Grandparents, parents – Prevent accidental Rx poisoning

Grandparents and young child at breakfastDear Grandparents and Parents,

We have an important message to you this holiday season about how you can help keep your grandchildren or children safe, whether you’re visiting them or they’re visiting you.

Keep medicines up, away and locked.

Approximately 60,000 young children are brought to emergency departments across the nation each year because they got into medicines that were left within reach. We see those terrified families in our Pediatric Emergency Department and know that the fear is compounded by the knowledge that this accident was completely avoidable.

The 2-year-old grandchild who got into grandma’s heart pills, the four-year-old who downed a whole bottle of vitamin D gummies, the toddler who picked up the errant hypertension pill that fell on the ground, we see it all the time. The very prescriptions and over the counter medications that keep us ticking along can be life-threatening to young children.

So this holiday season, when you may be visiting family, or they may be visiting you, take a moment to make sure that all prescriptions, over-the-counter medications, vitamins and even eye drops are:

1. Up and away

You’d be surprised at how resourceful a two or three-year-old can be in the pursuit of something that looks even a little like a candy. Make sure your medicines aren’t visible, and are stored high enough that even if they drag a chair over or climb on a table they can’t reach it. Your purse or bag isn’t safe, nor is a bedside table. If you’re visiting family ask if there is somewhere you can place medications safely.

2. Locked up tight

Make sure you use the containers with the child safety caps and place medicines in a locked cabinet. The child resistant safety caps are a challenge for children to open, but not insurmountable so don’t rely on the caps alone. When young children are around place pill organizers in a locked cabinet.

And that you:

3. Are prepared

Keep track of the names, quantity and location of your medications – this can be vital information if your other precautionary tactics have failed. Keep the number of the poison help number in all your phones (800) 222-1222.

4. Exit expired meds

Dispose safely of expired over-the-counter and prescription medications. The City of Tucson Dispose-A-Med program lists locations on its website.

If you’re a parent preparing to talk to your family this season about medication safety, my advice is to be upfront with them, share some basic information and suggestions. If they don’t have young kids at home, they may just keep their meds on a plate, not even in the container, or in a pill organizer. They also may not be familiar with just how clever young children can be. Perhaps say something like this, “Maya and Jordan are so curious these days and just getting into everything. I know you take some daily medications – I have the perfect place you can put them so they’ll be safe while you’re here.”

Blessings of the season,

Melissa

Melissa HodgesMelissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center since 2008. She is a knitting ninja apprentice who makes a mean chili and enjoys spending time with her family and friends in beautiful Tucson, Arizona.

Safe Kids Pima County is the local coalition of Safe Kids Worldwide, a global network of more than 600 coalitions in 23 countries bringing together health and safety experts, educators, corporations, foundations, governments and volunteers to educate and protect families. Tucson Medical Center spearheads the local coalition.

World Diabetes Day -Raising awareness about Type 1 and Type 2 diabetes

Today is World Diabetes Day. Have you donned blue today to raise awareness about the effects of diabetes on our community?

Why should I care?

According to the American Diabetes Association, nearly 400,000 Arizonans suffer from diabetes.  Thousands more may have the disease, and not yet know it!  An estimated one out of every three children born after 2000 will be directly affected by diabetes.

TMC Certified Diabetes Educator Nancy Klug has been helping people with diabetes for more than 30 years.  Listen as she explains the difference between Type 1 and Type 2 diabetes, the best ways to prevent Type 2 diabetes, and what she thinks is the biggest myth about diabetes prevention.

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

Diabetes is a metabolism disorder, a problem with how you process digested food for growth and energy. Type 1 usually presents when you’re a child, but not always. People with Type 1 diabetes do not produce the insulin needed to move sugar, glucose, into the body’s cells so that they may function and help us grow and move. The sugar stays in the blood stream. We don’t know what causes Type 1 diabetes and there is no cure at this time.

People with Type 2 diabetes are unable to produce enough insulin or their bodies are unable to it properly to move the glucose into the cells. Type 2 diabetes use to be considered an illness of adulthood, but increasingly Type 2 is seen in children too. We don’t know exactly what causes Type 2 diabetes, but it is closely linked to weight and exercise and can often be prevented and treated with good nutrition and exercise.

What you can do to help

  1. Know the symptoms of Type 1 diabetes which can appear even in infants. Recognizing these symptoms could save a life.
Warning signs (these may occur suddenly):
  • Extreme thirst
  • Frequent urination
  • Sudden vision changes
  • Sugar in urine
  • Fruity, sweet, or wine-like odor on breath
  • Increased appetite
  • Sudden weight loss
  • Drowsiness, lethargy
  • Heavy, labored breathing
  • Stupor, unconsciousness

 

2. Resist the temptation to turn on the television after dinner. Go take a walk as a family. Exercise and good nutrition can help prevent Type 2 diabetes and help those living with diabetes.

How can we help?

The Diabetes Education Program at Tucson Medical Center is offered by certified diabetes educators who are registered nurses and dietitians. We offer both individual and group training for diabetes Type 1, Type 2 and diabetes in pregnancy.

For uninsured patients or patients that have been diagnosed with pre-diabetes, TMC offers an eight-hour class, Journey for Control, Wednesdays from 1-3 p.m. To learn more or to register, please call (520) 324-1960.

Additionally, TMC offers free education sessions and support that cover a wide variety of helpful topics. Discussion is facilitated by a certified diabetes educator. Classes are held on the second Wednesday of each month from 5-6 p.m. at the El Dorado Health Campus Cafeteria. No registration is necessary. Here is the full schedule of classes.

We work with endocrinologists at TMCOne to help patients address and manage their diabetes.

TMC patient finds new freedom with 3-D Knee-replacement


“It’s so much like my natural knee that I couldn’t believe it,” said Barbara Wagner who received a custom-made knee replacement at Tucson Medical Center.

Serious knee pain is felt with every step and can significantly impact quality of life. Wagner was informed 10 years ago that she needed to have a both knees replaced.

She had the left knee replaced soon after the recommendation, but experienced complications. “It was very painful, so I decided to have cortisone injections on my right knee instead of surgery, which worked for a while.”

She received relief from cortisone therapy for several years. After moving to Arizona, the pain in her right knee was increasing. “The shots were becoming less effective. I was walking regularly with a limp and I needed to walk with a cane.” Wagner sought new options, and found much had changed in a decade.

“In the last 10 years, there have been extraordinary advancements in technology, implant materials and surgical techniques,” said Dr. Ali Dalal, an orthopaedic surgeon at Tucson Orthopaedic Institute who specializes in hip and knee replacements.

“The advancements have resulted in a better implant fit, which often means greater comfort, mobility and patient satisfaction,” said Dr. Dalal.

One such advancement involves producing a custom-made, knee replacement implant to fit the patient’s unique anatomy. “Generally, surgeons must choose an off-the-shelf implant from a limited range of sizes,” said Dr. Dalal. “With this technology, the implant is custom-made based on an advanced 3-D CT scan of the patient’s knee.”

Dr. Dalal explained the procedure and options to Wagner. “I have all the confidence in the world in Dr. Dalal and I also did my own research.”

Wagner had the required scan and the custom implant was produced and sent to TMC, where Wagner had her replacement surgery.

Recently, Wagner walked down the hall of Tucson Orthopaedic Institute with a smile and without assistance. “I can walk without pain,” she exclaimed. “It effects my entire body – I can walk without a limp and without my cane.”

“Ms. Wagner’s positive outcome is typical of what patients experience with this technology,” said Dr. Dalal. “I’m also pleased with her results and look forward to providing this option for more patients.”

What is next for Wagner? “Everything is so much easier, from walking my dog to making stained-glass crafts, my favorite hobby.” Plans she has put off for some time are now in the works. “My son and I are planning a hike – I haven’t been in more than 10 years.”

Wagner also plans on taking courses in glass fusion, pottery and woodworking. While these hobbies may not involve extreme physical activity, she said the successful surgery really made a difference. “It’s hard to describe just how debilitating bone-on-bone knee pain really is. The custom knee replacement has given me the freedom to be more comfortable in everything I do.”

See the Conformis website for more information about the custom-made total knee replacement implants.

TMC congratulates one of our TV dancers for selection as a Mayo Clinic’s WomenHeart Champion

At some point it was scary, but the first feeling Susan Smith remembers having when she was told she was having a heart attack was anger at the inconvenience of it all.

“I was in the middle of a late life career path – teaching writing, publishing a book, running a writers group, and going to twelve networking meetings a month,” Smith recalled. “My to-do list was a mile long, and I liked my busy lifestyle.”

Her heart attack was a wake-up call – and one she shared as a WomenHeart Champion at the 2018 WomenHeart Science & Leadership Symposium at the Mayo Clinic in early October.

The four-day symposium, which selected 50 women from 18 states, was designed to prepare the participants to be advocates for women’s heart health in their communities – providing support and education about heart disease, the number one killer of women.

Smith said she has now realized her “busyness” was stressing her system.

“I was so intent on taking care of everyone else, I put my own self-care at the bottom of the list.”

After four days in the hospital, she left not just with two stents, but a new attitude, she said. “Now I follow doctor’s orders; eating right, exercising, six medications, and no stress. That means people see a “new me” practicing self-care and moving through the day at a stroll instead of a sprint.”

She also walked away from the symposium with a new perspective. “I was amazed to meet so many young heart sisters at the training. More women in their 20’s, 30’s, and 40’s are experiencing heart disease.  That’s why it’s more important than ever we educate women and raise awareness.”

Good luck on your journey, Susan, and we’re proud of your work in helping others!

For breast cancer patient, the touch of a hand made the difference

YeseniaHelping our community right here in Tucson get and stay healthy and keep on dancing is what Tucson Medical Center is all about. We’re showing off some of our fabulous community members in our latest commercials and you get to find out a little more about them here on our blog. Meet TMC dancer, Yesenia Lopez.

The last time Yesenia Lopez had surgery, she was 15 and having a tonsil removed.

But here she was, about to have surgery to remove cancer that was diagnosed when her doctors found a lump in her breast.

“What helped the most in that moment was the nurse holding my hand when they were putting me under,” Lopez recalled. “She said, ‘Everything is going to be OK. I will follow you all the way into surgery.’ She was still there at recovery and she stayed with me from the time I went under until the time I woke up.”

When Lopez found she had cancer, she knew she would come to TMC. It’s where she brought her two children, now grown, when they were sick. “TMC is a big part of our world as a family,” she said, adding her recovery in the hospital was great, with her husband of 27 years by her side. “We received really good treatment there. And I know people will say what they will about hospital food, but the food was good!”

Lopez has refocused on her health, including losing a few extra pounds and taking up hiking.

What would she tell a woman recently diagnosed with breast cancer?

“A lot of people worry from the time they get diagnosed, but when you get a good staff working with you and guiding you, it makes the worry go away,” she said, noting she has already referred friends with breast cancer to her surgical oncologist, Dr. Michele Boyce Ley.

“I would tell them that it’s a long journey and you have to have patience, but with the right team of doctors, and the right staff at the right hospital, the journey is much easier. I’ve been blessed. This has been a hiccup and I’m looking forward to life even more now.”

Breastfeeding – 10 ways you can support the new mama in your life

10 ways dads can help with breastfeedingThere was a time when in the first fresh days and weeks of a baby’s life, a new mom would be surrounded by the women of her family and community. They would provide her support and guide her through breastfeeding and caring for her new child. Today, that is often not the case. A new mom may find herself without that sisterhood to draw upon. Breastfeeding support groups, lactation consultants and postpartum doulas provide valuable resources, but for day-to-day the support of dad or partner is critical in determining whether breastfeeding is successful.

TMC for Women Lactation Consultant, Susan Dennis IBCLC, shares these ten tips to help dads and partners help the new mom in their lives:

How to provide breastfeeding support to your partner:

  1. Before baby arrives attend a Breastfeeding Class with the expectant mom.
  2.  Tell the new Mom that she is doing a great job- encouragement is a key building block to success.
  3. Help recognize when the baby is showing feeding cues and help give mom private time to feed without distractions from other visitors.
  4. Place pillows under mom’s arms, back, legs to help support her in comfortable positions while feeding.
  5. Watch how staff at the hospital or birth center help the baby start a feeding and do the same when mom needs help.
  6. Hold baby skin to skin after feedings while mom takes a nap. This is a great bonding time for you and baby.
  7. Bring water and snacks whenever mom feels hungry.
  8. Be the mom’s sounding board when she feels frustrated. Sometimes she just needs to talk.
  9. Burp baby, change diaper and cuddle baby in between feedings so you get a chance to know the baby.
  10. Babies are only small for short time. When they cry they need to be held. This builds trust and later independence.

