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 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.

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.


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.


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

find a doctor in Tucson

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.

TMCOne opens specialty clinic on NW side, providing quality care and convenience

TMC One Med Group your health your team OLProviding high-quality care means recognizing all aspects that benefit patients and their families. Convenience matters, and TMCOne’s  new clinic will make quality medical care and treatment more convenient for northwest residents by including commonly needed follow-up services at one location.

TMCOne is opening a specialized clinic on 7510 N. Oracle just south of Magee road in northwest Tucson. The office will provide comprehensive and specialized care, as well as imaging, IV infusion and health management services.

Susan Vance 1“This unique clinic has been thoughtfully designed to meet varied medical needs in one place,” said TMCOne Executive Director Susan Vance. “From sports medicine and health counseling to imaging and same-day appointments, we’re taking the next step in care.”

Specialties that often converge such as wound care, chronic disease counseling and complex medication regimens can now be managed in one office rather than several clinics. On-site lab and x-ray services will also reduce multiple trips and appointments.

Borrás Carlos
Dr. Carlos A. Borrás has joined the provider team at the Oracle office. He specializes in both internal medicine and sports medicine, providing a needed perspective for injuries related to golf, swimming, tennis, and other sports.

Dr. Dawn Lemcke also joins the northwest office, brining more than 30 years of internal medicine experience – and a strong focus on communication with patients and families.

The office is conveniently located for Oro Valley, Marana and northwest Tucson residents. Same-day appointments and expanded hours further enhance accessibility.

Patients can visit or call (520) 324-4910 to schedule an appointment or for further information.





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.  


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 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 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.

New nurse practitioner in Rita Ranch available to help you and your family with an assortment of ailments

TMC One welcomes Arvie Webster, a board-certified family nurse practitioner who is now available to see patients at one of TMC One’s Rita Ranch locations. Arvie brings a wealth of knowledge and life experience in providing compassionate care for you and your family.


Arvie Webster, FNP-C

What is your background? 

I was born in Illinois and raised in Kentucky. I served in the military as a U.S. Army officer before practicing as a Nurse Practitioner. During that time, I was stationed all across the country. But I’m glad to have planted some roots in Tucson! I graduated with my bachelor’s degree in nursing from Bellarmine University in Louisville, Kentucky. Then I spent 10 years in nursing, primarily in emergency and trauma, before returning for my master’s degree in nursing and health care systems from Grand Canyon University. After having an administrative nursing role, I realized my passion was patient care so I returned for my post-master’s degree in family nurse practitioner from the University of Phoenix.

What inspired you to go into primary care?

Growing up in a small town, our community had one family medicine physician. He practiced on the ground level of his house and his wife was his office manager. As a child, I remember him taking such great care of my family and me – everything from strep throat to high blood pressure to stitching us up when we had accidents. He was always so calm, friendly and put you at ease during visits. I was never reluctant to go see him. I think everyone should feel the same way about visiting their primary care provider. He was my inspiration for choosing primary care.

What made you decide to come to Tucson?

My husband followed me all over the country while I served in the military so once I was released from active duty, I told him he could choose where we lived. I’m so glad he picked Tucson! There is so much to do outdoors and I love the diversity here. We enjoy all the road biking, mountain biking, rock climbing and swimming that Tucson offers.

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

I think everyday stress is the biggest health risk facing Southern Arizonans. We are all so preoccupied with world events, disasters, politics, finances, hectic work schedules and trying to be involved in our children’s activities, that we rarely find time for ourselves to “unplug.” High levels of ongoing stress lead to unhealthy eating habits, lack of time and energy to exercise, sleep deprivation, anxiety and mild depression due to feeling so overwhelmed. One way to combat stress is by having a healthy work-life balance and understanding that it is OK to have time to yourself to pursue things that make you happy.

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

Special interests of mine include injury and disease prevention as well as screening-exam education. For example, I have a unique approach to conversations that most patients may find awkward. I empathize with my patients and handle these topics with great concern while doing my best to make them feel comfortable when discussing things like how to perform a self breast examination correctly, or the importance of young men examining their testicles. I also feel like it is my obligation to educate patients about what medications may put them at an increased risk for injury with even minor trauma. I am a firm believer that quality education raises awareness rather than fear and avoidance.

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

Have you ever found yourself tasked with a project that you think will be easy and then you figure out that it is actually really complicated and you wish you had help? Health is very similar. For most people, it starts out easy but has the potential to get very complicated, very quickly.  By getting established with a provider before you get sick, you have help before things get complicated and can potentially prevent your health from getting complicated.

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

The military taught me many life lessons but the one lesson that always seemed to be natural to me was “take care of the soldier next to you.” This meant even if you didn’t see eye to eye with the person next to you, you still took care of them because they were your best chance of survival. In the civilian world, I believe this is also true for our communities. Even if we do not necessarily agree with someone, we must take care of each other in order to survive.

How do you approach your relationship with your patients?

My relationship with my patients is a partnership. I consider my patients experts with their own bodies because no one lives with their body as long as they do. I offer health education to prevent and manage illness, translate symptoms into health conditions and provide assistance in navigating the health care system, but  believe that both parties must be engaged in order for the partnership to succeed.

Arvie Webster is accepting new patients!
TMC One’s Rita Ranch location is at 9348 E. Rita Road, #100.
Expanded hours for your convenience! Appointments available as early as 6:30 a.m.
Call (520) 324-4760 to make an appointment.

