babies born around the holidays – I’m sentimental and I felt in my heart that I had to do something.”

Marlise Mackey’s Story

In 1988, Marlise Mackey was rushed to TMC, excitedly expecting her first child – but that excitement turned to worry when complications arose.

“My placenta had detached and I was taken to surgery right away – I was so worried for me and my baby,” she said. Both baby and mom made it through – Mackey welcomed a baby boy at 7 lbs. 9 oz.

“I never forgot the TMC doctors and nurses, they were so caring and so professional – it inspired me to become a labor and delivery nurse.”

Today, Marlise Mackey has been a nurse for almost 30 years, and she currently serves as a surgical technician right here at TMC Labor and Delivery.

When an expectant mother was experiencing a detached placenta, just as Mackey had, she provided comfort as she moved the mom-to-be into the very same operating room that she was treated in.

“We saved the mom and baby, who was born at 7 lbs. 9 oz., just like my son,” said Mackey. “When I had the chance to give back to a mom and baby in the same OR, with a son born in the same way and at the same weight – my heart told me I could do more.”

Marlise and Bridget

Two Hearts

The two hearts came together when Bridget Stith provided a generous grant to the TMC Foundation to fund the stocking materials, and Marlise Mackey offered the time and effort to tailor the festive garb.

“The doctors and TMC nurses were so good to me – they went above and beyond, and this is my way of doing the same,” said Mackey.

The non-denominational holiday stockings are provided for babies born the week before, during and after the Christmas holiday.

“I’m so excited to be a part of it,” said Stith. “I hope the stockings bring families the same joy and memories that it still brings me.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we will share an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do.

Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Do you have a TMC mission moment you’d like to share? Send it to Communications@tmcaz.com

Mission Moment: Transporter warms hearts with simple gesture

Transporter Christina Ruebush living the mission by going beyond.
When a simple get-well card brought joy to a discouraged patient, a TMC employee decided to provide a thoughtful card to every patient she serves.

TMC patient transporter Christina Ruebush joined the ranks six months ago, after having an exceptional health care experience at TMC. “The staff were so polite and thoughtful that I knew this would be a great place to work.”

Ruebush’s fast-paced position takes her back-and-forth across TMC’s 100-acre campus, but she doesn’t mind. “I really enjoy the patient interaction,” she said. “Anytime I can be supportive or help in any way, I do.”

Not long ago, a patient motivated Ruebush to start doing something new. “I had transported an elderly man several times – each time he was very unhappy, grumpy and even mean.”

Ruebush thought about what might help. “So I went out and bought him a get-well card.”

When Ruebush was called to transport him again, she handed the card to the patient. Although Ruebush didn’t expect anything in return, she received a new understanding that would change her forever.

“The patient’s demeanor was completely different – he kindly thanked me over and over, and explained that he was alone, with no friends or family – he really just wanted someone to talk with.”

After enjoying a conversation with the patient, Ruebush stopped by the dollar store on the way home. “I decided that I was going to give every patient I transported a get-well card.”

For months, Ruebush has been providing every patient she transports with a card offering kind and sincere wishes. “It’s well worth the heartfelt thank yous and smiles I get,” she said.

This week, Ruebush is doing even more – she is providing each patient staying at TMC on Christmas Day with a get-well card.

“At TMC, we thrive on patient experience,” said Ruebush. “No matter what they are experiencing, patients appreciate knowing that TMC cares.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we are sharing an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do.

Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Do you have a TMC mission moment you’d like to share? Send it to Communications@tmcaz.com

Mission Moments: Inspired by a 6 year old to first assume good intentions

Family of four standing in front of a bay

The call was enough to make a parent’s heart drop: Come to the school now. Your daughter may have to go to the Emergency Department.

Sanjay Timbadia, Tucson Medical Center’s Laboratory manager, rushed to school to find his first-grade daughter’s head bandaged with blood in her hair and on her dress.

A child had been throwing rocks on the playground and one of them had struck his daughter in the head while she played on the monkey bars. There wasn’t any malice: It was just an accident.

It was later, after she had been treated at the TMC Pediatric Emergency Department, that the little girl said something that was a poignant reminder for her father.

“That boy that threw the rock: I think he was just trying to get it out of the playground so that no one would trip on it,” she said.

It was a moment for pride and reflection, Timbadia said, and he shared the story with his team as they entered the holiday season.

“She has reminded us of an amazing lesson: to always assume positive intent first,” Timbadia said.

The lesson can be applied in the lab, which is a busy place that processes more than 2 million tests every year. It can also just as importantly be applied in everyday life as a balm against the divisions that can cause cultural and political divides – and it’s even stronger when peppered with gratitude, he noted.

“If I’m delayed because I’m in traffic or if I get a flat tire, I just try to remember that at least I have a car to take me places because there are many others who are waiting for a bus in the summer heat,” Timbadia said. “And if someone gets in front of me and drives slowly, you never know: Maybe that person just prevented me from getting into an accident.

“I think like anything else, assuming positive intent and being grateful is something we learn, and it’s also something that gets stronger with practice. At TMC, we are committed to being here to make things better for our patients and our community when they need us – and we approach that work with positive intent.”

Tucson Medical Center earlier this year adopted a new mission statement. To celebrate, we will share an ongoing series of “mission moments.”

What are mission moments? They aren’t necessarily dramatic stories of heroism, although our medical staff saves lives every day. These are moments that breathe life into words – moments that are profound or powerful or touching and that remind us why we do the work we do. Hundreds of these reminders happen every day. Thank you for letting us share some with you.

Do you have a TMC mission moment you’d like to share? Send it to Communications@tmcaz.com.

Making the most of your primary care visit

why you need a doctor before you get sickRegularly visiting a primary care provider is one of the best ways to maintain strong health – here’s what you can expect before, during and after the visit.

Knowing what to expect will put you at ease and help make the most of every visit.

Before the visit

First steps

When you schedule your appointment, ask about new patient registration forms. These forms usually request health history, medications, and insurance information.

Yes, there are forms to complete – but they serve a very important purpose and are not as long as you might anticipate.

“Providers want be your health partner and a little bit of preparation will be worth your time,” said Kathy McLeod, a family nurse-practitioner and primary care provider at the TMCOne Rincon location.

“As a provider, the more information I know about your health history, the better health partner I can be – providing information to best help you make current and future health choices,” McLeod said.

Arrive a little early

You should also take a peek at your insurance card to determine your copay, and be prepared to make your copayment when you arrive. If it’s your first visit, arriving 15 minutes early will help keep everyone on schedule.

If you have not completed the new patient forms yet – arrive about 30 minutes early to ensure you have enough time to finish them before your appointment.

Prioritize your questions and share your goals

It is recommended patients jot down a few questions a head of time, and prioritize them depending on their most immediate concerns.

“It is important to me to know what is foremost on a patient’s mind – and what their overall health goals are.”

During your visit

The PCP is here for you

If you are feeling nervous, remember that a PCP is your health partner and their purpose is to assist you. Discussions about your health care are confidential and protected by federal law.

“We want patients to feel confident sharing their health challenges and history so we can provide the best health advice and direction possible.”

Your needs are the priority

A PCP visit may include a physical exam. If you have privacy preferences, let the provider know.

“A dedicated PCP will make accommodations to ensure the patient feels comfortable, respected and valued,” explained McLeod.

Long-term health goals

The provider can do more than treat an immediate health need – they can review your health history and help make a plan to maintain good health going forward.

“A healthy lifestyle is not a one-size fits all,” said McLeod. “We think critically about each patient’s health and health challenges, discuss needs and preferences and help tailor a healthy plan just for you.”

After your visit

Schedule your next appointment before you leave

Numerous studies have shown that people who regularly visit their health care provider are healthier – so be sure to make your next appointment before you leave.

“Based on your health needs and challenges, you and your provider should decide when the next appointment should be.”

Schedule referrals, testing and blood draws right away

“It’s a good idea to make arrangements as soon as possible.” McLeod explained. “The faster you schedule, the faster you can get needed results and we can take action.”

The PCP is your health resource

Contact your PCP’s office with any health developments, because they can help facilitate treatment quickly. “Whether big or small – a PCP is your personal health resource. Please remember to call 911 immediately for emergencies and life threatening matters.”

Get all the answers

A patient’s health education and understanding are crucial – so what should a patient do if they have an additional question? “Online patient portals are becoming more commonplace and are one of the easiest and fastest ways to keep in contact with your provider,” said McLeod.


MyChart is secure, online access to your health information at TMCOne. Your health information and your visits to TMCOne are available at your fingertips from the privacy of your home computer, smartphone or tablet at any time, day or night. All that is needed is Internet access and an email account.

