2022-05-26 - Health Care Quarterly (Vol. 36) - Spring 2022 by Greenspun Media Group

Your baby, your birth center. At Dignity Health – St. Rose Dominican, we’re here to guide you on your journey to motherhood every baby step of the way. Our Birth Centers offer large birthing suites, designed to give mom plenty of room to move around during labor. And we were the first in the state to offer nitrous oxide for pain relief during childbirth. With boardcertified laborists on site 24/7, we’ll be ready to support you in meeting your new bundle of joy any time, day or night. To find pregnancy and childbirth classes, or to schedule a tour of our Birth Centers, visit StRoseHospitals.org/Baby.

BRANDON BSN ‘21

Unparalleled Skills Meet Empathic Heart When Brandon’s beloved Lola was dying, it was the hospice nurses who provided him extraordinary comfort. He could see how they not only cared for his grandmother in her last days, but how they cared for the family losing her. It was this moment in his life that led Brandon to Roseman, to become a nurse caring for others. Brandon earned his Accelerated BSN and graduated amid the COVID crisis. Now, a Cardiac Medical-Surgical Nurse at Mountain View Hospital, Brandon says that he knows his grandmother Esperanza is smiling down on him.

Uniting the Heart & Science of Healthcare TRANSFORMING EDUCATION

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From the editor

’ve been noticing how often we use the word “hope” in our daily language. “I hope you have a nice day.” “Hopefully the wind dies down.” “Let’s hope.” It’s a concept that’s so obvious, so innate, it’s referenced regularly. It exists wherever we are, but it’s more than just a pleasantry or sweeping platitude. You can find hope in almost everything—and as with most omnipresent concepts, there’s a scientific perspective behind it too. We began digging through studies about hope, of which there are many, and examining the many meanings of hope. Hope’s role in medicine, survival, happiness, wellness and more. We bounced these ideas around everywhere we could imagine, and then some. It turns out that hope is an incredibly broad topic, no matter what lens you’re viewing it through. It also might be an incredibly necessary trait. We’ll leave the conclusions about hope to you. We don’t draw any. Whenever we tried, we found a dissenting voice or an undeniable duality on the other side of the aisle. For instance, some of the hope studies we looked at measured hope against despair, begging the question: Can you have one without the other? The frustrating answer seems to be yes, and no. One of the most compelling studies we examined, Curt Richter’s 1957 rat study, was as fascinating as it was torturous. Simply put, hope ran us in circles. But it’s a topic worth exploring. I would like to extend my sincerest gratitude to Stephani Christensen at Comprehensive Cancer Centers, Josh Hamilton at the Hamilton Group, and Melissa Webb at Red Rock Psychological Health, who shared their remarkable exper-

tise, thoughtfulness, and care to the cover story. Speaking to each of these individuals was expansive and eye-opening. Almost this entire issue carries the throughline of hope, in part because the medical community itself is a testament to hope. In the following pages, you’ll read about new technologies, alternative medicines, and preventive care options. You’ll find examples of inspiring caregivers and up-and-coming treatment modalities. The medical landscape in Southern Nevada continues to fortify and innovate, and we’re so fortunate to be able to cover the many incredible happenings. While the goodness of our community is on full display here, it’s impossible to disregard some of the heaviness of our world. Again, we’re met with a complicated duality. If you’re feeling hopeless, if you’re reading from a place of despair, we’re not going to tell you to look on the bright side. There are plenty of reasons to be outraged and disheartened. But I would like to encourage everyone to tend to their mental health right now. Try to take care of yourself to the best of your ability, and absolutely do reach out for help. Your happiness is a worthwhile endeavor. We’re not alone; hope can be restored. And there are people in our community that can work with you to begin that process.

Emma Cauthorn Director of Strategic Content emma.cauthorn@gmgvegas.com

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Medical News RAPID SEIZURE TESTING AVAILABLE AT SUNRISE HOSPITAL Imagine suffering a life-threatening seizure. Where do you go for rapid testing and treatment? Sunrise Hospital, home of Southern Nevada’s only Epilepsy Center. Not all seizures are the same. Persons with epilepsy have seizures because of electrical short circuits in the brain. But far more commonly, seizures can be seen in persons without epilepsy, provoked by drug intoxication or withdrawal, or by a metabolic issue, like low blood sugar. Diagnosis is critical, and new technologies are precious when mere minutes can spell the difference between life and death. “By using a new, head band-based EEG for lifethreatening seizures, we can accelerate the process of starting aggressive treatment,” said Dr. Samir Bangalore, epileptologist and Medical Director of the Epilepsy Center at Sunrise. This novel EEG device allows for accurate diagnosis within 10 minutes, shaving two hours off the conventional technique. Dr. Bangalore says Sunrise Hospital stands alone as a comprehensive center for epilepsy care in Southern Nevada. Sunrise is also home to a comprehensive stroke center, neuro ICU, and neuro-interventional radiology program. For more information, visit sunrisehospital.com.

Inside this issue

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COVER STORY: The power of hope in health care

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Health care professionals share their thoughts on what it takes to care for the Black community

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Be proactive and follow these top 10 tips for cancer prevention Long COVID-19 has dozens of possible symptoms that can last for months

NEW ROBOT DECREASES EXPLORATORY PROCEDURE WAIT TIMES IN THE BATTLE AGAINST LUNG CANCER Southern Hills Hospital has a new tool in the fight against lung cancer: A robot that is so precise and minimally invasive, it can examine nodules in hard to reach and remote areas of the lung. Previously, if something was picked up on a scan, doctors would monitor it for up to a year before doing anything. The robot utilizes a 3.5 mm catheter and 3D camera allowing doctors to examine areas of concern within the lung with no wait time and no recovery time for the patient. Pulmonologist Dr. Changawala is one of only a few physicians trained on this new robot, and Southern Hills Hospital is one of the few hospitals in Nevada to offer this procedure.

NATHAN ADELSON HOSPICE PLACES ATTENTION ON CARDIAC CARE PROGRAM Nathan Adelson Hospice announced its participation in the National Partnership for Healthcare and Hospice Innovation’s cross-industry cardiac care initiative. The Advanced Cardiac Care Program provides clinical guidelines, resources, and advanced care to people suffering from heart disease through the palliative and hospice programs offered. As heart disease remains the number one cause of death in the United States, many advanced congestive heart failure patients often receive care in later stages of the disease, often too late to enhance quality of life. Nathan Adelson Hospice’s Advanced Cardiac Care program is three-fold and aims to increase access, address disparities in care and reduce the impact of COVID-19. Learn more at nah.org. M AY 2 0 2 2

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Lung cancer screenings expected to save more lives BY SARA SIBLEY

Sara Sibley is the Director of Physician Strategic Communications for HCA Healthcare, Far West Division. Timothy Hamilton, M.D. is a Cardiothoracic Surgeon with the Nevada Cardiovascular and Thoracic Institute at Sunrise Hospital and Medical Center.

n February 2022, the Centers for Medicare and Medicaid Services announced an expansion of coverage regarding lung cancer screening using low dose computed tomography (LDCT). The announcement expands eligibility by lowering the starting age from 55 to 50 years and continuing eligibility through the current guideline of 77 years. This national coverage determination update also reduces the tobacco-smoking-history criteria from at least 30 packs per year to at least 20 packs per year. The criteria update not only broadens access for screening to even more at-risk populations, it may also save more lives by catching the disease even earlier than before. The annual LDCT exam is the only test recommended and covered by Medicare to screen for lung cancer. It is approved for those who currently smoke or have smoked in the past and are asymptomatic. “The goal of this screening is to detect cancer in its earliest and most treatable stage,” said Timothy Hamilton, MD, board-certified cardiothoracic surgeon at Sunrise Hospital and Medical Center. “For those at high risk, routine screenings may even allow for less invasive treatment options when an intervention is needed.” There is little to no preparation for an LDCT screening. A patient meeting the criteria for this non-invasive exam will lie on a bed-like table, which will slowly move through a tunnel-like machine. The patient will need to be still during the CT scan of the chest to get an accurate image. The exam is quick — less than 15 minutes — and painless. The patient can eat and drink before the test is performed. The LDCT exam is a very low dose test, using up to 90% less radiation than a standard CT scan. Lung cancer screenings do require a signed order

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from a physician. “It’s important to discuss risk factors with your primary care physician and if you meet the current guidelines established,” Dr. Hamilton said. “Often there are no signs or symptoms until the disease has progressed or has spread. It’s vital to catch the disease early and with the expanded criteria, this will be easier than ever.” Patient access is key and knowing where to go for the screening is essential. Not all imaging or radiology centers have the capabilities or are accredited to offer this type of scan. “Our hospital system offers the full-circle patient experience with detection, treatment, and management. Sunrise Hospital offers outpatient imaging, surgery options and additional treatment, if needed,” Dr. Hamilton said. Along with this robust program, Sunrise Health has a unique offering, where a dedicated nurse navigation team works with each patient to guide them every step of the way and assist in arranging appointments, additional testing or surgery. “Lung LDCT has been proven to reduce the number of deaths from lung cancer in high-risk patients, whether that’s due to age or smoking history,” Dr. Hamilton said. Although the new screening guidelines have been adopted by CMS, most major insurance plans and health systems are still not fully on board with the recent changes. Lung LDCT is expected to be updated and covered by commercial plans soon. Dr. Hamilton is a leading expert treating lung cancer in our community. He is accepting new patients at Nevada Cardiovascular and Thoracic Institute at Sunrise Hospital and Medical Center. Visit nevadaCVTinstitute.com to learn more. For information about lung cancer screenings at Sunrise Hospital’s outpatient imaging, visit: sunrisehospital.com/specialties/pulmonary-care.

