Central Valley Physicians Spring 2024

Serving Fresno, Madera, Kern and Kings Counties

Spring 2024

INSIDE: Physicians Recognized for Outstanding Contributions Spring 2024

CHSUCENTRAL Celebrates VALLEY PHYSICIANS 100% Match 1

Health Professionals for Clean Air and Climate Action

Are you a health professional concerned about air pollution and climate change?

Climate change is already harming our health, from worsened ozone pollution due to warmer temperatures, to more frequent and intense wildfires producing dangerous particle pollution. Medical and health voices are critical to raising awareness of the overwhelming health burden caused by air pollution and climate change.

To take part in the American Lung Association’s growing Health Professionals for Clean Air and Climate Action community and sign up for our monthly newsletter, visit Lung.org/climatechangeshealth

VOLUME 9, NUMBER 1 • SPRING 2024

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Spring 2024

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PHYSICIANS HONORED FOR CONTRIBUTIONS

5 FROM THE EDITOR

17 WILLIAM DOMINIC, MD

7 FROM THE PAST PRESIDENT

19 KATHERINE FLORES, MD

9 FROM THE PRESIDENT

21 GARABET KHATCHIKIAN, MD

12 JOY OF MEDICIINE: HOW TO COMBAT OVERTHINKING

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CHSU CELEBRATES 100% MATCH

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ADDICTION MEDICINE

44

HARMONY IN HEALTH

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LOCAL PHYSICIAN APPOINTED TO MEDICAL BOARD

14 EDITORIAL: THE SHOULDERS OF GIANTS

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From the Executive Director

I’m thrilled to share that our FMMS membership continues to grow, fostering a dynamic and engaged community of physicians. Whether you’re drawn to advocacy, education, camaraderie, or something else entirely, we’re delighted to have you here and value your membership.

In the coming weeks, keep an eye on your inbox for some important emails. The first will be an engagement survey, offering STACY WOODS a comprehensive list of ways you can get involved with organized medicine at the local level. No question is mandatory, so take a moment to skim through the opportunities and check any box that speaks to you.

Additional emails to keep an eye out for include nominations for our annual awards: Lifetime Achievement and Special Projects, upcoming CME programs, and an FMMS Scholarship Foundation fund raiser.

Healthcare is becoming increasingly complex and the spotlight isn’t always shining in the right direction, yet despite the challenges, you all continue to ensure that the people of Fresno and Madera Counties receive the most optimal care possible, for which we are immensely grateful.

When Central Valley Physicians magazine was first conceived, it aimed to provide insight into the lives of our local physicians, residents, and now medical students. We love sharing professional triumphs and industry news but are looking for ways to include more personal pursuits, hobbies, side hustles, volunteer experiences, and talents to offer a wellrounded view of our local physicians. If you have a story you’d like to share or a topic you’d like us to explore, please reach out to the FMMS office at 559-224-4224 or email me at swoods@fmms.org.

Thank you for your steadfast dedication and service to the Valley.

Together, let’s continue making a positive impact on our community’s health and well-being.

PRESIDENT – Jennifer Davies, MD PRESIDENT ELECT – Pamela Kammen, MD VICE PRESIDENT – Greg Simpson, MD TREASURER – Jesus Rodriguez, MD PAST PRESIDENT – Marina Roytman, MD BOARD OF GOVERNORS Mark Alson, MD Nicole Calvillo, MD Karen Dahl, MD Richard Mendoza, MD John Mona, MD Anne Prentice, MD Jesus Rodriguez, MD Sonia Shah, MD Toussaint Streat, MD Benjamin Teitelbaum, MD Jai Uttam, MD CMA Trustee - Ranjit S. Rajpal CENTRAL VALLEY PHYSICIANS Editor – Farah Karipineni, MD Assistant Editor – Karen Dahl, MD Managing Editor – Stacy Woods EDITORIAL COMMITTEE Farah Karipineni, MD, Chair Don Gaede MD Karen Dahl, MD CREATIVE DIRECTOR prime42: DESIGN | MARKET | HOST prime42.com CONTRIBUTING WRITERS Richelle Kleiser, Marianna R. Aguilar, MA, LMFT, Fatima Yusuf, Chhaya Makhija, MD CONTRIBUTING PHOTOGRAPHERS Anthony Imirian CENTRAL VALLEY PHYSICIANS is produced by Fresno Madera Medical Society PLEASE DIRECT ALL INQUIRIES AND SUBMISSIONS TO Central Valley Physicians 255 W Fallbrook Avenue Suite 104; Fresno, CA 93711 Phone: 559-224-4224 | Fax: 559-224-0276 Email address: swoods@fmms.org MEDICAL SOCIETY STAFF Executive Director – Stacy Woods Marketing Coordinator – Jonah Vigilia

Warm Wishes,

Stacy Woods

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A message from our Editor > Farah Karipineni, MD

On Ethical Consumerism There’s a running joke at our house that the Amazon truck stops at our driveway every single day. It’s not far from the truth, either. With 3 kids and a dual surgeon household, one of our life hacks has always been to outsource everything possible so we can preserve quality time with our family. Living in a city where certain brands are not

available has also led to numerous packages at our doorat a time where consumers have so many options at their fingertips, it’s hard not to look for the “best” item online rather than find the sufficient version in stock nearby.

In a culture that massively favors convenience, it has never been more inconvenient to buy local. But it has also never been more crucial. As physicians whose household income tends to be on the higher end, we represent a powerful consumer group, and where and how we choose to spend our money represents more influence than we may have considered.

Living in the Central Valley, we have a front row seat to socioeconomic disparities and how they affect health.

Zip codes within 5-10 minutes of each other have different life expectancies and crime rates. Buying local keeps our dollars in Fresno, stimulating the local economy and providing or keeping jobs for those who work at our local establishments. It can reduce urban sprawl, which can help preserve natural habitats and green spaces. It also breeds an important sense of community that is irreplaceable and good for our health. For many of us, hectic schedules mean the grocery store or even Instacart or Amazon are more convenient ways to get our groceries. However, there is also

With 3 kids and a dual surgeon household, one of our life hacks has always been to outsource everything ABOUT THE AUTHOR

Farah Karipineni, MD, MPH, is board certified in General Surgery and fellowship trained in Endocrine Surgery. She is currently practicing in Fresno as an Assistant Clinical Professor for UCSF. Dr. Karipineni earned her medical degree from University of California, Irvine School of Medicine. Her residency in General Surgery was completed at Albert Einstein Medical Center, and she completed her fellowship in Endocrine Surgery at Johns Hopkins School of Medicine.

Dr Karipineni has been published in journals including The American Surgeon, the International Journal of Surgery and the Journal of Surgical Education.

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something very special about a local farmer, our beloved Farmer Dale, handing my daughter an extra Pink Lady apple at the farmer’s market where we go to buy what’s in season. In exchange for prioritizing convenience, we are gifted connection, community, and fresh air.

Another important reason to keep our dollars local is the environment.

Local businesses tend to use more local ingredients, which reduces transportation and its carbon footprint. Similarly, when we purchase something locally rather than shipping a different version of the same thing from a warehouse across the country (or even across the world), we reduce greenhouse gas emissions. Supporting local farmers also ensures their land security, which could otherwise be repurposed for industrial or commercial use. There is also far less packaging involved in buying something locally; the shirt you purchase from the local store doesn’t require any plastic wrap or cardboard box.

Lastly, though we may not think of this when we purchase something from Amazon, hopefully as educated, thoughtful, socially minded consumers, we should consider social justice when giving our money to a company,

especially large national or international companies. In our free market economy, it can be surprising to realize that these companies often have political interests, yet it’s vital as consumers to understand this as we may be fueling such interests with our dollars. If we remain uneducated or indifferent consumers, we may have to grapple with the ethical consequences of supporting companies with values that do not match our own. Companies like Google, Starbucks, Hewlett Packard, Amazon, and Zara have recently been under intense scrutiny for highly contentious political stances and financial contributions with significant world impact that the average consumer may not appreciate. However, it is our social responsibility to understand the businesses we are supporting, rather than blindly fall prey to the culture of consumerism and convenience. As highly educated, socioeconomically advantaged citizens, we can make Fresno a better place simply by being more intentional about where we get our cup of coffee, groceries, clothes and household items. It seems like a small thing, but small things add up to make a big impact if enough people do it over time.

However, it is our social responsibility to understand the businesses we are supporting, rather than blindly fall prey to the culture of consumerism and convenience.

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Spring 2024

A message from our 2023 President > Marina Roytman, MD

Looking back on my year as your medical society president Dear colleagues, It is hard to believe that my year of serving as the 145th president of Fresno Madera Medical Society has come to an end. And what a year it was!

As you recall, one of my main objectives last year was to increase participation, visibility and credibility of women in our society in general and in leadership in particular. In the past there were only 5 women that served as FMMS presidents with me being the 6th. I am delighted to report that there are more women leaders coming up behind me: Dr. Jennifer Davis, our incoming president and Dr. Pamela Kammen the following year. While it is far from being my achievement, it is my hope that having women leaders ABOUT THE AUTHOR Marina Roytman, MD, FACP, is board certified in Internal Medicine and fellowship trained in Medical Education. Dr. Roytman is a Professor of Clinical Medicine at UCSF and serves as the Liver Program Director at UCSF Fresno. Her interests include viral hepatitis, drug induced liver injury, autoimmune hepatitis, and medical education.

Dr. Roytman is a member of the American Association of Study of Liver Disease and an elected fellow of the American College of Physicians. Dr. Roytman earned her medical degree from Oregon Health and Science University and completed her residency in Internal Medicine at Mount Sinai Hospital and Medical Education Fellowship at John Burns School of Medicine, Honolulu, HI.

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3 years in a row will pave the way for many more in the future.

Women in medicine have made dramatic strides in the last 20 years with more than half of all medical students now being female. The drop-offs after that achievement have been pretty steep: only 42% of first year fellows are women with some fields having as low as 19% of women (for example Interventional Cardiology). Overall, only 36% of practicing physicians are women. As a woman in medicine, it has been my mission to model being a good physician, a motivating teacher, a humble leader and an inspiration to other women to do the same. I am happy to report that all 4 first year GI/hepatology fellows at UCSF Fresno are women. We expect great things from all of them!

Women’s health has long been seen as less important, less glamorous, and less worthy of study and research.

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Women have traditionally been underrepresented in clinical trials with estimates ranging from 29-34% of participants being female. These are challenging numbers to change in a short time but if we do not start we will never get there. We started this year by having our first FMMS Women’s Health Summit. It was women physicians (and Dr. Hawkins) teaching other women physicians about women’s health issues. We made it important, glamorous and worthy of repeating in the upcoming years.

However, not everything was smooth sailing this year. As you know the year started with the unexpected closure of Madera Community Hospital. Its unraveling became apparent between Christmas and New Years with most government agencies being firmly closed. The FMMS board spend the better part of the winter holidays learning about hospital finances and management and looking for ways to salvage the situation. We came back strong in January with the Physician Town Hall that brought together physicians, administrators, emergency personnel and public health representatives all with the goal of supporting Madera community and eventually reopening the much needed hospital. We continued to work on this issue throughout the year by providing assistance to physician practices affected by the hospital closure, raising awareness of this issue though multiple media sources and working closely with our elected officials. I hope that our efforts will pay off not only by having the hospital reopen but most importantly by preventing other community hospitals from suffering a similar fate.

Through our experience with Madera Community 8

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Hospital closure we learned the importance of working closely with our elected officials. Governance is a skill and this is how the FMMS project of legislative advocacy was born. We spent a Saturday in July learning the science and art of legislative advocacy. Shortly after, we had the opportunity to put it into practice (with mixed results at least from yours truly). On a serious note, FMMS has become a strong political voice. CMA now reaches out to us to talk with candidates and legislators on healthcare issues relevant to our community.

Medical education is one of the main reasons why I joined UCSF Fresno. It has been my privilege to continue and build upon the FMMS CME offerings this year including Nephrology, Dermatology, Addiction Medicine, Cardiology, GI and Hepatology, Perinatal SUD and Risk Management. I look forward to continuing my involvement in the FMMS CME arena in the future.

To quote Ted Lasso: “Taking on a challenge is a lot like riding a horse. If you’re comfortable while you’re doing it, you’re probably doing it wrong” I have to assure you that nothing about my year as the FMMS president has been comfortable. I want to humbly thank all of you for allowing me the opportunity to serve as your president and for supporting me while I was learning to do it right.

