2018-07-29 - Health Care Quarterly (Vol. 21) - Summer 2018

2018 | VOL. 21

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“With a concierge practice, I drastically limit the number of patients in order to spend a great deal of time with each and every person,” said Dr. Choi. “This gives me the opportunity to be my patient’s private physician and provide the best care I can give.” The concierge practice also provides 24/7 on-call access. This necessarily limits the number of patients the practice can accommodate.

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CONTENTS

24

24 are you a smarty-pants?

It’s pop quiz time at Health Care Quarterly.

Treat yourself to our sweet quiz.

35 pals for life

Pets can be crucial to our health 40 chemistry and cannabis

Understanding the parlance of pot and how marijuana’s makeup can affect your ailments

48 a reality check on statins

The noise can drown out the good news

35

COLUMNS 14

oncology Dr. Souzan El-Eid, Comprehensive Cancer Centers

16

medicine cabinet Jaclyn Latteri, Optum Rx

17

pharmacy counter Daniel W. Heller, Smith’s Food & Drug

18

sun safety Dr. Syed Saquib, UMC Lionis Burn Care Center

Michael Orth enjoys spending time with Hope.

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healthy pocketbook Christian Gitersonke, AR Rescue

Michael Orth photo by Christopher DeVargas

departments 52

40

Innovations Dr. Andrew Cohen, Comprehensive Cancer Centers

54

alphabet soup Tracy Wakefield, P3 Health Partners

58

technology Mike Braham, Trapollo

59

TECHNOLOGY Dr. Gillian Barclay, Nevada Governor’s Office of Economic Development

60

the golden years Vince Parker, Las Ventanas at Summerlin

There’s more to cannabis than THC.

62

COMMUNITY 62

making the rounds

Notes from the health care community

64

CALENDAR

Upcoming events and classes

OptumRx and BriovaRx raised money leukemia and lymphoma.

Top photo by Steve Marcus, Bottom photo by Al Powers/Powersimagery LLC

summer 2018

H E A LT H C A R E Q U A R T E R LY

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Group PUBLISHER Gordon Prouty (gordon.prouty@gmgvegas.com) publisher breen nolan (breen.nolan@gmgvegas.com)

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summer 2018

FROM THE EDITOR

H

ealth Care Quarterly has long prided itself on bringing you good information from Southern Nevada’s experts. Have you been paying attention? Turn to page 24 to find out.

We’ve got a sweet quiz that touches on a variety of topics from general knowledge and screening information to questions about percentages and trivia about Southern Nevada. The good news is that not only are we grading this quiz on an extreme curve (everyone who takes it gets an A!), but we’re pretty sure you’ll pick up a new bit of knowledge before you finish.

Of course, if you’re like me, testing brings with it an automatic reaction — the palms get sweaty and the blood pressure goes up. Testing stress; it’s something that never really goes away. Fortunately, I have a dog waiting for me at home and I know that he’ll help me forget my troubles. Pets are great for helping us deal with stress; they’re also a great motivator for getting active. Lindsey Reynolds of P3 Medical Group brings us some facts about the role pets play in health care.

Pets aren’t a cure for everything, however. Sometimes medicine needs to be involved — and when it comes to medications, you want to get all of your questions answered. Take statins, for instance. Statins are known for being effective at lowering cholesterol — and for causing other health problems. If your doctor suggests that you take a statin, go over the benefits and risks. Dr. Kevin Kapov of Southwest Medical Associates takes a look at statins and how misinformation has cast a shadow over the encouraging news.

Speaking of encouraging news, there is some to report regarding cancer care. For men, a new procedure to treat prostate cancer is available. Dr. Andrew Cohen of Comprehensive Cancer Centers reports on a new gel that helps protect surrounding tissue from radiation.

Not only does it act as a barrier against unwanted radiation, but it allows doctors to decrease the amount of radiation involved. Dr. Souzan El-Eid, one of the valley’s top experts when it comes to breast cancer, brings us up to speed and dispels some rumors about treating the disease.

That sort of expertise in crucial in helping form the best course of action when determining your care. There’s a lot of information that needs to be absorbed and little room for error — at any step in the process. Vigilance is required even after treatment is complete. Christian Gitersonke helps medical offices with their billing procedures and he’s identified a few common situations and mistakes that consumers can encounter with their bill. His advice can turn into savings for you.

While we’re focusing on increasing our knowledge, there are many avenues to go down — an MD isn’t the only medical expert in your life. You can also get help from an NP-C, a PA-C or a DO .... ... Wait. Don’t know what those mean? We wouldn’t leave you hanging; Dr. Tracy Wakefield of P3 Health Partners lays out what the abbreviations mean and how they add up to making you A-OK. So let’s not delay any longer; grab your favorite No. 2 pencil (they still make those, right?) and dive in!

Stay healthy!

Craig Peterson Editor of Special Publications craig.peterson@gmgvegas.com

summer 2018

H E A LT H C A R E Q U A R T E R LY

9

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OptumCare is a care delivery organization that improves patient health and helps make health care work better.

OptumCare is a registered trademark of Optum, Inc. All other trademarks are the property of their respective owners. Because we are continuously improving our products and services, Optum reserves the right to change specifications without prior notice. Optum is an equal opportunity employer. ©2018 Optum, Inc. All rights reserved. The company does not discriminate in health programs and activities. For communication assistance, please call 702.242.4357.

ONCOLOGY

A 2018 Update: Our ability to combat breast cancer is headed in the right direction

By Dr. Souzan El-Eid

F More cancer news: A new procedure is helping doctors fight prostate cancer in Southern Nevada.

See Page 52.

rom the measures to stay one step ahead of a potential diagnosis to treating the disease post-diagnosis, the breast cancer landscape has improved leaps and bounds in our lifetime. As a singular example, through history and up until the late 20th century, discovering breast cancer often entailed incredibly invasive, exploratory surgery to seek out a small amount of tissue for cancer testing.

And now, here in 2018, we live in a world with minimally invasive techniques, targeted therapies, promising clinical trials and growing knowledge of what may affect various types of breast cancer.

Amid the improvements, many Americans and their loved ones are still having to endure the pain of a breast cancer diagnosis. In Nevada alone, according to the American Cancer Society, approximately 2,180 women will be diagnosed with breast cancer this year. This figure is up slightly from a projection of 2,010 new cases in 2017.

So, what do you need to know about breast cancer in 2018?

Thinking about the ketogenic diet?

Opt for a Mediterranean diet instead.

A breast cancer diagnosis can lead patients to feel emotional, angry and, in many instances, scared. Patients will look for a fix and there are entities out there that play on that vulnerability.

Fad diets can be especially concerning. One that has made headlines recently is the ketogenic diet for breast cancer patients. A ketogenic diet is a low-carb and high-fat diet, essentially requiring your body to use ketone bodies for fuel instead of sugar. In some cases, this diet has been billed as a way of starving cancer cells, since they typically feed on glucose.

In reality, there is no proven benefit of this diet for breast cancer patients.

In lieu of this fad, a Mediterranean diet is always a safe option — recommended as a healthy, Mediterranean-style eating pattern by USDA guidelines. This diet type is loaded with fresh veggies and fruits, fish, chicken, whole grains, spices with their associated antioxidants benefits, low-fat dairy, nuts and seeds and healthy oil, such as olive oil. Several studies have shown that this diet leads to a decrease in the chances of a chronic illnesses, cancer, diabetes and heart diseases as well as cancers.

In Nevada alone, according to the American Cancer Society, approximately 2,180 women will be diagnosed with breast cancer this year. This figure is up slightly from a projection of 2,010 new cases in 2017.

And, as always, avoid processed meats, refined sugars, saturated fat and keep alcohol consumption to a minimum.

The staging of breast cancer has changed.

Effective January 2018, the way patients’ breast cancer is staged has been updated, based on the American Joint Committee on Cancer’s system (8th Edition). Whereas clinicians previously used lymph nodes, tumor size and metastasized locations to assess a cancer’s stage, now the driving force behind cancer growth, its biology and genomics are taken into consideration, painting a more accurate picture.

Example: Does this cancer grow on hormones? And, if it does, then it has a better prognosis and is down-staged compared to the old staging system.

Start screening at age 40.

The U.S. Preventative Services Task Force says an annual mammography should begin at age 50. The American Cancer Society says 45. And, the National Comprehensive Cancer Network says 40.

I recommend 40 years old to start this routine. Mammogram technology has improved drastically in recent times, including digital tomosynthesis, making it easier to see through dense breast tissue. The sooner and smaller you can catch the cancer, the better and the more curable it is.

Dr. Souzan El-Eid is a breast surgeon with Comprehensive Cancer Centers.

She is also a clinical assistant professor with the UNLV School of Medicine and is past president of the Clark County Medical Society.

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summer 2018

MEDICINE CABINET

Why Take a Chance? Multiple Meds Can Lead to Dangerous Drug Interactions

By Jaclyn Latteri

I

t’s easy to overlook the harmful interactions that may occur when taking multiple prescription drugs, over the-counter medications, vitamins or herbal supplements.

Adverse drug reactions are a significant public health issue that in many cases can be avoided.

als, including pharmacists and nurses as well as your doctors.

• Encourage your health care professionals to commuUnintended drug interactions nicate with each other. Ongoing coordination between may be deadly care providers will enable them to make the most apIt’s common for patients to see different doctors for vari- propriate medical decisions for you and give them better ous conditions, and in turn receive more than one prescrip- access to the most up-to-date information about your tion. Unfortunately, patients who have multiple doctors may course of treatment. not receive consistent guidance as to how the medications • Review your medications on a regular basis with your docthey are taking interact when taken together. tors to determine if they are still needed.

According to a 2017 Consumer Reports survey, more • With guidance from a doctor or pharmacist, stay organized than half of American adults regularly take a prescription by using a dosage schedule and pill box to ensure that medimedication – four, on average – increasing the risk of harm- cations are taken in the right amount at the right time of day ful drug interactions. When prescriptions are combined with or night. over-the-counter medications and herbal supplements, the risk increases. Even coffee or tea may be harmful due to caf- Don’t hold back information There may be situations where patients are afraid or emfeine, which can change how a patient may respond to medication. According to the U.S. Food and Drug Administration, barrassed to talk about their medications, especially when it more than 2 million serious ADRs, caused from one or mul- comes to antidepressants or other drugs used to treat mental illness. The stigma surrounding mental illness may lead tiple drugs, occur every year in the United States, leading to silence instead of sharing. It’s important for patients to to 100,000 deaths. ADRs are the fourth-leading cause of discuss all the medications they are taking with their health death in the country, causing more deaths than pulmonary care professionals. Mental illness is not something to be disease, diabetes, AIDS, pneumonia and car accidents. ashamed of and is very common in the United States. AcKnow what you are taking cording to the National Institute of Mental Health, in 2015, When it comes to taking medication or other supple- there were an estimated 43 million adults 18 and older with ments, follow these important tips: a mental illness, representing nearly 18 percent of all adults in the United States.

• Create a list of the medications and supplements you are Solving the problem taking, and ask your doctors if it’s safe to take all of these The dangers of accidental or adverse drug interactions things together. can be avoided with communication. If you head to the doc• Ask your doctors about side effects, the correct time and tor for a seasonal illness make sure you tell them about all sequence to take each medication or supplement, and what the medications you are taking so you can enjoy the holidrugs should be taken with or without food.

• Share information with all of your health care profession- days with family and friends.

Jaclyn Latteri is the site director of OptumRx Las Vegas. OptumRx serves more than 13.5 million people through its mail-service pharmacies and a national network of more than 67,000 community pharmacies.

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PHARMACY COUNTER

DON’T THINK OF DIETS AS A SHORT-TERM FIX; FIND A LONG-TERM SOLUTION THAT WORKS FOR YOU

By Daniel W. Heller

F

ood medicine is not a new term in our society, but it is one we should revisit. It was Hippocrates that said, “Let food be thy medicine and medicine be thy food.”

While it’s true that medication is needed to solve specific medical issues, the nutrition we receive from food also plays a vital role in our overall health. What we consume effects our daily lives; understanding nutrition is a key part of creating balance within the body.

For the last 15 years, I’ve worked with dieticians, nurses, and prescribers to help patients with a myriad of health issues reach their goals by adjusting the foods they eat (and don’t eat). During that time, I’ve personally given countless sessions of nutrition education and many nutrition tours.

Through mentoring so many patients, I’ve learned several tips that can help anyone glean the most nutritional benefit from their food.

It is easy to view food as something you eat just to feel full. However, by taking the time to understand exactly what you’re putting into your body, you’ll create a lifestyle of positive health and success.

Stop dieting and start changing your lifestyle.

