2022 - Nov/Dec - SSV Medicine

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Sierra Sacramento Valley Serving the counties of El Dorado, Sacramento and Yolo

November/December 2022


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What I Learned as Your 2022 President

Caroline Giroux, MD

Creativity on Display

PRESIDENT’S MESSAGE

Paul Reynolds, MD

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EXECUTIVE DIRECTOR’S MESSAGE

An Exciting New Era For SSV Medicine

Aileen Wetzel, Executive Director

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An Ordinary Life, An Extraordinary Man

At Your Own Risk

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PHOTO GALLERY

Enrico Lallana, MD, David A. Evans, MD, Marvin H. Kamras, MD

So Much Blood

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Karen Poirier-Brode, MD

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POETRY

Eric Williams, MD

American Medical Women’s Assn. Meets With White House Staff

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.

Board Briefs

New SSVMS Members

All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the Sierra Sacramento Valley Medical Society for permission to reprint.

2023 SSVMS Election Results

Caroline Giroux, MD

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Visit Our Medical History Museum 5380 Elvas Ave. Sacramento The SSVMS Museum of Medical History is currently open Tuesday through Friday, reservations are recommended. Visit ssvms.org/ museum.

Gone Too Soon Melody Law, MD

VOLUME 73/NUMBER 6 Cover photo: A warning for all at Lassen Volcanic National Park.

Photo by David Evans, MD

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

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx

November/December 2022

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Sierra Sacramento Valley 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.

2022 Officers & Board of Directors

Paul Reynolds, MD, President J. Bianca Roberts, MD, President-Elect Carol Burch, MD, Immediate Past President District 1 Jonathan Breslau, MD District 2 Adam Dougherty, MD Judith Mikacich, MD Susan Murin, MD Vanessa Walker, DO District 3 Ravinder Khaira, MD

District 4 Shideh Chinichian, MD District 5 Christina Bilyeu, MD John Coburn, MD Farzam Gorouhi, MD Roderick Vitangcol, MD District 6 Marcia Gollober, MD

2022 CMA Delegation District 1 Reinhardt Hilzinger, MD District 2 Lydia Wytrzes, MD District 3 Katherine Gillogley, MD District 4 Anand Mehta, MD District 5 Sean Deane, MD District 6 Marcia Gollober, MD

District 1 Alternate Tanuja Raju, MD District 2 Alternate Sharmilo Amolik, MD District 3 Alternate Toussaint Mears-Clark, MD District 4 Alternate Shideh Chinichian, MD District 5 Alternate Joanna Finn, MD District 6 Alternate Natasha Bir, MD

At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Janine Bera, MD Helen Biren, MD Carol Burch, MD Amber Chatwin, MD Angelina Crans Yoon, MD Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Douglas Gibson, MD Farzam Gorouhi, MD Richard Jones, MD Steven Kmucha, MD

Vong Lee, MD Charles McDonnell, MD Leena Mehta, MD Sandra Mendez, MD Taylor Nichols, MD Tom Ormiston, MD Sen. Richard Pan, MD Hunter Pattison, MD Paul Reynolds, MD Ernesto Rivera, MD J. Bianca Roberts, MD Ashley Rubin, DO Ajay Singh, MD Lee Snook, MD Tom Valdez, MD John Wiesenfarth, MD

At-Large Alternates Alyssa Ashbaugh, MD Christine Braid, DO Karen Hopp, MD Arthur Jey, MD Justin Kohl, MD Syed Latif, MD Hao (Harry) Li, MD

CMA Trustees, District XI

Adam Dougherty, MD

AMA Delegation Barbara Arnold, MD

Editorial Committee

Scarlet Lu, MD Carlos Medina, MD Siddharth Raghavan, MD Alex Schmalz, MD Ellen Shank, MD David Terca, MD Ashley Sens, MD Asmaneh Yamagata, MD Robert Oldham, MD Margaret Parsons, MD Sandra Mendez, MD

Megan Babb, DO Sean Deane, MD Caroline Giroux, MD Robert LaPerriere, MD Karen Poirier-Brode, MD

Gerald Rogan, MD Kayla Umemoto, MS II Michelle Ann Wan, MS III Lee Welter, MD Eric Williams, MD

Executive Director Managing Editor

Aileen Wetzel Ken Smith

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Sierra Sacramento Valley Medicine

HOSTED BY LOCAL PHYSICIANS

Listen and subscribe to Joy of Medicine - On Call on your favorite Podcast App or visit 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. ©2022 Sierra Sacramento Valley Medical Society SIERRA SACRAMENTO VALLEY MEDICINE (ISSN 0886 2826) is published bimonthly 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.


| FEATURED CONTRIBUTORS |

Paul Reynolds, MD

Caroline Giroux, MD

paul.d.reynolds@kp.org

Melody Law, MD

In his final message as SSVMS president, Dr. Reynolds looks back at what he has learned over the past year about your Medical Society, its members, and the future of medicine.

cgiroux@ucdavis.edu

In her column, Dr. Giroux talks about how her late uncle Denis was important in her life. In a separate feature, she explains how health care providers are at a high risk for trauma that can affect their lifepans.

melodylaw@yahoo.com Dr. Law is an addiction medicine specialist who is active on the Sacramento County Opioid Coalition executive committee. “Gone Too Soon” tells how the stories of those who died too young can save lives.

Karen Poirier-Brode, MD

Eric Williams, MD

Enrico C. Lallana, MD

Dr. Poirier-Brode reports on her recent trip to Washington, D.C. in which leaders of the American Medical Women’s Association met with White House staff to discuss key health and climate issues.

So much blood. That was the lasting memory that moved Dr. Williams to write a raw poem of the same name. It sat for two years before he was able to revisit it and share it with us.

Dr. Lallana’s work was featured on our last cover. This issue, he’s among the featured photographers in our gallery on page 22 with pictures from Stockholm, Sweden and Yosemite.

David A. Evans, MD

Marvin H. Kamras, MD

Dr. Evans provided this issue’s cover photo and chose a couple of his favorites to feature in our photo gallery. To see more of his wonderful, and often wonderfully bizarre, work visit his site on Flickr.

During the same Alaska trip on which Dr. Kamras shot our 2021 cover photo of an unlucky salmon and a bear, he was lucky enough to see—and shoot—the Northern Lights. See the photo in our gallery.

poirierbrodekaren@gmail.com

devans@sacent.com

imango@att.net

mhkamras@aol.com

enrico.c.lallana@kp.org

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

November/December 2022

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| PRESIDENT’S MESSAGE |

What I Learned as Your 2022 President T

he past year as your president has been more than fulfilling, it has been enlightening. Here is some of what I learned (or confirmed) as SSVMS president in 2022. Our members are amazing and are committed to our Medical Society. SSVMS is the largest local medical society in the state. You recognize the value SSVMS provides, because our retention rate in 2022 was 97.3% and we successfully recruited 100% of the medical students, residents and fellows at California Northstate University and UC Davis. While some societies have struggled, SSVMS continues to grow and has seen a 64% increase in members since 2018. You also know you can count on SSVMS as a resource. Our staff responded to over 400 member calls last year for assistance on issues such as practice management, billing and collections, legal and medical board issues, and much more. SSVMS and CMA get things done. CMA played a key role in negotiating this year’s landmark MICRA compromise while SSVMS leaders went to the state Legislature to give first-hand accounts of why bills before that body were needed or how they could be detrimental to patients or the medical profession. We also went to the halls of Washington, D.C. to fight for vital changes in Medicare reimbursement, expansion of telehealth and advocating for releasing money from the Provider Relief Fund. These are all issues that affect your practices. SSVMS is working to prevent overdoses and save lives. One of our signature projects this year was increasing awareness of opioid use disorders, reducing the stigma associated with getting help, and providing the tools to save lives in the event of an overdose. With grants secured from the California Department of Public Health and the California Public Health Institute, and in conjunction with Sacramento County, we administered

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Sierra Sacramento Valley Medicine

