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Now Open and Accepting New Patients At Partners in Primary Care you'll experience care that

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reach your health goals. We offer a team approach to healthcare with you and your goals at the center of everything we do. Your doctor and Care Team will

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doctors and Care Team to help our patients reach their wellness goals, while earning gift cards along their way.

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Touro University Nevada

702-777-8687

874 American Pacific Drive, Henderson, NV 89014 Touro University Nevada is accredited by the WASC Senior College and University Commission (WSCUC) as a branch campus of Touro University California and licensed in Nevada by the Commission on Post-Secondary Education. Touro University Nevada does not discriminate on the basis of race, ethnicity, age, sex, gender, color, creed, national origin, religion, sexual orientation or disability. 4

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V EGAS INC 2275 COR PORATE CI R CL E, SU I TE 300 HENDER SON, NEVADA 89074 | 702. 990. 2550

From the editor

OVID-19 was declared a global health pandemic by the World Health Organization in March, resulting in a stay-athome order by Gov. Steve Sisolak for the health and safety of all Nevadans. Now, as our community continues to slowly reopen and welcome back visitors, we carefully don our masks and regularly sanitize our hands as we await a more permanent solution to this virus — in the form of a vaccine. While several companies steadily work on the more immediate antiviral drugs needed to treat symptoms of COVID-19, others are working on vaccines that could be used as a preventive measure against the disease. Health Care Quarterly gathered several local medical professionals to share their expertise on vaccine development, how vaccines protect against viral infections, the impact of vaccinations on the community, and what the distribution and administration of the future COVID-19 vaccine may look like. We hope these stories serve as a foundation for an educated understanding of vaccines and their role in a healthy society. When it comes to our health, our bodies are quite the impressive vessel — from the largest organ to the smallest bacteria. Health Care Quarterly takes a look at the human microbiome – the beneficial bacteria that play an integral role in our overall health and wellbeing. We get up close to these tiny microorganisms, paying extra attention to gut health. With control of nearly 70% of the immune system, our guts offer a major indicator to our physical health. Also in this issue, the Nevada Donor Network discusses the need for life-saving organ and tissue donations, and UMC Center for Transplantation reports on its plans to double kidney transplants. Southwest Medical also shares how opening its Center for Clinical Innovation offers leading research and services to Southern Nevada residents on glucose monitoring, PTSD and integrated functional pain. The return of sports was welcomed by many, but

how have things changed for athletes in our new COVID world? Las Vegas Heart Associates explains the careful training these athletes undergo and how heart conditions, and impacts of COVID, require strict medical attention. Sports offer entertainment but also serve as a popular form of escape for those in need of a break from the day-to-day stressors of life. Perhaps you prefer something a bit calmer? Health Care Quarterly explores another option with mindful meditation. This relatively simple practice can help with stress, anxiety and depression, memory, cognition and attention, and pain management. If sports and meditation aren’t for you, Southern Hills Hospital shares why pet therapy is an effective form of treatment for many patients and how it has continued offering it during the pandemic. As we close out 2020 and look forward to 2021, we invite you to help us celebrate our many medical professionals — physicians, dentists, nurses, EMTs, administrators and more — by nominating them for Vegas Inc’s 2021 Health Care Headliners. Submit your nominations by Dec. 9 at vegasinc.com/healthcareheadliners. This has been a year like none other, especially in health care. Thank you to our medical community for showing your unwavering support to Southern Nevada’s health and for sharing your insight and advice with Health Care Quarterly through it all. To our readers: We hope you’ve enjoyed these stories and learned something new along the way! I can’t wait to see what 2021 has in store for us.

Jennifer Inaba Special Publications Manager & Editor jennifer.inaba@gmgvegas.com

NOVEMBER 2020 H E A LT H C A R E Q U A R T E R LY

Medical News TABLE OF CONTENTS

A LOOK AT VACCINES

What goes into developing a safe COVID-19 vaccine

DECODING THE HUMAN MICROBIOME

Healthy bacteria that contribute to immunity

Southwest Medical brings clinical innovation to patients

Nevada Donor Network and UMC explain organ donation priorities

Pet therapy provides stress relief at Southern Hills Hospital

Las Vegas Heart Associates discusses athletes and risks associated with COVID-19

Unmanned aircraft completes longest organ delivery flight in Las Vegas MissionGO, a provider of unmanned aviation solutions, and Nevada Donor Network, an organ procurement organization serving the State of Nevada, announced two successful test flights carrying a human organ and tissue via an Unmanned Aircraft System. The first flight transported research corneas from Southern Hills Hospital and Medical Center to Dignity Healthâ€“St. Rose Dominican, San MartĂn Campus. The second flight, which delivered a research kidney from an airport to a location outside of a small town in the Las Vegas desert, marked the longest organ delivery flight in UAS history.

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NOVEMBER 2020 NEW SOFTWARE EMPOWERS LABS TO PROVIDE SAME-DAY COVID RESULTS COVID-19 revealed a stark truth—medical labs were not ready for public health emergencies, and testing delays enabled the virus to spread. While in quarantine, Las Vegas-based software entrepreneur Jaswant S. Tony changed the paradigm by developing GoMeyra LIMS, a customizable cloud-based lab information management system. By streamlining sample accessioning from 5-10 minutes down to 10-20 seconds per specimen, the real-time automated solution empowers labs to triple processing capacity and, in turn, provide same-day results. Used by dozens of labs and businesses throughout the U.S., including casinos, pro sports franchises and enterprise level organizations, GoMeyra is enabling the public to return to work, school and normal activities quicker than any other lab solution since the start of the pandemic.

TRACING APPLICATION LAUNCHES TO SPEED UP NEVADA’S RECOVERY COVID Trace is a contact tracing mobile app developed by the Nevada Department of Health and Human Services that uses a technology called the Exposure Notifications System from Google and Apple. The app exchanges anonymous information with other phones in your vicinity and can notify you if you’ve come in contact with someone who has tested positive for COVID-19, effectively empowering you to quarantine safely, seek timely medical attention and reduce risk to your loved ones. The app works by using Bluetooth to exchange random codes with nearby phones. Each day, it checks a list of random codes from people who tell the app they tested positive. If it finds codes that match, the app notifies you that you’ve been exposed and explains what to do next. For more information, visit nvhealthresponse.nv.gov/ covidtrace.

THE ONLY ELECTROCONVULSIVE THERAPY TREATMENT IN THE STATE Southern Hills Hospital’s behavioral health unit, the Pavilion, is the only hospital in the state offering electroconvulsive therapy. ECT uses a small amount of electrical stimulation that induces a seizure in the brain while under anesthesia. The therapy is used to treat a variety of mental health conditions such as severe depression, mania, catatonia, schizophrenia and dementia with behavioral disturbance, and can be useful for people who have not responded to other treatments. Since the Pavilion began offering ECT in June, more than 200 treatments have been provided. Psychiatrist Dr. Jacob Manjooran said it’s a treatment he believes in, “With antidepressants there is only about a 40% efficacy rate, in comparison, studies show ECT has an 80% response rate.” Dr. Manjooran said he sees a difference in his patients in just 2-3 weeks and adds that the side effects are minimal. For more information on ECT, visit southernhillshospital.com.

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Medical education growth expands local health care base BY JENNIFER MCDONNELL

M Jennifer McDonnell is the director of public relations & communications for MountainView Hospital.

ountainView Hospital, a member of Sunrise Health Systems and HCA Healthcare, began its journey from community hospital to teaching hospital in 2015, with the founding of the Sunrise Health Graduate Medical Education Consortium, based at MountainView Hospital. Since that time, MountainView has grown its educational commitment to the community by educating the next generation of nurses, pharmacists and, more recently, paramedics. MountainView entered the world of graduate medical education with the launch of the MountainView-based GME program. With the inaugural class of 2016, the program has grown to include a wide mix of specialty fields. The program now encompasses anesthesiology, diagnostic radiology, emergency medicine, family medicine, general surgery, internal medicine, neurology, OB-GYN, physical medicine & rehabilitation, psychiatry and transitional year, and three fellowship programs, including endocrinology, diabetes and metabolism, gastroenterology, and most recently accredited, anesthesiology critical care medicine. There are now 244 residents who rotate at all Sunrise Health hospitals in Las Vegas. With recruitment to Las Vegas often an ongoing challenge for many fields, especially in health care, a strategic decision was made to begin “growing our own” in several different fields. In order to continue to recruit the highest caliber of board-certified pharmacists, the MountainView Pharmacy Residency Program was launched in 2017 with three residents. Three years later, the program has expanded to eight pharmacy residents. In 2020, the program also launched a post-graduate year two program in infectious disease. This is an additional year of training for pharmacists interested in specializing in a certain area and continuing their education.

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The MountainView Pharmacy Residency Program provides highly specialized rotations, from critical care to oncology to a focus in neonatal services, research or emergency medicine, that aren’t always present or easy to find all in one program. Continuing on the educational path, MountainView launched the MountainView Hospital Paramedic Institute, to facilitate the growth and education of paramedic students in our community. The inaugural cohort of paramedic provider students, who will begin this fall, will undergo a 12-month program that involves a stringent didactic regimen and hands-on clinical immersion. MountainView Hospital is partnering with local fire departments and private EMS transport agencies in creation of the program. Students attending the institute will be sponsored by each agency. MountainView also focuses on new nurse graduates, hiring them into the hospital’s StaRN program, a 10- to 12-week mentoring program that features didactic and clinical training. It allows new graduates to obtain acute care nursing experience through an intensive internship program. Following completion of the program, the StaRN will transfer to a hospital unit and work with a preceptor to continue training. MountainView provides unique access to all of its learners on campus, including the on-site Simulation Center that offers medical students, nurses, interns, residents and hospital clinical staff the opportunity to train in a virtual patient care environment using simulated patients and sophisticated technology. The center contains overhead cameras that tape the medical team’s actions, so leaders can provide feedback after the simulated training. MountainView’s commitment to education has not gone unnoticed at the national level. The Leapfrog Group named MountainView a Top Teaching Hospital in 2018 and 2019—one of only 120 hospitals to receive a top hospital award, which is widely acknowledged as one of the most competitive honors American hospitals can receive.