Know there are outside resources to help mama with breastfeeding, we provide outpatient consultations with certified lactation consultants as well as a weekly support group.

Resources

Pisacane, A., Continisio GI., Aldinucci, M., D’Amora, S., Continisio, P., A controlled trial of the father’s role in breastfeeding promotion Pediatrics. 2005 Oct;116(4):e494-8. [Accessed 6/13/2014]

Work colleague inspires fellow salon manager to get joint replacement

Charles and ANnieHelping our community right here in Tucson get and stay healthy and keep on dancing is what Tucson Medical Center is all about. We’re showing off some of our fabulous community members in our latest commercials and you get to find out a little more about them here on our blog. Meet TMC dancers Charles Colbath and Annie Collins.

Bavilon Salon owner Charles Colbath would wince a little seeing Salon Coordinator Annie Collins hobble about.

A former marathon runner, Collins had agonizing arthritis in her right hip. “I almost couldn’t walk. I couldn’t lift my leg to get in the car. I would be walking, and my leg would just freeze.”

She had hip replacement with orthopaedic surgeon Russell Cohen. “It was a miracle. I had surgery one morning and was home the next day by noon. I was pain free – literally, pain free.”

Colbath was struck at her recovery. He had been suffering with his own trick hip for four years. “Dr. Cohen did an evaluation and said he could do it. I trusted him. And I had the same experience Annie did. The whole process was amazing. I’ve had worse tooth extractions.”

Collins, who is an avowed pickleball addict, said dancing is her next favorite thing and she’s thrilled to be able to do it.

For Colbath, the minimally invasive procedure was a life changer. “It’s hard to believe you would go in for something that would be seen as major, but it honestly wasn’t,” he said. “The process they use now is so perfected, that I was back to my routine in three days. And I’m getting my life back now, which was key.”

From bariatric surgery to instructor of “Insanity” workout

IMG_0607When Marni Gould topped out at 248 pounds, it became evident she needed to make a change.

Dance and exercise had been her passion since high school – and although she had remained active even through her weight struggles, she was finding more and more she couldn’t do it anymore.

At 35, the middle school math teacher was grappling with sky-high blood pressure and a resting heart rate of more than 100 beats per minute. Her knees hurt from carrying too much weight for her frame, and her ankle rolled far too often. She had tried a number of diets and none of them seemed to work.

“I knew I needed help with food. I never knew how to properly eat,” she said, noting cheeseburgers were a particular weakness.

Gould’s two sisters each had had bariatric surgery and after seeing the results, she decided to learn more. After going through a six-month process of medically-supervised weight loss, she still had not lost enough weight. She had the surgery April 2016 and was back at work in two weeks. She almost immediately went back to the gym, doing serious modifications to ease herself back into being active and avoiding core exercises at first to give herself time to heal.

Gould also was strict that first year in particular with her diet – lots of protein shakes and thoughtful meal choices, with PowerCrunch bars to satisfy sweet-tooth cravings. “This just let me reset. Now I know I can eat the right things in balance with the amount of activity I do,” she said.

While Gould’s one sister took up running, Gould gravitated more toward strength.

IMG_5384Four months after her surgery, she started a high-intensity endurance workout called Insanity Live. She modified everything and kept plugging away. She learned to love it.

In a year, her body fat had dropped from 48 percent to 25 percent. By 18 months, she had lost her 100-pound goal. At 138 pounds, she went from a size 22 to a 6/8.

When her instructor moved, Gould couldn’t imagine a Saturday without Insanity Live. She decided to teach it. “At the training, they said, ‘You don’t have to be the best at the moves. You just have to be the most motivating.’ That stuck with me.”

While some instructors bark orders and push students to work at top capacity, Gould remembers the importance of pacing herself. “I really want to pull in people who are scared of it – it’s called Insanity for a reason. I want them in there so they can see how much they change over time. When you start losing and toning, it helps you stay motivated and keep going.”

Gould is so passionate about sharing her transformation, that she regularly attends the TMC Bariatric Support group and manages a Facebook group for local patients, as well as another accountability group for those who need more regular check-ins. “I love inspiring others. I remember early on when I was frustrated with the pace of my weight loss, someone told me, ‘You’re on a trajectory.’ And that changed everything. It’s not about the Right Now. It’s about progress, not perfection.”

“I just want to help others. I feel like I’ve been given this gift – and what good is this gift to me if I am not spreading it and using it to assist others?”

Flu season, like winter, is coming. Is your family ready?

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.”

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.

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

TMC presented with award, recognition for achievements in stroke treatment

BDP49509Tucson Medical Center routinely achieves critical treatment timelines for patients that give them the best outcomes after heart attack or stroke.

“On behalf of the American Heart Association and the American Stroke Association, I thank you for your commitment,” said Ron Loomis, Jr., the senior regional director for quality and systems improvement for the associations, in presenting an award to the TMC team.

TMC earned the Get with the Guidelines Stroke Gold Plus Quality Achievement Award by meeting specific quality metrics for the diagnosis and treatment of stroke within a designated period that are scientifically proven to reduce death and disability for stroke patients.

TMC additionally received the Target: Stroke Elite Honor Roll award, which reduces time between when a patient suffering from ischemic stroke arrives at the hospital and when treatment starts with a clot-busting drug. Ischemic strokes occur when the arteries to the brain narrow or become blocked, reducing blood flow. We are the only hospital in Southern Arizona with this top level designation.

Stroke is the fifth leading cause of death in the U.S. and a leading cause of disability. “Research has shown that hospitals adhering to these evidence-based guidelines often see improved outcomes and fewer readmissions,” Loomis said.

BDP49513Dr. David Teeple, the medical director for TMC’s stroke program, said the program has been growing in effectiveness for the last 10 years, to the point that TMC has for many years been recognized for putting proven knowledge and guidelines to work on a daily basis.

“It’s ingrained in what we do here now,” he told the team, “but don’t underestimate the hard work you all do to achieve these guidelines. I’m incredibly grateful and our patients are incredibly grateful.”

Triple bypass leads to a new approach on life

Sergio.jpgHelping our community right here in Tucson get and stay healthy and keep on dancing is what Tucson Medical Center is all about. We’re showing off some of our fabulous community members in our latest commercials and you get to find out a little more about them here on our blog. Meet TMC dancer, Sergio Gonzales

Sergio Gonzales was working out with his wife last July when he felt an unmistakable feeling.

“I felt the same symptoms I’d felt the previous year, when I had a heart attack while on vacation in Witchita, Kansas,” he recalled. When the feeling didn’t pass in a few minutes, he called 911 and a helicopter evacuated him for treatment. Only in his mid-40s, he would end up having a triple bypass.

“The care at TMC was outstanding. I will always remember being wheeled in and seeing the worried eyes of my doctor, the nurses and my family, but they immediately helped put me at ease and made me feel better about the situation,” said Sergio, a University of Arizona graduate who works in the defense industry and is a college sports referee on the side.  His wife, Deanna, a Tucson native, agreed. “It was a struggle every day, but the nurses were great and his cardiac team helped get him home quickly.”

Sergio, who participated in cardiac rehabilitation to rebuild his strength, said the heart attack forced him to make some big changes.

Cardiac rehabilitation link

 

“Before my first heart attack, I was invincible,” he said, even though his father had his first heart attack in his 50s. He takes his health more seriously – and shares his concerns with his son, too, to take note of his genetic predispositions to heart disease, even though he is only 21.

“I’ve really been utilizing this time to reconnect with my family and to enjoy life a little more,” he said, adding he enjoys concerts and has taken more vacations of late than he has in the previous five years combined. “I’ve also been trying to learn more about my physical and mental abilities. I push myself harder to learn more and to make a difference in people’s lives.”

Asthma shouldn’t keep a kid from being a kid – Dispelling myths

asthma mythsWhen your child experiences an asthma attack it can be terrifying for both your child and for you.

Understandably, you want to take the precautions to prevent asthma attacks, but there are many myths about asthma. Some of these myths can lead parents to overly limit a child’s activities and negatively impact your child’s health.

Dr. Jamie Ruderfer, a pediatric pulmonologist with Pediatric Pulmonary Associates, sets the record straight and explains how parents should take the appropriate precautions that build strong health because, as she says, “asthma shouldn’t keep a kid from being a kid.”

MYTH ONE: Allergies and exercise are the most common asthma triggers

Actually, the most common trigger of pediatric asthma is the rhinovirus, or common cold. The flu is right behind the cold as a significant asthma trigger.

I strongly agree with the American Academy of Pediatrics that every child should receive a flu vaccine, and it is even more important for asthmatic children.

Does that mean allergies and exercise aren’t triggers?

Allergies and exercise can be serious triggers, they just aren’t the most common triggers of asthma-related difficulties.

Every child who experiences asthma will have unique triggers. Some will be triggered more by allergies or exercise. Some will be triggered more by viral colds. This is where proper expert advice on management comes in.

Before taking extreme precautions, an evaluation by a pediatric pulmonologist can determine your child’s your child’s unique experiences with asthma and create a management plan that fits your child’s needs and lifestyle.

Should parents take extra precautions to keep their child from getting a cold?

When it comes to colds, asthmatic children cannot realistically take different precautions than a child who does not have asthma.

Parents need to work, and children need to go to school and daycare. I’m a mom, too, and I understand that preventing a child from catching a cold is nearly impossible. We should still take precautions, but reasonable and effective ones – like a flu shot, hand washing/sanitizing, a healthy diet and good sleep.

If an asthmatic child catches a cold (which they will), it does not mean that an acute asthmatic episode is certain – it means that parents should be more alert for signs and symptoms. Again, management is key. Your child should have an individualized asthma action plan developed by their pediatrician or pediatric pulmonologist for when they get the sniffles.

MYTH TWO: Asthma symptoms only involve wheezing, right?

Wheezing (both breathing in and out) is a symptom, but there are other symptoms and signs that parents should be aware of.

Symptoms the child may have an escalating issue include:

  • Chest tightness
  • Chronic cough
  • Respiratory infection
  • Shortness of breath
  • Waking in the night with breathing difficulty

Acute symptoms that require immediate treatment involve:

  • Severe wheezing
  • Rapid and/or labored breathing
  • Coughing that doesn’t stop
  • Pressure and pain in the neck and chest
  • Difficulty talking due to shortness of breath
  • Blue lips or fingernails

If your child is experiencing any of these acute symptoms, go to the nearest emergency department or call 911 immediately.

MYTH THREE: My child hasn’t had symptoms for a long time – so I don’t have to be as aware?

Children can go for long periods without asthma being triggered. Asthma is a serious condition and while parents don’t need to be overly cautious, they should regularly visit a health-care provider, stick to the asthma management plan and always be alert to symptoms.

MYTH FOUR: To prevent asthma just cut out sports

I’m just so afraid of an asthma attack – should I just cut out sports entirely?

An asthma diagnosis should not keep a kid from being a kid. Having a solid, ongoing management plan will make it possible for your child to safely enjoy sports and other physical activity.

Dr. Ruderfer graduated from the University of California, Irvine Cum Laude and Phi Beta Kappa with a B.S. in biological sciences with emphasis in cell biology. She received her medical degree from St. George’s University School of Medicine, and completed her 3-year residency in pediatrics at Winthrop University Hospital and a 3-year fellowship in pediatric pulmonary at Baylor College of Medicine/Texas Children’s Hospital. She is a member of the American Academy of Pediatrics. Dr. Ruderfer is married to Dr. Daniel Ruderfer (TMCOne pediatric infectious disease) and has two sons, Ethan and Josh, ages 3 and 6.

 

 

 

 

After knee replacement, ‘People tell me I look different’

Mary.jpg

Helping our community right here in Tucson get and stay healthy and keep on dancing is what Tucson Medical Center is all about. We’re showing off some of our fabulous community members in our latest commercials and you get to find out a little more about them here on our blog. Meet TMC dancer, Mary Rowley.

For business owner Mary Rowley, pain was a part of everyday life.

“I had bone-on-bone arthritis. I couldn’t use my knee very much,” Rowley recalled. “It was to the point where I forgot what it was like not to have pain.”

Rowley, who had two previous unrelated surgeries at TMC with great outcomes, came back to TMC, with orthopaedic surgeon Russell Cohen.

“It was great. The experience in the hospital was wonderful – I felt like I was with friends,” she said, noting she went home the next day.

“My knee is fantastic. Before, I coudn’t run at all. Now I can run up steps. I’m walking more, I’m exercising. I can bend. People tell me I look different: that I don’t have as much pain on my face.”

