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SOMBR ERO

P i m a C o u n t y M e d i c a l S o c i e t y M a r c h 2012
Home Medical Society of the 17th United States Surgeon-General

Member saves member with new CPR Dr. Khaled Hadeli vs. Qaddafi

If you feel as if your practice is under attack, youre probably right.


With reimbursements shrinking and the integration of electronic medical records, treating your patients effectively
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MAIN OFFICE | 4400 E. Broadway | Tucson, AZ 85711 | Tel (520) 321-4500 | Fax (520) 321-1956 NORTHWEST OFFICE | 6400 N. Oracle Rd | Tucson, AZ 85704 | Tel: (520) 219-5000 | Fax: (520) 219-1100 www.bankoftucson.com

SOMBRERO March 2012

Official Publication of the Pima County Medical Society

Vol. 45 No. 3

Pima County Medical Society Ofcers


President Alan K. Rogers, MD President-Elect Charles Katzenberg, MD Vice-President Timothy Marshall, MD Secretary-Treasurer John Curtiss, MD Past-President Timothy C. Fagan, MD

PCMS Board of Directors


Diana V. Benenati, MD R. Mark Blew, MD Editor Stuart Faxon Phone: 883-0408 E-mail: tjjackal@comcast.net
Please do not submit PDFs as editorial copy.

Neil Clements, MD Michael Connolly, DO Bruce Coull, MD (UA College of Medicine) Alton Hank Hallum, MD Evan Kligman, MD Melissa D. Levine, MD Lorraine L. Mackstaller, MD Clifford Martin, MD Kevin Moynahan, MD Soheila Nouri, MD Jane M. Orient, MD Guruprassad Raju, MD Scott Weiss, MD Victor Sanders, MD (resident) Cambel Berk (student) Christopher Luckow (student) Art Director Alene Randklev, Commercial Printers, Inc. Phone: 623-4775 Fax: 622-8321 E-mail: alene@cptucson.com Printing Commercial Printers, Inc., Andy Charles Phone: 623-4775 E-mail: andy@cptucson.com

Members at Large
Kenneth Sandock, MD Richard Dale, MD

Thomas Rothe, MD, vice-president Michael F. Hamant, MD, secretary

Board of Mediation
Bennet E. Davis, MD Thomas F. Griffin, MD Charles L. Krone, MD Edward J. Schwager, MD Eric B. Whitacre, MD

At Large ArMA Board


Ana Maria Lopez, MD,

Pima Directors to ArMA Timothy C. Fagan, MD R. Screven Farmer, MD Delegates to AMA


William J. Mangold, MD Thomas H. Hicks, MD Gary Figge, MD (alternate)

Arizona Medical Association Ofcers


Gary Figge, MD, past president

Advertising Bill Fearneyhough Phone: 795-7985 Fax: 323-9559 E-mail: bill5199@simplybits.net

Publisher Pima County Medical Society Steve Nash, Executive Director 5199 E. Farness Drive, Tucson, AZ 85712 Phone: (520) 795-7985 Fax: (520) 323-9559 E-MAIL: steve5199@simplybits.net Website: pimamedicalsociety.org
SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/ September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual subscription price is $30. Periodicals paid at Tucson,

Arizona. POSTMASTER: send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily represent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Ofcers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted. Copyright 2012, Pima County Medical Society. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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SOMBRERO March 2012

CONTENTS

5 6 8 14 20 22 26

Presidents Page
What will polio eradication look like?

DEPAR TMEN TS
In Memoriam.................................. 18 Members Classieds..................... 26

Executive Directors Page


A decade of the breakthrough that is PCAP.

PCMS News
Dr. Norman Levine is still with us, thanks to Dr. Marcus Dill-Macky and the new CPR.

Behind the Lens


Dr. Hal Travelin Tretbar travels to a Phoenix upscale car auction that is its own kind of gem show.

Reality Check
Dr. Michael S. Smith on what to be aware of when swimming with orcas. On the Cover
This 1957 Maserati 3500 GT Berlinetta, on display at Phoenixs Biltmore Resort & Spa, was sold in January by RM Auctions for $165,000. For the one-of-a-kind car that didnt sell, see this months Behind the Lens (Dr. Hal Tretbar photo).

Medical Missions
Tucsons and Tripolis Dr. Khaled Hadeli and his year of living revolutionarily.

Conferences & Seminars


Dont forget TOMFs 21st Annual Southwestern Conference on Medicine coming up in Tucson April 26-29.

Love

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4 SOMBRERO March 2012

PresIdents pAGe

Could we do it again?
One of the most signicant medical victories of all time is about to occura victory whose progress has spared countless lives and reduced untold suffering while saving far more money than it cost to create. A program started in the 1930s has been so effective that the charitable organization spearheading it had to reinvent itself. The victory is over poliomyelitis, commonly called polio. This acute viral disease is characterized clinically by fever, sore throat, headache, and vomiting, often Dr. Alan K. Rogers with stiffness of the neck and back. In the minor illness, these may be the patients only symptoms. The major illness, which may or may not be preceded by the minor, is characterized by involvement of the central nervous system, stiff neck, pleocytosis in the spinal uid, and perhaps paralysis. There may be subsequent atrophy of groups of muscles, ending in contraction and permanent deformity [1]. In the next few years polio will be declared extinct. On Jan. 13, India went an entire year without a single polio case. Its eradication in India is a monumental accomplishment that required untold numbers of dedicated healthcare workers and years of dedication. Now only Nigeria, Pakistan and Afghanistan remain as polio holdouts. Polio has been endemic since ancient times. Egyptian pictographs show withered legs and crutches in the time of the pharaohs. Polio aficted many well-known people, from romance writer Sir Walter Scott to actor Alan Alda. Actress Mia Farrow spent time in an iron lung. Polio frequently strikes young children; it was once the worry of every parent. The peak polio epidemic in the U.S. occurred in 1952. I was born in 1954 and remember my mother worrying about polio. I had to nap every afternoon so I would not get polio and was forbidden to swim in the lake near my home for fear of contracting polio. The neighborhood pool was dangerous because of lurking polio. Ironically, polio epidemics began only when public sanitation and health measures improved in the 20th century. Most people contracting the virus do not get disease and afterward have immunity. Polio virus is spread by fecal oral route, so better sanitation left large groups nave to the disease. Without herd immunity, polio began to attack vast numbers simultaneously. Karl Landsteiner identied the poliomyelitis virus in in 1908. Hilary Koprowski developed the rst vaccine in 1950. In 1952 came the more effective Jonas Salk version. The game changed, however, in 1958 when the National Institutes of Health chose Albert Sabins oral polio vaccine for world vaccination because of its low cost, ease of administration, and great effectiveness. President Franklin D. Roosevelt founded the March of Dimes in 1938 to raise money to combat polio epidemics sweeping across America. Widespread vaccination started in the 1960s was possibly due to government funding, but also because of effective public relations campaigns and political clarity. In a little more than three decades polio was gone from the Western Hemisphere. Vaccination programs were so effective that the March of Dimes was forced to nd another cause, and changed to its mission to the prevention of birth defects. A nal push for world eradication started just 24 years ago by the combined efforts of the World Health Organization, UNICEF, and
SOMBRERO March 2012

the Rotary Foundation. I am proud to say I am a long-term Rotary member, and so I have contributed in a small way to polios defeat. Rotary has the unique advantage of being a worldwide NGO that is able to cross borders and sidestep Third World geopolitical issues. Why are Nigeria, Pakistan, and Afghanistan still aficted with polio? Clearly not the lack of scientic knowledge; we know how the virus works and the vaccines are gloriously effective. It is not a lack of funding. Obstacles to vaccinating everyone in countries lacking infrastructure and education are daunting, but these obstacles have been overcome elsewhere. So what is the problem? A major factor is political. Inadequate and corrupt governments block or fail to aid eradication efforts, and engage in political rivalries and warfare. Parts of the Third World have citizen lack of trust of healthcare workers intentions. Reportedly, a 2005 Islamic fatwah issued in Nigeria declared polio vaccination to be a conspiracy of the United States and United Nations to sterilize true believers. Total eradication will require overcoming political and cultural obstacles in the Third World more than more funding or a new scientic breakthrough. But what about the United States? Could we accomplish a victory over polio again? Eradication efforts started in the 1960s, an era without our current trial lawyer/liability lawsuit industry. The public generally trusted public ofcials and public health edicts. The lack of instant media made it hard for crackpots to make their views widely known. Things have changed. Most Americans alive today do not know polio. Absence of withered limbs and iron lungs have made us complacent. Rates of vaccination for all childhood diseases have fallen due to apathy and cost. Well-meaning but ignorant celebrities campaign against vaccinations for a variety of non-scientic reasons and create mistrust. MTV personality Jenny McCarthy comes to mind. (Reality check: measles vaccination does not cause autism. It just doesnt. Measles is a serious disease with a signicant death rate.) Mandatory vaccinations became required in the 1960s for school admittance. Would we be able to start mandatory school immunizations today? Possibly not. Texas Gov. Rick Perry famously tried to make human papilloma virus vaccination mandatory but met a restorm of protest from conservatives right across to the liberal left. A recent bill before the Arizona Legislature would have allowed community colleges and private schools to opt out of vaccination requirements. Our mission as physicians must be to overcome hysteria and fuzzy thinking with scientic fact and accurate PR campaigns. We must remain politically active to combat poorly thought-out government policy. I call on all of us to aid in that effort. What about the future? Once polio is extinct, vaccinating for it will not be necessary. But will the virus truly be gone? A sobering fact about another extinct disease: the last case of smallpox in the world occurred in a laboratory worker in England. Therefore stockpiles of smallpox virus exist in laboratories around the world. Within a generation our immunity to smallpox will be gone and it will become a potent weapon. Could this occur with polio? I will be interested to see the media coverage when polio is nally declared extinct. I suspect the eradication of polio will not get the attention it deserves. REFERENCE [1] Dorlands Illustrated Medical Dictionary 24th ed. WB Saunders Co. 1965.
5

