2015-08-02 HealthCare Quarterly (vol 9) Summer 2015 by Greenspun Media Group

VEGAS INC HEALTH CARE QUARTERLY

WHAT’S ON YOUR PLATE? 2015 | VOLUME 9

2015 | VOL. 9 SPONSORED BY:

HEALTHY LIFESTYLES LEAD TO LONGER LIVES It’s well known that the United States is an aging population, given the number of “Baby Boomers” reaching retirement age and the fact that families are not having as many children today as they did in previous generations. This means that preventive and specialized health care is vitally important to every American today, as we continue to seek cures for diabetes, obesity, cancer, heart disease, etc. As health care providers, you certainly know how important it is that Americans lead a healthy lifestyle. Expert advice and personalized attention from a physician can help patients make informed decisions about their long-term health, including making smarter lifestyle choices, and the physician can be a valuable resource for patients seeking to remain as healthy as possible during their senior years. Just as patients need professional help to be their healthiest, physicians often need professional help to maintain the financial well-being of their practice. Nevada State Bank’s Professional Banking Group is a market leader in the medical industry. Simply put, we know how to assist our medical professionals when it comes to financial matters to expand their practices, purchase office equipment, set up business lines of credit and of course, handle all the personal banking matters each medical professional requires. In short, our team of dedicated, trusted financial advisors are highly trained in the medical industry. Each Relationship Manager has spent numerous hours learning the nuances of medical practice financing, commercial real estate transaction loans, equipment leasing and/or purchase, and properly setting up our physician clients with the working capital they need to help expand their practices. (To “meet” our team, please refer to the back page of this publication.) Your dedication and years of experience in providing excellent health care to Southern Nevada continue to shine. Many of our physician clients work overtime to provide needed health care to the sick, the elderly, the young, and the uninsured. I know many of my valued medical clients work long extended hours to meet the constant demand of providing excellent medical care to their valued patients. As a leader in the financial healthcare industry, Nevada State Bank Professional Banking Group takes great pride in calling our physician clients our friends.

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Senior Vice President, Nevada State Bank NMLS# 655079 Dean.Collins@nsbank.com 866.980.9585

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Lung Center of Nevada Joins Comprehensive Cancer Centers of Nevada

C OM PR E H E NS I V E

More resources. More treatment options. More hope. At Comprehensive Cancer Centers of Nevada, all of the specialists who treat you are right here where you need them. A diverse and dedicated team — which now includes Lung Center of Nevada, a division of Comprehensive Cancer Centers of Nevada — is here to deliver the highest level of coordinated care. From radiation and medical oncologists to pulmonologists and surgeons, at Comprehensive you’ll have more resources for seamless care. At every level, your treatment is a coordinated effort. The specialists treating you share data and reports in real time. And through our affiliation with The US Oncology Network, they will ensure you have access to the latest innovations in cancer treatment therapies as they are developed. Comprehensive treatment. Comprehensive care. Everything we have. For every part of you. Ask your doctor about Comprehensive. Visit cccnevada.com for more information or call 702.952.3350 to schedule an appointment today.

Lung Center of Nevada A division of Comprehensive Cancer Centers of Nevada 9280 W. Sunset Road, Suite 312 • Las Vegas, Nevada 89148 Tel: 702.737.5864

3150 N. Tenaya Way, Suite 125 • Las Vegas, Nevada 89128 Tel: 702.869.0855

Nisarg Changawala, MD, MPH | James S. J. Hsu, MD, FCCP, DABSM Lorraine Kossol, APRN, FNP-BC | Ralph M. Nietrzeba, MD, FCCP, FACP Dawn Willard, MSN, APRN, FNP-BC | John J. Wojcik, MD, FCCP, DABSM

John (Jack) Collier, MD, FCCP, DABSM | Lisa Reiter, APRN, FNP-BC George S. Tu, MD, FCCP, DABSM

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CONTENTS

24 NUTRITION Understanding the basics of what’s on your plate.

DIET & DIABETES The key to managing high blood sugar is to rethink your lifestyle.

EL DORADO Cantina is serving authentic Mexican food made with organic ingredients.

CHOLESTEROL Get the lowdown on your lipoproteins.

ULCERS Find out what’s really causing that pain.

KIDNEY STONES Southern Nevadans are more prone to stones because we don’t drink enough water.

Las Vegas Leonard Rosales uses his garden to prepare healthier meals.

MEDICAL STUDIES What’s healthy, what’s hype — and how can you tell the difference?

COLUMNS 14

CHILDREN Marissa Mussi, Sunrise Children’s Hospital

MEDICATION Jayme Garcia, Parma D, Smith’s Food & Drug Clinical Pharmacy

EATING DISORDERS Jessica Kantor, Solutions Recovery

ALLERGIES Claudine Mendoza, M.D. Good Night Pediatrics

Jill Clark, left, and Amelia Brewer, volunteers from Citibank, bag pears at Three Square Food Bank.

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DIABETES Joyce Goedeke, Southern Hills Hospital

Leonard Rosales photo by Mikayla Whitmore. Three Square photo by Steve Marcus.

36 Chef Paco of the El Dorado Cantina, learned his craft from his mother and grandmother.

DEPARTMENTS 60

CANCER Matthew W. Schwartz, M.D., Comprehensive Cancer Centers of Nevada

NUTRITION John Cisna, Science teacher

NONPROFIT Three Square Food Bank

VOLUNTEER Q & A Garfield and Brenda Matson, Children’s Hospital of Nevada

THE NOTES Notes from the health care community

COMMUNITY 68

CALENDAR Upcoming events and classes

MAKING THE ROUNDS Southern Nevada health care events in pictures

LOOKING BACK Abortion protesters square off against police

WHAT’S ON YOUR PLATE? 2015 | VOL. 9 SPONSORED BY:

Chef Paco photo by Steve Marcus.

COVER DESIGN Michele Hamrick

SUMMER 2015

H E A LT H C A R E Q U A R T E R LY

FROM THE EDITOR

spent an inordinate amount of time in the grocery store when I was growing up. Mom would haul me along during her Thursday shopping trips and if she needed a little peace and quiet (not that I wasn’t always a proper little gentleman, mind you), we’d get a cookie from the bakery and she’d drop me off with my dad, who managed the produce department in the store. I suppose it was my first job — working with Dad and the grownups in back, helping wash the lettuce or counting boxes for inventory while Mom filled her grocery cart. I was always a little impressed that she could plan out meals for a week, cross referencing the food a family of five would eat against coupons and sales. I’d go on to learn that it was a skill she picked up from her mother, who spent a lifetime shopping to provide meals and memories for children, grandchildren, great-grandchildren and even a few great-greats. This issue of Health Care Quarterly is packed with information about food, nutrition and being aware of what we put in our bodies. We’re hoping this issue serves as a reminder that serious health issues such as diabetes, heart disease and high cholesterol can be avoided or managed by making the right dietary choices. We’ll also dispel a few myths along the way. Nearly 10 percent of Americans have diabetes. The staff at Southern Hills Hospital, experts in diabetes education, are here to explain the disease, its symptoms and how to manage it. Elsewhere in the magazine, read about how Leonard Rosales was diagnosed as prediabetic and what he’s doing to stave off the disease (hint — his garden provides more than one health benefit). John Cisna is a science teacher who put his students to work helping him devise healthy meal plans. The experiment worked; Cisna lost 60 pounds after 180 days, but here’s the real surprise — Cisna was limited to eating food from McDonald’s. We know that it’s not easy to make healthy eating choices, especially when the news about what constitutes “healthy” seems to change every week. Bruce Morgenstern, associate dean for clinical affairs for Roseman University College of Medicine, explains why that happens and how you can make sure you’re getting the smartest information. My parents and grandparents have long since left this mortal coil, but every week that I fill my own grocery cart I’m grateful to them for the lessons they taught me about smart shopping and eating right. From my family to yours, I hope this magazine will help you learn something new about what’s going on your plate and in your body! Stay healthy!

Craig Peterson Editor of Special Publications craig.peterson@gmgvegas.com

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Secondhand smoke knows no boundaries. When people smoke near entrances and exits to businesses and other public places, it can pose a serious health risk to others. Did you know secondhand smoke contains more than 7,000 chemicals, including hundreds that are toxic and about 70 that can cause cancer? If you’re a smoker, think twice the next time you light up near an entrance, exit, or window — because when you smoke, everyone smokes with you. To learn more about smoking near entrances and exits of businesses and other public places, visit gethealthyclarkcounty.org. If you’re a business owner and would like to implement a policy to limit smoking outside of your business, call 702-759-1270. You can also call for FREE No Smoking signage.

It’s Time For “SUMMER”

PUBLISHER DONN JERSEY (donn.jersey@gmgvegas.com)

EDITORIAL EDITOR OF SPECIAL PUBLICATIONS CRAIG PETERSON RESEARCH LIBRARIAN REBECCA CLIFFORD-CRUZ RESEARCHER JULIE ANN FORMOSO

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LUNG

CANCER

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CHILDREN

THE LIST OF SIDE EFFECTS OF CHILDHOOD OBESITY IS LONG — AND CAN REACH WELL INTO ADULTHOOD By Marissa Mussi

hildhood obesity is more prevalent today than • Healthier foods tend to be less convenient and are often ever before. In America, approximately 17 percent more expensive than junk food. Because of this, children — 12.7 million children — ages 2 to 19 years old are who come from low-income families tend to be at a higher considered obese (That’s when a child weighs well above risk of being overweight or obese because the family does the average weight for his or her age and height). Obesity not have the time or resources to make eating healthy and is the result of a caloric imbalance, meaning not enough physical activity a priority. calories were burned to offset the amount of calories conCauses due to lifestyle can manifest themselves in many sumed. Overeating or a lack of physical activity lead in ways. When children sit down at the dinner table or in the that direction. kitchen with the family for a meal they are less likely to beThere are multiple causes come obese than children who and factors that contribute to eat on the go and at irregular obesity, many of which are the times. Children who grow up same for children and adults. in hostile environments or with The most common ones stem parents who have restrictive from genetic, behavioral, soeating guidelines tend to be cial, psychological, technologimore prone to developing poor cal, environmental, economic habits in terms of self-regulatand cultural issues. They create ing eating habits. According to the American habits that can be formed at a Surrounded by TV, computyoung age and may stick with ers and video games, children Heart Association, obese an individual throughout life aren’t getting nearly enough unless a change is taken. of the physical activity that is children are twice as likely Factors to consider: needed to try to offset any over• The American lifestyle is consumption or high caloric to die before 55 than their faster than ever before. Sointake. A child needs to get at ciety wants things that are least 60 minutes of physical acslimmer peers. convenient and immediate. tivity a day or more. Limiting the However, foods that are amount of time a child spends convenient and immediate in front of a screen can help. tend to be the worst for us by The increase in obese chilbeing high in calories, sugar, dren and teens is concerning salt and fat while low in nutribecause it has led to an onset ents. According to the Centers for Disease Control, these of health problems that typically aren’t seen until adulthood. unhealthy foods tend to be marketed heavily to children Childhood obesity has both an immediate and long-term efand adolescents. fect on the body. Some of the immediate health problems • The distortion or misconception Americans have in re- a child may face are risk factors for cardiovascular disease gard to serving sizes is another factor; typical portions we such as high cholesterol or high blood pressure, more likely receive are much larger than a recommended serving size. to be at risk for prediabetes, asthma, as well as social and Because of this, children are more likely to overeat. psychological issues such as low self-esteem or depression.

“

Marissa Mussi is the marketing manager of Sunrise Children’s Hospital.

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Marissa Mussi photo by Eric Jamison.

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Obese children run the risk of being obese adults and can be exposed a higher risk of more severe health problems such as stroke, type 2 diabetes, osteoarthritis, several types of cancer and more. According to the American Heart Association, obese children are twice as likely to die before age 55 than their slimmer peers. All of these long-term health problems are preventable. If a child is at risk for becoming overweight or obese, itâ&#x20AC;&#x2122;s important to seek guidance from a health care professional. Any changes made to a childâ&#x20AC;&#x2122;s diet need to be made in a healthy, gradual and maintainable fashion. By doing this, itâ&#x20AC;&#x2122;s more likely these changes will become permanent changes in eating and physical activity rather than short-term unmaintainable changes. Teach children about healthy habits. This can involve the entire family. Make eating healthy fun and interactive for children by involving them in the preparation and decision making process or creating fun shapes and designs out of the food. Cook and prepare food at home rather than going out to eat. Having children involved helps get them engaged and make healthy habits appear as less of a chore and more as something they want to do. By teaching children healthy habits at an early age, the more likely these habits are to carryover with them throughout their life and help reduce the onset of childhood obesity.

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M E D I C AT I O N

WHAT ARE YOU HAVING FOR DINNER? YOUR PHARMACIST WANTS TO KNOW By Jayme Garcia

ood interactions with prescription and over-thecounter medications are more common than one may think. Food, caffeine and alcohol may change how a medicine works in the body, and the interaction may block a medicine from working, make one side effect get worse or lead to another. Your pharmacist has reviewed medications for drug-drug interactions, but is most likely not aware of an individual’s particular diet and may not know which drug-food interactions would apply. Your pharmacist will provide counseling on the most common and dangerous drug-food interactions, but it is also important for patients to be aware that potential issues may exist. In general, foods interact with medications in various ways. Some foods may bind to a medication causing it to not be absorbed in the blood stream. Other foods may interfere with the enzymes that process the medication, causing it to be absorbed or eliminated too quickly or slowly and leading to an increase or decrease of the medication’s levels in the blood stream. Foods and beverages may also increase the side effects of certain medications if they themselves cause similar effects. Examples include drinking alcohol with a medication that causes drowsiness or taking caffeine with a medication that increases the heart rate. Both of these examples can be extremely dangerous and should be avoided.

“

Any food in the stomach can interfere with absorption, but some medications are better tolerated or better absorbed on a full stomach. Take ibuprofen with food. In other cases, eating or drinking near the time you take a medication can interfere with its action in the body, so taking the medication on an empty stomach is ideal. To help a medicine work as intended, make sure to read the labels. Prescriptions are dispensed with medication guides containing easy-to-read medication-specific information, including food-drug interactions. Prescription labels on bottles will also inform users about potential food-drug interactions and side effects. Nonprescription medications have a Drug Facts label that provides information that will help users take the medication safely. Do not hesitate to ask your pharmacist questions about all prescription and nonprescription medications. Managing food-drug interactions is based on understanding what interacts with your particular medication. Keep in mind that food-drug interactions are common and can be life-threatening. The only way to avoid food-drug interactions is to understand what types of food interact with your particular medication. It is possible to safely take medications, but it often requires that you learn about your treatment. Establish a relationship with your pharmacist. Your pharmacist can answer

Food, caffeine and alcohol may change how a medicine works in the body, and the interaction may block a medicine from working, make one side effect get worse or lead to another.

Certain foods interact with medicine more than others. Calcium, magnesium and zinc interact with some antibiotics by binding to the medication and causing them to be poorly absorbed. Grapefruit juice interacts with cholesterollowering medication known as “statins.” Large amounts of grapefruit juice can raise the levels of statins in the body, causing dangerous side effects including kidney failure. Vitamin K found in green leafy vegetables strongly interacts with warfarin, a blood thinner.

any questions you may have about your medications, their side-effects and their food and drug interactions. If you are seeking more information on your medication, make sure you are receiving it from reputable sources such as drug manufacturer and government websites, your physician or your pharmacist. The U.S Food and Drug Administration along with the National Consumers League has created a patient guide on How to Avoid Food-Drug Interactions. Visit fda.gov/drugs.

