Beruflich Dokumente
Kultur Dokumente
DECEMBER 2015
Territory Neurology
& Research Institute
Clinica Amistad:
New room for needy
When physician
becomes patient
Sombrero
Pima County Medical
Society Officers
President
Melissa Levine, MD
President-Elect
Steve Cohen, MD
Vice-President
Guruprasad Raju, MD
Secretary-Treasurer
Michael Dean, MD
Past-President
Timothy Marshall, MD
Richard Dale, MD
Charles Krone, MD
Jane Orient, MD
R. Screven Farmer, MD
Board of Mediation
Timothy Fagan, MD
Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Mark Mecikalski, MD
Delegates to AMA
William J. Mangold, MD
Thomas H. Hicks, MD
Gary Figge, MD (alternate)
Printing
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Thomas Rothe, MD
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Michael F. Hamant, MD
secretary
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Winchester Ranch
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Vol. 48 No. 10
$595,000
Madeline Friedman
Vice President
296-1956 888-296-1956
Inside
5 Dr. Melissa Levine: Tis the (obesity)
season.
On the Cover
Sombrero followers know that two gearheads regularly contribute to the magazine. Can you name them? One is Dr. Hal
Tretbar, who says, A 1955 Porsche 356 Pre A Speedster may go
at auction for between $300,000 and $400,000. I took this
photo with a Nikon D600. By mistake, the ISO was at 1600, yet
the program mode took an excellent image at 1/2000th second
at f22.
According to the CDC, more than one third of adults in the U.S.
are obese. Among children age 2-19, 17 percent are obese. Some
of this is related to socioeconomic status. Preschoolers in families
that live below the poverty level have the highest level of obesity.
In girls, obesity has declined in the approximate 10 years from
2000 to 2010, in families whose adult head of household is a
college graduate, and the rate has increased where the adult
head of household has not completed high school.
Normal-weight men with increased belly fat have significant
increase in premature death than those without. A just-released
study of almost 15,000 adults, from Mayo Clinic Rochester, found
an 87 percent increase in premature death over the 14 years of
the study. Compare those same men with the Santa bellies to
overweight and obese men, the risk of premature death is only
double for the guys with belly fat.
The number for women was not quite as bad, but still stunning.
Normal-weight women with extra belly fat had a 50 percent increase
of premature death over women with a more even distribution, and
compared to obese women the increase was 32 percent.
A recent small study of 40 kids showed kids as young as 8 who are
obese may have structural damage to their hearts. They
compared 20 obese kids ages 8-16 with 20 normal-weight kids.
They excluded kids with diabetes, or who, tragically, were too big
to fit in the MRI machine. They scanned their heart muscle and
found that on average the obese kids had 27 percent increase in
muscle mass of the left ventricle. Forty percent of those kids were
already showing decreased pumping ability.
Once again from the CDC, the estimated annual medical cost of
SOMBRERO December 2015
38th
Favorable rates include deep
discounts on lodging, ski
Available Feb. 20th 28th.
6
2
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2014
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SOMBRERO December 2015
Membership
The heart and soul of Clinica Amistad includes, from left, founding board member
Ricardo Elford, Board President Evan Kligman, M.D., Clinic Manager Alicia Swift, and
Medical Director Rick Graap, M.D.
11
dont ask them to donate, but we get about $350 per month in
patient donations.
and patient donations, Dr. Kligman said. The rest come from
grants and fund-raisers.
The clinic does not do annual physical exams, but prevention is a big
part of its future. Dr. Kligman said that he would like prevention to be
at the top of his list for expansion of the clinic in the next five years.
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PCMS News
13
Columnist: ACA in
death spiral
In a piece chosen last month by The Week as among Best Columns
in the U.S., Betsy McCaughey of the New York Post said that the
Affordable Care Act is heading toward a death spiral.
The administration recently admitted that the number of people
enrolled in state insurance exchanges will inch up by around 1
million in 2016to 10 million or sofewer than half the 10 million
enrollees the Congressional Budget Office predicted in March.
rights, international transactions and disputes, personal injury, DUI, divorce, child
custody, and employment law.
www.wechv.com
An independent member of
MERITAS LAW FIRMS WORLDWIDE
AMB update
Meritus Health
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supervision
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Steven J.
Blatchford,
MD
A. J. Emami,
MD, FACS
James D.
Gordon,
MD
(520) 792-2170
Adam D. Ray,
MD
Green Valley
Sierra Vista
Marana
David T.
Miyama
MD
during the first month of the grace period, while providers are
responsible for the remaining two months. Providers have raised
concerns that large numbers of enrollees could receive care
during the grace period without ever paying their premiums,
leaving providers at risk of absorbing the cost of care.
Please encourage your patients to remain current on their
premium payments in order to retain their insurance coverage.
