John C. Lincoln HealthBeat Sep.-Oct. 2013

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Essential Health News and Information

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The Beat Goes On

An Arizona First With Low Dose 3D Mammography John C. Lincoln’s Breast Health and Research Center in North Phoenix is now Arizona’s first site to offer low dose 3D mammography, the latest innovation in breast cancer screening.

The new low dose 3D software from Hologic requires less compression time and reduces radiation exposure.

“Even though groundbreaking 3D mammograms met FDA safety standards while providing never-beforeseen image clarity, some patients worried about the level of exposure,” said breast radiologist Linda Greer, MD, medical director of the Breast Health and Research Center.

“This new low dose technology eliminates that concern.”

Fewer Recalls The new technology is clinically proven to significantly reduce unnecessary patient recalls while simultaneously improving cancer detection.

The new mammograms are available at the Breast Health and Research Center, 19646 N. 27th Ave. “Lower dose 3D mammography allows radiologists to visualize the breast in greater detail than with 2D mammography alone,” Dr. Greer said.

“That results in earlier detection of cancers while reducing the false positives associated with conventional 2D mammography.”

For more information, visit us at JCL.com/3D.

September/October 2013

Becoming Whole Again New breast shaped from abdominal fat and skin looks and feels natural

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hysically, Inessa Ricci healed just fine from a mastectomy performed in Tucson in March 2012. Emotionally, she faltered.

“I knew I had to put my big girl face on for my kids,” said the 47-year-old Tucson mother of three, ages 12, 17 and 24. “And I did. But at my lowest points, I had to turn my back on the mirror — and I knew it was just a mirror — when I got out of the shower.” Facing the disfigurement was just too hard.

Lewis Andres, MD, and Inessa Ricci share a light moment at a Phoenix pool. It was during a dip in her Tucson pool two months after her mastectomy when Inessa decided it was time for reconstructive surgery.

Her surgeon had informed her of reconstruction options for her right breast, but Inessa wasn’t ready for it when she had the mastectomy. “I knew I didn’t want a foreign object — no implants — in my body,” she said.

Two months later, still dodging the mirror, she got in the pool and couldn’t swim. “It might have been that my arm was weak from the mastectomy, but my body felt unbalanced. continued on Page 2

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That’s when I knew I couldn’t live like this for the rest of my life,” she said.

Her Internet research uncovered a procedure called a DIEP free flap. DIEP stands Deep Inferior Epigastric Perforator.

The surgery leaves your abdominal muscle intact while using only fat from the lower abdomen to form a new breast.

The procedure can be done at the time of a mastectomy or afterward.

Only a few plastic surgeons in the U.S. perform the complex microsurgical procedure, and Lewis Andres, MD, with John C. Lincoln Hospitals in Phoenix, is one of them. He’s fellowship trained in advanced aesthetic and microsurgical/reconstructive surgery.

Inessa talked to a woman who had undergone the procedure and conversed online with another. In May 2012, she and her husband, Ben, traveled to Phoenix to consult with Dr. Andres.

“I was nervous,” Inessa said. “I’m petite — five feet, one inch, and 108

pounds — and I wasn’t sure I had enough abdominal fat. After examining me, Dr. Andres thought I did. On the way back to Tucson, I knew this surgery was for me. I felt really assured with Dr. Andres. He took the time to check out everything ahead of time.”

“The blood vessels that need to be reattached to the chest are less than one millimeter in diameter.”

– Dr. Lewis Andres He ordered an angiogram to ensure that the abdominal blood vessels essential to the surgery’s success would work, along with a CT scan to evaluate abdominal blood flow. The surgery was a go.

On Sept. 14, 2012, Dr. Andres performed the meticulous microvascular surgery at John C. Lincoln North Mountain Hospital.

He formed a new right breast with only

Meticulous Surgery The DIEP free flap surgery uses a woman’s belly fat to create a breast with the softest and most realistic look and feel.

“I dissect skin, fat and a blood vessel from the muscle in the lower abdomen, leaving the muscle behind,” said Lewis Andres, MD, a plastic and reconstructive surgeon. “Taking that muscle can lead to hernias and can make it difficult for a woman to flex and bend.

“The blood vessels that need to be reattached to the chest are less than one millimeter in diameter,” he continued. “Because there are two surgery sites, the recovery time, three to four weeks, is longer than with implants, but the results tend to look very natural.