eXecUtIVe dIrectors pAGe


The meaning of PCAP


Arizona had 100 candles on its cake Feb. 14, and all of us took a brief look back at a century of progress and hopes from when our state became the last admitted to the union in the lower 48. Throughout that time, Tucson physicians have made breakthrough contributions in making Arizona a livable, attractive place to take a stand. Over the last decade one contribution seems to bubble to the top: the Pima Community Access Program (PCAP).
Kevin Bowers, MD Thomas Boyer, MD Patrick Boyle, MD Richard Boyle, MD Caryl Brailsford-Gorman, MD Bradley Brainard, MD John Braunstein, MD Warren Breidenbach, MD Dean Brick, MD Jenny Brick, MD Steven Brick, MD Steven Brower, MD Lansing Brown, MD Mack Brown, MD Mark Brown, MD Thomas Brown, MD Rosemary Browne, MD Jared Browning, MD Edward Bryne-Quinn, MD Annemarie Buadu, MD Harvey Buchsbaum, MD Pooja Budhiraja, MD Dariusz Bulczak, MD Kimberly Burkholz, MD Robert Burman, MD Kim Burroughs, MD Julien Caillet, MD Craig Cain, MD Karen Caldemeyer, MD Diego Calonje, MD Brian Cammarata, MD Andrew Campbell, MD Michael Capp, MD Ligia Paulina Cardenas, MD Carlos Gerardo, MD Ann Carlson, MD Kevin Carmichael, MD Raymond Carmody, MD John Carolan, MD Gordon Edmund Carr, MD Harry Carrozza, MD Colin Cavenaile, MD Setsuko Chambers, MD Pong Chanvitayapongs, MD Songsiri Chanvitayapongs, MD Ang Chen, MD John Chen, MD Jason Chesley, MD Ananthakrishna Chilukuri, MD Margaret Chilvers, MD Stephanie Chin, MD Alexander Chiu, MD Parina Cho, MD Kenneth Choi, MD Scott Clark, MD Cathryn Cohen, MD Russell Cohen, MD Alan Cohn, MD James Collins, MD Brenda Conners, MD Bruce Coull, MD Janiel Cragun, MD Lee Cranmer, MD Bratu Cristian, MD Christopher Cunniff, MD John Cunningham, MD Clara Curiel, MD Stephen Curtin, MD Daines Cori, MD Michael Daines, MD Steven Dalbec, MD Shawn Daley, MD Matthew Dang, MD Murray DAngelo, MD Jonathan Daniel, MD Mark Davis, MD Thomas Davis, MD Ives De Chazal, MD Michale De Long, MD Gregory De Silva, MD Rajen Desai, MD Sarah Desoky, MD Marcus Dill-Macky, MD Hannah Dillon, MD Megan Dixon, MD Laurie Dodd, MD Shona Dougherty, MD Jeffrey Dowling, MD Leona Downey, MD Tomislav Dragovich, MD Kendra Drake, MD Sarah Ducharme, MD Curtis Dunshee, MD Elka Eisen, MD Sean Elliott, MD Emad Elquza, MD David Emmerson, MD William Erly, MD Audrey Erman, MD Carlos Escalante, MD Luis Esparza, MD Miguel Estevez, MD Lois Estok, MD James Evans, MD Gordon Ewy, MD Amit Fadia, MD Lionel Faitelson, MD R. Screven Farmer, MD Ronnie Fass, MD Jorge Favela, MD Thomas Fay, MD Susan Feather, MD Mark Feldman, MD Richard Feldman, MD Paul Fenster, MD Jose Fernandez, MD Daniel Ferry, MD Victoria Fewell, MD Martha Fielder, MD Terry Fife, MD Lisa Finch, MD William Fishkind, MD Kimberly Fitzpatrick, MD Amanda Fitzwater, MD Gary Flacke, MD Donald Foley, MD Stanley Foutz, MD Stephen Fox, MD Nicholas Fraley, MD Irwin Freundlich, MD Arnold Friedman, MD Randall Friese, MD Joel Funk, MD John Funk, MD

Steve Nash
Aiden Abidov, MD Thomas Abram, MD Rodney Adam, MD Ilana Addis, MD Karen Aderholt, MD Punit Aghera, MD James Aguilar, MD Geoffrey Ahern, MD Norman Ahl, MD Jamil Ahmed, MD Taro Aikawa, MD David Alberts, MD Stephen Algeo, MD Joseph Alpert, MD Todd Altenbernd, MD Rana Ammoury, MD Quinlan Amos, MD Quentin Anderson, MD Emil Annabi, MD Rein Anton, MD Emmanuel Apostol, MD Manuel Arreguin, MD Veronica Arteaga, MD Boyd Ashdown, MD Matthew Atlas, MD Catherine Azar, MD John Badal, MD Philip Bain, DO Michael Baker, MD Virginia Baker, MD Brock Bakewell, MD Frank Bakke, MD Colin Bamford, MD Bhaskar Banerjee, MD Brent Barber, MD Steven Barker, MD Mitzi Barmatz, MD Jeffrey Baron, MD Eric Barrett, MD Robert Bastron, MD Charles Bazzell, MD Susan Bazzell, MD J. Bernardo Bebeil, MD Paul Bejarano, MD Michael Belin, MD Matthew Bell, MD Joseph Bellal, MD M. David Ben-Asher, MD Philip Benedetti, MD Ronnie Bergen, MD Scott Berman, MD Lynn Bianchi, MD Maria Bishop, MD John Bjelland, MD Melissa Bloch-Menschik, MD John Bloom, MD Joelle Boeve, MD Jennifer Bogan, MD Bradley Bohnert, MD Dmitry Bolkhovets, MD Joseph Bonomolo, MD Michal Bookman, MD Troy Borboa, MD Guy Borders, MD Marisa Borders, MD Sudeshna Bose, MD John Boulet, MD

