When bed rest is required- Tucson Medical Center’s Antepartum Program

Bed rest at TMC for Women - a specialized antepartum program TucsonIn theory bed rest sounds glorious! Hours to read and to watch your favorite movies, without disruption! In reality, bed rest can be far from heavenly. The extra time to focus on concerns about your baby’s health as well as worries about disruptions to your family, your work and your relationships can make bed rest particularly difficult.

Expectant mothers on bed rest have always had a place at TMC for Women, and efforts are made to provide stimulation and support during this sometimes stressful time. After seeing how bed rest affects expectant mothers, talking with women who had experienced bed rest and reviewing the peer-reviewed research, Women’s and Children’s Services has formalized the TMC for Women Antepartum Program to better support women during this time.

Why are women placed on bed rest?

There are a myriad of reasons that you might be placed on bed rest.

Primarily, we see women who:

  • Are in preterm labor
  • Have problems with the placenta, such as placental previa or partial abruption (the placenta is near the cervix or a small section has separated from the inner wall of the uterus before delivery)
  • Have pre-eclampsia (a dangerous condition for mom and baby characterized by high blood pressure)
  • Have uncontrolled diabetes during pregnancy
  • Have a baby who is not growing sufficiently (intrauterine growth restriction)
  • Have a premature rupture of the membranes (the bag of water has broken)

While you may be able to restrict your activity sufficiently and stay at home on bed rest, it is dependent on how serious your condition, your proximity to the hospital, what support and demands you have at home, many women need to be at the hospital.

How the TMC for Women Antepartum Program supports women

Addressing the whole person

You and your baby’s health is our priority, and that includes your mental health. Finding out that your pregnancy and baby may be at risk would be enough, during the hormonal rollercoaster that is pregnancy, to depress any woman, but the other aspects also make it difficult for mom. In our antepartum program we monitor mom’s physical and mental health throughout, initiating counselling to support mom if need be. Rather than waiting until baby is here, our program recognizes the mental strains that accompany bed rest during the antepartum period.

Combating loneliness

Bed rest can be isolating. In the antepartum program you can have visitors throughout the day, 24/7, and a pull-out sofa is available for your support person. We also have opportunities to socialize with other women who are on bed rest. Knowing you are not alone can bring comfort.

Knowing what to expect

If we expect your newborn to stay in our Neonatal Intensive Care Unit (NICU), a neonatologist (specialist in newborns) will meet with you during your stay. We also have a weekly tour of the Neonatal Intensive Care Unit. Knowing what to expect, and the expert care that our Level III Nursery provides, helps lessen the fear of the unknown.

Making a home away from home

While we know that our hospital breaks the mold when it comes to providing yummy and nutritious food, we also know that sometimes you just want your grandma’s chili or a favorite snack. Each of the private rooms has a refrigerator, and you have access to a kitchen so you can enjoy a little bit of home. You can also decorate your room to make it homier, and as a unit we can help you celebrate festivities and your milestones.

Conquering boredom

We’re building a library of both fiction and baby-related books to share with you, as well as a growing DVD library when what you can find online (Hello, free Wi-Fi!) is no longer enough of a diversion.

Our pet therapy dogs love to visit, and those wagging tails and gentle dispositions are guaranteed to bring a smile to your face.

If your condition allows, wheelchair excursions to one of TMC’s beautiful courtyards can bring a little beauty into your day.

We have crafts to occupy your time and volunteers who can teach you to knit and introduce you to the world of fiber arts.

By recognizing the unique challenges of antepartum bed rest, we aim to make your journey a little easier.

Take a FREE tour of our maternity services.

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

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

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

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

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

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

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

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

 

Halloween Safety Tips from Jessica Mitchell, Safe Kids Pima County

I love celebrating Halloween with my family, but I must admit I feel like I’m holding my breath all evening. Like many Tucson neighborhoods, ours has few street lights and on Oct. 31, kids are EVERYWHERE, often in dark costumes, often zigzagging across the roads to trick or treat. It’s a safety nightmare! Did you know that children are more than twice as likely to be hit by a car and killed on Halloween than on any other day of the year?

We try to watch where we are going, watch where our little ones are and watch for cars all at the same time. It can be really tough. I give my kids glow sticks to help them be seen by others, including drivers of cars. An added bonus, they think glow sticks are the coolest things ever!

What can you do to make Halloween safer this year for your children?

  1. When selecting a costume make sure it is the right size to prevent trips and falls.
  2. Decorate costumes and bags with reflective tape or stickers and, if possible, choose light colors.
  3. Since masks can sometimes obstruct a child’s vision, try nontoxic face paint and makeup whenever possible.
  4. Have kids use glow sticks or flashlights to help them see and be seen by drivers.
  5. Children under the age of 12 should not be alone at night without adult supervision. If kids are mature enough to be out without supervision, remind them to stick to familiar areas that are well lit and trick-or-treat in groups.
  6. Popular trick-or-treating hours are 5:30 p.m. to 9:30 p.m. so be especially alert for kids during those hours.

Plan ahead and keep your little ghouls and goblins safe and sound this Halloween,

Jessica

Jessica Mitchell is the Safe Kids Pima County program coordinator. Safe Kids Pima County is a network of organizations whose mission is to prevent accidental childhood injury, a leading killer of children aged 19 and under. Spearheaded by Tucson Medical Center, the local coalition is part 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.

These halloween revelers need a few glow sticks and then theyll really be shining.

Is genetic testing right for you in determining cancer risk?

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

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

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

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

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

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

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

Make sure testing is appropriate for you.

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

Genetic testing isn’t just for women.

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

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

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

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

Is your family ready for flu season?

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

How should a family prepare for flu season?

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

If experiencing flu-like symptoms:

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

When should you get a flu shot?

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

What about vitamin C and a healthy diet?

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

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

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

Who should get the flu shot?

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

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

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

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

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

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

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

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

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

 

When pregnancy leads to bed rest: a mom’s tips

Early labor story, bedrest, bed restBed rest can be a stressful time for parents while they wait days and weeks to see if their little one will arrive before term.

For Alyssa Hoyt, restricted activity started at 20 weeks, with bed rest starting at 27 weeks.

At 31 weeks, Baby Teagan tried to come early, so Alyssa spent 10 days in TMC having labor stopped twice. Alyssa went home on bed rest until Teagan – now a healthy, bubbly toddler – arrived at 37 weeks.

“I really loved all of the nurses and doctors and got to know them throughout this time, which really helped me to stay positive and compliant too,” Alyssa said.

Precisely because bed rest can be a difficult time, Alyssa shared the top five things that helped her get through:

  1. Family and friend support. Alyssa’s husband spent every night with her and took her four-wheeling in her wheelchair. Her mother brought special treats like homemade lasagna. Just taking a break from the monotony of the everyday and being able to laugh and seek comfort in love and friendship made all the difference.
  2. Remember: This is all temporary. Don’t dwell. There is an end to it and you can get through it.
  3. Comply with your doctor’s orders. The goal is to have a better outcome and a healthy, safe birth.
  4. Look to the future. Alyssa researched toys and car seats and things she would need when she brought her baby home. Being actively engaged instead of just waiting helped her feel like she had more control.
  5. Being engaged and active. Having an endurance mindset as a runner and a running coach, helped her keep in mind that this was a different kind of endurance, but it still required mental toughness and grit. Alyssa did a lot of research about what to expect, and met with physicians to understand the possible outcomes so she would feel more prepared.

Alyssa had a unique inspiration, too, in that she herself was a premature baby. Thirty years earlier, her mother, Beth Day, was at Tucson Medical Center, standing by anxiously while her baby recovered in the newborn intensive care unit.

Alyssa would spend 9 days there, until she was strong enough to go home. While Alyssa was at TMC on bed rest, staff found the handwritten log book, capturing her own time in the unit.

She and Teagan were both 5 pounds, 4 ounces, separated by 30 years.

“It was amazing to be here, with my mom, while potentially having an early baby,” Alyssa said. “Knowing my mom went through it with me I just knew it was going to be ok: we got this.”

Save the date for your maternity services tour date.

 

 

TMC High Risk Breast Clinic – Personalized care, options and support

Are you at an increased risk for breast cancer? One in eight women will be diagnosed with breast cancer in their lifetime. How do you know if you are high risk? If you are at high risk – what’s next?

Tucson Medical Center has designed a clinic just for women who have these questions about developing breast cancer. The TMC High Risk Breast Clinic is focused on providing in-depth education, advanced diagnostics and compassionate support to best help high risk patients choose their next steps. TMC’s experienced high-risk team recognizes that every woman’s risk factors are different and will assess risk, and then tailor a personalized care plan based on each patient’s individual needs.

A team approach

michele boyce ley md breast cancer surgeonPatients will work with a team of breast-health professionals –who have decades of diagnostic and treatment experience. The team includes a women’s health nurse practitioner, a certified nurse navigator, and a breast surgical oncologist. In addition, patients have access to imaging specialists and genetic counseling.

“The multidisciplinary approach is central to an effective high risk program,” said Medical Director Dr. Michele Boyce Ley, a board-certified, fellowship-trained breast surgical oncologist and a fellow of the American College of Surgeons.

As a breast cancer survivor, Dr. Boyce Ley brings a unique perspective to the clinic, empathizing with patients on their journey.

“Our team meets weekly to discuss the unique aspects of each patient’s care and challenges,” Boyce Ley explained. “We leave no stone unturned, and focus on making the best care recommendations to the most important member of the care team – the patient.”

Specialized services

The TMC High Risk Breast Clinic features state-of-the-art imaging diagnostics to facilitate early and accurate detection. The dedicated breast imaging center houses the latest equipment to provide the care team with clearer images, even for patients with dense breast tissue. On-site breast biopsies by experienced physicians offers convenience and timely results.

“Our next-level diagnostics provides clearer, overall images that help identify abnormalities earlier,” said Karen Narum, WHNP-BC, the board certified, women’s health nurse practitioner at the TMC High Risk Breast Clinic. “We use an advanced breast tomosynthesis, which combines enhanced mammography with modern computer software to create three-dimensional images of the breasts.”

A genetic-testing panel can be performed to further identify risk factors and provide additional information to help guide patients through the decisions and options that are available. If surgery is determined to be the best option, patients can rely on advanced surgical techniques, including nipple sparing mastectomy and Hidden Scar techniques, which are both effective and respectful of appearance.

Meaningful support and resources

The TMC breast-health nurse navigator will be by the patient’s side every step of the way, functioning as a personal advocate, answering questions, arranging visits with specialists, lining up tests and coordinating care.

“A high-risk diagnosis can be overwhelming,” says Mary Verplank, BSN, RN, breast-health nurse navigator. “We’re here to help with anything and everything – from scheduling appointments to connecting patients with community resources.”

The nurse navigators work one-on-one with patients and family members to:

• familiarize them with all aspects of the treatment plan.

• share hospital and community resources.

• coordinate support services that may address specific needs during treatment.

• help resolve any issues that may arise, from financial questions to transportation.

For further information or to schedule an appointment call the TMC breast health nurse navigator at (520) 324-4848 or Breast.Navigator@tmcaz.com.

Are you at high risk for breast cancer? Not sure? Take our Breast Cancer Health Risk Assessment. Following completion we send the report to your email address so that you may take it to your primary care provider. Have questions? Our certified nurse navigator will reach out to those at high risk.

breast cancer risk assessment

Walk this way – Walk to School

Safe Kids Pima County and FedEx volunteers will join students from Whitmore Elementary and around the county to celebrate International Walk to School Day on October 4. International Walk to School Day raises community awareness about walking safety and promoting healthy behavior.

Did you know unintentional pedestrian injuries are the fifth leading cause of injury-related death in the United States for children ages 5 to 19? Teenagers are now at greatest risk with a death rate twice that of younger children and account for half of all child pedestrian deaths.

Whether or not your child’s school is participating, Jessica Mitchell, Safe Kids Pima County program coordinator, provides these suggestions for parents:

Teaching kids how to walk safely:

  1. Teach kids at an early age to look left, right and left again before crossing the street. Then remind them to continue looking until safely across. Teach them to never run or dart out into the street or cross between parked cars.
  2. Teach kids to put phones, headphones and devices down when crossing the street. It is particularly important to reinforce this message with teenagers. Parents, let your actions speak as loudly as your words.
  3. Encourage your children to be aware of others who may be distracted and speak up when they see someone who is in danger.
  4. It’s always best to walk on sidewalks or paths and cross at street corners, using traffic signals and crosswalks. If there are no sidewalks, walk facing traffic as far to the left as possible.
  5. Children under 10 need to cross the street with an adult. Every child is different, but developmentally, most kids are unable to judge the speed and distance of oncoming cars until age 10.
  6. Remind kids to make eye contact with drivers before crossing in front of them and to watch out for cars that are turning or backing up.
  7. It’s always best to walk on sidewalks or paths. If there are no sidewalks, walk facing traffic as far to the left as possible.
  8. Cross streets at corners, using traffic signals and crosswalks. Most injuries happen mid-block or someplace other than intersections.

As kids get older, they’re anxious for a little more freedom when walking to school or playing outside. But this is also a time when parents need to stress the importance of the little things big kids should do to stay safe.

Remember you are your child’s first role model. Lead by example:

  1. Be a good role model. Set a good example by putting your phone, headphones and devices down when walking around cars.
  2. When driving, put cell phones and other distractions in the back seat or out of sight until your final destination.
  3. Be especially alert and slow down when driving in residential neighborhoods and school zones. Be on the lookout for bikers, walkers or runners who may be distracted or may step into the street unexpectedly.
  4. Give pedestrians the right of way and look both ways when making a turn to spot any bikers, walkers or runners who may not be immediately visible.

For more resources to help keep your family safe
visit our website.

 

5 Reasons why you need a primary care provider

5 reasons why you need a primary care physiciaWhy do you need a primary care provider?

You feel fine. No major illnesses, the occasional sniffle, and that niggling headache of course, and your mom just got diagnosed with high cholesterol, but you? You feel fine. You haven’t seen a doctor since you had to rush into urgent care that weekend two years ago.

