2018-Nov/Dec - SSV Medicine

Sierra Sacramento Valley

MEDICINE Serving the counties of El Dorado, Sacramento and Yolo

November/December 2018

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Sierra Sacramento Valley

MEDICINE 3

PRESIDENT’S MESSAGE Year in Review

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The Adverse Childhood Experiences Study

Rajiv Misquitta, MD

Caroline Giroux, MD

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EXECUTIVE DIRECTOR’S MESSAGE Medical Staff Prevails in Self-Governance Battle

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More Reflections on Women in Medicine Experience

Aileen Wetzel, Executive Director

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Then and Now – Back to School

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GUEST EDITORIAL E&M Documentation to Change

Glennah Trochet, MD

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Yellow Fever

Matthew Huh

Gerald Rogan, MD

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Letter to the Editor

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Oh, the Places We Go

George Meyer, MD

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Podcasts Can Engage, Educate, Encourage

Karen Poirier-Brode, MD

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The Yale Young Global Scholars Experience

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“Paint and Sip” Evening of Fun

Matthew Huh

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Terrorists in White Coats

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Michael J. Lawson, MD

IN MEMORIAM Gerald W. Upcraft, MD

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BOOK REVIEW Surgical Care in War Zones

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Welcome New Members

Gerald Rogan, MD

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Board Briefs

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A Tour of CNU College of Medicine

Jack Ostrich, MD

We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below.

Authors will be able to review articles before publication.

Letters may be published in a future issue; send emails to SSVMedicine@ ssvms.org or to the author.

All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the medical society for permission to reprint.

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 pm M–F, except holidays.

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx The SSVMS Joy of Medicine Program sponsored a physician “Paint & Sip” event in August at The Painted Cork in Historic Folsom. Members and guests enjoyed an evening of fun socializing with colleagues and demonstrating their artistic flair. On our cover image Dr. Hanns Haesslein shows off his colorful creation. More photos are on pages 12-13.

Volume 69/Number 6 Official publication of the Sierra Sacramento Valley Medical Society 5380 Elvas Avenue Sacramento, CA 95819 916.452.2671 916.452.2690 fax info@ssvms.org

November/December 2018

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Sierra Sacramento Valley

MEDICINE The Mission of the Sierra Sacramento Valley Medical Society is to bring together physicians from all modes of practice to promote the art and science of quality medical care and to enhance the physical and mental health of our entire community.

2018 Officers & Board of Directors Rajiv Misquitta, MD, President Chris Serdahl, MD, President-Elect Ruenell Adams Jacobs, MD, Immed. Past President District 1 Seth Thomas, MD District 2 Tonya Fancher, MD J. Bianca Roberts, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD District 4 Ranjit Bajwa, MD

District 5 Sean Deane, MD Cynthia Ramos, MD Vijay Rathore, MD Paul Reynolds, MD John Wiesenfarth, MD District 6 Carol Kimball, MD

2018 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Russell Jacoby, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD At-Large Ruenell Adams Jacobs, MD Barbara Arnold, MD Natasha Bir, MD Richard Gray, MD Kevin Jones, DO Richard Jones, MD Charles McDonnell, MD Sandra Mendez, MD Rajiv Misquitta, MD Tom Ormiston, MD Senator Richard Pan, MD Kuldip Sandhu, MD James Sehr, MD Chris Serdahl, MD Ajay Singh, MD Don Wreden, MD

District 1 Harmeet Bhullar, MD District 2 Ann Gerhardt, MD District 3 Thomas Valdez, MD District 4 Richard Bermudes, MD District 5 Armine Sarchisian, MD District 6 Christopher Swales, MD At-Large Megan Anzar Babb, DO Helen Biren, MD Arlene Burton, MD Ronald Chambers, MD Amber Chatwin, MD Harprett Dhatt, MD Mark Drabkin, MD Karen Hopp, MD Carol Kimball, MD Derek Marsee, MD Anand Mehta, MD Leena Mehta, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD Naomi Ross, MD Vacant

CMA Trustees District XI Douglas Brosnan, MD

Margaret Parsons, MD

CMA Immed. Past President Ruth Haskins, MD CMA Speaker Lee Snook, MD AMA Delegation Barbara Arnold, MD

Sandra Mendez, MD

Editorial Committee Sean Deane, MD Maria Garnica, MS II Ann Gerhardt, MD Caroline Giroux, MD Sandra Hand, MD Nate Hitzeman, MD Robert LaPerriere, MD George Meyer, MD

Steven Nemcek, MS III John Ostrich, MD Karen Poirier-Brode, MD Neeraj Ramakrishnan, MS II Gerald Rogan, MD Glennah Trochet, MD Lee Welter, MD

Executive Director Managing Editor Webmaster Graphic Design

Aileen Wetzel Nan Nichols Crussell Melissa Darling Planet Kelly

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HOSTED BY DR. RAJIV MISQUITTA

Listen and Subscribe to Joy of Medicine-on Call on your favorite Podcast App or visit http://joyofmedicine.org

Sierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests.

Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising.

Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Š2018 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bi-monthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.

Sierra Sacramento Valley Medicine

PRESIDENT’S MESSAGE

Year in Review

By Rajiv Misquitta, MD THIS YEAR, WHICH is our 150th, is rapidly coming to an end. We are one of the oldest medical societies in the West. We are fiscally strong and a model for other medical societies around the nation. Furthermore, our society has been busy working hard to support our physician community and to improve the health of Sacramento.

Among the scores of activities carried out this year, our SPIRIT (Sacramento Physicians’ Initiative to Reach out, Innovate and Teach) program continues to provide care for those in need. With over 40 physician volunteers, SPIRIT has helped almost 500 patients who would otherwise have no access to care in 2018. Our latest initiative, the Opioid Awareness Summit, was also well attended and was a huge success in engaging the community and its leaders.

A major focus of this year has been addressing physician wellness and reducing burnout with our Joy of Medicine program, which was developed with input from all the medical groups in town. It’s rewarding to see the physician community working together to heal the healers. We held our 2nd annual Joy of Medicine summit and also launched a physician burnout survey, the first of its kind in Sacramento. With a record response rate, the survey results should ignite systemic change.

I am excited about our latest podcast series: Joy of Medicine–on Call, which premiered in late September. It is a collection of podcasts that feature our talented doctors and experts who share their journey in achieving wellness and offer insights to all of us. Here are some of the highlights: Vanessa Walker, DO, and Angela Trapp, MSW, discuss mindfulness strategies, physician peer groups, favorite books and more; Louise Glaser, MD, and Rochelle Frank, MD, from California Northstate University College of Medicine discuss wellness in medi

cal education. Eric Williams, MD, a vascular surgeon from The Permanente Medical Group, spoke on the healing power of mentorship and volunteerism. He shared his poem called “Preceptorship” with us.

Caroline Giroux, MD, from UC Davis discusses her passion for writing and her path into medicine. Melissa Marshall, MD, from Communicare Health Centers shared her personal story and discusses her project, “The Healer’s Art,” which addresses physician burnout, wellness, and joy. In case you missed them, you should be able to catch old episodes on www.joyofmedicine.org. There are also podcasts on meditation practices that can be used to relax during the day or at bedtime. I invite you to like our Facebook page on social media so that you can continue to be informed and engage with our various activities.

Finally, I would like to extend my heartfelt thanks to all our staff, led by our Chief Executive Aileen Wetzel, Director of Programs Lindsay Coate, and Associate Director Chris Stincelli who tirelessly work on our behalf. I feel confident in saying that we are the best society in the nation with the finest, mission-driven and caring physicians and staff. Our society is in good hands, and the physician community in Sacramento is strong and engaged.

It has been an honor and a privilege to serve as your president, and I look forward to meeting some of you in person when our paths cross in the future. Canadian physician William Osler, one of the four founding professors of Johns Hopkins Hospital, said “The best preparation for tomorrow is to do today’s work well.” I believe that we are doing that as a society. The work, of course, is not finished. Thank you for your devotion to our community and to each other. rajiv.misquitta@gmail.com November/December 2018

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EXECUTIVE DIRECTOR’S MESSAGE

Medical Staff Prevails in Self-Governance Battle

By Aileen Wetzel, Executive Director TULARE, CALIFORNIA, IS a small town in the Central Valley best known as the milk-producing capital of America. More than half of its 60,000 residents are enrolled in Medi-Cal and served by a small, 108-bed health care district hospital – Tulare Regional Medical Center (TRMC) – with a separate medical staff of about 175 physicians.

Two years ago, this small agricultural community became ground zero in a highprofile battle testing the legal scope of a hospital medical staff’s independence and right to be self-governing. Fundamentally, the question was raised: Who should be in charge of patient care and safety in a hospital – lay administrators or physician leaders?

In 2016, hospital administrators at TRMC executed a coup to take unilateral control over patient care at the hospital by terminating the entire medical staff and its duly elected officers. The hospital then adopted new medical staff bylaws in secret and without input from physicians at the hospital. The hospital installed hand-selected individuals to serve as leaders of the new medical staff, dictated standards of medical care, seized control of the disciplinary process without legal or factual justifications, and prohibited members of the terminated medical staff from voting on medical staff matters or holding leadership positions in the replacement staff.

The California Medical Association (CMA) supported the medical staff in its lawsuit against the hospital. CMA and the medical staff sought to enforce California law requiring all hospitals to recognize and honor the self-governance rights of their medical staffs. Had TRMC’s actions been left unchallenged, it would have created a dangerous precedent that could have

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

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had a negative effect on patient care across the country.

CMA worked with the medical staff’s attorneys and filed two amicus briefs to support the medical staff and take on the hospital, which had loaded up its defense from three different law firms. County and State Medical Societies, including SSVMS, provided significant financial support in the medical staff’s lawsuit.

This July, a favorable settlement of the lawsuit was reached that dissolved the replacement medical staff and fully reinstated the original medical staff, its officers and bylaws.

The hospital also consented to a stipulated judgment agreed upon by the parties and issued by the Tulare superior court that, among other things, expressly recognizes that the 2016 actions of the hospital board violated the medical staff’s rights to self-governance under California law. Perhaps most importantly, the settlement allows for the hospital to begin the process of reopening its doors and once again serving its community.

“I learned a lot what CMA means. It’s not only an organization, it is a partner,” said Abraham Betre, D.O., Chief of Staff of Tulare Regional Medical Center.

It cannot be understated how grave the consequences could have been on patient care and safety if the hospital’s illegal actions were left to stand. Medical staff self-governance would become meaningless if a hospital can pick for itself a replacement medical staff and eschew the large body of laws and regulations that require a truly independent medical staff that is self-governing and democratic. awetzel@ssvms.org

The Importance of Medical Staff Self-Governance Medical staff self-governance is a vital part of a carefully crafted system designed to ensure the delivery of quality patient care.