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Combating sex and gender disparity in those with Alzheimer’s BY JESSICA CALDWELL, PH.D.

Jessica Caldwell, Ph.D., is Director, Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic.

lmost two thirds of the 6.5 million Americans diagnosed with Alzheimer’s disease are women. Why is it that Alzheimer’s, the most common among the dementias, impacts women disproportionately? Since opening in 2020, the Women’s Alzheimer’s Movement Prevention Center at Cleveland Clinic, the nation’s first Alzheimer’s disease prevention clinic designed specifically for women — and staffed by an all-women team — has kept a waiting list of women seeking strategies for better brain health. We have also begun enrolling women in our ongoing research into how lifestyle changes and women-specific factors impact Alzheimer’s risk.

What we know today

Although scientists and doctors are still working to solve the puzzle of why Alzheimer’s is especially bad for women, we have a few of the pieces. Women have a greater a set of biological risks for brain changes, including living longer than men, experiencing loss of the protective properties of estrogen with the onset of menopause, having greater brain effects from conditions like diabetes, and having more sensitivity to some genes that can lead to Alzheimer’s. Women also have different mental health, social, and lifestyle risks.

Las Vegas learning for national impact Lancet Neurology published that up to 40% of all Alzheimer’s cases might be preventable through healthy lifestyle modifications — but which ones? And how might they differ for women? Clinical patients who choose to opt into research can help

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our clinician-scientists better understand Alzheimer’s disease risk and risk-reduction for women. One of our ongoing initiatives is investigating what lifestyle changes women are making based on our recommendations, and whether those changes are impacting outcomes like blood pressure and blood sugar, as well as related health issues such as sleep problems and low mood. We also have started asking women whether they would like to participate in our new study of stress, estrogen and Alzheimer’s risks. This study — which involves taking memory tests, getting bloodwork done, and having an MRI — will help us to understand whether stress and estrogen impact body and brain processes that might facilitate Alzheimer’s pathology in women at risk for the disease.

Why does the brain lag behind the heart, and who can change that?

Prevention is a widely accepted and used approach in heart disease, yet difficult and costly in the brain-health space because routine, preventive check-ups are not currently covered by insurance. More science is needed to demonstrate the impact of prevention in Alzheimer’s disease. Through research, we hope the data we collect will help illustrate the merits of prevention via risk reduction. It is critical that we provide access to patients and research participants who reflect the diversity of our community. We know African American women are at double and Hispanic women are at 1.5 times the risk of Alzheimer’s disease compared with White women. The Women’s Alzheimer’s Prevention Center at Cleveland Clinic is booked through 2022 as we seek further philanthropic support for our quest to help more women change their brain health trajectory. For more information, visit womenpreventalz.org.

Medical marijuana’s therapeutic uses for chronic illness BY PEJMAN BADY, D.O.

am a local board-certified physician of nearly 30 years who made the shift to the alternative medicine practice of cannabis. My background is in family medicine, emergency medicine, osteopathy and regenerative treatments, and years ago, I was vehemently against cannabis use. It wasn’t until my mother was diagnosed with stage four ovarian cancer and given a life expectancy of six months that I became a full-fledged supporter of cannabis. My mother lived another seven years after that diagnosis, a miracle that I largely credit to the efficacy of medical marijuana in enhancing her ability to eat and hydrate despite the negative side effects of chemotherapy. Thanks to cannabis, she was able to get the nutrients that her body needed so she could stay out of the hospital and in good spirits. This first-hand account supports research from the American Cancer Society and the National Cancer Institute, which shows that marijuana can help cancer patients or patients with serious illnesses by reducing nausea, inflammation and pain. Recent years have provided a worldwide shift in perspective concerning the efficacy of alternative medicine practices, including the use of cannabis. This is supported by the House of Congress’ decision to legalize marijuana nationwide. With this perspective shift comes an increased interest in the medicinal use of cannabis, largely driven by the discovery of the endocannabinoid system and the growing destigmatization of cannabis use. Cannabis is most commonly used to manage

chronic pain, especially multiple sclerosis and nerve-related pain. However, its therapeutic benefits reach far beyond pain management. Data produced by regulated studies has proven that medical marijuana can be advantageous in mitigating symptoms of nausea, anxiety, sleep disorders and cachexia (severe loss of appetite). It’s also effectively used to treat patients with endometriosis, interstitial cystitis, irritable bowel syndrome, Crohn’s disease and fibromyalgia. The historic use of cannabis to treat glaucoma and inflammation dates all the way back to the ancient Egyptians in 1213 BC. Recently, the first FDA-regulated study on the use of cannabis to treat PTSD in veterans produced favorable results — that cannabis can be successfully utilized to manage pain in addition to treating PTS, PTSD and anxiety disorders. Surprisingly, my patients battling Parkinson’s disease claim that cannabis’ ability to decrease their tremors is unparalleled. As co-owner and CEO of The Sanctuary, a popular local cannabis dispensary with two Las Vegas locations, we are proud to offer on-site medical marijuana consultations to dispensary guests 21+ on a pro bono basis. Through the years I have become a such strong advocate for cannabis that I’ve also become a member of the National Cannabis Industry Association (NCIA), ArcView Group, and Marijuana Policy Project (MPP) and the Founder and Chairman of the Board of Nevada Cannabis Medical Association (NCMA). I am dedicated to spreading awareness about all of the benefits of cannabis as an exceptional, holistic, and powerful source of alternative medicine.

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Pejman Bady, D.O., is Co-Owner of The Sanctuary cannabis dispensary.

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Stay aware of asthma and allergies during peak season BY SALVI GARCES, R.N.

M Salvi Garces, R.N., B.S.N, Case Manager, Disease Management, UnitedHealthcare

ay marks the peak of allergy season and the beginning of National Asthma and Allergy Awareness Month. While common side effects, such as congestion and runny noses, are well known, seasonal allergies are nothing to sneeze at, especially for those affected by asthma. Without proper treatment, asthma can lead to permanent airway narrowing, emphysema and chronic obstructive pulmonary disease, commonly known as COPD. It is of the utmost importance that those suffering from the disease never downplay asthma’s complications. Always use inhalers as prescribed with proper technique, rather than reserving these medications exclusively for asthma attacks. While many of those afflicted with asthma may be concerned about dependency on an inhaler, the medicine itself is non-habit forming and is essential in opening airways, especially during allergy season when environmental triggers are abundant. Despite the belief that one can “grow out” of asthma, the disease is a lifelong affliction that can be fatal, if left unchecked. During our lifetimes, we may move into newer or cleaner environments that may not trigger any reactions, giving the illusion of the disease disappearing. However, it is imperative we remember that asthma does not simply go away as we age. Symptoms of asthma can remain dormant for years, and while it is controllable, the symptoms can return at any time. Tips for combating the complications that may arise from seasonal allergies and asthma: n Household pets: Some pets may be mar-

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keted as hypoallergenic, but that is a myth. While they produce significantly less dander than their counterparts, all pets, aside from reptiles, will produce dander. If someone is suffering from shortness of breath and congestion around their pets, it may be time to reconsider your interactions with your furry friend. n Face masks: The mask mandates put in place during the pandemic are no longer needed, but those suffering from asthma should continue to wear a mask. Masks provide a simple and effective way to reduce the amount of contaminants and triggers in the air. n Cleanliness is key: Whether it is through our clothes, hair or body, we often bring allergens into our homes from the outside. As a preventative measure, clean bed sheets and pillowcases with hot water, vacuum and clean living spaces, and change clothing immediately upon entering the home to reduce the spread of allergens. n Keep your windows closed: Airborne contaminants and triggers often find their way into the home through openings such as windows and doors. While screens may keep out pests and other uninvited guests, they are ineffective at stopping dust and allergens, especially during windy times. n Preventative treatment: Before engaging in any activity that may cause an asthma attack, use your inhaler 15 minutes prior to open your airways. Allergy medications can be used in conjunction with the inhaler for an effective preventative treatment option. Health Plan of Nevada offers members access to a registered nurse specializing in asthma management through their disease management program. For more information or to make an appointment to speak with a registered nurse about asthma, please call 1-877-692-2059.