The time to go to your PCP is when you’re sick right? You don’t have time right now.

WRONG!

Establishing a relationship with your primary care provider has all kind of benefits:

  1. Try getting in to see a provider quickly if you don’t have a primary care provider.
    They’ll want you to have had a new patient appointment to get a history and baseline information first. Those long appointments are usually at set times and not as flexible as regular appointments. Having a PCP established means the office is more able to squeeze you in for a quick appointment or call you back to discuss an issue and get you back on your feet and maybe back to work quickly.
  2. Back on the road to recovery
    A primary care provider can follow up and make sure you’re on the way to recovery following a visit to urgent care or an emergency room.
  3. Keep you up to date
    Whether it’s a new flu strain or new wellness screening guidelines, your primary care provider can help you stay current on vaccinations and preventive screenings maintaining your good health.
  4. A medical professional who looks at the whole you
    Your cardiologist is worrying about your heart rate, your neurologist your seizures, but who is looking at the big picture? Your primary care provider can oversee management of your overall health – your PCP  is able to see results from all specialists and able to get the big picture. And because your PCP has a relationship with you, he or she can help come up with a plan if you have complex medical needs. Which leads us to:
  5. Someone you can talk frankly with about your health concerns
    With a relationship that develops over time, a primary care provider can better understand what matters to you with respect to your lifestyle choices, health goals, etc. Building trust and a connection is an important piece of the relationship between a patient and a primary care provider. If you have a good relationship, it is easier to share those pertinent factors that you might be shy about otherwise.

Don’t have a primary care provider? Let us help you find one today! Call (520) 324-4900

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Deep Vein Thrombosis: What You Need to Know about DVT

Deep vein thrombosisIf you’ve spent much time flying you’ve probably heard suggestions to avoid developing deep vein thrombosis, “Get up! Walk around. Do some squats.” But what is deep vein thrombosis? If you never fly do you have nothing to worry about? And how do we test and treat DVT?

What is Deep Vein Thrombosis?

DVT occurs when a blood clot develops in a deep vein in the body, usually in the legs.

Think of a blood clot as a traffic jam: the torrent of vehicles trying to get out of the area make it nearly impossible for other cars to come in. The blood clot usually forms on the valves of a deep vein and creates an obstruction to the outflow of blood. This creates swelling, redness and pain.

“Deep venous thrombosis is a serious condition that needs immediate attention,” said Dr. Layla Lucas, a vascular surgeon and endovascular specialist at Saguaro Surgical.

According to the Centers for Disease Control and prevention, as many as 900,000 Americans are diagnosed with DVT annually.

Risk factors for DVT

Although blood clots have an increased prevalence with age, many assume clots only happen to older adults. However, the challenges can appear across the age spectrum from teens to seniors.

At some point in our lives, we have all been at risk of developing a DVT or subsequent pulmonary embolism. A pulmonary embolism most commonly results from a blood clot that migrates through the heart into the arteries of the lung.  It can be life-threatening if untreated.

The Cleveland Clinic Center for Continuing Education cites PE as the third most common cardiovascular illness after acute coronary syndrome and stroke.

It is important to recognize these risks in order to prevent this risk of DVT:

  • Frequent travel (long flights or car rides)
  • People who are immobilized
  • Major surgery or trauma
  • Past history of DVT
  • Pregnancy
  • Women taking oral birth-control
  • Obesity
  • Cancer
  • Autoimmune disorders such as lupus

What are the symptoms?

The symptoms of DVT can range from:

  • Minor pain and swelling to significantly swollen legs and arms
  • Changes in skin color (redness)
  • Leg pain
  • Leg swelling (edema)
  • Skin that feels warm to the touch

If the blood clot breaks off and moves through the bloodstream it can get stuck in the blood vessels of the lungs to form a pulmonary embolism.

Symptoms of a pulmonary embolism:

  • Chest pain
  • Coughing up blood
  • Light headedness
  • Sudden shortness of breath

How will your doctor test for DVT?

Your doctor will perform a physical exam and

  1. A blood test called a D-dimer is a fast way to test for evidence of a blood clot.
  2. Duplex ultrasound. TMC uses duplex ultrasound imaging to evaluate for DVT. Duplex ultrasound combines both traditional and Doppler ultrasound. The Doppler ultrasound creates a picture of the venous blood flow and can identify which vein the clot has developed in and how extensive it is.

What to expect when having a duplex ultrasound exam?

PE is best diagnosed with a CT scan of the chest. Certain high-risk patients may get another test called a V/Q scan.

How we treat DVT and PE

With a problem this prevalent, TMC has developed one of the busiest programs in the nation for minimally invasive DVT and PE interventions.

DVT is easier to treat the earlier it is caught. Patients are started on blood thinners right away. If the DVT is extensive and the symptoms are severe, they’re evaluated for intervention and clot removal.

DVT can typically be fixed during one or two treatments.

Dr. Lucas explained the treatment advancements are put to best use. “As vascular surgeons, we see the consequences of untreated DVT and PE and therefore are aggressive in our management of these conditions.”

To find out more about vascular exams and procedures at TMC please visit our website.

Dr. Layla Lucas

Dr. Layla Lucas of Saguaro Surgical is board-certified in General Surgery and Vascular/ Endovascular Surgery. Dr. Lucas has a special interest in wound healing, limb salvage, stroke prevention and treatment of aneurysmal disease. She has been trained in a wide variety of minimally invasive endovascular techniques, as well as traditional open procedures in order to treat the full spectrum of vascular diseases.

Three reasons to have a vascular screening

3 reasons to have a vascular screeningMeet Ashley Marcolin, registered vascular technologist at TMC and one of six RVTs that perform vascular screening exams at TMC. Ashley is the newest addition to the team, but manager Sarah Yeager reports Ashley reflects the kindness, compassion and empathy typical of the whole team.

“When people come in for a vascular exam they’re often very nervous. Whether they’re in the hospital for a vascular-related concern or a vascular wellness screening, I want them to know that they can relax, this is a very non-invasive test. We use no radiation, no dyes, no needles, and it takes just 30 minutes.” Ashley said. “This really is a very simple way to catch serious conditions early before they become life-threatening. The screening can save a life, and it takes very little time.”

While Ashley is a new member of the team, she has a lot of experience with performing exams of this kind. In her training, she had to complete 960 clinical hours using the techniques she now uses every day. We calculated how many exams she has performed since she started at TMC, where she also completed her clinical training. It runs into the thousands. “You know when you come to TMC that your technologist is a registered vascular technologist and has undergone a two-year intensive or four-year course before they can even take the certification exams,” Sarah explained.

What is involved in a vascular wellness screening?

We do three separate tests that together take about 30 minutes. You need to fast for four hours beforehand and wear loose-fitting clothing that allows easy access to the abdomen, neck, legs and arms. You do not need a doctor’s referral to schedule an appointment, but we will need the name of your primary care physician to send the results.

Ankle-Brachial Index

We use ultrasound scans along with blood pressure cuffs on the ankles and arms to screen for blockages or signs of disease in the arteries of the limbs. For this exam, you need to take your shoes and socks off. This is a screening for peripheral artery disease. PAD is a very common condition, especially in people over the age of 50. PAD can cause chronic leg pain when you’re walking or performing other exercises.

Abdominal Aortic Aneurysm Screening

This screening uses ultrasound scans looking for a ballooning of the wall of the abdominal aorta. If this ballooning or aneurysm ruptures it can be fatal. For this screening, you lie on your back while an RVT places the ultrasound transducer on several areas of your abdomen. The transducer has a bit of warm gel on the end. The gel helps us get clearer pictures and will not hurt your skin. You may feel slight pressure from the transducer as it moves along your body.

Carotid Artery Duplex Evaluation

Using an instrument called a transducer, the RVT scans the carotid artery in your neck to check the flow of blood, which informs us of plaque and blockages that put you at risk for an ischemic stroke.

Should you get a vascular screening?

Sarah and Ashley suggest that everyone over the age of 50 with any of the below listed risk factors get a vascular screening, and that any additional testing or screenings should be repeated at your physician’s direction.

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You may also be at increased risk of arterial vascular disease if you have one of the following:

  • Have a family history of abdominal aortic aneurysm
  • Smoke or have a history of smoking
  • Have diabetes
  • Have high cholesterol and/or high blood pressure
  • Have coronary artery disease

When will I get the results?

Our exams are read in house by a vascular surgeon and the results sent to you within 3-5 days.

Three reasons to have a vascular screening:

  1. It’s quick, easy and painless
  2. It’s affordable
  3. It can help prevent stroke and detect abdominal aortic aneurysm and peripheral artery disease

Call (520) 348-2028 to schedule your vascular screening.

vascular screening special

Dr. Patel returns to Tucson, providing pediatric endocrinology at TMCOne

Patel C PhotoDr. Chetanbabu Patel returned to Tucson in June and joined the TMCOne location on 2380 N. Ferguson, across the street from the TMC main campus.

While there are many great reasons for moving to Tucson, Dr. Patel summed it with just one. “The best care for the children we are treating,” he said. “This was a unique opportunity to be a part of a comprehensive program involving specially trained staff who communicates frequently and openly with families – that’s why I chose TMCOne.”

Dr. Patel and his team provide care for children ages 0 to 18 who are experiencing a wide range of endocrine related illnesses, including diabetes, thyroid disorders, adrenal and pituitary disorders, metabolic challenges, and much more.

“Chronic endocrine issues are complex and require a team working together to best help children achieve strong health,” the doctor explained. The team involves the coordinated efforts of specialists at the TMCOne clinic and Tucson Medical Center. The specialists include clinical dieticians, social workers, certified diabetic educators and several others.

Why the certified educators? “The importance of communication cannot be overstated – we want parents to feel comfortable and confident working with us because they are the most important part of the treatment team.”

Peds Endocrinology Care Flyer JPEGEach endocrine challenge is as unique as each human body and what works for one child may not work for another, which can frustrate parents and the patient. Dr. Patel says empathy is an important part of the care provided at his clinic.

“I try and place myself in the parent’s shoes, and understand what is happening with respect to the family dynamics as well as with happening with that particular child. I give them my undivided attention and spend enough time so that they understand why I want them to get labs or to consider one of the treatment options.”

Dr. Patel has dedicated his career to learning as much as possible about pediatric endocrine illness, and he is a devoted advocate for children and their families.

“I always dreamed of becoming a doctor to help others,” he said. “I enjoy working with the parents as well as the babies and teenagers to help them achieve optimum health.”

In addition to his medical practice, Dr. Patel has held many respected positions, including director of diabetes education at the Steele Research Center, chief of pediatric endocrinology at Texas Tech University and assistant professor of pediatric endocrinology at the University of Arizona.

His immediate and extended family also reside in Arizona, and Dr. Patel has always felt that Tucson is his home. While basketball, tennis and reading are his favorite hobbies, he most enjoys spending time with his family.

Dr. Patel is currently accepting new patients. Please call (520) 324-1010 to schedule.

 

 

Comprehensive Weight-Loss Program now available at TMC

TMC Weight Loss Program 3Super foods – juice cleansing – metabolism kick starters – core workouts. Weight-loss is very challenging and the dizzying number of diets, fads and exercises can make it even harder. Tucson Medical Center’s Comprehensive Weight-Loss Program offers safe and effective plans that are personalized to meet each patient’s needs.

These days, busy lifestyles are common– stretching schedules for career, family, activities and so much more. With only so many hours in a day, it’s hard to make time for health and easy to put on pounds fast. More than 70 percent of American adults are overweight and we understand that everyone faces unique challenges to achieving a weight loss goal.

TMC Wellness Director Mary Atkinson explains how the TMC Weight-Loss Program is different. “We look at the whole person,” she said. “Registered dietitians and certified exercise-professionals will work with you to create a personalized plan you can live with, so you can lose weight and keep it off.”

Weight-Loss Counseling Program The 12-week program includes three, one-hour initial appointments and eight follow-ups that last about 30 minutes. Periodic assessments help determine what is working best and allow you and your team to make adjustments to keep

  • Nutrition, fitness and general wellness assessments
  • Reliable advice that you can use
  • Tracking of weight and estimated body composition
  • Development of personalized nutrition and fitness plans
  • Strategies to promote long-term weight-loss success

Weight-Loss Surgery from the TMC Bariatric Center

The TMC Bariatric Center, a comprehensive center accredited by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, guides you every step of the way on your weight-loss journey:

  • Pre-surgery counseling and evaluations
  • Post-op care that includes nutritional counseling
  • Psychological support
  • Instruction on incorporating exercises into your lifestyle
  • Discussion groups – build relationships with others who have had bariatric surgery at TMC
  • Some services may be covered by insurance.

TMC Weight Loss Program 4Weight Management Support Group

No matter what method you have used to lose weight, sticking to your new good habits and keeping the weight off can be a challenge. Don’t try to tackle it alone. Join our monthly support group, led by a certified health coach, to learn new tips and stay motivated.

Program Pricing

  • Flat fee for the entire program: $400
  • Weekly rate: $60 for one-hour sessions, $30 for 30-minute sessions (total of $480 for entire program)
  • Weight management support group = $5 per meeting (meets monthly at The Core at La Encantada)

For more details, please contact TMC Wellness, (520) 324-4163 or wellness@tmcaz.com.

Temps are rising and the pool is beckoning – do you know your water safety?

Pool Safety 3Is it hot enough yet? With Tucson temperatures exceeding 115 degrees for three straight days, many families will be heading for the pool this weekend.

It’s no surprise why swimming is a summer favorite. Parents get a chance to cool-off, kids max out on fun and families make memories.

With the summertime exuberance of visiting, splashing and playing, it can be easy for all to forget important safety rules. This is serious because Arizona has the second highest number of child drownings in the United States.

Child drowning is tragic but preventable. Safe Kids Pima County Coordinator Jessica Mitchell works with community partners to provide helpful tips and education to prevent childhood drowning. She provided us important water safety standards every
parent should know.