The first question I ask a patient who comes to me with a potential diet plan is: can you maintain this diet for the rest of your life? The answer is usually no, so I ask the patient to consider a lifestyle change instead. It’s true that diets will most likely give some positive effect, but once stopped, generally lead to the regaining of any weight lost. Nearly every time I see a patient able to stop one of their medications for blood pressure, diabetes, or cholesterol, it’s because that patient lost weight due to changes in their lifestyle rather than a temporary diet.

Healthy eating is healthy eating.

A healthy nutrition plan for someone with diabetes, high blood pressure, and high cholesterol is the same for those without such conditions. To put it bluntly, healthy eating is healthy eating. There are no special meal plans for people facing these medical conditions. However, when a patient is dealing with very specific medical conditions (i.e. kidney failure) that require strict control of what is eaten (i.e. potassium, sodium, etc.), there will be specific foods they need to avoid.

Quantity is almost always more important than quality.

The first area you should target is the amount of food you consume. Once you have that conquered, you can focus on quality. Calories are the equivalent of weight, and a person needs to consume roughly 3,500 calories to equal one pound. Cutting out 500 calories per day for just one week will lead to 3,500 less calories consumed and therefore one pound of weight loss if all other factors stay the same. Keep these calories in check, and you can keep your weight in check.

A successful food plan is about more than calorie count; what you eat matters as much as how much

Balance of foods will lead to success.

The main components of food you need to look out for are carbohydrates, protein and fat. It is generally accepted practice to keep these parts of food at 50 percent, 30 percent, and 20 percent of your diet respectively. Carbohydrates are our main energy source. Protein is key for muscle maintenance, and will help us feel full when eating. Fat should be limited due to its effect of adding to our fat tissue. Because it is difficult for our bodies to break down into energy, it generally just adds to our waistline.

Food labels will spell each of these out for you, and so will many smart phone apps.

It is easy to view food as something you eat just to feel full. However, by taking the time to understand exactly what you’re putting into your body, you’ll create a lifestyle of positive health and success. Proper nutrition is integral to living a balanced life, and if you follow the path of food medicine, your body will thank you in the long run.

Daniel W. Heller, Pharm D., is pharmacy practice coordinator for Smith’s Food & Drug Stores.

SUMMER 2018

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SUN SAFETY

SUMMER WEATHER CAN MEAN MORE THAN SUNBURN; HOT SURFACES CAN LEAD TO THE EMERGENCY ROOM

By Dr. Syed Saquib

E See Page 37 for more tips on sun safety.

ach summer, the UMC Lions Burn Care Center experiences an influx of patients with severe burns from touching the pavement and other surfaces that reach dangerous temperatures in the sweltering Las Vegas heat.

The dangers associated with pavement burns can result in life-altering injuries.

With pavement temperatures typically reaching 30 to 40 degrees higher than the air temperature, it only takes a matter of seconds for the pavement to cause dangerous seconddegree burns that can require hospitalization. Depending on the surface temperature and the duration of contact, the pavement can also cause more serious third-degree burns.

Severe burn injuries are often incredibly painful and require highly specialized treatment – including surgical intervention in many cases – to promote recovery and prevent life-threatening infections.

In 2017, UMC admitted 47 patients who suffered pavement burns; we are currently on pace to see an increased number of pavement burn admissions this year. In many cases, individuals sustain pavement burns by walking barefoot or wearing shoes that offer little protection from the hot surface.

UMC also sees patients who faint as a result of heat exhaustion or heat stroke and come into contact with hot pavement, sometimes for extended periods of time. In addition, intoxication can also lead to pavement burns, causing people to lose their footing or pass out on hot surfaces, resulting in similarly dangerous situations.

When people fall onto the pavement, they are essen-

tially cooking on a source of sustained heat, often resulting in deep burns over a large area of the body. These types of burns may require skin grafts, which are surgical procedures that involve the transplantation of healthy skin to the affected area.

A significant number of cases we see involve injuries to the feet. Never walk barefoot on the pavement or asphalt, and ensure children understand the importance of wearing shoes outside. Many backyards in our community have concrete patios that can reach dangerous temperatures, posing a serious risk to children and pets. During the summer months, it is important to wear shoes with thick soles to provide some protection from the hot pavement. Socks alone do not provide adequate protection from the heat, as the hot pavement can easily burn through socks and other clothing.

Remember, virtually every surface in the Las Vegas summer heat can get hot. Metal equipment and door handles can be especially harmful.

Our team encourages community members to avoid prolonged exposure to the heat. We urge people to stay hydrated and periodically spend time in the shade. Always remember to wear sunscreen with a minimum SPF of 30. In addition to playing a vital role in the prevention of skin cancer, sunscreen can help prevent painful sunburns. In some cases, individuals with serious sunburns may need care from medical professionals, potentially including a burn specialist.

If you or your loved ones experience a serious burn injury this summer, do not wait to seek treatment. Many burn injuries demand immediate attention from qualified professionals, and delayed care can result in less favorable medical outcomes.

At the UMC Lions Burn Care Center, our team is committed to providing community members with access to the highest level of burn care. While we offer a world-class team that is equipped to treat the most severe burn injuries, we also focus heavily on preventing injuries. We would prefer to see community members enjoying the summer with their friends and families, rather than spending the summer receiving extensive medical treatment.

By Dr. Syed Saquib is the medical director of the UMC Lions Burn Care Center.

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SUMMER 2018

HAPPY

1,000

TH

We’d like to congratulate Dr. Mulugeta Kassahun on performing 1,000 surgeries with the state-of-the-art da Vinci robot. And while every successful procedure is cause for celebration, we’re proud to recognize this important milestone.

USONV.COM ©2018 Urology Specialists of Nevada. All rights reserved.

H E A LT H Y P o c k et b o o k

Knowing the numbers: Mistakes can hide in a medical bill; understanding where they might be can save you money

By Christian Gitersonke

N

avigating the health care system can be tricky and intimidating. Understanding your insurance benefits, how they work, what provider you are allowed to see and how much it will cost can be overwhelming. Coupled with this, 67 percent of all medical claims have some error that usually favors the insurance carrier and not the patient, according to data from AR Rescue that looked at 127 clinics and 1.6 million individual claims in Nevada, Arizona, Indiana and Texas. These can present challenges at a time when a person wants to focus on rest and recovery, not paperwork and processing.

AR Rescue provides billing help for medical offices. Over the course of time, the company identified some of the common billing situations — from modest errors to exorbitant bills — that consumers encounter.

Know your deductible: Check your insurance paperwork to be familiar with your deductibles and how they are to be collected.

It’s a common practice for offices to ask for payment upfront; this payment would likely go toward your deductible. If you are faced with a medical situation that requires a number of different specialists, all of those upfront payments will accrue. This is a common practice and many times puts a financial strain on the patient. Many commercial health plans no longer allow this practice and with good reason.

By the time your bills are processed by the insurance company, it may determine you only owe one office any money from your deductible — it’s good news, financially, but you now have the painstaking process of trying to figure out how much money should be refunded to you and by whom.

To further complicate matters, practices may not refund the money until the insurance company has completely settled their bill.

Knowing your deductibles will help you ensure that this situation doesn’t arise; contact your insurance company if it does.

Medicare patients and non-covered services: Medicare is a robust engine that drives what other insurance companies pay. One common error involves the Advanced Beneficiary Notice. An ABN is simply a form that a physician’s office must get signed from a patient. It acknowledges that a specific service or procedure will probably not be covered by Medicare and the patient agrees to the out-of-pocket costs (that may not be cov-

ered by insurance). The ABN must be signed each and every time a patient has a service done that will more than likely be denied by Medicare. If this form is not signed by the patient and the service is denied by Medicare, the provider cannot bill the patient for that service. This is by far one of the most common situations we see when Medicare patients are sent to collections.

Asking for a reduced bill: A practice cannot waive copays.

That’s a direct violation of almost every insurance contract and can cause the provider to lose the contract. You can ask for an overall reduction in your bill. The doctor doesn’t have to comply, but a request made kindly can turn into savings.

Hardship writeoff: A little-known assistance program is a hardship writeoff. This can reduce or completely waive a patient’s balance. This is a debt-forgiveness program; forms range from simple one-page requests to multipage applications requiring extensive financial explanation and documentation.

The silver lining is that in most hardship requests AR Rescue has seen, an approval for either a partial or full forgiveness of the bill has been arranged.

Settle your account: If your problem is a large bill, you may be able to request a settlement agreement. With a settlement agreement, the facility or physician takes a greatly reduced payment up front and writes off (forgives) the remainder of the debt. This not only works for old health care bills but can be used when negotiating an up-front cost for a procedure. This step could affect your credit score, depending on if your bill has been sent to collections.

Collection accounts: One great driver for bankruptcy are health care bills that find their way to a collection agency.

Most people only discover this when they go to apply for a mortgage or vehicle loan and see their credit score. We have found that about half of these were assigned in error.

If a patient discovers a medical bill is in collections, the patient should immediately call and send in a certified letter with return receipt to the collection agency formally notifying them this bill is in dispute. This allows a 30-day window to resolve this without it being reported on the patient’s credit report. If it is already on the credit report and can be proved it was not the patient’s liability, the collection agency must remove it from the report as a deletion, so it will be as if it never happened.

Christian Gitersonke is the CEO of AR Rescue.

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SUMMER 2 0 1 8

bonus question

How many calories are in a roll of Smarties?

25. There are 25 calories in a roll of Smarties.

That’s the only freebie we’re giving you on this quiz. Turn to page 32 for the rest of the answers.

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summer 2018

questions

let’s play it

By craig peterson

Po p, p o p Fizz, fizz

Now’s a good time to take a quiz

W

e know that the thought of a quiz can leave a sour taste in your mouth and we don’t want to sugarcoat it — some of these questions are hard. But don’t let that intimidate you. Grab your favorite study snack and settle in — it’s time to take a test!

START

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25

QU IZ

To provide proper care, nurses are taught to follow FIVE STEPS in assisting patients.

While every patient is different, those steps follow the same trajectory, according to WGU Nevada’s College of Health Professionals.

Place them in order: A DIAGNOSIS B IMPLEMENTATION C ASSESSMENT D PLANNING E EVALUATION

People with diabetes should eat: A SPECIAL ‘DIABETIC’ FOODS B AN ALL-BACON DIET (HOORAY FOR PROTEIN!)

The sun is baking and the UV index is staying steady in the 8 to 10 range (very high).

C NO SUGAR

The best way to keep your skin safe and avoid a painful and potentially dangerous burn is to:

D NONE OF THE ABOVE

03

At what age should I start having regular colon and rectal cancer screenings?

A 20 C 45

B 35

A USE SUNSCREEN WITH AN SPF 30 OR HIGHER AND REAPPLY REGULARLY OR EVERY 2 HOURS B AVOID LONG-TERM, DIRECT SUN EXPOSURE BETWEEN 10 A.M. AND 4 P.M. C WEAR SUN-SMART CLOTHING D A, B AND C

D 50

E IN A PINCH, USE HOMEMADE SUNSCREEN

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05

How many Nevadans use Medicaid?

A MORE THAN 400,000 B MORE THAN 600,000 C MORE THAN 800,000 D MORE THAN 1 MILLION

reevaluate S

U

C

C

E

S

S

In healthcare education programs around the country, the old saying has been “C’s get degrees”. Roseman uses frequent evaluation within its Six-Point Mastery Learning Model to insure all students are not only grasping but mastering the complex content they are learning. Students are assessed every two weeks and must achieve a 90% or better on every evaluation to move on. It’s not just a number, it’s about training students in a different way so they can maximize classroom time and learn by doing. Roseman University of Health Sciences has been reevaluating the meaning of success since our inception in 1999. Using the Six-Point Mastery Learning Model we train a different kind of student to thrive and practice in today’s complex world of medicine and patient care.

Challenge. Reevaluate. Roseman.

Learn more at roseman.edu

Death and grieving are universal experiences that everyone will go through.

Place the stages of the grieving process in their common order: A ANGER

D ACCEPTANCE

B DEPRESSION

E BARGAINING

C DENIAL

07

IDENTIFY THE NEVADA CRITTER: I’m known as Centruroides sculpturatus in academic circles. Even though I’m the most venomous one of my kind, I don’t cause many human fatalities — but I’m quite capable of causing a lot of pain.

What am I?

COLLEGE OF DENTAL MEDICINE COLLEGE OF NURSING

COLLEGE OF MEDICINE COLLEGE OF PHARMACY

MASTER OF BUSINESS ADMINISTRATION

A GOPHER SNAKE B MOJAVE FRINGE-TOED LIZARD C BARK SCORPION D WOLF SPIDER

11 Sunset Way | Henderson, NV 89014 | 702-990-4433 10530 Discovery Drive | Las Vegas, NV 89135 | 702-802-2841 10920 S. River Front Parkway | South Jordan, UT 84095 | 801-302-2600

roseman.edu | @rosemanuhs

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27

QU IZ

Ready to put down your pencil and take a smoke break? Sigh.