Encourage healthy sleep habits in children for long-term benefits BY ANITA HENDERSON, M.D.

t seems we’re always trying to get back one of the most valuable commodities: time. One strategy that we’re all guilty of is shaving off a little sleep to get a jump on the day. A third of U.S. adults say they get less than the recommended amount of sleep every night. Sleep isn’t just a luxury, it’s integral to protecting our overall health. As with so many health-related issues, what’s important for us is especially necessary for our kids. For the first eight years of a child’s life, healthy brain development builds the foundation for future health. Not getting enough or the right kind of sleep negatively affects that development. The experts at the National Sleep Foundation recommend different amounts of sleep, depending on age. It’s recommended that those 18 and older sleep seven or more hours a night. Those numbers are much higher for children. Kids 6-12 years should be get nine to 12 hours of sleep a night. Teenagers can get by on a little less. They should sleep eight to 10 hours each night. There’s also a difference between good and bad sleep. Tossing and turning, snoring excessively, and frequently waking throughout the night can lead to poor sleep quality. If your child doesn’t feel rested in the morning, that’s an indication that they aren’t getting enough good sleep. This can directly lead to a lack of focus in school, falling grades and deteriorating study habits. Being tired and unrested can increase risk of physical injury, particularly for kids in af-

ter-school sports. Not getting enough sleep can put your child at an increased risk of developing or exacerbating chronic diseases, some of which can even lead to a lowered life expectancy. For example, poor sleep quality can cause metabolic changes that can lead to obesity. This is particularly true for children, as sleep helps regulate the hypothalamus regions of the brain, which manages both appetite and energy expenditure. Lack of sleep is also a predictor of the body’s blood sugar control and can increase the risk of developing Type 2 diabetes (for parents, improving your sleep can actually help your blood sugar levels if you’ve already been diagnosed with Type 2 diabetes). Sleep apnea can also be an important predictor of cardiovascular disease and conditions like stroke and hypertension. So how do we improve our kids’ sleep patterns? It’s always a good idea to speak with your pediatrician if you have specific concerns, but there are good habits you can introduce at home. Encourage physical activity, which helps maintain overall health, while also helping your child fall asleep faster and sleep better through the night. Unplug the video games, turn off the TV, and put away the phone at a reasonable hour. Dark, cool and comfortable spaces are much more conducive to healthy sleep. Finally, start and stick with a consistent bedtime routine. Go to bed and get up at the same time each morning to train the body. It’s best to teach our kids these good habits when they’re young. Good sleep is about more than just immediate benefits — good sleep is a key to good health.

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Anita Henderson, M.D., is Associate Medical Director of Pediatrics at Southwest Medical, a part of Optum Care

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BLACK Truly caring for Black communities in Nevada requires access, trust and representation BY AUTUMN WIDDOES

HYKEEM GADDIS, MBA

Senior practice manager at a myGeneration Clinic

s the health care industry seeks ways to address systemic inequities that may prevent Black Americans and people of color from living their healthiest lives possible, Intermountain Healthcare in Nevada invited Black caregivers to offer their perspectives. They discuss what Black health and wellness mean to them, what it means to the Southern Nevada community that we serve, and how health equity makes a difference in improving quality of care for Black patients and their communities.

Hykeem Gaddis entered health care after witnessing family and friends struggle with health issues caused by generations of compounded health outcomes and lack of resources. He saw these same issues affecting other Black individuals and communities. Working directly in a patient-facing setting, he understands how health care systems can make a difference in communities. “Health care workers at all levels must consider

WELL

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social determinants of health that impact Black communities at large,” Gaddis said. Gaddis believes that partnering with local community organizations in Black neighborhoods that already have knowledge and trust makes a difference in patient outcomes and community health. Establishing a relationship built on trust is necessary so that patients feel they can be vulnerable and open about the health issues they are facing, but many Black Americans may resist seeking care for physical or mental health needs because of systems that have harmed people of color in the past. They also respect and value different cultural knowledge that originated in response to not having equal access to resources historically. “Representation by people of color at all levels is needed, and that means building a pipeline of talent to become board directors, leaders, providers, nurses, care managers and support staff,” Gaddis said.

JACQUELINE JONES, LMSW

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Licensed master social worker with Intermountain Healthcare’s high-risk program Jacqueline Jones knows that building trusting relationships requires community participation and collaboration. Jones became a licensed master social worker because she’s always been passionate about advocacy for people of color. Her experiences working with an HIV/AIDS resource organization Continued on page 16

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BLACK WELLNESS CONTINUED in New Jersey enabled her to have the conversations required to make changes that impacted those most vulnerable to HIV and AIDS. “Building trust with patients and communities requires acknowledging the past while also looking forward to a more equitable future. If we are going to talk about equity, we need people at the table who have a voice and who are representative in effecting change,” she said. Jones believes that to make a profound difference, health care workers must recognize their biases and admit that they may not know what it’s like to walk the path of the individual or communities being served. They must be open to learning from interactions with others. She points to the fact that many working-class people are forced to work full-time while also being primary, full-time caregivers. Often, there are no safety nets or support systems available. COVID-19 also highlighted how Black communities are hesitant to receive vaccines. According to Nevada Health Response, only 6.1% of the Black population in Southern Nevada initiated or completed their COVID-19 vaccine. While other groups had larger percentages of vaccine compliance, it’s important to recognize what factors may prompt hesitancy.

DAVITA MURPHY Administrative assistant with Intermountain Healthcare Davita Murphy expressed that vaccine hesitancy is part of the legacy of mistrust towards the medical community. “There may always be a lack of trust until there is true equality. It’s a work in progress. We all must work at it togeth-

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er,” Murphy said. Murphy is concerned with the pandemic’s longterm impact of isolation on everyone. “None of us really know the full extent of the pandemic yet,” she said. She points out that Intermountain Healthcare’s partnership with Delivering with Dignity “has truly made a positive impact on individuals in our community that were isolated, had no transportation, and no family assistance.” She has been told by patients that if they had not received these meals, they would not have been able to eat. She believes continued investment in these programs and providing knowledge of these resources will have an impact.

YVONNE KEYS Director of clinical information systems at Intermountain Healthcare Yvonne Keys also believes that knowledge is power and “what you don’t know will hurt you.” This is true for patients that don’t know how to navigate a complex health care system. Keys moved to Las Vegas when she was 8-years-old but started her health care career path after relocating to Los Angeles at 18. It was there that she saw the continuum of care model created by Kaiser Permanente. It was unlike anything she’d seen in Nevada at the time. “The American health system is daunting, and facilitation of care is a major challenge. Sick patients do not feel good. How can we ask them to navigate a complicated health system where they may not know what they should do?” Keys said. “We have no clue what patients are dealing with, especially if we are coming from a privileged background or grew up in a stable household,” Keys said. Keys believes we need more health care workers who have firsthand knowledge and training so they can more easily connect with patients whose needs may be complicated. She also suggests that health care workers who move to Nevada to work here need to understand the community’s demographic needs, as Nevada’s history is unique because of the socioeconomic development of Las Vegas.

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EXAMINING HOPE’S ROLE IN HEALTH, HAPPINESS, WELLNESS AND MORE BY HEALTH CARE QUARTERLY STAFF Do you believe that something better is just around the bend? The concept of hope is complex, far-reaching and can mean different things to different people. Melissa Webb, LCSW, clinical director of Red Rock Psychological Health, calls hope “the idea that change is possible.” Meaning that expecting positive change isn’t just a matter of having an optimistic outlook—hope can be a motivator, too. It’s not just an expectancy for change; in many cases, it’s a call for change. The power of hope has been theorized about and studied for years; some of those studies are outlined in this article. But does hope have a place in health care? And if so, where?

In 1957, Johns Hopkins professor and researcher Curt Richter placed rats in water to observe how long they would swim before drowning. Wild rats, known for their swimming abilities, typically swam no more than 15 minutes before dying. Richter then altered the experiment. The rats were immersed in water and then removed, giving them a brief reprieve, before being immersed again. Rather than swim for an additional 15 minutes, as was the previously believed maximum for these rats, they went on to swim nearly 60 hours. More than two days. About 240 times longer than they previously had. Why? Richter attributed this to the introduction of hope. Because the rats believed that it was possible to be saved, they swam longer than we believed possible. “In this way the rats quickly learn that the situation is not actually hopeless; thereafter they again become aggressive, try to escape, and show no signs of giving up,” Richter wrote in Psychosomatic Medicine. While these studies are undoubtedly cruel, the results continue to be referenced nearly 70 years later, and the concept of hope continues to be examined clinically by researchers all over the world. What can these rats teach us about hope, even against dire odds? Is the loss of hope the loss of willingness to endure? If meaningful intervention—briefly removing the rats from the water—meant they could swim 240 times longer than they previously had, what might meaningful intervention mean for us?