NPs could be a key to improving college HPV vaccine rates BY MARIA D’ERRICO, DNP, APRN, FNP-BC AND RHONE D’ERRICO, DNP, MBA, APRN, FNP-BC

uman papillomavirus is the most common sexually transmitted infection in the United States. An HPV infection can be devastating, potentially resulting in anogenital warts and cancers of the cervix and oropharynx. According to the Centers for Disease Control and Prevention, HPV-related illnesses place an annual $8 billion economic burden on the U.S. each year. Despite the availability of a safe and efficacious HPV vaccine, many adolescents do not receive this routine childhood immunization. These unvaccinated individuals reach young adulthood at risk for contracting an HPV infection. Each year, 20 million young adults arrive on college and university campuses across the U.S. According to a recent national survey from the American College Health Association, 38.5% of undergraduates and 45.7% of graduate students report they have never received the HPV vaccine. These college students face barriers to vaccination, leaving them vulnerable to HPV-related illnesses. Student Health Centers on college and university campuses are where many college students receive health care. SHCs are commonly staffed by nurse practitioners who have a specific professional mandate to promote population health and focus on disease prevention. For these reasons, nurse practitioners are in a unique position to positively impact the health of college students by increasing uptake of the HPV vaccine in this population, and thereby reducing the rates of sexually transmitted infections and several forms of cancer. In a study we performed at a Nevada university SHC and published in the July issue of The Journal for Nurse Practitioners, we sought to examine both the perceived barriers to HPV immunization in the college student population as well as what recommendation this population would find most effec-

tive in increasing their uptake of the HPV vaccine. The study was led by a family nurse practitioner in the college health setting and supported by a research team that included another family nurse practitioner with college health experience, a Ph.D. nursing professor with wide experience in public health and an expert health science statistician. The study lead spent one month at the SHC and received more than 600 survey responses. The survey was developed by the team based on an existing validated HPV survey. In the study, most participants identified themselves as being unvaccinated, under-vaccinated or unaware of their vaccination status. It was found that the two most common barriers to HPV vaccination identified by the study sample were a lack of a health care provider’s recommendation to receive the vaccine and a lack of perceived risk from HPV exposure and infection. Further, the study found that the participants identified a recommendation from a health care provider as most effective in encouraging them to receive the HPV vaccine. Our study concluded that many college students are not fully vaccinated against HPV, a finding in line with other national statistics, and concerning based on the widespread availability of the vaccine and long-running national multimedia campaigns promoting the value and benefit of the vaccine. The lack of vaccination places these students at significant health risks arising from HPV infection. Additionally, the lack of a vaccine recommendation from a health care provider was a widely expressed barrier to HPV vaccination. Students identified recommendations to receive the vaccine as among the most influential when coming from a health care provider. Given the ubiquity of NPs in the college health setting, and the mandate for NPs to promote health and disease prevention, the study concluded that NPs are in a unique position to positively impact health by consistently recommending the HPV vaccine to college students.

NOVEMBER 2020

Maria D’Errico, DNP, APRN, FNPBC, is an adjunct faculty member and Rhone D’Errico, DNP, MBA, APRN, FNP-BC, is an assistant professor, both with Touro University Nevada School of Nursing.

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Trauma survivors: Remember coping tips as holidays loom BY TERRI KEENER, LCSW

T Terri Keener, LCSW, is the state behavioral health coordinator at the Vegas Strong Resiliency Center.

he COVID-19 pandemic has drastically affected life as we know it, emotionally and physically. A recent Wall Street Journal article revealed that studies are finding elevated PTSD rates among health care workers and young people. The article shared one study published in Psychiatry Research that surveyed nearly 900 18- to-30-year-olds in April and May and found that about 32% of young adults had high levels of PTSD symptoms, with those expressing more loneliness and worries about COVID-19 most affected. The pandemic adds another layer of anxiety or stress for those impacted by trauma, including the hundreds of survivors of the Route 91 Harvest music festival shooting tragedy. While the holidays can be stressful for anyone, those who have experienced trauma and loss can find it even more challenging. “Thinking about the families who are missing their loved ones and others who are still struggling, physically and emotionally, makes the holidays harder to celebrate,” said Jill Winter, who was at the Route 91 concert on Oct. 1, 2017. “It’s helpful to reach out to others. The reminder that we’re not alone and that we’re all in this together is huge.” It’s important to recognize that feelings and reactions are OK. It’s not necessary to justify them or make others understand. With an understanding that reminders and emotional reactions are likely during the holidays, people can prepare to manage them. Some can be anticipated, while others may be unexpected. Practicing and preparing coping strategies can help people handle difficult moments: n Be aware that special days may be difficult and remind you of losses. These reactions are normal. Acknowledge and allow feelings. n Attend to basic needs. Stay hydrated, eat well, stay active and get enough sleep.

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n Participate in comforting rituals. Create new ways to acknowledge and celebrate special days. n Reach out to family and friends who care. Do not isolate. Invite or accept invitations for social events and spend some time with others. n Talk about your losses with someone who will listen and understand. Be aware of the type and level of support they can provide, and accept it. n Do things that help you with overwhelming emotions. Take walks or write in a journal in the days around and on the special days. n Do what you would like to do rather than what you think you should do. n It’s natural to feel sad and angry when others seem to be enjoying themselves while you are having a difficult time. Acknowledge feelings and be aware that they are connected to grief or trauma rather than to anyone in particular. n Accept kindness from others. n Focus your attention on what is most important to you and what you can control. n Helping others may help you. Simple acts of kindness toward others may invoke positive reflections on what has meaning for you and how you can positively influence others. n Connect with other survivors. Remember that you are not in this alone. n Use grounding and mindfulness techniques. Winter uses a number of these coping techniques and recommends square breathing. Instead of counting to four when breathing in, holding, breathing out and holding again, she uses a mantra, “this won’t last forever.” The Vegas Strong Resiliency Center encourages anyone affected by the Oct. 1 tragedy to reach out for support. The Resiliency Center is a free service that offers resources to anyone affected by the attack, including survivors, friends and family members of victims, responders and their families, and those who witnessed the incident or tried to assist victims.

Nursing research efforts challenged during COVID-19 BY BARBARA ST. PIERRE SCHNEIDER, PHD, RN, FAAN

ost people know nurses for their bedside presence or caring for individuals with illness. However, there is a small proportion of nurses who are scientists or researchers. These researchers devote their efforts to systematically answering questions directed toward understanding and improving the human response to illness and treatment (known as nursing science) or the educational preparation of clinical nurses (known as the science of nursing education). These researchers can be found in academic institutions, in the community or even in a laboratory. For many years, I have been one of these nurse researchers, studying the white blood cell response to acute skeletal muscle injury. For the past 14 years, I have been a nursing faculty member at UNLV. When the COVID-19 pandemic hit in March, my 11-member team was in the middle of the third year of a four-year project with implications for wounded soldiers transported by air for medical treatment, known as en route care. When we received word that classes and meetings were being moved remotely, I felt I had to use my triage skills from clinical practice, thinking about how to maintain the integrity of the research but also keep the team safe. We were fortunate the school of nursing and university already had infrastructure in place for remote work. We just needed to figure out how to manage the lab work remotely, with a limited supply of personal protective equipment. From March through the middle of May, our procedures shifted in multiple ways. As a team, we decided which procedures we could put on hold. Because our knowledge about the virus was changing daily and the risk of infection and mortality rate were high, we avoided high-

stakes procedures and those that required multiple people to work together. We determined who needed to or could work remotely and staggered schedules. All of us became more dependent upon the internet for communication. Everyone had â€œjust-in-timeâ€? training on how to use video conferencing software so that assignments and goals could be discussed, and documents reviewed simultaneously. Our lab procedures shifted again when Nevada advanced to phase 2 of the COVID-19 pandemic at the end of May. We felt that we could complete the postponed procedures, but we needed to do so in compliance with the PPE, disinfecting and distancing requirements. As a nurse, I wanted to ensure we met these requirements in the safest and most practical ways. We did not resume our multiteam tasks until we had developed and practiced written protocols so that we could plan for the appropriate distancing. The project manager and I did a lot of research on disinfectant protocols and spent much time thinking of how to implement a feasible protocol for daily routine cleaning of high-touch areas (e.g., door knobs, chair backs, seats, computer keyboards). Other team members were instrumental in testing the feasibility of this protocol. The project manager explored multiple vendors to obtain the additional required PPE to be deemed working safely in the lab now. The COVID-19 pandemic has generated new challenges and prompted us to work differently in conducting research. However, I feel fortunate the team has adapted and been resilient in stepping up to these challenges and different ways of thinking and working. While the pandemic slowed our research progress, we have persevered to generate findings that could one day improve the en route care of wounded soldiers who make the ultimate sacrifice.

NOVEMBER 2020

Barbara St. Pierre Schneider, Ph.D., RN, FAAN, is a professor at UNLV School of Nursing.

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Immunotherapy option emerges for some breast cancer patients BY DR. STEPHANI CHRISTENSEN, MD

I Dr. Stephani Christensen, MD, is a medical oncologist at Comprehensive Cancer Centers.

n recent years, immunotherapy has transformed the way we treat many cancers. At its core, immunotherapy is a form of cancer treatment that essentially activates the body’s immune system to combat harmful cancerous cells. Notably, and as a testament to just how groundbreaking this form of treatment is, two prominent researchers who pioneered the field of immunotherapy took home the Nobel Prize in medicine for this innovation in 2018. Locally and here at Comprehensive Cancer Centers, we’ve been on the front lines of immunotherapy clinical research as well, with patients on colorectal cancer, advanced lung cancer, lymphoma, breast cancer and other trials throughout the years. For certain breast cancer patients, a promising new immunotherapy trial has just opened at Comprehensive Cancer Centers which combines standard chemotherapy with a type of immunotherapy called Atezolizumab. Atezolizumab is used in combination with chemotherapy to treat metastatic (or noncurable) triple-negative breast cancer patients. This trial seeks to see if Atezolizumab works in early stage (or curable) breast cancer as well. Atezolizumab works by helping the immune system activate to recognize and ultimately destroy cancer cells in the body. Atezolizumab, which is administered through an IV, is a monoclonal antibody that blocks the activity of programmed death ligand (PDL-1). PDL-1 proteins are found on cancer cells and block normal immune function, creating a phenomenon that resembles a force field that shields cancer cells

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from our normal immune response. Atezolizumab binds to PDL-1 and breaks these proteins down, thus eliminating the force field. By blocking PDL-1, the immune response is activated to find and kill cancer cells. To qualify for the trial — or any clinical trial, for that matter — patients need to meet specific criteria. For the Atezolizumab trial, patients must have triple-negative breast cancer, stage II or III breast cancer and be eligible to receive chemotherapy before planned surgery. After a biopsy-confirmed breast cancer diagnosis, enrolled patients will complete an immunotherapy-plus-chemotherapy regimen, followed by surgery (either a lumpectomy or mastectomy). After surgery, the study group will continue the immunotherapy treatment for one year. As with all of Comprehensive’s patients, we’ll establish a stringent follow-up regimen to check in on how things are going. Comprehensive’s very first patient on the trial officially enrolled in late September. In the coming weeks and months, we’ll certainly have others enrolled, not only positively impacting their own health scenarios, but potentially breast cancer patients throughout the world. As a final bonus, local research like this keeps patients from having to travel out of state for the latest and greatest treatments available. Within the broader research spectrum, this is just one of many trials. Comprehensive, an affiliate of the US Oncology Network, participates in more than 170 Phase I, Phase II and Phase III clinical research studies each year. To date, Comprehensive has played a role in developing more than 100 FDA-approved cancer therapies. For a list of the practice’s active clinical research studies, visit cccnevada.com/clinical-research.

