Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo
March/April 2021
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Sierra Sacramento Valley
MEDICINE 4
PRESIDENT’S MESSAGE
Listening Is the First Step Toward Changing Minds Carol Kimball, MD
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EXECUTIVE DIRECTOR’S MESSAGE
Crushing COVID-19
Aileen Wetzel, Executive Director
8
OPINION
To Be a True Healer, Be True to Yourself
15
2020 SSVMS Annual Report
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Students Bring Vaccine, Enthusiasm to Elk Grove Pranav Sathe, MS III
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PHOTOS
Crushing COVID-19, One Arm At a Time
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A Venomous Viper Faith Fitzgerald, MD
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Board Briefs
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New SSVMS Members
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We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review articles before publication. Letters may be published in a future issue; send emails to SSVMedicine@ssvms. org. All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.
POETRY
Are You a Christian?
Caroline Giroux, MD
Jon Davids, MD
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Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Temporarily closed due to the pandemic. Visit our website at ssvms.org/museum for updates and virtual events.
What You Need to Know About the COVID-19 Vaccines Glennah Trochet, MD
VOLUME 72/NUMBER 2 Cover photo: A female ruby-throated hummingbird finds a resting spot on a sunny day.
Photo: Jim LaPerriere
Official publication of the Sierra Sacramento Valley Medical Society
5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org
SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx
March/April 2021
1
Sierra Sacramento Valley The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community.
2021 Officers & Board of Directors
Carol Kimball, MD, President Paul Reynolds, MD, President-Elect John Wiesenfarth, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD
District 5 Christina Bilyeu, MD Sean Deane, MD Kristin Gates, MD Farzam Gorouhi, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD
2021 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD
District 1 Alternate Brian Jones, MD District 2 Alternate Vacant District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Vacant District 5 Alternate Joanna Finn, MD District 6 Alternate Natasha Bir, MD
At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Helen Biren, MD Jonathan Breslau, MD Amber Chatwin, MD Mark Drabkin, MD Gordon Garcia, MD Ann Gerhardt, MD Farzam Gorouhi, MD Richard Gray, MD Richard Jones, MD Mohammad Khan, MD Carol Kimball, MD Charles McDonnell, MD
Leena Mehta, MD Sandra Mendez, MD Tom Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD
At-Large Alternates Christine Braid, DO Angela Crans Yoon, MD Lucy Douglass, MD Rachel Ekaireb, MD Karen Hopp, MD Arthur Jey, MD
Steven Kmucha, MD Sam Lam, MD Taylor Nichols, MD Ashley Rubin, DO Alex Schmalz, MD Ashley Sens, MD
CMA Trustees, District XI Adam Dougherty, MD Robert Oldham, MD
AMA Delegation Barbara Arnold, MD
Editorial Committee
Margaret Parsons, MD
Sandra Mendez, MD
Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD Karen Poirier-Brode, MD
Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD Eric Williams, MD
Executive Director Managing Editor Webmaster
Aileen Wetzel Ken Smith Melissa Darling
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Sierra Sacramento Valley Medicine
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Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests. Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising. Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. ©2021 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.
| FEATURED CONTRIBUTORS |
Carol Kimball, MD
Caroline Giroux, MD
Glenah Trochet, MD
Physcians often face frustrating challenges, including convincing some patients to take the COVID-19 vaccine—or even to take the virus seriously. Dr. Kimball says more listening and less talking may be the key.
Dr. Giroux recounts her recent message to a Healer’s Art course. As a physician, she encourages you to trust yourself, listen to your intuition and celebrate what makes you unique as a doctor and as a person.
Dr. Trochet chairs the SSVMS Public and Environmental Health Committee and is Nevada County’s deputy health officer. In this issue, she offers the background and facts you need on the COVID-19 vaccines.
Pranav Sathe, MS III
Faith T. Fitzgerald, MD
Pranav tells the story of how California Northstate University’s medical students rallied to make themselves available to help members of the Elk Grove community receive their vaccinations.
Faith strikes again, this time with the story of an exotic and deadly venomous reptile, a very large nurse, and a late night phone call to the one person who might be able to save her patient.
carol.md.mba@gmail.com
Pranav.Sathe6123@cnsu.edu
Brandon Craig
bcraig@ssvms.org
cgiroux@ucdavis.edu
ftfitzgerald@ucdavis.edu
Marlee Turner
mturner@ssvms.org
trochetg@gmail.com
Jon Davids, MD
jdavids@shrinenet.org
Dr. Davids, the assistant chief of orthopedic surgery at Shriner’s Hospital, returns with a touching poem about a conversation between a father and his child’s surgeon. “Are you a Christian?” the father asks.
Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ssvms.org.
SSVMS staffers Brandon Craig, our programs and partnerships coordinator, and Marlee Turner, our new communications coordinator, were responsible for putting together the 2020 SSVMS Annual Report that appears in an excerpted form in this issue. Even though their names don’t appear on the report, we wanted to recognize their hard work in recounting a very busy year at SSVMS.
March/April 2021
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| PRESIDENT’S MESSAGE |
Listening Is the First Step Toward Changing Minds I
n February, the SSVMS Board of Directors honored the public health officers in the three counties SSVMS represents and also in Placer County, where many of our members live and work. Dr. Olivia Kasirye (Sacramento), Dr. Nancy Williams (El Dorado), Dr. Aimee Sisson (Yolo) and Dr. Rob Oldham (Placer) have worked tirelessly to limit the spread of COVID-19 and do what is best for their counties, often in the face of tremendous pressure and resistance. My son recently asked me what exactly a public health officer does, so like any good mom, I Googled the question. The best answer I found for him was that they focus on the overall health of communities instead of treating individual patients, educate the public on health risks and encourage people to live healthier lifestyles. In our last issue, Drs. Kasirye, Williams and Sisson said that what they need most from physicians was for us to support their efforts to combat COVID-19. They need us to reinforce their messages with our patients and to stand up and speak as experts whenever we can. We all know that there have been active disinformation programs around COVID-19 over the past year. In January, there were anti-vaccine protesters blocking Dodgers Stadium to prevent people from getting the vaccines that have been developed to save lives and return to the level of openness that, ironically, many of the protestors are calling for. This seems unfathomable, yet we have all seen that there is a spectrum of resistance to vaccines ranging from hesitancy to outright disbelief in the science. This has really caused me consternation and made me wonder how we can combat misinformation and conspiracy theories that, frankly, many of us have trouble believing anyone can take seriously. Books such as Escaping the Rabbit Hole by Mark West and others with advice for confronting this frustrating phenomenon suggest that the first step is listening with respect to whomever you are trying to convince that their narra4
Sierra Sacramento Valley Medicine
By Carol Kimball, MD carol.md.mba@gmail.com
tive is false. Simply giving the facts without engagement doesn’t usually work and will often leave a conspiracy theorist even more entrenched. Another technique is to dial back the conversation, peeling away the layers until you can start over at a point of agreement. Even though respectful dialogue doesn’t always bring change to those wary or opposed to the vaccine, listening to and understanding exactly what they believe is important. Someone may not want a vaccine because they believe it could cause an allergic reaction or they are worried that it hasn’t been tested enough. There are also cultural reasons that cause skepticism and wariness.
