2019-02-28 - Health Care Quarterly (Vol. 23) - Winter 2019

L I G H T S, C A M E R A, ACTION FORMER ACTORS HELPING TRAIN NEXT GENERATION OF HEALTH CARE PROVIDERS

SPONSORED BY:

2019 VOL. 23

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CONTENTS

24 LIGHTS, CAMERA, ACTION

COLUMNS 12

Former actors help train next generation of health care providers at Touro University Nevada

32

WHAT DO YOU KNOW ABOUT HEART HEALTH? Get up to speed on the risk factors for heart disease

38

42

Daniel W. Heller, Pharma D, Smith’s Food & Drug Stores

13

THE MISPERCEPTIONS AND REALITIES OF HOSPICE CARE

14

16

24

SNEEZIN’ SEASON Dr. Jim Christensen, OptumCare Lung & Allergy Care

18

MENTAL HEALTH Mendi Baron, LCSW, Ignite Teen Treatment

19

COMBATING ‘DR. WEB’

FIRST PERSON Rosalyn Haynes, OptumCare Cancer Care patient

People in the profession say the work is far from depressing

48

WORKPLACE Dr. Matthew Schwartz, Comprehensive Cancer Centers

APPROACHING WORKPLACE ADDICTION Know what to do if you suspect an employee is struggling

PHARMACY

POCKETBOOK Ayesha Medhi, Frontier Health Law

Recognizing fake medical ‘news’ before it becomes lethal

20

DIET AND FITNESS Joe Phelan, Power Hour 360

57

SIM Man is one of many training simulators at MountainView Hospital’s SIM Center.

Dr. K. Saad Jahangir and patient David Tesdall pause in the OptumCare Cancer Center.

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SIM Man photo by Christopher DeVargas.

Actor-patient Kerstan Szczepanski has his pupils checked by medical student Daniel DeMers in an exam room at Touro University Nevada in Henderson.

58 DEPARTMENTS 52

INROADS IN TREATMENT

COMMUNITY 61

Drs. Nicholas Vogelzang and Michael Anderson Comprehensive Cancer Centers

Notes from the health care community

64 54

BUSINESS Dr. John Rhodes Southwest Medical Associates

57

THE NOTES

CALENDAR Upcoming events and classes

EDUCATION SIM Center at Mountainview Hospital

58

PATIENT SUCCESS PROFILE David Tesdall, OptumCare Cancer Care patient

Photos by Steve Marcus.

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reimagine

E D U C A T I O N Over twenty years ago, three educators challenged the status quo in graduate level healthcare education. They believed all students could be competent, at very high levels, but only if they were taught differently. They believed the bar could be raised, but that innovation must trump tradition. They believed that the Six-Point Mastery Learning Model would prepare students better than ever before, and that they would transition into healthcare fields with ease, prowess, confidence and mastery. Roseman University has been rethinking education since our inception in 1999. Using the Six-Point Mastery Learning Model, we train students to thrive and practice in today’s complex world of medicine and patient care.

Challenge. Reimagine. Roseman.

Learn more at roseman.edu

publisher Mark De Pooter (mark.depooter@gmgvegas.com)

Editorial EDITOR OF SPECIAL Publications CRAIG PETERSON RESEARCH LIBRARIAN REBECCA CLIFFORD-CRUZ

Art ART DIRECTOR, contracted MICHELE HAMRICK Staff Photographers Christopher Devargas, Steve Marcus, wade vandervort

Advertising publisher of digital media Katie Horton publisher, las vegas magazine and vegas2go Jamal Parker MAJOR ACCOUNTS MANAGER & MARKETING MANAGER KATIE DIXON Account manager Dawn Mangum senior advertising manager BRIANNA KOURETAS Advertising managers Robert Blankenship, Wayne Liechty, MIKE MALL, TIANA MILLIRON, adair nowacki, Marlena Ocio, sue sran, alex teel Publication coordinator Denise Arancibia External content manager Emma Cauthorn

Production vice president of manufacturing maria blondeaux Production Director Paul Huntsberry Production manager Blue Uyeda PRODUCTION ARTIST MARISSA MAHERAS SENIOR Graphic designer DANY HANIFF Traffic COORDINATOR JEANNE GLEESON

DISTRIBUtion director of circulation ron Gannon Route Manager randy carlson FULFILLMENT Manager DORIS HOLLIFIELD marketing research manager Chad Harwood

Marketing and EVENTS events manager SAMANTHA PETSCH web content specialist clayt keefer

COLLEGE OF DENTAL MEDICINE COLLEGE OF NURSING

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2275 Corporate Circle, suite 300 henderson, nevada 89074 | 702.990.2550

FROM THE EDITOR

D

id you ever act sick? It’s a classic ruse; heat the thermometer on a lightbulb, throw on a mopey face and soften your voice because you’re oh so weak. Next, muster up a few sniffles and then kick back for a day of watching “Ferris Bueller’s Day Off” and reading comic books.

You might be able to get that past your parents, but would it work on a trained medical professional? Probably not — unless you’re a trained actor. Beverly Washburn and Kerstan Szczepanski are two such actors — but they don’t fake sick to get out of work, they fake sick to get into it.

The pair are among a group of “standardized patients,” people who work with the students at Touro University Nevada. It’s their job to act like real patients with questions, symptoms and, afterward, feedback.

The actors “allow us to step outside of our role as a student and allow us to feel more like an actual physician,” said Mehdi Talle, a first-year medical student at Touro.

Those students are learning what to look for in a clinical setting; there are instructors to offer guidance and followups to offer improvement. Such measures do not always exist in the real world, and without the proper background, we can find ourselves struggling to extract ourselves from any number of bad situations.

Such can be the case if you are a business owner and suspect that an employee is struggling with substance abuse. Matt Nielsen of the Ferraro Group talked to local employment experts about how to handle a situation like that. In short, be sure that your company’s policies are clear and in writing. Speaking with an expert and having a clear, accurate plan can make all the difference.

Of course, be careful where you find your experts. Dr. Fadi Braiteh of Comprehensive Cancer Centers reaches into his own experiences as a physician to remind us why it is crucial to seek out reputable medical advice and not limit research to dodgy websites and unverified opinions.

Fortunately, access to quality medical information is improving in Southern Nevada, and it’s having a “rising tide lifts all boats” effect. Health Care Quarterly takes a look at how the burgeoning medical district is helping boost multiple sectors of our economy. According to Jeremy Aguero, an expert in economics and fiscal policy, health care has been one of our fastest-growing sectors.

“The beautiful thing is that so many of the businesses that grow in and around these districts are small business,” he said. “The vast number of businesses in our state have fewer than 100 employees. That major investment in the (UNLV School of Medicine) has major spinoff effects, creating jobs in nearly every sector of the local economy.”

There’s much more to read about in this issue, so I won’t keep you any longer. Please enjoy, and stay healthy!

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

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Healthcare Quarterly HP 02-2019 REV.indd 1

2/12/19 1:57 PM

Leading the way in teaching the healthcare providers and educators of tomorrow while

caring for our community.

TOURO 2004

30

Employees who worked at Touro when the university opened

BY THE NUMBERS

78

20,000

1,485

180,000

Students enrolled

Square footage of campus space

2018

288

Employees currently working at Touro

Students enrolled

Square footage of campus space

4,160 Touro alumni

Learn more about Touro University Nevada. Call today for a tour.

702-777-3100 | www.tun.touro.edu 874 American Pacific Drive, Henderson NV 89014 Touro University Nevada is accredited by the Western Association of Schools and Colleges and licensed in Nevada by the Commission on Post-Secondary Education.

Touro University Nevada does not discriminate on the basis of race, ethnicity, age, sex, gender, color, creed, national origin, religion , sexual orientation, or disability in its employment, programs, or activities.

p har m acy c o u n ter

diligence, education and hard work pave a path to A Pharmaceutical career

By Daniel Heller

O

ne question I’m commonly asked is, “What does it take to become a pharmacist?” Pharmacy is an extremely rewarding career, and skilled pharmacists are always needed.

The only way to become a pharmacist is by attending an accredited school of pharmacy (foreign pharmacists coming to the United States take an equivalency exam). There are currently 142 schools in the United States, and the education typically takes four years to complete. Three of these years involve didactic classroom learning, while the last year is dedicated to advance pharmacy practice experience (also known as rotations). Some schools follow a year-round, accelerated model which condenses the pharmacy program to only three years.

Pharmacy schools also offer one and two-year residencies or fellowships to specialize in health care disciplines, which many pharmacist positions will require.

The necessary amount of undergraduate coursework to apply to pharmacy school can be completed in two years, but most students opt to obtain a bachelor’s degree beforehand to enhance their application status. The Pharmacy College Admission Test is also required by most institutions for consideration of enrollment. Cost of pharmacy school varies greatly based on multiple factors, such as in-state or out-of-state residency as well as if the school is public or private. Most public schools can range from $12,000 to $25,000 each year for in-state residents, while out-of-state or private university students could pay $40,000 to $55,000 each year.

One trend the pharmaceutical industry has seen is that although there are still see a handful of independent pharmacies in every city, they’ve mostly gone extinct. The competitive buying power of big chains has become too much for independent community pharmacists to compete with. That being said, there are quite a few disciplines in the pharmacy field to choose from. Working for a community pharmacy (i.e. Smith’s, Walgreens, CVS, etc.) is quite rewarding since many times you are the first health care provider people go to for questions and concerns. There are also many classifications of pharmacists that work in hospitals and health facilities, such as general inpatient, cardiology, ambulatory care, pediatric and psychiatric

pharmacists to name a few. Aside from this, pharmacists may find work in veterinary medicine, administration, consulting, informatics, research and drug sales for manufacturers.

Some people may believe a pharmacy career only consists of filling prescriptions, but this is not the case. There are many examples of how the pharmacy profession has become more dynamic in recent years. Pharmacists are now the primary health profession to provide vaccines, and you can get screened for some lab tests within pharmacies.

Additionally, many states now allow for collaborative practice agreements with prescribers. These agreements give pharmacists the opportunity to work closely with doctors to make therapeutic changes and dose adjustments for patients after they’ve been diagnosed.

Pursuing a career in pharmacy is beneficial for many reasons. I’ve always had great job satisfaction knowing I’m helping to improve the health of patients by making sure the medications they take are safe and effective. It is rewarding knowing that as a pharmacist you are helping keep people healthy with the medications you dispense. Additionally, most pharmacists are not on call 24 hours a day, which isn’t the case with other health care professions, which can be a major benefit when trying to balance your work life and time spent with friends and family. The salary range varies, but generally a pharmacist just out of school can expect to make just over six figures. However, salary can increase greatly the more a pharmacist becomes specialized in specific disciplines of the profession.

It’s not easy to pinpoint what makes a great pharmacist. A strong education in pharmacology and therapeutics as well as superb communication skills to be able to work with other health care professionals and patients are key ingredients. Regardless of the answer, hopefully this helps clarify the path a pharmacist takes from starting as a student to caring for their community.

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

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i n the w o r k p lace

a doctor’s own well-being can geT lost when navigating through long hours and a sea of paperwork

By Dr. Matthew Schwartz

A

healthy physician is vital to healthy patients and the broader health care system.

Employee burnout and, in turn, employee retention are serious issues that affect nearly every business and trade. Examining a variety of national studies and statistics and it is clear: Health care is certainly no exception.

A 2012 study published in the Journal of the American Medical Association, found that 45.8 percent of physicians reported at least one symptom of burnout. The study also concluded that physicians worked 10 more hours per week than the average American worker and were 10 percent more likely to show symptoms of work-related burnout.

The closing thoughts of a January 2018 report on physician burnout, released by the Massachusetts Medical Society, Massachusetts Health & Hospital Association and the Harvard T.H. Chan School of Public Health, explained: “If left unaddressed, the worsening crisis threatens to undermine the very provision of care.”

So, what are some of the symptoms of physician burnout, what is causing it and what may be done to address it?

Some of the most commonly cited symptoms associated with physician burnout include long hours and the psychological pressure associated with working in medicine.

However, in health care as a whole, there appears to be one underlying symptom that is leading to enhanced stress and triggering other burnout symptoms — the growing administrative burden.

The No. 1 Burnout Symptom Study after study shows that dealing with electronic health records and regulatory compliance are the top factors leading to physician burnout.

In a July 2018 survey conducted by Reaction Data and published by Health Care Informatics, EHRs were the No. 1 factor deemed to be contributing to burnout at 21 percent.

A Medscape survey released in early 2019 determined “too many administrative tasks” was the leading cause of burnout, cited by 59 percent of participating physicians.

And, the report released by the Massachusetts Medical Society, Massachusetts Health & Hospital Association and the Harvard T.H. Chan School of Public Health, claimed that

for every one hour doctors are spending with patients, doctors are spending two hours on administrative tasks.

The Solutions Today’s medical realm is vastly different than just 20 years ago, with records-related mandates like never before.

Here in 2019, it is absolutely vital to invest in the technology that streamlines pertinent paperwork and ultimately reduces the wait time for everyone — patients, staff and doctors.

Comprehensive is associated with US Oncology Network and McKesson Specialty Health, ensuring we have the best and the newest versions of electronic medical records systems internally.

