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.

 

Osteoporosis: “The most important factor is prevention”

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

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

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

OsteoporosisWhy are women at greater risk for osteoporosis?  

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

What can accentuate this risk?

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

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

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

What are the most effective means of preventing osteoporosis?

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

 

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

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

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

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

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

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

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

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

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

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

 

During National Donate Life Month, organ donation impacted TMC family

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Stroke Prevention Saturday April 15 at TMC

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

Free testing for:

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

A physician will review your results with you.

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

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

No appointment necessary. Please allow 45 minutes for screening.

Light snacks will be available.

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

Second chance at life means racking up the running miles

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Physician achieves ablation milestone at TMC

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A chance to meet with Dr. Peress

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

Peress.jpg

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

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

image3Cancer is often anything but a textbook disease.

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

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

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

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

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

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

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

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

Endocrinology addresses thyroid health challenges

Dr. Divya Reddy Pati addresses thyroid health issues, endocrinology

by Divya Reddy Pati M.D.

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

What is the thyroid gland?

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

 Prevalence

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

What is a nodule?

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

What are the risks?

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

Endocrinology

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

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

Treatment

Treatment of thyroid nodules depends on the type of nodule.

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

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

Regular provider visits

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

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

Stay in optimum health, prevent metabolic syndrome

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

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

Tell me more. What is metabolic syndrome?

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

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

How is it diagnosed?

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

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

Prevalence

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

Treatment

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

Optimum health

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

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Divya Reddy Pati, M.D.

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

TMC One Med Group your health your team OL

Vaccines are particularly important for seniors

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

Flu vaccine

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

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

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

Pneumococcal or pneumonia vaccine

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

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

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

Tetanus, diphtheria and pertussis vaccines

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

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

Shingles vaccine

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

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

Vaccines are particularly important for seniors

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

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

TMC One Med Group your health your team OL

Breast cancer – what men need to know

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

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

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

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

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

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

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

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

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

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

Additional resources:

Susan G. Komen

Susan G. Komen Arizona

National Breast Cancer Foundation, Inc.

Breastcancer.org

Breast Cancer Research Foundation

American Breast Cancer Foundation

Foundation for Women’s Cancer

American Cancer Society

Centers for Disease Control and Prevention

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

breast-center

 

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

Dementia: Starting the conversation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

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

 

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Support resources:

Local fire captain on the mend after catastrophic aneurysm

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Pharmacist shares information about prescriptions over video conference

Pharmacist shares information about prescriptions over video conference

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

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

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

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

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

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

Among other conveniences, the Pharmacy:

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

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

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

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

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

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

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

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

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

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

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

Arizona baseball coach Andy Lopez recovering well from heart surgery

by Anthony Gimino on Oct. 16, 2013

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

Photo by Anthony Gimino, TucsonCitizen.com

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

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

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

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

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

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

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

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

 

 

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

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

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

Vascular surgeon Dr. Matthew Namanny, Saguaro Surgical

Vascular surgeon Dr. Matthew Namanny,
Saguaro Surgical

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

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

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

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

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

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

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

Dr. Thomas Lindow,Internal Medicine

Dr. Thomas Lindow,
Internal Medicine

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

Luckily she did.

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

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

Dr. Matthew Namanny,Saguaro Surgical

Dr. Matthew Namanny,
Saguaro Surgical

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

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

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

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

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

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


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