Begun just after Arizona expanded AHCCCS eligibility to 100 percent of the federal poverty level, PCAP serves our Tucson neighbors who work, and earn between 100 and 250 percent of the federal poverty level. Although physicians and hospitals in the pro gram offer substantially reduced fees, this is no gimme. Patients must pay their portion, and most are glad to do so because they want a hand up, not a handout. Since 2001, PCAP has helped 41,426 Pima County residents. Medical bankruptcies have been prevented, and savings accounts preserved. For more information about the program, or to sign up, call Susa Frasquillo at 309.2931. Here are the physicians who made this program possible since 2001.
John Galgiani, MD Eric Gall, MD Steven Galper, MD Carlos Galvani, MD Dietmar Gann, MD Charles Gannon, MD Linda Garland, MD Rouba Garro, MD Arnold Gee, MD Brenda Gentz, MD Thomas Geron, MD Fayez Ghishan, MD Wendell Gibby, MD Dorothy Gilbertson-Dahdal, MD Katherine Gillaspy, MD Chris Glynn, MD Cynthia Goldberg, MD Steve Goldschmid, MD Gary Goldstein, MD Stephen Goldstein, MD Isaac Gomez-Avraham, MD Keith Gonzalez, MD Victor Gonzalez, MD Joes Goode, MD Margaret Goodman, MD Dhawal Goradia, MD Kaoru (Kay) Goshima, MD Ronald Gottlieb, MD Roni Grad, MD William Grana, MD Cheryl Grandone, MD Rafael Grau, MD John Graziano, MD Jerry Greenberg, MD Matthew Gretzer, MD Kurt Grifn, MD Arthur Groves, MD Kristen Grubb, MD Marlon Guerrero, MD Alfredo Guevera, MD Puja Gupta, MD Andrew Gyorke, MD Kai Haber, MD Shahid Habid, MD David Hafner, MD Stuart Hameroff, MD Aaron Hammond, DO Laurence Hanelin, MD Angela Hanga-Roche, MD Aileen Har, MD Jolene Clark Hardy, MD April Harris, MD Jules Harris, MD Hesham Hassan, MD Kenneth Hatch, MD Lisa Hazard, MD David Heaton, MD Michael Hecht, MD Amy Hellbusch, MD Jeffrey Hellbusch, MD Gary Henderson, MD Michelle Herman, MD Annette Hernandez, MD Magdiel Trinidad Hernandez, MD Evan Hersh, MD John Hettiarachchy, MD Robert Heyer, MD Thomas Hicks, MD Adora-Marie Higgins, MD George Hishaw, MD Bradley Holt, MD Charles Hoo, MD Craig Hoover, MD Susan Hoover, MD Holli Horak, MD Robert Horvath, MD Lawrence Housman, MD Lori Hudson, MD John Hughes, MD Daniel Hughes, MD K. Rebecca Hunt, MD Tim Hunter, MD Teh-Li Huo, MD Craig Hurst, MD Jose Hurtado, MD Mark Iannini, MD Rehan Iftikar, MD Julia Indik, MD Lindsey Inouye, MD Abraham Jacob, MD Wayne Jacobson, MD Leslie Jacobson, MD Mindy Jan, MD Cameron Javid, MD Sasanka Jayasuriya, MD David Jeck, MD Tracy Jeck, MD Joanne Jeter, MD Lalita Jha, MD Adam Johnson, MD David Johnson, MD R. Hill Johnson, MD Lili Jordan, MD Stephen Kaczynski, DO Stella Kahn, MD Bruce Kaplan, MD Val Kaplan, MD Christos Karabinas, MD Paul Kartchner, MD Zane Kartchner, MD Lawrence Kaskowitz, MD Emmanuel Katsanis, MD Jay Katz, MD Jeffrey Katz, MD Charles Katzenberg, MD Farhad Keliddari, MD Kevin Kelly, MD Karl Kern, MD Robert Kersh, MD John Kettelle, MD Khalid Khan, MD Toseef Khan, MD David Killion, MD Byung Kim, MD Jae Kim, MD Steven Kim, MD Jay King, MD Kim King, MD James Klein, MD Shayna Klein, MD Scott Klewer, MD Evan Kligman, MD Robin Kloth, MD Stephen Klotz, MD James Knepler, MD Steve Knoper, MD Kenneth Knox, MD Sitara Kommareddi, MD Lisa Kopp, DO Theresa Kramer, MD Edmund Krasinski, DO Sarah Kratz, MD Kerry Kreidel, MD Vincent Kresha, MD Rivitharan Krishnadasan, MD Joseph Kryc, MD Hemant Kudrimoti, MD Wendi Kulin, MD Phillip Kuo, MD Barry Kusman, MD John La Wall, MD Greg Labenz, MD David Labiner, MD Martha Laird, MD Lareyenth Lancaster, MD Clyde Lance, MD M. Peter Lance, MD Lou Lancero, MD Lisa Lane, MD Julie Lang, MD David Lapan, MD Mark Lathen, DO Leonard Latt, MD Andrew Laurie, MD Michael Lavor, MD Gregory Lawrence, MD Daniela Lax, MD Jaime Ledesma, MD Jong Lee, MD Kwan Lee, MD John Anthony Lee, MD Laura Lee, MD Hong Lei, MD Gerald Lemole, MD Jason Levine, MD Norman Levine, MD Kai-Uwe Lewandrowski, MD Peter Lichtenthal, MD Howard Lien, MD Mark Lin, MD Bai Liqun, MD Jeffrey Lisse, MD Perry Liu, MD Robert Livingston, MD Robert Loeb, MD Joy Logan, MD Ana Maria Lopez, MD Michael Lopez, MD David Lorenz, MD Pamela Lotke, MD Kapildeo Lotum, MD Anthony Lucas, MD David Lucas, MD Layla Corral Lucas, MD Richard Lucio, MD Ulrich Luft, MD Paul Lui, MD Sahba MaAni, MD James Macdonald, MD Machaiah Madhrira, MD Rebecca Madigan, DO

SOMBRERO March 2012

Rebecca Magno, MD Daruka Mahadevan, MD Jedidiah Malan, MD John Maltry, MD Jeff Maltzman, MD Anthony Manson, MD Donald Mar, MD Eugene Mar, MD Frank Marcus, MD Fernando Martinez, MD Ryan Matika, MD Matthew Mazurek, MD Alan McBride, DO Mark McClain, MD Sean McCafferty, MD Ann McColgin, MD Wendy McCurdy, MD N. Troy McDaniel, MD Kevin McDonnell, MD Kevin McGarvey, MD Kimberly McLaughlin, MD Shawn McManimon, MD John McNerney, MD John Medlen, MD Laura Meinke, MD Matthew Mendlick, MD Derek Merrill, MD William Meyer, MD Michael Bracht, MD Margaret Miller, MD Thomas Miller, MD Timothy Miller, MD Joseph Mills, MD Amy Mitchell, MD Frank E. Molls, MD Gary Monash, MD Nicholas Montalto, MD Patricia Montemayor, MD Adolben Montesclaros, MD David Moon, MD Monty Morales, MD Frank Morello, MD Jessica Moreno, MD Wayne Morgan, MD John Morrison, MD Jeramy Mosburg, DO Michael Moulton, MD Poornima Mukerji, MD Brian Mulkerin, MD Kim Mulligan, MD James Myer, MD Anil Nabha, MD Abhilash Nair, MD

Sita Narayanan, MD Narong Kulvatunyou, MD Gil Narvaez-Soto, MD Grant Nelson, MD Valentine Nfonsam, MD Mike Nguyen, MD Nam Nguyen, MD Bradley Nichols, MD Gregory Nichols, MD John Nichols, MD Brian Nielsen, MD Wallace Nogami, MD Wayne Oakeson, MD Sean OBrien, MD Matthew Offerdahl, MD Edward Oh, MD Peter Oh, MD Terence OKeeffe, MD James Okoh, MD Jason Oliphant, MD Christopher ONeill, MD Evan Ong, MD Kimball Orton, MD Maria Ospina, MD Peter Ott, MD Charles Otto, MD Theron Ovitt, MD Francisco Pacheco, MD Jeffrey Packer, MD Samata Paidy, MD Craig Palmer, MD Benjamin, Paras, MD Michael Parseghian, MD Sairam Parthasarathy, MD Chetanbabu Patel, MD Jitesh Patel, MD Priti Patel, MD Tushar Patel, MD Marc Paul, MD Ranie Pendarvis, MD Lisan Peng, MD Darren Peress, MD Daniel Persky, MD Mark Peterson, MD Todd Peterson, MD Richard Petronella, MD John Pettit, MD Theodore Phillips, MD Jeanette Pitts, MD Gary Podolny, MD Donald Porter, MD James Posever, MD Robert Poston, MD

William Prickett, MD Cheryl Putman, MD Rhoda Quick, MD Thomas Quigley, MD William Quinlan, MD Eduardo Quinones, MD Santiago Ramirez, MD Nicholas Ransom, MD Theodore Rasoumoff, MD Robert Rauch, MD Yuval Raz, MD Stephanie Reddick, MD Daniel Redford, MD Heather Reed, MD Bruce Reiner, MD Jennifer Reinhart, MD Annette Revak, MD Elson Revak, DO Christopher Reynolds, MD Edward Rhee, MD Peter Rhee, MD Birger Rhenman, MD Joshua Rieke, MD Jose Rios, MD Franz Rischard, DO Alejandro Rivero, MD Sergio Rivero, MD Donald Roach, MD Murray Robertson, MD Hugo Rocha-Mendez, MD William Roeske, MD David Rogers, MD Lee Rogers, MD Steven Rosenfeld, MD Richard Rossin, MD Thomas Rotkis, MD Stephen Rowe, MD Creed Rucker, MD Adam Rulnick, MD Ryan Barton, MD Egbert Saavedra, MD Rizwan Safdar, MD Gary Saito, MD Johan Samanta, MD Joseph Samson, MD Ricardo Samson, MD O. Sang, DO Donnie Sansom, DO Sujata Sarkar, MD Sam Sato, MD Katalin Scherer, MD Martin Schiff, MD Harry Schlosser, MD

Amy Schneider, MD Julie Schoeneman, MD Kai Schoenhage, MD Katherine Schuppert, MD Kent Scott, MD Philip Serlin, MD Rageev Seth, MD Gulshan Sethi, MD Julie Shaffrey, MD Rajul Shah, MD Sanjay Sharma, MD Gary Sharp, MD Scott Sheftel, MD Ziad Shehab, MD David Sheinbein, MD John Shekleton, MD Joseph Sheppard, MD Scott Sherman, MD Scott Sherman, MD Mohammed Sikder, MD John Siler, MD Erica Simon, MD Steven Siwik, MD Scott Slagis, MD James Slattery, MD Marvin Slepian, MD James Sligh, MD Allen Sloan, MD Joshua Smith, MD M. Christina Smith, MD Linda Snyder, MD Mitchell Sokoloff, MD Rodney Solgonick, MD Baldassarre Stea, MD Thomas Stejskal, MD Otis Stephen, MD Lawrence Stern, MD Robert Stern, MD Bruce Stevens, MD Michael Stevens, MD Bruce Stewart, MD Laiandrea Stewart, MD Alison Stopeck, MD Paul Strautman, MD Daniel Strifoc, MD Benjamin Strong, MD Craig Stump, MD Albert Su, MD Sreekumar Subramanian, MD Krista Sunderman, MD Amy Sussman, MD Harold Szerlip, MD Molly Szerlip, MD