Unfortunately, the landscape of EMRs communicating with each other remains disjointed nationally, making it administratively difficult to go from one specialist to another.

But, there are solutions emerging to reduce the broader administrative burden.

Perhaps equally if not more important than proper technology is proper staffing. At Comprehensive, we have hired more doctors, nurse practitioners, scribes, medical assistants and technicians so each physician can devote more time with patients. In addition to more face-time with patients, this ultimately reduces excess hours and provides for a better work/life balance.

A final thought: Doctors are humans, too. They have real feelings and emotions, just like anyone else. And, they are wanting to do the absolute best for their patients. Vital to a patient’s success is a doctor that is on his or her A-game.

So, as a practice and industry, we are always looking to push the needle forward and empower some of our most valuable assets.

At Comprehensive, we empower our employees through a number of benefits designed to keep them mentally and physical strong. These benefits include trainings that ultimately help improve communication between departments, a wellness initiative, and an employee assistance program providing free counseling, among other services.

A key thought behind our efforts and advocating for physicians is this thought: Everyone is on the same team and we’re in this fight together.

Doctors are humans, too.

They have real feelings and emotions, just like anyone else.

And, they are wanting to do the absolute best for their patients.

Dr. Matthew Schwartz is a radiation oncologist at Comprehensive Cancer Centers.

Photo by Christopher Devargas.

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f i r s t p er s o n

USING A brush and canvas to bring MY personal cancer battle out of the shadows and into the light

By Rosalyn Haynes

C

ancer has made its mark on my family. It has taken several of my immediate family members and impacted people close to me. It’s a disease that I know well.

While it’s been a shock seeing those closest to me affected by the disease, I had never experienced its trials and tribulations firsthand. Throughout most of my life, I had been a healthy woman. That good fortune and strength allowed me to raise three children and be a grandmother to even more.

That changed when I woke up one day. It was unclear what was wrong with my body. My whole right side was numb, a sign that something more serious was wrong. After a trip to the hospital, a benign mass the size of a golf ball was discovered on my brain. I went from being a healthy 66-year-old grandmother to having immediate brain surgery.

Although the surgery went well, that wasn’t the end of my health problems.

A malignant tumor was discovered on my kidney and I was quickly diagnosed with stage 4 cancer. The same disease that had taken my loved ones now had its eyes set on me. The thought of what was ahead was sobering and unclear. However, I knew my spirit, resilience and ability to laugh would help me in the fight.

My doctors decided to treat my cancer using immunotherapy, also called biologic therapy. This type of treatment helps boost the body’s own immune system to fight cancer. Within just the past few decades, immunotherapy has become a very important part of fighting certain types of cancer.

I would travel to the OptumCare Cancer Care clinic on Fort Apache Road in Las Vegas to see my doctor and receive my rounds of treatment. In order to attack the cancer and try to

knock it out, I would need six separate treatments. Sitting in the clinic during treatment, I tried to escape what was happening with my body. One of the most beautiful things about the brain is that when you focus on something else, it can strip away anxiety and pain — if only for a minute.

I focused on the art around the OptumCare Cancer Care clinic. There are paintings all over the clinic walls and the images really inspired me, allowing my brain to travel far away from the treatment. You could say the art sparked a creative awakening of sorts in me. To help me in the fight against cancer, I decided to paint.

Although I had never really been a painter, I knew my mind needed a way to express what was happening to my body.

For my very first painting, I wanted to bring to life what the cancer looked like inside my body. The deep reds and purples I dotted on the canvas showed the disease and the way my body was fighting it. Creating that first painting helped show me cancer can be defeated.

I also wanted to show how treatment was helping me get my strength, energy, and life back. I used vibrant greens, blues and yellows to paint a hummingbird getting nectar from a flower. That nectar represented me continuing to gather strength to enjoy life for years to come.

As I continued to go back for treatment, the more I developed relationships with the clinic staff. The staff was caring and became a support system. Painting was not only a way for me to express my cancer journey creatively, but it also was a way to say “thank you” to all the people at OptumCare Cancer Care who have helped me.

The paintings showed other patients that while your body may be weak, your mind can remain strong. It was also a lesson in not letting the cancer have control over your entire being.

I’m now planning on hosting paint nights for friends and others battling cancer. It’s a way to pass on what I’ve learned fighting this disease and to help someone else who needs it. I can truly say that painting has been the best form therapy. It’s my way to beat cancer.

Rosalyn Haynes is a local OptumCare Cancer Care patient.

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Photo by Christopher DeVargas.

Teaming up to move care forward.

Together, Urology Specialists of Nevada provides advanced care at four convenient locations.

Our diverse team includes the top talent in the field, using the latest tools and technology, from a group with deep roots in Nevada.

G et to know us at usonv. com .

A ppointment s at 702 . 87 7.0814.

CENTRAL

2010 Wellness Way, Suite 200 Las Vegas, NV 89106

G R E E N VA L L E Y

58 N. Pecos Rd. Henderson, NV 89074

SOUTHWEST

6190 S. Fort Apache Rd., Suite 200 Las Vegas, NV 89148

NORTHWEST

3150 N. Tenaya Way, Suite 165 Las Vegas, NV 89128

sneezin’ season

allergy season in southern nevada is nothing to sneeze at

By Dr. Jim Christensen

W

hether you realize it, spring is right around the corner. For some it can be one of the most enjoyable and beautiful times of the year in Southern Nevada. For others, it means the return of an unwanted and uncomfortable nuisance — seasonal allergies.

Although to some outsiders the Las Vegas Valley and its desert climate may not seem like a place known for its seasonal allergies, that’s far from the case. Over the years, Southern Nevada has become known as having one of the most acute allergy seasons in the country.

Just ask residents in the area, or doctors like me who treat them — springtime brings a host of unpleasant symptoms for people suffering from allergies. Patients are left dealing with nasal congestion, sneezing, runny nose, watery and itchy eyes, sore throat, difficult breathing, and sinus pressure. Symptoms vary from person to person, but they happen as a result of the immune system’s response to different irritants in the air.

The dry climate and the considerable amount of native and non-native plants and trees now growing in our desert can inflame allergies with their pollen.

Although they are banned from being planted and sold across the valley, mulberry and olive trees are still found in many areas. These trees are known as primary causes for a lot of our pesky allergy symptoms. Spring brings allergies with it because mulberry trees pollinate around March and olive trees in April. The warmer weather and windier conditions we typically get during the spring cause pollen from the trees to spread.

While we direct a lot of attention at mulberry and olives trees, they can’t take all the blame for our harsh allergy season. Other leading sources of allergies include ragweed, Bermuda grass, mesquite trees, tamarisk trees, oak trees, palo verde trees, sagebrush and tumbleweeds.

There is a lot you can do to control allergy symptoms. Taking prevention steps and managing symptoms will help you live a healthier life and not be afraid to enjoy the spring outdoors. One of the biggest things I stress to my patients is to re-

member that the highest pollen counts typically occur earlier in the morning, so move your outdoor recreation to evening times and don’t forget to shower afterwards.

While it can be challenging to fully prevent allergies for people who routinely get them, following these basic preventative measures can go a long way to helping you get through the allergy season: • Make a habit of keeping your windows and doors shut.

• Don’t forget to take your medicine.

• Regularly wash your bedding and pets.

• Change your clothes and shower regularly to get pollen off of you.

• Avoid or remove plants and trees most likely to contribute to your allergies.

• Change your air filters more often, at least three or four times a year.

A lot of allergy treatment options can be found over the counter, making it easier to get ahead of your symptoms.

Common treatments include antihistamines, inhalers, nasal sprays, allergy immunotherapy shots and decongestants.

Don’t forget — nasal steroids are the single most effective thing you can do to treat allergies.

Allergies can be especially problematic for people who suffer from asthma, so it’s important for those patients to be aggressive in allergy prevention to avoid serious asthma attacks.

It’s also important not to confuse allergies and the common cold. Symptoms like nasal congestion and sneezing may appear to be allergies at first. But if they are accompanied by a low-grade fever and general body aches, that means you are likely dealing with a cold instead of seasonal allergies.

Lastly, I encourage patients to schedule a visit with their allergist-immunologist to discuss allergies, develop a treatment plan, or get a seasonal steroid shot. Again, being proactive can go a long way in defeating — or at least treating — those pesky allergies.

Dr. Jim Christensen is a physician with OptumCare Lung & Allergy Care in Las Vegas.

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m e n tal health

anatomy of a crisis: Understanding involuntary hospitalization

By Mendi Baron

M So many families want to “return to normal” after a hold and hospitalization.

This is always a mistake.

The issue that triggered the hold will still be around afterward and will need attention and treatment.

— What to know about addiction in the workplace — Page 38

aybe you’ve heard something like this: “That kid was hospitalized today. Police came and placed her on a hold. She was a danger to herself.”

What does that mean?

Holds are involuntary detentions, known as Legal 2000s in Nevada, that are triggered when a mental health professional determines someone poses serious harm to himself or others or is “gravely disabled.”

There are myriad issues that can be at play, including addiction. Laws governing holds vary significantly in the criteria for commitment, length, and type of treatment, according to the Harvard Health blog. The blog reported Jan. 24 that the number of states allowing people to be committed for substance use disorder rose from 18 in 1991 to 31 in 2018, a 71 percent jump.

At a distance, these crises, viewed on social media or television, can seem upsetting. Up close, they can terrify friends and family who may not understand what being hospitalized really means.

How does it work?

Generally speaking, a hold is triggered by a professional when someone is determined to pose an immediate, serious danger to himself or others based on something the person has said, written or done.

In these cases, a mental health professional will be called in to assess the person and decide whether to send the person to a hospital. This is a serious decision. Putting someone on hold is a legal action that removes an individual’s right to selfdetermination.

If the person cannot be safely assessed on location, police may be called in and the person in crisis may be detained and taken for assessment and placement. The acting out that can lead to an involuntarily hold probably isn’t isolated and may stem from drug use.

If an involuntary hold is ever required for a young person, parents need to understand the clinical and legal decisions they’ll face. Here are some tips.

The basics If a qualified mental health practitioner determine someone is a danger to himself or others or is “gravely disabled,” the professional can place that person on an involuntary 72-hour hold.

After the 72 hours, a clinician who feels a patient is still at risk can petition a specialized judge to ask for more time. During this process, the person has right to petition for himself.

A few factors play into holds. One is timing and location: Where and when does the hold start? At the emergency room? At the police station? Or when the patient has been placed in psychiatric hospital bed? It can take hours or days to get an open bed.

Another is the perceived danger level: The hospital’s clinical team is trying to hold a client and assess danger while still waiting to reach a judge (which can also take time).

Parents need to keep focused on the next step and remember that they, and their loved ones, have rights.

Continuum of care So many families want to “return to normal” after a hold and hospitalization. This is always a mistake. The issue that triggered the hold will still be around afterward and will need attention and treatment.

Plan ahead for the posthospitalization period. Do your research. Make your calls.

• Ensure coverage. Determine which programs or professionals are affordable, covered by your insurance and can admit your young person immediately after he or she is discharged from the hospital. Make sure you obtain your insurance providers’ authorization for the care you are requesting.

• Mind the paperwork. Gather all the historical data, paperwork, files, notes and charts from any prior providers including the hospital. This paperwork will help you support the in-progress treatment and support insurance authorization. For most insurance plans, if it’s not documented, it never happened.

• Read. The internet is chock-full of articles about how parents in similar situations handle their crises.

• Help yourself. Find a support group. Get your own therapist.

Surround yourself with people of experience and expertise who can support and guide you through this process.

Getting support from others can help you help your child — and preserve your family.

Mendi Baron, LCSW, is the CEO of Ignite Teen Treatment.

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p o c k etb o o k

balance billing, upcoming legislation: what it means, what to ask your physician

By Ayesha Mehdi

A

family can plan for an emergency but life can throw a curve ball in the form of a large medical bill. Even with the best health care, most can attest to a situation where a bill comes as a surprise. Isn’t insurance supposed to prevent that?

One situation that can occur is called balance billing. It means that without any prior warning, you get hit with health care bills for treatments by out-of-network providers (or from out-of-network facilities) that are not covered by your insurance. In other words, there is still a balance owed on your medical bill after you’ve paid your deductible, coinsurance or copayment and your insurance company has covered all obligated fees.

It’s an issue that is getting legislative attention on a national level. A bipartisan group of senators introduced the Protecting Patients from Surprise Medical Bills Act in August 2018.

Anyone who has seen a medical bill knows that the amount owed could be significant. This rude shock is the result of an inability of providers to have proper authorizations in place and to offer consolidated billing statements that are clear and patient friendly. It is especially painful if you have been hit with such charges after ending up in the ER and you lack the ability to check if you’re in network!

Our firm, Frontier Health Law, was retained by a medical office to assist with such collections, and it was indeed the most eye-opening (and heartbreaking) experience when it came to realizing what is wrong with our health care system. Most patients were shocked that their surgeon would interact with them in that manner — why didn’t he or she merely ask their permission before referring to an out-ofnetwork anesthesiologist? We had no answer to that. Making those phone calls and speaking with the patients was disconcerting.

