2023-11-16 - Health Care Quarterly (Vol. 42) - Fall 2023 by Greenspun Media Group

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From the editor

o you know that feeling when you’re sick and the symptoms just won’t go away? When it feels like you’ve been congested for so long that you’ll never breathe normally again? As cold and flu season has been ramping up and as I’ve worked on this issue, I’ve thought about how many aspects of health I take for granted on a daily basis. So many systems in our bodies have to work together seamlessly to preserve and promote health. The heart pumps blood (circulatory system) to the lungs to receive oxygen (respiratory system) which is then distributed to all the muscles and organs (muscular system, digestive system, nervous system) so we can breathe, eat, think, and move. The immune system heals injuries, from papercuts to broken bones, and fights back when pathogens wreak havoc on carefully calibrated symbiosis. Bodies are marvels of efficiency. No machine or discovery of science has ever been able to replicate everything that the body does automatically. When the systems in a body don’t function properly or fail to communicate with one another it can cause pain and illness. Disease and/or disability will affect everybody at some point. Health Care Quarterly provides unique insights on the functions of bodies, both well and unwell, the providers in Southern Nevada that take care of our bodies, as well as the newest research local doctors and scientists have to offer. This issue delves into the interconnection between health and happiness, including tips on how to increase both. You’ll also find a fascinating article on the ways that post-pandemic

telehealth options have expanded the reach of mental health services, making the benefits of therapy and other treatments more widely accessible. Because mental illness remains an inhibitor to the happiness of many individuals, there is also a piece on resources and strategies for combating the rising rates of suicides, especially during the holiday season. You’ll also want to read about the increasing popularity of a drug originally formulated to treat type 2 diabetes that is now being used for weight management. Semaglutide, better known under brand names such as Ozempic, Wegovy, and Rybelsus, has been touted by celebrities and influencers for its success in treating obesity, but how does that work and what do researchers say about the medication’s effects on the body? If you’re looking for quick reads from health care professionals in the Las Vegas Valley, there are columns on sleep apnea and research connecting sleep quality to heart disease and dementia, new technology to help patients young and old overcome dental anxiety, and health care disparities in Alzheimer’s disease patients living in urban and rural areas.

Wishing you health and happiness,

Sierra Smart Special Publication Editor sierra.smart@gmgvegas.com

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Medical News GOVERNOR SIGNS BILL ESTABLISHING NAPRAPATHIC MEDICINE ADVISORY BOARD

ORGAN TRANSPLANT TECH PROVIDES IMPROVED QUALITY Nevada Donor Network announced it is the first organ procurement organization in Region 5 to provide normothermic preservation of livers using the OrganOx metra® ex vivo normothermic liver perfusion system. The implementation of the OrganOx technology can bring many benefits, including improved organ quality, increased transplant opportunities, extended preservation time, and collaborative research opportunities.

Assembly Bill 153, establishing an advisory board to oversee licensing of naprapathic medicine practitioners in Nevada, received Gov. Joe Lombardo’s signature July 17. State Assemblywoman Elaine Marzola, who sponsored the legislation, attended the signing with entrepreneur and physician Patrick Nuzzo, D.N. and other local and state officials. Naprapathic medicine is a drug-free method of treating pain in the connective tissue that supports the spinal column and bodily joints. The practice uses manual medicine, noninvasive modalities, therapeutic, and rehabilitative exercise and nutritional counseling. Nuzzo is co-founder and president of Southwest University of Naprapathic Medicine, based in Santa Fe, New Mexico. The school plans to open a Nevada campus.

LOCAL CONFERENCE SUPPORTS COMMUNITY CLINCIANS The Nevada Academy of Family Physicians held the 34th annual summer conference series in August, sponsored by Optum with support from Humana, Eli Lilly, and SGRO law firm. The conference was supported by more than 50 exhibitors, 70 medical students, and residents and 200 attendees from 12 states. A broad spectrum of primary care topics were covered to support community clinicians in improving care outcomes.

Inside this issue

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14 30

The path to happiness: Tips for developing and embracing joy

How loud is too loud? Five activities that could hurt your hearing

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34 38

Semaglutide: A new frontier in weight loss medication Finding solutions to Nevada’s provider shortage

40 46

Interpretation services offered in hospitals and clinics across the valley Implantable contact lenses that correct vision

SOCIAL JUSTICE

INTELLECTUAL PURSUIT

SERVICE TO HUMANITY

Nevada’s Largest School of Medicine Thank you for considering Touro in your philanthropic plans.

TUN.TOURO.EDU/GIVING

Nevada’s role in reducing dementia disparities in rural communities BY JUSTIN B. MILLER, PHD

I Justin B. Miller, PhD, is director of neuropsychology, director at Nevada exploratory Alzheimer’s Disease Research Center, Cleveland Clinic Lou Ruvo Center for Brain Health

n Nevada, the health disparities in Alzheimer’s disease and related dementias are striking in rural communities, where residents often go undiagnosed or are misdiagnosed because of lack of access to dementia specialists. Specifically: n The relative risk for dementia is 80% higher for those living in rural communities n Survival following diagnosis is often shorter compared with those in urban communities Ten percent of Nevada’s population is spread across about 90% of its land mass, making access to health care challenging for those living outside the urban cores of Reno and Las Vegas. An unfavorably low ratio of providers to population throughout the state compounds access issues. What’s more, those living and aging in rural communities are severely underrepresented in research. The literature on people with dementia in rural areas is scarce and usually includes only a small number with limited sets of biomedical data, derived from retrospective health care claims data. There is also a lack of diversity in rural aging research. This gap in care and lack of reliable data is the driving motivator for the Nevada exploratory Alzheimer’s Disease Research Center, awarded to Cleveland Clinic Lou Ruvo Center for Brain Health in 2020 and supported by $3.3 million in funding from the National Institute on Aging at the National Institutes of Health. The Nevada exploratory Alzheimer’s Disease Research Center is developing novel methodologies and technology to establish a cohort of rural-dwelling older adults and collect high-quality data to share with the broader scientific community. The goal is to better understand aging in rural America, including geographic disparities and the determinants of health that may increase risk for

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developing Alzheimer’s disease and other dementias in rural communities. Three years into our research, the Nevada exploratory Alzheimer’s Disease Research Center is already shedding new light on the pros and cons of rural living. New data suggests late-life rural living may be protective to some individuals. This may be due to reduced exposure to pollution, a stronger sense of community, greater access to outdoor recreation and green space, and reduced stress, but more research is needed to better understand the role of these factors. For others, rural living may undermine healthy aging. Lower education and access to quality health care can influence the risk of developing Alzheimer’s disease and other dementias and have also been found to differ between urban and rural communities. These and other social determinants of health account for upwards of 40% of health outcomes. Addressing them is a key step toward eliminating health disparities. The Nevada exploratory Alzheimer’s Disease Research Center has enrolled more than 100 individuals from Mesquite, Pahrump, Laughlin and neighboring communities in northwestern Arizona and southwestern Utah. The Nevada exploratory Alzheimer’s Disease Research Center is seeking research volunteers interested in participating in an observational study who: n Are at least 55 years old n Live in Nevada outside of Las Vegas or Reno n Do or do not have memory complaints Together, we can learn more about Alzheimer’s disease and how we can improve brain health—not just for our neighbors in rural regions, but for everyone across the Silver State. Visit nvadrc.org/LearnMore or call 702-701-7944 for more information. A stipend will be provided as a courtesy for participation.

Post-placement support should be a priority for birth mothers BY ALEXANDRA HOOPS

lacing a child for adoption is one of the most courageous and noble acts that a birth mother can do, but it can also be a painful journey that deserves post-placement resources from community adoption professionals. Before and throughout the adoption process, many adoption agencies are heavily involved in the development of an adoption plan while supporting the birth mothers they serve. In open adoption cases, some agencies may provide mediation support among the parties of the adoption triad (adoptee, adoptive parents, and birth parents), and depending on the state wherein the adoption facilitation took place, the birth mother may also receive financial assistance. Benefits like these, however, are only temporary and do not extend past finalization. Post-placement support is not always emphasized or provided by many adoption agencies. Many birth mothers are faced with traumatic experiences (including placing a child for adoption) and intense feelings of grief throughout their lives. This and the lack of available resources makes it extremely challenging for birth mothers to reach out and get the help they need to thrive. According to a 2022 study conducted by the National Council for Adoption, 65% of surveyed birth mothers indicated a need for individual counseling, but only 39% had received those services. Similarly, 51% of the reported birth mothers noted the need for post-adoption birth parent support groups, but just 31% of these women received support. These alarming gaps in statistics reiterate the need for formalized resources from adoption agencies to birth mothers, as they are often in great need of support and help even after finalization of their child’s adoption.