The American Psychological Association Dictionary of Psychology defines hope as “the expectation that one will have positive experiences or that a potentially threatening or negative situation will not materialize or will ultimately result in a favorable state of affairs.” C.R. Snyder, a researcher at the University of Kansas, Lawrence, was a scholar of hope and a specialist in the field of positive psychology. He created the Hope Theory, in which he defines hope as “the perceived capability to derive pathways to desired goals, and motivate oneself via agency thinking to use those pathways.” Within the study and concept of hope, these definitions hold weight, but hope can be a lot of things. Hope can be social science, and it can be psychology. Hope can be a tool of optimism, and it can be the home of optimism. Some argue that hope is active, while optimism is a passive belief structure, and some research implies that hope takes more work than general optimism, because hope, by nature, flies in the face of the unknown. Continued on page 22

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The World Health Organization (WHO) calls health “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” Health is not the lack of disease, it is the holistic wellness of our being. At Webb’s practice, Red Rock Psychological Health, she uses a framework called the Good Lives Model. It is an enhancement-model rehabilitation theory that guides the treatment of offenders. Webb explains it like a pin cushion. “We start with removing the bad pins—aggression, substance abuse, etc.—and once they’re gone, all that’s left is a pillow. It’s not a pin cushion anymore. It has no function,” Webb said. “Our job is to help add [positive] pins back in.” Those pins can be a job, a relationship, a hobby— anything that can have a positive impact on one’s life. “You can’t just take the negative away from someone; you have to replace it with something else,” Webb said. As we slowly add pins into people's lives, they start to realize there are things worth living for. My version of success is a full pin cushion.” Though the Good Lives Model was created for offender rehabilitation, the basic premise applies to everyone: It’s not enough to simply remove the bad— you must usher in the good as well. You must create conditions where good can thrive. This is echoed in the WHO’s definition of health too. Achieving health is reliant upon good mental health, which Josh Hamilton, APRN, psychiatric and behavioral health specialist at the Hamilton Group, believes can be a precursor as well as a result of hope. “Hope and expectancy explain about a third of the change that we see in therapy or treatment. It’s important,” Hamilton said. “Learning how to foster hope is a less structured dialogue [of] saying, ‘it’s going to get better,’ and more about reframing [it as], ‘yes, the glass may be half empty, but how do we fill it?’” In many cases, hopelessness is associated with depression and anxiety, so addressing hope and health may help mental health outcomes. While therapy and successful therapeutic practice varies by patient, Hamilton asserts the importance of therapy, medication, talk therapy and mindfulness practices. “These things have value. It’s not a waste of time. It’s not the act of pulling yourself up by your bootstraps. [Medication, therapy, mental health care] can

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restructure energy, chemicals and relational pieces of the brain,” Hamilton said. “It’s a generative cycle where good leads to more good. Because if you’re taking meds and doing therapy, these things support each other. And once you have energy back in the brain, then you can really engage in hope and expectancy work. There’s a real biological driver there.” This biological aspect is why seeking medical help when feeling hopeless or depressed is so essential— there are resources out there that can provide a needed biological boost. And in the context of mental health, the role of hope makes a lot of sense. But hope should also be thoughtful and ultimately grounded in realism, which may be especially true with looking at hope through the lens of serious disease.

The ability to conjure hope may be reliant upon a foundation that allows for it to be possible. A common motivational theory is called Maslow’s hierarchy of needs, which posits that humans are motivated by five categories of needs that build upon one another. The five main categories are, in ascending order, physiological, safety, love and belonging, esteem, self-actualization. This hierarchy is important when examining hope and higher-level emotional states, because there are basic needs that should be met first. When those basic needs are not met, all the needs above them suffer. For example, when you’re sick, or starving, or facing safety concerns, your psychological needs are significantly harder to nurture. “In a drug cycle, for example, someone can’t care about relationships. That’s three steps up,” Webb said. When your physiological resources are severely depleted, hope can fall by the wayside. In some circumstances, this may be a chickenand-egg conundrum: Hope is a powerful motivator, but the ability to conjure hope relies on inner resources, which rely on certain baseline conditions. It’s not to say that hope is impossible if you don’t have a safe place to sleep at night, for example, but the experience of hope is different for everyone. This is true of hope when battling disease, including cancer, which can seriously deplete someone’s physiological resources. Again, this doesn’t make hope impossible. Many people may find themselves especially motivated by hope during times of hardship. But hardship itself is depleting, Continued on page 24

This hierarchy is important when examining hope and higher-level emotional states, because there are basic needs that should be met first. When those basic needs— physiological and safety needs—are not met, all the needs above them suffer.

SELF-FULFILLMENT NEEDS

ACHIEVING ONE'S FULL POTENTIAL AND CREATIVITY

PSYCHOLOGICAL NEEDS

RESPECT, FEELINGS OF ACCOMPLISHMENT

INTIMATE RELATIONSHIPS, FRIENDS

BASIC NEEDS

SECURITY, SAFETY

FOOD, WATER, WARMTH, REST, HEALTH, SHELTER

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A 2020 study from Harvard University’s Human Flourishing Program examined the relationship between hope and health and wellbeing outcomes. Collecting data from nearly 13,000 people, the study found that a greater sense of hope was associated with better physical health and health behavior outcomes (including a reduced risk of chronic conditions). It also reported that hope is associated with higher psychological well-being and better social well-being. A 2010 study published in the International Journal of Existential Psychology & Psychotherapy found that hopeful people are more likely to believe that life is meaningful. A 2007 study published in the Journal of Personality reported that students who expressed a higher sense of hope had lowered measures of depression and anxiety. Several studies have demonstrated that hope is a better predictor of academic achievement than intelligence or previous academic success. This includes a 2010 study published in the Journal of Research in Personality, finding that hopeful college students had greater academic success regardless of their intelligence.

and hope might waver in those places. Trying to understand where someone is coming from, and understanding their baseline in any given circumstance, is an act of kindness—this is true when evaluating yourself as well. Stephani Christensen, M.D., medical oncologist at Comprehensive Cancer Centers, tells her patients to hope for the best but plan for the worst. “There’s no reason not to think positive when you get a grim diagnosis because there are patients that beat the odds and do great. [My patients] are on a journey where [they’re] going to be exposed to a lot of toxicity, so a lot of people won’t do it unless they have hope they’ll end up on the other side. But we need to be realistic and plan for things that could happen along the way.”

Can hope save us? Probably not. But arguably, that’s not the function of hope either. Hope isn’t the cure, but it can be a bridge that might motivate us to continue long enough that something could change. And even if nothing does change, even if the situation is truly dire, approaching challenges with a hopeful mindset may still improve your quality of experience. With everything, balance is key, and forced hope can create a false reality. An increasingly common term for this type of attitude is called toxic positivity, which describes the belief that, regardless of the situation, one should maintain a sunny outlook and cheery disposition. Perhaps well-intended, it can also be dismissive and counterproductive. “To me, toxic positivity is not offering a realistic solution but offering a blanket sentiment that puts you at fault for every possible problem. It’s a detached way of giving nonspecific advice,” Webb said. Christensen notes the negative impact of this narrative as well. “I think some patients end up feeling a lot of guilt or undue pressure when people are telling them to stay positive when a lot of what’s going on is not positive. They don’t feel good, they’re on drugs that don’t make them feel good, very often, it’s hard to stay positive,” she said. Hamilton calls toxic positivity self-defeating. “We see people who are living out denial though this narrative. […] It’s a mantra. They say it because really, at the heart of who they are, they want to believe that things will be good. But I think that becomes self-defeating, especially when used across every situation. [It is], in a way, a projection of denial. It’s an invalidation of a real, human, emotional experience.” When you’re denying someone the experience of their reality, you’re likely denying yourself the same. Hope, unlike toxic positivity, is an active process and motivating force. Productive hope can look like perseverance, the willingness to begin, and the willingness to continue. It can also fuel the future of health and longevity, be it personal goals or instances of research and development of new medications.

Medical research is an act of hope. Every day, new therapies are discovered, tested and improved by scientists looking for cures—this is hardcore, tangible, productive hope. Researchers tirelessly work

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toward a better tomorrow. This is true across the board in medical research, including within cancer research, which has made incredible strides in the past 30 years, especially. “I always say, ‘look, if we can keep you alive these five years, there could be another drug that’s around the corner that can keep you alive another year. And after that, another year.’ With the research that we’re doing, I think that we’re going to see better outcomes, and that’s certainly a reason to be hopeful,” Christensen said. “There’s been significant progress in diagnosing, treating and even prolonging life in the most common cancers. And survival rate has increased and continues to increase, all of which is great.” Comprehensive Cancer Centers of Nevada currently has clinical trials open for the following cancer indications: bladder, breast, endometrial, gastric, head and neck, hematologic, lung, lymphoma, ovarian, pancreatic, prostate, renal, and solid tumors. These are for a range of patients—from patients that have had no previous therapy, to patients that have had multiple prior lines of therapy. Clinical trials like these shape the landscape of medical intervention and maintain a throughline of hope in medicine.

