SOMBR ERO

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

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

With reimbursements shrinking and the integration of electronic medical records, treating your patients effectively
and running a protable practice has never been more difcult. Mike Hannley understands this, and he has the expertise to provide solutions. Early in his career, he specialized in helping medical and dental practices meet their unique needsand hes never stopped, even as President of Bank of Tucson. Now he is making it a Bank of Tucson priority with its Professional Services Division to create individualized solutions for the growing challenges that face the healthcare community. Visit Bank of Tucson or call Mike Hannley at 520-321-4500. Ask him about what Bank of Tucson is doing to help, and how you can focus on patient care without sacricing the nancial health of your practice.
Mike Hannley President Bank of Tucson

MEMBER
The more you know, the safer your money.

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MAIN OFFICE | 4400 E. Broadway | Tucson, AZ 85711 | Tel (520) 321-4500 | Fax (520) 321-1956 NORTHWEST OFFICE | 6400 N. Oracle Rd | Tucson, AZ 85704 | Tel: (520) 219-5000 | Fax: (520) 219-1100 www.bankoftucson.com

SOMBRERO April 2012

Official Publication of the Pima County Medical Society

Vol. 45 No. 4

Pima County Medical Society Ofcers

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

PCMS Board of Directors

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

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

Members at Large
Kenneth Sandock, MD Richard Dale, MD

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

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

At Large ArMA Board

Ana Maria Lopez, MD,

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

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

Arizona Medical Association Ofcers

Gary Figge, MD, past president

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

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

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

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SOMBRERO April 2012

CONTENTS

5 6 7 11 14 20 22

Presidents Page
When EMRs make non-meaningful use.

DEPAR TMEN TS
Conferences & Seminars................ 26 Members Classieds..................... 26

Executive Directors Page

If you nd yourself at an AMB hearing, you neednt go it alone.

PCMS News
History tour is soon; St. Es needs you.

Membership
A look at Western Neurologys three-year-old partnership in Carondelet Neurological Institute.

Time Capsule
The State of Arizona is 100 years old this year and its birthday was Feb. 14. Also, Dr. Samuel Paplanus recalls The Pus Club. On the Cover
Hobbles Off and Back to Work, by Western and y shing artist Rockwell E. Rock Jackson, M.D., is a modern portrait from a Wyoming cattle ranch in summer, echoing the Old West and some ways that have not changed since. A young cowboy, after taking his chuckwagon break, removes the hobbles from his horse. Hobbles link the forelegs closely enough to stop the horse from running off.

Reality Check
Dr. Michael S. Smith says the United States would be more united if more of us gave back to the country.

Travel
Dr. George Makol reports from his UofA alumni adventure to Antarctica.

Support

To find our way through the wilderness of grief, we often need guides that can provide some direction. It is into this task we have entered to assist others on this difficult journey. Frank Williams
Director of Social Services

Casa de la Luz Hospice offers sensitive medical, emotional, and spiritual support to individuals and their loved ones during the final phase of life. Contact us for more information.

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4 SOMBRERO April 2012

PResIDents paGe

EMRs: Keep it real

There is Meaningful Use and then there is meaningful use. In the rst sense, Meaningful Use refers to the ObamaCare-inspired initiative to promote widespread use of electronic medical records, or EMRs. Physicians who adopt EMRs are eligible to receive $42,000 or more from economic stimulus dollars if they meet certain criteria proving they really are using EMRs to improve patient care. Using electronic prescribing, giving Dr. Alan K. Rogers each patient a printed clinical summary at each visit, documenting smoking status and body mass index, recording race, ethnicity and primary language are just a few of the criteria that must be met to achieve Meaningful Use. By the way, if you have not started using EMRs, do it now. The incentives for them are fading and penalties for not using them are going to grow. Everyone in medicine will be using electronic records eventually, like it or not. What Im talking about, though, is using electronic records meaningfully. Every day we get pages and pages of faxed electronically generated medical records that contain a bewildering amount of non-pertinent information. Records from consultants, hospitals, emergency departments, and home-care agencies have grown in length with EMRs. I have learned to just skip to the last page and read the one paragraph about what is really happening to the patient. The rest is basically uff. I lay this extra uff at the hands of what I call EMR abuse. Lets face it; sometimes we do things just to satisfy government mandates. No, I really dont need to record peoples race, ethnicity, and primary language to get through my day or to avoid liability. But most of what we do is for the right reasons: to improve the care of our patients. EMRs must do both. Its just that we cannot let government mandates, liability shields, and uff win out. My examples of EMR abuse: The Copy Forward. EMRs allow the whole previous note to be brought into a new note. But the temptation is to bring it in without editing. So after a while notes have pages and pages of repeats and new information tends to be buried inside somewhere or added at the end. The Cut-and-Paste. Parts of prior notes can be cut and pasted into new notes. So the same physical exam or ROS gets placed into each note. Eventually all the chart notes contain exactly the same text over and over. Readers onto this skip redundant sections, but unfortunately may miss if new information is slipped in. The Up-Coded Note. EMRs do lead to better documentation of charge levels and are a big help to physicians in justifying coding. However, sometimes it is obvious that sections are put in just to achieve a higher code. Add a 12-point review of systems template and go to the next higher level. A red ag is when the ICD-9 code appears in parentheses after every diagnosis. Billing
SOMBRERO April 2012

and code level then seem to be the paramount factor in that physicians mind. Similarly, including verbiage from coding in your note is worrisome: I saw Mrs. Smith in a limited problem oriented fashion The Template. This is probably the funniest of notes. EMR systems allow you to build templates of text that are used repeatedly. Just click on a button and the template is incorporated in your note. But it is imperative to pick the right template; otherwise you get the double mastectomy patient with a symmetric breast exam, the male patient whose vault and vagina are clear, or the pediatric patient with a normal prostate exam. The Discharge Document. I have seen examples of hospitals, ERs and skilled nursing facilities simply printing medical administration records from the chart and giving it to the patient as their outpatient medication list. The hospital MARs of course include all kinds PRN meds, laxatives, analgesics, sleepers, and emergency medications not intended for home use. The MAR may also list a medication that is on the hospital formulary, but the patient was taking an alternate brand at home. So on hospital follow up, the patient is taking Nexium and Aciphex at the same time (and spending money on both). Electronic Gibberish. Voice-recognition software such as Dragon Dictation is great for busy physicians needing to put text into a note. I use it myself. It can eliminate transcription costs (tell your kids to not go into transcription as a career!) But it can misunderstand what you are saying and type sound-alike words that are completely unrelated to your meaning. So, if using voice-recognition, careful editing is mandatory. Also, a good idea may be to place a disclaimer at the end of your note: Voice recognition technology used in generating this note. Sound-alike errors may have been missed in editing. The Blank Template. Hospital ERs and urgent-cares are notorious for using visit templates that have a blank for every eventuality. Frequently these are left blank and faxed to me with a hand notation of see dictation. Save my printer ink! Either use the template or simply generate a customary EMR note. Electronic medical records are unquestionably a great advance in record keeping, and I am one of their biggest fans. EMRs have improved things from legibility to reduced liability, yet with every new technology comes a downside. I am worried that buried in all the redundant information is some clinically relevant piece of information I missed by just reading the last paragraph. When every note has exactly the same physical exam, its going to be a problem in court when the plaintiff s attorney claims no actual examination was doneit was just an added template. Plaintiff s attorneys apparently have not caught onto this yet. We as physicians are always pledged to do the best for our patients, and part of that is keeping clear, efcient, and concise medical records. Now that we are in the electronic age, we must keep our records meaningful.
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eXecUtIVe DIRectoRs paGe