Currently, 21 states have laws in place to protect patients from balance billing. Some states prohibit balance billing altogether, while others make insurers pay the entire charge if necessary; and then some states require both. In California,

if a patient visits an in-network facility, they will be responsible only for their in-network share of the cost, even if an out-of-network provider has treated them.

Nevada Assemblyman Mike Sprinkle, D-Sparks, chairman of the Health and Human Services Committee, has requested legislation to address balance billing with the goal of eliminating it. Gov. Steve Sisolak has also stated that surprise billing is one of his health care priorities. In addition, President Donald Trump recently voiced concerns on balance billing, one of his health care priorities, “The health care system too often harms people with some unfair surprises ... medical bills and the like.”

Until these rules and regulations come into play, I recommend that patients meticulously check and double-check to be sure their facilities and all doctors involved in the procedure are within their health plan’s network.

Also, know that balance billing is generally illegal in the following circumstances: if you have Medicare and a provider who accepts Medicare assignment; if you have Medicaid and your provider has an agreement with Medicaid; and if your doctor or facility has a contract with your health plan and is billing you more than that contract allows.

Ayesha Mehdi is principal attorney at Frontier Health Law.

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d i et a n d f i t n e s s

intermittent fasting may not be the quick way to weight loss you think it is

By Joe Phelan

T

he health and wellness industry is constantly evolving, with new research coming out almost daily finding physiological benefits of one program or another.

One trend that has been gaining attention in recent years is the concept of intermittent fasting. Intermittent fasting is the practice of periodically fasting for 18-24 hours with periods of normal calorie consumption in between. In a research setting, intermittent fasting has been shown to promote weight loss as well as some possible prevention of chronic disease. These discoveries have led to an effort by health and wellness professionals to market this practice.

Although intermittent fasting can have some beneficial effects, it is important to understand how and why these effects take place in order to make an informed decision on whether, and to what degree, you include intermittent fasting into your regular routine.

We all know that calorie restriction works as a method of weight loss, as energy cannot be created or destroyed.

If you eat less than you use you will decrease in weight. Calorie restriction has been shown to not only lower body weight but it also has been shown to reduce oxidative stress on the vital systems in the body (i.e the brain, heart, liver, and muscles) — meaning it reduces the effects of aging.

While intermittent fasting as a form of calorie restriction does show similar effects, in practice health benefits seem to be limited due to little or no change in the total calories consumed over time. Intermittent fasting calls for little to no food for 18 to 24 hours but it does not usually specify how much food can be eaten on the other days.

This means that often people who participate in diets that include intermittent fasting tend to overeat on the days they are allowed to eat — which leads to an equal or increased weekly caloric intake, ultimately leading

to maintaining or increasing body weight over time. The first thing to do when taking on a diet that includes intermittent fasting is to make sure that the weekly calorie intake is consistent with your goals (i.e. eat fewer calories than normal in order to lose weight).

Intermittent fasting has also gained headlines because of its effects on oxidative stress to certain tissues in the body and its effects on the aging process. While calorie restriction has been shown to have a positive effect on the levels of oxidants in the body and ultimately a slower aging process, intermittent fasting has shown mixed results in this area. With intermittent fasting, some vital organs such as the heart show a decrease in oxidative stress while others such as the brain, liver, and musculature will have an increase in oxidative stress which is one of the main contributing factors to the aging process. Other health benefits such as changes to insulin sensitivity and energy production have also shown that Intermittent fasting is less effective than calorie restriction. Studies have shown that calorie restriction can increase your body’s sensitivity to insulin making blood sugar levels easier to control while intermittent fasting has been shown to decrease insulin sensitivity making blood sugar levels less stable. These differences, just like with weight loss, are usually due to overeating on the unrestricted days. While intermittent fasting has been shown to have some health benefits, most of these benefits are related to overall calorie restriction.

The physiological benefits of intermittent fasting are limited, but it can be used as an effective form of weight loss as long as the daily and weekly calorie intake is lower than needed to maintain body weight. So if you are going to try intermittent fasting as a diet plan make sure you are using this practice to restrict weekly calories and not simply overeating some days and under eating on other days.

Next time you hear of a new fitness trend or a hot new diet, take a few minutes to ask why this might be beneficial. It is easy for the results of scientific research to be misinterpreted, even by professionals, and it is easy to lose your way when trying out a new program. Before you begin any diet or exercise program always be sure to review your options with your physician to make sure you are making informed decisions.

Joe Phelan is the sales manager of Power Hour 360, a fitness center.

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Lights, Camera,

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FORMER ACTORS HELP TRAIN NEXT GENERATION OF HEALTH CARE PROVIDERS AT TOURO UNIVERSITY NEVADA

ion

By Steven Slivka Continued on page 26

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Continued from page 25

A

few times each week, Beverly Washburn and Kerstan Szczepanski are being examined by students at Touro University Nevada.

Inside one of the exam rooms in Touro’s Objective Structured

Clinical Experience lab, Washburn complains about certain symptoms or asks for prescription drugs. It’s up to the student to properly assess the situation. Washburn isn’t really ailing; she is a standardized patient, an actor helping

Touro students hone their craft.

Continued on page 29

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Actor-patients and medical students pause for photos in an exam room at Touro University Nevada in Henderson.

On these pages: Michelle Baek looks into what might be ailing Beverly Washburn while Daniel DeMers works with Kerstan Szczepanski.

Photos by Steve Marcus.

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Working as a patient, we have to put ourselves in character and act how we might feel if these students were really our doctors. — Beverly Washburn

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Photo by Steve Marcus.

Continued from page 27

Trek’ career in Star Fleet where I would Washburn has had a lifetime of experibring people onto the ride. Eventually, I ence for this job as she was a notable child went on to work as an Andorian.” (Anactress of the 1950s. Acting as a patient, she dorians are a race of extraterrestrials in the added, is one of the best roles she’s ever had.

“Star Trek” universe.)

“Working as a patient, we have to put ourIt was a dream come true, as Szczepanski, selves in character and act how we might feel who grew up in New York, was raised on if these students were really our doctors,” “Star Trek.” When he was 10, he went as an Washburn said. “This is such a wonderful Andorian for Halloween. program that Touro University Nevada “When I got the job at ‘Star Trek: The provides for its students because they learn Experience,’ I was basically living my childhow to make their patients feel important. hood dream,” he said.

They might see 50 patients in one day after Once the show closed its doors in 2008, they graduate, but each patient wants to feel Szczepanski found himself looking for work. like they’re the most important.”

Touro has approximately 30 standardized It was at the annual Star Trek Convention shortly after when he first met Washburn. patients from a variety of backgrounds in He remembered her from her role as Lt. feature film, TV, commercials, theater and Arlene Galway in the original series, and as more. All of them work with students from the College of Osteopathic Medicine, as well as Touro’s Schools of Physician Assistant Studies, Nursing, Physical Therapy, and Occupational Therapy.

Using the skills that I’ve Washburn, 75, has spent most of her life as a working actress. When she was 6 years developed as an actor is old, the Southern California native landed her first role in the 1950 film “The Killer hopefully helping to make That Stalked New York,” featuring Evelyn Keyes and William Bishop. the students better health “I actually died of smallpox in that role,” she said with a laugh. “And here I am at care professionals.

Touro playing a patient.”

Washburn has died in more than one of her roles throughout her storied career. In — Kerstan Szczepanski 1967, she played Lt. Arlene Galway during the second season of the original “Star Trek” series. fate would have it, the two would later work “Funny enough, ‘Star Trek’ didn’t really start to become popular until after it ended,” together as standardized patients at Touro University Nevada. she said with a laugh.

“Using the skills that I’ve developed as In the episode titled “The Deadly Years,” an actor is hopefully helping to make the Washburn’s character died after rapid aging students better health care professionals,” caused by radiation. he said. “I’m in awe of how hard they work It was the “Star Trek” connection that on a daily basis.” first put Washburn in contact with SzczeDr. Ronald Hedger, associate profespanski, who came to Las Vegas after obtainsor in Touro University Nevada’s College ing his theater degree from Northwestern of Osteopathic Medicine, said working University. with standardized patients helps students Szczepanski played the Cowardly Lion become more comfortable in their environas part of the MGM Grand’s “Wizard of Oz” ment once they go on their rotations. theme when it opened in 1993, but he found All standardized patients are emailed his dream role in 1998 when the “Star Trek: their scripts a week before they perform The Experience” show opened in the Las their respective roles. The scripts are Vegas Hilton (now Westgate).

“I was one of the first two actors they hired written by the primary care physicians in Touro’s College of Osteopathic Medicine, for the show,” he said. “I began my ‘Star

and usually cover the material that students are learning in class at that time.

“The actors are able to take on roles that students would expect to see in an urgent care, emergency room or family practice setting,” Hedger said.

Hedger, who’s been on the Touro faculty since the university opened in 2004, helped start the patient-actor program with just 11 actors in 2005. While the university has since tripled the amount of patient actors it uses, expansion of the medical school and physician assistant studies program means they’ll need even more, he said.

Most standardized patients tend to range in age from the 40s-60s, though Hedger would like to include younger patient actors to help diversify the talent pool even more.

A typical standardized patient encounter lasts for 14 minutes, with another nine minutes scheduled for the students to complete their notes following the visit.

While students conduct their patient visits, Hedger and other Touro faculty watch and listen to every interaction from the OSCE lab’s control room. Each interaction is recorded and stored digitally, so students can watch their patient visits to see how they performed and what they can improve on for the next one.

“The patient actors have been a very important part of our education. They allow us to step outside of our role as a student and allow us to feel more like an actual physician,” said Mehdi Talle, a first-year medical student at Touro. “There are so many benefits to working with the patient actors, and I can’t speak highly enough about how great that experience is.”

Washburn said having a friendly and comforting demeanor is an important quality for the students to possess.

“If doctors don’t have that comfortable bedside manner and ability to connect with their patients, it can be very difficult,” she said. “What we try to do is give the students suggestions to help them improve on the little things to convey warmth and passion.”

Hedger said the actors will sometimes have “debriefing sessions” in order to provide students with the necessary feedback, though they never break character during the actual visit.

To make the visits more realistic, the patient actors each have a different backstory Continued on page 30

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Continued from page 29

that portrays a different home life, a representation of the diverse patient population students will see once they graduate.

“In real life, not everybody is happily married with two kids, a dog, and a white picket fence. There are all kinds of scenarios these students need to deal with,” Washburn said. “They’re going to have patients who are belligerent, crude, and nasty. They’ll also have the sweet ones or the ‘Whoa is me’ ones. Sometimes, they’ll get the patients who are only looking to get prescription drugs. So, when we get our script, it’s really fun to prepare for our role.”

Whatever the scenario calls for, Washburn is ready. Since she was a child, she’s been known for her ability to cry on command, an important trait when it comes to certain patient visits.

Washburn’s most notable role came in 1957 when she played Lisbeth Searcy in Walt Disney’s classic, “Old Yeller.” “‘Old Yeller’ is more than 60 years old now, and unfortunately almost everybody from that movie is gone,” she said. “Actually, Old Yeller’s real name was ‘Spike,’ and they had gotten him from an animal shelter. They trained him to do everything. When the studios did other movies that featured dogs, they would use several different ones throughout the films. But, Spike did everything as Old Yeller.”

Szczepanski made the joke that he works as an actor because he’s lazy, though he’s in awe of the work ethic and determination the students display.

“I come to Touro and I see these kids busting their butts. It’s incredible,” he said.

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Szczepanski and Washburn said first-year students are usually the most nervous, but they get better with more experience.

“We’ve grown to know and love these students, because we’ll see some of them as long as three years,” Washburn said. “We feel very fortunate to have this job because we want to help them even in the smallest way.”

Throughout the 1960s and 1970s, Washburn continued to work in TV, including “The Patty Duke Show,” “Gidget,” and “The Streets of San Francisco,” starring an up-and-coming Michael Douglas.

While she now works in a completely different capacity as a standardized patient, she’s just grateful to work with her fellow actors and actresses as they help train the next generation of doctors and health care providers at Touro.

“We really are like a family, and we love this job so much,” she said.

“These students are our future, and if we can do just one little thing to help them, then we’ve done our job.”

Steven Slivka is the communications coordinator for Touro University Nevada.

Actor-patients and medical students photo by Steve Marcus.

Blood vessels of the heart can be examined in detail at "Bodies ...

The Exhibition" at Luxor.

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WHAT DO YOU KNOW ABOUT

Heart Health?

By Emily LaBonte

Continued on page 34

Blood vessel photo by Mikayla Whitmore.

W I N T E R 2 0 1 9 H E A LT H C A R E Q U A R T E R LY

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A Continued from page 33

ccording to the Centers for Disease Control and Prevention, heart disease is the leading cause of death in the U.S., so it is important to know your risks and preventative measures you should take.

The CDC refers to the term “heart disease” as an umbrella for several types of heart conditions.

According to the CDC, “the most common type is coronary artery disease, which can cause a heart attack. Other kinds of heart disease may involve the valves in the heart, or the heart may not pump well and cause heart failure.

Some people are born with heart disease.”

