Livingwell AZ October 2014 by LOCALiQ

Livingwell A SPECIAL PUBLICATION CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING

a-z

HEALTHCARE NEWS YOU CAN USE FOR YOUR WHOLE FAMILY

OCTOBER 2014

2 End of the year tests | 3 Medicare 101 | 4-6 Top events & support groups | 7 Babysitting training; PCOS | 9 Trauma centers

Raoul Tibes, M.D., Ph.D., is working on the trial of a new drug that targets an abnormal gene associated with leukemia. In addition to being a medical oncologist specializing in blood malignancies, Dr. Tibes is also the director of the leukemia program at the Mayo Clinic in Scottsdale. He was recently named a Scholar in Clinical Research by the Leukemia & Lymphoma Society.

Research is personalizing treatments with specifically targeted therapies

STORY BY DEBRA GELBART | PHOTOS BY RICK D’ELIA

he standard of care for many cancer patients has been

surgery followed by chemotherapy. If/when the tumor

stopped responding to the first drug, a second course of

a different therapy would be tried. Today, an increasing

number of cancer patients are taking newer oral drugs

tailored to the genetic makeup of their cancer cells. “An oral drug doesn’t require a hospital visit and is easier for patients to take without disrupting their daily routine,” explained Michael Berens, Ph.D., deputy director for research resources and head of the Glioma (brain cancer) Research Lab at the Translational Genomics Research Institute (TGen) in Phoenix. Whether the therapy is intravenously or orally administered, chances are high that the drug has been chosen for the patient based on “molecular characteristics of the patient’s cancer cells,” said Javier Munoz, M.D., a medical oncologist and hematologist at Banner MD Anderson Cancer Center in Gilbert who specializes in treating blood cancers. “We are trying to treat cancer in a personalized fashion by learning as much as we can about the specific molecular makeup of the cancer cells.” CUTTINGEDGE CANCER TREATMENTS, continued on page 8

CUTTINGEDGE

CANCER TREATMENTS

AND CLINICAL TRIALS

a-z H E A LT H C A R E N E W S B R I E F S Abrazo Health donates to Backpack Buddies

Phoenix Children’s opens unit inside Mercy Gilbert Medical Center

A pediatric unit, with 22 private patient rooms staffed by Phoenix Children’s For a dozen years, Abrazo Health has hospitalists for children requiring supported the Legacy Backpack Buddies inpatient care, is scheduled to open Project, a nonprofit organization that today inside Dignity Health Mercy equips children from low-income families Gilbert Medical Center. The unit will with school supplies, hygiene items and offer around-the-clock pediatric coverclothing. Abrazo recently announced that Abrazo Health age that will enhance East Valley pediatric launched, Abrazo Health has donated more $15,152 in donations was collected from inpatient care and provide families and than $330,000, funds which were matched employees, an amount matched by the area physicians with access to the services BHHS Legacy Foundation, bringing the total by the BHHS Legacy Foundation. offered at Phoenix Children’s. to $30,304. The BHHS Legacy Foundation Robert L. Meyer, president and CEO of was funded in 2001 from the sale of Baptist More info • Abrazo Health: Phoenix Children’s, said that the opening Hospitals and Health Systems, Inc. AbrazoHealth.com; 602-674-6500 of this unit is the next step in Phoenix This year’s donations will serve 400+ • Legacy Foundation: Children’s alliance with Dignity Health. children who attend schools near Abrazo’s BHHSLegacy.org; 602-778-1200 Dignity Health’s Mercy Gilbert Medical six hospitals. Since the program was

Center is located at the intersection of Val Vista Drive and Loop 202, south of Pecos Road and east of Val Vista Drive.

More info

• Dignity Health: DignityHealth.org/Arizona • Mercy Gilbert Medical Center; MercyGilbert.org; 480-728-8000 • Phoenix Children’s Hospital: PhoenixChildrens.org; 602-933-4900

The Destination for Cancer Treatment Innovations Patients come to us for an innovative combination of cancer treatment and support, research, clinical trials and academic medicine. The Virginia G. Piper Cancer Center at Scottsdale Healthcare, the Valley’s destination for promising new cancer treatments.

AR-0008246632-01

Contact our Cancer Care Coordinators at 480-323-1255 or visit shc.org/cancer.

2 | Livingwell a-z | Wednesday, October 1, 2014

Testing, testing, 1-2-3 What kind of medical care should you seek toward the end of the year?

W By Debra Gelbart

ith just a few short weeks left until the end of 2014, which health screenings and preventive measures are most important to focus on? We asked two experts who are members of the local medical community for their advice. James Dearing, D.O., vice president and chief medical officer for the John C. Lincoln Accountable Care Organization, and John Keats, M.D., market medical executive for Cigna HealthCare of Arizona, agree that the most important step to take is to schedule an annual wellness exam that includes blood testing, if you haven’t yet had one this calendar year. Under the rules of the Affordable Care Act, yearly wellness exams typically are covered without a co-pay; some screenings are covered as well. Other recommended tests may not be covered, but if you have a flexible spending account that has to be used or forfeited by year’s end, you can use it for co-pays. “A yearly exam will ensure that you’ve had all the basic screening tests you need for your age,” Dearing said. Keats added that you should see your primary care provider at least once a year so that you have a prior relationship in the event of something more serious developing. “In addition, the annual exam ensures that appropriate vaccinations occur on a regular basis,” he said. Here are 10 steps both doctors recommend you take before the end of the year:

Call your healthcare provider today, Dearing urged, because “you may not be able to get an appointment for a wellness exam until December.” A fasting blood test will probably be needed prior to your exam; try to schedule the blood test for early in the morning so it’s easier to deal with fasting, which makes many blood tests more accurate.

Livingwella-z

2 3 4

If you’re a woman over 50, talk to your doctor about a mammogram. If you’re a man over 50, ask about PSA (prostate-specific antigen) testing. Regardless of your gender, schedule a colonoscopy if you’re 50 or older and haven’t had one in the past 10 years.

Women 65 and over should schedule a bone density test; ask your doctor for more information. If you’re a woman under 65 with risk factors for osteoporosis, your doctor may want you to have a bone density scan as well. Mammograms and colonoscopies (and bone density testing for women 65 and over) are considered screening tools and don’t carry a co-pay according to the rules of the Affordable Care Act. “But if any problem is discovered during these exams,” Dearing said, “they can then be considered ‘diagnostic’ and you can be charged a co-pay.”

Get a flu shot. If you’re 65 or older, get a pneumonia shot, too. And if you’re 50 or over (the previous recommendation was 60+), get a shingles vaccination, especially, Dearing said, “if you had a mild case of chickenpox as a child.” There is some evidence that a severe case of chicken pox may reduce your chances of contracting shingles, but a mild case increases the likelihood, he explained. If you choose to get any vaccinations or other care at a supermarket or drugstore clinic, Keats said, let your primary care provider know precisely what was provided to you so that all of your medical care is recorded in one place.

Talk to your doctor about whether a Hemoglobin A1C test, which evaluates blood sugar over the past three months, is appropriate for you. “This is a much more accurate test for diabetes than a glucose screening, especially if you’re at risk for diabetes,” Dearing said.

October 2014 | Vol. 4, No. 10

Living Well A-Z publishes on the first Wednesday of the month. From A to Z, we tackle a broad range of health issues and offer resources to find more specific information. For questions concerning content in this publication, please contact Editor Paula Hubbs Cohen.

7 8

If you’re a man between 65 and 75 and you’ve ever smoked, get an abdominal aortic aneurysm screening.

Arrange for or encourage your daughters and sons (or granddaughters and grandsons) ages 11 to 26 to be vaccinated against human papilloma virus, or HPV. “HPV can cause cervical and other cancers (including throat cancer)

9 10

Visit the dentist for a twice-yearly teeth cleaning and an oral health checkup. Consider scheduling a visit to a dermatologist for a head-to-toe skin cancer screening.

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Editor: PAULA HUBBS COHEN paula.cohen@cox.net; 602-444-8658 Contributing Editor: JIM WILLIAMS jlwilliams@republicmedia.com

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and genital warts but is almost completely preventable for those in this age group with a series of three vaccinations,” Keats said.

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Wednesday, October 1, 2014 | Livingwella-z | 3

Medicare 101

Important dates Open Enrollment, Oct. 15–Dec. 7: Medicare beneficiaries can change or renew their health plans during this period. Changes take effect Jan. 1. Initial Enrollment: A 7-month period that starts three months before the month you turn 65, includes the month you turn 65, and ends three months after the month you turn 65. General Enrollment, Jan. 1–March 31: Medicare-eligible beneficiaries who have not signed up for Medicare can enroll during this period. Those over 65 may be charged a late fee.

Help is available to navigate the Medicare maze

By Susan Lynne Fuchs

he first advice that experts offer is the simplest to say and the most daunting for newcomers to consider: Do your research before choosing a Medicare plan. “Look at your past year’s medical expenses,” advised Rick Beavin, Arizona Market President for Humana’s Senior Products. “Determine whether they were typical or an exception to your norm. Use your review and analysis to help you make the best decisions for coverage for the forthcoming year.”