Flu-like symptoms? TMC One offers same-day appointment

If you are seeking immediate care for flu-like symptoms, call TMC One, 324-2160, to schedule a same-day appointment.TMC One

TMC One’s Dr. William Abraham, M.D., specializes in same-day or next-day appointment. He is board-certified in internal medicine and has more than 30 years experience. His office is located at 1396 N. Wilmot Road.

Visit TMC One online at


TMC, TMC One now part of The Network – Arizona’s electronic health information exchange

HINAzToday Tucson Medical Center and TMC One join a growing list of Arizona health care providers electronically connected via The Network, Arizona Health-e Connection’s statewide electronic health information exchange, or HIE.

The Network aims to solve the challenge of knitting together a patient’s complete medical record in a traditionally fragmented system. Access to better and more complete information at the point of care can improve decision making and care management.

The Network includes a long list of providers, hospitals, reference labs and health plans. These entities can access and view a patient’s current and historical medical information from many sources. Additionally, the patient’s information can be queried and downloaded to a practice’s or a hospital’s electronic medical record.

The first time a patient is seen in one of these practices or visits TMC, including outpatient areas, the patient will be asked to sign an HIE notice explaining this secure electronic information sharing. Other than signing this notice, nothing needs to be done to have records made available to other providers. If a patient doesn’t want to share information, an opt-out form can be completed at this time. Patients have the right to change their mind at anytime to either opt out or to opt back in.

For additional information click for answers to frequently asked questions. You can also contact the Network directly, or (602) 688‐7200. The Network’s website is

Second opinions, survival rates and treatment options: TMC One’s breast oncology surgeon weighs in on cancer diagnoses

Throughout the month of October, Breast Cancer Awareness Month, we tapped into the expertise of Dr. Michele Boyce Ley, TMC One’s new board-certified breast oncology surgeon and medical director of TMC’s Breast Health Program. We’ve shared information with you including how to assess your breast cancer risk, asked her to weigh in on myths about breast screening including mammography and self-breast exams and had her tell us what to do – and consider – if you find a lump in your breast.

To round out this blog series, we asked her opinion on a story that was recently released by the Susan G. Komen organization titled: Debunking Five Common Myths About Breast Cancer Treatment.

We decided to focus on the three Dr. Boyce Ley thought would be the most meaningful.

Myth #1: I don’t have time to get a second opinion because I must begin treatment as soon as possible.

BDP36480First – that second opinion issue. “Second opinions are important for a couple of reasons,” said Dr. Boyce Ley. “Maybe the physician you initially went to isn’t a breast specialist. Or maybe they’re just not a good fit for you. Women need to know that it’s OK to find another doctor! Don’t worry about offending your current doctor or the person who referred you to them. It’s your health. People need to feel empowered to get multiple opinions.” Dr. Boyce Ley added that second opinions are also great because perhaps the first time around, you didn’t quite understand all of the information. Or maybe one physician has a treatment option that another doctor didn’t offer you.

Second – how soon after diagnosis should treatment start? The National Breast and Cervical Center Early Detection Program guidelines recommend starting treatment within 60 days of being diagnosed. Dr. Boyce Ley said that timeframe is readily accepted by most people – that two months is the maximum amount of time a patient should wait before starting therapy. She added that most patients in Southern Arizona begin therapy within a month of being diagnosed. “I think this is really hard for patients,” she said. “They feel like it’s an emergency, but realistically, it takes years for the cancer to grow. A couple of weeks in the life of breast cancer doesn’t change the outcome. Even a patient with an aggressive cancer will usually start therapy within a week or two.”

Myth #2: Everyone diagnosed with breast cancer dies from breast cancer or everyone diagnosed with breast cancer survives.

Dr. Boyce Ley stressed that breast cancer is not a death sentence. With modern treatment, an estimated 90 percent of women with early-stage breast cancer will go on to live five or more years after diagnosis without it recurring. Of course survival rates vary based on what stage the cancer is in and what kind of behavior the breast cancer has. According to the National Cancer Institute, there are about three million breast cancer survivors in the United States. However, more than 40,000 women and more than 400 men still die from breast cancer every year. The reality is that while most people will survive breast cancer, unfortunately some patients will not.

Myth #3: Chemotherapy and radiation therapy are more harmful than helpful.

Decades of breast cancer research have proven that chemotherapy and radiation therapy saves lives. “We know that these are two things that contribute to better survival,” said Dr. Boyce Ley. “Historically, doctors have gone from giving no chemotherapy to giving too much chemotherapy and now we’re working hard to give patients just the right amount.”

She added that doctors these days have lots of ways to analyze a patient’s cancer to identify more clearly what treatment would benefit the patient. This allows a treatment plan to be tailored to that specific patient. “We have ways to identify which patients are going to benefit from which targeted therapies,” said Dr. Boyce Ley. “The same can be said for targeted radiation. We have the ability to target one part of the breast where the cancer is and avoid radiation damage to the heart and lungs. Those are things we didn’t have available to us 15 years ago.”

Dr. Boyce Ley is accepting new patients! She is located at 2625 N. Craycroft Rd #201. Call (520) 324-BRST (2778) to make an appointment.

To schedule a mammogram, call (520) 324-2075. For more information about our free mammogram program for uninsured women, call the TMC for Women Breast Center at
(520) 324-1286 to review qualifications and schedule an appointment.

You’ve found a lump in your breast. Now what?