By Paul Reynolds, MD paul.d.reynolds@kp.org

Sacramento Opioid Coalition programs that included online public service announcements and creating a county-wide naloxone policy for all schools. SSVMS also took our campaign directly to the places where we could reach those who were at a greater risk of accidental overdoses of fentanyl and other opioids, including bars, raves and community wellness events. Our VISTA volunteer, Lauren Warner, has given over 150 presentations and distributed quick start Narcan kits that include fentanyl test strips and CPR face masks. SSVMS is deeply committed to helping you find joy in medicine and in life. We have one of the leading—if not the leading—Joy of Medicine programs in the country. Our members are eligible for up to six free sessions with one of 12 diverse providers for resiliency consultations. That has translated to over 200 sessions so far this year for members seeking help with professional burnout or stresses in their lives. We also held our annual Joy of Medicine Summit, which drew 75 attendees and was very well received. One of the things that makes this program really cool is that it is supported by $108,000 in partnership donations in addition to the $74,000 in grants secured by SSVMS staff. The future of medicine is bright. SSVMS is giving high school students a quality introduction to health care, especially low-income students. A more diversified workforce means better, more equitable care, and through our summer shadowing program and White Coat Week many high schoolers are seeing how they can make a difference in the future of health care. Importantly, that includes many students who never had thought about a career in health care, often because of economic circumstances, but now see that more doors are open to them. The SPIRIT of SSVMS is strong. In just the first half of the year, over 250 patients were treated and 66


surgeries performed under our SPIRIT program. Our members donated 350 hours during those six months and performed care for free that would have cost almost $300,000 otherwise. SPIRIT has been so successful and life-changing for patients that we were able to expand it into Yolo County through a contract with Sutter Davis. Thanks to a recent grant, SSVMS has also implemented a new electronic health record system to ensure that SPIRIT patients’ records are readily available to ensure consistent and quality care. The staff is top-notch. One of the perks of being president is seeing up close how hard the staff works to make everything I’ve talked about happen. I can’t thank them enough for all they’ve done to support me; it would be impossible for any of us who are in practice and administrative roles to serve as president without the dedication and hard work that, I have to say, probably makes us all look more efficient than we actually are (and that’s greatly appreciated!). In all seriousness, I’ve seen how they respond to member concerns, make new programs happen that have a real effect on our community, run the organization efficiently so it will be there for you and the next generation of physicians, and even how they make this magazine come together for

your enjoyment. Since this is my last article as president, I want to leave much the way I came in: by saying thank you to all of you for your support, your confidence in me to lead SSVMS this year, and for all the input and good ideas I have received from you in 2022. This is your Medical Society and that is why I believe it is important for its officers to listen carefully to the needs of our members. We won’t always agree on the best course of action, but I can guarantee that there will be thoughtful discussions that give due consideration to what the members are thinking. Finally, I want to congratulate J. Bianca Roberts, MD on her election as 2023 president. I know she will bring additional focus on important issues such as health equity to our Society and will do a fantastic job. It has been an honor serving as your president and thank you to our members and staff for all you do to serve our community and make our practices healthier. This great vocation demands much of us, but it also allows our talents to be used to help others as it strengthens our character. I am grateful for all that our profession accomplishes and for all that you do`to support your patients, our community and SSVMS.

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November/December 2022

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| EXECUTIVE DIRECTOR’S MESSAGE |

An Exciting New Era For SSV Medicine

More Content, More Convenience as Our Magazine Evolves

T

here’s an exciting change coming to SSV Medicine. Since the first issue in 1950, SSV Medicine has been the journal for members of our medical community. It has carried tales of the proud accomplishments of our physicians, where to find joy in your everyday practice and life despite the challenges of today’s health care world, shared the creativity of members through touching poetry and stunning photography, and helped medical students prepare to become the next generation of physicians. We’re still going to do that. Only, soon we’ll be bringing SSV Medicine to you in a much more vibrant—and convenient—way. Over the past several years, more of our readers have opted to read our magazine online. As a result, we have decided to bring SSV Medicine into the modern world as a digital-only publication in the coming months. I know that will lead to a big sigh from those of you who prefer, and increasingly miss, the feel of newspaper and magazine pages between your fingers. Even though most of my reading sources are now digital, I feel the same way but am happy to tell you that in addition to our regular issues every two months there will be one printed issue a year that includes our annual report and some of the best articles we’ve collected from you. This really is a case of being able to do much more for less. Printing and postage costs have dramatically increased, while we’ve found that only a fraction of our readers prefer a paper version. A while back we even discovered that most of the copies that went to a central mailbox for distribution to physicians within a health system ended up in the trash instead of readers’ hands. Changes at the Postal Service have led to lengthy delays before the magazine arrives in your mailbox, and that has been compounded by delayed printing dates due to our desire to include as much breaking news and relevant viewpoints as we can. While we post each issue 6

Sierra Sacramento Valley Medicine

By Aileen Wetzel awetzel@ssvms.org

online using ISSUU, we’ve learned that the “flip book” PDF format has some limitations and doesn’t work nearly as well on a phone as it does on a laptop or tablet. We’re still working out the particulars, but what I can tell you is this: You’ll have a brighter, more interactive magazine that better showcases your work and that adapts to whatever device you prefer—laptop, phone or tablet. We’ll have the opportunity to include extended photo galleries from events and of the fantastic shots taken by the our amazingly talented members whose work has appeared on our covers. You’ll be able to click through faster to register for events, potentially hear the authors read their articles and poetry in their own voices, watch videos related to our articles and even have more convenient ways to learn about the valuable services our advertisers provide. This is not a replacement for the current SSV Medicine, it’s the next step in its evolution (but I promise you’ll still be welcomed to each issue by our iconic cover). Over the years, we’ve brought in new authors with new viewpoints and moved from black and white to a greater use of color in a more dynamic layout. Going fully digital and making the most of all the possibilities it offers is the next logical—and exciting—step for our unique magazine. We’re in the early stages of planning, so we’d really like to hear your ideas about what you’d like to see in the way of content and format for our digital magazine. Let us know if you have any favorite online publications we should look at or if there are new features, such as a greater use of video or audio, that you’d like us to consider. Feel free to be creative! Frankly, our new digital version will allow us to do more for you at a significantly lower cost, so it’s truly a win-win situation. We’re looking forward to delivering a new, special experience with the launch of our digital magazine, so stay tuned!


Dec 1st

6 PM - 9 PM JOIN US!

Sierra Sacramento Valley Medical Society

Holiday Social

We Invite you to celebrate the most beautiful time of the year with us! You and a guest are invited to join your colleagues on December 1st for an evening of appetizers and drinks as we welcome the new year!

Register at tinyurl.com/2022HolidaySocial SEQUOIA AT THE CANNERY 1601 Alhambra Blvd Ste. 200, Sacramento, CA


| THE MINDFUL LIFE |

An Ordinary Life, An Extraordinary Man Laughter and Love Make a Life Full

T

he morning that would be the one when he passed, I woke up thinking of him. For the first time, what he represented in my life appeared to me clearly. Denis had always been in my life, as far as I could remember. At some point he had three cars, including a Camaro, which really impressed me as a kid (and especially one who knows nothing about cars). He looked like a fox, with his long nose and slanted eyes. He certainly was clever. He was bald in his twenties already, and let some hair in the back grow longer, very ’70s. His thunderous laughter was like no one else’s, a full-speed freight train cutting through the cloud of chain smokers at any party. He would laugh at anything and make anyone laugh about everything. I will always remember his spectacular imitation of a washing machine, or his candid-sounding offer to “hold” his wife’s breasts while she was walking around in their house. I was no longer a kid and didn’t take offense because Denis had always been a gentleman and explicitly refused to tolerate mistreatment of women. He said that if he had been a woman, he would have been a feminist. At a bar, he was the type of hero who once sent a disrespectful man to the hospital after he had made inappropriate comments to the waitress. Virile, yet not macho. Reasonably libidinal, yet respectful and decent. The opposite of a misogynist, attracted by intelligence in women, not threatened by them. He always seemed proud of me and showed interest in my writings as a young adult. He would go through the agonizing task of reading a rag of a draft, even though he had read maybe one book in his entire life after dropping out of high school at age 14 because playing pool was more fun. He knew that I would never be a Chanel No. 5 type of person, but that I preferred fruit fragrances on my skin. Our bond felt comfortable 8

Sierra Sacramento Valley Medicine

By Caroline Giroux, MD cgiroux@ucdavis.edu

enough for him to tell me that he preferred my hair long. I attended his funeral (my first virtual one) from my home. Instead of the formal black, I wore a turquoise cashmere sweater and pearls on my earlobes, gifts from a person who is so dear to me. I know he would have approved and appreciated the elegant simplicity. I was just thankful to “be” in the room with my family in Quebec and for my sister to have planned the FaceTime call. I was moved to see his wife, my maternal aunt Andrée, whom I always considered the big sister I never had. She had lived next door at my grandparents’ house until she married Denis. She was my chosen big sister, and that naturally made him my big brother. It was an epiphany that struck me the morning he died.