This system recognizes that the hospital’s medical staff is the only body with the medical expertise to conduct quality assurance activities integral to the health and welfare of the public.

Under state law and Medicare regulations, hospitals are required to have an independent, self-governing medical staff charged with the professional work of the hospital. The medical staff works with the hospitals to ensure quality of care and insulate medical decision makers from undue influences driven by profit motives or other reasons unrelated to patient care.

To preserve this autonomy, medical

staffs have a variety of rights provided for under California law, including the ability to retain legal counsel, elect leadership, conduct peer review and manage a separate bank account dedicated to medical staff funds. Medical staff associations also have the option to sue a hospital, should they feel their right to self-governance has been violated.

CMA provides hospital physicians with a variety of resources to help medical staffs maintain and assert self-governance.

Medical Staffs interested in scheduling a CMA speaker on this topic can contact Megan Sharpe, SSVMS Physician Relations Manager at (916) 452-2671 or msharpe@ ssvms.org.

BLOODSOURCE IS NOW VITALANT! BloodSource has served this community for over 70 years and we will continue to serve you - and those you care for – as Vitalant (pronounced Vye-TAL-ent).

Our new name embodies something vital and alive.

We have deep roots here. A change in our name does not change our commitment to this community or its people. In fact, we believe we will have greater impact and more capacity to welcome even more donors.

As ten blood centers across the nation unify as Vitalant, we connect people, resources, and the possibility to transform lives. All donations have the possibility of informing life-transforming research and can route to where patients most urgently need blood across the United States.

Learn more at Vitalant.org 877.258.4825 (877.25VITAL)

Formerly BloodSource

November/December 2018

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GUEST EDITORIAL

E&M Documentation To Change

By Gerald Rogan, MD Guest Editorials are welcome, as are comments regarding the editorials themselves.

ON JULY 27, 2018, THE Centers for Medicare and Medicaid Services (CMS) published its proposed 2019 Physician Fee Schedule Rule CMS 1693-P for notice and comment. In an attempt to simplify regulations, CMS proposes to eliminate cumbersome documentation requirements for office visit services, CPT codes 99212-99215. Known as “bullet points,” for decades physicians have been compelled to document a sufficient number of points in the patient’s history and physical findings in order to justify the level of office visit service billed to Medicare, receive appropriate payment for it, and survive any audit that alleges overpayment.

In the mid-1990s, some very bright physicians working at CMS invented the current system at a time when medical charting was on paper. The “bullet point” system has worked well to calculate the relative amount of work health care professionals provide across a variety of patient visits, specialties, new illness, follow-up care, and complexity. Nonetheless, physicians have bitterly complained that these “evaluation and management” documentation guidelines have grown overly obsessive. For years, Medicare program integrity reviewers and claims processing agents have spent countless hours counting bullet points against detailed spreadsheet templates to validate that payment is correct.

Now that most physicians chart electronically, bullet points from past visits can be cut and pasted into the record of a current visit to create the appearance of having done more work than was actually performed. As a result, the medical record has become filled with

duplicative and often useless information that interferes with timely retrieval of relevant data necessary to allow the physician to understand the patient’s story from visit to visit. CMS and its contractors name this process “cut and paste.”

Now CMS acknowledges that the EMR has made the current E&M documentation guidelines obsolete. In 2019, CMS proposes to require only enough documentation to support a 99212 service level. The physician will have the discretion to document more information, when useful, to manage the patient’s care over time. In other words, to qualify for proper payment, CMS will allow the physician to “doctor the patient” and not the medical record.

While the specific codes reported will not change, CMS proposes to pay one rate for office visits in the range of 99212-99215. This decision carries many other consequences, some predictable and some unknown. To address potential underpayment for complex patients, CMS will create a special set of add-on HCPCS codes not present in the CPT book. One can read the proposed rule for more information, posted at www.cms.gov. Enter “physician rule 2019” in the search bar.

These changes probably will help all concerned and not increase the risk of fraud or abuse. The change will allow the physician more time to focus on patients. It will be a refreshing change after decades of obsessing over the correct level of service to report. However, not all will agree. For that reason, CMS offered a notice and comment period, which ended September 10. The final rule will be published before the end of 2018. jerryroganmd@sbcglobal.net November/December 2018

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

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LETTER TO THE EDITOR

Letter to the Editor Dear Editor, I absolutely loved Dr. Ann Gerhardt’s article “Dead Diet Dogma” in the September/October 2018 SSVMS newsletter. It’s astonishing that health professionals continue to mindlessly promulgate the calories-in/calories-out (CICO) mythology. It’s as if decades of diet failures, and abundant research, are completely ignored.

In reality, physicians really get very little training in nutrition science, which is monumentally tragic given the obvious role of nutrition in almost all diseases of modernity!

Of course, nutritional science can be messy, as it’s often bogged down by conflicting studies of poor quality, relying often on epidemiological data. Nonetheless, it’s my personal view (and experience) that simple changes can make huge differences. By shunning those foods of modernity, the diseases of modernity can be avoided or ameliorated in large part. It can be

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

tough to coach patients on this, though, when they want a quick fix, or when they feel helpless and hopeless after unsuccessfully following the popular CICO method and (predictably) failing in the long term.

It is my opinion, based on both science and personal observation, that carbohydrate restriction, not calorie restriction, is the most promising strategy for most of these patients.

Intermittent fasting is also a great tool, one which can be successfully integrated into our busy lives.

Again, thanks to Dr. Gerhardt for her thoughtful essay. The CICO myth needs to die, or at least be heavily annotated, in the public mind, if we are to have any hope of reversing this exploding public health crisis.

Best wishes, Nate Simon, MD

Quick Response Code

By Bob LaPerriere, MD THIS SOUNDS LIKE a “code” one would hear over a hospital PA System, but it refers to a complicated version of a barcode utilized originally in 1994 for the automobile industry.

It subsequently became popular in many other applications due to its fast readability and greater storage capacity compared to a barcode.

You will now see QR codes used in our Museum of Medical History as an educational adjunct. Currently, there is one on the iron lung and one on the adjacent exhibit case, but the goal is to eventually have one at each exhibit case and major artifact. By scanning the code with a smartphone, you will link to a short video giving an overview of the artifacts

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displayed.

How do you scan a QR code? If you have an iPhone with a recent operating system (IOS 11), simply open your camera and point it at the QR code. Do NOT push the “shutter release” or try to take a photo of it. The phone will interpret the code and there will be a banner at the top of the screen. If you touch the banner, it will connect with a video. Many free QR code reader apps are available for the iPhone and Android.

Here is the QR code for the Iron Lung in the lobby. Give it a try. ssvmsedcom@gmail.com

Podcasts Can Engage, Educate, Encourage

By Karen Poirier-Brode, MD THE SACRAMENTO SIERRA Valley Medical Society (SSVMS) has recently started a podcast, the Joy of Medicine-on Call Podcast. SSVMS hopes that members and the community will enjoy the show, but recognize that while podcasting was established 12 years ago as a new form of media, many still ask, “What is a podcast?”

In general, podcasts are free broadcasts that one can listen to on an electronic device like a computer, tablet or phone, in other words, on-demand audio files. The portmanteau (blended word) arising from iPod and broadcast, is a term coined first by British journalist Ben Hammersley in February 2004. By December 2005, the Oxford American dictionary declared “podcast” as the word of the year, reflecting its growth as an entity.

Podcasting originated when Adam Curry, a media personality, and Dave Winer, a software developer, looked at Really Simple Syndication, referred to as RSS feed, and realized that an enclosure, such as an mp3 file (a format for digital audio), could be embedded into the code. RSS is a way to have information, like podcasts and blogs, delivered to individuals without that person needing to search the web for the files.

Apple Podcasts (iTunes) and other aggregators are platforms to distribute these files. The iPhone has a native app labeled Podcasts, featuring a violet button with a stylized microphone. Android users also have a separate app – Google Podcasts. Unfortunately, unlike the Apple Podcasts app in the iPhone, this Android app does not arrive already installed on the phone. However, it is an easy download from

the Play Store.

One can subscribe to any number of podcasts desired using an app or platform like Apple Podcasts (iTunes), or Google Podcasts.

Spotify, Stitcher, Pocketcast, Overcast, Gimlet and Castbox are some other aggregator app options. You just enter the app and search for the show you want and click to listen and subscribe. The shows need to be listed on the aggregator site for this to work.

If the owner of the podcast has a website or Facebook page, a podcast listener may be able to go to the URL (location on the web) or the page and click a play button on a screen.

The SSVMS podcast may be accessed on the society’s website. at http://joyofmedicine.org/joy-ofmedicine-on-call-podcast/. A podcast is uploaded from the “host” site to the page by direction of the podcast owner.

Personal devices such as Alexa and Google Home provide access to some shows. One can say, for example, “Alexa, play A Creative Approach Podcast.” I list that podcast because it is my personal show and I know it is easily found.

Some podcasts may even have a dedicated show app to allow a listener direct access to a show from a mobile screen. At present, most podcasts are consumed on mobile devices with 80 percent of podcast listeners utilizing Apple Podcasts (iTunes). With Android devices outnumbering iPhones, that will not be the case for long, though the lack of a native app may hinder Android growth for a while.

Choosing Podcasts How does a listener choose a podcast? Of

November/December 2018

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

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course, I suggest you listen to mine, A Creative Approach Podcast. While I’d love you to do that, there are other podcasts. As mentioned, SSVMS has recently started the Joy of Medicine-on Call Podcast which is available at the URL listed above and on YouTube.

Over half a million podcasts are available on Apple Podcasts with about 5,000 more added each week. In truth, only about 125,000 podcasts have had content updated in the past two months. Still, that is a formidable number.

Apple Podcasts does list the top 200 shows, a far more manageable number to review.

Another approach is to search online for a podcast URL with the term “podcast” and a “keyword” about a topic that interests you: knitting, a medical subject like emergency medicine, or fly fishing. This is how I often find podcasts.

One can subscribe to any number of podcasts desired using an app…

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Creating Podcasts A podcast can be styled as banter on a subject, or regular segments like news, weather and sports, or interviews. Some authors have written their books to be released first as podcast episodes, and later printed. Author Scott Sigler used this strategy to push into The New York Times best-seller list.

A reader of this article may consider an original topic for a podcast or a subject with a unique point-of-view or may be dissatisfied with the podcast options available in his or her choice of subject. Another reader may want to start a medical education podcast.

Many podcasts exist with meager budgets, but enthusiastic hosts. Some low-budget productions do own a large listenership; however, a quality product demands time and money.