Resources and supportive services include mental health treatment, food, coordination of housing or job assistance, and even safety planning because of domestic abuse. At Loving Hearts, we actively work to provide resources for the challenges birth mothers may experience and partner with various community organizations to help in ways we may not be able to accommodate. Our monthly Birth Mother Support Group is free to attend and open to any birth mother who has placed a child for adoption, regardless of the agency utilized. The Knee-to-Knee certified support group provides attendees with monthly topics of discussion and most importantly, a connection to a community of people who have experienced a similar situation. To ensure that birth mothers can access our monthly support group, we offer transportation services, online participation opportunities, food and free child care during the session. By actively listening to the needs of our birth mothers and tapping into our community connections, we can help provide resources like food and housing assistance, bus passes, clothing donations, and more to uphold our support to birth mothers in the lifelong adoption journey. Regardless of what or when help is needed, we believe it is vital for birth mothers to know they can trust and lean on the adoption agency they placed with to provide unwavering support. Loving Hearts Adoption Services is a not-forprofit, private adoption agency that aims to provide the most ethical services possible through education, compassion, and post-placement support to everyone in the adoption triad.

Alexandra Hoops is director of adoption at Loving Hearts Adoption Services

To learn more about the lifelong adoption process and Loving Hearts’ available services, please call 702-385-3351 or visit lovingheartsadoption.org.

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Many health concerns can be addressed with sleep apnea solutions BY JERRY HU, DDS

ore than one billion individuals worldwide battle undiagnosed or underdiagnosed sleep apnea. It is a severely overlooked health epidemic that is sweeping the globe today. Here’s a look at the many ways poor sleep affects your overall health, and what you can do about it.

Poor sleep is not normal

Jerry Hu, DDS, is founder of Nevada Dental Sleep. To learn more about Nevada Dental Sleep, visit NevadaDen-

talSleep.com.

In Las Vegas, we have a high number of shift workers whose natural sleep cycles are disrupted, making them ripe for sleep disorders. They may feel groggy and tired, and they often accept this as normal. It’s not. Constant fatigue contributes to depression, anxiety, strained relationships, and a growing phenomenon called sleep divorce. There are two types of sleep apnea, obstructive and central. Central sleep apnea occurs when the brain doesn’t consistently signal the body to breathe during sleep. Obstructive sleep apnea involves airway interferences. It can be caused by a large, misplaced tongue or obstructions that may occur because of misalignment of the jaw. Sleep apnea is also linked to obesity, heart disease and the buildup of proteins in the brain that contribute to dementia and Alzheimer’s disease. With a sleep disorder, your body operates in an oxygen-deprived state. Research has even found cancer to metastasize faster in a body with lower oxygen levels. Many assume sleep disorders occur only in obese people, but that’s not true. I’ve worked with athletes and others in excellent condition who find it hard to get a sleep disorder diagnosis, even with a sleep study. In the population with normal BMI, women in particular can run into misdiagnosis problems. Most sleep studies rely on the apnea-hypopnea index for a sleep disorder diagnosis. With AHI, sleep arousals must be 10 seconds or lon-

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ger. Those fewer than 10 seconds are considered micro-arousals and are not recorded. However, a person could have hundreds of micro-arousals in a night. The respiratory disturbance index is a reading that includes micro-arousals and often helps to uncover upper airway resistance syndrome, which significantly impacts health and well-being in these patients.

Rethinking treatment

The first line of treatment for sleep disorders is often a CPAP (continuous positive airway pressure) machine. While the device can help, it can also be uncomfortable, so many patients don’t use it every night and progress is stifled. Many may not realize that noninvasive dentistry specifically created to address airway disorders offers the best results by realigning the jaw. At Nevada Dental Sleep, we use a combination of approaches. We customize oral appliances for comfort and efficacy to guide growth or realign the jawbone. We also use orthotropics, or appliances that tap into the growth centers of the jawbone. These options can be combined with Craniofacial Epigenetics and Pneumopedics, which utilize your stem cells to assist in programming your craniofacial growth and realignment. Myofunctional therapy exercises are also employed to help guide the appropriate growth of the jaw. Because these dental treatments are comfortable, patients complete therapy and success rates are superior to CPAP or invasive surgeries. Patients also become excellent nasal breathers, which introduces nitric oxide into the body to support the parasympathetic nervous system for improved cardiac health and respiratory function. Nitric oxide also helps support weight control by regulating the production of ghrelin and leptin, often referred to as the body’s “hunger hormones.” Once sleep is regulated, patients often experience complete health transformations.

The lasting effects of food insecurity and homelessness for kids BY HEATHER ENGLE

unger and Homeless Awareness Week (November 11–18) shines a spotlight on homelessness in our communities and calls on individuals across the country to take action to end poverty. The Las Vegas Rescue Mission has faced numerous challenges with the prevalence of homelessness in Las Vegas. In Clark County’s 2023 Southern Nevada Homeless Census, the number of individuals experiencing homelessness increased 16% from the previous count, with 6,566 people without a permanent place to call home. Of those experiencing homelessness, several are children. According to the National Coalition for the Homeless, nearly 2.5 million children will experience homelessness in the U.S. each year. Food insecurity and chronic homelessness increase the risk of developmental, behavioral and psychological issues. Homelessness and food insecurity may: n Affect maternal and infant health. Food insecurity or lack of proper nutrition could endanger maternal and/or infant health, including increased risk of depression, anxiety or gestational diabetes in the mother and low birth weight and poor developmental outcomes in infants. n Cause delays in early childhood development. Young children who suffer from hunger and lack of proper nutrition may have trouble meeting crucial developmental milestones. n Disrupt academic learning. It is extremely difficult for any child to learn and focus when feeling gnawing hunger or navigating the stress of not knowing when they will have a roof over their heads.

n Affect children’s psychology. Children who suffer from food insecurity tend to shy away from social interactions and are less likely to participate in activities. n Cause chronic absenteeism among students. According to the findings in School House Connection’s The Education of Children and Youth Experiencing Homelessness, “…during the 2020-2021 school year, 41.9% of students experiencing homelessness were chronically absent, which is more than twice the rate of other students (20.3%), and significantly higher than the homeless student chronic absence rate in 2019-2020 (27.3%).” Some of the barriers that the group identified included students being unable to meet enrollment requirements, transportation issues, lack of school supplies, poor health, fatigue, hunger, emotional crises, and mental health issues. There are many ways to take action, not only during National Hunger and Homeless Awareness Week, but throughout the year. The Mission serves 30,000 meals each month and is always looking for individuals and businesses to hold food drives, fundraise or volunteer on our campus. We have a capital campaign underway to expand our campus—one component of the campaign is to expand our intact family programs and shelter so that we may provide more families with continuity and stability so they can begin to rebuild their lives. The Mission is the only facility with an intact family shelter, which keeps the family housed together. The shelter teams work with each individual and family to remove the barriers that keep them down. Food insecurity and chronic homelessness is a multifaceted issue with varied demographics, so it’s never a “one size fits all” answer. But together, we can each do our part to finally put an end to poverty.

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Heather Engle is the CEO of the Las Vegas Rescue Mission, which provides meals, emergency shelter, recovery programs with addiction counseling, and encouragement to help the low-income and homeless in our community. For more information, go to vegasrescue.org.

