2020-02-27 - Health Care Quarterly (Vol. 27) - Winter 2020 by Greenspun Media Group

Honored to be headliners. Grateful to be life-changers.

Dr. Nilesh Gokal

Southwest Medical

Dr. K. Saad Jahangir

OptumCare Cancer Care

OptumCare® congratulates Dr. Gokal and Dr. Jahangir for being named Health Care Headliners. Their dedication, commitment, and unwavering focus on high quality care sets the standard for all of us who endeavor to put patients first.

©2020 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 877-370-2845. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 877-370-2845. (Chinese), 877-370-2845

The entire family of OptumCare medical providers is here for you. Every day.

Our team members work across multiple disciplines so you can live your most rewarding life. Throughout these many areas of specialty, there is one commonality: a focus on putting patients first. This is how a strong southern Nevada happens. Because a healthy community thrives with healthy people.

Compliments of:

Publisher Mark De Pooter (mark.depooter@gmgvegas .co m ) Associate Publisher KATIE DIXON (kat ie.dixon@gmgvegas .co m )

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ften when we hear “headliner” in this town, our thoughts instinctively go to the Strip. I’d like to challenge that reaction with a healthy alternative. We have headliners throughout our valley in operating rooms, on the streets and behind desks working every day to ensure a healthier tomorrow for our community. I am thrilled to share 10 of these headliners with you in this issue. Our 2020 Health Care Headliners are a diverse and impressive group of health care professionals you should know. They each offer something unique — such as establishing community health centers and connecting uninsured Nevadans to lifesaving health insurance, developing protocols to safely conduct eye surgeries in-office and leading cuttingedge clinical trials to one day cure cancer. They all have the same focus: Building a healthier Southern Nevada. One patient, one experience, one day at a time. We couldn’t be more excited to honor these headliners and are incredibly thankful to Mama Rabbit at Park MGM for hosting the prestigious awards ceremony. We need to continue this positive momentum and support efforts to build our available physician network. How do we do this? Graduate medical education. The Cleveland Clinic Lou Ruvo Center for Brain Health and the Sunrise Health Graduate Medical Education Consortium explain the value of these fellowship and residency opportunities to the introduction of future health professionals to our community. Those who learn here tend to practice here. In fact, 70% of physicians stay in the community where they completed their graduate medical education. Even with all of these great health care resources and providers, we want to encourage you to be the leader of your health care team. Health Care Quarterly is here to share the importance of preventive health

screenings, which ones you should consider and when you should consider them. And, we also reveal some eye-opening reasons you need to take a hard look at yourself. Our bodies have the ability to give us signs of things happening beneath the surface — if we only take the time to pay attention. One area you should never skimp on is your cardiovascular health. The newly opened Las Vegas Heart Associates wants to keep you educated and provide comprehensive care on all matters of the heart. These physicians are advocating for better heart health from the start. You can do a lot to manage cardiovascular risk factors by living a healthy, active lifestyle and having regular visits with your doctor. In addition to taking care of ourselves, we need to do what we can to help others, especially our youth. It’s heartbreaking how many children in our neighborhoods and in our schools don’t have the means to meet their daily nutritional needs, especially since proper nutrition plays a vital role in their growth and development. Fortunately, local nonprofits such as Serving Our Kids Foundation are working to fill this gap and fill the stomachs of these children. They’re also educating us along the way on the importance of food security in each and every home. You’ll find all of these stories and many more in this issue of Health Care Quarterly which wouldn’t be possible without our sponsors Comprehensive Cancer Centers and OptumCare. It is their generous support that allows us to provide this important information to you.

Jennifer Inaba Special Publications Manager & Editor jennifer.inaba@gmgvegas.com

Winter 2020

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omprehensive Cancer Centers is proud to sponsor the Vegas Inc Health Care Headliners program each year. For more than 40 years, Comprehensive has been treating patients in Southern Nevada. We have a strong commitment to provide the best care possible to patients in our community. Over the years, the practice has grown into a multispecialty practice offering medical oncology, hematology, radiation oncology, breast surgery, pulmonary services, cancer genetic counseling and clinical research to locals and the thousands of out-ofstate patients who travel to us for treatment each year. Comprehensive always looks for ways to enhance the patient experience by constantly recruiting the best providers, investing in technology, serving as a steward to the community, and offering the latest treatments and services so there is no reason to leave the state for treatment. Comprehensive has developed an extremely robust research program, which provides patients access to the latest advancements in cancer treatment right here in Southern Nevada. In fact, last year alone, Comprehensive was the first site in the world to open two new groundbreaking clinical trials, enrolling the first patients in the world on novel treatments. In total, the practice participates in more than 170 Phase I, Phase II and Phase III clinical research

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studies each year and has played a role in developing nearly 100 FDA-approved cancer therapies. Beyond the compassionate care we provide those with life-threatening illnesses, weâ&#x20AC;&#x2122;re continuing our proactive efforts throughout the community with one primary goal: To never have to see you in one of our clinics with a cancer-related condition. Among our community initiatives in 2020, our popular skin-safety campaign continues with partners including American Cancer Society, Clark County Parks and Recreation, Downtown Summerlin, Las Vegas Aviators, Vegas Golden Knights, RTC Southern Nevada and others, providing free sunscreen and sun-safety tips to their audiences. To all of the headliners, congratulations! We look forward to hearing the continued, positive headlines we make together as a medical community. And to our patients, we are constantly innovating on your behalf and are by your side, just as we have been through the decades. Sincerely,

Jon Bilstein CEO Comprehensive Cancer Centers

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ama Rabbit Bar at Park MGM would like to congratulate the 2020 Health Care Headliners for their outstanding contributions to the health care industry. We appreciate the achievements made in community outreach, education, innovation, nursing, dentistry, research and more, as each category signifies a strong commitment by the honoree to elevate health and wellness in Southern Nevada. To celebrate their accomplishments, we are excited to host a special awards ceremony at Las Vegas’ premier mezcal and tequila destination, Mama Rabbit. The venue is a true Oaxacan experience featuring modern Mexican cocktails, live entertainment, a pop-surrealist art installation from Okuda San Miguel and more than 500 labels of tequila and mezcal. The nightlife hotspot is divided into three distinct spaces with the focal point of a doublesided bar that features Mama Rabbit’s stunning spirits collection, an intimate lounge beneath a cavern-like brick vaulted colonnade and a taverna that features a robust lineup of entertainment that transitions the mood of the

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venue throughout the evening. Mama Rabbit’s tequila and mezcal collection features agave-based spirits that cannot be found anywhere else in the world. Highlights include the world’s first mezcal-barreled Blanco tequila, the first-of-its-kind mezcal aged in premium Mendocino pot still brandy casks and a centennial blend featuring 10 aged tequilas in one bottle – adding up to 100 years of age. Classic cocktails are infused with the spirits bringing out bold and defining flavors with each sip. Mama Rabbit is the ideal venue to enjoy a cocktail, mingle with friends or relax while enjoying live music. We look forward to welcoming all of our industry friends and colleagues to Mama Rabbit as we acknowledge this year’s Health Care Headliners. Again, congratulations to all honorees as we wish you continued success in your future endeavors. Sincerely,

Sean Christie President of Events and Nightlife MGM Resorts International

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Steinberg Diagnostic Medical Imaging is the first institution in the world to install Canon Medical Systems USA Inc.’s Cartesion Prime Digital PET/ CT system. The system was designed to help clinicians advance clinical insights and expert solutions to more efficiently and effectively determine the appropriate course of action for patients. The Cartesion Prime’s digital PET detector achieves time of flight resolution of less than 280 picoseconds, resulting in high-quality images for increased clinical and diagnostic confidence and productivity. The detector also provides an expanded field of view coverage for quick exams and a more comfortable patient experience.

Canon Medical Systems USA Inc.’s Cartesion Prime Digital PET/CT system

UNLV has introduced a new department dedicated to the research and science of brain health, including traumatic brain injury. TBI is sudden damage to the brain caused by a blow or jolt and is often caused by crashes, falls, and of particular interest to UNLV, athletic injuries. The department is led by chair Jefferson Kinney, who will focus on building an interdisciplinary group of researchers and community partners to study TBI. Kinney is collaborating with Cleveland Clinic Lou Ruvo Center for Brain Health and Indiana University to build on existing research efforts, including establishing biomarkers associated with TBI among mixed martial arts fighters and boxers. The department will also look at associations between TBI and neurogenerative disorders, such as Alzheimer’s disease, with the goal of improving diagnosis, recovery and treatment.

Four new clinical trials aim to advance the treatment, outcome and comfort of cancer patients

In partnership with the National Cancer Research Foundation, OptumCare Cancer Care is conducting four clinical trials to advance the treatment, outcome and comfort of cancer patients. The clinical trials include: DOM-INNATE, a multinational study for the treatment of oral mucositis in patients undergoing concomitant chemoradiation for squamous cell carcinoma of the head and neck; LocoMMotion, a standard of care study for relapsed refractory multiple myeloma; PREVAIL, an observational study to assess the prevalence of PD-L1 expression in the first treatment of locally advanced/unresectable or metastatic urothelial carcinoma; and RECOMM, a disease registry encompassing the care of patients with multiple myeloma taking the drug panobinostat.

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Elite Medical Center is the first and only clinic in Nevada to be accredited to administer Zulresso, a state-of-the-art medication for women with postpartum depression. Zulresso is the first medicine specifically approved by the U.S. Food and Drug Administration (FDA) to treat postpartum and can only be administered by trained professionals. Elite received its accreditation to administer Zulresso from the FDA and Sage Therapeutics, the biopharmaceutical company that developed the medicine. Patients in need of treatment are referred to Elite and are treated by physicians and nursing staff who have received specialized training in the infusion of the medication. Patients stay at Elite to receive the medication by continuous IV infusion and are under the supervision of trained health care providers for the entirety of the treatment.

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HIPAA concerns and negative online reviews by Ayesha Mehdi Vaping-related illness in 2020 by Dr. George S. Tu Hair dye and breast cancer by Dr. Pamela Kurtzhals Advanced technology reducing radiation by Vicki Thornhill Effectiveness of CBD for pain by Dr. Michael S. Laymon

How Nevada stacks up in America’s Health Rankings with Dr. Rhonda L. Randall

Health Care Headliners: Local medical professionals who ensure you receive the best care

Combating physician shortages with grad programs with Dr. Dylan Wint, Susan Farris and Ashley Kim

Las Vegas man first in the world on new clinical trial for lymphoma by Dr. Anthony V. Nguyen

Know your health risks by staying up to date on these key preventative health screenings

Filling a need for heart health education and care by Ashley Kim and Jennifer McDonnell

Proper nutrition can affect children for a lifetime by Patricia Farley

Elite Medical Center photo by Wade Vandervort/Staff

What’s happening on your body’s exterior can be a window to your internal health

W i nt e r 2 0 2 0

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Health care providers should consider HIPAA before responding to negative reviews

Attorney Ayesha Mehdi is a partner with Spencer Fane LLP and is part of the firm’s Health Care Practice Group.

Disclaimer: This article is for information and educational purposes only and does not constitute legal advice.

ho reads online reviews? Just about anyone who has access to the internet. Unfortunately, the obligation to protect patient privacy under the federal Health Insurance Portability and Accountability Act of 1996 (HIPAA), as well as state privacy laws, are disadvantages that health care practitioners face when confronted with negative comments. The HIPAA privacy regulations require health care providers and organizations, as well as their business associates, to develop and follow procedures that ensure the confidentiality and security of protected health information (PHI). And, no, patients do not waive their HIPAA rights by posting their information online. Failure to comply with HIPAA can result in civil and criminal penalties and adverse licensure action, as well as privacy lawsuits. The latest violation was posted Oct. 2, 2019, by the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services. A privately owned dental practice in Dallas agreed to pay $10,000 to the OCR and adopt a corrective action plan to settle potential violations of HIPAA. On June 5, 2016, OCR received a complaint from a patient alleging that the dental practice had responded to a social media review by disclosing the patient’s last name and details of the patient’s health condition. OCR’s investigation found that the dental practice had impermissibly disclosed the PHI of multiple patients in response to patient reviews on its Yelp page. Additionally, the dental practice did not have a policy and procedure regarding disclosures of PHI to ensure that its social media interactions protect the PHI of its patients or a notice of privacy practices that complied with the HIPAA privacy rule. The American Medical Association has voiced its concern about these online evaluations being merely misleading vents of disgruntled patients. Such comments may be purposely untrue and made by a competitor or former employee. Regardless, it is important to understand that even the

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best businesses get negative reviews, and well-intentioned negative reviews may reflect shortcomings that help businesses improve. That being said, what should be your next steps if you receive an unfair or false review? First, know that your patient wants to be heard. By ignoring the comment, you will only magnify their displeasure. The best practice is to have policies and procedures in place for HIPAA-compliant responses: One that avoids acknowledging that the patient is, in fact, your patient and one that invites the patient to connect with you offline. For example, you may respond by stating: “Thank you for your feedback. We are sorry to read this review. At [Name of Practice] we strive to provide exceptional patient care. Please contact us at [email or phone number].” You may then contact the patient directly and try to resolve the issue. If the patient does not agree to remove the review, you could request that they give you a HIPAA-compliant authorization to appropriately respond online. If that does not work, you can try contacting the website directly; however, know you still have to comply with HIPAA and cannot divulge any PHI. Second, if the review is false and you really want to pursue a defamation claim (a last resort given the legal expense and challenge to prove damages), it is advisable to contact an experienced attorney for guidance. This is because not all negative comments meet the definition of defamation. If the attorney determines that the statement is defamatory and you are within the statute of limitations, then a strong cease-and-desist letter can do wonders. The attorney should also send a letter to the website demanding that the defamatory comments be removed — just know that the Communications Decency Act of 1996 protects internet service providers from liability for third-party comments. The best way to combat negative online reviews is to be proactive and seek out positive reviews. The reality is that most negative reviews are left because the patient feels that you or the practice were not available to address their concerns.