Rowley has a recommendation for others considering knee replacement surgery. “Everyone said put it off as long as you can. I would say don’t. If you really need it done, and a professional tells you that you need to get it done, get it done. It’s great on the other side.”

Check out Mary getting to dance again in our latest dance video.

Back to School: Know the warning signs of bullying

For many children, the start of a new school year can be stressful, especially if they’ve been victims of bullying in the past. Mayo Clinic Children’s Center psychologist Dr. Bridget Biggs says parents and caregivers should know the warning signs. “If your child is reluctant to go to school, stressed after spending time online or avoids social situations, he or she may be being bullied.”

What is bullying?

Dr.Biggs defines bullying as “any form of aggression that is repeated.” This can be physical, verbal, social (excluding victims from activities, starting rumors about them) and increasingly electronic. It can happen not just at school, but anywhere a group of children congregate, whether on the playground, in school or on social media.

Bullying differs from fighting or teasing because there is a power differential between the bully and the victim. The bully has power over the other child and tries to control them using fear over and over again.

Additional warning signs your child is being bullied:

From www.stopbullying.gov

  • Unexplainable injuries
  • Lost or destroyed clothing, books, electronics, or jewelry
  • Frequent headaches or stomach aches, feeling sick or faking illness
  • Changes in eating habits, like suddenly skipping meals or binge eating. Kids may come home from school hungry because they did not eat lunch.
  • Difficulty sleeping or frequent nightmares
  • Declining grades, loss of interest in schoolwork, or not wanting to go to school
  • Sudden loss of friends or avoidance of social situations
  • Feelings of helplessness or decreased self esteem
  • Self-destructive behaviors such as running away from home, harming themselves, or talking about suicide

Dr. Biggs points out that consequences of bullying can be serious. She says victims are at increased risk of depressionanxietysleep problemsself-harm, poor grades and in rare cases, suicide. She encourages parents and caregivers to directly ask their child if they have thought about self-harm. If a child knows that their parent or caregiver is open to discussing feelings about self-harm it can be a relief to the child and can open up lines of communication.

Dr. Biggs shares these tips for parents and caregivers on how to help children who are victims of bullying:

  • Talk it out – Ask your child about concerns.
  • Learn – Get information from your child about what’s happening.
  • Take notes – Record details of bullying events.
  • Discuss and practice how to respond – Walk away. Get help from trusted adult or peer.
  • Talk about technology – Before cyberbullying occurs set some ground rules including letting your child knows their electronic privileges will not be removed if they share that they have been cyberbullied.
  • Build self-esteem – Encourage your child to get involved in positive activities.
  • Team up – Reach out to teachers.

Watch: Dr. Bridget Biggs discusses warning signs of bullying.

Next week we will discuss cyberbulling, how to recognize it, react to it and prevent it.

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.

Ask the expert about Orthobiologics: The healing power of our own bodies

knee orthobiologicsOrthobiologics is a tongue twister, but the science behind regenerative medicine seems so simple. By taking our own healthy cells, extracting the growth factors, platelets or stem cells and then using those cells to heal our chronic pain, doctors are reducing the need for harmful therapies like steroids exponentially.

“Platelet-rich plasma (PRP) can stimulate stem cells to the area and create a healing cascade. The therapy wakes up your body’s own healing properties,” said Dr. Tad DeWald, of Tucson Orthopaedic Institute and noted expert on regenerative medicine procedures.Dr. Ted DeWald

“The PRP is injected into ligaments, tendons, muscle, or joints and is a long-term solution to musculoskeletal injuries and pain, including arthritic joints.”

When you have an acute injury like tendonitis, your body creates inflammation around the area to heal it. If the injury doesn’t improve after about 12 weeks, your body stops trying to heal. At this point the condition is considered chronic. The tendon fibers aren’t viable. “It still looks like a tendon, but it doesn’t act like one. Treatments like PRP and stem cells get your body back on board and working to heal,” said Dr. DeWald.

Stem cells have several unique abilities. They can transform into other cell types, such as bone, cartilage, muscle and tendon. And they also serve an important role as medicinal signaling cells, recruiting other stem cells to the target area and triggering nearby cells to begin the repair process.

“Healing properties that come from your body have no negative effects. For any active person looking to feel better and get around better, this treatment is beneficial. And for patients looking at a total joint replacement down the road, this treatment offers the possibility of delaying or avoiding surgery,” said Dr. DeWald.

To find out more about how these innovative treatments use your body’s own cells to heal, attend a free event at The Core at La Encantada, Wednesday, Aug. 15, 5:30 p.m. Register today!

Stroke, heart surgery came “out of nowhere” for 31-year-old

Clayton.jpgHelping our community right here in Tucson get and stay healthy and keep on dancing is what Tucson Medical Center is all about. We’re showing off some of our fabulous community members in our latest commercials and you get to find out a little more about them here on our blog. Meet TMC dancer, Clayton Green.

The rheumatic fever Clayton Green contracted as a child had greater significance than anyone realized at the time.

As his body fought off the infection, his heart valves were damaged in the process.

As he grew up, Green was careful to stay fit and eat right – he was a vegetarian for years and committed to an active lifestyle.

But one evening with his friends, the student and part-time bartender started feeling worse and worse, and when it became obvious he was having a stroke related to the heart disease, he was rushed to Tucson Medical Center.

His heart surgeon, Kushagra Katariya, identified other irregularities in his heart and corrected those as well.

“The stress of it was the worst. I had never been sick before and had been using preventive nutritional care and exercise so this wouldn’t happen. But the care was amazing from the nurses to the doctors and technicians, everyone there was courteous and made you feel at home, which helps when you’re in a situation that is very difficult,” he said.

Green was up and walking the day after surgery and four months afterward, was dancing in a TMC commercial.

Anyone can have a stroke, even children although the causes in children tend to be different. The elderly are not the only ones at risk for stroke although age is one factor. Stroke risk also increases with factors like increased blood pressure, diabetes, high cholesterol and atrial fibrillation. Know the symptoms of a stroke. Early recognition and treatment makes all the difference.

 

Couple face lung cancer together

TrasksHelping our community right here in Tucson get and stay healthy and keep on dancing is what Tucson Medical Center is all about. We’re showing off some of our fabulous community members in our latest commercials and you get to find out a little more about them here on our blog. Meet TMC dancers, Jeff and Viki Trask.

The Trasks came together to meet a challenge when Jeff hired Viki as his new director of sales to help him open a hotel in Tucson.

The owners indicated if they achieved a 70 percent occupancy in the first full year – rare in the business – they would give them a trip to Hawaii, all expenses paid. At year end, the hotel’s occupancy was 71.2 percent.

The Hawaii trip turned out to be their honeymoon.

The two are braving a new challenge now.

It started when doctors found cancer in Jeff’s left lung. His physician recommended cardiothoracic surgeon Douglas Lowell. Five days in the hospital passed quickly after the operation and he returned to his life.

Two years later, it would be the right lung, with Dr. Lowell summoned to help again. Another surgery, another five days in the hospital.

Two years later, Viki had the diagnosis: lung cancer. They turned to Dr. Lowell again.

“TMC was great. If you needed something, they were there,” Viki said. “We were even more impressed after we learned TMC is a nonprofit. That’s remarkable!”

Jeff and Viki stated, “We’re extremely grateful to our team of doctors and healthcare providers. They’re all fantastic and we want to thank our nurse navigator, Kim Kastel, who came up with the moniker: Team Trask.”

Jeff has since been diagnosed with his third bout. They both have had rounds of chemotherapy or immunotherapy in addition to their surgeries.

“We’re living with cancer,” Viki said. “Yes, it can be devastating to learn of the diagnosis, but we are determined to stay positive and understand we are living with cancer. We’re on the five-year plan and we just go from there.”

Jeff said one of his doctors recently asked how he’s feeling. “Do you get tired? I do, but only after I work on the oleanders for three hours. I still ride my bicycle during the week. It’s wonderful to be alive.”

Long-time smokers and ex-smokers breathe easier with a lung screening.

Make an appointment today. Call (520) 389-5390

Worries getting in the way of making that call to get a lung screening? You’re not alone. Nurse navigator, Kim Kastel addresses some common barriers people face in this blog post.

Oh no, I think my child has heatstroke, what should I do?

girl heatstrokeIt’s a difficult balance during summers in Tucson. I don’t want my boys inside all day so we try to get out early in the morning or in the evening, but the 100 degree days seem to start earlier and earlier and last longer. Along with dehydration, I worry about heat exhaustion and, worse still, heatstroke during these hot summer months. While we often think of heatstroke as what happens when children are left in a hot car, it can also happen when they’re just playing outside in the heat.

Because children have smaller bodies, they are more susceptible than adults to heat exhaustion and heatstroke, so it’s important to know the symptoms and what to do in case heatstroke strikes.

What is Heatstroke?

Heatstroke is when the body becomes overheated and fails to regulate its own temperature. Body temperatures rise, and may even get up to 105°F (40.6°C) or higher.

Heatstroke is a medical emergency, it can be life-threatening and requires immediate medical attention.

Here are some symptoms to look out for:

  • Skin is flushed, red and dry
  • Little or no sweating
  • Deep breathing
  • Dizziness, headache, fatigue or a combination of these
  • Less urine is produced, and it is of a dark yellowish color
  • Loss of consciousness

What to do if you suspect heatstroke:

  • Move your child out of the heat immediately and take your child to the hospital or doctor as soon as possible
  • If for some reason you cannot get your child to a hospital or physician, quickly move your child immediately out of the heat and place in a cool bath (although not less than 60 degrees, you don’t want to constrict the blood vessels)
  • When your child is in the bath, massage the skin to increase circulation, get them to a hospital or doctor as quickly as possible

What is heat exhaustion?

Heat exhaustion is not as severe as heatstroke, but is a result of the body overheating. It still requires careful monitoring and can be a precursor to heatstroke.

Heat exhaustion can take a while to develop especially with prolonged exercise.

Here are some symptoms of heat exhaustion to look out for:

  • Goosebumps and cool skin
  • Excessive sweating
  • Faintness and or dizziness especially upon standing (low blood pressure)
  • Complains of being tired
  • Pulse becomes rapid
  • Complaints of cramps, nausea or headache

When to do if you suspect heat exhaustion:

  • Stop all activity and rest
  • Move your child to a cooler place
  • Encourage your child to drink cool water or sports drinks
  • Contact your child’s pediatrician if signs or symptoms worsen or if they don’t improve within one hour. Seek immediate medical attention if your child becomes confused or agitated, loses consciousness or is unable to drink.

What can we do to prevent heat exhaustion and heat stroke?

  1. If your child is in camp or daycare, check to make sure the camp or child care provider has procedures in place to prevent dehydration and excessive heat exposure.
  2. Make sure your child stays hydrated.
  3. Incorporate water play into outdoor time. Whether it is swimming, a splash pad or sprinklers in the backyard, water play can make the outside bearable. Don’t forget sunscreen, swim shirts and hats though!
  4. Stop and rest. Children and adults alike tend to become exhausted in the heat. Build in rest time.
  5. Dress for the heat. Light-colored and light-weight clothing is best
  6. Check out some cool air-conditioned space for a change of pace from the house. Pima County libraries provide lots of activities year-round and are free. The Children’s Museum of Tucson provides an opportunity for active play.
  7. If possible for your family’s schedule, incorporate a siesta, or nap, into the hottest part of the day and then let the kids stay up later to enjoy cooler nighttime temperatures. Reid Park Zoo, Tucson Botanical Gardens and the Arizona Sonoran Desert Museum all have summer schedules that allow early morning or evening visits.

Keep cool in the Old Pueblo this summer,

Melissa

Melissa HodgesPediatric Emergency Notes from Melissa
Melissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for 10 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.

Smokers, Kim is here to help you breathe easier

Kim Kastel, Thoracic Nurse Navigator

Kim Kastel, Thoracic Nurse Navigator

The risks of being a long-time smoker can weigh heavily on your mind, especially when considering the threat of lung cancer. Early detection is vital for surviving lung cancer, but the symptoms often present themselves until the cancer is already advanced and a cure is elusive. The CT scanning technology that Tucson Medical Center uses during lung health screening can find the tiniest of nodules, allowing doctors to see suspicious lesions when the tumors are small and can be removed. This screening can literally save lives.

Many people who have a high risk of lung cancer feel unable to take that first step of getting a screening. Kim Kastel, the nurse navigator for the lung cancer program, addresses some of the emotional barriers she’s heard to help people overcome the struggle to get testing:

Am I going to be judged for smoking?

