Screening reveals stroke risk – An update on Norman

Norman and Mary Louise Clarke - carotid artery screening

Norman and Mary Louise Clarke

Norman Clarke had no reason to think that there was anything amiss when he stopped by for a preventative screening including a carotid artery screening at TMC two years ago. At 81 years old, the retired automotive engineer exercised three times a week at the gym, saw his doctor twice a year for checkups, took medication to keep his cholesterol in check – and his blood work always came back great.

He and his wife, Mary Louise, were stunned at his results of a preventative screening.

A scan of his carotid artery showed a blockage of more than 70 percent on the left side.

“I was shocked. There had been no symptoms and nothing to indicate this was a problem,” Norman recalled. “It was serendipity that we went that day, because I would never have known otherwise about the great risk I was facing.”

The carotid artery screening, part of the vascular wellness screening, uses an instrument called a transducer to scan the carotid artery in your neck. The transducer scans the carotid artery to check the flow of blood and can identify plaques and blockages that put you at risk for an ischemic stroke.

A stroke on the left side of Norman’s brain would have impacted the right side of his body, possibly impacting his mobility on the right side of the body, as well as speech and language problems, and memory loss.

Following the screening results, Norman’s doctor cleared the calendar to bring him in on a Monday morning, and by Monday afternoon he was having a scan of his arteries. The news was even worse than he had learned initially: the blockage was 90 percent.

Instead of being on a plane to Michigan, where the Clarke’s spend six months of the year, Norman was scheduled for surgery. The 90-minute surgery, known as a carotid endarterectomy, required one night of hospitalization and a week of good behavior at home: no lifting or dragging of heavy objects and listening to every instruction from Mary Louise, a former medical-surgical nurse and retired nursing professor.

Fast forward to 2017, Norman and Mary Louise are planning their return to their Tucson home from Michigan, to the magical pink mountains, the town and the network of Tucson friends, to volunteering at TMC, and to see Norman’s Tucson doctor.

Norman’s doctor monitors both the left and right carotid arteries every six months. The initial screening alerted the Clarke’s to the danger lurking in Norman’s left carotid artery. A subsequent screening has revealed a growing plaque in Norman’s right carotid artery. At this time there is no surgery planned, but monitoring is critical. Norman’s advice: “Be your own health advocate … get screened. Everything looked rosy for me, but just because your blood work is OK, it doesn’t mean everything is.”

 

TMC honors 50-year employee at annual employee recognition event

BDP42971.jpgNancy Spiller left home at 17, just out of high school, armed with little more than her diploma and some experience working as a volunteer candy striper.

She landed her first job at Tucson Medical Center – and now, 50 years after she was hired into the business office that day, she’s still coming to work every morning to the same place.

“Fifty is a big year – it’s very special to me,” said Spiller, who has worked eight different jobs during her tenure, most recently serving as clerical support in pediatric therapies.

Spiller will be celebrated at TMC’s annual Service Pin ceremony, which honors employees at every five-year milestone of their careers.

There are 467 honorees this year, including 18 people with upwards of 40 years of service. Spiller is one of two employees with the longest running length of service.

Aside from the fact she needed a job, Spiller wanted to help people, which is why she served as a candy striper. When she was in the fourth grade, her mother died, which in retrospect, she said, might have fueled her interest in health care.

Spiller came to TMC two months after the arrival of Don Shropshire, a beloved and iconic leader who served 25 years as TMC’s CEO.

She remembers being so naïve that her colleagues teased her routinely. One afternoon, they told her Mr. Shropshire was holding on the phone for her. She chided them, saying she knew they were making up stories. After much back and forth, an exasperated Spiller went to the phone.

“Who was on the other end? Mr. Shropshire. He was going on a business trip out of town and I was the only person with the combination to get into the safe for business travel. I was never so embarrassed,” she recalled.

NancySpillerCelebrates50YearsTMC was a very different place then; small compared to today’s campus. A cart that wheeled from room to room served as the gift shop.  Vending machines, not a cafeteria, stocked food. Laboring mothers were just screened off from one another with privacy curtains. Calls came in on old operator switchboards.

Five of her closest friends came from TMC – one of whom she’s known since she started 50 years ago.

“We’ve been through marriages and divorces and births and sickness and death and baptisms – you name it,” she said. “We’ve been through it all.”

Spiller remembered the hospital rallying around her when she had her first child, Steven, who was born with a heart condition and required complex surgery. Mr. Shropshire sent a card. The staff raised money through a bake sale. “It wasn’t just coming to do work here – it was like a family rallying around to help,” she recalled. “If I had to do all of it on my own, I’m not sure I could have made it.”

Steven lived to the age of 24. His younger brother Matthew is now a newlywed.

Both were born at TMC.

Spiller initially meant to retire at her 45th milestone, but here she is, still, 5 years later.

In part, it’s because the work is rewarding. She mists up telling of one boy with autism who came in speaking very little, if at all, and who now tells her all about his day.