It’s as easy as ABC

A = Adult supervision B = Barriers around pools, spas and hot tubs C = Coast Guard approved life vest and life-saving CPR classes

My kids love playing in the pool – what are the things to watch out for?

  • Active supervision is a must. Provide active supervision without any distractions – even if other adults are present and many kids are in the pool. They call drowning the “silent killer” because a drowning child can’t call for help.
  • Infants and toddlers should stay within an arm’s reach of an adult.
  • Don’t rely on swimming aids such as water wings and pool noodles. They are fun, but may not prevent drowning.
  • When finished, remove all toys from the pool. This can tempt children to go for the toys later, increasing the risk of them falling in and drowning.
  • Barriers should be in place to keep children from entering the pool on their own. Alarms on doors and pool fences with self-closing gates also helps to keep kids safe.
  • Always keep a phone nearby so that you can call 911 in the case of an emergency.
  • Empty kiddie pools and turn them upside down when finished. Tragedies have happened in just a few inches of water.

Pool Safety 2
What swimming rules should I set for my children?

  • Only swim if an adult is a present.
  • Do not dive in shallow areas of the pool (or the entire pool if it is not deep enough for diving).
  • Don’t push or jump on others.
  • Don’t go swimming during thunder/lightning storms.

My kids have already taken swimming lessons, so I probably don’t need to watch them as much, right?

While we encourage swimming lessons, children should not be swimming alone even if they are good swimmers. It takes multiple lessons before a child learns how to swim effectively and even then, there should still be active supervision by an adult.

How do I rescue a child I think might be drowning?

  • Take the child out of the water
  • If you are alone, call 911 and begin CPR. Starting CPR immediately is the most important thing you can do to prevent a child from dying.
  • If you are not alone, begin CPR and ask someone to call 911.
  • Check for breathing and responsiveness. Place your ear near the child’s mouth and nose to see if you feel air on your cheek? Determine if the child’s chest is moving and call the child’s name to see if he or she responds.

Should I be CPR certified?

Anyone who routinely supervises children around water should get CPR certified. The certification courses are provided by many community organizations, including the American Red Cross.

It sounds like there is a lot to prepare for – can the water still be safe and fun for my family?

Absolutely! Swimming can be great family fun. Make sure you take the necessary precautions, always supervise swimming children and that someone in the family has taken CPR classes.

Visit our website for more safety tips and information.

 

 

Wound Care Awareness Week – celebrating treatments that are changing lives

Tucson Medical Center is honoring Wound Care Awareness Week by celebrating the treatments and therapies that are improving the quality of life for patients.

WoundCare 1Healing can be taken for granted – and many are unaware that a wound, sore or infection can be a significant challenge for seniors, diabetics and individuals experiencing illnesses that impede healing.

Several years ago, Carolyn Herman began noticing small red bumps that looked like insect bites – but each bump grew into a painful sore that would not heal.

As the sores grew in number and severity, Herman sought help from dermatologists who diagnosed her with Pyoderma Gangrenosum, a rare autoimmune disease whose cause is unknown. It began taking over her life, until she found the TMC Wound Care Center and hyperbaric oxygen therapy.

“It’s so frustrating because treating it is so hard,” Herman said. “Any small cut or skin rupture can turn into a very painful lesion.”

Wound Center Lavor“I just felt like things were always going to get worse,” Herman explained. “I saw specialists and wound centers, but it wasn’t getting better. I had tens of lesions on my body.”

In early 2016, Herman’s dermatologist referred her to the TMC Wound Clinic. “Everyone from the desk clerk to the nurses did a wonderful job of making me feel comfortable and at ease.”

Herman saw Dr. Michael A. Lavor, the medical director at the TMC Wound Clinic. Lavor performed surgery to address infections and prescribed ongoing hyperbaric oxygen (HBO) therapy.

“With HBO, the patient enters a hyperbaric oxygen therapy chamber that looks like a wide hospital gurney with a large, clear acrylic cover – like a tube,” said Heather Jankowski, the director of outpatient services at the TMC Wound Care Center.

Woundcare4“The chamber is filled with 100 percent oxygen, and the air pressure in the chamber is raised– which allows the lungs to safely absorb greater amounts of oxygen,” Jankowski continued. “HBO strengthens oxygen absorption, helping tissue heal more quickly and completely by stimulating growth factors and inhibiting toxins.”

Herman engaged more than 100 treatments, every day for two hours. HBO is not painful and many patients sleep through it. Still, engaging so many treatments can take its toll. “The staff was so good to me, they were always compassionate and thoughtful – it made 117 treatments doable.”

The HBO provided great relief and sped healing. “I’m doing wonderful now – my infections are gone and I’m managing my condition much more easily,” Herman said enthusiastically.

The TMC Wound Care Center has been serving Southern Arizona for five years and treats a wide variety of patients with healing challenges such as diabetic foot ulcers, venous stasis ulcers, failed flaps, and ORN of the jaw.

For further information about the TMC Wound Care Center, please visit the webpage or call (520) 324-4220. Call (520) 324-2075 for scheduling.

 

Osteoporosis: “The most important factor is prevention”

May is Women’s Health Month, a great time to celebrate and promote stronger health and a perfect time to discuss the latest information about preventing and treating health challenges like osteoporosis.

More than 44 million American women experience the debilitating effects of the bone disease, and many women fear aching joints and brittle bones are an inevitable part of aging. It is important to know the risks, and engage opportunities to maintain optimum bone-health.

Dr. Lawrence R. Housman is an orthopaedic surgeon who specializes in musculoskeletal disease at Tucson Orthopaedic Institute. He sat down with us to discuss the best ways to prevent and treat osteoporosis.

OsteoporosisWhy are women at greater risk for osteoporosis?  

Women start with a lower bone density than men. They also lose bone mass more quickly as they age. Between ages 20-80, women will lose about 1/3 of her bone density compared to men who lose only 1/4 of their bone density in that time frame. Estrogen levels also affect bone density, and women lose bone mass more quickly in the years immediately following menopause than at any other time of their lives.

What can accentuate this risk?

Alcohol in moderation is not a risk factor, however more than four drinks per day results in a twice the risk of hip fracture. Steroids can also increase this risk. Long term use of steroids will double the risk of fracture in women.

It should be noted that proton pump inhibitors (e.g. Nexium/Protonix used for stomach disorders such as acid reflux) decrease the absorption of calcium from the stomach.

While increasing fiber, phylates (beans, wheat bran), oxalates (spinach, beet greens, rhubarb) and phosphorus (colas) can provide other health benefits they can also interfere with calcium metabolism.

What are the most effective means of preventing osteoporosis?

Regular exercise is one of the most effective means of preventing osteoporosis. Thirty minutes per day – walking is excellent, and Tai Chi reportedly decreases falls by 47 percent and hip fracture by 25 percent.

Nutrition is another import part of maintaining healthy bones. Fruits and vegetables are important. Women ages 19-50 should take in 1000 mg of calcium daily and women older than 50 should get 1200 mg per day.

Vitamin D is another vital nutrient the body needs to prevent osteoporosis. An individual can get their vitamin D through measured exposure to sunlight or through supplements. A diet with dairy, protein or calcium fortified foods (e.g. orange juice), fish (salmon/sardines) and yogurt (6 ounces has 300 mg of calcium) will go a long way in getting vitamin d to the bones.

What are the warning signs of the disease – and when is it time to see a doctor?

There are usually no warning signs before a fracture occurs; therefore, the most important factor is prevention.

A primary care provider (PCP) is the best person to monitor bone health. Most physicians recommend a DEXA (bone density test) after the age of 50.

The DEXA scan is the bone density test done most frequently and is predictive of fracture risk. The scan will also show whether you have normal bone density, osteopenia (bone is becoming weaker) or osteoporosis (bone is at high risk for fracture).

If a fracture occurs, then an orthopaedist would enter the picture to advise on treatment concerning the spine or extremity fracture.

If diagnosed with osteopenia or osteoporosis – what’s next?

With treatment patients can live normal, active and happy lives.

There are many types of medications that are now available – which work to reverse and then rebuild the bone loss. With treatment, the risk of a vertebral fracture drops from between 30-70 percent and the risk of a hip fracture drops by up to 40 percent.

Housman OsteoporosisDr. Housman is an orthopaedic surgeon who practices at the Tucson Orthopaedic Institute. He earned a medical degree from the University of Alberta in Edmonton, Canada and completed an orthopaedic surgery residency at the Montreal General Hospital and McGill University. Dr. Housman is fellowship trained in several orthopaedic pursuits and is a past chief of staff at Tucson Medical Center. He has also served as president of the Western Orthopaedic Association and Arizona Orthopaedic Society.

 

 

TMC celebrates 200 TAVR procedures – Tucson visitor thankful for life-saving technique

Furman 2Pennsylvania residents Frank and Jan Furman travel to Tucson every winter. This year, the couple was also visiting to attend an award ceremony for their daughter.

While in Tucson, a cardiac emergency put Frank Furman’s life in jeopardy. Thanks to a minimally invasive heart procedure known as TAVR, Furman has a new lease on life and was able to attend his daughter’s ceremony only a few days after the procedure.

Tucson Medical Center is celebrating the completion of 200 TAVR heart procedures. TAVR stands for transcatheter aortic valve replacement, a technique used to replace the aortic heart valve with less scarring, pain and recovery time than traditional open-chest surgery.

Furman had been experiencing some heart challenges, but received the OK to travel. Still, Jan worried for her husband as they made their way from Erie, Pennsylvania to Tucson. “He’s such a trooper and never complains, but I could tell he was more winded than usual.”

TMC Cardiovascular CenterThe couple enjoys southwest culture, and visited one of their favorite Tucson spots. “I couldn’t miss the Sons of the Pioneers show at Old Tucson Studios,” Furman said with a smile. But it was during the performance that things took a turn. Furman became so faint and winded after walking just 15 feet that he had to stop to catch his breath. The frightening experience motivated him to seek a cardiologist at Tucson Medical Center.

The structural heart team at TMC completed a number of advanced diagnostics and determined Furman’s aortic valve needed to be replaced immediately. While his family was concerned for his health, Furman had something else on his mind. “My daughter’s award ceremony was five days away – she’s worked so hard and I didn’t want to miss it,” Furman said.

waggonerThe close-knit family received some relief when Interventional Cardiologist Dr. Thomas Waggoner explained Furman was a strong candidate for TAVR.

With TAVR, an interventional cardiologist (or surgeon) guides the new heart valve through a catheter inserted in the upper thigh. The cardiologist then maneuvers into the heart and expands the new valve over the damaged valve, effectively replacing it with a tight seal.

The minimally-invasive procedure is an effective option for patients who are an intermediate/high surgery risk. In addition, patients experience minimal discomfort and a three-day average hospital stay – with patients returning to their normal activity after discharge.

“I felt better almost instantly,” Furman said. “The next day I was walking so fast that the physical therapist told me to slow down.”

Two days later, Furman left the hospital feeling great. “He looked so good! His face was full of color again and he had no trouble getting around,” said Furman’s wife, Jan. As for pain, “He didn’t even fill the prescription for pain meds,” she said happily.

Frank Furman’s life has changed; he’s no longer winded, has a strong prognosis and looks forward to rounding up the golf clubs again. “It’s the best thing that happened,” his wife of 57 years said.

TAVR Frank FurmanFurman wasn’t shy about sharing what he thought the greatest advantage of TAVR was. “I recovered fast enough to see my daughter Cheryl receive the Most Inspirational Mentor of the Year award; it was fantastic.”

TAVR is one of many procedures performed through TMC’s structural heart program, featuring advanced technologies, a specially-trained staff and a team of physicians who work with patients to evaluate and determine the best treatment plan.

The Furman family will soon be returning to Pennsylvania, where a new schedule for the patriarch includes walking, golf, cardiac rehabilitation and maybe a little more golf. When asked what he’d say to patients who are candidates for TAVR, Furman didn’t mince any words. “Go do it!”

TMC receives prestigious Get With The Guidelines-Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll Elite

American Heart Association recognizes TMC’s commitment to quality stroke care

TMCawardedGetWithGuidelinesTucson Medical Center is pleased to announce that our hospital was recently honored with the American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: StrokeSM Honor Roll Elite. The award recognizes TMC’s commitment to providing the most appropriate stroke treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

Hospitals must achieve 85 percent or higher adherence to all Get With The Guidelines-Stroke achievement indicators for two or more consecutive 12-month periods and achieve 75 percent or higher compliance with five of eight Get With The Guidelines-Stroke Quality measures to receive the Gold Plus Quality Achievement Award.

To qualify for the Target: Stroke Honor Roll Elite, hospitals must meet quality measures developed to reduce the time between the patient’s arrival at the hospital and treatment with the clot-buster tissue plasminogen activator, or tPA, the only drug approved by the U.S. Food and Drug Administration to treat ischemic stroke. If given intravenously in the first three hours after the start of stroke symptoms, tPA has been shown to significantly reduce the effects of stroke and lessen the chance of permanent disability. Tucson Medical Center earned the award by meeting specific quality achievement measures for the diagnosis and treatment of stroke patients at a set level for a designated period.

These quality measures are designed to help hospital teams follow the most up-to-date, evidence-based guidelines with the goal of speeding recovery and reducing death and disability for stroke patients.

“A stroke patient loses 1.9 million neurons each minute stroke treatment is delayed. This recognition further demonstrates our commitment to delivering advanced stroke treatments to patients quickly and safely,” said TMC’s Stroke Program Coordinator Renee McAloney.  “TMC continues to strive for excellence in the acute treatment of stroke patients. The recognition from the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke further reinforces our team’s hard work.”

TMC has also met specific scientific guidelines as a Primary Stroke Center and as a Comprehensive Stroke Center, featuring a comprehensive system for rapid diagnosis and treatment of stroke patients admitted to the emergency department. Certification as a Comprehensive Stroke Center, through the Healthcare Facilities Accreditation Program, is a prestigious designation held by only two hospitals in the state of Arizona.