❚■

34

It is important to understand that heart disease does not discriminate — it can happen at any age to any gender. Dr. Pamela Ivey of HealthCare Partners says that in her over 20 years of practicing cardiology, the risk factors for heart disease have not shifted dramatically.

“There are certain risks that are more common as it relates to heart disease, and some that are exclusively linked to one another,” said Ivey. “It is important to know your risk factors as soon as possible — including those out of your control like family history — so that you can take steps to lower your risk of heart disease.”

Here are the main risk factors that you should take into consideration for heart disease.

High Blood Pressure

Diabetes

Cigarette Smoking

Known as hypertension, high blood pressure is one of the main risk factors that can lead to heart disease says Ivey. The American Heart Association says that high blood pressure occurs when the force of the blood pushing against the walls of your blood vessels is consistently too high. "The primary way that high blood pressure causes harm is by increasing the workload of the heart and blood vessels — making them work harder and less efficiently," according to the AHA. According to statistics from the AHA, high blood pressure affects an estimated 103 million U.S. adults — nearly half of all adults in the country. In a recent AHA report, epidemiologist Dr. Paul Muntner suggests that “with the aging of the population and increased life expectancy, the prevalence of high blood pressure is expected to continue to increase.”

Diabetes happens when the body does not process food as it should, which leads to high blood sugar (or glucose), said Ivey.

“Having diabetes directly impacts the risk for developing heart disease,” said Ivey. “Your chances of diabetwes can increase if you have a family history of the disease. Although it can happen to anyone, diabetes for women is a far worse risk factor for heart disease than for men. Vessels are already small and unfortunately, they can get diseased easier when there is diabetes.”

According to the American Diabetes Association, “people with diabetes have a higher-than-average risk of having a heart attack or stroke. These strike people with diabetes nearly twice as often as people without diabetes… two out of three people with diabetes die from heart disease or stroke, also called cardiovascular disease.”

Cigarette smoking damages the heart and blood vessels and is one of the main ways that people develop heart disease, said Ivey. According to the CDC, approximately one of every four deaths from heart disease is due to smoking. The CDC says that “even people who smoke fewer than five cigarettes a day may show signs of early CVD (cardiovascular disease). The risk of CVD increases with the number of cigarettes smoked per day, and when smoking continues for many years. Smoking cigarettes with lower levels of tar or nicotine does not reduce the risk for cardiovascular disease.”

The sooner you quit, the better your chances are for preventing heart disease. Not only may quitting help prevent heart disease, it will improve your heart health which will lead to better overall health.

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Obesity According to Ivey, obesity has become a major risk factor in the U.S. for heart disease because it is also associated with diabetes and high blood pressure. According to recent research from the Cleveland Clinic, one in three Americans are obese, and that number continues to rise.

Obesity has a direct effect on the percent chance of developing heart disease, said Ivey. In a recent study published in the journal JAMA Cardiology, it concluded that adults between ages 40 and 59 who are overweight or obese have a significantly increased risk (ranging from 21 to 85 percent higher) of developing cardiovascular disease as compared with their normal weight peers.

Chronic conditions are another risk factor

T

hose with kidney disease or chronic dialysis usually also have high blood pressure and/or diabetes, said Ivey. If you have these, your risk for heart disease is nearly doubled, according to Ivey. In addition, those who have a chronic inflammatory disease, such as rheumatoid arthritis or lupus, have an increased risk for heart disease, Ivey added.

Ivey suggests that one single risk factor doesn’t necessarily mean you will get heart disease. “It is the sum of many of these risk factors that could increase your chances of acquiring heart disease, so it is important to increase prevention measures.”

Although there are risk factors to watch out for, the good news is there are steps you can take to lower your risk of developing heart disease.

Dr. Anne Schuchat, principal deputy director of CDC, stresses that “adults can seize the day using daily opportunities to reduce their risk of heart disease and stroke. Many of these cardiovascular events are happening to middle-aged adults — who we wouldn’t normally consider to be at risk. Most of these events can be prevented through daily actions to help lower risk and better manage medical conditions.”

Continued on page 37

Continued from page 35

Here are some ways that you can help take care of your heart and help lower your risk of heart disease.

Doctor Visits

Being Active

Screening Tools

Diet

It is important to maintain an ongoing relationship with your doctor to ensure you keep your heart healthy and know what options you have available.

Ivey suggests that you should go to your primary care doctor annually for a check-up to ensure your blood pressure and cholesterol levels are where they need to be. Knowing those factors can help you get ahead of any heart-related complications that may arise.

Being physically active daily, even if it is just walking, can go a long way in preventing heart disease, according to Ivey. “It’s not that you have to go to the gym every day,” said Ivey. “It’s less about what you do or do not do every day, it’s more about your lifestyle.

In 2019, there is still a major emphasis for physical activity, and you should strive for 150 minutes, or 2.5 hours, of physical activity every week.”

Keeping your body weight at a normal level is crucial, especially for postmenopausal women, suggests Ivey.

There are various screening tools available that may help you avoid a heart attack. According to Ivey, a coronary calcium scan gives you a snapshot of your heart’s arteries, so your doctor can see if there is any calcium buildup. This may be helpful for you to know so that you and your doctor can decide what health and lifestyle changes are necessary.

Aside from visits with your doctor where you can get a screening, it is a good idea to monitor your blood pressure two to three times a week at home.

A healthy diet and lifestyle can help reduce your risk for heart disease. From a dietary standpoint, just avoiding foods in boxes and bags will make a significant difference, said Ivey. The bulk of what you are eating should be unprocessed types of food. Going for fresh food as much as possible is key.

The AHA recommends that you eat a variety of food from all the food groups.

In Conclusion

About 610,000 people die of heart disease in the United States every year–that’s one in every four deaths, according to the CDC. Now that you know your risk factors and ways to prevent heart disease, take charge of your health and strive to keep your heart healthy. If you have any questions related to heart health, make sure to consult your doctor.

Dr. Janet Wright, a board-certified cardiologist and executive director of Million Hearts, said that “the solution for this national crisis does not depend on a brilliant new discovery or a breakthrough in science. The solution already lies deep within every person, community, and health care setting across America. Small changes — the right changes, sustained over time — can produce huge improvements in cardiovascular health.”

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Emily LaBonte is a nurse practioner — certified with HealthCare Partners Nevada.

Blood vessel photo by Mikayla Whitmore.

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APPROACHING

WORKPLACE

ADDIC

By Matt Nielsen

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ubstance abuse and addiction is not a new issue. According to a report published by the

Substance Abuse Prevention and Treatment Agency, from 2009 to 2010, 4.7 percent of those 12 and older reported having used an illegal drug in the past month in Nevada, whereas nationwide that rate was 3.6 percent. Similarly, the Substance Abuse Working

Group reported that in 2015, deaths attributed to heroin and methamphetamine use in Nevada rose by 25 percent and 22 percent respectively compared to the prior year. One aspect that shouldn’t be overlooked is how substance abuse and addiction can affect your business.

Applying policies evenly and consistently should be a top priority for a company.

An employee facing a substance abuse problem, whether the substance is illegal or otherwise, can pose many challenges in the workplace. Aside from the cost of lost productivity and increased potential for errors, employers also risk a loss of morale to other employees that are affected by their coworker’s aberrant behavior. In order to minimize complications and keep the workplace professional, companies should follow a few basic steps when facing issues of substance abuse in the work environment.

Have clear company policies in place

Having clear company policies is the first step employers should take to deal with potential addiction issues in an optimal manner. Allison Kheel, attorney at Fisher & Phillips, notes policies on the Americans with Disabilities Act, requests for leave, drug testing, employee assistance programs, etc. are all beneficial to have in writing. Employees should be made aware of the company’s expectations and the potential consequences of substance abuse and opportunities for as-

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sistance. A great place to start is with an employee handbook.

Commonly, businesses require new hires to sign a handbook or similar onboarding documentation, which outlines acceptable actions, behaviors and responsibilities in the workplace.

The clearer the policies a company has in place pertaining to employee use of drugs or alcohol and acceptable workplace conduct, the more likely that company’s bases will be covered if employee substance abuse issues arise.

Apply policies consistently

“Having clear policies and enforcing them evenly is your saving grace,” said Kheel. The last thing an employer wants is legal trouble because a policy, such as a pre-employment drug test, was only applied to certain select groups of individuals before they were hired. At that point, a legitimate policy turns into possible discrimination in the workplace. In Nevada, there are no laws regulating the use of drug and alcohol testing by private employers. However, unequal policy enforcement decreases employee morale and causes employees

to lose faith in management, making employees more apt to pursue legal action. This is a headache no employer wants to deal with, so applying policies evenly and consistently should be a top priority for a company.

Ensure HR department is properly trained

After an employee demonstrates aberrant behavior and signs of potential substance abuse, the next step is to involve the human resources department. It’s certainly in an employer’s best interest to ensure all employees are aware of reporting policies and the HR department is trained on how to properly handle such circumstances.

“Usually, situations fall into one of two categories: (1) employee is presenting significant aberrant behavior, creating a disruption or safety concern in the workplace, or (2) the employee is merely developing a pattern of unusual behavior and deficient job performance. Generally, situations in the second category are not so emergent that you can’t take a day to involve HR, outside counsel, inside counsel, and come up with a game plan,” said Kheel. However, not every company has the luxury of maintaining a large HR department, and depending on the size of the company, may require outside assistance to determine the best course of action. “If you’re unsure, call an attorney to get advice. He or she will usually be able to walk you through the right steps to take,” said Kheel.

“In my experience, a short preventative phone call can save a company thousands of dollars in later litigation.”

It’s impossible to predict when issues of substance abuse will crop up in the workplace, or to what extent it will disrupt operations and services. Of course, each instance of addiction is different and should be handled on an individualized basis with the involvement of both management and the HR department for the company. However, by considering and integrating some basic steps, especially prior to such a situation arising, your business will be much better prepared to face issues of substance abuse and addiction in the workplace and equipped to support your employees in getting the assistance and care that they need.

Matt Nielsen is public relations coordinator for The Ferraro Group.

Offer a confidential employee assistance program

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confidential employee assistance program is something no company should overlook. “I would encourage this in any workplace,” said Frank Reagan, director of crisis services for WestCare Nevada. “If you don’t have one, create one.” By giving employees the opportunity to come forward, say they have a problem and get the help they need, a company is simply protecting its assets. Hiring and training new staff is a costly investment for a company. If an employee is willing to take advantage of an assistance program and successfully change his or her behaviors, an employer can save both time and money in the long run.

Of course, not every staff member facing addiction will choose to use the confidential employee assistance program. It’s crucial for an employer to listen to other employees, take notice of potential substance abuse and act accordingly. However, this can be difficult depending on factors such as which substance the employee is abusing or how much their behaviors have changed in the period leading up to the present.

“Not always does someone present, especially if they’ve been using a long time,” said Reagan.

“Until someone has depressed motor skills, slurring, etc., some people function normally.” Reagan also notes that reporting persistent, aberrant behaviors is not the sole responsibility of management. “You have to have open lines of communication with all your staff, and they owe it to each other to look out for one another,” said Reagan. “Other employees have a duty to report unusual behaviors. It could be nothing, but if it’s something we have to address that as an agency.”

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FACING

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THE MISPERCEPTIONS AND REALITIES OF HOSPICE CARE

By Health Care Quarterly

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April Stewart photo by Wade Vandervort.

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eople who work in hospice care are often asked how they can work in a setting where most of the people around them are facing the end of their life — isn’t it “depressing”?

Put simply, hospice is end-of-life care that is both clinical and emotional in nature. It is designed to relieve suffering for the patient and his or her family during the last days of life — typically the final six months to a year.

It is initiated only when curative treatments are no longer an option. Hospice workers and volunteers help their patients live their last days in peace and comfort, receiving care that meets their wishes.

For those with limited time remaining, hospice care enables them to focus on enjoying their friends and family during their final days.

This is made possible with integrated clinical, emotional and spiritual support from a team of professionals. They include physicians to manage symptoms and pain; nurses who meet with patients and their families to gain a better understanding of their ongoing needs; and certified nursing assistants, including home health aides who provide hands-on care and support, as well as help with the activities associated with daily life.

Hospice is who I am.

Volunteer perspectives

April Stewart is chief nursing officer at Nathan Adelson Hospice.

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Deana Ozuna is a hospice volunteer for Southwest Medical Hospice. She had worked for 13 years in various administrative departments in health care locally and began volunteering in hospice care in 2006. She has encountered the “isn’t it depressing?” question before, and her answer is a resounding “no.”

“I accept things as they are,” she said. “Everyone wants to be cared for. They want to be acknowledged. Connecting with people and seeing smiles on their faces just make me feel so good.”

George Pratt is also a hospice volunteer for Southwest Medical Hospice and has done so along with his wife Patricia since 2008.

“Sometimes I would agree, it can be sad, but I look at it this way — if I have reached the last

Photo by Wade Vandervort.

From left, Deana Ozuna is a volunteer, Alek Phillips is volunteer coordinator, and Dr. Dean Tsai and Dr. Lisa Rosenberg are medical directors at Southwest Medical Hospice.

