THE ARIZONA REPUBLIC
A SPECIAL PUBLICATION CREATED BY REPUBLIC MEDIA CUSTOM PUBLISHING
IN THIS ISSUE:
HEALTHCARE NEWS YOU CAN USE FOR YOUR WHOLE FAMILY
Vol. 3, 3 No. 12
COVER/08: WEIGHT-LOSS SURGERY 02: AFFORDABLE CARE ACT 03: CYSTS, TUMORS, LUMPS AND GROWTHS 04: SMOKE ALARMS AND FIRE SAFETY 06: TESTING 1-2-3; FANTASTIC FIBER 06: TOP EVENTS/INFO ONLINE 07: CALENDAR OF EVENTS; SUPPORT GROUPS 09: PEDIATRIC AND ADULT CIRCUMCISION
Procedure can have a profound impact on health
BY DEBRA GELBART
Flexible Spending and Health Savings Accounts
Tax-free accounts can make a big difference in your healthcare bottom line BY ELISE RILEY
There’s a lot of talk these days about the Affordable Care Act, but the reality is that most people with health insurance obtain it through their employer. And besides selecting coverage options, one of the biggest financial decisions most people face at this time is whether or not to participate in flexible spending and/or health savings accounts. The benefits and offerings vary by employer, but in general, these types of accounts offer tax-free savings on healthcare and dependent care expenses. “Nearly everybody would benefit from these types of arrangements because they’re going to provide some kind of shelter from income tax,” said John Barlament, a partner with the law firm of Quarles & Brady. Barlament specializes in employee benefits.
Robin Blackstone, M.D., a bariatric surgeon and medical director of the Scottsdale Healthcare Bariatric Center, tells patients that weight-loss surgery will not solve all of their issues, but also said that this type of surgery has a profound impact on a patient’s well-being and can bring problems like diabetes, high cholesterol and sleep apnea under control.
f you or someone you love doesn’t need weight-loss surgery, why should you care about advancements in bariatrics, the field of medicine concerned with obesity?
“Weight-loss surgery has such a profound impact on a patient’s well-being and can bring problems like diabetes, high cholesterol and sleep apnea under control,” explained Robin Blackstone, M.D., a bariatric surgeon and medical director of the Scottsdale Healthcare Bariatric Center. “We’re hopeful that these surgeries will show us the way to solutions other than surgery that can be accessed easily by people who are struggling with weight issues but aren’t necessarily obese.” Blackstsone, who is the immediate past-president of the American Society for Metabolic and Bariatric Surgery, considers herself an advocate of a “holistic approach to obesity,” she said. “I tell patients that surgery will not solve all of their issues. There’s still plenty of hard work ahead of them, in terms of changing their eating habits and lifestyle.”
Overview of account types
Here’s a brief overview of the most common types of these tax-free accounts. As always, individual circumstances will vary, so check with your personal financial advisor on which accounts might work best for you and your family. FLEXIBLE SPENDING ACCOUNT (FSA): There are two kinds of FSAs: a health spending account and a dependent care assistance account. If available from employers, these accounts allow employees to contribute pre-tax dollars to accounts they can use throughout the benefit plan year to pay for eligible healthcare and/or childcare expenses. It’s important to note that all eligible expenses are outlined by the IRS. Previously, participants had to spend all the funds in their account each year, a condition referred to as “use it or lose it.” However, the IRS has relaxed these restrictions for 2014 and — if an employer permits and adjusts its plan — up to $500 can be carried over from year to year. Depending on what the employer plan permits, the maximum allowable employee annual contribution for an individual’s healthcare FSA is $2,500 annually. There are parameters based on filing status and other issues, but generally, the maximum allowable annual contribution for a dependent care FSA is $5,000.
By The Numbers
<18.5: is considered underweight 18.5–24.9: healthy weight 25–29.9: overweight >30: obesity >40: extreme obesity
There are many online calculators, however, the formula used is (weight in pounds X 703) divided by (height in inches X height in inches).
Blackstone, Podkameni and two other local bariatric surgeons interviewed for this article stated that they believe one of the most well-known bariatric surgery techniques is falling out of favor. Over time, they say, a patient’s gastric band — often referred to generically by its brand name “Lap-Band” — can slip, leave scarring and doesn’t prevent patients from regaining lost weight. Continued on page 8 WEIGHT-LOSS SURGERY
TOY RECALLS It is important to make sure the latest holiday-craze gizmo or gadget hasn’t been deemed a safety hazard. Fortunately, the good news is the number of toy recalls has signiﬁcantly decreased over the last few years:
2013: 31 2012: 38 2011: 34 2010: 46 2009: 50 2008: 172 THINKSTOCK
HSA (HEALTH SAVINGS ACCOUNT): These accounts are not controlled by employers and are linked to insurance plans. Individuals can contribute pre- and post-tax, without any “use it or lose it” rule. Funds grow tax-free and medical expenses are non-taxed as well. HSAs are also portable from job to job, which means health savings can transfer throughout someone’s career for years. Annual contributions are capped at $3,300 for individuals and $6,550 for families and catch-up contributions — much like with 401(k) plans — are possible at age 55.
BMI determines eligibility
The National Heart, Lung and Blood Institute states that a normal-weight Body Mass Index (BMI) is between 18.5 and 24.9; someone who is considered overweight has a BMI between 25 and 29.9. Someone with a BMI of 30 or above is considered obese. David Podkameni, M.D., a bariatric surgeon at the Banner Gateway Weight Loss Institute in Gilbert, said recommendations from the National Institutes of Health identify candidates for bariatric surgery as those with a BMI of at least 35 who have at least one co-morbidity factor such as high blood pressure, sleep apnea or coronary artery disease. A patient with a BMI of 40 or more is considered eligible for weight-reduction surgery without any co-morbidity factors, Podkameni said.
Body mass index (BMI) is a measure of body fat based on height and weight that applies to adult men and women.
The majority of toy recalls last year involved ingestion hazards, including chemical and magnetic dangers. For more information on product recalls, visit the U.S. Consumer Product Safety Commission’s website at cpsc.gov, or call 800-638-2772 (TTY 301-595-7054).
—PAULA HUBBS COHEN
2 | LIVING WELL A-Z | WEDNESDAY, December 4, 2013
Q&A: Affordable Care Act (ACA) A
If you are purchasing insurance through the Marketplace, you must enroll in a new health plan by Dec. 23, 2013 (recently changed from Dec. 15, 2013) in order to have coverage that starts Jan. 1, 2014. If you enroll after Dec. 23, your coverage can start no earlier than Feb. 1, 2014.
nswers provided by Cheryl O’Donnell, Arizona state director at Enroll America, a nonprofit group educating consumers about the ACA, and Allen Gjersvig, Director of Health Innovations, Arizona Association of Community Health Centers.
How can I figure out what a health insurance plan through the Health Insurance Marketplace will cost me?
A (O’Donnell): Get Covered America has a calculation tool available online at GetCoveredAmerica.org/calculator; there is also a calculator on the Kaiser Family Foundation website (kff.org). F These calculators provide an estimate T of how much you may be able to qualify for in subsidies, reducing the cost of any premium. We estimate that up to 90 percent of the nearly one million eligible uninsured in Arizona will qualify for some type of tax break or subsidy in the Marketplace, which they can then apply directly to the cost of their premium.