“The American Heart Association and American Stroke Association recognize TMC for its commitment to stroke care,” said Paul Heidenreich, M.D., M.S., national chairman of the Get With The Guidelines Steering Committee and Professor of Medicine at Stanford University. “Research has shown there are benefits to patients who are treated at hospitals that have adopted the Get With The Guidelines program.”

Get With The Guidelines®-S puts the expertise of the American Heart Association and American Stroke Association to work for hospitals nationwide, helping hospital care teams ensure the care provided to patients is aligned with the latest research-based guidelines. Developed with the goal to save lives and improve recovery time, Get With The Guidelines®-S has impacted more than 3 million patients since 2003.

According to the American Heart Association/American Stroke Association, stroke is the No. 5 cause of death and a leading cause of adult disability in the United States. On average, someone in the U.S. suffers a stroke every 40 seconds, someone dies of a stroke every four minutes, and nearly 800,000 people suffer a new or recurrent stroke each year.

 

 

TMC adopts new testing system to rapidly identify infections, allow targeted antibiotic treatment

Accelerate Diagnostics 4Tucson Medical Center has adopted a new technology developed by local biotechnology firm Accelerate Diagnostics Inc. that is expected to save precious time in identifying the source of bloodstream infections and determine which antibiotics would be most effective in treating them.

The U.S. Food and Drug Administration in late February allowed Accelerate to move forward with sharing information about the Accelerate PhenoTest BC Kit, which is designed to help save lives and reduce complications by initiating antibiotic treatment significantly more quickly in cases of bacterial or yeast blood infections.

About 2 million people are infected with antibiotic-resistant bacteria annually in the United States and at least 23,000 die as a result, according to the Centers for Disease Control and Prevention. Because these infections escalate very quickly, physicians concerned about a delay in treatment may sometimes employ a more broad-brush treatment. Over time, however, that builds resistance.

Accelerate Diagnostics“When we talk about heart attacks, we say that time is tissue, which is why we need immediate medical intervention,” said John Allen, director of TMC Laboratory Services. “When we talk about sepsis, time is life.

“We’re very excited by the promise of this test to help us find more targeted therapy as quickly as possible to improve patient outcomes and potentially save lives.”

TMC has worked closely with the company since it was recruited to Tucson in 2012, from providing specimens to helping run testing prototypes. “We’re very proud to work with the team at TMC,” said Lawrence Mehren, president and CEO of Accelerate Diagnostics. “Their dedication to providing the best care possible to our community is evident in the work they do each and every day.”

The company, which at the time pledged to add 30 jobs, has experienced rapid growth and now employs more than 100 people in leased space in the Abrams Public Health Center. “In addition to the life-saving work this company is doing, TMC is pleased to foster the biotech presence in our community and support local, ongoing economic development efforts,” Allen said.

Accelerate Diagnostics 3Traditional test results may take up to 48 hours after infection is detected in a positive blood culture. In a fraction of the time, the Accelerate PhenoTest BC Kit can identify more than two dozen species of bacteria and yeast that can cause infection, and help indicate its responsiveness to 18 different antibiotics, according to the FDA. It can also help identify whether the infection is showing indication of antibiotic-resistance.

FDA approval was based largely on a review of a primary clinical study, which determined the test correctly identified strains of bacteria or yeast more than 95 percent of the time in a sample of 1,850 positive blood cultures.

 

During National Donate Life Month, organ donation impacted TMC family

National Donate Life 4.jpgThe Spohn family had a special reason to celebrate this year’s National Donate Life Month – a kidney donation that has made a meaningful difference in their lives, providing great relief and renewed freedom.

When it comes to doing things together, the Spohns are a close-knit family who share every triumph and every challenge. Ed Spohn credits the support of his wife, Michelle and son, Phillip for helping him brave the extraordinary challenges of polycystic kidney disease (PKD).

The Spohns are also a part of the Tucson Medical Center family – Michelle has been a member of the TMC nursing-staff for more than 20 years, and Philip will soon be moving from transportation into patient safety.

Now in his late 50s, Ed has been coping with the disease since age 17. “They told me I’d probably have to go on dialysis in my 50s.” Unfortunately the genetic disease took grip far sooner, and dangerously enlarged Ed’s kidneys before he turned 40. In 1997, Ed received a kidney from his wife, Michelle.

Ed’s life changed and he could resume most activities. After the transplant, Ed says he felt “wonderful.” Gone was the chronic pain in his back, the swelling in his feet, the nausea, and the intense headaches and shortness of breath. Ed’s family experienced the challenges with him – and Michelle knows she did the right thing.

National Donate Life“It’s so gratifying to do something like this,” said Michelle. “It is so hard to see a loved one suffer and It made all the difference. I’d do it again if I had another to give.”

Michelle said she has not experienced any medical issues as a result of her donation, and she encourages others to donate. “I tell people to get tested for a tissue-match if they have a family member or loved one with kidney failure – it will change everything for them.”

Receiving a kidney transplant requires constant care and monitoring. While the rewards change lives, there is a risk of rejection and the recipient will need to take anti-rejection medications that have additional risks and side effects.

Unfortunately, transplant kidneys do not last as long as our own organs. Ed’s periodic blood tests revealed the transplant kidney was failing in 2013. He soon began dialysis – a process in which a machine called a hemodialyzer performs the function of the kidneys. The process is life-saving, but strenuous – often causing anemia, fluid overload, constant itching, trouble sleeping, and other taxing symptoms.

Ed received dialysis treatment three times a week, for several hours at a time. The process also involves frequent testing. “You have to adhere to a strict diet, and get fluids and blood checked all the time,” Ed said. “It was never easy, but we did what we had to do.”

Dialysis also requires frequent sessions, restricting any travel. “I missed a lot of things,” Ed stated. “I couldn’t go to so many family gatherings, like my niece’s wedding – I even missed my mother’s special birthday party when she turned 80.”

National Donate Life 3.jpgAfter a year, the Spohns also provided hemodialysis for ED at home – a very difficult task that was understandably stressful and overwhelming for the family. “We experienced a roller coaster of emotions,” Michelle said. “Ed was on the donation list and we answered every phone call with such hope.”

Those hopes came to fruition last week, when the Spohn family received the call they had been waiting for. The transplant was a success – and the Spohns are overjoyed to be sharing a triumph. Michelle attended a ceremonial flag-raising on the TMC campus last week to bring awareness to the need for organ donation.

“I’m so thankful,” Ed said, with a grateful smile. Transplant recipients can write an appreciative letter to the family of the deceased donor through the Donor Network of Arizona. Ed said he wants to take it a step further. “I really hope I get to meet them, so I can tell them how much it helps our family – I’m forever grateful.”

What’s next for the Spohns? The family will spend the next few months ensuring Ed’s body accepts the new kidney – after that, they hope to travel and celebrate Ed’s restored health. “I’m already feeling so much better!”

For further information about organ donation, visit the website for the Donor Network of Arizona.

National Donate Life 5

 

Tucson Orthopaedic Institute joins specialty care providers at TMC Rincon Health Campus

Tucson Orthopaedic Institute LogoTucson Medical Center is proud to announce Tucson Orthopaedic Institute is now providing orthopaedic care and physical therapy at the TMC Rincon Health Campus.

This January, Tucson Medical Center opened the TMC Rincon Health Campus at Drexel and Houghton to make high-quality care more available to eastside communities. The concerted effort includes partnering with premier health-care specialists in Southern Arizona, making specialty services more accessible and convenient.

Tucson Orthopaedic Institute joined the TMC Rincon Health Campus earlier this month, showing their commitment to caring for all of Southern Arizona’s communities and providing families with greater access to specialized care.

Tucson Ortho MapFive experienced and skilled TOI physicians are available at Rincon, providing comprehensive orthopaedic services, including; hip and knee, foot and ankle, pediatric orthopaedics, and non-surgical orthopaedic care.

In addition, TOI has designated their Rincon office as a dedicated physical therapy site. Eastside residents now have access to expert physical therapies administered by a highly-trained staff.

“Our practice is centered on patient needs,” said Dr. Ali Dalal, a TOI hip and knee reconstruction specialist providing care at the TMC Rincon Health Campus. “This location offers TOI’s quality and expertise at a convenient location where eastside families work and live.”

TOI’s Rincon office is located in suite 120 and is open Mon. – Tues. Their physical therapy location is in suite 130, open Mon. – Fri. Please call (520) 784-6200 for further information or to schedule an appointment.

Tucson Orthopaedic Institute PhysiciansTucson Orthopaedic Institute complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex.

Stroke Prevention Saturday April 15 at TMC

Are you at risk for a stroke? Join TMC and HealthSouth Rehabilitation Institute of Tucson for the annual free Stroke Prevention Saturday, April 15, 7 a.m. to noon at TMC Marshall Conference Center.

Free testing for:

  • Height, weight and body mass index
  • Blood pressure and oxygen saturation
  • Glucose and cholesterol measurements
  • Carotid Doppler ultrasound to look for blockages or narrowing
  • Electrocardiogram

A physician will review your results with you.

The screening is recommended for those 50 years and older. For best results, an eight-hour fast is recommended.

In addition, to learning about their risk for stroke, participants will also receive information on recognizing the signs of a stroke and how to control risk facts and the signs of a stroke.

No appointment necessary. Please allow 45 minutes for screening.

Light snacks will be available.

Click for a flier with map and, also, a Spanish-language version.

Second chance at life means racking up the running miles

Gary Brauchla will be the first to tell you he’s no fan of running.

When he went into cardiac arrest in the wee hours of the morning in September 2012, he had never run a 5k.

After his second chance at life, Brauchla tackled his first, a feat he calls “Death to 5k in 8 months.”

Now 72, he has been a member of Southern Arizona Roadrunners for 4 years and has chalked up 15 5ks to his name including three TMC-sponsored Gabe Zimmerman Triple Crowns.

He also signed up for the Under Armour “You Vs Year” 1000k challenge last year – and ended up surpassing his goal with 1,218 kilometers – the equivalent of 755 miles.

With each step, he’s been waiting to get to that runner’s high kind of zone. Hasn’t happened. “I don’t particularly like running. To me, it’s a chore. But I do it because I like the challenge and I like to sweat.” he said.

And, truth to be told, so he can eat some of the things he’s rather fond of, like the occasional cheeseburger and fries.

Brauchla’s story began when he went into cardiac arrest as he slept in his rural home about 90 miles from Tucson.

Earlier that evening, he had complained of pain in his right shoulder and excessive belching, but shrugged it off. Maybe it was the chili with beans talking.

About 3 a.m., his wife, Kathie, awoke to a loud snort, which she assumed then was snoring but later would realize it was her husband’s last gasp. She nudged him. Nothing. Nudged him again. Nothing. Pushed harder a third time. No response. “Then it all clicked together what was going on,” she recalled. “I flipped the light on and he was not breathing.”

Kathie knew to start CPR immediately, called 911 and sustained the chest compressions until help arrived. A defibrillator restored his heart rhythm.

Brauchla was flown by helicopter to Tucson Medical Center, where doctors induced a coma, put in some coronary stents to reopen blocked arteries and cooled his body temperature through therapeutic hypothermia in order to reduce the brain’s oxygen requirements and reduce the chance of brain injury.

He would remain in a coma for 2.5 weeks, while loved ones wondered about the degree of brain damage he may have sustained. Instead, he had a full recovery.

“By doing everything TMC did, I am still here physically and mentally,” Brauchla said.

When it comes to running, he’s not particularly fast. But for him, it’s enough. Five miles is five miles, plodding or no.

“People need to know they don’t need to give up just because they’ve had some kind of health problem,” Brauchla said. “How many people out there are thinking they will never be strong again, but I’m living proof. It’s not necessarily so.”

Physician achieves ablation milestone at TMC

Tucson Medical Center congratulates Dr. Darren Peress on a significant achievement: He has now performed 1,000 stereotactic ablations. The milestone is an accomplishment for Dr. Peress, Tucson Medical Center and patients challenged by an irregular heartbeat.

Dr. Peress is a specialist in cardiac electrophysiology, the study and treatment of the heart’s electrical activity. Put simply, a cardiac electrophysiologist helps when the heartbeat is out of rhythm.

peress-afibAn irregular heartbeat, also called an arrhythmia, can create premature or extra heartbeats, causing palpitations, a “fluttering” feeling in the chest. There are many different types of arrhythmias, ranging from mild to severe.

Serious arrhythmias can also cause chest pain, shortness of breath, dizziness, fainting, stroke or sudden death. The conditions significantly burden a person’s quality-of-life, leaving them with an anxious sense of uncertainty.

To witness him in action is to see careful focus and quiet determination. As Dr. Peress finished the procedure, his colleagues and nurses complimented his work ethic, talent and person. Some singled out his precision and teamwork. Another stressed his commitment to patient care.

Cardiac-electrophysiology procedures are unique because of the skill required, the technology used and the dramatic difference they make in a patient’s quality of life.

“It’s a quickly evolving field,” said Dr. Peress. “It’s impressive how far technology has come. Today, we’re helping patients that had few, if any, options just 15 years ago.”

The soft-spoken physician explained the various ways arrhythmias are treated, noting that procedures have quickly progressed from addressing minor conditions to tackling more complex arrhythmias.

The procedures are interventional (meaning they involve access inside the body) and can take anywhere from 45 minutes to a few hours, depending on the health challenges and needs of each patient.

Most patients are able to head home the same day, and many see dramatic results immediately – able to engage in normal activity without the possibility of vertigo, difficulty breathing and serious heart problems.

peress-steretactic-ablationIt is clear that developing technologies in operation and imaging are the essential elements pushing cardiac-electrophysiology forward. Dr. Peress said he is especially pleased to see efficacy rates increasing as technology advances.

The Stereotaxis equipment is a leading technology that provides very detailed information to the doctor in real time,” Peress said. “Movement and placement can be done more safely and accurately – making it possible to treat certain types of arrhythmias that were extremely challenging before.”

Technology makes a difference, and it is not available everywhere. “TMC is the only hospital in Arizona featuring the Stereotaxis equipment – one of the many reasons I perform my procedures at TMC,” the doctor explained.