Program addresses shortage of speechlanguage pathologists BY ANGEL L. BALL, PH.D.

evada State College has responded to the shortage of speech-language pathologists in our community by starting the only graduate program in Southern Nevada. According to Nancy Kuhles, CCC/SLP, of the Nevada Coalition, there are on average 77 vacancies yearly over the past 13 years in school settings. However, schools are not the only area of need.  pathologists serve Speech-language the communication and swallowing needs of individuals of all ages, from birth to older adults. According to the Bureau of Labor Statistics, the employment of speech-language pathologists is projected to grow 25% from 2019 to 2029 due in part to the increased needs of Baby Boomers. The 2020 US News and World Report on the 100 best jobs listed speech-language pathologists at No. 8, and No. 6 in best health care jobs. Graduate programs are accredited by the Council on Academic Accreditation in Audiology and Speech-Language Pathology of the American Speech-Language-Hearing Association. Students receive training on speech sound disorders, fluency and fluency disorders, voice and resonance disorders, receptive and expressive language delays and disorders, hearing issues with impact on speech and language, swallowing/feeding (including oral, pharyngeal, pulmonary, esophageal and gastrointestinal impairments), cognitive and social aspects of communication as well as augmentative and alternative communication modalities. Until now, Nevada had only one accredited program in speech-language pathology, at UNR. Nevada State College’s program now provides an opportunity to support the local workforce needs and improve the quality of care for our community.  The first Nevada State College graduate cohort began in the fall of 2019 and will be joining the workforce at the end of 2021. During their studies,

they will be entering externship opportunities with facilities across the Las Vegas area. Our on-campus training has already included diagnostics and treatment for children and adults with stuttering, aphasia, language and speech sound disorders.  With the support of the Scottish RiteCare, managed by faculty member Elizabeth Meyerowitz, Ed.D., CCC/SLP, children are receiving free telehealth therapy. The program’s clinic director, Melanie Bradle, MA, CCC/SLP, and faculty Christy Fleck, Ph.D., CCC/SLP, recently obtained a 2020 grant from the Parkinson Voice Project to provide SPEAK OUT! and LOUD Crowd speech-pathology services for communication issues with Parkinson’s disease.  Nevada State College is steadfast in addressing the needs of our community. With the construction of the new Glenn and Ande Christenson School of Education building, opening fall of 2021, the Speech-Language Pathology NSC Clinic will be a premier training site for students. Rooms are being designed with state-of-the-art equipment, audiovisual systems and will be autism-friendly. Services will be supervised by certified and licensed speech-language pathologists, who are also Nevada State College faculty. The SLP Clinic will provide high-tech diagnostics and treatment programs for voice, resonance, articulation and swallowing disorders of children and adults. The disorders may be related to structural and behavioral issues such as vocal fold damage of singers, transgender voice, cleft palate, Parkinson’s disease, cerebral palsy and stroke. Another area of service includes individual and group programs for adolescents and adults with communication challenges from stroke, head injury, autism spectrum disorders and other neurologic disorders.  The on-campus clinic will also have an augmentative and alternative communication lab that will service individuals who benefit from supportive technology for communication.

NOVEMBER 2020

Angel L. Ball, Ph.D. is the Certificate of Clinical Competence for Speech-Language Pathologists program director at Nevada State College.

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NOVEMBER 2020

COVID-19 VACCINES

THE CHALLENGES OF CREATING A COVID-19 VACCINE

or many of us, our daily lives have changed with the continued spread of COVID-19. As the pandemic persists, the pressure to approve and distribute a vaccine that would allow the world to return to normalcy is stronger than ever. The New York Times reports there are more than 50 vaccines in clinical trials on humans, and according to the World Health Organization, there are more than 100 vaccines in some phase of development around the world. But even with an accelerated timeline, the process is lengthy. The College of Physicians of Philadelphia states that it typically takes 10-15 years to bring a vaccine to market, with the fastest taking four years. The WHO estimates that a vaccine for COVID-19 will not be available until 2021. If you find yourself wondering why it takes so long and if it will be worth the effort, you’re not alone. We asked local health care professionals to provide us with the complete rundown on vaccines—from development and testing protocol to the medical importance and value they provide to our community.

Since initial reports of the COVID-19 outbreak in Wuhan, China, we have learned much about the virus’s myriad disease presentations and witnessed multiple vaccine candidates enter accelerated testing. Despite the escalated pace, there are key challenges in designing a new vaccine, largely because we are still learning exactly how the disease spreads and how it can trigger different immune responses in each individual. Does the type of virus determine its vaccine?

The way in which a virus causes its infection, and the immune response that occurs in response to the infection, must be factored into a vaccine. For some viruses, generating antibodies against the virus is an effective vaccine, but for other viruses, a more sophisticated immune response that includes activation of specialized immune cells is needed. The challenge with SARS-Cov-2 is that we are designing vaccines while still learning how the virus works. Why is the COVID-19 virus particularly challenging?

Scientists have noted that SARS-Cov-2 has unique characteristics far different from DR. CINDY M. P. DUKE, SARS and MERS, which are in the same MD, PHD, FACOG genus. However, because most of the biological characteristics of SARS-Cov-2 are still obscure, vaccinologists are extrapolating data from these related viruses to fast-track COVID-19 vaccines. Simply put, the newness of the SARS-CoV-2 virus makes it difficult to create a vaccine candidate in such a short time frame. Hence, vaccinologists are targeting every aspect of the virus in vaccine trials across the globe. Will a vaccine for COVID-19 protect against future coronavirus outbreaks?

It’s unlikely a vaccine will guarantee protection against future outbreaks. While all coronaviruses have a similar structure, the diseases vary in symptoms, severity and transmission. In addition, viruses mutate over time, so COVID-19 vaccines will have to evolve as well. It’s also too soon to say if a single treatment will protect against future outbreaks. We are still very early in the process of understanding how a potential COVID-19 vaccine would work. Continued on page 16

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Nov. 265,294 projected

Continued from page 15 What has the COVID-19 pandemic taught us about the spread of viruses and the importance of vaccines?

This pandemic is a stark reminder that emerging diseases with pandemic potential can inflict heavy human and economic tolls. We have to ensure that global health preparedness, including vaccine development, is always a top priority. COVID-19 has made it clear that we must place emphasis on maintaining strong and consistent affinity between the government, the scientific community and the populations at largeâ€”especially when it comes to implementing a wide spectrum of measures to contain, and in the future, prevent similar epidemics. Despite the ongoing race to develop the right vaccine, it is important that we impress upon ourselves that the goal is not to produce one winner. We have to recognize that in the early stages of release, different vaccines will target different aspects of this virusâ€™s biological profile. Vaccinologists are hard at work identifying and accelerating vaccine candidates into production, but their work is just beginning. For the next 18 to 36 months, we need to continue to emphasize the importance of the basics: handwashing, wearing a mask and physical distancing. Dr. Cindy M.P. Duke is a Ph.D.trained award-winning, virologist whose research interests centered on the interplay of viruses with the human immune system and viral vaccine development. She is also the physician founder, medical and laboratory director of Nevada Fertility Institute.

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TOTAL COVID-19RELATED DEATHS IN THE U.S. From the Institute for Health Metrics and Evaluation as of Nov. 7

August 183,938

1,495,514 deaths projected globally by the end of November

July 152,896

June 128,135

May 107,467

April 64,987

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Oct. 228,617 projected

Sept. 206,053

COVID-19 VACCINES

TOTAL COVID-19RELATED DEATHS IN NEVADA From the Institute for Health Metrics and Evaluation as of Nov. 7

November 1,987 projected

October 1,788 projected

September 1,600

August 1,315

July 807

June 513

May 416

VACCINES TEACH OUR IMMUNE SYSTEM TO BE READY With the current focus to find a immune response. vaccine for COVID-19, questions are Identifying or zeroing in on a raised about the development, safety vaccine formulation is often a very and approval process of vaccines. long and difficult process. This careVaccines are the most cost-efful process of vaccine development fective and efficient intervention and approval is necessary to ensure against infections, and play an public safety. important role in keeping people Once a candidate vaccine is healthy. identified, it goes through a rigorous The human body has process of testing known intricate mechanisms to as clinical trials. fight off infections, whethClinical trials have to be er caused by bacterial or long enough to show that viral infectious agentsâ€” there is an adequate imalso known as pathogens. mune response protecting After clearance of an the individual, and also infection, our immune that the immunity is long system remembers how lasting and safe. MANAS MANDAL, BSC, MSC, PHD it fought off the pathogen Typically, the safety and and remains ready if weâ€™re efficacy of the vaccine are infected with it again. studied in human volunteers with A vaccine is used to stimulate our oversight from the Food and Drug immune system to build immune Administration. Findings from the memory without causing the real clinical trials are reviewed by the infection, thus providing us with FDA, and only with satisfactory immunity from the pathogen. results, a new vaccine is released to The threat of infection is reduced the public. Even after release of a when most of the population is vaccine, the FDA continues to monivaccinated because this reduces the tor vaccine safety. ability of the infection to spread in Currently there are several the community. COVID-19 vaccines in trials to deTo stimulate our immune system termine safety and effectiveness in without causing infection, vaccines human volunteers. may contain parts of the pathogen or Due to the urgent need for a killed whole pathogen. COVID-19 vaccine, some are being Vaccines are often proteins but produced in large scale even before can also be genetic materials of the their safety and efficacy have been pathogen. Upon immunization, our proven. By doing this, the vaccine body develops antibodies, defense can be quickly distributed to the molecules via activation of white public following the FDA approval. blood cells against these proteins, which then neutralize the pathogen Dr. Manas Mandal, BSc, MSc, Ph.D., before it makes us really sick. is an associate professor of PharDeveloping a vaccine requires maceutical Sciences at Roseman that researchers find a safe and University College of Pharmacy and a correct mix that triggers a robust Fulbright Specialist.

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COVID-19 IS SHIFTING PATIENT VIEWS, DECISIONS ABOUT VACCINES The concept of immunization is very simple: A small part of a disease or virus is injected into the body to encourage the immune system to build antibodies to fight the disease. Immunizations have greatly minimized or eradicated conditions such as measles, mumps, rubella, tetanus, hepatitis and chickenpox, to name a few.   With the pandemic still playing out, our clinic is seeing a growing acceptance of life-saving vaccines and far less resistance or apathy around the subject. Yet JONATHAN BAKTARI, MD  there’s still more that can be learned about why they’re important and which ones a patient should receive at any given time.  Kids and adults

For simplicity, we often separate vaccines into the category of “childhood” or “adult.” Childhood vaccines get the bulk of the attention and most parents with children ages 6 months to 5 years adhere to the CDC recommended schedules in place.  Adult immunizations, however, can be largely underestimated. Data show that before COVID, about 50,000 vaccine-preventable deaths occurred in the U.S. annually. Think about that: In the past 10 years, 500,000 Americans lost their lives because they weren’t vaccinated for a specific disease.   Adult vaccines include tetanus shots, or Tdap, which includes tetanus, diphtheria and pertussis vaccines and should be given every five to 10 years; the annual flu shot; and meningitis immunizations, specifically recommend-

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ed for young adults headed to college. In addition, our practice administers travel vaccines, such as typhoid, cholera and yellow fever, which is spread through mosquito bites.   Seeing vaccines differently

At e7 Health, we vaccinate about 20,000 adults annually in Las Vegas alone. Recently, we’re finding that patients are happy to receive travel immunizations if the CDC recommends it for their travel destination. In the past, many shrugged them off as unnecessary.   As we educate patients on appropriate vaccines for their situation, we also see greater demand for flu vaccines. With the pandemic, the flu complicates medical decisions because it shares many symptoms with COVID-19. That’s why the vaccine is highly encouraged by the CDC.  Just as a grandparent surviving the Great Depression remained frugal, the current generations will forever have COVID-19 impacts on their mind. Once you’ve experienced one pandemic, you simply can’t move forward without the thought of another occurring in the future. With those thoughts top of mind, immunizations will continue to play a key role in keeping all of us safe.

DATA SHOW THAT BEFORE COVID, ABOUT 50,000 VACCINE-PREVENTABLE DEATHS OCCUR IN THE U.S. ANNUALLY. THINK ABOUT THAT: IN THE PAST 10 YEARS, 500,000 AMERICANS LOST THEIR LIVES BECAUSE THEY WEREN’T VACCINATED FOR A SPECIFIC DISEASE.

Dr. Jonathan Baktari is the CEO of e7 Health, a preventive health and wellness center with offices in Las Vegas and Chicago.

