2020-06-25 - Health Care Quarterly (Vol. 28) - Spring 2020 by Greenspun Media Group

All In This Together Comprehensive would like to thank all of the physicians and medical professionals on the frontline who have dedicated their lives to keeping us healthy and safe. Each of you has our deepest gratitude. On other fronts, the battle against cancer has not stopped. And all of us at Comprehensive are proud to do our part by supporting our patients, their families and the greater Southern Nevada community.

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Publisher MARK DE POOTER (mark.depooter@gmgvegas.com) Associate Publisher KATIE DIXON (katie.dixon@gmgvegas.com

EDITORIAL + ART Special Publications Manager & Editor J ENNI FER I N ABA

Our heroes on the frontlines of healthcare have shown remarkable tenacity, selflessness and strength. They have been there for us, day and night and they are still there, working hard, providing empathic care and putting their patients first.

Managing Editor/News DAVE MONDT

If you ever considered a career in the health sciences, now is the time. Our communities need the next generation of highly competent healthcare professionals to provide high-quality care to all.

Res ea rc h Li b ra ria n R EBECCA CL I FFOR D- CRUZ

Find out more about our nursing, pharmacy and dental programs. We need you now, more than ever.

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Now is the time. Learn more at roseman.edu

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From the editor

s our community is reeling from the consequences of a global health pandemic and our businesses, parks and restaurants reopen, many of us emerge with slight trepidation for ourselves and others. COVID-19 has changed our city. Some will argue that our health care system was not prepared to weather such a crisis. And while that may have been an early concern, the fortitude of our health care system was demonstrated by the rapid mobilization of front-line workers who have been dedicating their time and expertise to fight this disease, and ensuring those who need treatment and testing are provided the opportunity. It is through the tenacity of these health care professionals, generosity of our community and commitment of all residents to stay home, that we stand today in a much better position than originally projected. Health Care Quarterly talked to several of these front-line practitioners to share their experiences and advice to our community going forward. And we take a look at what we’ve learned about medical infrastructure and how we can all be better prepared for health crises when they hit. We’ve seen quite the rise in telemedicine and innovative ways to use technology to reach patients during this time, whether to maintain existing health conditions or monitor potential COVID-19 symptoms from home. Southwest Medical shares the value in telemedicine during social distancing, and HealthCare Partners Nevada explains how a simple adaptation to existing technology allowed them to reach our vulnerable aging population. Throughout this difficult time, we’ve learned how paramount it is to have proper access to our health care providers. If we can’t utilize telemedicine, we want them to be close to home. Colliers International Las Vegas and Nigro Construction explain the growing retailization of health care – how physicians are showing up in our neighborhood shopping centers and having

more control over their buildings – making our doctors more accessible than ever. Even during a crisis, it’s crucial we don’t neglect our ongoing health needs. The National Fitness Campaign has landed in Las Vegas to advocate outdoor activity through healthy infrastructure. Staying active is one of the best ways to build your immune system and provide defense against illness. And Cleveland Clinic Lou Ruvo Center for Brain Health reminds us that now is the time to decrease your risk of developing Alzheimer’s disease. Prevention, rather than treatment, is key. It’s also allergy season, which can cause confusion as many symptoms overlap between common cold, flu and now, COVID-19. OptumCare Lung and Allergy Care clears it all up for us. Because when you better understand your symptoms, you can better treat them and recover more quickly. As we all come out of quarantine into the summer season, we hope it involves more time outdoors with family and friends. Comprehensive Cancer Centers shares the importance of skin safety in our harsh desert sun. And with school out and the kiddos looking to stay busy, Health Care Quarterly takes a look at blue light exposure and if you should be concerned about screen time. Addiction often surges in times of crisis. It’s more important than ever to be aware of the signs of drug and alcohol dependency in those around you. The Center for Addiction Medicine helps us recognize these signs and explains why it’s urgent to seek treatment early on. Check on your family, friends and neighbors. Take care of yourself. Stay safe and stay healthy!

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

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Medical 22 News TABLE OF CONTENTS

COVID-19 pandemic: Lessons learned and advice from the front line

18 36 40 42 44 50 52 56

Blue light and how screen time can impact young childrenâ&#x20AC;&#x2122;s health Toilet talk: Everything you need to know about urine and stool

Addiction during crisis with Dr. Michael S. Levy Deep brain stimulation with Dr. Scott Glickman Differentiating common illness symptoms by Dr. Jim Christensen UNLV School of Medicine students overcome challenges, dedicate lives to helping others by Paul Harasim Reduce risk of skin cancer by staying skin smart this summer by Dr. Wolfram Samlowski Understanding brain health and how prevention is key by Dr. Marwan Sabbagh

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NEVADA DONOR NETWORK LEVERAGES GROUNDBREAKING TECHNOLOGY TO ACHIEVE RARE HEART AND LUNG RECOVERIES Nevada Donor Network (NDN), the only Nevada-based organ procurement organization (OPO), successfully reached two pivotal milestones: the recovery of a lifesaving heart for transplant after circulatory death and an ex vivo lung perfusion to prolong the viability of lungs for transplant. NDN is the first OPO in the southwest and among the first in the nation to recover a heart for transplant from a donation after cardiac and circulatory death. These donations are possible after the heart stops beating; most commonly, donation occurs when a personâ&#x20AC;&#x2122;s brain has completely and irreversibly stopped functioning. NDN also coordinated its first ex vivo lung perfusion, an innovative therapy that passes nutrients into donated lungs outside of the body to improve organ quality and transplant outcomes. This therapy allows lungs that would previously have been considered unsuitable safe for transplant. Without it, donated lungs must be transplanted within six hours.

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UNLV CARDIOLOGIST CONDUCTS CUTTING-EDGE RESEARCH ON STEM CELLS To Dr. Buddhadeb Dawn, the chair of the UNLV School of Medicine Department of Internal Medicine, “if we knew the secrets of stem cells, we will be able to reverse many natural as well as pathological processes, such as aging and heart failure.” Founding director of the Cardiovascular Research Institute and the Midwest Stem Cell Therapy Center in Kansas prior to joining UNLV in 2018, Dr. Dawn and his team have produced groundbreaking research that has found evidence of adult stem cells repairing and regenerating damaged heart tissue after a heart attack. “I have seen numerous patients improve who have been treated with stem cells,” the cardiologist says. Dr. Dawn’s research has appeared in peer-reviewed publications on more than 170 occasions. (Courtesy photo)

COMPREHENSIVE CANCER CENTERS AMONG FIRST TO OFFER NEW TREATMENT FOR PANCREATIC CANCER PATIENTS Percentage of the U.S. population that is obese. Read about the organization that’s combating this problem using healthy infrastructure, page 47

Comprehensive Cancer Centers is a leader in clinical research, participating in over 170 trials each year and has helped develop more than 100 FDA-approved cancer therapies. Comprehensive also offers groundbreaking cancer treatments and advanced clinical trials, including tumor treating fields or TTFields. TTFields are a non-invasive, regional antimitotic treatment that have been demonstrated to be safe and to have a low toxicity profile in multiple cancers, including pancreatic. TTFields act by delivering low-intensity alternating electric fields of intermediate frequency that pulse through the skin around the region of the body containing the tumor — interrupting the cancer cells’ ability to divide. Thus far, a local patient on the TTFields trial is improving tremendously by receiving this treatment, in addition to the standard of care chemotherapy.

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BY DR. LO FU TAN

Dr. Lo Fu Tan is the senior medical director, digital health at Southwest Medical, part of OptumCare.

here are many ways the health care industry meets the challenges presented by COVID-19, but perhaps one of the most interesting is the rapid expansion of telemedicine. Southwest Medical was an early adopter of this, launching our NowClinic in 2014. Since, NowClinic has surpassed 90,000 video consultations. NowClinic is part of our concept of on-demand medicine, providing patients with access to medical care 24/7 and without an appointment. This technology is especially helpful for patients for whom transportation or scheduling may be an issue. The video chat technology allows patients to use their computer or mobile device to have a virtual visit with Southwest Medical providers.  For everyday health care needs, the practical benefits of telemedicine are clear — not having to leave your home if you are ill, parents not having to take time off work or bring all their children to the doctor when only one of them is sick, being able to address health needs even if transportation isn’t available and more. Especially during cold and flu season, a telemedicine visit can be ideal. Respiratory symptoms are among the conditions most commonly evaluated with this approach. In fact, I led a three-person study team from Southwest Medical to conduct research during a nine-month period on the effectiveness of telemedicine. The study, published March 2017 in the Journal of Telemedicine and e-Health, determined that patients who use urgent care telemedicine visits for upper respiratory infections have better health outcomes and lower out-of-pocket costs in comparison to “brick-andmortar” urgent care centers. These virtual visits were associated with several positive results for patients, including: n The co-pay for a virtual visit was 40% lower. n Average wait time of four minutes, 10 times less than that of an urgent care visit. n Patients had a 45% reduced chance of a repeat visit within two weeks compared to those in an

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in-person urgent care clinic. n Virtual visits resulted in more successful treatment, with only 4% of telemedicine patients needing a repeat visit within two weeks, compared to 26% of those seen in urgent care. With concerns over the potential exposure to or spread of COVID-19, we have also seen an increasing number of local patients turning to telemedicine as a way to minimize exposure and avoid public places while still receiving medical care. And, of course, by using telemedicine, health care providers can avoid risk of contagious health conditions to themselves, their colleagues or other patients. Our NowClinic telemedicine visits increased in volume by more than 400% in March and April 2020, and we increased from a 2019 average of 70 NowClinic visits per day to over 375 visits a day during that same period this year. In response to the overwhelming need and interest, we also greatly increased the number of health care providers on the platform. At least 400 Southwest Medical and OptumCare providers were added, including multi-specialty health care providers. While some will help with urgent care NowClinic visits, others will provide care for scheduled primary and specialty care visits. Apart from the pandemic response, the health care areas that we can address through our telemedicine program include urgent care, behavioral health, adult medicine and specialty care visits such as cardiology, endocrinology, pediatrics, OB/ GYN, oncology and rheumatology, with more in progress, as well as hospice and geriatric care. NowClinic is staffed with Southwest Medical doctors, so when a patient has a NowClinic visit, that information goes into their medical record and doctors have it as part of their patient’s medical history during their next routine check-up. In spite of the current high demand, the average speed for a provider to answer an urgent care NowClinic call is eight minutes. On average, patients get eight minutes of video face-to-face time with the provider. Patients can download the free NowClinic app on Apple or Android devices or visit the Southwest Medical website for more eHealth tools.

WE’RE IN THIS TOGETHER During this critical time, here’s what connects us: neighbors helping one another, a community where everyone does their part, and the health care heroes along with first responders who are bravely out on the front lines. We look forward to seeing you. With additional protocols and social distancing, Southwest Medical, part of OptumCare®, invites you to come into one of our locations for your primary, specialty, or urgent care needs. You can also set up a virtual visit via smartphone, tablet, or computer through the secure online NowClinic® service. For more information or to schedule an appointment, please call us at 702.877.5199. We’re here for you when you need us.

Caring for community since 1972

BY DR. STEVEN EVANS, MD

Dr. Steven Evans, MD, is the senior medical director, UM and quality/ pharmacy director at HealthCare Partners Nevada, an Intermountain Healthcare company.

oronavirus put our nation to the test in unprecedented ways, both socially and medically. As COVID-19 spread throughout our community, Southern Nevada health care providers at Intermountain Healthcare were seeking ways to better protect and monitor their patient populations, while also attempting to make our patients feel safe at home. Because a large population of our patients in Nevada are seniors (65+), this was especially important. This led us to develop the nationâ&#x20AC;&#x2122;s first COVID-19/coronavirus downloadable in-home health monitoring application, based on an existing technology platform that we had used to monitor and treat patients for influenza. In 2019, HealthCare Partners Nevada, an Intermountain Healthcare company, implemented an influenza early detection monitoring and treatment program named Flu 2000 for many of our most vulnerable patients with Humana and UnitedHealthcare Medicare Advantage insurance. Partnering with Harmonize Inc., a leading digital health platform specializing in remote care, 2,000 patients enrolled with COPD and congestive heart failure in a program to monitor patients at home through the flu season and beyond. Using trained health coaches and Bluetooth-enabled home vital-sign monitors, such as blood pressure, pulse rate, weight and oxygen saturation, Intermountain Healthcare and Harmonize were able to often detect when patients first showed signs of the flu. Many times, this occurred even before the patients themselves knew they were coming down with the illness. The readings were analyzed remotely, and those that indicated a possibility of flu were flagged for closer examination. Doctors then reviewed the patientâ&#x20AC;&#x2122;s medical records and remote monitoring data before contacting the patients by phone

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and videoconference. The doctors were then able to assess what type of intervention was needed. Some of the patients were given prescriptions for Tamiflu. Others were brought in to visit their primary care physician. Others received a visit from a house-calls provider. This program and technology provided Intermountain Healthcare a platform to quickly pivot and launch a downloadable in-home COVID-19/ coronavirus monitoring application in midMarch called MyGeneration at Home. Seniors in our MyGeneration Senior Clinics, as well as our affiliate offices, were able to digitally communicate their temperature and symptoms related to COVID-19 to other medical professionals who could analyze the data remotely. The Intermountain Healthcare provider then arranged a video call to further assess the patient and provide recommendations. As of the end of April, there were more than 5,000 active users, with at least 20% using the application daily. Interventions included sending patients for COVID-19 testing, home visits, primary care appointments and even urgent care or emergency room referrals. Of equal importance, the application allowed our patients peace of mind, as they actively seek ways to protect themselves and others from the virus. In addition, it helped to dramatically reduce the number of people seeking in-person care at our clinics and area hospitals, reducing the risk of spread and stress on medical resources. Our ability to quickly repurpose existing technology possibly saved lives, provided peace of mind and set up a roadmap in addressing future potential infectious health issues. As social distancing becomes a more accepted way of daily life, technologies such as our flu and COVID-19 in-home monitoring applications will be essential in keeping our most at-risk patients safe, healthy and well cared for.

