2018-11-18 - Health Care Quarterly (Vol. 22) - Fall 2018

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2018 VOL. 22

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Choosing a Medicare Advantage plan?

Choose wisely.

Make sure your plan gives you Comprehensive Comprehensive Cancer Centers is the leading cancer treatment provider in Southern Nevada. Doctors and patients who have a choice choose Comprehensive.

Comprehensive Cancer Centers participates in a variety of Medicare Advantage plans.

• Aetna Medicare (HMO & PPO) • Blue Cross Blue Shield Medicare Advantage (PPO) • Humana Medicare (PFFS & PPO)

• United Health Care Medicare Solutions (PPO) • Hometown Health Senior Care Plus • Select Health Advantage (HMO)

(As of January 1, 2019. Plans are subject to change)

Not sure?

Call us or visit our website and we’ll let you know if we’re included in your plan.

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702.952.3350

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#choosewisely

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CONTENTS

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22 making the most of the golden years

32

Multiple resources in Southern Nevada are helping us live our best lives — at any age

mental health Reducing stigma is the key to healthy aging

38 Stop the bleed

Teacher lauded for bringing national program to Western High School

46 Caring and planning

Surviving grief during the holidays

COLUMNS 12

IMPROVING ACCESS Dr. Russell Gollard, OptumCare Cancer Center

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pharmacy counter Daniel Heller, Smith’s Food & Drug

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22

shop talk Dr. Ana Karamanides, P3 Medical Group

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coping skills Dr. Anthony Nguyen Comprehensive Cancer Centers

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community health Deacon Tom Roberts, Catholic Charities of Southern Nevada

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departments 50

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finances Linda Johnson, P3 Medical Group

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Insurance update Heather Korbulic, Silver State Health Insurance Exchange

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marijuana Chris Kudialis, Greenspun Media Group

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habits Dr. James S.J. Hsu, Comprehensive Cancer Centers

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patient success story Dr. Rupesh J. Parikh, Comprehensive Cancer Centers

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COMMUNITY 59

Q&A

Ayesha Mehdi with Frontier Health Law

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the notes

Briefs from and about the health care community

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CALENDAR

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FROM THE EDITOR

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ell, I managed to go 18 years without losing the key to my mailbox. In all that time, I kept the key in a couple of choice locations — either in my car, where I’d need it most frequently, or with my wallet. My handy system worked like a dream — especially after the other key went missing about a year ago.

And then it happened. The key disappeared. It’s not in the car. It’s not in a stray pocket. I think that I tossed it in the recycling bin with the junk mail. In any case, it’s gone.

Forgetful and silly, right?

We all do it, right?

Yes — most of the time. As we age, however, such moments can increase. When is being forgetful a part of life and when is it indicative of a larger health problem? This issue of Health Care Quarterly takes a look at that and other issues related to aging.

About those issues of forgetfulness — when is it time to talk to a doctor? Dr. Aaron Ritter with the Cleveland Clinic Lou Ruvo Center for Brain Health is here to lay out some of the warning signs of Alzheimer’s Disease.

While it’s a grand ideal to hope that our senior years are stress-free, issues like Alzheimer’s can weigh on us and may only be the tip of the iceberg when it comes to stress.

Are you doing enough to protect your mental health? Dr. Samuel Bauzon of Southwest Medical Associates has helped patients first-hand when health problems and life challenges begin to snowball toward issues like depression and suicidal thoughts. Ruth Almén and Dr. Dylan Wint take a look at care for the caregiver. As you tend to your senior family members, are you doing enough for yourself? And Dr. Nakeisha Curry of HealthCare Partners Nevada offers some thoughts on isolation and loneliness as we age.

At the other end of the age spectrum are the students who studied with teacher Brian Driscoll at Western High School. After the 1 Oct. tragedy, he mobilized his classes and introduced them to the national Stop the Bleed program. His efforts won him a Heart of Education Award from The Smith Center for the Performing Arts and a small army of students and teachers now have the skills to save lives in Southern Nevada and elsewhere.

Some of Driscoll’s students are looking forward to continuing in the health care field.

Will they be able to enjoy long and successful careers? That’s the dream for all of us, yes?

But burnout is a real problem in any career and the effects could have life-altering affects when it comes to a medical professional. Dr. Ana Karmanides of P3 Medical Group offers a compassionate look at burnout with ways to avoid it.

There’s much more to read about in this issue, including news about new options in cancer care and updates on Medicare, health insurance and medical marijuana. Take care of yourself and have happy holidays!

Stay healthy!

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

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IMPROVING ACCESS

New Center brings additional tools to fighting cancer

By Dr. Russell Gollard

A The center will open in three phases, with medical oncology coming in the first phase in December and additional cancer care services and treatments expected to be in place by spring 2019.

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major new resource in the fight against cancer is coming to Las Vegas.

More than one in three people get some form of cancer during their lifetime, making the disease one of the most prevalent and costly medical conditions, according to the American Cancer Society. Estimates from the American Cancer Society say in 2018 there will be more than 1.7 million new cancer cases diagnosed and over 609,000 cancer deaths in the United States.

In Nevada, it’s estimated that more than 14,000 people will be diagnosed with cancer in 2018, according to the American Cancer Society. Recent data from the Nevada Division of Public and Behavioral Health shows that cancer, along with heart disease, is more likely to kill Nevadans than any other causes of death.

Unfortunately, the surging population of Southern Nevada in recent years has outpaced available health care options.

To help combat this deadly disease and improve access to health care choices locally, OptumCare is opening the Cancer Center — a 55,000-square-foot treatment center that provides a new treatment option for patients. The Cancer Center will open its doors in December at the gateway to the Las Vegas Medical District at Charleston Boulevard and Rancho Drive, providing local patients with the care they need and deserve. The center will open in three phases, with medical oncology coming in the first phase in December and additional cancer care services and treatments expected to be in place by spring 2019.

As an oncologist treating cancer patients for more than 20 years, I have seen first-hand the impact the disease has on patients and their families. I’m thrilled that the services and level of care offered at the Cancer Center will promote a higher level of cancer care in Nevada and provide patients with another local choice when seeking the right treatment.

Services offered include medical oncology, surgical oncology, chemotherapy, immunotherapy, breast care, imaging, nutrition and psychiatric services, palliative care laboratory services, and a patient and family resource library.

The Cancer Center will feature dozens of private infusion centers for people undergoing chemotherapy, with

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plenty of natural light and space for friends and family. The infusion centers were built to maximize comfort and allow patients to connect while undergoing chemotherapy. The resource library will offer patients and their families the opportunity to conduct research and remain as informed as possible. Another interesting aspect of the Cancer Center will be the cause-based art that will decorate the building. The artwork, from the arts program at the nonprofit Opportunity Village, will be created by artists with intellectual and related disabilities.

While the center will treat all forms of cancer, breast cancer diagnoses will be the most common cancer diagnosis in Nevada in 2018, according to the American Cancer Society, so it’s crucial we have excellent breast care services and treatment options in Las Vegas.

When the center is complete, breast care and surgery will be offered to patients in one location. Working with me to oversee and manage the new Cancer Center is Dr. Courtney Vito, medical director of OptumCare Breast Care. Vito, a Las Vegas native, has spent her career researching new and innovative ways to treat breast cancer, with a tireless focus on bringing the latest advancements to her patients, and the Cancer Center and its services will help advance that mission.

Besides offering uniquely personalized and coordinated care for each patient, all of us involved in the Cancer Center are committed to making the patient experience as pleasant and encouraging as possible. The services and treatments offer Nevadans a close-to-home support and treatment option, rather than requiring them to leave Nevada to seek care.

“

In Nevada, it’s estimated that more than 14,000 people will be diagnosed with cancer in 2018, according to the American Cancer Society. Recent data from the Nevada Division of Public and Behavioral Health shows that cancer, along with heart disease, is more likely to kill Nevadans than any other causes of death.

The Cancer Center is more than just a place for doctor visits and treatment. It’s a community that will be an important proud addition to the Las Vegas Medical District. As one of the larger recent development projects within the Medical District, the Cancer Center will help advance the life-changing work being done in the area and serve as a catalyst for more growth in this vital part of Southern Nevada. With help from the Medical District and its partnering organizations, the Cancer Center and its staff are committed to helping to transform the medical landscape of Las Vegas.

We understand residents of Las Vegas have had significant challenges when it comes to accessing the health care they need over the years in our rapidly growing community.

It’s something we are working to improve on a daily basis.

That’s why we are excited to introduce the Cancer Center to the community and work to improve the quality of life, longevity and well-being of patients here in Southern Nevada.

Dr. Russell Gollard is medical director of OptumCare Cancer Center in Las Vegas

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p har m acy c o u n ter

new drug May Provide More flu Protection Than Traditional Vaccines for those 50-64

By Daniel Heller

A

s the heat of summer begins to lose steam, Southern Nevada gets to stop and take a moment to enjoy crisp autumn temperatures. Unfortunately, the beginning of fall isn’t symbolized only by sweaters and pumpkins. Flu season is nearly upon us, and there are no signs that it will be a light year. Contracting influenza is at best a nasty annoyance but at worst a life-threatening illness. According to the Centers for Disease Control and Prevention, the 2017-2018 flu season was both the longest and most severe since the pandemic of 2009. As this is not a trend that bears repeating, it’s up to all of us to take steps to prepare for the impending flu season.

One of the groups that is most likely to contract the flu is the elderly. The weakened immune systems of these individuals make them much more susceptible to the negative effects of influenza. In the past, the standard flu vaccine was the only method to try and mitigate the spread of this illness, yet now there may be another option.

Recently, a study was released in the New England Journal of Medicine on the efficacy of a relatively new flu vaccine known as Flublok. This study directly compared the flu prevention rate of Flublok and the standard flu vaccine in the 5064 age group. The results of this study indicate Flublok could prevent up to 30 percent more cases of influenza within this age range. If you or someone you know is a part of the 5064 age group, it is certainly worth considering Flublok as an alternative to the standard vaccine.

An interesting quality of Flublok is the way it’s produced.

Traditional flu vaccines are created using a process involving the inactivation of actual influenza virus that was grown in chicken eggs. However, Flublok production requires neither of these components. Because Flublok is not dependent on an egg supply and is synthetically produced in the lab, it can be produced much more quickly and in greater numbers. This vaccine is also beneficial for people with severe egg allergies.

During the 2016-2017 influenza season, the CDC estimated that flu vaccines prevented approximately 5.3 million illnesses, 2.6 million medical visits and 85,000 hospitalizations associated with influenza. These figures speak for themDaniel Heller, Pharm D., is pharmacy coordinator for Smith’s Food & Drug Stores.

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selves, and not only show the potential financial benefit of getting yourself vaccinated, but also just how important this step can be in reducing the spread of the flu. If these figures can be further increased by simply switching to Flublok, especially in a high-risk age group like 50-64, the nation could see tremendous benefits in its annual battle against influenza.

At Smith’s pharmacies, we’ve seen approximately 80 percent of plans cover Flublok but not all insurance plans cover the drug — due to the relative newness of the vaccine. Additionally, Flublok is about 20 dollars more expensive than the standard flu vaccine, which may be a factor in inhibiting some folks from choosing it. However, with an illness as highly contagious and potentially deadly as influenza it doesn’t hurt to evaluate all of your prevention options before making a decision.

It’s important to note that currently the CDC does not make a recommendation of any one flu vaccine over another, and simply states that everyone over six months of age should get a flu shot.

Keep in mind that when you’re dealing with a virus as crafty as the flu, there are always some caveats. There are many different strains of the flu, all constantly evolving. New vaccines are always being developed in an attempt to combat the shifting strains of the flu virus landscape. However, none of these provide absolute protection, so traditional methods of hand washing, keeping door handles and faucets clean, appropriately coughing into upper sleeve, getting enough rest/sleep, proper nutrition and staying hydrated will help maximize your chances of staying flu free this fall.

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s h o p tal k

when the doctor needs a doctor: burnout a big problem in the industry

By Dr. Ana Karamanides

I

t’s 7 p.m. You’ve just finished a long tough day at the office and your cell phone rings with a call from the hospital. One of your patients has been admitted.

