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CareConnection Innovative Healthcare in Your Backyard.

Volume 1 | Issue 2 | October 2014

Mood Disorders While Pregnant

pg 6

Change Is in the Air pg 9

Life. Changed Forever. pg 10

Living with Alzheimer’s

pg 15

Save Your Teeth pg 17

WellHealth Quality Care | wellhealthqc.com | @WellHealthQC facebook.com/WellHealthQualityCare | (855) 404-WELL


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When you need us, we’ll be here.

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Contents 06

MOOD DISORDERS WHILE PREGNANT

“An estimated half a million pregnancies every year involve a woman experiencing a mood disorder.”

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CHANGE IS IN THE AIR

“While seasons come with obvious differences, there may be some not-so-evident changes.”

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STAY FIT DURING THE HOLIDAYS

“Put down the pumpkin pie and lace up your sneakers.”

LIFE. CHANGED FOREVER. “When your child flat lines, it is an outof-body experience.”

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LIVING WITH ALZHEIMER’S “Tips for those who are taking care of a loved one.”

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SAVE YOUR TEETH

“Do you take over-the-counter or prescription medications? You may be at risk.”

Credits MEDICAL EDITOR

K. Warren Volker, MD, PhD

MANAGING EDITOR Meghan Bailey

COPY EDITOR Nick Dawson

ART & DESIGN

CONTRIBUTING WRITERS Jocelyn Ivie, MD Eric Smith, MD Steven Saxe, DO Lisa Lyons, MD Alfredo Brandt

Alyna Kakol

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Message from the CEO ‘Tis the season for Open Enrollment, and while Nevada continues to experience rapid growth, it is more important than ever to partner with quality physicians who can provide you with the best care. To do this, it is vital to research the plans available to you; whether from your employer or through the health exchange. As a patient, before you access care, be persistent and know what each network offers. Some helpful questions for you to ask before purchasing a plan: 1. Is my current provider(s) covered in-network? 2. How far will I have to travel to see specialists? 3. How long do I have to wait to get an appointment with a doctor? 4. What is the capacity of the network? (i.e. ratio of patients to a provider) 5. How easy is it to access the network? (i.e. online, call center, app’s, etc.)

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Finding the perfect insurance for you is possible. Just in the last year many leaps and bounds have been made to help you through your healthcare journey. The providers you find on a WellHealth network have all been hand selected, and doctors are reviewed by a quality assurance board to ensure they are continuing with WellHealth’s mission to provide Total Quality Patient Care. We have made it easier and faster for you to find a doctor, request an appointment, and learn more about living healthy. If you take a moment and research your options, finding a healthcare plan doesn’t have to be stressful. WellHealth is always available to answer your questions about our network and the plans we support. Have a happy and healthy holiday season.

K. Warren Volker, MD, PhD CEO of WellHealth Quality Care


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Letter from the Editor

As we enter the season of being grateful, I couldn’t be more grateful for you. The overwhelming, positive response to our first issue from community leaders, businesses, and most importantly, people like you, was stunning. I remember the first planning meeting for CareConnection. We sat around a conference room table with an agenda in hand, but once the meeting started, the agenda may as well have been ripped in half. The energy and passion for delivering real and raw stories to Nevada’s residents couldn’t be matched. Each and every planning meeting since has had no agenda. Instead, we start with a quote, something that resonates with our mission to deliver the best. So please allow me to share with you something: don’t wait for perfect health, take the time to make your health perfect. During the holiday season, you are faced with more than just budgeting for gift giving and juggling your schedule; you face how the new season will affect your health. With open enrollment beginning, you have to decide on the best health plan for you and your family. The cooler temperatures bring additional coughs and sniffles, and

believe it or not, your mind changes. The stories in this issue will pull at your heart strings, they will make you realize you’re not alone, and they will show you that your health needs to be in the forefront of your mind at all times. You only get your health once and the only person who can make sure it’s in tip top shape is you. So don’t let the holiday season give you more stress than joy. Take a tip from one of my favorite trainers, schedule you-time because you have to feel good to do good. Have a joyous and healthy holiday season. Managing Editor Meghan Bailey