Community and peer support surfaces in conversations about hope time and time again. Sharing life experiences fosters understanding, improves well-being and even models hope. “[Developing hope] is a slow progression. That’s why group therapy is the best practice for some populations, because they gain hope and companionship through each other,” Webb said. “They get to see other people getting jobs, other people having relationships, and it’s not just me telling them that they can. They get to watch it happen.” From a neurological perspective, there’s value in community settings, too. “Human-to-human, interpersonal contact is shown to provide some refurbishment of the neural structure. The act of being in it with each other, and not locking ourselves away in our rooms and silos, that’s also important,” Hamilton said.

Hope can be created, fostered, restored and nurtured. One of the first things you can do to begin this process is address your mental health. Work with a doctor or therapist, go to a support group, get active, read, and use all of the tools at your disposal. If you’re feeling hopeless, seeing a therapist is a great first start. Therapy can help encourage people to strengthen their inner resources and start working through discouraging thought processes. “[Therapy] is guiding people using their own experiences to formulate decisions. Teaching decision making skills. I think people think they’re going to come in here and get their questions answered, but all we’re doing is helping you find your own answer,” Webb said. Seeing a psychologist or psychiatrist can also be an invaluable resource. There are many methods of therapy, and all of them can be beneficial. Outside of one-on-one mental health treatment, support groups are another option. There are also many low- or no-cost support groups that cater to specific needs. One of the best mood-lifters is physical activity. It doesn’t need to be a 60-minute HIIT class either—just get outside and do something you like. Stretch, walk, take a jog. “I always talk to patients about exercise. Exercise is important because it helps physically and mentally, it can clear your head. As you stay more active, you often feel better,” Christensen said. There are also myriad of books aimed to help improve mindset. Hamilton recommends “The Positive Shift: Mastering Mindset to Improve Happiness, Health, and Longevity,” by Catherine A. Sanderson, Ph.D., for a feel-good option, or “You, Happier,” by Daniel Amen, M.D., for an approach rooted in neuroscience. Hamilton also recommends the following apps to his patients: Happify, Headspace and MoodKit, which takes a cognitive behavioral science approach. Regardless of what you do or where you start, be mindful about your hierarchy of needs. Work on your foundation and build from there. There’s a vulnerability in hope— can you be vulnerable enough to trust that things can change? This might just be the beginning of everything.

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It’s important to stay current with basic checkups and screenings. Men and women should get a colonoscopy as early as age 45 to screen for colorectal cancer. Women can consider getting a mammogram as early as age 40 to screen for breast cancer, after discussing with her doctors. Women should also get regular pap smears to screen for cervical cancer. Men should have a discussion with their physicians about screening for prostate cancer.

BY HENRY P. IGID, M.D. In the current health care climate, staying healthy can feel overwhelming. When it comes to cancer, the more you know, the better you’re able to influence your health destiny. Preventive measures are an opportunity to put your best foot forward and stay one step ahead of a prospective diagnosis. The goal is to be mindful of positive behaviors and adopt beneficial lifestyle choices. Here are 10 daily tips to be proactive against cancer. This is not an allencompassing list, but a reminder of the things that can, and should, be prioritized. Henry P. Igid, M.D., is a medical oncologist at Comprehensive Cancer Centers. He treats all cancers and serious blood disorders with a special interest in anemia, myeloma, lymphoma, leukemia, lung cancer and gastrointestinal malignancies.

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One of the most common risk factors that the public should be aware of is the correlation between tobacco use and cancer diagnosis. Tobacco is one of the most common causes of cancer and it accounts for more than 20% of all cancer deaths. If someone has already started smoking, they can talk to their doctor about ways to cut back and schedule a lung cancer screening scan for early detection of cancer.

Too much exposure to ultraviolet rays or the sun increases the risk of skin cancers and melanoma. It is best to avoid prolonged exposure to harmful UV rays and to wear protective sunscreen to prevent damage to skin—e.g., a sunburn—that can cause cancer.

Increasing physical activity can decrease the risk of various types of cancer. Physical activity three times a week for 30 minutes to an hour is a great start. Another technique to fit in some physical activity is to walk 15 minutes each day to decrease the risk of cancer, while also improving cardiovascular activity.

Avoid unprotected sex that can lead to sexually transmitted infections (STIs). Certain viruses, such as the human papillomavirus (HPV) can cause cervical, anal, oral and other types of cancer, and the human immunodeficiency virus (HIV) can increase the risk of cancers like lymphoma. By practicing safe sex and using protection, one can protect themselves against these infections that increase the risk of cancer. Individuals who are at risk for acquiring HIV through sex should discuss with their physician strategies, including medications, that reduce this risk.

Increased weight and extra fat can put stress on the body and is associated with increased risk of many types of cancers. If one is overweight or obese, diet and exercise are great initial strategies. Talking to your physician about other options, not limited to medications and surgery, may also help.

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Certain viruses like hepatitis B or hepatitis C can lead to liver cancer. To limit risk, make sure you are vaccinated against hepatitis B, get screened for hepatitis C and partake in safe practices to avoid infection, including not sharing needles and drugs. Vaccination against HPV also reduces the risk of acquiring the virus and HPV-related cancers.

Maintain a diet that is rich in fiber and vegetables, while limiting the intake of red meat and processed meat that has been linked to stomach cancer. The Mediterranean diet is an option that promotes a well-rounded diet of whole grains, fruits, vegetables and seafood. It is also best to avoid animal fats and to use plant-based oils when cooking.

Pay attention to your family’s history of hereditary cancers. Genetic counselors are vital resources that can shed light on a family’s history. They can recommend risk-reducing interventions such as earlier screening tests, scans and, in some cases, surgery. For breast cancer specifically, a person may benefit from medications to reduce the risk of breast cancer based on their family history, age, and prior abnormal mammograms that required biopsies. Families with a history of colon and other cancers that occurred earlier than 50 may also have genetic predispositions known as Lynch syndrome that increases the risk of cancer in these instances, and earlier screening methods are warranted.

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Alcohol is a carcinogen, a substance capable of causing cancer, and it can cause inflammation in the gut. It is best to avoid alcohol intake or to only consume in moderation. Evidence indicates that the more alcohol a person consumes, the higher the risk of developing alcohol-associated cancer.

Every heart has a story. We can help you live yours.

Sharing family traditions with your grandkids. That big career move. These moments define your story, and a healthy heart makes it possible. At Dignity Health – St. Rose Dominican, our cardiology team practices personalized medicine, tailoring your care to suit your needs. So, whether you have concerns or are simply due for a checkup, we’ll help you write your next chapter. Learn more and find a cardiologist near you at strosehospitals.org/heart.

Taylor Phelps’ twin boys Adryan, top, and Damyan in May. (Steve Marcus/Staff) 30

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‘You can’t even feed your own baby’ BY CASEY HARRISON Las Vegas mom Taylor Phelps can only describe the last two and a half months as a struggle. She lives with her boyfriend and helps care for five children ages 5 to 16. But the latest challenge has been finding baby formula for her 7-monthold twins amid supply chain woes and a recall by one of the largest U.S. producers. Store shelves are often picked over, and there are weekslong waits for online orders. “We’ll drive all the way across town, the whole entire city, all around, and it’s an all-day thing just trying to find enough food to last a week,” Phelps said.

“It’s very depressing and stressful,” she said. “It makes you feel so much guilt because you can’t even feed your own baby.” In February, Abbott Nutrition — which holds the bulk of the market share for baby formula — announced voluntary recalls on its Similac, Alimentum and EleCare brands in the wake of four infants contracting bacterial infections after consuming formula made at Abbott’s Sturgis, Mich., factory. Two of the babies died. The recalls have created a severe formula shortage in the U.S., and in May, the Washington Post reported the Sturgis factory said it’s months away from resuming production. Walgreens and CVS locations across the Valley have set purchase limits, representatives for the chains said. Target has no limits on in-store purchases but is restricting online purchases, a spokesperson said. Phelps’ twins were born premature and weighed less than 4 pounds at birth. They require a special calorie-rich formula, she said. “They’ve been on it their entire life. I didn’t want to change what they’re used to in order to be able to feed them,” she said. Phelps said she joined a Facebook group where area moms post photos of available stock when they see it while out shopping. “It’s just been dreadful for us, for a lot of moms,” Phelps said. “I’m hoping that they’ll start to produce a little more.” Phelps has also taken to online

Nationwide formula shortage has parents scrambling to find food for their children.