My employer-insurance rates went up again. Is this because of the ACA?
A (O’Donnell): Insurance rates have risen steadily for a variety of reasons over the past 20 years, well before the ACA went into effect. Eventually, higher levels of insured individuals will mean more consumers will get better care and healthcare facilities will be paid for services, a situation that will help minimize cost spikes in the future.
I’ve heard that the ACA makes employer-offered healthcare better. Is that true, and if so, how? A (Gjersvig): Simply put, both individual plans and employer-sponsored plans that begin on January 1, 2014 offer broader coverage than many old policies. As part of the ACA, employers who offer coverage
— Source: healthcare.gov to their employees are required to include these 10 essential benefits: 1. ambulatory patient services 2. emergency services 3. hospitalization 4. maternity and newborn care 5. mental health and substance use disorder services, including behavioral health treatment 6. prescription drugs 7. rehabilitative and habilitative services and devices 8. laboratory services 9. preventive and wellness services and chronic disease management 10. pediatric services, including oral and vision care.
What are the insurance company rebates I’ve heard about?A (Gjersvig): One part
of the ACA requires insurance companies to spend a minimum of 80-85 percent of premium income on medical benefits. Called the Medical Loss Ratio, or MLR, this reform was designed to assure consumers that most of their premium expenses were in fact spent on providing medical care to policy-holders. If an insurance company does not meet the required MLR, the insurance company must refund premiums to policy-holders.
How does the ACA impact veterans?
A (O’Donnell): Since Veterans Administration (VA) care meets the standard for healthcare coverage, veterans would not be eligible for assistance to lower their cost of health insurance premiums if they chose to purchase additional healthcare coverage outside of the VA. However, veterans may still purchase private health insurance on or off the Marketplace to complement VA healthcare coverage.
What is the deadline for signing up for health insurance to avoid having to pay a penalty?
A (O’Donnell): Recently, the U.S. Department of Health and Human Services clarified that people who want to avoid a penalty for not signing up for 2014 coverage have until March 31, 2014 to enroll in a health plan. March 31 is also the day the Open Enrollment period for 2014 ends. — REPORTED BY DEBRA GELBART
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Enrollment help is available: Along with the healthcare.gov website, you can enroll by phone and by paper application. You can seek the assistance of free, professional help through a Navigator or you can download and print a copy of the application from the healthcare.gov website and mail it in. Websites and phone numbers for help: Enroll America – Arizona: EnrollAmerica.org/states/Arizona; 480-779-0239 Get Covered America: GetCoveredAmerica.org; 800-318-2596 Local help page of Healthcare.gov: localhelp.healthcare.gov; 800-318-2596 The bottom line: If you have not enrolled in a health insurance plan by March 31, 2014, you will owe a penalty when you file your 2014 income tax return — either $95 per uninsured adult and $47.50 per child, up to $285 for a family, or one percent of family income, whichever is greater.
WEDNESDAY, December 4, 2013 | LIVING WELL A-Z | 3
What’s that bump? BY KRISTINE BURNETT
Cysts, tumors, lumps and growths—oh my!
It’s important to get bumps/lumps checked out before they grow since cancerous cells can spread to other parts of the body.
n the world of medicine, not all bumps are created equal — and while the medical implications of cysts, tumors, lumps and growths can vary dramatically, the terms often are used interchangeably. “Until a biopsy or other testing confirms exactly what medical condition is at play, these generic terms can be applied broadly,” explained Linda Greer, M.D., medical director of the John C. Lincoln Breast Health and Research Center. “It’s similar to how soft drinks may be referred to as soda or pop.”
Though not hard and fast rules, Mazen Khattab, M.D., medical oncologist with Arizona Oncology, offers the following definitions: • CYST: soft and possibly squishy; may be empty or fluid-filled • TUMOR: usually a solid mass, though sometimes empty or cystic in nature • LUMP: any abnormal bump that appears anywhere on the body
• GROWTH: similar to a lump and can develop anywhere
signs you need to have that bump checked out
1 If it appears and grows rapidly 2 If it develops and doesn’t go away after a few weeks 3 If it’s been there for a long time and suddenly starts changing 4 If it’s located in the abdomen 5 If it’s located in or around the breast Source: Mazen Khattab, M.D.
The thing to remember, Khattab said, is that any type of bump has the potential to be harmful. Though a cyst is more likely to be benign than a tumor or other solid mass, Khattab said there are no absolutes in medicine.
“Rather than get too concerned with what word is being used, the most important aspect is finding out if the bump is benign or malignant,” he said. “You can hone in on the exact term once you have a true diagnosis.” Greer echoed those sentiments, noting that while a certain type of bump may be more commonly associated with one condition over another, it’s important not to jump to conclusions. “People often think a tumor automatically means cancer, but that’s not always the case,” she commented. “Until a cancer diagnosis is confirmed, the word tumor really just means there is a mass that needs to be explored.”
stop there. A biopsy determines whether the lump is cancerous. “It’s a process of elimination to get down to a very specific diagnosis and replace these general terms with very specific ones,” she said.
Khattab and Greer agree that taking action and having a bump evaluated is paramount. “The old teaching that if it hurts, it’s not cancer is wrong,” warned Khattab. “Never take a bump that suddenly appears, or one that may have been there a long time and starts changing, lightly. Find out exactly what you’re dealing with.”
The vagueness of these terms and how they are used underscores the importance of being proactive and seeking medical attention when a new bump crops up. Greer said that in her practice, a lump in the breast is investigated via mammogram and ultrasound technology and then subdivided as being either a cyst or tumor. The investigation doesn’t
Resources American Cancer Society: cancer.org; 800-227-2345 MedlinePlus, National Institutes of Health: nlm.nih.gov/medlineplus National Cancer Institute: cancer.gov/dictionary; 800-4-CANCER
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4 | LIVING WELL A-Z | WEDNESDAY, December 4, 2013
Smoke alarms and fire safety Planning ahead saves lives
SK THE EXPERT: Captain Jonathan Jacobs, Phoenix Fire Department
Do smoke alarms wear out?
A: “The thought is that every 10 years, people should replace their smoke alarms. They are like a lot of other appliances — they will wear out. Most smoke alarms will last about 87,000 hours, which they will run through in about 10 years.”
How often should smoke alarms be tested? “There is a national
A: “Once a month. What this requires is going up and pressing the button.”
How often should the batteries in smoke alarms be replaced?
A: “Once a year. Although some people claim they have batteries in their smoke alarms that are supposed to last seven or 10 years, we suggest people change the batteries every year on their birthday, just because this is an easy day to remember.”
Where should smoke alarms be placed?
A: “Near the sleeping areas of a home and in the kitchen. If people have limited space or limited resources, they should definitely have one in the hall, high up on the ceiling. If a house is two stories, we suggest having one on each floor, and if a house has a basement, they should have a smoke alarm there as well.”
statistic indicating that if a family has a smoke alarm in their home and there is a fire, their survival rate will double.” — Captain Jonathan Jacobs, Phoenix Fire Department
How can families devise a fire escape plan?
