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

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

Dr. Chiarina Galvez explains when a child with asthma symptoms should see a pediatric pulmonology specialist can best help.

What is pediatric pulmonology?

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

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

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

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

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

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

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

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

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

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

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

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

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

  • Hospitalization
  • More than one ED visit
  • Received more than two courses of oral steroids in the past year
  • Or has complicating conditions (e.g. chronic lung disease of prematurity)

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

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

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

What are the most common illnesses you treat?

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

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

 

 

 

 

 

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

Cord Blood Kristen Wilt

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

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

What is cord blood?

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

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

Saving and improving lives

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

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

How donation works

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

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

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

Safety and anonymity

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

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

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

Cord Blood 3

Where it goes and how it helps

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

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

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

Why your donation matters, for others and for you

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

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

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

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

Patients, families enjoy afternoon of pampering thanks to generous volunteers

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

“A” is for Adult Supervision

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

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

“B” is for Barrier

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

“C” is for Classes

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

I have a few additional thoughts:

Having a party? Hire a lifeguard.

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

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

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

Eyes peeled

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

Hope your summer is splashing good fun.

Stay safe,
Melissa

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

Melissa HodgesPediatric Emergency Notes from Melissa
Melissa Hodges is a pediatric emergency room RN and mom to two young boys. Melissa has been at Tucson Medical Center for 10 years. She is a knitting ninja apprentice who makes a mean chili and enjoys spending time with her family and friends in beautiful Tucson, Arizona.

Dehydration and kids – what you need to know

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

Your kids are more susceptible to heat than you are!

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

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

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

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

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

Is my child dehydrated?

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

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

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

What should I do if my child seems dehydrated?

For children older than 1 and less than 11:

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

How can I prevent my child my child getting dehydrated?

  1. Hydrate, hydrate, hydrate.

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

  1. Stay indoors

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

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

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

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

  1. Keep it light and wear a hat

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

Stay cool this summer,

Melissa

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

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

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

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

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

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

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

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

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

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

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

IMG_2600

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

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

Children’s Miracle Network Champion – Emma Martin

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

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

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

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

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

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

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

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

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

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

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

Stroke Prevention Saturday – serving the community, saving lives

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

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

stroke awareness

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

Why has TMC invested in providing free events like Stroke Saturday

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

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

The screening that revealed a life-threatening issue

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

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

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

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

Make screening part of your annual care

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

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

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

Know your stroke risk

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

 

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

Pregnant? Set the stage for breastfeeding before your due date

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

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

 

Set the Stage-Before Your Due Date

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

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

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

Make a plan

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

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

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

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

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

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

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

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

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

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

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

Be present on rounds

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

Participate!

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

Know that longer conversations may have to happen later

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

Write your questions down on a piece of paper

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

medical students

Be part of shaping doctors of the future

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

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

 

 

Pregnant? Finding sleep elusive? Try a body pillow!

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

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

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

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

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

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

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

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

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

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

Hip hop dancing can be tough for anyone, but not for Brody – a seventh-grader living with the challenges of Type 1 diabetes.

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

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

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

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

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

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

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

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

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

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

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

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

When should I tell my child about an upcoming surgery?

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

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

When to tell your child:

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

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

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

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

What should I tell my child:

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

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

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

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

Amy Fregonese
Child Life Specialist

Surgery Tours

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

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

 

 

 

 

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

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

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

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

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

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

Smith had gastric sleeve surgery in summer 2017.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Melissa

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

Patient support at TMC Bariatric Center

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

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

Getting started

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

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

 Personalized program

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

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

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

Confident and prepared

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

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

More than medicine

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

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

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

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

Success

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

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

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

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

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

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

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

 

 

 

Cold home remedies – What should you try?

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

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

Zinc lozenges or nasal spray

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

Nasal irrigation and neti pots

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

Hot ginger and lemon tea

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

Echinacea

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

Vitamin C

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

Essential oils, aromatherapy

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

Steam vapor

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

Elderberry

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

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

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

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

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

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

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

 

 

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

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

Photo by Alex Pasarelu

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

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

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

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

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

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

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

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

 

An Emergency Room Visit: A Patient’s View

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

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

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

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

Signs of a stroke

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

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

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

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

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

Bell’s Palsy

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

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

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

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

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

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

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

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

What cheeses should I avoid during pregnancy?

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

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

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

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

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

So what cheeses can I eat?

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

Protecting your family against rabies

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

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

Advice to parents and caregivers regarding rabies:

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

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

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

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

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

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

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

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

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

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

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

We have bats in our house should I be worried?

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

Tim Bohan NPTim Bohan
Nurse Practitioner
TMC Pediatric Emergency Department

 

Why children with diabetes need a pediatric endocrinologist

Why see a pediatric endocrinologist

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

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

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

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

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

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

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

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

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

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

Type 1 diabetes

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

Type 2 diabetes

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

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

Which type of diabetes is more common in children?

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

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

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

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

Can children acquire both types of diabetes?

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

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

Check out our blog posts about Type 1 diabetes.

When your child is diagnosed with Type 1 diabetes

Dr. Priti Gupta Patel, pediatric endocrinologist

Dr. Chetanbabu M. Patel, pediatric endocrinologist

Dr. Chetanbabu M. Patel, pediatric endocrinologist

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Make my kid better please!

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

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

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

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

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

Healthy wishes,
Melissa Hodges RN

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

When your child is diagnosed with Type 1 diabetes

type one diabetes diagnosed

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

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

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

Symptoms of Type 1 diabetes

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

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

Is there a cure for Type 1 diabetes?