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Tackling dental anxiety: How practices can offer comfortable visits BY DEE DEE MEEVASIN, DMD

D Dee Dee Meevasin, DMD, is the owner of Dee for Dentist, which provides state-of-the-art digital dentistry and traditional dental services to encourage the highest level of long-term oral health.

ental anxiety is a common and distressing phenomenon that affects all ages and backgrounds. Statistics show that 50-80% of adults in the U.S. have some degree of dental anxiety, ranging from mild to severe, making routine visits a source of significant stress and apprehension. There are a number of ways that dental practices can minimize patient fear and anxiety by implementing operational processes and advanced technologies to help make each experience more comfortable.

Implementing automated processes

Streamlining the dental visit process is of utmost importance. For new patients, this can start with the convenience of receiving a text link to complete necessary paperwork. These forms can then be completed with ease from their phone whenever and wherever. Our dental practice boasts advanced internal software that seamlessly integrates with the patient experience. When patients submit their information via the provided text link, our system automatically transfers the data into our portal. This empowers patients to complete the required forms ahead of time, eliminating the need for manual data entry and significantly reducing the risk of errors. Patients can also conveniently confirm appointments through text and receive automatic reminders, offering a reassuring solution to pre-appointment anxiety. To reduce waiting room anxiety, it is important to bring patients back at the time of their appointment. Additionally, dentists can consider offering guided tours, introducing patients to cutting-edge technology and patient exam rooms. This fosters a sense of comfort and familiarity within the environment, a valuable

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gesture for new patients. Providing special touches, such as pillows, sunglasses and blankets can make a difference. In-office entertainment systems with streaming services or enjoyable videos can also help patients relax.

Advanced technology

Dental procedure anxiety can be mitigated through the integration of cutting-edge technology, which enhances the convenience and comfort of common treatments. For instance, the utilization of digital nitrous, which is essentially virtual reality, removes the need for traditional sedation methods that many find unsettling. Using a Solea Laser offers anesthesia-free cavity fillings, eliminating the need for the dreaded shot and vibrating sensations caused by drills. Having the capability to create crowns and bridges on site reduces the number of appointments for a patient. When dental practices possess the necessary in-house technology, patients do not need to be referred to other practices, which helps to streamline their dental journey. With the right technological tools at their disposal, dentists can provide a higher standard of care in a comfortable setting in less time.

Flexible financing

To alleviate the financial stress associated with dental care, offering a range of financing options is important. Beyond accepting conventional insurance plans, practices can streamline payment methods, including the convenience of options like text-to-pay and Apple Pay. Practices can partner with leading financial institutions to provide flexible monthly payment plans. People fear the unknown and unfamiliar aspects of visiting the dentist. Dentists can assess their practice procedures to determine strategies that help minimize patient anxiety and create a comfortable experience.

PROTECT YOURSELF AGAINST CANCER. EARLY DETECTION SAVES LIVES. “The greatest honor of being the protector of the ice, is the opportunity to serve as a protector in the community. By joining forces with Comprehensive Cancer Centers in the crusade against cancer, we can protect the health of our community. Through cancer awareness, early detection, advanced treatments, and groundbreaking research – we’re fighting on all fronts for a future without cancer. Learn to self-screen. Get checked. Protect yourself.”

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The Pa Your guide to combating sadness and cultivating joy

cientists and philosophers have sought a formula for happiness for centuries, and while there are common factors, there is no exact recipe. To some, happiness is a state of mind. For others, it’s an emotion. The good news is, research indicates that happiness can be cultivated. A Harvard Study of Adult Development tracked 200-plus individuals for decades and found that the health of our relationships has a strong correlation to an individual’s happiness. Alternately, researchers Sonja Lyubomirsky and Kennon M. Sheldon posit that nearly half

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of our happiness may depend on our genetics, and for some, happiness is easy to build, but for others, “it can be successfully pursued, but it is not ‘easy’.” Whether or not genes play a role in our baseline happiness, it’s clear that by forging healthy habits, healthy relationships, and positive mindsets, individuals can take control and pave the path to happiness. Another key step is being aware of and proactive when sadness rears its head. A 2022 study published in the American Journal of Preventive Medicine, found that the percent-

Path to age of individuals ages 12-34 in the United States who experienced depression in the past year increased year over year from 2015-2019. However, the percentage of individuals receiving treatment for depression did not increase at the same rate, even though access to information and help has improved. There are more resources than ever before for those faced with depression, mental illness or life setbacks. Seek help from a licensed professional. Lean on friends and family. Explore self-help books. Consider digital tutorials on meditation and selfcare. And, if you want to cultivate happiness, keep reading—this is a good place to start.

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Habits to wire your brain for happiness

BY LINDSEY PAOLI, MS MFT, MFTI, CPCI

Lindsey Paoli, MS MFT, MFTI, CPCI is a pre-licensed therapist, bestselling author, keynote speaker, and national expert news contributor. She is the creator of The MIND Fundamental Formula, a signature protocol rooted in neuroscience to create and sustain mental health through the daily practice of habits to improve neuroplasticity, cognition and focus, distress tolerance, and compassion.

he irony has been long standing that health care workers, who work so hard to take care of others, often struggle to prioritize themselves in the process. This is especially true for our mental well-being, especially when overworking and living in a heightened state of fight-or-flight has become the norm that makes us not only successful, but also the most impactful in our work. But, to best support our patients in their overall health, it’s important we learn to set the example for ourselves first. Just because we may have gotten caught in habits that increase stress, put us at higher risk for burnout, and negatively impact our personal relationships, doesn’t mean it’s too late to shift to a life with more health and happiness. I have created a very simple and evidence-based approach to improving mental well-being through a daily practice of seven simple habits: The MIND Fundamentals. These habits are easy to remember, as they spell out their intended goal—for you to be more MINDFUL amidst any busy lifestyle.

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M MOVEMENT

Movement is an undeniable resource for improved health. It reduces anxiety and depression, boosts selfesteem, improves overall cognitive function, increases energy, and improves sleep. But simply being on your feet all day does not cut it. Moving with you in mind is the mission to improve mindfulness.

INTENTION

Intention is the key to all of the MIND Fundamentals. Setting the intention to practice with your happiness as the end game in mind is the small mindset shift that can reframe an overwhelmingly busy day (a perceived negative) to a day full of evidence that you are reaching all of your goals (a positive). By taking a few moments to set intentions mentally or through journaling, we can create a more meaningful and joyful existence.

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NOURISHMENT

You must fuel your body in order for it to function properly, and the brain is no exception. If you’re a regular meal skipper, stop. Schedule time to eat regularly and hydrate appropriately. You can also nourish yourself emotionally by finding more joyful moments through hobbies outside of work.

DEEP CONNECTIONS It can feel isolating to be in health care, making deep connections mandatory for practitioners. Don’t get so caught up in helping others that you forget to invest in relationships that require vulnerability and emotional support that goes both ways. Allowing yourself to be supported can feel counterintuitive, but is a great remedy for the anxiety and depression that can result from the chronic stress of always being a caretaker.

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FRESH AIR

Regardless of the blistering heat or the unexpected snow outside, only 17 minutes outdoors daily has been shown to improve cognitive performance, stabilize moods, and decrease blood pressure. You get bonus points for taking your shoes off in the grass or touching a tree!

UNPLUGGING

Yes, this implies the importance of decreasing tech intake where you can, but unplugging actually refers to improving sleep hygiene so that your body can rest and repair as needed. Interestingly, paring down on screens is a great contributor to improved sleep, as are increasing some of the aforementioned fundamentals such as movement and fresh air.

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L LEARNING

Continuing to learn is a massive contributor to your happiness. Increasing your neuroplasticity by trying new things and continuing to expand your worldview is also a proven method for combating and preventing anxiety and burnout.

Your daily actions are constantly wiring your brain, for good or for bad. Improving your mindfulness through the MIND Fundamentals means you are actively wiring your pathways to cultivate a more positive mindset, increase your overall well-being, and experience greater levels of happiness and fulfillment. Remember that happiness is not a destination, but a journey, and by committing to these practices, you take a big step forward on that journey in your own life to better model and lead the patients that you care for.