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Mood Disorders While Pregnant With Eric Smith, MD & Jocelyn Ivie, MD An estimated half a million pregnancies every year involve a woman experiencing a mood disorder. We sat down with Dr. Eric Smith, a licensed psychologist, and a board certified OB-GYN, Dr. Jocelyn Ivie, to find out what’s normal, what can be done and who this happens to. Meghan Bailey – On average, how many patients do you see with a mood disorder? Dr. Ivie – Every day. The majority of my patients experience depression, anxiety, and grief. MB – Many people tell women that when they are pregnant hormones are released to protect them from a mood disorder; They receive a period of emotional well-being while they’re pregnant, is this true? Dr. Ivie – Although some women are blessed with “the perfect pregnancy,” the majority of women have symptoms during pregnancy that include irritability and depressed mood, weight, sleep and appetite changes. Dr. Smith – That is why it is essential to seek

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additional care when a woman experiences a serious mood disorder during or prior to her pregnancy. MB – Is it safe for women who find out they are pregnant to stop medications used to stabilize a mood disorder? Dr. Smith – It depends on what her diagnosis is, and if the medication is safe for her to stop taking. It is essential for her to call the doctor who prescribed the medications, as well as her OB-GYN. MB – Pregnancy comes naturally with an influx of hormones, has this ever prompted a woman who has never had a mood disorder to develop one?

“70% of pregnant women have some symptoms of a mood disorder.” Dr. Ivie – Around 70% of pregnant women have some symptoms of a mood disorder, but only about 10-15% of pregnant women will meet the full criteria for a diagnosis. Women who are taking their medication suffer significantly fewer relapses during pregnancy than women who discontinue their medications. Dr. Smith – This is a big life change so it can be normal to have depression or anxiety. It doesn’t make a woman a bad mom, in fact, seeking help is a great indicator that she is willing to do anything to keep herself and her baby safe.


mental disorder and ask for an appointment with your OB as soon as possible.

MB – What do you look for during your patients’ prenatal appointments that could signal they could be experiencing a mood disorder? Dr. Ivie – I keep notes throughout the pregnancy on their mood and any evidence of fatigue. Many patients can deal with the symptoms of pregnancy and look forward to the delivery date with anticipation. Lack of interest in the pregnancy and depressed and anxious moods are always triggers to discuss coping skills. Looking out for their support system is critical. If the patient comes to their visits alone every time, I start asking them who is there for them. It comes down to taking the time to notice their behaviors during their prenatal appointments.

“Lack of interest in the pregnancy...” MB – What are some effects that a prescribed mood disorder drug has during pregnancy? Dr. Smith – It all depends on the medication the patient is taking. We will continue to stress how important it is to connect with both doctors. Be open with whoever is scheduling your appointment, tell them you take medication for a mood or

MB – Does an Obstetrician and a Behavioral Health Provider work together to decide on the best course of action, or is this left to one or the other? Dr. Ivie – While an Obstetrician is trained to identify the most common mood disorders and can initiate treatment, having the expertise of a Behavioral Health provider is always considered. Dr. Smith – In the U.S., anxiety disorders (including panic disorder, obsessive-compulsive, posttraumatic stress) occur in the about 18% of the population, depression 17%, bipolar disorder (aka manic-depression) in 5%, and less frequently schizophrenia (1%). Having an OB patient see a mental health doctor allows them much needed time to focus and speak about their disorder. When the obstetrician and the behavioral health specialist work in concert, this ultimately is the best for the patient. Dr. Ivie – And if the patient is considering becoming pregnant and they are currently taking medication it is important for mother and future baby to have a pre-conception counseling session with their doctor(s).

WellHealth Quality Care is proud to support The Leukemia & Lymphoma Society!

The Leukemia & Lymphoma Society Southern Nevada Chapter 2014 Light the Night Walk. Saturday, November 1, 2014 Registration opens at 4pm, Walk begins at 6pm Downtown Las Vegas at the Learning Village (Just East of the Container Park)

Register to walk today :

LighttheNight.org/snv

(844) 586-2244 WellHealthQC.com @WellHealthQC facebook.com/WellHealthQC


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A season worth celebrating.

Team Stats 60 Top 10 Finishes 12 Top 5 Finishes 38 Podiums Finishes

WellHealth Quality Care is a proud supporter of the Carefast cycling team. The peak for flu season in the United States is in January or

Lisa Lyons, MD

February. Seasonal flu activity can begin as early as October and as late as May.