Even though respectful dialogue doesn’t always bring change, listening to and understanding exactly what they believe is important. There are people who will never change their mind, but it is incumbent on us as physicians to be honest, answer their questions thoughtfully and tell the story of how they can help themselves, their families, their community and the nation as a whole by doing their part to extinguish COVID-19. Humans are made for storytelling, and it is part of the art of medicine—we need to hear a patient’s story and pick out the part that leads to healing. It is also our duty to offer them a story that produces an emotional response and moves them to appropriate self-care. It is also important to get the story out to them before they gather a lot of other information—especially misinformation—because it is always easier to help someone make up their mind than it is to get them to change it. We must remember that some staff members, whom patients may look to as role models, are themselves wary of the vaccine. What do you say when your medical assistant says that she is afraid that she could die if she gets the vaccine, and she is the sole parent for her children? A thoughtful and calm discussion, and
a suggestion to get a second opinion can help, but the bottom line message is clear: people die from COVID-19, not the vaccine, and not getting vaccinated puts her child at more risk than if she receives the shot. As the public health officers said, mask wearing has become a political issue for some but others are wary simply because they don’t have or understand the data. I recently posted on Nextdoor, the community social media site, a response to someone who doesn’t trust the sources behind the science. “For me, it’s about the cost if I’m wrong,” I wrote. “If I wear a mask and it isn’t helpful, then I’ve wasted some time and money. If I choose to not wear a mask that could prevent me or another from getting sick, then I’m causing harm.” There is plenty of evidence to show wearing a mask does reduce transmission, but they are not infallible. I ended my post with, “Thanks for listening.” The first reply pointed out that masks must work because the influenza rate is way down this year. That helped amplify the story I am trying to tell, which is thinking of others can help keep everyone safe.
We can tell ourselves that we are miserable and that we are suffering unnecessarily. We can tell ourselves that we are rugged individualists, that we have the right to do as we please. But science suggests that we more readily thrive when we are part of a collective. World War II, the Spanish flu epidemic and the mass vaccination effort to wipe out polio were just a few of the times we have been able to collectively pull together for a goal. Our nation saw itself as a union, united in our willingness to forgo some individual freedoms—which is different than giving up individual rights—to fight a common enemy for the sake of the country as a whole. We can do it again in 2021. We have a chance to put this pandemic behind us now that vaccines are available, but we can’t let our guard down. It is up to all of us to do what we can to support our public health officers by echoing their messages of wearing masks, avoiding gatherings and by encouraging patients to get the vaccine when it is their turn. If we do our job, we can attain our highest calling as physicians: to help everyone live a safer and more fulfilling life.
March/April 2021
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| EXEC UTIVE DIRECTOR’S MESSAGE |
Crushing COVID-19 The Vaccines Are the Shot in the Arm We All Need
E
veryone associated with health care knew, at some point, a pandemic could occur just as it did a century ago. But I don’t think any of us ever could have really predicted the challenges and urgency our medical community would face as a result of COVID-19. Now, a new tool has been added to our arsenal to fight the virus. Vaccines with proven efficacy are now available, and that shifts the challenge to getting them into arms to protect health care workers. In some cases, however, that challenge also entails getting some members of our health care community to open their minds so that they will agree to roll up their sleeves. SSVMS jumped into action when it became apparent that there wasn’t a clear path for getting the vaccine to physicians not affiliated with a hospital. We partnered with UC Davis Health and in less than 24 hours had a vaccine clinic open for community physicians and their staff. By early February we have already facilitated appointments for over 1,500 independent physicians and medical practice staff to get their first dose, and by the time you read this we will have helped make the vaccine available to hundreds more. One somewhat surprising obstacle we have faced, however, is the hesitancy among some health care workers about receiving the vaccine. Physicians have been mostly receptive to taking the vaccine, but some members of the health care community have raised safety concerns about it. In response, SSVMS has launched a COVID-19 vaccine acceptance campaign with information that can help persuade reluctant health care staff and patients that not only is getting the vaccine safe, it’s the right thing to do to keep everyone safe. The resources available include a frequently asked questions sheet (see the 6
Sierra Sacramento Valley Medicine
By Aileen Wetzel awetzel@ssvms.org
opposite page) with talking points that can be used to address common concerns about the different vaccines now available. You can access the latest version quickly by pointing your phone’s camera at the QR code. The bottom line is that your chances of becoming sick or put in a life-threatening condition are exponentially higher if you don’t get the vaccine than if you do. Serious reactions to the vaccine have been a very small percentage of the number administered, and most have been quickly resolved. We’re also helping you spread the word that the vaccine is safe and that you’re so confident about that, you’ve gotten the vaccine yourself. We’ve put a twist on the “I Voted” stickers handed out during the election and are offering all our members—at no cost—“Crushing COVID-19, Got My Vaccine!” lapel and lab coat buttons. We’d be happy to drop some off along with FAQ cards at your practice location. Simply email Dana Brooks, SSVMS director of physician engagement, at dbrooks@ssvms.org and we’ll make it happen. I know we are all looking forward to better times ahead as the vaccines start to reduce the incidence of COVID-19. But I also want to look back for a moment at 2020, which was a remarkable year in so many ways. We saw our members take on a variety of challenges, and SSVMS was there with you every step of the way. We’ve listed some of our accomplishments over the past year on the opposite page. But while we’re proud of what we could do, we’re even prouder of what all our members did to treat thousands of patients, comfort them in difficult times, endure through long hours of distress, and provide quality care to our community. Some tough times lay ahead, but the outlook is brighter. Please join us in our campaign to literally give us all the shot in the arm we need to defeat COVID-19.
As a physician, I received the COVID-19 vaccine and strongly recommend my colleagues and patients do as well! Top Patient Concerns I’ve already had COVID, so I don’t need it. Multiple strains of COVID and cases of people contracting twice. Unknown how long natural immunity lasts. The vaccine has proven effective against multiple known strains. I fear it’ll give me COVID/I don’t understand mRNA vaccines. Messenger (m)RNA vaccines cannot give you COVID, and do not contain a live virus. Does not affect DNA; mRNA does not enter cell nucleus. mRNA contains a blueprint on how to make the coronavirus spike protein. The protein is released into the body and the body then makes antibodies against it. mRNA then breaks down and is disposed of. Analogy: Vaccine sends an email to cells with instructions to copy a small piece of the coronavirus. This action prompts our bodies to make antibodies to fight COVID-19. The email is then deleted. Are the vaccines safe? Most people do not have serious problems after getting vaccine. The vaccine is expected to produce side effects, especially after 2nd dose. These can be indicators that it is working. Arm may be sore, red, or warm to the touch. Symptoms usually go away within a week. Some people report headache, fever, fatigue, or body aches after getting vaccine. No significant safety concerns identified in clinical trials. What about the misconception the vaccine is being used as an experiment on communities of color? First two mRNA vaccines that received emergency FDA authorization tested in diverse group of people. About 30% of U.S. participants were Hispanic, African American, Asian, or Native American. About half were older adults. No significant safety concerns identified in these or any other groups. I want more people to get it first. More than 38 million Americans already received the vaccine, mostly physicians and other healthcare professionals. “I recommend you get the vaccine as my colleagues and I also received it.” What about long-term data? CDC will continue to monitor and address any rare long-term side effects. But COVID19 would be worse than vaccine. At least 8 weeks of safety data were gathered in trials. It is extremely unusual and unlikely that side effects appear more than 8 weeks after vaccination. The vaccine was developed too fast. While the vaccine was developed quickly, no “corners were cut.” mRNA technology was developed in the 1990’s, it is not new. Over 70,000 Americans were part of clinical trials. The vaccines were manufactured while conducting clinical trials to speed up process, however, were still subjected to same rigorous FDA testing as all other vaccines. I fear it will affect my pregnancy/ability to get pregnant. The vaccine does NOT cause infertility. Recommend enrollment in CDC’s v-safe program to receive information as soon as available. Card Information Last Updated: 2/16/2021 For the most recent info, please scan the QR code to the right.