Dr. Michele Boyce Ley, TMC One’s new board-certified breast oncology surgeon and medical director of TMC’s Breast Health Program, has shared her expertise with us over the past few weeks about how to assess your breast cancer risk. She also helped us clarify some myths about breast screening including mammography, while stressing the importance of being aware of changes in your body. Having a good gauge on what your breasts normally feel like will help you know when something isn’t quite right.

So – what if you find something?

Dr. Boyce Ley said your best bet is to start with your primary care physician. Don’t have one? Chances are you’ll find one you totally connect with at TMC One. Your physician will typically order breast imaging. A mammogram and ultrasound can solve many questions without escalating it to a breast specialist.

BDP36503When should your first call be to a breast specialist? If you notice changes with your nipple or if your breast has suddenly changed color, size, shape or texture. Dr. Boyce Ley said she often sees women who, upon finding an abnormal mass in their breast, instantly jump to a worst case scenario – “who will take care of my kids when I die?” She advises women in this situation to keep this in mind: “Most of the time, it’s not going to be cancer,” said Dr. Boyce Ley, “but that still means you should pursue it. Even if you have an abnormal screening mammogram, the chance of finding a cancer is very small. A majority of the time, we may need to do further testing but oftentimes it turns out to be something benign like a cyst or overlapping breast tissue. Those are the two most common things we find.”

The take away message: Statistically, it’s unlikely that the mass you feel is going to be cancer.
If it is cancer, it
’s likely small and easily treatable.

If the initial imaging shows the mass is benign, but your physician recommends a biopsy, Dr. Boyce Ley said it’s not a bad idea to get a second opinion before getting a biopsy. Sometimes the recommendation to biopsy may differ from physician to physician and some things can be followed with imaging and exams. You may feel an urgency to get an answer but taking your time to make a good choice is important. However, Dr. Boyce Ley cautioned that if a biopsy is recommended for you, follow through with it because it could save your life.

“So many women come in with ideas that they’ve gotten from their friends and neighbors instead of medical professionals. They’ve already decided that they’re dying or that they need a double mastectomy. As a breast surgeon, it can be very hard to unwind that thinking. Is it important to get into someone quickly? Yes. But breast cancer is not an emergency. A difference of one or two days – even a week – is not going to make a difference with your treatment. In the age of quick information that we live in, while it’s possible to find information easily, it’s not necessarily helpful.”  Dr. Boyce Ley gave this advice: “Get the facts. Figure out your options. And then come up with a game plan that’s best for YOU.”

Dr. Boyce Ley is accepting new patients!
She is located at 2625 N Craycroft Rd #201.
Call (520) 324-BRST (2778) to make an appointment.

To schedule a mammogram, call (520) 324-2075. For more information about our free mammogram program for uninsured women, call the TMC for Women Breast Center at
(520) 324-1286 to review qualifications and schedule an appointment.

COPD: Sorting out misconceptions and medication mismanagement

“It’s like breathing through a straw.”

“Most days, I feel like a fish out of water gasping for air.”

“It takes me three times longer to accomplish everything due to shortness of breath and lack of stamina.”

Dr. William Abraham Board-Certified, Internal Medicine TMC One

Dr. William Abraham
Board-Certified, Internal Medicine

That’s how some patients with chronic obstructive pulmonary disease, or COPD, describe life with their condition. It’s one of the most common lung diseases and it makes it difficult to breathe. According to the COPD Foundation, more than 24 million Americans, including more than 343,000 Arizonans, have been diagnosed with it. There are two main forms of COPD: chronic bronchitis, which involves a long-term cough with mucus, and emphysema, which involves damage to the lungs over time. Most people with COPD have a combination of both conditions.

Smoking is the main cause of COPD, but in rare cases, nonsmokers can develop emphysema. Other risk factors for COPD include exposure to certain gases or fumes in the workplace, exposure to heavy amounts of secondhand smoke and pollution, or frequent use of cooking fire without proper ventilation.

Symptoms include a cough, with or without mucus, fatigue, many respiratory infections, shortness of breath that gets worse with mild activity, wheezing and trouble catching one’s breath. There is no cure for COPD, but there are many things you can do to relieve symptoms and keep the disease from getting worse.

Medicines used to treat COPD include inhalers (bronchodilators) to help open the airways, inhaled or oral steroids to reduce lung inflammation, and anti-inflammatory drugs to reduce swelling in the airways. But there are a lot of common misuses with these medications.

Dr. William Abraham is a board-certified internal medicine physician with TMC One who has more than 30 years of experience. He sorted out some of the misinformation about popular medications in hopes of getting you to breathe easier.

Rescue inhalers: When are you puffing “too much”?

Short-acting bronchodilators or “rescue inhalers” are commonly used when a patient becomes short of breath. These are usually albuterol, under the brand names of ProAir HFA, Proventil HFA and Ventolin HFA. The liquid form may also be put in a nebulizer. They are designed to bring quick relief and work by relieving spasms in the airways or bronchial tubes. For inhalers, doctors usually prescribe two puffs every four to six hours as needed for shortness of breath or wheezing. While these medications provide instant relief, it’s important to keep in mind that they can also affect the heart and cause an irregular or a racing heartbeat. Using a rescue inhaler as it’s prescribed tends to only help the lungs although it’s not uncommon for some patients to notice their heart beat just a bit faster.

With COPD patients, the problem develops when they are short of breath and their condition is quickly becoming so severe that they start using their rescue inhaler significantly more than is prescribed – sometimes every 5 to 10 minutes! These medications can become quite dangerous and induce potentially fatal, irregular heart rhythms.

Bottom line: Never use a rescue inhaler more than every four hours.