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COVID-19 VACCINES

THE CENTERS FOR DISEASE CONTROL AND PREVENTION REVEALED THAT NEVADA HAD THE LOWEST FLU VACCINATION RATE IN THE COUNTRY DURING THE 2019-20 FLU SEASON, WITH ONLY 44.4% OF PEOPLE 6 MONTHS OR OLDER RECEIVING A FLU VACCINE.

VACCINES PLACE VALUE ON HEALTH AND COMMUNITY The COVID-19 pandemic has been a stark reminder of the importance of immunization. Not an evening newscast or online story about coronavirus concludes without a mention of the timing of vaccine availability. For the past 25 years, Immunize Nevada, a statewide coalition, has ensured all Nevadans have the information (and ultimately, vaccines) they need to protect themselves and their families. “We provide education to both the community and health care professionals,” said Immunize Nevada board member Melissa Shake, PharmD, a Las HEIDI PARKER Vegas-based immunization trainer for Walgreens. “Other times we team up to directly provide care. We serve as a resource to connect patients with the right care.”

means less illness and fewer people using medical resources needed for COVID-19 patients. Unfortunately, not everyone takes advantage of the protection offered by vaccines—especially against flu. The Centers for Disease Control and Prevention revealed that Nevada had the lowest flu vaccination rate in the country during the 2019-20 flu season, with only 44.4% of people 6 months or older receiving a flu vaccine. Nevada earned the same “last place” distinction in seven of the past 11 flu seasons. Immunize Nevada recognizes that the biggest obstacle to vaccination for many Nevadans— whether against flu or other preventable diseases, such as whooping cough, cancers caused by HPV or pneumonia—is access. Our health workers collaborate with businesses and community organizations to connect Nevadans with resources that include free vaccines offered at mobile clinics. “Vaccines protect both young and old from some of the world’s most devastating diseases,” said Renown Health Chief Transformation Officer and Immunize Nevada board member Bethany Sexton, MBA. “They protect me, but I also help protect others by making sure I get vaccinated.” When a COVID-19 vaccine becomes available, the organization will be ready. “But until then, Nevadans can stay healthy by making sure they’re current on other immunizations, including their annual flu vaccine,” Sexton said. For information about Immunize Nevada’s mission to ensure all Nevadans can access vaccines, health care and resources they need to stay healthy, visit immunizenevada.org.

Flu + COVID = ‘Twindemic’ Fears

Faced with a still-raging global health crisis and what could be a deadly flu season, the team at Immunize Nevada is working harder than ever to connect Nevadans with life-saving vaccines. More individuals receiving the flu vaccine

Heidi Parker is the executive director of Immunize Nevada.

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COVID-19 VACCINES

GIVEN THAT MOST VACCINES NOW BEING TESTED REQUIRE TWO DOSES TO BE EFFECTIVE, AT LEAST 500 MILLION VACCINE DOSES WILL BE NEEDED TO ACHIEVE RATES OF IMMUNITY NECESSARY FOR NORMALITY TO TAKE HOLD IN THE UNITED STATES WHERE THE POPULATION IS MORE THAN 300 MILLION.

UNLV PREPARES FOR STORAGE, DISTRIBUTION OF COVID-19 VACCINE You don’t have to be a doctor to know that millions of Americans are banking on a COVID-19 vaccine to curb the pandemic—a development that could bring a semblance of normalcy back to our lives. We hope to see the vaccine in 2021, depending on the success of clinical trials and approval by the federal Food and Drug Administration. While scientists and DR. MICHAEL GARDNER, physicians continue to MD, MPH, MMM believe that timeline is realistic, keep in mind that the fastest vaccine developed to date has been for mumps, and that took four years. Much media attention has deservedly been given to the testing of vaccines—a safe vaccine is most important. However, how a vaccine will be distributed nationally and across the globe carries tremendous importance as well. In Nevada, the UNLV School of Medicine intends to be a leader in distribution, just as it has been with curbside testing for the virus. Planning meetings to arrange Southern Nevada vaccination clinics are underway with government officials and our partners at the

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Southern Nevada Health District, the Nevada State Health Division and University Medical Center. Given that most vaccines now being tested require two doses to be effective, at least 500 million vaccine doses will be needed to achieve rates of immunity necessary for normality to take hold in the United States, where the population is more than 300 million. At first blush, storage of a vaccine may not seem to be all that consequential, but when you consider that two of the vaccines in clinical trials must be stored at freezing temperatures—one at minus-94 degrees Fahrenheit— the challenges become far more apparent. The kind of freezer required is not something you can purchase at Best Buy. Fortunately, UNLV Medicine has been the recipient of a generous gift from an anonymous donor that has allowed us to buy a special freezer that can hold 19 cubic feet of vaccine. At this point, we’re not sure just how many vials of vaccine it will hold. We do know that when one vaccine that holds promise does thaw, it must be

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administered within seven days. Make no mistake: Logistics will be important in making COVID-19 part of our past. Plans are underway for first responders, health care workers and vulnerable populations, such as residents of nursing homes, to get the vaccine first. Communities of color, which have been hardest hit by the virus, are also a priority. Thereafter, clinics and pharmacies throughout Southern Nevada will have the vaccine on hand. UNLV Medicine is determined to assist in delivering to Nevadans the vaccine that will help ensure COVID-19 is no longer an everyday tragedy, but rather a tragic chapter in our history. Dr. Michael Gardner, MD, MPH, MMM, is UNLV School of Medicine’s vice dean of clinical affairs and president/CEO of UNLV Medicine.

Our response began before the crisis did.

COVID-19 changed everything. But UMC was ready. Our team of infectious disease doctors had prepared for this moment their entire careers. Weâ€™d practiced pandemic drills over and over. Our stockpile of critical equipment was ample and robust. And we blazed new trails in large-scale testing, including every patient we admit, making us the safest hospital in the state. When Nevada needed us, we were there. Just as weâ€™ve always been. Just as we always will.

Highest Level of Care in Nevada

umcsn.com

THE MEDICINE OF MEDITATION AND MINDFULNESS BY HEALTH CARE QUARTERLY STAFF In recent decades, the perception of meditation and other mindfulness practices has shifted within the American culture. Once considered a predominately Eastern practice, meditation has evolved into a common tool that has mounting scientific evidence to support its value. Research suggests that meditation may have far-reaching benefits to emotional, physical and cognitive health. Here’s a glimpse into the medicine of mindfulness and what we know about the power of meditation.

THE BENEFITS

There are thousands of published studies touting the benefits of meditation and mindfulness practices. Though there are plenty of hypotheses regarding why meditation works, specifics surrounding how it works remain unclear despite its seemingly positive effect on a variety of maladies.

STRESS One of the key effects of meditation is stress reduction. Stress can wreak havoc on the body and mind—increasing inflammation, disrupting hormones and more. Adequate stress management is integral to a healthy lifestyle, and meditation is uniquely equipped to mitigate stress. A 2013 study from the University of Wisconsin-Madison concluded that mindfulness training reduced cortisol responses evoked by stress, leading to decreased neurogenic inflammation. Elevated cortisol is linked to anxiety, depression, heart disease, weight gain and obesity, and more.

HOW TO BEGIN A M E D I TAT I O N P R A C T I C E There are different types of meditation, so it’s best to explore your options to find an approach that suits your needs. There’s no “right” way to do this. If you’re looking for a simple method, mindful meditation is frequently the subject of clinical research studies and can yield meaningful results. Here are a few tips for practicing mindful meditation:

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GET COMFORTABLE

BECOME AWARE OF YOUR BODY

Find a quiet room and sit in a comfortable, upright position.

Close your eyes and relax your muscles one by one. Scan your body for locations where you’re holding tension, such as the jaw and mouth. If your tongue is pressed to the roof of your mouth, relax it. If your jaw is clenched, release it.

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W H O S H O U L D M E D I TAT E ? Meditation is generally safe for everyone, however there have been reports that meditating can exacerbate symptoms for individuals with some types of schizophrenia and psychosis. If you’re being treated for either, talk to your doctor before beginning a meditation practice.

D O E S I T R E A L LY W O R K ? Meditation has existed in varying forms for thousands of years. While the study of meditation and mindfulness is recent and ongoing, some doctors believe its effects are overstated. Researchers at Johns Hopkins University evaluated almost 19,000 meditation studies and found that only 47 met their standards of adequate testing protocol. Regardless of the quality and volume of evidence, meditation remains a helpful modality for millions of people in the United States and around the world. The only cost of meditation is your time and attention.

ANXIETY AND DEPRESSION Many psychologists are using meditation and mindfulness-based stress reduction techniques as a tool for patients with anxiety disorders and chronic depression. A 2014 study published in JAMA Internal Medicine found that an eight-week meditation practice improved anxiety and depression in adults. Meditation may also help with emotional regulation and a greater sense of well-being.

Additionally, researchers have found evidence that meditation can help with ulcerative colitis, irritable bowel syndrome, high blood pressure, insomnia and smoking cessation.

M E M O R Y, C O G N I T I O N A N D AT T E N T I O N Meditation trains your brain to maintain focus and block out unnecessary distractions. Some research suggests that meditation helps make people more perceptive, less reactive, better problem solvers and can reduce mind wandering. A 2011 study published in Psychiatry Research journal found that meditation may increase the density of gray matter in parts of the brain that govern learning, memory and perspective-taking.

PA I N M A N A G E M E N T A branch of the National Institutes of Health, the National Center for Complementary and Integrative Health, found that meditation can help manage pain without using the brain’s naturally occurring opiates. Further, the Society of Integrative Oncology recommends meditation as part of a multidisciplinary approach for cancer patients to help reduce symptoms such as pain, anxiety, depression and insomnia. Medically reviewed by Dr. Olayinka Alonge, MD, medical director at Intermountain Healthcare.

BREATHE DEEP

CHANNEL YOUR FOCUS

WELCOME BACK

Pay attention to your inhalations and steady your breathing. To relax your diaphragm, breathe from your belly, not your chest.

Clear your mind and continue to focus on breathing. If it’s helpful, you can also repeat a single word in your head or a short affirmation. When thoughts come into your mind, acknowledge them and let them pass. Maintain focus on your breath.

When you feel ready, slowly open your eyes and bring awareness back to your body. How does it feel?

Keep in mind, meditation is similar to exercise— it can take time to adjust to a new routine. If it’s difficult at first, keep trying. Practice makes perfect. Start with five minutes a day and slowly work yourself up to 15-20 minutes.

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DECODING THE HUMAN MICROBIOME BY HEALTH CARE QUARTERLY STAFF

ur bodies are home to a flourishing ecosystem of microorganisms, often referred to as the human microbiome or microbiota. The human microbiome is comprised primarily of bacteria, but also includes viruses, fungi, eukaryotes, archaea and other microbes. Itâ€™s been speculated that these microbes could outnumber our human cells by as much as 10 to 1, but recent research indicates that it may be less. Further, the exact ratio may vary from person to person. There is much we donâ€™t know about our microbiomes, but we do know they play an integral role in our overall health and well-being.

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WHAT IS THE MICROBIOME? Microbes inhabit your entire body—including large colonies in the gut, mouth, vagina and on the skin’s surface. While some microbes may be pathogenic and can cause disease, most of these microorganisms lead a copacetic and harmonious existence within the body. The National Institutes of Health reports that the microbiome is crucial for the synthesis of certain vitamins, helps break down food and extract nutrients, teaches the immune system to recognize invaders and produces anti-inflammatory compounds, among many other important tasks. Because of this, scientists believe that an individual’s microbial composition can be a key indicator of health and bio-individuality.