“I think it’s wonderful what TMC does in the community,” she said.

“I have gone home in tears because of these kids and what we’re able to do for them. If I can make a difference for just one person, that means a lot to me. I wouldn’t still be here if I didn’t think I still had that ability.”

TMC Jobs link

 

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.

 

 

Make summer snacks fun, tasty and healthy

Summer snack 3Summertime brings vacations, warm weather and great food. The TMC and TMCOne Clinical Dietician Kallie Siderewicz offers some tips to make summer food fun, tasty and healthy.

Healthy doesn’t mean boring

Try a peanut butter and low-fat Greek yogurt dip for fruit. Ranch seasoning also gives Greek yogurt the yum factor for dipping veggies.

Other fun dishes include fruit kabobs, apples slices topped with peanut butter, coconut, and chocolate chips. A summertime favorite is fruit coated with frozen yogurt.

Cool off by infusing water or tea with lemon, lime, berries, oranges, mint, or rosemary.

Summer snackFor an adult beverage, try light beer, a glass of red wine or liquor mixed with water or diet soda.

High-calorie pitfalls

Before hot summer days have you reaching for a frozen coffee drink – remember that a small serving can have over 500 calories. Sodas and most sports drinks offer hard-to-burn calories with no nutrition.

For adults, mixed drinks usually combine alcohol and sugar, piling calories on top of calories.

Fruit salads made with fruit canned in heavy syrup can have as many calories as pie and cake, especially if you add marshmallows and whipped cream.

Don’t forget water

Water is the absolute best thing you can give your body. It hydrates, helps cleanse and cool. Another good reason to drink water – it can aid in weight loss.

Kallie Siderewicz.jpg

 

 

Kallie Siderewicz is a clinical dietician at the TMCOne Rincon location. She also provides nutrition services at Tucson Medical Center.

Admissions nurse named ‘Heart of Hospice’

Karen Novak, R.N., sitting, with (l-r) interim director Kimberley Fore, manager Stephanie Carter and medical director Larry Lincoln

Karen Novak, R.N., with TMC Outpatient Hospice, was honored this morning at a quarterly recognition selected by her colleagues as the “Heart of Hospice.”

Novak, who has been with Tucson Medical Center for more than 20 years, is the TMC Hospice liasion for the hospital. As a TMC Hospice admissions nurse, she works closely with the Palliative Care Team and Case Management as well as with patients and families who are dealing with potential end-of-life issues.

“Karen helps to aid in transitioning patients smoothly between the hospital and Hospice,” according to her nomination. “Her bedside manner is impeccable. She has a way of speaking with patients and family members that allow them to feel that they are both being understood in what they want and cared for in a compassionate way that embodies the mission of Hospice.”

Novak learned her skills in a variety of settings, including in the Emergency Department when it included truma care, and Case Management. She works with patients of all ages, including pediatric cases.

The quarterly award comes with a recognition plaque on the unit, a pin and a dedicated parking space. The award allows colleagues to recognize their peers:

Everything he or she does is for our patients and families and personifies compassion, kindness, empathy, a great work ethic and knowledge. The Heart of Hospice is also someone who is calm under pressure, is respectful, is detail-oriented, is a critical thinker, and has great communication skills. This person is someone who is always there to help his or her peers and does so with grace and skill. Being able to nominate someone for this award is a gift because it means you have observed greatness, not just once, but every time you have interacted with this individual.

Has a hospice nurse made a difference to you or your family? Consider recognizing this extraordinary nurse with a DAISY Award nomination.

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.

pati1

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

Developing rituals can help build balance

Terri Waldman on developing rituals to balance lifeTerri Waldman, the Director of TMC’s Geropsychiatric Center, was one of the experts interviewed for the Arizona Daily Star’s series on dementia, Hope and Help. Among the stories was one on finding hope. Here is her monthly column on the importance of building ritual.

Every morning, I go for a walk with my dog.

If I miss that walk for some reason, my day just feels a little off.

It’s one of my rituals, along with meditation, that gives shape to my day.

Ritual, which is increasingly recognized as important to our health and wellbeing, is more than merely everyday habit. But to be clear, it also does not have to be reserved for just the sacred and complicated.

Whether we are talking about rituals of religion, families or individuals, those intentional steps we take on a regular basis help remind us about what’s important and help us build a sense of stability in our lives.

When I was a child, bedtime meant my parents would tell each other and their children that they were loved. For me, regardless of family squabbles or anything else that happened during the day, it gave me that sense of continuity. No matter what else I faced, love was not a negotiation.

When you hear “ritual,” there are all kinds of ideas in our head about what that looks like, often involving ceremonial trappings and historical foundations. But it can be as simple as having dinner as a family – a ritual that is growing in importance all the time as we lose some of that precious time to busy lives and technology.