We’ll wait. The percentage of people who smoke cigarettes nationally is 17.1 percent.

How does Nevada’s percentage compare?

A 10.5% OF NEVADANS SMOKE B 16.5% OF NEVADANS SMOKE C 19.5% OF NEVADANS SMOKE D 35.5% OF NEVADANS SMOKE

Every year, the American Lung Association and the Stratosphere invite people to SCALE THE STRAT. Participants climb the stairs of the tall tower to raise money for charity.

How many stairs do they climb?

A ALMOST 1,500 B ALMOST 2,000 C ALMOST 2,500 D ALMOST 3,000

The most effective treatment for colorectal cancer is: A A DIET OF ALL-NATURAL FOODS B SUPPOSITORIES AND ENEMAS C THERE IS NO KNOWN CURE AT THIS TIME D PREVENTION THROUGH TESTING

11 Ah, Nevada. The “SILVER STATE,” thanks to an abundance of ore that was also easy to extract in the mid-1800s.

Our supply of it helped us establish statehood.

What health benefits does silver have?

A RUBBED ON THE SKIN, SILVER IS AN EFFECTIVE ANTIBACTERIAL AGENT B AS A ROCK, SILVER PROVIDES VALUABLE ROUGHAGE IN THE BODY C THE REFLECTIVE POWERS OF SILVER HELP COMBAT THE SUN’S DANGEROUS RAYS, MAKING SILVER JEWELRY A NATURAL AND PRETTY SUNSCREEN D NONE

QU IZ

13 A team of employees from RB (formerly Reckitt Benckiser) helped out our community by filling 1,512 backpacks at their annual health conference.

Beyond helping local children, what made this especially distinctive?

A THE EMPLOYEES DID IT WHILE JUMPING

Shingles isn’t life threatening but it can be a very painful affliction.

What is it?

A AN ALLERGIC SKIN REACTION TO DEODORANT OR COSMETICS B AN INFECTION CAUSED BY THE CHICKENPOX VIRUS

B THE EFFORTS SET A GUINNESS WORLD RECORD

C RELATED TO JOB-RELATED INJURIES COMMON IN THE CARPENTRY AND CONSTRUCTION INDUSTRY

C THE BACKPACKS WERE AIR-DROPPED OVER VALLEY SCHOOLS

D A FORM OF ACNE

D ALL OF THE ABOVE

15 Your refrigerator seems cold — at least the ketchup is totally fine ... or is it?

At what temperature should the fridge be set to ensure food safety?

A 40° F OR BELOW B 30° F OR BELOW C 55° F OR BELOW D 0° F OR BELOW

On a hot day, your friend is complaining of headache, nausea, dizziness and weakness. Their skin is cool, moist, pale and appears ashen or flushed. What’s wrong?

Suicide is the ______-leading cause of death in Nevada.

A ROCKIN’ PNEUMONIA AND BOOGIE-WOOGIE FLU

A FOURTH

B HEAT STROKE

B FIFTH

C HEAT EXHAUSTION

C SIXTH

D HEAT CRAMPS

D SEVENTH

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29

QU IZ

Knowing your family health history is important. Consider this woman’s family tree: Her mother’s great-grandmother had breast cancer. Her mother’s father had prostate cancer. Her mother was diagnosed with breast cancer in her 50s.

For women who are concerned about their risks of cancer, the best course of action is to: A PERFORM MONTHLY SELF-BREAST EXAMINATIONS AND BEGIN BREAST IMAGING AT AGE 40 B PERFORM MONTHLY SELF-BREAST EXAMINATIONS AND HAVE YEARLY PAP SMEARS C SEE YOUR HEALTH CARE PROVIDER FOR ADVICE D CONSIDER HAVING GENETIC COUNSELING AND/OR GENETIC TESTING, IF APPROPRIATE E C AND D

19 According to data from the Association of American Medical Colleges, there are 271.6 active physicians per 100,000 people nationally.

Nevada has _____ physicians per 100,000 people.

A 150 B 165

Eliza Cook occupies a notable place in Nevada history.

What is it?

A SHE OPERATED A CLINIC FOR WORKERS BUILDING HOOVER DAM, MAKING HER THE HIGHEST-PAID WOMAN INVOLVED WITH THE PROJECT B SHE WAS NEVADA’S FIRST FEMALE DOCTOR C A GLOBAL HERO, SHE INVENTED THE MODERN BANDAGE D SHE WAS THE FIRST WOMAN TO RIDE A BIKE ACROSS THE STATE

Raw, unpasteurized milk is a great alternative to pasteurized milk.

C 200

A TRUE

D 220

B FALSE

Eliza Cook photo courtesy of nevadawomen.org/Nevada Women’s History Project

Know Your Cancer Risk.

Get Tested Today.

Cancer Genetic Counseling New at Comprehensive Your genes can predict your risk of certain cancers.

Today, there are genetic tests that could help your doctors provide more effective treatment. If you have a history of cancer in your family, you may be at higher risk. And as Southern Nevada’s only oncology practice to offer Cancer Genetic Counseling, Comprehensive can help you better understand how your genetic history might affect your future health.

Learn more. 702.862.1111 cccnevada.com/cancer-genetic-counseling Photo Credit

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qu iz

answer key 1

ANSWER: C, A, D, B, E

The curriculum of WGU (Western Governors University) Nevada’s College of Health Professionals teaches the steps as set forth by the American Nurses Association: (C) Assessment, (A) Diagnosis, (D) Planning, (B) Implementation and (E) Evaluation. An assessment is the first step in the process; a nurse will seek data not only about the immediate physical problem but will take into account other factors in a patient’s life. The next step, the diagnosis, becomes the basis for a care plan. The planning phase is the time when a nurse and patient will discuss goals for care. The implementation phase is the point when the care is being undertaken. The evaluation phase can be considered ongoing as changes to a care plan are contingent on how the care is progressing.

2

ANSWER: D

According to the American Diabetes Association, a healthy meal plan for people with diabetes is generally the same as a healthy eating for anyone – low in saturated and trans fat, moderate in salt and sugar, with meals based on lean protein, non-starchy vegetables, whole grains, healthy fats and fruit. “Diabetic” foods generally offer no special benefit.

Most of them still raise blood glucose levels, are usually more expensive — and can also have a laxative effect if they contain sugar alcohols.

3

ANSWER: C

According to Dr. Anthony Nguyen with Comprehensive Cancer Centers, people should start getting screened for colorectal cancers at age 45. In May 2018, the American Cancer Society lowered its age recommendation from 50 to 45, as Americans are now being diagnosed with colorectal cancers at younger ages. Recently released data from JAMA Surgery indicates that colorectal cancer in those 20 to 34 years old will increase by more than 90 percent by the year 2030. Americans born in 1990 or later are now two times more at risk for colon cancer and four times more at risk for rectal cancer than in the 1970s. Thus, if you have a family history of colorectal cancers, it’s important to start your screening regimen even earlier.

4

5

ANSWER: B

According to Las Vegas HEALS, more than 640,000 Nevadans rely on Medicaid. President Lyndon B. Johnson signed the legislation enacting Medicaid and Medicare in 1965. Las Vegas HEALS, a nonprofit health care organization, has been instrumental in helping Medicaid expand in Nevada.

6

ANSWER: C, A, E, B, D

According to the Nathan Adelson Hospice, the commonly identified stages of grieving were proposed by Dr. Elisabeth Kubler-Ross. The stages, in order, are (C) denial, (A) anger, (E) bargaining, (B) depression and (D) acceptance. Kubler-Ross’ work, “On Death and Dying,” is one of the preeminent texts on the subject.

7

ANSWER: c

The Arizona bark scorpion has a nasty sting — pain and numbness can last up to 72 hours but it’s rarely fatal. According to the Arizona-Sonora Desert Museum, they can be found in houses. Fortunately, they’re big enough to be seen and they glow green under ultraviolet light. The gopher snake, Mojave fringe-toed lizard and wolf spider are harmless to humans.

8

ANSWER: B

That’s right; Nevada’s average for smoking is lower than the national average, according to 2016 numbers and truthinitiative.org. The Centers for Disease Control reports that almost half of Nevada’s smokers — 47.5 percent — quit smoking for one day or more in 2016.

9

ANSWER: A

Participants in Scale the Strat-Las Vegas Fight For Air Climb go up 1,455 stairs. It’s a quick trip for the hearty and persistent — Josh Duncan from Illinois completed this year’s climb in 8 minutes and 10 seconds.

The Stratosphere climb might be considered a cake walk among stairclimbing events; the Fight For Air climb in Chicago uses four buildings and 2,340 stairs.

ANSWER: D

According to Dr. Wolfram Samlowski, skin cancer and melanoma expert at Comprehensive Cancer Centers, broad spectrum, SPF 30 (or higher!) should be your No. 1 skin-protecting defense this summer or any season. Whether at the pool, on the golf course or even if your arm is exposed as you drive down the highway on a cloudy day, you’ll want to reapply regularly or every 2 hours. Where possible, wear wide-brimmed hats, long-sleeve shirts and pants and avoid long-term exposure in the heat of the day.

As for a homemade sunscreen remedy? It’s best not to take a chance on your skin and go with a trusted, commercially available sunscreen that’s waterproof, paraben-free and oxybenzone-free.

10

ANSWER: D

According to Dr. Nicholas Tibaldi, department chief for gastroenterology at Southwest Medical Associates, the most effective treatment is prevention; the cancer is easily detected with a colonoscopy. “A colonoscopy really can prevent cancer altogether,” said Tibaldi. “Colon cancer, especially early on, doesn’t usually cause detectable symptoms, so screening is your best defense.” Over 50,000 Americans die from colorectal cancer each year. In cancers that affect both men and women, it’s the number-two cause of deaths in the United States. It’s estimated that recommended screenings could prevent at least 60 percent of these deaths. Another screening option is the fecal immunochemical test you can do at home and then mail to a lab for analysis. It’s a lowcost, no-risk stool test you can do at home that finds 70 to 80 percent of cancers. It’s a good option if you can’t have a colonoscopy.

11

ANSWER: d

Silver has no known health benefits, according to the Mayo Clinic and the US Department of Health and Human Services. It is not an essential mineral and no reliable studies on health benefits have been published.

12

ANSWER: B

RB is British company; the backpack filling was part of a recent conference. To achieve the record, backpacks had to be filled in one hour, contain five different school supplies and be zipped at the end of the hour. They were distributed to the Andre Agassi Foundation and the Boys and Girls Club of America.

16

17

ANSWER: B

Shingles is a contagious virus that can spread from a person with active shingles and cause chickenpox in someone who’s never had chickenpox or the chickenpox vaccine. Symptoms include pain and a rash on one side of the body. The virus is spread through direct contact with fluid from the rash blisters.

It most commonly affects older adults and people with weakened immune systems. Dr. Neil Gokal of Southwest Medical Associates says that “shingles is one of those times when ‘waiting is worse.’” If you think you have shingles, cover the rash, avoid touching or scratching and wash your hands frequently to prevent the spread and contact your doctor’s office. The only way to reduce the risk is to get vaccinated. The CDC recommends people aged 50 years and older get one dose of shingles vaccine, which is available in most pharmacies and doctor’s offices.

14

ANSWER: c

If you suspect heat exhaustion, take these steps immediately: move the person out of the heat and into a shady or air-conditioned place; lay the person down and elevate the legs and feet slightly; remove tight or heavy clothing and have the person drink cool water or other nonalcoholic beverage without caffeine. According to Dr. James Joslin of Southwest Medical Associates, if not treated, this condition can progress to heat stroke, a life-threatening condition. With heat stroke, the body systems are overwhelmed and begin to stop functioning.

Signs include extremely high body temperature; red skin which may be dry or moist; changes in consciousness; rapid, weak pulse; rapid, shallow breathing; confusion; vomiting, and seizures. Home treatment isn’t sufficient for heat stroke — seek emergency medical help immediately. Others should take steps to cool the person off while waiting for help to arrive.

15

ANSWER: a

Set your refrigerator to 40 degrees Fahrenheit or below for optimal food safety, according to the USDA. The freezer should be set at 0 degrees F or below. You can check the temperature using a freestanding appliance thermometer. And the USDA offers this cooking tip — meat and poultry that has been properly defrosted may be refrozen either before or after cooking.

