2019-08-20 - Health Care Quarterly (Vol. 25) - Summer 2019 by Greenspun Media Group

Hope Threads among strands of DNA of

PRESENTED BY:

2019 VOL. 25

SPONSORED BY:

SCIENCE IS FIGHTING BREAST CANCER IN THE TINIEST OF BATTLEGROUNDS — AT THE GENETIC LEVEL — AND IT’S WINNING

HELPING A LOCAL PEDIATRIC DENTIST HELP CHILDREN AROUND THE WORLD

“With my busy schedule, it’s convenient to have all my banking in one place, and I can access it online from anywhere. That gives me more time to pursue my passion of helping children with their dental health. I know Rich will be there to handle things for me, even if I’m halfway around the world.”

– Dr. Dawn McClellan

To call Dr. Dawn McClellan a busy professional is a serious understatement. In addition to her duties at Thunderbird Dental, a pediatric dental practice in Las Vegas, she is the co-founder and president of Dental Care International (DCI). DCI, founded in 2001, is a non-profit group that provides low-cost or free dental care to children at its North Las Vegas headquarters and in several foreign countries. Although Dr. McClellan travels extensively for DCI, she has called Las Vegas home for the last 20 years. The 10-chair DCI clinic, established in 2005, provides pediatric dental and orthodontic care primarily to the uninsured and the working poor, including children covered by Medicaid. Its five dentists handle about 15,000 patient visits per year. DCI also participates in the American Dental Association’s annual Give Kids a Smile event, a one-day clinic providing free dental care to children who desperately need it. As head of DCI, Dr. McClellan organizes groups of volunteers to treat children’s dental needs at drop-in clinics as far-flung as Sri Lanka and Ecuador. In Sri Lanka, DCI has also partnered with local agencies to run a program that trains young women to become dental surgical assistants. So far, 67 women have completed the program, enabling them to earn a living wage in the impoverished country. As a dentist, a non-profit administrator, and a homeowner, Dr. McClellan has many different banking needs. She chose Nevada State Bank to handle her personal and business finances, the banking accounts for her non-profit organization, and the mortgage for her home. “With my busy schedule, it’s convenient to have all my banking in one place, and I can access it online from anywhere,” she said. “That gives me more time to pursue my passion of helping children with their dental health.” Rich Justiana, VP/Private Banking Relationship Manager, helps Dr. McClellan coordinate her financial needs. “We may be in different time zones, so we often communicate by email,” she said. “I know Rich will be there to handle things for me, even if I’m halfway around the world.” As a medical professional, whether your needs are personal or business banking, lines of credit* or equipment financing*—or possibly a new mortgage* for that dream home you’ve been waiting to purchase—Nevada State Bank is here to help you. If you’re looking for a true banking relationship in which your banker is available when you need them, call us today at 702.855.4849. We’ll be happy to meet with you and discuss how Nevada State Bank’s Certified Medical Bankers can help you achieve your financial dreams. – James Rensvold

Dr. Dawn McClellan and Rich Justiana

Executive Vice President Private Banking Director, Nevada State Bank NMLS#603492 James.Rensvold@nsbank.com 702.706.9070

The Private Bank by Nevada State Bank provides specialized banking services to significant net-worth clients. Nevada State Bank is a division of Zions Bancorporation, N.A. Member FDIC *Credit products are subject to credit approval. Terms and conditions apply. See a banker for details. Equal Housing Lender NMLS # 467014

Health care for the whole you.

The specialists at OptumCare® dedicate themselves to your total health. We collaborate and communicate with your primary care doctor all along the way. The result is a health care team that works together for you—and that’s definitely something to feel good about.

Health care built around you. optumcare.com/nevada OptumCare®

Cancer Care Breast Care Orthopaedics and Spine Lung and Allergy Care Anesthesia

OptumCare is a care delivery organization that improves patient health and helps make health care work better. OptumCare is a registered trademark of Optum, Inc. All other trademarks are the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change speciﬁcations without prior notice. Optum is an equal opportunity employer. ©2019 Optum, Inc. All rights reserved.

The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call 1-877-370-2845. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 1-877-370-2845. 1-877-370-2845 (Chinese),

CONTENTS

30 Threads of Hope

among strands of DNA Science is fighting breast cancer in the tiniest of battlegrounds — at the genetic level — and it’s winning

22 neck pain is just a text away

Bad habits manifest themselves in many ways, including how we use our phones

38 Healthy Nevada The Healthy Nevada Project is studying the genetic fabric of Southern Nevadans

44 question everything you know Grab your pencil; it’s test time!

COLUMNS 12

pharmacy counter Daniel Heller, Smith’s Food & Drug Stores

Dr. Svetlana Barbarash knows the meaning of ‘be here now’ as a real world emergency happens.

FLU SEASON

David Roddy, MassMedia

skin safety Dr. Wolfram Samlowski, Comprehensive Cancer Centers

sexual health Dr. David Ludlow, Urolology Specialists of Nevada

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SUMMER 2019

community milestones

Dr. Aaron Ritter, Cleveland Clinic Lou Ruvo Center for Brain Health

community health

Camile Tanner, Ferraro Group

Dr. Barbarash photo by Sampel & Preston Photography.

This year marks the 10th anniversary of the Cleveland Clinic Lou Ruvo Center for Brain Health.

22 How we use our smart phones can lead to a condition known as “tech neck.”

departments 52

COMMUNITY

right time, right place

THE NOTES

Dr. Svetlana Barbarash, Southwest Medical Associates

Notes from the health care community

Business

calendar

Rebecca Clifford-Cruz, VEGAS INC

Upcoming events and classes

updates on growth Bryan Horwath, VEGAS INC

MEET THE PROFESSIONAL

Rebecca Clifford-Cruz, VEGAS INC

Cleveland Clinic Lou Ruvo Center for Brain Health photo by Steve Marcus.

SUMMER 2019

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publisher Mark De Pooter (mark.depooter@gmgvegas.com) Associate Publisher KATIE DIXON (katie.dixon@gmgvegas.com)

Editorial EDITOR OF SPECIAL Publications CRAIG PETERSON RESEARCH LIBRARIAN REBECCA CLIFFORD-CRUZ

Art ART DIRECTOR, contracted MICHELE HAMRICK

reimagine Y O U R

S M I L E

Staff Photographers Christopher Devargas, Steve Marcus, wade vandervort

Advertising publisher of digital media Katie Horton

A healthy, beautiful smile doesn’t have to be out of reach for you and your family. Fortunately, the faculty and resident dentists at Roseman Dental, the clinical practice of Roseman University College of Dental Medicine, are committed to providing outstanding dental and orthodontic care without the high cost.

publisher, las vegas magazine and vegas2go Jamal Parker

All of our orthodontic and dental residents are licensed dentists in the State of Nevada and are teamed with highly qualified, board certified or board eligible faculty to provide comprehensive dental and orthodontic care to patients of all ages.

External content manager Emma Cauthorn

DENTAL CARE Dental Examinations & X-Rays Extractions Tooth Sealants Root Canals Dental Fillings Teeth Cleanings Periodontal Procedures Dentures/Crowns/Bridges/Implants ORTHODONTIC CARE Two-Phase Traditional Metal Braces Clear Braces Invisalign® Sleep Apnea TMJ-TMD Retainers Make your appointment for a dental examination or orthodontic screening today by calling 702-968-5222 or visiting rosemandental.com

Account manager Dawn Mangum senior advertising manager BRIANNA KOURETAS ACCOUNT EXECUTIVES Robert Blankenship, Thomas Farr, MIKE MALL, adair nowacki, sue sran, alex teel, JOHN TOBIN, BRITTANY WALZ Publication coordinator Denise Arancibia sales assistant lexie arancibia

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SUMMER 2019

henderson, nevada 89074 | 702.990.2550

FROM THE EDITOR

ore than 2,000 Nevada women will be diagnosed with breast cancer this year, according to the American Cancer Society. That’s more than 2,000 of our friends, family and neighbors whose lives will be upended because of this vicious disease. And yet, the number represents a bit of encouraging news. Yes, any breast cancer is bad, but this number represents the cases that will be “diagnosed,” and that means that those cases can start getting treated and, possibly, cured. Southern Nevada is very fortunate to have Dr. Souzan El-Eid of Comprehensive Cancer Centers among our residents; she is a breast cancer expert who has worked on several clinical research studies. Her patients place a lot of trust in her, and Health Care Quarterly is fortunate that she took time out to tell us about some of the latest developments in fighting breast cancer. For such a big disease, inroads are being made at the smallest levels, i.e., at the level of DNA. Thanks to evolving genetic research, breast cancer is being caught sooner and the number of deaths is falling each year. Genetic testing is popping up everywhere, especially in Nevada. Perhaps you’ve heard of the Healthy Nevada Project? If not, don’t worry; we’ll tell you all about it. Healthy Nevada has a goal of collecting data samples from 250,000 Nevadans (our population in 2018 was 3.034 million). Not only will the project offer invaluable data about the health of our population, it allows individual participants the chance to review their personal data, which could provide an important head start on staying ahead of serious health complications. For instance, one Healthy Nevada participant found out that she was predisposed to a “silent killer” that could lead to early heart attacks. “Having this information has changed my life.” said Jordan Stiteler. Genetic studies are also on minds of the experts at the Cleveland Clinic Lou Ruvo Center for Brain Health. as administrators there celebrate 10 years of being in Southern Nevada, they’ve got their eyes on the future of Alzheimer’s disease and how precision medicine can combat it. Precision medicine tailors treatments to the individual based on factors including genetics. The clinic’s Dr. Aaron Ritter says that the hope is that the treatment of Alzheimer’s disease can follow that of breast cancer, where highly personalized approaches are transforming outcomes. Not all of our health care requires a degree in genetics, however. Sometimes we just need common sense and a critical mind. Dramatic headlines started to appear about young people developing horns because of their use of cellphones. Dr. Sukanta Maitra of OptumCare Orthopaedics and Spine wants to reassure us that that headlines are vastly overblown, but what isn’t overblown is the importance of good posture. How is your head positioned as your read this magazine? You may be setting yourself up for pain later. And don’t switch off your critical thinking just yet; we’ve got a quiz for you that offers up some intriguing health care-related trivia related to our desert lives. Thanks again for reading! Stay well and stay hydrated! Craig Peterson Editor of Special Publications craig.peterson@gmgvegas.com

SUMMER 2019

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THE DAYâ&#x20AC;&#x2122;S

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SUMMER 2019

SDMI welcomes 3 new Doctors!

Abdominal Imaging & Ultrasound

Breast Imaging

Musculoskeletal

Dr. Samuel

Dr. Victor W.

Dr. Anit

NYON

FONG

RASTOGI

Why did you choose Radiology?

As a medical student, it became obvious right away that

I enjoy the key role radiology plays in every medical specialty for

I chose diagnostic radiology because medical imaging plays such

radiologists have a significant clinical impact on every other

both diagnosis and treatment. I also appreciate the constant

a pivotal role in modern healthcare. It can completely change

specialty. Combining my love for anatomy, great mentoring &

evolution of imaging and technology in radiology that helps

the picture of what’s going on with a patient and guide the

the ability to impact a patient’s history through a single

achieve better outcomes for patients.

appropriate next step.

radiology study, I knew radiology was the right choice for me.

Why did you choose your sub-specialty?

Throughout radiology training, I always found musculoskeletal

Breast imaging combined the skills of diagnostic imaging inter-

It was a difficult decision to make & had narrowed my choices

pathology and treatment to be fascinating. Also, I am an avid

pretation and minimally invasive procedures, all in an outpatient

down to about 3 sub-specialties. Due to the emerging need for

sports fan who has always had a strong interest in MSK anato-

clinic setting. I feel like I have an impact, whether it is detecting

specialized body radiologists, I felt abdominal imaging fit my

my/physiology as well as mechanisms of injury.

breast cancer or reassuring a patient of benign findings. It also helped that I had great teachers during my residency and later

thirst for knowledge and gave me the best chance to land where

What made you want to work for SDMI?

I wanted to be.

on in fellowship.

The family and team-oriented environment of the group

What made you want to work for SDMI?

appealed to me as well as the compassionate care provided

What made you want to work for SDMI?

When I came to SDMI for my interview, all the radiologists and

by the group.

I did my internal medicine internship in Las Vegas and wanted to

staff I met were exceptionally welcoming and went out of their

return in a different capacity after finishing all my post-graduate

way to make me feel wanted. Everyone I met that had no

How do you see yourself impacting

medical training. SDMI with its many locations throughout the

connection to Las Vegas prior to moving said they took the leap

healthcare in Las Vegas?

region serves a big part of the community and has a consistent

and have never regretted it.

As a new radiologist, I want to help the Las Vegas healthcare

mission to provide quality care.

community continue to grow, as this is and will be my future

How do you see yourself impacting

home. I hope to positively impact the community by using my

How do you see yourself impacting

healthcare in Las Vegas?

specialized training in musculoskeletal imaging from a major

healthcare in Las Vegas?

I hope with my expertise in body imaging that I can help make

orthopedic oncology center, to provide exceptional care for the

I trained on both coasts which gave me experiences working

SDMI and Las Vegas a center that will assure patients they are

patients of Las Vegas.

with different healthcare systems and specialists. So I bring my

receiving the best possible healthcare available. Most of all, I will

own perspective and skill set to Las Vegas and hope to make a

continue treating each study I’m reading as if they were one of

What is your favorite part about

my own family.

being a doctor?

difference in the healthcare delivery system.