“If you gain or lose weight, the breast looks more natural, and there’s no chance of rupture like there is with an implant. A lot of women like the fact that it’s a tummy tuck, too,” he said.

Although every woman is a candidate for the procedure, precautions are needed for:

the abdominal fat and skin, and connected the chest’s blood supply to what used to be in Inessa’s abdomen. The surgery took close to five hours.

Amazing Care Inessa spent four days in the hospital recovering. “I was a big baby,” she admitted later with a laugh. “I’m very nervous in hospitals due to past experiences, but the care at North Mountain was amazing. I felt like I was in a hotel. Everyone was very responsive and encouraging.

Dr. Andres made me look at my new breast while I was in the hospital. I started crying. I thought it was the most beautiful thing in my life. I was afraid I’d look like Frankenstein, but I didn’t. The symmetry was very good.”

In a subsequent procedure in December at John C. Lincoln Deer Valley Hospital, Dr. Andres reconstructed a nipple and in January tattooed an areola.

“I’m so pleased with the results. It looks natural,” Inessa said. “I’d do all over again.”

For more information, please visit JCL.com/breastreconstruction.

Lewis Andres, MD, formed a new right breast for Inessa Ricci by using her abdominal fat and skin. He connected the chest’s blood supply to what used to be in Inessa’s abdomen.

> Diabetics. > Smokers. > Women who have had previous abdominal surgery such as a hysterectomy.

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September/October 2013

JCL.com

Your Health

Prevention is Best Medicine for Diabetes

B Free Diabetes Talk and A1C Test

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iabetes increases your risk for heart disease and stroke, along with a risk for blindness, kidney disease and non-healing wounds that might lead to amputation.

Join John C. Lincoln health care providers Aaron Boor, DO, of Del Lago Family Medicine, and Debbie Richmond, dietician at John C. Lincoln Wellness Elements, for a free talk about lowering your risk for diabetes. The first 25 people who register for this free talk will receive a free A1C test to screen for diabetes and diabetes risk following the talk.

The A1C test — a simple blood prick test that does not require fasting — is a good indicator of diabetes and pre-diabetes.

The free talk and Q&A session will be:

ecoming diabetic at 38 did not surprise Michele Kunz.

Her mother died from complications at 59, her grandmother at 72. Her father requires three to four shots a day.

Today, at 49, Michele takes oral medication for Type 2 diabetes and keeps a close eye on her progress with her John C. Lincoln primary care physician, Aaron Boor, DO. “It’s really important because I would like to have the best quality of life for me, my husband and 27-year-old son.

I want to be around for them,” said Michele, a flight attendant and Surprise resident. “Watching my mom pass away at such a young age motivates me to want to try even harder. I appreciate Dr. Boor. He’s not preachy about it and rude about it, scaring you. That doesn’t work. He’s a partner.”

Too many calories with not enough exercise causes weight gain over the years and puts adults at risk for Type 2 diabetes, said Dr. Boor. In the U.S., more than seven million people have undiagnosed diabetes, and another 80 million are pre-diabetic.

Plenty of Exercise Diet and exercise are the best prevention and the best cure, he said. He encourages his patients to exercise in a way they enjoy — 30 to 60 minutes daily for those in their weight range, and 60 to 90 minutes for those who need to lose weight.

“There are a thousand diets out there, but the bottom line is eating an appropriate amount of calories and reducing simple sugars — all the sodas, cakes and candy,” he said. “Fast walking is a great exercise, but the best exercise is the exercise you do. It’s important to pick something and follow through.”

Depending on your history and your family’s history, he recommends screening for diabetes every one to five years, using a fasting blood sugar test or the A1C test, a non-fasting blood prick test.

Find a John C. Lincoln primary care physician near you at JCL.com/practices.

John C. Lincoln Medical Office Building 1, 19841 N. 27th Ave., Room 400, Phoenix, on the campus of John C. Lincoln Deer Valley Hospital

JCL.com

TYPE 2 DIABETES SYMPTOMS

Symptoms often are so mild that individuals don’t realize they’re pre-diabetic or diabetic.

Symptoms include: > Frequent urination. > Feeling thirsty.

> Feeling hungry.

> Extreme fatigue. > Blurry vision.

> Slow healing cuts/bruises.

