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Sombrero

Pima County Medical Society
Home Medical Society of the 17th United States Surgeon-General

OCTOBER 2016

In 1961...
JFK was inaugurated
as president;

C

5 Years of Dedicat
5
g
ed
tin
Se
a
r
rv
b
e
ic
el
e

The Peace Corps was
established;
The USSR’s Sputnik
carried a dog into orbit;
Gas cost 27¢ per gallon;
Bob Dylan made his
first appearance;
101 Dalmations was
released by Disney;
...and

Doctors began

seeing patients at

St. Elizabeth’s

2

Calling all Supporters, Volunteers
and Former Volunteers:
We are Celebrating Your
Contributions to St. Elizabeth’s!
Join Us at St. Elizabeth’s for the Celebration
140 West Speedway Boulevard
Thursday, November 17th, 2016,
4:30 to 7:00 p.m.
Brief Program at 6:00 p.m.

Call 520-670-0907 for more information or to RSVP.

Do You Know Someone Who Has Served at
St. Elizabeth’s? Friends and Colleagues are Welcome!

Are You A Specialist Who Is
Willing to See Patients in Your
Office for St. Elizabeth’s?

We’d Love to Talk to You!
Call 520-628-7871 or email info@saintehc.org
and ask about service opportunities.

SOMBRERO – October 2016

Sombrero
Pima County Medical
Society Officers

Official Publication of the Pima County Medical Society

Jerry Hutchinson, DO
Roy Loewenstein, MD
Kevin Moynahan, MD
Snehal Patel, DO
Wayne Peate, MD
Kenneth Sandock, MD
Sarah Sullivan, DO
Salvatore Tirrito, MD
Debra Townsend, MD
Fred Van Hook, MD
Scott Weiss, MD
Leslie Willingham, MD
Jaren Trost, MD (Resident)
Aditya Paliwal, MD (alt. resident)
Jared Brock (student)

President
Timothy C. Fagan, MD
President-Elect
Michael A. Dean, MD
Vice-President
Susan J. Kalota, MD
Secretary-Treasurer
Unfilled / Appointment
Past-President
Melissa D. Levine, MD

PCMS Board of Directors
David Burgess, MD
Howard Eisenberg, MD
Kelly Ann Favre, MD

Members at Large

At Large ArMA Board

Charles Krone, MD
Clifford Martin, MD

Robert M. Aaronson, MD
R. Screven Farmer, MD

Board of Mediation

Pima Directors to ArMA
Timothy C. Fagan, MD

Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Sheldon Marks, MD
Mark Mecikalski, MD

Delegates to AMA
Timothy C. Fagan, MD (alternate)
Gary R. Figge, MD
Michael F. Hamant, MD (alternate)
Thomas H. Hicks, MD

Arizona Medical
Association Officers
Michael F. Hamant, MD
  Vice President
Thomas C. Rothe, MD
  Outgoing Past President

Executive Director
Bill Fearneyhough
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: billf 5199@gmail.com

Editor
Bill Fearneyhough
I welcome your feedback and story ideas.
E-mail: billf 5199@gmail.com

Printing
West Press
Phone: (520) 624-4939
E-mail: andyc@westpress.com

Advertising
Dennis Carey
Phone: (520) 795-7985
Fax:
(520) 323-9559
E-mail: dcarey5199@gmail.com

Art Director
Alene Randklev
Phone: (520) 624-4939
Fax:
(520) 624-2715
E-mail: alener@westpress.com

Publisher
Pima County Medical Society
5199 E. Farness Dr., Suite 151
Tucson, AZ 85712
Phone: (520) 795-7985
Fax: (520) 323-9559
Website: pimamedicalsociety.org

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Vol. 49 No. 8

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, AZ. POSTMASTER: Send address changes
to Pima County Medical Society, 5199 E. Farness Drive,
Ste. 151, 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 Officers 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 © 2016, Pima County
Medical Society. All rights reserved. Reproduction in whole
or in part without permission is prohibited.

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SOMBRERO – October 2016

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Inside
 5

Dr. Timothy C. Fagan: Patient Care Advocacy
companies help navigate the healthcare system.

 7

Letter to the Editor: Dr. Dietmar Gann takes on the
establishment about treating diabetes.

 8

UA College of Medicine: Dr. Charles Cairns talks about
a record-breaking year.

11

Road Trip: The Arizona Strip provides hidden treasures
and plenty of history.

15

Makol Call: What will be the roll of physicians in our
country’s future health care system?

17
18

In Memoriam: Remembering Dr. Harold “Bill” Kohl.

19

White Coat Ceremony: A leader in long-distance virtual
care reaches a milestone.

21

UA College of Medicine – Tucson: Record class takes
next step at White Coat Ceremony.

21

Urgent Care: Tucson physicians provide an alternative
to the ER at Urgent Care Specialists.

On the Cover

23

New Technology: Dr. Susan Kalota provides updates on
“The Magic Wand” and vaginal mesh.

26

News Briefs: TCPR improves outcomes; Dr. Julie
Bauman and Dr. Samuel Keim accept new positions.

From Oak Creek Canyon north to Sedona, late
October is prime time to see the foliage’s brilliant
color changes (Dr. Hal Tretbar photo).

Arizona Telemedicine Program: A leader in longdistance virtual care reaches a milestone.

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SOMBRERO – October 2016

What do you know about Patient Care
Advocacy?
By Dr. Timothy C. Fagan, PCMS President
Think about your elderly
patients!
How many have no family,
or no family in Tucson?
How many are not capable
of effectively interacting
with the medical system,
due to lack of education,
lack of medical knowledge
or cognitive dysfunction?
How does that affect the
patient’s health? How
much does that increase
the cost to the medical system, due to noncompliance
and delayed or inappropriate care, due to the patient’s
inability to provide adequate and appropriate information
to physicians and other health care providers? How well
is information transmitted between outpatient and
inpatient physicians? What does your patient do
between hospital discharge and first post discharge
outpatient appointment? Does he or she take the
discharge medications, the preadmission medications,
both sets of medications or none? I have had patients
choose each one of these 4 options.
What can you do for these patients?
Patient Care Advocacy is a relatively new and
unpublicized service, which can be of tremendous benefit
to patients, their families, their physicians and society.
Typically, when a patient or family member contacts a
patient care advocacy company, there is an initial
evaluation by a specifically trained and experienced RN.
This evaluation includes medical history, medications,
health insurance coverage, family member contact
information and medical providers. An advocacy plan is
developed as part of the initial assessment, and the
record is periodically updated. After the evaluation, an
RN is on call 24/7, to answer questions, give advice, and
provide liaison with providers.
If the patient goes to the emergency department (ED) or
is hospitalized, the RN coordinates rapidly with the ED
or inpatient physician. The method varies among the
agencies. In the hospital setting, the RN advocate
coordinates with hospital physicians, nurses, other
hospital staff and the patient’s outpatient providers. If
the patient requires extra care in the hospital, the RN
can arrange for caregivers. There are multiple
SOMBRERO – October 2016