By the time you leave the hospital, it’s 9 p.m. and you’re starving. You grab dinner at a drive-through window and head home. When you arrive, you grab the bag of food and your very heavy briefcase. The weight reminds you of the 15 charts you need to finish from the day’s appointments.

So much for sleep. You crack open your laptop and get to work, counting down, file by file.

It’s a nightly ritual for many medical professionals across the country. While the average American full-time employee is working 47 hours per week, a study by the American Medical Association found that 25 percent of physicians are working between 61 and 80 hours per week.

Physician burnout, defined by Medscape as “as a loss of enthusiasm for work, feelings of cynicism, and a low sense of personal accomplishment,” is far from new. In fact, a 2018 study found that 42 percent of doctors reported being burned out.

How is this happening? The hours are just a part of the equation. Medical red tape plays the largest role. Many providers are spending more than 27 percent of their days updating the medical records systems that were designed to make patient care and billing more efficient. There are just not enough hours in the work day to get it done. A 2017 study published in the Annals of Family Medicine found that the average doctor has an 11.4-hour workday and nearly an hour and a half of that time is at home.

“The frustration gets worse when physicians work in an environment that treats them and their patients like a commodity,” explains Dr. Amir Bacchus, chief medical officer at P3 Health Partners. “When corporate medicine sees health care providers as just another pawn on the board, they take away many of the elements that brought them to the profession in the first place, including spending time with their patients and leading patient care.”

What does this mean for patients? A study by a Stanford researcher Tait Shanafelt found that “physicians with symptoms of burnout are twice as likely to leave an organization as those without such symptoms.” When providers leave, it becomes even harder to get appointments at

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most medical practices. Patients are then handed off to new providers, often disrupting the continuity of their care.

In some cases, patient care becomes depersonalized because the physician doesn’t have the time to un-

“

With this strain, Harvard Health’s Dr. Peter Grinspoon said ‘doctors can suffer from impaired memory and attention, and poor decisionmaking. They can be distracted, and their communication with both patients and peers deteriorates.

They feel less empathetic and engaged in the outcomes of their day-to-day decisions.’ derstand all the factors that contribute to their patients’ health, such as financial restraints, family support and seemingly unrelated symptoms. With this strain, Harvard Health’s Dr. Peter Grinspoon said “doctors can suffer from impaired memory and attention, and poor decision-making. They can be distracted, and their communication with both patients and peers deteriorates. They feel less empathetic and engaged in the outcomes of their day-to-day decisions. Their bedside manner worsens. They can make mistakes, sometimes devastating.”

Medical professionals are usually compensated through insurance companies through a fee-for-service model (i.e., they only are paid for patient visits and services). Because the insurers have reduced their per-visit pay to physicians, providers must squeeze in 25-30 patients per day

to stay in the black. In an eight-hour day, approximately half is taken by administrative and documentation tasks, leaving about 13-16 minutes to spend with each patient.

This pressure not only leads to exhaustion, but also a detachment from why the provider chose the medical profession — caring for people. Dr. Ron Lamberts, an internist who also blogs at Physician’s Weekly, said, “Because I am paid by volume, I am constantly pressured to spend less time with my patients. This makes me feel like I’m not doing a good job on anyone…I constantly have to choose between doing good and getting paid, and that’s really lousy.”

Finding solutions to physician burnout are imperative to improving the quality of healthcare in Southern Nevada. However, it will take more than a checklist.

P3 Health Partners CEO, Dr. Sherif Abdou, believes combatting burnout requires a revolution in the medical profession. “Metrics need to shift from volume to value — for both the provider and the patient.” Rather than weighing the physician down, providers and their patients should be surrounded and supported by a care team. That team can follow up with patients and ensure proper documentation is made to build and help the patients regain and maintain wellness.

The American Academy of Family Physicians released a report earlier this year reinforcing the value of the care team model, especially when combined with strong communication and collaboration skills. In addition, a Harvard Business Review study found that doctors improved both burnout and patient satisfaction when their team included

mid-level medical professionals, such as certified nurse practitioners and certified physician assistants who can manage nearly all patient needs.

Shifting from volume to value, enlisting a qualified and collaborative care team and rewarding providers for quality care can make a difference for both physicians experiencing burnout and their patients who need access to medical professionals. As simple as it may sound, making these changes requires a farreaching commitment.

“Physician burnout did not appear overnight and resolving it in Southern Nevada takes collaboration and commitment from the medical and business communities,” said Abdou. “We need a clinically integrated system of care that focuses on wellness instead of profiting from sickness.”

Dr. Ana Karamanides is a practitioner with P3 Medical Group.

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C O P I N G s k ill s

Navigating the Emotions of a Cancer Diagnosis

By Dr. Anthony Nguyen

T

here is no undermining the real and raw emotions that can come with a cancer diagnosis. Amid the spectrum, there are a number of common emotions that we see in the oncology realm.

No patient is the same. And when it comes to navigating the emotions of a cancer diagnosis, no one ever follows the same flow of emotions.

Fear is the frequent emotion that nearly all patients experience throughout a cancer journey — including leading up to and during a first appointment. It’s the fear of not knowing what exactly may be going on. The initial meeting with an oncologist can provide answers. This first meeting can dispel cancer myths and shed light onto new treatment innovation.

There are so many different types of cancer. Each cancer diagnosis is unique and carries a different prognosis.

Some cancers have readily available curative treatments, whereas some may not even require treatment. Even for late stage cancers that are deemed incurable, many times new treatments may convert these diseases from “incurable” to something “chronic.” There is much hope with the development spanning clinical trials, immunotherapies and targeted therapies.

From an emotional and logistical standpoint, it’s helpful to have someone with you for your appointments, whether it is a family member or friend. There is so much information to absorb and having someone with you is great for keeping track of it all.

Some derive benefit from obtaining information prior to the initial consult. If so, information should be obtained from more reputable sources, like the American Cancer Society, www.cancer.net. Some do better with no information at all. The internet can be bewildering, and patients may end up with skewed information from non-trusted sources. It’s vital to find that right educational balance.

Some patients have found support groups to be incredibly beneficial. There unfortunately is no one-size-fits all approach to support groups, as folks have varying levels of comfort with those types of setting. A willingness to talk about one’s issues can also vary by a variety of demographical and cultural traits.

Comprehensive Cancer Centers has extended hours to accommodate varying schedules, an on-staff dietician, a team of social workers as well as an in-home nursing program to help patients navigate their unique scenarios.

Among our social worker team’s many assets, they can help patients find the right support group, if that’s what they are seeking.

The oncologist-patient relationship is massive. Having a trusted physician and team on your side can not only help you physically, but emotionally as well.

Dr. Anthony Nguyen is a medical oncologist and hematologist at Comprehensive Cancer Centers.

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c o m m u n i ty health

Support for Homelessness in Las Vegas is good but mental health issues need to be addressed

By Deacon Tom Roberts

L

as Vegas has ranked in the top 10 major U.S. cities for individuals experiencing homelessness over the past several years, according to a U.S. Housing and Urban Development reports.

At any given moment in Clark County there are more than 6,400 homeless people living “unsheltered,” meaning living on the street, in encampments, cars, tunnels and other places not meant for human habitation. The number continues to rise and shows no signs of slowing.

Catholic Charities currently feeds on average 1,000 of the city’s most vulnerable men women and children on a daily basis and provides shelter for 500 men every single night, while providing a variety of additional programs and services that can aid in our client’s return as a contributing member of society. We need to focus together to bring the appropriate resources and thoughtfully address the fundamental problem at hand: it’s extremely hard to get a job, buy a home, to care for a family, or achieve any level of financial independence when you don’t first have the mental capacity to deal with the foundations of your own personal health and wellness.

According to survey data gathered by Clark County Social Services, approximately 50 percent of the individuals who pass through our doors self-identified with mental illness and addiction issues as both the root cause of their homelessness, keeping them unemployed and a fundamental reason for continuing this particular way of life.

In my personal experience as CEO of CCSN, I can tell you that the real number is significantly higher, since many of our clients are afraid to say anything for fear of being discovered by authorities even though it would actually help them to do so; that is the anxiety of mental illness in control of them.

This systemic problem continues to grow, considering there are virtually no focused mental health resources near Downtown Las Vegas and in the newly opened Corridor of Hope Courtyard. Mental health and addiction resources must be the key focus for the programming for the permanent Courtyard project.

Modeled after the Haven for Hope in San Antonio, the Corridor of Hope Courtyard is an effort by Las Vegas to begin providing navigation to various community services

At any given moment in Clark County there are more than 6,400 homeless people living unsheltered.

in the immediate area, known as the Corridor of Hope; of which Catholic Charities is a major part.

This is a fantastic step in the right direction. But, until we as a community have the courage and commitment to take a legitimate step to address the mental health and addiction issues facing Las Vegas and the surrounding areas with increased programing and resources, services provided by organizations like CCSN will only serve as a Band-Aid to a community problem that needs emergency surgery.

We as a community must begin taking steps to develop a program that has the capacity to perfectly marry primary homeless services, such as food and shelter, with medical and behavioral services. This would allow us to treat the whole individual and give them the best chance at success when they’re moving toward breaking the cycle of homelessness and obtaining gainful employment and housing.

Our community and the most vulnerable people that live here deserve a legitimate solution to these issues that treat the mentally and behaviorally fragile with dignity, respect and appropriate resources.

Deacon Tom Roberts is the President and CEO of Catholic Charities of Southern Nevada.

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Photo by L.E. Baskow

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golden years

A l z h e i m e r ’ s D i s e a s e : W h e n S h o u l d Yo u V i s i t a D o c to r ?

By Dr. Aaron Ritter

One in 10 people over 65 are currently living with Alzheimer’s disease — a number that is expected to rise exponentially over the next few decades, especially here in Nevada. Recent statistics show that the “gray tsunami” is making waves in the Silver State, with an estimated 64,000 residents living with the disease by 2025 – a 48.8 percent increase from the 45,000 residents affected today.

Given these alarming statistics, it’s likely that at some point someone you know will be affected, which is why it’s important to be observant of the early warning signs. While the brain changes that cause AD start years and even decades before symptoms emerge, it can be difficult to differentiate between normal aging and signs of the early stages of the disease.

However, the earlier AD is detected, the better, as an early diagnosis can help those living with the disease, and their families, plan for the future, initiate treatment (both lifestyle and medications), and consider participation in a clinical trial. Clinical trials in AD —where new and promising treatments are being tested—are increasingly looking to test new medications at the earliest stages of the disease when symptoms first emerge.

To help recognize some of these early warning signs, below are five symptoms to look out for – most importantly being a noticeable change from prior level of functioning, which affects one’s ability to perform daily tasks.

1

Memory Loss and Cognitive Changes

AD is a brain disease that causes a slow decline in memory, thinking and reasoning skills. Most notably during the early stages, you may find that your loved one has started to forget information they recently learned, repeats themselves, loses things without being able to find them later, and becomes unable to complete tasks that used to be easy for them (e.g. paying bills, scheduling and attending appointments, and taking their medications). While mild memory loss is a normal part of aging, it shouldn’t be persistent or get worse over time. People with normal aging will eventually find their lost item or remember the appointment they scheduled. When memory loss becomes the “norm,” it’s time to get checked out.

2

Behavioral Changes

Aside from cognitive changes (thinking or memory), AD and other dementias can cause behavior changes. In some people, poor judgment, faulty logic when solving problems or difficulty concentrating may be the initial symptoms. Apathy (lack of interest in activities) and social withdrawal may also be signs of brain disease.

3

Language

Struggling to find the right word is a common symptom of normal aging—sometimes we are distracted with other things on our mind, had a bad night of sleep, or “are having a bad day.” Language changes in dementia are more than just finding the right word and affect a person’s ability to communicate. When a person has problems being understood or has difficulty communicating their thoughts, it’s important they be evaluated as this could be a sign of dementia.

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Visuospatial Difficulties

The visual system has two components: the capture, focus, and transfer of light (completed by the lens, retina, and optic nerve) and the interpretation of this light into meaningful information (completed by the back part of the brain or occipital cortex). In some dementias, the first symptom may be due to faulty ways that the brain is interpreting visual information.

Symptoms of these dementias may include difficulty judging distances (driving a car) or manipulating items (such as hanging a picture, using utensils or other household objects). If your loved one is experiencing visuospatial problems or vision problems that the optometrist cannot understand, it may be time for a neurological evaluation.