1,000 The number of bacterial species in your gut

2-6 POUNDS The amount of bacteria in a 200-pound adult

70%

The percentage of your immune system controlled by your gut

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ABOUT THE GUT AND GUT FLORA

WHAT CAN YOU DO FOR GUT HEALTH? Diet, age, existing health conditions and some medications can all affect the amount and diversity of microorganisms in the intestines. To encourage a healthy gut, the following tips may help.

Maintain a healthy diet that is rich in leafy greens, vegetables and fruit. Gut flora thrives with adequate fiber consumption, and veggies and fruit offer lots of fiber.

Reduce stress. Studies indicate that stress can disrupt microorganisms in the intestines. Exercise, sleep and meditation are just a few of the healthy ways to manage stress.

Minimize red meat consumption and limit refined sugar and carbohydrates, which can all disrupt gut flora.

Avoid smoking, excessive alcohol consumption and artificial sweeteners, which can negatively impact gut flora.

Eat fermented food such as natural yogurt, kimchi, kefir, sauerkraut and kombucha.

If you have food allergies or intolerances, respect your body’s limits and avoid those foods.

Eat prebiotic rich foods such as asparagus, bananas, garlic, onions and whole grains. Prebiotics are nondigestible carbohydrates that gut flora feed on, which encourages colony growth and health.

One of the most influential, widely studied and well-known microbial colonies in the body is the gut biome/gut flora. These terms refer to the trillions of microorganisms that thrive within your entire digestive tract—from your mouth, esophagus, stomach, colon and rectum. There are as many as 1,000 different bacterial species in your gut alone, which is about 2-6 pounds of bacteria in a 200-pound adult. For perspective, the average human brain weighs only about 3 pounds. This may be a fitting comparison because the gut is often referred to as our second brain, referencing the intimate relationship between the central nervous system and the enteric nervous system in GI tract. According to Johns Hopkins Medicine, the ENS is composed of more than 100 million nerve cells that line your entire digestive system. The ENS controls digestion and communicates with the brain—possibly triggering major emotional shifts. There is evidence that gastrointestinal irritation, including irritable bowel syndrome and functional bowel disorders, sends signals to the central nervous system in the brain, causing mood disturbances and vice versa. The nonstop communication between the brain and the gut, and issues in either, may be connected to anxiety, depression, mood disorders and more. Understanding the expansive role of the digestive system is important when considering the role of gut flora as well, because a balanced, diverse microbial community allows the GI tract to function optimally. Imbalances in the gut biome can trigger changes in the enteric nervous system, which can impact the body in a multitude of ways—including emotional health. Further, the gut controls approximately 70% of the immune system, making it a major contributor to your physical health as well. The nutrients absorbed during digestion fuel every organ in the body and allow each to function properly, while providing a defensive barrier from any harmful substances we may ingest. If the gut is compromised, it may allow dangerous substances to enter other parts of the body, causing inflammation and disease. Because of the role that gut flora play in digestion—allowing the body to break down indigestible foods, extract vitamins and fatty acids, and more—maintaining your microbiome is important for your immune system as well.

THERE IS EVIDENCE THAT GASTROINTESTINAL IRRITATION, INCLUDING IRRITABLE BOWEL SYNDROME AND FUNCTIONAL BOWEL DISORDERS, SENDS SIGNALS TO THE CENTRAL NERVOUS SYSTEM IN THE BRAIN, CAUSING MOOD DISTURBANCES AND VICE VERSA.

Medically reviewed by Dr. Vignan Manne, MD, a gastroenterologist fellow at Southern Hills Hospital and Medical Center.

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DECODING THE HUMAN MICROBIOME

WHERE DOES OUR GOOD BACTERIA COME FROM? Researchers believe the first major exposure to gut microbiomes occurs at birth. A 2019 study from the Wellcome Sanger Institute discovered that infants born vaginally have significantly different gut bacteria than those delivered via cesarean section. It reported that during a vaginal birth, the mother passes on bacteria from her gut biome. However, infants delivered by a C-section did not receive the mother’s bacteria and instead had more bacteria associated with hospital environments. So why not swab the baby with the mother’s vaginal fluid to encourage gut bacteria growth? The institute found that the microbiome of infants delivered vaginally do not come from the mother’s vaginal bacteria but from her gut. The controversial

OTHER NOTABLE MICROORGANISM COLONIES IN THE BODY The gut is not the only place with active flora communities

VAGINAL

An increasing body of research has been dedicated to the vaginal biome to better understand and treat women’s health conditions. When studying vaginal flora, researchers have found that some bacterial colonies are associated with sexually transmitted disease and poor birth outcomes, whereas others are associated with vaginal health. Many things can impact vaginal flora, such as menstruation, sex, menopause, hygiene, antibiotics and more. Taking probiotics may encourage healthy vaginal flora, as can avoiding harsh soaps and/or douches.

practice of “seeding” babies with vaginal bacteria has been warned against by various agencies claiming it may do more harm than good. Researchers aren’t clear about the long-lasting implications and health outcomes of children born vaginally versus via C-section, but the report notes that the Royal College of Obstetricians and Gynecologists says these findings should not deter women from having cesarean births as it is an important and sometimes lifesaving tool for mother and baby. Breastfeeding is another important opportunity for infants to collect good bacteria in the early months of their lives. Other factors such as the environment can also contribute to a healthy microbiome.

ORAL

A 2019 study published in the Journal of Oral and Maxillofacial Pathology reports that following the gut, the oral cavity has the second largest microbiota in the body, with more than 700 bacterial species. It’s a complex colony that includes hard surfaces, such as teeth, and the soft tissues of the mouth, such as the tongue and gums. Oral health has wider-reaching consequences than tooth decay and gum disease—it’s intrinsically linked with systemic health. Poor oral health, which often occurs as a result of bacterial imbalance, is also associated with cardiovascular disease, pneumonia, pregnancy and birth complications, and more. Maintaining regular oral hygiene practices, like flossing and brushing, can prevent the overgrowth of harmful bacteria in the mouth.

SKIN

The largest organ in the body hosts a variety of microorganisms that help utilize the few nutrients available on the skin, protect the skin against unwanted or disruptive microorganisms, and contribute to immune function. Skin flora survives off of the salt, water and sebum the skin releases. To protect and encourage healthy skin flora, avoid harsh soaps, detergents and personal care products. Use skin-safe, gentle products to avoid stripping your skin of these vital microorganisms. A healthy diet, drinking plenty of water and limited use of antibiotics can also be beneficial. There is also evidence that interacting with plants, soil and animals may affect your skin flora.

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New center aims to improve health outcomes with innovation

BY DR. KEVIN KAPOV, DO

Dr. Kevin Kapov, DO, is the chief clinical innovation officer at Southwest Medical, part of OptumCare.

very patient is different and presents their own set of challenges, so we need to adapt our treatment systems to be as unique as our patients themselves. That is why Southwest Medical launched the Center for Clinical Innovation, with the objective of bringing innovative ideas into the clinical environment. Founded in Las Vegas in 1972, Southwest Medical has long supported innovation in new programs, technologies and other health care approaches—such as our Medicine on the Move mobile health clinic and NowClinic for telemedicine visits—that increase access to health care and enhance health outcomes for patients.

Continuous glucose monitoring

One recent initiative pursued at the Center for Clinical Innovation has been the introduction of continuous glucose monitoring for patients with Type 2 diabetes. Southwest Medical was one of the first medical practices in the state to implement CGM for its patients in 2018. At the center, diabetic patients are introduced and educated regarding the use and benefits of CGM as well as counseled on the importance of dietary changes and exercise. Diabetics can suffer from a multitude of secondary complications such as cardiovascular disease, nerve damage, kidney, eye or foot damage, skin conditions, hearing impairment, Alzheimer’s disease and more. Better patient education and tools such as CGM can allow someone with diabe-

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tes to live a full, productive and meaningful life with less diabetic complications. This monitoring system includes data from “real life,” not just the doctor’s office. This allows for fine-tuning of medication and treatment plans to move the patients’ glucose levels into the optimal range. This occurs through education of the patient and empowering them to minimize glucose highs and lows. Southwest Medical has since introduced CGM to 14 of its Southern Nevada health care locations and provided training to more than 100 of its local health care providers and staff to utilize this technology in their daily practice. With the data being gathered, CGM has the potential to change the course of Type 2 diabetes treatment.

The ongoing opioid crisis

About one in five Americans experiences chronic pain at some point in their lives. That, coupled with the opioid crisis, highlights the extreme need for innovation in how pain is treated. During the last several years, the opioid crisis throughout our country has hit just about every community and family. Unfortunately, in a metropolitan area where we have been dealing with shortage of doctors and other health care providers for years, many providers lack adequate resources, tools and experience to address this devastating issue. Our innovations team has worked to address this problem and it has proven to have tremendous impact for our patients and the community. We began with the creation of commonsense policies, supported by training for all health care providers and support staff at Southwest Medical. This included revamping all of the paperwork to be consistent with company objectives and compliant with new state regulations. All health care providers attended classes and sessions on how to have frank discussions about these issues with patients. During the past two years, Southwest Medical has reduced the number of opioid prescriptions by 66% and reduced the amount of co-prescribing opioids and benzodiazepines at a similar level. These changes also led to the development of a functional rehabilitation and pain program that addresses patients with a multi-

Staff stand in a space being renovated at the Center for Clinical Innovation on Eastern Avenue. From left to right: Dr. Kevin Kapov, DO, Chief of Clinical Innovation; Carlos Corona, MA; Nichole Kennett, LPN, Supervisor of Clinical Operations; Jennifer Story-Salacup, APRN; Jason Fagan, PA-C; Linda Wallace, AAPC; Celeste Reyes, MA; Karen Tubay, MA; Pauline Marayonk, PA-C; Carla Cortes, MA; Dr. Steven Madhavan, MD. (Courtesy)

During the past two years, Southwest Medical has reduced the number of opioid prescriptions by 66% and reduced the amount of co-prescribing opioids and benzodiazepines at a similar level.

modal approach to their physical dysfunction and pain, including physical therapy, manual therapy, pain psychology, referral for medication-assisted treatment and specialty referral. In our program, specialists, mental health professionals, physical therapists and manual medicine practitioners work together to help tackle the various aspects of pain and functional limitation management in a streamlined manner. â€œFunctional limitationâ€? typically refers to pain and decreases in strength, range of motion, balance and endurance. We want to address all of these aspects in a comprehensive program that keeps track of the patient so they are not lost in the medical system. Continued on page 30

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Continued from page 29

PTSD: A hidden problem

As a physician, I’ve noted that anxiety, depression and post-traumatic stress disorder often go untreated and are handled by patients through denial, medication misuse and the use of alcohol. PTSD, for example, is not something experienced only by military members—it is a sizable problem in the civilian population as well. When people are in emotional pain, it can often manifest as symptoms of physical pain, which may be the outward expression of underlying issues. We have theorized that one of the ways to address these issues would be to employ new techniques. The Center for Clinical Innovation is developing a program to conduct psychological evaluations and interventions that empower the patient based on the understanding that the mind and body are connected. In doing so, we are exploring the use of virtual reality to create therapeutic content. Our goal is to provide physical and psychological therapy via virtual reality with individually tailored treatments that will not be tied exclusively to an office visit. Patients will still need to make office visits as needed, but we strive to reduce the patient requirement to be seen in person. With these new treatments, people who have lived their life with pain can enjoy improved functionality and higher quality of life. The ultimate goal is to better serve those on opioids for chronic pain, use the lowest effective dose and address the often-overlooked issues that accompany chronic pain and dysfunction, as well as interacting with those patients with acute pain before they fall into a harmful opioid or drug use cycle.