> Tingling, pain or numbness in the hands/feet.

Source: American Diabetes Association

Looking for Dr. Right?

Tuesday, Nov.12 6:30 to 7:30 p.m.

Registration is required at JCLdiabetes.eventbrite.com or by calling 623-434-6265.

Michele Kunz discusses nutrition advice with her family practitioner, Aaron Boor, DO.

Valer ie B usto s, DO

What do you look for from a primary care physician? Routine care from a practice that cares for your entire family? A partner to help you manage a chronic condition?

If you need someone who listens, someone you can trust and who can take the time to get to know you, choose the John C. Lincoln Physician Network. You’ll get a trusted health care partner and coordinated, high-quality care. Our offices offer flexible hours, convenient locations and a team of experts ready to help.

Find your Dr. Right at JCL.com/rightdoc.

September/October 2013

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Heart Health

A HEART in the Clouds

Pilot Damian Vasquez’s main heart valve had become defective.

His choice: have it surgically corrected or quit flying.

There was no question. He needed to fly.

There isn’t a better feeling than flying a plane, according to commercial pilot Damian Vasquez. “Every day you get a bird’s-eye view, sunrise . . . sunset. It’s amazing,” he said. There’s no better feeling, he repeated — unless it’s getting paid to fly a plane!

“I picked up the fever for flying in high school, and it became a passion,” he said.

Damian, 42, graduated from Embry Riddle Flight School in Prescott and flew for almost a decade as a cargo pilot for Ameriflight, LLC. It was the perfect job, until it wasn’t.

To understand what happened to Damian, said cardiologist John Raniolo, DO, you have to understand how the Federal Aviation Administration protects the public by medically certifying pilots.

The FAA designates specially trained physicians to become Aviation Medical Examiners (AME). They perform flight physicals for all pilots at regular intervals.

Without a successful and current flight physical, you can’t legally fly. If an airman develops a disqualifying medical condition, like Damian did, the pilot’s medical certificate is no longer valid.

That’s how Damian Vasquez and Dr. Raniolo met. Almost two years ago, Damian’s Aviation Medical Examiner diagnosed a murmur in Damian’s heart and referred him to Dr. Raniolo.

Narrowed Aortic Valve Damian had a medical condition called aortic stenosis, Dr. Raniolo said. The aortic valve became calcified and narrowed over time, restricting blood delivery to the body’s vital organs. Damian’s medical condition was genetically based. His choice was have it corrected or quit flying.

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Cardiologist John Raniolo, DO, diagnosed pilot Damian Vasquez’s narrowed aortic valve.

“There was no question. I would have the surgery,” Damian said. Dr. Raniolo referred Damian to cardiovascular surgeon Ken Ashton, MD. Because Damian’s aortic valve had narrowed, his heart was working harder at a higher pressure.

In surgery at John C. Lincoln Deer Valley Hospital, “we used a traditional approach, opening Damian’s sternum, which gives us better visibility,” Dr. Ashton said. “As soon as we put Damian on the heart-lung bypass machine, we were able to surgically remove his defective valve and replace it with an artificial valve. It all went very smoothly.”

Damian said the Deer Valley staff was great, “and the facility was amazing. If I ever had to go back, I would never want to go to any other hospital.”

September/October 2013

Damian’s medical information was reviewed by the Federal Air Surgeon’s Cardiology Consulting panel, on which Dr. Raniolo serves. If the pilot’s medical information meets FAA standards, he/she can be granted a time-limited Special Issuance authorizing him to resume flying.

Damian has since undergone postsurgical cardiac testing, which he hopes will result in being granted a Special Issuance that will authorize him to resume active flying status.

If Damian were not a professional pilot, he might have been able to delay surgery, Dr. Raniolo said. But the FAA takes its responsibility to the public very seriously, resulting in stringent standards.

For more information, please visit JCL.com/heart.

JCL.com

Medical Excellence Endoscopic gastroenterologist Anu Mathew, MD, shows Donald Cook an area of concern on an image of his esophagus.

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SE ON T H E R I ’S T A H T R NC E F E AT A C A E D G N I P L TS ARE HE T R E AT M E N

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Lincoln Deer Valley Hospital. Dr. Durrani used only a few small hen Donald Cook, 77, ate a meal, he felt full very quickly. incisions that caused Donald little pain.