With MyChart you can:

  • View your health summary, current list of medications and allergies
  • Email your provider with non-urgent medical questions (please allow 48 hours for answers)
  • Make and cancel appointments
  • e-Check In for scheduled appoints, allowing you to fill out any needed paperwork ahead of time.
  • Refill prescriptions
  • View test/lab results as released by your provider
  • Access medical information of children or dependent adults, including access to immunizations
  • Review post-visit instructions
  • Online bill pay

Provide input

Health care organizations like TMCOne often send surveys to their patients – please take a moment to share your experience.

“Your suggestions matter to the PCP,” McLeod said. “At TMCOne our mission is to provide the highest quality, compassionate care to every patient every time. We are always looking to improve patient experience and we take patient feedback very seriously.”

The TMCOne website provides patient resources, preparation information for your visit, and new patient forms.

Click here for further information about MyChart.

A snack to hike with – Brenda’s Power Bites

Brenda's power bitesNeed a portable source of fuel for a long hike or bike ride? Want a trail snack that isn’t simply candy in disguise? Brenda’s Power Bites are your solution! Recipe courtesy of Brenda Andreasen, instructor for TMC Wellness.


3 c oats (regular or quick cooking)
1 tsp cinnamon
1/4 c unsweetened flaked or shredded coconut (optional)
1/4 c roasted, salted sunflower seeds
2/3 c dried dates, finely chopped
2/3 c dried apricots, finely chopped
2/3 c dried cherries
1 tsp vanilla extract
1 c almond butter (or any nut butter)
1/2 c agave nectar (or honey)

Note:  Feel free to use any combination of dried fruit and nuts or seeds of your preference.


  1. In a large bowl, combine oats and cinnamon.
  2. Use a food processor to chop the sunflower seeds and coconut. Add to the dry ingredients.
  3. Combine dried fruits and vanilla extract in the bowl of the food processor. Coarsely chop the fruit. (The extract will aid the blades in the chopping process.) Add fruit to dry ingredients.
  4. Add nut butter and agave nectar to the rest of the mixture. Combine well until mixture begins to stick together.
  5. Form mixture into 1 inch balls.
  6. Place balls in an air-tight container, separating layers with wax paper.
  7. Refrigerate at least 4 hours or overnight to allow oats to absorb moisture.

Makes about 60  ½-ounce balls

Nutrition Information (per 2-bite serving)

Calories:  130
Total Fat:  6g
Saturated Fat:  1g
Protein:  3g
Potassium:  175mg
Sodium:  85mg
Carbohydrate:  16g
Fiber:  2.5g

Looking to maintain not gain this holiday season? Tips from one of our wellness experts


Thanksgiving wellness tipsAmy Ramsey, manager of TMC Employee Wellness & Engagement, mom, marathon runner, hiker and all around fitness guru shared these tips for all those looking to enjoy this holiday season while maintaining and not gaining.

Avoid large plates

Serve reasonably sized servings on smaller, appetizer plates instead of a massive dinner plate. If you’re hosting, do everyone a favor and keep your larger plates hidden away.

We eat with our eyes before we even take the first bite of food. I don’t know about you, but two tablespoons of hummus loos a lot less depressing if served on a smaller plate filled with veggies and seedy crackers than alone on a large plate.

We are all tempted to fill the plate when serving our selves, so think smaller plates for portion control.

Slow down

Clearing your plate is not a race, so there’s no need to preload your fork for each bite. Taking breaks will extend the time it takes to eat your meal and possibly reduce the amount of food you eat.

Did you know that it takes between 15 to 20 minutes for your brain to get the signal that your stomach is full? Give your stomach a chance to catch up with your brain!

Turn off the distractions

Televisions, phones and laptops should not be near your dining table. When electronics and other distractions have our attention, the amount of food that we’re putting into our mouths does not–it’s the perfect environment for mindless eating.

Thanksgiving can be a great day to have some football on in the background, so you may let this one slide for the special day, but losing the distractions is a good, all-around general tip for everyday meal times.

Freshen your mouth

When you’re done eating, keep your mouth busy with a piece of gum, or head to the bathroom to brush. Keeping a clean mouth may be motivating enough to keep us from mindlessly grazing on food.

I couple this tactic with shutting off the kitchen lights after dinner is done, and I’m definitely less likely to go looking around after the kitchen is “closed.”

Happy Thanksgiving. I hope you can find time to relax and enjoy whatever it is that makes YOU happy!

For more tips, recipes and wellness events sign up for our monthly Live Well newsletter.

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Health systems hosting enrollment event and family fun festival

health enrollment fairDo you need affordable health insurance?

Southern Arizona’s major healthcare providers have come together to make sure you have free, personal help to find the right fit!

With enrollment ending Dec. 15, the Pima County Enrollment Coalition will be offering in-person assistance with Medicare, AHCCCS/KidsCare and Marketplace coverage on Saturday, Dec. 2 from 8 a.m. to noon.

To make an appointment, call 800-377-3536 or go to coveraz.org/connector and enter zip 85713.

Walk-ins are welcome at the event, which will be at Kino Veteran’s Memorial Stadium, 2500 E. Ajo Way.

In addition to several community runs, there are lots of other activities as well:
• Check your blood pressure
• Drop off old medications
• Learn more about vision and dental assistance
• Find out about pet adoptions from Pima Animal Care Center
• Enjoy bouncy houses for the kids
• Pledge to end bullying

For more information on the event or enrollment, visit the SOAZCares website – sponsored by Tucson Medical Center, Carondelet Health Network, Banner-University Medical Center Tucson, El Rio Health, Northwest Healthcare and Pima County.

Those who miss the enrollment window may have to wait until the next enrollment period to get coverage, unless they experience a life changing event such as getting married or losing your health insurance through a job. “It’s easy to enroll and there’s plenty of help to make sure you understand the process,” said Nancy Johnson, CEO of El Rio Health.

Pregnancy and Back Pain – Tips from an Expert


The waddling gait, the hands pressed into the small of her back, mama-to-be is uncomfortable.

An aching back is such a common part of pregnancy that the waddling and back clutching is a stereotype of late-term pregnancy. But backaches can start much earlier in pregnancy. The vast majority of pregnant women will experience backaches during pregnancy. For many, it persists after the birth of the baby.

Tim Evens PT of Agility Spine & Sports Physical Therapy gave us the lowdown on why back pain is an issue during pregnancy and what to do to prevent and to treat back pain.

Why do so many pregnant women experience backaches?

As the baby grows and mama’s belly grows, the increased weight, shift in center of balance, and the increased mobility of some of the joints of the pelvis (hypermobility of the sacroiliac joint) all contribute to extra strain on the lower back. This added strain and resulting distorted movements with joints locked at the end range of motion can make daily life painful.

What can you do to prevent backaches during pregnancy?

A strong core and upright posture before and during pregnancy can help prevent backaches.

  • Squats help strengthen legs, abs and pelvic floor, and require balance and can be performed during pregnancy.
  • Balancing exercises, such as through yoga, can provide core strengthening
  • Avoid over stretching
  • Limit how much sitting you do each day
  • Exercise 30 minutes every day

When to contact a physical therapist?

Evens suggests that if back or pelvic pain is limiting daily function do not wait to seek help. Often it is an issue that can be easily addressed. The first port of call is your primary care physician who can rule out other issues. If this is a second or third pregnancy and this is a familiar pain you may wish to check in with your physical therapist’s office.

How can a physical therapist help you if you experience backaches?

A physical therapist can help you return to fully functional movement, and address tissue healing and trauma of back and pelvis pain. As many of these issues can be addressed simply, Evens encourages women to seek help if the pain is limiting their daily function. Don’t let it linger for months when it is easy to fix and can help reduce stress during a time that can be fraught with stress anyway.

At your appointment the physical therapist will evaluate your flexibility, strength, balance and posture. The therapist may manipulate or move your body to address immediate tissue issues, and almost always will provide you with at-home daily exercises to increase strength, mobility and flexibility.

How to perform a squat

Evens provided these tips for performing an effective squat:

  1. Hold your lower lumbar spine in a neutral position. As you squat the low spine should not flex (tail should not tuck under)
  2. Make sure your knees do not move in front of your toes. This ensures that the majority of motion is coming from the hips

Remember good squats require good hip strength and flexibility.


This post was first shared on May 1, 2014

Are you new to hiking? Here are tips and trails to get you started.

tips for new hikersFall has finally found its way to Tucson. As we welcome the cooler weather, Laurie Ledford, part of the TMC Wellness Department suggests that it is time to toss out the old “It’s too hot to exercise” excuse, lace up our shoes and get outside.