Pratt said that he often revisits various chapter of my life, I’d like someone there chapters of his own life and speaks with with me. The family also needs relief from patients on a wide range of topics. “It’s a the stress and strain of the situation. The matter of being able to listen, to show that end is inevitable, whether you are there or not. Being with them at the end to give them you care.”

The job isn’t as depressing as people a ray of sunshine is a good thing.” might think, said Stewart. “This is the most April Stewart is the chief nursing officer rewarding job I have ever had,” she said. for Nathan Adelson Hospice. She’s been working in hospice for 12 years. “Hospice is “Hospice patients have the most beautiful stories to share. How lucky are we to be a who I am,” she said. part of someone’s life at this point in their Ozuna said that attitude is everything. journey? If we as a team can come together She said one key is “the ability to be and provide true hospice care in the way it upbeat and smile when you walk into the was intended, it is an amazing journey for room. They love it because they so often all involved and can make a very sad, emoare around people acting somber and restrained. When I first started doing volun- tional time a little less scary. teer work, people were thrilled to see a Discovering a niche smile, and they want to talk and learn about me. They are happy to have company.”

After working in numerous hospitals Pratt agrees, adding that “you need to be and intensive care units, Dr. Dean Tsai, a comfortable simply sitting and conversing medical director of hospice and palliative with people. You need caring and patience.” medicine for SMH, felt that medical care

was often delivered without asking what the patient’s goals were, especially as patients got sicker and the treatments got more difficult. After helping a patient in respiratory failure to be comfortable as he was compassionately extubated, he sought out more experience in hospice care, leading to working full-time in the field in 2007 and transitioning to his job as medical director in 2008.

“It’s actually the most rewarding job I’ve ever had,” Tsai said. “We get heartfelt gratitude from families every day. Yes, it can be sad, at times, but it’s not depressing and almost always rewarding. I get to listen to patients tell their stories and often talk about what is most important in life.”

Tsai notes that the hospice setting and facing your own mortality can actually be a gift of sorts.

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Photo by Christopher DeVargas.

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“When people are enrolled in hospice, you time is very limited, it allows them to say don’t have to ‘go anywhere,’ and you aren’t their goodbyes, prepare their legacy, make necessarily bed-bound,” Rosenberg said. amends or speak to loved ones,” he said.

“The vast majority are cared for by family “This is considered the gift of hospice.” members at home with all the needed mediFor Dr. Lisa Rosenberg, also a medical cations, equipment and support from our director of hospice and palliative mediteam. We continue to manage disease and cine for SMH, her first hospice experience symptoms. If a new symptom emerges, and was volunteering while a medical student. a new medication is needed, we can have While she originally had planned to be a it in the home in less than two hours. We neonatologist, she realized her calling was for older adults. She later worked 15 years as deliver great care and when things need to happen quickly, they happen very quickly.” a geriatrician, spending time with patients Stewart said that there is often confusion near the end of their lives. End of life care about medications in hospice. was always part of her work. She considers “Some people still think that hospice just her move to hospice as the best professional medicates people with morphine to the decision she’s ever made. point that they can no longer be alert and Rosenberg has witnessed that some starves them,” she said. “It is so sad and patients and their families can be good at creates a lot of barriers in care. The truth is emphasizing the positive or the negative, the patient is the one in charge of their care depending on their personality.

“Part of it is who we are, the other part is acceptance of the situation and accepting assistance,” Rosenberg said. “Sometimes it is a sorting through of one’s life or relationships. When someone recognizes that their time is limited, it can actually be a gift. We have resources to help with that.”

Stewart received a bit of on-the-job training when beginning her hospice career.

— Dr. Dean Tsai “These skills develop over time. The wife of my first hospice patient in 2007 told me, ‘We like you and we want you to be our nurse.’ I shared with them that I was still — that’s what hospice is all about.” new to hospice so I would be in a supportive Rosenberg said that hospice care can take role,” Stewart said. “She then said to me, ‘If various forms. It’s about meeting the needs you come and care for my husband, I will of patients and their families wherever they show you how to be a hospice nurse.’ It are at that point in their journey. turns out that she had been a hospice nurse “If someone has stage-4 cancer and for many years before she retired. I learned says they want to go on a cruise or go to a a tremendous amount from the two of them. friend’s wedding, we can help them with Mainly — go into each situation with an these goals,” Rosenberg said. “If someone open mind and open heart, determine what is electing to pass peacefully at home is needed of you, and make sure it happens. surrounded by loved ones — which is how People don’t always need medical intervendeath has happened in most of mankind’s tion. More often than not — they need your recent history — rather than a hospital hand or your shoulder. Be present.” room, we support that.”

Hospice is a service, not a place.

Other misperceptions Tsai and Rosenberg have encountered other misperceptions beyond the “depressing” question, like where the care takes place.

“Hospice is a service, not a place,” said Tsai.

While hospice care can take place in a clinical setting, a lot of hospice care takes place in the home.

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When the end comes

One particular memory has remained with Stewart.

“I once had a patient who was married to his wife for 50-plus years. When he began to transition to his final journey he said to me, ‘Please promise me one thing. I want my beautiful wife to be the last thing I

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see.’ I promised him I would do my best to make sure that happens. I was providing continuous bedside care.

“The time came for his wife to turn in for the night. He started to exhibit signs that he may pass. I went and got his wife and told him she was there with him. I sat him up and he was able to open his eyes as he took his last breath while holding her hands.

“It was the most beautiful expression of love I have ever seen.”

Pratt said that thinking of the good times is a good approach.

“Whenever I am with a patient, we don’t talk about the end. We talk about the journey — grandkids at the holidays, gratitude for having grandkids,” Pratt said.

“One of the military service members I’ve worked with, he’s thankful he came home from the war, thankful that he married, thankful he raised a family, thankful that he traveled with his wife. You focus on the accomplishments and not the end.”

If others are encountering a similar struggle with a friend or family member with a terminal illness, he encourages them to just not give up.

“Treat them no differently than you would a friend. I’ve seen families that came together, some that pulled apart,” Pratt said. “When the whole family pulls together, that is best. It’s a team effort.”

Rosenberg said she has had hard days in her work, but most days are very good.

One recurring difficulty she has witnessed is when a patient said they are tired of fighting, and a well-meaning family member said, “you have to fight.”

“That is very hard,” the doctor said. “It’s important to listen to patients, to hear their wishes for this stage of their life and to be respectful of them.”

Rosenberg sees hospice care as a return to a more natural state of care, pointing out that 150 years ago, people typically died at home surrounded by family and friends. It’s often now turned into a medical event.

“Mostly, I think what we do is beautiful. We don’t put patients on the path to dying. They let us come in and support them. We’re all in the same place working to relieve suffering and maximize joy and meaning.”

Here for you.

Here for good.

Over the last 20 years, we’ve grown with this incredible city. We now provide outstanding care to well over 300,000 patients. Thank you for trusting us with your care.

See why patients choose Total Care at HCPNVHereForYou.com.

Sejal Duggal, MD Summerlin Clinic

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THE LAYPERSON MUST NAVIGATE A FURIOUS OCEAN OF INFORMATION WHEN IT COMES TO HIS OR HER HEALTH. 48

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‘Dr. Web’ COMBATING

RECOGNIZING FAKE MEDICAL ‘NEWS’ BEFORE IT BECOMES LETHAL

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By Dr. Fadi Braiteh

n the oncology realm, turning to “Dr. Web” — and trusting the advertised therapies or remedies that can stem from a rabbit hole of searching — can be the difference between life and death.

As health care practitioners, we are custodians and guardians of the welfare of our patients. In addition to providing recommendations and courses of meaningful action, to treat and prevent ailments, our duty is to shelter patients from harm to health, including misguidance to wellbeing. This practice is the essence of modern medicine in United States, rooted at the turn of the 20th century with drastic reform of medical education in 1910 with the Flexner Report, the establishment of laws in 1906 leading to the birth of the Food And Drug Administration, and the foundation of the National Institute of Health in the 1880s. This was, in part, in response to the spread of information (including advertisements, journalism, items off the printed press and the pouring in of new mechanical devices), equally spreading verified facts and falsified claims.

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A century later with the boom of the web, information — which may not be curated or verified, or may have ill intent — is in the hands of everyone. Anyone who ventures on the internet can acknowledge that such a flood of advertised information sometimes isn’t even the result of a guided search but imposed through popups. There is plenty of information out there, but unfortunately there is little solid knowledge that can result spontaneously: it requires a tremendous effort to verify and verify with trusted sources!

The layperson must navigate a furious ocean of information when it comes to his or

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her health — similar to navigating the seven seas and doing so safely. In most cases, this is no easy task — there is simply not enough time or expertise for the average person to decipher all of the information out there on an existing or prospective condition and make a responsible decision. This is the case with trusted sources, the problem becomes catastrophic when it’s a source that strives for financial gain, sells futile treatments or creates sensational misinformation to profit from inflated visitor statistics.

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This is where the physician-patient relationship has never been more important.

It is the physician’s responsibility to know and summarize the latest information and help the patient make an informed decision. It all must start by addressing the questions of, “How do you surf the internet for information and who helps you with that?”

How We Got Here

Two-thousand years ago, there was a near absence of medical information. Within our lifetime, a plethora has emerged. This abundance of information

OF AMERICANS SELF-DIAGNOSE ONLINE INSTEAD OF VISITING A MEDICAL PROFESSIONAL

unfortunately consists of some intentionally misleading information by third parties.

For example, think of a popular news site you have visited recently. Below the article you intended to read, there are clickbait-esque pieces trying to lure you in, with headlines like “Where are these 10 child prodigies now?” and “How to lose 50 pounds in one week!” If you click on something of interest, the process to get to any information whatsoever can be painful,

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often involving 20-plus different pages or clicks. Those clicks equate to marketing value which is primarily why they exist.

Unfortunately, when you scour the internet enough about a certain condition — e.g., cancer — the third parties can start to leech on to you, promoting fake items and these bogus stories. Before you know it, seemingly everything you engage with online is surrounded by inaccurate information and messages. Here is where a patient can easily be misled by promises of herbal medicines or the harm of traditional cancer treatments, like chemotherapy or radiation.

Some of these sites are pushing for one among many of its “conspiracy theories” such as claiming that doctors or pharmaceutical companies have the cure for cancer, but they hide it. Other sites or stories are getting sophisticated and laying down a few facts — with study-driven evidence — and then complementing them with an abundance of lies.

To everyone, these sites are distractive.

But, to some, it can very easily become literally destructive, if one is not vigilant.

It is time to recognize the enemy. And, unfortunately, it is not just one enemy inundating our lives — it is several that are creating chaos.

Determining Real Versus Fake

Fortunately, we can combat the chaos with a proactive approach. When it comes to deciphering helpful versus harmful information, there are some tips to keep top-of-mind: If it’s too good to be true, it’s probably not true.

Has the claim been clinically researched or proven time and time again? By whom?

Are the sources trustworthy?

Understand the word “trial,” especially the differences between a “research clinical trial” and a “30-day free trial of product X.” While both phrases have the word “trial” in them, they are fundamentally different.

If a website is asking for money or your credit card information, run away.

If it is torturous to get information — e.g. clicking through 20 brief pages of photos — the end result likely isn’t trustworthy.

If more than half the page is comprised of advertisements, be skeptical.

What do reputable sources say in comparison to what you’re reading. Some great go-to sources in the oncology realm include cancer.net (comprised of doctorapproved patient information from the American Society of Clinical Oncology) and cancer.org (the American Cancer Society’s website).

The Harm in Trusting ‘Dr. Web’

There are certainly downsides to trusting “Dr. Web” over a physician or second opinion. Most importantly, opting for alternative therapies may equate to missed treatment opportunities. The difference between weeks or months exploring an Internet-sourced treatment way be life-altering, when one could have been receiving a reputable and fully researched treatment all along.

And, alternative medicines can certainly be costly. The time and money wasted on therapies with little proven value can be invested in proven and impactful treatments

from the get-go. This is a perfect time to remind you: The Food and Drug Administration (FDA) exists for a reason. Formed in 1906, its mission statement reads: The Food and Drug Administration is responsible for protecting the public health by ensuring the safety, efficacy, and security of human and veterinary drugs, biological products, and medical devices; and by ensuring the safety of our nation›s food supply, cosmetics, and products that emit radiation... FDA is responsible for advancing the public health by helping to speed innovations that make medical products more effective, safer, and more affordable and by helping the public get the accurate, sciencebased information they need to use medical products and foods to maintain and improve their health.

The FDA and industry regulations exist to protect Americans. But unfortunately, amid the guidelines and pertinent warnings, some folks continue to opt for what they find online. Unfortunately for the cancer patients that I have encountered that have insisted on their own unproven findings, many are not alive to tell their stories.

An example: Two years ago, I had a young man, in his early 20s, visit me with an early, treatable stage of cancer. During our visit, he told me that he went online and found numerous articles that said he would die from chemotherapy and not from the cancer itself. In fact, he insisted that if we did any sort of surgery, the cancer would spread. I explained why this was wrong and how cancer did not resemble a wasp’s nest. He researched serious and valid pre-clinical laboratory papers about effect of some of the cannabis products on

certain cancer cells in certain conditions.