Spring 2024

A message from our 2024 President > Jennifer N. Davies, MD

Embracing the Dance of Medicine: Reflections on Community, Leadership and Change.

Since joining the medical society, the Installation and Awards Gala has always been my favorite event. As practicing physicians, our daily lives exist in sort of a microcosm, with the constant shuffle of responsibilities for patient care, practice management, medical education, and work-life balance. And some are better than others about looking out the window every now and then to see what everyone else is up to. I wasn’t always one of those people.

And at my first gala, which was in 2015 just prior to my first term on the Board of Governors, I was so astounded by the accomplishments of our colleagues- all that had gone on under my nose in our medical community that I was, at times, largely unaware of. I get that same sense of awe each year. The 2023 awards recipients are 3 more examples of the excellence we have in our community. Dr. Khatchikian,

ABOUT THE AUTHOR Jennifer N. Davies, MD is a boardcertified Otolaryngologist at Central California Ear Nose and Throat and the 2024 President of the Fresno Madera Medical Society. Dr. Davies graduated from University of Southern California Keck School of Medicine in 2002 and completed a residency at the University of Texas Health Sciences Center at Houston McGovern Medical School.

Dr. Davies is a Fresno native and enjoys ballet and spending time with her husband Jonathan and their two teens.

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Dr. Flores, and Dr. Dominic, you are inspiring to all of us.

You are examples of what many of us hope to be. Thank you.

But for a moment, I would like to focus on the rest of us. The 99 percenters of the medical society, if you will. Let me explain.

I certainly didn’t imagine 12 years ago when I moved back to Fresno that I would be in this position tonight.

In 2015, I received a phone call from Dr. Al Aminian, as I’m sure you can imagine, allergists and ENTs cross paths not infrequently. I assumed he was calling to talk about a mutual patient. To my surprise, Dr. Aminian asked if I might be interested in joining the Board of Governors for the Fresno Madera Medical Society. And while I wish I could say my response to him at that time was an enthusiastic “absolutely, please tell me more”, I think my initial response, tainted perhaps by a desire to not seek out additional meetings, was more like, “what kind of time commitment does that entail?” But to be honest with you, at that moment, I just didn’t understand why he was asking me. What skills did I have to offer? At that point I had no direct experience sitting on any board or hospital committee, had never even been a member of a medical society that I could recall. I was not in academic medicine.

I was, and am, a private practice surgical subspecialist in ENT. Here is a little more background about me. I am a local girl. I was born in Fresno Community Hospital. My parents were also born and raised in Fresno, and their parents the same. Both of my parents’ ancestors were Volga Germans-

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farmers who had gone from Germany to Russia under Catherine the Great. They emigrated to the US around the turn of the 20th century in search of better opportunities. I am the first in my family to have a career in medicine. I am a graduate of Clovis West High School, as is my husband, Jonathan. Though I left Fresno in 1991 and didn’t return until 20 years later in 2011, Fresno has always been home.

And having two young children back in 2011, coming home meant being closer to family. And also having babysitters. Those once-young kids are now teenagers. My son, Griffin, is in 8th grade and a baseball player. To any travel ball parents out there, you can empathize with that commitment, I’m sure. My husband and I are still learning the ropes, having gone more the swimming and water polo route in our youth. My daughter, Stella, is in 11th grade, with strong interest in paleontology, and heavily involved in ballet- an interest she likely gets from me having participated since I was a young girl.

I definitely still consider ballet a passion of mine (in fact most Tuesday nights you can still find me taking an adult class). I am also passionate about food- growing it, cooking it, reading about it, and of course, enjoying it.

So, back to 2015, clearly, I said yes to joining the FMMS board of governors. And that moment eventually led to this- me serving as the 2024 President of the Fresno Madera Medical society. This organization has a rich history and has continued to get stronger over the years.

In fact, as I’m sure you’ve heard once or twice before our medical society continues to grow year after year. The growth has created an FMMS membership that is diverse and far reaching. We now stand at 1941 members, of which 730 are active members (meaning not retired, student or resident). The longest serving member has been with FMMS for 46 years. The average membership is 12.4 years.

So, if you think about it, not only have we had recent new growth in the society, that new growth is supported by a dedicated base of long-term members. Diversity of practice

types is equally important, and FMMS has members in small, medium, and large size practices, members in academics, administration, government and hospital-based positions. We strive for similar practice diversity on our board of governors. Our 2024 Board of Governors, includes physicians in small, medium and large groups, as well as hospital based and academic physicians. They represent affiliations with all the local hospitals. As Dr. Roytman has pointed out, FMMS has increased the number of women leadership positions, and we actively strive for cultural and ethnic diversity as well. This isn’t to say we have reached the finish line regarding diversity, but we have made progress, and our current leadership is committed to continuing on that path. Having many perspectives represented is critical to maintaining an organization that serves all its members, and the ultimate strength behind this organization depends on the depth and breadth of membership to ensure the sustainability and success of the organization in the future.

Opportunities to learn and to make change are everywhere in this organization.

When first joining FMMS, a story was shared with me about a notable contribution from a previous CMA member. That example has stuck with me, exemplifying the ripple effect of small changes. In 1992, the CMA adopted a resolution to develop food labelling standards that ensured clear labelling of ingredients known to cause adverse reactions.

These standards are widely adopted today, and without a doubt have saved lives. One local physician’s idea about increasing transparency in food packaging and manufacturing has led to a change nationwide and perhaps further. The ideas of an individual, carried forward by the strength and commitment of an organization led to real change that we still see today.

Each year, and with each presidency, there are challenges. And while it is generally impossible to predict those challenges, such as a pandemic or an overnight hospital closure, some kind of challenge is inevitable. One

I am also passionate about foodgrowing it, cooking it, reading about it, and of course, enjoying it.

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of these is already upon us. We have recently faced an increasing minimum wage for healthcare staff while there is the constant reality of diminishing reimbursements, most notably Medicare cuts, challenges with preauthorization and continuing hurdles along the path to reopening Madera Community Hospital.

But all of that aside, the Medical Society is a place for you even if you don’t want to be politically involved. We have family events and wellness programs including the retreat at the Tenaya Lodge each December, webinars to help you manage your practice, and our CME offerings are increasing every year, and we are always open to new ideas on how we can help you to do what you do better. Or just provide a fun place to gather with colleagues. All of that is important, too.

So, when Dr. Aminian asked me to join the Board of Governors, it wasn’t because I had so much governing experience, or was a political powerhouse, because I don’t and I am not. But I do have a love of practicing medicine, a love of the central valley, a great respect for the Fresno Madera Medical Society, and a desire to be part of positive change. And maybe that’s why I am here serving as your 2024 president.

I expect most of you share some or all of those desires.

I hope you’ll join me in making a contribution, small or large, and seeing the change that can come with it. Like just saying “yes” if invited to become a board member, or sit on a committee. Like drafting a resolution about something you feel passionate about, that you feel would better the heath of our community or profession. Like calling your congressional representative and describing the tremendous repercussions of a Medicare reimbursement cut to Valley providers.

My older brother was a high school history teacher and a women’s water polo coach, and unfortunately, we lost

him to cancer last year. He was an incredible educator and an inspirational person who loved inspirational quotes. So in preparing these remarks, I thought what would Derek have said? His favorite mantra was the Winston Churchill quote, “Never, never, never give up.” And that is applicable to many situations. I guess medicine included. For his water polo athletes, he would say “pain is weakness leaving the body”. Probably not the best analogy in a medical context. But one of my favorites is how he would close every class period by saying, “Never forget who you are and what you represent.” These are words that can serve us all well. This is how we should live and lead.

But for me, maybe an analogy is more fitting than a mantra. In a ballet, you have the principal dancers. This would be like Mikhail Baryshnikov or Misty Copeland.

They are the stars of the show. You have soloists- they perform critical roles and are highly featured but are not the headlining act. Then you have the corps de ballet.

These are the large groups of dancers that pull it all together. They many times are moving in unison, with a common goal. The performance does not work without them, but you may not remember any of them individually. Recently, we celebrated three talented soloists and principal dancers – our Lifetime Achievement and Special Project Award recipients. Their performance is commendable. Their accomplishments brought us together, dressed in suits and gowns, to enjoy community and celebrate common interests. But we also have this fantastic corps, and that is you. The performance doesn’t work without you. Though I have been in the corps and would love one day if I too were a soloist or principal, this year I’ll consider myself your artistic director. And it will be honor to represent you.

Each year, and with each presidency, there are challenges. And while it is generally impossible to predict those challenges, such as a pandemic or an overnight hospital closure, some kind of challenge is inevitable.

Spring 2024

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Joy of Medicine

How to Combat Overthinking

BY MARIANNA R. AGUILAR, MA, LMFT ROUBICEK AND THACKER CONSULTING

Picture this… after a busy day you finally have a few quiet moments to yourself, only to immediately start wondering if you forgot to send an email or whether your coworkers noticed the coffee stain on your shirt this morning. Sound familiar? If so, you could be overthinking.

Occasionally everyone overthinks situations, but some people are plagued with a constant barrage of thoughts all the time. Worrying and overthinking are part of the human experience, but when left unchecked, they can take a toll on your well-being.

Chronic overthinkers rehash conversations they had yesterday, second-guess every decision they make, and imagine disastrous outcomes all day, every day. Thinking too much about something often involves more than words, overthinkers conjure up disastrous images, too. Thinking too much prevents you from getting anything done and can wreak havoc on your mood. Dwelling on the same thoughts may even increase your risk of certain mental health conditions. Are you an overthinker?

If you’re an overthinker, you’re familiar with exactly how it goes. A problem keeps popping up in your mind, for example, a health worry or a dilemma at work, and you just can’t stop dwelling on it. You desperately try to find some meaning or solution. Round and round the thoughts go, but unfortunately, the solutions rarely arrive.

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When we spend too much time analyzing our problems and dilemmas, we often end up more at a loss than we were to begin with. In addition, persistent overthinking can result in a wide range of symptoms such as insomnia, trouble concentrating, and loss of energy, which often leads to further worries regarding one’s symptoms, thereby creating a vicious cycle of overthinking.

In some cases, this eventually leads to chronic anxiety or depression.

WHAT IS OVERTHINKING? Overthinking is when you repetitively dwell on the same thought or situation over and over to the point that it disrupts your life. Overthinking often involves two destructive thought patterns, ruminating and incessant worrying. Ruminating involves dwelling on the past, such as: • I shouldn’t have said those things to my boss yesterday.

He must think I’m an idiot.

Persistent worrying involves negative, often catastrophic, predictions about the future, such as: • Everyone else will get promoted before me.

HOW DO I LEARN TO STOP OVERTHINKING? There are many different techniques, like deep breathing, that may help alleviate the stress of overthinking. You can also train your brain by Spring 2024

Joy of Medicine

remembering these 10 tips: 1. NOTICE YOUR RESPONSE

The way you respond to your thoughts can sometimes keep you in a cycle of rumination, or repetitive thinking.

Rumination can often cause negative consequences to a person’s mental health. The next time you find yourself continuously thinking things over in your mind, notice how it affects your mood. Do you feel irritated, nervous, or upset? What’s the primary emotion behind your thoughts?

Having self-awareness is key to changing your mindset.

2. FIND A DISTRACTION

Stop overthinking in its tracks by involving yourself in an activity you enjoy. This can look different for everyone, but some ideas include: • Trying a new recipe • Working out • Learning a new hobby • Volunteering 3. TAKE A DEEP BREATH

I’m sure you’ve heard it a million times, but that’s because it works. The next time you find yourself tossing and turning over your thoughts, close your eyes and practice deep breathing.

4. MEDITATE

Developing a regular meditation practice can help clear your mind of nervous chatter by turning your attention inward.

5. LOOK AT THE BIGGER PICTURE

How will the issues floating around in your mind affect you 5 or 10 years from now? Will anyone really care that you bought a dessert for the potluck instead of baking it from scratch? Don’t let minor issues turn into significant hurdles.

6. DO SOMETHING NICE FOR SOMEONE ELSE

Think of ways you can be of service to someone going through a difficult time. Realizing you have the power to make someone’s day better can keep negative thoughts from taking over. It also gives you something productive to focus on instead of your never-ending stream of thoughts.