examples of patient advocate interventions that have
been critical to the health of the patient. One example is
transfer to another hospital when a test or procedure,
such as a CT scan, was not available in a timely
fashion, e.g. that day. Another is preventing
inappropriately high doses of insulin, or insuring that
ordered laboratory tests were actually drawn and
results checked.
Prior to discharge, the RN advocate coordinates with
the patient’s outpatient physicians, assuring
coordination of medications and follow up
appointments. Home health care and caregivers can
also be arranged, if necessary. Home visits by a
physician or nurse practitioner can be arranged, if the
time to the scheduled outpatient physician follow up
appointment is longer than felt to be safe by the RN
advocate. If discharge is to a skilled nursing facility or to
assisted living, the patient care advocate will provide or
arrange indicated services.
The nurse advocate may accompany the patient to
outpatient visits, when necessary. Other outpatient
services that may be provided, directly or by referral,
include arranging referrals to appropriate medical
specialists, fiduciary services, discussion of end of life
issues and development of advance directives,
intervening on behalf of the patient with insurance
companies, explaining medical bills, and negotiating the
actual amount that needs to be paid. Individual patient
care advocacy companies may provide or refer for
some or all of these services. Rates for the services of
a patient care advocacy trained, experienced RN,
backed by the resources of the patient care advocacy
company, are approximately $100/hour in Tucson.
The Pima Council on Aging lists the three patient care
advocacy companies mentioned below on its website.
Karen Mercereau, RN, originated patient care advocacy
in Tucson, working with the University of Arizona
College of Nursing. She is the founder of the first
Tucson patient care advocacy company, RN Patient
Advocates. She also conducts programs to train RNs to
become patient care advocates, including online
programs. The initial patient evaluation used by this
company is called MEDiKEY. It is updated on a regular
basis. When the RN is notified that the patient is going
to the ED or is being hospitalized, the patient’s
MEDiKEY is faxed to the physician who is seeing the
5

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Alice Milton, Esq. has been a practicing Tucson
attorney for over 30 years. She founded Patient Care
Advocates after her parents experienced problems
negotiating the healthcare system. Her company also
includes its own Arizona and Medicare accredited home
health agency. In this company, when the RN is notified
that the patient is going to the ED or is being
hospitalized, the RN brings the updated patient record
and medication list, and is with the patient at the ED or
hospital within 75 minutes.
Debra McPherson, RN founded Arizona Care
Advocates in 2011. Her company is unique in that it
includes its own licensed fiduciary services.

– Eric, Administrator

I have met with the founders of each of these three
patient care advocacy companies and discussed their
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Local Contact Information
RN Patient Advocates
patientadvocates.com

(520) 743-7008

Patient Care Advocates
PCATucson.com

(520) 546-4141

Arizona Care Advocates
arizonacareadvocates.com

(520) 302-8962

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patient. RN Patient Advocates also maintains a national
directory of RN advocates, who have been trained by
Ms. Mercereau. Referrals are available by calling the
Tucson office.

National Organizations and referral resources for
patients who live outside of Tucson
RN Patient Advocates
patientadvocates.com
(520) 743-7008
Alliance of Professional Health Advocates
(also includes advocates in Canada, Great Britain,
Australia, South Africa, Spain, The Philippines and
Russia).
aphadvocates.org
National Directory of Healthcare Advocacy Consultants
nahac.memberlodge.com
Aging Life Care Association
aginglifecare.org
Medical & Hospital Bill Review, Negotiations &
Correction
Copatient
copatient.com
contactus@copatient.com
(888) 702-2330
This organization charges 35% of the amount that it
saves the patient on his or her bills.

n

SOMBRERO – October 2016

Leer to Editor

A new approach to diabetes
By Dietmar Gann, MD, FACC

I

t took more than 40 years to dismantle the nutrition
dogma of the low fat diet. There is overwhelming
evidence now that eating saturated fat does not
cause heart disease and eating cholesterol- containing
food does not raise blood cholesterol, our liver adjusts
cholesterol production based on cholesterol intake.
The whole low fat diet was a failed experiment
involving the entire population never supported by
science. How could this happen?
The Polish philosopher of science Ludwik Fleck
explains that scientists belong to a thought collective
exchanging ideas in a mutually comprehensible idiom.
The group inevitable develops a mind of its own, as the
individuals in it converge on a way of communicating,
thinking and feeling. This makes scientific inquiry
prone to the eternal rules of human social life:
deference to the charismatic, herding towards majority
opinion, punishment for deviance, and intense
discomfort with admitting to error.
Data from the year 2014 from the Diabetic Association
show that 29 million Americans are diabetic and 68
percent of the adult population is
prediabetic, most of those people are
obese. There are 248 000 diabetics
on dialysis. The cost of diabetes care
was $275 billion (almost half of the
defense budget).

consisting primarily of the pharma and food industry.
Entrance fee on the average is a million dollars. In my
opinion, this creates a severe conflict of interest. And
we should not forget the immense influence of the
United States Department of agriculture with a mission
to promote agriculture, not health. (A professor went
very successfully through our program but is unable to
promote our diet because of conflict with the USDA).
In our program – the Diet of Hope – we have seen over
7,000 patients with Diabetes or Prediabetes. On day one
of our program diabetic patients on insulin stop regular
insulin and reduce long acting insulin by 30 percent.
Patients receive complex carbohydrates from vegetables.
Simple carbohydrates and processed food are avoided.
Forty percent of insulin dependent diabetics come off all
insulin within six weeks, creating huge savings and at the
same time lower their HA1c by 1.2 percent.
Diabetics are intolerant to simple carbohydrates;
promoting carbohydrate for diabetics is promoting
diabetes. To stimulate discussion, we have invited
two world renowned physicians for seminars in
October and November. Dr. William Davis (Wheat
Belly). Dr. Robert Lustig (Sugar the bitter truth),
see our Sombrero announcement.

n

Percentage of US adults with diabetes
in the year 1980 was 6 percent and
was close to 25 percent in 2014
(Center for Disease Control and
Prevention). The rise of diabetes and
obesity started with the introduction
of low fat, high carbohydrate diet.
Where is the Diabetic Association or the
Dietetic Association? They are in denial.
They display intense discomfort with
admitting error. The mission of the
Diabetic Association is to prevent and
cure diabetes and to improve the lives
of all diabetics. The Diabetic
Association has been unable to
accomplish any of their goals, actually
in my opinion, their mission is a failure.
The Diabetic Association
recommends a healthy and balanced
diet. They advise that Carbohydrates
should provide at least 50% of daily
calories. Whole (healthy) wheat is a
big part of the diet. The Diabetic
Association has an advisory board
SOMBRERO – October 2016

7

UA College of Medicine

A record year for UA College of Medicine
By Charles B. Cairns, MD – Dean, College of Medicine, Tucson

T

he University of Arizona College of Medicine –
Tucson was founded in 1967, and while we’re
approaching the 50 th year of training physicians,
we’re still a relatively young school when you look at
medical colleges in the United States. In fact the first –
the University of Pennsylvania School of Medicine –
just celebrated its 250 th anniversary. Despite our
relative youth, we are making a remarkable impact on
health care in Arizona and this last year has been a
truly record year for the College in many respects.

Record year for medical students

place to encourage and support increasing diversity
for our student body, staff and faculty members to
better reflect, and treat, the populations we serve.
This is a record we want to continue.

Record year for residents
We had a record-breaking year for residencies. For
our graduating Class of 2016, 97 percent matched in
the residency of their choice. Furthermore, we had a
record percentage of College of Medicine graduates
chose a residency program associated with the
University of Arizona.

We have become a truly national College as applicants
from across the U.S. want to study at the UA College
of Medicine – Tucson. The College received a record
6,458 applications for the Class of 2020, more than
two and a half times the 2,500 applications received
in 2009, which was the first year we accepted
applications from students outside Arizona.