If running isn’t your style, or if you find walking too boring, you are in luck – Tucson is home to some of the most beautiful hiking trails imaginable. Here are Laurie’s suggestions for new hikers:

Before the hike

  • Dress properly. Layered clothing on the upper body is the way to go. This allows you to peel off outer layers as you warm up. If you want to wear shorts, be aware that you risk scrapes from cacti and rocks, so be careful! If you opt for long pants, choose something that allows you to move easily – in other words, not jeans.
  • Wear comfortable hiking boots or trail shoes with good tread. You want footwear that will keep your feet on the trail while keeping out little rocks and blisters.
  • Protect yourself from the sun. Cover any exposed skin with sunscreen, preferably a broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher. Cover your head with a wide-brimmed hat to protect your face, ears and neck. Shield your eyes with UVA- and UVB-blocking sunglasses.
  • Bring water and a snack. The weather might have cooled down, but exercise can still be dehydrating. A high-carbohydrate snack will prevent hypoglycemia. Even if you think you won’t be gone long enough to get hungry, you never know when you could get lost or delayed.
The view from Blacketts Ridge, Arizona

The view from Blacketts Ridge, Arizona

During the hike

  • Stay on the trail. This is safer for you and the environment in which you are hiking; you are less likely to run into a cactus or twist an ankle, and you won’t contribute to erosion.
  • Yield the right of way to anyone bearing a burden. If you meet another hiker on a narrow trail, who has the right of way? If the other hiker is heading uphill (and needs to maintain momentum) appears to be struggling or is carrying a heavy pack, be courteous and step aside.
  • Be aware of any faster hikers behind you. Please pull over and let them pass.
  • Respect your own limitations. Be mindful of the distance or time you have hiked and how much is still ahead of you. You don’t want to reach complete exhaustion before the end of the hike.
  • Before you head up a hill, think about how you’ll make it back down (or vice versa). If your legs get too tired, you could fall. If your knees are not in great shape, they are going to scream at you all the way down the mountain. Hikers with bad joints may want to stick to flat trails or use trekking poles for additional stability and support.
  • Leave no trace. If you bring something in, take it out with you. But don’t take out more than you brought – i.e., leave bird nests, flowers and saguaro ribs where you find them

After the hike

  • It is better to enjoy happy memories of your hike the next day than to suffer aching muscles. If you are new to hiking, you will likely feel sore afterwards, no matter what. Remember to go easy on yourself during and after a hike, and your fitness level will improve over time.
  • Re-hydrate, rest and refuel as you plan your next hiking adventure.
Tucson Medical Center employees enjoy a winter hike on Douglas Spring Trail

Tucson Medical Center employees enjoy a winter hike on Douglas Spring Trail

Hikes for the new-to-town

You may hear seasoned hikers talking about some of their favorite trails: Blackett’s Ridge, Finger Rock and Agua Caliente Hill among them. However, for those who are new to hiking, it is a good idea to start with something a bit easier.

  • Nature Trail at Catalina State Park is a one-mile, relatively flat, loop trail. Once you’ve tackled that, you can take on some of the park’s more difficult trails, such as Canyon Loop Trail (2.2 miles) and Romero Canyon Trail (5.9 miles round-trip, if you go all the way to the pools).
  • Garwood Trail, on the east side of town, takes you 3.4 miles, out and back. There is a fun and interesting network of trails to explore here, including Wildhorse Trail (3.2 miles) and Douglas Spring Trail (17.2 miles, if you do the whole thing). Bring a compass, map and a good sense of direction with you, it can be easy to turn down the wrong trail.
  • Sabino Canyon Recreation Area is home to many trails of varying levels of difficulty. By walking the tram road, you can enjoy canyon views without ever leaving a paved road. As you start feeling more adventurous, branch off to try sections of Esperero Trail, Phoneline Trail, or take Bear Canyon Trail to Seven Falls (8.2 miles).

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Laurie Ledford is a registered dietitian from Atlanta, Georgia, the land of grits, collard greens and super-sweet iced tea. She now works as a registered dietitian  in the Tucson Medical Center Wellness Department. She enjoys helping people improve their health through sustainable dietary changes while still relishing occasional indulgences. In her off hours, Laurie engages in foodie pursuits such as sampling unusual flavor combinations (olive oil and basil ice cream was a good one) as well as hiking and cycling.

Is it the flu or just a cold? Advice from a family nurse practitioner

Is it the flu or just a cold?

Natalie Olendorf, family nurse practitioner with TMCOne explains the difference between the two, what you can do to prevent falling victim to them, and when you should seek medical advice.

Both the flu (or influenza) and the common cold are viral infections. However, while the common cold is usually harmless although uncomfortable, influenza has the potential to be dangerous, especially for the very young, very old or those at risk for complications.

Typically the flu affects the nose, throat, and the lungs. The common cold, meanwhile, is a viral infection of just the upper respiratory tract or nose, sinuses, and throat.

Symptoms of the flu include chills, sweats, cough, sore throat, runny nose, body aches and fever over 101.4. It can make people feel quite ill – often they don’t even want to get out of bed. Symptoms will usually last 10-14 days.

Symptoms of the common cold are similar to those of the flu, but not as severe and include a runny nose, nasal congestion, a sore throat, facial pressure, mild aches, and even a low grade fever. Most people will recover from a cold within 7-10 days.

Treatment of the flu

Most people get over the flu without prescriptions, but if you are at risk for complications, you should see your primary care provider for an anti-viral medication called oseltamivir (Tamiflu) or zanamivir (Relenza).

It’s important to note that antiviral medications don’t work like an antibiotic. They help to shorten the flu illness and to prevent complications but do not cure the flu. They need to be taken within 48 hours of the onset of symptoms or they don’t work well. Other treatments include ibuprofen or acetaminophen, rest and fluids.

Should I take antibiotics?

Since the flu, like the common cold, is a viral infection an antibiotic should not be taken. Antibiotics are only good for getting rid of bacterial infections. It is not healthy to take antibiotics when they are not needed because your body can develop resistance, meaning they won’t work when they are needed in the future. Or you may have an unnecessary side effect or allergic reaction.

When should I contact a primary care provider?

You should contact your primary care provider if you have a high fever that is not relieved by over the counter medications; have shortness of breath or trouble breathing, severe cough, are unable to take in fluids or food, or start to become dehydrated.

Who is at risk for flu complications?

Complications of the flu can be significant even life threatening. They include pneumonia, bronchitis, asthma and COPD flare ups, heart problems, and ear infections.

Generally, people who are at risk for flu complications include children, pregnant women, the elderly, people with obesity, asthma, or COPD, smokers, and those with chronic medical conditions like kidney disease or diabetes. Even if you don’t fall into one of the risk groups, someone you love might. Getting the vaccination will help protect those you care about too.

How to prevent the flu

The most important thing that can be done is to get the flu vaccine in the fall.

The vaccine helps your body to make antibodies to fight off the flu without actually getting the flu. It takes about two weeks after you receive the vaccine for the antibodies to develop and provide you with protection from those flu strains. This is why it is better if you get vaccinated early in the flu season.

You can also protect yourself against the flu include keeping your immune system healthy by getting enough sleep at night, eating a variety of foods including fruits and vegetables, getting exercise, and managing stress. Wash your hands before and after eating and using the restroom. Avoid others with flu symptoms.

If you have a severe cough or fever, please don’t go to work or school. Stop transmission of the flu by limiting exposure to others.

But I always feel sick after the flu vaccine!

The flu vaccine has a form of a dead virus and a dead virus won’t get you sick with the flu.

However, some people may feel achy or under the weather for a couple days after having a flu vaccine. This is a sign of your body’s immune system making antibodies. Although uncomfortable, this is much milder than the feeling you have if you contract influenza.

The flu vaccine also is given during cold and flu season, so you may contract a separate cold or respiratory illness after being vaccinated. This is a coincidence and was not caused by the flu vaccine.

When should I get the flu vaccine?


If you haven’t already had your flu vaccine, get vaccinated before it starts spreading through our community. Even if it is late in the flu season the vaccine can still be beneficial. You can schedule an appointment to get the flu vaccine at the TMCOne Wyatt office by calling (520) 394-6619. A brief registration keeps you on schedule, the central location makes it easy and the friendly professionals provide the quality care your family expects from TMCOne. The flu shot is covered by insurance and only $25 for out of network plans.*


Natalie Olendorf F.N.P. and familyAbout Natalie Olendorf, F.N.P.