Dont go it alone when you dont have to

It was an exception. During calls to the public at Arizona Medical Board meetings, only three people may testify for three minutes each on a matter at hand. Three people had already spoken. After a break, AMB Chairman Douglas Lee, M.D. allowed PCMS to testify. He made clear this was a special dispensation. I thanked him for allowing me the chance, identied myself as repreSteve Nash senting Pima County Medical Society, and watched for the speaker light to go green. Pima County Medical Society asks that you refer this case to an administrative hearing, I began, trying to look at each of the 12 board members at least once. That way, you can question and assess the physician in this matter yourselves. Late last year the physician involved went through an administrative hearing to decide whether he knowingly violated his consent agreement, under which he agreed not to administer, prescribe, or dispense any controlled substances for three years. Since he worked in an urgent-care setting, he was allowed to administer prescribed substances in life-threatening emergencies. At the end of testimony, the administrative law judge recommended license revocation. The physician had represented himself during the administrative hearing because he could not afford an attorney. He was outlawyered during the hearing, and I told the AMB as much. The administrative hearing decided a legal question, however, I continued. The medical question remains should this doctors license be revoked for prescribing Lomitil? That is what concerns our board of directors, and it is a question that needs to be decided by his peers, not lawyers, and is the responsibility that selfregulation of the profession requires. Briey, I reminded the board the physician had completed the PACE evaluation of his clinical skills, surrendered his DEA license, and had appeared contrite and conscientious during our process. For the record, I concluded, this physician is not now, and has never been, a member. We sincerely believe it is in the interests of all Arizona physicians that he be allowed to state his case to his peers on this board. The eight physicians and four public members of the Arizona Medical Board debated this physicians case for more than an hour. In the end, his license was not revoked, but he was placed on ve years probation, ordered to do CME, and pay the costs of the administrative hearing. Did we help? No one knows for certain. One thing, it didnt hurt. Our message is: if you should be involved in such a case, you dont have to do all this alone. PCMS has been involved in the pain manWill transform the lives of your patients... agement issue since 2000. It has looked at sham peer review and problems at the AMB since 2006. The doctor in this case submitted to an interview with Dr. Bennet Davis, who has been our spear-point with the AMB since 2007. Dr. Davis gave several recommendations for Bariatric Surgery Center of ExcellenceTM the PCMS Board to consider. Our board of directors listed our concerns with the case, Stephen E. Burpee, MD | Patrick M. Chiasson, MD and directed me to testify in support. On the day in question, I got up early, but not early enough. The last 13 miles of Scottsdale trafc took longer than the 109 miles to 3 Laparoscopic Procedures Available: reach Phoenix. I arrived at 8:07, in time to Gastric Bypass Adjustable Gastric Band hear Jane M. Orient, M.D., Andrea Russell, Ph.D., and David Ruben, M.D. testify for the physician. Dr. Scott Forrer also testied indirectly in the matter. Later the exception was made for me to Post-Op Program oering patients education, speak, but being there was not exceptional. support & connection to cultivate a healthier lifestyle. PCMS is ready to help, whether it is for a group, a principle, or a physician like you. Register: 520-219-8690 | www.ArizonaWeightLoss.com

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SOMBRERO April 2012

pcms neWs

Committee invites members, guests for SE AZ tour

Members can join the PCMS History Committee on a jaunt to Southeast Arizona on Saturday April 14, for a guided tour of Fairbank, Tombstone, and (if theres time) the jail/museum in Gleason. There is no charge. You can drive or ride, and any PCMS member and guest are eligible to go. Please call 795.9484 to reserve your spot. The tour will leave from the PCMS parking lot at 7:30 a.m.

Before retiring, Dr. Richard Switzer would triage patients with suspected urological problems at the clinic. St. Es is hoping to nd another urologist willing to take on this important role. Referrals to specialists ofces can be arranged on a rotating basis or limited by the number of patients seen. St. Es is especially looking to build the pool of neurologists willing to see St. Es patients. Any physician interested in learning more about helping the uninsured patients of St. Elizabeths should call Dr. Mark Schildt at 628.7871.

Seeking RR hospital history

The committee has been considering subjects for its oral history and lecture projects sponsored by the Southern Arizona Transportation Museum, and considers that the history of the Southern Pacic Hospital, as told by the physicians who worked there, would be of interest to both the railroad-transportation community as well as the medical community, reports Dr. Ken Sandock, committee member and SATM director-at-large. We would like to identify and contact the doctors who trained and practiced at the SP Hospital, along with nurses and others who may have been associated with the hospital. We feel that this will be mutually benecial. Please call Steve Nash or e-mail steve5199@simplybits.net if you can be of help to the History Committee in this effort.

Alliance brunch May 10

The Pima County Medical Society Alliance will have a no-host brunch (not at a members home) on Thursday, May 10 at Schlomo & Vito New York Delicatessen, 2870 E. Skyline Drive in Tucson. The business meeting is 9:30-10 a.m., and brunch 10-11:30. Please RSVP Kay Dean at 520.232.0240 or kmcdean@yahoo.com, or Anastasha Lynn at 520.219.9800 or msdesertprincess@gmail.com Reminder: Dues are due! If you have not paid your PCMSA dues for the 2012 calendar year, please make checks payable to PCMSA or Pima County Medical Society Alliance, and submit to: Kay DeanTreasurer, 6433 N. Placita del Zopitote, Tucson 85750. Dues are $50; $25 for retirees and housestaff.

St. Es seeks volunteer docs

For more than 50 years, St. Elizabeths Health Center on Speedway, formerly St. Elizabeth of Hungary Clinic, has served its mission of providing healthcare for the uninsured and under-served in the Tucson community. Pairing a very small paid staff with volunteer physicians, nurses, dentists, dental hygienists and other healthcare professionals allows St. Es to provide services at the lowest cost possible. St. Es reports that it needs more physician partners with actice medical licenses. There are many ways to volunteer. Primary care physicians are always in need to see patients at the clinic, located at Stone and Speedway. Specialists may choose to come to St. Elizabeths to do consultation or see patients in their own ofces. Some retired physicians volunteer on a regular schedule. Were extremely grateful for all of our volunteer physicians and can be very exible in working with schedules and arrangements for how patients are seen, St. Es Medial Director Mark Schildt said. After retiring from a 20-year solo practice, primary care physician James Hudson, M.D. now comes to St. Elizabeths one halfday each week. Its a rewarding experience, Dr. Hudson said, serving people who otherwise wouldnt be able to get care. Now that Im retired, I have the time to do it. And for those who havent worked with computerized medical records, its pretty easy to learn and works pretty well. Dr. Hudson said he also enjoys the collegial relationships. Staff are nice and helpful, with good insights and skills. Its an enjoyable place to spend some time.
SOMBRERO April 2012

Conference: Vegetation Not Medication

Healthy You Network (healthyyounetwork.org) presents the Vegetation Not Medication symposium April 28-29 at the DoubleTree Hotel, 445 S. Alvernon Way, Tucson. For physicians interested in preventative medicine, this is an occasion not to be missed, organizers said. The program focuses on health benets of plant-based nutrition, including abundant information on the science behind a plant-based diet, and practical information on how to shop, prepare and explore the exciting world of plant-based nutrition. Presenters include: Caldwell Esselstyn M.D., author of Prevent and Reverse Heart Disease and one of the stars in the recent documentary Forks over Knives. Matthew Ledderman M.D., co-author of Keep it Simple, Keep it Whole and authority on nutrition and lifestyle medicine to treat obesity, diabetes, hypertension and heart disease. Doug Lisle, Ph.D., co-author of The Pleasure Trap, director of research for True North Health Center, and expert on evolutionary psychology and weight loss. Jeff Novick, M.S., R.D., L.D., LN., nutritionist who offers a unique, humorous and practical approach to health, tness, and natural living. John Robbins, social activist, humanitarian, and bestselling author of A Diet for a New America and Healthy at 100. For more information and/or to register for the conference, please call 520.275.7999 or log onto www.healthyyounetwork.org
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NHMA meets in D.C. this month