Growing our team. Building up hope. OptumCare Breast Care recruits the top talent in breast care, and we are happy to welcome two new surgeons to our team.

Catherine O’Connor, M.D., F.A.C.S., is a board-certified breast surgeon with more than 25 years of experience. She has most recently served as a surgeon with Riverbend Medical Group in Springfield, MA, a multispecialty practice.

Pamela Kurtzhals, M.D., F.A.C.S., is a board-certified breast surgeon who was integral to the formation of the Scripps Breast Care Center in La Jolla and Rancho Bernardo, CA. She comes to us from Genesis Healthcare in San Diego.

We happily welcome Drs. O’Connor and Kurtzhals, and we invite you to learn more about the advancements we’re making in furthering breast care in southern Nevada. See us at optumcare.com/NVcancercare.

©2020 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 702-724-8787. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 702-724-8787. (Chinese), 702-724-8787

ith a new study or regulation seemingly every week, it’s hard to keep up with all of the vaping-related headlines. According to the World Health Organization, the global e-cigarette market is estimated to be worth $19.3 billion. But amid its meteoric rise and general promises of being a safer substitute to traditional cigarettes, what does vaping really mean for our health, and what do we know now?

The facts

George S. Tu, MD, FCCP, DABSM is a pulmonologist at Lung Center of Nevada, a division of Comprehensive Cancer Centers, specializing in the treatment of pulmonary diseases and sleep disorders. For more information on Comprehensive and the pulmonary division, call 702869-0855 or visit cccnevada.com/ pulmonary-andsleep-medicine.

Whether investigating a new treatment, dietary fad, medicine or anything in between, it can take some time to have concrete evidence on the longterm effects. While many of the longer-term repercussions are still to-be-determined, there are some concrete facts we know on vaping. The first and most important fact that will not change: The best thing to breathe in and out is clean air. Period. With that being said, people still may seek a cigarette alternative. According to the Centers for Disease Control and Prevention (CDC), as of Dec. 27, 2019, 2,561 vaping-related cases or deaths have been reported from all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands. In Southern Nevada, there have been six confirmed cases by the Southern Nevada Health District. The CDC recommends that people do not use THC-containing e-cigarette or vaping products, and it has recently identified vitamin E acetate as a particular concern.

Vaping and its effect on the body

Vaping has piqued the interest of many, and teens have become a particular concern, as, according to the 2019 National Youth Tobacco Survey, approximately 5 million U.S. middle and high school students use e-cigarettes regularly. For teen vapers (and parents with teens), it’s important to remember that the adolescent brain continues to develop until age 25. E-cigarettes contain chemicals that can alter young brains and, ac14

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cording to the American Lung Association, cause permanent lung damage. Particular chemicals of concern include formaldehyde, which is known to cause cancer, as well as acrolein, an agent used in weed killer that causes significant lung damage. Branching out to the entire population, e-cigarettes can irritate your throat, eyes and lungs, making you that much more susceptible to getting a cold or the flu.

Where we go from here

In my professional opinion, we need to start screening patients more regularly for what may be a vaping-related illness. Just as the “do you smoke?” question is asked in a regular health screening, it may be time to include the “do you vape?” question, particularly in patients who may be admitted for pneumonia, bronchitis or another lung-related condition. As vaping regulations advance and more information becomes present, I see vaping-related testing evolving and it being a possible focal point for physician training moving forward. Also, as more private spaces such as movie theaters crack down on e-cigarette usage, we’ll get more answers to the effects of secondhand “smoke” related to vaping. Based on the technology at hand, it is too early to forecast whether we’ll see a COPD or lung cancer epidemic as we saw during the height of cigarette usage. We will, however, see more and more individuals — particularly among the younger generation — with acute respiratory illnesses as a result of the regular inhalation of a foreign substance. When it comes to smoking and/or vaping, it’s never too early to quit. Among Comprehensive’s efforts throughout the community, the practice recently partnered with UNLV for the fourth year of its “I Quit For” anti-smoking campaign, with this year having a major anti-vaping message. There are campus-wide educational components as well as bins throughout UNLV’s campus to encourage folks to discard tobacco and vaping products. Until there is more concrete evidence related to the long-term effects of vaping, you can do your part as well — keep breathing fresh air and fresh air only.

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UMCSN.COM | CHNV.ORG

Pamela Kurtzhals, MD, FACS, is a breast surgeon with OptumCare Cancer Care.

recent study from researchers at the National Institutes of Health (NIH) published in the International Journal of Cancer links chemicals most often used in hair dyes and chemical hair straighteners to an increased risk of breast cancer in some high-risk women. The phrase “an increased risk” can often cause concern, so let’s take a closer look and put the results of the study into perspective. The study focused on hair dye and chemical hair straighteners that permanently or semi-permanently “relax” the hair. It followed 46,709 women, all part of the “Sister Study,” a National Institute of Environmental Health grouping of women whose sisters had been diagnosed with breast cancer. The study found there was an overall increased risk (9%) of breast cancer development in those who used any such hair product. The risk was much higher among African-American women. The study also noted that the risk of breast cancer was lower in women who permanently dyed their hair in a professional setting such as a salon. What is unanswered in the study are the types of chemicals in these products. What makes some possibly harmful? Which brands are the safest? The reality is that most women and many men have highlighted or treated their hair at some point in their life. There’s another important consideration in interpreting the results: The study analyzes association, not cause. The women in the study were already at a higher relative risk for breast cancer because of their family history. Researchers have been studying the possible link between various chemical substances and cancer for a long time, but results are not always consistent. This doesn’t mean the topic is not worth looking into further. Any increase in risk is important, but understanding the statistics helps put the matter into perspective. While it is too early to make a firm recommendation based on this

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study, thoughtful use of these and other substances is always a wise move. Studies have shown that risk for breast cancer is due to a combination of factors, including family health history. The importance is understanding what we can do personally to lessen further risks.

Take control

So, what can women do with information like this? There are many other breast cancer risks women can control and these risks are more strongly supported by research: n Not being physically active. Women who are not physically active have a higher risk. n Being overweight or obese after menopause. Older women who are overweight or obese have a higher risk than those at a normal weight. n Taking hormones. Some forms of hormone replacement therapy (those that include both estrogen and progesterone) taken during menopause can raise your risk when taken for more than five years. Some birth control pills also have been found to raise breast cancer risk. n Reproductive history. Having your first pregnancy after age 30, not breastfeeding and never having a full-term pregnancy can raise your risk. n Drinking alcohol. Studies show that a woman’s risk for breast cancer increases with the more alcohol she drinks. n Smoking. A 100% association to development of breast cancer, cigarettes are filled with toxins that accumulate in breast ducts.

Final thoughts

Some women will get breast cancer even without any other risk factors – at least any that they know of. Simply having a risk factor does not mean you will get breast cancer, and not all risk factors have the same result. Most women have some risk factors, but most women do not get breast cancer. If you have risk factors, be sure to talk with your doctor about ways you can lower your risk and if you should be screened for breast cancer. We must continue the fight for a cure.

INTRODUCING LAS VEGAS PAIN MANAGEMENT AND DR. MADUKA TO THE CLARK COUNTY COMMUNITY

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STOP THE PAIN! REQUEST HELP NOW! GET A SECOND OPINION! Call us at 702-880-4193 or visit lasvegaspaininstitutes.com

Advanced technology and software lead to decreased radiation exposure ecent changes in imaging technology, coupled with ultra-cautious radiology providers, have decreased radiation exposure significantly for patients undergoing imaging exams across the nation. At Desert Radiology, our team of expert health care providers utilize innovative software that ensures safe radiation dosing for all of our patients, and we reinforce those safety practices by participating in national programs that monitor exposure. Vicki Thornhill is the imaging facility manager and an AART-certified technologist in computed tomography, mammography and radiography for Desert Radiology.

The field of radiology uses X-rays, ultrasounds and magnetic resonance imaging (MRI) to produce images that help diagnose disease or injury. Radiation is expended when patients require an X-ray, CT (computed tomography) mammography, and/or fluoroscopy to assist health care providers with high-quality images to better understand certain diseases or diagnoses. A 2019 report from the National Council on Radiation Protection and Measurement states that radiation exposure has decreased 15-20% from 2006 to 2016, due to advanced technology and software used in imaging equipment such as CT. According to the World Health Organization, radiations are a natural part of our environment. Natural radioactive sources are in water, air and soil. We are also exposed to manmade sources of radiation produced by mining and power generation. These sources account for 80% of the radiation a person receives over their lifetime. Medical exposure accounts for the remaining 20%. Extensive radiation exposure can cause cell damage. We have little control over

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natural sources of radiation, that is why monitoring and decreasing the level of radiation given by medical procedures has become so important. The awareness and use of advanced software are key practices at Desert Radiology that help ensure safe exams. This year, Desert Radiology will install two Canon Prime SP 80 row detector CT scanners. The scanners are equipped with two dose reduction software packages: Sure Exposure with Sure KV and AIDR 3D. Sure Exposure with Sure KV monitors the patient size and the body part being imaged and adjusts the exposure accordingly, reducing the dose to the patient. AIDR 3D is an iterative reconstruction software that reduces image noise, allowing us to maintain image detail while decreasing the dose to the patient. Along with innovative software, my colleagues at Desert Radiology practice ALARA (as low as reasonably achievable), which is a safety principle designed to minimize radiation dosage. Practicing ALARA means our radiologists and technologists continue to ensure that patients will not be overexposed to radiation and that we are aware of the amount of radiation used during exams. This practice is reinforced by our participation in Image Wisely, a national joint task force that focuses on lowering the amount of radiation used in medically needed imaging exams and the elimination of unnecessary procedures. Our patients at Desert Radiology are our top priority throughout our 11 Southern Nevada imaging facilities. Serving the community for over 50 years, our physicians continue to evolve our practice to guarantee the highest quality and safest imaging exams.

Natural radioactive sources are in water, air and soil. We are also exposed to manmade sources of radiation produced by mining and power generation. These sources account for 80% of the radiation a person receives over their lifetime. Medical exposure accounts for the remaining 20%.

Winter 2020

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Michael S. Laymon, PT, DSc., is a board-certified orthopedic clinical specialist and ISCD certified clinical densitometrist, and currently serves as the interim associate dean and chief research officer for the College of Osteopathic Medicine and as professor and director of the School of Physical Therapy for the College of Health and Human Services at Touro University Nevada.

ain is one of the most common reasons why a patient seeks a doctor. With the advent of the opioid crisis and new regulations on prescription opioid medications, health care costs and the difficulty of getting an appointment to see a physician, many people are turning to alternative methods to treat their pain. Enter CBD, one of over 537 compounds found in hemp and marijuana. CBD is one of the non-psychoactive components that does not produce a high and has been promoted as alleviating pain as well as many other health ailments, such as muscle spasms, seizures, anxiety, PTSD, weight loss, diabetes, high blood pressure, depression, schizophrenia, multiple sclerosis, Parkinsonâ&#x20AC;&#x2122;s disease, migraines, ADHD and sleep disorders. So, is it a miracle cure or snake oil? True scientific research (randomized, double blinded, controlled clinical studies) and data related to CBD are sparse, and claims are usually based on anecdotal testimonials. Although some credible research has been done on CBD, it has been limited to treatment of two types of epilepsy. This research led to the only CBD-containing product approved by the Food and Drug Administration as the prescription drug Epidiolex. Unfortunately, many use this data to support their claims of effectiveness of CBD for other conditions. Despite claims that there are no adverse reactions to CBD, it does come with some inherent risks. Generally, it is well tolerated; however, it can cause dry mouth, diarrhea, drowsiness and fatigue. It can also interfere with prescription medications and, in the case of blood thinners, could have deadly consequences. The greatest concern is that CBD products are not regulated, tested or verified for claims by the Food and Drug Administration or United States Department of Agriculture. Each crop has different concentrations of components and has no tracking or reporting mech-

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anism if a crop has a contaminant. Unlike a lettuce crop that is contaminated with salmonella and is recalled, CBD products do not have that regulatory oversight, and it is possible the product you get has contaminants. Furthermore, there are no quality controls related to content. A study in the Journal of the American Medical Association identifies greater than 87% of vaporization liquid, 75% of tinctures and 55% of oils are mislabeled for CBD content. Investigation of locally obtained CBD products has shown that 40% are labeled with containing more or less CBD in the product than it actually has and that some products labeled as containing no THC (the psychoactive component of hemp and marijuana) have tested positive for up to 4% content. Preliminary research does hold promise and points to the potential of CBD to offer a safe alternative to treating pain. However, the dosage, uses and administrative route still need much research. If you are convinced CBD holds the key to your pain relief, I would suggest you first check with your physician or primary care provider to see if the product is safe for you. Second, pick a product that is full-spectrum CBD. This means it contains not just CBD but other phytochemicals and antioxidants found in the hemp plant. Recent studies show greater relief of pain with full-spectrum versus pure CBD alone. CBD alone tends to show a very narrow therapeutic dose range that varies from individual to individual. Too little has no effect; too much can give adverse effects, such as somnolence, diarrhea, dry mouth, fatigue and drowsiness. Third, ask if the specific product you want to try has an independent lab analysis that includes the amount of CBD and screening for pesticides and contaminants, such as mold. The product should have a lot or production batch number that is specific to that analysis. Finally, buy products from reputable manufacturers who have their products analyzed.

