March/April 2014

Sierra Sacramento Valley

MEDICINE

March/April 2014

Serving the counties of El Dorado, Sacramento and Yolo

The Medical Injury Compensation Reform Act (MICRA) is California’s hard-fought law to provide for injured patients and stable medical liability rates. But this year California’s Trial Lawyers have launched an attack to

undermine MICRA and its protections and we need your help. Membership has never been so valuable!

savings of over $93,000

* Medical Liability Monitor - Annual Rate Survey Issue, Vol. 37, No. 10, October 2012. Annual rates with limits of $1 million/$3 million.

WAYS SSVMS/CMA IS WORKING FOR YOU!

Are you a SSVMS/CMA member?Physicians in El Dorado, Sacramento and Yolo Counties are saving an average of $93,748 this year.

2012 SIERRA SACRAMENTO VALLEY MEDICAL SOCIETY MICRA SAVINGS CHART

Sierra Sacramento Valley Medical Society5380 Elvas Ave, STE 101 Sacramento, CA 95819Phone: (916)452-2671 Email: [email protected] online today www.ssvms.org

General Surgery Internal Medicine OB/GYN Average (Non-Invasive)

El Dorado, Sacramento and Yolo counties $28,147 $7,976 $38,865 $24,996

Miami & Dade Counties, FL $190,088 $46,372 $201,808 $146,089

Nassau & Su¦ olk Counties, NY $127,233 $34,032 $204,684 $121,983

Wayne County, MI $121,321 $35,139 $108,020 $88,160

FL-NY-MI Average $146,214 $38,514 $171,504 $118,744

MICRA Savings $118,067 $30,538 $132,639 $93,748

CMA_MicraCharts_SSVMS_11x8.5_2013.indd 1 5/15/13 11:27 AM

March/April 2014 1

Word clouds are pictorial representations of a document. Several appli-cations for creating them are available as open source software. Wordle is one. The process is creative in that the “artist” selects all or part of an original document, and copy/pastes it into the word cloud, or paint-ing, before selecting the font, shape, and colors. Our cover, created by John Loofbourow, MD, features a Wordle of the entire Affordable Care Act, where the 75 most prevalent of its massive 11,585,000 words are depicted; only the index is excluded. Read more on page 21.

3 PRESIDENT’S MESSAGE When Doctors Burn Out

José A. Arévalo, MD

4 EDITOR’S MESSAGE Thank You For Your Stories

Nathan Hitzeman, MD

5 e-Letters to SSV Medicine

6 EXECUTIVE DIRECTOR’S MESSAGE Protect Access to Quality Health Care and Privacy

Aileen Wetzel, Executive Director

7 A Squirmy Rite of Passage

John Belko, MD

8 Wear Red Day Fashion Show

9 Robot Patients

Ann Gerhardt, MD

10 Match Day

Nathan Hitzeman, MD

12 A Family Physician’s Cancer Story

Larry A. Saltzman, MD

15 A Focus on Physician Wellbeing

Lee Snook, MD

17 Annual Meeting

21 Oceans and Clouds of Words

John Loofbourow, MD

22 Things You Didn’t Know You Couldn’t Live Without

Bob LaPerriere, MD

24 2014 Education Series

25 Most Memorable Night Call Experience

28 My HIV Test is Positive. How Will I Tell My Partner?

Sandra Hand, MD

29 SSVMS 2014 Committees

30 SSVMS Welcomes a “New Neighbor”

Bob LaPerriere, MD

33 IN MEMORIAM Alliance Past President Louise Shaffrath

Kim Majetich, President, SSVMS Alliance

34 Board Briefs

35 Meet the Applicants

36 Classified Ads


MEDICINE

Volume 65/Number 2

Official publication of the Sierra Sacramento Valley Medical Society

5380 Elvas Avenue Sacramento, CA 95819 916.452.2671916.452.2690 [email protected]

We welcome articles from our readers by email, facsimile or mail to the Editorial Committee at the address below. Authors will be able to review articles before publication. Letters may be published in a future issue; send emails to e.LetterSSV [email protected] or to the author.

All articles are copyrighted for publication in this magazine and on the Society’s website. Contact the medical society for permission to reprint.

Visit Our Medical History Museum 5380 Elvas Ave. Sacramento Open free to the public 9 am–4 pm M–F, except holidays.

SSV Medicine is online at www.ssvms.org/Publications/SSVMedicine.aspx

2 Sierra Sacramento Valley Medicine


MEDICINESierra Sacramento Valley Medicine, the official journal of the Sierra Sacramento Valley Medical Society, is a forum for discussion and debate of news, official policy and diverse opinions about professional practice issues and ideas, as well as information about members’ personal interests.

2014 Officers & Board of DirectorsJosé A. Arévalo, MD PresidentJason Bynum, MD, President-ElectDavid Herbert, MD, Immediate Past President

District 1Robert Kahle, MDDistrict 2Ann Gerhardt, MDLorenzo Rossaro, MDChristian Serdahl, MDDistrict 3Ruenell Adams Jacobs, MDDistrict 4Russell Jacoby, MD

2014 CMA DelegationDistrict 1Reinhardt Hilzinger, MDDistrict 2Lydia Wytrzes, MDDistrict 3Katherine Gillogley, MDDistrict 4Russell Jacoby, MDDistrict 5Elisabeth Mathew, MDDistrict 6Marcia Gollober, MDAt-LargeAlicia Abels, MD José A. Arévalo, MDJason Bynum, MDRichard Gray, MDKaren Hopp, MDMaynard Johnston, MDRichard Jones, MDCharles McDonnell, MDJanet O’Brien, MDMargaret Parsons, MDAnthony Russell, MDKuldip Sandhu, MD

CMA TrusteesDistrict 11Barbara Arnold, MD Douglas Brosnan, MD

CMA President CMA Imm. Past PresidentRichard Thorp, MD Paul Phinney, MD

AMA DelegationBarbara Arnold, MD Richard Thorp, MD

Editorial CommitteeNate Hitzeman, MD, Editor/ChairJohn Belko, MDSean Deane, MDAnn Gerhardt, MDSandra Hand, MDAlbert Kahane, MDRobert LaPerriere, MD John Loofbourow, MDShahid Manzoor, MD

Executive Director Aileen WetzelManaging Editor Nan Nichols CrussellWebmaster Melissa DarlingGraphic Design Planet Kelly

Advertising rates and information sent upon request. Acceptance of advertising in Sierra Sacramento Valley Medicine in no way constitutes approval or endorsement by the Sierra Sacramento Valley Medical Society of products or services advertised. Sierra Sacramento Valley Medicine and the Sierra Sacramento Valley Medical Society reserve the right to reject any advertising.

Opinions expressed by authors are their own, and not necessarily those of Sierra Sacramento Valley Medicine or the Sierra Sacramento Valley Medical Society. Sierra Sacramento Valley Medicine reserves the right to edit all contributions for clarity and length, as well as to reject any material submitted. Not responsible for unsolicited manuscripts. ©2014 Sierra Sacramento Valley Medical Society

SIERRA SACRAMENTO VALLEy MEDICINE (ISSN 0886 2826) is published bi-monthly by the Sierra Sacramento Valley Medical Society, 5380 Elvas Ave., Sacramento, CA 95819. Subscriptions are $26.00 per year. Periodicals postage paid at Sacramento, CA and additional mailing offices. Correspondence should be addressed to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396. Telephone (916) 452-2671. Postmaster: Send address changes to Sierra Sacramento Valley Medicine, 5380 Elvas Ave., Sacramento, CA 95819-2396.

District 1Jeffrey Cragun, MDDistrict 2Richard Pan, MD, AssemblymanDistrict 3Ruenell Adams Jacobs, MDDistrict 4Russell Jacoby, MDDistrict 5Robert Madrigal, MDDistrict 6Rajan Merchant, MDAt-LargeJohn Belko, MDNatasha Bir, MDHelen Biren, MDGregory Blair, MDKevin Elliott, MDAlan Ertle, MDBenjamin Franc, MDKarna Gocke, MDThomas Kaniff, MDVijay Khatri, MDDon Wreden, MD

George Meyer, MD John Ostrich, MDGerald Rogan, MDGlennah Trochet, MDLee Welter, MDGilbert Wright, MDAdam Dougherty, MS IV

District 5Steven Kelly-Reif, MDRajiv Misquitta, MDSadha Tivakaran, MDJohn Wiesenfarth, MDEric Williams, MDDistrict 6Tom Ormiston, MD

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March/April 2014 3

When Doctors Burn Out

I AM SURE THE TOPIC OF physician burnout is not new to most of you. Over the past few years, national publications like the NY Times and the Huffington Post have reported on the increasing epidemic of “doctor burnout” and the potential consequences of medical errors and poor patient experiences. Burnout is defined as a physical or mental collapse caused by overwork or stress. These articles point out that almost half of practicing doctors have experienced at least one symptom of the emotional, mental and physical exhaustion characteristics of burnout.

Overtaxed doctors are more likely to experience erosion of empathy and loss of professionalism which may lead to compromised quality of care. Other grave consequences include early retirement and even suicide. Although these numbers seem unusually high to me, the message here is that doctor burnout is a real and dangerously common phenomenon that threatens the very core of our profession.

A 2012 study in the Archives of Internal Medicine used a version of a tool called the Maslach Burnout Inventory to investigate burnout and satisfaction among U.S. physicians. Nearly 38 percent of physicians surveyed reported high emotional exhaustion, 29 percent had high depersonalization, and 12 percent had a low sense of personal accomplishment.

Another study found that more than 40 percent of doctors reported dissatisfaction with their work-life balance, saying their jobs didn’t leave enough time for a personal life or family, compared with 23.1 percent of non-doctors.

These same authors found that physicians worked about 10 hours more per week than other people on average (50 hours a week versus 40), and were much more likely to work extra long weeks of 60 hours or more; 37.9 percent of doctors worked at least 60-hour weeks, compared with only 10.6 percent of the general population.

It’s also no secret that we physicians experience stress at a very high rate. The dif-

ference between stress and physician burnout, however, is the ability to recover during our time off. Physician burnout begins when we are NOT able to recharge between call nights or office days. Burnout increases with physical and emotional exhaustion progressing to depersonalization and a reduced sense of personal accomplishment.

The root causes of doctor burnout are numerous. The

very nature of our work with ill and stressed-out patients too often spills over into our own identity. Couple that with the daily increasing administrative burdens and the mounting pressures for increased production, along with expanding documentation requirements and the ever-present concern over medical liability and ever-changing rules and regulations.

We, as a medical society, need to look into this complex and largely cryptic issue and start a conversation as to what we need to do to prevent and treat those who are affected. I welcome your comments and concerns.

[email protected]

By José A. Arévalo, MD

PRESIDENT’S MESSAGE

Comments or letters, which may be published in a future issue, should be sent to the author’s email or to e.LetterSSV [email protected].


MUCH OF THE SUCCESS of our publication comes from the contributions of local students and physicians with their stories and opinion pieces. Over the last few years, I have enjoyed reading about your days of training, your hobbies, your most interesting cases, your house call experiences, your volunteer work, and your travels abroad. I am also amazed by the obituary pieces that speak to the magnitude of a doctor’s contribution to our community − pioneering healers, obstetricians, and surgeons.

I want to recognize Drs. Bob LaPerriere, Kent Perryman, and Jack Ostrich for their regular pieces on the history of medicine. How much more meaningful something becomes when you learn of its origin. Almost every common day tool we use (the stethoscope, sphygmomano-meter, speculum) has a fascinating story and interesting prototypes which preceded it.

Dr. LaPerriere recently gave me and some medical students a personalized tour of the

museum. One hour later, we felt like we had time-travelled through 150 years of medicine! The time-honored leather physician’s bag, amber bottles and tin containers of medicinals, specimens in jars, black and white pictures of old hospitals and pharmacies, strange quackery devices, glass eyes, amputation saws, old melon baller-type devices to remove tonsils, porcelain bed pans, heart valve prototypes, and appliance size EKG machines, cautery devices, and the unforgettable iron lung machine. If you haven’t seen it, you really should check it out!