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Taylor Phelps, center, and her daughter, Elyana, 5, far left, and twin boys Damyan and Adryan. (Steve Marcus/Staff)

Continued from page 31 shops, like Facebook Marketplace, where cans of formula are going for several times more than the normal price. “It’s outrageously overpriced,” she said. Charities and food pantries also have struggled to keep up with a surge in parents seeking formula, said Kelly Maxwell, executive director of Baby’s Bounty, a Las Vegas-based nonprofit that distributes baby supplies. Baby’s Bounty has been received dozens of calls each week from parents seeking formula, Maxwell said. Normally, that’s not an issue, but the

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group has handed out nearly all its formula, she said. “We’re heartbroken for these families,” Maxwell said. “They’re panicked. They have new babies, and they don’t know what to do. And I don’t have terrific solutions for them.” Baby’s Bounty is expecting to get more formula through a partnership with the Three Square food bank, Maxwell said. “It could be toddler formula; it could be infant formula. And those are two different products,” she said. Parents in dire need of formula should speak with their pediatrician, Maxwell said. Most doctors have sample packs that may last a

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day or two, she said. Parents should never water down formula to stretch it over several meals, Maxwell said. Another option for some parents could be returning to breastfeeding. Facebook groups such as Eats on Feets Nevada and Human Milk 4 Human Babies are made up of moms who sell, trade or donate excess breast milk. La Leche League of Las Vegas, which provides information and support to mothers interested in breastfeeding and relactating, has resources available on its Facebook page, facebook.com/LLLofLasVegas, or by calling 702-822-2229.

Make Every Moment Special The right care at the right time can make all the difference to those living with terminal illness. That is why we offer patient-centered hospice unique to your needs. Doctors, nurses, chaplains, and bereavement coordinators are available 24/7 for physical, emotional, and spiritual services. Care continues even after passing, with bereavement support for loved ones. Make every moment special. Get the comprehensive, compassionate care you deserve.

Call 702.671.1111 or visit smalv.com/en/hospice

The company does not discriminate on the basis of race, color, national origin, sex, age, or disability in health programs and activities. We provide free services to help you communicate with us. Such as, letters in other languages or large print. Or, you can ask for an interpreter. To ask for help, please call 702-877-5199 TTY 711. ATENCIÓN: Si habla español (Spanish), hay servicios de asistencia de idiomas, sin cargo, a su disposición. Llame al 702-877-5199 TTY 711. (Chinese), 702-877-5199 TTY 711

The Clinical Simulation Center of Las Vegas was opened in 2009 and is now used by at least four university programs in the region. (Courtesy Clinical Simulation Center of Las Vegas)

A day in the Clinical Simulation Center of Las Vegas BY TIMOTHY CUMMINGS

Timothy Cummings is a Standardized Patient Program Specialist at the Clinical Simulation Center of Las Vegas.

t 6:30 a.m., IT Administrator Brandon Stone arrives at the Clinical Simulation Center of Las Vegas. He is walking briskly because there are a few things that need attention before the day can start. “I have the equipment programmed so that if something fails, I receive a notification,” Stone said. “That way, I know what to look for when I come in beyond the regular maintenance.” He enters the server room where two servers need attention. A shutdown and restart are all that is required. He plugs in his work phone to charge to be ready for any calls he may receive. “If it has a button, I’m in charge of it,” Stone said. And there are so many buttons—60 laptop computers and almost as many desktop computers, four classrooms with state-ofthe-art meeting software and cameras and video displays, 40 cameras to record student encounters, numerous servers to host all this equipment, and then there are manikins. “Even more buttons!” Stone said. Stone shares the responsibility of the manikins with Clinical Simulation Lab Technician Rich Dantes, who arrives shortly after Stone to set up simulations for student encounters. The manikins are not just dolls or dummies, but intricately crafted high-fidelity simulators that students can interact with in a variety of settings. The manikins can blink, their pupils can dilate, they can breathe, sweat, cry, and give voice to their concerns via a techni-

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cian at a microphone. One specialty manikin can even simulate giving birth. “It’s a lot of set-up,” Dantes said, “but the higher the fidelity of the simulation, the more fruitful it will be for the students. They’ll be able to flourish when providing care to actual patients.” Kyra Sciabica arrives at the CSCLV at the same time as Dantes. As a Clinical Simulation Specialist, Sciabica oversees skills development, as well as assisting in high fidelity simulation. With skills development, there are task trainers and supplies that need to be laid out for students to utilize.

“There are innumerable task trainers,” Sciabica said, as she sets out additional sutures for a suturing lab. “From injection pads to tracheotomy trainers, arterial lines, catheter trainers; whatever task needs to be accomplished, there is a low fidelity trainer for it.” It is Sciabica’s responsibility to set up these labs, to restock them while they are happening, to put the task trainers and unused supplies away when the lab is over, and to set up the next lab. Brenda Lopez, a Clinical Simulation Specialist, arrives early too. Depending on what is

Manikins are not just dolls or dummies, but intricately crafted high-fidelity simulators that students can interact with in a variety of settings. The manikins can blink, their pupils can dilate, they can breathe, sweat, cry, and give voice to their concerns via a technician at a microphone. One specialty manikin can even simulate giving birth.

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Nursing students practice on a manikin in the Clinical Simulation Center of Las Vegas. (Courtesy Clinical Simulation Center of Las Vegas)

scheduled for the day, she can assist anywhere in the center, from setting up a skills lab, running a simulation, or, as the only SAGES-certified proctor in the state of Nevada, preparing a surgical skills examination for a Fundamentals of Laparoscopic Surgery or a Fundamentals of Endoscopic Surgery. “It’s a lot of scheduling, but I am always so pleased to see the residents do well in their exams. It feels like everything we do here makes the world a better place,” Lopez said. Standardized Patient Program Specialists Brandi Blackman and Timothy Cummings arrive next. Together, they organize, train and deploy a cadre of dedicated Standardized Patients, people who have been coached to accurately and consistently recreate the history, personality, physical findings and responses of an actual patient. “Standardized patients can be utilized for numerous situations, such as live models for ultrasound training to detailed portrayals of patients with specific needs in an in-person encounter with undergraduate or graduate students,”

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Blackman said. Opened in August of 2009 at the Shadow Lane Campus of UNLV, the Clinical Simulation Center of Las Vegas was shared by the University of Nevada Las Vegas School of Nursing, Nevada State College School of Nursing and the University of Nevada School of Medicine. Four years ago, the University of Nevada Las Vegas School of Medicine began utilizing the CSCLV. Nursing students, graduate nursing students, medical students and graduate medical students utilize the facility to further their education and to promote greater collaboration among future health care workers within a collaborative and interprofessional framework. “Every day, we reach for our vision of optimizing the health of society through interdisciplinary health care education,” said CSCLV director Dr. Leland Rockstraw. “And this team does it the best. They are a tireless, collaborative, cooperative, collective that works hand in hand with academic faculty to deliver the best in health care simulation education.”

Clinical Research at Comprehensive has led to

100 New FDA Approved Cancer Treatments Giving me my chance to be mom again Comprehensive Cancer Centers has participated in the development of 100 new FDA approved cancer treatments. With 170 ongoing clinical research studies, right here in Southern Nevada, we are entering a new age in cancer treatment — where people are no longer entrenched in their battle against cancer, but instead living with cancer. These new cancer therapies are increasing the quality of life for our patients and their families, and most importantly, giving them the opportunity to live their lives to the fullest.

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Educate, don’t alienate unvaccinated individuals BY BENITO CALDERON

Benito Calderon, M.D., is a physician at Calderon Medical Group, a contracted provider with Optum Care Network of Nevada

hen it comes to the unvaccinated, many of us aren’t seeing the whole picture. My observations suggest that much of the language in the media and public conversations blaming the unvaccinated doesn’t help efforts to vaccinate those who may only be COVID-19 vaccine hesitant. I’ve seen first-hand news reports that refer to the unvaccinated as anti-vaxxers, with “anti” strongly implying they are against all vaccinations. We should recognize the power of informed choice in persuading people to get vaccinated. It is important that we educate people, and not alienate them. It’s about caring for each other. The reasons why some individuals hesitate to receive the COVID-19 vaccine or boosters can be complicated and extend beyond a lack of knowledge. From the conversations I have had in my own practice, what I often hear from concerned patients are lingering and unanswered questions about vaccines, especially relating to COVID-19 vaccination side effects. Poten-

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tial side effects are one of the main things we talk about when we seek informed consent for any procedure. If patients aren’t sure about that, it’s not surprising that many are still saying no. Acknowledging to patients who have vaccine hesitancy that vaccines or booster shots can cause unwanted effects and that their concerns are understandable is an important first step, especially for patients who have experienced adverse reactions with other vaccines in the past or who are more likely to be affected. It is important to note that although most people experience no or only mild adverse effects, letting patients know that they have easy access to your medical advice when side effects occur is essential to building trust and moving forward. Another potential roadblock to convincing people to get vaccinated or boosted is the manner in which potential side effects are presented. The way this information is presented can strongly influence decision-making and perception of symptoms. Rather than stating the probability of experiencing a particular side effect, we can provide the likelihood of not experiencing this effect (e.g., from very common to very rare). Of course, while severe adverse effects are a matter of concern and should be monitored closely, mild forms of fever, muscle pain, or fatigue also indicate the immune system is responding appropriately to the vaccine. Our approach has had mixed success, but an important aspect is that our patients feel respected and dignified. I believe this has more chance of convincing them to consent to the recommendation, because in the end, both vaccinated and unvaccinated just want to get on with their lives and live life to the fullest.