I am a board certified Family Nurse Practitioner. I have worked in family medicine and urgent care for the last 8 years. Prior to joining TMCOne I worked as a nurse in a Children’s Hospital in Chicago on a solid organ transplant unit and as an emergency room nurse in a Level 1 trauma center.

I attended University of Illinois Champaign/Urbana where I received by Bachelor’s in Nursing in 2003 and then attended University of Illinois Chicago where I received my Master’s in Nursing in 2009. Currently, I am working same-day care and the Fast Pass program at the TMCOne Wyatt location.

I am married and have a young son and daughter. I enjoy being active and outdoors with my family in my free time.


“Diabetes doesn’t change who I am”

Brody Coomler shares his insights on living with type 1 diabetesTwelve year-old Brody Coomler refuses to let type 1 diabetes define him – he explains how a seventh grader balances a full schedule with the challenges of diabetes.  

He’s an avid basketball player, he’s a hip-hop dancer, he plays the tuba and he’s a gamer. Brody is an active and enthusiastic tween who doesn’t let diabetes keep him from doing the things he’s passionate about.

At four, Brody and his family learned his pancreas was creating little to no insulin – the hormone that regulates blood sugar. He was diagnosed with type 1 diabetes, a chronic and life-long condition that causes blood sugar to spike and fall unexpectedly.

Surging blood sugar levels are far more than a nuisance, they can lead to serious medical complications and death if not properly managed through insulin therapy.

Managing Type 1 diabetes can be demanding, especially for a young person. During National Diabetes Awareness Month, Brody shares how monitoring diabetes is part of his life, but hasn’t taken it over.

What does having Type 1 diabetes mean to you?

Diabetes doesn’t change who I am. But it is a disease that I have to manage on a constant basis in order to stay safe.

Do you have to check your blood sugar all the time?

Yes, I do! I have to check before meals and before bed. If I’m feeling like my blood sugar is too high or if I’m feeling like my blood sugar is too low I have to test. I am very active and so I have to test before I play any sports or any dancing. Monitoring my blood sugar is a big part of having diabetes.

Do you have a special diet?

No, I don’t have a special diet. But like anyone I have to watch what I eat. I count my carbohydrates so that I can dose my insulin based on what I’m eating.

Does diabetes ever get in the way of sports or hobbies?

It definitely does. When I have low blood sugar I have to sit out of a sport or not be able to participate. I have to make sure that my blood sugars are in good range so that not only am I safe but also so that I can perform.

What do you want people to know about having Type 1 diabetes?

Don’t let Type one diabetes stop you from doing anything!

How would things be different for you if there was a cure?

I don’t let diabetes hold me back, but I would definitely be more free from having to test my blood sugar, put on new insulin pump sites or wear a continuous glucose monitor – things like that. I wouldn’t get sick as much as I get sick now. My mom wouldn’t call me as much.

What would you tell a friend who just found out they have Type 1 diabetes?

I would suggest that they make other friends who have Type 1 diabetes so that they can help one another. My friends with diabetes are a good support to me. You can expect the unexpected. You get to have some fun times and meet people that you didn’t think that you would otherwise meet.

For more information about Type 1 diabetes and how you can support research for a cure, visit the JDRF website or call (800) 533-CURE (2873).

TMCOne provides adult and pediatric endocrinology services – for more call (520) 324-4900.


Physicians and patients taking on the opioid crisis together

The practice of prescribing opioid drugs to patients following surgery has been the go-to standard in an environment where zero pain in recovery is the expectation. But with the fallout of opioid drug overuse painful to communities across the nation, both providers and patients are looking for alternatives.

Anesthesiologists from Old Pueblo Anesthesia, who practice at TMC, have been working to enhance their regional anesthesia program to provide additional options for patients.  If patients can keep opioid use to a minimum in those crucial first days after surgery, while reducing their pain and inflammation, the hope is that they can use fewer narcotics through their recovery period.

Opioids and Older Adults free seminar

Shoulder surgery, for example, is notoriously uncomfortable for some patients because the shoulder is engaged when a patient is standing or when laying down. Traditional anesthesia only lasts about 24 hours.

Now, in addition to direct injections to numb the area and block pain during surgery, physicians can place tiny catheters near the nerves that supply the shoulder with a local anesthetic to provide greater comfort for up to 3 days. The patient can care for the pump at home and throw it away when the anesthesia is depleted.

Dr. Robin Kloth said that Old Pueblo performed a comparison of patients with total shoulder replacement who used traditional pain relief and those who used interscalene catheter placement. “Over the course of the full 3 days, the catheter patients took less than half the narcotics that our compared group took in just a single day,” she said, adding patients also reported far less nausea.

Dr. Neesann Marietta concurred. “These techniques can really extend a patient’s pain relief, which greatly increases patient satisfaction. They can go home and sleep comfortably, which is so important for the healing process.”

And that’s just one example. For abdominal surgery, patients relied previously on epidurals that could only be used during their hospital stay. Now, anesthesiologists can do a block that provides local relief in the abdominal wall that will last up to 24 hours, and patients may be sent home the same day.

Colorectal and gyn-oncology surgeons are increasingly using a slow release local anesthetic that lasts up to 72 hours.

The colorectal program reports that between greater patient education, early ambulation and regional anesthesia, patients are seeing a decrease in patient length of stay by 1.3 days and an 88 percent decrease in morphine equivalent, given in the first 24 hours post-surgery.

“Both doctors and patients are becoming increasingly aware of the potential for the misuse of highly addictive pain medications and it’s important that we be part of this national discussion,” said surgical oncologist Michele Boyce Ley, who uses regional anesthesia as well as nonsteroidal medications such as Celebrex and gabapentin to help control pain for her patients having breast surgery.

Ley said her patients are doing so well, many are managing post-surgical pain with little more than Tylenol or ibuprofen.

“We have been working on this in earnest and getting training on these techniques because of concerns about opioid usage,” Kloth said. “Opioids have been the go-to solution for many years, in part because patients had high expectations of pain relief and because a bottle of Percocet is really cheap. These techniques are more labor intensive, but we’ve demonstrated value to the patient – and it’s the right thing to do,” she said.

Many patients also feel less lucid and less awake when using narcotics, which could delay physical therapy and rehabilitation.

Physicians have several opportunities to manage the use of narcotics, particularly important as patients leave the hospital with a plan for pain management during recovery.

Marietta said the techniques are not right for every patient and every case, but patients who are concerned about the potential for opioid misuse should have a conversation with their physician about pain control – and see if a nerve block would be appropriate.

Meet with Drs. Marietta, Kloth and Lambert Wednesday, November 15 as they discuss how anesthesiologists and patients can address this in practical terms at TMC for Seniors. More details available here.

Military service shaped TMC Imaging Director

danfelix3 (002)Every day is Veteran’s Day for Air Force veteran Dan Felix. There will be no parades or fanfare for him today. Instead, he will go to work to serve, shaped by his service in the Air Force.

Felix, the director of imaging at TMC, joined right after graduating from his high school in his rural, mining community of Hayden. There were 43 students in his graduating class.

A first generation U.S. citizen, whose parents hailed from Mexico, Felix was drawn to military service. “I wanted to give back to the country that allowed my parents to raise a family in America with all the benefits we all enjoy,” Felix explained. He’d seen firsthand great poverty in Mexico. “We had health care, clothing, food, money. From a young age, I learned to appreciate the opportunities and luxuries   our great country had to offer.”

The Air Force provided structure, taught him to develop his natural qualities of perseverance and patience, and challenged him to keep growing. He appreciated the mines – his father and brothers retired from that work – but he didn’t want it for himself. He signed up for college classes, obtaining associate’s degrees in X-ray technology and later, nuclear medicine. A bachelor’s in medical and imaging technology followed. He is now one class away from a master’s degree in leadership.

The transition was a natural one. “X-ray has some parallels to the technical work I was doing in the Air Force – there’s electronics and physics and you’re working with your hands – and that’s combined with an intellectual component.”

It was nuclear medicine that stole his heart. He initially told his instructor there was no way he was going to like it. But Day One he was besotted. “Just the sound of it is intriguing, but beyond that, you’re in the physics world, talking about radiation at its origin. I was living in this cerebral realm I had aspired to my whole life.”

He ended up joining Tucson Medical Center in 1999 to train in nuclear medicine. He never left.

“As I look back and analyze the mission of the military and TMC, they dovetail,” he said, noting both exist to serve others and play a role in providing for the greater good of everybody else.

He never takes the day off for Veteran’s Day. “I am so appreciative of being able to come into work to help others – the patients we serve, the workers who make up this hospital – and to provide for my family. I take a lot of pride in those three things, so if you think about that, why wouldn’t I want to work?”