My favorite part is having the ability to make a difference in

What is your favorite part about

people’s lives when navigating through the unknown of disease

being a doctor?

or injury.

My favorite part about being a doctor is making the diagnosis and knowing I made a difference in someone’s care.

I enjoy using the knowledge I’ve learned through radiology residency and fellowship as well as in medical school to help clinicians solve all their “mystery” cases so that patients will be able to successfully have their diseases treated properly.

“It’s What’s Inside That Counts.” Trust the team at SDMI to provide exceptional customer experiences and first-class medical imaging.

ANOTHER SDMI COMING SOON! For more information, go to https://sdmi-lv.com/ or call 702-732-6000

RENDERING - main entrance SDMI Craig

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BACK-TO-SCHOOL VACCINES CAN SAVE LIVES; STATE DATABASE CAN HELP KEEP TRACK OF RECORDS By Daniel Heller

A WebIZ.nv.gov Your child’s vaccine history can be tracked at WebIZ, the Nevada state vaccine registry.

s school starts back up, it’s a good time for parents to review their child’s immunization record. If you do not have organized vaccine records at home, your first stop online should be Nevada WebIZ, the state database for immunizations. Depending on your child’s age, there may be additional vaccines the Centers for Disease Control and Prevention recommends. It is recommended that children 11 to 12 years old — so those going into 7th grade — receive three vaccines: Tdap, (tetanus, diphtheria and pertussis), HPV (human papilloma virus) and meningococcal vaccines. Children are vaccinated against tetanus, diphtheria and pertussis (whooping cough) as babies, but immunity starts to wear off as they get older and a booster dose is again needed. Tetanus protects against infection caused by bacteria that may enter the body through cuts in the skin. Diphtheria and pertussis is spread airborne from coughing or sneezing. Children also should receive the meningococcal vaccine at 11 or 12 years of age, followed up by a booster at age 16. This vaccine helps protect the body against meningitis — bacteria that can infect the fluid and lining around the brain and spinal cord. It can also cause infections of the bloodstream (bacteremia and sepsis). Meningococcal infections spread when people have close or lengthy contact with each other through saliva, like coughing or kissing, or just from living in the same place. The HPV vaccine protects against infections that can cause a range of cancers and genital warts in both males and females. Depending on when the vaccine series is started it requires either two or three doses to be complete. Starting early — before the age of 15 — is best so that only two doses are required. Rates for starting and completing this vaccine series are extremely low in Nevada compared to the national Daniel Heller, Pharm D, is the health and wellness pharmacy practice coordinator for Smith’s Food & Drug Stores.

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

SUMMER 2019

average and compared to the rates of the other two vaccines we’ve discussed. This is a cancer-preventing vaccine and I strongly recommend it. Vaccines prevent serious illness and even death from infections. They are extremely important not only to protect the individual receiving the vaccine but also to protect those most vulnerable in our communities, including young infants and others who, for whatever reason, cannot be vaccinated and are unprotected. Nevada schools require proof that children have received their shots before registering for school, and Smith’s pharmacists provide these vaccines and can also review your child’s vaccine history on the WebIZ state vaccine registry. It’s very convenient — no appointment is necessary. Stop by your local Smith’s Pharmacy and speak with the pharmacist, or visit our website: SmithsFoodAndDrug.com and click on the pharmacy link.

FLU SEASON

SENIORS ARE THE MOST COMMON TARGET FOR THE INFLUENZA VIRUS, SO TAKE PREVENTATIVE ACTION EARLY By David Roddy

enjamin Franklin said, “Lost time is never found again.” Most would agree that procrastination is the enemy of many things in life, health care being one of them. Flu shots are no exception. Every year, doctors and health care professionals see patients who are suffering from influenza and frequently hear them say, “I wish I had done something sooner to prevent this.” Dr. Judith Ford of HealthCare Partners Nevada urges patients to get an annual flu vaccination as soon as it is available. Vaccinations are readily available at many locations throughout the community, and this is an extremely important preventative measure to take, especially for people in three categories who are most vulnerable — small children, senior citizens and those who are medically fragile. For senior citizens, the importance of vaccinations cannot be stressed enough. According to the 2018-19 Southern Nevada Health District’s Influenza Season Wrap Up, 64.1%, or nearly two of every three, confirmed cases of the flu in Clark County last year were in those age 50 and up. The statistics in the report also remind us that influenza can be deadly. Of the 39 deaths attributed to influenza in Clark County, 30 of those were people over the age of 50. Even so, last year was a mild year compared to 2017-18, when Clark County saw 62 flu-related deaths. While getting a vaccination does not guarantee that a person will not contract the influenza virus, it does diminish the chances of getting it. If a person who has been vaccinated does get the flu, the effects should not be as severe as they would be compared to someone who has not received the vaccination. In addition to getting vaccinated, there are other simple practices that people can take to reduce their chances of contracting the flu. Wash your hands frequently. This is another practice that cannot be emphasized enough. We encounter numerous germs throughout the day that can lead to contracting the flu virus. We touch door handles, light switches, keyboards, elevator buttons, handle money and use shopping carts that may have been used by someone carrying the influenza virus. With this in mind, it is also particularly important to avoid touching the eyes, nose, and mouth — they serve as direct pathways for the flu to enter your system.

To be proactive, HealthCare Partners Nevada recommends keeping hand sanitizer or sanitizing wipes in your possession at all times, and using them constantly. Also make it a habit to regularly sanitize high traffic areas in your home, as this can help to reduce the spreading of germs and harmful bacteria. Simple but regular practices like these can mean the difference between being sick for an extended time or being able to continue with your regular daily schedule throughout the year in a healthy way. It is also important to get vaccinated early. Flu vaccines cause antibodies to develop in the body about two weeks after vaccination. These antibodies provide protection against infection with the viruses that are in the vaccine. The seasonal flu vaccine protects against the influenza viruses that research indicates will be most common during the upcoming season. Many people mistakenly think they should wait until colder weather arrives before getting vaccinated. However, in many cases, they may have already been exposed and the vaccination may not be in effect or fully in effect by that time. Las Vegas is visited every day by countless people from around the world, thus increasing the potential exposure to the influenza virus. HealthCare Partners Nevada says this is yet another reason to get vaccinated early. Flu vaccines are offered in many doctor’s offices, clinics, health departments, pharmacies and college health centers, as well as by many employers, and even in some schools. For those who don’t have a regular doctor, flu vaccinations may be readily available at locations like a health department, pharmacy, urgent care clinic, or the workplace. With the number of locations where vaccinations are available, most people should be able to find a location close to where they live.

David Roddy is a public relations specialist with MassMedia.

SUMMER 2019

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

SKIN SAFETY

THE LATEST SKIN SAFETY MYTHS AND STAYING SKIN-SMART THIS FALL By Dr. Wolfram Samlowski

mid promising statistics surrounding other cancers, the number of skin cancer diagnoses continues to rise by 2% to 4% annually. Numbers-wise and according to the American Cancer Society’s 2019 Facts and Statistics report, more people are diagnosed with skin cancer in the U.S. than all other cancers combined. In total, more than 5 million cases are diagnosed annually. With skin cancer being the most preventable of cancers, why is this so? Simply put, people are not protecting their skin as they should. Unfortunately, there are also a number of incredibly harmful trends that catch on and highly publicized, questionable studies that make headlines and stir confusion. One trend is sunburn tattoos, where people put stencils on their skin and lay in the sun without any sunscreen to get a tan that shows off the stencil. A study from the U.S. Food and Drug Administration released in May triggered a knee-jerk reaction leading people to question the very safety of sunscreen. The study found that active ingredients in different sunscreens may enter the bloodstream at levels that exceed a recommended threshold. The notion is not a new one and a report from NBC noted that the FDA is requesting more data. Many products we use can be absorbed by the body. That includes cosmetics, mouthwash, toothpaste, detergent, clothing — the list goes on. These products have been thoroughly tested and are integral to everyday life. They contain absorbable components but have very few, if any, substantially identified issues. Additionally, when it comes to sunscreen and reapplying properly, it remains the absolute best, proven option in protecting your skin from prospective harm.

Skin-safe year round As the dog days of summer come to a close and temps begin to fall, skin safety measures remain equally as important. Before 9 a.m. and after 7 p.m. are the optimal daily times for outdoor activity, as harmful UV rays peak in the middle of

the day. Points to remember:

• Ball caps don’t protect your ears, back of the neck, or side of the face.

• Remember to apply sunscreen to your feet, lips, hands, and under straps.

• When possible, wear wide brimmed hats, sunglasses and long-sleeve shirts to protect your skin.

• Use sunscreen with a sun protection factor (SPF) of 30 or higher regularly.

Forget your sunscreen? Comprehensive Cancer Centers has been active with free sunscreen initiatives for several years. We are committed to establishing sunscreen partnerships that aim to preserve the health and well-being of the Las Vegas community. Our goal is to use a proactive approach in preventing unnecessary skin conditions. We have established sunscreen partnerships with the following partners: Wet ‘n’ Wild Las Vegas, Las Vegas Aviators, UNLV football, Las Vegas Lights FC, Nevada Cancer Coalition, Las Vegas Springs Preserve, Downtown Summerlin, Cowabunga Bay and the Cadence master-planned community. We also established a partnership with Clark County Parks and Recreation to offer free sunscreen kiosks at facilities around Southern Nevada. Additionally, we work with the Regional Transportation Commission of Southern Nevada on its annual Summer Heat campaign, donating free sunscreen. We also have a long-standing partnership with the Penta Building Group, providing free sunscreen and skin safety tips for construction workers throughout Las Vegas and California.

Treating skin conditions If and when a condition arises, there is help and skin cancer is very curable. In recent years, there has been incredible progress in surgeries, treatments and technologies to remove skin cancers. To maximize the chance for a full recovery, catching skin cancer early is key — ideally when a spot is less than the size of a quarter. Amid the technology and research, one fact remains: Your best chance of mitigating a potential skin cancer diagnosis is to continue wearing sunscreen and stay sun smart.

Dr. Wolfram Samlowski is a medical oncologist at Comprehensive Cancer Centers.

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

SUMMER 2019

s e x u a l h e a lt h

tight clothes and desert heat can lead to male infertility By Dr. David Ludlow

nfertility occurs in about 15% of couples, and in roughly a third of these couples, male infertility is usually the main issue. It occurs due to low sperm production and abnormal function or blockages of sperm. There are several medical and environmental factors that can lead to male infertility, including overheating of the testicles. High temperatures can damage sperm production and function. Happy sperm tend to thrive in an environment that is 4-6 degrees cooler than the male core body temperature (an average of 97-99 degrees), which is why testicles are equipped with the cremaster muscle. When the body gets too cold, the cremaster muscle contracts to pull the testicles closer to the body, and when the body gets too warm, the cremaster muscle relaxes to let the testicles hang low. When sperm are exposed to elevated temperatures, they begin to die, which leads to low motility. Prolonged heat exposure can have a damaging effect on the sperm production process, which will cause the body to produce fewer sperm. So what can be done?

And when prolonged heat exposure slows down the production process, it can lead many sperm to become abnormally shaped.

Boxers vs. briefs The ongoing debate about boxers versus briefs can be determined by a key factor — heat. Studies have shown that men who wear boxers have higher sperm counts than men who wear briefs. The tight fit that comes with wearing briefs is what ultimately contributes to lower sperm count. Testicles need to “breathe” to function properly, and when heat is thrown into the mix, the combination of tight briefs and increased temperatures can lead to low-functioning sperm, because the testes are unable to hang freely at a temperature that is ideal for fertility. Making a choice between something as simple as boxers versus briefs is one of the cheaper, more simple options for dealing with fertility struggles and can have a real impact on sperm health, especially in the hot Southern Nevada weather.

Factors that affect sperm health Fertility can be determined by several factors, including quantity, movement and structure. “Sufficient” fertility is likely if a single ejaculation contains at least 15 million sperm per milliliter. Too little sperm in a single ejaculation will make conception more difficult because there are fewer available sperm to fertilize an egg. Motility is the movement in which a sperm travels through a woman’s cervix, uterus and fallopian tubes in order to reach and fertilize an egg, ideally operating at a 40 percent rate or better to be considered fertile. As for how sperm look — the structure or morphology — “normal” sperm have oval heads with long tails, a structure that works together to facilitate and boost a smooth journey from start to finish. The more sperm that have the normal structure and shape, the better the fertility.

Producing healthy sperm There are several steps that can be followed in order to increase chances of producing healthy sperm. Maintaining a healthy weight and a healthy diet and consuming plenty of fruits and veggies that are rich in antioxidants can help keep sperm healthy. Another factor is practicing safe sex and protecting against sexually transmitted infections such as chlamydia and gonorrhea — which can cause infertility in men. Stress management is key for a variety of health reasons, with infertility being one of them. Stress oftentimes leads to decreased sexual function, which then causes an interference with sperm-producing hormones. Exercise and physical activity can help to increase levels of antioxidant enzymes, which help to protect sperm and keep them functioning efficiently.

Dr. David Ludlow is a physician with Urology Specialists of Nevada.