But he ignored the context and the limitations, even when stated by the authors, and instead he chose to stretch these basic observations to become as they were verified outcomes in patients. He did not recognize that such validations require decades of research, thousands of researchers, and potentially hundreds of millions of dollars of funding, before a compound or interventions are proven helpful.

His mother decided to visit me with him at a subsequent appointment. Unfortunately, her views aligned with his. Following that visit, he chose not to return to the clinic, and disappeared. Eight months later, after adopting alternative approaches (fundamentally non-medical) he returned very sick, bleeding to near death, with stage 4 widespread cancer relentlessly and graphically eating away at his body. He finally accepted and came to terms with science and modern medicine and accepted chemotherapy and radiation. Since it was late in the course of his disease, it was palliative in nature to alleviate his suffering and control his symptoms, until his passing few months later.

Unfortunately, this is certainly not an isolated rare case. A study of 840 cancer patients, published in the Journal of the National Cancer Institute in January 2018, found that patients using alternative medicines were 2.5 times more likely to die than those that opted for conventional cancer treatments.

There is real danger in exploring and ultimately trusting fake medical news. While it is always important to stay informed, it is equally as important to turn to reputable sources and obtain a second opinion.

Dr. Fadi Braiteh is a medical oncologist and director of the Translational Oncology Program Phase I and GI Malignancies Program for Comprehensive Cancer Centers. He is a clinical associate professor at University of Nevada School of Medicine and is board certified in medical oncology and palliative medicine and specializes in the area of gastrointestinal and thoracic oncology. Dr. Braiteh is also a principal investigator of numerous clinical research studies available at Comprehensive.

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i n r o a d s i n t r e at m e n t

a new promise arrives for stage 4 prostate cancer patients

By Drs. Nicholas Vogelzang and Michael Anderson

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ne in six men will face prostate cancer in his lifetime.

According to the American Cancer Society’s 2019 Facts & Figures report, 1,180 Nevadans will be diagnosed with prostate cancer this year. This marks a slight decline compared to last year’s projection of 1,190 diagnoses in the Silver State, but it’s still important to recognize the significance of the disease.

Prostate cancer is more likely to be cured when detected or treated early via recommended screenings. The five-year survival rate, encompassing all stages, is 99 percent and the 15-year survival rate is 96 percent. ACS recommends men with an average risk of prostate cancer begin screenings at age 50. Those at higher risk, including those having a family history or who are of African-American descent, are advised to start screenings as early as 40 years-old.

While the statistics surrounding a stage 4 diagnosis are not quite as promising, it is treatable. According to the National Cancer Institute, those whose prostate cancer metastasizes regionally to nearby lymph nodes have a 5-year survival rate of 99 percent. For those whose metastasizes to distant parts of the body, the rate is 28 percent.

A promising new therapy for those with advanced stage prostate cancer – a radionuclide treatment known as 177Lu-PSMA-617 – is currently in Phase III of testing. The intravenous therapy acts like a lightning bolt – it kills a cancer that is dividing by destroying its machinery for cell division.

And, with the small handful of patients that have received the treatment thus far, 30 to 40 percent have had a positive response.

On December 6, 2018, local grandfather and Comprehensive Cancer Center patient William Cooley became the very first in Nevada to receive the treatment.

Leading up to the treatment, Cooley had exhausted all of his options.

With a stage 4 diagnosis, he had undergone chemotherapy, radiation and testosterone deprivation therapy, among other measures. Nothing was having a lasting impact, and he was given one to two years to live. After being screened by Comprehensive’s research team, Cooley was found to be a genetic fit for the trial.

Thus far, the treatment has worked well for Cooley. His Prostate-Specific Antigen Test (PSA) figures, which were rising rapidly pre-treatment, have been reduced dramatically. His PSA at the start of the 177Lu-PS-

MA-617 treatment was 33ng/mL and is now at 5ng/mL (with 4ng/mL or less being normal).

Given the targeted nature of the therapy, he has also had no side effects and is incredibly optimistic about his journey moving forward. “I feel great and everyone can tell a difference,” Cooley said, “I am gaining weight back and I have so much energy now. I can spend time with my wife and family again without getting tired. I am at the top of my game. It is such a blessing.”

Cooley’s treatment calls for six visits with the Comprehensive team.

Given the positive impact that 177Lu-PSMA-617 has had on patients like Cooley, the Food and Drug Administration is expected to fully approve the drug in one to two years. Simultaneously, other radionuclides (including Actinium-225) are currently being explored that may very well have a similar or even greater results.

An affiliate of the U.S. Oncology Network, Comprehensive 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 FDAapproved cancer therapies. With these clinical trials, there have been incredible successes, some of which have ultimately impacted patients throughout the world.

And for so many, just like Cooley, these trials mark another path forward and an unwillingness to give up hope.

Dr. Nicholas Vogelzang is a medical oncologist at Comprehensive Cancer Centers and sits on the GU Committee for U.S. Oncology Research.

Dr. Michael Anderson is a radiation oncologist at Comprehensive Cancer Centers. He specializes in the use of Intensity Modulated Radiation Therapy and High Dose Rate Brachytherapy.

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THE BIGGER PICTURE

GROWTH IN THE HEALTH CARE COMMUNITY BENEFITS LAS VEGAS AS A WHOLE

By Dr. John Rhodes

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s Southern Nevada grows, so does the demand on the local health care system.

At the same time, as the local health care system itself expands, so do its contributions to the community and to Nevada itself.

In the race to meet a growing demand for health care ser- cluster effect of business growth encouraged by developments vices, Southern Nevada has seen a number of major develop- in a particular industry or sector of the economy. ments in recent years. Examples include partnerships between “Tesla in Northern Nevada is a good example,” he said. health care providers and local medical schools and the city of “There’s been a great deal of progress since 2011, and the supLas Vegas’ designation of a “Las Vegas Medical District.” The port provided through Gov. Sandoval and the Nevada Goverestablishment and growth of the UNLV School of Medicine and nor’s Office of Economic Development.” the expansion of schools like Touro University Nevada, RoseNot including Tesla itself, an additional 8,200 jobs and man University of Health Sciences College of Medicine, Nevada $466.3 million in annual payroll are supported at other local State College School of Nursing and the University of Nevada businesses in Northern Nevada, sparked by about $6 billion in School of Medicine are already making a significant impact. capital investment by Tesla and its partner Panasonic, which The same can be said for the ambitious recruitment and have developed a massive Gigafactory outside of Sparks to community collaboration efforts of local health care providers produce batteries for Tesla’s electric cars and energy storage like Southwest Medical Associates, part of OptumCare. In 2018, systems. Its construction supported 17,150 direct and 7,938 inOptumCare Nevada and Southwest Medical welcomed 95 new direct person-years of employment (i.e., one person employed health care providers. for one year).

Jeremy Aguero, principal analyst for Applied Analysis, a lead“What you generally have is an employer or group that being local economic, fiscal and policy research firm, has seen a comes the center — or nucleus — for a cluster business,” Ague-

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ro said. “I think, overall, the creation of the medical district is something that was a long time coming for Southern Nevada. It is absolutely the right step for the city of Las Vegas and Southern Nevada as a whole.”

The medical district was established in 2002 by the city of Las Vegas and includes 214 acres around UMC and Valley Hospital and another 460 acres near Martin Luther King Boulevard and Symphony Park.

In recent years, the newly launched UNLV School of Medicine partnered with UnitedHealth Group, which includes Southwest Medical, part of OptumCare. The partnership is powered by a grant provided through the United Health Foundation.

Longtime Las Vegan Dr. Robert McBeath, Southwest Medical’s president and CEO, explains that the grant supports the development and implementation of specialty programs and other initiatives that will integrate local medical students with the local health care community.

“With primary care physicians as instructors, or ‘preceptors’, and a primary care health center as a home base, each student becomes a key member of an interdisciplinary team providing comprehensive care to patients,” McBeath said. “We continue to collaborate and work closely with them.”

The grant also aids in the building of three multispecialty community clinics by the medical school, which will offer a full complement of primary care and basic specialty care services.

The new UNLV School of Medicine will help considerably in the years to come, producing more doctors to help address a continued shortage of health care providers in Southern Nevada.

In the meantime, demands on the system continue to grow, and Southwest Medical continues to partner in clinical education across the Las Vegas Valley, with a financial donation to the Touro University Nevada Physician Assistant Studies Program and working with Universal Health Systems hospitals to be the clinical site for its approved Family Practice and Internal Medicine residency longitudinal ambulatory care clinics.

Southwest Medical’s program recently brought in six Touro students to spend the majority of their clinical year training in the company’s facilities, before going to work for the practice by graduation. Southwest Medical will also be the clinical site for the UHS-approved family practice and internal medicine residency. This program will be producing 60 new family practice doctors and 120 internal medicine interns and residents that will take their place at medical practices within the Las Vegas community and beyond. This residency program pays its advanced practice clinicians a stipend while they train.

Jennifer Bergdoll is vice president of clinical talent acquisition for Optum, which is making increased investments in both physician retention and recruitment. She expects 2019 to follow a growth pattern similar to Continued on page 56

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Continued from page 55

last year, when the company had one of its best years ever for adding health care providers.

“The way we are trending, we project bringing on another 90 to 100 health care providers this year, with approximately 44 of them being physicians,” Bergdoll said.

The term health care providers typically refers to not just physicians, but also what are called “advanced practice clinicians,” such as nurse practitioners (NPs) and physician assistants (PAs).

“Many of our providers in the community are now training in Southern Nevada,” Bergdoll added. “To take advantage of this growing opportunity, we’ve expanded our teaching partnerships with Touro University and expanded other partnerships with UNLV School of Medicine, as well as the Valley Health System family medicine residency program, which starts in July 2019 and will be the largest family medicine residency program in Nevada.”

Despite diligent efforts by area health care providers and medical schools, Aguero explained that “at the moment, the local health care industry is only about 70 percent of what it should be for an economy our size. There is capacity within the state’s economy for health care services and the economic development associated with it.”

Stacy Scheer is vice president of the Healthcare Services Division for Colliers International, a leading commercial real estate services firm in Southern Nevada. She has witnessed newly generated interest from developers in and around the medical district, largely driven by the growth of the UNLV School of Medicine and demand for new retail amenities and parking facilities.

Ancillary medical uses, expansion of existing businesses and relocations by businesses taking advantage of the governmental incentive programs available in the medical district have also had a positive effect. Research and development facilities are taking note, such as Jubilee Clinical Research, Inc., a multi-specialty clinical research facility opening in the district in late 2018.

“UNLV and related facilities have absorbed a significant portion of existing inventory in response to their own growth over the past three years,” said Scheer, explaining that “absorption” refers to existing commercial real estate space that has been leased or occupied. “Vacancy of commercial medical office inventory in the Las Vegas Medical District is now at its lowest since 2009. It is currently at 8.6 percent as of Q4 2018, down from 18.1 percent during the peak of the recession. Which is not to say that new construction has not taken place in and nearby the medical district. Steinberg Diagnostic Medical Imaging was the first brick-and-mortar addition to the medical district in 2015, and most recently, Dignity Health completed its 36,672-squarefoot micro-hospital located at 4980 W. Sahara Ave. in 2017.”

Another recent development includes construction in the area where Southwest Medical first opened its doors, at the gateway to the medical district. Work has been taking place over the past year at Rancho

‘At the moment, the local health care industry is only about 70 percent of what it should be for an economy our size.’

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Drive and Charleston Boulevard for the OptumCare Cancer Center, a new 55,000-square-foot treatment center that provides a new treatment option for patients. The Cancer Center opened its doors in December and will continue expanding services in three phases, adding medical oncology in December and additional cancer care services and treatments expected to be in place by May 2019. Patients at the center will benefit from a wide range of personalized services offered under one roof, including medical oncology, surgical oncology, chemotherapy, immunotherapy, breast care, imaging, nutrition and psychiatric services, palliative care laboratory services, and a patient and family resource library.

Aguero noted that the UNLV School of Medicine promotes exactly this type of synergy. It facilitates growth of health care practitioners within a specific area of need.

“It’s analogous to the William S. Boyd School of Law when it was created 20 years ago,” Aguero said. “It enables us to retain and develop local talent.

With medical residencies and graduate medical education, we can grow our workforce locally.”

Aguero added that health care has been one of the fastest-growing sectors of the local economy during the past 10 years, even witnessing an increase during the previous recession. Since 1998, he said there has never been a period in which the health care sector has reported a year-over-year decline in employment.

From November of 2017 through November 2018, he said 4,400 jobs have been added in Clark County’s health and education services sector.

“If we look at employment in health and education services, the vast majority is in health-related activity,” Aguero said. “It comprises 103,000 jobs in Southern Nevada.”

He added that “the beautiful thing is that so many of the businesses that grow in and around these districts are small business. The vast number of businesses in our state have fewer than 100 employees. That major investment in the school has major spinoff effects, creating jobs in nearly every sector of the local economy.”

Commercial real estate professional Stacy Scheer has witnessed the first stirrings of that spin-off effect, recently handling a parking garage project that will serve the school, while also featuring both retail and medical space on the first level. The new project is located at 400 Shadow Lane in the Las Vegas Medical District.