A: “Sit down and decide who would be most at risk during a fire, and then talk about a couple of different ways to get out of the house. It’s also important to discuss where people should go if the fire is on one side of the house or another. That way, if someone comes out [of a room] and can’t see, they will know to go one way, but if that way is blocked, [they’ll know] to go the other way. People should also talk about how to go out through a
window, as long as the window is on the first floor, and they also need to make sure ahead of time that they have the ability to open the windows. Finally, families should come up with a meeting place so the kids will know where they should go.”
The house is on fire — now what?
A: “If you see smoke or hear the alarm, get down, crawl under the smoke and get out. It’s devastating to lose everything, but everything in the house — except the people — is replaceable. Call 911, and let the Fire Department come and take care of it, and don’t try to put the fire out unless you have the capability to do so.”
What if someone is still inside?
A: “Once you’re out, do not go back inside — smoke will put you down pretty quickly. It’s understandable to want to go back in if there are kids or pets still inside, but the Fire Department will be there in three or four minutes. If someone is still in the house, tell the first-responder who is inside and where they are. If you have pets in the house, tell us and we will make our best effort to get to them and open the back door to let them out.”
What about fire extinguishers?
A: “Buy a fire extinguisher that is labeled either ‘All Purpose’ or ‘ABC’. These will take care of most types of fires, including a grease fire in the kitchen or a gasoline fire in the garage. These types of fire extinguishers contain a dry chemical powder that will usually put the fires out. I can’t tell you how many times someone will have a grease fire in the kitchen and they will put water on it and that will just make it worse. The All Purpose or ABC extinguishers are so good, we carry them in our trucks and when we encounter a fire in the kitchen we will often walk in with one and spray the dry chemical on the fire from four to six feet away.” — REPORTED BY ALISON STANTON
Additional fire safety tips • Sleep with the bedroom door shut. If a fire starts during the night, a shut door will help prevent smoke from getting into the room. • Vacuum your smoke alarms regularly. This will help make sure they are dust-free and fully operational.
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Coordinated Care: The Team Approach to Better Health
hat is Coordinated Care?
Coordinated care is a way to deliver health care through teamwork among primary care doctors, specialists and other health care professionals, with a special focus on prevention and the management of chronic disease. Many studies show that more efficient primary care also helps lower costs in the long term by emphasizing prevention and reducing unnecessary procedures. By linking specialists, hospitals and other caregivers, patients can count on a single point of contact – a “medical home” – for clear answers, personal help and peace of mind. This is especially important for seniors, who often live with many chronic conditions. Studies show roughly half of patients do not follow their doctor’s orders. Coordinated care provides more patient education and encouragement to comply with the doctor’s orders so they stay healthy. As a result, coordinated care has been proven to reduce emergency room visits, hospitalizations, nursing home stays and other expensive interventions by increasing control of the chronic diseases of age.
A Focus on Quality The traditional healthcare system treats patients after they are already sick or experiencing complications, forcing doctors to practice reactive rather than preventive medicine. Under this system, doctors get incentives to bill early and often. Coordinated care takes a different approach. Rather than pushing doctors to see high numbers of patients and spend a short amount of time with each one, coordinated care brings the focus back to the allimportant doctor-patient relationship. Doctors receive assistance with patient tracking, communication and paperwork, so they have more time for face-to-face
interaction. They can also provide more preventive services and screenings, which lead to earlier diagnosis and better health outcomes. At Cigna Medical Group, for example, we’ve had great success with the coordinated care concept. We see the primary care doctor as the “quarterback” working with specialists to manage each patient’s health. In fact, Cigna Medical Group has been certified by the National Committee for Quality Assurance (NCQA) as a level three Patient-Centered Medical Home. This means that all 22 locations have received the highest level of recognition for meeting national quality standards in coordinated care. This doctor-led, patient-centered team approach enables open communication among all health care professionals and specialists. The coordinated care method helps doctors practice medicine the way it was intended, with the patient’s good health as the top priority. The result is better care, healthier patients and reduced healthcare costs.
Coordinated Care in Action People over age 65 are especially vulnerable to medication mishaps. It’s vital that you communicate with your doctors, and crucial that your doctors communicate with each other. In fact, it’s not exaggerating to say good communication can mean the difference between life and death.
Now’s the Time One of the most important aspects of coordinated care is the emphasis on preventive healthcare. Talk with your primary care doctor today about annual exams, tests and other preventive steps you can take now to stay healthy.
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6 | LIVING WELL A-Z | WEDNESDAY, December 4, 2013
The inside scoop on some common medical tests BY GREMLYN BRADLEY-WADDELL
he scenario happens daily in doctors’ exam rooms across the globe: A patient walks in for a check-up and, for a variety of reasons, walks out with an order for one or more medical tests. It’s a common occurrence — until, of course, it happens to you. And when it does, it may seem like all the questions you have — What does that test do? Do I have to go to the hospital for it? Will it be painful? — come rushing forward only as you begin the trek home, not when you’re propped up on the exam table in that crinkly paper gown. While it’s impossible to address every concern, the following questions and answers will help better prepare most folks who are facing an ultrasound, a colonoscopy or a sigmoidoscopy. (Note: In future issues of Living Well, we’ll cover additional types of tests. If there are tests you’d like us to investigate, email Paula Hubbs Cohen, Living Well editor, firstname.lastname@example.org.)
Colonoscopy and Sigmoidoscopy WHAT IS IT? A colonoscopy is a screening test that uses a tubular instrument called a colonoscope to examine the lining of the colon and rectum. It can help physicians determine the presence of ulcers, polyps, tumors, pre-cancerous growths and colorectal cancer, according to Jim Dearing, D.O., vice president and chief medical officer for the John C. Lincoln Accountable Care Organization (ACO). Other abdominal concerns (chronic constipation or diarrhea, for example) may also call for a colonoscopy. A sigmoidoscopy is a similar type of exam, but one that focuses on a shorter part of the colon. Talk with Ultrasound your doctor about which one is right for you. Both tests may be administered in a WHAT IS IT? This relatively simple and hospital or outpatient center. painless test (also known as a sonogram) uses high-frequency sound waves to WHO NEEDS IT? A screening colonoscopy create images of organs inside the body, is recommended at age 50 for men and according to Brett Skidmore, M.D., a women. After a normal result at age 50, radiologist with Cigna Medical Group in these exams are recommended every Sun City. The test can be administered 10 years thereafter. A sigmoidoscopy is at a physician’s office or in a hospital. recommended every five years for the same population; those who choose it WHO NEEDS IT? That depends, but it’s over a colonoscopy should also have a usually ordered for patients with medical fecal occult blood test. conditions that affect the abdomen, although the test can be used on other WHAT’S INVOLVED? The night before parts of the body. A pregnant woman will the procedure, patients must drink a typically undergo frequent ultrasounds liquid pharmaceutical preparation that stimulates the bowel so that the colon will to monitor the safety and growth of her baby, but the test is also good for be emptied. “Remember, whatever goes examining patients who might have into your body has to come out,” Dearing gallbladder or liver disease, narrowing said, “so if you limit your intake to clear (stenosis) of the arteries, or uterine-, liquids all day before you start the prep, ovarian- or prostate-related problems, the whole process will be much easier.” Once the prep is done, patients must only Skidmore said. ingest clear fluids until the test is finished. WHAT’S INVOLVED? The patient will be Patients are sedated during the half-hour instructed to lie down; the abdomen is colonoscopy, “so you can’t remember it,” then coated with a conducting gel. An Dearing said. Patients are semi-awake during a sigmoidoscopy and, due to the air ultrasound technician will use a transducer (which may look like a wand) and move it put into the colon during the exam, may over the gel-covered area. feel discomfort akin to gas pains, he said. ARE THERE RISKS? On extremely rare occasions, either procedure can lead to a punctured bowel. While the risk remains low, patients who have had diverticulitis are more at risk for adverse outcomes, Dearing said.