▪ Maintenance inhalers: Do they really need to be used every day?

Many patients with COPD also have long-acting bronchodilator and corticosteroid combination inhalers prescribed for them. The common brand names for these are Advair, Symbicort and Dulera. Unlike rescue inhalers, which provide instant relief, these medications become effective only when used over a long period of time. For example, the corticosteroid component must be taken for seven days in order to become completely effective! When used correctly, these inhalers can prevent severe wheezing and shortness-of-breath attacks or episodes when there is a lot more mucus produced than usual.

As a result, patients can absolutely feel the effects of these long-acting bronchodilator and corticosteroid combination inhalers. Since they find themselves needing their rescue inhaler less often, doctors say these maintenance inhalers have a good compliance rate.

Problems develop, however, when patients use their long-acting, combination inhalers once a day instead of the recommended twice a day in an attempt to save money. Keep in mind, the bronchodilator component is only effective for 12 hours. If you’re using one of these maintenance inhalers only once a day, that means that for half your day, your lung function will be significantly decreased while the medication is no longer active. Or, patients may only start using their long-acting, combination inhaler when they begin to feel sick and their breathing starts to suffer. By then, it’s too late in the game to be able to experience any real benefit.

Bottom line: All of these maintenance inhalers should be used every 12 hours every day in order to receive the maximum benefits of these medications.

▪ I was recently diagnosed with COPD. Realistically, what’s my quality of life going to be and is there anything I can do to slow down the progression of the disease?

Oftentimes, newly diagnosed COPD patients believe that they will gradually lose more and more lung function over the years. These patients also often think that how quickly they’ll decline is predetermined by aging and severity of the disease. A common misconception is that, eventually, their lung function will become so poor that simple breathing will become impossible. Realistically, however, there are many factors that determine how quickly someone’s lung function will deteriorate.

There are things COPD patients can do to preserve their lung function for as long as possible. Perhaps the most important: quit smoking. Studies show that patients with COPD who continue to actively smoke will have their lung function decline about twice as fast as patients who quit smoking. Regardless if you are diagnosed with mild, moderate or severe COPD, it is never too late to quit smoking. Even if your lung function is tempered by the disease, making it the best it can be will translate to a stronger ability to be active, and therefore, have a better quality of life.

Bottom line: Even if you have been diagnosed with COPD, it is never too late to quit smoking.

Dr. Abraham is available for same-day appointments including annual physicals
if you are finding it difficult to get in to your regular provider.
His office is located at 1396 N. Wilmot Road in Tucson, 85712.
Call (520) 324-2160 to make an appointment.

Screening and mammography myths – what’s your “normal?”

BDP36471We are continuing our weekly blog series with Dr. Michele Boyce Ley, TMC One’s new board-certified breast oncology surgeon and medical director of TMC’s Breast Health Program. Last week she shared with us highly valuable information about how to figure out if you’re really at high risk for breast cancer or not.

This week we’re focusing on how to sort out truths vs. myths when it comes to screening and mammography.

As women, we’re told to do our self-breast exam “when we pay our rent.” Or “on the same day every month as our birthday.” There are even apps to remind you. Most of us know we should do them. But the reality is, we don’t.

Are self-exams encouraged? And should you really be doing them? “Absolutely,” said Dr. Boyce Ley. “We want women to become really self-aware when it comes to their breast health. We want them to do monthly self-exams so that they become familiar with what their normal is. If they do regular checks and know what their breasts feel like, it’s easier to discover when something feels out of the ordinary. If you’re aware of it, you can monitor it and get in to see a breast specialist if necessary. When it comes to self-exams, it’s best to do it the first week after your menstrual cycle.”

Dr. Michele Boyce Ley Board-Certified, Breast Surgical Oncology Medical Director, TMC Breast Health Program

Dr. Michele Boyce Ley
Board-Certified, Breast Surgical Oncology
Medical Director, TMC Breast Health Program

Dr. Boyce Ley explained that there is chatter in the medical world that monthly self-exams may cause unnecessary imaging and biopsies. One of the many challenges, she explained, is that while there are a lot of risk factors we know about, there are also a lot of risk factors we don’t know about. It can be difficult to definitively decide that a 35-year-old, for example, should have a mammogram. “That’s when it’s appropriate for that patient to see a breast specialist,” she said. “If you’ve tried to figure out if you’re considered high risk or not, and you’re still unsure, or if you just need guidance to sort it all out, have a breast specialist help you,” she said. If a woman is identified as high risk, then imaging starts earlier.

▪ What about the risk of being exposed to so much radiation during a mammogram?

It may be recommended that younger people who are identified as high risk get mammograms every other year instead of annually at first. Or perhaps your doctor wants to combine a mammogram with an MRI. “Generally, radiation risks aren’t any higher than they were with regular film screen mammograms from 15 years ago,” said Dr. Boyce Ley. “MRI is a test without any radiation.”

▪ There are 2D and 3D mammograms. How do I figure out which kind I need?

Film screen mammography is a thing of the past. These days, all mammography is done digitally. A 2D, or standard mammogram, captures all of the layers of the breast tissue stacked on top of each other. During a 3D mammogram, the x-ray camera rotates around the breast, getting a picture of multiple layers of the breast. Those layers can then be separated out for an even more precise view. For a majority of patients, standard digital mammography is still very good. Doctors have found, however, that for all patients, especially those with dense breasts, 3D mammography allows them to do fewer call backs. That means that there is a smaller chance that you’d have to be called back in for a follow-up mammogram or ultrasound. “The detection rate for cancer is higher with 3D mammography, as it allows us to find more small cancers,” explained Dr. Boyce Ley. “The downside is it can cost more.”