7. STAY PRESENT

Not ready to commit to a meditation routine? There

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are plenty of other ways to ground yourself in the present moment. Be here now. It’s impossible to rehash yesterday or worry about tomorrow when you’re living in the present.

Mindfulness will help you become more aware of the here and now. Just like any other skill, mindfulness takes practice, but over time, it can decrease overthinking. Get outside. Take a walk outside, even if it’s just a quick lap around the block. Take inventory of what you see along the way, noting any smells that waft by or sounds you hear.

8. EMBRACE YOUR FEARS

Some things will always be out of your control.

Learning how to accept this can go a long way toward curbing overthinking. Accepting negative thoughts and fears can help improve psychological health. Of course, this is easier said than done, and it won’t happen overnight. But look for small opportunities where you can confront the situations you frequently worry about.

9. CHALLENGE YOUR THOUGHTS

It’s easy to get carried away with negative thoughts.

So, before you conclude that calling in sick is going to get you fired, or that forgetting one deadline will cause you to become homeless, acknowledge that your thoughts may be exaggeratedly negative. Remember that your emotions will interfere with your ability to look at situations objectively.

Take a step back and look at the evidence. What evidence do you have that your thought is true? What evidence do you have that your thought isn’t true?

10. ASK FOR HELP

You don’t have to do it alone. Seeking outside help from a qualified therapist can help you develop new tools for working through your thoughts and even changing your mindset. With help, you can train your brain to think differently. Over time, building healthier habits will help you build the mental muscle you need to become mentally stronger.

Roubicek & Thacker Counseling is a premier provider of individual, couples, family, and group therapy. Offering inperson and online remote therapy sessions. Call 559-323-8484 today to change the way you feel or view more on their blog at roubicekandthacker.com/blog

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Editorial

The Shoulders of Giants “I’m going to have to cancel your case,” I regretfully told my 65-year-old patient in the preoperative area. We both knew this was coming. He suffered from a large inguinoscrotal hernia that was symptomatic but not dangerous, a condition that had threatened his welfare for the past several months as his education level and social issues only afforded him career prospects involving manual labor. I sensed his desperation to return to work from the moment I met him in the office; he was eager to tell me how long Calviva had taken to process his referral, and I was just as eager to help him put the hernia behind him.

There was one small wrinkle in our plan: his methamphetamine addiction. I’ve always thought a good surgeon knows when not to operate, and carefully decided that while I would not operate on an active meth user, I would give him as many chances as needed to show up to the OR with a negative urine drug test. No shame, no judgment, no firing from my practice, just patience and faith. This was a skill I had been practicing for awhile, so it came somewhat naturally in situations like these. As a mom of 3, I am accustomed to people needing second (and third, and fourth) chances in a safe space to make good choices.

This is a treasured skill born of a string of many, many parenting failures.

But the real roots of believing in my patients, and investing in them as human beings, started far earlier in my life. As many do, I had a tumultuous transition from high school to college. On all outward accounts it would seem that things were going according to plan: the privileged daughter of wealthy physician parents, I had been recruited to UC Berkeley to play division 1 tennis on a (then) PAC -10 team, I was living on campus independently and was doing well in all my classes. But I had, up to this 14

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point, been good at pretending to be normal. In reality, I had already been struggling with anorexia for several years in my young life, and the stressors of college only made my eating disorder worse. Unable to keep up with the demands of college sports, I took a leave of absence on two separate occasions. In place of any meaningful direction or life ambition I found crystal meth through an old acquaintance. After using it daily for a month, I realized, finding myself unable to eat, sleep or even think rationally, that I had become something incompatible with life. Thankfully, I had a family who would only let me fall so far before intervening, and so began a long road back from a deep abyss at the ripe age of 20. I recall my path to recovery as more of a discovery-I never really knew myself, truly, before the Berkeley student-athlete visage of myself shattered into pieces. But here I was now forced to pick those pieces up and put them back together into some sort of identity that had nothing to do with my accomplishments or my appearance. I had to find my authentic self, and no one else had the answers. With nothing else to do - indeed I was too sick to do much of anything else-I threw myself into this recovery-discovery and plumbed depths at the time I wished I hadn’t needed to, but would be grateful I did for decades to come.

Through the course of my recovery, I came to appreciate the immense privilege of my existence, not only because I was born into a family that afforded private coaches and Kumon, but also because they refused to relinquish me to my downward spiral. I stood in awe of the physicians who helped me and my family clamber out of the abyss of my eating disorder and all it represented; towards the end of the tunnel, I recall marveling that anything good that came of my life moving forward, anyone I helped in Spring 2024

Editorial

the future, would have only been possible because of their excellent care and faith in my potential-what a powerful legacy.

As the physicians who helped me in my darkest moments 20 years ago, I was drawn to medicine to serve others in their own darkest moments -truly, needing healthcare is one of the most vulnerable positions we can find ourselves in. Mental health is particularly difficult, as stigma and fear of repercussions often block the path to help. While my interests in medicine led me into a field with very concrete, tangible ailments rather than psychiatric ones, I am always reminded of how powerful the mind is in the healing process, and connecting with patients on that level is a precious tool in my physician toolbox I may never have cultivated without my own suffering. As Abraham Verghese writes in The Covenant of Water, “Before we treat the flesh, we must acknowledge the greater wound, the one to the spirit.”

I am particularly reminded of my own privilege when I see patients in our community struggling to navigate their own mental health battles. The current meth user in and out of prison with congenital adrenal hyperplasia and adrenal tumors the size of twin infants. The recovered addict whose severe cardiomyopathy and palpitations were chalked up to his drug habit rather than the pheochromocytoma he had with 40 times the normal level of metanephrines. In my practice and within our community, I believe in making an extra effort to connect with and support the neediest, so many of whom are suffering mental health crises, battling addiction, incarceration and poverty with absolutely no social support. There I would be, but for the grace of God, and so there I continue to go, trying to lift them up in whatever small way I can. Empathy for the effects of Spring 2024

mental health on patients’ lives leads to deeper connections with patients from all walks of life, and enriches my own experience as a physician as well.

To become a physician requires extremely hard work and dedication, and also many fortuitous events-good health, access to resources, and social support. My path was extraordinarily fortuitous- I had a dedicated family with bottomless resources to navigate my illness, and every ambition I had upon recovery was met with even more support and abundant finances. Not every former meth user or mental health sufferer who falls as far as I did has the resources to obtain an MD/MPH, complete surgery residency and travel the world, carrying on as if nothing ever happened. But the fact remains that the path to recovery cannot be bought; it begins with nothing but the hope and faith of an individual and their support system.

I recall vividly that the physicians who cared for me at my worst always treated me like the person they knew I could become, rather than the person I was at that moment.

I stand on the shoulders of giants who had such hope and faith in me; I now have the privilege of being those shoulders for others.

As for my patient, he recently finally showed up to the operating room proudly with a negative urine drug screen, having decided to quit meth for good. He underwent a successful surgery and to date, sees this as a turning point after 30 years of addiction. I don’t presume to know his future, but I do know the power of someone choosing to invest in your humanity, rather than dismissing you for your struggles; I hope that this, if nothing else, will be my legacy.

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BY RICHELE KLEISER

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Three local physicians were honored for their exemplary medical practice, teaching, and serving our community and beyond during the 2023 Fresno Madera Medical Society Installation and Awards Gala on November 17.

For over 30 years, the FMMS has bestowed a lifetime achievement award, recognizing physician members who have gone beyond the call of duty and providing for the health and welfare of our community residents during their career in medicine.

This year, Lifetime Achievement Awards were presented to two notable physicians, William J. Dominic, MD, and Katherine Flores, MD. Prominent physician, Garabet Khatchikian, MD, received the Community Service Award for Special Project honoring his work with the Fresno Medical Mission to Armenia.

LIFETIME ACHIEVEMENT AWARD WILLIAM J. DOMINIC, MD, FACS While routinely ventilating a roof at a residential fire in March 2014, Fresno Fire Captain Peter Dern’s life changed forever when the roof gave way, and he was engulfed in a rage of flames and smoke.

His fire crew colleagues expertly tore into the structure at the ground level and rescued him within about two and a half minutes.

Dern was alive, but he suffered third and fourth degree burns over 70% of his body.

Dern was taken to the Community Regional Medical Center (CRMC) in Fresno, and his life was now in the hands of William J. Dominic, MD, FACS, Clinical Professor of Surgery at the University of California San Francisco (UCSF) Fresno Center for Medical Education and Research and Director of the Leon S. Peters Burn Center.

“He brought not just myself, but

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my wife and my family, and all my friends a lot of hope because early on I don’t think there was much,” said Peter Dern, retired Fire Captain in the City of Fresno.

Fortunately for Dern, the Leon S. Peters Burn Center at CRMC is now the only around-the-clock, comprehensive burn center between Los Angeles and Sacramento, treating patients within 15,000 square miles.

As director, Dr. Dominic spent his career building the center to what it is today and leading the development of new protocols and techniques for burn care.

“Through his discussions with our whole group of supporters, he really helped them understand what was going on and where the next step was going to be and potential outcomes. He spent a lot of time explaining that and I know my wife really appreciated his compassion,”

said Dern.

With 164 days of expert care in the Leon S. Peters Burn Center, and many surgeries and rehabilitation, Dern learned to walk again and regained his life.

He keeps in touch with Dr. Dominic, attributing his successful recovery to the efforts and encouragement he received from his doctors.

“My daughter and I just hiked Half Dome last month, and I sent him a text saying, ‘Hey, thanks to you, I’m able to do something like this again.’

Those are things I thought were gone

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forever but he brought them back, so I appreciate that,” Dern remarked.

As a core faculty member for the Department of Surgery, Dr. Dominic has dedicated over 37 years of his career to teaching general surgery and critical care.

His clinical and didactic teaching involve medical students, residents, and fellows in Surgical Critical Care and Acute Care Surgery. His focus includes emergency, general surgery, trauma, and critical care services with a broad variety of operations, including laparoscopic and complex abdomen thoracic cases.

“One of the most incredible things about Dr. Dominic, is that he has this ability to give each and every patient 110% of his love, hope, and work ethic,” said Shana Henry, CBRN, at the Leon S. Peters Burn Center at CRMC. Henry began working with Dr. Dominic as a new nurse and has worked with him for over a decade. She spoke about how Dr. Dominic’s incredible memory, connection to patients, and his “therapeutic communication” style benefited patients, especially during uncomfortable procedures.

“He would go to the end of the earth to assist patients at all costs, and I think that is one of the most amazing things about him. He was truly empathetic, compassionate when caring for patients; and would take the time to get to know them their likes and dislikes - and build a relationship with them,” Henry added.

Dr. Dominic has been a California Medical Association member for 31 years. He received

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his medical degree from Case Western Reserve University in Cleveland, Ohio, and completed his residency in general surgery at the University of Colorado, Denver. Dr. Dominic completed the Burns Fellowship Program at the University of Colorado, Denver and a Burns Clinical Research Fellowship at the University of California, San Diego.

Jim Davis, MD, met Dr. Dominic in 1986 while they were both fellows at the University of California, San Diego, “He is a dedicated, dedicated surgeon. He is brilliant. You can ask him a question about almost anything and he knows the answer.”

Dr. Dominic was working at the UC Davis Burn Center, when his friend Dr. Davis encouraged him to come to Fresno.

“I called him and got him to come down and interview to take over as the Chief of the Burn Center.

He has built that unit through all phases. You know everyone thinks doctors just operate, but Bill does everything. He does critical care, he’s there for the rehab, he’s there for the reconstruction. He has built one hell of a burn unit,” remarked Dr. Davis.

While introducing Dr. Dominic before presenting the FMMS Lifetime Achievement Award to his friend and colleague, Dr. Davis joked that Dr. Dominic once rode his bicycle “for fun” from San Diego through Death Valley to Denver and back, while on vacation.

Dr. Dominic is an avid cyclist.

He has a compelling story of triumph over injury when, several years ago, he was severely injured by a drunk driver while biking home

from work. He is an exemplary physician-citizen advocate for safer biking and safer choices in our community for young people.

While accepting the FMMS Lifetime Achievement Award, Dr. Dominic humbly remarked that he was very honored and grateful for the recognition and appreciation from his colleagues.