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March/April 2021
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| OPINION |
To Be a True Healer, Be True to Yourself Trust Your Unique Abilities and Intuition
R
Photo: Wikimedia Commons
ecently, in the opening session for the Healer’s Art course I have been involved with for four years at UC Davis, I started by asking questions. What sacrifices did you make to enter the path of a life of service? What parts of you did you suppress or what activities did you put aside since you started medical school? Does it seem to you that you are disconnected from your core and essence at times? Have you muted unusual ideas or beliefs because they were not “scientific” enough? Did you change the way you talk, dress or introduce yourself? If so, how do you feel about that? Does it feel harmonious, or does it bring you away from who you really are? In 1996, I started medical school in Montreal, Canada. The first to enter such a path in my family, I had no road map for what was to come, but I was filled with hope and confidence as I saw we had finally overcome the gender gap (which I didn’t put in those words back then) because the class was 60% female. There were also Asian students, a few students of Haitian and African descent, and other minorities. Diversity was natural. Yet, sooner or later, subtle manifestations
The Diagnostic and Statistical Manual of Mental Disorders—regardless of whether it is in English or French—doesn’t have all the answers. 8
Sierra Sacramento Valley Medicine
By Caroline Giroux, MD cgiroux@ucdavis.edu
of a clash with older generations of doctors occurred. About approaches, conceptualizations, gender roles, the interplay of race and illness… Despite it all, a familiar echo of deep knowing was there, within, trying to guide me. The DSM is not the whole of human experience. The one symptom-one pill approach doesn’t seem right. I can’t pinpoint why yet, but I believe this patient needs to go to intensive care. Maybe, like the younger me, you have heard that inner whisper, but your attempts to follow it are ridiculed. You don’t even know there is a word for this: micro-aggression. And because you feel alone in your reality, you start wondering, “What’s wrong with me? I must have gotten into med school by a stroke of luck!” I never did the Healer’s Art course as a student. I wish I had. I would have needed it as a validation for my experience of the imposter syndrome and as a reminder of the moral imperative for self-care. Such a course is a good reminder that self-care is not selfish, but necessary if we want to be responsible and attuned doctors and also if we want to maintain joy in our work. It took me many years to understand this. Even two years ago, the last time I co-led this course, I was still improving, recovering from the years-long shock and disillusionment about our socially unjust health care system, the fragmented approaches, the corporatization of healing. I was barely starting to catch my breath, believing I have a voice and should use it more, along with my socio-cultural advantage, to serve others. But then the pandemic hit. Contagious fear made me lose my balance. Gradually, I rediscovered my anchors. First, my breathing, which links body and spirit, often disconnected after trauma. Then, yoga, as a spiritual and general wellbeing practice, even if only 15 minutes per day. I felt I was mobilizing energies better. Energy, or
chi: a word that captured so much of the way I experienced life, yet it sounded almost esoteric, invisible, intangible. I decided to honor it nonetheless, and explore this again. Over the past months, I have been enjoying learning about feng-shui or vibrational frequencies. I joined various circles via Zoom as a way to
an extra hour after 5 p.m. if needed to deal with my in-basket. I finally embraced my shadow, or mystical nature: the divine feminine aspects of being a healer, at the portal of birth, death and renewal. We all have shadow elements, the disowned parts of the self. Because of the cultural and familial environ-
Intuition has always been real to me. It is the whisper of the heart. It speaks a truth that can’t be named. break isolation due to confinement: I found a tribe when I participated in a New Moon Circle, with meditation and drumming, understanding even more the importance of reconnecting with my own rhythms and the ones from nature. In a recent physician healing circle, a guest told us more about “medical intuition” and intention (rather than goal) setting. Over the years, I learned to trust my sensations, intuitions and wild dreams again. I decided to arrange my work day around self-care rather than the other way around: walking when it is daylight, and working
ment we grew up in, maybe we had to suppress parts of ourselves that were frowned upon or not valued. As a result, in order to survive and be accepted, we repressed them. But these facets, when brought to our awareness, are a source of magnificent potential. In order to feel whole, we must identify, acknowledge and accept the shadow elements. Only when they are integrated can we live authentically. Against the monotheism of evidence-based approaches in medicine, intuition was polarized in my life. But intuition is an inner gift to us healers. It can actually
enlighten the evidence base or guide it. Intuition has always been real to me. It is the whisper of the heart. It speaks a truth that can’t be named. It reminds us of the interconnectedness of everything. It is time to embrace this energy, this vibration of my soul and use it as a physician. I had deserted it to fit the mold or the professional persona, but as I started practicing medicine distracting questions multiplied, pseudo-answers created confusion, and my spiritual vacuum deepened. But I will no longer leave my inner compass in the shadow. Intuition and evidence should be integrated and balanced, just like our yin and yang characteristics. Healing (or doctoring) is both an art and a science. Shadow figures can appear in the unconscious such as dreams at night or imagery when your mind is wandering. For me, my shadow figure was a bold woman with red hair. I never made it to dyeing my hair the color of fire but I certainly allowed myself to express my bold self more. For years, I have used journaling and poetry to help me in March/April 2021
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my self-discovery. Symbolism is also a renewed interest. For instance, I pay attention to the shape of the trees on my daily walk, one bent like an arch looking like Omega, which means evolution, new start, enlightenment. Trees in general could represent our resilience, their roots being like the soul, the trunk like the body, and branches and leaves high as spirit. I notice animals and look for the meaning of their totem: wisdom for owl, broad perspective for hawk, reading through deception for fox, lightness and joy for hummingbird, doves for peace. Your own associations are great, too. It doesn’t matter. You can use what is all around you for your wellness. You are already whole. You are healers because you can listen to stories. And story listening is one of our most powerful healing tools. That is why during the Healer’s Art course we practice it. Whether you are a student or you have been practicing for years, pay attention to your inner self by looking at whatever part of you that you put in a box to survive medical school (music, sports, art, volunteering, friendships) and make room for it now. Keep writing, singing, hiking, meditating, contemplating, cooking, laughing, loving. It will feed your humanity during the act of listening to patients’ stories. Doctors are people and they are not interchangeable. You are unique and so is your role in medicine. You are like no one else before you, nor should you try to be. Being true to yourself will make you a better healer for your patients and your soul.