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c o m m u n i ty m i le s t o n e s

a time capsule for brain disease: celebrating the past and looking ahead to the Future By Dr. Aaron Ritter

T Participation in the Cleveland Clinic Lou Ruvo Center for Brain Health’s clinical trials program is FREE and open to the public. Even those with normal cognitive function are needed to participate as normal healthy controls. To learn more about how you can get involved, visit HealthyBrains.org or call 855-LOU-RUVO.

his year marks the 10th anniversary of Cleveland Clinic Lou Ruvo Center for Brain Health, and while the last Alzheimer’s disease drug was approved 15 years ago, some might wonder what researchers here at the center have been doing over the past decade to combat this grim statistic. We’ve been hard at work, providing care across a spectrum of brain diseases during 165,000 patient appointments, while simultaneously increasing our research efforts, conducting more than 70 clinical trials. As I reflect back on the past decade of the Lou Ruvo Center for Brain Health, I see great progress made. As I look ahead to the future, I am filled with hope for what lies on the horizon, made possible, in part, by the below clinical milestones:

Advanced imaging

Prevention

Installation of Positron Emission Tomography imaging has allowed us to look at the brain like never before, visualizing the structure of the brain to observe changes on a cellular level, and enabling us to participate in clinical studies of new compounds with potential for early diagnosis. In 2013, the amyvid scan was FDA-approved to image amyloid plaque, a hallmark of AD, and is one of the biggest milestones in the research and treatment of the disease in the last decade. Being able to confirm and image amyloid plaque in the brain is one of three “puzzle pieces” we use to diagnose AD before death.

Ten years ago, the idea that we could prevent brain disease didn’t exist. Today, we see this concept as a trend in AD drug development with a growing number of clinical trials aimed at preventing the onset of disease. We know that modifiable lifestyle factors such as diet and exercise can potentially ward off brain disease, so in 2015 launched our HealthyBrains.org platform. Based on six pillars of brain health, HealthyBrains.org arms individuals with the tools they need to take a proactive approach to brain health, including a free brain health self-assessment, personalized reports with customized recommendations and brain health news.

Publishing annual AD pipeline paper The center has become a leading voice in the AD drug development landscape with the publication of our annual Alzheimer’s Disease: Drug Development Pipeline paper, which draws attention to a 99.7% failure rate, while making recommendations for improvement. The 2019 issue of the paper revealed a surprising outcome: we’ve never seen more agents, more diversity of drugs targeting the disease or more funding in the pipeline, elevating us to an exciting and unprecedented state of drug development.

Dr. Aaron Ritter is director of clinical trials at Cleveland Clinic Lou Ruvo Center for Brain Health.

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We’ve celebrated our anniversary with a time capsule that is housed inside the center and includes predictions from our physicians on what we think will happen in our field during the next decade. What does the future of brain disease look like? I answer this question with another. You wouldn’t expect one size of a Tshirt to fit everyone would you? So why should we expect that in a treatment? This concept, referred to as precision medicine, summarizes the future of AD research and treatment and was my contribution to the time capsule. Current AD treatments only target the symptoms of the disease. What’s more, they don’t take into account the individual receiving treatment, and instead take a “one size fits all approach.” We know that brain disease is caused by several different changes in the brain, some of which are due to genetics, and others, environmental factors.

Precision medicine tailors treatments to the individual based on their genetics, environmental exposure and clinical history for a more refined, and personalized approach. With recent advancements in research and diagnosis, it is our hope that AD will follow a similar course to breast cancer or HIV, where highly-personalized treatment approaches have transformed these diseases from terminal to chronic. The time capsule will be reopened 10 years from now to see if our predictions have come to fruition. In order to achieve precision medicine as well as several of my colleagues’ predictions, we need your help. The biggest impediment to AD drug development is clinical trial participation. While I along with fellow researchers are encouraged by the amount of drugs currently in the pipeline, the bottom line is: as the pipeline grows, so does the number of people needed to test these medications.

Cleveland Clinic Lou Ruvo Center for Brain Health photo by Steve Marcus.

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c o m m u n i ty health

Specialty centers are helping remove barriers to comprehensive health services in southern Nevada By Camile Tanner

s one of the lowest ranking states for health care, the delivery of culturally competent health services,” said according to U.S. News & World Report — de- Linden. “For example, Silver State Health merged with the termined by factors of access, quality and public largest bilingual (Spanish) mental health service agency in health services — Nevada is challenged. Nevada to better cater to the growing Hispanic market. By One path to improving our ranking is through federally integrating primary care alongside these established bequalified health centers. FQHCs are community centers that havioral health models, we’re able to offer the community have emerged in recent years as a mainstay among local convenient, holistic and individualized care.” health-care systems. As an FQHC, Silver State Health is required to provide priDesignated as key providers to the uninsured and low- mary care and supportive services that enable access to all, income populations, they help underserved and vulnerable regardless of a patient’s ability to pay; to offer accessible locapopulations by providing high-quality health care, regard- tions and hours of operation including after-hours coverage; less of a patient’s ability to pay. to hire culturally and linguistically apOne such center is Silver State propriate physicians; to follow qualNevada is one of the fastestHealth, founded in 2017. Silver State ity improvement plans; to discount growing states in the nation. Health is a nonprofit that offers socosts of care based on a patient’s cial, mental health and medical serability to pay and to collaborate with However, the medical, mental vices and solutions to the physical health and social infrastructure other providers. and mental needs of the most vul“Uninsured and underinsured paare significantly behind other nerable Nevada communities. tients of the city have few resources states in providing quality ser“Nevada is one of the fastestto receive high-quality health care,” vices to vulnerable populations. growing states in the nation. Howsaid Linden. “While Medicaid cover — Ryan Linden ever, the medical, mental health and age has expanded over the past five Silver State Health social infrastructure are significantyears, without the robust services ly behind other states in providing an FQHC is designed to offer this quality services to vulnerable populations,” said Silver State demographic, the expansion goes underutilized.” Health Executive Director and CEO Ryan Linden. Through increasing access to primary care and mental In an effort to remove barriers that may prevent patients health services with a comprehensive action plan that infrom receiving quality medical and mental health care, Silver cludes socioeconomic support, Silver State’s specialists, State Health works with local organizations to provide trans- psychiatrists, clinical social workers, therapists and primary portation, food assistance, housing assistance, translation care physicians can work to achieve better health outcomes services, social services and more to give patients and their for Nevada and the greater United States, one patient and families an opportunity to receive well-rounded care and en- population at a time. sure their basic needs are being met. In addition, the agency “Often times our patients are unable to prioritize their merged with a bilingual behavioral health center, helping health care needs above more urgent housing, nutritional broaden their services to include mental health. and mental health concerns. By addressing their underly“Because of Las Vegas’ diversity, both culturally and ethni- ing psychosocial development, we’re able to treat the entire cally, barriers often exist revolving around translation and individual and offer more sustainable results,” Linden said.

Camile Tanner is a senior account executive with the Ferraro Group.

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SUMMER 2019

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NECK PAIN IS JUST

a Text Away By Dr. Sukanta Maitra

Continued on page 24

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BAD HABITS MANIFEST THEMSELVES IN MANY WAYS, INCLUDING HOW WE USE OUR PHONES SUMMER 2019

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n June of this year, some people came across headlines that were so sensational they just had to text their friends:

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“Horns” are growing on young people’s skulls. Phone use is to blame, research suggests

How to keep using your smartphone without growing a ‘neck horn’

“Are teens growing horns because of cellphones?”

Research links cellphone use to growth of horns (yes, horns) in humans

Tech disorder? Smartphones linked to bizarre horn-like skull bumps

Can you grow horns from hunching over your cellphone? Continued on page 26

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Continued from page 25

he research study that referenced the bumpy problem was published in February 2018 in the journal Scientific Reports. It focused on a feature known to scientists as the “external occipital protuberance,” a bump on the back of the skull in the middle, just where the neck muscles attach to the head. It makes for a dramatic headline, but rest assured, occurrences of this EOP were only hypothesized (not proven or documented) to be a result of “sustained aberrant postures associated with the emergence and extensive use of hand-held contemporary technologies, such as smartphones and tablets.” In short, let me ease your fears — no one is growing actual horns just yet, at least not that we can document in such a dramatic-sounding way. And while the topic has been sensationalized, at the core of the story lies an important question: Can bad mobile phone habits cause us physical harm? My answer to that is yes.

Smartphones are ruining our postures and stiffening our necks.

0°

10–12 lbs 26

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15°

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The problem and the pain

A study about how a person’s posture while texting affects the spine, published in the U.S. National Library of Medicine, said that most people have a tendency to tilt their neck while texting on their phone. The force to the cervical spine is about 10 to 12 pounds when your head at a “neutral state.” That’s the weight of the average person’s head. However, that force increases as the neck moves forward at different angles: by about 27 pounds at a 15-degree angle, 40 pounds at a 30-degree angle, 49 pounds at a 45-degree angle and 60 pounds at a 60-degree angle. Over time, your head shifts forward, with what orthopedic doctors call “forward head carriage,” which can cause excess

strain on your upper spine. Without correction, this poor posture, sometimes referred to as “tech neck,” may lead to problems such as headaches, pinched nerves, arthritis, bone spurs and muscular deformation, disc degeneration and nerve complications. The research study published in Scientific Reports notes that people spend an average of two to four hours a day with their head tilted to read text messages, emails, view social media and other electronic communications, adding up to 700 to 1,400 hours a year of what can accurately be described as heavy lifting. High schoolers spend even more time on their mobile devices, averaging about 5,000 hours in the “tech neck” position each year. If these statistics persist, people may need spinal care earlier in life. Continued on page 28

30°

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What you can do

It’s not all because of your phone or tablet

Mindfulness — being conscious about your posture — is a great way to start. Think about your body as much as you think about your text messages or that social media post. Even small efforts can go a long way toward easing discomfort, like using a cellphone or tablet stand to reduce strain when watching videos or reading e-books. Here are several things you can do to make things easier on yourself:

Practice good posture One great way to see if you might be suffering from tech neck is to look at your profile sideways in a mirror. If your ears are not lined up with your shoulders, your posture may be promoting chronic pain. Start with good posture and maintain it by moving your phone directly in front of you, so you’re not looking down all day. Your phone should fit you, not the other way around. Raise your mobile devices higher and closer to your line of sight, and to keep your head up when texting or scrolling. Move your eyes rather than bend the neck.

Of course, our aches and pains aren’t all attributable to our cellphones. Sitting at a desk all day can also cause spinal issues. To reduce neck flexion, use a monitor stand for the computer at your desk and set the stand so that the screen is at eye level. If you do frequent computer work, you may want to consider investing in a standing desk. It will not only help you avoid tech neck but staying on your feet can produce a variety of health benefits including reduced risk for obesity and cardiovascular disease. If a standing desk just isn’t your thing, make sure you sit in a chair with a headrest. The back of your head should stay in contact with the headrest while you sit. Doing so will help you avoid flexing your neck forward.

Signs of a problem

While the phrase “tech neck” indicates the neck, symptoms can often begin elsewhere. Your spine stretches from your head down through your back. If stress is placed on one area, it is likely to spread to others, or at least be felt elsewhere. With tech neck, the bending of the cervical spine often makes itself evident as pain the upper back, while it can also present itself as a mild ache, stiffness or a sharp pain in the neck as well as reduced mobility in the shoulder and neck region. If you ignore the early warning signs, the symptoms will only worsen, and it’s possible to aggravate pre-existing conditions. In most cases, ignoring tech neck will simply lead to more neck and shoulder pain. However, people with certain other conditions should be especially wary of tech neck. These conditions include cervical osteoarthritis and cervical degenerative disc disease. Both of these conditions can be aggravated by the associated stress of tech neck. If you suffer from either, it’s important to carefully monitor the amount of time you spend bent over a screen. By taking preventative measures, it is possible to make tech neck a minor and infrequent nuisance, but the reality is that many of us will spend at least some time every day looking down at our phones. The biggest thing to remember here is to stay physically fit year-round, develop and maintain good posture habits and to see a specialist if pain persists or gets worse.

If your ears are

There’s an app for that If your phone is possibly causing you pain, why not make it help you? There are apps designed to help maintain good posture. Some apps track your posture based on the tilt angle of your phone and provide real-time feedback, while others will guide you through different stretches to strengthen your neck muscles (e.g., chin retractions, shrugs, shoulder raises and “slow-no’s” where you turn your head side to side like you’re saying “no”).

not lined up with your shoulders,

your posture may be promoting chronic pain.

Stretch When you’re not using your phone, stretching is a quick and efficient activity you can include throughout the day. One great stretch for preventing tech neck is the corner stretch:

• Stand facing a corner with your feet together (about 2 feet from the wall)

• Place your forearms on each wall and keep your elbows just below shoulder height

• Lean forward as far as possible and hold for 30 seconds to one minute

Spread out your screen time Try to not fall into the habit of doing all of your “digital stuff” all at once. Take frequent breaks instead of spending numerous consecutive hours of screen time. You can set reminders on your smartwatch or phone for certain intervals throughout the day.

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Dr. Sukanta Maitra is a physician with OptumCare Orthopaedics and Spine.

KIDS ARE FEELING THE STRAIN, TOO By Dr. Blair Duddy

he annual back-to-school rush tends to elicit a mad dash for a mountain of school supplies that end up in our children’s backpacks. Between packing a lunch, water bottle, assorted school supplies, textbooks, binders, electronic devices and other odds and ends into the backpacks that they carry to and from school and activities, students are being weighed down — literally. I recommend that a backpack weigh no more than 5% to 10% of a child’s weight. Backpacks that are too heavy can have a damaging effect on a child’s growth and cause problems like poor posture and back, neck and shoulder pain.