Mark Takaki, MD Mihra Taljanovic, MD Andrew Tang, MD Chen Taylor, MD Kurtis Tedesco, MD Amy Tempkin, MD Lawrence Tempkin, MD Janet Teodori, MD Michael Teodori, MD William Thomas, MD Jess Thompson, MD Stephen Thompson, MD Cynthia Thomson, MD Stephen Thomson, MD Salavtore Tirrito, MD Gregory Titus, MD Katherine Tobin, MD Fredy Toiber, MD Richard Toothman, MD Myrka Torres, MD Michael Trakas, MD Ann Tran, MD Harold Trief, MD Vinod Trivedi, MD Eugene Trowers, MD Dax Trujillo, MD Patrick Tsai, MD Pei Tsau, MD Paul Tsong, MD Todd Tucker, MD Ajay Tuli, MD Barton Turecki, MD Linda Turner, MD Christian Twiss, MD Gerlinde Tynan, MD Evan Unger, MD Jorge Uribe, MD Roxanna Ursea, MD Mauricio Valdes, MD Santiago Valdes, MD Celia Valenzuela, MD Cindy Van Praag, MD Matthew Vanasco, MD Vaz Berchman, MD Cassie Volker, MD Dimitri Voulgaropoulos, MD Amy Waer, MD Reuben Wagelie, MD Amy Wagelie-Steffen, MD Marius Wagner, MD Jonathan Walker, MD Conrad Wall, MD Josh Walsh, MD

Mark Walsh, MD Paul Walshaw, MD Jon Wang, MD Mingwu Wang, MD James Warneke, MD Travis Warner, MD Danielle Weems, MD Debra Weidman, MD Martin Weinand, MD Andrew Martin Welch, MD Mark Wheeler, MD David Whittman, MD K. Ted Wickstrom, MD Jason Wild, MD John Wild, MD Kurt Wineinger, MD Jerrold Winter, MD Brenda Wittman, MD Derrik Woodbury, MD Edward Woolsey, MD Julie Wynne, MD Xu Guihong, MD Scott Yale, MD Hussein Yassine, MD Andrew Yeager, MD David Yocum, MD Mark Yoshino, MD Julie Zaetta, MD Tirdad Zangeneh, DO Tausif Zar, MD Alan Zehngut, MD William Zinn, MD Jeffrey Zorn, MD Jiyao Zou, MD ODs Randall Siekert, OD J. Daniel Twelker, OD DPMs David Armstrong, DPM Barbara Aung, DPM Anram Dahukey, DPM Scott Evans, DPM Barton Fink, DPM Brian Lepow, DPM Glen Nelson, DPM John Powers, DPM Richard Quint, DPM Gilbert Shapiro, DPM Jodi Walters, DPM Loren Wessel, DPM

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Member saves member


An old journalism maxim is that if a dog bites a man, thats not news, but if man bites dog, thats news. On that scale, one PCMS member saving anothers life must be off the chart. We heard in the February issue of Vistas, newsletter for members of Ventana Canyon Golf & Racquet Club, in a report by club CEO and General Manager George White, that he recommends the online video explaining the new life-saving cardiopulmonary resuscitation (CPR) technique developed at the UofA College College of Medicine, available at http://tinyurl.com/2fx8r59. And subsequently he had even more reason for the recommendation. If you view this video, he wrote, you will come away with enough information to assist in a situation where someones life is on the line. There is no better example of this than the recent incident at the club where one of our tennis members, Dr. Marcus Dill-Macky, intervened to save the life of fellow member Dr. Norman Levine, by performing chest compressions immediately after Norm collapsed on the tennis court. Both physicians are PCMS members. Dr. Dill-Macky continued compressions until the clubs Automatic External Debrillator (AED) arrived, White reported. After several shocks, Norm regained consciousness. Then he was wheeled to a waiting ambulance and taken to TMC where he received triple bypass surgery the following day. I am happy to report that Norm is recovering and should be home from the hos pital soon. Dr. Dill-Macky is the real hero here, thanks to his quick response and the use of the clubs AED. We hope to see Norm back on the courts playing tennis very soon. At PCMS we are equally happy to add that Dr. Levine went home on Feb. 2 and was reported to be doing well.

Dr. Green new TSS president


Donald D.J. Green, M.D. has been named president of the Tucson Surgical Society, a 90member, not-for-prot professional organization of physician surgeons, TSS Administrative Coordinator Bill Fearney hough reported Jan. 24. The 43-year-old board-certied surgeon has practiced in Tucson since August 2011 and is currently with Trauma and General Surgery at University of Arizona Medical Center University Campus, 1501 N. Campbell Ave., and UMCSouth Campus, 2800 E. Ajo Way. Dr. Green earned his M.D. at University of Washington at Seattle. He completed his GS residency at University of Arizona Afliated Hospitals, and a fellowship in Surgical Critical Care from the University of Southern California, Los Angeles. He served 10 years on active duty in the U.S. Navy. He is a Fellow of the American College of Surgeons and a member of the Association for Surgical Education and the Special Operations Medical Association. Dr. Green replaces Charles A. Atkinson, M.D., who now serves as TSS past- president.

Dr. Gordon named chief of staff


Family practice physician Paul Gordon, M.D., M.P.H. has been elected to a one-year term as chief of staff at University of Arizona Medical CenterUniversity Campus, the university reports. The appointment took effect Jan. 1. Elected by the hospitals medical staff, Dr. Gordon will be the chief administrative ofcer for the more than 700 university and community physicians who practice at The University of Arizona Medical CenterUniversity Campus. He also will serve as chairman of the hospitals Medical Executive Committee. Dr. Gordon, a professor in the University of Arizona Department of Family & Community Medicine, has been a board-certied family practice physician in Arizona since 1986. He received his medical degree at Mount Sinai School of Medicine in New York
SOMBRERO March 2012

If you dont vote for my candidate, youre nuts!


Its a year for all things political, so Sombrero is opening it pages to members who have aligned themselves with candidates whom they feel worthy to be our next U.S. Senate member, House of Representatives member, state representative, or county supervisor. Arizonans in abundant numbers have announced their intentions to run. Now its time to make your case, an opportunity to persuade your colleagues that the choice youve made is the right choice for them in the coming elections. So you are welcome to do it in Sombrero, or possibly a special election edition, for all to read, dissect, and digest. Its time for a robust discussion of candidates and were here to assist! Interested members willing and anxious to pen an op-ed piece on behalf of their candidate should reach Bill Fearneyhough at the society to talk deadlines and submission guidelines. E-mail bill5199@simplybits.net, or call 795.7985.
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and completed his internship and residency in family medicine at the University of Rochester. He also completed a faculty development fellowship and Master of Public Health degree at the UofA. Dr. Gordon practices full spectrum family practice, including care of hospitalized patients, maternity care and child care. His research interests include womens health, delivering medical services to underserved populations, and education. As a College of Medicine professor he teaches and supervises family practice resident physicians and medical students. Dr. Gordon succeeds outgoing Chief of Staff Scott Klewer, M.D. Neurosurgeon G. Michael Lemole, M.D., is chief-of-staffelect. Also elected to the hospitals Medical Executive Committee are John A. Guisto, M.D., secretary-treasurer; and members-at large Peter Rhee, M.D., Ana Maria Lopez, M.D., Bruce Kaplan, M.D., and David T. Hafner, M.D.

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Dr. Isersons book out


Improvising medicine at the District Hospital in Kapiri-Mposhi, Zambia in 2011, Dr. Ken Iserson warms a post-resuscitation severe preemie with a lightbulb warmer (Photo courtesy Dr. Iserson).

Peripatetic and alphabetic Kenneth V. Iserson, M.D., M.B.A., F.A.C.E.P., F.A.A.E.M., Fellow of the International Federation of Emergency Medicine and UofA professor emeritus, reports that McGraw-Hill has just published his newest book, Improvised Medicine: Providing Care in Extreme Environments. The intended audience is all healthcare professionals who practice in the midst of disasters or other resource-poor settings, Dr. Iserson said. A more complete description of the book, including the publishers short-term 20 percent discount offer, can be directly accessed at: h t t p : / / w w w. m h p r o f e s s i o n a l . c o m / p r o m o / i n d e x . p h p ? promocode=iserson&cat=39 The 6x9 578-page paperback retails for $54, or $42.50 with the offer. It is full of practical clinical pearls and proven strategies to show you how to operate outside your comfort zone and devise effective treatment solutions when the traditional tools (medications, equipment, and staff ) are unavailableor when you need to provide care outside of your specialty. The publisher calls it a must for anyone who plans to deliver healthcare under challenging eld conditions in global, disaster or other resource-poor settings.
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You can learn how to: 3 Make an endotracheal tube in seconds. 3 Perform digital-oral and blind-nasotracheal intubations. 3 Make plaster bandages for splints/casts. 3 Give open-drop ether, ketamine drips, and halothane. 3 Use subcutaneous/intraperitoneal rehydration/transfusion. 3 Make ORS and standard nutrition formulas. 3 Clean, disinfect, and sterilize equipment for re-use. 3 Warm blood units in seconds inexpensively. 3 Take/view stereoscopic X-rays with standard equipment. 3 Quickly and easily stop postpartum hemorrhage. 3 Fashion surgical equipment from common items. 3 Evacuate patients easily from high-rise hospitals. 3 Make esophageal and precordial stethoscopes. 3 Quickly improvise a saline lock. 3 Make ECG electrode/debrillator pads and ultrasound gel. Two Amazon.com reviewers gave the book ve stars. J. Hopkins: I highly recommend that it is on every M.D.s shelf and any person interested in working in a disaster environment would do very well to have this book as well. Troy A. Lettieri: This book does an excellent job of providing advance skills to layman and professional I have read various books on emergency, primitive, survivalist and backcountry medical care, and none have compared to this text.

and have six children, of whom JudeJu Juis youngest. Not only is Dr. Huether board-certied, but were told he also knows that Mommy is always right. Dr. Huether practices at 5980 N. La Cholla Blvd. The practices website is www.azskincancer.com. For more information about the book, please log into www.meetjuju.com.