While most shows will not “go viral,” as the first season of Serial did with over 40 million downloads (now over 350 million), just over 100 downloads a month represent a very respectable audience. With all the podcasts out there, unless a podcaster discovers a particular niche, it may be hard to create a blockbuster. However, even the most successful of podcasts tended to start small.

So, once the idea for a show is established and the format selected, narrators need to be

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chosen. Next are the nuts and bolts. Some of the following items are optional; one can record on a mobile phone versus using a microphone, for example. While a podcaster can create with a mobile phone or tablet, most opt for a computer.

• Microphones can help the quality of sound.

Good quality inexpensive microphones can be found on Amazon priced at around $100 to $200. Taking time to learn the technique in how to best use a microphone is more important than the excellence of the instrument.

• Quality recording software can be free if one owns an Apple product (Garage Band is a native app), and there are many inexpensive programs for PCs and specialized programs for remote recording.

• A podcaster can self-edit with any of numerous programs for the computer, including Apple’s Garage Band or can hire a professional editor.

• Videocasts are possible, but sound quality usually drops off when making a video recording. Bandwidth issues become significant when one moves from audio only.

• Once a show is recorded and edited it needs to live somewhere. Libsyn, Podbean and Blubrry are well-respected hosts with a wide range of plans. Anchor offers a free platform, but a podcast creator gives up ownership of content to host there.

• Cover art is necessary for aggregator sites like Apple Podcast. If posting to Facebook, episode art is also needed. Those can be made in an inexpensive program like Canva, or with Photoshop, and graphic designers are available at a range of price points.

• A website is not essential, nor are social media tools such as Facebook, or Twitter accounts.

Social media does serve to get a podcast advertised, but word-of-mouth works quite well, too. Social media platforms also facilitate listener interaction with the show.

• A website is an excellent location for show notes. Show notes are useful for listeners as they highlight the topics of the discussion and often have web links to direct the reader to more information. YouTube posting of shows

allows a podcaster to utilize the YouTube auto transcription service and provides an easy way to edit that transcription. The challenge of a YouTube broadcast is that video is needed on that format to get subscribers. As I mentioned, video can create a quality issue. As a selffunded independent podcaster, I find the transcription service makes using YouTube in audio-only worth it, even without listenership on that platform.

• Podcast costs can escalate with equipment for mobile podcasting, web designers, virtual assistants (VAs) to help with show notes and social media, business cards, professional transcriptionists and a dedicated show app.

The nuts and bolts of podcasting and personal experiences, like mine, are not the entire story. There are challenges and developments in this new form of media. In general, podcasters refer to podcasts distributed by the established media “Procasts.” Some podcasts are independent of commercial media platforms and public broadcasting (these are called “Indies” short for independent). A person like myself, known as an “Indie” podcaster, is a hobbyist. Indie podcasts also include those like the SSVMS Joy of Medicine-on Call Podcast, produced by a business.

Public radio commercial ad remuneration is based on streaming content listenership.

Podcasts sometimes make money with sponsorship calculated per 10,000 downloads or are self-sponsored, though most would prefer a positive cash flow.

Indie podcasters do not want to be forced into a world of streaming content and like the idea of people always being able to listen to shows whenever and however much the listener wants. Edison Research has found that instant download and immediate availability is significant for podcast listeners, too. A lot of commercial content is downloadable, but usually after first being aired over streaming content.

There are concerns in the Indie community that Procasters may be trying to push for a change in the podcasting model toward streaming of content.

This is only a simplistic look at one of the

complicated issues of streaming versus downloading. Bandwidth, piracy, and ownership are all nuances and complexities of the data consumption landscape.

Within the brief history of podcasting, an exciting development has been the growth of the podcast industry in both diversity and the participation of women. The first time I attended a podcast convention, those attending were mostly white and male. Addressing the needs of the underserved at that time appeared to me to mean a podcast for sports with avid fans but little attention in the mainstream media. Many of the men I spoke to at that Podcast Movement had a show on boxing, wrestling or martial arts.

Women and people of color of all genders attended this year’s Podcast Movement in numbers significantly higher than in the past.

Elsie Escobar, one of my mentors in the world of podcasting, is a significant player in the podcast world and has been a driving force for diversity representation in podcasting in hosts and in subjects covered.

Broadening the scope of podcasts has been very successful and suggests listeners are hungry for good content on a wide array of topics.

Around the world, podcasts serve as a way for people to connect, learn, laugh, cry and grow. Podcasts provide an excellent place to communicate a wide range of ideas and share the human experience. poirierbrodekaren@gmail.com

November/December 2018

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“Paint and Sip” Evening of Fun

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The SSVMS Joy of Medicine Program sponsored a physician “Paint & Sip” event in August at The Painted Cork in Historic Folsom.

Members and guests enjoyed an evening of fun socializing with colleagues and demonstrating their artistic flair. Watch the SSVMS website at www.ssvms.org for future events.

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November/December 2018

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Terrorists in White Coats Or are doctors in Nicaragua just doing their job?

By Michael J. Lawson, MD (Excerpts taken from the BBC and the La Prensa newspaper)

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

SINCE 2008, I HAVE had a very close relationship with Nicaragua involving medical training, initially through the cooperation of the University of California, Davis (UCD) with the National Autonomous University of Nicaragua (UNAN-León), and subsequently with the Government of Aragon and the Nicaraguan Ministry of Health (MINSA). The collaboration involved the UCD MEDICOS program under the auspices of Vice Dean Michael Wilkes, which includes exchanges between American first-year medical students and UNAN-Leon students.

With the help of Dr. Javier Pastora, we have been able to introduce more than 60 American medical students to Nicaraguan inpatient health care, plus we were able to bring over 10 Nicaraguan students to the United States to learn advanced medical techniques.

I was made an Honorary Professor of the UNAN-León in 2016 and presented at national gastroenterology meetings in Nicaragua.

Subsequently, diagnostic and advanced training projects in digestive endoscopy were developed with the medical and nursing staff of Chinandega, León and Managua. Over the last eight years, I have been witness to significant achievements in expertise in the Department of General Surgery and Endoscopy of Heodora, the only public hospital in Nicaragua providing invasive endoscopic bile duct exploration with comparable efficacy to other international centers. This work has been possible because of the efforts of Dr. Pastora, with the help of his colleagues.

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I initially helped with providing donated equipment from the United States, along with training from the help of Dr. Miguel Simon of Zaragoza, Spain. In all, 2,000 endoscopic therapeutic bile duct interventions have now been performed at no cost to the impoverished patients from all parts of Nicaragua, and minimal outlay by the hospital.

Hundreds of people have been killed in Nicaragua since April 18 in what has become a popular uprising against the Central American country’s president, Daniel Ortega, and his government. The crisis started somewhat unexpectedly when pro-government groups, popularly known as “grupos de choque” (shock forces), violently crushed a small demonstration against reforms to Nicaragua’s pension system which were announced on that date.

The repression, widely shared on social media, caused outrage and triggered more protests, which in turn met with further

repression. At least 400 people have been killed and thousands injured as protests have grown and attempts to suppress them intensified.

The Nicaraguan Health Ministry authorities have fired at least 135 doctors, nurses and other health workers from several public hospitals across Nicaragua. The dismissals follow government efforts to limit access to medical treatment for thousands of wounded anti-government protesters. In April when the protests started, and there were dozens of wounded, the hospital director of the Oscar Danilo Rosales Arguello School Hospital (Heodora) in León, Judith Lejarza Vargas, ordered security guards to close the doors and not allow in the wounded. Doctors at the hospital refused to obey the administrative order and treated the wounded in the streets.

Doctors at the hospital refused to obey the administrative order and treated the wounded in the streets.

Dr. Pastora is one of the most well-renowned doctors in the University City of León. He stood up alongside other Heodora Hospital doctors who refused to obey the administration’s order not to assist persons who arrived injured from protests. Dr. Pastora was fired by the Oscar Danilo Rosales Arguello School Hospital in León on July 27. He had worked for the Health Ministry for 32 years and was the hospital’s head of surgery and a teacher at the National University of Nicaragua in León. When Dr.

Pastora asked for an explanation, Lejarza Vargas said his participation in protests made him an “unstable element” for the hospital.

On the previous page, Dr. Javier Pastora and Dr. Miguel Simon address medical staff in Nicaragua.

At left, most of the staff shown in this image with Dr. Lawson (in maroon), have been fired. At right, protestors take to the streets against the Central American country’s president, Daniel Ortega, and his government.

Government officials have repeatedly accused protesters of being terrorists.

On July 30, Lejarza Vargas posted on Facebook that “There will be more doctors fired for being terrorists.” In an earlier post that day she said, “The medical students are participants in a coup and terrorists.” Government officials have repeatedly accused protesters of being terrorists. At least 10 doctors, 12 nurses and 13 medical staff employees at the Oscar Danilo Rosales Arguello School Hospital in León were arbitrarily fired by Lejarza Vargas, who admitted that the dismissals were for “political” reasons.

Dr. Pastora, the former head of the hospital’s Department of Surgical Gastroenterology, told Confidential (confidencial.com.ni), an independent journalist website, that Lejarza Vargas told him she had no complaints with his over 30 years of work at this center; however, the layoff was because he supported protesters in their fight for freedom against the government of President Daniel Ortega and his wife and Vice President, Rosario Murillo. Dr. Pastora’s dismissal constitutes a violation of Law No. 476 of the Civil Service and Administrative Careers.

Anger at the government has kept increasing with rising fatalities. The country is littered with

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roadblocks and barricades which the security forces have been trying to clear. Protesters allege that the security forces employ excessive force, using live bullets and sharpshooters against demonstrators. It is an allegation which has been echoed by many human rights groups.

University students and Nicaraguans from all walks of life and of all political affiliations are united in their demand for justice for those killed during the demonstrations. They are also demanding deep democratic reforms, with many believing neither can be achieved if President Ortega, who is on his third consecutive term in office, remains in power. With talks stalled, President Ortega ruling out early elections, and protesters voicing that there is no going back, the crisis seems likely to escalate further.

Dr. Pastora has been essential in coordinating endoscopic interventions and, together with the Ministry of Health, was in charge of donated material, making it possible to provide procedures for free throughout the

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year. Without him the invaluable procedure of endoscopic retrograde cholangiopancreatography (ERCP) will be lost to the public patients of Nicaragua. Avoidable deaths will occur, and there will be no training of younger physicians in this essential procedure.

At the time of writing this article, more doctors in other parts of Nicaragua were given dismissal notices because of their political views. To quote José Miguel Vivanco, America’s director of Human Rights Watch, “The Nicaraguan government should immediately allow health workers to return to their jobs or else compensate them for these arbitrary dismissals. Doctors should not be punished for meeting their duty to provide indiscriminate medical care to everyone who needs it.”

