Bridget O'Gara

Have you wondered how scientific research affects real lives? Look no further than the Human Genome Project for an example of how research moved from research labs to patient clinics, like Yavapai Regional Medical Center’s (YRMC’s) Genetic Clinic in Prescott Valley.

How did this information make it into our everyday healthcare world?

Oncology Nurse Practitioner Jody Pelusi, PhD, FNP, AOCP, who oversees cancer genetic testing at YRMC’s Genetic Clinic recalls, for example, that breast cancer genetic testing used to involve only two genetic mutations: BRCA1 and BRCA2. 

“Now we know many genes exist,” said Dr. Pelusi. “Therefore, we do panel testing to look at anywhere from 30 to more than 100 genes.”

What can genetic testing at YRMC’s Genetic Clinic accomplish? The answer to that question depends on the patient’s individual needs. Genetic testing is typically pursued to:

Pinpoint actual risk for developing cancer from a hereditary mutation versus a perception of cancer risk.

Learn cancer risk based on personal or family risk factors for people found not to be at high risk for cancer based on genetic testing.

Determine the best cancer treatment options, follow-up care and long-term monitoring for people diagnosed with cancer.

Learning Your Genetic Risk for Cancer

Before genetic testing happens – typically starting with a swab of saliva from the mouth – Dr. Pelusi meets with people to discuss their goals. Her approach is part scientist, part counselor and all supportive.

“We talk about genetic testing, the information they will potentially learn and if knowing that will make a difference in how they approach their healthcare,” explained Dr. Pelusi. “Some people may come from families who didn’t discuss illness or they may be adopted and have no knowledge of their genetic history. There are many different circumstances.”

During a first appointment, Dr. Pelusi introduces cancer genetic testing by:

Reviewing the goals of cancer genetic testing.

Discussing why the person is interested in cancer genetic testing.

Developing a profile based on the family’s history of cancer, including the type of cancer and at what age the family member was diagnosed with cancer.

Outlining the pros and cons of genetic testing, including how test results can affect the people being tested as well as their family members.

“About 10 percent of people will actually be found to have a genetic change that puts them at higher risk for potentially developing a cancer,” Dr. Pelusi said. “However, this 10 percent is significant, as this can be life changing. Some individuals will come in and get the information and want to think about it before they determine if they want to undergo testing or not; this is absolutely fine.”

Your Genetic Test Results

For people whose genetic test results show they’re at higher risk for cancer, Dr. Pelusi works with their clinicians to provide valuable information on health care and lifestyle options. This may include increased health monitoring and screenings, lifestyle changes, risk-reducing surgeries and chemoprevention (using drugs, vitamins or other agents to reduce cancer risk, delay its development or help prevent recurrence).

“These are emotional topics,” Dr. Pelusi said. “This is not a time to fear cancer. But we sure can fight it with our awareness, our knowledge and our actions. I make sure people have the information they need to make a decision they’re comfortable with. I listen and respect their approach. You can’t get that in a mail order test.”

To schedule an appointment at the Genetic Clinic for a genetic evaluation and possible testing, call 928-442-8747. QCBN

By Bridget O’Gara

Bridget O’Gara is a freelance writer, communications strategist and project manager who specializes in healthcare. She works with mission-driven healthcare organizations, including hospitals, other healthcare providers and advocacy organizations.

Science and history intersected during Patient Blood Management: Yesterday, Today and Tomorrow, Yavapai Regional Medical Center’s (YRMC’s) sixth Patient Blood Management (PBM) Symposium.

Approximately 350 people – PBM advocates from across the Southwest, physicians, nurses, college students and more – gathered for the most recent PBM Symposium at Yavapai College Performing Arts Center in Prescott. Throughout the world, even more streamed the symposium live on laptops, smartphones and other devices.

“It was the best of both worlds,” said Dale Black, Patient Blood Management Program coordinator at YRMC. “Our guests at the Yavapai College Performing Arts Center joined a pre-symposium reception that included an array of appetizers, lots of friendly conversation and information from our industry partners who support YRMC’s vision for PBM.”

Industry leaders who joined YRMC at the PBM Symposium included:

Instrumentation Laboratory

Daiichi Sankyo, Inc.

Haemonetics

Baxter

“During the symposium,” said Black, “we welcomed guests from throughout the globe who live-streamed the event. All symposium participants took away new information about the value of PBM and the leadership role YRMC plays in PBM.”

If you missed the symposium, we’ve collected some highlights to get you up to speed on PBM’s science, history and future.

Patient Blood Management wasn’t built in a day.