The National Hispanic Medical Association, on whose board Dr. E. Luis Aguilar serves, will have its annual conference at the Marriott Wardman Park Hotel in Washington, D.C. April 26-29. Scheduled to speak are Obama Administration Health and Human Services Secretary Kathleen Sebelius, and Dr. Richard H. Carmona, 17th U.S. surgeon-general (2002-2006), vice-chairman of Tucsons Canyon Ranch, and Distinguished Professor at the UofA Zuckerman College of Public Health. The NHMA reports that under the theme Innovations that Improve the Health of Hispanics, Families and Communities, national and international experts will make presentations about current innovation in medical homes, accountable care organizations, health insurance exchanges, prevention, integrative care, e-health, and cultural competence for the growing Hispanic populations in the U.S. CME credits will be provided. The three-day conference will include a brieng at the White House for Hispanic health professionals and a visit to Capitol Hill, where congressional staffers will provide updates on health nancing and policy. Other key speakers are Salomon Chertorivski Woldenberg, Mexicos minister of health; Dr. Ileana Arias, principal deputy director at the Centers for Disease Control and Prevention/Agency for Toxic Substance and Disease Registry; and Lorraine CortesVazquez, AARP executive vice-president for multicultural markets and engagement. The National Hispanic Medical Association, established in 1994, is a nonprot association representing the interests of approximately 45,000 licensed Hispanic physicians in the United States. NHMAs mission is to empower Hispanic physicians and other healthcare professionals to improve the health of Hispanic populations with Hispanic medical societies, and resident and medical student organizations in collaboration with public and private sector partners.

HealthGrades rates St. Marys high

HealthGrades, a leading independent healthcare ratings organization, has named Carondelet St. Marys Hospital as a Distinguished Hospital for Clinical Excellence, Carondelet reported in February. This prestigious distinction places St. Marys among the top ve percent of hospitals nationwide for clinical performance, they said. To put it simply, people are more likely to have successful treatment, fewer complications, and lower mortality, at these Distinguished Hospitals for Clinical Excellence. Carondelet reported that HealthGrades Hospital Quality and Clinical Excellence study, in which St. Marys is highlighted, objectively identies hospitals with the best total clinical performance across all 26 medical diagnoses and procedures. Out of 5,000 hospitals studied nationwide, only 263 were designated as a HealthGrades Distinguished Hospital for Clinical Excellence. We have a long list of physicians who have dedicated their careers to serving patients and their families at St. Marys, Chief Medical Ofcer Amy Beiter, M.D. said, and we are all honored to be recognized by HealthGrades and to know that our hospital is responsible for helping to elevate Tucsons reputation for quality clinical care. This is a testament to a great effort by our staff and associates who have an obsession with high quality and patient satisfaction, said Steven Shapiro, M.D., orthopedic surgeon and hospital chief of staff. Beyond earning the top award as a Distinguished Hospital for Clinical Excellence, Carondelet reported that St. Marys received highest ve-star ratings for its care of heart attacks, heart failure, stroke, pneumonia, sepsis and respiratory failure, Carondelet reported. The hospital also achieved HealthGrades Critical Care Excellence Award, placing it among the top 10 percent of hospitals nationwide for critical care. Ive been fortunate to work at St. Marys for the past 28 years as a cardiologist, said John Boulet, M.D.It has been rewarding to see the hospital grow into a true center of excellence. I enjoy working in a hospital that constantly strives to improve patient care. In cardiology, our nurses, technical staff, administrators and physicians have all pushed the envelope to assure better outcomes for our patients with heart attacks and heart failure, and it is an honor to be recognized for those efforts. Carondelet also reported that the hospital is undergoing a $1.75 million exterior renovation, expected to be completed in June and funded by the Centurions, a long-standing local civic and fund raising organization that supports the continuing mission of Carondelet Health Network.

Looking upway up
Astronomy has long been one of Sombrero columnist Dr. Mike Smiths passions. He notes that on May 20, an annular (ring) eclipse of the sun will be visible from the Grand Canyon, points northwest (Bryce and Zion), and southeast (path goes through Albuquerque and Lubbock). These must be viewed with solar lters, he said, but those are easy to obtain, and the large black disk of the moon in the middle of the sun and obscuring 90 percent of it is a stunning view, especially from the Grand Canyon. On June 5, late afternoon viewing of the exceedingly rare transit of Venus across the disk of the sun takes place. The next one wont be until December 2117, so come see a ltered viewso you dont fry your retinaeof Venus in front of the sun, Dr. Smith said. The three-dimensionality of the view is remarkable, and the transit will be visible until sunset. PCMS plans to host a Venus viewing party on the afternoon of June 5 so watch for details and plan on stopping by.
8

Ira Byock, M.D. on care transformation

Ira Byock, M.D., author of the new book, The Best Care PossibleA Physicians Quest to Transform Care Through the End of Life,
SOMBRERO April 2012

will be in Tucson in November for events, including a dinner lecture for physicians and spouses at the Arizona Inn. The evening is presented by Casa de la Luz Foundation. Dr. Byocks speech topic has not been given, but his book addresses the sorry state of dying in America and argues we must move past politics and our aversion as a society to acknowledge the fact of mortality so we can live emotionally authentic, healthier, more joyful lives. Sombrero will carry details as they are announced, but if you would like to learn more, and get the event on your calendar, you may call 544.9890 and ask for Carol Clark.

PCMS continues Walk With a Doc

Creating value in Physician practices since 1987

Pima County Medical Society, along with Carondelet Health Network and El Rio Health Centers, is in the national organization Just Walk/Walk With A Doc, and started programs for patients to walk with a physician this year. PCMS, CHN and El Rio each host one walk on three different Saturdays every month through May, and probably will throughout the summer and into fall. Each walk is led by a physician who will give a brief overview of the benets of exercise, and answer general questions during the walk. You can send your patients to any of the walks. Sample prescription pads were sent in our newsletter. Walks are open to anyone, and courses are generally at with some small hills. Advise patients to wear comfortableshoes. They may bring a cane or walking stick, and a bottle of water. Patients should be advised that a monthly walk should not be their only physical activity, but we want them to gain condence and a safe place to start walking. Walk schedules are posted at www.pimamedicalsociety.org. PCMS walks continue April 14, May 12, and June 9. Please arrive between 6:30 and 6:50 a.m. Walks will begin at 7 a.m. For any questions, please call 795.7985. The website is www.walkwithadoc.org.