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BY DR. ANTHONY V. NGUYEN, MD

Dr. Anthony V. Nguyen, MD, 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. He actively participates in clinical research for the practice and serves as clinical assistant professor for UNLV School of Medicine. For more information about Comprehensive, call 702-952-3350 or visit cccnevada.com.

here have been several headlines surrounding colon cancer lately. Among them are fluctuating guidelines on when to have a colonoscopy, an increase in colon cancer cases among young adults and varying preventative/dietary recommendations. Locally, the American Cancer Society says 1,480 Nevadans will be diagnosed with cancer of the colon or rectum in 2020, marking an uptick of its 2019 estimation of 1,340 new cases. Colon cancer is the fourth most prevalent cancer in the state, behind breast, lung and prostate cancers. So, amid the information available, how do we make sense of it all and what are the guidelines that should be followed? First and foremost, the American Cancer Society made changes and recommends healthy adults — with no family history of colon cancer — start having colonoscopies at 45. Yet the majority of the groups, including the U.S. Preventative Services Task Force, still recommends screening for colorectal cancer at age 50 and continuing until age 75. The decision to screen for colorectal cancer in adults aged 76 to 85 should be an individual one, taking into account the patient’s overall health and prior screening history. Once a colonoscopy takes place, follow-up tests are typically done in 10 years, contingent on your doctor’s recommendation. Screening for colon cancer can also be done with stool testing, including a fecal immunochemical test every year, fecal occult blood test every year and multi-targeted stool DNA test every three years. The stool DNA tests (e.g. Cologuard) can be done at home and are helpful in identifying possible pre-cancerous polyps as well as colon cancers. Those with a family history of colon cancer — which is becoming more and more identifiable

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thanks to cancer genetic counseling and testing — should have screening beginning at a younger age. Special cases such as those diagnosed with rare genetic mutations, should have much earlier screening. As for why we are we seeing more cases of cancer in young adults, specifically ages 20 to 34, the jury is still out. It is likely genetic changes that are contributing to the younger patients developing cancer. We also think obesity, smoking, inflammatory bowel disease and diet play important roles in colon cancer. We may not be able to change our genetics, but we can improve our lifestyle choices. It is important to eat fresh foods and vegetables where possible. Current research consistently links eating more red meat and processed meat to a higher risk of colon cancer. Although many times colon cancer symptoms can be silent, one should notify their medical provider if they notice blood in their stool, changes in bowel habits such as persistent diarrhea, constipation or narrowing of stool, unintended weight loss and cramps or abdominal pain. For those diagnosed with colon cancer, survival rates have improved in recent years. Cancer fighting techniques with surgery and medicines are improving and becoming much more individualized and targeted. For those with a later stage of colon cancer, there are clinical trials and targeted drugs that are available for our local Southern Nevada patients. At Comprehensive Cancer Centers, we have been able to give these new treatments and witness success stories in Stage IV patients where there was once little hope. The bottom line here during a time of global stress, we shouldn’t ignore or delay potentially life-saving screening, whether it is stool testing or colonoscopy. Prospective health issues and, especially cancer, do not pause for global events and we must stay proactive.

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BY DANIEL MATHIS

Daniel Mathis is the CEO of PureCare Living, a post-acute health care management company.

hen choosing an assisted living facility for yourself or a loved one, it’s important to understand the payment model and criteria that make up a facility’s overall quality as it pertains to the specific accommodations needed for your health care plan. In October 2019, the Centers for Medicare and Medicaid Services (CMS) implemented a new payment model for skilled nursing facilities (SNFs): the Patient-Driven Payment Model (PDPM). PDPM is a care model that focuses on the diagnoses and characteristics of the patient rather than the services, including the therapy services, provided to them. The system creates different financial incentives for SNFs than previous models. Facilities now receive a higher reimbursement rate for residents who are more clinically complex, including those who need ventilators and/or intravenous (IV) medications, are severely cognitively impaired and residents with depression. However, the more therapy a resident needs, the less the SNF is paid. At the same time, Nevada adopted R109-18AP, a regulation that allows Assisted Living Facilities (ALFs) and Residential Facilities for Groups (RFGs) to convert to a medical model. This allows the creation of a medical record as well as the ability to give insulin injections. Before this change, a person who could not manage their own insulin would need to be admitted to a SNF. The changes at federal and state levels incentivize SNF providers to change their clinical model to include higher acuity programming for higher reimbursement from Medicare and Medicaid. Lower acuity residents discharged from a hospital now can be admitted to the appropriate level of postacute care to include SNF, assisted living or home and community-based services.

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Once you understand a facility’s payment model, it’s also important to understand the type of facility actually needed. Nursing homes provide skilled care to people who can’t be cared for at home and need 24-hour care. Skilled care includes nursing or rehabilitation services such as occupational therapy, wound care, IV therapies and physical therapy to manage, observe or assess a resident’s care. Statistics and reviews regarding the quality of SNFs can be reviewed at Nursing Home Compare, a website that allows you to find and compare nursing homes certified by Medicare and Medicaid. This website contains quality of resident care and staffing information for more than 15,000 nursing homes around the country. ALFs or RFGs are regulated at the state level. With specific exemptions in the law, residential facility for groups are establishments that furnish food, shelter, assistance and limited supervision to a person with an intellectual or physical disability or a person who is aged or infirm. The term includes, without limitation, an assisted living facility. The Division of Public and Behavioral Health website lists all licensed facilities in the state of Nevada and includes inspection reports that can assist you in your decision-making process. The grading system is an excellent tool for those families wishing to place a loved one. To look up any licensed facility in Nevada, you can search “Find a Health Care Facility” on the Department of Health and Human Services website, and see its compliance history. In this current health care landscape, it is recommended to review a facility’s compliance for infection control as well as general compliance. When deciding on a health care plan, be sure the facility delivers appropriate level of care for your needs close to home, always meet the administrator and director of nursing and ask a lot of questions.

BY MICHAEL GAGNON n March 9, the U.S. Department of Health and Human Services announced two final rules that require providers, payers, electronic health record vendors and health networks to make health data available for exchange with patients and other providers and payers. Before these rules, there were no mandates in place and patients were severely limited in accessing and managing their own electronic health data. The first rule was published by the Office of the National Coordinator for Health Information Technology (ONC) and covers several aspects of health technology, including electronic health records and information blocking. The second rule, published by the Centers for Medicare and Medicaid Services (CMS), is more focused on payer system interoperability and it has implications for payers, providers and patients as well as the Conditions of Participation in the Medicare program. Both rules require the interoperability of health data between providers, payers and patients. The rules also give patients unprecedented access to their electronic medical records and require that they can be sent to any electronic application of their choosing. In addition, both rules enforce interoperability by defining and prohibiting information blocking. Information blocking is any practice that is likely to interfere with, prevent or materially discourage access, exchange or use of electronic health information. Here is a synopsis of the rules and timelines for each stakeholder through 2021:

PAYERS Late 2020: Public reporting of information blocking Jan. 1, 2021: Patient access to medical claims; provider directory access ELECTRONIC HEALTHCARE RECORD VENDORS AND HEALTH INFORMATION EXCHANGES Nov. 1, 2020: Compliance with information blocking rules Late 2020: Public reporting of information blocking March 15, 2021: First real-world testing plans due for open access to EHR PROVIDERS Nov. 1, 2020: Compliance with information blocking rules Late 2020: Public reporting of information blocking May 1, 2021: Hospitals must be able to send admission and discharge events to other providers electronically PATIENTS Nov. 1, 2020: Compliance with information blocking rules means access to your records Late 2020: Public reporting of information blocking if providers or payers do not comply

Michael Gagnon is the executive director of HealtHIE Nevada, a private, nonprofit, community-based organization dedicated to connecting the Nevada health care community by managing an accurate real-time health information exchange.

These new rules will change the landscape for health data interoperability and require that data is controlled by the patient and available to their providers, payers and any applications of their choosing. Failure to comply with the rules can be severe. As of now, information blocking by EHR vendors or health information exchanges can incur fines of up to $1 million per instance. For providers and payers, compliance is considered a Condition of Participation in Medicare and Medicaid programs. At HealtHIE Nevada we applaud these new rules, which should greatly improve the flow of health data, leading to higher quality care, improved patient safety and lower costs.

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BY HEATHER KORBULIC

Heather Korbulic is the executive director of Nevada Health Link, the health insurance marketplace for the state of Nevada.

t’s hard to believe that it’s been 10 years since the passing of the landmark health reform law, the Patient Protection and Affordable Care Act (PPACA or ACA), which dramatically improved both quality and access to health care coverage for millions of Americans and tens of thousands of Nevadans. As our worldview has been forever changed by the novel coronavirus, health care and its value has increased exponentially — not just for older generations, but for Nevadans of all ages who have now seen first-hand the devastation of a worldwide health crisis. Traditionally, health care coverage has been considered a must-have as consumers age. Young adults are typically more willing to go without health insurance given their age and relatively good health. The cost has also been a barrier to many who struggle to meet daily needs. Yet, as we know, illness and injury don’t discriminate. Accidents, by their very nature, are not predictable. Those are among the very reasons the ACA was created — to provide coverage to as many Americans as possible in the form of a Quality Health Plan. Not just any coverage but health care that covers what the ACA has defined as 10 essential health benefits. In addition to covering preexisting conditions, the ACA covers things like emergency and ambulatory services, hospitalization, maternity and newborn care, prescription drugs and mental health services, to name a few. It may not be widely known that many marketplace plans do not cover all these essential benefits. That’s why consumers need to shop carefully. Nevada Health Link is the only place where consumers can qualify for subsidies to help offset the cost of health insurance premiums. No other marketplace plan can offer that benefit. Just as the original architects of the ACA intended, the ACA has significantly reduced the number

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of Nevada’s uninsured population by almost half . Yet, according to a recent study by the Guinn Center, Nevada ranks sixth highest nationally for its uninsured population, an alarming statistic which illustrates there is still much work to be done to close the uninsured gap in our state. The Silver State Health Insurance Exchange began offering ACA-qualified plans in 2014 through Nevada Health Link. Annual enrollment grew to a peak of more than 91,000 Nevadans in 2018, and despite the ongoing uncertainty surrounding the ACA in Washington and an increasingly crowded insurance marketplace, enrollment has remained strong the past few years, a real testament to the need for the ACA. In March, as the COVID-19 crisis was heating up, we introduced a limited-time exceptional circumstance special enrollment period. This allowed qualified residents who missed the open enrollment period last fall to enroll in a plan that would take effect almost immediately. Our ability to offer that exceptional opportunity to uninsured and underinsured Nevadans is a direct result of our recent transition from the federal platform to become our own State Based Exchange. If we had remained on the federal platform, we would not have been able to respond to Nevadans’ immediate need for coverage during the pandemic and beyond. Nevadans should be extra mindful since there has been an increase in fraudulent activity involving sales of COVID-19 specific health coverage. All plans offered through Nevada Health Link cover COVID-19 testing and treatment. There is no need to purchase a plan specific to the coronavirus. Pandemic or not, nothing is more valuable than the peace of mind that comes from the safety net of quality health insurance that increases your access to health care while protecting you from financial devastation. Today, more than ever, health is wealth.

BY DR. AMY TONGSIRI hile expectant mothers busily prepare for the arrival of their little one, they must also prioritize their oral health. Pregnancy is characterized by complex hormonal and physiological changes that can alter a woman’s health in various ways, including an increased risk for periodontal disease and cavities. These issues, if untreated during pregnancy, can worsen and lead to poor outcomes during delivery and oral issues for the child at a young age. PERIODONTAL DISEASE Throughout pregnancy, women can become prone to pregnancy gingivitis — a mild form of gum disease that causes gums to be tender and sore, aggravated by changing and increased hormones such as progesterone and estrogen. In addition to red, swollen and bleeding gums, small lumps can also appear along the gum line or between the teeth. The Centers for Disease Control (CDC) estimates that 65-70% of pregnant women will have gingivitis during their pregnancy. If untreated, the bone that supports the teeth can be lost and the gums infected, which can eventually lead to tooth extraction to prevent further infection. While gingivitis and periodontal disease in a pregnant woman can be remedied, if left unchecked for too long can have serious effects on the pregnancy including preterm birth and low birth weight. CAVITIES AND BABY’S FUTURE HEALTH Pregnant women are at a higher risk of developing cavities due to changes in eating habits such as sweeter or saltier foods, attributed to cravings. A decrease in brushing and flossing is also common among pregnant women likely attributed to tender gums, less energy and, in some women, nausea.

These changes, while largely uncomfortable, can have a far greater risk for the child and its future oral health. The bacteria that causes cavities can be passed from mother to child during pregnancy and after birth, which can ultimately lead to cavities and extensive dental care at a young age. In fact, the CDC estimates that children of mothers with high levels of untreated cavities are three times more likely to have cavities in their youth and nearly three times more likely to miss school due to poor oral health and dental pain. EASY FIXES FOR HEALTHY FUTURES While periodontal disease and a higher risk of cavities are more prevalent among pregnant women, simple steps that can be taken to treat them: n Brush and floss — Practicing good brushing and flossing habits can help to rid the gums and mouth of bacteria, which can reduce and reverse inflammation of gingivitis and remove the sugars accumulated from changed eating habits. n Vitamin C — Found in many fruits, vitamin C can help to battle gingivitis and other bacteria that can build up in the mouth. n Rinse between brushing — Rinsing twice a day with a quality ADA-approved mouthwash can help keep the mouth clean while providing extra protection to kill plaque bacteria. n Consult your dentist — During pregnancy, dentists may recommend more frequent cleanings to help prevent and control gingivitis and cavities. It is important to contact your dentist if you are having any discomfort or symptoms of gingivitis.