Record year for faculty

A record yield rate of accepted students led to record
enrollment for the Class of 2020, with 135 students
starting their first year of medical school with us this
fall. In addition, we are attracting top students who
could go to medical school just about anywhere; seven
of our top 10 applicants chose to enroll here. The
students not only bring impressive grades and MCAT
scores in the top 1 percentile, they have also
conducted research in cancer treatment and nutrition,
volunteered time to improve lives overseas, provided
medical education to rural communities and more.
These experiences make our students successful as
clinicians, scientists and educators.
The Class of 2020 also made it a record year for
diversity: 35 percent of students are underrepresented minorities in medicine. Diversifying our
medical workforce goes a long way in improving health
in Arizona. It’s been shown that patients treated by
physicians who share their culture and language have
better outcomes. We have a number of programs in
8

It’s been a record year for faculty development and
engagement. A record number of faculty – 40 – were
promoted this year, a 30-percent increase from just
two years ago. We’ve also noticed record participation
in the governance of our College with 145 applicants
for 91 open committee spots. There are now 20 faculty
committees that advise the Dean in the governance of
the College. It’s heartening to see the dedication and
perseverance of our faculty during a time when we’ve
gone through significant changes and disruptions.

Record year for research and innovation
We were recently awarded a grant in the National
Institutes of Health (NIH) Precision Medicine Initiative®
Cohort Program. The Precision Medicine Initiative®
(PMI) Cohort Program aims to enroll 1 million or more
U.S. participants to improve prevention and treatment
of disease based on individual differences in lifestyle,
environment and genetics. In partnership with Banner
Health, we will enroll over 150,000 participants in
Arizona and across the seven states served by Banner
Health. The PMI program award totals $43.3 million
over five years and is the largest NIH peer-reviewed
grant in the College’s – as well as in the University of
Arizona Health Science’s – history.
We also had a record year for the impact of research
on the world. Publications from the College’s research
SOMBRERO – October 2016

programs create new opportunities in health care that
improve the lives of people in Arizona, across the U.S.
and the world. In the last fiscal year (FY16), we had a
record 613 NIH-funded studies published, up from 541
from the previous year, and the College recorded
$73.8 million in funding.
We had a record year in innovation with new highs in
inventions, patents and commercial applications. We
continue to make progre ss here as well. In FY16, the
College had a record:


•   62 invention disclosures, compared to 59 in FY15;
•   83 patents filed, compared to 58 in FY15; and
•   20 licenses/options exercised, compared to 17 in
FY15.

Thus, it’s truly been a remarkable year in the history of
the College.
As we move into our next decade serving the health
care needs of the state and beyond, I’m committed to
continuing the culture of innovation, excellence and
impact that our first dean, Dr. Merlin DuVal, brought
forth when he took on the daunting task of building a
medical college at the University of Arizona in Tucson.
We will be strategic in our initiatives and leverage the
large, wide-reaching health care partner we have in
Banner Health as we continue to train tomorrow’s
physicians and physician scientists, create new
knowledge, invent new technologies, develop new care
models and improve the lives of people in Arizona and
beyond through innovation and health care delivery. n

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SOMBRERO – October 2016

9

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SOMBRERO
10
– November 2015
2

Conference directors Robert Berens, M.D. and Alan Rogers, M.D.

SOMBRERO– –December
October 2016
17
SOMBRERO
2014

Road Trip

Vermilion Cliffs: Hidden treasures
along the Arizona strip
You’ll discover secluded beauty, endangered wildlife and pioneer history along this Arizona back road

By Monica Surfaro Spigelman / Photos by Leigh Spigelman

T

here’s a thrilling, remote adventure waiting for
you along US Route 89A in far north Arizona. It’s
where the natural sculptural stone giants called
the Vermilion Cliffs jut high above the mighty Colorado
River, and where the massive, endangered condors
make their home in a land rich in pioneer history.
There’s good pie up there, too.
The region is called the Arizona Strip – an isolated
area north of the Colorado and the Grand Canyon,
settled by Mormon pioneers in the mid-19th century.
Whether you have a weekend or a week, you’ll
certainly find a memorable experience waiting for you
just a couple of hours drive north of Flagstaff.

Cameron Trading Post Centennial
Heading north on US Route 89, after passing through
Flagstaff, a first stop should be in Cameron, just
outside the Grand Canyon and named for the senator
who supervised building of Bright Angel Trail in late
1800s. That’s where you’ll find the Cameron Trading
Post, celebrating its centennial this month. Cameron is
still a frontier trading center, with its original post
restored and now housing a remarkable collection of
Native American and western art. An historic swayback
suspension bridge sits alongside the post – Erected in
1911, it’s the first such bridge built over the Little

Spectaclular rock formations in the Vermilion Cliffs provide an
abundance of photo opportunities.

Colorado River. This bridge was used by pioneers,
particularly the Mormons, as the first passage over the
gorge. Learn about the bridge and frontier history from
nearby plaques and trading post memorabilia, and
take time to photograph some notable Arizona history
while shopping and munching frybread.
After the Cameron stop, drive through volcanic
country and lingering patches of Navajo sheep herds,
and, in Bitter Springs, turn westward to pick up US
Route 89A. This is the turnoff for Grand Canyon North
Rim that was designated as the Fredonia-Vermilion
Cliffs scenic road in 1996. It’s also the jump off point
to your drive along the Arizona Strip, with its unique
Mormon, Native American and cattle ranching legacy.
The Vermilion Cliffs are all around you now –
seemingly endless and impossibly vertical multicolored rock formations that are breathtaking photo
opportunities. Fourteen miles after the Bitter Springs
turnoff, you’ll come to the Navajo Bridge.

Historic Mormon Crossing

The Cameron Trading Post, located on US Route 89 above
Flagstaff, celebrates its centennial this October.
SOMBRERO – October 2016

You’ll see two bridges spanning the Colorado River
here. The first Navajo Bridge was built in 1928, to
replace the Mormon’s hazardous Lee’s Ferry crossing
further upstream. The second, modernized bridge
opened for motorists in 1995. The historic bridge is
now a Pedestrian Walkway, and there are several
historic markers and a large monument dedicated to
John D. Lee outside the Visitor Center, Gift Shop and
Navajo Bridge Interpretive Center at the Bridge’s west
bank. Along the Walkway, you can peer down to the
11

Reminders of the original Lee’s Ferry crossing and Mormon
history are still evident along the Arizona Strip.

Priceless views of the endangered California Condors are part
of the Vermilion Cliffs adventure.

Colorado River, which carves its way through the
canyons below. On the east end of the Walkway,
Native American artists often sell their wares.

rocks, Cliff Dwellers was founded by homesteaders
and today provides a small grocery, gift shop and a
lovely little restaurant where there’s tasty trout dining
as well as hearty breakfasts or burger lunches. The
Lodge’s gear shop is popular among anglers and trail
expeditions, and there are maps for nearby hikes of
varying levels.