Good Health Habits: Covering your mouth when you cough, frequent hand washing, and avoiding those who are sick.

The upcoming season’s flu vaccine will protect against the influenza viruses that research indicates will be the most common during the season. This includes an influenza A (H1N1) virus, an influenza A (H3N2) virus, and one or two influenza B viruses, depending on the flu vaccine.

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Complications of the flu include bacterial pneumonia, ear infections, sinus infections, dehydration, and worsening of chronic medical conditions.


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Change Is in the Air The seasons are changing. Soon pumpkin carving, trick or treating, and preparing to welcome family is in the very near future. While seasons come with obvious differences, there may be some not-so-evident changes.

1. You’re at a higher risk for dehydration. When the weather starts to change, so does your focus when it comes to your daily beverage choice. Remember, a lack of water can lead to cracked lips, dry skin, and general lethargy. Do not forget to carry your summer water habit into the fall.

2. You crave more sex. Researchers found when the weather starts to cool off your body signals your mind to crave sex. Your brain is trying to hold onto the “happy hormone” known as dopamine, ultimately giving you a boost of libido.

3. You’re more likely to get the amount of ZZZ’s recommended. Sleep is the time when your body repairs and rejuvenates itself. On average, most people sleep between 5-6 hours, instead of the recommended 7.5-8.5 hours per day. Fall days bring cooler temperatures and a quicker sunset. So, since Mother Nature has turned out the lights, maybe it’s time for you to as well.

4. You are still at risk for skin cancer. You may not being lying by the pool soaking in the summer sun, but you are still at risk for skin cancer. The sun’s UV rays will never go away, which means neither should your daily SPF routine.

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Life. Changed Forever.

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The first year of Greyson Gallardo’s life, as told by his father, Greg.

he morning of our 4D Ultrasound was full of excitement. It had been weeks since we last saw our baby boy. When we arrived, the ultrasound tech was so gracious. We heard our son’s heartbeat before she found his face, and once we saw it, we fell in love all over again. Our son looked strong; his cheeks were full, and the reality of being a parent in just a few short months was real. We remember looking at the ultrasound tech because she stayed in one area near his chest for quite a while, and her face was nervous. When the ultrasound was over, the tech gave us a copy of the ultrasound and told us that we needed to go to our doctor immediately. That is when our lives changed, forever.

“That is when our lives changed, forever.” Ever since my wife, Paloma, was little it had been a dream of hers to become a mother. When the pregnancy test came back positive with two pink lines, we were both so happy and overwhelmed with joy. The first prenatal visit was completely normal, and we were told that our due date would be mid-October. Paloma’s pregnancy was developing just as doctors, books, friends and family said it would. It wasn’t until August 5th at the end of our 4D Ultrasound that our lives changed forever. The ultrasound tech couldn’t tell us anything else except that we needed to call our doctor immediately. We panicked; we just saw our baby on the screen and everything looked okay to us, but we took her advice and called our doctor. We saw the doctor the very next morning and after reviewing the ultrasound, our doctor asked us to take a long lunch. She had called in a specialist, and we needed to come back in an hour and a half. At this point, we didn’t know what to expect; we didn’t know what was happening. Once the specialist arrived, we were told that our son had Tricuspid Atresia, a type of heart disease that is present at birth (congenital heart disease), in which the tricuspid heart valve is missing or abnormally developed. The defect blocks blood flow from the right atrium to the right ventricle. In our son’s case the right side of his heart was missing. Tricuspid atresia requires three open-heart surgeries within the first year of birth.

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Tricuspid Atresia can never be corrected, but the surgeries can help him to lead a close to normal life.

“The danger would strike when he was born.” According to Greyson’s cardiologist, Dr. Michael L. Ciccolo, 3 to 5 babies in every 100,000 receive this diagnosis. While the baby was still in his gestational state, he was completely fine, and everything was normal. The danger would strike when he was born. If we hadn’t found out about his condition, his chance of survival would have been almost non-existent.