My best source for following this situation has been La Prensa on Twitter and the BBC. aus.mlawson@att.net

BOOK REVIEW

Surgical Care in War Zones War Hospital, A True Story of Surgery and Survival by Sheri Fink, MD. Publisher: PublicAffairs, ISBN-13: 978-1586482671.

And, Searching for Augusta by Martin King. Publisher: Lyons Press, ISBN-13: 978-1493029075

Reviewed By Gerald Rogan, MD IN TIMES OF WAR, strife, and peril, ordinary people sometimes do extraordinary things allowing goodness to triumph over evil. This is a review of two books that explain in graphic detail the horrors of war and the contribution of health care professionals in the midst of battles.

“War Hospital, A true Story of Surgery and Survival” by journalist and Stanford University Graduate Sheri Fink, MD tells the 1992 story about medical services heroically provided during the religious and genocidal civil war in part of former Yugoslavia. The story takes place in the town of Srebrenica, Bosnia-Herzegovina, population 50,000. Physicians present included members of Doctors Without Borders, medical students, interns, and the United Nations Peacekeepers.

Srebrenica was being shelled from the surrounding hills and cut off from the outside world. To reach patients, the physicians placed their lives at risk, threading through the battle zones and mine fields to arrive at the city. The hospital had limited medication, dressings, and no running water.

Electricity was not reliable. Triage was required.

Surgery, including neurosurgery, was performed.

The only anesthetic available was Ketamine.

Dr. Fink describes the heroic efforts of the medical team, and the atrocities committed on both sides, including mass killings of the civilians. She discusses her book on C-span at https://www.c-span.org/video/?178739-1/

war-hospital. Surgical care is described in detail.

If you are interested in surgery, ethics, history, or journalism, this book is for you.

“Searching for Augusta, The Forgotten Angel of Bastogne” by award winning historian Martin King, is the story about the heretofore forgotten nurse who provided care to wounded soldiers during the Battle of the Bulge in 1944. The nurse, Augusta Chiwy, a civilian volunteer, was trapped in Bastogne when it was surrounded by the German army. The other nurse who served was Renée Lemaire. Her work is featured in the “Band of Brothers” TV miniseries, the story of Easy Company, 2nd Battalion, 506th Parachute Infantry Regiment, of the 101st Airborne Division during WWII. Nurse Lemaire was killed

by German artillery. Nurse Chiwy, who was a bi-racial Belgian-Congolese woman, lived through the siege, but was forgotten. The book not only details her heroic work, but also explains why her service had been ignored.

Motivated by the TV miniseries, the author Martin King (whom I met in Bastogne in 2018) chronicles his extensive work to find her and convince U.S. Army and Belgian government officials to recognize her service, which they did shortly before her death in 2015. His book has been made into a movie. More information is available online at https://www.youtube.com/ watch?v=dxAbVl6ReTo. jerryroganmd@sbcglobal.net

November/December 2018

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

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A Tour of CNU College of Medicine

By Jack Ostrich, MD ON THE MORNING of August 16, 2018, members and guests of the SSVMS Historical Committee gathered in the main lobby of the California Northstate University College of Medicine (CNUCOM), located in Elk Grove, about 16 miles south of central Sacramento.

We were there to meet with the Dean, Dr. Joseph Silva, and then to partake in a guided tour of the school and its facilities. Dr. Silva is a long-time member of our Medical Society who, after retirement as Dean at the UC Davis School of Medicine, took the position as Dean at the brand new CNUCOM when its first class was admitted in 2015. We sat with Dr. Silva for about half an hour as he gave us a brief history of the school, and then graciously answered questions posed by our group.

After the meeting with Dr. Silva, we went on a walking tour of the campus, guided by Grant Lackey, PharmD, and Mr. Thomas Giannini.

Dr. Lackey is Vice President of University Operations and is responsible for Faculty and Program Development, and Mr. Giannini is

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

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Executive Assistant to Dr. Silva. Mr. Giannini, by the way, was unaware of any relationship – as far as he knew – to A.P. Giannini, the founder of the Bank of America.

The schools of pharmacy and medicine are housed in a huge building, the center of which was originally a AAA call center. They will soon be joined by a College of Psychology. Everything is bright and shiny and squeaky clean, even the gross anatomy lab.

The medical students are introduced to “clinical” medicine soon into their first year, with the help of very sophisticated electronic simulations, the focus of which include “SimMan” manikins that are housed in a

setting designed to look like a hospital ward, a delivery suite, or an ED triage area. Additionally, the students participate in “OSCE” (Objective Structured Clinical Evaluation) where, in out-patient general medical office settings, they must communicate with, examine, analyze, and diagnose “standardized” real human “cases” presented by “patients” who have been trained to recite and enact a set of complaints.

All of those encounters are monitored by a faculty preceptor. The students go to affiliated hospitals for further training starting in their third year. Affiliated hospitals and clinics include all three Sacramento area Kaiser Permanente facilities, as well as Mercy General, Mercy San Juan, Methodist, Woodland Memorial, and, for more psychiatric experience, Sierra Vista and Heritage Oaks.

The first class, set to graduate in 2019, has 60 members. The latest, the class of 2022, has

97. The cost of tuition and fees is presently a bit under $60,000, which is very close to most other private medical schools in the United States. Add other necessities, such as housing, food, transportation, personal computer and health insurance, and the total yearly cost rises to around $93,000. That is also similar to most American medical schools.

Dr. Silva invites any SSVMS member to call the school (916-686-7300) to arrange for a visit and a tour. Especially if you have been out of medical school for 40 or 50 years, as are most of us on the Historical Committee, it is worth the trip to CNUCOM in Elk Grove.

On the previous page is Dean Dr. Joseph Silva.

Above is the class of 2022. At left is a “patient” room, and at right, staff and guests learn about school objectives.

jmost119@aol.com

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The Adverse Childhood Experiences Study 20 Years Later

By Caroline Giroux, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

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I WAS IN THE MIDDLE of my medical school training when the Adverse Childhood Experiences (ACE) study was published.1 The study explains the relationship between adverse childhood experiences, post-traumatic stress disorder (PTSD), and for some, an untimely death as an adult. Until recently, PTSD was limited to an affliction of military vets or survivors of natural disasters. Later, as a young attending psychiatrist in Minnesota, I started reading about PTSD because I recognized the gap in knowledge after many patients reported histories of trauma.

When I moved to the Sacramento area I worked at a county clinic. Treating the underserved was a baptism by fire: I discovered that childhood trauma was the rule rather than the exception among patients living in poverty who also have multiple medical and psychiatric co-morbidities. I discovered that following trauma, such as rape, some women develop eating disorders like bulimic tendencies. Victims of incest often struggle with addictions for decades before disclosing their trauma for the first time.

Trauma fosters adverse behavior which proves to be a dysfunctional coping mechanism by adversely affecting a person’s overall health status. I started researching the topic, and as I was developing a course on trauma for our residents, a colleague told me about the research study conducted by Kaiser Permanente and the Centers for Disease Control and Prevention.

Dr. Vincent Felitti, head of the Department of Preventive Medicine at Kaiser, conducted Sierra Sacramento Valley Medicine

interviews with people who had left a weight loss program to find out that a majority had experienced childhood sexual abuse.

In 1995-1997, Dr. Felitti and Dr. Robert Anda surveyed a large sample of mostly middleclass, college-educated, Caucasian people. The participants were asked about different types of childhood trauma (five types of abuse or neglect, and five types of family dysfunction, including witnessing domestic violence, divorce, etc.).

Their findings had the potential to revolutionize our approach in medicine.

People who have attachment trauma are at risk of developing maladaptive personality traits‌ First, adverse childhood experiences are very common: 69 percent reported having experienced at least one event. And one is usually a magnet for others; almost 40 percent of the original sample reported two or more ACEs, and 12.5 percent experienced four or more.

Think about a parent with mental illness. This parent is at risk of being either emotionally unavailable (neglectful) or erratic (abusive), which will interfere with secure attachment.

People who have attachment trauma are at risk of developing maladaptive personality traits and unhealthy coping mechanisms, since secure attachment is the foundation for self-esteem, mood regulation, executive functioning and

harmonious relationships throughout life.

There is a dose-response relationship between the number of ACEs and the severity and/or number of health and social problems across one’s lifespan, like smoking, alcohol or drug abuse, sexual promiscuity, severe obesity, depression, heart disease, cancer and chronic lung disease. For instance, a person with an ACE score of 4 or more had a 4- to 12-fold increased health risk for alcoholism, drug abuse, depression or suicide attempts.2 The lifespan is also reduced by up to 20 years for people who have seven ACEs or more.

The underlying mechanisms seem to be neuro-structural and immuno-endocrinological: in people who have experienced ACEs, the amygdala (the “alarm” system) can be bigger, the hippocampi (critical in memory, emotions), smaller (possibly due to high cortisol levels), and there is dysregulation of the HPA axis.

It is well known that too much cortisol also interferes with cognition: the impact of toxic stress on the prefrontal cortex of children can manifest in difficulty focusing, self-regulating or trusting others. I have assessed many people who reported a diagnosis of ADHD while in fact the symptoms appeared in the context of divorce or foster care environment.

The hyper-sensitized stress response systems, the catecholamine and cortisol levels, maintain chronic inflammation which increases cellular aging. Ultimately, it affects the telomere length and we witness the effects of transgenerational trauma among our patients of African American descent or Native Americans, for instance. This study validated what we encountered in our clinical settings: trauma affects the whole person.

Since a team of professionals who care about these issues expanded, we have been teaching, writing and presenting to various organizations on ACEs and trauma-informed care. Recently, I had the privilege of introducing those topics at a Public Health and Environmental Committee meeting. A significant proportion of the audience was not familiar with the study, which is still quite representative of our medical community, including residency applicants. People seeking care are more likely to have suffered ACEs, just like the doctors and nurses who try to

help them. It is important to know this because it abolishes this us/them divide. We must treat each patient in a trauma-sensitive manner.

Instead of judging others’ poor health habits, we must understand that people who mistreat themselves are more inclined to do so if they have suffered maltreatment from their caregivers when their brain was developing.

Trauma-informed care is the standard of care and is a set of universal precautions regarding survivors of trauma to prevent re-traumatization and promote healing. Institutions are also integrating resilience-building practices. We assess each person with respect, educating about the impact of trauma, explaining each step of agreed-upon treatments, titrating medications slowly, and we empower them, actively listening to their trauma stories. Storytelling is a powerful healing tool and doctors simply need more time to get to know their patients as people. They will learn more about how to help and treat them by listening with compassion rather than obeying the straightjacket of checklists. Access to psychotherapy resources for survivors of trauma is a widely accepted philosophy. Mindfulness practices help rebalancing the autonomous nervous system and re-sculpting/recalibrating the brain.