“I do anticipate more ‘from the ground up’ development happening,” she said. “Many existing buildings are obsolete for modern medical uses and larger spaces are needed by growing practices. You will see higher density and more high-rises to accommodate parking. Much of it will be tied to the school, but I think you will see that for the growing practices and the existing hospitals in the medical district. Housing is not yet (part of that mix), but will be there eventually to house employees working there and housing for students who will be learning there. And, of course, retail follows rooftops.”

Dr. John Rhodes is the senior medical director, Mountain West Region, for Southwest Medical Associates

TECHNOLOGY

SIMULATED SCENARIOS, REAL LEARNING

Robert Turner, simulation manager at MountainView Hospital’s SIM Center, demonstrates a 3D Systems Utrasound simulator.

T

he Sunrise Health Graduate Medical Education Consortium opened a robotic simulation center where residents can practice and hone their skills. The SIM Center, at MountainView Hospital, is an interactive learning facility that is open 24-7. It includes tools such as “SIM Mom” and “SIM Man” and robotic surgery. The center is also home to a virtual reality console, one of two in North America.

The Sunrise Health SIM Center was supported in part through a grant from the State of Nevada to further physician development and resident educational opportunities in our state.

The Sunrise Health Graduate Medical Education Consortium offers innovative approaches to residency training in a collaborative environment. Led by a team of medical educators, the consortium encompasses internal medicine, family medicine, general surgery, emergency medicine, OB-GYN, transitional year and anesthesiology. The Sunrise Health Graduate Medical Education Consortium is a member of the respected Sunrise Health System consisting of MountainView Hospital, Southern Hills Hospital, Sunrise Hospital and Sunrise Children’s Hospital, as well as several surgery, diagnostic imaging, urgent care centers and outpatient physician clinics.

Above right: Dr. Jonathan Ni, with assistance from Dr. Kristina Domanski runs through a training scenario.

Below right: SIM Man, an advanced patient simulator, is one of many training simulators at MountainView Hospital’s SIM Center.

Photos by Christopher DeVargas.

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p at i e n t s ucce s s Pr o f i le

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‘GOING TO THE DOCTOR SAVED MY LIFE’

By Tyler Richardson

D

“

Going to the doctor saved my life, I’m real thankful to be here today.

avid Tesdall was wary of going to the doctor for most of his life. In fact, the Las Vegas man would have rather done pretty much anything other than visit a doctor, instead choosing to handle on his own the aches and pains that came with being a professional handyman.

Tesdall values working hard and trying his best to provide for his family. It’s that blue-collar mentality that drove him to do everything in his power to not miss work, even if it meant ignoring a sickness or pain in his body.

“I just never liked going to the doctor,” he said. “It’s not something I did.”

It was this dismissive view of health care that almost cost him his life. One day, as he returned home after work, he could barely make it up the stairs.

He had been experiencing sudden pain in his legs and aches in his body. But the pain would subside and he wouldn’t think much of it after it was gone.

This was different, though. Not being able to walk up the stairs caused him real concern.

Hoping his symptoms would go away on their own and not require medical attention, Tesdall decided to rest at home for a while. Over the coming days, he began having trouble breathing and could barely lift his arms or legs.

“Plain and simple, I couldn’t use my muscles,” he said. “It was bad.”

The handyman finally decided it was time to seek medical attention. A trip to the hospital confirmed that he had stage 4 non-Hodgkin diffuse large B-cell lymphoma, a fast-growing form of cancer. It occurs when the body makes abnormal B-cells, which are white blood cells that help fight off infections. Lymphoma usually builds up in a person’s lymph nodes, though the cells can also affect other parts of the body.

Tesdall displayed many of the symptoms comContinued on page 60

Dr. K. Saad Jahangir and patient David Tesdall pause in the OptumCare Cancer Center.

Photo by Steve Marcus.

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Dr. K. Saad Jahangir, center, and patient David Tesdall. Also pictured are, from left, Vanessa Aguilera, clinic supervisor; Monica Sanchez, medical assistant; and registered nurses Pat Marshall and Holly Fett.

Continued from page 59

monly associated with the disease — weight loss, extreme fatigue and swelling. He was in such bad shape after checking into the hospital that he had trouble moving. He was given his first round of chemotherapy while still there in the hospital.

“When I first saw him, he was very sick,” said Dr. K. Saad Jahangir with OptumCare Cancer Care. “He could barely sit in a chair.”

Jahangir and staff with OptumCare Cancer Care took over Tesdall’s treatment. They also worked to make Tesdall comfortable with his treatment plan and process, helping him to get over his longtime aversion to seeking medical care.

He was treated with a combination of chemotherapy drugs commonly referred to as R-CHOP, which consists of rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone. This type of treatment is most commonly associated with non-Hodgkin lymphoma. It helps to quickly destroy cancer cells.

Tesdall received six chemotherapy treatments, which is common for patients with his diagnosis. The frequent trips for chemotherapy and checkups allowed him to interact and build relationships with Jahangir and the OptumCare Cancer Care staff. With each visit, a lot of the preconceived notions he had about health care began to fade away.

He saw the high level of compassion, commitment, and care that his medical team showed. Although the chemotherapy was hard on his body, Tesdall felt supported and realized his team of professionals sincerely cared for him, feelings he never expected to have when visiting his doctor.

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“The people at OptumCare, I swear they were my brothers and sisters.

That’s how much they cared,” he said. “I was depressed going into chemotherapy. It’s hard. It tears your body up. But they changed my attitude.”

Tesdall battled through all of his chemotherapy treatments and doctor visits. As his attitude towards health care changed, he fully bought into his recovery process. It gave him strength and inspiration to continue to fight for himself and his family.

For a patient that lived most of his life avoiding the doctor and most things health care-related, Jahangir says Tesdall committed himself to getting better.

“It’s a big credit to his family, who really helped take care of him,” Jahangir said. “He was very motivated as a patient and kept on fighting.”

It was that fight and willingness to open his mind to health care that led Tesdall to receive encouraging news. Jahangir was able to share the news that Tesdall was on his way to recovery.

Tesdall says he wants to use his experience as an example to others who tend to avoid doctor visits or ignore health issues that could be dangerous.

He now urges everyone to stay on top of their health and visit the doctor if something is bothering them, even if it appears minor.

“Going to the doctor saved my life,” he said. “I’m real thankful to be here today.”

Tyler Richardson is an account executive with B&P Advertising, Media and Public Relations

OptumCare photo by Steve Marcus.

THE NOTES

Anthem Blue Cross Blue Shield donated $10,000 to Sunrise Children’s Foundation at a luncheon honoring philanthropist Barbara Lee Woollen.

Event sponsors included Anthem Blue Cross Blue Shield, Artistic Iron Works, Southern Glazers Wine and Spirits and the Bruce & Barbara Lee Woollen Foundation.

SR Construction completed a 15,764-square-foot buildout of the Third Floor West of Henderson Hospital, which included 28 patient rooms, two nurse hubs and all supporting infrastructure for a new medical surgical unit.

The Valley Health System General Surgery Residency Program has been approved by the Accreditation Council for Graduate Medical Education for 28 total resident slots, which includes four categorical residents and eight preliminary resident slots. Under the direction of program director Dr. Saju Joseph, MD, the first cohort of 16 residents will begin in July. They will rotate through Desert Springs, Henderson, Spring Valley and Summerlin hospitals. The five-year program will feature a mix of simulation and operating room experiences, research, clinic follow-up with patients, specialty certification upon residency completion, and preparation for the American Board of Surgery Certification Exam. One of the residency’s unique features will be its video-based surgical skills training platform.

The Nathan Adelson Hospice collected more than 2,700 for area animal shelters during a recent pet drive.

Sances, partner, Greenspoon Marder; Dominique Schuster, marketing supervisor, Credit One Bank; Karyn Steenkamp, vice president design and construction, Caesars Entertainment; Travis Turner, administrative director, AWL Inc.; Anne Aniello-Wayman, Kaercher Insurance; Desiree Wolfe, corporate event and meeting manager, Red Rock Resort.

Jennifer Bradley, JB Public Relations, and Amanda Klein, Anthem Blue Cross Blue Shield, are co-chairwomen for the American Cancer Society of Las Vegas.

Dr. Douglas Turner is dean of the Nevada State College School of Nursing and Dr. Shartriya Collier-Stewart is associate dean of the NSC School of Education.

Cleveland Clinic Lou Ruvo Center for Brain Health was selected to join the Parkinson’s Foundation Center of Excellence global network, composed of 45 academic medical centers, 31 of which are in the United States and serve more than 145,000 people diagnosed with Parkinson’s annually. This designation identifies hospitals and academic medical centers with specialized teams who are at the leading edge of the latest medications, therapies and innovations in Parkinson’s disease.

Henderson Hospital, MountainView Hospital, North Vista Hospital and St. Rose Dominican Hospitals-Rose de Lima Campus were awarded an ‘A’ from the Leapfrog Group’s Fall 2018 Hospital Safety Grade. The Leapfrog Group is a national organization committed to improving health care quality and safety for consumers and purchasers.

Jennifer Braster, founder and managing partner of Naylor & Braster, Attorneys at Law, has been appointed to the Nevada State Board of Oriental Medicine. Braster practices primarily in the areas of business and civil litigation. The State Board of Oriental Medicine oversees and manages licensing for those seeking to practice Oriental medicine in Nevada. It includes the practice of acupuncture, herbal medicine and other services approved by the board.

New officers elected to the Shade Tree Shelter for Homeless Women and Children’s board of trustees include Dr. Phil Tobin, director and professor at Touro University, vice chair; Deborah Priebe, owner, Elegant Properties, assistant vice chair; Christine Zack, chief strategy and business development officer, The AMD Card, secretary; and Francine Miller, partner, Layton Layton & Tobler, treasurer. Stacey Lockhart is the organization’s executive director. New board members include: Monica Aldana, real estate advisor, The Collective; Dr. Hayat Jawadi, physician, Premier OB/GYN of Southern Nevada; Hilary Muckleroy, special counsel, Littler; Darrell Richards, vice president of construction, Wynn Design & Development; Amy

Spring Valley Hospital earned The Joint Commission’s Gold Seal of Approval for Sepsis Certification after undergoing a rigorous on-site review.

The Gold Seal of Approval is a symbol of quality that reflects an organization’s commitment to providing safe and effective patient care. Among the key initiatives in place at Spring Valley Hospital are ongoing education of the early recognition of sepsis in patient care settings and ongoing review of the key metrics associated with the early recognition of sepsis.

Selma Bartlett, a renowned philanthropist and icon in the local banking industry, received the annual Brad Garrett Humanitarian Award at Nathan Adelson Hospice’s “Serenades of Life — Doctors in Concert” event.

Proceeds from the concert went to the Bonnie Schreck Memorial Complementary Therapies program at the hospice.

HCA Healthcare donated $1 million to the American Red Cross to assist those affected by Hurricane Michael.

The Clark County Department of Family Services earned the Human Rights Campaign Foundation’s All Children — All Families seal of recognition for its commitment to supporting and serving LGBTQ youth and families.

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THE NOTES

Dr. Kimball Huang of My Generation Clinics.

Blue Cross and Blue Shield Foundation + CareMore Foundation gave $25,000 to Boys & Girls Clubs of Southern Nevada for Triple Play programming. Triple Play seeks to address socioeconomic and environmental factors that can negatively affect health and wellness in children.

Dr. Rachel Shirley is a fellowship-trained breast surgeon seeing patients at the Comprehensive Cancer Center at 653 N. Town Center Drive, Suite 402, Las Vegas.

HealthCare Partners has launched 24 myGeneration clinics, including one at 2650 N. Tenaya Way, geared toward senior citizens. Offerings include diagnostic testing, laboratory services and immunizations, wellness checks and treatment of long-term and chronic conditions. In addition, providers at the clinics have fewer assigned patients.

Spring Valley Hospital earned a Go Clear Award, presented by the Association of periOperative Registered Nurses (AORN), to recognize practices that eliminate smoke caused by the use of lasers and electrosurgery devices during surgery. Surgical smoke is the unwanted byproduct of energy-generating devices that are used in 90 percent of all surgeries. Its contents include toxic chemicals such as benzene, formaldehyde, hydrogen cyanide and carbon monoxide, viruses, bacteria, blood and cancer cells.

The UNLV School of Community Health Sciences, in collaboration with the Nevada Medical Center, received $100,000 from Hearst Foundations to continue its efforts to curb mental health issues among youth.

Dr. Mitchell Forman, founding dean of Touro University Nevada College of Osteopathic Medicine in Henderson, joined the UNLV School of Medicine.

Henderson Hospital was named a Top General Hospital and MountainView Hospital was named a Top Teaching Hospital by the Leapfrog Group, an independent hospital watchdog organization.

Desert Radiology was recognized as the No. 24 largest private radiology practice in the U.S. by Radiology Business Journal. The imaging company has been on the publication’s “Radiology 100” list for 11 years.

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Photo by Steve Marcus.

the n o te s

Caesars Entertainment collaborated with Clean the World to distribute 2,500 pounds of soap to 14,000 children in Zambia. The soap was handdelivered to young children and their families by Caesars team members, who were selected for the trip after being nominated by colleagues, including Georgina Guerrero, housekeeping floor manager at Planet Hollywood.