Diagnosed with a hiatal hernia years ago, the retired But his challenges weren’t over yet. A follow-up endoscopy engineer was accustomed to having the occasional revealed one more issue: Barrett’s esophagus with dysplasia digestive issue. When his symptoms — including a 25-pound weight — abnormal cell development — where the initial cancer started. loss — became too severe to ignore, he visited gastroenterologist With Barrett’s esophagus, parts of the esophageal lining change Joseph Fares, MD. into intestinal lining due to damage from chronic stomach acid.

The specialist confirmed the hiatal hernia during an endoscopy Patients with Barrett’s esophagus — a procedure using a thin, flexible tube may develop this dysplasia and a with a small camera inserted through higher risk of esophageal cancer. the mouth and into the esophagus.

Biopsy of a suspicious nodule Radiofrequency confirmed stage 1 (the earliest) cancer. > Barrett’s esophagus has no symptoms other Donald’s general surgeon, Sam Ablation than the typical ones of acid reflux (or Durrani, MD, wanted more gastroesophageal reflux disease – GERD).

Over the last several months, information. He called on the expertise Dr. Mathew has performed three > Barrett’s esophagus occurs in approximately of gastrointestinal endosonographer procedures to remove Donald’s 13 percent of Caucasian men over the age of 50.

Anu K. Mathew, MD. Barrett’s cells at John C. Lincoln “We needed to see if the cancer had > The incidence of esophageal cancer is rising North Mountain Hospital. She uses spread into the wall of the esophagus,” faster than breast cancer, prostate cancer or sophisticated new radiofrequency Dr. Durrani said. “If it had, we would melanoma. ablation (RFA) equipment that need to remove the esophagus. In a way, eradicates a thin layer of diseased Donald was fortunate to have the hiatal > Men develop Barrett’s esophagus twice as tissue, allowing new healthy tissue hernia because it led us to the earlyoften as women, and Caucasian men are to grow. stage cancer, which had no symptoms.” affected more often than men of other races.

“It looks much better,” Dr. Mathew said. “Mr. Cook still has Barrett’s Esophagus reflux and will need to take medication to prevent more Barrett’s cells from forming.” A couple Dr. Mathew performed an endoscopic ultrasound – endoscopy of islands of Barrett’s cells remain and will be removed during with a miniature ultrasound probe. “Fortunately, the cancer had follow-up RFA procedures. not spread deep into the esophageal wall; we could remove it,” “It’s been challenging,” Donald said of his journey back to good she said. In a procedure a week later, she scraped away the top health. “But I’m gaining back the weight. I’m happy to be back in two layers of the affected part of Donald’s esophagus. “We left the gym and feeling much better.” behind a very thin muscle layer.”

Donald then had laparoscopic hiatal hernia surgery at John C. For more information, please visit JCL.com/endoscopy.

Fast Facts

JCL.com

September / October 2013

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Foundation News

Food Bank Expands Efforts with Big Grant

B E C AU S E E V E RY K I D D E S E RV E S

A Healthy Smile “Each year, we learn more about how good oral health relates to good overall health.

Giving children a strong foundation in oral care can help them have a healthier life,” said Ju Lawrence, DMD, director of the Desert Mission Children’s Dental Clinic.

The facility helps kids in five big ways:

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he Nina Mason Pulliam Charitable Trust has awarded a $100,000 grant to the Desert Mission Food Bank. The funds will be used to buy a new refrigerated truck for the procurement and distribution of perishable and non-perishable food.

In 2012, the Food Bank distributed 40,752 emergency food bags to lowincome individuals (with incomes at or below 185 percent of federal poverty level), a 12 percent increase over 2011.

“The need in our service area continues to grow, and Desert Mission is working diligently to meet it,” said Cindy Hallman, executive director, Desert Mission, and vice president of the John C. Lincoln Health Network. “This grant allows Desert Mission to increase its capacity to serve others and to partner with other food banks and hunger relief agencies to meet the nutrition needs of individuals throughout the Valley.”

Food insecurity is becoming an increasingly common situation that many individuals and families face. In Arizona, and specifically in the Phoenix metropolitan area, the increase in demand for food bank services is significant.

Learn more about helping the community at JCL.com/desertmission.

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If a child is identified with an urgent need during a school screening, he/she is offered a free dental visit at the Clinic, located at 9201 N. Fifth St.