“I think the highest compliment that a doctor receives is the appreciation and recognition of their patients. But a close second to that is having your colleagues and peers see what you do and realize its value. So once again, I’m extremely honored by that,” remarked Dr. Dominic.

Dr. Dominic discussed his appreciation for his colleagues, especially those in attendance, who have helped foster his knowledge and helped him succeed over the last 31 years.

He said he was “surprised” to see several nurses from the burn center in attendance and added, “I often think of how it is unlikely that I would be standing where I am now without their support and acceptance of my somewhat quirky approach to some aspects of what we do. And I’m eternally grateful for that.”

He also humbly shared his appreciation for “the smart Dr. Dominic,” and stated, “Perhaps the person that’s taught me the most and has been the biggest influence on how I’ve become a physician is my wife, Dr. Susan Dominic.”

He gratefully added, “We’ve known each other for a very long and she’s put up with a tremendous amount of difficult situations over the years and surely has made tremendous sacrifices and that is never lost on me.”

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Dr. Dominic concluded with a renowned quote from Dr. Francis Peabody, “One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient,” which has guided his work over the last 30 years. He tried to remember that sentiment when dealing with patients and taught it to the over 150 residents he has trained, many of whom are practicing in the Central

Valley.

He also kindly recognized his colleagues by name, many of whom were in the audience, and thanked them for their contributions and roles in the success of the Leon S. Peters Burn Center. Jim Davis, MD, Chief of Surgery at UCSF-Fresno; Shana Henry, CBRN at the Leon S. Peters Burn Center at CRMC; and former patient Peter Dern, retired Fire Captain in the City of

Fresno, shared their appreciation and admiration for Dr. Dominic’s his work, expertise, and dedication in a video.

Dr. Dominic is a Fellow of the American College of Surgeons, and a member of the International Society for Burn Injuries, the American Burn Association, and the Fresno Madera Medical Society/ California Medical Society.

LIFETIME ACHIEVEMENT AWARD KATHERINE FLORES, MD According to research from the UCLA Latino Policy & Politics Initiative (LPPI), it could take up to five centuries to fully address the Latino physician shortage if present trends continue.

The LPPI California Physicians Shortage brief concluded that, “California can be the leading model in beginning to address the national physician shortage by building and supporting a diverse physician workforce reflective of its population demographics. To effectively attract primary care physicians to medically underserved areas in California, we must address and offer solutions to remediate academic disadvantage conditions and challenges for Underrepresented Minority (URM) students, which could substantially increase their acceptance and enrollment in California’s medical schools.”

In 1999, a visionary physician in the Central Valley addressed the health professional shortage by launching a 4-year pipeline program to expand accessibility to health professional careers to underserved Spring 2024

and underrepresented high school students.

Katherine Flores, MD, is the founding director of the UCSF Fresno Doctors Academy program through the UCSF Latino Center for Medical Education and Research.

She also serves as Associate Clinical Professor with the UCSF School of Medicine and has a bilingual family medicine practice with Community Health Partners.

“She is a healer for her community, not just physically, but emotionally and spiritually. She is a driver of trying to improve the health status of the underserved in Fresno County and the Central Valley,” Adriana Padilla, MD, Family Medicine physician at Community Health Partners.

Adriana Padilla, MD, Family Medicine physician at Community Health Partners, was a medical student when she met Dr. Flores at her first practice. Dr. Flores has served as her mentor, friend, and practice partner for over 30 years.

“At that time, I couldn’t decide whether to go into family medicine or

internal medicine. Kathy only had to show me her diverse and inclusive practice from babies to advanced age. Along with her innate ability to connect with not only her patients, but also their families, and her fulfilling practice sold me on family medicine,” said Dr. Padilla.

The Doctors Academy program began as a partnership between UCSF Fresno, Fresno Unified School District, and the Fresno County Superintendent of Schools. The program is made possible through funding by school district contracts, grants, and the UCSF Fresno Associate Dean’s office.

The first graduating class from the Doctors Academy was in 2003 from Sunnyside High School. Then CENTRAL VALLEY PHYSICIANS

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the Caruthers High School program graduated its first class in 2010.

Middle school programming was integrated later through the Junior Doctors Academy program at Caruthers Elementary, Kings Canyon Middle School, Sequoia Middle School, and Terronez Middle School.

When asked what he admired most about Dr. Flores, Ali Fayed, MD, Internal Medicine physician at Community Health Partners said, “Her dedication and commitment to medical education, try to encourage young Hispanic and non-Hispanic students to go to medical career.

That is one of her strongest and most admired commitment.”

According to 2022 data on the UCSF Fresno Doctor’s Academy website, over 1,800 students have been served by the program.

100% of the students have been accepted into 4-year college programs after completing high school earning: 105 associate degrees, 454 bachelor’s degrees, 74 master’s degrees, and 29 doctoral degrees. 6 students have completed the pipeline and graduated with doctoral degrees from UCSF. “When I talk to the students, they are insecure. They don’t exactly know what’s ahead of them. They are afraid of getting this humongous debt to become doctors or to go to college. It is so important to instill self-confidence, to tell them that no matter where they are right now, they still can do it. I think that this is the greatest accomplishment of the Doctors Academy,” said Sergio Ilic, MD, Orthopedic Surgeon.

While presenting the FMMS Lifetime Achievement award to her

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long-time friend and colleague, Dr. Padilla spoke about how Dr. Flores focuses on “5 spokes” in her life.

Dr. Padilla explained, “The first spoke is family.” Dr. Flores is a loving and dedicated wife, mother, grandmother, and has lots of extended family.

The second spoke is her bilingual family medicine practice and shared relationships. Dr. Flores is proud to provide medical care for “generations of families.”

Education is the third spoke, and Dr. Flores is the “ultimate collaborator.” In addition to her leadership with the UCSF Fresno Doctors Academy, she is involved with general advising and establishing premedical programs at Fresno State, including the Health Careers Opportunity Program (HCOP).

Dr. Padilla invited a former student to share how Dr. Flores made an impact on his life.

Patrick Ramirez, President and CEO of Community Health Partners and SVP Community Provider Network said, “I grew up in Firebaugh, small farming community an hour west of here. No one in my family went to college.”

Ramirez shared that his grandparents were from Mexico and every summer, they came to the Vally and lived in a trailer to work the farms.

His interest in medicine developed when his grandmother developed “black toe” and didn’t receive the medical treatment she needed, so she eventually died as result.

He decided to go to college.

While at Fresno State for about two years, he went to a talk given by Dr. Flores, which inspired him to

consider medical school.

After a couple of failed attempts to get into medical school and other ventures that didn’t go as expected, he went back to Dr. Flores for guidance.

“She believed in me in a way that I didn’t believe in myself. She told me, your path is not predetermined. Trust in yourself,” remarked Ramirez.

The advice and encouragement from Dr. Flores gave Ramirez what he needed to succeed in college and his career. He returned to the Valley, as he promised Dr. Flores he would, and started working at Community Medical Centers about 10 years ago.

“Without a shadow of doubt, without Dr. Flores I would have given up a long time ago. To have someone like her believe in you when you don’t believe in yourself is incredible,” said Ramirez.

The fourth spoke is board service. Dr. Flores has donated countless hours of volunteer work and service on many local, statewide, and national non-profit boards that serve and support health workforce development.

Some of the organizations include California Endowment Board of Directors, the California Blue Shield Foundation Board of Directors, the California Office of Statewide Health Planning and Development, Song Brown Workforce Commission and she serves as the Director of the California Health Professions Consortium. She serves on the Advisory Board for Fresno State.

She was also a past board and committee member of Community Medical Centers for 15 years.

Faith is the fifth spoke for Dr.

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Flores, which is important to her and her family. Dr. Padilla recited a prayer with a very personal meaning to Dr. Flores before presenting the award.

Dr. Flores accepted her Lifetime Achievement Award with “humility” because she loves her work and feels blessed to have been given the privilege to work within and for the community.

Dr. Flores proudly stated she is the daughter of Mexican immigrants and was raised by her maternal grandparents. For the first sixteen years of her life, she was a farmworker living five months of the year in labor camps following the crops.

This experience is where she learned about hard work, respect for others, and appreciation of culture.

She began to love and recognize the importance of family and community. She also learned firsthand about health inequities.

“I’ve also had the privilege of being a UCSF faculty member, where I have spent most of my career focused on developing programs to increase the diversity of health workforce,” said Dr. Flores.

She asked the many Doctors Academy and HCOP alumni, or

staff in attendance to stand and be honored with a round of applause.

“I’m grateful for the students who I’m grateful to mentor because they teach me every day,” remarked Dr. Flores.

She also expressed her love and pride for her family. She appreciated the understanding of her husband and children while she couldn’t always be there for family time due to being on-call for her medical practice.

She now has “amazing grandchildren” and wants to ensure they have a better future.

“As I now begin to see the world through their eyes, I am now more concerned about our environment and about our continued need to strive for racial equity and inclusion in our nation,” said Dr. Flores.

In closing, she called upon her colleagues to continue working as physician-citizen advocates for our community.

“As health providers we have a voice that we need to use to stand up for what is right and what is just. We owe that to our patients and to our families,” concluded Dr. Flores.

Many colleagues participated in a video honoring Dr. Flores, including physicians Ali Fayed,

MD, Internal Medicine physician at Community Health Partners; Sergio Ilic, MD, Orthopedic Surgeon; and Adriana Padilla, MD, Family Medicine physician at Community Health Partners.

They all expressed how they truly appreciated Dr. Flores for her remarkable contributions, they enjoyed working with her for decades, and admired her passion, drive, and amazing dedication to education, her patients, and community.

Dr. Flores graduated from the University of California, Davis and completed her internship and residency at Valley Medical Center in Fresno, California.

Dr. Flores served as chief resident and has won numerous awards for her work in leadership, education, teaching, and for her work in mentoring Latinos in medicine. She has received numerous awards for her quality patient care. She contributes to continuing education by her work with Doctors Academy and has hosted clerkships in her private clinical practice for medical students and residents.

COMMUNITY SERVICE AWARD FOR SPECIAL PROJECT GARABET KHATCHIKIAN, MD For over 20 years, Fresno Madera Medical Society has honored a physician each year who has been involved in a special project that benefits Valley residents, patients, and the community.

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This year, Garabet Khatchikian, MD was awarded the Community Service Award for Special Project due to his involvement with the Fresno Medical Mission to Armenia since 2015.

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Dr. Khatchikian received his medical degree from Orenburgskij Medicinskij Inst Orenburg in Armenia. He came to the Unites States to complete a post-doctoral research fellowship in basic cardiology at John Hopkins University Hospital in Baltimore, Maryland.

In 1998, he began his adult and geriatric medical practice in rural Minnesota at the Avera Worthington Clinic. 10 years later, he joined Kaiser Permanente Fresno and now serves as the Chief of Adult Medicine.

“As a physician, what I admire about Dr. Khatchikian is that he goes above and beyond. He obviously spends a lot of time in the clinic with his patients. He also is a leader within our organization, but he still finds time to help the community,” said Shahzad Jahromi, MD, Chief Medical Officer at Kaiser Permanente.

Berj K. Apkarian, Honorary Consul for the Republic of Armenia in Fresno and Vice President for Physicians and International Health Relations at Community Medical Centers, was introduced to Dr. Khatchikian by his wife. She and their children met Dr. Khatchikian and his family when they first came to Fresno from the Midwest.

Apkarian admired Dr. Khatchikian for humble nature and found him to be a “man of integrity.”

“It was really exciting to see a young Armenian fellow who has studied in Armenia and now completed his residency in the United States, and wanted to give back to the community,” said Apkarian, Honorary Consul for the Republic

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of Armenia in Fresno and Vice President for Physicians and International Health Relations at Community Medical Centers.

They developed a friendship and worked together on community projects, starting with the endorsement of creating the Honorary Consul for the Republic of Armenia in the Central Valley.

Apkarian launched the first Fresno Medical Mission to Armenia in 2015, which was made possible with collaboration from the Ministry of Health in the Republic of Armenia and much support of the local Armenian community and Fresno community at large.

Dr. Khatchikian took this opportunity to serve and give back to Armenia and its people where he grew up and studied medicine.

“It’s been truly inspiring, gratifying, to see a professional like him putting his personal life aside, his professional life aside rolling his sleeves and joining me in doing some projects that are going to last after we are gone and will be a testimony for others to serve and serve without any expectations,” said Apkarian.