Jayme Garcia, PharmD, is a team member of Smith’s Food & Drug Clinical Pharmacy.

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E AT I N G D I S O R D E R S

AN EATING DISORDER MAY FEEL LIKE A CRUTCH, BUT THAT’S A DANGEROUS LIE By Jessica Kantor

ating disorders are tough all around. They are tough on the body, tough on the mind, tough to recognize and tough to overcome. The good news is that these disorders don’t have to be fatal. There are many successful recovery stories, and with treatment, ED can be left in the past. Jennie is in her 30s. She has a full-time job, a new puppy and is glowing from getting married to the man of her dreams. She’s also a diagnosed anorexic with purging tendencies, something that she treated through therapy and hard work. “I’ve had trouble with eating disorders for over 20 years, since I was 16 years old. In the past I went to treatment and saw different therapists on and off. Now is my first time finding success,” said Jennie, adding that before recently, “I just don’t think I was ready to get some real help.” Jennie initially sought help at Solutions Recovery, Inc., an addiction recovery center in Las Vegas, to treat an addiction. The organization recognized that she also needed help with her eating disorder. She saw therapists and clinicians who encouraged her to attend groups for ED. “The program definitely helped. They gave me an edge and they kept me safe for a while and did a good job of watching me. They helped me see what was causing (the ED), why I was still doing it, and helped me learn how to let go,” she says. “Your eating disorder becomes your best friend, your crutch you can lean on. They helped me see that my ED was a way for me to have control over something in my life. They then taught me how to have real control.” Jennie said that learning all this, and experiencing horrible health consequences, was ultimately what has helped her stay successful in beating her ED. “I was in a coma for 9 1/2 days, pronounced brain dead. I had fallen into a diabetic coma from not eating, had a stroke and my right lung collapsed. They thought I was gone,” said Jennie. “I’ve also had bleeding ulcers and colitis, both of which could be caused by something else, but it’s pretty likely that my ED was involved.” Alana Jackson, a licensed clinical alcohol and drug counselor with Solutions Recovery, says that eating disorders are dangerous and should be taken very seriously. Jackson, who also has a master of science and is a certified professional coder, notes that treating ED isn’t just about looking at food and nutrition. You have to look at the brain, as well.

“Binge-eating and bulimia have a dopamine release that occurs in the brain. Anorexia and bulimia usually go handin-hand with body dysmorphia,” said Jackson, referring to a chronic mental illness in which individuals can’t stop thinking about a flaw in their appearance. Ultimately, ED often involves distorted perceptions, regulation of emotion, as well as a struggle of internal versus external locus of control, a term describing how much individuals believe they can control events affecting them. “ED is hard. You have to eat to live, so changing the association of food in someone’s brain can be much more difficult than you would think,” said Jackson. “There are some medications that can be used, cognitive behavioral therapy is strong in treatment, and some people need an in-patient setting to help with monitoring.” There are many forms of ED, including binge-eating, anorexia nervosa, bulimia nervosa, bulimarexia, pica and rumination disorder. With so many types of ED, it can be extremely hard to recognize. “Identifying it, like any addiction, usually needs family intervention,” said Jackson. “A lot of times people can’t see it. With ED (other than anorexia) they usually maintain a healthy body weight, so unless you see them in their ritualistic binging or purging, you’ll never know. This can go on for years.” Sometimes it goes unnoticed until, like Jennie, there are major health consequences. “Bleeding ulcers, heart conditions, kidney failure, teeth enamel damage, gastro-intestinal issues, hair loss, calcium deficiency, bone and muscle weakness...,” recites Jackson, adding that the list goes on. If you have an ED and are ready to get help, or if you know someone who does, Jackson recommends you seek help immediately. “Get help both with medical (care) and therapy. A full physical is needed. You should also seek out a dietist and nutritionist,” said Jackson. “Support groups are very helpful, but make sure you find one that caters to your specific diagnosis. Jennie now sees two therapists a week, twice a week, which she says is very helpful to her continuing success. Eating disorders are far more common than many people think, and Jennie is just one of many success stories. If you or someone you know is dealing with an ED, don’t wait to seek treatment.

Jessica Kantor is content developer with Solutions Recovery, Inc.

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ALLERGIES

PEANUT ALLERGIES ARE ON THE RISE — BUT MAYBE NOT FOR LONG By Claudine Mendoza, M.D.

he number of children affected by peanut allergies has significantly increased in recent years. According to a study funded by Food Allergy Research & Education, the rate of peanut allergies among school-age children more than tripled from 1997 to 2008. Although the results of the study came from a telephone survey, the sample size was more than 13,000 students, enough to affirm what those in the medical field have long suspected. Patients with peanut allergies can experience a variety of symptoms: rashes and hives, swelling and tingling around the throat, digestive issues and shortness of breath or wheezing. According to the Mayo Clinic, even if the symptoms are minor, it is advisable to see a doctor because of the risk of a more serious reaction in the future. Doctors have done myriad studies to explain, and ultimately limit, the impact of peanut allergies. The New England Journal of Medicine released a study earlier this year reporting that at-risk children who were routinely fed peanuts from birth through age 4 reduced their risk of developing a peanut allergy by an average of 81 percent. During the study, the feeding of peanut products to children was done under strict supervision by medical professionals. The study, which was overseen by the National Institute of Allergy and Infectious Diseases, followed 11,000 mothers and their children from birth until the age of 5 and challenges previous recommendations that it is advisable to withhold peanut products from children until the age of 3. While more research is needed to confirm these findings, this study could make a dramatic difference in preventing peanut allergies. The study states that “peanut avoidance was associated with a greater frequency of clinical peanut allergy than was peanut consumption, which raises questions about the usefulness of deliberate avoidance of peanuts as a strategy to prevent allergy.” From 2000 until 2008, the American Academy of Pediatrics recommended children not eat peanuts until the age of 3. The New England Journal of Medicine study could be a game changer in how medical professionals approach peanut allergies.

Health experts remain divided on which study or protocol is appropriate. There is still much to learn, and the severity of peanut allergy reactions can be lifethreatening. As a result, Good Night Pediatrics encourages parents to learn more about potential food and peanut allergies, and to speak to a physician before adopting a strategy of peanut avoidance or consumption. For a long time, conflicting reports and studies have created confusion among the general public, which has extended into schools. The rise in peanut allergies has compelled many school districts to ban peanuts and peanut products, sparking heated debates nationwide. Last year, an Arlington Heights, Ill., mother pleaded with her local school board to ban peanut products after her 8-year-old daughter had a serious anaphylactic reaction to peanuts in the cafeteria. The girl had a severe reaction from something a classmate had eaten. Her symptoms included puffiness in the face and body. Before the ambulance arrived, the school nurse gave the child a shot of epinephrine with an EpiPen, which is used for the emergency treatment of life-threatening allergic reactions. There is hope on the horizon that peanut allergies will be limited through modern medicine. It was recently announced that a French biopharmaceutical company has received fast-track approval from the Food and Drug Administration to test a drug — Viaskin Peanut — that boosts individuals’ tolerance to peanut products. Viaskin Peanut would be administered in patch form, and the goal is for it to be available in America in the first half of 2018. It is important for parents to take their children to a medical professional immediately if they are exhibiting symptoms of an allergic reaction. Good Night Pediatrics offers afterhours care when most primary care physicians and allergy specialists are closed. The clinic’s pediatricians are wellversed in how to treat allergic reactions, among a variety of other health issues. Good Night Pediatrics is open from 5 p.m. to 5 a.m. 365 days a year and accepts walk-in patients. For more information, visit goodnightpeds.com.

Good Night Pediatrics is an all-night urgent care for kids and teens.

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DIABETES

DIABETES IS SO VERY COMMON AND YET OFTEN MISUNDERSTOOD By Joyce Goedeke

D There’s more: See Diet & Diabetes on page 30.

iabetes. It is a word that is commonly known, and is also a condition that is sometimes undiagnosed. According to CDC’s 2012 National Diabetes Statistics Report, 29.1 million Americans, or 9.3 percent of the population, had diabetes and of those almost 28 percent went undiagnosed. This condition is one that continuous education is crucial to combat it as it can affect sufferers and loved ones with diabolical impacts limiting lifestyle. “Diabetes is a metabolic and chronic disease that we must be mindful of, and the diabetes conversation must remain constant,” said Joy DeGuzman, registered dietician, Southern Hills Hospital. “Diabetes can be prevented, managed and treated with the appropriate lifestyle choices and diet, and most importantly, with the right mindset.” What is diabetes? Diabetes is a condition in which the body cannot properly utilize glucose or sugar that is consumed from foods. Most foods are turned into glucose which is used in the body as energy; the pancreas releases a hormone called insulin that helps usher glucose into the cells of the body to be used as energy to perform its daily function. With diabetes, the body either does not make insulin (type 1 diabetes) to support this process or the body does not use insulin properly (insulin resistance or type 2 diabetes). Without the proper insulin function, glucose builds up in the blood that causes hyperglycemia that can result in damage to many organs like eyes, kidney, heart, and even nerves (CDC, 2015). The reason for diabetes prevalence is not fully understood, but genetics, age, lifestyle, and environment all play a role in the development of this disease (Diabetes.org, 2015).

Two important elements in understanding diabetes are insulin and glucose — breaking them down to their easiest form: • Insulin is a hormone that is produced by the beta cells of the pancreas and is needed to convert the food into glucose or sugar. When eating, insulin is released to move glucose into the cells for energy in order to perform daily task or store for future use (American Diabetes Association [ADA], 2015; Nutrition411.com, 2014).

• Glucose is one of the simplest forms of sugar. Food gets digested and broken down into glucose which is used for energy within the body in order to function daily (ADA, 2015). ••• Sound simple enough? These working parts all contribute to preventing, managing and treating diabetes provided appropriate attention is given to the overall condition. The first step is recognizing the most common symptoms, which include, but are not limited to: • Urinating frequently • Feeling very thirsty all the time • Feeling very hungry — even though you are eating • Extreme fatigue • Blurry vision • Cuts/bruises that are slow to heal • Weight loss — even with regular eating (type 1) • Tingling, pain, or numbness in the hands/feet (type 2) Some people with type 2 diabetes have symptoms so mild that they are unnoticeable — early detection and treatment of diabetes can decrease the risk of developing the complications of diabetes (ADA, 2015). The second step is to know your health numbers — blood glucose, blood pressure and cholesterol levels. If these numbers are high, take preventive steps to bring them back into the normal range. This can be accomplished through proper nutrition, regular moderate exercise and maintaining a healthy weight. Avoid or quit smoking because it increases the risk of diabetes, cancer, nerve and circulatory damage, heart disease, stroke, etc. Above all, use relaxation techniques, prioritize life’s tasks and stay positive. A healthy lifestyle reduces the risk of developing a host of other medical conditions. DeGuzman said the biggest mistake that diabetic patients can make is to think that this disease is not serious and that it can simply go away. People who monitor and maintain their blood glucose better and have regular checkups with their health care team (i.e. endocrinologist, dietitian, primary care

Joyce Goedeke is vice president of marketing/public relations for Southern Hills Hospital and Medical Center. Southern Hills Hospital Registered Dietician Julie Locklin and Dietary Interns Cristina Saheb and Mandi Waiters also contributed to this column.

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DID YOU

KNOW? • Complications from diabetes cause more deaths than breast cancer and AIDS combined every year (Diabetes.org, 2015)

• According to Behavioral Risk Factor

Surveillance System (BRFSS) 2012 data, nearly 8.9 percent of Nevadans had diabetes

TOP 10 DIABETES SUPERFOODS

Beans Dark green leafy vegetables Citrus fruits Sweet potatoes Berries Tomatoes Whole grains Fish high in omega-3 fatty acids Nuts Fat-free milk/yogurt Remember that total diet or overall eating patterns are most important in disease prevention. It is best to eat a “super diet” than to concentrate on individual foods as keys to good health!

physician, etc.) live a healthier life with fewer risks of complications. Along with lifestyle and diet choices, genetics certainly has its role. While genetics do factor into diabetes, a person’s environment plays a role in the development of the disease. Lifestyle interventions targeting diet and exercise during the pre-diabetes phase (when blood glucose is elevated but not high enough to be classified as type 2 diabetes) showed a 60 percent decrease in disease progression compared to medication alone in studies from both the US and China. (World Health Organization [WHO], 2006). The key to a better, longer life in the face of diabetes or just, in general, is simply to eat healthier and move more. DeGuzman said, “You can’t control everything that can impact your health, such as your genetic makeup, your age, gender, or even your family history of diabetes. As you get older, your risk for type 2 diabetes, heart disease, and stroke goes up. There’s nothing you can do about getting older. “Whether you’re male or female also affects how likely you are to develop heart disease. If your mother, father, sister, or brother has heart disease or diabetes, your risk goes up. DeGuzman provides this encouraging advice: “Compliance with a diabetic meal plan, medication and exercise play a significant role in successful diabetes management. Maintaining healthy blood sugars can prevent or even delay the onset of diabetes complications. Overall, maintaining a healthy lifestyle is key to preventing chronic diseases like hypertension, cancer, etc. We can manage this!”

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KNOWING

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WHATâ&#x20AC;&#x2122;S ON

YOUR PLATE By Sylvia Song

LEARNING THE FACTS BEHIND ORGANIC FOODS, GLUTEN, PESTICIDES AND GENETICS CAN HELP YOU LIVE A BETTER LIFE

here are always fad diets and super foods in the media; we are constantly

confused with information about changing our diets and the next new findings. There is an influx of information regarding organic

food, gluten-free diets, genetically modified organisms (GMO), fitness and more. In addition, there have been misconceptions about how too much of one thing can affect us and the role nutrition contributes to chronic diseases.

Continued on page 26

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Continued from page 25

Chronic diseases and nutrition

You are what you ate

Chronic diseases are long-term medical conditions that often can be prevented; the top ones include heart disease, diabetes, cancer and obesity. There is no super food or fad diet to combat them — the key is eating well, getting moderate physical activity, maintaining a healthy weight and avoiding smoking. “It is important to consume a low glycemic-load diet that is comprised mainly of vegetables, fruits, nuts, whole grains, spices and legumes. Proteins should include lean, organic, grass-fed meats and pasture-raised poultry, wild fish and/or plant proteins. Always try to avoid processed foods and trans fats and consume foods rich in anti-inflammatory and antioxidant fats such as omega-3 fats and olive oil,” said Dr. Brian Lawenda of 21st Century Oncology and the national director of Integrative Oncology and Cancer. “This is essentially following the traditional Mediterranean diet. The Mediterranean diet has consistently been reported as one of the most healthful diets in terms of preventing and helping to reverse numerous chronic diseases. This diet does not include many of the foods that are often associated with a modern-day Mediterranean diet, such as calorically dense meals with large quantities of pasta, breads, cheeses and wines.” It is important to: • Limit processed and prepackaged foods • Avoid adding excessive salt during food preparation • Cook with healthful oils such as extra-virgin, cold-pressed, organic olive oil or coconut oils.