Various disorders stemming from childhood trauma are treatable…

We should never pronounce a death sentence to people who have PTSD by labeling them “permanently disabled.” Various disorders stemming from childhood trauma are treatable as some of the brain abnormalities are reversible. Moreover, ACEs are preventable. As a psychiatrist, I treat parents who want to break the cycle of abuse. Maternal stress, depression and exposure to partner violence have all been shown to have epigenetic effects on infants.3 We need the entire medical community to join forces and screen for ACEs, intervene to change the trajectory of these children by buffering the effects of trauma and boosting their resilience, offer support to parents, fight social inequalicontinued on page 23 November/December 2018

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More Reflections on Women in Medicine Background: Recently female physicians were invited to share their thoughts and experiences that determined their medical career choice, and what changes in medical schools and practice systems might have altered their course. Most replies were printed in our September-October issue. An additional reply is below: IS OUR MEASURE OF EQUALITY MASCULINE? I think of linear numeric measures as being a bit more masculine, so using a monetary measure as the only measure of equality makes me think we may be missing a point, missing feminine values. Don’t misunderstand – if anyone is paid less because of gender, ethnicity, religion, or other non-value based reason, it is wrong.

However, if my goal is not monetary, then the choices I make may not result in higher pay.

If I choose to work four days a week, I will earn less. I may be happier, I may have children that do better in school, I may have stronger family relationships, or I may get to cook more meals and the average BMI in my household may be less. I may get to travel more, get another degree. I may read more books, I may take care of aging parents, I may live longer.

Life from my perspective is not so narrowly defined that measuring success can be done by looking at my salary. I think it is important in this high stress, time-demanding field to start by defining one’s own values and making sure that one’s goals are in line with those values. It is important to have the discussion, and it helps to have mentors that encourage striving to achieve true satisfaction.

But that isn’t really what you asked exactly is it?

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There were several stages of choices. I chose the medical school based on the amount of debt I’d be left with. This meant going to a UC school, and, of course, it was a great education and a good choice – it left me with many options going forward, including primary care. I had the choice of staying at that medical school and going into orthopedics or going into family medicine.

I chose the latter because my husband really disliked Southern California, so I chose to stay married. The choice after residency was to live within driving distance of his family. This ended up a good choice for me. I like this area.

I went to 4.5 days a week because I could not keep up with the pace of work after my second child. Maybe there was some unrecognized post partum depression there, but it was still a good choice – and not financially “sound.”

Then there were a series of family choices – a third child? Living on five acres or in town?

Should I take a leadership position? I ended up pursuing leadership because of financial reasons. The grind of office-based medicine was difficult to keep up. Leadership gave me growth opportunities and financial stability.

I am very glad that gender issues are explored more fully by the younger generation. We need to encourage couples to discuss individual values and aspirations, and home and work duties need to be split consciously by each couple. While I think my professional life has been successful, the lack of discussion did not lead to the best home relationship. I am happy now, but the changes in my personal life could be attributed in a small measure to the strains of choosing success and financial stability in my career.

–Carol Kimball, MD

Our Women Physicians Past and Present In the mid-fifties, with the encouragement of the Medical Society, Dr. Suzanne Snively tried to gather all of the women physicians in the area to form a group. There were 25 at the time. On one occasion in 1960, they managed to organize a luncheon and pose for a picture. This is their picture which appeared with an article, “Our Lady Medics,” in the December 1960 The Bulletin from the Sacramento-El Dorado Medical Society. In 1960, women physicians accounted for 5 percent of the membership of this society.

In 1987, they accounted for 7 percent. In 2017, our membership was 37.5 percent female.

Bottom Row (L to R): Drs. Eleanor Rodgerson, Nadine Janushkowsky, Delores Hadre, Helen Rotous, Libby Marks, Shirley Gunn, Kathleen Mannion, Sigrid Lenert. Back Row (L to R): Drs. Marion Kirkpatrick, Margaret Masters, Maude Tillotson, Marie Babich, June Wright, Betty Soo, Suzanne Snively, Julia Fong, Edna Mae Fong, Kit Huang. Not in the Photograph: Drs. Rosemary Brunetti, Martha Garstka, Dorothy Schallig, Jean Babcock, Jean Williams and Nanci Liddil.

The Adverse Childhood Experiment Study continued from page 21 ties, and educate society to prevent childhood trauma.

With the frightening “narcissization” of our culture, we need to prioritize attunement in our relationships with each other and nature. Seeking a deep understanding of all things for the prevention of ACEs will become the territory of hope where attachment theory, brain science, health literacy and human rights converge to allow people to express their full life potential.

REFERENCES 1,2 Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, Koss MP, Marks JS. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study. Am J Prev Med. 1998 May;14(4):245-58.

3 Kolassa, Iris - Tatjana. “Biological memory of childhood maltreatment – current knowledge and recommendations for future research” (PDF). Ulmer Volltextserver - Institutional Repository der Universität Ulm. 2012.

cgiroux@ucdavis.edu

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Then and Now – Back to School

By Glennah Trochet, MD

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

LIKE MANY PEOPLE my age, this year I attended my 50th high school reunion. Our graduation took place on December 12, 1968, almost a month later than usual. Our last year in school had been interrupted by a visit from Pope Paul VI to Colombia in August of that year. All schools in Bogotá closed down for three weeks to allow young people to hear and see the Pope.

My parents and I left the country three days after my graduation. I have never again lived in Colombia, although I now visit frequently.

The plans for this reunion started last year with an effort to find many of us who had not attended previous reunions. Several classmates had left the country and made our lives elsewhere; others were “lost” to those who were planning the occasion. With some effort, approximately 40 of the 70 graduates were located, and about 30 of us were able to attend the actual reunion, which took place on September 8th, while the rest sent regards, videos or texted us during the event.

For me, this was an emotional time. I attended a Presbyterian school in Bogotá, Colombia, from kindergarten through high school. Several of us went through all 12 grades together. Since my parents were foreigners in Colombia, my classmates were my substitute relatives. I had been close to women whom I had not seen or contacted in 50 years. Two of my good friends did not attend. One, a retired school teacher, lives in Barcelona, Spain, and couldn’t travel. The other is the president of a University in San Salvador in El Salvador, had just been to Bogotá, and couldn’t travel back again. She sent us a video to recount her life in that war-torn country, where she is determined

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to give its young people an education and a brighter future.

I arrived a few days early and was fortunate to host a lunch for the women who had been in my class and were available that day. In preparation for the trip, I dyed my hair. This was necessary to avoid an emergency beauty parlor appointment when I arrived. None of my friends would have allowed gray hair to appear in any photo of the group!

We had a wonderful time catching up with each others’ lives and hearing from one of our number who was probably the smartest, but also the most economically deprived girl in our class. None of us had heard from her since our graduation until that day. She had traveled from Pasto, a city in the southwest of Colombia, just to join us for this celebration.

Her story was riveting and inspiring. She told us about the difficult life she had as a child (which many of us had suspected), her struggles after a failed marriage with two children to raise, and her ultimate success in having a college degree, teaching elementary school and raising her children to be successful professionals with children of their own. Other friends also told their own stories, some happy, others not so much.

The day of our reunion began at 8:30 in the morning at our old school: Colegio Americano de Bogotá. The current vice principal and the chaplain welcomed us in the chapel where we sang some of the hymns we had sung in the assemblies of our youth, listened to a homily and to one of our classmates remind us of our own experiences there. We then had a tour of the school, which is now twice the size it

was when we attended. Two of the three star basketball players in our class, who had been on the women’s team that won the district championship our senior year, were present and shared their memories as we looked at the gymnasium. At noon we had planned to ride a school bus to a restaurant to continue the celebration on our own. Unfortunately, the vice principal had forgotten to tell the bus driver of this plan, so we all went to the street and flagged taxis to take us to the site of the ongoing revelry.

At the restaurant we had an opportunity to chat about our lives since leaving high school. I was astounded by some of the life stories I heard that day. One of my classmates married while in law school. Her husband became a senator in Colombia, and was assassinated during the terrible violence that took place in the 1980s.

In the same decade, another classmate who also ventured into politics, was made aware of a plot to kill him. He was forced to flee with his wife and two daughters to France, where he received political asylum for 20 years. He is now back in Colombia, still fighting the good fight on behalf of the poor and dispossessed.

The organizers hired a thirty-something duo that played and sang many of the songs of the 60s and 70s. You haven’t lived until you have heard “She’s got a ticket to ride” sung with a Spanish accent in a Colombian restaurant. We danced, we ate, and we talked. The group broke up at 6 p.m. with some continuing the party at a retro club called Cantares, while the rest of us went home or to other activities. The next day a group got together again for lunch and to continue the conversations started the day before.

Of the group that made it to this reunion, there were teachers at all levels of education, from grade school through university; community organizers and leaders; an accountant; four medical doctors (all of us women), a nurse, lawyers, engineers, and businesspersons. We shared affection for our younger selves through stories that illustrated how innocent and idealistic we had been. My parents had been teachers at our school. Several of my classmates

Above is the kindergarten class of 1957, and below are many of the same students today.

were kind enough to tell me stories about my parents that I had not heard before. It was a very emotional experience, but in a good way.

I am now back in Sacramento, still in touch with the rekindled friendships from the past, and understanding a little better how I became the person that I am today. trochetg@gmail.com

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Yellow Fever

By Matthew Huh Editor’s/SSVMS Museum Curator’s note: This is the sixth article in a series by Mira Loma High School student Matthew Huh, featuring diseases that were common and often fatal at the time of the inception of our Medical Society in 1868.

YELLOW FEVER IS generally considered a disease of the tropics (South America and Sub-Saharan Africa), but it claimed numerous lives worldwide throughout history. Although diseases like malaria, cholera, and smallpox proved more deadly, yellow fever caused equal dread and played a great role in shaping America’s history.

Napoleon was forced to sell Louisiana after yellow fever destroyed 85 percent of his expeditionary force in Saint Domingue (present day Haiti) in 1802. The epidemic froze his plans to invade North America through New Orleans, and he eventually sold off his territories in April 1803, marking the Louisiana Purchase.

Yellow fever has had over 150 names, including the American Plague, Saffron Scourge, Black Vomit, and Yellow Jack. It was a common cause of quarantined ships which would fly the yellow flag (jack). Yellow fever is still making recent headlines with multiple outbreaks in Brazil, Angola, Uganda, the Democratic Republic of the Congo and, most recently, French Guiana in August 2018.