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| VACCINE ACCEPTANCE |
What You Need to Know About the COVID-19 Vaccines mRNA Technology Has Been Known for Over a Decade, Researched for Flu, Zika, Rabies and More
T
he Emergency Use Authorization (EUA) of two vaccines—one by Pfizer, the other by Moderna— that protect against SARS-CoV-2 has been greeted with much appreciation but also with some concern. Some insight into the technology behind these two vaccines, including what is known and what we still need to learn, can help you answer questions from your patients about the safety and efficacy of the vaccines. The National Institutes of Health describe Messenger Ribonucleic Acid, otherwise known as mRNA, as “a single-stranded RNA molecule that is complementary to one of the DNA strands of a gene. The mRNA is an RNA version of the gene that leaves the cell nucleus and moves to the cytoplasm where proteins are made. During protein synthesis, an organelle called a ribosome moves along the mRNA, reads its base sequence, and uses the genetic code to translate each three-base triplet, or codon, into its corresponding amino acid.” Both the Pfizer and the Moderna vaccines use mRNA technology. This technology has been known for over 10 years. It has been studied in preliminary vaccine trials for flu, Zika, rabies and cytomegalovirus. The challenge in these trials was instability of the free RNA, inadequate immune response and inflammatory responses. Numerous clinical studies have been done using mRNA to encode cancer antigens to stimulate immune responses that would clear or reduce malignant tumors. Recent advances in the technology of RNA biology and chemistry have led to the discovery of new delivery systems that improve stability, safety and effectiveness. The current vaccines have strands of mRNA inside a special coating that protects the mRNA from enzymes that might break it down. This coating helps the mRNA enter dendritic cells and macrophages in the lymph node near the vaccination site. The cells then create
part of the spike protein specific to SARS-CoV-2, in a way that is antigenic but will not cause any harm. Our immune system cells then make copies of the spike protein and enzymes in the cells destroy the genetic material from the vaccine. mRNA never enters the nucleus of any cell and cannot change our own genetic material. The protein is recognized as a foreign protein; antibodies, T-lymphocytes and B-lymphocytes destroy it and remain in our bodies to fight the virus if we encounter it in the future. The CDC says mRNA vaccines have several benefits compared to other types of vaccines, including use of a non-infectious element, shorter manufacturing times, and the potential for targeting multiple diseases. mRNA vaccines can be developed in a laboratory using a DNA template and readily available materials. This means the process can be standardized and scaled up, making vaccine development faster than traditional methods. DNA and RNA vaccines typically can be moved more rapidly into clinical trials for initial testing, the CDC adds, noting that future mRNA vaccine technology may allow one vaccine to target multiple diseases. Phase 3 trials of both vaccines showed them to be 95% effective in preventing COVID-19 clinical disease after the second dose. Clinical trials for both vaccines are ongoing. Questions still remain regarding how long immunity lasts and if an immunized person could still harbor the virus and transmit it to others while not getting sick themselves. The first two vaccines approved require two doses, three weeks apart for the Pfizer product and four weeks apart for the Moderna product. Because there have been reports of severe allergic reactions, it is recommended that patients who get the vaccine be observed for a minimum of 15 minutes after inoculation and for up
SSVMS Forms Health Equity Advisory Committee
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Sierra Sacramento Valley Medicine
By Glennah Trochet, MD trochetg@gmail.com
Photo: Office of the Secretary of Defense
to 30 minutes for those who have a history of a severe allergic reaction such as anaphylaxis. Vaccinators must have ready access to epinephrine and emergency services in case such a reaction occurs. As of January 19, 2021, the CDC had reported 15 confirmed cases of anaphylaxis related to the Moderna vaccine and 45 confirmed cases after receipt of the Pfizer vaccine. This is a rate of 2.1 cases per million doses for Moderna and 6.2 cases per million doses of Pfizer vaccine, according to the CDC. Both vaccine information sheets for recipients list the ingredients. If an individual is allergic to any of the ingredients in the vaccine, they should forego vaccination. It is theorized that the most likely allergen in both vaccines is the lipid envelope of the mRNA that resembles polyethylene glycol (PEG), a frequent component of medical products such as wound dressings and laxatives, household products such as detergents, and cosmetics that has been known to cause allergies. The National Institute of Allergy and Infectious Diseases (NIAID) is the lead studying this possibility. In addition to allergic reactions, there are also known side effects, which reportedly tend to be more severe after the second dose, although they can occur after the first dose. These are similar to the side effects of other vaccines, but in some instances have temporarily disabled an individual for up to 48 hours. The listed side effects include injection site pain, tiredness, headache, muscle pain, chills, joint pain, fever, injection site swelling, injection site redness, nausea, feeling
Vaccines from Pfizer/BioNTech (above) and Moderna (following page) both use mRNA technonogy and have been shown to be 95% effective. unwell, and swollen lymph nodes (lymphadenopathy). There has been concern because of reports of deaths in people recently vaccinated against COVID19. On January 19 the World Health Organization convened its Global Advisory Committee on Vaccine Safety (GACVS) to review the reports of deaths throughout the planet. “The current reports do not suggest any unexpected or untoward increase in fatalities in frail, elderly individuals or any unusual characteristics of adverse events following administration of [the Pfizer–BioNTech COVID 19 vaccine],” the GACVS determined. “Reports are in line with the expected, allcause mortality rates and causes of death in the sub-population of frail, elderly individuals, and the avail-
able information does not confirm a contributory role for the vaccine in the reported fatal events. In view of this, the committee considers that the benefit-risk balance of [the vaccine] remains favorable in the elderly, and does not suggest any revision, at present, to the recommendations around the safety of this vaccine.” Physicians and others are encouraged to report adverse reactions through VAERS. Vaccine recipients also have the option of downloading a smartphone app called V-safe that uses text messaging and web surveys to check in with people who have been vaccinated and to report potential side effects of COVID-19 vaccination to the CDC. V-safe asks questions that help the CDC monitor the safety of COVID-19
March/April 2021
13
Photo: Giovanni Cancemi/stock.adobe.com
vaccines, provides second-dose reminders if needed and generates live telephone follow-up by CDC if a participant reports a significant health impact following vaccination. For more information on how to sign up, visit: www.cdc.gov/vsafe. There are differences between the EUA process and regular approval by the Food and Drug Administration. EUAs are used during an emergency: a product is allowed to be used, based on the best available evidence, without waiting for all the evidence that would normally be needed for full approval. The EUA is in effect until the emergency declaration is over. The FDA may also revise or revoke an EUA at any time based on ongoing review of the evidence available. The EUA process includes rigorous scientific review of the available evidence, both by agency scientists and advisory bodies such as the Advisory Committee on Immunization Practices (ACIP). The goal is for the drug to eventually gain full approval, which comes when the FDA determines that there is substantial evidence and clinical data that a drug or immunization is safe and
14
Sierra Sacramento Valley Medicine
effective for its intended use, and that the product can be made according to federal quality standards. There are guidelines that manufacturers must follow to obtain full approval for their product. In both instances the FDA must determine that the benefits of using the product as directed outweigh the risks of not doing so. The FDA has developed an infographic to explain how an emergency use authorization is accomplished entitled “The Path for a COVID-19 Vaccine from Research to Emergency Use Authorization.” As this article was being written, two more vaccines were in Phase 3 trials and nearing the stage where they can apply for an EUA. These vaccines, developed by AstraZeneca and Johnson & Johnson, use an adenovirus vector to induce immunity. Further information on them will become available if and when they receive Emergency Use Authorization. For more information on talking with your patient about the COVID-19 vaccines visit cdc.gov/vaccines/ covid-19/hcp/answering-questions.html.
2020
ANNUAL REPORT
Serving Over 6,000 Physicians in El Dorado, Sacramento, & Yolo Counties
By Jon Davids, MD jdavids@shrinenet.org
ssvms.org | facebook/ssvms | @ssvms | 5380 Elvas Ave. Suite 101, Sacramento, CA 95819 | 916.452.2671
March/April 2021
15
Physicians proudly display their work from the SSVMS Joy of Medicine Wellness Month virtual Paint and Sip event
Physicians pose for a selfie at the pre-pandemic annual SSVMS Honors Medicine event
Throughout the year, SSVMS delivered boxes with more than a million dollars worth of PPE to physicians
7000
SSVMS’s grassroots program, Operation Shields Up, distributed face shields to protect essential workers
membership growth •
6000
•
5000
•
4000 3000
•
2000
•
1000 2016
2017
2018
2019
2020
2020 ADVOCACY EFFORTS Advised the state’s executive orders to ensure public health officer safety. Secured more than $175 billion in financial assistance for physician practices. Protected Proposition 56 funding in the state budget for physician loan repayments and graduate medical education programs. Convened virtual grand rounds on COVID-19 to discuss transmission, testing, vaccines, and more. Created a COVID-19 website with daily updates, toolkits, and more.