That doesn’t mean he won’t spend some time reflecting on those who serve. “Joining the military at a young age means leaving your comfort, your home, your family and everything you know that is normal, and embarking into a huge world of unknowns,” he said.

“When I think about veterans, I think about those who decided to take a risk and take a leap of faith for the sake of their country. It’s not just a job. It’s a sacrifice for others – and I don’t think that’s easily understood unless you’re the one doing the sacrificing.”

Stay in optimum health, prevent metabolic syndrome

Tips from Endocrinologist Dr. Pati on how to prevent metabolic syndrome

Are you at risk for developing metabolic syndrome?

Metabolic syndrome, which often carries no signs or symptoms, is associated with several obesity related disorders including fatty liver and cirrhosis, kidney disease, polycystic ovarian syndrome, and obstructive sleep apnea. It places those affected by the syndrome at increased risk of developing diabetes and heart disease – and they never even know they have it!

Dr. Divya Reddy Pati, endocrinologist with TMCOne, answers our questions about this metabolic syndrome.

Tell me more. What is metabolic syndrome?

Metabolic syndrome, also known as insulin resistance syndrome or syndrome x, is a group of factors that increase the risk of developing diabetes, heart disease and stroke.

Insulin is a hormone produced by the pancreas that helps move blood sugar into the cell where it is used for energy. Obesity causes insulin resistance, which leads to high blood glucose.

How is it diagnosed?

A physician who specializes in endocrinology can prescribe the medical tests that diagnose metabolic syndrome, which is determined by a presence of three of the following:

  • Abdominal obesity, defined as a waist circumference in men ≥102 cm (40 in) and in women ≥88 cm (35 in)
  • Serum triglycerides ≥150 mg/dL or drug treatment for elevated triglycerides
  • Serum HDL cholesterol <40 mg/dL in men and <50 mg/dL in women or drug treatment for low HDL cholesterol
  • Blood pressure ≥130/85 mmHg or drug treatment for elevated blood pressure
  • Fasting plasma glucose ≥100 mg/dL or drug treatment for elevated blood glucose

What is the prevalence of metabolic syndrome?

Metabolic syndrome is more common in African-Americans, Asians, Hispanics and Native Americans. Chances also increase with age, as well as with lack of physical activity.

What is the treatment?

Treatment of metabolic syndrome is aggressive lifestyle modification focused on weight loss and increase in physical activity. Weight reduction is optimally achieved by diet, exercise and pharmacological treatment if needed. Medications are used to treat risk factors such as high blood pressure, glucose and lipids.

What do you suggest we do to stay in optimum health?

It is important to visit your primary care physician regularly and address an endocrinology specialist if metabolic syndrome is encountered. Maintaining a healthy diet and an exercise plan (approved by your provider) is an excellent way of avoiding metabolic syndrome and maintaining optimum health.

pati1Dr. Divya Reddy Pati is an endocrinologist practicing with TMCOne. She diagnoses and treats diabetes, thyroid problems, calcium disorders, osteoporosis, pituitary, adrenal and other hormonal disorders.


A version of this interview was first posted on December 21, 2016


Recent breast cancer diagnosis? Advice from breast cancer survivors

Vanessa H-B.jpg

Now what? Once you move beyond your initial reaction to a breast cancer diagnosis, whether it is disbelief, fear, anger or uncertainty, what should you do? We asked three breast cancer survivors for words of wisdom to the recently diagnosed.

1. Bring a trusted friend or family member as an advocate to your doctor’s appointments

When faced with a cancer diagnosis the options can seem daunting and the information overwhelming. It can be invaluable to have an advocate in the room to be a second set of ears. A person who is confident enough to ask questions, able to take notes and willing to process the information afterward with you. Advocates should understand their role prior to going to your appointment so they can be prepared.

2. Write down your questions

Create a written list of specific questions prior to your appointments to discuss with your doctor. Let your doctor know that you have questions at the beginning of your appointment.

3. Beware of Dr. Google

Dr. Michelle Boyce Ley, board-certified breast oncology surgeon, medical director of TMC’s Breast Health Program and a breast cancer survivor herself said, “Don’t google outcomes. I’ve seen what’s out there and they don’t look like my own patients.” Tess X, a patient of Dr. Boyce Ley’s, said “I didn’t do much reading outside the basics because you can really get into the weeds and pseudo-science. I looked up my particular variant of BRCA2 and did some calculations on risk over 10 years and lifetime, but I have a biology background. Then I talked with Dr. Boyce Ley to discuss my risks and treatment options.”

4. Talk to your doctor about risk and benefits

“Don’t assume the risks and benefits are the same as a friend’s with the same form of cancer,” Tess X said. Two people can have the same form of cancer, but the treatment plan might be quite different dependent on stage, location and the individual’s aversion to risk.

5. Ask about all the options including if there are options in treatment that they don’t offer.

“It makes me so sad when I give a talk and someone comes up afterward and says, ‘Why didn’t they offer me that?’” said Dr. Michelle Boyce Ley, . It’s important that your physician be willing to discuss all options with you, so you can participate in shared decision-making. “You can’t make a good decision unless you have the information.”

6. Don’t be afraid to share your diagnosis with others

“I met many survivors that way,” said Vanessa Hough Buck. “They have been an encouragement to me. Find a support group of survivors.”

7. Don’t avoid being in photographs while you’re going through treatment

“Even when you don’t feel your best, be in the picture. When I look back now, those are my favorite photos,” Buck said.

8. Let people know what you need from them

“Your friends and family have good intentions but don’t always know what to do. It’s alright to ask for specific help. And it’s OK to say ‘no’ to visitors,” Buck said.


Are you a breast cancer survivor? What advice would you give to the recently diagnosed?

TMC for Women has a high risk breast clinic that provides education, treatment options, and coordination to best help high risk patients choose their next steps.



Have you talked with your primary care provider about your weight? National Obesity Care Week

TMC offers surgical and non surgical scientifically based programs to support you achieve a healthy weight. The American Medical Association in 2013 recognized obesity as a disease, and in doing so took critical steps towards supporting those affected to access science-based healthcare.

The misperceptions and stigma surrounding the causes of obesity often negatively affect an individual’s ability to access the care they need. The more than 90 million adult Americans affected by obesity are at increased risk for a variety of health conditions, including type 2 diabetes, high blood pressure, and sleep apnea.

Despite the significant health impacts of obesity, many of us struggle to talk with our primary care provider about our weight and how a science-based approach can help us to achieve a healthy weight.

Tucson Medical Center offers safe and effective weight-loss programs with both surgical and non-surgical options. We know everyone faces unique challenges to achieving a weight-loss goal. Our team of medical professionals can help you choose the path that’s right for you.

Weight-Loss Counseling Program

Our registered dietitians and exercise physiologists will work with you to create a personalized plan you can live with, so you can lose weight and keep it off. The 12-week program includes: • Nutrition, fitness and general wellness assessments • Reliable advice that you can use • Tracking of weight and estimated body composition • Development of personalized nutrition and fitness plans • Strategies to promote long-term weight-loss success

The program is individualized for you and so you can begin at any time. For more details, please contact TMC Wellness, (520) 324-4163 or Wellness@tmcaz.com.

Weight-Loss Surgery from the TMC Bariatric Center of Excellence

At the TMC Bariatric Center, we offer a comprehensive approach to help those who qualify for weight loss surgery. For most people to qualify you must:

  1. BMI ≥ 40, or more than 100 pounds overweight
  2. BMI ≥35 and at least one or more obesity-related co-morbidities such as type 2 diabetes, hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease
  3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts

Our program guides you every step of the way on your weight-loss journey, starting with free seminars to discover if a surgical option is right for you; to pre-surgery counseling and evaluations; post-op care that includes nutritional counseling; psychological support; instruction on incorporated exercises into your lifestyle; and discussion groups where you can build relationships with others who have had bariatric surgery at TMC to help you achieve your goals.


The TMC Bariatric Center of Excellence is accredited as a comprehensive center by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program.

The American Society for Metabolic and Bariatric Surgery (ASMBS) Center of Excellence was started in 2004 to advance the safety and efficiency of bariatric and metabolic surgical care. Surgical Review Corporation administers the program on behalf of the ASMBS.

No matter what method you have used to lose weight, sticking to your new good habits and keeping the weight off can be a challenge. Don’t try to tackle it alone, talk to your primary care provider, talk to us, together we can take on the challenge of obesity and its complex nature and help you be a healthier you.