Dangers of a heavy backpack A backpack that is too heavy can cause a forward trunk lean and cause the upper back to round, which then causes a forward head posture with the neck extended. This can result in neck and shoulder pain and prevent muscles and ligaments from properly holding the body upright. A significant amount of strain is put on the shoulders when wearing a heavy backpack. This

strain causes joints and muscles to tighten and creates pressure from the body being thrown off balance. In such cases, the mid- and lower-back regions are likely to experience pain and muscle tightness, and the hips and knees will likely become sore from straining to align and carry the weight of the body and the backpack.

Choosing the right backpack To reduce the risk of injury, choose a backpack that can support a child’s weight, as well as the weight of everything being carried, without putting a strain on the back. The size of the backpack should not hang more than 4 inches below the waist and should not be wider or longer than a child’s torso. It should also have a padded back and shoulder straps, an ergonomic design, and ideally, multiple compartments to help distribute the weight. Parents or caregivers should make sure that the backpack is secured and worn correctly. Both shoulder straps should be used and should be kept snug and in place. Reminding your child to practice

good posture will help to avoid back strain and pain and will reduce pressure on the spine.

Lighten the load If a child is exhibiting symptoms that include marks on the shoulders from backpack straps, grunting when putting on or taking off a backpack, or if there are complaints about numbness or tingling in the arms, fingers, or shoulders, the backpack may be too heavy. Such injuries are preventable and increasingly common, so it’s important to help kids choose the right backpack and make sure that they are properly used and not overloaded.

Dr. Blair Duddy is a pediatrician with Southwest Medical Associates.

Dr. Duddy photo by Greg Anderson Photography.

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Thr among

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SCIENCE IS FIGHTING BREAST CANCER IN THE TINIEST OF BATTLEGROUNDS — AT THE GENETIC LEVEL — AND IT’S WINNING

eads Hope of

strands of DNA

By Dr. Souzan El-Eid Continued on page 32

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ccording to the American Cancer Society, 2,190 Nevada females will be diagnosed with breast cancer in 2019. This marks a slight increase year after year. Nationally, there has been a gradual, projected rise in new cases as well, with incidence rates increasing by approximately 0.4% in recent times. This is due to better detection at earlier stages with improved screening tools such as digital mammography, specialty 3-D mammograms and MRI screening when indicated. In the past 10 years, death rates have fallen by approximately 1.9% per year. This is due not only to earlier detection, but also to improved targeted therapy. Proactive measures are vital in keeping these statistics trending in the right direction and ultimately saving lives. And at the forefront of these measures is genetic testing.

â&#x20AC;&#x201D; The science and benefits of genetic testing â&#x20AC;&#x201D; From the methods to stay ahead of a diagnosis to treating the disease, the breast cancer landscape has evolved in our lifetime. In 2019, we live in a world with minimally invasive techniques, targeted therapies, promising clinical trials and growing evidence of what may affect various types of breast cancer. When it comes to genetic testing, as it pertains to breast cancer, when

we know someone is a gene carrier, or has a higher risk of carrying a harmful genetic mutation, we want to screen them as early as possible. Approximately 10% of cancers are gene-related. In the realm of breast cancer, there are a number of common mutations that have made their way to the forefront. Perhaps the most common are BRCA1 and BRCA2, genes that Continued on page 34

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In the breast cancer realm, we are always advocating for early detection.

And, for so many, early detection can lead to better outcomes.

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The leading risk factor for breast cancer is simply being a woman. Though breast cancer does occur in men, the disease is 100 times more common in women, according to City of Hope. According to the Susan G. Komen Breast Cancer Foundation, breast cancer occurs when cells divide and grow without their normal control. Ductal carcinoma in situ is a noninvasive breast cancer. It happens when abnormal cells grow in the milk ducts, but haven’t spread to nearby tissue. Invasive breast cancer cells spread to nearby tissue or other parts of the body. Invasive breast cancer that spreads beyond the breast and nearby lymph nodes to other parts of the body is called metastatic breast cancer. Menstrual cycles affect breast cancer. Females with more menstrual cycles (because they started menstruating early or went through menopause later) are at a slightly higher risk, believed to be because of a longer lifetime exposure to the hormones estrogen and progesterone, according to City of Hope.

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Research suggests breastfeeding for a year or more slightly reduces the overall risk of breast cancer. Why? There are a couple of theories: Breastfeeding can interrupt periods, meaning fewer menstrual cycles and less estrogen exposure. Others credit the reduced risk to structural changes in the breast after lactation and weaning, according to City of Hope.

Continued from page 32

produce tumor-suppressant proteins. When these genes are altered or mutated, DNA damage within the body cannot be repaired sufficiently, resulting in cells having a higher likelihood themselves of becoming cancerous. According to the National Cancer Institute, approximately 12% of women (1 in 8) will develop breast cancer in their lifetime. Those with a harmful BRCA1 or BRCA2 mutation are estimated to have an 80% chance of having cancer by age 80. Additional common mutations include the genes TP53 (or p53), ATM, CDH1 and PTEN, among others. Methods of genetic testing have evolved over the past few years, becoming more comprehensive and able to test patients for a number of mutations at once. In the past, these tests would test for a few genes; they now check patients for more than 80 possible gene mutations that are associated with syndromes and cancer in the human body. Patients who had gene testing prior to 2014 should be tested with the newest technology, covering the remainder of genes that we didn’t have the ability to test for previously. Recommended treatment, whether surgical or a chemotherapy regimen, may vary depending on which gene mutation is detected. For example, those with the TP53 mutation should not be offered radiation because that treatment may actually result in the development of a new type of cancer with their already existing genetic predisposition. All mutations are not equal across the genetic spectrum. Certain genes present a high risk for developing breast cancer and others are associated with an elevated but not a high risk — these do not equate to a necessary mastectomy. A fully up-to-date list of gene mutations and the cancers associated with them may be accessed on the NCI’s website. National Comprehensive Cancer Network Guidelines recommend prophylactic mastectomies for certain genes, and close follow up and screening with mammograms as well as MRIs for others. In addition to the common mutations, there are many variants being discovered on seemingly a daily basis. There are databases and registries for these variants that are accessible to the public. In addition to our practice’s efforts to log and track these variants, patients are encouraged to input their information and learn more with databases like PROMPT Registry (promptstudy.info). There are numerous pros to genetic examinations. First and foremost, if your test comes back negative for potentially harmful mutations, you may have peace of mind and return to a regular screening regimen afterward. I recommend 40 years old to start an annual mammography routine. Mammogram technology has improved drastically in recent times, particularly in dense breast tissue with 3-D tomosynthesis. If a patient tests positive for a specific gene, we dive deeper with screening scans that apply to the specific cancers associated with that gene. From there, and if there

Exercise reduces breast cancer risk for women of all body types, according to City of Hope.

According to the National Institutes of Health, breast cancer survivors face an increased risk of osteoporosis. Reduced estrogen levels can lead to bone loss.

According to the American Cancer Society, there is no study that has shown that taking vitamins can reduce breast cancer risk.

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Dr. Souzan El-Eid is a breast surgeon at Comprehensive Cancer Centers. She also serves as the medical director of the Breast Care Center and co-chair and co-moderator of the Breast Tumor Board at Summerlin Hospital and is a cancer liaison physician for its cancer program.

SUMMER 2019

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increase a woman’s risk, according to the

is a positive diagnosis, it’s imperative for the patient’s family (women and men) to have testing as well, as they have a 50/50 chance of carrying that gene.

Susan G. Komen Breast Cancer Foundation. The foundation also says that there is no link between permanent hair dyes and the risk of breast cancer.

The cost of testing

The cost of genetic testing has decreased drastically in recent years. In 2013, patent restrictions regarding genetic testing were released and several companies began offering testing. These advances focused on testing large amounts of DNA at once, resulting in a quicker turnaround, lower cost and a lesstedious process for patients. With enhanced genetics technology and decreasing costs for patients, there has never been a better time to be proactive. Previously, a full genetics test cost somewhere between $4,000 and $5,000. Now, most commercial insurance plans cover genetic testing, but even without insurance, cash-pay price is around $250 for a full gene panel.

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Eating sugar can lead to weight gain, which can increase the risk for breast cancer. But sugar itself does not cause breast cancer, according to the Susan G. Komen Breast Cancer Foundation.

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Cancer can develop in pregnant women, women who have just given birth, and women who are breastfeeding. The cancer doesn’t affect the fetus, but treatment

Looking ahead

In 2019, the American Society of Breast Surgeons updated its recommendations establishing a new consensus guideline on genetic testing, saying it should be available to any patient with a history of breast cancer. Genetic cancer is becoming more and more accessible and perhaps, eventually, breast cancer can be as commonly screened as diabetes and blood pressure. Needless to say, this proactive measure of genetic testing is here to stay and should be a part of a routine health screening, in my opinion. So, on that note, there is no time like the present to take action.

Neither saline nor silicone breast implants

might. Surgery is generally safe and some chemotherapy may be an option under certain circumstances, according to Susan G. Komen. Avoid breastfeeding when being treated with radiation, chemotherapy, hormones or targeted therapy.

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According to the National Breast Cancer Foundation, breast cancer in men is usually detected as a hard lump underneath the nipple and areola. Men carry a higher mortality than women do, primarily because awareness among men is less and they are less likely to assume a lump is breast cancer, which can cause a delay in seeking treatment. The symptoms for men are the same as for women.

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NEVADA MAKING SOME PROGRESS ON FIGHTING CANCER AT THE LEGISLATIVE LEVEL By Stephanie Winn

new report shows that Nevada made progress in the cancer fight this year, in part by passing a tobacco-control law. Nevada also made strides by enacting new legislation to protect kids from skin cancer later in life by allowing sunscreen at school. However, the report found Nevada can do more to implement policies to prevent and reduce suffering and death from cancer. According to “How Do You Measure Up?: A Progress Report on State Legislative Activity to Reduce Cancer Incidence and Mortality,” Nevada measured up to policy recommendations in five of eight evaluated issue areas. The report was released by the American Cancer Society Cancer Action Network, which is the advocacy affiliate of the American Cancer Society. “How Do You Measure Up?” rated states in eight specific areas of public policy that can help fight cancer: • Increased access to care through Medicaid • Access to palliative care • Balanced pain control policies • Cigarette tax levels • Smoke-free laws • Funding for tobacco prevention and cessation programs • Cessation coverage under Medicaid • Restricting indoor tanning devices for people under 18 Nevada received the highest marks for its access to Medicaid, palliative care, and its attempts to protect young people from the dangers of indoor tanning. Nevada got moderate marks for its pain policy, cigarette-tax rates and smoke-free laws. The report gave Nevada low marks for the funding of tobacco prevention and cessation programs, and for Medicaid coverage of tobaccocessation services. “This year alone in Nevada, 14,810 people will be diagnosed with cancer and, sadly, 5,390 will die from the devastating disease in 2019,” said Tom McCoy, ACS CAN Nevada government relations director. “We owe it to them — and to everyone at risk of developing this disease — to do everything in our power to prevent cancer and improve access to screenings and treatment.” This year’s report includes a special section examining efforts to stem tobacco use among teens. E-cigarettes have driven a dramatic 36% rise in overall youth tobacco use over the past year — and in statehouses across the country, policymakers have prioritized efforts to keep tobacco products out of the hands of our kids, introducing 88 bills that raised the age of sale for tobacco products.

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In Nevada, Senate Bill 263 helped address the youth e-cigarette epidemic by taxing the products and prohibiting use of e-cigarettes in non-hospitality workplaces and restaurants or wherever smoking is prohibited. McCoy is concerned about what the U.S. Surgeon General is calling a youth e-cigarette epidemic. The Centers for Disease Control and Prevention released new data in February showing e-cigarette use among high schoolers jumped an alarming 78% in the past year. McCoy worked to help educate lawmakers this session about why SB 263 was needed to help address the issue; the important legislation to tax e-cigarettes and cover them under the state’s Clean Indoor Air Act was signed into law in early June. While SB 263 appropriated $2.5 million for each year of the biennium for tobacco prevention, education and cessation, on top of about $1 million in existing funding, the CDC’s recommended funding level for Nevada is $30 million. That means even with the additional funding provided by the e-cigarette tax, Nevada will only be spending 11.67% of the CDC recommended amount. “Raising the sales age to tobacco is the next step in helping Nevada get a handle on this public health crisis,” said McCoy. “Effective legislation to raise the minimum age of sale to 21 should cover all tobacco products, provide public education and training as well as technical assistance to retailers while implementing measures for active enforcement.” Recently, the Nevada Attorney General’s Office reported the number of cases where retailers were caught selling tobacco to youth under 18 skyrocketed from 13% to 29%, as of April. Should Nevada end the year with an average violation rate above 20%, it could be penalized by the federal government. “By passing laws that prevent cancer and help patients get the care they need, our lawmakers can save lives and money in Nevada,” said McCoy. To view the complete report and details on Nevada’s ratings, visit FightCancer.org.

Stephanie Winn is director, region media advocacy for the American Cancer Society Cancer Action Network.

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Changin Through the Healthy Nevada Project, we now have the gift of insight to make needed changes not just for ourselves and loved ones, but for all of Nevada.