Caroline and Denis perform a skit at her grandparents’ 50th wedding anniversary in 1990, with Denis imitating her grandfather.


My aunt asked me how I was, amid her sorrow. She had the courage to truthfully name her grief reaction. Then, she asked, “Do you want to see him?” It took me by surprise. Really, I guess I am not used to attending those rituals anymore… I immediately became emotional but said yes. Seeing someone frozen in time and space in tense skin with makeup and an outfit they rarely wore in their daily life made the event of his death even more surreal. Seeing him so asleep, still, no longer animated… it was him and it was no longer him. I told him the words I needed to tell him. I hope he knows that in one important area of my life, I am in a much better place now. Did he think he had led a full life? He had never been to Europe. He gave up on the idea of having kids (after his wife vetoed the idea, terrified they would be “mini-hims”). I know there were many other discoveries he was planning to have in a longer lifespan. Those were the thoughts I had the morning he died, February 10th, a few days after I had a dream of him, his wife telling me he was not well. He indeed was not and succumbed to what is too common, what eats too many people from the inside: cancer. I knew this would happen soon. The last time I saw him was about a year prior on a video Dr. Giroux’s uncle Denis. His sense of humor and love for life kept call. He was already declining but had found him young, she says. the strength to get up from his bed because his determined wife made him so he could re-emphasize he knew at the time of his passing. He always wanted what she kept repeating to me: that I had to flee from a the best for me. I wish I could have told him in person very toxic situation. what I texted his wife when it was probably already On February 10th, I started my morning (or mourntoo late. I knew he had just been admitted to the ICU, ing) listening to the Bee Gees. We were both fans. Denis and I texted my aunt Andrée that Denis had been a big once got me a CD and then bought a second copy after I brother I always needed and always will. I’ve always commiserated that I had lost the first one in the context had some regret that I was the first-born, feeling it to of a precipitous move from a painful breakup. He was be a primal injustice, yet he had been in my life all this always happy to see me even though I seemed to be time and played that role. He was affirming of the core swimming in romance dramas. “Ahhh bien, salut Ca-r-rdimension that is my femininity, seeing something to it, e-line!” He would say my name like no one else, slightly even through my Garfield T-shirt and sweatpants look rolling or dragging the r, pronouncing the o more like an as a barnacled, short-haired, acne-invaded teenager. He e (or “uh” in English). was dignifying. I wish I could have told him that I am OK now. I hope He is another uncle who died while I was away from

November/December 2022

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my beloved country, away from family. I feel caught in the spiral of my life, this is all happening again, 10 years later. The previous uncle, also a Denis, also the husband of a maternal aunt, died of cancer but I had just given birth to my third son and couldn’t go to my family to grieve with them. It still affects me to this day. At least this time around is a little different. This is my homage to my big brother Denis. I hope his wife, who once told me, “Don’t you ever write about us!” will forgive me. I owe it to Denis, because he saw in me and affirmed what I could not name (nor could he) decades ago: my divine feminine. I hope my words can make it to him somehow so he can be reassured that I was able to find some peace in the tumult of my life. To those who didn’t know him, his life might be considered unremarkable. But how can a life of love and laughter that leaves an eternal imprint on all who knew him be considered anything but remarkable? Each day, the acts of kindness or selfishness we choose to make are woven into a legacy that will live on long after our life energy leaves our bodies to fill the memories of those we love. Life is too short to waste that energy on taking joy from others rather than finding your own. Denis, this seemingly ordinary but extraordinary man, would want each of us to live life fully, to say aloud what our heart dies to share, to dance, to celebrate, to leap into small acts of heroism, and to love, fiercely, as if there is no tomorrow.


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| OPIOID EPIDEMIC |

Gone Too Soon Grieving Parents Share Stories of Young Lives Cut Short by Fentanyl

By Melody Law, MD melodylaw@yahoo.com

G

ood people take drugs and drugs take good people. The opioid epidemic rages on and continues to tear families apart. But amidst the despair, there is hope. The Sacramento County Opioid Coalition (SCOC) hosted nearly 300 educators, public health professionals and family members at the 2022 Opioid Awareness Summit on Tuesday, October 11 at Sacramento State University. That’s 300 people who know they can work together to end the opioid epidemic and save lives in the Sacramento region. They learned how to administer naloxone to someone suspected of an overdose, how drug dealers operate on the dark web, about the latest science regarding addiction, and more. However, there was a looming presence throughout the day of those who couldn’t be there. Sitting up front were memorial posters of more than a dozen teenagers whose lives were cut short by opioids. These posters, part of a project called “Gone Too Soon,” share a picture of the individual, their lifespan, two dynamic descriptors of that person, and the city in which they lived. The project is designed to raise awareness of the dangers of opioids. “Gone Too Soon” will be sending these posters to various events in the region, including to local schools for assemblies, to put a face to the tragedy. “I was very scared and very nervous to share Zach’s story because I knew there was so much misinformation right now,” said Laura Didier, whose 17-year-old son Zach passed away in 2020. “I was afraid people would judge him and we would tarnish his memory.” Despite those concerns, she pushed forward and embraced her new role as a community ambassador. “His beautiful smiling face can motivate people to action,” she said. “I know that’s what he would want. He always wanted to help other people, he always looked out for other people and if sharing his story motivates 12

Sierra Sacramento Valley Medicine

other families and other young people to make better informed decisions and be safer, then his father and I are going to try to do that for him, in his honor and in his memory.” One of the most surprising things for Laura was the suddenness of Zach’s death. As a parent, she’d always known to look for signs of drug use among teenagers. “When fentanyl and counterfeit pills are involved,” she said, “you may not get red flags.” SCOC drives this point home by educating the community that even one pill laced with fentanyl can


from teenagers or parents hearing Kade’s story, it motivates you to keep going and keep sharing.” The teenagers highlighted in Gone Too Soon are your patients, your neighbors, your kids. That’s why it’s incumbent upon physicians to keep opioid use disorder front and center in their practices. If parents are brave enough to share their children’s stories, the worst day of their lives, then you can be brave enough to have conversations with patients about the risks and dangers of opioids and fentanyl. We all have a duty to be forthright and honest with them, no matter how awkward or uncomfortable the discussions might be, and we have no excuse not to have them. These conversations aren’t easy and no one should claim otherwise, but SCOC is providing brochures and resources to simplify them. Whether you’re trying to

Kade

Passionate, Endearing 2001 - 2022 Rocklin

be fatal. There may not be time to see grades slip or to lose interest in friends and activities before tragedy strikes. Laura has begun working with Song for Charlie, a nonprofit started by grieving parents that has tremendous resource materials for youth. She said if parents are wondering how to discuss drugs and drug addiction with their children, these resources will help facilitate those discussions.