Congratulations to the 2020 Dentistry Healthcare Headliner, Dr. Amy Tongsiri

Making members shine, one smile at a timeTM www.libertydentalplan.com

TREMOR:

How to Shake the Shakes The Department of Neurosurgery invites you to a free seminar UCLA movement disorders neurosurgeons will discuss treatment options for the surgical management of tremor including deep brain stimulation and focused ultrasound.

Saturday, March 7, 2020 Registration: 9 – 9:30 am Presentation and Q&A: 9:30 am — Noon

Support provided by: Abbott, Medtronic, Boston Scientific and Insightec

Topics include:

Suncoast Hotel and Casino

• Coping strategies

9090 Alta Drive, Las Vegas, NV 89145

• Surgical therapies — deep brain stimulation (DBS)

RSVP

• Noninvasive treatments — focused radiation and ultrasound

Please register by Wednesday, March 4, 2020 310-571-5741 ucla.tremor@gmail.com

neurosurgery.ucla.edu

dbs.ucla.edu

Refreshments will be provided

UCLA2735 Tremor (Shake the Shakes) Ad - LV Healthcare Quarterly 1/2 pg Color Date

2.18.20

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Andrew Edelstein

nowing your risk for a particular health condition puts you in control. Armed with new knowledge, you can develop a plan, adjust your lifestyle and forge a healthier tomorrow. Preventive health screenings give you this power because, as they say, knowledge is power. So what exactly is a health screening? Screenings are tests that look for diseases before you even have symptoms. They can find conditions or risk factors early and allow you to effectively treat them before they become severe or untreatable. The best part? Many of these screenings are covered by most insurance plans at no cost to you. These tests are often quick and painless, and the results will not only increase your personal health knowledge but may warn you of conditions you would otherwise catch too late. All too often these life-saving screenings are not utilized by patients. Lung cancer, for example, is the leading cancer killer of Nevadans yet the Silver State ranked last in the U.S. for lung cancer screenings. The reason lung cancer is often so deadly is that it is diagnosed at a later stage, after the disease has spread. Early detection is the key to successfully combating this disease and lung cancer screenings can offer this advantage. Take a proactive approach with your health care and talk to your doctor about what health screenings you should have. It may save your life.

Recommended preventive health screenings for each stage of life Not every screening applies to every person, nor is this a comprehensive list. The tests you may need depend on your age, sex, family history and certain risk factors. Always communicate with your primary care physician to ensure you are being properly screened for any potential health risks.

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q Anemia q Autism Spectrum Disorder q Blood pressure q Body mass index q Critical congenital heart defect q Depression q Developmental Dyslipidemia q Head circumference q Hearing q Height and weight q HIV q Immunization vaccines q Lead q Maternal depression q Newborn blood q Newborn bilirubin q Oral health q Psychosocial/behavioral q Sexually transmitted infections q Tobacco, alcohol or drug use q Tuberculosis q Vision

❑ Colorectal cancer/colonoscopy ❑ Mammogram ❑ Osteoporosis/bone density ❑ Prostate cancer ❑ Lung cancer ❑ …in addition to screenings listed

❑ Blood pressure ❑ Body mass index ❑ Cholesterol ❑ Cervical cancer ❑ Dental ❑ Diabetes (blood glucose) ❑ Infectious disease (STDs) ❑ Pelvic exam and pap smear ❑ Skin cancer ❑ Testicular ❑ Vision

for those ages 18-39

❑ Hearing ❑ …in addition to

screenings listed for those ages 18-39 and 40-64

Medically reviewed by Dr. Neil Gokal, a family physician at Southwest Medical, part of OptumCare. WINTER 2020

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Weâ&#x20AC;&#x2122;ve all been told to keep an eye on suspect moles or sudden changes in weight, but what if there are other visual cues that tell us something about our internal health? Health Care Quarterly wanted to dig into this proposition to uncover some of the most common external manifestations of internal health problems. Some of these may not be a surprise but others may shock you. The take away? Next time you pass by a mirror, take a good look at yourself. Pay attention to subtle changes that could be a warning sign of something serious. To be clear, not every rash, spot or bump means a dangerous disease is lurking. You know your body best. Be aware. And when in doubt, it is always best to have your doctor check it out.

Loss of eyelashes or eyebrows could be sign of alopecia areata, an autoimmune condition that attacks the hair follicles Dry and thinning hair may be a sign of an underactive or overactive thyroid

Brittle hair can be a sign of Cushingâ&#x20AC;&#x2122;s syndrome or too much cortisol

Hair that is looking dull can be due to lack of healthy fats, such as omega-3 fatty acids

Thinning eyebrows can be a sign of hypothyroidism Shedding hair could be a sign of low iron or anemia

Gray hairs can be attributed to chronic stress (also age and genes)

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Hair loss may indicate a protein deficiency

Winter 2020

Super dry eyes with saggy eyelids, a side effect from constantly rubbing, could indicate seasonal allergies Drooping eyelids could be a sign of myasthenia gravis, which makes the immune system attack and weaken muscles

White spots on the cornea could be a sign of corneal infection

A yellowish patch or bump on the whites of the eyes, to the side of the iris, could be a sign of too much sun

Inflamed, red and swollen eyes could be sign of lupus

A gray-white ring around the iris can be an indication of high cholesterol and triglycerides, which may mean an increased risk of heart attack or stroke (particularly if under 40)

A bulging of the eye is often a visual symptom of Gravesâ&#x20AC;&#x2122; disease or when the thyroid is releasing too many hormones

Eye bags and puffiness could be hypothyroidism and sleep apnea

Blood spots in eyes are common with high blood pressure or diabetes

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Getting shorter is a silent sign of osteoporosis

Sudden weight gain or loss could be a thyroid disorder

Yellow nails most often signify fungal infections, but could be a sign of something more serious, such as thyroid disease, lung disease, diabetes or psoriasis

Nail clubbing, when the fingers enlarge and nails curve around fingertips, most often signifies cardiovascular or pulmonary disease and less commonly inflammatory bowel disease and cirrhosis

White spots on the nails could be symptomatic of heart disease, kidney disease, liver disease or protein and vitamin deficiencies

Cracked, split, dry and brittle nails are often linked to thyroid disease or iron deficiency

Swollen knuckles could reveal high cholesterol

Clammy hands may be a sign of menopause, thyroid condition or hyperhidrosis (overactive sweat glands)

Nails that are very pale in color could be sign of anemia, congestive heart failure, liver disease or malnutrition

Swelling in feet and legs is often a symptom of heart disease (edema)

Abnormal and uncomfortable bloating can be a sign of ovarian cancer

Easy bruising could be a symptom of low blood platelet count and leukemia Unexplained weight loss could be a symptom of a serious illness, including cancer or diabetes

Unexplained lump, bump or swelling can be cancerous, especially when itâ&#x20AC;&#x2122;s large, hard, painless to the touch and if it appeared spontaneously A swollen toe can be an early symptom of gout and signal additional risk for chronic diseases, such as high blood pressure and kidney disease

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No half-moons in nails shows anemia, malnutrition or depression

A rippled or pitted nail surface could be an early indicator of psoriasis or inflammatory arthritis

Ridges in nails could be a sign of iron deficiency anemia (horizontal) or kidney disease (vertical)

Dark or black lines under the nail could be caused by melanoma, the most dangerous type of skin cancer, or it could be a sign of psoriasis or endocarditis (an infection of the inner lining of the heart chambers and heart valves) Nails blue in color or tint could mean the body is not getting enough oxygen or there is a lung problem, such as emphysema, or possible heart problems Peeling nails are a common sign of iron deficiency

Lack of toenail growth can be a sign of peripheral artery disease

A butterfly-shaped rash across the face could be rosacea or contact dermatitis, but sometimes is a sign of lupus A purple rash on the lower legs can signify a hepatitis C infection

Very dry, itchy skin could be a hormonal issue, such as low thyroid function

Itchy clusters of red bumps on the skin could indicate celiac disease

Darkening of the skin, mostly visible in scars and skin folds or joints like elbows and knees, could be a sign of hormonal disease, such as Addison’s disease, which affects the adrenal glands Yellow bumps on arms, legs or rear could be the result of high triglyceride levels, signaling uncontrolled diabetes

Wrinkles are primarily a sign of aging, but there is also a link between wrinkles and osteoporosis/ bone health

Yellowing of skin may signal liver failure Paleness could be a sign of anemia Thickening of skin on the shin could be a sign of high blood pressure and kidney problems

A pimple that won’t go away or heal could be basal cell carcinoma, the most common form of skin cancer

Dark skin patches or velvety plaques, usually with a color slightly darker than the skin tone, in the neck or armpit suggest diabetes (referred to as acanthosis nigricans) Acne distribution patterns for women along the lower face or jaw line and excess hair growth can be a sign of polycystic ovarian syndrome

Severely cracked, dry lips are sometimes symptomatic of an allergy or infection, and cracking in the corners of the mouth may be a sign of Sjögren’s syndrome, an immune system disorder that attacks glands that make tears and saliva

Moles can signal the presence of skin cancer (look for: asymmetrical, irregular border, color variance, larger than 6 mm or changing/evolving)

Medically reviewed by Dr. Neil Gokal, a family physician at Southwest Medical, part of OptumCare.

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Now in its 14th year,

Vegas Incâ&#x20AC;&#x2122;s Health Care Headliners honors doctors, nurses, administrators and other medical professionals who are working to ensure the best health care can be found right here in Southern Nevada. These 10 headliners are leading the way â&#x20AC;&#x201D; and making a major impact in the health of our community as they forge their path.

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Lifetime Achievement Ilona Van Boven

Physician Dr. Peter W. DeBry

Education Dr. Nilesh Neil Gokal

Research/Science Dr. K. Saad Jahangir

Manager/Administrator Heather Korbulic

Community Outreach Ryan Linden

Innovation Shaina Meyer

Nursing Dina Patel

Emergency Services Samuel Scheller

Dentistry Dr. Amy Tongsiri

WINTER 2020

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â&#x20AC;&#x153;... interpersonal skills are so important to me. I want to look people in the eye, hear their voice, convey a tone that is heartfelt and allows them to know that I care.â&#x20AC;?

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P h o t o b y Wa d e Va n d e r v o r t / S t a f f

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Silver State Health Insurance Exchange/Nevada Health Link Years in health care: 14

Steinberg Diagnostic Medical Imaging Years in health care: 48 You were one of Steinberg’s first employees almost 40 years ago. What has kept you there all these years? I love the Steinberg family and what they stand for. They have made patient care the No. 1 priority. They understand the importance of being available to take care of patients and allow all employees to support patients in any way needed – holding someone’s hand when frightened, hugging them when scared or lending a shoulder to cry on. What made you apply for that first position as an X-ray technician? Fate, a concert and two strangers. I was out one night a concert and met two girls. We started chatting about what I was going to do after college. They were both so excited about going to X-ray school and said I should join them. The next day I told my dad and interviewed with the school. Those girls dropped out, but here I am today still working in radiology. How have the technology and the services offered advanced over the years? The changes in the technology within the modalities have gone from handdeveloping films in a dark room, to using cassettes, to everything being digital. I’ve seen mammography go from analog to 3-D. I’ve had the opportunity to witness the install of one of the very first CTs and MRIs in the country. Today, we still consistently install the newest equipment available. I’ve seen the need for procedures like upper GIs be reduced thanks to the advances of CT. And the reduction in radiation used every year is astounding. We are more radiation conscious now than ever. Why is it important to you to develop a personal connection with patients? As a child, I watched how my mother interacted with people. She was always smiling at strangers and saying hello. I saw how people reacted to her kindness and how it made her feel. I wanted to have that same connection to people. Because of that, interpersonal skills are so important to me. I want to look people in the eye, hear their voice, convey a tone that is heartfelt and allows them to know that I care. Digital connections have their place, but nothing beats a personal connection. I believe there is more goodness in the world than anything else and I simply like people.