Absolutely not! This is a non-judgement zone. We’re pleased you’re taking this first step to protecting your health and the earlier we can catch lesions the better the outcomes. We work actively against that stigma and increasingly the general public is recognizing that while smoking puts you at increased risk for lung cancer, lung cancer affects non-smokers too.

Am I going to be pressured to stop smoking?

Or am I going to be told off for smoking? I don’t want to be shamed.

While we will encourage you to stop smoking, we know this is a difficult process and we’re not going to pressure you to stop. We can direct you to resources to help stop smoking if you’re ready to take that step.

(ASHLine is a local resource that can help if you’re ready to stop smoking and want support. You can call them at 1-800-556-6222)

What if they find cancer? I don’t want to have cancer.

No one wants cancer, but if we find a suspicious lesion during a lung health screening, you will have support from a nurse navigator throughout the process. The earlier we find any lesion the easier and quicker it will be to get you to being able to say you don’t have cancer.

If I have cancer, it’s already too late. What’s the point?

With early intervention it is possible in some cases to literally cut the cancer out and be done with it — no chemo, no radiation, no medications. If a lesion is found that requires treatment beyond surgical removal, know that in the past 10 years cancer treatments have made huge bounds forward in targeted therapy and are continuing to advance.

I stopped smoking five years ago, so I don’t need to worry with a lung screening, right?

Well done! You’ve lowered your risk. But if you smoked for a long time you will still want to be checked.

Who should get checked?

We offer lung CT screenings to individuals at high risk for developing lung cancer. You may be eligible for a screening if you are:

  • between the ages of 55 and 77 (some insurance companies will cover up to 80 years of age)
  • have smoked an average if one pack of cigarettes a day for the past 30 years
  • if not currently smoking, then quit smoking in the last 15 years.

Will insurance cover the screening?

Most insurance will cover the screening for those at high risk (see above). Medicare Part B covers a lung cancer screening with Low Dose Computed Tomography (LDCT) once per year for those who meet all of these conditions:

  • Aged 55 to 77
  • Asymptomatic, i.e., no current signs or symptoms of lung cancer
  • A current smoker or one who has quit within the last 15 years
  • A history of tobacco smoking for at least 30 “pack years” (an average of one pack a day for 30 years)
  • A written order from a doctor

Find out more about lung health screening by calling Kim, our nurse navigator

at (520) 389-5390

Breast cancer survivor spreading a message of body positivity

BethAnne King LobmillerBreastless and beautiful

When breast cancer survivor and advocate BethAnne King-Lobmiller was just 10 or 11 years old, she recalls accidentally barging in on her grandmother as she was changing her blouse. “I must have gasped or looked shocked … but she just smiled and invited me to come in and close the door. Then she explained to me why she didn’t have breasts.”

“She had a bilateral mastectomy in the 1970s, back when cancer surgery was radical and went deep, and as a result, she was completely flat.” King-Lobmiller recalls with a smile. “I had never noticed that she wore fake boobs – she even wore smaller ones in the summer to stay cooler – and none when she was in her pajamas.”

Possibly in part as a result of her grandmother’s unapologetic honesty and generosity in sharing her experience, King-Lobmiller dedicates herself to advocating for body-positivity after breast cancer. Breastless and Beautiful, the advocacy group she started, boasts more than 300 members and exists for women who have chosen not to undergo reconstruction after a mastectomy. Says King-Lobmiller, “I didn’t choose flat, it chose me … as corny as that sounds.”

But the journey to her current state of body-positivity took time, reflecting back on her own diagnosis, she says, “When I first heard that I was going to have a mastectomy, I was beside myself, I couldn’t’ accept it.”

“One of the things I noticed about myself as I attended support groups was that I was really more freaked out about it than anyone I knew. But I was just processing it and grieving the finality of the loss. I wasn’t soothing myself with the idea of the breasts I would have afterward, so it felt very raw and real.”

Choices post mastectomy include going flat

Not willing to go through additional surgery beyond her mastectomy, King-Lobmiller found there was an assumption among everyone from medical professionals to support groups that reconstruction would be the obvious choice. Going flat wasn’t an overt part of the mix.

“I’m not advocating for flatness, I’m asking for there to be a conversation about the option.”

Her philosophy is that, like most things, the more people see healthy, beautiful survivors who have chosen flat and the more the community knows about it, the more comfortable women will become with making the choice that is best for them.

“Honestly, hardly anyone notices. When they do, I think to myself, “Please say something to me” because I always want the opportunity to educate someone and help them to understand,” said King-Lobmiller.

“The idea that I’m not a feminine and beautiful woman because I don’t have breasts is ridiculous,” she said.

TMC’s dedicated Oncology Nurse Navigators are here to help with resources for patients and their families and information about support groups. And don’t forget to schedule your annual mammogram today.

Avoid these common mistakes to protect your child from the sun

sunscreen mistakesWe asked Dr. Gerald N. Goldberg of Pima Dermatology for advice on how best to protect our children from the blazing Arizona sun. Dr. Goldberg is board certified in both pediatrics and dermatology. 

1. Not applying sunscreen in spring, fall and winter

Really is there any time of year where sunscreen isn’t necessary at this latitude for you or your children?

Ideally, we are providing examples and modeling of good sun safe behaviors for our children from a young age. Daily application of a broad-spectrum, water-resistant sunscreen of SPF 30 or higher is ideal. This latitude provides tremendously intense ultraviolet exposure for much of the year. Worst times are late spring through early fall and midday from 10 a.m. to 3 p.m. when the UVB (“burning rays”) are most intense.

2. Assuming the shade will be enough to protect from the sun

Shade is not totally protective since there often are considerable reflected rays and filtered rays through partial shade. The same is true for cloudy days where filtered UVB light can still cause sunburn.

3. Using any old sunscreen

Not really. It’s best to look at labeling when considering if your sunscreen is up to snuff.

Broad-Spectrum: Blocks the UVA (“aging, wrinkling rays”) and UVB (“burning rays”).

Water-Resistant: Retains blocking power for 40 minutes of water immersion or “very water-resistant” if it retains protective effects after 80 minutes of being in the water.

An SPF (“sun protective factor”) of 30 or better is recommended. The FDA no longer allows “number chasing.” No sunscreen can be rated higher than SPF 50 or simply 50+. The SPF factor means that if it takes 15 minutes to burn in the June midday sun without sunscreen, with a sunscreen of SPF 10, it takes 15×10 or 150 minutes to burn with sunscreen SPF 10 in place. The FDA also no longer allows “sunblock,” “sweat-proof” or “waterproof” on labels.

Remember to check for the expiry date on your sunscreen too, old sunscreen won’t do!

Contrary to some written statements, sunscreens are relatively safe when applied properly. Zinc oxide and titanium dioxide are some of the best sunscreens since they truly reflect dangerous rays of both the UVB and UVA types. There are no substantiated claims of problems with toxicity or absorption of nanoparticles leading to a danger to health. Vitamin A, at reasonable doses, has been used for years to boost the immune system and to protect against cancer development. The more complex question is Vitamin D. Some modest amount of sunlight exposure (a few minutes a day unprotected) is probably fine on modest body surface areas to maintain good vitamin D health. If levels are low, the recommendation is to take a vitamin D oral supplement daily, and not to seek more sunlight to improve one’s vitamin D status.

4. Not using enough sunscreen

The most common error is inadequate application. Studies show that the average person puts on about 25-30 percent of the quantity necessary to achieve the stated SPF rating. A shot glass full of sunscreen is a fairly reasonable amount to apply for full-body protection. This is the other reason why SPF 30 or more is recommended – because of “sloppy” application.

5. Not allowing enough time

The next most important issue is taking time to apply sunscreen before activity. The sunscreen needs to bind to the skin to be effective, so try applying it 10 to 15 minutes before activity. Also, when using many products in the morning, apply sunscreen first to bind to the skin whenever possible.

6. Not reapplying sunscreen

Have you applied sunscreen again after swimming, hiking or just hanging out? Failure to reapply after being in the water or sweating; both can wash off sunscreen. Always reapply after water immersion or activity with significant perspiring.

What are the top three things parents can do to protect children from sun exposure?

ABCs:

A= Avoid the sun midday from 10 a.m. to 2 p.m.

B= Block the sun with sunscreen

C= Cover up with sun-protective hats and clothing (including swim shirts when in the pool)

 

 

When big breathing problems trouble little ones – Pediatric pulmonologists provide expert care

Asthma- when to see the pediatric pulmonologistStruggling to breathe can be terrifying, especially for children – and their parents. Acute and chronic respiratory challenges including asthma need specialized care to keep airways open – enter the pediatric pulmonologist.

Chiarina Galvez, M.D., explains when a child with asthma symptoms should see a pediatric pulmonology specialist.

What is pediatric pulmonology?

Pediatric pulmonology is a medical specialty that focuses on the care of infants, children and teenagers with disorders of the lung and airways, and those with sleep-related breathing problems.

If a child has moderate-to-severe asthma, should the child see a pediatric pulmonologist?

Children with moderate-to-severe persistent asthma may benefit from a consultation with a pulmonologist. Asthma guidelines recommend seeing a specialist for children ages 0 to 4 years who need daily controller therapy.

These recommendations are made because several studies have shown that patients who received specialized care had better outcomes, which included improvements in asthma symptoms, as well as fewer hospitalizations and emergency department visits.

If the asthma diagnosis is uncertain, or if there are difficulties maintaining asthma control, then pulmonology referral should be strongly considered.

Asthma is not as common in Arizona because the climate is hot and dry – right?

Unfortunately, we’ve learned over the years that asthma is prevalent in the state. In 2014, it was estimated that the prevalence of asthma in Arizona children aged 17 years and younger was higher than the national average (10.9 percent vs 9.2 percent).

Asthma is a complex condition, and it is likely that genetics and multiple environmental factors interact to trigger the disease.

The right environment depends on the individual’s triggers. A climate that might be good for one child’s asthma, might be terrible for another. Achieving good asthma control requires working with a specialist to identify and avoid triggers, medication adherence and regular follow-up visits to optimize therapy.

What respiratory symptoms should a parent of a child with asthma be mindful of?

In children, symptoms of respiratory problems are often varied and may be subtle. If a child is experiencing any of the following symptoms, a pediatric pulmonologist may be able to help.

  • Cough for more than four weeks and is not improving
  • Two (or more) episodes of pneumonia in one year
  • Chronic wet cough
  • Pauses or stops breathing while awake or asleep
  • Fast or labored breathing on a frequent basis
  • Frequent or recurrent brassy or honking cough
  • Gets a cough after he or she choked on food or another object, even if he or she choked on the object days or weeks ago

It may also be helpful to see a pediatric pulmonologist if a child has received treatment due to a respiratory illness.

  • Hospitalization
  • More than one visit to an emergency department
  • Received more than two courses of oral steroids in the past year
  • Has complicating conditions (e.g., chronic lung disease of prematurity)

Dr. Galvez - pediatric pulmonologistWhat motivated Dr. Galvez to become a pediatric pulmonologist?

It has been my life’s calling to care for children who are acutely ill and admitted to the hospital. But what makes pediatric pulmonology so special to me is the opportunity to see patients over the long term – I build relationships with the children and their families. It’s why I chose this field.

In addition to completing medical school and a pediatric residency, Dr. Chiarina Galvez completed her pediatric pulmonary fellowship – a three-year, specialized training in the treatment and management of pediatric, respiratory illnesses.

What are the most common illnesses you treat?

Conditions we frequently treat include asthma, bronchopulmonary dysplasia (breathing problems related to prematurity), chronic cough, recurrent pneumonia and sleep apnea. We also take care of patients who are technology dependent, such as those with tracheostomies and on home ventilators and oxygen.

Dr. Galvez is a pediatric pulmonologist at TMCOne. Call (520) 324-7200 for more information.

 

 

 

 

 

Incredible reward at no cost – How cord blood donations are changing lives at TMC

Cord Blood Kristen Wilt

Cord blood donations can enhance and save lives, and do even more – providing donors and their families with the uplifting benefit of knowing their cord blood gift will have a positive impact for years to come.

“My brother-in-law passed away from a rare blood disorder when he was just 19,” said Stephanie Babcock, a mom who recently donated the cord blood from her baby Midori at TMC. “It’s so rewarding to know our donation can save someone like my brother-in-law – we know what it means to that person and their family.”

What is cord blood?

What exactly is cord blood and why is it so beneficial?