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Let’s openly discuss mental health with our children BY CAROLINE BANFRO, MD

W Caroline Banfro, MD, is a board certified pediatrician at Southwest Medical, part of Optum

e are experiencing a mental health and suicide crisis in the U.S. that has only worsened for most groups the past few years. According to the most recent data reported by the Centers for Disease Control and Prevention, suicide deaths in 2022 increased by about 2.6% from 2021. The American Academy of Pediatrics and CDC agree that the health of young people has become a national emergency. The rates of mental health challenges among children, adolescents and their families have soared, and 2021 data suggests a rise in suicide-related emergency department visits among adolescents. With so many people experiencing mental and emotional health challenges, it’s important we create opportunities for honest and open conversations and help connect those struggling to find support. One in 6 children experience a mental health condition each year, and 50% of mental illnesses begin by age 14. The most prevalent issues are depression, anxiety, suicide and childhood trauma. Some conditions, such as eating disorders,

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can cause lifelong effects on families and the child affected. The stigma that often surrounds mental health can all too often make talking about mental wellness difficult and can prevent people from asking for help. This stigma can also make parents or caregivers feel uncomfortable checking on how a young person is doing, unsure of what language to use or how to address the topic.

TALK ABOUT IT

We can all play a role in helping young people get the support they need. An important first step is talking about it, but sometimes knowing how to start good discussions with a young person can be difficult. For some families, talking about mental health might be an everyday occurrence. For other families, it may be a new topic, and it may feel awkward and uncomfortable. But the more you do it, the more comfortable it may feel for children and adults. To support families who may be navigating behavioral health challenges, Optum has created a free “shuffle deck” of digital cards to help start conversations about mental health. Available by visiting optumconversation.com, these “Conversation Starters” cards make it easier for parents

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WAYS TO HELP PROTECT AGAINST SUICIDE Develop effective coping and problem-solving skills. Recognize reasons for living (for example, family, friends, pets, etc.). Strengthen one’s sense of cultural identity. Get support from partners, friends, and family. Connect with others. Connect with school, community, and other social institutions. Maintain access to consistent and high-quality physical and behavioral health care. Reduce or eliminate access to lethal means of suicide.

or caregivers to spark meaningful family dialogue. The goal is to reduce the stigma and equip caregivers with tools to have conversations with teens and young adults and to help them recognize when a young person is struggling so they can get appropriate support. A good place to start is with your family doctor or pediatrician. You can also check to see if your child’s school has resources, such as a licensed mental health counselor. Consider how your health plan may offer support, including virtual visits for mental health, which have become more widely available.

IT’S IMPORTANT TO GET HELP

If you or someone you know has thoughts about suicide, seek help right away. Call 988 to connect with the Suicide and Crisis Lifeline. The lifeline is available 24/7 and offers free, confidential emotional support to inviduals having thoughts of suicide or experiencing a mental health or substance use crisis. Text 988 and you will be given a short survey so the crisis center can understand what you’re going through, and then you’ll be connected with a counselor. If you’re more comfortable using a chat feature, visit 988lifeline.org. Similar to texting, you’ll be given a short survey so the crisis center can understand what you’re going through. You’ll then be connected with a counselor. If you or someone else is in immediate danger or has already self-harmed, it’s important to call 911 so help can be sent right away.

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In a post-COVID world, telehealth still essential for mental health clients BY FRANCHESCA VAN BUREN

or a range of health disciplines, telehealth quickly shifted from an experiment to a necessity during the COVID-19 pandemic. While COVID-19 is no longer a media headline, the telehealth seeds the pandemic nurtured continue to bring significant benefits to the field of mental health. Telehealth helped to expand access to therapy and deliver better care. Telehealth will be essential in mental health going forward for the following reasons. Franchesca Van Buren is CEO and Founder of Insight Therapy Solutions

CARE ACCESS

It’s not just rural residents who benefit from telehealth. Patients with medical conditions that make it difficult to leave home, those who battle psychological concerns—such as debilitating social anxiety— and those who simply can’t afford the gas, benefit from telehealth options as well.

GREATER TALENT DIVERSITY

COVID-19 brought changes in licensing restrictions to help therapists work across state borders. The Psychology Interjurisdictional Compact, which was created to advance the ability for psychologists to practice across state lines, now has about 38 signatory states. Organizations can now tap the expertise of many highly qualified out-of-state providers and the talent pool is much larger. Providers can also work from home. These shifts have been game changing because we can now offer world-class care from a diverse pool of professionals to serve our growing client base.

THERAPIST CREATIVITY

Online therapy has been proven to be just as effective as in-person therapy, but that doesn’t mean clinicians can approach it the same way.

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Some clinicians have great success with children using YouTube clips, online games, and other types of interactive online content. EMDR (eye movement desensitization and reprocessing) is a therapy that became famous for its efficacy with trauma and PTSD and involves visual, auditory, or tactile techniques. Prior to COVID, most clinicians would have told you that EMDR could not be performed remotely. We now have software specifically designed to facilitate remote EMDR, and clinicians have adapted their techniques to offer EMDR via telehealth. Even with all of telehealth’s benefits, some still want to mandate in-person care. Insurers are attempting to take away reimbursement for telehealth or pay less for it than in-person visits, and there are some licensing boards and old-guard clinicians who still voice their skepticism. While it’s clear there are people who will benefit more from an in-person visit, others will not; and the system now has an effective option for these clients, too. It’s important to continue improving telehealth, as it has proven itself a viable model to help more individuals live their best lives on their own terms. Not doing so would be a considerable disservice to the millions of Americans who have embraced virtual therapy and for future recipients as well. Learn more about Insight Therapy Solutions at InsightTherapySolutions.com.

NOVEMBER 2023

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It’s important for older adults to jumpstart their new year BY NEIL GOKAL, MD

Neil Gokal, MD, is medical director of clinical education for Southwest Medical, part of Optum

new year brings new resolutions that can lead to improvements in daily habits, as well as health benefits for many older Nevadans. In fact, according to a 2019 report published in the Journal of American Medicine, having a sense of purpose may not only extend people’s lives but may also result in fewer chronic conditions, less disability, and reduced mortality. For people who are already suffering from chronic conditions, setting simple and realistic goals that are manageable with their health challenges is important. As you consider changes and goals for 2024, here are five achievable resolutions that can help kick off the new year on the right foot.

PURSUE AN ACTIVE LIFESTYLE

Staying active is an admirable goal to have every year. Adults can engage in activities at home including aerobic activity, resistance training, yoga, and walks around their neighborhood. According to the Centers for Disease Control and Prevention, regular physical activity is vital for healthy aging. Talk to your doctor before significantly increasing your activity level and ask about the type and amount of activity that may be best for you.

EAT HEALTHFULLY

Prioritizing home-cooked meals and healthful snacks is one of the best places to start. Depending on how they are prepared, home-cooked meals can often have lower levels of sodium, sugar, and fat when compared with meals at a restaurant. If you have allergies or conditions that require a special diet, talk to your doctor about your meal plan.

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CHALLENGE YOUR BRAIN AND STIMULATE YOUR MIND

It’s important to practice a form of daily brain stimulation, as age can cause changes to brain size, vasculature and cognition, according to the National Institute of Aging. A healthy life, both physically and mentally, may be one of the best defenses against the changes of an aging brain. Completing crossword puzzles or playing games, such as chess, can be fun ways to keep your mind active while enjoying a new hobby.

STAY CONNECTED WITH FRIENDS AND FAMILY

Time spent with family and friends can be very beneficial. The NIA mentions that older people with strong social and community ties are more likely to live a longer life and cites research stating that isolation can contribute to high blood pressure. Even a virtual visit is better than no visit at all.

NURTURE AN INTEREST

People who engage in activities or hobbies may feel happier and healthier, according to the NIA. Learning new skills may also help increase cognitive function. Music, theater, dance, and creative writing are just some ways that older adults may be able to help improve their well-being. These interests may help with memory, boost self-esteem, reduce stress, and increase social interactions. A simple way to introduce almost all of the above into a regular routine is to visit one of the two Optum Community Centers: 5820 S. Eastern Ave., Ste. 100, or 8670 W. Cheyenne Ave., Ste. 105. Community centers are a great way for people 55 and older to stay connected, informed, and fit. Optum offers all kinds of activities, from dancing, fitness, and yoga classes to bingo, card games and support groups.