Yellow fever is caused by a RNA virus in the Flaviviridae family; it is related to the West Nile Virus. Seven genotypes have been identified, two in South America and five in Africa. Scientists believe that yellow fever has existed for more than 3,000 years. It is transmitted by infected Aedes aegypti mosquitoes, the same vector that spreads Zika, Dengue, Chikungunya, and Mayaro. After feeding on an infected human or primate, a female mosquito remains infective

for life. The female mosquito also can transmit the virus to her eggs and thus her offspring are infected.

Most patients infected with yellow fever have no or very mild symptoms. Others can experience flu-like symptoms including sudden onset of fever, headache, chills, nausea and vomiting, and fatigue. Interestingly, the heart rate may be slow even though temperatures are elevated. (This is called Faget’s sign, named after Jean Charles Faget who studied yellow fever in Louisiana in the 1850s.) About 15 percent may progress to more serious outcomes such as hemorrhagic fever, organ failure, and even death.

Infection causes liver injury and disrupts normal clotting of blood. Therefore, many patients bleed from the nose and gums and frequently vomit blood (black vomit). It is named yellow fever because it can cause liver failure and jaundice with yellowing of the eyes and skin. There is no specific treatment, but one exposure to yellow fever and/or one dose of vaccine gives a lifetime of immunity.

Scientists believe the virus originated in West Africa. As the population evolved from small villages to cities, the mosquitoes adapted as well. The Aedes aegypti mosquito thrives in urban areas and prefers to feed in the day. As trade and shipping expanded, they hitched rides in water barrels in ships to port cities around the world. The slave trade also helped introduce yellow fever to the Americas.

The first recorded epidemic of yellow fever occurred in the Yucatan Peninsula in 1648.

There were outbreaks in New York, Boston, and Charleston from 1668-1699, as well. Making its way to Europe, Spain reported 2,200 deaths in 1730. Outbreaks were less frequent in Europe, perhaps because the slave trade was not as active

November/December 2018

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

27

as in America.

In 1793, an epidemic in Philadelphia caused the deaths of 10 percent of the population.

Philadelphia was America’s capital at the time, and George Washington, Alexander Hamilton, Thomas Jefferson, and John Adams all witnessed the disease shut down the government. Dr. Benjamin Rush, a founding father and signer of the Declaration of Independence, led efforts to treat yellow fever patients. He was a well-known physician, but he had controversial yellow fever treatments. He believed the fever was “seated” in the liver and his treatments consisted of bloodletting, which he called “heroic depletion therapy.” He also used calomel (mercury compound).

Thomas Jefferson estimated Philadelphia’s yellow fever fatality rate at 33 percent, but the fatality rate of Dr. Rush’s patients was 46 percent. Dr. Rush believed that yellow fever was caused by putrid matter and his insistence on sanitation and improving standing water did help end the epidemic. By 1878, the disease was present in more than 100 cities in America, mainly Louisiana, Mississippi, and Tennessee.

By the close of the 19th century, yellow fever deaths approached 100,000 in America.

Yellow Jack.

Engraving from Frank Leslie’s Illustrated Newspaper, 21 September 1883.

New York Academy of Medicine.

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Until 1900, the epidemiology of yellow fever was unknown and there were many theories that it was caused by sanitation issues, smoking cigars, wind direction, and even by coffee spoiling on deck. In August of 1881, a Cuban physician, Carlos Finlay, was the first to correctly identify the mosquito as a vector. He published a paper called “The Mosquito Hypothetically Considered as the Agent in Transmission of Yellow Fever.” His research even pointed out the Culex fasciatus mosquito, the former name for Aedes aegypti. Unfortunately, no one accepted this for two decades.

It was not until the Spanish American War in 1898 that official research began. In this brief war in Cuba, fewer than 1,000 soldiers died from battle, but more than 5,000 died from disease, mostly from yellow fever. In response to this, the U.S. military formed The Yellow Fever Commission, led by Major Walter Reed who was sent to work in Cuba.

In 1900, Walter Reed met Dr. Carlos Finlay who pointed the commission in the direction of the mosquito. Dr. Reed and his research team used human volunteers, some volunteering themselves, to be bitten by infected mosquitoes, confirming what Dr. Finlay had theorized. In 1901, Dr. James Carroll, who was part of the research team, proved that yellow fever was caused by a virus, not bacteria. Dr. William Gorgas, Havana’s Chief sanitary officer, started mosquito control programs in Havana and the city was rid of yellow fever in 90 days.

Early attempts in the 1880s to build a canal across Panama were unsuccessful as yellow fever and malaria killed thousands of workers who were so terrified of yellow fever that they fled the site in droves at the first hint of the disease. In 1904-1905 Dr. Gorgas, applying the same techniques he had in Cuba, spent a year on a “mosquito brigade.” His efforts initially cut the disease cases by half and the last victim was identified in November 1906. The Panama Canal finally opened in 1914, thanks to the discovery of the cause and the prevention of Yellow Fever.

The Rockefeller Foundation dedicated over $14 million in the early 1900s for research

on yellow fever. In the 1940s, Dr. Max Theiler, director of the virus lab, developed two live attenuated strains of the vaccine; he grew the French strain in mouse brain (causing serious reactions in some patients) and another, 17D, in chick embryos. The Foundation produced over 28 million doses of 17D vaccine and distributed it free worldwide. Dr. Theiler won the Nobel Prize in Medicine in 1951. The vaccine conferred lifetime immunity for 99 percent of people immunized.

A single dose of today’s vaccine, YF-Vax, is effective against all genotypes of the virus.

According to the World Health Organization (WHO), it is extremely effective, safe, and affordable. However, WHO recommends a second dose after 10 years in certain conditions they have outlined. The CDC recommends the vaccine for people 9 months or older who are traveling to areas at risk in Africa and South

America. Sanofi Pasteur, the only manufacturer of the YF-Vax in the U.S., announced that it will not be available until sometime next year as the current supply was depleted in 2015. Currently Stamarill is available as an investigative drug, but only in limited locations in the Sacramento Area.

Though yellow fever never became established in Sacramento as an epidemic, it was a significant disease seen in those arriving here who had acquired it in the crossing of Panama. It is of interest that over the past decade the mosquito responsible for transmission of yellow fever has been found in California. matthewdhuh@yahoo.com REFERENCES The list of sources used in this article is available upon request from the author.

Oh, the Places We Go Do you have some favorite travel photos that are healthrelated or just eye-popping and would like to share them with our readers? Let us know! George Meyer, MD, submitted these from his ventures abroad. In a German rest stop men’s room, the urinals have TV screens with commercials. In Manchester, UK a pub invites customers of all ages.

November/December 2018

29

The Yale Young Global Scholars Experience At the Intersection of Science, Passion and Respect

By Matthew Huh Editor’s/SSVMS Museum Curator’s note: Matthew is currently a senior at Mira Loma High School. Several years ago he created a website for History Day that won our Museum’s Special Award. He has subsequently created several artifact manuals for our museum. This year he wrote a review of infectious diseases common in 1868, the year our Medical Society was formed, for each of our journal issues. I had the privilege of writing a letter of recommendation for him when he applied for this program, and our Editorial Committee suggested that he write an article on his experience. – Dr. Bob LaPerriere, Curator, Museum of Medical History.

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to SSVMedicine@ ssvms.org.

THIS PAST SUMMER I spent two weeks at Yale University in the Yale Young Global Scholars Program (YYGS). Its website describes it as a “very selective leadership-development program for high school students from around the world.” Every year it seems to expand, and this year it accepted 1768 students.

True to its name, students represented all 50 states and over 126 countries. Half of the students admitted were international. This year it offered six sessions: Applied Science & Engineering, International Affairs & Security, Frontiers of Science & Technology, Sustainable Development & Social Entrepreneurship, Biological & Biomedical Science, and Politics Law & Economics. Under the same program it even offered a separate session in Beijing called Asia in the 21st Century.

Applying to this program provided me a glimpse into the college application process.

My application journey began in the fall/winter

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Sierra Sacramento Valley Medicine

of my junior year of high school (the program accepts rising juniors and seniors). After several short essays, two recommendation letters, and entering grades and SAT scores, I submitted my application in February. Applicants received their acceptance in March. Of the six sessions, applicants list their first and second choices; I fortunately received my first choice, “Frontiers of Science & Technology.” In May, Yale sent out an interest form in which I preselected eight seminars from approximately 150.

From the moment I stepped onto campus I knew this was well organized. YYGS student leaders anticipated our arrival and the check-in process proved to be smooth. Each day began with an email that delineated our schedules, consisting of a morning lecture, afternoon seminar and evening preparation time for our capstone project. The entire group heard lectures from professors about topics ranging from global warming to how robotics can aid in special education. Small group seminars for 8-10 students encouraged questions and deep discussions.

The lecturer facilitated a lively discussion, drawing out thoughts that continue to circulate in my brain. Seminars on recent technology, like CRISPR and CAS9, augmented what I learned in IB Biology class. These thought-provoking seminars proved to be my favorite part of the day. We discussed, asked questions, reflected on different perspectives and in so doing, learned about each other.

Beyond these sessions, every student was assigned a capstone project, which involved

research in groups of four and presentations by the end of the session. Each group was required to hone in on a specific topic from a given broader one. These ranged from biology subjects like marine biology to technology subjects like 3D printing. With our umbrella topic being biotechnology and bioinformatics, our group decided to research how targeted cancer therapy, such as monoclonal antibodies and nanoparticle treatment, could potentially become a future replacement for chemotherapy and radiation treatment. On the second to the last day of the program, we presented our capstone project research to other students and teachers. This project provided a fruitful platform to polish my presentation and research skills.

The only problem with this program was its short duration. Despite this, I was able to meet some of the most deeply interesting and thoughtful people from around the world.

Those two weeks blurred and I found myself reluctant to leave. We were all swiftly whisked away back to our respective homes around the world, now only connected through Instagram posts and Snapchat stories. But I am content knowing that the YYGS curriculum left an indelible mark on how I will process future didactic experiences.

The program’s value derived equally from the curriculum and intelligent, diverse students.

Everyone was very friendly, and I immediately felt right at home from the start. Yale was my first East Coast experience: In the back of my mind, I was expecting to see a sea of button-up polos and sweaters balanced neatly around shoulders of snobby intellectuals. Instead, I met an extraordinary group of unique people whom I was able to connect with and learn.