ARE THERE RISKS? While nearly all medical procedures usually carry some element of risk, this one really doesn’t, Skidmore said. Radiation is not used, and “there’s no cutting, no injections and it’s less expensive than other tests,” he added.
TOP Events Please call to conﬁrm reservations and cost (if any).
Dec. 5 Advances in Radiation Treatment for Lung Cancer WHAT: Learn about the use of stereotactic body radiotherapy (SBRT) along with other forms of radiation including the risks and benefits of each treatment. WHERE:TheWellnessCommunity, 360 E. Palm Lane, Phoenix TIME: 6–8 p.m. COST: Free INFO/REGISTER: 602-712-1006; email@example.com
Dec. 5, 10 & 11 Health Insurance Marketplace Information Fairs WHAT: See a presentation on the Affordable Care Act (ACA) and learn about new healthcare options, speak to representatives of qualified health plans and talk to financial counselors who can answer questions and provide enrollment assistance. DEC. 5: 6–7:30 p.m.; Mountain Vista Medical Center, 1301 S. Crimson Rd., Mesa DEC. 10: 5:30–7 p.m.; St. Luke’s Medical Center, 1800 E. Van Buren St., Phoenix DEC. 11: 5:30–7 p.m., Tempe St. Luke’s Hospital, 1500 S. Mill Ave., Tempe COST: Free INFO/REGISTER: 877-924-WELL
Dec. 6 Grand opening of Chandler Family Health Center WHAT: Information on programs and services plus screenings for glucose, cholesterol, blood pressure, BMI, vision, hearing and dental. WHERE: Chandler Family Health Center (part of the Maricopa Integrated Health System/MIHS), 811 S. Hamilton, Chandler TIME: 10 a.m.–1 p.m. COST: Free INFO: mihs.org
Fantastic fiber BY ELISE RILEY
BANNER HEALTH: BannerHealth.com
hat old saying, “An apple a day keeps the doctor away” holds a lot of truth. That’s because a diet that has the right amount of fiber can help prevent diabetes and heart disease, control weight and even reduce the risk of colon cancer.
Apples, berries and bananas are great sources of fiber, but Thomson has a favorite source: beans. “I’m a big proponent of beans because they’re so inexpensive, there are so many varieties and they’re available everywhere,” Inadequate intake she said. “You can eat them cold, hot, you “Many of our chronic diseases are associated can add them easily to menu items — breads, in some way with inadequate intake of salads, vegetables — or eat as a side dish.” fiber,” said Cynthia Thomson, registered dietitian and professor in the Mel and Enid Health benefits Zuckerman College of Public Health at the Getting the right amount of fiber can University of Arizona in Tucson. help in preventing disease as well as Indeed, according to the Institute maintaining bowel health. It also has some of Medicine, an independent nonprofit connection to weight loss — Thomson said organization, the recommended daily that obese people typically consume only intake for total fiber for adults aged 50 14 grams of fiber a day. years and younger is 38 grams for men “Higher fiber intake is satiating so it fills and 25 grams for women. For men and people up and they’re not as hungry,” women over 50 it is 30 and 21 grams per Thomson said. “Is it possible to have too day, respectively, due to decreased food much fiber? Not really, but be sure to drink consumption. However, the National plenty of fluids as well.” Library of Medicine cites most Americans as consuming just under 16 grams a day. “Basically, we need to consume double the fiber that we are currently getting,” Thomson said. “Just remember that for every piece of fruit or vegetable you eat, • Oats you’re getting around three grams of fiber.” • Apples • Bananas • Peas “Fiber is one of the key • Beans • Skins of fruits components of a healthy diet.” • Berries and vegetables • Legumes • Whole-grain — Cynthia Thomson, professor, University of Arizona • Nuts and seeds breads and cereals
Dec. 7 Diabetic Sexual Health Seminar WHAT: Christopher Wolter, M.D., a urologist at the Mayo Clinic, will discuss autonomic neuropathy, which can affect the nerves of the sexual organs and urinary tracts of patients with diabetes. Open to Mayo and non-Mayo patients and their families. WHERE: Mayo Clinic Hospital, 5777 E. Mayo Blvd., Phoenix TIME: 10 a.m.–noon COST: Free INFO: azrdiabetessupportgroup @mayo.edu
Dec. 7 Pediatric Scoliosis Screening WHAT: Lecture by Michael Chang, M.D., of Sonoran Spine Center plus scoliosis screenings for children. WHERE: Scottsdale Healthcare Shea, 9300 E. Shea Blvd., Scottsdale TIME: 10 a.m.–12:30 p.m. COST: Free INFO/REGISTER: 480-882-4636; shc.org/events
Dec. 13 One-Year Anniversary Celebration of Maryvale Family Health Center WHAT: Information on programs and services plus screenings for glucose, cholesterol, blood pressure, BMI, vision, hearing and dental as well as pregnancy testing. Mr. and Mrs. Claus will visit and take pictures.