I want to recognize the students and residents who write to us and share the joys and frustrations of medical training. A lot of medical education occurs in our community, and despite interesting advances in actor-patients, simulator labs, and web-based learning, I think most learners like to see real live patients, help with a procedure, listen to an interesting heart sound, feel a lump and discuss the differential, and learn interesting pearls of practice. We need to continue to support that in the face of increasing time pressures.

Stories swirl all around us. While seeing a patient with chronic pain in our clinic recently, the staff was notified by an officer at the front desk that the patient had arrived in a stolen car, and they were there to apprehend her. They asked us not to tell her as they planned to intercept her on her way out. The patient was tipped off by a friend texting her while we were treating her in the exam room. She became visibly distressed, darted from the room, and was tackled by the officer in the hallway...

How was your week? Please continue to share your stories, poems, photos and artwork with us. They are most welcome!

[email protected]

By Nathan Hitzeman, MD

Thank you For your Stories


EDITOR’S MESSAGE

—William Nakashima, MD

March/April 2014 5

Reply to Dr. Serdahl, Jan/Feb 2014 issue

I read with some concern the essay by independent ophthalmologist Dr. Christian Serdahl in the Jan/Feb issue relating the pros/cons of his daughter pursuing a career in medicine. The piece seemed somewhat hostile to the group medical practice model. As one who has been in FFS practice, a physician in the military, and in pre-paid group practice, I can only advise Dr. Serdahl (and his daughter) that not all physicians are suited to group practice, any more than are all patients. One’s value systems, be they physicians’ or patients’, must be taken into account, or the multiple systems of practice would not exist. As a retired physician executive, I can assure Dr. Serdahl that I would have offered his wife the opportunity to practice in a much freer environment.

−Albert J. Kahane, MD

Why This Daughter Went into Medicine

Dr. Serdahl recently wrote an article entitled, “Should my Daughter go into Medicine?” in which he and his wife, also a physician, expertly identified several pros and cons of being a modern-day American physician. I do not have children, nor am I a physician out in practice, so part of me is completely unqualified to remark upon his advice. However, I am the daughter of a family physician, a remarkable one, who left my career choice completely up to me.

From the sidelines, I watched my father wrestle with change: managed care, electronic medical records, the disappearance of the lone practitioner. He struggled to get out of the office in order to be at tennis matches and water polo games. He came home from work to patiently listen to our inane stories of junior high school drama, after spending his day guiding patients through true tragedies of sickness and death. He continues to bring home charts to dictate, take

home calls, go into the office on a Sunday to stitch up a surfing buddy or make social rounds on a long-time patient. I never had to ask about the challenges of being a physician; I witnessed them daily.

Yet when we ran into his patients out in the world, at the grocery store or Back to School Night, I also witnessed their gratitude, their reliance on his care, their relief that someone as kind and intelligent as my dad was a part of their lives. And while medical treatments, physician reimbursement, and the structure of health care delivery in this country change radically, the exceptional relationship between doctor and patient remains as important as it did hundreds of years ago.

−Rebecca Stephens, MS IV, UC Davis

e.Letters to SSV Medicine


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Protect Access to Quality Health Care and PrivacyOppose the Costly MICRA Measure

ExECuTIVE DIRECTOR’S MESSAGE

YOU MAY BE AWARE OF a trial attorney-spon-sored ballot measure that would undermine the protections afforded to patients across California as part of the Medical Injury Compensation Reform Act (MICRA).

This coming November, these trial attorneys will ask voters to weigh in on “The Troy and Alana Pack Patient Safety Act,” which would make it easier and more profitable for lawyers to sue doctors and hospitals. This measure, according to California’s independent Legislative Analyst, could increase state and local government malpractice and health care costs by “hundreds of millions of dollars annually,” ultimately placing the burden of this additional cost on all of us.

As it stands now, county and state hospitals have to pay medical malpractice awards out of the budgets they receive from taxpayers. If medical malpractice awards increase, government costs will increase, too. Somebody has to pay, and that will be taxpayers through higher taxes and California citizens through higher health care costs.

The California Medical Association (CMA) and the Sierra Sacramento Valley Medical Society (SSVMS) have joined a broad coalition of doctors, community health clinics, hospitals, local governments, public safety, business and labor to oppose the proposed November ballot proposition.

Not only would this measure cost patients across the state, it’s a misleading measure intended to fool voters. Written by trial attorneys, the measure makes it easier and

more profitable for lawyers to sue doctors and hospitals. The authors of this proposal purposely threw in non-MICRA provisions, like drug testing doctors, to disguise the real intent, which is to increase the limits on medical malpractice awards so that trial lawyers make even more money.

The main proponent of the measure was recently quoted in the LA Times, saying, “The drug rules are in the initiative because they poll well, and the backers figure that’s the way to get the public to support the measure. ‘It’s the ultimate sweetener.’”

This measure also requires a government database with personal information on patients’ prescription drug history. Hackers have already managed to access personal information from millions of Target customers and even the Pentagon, and another big database will only make our information more vulnerable.

Community health care clinics, like Planned Parenthood, say this measure will raise insurance costs that will cause specialists, like OB/GYN’s to reduce or eliminate services to their patients. Finding doctors to deliver children in rural areas and community clinics is already difficult, and reducing services will make a bad situation worse.

Over 1,000 groups have joined together in support of MICRA and in opposition to this dangerous, costly measure (see: www.micra.org/about-capp/supporters.html). Be part of the effort to protect patients by visiting www.cmanet.org/micra today!

[email protected]

By Aileen Wetzel, Executive Director


March/April 2014 7

A Squirmy Rite of Passage

IT WAS A LOVELY WHITE Christmas Eve in Boston and I happened to be the Pediatric Infectious Disease Fellow on call. After finally finishing rounds at 7 pm, I trudged home through the snow to my apartment in Washington Square. I got about to the halfway point when my pager went off. I looked at the number and saw that it was the page operator. “Ugghhhh,” I thought. “That’s never a good sign.”

I fumbled with my phone as I walked numbly along with snow crunching under my boots. “Dr. Belko?” came the voice from the operator. “Yes?” I answered tentatively. “I have a call from Logan Airport for you. Please hold,” and before I could protest the transfer, I was connected to a frantic caller.

“Is this the doctor from infectious disease?” the male caller asked anxiously. “Yes, I’m Dr. Belko, fellow in infectious disease at Children’s Hospital,” hoping that my mention of pediatrics would get the caller to apologize and hang up. “Thank goodness,” the caller audibly exhaled. “I am Abu Yussuf, and my son and I just got off a plane from Mali. I need him to be seen immediately! Where are you?”

I was a bit perplexed and perturbed. “Unfortunately, the clinics are closed right now. What’s going on with your son? How old is he?” After a brief pause on the phone, as snowflakes drifted around me, “My son, he is 3, and he has a worm sticking out of his leg! It is killing him. He must be seen immediately! He must be treated immediately! Where do I get the medicine for my son?”

I stopped in my tracks, finally making it to Coolidge Corner. Worm sticking out of his leg? New Guinea? Dracunculiasis? Really? I was vacillating between excitement and anxiety. I couldn’t call my attending yet, since I didn’t really see him and I didn’t really have an appropriate history. “Mr. Yussuf, I can understand your

concern about your child; you can have the taxi driver take him to the closest emergency room for assessment or you can have the taxi driver take him to Children’s Hospital,” I stated.

Before I could rattle off the hospital address and instructions for where to go, “It will take too long,” he pleads whiningly, “tell me what medicine. I need it now! He is dying.” I was a bit taken aback for a minute as I fumbled through the crumpled Sanford Guide in my back pocket. “Mr. Yussuf, I cannot prescribe anything over the phone without your son being seen. Since you are very concerned about his welfare, I would suggest that you take him to the closest emergency room and the physician there can contact me and we can arrange to bring Yussuf to see me in a safe and rapid manner.”

“No!” he insists. “I want the medicine now! I will go to pharmacy!” I was speechless. I reiterated the need to seek urgent care, given his concerns, and after a few moments, I got hung up on with a very angry father cursing and threatening to sue me. I was stunned. After a few minutes standing in the swirling snow, I shrugged and finished the walk home. Once home, I tried paging my attending, but he didn’t reply. I decided I’d had a long enough day and I crawled into bed, not looking forward to rounding tomorrow.

At about 3 am, I received another page from the page operator. I groggily called back and as the operator connected me to the call, I could feel my heart start to race as I heard the voice on the other line. “I am here waiting for you in the Children’s Hospital. Where are you?”

I pulled my consciousness fully out of its slumber. “You are in the Emergency Department?” I managed to ask. “Yes, I am waiting. Please hurry!” and then the line went dead. Shrugging, still half asleep, I got dressed and headed back out into the snow, heading

By John Belko, MD



back to the hospital. About half an hour later, I got to the

ED and found the ED attending on call. He happened to be one of the ID attendings. “Dr. Harper,” I called, “I hear you have a possible case of dracuculiasis.” He furrowed his brow and looked at me funny before answering. “No, I’ve got some asthmatics and a kid with appendicitis, but no one with Guinea worm. Why do you think we do?”

As I described the story to him, I could see a smile building on his face as he seemed to desperately try to keep from laughing. “What’s so funny?” I asked. “Did you ever get a call back number? Did you call the ED before coming down here to see if the patient was really here?” he asked smiling. “Who’s your attending?”

I shook my head, thinking about the events of the evening and how I could have figured it out earlier. “Dr. Goldman,” and as soon as I said it he started to laugh heartily. “Welcome to Children’s!” he laughed, as he reached for the phone and dialed a number quickly. “Hi, it’s

Marvin in the ED, I have someone you should to talk to” and handed me the receiver.

“Hello, John?” A familiar sounding voice came on the line, and I was immediately quite cross. “You actually went in!” he said. “Well, since you’re already there, why don’t you round on the active patients and I’ll meet you in a couple of hours and then I’ll take your pager for the rest of the day,” he laughed. After I hung up the phone, I looked at Marvin smiling widely and just shook my head.”

“Don’t worry about it, John,” he said, “I fell for it, too, during my first year of fellowship. He got me by pretending he had just gotten off the plane from Burma and was having fever, chills and night sweats. That was 12 years ago. He called it a test of the quality and mettle of the fellows in the division. We all called it hazing.”

I sat there for a few minutes, entertaining some impure thoughts of vengeance, before I finally shrugged it off and headed off to rounds.

[email protected]

“My son, he

is 3, and he

has a worm

sticking out

of his leg!”

Wear Red Day Fashion ShowThe American Heart Association in Sacramento celebrated the 11th anniversary of National Wear Red Day with the first-ever Go Red fashion show at Arden Fair Mall on Friday, February 7. The fashion show featured local heart disease survivors, cardi-ologists, volunteers and members of Sutter’s heart transplant team. These “models” wore red clothing donated by Macy’s to raise awareness of heart disease in women. Few people in the general public are aware that heart disease is the greatest health

threat to women, killing more each year than all types of cancer combined. The event included free health screenings by Sutter Heart and Vascular Institute nurses. Macy’s also donated free red lipstick and gift cards, Twistin Tim created balloon art in the kids’ zone, and Sacramento Kings dancers and Slamson signed autographs. SSVMS member Dr. Ann Gerhardt, below, joined in the event wearing a lovely all-red ensemble complete with hat! −Photos by La Sage Imagery

March/April 2014 9

Robot Patients

ENOUGH ALREADY WITH ROBOT doctors, computer-assisted diagnosis and EMRs to keep us from forgetting to order an HgbA1c. OK, so we’re imperfect – we’re human. What about the other side of the equation – The Patient? Some days I crave a robot patient.

We’ll call him Hal. Hal exercises five days a week, 45 minutes per day. He eats a totally prudent, plant-rich diet every day, with no more calories than necessary to maintain his ideal body weight. He has never smoked or used recreational drugs, and minimal alcohol. He agrees to recommended vaccinations, washes his hands frequently and wears a mask during cold season.