Flight of the Condor
The historic bridge also is a prime spot for viewing
North America’s largest land bird, the California
Condor. These majestic creatures, with their nearly 10feet wingspans, were declared endangered in 1969.
Now the condor population is increasing, thanks to The
Peregrine Fund program begun at the Vermilion Cliffs
in 1996, in cooperation with partners including Arizona
Game and Fish. Bring your binoculars and your
cameras, as the sight of condors soaring on thermal
updrafts or nesting in cliff caves is spectacular indeed.
Along US Route 89A, after crossing the Bridge into
Lee’s Ferry, there are gas station amenities, several
lodges with historic roots and motels with mid-20 th
century charm. This area is the perfect, fun home base
for your days of exploring.
Descendants of a trading post still operate one favorite
accommodation located on US Route 89A several
miles after the Navajo Bridge: the Cliff Dweller’s
Lodge. This Lodge was a way station for cowboys
herding their cattle drives. Nestled in picturesque

The gift shop at the Cameron Trading Post is still an exceptional
stop for Native American crafts.
12

Arizona Strip Adventures
Using the Vermilion Cliffs accommodations as
headquarters to explore the Strip’s many points of
interest, visitors may travel either east or west along
US Route 89A to embark on a variety of off-roading,
hiking or sightseeing treks. For example, traveling
east, back toward the Navajo Bridge, those interested
in the area’s pioneer heritage may take a nearby
winding road to Lees Ferry Landing, the site of the first
Colorado River crossing and historic Mormon
settlement. There’s a walking tour of this National
Historic District, which also is a gateway to Grand
Canyon river trips and angler fishing. Portions of the
“Honeymoon Trail,” used by Mormon settlers in the
1870s to traverse the west, are still here. Nearby is the
Lonely Dell Ranch Mormon outpost, and remains of an
historic orchard, cabins and pioneer cemetery.

Several mid-20th century motels, like the Cliff Dweller Lodge,
offer charm, views and good cooking along the Arizona Strip.
SOMBRERO – October 2016

The increasing population of California Condors can be seen
from the Condor Viewing Station.

Soothe your sweet tooth with fresh-baked pie and cookies at
Jacob Lake Inn.

Page Ahead

spot a cluster of very old buildings. Would you be
surprised to note that this was where Sharlot Hall
wrote parts of her Arizona Strip diary?

For a northeasterly Arizona Strip side trip less than 40
miles from the Vermilion Cliffs, road trippers may head
to Page. Beyond the dominant Lake Powell water
recreation opportunities in Page, there’s the John
Wesley Powell Museum, honoring the geologist who set
out in 1869 to map the region and who led first
organized expedition down the Colorado River. On a
Page day trip, you also may enjoy great BBQ and
tableside barrels of peanuts at Big John’s Texas BBQ.
Check our Resources for information about these stops.

Westward Ho
Those wishing to travel further west along the Arizona
Strip have even more options. About three miles west
of the Cliff Dweller’s Lodge is US Forest Road 220,
where AZ Game and Fish manages a wildlife area that
includes a bison herd. These bison are descendants of
cattle-bison hybrids bred in 1905. Be aware that
glimpses of the elusive bison are very rare, and four
wheel drive is recommended for this trek, but even a
brief meander by a standard passenger vehicle along
this road will net stunning photo opportunities.
Back along US Route 89A, three more miles further
west, is Rock House Road (BLM 1065). Here you’ll

The Navajo Bridge offers a birds-eye view of the Colorado
River.
SOMBRERO – October 2016

Although condor viewing, as noted earlier, is also
available on the Navajo Bridge, if you take BLM 1065
two miles, you’ll come to the official condor viewing site.
There are special visitor activities at the viewing site in
September, but the interpretive panels, restroom and
viewing binoculars to the easterly cliffs and condor
release site are available year round. Check the
binoculars, which are preset for viewing the condors
high up in the distant cliffs. Chances of viewing are
good, as the huge birds are released and fed here.
From your Lodge base in the Vermilion Cliffs, you also
may travel even further west along US Route 89A,
heading toward the North Rim of the Grand Canyon.
The entrance to the Canyon and the North Rim close
mid-October, but there are plenty of other sights to
visit along this two-lane road that ascends from sage
meadows to scrubby piñon and tall ponderosa, with
many several scenic turnoffs. About 30 miles from Cliff
Dwellers, for example, there’s Jacob Lake Inn, a family
owned and operated public house operation since
1923. (Jacob Lake also is the turnoff to Highway 67,
which would lead you to the Grand Canyon North Rim

The Powell Museum in Page, Arizona, is an absorbing stop
during your Arizona Strip adventure.
13

Tasty barbecue can be found at Big John’s in Page, Arizona.

Pipe Spring National Monument , near Fredonia, offers historic
trails and fort tours.

Making your way back to your lodging, along the nooks
and crannies of US Route 89A, you’ll encounter a
wonderland of history, wildlife, local foods and arts.
And, amazingly, throughout this escapade through the
stunning Vermilion Cliffs and protected Arizona Strip,
anywhere you stop, you’ll find the hidden adventure
that you were seeking.
Resources

Cameron Trading Post
The historic post celebrates its centennial in October, and is open
year round. CameronTradingPost.com 928-679-2231

The original historic Navajo Bridge has been transformed into a
pedestrian walkway.

any time mid-May through mid-October.)

Stop for Some Pie
Jacob Lake Inn is a perfect place to stop and enjoy a
hearty Inn menu; you’ll save room, of course, for the
Inn’s famous pies or cookies. The fragrance from the
cookies combine with the welcoming crackle from the
Inn’s fireplace, and follow you into the Inn’s gift shop,
full of local artisan jewelry, baskets, rugs, books and
sand paintings. You’ll want to spend some time here,
enjoying the fragrances, the shopping and the food.
After the Jacob Lake Inn turnoff (which also has gas
station amenities), there’s still more to see along the
Arizona Strip, particularly if you continue your
adventure another 40 miles further west along US
Route 89A. You’ll descend along US Route 89A from
forest to the small Mormon town of Fredonia. Fourteen
miles southwest of Fredonia (follow signs to Arizona
State Route 389) is Pipe Spring National Monument,
where an impressive Visitor Center complex preserves
Pipe Spring, an oasis for Native American tribes as
well as Mormon settlers. The National Monument
complex, on the National Register of Historic Places,
offers an easy nature trail, an historic Mormon fort tour
and a museum celebrating the history of Kaibab Paiute
Indians and the Mormon settlement. There’s a great
little gift shop with many books and local artisan crafts.
14

California Condor Restoration Program
For information about the public Condor Release Program at
Vermillion Cliffs, contact Chris Parish, The Peregrine Fund:
928-606-5155. Check for general information, wildlife releases and
special events:
PeregrineFund.org/Condor
A main obstacle to condor recovery is lead poisoning exposure due
to scavenging on game remains. Arizona Game and Fish has
initiated a Non-Lead Ammunition Program for hunters. Learn more:
Azgfdportal.az.gov/wildlife/speciesofgreatestconservneed/
californiacondors
Cliff Dweller’s Lodge
Open year round, in the Vermillion Cliffs-Lee’s Ferry-Marble
Canyon area: LeesFerry.com/cliff-dwellers-lodge/ 928-355-2261
Jacob Lake Inn
Gift Shop, gas station and dining for breakfast, lunch and dinner are
available year round, with hours varying slightly when the North
Rim is closed. Don’t forget the cookies and pie!
JacobLake.com/restaurant/ 928-643-7232
Navajo Bridge Interpretive Center
Check October hours (the Center closes for the season this month).
The outside kiosks are worth exploring even if the Center is closed.
The Pedestrian Bridge Walkway also is open year-round.
NPS.gov/glca/learn/historyculture/navajobridge.htm 928-355-2319
Pipe Springs National Monument
The Monument complex is open year round, but travelers should
check for seasonally changing events and tours.
NPS.gov/pisp/index.htm
928- 643-7105
Exploring Page
Take a tour of the Powell Museum
6 N. Lake Powell Blvd. PowellMuseum.org/ 928-645-9496
Big John’s Texas BBQ
Refresh with tasty barbecue at Big John’s Texas BBQ
153 S. Lake Powell Boulevard. BigJohnsTexasbbq.com
928-645-3300