Medicare: Parts A, B, C, D

Understand your options

Katrina Cope, director of Medicare operations for Health Choice, a subsidiary of IASIS Healthcare, said that Medicare beneficiaries should think about their health needs as well as understand their options. “Before choosing, review the costs and benefits,” she said. “Ask if your medications and physicians are included.” In addition to traditional fee-for-service or HMO plans, Beavin said, special needs plans (SNPs) are available for Medicare beneficiaries diagnosed with specific diseases or chronic conditions such as diabetes, cardiovascular disease or congestive heart failure.

Thinkstock

Annual Notice of Change

Medicare beneficiaries get a lot of promotional mail, Cope said, but at this time of year, it’s essential to be on the lookout so you don’t miss something important. Existing Medicare beneficiaries should have received an Annual Notice of Change (ANOC) letter from their insurer by Sept. 30, 2014, said Dave Firdaus, chief executive officer, Blue Cross Blue Shield of Arizona Advantage. “This notice will outline any changes being made to a plan for the following year,” Firdaus said. “With a good understanding of what your insurer is offering for the year ahead, you can begin comparing other plans with that same insurer or with other insurers. In the comparison phase, look for plan star ratings and compare premium pricing and co-payments. Then shop.” Firdaus added that if you have an existing plan and are happy with your plan, you’ll be automatically renewed back into your existing plan on Jan. 1, 2015.

Check for changes

The most important change this year for existing Medicare beneficiaries, Beavin said, is that you cannot apply for new plans before the Open Enrollment Annual Election period begins on Oct. 15. If you do, your paperwork will be rejected. Some plans may make changes in their physician network or in the benefits that are not mandated by Medicare, Cope said. Firdaus said that one change for Part D — the prescription drug portion of Medicare — is that there will be an increase to the deductible from $310 in 2014 to $320 in 2015, but in some cases, Medicare Part D may allow seniors to pay less for generic drugs.

Where to get help

Along with Medicare.gov, the federal website that compiles Medicare information, there are numerous other resources

to help you understand your options. A sampling of them are: • Blue Cross Blue Shield: AZBlue.com/seniors; 800-422-0761 • Health Choice: HealthChoiceGenerations.com; 800-656-8991 • Humana: humana-medicare.com; 800-889-0301 • Medicare.gov phone numbers: 800-MEDICARE; TTY 877-486-2048 • United HealthCare: UHCMedicareSolutions.com; 877-596-3258 In addition, AARP has a wealth of information on their website, plus they publish a guidebook, Medicare for Dummies, to help members manage the Medicare maze. More info: aarp.org; 800-566-0242.

Part A: This covers inpatient hospital care, acute skilled nursing facility care (not long-term or custodial care), hospice and home health services. For Americans 65-plus who have paid Medicare taxes while working for at least 10 years, Medicare Part A is premium-free. Part B: This covers outpatient care by doctors or other healthcare providers as well as supplies deemed necessary to diagnose or treat medical conditions. Its premium also covers preventive services and screenings, some mental healthcare and durable medical equipment such as wheelchairs. You must enroll separately for Part B, which comes with deductibles and co-pays but lets you choose any healthcare provider who accepts Medicare payments. If you have Part B, you may want to purchase supplemental healthcare coverage (a Medigap policy) which is available at an additional monthly cost but covers some of the medical expenses not covered by Parts A or B. Part C: Called a Medicare Advantage plan, Part C works like a PPO or HMO that offers comprehensive coverage and may not require co-pays or deductibles, however, it typically limits your choice of healthcare providers. Most Medicare Advantage Plans include drug coverage. Part D: This covers prescription drugs. Different health insurance companies offer different Part D plans that cover different pharmaceutical products. Both the drug formulary (the list of drugs a company will pay for) and costs depend on the plan you purchase. Source: Various experts and Medicare.gov

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We understand that your mammogram may be abnormal, but your reaction to the news isn’t. At the Breast <?#>?5( 5: 05&&B? 1+ 2&"B?=#& -5&$B? -B&:B?, 566 "95>&#=:9$ :B=:= 5?B "#&B 5: '#8? 3?=: 5!!#9&:(B&: =# '#8 $5& >B: :;B 5&=)B?= '#8 &BB" A89$76'* 2&", 9@ :?B5:(B&: 9= &BB"B", #8? :B5( #@ =!B$9569=:= $#6654#?5:B :# $8=:#(9%B 5 !65& @#? '#8* 2= 5& 5""B" 5==8?5&$B, )B.?B 5$$?B"9:B" 4' :;B /5:9#&56 2$$?B"9:5:9#& <?#>?5( @#? 0?B5=: -B&:B?=* If you have an abnormal mammogram, call us immediately (480) 256-4584. US 60 & Higley Road • BannerMDAnderson.com • Connect with us: AR-0008153165-01

4 | Livingwell a-z | Wednesday, October 1, 2014

OCTOBER a-z

TOP EVENTS

Please call to confirm reservations and cost (if any).

NOW THRU DECEMBER GRIEF RECOVERY PROGRAM WHAT: Twelve-weekprogram foradultswhohavesuffered significantlossincluding,butnot limitedto,lossthroughdeath. WHERE/WHEN: Various dates, times and locations across the Valley PRESENTED BY: Banner Hospice; BannerHospice.com COST: Free ($15 for handbook) INFO/REGISTER: Rev. Cindy Darby, 480-657-1167, cindy.darby@BannerHealth.com

TUESDAYS & THURSDAYS SUPPORT THROUGH OTHER PARENTS WHAT: Support, advice and techniques for when children are testing limits or engaging in risky behaviors. WHERE/WHEN: Tuesdays,LarkspurChristianChurch, 3302W.LarkspurDr.,Phoenix Thursdays, First Presbyterian Church, 161 N. Mesa Dr., Mesa TIME: 7–9 p.m. PRESENTED BY: Support Through Other Parents COST: $5/week per member or $7.50/family; $24 annual dues INFO/REGISTER: 623-846-5464; SupportThroughOtherParents.org

OCT. 4 SPIRIT GIRLS & MOMS WHAT: Info and discussions related to the physical and emotional changes of puberty. WHERE: Banner Baywood, 6644 E. Baywood Ave., Mesa TIME: 9:30–11:30 a.m. PRESENTED BY: Banner Health COST: Free INFO/REGISTER: 602-230-2273 (CARE); BannerHealth.com

OCT. 9 PROSTATE CANCER SCREENINGS WHAT: For men age 40 and older (or younger if have a family history of prostate cancer). WHERE: Surprise City Court parking lot, 16000 N. Civic Center Plaza, Surprise TIME: 7:30–11:30 a.m.

PRESENTED BY: POP – Prostate On-Site Project COST: Co-pays apply. Accepted insurances: Blue Cross Blue Shield; United Health Care; Health Net; Humana Specialist. $72 without insurance. INFO/REGISTER: 480-964-3013; ProstateCheckup.org

OCT. 9 REDUCING THE RISK OF SIDS WHAT: Prevention strategies for Sudden Infant Death Syndrome (SIDS). WHERE: Scottsdale Healthcare Shea MedicalCenter,9003E.SheaBlvd., Scottsdale TIME: 6–7:30 p.m. PRESENTED BY: ScottsdaleHealthcare Women’s&Children’sServices COST: Free INFO/REGISTER: 480-882-4636; shc.org/medical-services/ womens-health

OCT. 11 WALK TO REMEMBER WHAT: Commemorate National Pregnancy and Infant Loss Month with balloon and ladybug release, light refreshments and a guest speaker. WHERE: Grayhawk Park, 20726 N. 76th St., Scottsdale TIME: 8–10 a.m. PRESENTED BY: ScottsdaleHealthcare Women’s&Children’sServices COST: Free INFO/REGISTER: 480-323-4313; shc.org/medical-services/ womens-health

OCT. 11 SHAKE, RATTLE & ROLL FOR PARKINSON’S WHAT: Motorcycle ride to benefit Banner Neuro Wellness; includes food, live music and poker. WHERE: Harley-Davidson of Scottsdale, 15600 N. Hayden Rd., Scottsdale TIME: 9 a.m. HOSTED BY: Knights on Bikes COST: $25 INFO/REGISTER: 480-318-6182; TwoGalsEvents.com

OCT. 11

OCT. 20

OCT. 25

GRAND-FAMILY TRIP TO CHILDREN’S MUSEUM WHAT: Grandparents and the grandchildren they’re raising can spend a day at the museum and foster learning through interactive workshops. WHERE: Children’s Museum of Phoenix, 215 N. Seventh St., Phoenix TIME: 10 a.m. PRESENTED BY: Duet COST: Free INFO/REGISTER: By Oct. 3; 602-274-5022, ext. 31

BREAST CANCER SEMINAR WHAT: Risk factors, screenings, signs and treatments associated with breast cancer. WHERE: Humana Guidance Center, 5943 E. McKellips Rd., Mesa TIME: 1–2 p.m. PRESENTED BY: Humana COST: Free INFO/REGISTER: 480-325-4707