ANSWER: E

According to cancer genetic counselor Barbara Caldwell of Comprehensive Cancer Centers, approximately five to 10 percent of cancers have a hereditary component, making genetic risk assessments and counseling vital in early detection efforts as well as customizing treatment plans. Getting providers involved in the process is also important.

18

13

ANSWER: d

Suicide is the seventh-leading cause of death, according to the CDC.

ANSWER: c

Nevada is near the bottom of the country when it comes to having enough doctors to treat people. According to Dr. Matthew Martin, assistant professor in Touro University Nevada’s College of Osteopathic Medicine, the best way to remedy the physician shortage in Nevada is to increase the number of post-graduate residency training positions. While that number has increased, Nevada is still inadequate compared to other states. Physicians are more likely to stay where they do their residencies.

19

ANSWER: b

Eliza Cook, born on Feb. 5, 1856, in Salt Lake City, began practicing medicine in 1891. She received her Nevada medical license in April 1899.

She was a physician in Reno and the Carson Valley. She was also active in temperance efforts and a supporter of women’s rights. Cook retired from medicine in 1921 and died in her sleep on Oct. 2, 1947. She was 91.

20

ANSWER: False

Unpasteurized milk is not a safe alternative to pasteurized milk, according to the CDC and the Nevada Department of Agriculture. Raw milk products carry a higher risk of bacterial contamination. Young children, the elderly, and those with compromised immune systems are particularly at risk. In addition, the NDA reports that there is no significant difference in the nutritional value of unpasteurized milk.

1-5 Correct. That’s OK.

It was a tough quiz and we didn’t give you any time to study.

6-10 Correct. You did great!

You’re on the right track to knowing how to live a healthy life.

11-15 Correct. Phenomenal!

Continue your studies of health care; it will serve you well.

16-20 Correct. You get a PhD

from Health Care Quarterly University! Great job!

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TOP INTERVENTIONAL CARDIOLOGIST 2018 T

R

I

P

L

E

B

O A

R

D

C

E

R T

I

F I

E D

Z I A U. K H A N M D , FAC C , F S C A I

w desertcardio.com p 702-822-2273 e jmuncie@desertcardiology.net 5785 Fort Apache Rd. Ste A-100 Las Vegas, NV 89148

Michael Orth and his 2-yearold Basenji mix, Hope, relax during an outing.

more than just our favorite targets for snuggles, pets can be crucial to our health

By Lindsey Reynolds

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Pets can reduce stress and lower blood pressure for their owners and anyone they meet.

Michael Orth is a “grandfather” to Hope, a 2-year-old Basenji mix.

P

ets can have an amazing effect on their owners. From unconditional love, to support, to completing duties such as a therapy animal would, pets benefit their humans’ lives, particularly as we age.

As we age, social interactions may be hampered by health conditions, preventing us from doing activities we once enjoyed. Pets can help fill the gap by being great companions, reducing stress and lowering blood pressure.

They can also help motivate us to get out

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and interact with others. A 2013 study published in the Journal of Physical Activity and Health found that “dog owner/dog walkers… participated in nearly 50 percent more total walking than nondog walking groups.”

Another study discovered subjects experienced a significant decrease blood pressure while petting a dog, which was equal to the relaxation effect of reading.

Michael Halpern, 65, and his pal, Zoey couldn’t agree more. Shortly after Michael moved to Las Vegas from New York he began the hunt for a canine companion. He

summer 2018

traveled to a Utah shelter to adopt a dog he’d learned about online only to discover it had already been adopted by the time he arrived. The shelter staff felt terrible, but there was a silver lining – a new threeyear-old rescue was coming in from Texas.

She had been rescued from a dog-fighting ring where she was used as a bait dog.

Halpern was prepared for a big training challenge, but when he met Zoey, he was pleasantly surprised. She was so sweet and docile, she quickly became a certified therapy dog with a local organization,

Photos by Christopher DeVargas

How seniors can beat the heat: Tips for staying active and safe

By DR. EFREM CASTILLO

Zoey takes a break in the shade during a stroll at Trails Park.

TODAY’S SENIORS ARE MORE ACTIVE THAN EVER BEFORE. However, as temperatures rise, so do the risks of heat stress. Extreme heat can be dangerous for anyone, but older adults are especially vulnerable.

The best defense against heat stress and related illnesses is staying informed, prepared and alert.

1 Know the signs. Be alert for common signs of heat exhaustion, which include heavy sweating, paleness, muscle cramps, tiredness, weakness, dizziness, headache, nausea, vomiting and fainting. Seek medical attention.

2 Stay hydrated. Your body needs more water than you may think – and you need to drink before you are thirsty. Ask your doctor how much you should be drinking if you are directed to limit fluids due to medications.

3 Time it right and take plenty of

breaks. Make the most of early morn-

Hope, left, and Zoey take Michael Halpern and Michael Orth for a walk.

Michael’s Angel Paws. Now Halpern and Zoey have a full touring schedule around the Las Vegas Valley at senior care centers, children’s hospitals and with other groups needing stress relief assistance.

Pets can reduce stress and lower blood pressure for their owners and anyone they meet. They can also boost mood and lessen loneliness. Many seniors have reported a better quality of life when they have a pet.

Several studies found that having an animal who relies on an older adult for care

ing and evening hours (before 11 a.m. and after 4 p.m.) when temperatures are cooler.

4 Don’t let the heat keep you sedentary. When it’s too hot for your usual outdoor jog or bike ride, explore indoor-based activities at the gym or your community center. Many Medicare Advantage plans cover gym memberships.

5 Use the buddy system. If you choose to do an outdoor activity when it’s hot, bring a friend. Besides enjoying each other’s company, you can help each other stay alert to any signs of heat stress or get help if necessary.

6 Skip the stove. Cooking can heat up your living space quickly, so avoid turning on the stove or oven when it’s very hot.

Dr. Efrem Castillo is the chief medical officer of UnitedHealthcare Medicare & Retirement.

How pets can beat the heat:

Tips for those all-important trips outside From THE AMERICAN SOCIETY FOR THE PREVENTION OF CRUELTY TO ANIMALS 1 Don’t let your pets linger on hot asphalt. They can develop burns on sensitive pads and, being so close to the ground, can heat up quickly., 2 Don’t shave your dog. A good grooming can look refreshing but the layers of hair help protect dogs from overheating and sunburn.

3 Do brush your cat. It can help

problems caused by excessive heat.

4 Know what overheating looks like: excessive panting or difficulty breathing, increased heart and respiratory rate, drooling, mild weakness, stupor or collapse. Advanced symptoms can include seizures, bloody diarrhea and vomit and an elevated body temperature of more than 104 degrees.

Continued on page 39

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Some of Southern Nevada’s animal welfare organizations include: THE ANIMAL FOUNDATION 655 N. Mojave Road, Las Vegas 702-384-3333 animalfoundation.com FORECLOSED UPON PETS forecloseduponpets.org 702-272-0010 HEAVEN CAN WAIT 546 N Eastern Ave, Suite 175 Las Vegas hcws.org A HOME FOR SPOT ahome4spot.com LAS VEGAS VALLEY HUMANE SOCIETY 3395 S. Jones Blvd., #454 Las Vegas, NV www.lvvhumane.org 702-434-2009 NEVADA SOCIETY FOR THE PREVENTION OF CRUELTY TO ANIMALS (NEVADA SPCA) 4800 W. Dewey Drive, Las Vegas 702-873-SPCA (7722) www.nevadaspca.org WAGGING TAILS waggingtailsrescue.org

For more information about pet therapy, contact: LAS VEGAS ANIMAL ASSISTED THERAPY vegasanimaltherapy.com 702-232-5048 LOVE DOG ADVENTURES lovedogadventures.com 917-301-4710 MICHAEL’S ANGEL PAWS www.michaelsangelpaws.org

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Halpern met Zoey at a Utah shelter. Zoey had been rescued from a dog-fighting ring where she was used as a bait dog.

Continued from page 37

and attention provides a significant sense of purpose that can decrease feelings of isolation and depression.

Before adopting a furry, feathered or scaly companion be sure to do your research. The American Veterinary Medical Association suggests that you consider the following questions: • Do you already have any pets? If so, will your current pet accept another pet of the same or a different species? If you’re not certain, your veterinarian can help you answer this question.

• What are you looking for in a pet?

Do you want a lap warmer? A walking companion? A pet that’s easy to care for?

This will affect your pet choice. Who will care for your pet? Consider the experience level and abilities of the caretaker who will provide for the pet.

• Do local laws or your housing arrangement limit your choice of pet? If you rent, your landlord may restrict the type or number of pets you can have. Condominium and townhouse associations may have similar restrictions. Consider also the amount of exercise your pet will need, and whether your living arrangements accommodate that need.

• Are you able to provide the amount of attention your pet will need? And how many years are you willing to commit yourself to caring for a pet? Animals have differing needs for companionship and attention, as well as differing life expectancies.

• Can you afford the costs of caring for your pet? Some species or breeds of pets have special needs that may require additional cost or effort. Think of the needs your pet will have for food, housing, socialization, exercise, grooming and veterinary care, and make sure you can afford and are willing and able to provide them.

• How long will you be away from your pet? Do you work long hours or travel frequently? Some pets need more frequent exercise or feeding, and might not be a good choice for owners who spend a lot of time away from home.

• Who will care for your pet in your absence? Consider not just short-term absences, but also what might happen if your pet outlives you, and plan accordingly

Feeling a little more adventurous than a volunteer position?

Consider fostering an animal. for your pet’s care.

For many seniors, the cost and responsibility of owning a pet may be more then they can handle. However, several research studies show that seniors who volunteer with an animal shelter or rescue organization can also see the same benefits of owning a pet.

There are many Southern Nevada organizations who provide various volunteer opportunities to work with animals. The Nevada Society for the Prevention of Cruelty to Animals and The Animal Foundation need help with grooming and walking animals and assistance at animal adoption events. Check out the listing of some of the valley’s animal organizations and find one that suits your talents and availability.

Feeling a little more adventurous than a volunteer position? Consider fostering an animal until they find their forever home.

There are a multitude of nonprofit rescue organizations who need good foster homes while their rescues await adoption. While this takes more time and commitment than being a volunteer, many animals need dedicated love and care before they head off to their permanent homes.

Even if you are unable to own a pet or volunteer, don’t count yourself out of the benefits pets can offer. There are many pet therapy organizations that will bring a therapy animal, like Zoey, to you. Research

conducted in a nursing home group therapy session showed that visits by trained therapy dogs stimulated interpersonal communication skills among older adults.

These positive benefits usually continue after the therapy session.

In some cases, like that of Michael and Connie Orth, having a “grand dog” has its benefits. They often care for their daughter’s dog, a white Basenji mix named Hope, showering her with love, attention and, of course, plenty of treats. “One of the best benefits of having a ’grand dog’ is much like the benefits of grandchildren,” said Connie. “You can send them back to their parents when you’ve had enough.”

Pets take responsibility and some financial commitment, but the health benefits, love and support they provide is priceless.

Pet and love your furry, feathered or scaly friends and enjoy your health together!

Lindsey Reynolds, PA-C, is a primary care practitioner with P3 Nevada Medical Group and is the proud owner of two Labrador Retrievers.

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By Chris Kudialis

Understanding the parlance of pot and how marijuana’s makeup can affect your ailments

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Photo Credit

Photo Credit

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Marijuana concentrates are displayed at Exhale Nevada

Tony Candelaria, a budtender at the Exhale Nevada marijuana dispensary, spent his early career educating people about nutrition and fitness as a personal trainer and smoothie vendor in Los Angeles.

He began working in California’s marijuana industry in 2016 before he moved to Las Vegas, where state law requires the chemical properties of the plant to be listed for buyers.

“I learned in California that when budtenders could educate people on weed, their sales improved,” he said.

Preliminary economic analyses of the Silver State’s fastest-growing industry estimate that legal recreational cannabis raked in about $305 million in sales from July 2017 to March and could contribute more than $70 million in tax revenue to state coffers in the industry’s first year.

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The number is expected to grow as more users study the medical effects of marijuana.

Candelaria is part of a 30-person team at Exhale Nevada that focuses on educating people about marijuana’s chemical compounds.

“A lot of times you get buyers that come in and just ask for the highest THC strain or either a strong indica or sativa,” he said.

“But there’s so much more to finding the right strain.”

Years of marijuana cross-breeding and mislabeling in both the legal and illegal markets has made evaluating a strain’s cannabinoid and terpene properties more important than ever, Candelaria said.