Dr. Khatchikian worked closely with the project leads Apkarian and Vatche Wassilian, DDS, organizing the medical mission to provide much needed medical care to the Armenian people in the border villages of this war-torn country.

“He does frontline work, which I value. It’s immeasurable, especially for those individuals who are getting that care, which some of these people have never actually had health care and never seen a physician,” said Marta Nalbandyan, DO, Internal Medicine

physician at Kaiser Permanente.

Marta Nalbandyan, DO, Internal Medicine physician at Kaiser Permanente, has known him personally and professionally for over 10 years.

When speaking about the long-term impact of his Medical Missions, Dr. Nalbandyan said, “He tries to leave something that will continue to flourish, evolve, and grow.”

In October, the Medical Mission completed their eleventh mission, which now includes Armenia and Lebanon.

“His participation, selflessly without any complaint, seeing patients all day long, year after year after year, taking his vacation time for the service part of the medical mission, is truly admirable,” said Apkarian.

Nicole Calvillo, MD, FMMS Board member and Family Practice physician at Kaiser Permanente, had the honor of presenting the FMMS Community Service Award for Special Project to her friend and colleague Dr. Khatchikian.

“Garo is fierce. He’s protective of the physicians in his department.

He’s resilient and adept to problem solving on the fly. He has a strong sense of integrity and of what is right and wrong. He’s compassionate,” remarked Nicole Calvillo, MD, FMMS Board member and Family Practice physician at Kaiser Permanente.

Dr. Calvillo remarked that she was first concerned that his service in countries and regions besieged by war “felt like a vacation from our department.”

“But I’ve seen him on his return from these trips although he looks

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tired, he also looks rejuvenated. I know it puts our calling as physicians into perspective for him.” Dr. Calvillo.

Upon accepting the award, Dr. Khatchikian humbly thanked many of his colleagues by name in attendance for their kind words and support. He also thanked those physicians and volunteers who participated in the medical missions. He wanted to “celebrate it with my many friends in the Fresno Medical Mission” in attendance.

The Fresno Medical Mission provides tremendous assistance to the people they serve. In addition to providing medications, medical care, and many surgeries, they have renovated and equipped their local community hospitals and medical clinics for a more lasting impact.

“We gave them state of the art operating rooms, PACU units, radiology suites, labor and delivery suites. You know, it was very difficult, and a lot of work has been done, lots of collaboration between our leadership and local and out of the state physicians who participated in this mission,” said Dr. Khatchikian.

He is proud to have more than 50 local and out of state physicians and volunteers participate in the medical missions from Los Angeles, New Jersey, New York, Boston, Texas, Chicago, Seattle, and many other states.

“It’s such a great mission that he can easily pull people in. I think that’s his greatest contribution that not only

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he is contributing, he makes other physicians contribute alongside him,” remarked Dr. Jahromi.

In the last two years, the medical mission has expanded its support to Lebanon after the devastating explosion at the Beirut port and resulting socioeconomic crisis the country has been facing.

“For the past two years we’ve been traveling along with volunteer physicians to Lebanon and seeing lots of patients over there, give them medications and humanitarian assistance. And we give them also infrastructure, medical equipment, and everything they needed to be on their feet and get care,” said Dr. Khatchikian.

In closing, Dr. Khatchikian dedicated the Community Service Award for Special Project to the 120,000 people of NagornoKaragakh whom the Fresno Medical Mission has served for many years. Filled with emotion, Dr. Khatchikian described how they were tragically subject to ethnic cleansing just two months ago.

He remarked, “Our medical mission witnessed the deportations of all these people from their thousands of years of ancestral homeland and leaving their homes without nothing, after being subjected to nine months of total blockade without food, no electricity, nothing.”

While on the eleventh medical mission in September, they witnessed the deportations and the

medical mission had to pivot from its main objective of providing medical care over to providing humanitarian assistance.

Dr. Khatchikian explained, “We could not stay still and just watch how these people were suffering. So our leader, Mr. Berj Apkarian, starting another mission on the spot over there, a new project, Operation Hope.”

When the Fresno Medical Mission returned home, they immediately started work for Operation Hope with the Fresno community.

“Thanks to the generous donations of the Fresno community, the mission was able to funnel financial resources to Armenia proper, where the deportees are right now, and give them all the means and tools for them to be able to stand up once more and for them to be able to support their existence,” concluded Dr. Khatchikian.

Many colleagues participated in a video honoring Dr. Khatchikian, including physicians Marta Nalbandyan, DO, Internal Medicine physician at Kaiser Permanente; Berj K. Apkarian, Honorary Consul for the Republic of Armenia in Fresno; and Shahzad Jahromi, MD, Chief Medical Officer at Kaiser Permanente.

Dr. Khatchikian has been a California Medical Association member for 12 years and is fluent in English, Arabic, Armenian, and Turkish, and some Russian.

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CHSU Celebrates 100% Residency Match Rate for Inaugural Medical Students The California Health Sciences University (CHSU) has announced a 100% match rate for its fourth-year medical students at its 2024 Match Day. “Achieving a 100% match rate for our inaugural medical students is extraordinary and we are so proud of these future physicians,” stated John Graneto, DO, Dean of the College of Osteopathic Medicine.

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In a nationwide process that is highly competitive, CHSU’s 65 medical students in the class of 2024 matched to a wide variety of residencies, including 34% located in the Central Valley.

After completing medical school and earning a Doctor of Osteopathic Medicine (DO) degree, CHSU medical students will need to pass a final board licensing Spring 2024

exam. They will start a residency program in hospitals, clinics, and health centers to help them train for a specialty before practicing independently.

65% of the CHSU medical students will complete their residency in Primary Care, which includes family medicine, internal medicine, and pediatrics.

“With the critical shortage of Primary care physicians in the Central Valley and beyond, we are excited that 65% of our inaugural students matched in primary care residencies,” said Dr. Graneto.

California Health Sciences University College of Osteopathic Medicine (CHSU-COM) Class of 2024 Residency Match Results:

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• CHSU achieved 100% match rate for inaugural class of 2024 • 65% of residencies are in Primary Care • 34% of residencies are in the Central Valley • 65 medical students will graduate in May CHUS followed the celebration of a 100% match with news of an accreditation for the University. California Health Sciences University College of Osteopathic Medicine has been granted a seven-year Accreditation by the Commission on Osteopathic College Accreditation (COCA).

COCA is recognized by the U.S. Department of Education as the accreditor of colleges of osteopathic medicine.

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“I ENJOYED LEARNING ABOUT THE DIFFERENT STRATEGIES FOR TREATING SUBSTANCE USE DISORDERS, INCLUDING UTILIZING SUBSTANCE USE NAVIGATORS, AND INCORPORATING MEDICATIONASSISTED TREATMENTS...”

OPTF MEMBER COURTNEY HU

BY FATIMA YUSUF

Chair, CHSU Overdose Prevention Taskforce 26

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O

n June 15, 2024, the Fresno Madera Medical Society (FMMS) and the California Health Sciences University College of Osteopathic Medicine (CHSU-COM) will host the second annual Continuing Medical Education (CME) event on Addiction Medicine at the CHSU-COM campus. The event will be modeled after the fall event which was hosted in collaboration with several local organizations, including the Central Valley Opioid Safety Coalition, California Bridge, Community Regional Medical Center (CRMC), and the University of California San Francisco (UCSF) at Fresno. Over 200 prescribers attended the hybrid event (inperson and virtual).

The inaugural event provided a comprehensive overview of Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) and the use of naloxone in managing opioid overdoses. The event brought together experts in the field to discuss best practices, alternative approaches to opioids, motivational interviewing techniques, and the role of substance use navigators.

Attendees gained a deep understanding of OUD, opioid overdose, and practical strategies for implementing MAT and naloxone in clinical practice. The event

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provided licensed physicians with CME credits related to identifying, treating, and managing patients with opioid or other substance use disorders that will count towards the new training requirement to obtain or renew a Drug Enforcement Administration (DEA) registration.

Dr. Rais Vohra (UCSF Professor of Clinical Emergency Medicine, UCSF Professor of Clinical Pharmacy, Interim Health Officer - Fresno County Department of Public Health, and Medical Director Fresno Madera Division of the California Poison Control System) started off the event with an overview of OUD and MAT. This was followed by a review of non-opioid analgesics by Dr. Francisco Ibarra (CHSU-COM Adjunct Assistant Professor, CHSU-COM’s Overdose Prevention Task Force (OPTF) Faculty Advisor, and CRMC Emergency Medicine Clinical Pharmacist) and a lively panel including local experts Dr. John Zweifler (Family Medicine Physician and Medical Director - Central Valley Medical Providers/MedPRO), Flindt Andersen (President and Founder of Parents and Addicts in Need), Dr. Shoaib Khan (Family Medicine Physician, Addiction Medicine Physician, and UCSF Fresno Assistant Clinical Professor of Family Medicine), and Michael Prichard (Owner -

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Covenant Training and Consulting and Staff Analyst for the Fresno County Department of Behavioral Health).

Following a quick break, the event resumed with a panel including local Substance Use Navigators (Joseph Pool from Clovis Community Medical Center and Stephanie Garcia-Martinez from Community Regional Medical Center) and several patients in recovery (Matt Martin, Tony Hoffman, and Silvia Baltazar Raiz) who shared how they connect patients with recovery programs and their ups and downs of recovery, respectively. The event concluded with an overview of motivational interviewing techniques led by Dr. Jonathan Terry (CHSU-COM Interim Assistant Dean for Community Clinical Education, CHSU-COM Interim Chair of Specialty Medicine, and Psychiatrist).

Several exhibitors attended the event to discuss their services, including: • CHSU’s Overdose Prevention Task Force • California Bridge Substance Use Navigators • First Steps Recovery • San Joaquin Valley Free Medical Clinic and Needle

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Exchange • Muir Wood Adolescent and Family Services • MyTime Recovery • New Perceptions North Drug and Alcohol Treatment • Parents and Addicts in Need • California Health Collaborative - Perinatal Substance Use Disorder Taskforce • Sierra Meadows Behavioral Health • Total Life Change - Fresno The event was organized by Stacy Woods (Executive Director - FMMS), Dr. Rais Vohra, Dr. Francisco Ibarra, and Brooke Crosswhite (CHSU-COM OMS-III and former chair of CHSU-COM’s OPTF) in partnership with CHSU-COM’s OPTF; a program deployed by the national Student Osteopathic Medical Association (SOMA) to create campus-tailored action plans to prevent overdoserelated deaths and facilitate naloxone distribution/ education. Since its establishment in October 2022, CHSU-COM’s OPTF has provided several on-campus naloxone trainings, educated high school students on how

Spring 2024

CHSU-COM OPTF Members Back Row (left to right): Dominic Guilani, Haley Bennett, Krishan Joshi, Bardya Haghighat, Nina Aghakhani, Likitha Aradhyla, Cullen Gaffy, Akshay Sharma, Ranvir Johal Front Row (left to right): Joshua Carter, Austin Dean, Shriya Deshpande, Fatima Yusuf, Brooke Crosswhite, Sara Jhanjar, Robert Palacios

to identify, treat, and prevent opioid overdoses, facilitated discussions between addiction medicine experts and students, and incorporated opioid overdose prevention strategies into the school’s curriculum.

OPTF members were present at the event to learn more about addiction medicine and ensure the event ran smoothly. Current OPTF chair Fatima Yusuf (OMSII) commented, “I enjoyed learning about the different strategies for treating substance use disorders, including utilizing substance use navigators, and incorporating medication-assisted treatments.

I’m interested in specializing in Addiction Medicine and firmly believe that effectively and compassionately treating patients with substance use disorders will require a deep understanding of the systemic issues contributing to the opioid epidemic and supporting initiatives like this CME that educate the greater medical community about overdose prevention.” OPTF member Courtney Hua (OMS-II) added, “From the Addition Medicine Updates event, I learned that conversations regarding Spring 2024

substance abuse should commence earlier in adolescence than I previously believed. Because of my interest in Pediatrics, I recognize the responsibility I bear to stay thoroughly informed, enabling me to support and guide my future patients to the best of my capabilities. I also extend my gratitude to the Fresno Madera Medical Society and Dr. Ibarra for providing medical students the opportunity to gain insights from experts on Medication Assisted Treatment (MAT) for Opioid Use Disorder (OUD) and motivational interviewing techniques.” Brooke Crosswhite concluded, “I learned that substance use disorder is a chronic, neurological condition deserving of our attention in the same way that we think of diabetes or heart disease. I support overdose prevention because everyone deserves access to safe, equitable care without fear of stigma or dismissal by healthcare professionals.” Additional event support was provided by Jory McKune (CHSU-COM Manager - Business Affairs and Administration).