Let’s address possible COVID-19 vaccination side effects with empathy and understanding. Patients should have easy access to your medical advice when making the decision to be vaccinated, and especially when side effects occur.

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Persuading unvaccinated patients

The COVID-19 misinformation that we have witnessed from the start of the pandemic has ranged from half-truths and speculation to conspiracy theories. This

The Nevada Army National Guard administer COVID-19 vaccinations at Cashman Field in 2021. (Steve Marcus/Staff)

misinformation can distort people’s opinions and their health decisions if not challenged. Vaccine hesitancy may involve mistrust of vaccine benefits, worries about future unknown effects, or commercial profiteering. It is important to identify a patient’s most common or strongest belief and focus the discussion on this area. The extent to which we are able to move a person from hesitancy to vaccination is impacted by our ability to communicate the immediate benefits a person receives from vaccination and the less obvious benefits, or those benefits of enhanced protection for family and friends within a social circle. Sharing the importance of the positive impact on the community and appealing to a person’s concern for the well-being of others can be very

important, especially for groups, such as adolescents, that are less likely to become severely ill if infected.

Onward

So, where do we go from here? First, don’t assume that all unvaccinated people are “anti-vaxxers.” Strive for understanding and open communication. If someone feels attacked or that they are somehow being treated unfairly or blamed for something, they will naturally feel defensive, and the ability to openly communicate and share information and mutual understanding is immediately damaged. As we noted earlier, it’s about caring for each other. It’s important that we educate people, and not alienate them. Let’s address possible COVID-19 vaccination side effects with empathy and understanding. Patients should have

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easy access to medical advice when making the decision to be vaccinated and especially when side effects occur. We need to acknowledge and understand the limitations there are on some of our patient communities regarding valid resources for medical information. Empathy for every patient and community member must be a part of outreach to the vaccine hesitant. Because of some Americans’ vaccine hesitancy, the goal of herd immunity will continue to distance itself until greater numbers of people are vaccinated. As this pandemic continues through various stages, it is vitally important that we continue to vaccinate and provide boosters to as many people as possible. Doing so will help determine how long this pandemic will ultimately last.

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What you should know about long COVID-19 and its symptoms BY BRYAN WERNER, M.D., M.P.H.

T Bryan Werner, M.D., MountainView Medical Associates, is a board-certified physical medicine and rehabilitation physician specializing in long COVID-19.

he time it takes to recover from a SARS-CoV-2 infection, or COVID-19, is different for everyone. Many experience mild symptoms for only a few days, while others have severe symptoms requiring hospitalization and intensive treatments for several weeks. Some may have symptoms that linger for much longer. Someone with persistent or new symptoms that last weeks or months following a COVID-19 infection, that cannot be explained by an alternative diagnosis, may be experiencing what is called post-COVID-19. The condition has been referenced using several names but the most common are long COVID-19 or “long haulers.” Also referred to as post-COVID syndrome, the long-term symptoms associated with the virus do not depend entirely on the severity of the initial illness. Many individuals who had mild symptoms after the initial infection report experiencing current and additional symptoms for a

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prolonged time, categorizing long COVID. It is important to note, symptoms may not remain static over time, there may be periods of improvement followed by periods of worsening symptoms called flare-ups. Intense exercise, strenuous physical or mental activity, as well as stress can trigger periods of relapse and intensify one’s symptoms. The most common long COVID symptoms appear to be related to the cardiovascular, pulmonary and neurologic systems. Symptoms may include fatigue, cognitive dysfunction, and post exertional malaise which is characterized as worsening symptoms after minor physical or mental activity. Persistent dysfunction of the cardiovascular system may include changes in peripheral vasculature, meaning the veins and arteries located throughout the body, as well as autonomic dysregulation affecting changes in pulse and blood pressure. The result can mean damage to blood vessels due to chronic inflammation related to the virus. Also common are dysrhythmias, or improper beating of the heart including bradycardia, tachycardia, and atrial fibrillation which can be the result of damage to the heart caused by a COVID-19 infection. Lasting changes to the pulmonary system can result from tissue damage to the lungs as an outcome of COVID-19 pneumonia that can cause lung tissue scarring or pulmonary fibrosis. The overall result of these changes can lead to decreased ability to deliver oxygen from the lungs to the blood, which is carried to organs or tissues such as the brain and muscles. The result of this can be “silent desaturations,” or a drop in blood oxygen levels that you may be unaware of and can lead to symptoms associated with long COVID including

Lasting changes to the pulmonary system can result from tissue damage to the lungs as an outcome of COVID pneumonia that can cause lung tissue scarring or pulmonary fibrosis. The overall result of these changes can lead to decreased ability to deliver oxygen from the lungs to the blood, which is carried to organs or tissues such as the brain and muscles.

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Continued on page 44

COVID-19 LONG-HAUL SYMPTOMS The lingering symptoms experienced with long COVID-19 can often result in functional restrictions that may require lifestyle changes, a change in overall physical activity levels, impact to social life and overall quality of life.

SKIN AND HAIR • Skin rashes • Alopecia • Excessive sweating

MUSCULOSKELETAL SYSTEM • • • •

Muscle weakness Myopathy Muscle pain Joint pain

HEART AND BLOOD VESSELS • Palpitations • Arrhythmias • Venous/arterial thrombosis • Myocardial inflammation • Limb edema • Thromboembolism • Arterial and venous inflammation

LUNGS

• Labored breathing • Cough • Pulmonary fibrosis • Lung hypoperfusion • Impaired lung function • Chest pain

Brain and nerve symptoms on page 44

DIGESTIVE SYSTEM

• General gastrointestinal upset • Loss of appetite • Nausea • Abdominal pain • Bowel incontinence • Acid reflux • Diarrhea • Vomiting

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cognitive effect here BRAIN AND NERVE COVID-19 LONG-HAUL SYMPTOMS • • • • • • • • • • • • • • • • • • •

Fatigue Headache Hyperesthesia Numbness Cognitive fatigue Apathy Neuropathy Brain fog and memory loss Bladder incontinence Swallowing difficulties Loss or altered smell/taste Post-traumatic symptoms Encephalopathy, dizziness, vertigo Tinnitus Earache Depression Sleep disorders Attention disorders Anxiety

Continued from page 42 fatigue, poor exercise tolerance, and changes in cognitive performance. Changes in cognitive function or “brain fog,” in addition to being caused by decreased oxygen levels, is also attributed to damaged nerve tissue thought to occur through neuroinflammatory and oxidative stress pathways following COVID-19 infection and immune reactions. The lingering symptoms experienced with long COVID can often result in functional restrictions that may require lifestyle changes, a change in overall physical activity levels, impact to social life and overall quality of life. Many of these persistent symp-

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toms can also have a strong negative impact on mental health as one adjusts to a change in health and function. There can also be changes in mental health attributed to direct damage to brain tissue as well as lingering effects from a traumatic experience surrounding COVID-19, which can present as post-traumatic stress disorder, anxiety and depression. Mental health difficulties can also impact cognition and energy levels. If you are having symptoms that you think may be related to long COVID, you should seek medical care and discuss it with your primary care provider. It is vital to make sure you are appropriately screened and diagnosed, as well as rule out other underlying health conditions that may mimic long COVID.

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You may need to have testing done as part of your care plan and may benefit from a referral to a physiatrist, also known as a physical medicine and rehabilitation physician, PM&R or rehab doctor. This specialist can help manage your recovery and improve overall function. The physiatrist will work with a multidisciplinary team to provide a personalized plan with respiratory therapists, cardiologists, occupational therapists, neuropsychiatrists or speech-language therapists. Dr. Werner is accepting new patients at MountainView Medical Associates on the campus of MountainView Hospital. Visit mountain-medical.com to learn more or to book an appointment.