More fruits and vegetables Chronic diseases, diabetes, hypertension, hypercholesterolemia and cardiovascular disease go hand in hand; it is common for a patient who has one to also have another. Lawenda says that it is much easier to follow a diet that is flavorful, simple to prepare, and consistent for the patient that incorporates ingredients that are compatible with a heart-healthy, anti-diabetes and anti-cancer lifestyle. “It is important to eat a variety of fruits, vegetables and legumes in a daily diet and it is about moderation,” said Lawenda. “The key is to find vegetables and fruits that are palatable and it is worth experimenting with the preparation. For instance, you may not like Brussels sprouts steamed but you may like it grilled. The preparation makes the difference. Do not disregard a vegetable because you did not like the way it was previously prepared and consumed.” Most adults in the United States do not consume enough fruits and vegetables on a daily basis. Fifteen percent of U.S. adults consume the minimum amount that the U.S. Department of Agriculture (USDA) recommends. This is still too low. Lawenda said, “The USDA recommends that we eat 2–3 cups of vegetables and 1–2 cups of fruits per day, but the latest data suggests that we should eat at least seven cups of fruits and vegetables daily. If you are trying to watch your weight, you should minimize your intake of high-glycemic, starchy vegetables such as potatoes, sweet potatoes and corn and instead consume low-glycemic vegetables like broccoli, cauliflower, spinach and Brussels sprouts.”

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We are what we eat — and that applies to what our food ate. For example, commercially raised cattle eat grain, soy and corn meal — not natural foods in the bovine menu. Cattle in their natural environment graze on grass and plants. The difference is that conventional beef has more fat and fewer nutrients. Grass-fed cattle have significantly less total fat and inflammatory fat content (omega-6 fatty acids) when compared to commercially raised cattle. You can find grass-fed meat at grocery stores and restaurants — it will be called “grass-fed,” but that might be for only a portion of the animal’s life. To obtain a richer flavor, the animal may be fed a cornmeal diet (called “corn finished”). Corn finishing increases the total fat and omega-6 fat content. Ask the butcher or restaurant if their grass-fed meat was “corn-finished.”

Plate size and portions In order to have a better understanding of plate size and portions, Lawenda prefers “The Healthy Eating Plate,” created by experts at Harvard School of Public Health and Harvard Medical School (see illustration).

The Dirty Dozen and the Clean Fifteen Eating fresh produce is the best way to obtain the nutrients that support optimum health, but pesticides used on many crops remain a major health concern. By choosing organic foods, you can reap the health benefits of fruits and vegetables while limiting exposure to potentially harmful chemicals. Some people believe that “organic” means “pesticide-free.” That’s not the case; food can be certified as organic and still be grown with pesticides that meet government approval (they must not be synthetically manufactured, for instance). The reason organic food is more expensive is because it is not subsidized by the government and organic farming produces smaller crop yields than nonorganic varieties. With regards to more common nonorganic produce, scientists who work for the Environmental Working Group (EWG) create an annual list of “The Clean Fifteen” and “Dirty Dozen.” These name the top most contaminated (“Dirty Dozen”) and least (“Clean Fifteen”) pesticide-contaminated produce from nonorganic farms across the United States. EWG scientists test only nonorganic produce from grocery stores across the U.S. “There are numerous studies published that support the fact that nonorganic foods are higher in pesticides, herbicides and other chemicals and often contain lower concentrations of micronutrients and phytonutrients than their organic counterparts. This is indisputable,” said Lawenda. “The real controversy is — does it matter? If you eat nonorganic produce every day, does that mean you will have a greater risk of developing cancer from the chemicals in these foods? The Environmental Protection Agency, the USDA and the Food and Drug Administration are the organizations that tell us whether or not pesticides, herbicides, antibiotics and hormones are safe to use in food. To date, there are little to no strongly supportive data that state that the use of chemicals approved by these organizations are definitively linked to an in-

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A WELL-ROUNDED DIET VEGETABLES

The more veggies — and the greater the variety — the better. Potatoes and French fries don’t count.

FRUITS

Eat plenty of fresh fruits of all colors

VEGETABLES

WHOLE GRAINS

FRUITS

HEALTHY PROTEIN

Choose fish, poultry, beans, and nuts; limit red meat and cheese; avoid bacon, cold cuts and other processed meats.

WHOLE GRAINS

Eat a variety of whole grains (like whole-wheat bread, whole-grain pasta and brown rice). Limit refined grains (like white rice and white bread).

WATER

Drink water, tea or coffee (with little or no sugar). Limit milk/dairy (1–2 servings/day) and juice (1 small glass/day). Avoid sugary drinks.

HEALTHY OILS

Use healthy oils (like olive and canola oil) for cooking, on salad, and at the table. Limit butter. Avoid trans fat.

creased risk of developing cancer or other chronic diseases in the amounts that are sprayed on food. The Environmental Protection Agency is the organization that tells us whether or not if it is safe to use and they say it is safe. There is no data that supports the use of pesticides is linked to cancer or other chronic diseases in the amounts that is sprayed on food.” Lawenda added, “However, there are concerning data from populations of farm workers who are exposed to high amounts of these chemicals over years that suggest that these chemicals may not be entirely safe. Epidemiologic data from farm workers have found that they have a higher incidence than the general population of developing many types of cancers such as, leukemia, lymphoma, sarcomas, gastrointestinal, brain and other cancers. We are exposing ourselves to lower amounts — does adding toxins matter?”

GMO and gluten-free foods “We have been genetically modifying our foods by cross-breeding plants and selecting the most and least desired qualities in plants and animals for thousands of years,” said Lawenda. “Food scientists are now splicing genes into plant DNA so that the plants grow faster and are more resilient to pests, drought and temperature extremes.”

Is this dangerous? Lawenda said, “This is the area of controversy we do not know. GMO now allows us to grow plants more hardily but it also withstands toxins that we spray on them. Therefore, fruits and vegetables have more toxins sprayed on them because they can tolerate it.” Gluten is a wheat protein. About 1 percent of adults in the U.S. have a true gluten allergy or celiac disease and 20 to 30 percent of the population may have gluten sensitivity. Having gluten sensitivities goes not mean you have gluten allergies and “gluten-free” does not equal “healthy.” “Whether it is actually the gluten or some other factor in these foods that causes their symptoms is not known,” said Lawenda. “One things is for certain: just because a food is “gluten-free” does not mean that it is healthy. Often, food manufacturers add extra sugar, fat and salt to enhance the flavor of these products, making them more calorically dense.” With anything, people should research and understand what are the benefits and detriments.

How does ‘too much’ affect us Moderation is important and too much of anything — red meat, grain, starch, etc. — can be bad for us.

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DIRTY CLEAN DOZEN

1 Apples 2 Peaches 3 Nectarines 4 Strawberries 5 Grapes 6 Celery 7 Spinach 8 Sweet Bell Peppers 9 Cucumbers 10 Cherry Tomatoes 11 Snap Peas 12 Potatoes (imported)

Continued from page 27

• Red Meat — Until recently, dieticians and nutritionists told us

FIFTEEN

1 Avocados 2 Sweet Corn 3 Pineapples 4 Cabbage 5 Sweet Peas 6 Onions 7 Asparagus 8 Mangos 9 Papayas 10 Kiwi 11 Eggplant 12 Grapefruit 13 Cantaloupe 14 Cauliflower 15 Sweet Potatoes

•

(frozen)

• • •

that consuming red meat increased serum cholesterol levels. However, the latest data reveals that dietary fat and dietary cholesterol do not significantly impact serum cholesterol in most people — being overweight or obese does. If you frequently consume larger servings on non-lean cuts of meat, which are calorically dense, you will gain weight. Therefore, it is best to limit the total servings of red meat you consume and preferentially choose leaner cuts and grass-fed varieties whenever possible. Grains — Whole grains are not much of an issue. Most people do not eat whole grains, instead they eat processed or refined grains, which convert instantly into sugar. Whole grains are less calorically dense and raise blood sugar to a much less extent than processed and refined grains such as, white flour and rice. Salt, Fats and Oils — If you do not have high blood pressure, heart disease or kidney disease, salt is unlikely to cause hypertension. If you do have any of these conditions, limit your salt intake. Consuming fats and oils are mainly a concern due to their calorie density. Make sure to minimize your intake of inflammatory omega-6 fatty acids (such as vegetable oils) and avoid trans fats (such as those found in margarine) entirely. Preferentially select healthy monounsaturated (such as olive oil) and anti-inflammatory omega-3 oils (such as fish oil). Starch — Similar to processed or refined grains, this converts instantly into sugar. Processed Foods — This has too much sugar and unhealthy fats and chemicals. Fruits and Vegetables — Most people do not eat enough of the recommended limit per day. If you did eat too much, it would be too much sugar. Try to consume at least 3 cups of vegetables and 1–2 cups of fruit per day. People should also be careful with juices even though it has 100 percent fruit juice because it still has loaded sugars. Although it may be natural sugars, it is still sugar which still leads to obesity.

Lifestyle Modifications In addition to moderation, the most important elements in reducing your risk of developing numerous chronic diseases are: • Eating a healthy diet • Being physically active • Maintaining a healthy weight • Avoid smoking And if you have any dietary questions or concerns, please consult your primary care physician.

Sylvia Song is the director of marketing for Sunrise Hospital & Medical Center.

SOURCE: EWG’s 2015 Shopper’s Guide to Pesticides in Produce

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Photo by Eric Jamison.

7/23/15 11:27 AM

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DIET & THE KEY TO MANAGING HIGH BLOOD SUGAR IS TO RETHINK YOUR LIFESTYLE

DIABETES

By Tracy Wakefield, M.D.

eonard Rosales knew something was wrong last year when he began noticing unusual symptoms. Constantly thirsty, he experienced sporadic episodes during which he simply felt “off,” his body indicating that something was definitely wrong. “I just felt strange,” the Las Vegas resident said. His primary care physician with HealthCare Partners Nevada confirmed his suspicions: He appeared to be prediabetic, his high blood sugar the cause of his sudden health issues. This was not wholly unexpected; Rosales had watched several close family members develop type 2 diabetes, one of them experiencing severe complications. Rosales, 66, is also overweight, a top risk factor for the disease. “Developing diabetes really worries me,” he said. “I’ve seen what happens to people with this disease.” It wasn’t all bad news, however. His doctor offered an encouraging outlook, with a slight catch. Rosales could manage his blood sugar, and possibly even avoid developing diabetes entirely, by making significant lifestyle changes. It primarily came down to changing what he put on his plate. “Now I’m checking the ingredients and the portions of what I’m eating. It’s something I never thought about before,” Rosales said. Although it hasn’t been easy, he has help. Rosales has received educational materials and direct support from HealthCare Partners Nevada, a leading medical organization offering 310 primary care providers and more than 1,700 specialists across Southern Nevada. With his new focus on nutrition, he is on his way to improving his condition. “I’m feeling better,” Rosales said. “I’m hoping to turn this around.” He is far from alone in this battle. Diabetes is increasingly common across the U.S., including Southern Nevada. One in 10 adults in the U.S. currently has diabetes, according to the Centers for Disease Continued on page 32

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T Working in his garden helps Las Vegan Leonard Rosales remember to eat healthy and provides exercise in the process.

Leonard Rosales photo by Mikayla Whitmore.

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Rosales has noticed significant improvements in his health since his doctor talked to him about addressing his diet and lifestyle last year.

Continued from page 31

Control and Prevention, a number that is projected to double or even triple by 2050. Dr. Sunita Kalra, primary care physician with HealthCare Partners Nevada, estimates that roughly 35 percent of her patients have diabetes, and the majority have type 2 diabetes. “I think many people are unaware that diabetes can occur at any age,” Kalra said. A metabolic disease in which the body doesn’t produce enough or sometimes any insulin, diabetes causes elevated glucose levels in the blood. Type 1 diabetes, often diagnosed during childhood, is caused by genetics and other unknown factors, while type 2 diabetes can develop at any age, the result of genetics and lifestyle issues such as being overweight. Mismanagement of diabetes can initially have minimal or no symptoms. But left unmanaged or poorly managed, diabetes can lead to severe health issues over the long term, including heart attack, kidney issues and lower leg problems that can result in amputations of the toes and legs. Having diabetes doesn’t have to be a death sentence, however, nor does it even have to be an inconvenience, if properly addressed. For individuals with type 2 diabetes, it is even possible to reverse the condition completely by taking the proper steps. “Diabetes is no longer the frightening diagnosis it once was,” Kalra said. “We can really manage it.”

Diet is key The key to managing diabetes is simple: proper nutrition. “Nutrition is very important for diabetics because it is key for controlling their overall blood sugar,” Kalra said. The chief step for diabetics to prevent complications from the disease is to avoid an excessive intake of food high in sugar, which raises the blood’s glucose level. Because diabetic bodies

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are developing minimal amounts to none of the hormone insulin, which plays a key role in circulating sugar from the blood into cells, glucose will build up in the blood, leading to health issues. Even without ingesting sugary foods, the human body produces glucose naturally, so diabetics already have to worry about their natural glucose levels without adding more from sugary foods, Kalra said. “Diabetics don’t have to avoid sugar entirely,” Kalra said. “The best advice is to simply eat everything in moderation. It’s not that diabetics can’t eat a single cookie, they just can’t indulge a craving and eat the whole bag. Portion control is everything.” The American Diabetes Association recommends for diabetics to consume roughly 45 to 60 grams of sugar per meal. (One sugar cube is 4 grams of sugar; there are 39 grams of sugar in one can of regular Coke.) Keeping sugar consumption in check involves more than just avoiding candy and desserts, Kalra said. It also requires avoiding a high intake of carbohydrates such as bread, pasta and starchy vegetables such as potatoes, which the body converts into glucose during digestion. There are a variety of foods diabetics can substitute for these items, Kalra said. She recommends a low-carbohydrate diet of non-starchy vegetables such as lettuce and broccoli, whole grains and lean protein such as chicken and fish, with allowances for fruits with lower sugar levels. To help with portion control during meals, the ADA suggests restricting one-fourth of a plate for starchy foods, filling half the plate with non-starchy vegetables, and saving the final quarter of the plate for foods high in protein. Kalra has observed that some patients have more success than others with adjusting to the diabetic diet. Many struggle during the holidays, when there is often an abundance of foods high in sugar and carbohydrates.

Photo By Mikala Whitmore.

7/23/15 6:56 AM

“The biggest thing to keep in mind is that this is not like going on a diet,” Kalra said, adding that these dietary recommendations apply to individuals with type 1 and type 2 diabetes. “It’s a lifestyle change that diabetics must incorporate into their daily lives.”

A new lifestyle Hearing that he had to dramatically change his diet was tough news for Rosales. He was raised in an environment immersed in food, his parents operating a restaurant and catering business. He went on to work in the restaurant industry himself, developing a strong appreciation for his product. “I like to eat,” Rosales said with a chuckle, admitting that his meals were often heavy in carbohydrates such as potatoes, French fries and rice, all of which contribute to higher blood sugar. “It bothers me a little to restrict what I eat.” Learning about the healthiest foods for diabetics has helped him adjust. HealthCare Partners Nevada provided him with booklets about diabetes and nutrition and his doctor advised him on obtaining a blood sampling device to measure his blood sugar every day. HealthCare Partners Nevada also offers classes about managing diabetes. In addition, nurses are available to counsel diabetic patients one-on-one about their condition. “We have a great support network for patients,” Kalra said. This support has helped Rosales become more mindful of what he consumes. He has learned to read nutrition labels and keeps a daily log of his meals, in addition to checking his blood sugar after every meal. “I write down what I’ve eaten and then I check my blood sugar,” he said. “If it goes up, I give up what I was eating.” He is eating vegetables from his garden a little more, and visiting his favorite buffets a little less. His commitment has paid off, with his blood sugar dropping up to 50 percent from its highest point. For overweight diabetics, Kalra suggests pairing nutritious eating with weight loss. Overweight individuals can significantly improve their blood sugar by losing just 5 to 10 percent of their overall body weight, according to the CDC. Following these nutrition recommendations and maintaining a healthy weight can make diabetes a controllable disease, Kalra said. Individuals with type 2 diabetes who follow a nutritious diet and reach a healthy weight typically don’t experience any health complications and often don’t need medications, she adds. She has even observed patients completely reverse their condition by making dramatic lifestyle changes. “This is only possible for patients with type 2 diabetes,” Kalra said. “Those with type 1 diabetes have a complete deficiency of insulin, meaning their condition can never be reversible. However, they can limit the amount of medications they need by following a nutritious diet and exercising.”