How did you first get involved in the health care field? I started working in health care as the business manager for a home health company. We primarily served seniors who needed extra help to remain in their homes. I took that experience and began a career with the state of Nevada, where I was a long-term care ombudsman working with people who live in assisted living and nursing home settings. In 2015, I started with Nevada Health Link. What would you say are some of the most important health care priorities for Southern Nevada? Southern Nevada has an incredible opportunity to reduce duplication of efforts and break through silos to better coordinate care, grow a professional workforce, and connect Nevadans to resources that can educate, support and improve health outcomes. What are your biggest challenges as a health care administrator? Health care is complicated. Navigating a disjointed and confusing system can be challenging for anyone; running a state agency within that system is equally complex. I spend a lot of time meeting with other health care groups and organizations to understand their work. I take from their best practices and align our strategies and priorities whenever possible. How have you worked to increase the number of insured Nevadans? We spend every single day working to connect uninsured Nevadans to insurance. Whether that’s through traditional advertising, grassroots outreach, or through engaging with community organizations, we are laser-focused C o u r t e s y p h o t o on finding and connecting Nevadans to the comprehensive plans sold through Nevada Health Link. What is the most rewarding part of your job? Learning about a life that has been saved because of an individual’s access to comprehensive health insurance makes every hard moment worth it.

Winter 2020

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Dina Patel with youth leaders from her HealthySunrise Youth Leadership program.

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Did you always know you wanted to be a nurse? As far as I can remember, I’ve always wanted to be a nurse and only wanted to work with children. It felt like my purpose. Once I graduated nursing school, I started working in the neonatal intensive care unit (NICU) and completely fell in love with working with babies and the families. What is your favorite part of working with children? Children have a resilient energy that is limitless, courageous and creative. How has your work on mother-to-child HIV transmission directly affected Southern Nevada residents? Through the Nevada Care Program from 2013-17, any HIV-positive pregnant women enrolled into our program had a baby that was not HIV-infected. We didn’t run a clinic, but a treatment-as-prevention program. If we can eliminate maternal-to-child HIV transmission, we can eventually eliminate HIV. Imagine a world where no more babies are born with HIV – that’s how we can work toward an AIDS-free generation.

“As far as I can remember, I’ve always wanted to be a nurse and only wanted to work with children. It felt like my purpose.”

P h o t o b y Wa d e Va n d e r v o r t / S t a f f

In 2013, you co-founded the HealthySunrise Foundation. What is the primary focus of this nonprofit? Our mission is to improve birth outcomes through enhanced maternal-child health programs. Our focus is to remain in the service of humanity, enhance the well-being of women and children by supporting health, orphans, pregnancy and educational (HOPE) programs. Recently, you started the HealthySunrise Youth Leadership Program in Las Vegas. Tell us about this initiative. I was fortunate enough to be surrounded by great mentors, such as Dr. Echezona Ezeanolue, who co-founded HealthySunrise, and Elena Ledoux who I co-founded MommyGO & MatchaGO with. Both of these inspirational individuals gave me their shoulders to stand on, provided me with sight to see further and to dream past my limitations. The SUN Initiative provides the same type of base for young generations to stand on. The HSF goal is to develop our young leaders, teach them to lead with strength, unity and nobility (SUN) across the globe for generations to come.

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HealthySunrise Foundation, President Years in health care: 13

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Cleveland Clinic Lou Ruvo Center for Brain Health Years in health care: 8 What attracted you to the field of rehabilitation services? I knew I couldn’t go wrong having a career with the mission of helping people be as independent as possible and live life to the fullest. How would you describe your approach to health care and working with patients? As an occupational therapist, my approach to health care is very holistic. When evaluating a new patient, I always begin and end with questions aimed at bringing out the individual’s goals. There is nothing more imperative than understanding what is most important to the patient. What are some of the programs you have spearheaded at Lou Ruvo and how have they affected the patients in Southern Nevada? With therapy being a skilled service, I encourage sites around the community to think outside the world of reimbursement and get creative with additional methods to encourage people to socialize and be physically active. In the last year, we worked with the Nevada Goes Fall Free Coalition to add Tai Ji Quan: Moving for Better Balance, an evidence-based community program that reduces risk of multiple falls and fear of falling. A couple of years ago, we created a new style of exercise class for people that have difficulty following complex, specific commands. This essential class is co-instructed by a physical therapist and music therapist and the goal is to socially engage, have fun and be active. What excites you the most about advancements in the rehabilitation field of health care? The recent shift from volume-based care to value-based care. Although this shift may pose unique problems to the industry, this is an opportunity for health care providers to consider new ways to improve the quality of care, address chronic conditions that may have been overlooked in the past, and ultimately address clients’ individual health priorities.

NV Eye Surgery Years in health care: 20 At what age did you recognize you wanted to be an ophthalmologist? During medical school, I knew I wanted a subspecialty that was procedure based. I spent time shadowing doctors and doing rotations, and found that ophthalmology resonated with me. I enjoyed the hightech aspects of the work and the detail of the microscopic procedures. I also felt like my personality fit in with the other doctors in that specialty. What excites you the most about advancements in eye surgery? Looking back over the last 15 years, it is amazing how much ophthalmology has changed. One of my interests is the development of protocols and procedures for doing eye surgery in an office-based surgery suite. We are one of the leading practices in the country for these surgeries. We are able to save patients money by having the option of surgery in the office setting. I believe we are the first clinic in the country to do many glaucoma procedures and even a partial cornea transplant in-office. The future of eye surgery will be doing more procedures in the office, and we are on the leading edge of that trend. Is there a particular surgery or patient experience that will always stay with you? I remember doing a glaucoma surgery on a young girl in high school that had juvenile glaucoma, which is very rare. She did great with the surgery. Her eye pressures were perfectly normal and the surgery gave her a 100% cure from her condition. It was a memorable moment to realize that my training and surgical techniques had saved her vision and given her the gift of sight for the rest of her life. How does your work with the Lions Sight Foundation affect our community? I have worked closely with the Lions Club since my residency because they have a specific focus for vision-related community service in their charter. I would never want a patient to lose their vision due to an inability to pay, so we see a few free patients every day and do a free surgery every week or two. I’ve probably done over 200 free cataract surgeries over the past five years.

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P h o t o b y C h r i s t o p h e r D e Va r g a s / S t a f f

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â&#x20AC;&#x153;I would never want a patient to lose their vision due to an inability to pay, so we see a few free patients every day and do a free surgery every week or two.â&#x20AC;?

P h o t o b y Wa d e Va n d e r v o r t / S t a f f

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Southwest Medical , part of OptumCare Years in health care: 10 In addition to your director role, you are also a family medicine practitioner. What made you choose this specialty? As a child, I often felt the arduous challenge of having immigrant parents with limited resources doing the best they could for their children â&#x20AC;&#x201C; especially for my oldest sister, who has suffered from developmental disabilities since birth. While she endured several surgeries as a child, I still remember the spirit of one of her orthopedic surgeons whose heart for medicine was overwhelming. I knew then that it was my chosen career and, amidst my clinical training, was privileged to work with esteemed physicians in northern New Jersey whose rapport and energy with patients solidified my love for family medicine.

â&#x20AC;&#x153;The opportunity to build relationships with compassion and trust is a beautiful thing, and it happens to be my job.â&#x20AC;?

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H E A LT H C A R E H E A D L I N E R S

What is your primary focus in your role as medical director of clinical education? As medical director of education, I have the privilege of combining my passions for teaching and providing health care. I am responsible for overseeing several joint ventures between Touro University, UNLV, Roseman University and our very own family medicine residency program within Optum to guide and impact the training of excellent future clinicians. What is most rewarding for you when working with medical students? Students continuously inspire me with their fervor and determination. I vividly remember the mentors in my life that have contributed to my happiness and I am so humbled to have the opportunity to be a part of someone elseâ&#x20AC;&#x2122;s journey. How do you hope your work is changing the future of Southern Nevada health care? What we do every day is impacting our community in a very large way. As an organization, we are committed to performing with excellence from the ground up. We arenâ&#x20AC;&#x2122;t just recruiting more clinicians to help care for our growing population; we are directly involved in the training and education of these providers from the start. What is your favorite part of your job? The people. I get to spend my day working with people â&#x20AC;&#x201D; learning about them and learning from them, talking, laughing, sometimes even crying. The opportunity to build relationships with compassion and trust is a beautiful thing, and it happens to be my job. What is your personal motto when it comes to living a healthful life? Kindness is always free, always an option, always a choice.

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â&#x20AC;&#x153;Being a part of statewide health initiatives and innovative solutions to our unique health concerns makes me feel connected to the patients we treat.â&#x20AC;?

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P h o t o b y C h r i s t o p h e r D e Va r g a s / S t a f f

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OptumCare Cancer Care Years in health care: 14

Silver State Health Years in health care: 7 Why is it important to you to be a part of making Las Vegas a healthier community? Community health centers like Silver State Health focus on providing high-quality care to all Las Vegas residents, regardless of their insurance, legal status or ability to pay. Being a part of statewide health initiatives and innovative solutions to our unique health concerns makes me feel connected to the patients we treat. How does your work directly affect patients and residents of the valley? I always tout the slogan “for Nevadans, by Nevadans.” Our services are designed to be impactful for the most underserved members of our community and are delivered in an accessible manner for those with unique daily challenges. How would you say your political science and business background has helped you in your role? My background in medical administration and business has allowed me to take basic principles learned in the for-profit realm and utilize them leading a nonprofit business model. My political science education has proved invaluable in navigating the local and statewide collaborative efforts of the organization. Because we receive considerable funding from the federal government and other local grant opportunities, having knowledge and background in some of the inner workings of the government has made for a smooth transition into the government funded sphere. What is a program Silver State offers that you are most proud to provide to the community? We are one of the primary grantees for the Antiterrorism and Emergency Assistance Program, which provides funding to support those affected in the Route 91 shooting. We continue to be one of the leading bilingual mental health agencies in the state. As such, we’ve been granted funds to address those experiencing trauma from the event who speak Spanish. We’re providing trauma-based group therapy, individual therapy, psychiatric and primary care services for those affected. It’s really great to be a part of the healing process for an event that touched everyone in Las Vegas.

Did you always know the area of medicine you wanted to specialize in? I always wanted to be an architect, but our life experiences shape our lives and our future goals. Unfortunately, my mother was diagnosed with pancreatic cancer and many other family members were diagnosed with the devastating disease. This diagnosis completely changed our lives. I come from a family of doctors and it was very interesting to witness that even doctors did not fully grasp the complexity of this diagnosis and struggled with mixed emotions of loss of a loved one. I quickly realized that despite our scientific advancements, only 3% of our aging population was represented in clinical trials. It was a natural progression for me to adopt a career in geriatric oncology. Why are clinical trials important to the advancement of medicine? In medicine, it’s the clinical trials that provide access to the latest cutting-edge technology to create novel opportunities to cure disease processes. We are committed to conduct studies for cancer prevention, symptom management and improve survivorship in all cancer patients, making sure that data is of highest quality and in compliance with the regulatory requirements. How has your work changed the lives of Southern Nevadans? My work has only begun. Unfortunately, health care in Las Vegas is very fragmented. Patients often find themselves running from clinic to clinic to gain access to their treatments. While this paradigm may work for other specialties, it is definitely not sustainable for weak, elderly and debilitated cancer patients who are often at the margin of financial bankruptP h o t o b y S t ev e M a r c u s / S t a f f cy. We have therefore created a 55,000 square-foot cancer center in the heart of Las Vegas where our patients have access to most of their treatments. What excites you the most about the advancements in health care? With current technology, we are able to target the mechanisms that drive malignancy and we are able to harness a patient’s own immune system to fight cancer. What really excites me is that this is just the beginning; we have just scratched the surface of scientific exploration in myriad intricacies of tumor genesis. Winter 2020

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Guardian Elite Medical Services Years in health care: 14 What drew you to a career in emergency medicine? I always wanted to be a police officer. When I graduated high school, I was not old enough to become a cop, so I decided to become an EMT to get experience with emergency calls for service. Fourteen years later, I am still in EMS. What has kept you working in EMS for so long? I like how it is never the same day twice. I like how I can come to work and teach one day, work on an ambulance the next, cover a large special event, and then participate in meetings that grow the profession. It is always something different. Why did you decide to start your own company? I was working for a private ambulance company and thought I could provide a better service to the community. By opening up Guardian Elite Medical Services, we have put more ambulances on the streets of Las Vegas and have reduced the time it takes for an ambulance to get on scene. What are some of the unique services you provide for the community? We provide classes in EMT, AEMT, CPR, First Aid and Wilderness First Aid. It is important to provide these services because someone who takes these courses might be in the right place at the right time when someone has a medical issue. By providing training, I can help ensure that loved ones see another day. What are some of the organizations you are involved with in the community? I started with the Lee Canyon Ski Patrol in 2004 and find it important to volunteer in the skiing community. I have been a ski patroller longer than I have been an EMT! I also sit on the advisory board for Veterans Tribute Career and Technical Academy, where I ensure that the interests of their EMT program are met. Lastly, I sit on the Medical Advisory Board, QA/QI committee and the Drug and Device Committee with the Southern Nevada Health District, where we make recommendations on new procedures for EMS providers in the valley. 40