At TMC’s Breast Center, both 2D and 3D mammography is performed. If you’re considering a 3D mammogram, be sure to check with your insurance first to see what it covers.

▪ I have breast implants. Do I have to do anything differently?

No. The screening recommendations are the same. Dr. Boyce Ley said that implants can distort the breast tissue. In some cases, implants can make it easier to find a lump by feeling the breast tissue during a monthly self-exam. On the flipside, in some cases, it may make it harder to find a lump by imaging since the breast tissue is being pushed around by the implant. It can be difficult to visualize all the breast tissue since the implant often distorts it.

▪ Does where I get screened matter?

Yes, according to Dr. Boyce Ley. Before you schedule your mammogram, do your research. Ask if your scan is going to be reviewed by a breast imaging specialist or radiologist with a specific focus who is able to give you an accurate interpretation. “You want to have your breast imaging read by someone who almost exclusively does mammographic imaging,” said Dr. Boyce Ley. “There are so many changes in technology and what we learn about the breast. It’s important to have someone who is highly experienced.”

Dr. Boyce Ley recommends asking a few questions when you call to schedule your appointment. Ask things like, “Can you tell me about your radiologist? Can I look them up online? Are they fellowship trained in breast imaging or are they a general radiologist? What percentage of their time do they read mammograms?”

At TMC’s Breast Center, all of our radiologists are trained as general radiologists and then receive specialized training in breast imaging. Additionally, our lead radiologist, Dr. Matthew Bell, as well as Dr. Shayna Klein are both fellowship trained in breast imaging. All of our radiologists must keep their training current, so you can be confident that if you get a mammogram at TMC, it’s being read by clinicians who are specially trained in reading mammograms.

Dr. Boyce Ley is accepting new patients!
She is located at 2625 N. Craycroft Rd #201.
Call (520) 324-BRST (2778) to make an appointment.

To schedule a mammogram, call (520) 324-2075.

Spread the word about when to have your first screening mammogram and the FREE screening mammograms for uninsured women by entering our TMC for Women photo contest. Snap a picture of you and your BFF and enter for a chance at a fabulous prize.

Not just surviving, thriving! Free presentation about breast cancer care and you

1204_2014 The CORE LogoSign up now for a free, interactive demonstration hosted by TMC One’s new breast oncology surgeon, Dr. Michele Boyce Ley. Dr. Boyce Ley is a board-certified breast cancer surgeon and medical director of TMC’s Breast Health Program. This weekend, she’s hosting an event in which she’ll talk about comprehensive breast cancer care.

From diagnosis to treatment, surgery to adjuvant therapy, Dr. Boyce Ley will give you the tools you need to help prepare you for your journey. After the talk, stick around for a fashion showcase plus local beauty vendors that will give you tips and tricks to feel fabulous every day!

Friends and family are encouraged to attend this event as well!

▪ Saturday, Oct. 10 from 10 – 11:30 a.m.
The Core, TMC’s Health and Wellness center
▪ La Encantada, upper level ∙ 2905 E. Skyline Dr. #277 (two doors down from Ra Sushi)
▪ Space is limited, so please register for this event by clicking here.

To view a flyer for the event, please click here.

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

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.

TMC One welcomes breast oncology surgeon Dr. Michele Boyce Ley to guide prevention and treatment

Dr. Michele Boyce Ley Board-Certified, Breast Surgical Oncology Medical Director, TMC Breast Health Program

Dr. Michele Boyce Ley
Board-Certified, Breast Surgical Oncology
Medical Director, TMC Breast Health Program

TMC One is expanding the scope of services available to you. We are thrilled to welcome Michele Boyce Ley, M.D., a board-certified breast cancer surgeon and medical director of TMC’s Breast Health Program. Dr. Boyce Ley brings high-level, compassionate specialty care to our well established and respected program. She is also fluent in Spanish.

Dr. Boyce Ley shares some insight into why she chose this field, what she thinks is the biggest misconception about breast cancer and how a string of profound experiences within her own family impacted how she treats each and every patient.

What is your background? 

I was raised in Northern California and have lived in Tucson since 2000. I graduated from Northwestern University with a bachelor’s degree in molecular and cellular biology. I completed medical school at St. Louis University and moved to Tucson for my general surgery residency at the University of Arizona.

I completed a fellowship in breast surgical oncology at the University of California San Francisco, Carol Frank Buck Breast Care Center in 2006 before establishing a breast surgical oncology practice in Tucson. Most recently, I was the director of breast surgery at the University of Arizona and associate professor of surgery.

What inspired you to go into breast surgical oncology?

I was always interested in the biology of cancer. It is so incredibly complex on a cellular and molecular level. Additionally, when you add in the human element – that the disease is happening in a person who has a set of values, beliefs and an individual health status, it adds another layer of complexity. It is very rewarding to take all of these issues into account when helping a patient choose a therapeutic pathway.

How do you help primary care physicians care for their patients with breast cancer?

I like to communicate with referring physicians to inform them of what their patients’ treatment options are. A lot of the information I pass on is educational including information about new evaluation and treatment options as well as updates on recent research.

We hear a lot about breast cancer in the media. What do you think is the biggest misconception about it?