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The recovery process was emotional. Paloma recalled, “Greyson flat lined on multiple occasions. Nurses and doctors would rush in and push us away to revive him. When your child flat lines, it is an out of body experience; seeing what doctors need to do to revive him and only being able to hope is such a helpless feeling.” Toward the end of the six weeks, Greyson started to show signs of improvement. His heart had started to settle, and he was able to go home on December 4th, 2013. It was the most joyous day you can imagine. A child who has Tricuspid Atresia has a few obstacles that a child without it doesn’t. Things such as a lack of endurance; they get tired very easily, and they have to take daily medication to ensure blood continues to flow normally. Their blood pressure and heart rate will never be normal. We were lucky we live in Las Vegas. There are only two pediatric heart specialists on the West Coast specialized to handle the type of heart condition Greyson has, and one of them practices in Las Vegas. “Studies have shown that Nevada has twice the national average of finding heart diseases because our state puts more into prenatal diagnosis,” said Dr. Ciccolo. On October 15th, our baby Greyson was born. Greyson was immediately taken to the Neonatal Intensive Care Unit and was prepped for surgery to keep his shunt open. All babies are born with their shunt open; it naturally closes within two days of birth. If Greyson’s had closed, the blood flow would have stopped, and he would have died. They were able to keep Greyson’s shunt open, and he spent two weeks in the NICU before having his first open heart surgery. Paloma and my mom never left his side.

Heart babies, as medical professionals call them, are one of a kind, and nearly sixty percent are diagnosed prenatally. “Being able to know baby Greyson’s condition prior to his birth gave him a greater chance of survival,” said Dr. Ciccolo. Greyson’s chances of survival within the first 24 hours was ninety-five percent; after his first operation the rate of survival stayed the same. The third surgery he had six months after birth has a survival rate of ninety-six percent. Fifteen years ago, they didn’t have these kinds of operations. With any luck, with the way medicine is

evolving, they will be able to find a way of extending the life expectancy of someone living with Tricuspid Artesia. As my wife says, we take things one day at a time, and we cherish him. You never know when he may not be here with us. If we could give any advice to parents - be diligent with your prenatal care, and trust your gut. Your life doesn’t end when you find out your baby has a defect or illness. There is a reason they came to you the way they are.

“We take one day at a time, and we cherish him.” If we would have found out earlier, people may have tried to talk us out of having him. With his heart condition or not, our life is our baby, Greyson, and we wouldn’t change anything.

Update:

Greyson just celebrated his first birthday. Although he still has many challenges ahead, he is happy and growing every day.

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Speedy access to the best doctors… When you and your doctor decide that seeing a specialist is necessary, par8o and WellHealth Quality Care will help you

get the care you deserve - without the wait. Your health is our priority and we will connect you to your preferred provider, before you leave your doctor’s office. That’s how par8o and WellHealth Quality Care are

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Copyright 2014 par8o, Inc.

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To learn more about how par8o is working with WellHealth Quality Care to simplify the referral

process and improve care coordination, email wellhealthqc@par8o.com.


Stay fit.

WELLHEALTHQC.COM.................................................. WELLHEALTH QUALITY CARE - TOTAL QUALITY PATIENT CARE Make your health a priority this holiday season. Put down the pumpkin pie, and lace up your sneakers; here are five easy tips to keep you in tip-top shape. With Alfredo Brant, Director of Group Fitness, Elevé Training Studios

1.

Manage your time. When planning is not in place, your workout and meals will suffer.

Eat before you eat. You may think we’re crazy, but one of

the biggest problems is “saving” calories for a big meal. Don’t starve yourself and then overeat. Continue to eat healthy meals and snacks throughout the day and your metabolism will continue to be kind to you.

3.

2.

Set a serious goal early. Why wait until January? Get a jump start on your New Year Resolutions now, and you’ll see they will stick far longer than those made in January.

Be Selfish. You will be pulled in numerous directions. Find a

time during the week that you can spend time working out. Whether it is walking, running, lifting or taking a class, prioritize that time. Block it from everyone else’s access and stick to it.

5.

4.

Look for Group Fitness Classes. Don’t be lingering

around the gym thinking of what you need to do or what you forgot to buy. A great group fitness class will take your mind off for 60 minutes, and get the workout done.

It is common to sacrifice a workout because it’s something that no one else is affected by except you. So protect your health, be ahead of the game, and gift yourself this holiday season confidence by achieving your health and fitness goals.

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Welcome to the practice!