What do you need to know about Medicare and other health plans in Southern Nevada?

Page 50-52

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Personality Changes

As we age, people typically become set in their routines and may be upset if this is disrupted. However, people with dementia may experience more drastic personality changes including becoming anxious, fearful, suspicious, confused or depressed.

It is important to be cognizant of dramatic changes like this and take action to have these changes evaluated.

••• If you’re still on the fence about whether to bring in your loved one for a checkup, ask yourself these questions: • Are you more worried about leaving your family member at home alone for a week than you used to be?

• Do you think he or she would be able to get by with food, take medications and handle any problems that could arise by themselves?

The course of AD varies from person to person and for some, it can be difficult to identify the early stages. But if you answered yes to either of these questions or are noticing some of the symptoms outlined above, it’s likely time to schedule an appointment with a doctor.

Dr. Aaron Ritter is the director of Clinical Trials program at the Cleveland Clinic Lou Ruvo Center for Brain Health.

To learn more about the early symptoms of AD or to schedule an appointment with a neurologist specialized in the early detection and treatment of brain disease, call 855-LOU-RUVO or visit ClevelandClinic.org/BrainHealth.

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g o lde n year s

How to Take Care of the Caregiver

By Ruth Almén and Dr. Dylan Wint

t takes a village” is a phrase that couldn’t be truer when it comes to caring for a loved one living with a brain disease. It’s one that we at the Cleveland Clinic Lou Ruvo Center for Brain Health often reiterate to caregivers who may be taking on too much and forgetting to take care of themselves.

When a spouse, family member or friend is diagnosed with a brain disorder, loved ones may not think twice about helping them in their time of need or even consider themselves the caregiver, but adapting to the physical, emotional, social and economic changes may have a profound impact on their life.

While the type of support varies based on capacity of the person living with the brain disease, health of the caregiver and geographic distance, for the most part, caregivers take on a variety of additional everyday activities such as: • Meal preparation, bathing, dressing and grooming • Housekeeping and laundry • Yard and home maintenance • Scheduling and driving to medical and other appointments • Shopping for groceries, clothing and supplies • Managing medications and daily dosage schedule

• Handling finances, insurance and legal matters • Planning social and recreational activities The most important thing a caregiver should know is that they are not alone.

The most effective caregivers are those who are well-informed and enlist help and support from all available resources to ensure they don’t sacrifice their own well-being.

Here are some challenges caregivers may face, along with coping strategies to help them find a new sense of balance.

1 Caregiving Responsibilities Caregivers may feel like they need to do it all, but they shouldn’t take on too much too quickly.

Instead, they should set realistic and obtainable goals for both their loved one and themselves, while knowing some days these goals won’t be achieved, and that’s okay. To do this they should utilize friends and family members and engage community organizations and social service agencies to assist with daily tasks and diseaserelated issues. Also, they should try and learn as much as possible about the disease their loved one is living with.

2 Physical Health It’s essential for caregivers to take care of their own health needs to ensure they’re able to properly care for their loved ones. This includes maintaining standing medical appointments, living a healthy lifestyle and alerting a medical professional about any new health concerns. It’s okay to have someone stay at home with their loved one if need be.

3 Emotional Health Caregivers can experience stress, anxiety, worry, depression or even frustration as a result of their new responsibilities.

Talking to a counselor or joining a support group

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is a great way to help with coping and allows the caregiver to hear from others in similar situations and find ways to solve challenging problems. Additionally, exercise, meditation and journaling have also proven to be stress reducers. The most important thing is for caregivers to find what works best for them, and then do it.

4 Well-Being Being a caregiver is a 24/7 responsibility, so those in this role should be sure to build breaks into their caregiving schedules. This respite care can be provided by family, friends, volunteers, daycares or skilled-care facilities and will allow caregivers the time they need to rejuvenate their mind and body. It’s also important to avoid isolation – strength, solace, and creativity are positive outcomes of interacting with others.

5 Legal and Financial Responsibilities Be sure to talk with loved ones early in their disease to discuss legal and financial issues and address any necessary changes while they still have the capacity to make these decisions. As the disease progresses, it’s the responsibility of the caregiver to ensure their loved one’s wishes are carried out. Younger caregivers should also take time to think about how this new role may affect their profession. This is the time to talk with the HR department or one’s supervisor about necessary changes and flexibility in the future.

Many individuals living with brain diseases will need daily assistance, which is an enormous responsibility for their caregivers. While it may be difficult for caregivers to put themselves before others, the most effective helpers listen to their bodies and take the time they need to rest and recuperate. This will allow them to provide the best care possible.

To learn more about assistance available at Cleveland Clinic Lou Ruvo Center for Brain Health, including a variety of programs at no cost to caregivers, call 855-LOU-RUVO or visit keepmemoryalive.org/caregivers-community.

Ruth Almén is clinical manger, social work services and Dr. Dylan Wint is the NV Energy Chair for brain health education at the Cleveland Clinic Lou Ruvo Center for Brain Health

golden years

watch for signs of Isolation and Loneliness Among Adults 65 Years and Older

By Dr. Nakeisha Curry ental health continues to be a growing concern for the overall population but what isn’t readily discussed the mental health of adults 65 years and older. Loneliness is an emerging issue for this population and it has a clear impact on their overall health. According to a 2017 report from IBM, if measures aren’t taken to counter these effects, seniors face continued detachment from the mainstream even as the population grows. The report includes research from multiple studies indicating there is a link between loneliness in seniors and declining health, including a 29 percent increased risk of coronary heart disease, 32 percent increased risk of stroke, 64 percent increase in developing dementia, and 26 percent increase in likelihood of death.

Another interesting conclusion from the IBM report is that “loneliness in older adults is almost always triggered by some form of loss, whether at a personal and/or societal level.” The report goes on to say that “physical losses, including mobility problems, as well as visual and hearing impairments, can lead to a striking increase in social isolation and diminished social interactions. And over time, many older adults experience the social loss of family and friends to old age or physical distance while seeing their own roles in society reduced or ignored.” As seniors become more disconnected from their family, these feelings can increase and pose problems to their health that shouldn’t be ignored.

In fact, Nevada has one of the fastest growing aging populations in the nation and the number of seniors in Nevada is expected to grow over the next several years to account for nearly one-third of the state’s population by 2030 , according to state demographer Jeff Hardcastle. This means that more resources will need to be dedicated to caring for seniors and their mental health needs and concerns in the future.

HealthCare Partners Nevada currently cares for approximately 100,000 seniors in Southern Nevada and that number continues to grow. Our doctors have a list of questions they ask if they identify a senior who may have feelings of loneliness or isolation. Some of the signs they look for include: depressed mood, difficulty sleeping, decreased interest in activities that normally give them pleasure, feelings of guilt, decreased energy, slowness in movement, decreased concentration, changes in appetite, or any suicidal ideation.

Senior isolation and loneliness are becoming growing concerns and preventative measures must be taken to mitigate risk of detrimental effects on their health. At HealthCare Partners, we look for senior patients who may have decline in physical

condition, weight loss, and some may even stop taking their medications. Patients will usually have symptoms of anxiety, anger, frustration and mood changes associated with specific behaviors of fatigue.

HealthCare Partners recently announced 23 myGeneration clinics across the valley for adults 65 years and older. The staffs have been specifically trained to understand and care for the unique health needs of people 65 and older on Medicare.

“There is a link between loneliness in seniors and declining health” HealthCare Partners created these clinics to bring innovative, senior-focused primary care to seniors in Southern Nevada and to help meet the needs and priorities of health care for seniors.

With isolation and loneliness amongst seniors as a top concern, HealthCare Partners believes these clinics will give seniors more personal and individualized care.

Mental health awareness is crucial, and seniors should be aware of what options they have available to them. I suggest seniors speak with their primary care provider who may recommend them to make an appointment with a behavioral health specialist. There are also support groups, counseling and therapy sessions available for seniors.

To schedule an appointment with HealthCare Partners, visit mygenerationclinics.com or call 702-766-8895.

When it comes to mental health, reducing stigma is key

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Dr. Nakeisha Curry is a practitioner with HealthCare Partners Nevada.

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g o l d e n year s

Aging Gracefully in the Valley: Foundation Assisting Seniors Provides a Variety of Resources and Services to Nevada Senior Citizens

By Favil West e like to think that, like wine, we get better with age. In fact, our “Golden Years” are something many of us look forward to and work for our entire lives. But aging is difficult and often accompanied by a wide variety of challenges including illness, lack of mobility, dementia and more. What’s more, it’s difficult for everyone involved and all of us will experience age-related issues at multiple points in our lives.

I first experienced these challenges with my parents, watching them struggle in a variety of aspects such as transportation and household tasks. It was during this time that I realized the lack of resources and services available to seniors. We as a society are so keen to help children, the sick and homeless, but not seniors. In fact, there are very few organizations that exist to solely aid seniors. It was this realization that led myself and close friend, Chuck Davis, to create the Foundation Assisting Seniors in 2002.

FAS provides assistance to seniors age 50 plus with a variety of free programs and recourses.

Our mission is to assist the senior community in times of illness, recovery, confinement at home, coping with loss of a loved one, and other senior challenges, as well as provide assistance with everyday tasks such as household maintenance and transportation. While we started out serving seniors in retirement communities like Sun City Anthem, Solera and Aliante, now, 16 years later, our impact can be felt on a national level.

One of our most widely used programs is our free durable medical equipment. At no cost, we provide seniors recovering from illness, surgery or injury with a short-term medical equipment loan. Our inventory is expansive and includes equipment that can really make a difference in day-to-day activities and mobility, including: crutches, oxygen concentrators, walkers, wheel-

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chairs, power scooters, shower seats, bedside commodes, hospital beds and more.

Allowing individuals to utilize this equipment helps us reduce both the financial and physical burden of an injury. Imagine being unable to walk, confined to a chair in your home and losing your independence. Receiving a free electric wheelchair or scooter to help you move around would help you regain that independence and greatly boost moral, at no financial expense.

Additionally, we’re proud to offer equipment that is not only dependable, but also sterilized, as it goes through a rigorous cleaning, disinfecting and sanitization process before use. We service Las Vegas residents and tourists alike and encourage anyone who has elderly guests visiting to give us a call, so we can assist them throughout their stay.

Complementing our free durable medical equipment is our national HowRU program, a service that is designed to give seniors and their families assurance and piece of mind with a daily safety call. HowRU is available to those ages 50 plus across the country and is perfect for seniors who live alone, have recently suffered from illness or the death of a spouse, or are without family nearby.

Participants will receive a daily check-in call at a designated time each day. When they receive the call, they dial one to let the program know seniors since it was implemented in 2016. Marthey are okay. If nobody answers the call, the lene Genadry, a HowRU user, found the program program will wait 15 minutes and then send a so beneficial, she now volunteers for it. follow up call. If the follow up call is still unan“Having moved to Nevada from New York swered, the program will notify the participants’ in 2002, I signed up for the HowRU program emergency contacts. Should none of the emer- when it first came out as it was a free service gency contacts answer, the program will call 311 that was especially beneficial to someone like for a welfare check. me who has no family near by,” said Genadry.

As Las Vegas is a premier retirement destina- “It’s incredibly reassuring to have the confidence tion, this program is especially beneficial in our that someone will call and check on me every area and has actually saved the lives of six local day, and if something does go wrong, will be

“It’s incredibly reassuring to have the confidence that someone will call and check on me ...” there to alert my family.”

Genadry now spends two weeks a month volunteering for the program, answering general inquiries and logging calls. “I highly recommend the HowRU program to any senior, but especially if you live alone. The security this program has given me allows me to live each day to my fullest.”

In addition to the HowRU program, FAS offers a daily medication reminder program, which, similarly to HowRU, services seniors with a free, daily phone call to remind them to

Photo by Steve Marcus

take their medication.

Lastly, FAS assists seniors who are unable to complete physically demanding household chores and are in need of light home maintenance. Replacing light bulbs, air filters, smoke alarm batteries or any other minimal household task are all things FAS can help with.

The work FAS is doing to serve seniors comes at a critical time for Nevadans. Currently, 15 percent of the Silver State’s population is 65 years and older, with that number expected to rise.