“His beautiful smiling face can motivate people to action. I know that’s what he would want.” — Laura Didler, Zach’s Mother Elizabeth Cheryl Dillender, whose son Kade passed away at 21, detailed her first experience sharing her grief. “Having Kade’s story out there is an odd experience,” she said. “On one hand, I find it beautiful that his life here on earth meant something significant enough to have his life in heaven save lives. When we get feedback

Jade

Outgoing, Smart 2001-2021 Sacramento

explain what opioids are or how naloxone works to your patients, or if you’re trying to find guidelines for safely prescribing opioids, the SCOC website has the information you need. SAMSA, California Bridge, and

November/December 2022

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Nyk

Kind, Superhero 1987 - 2021 Sacramento

nity by sending a representative to schools, health fairs, and other events. To ensure no one gets left behind, demonstrations have also been provided to bartenders and bouncers so that the local bar scene is prepared to act during a suspected overdose. Yes, good people take drugs and drugs take good people. A fallacy in American culture is that drug users are bad people who make bad decisions. But substance use disorder is not a moral failing; it is a disease and should be treated without judgment. We treat different disease processes every day in our practices without regard to moral character. “Addiction is a disease. Addiction is treatable. Treatment saves lives,” UC Davis emergency room physcian Aimee Moulin, MD said in her presentation at the Opioid Awareness Summit. If someone is a diabetic, you don’t deny them insulin and tell them to eat better. You provide them with insulin and the tools to live a healthier lifestyle. Why should opioid use disorder be any different? We have buprenorphine and other medications to treat it and empower our patients to make changes to their lives.

the State of California have grants and funding available to hire substance use navigators in the hospital setting and to distribute naloxone within the community, among other opportunities. Fentanyl poisoning impacts Sacramento residents of all socioeconomic groups and ages. In Sacramento County, 116 people lost their lives in 2021 due to fentanyl poisoning and 50 people died in the first seven months of 2022. Fentanyl has been found in virtually

“Addiction is a disease. Addiction is treatable. Treatment saves lives.” — Aimee Moulin, MD all street drugs today including cocaine, meth, heroin, Xanax, Oxy, Percocet, Adderall, marijuana, and vape pens. Illicit fentanyl is highly addictive and can cause sudden death. With the startling prevalence of fentanyl in mind, SCOC is taking the lead in providing not only naloxone kits but also facilitating demonstrations in the commu-

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Sierra Sacramento Valley Medicine

Mikael

Genuine, Humble 1997-2020 Sacramento


“I find it beautiful that his life here on earth meant something significant enough to have his life in heaven save lives. When we get feedback from teenagers or parents hearing Kade’s story, it motivates you to keep going and keep sharing.” — Elizabeth Dillender, Kade’s Mother What steps can be taken to bring an end to the epidemic? Familiarize yourself with the provider guidelines for opioids, become comfortable having the awkward conversations, don’t be afraid to tell your own stories, and ask others to share their own experiences.

Joseph

Ambitious, Loving

Issaiah

Vibrant, Outgoing 2005 - 2021 Sacramento

Elizabeth, Kade’s mother, said it better than anyone: “As a community, I believe that education, awareness, and advocacy are the only ways to keep our children safe. We have to start at the grassroots and continue to stay in the schools and have honest conversations with parents and children. There is hope, we all just have to stay strong and vigilant.” Do it for Zach. Do it for Kade. Do it for the thousands of people who have lost their lives to opioid use disor-

2001-2022 Rancho Cordova

der. Do it for the thousands of people who can be saved by having honest and frank conversations. To encourage family members to share the stories of loved ones who have passed, visit sacopioidcoalition. org. Permission must come from the next of kin, such as a parent or spouse. SCOC would be honored to show the true character behind victims of opioid use disorder, and to make increasing education on the dangers of opioids and the prevention of poisonings and overdoses part of their legacy. Melody Law, MD is an addiction medicine specialist. Brandon Craig contributed to this article.

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Trauma AT YOUR

OWN RISK

Trauma and PTSD are hazards of the medical profession. Left untreated, the impacts can be deadly. By Caroline Giroux, MD cgiroux@ucdavis.edu

P

erhaps there should be a disclaimer in brochures about applying to medical school that warns, “You are entering this profession at your own risk.” One would think that, before entering a high-risk profession such as medicine, there would be an explicit warning about the disturbing, overwhelming and traumatic situations a doctor is likely to face. We are increasingly more aware of the impact trauma has on the whole person throughout their life span, thanks to the landmark study that revolutionized the way we practice medicine and deliver care. A 1998 study led by Dr. Vincent Felliti, often referred to as the ACEs (adverse childhood experiences) study, highlighted a correlation between childhood toxic stress or developmental trauma, such as abuse or neglect, and medical conditions later in life, including cardiovascular disease, diabetes, addictions, depression, anxiety and suicide, to name a few. Scoring six or more on the 10-point ACEs survey (one ACE equals one point) reduces expected life expectancy by 20 years! The ACEs screening tool, as useful as it might be, 16

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is only one piece of the big puzzle because it doesn’t contain the whole realm of human traumatic experiences. In general terms, a trauma is an event that is so intense and overwhelming—such as witnessing someone dying, experiencing a house fire, or being assaulted—that it creates a fracture in the person’s timeline and a separation between mind and body. It often includes a form of boundary violation, whether it is physical (as in an assault or sexual abuse), or the type that doesn’t leave physical scars, such as emotional or spiritual abuse. Regardless of the type of trauma, it affects the whole person. It is important for doctors to consider their additional susceptibility to trauma on the job, especially because it can reactivate unprocessed childhood trauma and add to their personal ACEs score. Medical training itself has its load of trauma that can lead to depression, burnout, even suicide. Being an educator and hearing stories from residents brought my own medical training trauma to my awareness: during my Ob-Gyn rotation, a woman arrived to the labor and delivery


| POETRY |

So Much Blood So much blood. Running down my gown, into my shoes, soaking my socks and pooling onto the floor, thick, gelatinous, spreading till clotted, making its way into every crevice and leaving a red stain and filling the air with the odor of copper. There can be only so much blood. It kept coming, rising through the open abdomen, unyielding, all of the blood in the body five times over emptying from this cavernous belly, all at once, two suctions running at full bore could not keep up. Your blood was thick bright red then Kool-Aid and at the end cardinal crimson. So much blood. Yet your heart did not stop. Several times in an hour we pumped on your chest to support your life, yet we could not save your life. Anesthesia and the nursing team in concert worked feverishly on lifesaving efforts; blood for transfusion, calcium, bicarb and epi for your heart, Levophed to support your blood pressure which could not be sustained, yet we could not keep up. You said do everything that could be done but for the grace of God everything we did was not enough. Your whipped heart finally drummed its last beat at 0200. Now, the life of your family; wife of 60 years, son of 55 years, granddaughters must begin their life without you. But, your blood is their blood and you live on. The surgical team of 10 have done all that they could. We could not save this life. Did we learn something that will save the next bleeding patient? Can we look the monster of what feels like failure in the eye and ask thoughtfully, “What can we do differently next time?” — Eric Williams, MD imango@att.net

November/December 2022

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unit with second-trimester bleeding. She lost her baby, and I remember standing by the resident doing the speculum exam when the fetus came out due to cervix incompetency. I regret not having had an opportunity to process my feelings of helplessness at the time with supportive supervisors. Adding to the shock of this tragedy was the blame pointed in my direction when an attending said during a meeting that it took a while for the patient to be seen by “the med student.” (I will always remember this woman’s tears because, one day, they became mine. Years later, I had two pregnancy losses that made me vividly remember this mother-to-be and relive the experience. I felt more connected to this woman, and my personal experience made me fully grasp only over a decade later what she might have been going through.) A threat to the body and the self will trigger a cascade of survival reactions that can be the manifestations of one of the four Fs, a framework I find useful to detect any trauma response. Our brain is wired to fight, flight, freeze, or faint. “Playing dead” (freezing or, at the extreme, fainting) is one of the Fs of trauma that has saved many people’s lives, especially children, for instance in cases of sexual abuse. Since fighting back or fleeing is often not an option due to the power differential with the perpetrator, all children can do is freeze, or dissociate. Trauma that is so dense that it is simply too much for our mind and body to process all at once can lead to the phenomenon of dissociation, where the mind or spirit sometimes seemingly literally takes leave of the body to survive. I have heard patients tell me countless times that they saw themselves floating above their bodies while being abused. With the experience of the COVID-19 pandemic still fresh in mind, we know that first-responders and other health care workers are at risk of developing occupational post-traumatic stress disorder, commonly known as PTSD. PTSD can be caused by primary trauma, direct experience with life’s tragedy. Primary trauma is an overwhelming experience that creates a deep sense of shock, fear or horror. Examples in professional settings include a police officer arriving at a crime scene or a physician pronouncing death on a murdered child in the emergency department. With primary trauma,

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Sierra Sacramento Valley Medicine

the person or professional is the victim. Physicians share this work hazard with nurses, social workers, police officers, firefighters, correctional staff and people doing humanitarian work, and it can create an intense response especially if it is superimposed on unresolved childhood trauma. In personal life, a primary trauma might be domestic abuse, a difficult divorce or other catastrophic life events that overwhelm coping mechanisms, such as a car accident, war-related trauma, or natural disaster. Trauma in a professional setting can intensify the impact of trauma that is simultaneously taking place outside of work or rekindles past experiences. There is also another mechanism for the development of PTSD. This is via secondary, or indirect, trauma such as a psychiatrist who hears disturbing stories of child abuse experienced by patients. Secondary trauma is more indirect and characterized by the development of symptoms in the people who are helping those who have been traumatized. In this situation, the professional works with victims of trauma but is affected deeply by that work. Professions at high risk are psychologists,