When time allows, the busy doctor enjoys traveling with his family. His easy-going nature brought friendly laughter and smiles as he described a recent trip to Vietnam and Cambodia.

After reaching the benchmark of helping 1,000 patients, Dr. Peress was asked what his next goal is. His answer: “A thousand more!”

A chance to meet with Dr. Peress

If you are one of the millions of people struggling with Atrial Fibrillation you can meet Dr. Peress for an interactive presentation highlighting the revolutionary technologies available at TMC for treatment and lifestyle changes for prevention 2pm Sunday, February 12th at The Core.

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Dr. Darren Peress is a cardiac electrophysiologist who practices at Pima Heart and completes procedures at Tucson Medical Center.

Technology puts Tucson Medical Center at the center of complex cancer care

image3Cancer is often anything but a textbook disease.

Thoughtful deliberations go into each case: Is surgery an option? Should radiation and/or chemotherapy be considered? If so, in which order and for what duration?

When a case isn’t straightforward, it helps to bring a multidisciplinary team of experts together to review images and discuss the best treatment options.

And thanks to technology, physicians practicing here at Tucson Medical Center are now a part of the discussion with Mayo Clinic physicians through eTumor Boards via something akin to a WebEx on steroids.

Tucson Medical Center’s position as a member of the Mayo Clinic Care Network provides physicians with the ability to consult with Mayo Clinic specialists, as well as participate in multidisciplinary discussions regarding complex cancer cases.

And now, working with experts across the country, physicians have a dedicated room where they can share slides on an 80-inch screen with enough detail and definition to determine the best approach for each unique patient – all while having face-to-face conversations on a another screen.

The space, which accommodates 15 participants, also features high-definition screens at each individual station that allow the user to toggle back and forth between a speaker and the slides.

Scott Marshall, a manager of information services at TMC, thanked Mayo Clinic for its work with TMC on the eight month project. “Building a room like this is extremely intricate. We must have robust audio and video capabilities, while ensuring the information is encrypted and secure. The Mayo technicians were instrumental in guiding us through this project as we worked together to provide a mechanism for stronger collaboration that will improve outcomes for patients.”

Stephanie Boreale, the senior director of ambulatory services at TMC, said the facility supports best practices, since tumor boards are associated with improved clinical outcomes and patient satisfaction. “The ability to conduct video conferencing will facilitate the engagement of providers in discussions of cases, improving coordination and strengthening patient care.”

Endocrinology addresses thyroid health challenges

Dr. Divya Reddy Pati addresses thyroid health issues, endocrinology

by Divya Reddy Pati M.D.

You have probably heard the term thyroid, but are you aware of its significance and that it can involve health challenges? Thyroid issues are relatively commonplace and most cases are easily treated. An endocrinologist can best address thyroid problems and determine the best means of treatment.

What is the thyroid gland?

The thyroid gland is a butterfly-shaped gland located in front of the neck. This vital gland produces the thyroid hormone that helps regulate the body’s metabolism.  

 Prevalence

Thyroid-related health challenges, such as thyroid nodules, are very common. Nodules can create too much thyroid hormone or no thyroid hormone at all. Most are benign, although a very small percentage can be cancerous.

What is a nodule?

A thyroid nodule is a growth or lump on the thyroid gland, and is usually discovered by a patient, in a routine physical exam or incidentally by imaging. There are usually no symptoms associated with a nodule, although a nodule that is large may sometimes cause a change in voice or difficulty swallowing or breathing.

What are the risks?

The risk of developing thyroid nodules increases with age. While most thyroid nodules are benign (non cancerous,) the prevalence of cancer is higher in children and adults younger than age 30 or over age 60. There is an increased cancer risk for individuals who have a family history of thyroid cancer, and for patients who have received radiation therapy of the head and neck.

Endocrinology

Endocrinology is the medical study and treatment of hormones and endocrine glands, like the thyroid gland. An endocrinologist is a physician who specializes in this area, and will order lab tests to determine if the nodule is hot (overproducing) or cold (not producing). An ultrasound is needed to further determine the type of nodule, and give the endocrinologist information needed to determine the most effective treatment plan.

Based on the type of nodule, a specific biopsy, guided by ultrasound, will be ordered to best identify the nodule.

Treatment

Treatment of thyroid nodules depends on the type of nodule.

If a biopsy shows a benign nodule, monitoring might be recommended every 6 to 12 months with a physical exam and/or a thyroid ultrasound.

Surgery is only recommended for nodules that are cancerous or suspected of being cancer. In the rare situation that nodules are large enough to cause problems with swallowing or breathing surgery might also be recommended.

Regular provider visits

Thyroid nodules should always be addressed. While most are not harmful, there is a small risk of cancer.  Your health care provider can make the appropriate referral to an endocrinologist, one of the many reasons it is important to visit your primary care provider and receive periodic physicals.

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

Stay in optimum health, prevent metabolic syndrome

Optimum Health .jpgDid you know that some people have a syndrome that places them at increased risk of developing diabetes and heart disease – and they never even know they have it?

Metabolic syndrome, which often carries no signs or symptoms, is also associated with several obesity related disorders including fatty liver and cirrhosis, kidney disease, polycystic ovarian syndrome, obstructive sleep apnea.

Tell me more. What is metabolic syndrome?

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

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

How is it diagnosed?

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

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

Prevalence

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

Treatment

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

Optimum health

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

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Divya Reddy Pati, M.D.

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

TMC One Med Group your health your team OL

Vaccines are particularly important for seniors

vaccines seniorsVaccinations are important for all populations to prevent the spread of, and complications caused by, serious illnesses. It is particularly important for seniors to receive recommended vaccinations because the body’s immune system becomes more susceptible to illness as we age.

Flu vaccine

The most important vaccine for seniors is an annual influenza or flu vaccine. An estimated yearly average of 21,000 influenza-related deaths occur among adults 65 years-old and older.

New vaccines have been developed to address senior needs, and promote a better immune response.

Currently, high-dose influenza vaccines are licensed and available. Studies done on more than 31,000 people found 24 percent greater effectiveness with this compared to standard dose vaccines, although there are more potential side effects.

Pneumococcal or pneumonia vaccine

There are now two different vaccines for people 65 and older. These are 13-valent pneumococcal conjugate vaccine, or PCV 13, and 23-valent pneumococcal polysaccharide vaccine, or PPSV 23.

The first covers 13 strains of the bacteria that commonly causes pneumonia and the second covers 23 strains. PCV 13 is recommended to be administered first followed 6-12 months later by PPSV 23. If PPSV 23 has already been received, PCV 13 should be given one time at least one year later.

There are no repeat doses unless the patient received a first dose prior to age 65 and is experiencing chronic-disease complications.

Tetanus, diphtheria and pertussis vaccines

Since 2012 tetanus, diphtheria and pertussis (whooping cough, vaccine (TdaP) has been recommended for all adults aged 65 years and older.

Initially, it was given to adults under 65 in order to prevent it from spreading to children – then cases of whooping cough started occurring in people over the age of 65, leading to the recommendation for everyone 65 and older to receive it one time. After the one dose, it is suggested that seniors receive a tetanus and diphtheria vaccine every 10 years.

Shingles vaccine

Zostavax, a vaccine to help prevent shingles, has been available since 2006. Although Zostavax can have complications for individuals over 60, the vaccine prevented about 50 percent of shingles in this population.

Most importantly, it significantly decreased the incidence of post-herpetic neuralgia, or pain that continues for months and sometimes years after shingles is over. At this time, it is recommended that all people 60 and older receive one vaccination.

Vaccines are particularly important for seniors

Seniors should address a primary care provider and discuss their medical history, current needs, and how vaccinations fit into their overall health plan.

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Dr. William Abraham is board-certified in internal medicine and has more than 30 years of experience. He is a TMC One provider who specializes in same-day/next-day appointments at the Wilmot location.

TMC One Med Group your health your team OL

Breast cancer – what men need to know

shutterstock_325524227October is awesome! The baseball and football seasons are both thumpin’. The NFL just got into gear, and MLB is ramping up for the World Series. We’re talking Heath Miller, Deangelo Williams, Matt Kemp, Drew Brees, Richard Sherman, Anthony Rizzo and more! OK, where’s the remote and the chips?!

October is also awesome because it is Breast Health Awareness Month, and the athletes mentioned above are all taking part in supporting it. Guys, this should remind us all that men have a part in supporting breast health awareness.

“Hold up! I don’t have to worry about breast cancer; I’m a dude.” If that is your attitude, then you are wrong in two ways.

One: Men can get breast cancer. More than 2500 men are diagnosed with breast cancer every year. Two:  Breast cancer doesn’t affect just one person, it affects everyone around her. Whether it’s your mom, sister, friend, cousin, wife or daughter, their health and wellbeing are a part of your life. How serious could this be? Breast cancer is the most common cancer among women and a leading cause of cancer-related deaths in women.

“Got it; I’ll get out my pink t-shirt and pull on a pink bracelet. Done.” That’s great bro, but we can take the support up a notch.

No need to research for weeks or try to mansplain every detail. Knowing the basics and being able to thoughtfully answer some questions will help support her in making decisions about her own health. And it shows we care – because we do.

Here are a few things guys should know about breast cancer:

  • Early detection can save lives. Getting a regular mammogram is the best way to detect cancer early. At what age, and how often should a woman get a mammogram? Every woman is unique and should assess her risk and discuss preventative measures with her doctor.
  • Mammogram: OK, everybody has probably heard this term, but what it is exactly? It is an x-ray of the breast. There have been a lot of advancements in mammography. Digital and 3D mammography create clearer images for better detection. Just so ya’ know fellas, the breast has to be compressed and it isn’t fun.
  • Symptoms: Breast cancer has many symptoms other than a lump. Itching, redness, swelling, dimpling, clear or bloody discharge can all be symptoms of breast cancer. If a woman is experiencing these symptoms, she should consult her doctor.
  • There is more than one type. There are many forms of breast cancer, and there are varied treatments depending on the type of cancer and the age of the patient.
  • There is hope: There has been a dramatic increase in breast cancer survivability rates in the past 40 years. New tests, targeted drugs and early detection are making a difference. While one in eight women will be diagnosed with breast cancer, the five-year breast cancer survival rate is 90 percent, up from 75 percent in 1975.

Men are becoming more knowledgeable and involved in breast cancer awareness – and that rocks! We care and we want to be supportive.

The information is out there and easy to access. So guys, let’s browse these links and get the information that will help us be supportive this month, and the whole year-round.

Additional resources:

Susan G. Komen

Susan G. Komen Arizona

National Breast Cancer Foundation, Inc.

Breastcancer.org

Breast Cancer Research Foundation

American Breast Cancer Foundation

Foundation for Women’s Cancer

American Cancer Society

Centers for Disease Control and Prevention

If you have any concerns or questions, please feel free to contact the TMC Breast Center at (520) 324-1286 or email breast.navigator@tmcaz.com.

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Medical insurance covers annual mammography screening as a preventative service, and grant funds allow TMC to offer mammograms for uninsured women age 40 and over. To make an appointment, call (520) 324-2075.

Dementia: Starting the conversation

dementia1

Few things are more frustrating than misplacing the car keys – again. It is normal to forget things from time to time, like those keys, a wallet or that extra item on the grocery list. Even though this amounts to a mild inconvenience, it is aggravating and even distressing to have a lapse in memory.

Can you imagine how frightening it would be if you couldn’t remember the week-long vacation you just went on, as if the entire memory was erased? No matter how much you focused or concentrated you couldn’t remember taking that vacation. This is not an inconvenience; this is a symptom of dementia. dementia7

Dementia effects more than memory and can make everyday-life a struggle. Having a basic conversation is exhausting because every time you try to say a particular word, another comes out. You might read the simple instant-coffee directions over and over, but they never make sense. Easy tasks like buttoning your shirt seem impossible – as though your body isn’t doing what your brain is telling it to.

There are many aspects of dementia, and many misunderstandings. TMC is beginning a three-part blog series to discuss the definition, behaviors and treatment of dementia. This is the first blog, defining dementia and outlining its basic affects and characteristics. It might surprise you to learn all that dementia entails.

What is Dementia?
Dementia is a broad term for the diseases (or conditions) that cause nerve cells (neurons) in the brain to stop working or malfunction.

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Symptoms
When the nerve cells in the brain cease, a person will experience a decline in memory and the ability to think clearly and rationally. In addition, many experience changes in behavior, vision and motor function. The most common symptoms of dementia are:

•  Memory loss (affecting daily life)
•  Impaired judgment
•  Inability to reason
•  Problems focusing or paying attention
•  Confusion with time or place
•  Challenges completing familiar tasks
•  Problems finding the correct word(s) in speech and writing
•  Trouble understanding visual images and spatial relationships
•  Frequently misplacing things – inability to retrace steps
•  Changes in mood or personality

What are the causes?
The common causes of dementia are:

How does someone get a dementia-related disease?
Medical science has made significant advancements over the last thirty years, and dementia continues to be a dynamic research field. There are still many mysteries about the brain and it is not yet known, conclusively, what causes many dementia-related diseases.

Age is the greatest risk factor for acquiring dementia. According to the Centers for Disease Control and Prevention, about 10 percent of individuals over the age of 65 experience a form of dementia. Although the risk increases with age, not every senior will experience dementia.

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Family history is another strong risk factor. An individual is at higher risk if a sibling, parent or child has experienced dementia. Certain genes have been identified that indicate an increased risk for specific dementia-related diseases, such as Alzheimer’s.

Sudden or gradual?
Dementia symptoms progress slowly over several years. Many forms progress in stages:

  • Early Stage (Mild)
    • Recent memory loss
    • Difficulty managing money, driving, or handling social situations
  • Middle Stage (Moderate)
    • Difficulty with language
    • Problems keeping track of personal items
    • May need help with grooming
  • Late Stage (Severe)
    • Long- and short-term memory affected

If dementia symptoms are sudden and acute, it could suggest a reversible medical cause such as:

  • Urinary tract infections
  • Metabolic changes (Thyroid)
  • Nutritional deficiencies (Vitamin B12)
  • Tumors

The symptoms of dementia will drastically improve or alleviate when the reversible medical cause is treated. If sudden and severe symptoms arise, contact your doctor right away.