The 6th Annual PBM Symposium coincided with YRMC’s 75th anniversary, a perfect opportunity to highlight the history of PBM, courtesy of Pierre Tibi, M.D., FACS, cardiothoracic surgeon and medical director of the James Family Heart Center at YRMC West.

Dr. Tibi said the idea of transfusing blood goes back to 1556, but the first actual human-to-human “blood transfer” happened in 1818. Fast forward to the early 1900s for another milestone: the identification of human blood types – A, B, AB and O. Soon after, a test that allowed physicians to ensure blood compatibility before transfusing patients was introduced.

Another big breakthrough coincided with World War II as researchers discovered how to break down blood into components and products. Plasma – a blood product – saved the lives of many wounded soldiers during the war.

Blood is one tough tissue.

Daniel Beck, M.D., anesthesiologist at Prescott Anesthesia, emphasized that blood – a connective tissue – actually functions like a complex, multifaceted organ.

Comprised of water, electrolytes, small molecules, proteins and cells, blood performs many significant roles in the body. For example, Dr. Beck highlighted the important job performed by one of our two types of white blood cells.

“These white blood cells repair all types of tissue damage,” said Beck. “The repairs range from paper cuts to broken bones and all of the way to heart attacks.”

When it comes to the safety of our blood supply, the expression “we don’t know what we don’t know” applies.

Medical experts in the United States agree that our blood supply is the safest it has ever been when it comes to disease transmission.

“The concern is always about unknown infectious diseases,” said YRMC’s PBM Program Data Manager and Administrative Assistant Elizabeth Black. “Current blood testing measures are only going to test for infectious diseases we know about. You can’t test for something if you don’t know it exists.”

Storing your own blood for surgery comes with some potential complications.

Storing your blood for use during and after surgery sounds like an ideal way to prevent the transfusion of a virus. However, autologous blood donation – as it’s called – may lead to anemia, which can slow recovery.

“Even your own blood is stored blood,” said Black. “It is not the same quality as the fresh blood moving through our bodies or the blood that’s taken immediately before surgery.”

Physicians and PBM experts know: If you don’t use it, you won’t lose it.

YRMC’s thriving Structural Heart Program demonstrates how medicine is integrating PBM into its less invasive procedures.

Soundos Moualla, M.D., FACC, FSCA, an interventional cardiologist at the James Family Heart Center at YRMC West, uses less-invasive procedures and advanced technologies to help people previously considered too high-risk for surgery. These procedures require small skin punctures, rather than major incisions.

“These new technologies allow us to safely perform minimally invasive procedures,” said Dr. Moualla. “The procedures do not require blood use and typically there is no blood loss.”

New procedures at YRMC’s Heart Center support PBM principles.

In the 1980s, cardiology took its first steps in this direction with the introduction of cardiac stenting, which allowed some patients to forego open heart surgery. Today, many heart procedures are minimally invasive, including these that are available at YRMC’s Heart Center.

Left Atrial Appendage Closure (WATCHMAN)

Mitral Valve Repair with MitraClip

Paravalvular Leak Closure (PVL)

Transcatheter Aortic Valve Replacement (TAVR)

Your YRMC providers are your PBM partners.

PBM is at its best when there is strong communication between nurses, patients, family members and other patient advocates. This is standard operating procedure at YRMC.

“We’ll literally report at your bedside to involve you and your family,” said YRMC’s Selina Bliss, MS, Ph.D., RN. “This allows us to clearly communicate a care plan for your anemia.”

YRMC’s multi-disciplinary team – advanced clinical practitioners, dietitians, medical laboratory professionals, nurses, pharmacists, physical therapists, physicians and more – also share their best practices for preventing patient anemia during “Lunch and Learn” programs.

Recently, YRMC’s Emergency Department team outlined how early admission of a medication to treat excessive blood loss has helped patients experiencing traumatic bleeding. The ICU staff shared a successful strategy to monitor hemoglobin counts – a low count may indicate anemia – as a way of reducing the frequency of patient blood draws, which can lead to anemia.

Researchers are applying leading-edge science to the study of blood.

Creating a blood substitute…developing a universal blood type…transforming human stem cells into units of blood…all of these and more are under research today.

“Scientists are looking for the optimal artificial human blood that can carry oxygen to our tissues without any of the biological baggage associated with a unit of blood,” explained AGACNP-BC Hospitalist and NAZ Hospitalist Jared Head.

PBM’s future is now.

Even as researchers race toward an array of alternatives to blood transfusions, most medical experts point to PBM as the most effective way to safely care for patients.

“What we are doing now may well be the future,” stated Head. “Keeping blood inside of the body and minimizing the number of blood draws to harness anemia – these and other PBM strategies may be the future of transfusion medicine.”

PBM is making a difference at YRMC today.