Photos by Steve Marcus

Terms _CANNABINOIDS The most active ingredients “by far” in marijuana, cannabinoids like Tetrahydrocannabinol (THC) and Cannabidiol (CBD) provide users with a range of effects, from head highs to pain relief and sleep aid, said Todd Denkin of Las Vegas-based DigiPath Labs. Less common cannabinoids like Cannabinol (CBN) and Tetrahydrocannabivarin (THCv) help reduce anxiety and suppress appetite.

Of about 110 known cannabinoids, THC and CBD are the most common.

Each marijuana strain is made up of different cannabinoids with varying potencies. Industry officials say patients can find strains to suit their own health needs through research and consultations with dispensary budtenders.

_

TERPENES Terpenes are found in lesser quantities in marijuana. Metaphorically, budtenders tell clients to picture cannabinoids as a car and terpenes as its driver. Or in Candelaria’s case, picture cannabinoids as the cake and terpenes as the frosting. Together, terpenes with the cannabinoids produce an “entourage effect,” working together to produce and enhance various aspects of the plant’s psychoactive effects.

THC (Tetrahydrocannabinol)

_

Affecting mainly the central nervous and immune systems, THC is the primary psychoactive component of marijuana.

It’s used specifically for painkilling, antiinflammatory and appetite-stimulating effects. It can also combat depression.

Photo Credit

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_CBD (Cannabidiol)

INDICA

Researchers say the nonpsychoactive, second-most common cannabinoid has shown the most medical potential among cannabinoids, and actually has an antipsychotic effect that can decrease the high from THC when taken after THC consumption. It’s also touted as a potent anti-cancer, anti-inflammatory and anti-anxiety compound.

CBN (Cannabinol)

_

Marijuana products produced by indica plants generally have higher cannabidiol (CBD) concentrations and lower tetrahydrocannabinol (THC) counts than sativas. Indica strains are known for their sedative effects and are most commonly used for pain relief, appetite stimulation, relaxation and assistance with falling asleep.

With about 10 percent the psychoactive potency effect of THC, CBN is used as a sleep agent to help users suffering from insomnia. It also helps with anxiety and convulsions. CBN is the primary product of THC breakdown, meaning light and oxygen exposure can cause CBN content of a marijuana strain to increase as its THC content degrades.

THCv (Tetrahydrocannabivarin)

_

Its molecular composition is identical to THC, but THCv’s molecular sequence is different. It produces a more psychoactive and energetic high than THC, and researchers say that instead of increasing a person’s appetite, THCv suppresses it.

CBC (Cannabichromene)

_

CBC does very little on its own. But when paired with high amounts of THC, CBC can strengthen THC’s painkilling, anti-inflammatory, appetite-stimulating and depression combating effects. Limited research suggests that CBC on its own can work as treatment for acid reflux by reducing gastrointestinal inflammation.

CBG (Cannabigerol)

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Acting as a potent muscle relaxant and anti-anxiety treatment, CBG is also touted as an agent for blocking the growth of tumors.

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HYBRID Combination strains of both indica and sativa plants come in three general variations.

Sativa-dominant hybrids combine the euphoric brain effects typical of sativa strains with a slight relaxing effect to a user’s body. 50/50 hybrids produce a near-equal balance of head and body highs, and indica-dominant hybrids provide full-body pain relief with a slight head high.

SATIVA Sativa strains are known for their high tetrahydrocannabinol (THC) levels that contribute to euphoric feelings for users. Sativas boost serotonin levels in the brain and are popularly used to promote creativity while treating anxiety, depression and lethargy.

Photo Credit

Myrcene Believed to act in synergy with THC to create an enhanced high, myrcene is known for its sedative effects and is used as a sleep aid. It has a citrusy scent and is prevalent in mangos.

Terpineol Pinene Alpha-pinene is the most prevalent terpene in nature, giving pine trees their fresh smell and serving as a natural insect repellent. Found in marijuana strains Chemdawg and Trainwreck, among others, alpha-pinene relaxes and widens the bronchial muscle of users, and is thought to be a helpful asthma-treating agent. Cannabis researchers believe the terpene also aids in helping a user become more alert.

Beta-Pinene Found in Strawberry Cough and Island Sweet Skunk strains, among others, beta-pinene has more of a parsley and basil scent. It can produce a more euphoric high for pot users and is believed to assist in relieving depression.

Limonene With a citrus aroma and taste, it is found in lemons—as its name suggests—and many sativa strains, like Chernobyl. Like beta-pinene, limonene is used as a mood-booster and contributes to an uplifting, euphoric high. It’s a strong anti-fungal, anti-bacterial and anti-carcinogen used to help with acid reflux and digestive problems.

Found in many of the same strains as alpha-pinene, terpineol has a floral, lilac fragrance and causes drowsiness while helping users to relax. It’s used as a sleep aid and general sedative.

Linalool Associated with lavender, linalool is found in over 200 species of plants, as well as popular strains Grand Daddy Purple and Purple Kush, among others. Linalool has been touted as a calming agent, used to reduce anxiety and pain. Like CBD, linalool is believed to have anti-bacterial properties that might be effective in treating the core causes of acne.

Camphene Known for its damp-smelling woodland odor with a hint of fir needles, camphene could play a role in reducing heart disease, researchers say. Recommended as an alternative to pharmaceutical lipid-lowering agents, camphene is also found in products like camphor oil, citronella oil and ginger oil.

Humulene Prevalent in hops, coriander and several other herbs and flowers, humulene gives beer its “hoppy” flavor. It’s found in Gorilla Glue strain. Humulene is an anti-inflammatory and might play a role in eliminating cancer.

CARE AND FEEDING OF A BURGEONING INDUSTRY Pro-pot politicians and advocates of the plant have long referred to Nevada’s industry as “the gold standard” for quality marijuana. That’s because stringent state testing regulations require all marijuana sold in Nevada’s 61 open dispensaries to first pass laboratory tests for 24 pesticides, five microbials—including yeast and mold—common myctotoxins and heavy metals.

About 85 to 90 percent of marijuana flower passes state requirements on the first test, according to three Valley laboratory owners who opened their facilities to Las Vegas Weekly earlier this year. Excessive mold and yeast lead to the majority of failed cannabis tests.

Todd Denkin, owner of DigiPath Labs, holds a vial of homogenized marijuana flower at a cannabis testing facility.

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Photo by Steve Marcus

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Continued from page 45

Marijuana concentrates and edibles have a near-perfect success rate, said Todd Denkin, owner of DigiPath Labs in the central valley. The small number of failed tests were all for gram-negative bacteria that comes from sneezing and unwashed hands.

“Unless something goes horribly wrong in the kitchen, it’s highly unlikely for an edible to fail,” Denkin said. “The failed tests were from things that should be absolutely preventable with good hygiene.”

Opened in May 2015, DigiPath operated for more than two years at a loss in Nevada’s medical marijuana program. But like others, Denkin’s company has seen its bottom line improve since recreational cannabis launched last year. With more than $1 million in lab equipment and a staff of about 15 chemists and microbiologists, DigiPath has served more than 85 percent of the state’s 115 marijuana cultivators, a “significant increase” in clientele from before recreational marijuana hit dispensary shelves last summer.

Ben Chew, a Ph.D chemist working as the district manager of DB Labs, helps oversee one of DigiPath’s main Las Vegas competitors. To test for the four most commonly found heavy metals in Nevada soil — arsenic, cadmium, lead and mercury — Chew uses a $250,000 machine that combines argon gas and plasma. It forms an incubator with a temperature inside “as hot as the surface of the sun,” he said. That heat ion-

“DigiPath has served more than 85 percent of the state’s 115 marijuana cultivators.” izes the metals into their atomic form, allowing the machine to measure heavy metal concentrations by their atomic weights.

“Nevada’s water is not the cleanest,” Chew said. “The metals can get in the soil when the water is not purified properly.”

Stringent testing standards have also been challenging for the labs themselves.

The Nevada Department of Taxation has temporarily suspended the licenses of four of the state’s nine testing facilities since Question 2 on the 2016 election ballot gave it regulating authority over the marijuana industry. All suspensions—which took place between July 1, 2017, and March

1, sometimes lasting several weeks or months—have since ended with the facilities reopening. Interviewed lab owners said their suspensions, while costly, helped them better understand “complicated” state regulations.

Las Vegas-based G3 Labs had its license suspended for more than 150 days after state inspectors discovered incorrect labeling and testing methods. The lengthy shutdown caused G3 to lose all of its clients and many of its 12 employees. Months later, the Las Vegas lab is just now recouping most of its business.

“The state regulates us, but they’ve also been asking us how to make the regulations,” said G3’s owner, who asked to remain anonymous. “It’s a complicated process, and it’s truly an industry in its infancy.”

Denkin’s lab also had its license suspended in January for performing tests “not authorized by the state.” He said the experience helped improve communication between the lab and state officials, and added DigiLabs now operates as if it was going to be inspected by taxation department officials every day.

“We all want to be on the same page and we all want what’s best for the industry,” Denkin said.

Chris Kudialis writes for VEGAS INC and the Las Vegas Weekly.

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s t a t i N s

a reality check

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The noise over statins can drown out the good news

By Dr. Kevin Kapov

Cholesterol gets a lot of bad press these days but despite its bad rap, it’s a necessary component of your cells.

Nevertheless, if you have too much in your blood, it can stick to your arteries and narrow or block them, which can lead to a heart attack. If diet and exercise don’t reduce your cholesterol, you may need to take medication. Quite often, this medication is a statin.

Statins first became available in 1987 and have since been followed by numerous other statin medications. Today, it is estimated that 30 million people worldwide are taking statins.

And yet – many people do not take their medication, based on unfounded fears that statins are dangerous or overprescribed.

“Unfortunately, bad news about drugs travels fast,” says Dr. James Joslin, central division medical director for Southwest Medical. “What’s more, reports of side effects are rarely presented in a way that is genuinely helpful or informative to people who might be affected.”

Dr. Chinenye Ezeanolue, Western division medical director for Southwest Medical, agrees that incorrect information is pervasive, and it can be hard to sway patients who are otherwise convinced.

“Thanks to mailings, social media posts and websites claiming that statin medications are harmful or unnecessary, many patients are confused about whether they should take them,” says Ezeanolue. “Medical societies or your own doctor are where you will get accurate information.”

Statins are relatively safe for most people – and of course, there are always exceptions: they aren’t recommended for pregnant patients or for those with active or chronic liver disease. Some statins also interact adversely with other drugs. You may have fewer side effects with one statin

drug compared to another statin.

“It’s so unfortunate when patients do not adhere to their statin medication,” says Chang-Hoon Ahn, Eastern division medical director for Southwest Medical.

“Statins not only help prevent heart attacks and strokes but also lower the chance of

five myths about statins

myth Statins cause diabetes There have been some studies that have shown that statins may increase a patient’s blood sugar, perhaps predisposing a patient to diabetes. While statins may increase blood sugars, this does not offset the overall benefit that statins provide.

People with diabetes benefit the most from statins, which reduce their risk of heart attack, stroke and death. If you take statins, be sure to work closely with your doctor to monitor your blood sugar levels, watch your diet and be sure to include regular exercise in your routine. Often people are put on statin medication and treat this as if it were a license to eat whatever they want. This leads to weight gain, which is highly related to developing diabetes.

myth High cholesterol is not a bad thing Sorry, no. High blood cholesterol almost always results in a plaque buildup in the arteries. Is there the occasional lucky individual who has won the genetic lottery and nothing bad will happen to them? Yes. Chances are that’s not you. Uncontrolled high cholesterol over time will in almost every case lead to very bad outcomes.

myth Statins destroy muscle tissue Statins have been tested in over one million patients. Overwhelmingly, research shows that they do not cause muscle damage.

However, statins can cause mild muscle ache for a small number of people. Even more rarely, statins can cause severe muscle pain — which is a sign to talk to your doctor, who will have you stop your statins immediately. Of course, you should tell your doctor if you are feeling any muscle pain or weakness.

developing peripheral arterial disease, a condition where the arteries in the feet and legs become so narrow the tissues don’t get enough oxygen. Statins really are a wonder drug that have made the difference between life and death for so many patients.”

Nearly all medications have a potential for side effects, and statins are clearly of great benefit compared to the risks they pose. Yet those same risk factors have been over-hyped and led some people to fear taking their medication.

Let’s look at the most common misconceptions:

myth Statins don’t really prevent vascular disease Yes, they do. Statins primarily keep arteries with some plaque from getting any worse and also play a critical role in reducing inflammation, which is a key cause of cardiovascular disease. While statins can’t “clean out” the arteries, there are instances where statins can cause the plaque to shrink.

myth Doctors just want to give everyone a statin Public debate on statins almost without fail will eventually mention the specter of “big pharma.” There are of course legitimate concerns regarding the prospect of pharmaceutical companies overselling the benefits of their drugs, while dismissing potential risks.