Dedicated Dedicated to bringing together physicians from all modes of practice promoteofthepractice art and science of to bringing together physicians from alltomodes to quality medical care, enhance the physical andmedical mental health our entire community. promote theand arttoand science of quality care,ofand to enhance
the physical and mental health of our entire community.
2020 accomplishments
170 $29,000
200 +
Physician Resiliency Consultations
private practices received assistance
medical student sc holarships granted
$1.9+ M I L L I O N PPE donated
93
SPIRIT surgeri es donated
100+
Fabric face masks made and distributed
$385,453
in-kind donated SPIRIT patient ser vices
physician volunteers Face shields manufactured & distributed
ssvms.org
ssvms community programs joy of medicine
UC Davis emergency medicine physicians participating in a wellness event.
The Joy of Medicine will relieve physician pain and help to reclaim the joy of practicing medicine through education, advocacy, and program services designed to nurture individual well-being and collegiality and to promote systems-wide changes. In 2020, the Joy of Medicine Summit was moved to an online format and reached more than 250 physicians across five weekly sessions and counselors held more than 230 sessions.
medical student scholarship fund
Since 1969, SSVMS has supported the future of medicine by providing scholarships to deserving medical students who have graduated from a high school in El Dorado, Sacramento, or Yolo Counties. In 2020, $29,000 in scholarships were awarded to nine medical students. SSVMS SSVMS Medical Medical Student Student Sc Scholarship holarship Fund RRecipient ecipient
spirit SSVMS’s Sacramento Physicians’ Initiative to Reach
out, Innovate and Teach (SPIRIT) program recruits and places physician volunteers to donate medical services to the medically indigent and uninsured members of our community. Since its inception, SPIRIT has provided more than $12 million in donated care, treated more than 53,000 patients, and performed more than 1,100 surgeries. Thanks to the help of our amazing volunteer physicians and health system partners, we were able to continue to provide services despite the COVID-19 pandemic.
Dr.. Benscoter with SPIRIT patient Dr
Scarificator, a 19th century bloodletting tool
museum of medical history
Sierra Sacramento Valley Medicine
SSVMS’s Museum of Medical History showcases the history of medicine in our region and features medical artifacts from the fields of Surgery, Clinical Diagnosis, Infectious Disease, Pharmacy, Radiology, Chinese Medicine, Obstetrics and Gynecology, Medical Quackery, and more. In 2020, the museum hosted virtual guided school tours, catalogued the artifacts into an online database, and continued to expand the exhibits.
honoring wishes
Honoring Wishes is dedicated to providing the resources necessary for the medical community and community at large to facilitate meaningful end-of-life care conversations and planning. Launched in late 2020, Honoring Wishes is still in its infancy and focused on planning for 2021 and beyond.
,
rx safe physicians
In partnership with the Sacramento County and the El Dorado County Opioid Coalitions, SSVMS’s program focuses on educating providers on safe prescribing and increasing access to treatment for opioid use disorder. In 2020, with grants from CDPH, the program launched a website to inform the public about opioid use disorder, conducted multiple campaigns to raise awareness of the dangers of Fentanyl, and created new public service announcements. Learn more at SacOpioidCoalition.org
health equity committee
SSVMS convened a Health Equity Committee in 2020 that includes Diversity & Inclusion experts throughout the region with the goal of identifying and developing best practices for addressing racism in medicine and improving access to care.
SSVMS’s Community Programs are supported through grants and generous donations from the medical community. Consider making a tax-deductible donation at www.ssvms.org/programs.
donate now
| PANDEMIC |
Students Bring Vaccine, Enthusiasm to Elk Grove Volunteers Excited By Historic Chance to Serve Community
E
Photo: Nitya Janardhan
ven as the clock strikes 4 p.m. on a January day, a long vaccination appointment line stretches out the two-door entrance. California Northstate University’s campus has become the site of a busy vaccination clinic in a usually slow-paced Elk Grove. When the FDA granted the Emergency Use Authorization to the Pfizer COVID-19 vaccine on December 11, 2020, fourth-year California Northstate University medical student and class president Radhika Gulhar took the initiative to help vaccinate her fellow classmates. She made contact with the California Department of Public Health and Sacramento County to
Kim Lau receives her vaccine at California Northstate University’s clinic in Elk Grove. 20
Sierra Sacramento Valley Medicine
By Pranav Sathe, MS III Pranav.Sathe6123@cnsu.edu
get medical students approved to receive the vaccine so they could help vaccinate others. By January 8, Gulhar’s efforts to help CNU’s medical students receive their vaccinations had paid off and they were able to work at the community clinic sponsored by the school’s College of Pharmacy. “Getting the medical students vaccinated felt like something that was part of my duty as class president,” Gulhar said. “I wanted to help our students feel safe and protected while living with their loved ones and working the frontlines in this pandemic.” Other students were eager to help and be a part of this historic effort. Stephen Howell, a second-year medical student at CNU, has been coordinating the volunteer sign up sheets for the students. “We started having more and more patients sign up,” he said, adding that the number quickly went from about 100 patients served in the three-hour blocks to 300. “So we expanded and now have almost all of the M1 and M2 classes vaccinated as well as volunteered. More are signing up to volunteer again along with M3s and M4s.” Howell said CNU reached out to other university health care programs, and that lead to a combination of volunteers at the clinic from CNU, UC Davis and Sacramento State. While the pharmacy students at California Northstate University administer injections, the medical students are in charge of monitoring side effects and helping patients make their next appointment. Students interact with the patients from the minute they enter the doors to get vaccinated through the moment they exit. “Every time patients at the vaccination clinic said thank you or smiled, it was a very rewarding and humbling experience,” Gulhar said. By ErictoWilliams, All medical students have the ability sign MD up imango@att.net
Photo: Anna Thiemann
to volunteer at the clinic and are encouraged by the school faculty to do so. I had the chance to help out at the vaccination clinic in between my clinical. Many people were bringing their parents or other elderly family members eligible to receive the vaccine. Others were couples receiving their vaccines together. One man with a full head of white hair said he was feeling overwhelmed at seeing so many other people his age in the same room. He described how he had to forego seeing his family during the holidays and hadn’t Anna Thiemann (left) and Abha Sathe happily display their vaccination cards. seen his friends in person for many, many months. At one point during the evening appointments, I “Of course, it was all worth it in the end,” he said. took a moment to reflect on the general atmosphere of “Now I don’t have to worry about dying every second.” the evening. I felt grateful that we are one step closer Another couple who had just received their second to ending this pandemic and that after months upon doses said completing their vaccinations gave them months of sadly watching new record daily and weekly some peace. death totals, we can finally begin to replace those “Anxiety and stress—the two emotions we felt most numbers with daily records of vaccinations. While I of last year,” the husband said. “Now we can, hopefully, share the ambivalence many people feel as we acknowlrelax a little.” edge this victory but know the battle is not yet over, I’m Others said they were feeling grateful but expressed thankful that after a year filled with hate, violence and uncertainty about the future. They were unsure what division I don’t feel naive for having hope again. “going back to normal” actually meant, and if it was California Northstate’s vaccination clinic underscores even possible, what the timeline would look like. the role that medical students, in addition to health care I recognized one particular vaccine recipient as a professionals, are playing in bringing the community member of the area SPCA who would bring therapy together and uniting it against this truly destructive dogs to the campus once a semester. He was happy to pandemic. Our vaccination clinic was student-led from receive the vaccine, and I was happy we were able to the start and is still student-led as it enters the thick of give back, through vaccination, to those who supported the vaccination effort. us in our journeys. I am proud that driven and motivated students are I asked him about Dante, a bear-sized Bernese uniting to do our part in ending this pandemic. We have Mountain dog and campus favorite, and his response found a voice of our own through this pandemic in made me realize that the impact of the pandemic our commitment to serve patients and promote overall extended beyond just human society. He said that wellbeing. As the vaccination effort is just beginning, because of the pandemic, none of the dogs had a chance we know there is much more work to do. For now, we to meet any people or go to any events. The dogs were use the tools at our disposal: vaccination doses, public lonely, and so were the people who relied on their health messaging and compassion for our community. company.