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Liberty Dental Plan Years in health care: 11 Why did you choose a career in dentistry? My mother was a nurse and always encouraged me to join the health care field. She taught me to care for people from the inside out. As I went to dental visits, I become more intrigued by the profession. Now, I love seeing my patients every six months and hearing about their lives and families. What do you remember from your first day with patients? It was a combination of emotions: Scary, exciting, overwhelming, intimidating, proud and not productive! In your mind, you plan for an amazing full day of patients and donâ&#x20AC;&#x2122;t account for no-shows, people running late, equipment malfunctions, staffing hiccups and procedures going not quite as you planned. At the end of the day, I knew my staff had tried their hardest and that my patients were happy. The experience was humbling. What is it like for you to return to UNLV to teach at the School of Dental Medicine? At first it was difficult because I related more to the students than to the faculty. As time progressed, I transitioned more to faculty and understanding why it was so important to get the students to learn as much as they could while they were in school. I love teaching and working with students because they are so vibrant and tireless. Do you have any goals for your new role as dental director? I was born and raised in Nevada, so it is my passion to improve oral health care for this state. Liberty Dental Plan is here to help Nevada improve our health care ranking nationally, as well as being an industry leader in health care. P h o t o s b y C h r i s t o p h e r D e Va r g a s / S t a f f

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A winner of the Alfred Murdock Teaching Award and the Anthony F. Coppola Clinical Excellence Award, Dr. Gokal has engaged in research projects at Overlook Medical Center in Summit, N.J., Glaucoma Institute Beverly Hills in West Hollywood, Calif. and the Alzheimer Disease Research Center–USC in Los Angeles. Dr. Gokal received a degree in biomedical (biochemical) engineering at the University of Southern California. He attained his medical degree from St. George’s University in Grenada, West Indies, and completed his residency with Atlantic Health Systems in New Jersey and a global health track with Mount Sinai Medical Center in New York City.

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r. Nilesh “Neil” Gokal is the medical director of clinical education for Southwest Medical, part of OptumCare, as well as a family medicine practitioner. He also is an adjunct clinical faculty member for the UNLV School of Medicine and is pending affiliation with Roseman University.

r. K. Saad Jahangir is the director of oncology clinical trials and oncology breast cancer clinical trials for OptumCare Cancer Care in Las Vegas. He is passionate about geriatric and palliative care and believes in a holistic approach that focuses on body, mind and soul working in sync to yield the best therapeutic outcomes to ensure a high quality of life for his patients and their families. Dr. Jahangir is board-certified in oncology and internal medicine, and completed his residency in internal medicine at the University of Nevada, Reno School of Medicine. He was chief fellow of the hematology and oncology fellowship program at Louisiana State University School of Medicine in New Orleans, La., and fulfilled his fellowship in geriatrics at Maimonides Medical Center in Brooklyn, N.Y. He completed an internship in general surgery at the State University of New York at Syracuse, and he attended medical school at Ross University School of Medicine in Miramar, Fla. Dr. Jahangir is fluent in Urdu and Punjabi, and his interests include painting and sketching, and sports such as cricket, tennis, skiing and horseback riding.

Dr. Gokal speaks several languages, including Spanish and Gujarati. In his personal time, he enjoys music, including piano and guitar, traveling and baking, as well as competing in local triathlons.

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Dr. Rhonda L. Randall, D.O., senior medical adviser to the United Health Foundation and the America’s Health Rankings platform

ince 1990, the United Health Foundation has helped create awareness of how states and the nation are faring across a wide range of public health measures through its platform America’s Health Rankings. During the past 30 years, the understanding and science of public health have changed dramatically. Many health issues that were a concern in 1990 remain so today, and additional issues have arisen that require action now. Dr. Rhonda L. Randall, D.O., senior medical adviser to the United Health Foundation and the America’s Health Rankings platform, talks about findings from the 2019 annual report and how Nevada fares nationally. Tell us about your background, how your career has evolved and about your primary duties in your current role? I’m a fellowship-trained geriatrician and boardcertified in family practice, hospice and palliative medicine. Currently, I’m chief medical officer of UnitedHealthcare Employer & Individual, which serves the health coverage and well-being needs of nearly 28 million Americans. I collaborate with U.S. employers who are looking for quality, cost-effective, long-term solutions to health benefits for their employees and retirees. I also lead the clinical strategy development for these businesses to improve quality outcomes, ensure affordability and improve health and well-being. Additionally, I support UnitedHealth Group’s clinical strategy through my work in the corporate office of Medical Affairs and as a senior medical adviser to the United Health Foundation and the America’s Health Rankings platform.

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What is the mission of your organization? America’s Health Rankings builds on the United Health Foundation’s work to help draw attention to the cornerstones of public health and better understand the health of various populations. The mission is to provide a wide variety of health and health-related information to help policymakers, advocates and individuals understand a population’s health in a holistic, inclusive manner. What is the purpose and methodology behind the foundation’s annual report? The model and measures used in the annual report have advanced as our understanding of public health has evolved. Today, measures cover health behaviors, community and environment, policy, clinical care and outcomes data, drawing from 19 publicly available data sources. The current model reflects a greater understanding of how broader determinants, such as education, air pollution and the supply of mental health providers, impact our overall health. The United Health Foundation provides actionable insights in this report, along with the online database of more than 160 measures. America’s Health Rankings will continue to provide an evolving state and national snapshot to inform and drive action to build healthier communities. As the country continues to make progress and different health challenges arise, the report will lead important public health discussions and spark action. Based on the report, what are Nevada’s biggest strengths, challenges and overall highlights? Nevada’s strengths include a low prevalence of obesity, high HPV immunization coverage among adolescent males, and a low percentage of children in poverty. Nevada is challenged in areas related

to its high violent crime rate, low rate of primary care physicians and high cardiovascular death rate. Nevada has enjoyed a 36% increase in dentists since 2003 and a 10% increase in immunizations among toddlers since 2012, but also a 46% increase in chlamydia since 2009 and a 20% increase in adult diabetes since 2012. Nevada has one of the highest death rates due to cardiovascular deaths. What can be done on a state level to curb those numbers? Interventions to reduce the burden of cardiovascular disease should focus on improving access to quality health care and addressing risk factors such as unhealthy diet, physical inactivity, obesity and diabetes. The state has seen a continued drop of infectious diseases the past few years. What initiatives are in place on a local and national level to keep infectious diseases on the decline? Nevada has one of the lowest rates of

infectious disease in the country. Immunization is a cost-effective prevention method. Childhood vaccine programs in particular prevent millions of cases of disease and reduce health care costs. The Centers for Disease Control and Prevention tracks these and other infectious diseases through the National Notifiable Diseases Surveillance System. Monitoring infectious diseases helps identify, control and prevent outbreaks. In addition, careful surveillance can prevent the re-emergence of old diseases in addition to new infectious threats. What can state leaders do to improve the overall health of residents? We encourage policymakers, health officials and community leaders to engage in meaningful dialogue about the data we provide. The insights from this year’s report can and should encourage even greater cross-stakeholder collaboration and drive action in improving the lives of Americans and the health of their communities.

Nevada is the 35th-healthiest state in the nation, which is up one spot from 2018. Since the inaugural report in 1990, Nevada has improved 10 spots but ranks lower compared with its neighboring states.

Utah

California

Idaho

Oregon

Arizona

Nevada

If you had the power to change one thing in our health care system, what would it be? There should be a greater focus on health care prevention strategies such as immunizations and screenings. We can see that in the states that are ranked higher in the annual report, individuals are generally making better choices around their own health, and their communities are making strides to be more physically active, smoke less, finish high school and maintain healthy weight. Prioritizing these issues sets you up for a lifetime of better health. Once preventable illnesses start to manifest themselves, the cost associated with diseases like diabetes, heart disease and renal failure come with an emotional and financial burden on the individuals, their communities, the states and the nation. We end up in a bigger problem than we can solve, and most cases were preventable if we would have intervened earlier. What is the best professional advice you’ve received? One of the physicians who trained me early on would tell us every day to “do good things.” I know it sounds simple and it’s probably akin to the oath we take to do no harm, but it’s a not-too-overcomplicated mantra that I keep top of mind. Anything else you want to tell us? America’s Health Rankings is more than just a report. It has developed detailed analyses on the health of key populations in the country, including seniors, women and children, and those who have served in the U.S. Armed Forces. One of the key takeaways from the platform is to understand just how local health is. There is no “one size fits all” approach to improving the health of our communities. Community and environment, individuals’ access to care, as well as the engagement of public health officials and local officials, all play roles in building healthier communities. The United Health Foundation is proud to lead this effort through America’s Health Rankings, providing insights for healthier communities. To learn more about America’s Health Rankings, visit AmericasHealthRankings.org.

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Combating physician shortages: The importance of graduate education

can play into part of the solution.” Given that 70% of physicians practice medicine within the community where they completed their GME, the most efficient way to bring top-tier talent to Southern Nevada is to offer high-demand medical education programs.

Cleveland Clinic Lou Ruvo Center for Brain Health

Fellowships provide advanced training within a subspecialty, allowing physicians to become leaders and experts within a niche area of medicine. Lou Ruvo Center for Brain Health has seen the return on investment in its GME proraduate medical education program, with three fellowship graduates staying grams are the key to attracting to practice in Las Vegas, allowing our commuand keeping preeminent physinity to have dramatically increased access to cians right here in Southern Nephysicians with expertise in neurodegeneravada. These medical internships, residencies tive disorders. and subspecialty fellowships The center offers a felloware low across the board in ship in behavior neurology and Nevada, putting the state’s neuropsychiatry (BNNP) and a residents at risk of needless clinical neuropsychology postsuffering in their search for a doctoral fellowship. health care provider. The neuropsychology fellowThis is crucial to not only ship develops the necessary the Las Vegas community, specialized knowledge and but the entire state. Nevada is skills to accurately diagnose ranked 47th in the country for disorders of cognition. This felthe number of physicians per lowship has a strong research capita. The national average component that continually is 307 physicians per every advances knowledge in this 100,000 people; however, field. The neuropsychology Nevada has 218 physicians per fellowship boasts four graduevery 100,000 people. ates and a current fellow, Dr. The Cleveland Clinic Sharlene Jeffers. Lou Ruvo Center for Brain The BNNP fellowship proHealth and the Sunrise gram trains neurologists and Health Graduate Medical psychiatrists to prevent, detect Education (GME) Consortium and treat disorders of cognition are working to combat this and behavior, and their comDr. Maureen Strohm crisis through expanding the plications. To date, the center Sunrise Health GME number and types of graduhas had three BNNP fellows. Consortium family medicine ate education opportunities Dr. Aaron Ritter, who graduresidency program director available. ated in 2016, is now director of “This isn’t a problem we clinical trials at the center. Dr. see just in Nevada; it’s a national problem,” Adrienne Pan (2018) provides dementia care says Dr. Maureen Strohm, Sunrise Health at Southwest Medical, part of OptumCare. GME Consortium family medicine residency And Dr. Amanda Fletcher will complete her program director. “New data shows that by fellowship in June. Dr. Fernando Mendez, 2030, there may be a shortage of 50,000 to the next fellow, has committed to remaining 120,000 physicians. However, Nevada shows Story continued on page 48 opportunity for demonstrated growth that

“

Contributions for this article were made by Dylan Wint, MD, above, director of education and Susan Farris, top, M.Ed, program manager, both with Cleveland Clinic Lou Ruvo Center for Brain Health and Ashley Kim, marketing coordinator with MountainView Hospital.

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“This isn’t a problem we see just in Nevada; it’s a national problem. New data shows that by 2030, there may be a shortage of 50,000 to 120,000 physicians. However, Nevada shows opportunity for demonstrated growth that can play into part of the solution.”

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Attending physician Dr. Michael Lundberg spends time teaching in the ER with Sunrise Health GME Consortium residents Dr. Jacob Schwab and Dr. Darryl McFarland. (Courtesy)

Story continued from page 46 in Las Vegas after he completes his training in 2021. Today, Cleveland Clinic Lou Ruvo Center for Brain Health fellows have completed about 5,000 hours of intense training, and will soon recruit for a newly approved fellowship in multiple sclerosis starting in 2021. The center also supports many other medical and teaching institutions in their education efforts and has hosted residents from across the valley in neurology, internal medicine and family medicine, providing 5,400 hours of clinical training to date.