Everyone who is diagnosed with breast cancer, even if it is just pre-cancerous cells, worries that she will die from breast cancer. While there are about 45,000 deaths a year from breast cancer, the majority of patients with breast cancer have a 85-90 percent of a 10-year survival. This means that 10 years after diagnosis, 85-90 percent of these patients are still alive. There are certainly people who do not survive their disease, but these are primarily people in whom the breast cancer was diagnosed late, not properly treated or their particular type of cancer is extremely aggressive.

If a patient has not been diagnosed with breast cancer, but has it in her family history, do you recommend she get established with a specialist like yourself for regular checks/preventative care?

There is great interest in breast health to know your risk. The best way to assess your risk is to meet with a breast specialist to accurately take a history, estimate risk and develop a prevention plan. This plan usually includes regular breast exams, imaging and lifestyle modifications. Sometimes a prevention plan includes risk-reducing surgery or medications.

You’ve lived in Tucson for 15 years. Is there anything in regards to breast health/breast cancer prevention that you’ve found is unique in this part of the country?

One of my goals in returning to practice after my fellowship at UCSF was to raise the level of breast cancer care in Southern Arizona. This has certainly happened as immediate breast reconstruction and nipple-sparing mastectomies have become more commonplace. I hope that we continue to improve our access to routine breast care, breast health education and wellness education.

What interests you outside of work?

I love to cook up healthy meals and I like baking desserts – especially sugar-free ones! I have recently adopted a low-carbohydrate lifestyle that has been both a challenge and a reward. I have two children, Logan, 9, and Lauren, 4, who are bright and energetic. We try to spend time together when we’re not at school and work. My husband takes us camping and as a family, we enjoy adventuring in our time off!  It’s good for all of us to be outside and be unplugged. My other pastime is reading. My son and I have challenged each other to read 40 books this year. He’s ahead of me already! We are all looking forward to skiing this winter, as my daughter is ready to take lessons so that we can all hit the slopes together!

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

A few years ago, several of my family members were diagnosed with cancer in the same year. My father was diagnosed with leukemia and died after three years of incredibly difficult treatment. My aunt had a recurrence of her breast cancer and eventually passed away from it. Her daughter had a rare form of sarcoma and fortunately is doing well today. All three of my loved ones underwent intensive treatments over a varied amount of time. This was challenging for our family as we had family members who needed support in different parts of the country.

My father and my aunt were relatively young when they died at ages 64 and 62. My family and I felt robbed of the time we should have had with them and were saddened at the suffering they had to endure. Both my father and my aunt accepted hospice care, which was so good for them and our family. My father and my aunt did not want their lives to be defined by their cancer diagnoses. They wanted to live and be involved in the lives of their children and grandchildren. They saw beauty in every day they were given.

These experiences have changed the way I look at my life as well as how I see my patient’s lives. I know that not every treatment is necessary. I know that many treatments may have little benefit and incur risk of long-term effects. I also work to be more understanding of the whole picture of a patient’s life when faced with disease. They have families and pressures outside of their diagnosis that form their response to the illness. From a family perspective, it’s so wonderful to have a physician who “gets” you and sees you as a human – not just as a diagnosis.

How do you approach your relationship with your patients?

Patients are people with an illness, and in the case of breast cancer, these people don’t usually feel ill. I try to put my patients at ease initially to let them know that they will be cured with a little hard work. I often have to deliver news that is disappointing or surprising, so I try to be frank, yet gentle. I really enjoy getting to know my patients and their families. Regardless of our backgrounds, we are all people with feelings and personal challenges and triumphs.  I strive to make their experience of the breast cancer process a positive, triumphant part of their life.

Dr. Boyce Ley is accepting new patients!
She is located at 2625 N. Craycroft Rd #201.
Call (520) 324-BRST (2778) to make an appointment.

Need a primary care doc? TMC One welcomes new internal medicine physician

Dr. Katie Kellogg Internal Medicine TMC One

Dr. Katie Kellogg
Board-Certified, Internal Medicine

Mutual trust and respect are two things Dr. Katie Kellogg believes are essential for a successful relationship between a patient and physician. Dr. Kellogg is an internal medicine physician who is new to TMC One. Her focus is on helping her patients prevent diseases and educating them on how to best manage their health. Dr. Kellogg is available to treat patients at TMC One’s Wyatt office, conveniently located on the TMC campus.

Learn more about Dr. Kellogg, her approach to caring for others and how a personal experience impacted her decision to go into medicine. 

What is your background? 

I was born and raised in Southern Colorado. I attended Colorado College for my undergraduate degree. I then went to the University of Colorado for medical school and training. I practiced with Kaiser for a year before moving to Montana where I practiced for five years. I am delighted to now be in Tucson.

What inspired you to become a PCP?

I wanted to become a primary care physician because I have a desire to care for the whole patient rather than focusing on one organ or disease state.

What made you decide to come to Tucson?

I wanted to come to Tucson because I love sunshine and the opportunity to be outdoors all year.

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

Like all of America, I think the biggest health risk facing Southern Arizonans is obesity and the medical problems that accompany it including diabetes, high blood pressure, heart disease and increased risk for many cancers.

Do you have any areas that are of particular interest to you, both in medicine and also outside of work?

I enjoy working with patients to prevent disease as well as helping them to manage chronic illnesses like diabetes and high blood pressure. Outside of work, I mountain bike, scuba dive, camp and ride dual sport motorcycles.

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

We often focus on disease control in our country. Prevention of disease and promotion of wellness should be more emphasized. Often, by the time people realize they are sick due to a chronic illness, irreversible damage has already been done. By working with a provider to monitor overall health early on, many of the complications related to chronic disease can be prevented.