Dr. Amy Tongsiri is the Nevada dental director for LIBERTY Dental Plan and a practicing dentist in the Las Vegas area. She also serves as a professor at the UNLV School of Dental Medicine.

Nevada Medicaid members have additional benefits during pregnancy including exams, cleanings, fillings and emergency services. To find a dentist or arrange transportation to a dental appointment, call LIBERTY Dental Plan’s member services toll free at 866-609-0418 or visit libertydentalplan. com/NVMedicaid.

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BY HEALTH CARE QUARTERLY STAFF As technology continues to insert itself into our daily lives, it is inevitable that our children will be exposed to it. It offers education and entertainment but can quickly become a babysitter as busy parents and caregivers struggle to find a balance. Even those with the best of intentions often surrender to the bright lure of the screen. Âś According to the American Academy of Pediatrics (AAP), children spend an average of seven hours a day with entertainment media such as televisions, computers, phones and other electronic devices such as tablets. Âś With increased screen time, comes increased exposure to blue light. What is blue light and should we be concerned about its impact on our young children?

WHAT IS BLUE LIGHT?

While we often hear about blue light emitted by electronics, sunlight is the main source of natural blue light. In fact, it is the blue light radiating from the sun that causes us to see the sky as blue. Artificial sources of blue light are also found in the digital display screens of computers, laptops, smart phones and tablets. Blue light has many positive attributes. It helps boost alertness, elevates mood and increases the overall feeling of wellbeing. It is also good at preventing the release of melatonin, a hormone that regulates your sleep cycle, meaning it plays a very important role in setting circadian rhythms. Because of this, use of blue light-rearing devices prior to bed can delay sleep onset, degrade sleep quality and impair alertness the following day.

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The American Academy of Ophthalmology recommends parents encourage a 20-20-20 rule. This isn’t just for children, either. Adults should also consciously take screen breaks to protect their vision.

Look at an object at least 20 feet away

BLUE LIGHT AND OUR EYES

Every 20 minutes

For at least 20 seconds

Our eyes are unable to block or reflect blue light. Yes, we’ve always been surrounded by it outdoors, but our eyes didn’t evolve to compensate for additional electronic exposure. With screens in such close proximity to our eyes, they bring a different level of concern. The National Eye Institute funded a French study on the potential risk of blue light emissions on the eye. They found that children’s eyes absorb more of the blue light than adults from digital device screens. This is of particular concern because almost all visible blue light passes through the cornea and lens and reaches the retina at the back of the eye. This could affect vision and prematurely age the eyes, and too much exposure to blue light could lead to digital eye strain and retina damage. The American Optometric Association also notes that children may be at higher risk for blue light retinal damage than adults because their lens absorbs less short-wavelength light than adults which allows more blue light to reach a child’s retina. Continued damage to retinal cells could cause vision problems such as age-related macular degeneration, though long-term consequences of blue light exposure in children are not yet adequately understood. Additional short-term effects to a child’s eyesight include blurry vision, digital eye strain, eye pain and eye fatigue. These can easily be addressed by setting daily screen-time limits and ground rules.

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SETTING SCREEN-TIME LIMITS

AAP recommends screen time limitations for children to help parents and caregivers to better manage children’s exposure.

Avoid screen media other than video chatting

Limit to one hour per day of high-quality programs

Set a consistent limit to ensure screen time doesn’t take the place of adequate sleep, physical activity and other behaviors essential to health

BLUE LIGHT AND SLEEP

While there are still many unknowns regarding blue light’s effect on children, the one consistent issue recognized by experts across the board is the role it plays in regulating sleep patterns. Exposure of the short-wavelength blue light that comes out of phones, tablets and e-readers suppresses the production of melatonin more than any other type of light, according to a study in the Journal of Endocrine Society. This can interrupt normal sleep patterns and reduce healthy sleep for children. The National Sleep Foundation says about one-third of children don’t get enough sleep, which is critical for mental and physical development. The foundation recommends 11-14 hours in a 24-hour period for toddlers aged one to two years, 11-13 hours each night for preschoolers three to five years of age and 9-11 hours of sleep for school-aged children six to 13 years old. Screen time should be limited late in the day to prevent sleep problems.

WAYS TO MANAGE EXPOSURE

There are some ways to help manage a child’s digital blue light exposure. Limit screen time, especially prior to bed. In addition, there are accessories that can help reduce and block blue light such as tablet and phone blue light blocking screen shields and blue light filtering glasses. You can also turn the color or brightness setting on the device down or to warm, which gives the screen a more amber appearance.

OTHER SCREEN-TIME RISKS Excessive screen time is also tied to several health and developmental concerns for young children. The Mayo Clinic reports that too much or poor-quality screen time has been linked to obesity, irregular sleep schedules, behavioral problems, loss of social skills, violence and less time for play.

Medically reviewed by Dr. Blair Duddy, MD, the associate medical director, pediatrics at Southwest Medical, part of OptumCare. SUMMER 2020 H E A LT H C A R E Q U A R T E R LY

ajor events encourage great leaders to step back and acknowledge their strengths and weaknesses. The COVID-19 pandemic is no exception. The biggest health crisis in recent history has sparked a wave of evaluations and reflections from the front lines of our community. Their voices tell a story of courage, dedication, gratitude and optimism. They are captivating and encouraging. They allow us to see through their perspective â&#x20AC;&#x201D; facing COVID-19 head on with a commitment to stop the spread and provide treatment, testing and care to all in need. Here are just a few of the many thoughts from individuals propelling Las Vegas forward in a pandemic.

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A man is tested for COVID-19 in the drive-thru testing site at the Orleans on May 8. (Steve Marcus/Staff)

“Please remember that COVID-19 testing is readily available in our community. UMC offers public testing at no out-of-pocket cost, and I encourage our friends, neighbors and family members in Southern Nevada to utilize this valuable resource.” —Mason VanHouweling, CEO, University Medical Center

“The COVID-19 pandemic is a truly historic event. The combination of a lethal, communicable, and as of yet, untreatable disease turns the clock back to an earlier century in which basic public health practices saved the day.” — Dr. Michael Allswede, DO, Program D irector, Emergency Medicine Residency, Sunrise Health GME Consortium

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“Never before has health been more important. Protecting your health starts with coverage that gives you access to quality care and protects you from financial ruin. And regardless of your age, your income or your current health status, everyone should have and deserves health insurance.” —Janel Davis, Communications Officer, Silver State Health Insurance Exchange/Nevada Health Link

“I have learned that rapid change and rapid adaptation to change is not that easy. In a time of anxiety and fear, we have to adapt on the fly and that can compound the anxiety. As a physician, leader and an individual, I have realized how grateful I am for everything I do have. I have also learned to be more mindful of my mental health. This has been an unprecedented time, but for me, it’s also been an opportunity for reflection.”  —Dr. Marwan Sabbagh, MD, Director of Cleveland Clinic Lou Ruvo Center for Brain Health

“Nurses practice within a philosophy of caring that has been made more visible during COVID-19. We have engaged in transpersonal relationships that inspire hope and lessen anxiety. The role of the nurse has never been stronger or more recognized, as we combine the best of science with the best of authentic healing presence, creating an environment of hope. I have learned that, even with the continual growth of the technical aspects of human care, nurses have not strayed too far from their roots of valuing and supporting the personal, emotional and heart-centered aspects of providing patient care.” —June Eastridge EdD, MSN, RN, CNE, COI, Dean, Nevada State College School of Nursing

Sabbagh photo by Wade Vandervort/Staff 24

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“COVID-19 has shown us a new way to share medical information quickly, through the power of social media. Across different platforms, social media groups were formed to spread ideas, innovations, data, treatment protocols and other medically relevant information regarding COVID-19. The traditional method of awaiting research to appear in print media was simply not rapid enough to respond to the evolving crisis. The appropriate use of social media, with vetting of group members to confirm their identities, allowed this information to be shared quickly, nationwide and internationally.”  —Dr. Staci McHale, MD, President-Elect, Clark County Medical Society

“Over the course of the pandemic we have had people reach out asking what they can do to help, including filling some of our non-clinical roles or just simply offering to buy our staff food. The community’s response to supporting the EMS community has been amazing.”  —Samuel Scheller, CEO, Guardian Elite Medical Services

“We have always seen telehealth as an ‘only if needed’ option rather than a practical, and in some cases, necessary response to access health care. At FirstMed Health and Wellness, we made a significant investment in our electronic health record and telehealth infrastructure in late 2019 to accommodate projected growth in 2020 — well before COVID-19 was on the map.”

“I have witnessed the heroic efforts of our world-class medical professionals on the front lines as they work tirelessly to save and improve the lives of COVID-19 patients. I have also seen the dedicated team members working behind the scenes to support our health care providers and expand access to testing in Southern Nevada.”

—Angela Quinn, CEO, FirstMed Health and Wellness

—Mason VanHouweling, CEO, University Medical Center

“I learned that I’m not as tough as I thought as I was. Cried many nights at home thinking of those sick with COVID, families that didn’t get to say goodbye and touch their loved one. That my heart and soul is in the right place, here taking care of those that I’m trained to help…The day I had to Facetime a young man to say goodbye to his father, who was dying of COVID-related illness. It broke my heart and will forever change me. It sparked a deeper passion to always give every effort to embrace family and the patient in a much more spiritual aspect.”   — Joe Sandy, RN, House Supervisor, Dignity Health-St. Rose Dominican, Siena Campus

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“The community should continue to hold on to their trust in their local hospitals and health care workers. They should do their best not to get distracted in all the conflicting information that is flooding them on television, social media and even from friends and family. They can always seek out answers from their local hospital’s website or make a call to their primary doctor or hospital if they have questions.” —Dr. Irena Vitkovitsky, MD, FACEP, Emergency Department Medical Director, Dignity Health-St. Rose Dominican Hospitals

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“I learned how quickly the medical community can pull together to achieve a goal. Three months ago there was no testing, no knowledge of how contagious COVID-19 was or how to slow the progression. As a whole, in the past 12 weeks we now have more answers than questions and we are able to stop the spread of COVID-19. New medications and vaccinations are being worked on in record speed. It is also inspiring to see the teamwork here at the hospital, as well as in the community.” —Deb LaCava, D irector of Laboratory, D ignity Health-St. Rose Dominican Hospital, Siena Campus

Health care professionals from Sahara West Urgent Care test Las Vegas residents for COVID-19 on March 18. (Christopher DeVargas/Staff) SUMMER 2020 H E A LT H C A R E Q U A R T E R LY

ith COVID-19 forcing routine patient care to be delivered primarily through televisits, I spend most of my time these days on the phone and computer, checking on my patients. The conversations are less medical than personal, as we connect about how they’re faring in the crisis and ways they’re coping with the isolation. Although emotionally exhausting, it’s been spiritually rewarding in a way I never expected. I relish the kindness of patients who express so much gratitude for their clinicians. And I, in turn, am buoyed by the opportunity to get to know my patients more intimately than a brief exam can afford. Recently, I was on the phone with a woman I’d gotten to know over the years. Previously raucous and ebullient, she struck me as uncharacteristically frail. Her husband had been ill for over a week, she told me. Unable to drive, afraid to leave the house, and without family in the area, she was struggling. I asked if she had food at home. Timidly, she responded that she didn’t. I could feel the shame in her voice. When we hung up, I did something I rarely do; I took a break. I got into my car, and texted my medical assistant. In minutes, she responded with the address of a grocery store near my patient’s home. And so, in the middle of my workday, I went shopping. With a cart full of food, I stood briefly in the parking lot and looked at the blue sky. I felt the warm sun on my face. I took a deep breath. For a passing moment, I almost forget the turmoil of the world around me. The drive to her home was unfamiliar. I parked my car beside the fence that surrounded her home. Hearing the car door close, she cautiously emerged from the entrance. When

she recognized me, her face lit up with that same warm-heartedness I’d grown to enjoy, her strength peeking out from beneath the strain of her situation. As I placed bags of food on the ground beside the gate, she stood beaming with hands together, almost as if in prayer. Then she started to weep. I gave her a wave from behind my mask, and then I, too, clasped my gloved hands. So much of my role as a health care leader and physician is to support my teams and push clinicians to practice at the top of their license. My work is also to nurture the kind of compassion, integrity, connection and empathy that so perfectly aligned on that afternoon—to remind myself and others of the important work we do every day in service of better, healthier lives. It was my first lunch break in as long as I could remember. I hadn’t eaten, but I was filled. I was reminded of just how blessed I am to be able to connect with the people and patients who give life so much meaning. And I was energized to move forward with grateful fortitude. — Dr. Neil Gokal, MD, is a primary care physician and the medical director of clinical education with Southwest Medical, part of OptumCare. He is also the site director and associate program director for Valley Health System family residency program, an assistant professor at the Department of Family Medicine at Roseman University and a member of UNLV’s adjunct clinical faculty.