STRIDES AGAINST BREAST CANCER WHAT: Three-mile walk benefits research, education and support programs. WHERE: Tempe Beach Park, 80 W. Rio Salado Pkwy., Tempe TIME:Registration7a.m.; Walk8a.m. PRESENTED BY: American Cancer Society COST: Free INFO/REGISTER: 602-778-7625

OCT. 17 KEY TO THE CURE WHAT: Fashion show, shopping, food and more to benefit breast and ovarian cancer research. WHERE: Saks Fifth Avenue, Biltmore Fashion Park, 2446 E. Camelback Rd., Phoenix TIME: 8:30–10:30 a.m. PRESENTED BY: Saks Fifth Avenue & TGen Foundation COST: $125 INFO/REGISTER: 602-343-8572; TGenFoundation.org/events

OCT. 21 PREPARING FOR THE INEVITABLE WHAT: Managing the options for loved ones, including advanced directives and strategic financial decisions. WHERE: Mountain Vista Medical Center, 1301S.CrismonRd.,Mesa TIME: Noon PRESENTED BY: Elaine Poker-Yount, Community Liaison, Visiting Angels East Valley COST: Free INFO/REGISTER: 877-924-WELL (9355)

OCT. 23

CAMP ILA (ARTHRITIS) WHAT: Family weekend retreat for children with juvenile arthritis and related diseases. WHERE: Retreat at Tontozona, Camp Tontozona Rd., Payson PRESENTED BY: Arthritis Foundation COST: $40/family; scholarships available INFO/REGISTER: 602-212-9905; JuvenileArthritis.camp

CANCER TREATMENT & SIDE EFFECTS WHAT: How to manage side effects of treatment; led by an RN from Banner Good Samaritan. WHERE: Via Linda Senior Center, 10440 E. Via Linda, Scottsdale TIME: 10–11:30 a.m. PRESENTED BY: Cancer Support Community Arizona COST: Free INFO/REGISTER: 602-712-1006; rsvp@cscaz.org

OCT. 19

OCT. 23

SUNFARE HEALTH RUN 2014 WHAT: 5K&10KWalk/Runbenefitting ProKidsUSA,anonprofit organizationthatworkstoimprove thelivesofat-riskyouthsthrough organizedsports. WHERE: Reach 11 Sports Complex, 2425 E. Deer Valley Rd., Phoenix TIME: Registration 7 a.m.; Walk/Run 8 a.m. PRESENTED BY: Sunfare COST: Starts at $25 INFO/REGISTER: 480-338-7041; Sunfare5K10K.ItsYourRace.com

A LIFE FREE FROM MUSCLE & JOINT PAIN WHAT: Banner CORE physicians present info on hip, knee, foot and ankle diagnostics, procedures and treatments. WHERE: Banner Del E. Webb, 14502 W. Meeker Blvd., Sun City West TIME: 1–3 p.m. PRESENTED BY: Banner Health COST: Free INFO/REGISTER: 602-230-2273(CARE)

OCT. 1719

COST:$50(includeshorsd’oeuvres, movie,coffee,dessertsanda paneldiscussion/Q&Asessionwith expertsincludingMikeJanicek, M.D.,gynecologiconcologistat ArizonaOncologyandMedical DirectorofGeneticRiskAssessment atArizonaOncologyandThe VirginiaG.PiperCancerCenterat ScottsdaleHealthcare) INFO/TICKETS: 480-499-TKTS; AnnieParkerPHX.com

NOV. 5, DEC. 3

FAMILY HEALTH FAIR WHAT: Health and disaster preparedness info, children’s activities, car seat checks and more. WHERE: West Valley Hospital, 13677 W. McDowell Rd., Goodyear TIME: 9 a.m.–1 p.m. PRESENTED BY: Abrazo Health’s West Valley Hospital COST: Free INFO: 623-882-1500

MINI-MED SCHOOL WHAT:Experienceaglimpseof whatmedicalstudentsare learning,frommolecular medicinetobioethics. WHERE: HealthSciencesEducation Building,435N.FifthSt.,Phoenix WHEN: 5:30–7 p.m. PRESENTED BY: The University of Arizona College of Medicine COST: Free (light dinner available for purchase) INFO/REGISTER: 602-827-2024; PhoenixMed.arizona.edu/ mini-med

OCT. 25

NOV. 8

OCT. 25

FAMILY HEALTH FAIR WHAT: Paradise Valley Hospital’s 30th anniversary celebration, educational booths, food, games, fire truck and helicopter. WHERE: Paradise Valley Hospital, 3929 E. Bell Rd., Phoenix TIME: 10 a.m.–4 p.m. PRESENTED BY: Abrazo Health’s Paradise Valley Hospital COST: Free INFO: 602-923-5000

OCT. 25

MOVIE SCREENING: ‘DECODING ANNIE PARKER’ WHAT: ‘Decoding Annie Parker’ is a recently released movie about the discovery of the BRCA gene mutation associated with breast and ovarian cancers. Featuring guest of honor and four-time cancer survivor Annie Parker, this screening is a fundraiser for the Arizona Oncology Foundation. WHERE: Scottsdale Center for the Performing Arts, 7380 E. Second St., Scottsdale TIME: 6 p.m. PRESENTED BY: The Arizona Oncology Foundation

ARIZONA MYELOMA GOLF TOURNAMENT WHAT: Benefits programs for myeloma patients, families and caregivers. WHERE: McCormick Ranch Golf Club, 7505 E. McCormick Pkwy., Scottsdale TIME: Registration 6 a.m.; Shotgun start 8 a.m. PRESENTED BY: Arizona Myeloma Network (AzMN) COST: $200 per golfer INFO/REGISTER: 480-251-1671; GatewayGolfGroup.com

NOV. 15 PHOENIX UNDY RUN/WALK WHAT: All-ages 5K walk/run benefits the Colon Cancer Alliance. Participants are encouraged to wear familyappropriate ‘undy-attire’. WHERE: State Capitol District, 1600 W. Washington St., Phoenix TIME: Registration starts 7:30 a.m. COST: $25/$35 PRESENTED BY: Colon Cancer Alliance of Arizona INFO/REGISTER: 202-628-0123; UndyRunWalk.org

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Wednesday, October 1, 2014 | Livingwella-z | 5

OCTOBER Allgroupsandeventsarebelieved, butnotguaranteed,tobefreeunless otherwisestated.Everyefforthasbeen madetoverifyaccuracy,butpleasecall beforeattendingtoconfirmdetails.

WELLNESS MEDICATION CHECKS Call to schedule a personal meeting St. Luke’s, 1800 E. Van Buren St., Phoenix Tempe St. Luke’s, 1500 S. Mill Ave., Tempe Register: 877-351-WELL (9355) WALKING GROUPS Various dates & locations, 9–10 a.m. By Humana; 480-325-4707; humana.com FOODS FOR BONE HEALTH Oct. 8, 6–7:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-882-4636; shc.org/events OSTEOPOROSIS EDUCATION FORUM Oct. 15, 9–10 a.m. Scottsdale Healthcare Shea Medical Center 9003 E. Shea Blvd., Scottsdale 480-323-3663; shc.org WOMEN’S HEALTH Oct. 20, 1–2 p.m. Humana Guidance Center 5943 W. McKellips Rd., Mesa 480-325-4707 MANAGING EFFECTS OF ILLNESS & TREATMENT Oct. 27, 5:30–7 p.m. Banner Thunderbird 5555 W. Thunderbird Rd., Glendale Register: 602-865-5450

CAREGIVERS CAREGIVERS SUPPORT Various dates, times & locations By Duet; 602-274-5022; DuetAZ.org CAREGIVER SUPPORT Oct. 8, 2:30 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-WELL (9355) ONLINE NETWORKING (DUET) Oct. 11 & 28, various times Register: DuetAZ.org (Events tab) 602-274-5022 CAREGIVERS SUPPORT Oct. 13 St. Joseph’s Outpatient Rehab 114 W. Thomas Rd., Phoenix Call for time: 602-406-6688 CAREGIVING SUPPORT Oct. 17, 9–11 a.m. By Benevilla at Birt’s Bistro 16752 N. Greasewood St., Surprise 623-584-4999

GRIEF GRIEF SUPPORT GROUP Various dates, times & locations By Banner Hospice Rev. Cindy Darby, cindy.darby@BannerHealth.com BannerHospice.com; 480-657-1167 GRIEF SUPPORT GROUP Various dates, times & locations By Hospice of the Valley hov.org/grief-support-groups; 602-530-6970 PREGNANCY & INFANT LOSS Oct. 2, 6–8 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-4313; shc.org GRIEF SUPPORT Oct. 2, 16 & 30 St. Joseph’s

350 W. Thomas Rd., Phoenix Call for time: 602-406-3275 HOSPICE OF THE VALLEY GRIEF SUPPORT Oct. 14 & 28, 3–4:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321 CHILD LOSS SUPPORT Oct. 20, 6–8 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-3878; shc.org