n

SOMBRERO – October 2016

Makol’s Call

The day medicine died
By Dr. George J. Makol

I

t was just another
Monday and Dr. Smitty
was driving to work,
straining to remember the
lyrics to that song his dad
used to play, written back
in the
1970’s,
long
before his
birth. It
went
something
like: “Bye,
Bye Miss American Pie, Drove my
Chevy to the levee but the levee was
dry” but it was not that part that struck
him so. It was the verse:
I was a lonely teenage broncin’ buck
with a pink carnation and a pickup
truck,
but I knew I was out of luck
the day the music died
As he reflected on his career, he tried
to think back to the specific day that
medicine “died”. There was certainly a
lot of days to choose from. He was
only a teenager in 2009 when the first
minority U.S. president added on to a
huge stimulus bill the requirement that
all medical doctors would, under
penalty of law, have to switch to
computerized records, although 9 out
of 10 physicians at that time could not
even type.
Not only did that stimulus bill lead to
the longest recession in U.S. history,
lasting up to the current date, January
of 2025, but that bill began the long
slide into what medical doctors had
become by now. It had begun
innocently enough, with doctors hiring
scribes to deal with the complicated
electronics. There were the
information technologists that were
supposed to help make the transition
easier. Sooner or later the patients
SOMBRERO – October 2016

and the politicians noted that their own doctors were
typing and had ceased to even look at them during a
visit. However, the IT guy in the office was a master at
entering data, much superior to their own MD.
In the meantime, the country had elected the first
female president. She had won in a landslide over her

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billionaire opponent. This was principally because it
had been revealed just before the election that he had
only run for president because of a dollar bet he had
made with the Russian premier that he could beat any
traditional politician and become President of the
United States. “Can you imagine someone with that
big of an ego?” thought Dr. Smitty.
Erstwhile, most surgeries were now robotic and “Up To
Date” was now available to laymen. It was installed in
each waiting room on 3-D holographic I-Pads, so they
could work on their own diagnosis. Most doctors had
given up private practice by now, and worked for
hospitals or corporations. Gradually their autonomy
and authority was whittled away, and soon they just
considered themselves employees. They owed
obsequence only to the corporation, or the hospital
administrator, no longer to the patient.
It was not a stretch nor a shock when that first female
president in 2023 issued a Presidential mandate making
all IT workers eligible to become doctors after a sixmonth rush course on medical theory. Medical doctors,
meanwhile, were kept on as technical advisors at much
reduced salaries. The best physician slots available
now were at the mini-medical schools; the local medical
school had 432 resumes submitted for a two-day slot

The Faces of Casa are the
James Nicolai, M.D.
Associate Medical Director

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.

teaching pediatric endocrinology, including resumes
from 430 medical doctors and two chiropodists.
Of course, there were some bumps in the road. The
death rates at hospitals did double, and then triple.
However, every dead patient had perfect PQRS
scores, and all computed data was correctly entered
on their electronic charts, so they did not really die.
Patient charts were improved until every event that
ever occurred during a patient’s life was included in
unlimited fashion, all documented and compiled in
thousands of pages of drivel. By incorporating their
Facebook pages, vital information like “I am relaxing
now with a glass of wine” was now part of the record.
Certainly it was a little hard to determine from the
copious record why a patient was actually visiting the
clinic that day, so the IT techs had to resort to asking
the patient why he or she was there. The word “patient”
was now banned from the hospitals; there were only
“clients” and “technicians”. There was no more of this
hoity-toity doctor stuff. It was all business now.
Dr. Smitty sighed as he slid his Tesla Model XXXXVV
into 15 th gear, the extension cord playing out from the
trunk at 30 miles per hour. Although electric vehicles
had become all the rage about a decade ago, onboard
energy storage was banned when it was discovered
that the massive piles of discarded
batteries had polluted one-third of the
U.S. soil. Huckster Elon Musk, who
was now buried on Mars per his
wishes, actually never made a dime
from any of his companies, and blew
up a bunch of rockets, but never
could design a car that could make it
to Phoenix and back. So much for
cutting the cord!

Dr. Smitty was late for his job as
Chief Medical Advisor to 150 patient
technicians at the local clinic.
Although a highly-trained surgeon,
since all surgery was now robotic, he
could only advise. After all, even he
had to admit that the “technicians”
were much better at entering data
than he was.
His mind went back to the final lyrics
of that famous Don McLean song
from 1971:

520.544.9890 | www.casahospice.com
Hospice services are paid for by Medicare

16

Them good ole boys were drinking
  whiskey ‘n rye
singin’ this’ll be the day that I die
this’ll be the day that I die.

n

SOMBRERO – October 2016

In Memoriam

Dr. Harold W. “Bill” Kohl, Jr., 1935-2016

H

arold W. “Bill” Kohl Jr. Tucson native and physician, passed away September
5, in Austin, Texas at age 81.

Born and raised in Tucson, Kohl and his father Harold W. Kohl, Sr. practiced
internal medicine together for 25 years. After graduating from Tucson High School,
Kohl received a bachelor’s degree from UA. He graduated from St. Louis University
School of Medicine in 1960. He continued his medical training at the Hospital of the
Good Samaritan in Los Angeles as an intern in 1960-61 and completed his
residency in internal medicine in 1962.
He returned to his hometown in 1962 and joined the Pima County Medical Society
where he was a member of the Rehabilitation Committee. Kohl served as a delegate
to the Arizona Medical Association, 1968-70 and was an alternate delegate, 197173. He was elected to the ArMA Board of Directors in 1976. He also represented
PCMS for the Tucson Community Council Health Care Center for the Aging. He
resigned from PCMS in 1982. He was a member of the American College of
Cardiology and was a fellow of the American Geriatrics Society.

Kohl was a fan of UA sports and avid hiker. He was preceded in death by his wife
Rose Ann. He is survived by three children: son Harold W. “Bill” III of Austin (Ann L. Kohl), Elizabeth Kohl Miller of
Albuquerque (Jeffrey W. Miller) and John T. Kohl of Colorado Springs and three grandchildren. In lieu of flowers
the family requests donations be considered to the Postal History Foundation of Tucson.
n

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Arizona Telemedicine Program

Two decades of long-distance health care

T

he Arizona
Telemedicine
Program, based at
the University of Arizona
College of Medicine –
Tucson, is an international
leader in the “virtual”
delivery of health care
and long-distance
learning opportunities for
patients, physicians and
other health-care
professionals.
In 1993, the program was
only an idea.
Former state legislator
Bob Burns, now a
member of the Arizona
Corporation Commission, learned about the benefits
of telemedicine at a conference in Scottsdale that
year. He presented the idea for a telemedicine pilot
program to fellow legislators and then-UA College of
Medicine
Dean James E.
Dalen, MD, MPH.
Dr. Ronald S. Weinstein

Dr. Dalen
embraced the
concept and
appointed Ronald
S. Weinstein, MD,
then chair of the
Department of
Pathology, as
director, a title
Dr. Weinstein
still holds. The
Arizona Legislature
authorized funding
for the Arizona
Telemedicine
Program (ATP) in
June 1996. In
July 1997, the
program went live
with its first two
sites, Mariposa
Clinic in Nogales,
Ariz., and the
state prison in
Yuma.