Ever onward

At Southwest Medical, our approach to care is called team medicine. Primary care physicians lead our health care teams, working with other doctors, nurse practitioners and physician assistants to personalize patient care. Our technology-enabled offices offer modern health care, with data-driven analysis to provide our teams with the best information possible to develop patient care plans. Through innovation and personalization, we’re working to make health care better for everyone, especially here in Southern Nevada.

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M E DICAL OF F IC E SPA CE AVA I LA B L E F O R L E A S E

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African Americans and Asians often suffer disproportionately from conditions such as diabetes, hypertension and heart disease, which increases the risk of organ failure. Race or ethnicity of a donor can make a difference when matching donated organs or tissues to an individual in need of a transplant. While people of different races and ethnicities frequently match one another, there is a higher likelihood of achieving a match if the donor and intended recipient share the same ethnic background. Critical factors in donor/ recipient matching, such as blood types and tissue markers, are more likely to be found among members of the same ethnicity. Therefore, if donor registration among the diverse BY ALMA RODRIGUEZ population can be increased, there is potenhis past year, hundreds of employtial to increase access to transplantation for ees lined the hallways of Universieveryone who desperately waits. ty Medical Center during its first Of the 650 people waiting for a transplant donor walk honoring Las Vegas in Nevada, 25% are Hispanic/Latino, 15% are native Michael Sigler. His mother, Courtney African American/Black and 13% are Asian. Kaplan, believes Michael was destined to be a Kidney remains the No. 1 most-needed organ. beacon of hope for others. Only two months after her son’s passing, “There were so many signs, I think Michael Kaplan became an Advocate for Life for knew,” said Kaplan. “When I took him to the Nevada Donor Network, volunteering at DMV for his motorcycle lioutreach events, speaking cense, the paperwork asked to families and encouragabout donation. For him it ing people to register to was a no-brainer.” become an organ, eye and Michael was a senior at tissue donor. Cimarron High School, just “Being a mother, knowweeks from graduation. He ing what it’s like, I’m living was unsure of his path, but this too. I had to offer my his mother believes organ support to other families donation was his purpose. faced with this decision,” Kaplan said that during said Kaplan. the last six months of Thinking of the impact of Michael’s life he started Michael’s gift helps Kaplan working out religiously. during the healing process. “They found at least nine Kaplan wants people to recipients, because all of know that the decision to Michael’s organs, includdonate can be the greatest ing his heart, lungs and act of heroism. Courtney Kaplan and her son, kidneys, were transplanted Michael Sigler. (Courtesy) “Organ donation is a way for because his organs were ordinary people to do extraorincredibly healthy,” said Kaplan. “He had the dinary things,” said Kaplan. “We all have the rarest blood type—B positive—patients with opportunity to give life to a person in need.” this blood type wait for a long time.” Sigler was African American and white, To learn more about donation and which is important because the need for multo register as an organ, eye and tissue donor, ticultural donors remains critical. Hispanics, visit nvdonor.org.

Student’s decision highlights need for multicultural organ donors

T Alma Rodriguez is the multicultural outreach coordinator for Nevada Donor Network.

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ORGAN DONATION: MYTHS VS. FACTS

There are many myths surrounding organ, eye and tissue donation which can impact a person’s decision to register. When you understand the facts, you can make a more educated decision on whether or not you would donate your organs.

MYTH

If doctors know I am registered organ donor, they will not work hard to save my life.

FACT

All medical personnel are trained first and foremost to save lives. Donation is only considered after all life-saving measures have been unsuccessful.

MYTH

Organ donation is against my religion.

FACT

Most major organized religions support organ, eye and tissue donation and view it as the final act of charity or love. A list of religions and their stance can be viewed at nvdonor.org.

MYTH

FACT

If I donate my organs, I won’t be able to have an open-casket funeral. A donor’s body is treated with respect and dignity. Organs and tissues are recovered in a surgical procedure and all incisions are closed and dressed. Every effort is made to minimize changes to the physical appearance.

MYTH

Rich and famous people automatically go to the top of the list waiting list.

FACT

Social and financial status is in no way taken into consideration in organ allocation.

Registering is enough, my family doesn’t need to know about my decision. Everyone is strongly encouraged to discuss their wishes with their family and friends to ensure your decisions are being honored, as organ procurement organizations work with families to get needed medical history.

Of the 650 people waiting for a transplant in Nevada, 25% are Hispanic/Latino, 15% are African American/Black and 13% are Asian. Kidney remains the No. 1 most needed organ.

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UMC expands access to lifesaving kidney transplants

BY DR. SUNIL PATEL, MD, FRCSED, MBA

Dr. Sunil Patel, MD, FRCSEd, MBA, is a board-certified general and transplant surgeon and serves as the program director at the UMC Center for Transplantation.

s Nevada’s only transplant center, the UMC Center for Transplantation has a unique responsibility to provide life-saving care for a large number of patients across the state. In support of our patient-focused mission, we introduced a comprehensive strategy to significantly improve access to kidney transplants in Nevada. As a result of this innovative approach and our newly expanded team of experts, we have experienced an exponential increase in transplants. In recent years, the UMC Center for Transplantation performed an average of 42 transplants per year. In the past three months alone, our team has performed 35 transplants, with a 100% success rate. Since joining UMC earlier this year, I have worked alongside the Center for Transplantation’s highly experienced team to expand the criteria for kidney transplant recipients. In the past, many patients were ineligible for transplants based solely on their age or body mass index. To provide kidney transplants for a larger number of patients, we have expanded the BMI limit from 35 to 45, while evaluating patients up to 80 years old for transplants. Patients who fall within the expanded criteria are no longer automatically disqualified.

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Our team assesses each prospective organ recipient on a case-by-case basis, analyzing a variety of health factors to promote the best possible outcomes. While BMI plays a key role in a person’s overall health, a higher BMI has not been shown to affect outcomes for kidney recipients. Kidney failure patients with higher BMIs often fall into a vicious cycle: They are not eligible to receive a transplant as a result of their weight, but without a transplant, many are unable to regain the necessary mobility and energy to lose weight. At UMC, our team believes these patients deserve the opportunity to break this cycle and live healthier, more fulfilling lives. Rather than facing the prospect of remaining on dialysis indefinitely, many of these patients now have the opportunity to improve their quality of life. By caring for additional transplant patients at UMC, we will increase Nevada’s future share of allocated kidneys in proportion to local need from the United Network of Organ Sharing, which manages the national organ transplantation system. While upcoming changes to this allocation system will send more organs to surrounding states with higher populations and much longer waiting lists, the UMC Center for Transplantation is well-positioned for continued expansion. Our team remains focused on partnering with local nephrologists to serve kidney failure patients in need across the state. We also look forward to expanding our services to include pancreas transplants in the near future. As the UMC Center for Transplantation continues to grow and evolve, our team is committed to providing Nevadans with improved access to the highest level of care. We want to give every Nevadan the best opportunity at surviving kidney failure with a renewed sense of hope for the future.

Clinical Research at Comprehensive has led to

100 New FDA Approved Cancer Treatments. And given me a chance to get back to being mama.

Comprehensive Cancer Centers has participated in the development of 100 new FDA approved cancer treatments. With 170 ongoing clinical research studies, right here in Southern Nevada, we are entering a new age in cancer treatment â€” where people are no longer entrenched in their battle against cancer, but instead living with cancer. These new cancer therapies are increasing the quality of life for our patients and their families, and most importantly, giving them the opportunity to live their lives to the fullest.

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Advancing health care in Southern Nevada jails BY DR. JEFFREY ALVAREZ, MD, CCHP

or years, the health care provided in hospitals, assisted living and rehabilitation facilities has been driven to new heights because of advances in medicine and technology, and pressure from the public and media to achieve more. However, the advances made in atypical health care settings has gone largely unnoticed, particularly those made in correctional facilities.

Dr. Jeffrey Alvarez, MD, CCHP, is the chief medical officer for NaphCare, overseeing all clinical care, peer review, policy and procedure development, centralized quality control and compliance with NaphCare’s Proactive Care Model. He also serves on the NCCHC board of directors as the liaison of the American Academy of Family Physicians.

Caring for an underserved population

Jails and prisons have become some of the largest providers of medical and mental health care in America providing full-scale health care services within these facilities. In several Southern Nevada jails, NaphCare, a national leader in advancing correctional health care, has created a new standard of care for people who are incarcerated. For more than 30 years, NaphCare has partnered with city, county, state and federal government agencies nationwide to provide proactive, patient-focused health care in correctional facilities. Bringing innovative solutions for medical and mental health care and leading-edge technology to correctional facilities has created an opportunity to provide community-standard care to an underserved population, ultimately benefitting local communities.

Redefining correctional health care

Correctional health care provides a unique opportunity to provide medical care for some who would not have received it otherwise and assist them in accessing care when they return to their community. Individuals entering correc-

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tional facilities come from diverse backgrounds and often have various pre-existing conditions. In order to properly treat the unique and diverse population of individuals in jails across Southern Nevada, NaphCare utilizes a proactive care model. We aim to ensure that every patient we treat receives the highest quality health care to support a healthy return to the community. Our approach begins with early identification of medical and mental health issues, so that our clinicians can quickly intervene and begin treatment. Everyone who is booked into a jail receives a thorough medical and mental health screening, which is then used to develop a personalized treatment plan to ensure that patients are healthier in the long-term. Essentially, our proactive approach emphasizes continuity of care between the community and the jail.

Advancing care through technology

Recognizing the differences in a hospital and jail treatment environment, NaphCare has introduced new technologies to help better coordinate care within correctional facilities. For instance, we developed TechCare, an electronic health record system designed specifically for managing health care in a correctional facility. TechCare can also interface with local and state health information exchanges, such as HealtHIE Nevada, to share health information efficiently between the jail and community providers. Furthermore, our team utilizes telehealth to ensure that patients receive access to needed care quickly and efficiently, regardless of a physician’s ability to be physically at the jail.

Focus on mental health care and substance use disorder

Many of our patients are suffering from mental health issues and substance use disorder. According to the National Institute of Corrections, growing numbers of mentally ill offenders have strained correctional systems, estimating that more than 500,000 adults incarcerated in local jails—a number that continues to increase. NaphCare is on a mission to improve the care of people suffering from mental health issues and opioid withdrawal in America’s jails and save lives. In order to effectively treat patients while ensuring their safety and the safety of those around them, our medical and mental health teams work closely with local mental health and substance abuse agencies to provide advanced treatment within the jail and create plans for patients to continue care after release.