UNDERSTANDING STROKE Oct. 9, 1–2 p.m. Scottsdale Public Library 3839 N. Drinkwater Blvd., Scottsdale 480-882-4636; shc.org/events STROKE SUPPORT Oct. 15, 1 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-WELL (9355)

DIABETES DIABETES SUPPORT Oct. 2, 7–8 p.m. The Nutrition Professionals 2158 N. Gilbert Rd., Mesa Register: 480-216-1635; laura@NutritionPro.net

GRIEF BEFORE LOSS Oct. 29, 10–11 a.m. By Benevilla at Birt’s Bistro 16752 N. Greasewood St., Surprise 623-584-4999

DIABETES SUPPORT Oct. 13, 3 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-WELL (9355)

KNEES, HIPS, SPINE, JOINTS

ALZHEIMER’S/DEMENTIA

MINIMALLY INVASIVE KNEE SURGERY Oct. 7 & 21, 6–7 p.m. Various locations 623-879-5249; JCL.com/events

ALZHEIMER’S & MEMORY SUPPORT Oct. 3, 9–11 a.m. By Benevilla at Birt’s Bistro 16752 N. Greasewood St., Surprise 623-584-4999

ROBOTIC KNEE SURGERY Oct. 13, 6–7:30 p.m. Scottsdale Orthopedic Institute 20401 N. 73rd St., Scottsdale 480-882-4636; AZKneeReplacement.com

DEMENTIA CAREGIVERS Oct. 7, 10–11:30 a.m. Oct. 29, 4–5:30 p.m. Banner Alzheimer’s Institute 901 E. Willetta St., Phoenix Register: 602-839-6850

MINIMALLY INVASIVE SPINE SURGERY Oct. 20, 6–7:30 p.m. Scottsdale Orthopedic Institute 20401 N. 73rd Ave., Scottsdale 480-882-4636; ScottsdaleSpineSurgery.com

ALZHEIMER’S & MEMORY SUPPORT Oct. 7, 14, 21 & 28, 10 a.m.–noon By Benevilla at Faith Presbyterian Church 16000 N. Del Webb Blvd., Sun City 623-584-4999

LESS-INVASIVEHIPREPLACEMENT Oct. 21 & 28, 6–7:30 p.m. Various locations 480-882-4636; AZHipReplacement.com

ALZHEIMER’S CAREGIVERS SUPPORT Oct. 7 & 21, 12:30–2 p.m. Duet, 555 W. Glendale Ave., Phoenix 602-274-5022

INNOVATIVE HIP & KNEE HEALTH Oct. 22, 10–11 a.m. BySt.Luke’satPhoenixAirportMarriott 1101 N. 44th St., Phoenix Register: 877-351-WELL (9355)

ALZHEIMER’S PREVENTION RESEARCH Oct. 10, 10:30 a.m.–noon Banner Sun Health Research Institute 10515 W. Santa Fe Dr., Sun City Register: 602-230-CARE (2273)

RHEUMATOID ARTHRITIS Oct. 22, 6 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-WELL (9355)

PAIN HOPE FOR TODAY Oct. 7, 14, 21 & 28, 3:30–4:30 p.m. By Chronic Pain Anonymous at Temple Chai Shalom Center House 4635 E. Marilyn Rd., Phoenix cpa-az@cox.net; ChronicPainAnonymous.org NEUROPATHY: NATURAL SOLUTIONS Oct. 7, ; Nov. 4, 6 p.m. Renovare Wellness By Design 18969 N. 83rd Ave., Peoria 623-776-0206; RenovareWellnessByDesignPro.com

HEART/STROKE MENDED HEARTS SUPPORT Oct. 2, 6–7 p.m. John C. Lincoln Cowden Center 9202 N. Second St., Phoenix 623-879-5583; JCL.com/events

PLANNING AHEAD FOR CAREGIVERS Oct. 13, 1–3 p.m. Banner Alzheimer’s Institute 901 E. Willetta St., Phoenix Register: 602-839-6850 ALZHEIMER’S SUPPORT Oct. 19, 11 a.m.–12:30 p.m. Dignity Health Huger Mercy Living Center 2345 W. Orangewood Ave., Phoenix 602-406-5600 (lunch provided) ALZHEIMER’S CAREGIVER SUPPORT Oct. 20, 1:30–3 p.m. By Tempe St. Luke’s at Pyle Adult Recreation Center 655 E. Southern Ave., Tempe Register: 877-351-WELL (9355)

3D MAMMOGRAPHY SEMINAR Oct. 2, 6–7:30 p.m. John C. Lincoln Sonoran Health Center 33423 N. 32nd Ave., Phoenix 480-323-1563; JCLBreastHealth.EventBrite.com BREAST CANCER SURVIVORS Oct. 8, 6–7:30 p.m. Banner Gateway 1900 N. Higley Rd., Gilbert 602-230-2273 BREASTCANCER LEARN&SUPPORT Oct. 9 & 23, 6–8 p.m. John C. Lincoln Breast Center 19646 N. 27th Ave., Phoenix 623-780-4673; JCL.com/BreastHealth BREAST CANCER SUPPORT Oct. 10, 10 a.m.–noon Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321 BREAST CANCER SUPPORT Oct. 13, 2–4 p.m. Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler Register: 480-340-4013; IronwoodCRC.com BREAST CANCER AWARENESS Oct. 15, 10:30–11:30 a.m. Humana Guidance Center 5943 W. McKellips Rd., Mesa 480-325-4707 BREAST BUDS SUPPORT Oct. 18, 11 a.m.–1 p.m. MidFirst Bank Conference Room 6508 W. Bell Rd., Glendale 480-657-0500; BreastBuds.org CAREGIVERS Oct. 23, 6–8 p.m. John C. Lincoln Breast Center 19646 N. 27th Ave., Phoenix 623-780-4673; JCL.com/BreastHealth BREAST CANCER SUPPORT Oct. 28, 5–6:15 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673 LABS & PATHOLOGY Oct. 28, 6–8 p.m. John C. Lincoln Deer Valley 19841 N. 27th Ave., Phoenix 623-434-2784; JCL.com/BreastHealth 3D MAMMOGRAPHY SEMINAR Oct. 29, 6–7:30 p.m. By John C. Lincoln at Anthem Community Center 3701 W. Anthem Way, Anthem 480-323-1563; JCLBreastHealth.EventBrite.com

WOMEN’S CANCER

LOOK GOOD, FEEL BETTER Oct. 6, 4–6 p.m. Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler Register: 480-855-2224; IronwoodCRC.com GYNECOLOGICAL CANCER SUPPORT Oct. 14, 5–6:15 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673

HOW TO AVOID ARGUMENTS Oct. 21, 12:30–2:30 p.m. Banner Alzheimer’s Institute 901 E. Willetta St., Phoenix Register: 602-839-6850

WOMEN EMPOWERED Oct. 14, 5:30–6:30 p.m. Banner MD Anderson Cancer Center 2946 E. Banner Gateway Dr., Gilbert RSVP: 480-256-6444

BREAST CANCER

OVARIAN CANCER SUPPORT Oct. 18, 10–11:30 a.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org

HEART OF A WOMAN SUPPORT Oct. 7, 10–11 a.m. Scottsdale Healthcare Shea Medical Center 9003 E. Shea Blvd., Scottsdale 480-323-3663; shc.org

BOSOM BUDDIES SUPPORT GROUPS Various dates, times & locations Ahwatukee/Chandler: 480-893-8900 East Valley: 480-969-4119 Northwest Valley: 623-236-6616 West Valley: 623-979-4279

STROKE SUPPORT Oct. 7, 6–8 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 602-406-6688

BREAST CANCER SUPPORT By Cancer Support Community 360 E. Palm Lane, Phoenix Contact for times: 602-712-1006; rsvp@cscaz.org

ORAL, HEAD & NECK CANCERS

HEAD & NECK CANCER SUPPORT Oct. 7, 5:30–7:30 p.m. UA Cancer Center at St. Joseph’s 500 W. Thomas Rd., Phoenix 602-406-6621

ORAL, HEAD & NECK CANCER SUPPORT Oct. 15, 4:30–6:30 p.m. Banner MD Anderson Cancer Center 2946 E. Banner Gateway Dr., Gilbert RSVP: 480-256-6444 ESOPHAGEAL CANCER SUPPORT Oct. 16, 6–7:30 p.m. By Cancer Support Community at Banner Good Samaritan 1111 E. McDowell Rd., Phoenix Register: 602-712-1006; rsvp@cscaz.org ORAL, HEAD & NECK CANCER SUPPORT Oct. 16, 6:30–8:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-3214