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Welcome to Las Vegas, breast-imaging specialist, Dr. Janis Yee

r. Janis Yee, has joined Steinberg Diagnostic Medical Imaging (SDMI) after completing her fellowship at UCLA. SDMI is excited to welcome her to Las Vegas and its outpatient radiology practice. Adding another sub-specialized Breast Imaging Radiologist will positively affect southern Nevada patients. SDMI Director of Women’s Imaging, Dr. Aanshu Shah, looks forward to having another breast specialist to collaborate with “It is always nice to have someone come in with a fresh perspective.” SDMI’s marketing team was able to spend some time with Dr. Yee to talk about her new role. SDMI: Why did you choose Radiology? YEE: Radiology is a dynamic, engaging, and rewarding field. I am proud of the crucial role we play in patient diagnosis and clinical management.

SDMI: What made you want to join the SDMI Family?

SDMI: Why did you choose your subspecialty?

SDMI: How do you see yourself impacting healthcare in Las Vegas?

YEE: I enjoy the multidisciplinary and patient-centered approach to breast imaging. Women’s health and well-being have always been an interest and focus of mine.

YEE: I appreciated the warmth and welcoming nature of the staff and physicians and their focus on quality patient care.

YEE: I plan to utilize the knowledge and skills I gained during my training to provide accurate diagnoses, keep patients up-todate with the latest guidelines, and current technology. To read the full -length interview and learn more about SDMI, Dr. Yee and their commitment to women’s imaging in southern Nevada, visit sdmi-lv.com

Get to know us @sdmilv

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5 activities that could hurt your hearing BY JUSTINE SUBA-COHEN, DO, MHS our ears are small but mighty orNOISE-INDUCED HEARING LOSS Your ability to hear relies, in part, on microscopic gans that contain some of the body’s hair-like projections on tens of thousands of tiny sensors tiniest, most unique bones — all of called hair cells in your cochlea. These hair cells convert which work together to help vibrations into electrical impulses, which eventually travel to your brain. Hearing loss you hear and keep your balance. In a can happen when any part of the ear or world filled with big sounds and loud related nerves don’t work in the usual way. In situations, you may be unknowingly some cases, hearing loss can be temporary, but it can be permanent when vital parts of putting your hearing at risk. Nearly the ear have been damaged beyond repair. 1 in 4 U.S. adults who thought they Loud noise is especially harmful to the had good to excellent hearing were cochlea. Listening to loud noise for a long shown to already have signs of hearing time can overwork hair cells in the ear, which can cause these cells to die. The damage. Aging tops the list of causes hearing loss progresses as long as the for hearing loss, but excessive noise exposure continues. Harmful effects might Suba-Cohen exposure—either one time or over continue even after noise exposure has stopped. Damage to the inner ear or auditory neural many years—is now generally considered the system is generally permanent. second most common factor. That means, in With this type of hearing loss, once it’s gone, you can’t some cases, hearing loss may be preventable if get the hearing back, and treatments, such as hearing aids, become the best option. you dial down the decibels. NOVEMBER 2023

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While sound around 60 dB, such as the level of normal conversation, is unlikely to damage hearing, there are other situations where noise can exceed safe dBs:

YARD WORK

The hum of a common gaspowered mower can create noise levels as high as 80-85 dB, which may damage hearing after two hours of exposure.

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MOTORCYCLING

The open road can be a dangerously noisy place. Just 50 minutes of exposure to a rumbling motorcycle engine, which clocks in at 95 dB, may contribute to hearing loss.

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FIREWORKS

Loud sounds don’t have to be prolonged to be dangerous. A firework explosion can be so loud that one quick blast may cause lasting hearing loss or a ringing in the ear called tinnitus. Almost all fireworks create noise that is over 140-150 dB.

Limiting the duration and intensity of exposure to noise can be your best defense for protecting your hearing. These suggestions may help: Consider using a sound meter app to monitor what may be unsafe noise in public, such as in restaurants or fitness classes. Avoid noisy places or take frequent breaks, including at music shows. Wear hearing protection (earplugs, earmuffs or specially made hearing protection devices) if you can’t avoid extended exposure to loud sounds and places. Use noise-canceling headphones or earbuds. Follow the 60-60 listening rule: Set audio devices at no more than 60 percent of maximum volume and listen for no more than 60 minutes a day. If you show signs of hearing loss, talk to your doctor about your options.

SPORTING EVENTS NIGHT CLUBS AND CONCERTS

The risk to hearing damage may be even greater at a live music event. Nightclubs and rock concerts can produce sound readings of 105-110 dBs. Without ear protection, permanent hearing loss is possible in fewer than five minutes. Personal audio devices that pipe music to the ears through earbuds or headphones can also expose the listener to unsafe levels of sound that increase the risk of hearing loss over time.

The noise at a 2014 Kansas City Chiefs football game peaked at over 142 dB, setting a Guinness World Record for crowd roar at a sports stadium. A study from 2014 of noise levels at 10 intercollegiate basketball games measured by 20 participants showed that noise at more than half of the games exceeded acceptable intensity levels when compared with a national workplace noise exposure standard.

NOVEMBER 2023

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A NEW

FRONTIER

Are prescription weight loss medications effective and safe? BY MELANIE SPEED, MSN, NP-C, CANS

ealth care providers have made it their life’s mission to guide their patients toward optimal health. All too often, this includes addressing the complex issue of obesity, as it affects 4 out of 10 Americans, according to data from the Centers for Disease Control and Prevention. Another 31.6% are overweight and 7.7% are severely obese, according to the Food Research and Action Center. Patients who are overweight or battling obesity are at increased risk for health problems that can become fatal if not addressed. In fact, four million people die each year as a result of obesity, according to the World Health Organization.

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For patients and health care providers, traditional avenues of managing this pervasive condition have been limited and usually involve drastic lifestyle changes, surgical interventions, or medications with severe side effects. Recent clinical trials have shown promise in a very unexpected area—a diabetes medication that was initially approved for Type 2 diabetes. This medication, officially referred to as Semaglutide, is clinically proven effective in the prevention and treatment of obesity.

HOW SEMAGLUTIDE WORKS IN THE BODY The body naturally generates a hormone called GLP-1 that works to regulate blood sugar by stimulating insulin and suppressing glucagon, both of which are key players in the game of blood sugar management. The active ingredient in this Type 2 diabetes medication, Semaglutide, is like a super-charged, longer-lasting version of the naturally occurring GLP-1 hormone. It stays in the body for a more extended period of time than natural GLP-1 does, helping to effectively balance blood sugar levels. The most beneficial part is that Semaglutide slows down gastric emptying—which means that it sends signals to the brain to make patients feel fuller for longer and regulate their appetite. It’s sort of the coach of the body, keeping hunger and blood sugar in check and on track. When it comes to weight management or treating obesity, Semaglutide capitalizes on this deceleration of gastric emptying, helping patients reach and maintain an optimal weight. Semaglutide also incites a feeling of fullness even when less food has been consumed through the activation of the body’s GLP-1 receptors, Continued on page 36

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Continued from page 35 thereby reducing one’s overall caloric intake. Previous weight-loss medications focused exclusively on the mechanisms of the body’s metabolic rate or the body’s fat absorption. Semaglutide is different in that it fundamentally alters the body’s hunger signals, fostering a more natural, sustainable weight-loss journey.

CLINICAL EVIDENCE A multitude of large-scale, randomized clinical trials have confirmed Semaglutide’s effectiveness in treating obesity and managing weight. These trials showed that participants who were administered Semaglutide lost significantly more weight than those who were given a placebo, yielding up to a 15% reduction in body weight. However, what makes these results so compelling is their sustainability. As proven by various long-term patient follow-ups, these results were sustained over a long period of time. Since traditional weight loss methods are usually accompanied by the dreaded cycle of losing weight and later gaining it back, which is commonly referred to as the “yo-yo” effect, Semaglutide’s potential for sustained weight loss is promising.

PATIENT QUALIFICATIONS Melanie Speed, MSN, NP-C, CANS, is owner of Flawless Medspa

Although Semaglutide can provide ample benefits to those struggling with weight management or fighting obesity, this medication is not for everyone. There are strict qualifications that a patient must meet to be deemed eligible to use Semaglutide as a weight loss treatment. In order to be a qualified candidate, a patient must have a Body Mass Index of 30 or higher or a BMI of 25 or above accompanied by at least one weight-related comorbidity or co-existing condition, such as hypertension or dyslipidemia.