“Cord blood is the blood that is left inside the umbilical cord and placenta after a baby is born,” said Kristen Wilt, cord blood coordinator at TMC. “It is so important because it contains blood-forming stem cells that can be used in blood transfusions to heal or repair damaged cells that cause serious diseases.”

Saving and improving lives

Wilt explained cord blood stem cells are used to treat more than 80 life-threatening diseases, which include many forms of cancer, as well as immune and genetic disorders. “Acute myeloid leukemia, Hodgkin’s lymphoma and sickle cell anemia to name just a few,” Wilt said.

Cord Blood 4Blood transplants can have a significant and permanent effect for individuals facing specific debilitating and severe health challenges, she explained. “By and large, the treatments can cure many diseases or have a significant impact that dramatically improves the quality of life for the recipient.”

How donation works

Wilt said the process is quick, easy, and it is free. “At TMC the mom and family are asked if they would like to donate the cord blood immediately after birth,” explained Wilt. “There is one simple consent form to sign and a health history questionnaire to review and you’re done – you’ve just created a life-saving possibility for someone.”

Participation in the Arizona Public Cord Blood Program is growing, but currently available only in a few Arizona hospitals. “It made a great impression on us that TMC was the only hospital in Southern Arizona who offers cord blood donation,” said donor Babcock. “It can seem like a small thing but has such an incredible impact.”

Cord blood donations from TMC have gone to help patients all over the United States and as far away as Australia.

Safety and anonymity

Donating cord blood poses no risk to the baby or mom because the cord blood is collected after the birth, when the placenta and umbilical cord are no longer needed.

The hospital assigns a number to each donation so that it is received and tracked by the public cord blood bank anonymously.

“We did our research,” said Babcock. “We had no concerns about safety or privacy – TMC made it a simple, easy part of the birthing experience.”

Cord Blood 3

Where it goes and how it helps

For the past four years, TMC has worked with the Arizona Public Cord Blood Program and has provided almost 5,000 cord blood donations.

“Within 48 hours, the cord blood is delivered to the University of Colorado Cord Blood Bank (an FDA-licensed facility), where it is cryopreserved in liquid nitrogen tanks,” said Wilt. “This process conserves the stem cells in the blood for a very long time – donations have been used after 20-25 years.”

The donation becomes part of the national registry managed by NMDP/Be the Match registry. “Worldwide, patients of all ages who are in need can work with the registry to determine if they are a match,” Wilt said.

Why your donation matters, for others and for you

Some moms and families decide to save and privately store their baby’s cord blood. However, the cryopreservation process and on-going storage fees can be cost-prohibitive. “If cord blood is not donated, it is disposed of as medical waste – and it is truly a waste,” said Wilt.

Donating cord blood has such significance because finding a match can be very difficult. “About 70 percent of people in need are not able to find a match from their family,” Wilt said. “More cord blood donations means a greater chance that someone in need will find a match.”

For Babcock, making the donation was more than a fulfilling gesture. “It’s not a big sacrifice, and it changes your life just knowing that you could save an adult or child who is fighting a deadly disease.”

Cord Blood 1For more information about cord blood donations, contact Kristen Wilt at (520) 324-6210 or visit the Save the Cord Foundation website.

Patients, families enjoy afternoon of pampering thanks to generous volunteers

PFAC3.jpgEdmundo Zevallos knows all too well the stress of having a child in the newborn intensive care unit.

In 1993, his premature baby spent five months recovering in the NICU at Tucson Medical Center. His son is now a healthy 25-year-old, but back then, Zevallos remembers around-the-clock vigilance, being tethered to a pager that would summon him to the hospital from work in an emergency, and the struggles with managing heart monitors and other medical equipment when his baby finally came home.

Zevallos, who serves on the Patient and Family Advisory Council at TMC, helped coordinate Family Day, designed to support the parents of children recovering in the hospital.

PFAC1.jpg“It is important that the family or support unit of the patient take care of their own well-being. The patient will need them to be strong and healthy for the journey ahead. They shouldn’t try to tough it out. We want them to know we understand and support them, and that we are here to help them,” Zevallos said.

The event served about 20 parents, relatives and patients of TMC for Children and TMC for Women. Each visitor received a bag filled with small gifts, discount coupons and a fresh flower.

The day wouldn’t have been possible without the support of about a dozen different vendors.

“It’s just a nice way to give back,” said Andrea McCully, from ANR Massage, who provided massage services to patients. “When you learn more about what other people experience, it’s really gets you to think outside of yourself.”

Those sentiments were echoed by Kashmir Crossley, of Salon Kashmir, and Casey Reminder, of Z.E.N. Studio. Fellow stylist Silviya Warren said she used to paint the fingernails of a 6-year-old who was struggling with cancer treatment. “She made me fall in love with her,” she said. “She survived, but I know how hard it can be on families. I thought of her and said of course I would help.”

PFAC2Lory Sullivan, a beauty consultant with Mary Kay, remembers how it felt when her granddaughter, now a healthy 15-year-old, was born prematurely. “I know parents have to be stressed and be scared when their child is ill, so if I can help them take that moment to relax and take a deep breath, I’m grateful for that opportunity.”

Amy Clemans, an acupuncturist with Mountain Waters Acupuncture, who shared a Chinese body work practice, said as a parent of a special needs child, she wanted to give back. “I know how important it is for parents to do self-care,” she said.

Also in attendance were Mary and Jim Harvey from BioPhotonic Therapy Solutions, Lisa Westerwick from Serenity Holistic Touch and Kim Adair from Women Under the Sun. The Basket Butler provided gift baskets, the Flower Shop on 4th Avenue provided flowers, and Epic Café, in conjunction with Women Under the Sun, donated the pastries.

The Patient and Family Advisory Council shares information with TMC on how to better serve parents and families by creating a family-centered environment.

Some of their projects have included assisting in the layout of pediatric areas of the hospital, creating child-friendly words for specialty procedures and providing input on the KidSpeak mobile app that helps children become more familiar with the hospital and medical terminology through virtual tours and a digital whiteboard. Click to learn more about serving on the Patient and Family Advisory Council.

Do I need a fence for the inflatable above-ground pool? Pediatric Emergency Notes

Do I need a fence for our above ground pool? Drowning prevention,We don’t have a built-in pool at our home, but we often use a little splash pool which got me to thinking about the safety of above-ground pools — you know, the sort that just go up for the summer, whether rigid sides or inflatable, and come down when school is back in session.

As a pediatric emergency department nurse I’ve seen my fill of child drowning victims and so I tend to be hypervigilant around pools. The absolutely crushing part about drownings is that they are nearly always preventable.

I asked Jessica Mitchell, Safe Kids Pima County coordinator, what the rules are regarding fencing and general safety practices around temporary above-ground pool structures.

“The law…oh the law on pools! It can be so confusing. Pretty much, if you have a pool that is taller than 18 inches and wider than 8 feet intended for swimming, it requires a fence/barrier that is at least 5 feet tall with a self-closing or self-latching gate. The entire law for pools can be found on the Arizona government pages“ Jessica shares.

“Mesh fencing is a great option for those with above-ground temporary pools because when the pool comes down, the mesh fence can also come down. There is one exception to having to put up a pool fence, and that is if everyone in the household is 6 years or older, no safety measures need to be in place. This doesn’t mean this is the safest option. Not everyone over the age of 6 can swim, and even swimmers can get into difficulty in a pool.

“If you decide to get a temporary above-ground pool make sure you have a fence at least 5 feet tall with a self-latching gate. Make sure your child cannot use a chair or other item to climb over the barrier or to unlatch the gate. And emphasize to all kids and adults that the gate is not to be propped open.”

Also, we worry most about pool mishaps in the summer, but be vigilant all year for drowing hazards. Empty the cooler of melted ice water; dispose of the bucket of mop water; drain the bathtub (and never leave your toddler or pre-schooler in the tub unsupervised). Unfortunately, we see all these drowning scenarios in the emergency department.

Whether it’s in the pool, the ocean or the bathtub, you will not hear a child drowing. Drowning is silent … keep your eyes on your child.

This summer we’re going to follow all the advice above as well as the ABCs of pool safety whether it’s a splash pool or a regular pool:

“A” is for Adult Supervision

Always have an adult watching the pool, not reading, not looking at their phone, not taking an afternoon siesta – just watching the kids in the pool. Go ahead and take turns if it’s a social gathering, but make sure that the designated adult knows the rules. Better yet, consider hiring a trained lifeguard. While it seems like the more adults who around, the better. But the reality is that it seems to be the opposite – everyone thinks someone else is wathcing. Make hiring a lifeguard a part of your pool-party budget.

Jessica also wanted to remind folks that floaties are toys and not safety devices. If you have a life vest, they need to be the right size, and they are not a substitute for adult supervision.

“B” is for Barrier

Yes, even with an above-ground temporary pool that you picked up for $75 you want a barrier. It can be mesh; it just has to be at least 5 feet tall and have a self-latching gate. Even if your kids are over the age of 6, what about the neighbors or the grandkids? Make sure the barrier isn’t compromised – there aren’t any chairs or trash cans that can be dragged over to act as a ladder, and that nobody props open the gate.

“C” is for Classes

Tucson has lots of great options for swim classes including Vest it Up!  TMC for Children and Credit Unions for Kids offer FREE year-round swim lessons at dates, times and locations that meet the needs of busy families. These free lessons are at local YMCA locations and include a free personal flatation device, or PFD. This U.S. Coast Guard-approved life vest for kids is provided to kids completing swim classes. The free classes are available to the first 400 kids each year between 4-17 years old.  Register here for Vest it Up!

I have a few additional thoughts:

Having a party? Hire a lifeguard.

It seems like the more adults are around to watch the better right? But in reality it seems to work in the opposite way. Everyone thinks someone else is watching. Make hiring a lifeguard part of your pool party budget.

It’s not just pools and it’s not just summer time

We worry especially in the summer when kids are in the pool, but be vigilant all year. Empty the cooler of melted ice water, dispose of the bucket of mop water, drain the bathtub (and never leave your baby, toddler or preschooler in the bathtub unsupervised.) Unfortunately, we see all these drowning scenarios in the emergency department.

Eyes peeled

Whether it is in the pool, the ocean or the bathtub you will not hear your child drowning. Drowning is a silent affair…keep your eyes on your child.

Hope your summer is splashing good fun.

Stay safe,
Melissa

P.S. Did you know that the Drowning Prevention Coalition of Arizona provides pool safety checks? Request one here 

Melissa HodgesPediatric Emergency Notes from Melissa
Melissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for 10 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.

Dehydration and kids – what you need to know

Dehydration and kids what you need to knowWhile standing on the sidelines cheering my eldest on at his soccer game is enough to get me reaching for my water bottle, my kindergartener with the flushed face needs a little reminding to hydrate. As temperatures soar it becomes especially important to make sure our children are hydrated – dehydration and heat stroke are all too common in the region and in the emergency department. And children are more prone to dehydration and heat stroke than adults.

Your kids are more susceptible to heat than you are!

As kids have a smaller mass-to-surface-area ratio, they can lose fluid more quickly than adults and become dehydrated more rapidly. Children also have a higher metabolic rate, so their bodies use more water, too. Add to that their kidneys do not conserve water as well as an adult’s and kids often may not drink or eat when they are not feeling well, and you have a recipe for a dehydration disaster! Luckily dehydration is easily preventable. Given the average temperatures here in the desert, we need to be aware year round and teach our children how to prevent dehydration.

To encourage my 5 year old to make a habit of hydrating, I follow two pieces of advice:

    1. Encourage constant sipping over infrequent large gulps
    2. Let him pick out an insulated water bottle that would keep the water cool

Remember: be a good role model -drink sips of water often. Throw a slice of fruit in your child’s water, or a silly straw, or perhaps fun colored ice cube shapes – anything that will encourage constant sipping.

The advice below is not a substitute for seeing a physician.

Is my child dehydrated?

  • Does the child seem sluggish?
  • When crying are there few or no tears?
  • Are there complaints about a dry mouth?
  • Is the child more cranky, irritable or fussy than usual?
  • Is urine darker than usual?
  • If child is an infant, is urination less frequent (fewer than six wet diapers a day)?
  • Is the child constipated?*
  • Is the child’s skin particularly dry and lacking its normal elasticity? Maybe even wrinkled?
  • Do the eyes appear sunken?
  • If your child is an infant is the soft spots (fontanel) sunken?

*Sometimes your child may be dehydrated due to diarrhea. Don’t forget to treat the dehydration.

“Yes” to any of the above may indicate that your child is dehydrated. If it is fairly mild you may be able to address this at home, but check with your physician if you have any questions.