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

SUMMER 2019

g the Game HEALTHY NEVADA PROJECT IS STUDYING THE STRANDS IN THE GENETIC FABRIC OF SOUTHERN NEVADANS

By Jocelyn Silva

t started with a cup of coffee. In 2016, Dr. Tony Slonim, Renown Healthâ&#x20AC;&#x2122;s president and CEO, sat down for coffee with Dr. Joseph Grzymski, a computational biologist at the Desert Research Institute, to discuss the connection between science and health care. Understanding the importance of preventive care and seeing the emerging access to personal health data through low-cost DNA tests, their conversation led to a question â&#x20AC;&#x201D; could this be a

new path toward treating illness and disease prior to diagnosis? Using the advanced science and

growing popularity of personal DNA tests, they recognized that by working together they could apply these new tools to decrypt health predispositions and better understand risks for disease encoded in the genes of Nevadans. Fast forward to 2019. The Healthy Nevada Project, which allows people to get no-cost DNA

testing, has become the fastest-growing community-based population health study in the world. The goals of the project are to improve health literacy, give patients actionable personal health data and results that foster a desire to lead healthier lives, improve medical research and save lives in Nevada. Continued on page 40

SUMMER 2019

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

Continued from page 39

DNA testing is looking to make its mark in routine preventive care

The road to wellness The Healthy Nevada Project initially launched in 2016 in Reno, offering 5,000 openings to participants as part of a collaboration between Renown

The Healthy Nevada Project has become the fastestgrowing community-based population health study in

and DRI. The community response was so favorable that the openings filled within 24 hours. Renown and DRI opened another 5,000 testing spots that filled the next day with people eager to volunteer to submit their DNA for analysis as part of the study. In March 2018, Renown and DRI launched Phase II of the project with an additional 40,000 openings and a new partnership with Helix, one of the largest accredited sequencing labs in the nation. They also expanded their geographical reach to other parts of Nevada, including Carson City, Elko,

the world, offering no-cost

Tonopah, Winnemucca, Lovelock, Silver Springs, and more.

DNA testing to participants

Las Vegas and Clark County with 25,000 additional slots now available for

across the entire state.

valley where participants can receive genetic testing at no cost — its urgent

Now, the Healthy Nevada Project has offered free testing to people in interested participants. UMC has provided three testing facilities across the care clinics located at Blue Diamond, Centennial Hills and Rancho. “For the first time, we are providing information at the individual level so study volunteers can make lifesaving changes to reduce their risk based on their genetics,” said Slonim. “We’re also doing it on the community level to

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

SUMMER 2019

develop leading-edge research on health determinants for

Education, then reviews de-identified project participant

entire neighborhoods, states and eventually, the country.”

results, looking for Centers for Disease Control’s Tier 1

The Healthy Nevada Project requires those interested in testing to spit saliva into a sample tube and submit it

genetic conditions. Participants with these genetic markers have a higher

for analysis. The whole process takes less than 20 minutes,

risk of developing serious illnesses including heart disease,

with most of the time spent going through the three-step

breast, ovarian, colorectal, and other cancers. Those who

patient security, confidentiality and consent process. Once the tube of saliva is collected, the DNA is analyzed

test positive for these genes receive genetic counseling and can use their results to begin preventive care by their

by Helix. Helix uses a proprietary method to sequence the

primary care provider. Tier 1 genetic conditions include

part of our genome that codes for the proteins that tell our

familial hypercholesterolemia (which affects cholesterol),

bodies how to function. Once the saliva sample is tested,

BRCA 1 & 2 (which is related to breast cancer), and Lynch

patients have access to their results where they can learn

syndrome (a genetic predisposition toward certain can-

more about their health, including how they interact with

cers).

coffee consumption, their body mass index, saturated

“We are returning clinically actionable results so Ne-

fat, vitamin D and calcium levels, as well as their ability to

vadans can reduce their risks for often preventable but

tolerate lactose and gluten. The Healthy Nevada Project

serious disease,” said Michele Frankovich, administrative

also identifies the participant’s regional ancestry, offering a

director of the Healthy Nevada Project. “Our goals are to

historical breakdown to explain where they came from.

educate our community on how genetics and our environ-

A population health research team at DRI, the envi-

ment influence our health so we can make informed health

ronmental research arm of the Nevada System of Higher

choices that help us prevent illness and disease proactively.” Continued on page 42

SUMMER 2019

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

Continued from page 41

Lifechanging discoveries

For many, the results have changed their outlook on health. When Jordan Stiteler’s father and grandfather both died of a stroke in their 40s, their deaths left more questions than answers. It wasn’t until 2018 when Stiteler answered an unexpected call that finally gave her and her family an answer. Earlier that year, Stiteler decided to get her DNA tested with the Healthy Nevada Project. When asked if she wished to be contacted if she tested positive for a CDC Tier 1 genetic condition, she checked yes. A few weeks later, Stiteler tested positive for a genetic factor that predisposes her to familial hypercholesterolemia, and a genetic counselor from the Healthy Nevada Project contacted her to deliver the news. A known “silent-killer,” FH is a genetic disorder that prevents the body from removing lipoproteins from the blood and thus causing high cholesterol. Undiagnosed and untreated, FH can lead to early heart attacks and heart disease. Having received clinically actionable results, Stiteler worked with her primary care physi-

Confidentiality

One of the primary concerns potential participants of the Healthy Nevada Project may have is what the study is doing to protect the personal genetic data they submit. The study takes privacy very seriously and receives oversight from an Institutional Review Board. The study has acquired a Certificate of Confidentiality from the National Institute of Health that legally allows researchers to refuse to disclose information that identifies the participants in any federal, state, local, criminal, or other proceedings, including a court subpoena. In addition, the project de-identifies the genetic information during the sequencing process to protect the identity of the individual. To further explain:

• Helix’s clinical laboratory platform conducts initial testing using de-identified genetic information.

• Helix sends the information to DRI for additional testing where they look for CDC Tier 1 genetic markers.

• If found, DRI verifies information provided by the participant during the consenting process. The information is still de-identified during this stage.

To learn more about the

Healthy Nevada Project, please visit

HealthyNV.org

• If the participant chose to be contacted for a Tier 1 marker, the information is sent back to the Healthy Nevada Project where it is re-identified and a genetic counselor will make a call to the participant.

• All basic research is performed on de-identified data.

The way of thefuture

cian to take preventative measures and start medication. Since her diagnosis, Stiteler’s brother and grandmother have also been diagnosed with the disorder. “Having this information has changed my life. We are so glad we got this testing,” said Stiteler. The pool of testing participants diagnosed with a Tier 1 genetic condition is rare, meaning only a small group of people will receive a call from a genetic counselor following their initial results. Once the results are delivered, affected individuals can inform their primary care practitioners and develop a course of action centered on prevention. At 40,000 acquired samples, Healthy Nevada Project researchers are finding that current medical protocols miss these Tier 1 genetic markers. Just over 1% of people contacted through the Healthy Nevada Project were found to have highly actionable genetic factors that increase their risks for certain diseases. Among these individuals, 90% would not have known of their genetic risk based on current medical guidelines that stipulate who is a good candidate for genetic screening.

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

SUMMER 2019

Moving forward, the Healthy Nevada Project hopes to collect 250,000 samples from Nevadans to help improve the overall health of families, friends and communities. Over the next few years, the Healthy Nevada Project will offer additional clinically actionable genetic results to participants. “Returning these results means two things,” said Slonim. “For the community at large, we can understand the prevalence of genetically programmed diseases and illnesses that we have here in Nevada and ensure we are providing the best prevention and care plans. For the individual, the return of results can be lifechanging.” To learn more about the Healthy Nevada Project, please visit HealthyNV.org.

Jocelyn Silva is a public relations professional with the Ferraro Group.

215

North Las Vegas 95

Sahara West Flamingo

515

215

Blue Diamond

215

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

SUMMER 2019

Q QUESTION EVERYTHING YOU KNOW By Health Care Quarterly

ere at Health Care Quarterly, we like to provide answers to the questions that Southern Nevadans have about medicine — until now. It’s time to flip the script a bit and quiz you, our readers. Grab your pencil; it’s test time!

&A Continued on page 46

SUMMER 2019

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

Q& A

Type 2 diabetes can lead to a host of health problems, including:

A KIDNEY DAMAGE B ARTHRITIS C PROSTATE CANCER D A&B

1931 was an exciting year in Nevada. Thousands of workers came to the southern part of our state to build Hoover Dam. Two hospitals opened that year, one in Boulder City and one in Las Vegas; which one opened first? A BOULDER CITY HOSPITAL, BUILT BY SIX COMPANIES. IT INCLUDED A “PEST HOUSE,” A SEPARATE ISOLATION FACILITY FOR CONTAGIOUS DISEASES. B THE CLARK COUNTY INDIGENT HOSPITAL, WHICH WOULD CHANGE ITS NAME OVER THE YEARS BEFORE EVOLVING INTO UMC IN 1986. THE CLARK COUNTY INDIGENT HOSPITAL OPENED WITH 20 BEDS, ONE DOCTOR AND ONE NURSE.

We live in the desert; we get busy; we forget to take care of stuff, like drinking enough water. Dehydration is a common malady and there are different opinions on how much water we should be drinking. The Mayo Clinic says that drinking 64 ounces of water a day (eight 8-eight ounce glasses) is a good rule of thumb but some may get by with less and others may need more. How might you know if you are dehydrated? A DRY SKIN THAT DOESN’T BOUNCE BACK WHEN PINCHED B FEVER AND CHILLS C DARK URINE D ALL OF THE ABOVE

There were more than 400 opioid-related overdose deaths in Nevada in 2017. A TRUE B FALSE

A food intolerance is synonymous with a food allergy. A TRUE B FALSE

Speaking of allergies, people who are allergic to ragweed know to avoid it. What else might they want to avoid? A ALASKA, WHERE RAGWEED IS ABUNDANT B EATING CANTALOUPE, AS IT HAS PROTEINS SIMILAR TO THOSE IN RAGWEED C RAINY DAYS, WHICH ACTIVATE RAGWEED POLLEN D ANY MEDICATIONS AS THEY WILL NOT BE HELPFUL

Q& A

Have you heard about cerumen impaction? Is it something you’ve suffered from? Probably. How do you treat it?

There’s a chance your travels across the Southwest could bring you in proximity to a nine-banded armadillo, particularly if you’re near a water source. Even though it’s not apparent at first blush, what do humans have in common with it?

A BY WRAPPING THE AFFECTED AREA WITH GAUZE

A LEPROSY! THEY’RE THE ONLY ANIMALS BESIDE US TO CARRY THE DISEASE.

B BY DRAINING THE WOUND

B A DIET OF WORMS AND GRUBS

C USING A COTTON SWAB TO CLEAN THE AFFECTED AREA

C THE APPEARANCE OF SCUTES ON THE BODY

D NONE OF THESE

D RUNS AWAY WHEN FRIGHTENED

11.

You’re having a glorious day on the Strip, spent enjoying yard-long margaritas and ice cream cones when the headache and chills strike, fast and hard. The feeling makes you grimace and groan. Fortunately, a nearby doctor comes to your aid, diagnosing you with sphenopalatine ganglioneuralgia. What in the world happened? A OVEREXERTION FROM TOO MUCH ACTIVITY B TIGHT CLOTHING IS RESTRICTING PROPER BLOOD FLOW C BRAIN FREEZE FROM COLD FOODS AND BEVERAGES D GENETIC PREDISPOSITION TO HEADACHES

Blood sugar isn’t all about candy bars and ice cream. Which of the three factors below can increase your blood sugar? A DEHYDRATION B INCREASED FIBER C GUM DISEASE D SUNBURN

12.

Autism is ___________________ A A DISORDER THAT CAN AFFECT VERBAL AND NONVERBAL COMMUNICATION

The first meeting of Gamblers Anonymous was in Las Vegas.

B CURABLE WITH PROPER MEDICAL OVERSIGHT C EASY TO DIAGNOSE EARLY D ALL OF THE ABOVE

A TRUE B FALSE

Answers on page 48

SUMMER 2019

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

Q& A

AND THE ANSWERS ARE... 1

ANSWER: D

According to the Mayo Clinic, diabetes can lead to kidney failure or kidney transplant. There is no evidence it affects arthritis or prostate cancer. There’s no cure for type 2 diabetes, but a responsible diet and exercise can help manage it. 2

ANSWER: B

The Clark County Indigent Hospital opened in July 1931, according to UMC records. The Boulder City Hospital opened in November of that year. 3

ANSWER: B

They affect different systems of the body. A food intolerance is going to hit your digestive system; for instance, people who are lactose intolerant will experience gas, bloating and discomfort. A food allergy causes your immune system to react to a food and may result in life-threatening situations, according to the University of Rochester Medical Center. 6

ANSWER: B

Ragweed is uncommon in Las Vegas but people who suffer from ragweed allergies may want to avoid eating cantaloupe to avoid crossreactivity. If it causes your mouth to itch, URMC recommends seeing a doctor. Alaska is the only state where ragweed does not grow. Rainy days tamp down the pollen and can offer relief to allergy sufferers, as can medication. 7

ANSWER: B

The first meeting of GA was in Los Angeles in 1957. Visit GamblersAnonymous.org for information about meetings in Las Vegas.

ANSWER: A

True, according to the National Institute on Drug Abuse. Of those deaths, 276 involved prescription opioids. 5

ANSWER: C

Who knew that brain freeze had such a fancy name? The resulting pain that comes from taking a fast drink occurs because of how nerves at the back of the throat react to the cold, according to Healthline.

ANSWER: D

Other symptoms of dehydration include confusion, rapid heartbeat and breathing, and possibly, unconsciousness. Remember to stay hydrated. 4

ANSWER: A

The New England Journal of Medicine published an article in 2011 linking the armadillo to human leprosy cases. According to Smithsonian magazine, the risk of transmission is low. Scutes, by the way, are the scaly plates that cover the armadillo.