SIDE EFFECTS Although Semaglutide has proven effective in managing weight, it is by no means a magical cure and should not be used as one. It is a medication that should only be utilized as part of a broader treatment regimen, one which also includes lifestyle

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modifications. Additionally, Semaglutide needs to be taken under a medical provider’s supervision. Since Semaglutide is a Type 2 diabetes medication, patients should be aware that it has the potential to lower blood sugar levels, which could require some adjustments to be made to other medications. Furthermore, the drug does have potential gastrointestinal side effects. These potential side effects include nausea and diarrhea. Although some of these side effects will usually subside as the body acclimates to the medication, they should still be taken seriously.

THE FUTURE IS BRIGHT The off-label use of Semaglutide for treating obesity has garnered a lot of popularity from multiple celebrities showcasing their dramatic weight loss results and lots of discussion in mainstream media, and with good reason. Semaglutide has the potential to be a new frontier in weight management. However, it’s essential for both patients and health care providers to exercise due diligence by thoroughly evaluating each patient’s medical history and needs before starting treatment. The battle against obesity is long and complex, but with innovations like Semaglutide, we’re taking meaningful steps toward treating and managing obesity. Studies have shown that weight loss in conjunction with exercise can help prevent diabetes, cancer and heart disease. As health care providers, it is our duty to stay informed about emerging and innovative treatments in order to offer our patients the best and most advanced care possible. It seems that Semaglutide is certainly shaping up to be a game-changer in treating obesity and managing weight. Founded in 2014 by celebrity injector Melanie Speed NP-C, Flawless Medspa is a premier medical spa in Las Vegas, offering a variety of renowned non-surgical cosmetic and wellness treatments, including injectables, Plasma IQ pens, thread lifts, hair restoration, vampire facials/facelifts, vitamin shots, and more. Flawless Medspa is located at 9418 W. Lake Mead Blvd., Las Vegas, NV 89134. For more information, please call Flawless Medspa at 702-588-2260, visit Flawlessmedspas.com.

The most beneficial part is that Semaglutide slows down gastric emptying—which means that it sends signals to the brain to make patients feel fuller for longer and regulate their appetite. It’s sort of the coach of the body, keeping hunger and blood sugar in check and on track.

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Why can’t Nevada hang on to its health care providers? BY KATIE WAECHTER

T Katie Waechter is CEO of Watch Media Group

he Nevada doctor shortage has been ongoing for decades. If you’ve lived here long enough, you may have heard the running joke, “if you want good health care, go to the airport.” The question is, why? Each year, Nevada gets a little bit bigger in many ways including population growth, business expansion and the addition of sports teams, just to name a few. However, health care continues to struggle to keep up with demand. Mental Health America reports that Nevada ranks 51st nationally in overall mental health and youth mental health. Our doctor numbers are almost as bad. We rank 48th nationally for primary care and 49th for specialist care, according to a 2022 Kaiser Family Foundation report. Shivesh Kumar, MD, MBA, FHM, explained, “I’ve lived here since I was a young professional and seen incredible growth in housing, entertainment, and sports, all of which should be applauded. But that opportunity has not been mirrored by a good medical system. We can do better.”

A quick history

In the early 2000s, there was a significant doctor shortage, medical malpractice insurance rates went wild and liability companies actually moved out of the state. Rudy Manthei, DO, remembers it well. He explained, “The [medical malpractice] awards started getting out of control, and the frequency of claims got out of control, too… those verdicts of enormous amounts drove the frequency way up and basically drove doctors away.” The issue of medical malpractice hit a tip38

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ping point, and the Keep Our Doctors in Nevada (KODIN) initiative was created. As Manthei described, “We created an initiative, we went to the people, and the people voted.” KODIN helped the public understand that medical malpractice laws were needed to stabilize health care in the state. The people voted in 2004, insurance companies stopped fleeing and doctors saw malpractice insurance costs drop.

Not enough residency options

While Nevada medical programs have grown, residency programs have struggled to keep up. Statistically speaking, where doctors do their residency is geographically where they end up practicing—which is bad news because only 15% of UNR’s school of medicine class of 2022 chose Nevada for residency. In Las Vegas, the problem isn’t quite as bad, but close to half of UNLV med school grads are training elsewhere, not because they want to, but because they have to. We lack good opportunities for specialty residency programs. As a direct result, we lack specialty doctors.

Doctors blocked by licensing boards

Board certified physicians moving here face a different challenge. Marc Kahn, MD, MBA, MACP, FRCP, Dean and VP for Health Affairs at UNLV, explained, “Not having a nimble licensing process makes it challenging to get new doctors into the state.” When Dr. Kahn moved to Nevada, he accepted his position in December, applied for his license to practice in Nevada in January, and wasn’t approved until the end of July, seven months later. For one of his colleagues, getting licensed to practice here took over 10 months.

Medicaid and funding problems

Getting doctors to Nevada is half the battle. Getting them to stay for less money is the other half. Nevada has ranked 50th in the nation for public health funding for decades, according to the Nevada Independent. “If you want to start understanding the problems with pay,” Dr. Kumar explained, “You need to look at how much the reimbursement rates are here when compared to other states. The lack of fair and competitive reimbursement rates makes it difficult to attract specialists and the specific services that we need,” he said. To be clear, it’s not just about paying physicians more. It’s about the patients. The Nevada Current reports that more than half of the 169 behavioral health clinics do not accept Medicaid because of low reimbursement rates or insurance problems. Some providers only accept cash, which continues to limit patient access.

Next steps

Nevadans were hopeful that health care would get some needed attention at the 2023 Nevada legislative session, and it did. During the process, Gov. Joe Lombardo vetoed no less than 12 health-related bills, but he did not veto one bill that has Nevada doctors most concerned: AB 404, which tips medical malpractice laws back in favor of attorneys. Some health care providers are disheartened by the results of the 2023 legislative session. Diego Trujillo, CEO of Las Vegas HEALS, has a more optimistic outlook and said, “I don’t see our role as waiting until it gets worse but rather getting ready for the next legislative session and working towards a better outcome.” It’s time to work together, innovate together, and advocate for better health care in Nevada together. Improving health care in the state is an uphill battle, but we Nevadans are Battle Born and we can take on any challenge. NOVEMBER 2023

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Intermountain Health offers interpreter services for 120-plus languages BY KEYONA COLE

I Keyona Cole is Region Chief Nursing Officer at Intermountain Health

magine living in a world where you’re not able to access quality health care because of a language barrier or disability. This is reality for many individuals throughout the United States. U. S. Census Bureau data suggests that as many as 1 in 10 working adults in the U.S. has limited English-language proficiency. Many choose to delay medical care because of this issue, which can eventually lead to additional health challenges and complications. Not only do language barriers affect a patient’s experience, but they can potentially lead to safety issues, including patients not receiving the correct medical attention they require. The need for translators and interpreters remains constant. Intermountain Health has worked to ensure that all of its clinics and facilities in Southern Nevada have full interpretation services and provides accommodations for those who need communication assistance, whether because of a disability, such as the deaf or hard of hearing, or due to limited English proficiency. This is just one example of how Intermountain Health is prioritizing diversity, equity, and inclusion for our patients, caregivers, and the community as a whole. Interpretation services are offered free of charge in all of our facilities, at all points of contact, and during all hours of operation. “Intermountain Health is committed to ensuring that all persons have an equal opportunity to access all care and services we offer,” said Jennifer Merritt, Intermountain Health senior director of utilization management and lead for

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Intermountain Health’s Nevada DEI committee. “The communities we serve are diverse, and it is so important that everyone has the same, equal access to high-quality care and that everyone is treated with dignity and respect.” In 2022, Intermountain Health provided interpretation services in at least 120 languages and interpretation services at about 53,000 patient encounters across the health system each month. “Equity is one of Intermountain Health’s fundamental values, and we are committed to ensuring that everyone can receive care in their preferred language or in a language they understand,” said Carlos Martinez-Morales, language services and cultural competence manager at Intermountain Health. Intermountain Health’s team of more than 90 staff interpreters offer services in eight languages which include Spanish, Portuguese, American Sign Language, Tongan, Samoan, Cantonese, Mandarin, and Marshallese. Intermountain Health also contracts with multiple in-person and remote interpretation agencies that provide services in nearly 200 different languages. Interpreters are required to be professionally trained and/or certified. Intermountain Health is a licensed trainer for professional medical interpreting classes that are offered several times a year. For prescheduled appointments, patients should notify the scheduler of the need for interpretation for themselves or any of their family members during the appointment scheduling process, specifically of additional special needs or preferences such as in-person, video remote interpretation, or telephone inContinued on page 42

U. S. Census Bureau data suggests that as many as 1 in 10 working adults in the U.S. has limited Englishlanguage proficiency. Many choose to delay medical care because of this issue, which can eventually lead to additional health challenges and complications.