CANCER SUPPORT GROUPS

CANCER CAREGIVERS SUPPORT By Cancer Support Community 360 E. Palm Lane, Phoenix For times: 602-712-1006; rsvp@cscaz.org GENERAL CANCER SUPPORT By Cancer Support Community 360 E. Palm Lane, Phoenix For times: 602-712-1006; rsvp@cscaz.org CANCER SURVIVORS SUPPORT Oct. 1, 5:30–6:30 p.m. Oct. 13, 12:30–1:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321 MULTIPLE MYELOMA SUPPORT Oct. 2, 10–11:30 a.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org CAREGIVER SUPPORT Oct. 2, 6–8 p.m. Ironwood Cancer & Research Centers 6111 E. Arbor Ave., Mesa Register: 480-324-5279; IronwoodCRC.com LIVING WITH LOSS Oct. 7 & 21, 1–2:30 p.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org SURVIVING & THRIVING Oct. 7 & 21, 1–2:30 p.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org COLON CANCER SUPPORT Oct. 7, 5–6 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673 CANCER NUTRITION & COOKING Oct. 8, 6–7:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1250; shc.org/events NON-HODGKIN’S LYMPHOMA SUPPORT Oct. 9, 6–8 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321

LYMPHOMA SUPPORT Oct. 11, 10–11:30 a.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org PANCREATIC CANCER SUPPORT Oct. 11, 10–11:30 a.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org CARCINOID SUPPORT Oct. 11, 1–2:30 p.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org LUNG CANCER SUPPORT Oct. 11, 1–2:30 p.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org PANCREATIC CANCER SUPPORT Oct. 14, 4–5:30 p.m. Virginia G. Piper Cancer Center 10510 N. 92nd St., Scottsdale 480-323-1321 NEWLY DIAGNOSED SUPPORT Oct. 14, 6–7:30 p.m. By Cancer Support Community at Banner Good Samaritan 1111 E. McDowell Rd., Phoenix Register: 602-712-1006; rsvp@cscaz.org CANCER SUPPORT INFO Oct. 15 & 29, 10–11 a.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org CAREGIVER & FAMILY SUPPORT Oct. 15, 5:30–6:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1321 COLORECTAL CANCER SUPPORT Oct. 18, 10–11:30 a.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org CAREGIVER SUPPORT Oct. 18, 10 a.m.–noon Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler Register: 480-340-4013; IronwoodCRC.com MULTIPLE MYELOMA SUPPORT Oct. 20, 1–3 p.m. Banner MD Anderson Cancer Center 2946 E. Banner Gateway Dr., Gilbert RSVP: 480-256-6444 METASTATIC CANCER SUPPORT Oct. 22, 3–4:30 p.m. Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler Register: 480-340-4013; IronwoodCRC.com TREATMENT & SIDE EFFECTS Oct. 23, 10–11:30 a.m. By Cancer Support Community at Via Linda Senior Center 10440 E. Via Linda, Scottsdale Register: 602-712-1006; rsvp@cscaz.org CALENDAR CONTINUED | page 6 INTERESTED IN PARTICIPATING IN CLINICAL STUDIES?

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6 | Livingwell a-z | Wednesday, October 1, 2014

OCTOBER CONTINUED | from page 5 LIVING WITH LYMPHEDEMA Oct. 27, 6:30–8:30 p.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-1100; shc.org/events

PARKINSON’S EXERCISE CLASS Various dates, times & locations By Muhammad Ali Parkinson Center Register: 602-406-6903 PD 101: PARKINSON’S EDUCATION Various dates, times & locations (Phoenix, Scottsdale and Tucson) By Muhammad Ali Parkinson Center Register: 602-406-6903; Spanish sessions available PD 202: ADVANCED EDUCATION Various dates & times By Muhammad Ali Parkinson Center at Barrow Neurological Institute 350 W. Thomas Rd., Phoenix (Also available via webcast) Register: 602-406-6903 INFO FOR NEWLY DIAGNOSED Oct. 6, 13, 20 & 27, 10 a.m.–noon Oct. 9, 1:30–3:30 p.m. Muhammad Ali Parkinson Center 240 W. Thomas Rd., Phoenix Register: 602-406-6903 PARKINSON’S CAREGIVERS SUPPORT Oct. 6, 1:30–3 p.m. Red Mountain Multi-Generational Center 7550 W. Adobe St., Mesa 602-274-5022 MUSIC & MOVEMENT Oct. 6, 13, 20 & 27, 2:30–3:30 p.m. Muhammad Ali Parkinson Center 240 W. Thomas Rd., Phoenix Register: 602-406-6903 VOICE CLASS Oct. 7, 14, 21 & 28, 11 a.m.–noon Muhammad Ali Parkinson Center 240 W. Thomas Rd., Phoenix Register: 602-406-6903 PARKINSON’S CAREGIVERS SUPPORT Oct. 8, 1:30–3 p.m. Duet, 555 W. Glendale Ave., Phoenix 602-274-5022 PARKINSON’S SUPPORT Oct. 21, 3–4 p.m. By Benevilla at Shepherd of the Hills United Methodist Church 13658 W. Meeker Blvd., Sun City West 623-584-4999

a-z I N F O R M AT I O N O N L I N E

MASTERING YOUR ANXIETY Oct. 24 & 31, 1–2:30 p.m. Muhammad Ali Parkinson Center 240 W. Thomas Rd., Phoenix Register: 602-406-6903

ABRAZO HEALTH CARE: AbrazoHealth.com Arizona Heart Institute and Arizona Heart, Arrowhead, Maryvale, Paradise Valley, Phoenix Baptist and West Valley hospitals BANNER HEALTH: BannerHealth.com BARROW NEUROLOGICAL INSTITUTE: TheBarrow.org CARDON CHILDREN’S MEDICAL CENTER: BannerHealth.com CHANDLER REGIONAL MEDICAL CENTER: ChandlerRegional.org JOHN C. LINCOLN HOSPITAL: JCL.com MARICOPA INTEGRATED HEALTH SYSTEM: MIHS.org MAYO CLINIC: MayoClinic.com MERCY GILBERT MEDICAL CENTER: MercyGilbert.org MOUNTAIN VISTA MEDICAL CENTER: MVMedicalCenter.com MUHAMMAD ALI PARKINSON CENTER: TheBarrow.org/NeurologicalServices PHOENIX CHILDREN’S HOSPITAL: PhoenixChildrens.org SCOTTSDALE HEALTHCARE: SHC.org ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER: StJosephs-Phx.org ST. LUKE’S MEDICAL CENTER: StLukesMedCenter.com TEMPE ST. LUKE’S HOSPITAL: TempeStLukesHospital.com

SENIORS UNDERSTANDING ESTATE PLANNING Oct. 22, noon Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-WELL (9355) SENIOR FINANCIAL DECISIONS Oct. 23, noon Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-WELL (9355)

GASTROINTESTINAL OSTOMY SUPPORT Oct. 2, 2 p.m. Banner Boswell 13180 N. 103rd Dr., Sun City 602-678-4441 OSTOMY SUPPORT Oct. 14, 6 p.m. Elite Home Healthcare Services 2140 W. Greenway Rd., Phoenix 602-246-8221

RESPIRATORY

PROSTATE CANCER SUPPORT Oct. 2, 6–7:30 p.m. By Cancer Support Community 360 E. Palm Lane, Phoenix Register: 602-712-1006; rsvp@cscaz.org INTERSTITIAL CYSTITIS SUPPORT Oct. 12, 2 p.m. Phoenix Baptist Hospital 2000 W. Bethany Home Rd., Phoenix 602-349-4611; HeatherBarrowBrown@gmail.com

BETTER BREATHERS/ COPD SUPPORT Various dates, times & locations By the American Lung Association 602-429-0005; BreatheEasyAZ.info BETTER BREATHERS CLUB Oct. 10, 1–3 p.m. SCAN Health Plan Arizona 1400 E. Southern Ave., Tempe 602-258-7505; BreatheEasyAZ.info GET P.A.S.T. ASTHMA Oct. 13, 6:30–8 p.m. John C. Lincoln 19841 N. 27th Ave., Phoenix 623-879-5452; JCL.com/events BETTER BREATHERS CLUB Oct. 15, 2–3 p.m. Chandler Regional 1955 W. Frye Rd., Chandler 480-728-5655; BreatheEasyAZ.info BETTER BREATHERS CLUB Oct. 20, 4–5 p.m. Yavapai Regional Medical Center 1003 Willow Creek, Prescott 928-771-5264; BreatheEasyAZ.info

PROSTATE CANCER SUPPORT Oct. 13, 7–9 p.m. Ironwood Cancer & Research Centers 685 S. Dobson Rd., Chandler Register: 480-340-4013; IronwoodCRC.com

CAREMORE BETTER BREATHERS CLUB Oct. 21, 10:30–11:30 a.m. Scottsdale Care Center 5225 N. Scottsdale Rd., Scottsdale 480-395-0792; BreatheEasyAZ.info

PROSTATE CANCER SUPPORT Oct. 27, 7–9 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673

ALLERGIES, COUGH & ASTHMA Oct. 23, 1–2 p.m. Scottsdale Public Library 3839 N. Drinkwater Blvd., Scottsdale 480-882-4636; shc.org/events

OSTOMY SUPPORT Oct. 16, 12:30 p.m. La Casa de Cristo Lutheran Church 6300 E. Bell Rd., Scottsdale 623-580-4120

PROSTATE/ UROLOGICAL

Sleep apnea and CPAP usage

By Nick Kostenko

bstructive sleep apnea is a chronic condition in which the patient endures pauses in breathing while sleeping; these pauses may occur 30 or more times an hour, according to the National Heart, Lung and Blood Institute. Typically, when breathing starts again, the individual makes a loud snort, snore or choking sound. As a result of all the breathing pauses, the quality of sleep is poor, resulting in excessive daytime sleepiness. Patients with sleep apnea are typically prescribed a Continuous Positive Airway Pressure machine — commonly referred to as a CPAP — that features a mask that covers the nose and mouth. The CPAP gently blows air into the throat; the pressure from the air helps keep the airway open while sleeping.