Independent scientific study has clearly established that statins are safe and effective. Conspiracy theories are simply poisoning reasonable discussions, tarnishing legitimate criticism with pseudoscientific conspiracy-mongering and frightening people in medical need away from effective treatments.

“Legitimate debate focuses on where to draw the line – who gets treated?” said Ahn. “Every patient should have that discussion with their own physician. A patient’s risk factors, other medical issues and age are all important considerations.”

Ezeanolue agrees. “Of course, first-line treatment for high cholesterol should be diet and exercise. Maintaining a lean body mass, regular exercise and not smoking are the most effective ways to prevent heart disease for most people. Unfortunately, lifestyle interventions are not very effective.” This isn’t because they don’t work, but because it is very difficult for most patients to maintain these lifestyle changes over the long term.

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Risk factors and lifestyle changes If you’re following recommended lifestyle behaviors but your cholesterol, particularly your LDL (bad) cholesterol remains high, statins might be an option for you.

Risk factors for heart disease and stroke are: • Being overweight or obese • Diabetes • Family history of heart disease, especially if it was before the age of 55 in male relatives or before 65 in female relatives.

• High blood pressure • High cholesterol • Narrowing of the arteries in your neck, arms or legs (peripheral artery disease) • Not exercising • Older age • Poor stress and anger management • Smoking

Lifestyle changes are still an essential part of reducing your risk of heart disease, whether you take a statin or not. To reduce your risk:

• Be physically active. Sit less and exercise regularly.

• Eat a healthy diet that’s low in saturated fat, trans fat, refined carbohydrates and salt, rich in fruits, vegetables, fish and whole grains.

• Maintain a healthy waistline: less than 40 inches in men and less than 35 inches in women.

• Quit smoking and avoid secondhand smoke.

“In general, statins are safe and well tolerated,” says Joslin. “If any of the common and minor side effects (e.g., muscle aches) develop, switching to another statin or changing the dose or frequency will often solve the problem.”

Although statins are well-tolerated by most people, they do have side effects, some of which may go away as your body adjusts to the medication. The risk of more severe effects (e.g., liver failure or muscle inflammation) is quite rare, and close monitoring with attention to interacting medications can help to prevent them.

What does this mean for you?

“Medical societies or your own doctor are where you will get accurate information.”

There is no question that statins can protect those who’ve already had a heart attack or stroke and thus face a significant risk of a recurrence that could prove fatal.

The longer someone is on statin therapy, the greater the reduction in the risk of a cardiovascular event.

Keep in mind that when you begin to take a statin, you’ll most likely be on it for the rest of your life. If you experience side effects, talk to your doctor about the prospects of decreasing your dose or trying a different statin. Don’t stop taking a statin without talking to your doctor first.

To avoid confusion over conflicting information online, patients should always get medical advice from their doctors or reliable sources.

Dr. Kevin Kapov is the medical director of adult medicine at Southwest Medical Associates, part of OptumCare

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i n n n o v at i o n s

procedure to treat prostate cancer allows doctors more control over radiation SpaceOAR procedure available in Southern Nevada

By Dr. Andrew Cohen

T

here have been incredible advances in radiation therapy during the past 30 years.

These innovations primarily involve improved abilities to visualize the cancerous target and contour high doses of radiation around the harmful spot, thereby decreasing radiation to surrounding normal tissues.

A new procedure is available that allows doctors to escalate the radiation dose and increase cure rates, while decreasing side effect and complication rates simultaneously.

SpaceOAR hydrogel is a groundbreaking product for men choosing to undergo radiation therapy for prostate cancer. Applied during a minimally invasive procedure, the hydrogel acts as a protective spacer between the prostate and the rectum. The SpaceOAR procedure moves most of the rectum away from the prostate and therefore away from where the high doses of radiation are being given. It has been clinically proven to reduce the risk of side effects from radiation treatment and, in April 2015, the Food and Drug Administration cleared SpaceOAR hydrogel.

In a prospective, randomized, multi-center clinical trial in the United States, patients treated with SpaceOAR hydrogel prior to prostate cancer radiation treatment demonstrated bowel, urinary, and intimacy benefits through three years of follow-up. The study found that the patients who did not receive SpaceOAR hydrogel experienced a clinically significant decline in bowel, urinary, and intimacy quality of life eight times more often than patients that received the procedure.

The outpatient procedure requires only local or general anesthesia. Patients can immediately resume their normal activities upon completing the procedure. The gel stays in place for approximately three months and is then naturally absorbed and cleared in the urine in about six months.

Locally, more than 15 men have had this procedure. It has essentially allowed doctors to successfully plan treatments with significantly lower rectal doses than if they did not have the SpaceOAR. The patients have all tolerated the procedure well, with very few noticing minor side effects. A few have observed a full feeling in the rectum that has gone away within a couple of days after the SpaceOAR was put in.

There is always a risk of rectal bleeding or complications to the rectum from prostate radiation. In radiation therapy, we are especially alert when we give high doses of radiation at one time, as we do with CyberKnife radiation

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therapy. Another benefit of SpaceOAR is if we want to try to dose-escalate and increase the cure rate. We have used this procedure in combination with seed implants, which is another popular form of radiotherapy. When both the seed implant and external beam radiation therapy are done, there is also a high dose to the rectum. Using the SpaceOAR has allowed us to significantly decrease that respective dosage.

In 2018, approximately 1,200 Nevadans will be diagnosed with prostate cancer. And, for these patients as well as patients who are currently in the heart of their battle, the SpaceOAR procedure is a game changer.

Dr. Andrew M. Cohen joined Nevada Radiation Oncology Centers in 1997, which became Comprehensive Cancer Centers in 2001. He currently serves on the faculty of the UNLV School of Medicine as a clinical assistant professor and was previously an adjunct assistant professor of oncology/radiation at Touro University Nevada College of Osteopathic Medicine. He is certified in the use of SpaceOAR.

q & a

Health care company helping bring back the house call

By Rebecca Clifford-Cruz

D

r. Mark Prather, an emergency room physician, started DispatchHealth in Denver, Colo., in an attempt to reduce the number of people using the ER for nonlifethreatening health issues. “Our care model has proven acute care can be delivered safely in the convenience of the patient’s home or location of need,” Prather said. The concept took off and has spread to Southern Nevada.

Describe your business.

Unlike traditional urgent care or emergency room visits, DispatchHealth brings treatment right to the privacy and comfort of your home, your workplace or senior living community. The medical team consists of an emergency medical technician and a trained and board-certified nurse practitioner or physician assistant.

The concept for DispatchHealth was created in 2013 by an emergency room doctor in Denver, Colorado, in an attempt to reduce the number of persons utilizing the ER for non-life threatening health issues that could be treated outside of the hospital setting.

Who are your customers?

Our unique, care delivery model and clinical capabilities allow us to treat the entire family. We are bringing back the house call!

We focus much of our attention on the senior community – as they often have fewer options and more difficulties getting into their primary care provider. They may also have limited transportation options and mobility challenges making it difficult to leave home.

physician or home health provider, but support their efforts, when needed, for specific urgent care needs of their patients. Our medical team leaves a copy of all treatment notes, tests results and prescriptions with the person being treated, as well as, sending a copy to their designated primary care physician and other care providers as requested. We want to tuck everyone back with their care team.

What is the hardest part about doing business in Las Vegas?

Being a mobile urgent care, navigating the road construction right now in Las Vegas can be a bit tricky and time consuming. But we are learning all the side streets and back routes, thanks to input from long-time, local residents. And then there’s always Google maps !

What sets you apart from similar services in the area?

What is the best part about doing business in Las Vegas?

The option of having affordable, personalized care in the home setting is a welcome and much needed addition to the care continuum. Individuals tend to be more relaxed, share more information about their health issues and have better outcomes when treated in their home.

Our goal is not to replace the primary care

The best part of doing business in Las Vegas is the people and the business climate. Las Vegas has always been open to new and innovative ideas. The business community is quick to recognize and embrace new technology, solutions to problems and quality service endeavors. There are also many networking groups, community

Name of Business DispatchHealth

Local Address 3841 West Charleston Blvd, Suite 203, Las Vegas, NV 89102

Contact 702-848-4443 info@dispatchhealth.com dispatchhealth.com events and organizations, such as the Las Vegas Chamber of Commerce, that are eager to engage and support new business.

What’s the best business advice you’ve received?

BJ Wright, the Community Engagement Manager for the Las Vegas office of DispatchHealth shared some of the best business advice given to her: Never stop learning. Listen more than you talk. Find common ground. Embrace possibilities.

Give more than you receive. Always start the day with a positive outlook. Stay true to yourself. Expect opportunities to show up. Believe you can change the world.

Rebecca Clifford-Cruz is the Greenspun Media Group research librarian.

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al p ha b et s o u p

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EXPANDING THE ABBREVIATIONS: Physician assistants and nurse practitioners are vital to improving health care access in Southern Nevada

By Tracy Wakefield

“I

’m sorry, the MD is booked until October, but if you don't wish to wait, I can get you in with his PA tomorrow. Would that be OK?”

Odds are, you’ve probably had a similar conversation or two with your doctor’s office. Did you opt for faster care with the PA? Or did you hold out for the MD? If you picked the doctor, you’re not alone. However, you may be unnecessarily delaying your care, possibly putting your health at risk.

Like a medical doctor, a physician assistant (better known as a PA), is a qualified, independent medical professional who is licensed to do nearly all the same things that a medical doctor or an osteopath can do. Seeing one would have been nearly identical to your visit with the doctor.

This situation is very common said Carolyn Dechaine, PA-C (certified physician assistant) from P3 Medical Group’s Summerlin Clinic, because the health care profession has been challenged by the need for more medical providers for decades. In the 1960’s, universities responded to the need by creating physician assistant and nurse practitioner programs.

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Photo Credit

Like a medical doctor, a physician assistant (better known as a PA), is a qualified, independent medical professional who is licensed to do nearly all the same things that a medical doctor or an osteopath can do.

Continued from page 55

Since then, training has continued to grow, bringing more than 100,000 certified physician assistants to the medical field. Most physician assistants obtain a bachelor’s degree from an accredited program, and all candidates must complete at least 2,000 hours of direct patient care as well as pass strenuous examinations to be certified by their state’s medical board. After achieving their certification, Nevada’s PA-Cs must complete 100 hours of continuing education every two years and successfully retake the board examination every 10 years.

“My job title is a bit of a misnomer,” Dechaine said. “Many people think I just assist a physician with their daily tasks.” While PA-Cs are required to be supervised by a medical doctor, they can perform nearly every function in a primary care practice that the physician can, including conducting examinations, ordering and reviewing labs and tests and prescribing medications.

“The more I know, the better,” said Dechaine. “It’s like being a private investigator, but with health care. I love the challenge of finding out what’s wrong. I don’t stop until I’ve exhausted every option.”

Mary Nara chose a different path to care for her patients. After earning her bachelor’s degree in nursing, she began her career as a registered nurse.

She continued her education, earning a master’s degree and becoming a certified family nurse practitioner (FNP-C). She later attained her accreditation.

Her love for family medicine began at a young age when she volunteered at nursing homes.

“I wanted to care for the whole person and their family,” she said. “Taking a more holistic approach goes beyond a patient’s anatomy and physiology and the pathology of their illness.”

Like Dechaine, Nara often corrects patients on the myths and misnomers of her field.

“Some patients think that I’m just practicing to be a nurse. The reality is that the day-to-day job description for patient care is pretty much the same for me as my PA-C, MD and DO colleagues. We all just took different paths to get here.”

Both women believe that their fields are a key component to addressing the physician shortage, especially in Southern Nevada, as certified physician assistants and nurse practitioners are authorized and capable of handling a significant percentage of a patient’s primary care needs. Numerous studies, including one by the American Association of Medical Colleges, are projecting up to a 41,000 shortfall in primary care physicians 2030. The Bureau of Labor Statistics forecasts a 37 percent increase in physician assistants and a 31 percent increase in nurse practitioners by 2026, largely to help with demands of our aging population.

“We deliver great, quality care to our patients and help keep healthcare costs down,” Nara said.

“In addition, when we are in a practice, we can free up our MD colleagues to focus on more complicated cases.”

Dr. Roopa Dani works with Nara at the P3 Southern Hills clinic and attests that collaborative approaches to care benefit their patients.

“In my experience, certified physician assistants and family nurse practitioners are well trained and prepared,” said Dani. Having capable colleagues on the team means patients get more time and attention. “I love having the time to see my patients as a whole – not just as a disease or condition. I can look at everything all together.”

Dr. Tracy Wakefield is the president of P3 Health Partners Nevada Medical Group

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tech n o l o g y

Do seniors want FaceTime or face-to-face time when it Comes to health care?