Hal is on time for his appointments. He maintains a current insurance policy and budgets money for his medication co-pays. He knows his medications and takes them precisely as prescribed, every day. He calls in advance for refills.

When he has a new problem, he presents it in logical order, describing onset, quality, frequency, intensity and duration in concrete terms, without histrionics or editorializing. He uses unambiguous terms common in medical parlance, since he’s been programmed with medical textbooks. He leaves out extraneous data, like his little sister’s reaction to his sputum. He provides a complete relevant review of systems, family history and social updates.

He mentions his concerns, but allows you to generate a differential diagnosis and plan that addresses his concerns but is independent of his bias. He doesn’t demand testing or the latest Internet remedy. He does prescribed testing and sees referrals as soon as possible. He follows the plan and gives an update in a pre-designated amount of time. If he’s not happy with your plan, he notifies you and requests a revised

plan, which he then follows. Hal knows you work hard on his behalf, but

are often screwed by the insurance companies. He discovers your favorite restaurant and gives you a gift card during a holiday season appropriate for your heritage. (OK, so this is a bit extreme).

BUT…if all patients were like Hal, most would stay healthy into old age, without hypertension, diabetes, heart disease and life-style-related cancers. This would eliminate the need for probably a third of all doctors. Another third would need to switch to geriatrics (for the arthritis, infections and vascular disease that would finally appear) and orthopedics (to deal with injuries incurred during bocce ball and sky diving.) A significant number of the last third would be BORED. It’s the non-robot behaviors that make medicine interesting, entertaining and challenging.

I would really miss the English majors and artists who describe symptoms in graphic metaphors. And those who act out their symptoms. And those whose personalities are revealed in the stories they tell. And the manic patients who are downright entertaining, even if they don’t hear what I say and refuse to take medication (don’t you envy Robin Williams’ doctor?).

Patients whose bodies and diseases don’t follow the textbooks remind us that we don’t know everything. We LEARN from them, as we discover new disease presentations, behavior types and reactions to substances and drugs. A tough diagnosis is more fulfilling when I have to dig deep in the history and physical exam and creatively address testing, rather than have it handed on a platter of totally relevant history. Treatment decisions that consider genetic differences, personality types and co-existent

By Ann Gerhardt, MD


continued on page 36


The Match: A Box of Chocolates

before them. They look at program websites, as well as various underground “YELP-like” websites that claim to give the skinny. They go to residency fairs. They do elective rotations at programs of interest. They may perform terribly, fair, or stellar on their rotations. They may or may not bring in cookies and thank you cards on their last day.

They send in their applications. They interview. They may or may not still fit into their suits from four years prior. Once in a while an applicant will break out in a lofty hat, bright red blazer, a feather boa, or bow tie. It is usually not a good idea. Occasionally, someone brings in a spouse or partner, which is usually awkward.

Applicants note the degrees of friendliness of the administrative staff, clinic staff, hospital staff, residents, and faculty. They urinate frequently between interviews and avoid eating much for fear of food getting stuck between their teeth. Some ask questions incessantly and carry clipboards. Some quietly take up space. When asked about their interest in medicine, they now have to respond in depth beyond the “helping people” and dying grandfather stories that worked so well four years ago.

Residency programs, in turn, do their best to uncover the real applicant behind the suit and CV. They are not allowed to ask about family or religious background; but rather how well an applicant can perform as a resident based on personal characteristics and past experience, and what their future interests are. On the other hand, all the personal information comes out when applicants meet with residents at the lunch time socials or evening mixers; and once divulged, it is fair

ON MARCH 21ST, OVER 25,000 medical students around the nation find out where they will do their residency. The process is called “the Match” – a product of an algorithmic software program. Residency programs rank applicants by their preferences, and applicants rank programs in like fashion. A certain leap of faith happens as everyone confidentially submits their preferences, and a match list comes out of the other side of a Willy Wonka machine.

As a 4th year student near the turn of the millennium, I vividly recall congregating in a multipurpose room at UCLA and pulling envelopes with our names on them off the wall to find where we would spend the next chapter of our lives. There were tears of joy and disappointment, shock, elation, and sometimes ambivalence.

The match day festivities have evolved over time. A few years back, UC Davis School of Medicine even posted a video of their students reacting to their matches. It was quite poignant. Somehow the whole process works reasonably well, and everyone seems to make the most of the cards they are dealt. Occasionally, someone may get hit by a bus, be deported or arrested, or realize at the last minute that they wanted to change careers. In these cases, another process called “the Scramble” occurs and, by its name, is self-explanatory.

What leads up to the match is a tangle of interactions, performances, reviews, pow-wows, and posturing that has everyone guessing what is window dressing and what is reality. Medical students learn a great deal by word of mouth from peers or upper classmen who matched


By Nathan Hitzeman, MD

March/April 2014 11

Dr. Hitzeman is a faculty member of the Sutter Health Family Medicine Residency Program. He also likes fresh baked cookies and dark chocolates with nuts.

game for discussion by the program. The paper applications are scrutinized for

a certain floor of decency. Did the applicant come from a good school; were USMLE and COMLEX tests passed; are there typos in the personal statements; what extracurriculars or work experience does the applicant have, and were rotation evaluations good?

I’ve come to appreciate that an almost unbelievably high number of applicants run marathons, speak various languages, know martial arts, or play instruments. It is hard to confirm those talents. On the other hand, community service runs the full gamut. Some may claim longitudinal experience over years that ends up being an annual health fair that they did four times with an unclear level of participation. Others did more hardcore commitments like Teach for America, Peace Corps, or the Armed Forces.

International applicants may have been neurosurgeons in other countries, but have been

working as dental assistants for the last two years and volunteering as orderlies in the hospital. There is great accomplishment, humility, perseverance, and sometimes desperation in this group.

Handshake grip, perspiration levels, appropriate vs. inappropriate remarks, brown-nosing, nose-picking, ingratiation, composure, level of perfume or cologne, small talk – all is noted. At the end of the day, though, applicants and programs just want to see if they will get along with each other. Usually, it is clear who is a good fit and who is not, and both parties seem to agree. But no matter how many oaths of allegiance and “you are my first pick” emails, the box of chocolates will open on March 21st. The mix will be intriguing, will have a varying degree of nuts, and will not be close to what anyone predicted!

[email protected]

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had declared itself as one that would progress. Not surprising, since all my “prognostic” tests predicted this result.

That brings us to the winter of 2012. I like to run. I find it to be a healing therapy for my mind and body. To that date, I had completed 13 marathons, always trying to qualify for Boston. But like the great Maxwell Smart, I always missed it by “that much.”

Often on the American River, I connect with my running buddy, guru, and marathon mentor, Dr. Steve Polansky. It was Steve who was one of the first people I confided in during the winter of 2010 that I had cancer. And it was Steve who hatched the plan that I would enter the Boston Marathon in 2012 to raise money for the Leukemia and Lymphoma Society (LLS) through its Team in Training (TNT) Program.

And so I did, raising over $39,000 for LLS. That year the run was held in temperatures approaching 90 degrees. I completed the run totally drained (literally) and posted my slowest time ever in a marathon. The experience left me with a feeling of wanting more.

So one year later, I made the decision to once again prove to myself, and to others, that living with cancer does not necessarily mean one has to give up the things that we love doing. I decided to do this, even though my cancer was worsening. My white blood cell counts, which were 23,000 in 2012, were 60,000 and rising.

For 2013’s Boston effort, I raised over $60,000. That was the most money raised by one individual in the history of the Team in Training efforts in Boston. That was the positive aspect of the story. The negative was the

A Family Physician’s Cancer Story

I PRESENT MY STORY TO YOU today as a 60-year-old board certified family physician who has cancer, Atypical CLL and associated Small Cell Lymphocytic Lymphoma (SLL).

My journey began in the fall of 2009 when I received the results of my annual blood screening. My CBC showed an almost imperceptible rise in the percentage of lymphocytes in the differential, although my total WBC count was well within the normal range. That rise concerned me and I did a self-exam of my lymph nodes and found enlarged nodes in my left neck and supraclavicular area. Internally, I knew I had a problem but like many physicians, or patients in general, I denied the issue and did not tell anyone about this, including my spouse.

Two months later I had my regular check up with my PCP and told him what I suspected. He went along with me and ordered blood cytogenetics, and the diagnosis was made officially in January of 2010.

Now the conversion from physician to patient began. And I am here to say, not all of the experience over the last three years has been positive. The shock of a diagnosis of cancer shakes one to the core. In my case, I have been a very active person and I did not want this to change my day-to-day lifestyle – a valiant goal, but difficult to achieve.

In many ways, I am lucky. My cancer was diagnosed so early in its process that for some time it did not represent a physical problem, only a mental one. Early on I was told I had a 50/50 chance that I would not need treatment at all. How does one mentally cope with that except for hoping for the best. Unfortunately, within two years after diagnosis, my condition


By Larry A. Saltzman, MD

March/April 2014 13

…living with

cancer does

not neces-

sarily mean

one has to

give up the

things that

we love

doing.

both the insurance coverage as well as the clinical worlds. I honestly can’t imagine going through this journey without the advantage of knowledge that I have been given. Although clinical medicine can create true miracles, it has a long way to go in supporting the actual patients going through the maze of therapy.

After completing six monthly cycles of chemotherapy, my leukemia/lymphoma has been beaten back, now with normal blood counts and no active disease in my lymph nodes. A miracle you might say, but really just good science, medicine, prayers, and support from the Leukemia and Lymphoma Society (LLS).

So this coming April, my mentor, Dr. Steve Polansky, and I plan to toe the line at the 118th Boston Marathon, raising funds via TNT. Considering the tragedy that surrounded last year’s event, being able to train for this so soon after chemotherapy is truly a gift, one that I am not taking lightly. My fundraising goal for 2014’s effort is to match my peak WBC

“bombing.”The day of the event opened under sunny

blue skies and crisp, perfect running temperature. The energy in the athlete’s village was palpable. I ran well. Had I finished the run, I would have cut more than a full hour off my finish time from 2012.

However, I was stopped approximately a half-mile from the finish and the reason soon was known only by rumor – an explosion. In my daze of dehydration and muscle cramps, all I could think of was that my wife, Sharon, was supposed to be there right now. And actually she witnessed the blasts in real-time.

Nobody knew what to do. There were no instructions, only the sound of sirens. We runners stood for an hour which seemed like an eternity. The local residents were fantastic, bringing out water for us to drink and garbage bags for us to wear. Finally, we started moving and I found my way to an area where I could collect my belongings and make my way over to the TNT meeting hotel. The mood there was as somber as I have ever seen.

As awful as this was, what made it even worse was that the timing of the attack coincided with the time when all the charity runners were starting to arrive at the finish, and, of course, their families were there waiting. How cruel.

Make no doubt about it; although we were safe, we were traumatized. We mourn for the loss of lives and limbs. We worry to what extent our society will again be changed. And we worry that these athletic events, which have become such a force in fundraising for horrible illnesses, will take a fall as people will be afraid to participate in large-scale events.

Three months later, my WBC count had increased to 115,000, with a doubling time of every three months. My PET scan showed my nodes light up like a Christmas tree and it was time for chemotherapy. I entered the world of infusions for six months. I learned what morning sickness and chronic fatigue feel like. And I saw that there were many patients in more dire predicaments than my own.

I also learned the value of having an advocate. In my case, it was yours truly navigating


count, or $115,000. Our secure fund raising web page link is: http://pages.teamintraining.org/ma/boston14/drlarrys

Since that tragedy, Boston, the city and its citizens, appear to have come through stronger − “Boston Strong.” As hard as it may be for you to believe, these last four years, and especially the last nine months, have made me physically and emotionally stronger, with a greater appreciation for life and morbidity − of others as well as mine − and I challenge myself to make each day meaningful.

I appreciate your time and consideration of my journey and hope my experience can offer you and your patients, who may be afflicted with cancer or other chronic illnesses, inspiration to push their limits. After all, failure is not an option.