Secondary traumatic stress is almost unavoidable in our field, as we will meet many people with whom we can easily identify or who might remind us of painful life experiences. psychotherapists and attorneys, to name a few. Secondary traumatic stress is seen when a professional worker’s signs and symptoms of PTSD mirror those of their patients. Sometimes, the professional is unaware that an exposure has had a traumatic impact on them. A patient’s attitude or behavior can also act as a “trigger” and reactivate traumatic responses by reminding a physician of their own trauma stories if that past trauma has been repressed and the physician has not fully healed. Secondary traumatic stress is almost unavoidable in our field, as we will meet many people with whom we can easily identify or who might remind us of painful life experiences. How an earlier trauma was addressed —or not—may determine how a professional will cope with new trauma, whether that might be a patient who threatens the physician or having to deal with another patient’s catastrophic injury or illness. Hence the importance of being aware of our own triggers. Without that awareness, a physician is at risk of using avoidance strategies and of being more reactive (irritated or dismissive) rather than being responsive and listening attentively, which can put the patient at risk of re-traumatization and compromise the quality of care. It is important to be cognizant of PTSD signs and symptoms not only in our patients, but also in our colleagues. Chronic, untreated PTSD can be one of the mechanisms of burnout. It is essential to recognize the signs of PTSD so support and treatment can be offered early, just as we try with diseases such as cancer. PTSD doesn’t always manifest itself through flashbacks or nightmares; it can look like depression, panic or addiction to substances. So, what do we do after a traumatic event at work to prevent the development of PTSD symptoms? Debriefing is not recommended because it can lead to re-traumatization through reliving the events and pain. Instead, it is preferable to encourage a pause after traumatic scenarios such as suicide, repatriation of refugees

or a death. A pause allows the team to acknowledge the emotional experiences from sad outcomes such as feelings of loss. A healing circle where colleagues sit together in silence can be a way to process and integrate difficult emotions by feeling part of a bigger whole, and get support from a sense of community and belonging. It is better to offer support and ask each person who was exposed to trauma what their needs are right at that moment. Healing must often occur in the body through holistic techniques such art therapy, yoga, and movement rather than traditional talk therapy. Because trauma first elicits bodily responses (through elevated heart rates, shaking, muscular tension, sweating, etc.), we must recalibrate the stress response systems by regulating the autonomic hyper-reactivity, for instance by practicing meditation. While secondary trauma, just like primary trauma, can lead to post-traumatic manifestations, it can also be an opportunity for expansion of awareness and growth. Ironically, a patient’s trauma can bring something to our awareness that makes us feel grateful, teaches us and enables us to be more present to ourselves and others. For example, a physician who finds a patient’s childhood stories similar to their own may discover a new understanding of his or her own experiences, leading to a more hopeful outlook and an enhanced capacity to experience awe and do good. Trauma is universal, although it might be found in more concentrated versions in our field. It is vital to continue to build upon our resilience by inhabiting our default state of relaxation as often as possible, by not mistreating our own bodies, by being responsive rather than reactive to challenges, and by healing from adversity as we continue to learn about the human condition while helping others. In between the traumas of our lives, we must continue to nurture our souls and take care of ourselves by learning to regulate our emotions, by finding meaning and by cultivating joy. If we can do that, “at your own risk” might then become “at our own risk of growth and enlightenment.”

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| PUBLIC HEALTH |

American Medical Women’s Assn. Meets With White House Staff Reproductive Care Services, Environmental Justice Among Top Priorities Discussed in D.C. Visits

A

merican Medical Women’s Association (AMWA) leaders recently traveled to Washington, D.C. to meet with senior Biden Administration officials. Gender policy, reproductive rights, and planetary health were the key topics. Our conversation considered the growing challenges facing population health and environmental justice. The adverse effects of idling diesel buses on children’s health, studied and addressed by the California Air Resources Board, remains a concern and relatively unaddressed in much of the nation. Other areas discussed with senior staff in the White House Office of Public Engagement include air quality from wildfires, waterborne diseases from flooding, and sustained and excessive heat exposure leading to increased rates of chronic conditions such as asthma, cardiovascular disease, and Parkinson’s disease. We agreed on the need for an immediate and vigorous effort to publicize these connections. AMWA (amwa-doc.org) believes the U.S. must urgently commit to policy changes ensuring individual health and population survival. Senior Advisor Josh Dickson shared recent efforts surrounding President Biden’s executive order protecting access to reproductive health care services. The Department of Health and Human Services distributed guidance on non-discrimination to pharmacists nationally and also on the Emergency Medical Treatment and Active Labor Act, which includes abortion services. The White House advisors welcomed AMWA’s insights on the challenges facing physicians and trainees, ranging from privacy issues and limitations on telehealth across state lines to the need for education about the myriad clinical consequences in the “gray zone” that will escalate with abortion restrictions. We raised the threat to public health given an anticipated physician shortage in states with restrictive bans. Fewer medical students and trainees (increasingly women) may apply to those medical institutions and more doctors could choose not 20

Sierra Sacramento Valley Medicine

By Karen Poirier-Brode, MD poirierbrodekaren@gmail.com

to practice in states that criminalize appropriate delivery of medical care. The impact on health services could increase, particularly demand for gynecological services in states providing complete reproductive care. After our White House visit, we met with HHS Assistant Secretary Admiral Rachel Levine, MD. She stressed the importance of contacting Congress to fund many tremendous but under- or non-funded programs, including HHS’s desire to restore and revitalize Title X programs centering on adolescent health. Title X, a fantastic public health success story, has consistently decreased teen pregnancies over the past 30 years. Efforts stalled when funding was withheld between 2016 and 2020, affecting services providing cancer screenings, contraception, sexually transmitted infections, and mental and behavioral health care. AMWA’s delegation and Adm. Levine discussed the growing prevalence of long COVID and associated conditions, particularly among women, and the need for more research into the causes and potential management strategies. Adm. Levine spoke to HHS’s focus on health equity among underrepresented groups and efforts to address health disparities. She said three new offices established within HHS—the Office of Climate Change and Health Equity, Office of Environmental Justice, and Office of Long COVID—have been created to address those concerns. While in D.C., AMWA also met with legislative staff in Senator Dianne Feinstein’s office to discuss our organization’s priorities: opportunities to expand support for research, education, and training in sex and gender health care; gun violence solutions; and reproductive rights. Andrew Fuentes, Sen. Feinstein’s legislative assistant for health issues, also welcomed AMWA’s input on other health care issues, including the need to ensure fair and equitable algorithms when applying machine learning and artificial intelligence toward the improvement of health care delivery.


Sponsored by the Sacramento County Opioid Coalition Elizabeth Morrison, PhD CEO, EM Consulting

TWO-PART SERIES

Join us for two important workshops aimed at giving you the tools to increase rewarding patient interactions and improve health outcomes.

Session One

Session Two

CONTINUAL GROWTH: Self-Reflection as a tool for Improving Patient Health Outcomes

MAKING A DIFFERENCE IN 10 MINUTES: Motivational Interviewing for Substance Use Disorders

VIRTUAL WORKSHOP Tuesday, November 29, 2022 6:30 PM

IN-PERSON WORKSHOP Wednesday, December 7, 2022 6:30 PM

Register at: tinyurl.com/Continual GrowthNov2022

Register at: tinyurl.com/Motivational InterviewDec2022


We have several talented photographers among SSVMS members who submit photos for our covers. Unfortunately, we can’t use them all, so we wanted to showcase some that didn’t make the front page, some favorites of the photographers, and a couple of our own that we like and thought you’d enjoy. We encourage you to send photos for consideration to bcraig@ssvms.org. “Standing Still,” Stockholm, by Enrico Lallano, MD

Bristlecone Pine, by David A. Evans, MD 22

Sierra Sacramento Valley Medicine

Yosemite, by Enrico Lallano, MD


Northern Lights, Alaska, by Marvin H. Kamras, MD

“Real California Cows,” conceptual image by David A. Evans, MD November/December 2022

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| BOARD BRIEFS |

Board Briefs September 12, 2022

Approved the following Membership Reports:

THE BOARD: Approved the Nominating Committee recommendations for 2023 nominations to vacancies on the Board of Directors and the Delegation to the California Medical Association. Approved the recommendations from the Scholarship & Awards Committee to provide 2022 medical student scholarships to: Reeta Asmai, first-year medical student at UCLA David Geffen School of Medicine, recipient of the Paul J. Rosenberg Medical Student Scholarship; Kathleen M. Barnett, fourth-year medical student at California Northstate University College of Medicine; Adrienne P. Davis, second-year medical student at Medical College of Wisconsin-Milwaukee;

August 22, 2022 For Active Membership — Sanaz Ghafouri, MD; Lucy Funk, MD; Erik Campbell, MD; Aaron Thornburg, DO; Jaskiran Ranu, MD; Mary Gauthier, MD; Azad Karim, MD. For Resignation — Christopher Liang, MD; Kamran Sahrakar, MD. For Termination of Membership — Andrew Pelch, MD (license expired). Deceased — Joshua Crane, UC Davis Medical Student. September 12, 2022

Jade Tso, second-year medical student at UC Davis School of Medicine;

For Active Membership — Neil Beri, MD; Prema Bezwada, MD; Walter Wai-Tak Chien, MD; Pooja Sheth Dhillon, MD; Rajkamal Hansra, MD; Camille Huwyler, MD; Manmeet Kaur, MD; Brian Lee, MD; Wentao Li, MD; Wyatt Messenger, MD; Shelby Mclaughlin-Patel, MD; Wut Yi Phoo, MD; Harkinwal Singh, MD; Uday Gajjandra Sandhu, MD; Dana Sheng, MD; Ravi Paul Sing Virdi, MD; Shi Ying Zahang, MD.

Wendy Woo, fourth-year medical student at Virginia Commonweatlh University School of Medicine.

For Resident Physician Active — 289 UC Davis 2022 Residents; 25 Methodist 2022 Residents.

Approved the 2nd Quarter 2022 Financial Statements, Investment Reports and Recommendations.

Dropped for Nonpayment of 2022 Dues — Nathan S. Beckerman, MD; Tiffany G. Heu, DO; Jacqueline A. Johnsen, DO; John R. Loudermild, MD; Craig H. Morris, MD; Manjit S. Sran, MD.

Christian Bryan G. De Guzman, first-year medical student at UC Davis School of Medicine; Brynn A. Sargent, fourth year medical student at UC Irvine School of Medicine;

Approved the following appointments to the SSVMS Delegation: Sharmilo Amolik, MD to AlternateDelegate Office 2; Ashley Ashbaugh, MD (resident) to Alternate-Delegate Office 24; Hao (Harry) Li, MD to Alternate-Delegate Office 18; Syed Latif, MD to Alternate-Delegate Office 16; Siddharth Raghavan, MD to Alternate-Delegate Office 10; Ellen Shank, MD (resident) to Alternate-Delegate Office 17.

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Sierra Sacramento Valley Medicine

Transfer of Membership — Kellie N. Corcoran, MD (to Solano); Constantine Dimitriada, MD (to PlacerNevada); Lavina Malhotra, MD (to Alameda); Mayra Orozco-Llamas, MD (to Sonoma).


October 10, 2022

October 10, 2022

Acknowledged the following Outgoing Directors whose terms end December 31, 2022: Carol Burch, MD, Immediate Past President; Jonathan Breslau, MD; Marcia Gollober, MD; Judy Mikacich, MD.

For Active Membership — Cosby Arnold, MD; Patrick Berg, MD; Sheryl Boon, MD; Samantha Brown, MD; Trevor Bushong, MD; Connor Caples, MD; Jonathan Chan, MD; Flora L. Chang, MD; Ho-Hin Choy, MD; Karen Chung, MD; Samuel Devictor, MD; David Dillon, MD; Samuel Feldman, MD; Michael Gale, MD; Damanvir Garcha, MD; Regina Graham, MD; Sean Heavy, MD; Brian Hernandez, MD; Daniel Hernandez, MD; Alison Ho, DO; Sundip Jagpal, MD; Manan Jhaveri, MD; Sadia Khan, DO; Jaehwan Kim, MD; Jose Lado Abeal, MD; Christopher Langlo, MD; Richard Lau, MD; Charles Lavender, MD; Gerald Lee, MD; Jack Lin, MD; Jeffrey Lin, MD; Pei-Yin Lin, MD; Mina Maximous, DO; Sobia Mirza, MD; Mark Moubarek, MD; Bao Nguyen, DO; Haeli Park, MD; Benjamin Pirotte, MD; Gauravi Sabharwal, MD; Ahmad Shahzad, MD; Nandita Sharma, MD; Shanti Shenoy, MD; Roya Sheridan, MD; Averyl Shindruk, MD; Maisa Siddique, MD; Prithpal K. Singh, MD; Jonathan Snider, MD; Kaitlyn Spears, MD; Rebecca Surrey, MD; Karla Talavera, MD; Lillian Tran, MD; Sophia Yang, MD.

Received an update regarding the activities of the Public and Environmental Health Committee from Glennah Trochet, MD, Chair. Approved the 2023 Budgets for the Sierra Sacramento Valley Medical Society and the Community Service, Education and Research Fund. Approved the 2021 tax returns for the Sierra Sacramento Valley Medical Society and the Community Service, Education and Research Fund. Approved the August 2022 Financial Statements and Investment Reports. Approved appointing David Terca, MD to the SSVMS Delegation representing Alternate-Delegate Office 24. Approved the following Membership Reports: September 26, 2022 For Active Membership — Prema Bezwada, MD; Anshul Dixit, MD; Yee Lo, MD; Jake Ni, MD; Cameron Pole, MD; Amripal Sandhu, MD; Dana Sheng, MD. For Resignation (license expired) — Lars Berglund, MD; William Bradford, MD; Albina Gogo, MD; Colleen Hendershott, MD; Lindsay Olinde, MD. For Transfer of Membership — Elaine Chau, MD (to Placer-Nevada); Matthew A. De Niear, MD (to Alameda); Justin Heilman, MD (to Santa Barbara); Deborah Hong Lee, MD (To Alameda-Contra Costa); Rohit Nalamasu, DO (to Alameda-Contra Costa); Shalvin Prasad, MD (to Solano) Ruchika Sunil Chhibar, MD (to Alameda-Contra Costa).

For Reinstatement to Active Membership from Retired Membership — Sadha Tavakaran, MD For Resident Membership to Active Membership — Daphne O. Darmawan, MD; Steven K. Dennis, MD; Amanda J. Ferguson, MD; Maria G. Garnica Albor, MD; Batool A. Hussain, MD; Jessie P. Medina, MD; Princella G. Olalo, MD; Soe H. Thein, MD; Stephen Vong, MD; Iris Vuong, MD. For Resident Physician Active Membership — Haylee A. Bettencourt, MD; Mehlika Faire, DO; Rachael Fields, MD; Jacob Frey, MD; Archana Ganta, MD; Brian Hendricks, DO; Thomas Huey, MD; Soo Kyung Hwang, MD; Devon Kuhlmann, DO; Arely Macias, MD; Brandon Maxwell, MD; Kate G. Meizlish, MD; Emerald L. Nguyen, MD; Alejandro Rodriguez, MD; Savannah Schwewe, MD; Ashley Schmidt, MD; Jaspreet Singh, DO; Chenxi Song, MD; Johanna Wu, DO.

November/December 2022

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| NEW MEMBERS |

New SSVMS Members The following applications have been approved by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — Adam Dougherty, MD, Secretary.

New Active Members *Physician specialty abbreviated following name.