What should I do if my child seems dehydrated?

For children older than 1 and less than 11:

  • If your child is dehydrated use an oral rehydration solution, such as Pedialyte. If your child is eating food, plain water may be used to replace lost fluids. But if the child isn’t eating, plain water doesn’t provide essential electrolytes, so an oral rehydration solution is needed. Avoid sodas, caffeinated beverages or gelatins, which don’t relieve dehydration and may make symptoms worse.
  • Make sure your child is drinking small amounts, frequently.
  • Rehydration may take a few hours, so keep your child in a cool, shaded area and sipping fluids frequently
  • Allow your child to drink as much fluid as he or she wants. Encourage your child to drink extra fluids or suck on flavored ice pops, such as Popsicles. Children ages 4 to 10 should drink at least six to 10 glasses of liquids to replace lost fluids.
  • Call your doctor if symptoms do not improve or if they worsen

How can I prevent my child my child getting dehydrated?

  1. Hydrate, hydrate, hydrate.

Insist on your children taking plenty of breaks to drink fluids while playing outside, especially if playing sports or engaged in vigorous physical activity. Perhaps set up a timer as a reminder. Also, hydrate before, during and after time in the heat.

  1. Stay indoors

We’re all about getting kids out and physically active, BUT when the heat is high, avoid spending time outdoors. In Tucson summers this means stay indoors any time after 9 a.m. into early evening.

Our suggestion: wake early to play outside, take a siesta in the afternoon and then venture out in the evening.

  1. Never leave a child in a parked car at ANY TIME, NOT EVEN FOR A MINUTE

Even if the windows are open, temperatures can rise to shocking temperatures in minutes.

  1. Keep it light and wear a hat

Have children wear light, loose-fitting clothes when they’re outside. Breathable fabrics like cotton are best.

Stay cool this summer,

Melissa

Melissa HodgesMelissa 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.

This advice does not substitute for that of a medical professional. If you are concerned that you or your children may have heat stroke or moderate to severe dehydration please seek in person medical advice.

Tucson youngster collects books for rite of passage to share with pediatric unit

IMG_2597Addison Braswell surprised her parents as a kindergartener when she decided to donate to pediatric cancer patients all of the contents from her piggy-bank that she had collected over the year from gifts and holidays.

She has done the same thing every year since, explaining that she feels badly for children who are sick and wished she lived in a world where sickness didn’t exist.

So when she celebrated her First Holy Communion this year, it was completely within character that the 9-year-old asked her friends and family members to purchase children’s books for donations to give to children recovering in the hospital.

“Sometimes, when I don’t feel well, stories help me imagine that I’m somewhere else,” explained Addison, who donated more than 20 books to TMC for Children.

Jamie Antrim, a Child Life assistant at TMC, thanked Addison for her kind spirit. “Sometimes, when children spend the night in the hospital, they can feel a little sad because they miss their house and their pets or their friends, so we work hard to help them feel better,” she said. “Having a book to read can help make the hospital feel a little more relaxing and a little more like home.”

Not only does TMC for Children have a library for children, but every pediatric patient gets a coupon to pick out a brand-new book when leaving the hospital. Addison helped put her donations into the Book Nook, while little sister Avery looked on.

Addison’s mother, Anne-Marie Braswell, works for Golder Ranch Fire District, which is a partnering organization in Safe Kids Pima County, a coalition led by TMC that is working to prevent accidental childhood injury.

“I knew as a community hospital, TMC has a commitment to programs that cater to kids,” she said.

IMG_2600

Addison, who wants to be a veterinarian or a teacher someday, was satisfied about how she spent the first day of her summer vacation. “It made me feel good that I was going to be able to help a lot of people and maybe put a smile on someone’s face.”

For more information on TMC’s wish list for pediatric donations, please visit donating to TMC for Children.

Children’s Miracle Network Champion – Emma Martin

Nine-year old Emma Martin is spunky! No two ways about it, this little girl has a big personality, an infectious laugh and the kindest heart. Emma is also TMC for Children’s 2018 Children’s Miracle Network Champion.

Each year Children’s Miracle Network recognizes one child in southern Arizona who embodies bravery, spirit and hope and is a champion for every child who spends time in our hospitals. We are thrilled to announce that Emma has been recognized as Southern Arizona’s champion for 2018.

While Emma was still in the womb, several of her internal organs developed and fused together, meaning she was without a crucial organ to remove waste from her body. In addition, Emma was born with only one kidney, making it even more difficult for her body to process fluids. A triplet, Emma spent an extended time in the NICU with her sisters, but faced with additional complications went home months after her sisters had left.

Over the past nine years Emma has spent months in the hospital, had over 20 surgeries to address the original congenital issues and the subsequent developments. A fungal infection caused her bladder to be removed, and she lost a majority of her colon in 2016 to a dangerous form of colitis. Emma must use a colostomy and urostomy bag for the rest of her life.

Despite years of complex surgeries and painful symptoms, Emma is joyful, kind and has a giving heart. “She will help others before herself, even her sisters,” said Emma’s mother, Shannan Martin. “She is a special and amazing person who is so positive – she lights up any room she walks into.”

Through Emma was born with rare and daunting health challenges, she keeps an enthusiastic positivity that is nothing short of inspiring – she is a true champion.

Southern Arizona communities can look forward to seeing Emma out-and-about in 2018, sharing her story and advocating for the courageous families and kids who are receiving care at TMC for Children.

You can support Emma’s efforts by contributing to TMC for Children/Children’s Miracle Network. Every dollar donated stays right here in Southern Arizona to support wellness programs, purchase life-saving equipment and provide vital health services to help children like Emma be as healthy as possible.

“TMC for Children has made an incredible difference for our amazing Emma,” said Martin. “We are grateful for the staff, technology and the continued services that have kept Emma alive and brought us all hope.”

Congratulations Emma and thank you for serving as the 2018 TMC for Children Champion!

Learn more about how TMC for Children/Children’s Miracle Network are making a difference, and how you can join the effort to provide life-saving equipment and health services for Southern Arizona children.

Stroke Prevention Saturday – serving the community, saving lives

After experiencing a heart attack, two strokes and a ministroke, Mr. Kissel wasn’t taking any chances with his health.

“In 2013 I was visiting my doctors regularly and I was doing everything I could to prevent another stroke,” said Kissel. “When my wife and I heard about TMC’s free Stroke Preventions Saturday – we knew right away we’d be going.”

stroke awareness

Each year, Tucson Medical Center hosts Stroke Prevention Saturday, a local event providing free vascular screenings. The wide-breadth of tests involve many medical professionals and advanced diagnostic equipment.

Why has TMC invested in providing free events like Stroke Saturday

“Because stroke is the third leading cause of death and the leading cause of serious, long-term disability,” said Renee McAloney, the TMC stroke program coordinator. “It is uplifting to know we are assisting community members who may not have access to these important screenings – I believe we are saving lives.”

From checking cholesterol and oxygen saturation to an electrocardiogram and a carotid doppler ultrasound, attendees have the opportunity to discuss results with a health care provider.

The screening that revealed a life-threatening issue

Carotid doppler ultrasound screening provided at the 2013 Stroke Prevention Saturday revealed Mr. Kissel’s carotid artery (the blood vessel delivering blood to the brain) was more than 50 percent blocked by plaque.

Kissel took the reading to his doctors. “I was referred to a vascular surgeon who said I needed to have surgery right away to clear the blockage.”

After the surgery, Mr. Kissel learned just how serious the situation was. “The doctor told me the soft plague in my carotid artery was dangling and could have broken off at any moment and caused a massive stroke.”

Since that procedure, Mr. Kissel has not experienced another stroke or ministroke. “The Stroke Prevention Saturday screening led to my surgery, and I’m grateful,” he said.

Make screening part of your annual care

The event is a now part of the annual routine in the Kissel household. “It takes place every spring in the March to April time frame, and I make sure my wife goes every year to get checked.”

Mr. Kissel feels healthier, strong and better these days and he says Stroke Prevention Saturday made a difference. “I’m not sure what might have happened without that screening.”

For more information about Stroke Prevention Saturday, contact TMC for Seniors at (520) 324-4345 or seniorservices@tmcaz.com

Know your stroke risk

Anyone can have a stroke, even children although the causes in children tend to be different. The elderly are not the only ones at risk for stroke although age is one factor. Stroke risk also increases with factors like increased blood pressure, diabetes, high cholesterol and atrial fibrillation. Know those factors you can control for. This guide from the American Stroke Association highlights factors you need to be aware of.

 

Sign up to receive the TMC for Seniors event calendar  which include events like Stroke Prevention Saturday.

Pregnant? Set the stage for breastfeeding before your due date

You work.
You’re about to have a baby.
You plan to breastfeed.
You plan to continue to breastfeed when you go back to work.
Now, just how is that going to work?

Despite all the known benefits of breastfeeding for the health and well-being of our children, many of us face barriers and challenges when we return to work that derail our efforts to continue to breastfeed. Here are some tips from our lactation consultants about actions you can take while you’re pregnant and still working to make things easier upon your return to the workplace.

 

Set the Stage-Before Your Due Date

Before your due date talk to your employer or supervisor about your plans to breastfeed and the positive implications for your workplace if you’re able to continue to breastfeed and to express milk when you return to work:

  • Lower health care costs for both mother and child. Breastfed babies have lower rates of infection and illness and breastfeeding has positive implications for mothers too, including lower rates of breast cancer, ovarian cancer, diabetes and osteoporosis.
  • Lower absentee rates
  • Higher employee morale (and so productivity) and positive view of a “family-friendly” employer.
  • Retention of experienced employee

It is also useful to know the legal requirement of employers to be supportive. The Healthcare Reform Act (Patient Protection and Affordable Care Act) made clear the responsibility of all employers to provide suitable (private, not a bathroom) space and reasonable time for mothers to express their milk multiple times a day without interruption. You can find more information about the federal law here.

Make a plan

Before your due date, come up with a plan with your employer or supervisor to make pumping successful. Your plan should include:

  • The location of a private, non-bathroom space, where you will not be disturbed or viewed while you express milk.
  • How your work schedule will allow you two to three approximately 15 minute (plus travel time) breaks every work day.
  • Where you will be able to store your breast milk. Susan suggests a cooler that you can take to and from work.
  • Where you will be able to store and clean your breast pumping equipment.
  • How you might modify your schedule at the beginning to ease into being away from your baby. If possible, see if you can return to work for reduced hours the first few weeks or starting in the middle of your work week so that you have less time away from baby the first week back.

Once you have agreed upon a plan, write it down and share a copy with your employer and supervisor.

Don’t forget to tap into a powerful resource, your colleagues. Is there someone in your workplace who breastfed their children? Or whose partner breastfed? Can this person be a champion for you?

Sign up for Breastfeeding Basics – A class for expectant mothers to support them on the breastfeeding journey

Until we have a child and start to breastfeed, we may be oblivious to those in our workplace who were forging the way with regard to breastfeeding and working. These colleagues may be able to offer support and practical solutions for your specific workplace.

If you work at a site with a human resources office you may wish to check in with the folks there, first, as there may be a site-based program to support you. The Business Case for Breastfeeding from Womenshealth.gov provides a wealth of information your human resources or employer can use. Among other items this document includes a list of myths and facts that you may wish to arm yourself with in case your employer or supervisor has concerns.

My child is in hospital – what are family-centered rounds and how can I make the most of them?

family centered roundsRounds are the discussions that happen every day between the medical staff and parents of a child at TMC for Children, about the child’s progress and plan of care. The family-centered rounds take place in the patient’s room and include the family and patient as a critical part of the health team.

“Parents know their children and know how they’re going to react to new situations. The physicians and medical staff know what the evidence-based care is appropriate for the child. Working together in family-centered rounds, parents and medical staff can develop a plan of care that is best for the child.” said Jordan Richardson, child life specialist. “When parents take an active role in the family-centered rounds, they feel more involved. It improves communication and outcomes when everyone is on the same page.”

What can parents do to capitalize on family-centered rounds?

Be present on rounds

Try to be at the rounds. We know that it can be difficult to be there, and particularly if you don’t have flexibility in work schedules. At TMC, rounds on the pediatric unit occur from 9 a.m. – noon every day. The order and the time of rounds is dependent upon how sick patients are and varies from day to day as acuity often changes.

Participate!

Listen on rounds. Ask questions about things you don’t understand. Don’t hesitate to speak up on rounds.

Know that longer conversations may have to happen later

Our staff spends time with each patient, but needs to see everybody by the end of the morning. Once the hospitalist sees all of the patients and develop plans to move everyone’s care forward, he or she can return in the afternoon to have more in-depth discussions.