[email protected]

All webinars are free for SSVMS/CMA members and their staff. Nonmember price is $99. For more informa�on or to register, visit www.cmanet.org/events or call CMA’s Member Help Center at (800) 786‐4262.

March 5: HIPAA Security Risk Analysis: How to Make Sense of this Requirement. 12:15 – 1:15 p.m. This webinar reviews what is required to properly fulll compliance obliga�ons and at the same �me secure your pa�ent's health informa�on. March 6‐8: Stepping Up to Leadership Conference, San Diego. The Stepping Up to Leadership program trains medical staff lead-ers in issues of communica�on, problem-solving, and improving outcomes for pa�ents and staff. March 15: Assessing the Aging Physician. Part 1 of 2. Open to all physicians and medical staff personnel. Visit h�p://cppph.org/regional‐network/sierra/. March 20: Council on Legisla�on, Sacramento Conven�on Cen‐ter. The CMA Council on Legisla�on (COL), which formulates policy recommenda�ons to the Board of Trustees regarding

sponsored legisla�on or posi�ons on an�cipated major legisla�on affec�ng physicians, will meet to discuss poten�al legisla�ve ac-�ons. April 10‐13: Western Health Care Leadership Academy, San Die‐go. Top thinkers and doers share strategies and resources for accelera�ng the shi� to a more integrated, high performing and sustainable health care system. Sponsored by CMA, CMAF, and California MGMA. See yer in this issue or visit www.westernleadershipacademy.com. April 22: Legisla�ve Leadership Conference, Grand Sheraton, Sacramento. This is a unique event for California physicians and is free of charge to all CMA members. Plan to join more than 400 physicians, medical students and CMA Alliance members who will be coming to Sacramento to lobby their legisla�ve leaders as champions for medicine and their pa�ents.

Sponsored by:

Supported by:

Saturday, March 15, 2014 Valley Hi Community Park, Sacramento

Saturday, March 29, 2014 Phoenix Park, Fair Oaks

Saturday, April 5, 2014 Howe Park, Sacramento

Saturday, April 19, 2014

Eastern Oak Park, Sacramento

Saturday, May 3, 2014 Arcade Creek, Sacramento

Saturday, May 17, 2014

Freedom Park, North Highlands

Walk with a Doc is FREE to anyone who is interested in taking steps to improve their heart health.

We are still looking for Doc leaders for some 2014 Walk

with a Doc events.

To volunteer, or for more info.,

contact Kris Wallach at 916 453‐0254 or

[email protected]

For details, visit www.ssvms.org/events.aspx

March/April 2014 15

A Focus on Physician Wellbeing

IT HAS BEEN MY PLEASURE to serve as a founding member of the Board of Directors of California Public Protection and Physician Health (CPPPH) since its inception in 2009. I would like to share with SSVMS members how much CPPPH has grown into an effective physi-cian health organization for California.

The Medical Board of California’s Diversion Program has now been closed for nearly five years. CPPPH, which was created by the medical community to fill the gap left by that closure, has evolved over those years into an important resource for all those with responsibility for patient safety, quality of care and physician health. It is the hospital medical staffs and medical groups who identify, refer and monitor physicians with substance abuse issues, mental or physical health matters, or behavior problems. They also address the professional stresses – even burnout – that can have serious effects on the physician workforce today. CPPPH has built a network and stepped up to help address those issues in partnership with these entities.

The Sierra Sacramento Valley Medical Society has played an important role, not only in contributing to CPPPH’s start-up with financial contributions, but also in hosting regional workshops for hospital and medical group well-being committee members. CPPPH sponsors these workshops three times a year in four regions of California and, in addition, has established a network of the medical school well-being committees.

With the support of SSVMS and others, CPPPH has evolved into the only physician health organization in California with a focus well beyond the original vision, which was to secure

legislation to reestablish the Diversion Program. While the CPPPH founding organizations will continue to seek legislation for state funding for a physician health program, CPPPH will go forward, whether or not legislation materializes.

For example, a collaboration comprised of persons from the CHA Center for Healthcare Medical Executives, CMA, and CPPPH has begun work with legal counsel from CPPPH’s Advisory Group of Attorneys on development of a guideline document on the critical issue of physician aging. And, CPPPH is bringing a two-part series of workshops on the aging physician to each of the four regions of the state:

Part One - In Sacramento on March 15, “Neuropsychological and Psychological Factors Pertaining to Fitness for Duty” with William Perry, PhD, Professor, Department of Psychiatry, Associate Director of Neuropsychiatry and Behavioral Medicine, UCSD.

Part Two - On May 3, “Legal Aspects” with Richard Barton of Procopio, Cory, Hargreaves and Savitch, LLP, San Diego.

Participation in CPPPH workshops is usually limited to those who serve on physician health committees or have similar responsibilities. But, because this topic is of wide-ranging interest, invitations are extended to all interested persons with clinical roles related to neuropsychological examinations or roles related to policies and procedures in medical groups, medical staffs and hospital administration for this series on assessing the aging physician.

For more information and to register, visit www.cppph.org.

[email protected]

By Lee Snook, MD


No matter where you are in life, SSVMS Group Level Term Life Insurance benefits can be an affordable solution to help meet your family’s financial protection needs.

Mercer and SSVMS leveraged the buying power of your fellow members to secure dependable and affordable life insurance benefits at competitive premiums from ReliaStar Life Insurance Company, a member of the ING family of companies.

With quality life insurance benefits extended at competitive rates, you’ll rest easy knowing you’ve provided coverage for your loved ones through the Group 10-Year and 20-Year Level Term Life Plans.

As a member, you can conveniently help protect your family’s financial future with the Group 10-Year and 20-Year Level Term Life Plan. It features:

• Benefits up to $1,000,000

• Rates designed to be level for 10 or 20 full years*

• Benefit amounts that never change provided premiums are paid when due

65408 Sierra Sacramento March TL Ad (3/14)Full Size: 8.5” x 11” Bleed: Yes= 8.75”x11.25” Live: 7.5”x10”Folds to: N/A Perf: N/AColors: 4C=(CMYK)Stock: N/A Postage: N/A Misc: N/AM

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See for Yourself: Get more information about your Group 10-Year and 20-Year Level Term Life Plans, including eligibility, benefits, premium rates, exclusions and limitations, and termination provisions by visiting www.CountyCMAMemberInsurance.com or by calling 800-842-3761.

65408 (3/14) Copyright 2014 Mercer LLC. All rights reserved.

Mercer Health & Benefits Insurance Services LLC • CA Ins. Lic. #0G39709777 South Figueroa Street, Los Angeles, CA 90017 • 800-842-3761 • [email protected] • www.CountyCMAMemberInsurance.com

* The initial premium will not change for the first 10 or 20 years unless the insurance company exercises its right to change premium rates for all insureds covered under the group policy with 90 days’ advance written notice.

The County Medical Associations and Societies/NORCAP/CMA receive sponsorship fees for insurance programs that offset the cost of program oversight and support member benefits and services.

Sponsored by: Underwritten by:

Insurance is provided by ReliaStar Life Insurance Company, a

member of the ING family of companies.

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March/April 2014 17

ANNuAL MEETING

Annual MeetingTHE 2014 SSVMS AND ALLIANCE Annual Awards and Installation Dinner was held January 16 at the Hyatt Regency Hotel in Sacramento. José A. Arévalo, MD, Family Physician and Medical Director of Sutter Independent Physicians, Inc., was installed as the 140th President of SSVMS.

Also installed were the following SSVMS 2014 Officers and Board of Directors: Jason Bynum, MD, President-Elect; Lorenzo Rossaro, MD, Secretary; Ruenell Adams Jacobs, MD, Treasurer; David Herbert, MD, Immediate Past President; and Directors, Ann Gerhardt, MD; Russell Jacoby, MD; Robert Kahle, MD; Steven Kelly-Reif, MD; Rajiv Misquitta, MD; Tom Ormiston, MD; Christian Serdahl, MD; Sadha Tivakaran, MD; John Wiesenfarth, MD; Eric Williams, MD.

The Society’s highest honor, the Golden Stethoscope Award, was presented to Bradley E. Chipps, MD, a solo practitioner specializing in Allergy and Pediatric Pulmonology, for his devotion to patient care and the medical needs of the community.

The Medical Honor Award was presented to John W. Young, MD, in recognition of his dedication to the uninsured and exemplary service to the SPIRIT Program.

The Cordova Community Council received the Medical Community Service Award in recognition of its annual Kid’s Day in the Park event which provides health and wellness education to children in our community. Executive Director, Shelly Blanchard received the award on behalf of the council.

The Alliance presented its highest honor, the Dorothy Dozier Helping Hands Award, to Susan Brownridge for devoting her time, energy and talents to the Alliance. Celeste Chin received the California Medical Association-Alliance Dedicated County Member recognition.

Guests at the event were entertained by Gardenia Azul, a trio of musicians who have performed and recorded in the Sacramento region for many years with songs rich in the heritage of Mexican and Cuban music.

1 Dr. David Herbert, SSVMS Outgoing President, presents gavel to Dr. José A. Arévalo, SSVMS 2014 President

2 President José A. Arévalo, MD presents plaque and gift to Outgoing President David Herbert, MD

1 2


ANNuAL MEETING

Sierra Sacramento Valley Medical Society and Alliance

Annual Dinner January 16, 2014

Hyatt Regency Hotel

7

3

6

10

8

11

Photos by David Flatter (flickr.com/davidflatter)

March/April 2014 19

ANNuAL MEETING

3 Margaret Parsons, MD (4th from left), Chair of the Scholarship and Awards Committee, joins Members of the Cordova Community Council, recipient of the Medical Community Service Award for its Kid’s Day in the Park Event.

4 SSVMS Board of Directors present at the event include L-R, Drs. Lorenzo Rossaro, Secretary; John Wiesenfarth, Director; Eric Williams, Director; Russell Jacoby, Director; David Herbert, Immediate Past President; Ruenell Adams Jacobs, Treasurer; Jason Bynum, President-Elect; José A. Arévalo, President.

5 Dr. José A. Arévalo and spouse, Sandra Arévalo.

6 Chris Serdahl, MD, SSVMS Director; Margaret Parsons, MD, Chair, Scholarship & Awards Committee; David Sander, Ph.D., Council Member, City of Rancho Cordova and Aileen Wetzel, SSVMS Executive Director.

7 Assemblymember Richard Pan, MD and José A. Arévalo, MD, SSVMS President.

8 Gardenia Azul.

9 SSVMS President, José A. Arévalo, MD, presents Bradley Chipps, MD with the 2013 Golden Stethoscope Award.

10 UC Davis Medical Students.

11 L-R: Celeste Chin, Recipient of the Alliance CMA-A Dedicated County Member Award; Kim Majetich, Alliance President; Susan Brownridge, Recipient of the Dorothy Dozier Helping Hands Award.

12 BloodSource President Skip Lawrence, DDS and spouse, Cookie Lawrence.

4

12

5

9

Photos by David Flatter (flickr.com/davidflatter)


ANNuAL MEETING

13 Golden Stethoscope Recipient, Dr. Bradley Chipps and Family.

14 Medical Honor Recipient, Dr. John young and Mrs. Karen young.

15 L-R: SPIRIT Volunteers, Drs. Chris Swanson, John young and Ben Hunt.

16 L-R: Olivia Kasirye, MD, Sacramento County Public Health Officer; Lee Snook, MD, CMA Vice Speaker; Sherri Heller, Ed.D., Director, Countywide Services, Sacramento County; Ruth Haskins, MD.

17 L-R: Susan Brownridge, Recipient of the Alliance’s Dorothy Dozier Helping Hands Award and Alliance Past President, Gabriella Neubuerger.