Given the prevalence of seniors in our community, it is imperative that FAS continues its mission to support seniors in need. Our efforts are made possible by both monetary and medical equipment donations. For more information about FAS or to make a donation visit FoundationAssistingSeniors.org or call 725-244-4200.

Favil West is the chairman of the board and co-founder of Foundation Assisting Seniors.

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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 on the basis of race, color, national origin, sex, age, or disability in health programs and activities.

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By Dr. Samuel Bauzon

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As a society, we have seen examples of this play out on a grand scale, with the high-profile suicides of Anthony Bourdain, the celebrity chef, author and television personality, as well as Kate Spade, fashion designer and businesswoman made famous by her iconic handbag line.

According to Dr. Anne Schuchat, deputy director of the U.S. Centers for Disease Control and Prevention, “depression is not a condition that’s related to success or failure.” In other words, no one is immune to suicide.

Older people may experience stresses common to all people, but stresses can be more common in later life. For example, older adults may experience reduced mobility, chronic pain, frailty or other health problems, for which they require

some form of long-term care. In addition, older people are more likely to experience events such as bereavement after the death of a partner or close friend, or a drop in economic status with retirement.

And, as our brains age, the blood supply and brain chemicals that affect our moods change, leaving older adults more susceptible to depression. All of these factors can result in isolation, loneliness or psychological distress.

In my own experience as a physician, I have observed that life changes that can trigger mental health issues can take different forms and present different challenges.

One example is a 72-year-old woman who I began seeing in 2006. In addition to multiple chronic conditions such as high blood pressure, chronic kidney disease, high cholesterol, chronic lung disease, thyroid disease and depression (previously under the care of her psychiatrist), what

has bothered her the most is having to constantly deal with chronic back pain, despite numerous back surgeries and procedures that she had done in the past. Making the matter worse is her reliance on opioid medications which gives her marginal relief at best, a somber reminder that she needs pain pills every day to have some semblance of function. While she does not visit her psychiatrist on a regular basis, her constant pain – which affects her activities of daily living – is an area of awareness and focus on my part as her physician. Pain and depression create a cycle in which pain worsens symptoms of depression, and then the resulting depression worsens feelings of pain – we always look for this in chronic pain patients. During one of our visits earlier this year, she was a bit fearful but excited about the idea of travelling to attend her grand-daughter’s wedding in Spain. She has something to look forward to despite physical limitations. I am happy to say that she is managing the stresses in her life. She has been referred to our pain management department and receiving injections for pain as well as regular physical therapy. I see her frequently for support.

Other patients can become quite overwhelmed by negative events in their life and they respond by denying the reality and gravity of the situation. “Ms. X” is a 70-yearold patient whom I have been seeing for more than 10 years. Late last year, she was diagnosed with invasive breast cancer.

After this life-changing diagnosis, instead of complying with recommendations for additional tests and follow up, she instead chose to follow a special diet which she hoped would cure her breast cancer. In the meantime, outreach was made by letter and by phone, sadly with no response. Recently I reached out again by phone, and I am happy to say she returned the call. She has now resumed her care and is responding to our recommendations. She is also involving her family now – her two adult children and a friend who know about her situation. Her journey is in progress.

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Symptoms of mental health problems can be misunderstood. There are many different mental health problems, so symptoms can be common to more than one diagnosis (for example: depression and anxiety).

Here are five lesser-known signs of the two most common mental health conditions (depression and anxiety). If you find you are experiencing these signs, don’t ignore it: Avoiding social situations If you notice that you’re canceling social occasions with your friends and family that you would normally take part in, give this some thought.

Having a “bad day” is a perfectly normal part of life, and usually these feelings will pass without any real problem. But if these feelings don’t go away after a few weeks – or if they get worse or keep returning – it could be a sign that you’re experiencing depression.

Feeling “numb” With mental health problems like depression, or post-traumatic stress disorder (PTSD), it’s possible to feel a sense of “unreality” or “depersonalization.” This can mean that you find it difficult to connect to your surroundings and connect with other people.

Physical complaints As a physician, I have often found that people will mention a physical pain that is later found to have its roots in depression or anxiety. Many people with depression experience fatigue and find it difficult to look after themselves. People with anxiety often experience physical symptoms like panic attacks, nausea and sweating.

Trouble concentrating You may find it more difficult remembering certain things or concentrating. If you find your concentration is worse than usual, or that you’re having trouble with things like showing up on time or making decisions, this could be a symptom of living with a mental health problem.

Trouble sleeping Many people with depression can find it difficult to wake up in the morning and find themselves sleeping more than usual. This can result in feeling exhausted and having a difficult time carrying out everyday activities.

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Consider it a red flag when someone: Changes their eating habits. This can mean a sudden change with corresponding weight changes.

Displays frequent anger or irritability. A depressed person can find it a struggle just to get through the day.

The everyday challenges others may face will become more difficult for them and this can lead to frustration.

Expresses negative thoughts. You might be excited or happy about something and your friend or loved one might come back with a “downer” response, such as “who cares,” or “it doesn’t really matter.”

Loses interest in activities and pursuits that were previously pleasurable. Your friend or loved one may stop pursuing their usual activities and gravitate only toward the few things that are easily enjoyed and require the least amount of effort, like watching television or surfing the internet.

Expresses suicidal ideas. Always take statements like these very seriously. Not only are statements like these key elements of depression, they suggest that such treatment is urgent.

How to help them (or yourself ) get the care needed If you suspect depression, encourage your friend or loved one to seek consultation and treatment with a qualified person. The same goes for yourself if you suspect that you may be depressed. Your doctor (primary care physician) is a great place to start. It is very common for physicians to initiate treatment for mental health issues like anxiety and depression.

Starting the conversation For anyone dealing with depression or suicidal thoughts, or who has a loved who is struggling, it can be difficult to know what to do. One of the best things you can do is express concern and willingness to help, and then let them do most of the talking. Don’t attempt to solve the problems yourself.

If you’re worried someone may be suicidal, don’t hesitate from asking about suicidal thoughts if you think that person may be at risk. Talking about suicide won’t plant the idea in a person’s mind and telling someone you care and want to help is always a good idea. Don’t ever use guilt or threats to try to prevent a suicide.

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If you notice these warning signs in a friend or loved one, don’t wait. Contact the National Suicide Prevention Lifeline at 800-273-8255 without delay. This national network of local crisis centers offers free and confidential help to people who are contemplating suicide and their loved ones.

You can also take your loved one to an emergency department if you think they are not safe. Also, don’t leave them alone.

Make sure there are no firearms in the house and secure any medications.

The more we as a society are willing to discuss and understand issues related to depression and suicide prevention, the more likely we are to reduce the stigma of mental illness and see the rate of suicide begin to decrease. Ultimately, we need to create a culture that is open to talking about mental health and suicide prevention.

The column does not constitute medical advice and is not meant to diagnose, treat, prevent or cure disease. Please contact your doctor. The information provided is for informational purposes only.

Dr. Samuel Bauzon is the senior medical director, Southwest Medical Associates

Photo Credit

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Educator’s goal is to get life-saving tools and skills into the hands of everyone in Nevada

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By Alecia Westmorland Photos by Steve marcus

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The Las Vegas educator didn’t feel it was enough to just chat through it, especially as many seniors in his sports medicine class would likely enter the medical field and face emergency situations every day.

“I wanted my students to have a chance to be proactive, rather than reactive,” Driscoll said.

He had an idea of how to do so.

Driscoll decided to tell his students about the Stop the Bleed campaign, a federal initiative encouraging citizens nationwide to become trained and equipped to stop life-threatening bleeding in an emergency before first responders arrive.

“On October 2, I told my students the general idea and said, ‘If you like, we can turn (implementing this) into our senior capstone project,’” Driscoll said. “They unanimously decided to be a part of this

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and put it together.”

Little did Driscoll know the impact he and his senior students would have, eventually implementing a school-wide Stop the Bleed program that trained over 130 teachers in emergency life-saving skills, stocked the school with top-grade, bleeding-control kits, and provided his students with key education about emergency injuries.

“We were the first school to put (Stop the Bleed) into place in Nevada,” said Driscoll, now working with more Clark County School District schools to follow suit.

These accomplishments resulted in Driscoll being named one of 20 CCSD teachers out of several hundred finalists in 2018 to receive a Heart of Education Award from The Smith Center for the Performing Arts.

This annual awards program honors outstanding teachers with a $5,000 cash prize and a $1,000 donation to their school.

“My goal is for every single school in CCSD, and eventually throughout Nevada, to have these supplies and training available to them,” Driscoll said. “This is emergency equipment that we hope to never have to use, but we want it to be there so we could save a life.”

essential tools for stopping life-threatening bleeding.

The training includes how to quickly identify life-threatening bleeding, provide pressure to stem hemorrhaging, apply a tourniquet and pack a wound.

“The most interesting thing I learned was that your chest can fill with air through a puncture in the chest,” Navas said. “The hands-on part was the highlight, because after you research the body, these techniques give you a whole different perspective.”

The seniors quickly decided that just training students wasn’t enough, Driscoll said.

“They realized, ‘This needs to be made available to every teacher,’” he said.

Expanding the Vision Driscoll’s students also determined the school needed to be stocked with specific emergency supplies to address potential bleeding injuries.

“I explained that with both training and supplies, the difficult part would be paying for that,” Driscoll said.

He tasked his students with first compiling a strategy to provide school-wide training and supplies under the Stop the Bleed campaign — then pitching that strategy to the principal to fund its implementation.

The students began with researching medical supplies necessary for bleed-out emergencies, quickly focusing on publicaccess bleeding-control kits that contain items like a tourniquet, gauze, compress bandage and scissors.

“Those simple tools will allow you to stop hemorrhaging in virtually all cases that involve a limb,” Driscoll said.

Driscoll and his class also examined the best companies to provide these kits for the school. Reviewing product development, studies and company profiles, they eventually landed on North American Rescue, which supplies medical products to the American armed forces overseas.

“We picked the company with the most scientific literature published on their products,” Driscoll said. “A lot of this science has come out of (combat care) in Afghanistan and Iraq.”

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Learning to Save a Life Abraham Navas, student president of the school’s sports medicine program in fall 2017, immediately thought implementing Stop the Bleed with his class was a useful idea.

“Things can happen even somewhere we think is relatively safe, and it’s necessary and proper to prepare,” Navas said.

The students’ efforts started out simply.

First, they learned life-saving techniques themselves, with Driscoll bringing in medical professionals from UMC to give his class bleeding-control training.

Created as part of the national Stop the Bleed campaign, this hands-on training is designed to provide people outside of the health care profession with the

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What It Takes to Save a Life While compiling their strategy to pitch to the principal, Driscoll’s students learned more than they expected about bleeding injuries, Navas said.

“We learned that someone can fatally bleed out from an injury in just four minutes,” he said.

With this in mind, the students

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reviewed the school’s emergency action protocols — spanning evacuations, lockdowns and more — and analyzed how to best prepare the campus for addressing a bleed-out injury at any time.

“I made the kids run all over campus to figure out where these bleeding-control kits would need to be, so someone could get the supplies and get back in less than four minutes,” Driscoll said.

Myah Moore, a senior who participated in the project, learned that having emergency supplies on hand is vital because most bleeding injuries occur in everyday events like car accidents, falls and mishaps in the kitchen.

“Bleeding causes people to go into shock and causes organ failure, and that causes more problems for doctors to address,” Moore said. “If you know how to stop the bleeding, that can prevent other major issues from occurring.”

Moore, now attending UNLV to become an athletic trainer, said Driscoll’s project educated her about many topics essential for her future career.

“It was like a next step in my education,” she said. “I realized, ‘One day I could be in a situation where I will need to save a life.’”

The Big Pitch The students compiled a PowerPoint presentation with their overall strategy for implementing Stop the Bleed, and rehearsed it repeatedly before pitching the principal.

“Mr. Driscoll assured us the worst that could happen is the principal would say no,” Moore said.

But when Principal Monica Cortez saw their presentation — including an “impressive” demonstration of applying a tourniquet — she says she was quickly convinced to fund the program with the school’s Strategic Budget.

“The turning point was the research the students conducted of the actual material cost, relative to the cost of a life,” Cortez said. “Our students brought forward a solution with a plan of action, that saving a limb or a life far outweighs the dollar expense.”