Write your questions down on a piece of paper

If you think of questions after the doctor leaves, or in the middle of the night, write down the question on a piece of paper or on the whiteboard in the room.   “We will be happy to answer them on rounds in the morning.” Richardson says.

medical students

Be part of shaping doctors of the future

The attending physician often is working with physicians in training and medical students. The attending physician will allow the trainees to present your child in a formal format and then may do some quick bedside teaching.   The teaching is for you as well! Please listen in and participate. This is how we all learn.   Don’t be surprised if you find that you have something to teach our trainees; our families often have valuable insight.

Just with every team, everybody brings different strengths. You, as a parent are a key team player on family-centered rounds.   Do not hesitate to ask questions and express your concerns.   Our goal is to provide high-quality, effective care for your child while in the hospital, and the best way we can do that is with your involvement.

 

 

Pregnant? Finding sleep elusive? Try a body pillow!

The ever-changing state of your body during pregnancy inevitably makes getting comfortable enough to beat those fits of insomnia feel impossible. Your body is working to create a new life and an important part of that process is rest.

You know that sleeping on your back again will have to wait and the best position for you and your baby is with you on your side, but that doesn’t make it any easier. With a little help from the right pillow, you’ll ease the strain on your body and get a restful night’s sleep.

As with anything, the best option for you won’t necessarily be the best for someone else. There are a variety of options out there to fit your particular needs.

The pregnancy body pillow – designed in the curved shape and length of your body, this option is like snuggling your partner all night.

The u-shaped pregnancy pillow – the name says it all, this versatile pillow is constructed to wrap around your body from front to back, allowing you to turn from your right to left sides and prop your head up when on your back.

The inflatable pregnancy pillow – shaped like a pool float, this option has a belly-shaped hole that allows you to rest comfortably on your stomach.

The wedge – small and intended for targeted areas, this pillow can be shaped to fit between knees, under the lower back or anywhere else that needs a little help.

“Getting enough rest is vitally important for your body and the development of your baby,” said Stacie Wood, clinical educator for Women’s and Children’s Services and Tucson Medical Center.

Now that you know your options, if you’ve got the DIY spirit and the reluctance to spend extra money, get creative! Hop onto Pinterest and get those creative juices flowing. Check out these pins we’ve saved for you on DIY Pregnancy Pillows.

Hip Hop dancing with Type 1 – Brody’s got this!

Brody Coomler shares his insights on living with type 1 diabetesHip hop dancing can be tough for anyone, but not for Brody – a seventh-grader living with the challenges of Type 1 diabetes.

“Diabetes doesn’t change who I am,” said twelve-year-old Brody. “But it is a disease that I have to manage on a constant basis in order to stay safe.”

The moves? Brody’s practiced for years. The look? He’s got it on lock. The music? Please. So what happens when his insulin pump comes out during a performance? Brody’s got this.

Brody doesn’t miss a single beat – incorporating the pump wires into his routine.

The situation is a metaphor for Brody’s life. When Type 1 diabetes unexpectedly surfaced – he didn’t let it affect his dance, and Brody doesn’t let Type 1 stop him from playing basketball, gaming, learning to play the tuba or experiencing all life’s got to offer.

But Brody says it much better. “Don’t let type one diabetes stop you from doing anything!”

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.

“I have to check [my blood sugar] before meals and before bed,” Brody explained. “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.”

Even though this brave young-man doesn’t let Type 1 slow him down, he admits his life would be different if there was a cure.

“I would definitely be free from having to test my blood sugar, put on new insulin pump sites or wear a continuous glucose monitor – things like that,” Brody said. “I wouldn’t get sick as much as I get sick now. My mom wouldn’t call me as much.”

You can help kids like Brody by supporting Type 1 research through events like the JDRF Sip, Savor & Celebrate being held Friday, March 23 at La Encantada. Festivities start at 6 p.m. – enjoy live music, fantastic food and drink, and help move research closer to a cure.

Purchase tickets at www.celebratejdrf.com or call (520) 203-8084.

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.”

In new book, TMC Hospice physician explores the human journey of navigating life’s losses

For those who’ve had therapy to deal with loss, Dr. Larry Lincoln’s new book “Reclaiming Banished Voices: Stories on the Road to Compassion” will resonate about what it means to suffer loss and how to successfully navigate through it.

For those considering therapy or trying to resolve their own grief, Dr. Lincoln’s book offers insight into the power of coming to terms with our losses – even those we might not fully recall or realize their impact. Dr. Lincoln’s writing is accessible to the lay person, yet grounded in his decades of clinical experience as a physician as well as his time spent training and traveling with death and grief pioneer Elisabeth Kübler-Ross.

Dr. Lincoln, the medical director of TMC Hospice for more than 25 years, also has had a successful clinical infectious disease practice. A graduate of Amherst College, Columbia University College of Physicians and Surgeons, he and his wife, Anne, offered their Growth and Transition Workshop program for 31 years, after initially training under Kübler-Ross. The couple has two children and three grandchildren.

All of these roles — physician, workshop leader, Kübler-Ross devotee, husband, father, grandfather — come into play in this book. Part memoir, part self-help, Reclaiming Banished Voices explores what happens when one is denied his “birthright,” as Dr. Lincoln explains, “to use the tools we are born with to process life’s inevitable losses.”

Unexpressed grief has a way of getting out. People who’ve experienced major losses especially as children, such as the death of a parent or living through abuse or neglect, are at higher risk for depression, addiction, failed relationships and other negative consequences from early pain – what many would see as manifestations of unresolved grief. But Dr. Lincoln shows that any loss, if not adequately grieved, can still impact a person long after the loss has faded.

In the book, Dr. Lincoln examines his own life, and how, although he found himself living his dream — a successful medical practice, married to the woman of his dreams and father to two beautiful children — he was facing burnout, while beginning to dread and resent his unpredictable workload. He would shut down to the people who loved him and waste precious emotional energy maintaining the mask of calm competency.

He shares his own story, in part, so people can trust him and the process he uses. “It’s not just an intellectual read, but shows how one processes grief,” he said. “I tried to speak to multiple levels, including our unconscious.”

Writing the book wasn’t easy. He had written about half and then tossed it out. “It was too academic. It was not me,” he said. He started over – a few times – before he finally found the voice he wanted. And it’s a very personal voice – one that doesn’t shy away from showing his own shortcomings and struggles. It took him about four years to write the book, he said, including an entire year when he had writer’s block and didn’t write a thing.

For each chapter, he’d have to go through five or six re-writes of the first five or six pages before being able to proceed. “Once I learned that that’s how it was going to be, I was OK with it,” he said, adding that he settled on a format where each chapter could tell its own story as well as add to the coherent message of compassion.

For his own story of transformation, his first breakthrough came in 1984 when he attended a five-day residential program with Kübler-Ross, the Swiss psychiatrist whose 1969 book “On Death and Dying” was foundational in creating the modern hospice movement. It was there that Dr. Lincoln discovered how a long-forgotten incident when he was 5 years old had instilled in him a drive to succeed to such an extent that it was consuming his life.

“I began to recognize how what seemed to be an unrelated and barely remembered childhood event was impacting my life as a physician, partner and father.”

Dr. Lincoln eventually went on to train and work with Kübler-Ross, traveling internationally and conducting “Life, Death, and Transition” workshops, where participants would externalize buried grief in an effort towards better self-awareness, forgiveness and healing.

Dr. Lincoln explains in the book how, as humans, we have the “the gift of grief” and how when that gift is taken away, it impacts our ability to confidently navigate the world:

When we grieve, all our emotions come into play. We shake our fist at the universe, rend our clothes in mourning, agonize over fears of future pain, and ultimately face the existential decision to live again. As our compassion for ourselves deepens, we praise our Maker for the exquisite bittersweet wonder that is life. And we dare to open our hearts once again, each time with more wisdom and abandon.

But as children, we give up our birthright rather than risk injury (physical or emotional) or exile. Survival trumps free expression. The price of unexpressed natural emotions is our reactivity and the accumulation of resentments, fear, envy and self-doubt.

Unable to express his fear and anger, a young Larry Lincoln resolved to be stronger, faster, better so that no neighborhood kid would ever hurt him again. Once Dr. Lincoln connected with younger versions of himself, he was better able to attend to his needs and become the man he wants to be.

Dr. Lincoln doesn’t just rely on his own story, though, to share the transformative power of grief work. He is able to draw on decades of experience from his medical practice, including his work with the dying, his work with Kübler-Ross, the workshops he and his wife ran, and the stories of his own family to show the human need to express grief and the gifts that result.

A daily, inner dialog with his younger selves is his way to better understand himself. “It’s a form of meditative inquiry, a form of mindfulness,” he said, adding that there are other ways to get to the same information. Meditation, writing and art are some techniques others use to tap into one’s subconscious needs and desires.

“I continue to learn that emotional and spiritual care is a lifelong commitment. If I don’t tend my garden, the weeds choke out the vegetables,” he said. When he ignores his emotional and spiritual needs, frustration, resentment, irritability and reactivity creep back in.

This grief work is not about assessing blame. He readily admits his parents might have done some things wrong. “But they fiercely loved me and were doing their best”, he said, adding that he can understand and forgive his parents, as well as have compassion – and ask forgiveness – for his own parental shortcomings. “I want people to have compassion for themselves, but also take responsibility for their actions.”

In his book that has been a lifetime in the making, Dr. Lincoln offers us a roadmap from the hard work of grief to a place of understanding and compassion.

“When we listen with our hearts, magic happens.”

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.

Gun Safety – Steps you can take today to protect your children

As I grieve for the families of the victims and survivors of the school shootings that continue to threaten our children’s safety, my thoughts turn to my own little boys. How can I help keep them and their classmates safe? Is there anything we can do? I don’t have the answers to these big questions, but it does make me think about things I can do in my own community to keep our children safer.

As a mom and as a pediatric emergency room nurse I know that it isn’t just school settings that we need to address when it comes to gun awareness and safety. Along with handguns and rifles, we also need to apply safety concerns to pellet and BB guns, and we need to start taking action.

We talked with Jessica Mitchell, Safe Kids Pima County coordinator, who shared the following about what parents can do to help prevent gun incidents with children:

“Did you know about two-thirds of students who used guns in violent acts at school got those guns from their home or at a relative’s house?

The first thing you can do is make sure that if you keep a gun in your home, it is kept unloaded and locked away. Make sure that the ammunition is stored separately from the gun in a locked container and make sure the keys are hidden away, too. If the gun is not in its lock box make sure it’s in your line of sight.

You can pick up gun locks at TMC Family Support Services located next to the Desert Cradle.”

The other thing we must do is talk to the adults in homes where our children spend time ‑ whether it’s with the grandparents, aunts and uncles, family friends or a play date – about the status of guns in the home. Don’t make assumptions about whether someone has a gun, or whether it is unloaded and locked away. Don’t assume the children in the house don’t know when the guns are kept – ask.

I know it feels uncomfortable, but what’s worse ‑ a few seconds of discomfort or the unthinkable?

How to ask the parent or guardian of your child’s play date whether there is a gun risk in their house

This would be so much easier if it was commonplace to ask on a first play date, so let’s make it commonplace. Be brave. Ask.

Offer information on the gun status at your house when children come to visit:

“Hey, we’re so excited for Lily to visit. I just want to check that she doesn’t have any food allergies and to assure you that while we have guns in our house they are not loaded and are in a locked gun safe that the kids can’t access. I know that it can be a concern especially given how curious kids are”

Prior to the first play date or if there is a new adult in the home, ask:
“Lucas is looking forward to hanging out with Omar after school today. It feels a little uncomfortable to ask this, but do you have unlocked guns in your house? Kids can be so curious even when we warn them about not messing around with guns.” If there are guns in the house, ask if they are stored unloaded and locked away where kids have no access. Remember to ask if a new adult joins the family or is staying. Whether it is grandpa visiting for an extended time or mom or dad has a new partner.

Uncomfortable asking in person or over the phone? Text 
Sandwich the question in between the usual questions, “Hi Tom, this is Melissa, Jack’s mom. Jack’s really looking forward to coming over after school today. What time should I pick him up? Also, weird question I know, but I’m trying to get in the practice of asking this given recent events. Do you have guns in your house? Just want to check that they’re unloaded and locked away from the ammunition. Thx”

Blame your pediatrician
Or at least deflect the origin of the query to your pediatrician. Our pediatrician asks us at every annual check-up whether there are guns in the house and if they are unloaded and locked away. Say something like, “Our pediatrician suggested that we ask about guns, even BB guns, just to check that they’re unloaded and locked away.”