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Staff provides education related to oral and overall health. Kids also receive free Smile Kits (see box at right).

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Kids receive access to specialty care through volunteer specialists — oral surgeons, pediatric specialists, endodontists and periodontists.

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The Clinic is a referral source for local Head Start programs; Women, Infants and Children (WIC) programs; and immunization clinics.

Clinic staff members work with these programs to see children for routine and urgent dental visits.

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Staff encourages parents with limited financial resources to bring in their child as soon as the first tooth appears, at no charge. This allows a dental professional to apply a fluoride varnish, as needed, and provide oral education for the family.

SAVE THE DATE The 45th Annual Gold Ball will start at 6 p.m.

Saturday, March 22, 2014, in the new Palomino Ballroom of the Fairmont Scottsdale Princess, 7575 E. Princess Drive, Scottsdale.

The gala raises funds for the hospital and community programs of the John C. Lincoln Health Network. For more information, visit JCL.com/ball or call 602-331-7860.

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September/October 2013

Three ways you can help: > Donate Smile Kits or supplies: toothbrushes, floss and travelsize toothpaste. Organize a drive within your organization or church. > Volunteer: Encourage your dentist, hygienist or dental assistant to volunteer with us or donate supplies. > Share information. New patients — those who are uninsured or on particular AHCCCS plans — up to the age of 21, are welcome.

For more information visit JCL.com/ childrensdental.

LAST CALL FOR GOLF Join more than 200 golfers to tee off in support of the important community programs of Desert Mission at the 27th Annual Lincoln Guild Invitational. The tourney is slated for Friday, Sept. 20, at the Wildfire Golf Club at JW Marriott Desert Ridge, 5350 E. Marriott Drive, Phoenix. Register at JCL.com/golf or call 602-331-7860.

JCL.com

Whatâ&#x20AC;&#x2122;s Happening >

Sept. & Oct. > Screenings/Seminars

Medicare 101 Medicare 101

Learn about your Medicare benefits and the various benefit options you have during the Fall open enrollment period. Simple, easy-to-understand Medicare basics. Presenters are Heather Jelonek, COO of the John C. Lincoln Accountable Care Organization, and Dan Droen, manager of JCL Patient Navigation Services. Pick from one of these identical presentations and register at JCLMedicare101.eventbrite.com.

> 9 to 10 a.m. Wednesday, Sept. 25, Cowden Center, 9202 N. Second St., Phoenix, on the campus of John C. Lincoln North Mountain Hospital.

At this presentation only, free blood pressure checks will be offered the hour before and after the discussion. > 9 to 10 a.m. Saturday, Sept. 28, John C. Lincoln Medical Office Building 1, 19841 N. 27th Ave., Room 400, Phoenix, on the campus of John C. Lincoln Deer Valley Hospital. > 9 to 10 a.m. Wednesday, Oct. 9, LifeStream Senior Living at Youngtown, Virt Hall-North Campus, 11555 W. Peoria Ave., Youngtown. > 9 to 10 a.m. Saturday, Oct. 12, LifeStream Senior Living at Thunderbird, Chapel, 13617 N. 55th Ave., Glendale.

Learn more at JCL.com/events.

JCL.com

Spinal Stenosis and Back Pain

Igor Yusupov, MD, a neurology spine surgeon at John C. Lincoln Hospitals, will give a free talk about spinal stenosis, the narrowing of open spaces in the spine that creates pressure on the nerves and spinal cord and causes pain. He also will discuss minimally invasive treatment options. The seminar will be 6 to 7 p.m. Wednesday, Oct. 9, at Cowden Center, 9202 N. Second St., Phoenix, on the campus of John C. Lincoln North Mountain Hospital.

Register for the event at JCLspine. eventbrite.com or call 623-434-6265.

> Breast Cancer

Programs

The John C. Lincoln Breast Health and Research Center, 19646 N. 27th Ave., Suite 205, Phoenix, hosts several free programs and support groups to meet the needs of those affected by breast cancer. For more information about any of the groups, call 623-780-HOPE (4673), email BHRC@JCL.com or visit JCL.com/breasthealth.

Yoga for Recovery

6 to 7:30 p.m. every Wednesday.

(Note: Held at 19841 N. 27th Ave., Room 400, Medical Office Building 1, on the campus of John C. Lincoln Deer Valley Hospital).