ANSWER: A, C, D

According to the Centers for Disease Control, dehydration increases the concentration of sugar in the blood. The CDC also says that the pain of a sunburn can cause stress, which raises blood sugar levels and points out that gum disease is both a complication of diabetes and can cause sugar levels to spike. Increasing your fiber content is a way to lower blood sugar. 12

ANSWER: A

A broad range of symptoms can present themselves. People with autism may not process information in a way that seems typical. Behaviors may show up early but they can be difficult to diagnose if they’re masked by developmental milestones, according to information from Families for Effective Autism Treatment. There is no cure for autism spectrum disorder.

ANSWER: D

Cerumen impaction is the name for excess earwax. Doctors discourage the use of cotton swabs because they can drive the wax in deeper and stray fibers can find their way inside the ear, potentially exacerbating the problem. The Cleveland Clinic recommends that you talk to a doctor.

0-4 CORRECT. THAT’S OK.

It was a tough quiz and we didn’t give you any time to study.

5-8 CORRECT. YOU DID WELL!

You’re on the right track to knowing how to live a healthy life.

9-10 CORRECT. PHENOMENAL!

Continue your studies of health care; it will serve you well.

11-12 CORRECT. YOU GET A PHD

from Health Care Quarterly University! Great job!

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

SUMMER 2019

C O L L A B O R AT E . I N N O VAT E . E D U C AT E . Academic medicine at UMC creates breakthroughs for today—and the doctors and nurses of tomorrow. This means we’re collaborating with the best and brightest in medicine, conducting research that leads to life-saving treatments, and implementing the latest tools and technologies so that our next generation of medical professionals can provide the utmost in state-of-the-art care.

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RIGHT TIME, RIGHT PLACE

MEANING OF ‘BE HERE NOW’ BECOMES CLEAR AS REAL-WORLD EMERGENCY HAPPENS By Dr. Svetlana Barbarash

he older man’s face was blue. His body was still, and his head rested on his shoulder. He was seated in a miniature racing car used to drive around the track of the large indoor amusement center. But now all the cars were stopped, and people were milling about, not sure how to help. I had been in the far corner of the amusement center with my husband, Dmitriy Kosyagin (also a doctor), my youngest and middle sons (10 and 14 years old), and my co-worker, Dr. Wong Khaw. Khaw is an emergency room hospitalist, my husband is an internal medicine physician and I work as chief of cardiology at Southwest Medical in Las Vegas. I had met Wong just a few weeks earlier at a UnitedHealth Group Culture session. “Be Here Now” was the takeaway from that day. It was at that time that we discovered our 10-year-old sons were not only in the same local school but were friends. So, when I set up this party, I made sure to invite Wong and her family. At this moment, we were in a private party room setting up birthday festivities. I could see there was a commotion, but it was far off and initially, we did not give it much concern. More commotion grew from the far corner. We glimpsed the person in the car, not clearly, but with a growing number of people around him, including amusement center employees, and what seemed to be his grandchildren — younger teenagers, now pacing around the car. One of them was sitting on the ground, his arms up in the air, as if frustrated or distraught. Khaw, my husband and I instinctively knew we might be able to assist and made our way to the commotion. The more we saw, the quicker we moved.

No Pulse and Unresponsive Finally getting through the crowd, we saw the man and his color. He was unresponsive and did not seem to be breathing. His family members were crying. Death was potentially closing in and time was of the essence. Dmitriy and I both took his pulse. There wasn’t one. “Is there a defibrillator?” Dmitriy asked. Employees looked at each other, somewhat stunned, and shook their heads. Without speaking, we began to take action, lifting the gentleman from the car and laying him upon the floor. We began chest compressions. The manual compressions on the sternum moved oxygenated blood through his blood vessels. The goal was to keep a good blood flow — especially to the brain — for as long as it took until he could get more care from the paramedics, who had more tools. It did not look good. The three of us felt that, at best, the man would likely have major health issues if he managed to make it. But our job was to bring this guy back. As minutes ticked by, his heart still did not beat on its own. Suddenly, the paramedics arrived. As they moved the man to the gurney, Wong

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

SUMMER 2019

took one last pulse check. She felt the faintest movement. The three of us then consoled those who were still there and were optimistic with the remaining crowd. Of course, we all hoped for the best. What we witnessed made us think that the outcome would not be good.

A Different Tone Needless to say, our birthday party regrouped with a somber tone. I had some concern for my youngest son that his celebration of life now had, well, the shadow of death mixed in. Still, this was a learning opportunity for the family that could not be discounted. Life is precious and we should appreciate every moment. On the way home, our 14-year-old middle son seemed very contemplative. Eventually, he quietly asked, “Mom … Dad ... is that what you guys do at work every day?” Dmitriy and I exchanged a smile. I’m pleased to report that I was contacted later about the man’s condition. He made a full recovery.

Looking Back Needless to say, it’s easy to wonder how things might have turned out if we, as physicians, had not been there that day. My sincere hope is that my fellow health care professionals will do their part to ensure their office staff, patients and others they may encounter are aware of the importance of CPR and resources that are available to those who wish to learn. For anyone else who may be reading this article, I sincerely hope you consider CPR training as well. Those who are responsible for children, the elderly or others not fully capable of caring for themselves should consider CPR training, as well as anyone in a position that requires them to be around the water, live electrical lines or other dangerous activities on a regular basis. Regardless, I encourage anyone with a family to learn CPR, because 85% of cardiac arrests occur at home. This could mean the difference between life and death for your child, parent or spouse or friend.

Dr. Svetlana Barbarash is the chief of cardiology at Southwest Medical Associates.

Dr. Barbarash photo by Sampel & Preston Photography.

Dr Svetlana Barbarash, second from left, stands with her husband, Dr. Dmitriy Kosyagin, second from right, and her children and mother-in-law.

RESOURCES While not a comprehensive listing, there are a number of resources in Southern Nevada for CPR training: American Red Cross RedCross.org/local/nevada.html 444 E. Warm Springs Rd., Suite 101, Las Vegas, NV 89119 (702) 791-3311

CPR Society CPRsociety.org 3160 S. Valley View Blvd., Ste. 108, Las Vegas, NV (888) 860-3031 x1

Vegas Valley CPR VegasValleyCPR.com 5160 S. Eastern Ave., Ste. C Las Vegas, NV 89119 (702) 427-6970 (call or text)

S U M M E R 2 0 1 9 H E A LT H C A R E Q U A R T E R LY

bu s i n e s s

Helping people during the end of the journey By Rebecca Clifford-Cruz

Aaron Forgey, Laura Sussman and Wendy Kraft of Kraft-Sussman Funeral & Cremation Services.

or Wendy Kraft and Laura Sussman, it ligious and community organizations. Our staff is an honor to care for the deceased. does not work on commission and we have a Both were part of the Jewish burial so- grief therapy dog, Obie. Because we don’t own ciety, or chevra kadisha, and say it was a ful- a cemetery, we work with all of them and profilling, spiritual experience. “Each day we feel vide information on all of the cemeteries so blessed that we can perform this mitzvah and families can make informed choices. We care help the families of our community,” Kraft said. for the deceased in our facility, versus a central Although the women are Jewish, their business, “care center” used by many funeral homes. Kraft-Sussman Funeral & Cremation Services, Kraft-Sussman offers continuity of care, so caters to the needs of all cultures and religions. families can develop a relationship with one staff member, instead of having to deal with numerous people throughout the process. We What types of funeral services do you offer? Funeral services, memorial services, burials, are totally transparent and provide our pricing cremations, worldwide transport for burial in on our website. We offer a free final visit for families prior to cremation or burial. other locations, advance planning. In the near future, we’ll offer alkaline hydrolysis cremation, or aquamation. We also do a number of edu- What is a misconception about your industry? Most people don’t know that embalming is cational seminars for local groups, to inform them and demystify information about funeral not required by law, except in certain cases. service. We can do traditional services and have certified celebrants on staff to do more At what age should someone consider personalized services. pre-planning their funeral arrangements? Any age. It’s good to have these discussions with people who are important to you at any How has the funeral business evolved time. We are always available to meet with in recent years? people — at no charge — if they want to plan for Corporations have taken over many of the family-owned firms. Some people say this their care. People can pay for their plans if they decreases service and increases price. Some want to lock in the costs, but that is not required. firms are beginning to do online arrangements, The funeral industry has embarked on a program called “Have the Talk of A Lifetime.” We have where families don’t even meet with a funeral director. There is a considerable trend for fami- playing cards that families can use to start that conversation in a healthy, informative way. lies to choose cremation over burial. What sets you apart from other funeral homes? We are locally and woman-owned. We are part of the community, sitting on a number of nonprofit boards and involved in numerous re-

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

What advice can you offer those who have never arranged a funeral? Start thinking about what your final wishes are. There are numerous resources online. Some initial questions are:

SUMMER 2019

• Think about the type of services you desire. • Are there any religious traditions you want observed? • Would you like a funeral or memorial service? • Where will the service take place? A funeral home, house of worship, graveside, home, or some other place? • Will you be arranging a burial, cremation or shipping to another location? • Do you want to be embalmed? • How will you be dressed? • Will there be a visitation or viewing? • Is there any special music, poetry or prayer you would like included? What is the best part about doing business in Las Vegas? Because Las Vegas is a melting pot of sorts, we have the opportunity to work with people from all over the world with different religious and cultural backgrounds and customs. Most people are from somewhere else, with little or no local family support. Our staff understands that we need to take the time to educate and inform the families we work with, as this may be the first experience many have had with death. We’re not salespeople as much as we are educators and counselors.

Rebecca Clifford-Cruz is research librarian at the Las Vegas Sun.

Kraft-Sussman photo by Wade Vandervort.

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UNION VILLAGE VISION IN HENDERSON BECOMING A REALITY By Bryan Horwath

“

To have the first integrated health care village in the nation speaks to our health care priorities in the city of Henderson. — Henderson Mayor Debra March

mid a collection of large and expensive projects progressing in the Las Vegas Valley, one seems to have existed a bit under the radar. A city within a city in Henderson continues to go up east of U.S. 95 near Central Church. It’s called Union Village, and it’s already home to Henderson Hospital and an upscale apartment complex called The Well, which has about 400 units. In the coming months and years, plans are for the sprawling 155-acre, $1.2 billion development to include a 14,000-square-foot dialysis clinic, a memory and dementia care “village,” a hotel, a 300-unit condominium build-out, an additional condo project, a promenade, restaurants and other retail spaces, more apartments (including senior-living units), and a new 95,000-square-foot Las Vegas Athletic Club facility. That’s just part of what’s planned, said Craig Johnson, one of the founders of the Union Village development, which broke ground in 2014. “We’re building a 5-acre park, which we’ll give to the city (of Henderson),” Johnson said. “We’re calling this an integrated health care village, and it’s a first of its kind around the country. It’s a place where you can live, work and play, and it’s all based on health and wellness.” Henderson Hospital, which opened in late 2016 and features nearly 170 beds, has been the most visible of the projects within the Union Village build-out, but more will be coming soon. “We’re proud that Henderson Hospital is the anchor for Union Village,” said Sam Kaufman, the hospital’s CEO. “We’ve been very successful. The community engagement here has been phenomenal. We’re adding a (catheterization) lab this summer and a new patient tower with additional beds, which we plan to open in 2021.” While it’s a process, the area is beginning to fill in. A leasing consultant with The Well, managed by the Wolff Co., said its apartment units are almost all leased, and the Las Vegas Athletic Club space is expected to open late this year. The Wolff Co. also has a 350-unit apartment complex being built adjacent to The Well. Another planned piece for Union Village is a 50,000-squarefoot wellness center that, Johnson said, will feature a full health and well-being experience.

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“It will have everything from physical therapy and athlete training to psychological services and even some Eastern medicine components,” Johnson said. “There’s nothing really like it right now in the world. We’re building another one at the Pro Football Hall of Fame.” The connection with the hall of fame comes from the Canton, Ohio, facility’s president, David Baker. An original member of the three-person team that first envisioned Union Village back in 2009, Baker went to work at the Pro Football Hall of Fame in 2014. With the Las Vegas pro sports scene exploding, Johnson said his group would like to explore possible partnerships in the sports realm. “We’d love to reach out when we’re ready,” Johnson said. “Ideally, we’d love to talk to the Raiders about possibly sponsoring a senior-

living facility for former players and personnel. We have so much on our plate right now, that would be down the road.” Henderson Mayor Debra March said she’s looking forward to watching the full Union Village vision become a reality. “To have the first integrated health care village in the nation speaks to our health care priorities in the city of Henderson,” March said. “This is an exciting time in our city and we look forward to its completion.” One of the traits that attracted Johnson and his team is accessibility. “We believe this is the future of health care,” Johnson said. “You have everything health- and wellness-related and people living in an environment where they can walk to work and walk to places where they can eat healthy. You’re part of a bigger community, but you have your own little community, too, and that’s the exciting part of Union Village.”

Bryan Horwath photo by Christopher DeVargas.

Henderson Hospital anchors the 155-acre Union Village, an “integrated health care village” in Henderson.

Bryan Horwath is a reporter for VEGAS INC.