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Continuing Medical Education for Substance Use Disorder CA Bridge Academy These asynchronous virtual trainings are free and available to all interested in growing their knowledge and better serving patients. To access this training, visit CA Bridge Academy.

CA Bridge is pleased to offer free continuing medical education (CME) courses for MDs, DOs, PAs and NPs about substance use disorder (SUD) treatment. Current offerings are listed below with more planned for the future!

Addiction is a Pediatric Disease: Youth and MAT Advanced Buprenorphine and Injectables Advancing Equity in OUD Treatment Back to Basics: Bup 101 Buprenorphine Starts for Fentanyl use Case Studies in Precipitated Withdrawal Innovations in Post-Overdose Care Just Start It! Buprenorphine Self-Starts Let’s Talk about Alcohol Use Disorder and Polysubstance Use MAT for Stimulant Use Disorder: What We Know So Far New Best Practices in Harm Reduction Pain Control for People with OUD: Alternatives to Opioids (ALTO) Precipitated Withdrawal: What You Need to Know

0.5 CME hours 1 CME hours 1 CME hours 0.5 CME hours 0.5 CME hours 0.5 CME hours 0.5 CME hours 0.5 CME hours 1 CME hours 1 CME hours 0.5 CME hours 1.5 CME hours 0.5 CME hours

Visit cabridge.academy.reliaslearning.com or scan the QR code Accreditation Statement: These activities have been planned and implemented in accordance with the accreditation requirements and policies of the California Medical Association (CMA) through the joint providership of Fresno Madera Medical Society and Public Health Institute. Fresno Madera Medical Society is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.

Credit Designation Statement: Fresno Madera Medical Society designates these activities for AMA PRA Category 1 Credit(s) ™.

CA Bridge is a program of the Public Health Institute. © 2023, California Department of Health Care Services. Content available under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).

CA BRIDGE ACADEMY: Continuing Medical Education for Substance Use Disorder, June 2023 More resources available www.cabridge.org 30 CENTRAL VALLEY PHYSICIANS

Spring 2024

Closer to home + enhanced referrals = easier access to WORLD-CLASS CARE Offering added convenience for our referring providers From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Northern California and the Central Valley.

Your referred patients benefit from shorter drives, less traffic, affordable lodging, and more. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.

Referring your patients to UC Davis Health care is easier than ever.

Our physician referral liaisons are here to serve as direct lines of communication — helping to navigate and expedite referrals.

Our liaisons can help to: ■

■ ■

■

■

Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and webinars Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and other events

Reach out to your local Physician Referral Liaison today: Joaquin Muñoz | 916-878-7310 | joamunoz@ucdavis.edu

David Cooke, M.D., F.A.C.S. Professor and Chief, Division of General Thoracic Surgery, Director, General Thoracic Surgery Robotics Program Specialties: Cancer, Thoracic Surgery, Robotic Surgery

referrals.ucdavis.edu

OPIOID TREATMENT

X-ing the X Waiver Now All Physicians Can Treat Opioid Use Disorder

BY RONEET LEV, M.D. FACEP Opioid Use Disorder (OUD) continues to be a significant issue physicians must be aware of. In the past, medical providers with a DEA license could prescribe opioids but were not allowed to prescribe treatment for opioid addiction without additional government hoops.

That stipulation was known as the X-Waiver. Now the X waiver barrier has finally been removed by Congress.

In short, the X-waiver is no longer required to prescribe buprenorphine for Opioid Use Disorder (OUD) treatment. Additionally, there are no caps or limitations on the number of patients a prescriber can treat simultaneously.

That means that every DEA-licensed physician can provide opioid addiction treatment. It is a move in the right direction for integrating physical health, mental health, and substance use disorder (SUD).

There is a learning curve to everything. But you can do this. You learned many new things in your medical career, and treating opioid use disorder is rewarding.

Our San Diego Medical Examiner reported 2.25 - 2.5 deaths a day from fentanyl for the past two years.

Fentanyl is the public health crisis of our times. The medical community needs to rise to this crisis like we did for COVID. This is an opportunity to point out that substance use disorder is a chronic, relapsing, yet treatable brain disease.

Addiction relapse rates are like other chronic diseases such as asthma or diabetes. Treating addiction is rewarding.

Using medications to treat opioid use disorder reduces the death rate by 50% or more and has excellent retention rates of 50% at one year.

No patient should ever suffer from opioid withdrawal.

We have a very effective treatment with buprenorphine. A general guide for a COWS (Clinical Opioid Withdrawal Scale) of 8, give 8 mg of Suboxone.

Physicians of most specialties should be able to

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start and maintain patients on Medication for Opioid Use Disorder . You can undoubtedly refill medicines for patients who are in treatment.

There are three excellent resources to start your rewarding experience treating addiction, especially opioid use disorder: • California Bridge - Bridgetotreatment.org Tools on this website include Buprenorphine Quick Start, Buprenorphine Patient Materials, and much more.

• National Clinical Consultation Center (NCCC) California Substance Use Line 844-326-2626 The California Substance Use Line is a free 24/7 teleconsultation for California clinicians.

UCSF runs this NCCC and is familiar to many clinicians who used their service for HIV Post Exposure Prophylaxis. They offer similar services to assist with alcohol and drug treatment recommendations. Call them if you are new to MAT, need advice on a specific patient, or have a complex addiction case.

• SAMHSA Buprenorphine Quick Start - samhsa.gov/ sites/default/files/quick-start-guide.pdf The Substance Abuse and Mental Health Services Administration has a quick start and pocket guide for buprenorphine.

Dr. Lev was the first Chief Medical Officer of the White House Office of National Drug Control Policy, ONDCP. She is a nationally acclaimed medical expert and speaker who continues to treat patients in the emergency department. In 2012, she established and chaired the San Diego Prescription Drug Abuse Medical Task Force, the first of its kind in California that integrated physicians of various specialties along with hospitals, law enforcement, hospital administration, treatment programs and public health for the purpose of decreasing deaths and mortality from prescription drugs. Her program on Safe Prescribing in the emergency department won the 2014 National Association of Counties award. The California US Attorney’s office nominated her for the White House Champion of Change Award.

Spring 2024

XYLAZINE

Information for Healthcare Professionals

What is xylazine?

Xylazine is a veterinary tranquilizer, (a nonopioid), which is sometimes mixed with fentanyl and other illicit drugs. Xylazine is an analog of clonidine acting as an alpha-2 agonist. It is FDAapproved as a sedative in veterinary medicine but is not approved for human use. The drug is not scheduled under the Controlled Substances Act.

Why do people use xylazine?

Illicit xylazine is also known as Tranq. It may be found as an adulterant in fentanyl, heroin, cocaine, and methamphetamines. People often use the drugs that are available to them in their local supply. Similar to fentanyl, many people did not know they were being exposed to it in their supply. Some people also report purposely using xylazine-containing fentanyl to lengthen its euphoric effects.

Has xylazine been detected in San Diego County?

The San Diego Medical Examiner’s Office reported one xylazine death in 2020 and no deaths in 2021.

Previously, xylazine was not routinely tested for unless expanded testing was indicated. In late April 2023, xylazine testing was initiated in all routine post-mortem screenings, and of more than 1,000 screened deaths occurring between November 2022 and May 2023, six were positive for xylazine. Of the six xylazine cases, all were also positive for other drugs, including fentanyl

FDA WARNING The United States Food and Drug Administration (FDA) issued a letter to stakeholders providing clinical information about the risks of severe, necrotic skin ulcerations from repeated xylazine exposure, possible withdrawal symptoms, and xylazine’s interference with successful treatment of opioid overdoses. View the letter: www.fda.gov/media/162981/download It is not known at this time whether the xylazine is illicitly produced (unapproved) or

and methamphetamine. The San Diego Sheriff’s Department Crime Lab includes xylazine testing in all drug seizure cases and has confirmed thirty-six samples where illicit drugs contained xylazine from 2021 through the first quarter of 2023. Although xylazine does not appear to be as prevalent in San Diego County as in some other jurisdictions, residents should be aware of the risks associated with xylazine and be proactive in mitigating them, particularly because national trends indicate its increasing presence in overdose deaths and the illicit drug supply.

How do you test for xylazine?

As of May 2023, there are no FDA-approved rapid tests checking for xylazine in patients in a hospital or clinic setting. Testing may be available as a send out laboratory specimen to a specialized lab that uses gas chromatography/mass spectrometry.

Xylazine test strips are commercially available

by BTNX for testing drug products.

What are the signs and symptoms of a xylazine-involved overdose?

The main effect of xylazine is heavy sedation, so the person who has overdosed will likely be unresponsive. When xylazine is found in combination with fentanyl or other opioids, the signs and symptoms can include blue or greyish skin and slowed breathing and heart rate.

diverted from the animal drug supply. FDA is continuing to investigate the source of xylazine in the illicit drug supply and will provide an update when new information is available.

FDA encourages health care professionals and patients to report adverse events in humans associated with possible illicit xylazine exposure to FDA’s MedWatch Adverse Event Reporting program. Complete and submit the report online at www.fda.gov/medwatch/report.htm; or download and complete the form, then submit it via fax at 1-800-FDA-0178.

Customized insurance solutions for members The CMA Insurance Program, administered by Lockton Affinity, offers key benefits: Using group purchasing power, CMA members get exclusive, comprehensive coverage at discounted rates.

Unique coverage offerings help safeguard yourself, your loved ones, your business and your livelihood.

Access to newly available Medical Malpractice insurance.

Visit LocktonAffinityCMA.com to schedule a 15-minute call with Lockton Affinity’s dedicated team. Together, we will determine the policies you need to be fully protected.

Info@LocktonAffinityCMA.com | (800) 278-8130

The CMA Insurance Program is administered by Lockton Affinity, LLC d/b/a Lockton Affinity Insurance Brokers LLC in California #0795478. Coverage is subject to actual policy terms and conditions. Policy benefits are the sole responsibility of the issuing insurance company. The California Medical Association will receive a royalty fee for the licensing of its name and trademarks as part of the insurance program offered to the extent permitted by applicable law. Not available in all states.

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Spring 2024

Students Attend AMA Interim House of Delegates Meeting MARTIN GARCI

OMS-II, California Health Sciences University

I

had the incredible privilege of attending the American Medical Association (AMA) Interim House of Delegates’ Meeting in National Harbor, Maryland, last November. This opportunity arose after my colleague Lucia Liu and I, having collaborated on a summer research project, learned that our poster had been accepted for the AMA Poster Showcase during the event. With the swift coordination facilitated by California Health Sciences University (CHSU) faculty and the Fresno Madera Medical Society (FMMS), Lucia and I embarked on a trip from California to Maryland.

Arriving in Maryland on a Thursday evening, the experience proved invaluable for an OMS-II medical student like myself. As a member of the AMA Chapter at CHSU, my previous involvement in such meetings had only been virtual. Finally, I had the opportunity to attend a live Medical Student Section (MSS) resolution review.

Alongside fellow AMA Chapter delegates, Matinder Dhillon and Cortland Jell, representing MSS Region 1, I joined in discussions where passionate medical students advocated for diverse healthcare topics, from Native American population care to international healthcare advocacy. This firsthand exposure to the process of crafting and passing resolutions through AMA motivated me to continue my engagement in AMA activities and contribute to resolution writing on subjects close to my heart throughout my professional journey.

With a deep interest in street medicine, I also eagerly attended the “Stepping Outside the Four Walls: Understanding Street Medicine” educational program.

Building on our existing volunteer program at CHSU led

by Dr. Marc Lasher, focusing on clean needle exchange and healthcare for downtown Fresno patrons every Saturday, I sought to explore ways to expand opportunities for our students. The panelists shared valuable insights into successful street medicine program development, emphasizing collaboration with community outreach organizations and the core tenets of meeting patients where Spring 2024

they are, understanding the local landscape, and addressing the specific needs of the patient population (even if it’s just clean socks during the winter!).