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Dr. Melissa Gutierrez is a recent graduate of a two year post-graduate fellowship specializing in the latest minimally invasive techniques as well as pelvic reconstruction. During her fellowship she successfully performed over 500 minimally invasive gynecological surgeries. Dr. Gutierrez joins LVMIS as the Associate Director of the center.

Melissa Gutierrez, MD Now accepting new patients.

(702) 304-5800 | LVMIS.com facebook.com/LVMIS

WellHealth Women’s Specialty Care

WELCOMES Tanja Scherm, M.D. Tanja Scherm, M.D. Now welcoming new patients at the Summerlin Office!

Dr. Scherm joins the WellHealth Women’s Specialty Team as a highly accoladed board certified Obstetrics and Gynecology physician. She was also a Fellow of the American Congress of Obstetricians and Gynecologists. Dr. Scherm will be seeing patients at the Summerlin WellHealth Women’s Specialty Care location.

A WellHealth Quality Care Clinical Center of Excellence

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(702) 255-3547 | @YourWSC WomensSpecialtyCare.com facebook.com/WomensSpecialtyCare


Living with Alzheimer’s

The story of the Castellano family.

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s time goes on, my mother and I have increasingly common “what if” conversations as she ages. One of her largest concerns is the onset of Alzheimer’s Disease. Just the everyday loss of elasticity of her memory causes her to fret over the future, and I can understand her fears completely.

4. Practice healthy eating. The Alzheimer’s Association recommends limiting saturated fats, refined sugars, and high-sodium foods. It’s important to remember that your loved one’s tastes may also be changing due to side effects of medications.

Alzheimer’s Disease is a form of dementia, an illness that involves the deterioration of the brain, affecting both thinking and social abilities, primarily in regards to memory. As with most types of dementia, Alzheimer’s develops slowly and gets worse over time, eventually interfering with the most basic of daily tasks such as eating and bathing. The majority of Alzheimer’s patients live an average of eight years after diagnosis, but survival length can vary drastically depending on age and health at the onset of the disease. Alzheimer’s has no cure; however, there are treatments for symptoms that can slow the progression of the disease and improve quality of life. Until a cure is found, there are a few tips for those who are taking care of a loved one with Alzheimer’s. 1. Create a Daily Plan. It is vital to keep in mind your loved one’s preferences, as well as how they structured their time in the past. Drastic changes can make life more difficult for them and you. The idea is to form a plan that creates structure and consistency, but don’t forget that flexibility and adaptability will get you further than rigidity. 2. Encourage activity. The activities you choose should include things that your loved one chooses for themselves, enjoys participating in, and are in their skill set.

5. Seek Professional Help. Even with all the right choices, it can be incredibly draining and overwhelming devoting your life to caring for a loved one with Alzheimer’s. Choosing to place a loved one struggling with Alzheimer’s in a facility where they will be cared for can be one of the most difficult decisions you will face, but it may be the most important. Feelings of increased depression, inadequacy, and failure are common, but those who have struggled with this decision have found that although they thought they were the ones who could best care for their loved one, this was not the case. If you or a loved one has been diagnosed with Alzheimer’s, know it will be an uphill battle, but it is not something that you will have to face alone.

3.Communicate with understanding. Be patient and understanding, and never criticize or argue. During later stages of Alzheimer’s, you will need to learn to speak in a direct and clear way that will help your loved one better understand what you are trying to communicate to them.

Alzheimer’s Association | http://www.alz.org/ | 24/7 Helpline: 800.272.3900 Southern Nevada Regional Office | 5190 S Valley View Blvd., Suite 104 | Las Vegas, NV 89118 | P: 702.248.2770

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Do you regularly take over-the-counter or prescription medications? You may be at risk of Xerostomia (“zero-sto-me-uh”), a dental disease that may cost you your teeth. But what is Xerostomia? “Xerostomia manifests itself with symptoms of bad breath, alteration of taste and encouragement of dental decay,” states Dr. Steven Saxe. “This disease decreases saliva, which moistens the mouth, helps with digestion of food, swallowing and controls potential infections and tooth decay.” The most common cause of Xerostomia is the use of many over-the-counter drugs and prescription medications. The top ten most commonly prescribed drugs all have this unfortunate side effect. Some people may take these medications for years without this symptom. Then, one day those individuals find out they have rampant tooth decay at a routine dental appointment. Other causes of Xerostomia that result in tooth decay exist. Causes such as smoking, snoring, autoimmune diseases, Sjögrens Syndrome, and cancer treatment to the head and neck, including both chemotherapy and radiation therapy. “As we age, the risk of tooth decay increases because many will experience bone loss around the teeth exposing vulnerable root surfaces that are not covered with resilient enamel,” Dr. Saxe continued. “Those root surfaces become the target of decay, rapidly causing the crowns of the teeth to break off at the gum line.” What can be done to prevent Xerostomia?