S U M M E R 2 0 1 9 H E A LT H C A R E Q U A R T E R LY

m eet the p r o f e s s i o n al

providing peace of mind when it’s needed most By Rebecca Clifford-Cruz

Karen Rubel, president and CEO of Nathan Adelson Hospice.

aren Rubel, who has worked for Nathan Adelson Hospice for over 12 years in roles such as chief operating officer and vice president of development, was tapped to succeed Carole Fisher as president and CEO of the nonprofit organization, which has served more than 70,000 people in its nearly 40 years in Southern Nevada. What do you hope to bring to the patients and families of Nathan Adelson Hospice? I’d have to say peace of mind. It can be overwhelming for most people to experience the illness of a loved one. As a society, we don’t pay as much attention to the end of life as we should. We don’t plan and we avoid thinking about it — until it’s often too late. Our team is able to help guide patients and families through the process. We strive to provide comfort and dignity for patients. That is priority No. 1 for us as a team and as an organization. Once a family member experiences hospice care, they often become incredible advocates for it. We have volunteers here who have worked with us for decades, since they believe so strongly in what we do. What is your vision for the future of Nathan Adelson Hospice? My priority is to continue the incredible legacy that has been established here over the past 40 years. It’s a privilege for me to be part of this organization and to now lead it. I know I have big shoes to fill. Under the guidance of our board of trustees, we have accomplished so much. From the beginning, Nathan Adelson Hospice was innovative. The Swenson inpatient unit was the second of its kind in the country. Every leader since then has made their mark, and we have

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truly grown up with the community. I want to find innovative ways to provide care for those who need us and strengthen the partnerships we have with other nonprofit organizations, health care providers and insurers. Health care is always changing and evolving, and I want us to keep evolving as well. How do you decompress after a long week? There’s a myth that it must be depressing to work in hospice care. On the contrary, the acts of love and caring we see daily is rejuvenating. Outside of work, I love to be outside, and spending time laughing with friends always reboots me. I love to travel, and if that involves getting to the beach, so much the better. If you could change one thing about Southern Nevada, what would it be? I would like to see an emphasis on collaboration. We don’t lack for outside-the-box thinkers in our community. Connecting people and ideas would be beneficial. What is your management style? I think the role of a good leader is to connect people to a common purpose. Having the right people in the right roles is key to an organization’s success. I think mistakes provide great learning. Giving people the tools they need to do their jobs well is important for success. Where’s your favorite place to explore in Las Vegas? I really like to visit new restaurants. There are so many great choices in the valley, it’s hard to pick one. My current favorites are Panevino and Vintner Grill. I love to see new shows as well.

SUMMER 2019

One of the terrific things about Las Vegas is there’s no shortage of shows and concerts. What is your dream job outside of your current field? Teaching. I was a teacher very early in my career and someday I’d like to do that again. If you could live anywhere else in the world, where would it be? Ireland. I have traveled there frequently and love the people, and the country is breathtaking. I have two favorite cities — Dublin and Killarney. I’m not sure I could choose which one to live in. Whom do you admire? My mentor and friend Carole Fisher is a woman I greatly admire. She hired me and her guidance allowed me to grow into the leader I am today. She is smart, compassionate and has great business instincts. She has taught me so much. What advice would you offer your younger self? Don’t place so much emphasis on trying to please everyone.

Rebecca Clifford-Cruz is research librarian at the Las Vegas Sun.

Karen Rubel photo by Adam White.

the n o te s

Criss Angel prepares to leave a handprint inside a new Criss Angel-themed patient exam room sponsored by the illusionist at Cure 4 The Kids Foundation.

Cure 4 The Kids Foundation unveiled a Criss Angel-themed patient room, sponsored by the Strip entertainer. The room draws inspiration from “Mindfreak,” Angel’s show at Planet Hollywood. Angel has been an advocate for those affected by pediatric cancer, including his 5-year-old son, who is now cancer free after a three-year battle with acute lymphoblastic leukemia. The Nevada Department of Agriculture Animal Disease Laboratory confirmed multiple positive rabies cases in bats in Nevada, including in Clark County. Rabies is common in bats throughout Nevada, and bat activity tends to increase between the months of May and October. Any bats, dead or alive, that may have been in contact with people or domestic animals should immediately be submitted to the Animal Disease Laboratory for testing and reported to county animal control and health authorities Contact the lab or your local animal control agency before attempting to pick up a bat. College of Southern Nevada received a three-year, $50,000 federal grant for counseling and psychological services. The services include mental health counseling for students and training for faculty on how to recognize early warning signs of distress in students. The grant is from the Substance Abuse and Mental Health Services Administration, a branch of the U.S. Department of Health and Human Services.

Criss Angel photo by Wade Vandervort.

Lyft Nevada donated $23,000 to Susan G. Komen Nevada. AMBUCS, formerly known as American Business Clubs, provided 17 customized tricycles for children who are unable to ride a traditional bike. Team Construction hosted the event where the tricycles were handed out and students from Touro University Nevada’s occupational therapy program volunteered. The Foundation for Recovery announced its 2019 Recovery Award Winners. Recipients of the Bob Gray Community Partner Award included: Cherie Hughes, Dignity Health – St. Rose Hospital, Women’s Care and Outreach Centers; Debbie Isaacs, Unshakeable.org and Levy Production Group; and Marilyn Kirkpatrick, Clark County Commission. Recipients of the Steve Sigman Recovery Awareness Award included: Rhonda Fairchild, There is No Hero in Heroin and Mission High School; Jackie and David Siegel, Westgate Resorts; and Lawrence Weekly, Clark County Commission. Recipients of the Excellence in Research and Education Award included: Brad Donohue, professor, Psychology Department and Director of Family Research and Services, UNLV, and editor, Journal of Child & Adolescent Substance Abuse. Recipients of the Robert Rehmar Addiction Professional Award included Christie Medina, HELP of Southern Nevada. The recipient of the Foundation for Recovery Brick Award was Heidi Gustafson, Foundation for Recovery, Advocate.

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THE NOTES

Terrence Thornton is executive director of Special Olympics Nevada.

William Caron is the director of the Veterans Affairs Southern Nevada Healthcare System.

The Camp Transformation Center, a national fitness center, opened Camp Las Vegas at 7885 W. Sahara Ave., Las Vegas. Adel Bazzi, Blanca Tinoco and Jose Amezcua will manage daily operations.

Silver State Home Health Care, Silver State Health, Pulmonology Group, McDonald Carano, R&R Healthcare Essentials, Nevada State Bank, LifeCare Specialty Pharmacy, Montevista Hospital, Desert Radiology and PharmaScript Ambulatory Infusion Center joined Las Vegas HEALS (Health, Education, Advocacy and Leadership for Southern Nevada).

THORNTON

Brittany McCoy is development officer at St. Jude’s Ranch for Children. HealtHIE Nevada is collaborating with the Nevada McCOY Hospital Association and Collective Medical to reduce avoidable hospital readmissions. In 2018, 15.6% of Nevada’s Medicare enrollees over age 65 were readmitted 30 days after hospital discharge, according to the United Health Foundation. HealthHIE Nevada and Collective Medical help health care organizations communicate and share records. Nigro Construction completed work on the Mountain’s Edge Hospital Orthopedic Surgery Center, a $7 million expansion project at Mountain’s Edge Hospital. The addition includes a surgical suite, five operating rooms, preoperative and recovery suites, and material management. New medical equipment for the center totals $4 million, bringing the overall value of the project to $11 million. Peyton Barsel, 16, and Jackson Bentham, 11, both of Las Vegas, were named Nevada’s top two youth volunteers of 2019 by the Prudential Spirit of Community Awards, a nationwide program honoring young people for outstanding acts of volunteerism. Barsel, a junior at The Meadows School, helps children who have been traumatized by the death of a parent or sibling through her work at Adam’s Place, a grief counseling center in Las Vegas. Bentham, a sixth-grader at Somerset Academy Lone Mountain, conducted a food and toiletry drive at his school to benefit service members returning from combat. He then held a raffle that raised funds to buy toilet paper for veterans in need. The Olympia Companies SH Charitable Foundation raised $1.3 million at its 19th Annual Governor’s Black-Tie Event at Southern Highlands Golf Club and M Resort. Money raised will support local charities including Boys and Girls Club of Southern Nevada, Candlelighters Childhood Cancer Foundation of Nevada, Nevada Childhood Cancer Foundation, Children’s Heart Foundation, Assistance League of Las Vegas, Opportunity Village, Andson, Discovery Children’s Museum and the Folded Flag Foundation. Attorney Adam Kutner donated $1,800 to Adam’s Place, a group for children, teens and families experiencing the loss of a loved one. Founded in 2009 by Kelly Thomas-Boyers, Adam’s Place was established in memory of Adam Gregory Thomas Kelly. Smith Plastic Surgery is open at 7650 W. Sahara Ave., Las Vegas.

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SUMMER 2019

Comprehensive Cancer Centers is an official partner of the Las Vegas Aviators, providing free sunscreen to fans during daytime baseball games throughout the season. Alexis Mussi is CEO of Southern Hills Hospital. MountainView Hospital was awarded an “A” from the Leapfrog Group’s spring 2019 Leapfrog Hospital MUSSI Safety Grade. This is the second “A” in a row that MountainView Hospital has received. The designation recognizes MountainView’s efforts in protecting patients from harm and meeting the nation’s highest patient safety standards. The Leapfrog Group is a national nonprofit organization committed to improving health care quality and safety for consumers and purchasers. Also, MountainView earned two distinguished three-star ratings from the Society of Thoracic Surgeons for its patient care and outcomes in isolated mitral valve repair and replacement procedures, and mitral valve repairs and replacements with coronary artery bypass graft procedures. The STS star rating system is one of the most sophisticated and highly regarded measures of quality in health care, rating the benchmarked outcomes of cardiothoracic surgery programs across the U.S. and Canada. MountainView Hospital received the American Heart Association/ American Stroke Association’s Get With The Guidelines Target: Stroke Honor Roll Elite Gold Plus Quality Achievement Award. The award recognizes the hospital’s commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence. Henderson Hospital was awarded a second consecutive “A” from the Leapfrog Group. The designation recognizes Henderson Hospital’s efforts in protecting patients from harm and meeting the highest safety standards in the United States. The Leapfrog Group is a national organization committed to improving health care quality and safety for consumers and purchasers. HealtHIE Nevada, a health information exchange, is partnering with RosettaHealth, a company that streamlines the process of sharing medical records. The Professional Fire Fighters of Nevada broke ground on a Nevada Fallen Firefighter Memorial at the Capital Complex in Carson City. Artist Austin Weishel was commissioned to construct the exhibit, which will include five life-size bronze firefighter statues surrounded by fire-emblazoned walls with the names of the fallen.

Thornton photo by Shannon Keene, 501 Studios.

YOUR CARE OF LITTLE ONES DESERVES IG RECOGNITION. BIG Southwest Medical proudly congratulates Dr. Blair Duddy on being recognized as one of Healthcare Quarterly’s 2019 Top Docs—and his dedication, every day, to patient-centered pediatric care.

Our pediatricians are committed to the families we serve, and we’re accepting new patients at locations valleywide.

Call 702.877.5199 to make an appointment today.

SMALV.COM

©2019 Southwest Medical Associates, Inc. All rights reserved. The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call 702.877.5199 TTY711. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 702.877.5199 TTY711. (Chinese), 702.877.5199 TTY711

THE NOTES

Sheila Hernandez is executive director of the Bridge at Paradise Valley, an assisted living community. March of Dimes’ NICU Family Support Program HERNANDEZ launched at UMC. Funded by UMC Foundation and a donation by Raising Cane’s, the program provides education and support to parents with babies in the neonatal intensive care unit. The UMC program will be managed by Ismael Martinez. Walker Furniture donated mattresses, foundations and mattress protectors to Firehouse Station 27 at 4695 Vegas Valley Drive and Firehouse Station 33 at 865 E. Desert Inn Road as part of the store’s “Project Firehouse: Rested and Ready” program. Rita Vaswani is on the UNLV School of Nursing Advisory Board. Vaswani is vice president, client relationship manager for Nevada State Bank and has more than two decades of banking experience with a strong background in health care.

VASWANI

Betty Dobbs-Funk is director of palliative care operations at Nathan Adelson Hospice. She will develop and manage the Elaine Wynn Palliative Care Program. Karla Perez joined the Nathan Adelson Hospice board of trustees. Perez is regional vice president of Universal Health Services; she oversees the operations of Spring Valley, Summerlin, Desert Springs, Valley, Centennial Hills and Henderson Hospital Medical Centers in Las Vegas, Desert View Hospital in Pahrump, and Northern Nevada Medical Center in Sparks. Clinicians on staff at Sunrise Hospital and Medical Center achieved a milestone recently by completing 500 transcatheter aortic valve replacements since beginning the TAVR program in 2012. Dr. Miriam Adelson received an honorary doctoral degree from Bar-Ilan University in Ramat Gan, Israel. She was recognized for her contributions to medicine, philanthropy and humanitarian activities. Poet’s Walk Henderson received a 2019 Employee Approved Award from NRC Health, a company that provides data for health care companies. The award recognizes 20 independent-living, assisted-living, or skilled-nursing organizations across the country for engaging and inspiring their employees. Winners were selected according to the results from NRC Health’s 2018 Employee Experience Survey. Nevada HAND, in partnership with Three Square Food Bank, opened a food pantry at the Rochelle Pines Apartment Homes at 4285 Hildebrand Lane, Las Vegas. The property is home to about 140 low-income senior residents. The food pantry will offer food provided by Three Square on a regular basis. There will be a pantry manager on site to support with healthy meal planning, nutrition assistance and other resources.