18

One of the early cases at the Nogales clinic, now
known as Mariposa Community Health Center, was
that of a little girl with a serious viral infection. Her
doctor was consulting with UA professor of
Pediatrics Ziad Shehab, MD, an infectious disease
specialist. The little girl and her mother – who did not
have a car – were in the room, and at the end of the
consult, Dr. Shehab said to the child, “I’m so sorry I
can’t give you a hug.”
The girl walked over to the monitor and gave it the
biggest hug she could. The child now is an adult – a
tribute to the advances in viral disease care, to which
Dr. Shehab is a widely recognized contributor, and the
convenience of telemedicine, which made it possible
for the girl to be seen by an expert.
In 2003, the ATP established the T-Health Institute in
downtown Phoenix, to offer training programs and
videoconferences on innovations in education and
health-care delivery.
ATP now is connected to 170 sites throughout Arizona.
Specialists in a wide range of fields – trauma surgery,
newborn intensive care, stroke diagnosis and care,
ophthalmology, cancer treatment, burn care,
behavioral health care and other specialties, as well as
primary care – consult with their colleagues in almost
every rural community in the state.
Outside the United States, ATP has helped establish
telemedicine programs in Albania, Kosovo, Africa and
Panama, and is exploring opportunities in other
countries.
Over the years, ATP has been recognized with
numerous honors. In May, the U.S. Distance Learning
Association honored the ATP for its “distance learning”
sessions that physicians and other health-care
professionals can log onto from around the state. The
USDLA Annual Eagle Award, given annually to a
public figure who has achieved national recognition for
his or her commitment to furthering the goals of
distance learning, was awarded to Bob Burns.
Asked if he had any idea 20 years ago what
telemedicine would look like today, Dr. Weinstein said,
“We would have recognized that in a decade the world
would be very different. We just wouldn’t have been
able to say precisely how that would be.”
n

SOMBRERO – October 2016

UA College of Medicine

White Coat Ceremony welcomes
record class

T

he largest class ever
admitted to the
University of Arizona
College of Medicine – Tucson
– 135 students – celebrated
their entrance into medical
school at the College’s 22nd
annual White Coat Ceremony.
The July ceremony is
designed to honor new
medical students as they
accept the responsibility of
the doctor-patient
relationship. Each student will
receive their first white coat
and a stethoscope, thanks to
the generosity of UA College
of Medicine – Tucson alumni, - The UA School of Medicine class of 2020 recites the medical students’ vision and mission
faculty and friends.
statement that they crafted during the first few days of medical school. (Mark Thaler/UAHS
BioCommunications).

In addition, each white coat
has Humanism in Medicine
pin that symbolizes a shared
commitment to providing compassionate and
competent patient care. The pins are provided as a gift
from the Arnold P. Gold Foundation, initiators of the
first White Coat Ceremony in 1993. (The UA College of
Medicine in Tucson was one of the earliest U.S.
medical schools to adopt the ceremony, holding its first
White Coat Ceremony in July 1995.)

Law who worked with immigration and family
advocacy law and the rights of indigenous people

herself through college

Students in the Class of 2020 include:

• A graduate of the UA P-MAP (Pre-Medical
Admissions Pathway) program whose family fled
Kenya and lived in a refugee camp for 17 years

• A Navajo student who worked with Johns Hopkins
University Center for American Indian Health to
build communication with Native American
patients

• A graduate of the UA James E. Rogers College of

SOMBRERO – October 2016

• Five students pursuing dual medical and doctoral
degrees in the UA College of Medicine – Tucson’s
MD-PhD Program, designed to train students
planning careers in academic medicine or
biomedical research. Completion of both degrees
typically takes seven to eight years: the first two at
medical school, then completion of graduate
course work and dissertation research, followed
by two years of medical school clinical
requirements.

Bruce M. Coull, MD, UA professor of neurology and
medicine, delivered the keynote address, “Fifty Steps
in Four Years: Professionalism on the Road to
Becoming a Doctor.”

• A nurse who grew up in Togo and supported

• Eleven graduates of the UA College of Medicine –
Tucson’s P-MAP (Pre-Medical Admissions
Pathway) program. Increasing diversity in the
health-care workforce is a top priority nationally,
and has been identified as a key factor to address
health disparities and ensure the adequate
provision of culturally competent care to our
19

nation. The UA College of
Medicine – Tucson’s
commitment to training
students who are inclined
to help address the
dramatic health
disparities encountered
by underserved
communities – including
reservations and rural
and border communities
– is illustrated by P-MAP,
launched in 2014. The
one-year program, which
includes a master’s
degree in cellular and
molecular medicine, is
open to Arizona residents
who have not had the
educational and
economic experiences
UA School of Medicine students celebrate at the 2016 White Coat Ceremony held July 29 at
that help students get

Centennial Hall. Pictured are: (left to right) Arif Muhammad, Amisha Singh, Kevin Severson,
Jessika Iwanski, Nicole Bejany. (Kris Hanning/UAHS BioCommunications).

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admitted to medical school, but
whose diverse life experiences and
skills – and their academic records –
make them outstanding candidates.
Preference is given to those who are
first-generation college students;
who grew up in rural or border
communities, or are registered
members of federally recognized
tribes.
The UA College of Medicine – Tucson
Class of 2020 accepted 135 students
from 6,458 applications. There are 74
women 61 men and
underrepresented minorities make
up 35 percent of the class. There
are 92 Arizona residents with a
3.63 average GPA and a 3.54
average science GPA. Fifty one
received an undergraduate degree
from UA and 37 percent have
graduate degrees.
n

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Janis Gasch, Au.D.
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20

SOMBRERO – October 2016

Urgent Care

New urgent care facility helps patients
avoid ER visits and costs

P

roviders, patients
and payors all agree
one way to keep
health care costs down is
to avoid expensive ER
visits for non-emergency
situations. Urgent
Specialists, located at
2120 W. Ina Road, was
established to treat a
multitude of cases that
typically end up in a
hospital emergency room,
even though they are not
emergency situations.

The new urgent care
facility offers access to
Otolaryngologist Robert Dean, board-certified physicians
MD. (Photo Courtesy Russell
in orthopedics,
Public Communications)
ophthalmology, and
otolaryngology. It opened in early September after four
Tucson specialists and UA classmates collaborated on
the idea. They all agreed there was gap to be filled
between private practice and the ER for some types of
specialties.
“Our unique multi-disciplinary urgent care model
solves many problems in healthcare today,” said
PCMS member Robert Dean, MD, an otolaryngologist
and a principal with Urgent Specialists. “Far too many
people are taking needless trips to local emergency
rooms for illnesses and injuries to the bones, muscles,
joints, eyes, ears, noses, and throats, which is a costly
and time-consuming option, not to mention clinically
unnecessary. Emergency rooms serve this community
best when they can focus their resources on
addressing life-threating situations.”
Dean said many of the cases that are most common
in today’s emergency room can be treated effectively,
and less expensively, at Urgent Specialists. These
include fractures, dislocations, sprains, abscesses,
dizziness, ear and eye trauma, sinus infections,
corneal abrasions, retinal detachments, and a host
of other orthopedics, ophthalmology, and
otolaryngology cases.
Joining Dean are fellow PCMS members
otolaryngologist David Parry, MD, and orthopedic
surgeon Timothy Dixon, MD. Other clinical staff
members include ophthalmologist Jason Levine, MD,
and nurse practitioners Tina Pristach-Patrick and
Cynthia Carlson. The director of operations is
Barbara Marco.
The center is nearly 6,000 square feet including six
SOMBRERO – October 2016