Behavior
Dementia can cause strange and unexpected behavior, which can be one of the most challenging symptoms for individuals and their caretakers. Like most chronic conditions, dementia can affect every person differently. Some of the more common behaviors are:dementia9

  • Repetitive actions, such as hitting, wiping surfaces, making noise (clapping, etc.), rocking
  • Wandering and pacing, not able to sit still
  • Going to the door often, trying to open locked doors, trying to leave when visitors leave
  • Boredom, lack of purpose, looking for something lost
  • Anxiety, stress, fear
  • Hunger, thirst, bathroom needs
  • Wanting to go home (even if at home)

Assisting a friend or family member who has dementia can be exceptionally challenging because symptoms can be severe and persistent. Often, a caretaker will have to repeat things several times – even within the span of a few minutes. The affected individual will usually respond negatively if someone tries to convince them that their thoughts or actions are irrational. The symptoms may become so acute that constant monitoring is needed.

Sound like it would be pretty hard to be the caretaker? It is, however, we must recognize the person’s behavior is beyond their control.

“If you are going to help a person with dementia, you must understand they cannot think, reason or remember,” said Terri Waldman, former director of memory and dementia care at Handmaker/Tucson Medical Center. “You have to let things go, and refrain from challenging their misconceptions.”
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What can we do?
Consult a physician who specializes in dementia-related illness. “It is important to get a diagnosis,” Waldman said. “A diagnosis will determine the most effective medical treatment(s) and will help the individual and their family develop the best care plan.”

 

Medical specialists will perform:
•  Mental status test (memory, reasoning, visual-motor skills)
•  Physical examination (lab tests, brain scan, test for other disorders)
•  Psychiatric evaluation (rule out emotionally related symptoms)
•  Family interviews (get more information about behavior and symptoms)
What treatments are available?
Currently, there is no cure for dementia and all dementia-related conditions are degenerative, meaning they will get worse over time. There are medications that can control or reduce the severity of symptoms, and there are medications that can slow the progression of dementia-related diseases. Medication therapy can help with behavioral and cognitive challenges, and improve the quality of life for some individuals experiencing dementia.

More than memory loss
Dementia is more than memory loss, and the numerous life-changing symptoms have a detrimental impact on individuals and families. Treatments are available, and it is important to know what symptoms to look for and who to talk with. Medical research continues to move quickly, in hope of finding a conclusive prevention and cure.

 

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Support resources:

Local fire captain on the mend after catastrophic aneurysm

IMG_0612On March 26, Rural/Metro Fire Captain Eric Cline was celebrating his fourth wedding anniversary with his wife, Risa, when he complained about his head hurting and suddenly collapsed. Cline suffered a brain aneurysm that then caused a stroke. He was rushed to Tucson Medical Center where Kurt Schroeder, M.D., a neurosurgeon from the Center for Neurosciences, helped save his life.

Stephanie Innes from The Arizona Daily Star wrote this story about Cline, the incredible camaraderie displayed by his firefighting family and just how rare this diagnosis is in a young person. Cline, a father of three, is only 40-years-old.

Sam Salzwedel from KVOA News 4 Tucson also aired this story about Captain Cline.

As a Neuroscience Center of Excellence, TMC is nationally recognized for its neurological and stroke care.

New non-invasive colon cancer screen hits the market; is it better than a colonoscopy?

colon cancer awareness true or falseA new home-based screening test for colon cancer has recently hit the scenes. Cologuard or stool DNA testing was approved by the U.S. Food and Drug Administration this past August and is covered by Medicare.

The test looks for cancer-related DNA and red blood cells in a person’s stool. On the one hand, it doesn’t require the unpleasant preparation that is needed for a colonoscopy. But on the other hand, the $600 cost, which is not yet covered by private insurers, is much greater than the $25 it costs for a more basic fecal occult blood test, also called a FIT test.

colon cancer awareness ribbom“It’s a good test. It’s better than the stool occult blood test. Cologuard detected 92 percent of colorectal cancers and 42 percent of advanced adenomas, or polyps, in the study population, while the FIT screening test detected 74 percent of cancer and 24 percent of advanced adenomas. But it’s a very new test,” said Fadi Deeb, M.D., a local gastroenterologists, who also serves as TMC’s section chief for gastroenterology, “and we don’t know how often we should do it, every two years, every three years, or every five years? Intervals have not been tested, so we just don’t know.”

Given its $600 cost, which is equal to 24 FIT tests, it would be interesting to see a study comparing one Cologuard to 20-24 consecutive FIT tests over a period of one to three years, in detecting colon cancer and advanced adenomas. Dr. Deeb said.

It is not currently recommended as a method to screen for colorectal cancer by the United States Preventive Services Task Force. The USPSTF recommends adults age 50 to 75 who are at average risk for colon cancer to be screened using fecal occult blood every year, a sigmoidoscopy every five years plus stool occult blood every three years, or colonoscopy every 10 years.

Dr. Deeb said the new test had its limitations. “You can’t use it if you have a personal history of colon polyp, colon cancer, a family history of colon cancer, ulcerative colitis, Crohn’s disease, familial adenomatous polyposis or bleeding hemorrhoids.”

Cologuard was not test directly against colonoscopy for screening. “Colonoscopy is the gold standard” and is more effective in detecting precancerous polyps, which can be removed during the same procedure. Regular screening for and removal of these polyps with a colonoscopy can reduce a person’s risk of developing colorectal cancer by up to 90 percent.

This new test has a false-positive rate of about 13 percent, meaning those people will likely need to undergo a colonoscopy to rule out cancer.

“The test is an option for certain patients who don’t like invasive procedures or for those who can afford it,” he said.

Without getting out of bed patients can have their prescriptions filled, video chat with pharmacists

Pharmacist shares information about prescriptions over video conference

Pharmacist shares information about prescriptions over video conference

It’s now easier than ever for patients to fill their prescriptions before leaving Tucson Medical Center.

Patients can have those medications delivered right to their bedside and can even have a counseling session with the pharmacist over a video call without ever leaving their bed.

It goes far beyond a matter of one-stop convenience.

It’s also a matter of safety, since there are a multitude of barriers that could prevent that prescription from being filled after patients leave the hospital, said Pharmacy Director Gilbert Romero. Maybe they don’t have transportation. Maybe they don’t feel up to making that extra stop on the way home and to get prior authorization if they need it. Maybe the prescription is more expensive than they anticipated and they can’t afford it.

“If they’re home and they don’t have their medicine, then they’re not following through with their discharge plan, and that’s when they’re really at risk of re-admission,” Romero said. “Our goal is not only to take care of patients while they’re here, but to make sure they’re on a healthy path after they leave as well.”

If patients run into trouble filling a prescription, they may be helped by drawing on the full resources of the hospital. If a medication is too expensive, case managers can work with that patient to help find a solution. In hardship cases, for example, some medications may be provided for 30 days for free, which at least will serve as a bridge until the patient can see their primary care physician.

Among other conveniences, the Pharmacy:

  • Accepts all large private insurance plans, as well as the state’s Medicaid plans, known more familiarly as AHCCCS.
  • Takes manufacturer’s coupons.
  • Alerts customers via text, email or phone when prescriptions are ready.
  • Offers a great bargain, from inexpensive generics to reasonably priced prescriptions. In fact, for employees, the plan is designed so that the Pharmacy is among the cheapest options in town.
  • Operates during convenient hours; Monday through Friday from 7 a.m. until 7 p.m. – including through lunch hours – and Saturdays from 7 a.m. until 3 p.m. The Pharmacy is closed Sundays and holidays.

Rosemary Duschene: Bariatric surgery and hard work lead to a new life

RosemaryRosemary Duschene had grown weary of her diabetes – and along with it, her daily regimen of multiple pills, multiple shots and multiple complications.

“I happened to catch a commercial that said bariatric surgery improves the diabetic condition,” she said.  “I had been a diabetic for 25 years, and it was just becoming totally unbearable.”

With support from her physicians and loved ones, she underwent the surgery just over a year ago, and now reports her diabetic regimen is down to just one pill per day – with the hope that even that one last pill could become unnecessary.

“Within one year’s time I lost 65-70 pounds,” Duschene recalled, noting the lifestyle change was “really not so difficult!  TMC made certain everything was perfect before I became a candidate for surgery.”

After the bariatric surgery to assist her weight loss, she was quickly back on her feet and active. “I wasn’t used to sitting around, and now I had all this added energy and less weight to carry around, so it was easy to get up and move.”

She had a dog to walk, so that was a great motivator – but the biggest energy stimulus has to be Duschene’s 2-year-old grandson, always ready for a trip to the park.

“I let him run, and he chases me, and I chase him…I want so much to be a part of his life.  It’s hard to keep up with a 2-year-old, but it isn’t so bad any more!  I don’t get so tired. It’s just really great to feel so good.”

UA baseball coach sends a shout-out to TMC surgical team

An updated story in the online Tucson Citizen Sports Section includes good news from popular Wildcat baseball coach Andy Lopez.  Thanks, Coach, and continue a speedy recovery! 

Arizona baseball coach Andy Lopez recovering well from heart surgery

by Anthony Gimino on Oct. 16, 2013

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Andy Lopez will be back at Hi Corbett in time for preseason practice.

Photo by Anthony Gimino, TucsonCitizen.com

Arizona Wildcats baseball coach Andy Lopez, following quadruple bypass surgery on Oct. 7, is expected to return to coaching duties when the team begins preseason practice on Jan. 15.

“All of my doctors have assured me that the surgery went very well and I will fully return to coaching,” Lopez said in a statement released by the athletic department Wednesday.

“With the doctors’ advice, I will take the rest of our fall practice season off and resume all of my normal coaching duties when we begin preseason practices.”

Lopez, whose surgery was originally intended as a triple bypass, returned home Friday after being released from Tucson Medical Center.

“I cannot thank the entire medical team at Tucson Medical Center enough for their care and support through this process,” Lopez said. “I am grateful of the tremendous team effort by everyone involved.

“My primary physician, Dr. Jeffrey Selwyn, got the ball rolling, and I received unbelievable treatment from my cardiologist, Dr. Salvatore Torrito, and my heart surgeon, Dr. Raj Bose. Each of them has said I will be raring to go in January.”

The Wildcats began fall practice last week, with assistant coaches Shaun Cole and Matt Siegel leading the team in Lopez’s absence.

Lopez will be entering his 13th season at Arizona with a record of 437-267-1, highlighted by winning the 2012 College World Series.

 

 

Amputation as a last resort – How TMC’s Save A Limb program is saving lives

It is no secret that we live in a region where diabetes is rampant.  Statewide, the statistics are stunning.  According to the American Diabetes Association, one out of every nine Arizonans – nearly 500,000 people – are affected by the disease.

One of the most devastating consequences of the disease is amputation, and with more than 60 percent of non-traumatic lower-limb amputations occurring in people with diabetes, it is a common complication. And it doesn’t stop there with the loss of a limb; mortality rates increase with amputation.

Vascular surgeon Dr. Matthew Namanny, Saguaro Surgical

Vascular surgeon Dr. Matthew Namanny,
Saguaro Surgical

The goal of TMC’s Limb Salvage Team is to “save a limb, save a life.”  They work to keep these patients functional.  TMC’s Save A Limb program is a multidisciplinary approach to patients with advanced vascular disease or Peripheral Artery Disease (P.A.D.).  A team of vascular and podiatric surgeons, nurses, technicians and registered dieticians coordinate their care to save limbs and prevent amputations.  “The surgeons on this team are considered experts in this area,” explained Dr. Matthew Namanny, a vascular surgeon with Saguaro Surgical.  “If patients are suffering from severe P.A.D. or wounds, or if these patients are identified by physicians and nurses in hospitals and clinics, we want them sent here so that we can do everything possible to prevent that amputation.  That’s what we want to be known for.”

The team uses the most advanced methods available to treat patients, like rapid endovascular interventions, synthetic skin substitutes and prophylactic elective surgery to eliminate biomechanical foot abnormalities.

“We have a prevalent Native American population here, and a lot of our population is at high risk for P.A.D. because of obesity, coronary artery disease, and hypertension.  Having the Save A Limb program available at a community hospital is such a huge benefit to patients in Southern Arizona as well as the rest of the state.  Our team helps hundreds of patients a year, but we know there are hundreds more who could benefit, ” Dr. Namanny said.

For more information about TMC’s Save A Limb program, please click here.

Ticking time bomb: Screening saves Tucson woman from “silent killer”

The only time Barbara Unger spent time in the hospital as a patient was when she had her two babies.  At 82 years old, that’s pretty impressive.

The retired secretary and bookkeeper was diagnosed with an abdominal aortic aneurysm many years ago during a routine checkup.  The aorta is the main artery that carries blood from the heart, and stretches down into the rest of the body.  In Barbara’s case, the wall of the aorta was permanently ballooned out in her abdomen due to the pressure of blood passing through.  If it ruptured, the results could have been catastrophic.

Dr. Thomas Lindow,Internal Medicine

Dr. Thomas Lindow,
Internal Medicine

After the diagnosis, her aneurysm wasn’t monitored until she switched primary care physicians in May 2010.

Luckily she did.

Her new PCP, Dr. Thomas Lindow, ordered an ultrasound right away.  “The moment we got the results, I saw instantly that it had to be repaired.  I immediately referred her to Dr. Matthew Namanny at Saguaro Surgical,” he said.

“I was very happy to have seen Dr. Lindow.  I’m so grateful he told me how serious the situation was getting,” said Barbara.  Dr. Namanny ordered a CT scan and determined that she needed surgery.

Dr. Matthew Namanny,Saguaro Surgical

Dr. Matthew Namanny,
Saguaro Surgical

During the procedure at Tucson Medical Center, Dr. Namanny placed a small catheter in Barbara’s groin, and used it to insert a stent in her aorta.  This removed the pressure that was causing the aneurysm, and eliminated the chance of it rupturing.  Barbara slept through the entire thing.  “I had no pain, no problem at all.  It was very simple.  I stayed overnight, and went home the next day.  It was as pleasant as a hospital stay can be.  TMC was very accommodating and the nurses took good care of me.  We laughed a lot,” she chuckled.   The surgery was a success.  She’ll just need an annual screening from now on to make sure everything is okay.