Photo by Wade Vandervort

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“We take our everyday activities for granted. That includes the daily effort our teammates who put their hearts and soul into their work every day. It has been encouraging to see our staff ’s resilience and courage throughout this situation. Their commitment to show up every day to take care of our patients has been inspirational.” —Matt Grimes, Senior Vice President of Operations/COO, Desert Radiology

“Support those in need and check in on your neighbors. Pay attention to your mental health. Don’t feel guilty for being stressed, anxious or depressed about what’s going on. All you can do is your best and take one day at a time.” —Dr. Laurine Tibaldi, MD, Chief Medical Officer, UnitedHealthcare’s Health Plan of Nevada and Sierra Health and Life

“As someone who has been in the health care industry for more than 25 years, I’ve seen it all, but nothing compares to the unprecedented circumstances and global implications of COVID-19. Playing a role in health care means more than doing a job; it requires passion and a desire to use talent, education and a unique skillset for the greater good. The best thing I have heard recently is, “we do this work because we answered a true calling to do this work.” It means waking up every morning and knowing it’s another day and another opportunity to help others, provide treatment and potentially save lives.” — Dr. Wolfgang Gilliar, Dean, College of Osteopathic Medicine, Touro University Nevada

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mid concerns about the novel coronavirus overwhelming the nation’s health care infrastructure, Southern Nevada’s practitioners pulled together to support the community—they sourced PPE from unconventional places, pooled resources and prepared to weather an uncertain storm. These efforts saved countless lives while also making apparent a roadmap for necessary improvements. “The COVID-19 pandemic has brought to light many of the vulnerabilities of our health care system, however it has also highlighted the ability of health care professionals to quickly adapt to change, implement new processes and step up to the plate to provide safe, high-quality care,” said Andria Peterson, PharmD, NICU/Pediatric Clinical Staff Pharmacist, Co-Director- Dignity Health EMPOWERED program, Dignity Health-St. Rose Dominican, Siena Campus. It’s that ability to adapt and see the learning opportunities before us that will create a better future for medical care in Southern Nevada. “My best advice as we recover: we should not rebuild what we have had, but we need to build something new that better provides care for our entire community,” said Dr. Marc J. Kahn, Dean at the UNLV School of Medicine. Here is a glimpse into some of what we learned about medical infrastructure during the COVID-19 crisis.

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While some public health officials believe that it was only a matter of time before we were to face a pandemic such as COVID-19, many health care providers did not have comprehensive plans in place to deal with a disease outbreak on such a scale. Evaluating and updating plans based on what we’ve learned will be integral moving forward. “Many disaster scenarios prior to COVID-19, practiced by hospitals and outpatient facilities, were for mass casualty or weather-related disasters. I think the health care system is going to view disasters differently and prepare in a different way. I think there will be new cleaning standards and new ways of looking at personal protective equipment for employees. Just like 9/11 changed the way we travel, COVID-19 will change the way we prepare and deliver health care.” —Rich Bodager, Executive Vice President/ CEO, Desert Radiology “I would hope and anticipate all pandemic plans and patient surge plans will be scrutinized and updated using actual experiences, not anecdotal or ‘what if’ scenarios.” —John Morley, RN, BSN, Patient Safety Program Manager, Dignity Health-St. Rose Dominican, Siena Campus

Hospital surge capacity became the main area of concern for the health care community, as other cities and countries across the globe were unable to accommodate the influx of patients in need of care. The United States does not have enough ICU beds, ventilators, specialists or even PPE pipelines to provide for the level of care required in some worst-case scenario predictions. This awareness is inspiring change on an individual level, as hospitals, clinics and more are reframing their preparedness practices, as well as on a regional, national and global stage.

“The COVID-19 pandemic not only highlights the deficit of adequate personal protective equipment, but also magnifies the discrepancy between the number of health care providers and amount of people who need care. Further steps should be taken to ensure that health care providers have the necessary PPE if there is a second wave of COVID-19 or a future pandemic. Furthermore, the physician shortage is a known reality, and schools such as UNLV School of Medicine are working to rectify this situation by training future doctors to practice in Southern Nevada. An increase in physicians here, will help lessen concerns of overwhelming the health care system in a future pandemic.” —Lauren Hollifield, MS, MD Candidate, Class of 2021, UNLV School of Medicine “Our medical infrastructure was woefully unprepared for a crisis of this nature. We struggled on many levels, including supply chain issues, laboratory testing capabilities, supply preparedness in hospitals, safety in nursing homes and more. Nevada has adapted rapidly to the changing recommendations, data, and needs of our state, both by increasing testing capabilities, mobilizing medical providers and sourcing needed medical equipment/supplies. We will be ready for a second wave later this year should this be needed.” —Dr. Staci McHale, MD, President-Elect of Clark County Medical Society

According to a report from the Guinn Center, Nevada has the sixth highest uninsured rate in the country, with 14% of Nevadans, nearly 400,000 residents, without health insurance. Under normal circumstances, that can have dire consequences. During a major global health crisis, it can be catastrophic. The more Nevadans that have access to affordable health coverage, the better for the health care system and community at large.

“Many Nevadans don’t realize they can enroll in a health insurance plan year-round at Nevada Health Link if they experience a qualifying life event such as job or insurance loss. We encourage everyone to explore their options during this unprecedented time. In many cases, insurance through Nevada Health Link is cheaper than COBRA.” —Janel Davis, Communications Officer, Silver State Health Insurance Exchange/Nevada Health Link

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Front-line and essential workers were vulnerable to contracting COVID-19, but in the first months of the pandemic, other alarming patterns began to emerge. The CDC reports significantly higher hospitalization and mortality rates among black patients and higher mortality rates in Hispanic patients. Elderly and immunocompromised individuals were also at higher risk for hospitalization and death. Working to protect these populations and prioritizing care for those considered at-risk is necessary to save lives.

“Through the adversity faced over the past several months, innovative practices, novel business models, and the future of health care delivery has begun to reveal itself as the facade of our health care system more rapidly deteriorates. I think we’ve learned that by leveraging technologies like electronic health records and telemedicine, we can more efficiently deliver care while extending the impact of our valuable health care professionals. I think COVID-19 has placed a spotlight on the need to provide equal access to health care in the United States.” —Ryan Linden, CEO, Silver State Health “I think the current pandemic underscores the need for an academic medical center in Las Vegas and that the pandemic has revealed disparities in our current health care system. The virus has affected different groups with different mortality rates and has disproportionately affected service personnel who could not work from home.” —Dr. Marc J. Kahn, Dean, UNLV School of Medicine

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To prevent possible exposure and keep as many people, and patients, at home as possible, many doctors began offering telemedicine and video appointments in lieu of being seen in-office. Smart uses and better technology can continue to streamline and improve the process of receiving care. Even as we begin to lessen restrictions on social distancing, the access and convenience telehealth provides may endure. “The future of telemedicine is here now. We have to use technology to help improve it because the fundamentals of sound medicine are: Look, Listen and Feel. The feel part is tricky at this time, but there is a lot we can accomplish in a video chat by looking and listening.” —Howard Cohen, Pulmonary Respiratory Therapist, OptumCare Lung and Allergy Care “Virtual visits enable people to connect 24/7 with a health care provider on their smartphone, tablet or personal computer. This is especially valuable to anyone with a chronic condition or those of us who seek the immediacy and convenience of consulting a doctor without braving traffic or sitting in a waiting room with potentially infectious patients... We have been trying to promote, educate and utilize a robust telehealth strategy for years; COVID-19 propelled telehealth faster and broader than any of our previous efforts. These virtual patient-provider visits are now being embraced by physicians nationwide and may over time become a method of choice by consumers.” —Dr. Laurine Tibaldi, MD, Chief Medical Officer, UnitedHealthcare’s Health Plan of Nevada and Sierra Health and Life

Distillery workers Julian Morales, left, and Will Wood mix hand sanitizer at the Las Vegas Distillery in Henderson on May 13. The distillery switched from making distilled spirits to hand sanitizer in order to help in the fight against the novel coronavirus. (Steve Marcus/Staff)

“The health care system, although stressed at times, came to the aid of our community. However, this crisis did cause a tremendous economic effect on the health care system. The disruption caused many workers to be furloughed, physicians to take massive reductions in pay and put an economic strain on many medical groups, private practices and hospital organizations. We also need to work with our government to develop better ways to support the health care industry economically during similar types of crisis. Although Las Vegas was greatly affected, we were not hit as hard as some rural areas. Some of these hospitals and medical groups in these areas may not recover, leaving communities without proper health care.” —Matt Grimes, Senior Vice President of Operations/COO, Desert Radiology

The economic impact of the coronavirus pandemic is vast and far-reaching—and no industry was left unscathed, including medicine. Providing support for small practices and clinics will be crucial for their survival moving forward.

“The key weakness of the medical infrastructure is that it is a high volume, low margin business model. The overhead costs of running a hospital are considerable and without the patient volume to match that overhead, financial crisis is probable. Unlike other civic services (police, fire, etc.), hospitals are more subject to health care market fluctuations. I would support some form of crisis funding to be an outcome of this COVID-19 pandemic in order to compensate the economic model of modern medicine.” —Dr. Michael Allswede, DO, Program Director Emergency Medicine Residency, Sunrise Health GME Consortium

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There’s one thing for certain. These dedicated medical professionals will do anything for the health and safety of a community in crisis. Now they offer their sound advice to help us all move forward, starting with taking care of ourselves and our families.

CONTINUE TO BE PROACTIVE

As we continue to fight COVID-19 as a community, we need to support our health care workers and do our part to help stop the spread of this disease. Here’s how:

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■ Wear a mask when you must go into public.

■ Continue to practice safe social distancing.

■ Wash your hands often and thoroughly.

■ Stay home when possible.

■ Contact your health care provider if you believe you have or have been around someone that has been infected.

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“Taking care of your personal health is something that cannot and should not wait nor continue to be put on the back burner. As the global medical and scientific community continues to work toward the development of a vaccine, we cannot afford to let COVID-19 get in the way of preserving overall personal and public health. We have too much at stake to delay taking care of ourselves, our families and our communities.” —Brian Knudsen, Las Vegas City Councilman Board Member, Southern Nevada Health District Advisory Committee Member, Las Vegas Medical District

“Embrace compassion and understanding in trying times such as this. Continue to follow the best-known guidance provided by science and our designated leaders, not news or gossip.” —Joe Sandy, RN, House Supervisor,  Dignity Health-St. Rose Dominican, Siena Campus

Now is not the time to cancel your health insurance. Work with your insurance carrier to see if you can receive more subsidies to lower your monthly premium. Everyone deserves access to quality health care and the peace of mind that comes with knowing you and your family are covered should the unexpected happen.” —Janel Davis, Communications Officer, Silver State Health Insurance Exchange/Nevada Health Link

“All the hype and hysteria is damaging to our psyche. This pandemic has caused a lot of stress and anxiety and it is not good for our health. COVID-19 isn’t going to go away. We will eventually vaccinate our way out of it, but this is our new reality and we do have to rethink the way that we do everything. Pay attention to your mental health and take care of yourself. ”  —Dr. Marwan Sabbagh, MD,Director of Cleveland Clinic Lou Ruvo Center for Brain Health

“Be careful, be safe, and protect and teach your kids and family good hygiene techniques. Little ones are like sponges and watch everything adults do, so show them how it’s done correctly.” —Reginald Evans, Pulmonary Respiratory Therapist,  OptumCare Lung and Allergy Care

“Only through shared action, community support and true collective planning can our city overcome the challenges of the future. We need to take the months and years that come after COVID-19, and better understand how we can create a system that is part of a moving whole, instead of an isolated cog.”  —Ryan Linden, CEO, Silver State Health

“Show respect for your health care providers and front-line workers by continuing to wear facial coverings when in public. Covering your face shows that you care about protecting others. ... Understand that many of us who have worked to keep our city going during this crisis continue to feel anxious about the spread of COVID-19, and highly appreciate those who keep us protected by wearing a facial covering.”  —Dr. Staci McHale, MD, President-Elect of Clark County Medical Society

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BY HEALTH CARE QUARTERLY STAFF It may be a sensitive topic, but we all do it. Because it’s second nature, you probably don’t pay it much attention. How often should you go? What should it look like? Is it OK if it smells? You may be embarrassed to ask your doctor these questions but you should know what is considered healthy urine and stool waste. As with many things, human waste is not an exact science. What may be normal for one person may be completely abnormal for another. It’s important to consider what your normal is and that you are consistent with that normal expectation. Use the guidelines below as reference for what is typical, and ask questions at your next checkup if something seems a little off. Remember, doctors have heard it all and they are there to answer your health questions, no matter how uncomfortable the topic.

Liquid waste is made as your kidneys filter toxins and excess water from your blood. Urine mostly consists of water, salt, electrolytes, such as potassium and phosphorus, and chemicals referred to as urea and uric acid. The bladder acts as a reservoir, storing the urine. With a healthy urinary system, your bladder can hold up to 16 ounces of urine comfortably for two to five hours. The amount of urine produced for each person depends on several factors, such as liquid and food intake and the amount of fluid expelled through sweat and breathing. As the bladder fills to capacity, a signal is sent to the brain to tell you to find a toilet soon.

FREQUENCY

TIMES PER DAY ON AVERAGE

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Most people urinate six to seven times in a 24-hour period, but anywhere from four to 10 times a day is considered normal if you are healthy. During normal urination, the urine stream starts slowly and speeds up until the bladder is nearly empty. For men, if you have a weak or inconsistent urine flow, it could be from an enlarged prostate. For women, it could be a bladder prolapse causing problems with your stream.

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COLOR

CONSISTENCY

Urine naturally carries a yellow pigment in color but this can change given your environment and diet. Healthy urine should be a pale yellow to gold shade. If you’re well hydrated, your urine will be a very light yellow or close to clear. If you’re nearing dehydration, your urine will become deep amber or light brown. Keep in mind, foods you eat or medications that you may take can be carried into your digestive tract and change the color of your urine. For instance, if you ate beets or blueberries, your urine may appear red or pink in color.

Fully Hydrated

Hydrated

If your urine has a cloudy appearance, it could be a sign of a urinary tract infection, and if accompanied by foam or bubbles, this could be a sign of excess protein intake or a symptom of a more serious health condition, such as Crohn’s disease or diverticulitis. Bubbles that flush away are normal, but they can be considered abnormal if they persist after flushing.