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Crushing COVID-19, One Arm At a Time SSVMS Clinic Offers Private Practice Physicians, Medical Staffs a Dose of Prevention
O
ver 1,500 COVID-19 vaccinations have been administered to local private practice physicians and their staff members through a vaccination clinic operated by SSVMS in partnership with UC Davis and Sacramento County. Each vaccination is another step forward toward crushing COVID-19 and protecting health care workers from the virus. Getting the vaccine also sends a strong message to patients and reluctant colleagues that the vaccine is safe, effective and an important step toward reopening schools and businesses. For more information about scheduling a vaccine, contact Dana Brooks at dbrooks@ssvms.org. Additional information, including links to vaccine clinics in surrounding counties, is available by visiting the SSVMS website (ssvms.org) and clicking on the COVID19 tab.
Dr. Masoud Ghalambor, right sends a message to Dr. Anthony Fauci while getting his vaccine at the SSVMS clinic. Alejandra Aguilar, above, a medical assistant at Dermatology Consultants of Sacramento, smiles behind her mask while showing her vaccination card.
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Sierra Sacramento Valley Medicine
Photos: Top left, bottom: University of California, Office of the Chancellor; top right, SSVMS staff
UC Davis hosted the clinic and provided staff. Right, Dr. Michael Burman gets his first dose. Over 1,500 private practice physicians and their staff members have been vaccinated at the clinic.
March/April 2021
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| ESSAY |
A Venomous Viper An Exotic Snake, the Nurse Who Ran Away, And a Race Against Time
I
t was over a third of a century ago, when I was the night-call admitting resident on the Internal Medicine wards at the University of California, San Francisco’s Moffit Hospital. I was summoned around 9 p.m. by overhead page to go immediately to the emergency room to admit a very sick patient. When I arrived, I was met by an exceptionally nervous intern (it was a time when interns staffed the ER, which was then never very busy at night) and several equally anxious nurses putting intravenous lines in each arm of a patient they wanted me to admit. “What’s the story?” I asked the intern as I went to the man on the gurney. “Snake bite,” said the intern. “Snake bite?” “Yes. And we have no antivenom for this snake. I asked our pharmacist. No antivenom. I called the Golden Gate Park Aquarium herpetarium: no antivenom. I called the San Francisco Zoo: no antivenom. Not for this snake!” The intern and I were now standing next to him, and the patient seemed badly obtunded. “Was he like this when you got him?” I asked the intern. “No. He’s much worse. When he came in he was able to tell me that he was a Customs officer at San Francisco Airport and had been screening a man arriving from India. The man, an American, had a zippered red canvas bag hanging from his arm with the label ‘Venomous Viper’ on it. Well, our guy here wasn’t about to just let him through. Maybe, he said, the passenger was a smuggler of some illegal substance trying to avoid full search.” Our patient first gloved both his hands, then very carefully opened the red canvas bag to take a look. He was immediately struck by a very swift and loudly hissing snake, and its fangs not only went through the gloves but pierced his right hand. The passenger, detained by the airport police, identified the snake as 24
Sierra Sacramento Valley Medicine
By Faith Fitzgerald, MD ftfitzgerald@ucdavis.edu
a Russell’s viper—one of the deadliest snakes on earth. I learned later that during this period in time there had been an increase in the number of pet shops in San Francisco offering exotic animals for sale, and the more exotic the better, it seemed. The passenger was an agent of these pet shops. “Did you call our clinical pharmacologist?” I asked the intern. “We have a clinical pharmacologist?” he answered. I asked him to make the call. I examined the patient. He could only moan and seemed unable either to hear or to speak. His face was swollen. He had blood in his mouth. He was looking worse and worse. I took the gauze cover off his hand, which was now greatly swollen with blistering and areas that resembled gangrene. His blood pressure was dropping, his heart slowing. Then the clinical pharmacologist had me paged. “Try calling a guy in Southern California named Findlay Russell,” he said. “He’s an internist and expert in snakes. The reason I remember him is that he’s got the same name as the fellow for whom Russell’s viper was named in the 19th century.” It was now close to 3 a.m., but I put in the call to Dr. Russell. A woman’s voice answered the phone. “Is Dr. Findlay Russell there?” I asked her. “I’ve got a patient dying from a viper bite.” “Findlay,” she said, sighing. “It’s for you. Another snakebite.” His sleepy voice came on, and I told him what had happened. He first suggested seeking the antivenom at all the places the intern had already tried. When I told him that, he said he would send the antivenom up by the next available airplane going to San Francisco from Southern California as soon as he could, and he gave me instructions in how to use it. I went to see my patient who had, by then, been transported to the Medicine ward. He looked terrible.
Photo: Wikimedia Commons
Then I saw, coming into his room, a very large nurse whom I did not know, and when I went towards her to ask for the recent vital signs I was astonished when she turned around and ran away from me. Did she think I was contagious, I wondered? Then another nurse came in, one that I knew, and she explained that the large “nurse”—who had rushed past her in the opposite direction when she was coming to talk to me—was not a nurse at all. He was a newspaper reporter, and when he first heard from the airport what he considered to be a “great story,” he had come to Moffit to get that story. None of the doctors, nurses or staff in our hospital could give out information to a non-family member without our patient’s permission. So the reporter wanted to interview our patient, but had been denied entry since our parent was critical and unresponsive. He then tried to sneak into the patient’s room disguised as a nurse, complete with a nursing outfit, including a hat that the nurses of that era wore, the style of which depended on where they had gone to nursing school. His look like a nun’s headpiece, called a coif. He was subsequently escorted out of our hospital by the police. The antivenom arrived by plane and then was brought by courier from the airport to us at about six in
A Russell’s Viper wasn’t the only snake that tried to attack Faith’s patient that day. the morning. I thought it might be too late, but I gave our patient the antivenom as Dr. Russell had instructed me to. I sat with him, then checked out to the day team and went to take a brief nap. When I awakened, I went back to his room. He was better! The swelling was abating. He would require plastic surgery on the envenomated hand, but he would survive. I called Dr. Russell and thanked him. And so my patient survived serious potential injuries (the first to his body and the second to his privacy) given him by two threatening attacks in one 24-hour day. The first attack was by a venomous viper and the other by this particular newspaper man, whom I have always since thought of as a quite different species of snake.