Sunrise Health GME Consortium

Founded in 2015, and ushering in its inaugural class in 2016, the Sunrise Health GME Consortium encompasses internal medicine, family medicine, general surgery, emergency medicine, OB-GYN, physical medicine and

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rehabilitation, transitional year, anesthesiology and psychiatry, with more on the way. Additionally, the consortium welcomed the inaugural classes of the endocrinology, diabetes and metabolism fellowship, and gastroenterology fellowship programs in 2019. “Since the consortium was founded in 2015, we have grown to accommodate a total of 179 residents and five fellows throughout 10 residency programs and two fellowship programs,” says Dr. Kartika Shetty, Sunrise Health GME Consortium internal medicine program director. “We are very proud to have seen six classes graduate to continue their trainings or begin their careers as highly qualified practitioners.” The Sunrise Health GME Consortium is a member of the Sunrise Health System consisting of MountainView Hospital, Southern Hills Hospital, Sunrise Hospital and Sunrise Children’s Hospital, as well as several surgery, diagnostic imaging, urgent care centers and

outpatient physician clinics, offering a range of specialized and technologically advanced services.

What GME means to the community

“MountainView Hospital, Southern Hills Hospital, Sunrise Hospital and Sunrise Children’s Hospital are now recognized as teaching hospitals in Las Vegas and throughout the country,” says Jeremy Bradshaw, MountainView Hospital CEO. “Teaching hospitals raise the bar on patient care and physician training, which ultimately is beneficial for the overall quality and patient experience.” Not only do these GME programs bode well for Southern Nevada’s future health landscape, those patients who attend these teaching hospitals and clinics benefit from exposure to elite-level care now. “A teaching hospital, in general, provides a better health care experience, and the outcome is better compared to a non-teaching hospital,” said Dr. Se Won Lee, Sunrise Health GME Consortium physical medicine and rehabilitation residency program director. “Patients are expected to meet more doctors, or a team of doctors including resident physicians, attending supervisors and medical students, during each visit or stay. Therefore, each patient has more opportunities to discuss his or her health issues and be monitored by multiple doctors. The team approach and discussion is one of the most important factors to improve outcome. At a teaching hospital, there are more opportunities to receive advanced treatment options, as the teaching hospital is engaged more in clinical research to improve health care outcome.” GME is expensive, time-consuming and requires support of the government, philanthropy, practicing physicians and those who believe in their right to quality health care. These programs are collectively establishing Las Vegas as a destination for quality medical care now and in the future.

hysicians have among the most rigorous and demanding education and training requirements of any profession. Students enter medical school typically with a bachelor’s degree (BS or BA). Medical school takes four years to complete, followed by specialty training in a residency program that usually lasts between three and seven years. Thus, the entire education may last between 11 and 15 years after high school. A few medical schools offer combined undergraduate and medical school programs that last six to eight years. While the years spent in medical school are known as undergraduate medical education, the time during residency is known Wolfgang Gilliar, as graduate medical education. Currently D.O., FAAPMR is there are nearly 120,000 medical stuthe dean and chief academic officer of dents in the United States, an increase of the College of Os52% since the 2002-03 academic year. teopathic Medicine Medical schools continue to be highly at Touro University competitive. Most applicants must subNevada. mit transcripts reflecting the student’s major and minor choice of study and courses taken during the undergraduate program, as well as the scores from the Medical College Admission Test (MCAT), along with letters of recommendation. Schools also take into account an applicant’s maturity and personality, demonstrated leadership qualities, and prior participation in extracurricular activities. Many schools require applicants to participate in an on-campus interview with members of the admissions committee and active faculty. What is interesting to note, and this is unique to the United States, is that there are two pathways to becoming a doctor in medicine: one is the course of study that leads to the M.D. degree (medical doctor) and the other is the D.O. degree (doctor of osteopathic medicine). There are currently 22,000 M.D. students and 8,000 D.O. students in their first year in nearly 160 M.D. schools in the U.S. and Canada; and 36 accredited colleges of osteopathic medicine in 33 states that grant the D.O. degree. Starting in 2020, there is one single accreditation system for medical students graduating from M.D. or D.O. programs to enter specialty training in a residency of their choice. Both M.D. and D.O. designations equate to fully licensed physicians who provide the complete range of medical services to the population. There are many common practices among the two professional groups, and while there are differences in approach and emphasis, the common goal is to assure and contribute to the best well-being of a healthy society. Winter 2020

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Dr. Anthony V. Nguyen is a medical oncologist and hematologist with Comprehensive Cancer Centers of Nevada, specializing in aerodigestive tumors, lung cancer, gastrointestinal cancer, integrative oncology and benign/malignant hematology. For more information on Comprehensive, call 702-952-3350 or visit www. cccnevada.com.

as Vegas local Fred Warnick is a man of many titles: A retired engineer, jokester, husband, father of six and grandfather to 10. He is also the first patient in the world on a new lymphoma clinical trial, happening right here in Southern Nevada at Comprehensive Cancer Centers. In June 2019, Fred, 73, went to a local urgent care center complaining of bloating and severe pain in his abdomen and legs. He was diagnosed with stage IV mantle cell lymphoma, a rare form of non-Hodgkin’s lymphoma. A potentially aggressive type if left untreated, mantle cell lymphoma affects the lymphocytes, a specific type of white blood cell. Lymphocytes are found in the lymph nodes, which are small glands in the neck, groin and armpits. The disease was in Fred’s chest, abdomen, and pelvis, and had spread to his kidneys. Traditional treatment includes strong chemotherapy and a bone marrow transplant, requiring hospitalization for a month or longer. But there was another option available: A brand-new drug trial at Comprehensive for non-Hodgkin’s lymphoma. The trial is a combination of the drugs Zanubrutinib and Rituximab, aimed at patients over age 70 who may not be able to withstand other treatments, such as chemotherapy, or a transplant. Zanubrutinib was recently approved by the U.S. Food and Drug Administration (FDA) for adult patients who had previously undergone one form of treatment. Fred’s immunotherapy, or targeted therapy, includes four pills a day of Zanubrutinib to stop the growth of cancer cells, and every 28 days, he receives Rituximab intravenously, which helps the immune system destroy cancer cells. As he has undergone treatment, Fred’s smile and jokes have returned, filling our office with laughter and positivity during every visit.

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Comprehensive, which is currently conducting more than 170 total Phase I, Phase II and Phase III drug trials each year, is the first in the world to activate the trial. To date, the practice has played a role in developing more than 85 FDA-approved cancer therapies. Fred’s landmark treatment marked the second time that Comprehensive offered a first-in-the-world trial for a local patient within the same year. Local clinical trials ultimately equate to better access to care and fewer Southern Neva-

Dr. Anthony V. Nguyen discusses a treatment plan with lymphoma patient Fred Warnick at Comprehensive Cancer Centers of Nevada in Henderson in December. (Wade Vandervort/Staff)

dans needing to travel out of state for life-extending treatment. Participants also receive costly drugs free of charge. The trials give more options to patients facing lifechanging decisions. It also gives them more hope. Since beginning treatment in August, Fred has experienced minimal adverse effects and excellent therapeutic benefit compared with the routine treatment. All of his tumors have shrunk, including one under his arm that has completely disappeared. He has regularly gained weight, something that can be

difficult to near-impossible for cancer patients, especially of his age. In early 2020, Fred finished his sixth and final treatment of Rituximab. Given his progress, heâ&#x20AC;&#x2122;ll continue his Zanubrutinib regimen indefinitely. With an infectiously positive attitude and the help of a groundbreaking clinical trial right here in Las Vegas, Fred has faced impossible odds and come out stronger. A true success, his story will serve as a beacon of light and hope for so many others who may find themselves enduring a similar path.

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Community need for heart health education and services leads to opening of Las Vegas Heart Associates

Ashley Kim, top, is the marketing coordinator and Jennifer McDonnell, above, is the director of public relations & communications for MountainView Hospital.

o you know the signs of a heart attack? Nearly half of Americans don’t, according to a recent study published in the JAMA Network Open, a medical journal published by the American Medical Association. “What this study shows is that people are unsure of what the signs of heart attack are, and in turn, they delay their care, resulting in worse short-and long-term outcomes,” said Dr. Jeffrey Levisman, board-certified interventional cardiologist, chief of cardiology and a physician with Las Vegas Heart Associates, affiliated with MountainView Hospital. The results varied among socioeconomic, ethnicity, income and education, the researchers found. “Bottom line, we need to make sure the message gets out about the signs of a heart attack and the right response,” Dr. Levisman said. So what are the symptoms of a heart attack and what should you do if you or someone you are with is suffering from a heart attack? Heart attack symptoms can vary from person to person, and from men to women, but in general heart attack symptoms involve: n Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. n Upper body discomfort in one or both arms, the back, jaw or stomach. n Shortness of breath may occur with or before chest discomfort. n Other signs include nausea, vomiting, fainting, light-headedness or breaking out in a cold sweat. In women, symptoms may also include indiges-

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tion or gas-like pain, or a heartburn sensation. Women may also experience unexplained weakness or fatigue. To help patients achieve their best heart health, MountainView Hospital recently embarked on a new model to deliver care with Las Vegas Heart Associates, a cardiology practice employing six cardiologists affiliated with the hospital. The clinic is part of the larger Las Vegas Heart Institute, which includes the MountainView Cardiovascular & Thoracic Surgery Associates and the hospital’s outpatient cardiac rehab program. While common in other states, physician employment and hospital-owned clinics are rare in Nevada. “By employing a group of cardiologists, we will be able to continue to raise the bar of the quality of care that is delivered to our heart patients, at every stage of their care,” said Jeremy Bradshaw, MountainView CEO. Las Vegas Heart Associates offers comprehensive patient management using the latest techniques, equipment and procedures. “We hope that by breaking the mold of how we deliver care, we will exceed the quality of that care we provide to patients,” Dr. Levisman said. “Our goal at Las Vegas Heart Associates is to provide patients access to the most comprehensive and total care, working with our team to achieve the very best outcomes.” Among the areas of specialty, the practice will cover cardiology, interventional cardiology, sports cardiology (adult), heart failure and will provide in-office echo testing. The cardiology program at MountainView will continue to be an “open” model, meaning affiliated community physicians will still practice at MountainView and will continue to be an integral part of the patient care continuum. The Las Vegas Heart Associates physicians believe it is not too late to start taking control of your heart health. “First and foremost, adhering to a healthy diet reduces long-term cardiovascular risk,” said Dr. Shadi Daoud, Las Vegas Heart Associates cardiovascular disease specialist. “A heart healthy diet consists of generous consumption of vegetables, fruits, legumes, nuts, whole grains and fish. Saturated fats, high sodium/high cholesterol foods, as well as processed meats and sweetened beverages, should be minimized.” Consuming a diet low in sodium, around 2,000 mg per day, helps prevent high blood pressure, also known as hypertension, which reduces overall cardiovascular risk. Story continued on page 54

In women, symptoms may also include indigestion or gas-like pain or a heartburn sensation. They may also experience unexplained weakness or fatigue.

Most heart attacks involve discomfort in the center of the chest that often lasts more than a few minutes or may come and go.

Upper body discomfort in one or both arms, the back, jaw or stomach.

Nausea, vomiting, fainting, lightheadedness or breaking out in a cold sweat.

Shortness of breath may occur with or before chest discomfort.

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Story continued from page 52 Pictured from left: Mountainview Hospital cardiologists Shadi N. Daoud, MD; Alfred Danielian, MD; Jeffrey M. Levisman, MD; Anthony P. Dota, MD; Ronny Jiji, MD; Jonathan Rhee, MD, stand in the new Las Vegas Heart Associates clinic. (Courtesy)

“Secondly, regular physical activity reduces cardiovascular risk,” Dr. Anthony Dota, Las Vegas Heart Associates interventional cardiologist, said. “Exercising on a regular basis improves blood pressure, blood glucose and cardiovascular conditioning.” A nutritious diet and consistent physical activity can aid weight loss and maintenance of a healthy weight, leading to a higher quality of life of increased energy levels, better circulation and improvement in other conditions, such as cholesterol and diabetes. Additionally, cardiovascular risk factors, such as high blood pressure, and overall wellness go hand in hand. “Regular visits with your doctor can help with screening for risk factors so they can be appropriately addressed,” Dr. Alfred Danielian, Las Vegas Heart Associates cardiovascular disease specialist, said. “Many of the cardiac risk factors carry no symptoms, and routine checks can help identify problems before they lead to heart disease.” “Along with regular visits with your doctor, I encourage visits to your dentist and good oral

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hygiene practices, as gum disease is a source of chronic inflammation and is associated with high blood pressure,” said Dr. Ronny Jiji, Las Vegas Heart Associates cardiovascular disease specialist. Good sleep habits also can pave the way to a healthy heart, as poor-quality sleep or inadequate sleep hours can contribute to high blood pressure, diabetes and weight gain. “Adults need 7-9 hours of sleep at night,” Dr. Jonathan Rhee, Las Vegas Heart Associate interventional cardiologist, said. “Snoring and excessive daytime fatigue can be symptoms of sleep apnea, a condition that causes low oxygen during sleep. Sleep apnea has been linked to high blood pressure, congestive heart failure, increased risk of stroke and heart rhythm disorders.” As you age, it is important to not only see your primary care physician regularly, but also to establish yourself with a cardiologist. Cardiologists can counsel patients on the risks of heart disease, how to prevent it and how to live your best life with a healthy heart. If you think you or someone you know may be having a heart attack, call 911. Taking a private car can delay treatment.