Barbara is one of the lucky ones – although she doesn’t quite fit the mold of who abdominal aortic aneurysms affect most often.  “This disease is typically found in older, white men who smoke,” said Dr. Namanny.  Family history also plays a major role.  “I tell every patient who has this, ‘Go tell your siblings, and notify your children.  When they’re about 40 years old, they need to get screened for this,’” he said.

That screening is absolutely essential, and is usually covered by insurance.  Since these aneurysms often don’t present any symptoms, they can go undiagnosed until they rupture and become fatal.  Fortunately, improvements in technology have made it easier for physicians to detect and treat them.

What used to require an open operation followed by a 7-10 day hospital stay, can now be accomplished in one day.  And since the procedure is less-invasive, physicians can operate on older patients who wouldn’t have been able to tolerate the surgery in the past.

For more information on abdominal aortic aneurysm screening, click here.

For information to help you determine if you should get a screening test, click here.

The Beat Goes On, Thanks to Friends of Cardiac Rehab

A new scholarship program is getting under way for patients in TMC Cardiac Rehabilitation who need a little help paying the ‘toll’ on their road to recovery.

 

The vision behind the scholarship comes from Friends of Cardiac Rehab, current and former cardiac rehab patients who want to maintain a positive connection between patients and the community. They have coordinated a variety of informational and fundraising events as part of their support the TMC Cardiac Rehab, in partnership with the TMC Foundation.

 

Typically, health insurance will pay for cardiac rehabilitation for patients with heart failure, heart attack, angioplasty and bypass surgery. But there are cases where insurance is unavailable, and some patients may not be able to handle even the reduced fee offered in Cardiac Rehab’s “post-grad” program.  That’s where the new scholarship can help.

 

In addition, Friends of Cardiac Rehab have just formed a new Volunteer Program.  The idea is to connect with patients who have recently undergone cardiac surgery or other medical procedures to let them know about the benefits of Cardiac Rehab.

“The Cardiac Rehab Volunteers are cultivating a stronger relationship with post-surgery patients at the hospital through one-on-one communication,” said Mark Gaxiola, Cardiac Rehabilitation supervisor.  “These volunteers really want to make a difference in people’s lives by sharing their positive experience at TMC.”

 

Many people with heart disease, including those who have had a heart attack or a cardiac intervention, are not aware of the benefits of medically supervised cardiac rehabilitation. Such programs will support them in reducing the risk of further heart problems and help them return to an active life.

 

“Friends of Cardiac Rehab help educate these patients and the general public through outreach community events, health fairs and one-on-one meetings,” Gaxiola said. “In addition, they have raised money to purchase additional exercise equipment for our department, supply patient educational materials, and now create a new scholarship program, with support of the Foundation, for those who need assistance in paying for cardiac rehab services.”

 

“The TMC Foundation is proud to serve as the fundraising arm for the new scholarship program,” said Michael Duran, VP and Chief Development Officer.  “Many long-time survivors have joined the Friends of Cardiac Rehab as living examples of the program’s benefits, and their efforts are making Cardiac Rehab more accessible for new and ongoing patients.”

 

 

Type 1 vs. Type 2 Diabetes: Under new management

No doubt, a diabetes diagnosis changes a person’s life.  They may find themselves doing things they’ve never had to do before, like check their blood sugar multiple times a day, count carbohydrates, and perhaps even give themselves insulin shots.  Even starting an exercise plan may be a first for them.  The good news is that diabetes educators are available to help.  Diabetes educators are health care professionals who teach those with diabetes how to adjust their lifestyle and behavior so that they can successfully manage their disease.

Nancy KlugTMC Certified Diabetes Educator

Nancy Klug
TMC Certified Diabetes Educator

TMC Certified Diabetes Educator Nancy Klug developed her passion for educating others about diabetes after two close family members were diagnosed with it.  She’s been helping diabetics understand their disease, and get their blood sugar under control for more than 25 years.  She shares some valuable information about appropriate diabetes testing, and how the disease is managed.

Type 1 Diabetes

Background:  People with Type 1 diabetes often get strong symptoms that could land them in the emergency room.  Their blood sugar may be 300 or higher.  Many times they are very sick.  They may be vomiting, and even have trouble breathing.  Other symptoms include increased urination.  They may find themselves getting up many times during the night to use the restroom.  They’re also very thirsty, and extremely tired.  Rapid weight loss is another common symptom we see.  Many times Type 1 affects people who are under age 30.  There is a hereditary factor, but it’s not as strong as it is in Type 2.

Appropriate Testing:  A test called c-peptide is done.  This tells a clinician if the patient is making insulin.  They’ll also do some antibody testing to see if the patient has the antibodies that would kill their beta cells. 

Managing Type 1:  Type 1 diabetics will start on insulin right away.  They’ll need at least four shots a day.  A short-acting insulin at each meal, and then a long-acting insulin.  Or, they may be on an insulin pump.  There is no cure for Type 1, but like Type 2, it can be controlled.

Type 2 Diabetes

Background:  With Type 2 diabetes, there s a very strong hereditary factor, but it is possible for someone to develop it without having a family history.  The tricky part with Type 2 is that oftentimes it’s difficult for people to tell they have the disease, as there are no, or very few, symptoms.  Patients may have to get up in the middle of the night to use the restroom.  They also may be a little thirstier or more tired than usual, and have a wound that is slow to heal.  Unlike Type 1 diabetics, Type 2 diabetics do not have weight loss.  If diabetes goes uncontrolled for several years, complications can develop, including kidney, nerve and eye damage.  The biggest complication, however, is heart attack and stroke.

Appropriate Testing:  A physician who suspects a patient has diabetes will order an A1C test.  The blood test gives the physician an average of the patient’s blood sugar over the last three months.  A non-diabetic person may have an A1C around 4-6 percent.  Prediabetes is 5.7-6.4 percent.  A diabetes diagnosis is 6.5 percent or higher.

Managing Type 2:
  The American Diabetes Association recommends patients start on a medication called Metformin.  Patients are advised exercise at least 30 minutes, five times a week, and attend diabetes education classes where they’ll learn how to count their carbs, and keep them down, along with their saturated fat intake.  Eighty percent of Type 2 diabetics are overweight, so losing even a little weight can be very beneficial.

The American Diabetes Association (ADA) suggests Type 2 diabetics have a blood sugar range of 70-130 before meals, and 130-180 two hours after meals.  The American College of Endocrinology (ACE) has even stricter guidelines.  They recommend a blood sugar level of under 110 before meals, and under 140 two hours after meals.  At TMC, Klug says they teach patients both sets of guidelines, encouraging them to get into the ADA range first, and then aim for the ACE range.

In conclusion, Klug says, “The good news is that we know how to control diabetes.  Patients have to learn how to do it, but a diabetes educator and their team can work with you.  If you’re able to keep your numbers down, you can minimize the complications and have a fairly healthy life.  There’s nothing that you can’t do with diabetes.  There is no cure, and it will never go away, but you can get it under control.”

If you or someone you know has diabetes and wishes to speak to a diabetes educator at TMC, please call (520)324-3526 or (520)324-1265.

Palliative Care: Options not absolutes

Generally speaking, we live in a society that is uncomfortable talking about suffering and death. The reality though, is that both are a part of life. It is important that medical and clinical staff, along with chronically ill patients and their families understand that it must be acknowledged on the way to an open dialogue about palliative care options.

The term “palliative care” is often misunderstood, and often confused with hospice care. However, palliative care services offer a wide array of options that do not center on death. While death might ultimately be a part of the conversation, the broader scope of palliative care is for anyone with a serious, complex or chronic illness.

The goal of palliative care is to prevent and relieve suffering. Its purpose is to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Additionally, it helps guide and assist the patient and family in making decisions that will help them achieve their goals—improving their quality of life and often extending it as well.

In a well-known study published in 1996, known as the SUPPORT study, it was reported that Americans often died in pain, and their wishes for how they’d like to live out the remainder of their lives were either unknown or ignored. It raised an important question that is the basis for palliative care: What are a patient’s desires and wishes?

“Quite often we get so hung up on what we can do for someone medically that we don’t ask who the people are and what they would really want. And that, I feel, is the more important question,” says Kathy Kennel, NP, a Palliative Care coordinator at Tucson Medical Center.

Kennel receives many letters from patients and their families who have benefitted from Palliative Care. One such letter reads, “As a daughter, we didn’t know which direction to go, and you helped clarify what would be important for our mom. Thank you for asking about who our mom is.”

The benefits of this approach extend well beyond the individual patient. In an excerpt from his recent article entitled Palliative Care: Improving Care for Chronic Illness, Dr. Scott Lake states:

“When asked, most Americans say they would prefer to die at home, yet the majority of us die in hospitals and other institutions, often in pain. It would seem logical that the more health care a patient gets, the better that patient’s care would be, but for those nearing the end of life, this is not always the case. In 2009, Medicare spent an estimated $143 billion caring for people in their last year (25% of all Medicare spending). It is estimated that 20-30% of this care had no meaningful impact on the outcome of the illness; to the contrary, such spending and extensive treatment can too easily decrease quality of life during this period, and thus, the quality of death.”

 

Although the practice of palliative care has really picked up momentum in the last 5-10 years, there are still a lot of myths and confusion surrounding it. At Tucson Medical Center, actively offering Palliative Care options and discussions to our patients and their families from the onset of symptoms from a serious, life-limiting disease, is in alignment with TMC’s mission, vision and values. As such, it is important that the community is able to truly understand what it is.

 

Seriously ill patients should know there is a medical specialty focused on meeting their unique needs. TMC’s palliative care nurse practitioner can work with a primary care physician to provide treatment of the pain, discomfort, and stress while the patient is receiving other treatments at all stages of an illness.

For anyone who wishes to learn more about palliative care programs and options, TMC will be hosting a panel discussion on Nov. 14 at the El Dorado Health Campus from 10 to 11:30 a.m.  Join Larry Lincoln, MD, Kathy Kennel, NP, and Mary Steele, RN, to learn what Palliative Care is all about, when to access this service, and the future of Palliative Care.

To sign up, contact Joanne at Health Living Connections at (520) 324-1960.

New CT boosts TMC’s array of imaging options

Tucson Medical Center has greatly increased its imaging capabilities by adding a second suite for advanced Computerized Tomography (CT) scanning. TMC has replaced one older scanner, and now provides two 64-slice CT units offering precise, detailed representations of organs and blood vessels.

Fully installed and tested at the end of October, the new unit is called a 64-slice CT because it uses 64 detectors to produce and combine images. The Siemens Definition 64-slice unit offers a refined set of features:

  • Dose adjustment and reduction for pediatric or adult populations
  • Larger gantry for bariatric patients
  • Faster reconstruction times
  • Perfusion package to aid ‘Neuro-Red’ suspected stroke cases

The technology provides up to 64 slices per rotation with previously unknown sharpness and diagnostic detail. The imaging information is instantaneously available for physicians for a fast and reliable diagnosis.

TMC’s original 64-slice CT scanner remains in service and continuously busy down the hall, with both units now able to handle scheduled and emergent imaging cases.

Varicose Vein Disease

Dr. Luis Leon
Agave Surgical

Dr. Luis Leon from Agave Surgical spoke about state-of-the-art management of varicose vein disease to physicians, nurses and ultrasound technologists.  While this disease is fairly common, it’s seen more frequently in older women, and tends to be hereditary.  Other risk factors include obesity, oral contraceptives, multiple pregnancies, and constipation.

Varicose vein disease ranges from mild spider veins to bulging, painful veins to severe ulcers that are slow to heal.  Dr. Leon says patients often try one unsuccessful fix after another, only to end up at the surgeon’s office with advanced stages of venous disease.  “I think a lot of people attribute their leg aches and pains to getting older, but simple aging doesn’t explain leg pain.  These people are unaware that they’re suffering from venous disease.  Their problem can be fixed, and their life can be very different.”

That fix includes a simple office-based procedure that requires only local anesthesia.  A radio-frequency ablation can be done during a patient’s lunch hour.  Dr. Leon says, “ It was interesting to see the reaction of health care providers when they heard about the new way to treat this problem.  The old way to treat this required anesthesia and an operation in the hospital.  They were very surprised to hear that we can fix this problem in the office in about ten minutes.”  He stresses the need for more awareness and education about this to general practitioners, other healthcare providers, and the public.

 

New Sensory Integration Room to Open in Pediatric Emergency Department

When the Pediatric Emergency Department opens next week on Oct. 2, one of most notable changes will be the addition of a sensory integration room. The room, which is designed for babies born with substance addictions and children with sensory processing disorders, autism and ADHD, came about as a result of a suggestion from various staff members as well as the TMC Pediatric Family Advisory Council. The Council is comprised of TMC staff members, physicians and patient families and meets once a month with the goal of improving the facilities, processes and care given to pediatric patients at TMC.

“We have been very fortunate to work with a family on the parent advisory committee who is passionate about helping us design a room that will be available to patients and their family in an effort to continue their routine while in an unexpected situation,” explains Melissa Moreno, Director of Emergency Services.

For children with sensory integration disorders, an unknown and busy emergency department can be a scary world of unfamiliar strangers, strange smells, and unbalancing movements. For a parent, the resulting melt-down can be frustrating and taxing. For the child it can be terrifying and traumatic.

In order to create a calming space for these children, the new room is a muted color with minimal wall art to decrease stimulation. Additionally, there will be various things available in the room to help pass the time including bean bags for them to sit on, therapy mats to lie on, squeeze balls, sensory balls of various shapes and textures, books, Legos and toys. For special procedures, the room will be equipped with weighted vests and blankets that provide calming and constant pressure.