It can be having a cup of coffee on your patio to start your morning. It could be a cup of tea in the evening. It could be a prayer before bed.  It’s any time you carve out that feels good and centering and maybe even healing to you.

In the work I do, I’ve noticed that some people’s lives become imbalanced because they lack structure. Rituals have a way of grounding you. Even if you’re traveling, you can still have that morning coffee or that bedtime tea and feel a sense of structure. Ritual does not have to be rigid. And it doesn’t have to be something handed down through generations – it can be something you create.

If ritual is something you want to more fully develop in your life, you might look at your life to see what you have in it already.  You probably have more of it in your life than you think. If it isn’t obvious to you, you might ask a friend: What do you see in my life that brings me comfort?

You might just start with something simple: Finding 5 minutes of quiet time with your thoughts. It’s easy to click on the TV or the radio for a distraction, but learning to be present with oneself can be a gift. And it might just start with one, simple ritual.

Terri Waldman has more than 20 years of experience in providing services, advocacy and leadership in the field of aging in Pima County. Currently the Director of the TMC Geropsychiatric Center at Handmaker, Waldman received her Masters in Social Work at Arizona State University. She follows her father’s philosophy that five minutes of laughter every day leads to quality in life.

TMCOne now offers highly experienced care for your entire family in Rita Ranch

Thomas Weisman, M.D. Family Practice TMC One

Thomas Weisman, M.D.
Family Practice
TMCOne

As a board-certified family physician, Thomas Weisman, M.D., brings a wealth of experience to TMCOne. For decades, he worked in family medicine and emergency care. Having worked in Rita Ranch for the past 12 years, he knows the community well. He’s excited to now offer his expertise as part of TMCOne – a group that he feels provides a spirit of medical care that is much needed in the Tucson area. He describes this care as “medical care with a heart.”

Dr. Weisman looks forward to earning your trust, and is confident that TMCOne will make a positive contribution to people who live in Southeast Tucson.

▪ What is your background? 

I was born and grew up in New Jersey. I attended Haverford College in Pennsylvania, then graduated from University of Pennsylvania Medical School. I interned at Cook County Hospital in Chicago before opening my own family medicine private practice in West Virginia where I cared for patients for 18 years.  I eventually left private practice and became a full-time Emergency Department physician. Over the next decade, I worked in emergency rooms in West Virginia and California. My family and I decided to move to Arizona where I returned to family practice. I worked in Rita Ranch for 12 years and am thrilled to now provide care to this community through TMC One. I am married with two children.

▪ What inspired you to go into primary care?

A profound experience as a child inspired me to go into primary care. When I was a little boy, I was cared for by my cousin who was a general practitioner. His office was on the second floor of a house and he would often see me at home when I was sick. I have vivid memories of his dark suit, vest, pocket watch and bag that smelled of leather and alcohol. He was extremely dedicated to his work and it seemed like a noble path for my life as well.

▪ What made you decide to come to Tucson?

My family and I decided to come to Tucson because my wife’s family lives here and they love it. My wife fell in love with Tucson, and I followed her lead. Truth be told, the first time I visited here it was 110 degrees out. I wasn’t so sure about uprooting from California but I’ve grown to tolerate the Arizona heat!

▪ What do you think is the biggest health risk facing Southern Arizonans?

I think the biggest health risk facing Southern Arizonans is the rapidly rising cost of care, and the confusion of our health care financial system. Who can keep track of it all?

▪ Do you have any areas that are of particular interest to you?

My interests are primarily focused on internal medicine, which is a major area of my studies. I enjoy family medicine because I’m able to foster a relationship with my patients and their families. Having deep-rooted knowledge of a family and their dynamic allows me to know the full story and therefore provide exceptional care.

▪ Why is it so important for people to get established with a PCP before they get sick?

I know that no one likes to get sick, and no one likes going to the doctor as it can be stressful. But the reality is, people get sick. If you have established a good relationship with your PCP and have faith in them when you’re healthy, it makes things easier when you are sick and need to go see them. From a physician’s perspective, it’s easier to make an accurate diagnosis and create an appropriate treatment plan if you know your patient’s case beforehand.

▪ What has been your most valuable life experience that has impacted your medical career?

My most valuable life experience that has impacted my medical career is having a family. It has helped me relate to so many of my patients. I believe that many of us have similar life problems, and having empathy for each other helps us ultimately understand each other better.

▪  How do you approach your relationship with your patients?

I have found that being a partner to my patients helps me create a plan of care with them rather than for them. I don’t want my patients to look at me as the boss of their health care. My goal is to partner with them to try and keep them healthy, or get them better quickly when they are sick. I use an understanding and patient approach when dealing with my patients and work to not just treat their symptoms, but help organize their care.

Dr. Weisman is accepting new patients!
TMCOne’s Rita Ranch location is at 9356 E. Rita Road, #180.
Expanded hours for your convenience! Appointments available as late at 8 p.m.
Call (520) 324-4499 to make an appointment.

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.”


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