This week is National Obesity Care Week where the goal is to advance an evidence-based understanding of obesity and widespread access to respectful, comprehensive and appropriate care.

Bust that sugar habit in four easy steps

Tucson Medical Center is part of the Mayo Clinic Care Network.

Is hidden sugar adding inches to your waistline? Laurie Ledford, Registered Dietitian, follows this video from the Mayo Clinic with four easy steps for reducing the sugar in your diet:

Step 1 – Know Where the Sugar Is

Major Sources:

  • sugar-sweetened soda, energy drinks, sports drinks, sweet iced tea
  • fruit drinks
  • grain-based desserts (e.g., cakes, cookies, doughnuts, pies and granola bars)
  • dairy desserts (e.g., ice cream custard)
  • candy
  • ready-to-eat cereals
  • breads

Sugar can also be found lurking in salsas and sauces, such as ketchup. You have to read the ingredients label to find it. You may see sugar called by many different names on food labels. Some of its aliases are dextrose, confectioner’s powdered sugar, corn syrup solids, fructose, glucose, high-fructose corn syrup (HFCS), invert sugar, lactose, malt syrup, maltose, molasses, nectars (e.g., peach nectar, pear nectar), syrups (corn, maple) or sucrose. If you add brown sugar, raw sugar, honey or agave syrup to your food or drink, you are still adding sugar.

But what about the sugar in fruit?

Yes, there are naturally occurring sugars in fruit (also in other minimally processed foods, such as milk), but these are accompanied by essential nutrients. Processed foods with added sugars are usually nutrient-poor. Said another way, they are just empty calories… until you see them sitting on the back of your thighs.

Step 2 – Know Your Limit

The American Heart Association recommends limiting the calories you consume from added sugars. For most women, the limit is 100 calories or 25 grams per day. For most men, the limit is 150 calories or 37 grams. You know your limit, now how to figure out how much you’re eating.

Step 3 – Know How Much You Are Eating

Read the Nutrition Facts panels on packaged foods, and remember to pay attention to the number of servings you are actually eating. If you have a smartphone try an online nutrition app like MyFitnessPal for tracking.

If you are adding sweeteners yourself be familiar with what the caloric intake is

  • 1 tsp sugar = 16 calories
  • 1 tsp maple syrup = 17 calories
  • 1 tsp molasses = 19 calories
  • 1 tsp honey = 21 calories
  • 1 tsp agave syrup = 21 calories

And if you add more than 1 teaspoon multiply the calories accordingly.

Step 4 – Cut Back Where You Can

Here are some suggestions from the Center for Science in the Public Interest, publisher of the Nutrition Action Health letter:

  • Cut back on soft drinks (which they call “liquid candy”) and sweet tea. Instead, try club soda, seltzer, unsweetened tea, low-fat or non-fat milk. Better yet, drink water.
  • Avoid fruit drinks, -ades and cocktails. These are essentially non-carbonated soda pop. Sunny Delight, Fruitopia, and others are only 5-10 percent juice. If you want juice, choose 100 percent juice and watch your portion size.
  • Limit candy, cookies, cakes, pies, doughnuts, granola bars, pastries and other sweet baked goods. Eat fruit, veggies or nuts instead.
  • Fat-free cakes, cookies and ice cream may have as much added sugar as their fatty counterparts, and they’re often high in calories. “Fat-free” on the package doesn’t mean fat-free on your waist or thighs.
  • Look for breakfast cereals that have no more than 8 grams of sugar per serving.

We all have some special sweets we don’t want to give up forever. You don’t have to. Instead, treat them as indulgences and eat them less often or in smaller portions. You can also prepare them yourself, so that you can control the amount of added sugar that goes into them. As a challenge, try gradually reducing the amount of sugar in your recipes to see how little you can get away with.

Another option you might want to try is using artificially sweetened beverages and desserts. Not everyone likes artificial sweeteners, but they can help some people satisfy their sweet tooth without the extra calories or rise in blood sugar.

Start today! Break your sugar addiction.

Challenge yourself to try one or more of these easy strategies for cutting back on wasted calories:

  • I will replace one sugar-sweetened beverage with an equivalent amount of water on at least three days during the next week.
  • I will try a breakfast cereal that contains less than 8 grams (2 teaspoons) of sugar per serving.
  • The next time I eat yogurt, I will replace half of the sweetened yogurt with plain yogurt. (Then I can save the other half of that sweetened yogurt for the next day.)
  • The next time I bake, I will reduce the amount of sugar in the recipe by 25 percent. (For example, use 3/4 cup instead of 1 cup of sugar.)
  • The next time I order dessert in a restaurant, I will share half (or more) of it with someone else.

Need support in making healthy changes to your diet?

Tucson Medical Center offers personalized nutritional assessments by registered dietitians to help you reach your goals.

Laurie Ledford MS RD aka The Nutritionista
Laurie is a Registered Dietitian from Atlanta, Georgia, the land of grits, collard greens and super-sweet iced tea. She works as a Registered Dietitian at Tucson Medical Center. She enjoys helping people improve their health through sustainable dietary changes while still relishing occasional indulgences. In her off hours, Laurie engages in foodie pursuits such as sampling unusual flavor combinations (olive oil and basil ice cream was a good one) and discovering delicious food and beverage pairings. She is still trying to find the perfect wine to serve with Brussel sprouts.



One foot at a time – Newborn screening

Electine Orido RN and Baby Cash

A quick pin prick to the heel of the foot, a small cry, a few drops of blood on card and you and your baby have taken an important step in keeping your child healthy – newborn screening.

Here in Arizona the newborn screening looks for 31 core disorders. In addition, we conduct a screening for hearing loss , for critical congenital heart defects and for jaundice. The list continues to expand as medical understanding grows.

Find out more about the Arizona Newborn Screening Panel

In July 2017, the State of Arizona Health Department added severe combined immunodeficiency, or SCID, to the list of conditions screened. While you may never have heard of SCID, a rare disorder affecting about one in 50,000 to 100,000 babies in the United States, you may have heard of the “Boy in the Bubble.” A young boy, David Vetter, brought this disease to notice when he survived for 12 years living in a plastic enclosure that excluded the everyday germs that generally kill affected infants in the first year of life. Generally, infants appear healthy at birth, but the lack of a functioning immune system makes them vulnerable to even everyday germs. Today, survival rates for children affected by SCID are much higher due to improved screening and treatment. If an infant receives a bone or cord blood transplant in the first three and half months of life prior to active infections, the survival rate can be as high as 94 percent.

But my baby looks healthy … Why every newborn needs newborn screening

We screen all babies because ALL babies are at risk, even if they look healthy. Most babies who are identified through screening have no family history of a disorder. The sooner a disorder is identified the quicker treatment can begin, which can prevent disability and even death.

What is involved in newborn screening?

Kassandra and baby Cash

1. Blood Test

At about 24 hours after birth, we start newborn screening with what is often called the heel-stick test.

Your baby’s heel will be cleaned and warmed. A quick pin prick allows five drops, yes just five drops, from your baby’s heel to be dropped onto a card with special filter paper to absorb the blood.

Once your baby’s details and your contact information are collected on the card it is sent off to the Arizona State Laboratory for testing.

Your child’s healthcare provider will be informed of normal or abnormal results. Be sure to ask your child’s provider for the test results if they do not volunteer them.

2. Pulse Oximetry

By using a sensor to detect low oxygen levels in the blood, we can identify babies who may have severe heart defects known as critical congenital heart disease. The pulse oximetry test is quick, easy and painless. We usually perform this screening test about 24 hours after birth. If a newborn’s oxygen level is below normal, your baby may need to have an ultrasound of the heart (echocardiogram). Unfortunately, the pulse oximetry screening is limited in that it won’t find all heart conditions.

3. Bilirubinometer

We assess all babies for jaundice using a special light meter, which calculates the level of bilirubin by analyzing how the light reflects off the skin. Because bilirubin levels, which cause the yellowing of the skin, peak between the second and fourth day after birth, your newborn’s health care provider should check for jaundice after release from the hospital. If jaundice is suspected, the level of bilirubin in the blood will be assessed too.

4. Newborn hearing screening

This is a simple, non-invasive hearing screening. If your baby appears to have a hearing issue during the initial screening the baby will be referred for auditory brainstem response and otoacoustic emissions testing. Your baby will be asleep during the ABR testing, and if the infant sleeps well, we usually give the results of the testing immediately following the test.

Whether you deliver with a midwife or obstetrician at TMC for Women we will take care of these critical newborn screenings. To find out more about our maternity services check out the free maternity services tour.

Find out more: FREE maternity services tour.