PCMS 2012 meetings

The ArMA Annual Meeting (delegates only) is June 1-2. Our coming Regular Membership Meetings are Tuesday Nov. 8, 7 p.m. including reading of the nominees slate, and Tuesday Dec. 11 after the Board of Directors meets, for ballot count and declaration of election winners. Coming PCMS Board of Directors and Executive Committee (ofcers only) meetings are: BOARD: EXECS: Tues. April 24, 6:30 p.m. Tues. April 24, 5:30 p.m. Tues. May 22, 6:30 p.m. Tues. May 22 5:30 pm (Memorial Day May 30) Tues. June 26, 5:30 p.m. Tues. Aug. 28, 6:30 p.m. Tues. Aug. 28, 5:30 p.m. Mon. Sept. 24, 6:30 p.m. Mon. Sept. 24, 5:30 p.m. (Yom Kippur starts Sept. 25) Tues. Oct. 23, 6:30 p.m. Tues. Oct. 23, 5:30 p.m. Tues. Nov. 13, 5:30 p.m. Tues. Dec. 11, 6:30 p.m. Tues. Dec. 11, 5:30 p.m.
SOMBRERO April 2012

Pima County Medical Foundation Evening Speaker Series

Pima County Medical Foundations Evening Speaker Series is on the second Tuesdays in February, March, April, May, June, September, October, and November, often including CME. Dinner is at 6:30 p.m., speakers presentation at 7. Coming topics include: April 10: Bruce Parks, M.D., retired Pima County medical examiner, presents a forensic pathology lecture in honor of the late Dr. Richard Froede. May 8: Cocci specialist Dr. John Galgiani. June 12: Medical liability and tort reform, speaker TBD. May 8 will also be presentation of the Foundation Awards, honoring physicians who have made exemplary efforts in furthering medical education. Recipients are Dr. James Corrigan, rst pediatric hematolgist at the University of Arizona College of Medicine, former dean at Tulane University School of Medicine, and 1988 PCMS president; Dr. Brendan Phibbs, professor of clinical medicine at the UofA College of Medicine and for more than 30 years cardiology chief at Kino Community Hospital, now University of Arizona Medical CenterSouth Campus; and Dr. Vincent Fulginiti, founding chairman of the Department of Pediatrics at the UofA College of Medicine, who preceded Dr. Corrigan as dean at Tulane, and was later vice-president for health sciences at the University of Colorado.

February monthly report

Referrals to physicians: 104. Meeting rooms occupied: 24.3 percent (8 a.m.-10 p.m., seven days per week) Executive Committee: PCMS President Alan Rogers MD presided Feb . 15, 5:43-6:50 p.m. The execs examined plans for 2012, year-end nancials from 2011, and in general got to know one another. The PCMS ofcers looked at the Citizens United Supreme Court case, which has made clear that non-prots can be far more political than in the past, but decided for the upcoming election to retain current policies about not endorsing candidates. Board of Directors: The board did not meet in February. This was an attempt to try having fewer board meetings. The Board of Mediation, Chairman Edward Schwager MD, did not meet in January. Public Health Committee: Abraham Byrd MD presided Feb. 6, 12:30 -1:25 p.m. Committee members considered an Exercise is Medicine resolution and decided to forward it to the board as a good idea. A bill to allow bicyclists older than 16 to treat stop signs as yield signs has been introduced. More information will be gathered. Stats on physician health will be gathered to see if a campaign for colleagues to watch out for colleagues is warranted. The December Health Surveillance document from the county health department was studied. The Bioethics Committee, Chairman David Jaskar MD, did not meet in February. The History Committee, Chairman James Klein MD, met Feb. 14. No more details were available at press time. Pima County Medical Foundation, Inc.: President James Klein MD. The foundation met Feb. 21. It presented the Evening Speaker Series Feb. 14, featuring Dr. Abraham Rudy Byrd speaking on Statehood Day about medicine in Arizona prior to 1912. The next Regular Membership Meeting will be Nov. 13. Odds & Ends: Leslie Willingham MD led PCMSs rst Walk With a Doc session Feb. 11. She took 16 people on a mile course along the Rillito River. Candidates for state and county ofce have met with PCMS to nd out the issues that concern physicians. PCMS participated in a day-long retreat to consider a future for Activate Tucson, a grouping of groups committed to making Tucson a place where good nutrition and physical activity are the norm, not the exception. Executive Director Steve Nash taught pre-meds about law and regulation in medicine. He said, Fifty minutes isnt long enough. PCMS participated in board meetings with PCAP and HINAz in February, and continued its long-standing work with Paula Maas, D.O. and her USHIN project.
SOMBRERO April 2012

10

memBeRsHIp

Western Neurosurgerys vision in practice

By Stuart Faxon
Were they visionaries? They said so three years ago. And no one would argue that a signicant medical and community enterprise is accomplished without a solid vision of the future. At the April 2009 grand opening of Carondelet Neurological Institute on the St. Josephs Hospital campus, Western Neurosurgerys visionary team said CNI represented a new era in neurosciences and that it will be overseen and staffed by a team of highly qualied neurosurgeons, neurologists, neuro-specialists, nurses, technicians, therapists and support personnel who adhere to the highest clinical standards. We are committed to treating the patients and physicians we serve with the utmost respect, concern and care. As we continue to advance through the years ahead, we will remain rmly focused on our mission to meet the needs of the people of Southern Arizona and beyond. With 10 specialist physicians then and a dozen now, Western Neurosurgery, Ltd. is an afliated partner of CNI, but the practice goes back to 1980 and its founding by Robert P. Goldfarb, M.D., F.A.C.S., F.A.A.N.S, managing partner, group president, and since 2009 CNI chairman. The Phoenix native has been practicing for 43 years. His wife, Lesley, is a community volunteer and serves on several organizations boards. The couple has two daughters, one of whom is vice-president for programming and strategy for cable TVs Discovery Channel, and the other an insurance broker in Chicago. For a number of years, Dr. Goldfarb said, I and a number of my partners were attempting to interest several hospital administrators about the neurosurgical and neurological needs in the community. Many patients were being sent to Phoenix, Flagstaff, and Santa Fe because no Tucson hospital had 24-7 neurosurgical and neurological coverage other than the trauma center. We were trying to overcome the gap. With 1.2 million people in Southern Arizona there was no need to be sending people out of town. Carondelet understood the need, and we assisted them in development of the center. We moved our ofce and our practice to this campus, where we are able to offer outpatient and inpatient service on one campus. Western had been near PCMS at Rosemont and Farness in Tucson Medical Park, where TMCs sleep lab is now. The eld has been around for many years, but in the last few years our technology has allowed us to do many things with navigational devicesthey act like a GPS to the brainso that at any given instant the neurosurgeon has sub-millimeter accuracy during surgery. He cited the impact of CT and MRI scans for conditions of the brain and spinal cord. Computers have made a big difference in neurosurgery. This means we can enhance our ability to remove brain tumors and aneurysms of the brain, Dr. Goldfarb said. It enhances our ability to do complex spine surgery. The operating microscope was
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Dr. Matt P. Wilson, who specializes in spine and brain surgery, does a leg stretch test as part of a back exam on a patient. He also specializes in stereotactic radiosurgery, a form of tumor therapy focusing powerful X-ray beams of radiation using sub-millimeter precision. We have one of the newest machines for this at St. Josephs, Dr. Robert Goldfarb said. (Carondelet photo by Tom Spitz).

a big addition; it allowed us to see and operate on microscopic structures. He noted that in the 1970s, he helped to bring the rst CT scanner to a local hospital, Tucson Medical Center. EMI made it; they were big in the scanner business, he said. He also helped to bring the rst brain navigation device to TMC in late 1980. (EMIs familiarity to many Americans is because it owned Parlophone Records in England and later Capitol Records here, which manufactured and distributed the Beatles records.) Weve been very busy, Dr. Goldfarb said. The center has continued to grow, and weve expanded programs with sub-specialists. CNI has 54 beds, 12 of which are a neurological care unit, the only one in Southern Arizona, he said The medical director, Dr. Adaeze Onuoha, has fellowship training in neurocritical care neurology. Western/CNIs Southern Arizona innovations include the rst CT scanner in an OR, integration with the latest technology, and the rst hospital in North America to collaborate with Brain Lab and Siemens to fully integrate CT navigation in the OR, Dr. Goldfarb said. He added that CNI has a Joint Commission-certied stroke center and brain and spine tumor center, referring to the federal Joint Commission on Accreditation of Health Care Organizations, formerly JACO, begun in 1951 as the Joint Commission on Accreditation of Hospitals and now known just as the Joint Commission. We are the rst private hospital in Tucson to have received that status, Dr. Goldfarb said. Dr. Goldfarb graduated from Tulane University School of Medicine in 1962 and interned at Michael Reese Hospital and Medical Center in Chicago. He did his GS residency at PresbyterianSt. Lukes Hospital and neurology residency at University of Illinois
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Dr. Diana V. Benenati, neurologist who specializes in neuromuscular disorders (and is a PCMS Board of Directors member), does part of an EMG to test a patients nerve conduction time (Carondelet photo by Tom Spitz).