Don’t assume that girls aren’t curious about guns 
Ask.

Don’t stop asking once your child is old enough to walk home alone or whether you will be at the house or not
Gun accidents happen whether the child is 4 or 13. Children can be impetuous when little and even more so when teens.

Undoubtedly, there is much more to be done, but this…this we can do today.

Melissa

Melissa HodgesMelissa 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.

Patient support at TMC Bariatric Center

Bariatric SurgeryRegardless of a person’s background, lifestyle or motivation – weight-loss is challenging. What approach works for one person might not work for another. Patients who choose weight loss surgery have the best outcomes with access to the right information and support. Fulfilling that crucial need is Rachel Deal, the TMC metabolic and bariatric coordinator.

“The TMC Bariatric Center is nationally accredited as a comprehensive center,” said Deal. “We provide education and assistance at every stage, from a patient’s first questions through years after a procedure – a patient is never in this alone.”

Getting started

Patients considering weight-loss procedures have questions about their unique factors and options. With a dizzying amount of information available on the web, it can be difficult to know where to start.

“With a quick phone call or email, we can get you started with information or a consultation with a bariatric specialist,” said Deal. “TMC also offers a monthly seminar on the second Tuesday of every month – It’s a great way to learn more about weight loss surgery in a comfortable and informal setting.”

 Personalized program

Weight loss procedures are often thought of as one particular surgery. In fact, there are many options available to meet the unique health factors, experiences and goals of each patient.

“Bariatric procedures are not a one-size fits all – everything in the program is personalized,” explained Deal. “We work as a team and take the time to make sure each patient has received all the information about their options and health, so they can make the most informed decision.”

Deal said this careful, custom and vital process can take months, but has an important side-effect that supports a successful outcome. “Patients say they feel empowered – the information gives them the control and authority to make an active decision about their health.”

Confident and prepared

Preparing for a medical procedure is not a common experience, and patients can rely on Ms. Deal to provide the support and help to feel confident and prepared.

“We help educate for pre-op and post-op, so patients understand the dos and don’ts and know what to expect,” says Deal. “In addition, we facilitate resources for aftercare, and make exercise, diet and action plans for the first year after surgery.

More than medicine

The TMC Bariatric Center was designed to be a comprehensive program, assisting patients with all aspects that affect weight loss.

“There are many factors that contribute to successful weight loss,” Deal said. “That’s why the TMC program also provides a dietitian, exercise physiologist and psychologist.”

Weight-loss surgery patients also have the opportunity to participate in a monthly support group, and discuss triumphs and challenges with individuals who are having like-experiences.

“We also have insurance specialists available to assist with information about coverage and payment options – we want to leave no stone unturned.”

Success

Deal says the TMC Bariatric Center has combined medical, clinical and professional support with one focus. “Patient success is our goal – we hope to be each patient’s partner here after.”

If new weight loss challenges arise after surgery, Deal explained her role is to help keep patients motivated, determine new plans and provide needed information or referral resources. “Our patient partnerships are meant to last a lifetime – not just for the first or second year after surgery.”

Deal also explained why patient success is so important to her. “It’s amazing to see the bliss and happiness when patients reach their goals – and not all successes involve the scale.”

Success can mean being healthy enough to walk up the stairs unassisted, or being fit enough to comfortable take family on a trip to Disneyland.

“Mostly, I hear patients say they never could have imagined life being this good.

Rachel Deal has a degree in dietetics and nutrition. She has a passion for patient care and has worked in bariatric medicine for several years. When time allows, Ms. Deal enjoys sampling healthy dishes at Tucson’s diverse restaurants and traveling with her husband and young son.

For more information about Tucson Medical Center’s Bariatric Center of Excellence and to sign up for a FREE seminar see our website or call (520) 900-1842 today.

 

 

 

Cold home remedies – What should you try?

Home cold remediesYou’ve got a runny nose, you’re congested, your head aches, your throat throbs and you just feel wiped out. It might ‘just’ be a cold, but that isn’t helping you get through the day. Colds are viral infections so antibiotics are no help (and may even be harmful). What should you do? What about all those natural remedies on the internet? Do they have any merit?

We asked TMCOne nurse practitioner Natalie Olendorf for her feedback on some of the more common home-remedy suggestions:

Zinc lozenges or nasal spray

Some studies show starting zinc lozenges or syrup in the first 24 hours of cold symptoms can shorten the length of the cold, but don’t use them for longer than 3 days as they can cause nausea when taken for longer. Some people have lost their sense of smell permanently from use of the zinc nasal spray, so it isn’t recommended.

Nasal irrigation and neti pots

Neti pots have reached the mainstream – they and nasal saline sprays may help relieve symptoms such as pressure and drainage as well as shorten the life of the cold by flushing out mucus and viruses. It’s important to make sure that you use sterilized or distilled water.

Hot ginger and lemon tea

Yum! This combination is soothing and can help reduce inflammation in the throat. Go ahead and try it. It won’t cure your cold, but it might bring some relief.

Echinacea

Echinacea can be helpful to relieve symptoms, but no strong evidence exists to show that it makes an impact on the length of the cold.

Vitamin C

Who hasn’t been tempted to dose up with vitamin C after being exposed to a snotty kid? High doses of vitamin C are thought to help support the immune system, but only take these for FEWER THAN FIVE DAYS. High doses of any vitamin can be dangerous and too much vitamin C may cause kidney stones. Also, it won’t prevent the cold, but the illness may last fewer days if your immune system is more robust. Most people get enough vitamin C from a good diet.

Essential oils, aromatherapy

There are very limited studies on the use of essential oils. And while some may help improve congestion and drainage, it is important not to use them topically or to ingest them.

Steam vapor

Steam vapor helps to decrease congestion and open up the sinuses, which can provide relief from that headache.

Elderberry

Elderberry, extract Sambucol, may help decrease the sore throat, headache and fatigue of a cold. Talk to your physician about using elderberry extract as it may interact or impact other medications you are taking.

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

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.

 

 

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.)

Pregnant? Stop before you put that cheesy snack in your mouth

The 411 on cheese you can eat when pregnantFor those of us with a deep love of cheese including those fancy stinky foreign cheeses pregnancy can put a bit of a dampener on our cheese adoration.  Don’t worry, that slice of pizza is probably just fine, but the slice of apple with brie or the salad with Roquefort cheese is out. Confused as to whether you can chow down on mozzarella or inhale camembert? Read on.

What cheeses should I avoid during pregnancy?

Generally you can divide the cheeses you shouldn’t eat into two groups, those soft crumbly blue veined cheeses like Danish blue and gorgonzola and soft cheeses like brie and camembert.
  • Brie
  • Camembert
  • Chevre (a soft goats cheese that often comes in a log like form)
  • Danish blue
  • Gorgonzola
  • Roquefort
  • Queso fresco

But I have an undeniable craving for brie or a blue cheese salad! What should I do?

A baked brie and a pastry crust is a little bit of heaven and it’s a treat you can still enjoy when pregnant! Cooking to 165F should kill any bacteria and make it safe to eat. Can’t live without your gorgonzola sprinkles on your salad, you like cheese with some flavor after all? Try a hard stilton cheese instead.

Just why are some cheeses a no-no during pregnancy?

Soft cheeses tend to contain more listeria bacteria than those that might be present in hard cheeses. Listeria bacteria can cause an infection called listeriosis which pregnant women are at a great risk of getting due to hormonal changes- 13 times more likely. While it might cause merely mild flu-like symptoms in the woman or even no symptoms the impact on the fetus can be significant. If a pregnant woman develops listeriosis it can cause premature delivery, miscarriages and still births. Early treatment with antibiotics may prevent fetal infection. Listeria bacteria is present in other foods.  Alicia Arino, clinical dietitian at TMC, adds “Unpasteurized cheese and milk can also cause Brucellosis (a food borne illness caused by ingestion of raw milk, unpasteurized cheeses, or raw meat) which can have particularly harmful effects during pregnancy.

So what cheeses can I eat?

It’s safe to eat hard cheeses ex.  Gouda, gruyere, parmesan and cheddar and the following soft cheeses are safe as long as they’re made from pasteurized milk: ricotta, cream cheese, cottage cheese, mozzarella, feta and some goat cheeses.
Alicia Arino is a clinical dietitian, board certified lactation consultant and Assistant Manager of Clinical Nutrition at Tucson Medical Center.
 

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 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.

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 a cold 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.

FIND OUT MORE ABOUT ANTIBIOTIC MISUSE AND DRUG-RESISTANCE HERE.

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.

When your child is diagnosed with Type 1 diabetes

type one diabetes diagnosed

“Our biggest goal in properly managing diabetes is to help the patient and family achieve a lifetime of good health.”

Dr. Priti and Chetanbabu M. Patel, TMCOne pediatric endocrinolgists

If your child has received a Type 1 diabetes diagnosis you may be feeling overwhelmed. While the condition develops gradually, the symptoms can seem to appear overnight.

Symptoms of Type 1 diabetes

  • Excessive thirst
  • Hunger or loss of appetite
  • Dry skin
  • Blurry vision
  • Numbness
  • Fruity breath
  • Excessive urination
  • Weight loss
  • Excessive sleeping
  • Irritability
  • Weakness
  • Delays in wound repair or infection control
  • Nausea and vomiting

Not all children will present with the same signs and symptoms. Some children may present with few or none of the above symptoms and some children may present with many.

Is there a cure for Type 1 diabetes?

While there isn’t a cure yet, the past decade and specifically since about 2014, leading-edge technology is helping the diabetes community.

Today some insulin pumps are capable of making micro adjustments to help the patient curb hyperglycemia (low blood sugar) and can turn off the insulin supply if the patient is experiencing hypoglycemia.

Continuous glucose monitors allow patients and families to glance at a screen at any moment to see glucose levels in real time. These advancements are without a doubt life-changing.

However, we still have not discovered the elusive cure. Until that time, it is imperative children with diabetes and their families feel supported and confident in their ability to control blood glucose levels. Please remember people with diabetes do incredible things every day. There are actors, Olympians, scientists and neurosurgeons with diabetes. People with diabetes can live long, productive and healthy lives!

Why is it so important that my child learns to manage Type 1 diabetes?

“We know that if we can help get the glucose (sugar) levels down in the first 5 years, those children will have a smaller number of complications than children who were not able to properly manage their diabetes,” said Dr. Patel. “The three main complications we try to prevent as an adult or older teenager are eye disease, kidney disease and nerve disease.”

Type 1 diabetes is a life-long condition with life-threatening implications if not under control. We know the habits children develop at an early age can stay with them for a lifetime. If children remain supported and encouraged to care for themselves early on, they can develop positive coping skills which can help keep them healthy and happy into adulthood.

What does it mean to ‘manage’ diabetes?

When people with Type 1 diabetes eat carbohydrates–whether whole wheat bread, pasta, fruit or candy–they must inject insulin into their body to help their body move the glucose out of the blood stream and into the cells. You must figure out just how much insulin to inject based upon the amount of carbohydrates consumed. As children’s bodies are constantly growing their insulin needs increase making this adjustment an ever changing target.

Learning how to count carbohydrates at every meal can be demanding for a family. Even families with the best routine can easily forget to cover carbohydrates at a busy family event or on a long road trip. The reality of it is that sometimes life gets in the way. Learning to plan, cope, organize and forgive yourself are some of the best tools for any new Type 1 diabetes family.

The child’s pediatric endocrinology team can be a support system to help the family understand how to safely manage changes in insulin requirements.

What should I do if I think my child may have Type 1 diabetes?

As noted earlier, some children present with few or none of the symptoms listed above, and some children may present with many.

Remember, children go through growth spurts and might ask for more water, might sleep a little more or might be constantly hungry. These symptoms might seem normal, but they could also be clues to a potential diabetes diagnosis.

If you’re concerned, don’t delay. Ask your child’s primary care provider for a glucose test. Depending on the result, the PCP may order additional tests, may start your child on insulin or have your child admitted to the hospital for close monitoring.

Don’t doubt your parental gut feeling! Untreated diabetes can escalate quickly to critical diagnoses like diabetes ketoacidosis or coma. If your child DOES have diabetes, TMC and TMCOne can form a team to help support your child to learn to care for this manageable chronic condition.

You can find the TMCOne pediatric endocrinologist contact information here.

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

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.

Pregnancy and Back Pain – Tips from an Expert

pregnancy-back-pain

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


Tucson Medical Center | 5301 E. Grant Road | Tucson, Arizona 85712 | (520) 327-5461