Here is what I learned: We are all the same. My friend from Ghana and I worship the same God. My friend from Kenya laughs at the same jokes that I do. Back at home, I Snapchat my Pittsburgh friend something cool I heard on NPR while captive in my mom’s car, and he responds back immediately, “NPR is bae.” (“Bae” is a slang term used to show affection.) We also found common ground in the music we listened to, in the types

of food we enjoyed, and the shared anxiety of the looming college applications.

I need to learn more languages but respect is the universal language. I found that most Asian, African, and European students all spoke English on top of a couple of more languages!

We Americans don’t speak enough languages.

I sincerely regret not continuing Spanish this year, even though I finished four years. I suddenly find myself craving to learn a new language. Now, Mandarin seems interesting as does Arabic. Language is our social connection and through language we share and express our thoughts and emotions. But, ultimately, I came to realize that even language cannot express everything we think. Respect does. Respect is the universal language. In this special place, we respected each other’s cultures and differences.

This program fostered approaching ideas with minds wide open and without judgment.

Pay special attention to the endings. I had been looking forward to this program for so long and couldn’t wait for it to start. While beginnings are important, it was the ending that provided the greatest source of learning. For me, it was only at the end that I looked back to find out what I might have improved on and what I did well so that I could apply that knowledge to my next adventure. This program and my growth from it definitely make me approach my last year in high school differently than before.

Lastly, I saw a glimpse of how difficult it must be for college admissions boards. How do these highly selective schools choose from this collection of distinct and highly qualified people? They all “breathe the same thin air.” I truly appreciate the difficulty of handpicking who justly deserves the “golden ticket” to these competitive colleges. I know I definitely could not choose between my uniquely talented friends. I began to feel a little better with myself after this epiphany. As I embark on this college journey, I know that a rejection from a particular school does not mean I am less worthy. It simply means our generation and my friends are all remarkable human beings. matthewdhuh@yahoo.com

November/December 2018

…I was able to meet some of the most deeply interesting and thoughtful people from around the world.

Detailed instructions and application to the Yale Young Global Scholars Program can be found at https:// globalscholars.yale. edu/.

31

IN MEMORIAM

Gerald W. Upcraft, MD 1952–2018

IT IS WITH GREAT SADNESS that we report the passing of Dr. Gerald (Jerry) Upcraft, one of our retired physicians. He passed away on June 27th, 2018, from complications after a prolonged heart surgery.

Jerry grew up in Southern California where he met his wife, Karen, during high school. He attended California State University Northridge, majoring in biology and chemistry, then worked as a chemist for almost 10 years before deciding to go to medical school.

He was accepted to the University of California, Davis, but developed Hodgkins Lymphoma and had to delay entrance until 1982.

Jerry then completed his residency in Obstetrics and Gynecology at UC Gerald W. Upcraft, MD Davis and, as part of that program, rotated at Kaiser Sacramento. Following completion of his residency, he was offered a position in the Kaiser Sacramento OB/GYN Department. For many years, he was the OB/ GYN Residency Director, interfacing seamlessly the needs of the Kaiser Permanente and the UCD residency programs.

The residents appreciated his teaching skills and famous tongue-in-cheek, quick learning tips such as, “When you deliver the placenta, don’t pull on the cord, because if the cord comes off you won’t have anything to pull on.”

After helping to open the Point West Medical Office Building, and then initially working there, Jerry ultimately moved his practice to the Kaiser Davis facility. He was loved by his patients and respected by his colleagues.

Jerry was very good with computers and arrived at just the right time to help his department transition into the computerized

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prenatal record and, ultimately, to the full electronic medical record, HealthConnect.

Jerry chaired the Kaiser Sacramento/Roseville Transfusion Committee, and also served on the Health Information Management and OB/GYN Nurse Practitioner Protocol Committees.

Dr. Upcraft was a member of the Northern California Obstetrics and Gynecology Society, and he used his computer skills to design and maintain their website. He was also a Fellow of the American College of Obstetrics and Gynecology.

He was a 28-year member of the Sierra Sacramento Valley Medical Society and the California Medical Association. During that time, he served on the Society’s Delegation to the California Medical Association from 20062011.

After practicing OB/GYN for 25 years, health issues forced Jerry to go on medical disability/retirement. This gave him time to engage in many hobbies. He was an excellent woodworker, brewed wonderful beer, and became an official beer competition judge.

He was always willing to lend a hand when a friend needed a favor. He was able to parlay his surgical skills into sewing costumes for his grandson, Alex’s, musical theater roles. Jerry was always up for a new challenge.

Jerry is survived by his wife, Karen J. Upcraft, daughters, Megan N. Richmond and Lindsay D. Watts, and grandchildren, Alex James, Ryan Taylor Richmond, and Owen Gerald Watts.

He is also survived by his father, Kenneth B. Upcraft, and siblings, Kenneth B. Upcraft Jr. and Deborah E. Walker.

–Joe Zimmerman, MD, and Marc Schiff, MD

Welcome New Members APPLICANTS FOR ACTIVE MEMBERSHIP: Tyson Adams, DO, General Medicine, Touro University College of Osteopathic Medicine – 2013, The Permanente Medical Group, 1650 Response Rd, Sacramento, CA 95815 Sharmila Amolik, MD, Internal Medicine, Grant Medical College, India – 1992, Sutter Medical Group, 2575 East Bidwell Street, suite 100, Folsom, CA 95630 Ashley Anderson, DO, Family Medicine, Univ North Tx Hlth Sci Ctr Coll Of Osteo Med – 2012, Woodland Clinic Medical Group, 2330 W Covell Blvd, Davis, CA 95616 Matthew Anger, MD, Ophthalmology, University of Colorado School of Medicine – 2012, The Permanente Medical Group, 7300 Wyndham Drive, Sacramento, CA 95823 Odilia Anthony, MD, General Medicine, University of The Philippines College of Medicine – 2003, The Permanente Medical Group, 1650 Response Rd., Sacramento, CA 95815

Jonathan Funk, MD, Psychiatry, University of Miami School of Medicine – 2014, Woodland Clinic Medical Group, 1207 Fairchild Ct., Woodland, CA 95695

Robert Lurvey, MD, Urology, University of Illinois College of Medicine – 2011, UC Davis Medical Center, 4860 Y St Ste 2200, Sacramento, CA 95817

Janice Gee, MD, Pediatrics, Michigan State University College of Human Medicine – 2014, The Permanente Medical Group, 6600 Bruceville Rd., Sacramento, CA 95823

Santya Mantripragada, MD, Pediatrics, Rangaraya Medical College – 2004, Pediatric Medical Associates, 650 Howe Ave Ste 100, Sacramento, CA 95825

Todd Gledhill, MD, Emergency Medicine, Virginia Commonwealth University – 2015, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823

Richard Mchugh, MD, Otolaryngology, University of Southern California School of Med – 2006, The Permanente Medical Group, 7300 Wyndam Drive, Sacramento, CA 95823

Amy Glick, MD, Psychiatry, Jefferson Medical College of Thomas Jefferson University – 2012, Woodland Clinic Medical Group, 1207 Fairchild Ct., CA 95695

Dan-Vinh Nguyen, MD, General Medicine, Eastern Virginia Medical School – 2010, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823

Lisa Guirguis, MD, Surgical Oncology, University of Vermont – 1992, Sutter Medical Group, 2800 L Street Ste 300, Sacramento, CA 95816

Filbert Nguyen, MD, Ophthalmology, University of Oklahoma College of Medicine – 2011, Woodland Clinic Medical Group, 1321 Cottonwood St, Woodland, CA 95695

Kimberly Hart, DO, Pediatrics, A.I. Still University, Kirksville College of Osteopathic Medicine – 2015, Mercy Medical Group, 6555 Coyle Avenue, Carmichael, CA 95608

Michelle Apple, MD, Ob/Gyn, University of Illinois College of Medicine – 2014, The Permanente Medical Group, 1650 Response Rd, Sacramento, CA 95815

Melinda Henry, MD, Emergency Medicine, Mayo Medical School – 2009, The Permanente Medical Group, 2025 Morse Ave, Sacramento, CA 95825

Leopoldo Basilico, MD, General Medicine, Ross University School of Medicine – 2010, The Permanente Medical Group, 2155 Iron Point Rd, Folsom, CA 95630

Clayton Hodges, MD, Orthopedic Surgery, Ohio State University College of Medicine- 2012, Woodland Clinic Medical Group, 632 W Gibson Rd, Woodland, CA 95695

Shaunye Belcher, MD, Family Medicine, Ross University School of Medicine – 2015, Mercy Medical Group, 8220 Wymark Dr. #200, Elk Grove, CA 95757

Erik Hofmann, MD, Emergency Medicine, Drexel University College of Medicine – 2014, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823

Amilcar Cardona, MD, Occupational Medicine, Universidad De Buenos Aires - Facultad De Ciencias Medicas – 2005, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823 Albert Chang, MD, General Medicine, Brown University Program in Medicine – 2000, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823 Howard Ching, MD, Anesthesiology, Tufts University School of Medicine – 2010, The Permanente Medical Group, 2025 Morse Ave, Sacramento, CA 95825 Joseph De Leon, MD, General Medicine, University of Santo Thomas – 2005, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823 Mikla Derlet, MD, Pediatrics, State Univ of NY Health Science Center at Brooklyn – 1997, UC Davis Medical Center, 2521 Stockton Blvd. # 2200, Sacramento, CA 95817 Satinderpal Dhah, DO, Physical Medicine, Western University of Osteopathic Medicine and Health Sciences – 2010, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823

Hung-Anh Nguyen, MD, General Medicine, St Georges University School of Medicine – 1998, The Permanente Medical Group, 10725 International Drive, Rancho Cordova, CA 95670 Tin Nguyen, MD, Cardiology, St. George’s University School of Medicine – 2012, Mercy Medical Group, 3000 Q St., Sacramento, CA 95816 Jonathan Patane, MD, Emergency Medicine, University of California, Irivine – 2015, The Permanente Medical Group, 6600 Bruceville Road, Sacramento, CA 95823 Margaret Pietrowski, MD, Emergency Medicine, Jagiellonian University Medical College – 2014, The Permanente Medical Group, 2025 Morse Ave, Sacramento, CA 95823

Craig Johnson, DO, Pediatrics, Des Moines Univ Coll of Osteo Med Surg – 2015, The Permanente Medical Group, 2155 Iron Point Rd, Folsom, CA 95630

Tricia Roberts, MD, Psychiatry, UC Davis School of Medicine – 2013, The Permanente Medical Group, 10725 International Drive, Sacramento, CA 95670

Pooja Kanth, MD, Pulmonary Critical Care, St. George’s University School of Medicine – 2011, Mercy Medical Group, 3000 Q St, Sacramento, CA 95816