Experience the physical as well as emotional benefits of yoga.

No RSVP required.

THRIVE! Young Breast Cancer Survivor Group

6 to 8 p.m. on the second Tuesday of every month for those in their 20s, 30s and 40s to meet with others facing early diagnosis.

No RSVP required.

Breast Cancer Learn and Support Group 6 to 8 p.m. on

the second and fourth Thursday of every month. Discuss aspects of

living with cancer, treatments, side effect management and survivorship. Open to family and friends. No RSVP required.

Circle of Help Advanced Breast Cancer Support Group 6 to 8 p.m. on the fourth Thursday of every month for those living with advanced or recurrent breast. Co-sponsored

by Bosom Buddies of Arizona.

No RSVP required.

For Men Only: Supporting the Women We Love

6 to 8 p.m. on the fourth Thursday of every month. Men can meet other men whose loved one has been affected by breast cancer.

No RSVP required.

John C. Lincoln Health Network offers a variety of classes, events and support groups to the community each month.

Cooking for Wellness:

6 to 8 p.m. Oct. 22. A registered dietician covers breast cancerrelated nutrition topics during a cooking demonstration. Open to family and friends.

RSVP: 623-780-HOPE (4673) or email BHRC@JCL.com.

> Support Groups Better Breathers for those

living with lung disease: 1:30 to 3 p.m. on the fourth Thursday of every month. Call the Respiratory Care Department at 602-870-6060 ext. 5793 for meeting locations. Free.

Caregivers Support Group 10:30 a.m. to noon on the first Wednesday of every month, Cowden Center, 9202 N. Second St., Phoenix, on the campus of John C. Lincoln North Mountain Hospital. Free. No registration necessary. 602-870-6374

Hearing Screenings John C. Lincoln audiologist Kristin Wells, AuD, will conduct free hearing tests for adults from 8 a.m. to 4 p.m.

Sept. 24, 25 and 26 and Oct. 22, 23 and 24 at the Tatum Health Center, 18404 N. Tatum Blvd., Suite 101, Phoenix. Call for a required appointment at 602-494-6237.

Special offers on hearing aids also will be available.

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Living with Knee or Hip Pain from Arthritis?

Learn about the latest treatment options at a free event with orthopedic surgeon Christina Khoury, MD, with John C. Lincoln Hospitals from 6 to 7:30 p.m. Tuesday, Oct. 29, at John C. Lincoln Medical Office Building 1, 19841 N. 27th Ave., Room 400, Phoenix, on the campus of John C. Lincoln Deer Valley Hospital. Registration is required by calling the Arthritis Foundation at 602-212-9900.

Visit JCL.com/events for more information.

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John C. Lincoln > Honored by Experts. Honored to Serve.

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e’re a not-for-profit organization that includes hospitals, physician p ­ ractices and a network of charitable community service programs. The honor and privilege of serving the people of the Valley has been a mission that’s driven our efforts for more than 85 years.

Although our focus is local, we hold ourselves to standards of health care and business excellence worthy of national recognition. From nursing care to community service to business ethics and more, we’ve been honored by experts with awards for practically every aspect of what we do.

But it’s not the trophies that matter. The way we see it, the greatest honor of all is that people trust us with their lives in moments of their greatest vulnerability. That’s a privilege we take seriously.

John C. Lincoln Urgent Care

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Carefree Highway

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John C. Lincoln Breast Health & Research Center

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Emergency Department and Level 1 Trauma Center.

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Dunlap Avenue

2nd Street

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John C. Lincoln Health Foundation

Emergency Department and our 24/7 Children’s Emergency Center, Mendy’s Place.

John C. Lincoln North Mountain Hospital 602-943-2381

7th Ave.

43rd Ave.

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John C. Lincoln Deer Valley Hospital 623-879-6100

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Tatum Boulevard

John C. Lincoln Immediate Care

Cave Creek Road

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John C. Lincoln Urgent Care 623-434-6444 John C. Lincoln Immediate Care 623-580-5800 Provides walk-in care 7-days a week.

John C. Lincoln Health Foundation 602-331-7860

Supports the Network’s health care and community service programs through fundraising and investment of donations.

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Providing 101 service for our community’s most vulnerable.

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Find a family physician near you at JCL.com/practices.

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