Cosby G. Arnold, MD, EM, UCD Neil Beri, MD, GM, TPMG Prema Bezwada, MD, CD, MMG Patrick S. Berg, MD, GS, UCD Sheryl J. Boon, MD, PPR, UCD Samantha K. Brown, MD, EM, UCD Trevor R. Bushong, MD, NPM, UCD Connor M. Caples, MD, VS, UCD Jonathan Chan, MD, EM, UCD Walter Wai-Tak Chien, MD, CD, MMG Ho-Hin K. Choy, MD, IM, UCD Karen K. Chung, MD, FP,UCD

Daphne O. Darmawan, MD, PD, UCD Steven K. Dennis, MD, OTO, UCD Samuel R. Devictor, MD, FPS, UCD Pooja Sheth Dhillon, MD, P, TPMG David J. Dillon, MD,MPH, PhD, UCD Anshul Dixit, MD, IM, BS of CA Samuel R. Feldman, MD, OPH, UCD Amanda Ferguson, MD, R, UCD Michael J. Gale, MD, OPH, UCD Damanvir S. Garcha, MD, P, UCD

Maria G. Garnica Albor, MD, IM, UCD Regina R. Graham, MD, P, UCD Rajkamal Hansra, MD, IM, PMA Sean F. Heavey, MD, EM, UCD Brian O. Hernandez, MD, ORH, UCD Daniel O. Hernandez, MD, OTO, UCD Alison U. Ho, DO, OSS, UCD Batool A. Hussain, MD, N, UCD Camille Huwyler, MD, OTO, WMG Sundip K. Jagpal, MD, MT, UCD Manan A. Jhaveri, MD, IMG, UCD

2022 CALENDAR 29

CME Presentation - Virtual Training Continual Growth: Self-Reflection as a Tool for Improving Patient Health Outcomes

01

SSVMS Holiday Social 6:00 PM - 9:00 PM The Cannery, Sacramento

NOV

DEC

07 DEC

26

CME Presentation - In-Person Training Making a Difference in 10 Minutes: Motivational Interviewing for Substance Use Disorders

Sierra Sacramento Valley Medicine


Manmeet Kaur, MD, N, PMA Sadia Khan, DO, GS, UCD Jaehwan Kim, MD, D, UCD Jose J. Lado Abeal, MD, FP, UCD Christopher S. Langlo, MD, OPH, UCD Richard Lau, MD, R, MMG Charles A. Lavender, MD, GE, UCD Brian Lee, MD, OPH, TPMG Gerald K. Lee, MD, DR, UCD Wentao Li, MD, N, TPMG Jack J. Lin, MD, N, UCD Jeffrey M. Lin, DO, EM, UCD Pei-Yin Lin, MD, A, UCD Yee Lo, MD, FP, WMG Mina V. Maximous, DO, IM, UCD Shelby McLaughlin-Patel, MD, HOS, TPMG Jessie P. Medina, MD, IM, UCD

United States Postal Service

13. Publication Title

Statement of Ownership, Management and Circulation (All Periodicals Publications Except Requester Publications)

1. Publication Title 4. Issue Frequency

BIMONTHLY

SIERRA SACRAMENTO VALLEY MEDICINE

15.

2. Publication Number

SIERRA SACRAMENTO VALLEY MEDICINE

7

5

3

-

5

7

0

5380 ELVAS AVE. STE. 101

Addr 1: Addr 2: City, State ZIP:

SIERRA SACRAMENTO VALLEY MEDICAL SOCIETY 5380 ELVAS AVE. STE. 101 SACRAMENTO, CA 95819

Name: Addr 1: Addr 2: City, State ZIP:

SIERRA SACRAMENTO VALLEY MEDICAL SOCIETY 5380 ELVAS AVE. STE. 101

Name: Addr 1: Addr 2: City, State ZIP:

LINDSAY COATE 5380 ELVAS AVE. STE. 101

Name: Addr 1: Addr 2: City, State ZIP:

KEN SMITH 5380 ELVAS AVE. STE. 101

10/18/2022 6. Annual Subscription Price

6

7. Complete Mailing Address of Known Office of Publication (Not printer) (Street, city, county, state, and ZIP+4)

Addr 1: Addr 2: City, State ZIP:

Contact Person

SACRAMENTO, CA 95819

JUDITH CITRINO (916) 452-2671

9. Full Names and Complete Mailing Addresses of Publisher, Editor and Managing Editor (do not leave blank) Publisher (Name and complete mailing address)

09/01/2022

Average No. Copies Each Issue During Preceding 12 Months

2,243

b. Paid and/or Requested Circulation

Mailed Outside-County Paid Subscriptions Stated on (1) PS Form 3541 (Include paid distribution above nominal rate, advertiser's proof copies, and exchange copies) Mailed In-County Paid Subscriptions Stated on PS (2) Form 3541 (Include paid distribution above nominal rate, advertiser's proof copies, and exchange copies) Paid Distribution Outside the Mails Including Sales (3) Through Dealers and Carriers, Street Vendors, Counter Sales ,and Other Paid Distribution Ouside USPS Paid Distribution by Other Classes of Mail Through (4) the USPS (e.g. First-Class Mail)

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[Sum of 15b. (1), (2), (3), and (4)] Free or Nominal Rate Outside-County d. (1) Free or Nominal Copies Included on PS Form 3541 Rate Free or Nominal In-County Copies Included (2) Distribution (By on PS Form 3541 Mail and Free or Nominal Rate Copies Mailed at Other (3) Classes Through the USPS (e.g. First-Class Mail) Outside the Free or Nominal Rate Distribution Outside the Mail Mail) (4) (Carriers or other means) e. Total Free or Nominal Rate Distribution (Sum of 15d. (1), (2), (3) and (4))

SACRAMENTO, CA 95819

Editor (Name and complete mailing address)

SACRAMENTO, CA 95819

Managing Editor (Name and complete mailing address)

f. Total Distribution (Sum of 15c. and 15e.)

SACRAMENTO, CA 95819

10. Owner (Do not leave blank. If the publication is owned by a corporation, give the name and address of the corporation immediately followed by the names and addresses of all stockholders owning or holding 1 Percent or more of the total amount of stock. If not owned by a corporation, give the names and addresses of all the individual owners. If owned by a partnership or other unincorporated firm, give it's name and address as well as those of each individual owner. If the publication is published by a nonprofit organization, give it's name and address.)

SIERRA SACRAMENTO VALLEY MEDICAL SOCIETY

14. Issue Date for Circulation Data Below

a. Total Number of Copies (Net press run)

$26.00

Telephone

8. Complete Mailing Address of Headquarters or General Business Office of Publisher (Not Printer)

Full Name

Extent and Nature of Circulation

3. Filing Date

5. Number of Issues Published Annually

(EVERY OTHER MONTH)

Averyl M. Shindruk, MD, EM, UCD Maisa M. Siddique, MD, EM, UCD Harkinwal Singh, MD, HOS, MMG Prithpal K. Singh, MD, P, MMG Jonathan D. Snider, MD, OBG, UCD Kaitlyn Spears, MD, OBG, SOLO Rebecca L. Surrey, MD, OBG, UCD Karla M. Talavera, MD, IM, UCD Soe H. Thein, MD, P, UCD Lillian T. Tran, MD, OPH, UCD Ravi Paul Singh Virdi, MD, PCC, SOLO Stephen Vong, MD, DR, UCD Iris Vuong, MD, IM, UCD Shi Ying Zhang, MD, HOS, TPMG

Sobia K. Mirza, MD, R, UCD Mark L. Moubarek MD, EM, UCD Bao X. Nguyen, DO, IM, UCD Jake Ni, MD, SME, WMG Princella G. Olalo, MD, P, UCD Haeli Park, MD, HOS, UCD Wut Yi Phoo, MD, GM, TPMG Benjamin D. Pirotte, MD, EM, UCD Cameron Pole, MD, OPH, SOLO Gauravi K. Sabharwal, MD, R, UCD Amrtipal Sandhu, MD, FP, WMG Uday Gajjandra Sandhu, MD, CD, MMG Ahmad Shahzad, MD, FP, UCD Nandita Sharma, MD, PD, UCD Dana Sheng, MD, SM, MMG Shanti K. Shenoy, MD, D, UCD Roya Sheridan, MD, IM, UCD

Complete Mailing Address

5380 ELVAS AVE., STE. 101, SACRAMENTO CA 95819

No. Copies of Single Issue Published Nearest to filing Date

2,151

870

821

1,373

1,330

0

0

0

0

2,243

2,151

0 2,243

0 2,151

g. Copies not Distributed (See Instructions to Publishers #4 (page #3)) h. Total (Sum of 15f. and g.) Percent Paid i. (15c. Divided by 15f. Times 100)

2,243

2,151

100.00%

100.00%

2,243 2,243 100.00%

2,151 2,151 100.00%

* if you are claiming electronic copies, go to line 16 on page 3. If you are not claiming electronic copies, skip to line 17 on page 3. 16. Electronic copy Circulation If present, check box a. Paid Electronic Copies b. Total Paid Print Copies (Line 15c) + Paid Electronic Copies (Line 16a) c. Total Print Distribution (Line 15F) + Paid Electronic Copies (Line 16a) 11. Known Bondholders, Mortgagees and Other Security Holders Owning or Holding 1 Percent or more of Total Amount of Bonds, Mortgages, or Other Securities. If none, check box Full Name

d. Percentage Paid (Both Print & Electronic Copies (16b divided bt 16c x 100) I certify that 50% of all my distribution copies (electronic and Print) are paid above a nominal price Complete Mailing Address

17. Publication of Statement of Ownership

X Publication required. Will be printed in the

NOV/DEC

18. Signature and Title of Editor, Publisher, Business Manager, or Owner 12. Tax Status (For completion by nonprofit organizations authorized to mail at nonprofit rates) (Check one) The purpose, function, and nonprofit status of this organization and the exempt status for federal income tax purposes: X Has Not changed During Preceding 12 Months Has Changed During Preceding 12 Months (Publisher must submit explanation of change with this statement below)

Judith A. Citrino

Judith A. Citrino

issue of this publication.