Rolling Out the Campaign The school implemented the students’ proposed Stop the Bleed program within a matter of months, with UMC returning to provide the same hands-on, bleedingcontrol training for over 130 teachers.

Western High School teacher Cheryl Gavin says all of the teachers took the UMC training seriously.

“I walked away from the training feeling that I would be able to help individuals in need,” Gavin said. “I believe it was one of the most beneficial and meaningful trainings I have been to in all of my years of teaching.”

Under the program, every Western High School teacher has also been allotted an emergency backpack stocked with North American Rescue’s public-access, bleeding-control kits.

These backpacks accompany teachers everywhere, including during evacuations and lock-downs.

Gavin believes her backpack could come in handy for a wide range of situations.

“I feel that it is critical to have the materials that would be necessary to help my students or colleagues at arm’s reach,” she said.

The school has also been strategically stocked with bleeding-control kits in several key locations like the library, athletic fields and cafeteria, Driscoll said.

“If there were a major event, such as bleachers collapsing, we would have those 8-Packs available to grab quickly,” he said.

The Next Steps Also a licensed athletic trainer at Western High School, Driscoll has worked to help other CCSD athletic trainers also receive UMC’s bleeding-control training.

“They passed it on to their schools, and by the end of last school year, several other schools had teachers who were taught these skills,” he said.

Cassandra Trummel, UMC’s trauma outreach and injury prevention program coordinator, hails Western High School’s campaign as “very proactive.”

Stop the Bleed can be beneficial for any organization to implement, she says, even beyond schools.

“In any emergent situation, there will always be a lag time before first responders can get to you,” Trummel said.

“Everyone should know how to control life-threatening bleeding, potentially saving themselves or someone else.”

Get Involved Trummel encourages any organizations interested in pursuing bleedingcontrol training to contact her at stopthebleed@umcsn.com.

“I am so very proud of the initiative that Western High School took by providing this training for its faculty,” she said.

You can nominate CCSD teachers for The Smith Center’s fourth-annual Heart of Education Awards through Jan. 18, 2019, at TheHeartofEducation.org.

Alecia Westmorland is the communications manager for the Smith Center for the Performing Arts.

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and remembering are the keys to get you While the season is joyous, it can also through this difficult time. be a season of stress. For those coping First, it is important to remember to with the loss of a loved one, this stress care for yourself first. It is okay to pass is compounded. Reminders of hapon the holidays either in their entirety pier times, disruptions in plans, empty or only certain traditions and events. spaces at family tables, and the societal There is overwhelming social pressure stress to be happy and joyful can trigger from every angle to be happy because increasing and vivid pain in those dealit’s the holidays. Those dealing with ing with loss. It is never easy to grieve, grief can even be made to feel that they but during the holidays grief can become are “ruining” the holidays by feeling sad. overwhelming.

This is simply not the case. No law exists However, it’s important to know there forcing people to celebrate the holidays. is hope. Despite the pain you might be There is not a “naughty list” for those feeling, the holidays can be endured who aren’t able to emotionally particiand maybe even slightly enjoyed – even pate. One participant in our grief groups if it needs to be in a different way than at Nathan Adelson Hospice loved to say you have enjoyed holidays in the past.

“Maybe next year” to those family and With strong self-awareness and advance friends urging her to do holiday-related forethought and planning, you can find things after she lost her partner. Not meaningful ways to connect with the participating is always an option. The memories and legacy of your loved one. holidays will return next year and every In doing so, the holidays can become less year after. of a burden and maybe even be transformative in your grieving. Caring, planning, Continued on page 48

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Realistic coping with the holidays always involves a check-in with yourself and those close to you to discuss your goals and limitations during this time.

Pay attention to those activities and traditions which might be hard to do without that special person there. Know what carols and movies might trigger

through the holidays. Maybe re-watch favorite TV shows or movies that have nothing to do with the holidays. Find time to be outside or to find other nonholiday ways of relaxing. Awareness of your own limitations and needs is vital during this time.

Once you have developed this aware-

painful memories. Gauge your energy level for time and energy-consuming activities like sending holiday cards and baking. Most of all, pay attention to what you will need for yourself in order to get

ness, be sure to communicate your needs to the people around you who may be impacted by your decisions. If there is a holiday bash that you and your loved one attended every year that will

be just too hard for you to attend, or a special dish you are expected to make, let people know.

The holidays are stressful for others too. The sooner you let them know what you are coping with and feeling, the less ambushed they will feel by your decisions.

Planning is another key to surviving the holidays. Think about what you will be doing during the holidays as far ahead as possible. Will you shop online to avoid the holiday music and displays at stores and malls? Will you send holiday cards this year or at least not send the annual holiday letter? Which invitations to holiday events will you accept? Which will you decline? Is there someone you can take to that holiday party who can support you or cover for you if your grief gets too intense that you have to leave?

Where will you spend the holiday? Who will you spend it with?

The more you can figure out the answers to these and similar questions, the more smoothly your holiday season will go. Be sure to communicate them with the people who will be impacted by them. Have a back-up plan or resolve to be okay if these plans are disrupted by either your grief or the chaotic nature of the holiday season.

The final key for surviving the holidays can be the most powerful and transformative one. Remember your loved ones during the holiday. Light a candle.

Make a gift in their name to a favorite charity. Find people to share your memories with. Keep their place set at the family table. Pour them a glass of wine or eggnog. Beyond the wild consumerism and social activity of the holidays, look to hope – hope in a new beginning, hope in lights that do not go out, hope in the enduring and eternal nature of family bonds and love. This hope can be relentless too. May it strengthen and guide you as you work your way through the holidays and each of the days beyond.

Matthew Metevelis is the chaplain at Nathan Adelson Hospice.

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f i n a n ce s

plans change — is your medicare still working for you?

By Linda Johnson

M

any seniors sign up for Medicare Part A and B, better known as traditional Medicare, when they turn 65. Most are still healthy and looking forward to an active retirement that may include travel and time with family. They like the flexibility of traditional Medicare. These seniors may see any provider or hospital that takes Medicare, no matter where they are in the United States.

Because they are relatively healthy, they generally don’t pay attention to what their Medicare plan covers, until they need to use it.

Needs evolve with age Five or 10 years later, however, they may be diagnosed with a chronic condition, like diabetes, kidney disease or a heart condition. They start seeing more specialists and medications become increasingly expensive.

While things are looking better in 2019, Medicare Part D participants will still have to pay 25 percent of their prescription costs af-

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ter they have reached their prescribed threshold. For someone with chronic obstructive pulmonary disease, better known as COPD, the monthly costs for medication can exceed $800. Once seniors fall into the coverage gap, also known as the “donut hole,” they are paying more than $200 per month out of pocket until they reach their plan’s catastrophic maximum.

“For seniors on a fixed income, $200 per month may require a choice between their prescriptions and their utility bills or groceries,” notes Dr. Roopa Dani of P3 Medical Group’s West Sunset Clinic. “All too often, we see patients who have stopped taking their medications.

Their conditions have significantly worsened, and, in some cases, they require hospitalization.”

This lack of coverage negatively affects the health of many seniors.

Falling through the cracks When chronic conditions set in, many seniors appreciate their doc-

They continue to spiral towards expensive hospitalization when they could be on an upward trajectory with wellness-focused care.

For seniors on a fixed income, $200 per month may require a choice between their prescriptions and their utility bills or groceries. tors addressing their ailments, but something is often missing. “My husband and I are more than our conditions,” says Bonnie Zavsza, who sees Carolyn Dechaine (PA-C) at P3’s Town Center Clinic. “I have multiple specialists helping us with various health issues, we followed Carolyn to her new practice because she is so kind and makes sure we’re treated as whole people.”

This is often the case with the fee-for-service approach of traditional Medicare. Medical providers are only compensated for the patient’s office visit, creating little incentive for primary care providers and specialists to see the patient holistically and thoroughly coordinate patient care.

As a result, it’s easy for seniors to skip follow-up tests and appointments.

Taking advantage of Medicare Advantage There are alternatives available that can help expand coverage and get seniors the comprehensive and coordinated care they need. Seniors with traditional Medicare can add supplemental coverage to their existing plan which can help them cover costs of Medicare-authorized expenses such as co-pays and deductibles.

Medicare-eligible patients can also opt for a Medicare Advantage (MA) plan. An MA plan covers all the traditional Medicare benefits, including hospitalization, dwoctor visits, and medical equipment. MA plans also offer additional benefits like dental and vision coverage— critical aspects of maintaining one’s overall health. These plans can also include transportation services to helps seniors run errands and get to medical visits. Furthermore, these plans may cover grocery or home meal delivery after hospitalization.

Dani recommends patients consider MA plans during the Medicare Annual Election period, which runs through Dec. 7, 2018. “The best part of having a Medicare Advantage plan is that it helps providers like me better coordinate your care. Under this plan, healthcare providers are better able to focus on keeping their patients happy and healthy.”

After realizing that she needed to make a change to her Medicare Advantage plan to keep her provider, she reached out to her broker and discovered the two new plans in the market include P3 Nevada (and Carolyn) in their network. “We’re so happy to be able to stay with the provider we love and it we’ll even save money in the long run.”

Dr. Linda Johnson is a provider with P3 Medical Group.

Where to turn Senior Care Plus, the Medicare Advantage plan from Hometown Health, has teamed up with P3 Health Partners.

“The relationship between Senior Care Plus and P3 Health Partners will focus on the provider and patient experience and healthcare outcomes through high-value care and benefits,” said Ty Windfeldt, Hometown Health CEO & Renown Health Senior Vice President. “P3’s community of experienced providers deliver excellent patient care at their physician-led clinics where they specialize in helping southern Nevada’s seniors remain healthy and active.”

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i n s ura n ce u p d ate

What Nevadans need to know about this year’s Open Enrollment for health insurance

By Heather Korbulic

O

pen Enrollment for health insurance started about two weeks ago, giving uninsured and underinsured Nevadans the opportunity to sign up for budget-appropriate, qualified health insurance through our online marketplace, Nevada Health Link. This means the staff and I at the Silver State Health Insurance Exchange have less than four weeks remaining to reach all eligible Nevadans statewide with one important message: no one can afford to be without insurance — regardless of health, age or life circumstance.

To learn about Nevada Health Link and to find out if you’re eligible, a pre-screening tool on our website can help. Of the consumers who enroll in one of our plans, over 80 percent of them qualify for federal subsidies and tax credits, helping reduce their out-of-pocket costs and assist in reducing the monthly premium. This year, rates on the Exchange are down slightly and that is good news for consumers looking to find affordable comprehensive health insurance.

Some Nevadans even qualify for very low to zero ($0) premium plans. But, because so many consumers opt out of exploring their options, significant dollars and monetary assistance goes unused, and more importantly, uninformed Nevadans aren’t getting the financial assistance for the health insurance coverage they need and deserve.

I live and breathe health insurance related policy, and I am still intimidated with the process of applying for health insurance, just as most people are. But Nevada Health Link is here to help guide consumers through what can otherwise be a complicated process.

One of our biggest hurdles this year is educating consumers on the critical differences between plans. Changes on the

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federal level have minimized health insurance requirements, making consumers even more vulnerable of purchasing plans that could leave them high and dry.

I can’t emphasize enough how imperative it is to read the fine print and understand that some plans may come with limitations — including those on pre-existing conditions and emergency visits — and don’t adhere to previous Affordable Care Act requirements.

If you already have a plan purchased, I still encourage you to reassess your coverage and shop the marketplace every year, because plan and rate changes occur each year.

And remember that outside of Open Enrollment, there are certain changes in an individual’s life that make them eligible for a Special Enrollment Period, allowing them to enroll anytime during the year. Qualifying life events include loss of employer-based coverage, changes in income, and changes in family size through marriage, divorce or the birth or adoption of a child.

There are only a few things you need to enroll with the Exchange, such as a valid Nevada driver’s license, Social Security card, proof of Nevada residence and household income (the complete checklist is on our website). If you have any questions or need help finding in-person assistance near you, please visit us online (NevadaHealthLink. com), contact us by phone (1-855-768-5465) or email (customerserviceNVHL@exchange.nv.gov).

Heather Korbulic is the executive director of the Silver State Health Insurance Exchange.