15 16

17

14

13

March/April 2014 21

Oceans and Clouds of Words

WORD CLOUDS ARE PICTORIAL representations of a document. Several applications for creating them are available as open source software. Wordle is one. The process is creative in that the “artist” selects all or part of an original document, and copy/pastes it into the word cloud, or painting, before selecting the font, shape, and colors. The number of words used can be altered. Numbers themselves can be excluded. Preferred phrases can be selected instead of only individual words; objectionable words or phrases can be excluded. That process can be continued and modified indefinitely.

The size of a word in the painting reflects its relative prevalence. Generally only nouns are used; what is the import of prevalence for “and,” “a,” or pronouns?

Word clouds offer a quick visual impression of a document, even − or especially one I will call a Word Ocean − like the Affordable Care Act, holding over eleven million five hundred and eighty-five thousand words, a number as irrational as i, guaranteeing interpretational conflict, whether by design or by accident. The ACA is so voluminous and mutable that at any one time, the actual number of words is indefinable.

By comparison, the Gettysburg Address contains 270 words; the U.S. Constitution contains 4,400 words, or 7,818 if the first ten amendments are included. Even so, the Constitution has required centuries of debate, and interpretation, including that of the Supreme Court, to determine what certain parts mean. The Old Testament of the Bible contains about 590,000 words, the New Testament, 181,000 words, the Qur’an less than 80,000. To this very moment, disagreement about the meaning of

holy writ fuels dissent, hatred, prejudice, and war, being interpreted to justify much holy slavery, misogyny, homicide and genocide.

In this cyber-century, we seem to be at a point of logarithmic wordiness, where words are ever more readily used to obscure meaning, and thereby, intent. When no one, and no thing − electronic or transcendental − can decipher what is written in some piece of legislation or regulation, different administrators of different

sections of conflicting documents can act according to their differing intentions. The ACA seems to be an intent to navigate the Health Care Word Ocean. Can we trust our crew? We’ll see.

Meanwhile, for citizen passengers, word cloud paintings are, arguably, at least as intelligible as oceans of words. They can be more amusing, and less harmful or irrational than crossword puzzles, cybersex or the game Candy Crush; or multimillion word laws. Our cover features a Wordle of the entire ACA, where the 75 most prevalent words are depicted. The one here displays the most prevalent 150 words.

[email protected]

By John Loofbourow, MD



past two years. Several interesting devices to help an individual relax and “de-stress” were evident this year.

There was an increasing focus on sharing various measurements with others, especially the individual’s physician, via a “cloud.” Such a proliferation of mobile connected technologies allows physicians to have access to various parameters of their patients on an ongoing basis and encourages patients to play more of a part in their own health. In 2012, 250 million smartphone users downloaded mobile health apps. By 2015, it is estimated that 500 million will do the same. It is predicted that by 2017, there will be almost 170 million wearable wireless devices on the market worldwide.

Some of the more interesting products include those listed below.

•A continuous blood sugar monitor (Dexcom G4 Platinum). The needle sensor, attached to a small unit that adheres to the skin, can be inserted by the patient. It needs to be changed on a weekly basis.

•A small capsule (e-Celsius) which, when swallowed, continuously transmits the body’s core temperature to a monitor or wristband that can then send the data to a smartphone or similar device.

•HealthPatch captures eight clinical-grade biometric measurements, including single-lead ECG, heart rate and variability, respiratory rate, skin temperature, posture, steps and fall detection. A similar unit, the e-Tact, is a small patch applied with a Band-Aid that measures activity, temperature and body tilt.

•“Personal” wireless devices are being manufactured by a variety of companies.

Things you Didn’t Know you Couldn’t Live Without

ARRIVING AT THE LAS VEGAS airport and entering a several block line waiting for one of the 55,000 taxicabs in the city, I had a taste of the organized congestion I would experience for the next several days. Embedded with over 150,000 other people from more than 150 countries, and attempting to visit 3,200 exhibitors, I, for my second time, visited the Consumer Electronic Show (CES) in Las Vegas in January.

This event started over 40 years ago and is produced by the Consumer Electronics Association (CEA), the technology trade association representing the $203 billion U.S. consumer electronics industry. Incorporated in CES is a two-day Digital Health Summit, now in its fifth year.

If I had to choose two words to summarize the major concept covering so many of the products I saw, they would be wireless connectivity. Though some products used the ubiquitous Wi-Fi, most established their connection by Bluetooth. Therefore, a smartphone is almost a necessity today for anyone hoping to “survive” the digital world. Another prominent theme was “wearable tech,” exemplified by the smart watch.

My first day focused on the “Digital Health Summit” exhibits, which featured over 60 exhibitors. This was a 20 percent increase over last year, making CES the largest health tech event in the world. The smartphone is an integral part of many of the devices that I saw, and there was a dramatic increase in devices, including blood pressure cuffs, scales and pulse oximeters that link with smartphones using Bluetooth.

There has been an abundance of fitness and activity monitoring devices developed over the


By Bob LaPerriere, MD

March/April 2014 23

Withings produces wireless blood pressure monitors, scales, a body analyzer that measures weight, body fat, heart rate and monitors the air quality, a baby monitor and a pulse monitor. iHealth showed blood pressure monitors, oximeters, body scales and an activity tracker, all wireless. iHealth also has a wireless smart glucose monitoring system.

Omron, long known for their blood pressure gauges, now has a number of “connected” products. For those without a smartphone, Eocene Health Systems has a remote home monitoring system that sends glucose, blood pressure and weight to the patient’s doctor. Numerous pulse oximeters were evident, many wireless. One (iOximeter) records continuously for 12 hours and plugs into the headphone jack on an Android or iPhone.

•iHealth has gone beyond their many “personal” monitors with their ECG monitor that is designed for continuous wear, allowing users to track and record ECG information throughout their normal daily routine using a companion iOS app and a Bluetooth Low Energy connection. A number of companies are producing similar devices, though I did not see them. See: www.medicalexpo.com.

•For asthma management AirSonea, developed in Australia, is now available. It uses special acoustic sensors and algorithms to evaluate wheezing, even if it is not clinically evident, producing information that the patient can transmit to his physician. As it connects with a smartphone, data such as air quality based on GPS can be recorded, along with the patient’s symptoms. It is pending FDA approval.

•InBody Dial, a personal model of a professional body composition analyzer, measures weight, muscle mass and body fat mass.

•Paro, a therapeutic robot that looks like a fur seal, has tactile, light, audition, temperature and posture sensors, and interacts with humans.

•The Ekoscope by Parace Bionics is a Star Trek-looking stethoscope that has three modes, but also will do a six-lead EKG. It won a double CES award this year for design and engineering. Their website highlights other products they are

working on, which is worth a visit at www.ekoscope.com.

•A number of products physically connect to a smartphone. Iterium, from Russia, is marketing a radioactivity tester (Geiger-Mueller counter), a food tester that measures nitrate levels in fruits and vegetables, and a UV radiation tester that measures UVA, UVB and UVC, all available for both iPhone and Android.

•A rather colorful device, the Smart Diet Scale, has four dishes and is connected wirelessly with an app on a smartphone. A different food goes on each of the four plates, the food type is input into the app, and the scale weighs and produces a nutritional panel for each food.

•Two comparatively “low tech” companies produce items useful in a hospital. One (Loksak) has various Ziploc-like bags for electronics − one for the iPhone that seals so well it allows you to use the phone down to 200 feet in water, also useful for protection in contaminated environments. The other (Seal Shield) produces keyboards, mice, and coverings for various electronics that are dishwasher-safe and 100 percent waterproof, and also include antimicrobial product protection.

•Another lower-tech item is by Clinical Guard (a company that produces a wide variety of health and medical monitors) − an electronic comb that kills head lice and destroys eggs.

•Apple introduced the use of the fingerprint to unlock the new iPhones. Another company is introducing the iris scan (EyeLock Myris) which provides greater security, and another is using the imprint of your ear to provide access to Android phones.

•Many products are crossovers between med-

The photo, above, shows the head of the Ekoscope stethoscope. The companion photo on the following page shows that the earpiece can be detached exposing a USB port wherein practitioners can download/upload the recorded data.

Personal wireless devices are being manufactured by a variety of compa-nies. They include everything from blood pressure monitors, body fat analyzers, and pulse oximeters to ECG and glucose gauges.


other functions on a screen. For people with low visibility (often macular degeneration), Orcam has a miniature camera attached to a pair of eyeglasses. The camera recognizes objects and speaks what it sees through a bone-conduction earpiece.

•Stress reduction was featured by Inner Balance, an app and earlobe sensor that allows a person to improve relaxation by synchronizing breathing with the heart rhythm; whereas emWave2, a hardware unit by the same company, aims to reduce stress and anxiety using pulse data, and coordinates data on “HeartCloud.” Muse by InteraXon uses a headband with seven sensors that can read four EEG channels of data. The Tinke by Zensorium also had an exhibit (see my article in Sept/Oct 2013 SSV Medicine) and uses breathing and pulse to reduce stress. It also functions as a pulse oximeter.

•Several advisory groups were at the show. The American Speech-Language-Hearing Association distributed their brochure regarding the dangers of overly-loud audio with headphones or earbuds. The Health-eHeartStudy.org from UCSF encouraged people to join the study being done regarding heart disease, an attempt to update data from the 50+ year-old Framingham Heart Study. The Vision Council presented information on the impact of digital screens on eye health, including the effect of blue light, which is emitted by many modern electronics.

Beyond medical/health/fitness products, there were numerous products that excite and stimulate the mind (and are also on my wish list). Devices not already on the market will generally be available sometime in 2014. I did wear my Fitbit. On one day I logged over 18,000 steps, approximately eight miles. I’m always amazed at the exciting innovative products at CES − not good for keeping my wish list short.

I am hoping to receive some other devices that are more medically related to evaluate later.If you have questions please do not hesitate to email me.

[email protected]

icine and fitness. A strap that goes on the mattress (Beddit) tracks sleep quality, heart rate, breathing, snoring and sleeping environment, and transmits data to a smartphone. In the Fitness

and Activity Trackers category, there are now numerous competitors to the Fitbit, which I reviewed in the Sept/Oct 2013 issue of this journal. Also demonstrated was Skulpt, a hand-sized unit that measures the fat in individual muscles.

•Several products are major inroads for people with disabilities. Tobii EyeX and Eye Tech digital systems specialize in eye tracking, allowing your eyes to move a cursor or activate

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March/April 2014 25

Most Memorable Night Call Experience


Background: Almost everyone remembers a call night where everything went well or wrong, or somewhere in between. Here are responses from some of our members.