Iliana Rodriguez, MD, General Medicine, St. George’s University School of Medicine – 2015, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823

Jennifer Kirkpatrick, MD, Emergency Medicine, University of Arizona – 2014, The Permanente Medical Group, 2025 Morse Ave, Sacramento, CA 95825

Jonier Rodriguez, MD, General Medicine, St. George’s University School of Medicine – 2015, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento, CA 95823

Edward Hale Lee, MD, Occupational Health, New York University School of Medicine – 1998, Mercy Medical Group, 3000 Q St., Sacramento, CA 95816

John Schwerkoske, MD, Hematology/Oncology, Creighton University School of Medicine – 2012, Woodland Clinic Medical Group, 515 Fairchild Ct, CA 95695

Aristeo Lopez, MD, Hospitalist, Stanford University School of Medicine – 2015, Mercy Medical Group, 4001 J Street Sacramento 95819 Joshua Lucas, MD, Neurosurgery, University of Southern California School of Medicine – 2011, Mercy Medical Group, 6555 Coyle Ave. # 250, Carmichael, CA 95608

Samantha Siegel, MD, General Medicine, Thomas Jefferson University – 2012, The Permanente Medical Group, 1955 Cowell Blvd, Davis, CA 95616 Lien Tran, DO, Occupational Medicine, Touro University College of Osteopathic Medicine – 2010, The Permanente Medical Group, 2016 Morse Avenue, Sacramento, CA 95825

November/December 2018

33

Louise Wen, MD, Anesthesiology, New York University Medical College – 2012, The Permanente Medical Group, 2025 Morse Ave, Sacramento, CA 95825

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Amanda Woodward, MD, Hospitalist, University of Nebraska – 2015, Mercy Medical Group, 7500 Hospital Dr, Sacramento, CA 95823 Shi-Hua Wu, MD, Pediatrics, University of Texas Medical School – Houston – 2014, The Permanente Medical Group, 2155 Iron Point Rd, Folsom, CA 95630

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APPLICANTS FOR RESIDENT ACTIVE MEMBERSHIP: Anjani Amladi, MD, UC Davis Medical Center Resident & Fellow Prog – 2019 Erik Carpio, MD, Sutter Family Med Residency Prog – 2021 Amarsha Chakraburtty, MD, UC Davis Medical Center Resident & Fellow Prog– 2020 Flora Chang, MD, UC Davis Medical Center Resident & Fellow Prog – 2020 Jovauna Currey, MD, UC Davis Medical Center Resident & Fellow Prog Sonja Dardenelle, MD, UC Davis Medical Center Resident & Fellow Prog - 2019 Parastoo Davari, MD, UC Davis Medical Center Resident & Fellow Prog - 2020 Priya Duggal, MD, UC Davis Medical Center Resident & Fellow Prog Joanna Eldredge, MD, UC Davis Medical Center Resident & Fellow Prog Abd-elrahman (Abdul) Hassan, MD, UC Davis Medical Center Resident & Fellow Prog – 2023 Joseph Kim, MD, UC Davis Medical Center Resident & Fellow Prog – 2022 William Leon, MD, UC Davis Medical Center Resident & Fellow Prog – 2021 Lauren Marasa, MD, UC Davis Medical Center Resident & Fellow Prog Alejandro Mendoza, MD, UC Davis Medical Center Resident & Fellow Prog Alyssa Milliron, MD, UC Davis Medical Center Resident & Fellow Prog - 2020 Manisha Notay, MD, UC Davis Medical Center Resident & Fellow Prog – 2021 Katherine Ostedgaard, MD, UC Davis Medical Center Resident & Fellow Prog Amanda Phares, MD, UC Davis Medical Center Resident & Fellow Prog – 2022 Tyrell Simkins, DO, UC Davis Medical Center Resident & Fellow Prog – 2019 Marc Van de Rijn, MD, UC Davis Medical Center Resident & Fellow Prog Kearnan Welch, DO, UC Davis Medical Center Resident & Fellow Prog Nasim Wiegley, MD, UC Davis Medical Center Resident & Fellow Prog Janet Yang, MD, UC Davis Medical Center Resident & Fellow Prog Jessica Yesensky, MD, UC Davis Medical Center Resident & Fellow Prog Hosniya Zarabi, MD, UC Davis Medical Center Resident & Fellow Prog Matthew Zeiderman, MD, UC Davis Medical Center Resident & Fellow Prog – 2022

34

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Locum Tenens ~ Permanent Placement

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Board Briefs September 10, 2018 The Board: Received an overview of the Cooperative of American Physicians (CAP) from Daniel Cavanaugh, Vice President of Membership Development.

Approved the recommendations from the Scholarship & Awards Committee to grant 2018 scholarships to the following applicants: E. Cristina Monterroza, a third year student at U. C. Davis School of Medicine; Lisa M. Teixeira, a first year student at Albany Medical College; Kayla K. Sheehan, a third year student at California Northstate University College of Medicine; Hamad K. Hamda, a first year student at Geisinger Commonwealth School of Medicine and the Paul J. Rosenberg, MD Medical Student Scholarship to Ashley N. Kyalwazi a first year student at Harvard Medical School.

Approved the 2018 Nominating Committee Report listing the nominations to vacancies on the Board of Directors and Delegation to the California Medical Association for 2019. The report is sent electronically to all Active members who may submit additional nominations for any vacancy in any office by completing the nomination form.

Approved the 2nd Quarter 2018 Financial Statements, Investment Reports and Recommendations.

Approved endorsing the candidacy of Lee Snook, MD for CMA President-Elect in 2019-2020.

Approved Mela Fratarcangeli of Sotheby’s in the Vetted Vendor Program.

Approved the Membership Reports September 10, 2018 and August 27, 2018: For Active Membership – Tyson Adams, Sharmila Amolik, MD; Ashley Anderson, Matthew Anger, MD; Odilia Anthony, Michelle Apple, MD; Leopoldo Basilico,

for DO; DO; MD; MD;

Shaunye Belcher, MD; Amilcar Cardona, MD; Albert Chang, MD; Howard Ching, MD; Grigorios Chrysofakis, MD; Joseph De Leon, MD; Mikla Derlet, MD; Satinderpal Dhah, DO; Jonathan Funk, MD; Janice Gee, MD; Todd Gledhill, MD; Amy Glick, MD; Lisa Guirguis, MD; Kimberly Hart, DO; Melinda Henry, MD; Clayton Hodges, MD; Erik Hofmann, MD; Craig Johnson, DO; Pooja Kanth, MD; Jennifer Kirkpatrick, MD; Edward Hale Lee, MD; Aristeo Lopez, MD; Joshua Lucas, MD; Robert Lurvey, MD; Santya Mantripragada, MD; Richard Mchugh, MD; Dan-Vinh Nguyen, MD; Filbert Nguyen, MD; Hung-Anh Nguyen, MD; Tin Nguyen, MD; Jonathan Patane, MD; Margaret Petrowski, MD; Tricia Roberts, MD; Iliana Rodriguez, MD; Jonier Rodriguez, MD; John Schwerkoske, MD; Samantha Siegel, MD; Lien Tran,DO; Louise Wen, MD; Amanda Woodward, MD; Shi-Hua Wu, MD; Deborah Yao, MD. For Resident/Fellow Physician Active Membership – Anjani Amladi, MD; Erik Carpio, MD; Amarsha Chakraburtty, MD; Flora Chang, MD; Jovauna Currey, MD; Sonja Dardenelle, MD; Parastoo Davari, MD; Priya Duggal, MD; Joanna Eldredge, MD; Anu Gupta, MD; Abd-elrahman (Abdul) Hassan, MD; Joseph Kim, MD; Manau Kumar, MD; William Leon, MD; Lauren Marasa, MD; Alejandro Mendoza, MD; Manisha Notay, MD; Alyssa Milliron, MD; Katharine Ostedgaard, MD; Amanda Phares, MD; Archana Reddy, MD; Rahel Robertson, MD; Tyrell Simkins, DO; Marc Van de Rijn, MD; Kearnan Welch, DO; William White, MD; Nasim Wiegley, MD; Janet Yang, MD; Jessica Yesensky, MD; Hosniya Zarabi, MD; Matthew Zeiderman, MD. For Reinstatement to Active Membership – Hanns Haesslein, MD. For Retired Membership – Norman Chow, MD; Edwin Gyorffy, MD; John B. Mitchell, MD; Thomas Nesbitt, MD; Kurt Rosen, MD; Amy Wandel, MD. For Transfer of Membership to Placer-Nevada – David S. Smith.

November/December 2018

35

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CMA’s Institute for Medical Quality (IMQ)

Health Information Technology Free secure messaging application

DocBookMD www.docbookmd.com/physicians/

HIPAA Compliance Toolkit Various discounts; see website for details

PrivaPlan Associates, Inc www.privaplan.com

Magazine Subscriptions 50% off all subscriptions

Subscription Services, Inc

Medical ID’s 24-hour emergency identification and family notification services

MedicAlert www.cmanet.org/groupdiscounts

Medical Waste Management Save 30% or more on medical waste management and regulatory compliance services

EnviroMerica www.cmanet.org/groupdiscounts www.enviromerica.com

Office supplies, facility, technology, furniture, custom printing and more… Save up to 80%

StaplesAdvantage www.cmanet.org/groupdiscounts

Physician Laboratory Accreditation 15% off lab accreditation programs and services Members only coupon code required

COLA www.cmanet.org/groupdiscounts

Security Prescription Products 15% off tamper-resistant security subscription pads

RxSecurity www.rxsecurity.com/cma-order

PUBLICATIONS CMA Publications

www.cmanet.org/news-and-events/ publications CMA Alert e-newsletter CMA Practice Resources CMA Resource Library & Store www.cmanet.org/resource-library/list? category=publications

Advance Health Care Directive Kit California Physician's Legal Handbook Closing a Medical Practice Do Not Resuscitate Form HIPAA Compliance Online Toolkit Managed Care Contracting Toolkit Model Medical Staff Bylaws Patient-Physician Arbitration Agreements Physician Orders for Life Sustaining Treatment Kit

SSVMS Publications

www.ssvms.org/publications.aspx Sierra Sacramento Valley Medicine (bi-monthly magazine) Medical Society News (monthly e-Bulletin)

info@ssvms.org | (916) 452-2671

Honors Medicine Join SSVMS for an evening of fine food, wine and entertainment as we honor the 2019 recipients of the Golden Stethoscope, Medical Honor, and Medical Community Service Awards.

Proceeds and auction to benefit SSVMS’ Medical Student Scholarship Fund.

Save the Date

Thursday, February 28, 2019 Tsakopoulos Library Galleria 6:30pm to 8:30pm

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