Fairly Hydrated

Dehydrated

Slightly Dehydrated

Very Dehydrated

Severely Dehydrated

SMELL

Usually, urine doesn’t carry a strong smell but as with color, some foods can change the odor. Asparagus and vitamin B-6 supplements are common dietary influences on urine smell. If you’re dehydrated and your urine gets very concentrated, it can have a strong ammonia stench. In some cases, a strong odor could be a sign of a UTI, diabetes, bladder infection or metabolic diseases.

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Your digestive system works by pushing food through the intestines, absorbing fluids and nutrients along the way. Once the food reaches the colon, it is time to store, process and expel waste. The waste travels to the rectum, which stretches and triggers a message to the brain that the bowel is full and needs to be emptied. Stool is essential to human function, as it carries waste away from our bodies.

Water

CONSISTENCY

Ideal stool appearance and consistency should be sausage-shaped with cracks on the surface or snake-like, smooth and soft. If your stool is made of separate, hard lumps or it is sausage-shaped but lumpy, you are likely constipated. Stool that is soft blobs with clear-cut edges, fluffy pieces with ragged edges and mushy or watery with no solid pieces typically indicates diarrhea.

Dead and living bacteria, undigested food residue or fiber, protein, fats, salts and cellular linings of the gastrointestinal tract

WHEN SHOULD YOU CALL YOUR DOCTOR?

PER DAY TO 3 A WEEK

FREQUENCY

The frequency of bowel movements varies greatly person to person. It is generally accepted that anywhere from three bowel movements a day to three a week can be considered normal. Most people have regular bowel movements, going about the same number of times a day and even at similar times each day. Diet, age and activity level are all factors in how often you need to defecate. Stool should be soft and relatively easy to pass. Loose stools passing too fast can be a sign of a digestive irritation. Stools that are difficult to pass can lead to hemorrhoids and cause backup in your intestines. Medically reviewed by David Ludlow, MD, and Jeffrey Wilson, MD, urologists at Urology Specialists of Nevada.

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If you canâ&#x20AC;&#x2122;t link changes to the appearance, frequency or scent of your urine or stool to a new medication or a recent meal, it may be time to call. Always seek immediate medical attention if there is blood in your urine or stool. If the changes in your normal routine last more than a couple days, your doctor can help you determine the root cause and begin treatment.

CONSTIPATION

SMELL

IDEAL CONSISTENCY

The smell of stool varies quite a bit depending on your diet and whatâ&#x20AC;&#x2122;s going on in your body. It is completely normal for your stool to have an unpleasant smell. If your stool becomes foul-smelling, it could be from food or bacteria in your colon. Some medications and supplements also cause gastrointestinal discomfort and antibiotics may cause foul-smelling stools until your normal bacterial flora is restored. Malabsorption or infection are also potential causes of an increased foul odor to your stool.

COLOR

DIARRHEA

Stool should typically be a light to dark brown color due to the breakdown of red blood cells in the body. Changes in diet can produce varying stool colors, however. Food such as beets, green vegetables or licorice can have an impact on the color of your stool, and drinks with heavy dye such as Kool-Aid can have a similar effect. There are potential illnesses that can cause non-brown stool as well, including gallbladder disease, celiac disease, ulcerative colitis, Crohnâ&#x20AC;&#x2122;s disease, tumors and cancers.

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Understanding addiction in times of crisis

BY MATT NIELSEN

ince 1980, Dr. Michael S. Levy has been helping people deal with substance use disorders. In 1995, he established the first medical practice in Nevada specializing in addiction medicine. Over this period, the field of addiction medicine has changed drastically. Advancements in science and technology have allowed experts similar to Dr. Levy to not only treat patients with substance use disorders more effectively, but to also better understand the underlying factors that cause these issues in the first place.

Dr. Michael S. Levy is the founder and medical director of the Center for Addiction Medicine. Matt Nielsen is an assistant account executive with The Ferraro Group.

What kinds of addictions are more prevalent today?

For the purpose of definition, let’s start with a reference to diagnostic and statistical manual diagnostic parameters for “substance use disorders,” rather than addictions. These definitions, when combined with patient placement criteria, allow the physician to provide the patient a set of recommendations based on science and without judgement or criticism. The most prevalent substance use disorder for many years has been the opioid class of drugs. We felt this had reached epidemic proportions before the recognition that this was a national crisis. Initially, the opioid crisis was primarily focused on the U.S. Drug Enforcement Administration’s scheduled drugs for treatment of acute and chronic pain. In my practice we saw this change approximately 15 years ago. Alcohol has continued to be a significant problem. The interesting change is that there are now minimal gender differences in the incidence of alcohol use disorders. The pain pill problems have significantly decreased with the advent of greater scrutiny and oversight on prescribing physicians and phar-

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macies. Unfortunately, the primary opioid that we have seen on a regular basis is heroin, usually in combination with methamphetamine.

What are the signs of someone who may be dealing with substance addiction?

With any substance use disorder, there are recognizable and consistent signs and symptoms that are both physical and behavioral. Observations of change will be provided by those closest to the individual and provide valuable information. Behavioral changes may be subtle and are usually progressive as are the physical changes. Sleep, appetite, changes in bowel habits that may be combined with secretive behaviors, isolation, financial stress. The list goes on and on.

During times of crisis like we are currently facing, do addictions tend to rise among people?

From the literature I’ve been reading, relapse has increased by about 60% across the country, as well as domestic violence, anxiety, depression and substance use. It’s easy to see why — the certainty that we relied on in life no longer applies. Anxiety over the return of jobs in this city and how folks are going to take care of their families if those jobs don’t come back are the pragmatic issues. For some, self-medication provides a temporary respite to reality. And that can progressively lead to a substance use disorder.

What are some tips you can give to people who might relapse or face new addiction issues?

There is still help available. Our practice is open and there is a litany of online resources that are available. Some might not have access to the internet. For those individuals, it may feel as though they’ve lost their connection to life. Friendship and family are crucial in today’s world. It is important not to treat people suffering from addictive disease with criticism or judgement. It is considered a chronic progressive relapsing disease of the brain that may be fatal. It is a medical disorder and it’s important that physicians have an understanding of this disorder because they will see it on a regular basis. We make every effort to not use labels and to treat our patients with respect and dignity. It is a difficult disease to treat and there are varying

measures of success. However, people donâ&#x20AC;&#x2122;t die from treatment and recovery, they die from active disease.

How can family or friendâ&#x20AC;&#x2122;s help someone who is facing addiction?

There is a certain amount of responsibility that comes with recovery. This is a disease that may go into remission for undetermined periods that may last years, and in some cases, remission may last a lifetime. The role of the family and friend is critical. Learn as much as they can about the disease. Provide a mechanism for communication that is dependable and reliable. Be supportive without enabling. Recovery isnâ&#x20AC;&#x2122;t easy. Recovery by itself may not change the altered brain chemistry or damaged receptor sites, and changes in neurotransmitter production that may persist long after the last use of the drug. This condition is manifested by anxiety, irritability, change in sleep patterns, mood swings in the initial stages, and represent a high risk for relapse. Family and friends would benefit in understanding stages of this disease to better understand what their loved one was experiencing. Treatment is always recommended.

What trends do you see for the future of addiction medicine?

We have known for many years that substance use disorders are consistent with a brain disease. To this point, we have had few therapeutic options to effectively treat the disease. We now know that repetitive magnetic pulses to specific areas of the brain may result in changes to the neuroplasticity of the brain with reduction of drug craving, improvement of sleep and elevation of dopamine levels. At the Center for Addiction Medicine we are preparing to introduce EEG-guided electromagnetic brain pulse to our community. This is a non-pharmaceutical approach to treatment that is revolutionary. For me, after the privilege of being in this field for almost my entire career, this electromagnetic pulse treatment represents a quantum leap for the field of addiction medicine.

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Surgical procedure treats disabling neurological symptoms

BY LAGUARDIA MEDIA AND PUBLIC RELATIONS

eep brain stimulation (DBS) has been heralded as one of the most remarkable breakthroughs in the treatment of movement disorders. In an interview with expert neurosurgeon Dr. Scott Glickman, the mystery behind this treatment is revealed.

What is deep brain stimulation?

Dr. Scott Glickman, DO, FACOS, is a board-certified neurosurgeon with the Las Vegas Neurosurgical Institute for Spine and Brain Surgery.

DBS is often described as a pacemaker for the brain. It works much like a pacemaker, sending electrical signals to the brain instead of the heart. It is primarily utilized for patients who have Parkinson’s disease, dystonia or essential tremor who can’t adequately control their disease with medication or the side effects of the medications are intolerable or disabling.

What does it do for the patient?

For those with Parkinson’s disease, DBS can reduce tremors and significantly improve slowness and stiffness, and make tremors disappear or significantly improve for those with essential tremor. DBS can help relax the neck muscles and improve abnormal posture and head position caused by muscle contractions for those with dystonia. In all cases, DBS can dramatically help enhance patients’ quality of life. It’s important to understand that DBS does not offer a cure for your disease, but a way to manage it more effectively.

What does DBS feel like when the device is on?

During the programming or reprogramming of the DBS generator, individuals may experience slight, temporary shocks or tingling as

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placement and levels are adjusted. Identifying the best lead stimulation combination and levels enables the greatest benefit possible based on each patient’s unique condition and needs. Most individuals feel little if any sensation at all during normal use, other than the ability to function better. For those who do, it is described as a slight tingling down an arm or leg, or mild facial pulling, which most commonly subsides over time. This is more common in individuals using DBS for essential tremor as the device can be turned off at bedtime.

Where would you put the DBS  stimulator if a patient already has a pacemaker?

Cardiac pacemakers are typically placed in the same location on the chest where DBS stimulator generators are placed. Cardiac pacemakers are most commonly placed on the left side of the chest, while the DBS stimulator is most commonly placed on the right side of the chest. Other alternatives include placement of the DBS generator in a similar pocket anywhere in the abdomen. The extension wires to abdominal locations need to be longer, but that does not impact the function of the DBS.

Does undergoing DBS prevent someone from getting other treatments that arise in the future? One of the advantages of DBS is that it is reversible. The stimulator can be turned off and the hardware can even be removed. Undergoing placement of DBS now should not prevent you from getting another treatment in the future. One thing to be aware of in any condition is that during the clinical testing phase for new treatments, if you have had any prior treatment (such as DBS or other surgery), you may not be able to participate in the trial because they are often restrictive in their inclusion criteria. However, other trials or arms of a clinical trial may specifically target patients with prior DBS or surgical treatment.

What is the success rate of DBS?

DBS is a highly successful and satisfying procedure for patients with appropriate indications. In fact, greater than 92% of patients report being happy with their DBS, 95% would recommend it to others and more than 75% report adequate symptom control. DBS is associated with increasing the 10-year survival rate of patients by 51% as well.

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What to do if you have allergy symptoms:

Differentiating symptoms: Cold, flu, allergies or COVID-19? BY DR. JIM CHRISTENSEN

I Dr. Jim Christensen, MD, is an allergist-immunologist with OptumCare Lung and Allergy Care.

t seems to happen every year. You’re not feeling so great. Maybe you have the sniffles. Maybe even some sneezing and a sore throat. Is it a cold, flu or allergies? It can be hard to tell them apart because they share so many symptoms. And in recent months, it has become more complicated — and perhaps a little scary. Is it a cold, flu, allergies or COVID-19? Cold, flu, COVID-19 and allergies all affect your respiratory system, which can make it hard to breathe. Each condition has key symptoms that sets it apart. Understanding the differences will keep you at your healthiest and help you choose the best treatment.

Allergy symptoms

Allergy symptoms occur when your immune system overreacts to something that is harmless to most people but triggers a reaction in someone sensitive to it. This substance is known as an allergen. Symptoms of seasonal allergies can include itchy nose, mouth, eyes, throat, runny nose, sneezing and watery eyes. Other symptoms may include clogged ears and decreased sense of smell, cough, headache, fatigue, puffiness or itchiness around the eyes, sore throat and stuffy nose. While sneezing is often associated with both allergies and the common cold, there are other symptoms that can help some people determine the difference. The common cold is usually not associated with itchy eyes. If you have a cough, that’s usually more strongly associated with a cold than allergies, except for those with allergic asthma.

Take steps to reduce your exposure to the things that trigger your allergy symptoms. Stay indoors on dry, windy days and take extra steps when pollen counts are high. Check for pollen forecasts and current pollen levels, and if high pollen counts are forecast, start taking allergy medications before your symptoms start. Close doors and windows at night or any other time when pollen counts are high, avoid outdoor activity in the early morning when pollen counts are highest, and keep indoor air clean. Several types of over-the-counter nonprescription medications can help ease allergy symptoms. They include oral antihistamines, different types of nasal sprays and combination medications (some allergy medications combine an antihistamine with a decongestant). When these steps aren’t enough, see your doctor.

Cold symptoms

Most people get colds in the winter and spring, but it is possible to get a cold any time of the year. Colds generally do not result in serious health problems, such as pneumonia, bacterial infections or hospitalizations, and most people will recover from a cold in about seven to 10 days. Symptoms usually include cough, headache, muscle or body aches, runny or stuffy nose, sneezing and sore throat. What to do if you have cold symptoms:

While there is no cure for a cold, to feel better you should get lots of rest and drink plenty of fluids. Over-the-counter medicines often help ease symptoms, but they will not make your cold go away any faster — and antibiotics will not help you recover from a cold caused by a respiratory virus. They do not work against viruses, and they may make it harder for your body to fight future bacterial infections if you take antibiotics unnecessarily.