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

The most valuable life experience that has impacted my medical career is when my grandfather was diagnosed with terminal lung cancer when I was age 13. We were extremely close. We played Cribbage and I cooked him dinner at least once a week while he was ill. Watching the illness affect him so quickly and watching the Hospice team help him focused me towards medicine.

How do you approach your relationship with your patients?

I like to work with my patients as a team. I like patients to feel they have some control over what happens with their health. I feel that mutual trust and respect are essential in the patient/physician relationship.

Dr. Kellogg is located at TMC One’s Wyatt office, 2424 N. Wyatt Drive, #100, on the TMC campus.
Valet parking is available! Dr. Kellogg is acc
epting new patients.
Call (520) 324-TMC1 (8621) to make an appointment.

TMC One’s new nurse practitioner ready to partner with you and your family


Maria “Maricruz” Bustamante 
Family Nurse Practitioner

Maria “Maricruz” Bustamante is a board-certified family nurse practitioner with TMC One who is ready to provide compassionate health care for you and your entire family during every phase of life. Bustamante partners with her patients of all ages to help them achieve health and well-being with a focus on disease prevention. She blends her expertise and passion about fitness, nutrition and wellness coaching to help her patients achieve their goals, whether they be weight loss, increasing strength, reducing or eliminating medication, managing chronic health concerns, or decreasing pain.

Bustamante is also fluent in Spanish.

▪ What is your background?

I am a registered nurse with more than 12 years of intensive care experience. I have worked at all the local ICUs in town throughout my career. I decided to further my education in hopes of preventing patients from being admitted to the ICU from things like a high blood pressure crisis and diabetes complications.

▪ What inspired you to go into primary care?

I am a firm believer that health care starts in the home. I enjoy empowering parents to lead the way for their children in the hope that good health will be passed from one generation to another. I want to care for the whole family. Knowing and understanding the dynamics of an entire family allows me to better tailor the care plan for the family as a unit.

▪ What made you want to practice in Tucson?

I was raised here, so Tucson is and always will be a special place for me. I understand the culture and I see the need for people to do better for themselves. It is my sincere hope to help them make that happen by focusing on health care as wellness, not disease management.

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

I believe the biggest health risk facing Southern Arizonans is obesity. In most cases, obesity is preventable. I strongly believe that if we educate our patients and empower them to take control of their well-being, many diseases can be prevented.

▪ Do you have any areas both in your practice and outside of work that are of particular interest to you?

In primary care, I love caring for the entire spectrum from newborns to the elderly. I especially enjoy pediatrics and women’s health, as well as helping patients manage their diabetes. When I’m not working, you’ll likely find me outside hiking and enjoying nature. For indoor activities, I love breaking a sweat with Zumba classes and really experience the health benefits of yoga.

▪ Why is it important for people to get established with a primary care provider before they get sick?

It is so important for people to get established with a primary care provider before they get sick because many specialty care needs can be prevented. I strive to help my patients and their families with disease prevention. I approach every patient holistically and team with them to best meet their health care needs. Being under the supervision of a primary care provider can also help in coordinating care for those times when specialty care is needed.

▪ 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 has been my time as an ICU nurse. It taught me not to take life for granted and showed me how quickly our loved ones can be taken from this earth.

▪ How do you approach your relationship with your patients?

I approach my relationship with my patients as a partnership. I love empowering them to take control of their health and will be there for them along the way, acting like their biggest cheerleader and guide.

Maricruz Bustamante is located at TMC One, 5295 E. Knight Dr., right across from TMC.
She is accepting new patients! Call (520) 324-1010 to make an appointment.

An annual physical: Do you really need one?

Dr. William Abraham Board-Certified, Internal Medicine TMC One

Dr. William Abraham
Board-Certified, Internal Medicine

You’re healthy. You take good care of yourself and have no real ailments. Do you really need to make an appointment for an annual physical? “Absolutely,” said Dr. William Abraham, a board-certified internal medicine physician with TMC One, formerly Saguaro Physicians. “There are a number of medical problems that do not necessarily cause symptoms or obvious physical changes that someone without medical training may not recognize,” said Dr. Abraham. “These problems can often be detected during a physical, which is why it’s so important to see your primary care practitioner once a year.”

Hypertension, or high blood pressure, for example, is referred to as “the silent killer.” It oftentimes goes undetected, and can lead to a heart attack, stroke and even kidney failure. But it can be detected during a routine medical exam. Diabetes, or high blood sugar, can also cause those complications along with an assortment of other potentially devastating ones. How is it detected? A simple blood test. Also in this category – high cholesterol. It never causes symptoms, but can lead to heart attacks and strokes. Oftentimes people may not realize they have high cholesterol until it’s too late and they have suffered something catastrophic.

A routine blood test can also detect anemia, which can be a sign of undetected bleeding, malnutrition, vitamin B12 deficiency or numerous other possible illnesses. And it can easily detect other metabolic abnormalities such as decreased kidney function.

A once-a-year check of your heart also makes getting a physical invaluable. “When a practitioner listens to your heart or performs an electrocardiogram, they can detect heart disease such as atrial fibrillation. This common, irregular heart rhythm increases the risk of stroke but can be treated with medication to reduce your risk,” explained Dr. Abraham.

Your primary care practitioner can also examine your skin at a screening exam – a good way to detect pre-cancers and cancers of the skin, particularly in areas that are hard for someone to see on their own body, like their back or the top of their head.