A patient group therapy session for mental health is led by a NaphCare provider. (Courtesy)

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tioned outside, Southern Hills Hospital was under a no visitor policy. The only visitors allowed to enter were for serious circumstances, such as end of life. Nansen believed the continuing of the pet therapy would be beneficial for employees and for those visitors still coming to the hospital. Unlike service dogs that are trained to help their handlers, therapy animals have one role: to cheer people up. Studies have shown petting an animal can lower your heart rate and blood pressure. The animals are all registered through Pet Partners, a national pet therapy organization. Pet Partners has a wide array of animals they bring in to help Southern Hills Hospital: dogs, cats, a bunny and even BY CYNDI LUNDEBERG a guinea pig. The pet partners visiting the hen the COVID-19 pandemhospital are all screened for things such as ic hit Las Vegas, Southern temperament, adaptability and sociability Hills Hospital and Medical with strangers. Center knew there was one Despite the pandemic Southern Hills routine they wanted to keep for their colHospital’s therapy animals have been able leagues: the pet therapy program. Southern to visit six times, including a visit to comHills Hospital partners with Pet Partners of memorate the third anniversary of the Route Las Vegas–Love Dog Adventures, and prior 91 Harvest festival shooting. Nansen said to COVID, the therapy animals October 1 is a difficult time could be found rounding on pa“These animals are just around the Las Vegas Valley tients and staff, as well as helping and a difficult time for health amazing. One second care workers who either worked in the behavioral health unit. Erica Nansen is the director or were somehow impacted by you’re in a hospital, of community outreach and the shooting. and then after the volunteer services at Southern “We wanted to think of a way visit you realize you’re to take a little bit of stress and Hills Hospital, and serves as the coordinator for the therapy anxiety away from our amazing smiling, and maybe animals visits on campus. caretakers,” Nansen said. “We you feel a little less During the height of the panthought if someone was feeling tired and a bit more demic Nansen came up with a anxious and could not think creative solution so that the hosoptimistic. That’s what about that for even a few secpital could still allow the therapy these animals can do onds because they were petting animals. an animal, then planning the for people.” “We know our team and the therapy animals entire visit is — Erica Nansen people who visit our hospital worth it.” benefit from these animals,” For the time being, the theraNansen said. “So when we shut down for py animals will continue visiting outside but visitors and our colleagues were working tireNansen looks forward to when they can be lessly, I knew it was more important than ever seen roaming through the hospital again. to get these animals here. We came up with a “These animals are just amazing,” she plan that was pretty simple, instead of having said. “One second you’re in a hospital, the animals and handlers inside the hospital and then after the visit you realize you’re we set up outside and had our team come outsmiling, and maybe you feel a little less tired side to greet the animals and spend time.” and a bit more optimistic. That’s what these At the time that pet therapy was transianimals can do for people.”

More pets, less stress: How therapy animals help a local team

Cyndi Lundeberg is the director of marketing and communications and Erica Nansen is the director of community outreach and volunteer services, both with Southern Hills Hospital & Medical Center.

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Pet Partners therapy cat, Tommie, is ready to comfort patients and staff at Southern Hills Hospital and Medical Center. (Courtesy)

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Orthopedic implant dramatically improves quality of life for amputees

BY LAGUARDIA MEDIA AND PUBLIC RELATIONS

Dr. Ronald Hillock, MD, is board certified by the American Board of Orthopedic Surgery and is an orthopedic surgeon and osseointegration specialist at Nevada Orthopedic and Spine Center.

r. Ronald Hillock, an orthopedic surgery specialist, is one of only eight doctors in the world who performs osseointegration. As a proud veteran, Dr. Hillock became an expert in the procedure to provide amputees with greater mobility, comfort and quality of life. He is on the staff of Nevada Orthopedic and Spine Center and is the only doctor in Nevada who performs OI as well as trains other physicians in the procedure. “The basic concept provides a big improvement for someone with an above the knee (transfemoral) amputation,” Hillock explained. “The majority of these patients are uncomfortable wearing a suction socket-style prosthesis.” Jeffrey Ladouceur, a patient of Dr. Hillock who underwent surgery, was able to walk without using a cane immediately after the procedure. In 2012, he lost his right leg in a hit-and-run accident while attempting to pick up his motorcycle lying on the ground. Ladouceur’s leg was amputated initially below the knee, and he sought a sports specialist’s help, who recommended Ladouceur see Dr. Hillock. After learning and researching about the procedure, he decided to have IO done. “The prosthetic does not move around, like the socket method,” Ladouceur said. “When I had the prosthetic using the socket method, my leg would fall off when I exited my truck. It just limited my quality of life. Using OI, it is the closest to having my leg back. I am active and looking forward to go-

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Jennifer Adkins, a patient of Dr. Ronald Hillock, proudly stands outside of her home. (Courtesy)

ing back to work in construction.” He praised Dr. Hillock, his ability and emphasized, “this has really changed my life.” Dr. Hillock focuses on hip, joint pain management, joint replacement, knee, musculoskeletal oncology and stature/limb lengthening surgery. “I have always been intrigued by the process of healing and reconstruction while helping people overcome problems,” he said. Jennifer Adkins was severely injured in an accident in 2017 and her husband was killed. They were riding their motorcycle with a group of friends when a car hit her and her husband head-on. Adkins was thrown about 85 feet and shattered most of her bones, except her head. Her left leg was amputated well above the knee, and it was challenging for her to walk, even with crutches. Adkins suffered pressure ulcers and severe pain but went back to work as a nurse on desk duty.

Osseointegration patient Jeffrey Ladouceur wears his prosthetic fitted by Dr. Ronald Hillock. (Kiblena Peace/Courtesy)

“When I had the prosthetic using the socket method, my leg would fall off when I exited my truck. It just limited my quality of life. Using OI, it is the closest to having my leg back. I am active and looking forward to going back to work in construction. This has really changed my life.” — Jeffrey Ladouceur

She was referred to Dr. Hillock, and her two IO surgeries were performed in 2019. “After my second surgery, I was able to walk with a crutch and started working out,” Adkins said. “I traveled to England to see my son, and I didn’t need crutches or a wheelchair. I can put my leg on in about 10 seconds, and I am comfortable all day.” Dr. Hillock’s career path began by enlisting in the U.S. Army. Serving for 17 years, “I participated in many wars, saw many amputations and witnessed many bad outcomes from battles,” Hillock said. “These experiences motivate me—the battle amputee.” Dr. Hillock estimates there are about 6,800 battle amputees. The army plans to bring OI to its patients in the Department of Defense and the United States Department of Veterans Affairs system. He estimates that the DOD and VA perform about four surgeries for amputees per month. The proposed program will expand opportunities for battle amputees to be given needed surgery, and Dr. Hillock plans on reaching out to participate in the proposed program. “The amputee population experiences many medical problems that impact their family, friends and community,” Hillock said. “If we can perform a successful OI, the amputee can go back to being employed, resume many independent functions and have a better quality of life and more satisfaction.”

NOVEMBER 2020 H E A LT H C A R E Q U A R T E R LY

Sports cardiologist weighs in on COVID-19’s effect on an athlete’s heart

BY SARA SIBLEY

ince the beginning of the pandemic, Dr. Danielian has been regularly assessing and evaluating athletes who have tested positive for COVID-19, performing cardiac testing for return to play clearance. Dr. Alfred Danielian is an active member of the American College of Cardiology Sports and Exercise Cardiology Section Leadership Council. Because of his extensive training and qualifications, he and his colleagues across the nation have helped frame the standard of care in creating return-to-play recommendations and guidelines that many throughout the world use to care for their athletes post-COVID-19 infection. During this ever-evolving pandemic, Dr. Danielian has provided his professional expertise on myocarditis and the importance of recognizing the effects of COVID-19 on the athlete’s heart.

Alfred Danielian, MD, FACC, FASE, is board-certified in cardiovascular disease and is the director of sports cardiology & echocardiography at Las Vegas Heart Associates. He is the preferred sports cardiologist for many professional and collegiate teams in Las Vegas. Sara Sibley is the director of physician strategic communications with HCA Healthcare–Far West Division. 42

It can also affect the heart’s electrical system and can cause life threatening arrhythmias and even sudden death. Are athletes, who are seen as otherwise-healthy individuals, at risk for developing this heart condition?

Athletes, as any other segment of the population, are at risk for developing myocarditis. In fact, while classified as a rare condition in the general population, myocarditis is one of the more common causes of sudden cardiac death in athletes. As everyone else, athletes are also at risk for developing myocarditis after COVID-19 infection. However, we do not have reliable data to determine how prevalent the condition is in athletes infected with COVID-19. If an athlete develops myocardial injury caused by COVID-19, can this be life-threatening with continued exercise?

In athletes or in any individual engaging in intense levels of exercise, exercise can increase the viral replication and make the active inflammation in myocarditis worse. With worsening of the active inflammation, this can lead to potentially life-threatening arrhythmias and even sudden death. How do you treat the athlete with respect to return-to-play recommendations when there is evidence of cardiac injury after COVID-19 infection?

When we see laboratory cardiac markers or imaging studies suggestive of cardiac injury, we treat the athlete as if they have underlying myocarditis with respect to return-to-play recommendations.

What is myocarditis?

Myocarditis is inflammation of the myocardium—or heart muscle—usually caused by a viral infection. It can affect the entire heart or just part of it. It is variable in its presentation. It can be subclinical—which is not severe enough to present definite or readily observable symptoms—mild or even severe. Many forms of the infection get better on their own or with medications, but others can cause serious heart problems and even death.

What happens when myocarditis is diagnosed in athletes?

When myocarditis is diagnosed, we usually recommend rest with restriction from physical training for a minimum of 3-6 months. After this period, the athlete would undergo a series of cardiovascular testing, which includes but is not limited to imaging, and exercise testing and monitoring of the heart rhythm. If all of those tests are normal, the athlete would then be cleared to return to play.

Why is myocarditis so concerning?

In severe cases, it can cause irreversible damage to the heart, which can reduce the heart’s ability to pump blood, and lead to heart failure.

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Why do athletes who have had mild symptoms caused by COVID-19 require cardiac testing before being cleared to return to play?

In severe cases, it [myocarditis] can cause irreversible damage to the heart, which can reduce the heart’s ability to pump blood, and lead to heart failure. It can also affect the heart’s electrical system and can cause life threatening arrhythmias and even sudden death. Studies in the general population have suggested that up to 20% of hospitalized COVID-19 patients have suffered some sort of cardiac injury, including myocarditis. Since this is a novel virus and we are seeing more problems with the heart than other respiratory viruses, we have chosen to take a more conservative approach in terms of our recommendations for return to play. This approach includes cardiac testing to look for any evidence of damage to the heart muscle. If an athlete tests positive for COVID-19, what is your advice?

For those that are asymptomatic or experiencing mild symptoms, it is recommended to quarantine and rest without any exercise for two weeks from the positive test result or after symptom resolution. During this two-week convalescent period, it’s important to allow your body to rest and heal and to not transmit the virus to others. After that period, the athlete is evaluated by a medical professional for consideration of slow resumption of activity under the guidance of the health care team. For the workout enthusiast or recreational athlete, do you recommend continuing to work out during the pandemic?

I recommend that all individuals exercise to keep fit and healthy while observing social distancing and following safety guidelines. The benefits of exercise are unequivocal and associated with numerous beneficial health outcomes. For more information about Las Vegas Heart Associates and Dr. Alfred Danielian, please visit LasVegasHeartAssociates.com or call 702-962-2200.

Dr. Ronald Hillock Osseointegration Expert

What is Osseointegration? Osseointegration (also known as OI) is a process of anchoring an implant into bone and coupling through the skin to an external device. OI was first developed in dentistry as a way to anchor a prosthetic tooth to the bones of the jaws. OI has been used in extremity amputations for the last 30 years in Europe. I have been working with an expert team of surgeons and engineers toward the development of an OI system for US amputees for the last 10 years.

What is your interest in OI? The first years of my career were as a surgeon in the US Army. I participated in several combat deployments and treated many battle casualties. The battle amputee is near to my heart. They have given a limb for their service to our freedom and we owe them whatever can be done to improve their quality of life. I saw OI and its many advantages while stationed in Europe and have been working to bring this technology to the US since.