Dr. Goldfarb calls Westerns physicians super-specialists. They are: Neurosurgery Hillel Z. Baldwin, M.D., minimally invasive spine and skull base surgery. Joseph A. Christiano, Jr., M.D., Parkinsons and other movement disorders surgery, chronic pain, brain and spine surgery. Robert P. Goldfarb, M.D., F.A.C.S., consultant in neurology. Eric P. Sipos, M.D., spine and brain surgery, stereotactic radiosurgery. Matt P. Wilson, M.D., spine and brain surgery. Neurology Diana V. Benenati, M.D., neuromuscular disorders, including EMG and general neurology. Hemant S. Kudrimoti, M.D., Ph.D., electrophysiology, epilepsy and general neurology. William B. Lujan, M.D., general neurology and EMG. Cynthia S. Reed, M.D., fellowship-trained movement disorders specialist including Parkinsons, general neurology.

Research Hospitals, both in Chicago. Starting in 2002 he served on the Arizona Medical Board and chaired it in 2006. Physicians are led to specialties by diverse paths. Dr. Goldfarb, who will turn 76 this year, said that during his internship, I became interested in neurosurgery during my rst service in the emergency room. We saw a lot of brain trauma and tumors. Trying to understand now the nervous system works is really a challenge.

David R. Siegel, M.D., general neurology, EMG (PCMS pastpresident). L. Rod Anderson, M.D., fellowship-trained stroke neurologist, vascular and general neurology. Adaeze A. Onuoha, M.D., neuro-intensivist.

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tIme capsULe

For the longest time up until the 20 century, Dr. Byrd said, infectious diseases and epidemics were what killed the most people. In the time of Montezuma II, the Aztecs were more advanced than By Stuart Faxon were Europeans in medicinal plants and herbs, as reported back to Happy 100th Birthday to Arizona said Pima County Medical Spain by Cortez. They treated fevers, arthritis, and all manner of Foundation Feb. 14, for as we all know, Arizona statehood began ailments. By nature of what we know about their human sacrices, on Valentines Day 1912. It was a long slog to get there, as Dr. Jim they had signicant knowledge about anatomy. Klein, PCMF president, notes below. In 1519-21, Cortez brought the humoral theory of medicine Nineteen-twelve medicine was not what we would want to dispense when he conquered Mexico. Humoral theory was universally acto patients today. But in a CME presentation, Tucson native and histocepted in Europe, Dr. Byrd said, and in most of the West, and rian Dr. Abraham Rudell Rudy Byrd III, surgeon-general of the Nagoes back as least as far as Hippocrates. tional Society, Sons of the American Revolution, explained the connecIndeed, humoral theory was one of the central principles in Westtions that make Southern Arizona medicine what is was and is. ern medicine through the 19th century. Humoral comes from A wry Dr. Byrd noted that medicine before statehood consists humor, which in this context means uid. The human body was of a mere 12,000 years of human history in Arizona, so all we need thought to contain a mix of the four humors: black bile (also known do is summarize from Paleolithic man to the earliest inhabitants of as melancholy), yellow or red bile, blood, and phlegm. Each individthe Santa Cruz Valley! Nevertheless, this area is the longest continual was supposed to have a particular humoral makeup or constituually human-inhabited place in the U.S., and fossilized feces from tion, and health was dened as the proper humoral balance for that around 1000 B.C. reveal pollen and plant parts including creosote individual. An imbalance of the humors resulted in disease. [1] The bush and ephedra (Mormon tea). These things were not good humors were also used to refer to four individual psychological temor tasty to eat, Dr. Byrd said, so probably they were eaten for meperaments: melancholic, sanguine, choleric, and phlegmatic. This dicinal purposes. Contrary to what we might presume about reects the humoral concept that physical health and individual persemi-arid deserts compared to water-rich places, this areas deserts sonality were part of the same whole. [2] and mountains were rich in ethno-botany. Development of humoral theory is associated originally with Hippocrates (circa 460370 BCE). In the second century CE, Galen elaborated on this theory, which was further developed by Arabic writers beginning in the 9th century and by European writers beginning in the 11th century. [3] While the Spanish were brutal, they were very interested in medicinal use of plants, Dr. Byrd said. They avidly sought to learn about things that had to do with the plants and herbs of New Spain, and they would seek out native medicine men. Francisco Hernandez, court surgeon to Philip II, wrote a treatise on herbal medicine, and he wrote in Nahuatl, the Aztec language. The Spanish Crown suppressed it as subversive, but Simines put out a copied version We are preferred providers in the early 1600s. Many of the physicians who on most insurance plans. eventually came to this area were those kinds of Helping you hear your best physiciansscientists who learned the language of the natives and wrote in it. Janis Wolfe Gasch, Au.D. We appreciate your referrals! Unfortunately, but naturally, Western mans Doctor of Audiology, Founding Director diseases came with the Spanish occupation, 7574 N La Cholla Blvd 6969 E Sunrise Dr, #203 512 E Whitehouse Canyon Rd, #196 and the 16th century had epidemics of smallTucson, AZ 85741 Tucson, AZ 85750 Green Valley, AZ 85614 pox and measles. Dr. Byrd noted that by the 18th 520.742.2845 520.742.2845 520.648.3277 century, smallpox and measles were still deadly www.arizonahearing.com here. Humoral theory started to break down by the late 18th century, but purging, bleeding, or cathartics such as castor oil and jalapenos
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were still used. George Washington was probably bled to death as well as purged. It was only in the 19th century that scientic knowledge ultimately prevailed over humoral theory. Even so, Dry Byrd noted, bleeding was still mentioned as acceptable treatment in some instances in Sir William Oslers book on principles and practices of medicine in 1923. In the presidio period in Tucson, the nearest doctor was still in Sonora. The only antibiotic was quinine, and it was used for everything. Mexico was unable to maintain the presidio system, but in Tucson 150 years ago we still had a cholera epidemic that killed 1,000 people in the Altar Valley and 25 percent of the people in Tucson. By the 1800s medical colleges were being founded. But in 1836, one John Marsh in California claimed to be a doctor, gave Harvard credentials in Latin, and got away with it because no one around could read Latin. He did have a Harvard B.A., but he only intended to study medicine! With the Gadsden Purchase in 1854, this area became part of the United States. The rst physicians here were likely military surgeons under army contract. In the Civil War,