March/April 2021
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| BOARD BRIEFS |
Board Briefs January 11, 2021 THE BOARD: Installed Carol Kimball, MD as the 2021 SSVMS President and thanked John Wiesenfarth, MD, outgoing president, for his outstanding service as President in 2020. Received a COVID-19 update from Olivia Kasirye, MD, Public Health Officer, Sacramento County. Elected J. Bianca Roberts, MD, 2021 Secretary, and Vanessa Walker, DO, 2021 Treasurer, who will join the 2021 SSVMS Executive Committee members, Carol Kimball, MD, President, Paul Reynolds, MD, President-Elect and John Wiesenfarth, MD, Immediate Past President. Approved to provide COVID-19 resources available through SSVMS and recommend a moment of silence for the members in the community who have passed away due to the COVID-19 virus. Approved the following Membership Reports: December 14, 2020 For Active Regular Membership — Ali R.Akram, MD; Bells M. Aladag, MD; Terah J. Allis, MD; Anthony S. Alvarado, MD; Sepideh Bagheri, MD; William P. Barley, Jr., MD; Robert C. Benzl, MD; Harchitwant S. Bhinder, MD; Vijay K. Bodukam, MD; Matthew S. Bowdish, MD; Mekhala Chandra, MD; Sina Dadfarmay, MD; Deepa Deot, MD; Ramandeep S. Dhaliwal, MD; Amandeep S. Dhillon, MD; Manuel Doblado, MD; Lance D. Edmonds, MD; Morgan R. Effron, MD; Jacob H. Fennessy, MD; Kimberly H. Fok, MD; Jacob D. Gire, MD; Joseph D. Hall, MD; Kayla R. Harrington, MD; Stephen S. Henrichon, MD; Amrith Jamoona, MD; Michael S. Kim, MD; Kent M. Lai, MD; Tom S. Liu, MD; Stephanie H. Mai, MD; Lavina Malhorta, MD; Ramya Mallareddy, MD; Michael A. Massoud, DO; Laura B. Mathew, MD; Kavitha Mattaparthi, MD; Conor W. McLaughlin, MD; Hugh McSwain, MD; Alexandria N.
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Sierra Sacramento Valley Medicine
Meyers, MD; Myles M. Mitsunaga, MD; Michael J. Murray, MD; Allison L. Overmon, MD; Thomas S. Pattison, MD; Vinay Penmetcha, MD; John C. Perlegos, MD; Ethan T. Phan, MD; Albi Qeli, MD; Anne E. Ray, MD; Subhas Reddy, MD; Mahwash Saeed, MD; Christopher D. Sanders, MD; Maninder S. Sanghera, MD; Katharina R. Scharruhn, MD; Alicia R. Schlenz, MD; Karen E. Schultz, MD; Robert C. Schulze, Jr., MD; Luke B. Simonet, MD; Jaideep S. Sohi, MD; Vicki L. Soloniuk, MD; Jacob T. Stephenson, MD; Teddy J. Su, MD; Emma C. R. Swan, MD; Felicia C. Tang, MD; Korina A. Tanner, MD; Debra J. Templeton, MD; Thimmaiah G. Theethiara, MD; Tamara T. Watson, MD; Melissa J. Wilcox, MD; Ely A. Wolin, MD; Osama Zahriya, MD; Jessica Bl Zhang, MD. For Physician Active Resident to Active Regular Membership — Quraish G. Fazleabas, DO; Rachel J. Heidt, MD; Carter W. Kittleson, MD; Caroline M. Ornellas, MD. For Retired Membership — Regan Asher, MD. Membership Terminated for Nonpayment — John T. Waring, MD. For Resignation — Okeanos Z. Gerell, MD (moved out of state); Jeffrey J. Lee, MD; Tennyson Lee, MD; Thomas Maney, MD. For Transfer of Membership — Ryan M. Alward, MD (to Alameda-Contra Costa); Sami A. Bajwa, MD (to FresnoMadera); Tiffany A. Heckendorn, MD (to Placer-Nevada); Vaneet K. Kalra, MD (to Alameda-Contra Costa); Petrina Kluzhny, MD (to Santa Clara); Samira Kirmiz, MD (to Placer-Nevada); Trang T. T. Le, MD (to Stanislaus); Irene C. Liu, MD (to Fresno-Madera); Dana Y. Pan, MD (to Los Angeles); Tulsi Singh, MD (to San Mateo).
| NEW MEMBERS |
New SSVMS Members
The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — J. Bianca Roberts, MD, Secretary.
New Active Members
*Physician specialty abbreviated following name.
Ali R. Akram, MD, GE, The Permanente Medical Group
Michael J. Murray, MD, REI, Northern Calif Fertility Med Ctr
Belis M. Aladag, MD, P , The Permanente Medical Group
Caroline M. Ornellas, MD, FP, The Permanente Medical Group
Anthony S. Alvarado, MD, IM, The Permanente Medical Group
Allison L. Overmon, MD, AN, Sutter Medical Group
Sepideh Bagheri, MD, D, The Permanente Medical Group
Akilesh Palanisamy, MD, FP, Sutter Medical Group
William P. Barley, Jr., MD, FP, Scharruhn & Barley Prof Med Corp
Thomas S. Pattison, MD, PM, Solo Practice
Matthew S. Bowdish, MD, AI, Sac ENT Surgical & Medical Grp Deepa Deot, MD, IM, The Permanente Medical Group Amandeep S. Dhillon, MD, HOS, Mercy Medical Group Manuel Doblado, MD, REI, Northern Calif Fertility Med Ctr Morgan R. Effron, MD, OBG, The Permanente Medical Group Quraish G. Fazleabas, DO, EM, The Permanente Medical Group Jacob H. Fennessy, MD, ORS, The Permanente Medical Group Jacob D. Gire, MD, ORS, The Permanente Medical Group Joseph D. Hall, MD, P , The Permanente Medical Group Kayla R. Harrington, MD, PD, The Permanente Medical Group Rachel J. Heidt, MD, PD, The Permanente Medical Group Amanda A. Kamali, MD, ID, Calif Dept of Public Health Michael S. Kim, MD, FP, The Permanente Medical Group Carter W. Kittleson, MD, OM, The Permanente Medical Group
Vinay Penmetcha, MD, HOS, Sutter Medical Group Ethan T. Phan, MD, IM, The Permanente Medical Group Mahwash Saeed, MD, IM, Sutter Medical Group Michael J. Sasevich, MD, TS, Sutter Medical Group Katharina R. Scharruhn, MD, FP, Scharruhn & Barley Professional Med Corp Alicia R. Schlenz, MD, R, Sutter Medical Group Robert C. Schulze, Jr., MD, PD, Sutter Medical Group Luke B. Simonet, MD, DR, Sutter Medical Group Jaideep S. Sohi, MD, DR, Sutter Medical Group Vicki L. Soloniuk, MD, PD, Sutter Medical Group Jacob T. Stephenson, MD, PDS, Sutter Medical Group Felicia C. Tang, MD, UC, Sutter Medical Group Korina A. Tanner, MD, UC, Sutter Medical Group Debra J. Templeton, MD, ORS, Sutter Medical Group
Eric C. Kuo, MD, VS, Sutter Medical Group
Thimmaiah G. Theethira, MD, IM, Mercy Medical Group
Kent M. Lai, DO, FP, The Permanente Medical Group
Peter Valenzuela, MD, FP, Mercy Medical Group
Tom S. Liu, MD, PS, Liu Plastic Surgery
Tamara T. Watson, MD, PD, The Permanente Medical Group
Laura B. Mathew, MD, PD, Sutter Medical Group Kavitha Mattaparthi, MD, IM, The Permanente Medical Group Hugh McSwain, MD, NRN, Sutter Medical Group Alexandria N. Meyers, MD, R, Sutter Medical Group
Melissa J. Wilcox, MD, FP, Sutter Medical Group Osama Zahriya, MD, GS, Sutter Medical Group Jessica B. Zhang, MD, EM, The Permanente Medical Group
March/April 2021
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| POETRY |
Are You a Christian? By Jon Davids, MD jdavids@shrinenet.org
After A comprehensive Work up
And
And
Didn’t ask
Several Clinic visits
“Do you
The father
In God?”
Has entrusted
Believe
Me
“Yes…”
To perform
Easiest answer
Surgery
Is the
On his child
“Will you
The day of surgery
With us?”