Have your office staff check patient insurance status and
information. Additionally, while participating in an exchange may
be voluntary, physicians may not be certain what plans they are
participating in, and should review their contracts or directly
contact insurance companies to determine what marketplace
plans include them as part of the network.
n
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Remote Receptionist
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Order Taking
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18
Preparing for
prescribing report card
Arizona law requires all medical practitioners, including MDs and
DOs, who are licensed under Title 32 and who possess a DEA
registration, to also possess a current Controlled Substances
Prescription Monitoring Program (CSPMP) registration issued by
the State Board of Pharmacy.
Earlier this year, ArMA reported in AzMedicine on the
Prescription Drug Monitoring Program (PDMP) Report Cards
being expanded by the Arizona CSPMP. The PDMP Report Card
offers all prescribers the opportunity to review their prescribing
patterns in relation to the average data of other prescribers in
their specialty type.
The State Board of Pharmacy operates the CSPMP and, as part of
their work to meet new legislative requirements, distributes the
Prescriber Report Card to all registered prescribers. They need
your help to update to e-mail addresses for all registrants. Please
register or log-in to verify that your email address is on file with
CSPMP at https://www.azrxregistration.com/Login.aspx.
19
I was looking for locations when I spotted this yellow and purple wall on a
furniture store. The store gave me permission to photograph and moved several
parked cars. The magazines art editor had asked for an artsy image, so I laid on
the ground and shot with a wide angle of 27mm for distortion. I lined up the purple
line to meet the bottom of the windshield and kept the yellow bricks perpendicular
on the left edge. I used manual focus at f.16 to ensure depth of field. ISO was 640
with color balance set on cloudy weather to warm up the overcast. The editors like
it so much that they gave it a two-page spread to introduce the seven-page article.
Weve been in Tucson for a long time, and I have been able to find
some great locations for car photography. I like an area that
doesnt have distracting elements such as buildings in the
background. Usually the light is best early or late in the
day, so keep that in mind.
The most common angle for an auto image is a three
quarters front view with either a slightly high aspect, or
low enough to show some light under the car. But I
usually take side and rear views if possible. I also take
both slight telephoto and mild wide angles to see which
proportion looks best.
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Makols Call
top it off, the airline moved our trip up by two hours on short
notice, cutting our sleep severely the night before our ridiculously
early morning takeoff. At least there were no flying birds to be
sucked into the enginethey were all still sleeping in the trees
when we took off.
For the last couple of years Ive had a borderline hypertension
condition, a borderline elevated cholesterol, and some have
claimed even a borderline personality disorder. I truly do wish
that my IQ had been going up as fast as my blood pressure
reading and cholesterol numbers. I also cant figure why I am
growing so much hair on my ears and so much less hair on my
head. But I digress. My main point is that eventually, every one of
us will become a patient, and perhaps this can be a learning
experience.
As a hospice physician, it is
incredibly satisfying to work with
a team of individuals totally
devoted to easing suffering for
patients and their loved ones.
This is why I became a doctor in
the first place.
520.544.9890 | www.casahospice.com
Hospice services are paid for by Medicare
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I did not touch my plate, and so my wife knew there was really
something wrong with me, and she said, Im going to take you to
Mary Greeley Hospital. Its a great hospital. I was born there, Of
course she neglected to tell me she had not been back there since
she was born, so we rode around for a bit looking for the hospital,
all the while Hulk Hogan still holding me by the throat. Finally, after
following one of those posted H for Hospital signs, we arrived at
the emergency department, and once they knew I was insured I
was whisked into a treatment room, and greeted by a lovely Aussie
nurse. Now I had just come back from Australia so we had a great
time talking about her country, but she did pause to tell me my
blood pressure was 198/104 and my pulse 120.
The story does have a happy ending. I passed a stress test on the
third day in the hospital, have no evidence of cardiovascular
disease, and my Tucson cardiologist thinks that it was a muscle
spasm in my neck. Interestingly, they did discharge me on no
medications, but luckily I was headed to Cedar Rapids, where I
have a friend who is a cardiovascular surgeon. He saw me as a
patient that next day, and immediately joked that because he was
a surgeon, he really didnt know much about treating hypertension,
but then proceeded to dazzle me with his knowledge of cardiovascular physiology. One beta blocker later my pressure was
controlled, and my pulse fell from 118 to 69 BPM.
I would like to point out that I was covered by Medicare and a good
AARP supplement policy, and out of the $11,000 bill for just five
hours in the ER, not counting the hospital stay, I have been billed for
$17.65 so far; they have even offered me a payment plan! Medicare
is a terrific insurance, not free, but available at a reasonable
monthly cost, and of course I have paid 2 percent of my income for
the last 20 years in Medicare taxes before ever being covered.
BUZZING
My blood pressure came right down, the tests were all normal, and
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We are preferred providers
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520.742.2845
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January 2016
Jan. 9: The Mayo Clinic 1st Annual Update on Infectious Diseases is
at Mayo Clinic Education Center, 5777 E. Mayo Blvd., Phoenix
85054; phone 480.301.8000. Accreditation TBD.