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

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

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

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

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

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

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

What does it mean to ‘manage’ diabetes?

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

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

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

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

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

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

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

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

You can find the TMCOne pediatric endocrinologist contact information here.

Making the most of your primary care visit

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

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

Before the visit

First steps

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

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

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

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

Arrive a little early

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

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

Prioritize your questions and share your goals

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

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

During your visit

The PCP is here for you

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

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

Your needs are the priority

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

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

Long-term health goals

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

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

After your visit

Schedule your next appointment before you leave

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

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

Schedule referrals, testing and blood draws right away

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

The PCP is your health resource

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

Get all the answers

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

MyChart

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

With MyChart you can:

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

Provide input

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

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

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

Click here for further information about MyChart.

Pregnancy and Back Pain – Tips from an Expert

pregnancy-back-pain

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

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

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

Why do so many pregnant women experience backaches?

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

What can you do to prevent backaches during pregnancy?

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

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

When to contact a physical therapist?

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

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

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

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

How to perform a squat

Evens provided these tips for performing an effective squat:

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

Remember good squats require good hip strength and flexibility.

 

This post was first shared on May 1, 2014

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

Is it the flu or just a cold?

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

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

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

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

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

Treatment of the flu

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

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

Should I take antibiotics?

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

When should I contact a primary care provider?

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

Who is at risk for flu complications?

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

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

How to prevent the flu

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

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

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

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

But I always feel sick after the flu vaccine!

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

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

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

When should I get the flu vaccine?

Now!

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

 

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

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

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

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

 

“Diabetes doesn’t change who I am”

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

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

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

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

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

What does having Type 1 diabetes mean to you?

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

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

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

Do you have a special diet?

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

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

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

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

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

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

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

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

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

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

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

 

Stay in optimum health, prevent metabolic syndrome

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

Are you at risk for developing metabolic syndrome?

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

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

Tell me more. What is metabolic syndrome?

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

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

How is it diagnosed?

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

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

What is the prevalence of metabolic syndrome?

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

What is the treatment?

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

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

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

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

 

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

 

Recent breast cancer diagnosis? Advice from breast cancer survivors

Vanessa H-B.jpg

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

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

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

2. Write down your questions

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

3. Beware of Dr. Google

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

4. Talk to your doctor about risk and benefits

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

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

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

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

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

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

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

8. Let people know what you need from them

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

 

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

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

 

 

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

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

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

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

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

Weight-Loss Counseling Program

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

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

Weight-Loss Surgery from the TMC Bariatric Center of Excellence

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

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

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

 

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

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

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

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

Advancements in chronic pain treatment – more than medication

chronic pain treatment, beyond medicationPain management specialist Dr. Robert J. Berens shares how advancements in chronic pain treatment are providing relief without a prescription.

What advances have a made a significant impact in chronic pain treatment?

Over the past few decades, the treatment options have been refined and improved for interventional pain medicine. We have many techniques to target specific nerves and try to reduce or eliminate their ability to generate pain signals in the brain.

Sometimes we can accomplish this with medication management and other times, minimally invasive techniques can offer more directed treatment with a more rapid resolution.

We have advanced techniques in radio frequency treatments to provide longer-term control of pain, in addition to directed nerve root therapies to establish relief.

Spinal cord stimulation is an area of significant improvement. We are now able to implant targeted stimulators into the area of the spine to control abnormal signals to the brain that are difficult to treat with other modalities.

What is interventional pain management?

Interventional pain management is a discipline in pain medicine that helps relieve patients of their pain by going beyond medication. It relies on a wide array of therapies to diagnose, reduce, and often eliminate a patient’s pain.

Minimally-invasive techniques have the ability to diagnose a problem and treat the pain accordingly – often via a procedure or treatment, such as injections or devices and managed over time if necessary.

Many interventional treatment therapies have been used to treat most aspects of spine related pain, and return a patient to their normal level of activities as soon as possible.

What are the advantages of seeing a pain management specialist?

Most patients initially receive their pain care from the primary physician. When pain control is not within reach or a more targeted treatment is available, the primary physician or others will refer to a pain specialist.

When is it time to seek a pain management specialist?

Pain can often begin as an acute problem and slowly change into a chronic problem that is difficult to treat. Chronic pain can be from a long-standing problem with or without an initial injury.

Once a problem does not appear to be improving, it is likely entering a chronic phase. Acute and chronic pain can be treated by a pain specialist and this should be considered at any time in the course of the problem.

It can often be noted that early referrals to an interventional specialist can often help to provide a more rapid reduction in pain, and at times eliminate the source.

Why have you continued to provide care at TMC?

I have been associated with TMC since 1990 because TMC has been a leader in our community and has consistently provided patient-centered care.

We have been fortunate to have a fabulous staff to support our services and provide compassionate care to our patients.

TMC has established itself through its commitment to excellence and its focus on creating the best team approach in Southern Arizona.

Dr. Berens

Dr. Robert J. Berens is board certified in pain management and anesthesiology. He has been in practice since 1990 and has served as the medical director of the TMC Integrative Pain Center since 2004.

For further information or to schedule an appointment, please call (520) 324-2080.

The Integrative Pain Center is located at 5355 E. Erickson Dr.

 

One foot at a time – Newborn screening

Electine Orido RN and Baby Cash

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

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

Find out more about the Arizona Newborn Screening Panel

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

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

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

What is involved in newborn screening?

Kassandra and baby Cash

1. Blood Test

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

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

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

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

2. Pulse Oximetry

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

3. Bilirubinometer

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

4. Newborn hearing screening

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

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

Find out more: FREE maternity services tour.

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.

 


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