One part of the Affordable Care Act requires that insurance companies cover 100 percent of an annual physical so that no co-pay is required, even with high-deductible insurance policies. The only exception is Medicare and certain Medicare managed care plans. It’s best to check with your insurance company about your coverage.

Dr. Abraham has more than 30 years of experience and is available for same-day appointments including annual physicals if you are finding it difficult to get in to your regular provider.

His office is located at 1396 N. Wilmot Road in Tucson, 85712.
Call (520) 324-2160 to make an appointment.

New TMC One endocrinologist is now available to tackle an assortment of complex cases

Dr. Shubh Preet Kaur Board-Certified Endocrinologist  TMC One

Dr. Shubh Preet Kaur
Board-Certified Endocrinologist

Tucson Medical Center and TMC One, formerly Saguaro Physicians, are proud to welcome Dr. Shubh Preet Kaur, a board-certified endocrinologist who is accepting new patients. She specializes in diagnosing and treating diabetes, thyroid disorders, adrenal and pituitary gland disorders, metabolic disorders, menstrual irregularities, osteoporosis and calcium disorders.

“I believe in providing the same care to each patient that I would want for my family. My goal is to provide evidence-based, cost-effective and personalized health care of the highest quality to all my patients,” said Dr. Kaur.

Learn more about Dr. Kaur, her unique approach to patient care and why she really knows firsthand what challenges diabetics face:

What is your background?

I grew up in India and completed medical school there before starting a residency in internal medicine at Rochester General Hospital in upstate New York. I was then presented with a great opportunity to be the chief resident for the Internal Medicine Residency Program at the University of Arizona. I went on to complete an endocrinology and metabolism fellowship here at the University of Arizona.

What inspired you to go into Endocrinology?

I find complexities of the endocrine system challenging and fascinating. Having multiple family members with diabetes inspired and attracted me further to care for people suffering from diseases of the endocrine system.

How do you help primary care physicians care for their patients with diabetes?

Diabetes is a very complex disease, which affects almost all the organs of the human body. I help primary care physicians care for patients affected by this dreadful disease in whom simple medication regimens do not work, whose disease is hard to control or whose disease has progressed to a stage of complete insulin dependence or overt organ damage. Together, we help patients maintain optimal metabolic goals with the latest the field has to offer. I work with my patients to help them prevent further complications and maintain a healthy and independent lifestyle. Multiple other specialists also help us provide the best possible care to our patients.

At what point does a diabetic patient need to see an endocrinologist rather than just receive care from a primary care physician?

Patients are usually referred to an endocrinologist for adrenal, pituitary, thyroid and calcium metabolism-related issues. Patients with diabetes are often referred if the disease is hard to control, progresses to a state where they require complex medication regimens, have wide blood sugar ranges, multiple complications or if they are having difficulty getting to their target blood sugars.
After completing your endocrinology fellowship from the University of Arizona, what made you decide to stay in Tucson?

My training brought me to Tucson. I never thought I would stay here long, and now I don’t think I will ever leave. The small town feel with the amenities of a big city, great outdoors and the warm weather keep me in Tucson.

What interests you outside of work?

I try to spend as much time as possible with 2-year-old daughter, taking her to the zoo to meet her favorite animal, Nandi, the baby elephant.

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

My parents have diabetes so I have firsthand experience about how difficult it can be on patients and their families. I think of my parents when I see my patients and strive to improve their quality of life.

How do you approach your relationship with your patients?

I believe in providing the same care to each patient that I would want for my family. My goal is to provide evidence-based, cost-effective and personalized health care of the highest quality to all my patients.

Dr. Kaur is located at TMC One, 5295 E. Knight Dr., right across from TMC.
She is accepting new patients! Call (520) 324-1010 to make an appointment.
Standard office hours are Monday through Friday, 8 a.m. – 4 p.m.

Saguaro Physicians’ new administrator has precision focus on patient-centered care

Susan Vance

Susan Vance

The new year brings new changes to Saguaro Physicians, which is taking on a new name.  TMC One will officially launch on Jan. 1. The updated look and fresh focus will create a stronger connection with Tucson Medical Center and serve as one stop for wellness and primary care.

As part of the changes, TMC will welcome Susan Vance as TMC One’s director of administration early next year. She comes to TMC from Scottsdale Lincoln Health Network where she currently serves as the Senior System Director. She also worked with Mayo Health Systems and is a seasoned professional with more than 16 years of healthcare experience including at St. Joseph’s Hospital and Scottsdale Healthcare Family Care. The Louisiana State University graduate is also currently pursuing her master’s degree in leadership.

Vance knew right away that TMC’s focus aligned with her own values as a healthcare executive. “During my interviews and all of my subsequent interactions at TMC, from the executive team and beyond, there was such a strong dedication to the patient,” she said. “During every conversation, literally, it is clear that the focus is taking care of the patient, growing the organization and building a team. These are also my top priorities and I am so excited to be a part of it. It feels like I am coming home.”

Vance’s commitment to patient-centered care was established at an early age when she learned by example from her father – whom she describes as her mentor. “My dad was a primary care physician when doctors used to still make house calls. I remember waiting outside of people’s homes or in the parking lot of a hospital emergency department while my dad was visiting patients,” she said. “He always taught me that the patient comes first. So this has always been key for me. In coming to Tucson, it was important to me to make sure that the organization that I work with had the same mission. And, I really wanted to work with a community hospital dedicated to staying independent and carving out a niche that always stays focused on taking care of the community,” she said.

Vance and her family are looking forward to settling in Tucson shortly, as she will start her new position in late January.

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