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both the Federal and Confederate governments tried to care for their soldiers, but really it was almost no medical care compared to later, and woefully inadequate by modern standards. When a .58 caliber Minie ball shattered bone, the resulting amputations had a 25 percent mortality rate in the rst 24 hours, 50 percent in two days, and higher later. Everyone was infected and no one had antibiotics. They had ether and chloroform, so it was not that they did not have anestheticsthey simply ran out. Two-thirds died of disease, which was a far lower mortality rate than in previous times, including the Mexican-American War. Cleanliness habits started in the Civil War are still in use today. In the post-Civil War period in Territorial Tucson we had the hot-tempered physician John Handy, who was killed in a street ght with the lawyer who represented his wife in a divorce. But he demanded actual credentialing of doctors by other physicians in the community, Dr. Byrd said. Walter Reed served here, later famed for nding mosquito transmission of yellow fever and malaria. Some of our members are aware of George Goodfellow, who became the gunshot wound expert of his day thanks to the frequent opportunities offered in Tombstone. John Henry Doc Holliday may be our most famous example of climate-based survival. The consumptive Georgia dentist came here and lived 15 more years as a gambler and gunghter. Politicians, businessmen, and quacks promoted Arizona as a cure for pulmonary ailments, but it was valid that the dry and cleaner climate was salutary for asthma, arthritis, and TB, Dr. Byrd said. In the march to today, the Arizona Medical Association was founded in 1892, and in 1897 Arizona began registration of doctors, but did little checking on authenticity. By 1902, doctors had to pass an exam. Southern Arizona physicians today, Dr. Byrd said, are inheritors of an ancient tradition of healers who found in the natural world around them means of relieving pain and suffering.
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1863: The Arizona Organic Act, making Arizona a territory separate from New Mexico, was signed by President Abraham Lincoln on Feb. 24. 1891: A constitutional convention met in Phoenix in 1891 to draft a constitution that would be submitted to the voters of the territory and, once gaining approval, would be sent to the U.S. Congress along with a petition for statehood. Arizona voters approved the resultant constitution in December and it was transmitted to Washington, D.C. 1892: The proposed Arizona statehood constitution was apSOMBRERO April 2012

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proved by the House of Representatives, but died in a Senate committee. A principal reason for disavowal was that the proposed constitution called for free coinage of silver as legal tender, and thus it ran afoul of those supporting gold as legal tender. 1902-06: Largely because Arizona voted Democratic and New Mexico voted the R epublican ticket, national Republicans, including President Theodore Roosevelt and Republicans in the U.S. Senate, advocated joint statehood for Arizona and New Mexico, meaning admission as one state, with the capital in Santa Fe. By congressional action, the question of jointure was submitted to the voters of Arizona and New Mexico, with the provision that if either rejected jointure, the issue would fail. In the November 1906 referendum, New Mexico approved jointure, but Arizona rejected it. 1910: A statehood Enabling Act, providing for separate admission for Arizona and New Mexico, was signed by President William Howard Taft on June 20. In accordance with the act, a constitutional convention convened in Phoenix on Oct. 10, and completed its work on Dec. 9. In spite of President Tafts known sentiment against recall of judges, a provision for judicial recall was included in the document. 1911: On Feb. 9, Arizona voters approved the new constitu-tion by a margin of more than three to one. Congress approved the statehood constitution, but President Taft vetoed the statehood bill on Aug. 15, citing the provision for recall of judges in his veto message. On Aug. 21, President Taft signed the Flood-Smith Resolution, which promised statehood for Arizona provided that the voters removed the judicial recall provision from its constitution. On Dec. 12, Arizona voters removed judicial recall from the constitution and also elected ofcials for the new state. 1912: The ofcial canvass of votes was not competed until near the end of January, after which time the necessary certication was sent to President Taft. He signed the statehood proclamation document on Feb. 14 at 10:02 A.M. Washington, D.C. time. Arizona became the 48th state. (New Mexico was admitted as the 47th state on Jan. 6 because President Taft approved its constitution without seeking amendment.) President Taft did not sign the proclamation on Feb. 12, L incolns birthday, because it was a federal holiday. He did not sign it on Feb. 13 because he was afraid some might deem the date u nlucky!

Tucson Mayor Jonathan Rothschild and Ron Barber of Rep. Gabby Giffords ofce display the 48-star ag.

Hal Tretbar, M.D. and Barry Friedman, M.D. Jewish History Museum board chairman, proudly show this important piece of Tucson history.

Tucson celebrates statehood

By Dr. Hal Tretbar
In his presentation for the opening ceremonies of the Tucson Arizona Centennial Celebration on Friday Feb. 10, Mayor Jonathan Rothschild noted that physician I. E. Hoffman, M.D. was mayor of Tucson (1912-1915) when Arizona became the 48th state on Feb. 14, 1912. Rothschild said that Dr. Hoffman was a progressive mayor who was credited with paving the streets of this frontier town. The original ag raised over Tucson on Statehood Day was displayed as part of the ceremonies. As Josh Brodsky recalls in his Feb. 9 article in the Arizona Daily Star, store owner Charles Gold bought this 48-star ag in anticipation of statehood. He had to wait several years before he could raise it on top of his general store downtown on Feb. 14, 1912.
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The ag remained in the family until several years ago when they donated it to the Jewish History Museum. When I talked to museum Director Eileen Warshaw at the celebration, she said the ag was in good condition considering its age. She held it closely, saying, I dont let it out of my sight. She was glad that it would not be own, but held by Girl Scouts from Troop 173 during the national anthem. After the ceremony, Warshaw brought the ag Executive Director Eileen Warshaw of the out again, and many digni- Jewish History Museum holds the original taries wanted be photo- ag that ew over Tucson on Statehood graphed with this piece of Day, Feb. 14, 1912. Tucson history. The ag will be returned to the Jewish History Museum to hang from the ceiling of the original synagogue.
SOMBRERO April 2012

Memories of the Pus Club

By Samuel H. Paplanus, M.D.
In the spring of 1959 I was nishing my two-year service at the Army Chemical Warfare Laboratories in Edgewood, Md., and I had just been accepted as a research fellow under Paul Beeson at Yale. One day I was invited to attend a meeting at Johns Hopkins of something called the Pus Club. In a small meeting room in the basement of the medical school dorm at Hopkins, I met with a dozen or so physicians from Hopkins, Yale, and Cornell who somewhat informally presented research work that was then in progress. I learned that the group had been founded a few years earlier by three physicians who were actively engaged in infectious disease research: Paul Beeson from Yale, Barry Wood from Johns Hopkins, and Walsh McDermott from Cornell. They and their research fellows would meet a couple of times a year to present and discuss work in progress. These were simpler days, and there was no fear that rivals would rush home to purloin and publish the ideas of others. The ofcial name of the group was the Interplanetary Society, probably a takeoff on the In terurban Club, a society of prominent Eastern physicians, but the more appropriate name Pus Club was the common designation. There were only three membersBeeson, Wood, and McDermottall other attendees were guests. Paul Beeson said. We dont want committees or votes. The fever investigators from Barry Woods lab, Elisha Adkins, Robert Collins, and Mary Ruth Smith, presented their work. The pyelonephritis investigators from Yale, such as Lawrence Friedman and Lucien Guze, were heard. Robert Wagner began talking about work with interferon and Allen Levy presented work on computer simulation that raised puzzled eyebrows. Bob Petersdorf talked about e. Coli, and Lee Cluff presented work on endotoxin. Even I made a couple of presentations. Soon the participant pool expanded. The infectious disease group from Rockefeller University, across the street from Cornell, (Rene Dubose, Zan Cohn, Steve Morse) presented its work. After David Rogers left McDermotts group and became chief of medicine at Vanderbilt, participants from Nashville began to come and present. Paul Beeson mumbled, Soon well have to meet at the Steel Pier. The group continued to meet once or twice a year, usually in Baltimore, New York, or New Haven. In July 1965, we traveled to Nashville for a two-day meeting. That year Beeson left Yale to become Nufeld Professor of Medicine at Oxford. At 8 p.m. on March 22, 1968, 35 of us met at JFK airport to take Pan Am ight No. 2 to London. We then traveled to Oxford. Our headquarters in Oxford was New College (actually one of the oldest of the Oxford colleges, founded in 1379) where we slept and had our meetings. After the traditional sipping of sherry, our dinner the rst night was in the great hall. It was a heady experience for a boy from the hills of Tennessee. In 1960 I left Yale for Hopkins, where I continued infectious disease research in collaboration with Ivan Bennett and Walter Sheldon. I continued to go to the Pus Club meetings until 1970, two years before I left Hopkins to come to Tucson. By that time my interests had migrated to development of information systems. The Pus Club presentations by that time had also changed. Instead of work in progress, the work presented was usually ready for publication or in press and suggestions for changes were no longer appropriate. It became a scientic/social meeting. I still remember the Pus Club as one of the most intellectually stimulating experiences of my life. Associate Member Dr. Paplanus is a PCMS Bioethics Committee member and professor of pathology at the UofA College of Medicine.