MARIJUANA

‘THE EVIDENCE IS THERE’: MEDICAL PROFESSIONALS SAY POT AN EXPANDING PART OF CHILDREN’S MEDICINE

By Chris Kudialis

P

ORTLAND, Ore. — As the marijuana industry expands to a greater role in mainstream medicine, doctors across the country, including in Las Vegas, are promoting the plant in the treatment of sick children.

“Cannabis is safe, especially under medical supervision,” said Dr. Bonni Goldstein, a Los Angeles-based pediatrician, at the Cannabis Science Conference held in August. “People worry using cannabis would make kids worse, but we’re finding the exact opposite is true.”

Goldstein for a decade has operated Canna-Centers Wellness & Education in Southern California. The practice has exploded in recent years as parents of youth patients from across the country have sought pot-based treatments for extreme conditions like epilepsy, autism, obsessive compulsive disorder, cancer and Tourette syndrome.

Cannabis is safe, especially under medical supervision.

Nevada law does not allow minors under age 18 to apply for a medical card. But adults can apply for a card on behalf of a minor, and legally have the authority to purchase medical marijuana products and serve them to that minor. Medical marijuana is legal in 30 states.

Instead of swallowing pills or forcing down liquid prescription drugs, Goldstein’s patients are given cannabidiol oils (CBD) to drop under their tongues or, for patients who can’t swallow, to serve through a gastronomy feeding tube.

Cannabidiol, which is also used by elderly patients as a pain reliever, satisfies a part of the brain called the endocannabinoid receptor, Goldstein said. The California pediatrician says she rarely suggests high doses of tetrahydrocannabinol (THC), the active ingredient in marijuana that provides users with a psychoactive high, unless the patient has trouble sleeping or suffers from high anxiety.

Goldstein, who started in the medical industry as an emergency room doctor, says she has prescribed cannabis medication for more 600 children, as young as 6 weeks old, from across the United States. While her youth patients are

treatment resistant — meaning regular pharmaceutical prescription drugs designed for their medical conditions haven’t worked — Goldstein says she has seen success rates of more than 85 percent when switching to pot.

“The results have been incredible,” she said. “The evidence is there.”

Medical professionals emphasized that marijuana is often a last resort for child patients with life-threatening disabilities.

For children in good health looking to improve their overall sense of wellness, Bernstein said brain-altering substances are not a responsible option.

“There’s no reason to mess with a system that’s already functioning,” she said. “If you’re well, just leave your brain alone” Research on the plant is limited because the federal government classifies it as a Schedule I narcotic, which means institutes can’t receive grant money to study weed. Goldstein said the negative stigma of marijuana remains, especially from parents who bring their children to her office for the first time.

Jan Roberts, a New York City-based psychologist, founded the International Research Center on Cannabis and Mental Health last fall with a goal of advising medical professionals on how to recommend cannabis for the mental well-being of their young patients. Roberts, like Bernstein, said the plant helped treat diseases in young patients who did not benefit from prescription drugs.

Roberts in a speech during the conference described a teenage patient suffering from years of extreme anorexia, who with cannabis developed a desire to eat and maintain a regular weight within six months.

“I’m a huge proponent of talk therapy, but cannabis in conjunction with talk therapy has changed this young woman’s life,” Roberts said.

Robert Cohen of the Cohen Medical Center in Las Vegas said the need for cannabis as part of youth medicine is “definitely there.”

“We’re trying to change the perception of this. It’s medicine,” Cohen said. “Too many professionals still don’t know enough about it to steer people in the right way.”

Chris Kudialis is a reporter with Greenspun Media Group.

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ha b i t s

beware vaping's hype; clean air is still the best air for your lungs

By Dr. James S. J. Hsu

T

he statistics surrounding vaping are astounding and, in some cases, pretty confusing.

Let’s start with the hard facts. According to the Population Assessment of Tobacco and Health, approximately 18 million people vape regularly in the United States. Approximately 16 percent of high school students have used vapes. And, with the prevalence of vape shops, smoke shops and the availability of e-cigarettes at convenience stores and the like, it appears that vaping isn’t going anywhere anytime soon.

On one end, there is certainly a pro-vaping contingency. According to Johns Hopkins Medicine, among a number of other sources, vaping and e-cigarettes expose users to fewer toxins than traditional cigarettes — though the exact chemicals present in vapes can certainly vary. In 2015, the United Kingdom’s Public Health department declared that vaping was “95 percent safer than smoked tobacco and can help smokers quit.” And, according to PATH, vapers have 97 percent less of NNAL (a bi-product of nicotine) in their bodies than tobacco smokers.

On the flip side, there are cons to vaping, some of which have emerged as a result of new studies. The Food and Drug Administration is weighing a ban on flavored-cigarette liquids, given that many believe vaping devices may actually lead teens to a nicotine addiction later in life. Perhaps the biggest concerns with vaping are the unknowns. Giving the habit has risen to popularity in the last few years, there simply isn’t enough evidence to clearly define long-term effects.

Perhaps the biggest concerns with vaping are the unknowns.

From a pulmonologist’s point of view, here is the bottom line: Don’t put anything in your lungs that shouldn’t be there, whether it is smoke stemming from a cigarette, marijuana, vaping, hookah or anything like it. Good clean air is best for your lungs and that’s that.

Is there or will there be a place for vaping? Perhaps. At this point in time, we are pretty sure that vaping is safer than smoking, but there just isn’t enough evidence to definitively say so.

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An overarching concern with vaping, aside from what has already been outlined, is the notion of heating something and then breathing it in. What is being smoked as well as the chemical structure of the device itself may be compromised and harm the body. An example: Some vapes and liquids have a chemical called diacetyl, which historically was used in movie popcorn to give it a buttery flavor. The chemical was found to ultimately cause, in select instances, a respiratory illness and inflammation of the lungs – known as “popcorn lung.” A number of health concerns remain about its effects related to vaping.

So, if vaping isn’t the answer to get someone to stop smoking, what is? There are plenty of alternatives available that should be considered far before vaping. These options include nicotine patches, gum, lozenges, inhalers, nasal sprays and even prescriptions like Bupropion and Varenicline. Whether related to

smoking or not, if you are experiencing persistent cough shortness of breath or coughing up blood, it is vital to see a pulmonologist as soon as possible.

In the pulmonary world, there are a number of tests to determine the source and severity of lung-related issues. These tests include pulmonary function tests, bronchoscopies, thoracoscopies, ultrasounds and fine needle biopsies. In terms of detecting lung cancer – which is true with so many cancers – it is often si-

lent until it reaches a certain point. Those that should immediately consult a physician are patients who experience a cough that will not go away or unexplained weight loss. And, when it comes time to test for lung cancer, the latest in lung cancer screening technology is now available right here in Southern Nevada.

There is and can be a solution for you to quit smoking. It’s never too late. But, it is still too early to give vaping and all that comes with it a definitive thumbs up.

James S. J. Hsu is a pulmonologist at Lung Center of Nevada, a division of Comprehensive Cancer Centers.

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p at i e n t s ucce s s s t o ry

Audrey Marrow is patient of Comprehensive Cancer Center's Dr. Rupesh Parikh.

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Photo by Christopher DeVargas

DRUG'S ABILITY TO PREVENT CANCER FROM HIDING COMES TO AID OF LOCAL PATIENT

By Dr. Rupesh Parikh

I

mmunotherapy is a word you’ve may have heard... it's certainly a word you'll be hearing again.

Immunotherapy is a form of targeted therapy that has become a research focal point among top research institutions. In a nutshell, immunotherapy boosts the body’s immune system to find and ultimately attack harmful cancer cells. A number of cancers have the ability to hide from detection in the body. Immunotherapies are being developed and emerging — each in their own unique way — to help the body essentially outsmart these cancers.

Among these therapies is Keytruda, which prevents cancer cells from hiding. Keytruda is administered via an intravenous line, lasting approximately 30 minutes per treatment. Keytruda is typically given every three weeks, with the patient’s doctor determining how many treatments are needed.

Keytruda has been in the spotlight for nearly five years, dating back to Merck achieving “breakthrough status” by the Food and Drug Administration for the drug in 2013. Preliminary trails focused on the treatment of melanoma and lung cancer.

In 2014, the FDA approved Keytruda for the treatment of melanoma patients who carried a specific mutation. Subsequently, the drug has been approved for the treatment of a number of different cancers, including: non-small cell lung cancer; head and neck squamous cell cancer; classical Hodgkin lymphoma; urothelial carcinoma; select stomach cancers; and a specific type of cervical cancer that tests positive for the PD-L1 protein.

Additionally, Keytruda remains in trial phase for a number of cancers, including breast cancer. At Comprehensive Cancer Centers, the practice participates in more than 170 Phase I, Phase II and Phase III clinical research studies each year and has played a role in developing more than 70 FDA-approved cancer therapies.

Among those trials Comprehensive had access to in mid-2016 was Keytruda for a specific type of breast cancer. And, that access and the treatment that ensued turned out to be a life-changing scenario for a local patient who had exhausted so many other options.

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Continued from page 57

Meet Audrey Philadelphia native and Vegas local Audrey Marrow is unfortunately no stranger to a cancer diagnosis. In 2005 she was diagnosed with ovarian cancer and underwent chemotherapy and a hysterectomy. I first met Audrey four years ago, shortly after she noticed a lump in her right breast. After conducting the appropriate tests, we determined she had a very aggressive form of breast cancer, known as HER 2-Negative.

We immediately devised a treatment plan for her at that time that began with chemotherapy. She completed this regimen in February 2015 and in April 2015, had a complete mastectomy. Following the mastectomy, there was no residual breast cancer. However, during a follow-up appointment, we noticed cancer development in a left axillary lymph node. This was the opposite side of where her breast cancer had originally developed, which was certainly cause for concern.

So, in early 2016, we sat back down with Audrey to discuss her options. At the time, immunotherapy was certainly all the buzz and more and more therapies were being approved for trials for other cancer diagnoses.

One of them was Keytruda for breast cancer.

After discussing options with Audrey and sending her pathology off for laboratory review, she was deemed to have the PDL1 protein marker that Keytruda affects. Not wanting to return to chemotherapy regimen, Audrey signed on and immediately began the trial.

She’s been on the trial since. And, since embarking on the trial, it’s been a steady shrinkage of tumors and zero emergence of any new tumors. In the oncology world, we like to call this a “complete response” to the treatment.

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Audrey Marrow, a patient of Comprehensive Cancer Center's Dr. Rupesh Parikh, turns 70 on New Year's Eve.

Where Audrey was once frustrated by yet another cancer diagnosis and lacking the confidence that she’d return to normal health, she has now been cancer free for nearly two years. She has experienced zero side effects during the past two years as well.

With her newfound energy and livelihood, she’s been able to support some of her closest family members and friends during their own difficult times.

On New Year’s Eve, she’ll turn 70. Her spirits have been lifted and her spunk has returned, often asking me, “when are we heading on our vacation?”

Beyond Keytruda The outlook for immunotherapy is bright.

Here in Nevada, the American Cancer Society estimates that 14,060 residents will be diagnosed with cancer this year. Approximately 2,180 of these cases will be breast

cancer. Globally, each year, breast cancer accounts for nearly 12 percent of all cancer diagnoses. Amid the statistics, more and more trials are emerging to potentially help and heal each unique patient.

New targets are emerging — just like PD-1 and PDL-1 — for targeted therapies. And, the beauty of immunotherapy and targeted therapies is that when patients do respond, they are typically having a sustained response, living longer and happier.

In addition to Keytruda, there are a number of clinical trials available for breast cancer patients.

An example: Yervoy is a growlingly popular immunotherapy treatment, initially approved by the FDA in 2011 to treat specific types of metastatic melanoma. It has since been tested for prostate, lung and bladder cancer patients. Currently, there are a number of phase I and II trials available for recurrent metastatic, triple-negative and locally advanced breast cancers, sometimes being paired with the PD-1 antibody, Opdivo.

In cancer, unfortunately there is no magic formula that applies to all cancer patients just yet. But, it’s patients like Audrey and the promising Phase I, II and III trials that continue to grow locally and globally that give us hope and drive us to keep fighting.

Dr. Rupesh Parikh is a medical oncologist and practice president of Comprehensive Cancer Centers.