By Mike Braham

N

early 120 million Americans will be 65 or older by 2020. And according to the AARP, 90 percent want to spend their golden years in their own homes versus moving in with their children or transitioning to assisted living communities. This trend is known as “aging in place” and it’s becoming increasingly possible, in part, because of technology.

Smart home solutions, telehealth and remote patient monitoring have made aging in place an easier and more realistic option for seniors and a recent study conducted by Pew Research Center states seniors are more digitally connected than ever before.

Defining Telehealth and Its Role in Aging in Place Telehealth is largely facilitated as a real-time patient-to-physician consultation via video. It’s interactive, secure and ultimately saves patients time and money. The University of California conducted a 20-year study on telemedicine and found telemedicine visits saved patients approximately nine years of travel time, five million miles and $3 million in costs.

Remote patient monitoring is another component of telehealth that’s transforming patient care. It uses mobile technology for the real-time collection and transfer of a patient’s medical data to a health care professional for analysis.

Time is of the essence when it comes to patient outcomes. This can be useful for diagnoses, as well as making alterations throughout the course of treatment. This can be especially useful for patients making medication changes, as they’ll be able to report any side effects and adjust quickly if need be.

Half of Baby Boomers take heart medications, while one in five battle diabetes. The need for constant care and monitoring places health care organizations under greater pressure, while contributing to higher costs for those who make constant trips to the doctor. Remote patient monitoring provides a logical answer to this challenging scenario.

Cox and Connected Independence Cox Communications of Las Vegas partnered with Los Angeles-based homebuilder KB Home to showcase what telehealth could look like in this new era of digital living for seniors aging in place. Cox installed more than 50 smart devices in a single-story Desert Mesa community model home located in North Las Vegas. In addition to facilitating video consultation with a physician, these devices could monitor, send blood pressure, heart rate, oxygen readings and other information to a doctor via the internet. The home also included room sensors that notified emergency contacts if the homeowner or an occupant of the home fell. This is an important feature not only for aging in place seniors, but for caregivers as well.

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Cox, with the acquisition of Trapollo – a telehealth company – has begun focusing more on connected independence and how innovative telehealth technology could be used in practical ways for aging in place seniors, caregivers and healthcare providers.

“Smart home technology can help families avoid the wrenching decision and the expense of moving an aging parent to an assisted living facility,” said Mike Braham, vice president and general manager of Trapollo. “A connected home ensures seniors can continue their daily routine while maintaining – and even enhancing – their quality of life in their own home.”

According to a study conducted by Foley and Lardner, 90 percent of healthcare professionals report that their organizations have begun developing or implementing a telemedicine program.

Cox Communications will be demonstrating Trapollo and its remote patient monitoring capabilities at more Cox Smart Home one-day open houses

Mona Shield Payne Photography/ Mona Shield-Rice

Redesigning the Future of Care: The Role of Technology in Health

By Dr. Gillian Barclay

H

across the country through the end of 2018.

When factoring in the convenience, comfort and overall improvement to the patient experience telehealth offers, seniors and many others agree FaceTiming your doctor may be a better alternative to actual face-to-face time.

Mike Braham is the vice president & general manager of Trapollo

ealth care is one sector that can proudly claim decades of successful disruptive innovations in technology — from the early use of stethoscopes and X-ray radiography to autonomous systems of magnetic resonance imaging and advancements in biotechnology and genetics.

Health care has transformed beyond collecting clinical information to determine how lifestyle or behavior contributes to physical or mental health.

Although this type of data is important, we now know that in some cases to successfully maintain health is beyond the control of the individual. A person’s environment and community also contribute to their overall health and wellbeing.

Innovation has set the stage for approaches to better understand the environments in which people live, how they are linked to the quality of people’s lives, their overall health, and how long they live.

Mapping technology can organize data on the level of one’s ZIP code. New methodologies such as artificial intelligence allow overlaying of data from different sources and sectors as well as the ability to analyze and link that data down to individual levels. It lets hospitals and health-care agencies paint living pictures, stories and better understand the communities in which their patients live. For example, patients with chronic conditions such as diabetes can find it challenging to manage their health if they live in neighborhoods without grocery stores or healthy food options. This gives health care professionals the ability to make decisions for the health of

their patients based on more than simply findings from clinical data New technologies and data analytics also contribute to understanding disease trends and how they are associated with community air quality. These new technologies have the potential to contribute to efforts that predict the level or dose of environmental changes that lead to fluctuations in local disease trends. Decades of scientific inquiry have shown how changes in environmental conditions such as air quality and pollution can impact health outcomes. Innovations such as drone technology have improved sensitivity and specificity to measure and monitor air quality. New technologies and microsensors provide data on shortterm measurable changes in the environment that lead to long-term, measurable, health and economic impacts.

Although the future may be exciting for technological innovations and data analytics in health, simplistic approaches are not advisable when one considers their use in strategies for long-term improvements in health outcomes. Health care cannot improve health outcomes in isolation. This means that key stakeholder voices and sectors that are important for health should be involved when the use of non-healthcare data and technology are being considered. Successful and mutually beneficial multi-sectoral partnerships built upon trust and respect are important to improve patient and community health outcomes. Patients can identify the non-medical barriers that prevent optimal health, and their feedback can identify and engage the non-health sectors that are important for health outcomes.

Dr. Gillian Barclay is the health care industry specialist of the Nevada Governor’s Office of Economic Development.

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the g o l d e n year s

How to Identify Loneliness in Seniors and Why Socialization is A Crucial component to Their Physical Health

By Vince Parker

R

esearch has identified clear benefits when health care professionals focus on socialization among seniors.

Experts in senior care have seen the effects of loneliness, and they can tell stories about the remarkable changes that occur from stronger socialization. That’s why well-run facilities for senior living put attention on social events.

Thanks to research funded by the National Institutes of Health, we now know that loneliness actually has negative effects on the production of white-blood cells in older people. And that, in turn, helps explain findings by University of Chicago psychologist John Cacioppo that feelings of extreme loneliness can increase the chances of premature death by 14 percent for an older person.

The changes that commonly face seniors almost inevitably raise the threat of loneliness. They may lose a spouse. Best friends may die. Neighbors may move away. The loss of the ability to drive can limit a senior’s ability to get together with friends for coffee, attend church or club meetings or stay in touch with family members. A diagnosis of dementia often leads to loneliness. Not surprisingly, loss of hearing or sight can reduce connections.

Not every senior who travels through a transition in life, of course, will become lonely. Families, friends and health-care professionals, however, all should keep attuned to indications that a senior may be beset by loneliness.

Among the warning signs: • A change in call frequency. More calls are an obvious sign of loneliness.

But fewer calls can be an indication that a senior is withdrawing into a smaller world with fewer friends.

• Conversations that carry a sense of longing about family and friends who no longer stay in touch. It’s natural to miss friends and family, of course, but the senior who is growing lonely may return to these conversations often.

• Fewer journeys away from the house. A senior who has lost friends may find less reason to leave the house. A senior who no longer drives will have less ability to go out. Whatever the reason, an increasingly stayat-home senior may be feeling the onset of loneliness. A resident of a senior living complex, meanwhile, may lose interest in social activities or visits with friends.

• Changes in personal habits. Researchers at Yale University, for instance, found that many people who feel the cold of loneliness in their lives begin

to take longer showers and baths to restore some of the psychological warmth they miss. Few of them, the researchers found, are even aware the relationship between a hot bath and their loneliness. A senior who begins shopping more than usual may be hoping that material goods fill a heart that feels empty.

The good news about loneliness is this: The cures are well-known and don’t carry a big price tag.

While thyroid activity as well as levels of vitamin D and B12 can play a factor in energy and socialization, loneliness in most seniors can be addressed with informal socialization — inclusion in family activities, a visit from a friend who takes time to listen — or structured events such as those offered by community senior centers and senior-living facilities.

Since he stepped down as U.S. surgeon general in 2017, Dr. Vivek Murthy has focused much of his time on the battle against loneliness, which he has called the fastest growing public health crisis in the United States.

Fortunately, we have the tools to combat this crisis. All of us — health care professionals and lay people alike — will play our role to play in improving seniors’ socialization and reducing the threats of loneliness.

By Vince Parker is the director of sales at Las Ventanas at Summerlin

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M a k i n g the r o u n d s To include your photos in the next issue, contact Craig Peterson at craig.peterson@gmgvegas.com

Spirit Halloween’s Spirit of Children program provided Children’s Hospital of Nevada at UMC with $65,434 for Child Life services. The hospital’s Child Life Department offers highly skilled specialists who work alongside children to minimize stress and provide valuable emotional support through a variety of activities.

Dunkin’ Donuts Las Vegas donated $12,500 to the Nevada Childhood Cancer Foundation on behalf of Dunkin’ Brands’ Joy in Childhood Foundation.

The Engelstad Family Foundation announced the gift of $3 million for the proposed CSN & Nevada State Health & Science Building. The gift is a match intended to help the colleges raise another $3 million from the community before the start of the next legislative session.

The 17th annual Ronald McDonald House Food Drive collected more than 13,000 pounds of food and more than $11,000 in cash and gift card donations.

Catholic Charities of Southern Nevada received $2,500 from Meals on Wheels America to support its pet-support program for clients.

To commemorate the organization’s 40th anniversary, the Candlelighters Childhood Cancer Foundation of Nevada launched 40 Faces of Candlelighters at candlelightersnv.org. The stories chronicle individuals and their families who have benefited from Candlelighters support.

Easterseals Nevada opened a Children’s Therapy and Autism Clinic at 7281 W. Charleston Blvd., Las Vegas.

The Kendra Scott store at Fashion Show Mall helped raise more than $1,100 for Olive Crest, a nonprofit dedicated to preventing and treating child abuse.

The FBI Citizens Academy Alumni Association, Las Vegas chapter, gave a Little Free Library to the Shade Tree. The donation includes a weatherproof library box to house books that will be donated and restocked by the Las Vegas Clark County Library District Foundation.

Construction vs. Cancer, sponsored by Las Vegas Paving, raised more than $280,000 to benefit the American Cancer Society. Other sponsors included Barrick Gaming, Nevada Contractors Association, M.J. Dean Construction, McCarthy Building Companies, John C. Kish Foundation and Penta Building Group.

Lisa Ferrari is Humana’s regional vice president of provider experience for the California/

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Desert Radiology partnered with Kathy L. Batterman Elementary School to host an art contest. Winning art pieces were displayed in the lobby at Desert Radiology’s Centra Point Imaging Center. Desert Radiology awarded prizes to the top three students in the contest and donated $500 to the school for new art supplies.

Nevada and Pacific regions.

The Aging Service Directors Organization elected its 2018-19 officers. Michael DiAsio, co-owner and director of Visiting Angels Las Vegas, was elected chairman with Cassandra Cotton, community outreach manager for Nathan Adelson Hospice, as vice chairwoman; Kim Harney-Moore, Nevada Senior Medicare patrol director for the Nevada Department of Health and Human Services, as secretary; and Cory Lutz, Respite Care, as treasurer. DiAsio takes over the position from Herb Randall, Ed.D., who was named immediate past chairman.

Dr. Scott Slavis is a urologist with Urology Specialists of Nevada.

Las Vegas music therapist Judith Pinkerton was awarded the AFLAC ACM Lifting Lives Honor. As a music therapist for Desert Hope Treatment Center and Solutions Recovery, Pinkerton provides music to more than 150 patients every week who are in recovery from alcohol and/or drug addiction.

Dr. Avi Weiss of Urology Specialists of Nevada and his wife, Devra, were awarded the 2018 Solomon Schechter Day School Champions Award at the school’s L’Dor V’Dor Gala, which benefits the school scholarship fund.

summer 2018

The Juvenile Arthritis & Rheumatology Care & Research Center (also known as Kids Arthritis Care) is open at 3017 West Charleston Blvd., Suite 50, Las Vegas. Dr. Robert Lowe is founder and medical director.

Rí Rá Las Vegas raised more than $10,000 for the St. Baldrick’s Foundation during its seventh annual head-shaving fundraiser. Twenty-four people had their heads shaved at the event.

Dental Care International’s seventh annual “Give Kids a Smile” event presented by Nevada State Bank provided free dental care to 59 uninsured children. The total dental care at the event was worth $45,506; 44 dental professionals assisted at the event.

Dr. John Nunes is MountainView Hospital’s chief medical officer.