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REALITY CHECK

Giving back to the country

In the visitors center in Waldport, midway down the Oregon Coast, is a sign that reads: Federal Emergency Administration of Public Works, 1936, Project No. 982. This project was a bridge over the Alsea River, which ows into the Pacic about a mile west of the bridge. Project No. 982, the rst bridge, was replaced with a new span in 1991. Outside the visitor center is a wall covered with plaques, each with a name of volDr. Michael S. Smith unteers who helped during the period when the new bridge was built. At the top, on the right, are the names of my parents. My father showed me the plaque in 2003, his last summer there, and the only one of the 30 summers he spent alone in Oregon. For me, this is a sacred wall. I dont believe in turning back the clock to the golden days that werent so golden (equipment was less reliable, more people died in transportation accidents, Jim Crow laws, smoking and drinking were cool, and the KKK was alive and well), but I do believe in learning from history. I had hoped we would have learned from Vietnam. We didnt, for now we are discussing war with Iran, concurrent with the already impossible demand to cut government spending and not raise taxes. I have yet to hear one word from the Republican-controlled House about how we are going to do this. I believe that perhaps we can learn from ideas engendered from the Great Depression, where we put people to workhonest, hard workbuilding this countrys infrastructure. Many trails right here in Arizona were built by the Civilian Conservation Corps. Traveling the Oregon Coast by car no longer requires ferry crossings, because of the CCC. A few kilometers south of Waldport is Cape Perpetua, 300 meters above the Pacic, a lovely park built by the CCC. We need a new CCC, a requirement that every person serve this country. Every person. I had hoped in 2009 it would happen, but it didnt. We need it. America needs it. We need more to give freely, time and money, to the have-nots. During Katrina, we certainly learned how many have-nots were in one city. I dont know what embarrassed me as an American more, the lack of response to the poor in New Orleans, or our homegrown fundamentalists such as Pastor John Hagee, TV evangelist and founder of Cornerstone Church in San Antonio, Texas, who blamed the disaster on homosexuality because of the previous days gay pride parade in the city. The blame should point to how we treated the Atchafalaya River or the way the Earth remains in heat balance. They obviously didnt know about riverine piracy, and that heat balance requires tropical and extra-tropical cyclones. We need people to give freely to a variety of secular organiza20

tions here in America. We can start with infrastructure, so that interstate bridges in Oklahoma and Minnesota dont fall into rivers, and trains dont derail near Kingman because water washed out part of the rail bed. I think we need volunteers/CCC in the public schools, before, during and after school, and on weekends. We need people to help kids get outside and exercise more, as well as to teach good eating habits. That might help with obesity. We need people to actually measure some of these outcomes appropriately, the way I and some PCMS volunteers did for free, so we know what works and what doesnt. Things that dont work are helpful to know, if we learn from the mistakes. I think we need volunteers/CCC in animal shelters, teaching the next generation about care of animals, because animal cruelty by children is a huge red ag for trouble as an adult. Did I mention that leg-hold traps and cockghting used to be legal? Two more words: Michael Vick. We need people who are uent in other languages to help out in public places, be it airports, hospitals, or national parks. One of my dreams is that I will be able to do that adequately in German some day. We need volunteers/CCC to teach people to read, since a frighteningly high percentage of Americans cannot. I think citizen science should count as volunteerism: the annual Christmas Bird Count, more than 110 years old, is one example, where we have learned that the center of the range of three-fths of the species has moved 160 kilometers farther north. Those who volunteer measuring variable stars and those who work in nursing homes reading to the elderly, or just taking them outside, deserve credit. I see volunteers/CCC participants wearing large V or C pins; red, white and blue if they are a veteran, blue otherwise, for justice, since that is what the blue in our ag stands for. Volunteers would earn a star for every 1,000 hours; we would house, feed, and pay the CCC workers. What a great way to spend tax dollars, investing in people and the country simultaneously! Many young people are unclear about their future. Many never see much of America, and many have never taken orders from somebody other than a teacher or parent. Two years of national service would show many their country, teach them to give back, take orders, and learn new skills. It would be benecial. Sen. Jon Kyl (R-Ariz) wrote me and was quite clear he thought this was a bad idea. But the senator cant prevent me from wearing a red, white and blue V pin with four stars. And maybe a few people would ask why. Sombrero columnist Dr. Mike Smiths blog is http://michaelspinnersmith. com, where there are previous Reality Check columns, outdoor writing, descriptions and pictures of National Parks, Alaska hikes, eclipse-chasing, mental arithmetic, op-eds, and two non-technical neurology articles that physicians might enjoy.
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tRaVeL

Antarctica: Penguins and so much more

By Dr. George J. Makol
To experience natures majesty in the form of the Antarctic Peninsula, from which I have just returned, is to be at a loss for words. But I will try to convey the feelings. First, no one goes to Antarctica proper or to the South Pole, as it is -20 degrees centigrade in the summer, and the interior of Antarctica has no wildlife at all. About 30,000 people a year from all over the globe visit the Antarctic Peninsula. Of course since I was now convinced of imminent global warming, I only packed shorts and ip-ops. Mark Twain who famously said, The coldest winter I ever spent was a summer in San Francisco. Thats because he never spent a summer in Antarctica, though actually the weather was not bad. Our group of 199 alumni from various colleges met in Buenos Aires, Argentina. We spent three days there trying not to get our pockets picked and enjoying the beautiful parks and the incredible architecture of this European-like city.
On one of several excursions, Dr. Makol greets some of the local penguins. The white tufts adorning the brow shows that these are Gentoos, Pygoscelis papua, which are not as aggressive as some Adelies and Chinstraps. The scientic name is a bit of a mystery, as no Gentoos live within 4,000 miles of Papua or New Guinea. Gentoos are more adaptable to climate variation than Adelies or Chinstraps, breeding as far south as the frozen Antarctic Peninsula, and as far north as the temperate Falkland Islands.

We then ew to Usuaia, Argentina, in Tierra del Fuego Province, to tour the national parks and then board our ship, MV Le Boreal. This is a state-of-the-art French ship built in 2010, winning the European award for ship design that year. It is powered by diesel engines that generate electricity to run the ships motors, which are all electric and almost silent. The service and cuisine are ve-star level, and it is a smaller ship, to be able to navigate channels and bays unavailable to the larger cruise ships. Passengers on the big boats look through binoculars to see the wildlife. We disembarked in zodiac craft and practically swam with the whales, seals, and penguins. Fortunately we were issued waterproof parkas with hoods! First we had to cross the notorious Drake Passage, where the Atlantic, Pacic and Arctic Ocean currents meet. That led to our rst mishap. My wife was asleep and the boat was rocking somewhat, and I was awakened by a whistling sound. Then suddenly there was an incredibly loud bang and our room was lled with ocean spray and 30-degree air. I jumped up fearing that we were attacked by an RPG red by Somali pirates, but since they actually do wear shorts and ip-ops they would have frozen to death well before the Drake Passage. I quickly realized that the sliding glass door to our deck had disengaged its lock and the noise was from it being
22 SOMBRERO April 2012