PCMS Walks With a Doc

Huethers address kids and sunblock


Amy and Dr. Michael Huether (thats pronounced heater), of Arizona Skin Cancer Surgery Center, P.C., have entered the juvenile ction category with Ju Ju and the Sunblock. As a dermatologist and Mohs surgeon, I know personally how difcult it is to get kids to wear sunblock, Dr. Huether said. My wife and I have six of them who resist it daily. In addition to treating thousands of skin cancer cases every year, I also have a very personal connection. My younger sister, Lisa, was diagnosed with melanoma last year. I am passionate about skin cancer prevention. The book is dedicated to Auntie Lisa, all other skin cancer survivors, and to the memory of those who did not survive. This is why my wife Amy and I teamed up to write Ju Ju and the Sunblock. As parents, we recognize the importance of educating at an early age. Ju Ju is intended to be a fun and engaging way for parents to teach their children about protecting their skin from harmful UV radiation, Dr. Huether said. Our goal is to get this tool into the hands of as many children and educators as possible. We hope it will be a message that stays with them for a lifetime. We believe that the more children and families we can reach, the lower their risk for developing skin cancer later in life. Amy and Michael have been married for more than 20 years
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This was a happy group of bipedal and quadrupedal walkers at PCMSs Just Walk/ Walk With a Doc event Feb. 11. Walk With a Dog is optional (Steve Nash photo).

Pima County Medical Society, along with Carondelet Health Network and El Rio Health Centers, has joined the national organization Just Walk/Walk With A Doc, and has started programs for patients to walk with a physician this year. All our missions involve improving public health, PCMS Executive Director Steve Nash said. We want our neighbors all to become more active and one way to do that is to show them that they indeed can walk a mile. Beginning last month, PCMS, CHN and El Rio each began to host one walk on three different Saturdays every month through May, and probably will throughout the summer and into fall. Each walk will be led by a physician who will give a brief overview of the benets of exercise, and answer general questions during the walk. You can send your patients to any of the walks. Sample prescription pads were sent in our newsletter. Walks are open to anyone, and courses are generally at with some small hills. Advise patients to wear comfortable shoes. They may bring a cane or walking stick, and a bottle of water. Patients should be advised that a monthly walk should not be their only physical activity, Nash said. They are free to come again, but we really just want to give them the condence, and a safe place, to start walking. Walk schedules are posted at www.pimamedicalsociety.org . CMS and Carondelet use Rillito River Park. Have patients use the parking lot on the east side of Swan, just south of the bridge. The group meets at the ramada by the water fountain. PCMS began Feb. 11 and will walk March 10, April 14, May 12, and June 9. For the March walk, please arrive between 7:30 and
SOMBRERO March 2012

7:50 a.m; it will begin at 8 a.m. April through June, please arrive between 6:30 and 6:50 a.m. Walks will begin at 7 a.m. For any questions, please call 795.7985. Just Walk/Walk With a Doc is a program founded in 2005 by David Sabgir, M.D., a board-certied cardiologist in Columbus, Ohio, and now has 40 sites nationwide. Just Walk is a non-prot organization dedicated to encouraging healthy physical activities for people of all ages and tness levels. For more information, the website is www.walkwithadoc.org.

Pima County Medical Foundation schedules Evening Speaker Series


Pima County Medical Foundations Evening Speaker Series is on the second Tuesdays in February, March, April, May, June, September, October, and November, often including CME. Dinner is at 6:30 p.m., speakers presentation at 7. Coming topics conrmed as of this month are: March 13: Compression-only CPR with Dr. Karl Kern. April 10: Bruce Parks, M.D., retired Pima County medical examiner, presents a forensic pathology lecture in honor of the late Dr. Richard Froede.

Committee invites members, guests for SE AZ tour


PCMS members can join the PCMS History Committee on a jaunt to Southeast Arizona on Saturday, April 14, for a guided tour of Fairbank, Tombstone and (if theres time) the jail/museum in Gleason. There is no charge, you can drive or ride, and any PCMS member and guest are eligible to go. Please call 795.9484 to reserve your spot. The tour will leave from the PCMS parking lot at 7:30 a.m. Seeking RR hospital history The committee has been considering subjects for its oral history and lecture projects sponsored by the Southern Arizona Transportation Museum, and considers that the history of the Southern Pacic Hospital, as told by the physicians who worked there, would be of interest to both the railroad-transportation community as well as the medical community, reports Dr. Ken Sandock, committee member and director-at-large of the museum. We would like to identify and contact the doctors who trained and practiced at the SP Hospital, along with nurses and others who may have been associated with the hospital. We feel that this will be mutually benecial. Please call Steve Nash or e-mail steve5199@simplybits.net if you can be of help to the History Committee in this effort.

January monthly report


Referrals to physicians: 133 Meeting rooms occupied: 28.5 percent (8 a.m.-10 p.m., seven days per week) Executive Committee: PCMS President Alan Rogers MD presided Jan. 10, 5:40-6:15 p.m. The license revocation case involving a former Pima County physician was discussed and the board will be asked to support a formal hearing request. Several carryover items from the last board meeting were also discussed, and preparations made how to present them to the board.

PCMS 2012 meetings


The ArMA Annual Meeting (delegates only) is June 1-2. Our coming Regular Membership Meetings are Tuesday Nov. 8, 7 p.m. including reading of the nominees slate, and Tuesday Dec. 11 after the Board of Directors meets, for ballot count and declaration of election winners. Coming PCMS Board of Directors and Executive Committee (ofcers only) meetings are: BOARD: EXECS: Tues. March 27, 6:30 p.m. Tues. Mar 27, 5:30 p.m. Tues. April 24, 6:30 p.m. Tues. April 24, 5:30 p.m. Tues. May 22, 6:30 p.m. Tues. May 22 5:30 pm (Memorial Day May 30) Tues. June 26, 5:30 p.m. Tues. Aug. 28, 6:30 p.m. Tues. Aug. 28, 5:30 p.m. Mon. Sept. 24, 6:30 p.m. Mon. Sept. 24, 5:30 p.m. (Yom Kippur starts Sept. 25) Tues. Oct. 23, 6:30 p.m. Tues. Oct. 23, 5:30 p.m. Tues. Nov. 13, 5:30 p.m. Tues. Dec. 11, 6:30 p.m. Tues. Dec. 11, 5:30 p.m.


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Board of Directors: PCMS President Timothy Fagan MD presided, then handed the meeting to new PCMS President Alan Rogers MD, Jan. 10, 6:35-7:35 p.m. The new PCMS Board of Directors introduced themselves to one another, then got down to business, approving a letters to go out and a resolution for the ArMA meeting in June. The board approved support for a former Pima County physician now appearing before the licensing board, and heard reports from AHCCCS and the UofA College of Medicine. Housekeeping rules and policies were reviewed. Under a new schedule, the board does not meet again until March. The Board of Mediation, Chairman Edward Schwager MD, did not meet in January.

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Public Health Committee: Jane Orient MD presided Jan. 9, 12:18 -1:17 p.m. Committee members met with state Rep. Matt Heinz MD (D29-SE Tucson) to discuss his mental health reporting bill aimed at stopping incidents like the shooting of Rep. Gabby Giffords. It has gone from a notication action to a referral to a crisis line. He is also considering putting into statute the common law right that a gun owner has the right to refuse service to anyone. This will be sent to the PCMS Board of Directors to consider support. A discussion was held about adjuvants added to vaccines and the possibility these might cause allergies. The committee also looked at a supplement being offered to physicians to give to patients in Tucson. Bioethics Committee: David Jaskar MD, chairman, presided Jan. 17, 12:39-1:10 p.m. The committee made several important changes to the case being prepared for publishing in Sombrero. It also decided to take a look at We are Tucsons homegrown law firm providing the ethics surrounding triage and emergencies. legal services for Southern Arizona since 1969. History Committee: Chairman James We can assist with all legal needs, from Business Klein MD. and Real Estate, to Bankruptcy, Family Law, The committee met on Jan. 10. No more Estates and Trusts, and Personal Injury. details were available at press time. Barry Kirschner is recognized as an AV Pima County Medical Foundation, Inc.: Preeminent attorney by his peers for his 30 years of legal work in Tucson including as a President James Klein MD. partner at Waterfall Economidis since 2003. The Foundation met on Jan. 17 and made As a member of the firms Litigation Practice sure the nal details of the years Evening Group, Barry represents disabled persons whose Speaker Series were done. claims have been denied or terminated by disability insurance carriers. Successful verdicts, Regular Membership Meeting: The meetsettlements and administrative appeals come ing on Jan. 10 coincided with the PCMS Board from knowing how to approach the problem of Directors meeting and attendees were able to effectively with clear, convincing and honest medical assessments by treating physicians. comment on plans the board was making for When an insurance company inappropriately 2012. relies on a doctor who has never seen the Odds & Ends: PCMS joins Maricopa patient, Barry supports the treating physician County Medical Society and the Arizona Medto ensure his or her opinion is not over ridden by the insurer. ical Association in hosting a Legislative Reception every year, and this years was abuzz about Barry practices law with the conviction of a man who has dedicated his life to helping others. the resignation of Rep. Giffords and all the Passion like that cannot be duplicated and is candidates gearing up to replace her. With the part of what makes Barry a preeminent lawyer. new congressional district for Arizona, Maricopa legislators also were jockeying for position, more info on Barry or the firm visit: making a ne stew of whispers and political thinking during a very interesting, low-key event Jan. 23. PCMS was involved in a DEA hearing and learning the details of a Recovery Audit Contractor probe in January. Planning continues for an Exercise is Medicine conference in March. Alan Rogers MD and Tyna Callahan from the PCMS Alliance walked the PCMS course for Just Walk, a monthly effort by PCMS to get Williams Centre | 8th Floor | t 520.790.5828 patients more active.
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BehInd the Lens