WHERE: Maryvale Family Health Center (part of the Maricopa Integrated Health System/MIHS), 4011 N. 51 Ave., Phoenix TIME: 10 a.m.–1 p.m. COST: Free INFO: mihs.org
Dec. 14 & 15 Free Health Screenings WHAT: Get health screenings and dental checks provided by the Maricopa Integrated Health System (MIHS). Screenings will be offered for diabetes, blood pressure, cholesterol, vision and BMI. WHERE: Food City Tamale Festival, Cesar Chavez Plaza, 200 W. Washington St., Phoenix TIME: 10 a.m.–6 p.m. both days COST: Free for health screenings; food can be purchased from various vendors INFO: mihs.org; bashas.com
Dec. 23 Grandfamilies Holiday Potluck Party WHAT: Annual event for grandparents and the grandchildren they care for. Fun activities for the kids while adults discuss the rewards and challenges of raising grandchildren. Sponsored by Duet. WHERE: 555 W. Glendale Ave., Phoenix TIME: noon–2:30 p.m. COST: Free INFO/REGISTER: By Dec. 16, 602-274-5022; duetaz.org
INFO Online ABRAZO HEALTH CARE (AZ Heart Institute and AZ Heart, Arrowhead, Maryvale, Paradise Valley, Phoenix Baptist and West Valley hospitals): AbrazoHealth.com
A natural prescription for good health
BARNET DULANEY PERKINS EYE CENTER: GoodEyes.com BARROW NEUROLOGICAL INSTITUTE:TheBarrow.org CARDON CHILDREN’S MEDICAL CENTER: BannerHealth.com
Great sources of fiber
CHANDLER REGIONAL MEDICAL CENTER: ChandlerRegional.org
MOUNTAIN VISTA MEDICAL CENTER: MVMedicalCenter.com
PHOENIX CHILDREN’S HOSPITAL: PhoenixChildrens.com
JOHN C. LINCOLN HOSPITAL: JCL.com
SCOTTSDALE HEALTHCARE: SHC.org
LASER SPINE INSTITUTE: LaserSpineInstitute.com
ST. JOSEPH’S HOSPITAL AND MEDICAL CENTER: StJosephs-Phx.org
MARICOPA INTEGRATED HEALTH SYSTEM: mihs.org MAYO CLINIC: MayoClinic.com MERCY GILBERT MEDICAL CENTER: MercyGilbert.org
ST. LUKE’S MEDICAL CENTER, PHOENIX: StLukesMedCenter.com TEMPE ST. LUKE’S HOSPITAL: TempeStLukesHospital.com
WEDNESDAY, December 4, 2013 | LIVING WELL A-Z | 7
December Take advantage of dozens of opportunities to meet others with similar issues and learn more about various aspects of your health – from A to Z.
MEDICARE MEDICARE ABCs Dec. 6, 10:30–11:30 a.m. By St. Luke’s at Senior Opportunities West 1220 S. Seventh Ave., Phoenix Register: 877-351-9355
WELLNESS HEALTH INSURANCE INFORMATION FAIRS Various dates, times & locations By St. Luke’s 877-351-9355 MEDICATION CHECKS Various dates, times & locations By St. Luke’s Register: 877-351-9355 NUTRITION STRATEGIES & WEIGHT MANAGEMENT Various dates & times Lifeprint Community Center 20414 N. 27 Ave., Phoenix 623-707-2899 PILATES PLUS Various dates & times Lifeprint Community Center 20414 N. 27 Ave., Phoenix 623-707-2899 MAKOPLASTY KNEE REPLACEMENT SEMINAR Dec. 4 & 5, 6–7 p.m. Arrowhead Hospital 18701 N. 67th Ave., Glendale 855-292-9355; azhealthyhours.com
GRIEF GRIEF SUPPORT Various dates, times & locations Hospice of the Valley 602-636-5390; hov.org/grief-support-groups
PAIN CHRONIC PAIN ANONYMOUS Dec. 10 & 17, 3:30–4:30 p.m. Temple Chai Shalom Center House 4635 E. Marilyn Rd., Phoenix chronicpainanonymous.org; firstname.lastname@example.org PAIN SUPPORT Dec. 11, 6:30–8 p.m. By Chronic Pain Association at Via Linda Senior Center 10440 E. Via Linda, Scottsdale 480-314-2330 PAIN SUPPORT Dec. 13 & 27, 6–8 p.m. By Chronic Pain Association at Catholic Outreach Center 12301 W. Bell Rd., Sun City 602-532-2981
HEART/STROKE STROKE SURVIVOR Dec. 12, 2:30–4 p.m. Chandler Regional 1875 W. Frye Rd., Chandler 877-728-5414 STROKE SUPPORT Dec. 17, 3 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355
BALANCING NUTRIENTS WITH MEDICATION Dec. 9, noon Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355
TAKING CONTROL OF DIABETES Various dates, 6–7 p.m. Phoenix Baptist Hospital 2040 W. Bethany Home Rd., Phoenix Register: 602-841-5505; pastoralcareaz.org
RELIEVING SHOULDER STRESS & PAIN Dec. 11, 6 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355
DIABETES SUPPORT Dec. 9, 3 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355
HEART-HEALTHY EATING Dec. 17, 11 a.m.–noon Banner Heart Hospital 6750 E. Baywood Dr., Mesa 480-854-5589 MEDITATION Dec. 20, 9:30–10:30 a.m. Lifeprint Community Center 20414 N. 27 Ave., Phoenix 623-707-2899
CAREGIVERS SUPPORT GROUPS (DUET) Various dates, times & locations 602-274-5022 SUPPORT GROUP Dec. 11, 2:30 p.m. Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355 ONLINE NETWORKING (DUET) Dec. 14, 9–10:30 a.m. 555 W. Glendale Ave., Phoenix Register: DuetAZ.org (Events tab) 602-274-5022 SUPPORT GROUP Dec. 20, 9–11 a.m. By Benevilla at Birt’s Bistro 16752 N. Greasewood St., Surprise 623-584-4999
FOOT PAIN & DIABETES Dec. 11, noon Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355 DIABETES SUPPORT Dec. 12, 1–2 p.m. St. Luke’s 1800 E. Van Buren St., Phoenix Register: 877-351-9355 DIABETES PUMPERS GROUP Dec. 17, 7–8 p.m. By Mercy Gilbert at Rome Towers 1760 E. Pecos Rd., Gilbert 877-728-3535
ALZHEIMER’S/ DEMENTIA ALZHEIMER’S & MEMORY SUPPORT Dec. 10, 17 & 24, 10 a.m.–noon By Benevilla at Faith Presbyterian 16000 N. Del Webb Blvd., Sun City 623-584-4999 CAREGIVER SUPPORT Dec. 16, 1:30–3 p.m. By St. Luke’s at Pyle Adult Rec. Center 655 E. Southern Ave., Tempe Register: 877-351-9355
CAREGIVER SUPPORT (DUET) Dec. 17, 12:30–2 p.m. 555 W. Glendale Ave., Phoenix 602-274-5022 ALZHEIMER’S & MEMORY SUPPORT Dec. 31, 9–11 a.m. By Benevilla at Birt’s Bistro 16752 N. Greasewood St., Surprise 623-584-4999
CAVE CREEK CANCER SUPPORT Dec. 14, 10 a.m.–noon By Scottsdale Healthcare at Good Shepherd Episcopal Church 6502 E. Cave Creek Rd., Cave Creek Register: 480-488-3283
LYMPHOMA SUPPORT Dec. 14, 10 a.m.–noon By The Wellness Community 360 E. Palm Ln., Phoenix Register: 602-712-1006; email@example.com
STAYING ACTIVE THROUGH THE YEARS Dec. 6, noon–1 p.m. By Tempe St. Luke’s at Tempe Library 3500 S. Rural Rd., Tempe Register: 877-351-9355