After informed consent
Pray
And surgical site marking
In a circle
The father
Our heads bowed
Asks me
Holding hands
“Are you a Christian?”
He seeks blessing
Will
To become
My Answer Destroy the Bond of trust Established between us? “No…” He wasn’t
For my hands
An instrument Of the Divine Thus We remain United
Expecting this
In caring
I didn’t
For His child
Tell him What I am
28
He
Sierra Sacramento Valley Medicine
thank you
2020 donors
Jose Abad, MD Richard Astonino, MD Thomas Atkins, MD Ranjit Bajwa, MD Jonathan Beck, MD Mark Blum, MD James Boggan, MD George Bolton, MD Robert Bonar, MD Harvey Cain, MD,JD Jeffrey Clayton, MD Ronald Cole, MD K. Michael Conroy, MD Jose Cueto, MD Robert Diamond, MD David Dozier, MD Michael Fazio, MD
thank you
SSVMS Partners in Medicine
Richard Frink, MD Alan Frueh, MD Dennis Fung, MD Francine Gallawa, MD Francisco Garcia, MD Nancy Gilbert, MD, MA Christopher Gresen, MD Jennifer Griffith, MD Guy Guilfoy, MD Hanns Haesslein, MD Robert Hales, MD Sandra Hand, MD, MPH Cary Hart, MD Barbara Hays, MD Romie Holland, MD Julian Holt, MD Monte Ikemire, MD
Bruce Jensen, MD Weldon Jordan, MD Millie Kahane, RN, MS Carol Kimball, MD Rosalind Kirnon, MD Ralph Koldinger, MD Nick Maloof David Manske, MD George Meyer, MD Brenda Mock Anh Nguyen, MD Gail Pirie, MD Karen Poirier-Brode, MD Margaret Portwood, MD Francis Poulain, MD Jeffery Rabinovitz, MD John Rice, MD
John Roe, MD Gerald Rogan, MD Jack Rozance, MD Katharine Rutherford, MD Patrick Ryan, MD Michael Schermer, MD Elaine Silver, MD Lee Snook, MD, FACP Sarah Stoltz, MD Fern Takemoto, MD Marian Te Selle, MD Clarissa Tendero, MD Sadha Tivakaran, MD Glennah Trochet, MD John Vallee, MD James Vasser,MD John Whitelaw, MD
Diamond Level Cooperative of American Physicians NORCAL Group Vitalant Gold Level Ameriprise – Crumley & Associates Silver Level Maloof Law Group First Citizens Bank Bronze Level Jamie Baker & Company Accounting
2020 volunteers and committee members
Sallie Adams, MD Regan Asher, MD Richard Astoino, MD Megan Babb, DO Katie Baker, DO Robert Bellinoff, MD Brent Benscoter, MD Christopher Bowlus, MD Christopher Bradburn, MD Nicole Braxley, MD, MPH Jacob Brubaker, MD Daniel Carlton, MD Peter Carruth, MD Eric Chak, MD Margaret Chang, MD Ron Chapman, MD Joseph Chiang, MD George Chiu, MD Clinton Collins, MD Sean Deane, MD Margaret Delmore, MD, DDS Edward Denz, OD Anthony DeRiggi, MD Kryls Domalaon, MS
Matthew Donnelly, MD Andrew Elms, MD Malcolm Ettin, MD Roel Farrales, MD Michael Fazio, MD Christine Fernando, MD Richard Fike, MD Jessica Fortin, MD Francine Gallawa, MD Juan Garcia, MD Hernando Garzon, MD Ann Gerhardt, MD Caroline Giroux, MD Eli Groppo, MD Hanns Haesslein, MD James Hamill, MD David Hamilton, MD Ruth Haskins, MD Saman Hayatdavoudi, MD Maya Heinert, MD Wesley Hilger, MD Julian Holt, MD Donald Hopkins, MD Mary Horner, MD
Peter Hull, MD Dayna Isaccs, MS Ruenell Adams Jacobs, MD Joelle Jakobsen, MD Maynard Johnston, MD Kevin Jones, DO Richard Jones, MD Burzeen Karanjawala, MD Olivia Kasirye, MD Abdul Khaleq, MD Jocelyn Kim-Dunlavey, MD David Kira, MD Rosalind Kirnon, MD David Kissinger, MD Abhinav Koul, MD Alexander Kuo, MD Robert LaPerriere, MD Melody Law, MD Michael Lawson, MD Vinh Le, MD Michael Leathers, MD Dennis Lee, MD Samuel Lee, MD Marketa Leisure, MD
Shilpa Lingala, MD Mark Lischner, MD Xiongfei Liu, MD Donald Lyman, MD Nilufar Maboudi, MD Maurice Makram, MD Eric Mao, MD Joseph Marsano, MD Elisabeth Mathew, MD Robert Meagher, MD Roger Mendis, MD Devin Merchant, MD George Meyer, MD Dennis Michel, MD Joseph Morris, MD Aimee Moulin, MD John Ostrich, MD Margaret Parsons, MD Chiraag Patel, MD Manish Patel, MD Mary Pat Pauly, MD Robert Peabody, MD Kent Perryman, PHD Gail Pirie, MD
Karen Poirier-Brode, MD David Pompa, MD Ajay Ranade, MD J. Brian Reed, MD James Rybka, MD Souvik Sarkar, MD Ja’Nahn Scalapino, MD Catherine Schnepp, MSN, FNP Christian Serdahl, MD Patricia Sierra, MD Mariam Soni, MS Christian Swanson, MD Seth Thomas, MD Brian Tracy, OD Glennah Trochet, MD, MPH Tony Tsai, MD Sam Turnipseed, MD Shiro Urayama, MD John Valle, MD Justin Wagner, MD William Webster, MD Nancy Williams, MD
2020 board of directors 2020 ssvms delegation to cma house of delegates OFFICERS President - John Wiesenfarth, MD President - Elect - Carol Kimball, MD Previous President - Christian Serdahl, MD Secretary - J. Bianca Roberts, MD Treasurer - Paul Reynolds, MD DIRECTORS Ranjit Bajwa, MD Sean Deane, MD Adam Dougherty, MD Kristin Gates, MD Marcia Gollober, MD Farzam Gorouhi, MD Ravinder Khaira, MD J. Bianca Roberts, MD Roderick Vitangcol, MD Vanessa Walker, DO Angie Yu, MD EXECUTIVE DIRECTOR Aileen E. Wetzel
Ruenell Jacobs Adams, MD Barbara Arnold, MD Megan Anzar Babb, DO Natasha Bir, MD Helen Biren, MD Christine Braid, DO Ronald Chambers, MD Amber Chatwin, MD Sean Deane, MD Adam Dougherty, MD Lucy Douglass, MD Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Katherine Gillogley, MD Marcia Gollober, MD Richard Gray, MD
Reinhardt Hilzinger, MD Karen Hopp, MD Brian Jones, MD Richard Jones, MD Mohammad Khan, MD Carol Kimball, MD Charles McDonnell, MD Anand Mehta, MD Leena Mehta, MD Sandra Mendez, MD Rajiv Misquitta, MD Thomas Ormiston, MD Sen. Richard Pan, MD Neil Parikh, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD Kuldip Sandhu, MD
Romero Santiago, MD James Sehr, MD Christian Serdahl, MD Ajay Singh, MD Christopher Swales, MD Thomas Valdez, MD John Wiesenfarth, MD Lydia Wytrzes, MD CMA TRUSTEES Doug Brosnan, MD Margaret Parsons, MD AMA DELEGATION Barbara Arnold, MD Sandra Mendez, MD