In addition to these enriching experiences, Lucia and I had the privilege of presenting our research during the Poster Showcase. Our project, titled “A Course Assessment of the California Health Sciences University (CHSU) Nutrition and Culinary Medicine (CM) Curriculum after OMS-IV Finished Their 3rd-year Rotations,” explored the impact of culinary medicine training on our students. The positive reception from both students and faculty underscored our shared belief that nutrition is often understudied and, at times, stigmatized in the field of medicine. The warm welcome from the osteopathic community at the showcase was particularly rewarding, considering we were among the first to represent our school at the conference.

Overall, it was amazing to see the impact of our research come to fruition. I extend my sincere gratitude to Dr. Sara Goldgraben, Maria Torres, and Jessica McCune for their leadership and support throughout our research journey. Special thanks to CHSU, Dr. John Graneto, and the FMMS Board of Governors for making this unforgettable opportunity possible!

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Empowering the Future of Healthcare

Celebrating the 2023 San Joaquin Valley Medical Foundation Scholarship Awards

I

n the heart of the San Joaquin Valley, a powerful force for positive change is at work, shaping the future of healthcare and empowering the dreams of aspiring medical professionals. The San Joaquin Valley Medical Scholarship Foundation, with its unwavering commitment to fostering excellence in medicine, has once again made its mark with the announcement of the 2023 scholarship recipient.

This year’s deserving awardee is Xeng X. Xiong, MD. This scholarship marks a significant milestone, as the foundation continues to make strides in its mission to alleviate the medical tuition debt burden for Residents pursuing primary care specialties. From Family Medicine to Pediatrics and beyond, these dedicated individuals play a crucial role in addressing the healthcare needs of our community.

The foundation’s criteria for awarding this esteemed scholarship are stringent, ensuring that recipients are not only exceptional students but also committed to making a lasting impact in underserved areas. To be eligible, the Resident must be a native of the San Joaquin Valley, dedicated to remaining and working within the region, and devoted to serving in underserved communities for a span of four years. A pledge to care for at least 30% Medi-Cal and/or uninsured patients is essential, as is the possession of a formal loan from a recognized financial institution.

The financial support offered through this scholarship is truly transformative. With an annual award of $55,000, it spans four years of medical school, amounting to a

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staggering $220,000. This assistance not only lightens the financial load for recipients but also enables them to focus entirely on their studies and their future contributions to healthcare accessibility in our region.

Last year, the scholarship was awarded to Tania Zavalza, MD, a resident from the UCSF Fresno program.

Her inspiring journey and dedication to the field have made her a role model for aspiring medical professionals.

This year, Tania received the second installment of her scholarship, a testament to the foundation’s commitment to long-term support. The scholarship is fittingly named after James P. Zettas, MD, a remarkable Orthopedic Surgeon whose legacy continues to inspire.

Xeng X. Xiong, MD, the 2023 scholarship recipient, embodies the foundation’s values of resilience and determination. As a thirdyear Family Medicine Resident at Valley Health Team, mentored by Lydia Herrera-Mata, MD, Xeng’s journey from Laos to the United States has been one of overcoming adversity.

Becoming the family translator for medical visits at a young age sparked his passion for medicine, and now, with a debt exceeding $450,000, Xeng’s story resonates as a testament to the power of dedication.

The generosity of donors remains at the heart of the foundation’s success. Every contribution, big or small, plays a vital role in shaping the trajectory of these aspiring medical professionals and strengthening our community’s healthcare sector. As we look ahead, the foundation’s ambitions continue to grow. With the goal of establishing a

Spring 2024

Empowering the Future of Healthcare

SJVMSF GRANTS TWO SCHOLARSHIPS

third scholarship in 2024, the foundation is calling upon individuals to become part of this transformative journey.

To those who wish to support the cause, the foundation welcomes donations through their website, www. sjvmedicalscholarship.org. By investing in these scholarships, donors are not only contributing to the education of remarkable individuals like Xeng X. Xiong and Tania Zavalza but also to the overall wellbeing of our community.

The San Joaquin Valley Medical Scholarship Foundation extends its deepest gratitude to its supporters, donors, and partners.

Through collective efforts, the foundation is transforming the landscape of healthcare, one scholarship at a time, and paving the way for a brighter, healthier future for all.

Spring 2024

The San Joaquin Valley Medical Scholarship Foundation (SJVMSF), was able to grant two scholarships on July 30, 2023.

Tania Zavalza Jimenez, MD, received the second installment of her four $55,000 annual scholarship. She just graduated from UCSF Family Medicine program and she is working in Parlier, besides becoming a Faculty member.

Xeng X. Xion, MD, received his first of four $55,000 dollar scholarship on the same day. He is a 3rd year resident of the Valley Health Team program.

He will work treating immigrants from South East Asia, who are quite underserved due to language and cultural barriers, once he graduates in 2024.

The scholarships are given to residents in a primary care program, that are from the Valley, will remain in the Valley and will work in an underserved area for 4 years.

The scholarship goal is to help pay as much as possible of the medical tuition debt they graduate with, is paid retroactively annually, for the 4 years of medical school tuition.

The Board of the SJVMSF wants to thank all our donors that have made this possible.

We also want to be able to give a 3rd scholarship in July 2024, and for this we need your continuing help.

We are making a difference, helping to get more PCPs to the Central Valley, and at the same time we are helping underserved towns to get better medical care.

Your donations will be appreciated.

Please go to our website to know more about the Foundation and the recipients of the scholarships, and how to donate on line.

CENTRAL VALLEY PHYSICIANS

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Enhanced referrals for WORLD-CLASS CARE, closer to home Convenience for referring providers From delicate robotic and catheter procedures to precision therapeutics, we’re proud to offer diagnostic and treatment options for adult and pediatric referring providers across Northern California and the Central Valley.

Your referred patients benefit from shorter drives, less traffic, affordable lodging, and more. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.

Our physician referral liaisons are here to help navigate referrals and: ■

Facilitate access to our secure EMR system, PhysicianConnect

■

Assist with UC Davis Health clinical trials and telemedicine

■

■

Keep you abreast of new services, providers and research programs Arrange meetings and webinars, and share information about CME and events

Your local Physician Referral Liaison: Joaquin Muñoz | 916-701-7161 | joamunoz@ucdavis.edu Misty D. Humphries, M.D., M.A.S. Associate Professor, Department of Surgery Interim Chief, Division of Vascular Surgery Interim Director, UC Davis Vascular Center and UC Davis Wound Care Center Specialty: Vascular Surgery

referrals.ucdavis.edu 38

CENTRAL VALLEY PHYSICIANS

Spring 2024

Inside Look:

Valley Children’s Pediatric Residency Program Welcomes Physicians for a Healthy California

P

hysicians for a Healthy California (PHC) and members of the media visited Valley Children’s Pediatric Residency Program in Madera, which receives critical funding through CalMedForce, PHC’s graduate medical education (GME) grant program.

“PHC is grateful to Valley Children’s for allowing a behind-the-scenes look at training new pediatricians,” said PHC President and CEO Lupe Alonzo-Diaz. “PHC’s mission is to improve community health, grow a diverse physician workforce and promote health equity and it is wonderful to partner with Valley Children’s as they work to achieve these goals in Madera.”

CalMedForce dedicates voter-approved, state tobacco tax revenues from Proposition 56 to fund residency slots to train physicians and help California address its growing physician shortage. The San Joaquin Valley suffers from a particularly severe physician shortage — with 22% fewer primary care doctors than the state average.

Valley Children’s Pediatric Residency Program applied for and received funds from CalMedForce’s five application cycles, receiving a total of over $6.2 million from 2018-2023. Funds were used in a number of ways to train the next generation of California pediatricians, including improved curriculum, expanded services in underserved communities and increased community engagement. Valley Children’s was also able to purchase critical simulation equipment that allows residents to learn about Spring 2024

comprehensive patient assessments.

PHC President and CEO Lupe Alonzo-Diaz and PHC staff were welcomed by Valley Children’s Vice President of Academic Affairs and Designated Institutional Officer Jolie Limon, M.D.; Residency Program Director

CENTRAL VALLEY PHYSICIANS

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Vini Vijayan, M.D.; Valley Children’s Community and Government Relations Director Tim Curley; and GME Manager Athena Gonzalez. After the hospital tour, they watched a demonstration of Valley Children’s Simulation Program – which uses medical manikins to simulate common medical procedures, complex medical conditions and life-threatening emergencies – by Simulation Program Manager Kim Bilskey.

“We are very grateful for the funding that CMF has awarded to Valley Children’s Pediatric Residency Program, which has assisted us with not only hiring residents, but also enhancing their learning experience,” says Dr. Limon.

“We have used the funds for faculty development and retreats, resident wellness, and expansion of simulation training. We started this program with the goal of 50% retention of our graduates in the Central Valley and we

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are meeting that metric. CMF has allowed us to ‘grow our own’ and to help provide this underserved region with new generations of pediatricians.”

So far, hundreds of programs in hospitals, medical centers and community clinics have received over $189 million to retain and expand graduate medical education programs in primary care (family medicine, internal medicine, pediatrics, and obstetrics/gynecology) and emergency medicine.

The next application cycle of CalMedForce opens August 1, 2023. Programs interested in applying for funds should visit phcdocs.org/calmedforce for more information.

Spring 2024

O FF IC E S PAC E F O R S A LE 1275 E SPRUC E AVE , FRESNO, C A 9 3 7 2 0

Fortune Associates proudly presents this hard-to-find professional medical building for sale, a perfect opportunity for an owner/ user. It lies just north of Herndon Ave, in Fresno’s premier medical corridor. 1275 E. Spruce Ave was built by the Seller in 2004, featuring 12,912 sf in move-in condition with monument signage, ample surface & underground parking, tailored for a large medical practice.

Unique opportunities from the seller for medical group ownership include: 1) A traditional purchase or partial ownership.

2) Purchase and use remaining space along with an existing group

BRANDON LAMONICA Blamonica@FortuneAssociates.com (559) 490-2500 x114 DRE#01317857

JAMES BITTER Jbitter@FortuneAssociates.com (559) 490-2500 x122 DRE#02044628

470 E. Herndon Avenue, Suite 200, Fresno, CA 93720 All information, representations and projections indicated in this brochure are based on information supplied by the owner or sources deemed reliable and are not warranted by FORTUNE ASSOCIATES. DRE00746807

Up Close:

Liver Transplant Patient Credits UCSF Fresno Hepatologist with Saving His Life

BY BARBARA ANDERSON UCSF Fresno Communications

R

ick Amparan had a badly scarred liver after decades of heavy drinking – and a grim prognosis of only three to six months to live – when he made an appointment four years ago to see Marina Roytman, MD, FACP, a UCSF Fresno liver diseases specialist and Liver Program director.

Dr. Roytman told Rick, 69, of Clovis, his liver would eventually stop working properly and he would need a transplant. But she could help him stay healthy for as long as possible and prepare for a transplant, if he followed these steps: maintain sobriety, regularly attend substance use meetings and have a support system, among other requirements.

She pushed him mentally, physically, and emotionally, but foremost she gave Rick hope. “She was a very positive person. She didn’t give up on me.”

Dr. Roytman remembers having a lot of “heart to hearts” with Rick about the importance of attending support group meetings. “That did not fully hit home for a while,” she says.

With the support of his wife, Debbie Rogers, Rick maintained his sobriety and met the criteria to be on a list for a liver transplant at UCSF in San Francisco. In December 2021, he received a donor liver.

His journey to sobriety was not easy, Rick says. He started drinking as a teenager and over many years the use of alcohol increased. “The alcoholism is a lot stronger than your mind. And it’s easy to just say, ‘tomorrow I’m going to slow down.’”

Alcohol misuse is a disease, Dr. Roytman says. “And we should approach it as a disease rather than a moral failure.” Rick is doing great, she says. “He’s committed to sobriety. He’s helping others in his situation. He is an amazing, amazing role model.”

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L to R: Marina Royman, MD, and patient Rick Amparan

Increasingly, she is sounding an alarm about alcohol use and liver disease. And her concern goes beyond patients like Rick whose chronic alcohol use led to cirrhosis of the liver. Since the COVID-19 pandemic, she is seeing younger patients in severe liver injury who have alcohol related hepatitis or severe inflammation of the liver. The condition develops much quicker and can be just as life-threatening as cirrhosis.