PANCREATIC CANCER SUPPORT Dec. 14, 10 a.m.–noon By The Wellness Community 360 E. Palm Ln., Phoenix Register: 602-712-1006; firstname.lastname@example.org
COLD & FLU Dec. 12, noon Mountain Vista Medical Center 1301 S. Crismon Rd., Mesa Register: 877-924-9355
CARCINOID SUPPORT Dec. 14, 1–3 p.m. By The Wellness Community 360 E. Palm Ln., Phoenix Register: 602-712-1006; email@example.com
LUNG CANCER SUPPORT Dec. 14, 1–3 p.m. By The Wellness Community 360 E. Palm Ln., Phoenix Register: 602-712-1006; firstname.lastname@example.org
BOSOM BUDDIES SUPPORT GROUPS Various dates, times & locations Ahwatukee/Chandler: 480-893-8900 East Valley: 480-969-4119 Banner Boswell Northwest Valley: 623-236-6616 Scottsdale: 623-236-6616 West Valley: 623-979-4279 YOUNG SURVIVOR GROUP Dec. 10, 6–8 p.m. John C. Lincoln 19646 N. 27 Ave., Phoenix 602-780-4673; email@example.com YOGA FOR RECOVERY Dec. 11 & 18, 6–8 p.m. John C. Lincoln 19646 N. 27 Ave., Phoenix 602-780-4673; firstname.lastname@example.org LEARN & SUPPORT Dec. 12, 6–8 p.m. John C. Lincoln 19646 N. 27 Ave., Phoenix 602-780-4673; email@example.com
PROSTATE CANCER PROSTATE CANCER Dec. 23, 7–9 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673
WOMEN & CANCER
GRANDPARENTS RAISING GRANDCHILDREN (DUET) Dec. 12, 9–11 a.m. 555 W. Glendale Ave., Phoenix 602-274-5022
OSTOMY SUPPORT Dec. 15, 2–4 p.m. First Presbyterian Church 161 N. Mesa Dr., Mesa 480-812-0324
RESPIRATORY BETTER BREATHERS/ COPD SUPPORT Various dates/times in Surprise, Sun City, Scottsdale, Chandler, Mesa, Wickenburg and several locations in Phoenix Presented by the American Lung Association 602-429-0005; breatheeasyaz.info
BRAIN PROGRESSIVE SUPERNUCLEAR PALSY (PSP) SUPPORT Dec. 14, 1:30–3:30 p.m. Pyle Adult Recreation Center 655 E. Southern Ave., Tempe 480-966-3391; firstname.lastname@example.org
BREASTFEEDING BREASTFEEDING SUPPORT Dec. 4, 11 & 18, 11 a.m. Chandler Regional 1875 W. Frye Rd., Chandler 877-728-5414
ORAL, HEAD & NECK CANCER SUPPORT Dec. 18, 4:30–6:30 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673
BREASTFEEDING SUPPORT Dec. 6, 13 & 20, 10 a.m. Mercy Gilbert 3555 S. Val Vista Dr., Gilbert 877-728-5414
ORAL, HEAD & NECK CANCER SUPPORT Dec. 19, 6:30–8 p.m. Virginia G. Piper Cancer Center 10460 N. 92 St., Scottsdale 602-439-1192
PARENTING CHILDBIRTH EDUCATION (2–WEEK CLASS) English and Spanish Various dates, 6:30–9:30 p.m. Maryvale Hospital 5102 W. Campbell Ave., Phoenix Register: 855-292-9355; azhealthyhours.com
COLORECTAL CANCER SUPPORT Dec. 21, 10 a.m.–noon By The Wellness Community 360 E. Palm Ln., Phoenix Register: 602-712-1006; email@example.com
GRANDPARENTS RAISING GRANDCHILDREN By Benevilla Various dates, times & locations 623-207-6016
PARKINSON’S CAREGIVERS SUPPORT (DUET) Dec. 11, 1:30–3 p.m. 555 W. Glendale Ave., Phoenix 602-274-5022
INFANT BRAIN DEVELOPMENT Dec. 14, 9 a.m.–1 p.m. Tempe St. Luke’s 1500 S. Mill Ave., Tempe Register: 480-784-5588
WEIGHT LOSS WEIGHT LOSS SURGERY SEMINARS Various dates, times & locations By Scottsdale Healthcare Register: 480-882-4636; bariatricsurgeryaz.com WEIGHT LOSS SURGERY SEMINARS Various dates, times & locations By St. Luke’s Register: 800-248-5553 BARIATRIC INFO SESSIONS Dec. 7, 10 a.m.–noon; Dec. 18, 11:30 a.m.–12:30 p.m.; Dec. 21, 10 a.m.–noon Banner Gateway 1900 N. Higley Rd., Gilbert bannerhealth.com/gatewaybariatrics
SPINAL CORD INJURY/ DISABILITY SPINAL CORD INJURY, WOMEN’S DISCUSSION GROUP Dec. 17, 5:30–7:30 p.m. Disability Empowerment Center 5025 E. Washington St., Phoenix Info: firstname.lastname@example.org MEN’S DISABILITY DISCUSSION GROUP Dec. 19, 5:30–7 p.m. Disability Empowerment Center 5025 E. Washington St., Phoenix 602-980-3232; email@example.com
POISON CONTROL BANNER GOOD SAMARITAN Poison & Drug Information Center Hotline: 800-222-1222
SUPPORT THROUGH OTHER PARENTS (S.T.O.P.) Various dates & locations, 7–9 p.m. 623-846-5464
SUPPORT GROUP Dec. 17, 3–5 p.m. By Benevilla at Shepherd of the Hills United Methodist Church 13658 Meeker Blvd., Sun City West 623-584-4999
POSTPARTUM DEPRESSION Dec. 4, 11 & 18, 1–2:30 p.m. Chandler Regional 1875 W. Frye Rd., Chandler 877-728-5414 CHILDREN’S MOOD SWINGS Dec. 7, 9–11 a.m. By Phoenix Children’s Hospital at Rosenberg Children’s Medical Plaza 1920 E. Cambridge Ave., Phoenix 602-933-0956
GYNECOLOGICAL CANCER Dec. 10, 5–6:15 p.m. Banner Desert 1400 S. Dobson Rd., Mesa 480-412-4673 OVARIAN CANCER SUPPORT Dec. 21, 10 a.m.–noon By The Wellness Community 360 E. Palm Ln., Phoenix Register: 602-712-1006; firstname.lastname@example.org
CANCER SUPPORT ASK THE EXPERT: CANCER PREVENTION SERIES Dec. 11, 6–7:30 p.m. Banner Gateway 1900 N. Higley Rd., Gilbert 602-230-2273
MEDICARE ADVANTAGE PLANS
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morning and afternoon seminars are available WHERE: Cigna Medical Group locations throughout the valley COST: Free seminar, receive a free no obligation gift
All groups and events are believed, but not guaranteed, to be free unless otherwise stated. Every effort has been made to verify accuracy, but please call before attending to confirm details.
JOURNEY TO WELLNESS Dec. 12, 5:30–6:30 p.m. Banner MD Anderson 2946 E. Banner Gateway Dr., Gilbert 480-256-4744
Wednesday, Dec. 11, 6-8 p.m. Banner Del E. Webb Medical Center 14502 W. Meeker Blvd., Sun City West RSVP: (602) 230-2273 or www.BannerHealth.com/230CARE
You can choose one doctor.
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8 | LIVING WELL A-Z | WEDNESDAY, December 4, 2013
Continued from cover WEIGHT-LOSS SURGERY
FAMILY MEDICINE Heeran Abawi, MD Board certified in family medicine, Dr. Abawi has a special interest in women’s health and the treatment of diabetes, hypertension, heart disease and osteoporosis. She earned her medical degree from the Ross University School of Medicine in Roseau, West Indies. Dr. Abawi completed her internship and residency at St. Joseph’s Hospital and Medical Center in Phoenix.