Keep it clean

One of the mistakes that many users make is in not keeping their CPAP as clean as they should. “Mild detergent and warm water should be used to clean the mask, headgear and water chamber,” said Lauri Leadley, RPSGT,

350 W. Thomas Rd., Phoenix 602-508-8024 or 602-406-6688

BETTER BREATHERS CLUB Oct. 23, 1:30–3 p.m. John C. Lincoln Cowden Center 9202 N. Second St., Phoenix 602-870-6060; BreatheEasyAZ.info CAREMORE BETTER BREATHERS CLUB Oct. 28, 10:30–11:30 a.m. West Phoenix Care Center 2330 N. 75th Ave., Phoenix 602-300-5672; BreatheEasyAZ.info

BRAIN/ NEUROLOGICAL YOUNG ADULT BRAIN INJURY SUPPORT Oct. 8, 6–7:30 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 602-996-1396 or 602-406-6688 PROGRESSIVE SUPRANUCLEAR PALSY SUPPORT Oct. 11, 1:30–3:30 p.m. Pyle Adult Recreation Center 655 E. Southern Ave., Tempe 480-966-3391; ALudwig@asu.edu BRAIN ANEURYSM SUPPORT Oct. 15, 6–8 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 760-333-7658; Kimberly@JoeNiekroFoundation.org BRAIN INJURY SUPPORT Oct. 23, 6–7:30 p.m. St. Joseph’s Barrow

WOMEN WITH MULTIPLE SCLEROSIS Oct. 25, 10 a.m. St. Joseph’s 350 W. Thomas Rd., Phoenix 480-829-6563

WEIGHT LOSS BARIATRIC SURGERY SEMINARS Various dates, times & locations By Banner Health BannerHealth.com; 480-543-2606 WEIGHT LOSS SURGERY SEMINARS Various dates, times & locations By Scottsdale Healthcare BariatricSurgeryAZ.com; 480-882-4636

BRAIN TUMOR SUPPORT Oct. 28, 6–8 p.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 623-205-6446

PARENTING GRANDPARENTS RAISING GRANDCHILDREN Various dates, times & locations By Benevilla; 623-207-6016; benevilla.org GRANDPARENTS RAISING GRANDCHILDREN Various dates, times & locations By Duet; 602-274-5022; DuetAZ.org MOMS ON THE MOVE Various dates, times & locations By Scottsdale Healthcare shc.org/medical-services/ womens-health 480-323-3878 MOTHER-TO-MOTHER SUPPORT Oct. 1 & 24, 10–11:30 a.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 877-602-4111 PREGNANCY & POSTPARTUM DEPRESSION Oct. 3, 9:30–11:30 a.m. Virginia G. Piper Cancer Center 10460 N. 92nd St., Scottsdale 480-323-3878; shc.org BREASTFEEDING SUPPORT Oct. 6, 13, 20 & 27, 10–11:30 a.m. St. Joseph’s Barrow 350 W. Thomas Rd., Phoenix 602-406-4954 GUARDIANSHIP CLINIC Oct. 10, 3–5 p.m. Duet, 555 W. Glendale Ave., Phoenix RSVP: 602-274-5022

WEIGHT LOSS SURGERY SEMINARS Various dates & times Bridges Center for Surgical Weight Management at St. Luke’s, 555 N. 18th St., Phoenix Register: 800-248-5553; webinar: BridgesAZ.com

HEARING LOSS HEARING LOSS SUPPORT Oct. 9, 12:45–2:30 p.m. By Hearing Loss Association of America at Ed Robson Library 9330 E. Riggs Rd., Sun Lakes 301-657-2248; HearingLoss.org; ReggieFaith@gmail.com HEARING LOSS SUPPORT Oct. 22, 1:30–3:30 p.m. By Hearing Loss Association of America at Fountain Hills Community Center 13001N.LaMontanaDr.,FountainHills 301-657-2248; HearingLoss.org; KFonville@fhfh.az.gov HEARING LOSS SUPPORT Oct. 23, 1:30–3:30 p.m. By Hearing Loss Association of America at Lions Foundation Campus 9451 N. 99th Ave., Peoria 301-657-2248; HearingLoss.org; melanie.orourke@gmail.com

VALLEY FEVER INFO AZ VICTIMS OF VALLEY FEVER ArizonaVictimsOfValleyFever.org 623-584-8331; pat-valleyfever@live.com 602-242-9527; mmfcreate@aol.com

FREE GRAND-FAMILY MOVIE NIGHT Oct. 10, 6–8:30 p.m. Duet, 555 W. Glendale Ave., Phoenix RSVP: 602-274-5022 INFANT BRAIN DEVELOPMENT Oct. 11, 9 a.m.–1 p.m. Tempe St. Luke’s 1500 S. Mill Ave., Tempe Register: 480-784-5588

VALLEY FEVER CENTER FOR EXCELLENCE 602-406-8253; vfce.arizona.edu ValleyFeverCenter@DignityHealth.org

POISON CONTROL BANNER GOOD SAMARITAN Poison & Drug Information Center Hotline: 800-222-1222

Looking for Dr. Right?

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president of Valley Sleep Centers. “It is best that they are washed after each use.” Leadley added that if CPAP equipment is not cleaned properly, germs can cause nasal infections and/or dirt and oil can cause an improper seal and the benefits of therapy will be limited.

Alvin Wong, DO

Mel an ie Patton , M D

Ask about a sleep test

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Wednesday, October 1, 2014 | Livingwella-z | 7

Babysitting training

Classes teach safety, discipline, age-appropriate activities

By Meghann Finn Sepulveda

ost parents of young children would be more apt to hire a babysitter who has had CPR training, knows how to properly change and feed a child, and comes prepared with games and toys to keep the little ones safely entertained. Likewise, most parents of teens and pre-teens who are ready and willing to babysit would like to ensure that their youngsters have the skills to handle everyday childcare activities as well as emergencies. Fortunately, there are a number of organizations that offer babysitter certification classes for kids ages 11 to 18.

Safety is paramount

“In our safe babysitter class, we cover the characteristics of a great babysitter including how to be responsible, polite and organized,” said Suzanne Clinton, RN, BSN, program manager for prenatal and

postpartum education at Banner Desert Medical Center in Mesa. “We also spend time addressing appropriate behavior, presenting scenarios and demonstrating feeding, diapering and sleeping techniques.” Clinton and her team warn students about household concerns including toys, outdoor hazards, and water and gun safety. “We also provide ideas for an activity basket that includes games, books and puzzles for the babysitter to bring to the home,” Clinton said. “We give them tools to handle challenges such as bedtime struggles and offer suggestions for positively managing misbehaviors.”

CPR and ﬁrst aid

CPR and first aid is taught at most babysitter classes and usually takes up at least half of the curriculum. “We reinforce that babysitting is a huge responsibility and we present the worst-case scenarios to help them make good, smart

Polycystic Ovarian Syndrome The importance of diagnosing and treating PCOS

A sampling of babysitting courses American Red Cross Babysitter’s Training Cost: $140 for two-day class More info: RedCross.org; 800-REDCROSS YouTube: “The Babysitter You Don’t Want to Be”

choices,” said Jill Healey, babysitter certification coordinator for the United Phoenix Firefighters Association. “We prepare them with the knowledge to handle an emergency like choking or serious injury.” Stephanie Steinberger, an instructor for the American Red Cross, said that babysitters need to know when it is time to call the parents or 911. “We present many different scenarios, such as treating a broken limb or dealing with an allergic reaction,” she said. Steinberger also said that training includes ways to safely pick up and hold a baby as well as how to prevent accidental head or neck injuries. “In addition to becoming CPR-certified, participants [in Red Cross courses] learn basic first aid including

olycystic Ovarian Syndrome — or PCOS — is commonly known as a disease that can affect a woman’s ability to conceive. But the risks for PCOS patients can go beyond infertility if the disease remains undiagnosed and unmanaged.

how to properly clean and stop a wound from bleeding,” she said.

Extra eﬀort appreciated

At babysitter training, students are reminded to stay off their smartphones and to pick up toys after the children are in bed. “We explain that the house should be as clean as it was when the babysitter arrived,” Healey said. “The parents will definitely notice and appreciate the extra effort.” What’s more, babysitters should expect parents to ask their children about their experience. “Babysitters need to conduct themselves in a proper manner by respecting the home and the children, and keeping everyone safe,” Healey said.