Hidden Scar technology allows surgeons to minimize scarring without compromising breast cancer treatment

Hidden Scar breast cancer surgery centerBreast cancer surgery can save a woman’s life. And with new advances, surgery doesn’t necessarily mean leaving scars behind that serve as a visible reminder of cancer.

Tucson Medical Center is a Hidden Scar Center, with demonstrated expertise in surgical techniques that minimize scarring while retaining effective oncologic results.

Through Hidden Scar, surgeons make incisions in a location that’s harder to see so the scar is less visible. Advanced tools and technology make it easier for surgeons to make small incisions and reduce the risk of complications, all while keeping as much healthy breast tissue as possible.

“It’s important to me to individualize the care my patients receive,” said breast surgical oncologist Michele Boyce Ley. “For many women, scars do matter.  They can impact clothing choices, self-confidence, self-esteem, intimacy, and other important factors of daily life. Through Hidden Scar techniques, women can have surgical treatment that not only offers the best clinical outcomes, but provides the best aesthetic outcome as well.”

One option to consider is whether a nipple sparing mastectomy might be appropriate. “This technology facilitates preservation of the nipple for a more natural appearance after mastectomy,” said Boyce Ley, a fellow-ship trained surgeon.

Because every cancer is different, it’s important to discuss options with your physician and surgeon, based on the size and location of the tumor.

“Sometimes, we need a creative solution; I take a lot of pride in finding the solution that best matches the needs of each patient,” said Boyce Ley.


Bean spread – Packing a protein punch in an inexpensive and quick way

not hummus, cheap, quick bean dips for a protein punchHummus is available in almost any grocery store, and you can find it in a variety of flavors. However, not everyone is a fan of garbanzo beans or tahini or some of the other common hummus ingredients. Making your own bean spread allows you to customize it to your preferences, and it saves a little money.
You can spread it on pita triangles as a snack; use it in a sandwich for additional protein and flavor; or use it as a dip with raw veggies or tortilla chips.
If you don’t have a food processor, you can do this in a blender by adding more water to the recipe. The result will be a little runnier, which makes for a better dip than a spread.

Basic Ingredients

1 can of beans (such as pinto, kidney, cannellini, black or garbanzo)

1 Tbsp lemon juice

2 Tbsp good quality olive oil water, as needed


Choose one or more of the following ingredients to personalize your bean spread:

  • garlic
  • fresh basil, parsley or cilantro
  • spices, such as cumin, paprika or cayenne pepper
  • baby spinach
  • artichoke hearts
  • sundried tomatoes, soaked in warm water for about 20 minutes and drained
  • roasted red peppers
  • jalapeño  or other hot pepper


1. Rinse and drain beans thoroughly.

2. If using fresh garlic, peel it and process in the food processor until finely chopped.

3. Add beans and lemon juice to the food processor. Drizzle olive oil over the beans.

4. Process until beans are coarsely chopped; then add your special ingredients.

5. Continue processing until the mixture reaches your preferred consistency. You may need to add a few tablespoons of water to make it smoother.

6. Serve or chill immediately.

For more healthy recipes, wellness tips and events sign up for our monthly Live Well newsletter.

Five-part series helps inform transformation agenda for health care, business

TransformationReportHealth care industry leaders face incredible challenges in shifting from traditional, volume-driven fee-for-service to value-based care.

As a member of the national Health Care Transformation Task Force, an industry consortium, and as the hospital member of two accountable care organizations, Tucson Medical Center is at the forefront of innovative work to provide higher quality, more efficient health care.

“The Transformation to Value: A Leadership Guide” from the Health Care Transformation Task Force shares the collective experience and wisdom from organizations at the vanguard of value-based payment and care delivery.

The Health Care Transformation Task Force created the “The Transformation to Value: A Leadership Guide” to assist health care leaders as they design and implement their transition to value based delivery and payment. This series of captures the transformation journeys of individual organizations, including both successes and lessons learned, and allow decision makers to benchmark themselves against similar organizations that are actively moving toward value-based care.

“The Transformation to Value: A Leadership Guide” is one more reason we’re proud to be part of the Health Care Transformation Task Force,” said Julia Strange, vice president of community benefit for TMC. “This new series offers proven advice to health care leaders as they design and implement their own transition to value based delivery and payment. This initiative reflects our and other task force members’ common commitment to facilitate transformation, both for members and others.

The Transformation to Value: A Leadership Guide” from the Health Care Transformation Task Force is practical freeware that can save organizations at any stage of the transformation journey countless hours, while avoiding the pitfalls uncovered by early adopters. Others are encouraged to use and share this work. http://bit.ly/2ylIwEK

Dispose of unneeded medications Oct. 23 at TMC Senior Services

Meds.jpgHaving old medications lying around puts children, teens and even pets at risk from inappropriately ingesting them.

It also increases the risk of mix-ups with any of your existing prescriptions.

If you have any medications you don’t need any longer, dispose of them safely and securely at a free Dispose-A-Med event at 1400 N. Wilmot in the El Dorado Health Campus.

Tucson Police Department will be on hand from 10 a.m. to noon to accept prescriptions or over-the-counter medications and vitamins. Sorry but sharps aren’t accepted, and we have to decline medication in liquid, creme or inhalation/aerosol form.

Come early for a free 9 a.m  presentation that morning on medication safety – and make sure to bring your current bottles for free one-on-one pharmacist consultations from 10:30 am. – noon.

To RSVP for the presentation, please visit the event registration page at TMC Senior Services.

For more information, please call 324-1960.


Ballots are in the mail for Nov. 7 election

Engaged voters are fundamental to a healthy community and a healthy democracy.

If you’re registered to vote, watch for a ballot coming soon to your mailbox for Nov. 7’s consolidated election.

Depending on where you live, you’ll have a say in:

  • ward races for the Tucson City Council
  • ballot propositions that would raise the salary of Tucson’s mayor and council as well as to increase the sales tax to fund zoo improvements and early childhood education
  • bond or override elections in several school districts, including the Tucson, Sunnyside, Flowing Wells and Marana unified school districts
  • funding and other issues in several fire districts

Oro Valley, where voters will decide on a park improvements package, will have polling sites open on Election Day, but the other jurisdictions are holding mail elections.

Please mail your ballot by Thursday, Nov. 2 to ensure your ballot is ready for counting on Election Day.

You may also track the status of your Vote-by-Mail ballot online. Simply visit: www.recorder.pima.gov and click on “Early Ballot Status” to ensure your ballot was received and processed.

For more information, please direct questions to the Pima County Recorder’s Office at (520)724-4330

Is genetic testing right for you in determining cancer risk?

should i get genetic testing to determine my risk for breast cancer?Medical advances have now allowed us to identify whether patients with certain inherited gene mutations have an increased risk of breast cancer.

Awareness is growing among patients that there are genes related to breast cancer and steps they can take to reduce future risk – but that doesn’t necessarily mean we should all get tested.

Here are some things to consider when deciding whether testing is appropriate for you:

Genetic testing will only provide insight into one area of risk.

You might still be high risk, even if the test shows no gene mutation. Maybe you have dense breasts, maybe you’ve never had kids, maybe you smoke, or you drink alcohol daily. Genetic abnormalities are associated with about 10 percent of cancer cases. That means no matter your test result, if you have factors that place you at higher risk, it is still important to have regular screenings.

If you were tested 5 years ago or more, you may consider retesting.

Back then, tests were only looking for mutations in BRCA 1 and 2. Now, tests routinely look at more than 25 genes that have a connection to increased risk for cancer development.

Make sure testing is appropriate for you.

Testing is most appropriate for those with a family history across multiple generations. Some special populations, such as Ashkenazi Jews, also have a higher tendency toward mutation and would be good candidates for testing.

Genetic testing isn’t just for women.

Gene mutations don’t discriminate and men get breast cancer as well. Testing, however, is not recommended on minors since the mutations inform lifetime cancer risk and children are too young to consider potential interventions.

You’ll want someone with expertise to help with the results.

There are interventions that may reduce the risk of cancer, from more frequently screenings to medication and surgery. Your primary care physician may be a good place to start the conversation, but often a specialist in breast cancer risk is best equipped to partner with patients to help them identify the next steps that are right for them. TMC offers a High-Risk Breast Clinic . Please call 324-2778 for more information.

Dr. Michele Boyce Ley, a board-certified breast oncology surgeon, serves as medical director of TMC’s Breast Health Program. She is accepting new patients and is located at 2625 N. Craycroft Road.

Help celebrate Physical Therapy month throughout October

EmilyBurdettePhysical therapists work hard to help patients improve their range of motion, strength and flexibility so they can lead their most active lives and obtain better outcomes.