Banner Health Center Specializing in Family Medicine 14416 West Meeker Blvd, Building C, Suite 200 • Sun City West 623.876.3980 • www.BannerHealth.com/BAMC-PrimaryCare
CORNEA,VISION CORRECTION & CATARACT Robert Fintelmann, MD Dr. Fintelmann is a board certiﬁed Ophthalmologist by the American
Barnet Dulaney Perkins Eye Center Cornea, Vision Correction and Cataract Surgery Locations throughout Arizona 800.966.7000 • www.GoodEyes.com
GYNECOLOGY, OBSTETRICS Erin Labesky- Scoggin, DO Dr. Labesky-Scoggin is committed to meeting the physical, emotional and educational needs of her patients and specializes in adolescent female reproductive health and minimally invasive surgery. She is a graduate of the University of Kirksville College of Osteopathic Medicine in Missouri and completed her residency through the Ohio University College of Medicine at Grandview Hospital in Dayton. Dr. Labesky-Scoggin sees patients at the Banner Health Centers in Maricopa, Chandler and Gilbert. Banner Health Center Specializing in Obstetrics and Gynecology 17900 N. Porter Road, Maricopa (520) 233-2500 www.BannerHealth.com/HealthCenterMaricopa
FAMILY MEDICINE Aimee Lee, MD Dr. Lee is a board certified family medicine physician who enjoys working closely with patients and their families to ensure that all of their questions and concerns are addressed. A graduate of the Mount Sinai School of Medicine in New York, she completed her internship, residency and geriatrics fellowship at Kaiser Permanente Los Angeles Medical Center.
Banner Health Center Specializing in Family Medicine 1435 South Alma School Road • Chandler 480.668.1600 • www.BannerHealth.com/HealthCenterChandler
PAIN RELIEF Dr. Theodore Manos Dr. Manos is a Board Certified Specialist in Anesthesiology and Pain Management. He specializes in procedures such as epidural steroid treatments and facet joint block procedures that can relieve lower back pain and help improve patient’s daily comfort level. Whether it’s arthritis, a herniated disc, sciatica or spinal stenosis of the lower back, his treatments can help patients regain mobility and functionality. These treatments can help eliminate or reduce the use of oral pain medications that patients may be taking on a regular basis. Anyone experiencing chronic lower back pain may be a candidate. In most cases, pain therapy can last for long periods of time. During the first appointment Dr. Manos will evaluate the patients’ unique condition and develop a treatment plan specific to their needs.
Cigna Medical Group | Outpatient Surgery Center 3003 N. 3rd Street, 2nd Floor Phoenix, AZ 85012 602.282.9600
GENERAL SURGERY Richard Perry, MD, FACS Board certified in general surgery, Dr. Perry specializes in treating diseases of the breast, endocrine system and gastrointestinal tract and is experienced in advanced laparoscopic procedures. A graduate of the University of Arizona College of Medicine in Tucson, he completed both his internship and residency at Emory University and Affiliated Hospitals in Atlanta.
Banner Good Samaritan Surgical Associates Specializing in General Surgery 1300 North 12th Street, Suite 512 • Phoenix 602.258.1519 • www.BannerHealth.com/BMG-GoodSamSurgery AR-0008119003-01
Board of Ophthalmology and a fellow of the American Academy of Ophthalmology. He provides excellence in care of corneal disease, as well as cataract and vision correction surgery. Besides cataract surgery and vision correction (including LASIK and ICL), he performs a range of procedures including corneal transplants, partial thickness corneal transplants (DSAEK), and laser surgery to implant intracorneal segments for keratoconus (Intacs). He has presented at national and international meetings and has published multiple peer-reviewed articles.
Michael Bedore underwent gastric bypass surgery in 2009 when he weighed 454 pounds. He now weighs 245 pounds thanks to surgery and a drastic change in his eating habits. He frequents the District American Kitchen & Wine Bar at the Sheraton Phoenix Downtown Hotel where his favorite meal is their black bean hummus with lemon, grilled pita, lavash, vegetables and olive oil.
The band, a synthetic device placed around the upper part of the stomach, provides a partial barrier to food intake without altering hormonal and physiologic abnormalities that lead to severe obesity in the first place, said Kurt Sprunger, M.D., a bariatric surgeon with the Phoenix Bariatric Center at Paradise Valley Hospital. Some patients without diabetes who have up to about 70 pounds to lose may do well with a gastric band, said Daniel Fang, M.D., co-medical director of the Bridges Center for Surgical Weight Management at St. Luke’s Medical Center. “These patients may not need the added benefits of gastric bypass,” he said. However, he noted that gastric band placement has comprised less than 10 percent of the weight-loss surgeries he has performed this year. “The patients who do the best with the band are those who understand that the band has to be frequently and actively managed — tightened or loosened by the surgeon initially every three weeks as weight changes,” said Michael Orris, D.O., a bariatric surgeon with Weight Loss Institute of Arizona. “With proper diet, exercise and behavior modification, the band serves to reduce a patient’s hunger and increase cognitive restraint with regard to food.”
Gastric bypass surgery has been performed laparoscopically (using small incisions near the belly button) for about 18 years, Sprunger said, and involves dividing the stomach into a small upper pouch separated from the remainder of the stomach and rearranging the small intestine to connect directly to the stomach pouch. “The larger leftover portion of the stomach is bypassed,” Podkameni said. Unaltered, the stomach can typically hold between 35 and 50 ounces of food, Sprunger said. Gastric bypass reduces the capacity of the stomach pouch to just one ounce. The success rate for gastric bypass far exceeds the gastric band, Blackstone said. “Only seven percent of gastric bypass patients experience regaining lost weight — often between 80 and 130 pounds — after two decades,” she said. “About 67 percent of these patients experience remission of diabetes.” The risk of complications from the surgery is low, she said; less than four percent of patients may experience postoperative bleeding or infection. Phoenix resident Michael Bedore, 57, who is a patient of Blackstone’s, underwent gastric bypass surgery in 2009. He weighed 454 pounds before surgery; six months later, he weighed 288 pounds. Today, he said, he weighs 245 pounds.
“The biggest change in my life, besides the obvious weight loss, is that instead of mindless eating, I have to focus on mindful eating,” Bedore said.
A technique known as sleeve gastrectomy involves surgically removing threequarters of the stomach, reducing the size of the stomach to accommodate three to four ounces of food at a time, Sprunger said. Podkameni said that the patients who are the best candidates for this procedure are those who do not have diabetes, adding that patients with gastroesophageal reflux disease (caused by stomach acid going into the esophagus) should not have a gastrectomy, because the disease can be worsened as a result.
Another weight-loss surgical technique is called the duodenal switch, a combination of gastrectomy and intestinal bypass, Podkameni said. This technique is most appropriate for patients with diabetes whose BMI is above 55, he said, because it often results in greater weight loss.