Questions PCOS patients should ask their healthcare provider What kinds of tests might I need? How does this condition affect my ability to become pregnant? Are medications available that might improve my symptoms or my ability to conceive? I have other medical conditions. How can I best manage them together? What side effects can I expect from medication use?

Women with a family history of the disease are more likely to develop it, doctors say. For some patients symptoms begin around puberty, while other women may develop PCOS in their 20s or 30s and only realize there is a problem when they try to conceive a child. “That’s usually how those patients come in,” Howard said. “They say, ‘I haven’t had a period in six months, Center. “There is a lot of interest in looking and my husband and I are trying to get What is PCOS? at that connection right now.” pregnant’.” Women with PCOS develop small, benign That’s why doctors say women of all cysts within one or both ovaries as well as a ages with these symptoms should consult variety of symptoms including irregular or Reasons for treatment with a physician as soon as possible. “You absent menstrual cycles, male-pattern hair Infertility or irregular menstrual cycles hope patients won’t take years to see you,” aren’t the only reason why PCOS should be growth, acne and infertility. treated, though. Women with PCOS also face Howard said. “The older the patient, the “The body has certain mechanisms that higher the risk [for cancer].” a heightened risk later in life for a variety come into play that cause some women of other conditions including endometrial to secrete more testosterone,” said Miles Managing PCOS Howard, M.D., an OB-GYN on staff at Abrazo cancer, hypertension and high cholesterol. “There’s even new research that indicates Patients who are diagnosed with PCOS Health’s West Valley Hospital. “There is around puberty likely will face a lifetime of these patients may have higher rates of a release of excess insulin which causes managing the disease, often with hormone type 2 diabetes and heart disease,” said the ovary and adrenal gland to produce treatments. “It probably can’t be cured in Linda Nelson, M.D., Ph.D., an OB-GYN and more androgen and testosterone. This those cases,” Nelson said. “But once the reproductive endocrinologist at Dignity leads to problems with ovulation and symptoms are managed, the patient’s Health St. Joseph’s Hospital and Medical menstruation.”

By Meghan Moravcik Walbert

Banner Desert Medical Center Safe Babysitter Class Cost: $35 for four-hour class More info: BannerHealth.com; 602-230-CARE United Phoenix Firefighters Association Babysitter Certification Cost: $35–$40 for five-hour class More info: SaveRKids.org; 602-277-1500

Under what circumstances do you recommend surgery? What treatment do you recommend for my situation? What are the long-term health implications of PCOS? Do you have any brochures or other printed materials that I can take with me? What websites do you recommend visiting? Source: Mayo Clinic, MayoClinic.org

quality of life becomes much better.” However, patients who develop PCOS symptoms later in life may be able to reverse many of the symptoms through lifestyle changes, Nelson noted. “For patients who have symptoms that seem to intensify as they gain weight, often, if they lose weight, they may see improvement in most of their symptoms,” she said. Women who have struggled with infertility as a result of PCOS may be able to use medication to successfully stimulate ovulation and conceive. “Most of these women have plenty of healthy eggs,” Nelson said. “Once you induce ovulation, it’s often very easy for them to get pregnant.”

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Cutting-edge cancer treatments

continued from the cover

INTERNAL MEDICINE

Kidney cancer, lung cancer, melanoma

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One of the most exciting developments in treating kidney cancer, lung cancer and melanoma occurred just this past July, when Japan approved use of a drug called Nivolumab. The drug works by preventing T cells (white blood cells that attack foreign substances in the body) from becoming inactive against cancer cells, explained Sam Ejadi, M.D., a medical oncologist and clinical investigator with the Virginia G. Piper Cancer Center at Scottsdale Healthcare. The U.S. Food and Drug Administration has granted a fast-track designation for Nivolumab against melanoma, non-smallcell lung cancer and kidney cancer. Several clinical trials involving Nivolumab are underway in the Valley, said Mahesh Seetharam, M.D., a medical oncologist with Arizona Oncology.

“All lung cancer patients in Stage 4 should be evaluated to determine whether they can enroll in a trial,” said Klaus Wagner, M.D., medical oncologist at Banner MD Anderson Cancer Center.

VASCULAR SURGERY Douglas Carlon, MD

A graduate of University of Colorado School of Medicine in Denver, Dr. Douglas Carlon completed his internship and residency at Phoenix Integrated Surgical Residency. Dr. Carlon is board certiﬁed and specializes in comprehensive peripheral vascular care.

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While infusion nurse Brian Hopp, RN, draws blood for testing, Sam Ejadi, M.D., a medical oncologist and clinical investigator with the Virginia G. Piper Cancer Center at Scottsdale Healthcare, talks with Roger Lidman of Chandler. Lidman is having blood drawn to check on the progress of his treatment for metastatic uveal melanoma, a cancer in the eye that has been helped by a trial medication.

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More info: • Lung cancer study at Arizona Oncology: 602-217-8915 • Nivolumab melanoma trial at Virginia G. Piper Cancer Center: 480-323-1791 • Nivolumab lung cancer study at Banner MD Anderson Cancer Center: 480-256-6444

“We’re searching for the drugs that are more potent against blood cancer while sparing normal, healthy cells,” he added. The Mayo Clinic is one of only about six academic centers in the country conducting a clinical trial targeting an abnormality in a gene associated with leukemia, said Tibes, who was recently named a Scholar in Clinical Research by the Leukemia & Lymphoma Society. A drug called EPZ-5676 is being administered to patients with acute leukemias who have a specific genetic abnormality — “what’s known as a translocation of the MLL (mixed-lineage leukemia) gene on chromosomal band 11q23 — and have failed a previous round of therapy,” Tibes said. More info: 480-301-9875

Lymphoma

At Banner MD Anderson Cancer Center, doctors are recruiting participants for clinical trials for patients with relapsed lymphoma. Some of these clinical trials involve oral agents called Ibrutinib and Lenalidomide. It is hoped they will be less toxic than traditional chemotherapy. More info: 480-256-6444

Pancreatic cancer

Arizona Oncology is conducting a clinical study of two drugs for Stage 4 pancreatic cancer patients who have failed at least one round of treatment. The study is evaluating the effectiveness of a drug called Ruxolitinib that is designated as investigational in pancreatic cancer Breast cancer patients. When combined with an already Banner MD Anderson Cancer Center is FDA-approved oral chemotherapy drug testing the safety and effectiveness of a new called Xeloda, Ruxolitinib has been shown investigational drug that, when combined in early-phase studies to decrease inflamwith chemotherapy, may help breast cancer mation around the pancreas and help patients who carry harmful mutations in Xeloda work more effectively, Seetharam, two key genes. of Arizona Oncology, said. A study examining the oral drug Veliparib More info: 480-217-8915 taken in combination with chemotherapy treatments will enroll patients with hereditary breast cancer that has spread to Pediatric cancer The Ronald A. Matricaria Institute of other parts of the body or has come back in Molecular Medicine at Phoenix Children’s the original area. These patients also have Hospital is looking to enroll children with mutations in the BRCA1 or BRCA2 genes. into a gene sequencing study, leukemia In other discoveries about breast cancer, Arceci, M.D., who is director Robert said the New England Journal of Medicine of the Institute. Gene sequencing and published a study recently that found a for testing cancer methods sophisticated mutation on the PALB2 gene was associated are allowing drugs new to sensitivity with up to 30 percent of all hereditary doctors to identify potential cancer-causing breast cancer, said Jennifer Siettmann, mutations and specifically target them. a genetics counselor with Banner Good help will this as such studies said Arceci Samaritan Medical Center in Phoenix. The the 300 children diagnosed every year mutation was found to occur primarily among Caucasians with European ancestry, with cancer at Phoenix Children’s Hospital she said, and can be carried by both women and eventually the 20,000 children throughout the country diagnosed and men. The mutation may account for annually with cancer. 13 percent of all male breast cancer. Although testing for this single mutation More info: 602-827-2508 is expensive and not yet covered by most insurance companies, Siettmann said a Be your own advocate “high-risk panel” — a test of whether six The bottom line, said Javier Munoz, M.D., high-risk genes associated with breast medical oncologist and hematologist at cancer have mutations — often is covered Banner MD Anderson Cancer Center, is that by insurance. Siettmann is hopeful that by “even though we advocate for our 2015 at least some insurance carriers will cover the PALB2 test, too. patients with passion, patients have More info: • Veliparib: 480-256-3420; BrocadeStudy.com • Genetic testing at Banner Good Samaritan: 602-839-6385

to be their own advocates and always ask their cancer doctors about the best clinical trials available.”

Leukemia

Editor’s note: Phone numbers indicated in this article may connect with specific individuals’ voicemail recordings or they may be for a facility rather than a research office, but all phone numbers have been recently verified. If you leave a message, be sure to not only leave your name and contact information, but also the type of clinical study in which you’re interested.

“Although we’ve learned much about the genetic makeup of leukemia, we still haven’t found the essential molecular event that leads to leukemias,” said Raoul Tibes, M.D., Ph.D., a medical oncologist specializing in blood malignancies and the director of the leukemia program at the Mayo Clinic in Scottsdale.