Publication not required

Title

Date

Director of Finance & Administration

10/18/2022

I certify that all information furnished on this form is true and complete. I understand that anyone who furnishes false or misleading information on this form or who omits material or information requested on the form may be subject to criminal sanctions (including fines and imprisonment) and/or civil sanctions (including civil penalties)

PS Form 3526, July 2014 PS Form 3526, July 2014

November/December 2022

27


2023 SSVMS Election Results President

J. Bianca Roberts, MD President-Elect

Vanessa Walker, DO Immediate Past President

Paul Reynolds, MD

District 1 (North): Lisa Guirguis, MD

District 4 (El Dorado County): Shideh Chinichian, MD

District 2 (Central): Janine Bera, MD; Adam Dougherty, MD; Raminder Gill, MD; Susan Murin, MD

District 5 (TPMG): Christina Bilyeu, MD; John Coburn, MD; Farzam Gorouhi, MD; Roderick Vitangcol, MD

District 3 (South): Ravinder Khaira, MD

District 6 (Yolo County): Karen Hopp, MD

2023 SSVMS Delegation to the CMA District 1: Reinhardt Hilzinger, MD Alternate: Tanuja Raju, MD District 2: Lydia Wytrzes, MD Alternate: Sharmila Amolik, MD District 3: Katherine Gillogley, MD Alternate: Toussaint Mears-Clark, MD

District 4: Anand Mehta, MD Alternate: Shideh Chinichian, MD District 5: Sean Deane, MD Alternate: Joanna Finn, MD District 6: Tom Ormiston, MD Alternate: Natasha Bir, MD

At-Large Delegates R. Adams Jacobs, MD Barbara Arnold, MD Megan Babb, DO Janine Bera, MD Helen Biren, MD Carol Burch, MD Amber Chatwin, MD Angelina Crans Yoon, MD

Mark Drabkin, MD Rachel Ekaireb, MD Gordon Garcia, MD Ann Gerhardt, MD Douglas Gibson, MD Farzam Gorouhi, MD Richard Jones, MD Steven Kmucha, MD

Vong Lee, MD Charles McDonnell, MD Leena Mehta, MD Sandra Mendez, MD Taylor Nichols, MD Sen. Richard Pan, MD Hunter Pattison, MD Paul Reynolds, MD

Ernesto Rivera, MD J. Bianca Roberts, MD Ashley Rubin, DO Ajay Singh, MD Lee Snook, MD Tom Valdez, MD Vanessa Walker, DO John Wiesenfarth, MD

At-Large Alternate Delegates Sharmila Amolik, MD Alyssa Ashbaugh, MD Christine Braid, DO Karen Hopp, MD Brent Jackson, MD 28

Arthur Jey, MD Carlos Medina, MD — Eric Williams, MD Justin Kohl, MD Leonel Mendoza, MD Syed Latif, MD Siddharth Raghavan, MD Hao (Harry) Li, MD Alex Schmalz, MD Scarlet Lu, DO

Sierra Sacramento Valley Medicine

Ashley Sens, MD Ellen Shank, MD David Terca, MD Asmaneh Yamagata, MD


Closer to home + enhanced Closer to =home + access to referrals easier WORLD-CLASS enhanced referrals CARE =

easier access to world-class care

Offering added convenience for our referring providers From the most delicate robotic and catheter procedures to the latest precision therapeutics, we’re proud to offer up-to-the-minute diagnostic and treatment options for both adult and pediatric referring providers across Shirin Jimenez, M.D. Northern California and the Central Valley. Associate Professor, Division of Cardiovascular Medicine Specialties: Cardiology, Advanced Heart Failure Your referred patients benefit from shorter drives, less traffic, affordable lodging, and more. We also offer robust telehealth and telemedicine options, for both initial consultations and follow up care.

UC Davis Health offers nationally ranked expertise — now with added convenience for our referring providers

Referring your patients to UC Davis Health care is easier than ever. Our physician referral liaisons are here to serve as direct lines of communication — helping to navigate and expedite referrals. Our liaisons can help to: From the most delicate robotic and catheter procedures ■ Facilitate access to our secure EMR system, to the latest precision therapeutics, we’re proud to offer PhysicianConnect up-to-the-minute diagnostic and treatment options for both adult and referring providers across ■ Arrange meetings andpediatric webinars Northern California and the Central Valley. ■ Assist with UC Davis Health clinical trials and telemedicine Your referred patients benefit from shorter drives, less traffic gridlock, affordable lodging, and more support ■ Keep you abreast of new services, providers from localprograms family and friends. We also offer robust and research telehealth and telemedicine options, for both initial ■ Share information about CME and other events consultations and follow up care. Reach out to youryour local Physician Referral today: Referring patients to UC Davis Liaison Health specialty

Tracy Bayne | 916-281-8734 thbayne@ucdavis.edu and subspecialty care is| now easier than ever. Our physician referral liaison team is here to serve as direct lines of communication — helping to navigate David Cooke, M.D., F.A.C.S. and referrals. Professor andexpedite Chief, Division of General Thoracic Surgery

Our liaisons can also help to: ■

Facilitate access to our secure EMR system, PhysicianConnect Arrange meetings and/or webinars with our clinicians Assist with UC Davis Health clinical trials and telemedicine Keep you abreast of new services, providers and research programs Share information about CME and events such as tumor boards, grand rounds, symposiums, etc.

Reach out to your local Physician Referral Liaison today: Tracy Bayne | 916-281-8734 | thbayne@ucdavis.edu

Director, General Thoracic Surgery Robotics Program Specialties: Cancer, Thoracic Surgery, Robotic Surgery

referrals.ucdavis.edu

referrals.ucdavis.edu


You’ve worked hard to achieve success. You deserve financial advisors who work as hard for you. As an Ameriprise private wealth advisory practice, we have the qualifications and experience to help navigate your complex financial needs. Whether it’s investment management, tax strategies or legacy planning, we can work with you to grow and preserve what you’ve worked so hard to achieve. Call us today and discover the personal service you deserve.

Douglas A. Crumley Jr. CFP®, CRPC®, APMA®, CKA® CERTIFIED FINANCIAL PLANNER™ practitioner Private Wealth Advisor Business Financial Advisor Crumley & Associates A private wealth advisory practice of Ameriprise Financial Services, LLC 7956 California Ave, Fair Oaks, CA 95628 916.638.4600 | dougcrumleyjr.com douglas.2.crumley@ampf.com Crumley & Associates will donate $100 to the Joy of Medicine program for each SSVMS physician member who engages in financial planning.

Not Federally Insured | No Financial Institution Guarantee | May Lose Value CA Insurance #0E45453 The Compass is a trademark of Ameriprise Financial, Inc. Certified Financial Planner Board of Standards Inc. owns the certification marks CFP®, CERTIFIED FINANCIAL PLANNER™ and CFP (with plaque design) in the U.S. Ameriprise Financial is not affiliated with any religion or faith-based financial advisor organization. Ameriprise Financial, Inc. does not offer tax or legal advice. Consult with a tax advisor or attorney. Ameriprise Financial Services, LLC. Member FINRA and SIPC. © 2022 Ameriprise Financial, Inc. All rights reserved.