“Instead of literally years and decades of excessive drinking, we may see weeks or months of excessive drinking and instead of the liver being small and shrunken like in cirrhosis, we’re seeing massively enlarged and inflamed livers,” Dr. Roytman says. “This is the hallmark of alcohol related hepatitis.”

Cases of alcohol related hepatitis have skyrocketed since March 2020, the beginning of the pandemic. A

Spring 2024

UCSF Fresno study, terrified, people were led by Dr. Roytman, depressed, people were found a 51% increase in anxious. There were admissions for severe shelter in place orders, alcohol related hepatitis which created easy in 2020 as compared access to alcohol as well to 2019, and a 64% as lack of distraction increase in 2021 as from consuming it,” she compared to 2019. says. Additionally, the The study looked economy was taking a at patients seen at nosedive. People were Community Regional losing their jobs, and L to R: Rick Amparan and wife Debbie Rogers. Photo credit: Debbie Rogers Medical Center, Clovis some were losing their Community Medical homes. “So, lots of Center and Fresno Heart & Surgical Hospital. stressors there.”

Women and patients younger than 40 years of age are Now, more than three years into the pandemic, suffering the most from alcohol related hepatitis. In women, Dr. Roytman says alcohol related hepatitis cases remain hospital admissions were up 129% in 2020 from 2019 high – perhaps driven now by the stresses associated with and increased 179% in 2021 from the baseline. Similarly, rising inflation, and more so by the habits of heavy alcohol patients younger than 40 years of age had a 100% increase consumption acquired during the pandemic years – and in hospital admissions in 2020 and a 136% increase in 2021 she is doing her best to increase awareness. “We really need from the 2019 baseline. a large public awareness campaign to recognize that this is a This year, Dr. Roytman and her team looked at a huge problem.”

National Inpatient Sata sample of 800,000 patients and Her prescription for individuals: “I really want us saw a massive increase from 2019 to 2020 in hospital to remember how life was before the pandemic. Let’s go admissions for alcohol related hepatitis with particularly outside. Let’s have a picnic at the park. Let’s go back to the startling increases for women and young patients. gym. Movie theaters are open. Let’s find other things that Patients with alcohol related hepatitis sometimes give us joy rather than focus on alcohol.” recover slowly, but “the hardest thing is we really are not She recognizes the stigma surrounding alcohol use able to fully predict with 100% certainty who is going to disorder remains a roadblock to sobriety for many. “I feel recover and who is not going to recover,” she says. “Patients it is more stigmatizing than smoking. So, we absolutely may die just as well from alcohol related hepatitis as they need that government public education campaign and I are from alcohol related cirrhosis – and sometimes even think we can find patients, like Rick, who could be our faster.” spokespeople.”

She recalls at least a half a dozen patients in the first Rick and wife, Debbie, support Dr. Roytman’s efforts half of 2023 who were referred to transplant centers, but to educate the public about alcohol use disorder and health that is an underestimate of those in need. “These are the consequences. “He would not be here if it were not for her. good candidates. They have good support systems; they We know that deep down inside,” Debbie says. “We know understand they got into trouble with drinking; they are she is the one who helped me to help him believe that he willing to engage in treatment; they have a car to get to the had a chance.” transplant center.”

There’s no doubt Dr. Roytman saved his life, Rick Dr. Roytman gets asked why alcohol related hepatitis says. Since his transplant, and his strength is returning, has increased since the start of the COVID-19 pandemic he freely expresses his gratitude at appointments. “She’s and its ensuing lockdowns and surges. “Our hypothesis just been my angel,” he says tearfully. “She turned my life is that COVID-19 created this perfect storm. Early in around. She really, really did. God, I’m just so thankful for the pandemic we had a mental health crisis. People were that.”

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n the realm of preventing and managing complex conditions like diabetes mellitus, hypertension, heart disease, hypercholesterolemia, stroke, obesity, fatty liver disease, mental health, certain malignancies and beyond, guidelines consistently advocate for a foundational approach—lifestyle modification.

However, the pivotal question arises: who guides patients through this intricate maze of lifestyle changes, customizing recommendations to suit individual needs?

This dilemma echoes in the minds of patients, physicians, and even within community discussions.

While a referral to a nutritionist or dietitian is a plausible step, it often falls short of immediately addressing the myriad questions our patients harbor. But it’s not just about nutrition. What about physical activity or movement? How does one navigate the labyrinth of sleep hygiene? What coping mechanisms are in place for managing stressors? Substance use counseling and fostering social connections—are these not integral components of overall health? The World Health Organization states that, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The holistic nature of well-being demands aligning evidence-based strategies and lifestyle interventions for comprehensive approach.

In our roles as physicians and educators, the bedrock of our practice lies in evidence-based science and medicine. The American Diabetes Association highlights a range of lifestyle programs, demonstrating the evidence and possibility of reducing the risk of developing type 2 diabetes by almost 50% by adopting small changes overtime. The American College of Cardiology is actively engaged in promoting cardiovascular health through its “Food as Medicine Initiative”. Recognizing the pivotal role of nutrition in heart health, this initiative reinforces the idea that dietary choices are integral to cardiovascular disease prevention. The American Heart Association provides evidence based educational steps encapsulated in “Life’s Eight Essentials.” These comprehensive steps include Eat Better, Be more Active, Quit Tobacco, Get healthy Sleep, Manage Weight, Control Cholesterol, Manage Spring 2024

Blood Sugar, and Manage Blood pressure. For NonAlcoholic Fatty Liver Disease (NAFLD) and fibrosis, the American Gastroenterology Association advocates lifestyle modifications as a foundational approach.

Their best practice advice underscores the benefits of lifestyle changes, particularly weight loss ≥5% of total body weight can decrease hepatic steatosis, weight loss ≥7% of total body weight can lead to nonalcoholic steatohepatitis resolution, and weight loss ≥10% of total body weight can result in fibrosis regression or stability.

The World Health Organization (WHO) Guidelines on risk reduction of cognitive decline and dementia emphasize evidence-based recommendations on lifestyle behaviors. These guidelines provide a roadmap for individuals to adopt interventions that can delay or prevent cognitive decline and dementia.

Other prominent societies, including the American Rheumatology Association and the American Psychological Association, echo this sentiment. Their recommendations center on behavioral modifications and lifestyle changes, with a specific focus on nutrition, physical activity, sleep, and stress management. The substantial evidence supports these interventions for both disease prevention and management, often complementing medications synergistically.

Reflecting on our own educational journeys during medical school, residency and fellowship, the absence of a dedicated class on lifestyle, nutrition, or the psychology behind understanding a patient’s readiness for lifestyle interventions is palpable. The constraints of time during medical appointments exacerbate the challenge, leaving a small window for a cursory discussion. Referrals to nutritionists, dietitians, cognitive behavioral therapists come along with limited availabilities as well as long waits for referrals.

Within the confines of clinics and hospitals, handouts listing lifestyle changes abound. However, for our patients and the community, it’s not just about the “what” but the critical “how to.” The missing link lies in the practical application of these changes in the day-today lives of individuals.

As an endocrinologist, this integration has not only CENTRAL VALLEY PHYSICIANS

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empowered my patients but has also become a source of professional fulfillment. It’s a journey that transcends the traditional disease-centric model, focusing on reducing both disease and medication burden.

Witnessing, in certain cases, the reversal of disease adds a profound dimension to the therapeutic relationship.

This is more than a clinical strategy; it’s a commitment to improving health outcomes and enriching lives. Lifestyle medicine is a medical specialty with focus on six pillars —a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections.

The emphasis on the importance of these factors, as we advance in science and witness groundbreaking discoveries in areas such as diabetes, obesity, cardiovascular diseases, mental health, oncology, and rheumatology, becomes even more crucial in the contemporary medical landscape. Commendably, our near-future physicians at CHSU-COM are equipped with the indispensable tool of nutrition education.

Undoubtedly, the integration of Lifestyle Medicine demands time, access, education, and ongoing support for patients and their families. It’s a testament to the enduring commitment required for a transformational shift in health. The long-end game that Lifestyle interventions embodies is not without its challenges, but the absence of side effects makes it a remarkable endeavor.

As a physician, I recognize that education stands as a potent ally, a tool that not only alleviates anxiety but also addresses the myriad worries and concerns that accompany chronic conditions.

Education becomes the catalyst, offering a platform where patients can voice their questions, clarify doubts, and seek guidance. Sometimes, it’s the gift of time—time to delve into their concerns, understand their fears, and empower them with knowledge. At other times, it’s about steering them towards the right physical activities, educating them about foods that nourish their bodies, or assisting them in budgeting for weekly food expenses.

By stabilizing the mental and psychological aspects of health, patients are better equipped to navigate the intricate path toward controlling parameters like blood

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sugar, weight, blood pressure, cholesterol, and more.

As physicians, educators, and advocates for health, our role extends beyond the confines of diagnosis and prescription. It’s about instilling confidence, providing the right tools, and fostering a mindset that views health as an ongoing journey, not a destination. Crucially, patient accountability takes center stage. The narrative shifts from passive recipients of healthcare to active participants in their well-being. Tracking progress, celebrating victories—no matter how small—and fostering a sense of ownership become integral aspects of patient care.

The epidemic of obesity, type 2 diabetes, fatty liver disease, insulin resistance and hypertension looms large, casting a shadow over both adults and the younger generation. For pediatricians, the urgency is amplified. Obesity, diabetes type 2, and hypertension are increasingly infiltrating childhood, setting the stage for a lifetime of health challenges. It’s about instilling habits that transcend the clinic walls, creating an environment where health is an integral part of daily life.

Small changes, when embraced collectively by families, have the potential to exert major impacts. It’s not about radical transformations; it’s about introducing healthier choices into our everyday routines. Discussions about nutrition become family dialogues, physical activities transform into shared adventures, and sleep hygiene becomes a household priority.

In this era of interconnectedness, the impact reverberates beyond individual lives. It extends to communities—a shared commitment to a healthier, more resilient future. It’s about inspiring change, providing the tools for transformation, and fostering a culture where health is an evolving journey—a journey that, even in its smallest steps, holds the promise of a brighter, healthier tomorrow.

AUTHOR: Chhaya Makhija, M.D, DipABLM (Board certified Endocrinologist and Lifestyle Medicine specialist) Adjunct Assistant Professor, CHSU-COM, Clovis, CA Assistant Professor, UCSF, Fresno, CA

Spring 2024

Hemant Dhingra, MD Appointed to Medical Board Governor Gavin Newsom of California has recently appointed Dr. Hemant Dhingra to the Medical Board of California. Dr. Dhingra, who served as the President of the Nephrology Group since 2014 and as the Chief of Medical Staff at the Saint Agnes Medical Center of Fresno since 2023, brings extensive experience and leadership to this important role.

In addition to his role at the Nephrology Group, Dr. Dhingra has been a past president of the Fresno Madera Medical Society and a board member for the California Medical Association Political Action Committee. Dr. Dhingra is an active member of the American Society of Nephrology, the California Medical Association and the Fresno Madera Medical Society.

Dr. Dhingra earned his Doctor of Medicine degree from the Mount Sinai School of Medicine and completed

his Fellowship in Nephrology at Texas Tech University. He received his initial medical degree from Government Medical College Amritsar and has been in practice for over 20 years.

This prestigious appointment to the Medical Board of California requires Senate confirmation, with a compensation of $100 per diem. Dr. Dhingra’s expertise and dedication make him a valuable addition to this vital regulatory body overseeing medical practice in the state.

In Memory

J. Malcolm Masten August 21, 1919 – March 26, 2024 An ultimate gentleman and beloved husband, father, grandfather, physician and friend, J. Malcolm Masten died on March 26, 2024 at the age of 104 ½ years. He was active in leadership roles at Fresno High, Fresno State College, and in the Fresno medical community where he practiced Internal Medicine for 40 years. He and his high school sweetheart and wife of 79 years, LaVerne Call, were dancers, backpackers, gardeners, and world travelers-visiting more than 100 countries over the years. Predeceased by LaVerne, Malcolm is survived by his daughter Marlene Masten, his daughter Marilyn Masten Honegger and husband Scott, granddaughter Julie and husband Mitch, grandson David and wife Sarah, and three great-grandsons. Dr. Matsen was a member of the California Medical Association and Fresno Madera Medical Society for 59 years.

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