Worst-case scenarios Not everyone handles diabetes well, Kalra said. Those who fail to kick their sugar habits and remain at an unhealthy weight can experience extreme health issues. These can include damage to blood vessels in the kidneys, resulting in

kidney failure, as well as retinopathy, which occurs when small blood vessels in the eye become damaged, leading to vision loss. High glucose levels among diabetics can also lead to neuropathy, or nerve damage, which can cause toe and foot deformations, as well as loss of feeling in the foot, hindering people’s ability to recognize when their feet are injured, according to the ADA. Poor circulation is also a common symptom. It can cause blood vessels in the feet and legs to harden. Because of the many foot and leg issues diabetics can experience, they are far more likely to have a foot or leg amputated that those without the disease, the ADA says. Heart attacks are one of the most common of diabetes’ extreme complications, Kalra said, as a result of high blood sugar damaging nerves and blood vessels. “These complications occur among diabetics who have extremely advanced cases,” she said, noting that just 4 to 5 percent of diabetics in her patient population have experienced such issues. “If diabetes isn’t properly managed or isn’t caught in time, the disease can have a severe impact on the body.” Rosales is well acquainted with the potential complications of diabetes. Of his many relatives with diabetes, one immediate family member experienced the worst symptoms, he said. These included vision issues that nearly led to blindness, he says. She also experienced complications with her lower extremities. Her doctors first amputated her toes, he recalls, then worked their way up to the feet and legs. “That was definitely concerning,” he said. “This is why people need to watch their diets, to try not to get to that point.”

Making the right choices Rosales has noticed significant improvements in his health since his doctor first spoke with him about addressing his diet and lifestyle last year. He has more energy to engage in activities beneficial to his health, and he isn’t experiencing the episodes he previously noticed. “I’m always outside being active, working in my garden or in the yard,” he says. Such positive results are possible for many people with prediabetes and diabetes, Kalra says, if they take the steps to manage their condition and meet regularly with their primary care providers to monitor for complications. “People can enjoy a healthy, active life with diabetes,” Kalra says. “For those who learn how to manage the disease and make the right choices, this disease never has to lead to significant health problems.”

Tracy Wakefield, M.D., is an internist with HealthCare Partners Nevada.

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DIABETES-FRIENDLY RECIPES Provided by Joy Deguzman, registered dietician at Southern Hills Hospital

GRILLED CHICKEN MARSALA Portions: 4

Serving size: 1 chicken breast with sauce

MANGO-GINGER MAHI MAHI Portions: 6

Serving size: 1 fish fillet

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Photo Credit

7/23/15 6:58 AM

THE CHOICE IS

NATURAL EL DORADO CANTINA IS SERVING AUTHENTIC MEXICAN FOOD MADE WITH ORGANIC INGREDIENTS

f you try to eat organically and avoid genetically modified ingredients, going to a restaurant can be tough. It’s one thing to buy organic at the grocery store, but that might not be as easy

to do when dining out, leaving you with a tall glass of delicious water while your dining companion dives in to the rib-eye with béarnaise sauce. El Dorado Cantina Chef Paco and Owner Darin Feinstein have heard your cries. The Mexican restaurant uses organic ingredients and GMO-free meat, produce and dairy — and tells diners which suppliers they rely on in the pages of their menu so that the information can be double checked. Continued on page 38

Photo Credit

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Left: Mahi tacos with cilantro rice and black beans. Below: Chicken lettuce wraps with cilantro rice and pinto beans at El Dorado Cantina. The Mexican restaurant specializes in meals made with GMO-free, organic ingredients. The beef is grass-fed, the fish is farm-raised and the chicken is free-range.

Continued from page 37

How do you describe the menu to new customers? Organic and GMO-free Mexican cuisine.

What has been the response from the public? Overwhelmingly supportive. A majority of our customers have heard about us via social media or our marketing efforts espousing that El Dorado cares about the food that we serve to our customers.

What made you decide to offer USDA-approved organic and GMO-free food? Your body is a delicate ecosystem. If you eat food that is filled with pesticides, hormones, steroids and other potentially poisonous products you run the risk of suffering from adverse effects of those poisons.

What is USDA-approved organic beef? The USDA organic seal verifies that producers met animal health and welfare standards, did not use antibiotics or growth hormones, used 100 percent organic feed, and provided animals with access to the outdoors. We source our organic beef from ranchers who meet the organic standard from pasture to plate.

How did you go about selecting vendors for the restaurant? We require USDA organic certification from all of our vendors. That’s the first step. If they don’t have the official organic certificate for their products, the conversation ends there. After verifying they are organic we research the farm and if possible speak to the owners of the farm. We source regionally when we can, although living in the desert makes that difficult. We take sourcing our vendors seriously, and have spent the better part of a year procuring the vendors we have now.

What oil do you use for frying? How does the kitchen ensure that the gluten-free menu choices stay that way? We use a non-GMO sunflower oil at El Dorado Cantina. We also have separate utensils, pans and a separate frier for gluten-free items to prevent cross-contamination.

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When you go out to a restaurant that doesn’t label its menu items as gluten-free or non-GMO, what do you look for to order? This is why we strive for transparency here at El Dorado Cantina. If you don’t know where your food comes from, it can be very difficult to find gluten-free and non-GMO options. The way we see it, we are proud to offer these products to our customers, and we want everyone to know about it. Why wouldn’t we label our menu? Unless you are hiding something, it makes no sense for companies or restaurants to not label their food.

Chef Paco, where did you learn your skills as a chef? Was there a learning curve to adjust to the philosophy behind El Dorado Cantina? I learned my skills as a chef from my grandmother and mother. Many of the recipes at El Dorado are based on traditional recipes passed down in my family. The biggest learning curve for me was learning how to incorporate organic and non-GMO products into these traditional dishes while still maintaining the spirit and authenticity of the cuisine.

There’s a lot of heat on the menu. Are there any health benefits to eating spicy food? The compound that makes peppers spicy is called capsaicin. Capsaicin has anti-bacterial, anti-carcinogenic, analgesic and anti-diabetic properties and has also been shown to reduce high blood pressure. Additionally, chilies are a great source of essential minerals, antioxidants and Vitamin C. One of our favorite spicy dishes is Paco’s pozole, which we have nicknamed Mexican chicken soup. A bowl of pozole will give your immune system the jump-start it needs to fight off any bug.

Story photos by Steve Marcus.

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Family Physician SUMMER 2015

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THE LOW D ‘PEOPLE CAN EAT TWO EGGS A DAY AND IT WILL NOT IMPACT CHOLESTEROL LIKE WE USED TO THINK.’ — DR. IRENE LAMBRIS

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W DOWN ON

CHOLESTEROL By Judith Ford, M.D.

levated total cholesterol can be an indicator of failing heart health, although it is far from a death sentence. Achieve cholesterol health by

living a healthy lifestyle and following the recommen-

dations of knowledgeable medical professionals. The American Heart Association says that high cholesterol is one of the major causes of coronary heart disease, heart attack and stroke, and early detection helps save lives. HealthCare Partners Nevada, a medical network with locations across Southern Nevada, strives to make patients aware of their risk factors and develop customized treatment plans suited to their needs. Continued on page 44

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Good vs. bad cholesterol There are two different types of cholesterol — low-density lipoprotein (LDL) and high-density lipoprotein (HDL) — and the body’s total blood cholesterol is measured by adding the LDL and HDL cholesterol levels, along with 20 percent of the body’s triglyceride level, according to the AHA. Triglycerides are fat that can enter the bloodstream through foods that are high in simple sugars, fat and carbohydrates. Elevated triglyceride levels can contribute to the hardening of arterial walls and increase the risk of heart disease and stroke, according to the Cleveland Clinic. LDL is often called “bad” cholesterol because it can build up in the arterial walls and form plaque, which can reduce blood flow and increase the risk of heart disease. HDL cholesterol is known as the “good cholesterol” because it is thought to help remove the LDL cholesterol that clogs arterial walls. While higher HDL cholesterol levels indicate strong cardiovascular health, raising HDL cholesterol via medication has not been proven to be beneficial, according to a study by the British Medical Journal. Monitoring cholesterol levels is crucial, since low HDL and high LDL cholesterol are major risk factors for heart disease. Heart disease is a leading cause of death among men and women in the U.S. and, according to the Centers for Disease Control and Prevention, roughly 730,000 Americans suffer heart attacks each year. Of those, approximately 525,000 are first-time heart attacks. The CDC says that heart disease claims more than 600,000 lives in the U.S. each year and is the No. 1 cause of death among most ethnicities.

“Genetics play a key role with cholesterol,” says Dr. Irene Lambiris, a physician with HealthCare Partners Nevada. “Between the ages of 20 to 30, individuals should undergo one cholesterol check. If that cholesterol check is abnormal, it is advisable to proceed to annual checkups.” Kalra says he has high cholesterol as a result of genetics. He works out and watches what he eats to help prevent the onset of heart disease. When it comes to relaying the importance of cholesterol, he says it can be difficult to get through to certain patients. “People tell me, ‘I’m thin, I don’t have to worry about cholesterol,’” Kalra says. “They don’t understand the importance of getting cholesterol down to prevent heart attacks and stroke. The really thin people, and even young people, often don’t realize how important it is to get cholesterol under control.”

Medicating high cholesterol When it comes to treating high cholesterol, the National Heart, Lung and Blood Institute says the goal is to reduce cholesterol levels to a point where the risk of developing heart disease or suffering a heart attack decreases. Lambiris says she starts to become concerned when a patient’s LDL cholesterol is above 160 milligrams per deciliter (mg/dl). Prior to starting medication, HealthCare Partners Nevada recommends a cholesterol-lowering diet, physical activity and weight management for six months. If that does not work, medication, along with diet and exercise, is the next step. There are myriad cholesterol medications that help regulate cholesterol levels, including statins, bile acid sequestrants, nicotinic acid, fibric acids and cholesterol absorption inhibitors. Statin drugs, including Lipitor and Crestor, are very common in cholesterol treatment and lower LDL and triglyceride levels while slightly raising HDL levels. Cholesterol absorption inhibitors and bile acid sequestrants lower LDL levels and can be taken alone or in conjunction with statin drugs. Nicotinic acid drugs lower LDL cholesterol and triglyceride levels, while fibric acids are typically implemented to treat high triglyceride and low HDL levels. The AHA says statins are recommended for most patients because they are the only cholesterol-regulating medications that have been proven to decrease the risk of a heart attack. They reduce the amount of cholesterol deposited into the lumen of the artery, which is the hollow part of the artery in which blood passes through. Statins also lessen the inflammatory state of the artery, making the plaque more stable so that it does not break off and cause a heart attack. Lambiris compared the lumen to pipes in a house, saying “If they keep getting clogged, that’s a problem.”

THE CDC SAYS THAT HEART DISEASE CLAIMS MORE THAN 600,000 LIVES IN THE U.S. EACH YEAR AND IS THE NO. 1 CAUSE OF DEATH AMONG MOST ETHNICITIES.

Risk factors and symptoms High blood cholesterol itself is not symptomatic, so many people are unaware of their condition. It is important to undergo cholesterol testing so medical professionals can begin their treatment plan. Dr. Rakesh Kalra, a HealthCare Partners Nevada physician, says that body type is not an indicator of high cholesterol. A thin frame, regular exercise and living a healthy lifestyle does not ensure healthy cholesterol levels. On the other hand, being overweight is not necessarily an indicator of elevated cholesterol and triglyceride levels. There are numerous ailments and lifestyle choices that can contribute to a person developing high cholesterol. According to the University of Maryland Medical Center, a diet high in saturated fat and trans fats, a lack of exercise, obesity, high blood pressure and diabetes are some of the top risk factors. Genetics are the most important risk factor, and poor cholesterol health can be passed down from a parent.

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The red meat debate According to Kalra, red meat can have an adverse impact on cholesterol, since it is generally high in cholesterol and saturated fat but it is typically safe to eat occasionally — if you select the right kind. If people are going to eat beef, he suggests purchasing lean beef with 10 percent fat or less. The AHA recommends consuming no more than six ounces of cooked, trimmed lean meat a day, which includes shellfish, skinless poultry, and trimmed, lean red meats. Processed, highly salted red meats such as bacon, sausage and salami are associated with a much higher risk of heart disease. They are loaded with calories and saturated fat and are often packed with sodium. According to a Harvard T.H. Chan School of Public Health study, eating 50 grams a day of processed red meats like sausage and bacon resulted in a 42 percent greater risk of heart disease and 19 percent higher risk of Type 2 diabetes. “The sodium content in processed red meats is exorbitant, and eating too much salt can increase blood pressure as well,” Lambiris says. “I encourage all of my patients to avoid eating processed red meats.”

Eggs Eggs were long considered harmful to heart health because of their high cholesterol content. In recent years, that school of thought has changed and many medical professionals sing the praises of eggs as a nutrition-packed staple of a well-balanced diet. In fact, most healthy individuals can eat at least seven eggs a week without increasing their risk of heart disease, according to the Mayo Clinic. In addition, studies have shown that egg consumption can also reduce the risk of stroke. The negative perception of eggs has led to Americans eating fewer than ever. According to the U.S. Department of Agriculture, the average American in 1945 ate 421 eggs per year, a number that dropped to 250 by 2012.

“People can eat two eggs a day and it will not impact cholesterol like we used to think,” Lambiris says. “I would rather have my patients eat an egg omelet in the morning than oatmeal.” Oatmeal is high in carbohydrates, which raises the body’s triglyceride levels, Lambiris says. She notes that oatmeal is broken down into sugar and stored as fat, whereas protein and fat sources like eggs are broken down more easily and used as fuel much quicker than carbohydrates. While eggs are high in cholesterol, the impact of egg consumption on blood cholesterol is minimal when compared with trans fats and saturated fats. The risk of heart disease may be more closely related to the foods many people eat with eggs, such as the sodium in bacon, sausage, ham and the saturated fat or oils with trans fats used to fry eggs and hash browns.

Overall diet While having in-depth diet discussions with his patients, Kalra provides them with a handout outlining healthy foods low in saturated fat, fat free or 1-percent dairy products, lean meats, whole grains, fruits and vegetables. In addition, he suggests consuming 25 grams of fiber per day. According to the Mayo Clinic, fiber contributes to reducing “bad” cholesterol levels, controls blood sugar and helps maintain bowel health. “I have seen miraculous health improvements in patients committed to diet and lifestyle changes,” Dr. Lambiris says. “Sometimes, lifestyle changes are not enough because of genetics, but we do want to get them on that path where they are living healthier lives.” And a healthy lifestyle, combined with regular checkups and a commitment to medications, can help keep cholesterol levels in check. HealthCare Partners Nevada’s primary care providers and cardiologists are committed to promoting healthy cholesterol levels and are happy to answer any questions about cholesterol and heart health. Visit www.hcpnv.com to learn more about the services offered by HealthCare Partners Nevada.