Flu symptoms

The flu is a contagious respiratory illness caused by influenza viruses. It can cause mild to severe illness, and at times it can be deadly. Flu symptoms usually emerge suddenly. People who are sick with flu often feel some or all of these symptoms: cough, fever, or feeling feverish or chills, fatigue, headache, Story continued on page 46

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Story continued from page 44 muscle or body aches and runny or stuffy nose. Some people may have vomiting and diarrhea, although this is more common in children than adults. Flu and the common cold are both respiratory illnesses, but are caused by different viruses. Because they have common symptoms, it can be difficult to tell the difference based on the symptoms alone. In general, flu causes an illness that is worse than the common cold, with symptoms that are more intense. People with colds are much more likely to have a runny or stuffy nose. What to do if you have flu symptoms: Most people with the flu have mild illness and do not need medical care or antiviral drugs. If you get sick with flu symptoms, in most cases, you should stay home and avoid contact with other people except to get medical care. However, if you have symptoms and are in a high-risk group, or are very sick or worried about your illness, contact your health care provider.

DIFFERENTIATING SYMPTOMS

Flu, cold, allergies and COVID-19 The chart below indicates which symptoms are common with each illness Frequently

Occasionally

COVID-19 FLU

Rarely

None

COLD ALLERGIES

Cough

Fever

Breathlessness

COVID-19 symptoms

People may have COVID-19 for one to 14 days before developing symptoms. The most common symptoms are dry cough, fever, or feeling feverish or chills, and shortness of breath. Other symptoms that have been reported include nausea, vomiting, diarrhea, disorders of smell and taste, and body aches and fatigue. According to the Centers for Disease Control and Prevention, there are reports of asymptomatic infections (detection of virus with no development of symptoms) ranging from 2550% of cases, which is why isolation and social distancing has been effective in diminishing its spread. What to do if you have COVID-19 symptoms: If you have COVID-19, or suspect you are

infected with the virus that causes COVID-19, it is essential you take steps to help prevent the disease from spreading to people in your home and community. If you develop a fever and symptoms, such as cough or difficulty breathing, call your health care provider for medical advice. About 80% of people can recover from the disease without needing special treatment. Older people, and people with other medical conditions (such as asthma, diabetes, or heart disease), may be more vulnerable to becoming severely ill.

Body aches

Headache

Fatigue

Sore throat

Diarrhea

Runny nose

Sneezing

Watery eyes Source: World Health Organization; Centers for Disease Control and Prevention

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National fitness campaign declares decade of healthy infrastructure BY MITCH MENAGED

Mitch Menaged is the founder of the National Fitness Campaign and Fitness Court.

ccording to the World Health Organization, obesity rates have nearly tripled worldwide since 1975, and nowhere is worse than right here in the U.S. where a staggering 39.6% of the adult population is obese. Obesity increases other health risks and it costs $147 billion in added medical expenses per year in the U.S. We’ve been living in cities built for cars for too long, and the result of our driving culture is obesity rates at epidemic levels. The trend towards building and supporting healthy infrastructure is gaining momentum around the country. It’s becoming abundantly clear that when we design an environment to support human-powered movement, entire communities benefit. To challenge these statistics and ignite change across the country, the National Fitness Campaign, an organization that specializes in funding, activating and promoting healthy infrastructure through partnerships with cities and schools, has officially declared 2020 the kick-off year for a Decade of Healthy Infrastructure. You may be wondering what is healthy infrastructure?

Healthy infrastructure is the parks, the Fitness Courts and trails that form a human-powered network, encouraging and motivating people to get outdoors and into a healthier, active lifestyle. It includes the adoption of programs to promote human power for transportation, recreation and fitness, resulting in better health, longer life and improved happiness and wellbeing. It’s about developing the built environment in ways that get people out of cars and connected in a more involved way with their friends, neighbors and community. The Fitness Court is the centerpiece of healthy infrastructure as the world’s best outdoor gym. The Fitness Court delivers the most effective full-body high-intensity interval workout in seven minutes or less, regardless of age or fitness level. It was designed by a team of experts in exercise science, fitness and design and includes an integrated application that is regularly updated, delivering seven new fitness routines every 12 weeks. Free classes, taught by NFC trained ambassadors, are also available at most locations and Fitness Courts are always free for everyone. The momentum is growing to use the built environment to chip away at the current health crisis of obesity with cities across the country expanding the number of parks and miles of trails to draw more people outdoors and into a healthier way of life. The National Fitness Campaign believes that adopting a healthy lifestyle is contagious and being around fit, happy people on trails or the Fitness Court inspires, encourages and motivates everyone to improve their health. Despite a slight decline over the last two years, commuting by bicycle has increased 40% over the last 20 years. According to the National Association of City Transportation Officials, bike share programs in the U.S. have continued to experience rapid growth,

Healthy infrastructure is the parks, the Fitness Courts and trails that form a human-powered network, encouraging and motivating people to get outdoors and into a healthier, active lifestyle.

Story continued on page 49

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Healthy infrastructure is free to the public and designed to get people outdoors and active. (Courtesy)

Story continued from page 47 with 35 million trips taken in 2017, 25% more than in 2016. And the number of bike-share bikes more than doubled – from 42,500 at the end of 2016 to about 100,000 by the end of 2017. With investments in healthy infrastructure, there’s less traffic on the roads, the air is cleaner and people are healthier and happier. With the Decade of Healthy Infrastructure, perhaps we can move the needle and bring people outdoors, connecting with healthy resources and ways of moving through their lives on human power. I am proud to say that in just the last two years, NFC has raised more than $25 million in over 100 cities and has made free worldclass fitness available to millions of people of all backgrounds. Supported by hundreds of local, regional and national sponsors who believe in the mission to provide free fitness for all while building healthy infrastructure across America, the NFC continues to grow and has commitments for 1,000 Fitness Courts by 2022. We recently celebrated the unveiling of the 100th Fitness Court in Las Vegas as part of NFC’s Model City Program, a comprehensive plan connecting people with trails, parks, Fitness Courts, bike-share programs, access to healthy food, hydration, services and hubs to connect it all. With over 50 major cities in the queue after Las Vegas, and another 50 projected by the end of 2022, it is through the Model City Program that NFC will build and support healthy infrastructure, while fighting the obesity epidemic going forward. Learn more about NFC at NationalFitnessCampaign.com and follow us on social @NatFitCampaign.

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UNLV medical students overcome challenges, dedicate lives to helping others

BY PAUL HARASIM

Paul Harasim is the editorial associate director of UNLV School of Medicine.

eel good stories — the slices of life that support the conviction that a combination of talent, attitude and hard work can overcome adversity — have fueled our belief in the American dream. Such stories, including two about UNLV School of Medicine students who’ve overcome incredible challenges, are an example of the pursuit of that dream. “My mom was a single mother... In my early childhood, we were evicted from apartments because what my mom made didn’t cover all the bills,” Caleena Longworth said. “We’d move in with grandma and grandpa into their small 16-foot RV. There were six of us, so it was pretty tight.”  Longworth’s goal of becoming a family physician began in the wake of a childhood surgery to overcome a life threatening kidney condition. Despite a chaotic home life that saw her studying when not working part-time at a casino or in retail, Longworth was a high school honor student. She enlisted in the Air Force and used the GI Bill to graduate from University of Nevada, Reno. Now an officer in the Nevada Air National Guard while in medical school, Longworth has been in charge of the Guard’s presence at the UNLV Medicine curbside testing program for COVID-19, the leading testing center in the state. “I could have been angry about the hand I was dealt,” Longworth says. “But I think it

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made more sense to work hard and do well so I could make the world a better place.” Fellow medical student Arturo Montes still marvels that he’s on the path to become a physician. “I’m the first in my family to even graduate from high school... I didn’t even think of going to college until I was 18,” Montes said. As a child, Montes’ family of four moved from East Los Angeles to Las Vegas to find jobs. “We had little food to eat... We were hungry a lot,” Montes said. His father worked 80 hours a week as a custodian and dishwasher, while his mother became a full-time casino porter. With his parents from Mexico and El Salvador, Montes grew up speaking Spanish. “I didn’t start to speak English until I entered kindergarten,” Montes said.

As his parents studied to become citizens, Montes completed high school, but he admits to concentrating more on football and wrestling than his studies. It was when he nearly lost his mother — who suffered a heart attack when he was 18 — that he found his calling. As his mother recuperated, Montes thought about watching the cardiologist that brought her back to life. “I realized I wanted to help people in much the same way as that doctor helped my mother, “ said Montes. “I wanted to be a doctor.” While working as either busboy or custodian, Montes studied at College of Southern Nevada before transferring to UNLV where he graduated with dual majors in kinesiology and biology. Professors at the school acted as mentors, as did a doctor who allowed Montes to shadow him, to see what it was like to be a physician. “I want to give back to this community,” Montes says. “I love this city...my family was given a chance here.”

Top: Caleena Longworth, an officer in the Nevada Air National Guard and UNLV School of Medicine student. Left: Arturo Montes works on his studies at UNLV School of Medicine. (Courtesy)

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Staying skin smart as we venture outside

BY DR. WOLFRAM SAMLOWSKI, MD, FACP

Dr. Wolfram Samlowski, MD, FACP, is a medical oncologist at Comprehensive Cancer Centers and expert in treating melanoma and skin cancer. He serves on the clinical faculty at University of Nevada, Reno School of Medicine and UNLV School of Medicine. He also participates in the Health Economics and Outcomes Research Program of US Oncology/McKesson. For more information about Comprehensive, visit www.cccnevada.com or call 702-952-1251.

uring this time of quarantine and with only the periodic escape outside to enjoy some fresh air, you may forget to apply your sunscreen. As the weather warms up and we find ourselves venturing outdoors that much more, it’s important to stay skin safe amid the harsh sun. It could even save your life. Skin cancer is the most common cancer in the United States. In fact, more than 5 million basal and squamous cell skin cancers are diagnosed each year. Locally, according to the American Cancer Society, nearly 840 Nevadans will be diagnosed with melanoma this year. At Comprehensive Cancer Centers, we hope you never have to step foot inside one of our facilities due to cancer, especially skin cancer. However, we know certain factors may put people at higher risk for getting melanoma, such as age, fair skin and family history, but it’s important to remember that anyone can get it. With such a high number of reported cases each year, skin cancer is one of the most preventable forms of cancer. When this type of cancer is so preventable, why is it still so common, particularly locally? The answer boils down to a person’s exposure to ultraviolet (UV) light, either via the sun or artificial sources such as tanning beds. UV rays can damage your skin in as little as 15 minutes, especially where the UV index can easily reach extreme levels in the summer, like here in Southern Nevada. Increased exposure over time can, and will, increase your risk of developing skin cancer. Skin pigmentation and ability to tan is another important consideration. Most people

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know from experience whether they burn easily every time they go out into the sun. Others burn then tan. Some tan easily and seldom burn. The need to limit sun exposure to prevent sun damage relates to frequency of sunburns, especially early in life. Protecting children from sunburns, therefore, is a high priority to prevent skin cancers. If you and your family practice all the right ways to protect your skin when you have to go outside, you will significantly decrease your risk of getting skin cancer.

Stay safe and recognize the ABCDEs of melanoma

Protection from UV rays is important not only during the summer, but all year round. Before 9 a.m. and after 7 p.m. are good times for outdoor activity, as there is very little UV light that penetrates the atmosphere. Harmful UV rays peak in the middle of the day. While enjoying time in the midday sun, here are a few tips to keep in mind: n When possible, wear wide brimmed hats, sunglasses and long-sleeve shirts to protect your skin n Remember to reapply sunscreen to your feet, lips, hands and under straps n Ball caps do not protect your ears, back of the neck or side of the face n Clouds do not reduce UV rays n A sunburn is actually a burn and can permanently damage your skin n Use sunscreen with a SPF of 30 or higher regularly and reapply frequently Additionally, it’s important to recognize the patterns of any marks on your skin, including moles and freckles, and check them once a month. At home, you can use the ABCDE method: n Asymmetry — one half of the mole does not match the other half n Border irregularity — the edges of the mole are ragged or notched n Color — the color of the mole is not the same all over n Diameter — the mole is wider than a quarter-inch n Evolution — changes over time (This is the single most important feature!) Story continued on page 54

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Children utilize free sunscreen, courtesy of Comprehensive Cancer Centers, at Moapa Recreation Center. (Courtesy)

Story continued from page 52 The ABCDE method can help distinguish between a regular mole and melanoma, but if there is a mark that is of concern, it’s best to consult with your doctor.

Diagnosis and treatment

If you have a new growth on your skin, a sore that doesn’t heal or a change in an old growth, it’s time to see a doctor. If cancer is suspected, your physician may perform a skin biopsy of the affected area, and additional testing may be needed to determine if it has spread to other parts of the body. Treatments are different for types and stages of cancer, but there are a range of options available that can include surgery, radiation therapy, chemotherapy and immunotherapy. Skin cancer is generally very treatable, especially when diagnosed early. Early detection and screenings can be a matter of saving your life, and you can even do an at-home screening before seeing a doctor.