With Dr. Steven Saxe

Xerostomia is completely preventable; your dentist is the first line of defense. During your regularly scheduled cleanings, the dentist examines your teeth for early signs of dry mouth. It is very important for your dentist to thoroughly review your health history with your family physician, including discussing examination findings and in rare cases determining if there are any redundant or unnecessary medications.

It can be very easy to prevent Xerostomia while still taking your necessary medications. If you are taking medication for high blood pressure, diabetes, anxiety, depression, pain, allergy, cold and flu or muscle relaxants, you should be extra diligent in maintaining your dental hygiene by seeing a dentist at least twice a year for cleanings and topical fluoride applications. Additionally, the dentist can prescribe a fluoride gel to apply daily to teeth in a custom tray along with special rinses that substitute your salivary secretions throughout the day. Your dentist or physician can also prescribe medications in the very worst cases. By taking simple preventative measures, you can greatly reduce the chances of developing Xerostomia. 17


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Physician Profiles:

JOCELYN IVIE, MD is board certified with the American Board of Obstetrics and Gynecology. Dr. Ivie is a former member of the United States Air Force Medical Corps. She is a member of the American College of Obstetrics & Gynecology, and is a Junior Fellow with the American Medical Association. She completed her residency at University of Southern California School of Medicine in Los Angeles. Dr. Ivie is married with one child.

ERIC SMITH, PhD attended Kent State University where he graduated with his B.A. in psychology in 1971 and a B.S. in education in 1972. He received a graduate scholarship to pursue a Master’s degree in Behavioral Disorders, and then earned his Ph.D. in Educational Psychology. Dr. Smith began his career as a Probation Officer in Canton, Ohio. Dr. Smith moved to Las Vegas in 1977, where he was Supervising Clinical Psychologist for Clark County Juvenile Court and began his private practice. Dr. Smith opened the first Headache and Stress Clinic in Southern Nevada with a psychiatric group. Over a 5 year period, Dr. Smith was responsible for developing and implementing a stress management procedure for psychiatric inpatients as well as biofeedback clinic. As a Board Certified Forensic Examiner, Dr. Smith has been identified as an expert in Family and Juvenile Court, District Court, and Federal Court. STEVEN SAXE, MD initially earned his Bachelor’s degree at the University of Nevada, Las Vegas. Then received his Doctor of Dental Medicine degree at Washington University School of Dental Medicine in Saint Louis, Missouri. Dr. Saxe continued his education at Sinai Hospital of Detroit, completing a four year residency in Oral & Maxillofacial Surgery. His training was quite dynamic including Internal Medicine, General Surgery, Anesthesiology, Pediatric Anesthesiology, Craniofacial Surgery, Oral Pathology and extensive training in Oral Implantology. LISA LYONS, MD is board certified in Internal Medicine. She completed her residency at University Medical Center in Las Vegas, Nevada in 2000. Dr. Lyons received her undergraduate degree from The University of Nevada, Reno and then chose to study medicine at the University of Nevada School of Medicine. After residency, Dr. Lyons stayed in the valley practicing medicine where she focused on hospice and palliative medicine. In addition, she serves as a trustee for the University of Nevada, Reno foundation.

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Health Insurance is complicated. We’re the un-complicators. The new Nevada Health CO-OP became the fastest growing health insurance company in Nevada in just a matter of months. How? We un-complicated healthcare: • Lower Premiums – Our rates are among the most competitive in the state. • Quality Networks – Our Star plans give you access to WellHealth Star Doctors. • Personal Service –You’ll talk to a real human being each and every time you call us. Our customer service call times average less than a minute. • Convenience –You can also visit us at our walk-in center at 3900 Meadows Lane in Las Vegas. We can help, and we can help fast.

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