plopped down not ve feet from me, looked up at me and then iolently ung open. In the morning we were upgraded to an even v took a nap! better cabin, with a secure veranda door. We visited Deception Island, a volcanic isle with no wildlife. It We reached the Shetland Islands off the Antarctic coast and last erupted in 1974 (no, this was not the third mishap!) All was then navigated the narrow LeMaire Channel. This put us in an inquiet, and even though I shot in color the landscape is stark black side passage such as on Alaska cruises, and protected us from wind and white, snow over volcanic rock. I got great shots from the crest and rough seas. Often this channel is iced over even in summer; we of the volcano down into the crater. were fortunate to nd it open and passable, if only by a small ship. On a beach on Walker Bay, an unhappy 500-pound fur seal Imagine volcanic black rock-surfaced islands, covered in 50 feet of tried to chase us off his beach by charging full-speed at us with his snow, towering on both sides of the boat. What about avalanche teeth showing. Our naturalist stepped in front of us, kicked sand in danger? Well, that was our second mishap. its direction, and it stopped in its tracks not ve feet away. He had There was a small avalanche 500 yards or so to our port, high us all back up slowly to the shore, and the fur seal went back to on a volcanic cliff. The captain announced that we should go look, basking in the sun. and those who did were greeted by the whole top of the mountain coming off and hitting the water, creating a huge cloud of snow and ice 60 feet high coming at the boat at about 70 mph. Almost everyone got back inside before the ship was blacked out for 45 seconds. One couple could not close the deck door soon enough and were We are Tucsons homegrown law firm providing soaked through and covered in a foot of snow legal services for Southern Arizona since 1969. and ice. They were wet and cold but OK, and We can assist with all legal needs, from Business they got an extra dessert at dinner that night! and Real Estate, to Bankruptcy, Family Law, Estates and Trusts, and Personal Injury. We were told if the weather was good, we would get seven excursions in the four days at Barry Kirschner is recognized as an AV the peninsula, but warned that the weather alPreeminent attorney by his peers for his 30 years of legal work in Tucson including as a most never allows this. However, we had sunpartner at Waterfall Economidis since 2003. ny weather all four days, with clear skies and a As a member of the firms Litigation Practice temperature of about 0 degrees centigrade. Group, Barry represents disabled persons whose The boat was a whale magnet and our fabulous claims have been denied or terminated by disability insurance carriers. Successful verdicts, French captain would stop the ship whenever settlements and administrative appeals come whales approached. I have photos of pairs of from knowing how to approach the problem Humpback whales playing around and under effectively with clear, convincing and honest the ship, rolling and frolicking as if to entermedical assessments by treating physicians. When an insurance company inappropriately tain us. This happened four or ve times. We relies on a doctor who has never seen the disembarked to Half Moon Bay, only to come patient, Barry supports the treating physician upon two more whales that surfaced many to ensure his or her opinion is not over ridden times within 15 feet of our small zodiac craft. by the insurer. Never have I seen such beautiful and majestic Barry practices law with the conviction of a man creatures up close and in the wild. who has dedicated his life to helping others. The ship passed ice oes where crab-eater Passion like that cannot be duplicated and is part of what makes Barry a preeminent lawyer. seals and leopard seals lounged in the sun and basically ignored us. At Port Charcot, named after the famed French explorer (yes, his father For more info on Barry or the firm visit: was that Charcot of Charcot Leyden crystals and the Charcot joint), we were in a zodiac craft when 50 or more seals on the hunt thundered by us like torpedoes in previously still water. We were shuttled to Yalour Island, where we were surrounded by thousand of mostly Gentoo penguins. These little guys are friendly and curious, and although we were not allowed to approach within ve meters of any animal, if you sat still and crouched down to make yourself smaller, the younger, braver Williams Centre | 8th Floor | t 520.790.5828 penguins would walk right up to us. One

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We had a total of seven excursions, and never have I seen such pristine conditions. I did not see one piece of debris in the ocean, and we left nothing but footprints in the snow on the mainland and the islands we visited. You could see 50 feet down in the clear waters. We saw Chinstrap, Gentoo, and Adelie penguins. Five of the 17 penguin species are found in Antarctica, but we did not see Emperors, the largest, or Macaronis, since they are found around the continental periphery. And the only ice I saw melting was in my Margarita at sunset, and if you stood out on the rear deck at sunset, the ice in your glass would not even melt. Oh, about that third mishapsince they always come in threes. I was seated at lunch one day next to a medical malpractice attorney! This was probably the most dangerous part of the adventure! I came upon this fabulous trip because I belong to the University of Arizona Alumni Association. They send me a brochure about every two weeks, each offering the trip of a lifetime. On this one we were accompanied by eight naturalists who supervised our excursions, and we had eight university professors from such schools as Duke, UCLA, University of Michigan, and Dartmouth who lectured on space, weather and the Southern lights, whales, penguins, and the ora and fauna we would see. On an alumni trip to Italy, art professors lectured us before we visited the Ufzi gallery and the Academy to see the David sculpture. I missed a Baltic cruise featuring Nikita Krushchevs son and Mikhail Gorbachev, the USSRs last head of state. Now thats the way to visit Russia! If you are interested, you can join the Arizona Alumni Association as an alumnus or friend of one; you have my permission to use my name even if you are a political liberal! It is just $50 a year and a real bargain if you take just one trip. They range from a recent

Looking into the volcano crater on Deception Island, which is devoid of wildlife. Snow and volcanic rock also make it devoid of color, making this color photo seem black-and-white (Dr. Makol photo).

Greek Isle cruise, with airfare, on the Oceana line starting at $1,500 per person, to a trip around the world on a private jet for $64,000. The Antarctica trip for two is about mid-range in price between these two extremes, and I understand it will be offered next year. For trip information you can contact Lisa Valentine at lisaval@ al.arizona.edu or at 520.621.5333, and check out the website: alumni.arizona.edu/alumni_travel/about. George J. Makol, M.D. practices with Alvernon Allergy and Asthma, 2902 E. Grant Rd. He has been a PCMS member since 1980.

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ConFeRences & SemInaRs

April
April 26-29: Tucson Osteopathic Medical Foundation presents the 21st Annual Southwestern Conference on Medicine, offering CME for DOs, MDs, PAs, and NPs, at JW Marriott Star Pass Resort & Spa, Tucson. CME: 26 AMA PRA Category 1 Credit; 26 AOA Category 1A; four more credit hours available with bonus workshops. Early registration: $500 for active physicians, $400 for retired physicians, NPs, and PAs. After March 31, $550 for active physicians, $450 for retired physicians, NPs, and PAs. Register online at www.tomf. org/cme, or call 520.299.4545 for more information.

allied health personnel with a cardiovascular interests. Contact: Staci King, CME Dept., Mayo Clinic Scottsdale, 13400 E. Shea Blvd.; phone 480.301.4580; fax 480.301.8323. Website: www. mayo.edu/cme

September
Sept. 15: Mayo Clinic Acute and Chronic Leukemias 2012: A Case-Based Discussion is at Mayo Clinic Education Center, 5777 E. Mayo Blvd.,Phoenix 85254; phone 480.301.4580. CME: 7.5 AMA PRA Category 1 credits. American Osteopathic Association (AOA) 7.5 hours of Category 2-A credit. American Academy of Family Physicians (AAFP) credit pending. This one-day comprehensive workshop designed for physicians, nurses, NPs and PAs presents attendees with a case-based analysis on the diagnosis, treatment, and challenging real-world scenarios with chronic myeloid leukemia, myeloproliferative neoplasms, myelodysplastic syndromes. acute myeloid leukemia, chronic lymphoid leukemia, acute lymphocytic leukemia, the role of stem cell transplant in 2012, and challenges to the nurse, NP, and physician in caring for leukemia patients. Contact: Heather Langdon, Mayo School of Continuous Professional Development, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale 85259; phone 480.301.4580; fax 480.301.8323. Website: http://www.mayo.

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

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