Death rates are dropping

At the beginning of 2020, the American Cancer Society announced that cancer death rates had recently dropped 2.2%, marking the largest single-year drop ever. The large decline, utilizing data from 2016 to 2017, is due to a drop in skin and lung cancer deaths, and is a reminder that we are continuing to improve as research grows. Amid stable to decreasing death rates, the inci-

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dence rate of melanoma and skin cancer is increasing, with new melanoma cases alone increasing 47% nationally from 2010 to 2020, according to the American Cancer Society. To help locally, Comprehensive has implemented a number of skin safety partnerships within the community to raise awareness and prevent any unnecessary skin conditions while enjoying time outside. This year, Comprehensive has been named the exclusive sun safety partner in Southern Nevada for the American Cancer Society. As we navigate the pandemic environment, Comprehensive is working with its various partners to promote skin safety and offer free sunscreen in community spaces. The practice’s recent partners have included Clark County Parks & Recreation, the Regional Transportation Commission of Southern Nevada, Las Vegas Aviators, Vegas Golden Knights, Las Vegas Lights, UNLV, Downtown Summerlin, Springs Preserve, Cadence master-planned community and Cowabunga Bay. We have also provided sunscreen packets and sun safety tips to workers with the PENTA Building Group at job sites in Las Vegas and Southern California. In the coming years, with effective skin safety education and implementation, we can achieve an even more significant drop in skin cancer diagnoses and deaths. By adhering to preventative measures and staying skin smart, you can prevent ever having to step foot in one of our clinics with a skin-related illness.

from our local government with each annual launch of the program. In 2018, for the first time, we partnered with leading health care provider, Henderson Hospital. Henderson Hospital is the anchor hospital for our Henderson community and prides itself on providing quality care to each and every patient. This partnership has been instrumental in the continued success of our Safe Pools Rule! campaign. While first responders may be the first on the scene, it is the health care professionals who provide the ongoing, life-saving medical services necessary to save a life following our emergency response to a submersion incident. BY DAN PENTKOWSKI “Henderson Hospital is proud to n Southern Nevada, there are partner with the Henderson Profesthousands of private and com- sional Fire Fighters for their Safe Pools munity pools that are enjoyed Rule! campaign,” said Sam Kaufman, by more than 50 million visitors CEO of Henderson Hospital. “Safe and residents each year. Henderson, Pools Rule! provides a platform for and more broadly the City of Las Vegas, our hospital to share insight from the are known for high health care perspecsummer temperatures tive and reiterate the and an extended pool importance of a comseason. munity-based camIn 2011, the Henpaign that is focused derson Professional on the well-being of Fire Fighters saw a our most precious need for a commuassets, our children.” nity-based safety We are excited to campaign centered on have Henderson Hosdrowning prevention, pital as a partner for leading to the creation our 2020 Safe Pools of Safe Pools Rule! Rule! campaign, and This campaign aims to have united with a educate the commuhandful of impactnity on the imporful partners for this tance of water safety year’s launch, includSam Kaufman and provides tips to ing Life Time Fitness, CEO of Henderson Hospital prevent submersions the Henderson Fire and drownings from Department and the occurring. American Red Cross. Over the past nine years, Safe Pools Together, we look forward to another Rule! has been reimagined to better successful year of Safe Pools Rule! reach our ever-changing audience and and hope you all have a safe and fun community. To strengthen our camsummer! For more information about paign, we have partnered with various our campaign, visit our Henderson organizations that align with our misProfessional Fire Fighters social media sion and have received ample support pages.

Community partnership helps make pool safety a priority

I Dan Pentkowski is the president of the Henderson Professional Fire Fighters.

“Safe Pools Rule! provides a platform for our hospital to share insight from the health care perspective and reiterate the importance of a community-based campaign that is focused on the well-being of our most precious assets, our children.”

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A patient at the Cleveland Clinic Lou Ruvo Center for Brain Health participates in an art making class. (Courtesy)

Paving the path to Alzheimer’s disease prevention

BY DR. MARWAN SABBAGH, MD

Dr. Marwan Sabbagh, MD, is the director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

t’s been 15 years since the last Alzheimer’s drug was approved and while researchers around the world are working toward a cure, the current drug failure rate for Alzheimer’s disease is 99.7%. There’s no sugarcoating it: this is a volatile time for drug development. But what we lack in drug development, we make up for in a relatively new frontier in Alzheimer’s disease: prevention. The concept of prevention is keeping the disease from developing rather than treating its onset. We’ve seen prevention used as a strategy in heart disease and now are seeing a similar transformation in the way we look at Alzheimer’s disease. The enthusiasm for this approach continues to build following a recent study in Lancet Neurology, which found that one-third of Alzheimer’s cases could be prevented through healthy lifestyle modifications such as diet and exercise. Long at the forefront of this prevention initiative — aimed at educating the community on how to live a brain healthy lifestyle and reducing the risk of brain disease —is Cleveland Clinic Lou Ruvo Center for Brain Health’s HealthyBrains.org platform. Launched in May 2015, the goal is prevention; the means are risk reduction. HealthyBrains.org is an interactive online community where anyone can complete a free brain health self-assessment, receive personalized reports and keep up-to-date on brain health news. Progress is recorded, tracked and presented on an individualized dashboard, displaying customized recommendations based on your Brain Health Index (BHI). Ranging from nutritious recipes, tips to get a better night’s sleep and the importance of exercise,

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information presented is based on Cleveland Clinic’s Six Pillars of Brain Health:

1. Physical Exercise

People who exercise regularly have a lower risk of developing Alzheimer’s disease. Exercise improves blood flow and memory, and it stimulates chemical changes in the brain that enhance learning, mood and thinking. One hundred and 50 minutes a week of moderately intensive aerobic exercise such as running,

jogging, cycling or brisk walking is recommended.

2. Food & Nutrition

Research shows that a Mediterranean-style diet rich in fish, whole grains, green leafy vegetables, olives and nuts helps maintain brain health and may reduce the risk of Alzheimerâ&#x20AC;&#x2122;s disease. Cook and eat fresh food, savor the taste, enjoy dining with family and friends. A Mediterranean regimen is more than just a diet. Itâ&#x20AC;&#x2122;s a lifestyle, a way of living well. In addition to what you eat, you should also pay

attention to when you eat. New research suggests that intermittent fasting may be good for the brain. During the course of the day the brain is constantly breaking down sugars to create fuel called glycogen. If the body goes into a fasting state (usually more than 8-12 hours since eating), it switches over to a different source called ketones. There is some evidence that ketones may be a more beneficial source of fuel for neurons. Story continued on page 58

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Story continued from page 57

3. Medical Health

A variety of medical conditions are strongly linked to the decline of brain function. Midlife hypertension, obesity, hearing loss, gingivitis, diabetes and blood sugar are all conditions that can play a critical role in brain health. Smoking can make your risk of dementia increase by three times. Take control of your physical health by visiting a doctor annually, take medications as prescribed and lower salt and sugar intake.

4. Sleep & Relaxation

Our brains remain busy while we sleep — doing repairs, boosting the immune system and creating long-term memories. During deep sleep, excess amyloid protein — the protein associated with the formation of plaques in Alzheimer’s disease — is cleared from the brain. More evidence is mounting that poor-quality sleep is linked to a decline in memory and thinking abilities and leads to a higher risk of Alzheimer’s. Eight hours a night is recommended for adults, but it’s not just the quantity of sleep you get, it’s the quality. To ensure a quality night’s sleep, implement a sleep routine: n Go to bed and wake up at the same time every night — even on the weekends n Exercise regularly, but do not do it within three hours before bed n Avoid caffeine late in the day n Don’t eat a large meal before bed and remember that alcohol can disrupt sleep

5. Mental Fitness

We have something called “brain reserve,” which helps our brain adapt and respond to changes and resist damage. Our brain reserve begins to develop in childhood and gets stronger as we move through adulthood. People who continue to learn, embrace new activities and develop new skills and interests are building and improving their brain reserve. Doing puzzles, socializing, learning a language or new instrument are ways that help the brain grow new connections, which may ultimately prove to be effective in reducing risk for dementia.

6. Social Interaction

A rich social network provides sources of support, reduces stress, combats depression and enhances intellectual stimulation. Studies have shown that those with the most social interaction within their

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community experience the slowest rate of memory decline. Happy marriages or long-term relationships and having a purpose in life have shown significant protective effects against age-related cognitive impairment. Five years after its inception, I’m humbled to announce that HealthyBrains.org has armed more than 1 million visitors with the tools they need to take a proactive approach to brain health. However, HealthyBrains.org isn’t just an education tool, it’s an online community that’s helping the fight against Alzheimer’s disease by recruiting clinical trial participants. In addition to providing lifestyle recommendations, HealthyBrains.org offers users the opportunity to join a larger brain health registry and the option to participate in cutting-edge clinical trials for which they qualify. To date, we’ve enrolled 25,000 participants to the registry and have made 1,200 clinical trial referrals. Considering lack of clinical trial participation is one of the biggest challenges in Alzheimer’s drug development, I am incredibly encouraged by the progress we’ve made in just a handful of years. Last year, HealthyBrains.org celebrated another milestone when we expanded the website and mobile platforms, offering a Spanish-language interface, CerebrosSanos.org, to accommodate a broader array of users seeking to better understand their brain health. Utilizing the Spanish translation, we hope to help meet the growing need for a comprehensive group of clinical trial participants, inclusive of all ages, genders and ethnicities. With a diverse group of participants signaling an interest in learning about their own brain health, as well as opportunities to contribute to research, we can begin to bridge the gap in discovery for new treatments. There is no magic bullet to prevent Alzheimer’s disease, but we do know that implementing a healthy lifestyle can decrease your risk of developing the disease. People often ask me, “What can I do now to reduce my risk of Alzheimer’s?” and the answer is HealthyBrains.org. We know that changes in the brain associated with Alzheimer’s disease begin 20 years before symptoms present, so I encourage anyone reading this article to start making these lifestyle changes now. It’s never too late — or too early — to start. For more information about the Healthy Brains Initiative, visit HealthyBrains.org and take the free brain health assessment.

Dr. Nguyen delivers patient care at the Cleveland Clinic Lou Ruvo Center for Brain Health. (Courtesy) SUMMER 2020

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Health care providers taking control of building construction BY ALEXIA CROWLEY AND MICHAEL NIGRO

Alexia Crowley, CCIM, is the associate vice president of Colliers International Las Vegas and Michael Nigro is president of Nigro Construction.

ven before the current pandemic and accompanying public health crisis, Southern Nevada’s medical office sector had seen a wave of urgent care facilities and micro hospitals constructed over the last few years. Doctors and health care providers are outgrowing their shared practices and expanding into their own medical office buildings and surgery centers. In addition, the retailization of health care began to emerge several years ago. This trend is driven by patients who have one commonality when searching for health care: convenience. Consumers have grown accustomed to the instant gratification and convenience of online shopping and smartphone applications. This type of consumerism has crossed into the health care industry, influencing medical companies and physicians to shift their traditional strategy to one that is more customer serviceoriented. This shift is leading physicians and health care decision-makers into the real estate market, where they are looking for new office space in retail centers located in popular areas of town, including small neighborhood shopping centers and larger retail centers near major intersections. To lean into the retailization of health care trend, some physicians are choosing to open their offices in neighborhoods to help meet the demands of their current and future patients. For example, the southwest part of the valley continues to be developed with retail centers, office buildings and numerous neighborhood communities, making it prime real estate for health care decision-makers. Similar to other growing areas of the valley, physicians are able to build their space from the ground up due to the availability of undeveloped land in the area,

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while meeting the needs of the nearby communities. Nigro Construction is among the few contractors in Southern Nevada that understands the regulations and requirements that go into building such facilities. In 2019 alone, Nigro completed over 79,000 square feet of medical projects and is continuing this trend into 2020. Nigro Construction is involved in the construction and improvements of multiple medical facilities throughout the valley. This includes specialty surgery centers and medical office buildings. Recently completed medical facilities include: the 11,234-square-foot Minimally Invasive Hand Institute, a 6,000-squarefoot Center for Wellness and Pain Care as well as a 10,378-square-foot Advanced Orthopedics physical therapy center. Projects scheduled to begin this year include the 13,000-square-foot Las Vegas Institute of Advanced Surgery along with a tenant improvement lab extension for Elite Medical Center. Michael Nigro, president of Nigro Construction, said his firm is seeing a rise in physicians interested in upgrading their space and recognizing the benefits of owning their own practice. “There are significant tax advantages in owning your own building,” Nigro said. “The mortgages are often less than or comparable to renting a space, and the ability to build a facility suited to their specialty is a huge benefit to physicians.” Some physicians are choosing to renovate vacant buildings near major intersections and shopping centers closer to the center of town. For example, Dr. Lane Smith chose to build out his surgery center, Smith Plastic Surgery, in a vacant building that was formerly occupied by Cumorah Credit Union and Deseret Bookstore near Summerlin. Smith transformed this building into three Class C operating rooms, pre-op and post-op exam rooms and a state-ofthe-art medical and wellness spa. These Class C operating rooms and outpatient surgery center can also accommodate patients with private recovery rooms. Patients are attracted to this facility due to its convenience, and surgeons enjoy operating at this facility due to schedule flexibility when it comes to surgeries and procedures. According to Nigro, more and more doctor groups are joining together to build facilities

that range anywhere from 5,000 to 10,000 square feet. Due to the cost savings and control, more surgeons and doctors want to step out of the hospital setting and create a better patient experience in their own “build-to-suit” facility. Health care providers say the design and construction of these facilities enable them to provide a better experience for their patients. No matter where a physician chooses to open a facility, there are several factors they consider. One of the most important factors is visibility. As with any business, you want consumers to be able to see your signage and office from a major street or intersection. Other major factors taken into consideration include parking and the desire for one-story buildings. Physicians want to be sure they are providing an easily accessible office with ample space for both patients and staff. “We have found that many of our clients are looking to design with upgraded efficiencies and from a design perspective,” Nigro said. “For example, it is not necessary to build file

rooms anymore because of the new technology. It allows for better patient flow.” In traditional medical office buildings near hospitals, visibility, signage and parking are hard to come by, making it nearly impossible to accommodate a physician’s real estate desires of ample parking space, branding and easy office accessibility. With the regulations related to building and operating medical projects being stringent and often complex, Nigro said his firm has created a team that is able to complete a surgery center and clinic with zero corrections during inspections. Overall, the retailization of health care is a trend driven largely by consumers. It provides patients with convenient options that fit the needs of their nuanced lifestyles. As this trend continues to evolve and grow, it is possible that the valley can see future mix-use developments that incorporate a healthy living lifestyle where medical, retail and office space will be conveniently located at the center point of residential communities.