Intermountain Health professionals use interpretation services to help a patient. (Courtesy)

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A video remote interpreter helps two Intermountain Health patients. (Courtesy)

Continued from page 40 terpretation. If in-person interpretation is desired, we will do our best to accommodate those requests as received. “We want to make sure that all members of our community know that they can receive care through qualified interpreters regardless of their language preference. Their safety and wellness are our top priority,” Martinez-Morales said. In-person interpreters’ availability varies depending on the language requested, time of the day, and the facility’s location. If staff are unable to find a qualified in-person interpreter in a timely manner, a qualified video remote or audio-only telephonic interpreter will be made available in order to avoid delay in care. For emergency or unscheduled visits, patients should let caregivers at the reception desk know they

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would like an interpreter upon arrival. Please be assured, we only allow qualified medical interpreters to participate in care for patients in our facilities. Family members (especially those who are children), friends, or non-trained bilingual individuals should not be relied upon as interpreters. Interpreters are also cultural mediators and bring context to cultural differences that may impact communication. Professional interpreters will interpret everything that is said exactly as it is said. They become the patient’s voice and will not add, take away, or change anything. Their goal is to make the conversation flow as if both people spoke the same language. They are bound by the Health Insurance Portability and Accountability Act and will keep everything strictly confidential. Intermountain Health currently

NOVEMBER 2023

has more than 60 clinics throughout Southern Nevada, which include locations in Mesquite, Pahrump, and Boulder City, offering primary care, specialty care, and Instacare (urgent care). About half are myGeneration Senior Clinics dedicated to serving the unique needs of the senior population. And, when looking for an Intermountain Health provider, you can search for a provider based on a specific language that they speak on our website. Simply click “Find a Provider” at the top bar, then choose the desired language from the drop-down menu to view a list of providers who speak that language. For more information about Intermountain Health’s locations and services available in Southern Nevada, or to find a provider that speaks your preferred language, please visit intermountainnv.org.

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Juvenile corrections requires a different psychological approach BY TIMOTHY JEIDER, MD

ow we rehabilitate youth in the corrections system requires more attention. The system often employs adult strategies for teens who can’t identify with them. It’s a subject that’s worth our time and our investment because the youth in our community influence the future.

Timothy Jeider, MD, is a psychiatrist and co-founder of Nevada Mental Health. Learn more at NevadaMentalHealth.com.

The purpose of juvenile correction

Juvenile correction is not supposed to be punitive. The goal is a corrective process and active intervention to change behavior. However, in an overburdened system, corrections officers may take a forceful approach to maintain control. As a result, juveniles learn to cope and behave in a way that satisfies the criteria for release but does not teach them social reciprocity and mutual respect.

Why adult logic in juvenile corrections doesn’t work

Nevada Mental Health staff worked with a teen on probation who missed a court date, and unbeknownst to him, a warrant was issued for his arrest. One night he was with two friends at a convenience store where the friends assaulted the clerk. All three left the scene. The clerk phoned the police to describe the two perpetrators and said the third person tried to intervene and deescalate the fight. When the police caught up with all three teens, the two perpetrators were told to later appear in court and were released. The third teen, who did not participate in the assault, was arrested because of the previously issued warrant. His assessment of the situation was that he was arrested for trying to stop a fight.

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This story is an example of the disconnect between adult and juvenile thought processes. Juveniles prioritize instant gratification, and delayed punishment doesn’t register well. However, when an adult gets a traffic ticket they may think about a court appearance, fines or insurance premium increases. They think about the future and the consequences of the ticket. When a juvenile receives a ticket to appear in court or is punished for something they did in the past, they may not connect the action to the consequence.

Caregiver influence

A juvenile in the corrective system may come from a home where parents may not be able to supervise their children or aren’t likely to show up for a court date themselves. How a caregiver behaves and perceives the world is the prototype for how the juvenile connects with the world. It can be challenging to establish corrective intervention for a child while their family dynamic is not set up for success.

Correcting the problem

These are big issues with complicated considerations. One step toward change may be rethinking the approaches that don’t work for teens. Another consideration is psychiatric and psychological treatment for juveniles and their caretakers. Connecting the juvenile and their caretakers with individual and community resources may foster positive change for both and better ensure success. When a juvenile is stabilized but sent back into an environment not designed for success, they will likely reoffend. Acknowledging these realities and continuing a dialogue about bettering the corrections system for teens can be the first steps to positive change.

TRANSFORMING HEALTHCARE IN NEVADA Southern Nevada continues to grow and so do we. Join our vital mission of expanding and improving healthcare for our entire community, affecting generations to come. unlv.edu/jobs

Nationally recognized care. Here at home. Dignity Health – St. Rose Dominican has been awarded some of the U.S. News & World Report’s highest honors in health care. This recognition is a reflection of our team’s tireless commitment to deliver world-class care to each and every person we treat. And while accolades like this are gratifying, they don’t tell the whole story—one that’s built on compassionate listening, a personal connection to provide comfort and hope, and a steadfast belief in the healing power of humankindness. Learn more about us at StRoseHospitals.org.

Examining the benefits of implantable lenses for vision correction BY PETER W. DEBRY, MD

T Peter W. DeBry, MD, is an ophthalmologist for NV Eye Surgery. Dr. DeBry was one of the first eye surgeons to implant the ICL after its initial FDA approval almost 20 years ago. Dr. DeBry’s office offers free consultations for people who want to learn more about their vision correction options including ICL and LASIK. They can be reached at 702-825-2085.

he quest for better vision without glasses or contacts continues. As a spokesperson for ICL, Joe Jonas brought a lot of internet attention to this procedure. But what is ICL? And who qualifies for the procedure? ICL surgery offers a safer and more accurate option for vision correction and has become more widely adopted across the U.S., competing with LASIK. ICL stands for implantable collamer lens, also sometimes referred to as the implantable contact lens. The technology was initially developed as a surgical procedure for patients who did not qualify for LASIK. However, many patients who learn about the technology end up choosing ICL because of the benefits inherent in this procedure. What type of vision problems does ICL correct? The ICL is most commonly used as a treatment for myopia (nearsightedness) for individuals who are not good LASIK candidates. They may have an abnormal or thin cornea, dry eye, or certain medical conditions, such as autoimmune diseases that can interfere with normal healing. Those with myopia can see objects up close without glasses but have difficulty seeing objects, such as street signs, far away. Glasses and contact lenses are usually used to correct nearsightedness. How are LASIK and ICL different? LASIK and ICL are used to help the eye focus light more accurately, but the methods used for treatment are significantly different. LASIK uses a laser to reshape the surface of the eye by shaving away very small layers of the cornea. ICL uses a small lens implant that goes inside the eye

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behind the pupil to change the focus and help people see without glasses. LASIK is a permanent treatment, but the ICL is reversible and can be removed. Both treatments are outpatient procedures that take between 20 and 30 minutes to complete and have a quick recovery. Are there risks to ICL surgery? Yes, every eye surgery has risks. For LASIK and ICL, success rates are above 95% —1-2% of individuals with ICL surgery will develop a cataract, which is cloudiness in the natural lens of the eye. This happens because of the microscopic trauma that can occur. In an FDA study, every patient who developed a cataract still ended up with 20/20 vision. Another potential risk of LASIK and ICL procedures is the visual symptom of glare afterward. This can occur when the size of the treatment zone or ICL lens is a bit smaller than the size of the pupil. It’s typically noticeable at night when the pupil is large and bright lights, such as a car headlight, are shining into the eye. Although some notice glare after refractive eye surgery, it is typically minor, and individuals adjust to it over time. Who is a good candidate for ICL surgery? With the inherent benefits of ICL, more patients are candidates for vision correction than ever before. LASIK is limited by the thickness of the cornea, and many can’t have LASIK because they are very nearsighted. For those with dry eye syndrome, ICL becomes their best option—the surgery does not damage corneal nerves, and will not increase dry eye symptoms. Finally, the best candidates for an ICL have perfectly healthy eyes, stable refraction and minimal changes in the strength of their glasses or contact lenses the past few years.