National Physical Therapy month is held each October and Tucson Medical Center would like to take this time to recognize the impact of our therapists. A big thank you is in order for the 14 physical therapists and six physical therapy assistants in adult acute therapies, as well as the 11 therapists in pediatric therapies.

It’s also an opportunity to highlight the achievement of those therapists that have worked towards their advanced certifications.

According to the American Board of Physical Therapy Specialists, certification was established to:

  • recognize physical therapists with advanced clinical knowledge, experience, and skills in a special area of practice
  • assist consumers and health care community in identifying physical therapists who have advanced skills
  • address a specific area of patient need

Certification takes a great deal of work: Therapists must have extensive background in their specialty area including direct clinical hours and passing a board exam.  In order to maintain the certification, therapists must retake the exam and participate in professional development activities including service to the profession, teaching, and participation in research studies.

We caught up with Emily Burdette, who recently earned her certification, to learn more about the effort.

Why did you pursue this certification?

I wanted to pursue the designation of board-certified clinical specialist in pediatric physical therapy in order to demonstrate my commitment to the profession of pediatric physical therapy as well as my patients. I wanted to set myself apart as a clinician who is considered to have advanced clinical skills in pediatric physical therapy.

I pursued this certification as a commitment to further the profession of pediatric physical therapy. In order to become re-certified as a pediatric certified specialist, I must be active in the profession of pediatric physical therapy by attending continuing education courses, teaching physical therapy students during their clinical internships, participating in research projects, and becoming a mentor to other pediatric physical therapists.

Lastly, I wanted to pursue this certification to continue my commitment for life-long learning as a pediatric physical therapist. It is a personal commitment of mine as well as the other therapists working at Tucson Medical Center Pediatric Therapies to stay as up-to-date as possible on all research regarding the treatment of children. We all pride ourselves on the emphasis Tucson Medical Center Pediatric Therapies has on evidence-based practice.

How rigorous was the process? 

I studied every day for nine months for about 2-3 hours per day. I was busy reviewing various diagnoses that are seen by pediatric physical therapists in different areas of practice. I also reviewed research papers from the Pediatric Physical Therapy Journal and Physical Therapy Journal and took continuing education courses for diagnoses that I am not as familiar with. The actual test for certification was 6 hours long and 200 questions.

Was it worth it? 

It was worth the sacrifice so that I could provide the best evidence-based care to my patients. It helped me to review treatment of pediatric diagnoses I am familiar with as well as learn about the treatment of diagnoses I am not as familiar with. I believe that all of the studying and reviewing of research articles has made me a better, more knowledgeable pediatric physical therapist!​

Optimize your fruit and vegetable choices with tips from our wellness experts

eating well doesn't have to break the bankIt should come as no surprise that eating plenty of fruits and vegetables is part of a healthy diet. The more vegetables and fruit you eat, the less likely you are to develop cardiovascular disease, age-related eye diseases, osteoporosis and some types of cancer. What does seem to be surprising to many is how easy it is to incorporate vegetables and fruit into our diets. We often hear one of these comments as the reason someone is not eating enough vegetables and fruit:

     “Fresh produce is so expensive.”

     “Fresh produce goes bad before I use it.”

     “I don’t know what I should buy, and I don’t know what to do with the stuff I do buy.”

These are legitimate questions and concerns. Here are some things to consider that will hopefully help to address how to incorporate produce more easily into your diet.

Add More Variety

We eat with our eyes. Lots of color and variety is key. We eat with our eyes – color and variety make a plate of food look more enticing. Keep this in mind when you are trying to persuade yourself or your family to eat more vegetables and fruit. Not only does variety prevent boredom, it also ensures that your body gets a full spectrum of nutrients. Different types and colors of foods provide different vitamins, minerals and other plant compounds that enable your body to perform its everyday functions and prevent disease. Add produce that is in season or locally grown is likely to be fresher and more flavorful, and generally it is more cost effective.

TIP: Purchase produce in season, cut it up into smaller pieces and freeze for use throughout the year.

Fresh vs. Frozen vs. Canned

While fresh is always best, it may not always be possible to have fresh produce. Frozen fruits and vegetables are convenient, nutritious, and often less expensive, so they are your next best option. Avoid items with added sugar, butter or sauces, as this adds extra calories and fat. In the case of beans and tomato products, canned versions are far more convenient and can still be relatively healthy. When buying canned vegetables, choose low-sodium or no-salt-added options; otherwise, drain and rinse thoroughly to reduce the sodium.

TIP: Keep some frozen vegetables on hand for a quick and easy addition to soups, pastas or rice dishes.

Think About Organic

Should you buy organic produce? That’s something you have to decide for yourself.

If you would like to eat organic foods to reduce the amount of synthetic chemicals you ingest, but you can’t buy organic every time, here are a few suggestions for prioritizing your purchases:

  • If you frequently eat a lot of certain types of fruits or vegetables, buy organic versions of them to reduce your intake of the particular pesticides commonly used on those crops.
  • Check out “The Dirty Dozen.” It is a list of conventional produce that, according the Environmental Working Group, carries a high pesticide load. Buying organic versions of these foods can reduce your consumption of toxic chemicals.
  • Most pesticide residue exists on the outer surface of produce, so you may want to buy organic if you are planning to eat the skin.

Organic foods are not necessarily more nutritious, and there is no good evidence to show that eating organic produce reduces your risk of cancer. The important thing is that you eat more fruits and veggies, however you manage to do it.

For more tips on making the most of your produce see this TMC for Women post.

Design your personalized nutrition plan or tour the grocery store with help from our registered dietitians

Is your family ready for flu season?

Are you ready for flu seasonFrom cooler temperatures to pumpkin pie, we welcome many things that come with the fall season, but the flu is not one of them. Dr. Katherine Leitner, a TMCOne provider at TMC Rincon Health Campus, provides some important pointers to best prepare families for flu season.

How should a family prepare for flu season?

The most effective preventative measure is a flu vaccination. Everyone in the family should get a flu shot.

If experiencing flu-like symptoms:

  • cover your mouth when coughing
  • avoid touching your face
  • wash your hands with soap and water frequently
  • disinfect surfaces you come in contact with
  • and stay at home for at least 24 hours

When should you get a flu shot?

The Centers for Disease Control recommends receiving a flu vaccine in October. Even if you did not receive the flu shot in October, it is still beneficial to obtain one throughout the flu season which can run through January or later. It is also important that everyone get the flu shot yearly, because the flu strain changes from year to year.

What about vitamin C and a healthy diet?

Studies have shown that supplementing with vitamin C during a cold does not actually improve the outcome or decrease the duration of illness. However, it is always important to stick to a healthy diet so you can build a good immune system for when you do get sick. During an illness, drinking lots of fluids and staying hydrated is very important.

What should you do if a child is showing flu symptoms?

Make an appointment with your child’s health care provider right away. The provider can test for the flu and treat it with a medication if caught early. To prevent the spread of illness, keep your child out of school until he or she is feeling better.

Who should get the flu shot?

Dr. Robert Jacobson, a pediatrician with Mayo Clinic, says, “The latest recommendations from the CDC reaffirm that all of us are at risk for catching and spreading the flu, and all of us should get our flu shot this fall. Very few of us cannot get the vaccine. Our getting the vaccines protects them, too.”

Influenza vaccine recommendations for the 2017-18 season include these updates and changes:

  • Afluria Quadrivalent and Flublok Quadrivalent are now available for patients 18 and older.

  • FluLaval Quadrivalent may be given to children as young as 6 months. Previously, administration was limited to children 3 and older.

  • Pregnant women may receive any age-appropriate flu vaccine that is approved and recommended by the U.S. Food and Drug Administration.

  • FluMist Quadrivalent should be not should not be used during the 2017–2018 season due to concerns about its effectiveness against influenza A(H1N1)pdm09 viruses in the U.S. during the 2013–2014 and 2015–2016 influenza seasons.

The CDC continues to recommend vaccination for all people aged 6 months and older without contraindications, preferably by the end of October. For those aged 65 and older, the CDC says standard-dose or high-dose vaccine is acceptable.
As a member of the Mayo Clinic Care Network, Tucson Medical Center works directly with Mayo Clinic, the nation’s No.1 hospital according to U.S. News & World Report. Our doctors get access to Mayo Clinic knowledge and resources, and you get the best care, close to home.

For information on how to protect infants under 6 months from the flu see this TMC for Children post.

Dr. Leitner is a TMCOne provider at the TMC Rincon Health Campus, near Drexel and Houghton.


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