Course combines essentials of coccidioidomycosis with an update
on how to manage infections encountered in the outpatient
setting. New course is designed to enhance physicians knowledge
and ability to diagnose, treat, and prevent the infections they will
commonly see in practice. Topics include cocci; rapid diagnostic
tests for infectious diseases; differentiating viral and bacterial
infections in the office setting; managing common infections in an
era of multi-drug resistance; how to use new immunizations;
measles, MERS, chikungunya and moretools to help you
recognize and prevent spread of emerging infections; antimicrobial
stewardship; whats new in infectious diarrhea; update on UTIs;
whats new in management of skin, soft tissue and MRSA
infections; antibiotic prophylaxis for primary care; and Get Smart:
When to Suspect ABX Resistance and What To Do About It.
Contact: Mayo School of CPD, Mayo Clinic, 13400 E. Shea Blvd.,
Scottsdale 85259; phone 480.301.4580. mca.cme@mayo.edu
https://www.ce.mayo.edu
February 2016
Feb. 12-13: Mayo Clinic Scottsdales Enhancing Recovery After
Surgery 2016Improving the Quality of Recovery for the Patient
is at Pointe Hilton Tapatio Cliffs Resort, 11111 N. 7th St., Phoenix
85020. Accreditation TBD.
Enhanced recovery after surgery (ERAS) is a multidisciplinary
perioperative care pathway designed to reduce the stress response
during a patients surgical procedure and preserve organ function
while promoting early recovery, presenters say. This proactive
approach is comprised of interventions starting at preoperative
planning and continuing through intraoperative management and
post-operative care. The course will provide evidence-based best
practices on the ERAS approach. Breakout sessions provide
learners the opportunity to exchange ideas into improve patient
outcome and speed up patient recovery. Surgical, perioperative
and post-op teams are invited to attend.
March 2016
March 16-10: The 27th Annual Family Medicine and Internal Medicine
Update is at Westin Kierland Resort & Spa, 6902 E. Greenway Pkwy.,
Scottsdale 85254. Accreditation from AMA, AOA, AAFP.
Four-day course features the most recent medical update and
management strategies for various diseases, presenters say.
Program includes didactic lectures, Q&A panel discussions with
interactive format allowing for immediate audience participation,
Meet the Preceptor (MTP) luncheons for one-on-one interaction
with faculty, and various afternoon breakout sessions.
Contact: Mayo School of CPD, 13400 E. Shea Blvd., Scottsdale
85259; phone 480.301.4580; fax 480.301.9176. Website: http://
ce.mayo.edu/node/4985 mca.cme@mayo.edu .
March 31-April 2: Tackling Problematic Sinusitis: Module-Based
Solutions is at Mayo Clinic Education Center, 5777 E. Mayo Blvd.,
Phoenix 85054; phone 480.301.8000. Accreditation from AMA,
AOA, AAFP.
Website: https://ce.mayo.edu/surgical-specialties/content/enhancingrecovery-after-surgery-improving-quality-recovery-patient-2016
Mayos fifth symposium on challenging sinus disease is a modulebased approach to problematic sub-types of sinus disease. Experts
present latest research in patho-physiology and treatment, and a
live prosection, and hands-on nasal endoscopy training for medical
providers will be offered.. World leaders in otolaryngologyrhinology, allergy-immunology and basic sciences address most
challenging aspects of managing sinusitis and other rhinologic
disorders. Program includes expert debates and brainstorming
sessions using interactive formats with the goal of synthesizing
innovative management strategies based on the latest evidence,
and experience of global experts.
https://ce.mayo.edu/otorhinolaryngology/content/tacklingproblematic-sinusitis-module-based-solutions-2016
Contact: Mayo School of Continuous Professional Development,
Mayo Clinic Scottsdale,
Members Classifieds
MEDICAL OFFICE FOR LEASE - Well situated on
Northwest Medical Center campus with great visibility
on Orange Grove. Well designed, 4,300 square feet,
aesthetically-pleasing with high efficiency, suited for
4-6 providers, built in 2006. Features 12 exams rooms,
including 1 procedure room; 4 offices; and 1 large
reception area; spacious storage area for supplies;
at door parking. Available April 2016 (Current leaser
is merging with another practice) Competitive rates.
Contact Catherine Westerband, MD, 520-488-7515 or
cwesterband@genesisobgyn.net
FULL-TIME PEDIATRICIAN Great family and golf
community. Full-time Pediatrician BC/BE to join
well established Pediatric practice in Tucson, Az.
Competitive salary with excellent benefit package,
including bonus compensation. Send CV to kolleenr@
comcast.net
ATTENTION CARDIOLOGISTS Very busy central
Tucson cardiology office is seeking an experienced
cardiologist to join its practice. Interested candidates
contact Denise at timm@flash.net with resume or any
questions about the position.
Website design
SEO
Disc duplication
Digital printing B&W and color
UV Coating
Full-color digitally printed envelopes
Scan with
a QR code
reader enacted
phone.
26
520.624.4939 | 888.637.0337
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IMAGING 2016
Youre
Invited!
Marcus J. Dill-Macky, M.D.
Breast Cancer Screening:
What if I Do Nothing?
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