Better patient access and experience has led health care providers to build and design their own facilities. (Courtesy)

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HCQ Notes Henderson Hospital was recertified by The Joint Commission for its disease-specific care for total hip and knee replacement surgery by demonstrating continuous compliance with its performance standards. The hospital also earned The Joint Commission’s Gold Seal of Approval and the American Stroke Association’s Heart-Check mark for Advanced Primary Stroke Certification. In addition, the hospital received certification as a Level III neonatal intensive care unit (NICU) to care for newborns who are born prematurely or may have needs and conditions that require additional, specialized medical care. To prepare for its Level III certification, additional equipment was purchased, including conventional and high frequency ventilators, phototherapy lights, specialized isolettes that provide heat and humidity, and monitors that provide continuous monitoring of infants breathing, heart rate and oxygen saturation levels. The NICU staff members underwent additional certification to work in the Level III NICU, and a specialized transport team was developed that could transfer babies from other hospitals to the Henderson Hospital NICU. Anthem Blue Cross Blue Shield Nevada designated Spring Valley Hospital as a Blue Distinction Center+ (BDC+) for Knee and Hip Replacement, part of the Blue Distinction Specialty Care program. Blue Distinction Centers are nationally designated health care facilities that show a commitment to deliver-

Martinez

Stephens

Jahangir

ing high-quality patient safety and better health outcomes, based on objective measures that were developed with input from the medical community and leading accreditation and quality organizations. Spring Valley Hospital is also the only hospital in Southern Nevada to earn the BDC+ designation, which means the 364-bed hospital also met cost measures that address the consumers’ need for affordable health care. Nevada State College hired June Eastridge, Ed.D., MSN, RN, CNE, COI, as the new dean of the School of Nursing. Dr. Eastridge worked for more than two decades as a registered nurse specializing in trauma and critical care in New Mexico. During this time, Dr. Eastridge earned her tenure as an associate professor at the University of New Mexico Eastridge where she helped develop statewide nursing curriculums that prepare the next generation of nurses. Dr. Eastridge joined the Nevada State College faculty in 2014 as a lecturer and later became the pre-licensure program director where she played an active role in recent efforts to integrate caring science into the curriculum.

Jordan

Hale

OptumCare Cancer Care completed its Las Vegas cancer research office and hired two new health care professionals to staff it. Christine Martinez, MS, CCRC, was brought on as a clinical research coordinator, and Nicole Stephens, PhD, was hired as a research regulatory coordinator. The research office is led by Dr. K. Saad Jahangir, MD, the director of OptumCare Cancer Care research in Las Vegas. William Jordan, MBA, MHA, is the director of research operations, and Amy Hale, PharmD, BCPS, RN, is the clinical research pharmacist.

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Fertility center coming to Las Vegas

Construction of the new southwest location of The Fertility Center of Las Vegas is expected to begin in fall with general contractor SR Construction leading the design and construction. The facility, which is a part of a 4.46-acre commercial development located at Durango Avenue and Hacienda Drive, will consist of a single-story space totaling 18,540 square feet and will include an ambulatory surgery center, laboratory and fertility clinic. The Fertility Center of Las Vegas was founded by Dr. Bruce Shapiro and has another valley location on Sahara Avenue. (Courtesy rendering)

PureCare Living opened to provide integrated services for health care management and real estate investment opportunities with a focus on post-acute health care facilities. PureCare Living consults and assists with planning, operations, compliance, programming and development oversight. PureCare also started construction on Silver State Pediatric, a 22,442-square-foot skilled nursing facility that specializes in post-acute care for children with traumatic injuries. MountainView and Henderson hospitals were awarded an ‘A’ in the spring 2020 Leapfrog Hospital Safety Grade, a national distinction recognizing the hospitals’ achievements providing safer health care. The Leapfrog Group is an independent national watchdog organization committed to health care quality and safety. The Safety Grade is a letter grade assigned to all general hospitals across the country and updated every six months, assessing how well the hospital prevents medical errors and other harms to patients. The recognition marks the fourth consecutive A grade for both hospitals.

Siddiqui

Biggans

Praus

Several health care providers with Southwest Medical, part of OptumCare, were recognized for their contributions in the field of cardiology during the 69th Annual Convocation of the American College of Cardiology (held online because of the ongoing coronavirus pandemic). Dr. Yasmin Siddiqui is a newly designated fellow of the American College of Cardiology; Kelli Biggans, PA-C, and Teresa Praus, APRN, are both newly designated associates. The American College of Cardiology is a major organization that provides practice guidelines and reports on new findings in the cardiology field.

Notes continued on page 64

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HCQ Notes continued Dr. Marc J. Kahn, MD, MBA, was hired as the new dean of the UNLV School of Medicine. A hematologist and medical oncologist, Dr. Kahn was a senior associate dean at Tulane University School of Medicine before joining UNLV in April. He completed his undergraduate degree, medical school, residency, chief medical residency and hematolKahn ogy/medical oncology fellowship at the University of Pennsylvania, where he graduated summa cum laude. In 2019, he was one of only a few physicians not trained in the United Kingdom elected as a fellow of the Royal College of Physicians of London, the oldest medical college in England.

Celebration of Life virtual ceremony

In remembrance and celebration of loved ones who’ve passed away, Nathan Adelson Hospice hosted its 17th annual “Celebration of Life” butterfly release in April. Presented for the first time in video format because of COVID-19 restrictions and social distancing guidelines, the heartwarming, virtual event allowed individuals a platform to tune in, witness the butterfly release and remember their dearest loved ones. Viewers heard from Karen Rubel, Nathan Adelson Hospice’s CEO and president, and Chaplain Richard Martin, as they shared uplifting words of hope and explained the symbolism behind the butterfly release. (Courtesy)

A L L YO U R H E A LT H C A R E N E E D S , A L L I N O N E P L AC E .

Born out of a concern for patient health and safety.

Formerly Cathay Medical Center WWW.VEGASMDC.COM 5300 W. Spring Mountain Road #112 • Las Vegas, Nevada 89146 P: 702.362.6373 • F: 702.362.6420

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Valley Hospital earned certification as an Advanced Comprehensive Stroke Center (CSC) from The Joint Commission and the American Heart Association/American Stroke Association. Valley Hospital is the only Comprehensive Stroke hospital in Nevada to achieve the comprehensive stroke designation and have a neurology residency program approved by the Accreditation Council for Graduate Medical Education. It is one of only three CSCs in Nevada and one of approximately 208 CSCs in the U.S., according to the American Stroke Association. Valley Hospital treats over 800 stroke patients each year. Dr. Deborah Kuhls, a UNLV School of Medicine professor/surgeon/researcher, will be installed July 1 as Clark County Medical Society president. Also medical director of the UMC Trauma Intensive Care Unit, Dr. Kuhls is the former chair of the American College of Surgeons Committee on Trauma Injury Prevention and Control. She earned her MD at the Medical College of Pennsylvania, now the Drexel School Kuhls of Medicine, finished her residency in general surgery at Albert Einstein University/Montefiore and her fellowship in trauma surgery and critical care at the R. Adams Cowley Shock Trauma Center at the University of Maryland. Students from Touro University Nevada established the #MedReady website to gather volunteer opportunities to help address urgent community needs related to the COVID-19 pandemic while also promoting inter-professional student service learning. The website is the brainchild of osteopathic medical student leaders Cassandra McDiarmid, Parisun Shoga and Ashlie Bloom who were encouraged by Dr. Wolfgang Gilliar, dean of the College of Osteopathic Medicine, to brainstorm ideas on how students could help the Southern Nevada community. The website helps connect local organizations and community members with Touro students seeking volunteer opportunities in three primary areas: free K-12 online tutoring; free undergrad and MCAT online tutoring; and general community assistance, including grocery pickup for seniors, first responders and health care workers, assistance with screenings and other frontline opportunities for health care students. Comprehensive Cancer Centers hired medical oncologist and hematologist Dr. Liawaty Ho, MD, to see patients at Comprehensive’s central valley office in Las Vegas. Dr. Ho has special expertise in treating breast cancer as well as colon cancer, lung cancer and lymphoma. She is dedicated to offering patients the latest in treatment and research, and as an oncologist at Comprehensive, she has access to a database Ho of more than 170 clinical trials that the practice participates in annually. Dr. Ho is also a founding medical expert in hematology and medical oncology at HealthTap.com. Prior to joining Comprehensive, she served as a medical oncologist and hematologist at OptumCare Cancer Care and Nevada Cancer Center/HealthCare Partners.

Dr. Ronald Hillock Osseointegration Expert

What is Osseointegration? Osseointegration (also known as OI) is a process of anchoring an implant into bone and coupling through the skin to an external device. OI was first developed in dentistry as a way to anchor a prosthetic tooth to the bones of the jaws. OI has been used in extremity amputations for the last 30 years in Europe. I have been working with an expert team of surgeons and engineers toward the development of an OI system for US amputees for the last 10 years.

What is your interest in OI? The first years of my career were as a surgeon in the US Army. I participated in several combat deployments and treated many battle casualties. The battle amputee is near to my heart. They have given a limb for their service to our freedom and we owe them whatever can be done to improve their quality of life. I saw OI and its many advantages while stationed in Europe and have been working to bring this technology to the US since.

Are there problems with conventional suction socket systems for amputees? Amputees almost universally share the problem of skin irritation in the area where the socket is in contact. They develop calluses and blisters on the amputated residual limb due to friction from the socket against the skin routinely. If the amputee’s weight changes by as little as 5 pounds up the socket will be too tight, or 5 pounds lost the socket will be too loose and slip or fall off the limb.

Who qualifies for treatment with an OI system? • Transfemoral level amputees (above the knee) • Transtibial level amputees (below the knee) • Transhumeral level amputees (above the elbow arm amputees) The patient must be an adult, over 18 years of age and otherwise healthy. The cause of amputation must be due to one of the following reasons: 1. Traumatic amputation 2. Tumor related amputation 3. Congenital malformation/birth defect

Nevada Orthopedic & Spine Center

7455 W. WASHINGTON AVE. STE 160 • LAS VEGAS NV 89128

For more information on Osseointegration contact

DR. RONALD HILLOCK 702-258-5567 RON_HILLOCK@ME.COM www.nevadaorthopedic.com

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Calendar

Area hospitals and medical centers continue to monitor the impact of COVID-19 on our community, and in accordance with guidance from the CDC, they will update and address class, workshop and support group offerings directly on their websites. Please visit the below websites for the most up-to-date information for each hospital.

CENTENNIAL HILLS HOSPITAL

MOUNTAINVIEW HOSPITAL

CentennialHillsHospital.com

Mountainview-Hospital.com

SUMMERLIN HOSPITAL SummerlinHospital.com

DESERT SPRINGS HOSPITAL

SOUTHERN HILLS HOSPITAL

SUNRISE HOSPITAL

DesertSpringsHospital.com

SouthernHillsHospital.com

SunriseHospital.com

HENDERSON HOSPITAL

SPRING VALLEY HOSPITAL

UNIVERSITY MEDICAL CENTER

HendersonHospital.com

SpringValleyHospital.com

UMCSN.com

ST. ROSE DOMINICAN HOSPITALS DignityHealth.org/Las-Vegas

LEADING the way in

TEACHING the health care providers and educators of tomorrow while

HOME TO NEVADAâ&#x20AC;&#x2122;S LARGEST MEDICAL SCHOOL Doctor of Osteopathic Medicine Doctor of Physical Therapy Doctor of Nursing Practice Doctor of Education ~ Education Administration and Leadership Occupational Therapy Doctorate Master of Physician Assistant Studies Master of Science in Medical Health Sciences

CARING for our community.

Master of Science in Nursing ~ Family Nurse Practitioner Master of Education ~ Curriculum & Instruction (with an emphasis in School Counseling)

~ School Administration ~ Special Education (with emphases in Applied Behavioral Anaylsis, Autism Spectrum Disorder, or Generalist Resource)

Registered Nurse to Bachelor of Science in Nursing Education Advanced Studies Certificate Programs

For more information about Touro University Nevada, please call 702.777.3100 or visit our website at tun.touro.edu.

874 American Pacific Drive, Henderson NV 89014 Touro University Nevada is accredited by the WASC Senior College and University Commission (WSCUC) as a branch campus of Touro University California and licensed in Nevada by the Commission on Post-Secondary Education. Touro University Nevada does not discriminate on the basis of race, ethnicity, age, sex, gender, color, creed, national origin, religion, sexual orientation or disability.

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M E DICAL OF F IC E SPA CE AVA I LA B L E F O R L E A S E

on the hospital campuses of:

HENDERSON CENTENNIAL HILLS DESERT SPRINGS SPRING VALLEY SUMMERLIN VALLEY

Fo r l e a s i n g i nfo r m ati o n:

MIKE T YMCZYN

JAMIE KRAHNE

mt ymc z yn@ensemble.net

jk rahne@ensemble.net

702 /216 -2371

702 /216 -2363

License #177844

License #B.0143850.LLC

ensemble.net

Tyler,

PEDIATRIC TRAUMA PATIENT

This is where hope began. When he was 11, Tyler was struck by an SUV and suffered a broken neck, 22 broken ribs, and injuries to his liver, lungs, kidneys and spleen. With Nevada’s only Designated Pediatric Trauma Center, UMC Children’s Hospital was there with life-saving technology and expertise. Today, Tyler is back on his family’s ranch, riding horses and enjoying life. New breakthroughs. New beginnings. Only at UMC. umcsn.com

2020-06-25 - Health Care Quarterly (Vol. 28) - Spring 2020

Articles inside

UNLV School of Medicine students overcome challenges, dedicate lives to helping others by Paul Harasim

Deep brain stimulation with

Addiction during crisis with

Differentiating common illness symptoms