Urgent Specialists opened its doors at 2120 W. Ina Road in
early September. It hopes to keep patients out of the ER for
non-emergency specialty situations. (Photo Courtesy Russell
Public Communications).

exam rooms and dedicated suites for the treatment of
bone, muscle, joint, eye, ear, nose, and throat illness
and disease. It also maintains a state-of-the-art
radiology suite for routine imaging procedures.
“We looked at studies to determine what where the
most common conditions that could be treated in
urgent care outpatient setting.” said Dean. “It is not
designed to replace primary care physicians, but some
primary care practices are not equipped to handle
some of the illnesses and injuries we will handle. It
gives physicians and patients another option. And
things happen when a primary care office is not open
or has no appointments available on short notice.”
The physicians will continue to practice outside Urgent
Specialists. The center will always be staffed with
nurse practioners and physicians when available.
Patients may also be directed to the office of one of
the specialists if the specialist is not at the center.
“It is new to all of us so we are probably going to make
changes as we go,” Dean said. “The focus is keeping
patients away from the ER who are not in lifethreatening situations. That is a model that works
better for everyone.”
Dean said the center is still working on contracting
with insurance companies. They plan to accept
nearly all insurance plans including Medicare and
AHCCCS . Hours of operation are Monday – Friday,
7 a.m. – 7 p.m., and Saturday and Sunday, 9 a.m. –
5: p.m. You may contact the center at 395-0471, or 

www.urgentspecialists.com.

n
21

SAVE  THE  DATE  
                                               Dr.  Gann’s  Diet  of  Hope  

                                                             Disease  Management-­‐Prevention-­‐Nutrition  
 

With  over  29  Million  Americans  Suffering  From  Diabetes  and  Another  
86  Million  Prediabetic.  Its  Time  To  Discuss  how  We  Can  Take  Control  
of  This  Disease.    
We  Are  Pleased  to  Bring  Two  Best  Selling  Authors  and  Scientists  to  
Tucson  
JOIN  US  IN  THE  DISCUSSION  
Dr.  William  Davis  
Wednesday  October  26,  
5:30  Pm  
 

DOUBLETREE  INN  
445  S.  Alvernon  Way  

 

 
Dr.  Davis  is  Hosting  a  Special  Retreat  on  Health  Empowerment  on  October  27-­‐30  at  Loews  Ventana  for  
More  Information:  health-­‐empowered-­‐vacations.com  
 

Dr.  Robert  Lustig  
Friday  November  18  
6:30  PM  
 
         

                                     

DOUBLETREE  INN  
445  S.  Alvernon  Way  

   

Dr.  Robert  Lustig  is  an  internationally  renowned  pediatric  endocrinologist  who  treats  childhood  
obesity  and  has  studied  the  effects  of  sugar  on  the  central  nervous  system,  metabolism  and  disease.          

22

SOMBRERO – October 2016

New Technology

“The Magic Wand”
Mona Lisa Touch Vaginal CO2 Laser Therapy and a quick update on Vaginal Mesh
By Susan Kalota, MD

T

he time has finally
come when we are
not only talking
about, but also doing
something for women’s
sexual and vaginal
health! Since Ancient
times, men and women
have been searching for
ways to enhance their
sexual abilities and
enjoyment. This has
mainly translated into
treatment options for men, leaving the women behind
and often quite uncomfortable with the new found
sexual prowess in their male partners.
In recent times, we have had the “Viagras” to assist
men and have been searching for a similar ‘magic pill’
for women. 
Our ‘pill’ may actually be a wand! 
Many women are hindered in their ability to enjoy
sexual intercourse by vaginal dryness. This is a normal
evolution of aging, but who wants to give in to that! 
Vaginal estrogen can help reverse this in some but it is
not always successful, and is not available to all
(Breast Cancer survivors).  
Fractional CO2 Lasers have been used for years in
Aesthetic medicine but it took the Italians to think of
using it in the vagina, with the Mona Lisa Touch!  Other
companies have promoted similar products/procedures
but this one seems the most exciting to me because
the technology allows the effect to reach deeper into
the vaginal epithelium through a ‘stacking’ mechanism.
This promotes a longer duration of effect.  The Mona
Lisa Touch” is a vaginal probe delivery system of a
fractional CO2 laser treatment to the vaginal canal and
then an external delivery system for the labia and
external skin that uses laser energy to revitalize the
vaginal tissue.  This has been used to treat thousands
of women worldwide over the past approximately
8 years.
SOMBRERO – October 2016

This allows rejuvenation of the vaginal mucosa,
optimized over three consecutive treatments, 6 weeks
apart, and yearly ‘tune ups’.  This translates clinically
into much less vascular dryness -so sexual intercourse
can be much more enjoyable in those women with
issues of vaginal dryness or those with changes
related to lichen sclerosis.  It can also help with urinary
control in those with mild stress or urge incontinence. 
(It is NOT a treatment for severe incontinence!)
The laser therapy has been shown to restore
gynecologic health by generating new collagen, elastin
and vascularization.  The treatment causes an ‘injury’
that triggers a series of events that initiates neocollagenesis, collagen remodeling with angiogenesis,
epithelialization and the production of new
glycosaminoglycans and proteoglycans necessary for
the healing process and important in the
revascularization in the vagina.  The histological slides
of these changes are amazing!  I’m not terribly fond of
looking at H&E stained pathology slides (it brings back
nightmares of studying for my Board examinations) but
these really are impressive changes! It is reassuring
to see the hard evidence of the changes we want to
see—turning back the hands of the time/the effects of
ageing.
Candidates for this therapy are women with
gynecologic changes due to a decrease in vaginal
estrogen or those with lichen sclerosis in the vagina. 
This can be especially helpful in women with a history
of breast cancer, thrombophlebitis or other
contraindications to estrogen therapy; or women who
have not responded adequately to estrogen therapy. 
This is an office procedure that is virtually painless
vaginally, requiring no anesthetic. Externally some
patients will experience discomfort so most
practioners will use a local anesthetic cream prior to
treatment externally on the labia.
Contraindications to the therapy are the presence of
vaginal mesh for previous prolapse repair, a history of
vaginal or colo-rectal radiation, pregnancy, an active

23

vaginal lesion/infection, or prolapse beyond the
hymen.

For a quick update on the vaginal mesh issue,
according to Kalota... 

My hope is that this is only the beginning of many new
options opening up for women but I am excited that we
have this to start with. It is restoring vaginal health to
many women who believed that they had no options
but to live with atrophy of age or cancer treatment.