From off a line to one of a kind


When I grew up in a small town in central Kansas during the 1930s and 40s, there were always some old cars around. By old I mean aging Ford Model As and Ts and an occasional Chevy. I do remember a rundown Chrysler limousine parked in someones yard that had mouse droppings on the seats. There were few that would draw your attention when they drove by, maybe a Buick from the local dealership. There is one car that sticks Dr. Hal Tretbar in my mind. It belonged to Joy Thompson, who had the local radio repair shop (remember when you had to replace burned-out tubes?). He had a garage in back of his shop where he kept his favorite auto. I remember sneaking in to look at it from time to time. It was a large, elegant sedan with the nest mohair upholstery. The dash was full of shiny instruments. But it was the headlights that set it apart. The car was a late 1920s

The body of this 1920 Pierce-Arrow is covered in 23-karat gold leaf. The hood and fenders are nickel-plated.

or early 30s Pierce-Arrow with those bug-eye lights that ared into the swooping fenders. I can still picture it like it was yesterday. In the last century America fell in love with the automobile, and the affair continues. There are major car collector auctions across the country throughout the year, from Las Vegas, Nev. to Florida. January 15-20 is a big week for Scottsdale and Phoenix for car auc-

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tions. There are at least four major ones, and several lesser ones. Recently I attended the upscale RM Auction at the Biltmore Hotel Resort and Spa. On the Friday I was there, 75 cars were sold. A variety of highly desirable vehicles were rst displayed on the grassy lawn and then auctioned in the ballroom. All had been preserved or restored to as good as new condition and were fully drivable. Examples and nal bids ranged from a 1914 Rolls-Royce Silver Ghost Landaulette ($550,000); a 1934 DeSoto Airow Coupe ($52,250); a 1970 Ford Mustang Boss 429 Fastback ($170,500); a 1927 Isotta-Fraschini Tipo 8A Boat-tail Tourer ($407,000); a
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The Pierce-Arrow coupe is remarkably preserved after being restored 40 years ago. Here it is shown on the auction turntable.

2005 Porsche Carrera GT ($374,000); a 1903 Waverly Electric Surrey ($110,000); a 1957 Ferrari 410 Superamerica Coupe ($1,815,000); and nally a German 1964 Gogomobil TS400 Coupe ($27,000). As I was making my way around the hotel grounds drooling over the marvelous machines, a glint of gold caught my eye and then my gaze lit on those wonderful prominent ared headlights. A 1920 Pierce-Arrow glistened like a golden beacon in the sunlight, and what a story lay behind this singular treasure. In 1920 a new Pierce-Arrow Model 48 2/3 Passenger Coupe was delivered to Emerson Carey of Hutchinson, Kan. He was the founder and owner of the nationally known Carey Salt Company. The auto had a 48hp six-cylinder engine, a three-speed gearbox, the solid front axle and the live rear axle had leaf springs, and was stopped by two-wheel mechanical brakes. Unusual for such a large car, it had seating for only three people, two in the main seat and one on a jump seat on the left. All Pierce-Arrows were right-hand drive until 1921. It remained with the family in Hutchinson (40 miles from my home town of Stafford) until 1945 when it was sold to a wealthy collector
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Remarkably preserved after nearly 40 years, this Pierce-Arrow is truly one of a kind, yet it was not sold at RM because it didnt meet the reserve price of about $200,000. The Pierce-Arrow Company, established in 1901, was always oriented to the upper-end market, and it closed in 1938 after failing to survive the Great Depression. Thanks to Amy Christie, public relations for RM Auctions, for the history of this marvelous Pierce-Arrow Coupe.

This elegant 1914 Rolls-Royce 40/50 Silver Ghost Landaulette sold for $550,000. .

in Great Bend, Kan., 30 miles from Stafford. You just never know where fascinating old cars might be hiding! The new owner spent nearly 30 years restoring the car. He had decided to do something unusual and different, so he had skilled workers cover the aluminum body with 23-karat gold leaf! Then every inch of the chassis and engine was plated with either gold or nickel. All interior ttings were silver-plated. Black leather nished off the rest of the interior. Few people saw this car until it went on display in Denver in 1974.

Among the high-dollar cars a German import, this chummy 1964 Gogomobil Coupe, was a bargain when it sold for $27,500. It is one of only four in the U.S

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In memorIAm

By Stuart Faxon

Dr. Gerald Giordano, 1943-2012


Dr. Gerald F. Jerry Giordano, IM physician specializing in hematology and oncology, who joined PCMS in 1975, known as Dr. G and in his family as Grandpa Bear, died Feb. 8 at his Tucson home surrounded by his family, they reported in the Arizona Daily Star Feb. 16. He was 68. Gerald Francis Giordano was born Feb. 20, 1943 in Philadelphia, where he earned his A.B. degree at LaSalle College. Dr. Gerald Giordano in 1984. He earned his M.D. at Temple University in 1968, including a summer research fellowship. He interned at Temple University Hospital in IM and University of Rochester (N.Y.) School of Medicine. He did residencies in hematology at Rochester and in oncology at Arizona Medical Center Division of Radiology Oncology. He also was a research assistant and instructor at Rochester. He was a diplomate of the National Board of Medical Examiners and the American Board of Internal Medicine, and a member of Alpha Epsilon Delta Honor Society, Babcock Surgical Honor Society, and Phi Rho Sigma Fraternity. He published on topics including marrow cell egress: central interaction of barrier port size and cell maturation; and effects of sulfhydryl inhibitors on granulocyte function. He moved his family to Tucson in 1973 to start his practice, and he was on staff at St. Josephs Hospital and Tucson Medical Center. He was a brilliant, compassionate, and dedicated physician, his family said. He was a remarkable man and dearly loved husband, father, brother, uncle, grandfather, and friend. We will miss and remember him always. Dr. Giordano was a longtime supporter of PCMS and its mission. In 1979-81 he served on the PCMS Board of Directors and as a delegate to ArMA. In 1982 he and Dr. Steven J. Ketchel added Dr. Robert J., Brooks to their IM-hematology-oncology practice on North Country Club Road. Also that year Dr. Giordano served on an AMA Council on Scientic Affairs national advisory panel on the use of aphaeresis in treatment of disease. At the time he was medical director of El Dorados Hospitals Aphaeresis Unit. In 1983 Dr. Giordano was honored by the 88-CRIME Board of Directors for his help in convicting a self-proclaimed cancer specialist of fraud. Giordano testied as an expert witness in the trial in California of Vlastimil Milan Brych, 44, the Arizona Daily Star reported Sept. 14, 1983. The jury found Brych guilty of 12 felony counts involving defrauding cancer victims in California. Brych was given six years in prison. In 1985 Dr. Giordano chaired the PCMS Board of Mediation. In 1987 he was elected Professional Education Chairman of the American Cancer Society. In 1897 he served on the medical staff of Sierra Vista Community Hospital. In 1989 he chaired the PCMS Group InYou cant imagine owning any other car. surance Committee. In 2001 he resumed his Your BMW is perfect. We can help you keep it that position as medical director for United Blood way with top technicians, advanced technology and Services in Tucson world-class detailing products. Our passion is to make Dr. Giordanos wife, Bev; sister Joy Galante your BMW as good as new... maybe even betterer. and her sons Stephen, Robert and Richard; sons Jerry Jr. and Dave; daughter Kristin; stepCall 520-300-4220 son John Wallace; stepdaughter Nicole Pierce; BlueAndWhiteBMW.com and 11 grandchildren survive him. 5728 East 22nd Street Tucson, Arizona A funeral Mass was celebrated Feb. 13 at The Church of St. Pius X in Tucson. The family requests that memorial donations in Dr. Giordanos name be made to the St. Pius church, or the charity of the donors choice.
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REALITY CHECK