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SUMMER 2019

Impact Las Vegas, a Nevada nonprofit women’s collective giving organization in its sixth grant year, voted to award a $50,000 grant to Eye Care 4 Kids, which provides comprehensive vision care services to children in the Clark County School District at little to no charge. With the grant, the agency will be able to create the Patient Eyeglass Replacement Fund. Make-A-Wish Southern Nevada received $2,510 in donations from One Nevada Credit Union’s annual spring shred event. Blue Man Group Las Vegas raised $9,500 for Grant a Gift Autism Foundation at its fifth annual sensory-friendly benefit performance. The show was suitable for children and adults on the autism spectrum. Michael Patane is a certified physician assistant with Urology Specialists of Nevada, working at the practice’s 2010 Wellness Way location. The Roseman University of Health Sciences Bachelor of Science in Nursing program has been granted an initial five-year accreditation by the Commission on Collegiate Nursing Education. The Henderson campus has been accredited by the Accreditation Commission for Education in Nursing, formerly the National League of Nursing Accreditation Commission, since 2008. SR Construction completed the third-floor renovation at the Northern Nevada Medical Center in Sparks. The project consisted of a 17,475-square-foot improvement of the existing third floor in the hospital to include a pharmacy, five surgical recovery rooms, administrative support space and 16 private rooms. Marquis Care at Centennial Hills received the bronze “National Quality Award” from the American Health Care Association/National Center for Assisted Living. Helping Hands of Vegas Valley and James Seastrand Helping Hands of North Las Vegas have merged. The two agencies have combined office and warehouse space and will continue under the name Helping Hands of Vegas Valley. Their office is at 3640 N. Fifth St., Suite 130, North Las Vegas. Marcia Blake is executive director. Phil Ralston, president of American Nevada Company, joined the board of directors for the St. Baldrick’s Foundation, the largest private funder of childhood cancer research grants. Cure 4 The Kids Foundation launched a community advisory council to provide input and guidance on several aspects of the foundation’s operation. The first members of the council include Catherine Laska, Creecy Underwood and Shawn Nason. Laska is a founding board member of Cure 4 The Kids Foundation, parent of a childhood cancer survivor and an owner of StoryBook Homes. Underwood began her volunteer work with Cure 4 The Kids Foundation as venue events manager for the organization’s largest fundraiser, Circus Couture. Nason is the founder and CEO of the Nason Group.

Hernandez photo by David Smith; Vaswani photo by Greg Anderson Photography.

Las Vegas health care attorney Ayesha Mehdi of Frontier Health Law has been selected for the Leadership Development Program of the American Health Lawyers Association’s Fraud and Abuse Practice Group. She will help provide a forum for other attorneys who represent health care providers, facilities and businesses.

MEHDI

The College of Southern Nevada’s paramedic medicine students received training in the use of life-saving portable ultrasound technology, thanks to a grant from the Governor’s Office of Economic Development. The $315,000 Workforce Innovations for a New Nevada grant allows CSN to purchase the necessary ultrasound equipment, train faculty and paramedic students, and to partner with Valley Health Systems Graduate Medical Education program to jointly develop course curriculum and train emergency room physicians. Project Marilyn has launched in Southern Nevada. The nonprofit, formed by Wendi Schweigart and Nikki Blake Ferraro, provides monthly feminine hygiene products to homeless women and teens in need. Miracle Flights announced a record 8,618 free flights provided in its fiscal year ending April 30, up nearly 4 percent from last year’s previous record of 8,299 flights. The Las Vegas–based national nonprofit coordinates approximately 700 flights each month through commercial airline carriers to help critically ill children reach life-changing medical care far from home. Since its founding in 1985, Miracle Flights has provided 125,181 flights free of charge to families facing medical crises, covering more than 70 million nautical miles. Modern Healthcare magazine named Dr. Anthony Slonim, president and chief executive officer of Renown Health, as one of this year’s 50 Most Influential Clinical Executives in the nation. SLONIM Dr. David Cotter joined the staff of Las Vegas Dermatology, 653 N. Town Center Drive, Suite 414, Las Vegas. Dr. Doyle Huey practices medicine at Southwest Medical’s Oakey Health Care Center, 4750 W Oakey Blvd., where he specializes in pain management. Dr. Bryan Werner practices at Southwest Medical’s Tenaya Health Care Center, 2704 N Tenaya Way. He specializes in adult medicine. Dr. Olivia Yuson joins Southwest Medical’s Nellis Health Care Center, 420 N. Nellis Blvd., where she specializes in pediatrics. Southwest Medical, part of OptumCare, was recently announced as one of the winners at the 11th annual Intalere Healthcare Achievement Awards. The Southwest Medical Pharmacy & Home Medical Equipment division and its Pharmacy Transitions of Care Program were recognized in the category of Quality/Patient Care Delivery and/or Patient Satisfaction. Intalere is a health-care services company.

Mehdi photo by Melissa Haereiti, Timeweavers Photography; Slonim photo by Jamie Kingham.

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

30th annual Candlelighters Superhero 5K For more, visit CandlelightersNV.org Sept. 14 Registration begins at 7 a.m. Exploration Peak Park, Mountain’s Edge (9700 S. Buffalo Drive, 89178)

CENTENNIAL HILLS Hospital For more, visit CentennialHillsHospital.com Stroke Support Group Meets the second Tuesday of the month, 3 p.m. Conference Room 1 and 2 6900 N. Durango Drive Better Breathers Meets the second Tuesday of the month, noon 6900 N. Durango Drive

Desert Springs Hospital For more, visit DesertSpringsHospital.com Stroke Support Group Meets the first Saturday of the month, 10 a.m.–noon. Lunch provided. South Magna Conference Center 2075 E. Flamingo Road Cardiac Support Group June 20, 2 p.m. South Magna Conference Room 2075 E. Flamingo Road

mountainview Hospital Call 702-233-5300 to register at least 48 hours in advance. For more information, visit MountainView-Hospital.com Alzheimer’s Support Group Representatives from the Alzheimer’s Association lead this free support group that provides an opportunity for family, friends, caregivers and others to meet regularly. Meets the third Tuesday of every month, 10 a.m. H2U MountainView Office, Suite 114 3150 N. Tenaya Way Stroke Support Group Sept. 3, Oct. 1, Nov. 5, 2 p.m. Rehab Conference Room 3150 N. Tenaya Way

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Pre-Surgery Orthopedic and Spine Education Class For patients who are already scheduled for orthopedic and/or spine surgery at MountainView Hospital and who will be admitted to the hospital. If you will not be admitted to the hospital after your surgery, then this class is not recommended for you. Aug. 30, Sept. 13, Sept. 20, Sept. 27, Oct. 4, Oct. 11, Oct. 18, 9 a.m. 3150 N. Tenaya Way Aquamation — Eco-Friendly Alternative To Cremation Aquamation is an alternative to traditional flame-based cremation. It is offered by Kraft-Sussman Funeral & Cremation Services. Sept. 10, 1:30 p.m. H2U MountainView Office 3150 N. Tenaya Way, Suite 114 Lunch and Learn: ER vs. Urgent Care When you should utilize a CareNow Urgent Care clinic versus an Emergency Room. Sept. 19, noon H2U MountainView Office 3150 N. Tenaya Way, Suite 114

Southern Hills Hospital For more, visit SouthernHillsHospital.com Play Harmonica, Live a Healthy Llife Join Dr. Wilfred Krom as he teaches you different breathing techniques to help increase your lung capacity and oxygen storing capacity. Attendees must provide a 10-hole, diatonic harmonica, in the key of “C.” Aug. 21, 10 a.m. Education Room, First Floor 9300 W. Sunset Road What’s Best for Breast Learn the latest breast cancer information. Sept. 9, 6 p.m. Education Room, First Floor 9300 W. Sunset Road

SUMMER 2019

spring valley Hospital For more, visit SpringValleyHospital.com Cardiac Support Group Meets the fourth Tuesday of each month, 11 a.m. Lunch provided. Conference Room B 5400 S. Rainbow Blvd.

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 GV WomensCare/Outreach Center, Green Valley 2651 Paseo Verde Pkwy., Suite 180 HEND WomensCare/Outreach Center Rose de Lima Campus 98 E. Lake Mead Pkwy., Suite 301, Henderson MAC Siena Campus–MacDonald Room 3001 St. Rose Pkwy., Henderson RAN Rose de Lima Campus–Annex 102 E. Lake Mead Pkwy., Henderson RDL Rose de Lima Campus, Henderson 102 E. Lake Mead Pkwy., Henderson SAN San Martín Campus 8280 W. Warm Springs Rd., LV WEST WomensCare/Outreach Center 7220 S. Cimarron Rd., Suite 195, LV Support Groups For dates, times, and locations visit StRoseHospitals.org/classes or call 702-616-4900. • AA Co-ed • AA for Women • ALS Support • Alzheimer’s Support • Arthritis Support • Bereavement Support • Better Breathers COPD • Breast Cancer Support • Compulsive Eaters • Diabetes Support • Divorce Support • Fibromyalgia Friends • Gamblers Anonymous • Leukemia and Lymphoma Support • Multiple Sclerosis Support

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Prenatal Classes Baby Basics $ 30 GV Breastfeeding $ 30 GV Daddy Boot Camp $ 20 GV Gestational Diabetes Consultations Call 702-616-4975. Infant CPR $ 20 GV, WEST Prepared Childbirth $ 50 GV Smoking Cessation for Pregnancy 702-784-8669 Dragon Boat Paddling Paddle for fun and fitness. Open to beginner and experienced paddlers. Visit Meetup.com/LVDragonBoatClub. Lake Las Vegas Marina 10 Costa DiLago Enhance Fitness Exercise group program helps older adults at all levels of fitness become more active, energized, and empowered to sustain independence. Free. GV: Mondays, Wednesdays and Fridays, 9 a.m. GV: Mondays and Wednesdays, 10 a.m. GV: Tuesdays, Thursdays, and Fridays, 8 a.m. GV: Tuesdays, 2:30 p.m. WEST: Mondays, Wednesdays, and Fridays, 1 p.m. WEST: Tuesdays and Thursdays, 9 a.m. City of Henderson Heritage Park Senior Center: Mondays, Wednesdays, and Fridays, 8 a.m. Ageless Woman Workout: Osteoporosis Exercise Target aging zones with breathing and movements. $5 per session or five sessions for $20. GV: Tuesdays and Thursdays, 9 a.m.

Chronic Pain Self-Management Program This six-week chronic pain self-management program teaches techniques to overcome ongoing issues associated with chronic pain. Free. GV: Aug. 21-Sept. 25, 9-11:30 a.m.

Breast Cancer Empowerment/ Support Group Meets second Tuesday of the month, 6-7:30 p.m. Breast Care Center at Summerlin Hospital 657 N. Town Center Drive

Tea and Talk Book Club Call 702-616-4900 for monthly book titles. Free. GV: Sept. 19, 2:30 p.m.

Bladder Cancer Support Group Meets fourth Wednesday of the month, 6-7:30 p.m. Summerlin Hospital 657 N. Town Center Drive

Knit to Heal Prayer Shawls Learn to knit or crochet shawls for patients and loved ones (or pick one up for someone facing illness). Yarn donations appreciated. Free. GV: Aug. 22, Sept. 12, Sept. 26, 10 a.m. WEST: Thursdays, Aug. 22, Sept. 12, Sept. 26, 11:30 a.m. Love and Logic: Parenting Made Fun Learn helpful and easy tips so you can parent without breaking a sweat. $50 per individual/couple GV: Aug. 23 and 30; Sept. 6, 13 and 20, 3 p.m. Mommy and Baby Yoga For moms with babies ages 6 weeks to 1 year. $3 per class oreight sessions for $20. GV, WEST: Mondays, 3 p.m. Toddler Play Group Toddlers ages 3 and under join us for music and movement. Free. GV: Tuesdays, noon-12:45 p.m. WEST: Tuesdays, 3-4 p.m.

SUMMERLIN Hospital For more, visit SummerlinHospital.com Stroke Support Group Meets fourth Tuesday of the month, 3-4 p.m. Conference Room B 657 N. Town Center Drive Cardiac Support Group Meets third Wednesday of the month, 10 a.m. Classroom 1A 657 N. Town Center Drive

sunrise hospital Registration is required for all events. Call 702-233-5454 at least 48 hours in advance. For more, visit SunriseHospital.com Stop the Bleed Learn appropriate use of pressure, dressing and tourniquets. Registration required. Aug. 26, Sept. 23, Oct. 28, 6-8 p.m. Sunrise Hospital and Medical Center Auditorium, 3186 S. Maryland Parkway Sunrise Oncology nutrition Class Cancer survivors and their loved ones are invited to learn about healthy eating after being diagnosed with cancer. With Judy Reinhardt. Sept. 18, 6 p.m. The Breast Center at Sunrise Hospital 3006 S. Maryland Parkway, Suite 250

University Medical Center Register at 702-383-7353 or umcsn.com Fur Baby First Aid Do you want more information about how to keep your dog safe? Join us for this informational class. While this class will not issue an official Pet First Aid certification, it will provide you with valuable skills. Sept. 26, 6-7 p.m. The Healthy Living Institute at UMC 901 Rancho Lane, Suite 180 Stop the Bleed Learn appropriate use of pressure, dressing and tourniquets. Registration required. Oct. 9, 1 p.m.; Nov. 2, noon The Healthy Living Institute at UMC 901 Rancho Lane, Suite 180

SUMMER 2019

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Dr. Paul Lanfranchi is Board-Certiﬁed with a specialty certiﬁcation in Facial Plastic Surgery by the American Osteopathic Board of Otolaryngology – Head and Neck Surgery.

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