The Boulder Highway Collaborative Campus is open on Boulder Highway, NUNES just south of Desert Inn Road. The nonprofit collaboration includes Boys & Girls Clubs of Southern Nevada, Lutheran Social Services of Nevada and Nevada HAND. Beneficiaries include residents of Nevada HAND’s 264 Boulder Pines Family Apartment homes, who will have access to

MAKING THE ROUNDS the new Boys & Girls Clubs facility, as well as the Comprehensive Safety Net Center and Food Pantry operated by Lutheran Social Services of Nevada. Funding was made possible largely by a $5.8 million grant through the U.S. Department of Housing and Urban Development’s Community Development Block Grant program. Other financial partners include Citi Community Development, Federal Home Loan Bank of San Francisco, Raymond James Financial and NeighborWorks America. HAND Construction Company, a board-controlled affiliate of Nevada HAND Inc., was the builder.

Branch Benefits Consultants, which assists with benefit programs offered by employers, purchased its headquarters at 4584 North Rancho Drive, Las Vegas. Total costs for the project, which included the purchase and tenant improvements, were $593,030. Nevada State Development Corporation facilitated financing. Pacific Premier Bank also contributed to the package.

Henderson has been selected as a top retirement destination by Where to Retire, a magazine geared toward helping people with retirement relocation decisions. The city is profiled in the July/August 2018 issue. Editor Annette Fuller said Henderson possesses qualities important to today’s retirees. “Eyes here rest upon lovely mountain ranges in almost every direction, and retirees like that Nevada has no income tax,” she said. “Henderson is one of

Students and staff of Touro University Nevada celebrated a Day of Service this summer by volunteering at the Nevada SPCA No-Kill Animal Shelter, Spread the Word Nevada, Three Square, City of Henderson Government, Project 150, St. Jude’s Ranch for Children and the Salvation Army Henderson.

the fastest-growing locales in the country and is chock-full of master-planned communities, arts and sports events and outdoor draws like Lake Mead.”

Jodi Tyson is vice president of strategic initiatives at Three Square Food Bank.

Comprehensive Cancer Centers hired medical oncologist and hematologists Dr. Vikas Gupta and Dr. Restituto Tibayan, and nurse practitioner for medical oncology Christy Hess.

Nathan Adelson Hospice formed Paws For Paul – The Paul Ames Pet Therapy Program. Paul

Ames, brother of actor and comedian Brad Garrett, was a passionate advocate for animals, especially the dogs he cared for during his life.

“After such a devastating loss, it was important to me to find a way to honor my brother, Paul.

Working together with my family at Nathan Adelson Hospice, we developed this incredible program,” said Garrett. “My brother took so much comfort from his dogs during his life and all the way through his illness. I am overjoyed that his memory will live on in a way that will help so many others like him and the animals that bring them comfort.” Healthy Minds, a mental health provider, launched a substanceuse disorder program being spearheaded by clinical director Melissa Paller.

Jasmine Taylor is the assistant director of the Sunrise Children’s Foundation.

Sunrise Hospital and Medical Center received the American Heart Association/American Stroke Association’s Get With The Guidelines-Stroke Gold Plus Quality Achievement Award, which recognizes the hospital’s commitment to ensuring stroke patients receive treatment according to nationally recognized, research-based guidelines.

Dr. Souzan El-Eid, a breast surgeon at Comprehensive Cancer Centers, is chairwoman of the American Society of Breast Surgeons’ Breast Imaging Technologies Certification and Accreditation Committee.

Gerald Ward is executive chef at the Blind Center of Nevada’s Visions of Greatness Center.

The Garden Foundation, a nonprofit dedicated to servicing those with special needs through education, independence, inspiration and inclusion, is open at 7485 W. Azure Drive,.

Flip For Me Gymnastics is open at 8425 Duneville St., Las Vegas.

Southern Hills Hospital & Medical Center offers procedures done with a Mako advanced robotic arm for total knee, partial knee and total hip replacements. The first procedure using the device was performed at the hospital by Dr. Roger Fontes.

John Burke is vice president of memberships at Las Vegas HEALS. Carole Fisher, president and CEO of Nathan Adelson Hospice, joined the Visiting Nurse Associations of America’s board of directors.

Employees gather to watch OptumRx Las Vegas Site Director Jaclyn Latteri get dunked at the OptumRx and BriovaRx facility during the annual fundraiser to raise money for the Light the Night Walk benefiting research for the Southern Nevada Chapter of the Leukemia & Lymphoma Society. Over $8,000 has been raised so far.

OptumRx photo by Al Powers/Powersimagery LLC

The San Martin campus of Dignity Health-St. Dominican Hospitals received a Best in Keys Award from the National Association of Healthcare Access Management. The award recognized success following the association’s AccessKeys guidelines.

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cale n d ar To include your calendar items in the next issue, contact Craig Peterson at craig.peterson@gmgvegas.com

Cleveland Clinic Lou RUvo Center for Brain Health For more information, please contact 702-483-6055 or louruvosocialsrv@ccf.org ART THERAPY

Therapeutic art making experiences designed to empower those with memory and movement disorders. Call Ruth, 702.483.6054 or email almenr2@ccf.org.

Frontotemporal Disorders Support Group

A support group for FTD and Primary Progressive Aphasia (PPA) care partners.

Meets the first and third Wednesday of each month in the evening

Register at almenr@ccf.org

Feinberg Education Center

888 W. Bonneville Ave.

Huntington’s Disease Support Group Meets the third Thursday of each month, noon–1 p.m.

Register at 702-483-6035 or email municd@ccf.org

2nd Floor Conference Room

888 W. Bonneville Ave.

Memory Loss For Caregivers Support Group* Meets each Wednesday, 1:15–2:45 p.m.

*First time attendees call 702-483-6035 email muncd@ccf.org

2nd Floor Conference Room

888 W. Bonneville Ave.

Parkinson’s Support Group

Separate groups for early-stage Parkinson’s Disease & adult family members/ care partners.

Meets the second Tuesday of each month, 11:30 a.m.–12: 30 p.m.

Register at 702-483-6006 or email hicksos@ccf.org

2nd Floor Conference Room

888 W. Bonneville Ave. Music Therapy

Caregivers participate in music therapy with your loved one or allow them to enjoy this program while you attend the Memory Loss for Caregivers Support

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Group. Free.

Meets each Wednesday 1:15–2:45 p.m.

Reservations requested.

Contact louruvosocialserv@ccf.org

Feinberg Education Center

888 W. Bonneville Ave.

centennial hills Hospital For more, visit CentennialHillsHospital.com Stroke Support Group Meets the second Tuesday of the month, 3–4 p.m.

Conference Room 1 and 2 6900 N. Durango Drive Better Breathers Meets the second Tuesday of the month, noon–1 p.m.

6900 N. Durango Drive ARE YOU SMARTER THAN A SCAM ARTIST? Protect yourself from scam artists and

Medicare fraud. Includes lunch.

Aug. 17, 11:30 a.m.-1 p.m.

Conference Room 1 and 2 6900 N. Durango Drive

Desert Springs Hospital For more, visit DesertSpringsHospital.com Stroke Support Group Meets the first Saturday of the month, 10 a.m.–noon. Lunch provided.

South Magna Conference Center

2075 E. Flamingo Road.

Community Health and Diabetes Fest

Health screenings and giveaways Oct. 13, 9 a.m.-noon

2075 E. Flamingo Road.

HENDERSON Hospital For more, visit HendersonHospital.com The GLOBAL BIG LATCH ON

In honor of World Breastfeeding Week.

Aug. 3, 10 a.m.-noon

Education Room on the fourth floor of the Birthplace at Henderson Hospital

Contact 702-963-7401 for information.

1050 W. Galleria Drive

SUMMER 2018

Resolve through sharing support group

For people who have experienced the loss of an infant.

Select Thursdays, 6-7 p.m.

Community Education Room, fourth floor

1050 W. Galleria Drive

spring valley Hospital For more, visit SpringValleyHospital.com Stroke Support Group Meets the third Friday of each month, 11 a.m.–12:30 p.m.

Lunch provided.

Conference Room B 5400 S. Rainbow Blvd.

Cardiac Support Group Meets the fourth Tuesday

of the month, 11 a.m.–12:30 p.m.

Conference Room B 5400 S. Rainbow Blvd.

Valley Hospital For more, visit ValleyHospital.net Stroke Support Group Meets the fourth Thursday of the month, 10–11 a.m.

Call 702-388-8441 or 702-388-4619.

Fourth floor, Acute Rehabilitation Unit 620 Shadow Lane

Summerlin Hospital For more, visit SummerlinHospital.com Stroke Support Group Meets the fourth Thursday of the month, 3–4 p.m.

Conference Room B 657 N. Town Center Drive Cardiac Support Group Meets the third Wednesday of the month, 10 a.m.

Classroom 1A 657 N. Town Center Drive breast cancer Support Group Meets the second Tuesday

cale n d ar

of the month. 6–7:30 p.m.

Breast Care Center 657 N. Town Center Drive

gynecological cancer support group

Meets the third Thursday of the month, 5:30–6:30 p.m.

Room 1B

657 N. Town Center Drive

MOUNTAINVIEW HOSPITAL Call 702-233-5300 to register at least 48 hours in advance. For more information, visit MountainView-Hospital.com YOGA 4 U For all skill levels

Thursdays in August, 9-10 a.m.

$5 per class.

H2U MountainView Office

3150 N. Tenaya Way Movie Matinee: ‘Finding Your Feet’

This 2017 comedy-romance is rated PG13 Thursday, Aug. 2, 1:30-3:30 p.m.

H2U, Suite 114

3150 N. Tenaya Way

Stroke Support Group Aug. 7, 2-3 p.m.

H2U, Suite 114 3150 N. Tenaya Way

Ostomy Support Group Aug. 8, 5:30-7:30 p.m.

H2U, Suite 114

3150 N. Tenaya Way

Aug. 15, 11:30 a.m.-1 p.m.

MountainView Hospital’s 1 South Classroom

3100 N. Tenaya Way Alzheimer’s Support Group Aug. 21, 10–11 a.m.

H2U MountainView Office

3150 N. Tenaya Way Lunch & Learn ‘Let’s Talk About Alzheimer’s’ Aug. 23, noon-1:30 p.m.

Joyce Kreus who will discuss signs, symptoms, and tools for the caregivers. Lunch Sponsored by: Comfort Keepers

H2U, Suite 114

3150 N. Tenaya Way

Southern Hills Hospital For more, visit SouthernHillsHospital.com Joint Replacement Education Class

Orthopedic team experts guide you through the process so you know what to expect before, during and after surgery.

Fridays, 9–10:30 a.m.

Multipurpose Room, fifth floor 9300 W. Sunset Road

lunch and learn: living with diabetes Aug. 29, 11:30 a.m.-1 p.m.

Education Room, first floor

9300 W. Sunset Road

Sunrise HOSPITAL

Parkinson’s Support Group Aug. 10, 10 a.m.-noon

H2U, Suite 114

3150 N. Tenaya Way

Registration is required for all events.

Call 702-233-5454 at least 48 hours in advance.

For more, visit SunriseHospital.com LUNCH AND LEARN: Medication safety Aug. 14, 11:30 a.m.–1 p.m.

3131 La Canada St., Suite 107

Hernia Education Class Aug. 13, 6-7 p.m.

Mark Howard Lobby Classroom

3100 N. Tenaya Way

University Medical Center

Diabetes Overview and Medication Review

what are current recommendations for dietary consumption and exercise? Can you prevent type 2 diabetes even if you have a family history?

Aug. 16, noon-1 p.m.

The Healthy Living Institute at UMC

901 Rancho Lane, Suite 180 freedom from smoking

Eight-week class for quitting smoking.

Begins Aug. 17, 3:30-5:30 p.m.

The Healthy Living Institute at UMC

901 Rancho Lane, Suite 180

St. Rose Dominican Hospitals For information, visit www.StRoseHospitals.org, or call 702-616-4900 for class reservations and to learn about other programs.

Rose Regatta Dragon Boat Festival

For information about the ninth annual Rose Regatta, visit roseregatta.org.

Oct. 14, 7 a.m.–4 p.m.

Lake Las Vegas Support Groups

For dates, times, and locations visit StRoseHospitals.org/classes or call 702-616-4900.

• AA Co-ed

• AA for Women

• ALS Support

• Alzheimer’s Support

• Arthritis Support

• Bereavement Support

• Better Breathers COPD

• Breast Cancer Support

• Compulsive Eaters

• Diabetes Support

• Divorce Support

• Fibromyalgia Friends

• Gamblers Anonymous

• Leukemia and Lymphoma Support

• Multiple Sclerosis Support

• Narcotics Anonymous

• Suicide Prevention Lifeline

800-273-8255

• Widows Support

Register at 702-383-7353 or umcsn.com LUNCH and learn: preventing diabetes through healthy lifestyle

What does a healthy diet looks like and

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