Be the leader of your heart health care team

By Daniel Heller

Daniel Heller, Pharm D, is the health & wellness pharmacist for Smith’s Food & Drug Stores.

eart disease is the leading cause of death for men and women in the United States. Our body relies on the heart to make it go. When the pumping action of our heart is compromised or when the blood the heart is pumping to the rest of the body can’t get through, problems will arise. There are many forms of heart disease, which have various causes. Coronary artery disease (CAD) is one form in which making healthy lifestyle choices can have a big impact. In people with CAD, plaque builds up in the arteries around the heart, blocking blood from reaching its destination. If enough blockage occurs, this could bring on a heart attack or stroke. Regardless of whether you have been diagnosed with CAD or are trying to prevent the disease, you should know your risk factors and how changes in lifestyle can reduce your risk. Unfortunately, some risk factors cannot be changed. Those are age, family history and gender. The older we get, the higher our risk. In fact, once you turn 65, your age is considered a risk factor. If a parent or sibling had a heart attack or stroke before the age 65, you are at higher risk of CAD. As for gender, men have higher CAD risk than women at an earlier age, but once women have gone through menopause, they generally catch up with similar risk as men. There are other risk factors that we can control: diabetes, high blood pressure, high cholesterol, being overweight, being inactive and nicotine use. The single best thing a person can do for good health is quit smoking if they are a

current tobacco user. Use services like our state’s free tobacco quit line at 1-800-QUITNOW to get assistance with quitting. Over time, high blood pressure will damage blood vessels, leading to more risk of blockage. Controlling this at an early age will lessen your CAD risk. Read up on the DASH diet for great lifestyle ideas for controlling blood pressure without the need for medication. High cholesterol over time will most likely lead to a buildup of plaque in blood vessels, so a diet lower in cholesterol and saturated fat will decrease that risk. If you’re diabetic, controlling blood sugars will make a big impact on lowering CAD risk. Over the past 20 years working in pharmacy, I saw many patients lower their risk, and even require less medication, by reaching a healthier weight. Knowing how many calories you are putting into your body on a daily basis, along with getting a minimum of 150 minutes of physical activity per week, will help lower your risk. Begin to empower yourself through knowledge. Understand what a good lab result is and make sure to see your results. Ask questions if you do not understand the numbers. Then, set goals and begin to make reasonable changes that will improve your numbers. Smith’s Pharmacies offer resources to help, including OptUP, a smartphone application that scores grocery purchase history on national dietary guidelines and makes personalized product recommendations for better nutritional choices. Wellness Your Way is a program that offers personalized health care support and nutritional advice, as ways to lead you in a healthy direction. Do all you can to know your numbers, learn all you can about your risk and how to live a healthier lifestyle, and strive to be the No. 1 provider on your health care team.

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Feeding the children: Importance of proper nutrition

Patricia Farley is chairwoman of the board of Serving Our Kids Foundation and vice president and vice chair of Children’s Advocacy Alliance.

ood security — access at all times to enough food for an active, healthy life — provides an important foundation for nutrition and health. Unfortunately, not everyone, and particularly children, has enough food to eat. Sadly, hunger is a serious issue in our country and community. While having access to enough food is one struggle, the stark reality is that more and more children are meeting the definition of “chronically hungry” in Nevada. This should be a top concern to all those in charge of public funds and services. Chronic hunger is defined as having access to minimal food some of the time. According to the United States Department of Agriculture (USDA), an estimated 11.1% of U.S. households were “food insecure” at least some time during the year in 2018. In Nevada, 12.2% struggle with food insecurity. This means everyone in the house lacks access — at times — to enough food for an active, healthy life, and limited or uncertain availability of nutritionally adequate foods. This also reflects times when parents and caregivers sometimes make trade-offs in order to pay for essential basic needs, such as housing, medical care and nutritional food items. Additionally, some U.S. households with children relied on a few kinds of low-cost food to feed children because they were running out of money for food, affirmed they cut the size of children’s meals because there was not enough money for food, and had children skip meals. Some also reported that children had not eaten for a whole day at some time in the past year because there was not enough money for food. In Nevada, a 2019 study by Feeding America reported that in 2017, 365,160 people struggled with hunger, and 136,800 of them were children, with the majority in Southern Nevada. While what we eat can affect all of us, children

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are among the most vulnerable. The nutritional content of their diets affects not only their current health but also their physical, mental and social development — and thus, their future health and well-being, the USDA’s Economic Service Reports finds. Without enough food — and importantly, nutritional food — these kids are more likely to have adverse outcomes compared with children in food-secure homes. While some more recent studies have indicated a decrease in overall food insecurity, some subpopulations continue to be at a higher risk for child food insecurity and related problems. Rates of food insecurity among children in households headed by single mothers and for households headed by African-American, non-Hispanic adults in 2018 were more than twice the national rate. In recognizing the overall food insecurity problem, the government and nonprofit groups have developed various programs to provide food and/or nutritional assistance to those at-risk. Government programs such as the Supplemental Nutrition Assistance Program (SNAP, formerly food stamps) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) play a crucial role in helping low-income families break out of the cycle of hunger and dietrelated disease. Both programs augment households’ food budgets, allowing them to purchase more healthful foods, and provide nutrition education to participants. More than 52% of Clark County School District students are eligible for free or reduced-price meals, depending on family size and income, as part of the National School Lunch/Breakfast Program. This provides nutritious meals every school day for eligible students at participating elementary, middle/junior high and high schools. Nonprofit organizations also are helping to feed hungry youths. Three Square Food Bank does a tremendous job of focusing on the population who qualify for nutrition assistance. Three Square and other charitable groups also operate food banks that provide food for greatly reduced prices or no charge. However, there are stringent guidelines and eligibility forms to access government help, and some families with children fall through the cracks. They may be just over the limit to qualify and struggle to make ends meet and have to choose which bills to pay. Kids receive food at school Monday through Friday and go hungry on the weekends. Some Story continued on page 58

Proper, healthy nutrition has positive effects on a childâ&#x20AC;&#x2122;s energy, mind and mood. (Courtesy)

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Serving Our Kids volunteers distributing weekend food bags to students. (Courtesy)

Story continued from page 56 families may not understand how to complete required forms, and some struggle to purchase food at food banks. Regardless, kids suffer. They donâ&#x20AC;&#x2122;t understand what eligibility means. They just know they donâ&#x20AC;&#x2122;t have enough food to eat and are hungry. The Serving Our Kids Foundation is another local nonprofit organization that provides weekend food bags to local school students on Fridays, so they have food to eat on Saturdays and Sundays. Serving Our Kids delivers bags to 3,500 kids who do not receive weekend food bags from any other nonprofit or government program and would otherwise go hungry. Recommendations come from school principals, teachers and counselors. There is no qualification and no questions are asked. Some of the recipients receive multiple bags for siblings and parents. Hunger is a growing problem for both lawmakers and communities who are seeking to eliminate it.

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Serving Our Kids is currently at capacity, based on donations and donated items, and has a waiting list for weekend food bags. It is estimated the actual need for weekend food bags is between 8,000 and 10,000. It is imperative that we as a society and community recognize that there continues to be a food insecurity gap, and help children before adverse medical and mental health conditions develop. Each community is capable of solving childhood hunger. First, the problem needs to be more than just talked about. We need specific programs funded by state and federal government. While that would greatly reduce the number of chronically hungry children, it will be the members of the community who support an organization providing for these children that will fill the gaps. These initiatives can make a huge impact on a childâ&#x20AC;&#x2122;s well-being and can mean dramatic health care savings for society as a whole.

From the Childhood Obesity Report by the Childrenâ&#x20AC;&#x2122;s Advocacy Alliance, Southern Nevada Health District and other coalition partners

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Valley Hospital broke ground on a 20-bay patient care unit at 620 Shadow Lane. These observation units are for patients who need additional evaluation for a specific medical condition or diagnosis before they are either discharged or admitted to the hospital, and frees up emergency medicine beds for incoming and emergent cases. Health Plan of Nevada/Sierra Health & Life Insurance Company (HPN/SHL) and HCA Healthcare Sunrise Health System reached a multiyear agreement to provide more than 500,000 HPN/SHL members with in-network access to the health services at Sunrise Hospital & Medical Center, Sunrise Children’s Hospital, MountainView Hospital and Southern Hills Hospital and Medical Center. In addition, this agreement provides HPN/SHL members with in-network access to 17 CareNow Urgent Care facilities, four surgery centers and two free-standing emergency rooms. Sunrise Hospital & Medical Center opened its new and expanded trauma and emergency department, doubling the square footage of its adult ER. The 182,000square-foot expansion is the centerpiece of the hospital’s $200 million, multi phase campus expansion and included a new ambulance bay and helipad.

Calderon

Mun

Ramanathan

The OptumCare Network of Nevada added five independent practice physicians to help meet the growing need for health services in the Las Vegas community: Dr. Benito Calderon, Dr. Roger Estevez, Dr. Jang Suk Mun, and Dr. Julie Wu, specializing in internal medicine; and Dr. Ravi Ramanathan, specializing in family medicine.

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The Shade Tree opened its newly renovated and expanded Stallman Touro Clinic. The clinic, which is operated by Touro University, enables residents to receive much-needed health care services on property, including acute medical care and chronic illness management. Dr. Mark Pandori was named director of the Nevada State Public Health Laboratory. As director, Pandori will lead Nevada’s centralized lab that protects, maintains and improves the health of residents and visitors through the rapid detection of public health threats.

Pandori

Henderson Hospital was named a Top General Hospital nationally for its achievements in patient safety and quality for the second consecutive year. The designation was awarded by The Leapfrog Group, a national watchdog organization of employers and other purchasers focused on health care safety and quality. The Leapfrog Top Hospital award is widely acknowledged as one of the most competitive honors American hospitals can receive. MountainView Hospital was named a Top Teaching Hospital nationally for the second year in a row by The Leapfrog Group. The recognition follows the recently awarded “A” hospital safety grade, the third time MountainView has earned that honor, also from The Leapfrog Group. To qualify for the Top Hospitals distinction, hospitals must rank top among peers in the 2019 Leapfrog Hospital Survey, which assesses hospital performance on the highest known standards for quality and patient safety, and achieve top performance in its category. MountainView Hospital also opened Las Vegas Heart Associates, a cardiology practice offering the full spectrum of cardiovascular care, including comprehensive patient management using the latest techniques, equipment and procedures. The clinic is part of the larger Las Vegas Heart Institute, which includes the MountainView Cardiovascular & Thoracic Surgery Associates and the hospital’s outpatient cardiac rehab program. Gov. Steve Sisolak named Dr. John Packham chair of the new Patient Protection Commission. The 10 additional panel members include Dr. Howard Baron,

New ultrasound training facility opens doors Touro University opened its new OptumCare ultrasound training facility located inside the schoolâ&#x20AC;&#x2122;s Michael Tang Regional Center for Clinical Simulation. The facility was constructed and equipped through a $150,000 contribution from OptumCare to provide students with access to state-of-the-art equipment and technology to enhance their educational experience.

Pediatric Gastroenterology & Nutrition Associates; Dr. Ikram Khan, Quality Care Consultants LLC; Dr. Anthony Slonim, Renown Health; W. Mason Van Houweling, University Medical Center; Bobbette Bond, UNITE HERE Health Fund; Shaun Schoener, UnitedHealthcare; Flo Kahn, PhRMA; Jessica Flood, Nevada Rural Hospital Partners; Yarleny Roa-Dugan, Southern Hills Hospital and Medical Center; and Theresa L. Bohannan, special health care needs advocate. Non-voting members include Richard Whitley, state Department of Health and Human Services; Barbara Richardson, state Division of Insurance; and Heather Korbulic, Silver State Health Insurance Exchange. The commission is charged with taking a comprehensive look at the state of health care in Nevada. It will identify areas for improvement to ensure that every Nevadan has access to affordable, quality health care. Dr. Neil Gokal of Southwest Medical, part of OptumCare, received an honorary Pi Alpha Award by the Pi Alpha

Honor Society. The award recognizes accomplishment in the areas of significant academic achievement, leadership, research, community and professional service, and the encouragement of a high standard of character and conduct among physician assistant students and graduates. Diana Quach, clinical pharmacy manager at Southwest Medical Pharmacy, was presented with the 2019 Bowl of Hygeia Award Quach for Nevada at the Nevada Society of Health-System Pharmacists annual meeting. The award recognizes one pharmacist in each participating state who possesses outstanding records of civic leadership in their communities and encourages pharmacists to take active roles in their communities.

Winter 2020

The Valley Health System partnered with Southwest Medical, part of OptumCare for an outpatient family medicine continuity clinic in what will be the largest family medicine residency program in Nevada. MountainView Hospital named Michelle Bookout, DNP, MSN, BSN, PCCN, chief nursing officer (CNO). Bookout Bookout was previously CNO at Mercy Hospital in Florida and brings 25 years of professional development and management experience to MountainView, with a focus on high-quality care outcomes, excellent patient satisfaction and a highly engaged team.