I was a new first-year ENT resident covering night call at Los Angeles County Hospital. A young lady arrived choking and gurgling with a blood-soaked dressing around her neck. Her neck was deeply slit open from ear to ear through her left jugular, thyroid gland, and into her trachea. I immediately placed her into trendelenberg, trached her and clamped bleeders until my senior resident arrived, and we took her to the OR. She had run away from her family in Boston with a hospital orderly. They crashed at 70 mph into a light pole. Her head went through the windshield (this was before seat belts) and her neck came down on the remaining glass. She healed with good function. And I gained confidence for future challenges. −Richard Park, MD

Too many memorable nights, but one I will share involves a post-partum hemorrhage several years ago on Thanksgiving night. After the delivery, I was feeling good because it was early afternoon and I thought, “This is good. I can enjoy Thanksgiving dinner with all the fixings.” Was I ever wrong. Several hours later I received a call that my patient was hemorrhaging. I rushed in and the patient was starting to go into shock, and she looked at me and said, “Doctor, please don’t let me die!” We started giving her blood and moved her to the ICU with plans to possibly take her to the OR. I called one of my colleagues to help me should she require surgery, and he said he was going to have Thanksgiving dinner and as long as she stayed stable, we could operate after

dinner and he told me to do the same. Needless to say, I sat at her bedside, called my wife and told her to save me a plate, but I would not be coming home anytime soon. I sweated at her bedside and finally called the other doctor and said we had to go back to the OR. He had just finished dinner and came in and we ended up having to do a hysterectomy. The patient did well, and I finally had Thanksgiving dinner the next night. We have a lot to be thankful for, especially when our cases go well and our patients do well. −Jose Cueto, MD

A few years ago I was on call and was notified that the patient in bed “B” had stabbed the patient in bed “A” with a kitchen knife she had in her bag. The victim was a non-English speaking double amputee. Needless to say, that topped them all. There was no serious injury. The police arrested the lady in bed “B” and administration handled the rest. The trauma surgeon on call evaluated and cleared the victim. −Anissa Slifer, MD

Years ago, I was on general surgery call when an elderly woman arrived in the ER with a ruptured abdominal aortic aneurysm, and no apparent blood pressure. I spoke to her daughter about my recommendation that we operate, and the good chance that we wouldn’t be able to save her mother. The daughter asked, “Well, but how long will it take?” I’m not now and never have been a vascular surgeon, so I called in a real one. Meanwhile, I started the case, along with my second-year resident, and the orthopedic surgeon whose case I’d just bumped. I had trouble finding the aorta and the orthopod kept saying, “Well−there’s the spine!” Real help arrived, and the patient lived. When she came into clinic subsequently, using the supplemental oxygen that she’d been using


When I

suggested

she let me

go back to

sleep, she

informed me

that I was

being paid

to stay up all

night (news

to me!!!)…

the windows, breaking the glass and sustaining multiple wounds, but being stopped by the metallic mesh outside the window. When that three-hour job was done, I was paged, “STAT,” to the ICU where I found one of our surgical patients in severe respiratory distress, needing endotracheal intubation. With no in-house anesthesia staff, I had to intubate him on the spot. Fortunately, it was an easy “tube” and he did well. But I saw a few gray hairs when I later looked at myself in the mirror! At the end of that very eventful shift, my call partner gave me the highest compliment, saying, “Man, tonight you were just like a resident!” −David J. Manske, MD

In my first year (1964) of surgical practice in Sacramento, in the era prior to ER physicians, I covered the ER 24/7, and finally succumbing to exhaustion, I took the phone off the hook at home. About an hour later, I heard banging on the front door of my childhood home at 1614 T Street. It was the police informing me that Mercy Hospital was trying to contact me for the previous hour. Thinking the worst of one of my patients, I quickly called Mercy Hospital in a panic, and the nurse told me that my patient could not sleep, and could I prescribe a “sleeper.” Imagine calling the police to contact the doctor in the middle of the night to prescribe a sleeping pill for a patient! −Franklin K. Yee, MD

I am an allergist now, so night call is essentially non-existent for me. When I was an Internal Medicine-Pediatric resident working at Long Beach Memorial Hospital in about 1990, as the senior pediatric resident I was sent in a life-flight helicopter out to the desert to help transport a critically-ill teenage girl to our PICU for care. I can’t recall if the girl was conscious at the time we arrived, but I do recall how she deteriorated over the course of the evening, presumably from some sort of encephalitis. Heroic efforts were made to control her intracranial pressure, but by the morning, she had blown pupils and no brain activity. Really devastating − this had been a completely healthy girl just days before. I’ll never forget that night. −Gordon Garcia, MD

My most memorable call night was during

before her aneurysm gave way, her daughter asked, “Why does she still need oxygen?” Some questions can’t be answered easily. −Scarlet La Rue, MD

I was covering calls at a trauma center and was called in at midnight to look at a motorcycle accident victim’s leg, as he had sustained a supposed puncture wound to the calf, as the message went. I tiredly arrived and examined the 27-year-old’s leg, only to determine he had sustained a very serious knee dislocation, putting the arterial supply to the entire leg at risk. He ultimately did well after a vascular evaluation and three hours of knee reconstructive surgery that night! −William Junglas, MD

My worst call night was the night I got two phone calls after midnight. The first was an elderly lady with chronic insomnia who complained that she couldn’t sleep and wanted me to fix it. I tried to sympathize, but didn’t fix it. The second phone call was from a young woman who burned her hand earlier in the day and it was very painful, in spite of icing it all evening. I told her that prolonged icing can further the damage, suggested she use cool water instead and take an anti-inflammatory. She then spent over a half-hour arguing with me about ice’s benefits. When I suggested she let me go back to sleep, she informed me that I was being paid to stay up all night (news to me!!!) and I had to help her. It’s the needless sleep loss that makes call nights the worst. −Ann Gerhardt, MD

My most memorable call night was very early in my internship at UCDMC in July 1981. I was barely out of medical school and was one of the General Surgery interns in-house at the VA Hospital, then in Martinez. We had a gentleman arrive at the hospital having had a very significant intracranial bleed. As we had no neurosurgeon at that facility, he was transferred, “code 3,” via ambulance to Stanford. I was sent with the EMS crew, to keep him alive until he arrived at Stanford. To say I was petrified is a huge understatement! The patient survived the ride, but I lost about three years of my own life! Upon my return to the VA, I was paged by the other intern, to help her suture the multiple lacerations of a man who had tried to jump out of one of

March/April 2014 27

To say I was

petrified is a

huge under-

statement!

my fourth year of medical school at UCD during my OB rotation. I was just finishing that rotation. It started out early in the evening as a young primipara with no prenatal care and very little English presented in rapidly-progressing labor. It proceeded to be a fairly easy delivery during which, under supervision of the resident, I delivered a term baby. It was one of the messier deliveries I have seen. Truly we are born between urine and feces. We cleaned everyone up and went back to bed. A few hours later, both mother and baby spiked fevers. We cultured everything, started antibiotics and by then the next shift was in, and I was off to my pediatric rotation at Travis AFB. Several days later, I was in Cowell Hospital with diarrhea and dehydration, and UCD OB staff were looking for me everywhere to tell me the mother tested positive for Shigella. We never cultured it from me, but I was quite ill for a week and have no doubt that I had had it and efficiently removed it before we got a chance to culture it. In

addition to a lesson in how infectious is that bug, the saddest part was learning we lost that baby. −Sandra Hand, MD

It was in June of 1969, my very first night on call as a surgery intern at the UCSD hospital, quite late in the evening, or maybe it was early morning. I had been summoned by the nurse on the urology ward to check out a post-op patient who was in a great deal of pain. The patient was a three-year-old girl who had earlier that day undergone some sort of vesicoureteral procedure. She lay quietly in bed, tears running down her cheeks, clearly having no fun at all. Her vital signs were normal and the urine in the Foley collection bag looked clear. The nurse, probably three times my age, sat next to her, holding her hand. A cursory exam revealed no sign of serious thoracic or abdominal trouble. And so I asked, “Where does it hurt, sweetie?” She responded in a tiny tear-choked voice, “My body hurts!!” I must have looked flummoxed

continued on page 28


SINCE THE MIDDLE OF THE last decade, California law has provided guidance that advises universal HIV testing of persons between the ages of 13 and 64. In California, both anon-ymous testing through the Office of AIDS and confidential testing are available. However, all medical providers should routinely offer their patients a test and provide information about the test, as well as treatment options.

In the past, written consent was required before testing. This is no longer the case for medical providers. A new law was just signed by the governor making access to testing in non-medical outreach centers, such as mobile testing vans, even more readily available. The medical provider must inform the patient that a test is planned. Patients may opt out (per the so-called “opt out” legislation) of the testing after the above requirements have been met, and this decision should be documented.

Patients who have STDs or TB should be tested at the time those conditions are identified, as these affect both vulnerability and treatment. HIV testing has long been advised for all pregnant women. Persons who are at risk through their sexual activity should also be tested annually, and those at high risk (STDs, multiple partners, unprotected activity, sex workers, IV drug addicts, or men who have sex with other men) should be tested every three to six months.

Against this background of enhanced testing, there will be more persons with positive tests. After confirmatory testing and discussions of treatment, an important issue confronting the patient and the provider is partner notification. In some cases, this poses no problems. But many

patients are reticent to directly inform a partner. Sometimes there is a real fear of detriment to, or loss of, the relationship, or even of violence. In these cases, residents in our Sacramento region have supportive resources to assist them. Dr. Miriam Shipp, the STD controller at Sacramento County Public Health, would like everyone to know of the partner notification services that are available.

If the HIV-positive patient agrees to use this service to contact their partner/partners of the exposure, then both the County Public Health Department and the CARES Community Health Center will be able to provide partner notification services. The exposure notification is couched in general terms by trained staff, and the HIV patient is not identified to the partner. The Department of Public Health STD unit can be reached at 916-874-2738, and the CARES Clinic contact number is 916-443-3299. Information on testing and post-exposure prophylaxis (PEP) is also available from those agencies.

[email protected]

My HIV Test is Positive. How Will I Tell My Partner?

By Sandra Hand, MD, MPH


Memorable Night Callcontinued from page 27

and the nurse nodded her head to indicate I should follow her into the hallway. She strongly recommended that I order a B&O suppository ASAP, which I, dutifully, did. I checked back in an hour and found my little patient sleeping contentedly. I thanked the nurse, and she smiled knowingly. At least she had known what to do. −Jack Ostrich, MD

March/April 2014 29As of December 2013

Sierra Sacramento Valley Medical Society 2014 Committee Appointments

CHILD AND ADOLESCENT HEALTH SERVICES -- REAPPOINTMENTS: Drs. Mary Jess Wilson, Chair;Marcia Britton-Gray, Christine Fernando, Maynard Johnston, Robert Meagher, Anthony Russell and Patricia Samuelson

EDITORIAL -- REAPPOINTMENTS: Drs. Nathan Hitzeman, Editor/Chair; John Belko, Sean Deane, Ann Gerhardt, Sandra Hand, Albert Kahane, Robert LaPerriere, John Loofbourow, George Meyer, John Ostrich, Gerald Rogan, Lee Welter, Gilbert Wright, Adam Dougherty, MS IV and Nan Crussell, Managing Editor NEW APPOINTMENTS: Drs. Shahid Manzoor and Glennah Trochet

EMERGENCY CARE -- REAPPOINTMENTS: Drs. Peter Hull, Chair; Seth Thomas, Vice Chair; Matthew Donnelly,Devin Merchant, Troy Falck, Roel Farrales, Hernando Garzon, Kendrick Johnson, J. Douglas Kirk, Vinh Le, Alexis Lieser, Harold Renollet, Jeff Rogerson, R. Steve Tharratt, Justin Wagner, Lee Welter, and David Wisner NEW APPOINTMENT: Drs. Karen Murrell, Sam Turnipseed, Brian Wippermann and Rodolfo Zaragoza,

HISTORICAL -- REAPPOINTMENTS: Drs. Robert LaPerriere, Chair, Malcolm Ettin, Christine Fernando, Francine Gallawa, James Hamill, Gabor Hertz, Julian Holt, Jack Ostrich, Gail Pirie, F. James Rybka and Irma West; Kent Perryman (guest) NEW APPOINTMENT: Dr. Donald Hopkins

JUDICIAL -- REAPPOINTMENTS: Drs. Joanne Berkowitz, Barbara Hays, and Anthony Russell NEW APPOINTMENTS: Drs. Alicia Abels and Paul Phinney

MEDICAL REVIEW AND ADVISORY -- REAPPOINTMENTS: Drs. Howard Slyter, Chair; Joanne Berkowitz, Vice Chair; Alicia Abels, Denny Anspach, José Arévalo, Richard Axelrod, Gregory Blair, Peter Carruth, Mark Chang, Satya Chatterjee, George Chiu, Jose Cueto, Douglas Enoch, Ronald Foltz, Benjamin Franc, Kenneth Furukawa, Richard Gray, Kern Guppy, Ruth Haskins, Edward Hearn, Reinhardt Hilzinger, Stephen Hiuga, Donald Hopkins, Maynard Johnston, Marvin Kamras, Thomas Kaniff, Abdul Khaleq, Michael Klein, Charles Kuehner, Scarlett La Rue, Shahid Manzoor, Mylon Marshall, Elisabeth Mathew, George Meyer, Conrad Pappas, Gail Pirie, Kristen Robinson, Linda Schaffer, James Sehr, Boone Seto, and Gerald Simon NEW APPOINTMENTS: Drs. Helen Biren, Robert Midgley, Michael Novotny, Tom Ormiston, Praveen Prasad, and Pandur Yenumula