Dr. Judith Ford is the lead physician of clinical quality at Healthcare Partners Nevada

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IS THE FOOD YOU’RE EATING GIVING YOU AN ULCER? MAYBE NOT.

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GUT FEELING By Nicholas Tibaldi, M.D.

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ike many modern health issues, our understanding of ulcers has evolved over time. For the better part of a century, the cause of ulcers was hotly debated, with infections and excess stomach acid most frequently thought to be triggers. Other factors, such as diet and lifestyle, were also considered. Interestingly, in some circles, a stomach ulcer was thought to be a “badge of success” or an occupational hazard related to dealing with big decisions. Everything changed in 1983, when Australian doctors J. Robin Warren and Barry Marshall isolated Helicobacter pylori, a bacterium later determined to be the primary cause of peptic ulcer disease. While many scientists were slow to accept this discovery, today most doctors regard ulcer management as greatly improved thanks to Marshall and Warren’s discovery. Ulcers — more specifically called peptic ulcers — are open sores that may develop on the interior lining of your stomach and the upper portion of your small intestine. They include gastric ulcers found on the inside of the stomach and duodenal ulcers found on the inside of the upper portion of your small intestine (the duodenum). The most common symptom of a peptic ulcer is abdominal pain. But Spices such as black pepper, how do you determine the difference between the chili powder and red pepper commonly experienced may cause indigestion, but pain of an upset stomach from a large or spicy meal, they have not been shown to and the pain of an ulcer? cause or contribute to ulcers. While peptic ulcers can sometimes produce no symptoms, a burning pain is the most common. This pain is aggravated by stomach acid coming in contact with the ulcerated area. The pain may be felt anywhere from your navel up to your breastbone. It can be worse when your stomach is empty and is often temporarily relieved by eating certain foods that buffer your stomach acid (or by taking an acidreducing medication). This pain can disappear and then return for a few days or weeks, and it often flares up at night. Other symptoms may include nausea, vomiting or vomiting of blood, dark blood in stools, or stools that are black or tarry, as well as appetite changes or unexplained weight loss. These symptoms may also underlie other conditions, some even more serious, so it is important to obtain a medical evaluation for them. Your digestive tract is coated with a layer of mucus that normally protects against stomach acid. But if the amount of acid is increased or the amount of mucus is decreased, you could develop an ulcer. Again, Helicobacter pylori is the primary cause of peptic ulcers. Usually this infection causes no problems, but it can cause

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inflammation of the stomach’s inner layer, leading to an ulcer. It’s not yet clear how Helicobacter pylori spreads. It may be transmitted from person to person by close contact, such as kissing. People may also contract it through food and water. Another common cause of peptic ulcers is regular use of certain pain relievers used to reduce inflammation (commonly known as “nonsteroidal anti-inflammatory drugs” or NSAIDs), which can irritate the lining of your stomach and small intestine. These medications include aspirin, ibuprofen (such as Motrin or Advil), naproxen (Aleve) and many other anti-inflammatory medications often used to treat pain and arthritis. There are prescription medications and other health conditions that can also lead to ulcers, but these are much less common.

Nutrition and ulcers For decades, doctors recommended dietary changes to prevent or treat ulcers. Common suggestions included avoiding spicy foods, coffee and alcohol, or eating bland foods and drinking milk. Some of these suggestions have not stood up well when tested in controlled trials. For example, drinking milk tends to produce more acid. Also, spices such as black pepper, chili powder and red pepper may cause indigestion, but they have not been shown to cause or contribute to ulcers. Recent studies have made connections between diet and ulcers. They include: • High-fiber diets — A Harvard School of Public Health study found that high-fiber diets were associated with a reduced risk of developing ulcers. Over a six-year period, the risk was 45 percent lower for those with the highest fiber intake, compared to those with the lowest. Foods with soluble fiber were most protective, lowering the risk by 60 percent. However, dietary fiber from wheat bran had no effect on ulcer recurrence, and high-fiber diets appeared to have no benefit on ulcer healing rates. • Avoiding alcohol — Chronic alcohol abuse aids Helicobacter pylori infection and also slows the healing of existing ulcers. • Avoiding coffee — Coffee (caffeinated or caffeine-free) stimulates acid production. Some studies have suggested a close association between coffee intake and symptoms. However, it is unclear whether consuming coffee increases or decreases the risk of Helicobacter pylori infection. • Green tea — Some studies show that regularly drinking green tea can reduce the risk of gastritis by 40 to 50 percent. The chemistry of green tea may act as antioxidant and antibacterial to suppress the Helicobacter pylori bacterium. • Probiotics — Probiotics, such as the live culture Lactobacillus caseii found in many yogurts, are microorganisms believed to provide health benefits. They may interfere with Helicobacter pylori growth. Some studies have shown that probiotics also increase the effectiveness of antibiotic treatment for this bacterium and may reduce the side effects of treatment. However, further study is necessary before probiotics can be recommended to prevent or treat ulcers.

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Testing and diagnosis Your doctor may recommend tests to determine whether you have this bacterium in your body. These tests may use your blood, breath or stool sample. Your doctor may also recommend an endoscopy or X-ray. In an endoscopy, your doctor passes a hollow tube equipped with a lens (an endoscope) down your throat and into your esophagus, stomach and small intestine to look for ulcers. If one is detected, a small tissue sample (a biopsy) may be removed for examination in a lab. A biopsy can also identify the presence of Helicobacter pylori in your stomach lining. Your doctor is more likely to recommend this test if you are older, have signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing. Your doctor may also suggest an X-ray. Sometimes referred to as an “upper gastrointestinal (GI) series” or a “barium swallow,” this series of X-rays creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid containing barium that coats your digestive tract and makes an ulcer more visible.

Treatment If you’ve been diagnosed with an ulcer, your treatment will depend on the cause. Treatments can include: • Antibiotic medications to kill Helicobacter pylori. If Helicobacter pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics and other drugs to kill this bacterium. You’ll likely need to take these medications for several weeks, in addition to medications to reduce the production of stomach acid. • Medications that block acid production and promote healing. Proton pump inhibitors are a group of drugs used primarily to reduce the production of gastric acid. These drugs include over-the-counter medications such as omeprazole (Prilosec) and prescription drugs such as lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). • Medications to reduce acid production. Acid blockers, also called histamine (H-2) blockers, reduce the amount of stomach acid released into your digestive tract, which can relieve ulcer pain and encourages healing. Available by prescription or over the counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet) and nizatidine (Axid). • Antacids that neutralize stomach acid. Your doctor may recommend an antacid as part of your treatment regimen. Antacids neutralize stomach acid and can provide rapid pain relief. Some of the side effects can include diarrhea, rash, dizziness, headaches and fatigue. While antacids can ease your symptoms, they can’t heal your ulcer.

What can you do?

Choose a healthy diet containing lots of fruits, vegetables and whole grains. For more information on how you can make your diet healthier, visit www.choosemyplate.gov. Reduce stress in your life. Stress may worsen the signs and symptoms of a peptic ulcer. Determine the sources of your stress and do what you can to address it. While some stress is unavoidable, you can find methods to cope. In some cases, seeking the assistance of a counselor or therapist may be helpful. Stop smoking. In addition to the other hazards it creates, smoking increases stomach acid and can interfere with the protective lining of the stomach, making it more susceptible to developing ulcers. Avoid or limit alcohol. Excessive use of alcohol can irritate and erode the lining in your stomach and intestines, causing inflammation and bleeding. If you drink alcohol at all, don’t exceed one drink per day for women or two drinks per day for men. Some people should drink less or no alcohol at all. Consult your doctor to see what’s best for you. See your doctor if you have any signs or symptoms suggestive of an ulcer. Ask your doctor for suggestions on the best ways to relieve any pain you may be having. Here are some ways to prepare for the visit with your doctor: • Write down personal information such as other medical problems, previous surgeries, major stresses or recent life changes. • Make a list of all of your prescription and over-the-counter medications, vitamins and supplements that you may be taking. It's especially important to note any pain relievers you take, and at what dosage and frequency. • When you make your appointment, ask if there’s anything you need to do in advance, such as restrict your diet. Some medications can affect ulcer tests, so your doctor may want you to stop taking them, and can suggest alternatives to these drugs. Food may also alter the results of laboratory tests that might be done. • Write down any symptoms that you’ve been experiencing, even those that might seem unrelated. It’s also a good idea to keep a food diary that you can share with your doctor. • Make a list of questions for your doctor and don’t hesitate to ask if you are having problems understanding his explanations or instructions.

Nicholas Tibaldi, M.D., is the gastroenterology department chief for Southwest Medical Associates.

To ease the pain of a stomach ulcer, try these tips:

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STONE SOUTHERN NEVADA HAS HIGHER NUMBERS OF A PAINFUL PROBLEM By Sarah Ryan, M.D.

ydration, hydration, hydration — remember when people simply just said, “drink plenty of water?” Whatever name you give to it, there is good reason

for the advice, especially when it comes to kidney stones and

the Southwest. If you draw a line along the Southern states, this area is often referred to in the medical profession as the “Stone Belt” because of the hot climates where dehydration is common. A study several years ago in the Proceedings of the National Academy of Sciences suggested that as global warming causes temperatures to rise, Americans living in certain areas of the country may suffer from as many as 30 percent more kidney stones by the year 2050.

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Fluid loss through excess sweating explains the link between hot climate and kidney stones. More water loss through perspiration means more concentrated urine — and more concentrated urine means a higher risk of kidney stones. Of course, there are many reasons for kidney stones beyond dehydration. If you’ve had kidney stones, you know what they are and how they feel. If you haven’t been diagnosed before, there are signs to watch out for.

What are kidney stones (besides painful)? Kidney stones are small, hard deposits that form inside your kidneys. The stones are made of mineral and acid salts. They can have many causes and can affect any part of your urinary tract from your kidneys to your bladder. Passing stones can be very painful, but usually causes no permanent damage. In some instances, however, stones can become lodged in the urinary tract or cause other complications and require surgery.

Signs of a problem You may not experience any symptoms until a stone moves around within your kidney or passes into your ureter (the tube connecting the kidney and bladder). If that happens, you may experience one or more of the following: • A persistent need to urinate • Cloudy or foul-smelling urine • Fever and chills (if an infection is present) • Nausea and vomiting • Pain when urinating • Severe pain in your sides and back, below the ribs • Pain that spreads to your lower abdomen and groin • Pain that comes in waves and fluctuates in intensity • Pink, red or brown urine • Urinating more often than usual • Urinating small amounts of urine You should seek immediate medical attention if you experience: Blood in your urine Difficulty passing urine Pain so severe that you can’t find a comfortable position Pain accompanied by nausea and vomiting Pain accompanied by fever and chills

• • • • •

But why? Kidney stones often have no definite, single cause, although there are several factors that can increase your risk. Dehydration. Not drinking enough water can increase your risk of kidney stones and people who live in warm climates (like here in Southern Nevada) and those who sweat a lot (e.g., those who perform manual labor, especially outdoors) may be at higher risk than others. Diet. A diet high in protein, sodium and sugar may increase your risk of some types of kidney stones. This is especially true with a high-sodium diet. Too much sodium increases the amount of calcium your kidneys must filter and increases your risk of developing kidney stones.

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Digestive diseases and surgery. Chronic diarrhea, inflammatory bowel disease or gastric bypass surgery can cause changes in digestion that increase the levels of stone-forming substances in your urine. Family or personal history. If someone in your family has kidney stones, you’re more likely to develop stones. And if you’ve already had one or more kidney stones, you’re at increased risk of developing them again. Obesity. A high body mass index (BMI), large waist size and weight gain have been linked to an increased risk of kidney stones.

Things you can do Prevention may include a combination of lifestyle changes and medications. We need to drink a lot of water to stay healthy and function well in an environment where summer daytime temperatures commonly hover above 100 degrees and relative humidity is often below 20 percent. Drinking an average of eight glasses of water a day (about 1 liter) will curb dehydration. This equates to drinking one 16-ounce bottles of water with each of three meals a day and one or two bottles of water in between meals. If you exercise frequently you may need to drink even more water to produce enough urine. If your urine is light and clear, you’re likely drinking enough water. But water is obviously just part of your diet. Choosing a diet low in salt and animal protein can help reduce your risk. You can continue eating calcium-rich foods, but you should be cautious with calcium supplements. Calcium in food doesn’t have an effect on your risk of kidney stones. Ask your doctor before taking calcium supplements, as these have been linked to increased risk of kidney stones. You may reduce the risk by taking supplements with meals. Diets low in calcium can increase kidney stone formation in some people. Your doctor can refer you to a dietitian who can help you develop an eating plan that reduces your risk of kidney stones.

What your doctor can do If your doctor suspects you have a kidney stone, there are different diagnostic tests and procedures that may be used, such as: Analysis. You may be asked to urinate through a strainer to catch stones that you pass. Lab analysis will reveal the composition of your kidney stones and provides your doctor with the information needed to determine what’s causing your kidney stones. Blood tests. These tests can reveal the level of calcium or uric acid in your blood. It can also help your doctor monitor your kidney health. Imaging. Imaging tests may show kidney stones in your urinary tract. Imaging options range from non-invasive tests like simple X-rays to computerized tomography (CT) scans and ultrasounds. Other imaging tests include intravenous urography, which involves injecting dye into an arm vein and taking X-rays or obtaining CT images as the dye travels through your kidneys and bladder. Urine tests. A 24-hour urine collection test may show that you’re excreting too many stone-forming minerals or too few stone-preventing substances.

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A GROWING RISK

Expansion of the “Stone Belt” over time.

2000

2050

2095

Getting rid of those stones Treatment of kidney stones can vary, depending on the type and cause of the stone. If the kidney stones are small, and symptoms are minimal, they typically won’t require invasive treatment. Drinking as much as 2 to 3 quarts a day may help flush out your urinary system. Unless your doctor tells you otherwise, drink enough fluid — mostly water — to produce clear or nearly clear urine. Passing even a small stone can cause discomfort. To alleviate mild pain, your doctor may recommend pain relievers such as ibuprofen (Advil, Motrin IB, others), acetaminophen (Tylenol, others) or naproxen sodium (Aleve). Your doctor may give you a prescription medication known as an alpha-blocker to help pass your kidney stone. This type of medication relaxes the muscles in your ureter and helps you pass the stone more quickly and with less discomfort. Large kidney stones that can’t be treated with these milder measures may require surgical intervention. Using sound waves to break up stones is one solution. Depending on the size and location of the kidney stone, your doctor may recommend a procedure called extracorporeal shock wave lithotripsy (ESWL), which uses sound waves to create strong vibrations that break the stones into tiny pieces that can be passed in your urine. To remove a small stone in your ureter or kidney, your doctor may pass a thin, lighted tube equipped with a camera (called a

Map illustration by Sean Rademacher.

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This map shows the growth of the “Stone Belt” as it relates to projected temperature changes. The orange and red areas represent the expected growth of the area over time. Source: Proceedings of the National Academy of Sciences

ureteroscope) through your urethra and bladder to your ureter. Once your doctor locates the stone, special tools can grab the stone or break it into tiny pieces that will pass in your urine. If the stone is larger and located in the kidney, a procedure called “percutaneous nephrolithotomy” may be recommended. This procedure involves removing a kidney stone using small scopes and instruments that are inserted through a small incision in your back. You would typically receive general anesthesia during the surgery and be in the hospital for one to two days while you recover. Your family doctor can usually treat small kidney stones that don’t block your kidney or cause other problems. But if you have a large kidney stone and experience severe pain or kidney problems, your doctor may refer you to a urologist — a doctor who treats problems in the urinary tract.