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+ HCQ Notes The Nevada Rare Disease Advisory Council announced the appointment of Sumit Gupta, MD, as its newest physician member. Dr. Gupta serves as a board-certified hematology/ oncology phyGupta sician at Cure 4 The Kids Foundation, Southern Nevada’s pediatric cancer and rare disease treatment center. U.S. News & World Report named Cleveland Clinic to its honor roll of the top hospitals in the country in its 2023-24 best hospital rankings. The annual rankings also named Cleveland Clinic the No. 1 hospital for cardiology and heart surgery for the 29th year in a row.

Justin Brandwein was appointed as the senior management executive at Longevinex, an international supplement company based in Las Vegas. Snell & Wilmer attorney Rob Kinas was chosen by the American Cancer Society as a 2024 Game Changer Gala honoree. Honorees are selected based on their focused influence and efforts to Kinas improve the lives of those battling cancer and their families’ lives via advocacy, research and patient support. Comprehensive Cancer Centers announced the hiring of Bethany Baird as advanced practice provider, bringing nearly two decades of experience to the practice. As an APP at Comprehensive’s Baird Siena location, Baird will provide continuous support to Comprehensive’s physicians by

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helping manage the treatment plans, oncology care and follow-up guidance for patients with cancer and serious blood disorders. Southwest Medical added nine new providers to help meet the growing need for health services in the Las Vegas community. Dino Lorenzo A Dy, MD, joined Southwest Medical (540 N. Nellis, Las Vegas) and specializes in adult medicine. Ian Weng Lam, DO, joined Southwest Medical (4475 S. Eastern, Las Vegas) and specializes in family medicine. Emeka Madu, APRN, joined Southwest Medical (888 S. Rancho Dr., Las Vegas) and specializes in cardiology. Anna Zabek, APRN, joined Southwest Medical’s Tropicana Health Care Center location (4835 S. Durango Dr.) and specializes in adult medicine. Loc Nguyen, DO, joined Southwest Medical’s Nellis Health Care Center (420-560 N. Nellis Blvd.) and specializes in adult medicine. Christian Beau Hicken, DO; Chee Lim, DO; Tony Ramogi, MD; and Xiaoyin Qiao, MD, joined Southwest Medical as hospitalists. Comprehensive Cancer Centers hired medical oncologist and researcher Kyaw Zin Thein, MD. Dr. Thein is seeing patients at Comprehensive’s central valley treatment center, located at 3730 Thein S. Eastern Ave., providing medical care for a wide range of cancer and severe blood disorders with a special interest in thrombosis, head and neck, thyroid, genitourinary, and rare cancers. Cure 4 The Kids Foundation announced the addition of Dr. Raúl Montiel-Esparza to its team. Dr. Montiel-Esparza brings a wealth of experience and expertise in pediatric stem cell transplantation and cellular

therapy. Montiel-Esparza is board-certified in pediatrics and pediatric hematology oncology, and fluent in English and his native Spanish. Intermountain Health finalized its acquisition of Advent Home Health, a leading home health agency in Southern Nevada. As a part of Intermountain Health, Advent Home Health now operates as Intermountain Health Homecare. “We’re thrilled to welcome the Advent Home Health team to Intermountain, expanding our ability to care for patients across their entire journey,” said Dr. Cara Camiolo, region chief medical officer for Intermountain Health.

Montiel-Esparza

Southwest Medical Hospice Care bereavement coordinator Jeff Long was appointed to Nevada’s Funeral and Cemetery Services Board by Gov. Joe Lombardo. The Nevada Funeral Long and Cemetery Services Board consists of seven members appointed by Nevada’s governor. It’s committed to protecting the health, safety and welfare of the public by regulating the funeral services profession. Dr. Leo Capobianco of Doctors Center, a contracted provider for Optum– Nevada, opened a new office at 1681 W. Horizon Ridge Pkwy. in Henderson. The location features an in-house laboratory and joins two other locations across the valley. Cleveland Clinic was named among top employers on the Forbes 2023 America’s Best Employers for Women

list. Cleveland Clinic ranked 116th of 400 U.S. corporations across all industries and 26th in the health care and social sector. Advanced Radiotherapy Technologies, a Kingsbarn company, started construction of a state-of-the-art radiation treatment center in Henderson. The center is expected to open for patient care during the first half of 2024 and will have the capacity to treat thousands of cancer patients annually. This will be the most advanced radiation treatment center in Nevada, providing the residents of metropolitan Las Vegas and Southern Nevada access to the most contemporary cancer therapies. The Meadows Outpatient Center-Las Vegas is now in-network for members of Health Plan of Nevada/Sierra Health & Life/Sierra Health-Care Options. Admissions specialists for the Meadows Outpatient Center-Las Vegas offer free insurance verification and can walk potential patients through the admissions process. The Meadows Outpatient program is a member of Meadows Behavioral Healthcare, the industry leader in evidence-based treatment for everything from emotional trauma and drug and alcohol addiction to sex addiction, intimacy issues, and eating disorders. MBH offers a full continuum of programs, personalized treatment plans, and services. Four Valley Health System leaders were honored by the Nevada Action Coalition during their 2023 Future of Nurses in Nevada gala on August 19. They include: Karla Perez, regional vice president, who was honored with the nurses choice 2023 nurse advocate of the year award; Kimberly Foxworth, DNP, MSN, BSN, RN, CCRN, RCIS, CPHQ, NEA-BC, chief nursing officer for Valley Hospital who received the diversity award; Marlene Lee, recruiter for Henderson Hospital, who received the NV HOPE champion award; and Jeanne Reeves, MS, BSN, RN,

Two Dignity Health-St. Rose Dominican Hospitals in Southern Nevada were named by U.S. News & World Report to its 2023-2024 Best Hospitals survey as high performing hospitals. This is the highest distinction a hospital can earn for U.S. News’ best hospitals procedures and conditions ratings. Siena Hospital in Henderson earned high-performing distinctions in five categories, including heart attack, heart failure, kidney failure, knee replacement, and stroke. San Martin Hospital in southwest Las Vegas earned high-performing distinctions in two categories: heart failure and kidney failure. The annual procedures and conditions ratings are designed to assist patients and their doctors in making informed decisions about where to receive care for challenging health conditions or elective procedures.

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+ notes continued Spring Valley Hospital achieved certification as a gluten-free food service program, joining a handful of other hospitals in the U.S., including Valley Health System facilities Centennial Hills, Summerlin and Valley hospitals.

Continued from page 49 chief nursing officer for Summerlin Hospital, who received the nurse advocate of the year award. Dr. Ben Kermani opened a practice in Summerlin, his second location offering concierge medicine. Dr. Kermani has been practicing internal medicine for 28 years and believes in supportKermani ive, personalized care that creates a mutual partnership with patients.

The Sarah Cannon Transplant & Cellular Therapy Program at MountainView Hospital, part of HCA Healthcare, received internationally recognized accreditation by the Foundation for the Accreditation of Cellular Therapy for adult autologous transplantation and immune effector cell therapy. The Sarah Cannon Transplant & Cellular Therapy Program at MountainView Hospital, which opened in 2021, is the only such program in Nevada. Optum Cancer Care added three new providers. Dr. Daniel Brunnhoelzl, Dr. Vatsal Patel, and Ana Manalili, APRN, joined Optum Care Cancer Care (624 S. Tonopah, Las Vegas) and specialize in radiation oncology.

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