Swimming with the orcas


In nature there is no right or wrong, only consequences.
An Alaskan cruise ship happened upon several deer swimming across an inlet.Suddenly, several orcas appeared, attacking the deer, killing the whole group.The passengers screamed, begging the captain to do something. There was, of course, nothing the captain could do, or should have done. This is how nature works, predator and prey, survival of the ttest.We may nd such things horrifying, but deer feed other animals, as Dr. Michael S. Smith well as breeding and making more deer. It is the way of the world. Unfortunately, I didnt like the way of the world when lightning caused Minnesotas Pagami Creek Fire. It was monitored, because wilderness res are benecial to the ecosystem. Jack pine seeds can only open after a re, and Ive seen large forests of young jack pines 10 years after a major burn. Unfortunately, one day the re exploded, running 12 miles, ultimately burning 92,000 acres. Re-growth has already begun, but I will never again wish to travel my favorite route to Lake Insula. It is the way of the world. Large res have burned huge swaths of Minnesota, the last big one in 1918. That fact has not stopped many on the Iron Range from blaming the re on the Forest Service or radical environmentalists like me. Scientists know re belongs; if there is anything radical, it is the idea that forests, like life itself, are immutable. Often, many who decry big government are quick to ask where government is when there is a disaster. Wildland reghters, who save so much property and risk their lives, are part of big government. A PCMS member once made a pejorative remark to me about government doctors. I think those of us who were medical ofcers, including the VA physicians who trained all of us, might feel differently. The previous vice-president, who never wore a uniform, referred to those 16 percent of us against the Iraq invasion as traitors. I want every president to succeed, because if they fail, we are in big trouble. If being against a war is treason, wishing a president to fail borders on such, unless there is a double standard. Alas, double standards are the way of the world. To many, government is inherently bad. But as long as we have people with differing opinions on how they choose to liveand endtheir lives, we need some form of government to regulate what each of us can and cannot do. This regulation costs money, and good regulation should be worth the money spent. If we as a collective society want certain benets, like clean air and acid-free rain, which formerly were problems, or rivers that dont catch re, which Ohios Cuyahoga did, then we either have to pay for these changes through taxes or do without. If millions of people cant get medical care, then we as a people
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need to decide whether it is worth paying for them to obtain such care. Each of us has a stand on an issue; sometimes we get our way, sometimes not. To me, the concept of drowning government in a bathtub would lead to anarchy, misery, and death for millions who are not well off, along with no national defense. I dont want that. We did canoe in Minnesota, just not where we had hoped. While the re was benecial, we are likely to see more of these as boreal rainfall patterns are changing to savannah-like ones with oods and droughts, rather than an even weather pattern, a change ascribed to climate change. The oceans are more acid, the Ksp (solubility product) of calcium and phosphate will now, with 30 percent more hydrogen ions, cause deterioration in shell formation. This is a major concern, since the oceans are acidifying at a rate 100 times faster than ever recorded during the past 20 million years. Carbon dioxide + water=carbonic acid. Nearly every glacier is retreating, and the volume of cubic kilometers of fresh water entering the ocean will further change the climate. This isnt bad, it just is, unless you are human, live on a coast, eat seafood, or get your water from a glacier, as do Peruvians and Indians, in which case it is a huge concern. Every prediction of the future must quantify uncertainty; to do otherwise is unscientic. No argument Ive heard against climate change has stated a p-value, condence interval, or margin of error. The late New York Sen. Daniel Patrick Moynihan said, You can choose your opinions, but not your facts. The International Panel on Climate Change is 95 percent condent, which we statisticians consider high. Using a cold week or a record low as a counter-example shows an inability to distinguish between local weather and global climate, which is basic to understanding climate change. For the record, Tucson temperatures have been above normal every year since 1984, and the normals have been raised three times. In Tucson there have been 6.5 times as many record highs than lows since 2001 (142/22). Our rainfall deficit is 2.5 years in the last 15. These are facts. No argument Ive heard against climate change has been free of personal attacks. Ad hominem arguments have nothing to do with science, obscure the issue, and dilute and degrade the attackers thesis. The subject is climate change, not what hikers wear. I have discussed the science using statistics, which may be conrmed. To clarify, I have been to ANWR twice, hiked 120 miles in three of its major river valleys, including 1002, and I nd it and Antarctica among the most beautiful places on Earth. I strongly disagree with those who disparage ANWR or deny climate change without having ever seen or understanding each respectively, and I have considerable knowledge of both topics. Of course, some scientists, ever fewer, do not agree, but the vast majority of reputable scientists believe manmade climate change has occurred. Percent occupancy of the globe is statistical misuse. Fukushima is 0.0003% of Japans area, but radioactive Cesium contaminated 10% of the country.
SOMBRERO March 2012

It is the way of the world that as a statistician, I frequently see statistics misused (99.999996% of aircraft ights in the U.S. were not hijacked in 2001). Mankind has never encountered CO2 levels this high. We are running an uncontrolled experiment; worse, models are under-predicting the consequences. The average temperature has risen, weather patterns have changed over-all, huge amounts of fresh water are in the Arctic Ocean, and the higher sea level has already caused problems. These are facts. It is the current way of this world, which like the forests, is not immutable. When I was a neurologist, I often delivered bad news. I do so again as a scientist and writer. As a physician, I changed my patient management in the face of convincing evidence. I believe I have convincing evidence about the worlds climate. I believe if nobody speaks out against those who disagree, and I continue to be polite with my choice of verbs, misinformation will continue. I am calling them out; I will not be silent. It is the way of my world. The voters who elected this Congress believe that they will benet from smaller government. Ironically, many of these voters will need SSI and Medicare, which may be cut. They are deer, and they actually want to swim with the orcas. Sadly, it is the way of their world. Sombrero columnist Dr. Mike Smiths blog is http://michaelspinnersmith. com, where there are previous Reality Check columns, outdoor writing, descriptions and pictures of National Parks, Alaska hikes, eclipse-chasing, mental arithmetic, op-eds, and two non-technical neurology articles that physicians might enjoy.

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medIcAL mIssIons

The year of living revolutionarily


By Dr. Khaled O. Hadeli and Stuart Faxon
Dr. Khaled Hadeli had a helluva 2011. So did grandiloquent, near-mad Libyan dictator Muammar al-Qadda. Fortunately, the brute came out of it dead, while Dr. Hadeli merely got tired from nation building. Dr. Hadeli, a native Tripolitan, is a partner with eight physicians in Tucson Pulmonology and has practiced here since 2003. Before that he was on the Dr. Khaled O. Hadeli faculty of then-UPH/Kino Hospital. He is a graduate of Libyan University Medical School, Tripoli, and did his IM residency at the UofA. He is fellowship-trained in pulmonary and critical care medicine. To say the least, It was a very busy year for me and my family, Dr. Hadeli said. It started in January at a quiet pace, revolving mainly around the news of the Arab Spring and the Tunis and Egypt revolutions. On Feb. 15 the news of revolt in Benghazi started to surface. On Feb. 20, Tripoli, my hometown, joined with peaceful protests, calling for freedom and respect to the people in Benghazi. Both protests were dealt with in a violent way by Qaddas forces. The entire country followed the movement and war erupted over almost all of Libya. Since its beginning, it was as if were climbing on a roller coaster that, when it reached the top, came down at high speed for more than eight months, ending with the capture and killing of Qadda and one of his sons. The whole country was dragged into a war that ended 42 years of dictatorship. Libya was once an extremely wealthy country with low population, only 2.5 million as of 1969. During Qaddas four-decade dictatorship Libya became a very poor and underdeveloped country with a bad reputation, having been one of the main sponsors of international terrorism. During the revolution I was involved in many projects; it was amazing I was able to keep my job! Dr. Haedli said. The rst could be called Tucson to Zentan. Jo Samaha, a medical supply provider in Tucson, kindly donated tools and supplies worth almost $50,000. I made my request to him after I saw a spokesman from Zentan on the news, stating that a surgeon had to amputate limbs using household tools to save ghters lives, due to lack of basic medical equipments. The supply was shipped to Zentan by help from Medical Teams International of Portland, Ore. On March 21 I gave a talk, Qaddas 42 Years of Achieve22

ments, as part of the UofAs Near-Eeastern Studies panel discussion. In April North American Libyans had a meeting in Washington, D.C., at which the Libyan community in North America attempted to organize itself to help the revolution in Libya. I took the role of medical relief coordinator/USA. This started many committees and coordinated at least some of the medical and humanitarian activities out of the USA. The National Transitional Council (NTC) is the interim high authority in Libya, Dr Hadeli said. It was established on Feb. 25, a week after the crisis began, by Qadda Minister of Justice Mustafa Abduljalil. Recently the NTC formed the interim government, passed the executive duties, and retained the legislative high authority pending establishment, by election, of a national congress, at which time the NTC will have completed its mission. The national congress will be the high authority empowered to write the constitution and oversee the rst democratic election of government and parliament. Late in April, Dr. Hadeli said, the minister of health for the NTC asked him to join an advisory committee to the minister. I chaired this committee until the end of its existence. We had one-to-two-hour meetings, sometimes daily, for at least ve months. This role enabled me and ve other colleagues from Canada, the U.K., Qatar, and the U.A.E. to ofcially participate in humanitarian activities. Dr. Hadeli said that the Medical Supply Containers to Libya project was a team effort that included Hesham Fallah, a Libyan oral surgeon from the San Francisco Bay Area. He facilitated communication with Medshare, a surplus medical consumable supply company that provided us with 42-foot containers full of consumable medical supplies at fraction of what it would cost otherwise. Medwish, another supplier, also contributed with some containers, Dr. Hadeli said. Hope International Relief and Development of Columbus, Ohio took care of fund-raising and collection for this project. Thanks to Messrs Shwehdi and Huedi, the logistics part of this project was covered with no problems. The estimated value of all containers was $3 million. In July, a trip to Tunis and Libya enabled me to meet with the Tunisian ofcials and the Tunisian head of Red Crescent to help facilitate transport of medical supply containers from Tunisian ports to Libya. I also met with my displaced family, who had to stay in Tunis for three months during the revolution. I attended the rst medical relief multi-organization meeting
SOMBRERO March 2012