Photo by Christopher DeVargas

q & a

Health care attorney: 'Running a business is similar to running a marathon'

By Rebecca Clifford-Cruz

A

yesha Mehdi, principal attorney at Frontier Health Law, works with health care providers, such as physicians, dentists, nurses, and physician assistants, as well as health care delivery entrepreneurs. Since 2015, she has provided her clients with counsel pertaining to their business and corporate law matters, regulatory compliance and licensure issues.

What inspired you to become a lawyer, particularly in health care?

Great minds and leaders that were shaped by the legal profession inspired me to become a lawyer. I am in awe of the logical thinking, reasoning and speaking abilities of game-changers such as Muhammad Ali Jinnah, Gandhi, Abraham Lincoln and Nelson Mandela. As for choosing health care law, I believe there’s a need for more diversity specifically in health care law, which is a growing field. Southeast Asian law students tend to go into immigration or general corporate law. I deliberately chose health care law because our medical community is quite diverse, while there are not as many diverse attorneys to cater to their needs.

Do you need to have previous health care industry experience to become a health lawyer?

It’s not required but there is no substitute for experience. I was in health care management for a couple of years before I started practicing law. I also have a master’s in health services administration, and I used it to help establish and manage Hope Cancer Care of Nevada.

How did you decide to base your practice in Nevada?

My personality epitomizes what Nevada stands for — it is a state that is battle born — the Wild, Wild West. And Las Vegas, in particular, is the perfect place for new beginnings, to launch and grow a new business and even raise a family.

Photo by Wade Vandervort

How can Nevada bolster its health care laws to protect consumers and providers?

Health care costs, and employee benefits costs, have been increasing at an alarming rate for nearly a decade. There are various reasons, such as consolidation of managed care companies, government regulation, increased prescription costs, an aging population, the list goes on.

Many employers are choosing to pass more costs to employees to handle such increases. Like other states, Nevada should continue to pass legislation aimed at reducing health care costs, which, in turn, would reduce the growth of the health insurance premiums paid by employers.

What is the best business advice you can give?

mately determine my practice’s success or failure.

How do you decompress after a long week?

By running a few miles, hitting the gym, meditating, reading a good book and spending time with my friends and family.

What advice do you have for aspiring health care lawyers?

I would suggest aspiring professionals in any field invest time and energy in building relationships with their mentors and peers. These relationships have proven invaluable for me. Aspiring health care lawyers should also strive to be actively involved with organizations such as the American Bar Association Health Law Section, and the American Health Lawyers Association.

Running a business is similar to running a marathon — entrepreneurs need to be prepared to mitigate the incessant ups and downs by believing in themselves, keeping their energies focused, continuing to improve, listening to their instincts and reminding themselves why they started their businesses in the first place. For example, I started my own firm to have the independence of my time and to be able to make decisions that ulti-

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

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THE NOTES The Foundation Assisting Seniors moved to 2518 Anthem Village Drive, Suite 102, Henderson.

Construction vs. Cancer, presented by Las Vegas Paving Corp., raised almost $300,000 at its inaugural event. Criss Angel was presented with the American Cancer Society Compassionate Heart Award.

The Smith Center for the Performing Arts honored local teachers at the third annual Heart of Education Awards. Each winner received $5,000 and each winner’s school received $1,000 to go toward a program of the teacher’s choice.

Award recipients were: Stephenia Courtney, William E. Orr Middle School; Julie Pribyl, Roy W. Martin Middle School; Dana Wynne, Jerome D. Mack Middle School; Ciara Owens, Mario C. and JoAnne Monaco Middle School; Shawn Kelly, John C. Fremont Middle School; Kristine Grant, Sig Rogich Middle School; Kevin Chung, Advanced Technologies Academy; Brian Driscoll, Western High School; Erin Hill, Green Valley High School; Stacey Johnston, Las Vegas Academy of the Arts; Andrew Magness, Valley High School; Ramiro Martinez, Del Sol Academy of the Performing Arts; Amy Murray, Spring Valley High School; Luanne Wagner, Ed W. Clark High School; Lisa Dalton, Reynaldo L. Martinez Elementary School; Karen Kanwhen, Lewis E. Rowe Elementary School; Alana London, Eileen B. Brookman Elementary School; Olivia Terrell, Dr. C. Owen Roundy Elementary School; Laura Juliana Urtubey, Crestwood Elementary School; and Tika Epstein, Keith C. & Karen W. Hayes Elementary School.

The College of Southern Nevada Foundation honored community supporters and first responders, as represented by CSN alumni, at its Blooming in Blue gala. Las Vegas Convention and Visitors Authority CEO Rossi Ralenkotter was awarded the Community Achievement Award.

The Community Education Award was given to Switch. CSN presented the Community Hero Award to a group of alumni nurses, emergency personnel, police officers and firefighters that were involved in the Oct. 1 response.

Huntridge Family Clinic founder John “Rob” Phoenix was given the Southern Nevada Health District’s Public Health Hero Award. Phoenix was given the honor for his work with the LGBTQ community and people living with HIV. Touro University Nevada, in partnership with City National Bank, the Vegas Golden Knights and Zappos, unveiled the institution’s third mobile health care clinic. It will provide on-site medical care at several Nevada HAND housing locations, Henderson’s Heritage Park and

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Las Vegas HEALS hosted its seventh annual Inspired Excellence in Healthcare Awards on Oct 25, at the Four Seasons. Inspired by the pioneer exploits of Dr. Royce W. Martin, Las Vegas’ first chief surgeon circa 1905, the award ceremony recognized six health care leaders who ignite and inspire continued possibilities for healthcare excellence. Above, pictured from left are, David Marlon, vice president of American Addiction Centers and founder/president of Solutions Recovery; Dr. Deborah Kuhls, UNLV School of Medicine professor, trauma & critical care, and medical director, UMC trauma intensive care unit; Dr. Lindsay Hanson, chairman, Summerlin Hospital department of medicine, and medical director of the El Jen Convalescent Hospital & Plaza Regency; Dr. Eddy Luh, vascular surgeon with Las Vegas Surgical Associates; Dr. Mark Winkler, partner/radiologist with Steinberg Diagnostic Medical Imaging, and member of the medical advisory board of Cannon Medical Systems; and Dr. Rupesh Parikh, medical oncologist at Comprehensive Cancer Centers. (Courtesy photos)

senior centers. Touro medical students, under the supervision of Touro faculty, will provide the medical care.

North Vista Hospital’s bariatric surgical center is accredited as a Comprehensive Center under the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program, a joint program of the American College of Surgeons

and the American Society for Metabolic and Bariatric Surgery.

Refined Personal Training is open at 11251 S. Eastern Ave., Suite 180, Henderson.

Gabby Kompare, neonatal physical therapist at Spring Valley Hospital, earned her designation as a certified neonatal therapist, one of approximately 250 in the world.

the n o te s Ijafeh Akpe and Stephanie Lim are fellows of the American College of Healthcare Executives, the nation’s leading professional society for health care leaders. Akpe is assistant system director of health information management and physician/clinical documentation improvement for the Valley Health System. Lim is director of business development for Spring Valley Hospital.

MountainView Hospital’s Magnetic Resonance Imaging system received an advanced system update from GE Healthcare. It is devised to help clinicians improve workflow, lower cost of ownership and improve patient comfort. The system uses 34 percent less power than previous MRI systems and requires a smaller footprint for installation. Two to three more patients per day can be scanned due to new features and an anticipated increase in productivity.

MountainView Hospital received the American Heart Association/American Stroke Association’s Get With the Guidelines-Stroke Gold Quality Achievement Award, which recognizes a commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest science.

Summerlin Hospital offers Blue Light Cystoscopy with Cysview, an optical imaging agent for the detection of papillary cancer of the bladder in patients with known or suspected bladder cancer. Cysview is the only FDA-approved imaging agent for use with blue-light cystoscopy.

Dignity Health-St. Rose Dominican Hospitals launched EMPOWERED (Empowering Mothers for Positive Outcomes With Education, Recovery and Early Development), which is designed to help mothers whose children may suffer from neonatal abstinence syndrome as a result of medicine, drugs, nicotine, alcohol, marijuana and other substances used during pregnancy. The program offers resources on prenatal, postpartum, and early childhood development.

Consumer Reports recognized MountainView Hospital and 62 other hospitals for successes in heart surgery. MountainView is the only Nevada hospital on the list. Ratings were determined by data provided by the Society of Thoracic Surgeons for hospitals that agreed to share information.

Sunrise Hospital changed phone numbers. The main number is 702-961-5000.

MountainView Hospital opened a new fourth floor medical-surgical unit with 32 patient beds.

Dr. Mulugeta Kassahun of Urology Specialists of Nevada completed his 1,000th robotic surgery.

The Ronald McDonald House’s Runnin’ for the House 5K & Family Fun Walk, which included an appearance from Carrot Top, raised more than $75,000. (Courtesy photo) Joseph Wang, Chris Wolfgram and George Fournier joined the board of the Foundation Assisting Seniors.

HCA Healthcare presented an honorary award of distinction to Sunrise Hospital & Medical Center for the hospital’s response to the shooting on Oct. 1. Also receiving an award was David Chia, director of application services for the Far West Division.

Clean Focus Renewables installed solar arrays at the San Martin and Siena campuses of Dignity Health—St. Rose Dominican Hospitals. The San Martin Campus project has 5,885 solar modules situated on carports covering 720 parking spaces. The Siena Campus project consists of 4,795 solar modules on carports covering 430 parking spaces in the existing parking garage.

Solutions Recovery and Desert Hope Treatment Center implemented the EarlySense patient monitoring system. It helps staff track a patient’s vital signs and detect early signs of deterioration, specifically during detox.

Desert Hope Treatment Center received the Joint Commission’s Gold Seal of Approval.

The accreditation signifies that Desert Hope has demonstrated its compliance with performance standards and commitment to provid-

ing safe, effective care.

The Association for Professionals in Infection Control and Epidemiology awarded MountainView Hospital the 2018 Heroes of Infection Prevention Award. Since early 2015, the Infection Prevention and Quality Management departments at MountainView Hospital created processes to reduce hospital acquired conditions with an emphasis on Clostridium difficile (C. diff).

Using evidence-based guidelines, the MountainView team developed a C. diff testing algorithm designed to prevent unnecessary and duplicative C. diff testing. The facility’s C. diff rate dropped from 1.78 standardized infection ratio in 2015 to 0.56 in mid-2016.

Gov. Brian Sandoval appointed Diane Fearon of Nathan Adelson Hospice to serve as chairwoman of the Commission for Women for the State of Nevada. Fearon is the hospice’s vice president of philanthropy and strategic partnerships.

Dr. Jeffrey Cummings received the Bengt Winblad Lifetime Achievement Award in Alzheimer’s Research, presented by the Alzheimer’s Association. Cummings is founding director of the Cleveland Clinic Lou Ruvo Center for Brain Health.

4 The Kids raised $70,000 for the Cure 4 The Kids Foundation.

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THE NOTES The national Parkinson’s Foundation named the Cleveland Clinic Lou Ruvo Center for Brain Health a Center of Excellence in Parkinson’s care.

The Parkinson’s Foundation Center of Excellence network comprises 45 leading academic medical centers, 31 of which are in the United States.

Diane Fearon, Dave Marlon and Alexandra Silver joined the board of directors of Las Vegas HEALS. Fearon is vice president for philanthropy and strategic partnerships at Nathan Adelson Hospice. Marlon serves as American Addiction Center’s regional vice president of Nevada, including Solutions Recovery and the Desert Hope Treatment Facility. Silver serves as executive director for Clark County Medical Society.

Centennial Hills Hospital physical therapist Wendy Hubbard-Alexandre earned the designation of Certified Neonatal Therapist by the National Association of Neonatal Therapists.

Henderson was ranked second among Nevada’s five safest cities in a report released by SafeWise, a professional review and comparison website for the home security industry.

Henderson Hospital added an eight-bed, Level II neonatal intensive care unit.

Sunrise Hospital and Medical Center received reverification of its Level II Trauma Center by the American College of Surgeons. The process ensures that the trauma center is meeting the standard of care as outlined by ACS Resources for Optimal Care of the Injured Patient manual.

Alyson Martinez is the director of programming at the Las Vegas Rescue Mission. She will focus on policy and procedure development, staff education/training, and programs such as Shelter of Hope.