Sarah Ryan, M.D., is board-certified in urology and in female pelvic medicine and reconstructive surgery, with a primary interest in female urology. She joined Urology Specialists of Nevada in 2014.

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WANT A HEALTHY HEART? DRINK MILK

— The Economic Times, June 12, 2015

HARVARD SCIENTIST URGES PEOPLE TO STOP DRINKING “LOW-FAT” MILK IMMEDIATELY — Healthy Food House, Dec. 30, 2014

6 REASONS WHY EGGS ARE THE HEALTHIEST FOOD ON THE PLANET

— Authority Nutrition, no date given

EGG YOLKS ALMOST AS BAD FOR YOUR HEART AS SMOKING CIGARETTES, SAYS STUDY — New York Daily News, Aug. 17, 2012

8 FATTY FOODS WITH HEALTH BENEFITS: BUTTER

— Mens Health

NEW GUIDELINES ON CHOLESTEROL: EGGS ARE OK, BUTTER’S STILL BAD — Smithsonian Magazine, Feb. 11, 2015

HEALTH BENEFITS OF SUGAR

— AskMen.com, no date given

SORRY, BUT THERE’S NO SUCH THING AS A ‘HEALTHY SUGAR’ — Huffington Post, May 19, 2014

THE PALEO DIET IS UNCIVILIZED (AND UNHEALTHY AND UNTRUE)

— The McDougall Newletter, June 2012

A PALEO DIET MEAL PLAN AND MENU THAT CAN SAVE YOUR LIFE — Authority Nutrition, no date given

THE LEMON DETOX DIET — A RECIPE THAT REALLY WORKS

— Natural News, May 13, 2012

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SORTING

FACTS FROM FICTION HOW CAN YOU TRUST THAT THE HEALTH INFORMATION YOU’RE GETTING IS ACCURATE? By Bruce Morgenstern, M.D.

e’re inundated with news of new medical advancements, new drug discoveries, and research on what’s good and what’s bad for you. It’s challenging to decipher just what is truly real and what is not. How can health care providers even stay current when so much happens so fast? How do I ask my provider about something I heard on the news or read online? These questions are all important ones for patients or even concerned friends and family members. Fortunately, there are some general guidelines to follow.

Take note of where you read it

“peer review.” This allows a group of qualified First, if you hear or read something, try to experts (peers) to review an article before it is capture where you heard it or read it. Usually, if actually published. Peer review is not perfect. it’s a news story on television or the radio, re- When high-quality journals discover a problem, member the station; you can go to their website they retract the paper, but that does not make and find the story. Same thing holds for news- people forget it was there. papers — the stories are generally also availA classic example was the paper that claimed able online. This is important because most of there was an association between some childus won’t hear, or won’t remember all the details hood vaccines and the development of autism. the first time through, so you’ll need to go over Not only was the paper retracted (12 years afthe story a second time. It sounds a bit like ter it was published), but the main author had studying, but it’s the best way to see if the issue committed scientific fraud in the process of really relates to you or your loved one. It also conducting the study. He is barred from prachelps, because if you have it handy when you ticing medicine in the United Kingdom, where go see your provider, you can quickly share it if the fraudulent research was conducted. Still, the story is new to him or her. the paper and its conclusions had more than a Is anyone really in a good position to be able decade to influence public opinion. to look at a story and know if it’s true or not? Additionally, medical journals like to publish That’s a really complicated question. Some- “new” things, for some fairly obvious reasons: times very reliable sources have published physicians and scientists are drawn to jourthings that turn out not to be true. The more nals that publish cutting-edge information, and reliable medical journals have a process called those journals develop what’s called a highContinued on page 58

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impact factor. We physicians like to have our papers in these high-impact journals and we read those journals. News media scan the high-impact journals to report on their papers, thinking that if a high-impact journal has accepted the paper, and it’s passed that journal’s peer review process, it has got to be an important finding and “true.” On the other hand, near the end of every paper that describes something new, the authors will usually write something that says additional studies are needed to verify the findings. Later studies do not always verify the first, “new” paper. The new finding may have been wrong because, if the first study described a new treatment, it may have more negative side effects than were seen in the first study. This usually happens when the first study is very selective in selecting patients. Often, larger populations lead to different results. Unfortunately, the follow-up papers that negate the “new” findings may be published in a lower impact journal, and may not have the same audience. With information easily accessible on the Internet, it’s hard to tell from a website address how reliable the information will be. Many are reliable, but some dot-com sites are trying to sell you something. Some dot-edu sites, which are from teaching institutions, are postings from individuals and have not been reviewed in any way. Dotorg sites may also not be reputable.

Another site is the Cochrane Collaborative (cochrane.org). This is an international collaboration of physicians, researchers, scientists and others that works to perform systematic reviews of medical literature to determine the best evidence to treat, manage or diagnose illnesses. The search accepts “plain” English, but for me, the results are more useful if I use the actual medical term. If you search, for example, “ear infection,” the first results are about external ear infections. If you search otitis media (the medical term for middle-ear infection) the results are more focused (and the same as if you searched using the term “middle-ear infection”). At the Cochrane site, results often include an assessment of the medical evidence, generally developed by trying to combine many studies and looking for the most likely outcome. The evidence-based reviews offer a “plain language summary.” So it’s easy to understand what the evidence shows. Finally, there are other good sources of information. These include organizations like the American Academy of Pediatrics (aap.org), which are national groups of physician specialists. Many of these organizations have current and validated information about diseases, diagnosis, management and treatments. One organization, the American Board of Internal Medicine Foundation, started the Choosing Wisely Take control of your education initiative (choosingwisely.org), another effort Near the end of every paper So, what can you do as an advocate for to weigh evidence and make recommendayourself or for a loved one? Don’t give up tions about what not to do. Many specialty that describes something on Google (there are other good search enorganizations have now contributed to this new, the authors will usually gines, of course). Google reports that 1 in site, in an effort to help providers and pawrite something that says 20 searches now are for health-related istient not do too much. The team behind sues. In an effort to help with search results, Consumer Reports magazine is also contribadditional studies are needed in February they partnered with the Mayo uting to this site, in collaboration with the to verify the findings. Later Clinic to offer expert-reviewed information specialist groups. studies do not always verify that appears in a box on the right side of Patient-support groups have grown the screen of your Internet browser, and is around specific diseases. For example, the first "new" paper. prominent in the Google app on mobile dethere are a group of kidney diseases called vices. Still, as we’ve shared, the experts may polycystic kidney disease (PKD). The PKD be “right,” but that does not mean that what Foundation has been founded to help supis suggested is reliable or widely available. port patients and their families with PKD. What are reliable places to look that your provider is likely to agree are Its website (pkdcure.org) has basic information and also has a “Research” reliable? Three offer very useful information. One is the Centers for Dislink. Off that link you can see what trials are going on for patients with ease Control and Prevention (cdc.gov). That federal agency focuses on in- these conditions, what the trials are studying, and even how to contract fections and poisons. This is the group that advises providers on what im- to see about getting enrolled on a study. munizations are best for people at different ages. Their guidelines are easy So, there are ways to get really good, really useful information off the to understand. The search tool takes “plain” English and medical terms, so Web. The most important thing is to discuss what you find with your proyou can search, for example, ear infection or it’s medical term “otitis media.” vider. Bring the information either printed or being a list of the websites The National Institutes of Health (nih.gov) covers a great many ill- you’ve found. Together, you and your provider can work to make your nesses and also offers the National Library of Medicine, which is where care state of the art. many medical journals are indexed. So, if you search the NIH site for what happens when there’s a full moon, the results almost all have an “nlm” in the URL. When you click on a link like that in a search result off the NIH site (you can occasionally get the same site using Google), you get a brief summary of the paper called an abstract. Abstracts are usually a Bruce Morgenstern, M.D., is the associate good way to see if the paper has what you’re looking for: in the case of dean for clinical affairs at Roseman University College of Medicine. searching full moon, almost all the abstracts do not find a relationship between full moons and human health. If you search a specific disease on the NIH site, you may well get “plain” English information, guidelines for treatment, and can find ongoing clinical trials investigating that illness.

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CANCER

PREVENTING AND TREATING CANCER ONE SMART BITE AT A TIME By Matthew M. Schwartz, M.D.

hile “an apple a day” doesn’t automatically equate to keeping the oncologist away, nutrition is a vital component in helping prevent and fight cancer. According to the American Cancer Society, nearly 600,000 Americans die of cancer each year. Of these deaths, approximately one-third are related to bad eating habits, a lack of physical activity and/or being overweight. Maintaining a healthy diet is among one of the most important things you can do to prevent cancer in addition to not smoking, staying active and maintaining a healthy weight. (A healthy weight, in the cancer world, is generally defined as having a body mass index below 25.) What can you do to stay one step ahead of cancer? There are some major do’s and don’ts in terms of nutrition that can drastically impact your likelihood of a cancer diagnosis.

A ‘Super’ way to prevent cancer The term “superfoods” can encompass different food items with different health benefits, depending on with whom you speak. In the realm of cancer, it’s important that superfoods are high in antioxidants, good chemicals that essentially confront and neutralize the free radicals in the human body. Free radicals are chemicals that have the potential, in high concentrations, to harm the body. One of those potential harms is the damaging of DNA, which could in turn evolve into cancer and/or other detrimental diseases. Grapes, blueberries, green leafy vegetables, salmon and acai berries are among the foods that are high in antioxidants and considered cancer superfoods. Detailed information about many of these superfoods can be found through Comprehensive Cancer Center of Nevada’s website at cccnevada.com/diet-nutrition.

The sugar (and fat) that’s not so sweet for your health To decrease your likelihood of cancer, the foods to avoid are items with refined sugars and trans fat. Refined sugar starts as a sugar in its raw form and is dissolved of all sus-

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George Linton, with Dr. Schwartz, holds his wife’s innovative cookbook.

pected contaminants. These sugars are packaged as table, granulated and powdered sugar, among others, and are found in a growing number of everyday foods, including high-sugar breakfast cereals, sweetened beverages, pudding, spaghetti sauce and milk. It takes a conscious effort to notice and avoid these sugars, but an effective first step in cutting them out is not proactively adding them to meals and snacks. Alternatives like honey or agave are much healthier options. Another ingredient to avoid is trans fat, which is widely considered to be the worst type of fat you can consume. Trans fat is incredibly high in “bad” cholesterol, increases inflammation and lowers the “good” cholesterol that fights a number of diseases. Trans fat has come under much public scrutiny in the last few years and drastic measures have been made to reduce the amount of it in our food. According to the Grocery Manufacturers Association, food manufacturers have voluntarily reduced the amount of trans fat in food offerings by more than 85 percent since 2003. Amid these improvements, trans fat can still be found in a lot of foods we eat every day. Some examples include popcorn, frozen pizzas, cake frosting and fatty cooking ingredients such as oil, margarine and shortening. The Food and Drug Administration requires all companies, by law, to list their products’ trans fat content on nutrition labels. The FDA announced in June that companies must phase out trans fats in all foods over the next three years.

Cancer treatment nutrition do’s There is no blanket diet plan for those battling cancer and all patients should consult their physician(s) for an appropri-

Dr. Schwartz and George Linton photo by Mikayla Whitmore.

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ate nutritional plan. With that, there are some overarching thoughts that nearly all cancer patients should consider. For a cancer patient undergoing treatment, calories should be considered most important. The nutritional needs of patients who are sick skyrocket in the heart of treatment. Their basic metabolic rate goes up and they need more calories to live. Their immune systems are trying to clear all of the damage that has been made during treatment as well as the underlying cancer itself. Just to maintain their body weight, they have to increase their caloric intake on a daily basis. For the average Joe or Jane, a hearty bowl of ice cream may not be recommended on a daily basis. But for cancer patients, they should be eating whatever they enjoy as well as whatever helps them to get enough calories. Another nutritional priority for cancer patients receiving treatment is protein. Protein repairs damaged body tissue, sustains immune systems and helps resist infections. Protein also revitalizes damaged tissue from radiation. When the body does not have enough protein, it turns to muscle to generate the energy it needs, essentially breaking down and weakening the muscular system. There are plenty of sources of protein out there, but its best to stick with lean options. Fish, poultry, legumes and eggs are all great starting points.

Cancer treatment nutrition no-no’s Alcohol in excess during cancer treatment is a big no-no. However a glass of red wine, in moderation, while undergoing treatment may actually have health benefits. Early research indicates that resveratrol, an antioxidant found in the skin of most red grapes, can actually combat the formation and/or spreading of cancer. To replenish depleted nutrients, many unadvised cancer patients instinctively turn to vitamin supplements for support. The only supplement that has been scientifically proven to help cancer patients is a daily multivitamin, according to a 2012 study published by the Journal of the American Medical Association. Multivitamins typically contain the right amount of vitamins and minerals, without being excessive. Vitamin-specific supplements — which can contain upwards of 10,000 percent of a nutrient’s recommended daily value — may, in some instances, counteract the effects of radiation. Whereas if you maintain a healthy diet, the body will take what it needs from food, so a supplement that has drastically more the daily value of everyday food acts like a nuclear bomb and the body doesn’t know how to respond. Nutritional supplement drinks like Boost or Ensure help patients get the right balance of nutrients without going overboard.

Recipes for throat cancer success Henderson resident George Linton is all too familiar with cancer diagnoses and the unique dietary challenges that can come with them.

Linton’s first cancer battle came in 1986 when he was diagnosed with colon cancer. He and his wife, Judy Best, decided to go vegetarian in an effort to improve his eating habits. Best, who studied at the Gourmet Cookery School of Manhattan and graduated from Le Cordon Bleu College of Culinary Arts, prepared vegetarian juices and smoothies for her husband, who had difficulty swallowing rigid and textured foods. More than 20 years later, in 2007, Linton was diagnosed with head and neck cancer after discovering a lump in his neck. Linton had 11 of his lymph nodes removed and underwent two rounds of chemotherapy and radiation. Ultimately, his cancer went into remission. But in 2011, the cancer came creeping back in the form of throat cancer, requiring Linton to undergo further radiation and chemotherapy. At one point, Linton had to eat through a feeding tube, which was removed after radiation. Linton and Best again faced the familiar challenge of navigating through his swallowing difficulties and cancer treatment. Linton was not only struggling with swallowing his food but he was also getting food stuck in his throat. At the time of Linton’s latest diagnosis, Best decided to kick her culinary expertise into high gear. Best created various recipes, shakes and meals that her husband could tolerate given his throat condition. These recipes featured high-moisture and soft ingredients, such as avocado, cottage cheese, and even finer foods like foie gras (Linton’s favorite dish) and exotic, soft vegetables. These recipes added up over a nine-month span and ultimately amounted to a cookbook titled “Down Easy: A Cookbook For Those With Swallowing Difficulties.” The cookbook features 175 step-by-step recipes, rated on a scale of zero to five in terms of how easy the food can be swallowed. The recipes use only whole foods as well as natural ingredients. Some of the dishes include cottage cheese-pesto stuffed tomatoes, avocado papaya salad and tomato basil chicken. The overarching goal of the cookbook is to help cancer patients get the appropriate calories needed post-chemotherapy and radiation. Best’s scrumptious recipes worked for Linton. Today — thanks in part to his dietary regimen and treatment by the Comprehensive Cancer Centers of Nevada team — he is cancer-free. While his throat and swallowing issues have improved, he continues to make healthy eating decisions and lives an active lifestyle. George Linton is a true success story in the world of cancer treatment and nutrition. By making healthy decisions, many Southern Nevadans can keep their cancer risks low and avoid a potential diagnosis. And for those diagnosed with cancer, proper nutrition can equate to a longer and healthier life. To obtain a copy of “Down Easy: A Cookbook For Those With Swallowing Difficulties,” visit amazon.com.