Wednesday, October 1, 2014 | Livingwella-z | 9

Trauma centers ost folks won’t ever need the medical expertise provided by one of Arizona’s 38 trauma centers — thank goodness. But for those who do find themselves or a loved one seriously injured — perhaps after a car crash or a bad fall — a hospital that’s been designated as a trauma center has the skilled personnel and medical capabilities that can literally mean the difference between life and death. That’s why Arizona’s safety net of trauma centers are distributed across the state and designed to work with each other, said Terry Mullins, bureau chief of the Emergency Medical Services and Trauma System for the Arizona Department of Health Services (ADHS) in Phoenix.

High level of commitment

There’s more to trauma centers, however, than meets the eye. Mullins said a hospital that takes on this extra responsibility must have a high level of commitment beginning at the executive level and extending to the highly trained surgeons, physicians, nurses and ancillary staff that are dedicated to caring for seriously injured patients. “It incorporates every department in a hospital and it’s a system-wide commitment within the facility to not only spend time, money and expertise, but also to make a commitment to evaluate themselves in a painfully in-depth way,” Mullins said. “The ‘special sauce’ of a trauma center is in its research, quality improvement and its dedication to getting it right and doing it better.”

Four levels of care

Jeffrey Salomone, M.D., trauma director at Maricopa Integrated Health System, said that while some states take a different approach, most use the guidelines established by the American College of Surgeons (ACS), which classifies trauma centers into the four following levels:

Source: Arizona Department of Health Services (as of August 21, 2014); azdhs.gov/bems/trauma

Level I

Dignity Health, Chandler Regional Medical Center 1955 W. Frye Road, Chandler Flagstaff Medical Center 1200 N. Beaver St., Flagstaff

+ Flagstaff

Lake Havasu City

Prescott Valley Prescott

+ Parker

+ +

Show Low

Springerville

Payson

++ + + Scottsdale PHOENIX +++ + + Mesa Goodyear + + ++ + + + Gilbert Globe

John C. Lincoln - North Mountain 250 E. Dunlap Ave., Phoenix

Wickenburg Sun Cities

Maricopa Medical Center 2601 E. Roosevelt, Phoenix Phoenix Children’s Hospital 1919 E. Thomas Road, Phoenix

Chandler

Central Region

St. Joseph’s Hospital & Medical Center 350 W. Thomas Road, Phoenix Scottsdale Healthcare – Osborn 7400 E. Osborn, Scottsdale

Southeastern Region

The University of Arizona Medical Center – University Campus 1501 N. Campbell Ave., Tucson

Tan + San Valley

+ Tucson ++

Safford

Oro Valley

Benson

+ + Willcox

West Valley Hospital 13677 W. McDowell Road, Goodyear

Banner Page Hospital 501 N. Navajo, Page

Level III

Benson Hospital 450 S. Ocotillo Ave., Benson

Banner Baywood Medical Center 6644 E. Baywood Ave., Mesa

Chinle Comprehensive Health Care Facility Highway 191 and Hospital Drive, Chinle

John C. Lincoln Deer Valley Hospital 19829 N. 27th Ave., Phoenix

Cobre Valley Regional Medical Center 5880 S. Hospital Drive, Globe

Mountain Vista Medical Center 1301 S. Crismon Road, Mesa

Copper Queen Community Hospital 101 Cole Ave., Bisbee

The University of Arizona Medical Center South Campus 2800 E. Ajo Way, Tucson

Level IV

Havasu Regional Medical Center 101 Civic Center Lane, Lake Havasu City

Tuba City Regional Health Care Corp. 167 N. Main St., Tuba City

Banner Boswell Medical Center 10401 W. Thunderbird Blvd., Sun City

Kingman Regional Medical Center 3269 Stockton Hill Road, Kingman

Verde Valley Medical Center 269 S. Candy Lane, Cottonwood

Banner Del E. Webb Medical Center 14502 W. Meeker Blvd., Sun City West

La Paz Regional Hospital 1200 W. Mohave Road, Parker

White Mountain Regional Medical Center 118 S. Mountain Ave., Springerville

Banner Estrella Medical Center 9201 W. Thomas Road, Phoenix

Mt. Graham Regional Medical Center 1600 S. 20th Ave., Safford

Wickenburg Community Hospital 520 Rose Lane, Wickenburg

Northern Cochise Community Hospital 901 W. Rex Allen Drive, Willcox

Yavapai Regional Medical Center – West 1003 Willow Creek Road, Prescott

Oro Valley Hospital 1551 East Tangerine Road, Oro Valley

Yavapai Regional Medical Center – East 7700 E. Florentine, Prescott Valley

—Terry Mullins, Bureau Chief Emergency Medical Services and Trauma System Arizona Department of Health Services

Patients have the right to make their own call as to which hospital they should be taken to, and when a patient has sustained a minor injury that does not appear to be severe, the EMS provider will honor that request. However, if the EMS provider believes for any reason that the patient is making a “poor clinical choice,” Mullins said, the provider will try to educate the patient about the services of the various facilities available and encourage the person to make a decision based on the potential injury. However, the situation changes when someone’s critically hurt. “When you’re severely injured, the EMS providers are going to take you to a trauma center — and you’re going to want a trauma center,” he said.

Payson Regional Medical Center 807 S. Ponderosa St., Payson Summit Healthcare Regional Medical Center 2200 Show Low Lake Road, Show Low

We offer support and guidance every stepalong the way. here he h e r re e e e her her

re e h

here here here

“When you’re severely injured, the EMS providers are going to take you to a trauma center — and you’re going to want a trauma center.”

+ Bisbee

re he

Salomone said that ACS verifies Level I through III trauma centers through an extensive questionnaire process and subsequent visit; Level IV centers are similarly inspected by Arizona trauma surgeons and trauma program managers. Hospitals can choose whether they want to meet ACS or state criteria for designation. The standards in both criteria are quite close and work complimentarily, according to Mullins. But that also means that a hospital can be listed as a Level I trauma center according to ADHS but listed as a Level II trauma center according to ACS, Salomone said. That can be confusing for the public. The reason for allowing a hospital to meet state criteria instead of ACS criteria, Mullins added, is that in order to meet the initial ACS verification criteria, a hospital must have collected trauma data for a year. “And you can’t collect trauma data unless you are a trauma center,” he said. While there may be some minimal differences between a state facility and an ACS facility, in the majority of cases, he said this difference will have no impact on the care a patient receives.

Northern Region

Cottonwood

+ Chinle

+ Tuba City

+ Kingman

Banner Good Samaritan Medical Center 925 E. McDowell Road, Phoenix

Banner Gateway Medical Center • LEVEL I 1900 N. Higley Road, Gilbert A hospital that provides the highest level Banner Ironwood Medical Center of care on an immediate (or very prompt) 37000 N. Gantzel Road, San Tan Valley basis, it’s also a teaching hospital and a research facility, so it’s typically at an academic institution. It must have a Triaging patients surgical residency program and 1,200 Deciding which trauma center a critically admissions annually. injured person will be transported to, Mullins said, is really “an art, not a science, “Level I trauma centers are required to but EMS (Emergency Medical Service) providers do their best in a difficult keep OR (operating room) personnel situation.” and anesthesia in-house 24 hours a day, Here’s an overview of how it works: The state is divided into four EMS regions seven days a week, 365 days a year.” and each region has an oversight group — Jeﬀrey Salomone, M.D., Trauma Director that conducts regular meetings and Maricopa Integrated Health System establishes triage and treatment guidelines that serve as a tool for the EMS agencies • LEVEL II A hospital that has nearly every medical and medical directors. In an emergency, these triage and treatment guidelines specialty as a Level I center. Per ADHS, there are no Level II hospitals in Arizona. require EMS providers to evaluate which body parts of the patient have been • LEVEL III injured and ascertain the ‘mechanism A hospital capable of caring for the of injury’, such as if it was a low-speed majority of trauma patients, with an automobile crash or a high-speed motoraround-the-clock emergency departcycle crash. Providers evaluate all the ment, an on-call (or overnight) operating information they have and then make a room staff and surgeons on-call at all decision; they’ll also typically build in hours. Patients brought here with severe an over-triage factor, or what’s called a or chronic injuries may be transferred to ‘suspicion factor’. a Level 1 or Level II facility. “An example of that would be if there was a severe accident but the patient • LEVEL IV appeared to be stable,” Mullins said. A small community hospital, usually in a “Out of an abundance of caution, the EMS rural area, which can treat patients with provider would transport to a trauma minor injuries and stabilize critically center with a higher level of care or take injured patients before moving them to the patient to the closest local hospital that a better equipped hospital. It may have can make an evaluation and then transport some surgical capabilities. the patient on.”

Extensive evaluation

Western Region

her here e

By Gremlyn Bradley-Waddell

Arizona Trauma Centers

here

Providing a safety net for critically injured patients

+ Page

KEY:

+ Level I + Level III + Level IV

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