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Easter Seals Nevada, a health care and human services nonprofit serving families and children with developmental delays and adults with physical and intellectual limitations, has rebranded to Capability Health & Human Services. Dr. John Rhodes, senior medical director for the Mountain West Region of primary John and and adult Shelley Rhodes medicine for Southwest Medical, part of OptumCare, and his wife Shelley received the Heitkotter Award from Faith Lutheran Middle School and High School. Dr. and Mrs. Rhodes were co-chairs of the “You Gotta Have Faith” campaign that raised nearly $6 million toward construction of the school’s chapel and performing arts center. They were also catalysts for the creation of the Mark 10:14 proLibby gram to help developmentally disabled students.

Bratton

Eugene Libby, D.O., F.A.C.O.S. and Anthony Bratton, M.D. joined OptumCare Orthopaedics and Spine as

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Raising funds for individuals with special needs Southwest Medical, part of OptumCare, served as the gold sponsor for Friendship Circle’s Walk4Friendship annual walk that raises crucial funds and community awareness for individuals with special needs.

orthopedic surgeons to help meet the growing need for health services in the Las Vegas community. Vegas PBS and the Nevada chapter of the American Academy of Pediatrics have partnered to provide tips and information for caregivers of young children via text message through Vegas PBS’ free Bright By Text service. This new partnership will ensure trusted, fact-based and local information is distributed, including developmental milestones, brain development, social-emotional behavior, nutrition and more. Caregivers can sign up for Bright By Text by texting “SHINE” to 274448. UNLV named Dr. Marc J. Kahn the

Winter 2020

new dean of the School of Medicine. Kahn is currently a senior associate dean at Tulane University School of Medicine and was selected following a national search for the position. He takes his post at UNLV on April 1. OptumCare Cancer Care received a national grant from UnitedHealth Group (UHG) to develop an investigator-initiated protocol focused on palliative care. This protocol, written by Dr. K. Saad Jahangir, director of OptumCare clinical research, will be one of six research projects for the year within UHG nationwide. In addition, Dr. Jahangir and Dr. Russell Gollard became voting members of University

Medical Center Institutional Review Board. The boardâ&#x20AC;&#x2122;s mission is to protect the rights and welfare of human subjects. Southwest Medical, part of OptumCare received the Intalere Healthcare Achievement Award, recognizing outstanding and innovative contributions in reducing health care costs, improving health care quality and community service. Additionally, Southwest Medicalâ&#x20AC;&#x2122;s Pharmacy & Home Medical Equipment Division was recognized for its Pharmacy Transitions of Care Program, intended to ease the process for patients as they transition into or out of a long-term care setting. Dr. Nicholas Tibaldi, Dr. Neil Braunstein, Dr. Carl Allen and Dr. Ross Seibel with Southwest Medical, part of OptumCare, competed in the Fat Boy Open golf tournament, in support of Families for Effective Autism. Its mission is to provide information on treatment resources for families with children diagnosed with autism, autism spectrum disorder and related disorders.

Top honors for these Nevada Nurses Nevada nurses received top honors at the March of Dimes Nurse of the Year awards gala recognizing patient care, compassion and customer service. The 2019 winners included Susan S. VanBeuge, Minnie Wood and Andrew Thomas Reyes of UNLV; Rebecca Kole and Janet Wright of Centennial Hills Hospital Medical Center; Maricris Rivera and Arlene Blanco of Desert Springs Hospital Medical Center; Jane Liu, Cathleen Hamel, Dawn Hume, Ismael Martinez, Aesa Jackson and Michelle McGrorey of University Medical Center; Aleta Campbell Alexander of Sunrise Hospital and Medical Center; Calaiselvy Elumalai of Dignity Health St. Rose Dominican Siena Campus; Jessica Povey of MountainView Hospital; Lisa Salerno and Meaghan McLaughlin of Henderson Hospital; and Deborah Swink of Southwest Medical/OptumCare Surgery Center.

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To include your calendar items in the next issue, contact Jennifer Inaba at jennifer.inaba@gmgvegas.com

19th annual Clark County Medical Society Alliance Fashion Show and Luncheon Four Seasons Hotel, March 19, 10 a.m.-1:30 p.m. For more, visit e.givesmart.com/events/ etV

Birthing Babies: A Natural Approach to Childbirth April 20 & 27, 6-9 p.m. $60 per couple

Diagnosis of Infertility in Women and Men March 11, 5:30-7 p.m. Free

HendersonHospital.com 1050 W. Galleria Drive

MS Stretch and Flex March 12, 10:30-11:30 a.m. Free for individuals with Multiple Sclerosis, $5 for others (cash only)

Breastfeeding Support Group Wednesdays, 11 a.m.-1 p.m. CentennialHillsHospital.com 6900 N. Durango Drive Sunday Tours of the Womenâ&#x20AC;&#x2122;s Center Sundays, 3 p.m. Free Mother-Baby Support Group Mondays, 1 p.m. Free Sibling Class March 10, April 14, 5-6:15 p.m. $20 per family Childbirth Preparation Class March 14, 28 and April 11, 9 a.m.-2 p.m. $60 per couple Baby Basics for Moms and Dads March 18, April 15, 6-8:30 p.m. $30 per couple NICU Support and Encouragement Group March 19, April 2 and 16, 9 a.m. Free Breastfeeding Class March 19, 21 and April 16, 18, 6-8 p.m. $25 per couple

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Postpartum Wellness Group Thursdays, 10:30 a.m.-noon

Self Defense March 13, 1-3 p.m. $25

Baby Care Basics March 14, May 9, 9-11:30 a.m. $20 per couple

SouthernHillsHospital.com 9300 W. Sunset Road

Birthplace Tours March 15, April 19, May 17, 11 a.m.-1 p.m. April 2, May 7, 5-7 p.m. Free

Breastfeeding Support Group Wednesdays, 11 a.m.-12:30 p.m. Free

Childbirth Basics March 18 and 25, 6-9 p.m. April 4, 9 a.m.-4 p.m. $50 per couple

Maternity Tours Thursdays, 7:30-9 p.m. Saturdays, 12:30-3 p.m. Free

Breastfeeding Basics April 4, May 7, 6-8 p.m. $10

Infant CPR Class Every other Friday, 10-11 p.m. Free

Mountainview-Hospital.com 3100 N. Tenaya Way

Prepared Childbirth Education March 11 and 18, 6-9 p.m. $15

Blood Pressure Screenings Tuesdays, 9-10 a.m. Free

New Sibling Class March 14, 11 a.m.-12:30 p.m. Free

Zumba Gold March 10, 10-11 a.m. $5 (cash only) Ostomy Support Group March 11, 5:30-7:30 p.m. Free

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SpringValleyHospital.com 5400 S. Rainbow Blvd. Joint Camp First Tuesday and Third

Thursday of every month, 10-11 a.m. Childbirth Preparation Class March 11 and 18, April 15 and 22, 6-8 p.m. (two-part class) March 14, April 11, 9 a.m.-4 p.m. (one-day class) $40 per couple Breastfeeding Education Class April 4, 10 a.m.-noon $15 Birthplace Tours April 12, 3 p.m., 4 p.m. and 5 p.m.

SummerlinHospital.com 653 N. Town Center Drive Breast Cancer Empowerment Support Group Second Tuesday of every month, 6-7:30 p.m. Stroller Strides Wednesdays, 5:30-6:30 p.m. Car Seat Installation/ Checks Second Saturday of each month, 10 a.m-noon Free Birthplace Tours March 10, 12, 26, 4 p.m. Infant Play Group March 12, April 9, 10 a.m.-noon Free for NICU graduations, $10 for others Natural Birth Methods Class March 12, May 14, 6-9 p.m. $30 per couple

Infant Massage March 17, April 7, 21, 10 a.m.-noon Free for NICU graduates, $10 for others Breastfeeding Basics March 26, April 30, 6-8 p.m. Free Infant Loss Bereavement Support Group April 9, 6-7:30 p.m. Childbirth Basics April 14, May 5, 6-9 p.m. $80 per couple Childbirth Basics Express April 18, May 16, 9 a.m.-noon $50 per couple Finding the Strength for Motherhood April 23, 6-7:30 p.m. Free

SunriseHospital.com 3186 S. Maryland Parkway Oncology Nutrition Class March 18, May 20, 6-7:30 p.m. Free Baby Safety Class April 8, June 10, 6-8 p.m. $25

UMCSN.com 1800 W. Charleston Blvd. Classes held at 901 Rancho Lane, Suite 180 Infant and Child CPR March 14, 9-11:30 a.m. $10 deposit, will be refunded at class Breastfeeding Preparation March 16, 6-8:30 p.m. Free Stop the Bleed March 20, 3-4 p.m. Free Baby Basics & Post Partum Care April 9, 6-8:30 p.m. Free

Baby Basics II: Soothing & Sleeping April 22, 6-8 p.m. Free Infant Massage April 28, 10-11 a.m., Free

Thursdays, 9:15-9:45 a.m. 98 E. Lake Mead Parkway Thursdays, 11:15-11:45 a.m. or noon-12:30 p.m. Saturdays, 9:15-9:45 a.m. 2651 Paseo Verde Parkway Free

DignityHealth.org/LasVegas Various locations, see listing

Zumba Kids Jr. (ages 4-6) Tuesdays, 1-2 p.m. 2651 Paseo Verde Parkway Wednesdays, 3:30-4:30 p.m. 7220 S. Cimarron Road Free

Gentle Yoga Every Monday, Wednesday and Friday, 9-10 a.m. 722 S. Cimarron Way Every Tuesday, Thursday and Friday 10-11 a.m. 2651 Paseo Verde Parkway $5 per session, $20 for 5 sessions HIGH Fitness Mondays, 6-7 a.m. 2651 Paseo Verde Parkway Free Infant Development Mondays, 2-3 p.m. 2651 Paseo Verde Parkway Free Letâ&#x20AC;&#x2122;s Talk: Peer Support During and After Pregnancy Mondays, noon-1 p.m. 98 E. Lake Mead Parkway Wednesdays, noon-1 p.m. 7220 S. Cimarron Road Fridays, noon-1 p.m. 2651 Paseo Verde Parkway Free New Mommy Mixer Mondays, 11 a.m.-noon 98 E. Lake Mead Parkway Wednesdays, 11 a.m.-noon 7220 S. Cimarron Road Fridays, 11 a.m.-noon 2651 Paseo Verde Parkway Free Prenatal Yoga Mondays, 4-5 p.m. 7220 S. Cimarron Road Mondays, 4:15-5:15 p.m. 2651 Paseo Verde Parkway $3 per class, $20 for 8 sessions Zumbini (ages 1-4) Tuesdays, 11-11:30 a.m. Fridays, 10:15-10:45 a.m. 7220 S. Cimarron Road

Zumba Kids (ages 7-11) Tuesdays, 3:30-4:20 p.m. 2651 Paseo Verde Parkway Free Zumba Tuesdays, 4:30-5:30 p.m. 2651 Paseo Verde Parkway $5 per session, $20 for 5 sessions SNAP: Supplemental Nutrition Assistance Program Tuesdays, 8 a.m.-noon 2651 Paseo Verde Parkway Infant Nutrition Wednesdays, 2-3 p.m. 2651 Paseo Verde Parkway Free Zumba Gold Wednesdays, 11 a.m.-noon Thursdays, 1-2 p.m. 2651 Paseo Verde Parkway $5 per session, $20 for 5 sessions Healthy Hearts Club Third Wednesday of every month, 10-11 a.m. 2651 Paseo Verde Parkway Free Us Too: Prostate Cancer Support Group Third Wednesday every month, 7-8 p.m. 8280 W. Warm Springs Road Better Breathers Club First Thursday of every month, 1-2 p.m. 2651 Paseo Verde Parkway Free Compulsive Eaters Support Group First Saturday of every month, 9-10 a.m.

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3001 St. Rose Parkway Free FIT Colon Test Pick up or drop off at any WomensCare/Outreach Center $15 Baby Basics March 11, 6:30-9:30 p.m. 2651 Paseo Verde Parkway $30 per couple Balancing Energy Fields March 11, 6-8 p.m. 7220 S. Cimarron Road Stop Smoking with Hypnosis March 11, 6-8 p.m. 2651 Paseo Verde Parkway $25 Eating for a Healthy Heart March 13, 1:30-3 p.m. 2651 Paseo Verde Parkway Free What is Prediabetes? March 13, 9:30-11:30 a.m. 2651 Paseo Verde Parkway $10 Diabetes Self-Management Six-Week Program March 16-April 20, 10 a.m.-12:30 p.m. 2651 Paseo Verde Parkway Free Breastfeeding Class March 17, 6-8:30 p.m. 2651 Paseo Verde Parkway $30 per couple Kidney Smart March 18, 1 p.m.-2:30 p.m. 98 E. Lake Mead Parkway Free Weight Management March 19, 10:30-11:30 a.m. 7220 S. Cimarron Road March 25, 10-11 a.m. 2651 Paseo Verde Parkway Free Daddy Boot Camp April 4, 10 a.m.-noon 2651 Paseo Verde Parkway Free for veteran dad, $20 for new dad

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THE DAYâ&#x20AC;&#x2122;S

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