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Dr. Matthew W. Schwartz joined Comprehensive Cancer Centers of Nevada as a radiation oncologist in July 2006.

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NUTRITION

THE SKINNY ON SMART CHOICES WHEN IT COMES TO FAST FOOD By John Cisna

t’s a common belief that eating fast food directly contributes to obesity and poor health. I can speak from experience that this isn’t always the case. I am a science teacher who, as a result of a classroom experiment designed to apply critical thinking to everyday life, lost 43 pounds while eating nothing but McDonald’s for breakfast, lunch and dinner for 90 days. Most people respond to this with the same question: “How could that be possible?” The truth, which I shared during the Nevada PTA Convention in Las Vegas, is that It all comes down to making careful, educated choices about which menu items to consume and how much to consume, in addition to It is possible to become maintaining a reasonably active lifestyle. better off eating food My weight-loss journey from any grocery store, began with a challenge to my science students: any fast food chain or any design an experiment to test whether an individual restaurant if you make could become better off by eating nothing but McDonthe right choices and you ald’s for 90 days. include moderate exercise The motivation behind the experiment wasn’t to in your routine. promote eating fast food, but to highlight the importance of using critical thinking before making decisions regarding food choices. This applies to all aspects of life, including eating. I have been obese for nearly all of my adult life, which is why I volunteered myself as the 280-pound, 54-year-old guinea pig for the experiment. Nearly all of the students and school staff members were skeptical, but I set very specific parameters for the project. In order to test the hypothesis, my students had to design daily meal plans that limited my food intake to 2,000 calories a day and also included 15 important nutrients, including protein, dietary fiber, vitamin A, vitamin C, calcium and iron. One of the goals was to keep these in line with the recom-

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mended daily allowances as established by the Food and Drug Administration for a 2,000-calorie diet. McDonald’s incorporates the nutritional information for their menu items right on their website. Having this information readily available was crucial in this experiment. Surprisingly, the students’ meal plans allowed me to eat the majority of items on the menu, including higher-calorie items. On days that I consumed a high-calorie item during lunch or dinner, the students made the necessary adjustments with both the calorie intake and nutritional intake for the rest of the day so I did not exceed the 2,000-caloriesper-day limit. One of my daily menu plans included a sausage burrito, fruit and maple oatmeal and orange juice for breakfast; fruit and yogurt parfait, a premium Southwest salad and apple slices for lunch; and a large diet Coke, premium grilled chicken classic sandwich, hot fudge sundae and a grilled honey mustard snack wrap for dinner. This kind of meal planning is an effective approach to a balanced diet, regardless of where people eat. In the original 90-day plan, the students were able to put together 56 different combinations of foods, which kept them as close to the FDA’s recommended dietary allowance as possible. I also exercised regularly as part of the experiment. I took a moderate approach to exercise that I consider attainable for most people: walking briskly for 45 minutes, four to five days a week. Not only did I lose weight throughout the project, but my overall cholesterol dropped from 249 to 170 milligrams per deciliter (mg/dL), and my low-density lipoprotein (LDL) cholesterol declined from 170 to 113 mg/dL. My triglycerides decreased from 156 to 80 mg/dL. The results of the experiment were so successful that I extended the experiment to 180 days. At the end of those 180 days, or 540 straight meals, I ended up losing 60 pounds and my blood pressure ended at 121/78 millimeters of mercury (mmHg). What my class and I achieved with our meal planning experiment shows that it is possible to become better off eating food from any grocery store, any fast food chain or any restaurant if you make the right choices and you include

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John Cisna — before and after — his diet of nothing but McDonalds’ for breakfast, lunch and dinner. Students in his science class helped him plan his meals.

moderate exercise in your routine. Since this project ended, I have maintained my new weight by holding to the lesson reinforced throughout the project: Make careful choices with meals by evaluating the caloric and nutritional content of food, and maintain a moderately active lifestyle. I always emphasize that this experiment wasn’t about McDonald’s, and it wasn’t about reducing my belt size. I would not recommend that anyone eat only at one restaurant every day for months. It was about educating students to apply critical thinking to what they eat. Kids aren’t the only ones who can learn from this. Anyone can apply this approach to eating. One of my students phrased it well: “This experiment has shown me that it’s not McDonald’s that makes us fat, it’s our choices of what we eat that make us fat.” I hope people of all ages can learn as I have that it’s not where you eat, but what you eat and how much that matters.

Follow John Cisna on Twitter: @John Cisna

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NONPROFIT

HUNGER HURTS AT ANY AGE

THE HEALTH CARE COMMUNITY CAN HELP ENSURE OLDER PATIENTS ARE GETTING ENOUGH TO EAT By Jodi Tyson

he number of households that were financially challenged and unable to afford enough healthy food for themselves and their families grew dramatically between the years of 2007 and 2013. Individuals and families that struggle to secure enough food for a healthy, active lifestyle are referred to as food insecure. The most recent figures (2013) reflect a dramatic increase — nearly 50 million people. While Americans overall became more food insecure, data reflects that certain age groups became more vulnerable; adults, age 65 and older, experienced a 25 percent increase in food insecurity, while their younger counterparts, ages 50 to 64, experienced a 38 percent increase! Higher income volatility, growing rates of nutritionally related chronic disease, and lower participation in federal assistance programs justifies the health care community’s need to focus on this group of “younger” older adults. The nation took notice of hunger as a public health concern and public policy priority when participation in the Supplemental Nutrition Assistance Program (SNAP) increased during the Great Recession. More than 45 million citizens currently participate in SNAP. Based on their income and family size, SNAP benefits generally last a family three weeks. What about the rest of the month? Nearly half of all SNAP recipients have also used a food pantry. About 270,000 Southern Nevada residents were recipients of SNAP in 2013; Three Square’s programs and network of Agency Partners served more than 137,000 individuals in a single month in 2013. Without federal nutrition programs as the first line of nutritional defense, Three Square would not have been able to manage demand with the available charitable food supply. During the economic downturn, low-income families with children had the highest take-up rate (i.e., enrollment) in federal nutrition programs, while older adults, ages 50 to 64, had the lowest take-up rate. This low participation is troubling, especially for widely known nutrition programs like SNAP. Research indicates adults 65 and older experience less food insecurity than their younger counterparts aged 50-64 as a result of federal programs. Social Security, while averaging only $1,200 a month, stabilizes income for senior citizens and reduces food insecurity risk.

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Medicare has also proven to be protective against food insecurity but these programs aren’t accessible to adults aged 50-64 years. Economists are concerned about the frailty of income for adults aged 50 to 64. During this period in their lives, unemployment is higher and reemergence into the workforce is more difficult than for those who are 10 or 20 years younger. The increasing population of adults 50 and older in the U.S. concerns social demographers, who see more adults entering this age range who may already be at risk for nutritionally related chronic disease. After the age of 45, the risk of developing Type 2 diabetes increases as lifestyles become more sedentary and exercise decreases, resulting in unhealthy weight gain. This increased risk of diabetes follows older adults until the age of 65. The lack of take-up among older adults aged 50 to 64 years may be partially attributed to social influences, such as stigma, feelings of inadequacy and fear of being judged by others in their peer group, community, or even service providers. However, these barriers are changing as participation in federal nutrition programs across the country has grown. The tipping point has been reached: today, nearly everyone knows an adult who has lost a job and suffered financially as a result. In addition to stigma, the “untruths” of government programs are heavily reinforced. The biggest falsehood, which is often heard by advocates among all older adults, is that SNAP benefits require “a lot of paperwork for only $16 a month.” To address the demand to reduce paperwork, Congress took up the issue of seniors participating in SNAP during President George Bush’s administration. Today, the requirement for recertification (verifying a recipient’s continued eligibility) is every two years for senior citizens, but more often for recipients under the age of 60. With regards to the benefit amount each month, the average benefit for a senior citizen over the age of 60 actually averages $113 per month, while the average benefit for a single individual is $127. There is not much difference between the benefits provided to an older adult and a younger individual. Depending on employment circumstances, adults ages 50 to 64 can estimate their monthly benefit between these two amounts.

Photo by Scott Streble.

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Left: Three Square Food Bank works with approximately 1,300 groups and organizations to reach people at risk of hunger. Below: Warehouse assistant Joe Thomas wraps a load of produce to go into a cooler.

Outreach is an important strategy as public health and nutrition advocates work toward connecting all eligible households to benefit programs. The health care community is the new frontier for outreach to the food insecure. Professionals in the health care community are perfect advocates to help connect those unconnected older adults to federal nutrition programs like SNAP that directly increase their financial resources to secure an adequate supply of healthy food. The health care community has made great strides in actively promoting health and well-being through emphasis on a balanced diet, physical activity and stress management with patients of all ages, especially among seniors. This type of attention on health promotion among health care workers needs to be directed to younger, older adults as well. Twenty years ago, many in the health care community were less confident asking about personal care habits of adults; afraid to offend, or for fear of what they might hear, these questions were largely unasked. Now, many physician assessments for patients include questions to establish the diet and exercise habits of patients. However, rarely do health care professionals ask questions about healthy eating in relation to patients’ ability to afford enough healthy food. This is a ripe opportunity to connect at-risk patients to federal nutrition programs. Personal finances are a touchy subject. Understood. The health care community need not commit to financial assessments to help connect at-risk older adults to benefit programs. Knowledge that a patient is between 50 to 64 years and has risk factors for food insecurity—being unemployed, experiencing poor health, having chronic disease or disability, or maintaining less-than-optimal diets — is all that is needed to make a referral.

Top photo by Scott Streble. Right photo by Steve Marcus.

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For example, a physician or nurse might say to a patient, “Here is your prescription (or receipt for your visit). I also attached this referral form, which has the name and number of a community-based organization that specializes in connecting people in situations like yours to available nutrition programs like SNAP and food pantries as means of getting more of the healthy food you need to be and stay well! Thank you for coming in today. Have a great day!” Southern Nevada is fortunate to have a health care community who is already engaged with Three Square Food Bank. Every day, health care-associated teams from doctor’s offices to corporate health care systems come to volunteer at Three Square. Not only does Three Square Food Bank serve as a hub where food is either donated or purchased outright for food pantries across Southern Nevada, it also functions as a gatekeeper organization for federal nutrition programs and other services. Three Square has a team of dedicated employees who are contracted by the state to help connect food insecure households to federal nutritional programs like SNAP by assisting with the application and submitting it on the households’ behalf. During open enrollment for health insurance under the Affordable Care Act this fall, Three Square’s SNAP Outreach Team will also be able to provide enrollment services for all types of subsidized and unsubsidized health care insurance plans through a contract with the Nevada Division of Insurance. For more information about how Three Square can serve as referral source for patients and the health care community, call 702-765-4030.

SUMMER 2015

Jodi Tyson is Director of Government Affairs for Three Square Food Bank. www.threesquare.org

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VOLUNTEER Q & A

GARFIELD AND BRENDA MATSON VOLUNTEERS CHILDREN’S HOSPITAL OF NEVADA, UNIVERSITY MEDICAL CENTER

What is your favorite part about volunteering? Garfield (Gar): The best part about coming to volunteer here at the Children’s Hospital every week is being able to work with the incredible staff and being able to hang out with the kids. Brenda: My favorite part is definitely helping the children. It’s also rewarding to be able to make things a little easier for the great nurses. To see how generous the people of Las Vegas are with their donations and time is pretty amazing as well.

How long have you been volunteers at the hospital and how many hours do you volunteer each week? Gar & Brenda: Almost two years and we volunteer four hours a week.

How long have you lived in Las Vegas? Gar & Brenda: Three years (since July 2012)

What volunteer activities do you take part in at the hospital? Gar & Brenda: Have helped out with the hospital’s annual car show, Win-Win performers.

How can someone else become a volunteer there?

What things do you do during your shift at the hospital?

Gar & Brenda: The application can be found online at umcsn.com. Once you have completed the form, contact the volunteer department (702-383-2388) for an interview. When the interview is done, you will go through the onboarding process which consists of a TB test, drug test and background check. The last step is to attend the hospital orientation where you will receive your hospital badge and you are ready to get started.

Gar: Clean toys in the playroom. Pass out donations such as blankets, stuffed animals and toys. Assist the staff in transporting patients to the playroom for the weekly performers who come to the hospital through the nonprofit, Win-Win Entertainment. Brenda: Clean the playroom, deliver gifts to the patients, play with the kids and feed the younger patients.

How long do you plan to work as a volunteer there?

What other activites are you involved in when you aren't volunteering?

Gar: As long as my body holds out. Brenda: As long as I’m able to.

Gar: A good listener (listens to what the staff needs) and someone who has compassion for the patients. Brenda: You need to be willing to give of your time and to abide by all of the rules.

Gar: Help assist with the Las Vegas Summerlin Lions Club Fundraisers, help with the Lions “Lotza Fun” Summer Camp and highly involved in the Mustang & Classic Ford Club. Brenda: Help assist with the Las Vegas Summerlin Lions Club Fundraisers and Lions Summer Camp “Lotza Fun”. Also a member of the Mustang & Classic Ford Club of Las Vegas.

Are you retired? If so, what was your career?

What is the biggest reward from volunteering?

Gar: I am retired. I was in the home medical equipment business since 1973 and prior to that was in sales (selling high-tech medical equipment). Brenda: Retired as well. Spent many years managing a farm.

Gar: The smiles and “thank you’s” from the kids, families and staff. Brenda: Helping others makes you appreciate what you have. It’s rewarding to be able to improve things for someone one.

What makes a good volunteer?

Do you know a medical volunteer who we should know about? Please contact Craig Peterson at craig.peterson@gmgvegas.com.

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SUMMER 2015

7/23/15 7:09 AM

THE NOTES

Several people joined the staff of Southwest Medical Associates. Chad Bullock, an advanced practice registered nurse, BULLOCK HOLLOWAY specializes in adult medicine at the Lake Mead Health Center, 270 W. Lake Mead Parkway, Henderson. Phyician’s Assistant Marcy Holloway specializes in adult mediMANALO BARLAAN cine at the Lifestyle Center-West, 8670 W. Cheyenne Ave. and the West Flamingo Health Center, 6330 W. Flamingo Road, both in Las Vegas. Dr. Maria Manalo speSANDHU WADHWA cializes in adult medicine and Nurse Practitioner Maria Barlaan and Dr. Jyotu Sandhu specialize in urgent care at the Urgent Care Center, 2704 N. Tenaya Way, Las Vegas. Dr. Josef Abbo specializes in urgent care at the Charleston/Rancho Urgent Care Center, 888 S. Rancho Drive, Las WILSON Vegas. Dr. Mukesh Wadhwa specializes in anesthesiology at the Surgery Center, 2450 W. Charleston Blvd., Las Vegas, and Physician’s Assistant Lyndsie Wilson specializes in gastroenterology at the Charleston/Rancho Health Center, 2316 W. Charleston Blvd., Las Vegas.