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The evolution of health care services for athletes BY MALLORY ZITO

s a medical provider for professional, amateur and recreational athletes, ProAm Sports Medicine provides world-class medical care, including expedited injury treatment, physical therapy, pre-competition medical exams, COVID testing and improved performance resources at its state-of-the-art medical practice and training facility. But it didn’t start that way. James Murphy tells us about the evolution of his business and the growing need for athlete-centered health care in Southern Nevada.

How did you decide to enter the health care industry?

Mallory Zito is the PR manager at GYC Vegas. James Murphy is the founder and CEO of ProAm Sports Medicine.

Being skilled at business development and marketing, I had a friend who owned an urgent care ask me to analyze some of the operations to help grow the patient base. Through the experience, I discovered the prefight medical requirements for professional fighters and the exams they must pass before being authorized to compete in the state they’re fighting in (states have varying requirements and forms). I saw the opportunity to consolidate complex processes into simpler form for better patient experiences. I questioned why no one had consolidated the process to make it easier for the promo-

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tions, fighters and managers to make one call and get all the necessary medicals scheduled. Realizing the void, I assembled a network of providers, labs and advised the promotions licensed in Nevada — UFC, Golden Boy, Top Rank, etc. Within a week, they started sending us fighters to manage their care. With the help of my business partner and medical director Dr. Nick Sadeghi, we opened our own practice. Within six months we dominated the market, handling fight medicals for most professional boxing and MMA athletes within the field. We expanded our network to include physicians and medical resources across the country, including labs, neurologists, ophthalmologists, general practitioners and imaging providers. We now have more than 200 medical providers nationwide in our network, including nationwide providers Concentra and Labcorp.

ProAm Sports Medicine recently debuted a new health care concept— expedited injury treatment. How is it different than an urgent care, concierge medicine or a general practitioner office? When it comes to concierge medicine and urgent care, we combine the best of both worlds. Our patients receive the highest quality service that a concierge medical practice provides, along with the expediency of an urgent care. It’s what makes us extremely unique in this industry. We start the evaluation before a patient even visits our office to get to the root of the problem more quickly. Usually, patients first visit their general practitioner, get a referral for imaging, wait for an appointment, have the images reviewed by the GP, and then get referred to a specialty provider. By then, patients are 3-4 weeks into the process. Our structure allows us to initiate the process as soon as a patient contacts us. For example, if we have a morning patient who needs an MRI, we can typically get them scheduled in the afternoon and evaluated that evening or the following morning. Instead of taking weeks to go through the traditional process, our goal is to make the treatment and rehabilitation timeline as efficient as possible. We keep all treatment under our umbrella

of preferred providers and guide each patient throughout the entire process to ensure they stay on track with appointments and treatment, never falling through the cracks.

How did you determine there was a need for it within the medical community? The traditional medical process has always been an issue because of the length of time between evaluation, treatment and recovery. We knew if we looked at the business from a completely different perspective than traditional health care, we would be able to provide a great service to the athletic community. By consolidating and expediting the injury treatment process, we’re able to provide exceptional service to our patients, just as any typical business would for their clients.

You recently launched a new sports performance and treatment complex. How does that partnership supplement your practice and assist patients? In this endeavor, I partnered with Syndicate MMA Gym to take the idea of a sports medicine practice to the next level and create an all-encompassing environment. With athletes training onsite, we can enhance their performance with complete training programs to ensure optimal fitness and peak performance, including nutrition and sport-specific mechanics. At our complex, athletes can perfect their craft, address medical issues and have specialists under one roof to help them excel at their sport.

Where do you see the future of health care heading? I think people are going to notice how we’re operating and realize how efficient our system is. Our concept leads to better patient outcomes and experiences, which should be the future of health care. I hope individuals will continue to push to improve health and medicine standards and not fall into the status quo. Our ultimate goal is to expand nationwide and emulate what we have created in Las Vegas in other markets.

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HCQ Notes Bridge Counseling announced the promotions of Dan Ficalora, M.A., to clinical director, and Merlelynn Harris, M.S., MFT, to clinical director emeritus. Ficalora joined Bridge in 2015 as a staff therapist and has worked in a variety of roles, supervising the U.S. Bureau of Prisons and U.S. Probation programs and Ficalora later leading the intensive outpatient program. Harris has served as Bridge Counseling’s clinical director since 2015. She will remain an integral part of the leadership team Harris and will focus on direct supervision and clinical leadership development in her new role as clinical director emeritus. In addition, Bridge Counseling invested $27,000 to provide training for therapists across Nevada in eye movement desensitization and reprocessing therapy, a specialized trauma practice that focuses on changing distressing emotions, thoughts or behaviors to allow the brain to naturally heal.

Wint

Dr. Dylan Wint was named director of Cleveland Clinic Lou Ruvo Center for Brain Health. While continuing to see patients, as director, Dr. Wint will focus on strategic

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UNLV commemorates residency space The Kirk Kerkorian School of Medicine at UNLV commemorated its partnership with Optum Care by renaming its graduate medical education classroom space the Optum GME Classroom. The UNLV orthopedic surgeon residency program is the first of its kind in Nevada. Residents learn from Optum Care surgeons and train at University Medical Center. Optum also established the Optum Dr. Tony and Renee Marlon Endowed Chair in the Department of Orthopaedics with a pledge of more than $1.2 million over five years. Dr. Tony and Renee Marlon have donated a match to those funds, for a total of $2.5 million.

growth, expanding the Lou Ruvo Center for Brain Health’s work to prevent and relieve suffering through excellent clinical care, research and education. Goodwill of Southern Nevada launched a program designed to bridge the employment gap for underserved populations, while also alleviating the shortage of healthcare workers. Created by NV Careers and Intermountain Healthcare, the 90-Day Medical Assistant training program is now instituted as a Good-

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will train-to-hire program. For more information, visit goodwillvegas.org. Nathan Adelson Hospice, the top choice for hospice and palliative care in southern Nevada, was awarded the 2022 Top Workplaces USA award. This award is based solely on anonymous employee feedback gathered through a third-party survey measuring several aspects of workplace culture including: alignment, execution, and connection, just to name a few. “To be recognized on a national level is an honor and makes me incredibly

proud of our organization,” said Nathan Adelson Hospice President and CEO Karen Rubel. “This award helps renew us each day in our critical work to ensure no one ends the journey of life alone, afraid or in pain.” Southern Hills Hospital and Medical Center partnered with Prenatal Yoga Las Vegas to bring expecting moms a free weekly class. Exercises focuses on pregnancy, postpartum, pelvic health and more. The class is every Tuesday from 4-5 p.m. Registration is required. Sign up by going to southernhillshospital.com or by calling (702) 916-5023. Sunrise Health System and HCA Healthcare opened its 17th CareNow urgent care location to serve patients in the northwest Las Vegas community. The new clinic is located at 6440 Centennial Center Blvd., Suite 110. Seven Hills Hospital is now offering evening classes for working adults struggling with chemical dependency. The Intensive Outpatient Program is offered Tuesday, Wednesday and Thursday from 6-9 p.m. Participants will have the ability to practice skills in real-life settings through cognitive behavioral therapy, 12-step programming, trauma-informed care and motivational interviewing. Participants also benefit from the group therapy environment where they can interact and learn from others going through the same struggles. Call 702-6465000 ext. 401 to register. Spring Valley Hospital and its freestanding emergency department, the ER at Blue Diamond, earned the Joint Commission’s Gold Seal of Approval and the American Heart Association’s Heart Check-Mark as a certified primary heart attack center for the hospital and an acute heart attack ready center for the ER at Blue Diamond.

MountainView Hospital expanded its women’s services unit to better serve patients and their families. The new dedicated 10-bed expansion is on the third floor, adjacent to the labor and delivery, postpartum and antepartum rooms. This brings the Women’s Services department to 27 privatepostpartum beds in total.

MDX Labs announced two additions to the company to support its growth and assist in long-term expansion objectives. Trent Hofmockel and James Utley, Hofmockel Ph.D., MLS have a combined 50 years of experience working in the medical and laboratory industries with recognized health care brands. As clinical operations advisor, Hofmockel will Utley utilize his experience managing large clinic operations to streamline MDX processes

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and services. Dr. Utley is laboratory manager for MDX Labs and will oversee all laboratory operations. Nigro Construction completed a new office and procedure facility for Couture Dermatology and Plastic Surgery. The new space on 9950 W. Flamingo Road features nearly 10,000 square-feet that now includes a reception area, multiple offices, exam rooms, Category II procedure rooms, support rooms, and circulation areas. Southwest Medical added three new health care providers to help meet the growing need for health services in the Las Vegas community, including Dr. Kevin Garth at its Southwest Medical Surgery Center at Charleston, specializing in anesthesia; Jessica Miller, APRN at its Rancho Urgent Care, specializing in urgent care; and Rosemarie Sabijon, APRN at the Rancho Healthcare Center, specializing in urgent care.

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