PROFESSIONAL CONDUCT AND ETHICS -- REAPPOINTMENTS: Drs. Joanne Berkowitz, Chair, George Chiu, Douglas Enoch, Malcolm Ettin, Jon Finkler, Richard Gray, James Hamill, Barbara Hays, Edward Hearn, Richard Jones, John Kasch, Paul Kelly, Ralph Koldinger, and Harold Renollet

PUBLIC AND ENVIRONMENTAL HEALTH -- REAPPOINTMENTS: Drs. Donald Lyman, Chair; Ruenell Adams Jacobs, Regan Asher, Clinton Collins, Denette Dengler, Anthony DeRiggi, Christine Fernando, Albert Kahane, Olivia Kasirye, Robert LaPerriere, Stephen McCurdy, Robert Meagher, Caroline Peck and Richard Sun NEW APPOINTMENTS: Drs. Dennis Michel, Robert Midgley, Karen Murrell, and Glennah Trochet

SCHOLARSHIP AND AWARDS -- REAPPOINTMENTS: Drs. Margaret Parsons, Chair, Ruenell Adams Jacobs, Sean Deane, Ray Fitch, Francine Gallawa, Charles Hammel, Paul Kelly, Mark Levy, Travis Miller, Jack Ostrich and Patricia Samuelson NEWAPPOINTMENTS: Drs. Robert Midgley and Pandur Yenumula

WELLNESS COMMITTEE -- REAPPOINTMENTS: Drs. Michael Parr, Chair, Lee Snook, and Captane Thomson


IF YOU HAVE BEEN WONDERING what happens at our SSV Medical Society building beyond the society office, museum and the versatile conference room, let me introduce you to the other occupants. Health Services Advisory Group (HSAG) occupies the office next to the museum. Upstairs are offices of the California Neurology Society, the California Association of Neurological Surgeons, California Health Advocates (CHA), and the SPIRIT Program (Sacramento Physicians’ Initiative to Reach Out, Innovate and Teach), associated with the Community Service, Education and Research Fund (CSERF) of our medical society. Also, the Sacramento County Historical Society maintains a small office here, as well as the SSVMS Alliance.

However, the featured and newest occupant is the California Food Literacy Center. This was started by Amber Stott, the Executive Director. Amber has a background in non-profit management. Her passion about our food system is reflected in the food blog she started in 2008 and in her reflections as a freelance food writer. She says that she felt compelled to start this community-based organization. Her desire to do so was stimulated by seeing hungry people, and obese people, and people who received vegetables from food banks, but did not know what to do with them.

The last few generations have seen fewer and fewer people who actually know how to cook (people watch in fascination as the professionals do it on Food Network!). Furthermore, only 14 percent of the population consumes fruits

and vegetables. If a taste for vegetables is not developed as a child, even prenatally, people are less likely to eat them later on.

I attended the first of three 45-minute K-5 presentations on December 18th at Capitol Heights Academy in Oak Park. That afternoon, a total of 135 students would enthusiastically learn four recipes they could easily use to make tasty and healthy vegetable dips. Amber is supported at these weekly classes by volunteers and “food geniuses.” A “food genius” is a volunteer who has completed a 10-week course on food literacy.

The majority of children in this school are low-income, and the program is tailored to this target audience. Children are also given recipes to take home. Follow-up evaluations have shown that 88 percent know how to read a nutrition label, about 90 percent say healthy food tastes good, and 70 percent go home and request the foods they have tasted in class. Success is also measured by the positive response of a child who experiences the taste of an apple, plum or strawberry for the first time. The program collaborates with a California State University Sacramento professor on behavioral change.

The day I visited was the last before the holiday break, so the youngsters were provided with fresh fruit and vegetables to take home. Items were gathered through a food drive which was held in front of Whole Foods Market with an accumulation of 3500 “pieces.” The lesson of the day featured four veggie dips, with the goal of stimulating the kids to create healthy

SSVMS Welcomes a “New Neighbor” California Food Literacy Center offers classroom learning and tasting

By Bob LaPerriere, MD


Amber Stott, above, is the Executive Director of the California Food Literacy Center.

March/April 2014 31

snacks at home. During the summer school break and continuing every month, California Food Literacy Center is involved in numerous programs in libraries.

The very enthusiastic youngsters shared their food literacy knowledge, learned the concept of calories, and the difference between fruits and vegetables....and more. They shared food facts that even I was not aware of. The kids were divided into four groups, each preparing a different dip, which was then shared with everyone. They provided a wide variety of vegetables to dip, including bell peppers, radishes, Brussels sprouts and carrots. The class ended with one child from each group telling what they made and why it was good.

California Food Literacy started in 2011 as a non-profit, stand-alone 501(c)(3), but it partners with a lot of other non-profits. The 60 active volunteers, who have been working together by telecommuting, now have their first “bricks and mortar” site.

The first project was to pilot a 13-week

curriculum at Capital Heights Academy in Oak Park. This program began with 120 children per week and reached 2,400 children last summer. The program is hands-on and highlights the “produce of the day,” such as broccoli and snap peas, which the kids taste, raw or in a recipe, always local and in season. They also learn “how food works,” where it comes from, and some basics of food preparation and cooking. Each week, three 45-minute classes, back to back, serve over 100 youngsters. Some of the produce is from the Sacramento Food Bank and the Soil Born Farms.

The second project was a food literacy academy which started February 2013, and has trained 27 community members in food literacy education, classroom management and food systems. The program is now involved in a fund raising campaign trying to raise $30,000 to afford a move into other schools. More than six schools are waiting to introduce the program.

In their first year, the program worked with Assemblyman Roger Dickinson, designating

Students at the Capital Heights Academy in Oak Park learn about their vegetables and “how food works.”


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every September in California as Food Literacy Month. This designation also occurred in Yolo County, Sacramento County and Sacramento City.

Due to minimal funding and staffing, the program is now trying to do what they do really well − they inspire kids to eat their vegetables, and they teach low-income K-5th graders about cooking, nutrition and where their food comes from. They function with a pro-bono PR consultant and a lot of dedicated volunteers with the future expectation of expanding to other groups.

There are relatively few similar programs. San Francisco has “Nourish,” a free curriculum on a website for teachers. The Jamie Oliver Food Foundation has primarily a cooking focus rather than the origin of food. Chicago has “Purple Asparagus” which takes cooking classes into schools. The California Food Literacy Center looks forward to the possibility of starting more after-school programs and to bringing farmers and chefs into the classroom.

Their current focus centers around three not-so-small goals: 1) To determine the most important dietary components to change; 2) Obesity prevention; and 3) Healthy eating promotion, including adding more fruits and vegetables, more fiber from whole grains, healthy fats, no added sugars and less processed food.

Needs, in addition to financial, include items such as aprons, spoons and forks, measuring cups, paper plates, Crayons, and glue sticks. Several events are coming up in 2014 and these can be found on their website, http://californiafoodliteracy.org.

[email protected]

March/April 2014 33

IN MEMORIAM

LOUISE SHAFFRATH, A FORMER PRESIDENT of our local Medical Alliance and wife of ortho-pedic surgeon, Max D. Shaffrath (Past President of Sacramento’s Medical Society in 1971), died in Marin County on December 10, 2013 at the age of 90.

In 1971, as the president of what was then known as the Sacramento County Medical Auxiliary, Mrs. Shaffrath “expanded the vision of what was a very conservative organization,” former Sacramento Mayor Anne Rudin said. Rudin, who also belonged to the Auxiliary at that time, recalled a discussion about whether the group should join the Environmental Council of Sacramento, a coalition of community organizations. “The question was whether the Medical Auxiliary really had environmental interests, and she said, yes, there is a relationship between health and the environment. From then on, the Medical Alliance was very involved in environmental issues.”

She was active in promoting careers in the health field. She served on the Golden Empire Health Planning Council and the curriculum advisory committee for medical assistants at American River College. She oversaw planning for “Health Career Day” at UC Davis Medical Center that drew hundreds of local high school students.

Mrs. Shaffrath was also president or board member of many civic and cultural groups, including the Sacramento Children’s Home, Junior League, Opera Guild, and Sacramento Cancer League. She led a public campaign that resulted in a $1 million Ford Foundation grant to the Sacramento Symphony Association. In 1970, she was named Woman of the Year by the Sacramento Soroptimist Club. The Sacramento

Symphony Association honored her fundraising efforts the same year with its Presidential Citation.

It should also be noted that Mrs. Shaffrath became an honorary lifetime member of the SSVMS Alliance. This designation would only be bestowed if someone had performed significant service to the Medical Alliance (then Auxiliary) and would be voted on by the Alliance Board of Directors.

Although known for her style and polish, she was always eager for adventure which included running the Bay to Breakers several times, taking an African safari, climbing Mt. Olympus and Lassen, trekking in Iceland, traveling by van through Baja California with friends, and extended stays in other countries such as a year-long stay in Pakistan and Iran where her husband was a Fulbright Scholar.

The daughter of a former mayor of Omaha, NE, Louise McManis was born July 17, 1923, in Nebraska. She was raised in Colorado and California. She graduated from high school in Santa Monica and attended the University of Redlands. She married Dr. Max Shaffrath, an Army physician, in 1946. They settled in Sacramento in 1950 and raised three children.

Besides her husband, who was a medical partner of Dr. Gilbert Wright, a member of the SSVMS Editorial Committee, she is survived by two daughters, Ann Reed and Margaret Lanzone; a son, James; three grandsons; and two great-grandchildren.

− Kim Majetich, President, SSVMS Alliance

Alliance Past President Louise Shaffrath1923-2013

Louise Shaffrath


December 9, 2013 Serving as the Member Board to Blood-

Source, the Board received the BloodSource Annual Report from Chief Executive Officer, Michael Fuller. The Member Board also approved the following BloodSource 2014 Officers and Board of Directors: Harry Lawrence, DDS, Chair/President; Sherri Kirk, Esq., Vice Chair/President; Keith McBride, Esq., Immediate Past President; Travis Miller, MD, Secretary (SSVMS Appointee); Jim Schraith, Treasurer; Directors, John Belko, MD, Mark Carter, MD, Angelo de Mattos, MD, Keith Doram, MD, Michael Lucien, MD (SSVMS Appointee), Anthony Russell, MD, Mark Skinner, JD, Christine Taylor.

Approved the 2013 Third Quarter SSVMS Financial Statements, Investment Reports and Recommendations. It was noted that the strong growth in membership has enabled SSVMS to exceed budgeted dues-related income and commissions by four percent and eleven percent respectively.

Serving as the Board to the Community Service, Education and Research Fund, the Board approved the 2013 Third Quarter CSERF Financial Statements, Investment Reports and Recommendations.

Approved the 2014 Committee Appointments.

Approved the Membership Report:For Active Membership — Richard P. Ericson,

MD; Tri-Dung G. Hoang, MD; Linda W-L Lee, MD; Harris D-P Levin, MD; Saba Sajid, MD; William R. Stevens, MD; Samuel D. Turnipseed, MD; Mitra Yazdi, MD.

For Resident Membership — Dominique L. Rash, MD.

For Multiple Membership — Michael Luszczak, DO (Active with Placer-Nevada).

For Reinstatement to Active Membership — Sara E. Dougherty, MD; Hung G. Hoang, MD; Anh H. Nguyen, MD; Rachel Weinreb, MD.

For a Change in Membership Status from Active

to Active 65/20 — Mark Blum, MD.For Retired Membership — Helen G.

Armstrong, MD; Jack E. Rozance, MD.For Resignation — Michael L. Carl, MD

(retired/moved to San Diego); Satyendra Giri, MD (moved to Oregon); Deepa Gupta, MD (transferred to LACMA); John D. Hamilton, MD, (retired/moved to Massachusetts); Adrian C. Lawrence, MD (transferred to San Francisco); Irene Lee-Klass, MD (Resident Member transferred to San Mateo); William A. Nickerson, MD (retired/moved to Washington); Will Tseng, MD (Resident Member transferred to Santa Clara); Millie M.L. Tolentino, MD (transferred to Orange County).