Southern Nevada hospitals recently were ranked by Leapfrog Group’s Hospital Safety Score, which grades hospitals on the basics of medical care, such as handwashing, entering prescriptions in a computer and availability of nurses. Hospitals that received an “A” for spring 2015 are Dignity Health St. Rose Dominican-Rose de Lima campus, Desert Springs Hospital Medical Center and Mountainview Hospital. Hospital Corporation of America, which includes Sunrise Hospital & Medical Center, MountainView Hospital, Southern Hills Hospital & Medical Center and Sunrise Children’s Hospital, supported the Nepal earthquake relief efforts with multiple donations. HCA donated $250,000 to Doctors Without Borders and $250,000 to MedShare International, a nonprofit that redistributes surplus supplies and equipment to those in need. Additionally, HCA agreed to match up to $500,000 of donations from HCA employees and vendors to the American Red Cross to support its relief effort in Nepal.

The Runnin’ for the House 5K Run and 1 Mile Walk raised more than $60,000 for Ronald McDonald House Charities of Greater Las Vegas. The 11th year of the run brought together CARROT TOP more than 950 runners and walkers. Southern Nevada McDonald’s restaurants also raised $42,000 for the Ronald McDonald House Charities of Greater Las Vegas scholarship program during an annual Green for Grads one-day fundraiser. Since the scholarship program was established in 1999, local McDonald’s owner/operators have helped award more than $3.3 million in scholarships to high school seniors in Clark and Nye counties. Construction has started on the Valley Health System’s sixth hospital. Henderson Hospital, at Galleria Drive and Gibson Road, is expected to open in the fall of 2016.

HENDERSON HOSPITAL

The Clark County Medical Society honored Lindsey Murphy of the University of Nevada School of Medicine and Robert Wills of Touro University Nevada College of Medicine with its 2015 Student Rising Star Award: Steinberg Diagnostic Medical Imaging’s 14,000-square-foot facility at 800 Shadow Lane is the first major development in the Las Vegas Medical District since UNLV announced its medical school that will be in the area. It will bring two dozen jobs to the area. Nathan Adelson Hospice is welcoming three fellows to the American Osteopathic Association-approved Hospice and Palliative Medicine Fellowship Program. Dr. Andrea Kurz, family medicine; Dr. Jonathan Von Koenig, family medicine; and Dr. Katherine Steele, internal medicine, are joining the fellowship for the 2015–16 academic year, with Kurz appointed as chief fellow. Dr. Mulugeta Kassahun of Urology Specialists of Nevada was recognized at the Las Vegas Black Image Magazine Honors. Kassahun is a native of Ethiopia and was a clinical pharmacist in Denver before pursuing a medical degree and specializing in urology. He has been with Urology Specialists of Nevada since 2004.

Dr. Craig Hunter joined Urology Specialists of Nevada. Hunter was a fellow in the 2014 Genitourinary Reconstructive Surgery Fellowship at the Kulkarni Center for Reconstructive Urology in Pune, India. He received his degree in medicine from Arizona College of Osteopathic Medicine and completed his urologic residency as chief resident at the Detroit Medical Center, Michigan State University consortium.

SUMMER 2015

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KASSAHUN

H E A LT H C A R E Q U A R T E R LY

7/23/15 7:09 AM

CALENDAR To include your calendar items in the next issue, contact Craig Peterson at craig.peterson@gmgvegas.com

SUNRISE HOSPITAL

help cancer patients look good, improve self-esteem and manage treatment. Aug. 24, Sept. 28, Oct. 26, 10 a.m.–noon The Breast Center at Sunrise, 3006 S. Maryland Parkway, Suite 250

Registration is required for all events. Call 702-233-5454 at least 48 hours in advance. For more, visit SunriseHospital.com FETAL INCONTINENCE SEMINAR/ PATIENT SUPPORT GROUP Aug. 4, Sept. 1, Oct. 6, 10–11:30 a.m. Sunrise Hospital Auditorium, 3186 S. Maryland Parkway PREPARING FOR CHILDBIRTH CLASS Aug. 8, Aug. 22, Sept. 5, Sept. 19, Oct. 3, Oct. 17, Oct. 21, 8:30 a.m.–4:30 p.m. $55; Sunrise Hospital Auditorium, 3186 S. Maryland Parkway ADULT OUTPATIENT DIABETES CLASS — OVERVIEW AND MEDICATIONS Aug. 11, Sept. 1, Oct. 13, 2–4 p.m. 3121 S. Maryland Parkway, Suite 600 ADULT OUTPATIENT DIABETES CLASS — NUTRITION Aug. 19, Sept. 2, Oct. 14, 2–4 p.m. 3121 S. Maryland Parkway, Suite 600

BREAST CENTER AT SUNRISE HOSPITAL YOUNG SURVIVORS BREAST CANCER SUPPORT GROUP Offered to all women 40 years old and younger who have been diagnosed with breast cancer. Free. Aug. 12, Sept 9, Oct. 14, 6–7:30 p.m. The Breast Center at Sunrise, 3006 S. Maryland Parkway, Suite 250 ONCOLOGY NUTRITION Led by Judy Reinhardt, registered dietitian. Cancer survivors and their loved ones are invited to learn about healthy eating after a diagnosis of cancer. Register at 702-233-5454. Sept. 16, 6–7:30 p.m. The Breast Center at Sunrise, 3006 S. Maryland Parkway, Suite 250 LOOK GOOD, FEEL BETTER American Cancer Society program to

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MOUNTAINVIEW HOSPITAL For more information, visit MountainViewHospital.com. Call 702-233-5300 to register at least 48 hours in advance. DIABETES OVERVIEW AND MEDICATION REVIEW Learn about diabetes and join us for a discussion about how disease management is essential to living a happy and healthy life. In addition, bring your questions and your medications for a review. Aug. 4, 11:30 a.m.–1 p.m. Mark Howard/Lobby Classroom, 3100 N. Tenaya Way DADDY 101 Designed to prepare new dads for assisting mom and baby after leaving the hospital. Sorry, no moms or kids allowed. $25. Aug. 11, 6–8 p.m. Lobby Classroom, 3100 North Tenaya Way PARKINSONS CAREGIVERS SUPPORT GROUP Provides an opportunity for caregivers to meet regularly for mutual emotional support and to exchange coping skills. Call 702-233-5474. Aug. 14, Sept. 11, Oct. 9, 10–11 a.m. H2U MountainView Office, 3150 N. Tenaya Way, 89128

SOUTHERN HILLS HOSPITAL LUNCH AND LEARN: WHAT IS EARLY HEART ATTACK CARE? Learn early signs and symptoms to look for and possibly prevent a heart attack from ever happening. Aub. 25, 11:30 a.m.–1 p.m. Education Room/First Floor, 900 West Sunset Road

UNIVERSITY MEDICAL CENTER INFANT AND CHILD CPR Aug. 15, 9 a.m.; Sept. 8, 2 p.m.; Oct. 17, 9 a.m. $10 deposit (returned upon completion of class) Family Resource Center, 901 Rancho Lane, Suite 180

SPRING VALLEY HOSPITAL SEMINAR: WHAT IS HYPERBARIC OXYGEN THERAPY? Learn about this process, along with the types of medical issues it can help treat. Includes lunch. Registration required; call 702-388-4888. Aug. 27, noon–1 p.m. Conference Center, 5400 S. Rainbow Blvd.

CENTENNIAL HILLS HOSPITAL STROKE SUPPORT GROUP Second Tues. of every month, 3–4 p.m. Conference Room 1 & 2, 6900 N. Durango Drive TEDDY BEAR CLINIC Bring children and their favorite stuffed animals to explore what happens during a visit to the hospital. Aug. 5, 10 a.m.–noon 6900 N. Durango Drive

DESERT SPRINGS HOSPITAL STROKE SUPPORT GROUP First Sat. of every month, 10 a.m.–noon South Magna Conference Center, 2075 E. Flamingo Road

SUMMERLIN HOSPITAL STROKE SUPPORT GROUP Fourth Thurs. of the month, 3–4 p.m. Conference Room B, 657 N. Town Center Drive

VALLEY HOSPITAL STROKE SUPPORT GROUP Fourth Wed. of every month, 10 a.m.–11:30 a.m. Fourth floor, acute rehabilitation unit in the dining room, 620 Shadow Lane

SUMMER 2015

7/23/15 7:10 AM

CALENDAR

ST. ROSE DOMINICAN HOSPITALS For information, visit www.strosehospitals.org, or call 702-616-4900 for class reservations and to learn about other programs. Location Abbreviations FTF Family to Family Connection, Henderson FTF WIC Family to Family Connection, Henderson HEND WomensCare Center, Henderson MAC Siena Campus - MacDonald Room, Henderson RAN Rose de Lima Campus - Annex, Henderson SAN San Martín Campus, Las Vegas SGR Siena Campus - Garden Room Henderson WEST WomensCare Center, Las Vegas SING AND SIGN: FOOD TIME Learn ASL signs for healthy foods using songs, books and toys. For parents with children up to 2 years old. Free. Tuesdays, 2-2:30 p.m.; First Saturday of the month, 1–1:30 p.m. GV FREEDOM FROM SMOKING Kick the habit with this supportive, seven-week American Lung Association program. Free. Tuesdays, Aug. 18–Sept. 29 and Thursday, Sept. 10, 5:30–7 p.m. GV WHAT IS PRE-DIABETES? LEARN HOW TO AVOID OR DELAY DIABETES Learn how to avoid or delay diabetes Aug. 31, 4–6 p.m.; Sept. 30, 10 a.m.–noon GV: Free Sept. 29, 10 a.m.–noon HEND: Free

DIABETES SELF-MANAGEMENT PROGRAM Six-week program offers support, eating tips and medication management. Free. Fridays, Aug. 28–Oct. 2, 9–11:30 a.m. HEND Thursdays, Sept. 10–Oct. 15, 10 a.m.–12:30 p.m. Heritage Park Senior Facility, 300 S. Racetrack Road INTRODUCTION TO ANCIENT GRAINS Tired of eating the same old grains? Learn about the options. Free. Sept. 1, 1:30–3 p.m. GV HEART HEALTHY COOKING Nutrition facts, meal planning and exercise tips. Sept. 11, 1–2:30 p.m. GV GROCERY SHOPPING TOUR WITH A REGISTERED DIETITIAN Follow a virtual grocery store tour with a registered dietitian through the aisles to learn how to select healthy foods. Free Sept. 15, 1:30–3 p.m. GV FOODS AROUND THE WORLD Discover traditional foods by taking a virtual guided food tour. Free Oct. 1, 10:00–11:30 a.m. GV ROSE REGATTA TEAM REGISTRATION Organize 20 paddlers and take to the lake to raise funds for St. Rose breast cancer programs. Registration includes one training session, equipment use and race entry. Visit roseregatta.org or call 702-616-5762 Oct. 10, 8 a.m.–5 p.m. Regatta is at Lake Las Vegas. GLUTEN SENSITIVITY AT MENOPAUSE Learn the causes and symptoms of celiac disease and how to manage it. Free. Sept, 24, 6–8 p.m. GV

HEARTSAVER CPR/AED Learn American Heart Association adult, child and infant CPR and AED. Two-year certification. $30 Sept. 16, 5–9 p.m. WEST STEPPING ON: FALL PREVENTION PROGRAM Did you realize that one out of three people over 65 fall each year? Learn how to prevent serious injuries like hip fractures in this six-week class. Free. Wednesdays, Aug. 5–Sept. 16, 2:30–4:30 p.m. GV FIT COLON TEST Age 50 or better? Take home a Colorectal Cancer F.I.T. (fecal immunochemical test), return your sample to a WomensCare Center and receive test results by mail. $15 GV; WEST MAMMOGRAMS Uninsured or underinsured? You may qualify for a free mammogram. Call the R.E.D. Rose Program at 702-492-8557 if under age 49 or call the Mammovan if over age 50 at 877-581-6266. WALKING CLUBS All ages and fitness levels. Strollers welcome. No registration required. Free. Mondays and Thursdays from 8:30–9:30 a.m. Call 702-616-4902 for seasonal meeting locations. WEIGHT MANAGEMENT CLUB Reach your weight management goals. No preregistration required. Free. Last Wednesdays of each month from 5–6 p.m. GV FLEX FUSION Therapeutic stretching with flexibility for floor or chair exercise. Drop-in class. Free. WEST

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MAKING THE ROUNDS To include your photos in the next issue, contact Craig Peterson at craig.peterson@gmgvegas.com

Above: Southwest Medical Associates celebrated its open house at 10105 Banburry Cross Drive in Summerlin. Seen here are John Hambrick, speaker of the state Assembly; Dr. Robert McBeath, CEO and president of Southwest Medical; Dr. John Rhodes, associate medical director of primary care for Southwest Medical, and other Southwest Medical health care providers and VIPs.

Right top: Southwest Medical Associates welcomed North Las Vegas to one of its newest health centers ( 2225 Civic Center Drive). Dr. Carl Allen, medical director, presided while meeting the public and providing a look at the new center.

Right bottom: The MEDi/Nao Robot visited Sunrise Children’s Hospital. It’s the first of its kind used to help children manage painful medical procedures.

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SUMMER 2015

MEDi/Nao Robot photo by Marissa Mussi

7/23/15 7:11 AM

MAKING THE ROUNDS

Above: Anthem Blue Cross and Blue Shield in Nevada and the Safe Routes to School National Partnership celebrated the importance of staying active with the grand prize check presentation to Myrtle Tate Elementary school. The party marked the end of this year’s first-ever “Fire Up Your Feet” challenge, which encouraged Clark County School District (CCSD) kindergarten-8th grade students to be more physically active during an eleven-week period. More than 4,000 kids at schools throughout CCSD participated in the challenge, and Myrtle Tate had the highest number of participants of any school.

Left: Southwest Medical Associates Vice President of Operations Toni Corbin received the 2015 Women of Distinction award from the Nevada Association of Women Business Owners at its 17th annual Women of Distinction awards ceremony. The award recognizes her work in medical/ health care services. Corbin has been with Southwest Medical for 24 years and oversees 21 medical clinics.

SUMMER 2015

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LOOKING BACK

ABORTION PROTESTERS SQUARE OFF AGAINST POLICE By Rebecca Clifford-Cruz

fter the 1973 Supreme Court decision in Roe v. Wade, locals who supported the anti-abortion movement continued for years to demonstrate at medical clinics across the valley. On Jan. 28, 1989, 90 protesters were arrested after blocking the entrances to the Family Planning Institute operated by Dr. James A. Lewis at 501 S. Rancho Drive. The protest was organized by Southern Nevada Operation Rescue as part of a loose-knit national movement to end abortion by blocking access to clinics that performed them. Metro Police arrived in force an hour after the protest began and prepared to arrest demonstrators who were intimidating clinic employees and patients. Officers took turns approaching protesters who were on the ground and asking if they would come peaceably to a waiting police van. As each protester refused, officers lifted them by the hands and feet and carried them away. Several were arrested and charged with unlawful assembly, then taken to the Clark County Detention Center for booking.

H E A LT H C A R E Q UA R T E R LY

SUMMER 2015

Photos courtesy of Las Vegas Sun

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From left to right: Mike Trainor, D.O., Eugene Libby, D.O., Nicole Dalessandro, D.P.M., Thomman Kuruvilla, D.P.M., Randall E. Yee, D.O., Timothy Trainor, M.D., Xin Nick Liu, D.O., Matthew H.C. Otten, D.O., Sep Bady, M.D.

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