Golden Entertainment raised more than $30,000 for the ALS Association Nevada chapter at the company’s 12th annual golf tournament.

The United States Bartenders’ Guild helped raise $10,000 for Keep Memory Alive by crafting the world’s largest gin and tonic. The organization broke the previous Guinness World Records title by mixing 249.99 gallons of beverage.

Wynn Las Vegas partnered with The Leukemia & Lymphoma Society of Southern Nevada for a benefit performance of Le Rêve— The Dream that raised more than $120,000 for the organization.

Veterans Village received a vehicle as part of Progressive Insurance’s Keys to Progress. The donated vehicle was refurbished by Winners Circle Kustom Autobody.

Dr. Yen Cao, a second-year internal medicine resident at UMC, received the UNLV School of Medicine’s inaugural Above and Beyond Award for stopping on her way to work to assist at an accident.

The American College of Radiology awarded a three-year term of accreditation to Comprehensive Cancer Centers’ Radiation Oncology Division.

Comprehensive has received the accreditation for seven consecutive threeyear terms. Comprehensive’s Radiation Oncology Division comprises five of its 14 medical offices. The division includes the Northwest Medical Office, on Peak Drive near MountainView Hospital; the Summerlin Medical Office and Las Vegas CyberKnife at Summerlin, on the Summerlin Hospital campus; the Southwest Medical Office, on the Southern Hills Hospital campus; the Central Valley Medical Office, on South Eastern Avenue near Flamingo Road; and the Henderson Medical Office, on the St. Rose Dominican Hospital—Siena Campus in Henderson.

Ayesha Mehdi, principal at Frontier Health Law and of counsel at Frier Levitt, joined the board of directors for the Clark County Medical Society Alliance.

Kathi Whalen is senior vice president and chief ethics and compliance officer, and Phil Billington is senior vice president of internal audit services, at HCA Healthcare.

MEHDI

Robert Sanchez is vice president of corporate alliances at Miracle Flights.

Dr. Michael Albring is a hospitalist with Southwest Medical Associates, part of OptumCare. Dr. Cornell Clark specializes in urgent care at SouthDICKERSON CLARK west’s Rancho Health Care Center, 888 S. Rancho Drive.

Amanda Dickerson is an advanced practice registered nurse who specializes in adult medicine at Southwest’s EastJOHNSON FU ern Health Care Center, 4475 S. Eastern Ave. Dr. Pei-Chi Fu specializes in adult medicine at Southwest’s Siena Heights Health Care Center, 2845 Siena Heights Drive. Diane RHIM-KIM REFAHIYAT Johnson is a certified physician assistant who specializes in adult medicine at Southwest’s Lake Mead Parkway Health Care Center, 270 W. Lake Mead Parkway.

Kevin Refahiyat is a certified physician assistant who specializes in urgent care at Southwest’s DuranVEGA go Convenient Care, 7150 S. Durango Drive. Dr. Hae Ran “Helen” Rhim-Kim specializes in rheumatology at Southwest’s Oakey Health Care Center, 4750 W. Oakey Blvd. Dr. Sandra Vega is an OB/GYN at Southwest’s Montecito Health Care Center, 7061 Grand Montecito Parkway.

Ground was broken on a new women’s residence at the Salvation Army’s Las Vegas adult rehabilitation center at 2035 Yale St., North Las Vegas.

This facility will allow up to 30 women to live on the campus. Currently, about 85 men live on campus, and women reside on another property.

Dr. Boris Decourt is leading the Cleveland Clinic Nevada’s Translational Neurodegeneration Research Lab, located at Roseman University. The end game of the research is to build on basic research to create new therapies, procedures or diagnostics. Decourt received his doctorate of philosophy in neuroscience and pharmacology from the University of Bordeaux in France. He has conducted nearly 10 influential research projects, specifically targeting early treatment options for Alzheimer’s disease.

The Matzinger Institute of Healing, a Henderson-based medical center owned by Dr. Carolyn Matzinger at 1740 W. Horizon Ridge Parkway, purchased its building for $1,609,017. Nevada State Development Corporation assisted with financing for the purchase in partnership with Bank of George.

Jacquelyn Warn is the Nevada Donor Network vice president of quality and regulatory affairs. Sarah Harris is manager of organ services.

SANCHEZ HCA Healthcare donated $1 million to the American Red Cross to assist those affected by Hurricane Michael.

Desert Radiology opened diagnostic imaging facilities at 2611 W. Horizon Ridge Parkway in Henderson and 3025 S. Rainbow Blvd. in Las Vegas.

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

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 Sunday Tours of the Women’s Center

Sundays in March and April, 3 p.m.

6900 N. Durango Drive

spring valley Hospital For more, visit SpringValleyHospital.com Cardiac Support Group

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

Lunch provided.

Conference Room B 5400 S. Rainbow Blvd.

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 March and April, 10:30–11:30 a.m.

H2U MountainView Office, Suite 114

3150 N. Tenaya Way

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General Cancer Support Group

Devoted to helping patients with cancer improve their quality of life while undergoing treatment or if they are in survivorship. It is open to patients, caregivers, and families.

March 21, April 18, May 16, 2-3 p.m.

H2U Office, Suite 114 3150 N. Tenaya Way

Stroke Support Group

March 5, 2-3 p.m.

Rehab Conference Room

3150 N. Tenaya Way Eating Well with Cancer

March 6, 4-5 p.m.

Mark Howard Lobby Classroom

3150 N. Tenaya Way Stop the Bleed

March 20, 1:30-3 p.m.

1 South Classroom

3100 N. Tenaya Way Lunch and Learn — Lighten the Load of Being a Caregiver

A speaker from Comfort Keepers In Home Care will inform you how to lighten the load of being a caregiver for your spouse, loved one or friends. Information on health care and types of care are offered.

A representative from the Alzheimer’s Association will on hand to discuss the latest advancements in care for those suffering with Alzheimer’s. Lunch sponsored by: Comfort Keepers In Home Care.

March 21, noon-1:30 p.m.

H2U Office, Suite 114

3150 N. Tenaya Way Lunch and Learn — Protecting Your Financial Legacy

Join Adam Goodman of Goodman Lifetime Wealth Strategies to discover financial strategies related to protecting and maximizing your financial legacy, including how to provide lifetime income for a spouse, Maximize assets for children and/or grandchildren while minimizing the impact of taxes. Lunch provided by Goodman Lifetime Wealth Strategies.

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March 26, noon-1:30 p.m.

H2U Office, Suite 114 3150 N. Tenaya Way

Summerlin Hospital For more, visit SummerlinHospital.com Stroke Support Group

Meets fourth Tuesday of the month, 3-4 p.m.

Conference Room B, 657 N. Town Center Drive Cardiac Support Group

Meets third Wednesday of the month, 10 a.m.

Classroom 1A, 657 N. Town Center Drive Breast Cancer Empowerment/ Support Group

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

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

Meets fourth Wednesday of the month, 6-7:30 p.m.

Summerlin Hospital 657 N. Town Center Drive

Desert Springs Hospital For more, visit DesertSpringsHospital.com Stroke Support Group

Meets the first Saturday of the month, 10 a.m.–noon. Lunch provided.

South Magna Conference Center,

2075 E. Flamingo Road Cardiac Support Group

March 21, 2 p.m.

South Magna Conference Room,

2075 E. Flamingo Road Cardiac Lunch and Learn

Call 702-902-1700 to reserve a seat.

March 26, 1-2 p.m.

South Magna Conference Room,

2075 E. Flamingo Road

cale n d ar

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

Location Abbreviations FTF Family to Family Connection, Henderson FTF WIC Family to Family Connection, Henderson HEND WomensCare Center, Henderson MAC Siena Campus – MacDonald Room, Henderson RAN Rose de Lima Campus – Annex,

Henderson SAN San Martín Campus, Las Vegas SGR Siena Campus – Garden Room Henderson WEST WomensCare Center, Las Vegas Support Groups

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

• AA Co-ed

• AA for Women

• ALS Support

• Alzheimer’s Support

• Arthritis Support

• Bereavement Support

• Better Breathers COPD

• Breast Cancer Support

• Compulsive Eaters

• Diabetes Support

• Divorce Support

• Fibromyalgia Friends

• Gamblers Anonymous

• Leukemia and Lymphoma Support

• Multiple Sclerosis Support

• Narcotics Anonymous

• Suicide Prevention Lifeline

800-273-8255

• Widows Support Prenatal Classes

Baby Basics

$30

GV

Breastfeeding

$30

GV

Childbirth Express

$35

GV

Daddy Boot Camp

$20

GV

Gestational Diabetes Consultations

Call 702-616-4975.

Infant CPR

$20

GV, WEST Prepared Childbirth

$50

GV

Smoking Cessation for Pregnancy

702-784-8669 Fall Prevention Program

Learn to prevent serious injuries such as hip fractures in this free seven-week class.

April 1-May 13, 1-3 p.m.

SAN FIT Colon Test

Age 50 or better? Take home a Colorectal Cancer FIT (fecal immunochemical test) Screening Kit, return your sample to any WomensCare/Outreach Centers, and receive your test results by mail.

$15 Knit to Heal Prayer Shawls

Knit prayer shawls for patients and loved ones (or pick up a prayer shawl for someone facing illness). Learn to knit or crochet. Yarn donations accepted.

March 14 and 28, times vary

WomensCare/Outreach Center Green Valley and West locations,

2601 Paseo Verde Parkway, Suite 180;

and 7220 S. Cimarron Way, Suite 195 Enhance Fitness

This free evidence-based exercise program helps older adults at all levels of fitness become more active, energized, and empowered to sustain independence.

WomensCare/Outreach Center -Green Valley

2651 Paseo Verde Pkwy., Suite 180

Mondays, Wednesdays, Fridays, 9-10 a.m.

Mondays and Wednesdays, 10-11 a.m.

Tuesdays, Thursdays, Fridays, 8-9 a.m.

WomensCare/Outreach Center-West 7220 S. Cimarron Road, Suite 195 Mondays, Wednesdays, Fridays, 1-2 p.m.

Tuesdays, Thursdays, 9-10 a.m.

Henderson Heritage Park Senior Center 300 S. Racetrack Road Mondays, Wednesdays, Fridays, 8-9 a.m.

Southern Hills Hospital For more, visit SouthernHillsHospital.com New H2U Director Meet and Greet

Meet H2U Director Erica Nansen.

March 6, noon

Education Room, First Floor

9300 W. Sunset Road Lunch And Learn — Food Prep and Kitchen Cleaning Do’s and Don’ts

Southern Hill’s Hospital Executive Chef Andra Zachary-Netherton will share tips and tricks to help keep your kitchen and food properly cleaned and most importantly, safe.

March 13, 11:30 a.m.–1 p.m.

Education Room, First Floor

9300 W. Sunset Road

University Medical Center Register at 702-383-7353 or umcsn.com Triple P: Raising Resilient Children (Parenting Workshop)

Help children manage their feelings and to deal with life stress March 21, 9:30 a.m.

The Healthy Living Institute at UMC

901 Rancho Lane, Suite 180 Tomato Garden Basics

Kathie Slaughter, UNCE master gardener, will talk about how to create a fruitful tomato garden.

March 28, 10 a.m.–11 a.m.

The Healthy Living Institute at UMC

901 Rancho Lane, Suite 180

Stop the Bleed

Learn appropriate use of pressure, dressing and tourniquets.

March 29, 3 p.m.

The Healthy Living Institute at UMC

901 Rancho Lane, Suite 180

WINTER 2019

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

65

59 FOR A PRACTICE LIKE NO OTHER,

YOU NEED A BANK LIKE NO OTHER. As our client, you’ll be assigned a Certified Medical Banker* who knows the challenges you face in your personal and professional life.

Whether you need assistance financing your practice, managing cash flow, building your dream home, or planning your financial future, we’ll be there to offer customized solutions** to help you live your best possible life.

*Certified by Nevada State Bank. **Loans subject to credit approval. Terms, conditions and restrictions apply. See banker for details.

A division of Zions Bancorporation, N.A. Member FDIC. Equal Housing Lender NMLS# 467014

RAINE SHORTRIDGE Senior Vice President Certified Medical Banker NMLS# 603493 702.706.9046

RITA VASWANI Vice President Certified Medical Banker NMLS# 655119 702.855.4504

SUSAN SPLAN Vice President Certified Medical Banker NMLS# 1745998 702.855.4870

SONNY VINUYA Vice President Certified Medical Banker NMLS# 603686 702.706.9509

CHAYA PLATT Vice President Certified Medical Banker NMLS# 1744872 702.855.4887

nsbank.com | nevadasmallbusiness.com

C O L L A B O R AT E .

I N N O VA T E .

E D U C AT E .

Academic medicine at UMC creates breakthroughs for today—and the doctors and nurses of tomorrow. This means we’re collaborating with the best and brightest in medicine, conducting research that leads to life-saving treatments, and implementing the latest tools and technologies so that our next generation of medical professionals can provide the utmost in state-of-the-art care.