January 13, 2014The Board:Welcomed new Directors, Ruenell Adams

Jacobs, MD; Rajiv Misquitta, MD; Sadha Tivakaran, MD; John Wiesenfarth, MD; Eric Williams, MD. Continuing as Directors in 2014 are: José A. Arévalo, MD, President; Jason Bynum, MD, President-Elect; David Herbert, MD, Immediate Past President; Ann Gerhardt, MD; Russell Jacoby, MD; Robert Kahle, MD; Steven Kelly-Reif, MD; Tom Ormiston, MD; Lorenzo Rossaro, MD; Christian Serdahl, MD.

Unanimously approved the election of Lorenzo Rossaro, MD as 2014 Secretary and Ruenell Adams Jacobs, MD as 2014 Treasurer.

Approved the 2014 Board of Director meeting dates.

Approved the request from the California Public Protection and Physician Health, Inc. (CPPPH) to provide SSVMS endorsement for their three regional workshops and allowing use of the SSVMS name in their announcements. CPPPH, an independent, non-profit public benefit corporation, was formed in 2009 after the Medical Board of California closed its Diversion Program for Physicians. Its mission is to develop a comprehensive physician health program for the state so that California does not

Board Briefs

March/April 2014 35

Meet the ApplicantsThe following applications have been received by the Sierra Sacramento Valley Medical Society. Information pertinent to consideration of any applicant for membership should be communicated to the Society. — Lorenzo Rossaro, MD, Secretary.

Duong, Vicki P., Pediatrics, St. George’s University 2004, 7260 E. Southgate Dr #D, Sacramento 95823 (916) 428-8134

Ericson, Richard P., Cardiology, University of Maryland 2004, Sutter Medical Group, 5301 F St #117, Sacramento 95819 (916) 733-1788

Fujii, Scott K., Orthopedic Surgery/Sports Medicine, Drexel University 2006, Summit Orthopedic Specialists, 6403 Coyle Ave #170, Carmichael 95608 (916) 965-4000

Gopalakrishnan, Rajalakshmi T., Nephrology, Madras University, India 1997, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento 95823 (916) 688-6988

Greene, Hunter S., Orthopedic Surgery/Sports Medicine, Tufts University 1998, Summit Orthopedic Specialists, 6403 Coyle Ave #170, Carmichael 95608 (916) 965-4000

Hoang, Hung G., Family Medicine, University of Saigon, Vietnam 1971, 6540 Stockton Blvd., #3A, Sacramento 95823 (916) 391-0170

Hoang, Tri-Dung G., Internal Medicine, St. George’s University, West Indies 1998, 6540 Stockton Blvd., #3A, Sacramento 95823 (916) 391-0170

Hull, Peter V., Emergency Medicine, University of Illinois 1989, CEP-Sutter Roseville Medical Center, One Medical Plaza, Roseville 95661 (916) 781-1000 (Multiple Member)

Hundal, Rajbarinder (Rajan) S., Cardiology, University of Nevada 2004, Mercy Medical Group, 3000 Q St, Sacramento 95816 (916) 733-3333

Javeed, Mansoor, Hematology/Oncology, Bangalore Medical College, India 1984, Sierra Hematology Oncology, 1580 Creekside Dr #230, Folsom 95630 (916) 984-6230

Lee, Linda W-L, Gastroenterology, University of Missouri-Kansas 2007, Mercy Medical Group, 3000 Q St, Sacramento 95816 (916) 733-3333

Mandal, Binita, Allergy/Immunology, University of Miami 2000, Mercy Medical Group, 3000 Q St, Sacramento 95816 (916) 733-3333

Martineau, Daniel S., Pediatrics/Adolescent Medicine, Uniformed Services University 1992, The Permanente Medical Group, 1650 Response Rd, Sacramento 95815 (916) 614-4060

Paris-Pombo, Alicia, Preventive/Family Medicine, University of LaSalle, Mexico 1991, El Dorado County Health Department, 931 Spring St, Placerville 95667 (530) 621-6277 (Government Member)

Patel, Chiraag S., Allergy/Immunology, Northeastern Ohio University 2005, Pulmonary Medicine Associates, 1485 River Park Dr #200, Sacramento 95815 (916) 325-1040

Rash, Dominique L., Radiation Oncology, George Washington University 2009, UCDMC, 4501 X St #G140, Sacramento 95817 (916) 734-3754 (Resident Member)

Rieland, Tris L., Emergency Medicine, Chicago School of Medicine 1998, The Permanente Medical Group, 6600 Bruceville Rd, Sacramento 95823 (916) 688-2106

Sady, Stanley P., Anesthesiology, University of Michigan 1993, UCDMC, 4150 V St #1200, Sacramento 95817 (916) 734-5031

Sajid, Saba, Family Medicine, University of Karachi, Pakistan 2003, Woodland Clinic Medical Group, 1207 Fairchild Ct, Woodland 95695 (530) 666--1631

Taneja, Taresh, Cardiology, GOA Medical College/Bombay University, India 1989, The Permanente Medical Group, 2025 Morse Ave, Sacramento 95825 (916) 973-5000

Turnipseed, Samuel D., Emergency Medicine, East Carolina University 1987, UCDMC, 4150 V St #2100, Sacramento 95817 (916) 734-8572

Walton, Stephanie A., Pediatrics, Howard University 1985, Walton Pediatrics & Medical Associates, 7237 E. Southgate Dr #A, Sacramento 95823 (916) 422-6635

Yazi, Mitra, Family Medicine, Islamic Azad University, Iran 1999, Woodland Clinic Medical Group, 1207 Fairchild Ct, Woodland 95695 (530) 666-1631

Yu, Limin, Pathology/Dermatopathology, Nanjing University, China 1994, Diagnostic Pathology Medical Group, 3301 C St #200E, Sacramento 95816 (916) 446-0424

Zaragoza, Rodolfo H-P., Emergency Medicine, University of Illinois 1996, CEP-Rideout Memorial Hospital, 726 – 4th St, Marysville 95901 (530) 749-4300 (Multiple Member)

remain one of the few states without such a resource. Approved the establishment of an ad hoc committee, chaired by Christian

Serdahl, MD, to address issues concerning solo and small group physician practices.

Approved the Membership Report:For Active Membership — Scott K. Fujii, MD; Hunter S. Greene, MD; Binita

Mandal, MD; Daniel S. Martineau, MD; Chiraag S. Patel, MD; Tris L. Rieland, MD; Stephanie A. Walton, MD.

For Government Membership — Alicia Paris-Pombo, MD.For Multiple Membership — Peter V. Hull, MD; Rodolfo H. P. Zaragoza, MD.For Reinstatement to Active Membership — Adel D. Agaiby, MD; Richard

Areen, MD; Philip Bernstein, MD; Gregory M. Bricca, MD; Caron A. Houston, MD; Kevin X. McKennan, MD; Randall A. Ow, MD; Vivien K.Y. Tseng, MD.

For Retired Membership — Michael D. Bell, MD; Satya N. Chatterjee, MD; Harvey S. Edber, MD; Steven R. Ferronato, MD; John W. Young, MD.

For Resignation — Emily Y. Chan, MD; Petra Hoette, MD; Erin R. Prince, DO (transferred to Los Angeles); Steven Seto, MD; Kyi Zin, MD.

Board Briefscontinued from previous page


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MEMBERSHIP HAS ITS BENEFITS!Free and Discounted Programs for Medical Society/CMA Members

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Car Rental / Avis or Hertz Members-only coupon code is required Go to: www.cmanet.org/memberhip-benefits or call 800.786.4262

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Investment Planning Resources Wells Fargo Advisors (855) 225-4369 or email [email protected]

Legal Services & CMA On-Call 800.786.4262 or email [email protected]

Magazine Subscriptions Subscription Services, Inc. 50% off subscriptions 1.800.289.6247 / www.buymags.com/cma

Medic Alert 1.800.253.7880 / www.medicalert.org/cma

Medical School Debt Management Members-only coupon required: www.cmanet.org/membership-benefits

Practice Financing Members-only coupon code is required Reduced Loan Administration Fees 1.800.786.4262 / www.cmanet.org/benefits

Office Supplies/Equipment-Staples, Inc. To access the members only discount link visit: Save up to 80% www.cmanet.org/membership-benefits

Reimbursement Helpline Contact CMA at 888.401.5911 or email Assistance with contracting or reimbursement [email protected]

Security Prescriptions Products Rx Security www.rxsecurity.com/cma.php or call (800) 667-9723

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SIERRA SACRAMENTO VALLEYM E D I C A L S O C I E T Y

Doctor-Mentors NeededAre you a physician willing to donate a few hours of your time to mentor eager new medi-cal students? The Willow Clinic, an affiliated UC Davis School of Medicine program, needs doctors like you. We’re recruiting friendly people with a desire to teach the next generation of physicians and to help the community. The clinic serves Sacramento’s homeless and is open every Saturday from 9 a.m. to 1 p.m. Volunteer physicians are welcome on a one-time only or rotating basis. For further information, contact: [email protected].

Visit SSVMS online at www.ssvms.org

Robot Patientscontinued from page 9

disease, rather than blindly follow an algorithm (oh, my, such heresy!) have a better chance of working.

Eating disorder patients, who withhold information and are non-compliant because they need their disordered behavior to psychologically cope, are terribly frustrating. But when they actually recover, each in their own, unpredictable way, I remember why I’m a doctor, and not a technician. The same is true for other addictions and challenging personality types.

I doubt that any human is a Hal-type patient. I’ve never taken medication four times a day in my life, and three a day is a stretch. But too many of us brand patients as “difficult” or “non-compliant,” as if to rid us of the responsibility of dealing with our patients’ human side. Herein lies the “art” of medicine.

[email protected]

THE Art OF Medicine

April 26, 2014 Auction & Dinner

The SSVMS Alliance is hosting an evening of fine art & fine wines. Proceeds from the auction go directly

into our Community Endowment Fund the sole source of funding for community health grants and medical/nursing school scholarships.

April 26th, 2014

$100pp Dinner and Host Bar Del Paso Country Club

Enjoy Premium Napa Wines from Our Dinner Sponsor

NAPA VALLEY

Join our efforts to give back to our community.

1. Become a Sponsor: Patron Level $5,000, Masters Level $2,500, Artisan Level $1,000, Craftsman $500, Apprentice Level $250 (Visit www.SSVMSA.org to view benefits of sponsorship)

2. Contribute to the SSVMSA Wine Auction

3. Are you an artist, do you know one? Make or obtain a donation of artwork from an artist or gallery.

Join Our Growing List of Sponsors 2014 Artists and Galleries Dignity Health Tom Bennett Sculpture Infiniti Elk Grove Gregory Kondos Northern Calif. Spine & Rehabilitation Assoc. Elliot Fouts Gallery Sutter Medical Group Ventana Art Gallery Heritage Oaks Hospital Barbara Arnold, MD MPMC Paula Cameto SSVMS And Many More…. UC Davis Health Systems Preview artwork at www.ssvmsa.org CWT Vacations: Barbara Andras 2013 Community Grants: $27, 175 Bank of Sacramento 2013 Scholarships: $8,975

To make a donation or become a sponsor contact Gabby Neubuerger at [email protected] or 916- 736-1613. For advanced reservations contact Catherine Doggett at [email protected] or 916-903-7529. SSVMSA is a 501 (c) 3, Donations/Sponsorships are fully tax deductible.

NORCAL Mutual is owned and directed by its

physician-policyholders, therefore we promise

to treat your individual needs as our own. You

can expect caring and personal service, as you

are our first priority. Visit norcalmutual.com, call

877-453-4486, or contact your broker.

P R O u d tO b e e N d O R s e d bY t h e s i e R R A s AC R A M e N tO VA L L e Y M e d i C A L s O C i e t Y.

A N o r c A l G r o u p co m pA N y

March/April 2014

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