“We understand that parents don’t plan to come to the emergency department, and when they are faced with a situation in which they have to, their child is in an environment that can cause additional anxiety for both the child and the parent,” Moreno said. “Creating this room just felt like the right thing to do for our pediatric patients and their families.”

New Hyperbaric Chamber at TMC’s Wound Care Center

As diabetes continues to be on the rise, the need for comprehensive wound care also continues to grow in Tucson. In addition, the rising obesity epidemic and aging population will also contribute to the rising incidence of chronic wounds.

It was this obvious need that originally drove Tucson Medical Center to open an advanced wound care center in March of this year at its El Dorado Health Campus. When it opened, the 4,700 square-foot facility was equipped with two new hyperbaric chambers and five treatment rooms.

Since its opening, the center has experienced a flood of new patients and a rapid increase in procedures conducted.  In March the center completed 192 procedures, followed by 793 in July, and over 1056 in August.  As a result, the Wound Care Center is adding a third hyperbaric chamber to the facility.

Hyperbaric chambers help heal wounds by providing oxygen to the bloodstream and helping the patient heal from within.

What sets these chambers apart from others is their size.

“The reason why the size of a chamber is important is because a patient may spend as much as 2-2 ½ hours a day, five days a week, for six to eight week sessions in these enclosures. These chambers provide a comfort that is second to none and does not compare to smaller chambers,” explains Suzanne Pinon-Martinez, Program Director.

“The new chamber will allow TMC’s Wound Care Center to meet the increasing demand of this kind of treatment in the Southern Arizona community,” says TMC Chief Operations Officer Linda Wojtowicz.

In addition to hyperbaric treatments, the Wound Care Center also performs the employs the latest methods in skin substitute and debridement procedures.  It is one of more than 500 Healogics facilities staffed with highly trained physicians and clinicians who treat chronic wounds through a multidisciplinary approach and advanced treatments.

“We are truly on the breaking edge of wound care technology,” notes Pinon-Martinez.

Seven Simple Steps to Reducing Stroke Risk

Seven simple steps could dramatically pare down your risk of stroke.

Tucson Medical Center promotes Life’s Simple 7, by the American Heart Association/American Stroke Association.

“They’re really very manageable,” said Molly Griffis, the stroke program coordinator for Tucson Medical Center. “I think if people make the commitment day by day, they are achievable. But to get started, they have to be aware of them and then make them part of their regular, everyday routine.”

Here’s a look at the seven:

1)  Don’t smoke cigarettes or use other tobacco products. “I think people know the correlation between lung disease and smoking, but it is also the strongest risk factor for heart attack and stroke if coupled with hypertension,” Griffis said.

2)  Keep a healthy body weight. Keeping a body mass index less than 25 kg/m is a good aim, Griffis said, “but the main idea here is to eat well and keep moving.”

3)  Get at least 150 minutes of moderate intensity physical activity or 75 minutes or vigorous-intensity activity (or a combination) each week. “It can be as simple as working in 30 minutes of exercise on most days,” Griffis said. “Do some yoga, go swimming, take a bike ride, go on a hike, – whatever makes you happy. You don’t have to run a marathon or do the Tour de Tucson.”

4)  Eat a healthy diet consistent with current recommendations from the American Heart Association. “Shoppers should try to stick to the perimeter of the grocery store, and look for a variety of colors through fruits and vegetables, while picking up items such as fish and fiber-rich foods,” Griffis said. “Shop moderately from the inner aisles where the processed, canned, and packaged foods are since they typically contain extra sodium, fat, and sugar.”

5)  Keep total cholesterol less than 200 mg/dl, or LDL less than 100 mg/dl.

6)  Keep blood pressure below 120/80 mm Hg. “uncontrolled High blood pressure is the strongest risk factor for both Ischemic and Hemorrhagic Strokes” Griffis said.

7)  Keep fasting blood glucose less than 100 mg/dl.  Diabetics have a 2-4 x higher risk of heart attack and stroke, so managing the illness is extremely important, Griffis said.

Medications that might be appropriate to consider:

  • Anti-platelet medicines, including Aspirin, keep platelets in the blood from sticking together and forming clots. Plavix and Aggrenox are also options.
  • Anti-clotting drugs, such as Warfarin, Pradaxa, and Xarelto may be needed to help ward off stroke in some patients, particularly those at high risk of clots with a medical history including Atrial Fibrillatin, Atrial Flutter, or with a past history of afflictions such as deep vein thrombosis or pulmonary embolism.
  • Frequently, doctors will prescribe cholesterol and lipid lowering drugs, such as a Statin, to lower cholesterol and lower the inflammation that is caused by the build-up of atherosclerosis in the blood vessels.
  • Finally, if you have high blood pressure, your doctor will prescribe medication to lower it. There are many different kinds of anti-hypertensive medications.

A heart-warming history of cardiac care

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One family’s long-standing commitment to Tucson Medical Center is recognized with a special inscription at Unit 420 – now designated as the Cecil D. Wilson Cardiac Care Unit.

Family members of all ages gathered recently to recall the original gift, celebrate the family’s contributions for cardiac care, and officially dedicate a plaque to TMC at the unit entrance. The TMC Foundation welcomed the Wilson relatives at the newly refurbished unit, celebrating the legacy established in 1968. At that time, Mrs. Fern Wilson and family made the gift that launched Tucson’s first Cardiac Care Unit, commemorated at the time with a bronze plaque.

As noted on the newly minted acrylic plaque in 2012, “The family of Cecil D. Wilson is proud that TMC wisely used the initial gift from Mrs. Fern Wilson to start the Cardiac Care Department.  The vision and generosity of the Wilson family has created a succession of improvements to cardiovascular care and continues the great tradition at TMC.”

Cardiac Medical unit reopens after facelift

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Earlier this fall, TMC closed down Unit 500, Cardiac Medical, to give it a makeover.  Over the years, the hospital has been closing one unit at a time in order to update them.

Patients began occupying the unit on Monday.

“The patients have expressed their gratitude and everyone loves the work that’s been done,” said unit manager, Joyce Drozd. “It’s very exciting. The place still has that ‘new car’ smell; it’s all shiny and new.”

The work includes new flooring,  repainted and textured walls, renovated bathrooms, updated lighting and more. For the staff, new space was carved out of storage areas, the lounge was enlarged and a consultation room was included for doctors to speak with family.

And at the top of the walls visitors will see a stylized TMC heart, artwork of the TMC CardioVascular service line, spaced out every 10 feet. As a cardiac unit patients may be just getting back on their feet,  so staff wanted an easy way to measure a patient’s progress and to make sure they don’t overdo it.

Triple A’s and endovascular repair: less invasive, less risk than traditional surgery

By M. Scot Skinner

Putting three A’s together can signify lots of things.

But when Dr. Luis Leon talks to you about Triple A, he’s probably not referring to the massive roadside-assistance club or America’s former credit rating or the type of baseball played by the Tucson Padres.

Vascular surgeons and all too many of their patients know Triple A as shorthand for an abdominal aortic aneurysm. It’s a ballooning of the body’s largest vessel, a condition with an unknown cause that becomes more serious as the aneurysm grows. If the bulge bursts, the result is often excruciating and sometimes fatal.

Abdominal aortic aneurysms, in fact, are the third-leading cause of sudden death in men age 60 and older. Triple A’s are five to 10 times more common in men than in women. Those with a history of smoking are at greater risk than those who don’t.

One way of fixing this vital stretch of infrastructure is open surgical placement of a stent graft to shore up the weakened artery. Depending on the shape and position of the aneurysm, along with other factors, this might be the best way to go.

But the other option, endovascular repair, is where everything is headed. It’s a much less invasive procedure that requires just a 2-inch incision in one groin, and a puncture in the other.

Patients can usually go home the next day, says Leon, while the recovery time for open surgical repair requires an average of seven nights in the hospital, followed by another six weeks at home.

“Risk to the patient, blood loss, length of stay in the hospital, complications and mortality has been dramatically reduced with endovascular techniques,” he says.

Endovascular surgery, which represents 85 percent of Leon’s practice, involves the introduction of a catheter through the skin and into major blood vessels.

According to the Society for Vascular Surgery, the world’s first endovascular aortic repair was performed in 1987 in the former Soviet Union. The technique was introduced in Argentina in 1991 and in the United States that same year.

“The downside to doing endovascular Triple A repair is that the stent graft has a tendency to move downward,” says Leon. For that reason, patients must have long-term follow-up examinations and further endovascular surgery might be required at some point.

“The good thing about doing it the old way is that you don’t have to do it again,” said Leon. No long-term follow-up is required.

Last month, Leon became the first surgeon in Tucson to use a new stent from Endologix, one of four makers of such products. Since then, he has performed two more surgeries using the stent, which he says has an improved design that makes navigation easier and helps prevent migration.

“The estimated blood loss for the three patients was about 50 to 60 cc’s each,” he added. “With open surgical repair, blood loss averages 400 cc’s. All three were discharged the next day.”

Leon, a native of Peru, earned his medical degree in 1996 at Cayetano Heredia Peruvian University. He received surgical training at Harbor-UCLA Medical Center and San Joaquin General Hospital in California, from 1997 to 2003. He also completed a Vascular and Endovascular Fellowship at Loyola University Medical Center in 2005.

He comes from a family of physicians. His father and his brother are both surgeons, and his mother is a nurse. They live and work in Lima.

Leon, a fitness nut who finds time for regular ultra-runs, joined Agave Surgical Associates in 2009. Before that, he was the chief of vascular surgery at the Veterans Affairs hospital in Tucson.

His enthusiasm about the endovascular world and all its possibilities is contagious.

“Surgeons at TMC are moving rapidly into an entirely percutaneous environment,” says Leon, clearly excited to be among those leading the way.

For more information about abdominal aortic aneurisms, go online to www.findtheAAAnswers.orgFor more information about the AFX Endovascular AAA System, go to www.endologix.com.

M. Scot Skinner, an Arizona native, is an award-winning reporter with more than 25 years of experience in daily journalism. After a long career at the Arizona Daily Star, he is now working for Tucson Medical Center as a freelance writer. He can be reached at mscotskinner@gmail.com.

Multidisciplinary Team Approach Saves Limbs of Diabetic Patients

Amputation is one of the most devastating consequences of diabetes. In fact, more than 60 percent of non-traumatic lower-limb amputations occur in people with diabetes, and one diabetes-related amputation occurs in the world every 30 seconds. In addition, mortality ratesincrease with amputation. TMC’s goal is to “save a limb, save a life,” says Karen Reinhard, NP, a member of TMC’s Limb Salvage Team.

Patients with diabetes often suffer foot problems because of myriad complications. Poor circulation and nerve damage lessen the body’s ability to feel pain in the foot or detect injuries. Even tiny cuts or ingrown toenails, left untreated, can cause serious tissue damage that may require amputation.

TMC’s Limb Salvage Team began last December and is comprised of vascular and podiatric surgeons, nurses, technicians and registered dieticians available to all patients with a lower-extremity ulceration. This combination of specialties arises from the concept of “toe and flow,” in which podiatric surgeons manage the non-vascular issues of the foot, and vascular surgeons perform the necessary measures to ensure adequate circulation for healing.

The team utilizes cutting edge methods such as rapid endovascular interventions, synthetic skin substitutes and prophylactic elective surgery to eliminate biomechanical foot abnormalities.

“I am incredibly pleased that we’ve developed a team of professionals who have been successful in preventing amputations in these patients,” says Dr. Gulshan Sethi, Section Chief of Cardiothoracic Surgery. “You need a vascular surgeon who can evaluate blood flow and find out if there is a blockage. Many of these patients – 60 to 70 percent – have cardiovascular disease. There is not enough blood flow to make an ulcer heal.”

“Losing a limb is not only a major limitation to a patient, it’s functionally devastating,” Sethi says. “We can do a better job. Doctors tell their patients what they need to do to improve, but if we have a team of people seeing the patient together in a combinedclinic, it can be very strong.”

Cardiac Care — In a Heartbeat

Pan Langseth

Pan Langseth was enjoying a night with her family when she suddenly felt very ill. Rushed to Tucson Medical Center, it took only minutes before she made it to the team that would save her life.

“We were celebrating birthdays and I suddenly felt like I was going to faint,” she recalls, “The next thing I knew I woke up in TMC.” Langseth had complete blockage in four arteries, but thanks to TMC’s rapid “door-to-balloon” time, she bypassed a wait at the emergency department and was promptly wheeled into the Catheterization Lab Suite.

“She presented with probably the worst initial clinical situation of cardiogenic shock and respiratory failure,” recalls cardiologist Dr. Marius Wagner. Given her unstable condition and realizing the need for quick intervention, the ED physician alerted the Cardiac Team, which was ready and in place. Within 30 minutes of her arrival, her artery was opened and the balloon pump in place to support her heart.

“She was discharged four days later!” Wagner says. “Just 10 years ago, a similar condition had a 95 percent mortality rate within the first day. Those who survived the initial hospitalization died of heart failure within the next six months.” Langseth has recovered and is back to playing golf with her friends and enjoying life.

The door-to-balloon time, a core indicator of a hospital’s quality of care, is measured from the moment a chest-pain patient comes through the hospital door to when they undergo angioplasty. TMC’s average is 65 minutes, compared with a national standard of no more than 90 minutes. Physicians know, when it comes to the heart, any delays in treatment increase the likelihood of damaged heart muscle. This is particularly important in patients who have suffered heart attacks – the first three to four hours are critical to heart salvage.

TMC’s Catheterization Lab Suite, or “Cath Lab,” is a sophisticated technical area equipped to perform total assessments of heart function, including evaluation of coronary artery disease, and electrophysiology procedures. It is expertly staffed by a team of cardiologists, registered nurses and technologists 24 hours a day, seven days a week.

“I have worked at TMC since 1983,” says Wagner. “The Cath Lab is the finest one in the city. I, for one, bring most of my patients here.”

TMC has fostered a collaborative process among TMC cardiologists, heart surgeons and nurses – all working together to solve problems, improve quality outcomes and lower costs. “It is a unique environment. I think the collaboration encourages not only competition, which is very healthy, but also cooperation and learning from each other.”


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