Several of the companies producing vaginal mesh kits
have stopped producing their products but recently the
industry leader, the most prominent vaginal mesh kit
supplier, decided to get out of the market.  AMS
(American Medical Systems) sold their women’s
division to ASTORA and finally a decision was made to
This is available in my office as well as in a couple of
close that division entirely.  My understanding is that
gynecologic offices in town. It should only be
despite settling a big class action lawsuit they found
performed by a qualified pelvic medicine practioner.
that they were still at risk for further lawsuits and
decided to get out of the field. 
Luckily, there are still a couple other
companies willing to produce
vaginal mesh kits.  They are
concentrating on extensively
teaching appropriate implanters
(urologists, urogynecologists, or
gynecologists) how to identify the
appropriate surgical candidates and
teaching them the surgical techniques
for optimal results.  As with any
surgery there are risks and expected
benefits, we need to make sure the
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risks are as low as possible and that
the Waterfall lawyers know the ins and outs of Tucson and Southern Arizona.
the benefit is likely achievable.  As
Get the power of solid, smart, skilled, effective and creative legal support.
surgeons, a major part of our job is
Barry Kirschner professionally handles claims of persons who have become medically
to manage patient’s expectations
disabled from employment through personal or group disability insurance policies and are
and to make appropriate
denied benefits. Barry has successfully litigated on behalf of doctors, lawyers, and other
recommendations.  Vaginal mesh
professionals. Barry has handled ERISA terminations administratively and in court, opposing
is NOT for everyone since it does
every major disability insurance carrier. Barry continues to be selected by his peers for
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inclusion in The Best Lawyers in America® in the field of Litigation — ERISA and continues
to those with significant vaginal
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prolapse, and especially in those
who have failed a previous repair
and now present with even more
extensive prolapse. 

AS POWERFUL AS OUR NAME.

 I am very happy that I still have this
useful tool in my toolbox to offer
appropriate patients. 
Dr. Kalota practices with Urological
Associates of Southern Arizona.
She is ABU-certified with subspecialty certification in Female
Pelvic Floor Medicine and
Reconstructive Surgery.
n

24

SOMBRERO – October 2016

Cameron
Cameron Javid
Javid MD
MD

April
April Harris
Harris MD
MD

Egbert
Egbert Saavedra
Saavedra MD
MD

One of the Nation’s Premier
Retinal Subspecialty Groups
St. Joseph’s Medical Plaza
6561 E. Carondelet Drive
Tucson, Arizona 85710
Northwest Medical Center
6130 N. La Cholla Blvd., Suite 230
Tucson, Arizona 85741
1055 N. La Cañada Dr., Suite 103
Green Valley, Arizona 85614
You may reach all locations at
520.886.2597 or toll free at

800.769.5874

Mark
Mark Walsh
Walsh MD
MD

Common conditions
treated include:

• Macular degeneration
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• Macular diseases, e.g., macular
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• Flashes and floaters
• Retinal tears
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• Pediatric retinal conditions
• Tumors involving the retina
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• Second opinions
New treatments available in clinical
research trials for wet & dry macular
degeneration and diabetic retinopathy

For maps of office locations, visit the contact us page.

www.RetinaTucson.com

SOMBRERO – October 2016

25

News Briefs

Telephone CPR improves
cardiac arrest outcomes

Bentley J. Bobrow, MD

The implementation of a
Telephone Cardio-pulmonary
Resuscitation (TCPR) program
increases survival rates and
favorable outcomes for patients
who experienced an out-ofhospital cardiac arrest,
according to a UA Department of
Emergency Medicine study
published online in JAMA
Cardiology.

“Although out-of-hospital cardiac
arrest (OHCA) is a major public health problem in the
U.S., we have a life-saving treatment – CPR. Most
cardiac arrest victims, however, don’t get that
treatment before trained rescuers arrive,” said Bentley
J. Bobrow, MD, professor at the UA College of
Medicine in Tucson and Phoenix and co-director of the
Arizona Emergency Medicine Research CenterPhoenix, part of the UA Department of Emergency
Medicine.
Bystander CPR (BCPR) has been shown to double or
even triple survival from OHCA. Despite decades of
public CPR training, in most communities fewer than
half of all individuals with cardiac arrest receive any
BCPR, and bleak survival rates persist.
Both the American Heart Assoc. and the Institute of
Medicine have emphasized the importance of
telecommunicators (9-1-1 call takers and dispatchers)
identifying cardiac arrest and assisting lay rescuers
(people without medical training) in providing BCPR to
improve survival.

Salpointe Grad New Chief of
UA Hematology & Oncology
Julie E. Bauman, MD has been
named the new chief of the
Division of Hematology and
Oncology at the UA College of
Medicine and UA Cancer Center.
Bauman, a 1985 graduate of
Salpointe Catholic High School,
spent the past four years in
Pittsburgh where she was
associate professor of medicine
at the Univ. of Pittsburgh Cancer
Julie E. Bauman, MD
Institute, co-leader of the UPCI
Head and Neck Cancer Program, director of its Head
and Neck and Thyroid Cancer Sections, and co26

director of the Head and Neck Cancer Center of
Excellence at the Univ. of Pittsburgh Medical Center.
Her research focuses on design of biomarker-driven,
early-phase clinical trials to prevent and improve
survival in head and neck cancer – a disfiguring and
devastating disease.
Her goal for the division is to work with faculty and
staff to design and conduct clinical trials that bring
cutting-edge scientific laboratory finds into the
prevention and treatment of cancer. Bauman’s three
areas of research have focused on “green
chemoprevention” using plants such as broccoli or
their simple extracts to help the body detoxify
carcinogens, battling an epidemic of throat cancer
caused by human papillomavirus and the emerging
field of immune-oncology (novel treatments to activate
the immune system to fight cancer).

Dr. Samuel Keim joins
ABEM board
Samuel M. Keim, MD, MS, has
been elected to the board of
directors of the American Board
of Emergency Medicine (ABEM).
Dr. Keim is professor and chair of
the University of Arizona
Department of Emergency
Medicine, director of the UA
Emergency Medicine Research
Center (AEMRC) and professor in
Samuel M. Keim
the Division of Epidemiology and
MD, MS
Biostatistics at the UA Mel and
Enid Zuckerman College of Public Health. Dr. Keim
practices clinically at Banner – University Medical
Center Tucson and Banner – UMC South.
Dr. Keim has been an ABEM volunteer since 1999,
having served as an Oral Certification Examination
examiner and case reviewer, an item writer for the
ConCert™ Examination and a member of the ABEM –
American Board of Internal Medicine Critical Care
Medicine Task Force. He also has served as president
of the National Council of Emergency Medicine
Residency Directors and on the residency review
committee of the Accreditation Council for Graduate
Medical Education.
The ABEM develops and administers the emergency
medicine certification examination for physicians who
have met the ABEM credentialing requirements. The
ABEM board of directors is comprised of volunteer,
board-certified, emergency physicians participating in
ABEM Maintenance of Certification, a program of
continuous learning and periodic assessment, and are
practicing physicians in emergency medicine. The
ABEM has more than 31,000 emergency physicians
currently certified and is one of 24 member boards of
n
the American Board of Medical Specialties.
SOMBRERO – October 2016

The RadVision Mobile App has arrived!
Introducing our new
iOS Mobile App!
Our
Mobile App allows you to access patient reports
quickly and easily from your hand-held device. This app is also
HIPAA-compliant, which ensures safety for you and your patient’s
personal health information.
Directions:
• Go to the iOS App Store.
• Search for our mobile app partner “Royal Solutions Group.”
• Download “Royal Solutions Group” app.
• Enter access code “Tucson.”
• Enter username and password to begin reviewing reports.
If you do not have a username and password, please call
the RadVision Hotline at (520) 901-6747.

Benefits Include
Alerts for finalized
patient reports
Customizable notifications
Alert preferences
User friendly interface
Compatible with
iPhone and iPads
(Android app coming soon)
Free download from
the iOS App Store

For more information, contact RadVision Technology Services at (520) 901-6747 or radvision@radltd.com.
A TUCSON TRADITION FOR MORE THAN 80 YEARS

radltd.com | (520) 901-6747 |
SOMBRERO – October 2016

27

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28

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SOMBRERO – October 2016