we founded the nongovernmental organization in Tripoli to facilitate supply distribution in Libya. Dr. Hadeli had what he calls a minute of fame when he did an interview with KUATs Arizona Illustrated that was aired on NPR. He also gave two talks at the UofA Eller College of Management, on Libyan history and on medical humanitarian activities to Libya during the crisis. There were other events that took place in the 2011, he said. Some were good and some not. But thank God, all ended well. My youngest son Zackariya was born March 22. My mother-in-law visited us during the birth of my son. She had to undergo an emergent surgery that was complicated by heart failure, respiratory failure, kidney failure, and a 10-day stay in the ICU. I discharged her on the day I was traveling to Libya on my rst visit. My parents visited in September and my father had to be admitted to the ICU for a tongue hematoOn the Libyan-Tunisian southern border checkpoint, Dr. Hadeli shows a collection of Qaddas ammunition for use on the Libyan people, captured by freedom ghters in early July 2011. ma! I worked in ICU for 20 years but never saw one! This took place during my second visit to Libya. in Sfax. The highlight of this visit was the travel inside Libya with I was asked to submit my CV to be considered for Libyan mina small team of doctors, including the very active young Libyan ister of health in November, but I respectfully declined, as it was physician Anas Baio, who was running the humanitarian medical my recommendation that the MOH should be from among local relief in Tunis for a good part of the revolution. I traveled all the Libyan doctors or health experts. Also, I ran out of energy by then! way to Gwalish, the last point, 2 kilometers from the re line and Finally, the boys missed out on vacations and annual trip. 25 kilometers from Gerian, which was then a stronghold of QadThey did well during the events; Nizar donated all his savings das forces. We visited most hospitals in the region and held a during one of the local fund-raising events. Nader helped his large meeting with the heads of all hospitals and NTC health repmom with the baby and gave us less trouble than usual. So they resentatives from all cities in the western mountain area. We orwere awarded an end of the year visit to Disneyland! ganized medical evacuation protocols and treatment of wounded, I am grateful to my lovely wife for her support, especially and visited the front mobile unit at Gwalish. taking care of Zack and our ailing parents. I am also grateful to Dr. Hadeli made his third visit to Libya in October, which included evacuating wounded to the U.S. After the capture of Tripoli by the revolutionaries and a week before the capture of Qadda, the minister of health asked me to attend a meeting with American Ambassador to Libya Gene Cretz. I helped organize the evacuation of 26 Libyan wounded to Spaulding Hospital in Boston, and six critically wounded patients to a German hospital. During this visit I also met with NTC leadership, the minister of health, the minister of war wounded, the head of Tripolis governing council, the acting president of Tripoli University, and the head of Tripoli Medical Center. All meetings revolved around wounded evacuation, medical supply distribution, and health system development and structure for the new Libya. Along with local colleagues and my brother,
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Nation in transition
Libya is at high noon on the map of Africa, bordered by Algeria and Tunisia to the west, the Mediterranean Sea to the north, Egypt to the east, Sudan to the southeast, and Chad and Niger to the south. With an area of almost 700,000 square miles, Libya is the fourth largest country in Africa by area, and the 17th largest in the world. The largest city, Tripoli, is home to 1.7 million of Libyas 6.4 million people. The three traditional parts of the country are Tripolitania, Fezzan, and Cyrenaica. In 2009 Libya had the fourth-highest GDP (PPP) in Africa, behind Seychelles, Equitorial Guinea and Gabon. Libya has the 10th-largest proven oil reserves of any country in the world, and the 17th-highest petroleum production. As a result of the civil war of February to October 2011, the Libyan Arab Jamahiriya, which had then existed for 34 years, collapsed, and Libya entered a period of governance by an administration called the National Transitional Council. The NTC has stated its intention to oversee the rst phase of a transition to constitutional democracy, after which it claims it will dissolve in favor of a representative legislature. Source: Wikipedia

Two kilometers from the re line at Gwalish, Dr. Hadeli and a group of doctors inspect signs leading to the eld hospital.

my partners, associates, and Tucson Pulmonology staff for their support during my very hectic year. My colleagues at Tucson Pulmonology are doctors Neil Clements, Sunil Natrajan, Brian Shon, James McCartan, Yuya Huang, Chuck Reilly, Annu Mallampalli, and Ubair Ahmed. Im looking forward to a relaxing and quiet 2012!

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ConFerences & SemInArs


April
April 12-15: The Multidisciplinary Update in Pulmonary & Critical Care Medicine is at Westin Kierland Resort & Spa, 6902 E. Greenway Pkwy., Scottsdale 85254. CME: AMA and AOA credits TBA. Course targets pulmonary physicians, internists, hospitalists, and specialists in critical care medicine, bringing together a multidisciplinary faculty. Lectures by leaders in pulmonary and critical care medicine, pulmonary pathology, and radiology provide a comprehensive approach to the current evaluation and management of various respiratory diseases. Course features new and pertinent information regarding developments in respiratory and critical care medicine, including Pulmonary Literature Review and Critical Care Literature Review. Program includes option to attend the American Board of Internal Medicine (ABIM) SEP Medical Knowledge module for Update in Pulmonary Disease and Update in Critical Care Medicine. Contact: Lora Jacobson, Mayo School of Continuous Professional Development, mca.cme@mayo.edu; phone 480.301.4580; fax 480.301.8323. Website: http://www.mayo.edu/cme/pulmonary-medicine-2012s495 April 26-29: Tucson Osteopathic Medical Foundation presents the 21st Annual Southwestern Conference on Medicine, offering CME for DOs, MDs, PAs, and NPs, at JW Marriott Star Pass Resort & Spa, Tucson. CME: 26 AMA PRA Category 1 Credit; 26 AOA Category 1A; four more credit hours available with bonus workshops. Early registration: $500 for active physicians, $400 for retired physicians, NPs, and PAs. After March 31, $550 for active physicians, $450 for retired physicians, NPs, and PAs. Register online at www.tomf.org/cme, or call 520.299.4545 for more information.

recognition of concussion, and the potential for short-term catastrophic consequences and disabling long-term neurological impairment from repeated concussions, has prompted passage of legislation in many states that requires immediate removal from play of an athlete suspected of having concussion, mandatory concussion education of all those who intersect with an athlete, and return-to-play clearance by a qualied healthcare provider. Symposium highlights the epidemiology of concussion in sport and military combat; pathophysiology of concussion; sideline and outpatient clinical evaluation; standard and novel diagnostic strategies; and implementation of return-to-activity guidelines. Format includes platform lectures, small-group workshops, panel discussions, and live two-way remote audio/video concussion evaluations using robotic teleconcussion technology. Faculty are renowned scientic and clinical experts in concussion from Mayo Clinic and leading U.S. academic medical centers. Targets athletic trainers, athletic directors, allied health professionals, and physicians interested in evaluation and case management of people with concussion. Contact: Jodi Lee Beert, Mayo School of Continuous Professional Development, mca.cme@mayo.edu; phone 480.301.4580; fax 480.301.8323. Website: www.mayo.edu/cme/internal-medicine-and-subspecialties-2012s814.

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August
Aug. 3-5: The Mayo Clinic Cardiology Update 2012 is at Enchantment Resort, 525 Boynton Canyon Rd., Sedona 86336; phone 928.282.2900. CME credits to be determined. Program covers a wide spectrum of topics in CHF/heart transplant, coronary artery diseases, cardiac arrhythmias, and adult congenital heart diseases, among others. Participants will learn about the new anticoagulants available to use in patients with atrial brillation techniques, percutaneous aortic and pulmonic valve replacement, and new devices for the treatment of CHF. Course targets practitioners in adult cardiology, cardiovascular surgeons, cardiovascular trainees, general internists, and allied health personnel with a cardiovascular interests. Contact: Staci King, CME Dept., Mayo Clinic Scottsdale, 13400 E. Shea Blvd.; phone 480.301.4580; fax 480.301.8323. Website: www.mayo.edu/cme

September
Sept. 15: Mayo Clinic Acute and Chronic Leukemias 2012: A Case-Based Discussion is at Mayo Clinic Education Center, 5777 E. Mayo Blvd., Phoenix 85254; phone 480.301.4580. CME: 7.5 AMA PRA Category 1 credits. American Osteopathic Association (AOA) 7.5 hours of Category 2-A credit. American Academy of Family Physicians (AAFP) credit pending. This one-day comprehensive workshop designed for physicians, nurses, NPs and PAs presents attendees with a casebased analysis on the diagnosis, treatment, and challenging real-world scenarios with chronic myeloid leukemia, myelo proliferative neoplasms, myelodysplastic syndromes. acute myeloid leukemia, chronic lymphoid leukemia, acute lymphocytic leukemia, the role of stem cell transplant in 2012, and challenges to the nurse, NP, and physician in caring for leukemia patients. Contact: Heather Langdon, Mayo School of Continuous Professional Development, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale 85259; phone 480.301.4580; fax 480.301.8323. Website: http://www.mayo.edu/cme Sept. 28-29: The Mayo Clinic Symposium on Concussion in Sport is at Mayo Clinic, 13400 E. Shea Blvd., Scottsdale 85259; phone 480.301.4580. AMA, AOA, AAFP CME credits to be determined. Concussion has become a major public health priority that transcends age, gender, and sport. The under-reporting and

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