The Nevada Blind Children’s Foundation opened a learning center for blind and visually impaired children. It offers education, adaptive recreation, employment and life-skills training. Its address is 95 S. Arroyo Grande Blvd., Henderson.

Desert Radiology opened a new outpatientbased imaging facility at 3175 St. Rose Parkway, Suite 130, Henderson.

Spring Valley Hospital opened a new patient care unit, adding 36 private rooms on the third floor especially for orthopedic and spine surgery patients. The expansion increases the hospital’s licensed bed count to 328.

The hospitals of the Valley Health System received Mission: Lifeline Quality Achievement Awards for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients

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The third annual Mad Hatter Cocktail Tea Party raised $25,000 for the StoryBook Homes Long-Term Follow-Up Clinic for childhood cancer survivors. Operated by Cure 4 The Kids Foundation, it is the only clinic in Nevada created specifically to address the medical, emotional, educational and social needs of childhood cancer survivors. (Courtesy photo) who suffer severe heart attacks. Awards were earned by meeting specific criteria and standards of performance for quick and appropriate treatment through emergency procedures to reestablish blood flow to blocked arteries in heart attack patients coming into the hospital directly or by transfer from another facility. VHS hospitals also received the American Heart Association / American Stroke Association’s Get With The Guidelines-Stroke Quality Achievement Award.

The award recognizes the hospitals’ commitment to ensuring stroke patients receive the most appropriate treatment according to nationally recognized, research-based guidelines based on the latest scientific evidence.

GetInsured has been awarded a contract with Nevada Health Link—the state’s health insurance marketplace. GetInsured will operate Nevada Health Link’s technology platform for eligibility and enrollment, as well as its call center, when it transitions to a state-based exchange next year. Nevada Health Link currently leases the Healthcare.gov platform to facilitate the sale of qualified health plans and will continue to do so through plan year 2019.

Claude Wise is CEO of Valley Hospital Medical Center.

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

the n o te s Nevada Women’s Philanthropy gave $465,000 to Future Smiles to create the NWP Dental Wellness Center at the Elaine P. Wynn Elementary School, where it will provide comprehensive dental treatment to children.

The grant will allow Future Smiles to add a permanent clinic as well as a dentist and dental assistant. The clinic will be a collaboration between Future Smiles, Roseman University and the Clark County School District.

The Nevada Women’s Philanthropy Founders Gift for $30,000 was awarded to The Blind Center of Nevada.

The third annual Rock the Socks Golf Classic raised more than $27,000 for Ronald McDonald House Charities of Greater Las Vegas. Sponsors included UFC, Lexus of Las Vegas, Boyd Gaming, Four Seasons Hotel Las Vegas, H&K International, McCarthy Kaster Guerrero CPAs and Southern Glazer’s Wine and Spirits.

The Las Vegas St. Jude Walk Run to End Childhood Cancer hosted an ice skating fundraiser that raised nearly $4,000. Chance, the Vegas Golden Knights mascot, and Sharkey from Shark Reef made appearances.

The American Ambulance Association honored six paramedics from American Medical Response and Medic West in Las Vegas as part of its Stars of Life. The six professionals, selected for their efforts during October 1, were: Alexander Anderson, critical care paramedic; Brett Dragun, paramedic and operations supervisor; Dr. Michael Barnum, assistant emergency room director for Valley Hospital and medical director for AMR; Callen Daquioag, paramedic; Stacy Dockery, critical care paramedic; and Sheri Jones, critical care paramedic.

Desert Audiology donated $20,000 worth of assistive-listening devices to the Smith Center.

Seventeen Las Vegas-area Special Olympics athletes represented Nevada at the 2018 Special Olympics USA Games in Seattle. Playing basketball were Paul Brooks Jr., Patrick Brown, Gerardo Cortez, Rob Doyle, Jesse Frankel, Quentin Kurz, Kelvin Rainey, Mahmood Sajjidi, Shautief Toenniges and James Stinson. Bowling were Matt Fiscus, Jackie Jones, Stacy Mullins, Wesley Oana and Krystelle Rodriguez. Jolina “JoJo” Harris competed in swimming and Sandra Josephson in track & field.

Southwest Medical Associates partnered with Project 150 to open a student resource room at Desert Pines High School, donating a refrigerator, microwave, storage space and clothing rack.

The resource room provides students with a place to work, rest, eat and find essential items

like food, clothing, hygiene products and school supplies.

Nurse Lynn Hanssen (RN Manager for Gastroenterology and Immunology at Southwest Medical Associates) was recognized with the Clark County Medical Society’s Winged Heart Award for her efforts against colon cancer and promoting colon cancer screening.

OptumRx, a pharmacy care services company, is producing prescriptions for home delivery in fully recyclable packaging which is biodegradable, compostable and reusable.

Dr. Janet Lee is an ophthalmologist with Shepherd Eye Center at 9100 W. Post Road, Las Vegas.

Dream Adult Day Care is open at 1445 W. Alexander Road, Suite 103, North Las Vegas.

HealthCare Partners launched a myGeneration Clinic at 2650 N. Tenaya Way, Suite 302. The clinic focuses on health care for seniors.

Mark Amox is chief operating officer of Sunrise Children’s Hospital.

Lisa Kunz was named Employee of the Year at Touro University Nevada. Kunz works at Touro’s autism center, the Sharon Sigesmund Pierce & Stephen Pierce Center for Autism & Developmental Disabilities.

MDL Group raised $1,222 for the Susan G. Komen Breast Cancer Foundation.

The Elaine P. Wynn & Family Foundation gave $568,000 to Nathan Adelson Hospice’s Elaine Wynn Palliative Care Program.

AT&T awarded Dustin Jones the Gold Vail Award for his heroism during the October 1 mass shooting. Jones helped lead 80-100 concertgoers, including several who had been shot, to safety in a nearby office building.

Urology Specialists of Nevada’s Dr. Jason Zommick received recognition as a Rezūm System Center of Excellence for his expertise in treating benign prostatic hyperplasia, or enlarged prostate.

HCA Healthcare is acquiring Mission Health, a nonprofit North Carolina health system. HCA will acquire substantially all the assets of Mission Health for $1.5 billion.

Senior Living broke ground on Mesa Valley Estates Assisted Living and Memory Care, an $8 million, 78-unit senior living community that will serve seniors and families in the Mesquite and Moapa Valleys, Arizona Strip and southern Utah areas. The community, at 1328 Bertha Howe Ave., Mesquite, will be

built by MSL Construction.

Solutions Recovery—McLeod is open at 4011 McLeod Drive, Las Vegas.

Ground was broken on the ER at Blue Diamond, on the northwest corner of Blue Diamond Road and Cimarron Road. The facility will operate as a 24-hour extension of Spring Valley Hospital’s emergency department and will feature eight treatment rooms, three rapid medical exam rooms, advanced imaging services such as CT, ultrasound and X-ray, and an on-site laboratory.

Comprehensive Cancer Centers installed three sunscreen kiosks at Sam Boyd Stadium.

The kiosks are in the main parking area at Star Nursery Field near the main walk-in gate; in the alumni tailgate area; and on the concourse near the 50/50 raffle area.

The Best Doctors in America list, published annually by Best Doctors, includes 49 members of the Clark County Medical Society: Dr. Carlos Fonte, Dr. Cres Miranda, Dr. Charles Allen Rhodes, Dr. Douglas Thomas, Dr. W. Reid Litchfield, Dr. Donald Kwok, Dr. Gregory Kwok, Dr. Jerome Frank Hruska, Dr. Gary Skankey, Dr. Eugene Spec, Dr. Mark Charles Handelman, Dr. Jerrold Schwartz, Dr. Bradley Thompson, Dr. Fadi Braiteh, Dr. Souzan E. El-Eid, Dr. Russel Gollard, Dr. Edwin Kingsley, Dr. James Delfino Sanchez, Dr. Nicholas Vogelzang, Dr. Zvi Sela, Dr. Derek Duke, Dr. Jeffrey Lee Cummings, Dr. Luis Diaz, Dr. Paul Bandt, Dr. Jocelyn Ivie, Dr. Florence Jameson, Dr. Kirsten Rojas, Dr. Bruce Shapiro, Dr. Mark Doubrava, Dr. Emily Fant, Dr. Walter (Russ) Schroeder, Dr. Robert Wang, Dr. Doug Fife, Dr. Jonathan Strauss, Dr. Ruben Acherman, Dr. William Evans, Dr. Abraham Rothman, Dr. Ricardo Samson, Dr. Craig Nakamura, Dr. Goesel Anson, Dr. Michael Edwards, Dr. Julio Garcia, Dr. Michael O’Hanlan, Dr. Terence Banich, Dr. Annabel Barber, Dr. John Fildes, Dr. Arthur Fusco and Dr. Sheldon Freeman.

Cleveland Clinic Lou Ruvo Center for Brain Health boosted the Nevada economy by $47 million in 2016, according to the hospital system’s most recent economic impact report, “A Vital Force in Nevada’s Economy.” Activities at the clinic supported 320 Nevada jobs in 2016, representing more than $21 million in total earnings. Those earnings supported 200 households statewide, for a total of $12 million in household spending.

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cale n d ar

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

Cleveland Clinic Lou RUvo Center for Brain Health For more information please contact 702-483-6055 or louruvosocsrv@ccf.org Memory Loss For Caregivers Support Group

For adult family members or care partners of individuals with memory loss.

First-time attendees call 702-483-6035.

Wednesdays, 1:15–2:45 p.m.

Second Floor Conference Room

888 W. Bonneville Ave. Parkinson’s Disease Support Group

For individuals with Parkinson’s disease and adult family members Call 702-701-7929.

Second Tuesday, 11:30 a.m.-12:30 p.m.

Second Floor Conference Room

888 W. Bonneville Ave. PSP Support Group

An education and support group for those living with Progressive Supranuclear Palsy (PSP) and their caregivers.

First-time attendees call 702-483-6054.

First Monday, Noon-1 p.m.

Second Floor Conference Room

888 W. Bonneville Ave.

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 Room,

2075 E. Flamingo Road Cardiac Support Group

Meets Nov. 15 and Dec. 20, 2 p.m.

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2075 E. Flamingo Road

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 Fourth Tuesday, 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, 5:30-7 p.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, most months, 3–4 p.m.

Conference Room B, 657 N. Town Center Drive Breast Cancer Empowerment/Support Group

Meets the second Tuesday of the month, 6-7:30 p.m.

Breast Care Center 657 N. Town Center Drive Bladder Cancer Support Group

Meets the fourth Wednesday of the month (no meetings in November or December), 6-7:30 p.m.

Breast Care Center 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 Alzheimer’s Support Group

Representative from the Alzheimer’s Association lead this free support group that provides an opportunity for family, friends, caregivers and others to meet regularly.

Meets the third Tuesday of every month, 10–11 a.m.

H2U MountainView Office, Suite 114 3150 N. Tenaya Way

Dancing With Parkinson’s

With instructor Pamela Lappen. Exercises begin in a seated position and move to a standing position. Exclusive class for H2U members. Doctor’s release required for all exercise programs. $5.

Wednesdays in November, 10:30–11:30 a.m.

H2U MountainView Office, Suite 114 3150 N. Tenaya Way

Parkinson’s Support Group

Jamillah Ali-Rahman of the Friends of Parkinson’s local nonprofit organization will lead this support group.

Dec. 14, 10 a.m.-noon

H2U MountainView Office, Suite 114

3150 N. Tenaya Way

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

Orthopedic experts help you know what to expect before, during and after surgery.

Fridays, 9–10:30 a.m.

Multipurpose Room, Fifth Floor

9300 W. Sunset Road

sunrise hospital Registration is required for all events.

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

For more, visit SunriseHospital.com Tai Chi Class

Terry Tichota has been practicing and teaching tai chi since 1995 and specializes in working with seniors.

Thursdays, 11 a.m.–noon.

Breast Center Multipurpose Room

3006 S. Maryland Parkway, Suite 250

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

University Medical Center

Register at 702-383-7353 or umcsn.com Adult CPR

$10 deposit Dec. 6, 2 p.m.

The Healthy Living Institute at UMC

901 Rancho Lane, Suite 180

Yoga for Healthcare Professionals

Free

Most Wednesdays, 5:15-6:15 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.

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

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