Follow-up for weight-loss surgery patients typically continues for five years, the surgeons said, and includes blood tests to check vitamin and mineral levels. Working with a dietitian after surgery to ensure proper eating habits is essential for success, said Michael Murphy, R.D., a registered dietitian with Weight Loss Institute of Arizona. Finally, Sprunger wants the community to understand that “severe obesity is a metabolic disease. It’s not a character flaw or a failure of willpower. That is a terrible misrepresentation of the medical facts.” Because severe obesity results in physiologic changes in metabolism, he said, “research has shown that for patients with severe obesity, all nonsurgical treatments have a lasting success rate of five percent or less.”
Resources Banner Gateway Weight Loss Institute: bannerhealth.com; 480-543-2606 Bridges Center for Surgical Weight Management: stlukesmedcenter.com; 602-251-8100 Phoenix Bariatric Center: phxbariatric.com; 602-422-9690 Scottsdale Healthcare Bariatric Center: shc.org; 480-882-4000 Weight Loss Institute of Arizona: wliaz.com; 480-829-6100
WEDNESDAY, December 4, 2013 | LIVING WELL A-Z | 9
The circumcision decision A personal choice
Adult male circumcision
BY GREMLYN BRADLEY-WADDELL
Adult male circumcision is not nearly as common as the pediatric version. Nevertheless, Roscoe Nelson, M.D., a urologist and a founder of Arizona State Urology which has offices in Phoenix and Glendale, performs 25 to 40 circumcisions on adolescents and adults each year when more conservative medical treatments fail to work. The procedure is usually necessary due to one of the following medical conditions, which almost exclusively affect uncircumcised men:
he decision to circumcise an infant boy — or not to do so — is a personal one. In certain religions and cultures, pediatric male circumcision — the surgical removal of all or part of the foreskin of the penis — is an important ritual. For other individuals, the procedure may be desirable for its medical benefits or for aesthetic reasons. But, according to Duane Wooten, M.D., a pediatrician and founder of Rainbow Pediatrics in Phoenix, “the main reason baby boys get circumcised is because it’s habit.” Wooten estimates he’s performed 10,000 circumcisions since 1983.
• PHIMOSIS, which occurs when the foreskin of an uncircumcised male cannot be pulled back behind the glans penis, or head of the penis. It can affect an adult’s ability to urinate and causes skin on the penis to become painfully cracked or chapped. Symptoms can include skin that’s either pale or red and inflamed.
The American Academy of Pediatrics (AAP) leaves the choice to circumcise or not up to families. As recently as this past September, the organization stated circumcision “has potential medical benefits and advantages, as well as risks,” but noted a recent analysis it had conducted “concluded that the medical benefits of circumcision outweigh the risks.” The decision, therefore, “is one best made by parents in consultation with their pediatrician, taking into account what is in the best interests of the child including medical, religious, cultural and ethnic traditions and personal beliefs,” the organization says. While complications from circumcision are described as very rare on the AAP’s parenting website, healthychildren.org, the medical benefits are listed as: • A markedly lower risk of acquiring HIV, the virus that causes AIDS • A significantly lower risk of acquiring a number of other sexually transmitted infections (STIs) including genital
Benefits and risks
herpes (HSV), human papillomavirus (HPV) and syphilis • A lower risk of urinary tract infections (UTIs) • A lower risk of getting cancer of the penis • Prevention of foreskin infections • Prevention of phimosis, a condition in uncircumcised males that makes foreskin retraction impossible • Easier genital hygiene That all may be true, Wooten said, but he noted that “the AAP has waffled on the pros and cons of circumcision at least five to ten times in the past few years,” and although there are medical
• PARAPHIMOSIS, which occurs when the foreskin of an uncircumcised male is retracted and cannot be pulled over the glans penis.
benefits, he believes they are statistically insignificant.
• BALANOPOSTHITIS, an inflammation of the glans penis and foreskin.
Good hygiene necessary
• HUMAN PAPILLOMAVIRUS (HPV), a sexually transmitted infection that occurs in both circumcised and uncircumcised men. It presents as a growth in the area of the genitalia and is a cause of penile cancer.
If parents choose not to circumcise, they shouldn’t feel badly about it, Wooten said, adding that parents just need to practice extremely good hygiene with their baby boy by: • Gently washing the penis with soap and water, including cleaning under the foreskin • Thoroughly drying the area afterward • Keeping the genital area clean “It’s about five to ten seconds of your day,” Wooten said.
Circumcision surgery on an adult male takes about 15 to 25 minutes and is done under general anesthesia. Afterward, Nelson said, patients need to take it easy for a few days before resuming work and wait about three weeks before having intercourse.
Look for Livingwell a-z on the first Wednesday of each month! Each month, we bring you local health information you can use to keep you and your family living well. From A to Z, we tackle a broad range of health issues and offer you a wealth of resources where you can find more specific information. This publication is produced by Republic Media Custom Publishing. For questions concerning any content included in this publication please contact: Editor Paula Hubbs Cohen, Paula.Cohen@cox.net or call 602-444-8658. A division of The Arizona Republic. 200 E. Van Buren St., Phoenix, AZ 85004
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* Most recent 2013 rating from www.Medicare.gov. Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next. ** You must continue to pay your Medicare Part B premium. The benefit information provided is a brief summary, not a complete description of benefits. For more information, contact the plan. Limitations, copayments and restrictions may apply. Benefits, premium and copayments may change on January 1 of each year. 1 Within the service area. “Cigna,”“Cigna Medicare Select Plus Rx” (HMO), and the “Tree of Life” logo are registered service marks of Cigna Intellectual Property, Inc., licensed for use by Cigna Corporation and its operating subsidiaries. All products and services are provided by or through such operating subsidiaries, including Cigna HealthCare of Arizona, Inc. (CHC-AZ), and not by Cigna Corporation. Cigna Medicare Select Plus Rx HMO plans are offered by CHC-AZ under a contract with Medicare. As of the date of publication, Cigna Medicare Select and Cigna Medicare Select Plus Rx plans are offered to employers and individuals in Maricopa County and certain zip codes within Apache Junction and Queen Creek, Arizona only. Enrollment in Cigna Medicare Select Plus Rx depends on contract renewal. This information is available for free in other languages. Please call our customer service number at 1-800-627-7534 (TTY 711), 8 am–8 pm, seven days a week. For accommodation of persons with special needs at a sales meetings call 1-800-627-7534 (TTY 711). A sales person will be present with information and applications. H0354_892012a Accepted AR-0008122567-01
Our Community Depends on Us A strong public teaching hospital and public healthcare system are as much a mark of a healthy community as quality universities, modern transportation systems, and thriving arts organizations. Through the Maricopa County Special Health Care District, you are supporting our vital work in preventing disease, training the next generation of physicians, and providing care that touches nearly every corner of our community. $ .!>&%26 ,=!2 *"2?"! $ .!>&%26 *@>8/!"2'A *"2?"! $ :74(.7); *8>2>1 $ *%5#!"@"2A><" :"68?@ *"2?"! $ -6!>1%#6 -"/>168 *"2?"! $ +">B@3%!@%%/ :"68?@ *"2?"!A $ ,"@6<>%!68 :"68?@ :%A#>?68A $ 0"<"8 7 9!6=56 *"2?"!