Are there problems with conventional suction socket systems for amputees? Amputees almost universally share the problem of skin irritation in the area where the socket is in contact. They develop calluses and blisters on the amputated residual limb due to friction from the socket against the skin routinely. If the amputee’s weight changes by as little as 5 pounds up the socket will be too tight, or 5 pounds lost the socket will be too loose and slip or fall off the limb.

Who qualifies for treatment with an OI system? • Transfemoral level amputees (above the knee) • Transtibial level amputees (below the knee) • Transhumeral level amputees (above the elbow arm amputees) The patient must be an adult, over 18 years of age and otherwise healthy. The cause of amputation must be due to one of the following reasons: 1. Traumatic amputation 2. Tumor related amputation 3. Congenital malformation/birth defect

Nevada Orthopedic & Spine Center

7455 W. WASHINGTON AVE. STE 160 • LAS VEGAS NV 89128

For more information on Osseointegration contact

DR. RONALD HILLOCK 702-258-5567 RON_HILLOCK@ME.COM www.nevadaorthopedic.com

NOVEMBER 2020 H E A LT H C A R E Q U A R T E R LY

HCQ Notes Alexander Mylavarapu, MD, was named Nathan Adelson Hospice’s new associate fellowship program director. Mylavarapu will be responsible for the medical care and treatment of patients and providing medical direction and support to the members of the interdisciplinary team to ensure that Mylavarapu patients and families receive the highest quality care.  Intermountain Healthcare opened its first heart and vascular clinic in Mesquite. The new clinic will be staffed by five cardiology providers and two vascular clinicians, and will feature stateof-the art technology. The full range of the services available at the clinic includes ECG, echocardiograms, vascular ultrasounds, device interrogations, cardiac arrhythmia risk evaluations, structural heart evaluations, general cardiology evaluations, and venous and arterial evaluations. Desert Radiology became the first medical imaging practice in the Las Vegas area to use the Airo-Flex U-120 to apply Proguardeum, a cutting-edge disinfectant that will be used inside of MRI and CT equipment as well as patient waiting rooms. Acquired to enhance the practice’s cleaning and sanitation protocols, Desert Radiology will use the new advanced disinfectant to further safeguard patient and team member health and safety as routine imaging exams continue to be essential throughout the pandemic. UnitedHealthcare donated $1 million to Catholic Charities of Southern Nevada. The funds will be distributed over the next three years and will go to help with the expansion of two vital pro-

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The Collaboration Center Foundation opened as a one-stop concierge service to assist individuals with physical, intellectual and developmental disabilities of all ages. The foundation is a community for inclusion, focused upon family and peer engagement, social interaction, recreation, therapy and education. Their core concept, Pathways, helps disabled individuals and their families access care and support systems through a unique, concierge case management approach. Learn more at collablv.org or 702-329-3208.

grams, Meals on Wheels and Renewing Hope for Men. Project Marilyn, a nonprofit that provides feminine hygiene products for those in need, with support from sponsors, including Women’s Health Associates of Southern Nevada and Anthem Blue Cross Blue Shield, is now partnered with nearly 30 other nonprofit organizations in Southern Nevada to help end period poverty. In response to COVID-19, Screaming Images, the Las Vegas-based grand format printing and installation company known for its large-scale building wraps and graphic installations, formed the Signage & Safety Consultant Division, with the goal of provid-

NOVEMBER 2020

ing businesses with solutions to help adhere to social distancing guidelines. The result was their new SHARESHIELD products–clear plastic barriers that are fully customizable, affordable and easily installed to help maintain social distancing and produce safe and comfortable experiences in a variety of environments. What started with casino gaming tables has evolved into products for bars, ride share, schools, live events and more. For the fifth consecutive year, VA Southern Nevada Healthcare System was chosen as one of Practice Greenhealth’s top hospitals in the nation for Environmental Excellence. This year

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**Due to legal constraints, this free consultation offer cannot be extended to Medicare or Medicaid beneﬁciaries, or other recipients of federal or state health care beneﬁt programs, or when prohibited by an insurance coverage provider. Offer expires February 28, 2021. Consultation must occur on or before February 28, 2021. This offer is valid with participating insurance networks. One free consultation per person during the promotional period. New patients only. Not redeemable for cash.

HCQ Notes continued VASNHS was selected as a Partner for Change Award recipient and recognized for leading the health care industry with innovation in sustainability, maintaining superior environmental programs and illustrating how green initiatives are entrenched in the facility’s culture. The statewide Nevada Dental Association hired Michele Reeder as its new executive director. Reeder joins NDA after serving most recently as vice president of Reeder client success for SBI Association Management in Seattle, where she led a team that worked to ensure client satisfaction, retention and company profitability. She previously served as executive director for the American Academy of Oral Medicine and the

American Board of Oral Medicine, as well as the Pacific Coast Reproductive Society. In partnership with Tyler Robinson Foundation and Project 150, Summerlin Hospital Medical Center opened a reimagined nourishment room on the pediatric oncology floor, inspired by TRF warrior, Delilah Juarez. TRF and Project 150 also donated and delivered bags of favorite snacks to stock the nourishment room, which offers patients and family members easy access to their favorite foods while in the hospital. HealtHIE Nevada, the only statewide health information exchange providing doctors with real-time access to patient medical records, successfully sent hundreds of inpatient alerts related to coronavirus to the Southern Nevada Health District, boosting essential data surveillance in the era of COVID-19. In early 2020, HealtHIE Nevada and SNHD had already begun work to establish electronic case reporting, which

automatically transmits clinical data from the HIE to the SNHD’s disease surveillance system. When pandemic struck, a mechanism to specifically monitor COVID-19 cases went into effect and since going live with this technology in March, HealtHIE Nevada has sent thousands of reports to SNHD. Jonathan Rhee, MD, a board-certified interventional cardiologist, expanded his practice to the Southwest. The additional location of Las Vegas Heart Associates is on Rhee the campus of Southern Hills Hospital. Rhee continues to care for patients at the MountainView Hospital location and specializes in coronary interventions and structural heart disease.

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Cure 4 The Kids Foundation announced a firstof-its-kind educational partnership within Nevada to help pediatric cancer patients and others with catastrophic conditions advance their educational progress while receiving life-saving treatments. The Andre Agassi Foundation For Education Learning Center, located in the same building as Cure 4 The Kids, will provide patients with direct access to a licensed Clark County School District teacher. CCSD educator Jennifer Morris along with a teacher’s aide will work throughout the school year to assist patients before and after clinic appointments. Funding from the Agassi Foundation will cover the Learning Center’s build-out, operating costs, supplies, educational software and equipment and more. The National Institute on Aging at the National Institutes of Health awarded a grant expected to total $3.3 million to Cleveland Clinic Lou Ruvo Center for Brain Health to establish the Nevada exploratory Alzheimer’s Disease Research Center. The three-

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Ballesteros

Siuta

Manalili

Waldman

Comprehensive Cancer Centers hired four advanced practice providers to its staff: Yashmine Ballesteros, MSN, APRN, FNP-BC; Ana Katrina M. Manalili, MSN, APRN, FNP-C; Aleksandra Siuta, MSN, APRN, FNP-C; and Andrea Schuiling Waldman, PA-C. Ballesteros is a nurse practitioner at Comprehensive’s Northwest treatment center, where she helps manage the care and treatment for patients with cancer and blood disorders. Manalili is a radiation oncology nurse practitioner where she provides follow-up care to patients undergoing radiation treatment. Siuta is a nurse practitioner at Comprehensive’s Central Valley treatment center. As nurse practitioner, she supports Comprehensive’s physicians in helping manage the care and treatment plans for patients with cancer and serious blood disorders. Schuiling Waldman is a physician assistant at Comprehensive’s treatment center located in Southeast Henderson.

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HCQ Notes continued year award, which is the first of its kind to be presented as part of the NIH’s Alzheimer’s Disease Research Centers Program, will help build the infrastructure and initiate state-wide collaborative activities needed to establish an Alzheimer’s Disease Research Center focused on reducing disparities faced by individuals with dementia in rural settings. In addition, The National Institute of Neurological Disorders and Stroke at the NIH awarded a five-year grant expected to total $3.8 million to Virendra Mishra, Ph.D., associate staff, to identify biomarkers to predict dementia in patients with Parkinson’s disease.

home. Now, the Wellness Center offers dozens of free online classes each week. Fun fitness, gentle yoga, Tai Chi, zumba and more. More than 20,000 home-bound clients have participated. View the current list of online classes at StRoseHospitals.org/virtualclasses. Attorney Ayesha Mehdi, partner at Spencer Fane, was appointed to two positions within the American Bar Association health law section. Mehdi joins the coordinatMehdi ing committee on diversity as vice chair. The committee works to encourage that the health law section membership reflects the diversity of practice areas, geographic location, ethnicity and gender of the health law profession. Mehdi also was selected to serve as vice chair of the health care fraud and compliance interest group,

The arrival of the pandemic unexpectedly drew Dignity Health Wellness Centers into a new line of business: virtual wellness. The centers closed to prevent the spread of the virus, leaving hundreds who relied on the centers for fitness, exercise and education classes at a loss. In less than two days, with no fancy equipment or technical expertise, instructors began hosting online classes people could log on to from

where she will help the group address topical, cutting edge issues focused in the health care industry. In her practice, Mehdi focuses on representing physicians and other health care professionals, along with various health care and closely held businesses, in a wide range of corporate, transactional, regulatory and licensure matters. Suzan Hadwan, DO, board-certified in neurology by the American Osteopathic Board of Psychiatry and Neurology, joined Nevada Neurosciences Institute at SunHadwan rise Hospital & Medical Center, a comprehensive neurology outpatient practice. Hadwan has a specialized focus in headache and multiple sclerosis. She treats and manages patients 18 years of age and older.

We applaud the Healthcare Heroes of Southern Nevada. Thank you for keeping our community healthy and safe. The Faulis Shydler Group Merrill Lynch Wealth Management 400 S Rampart Blvd Suite 300 Las Vegas, NV 89145 702.341.2067 https://fa.ml.com/the-faulis-shydler-group/

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Gabriela Gregory, MD, board-certified in neurology joined Nevada Neurosciences Institute at Sunrise Hospital & Medical Center, seeing patients for Gregory both inpatient and outpatient neurological care. Gregory has been practicing medicine in Las Vegas for over 28 years and most recently was a full-time neuro-hospitalist seeing patients only in the hospital. She treats and diagnoses multiple sclerosis, headache, stroke, epilepsy and has experience in botulinum injections for migraine and spasticity. Southwest Medical teamed up with Chance and the Vegas Golden Knights for two drive-thru flu shot clinics in September, with over 2,000 shots administered.

Labor and Delivery/Women’s Services in Sunrise Children’s Hospital, part of Sunrise Hospital & Medical Center, announced several national Healthgrades honors, topping the list with the 2020 Obstetrics and Gynecology Excellence Award for two years in a row and the 2020 Labor and Delivery Excellence Award for three years in a row. Both distinctions recognize Sunrise for exceptional clinical outcomes while caring for women during labor and immediately after delivery for their newborn, as well as women undergoing gynecologic procedures. Healthgrades is the leading online health care information resource connecting almost 1 million patients daily with physicians and hospitals.

A PLACE OF HEALING

At Boulder City Hospital, our priority is to provide a safe and equitable healthcare experience for all.

Specialty Physician Opportunities Available Inquire at information@bchnv.org

QUALITY CARE CLOSE TO HOME Boulder City Hospital, established in 1954, is a private, nonproﬁt 501(c)(3) charitable organization committed to providing compassionate, quality care for our patients and the communities we serve.

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