YRMC has experienced an impressive reduction in the use of blood products, thanks to its hospital-wide PBM Program.

“YRMC launched its PBM Program in 2012,” said Diane Drexler, RN, BSN, MBA, FACHE, Chief Nursing Officer at YRMC. “Since then, our use of red blood cells and fresh frozen plasma has declined by 32 percent and 61 percent, respectively.”

Why is this decline good news for YRMC’s patients? It means YRMC’s surgeons and other physicians are minimizing patients’ blood loss and reducing unnecessary transfusions. And, as studies have shown, both of these PBM strategies can improve patient outcomes and speed recovery. QCBN

By Bridget O’Gara

For more information about YRMC’s Patient Blood Management Program, visit YRMC.org.

Bridget O’Gara is a freelance writer, communications strategist and project manager who specializes in health care. She works with mission-driven healthcare organizations, including hospitals, other healthcare providers and advocacy organizations.

John Spitalieri, D.O., believes in “repairing before replacing.” His parents – his mother a music teacher and his father a math/science teacher – impressed this value on him while growing up in New Jersey. 

“Whether we were fixing the car or repairing the lawnmower, it was my job and my brother’s job to help our dad,” said Dr. Spitalieri. “We would hold the light so he could see what he was working on or he would have us fetch a tool for him.” 

Fast forward to 2018 and the Yavapai Regional Medical Center (YRMC) PhysicianCare neurosurgeon is passing along this life lesson to the next generation as he works with his nine-year-old son on building projects. 

“When I’m fixing or building something, I limit myself to the tools I have,” he explained. 

“If I get stuck, I have to figure it out with the tools I have available.” 

Spitalieri’s tools are from his father – who worked at Yankee Tool for a time – made by Spitalieri in his workshop or found at antique shops. Instead of using a power sander, for example, Spitalieri has a pre-World War I block plane to smooth the surfaces of edges he plans to join together. 

A Neurosurgeon is Born 

Spitalieri’s career choice was influenced by several people, including his father and, later on, Neurosurgeon Martin Swiecicki, M.D.  

“I decided to become a neurosurgeon quite late in life. I was seven years old,” Spitalieri said with a smile. “My mentor, Dr. Marty Swiecicki, told me he made up his mind when he was five.”  

Dr. Spitalieri first was exposed to the workings of the brain and spine while perusing one of his father’s college anatomy textbooks. 

“Shortly after that, I started telling people I was going to be a brain surgeon,” he said. “I’m not really sure I knew what that meant at that age, but it sounded pretty cool.” 

Even cooler is that Spitalieri realized his childhood dream. He graduated from Philadelphia College of Osteopathic Medicine and then pursued a neurosurgery residency at Arrowhead Regional Medical Center (ARMC) in Colton, California. The San Bernardino County hospital, ARMC, has the second busiest emergency department in California, with a heliport that easily holds five medical helicopters. 

After his residency, Spitalieri pursued a fellowship in neurosurgery at Cooper Hospital in Camden, New Jersey, followed by a Pediatric Spine Surgery fellowship at Shriners Hospital in Philadelphia.  

Prescott Calls  

After living in large, urban areas, Spitalieri, and his wife, Donna – a labor and delivery nurse and nurse midwife – decided they wanted to live in less populated communities. The couple learned about the Quad Cities through Kiplinger’s Magazine, which touted the area’s four mild seasons and diverse activities ranging from the arts to the outdoors. 

“We love it here. The people are friendly and we always find something to do.”  

New Spine Treatments 

At YRMC PhysicianCare’s Spine Center in Prescott, people with herniated discs, subdural hematomas (bruises on the brain), spinal trauma, spinal compression fractures and more turn to Spitalieri for care. 

“Compression fractures are very painful,” said Spitalieri. “They’re no less painful than breaking your arm. But when you break your arm, you go to the ER within a day or two, where you get a cast and then perhaps have surgery. With compression fractures of the spine, it usually takes weeks before they’re appropriately diagnosed. People tend to think, ‘I just threw my back out.’”  

Spitalieri repairs these spinal fractures with a procedure called kyphoplasty. He uses a hollow needle to insert a balloon into the fractured bone and then creates a cavity or space. After the balloon is removed, a medical-grade cement is injected into the cavity to stabilize the fracture. 

While the tools he uses to treat patients are state-of-the-art, Spitalieri’s strong work ethic and problem-solving skills are the same as when he worked alongside his father in the family’s garage in New Jersey.  

“Those are good, strong memories for me.” 

And now, the Spitalieri family is building memories in the Quad Cities. QCBN

 

By Bridget O’Gara   

Bridget O’Gara is a freelance writer, communications strategist and project manager who specializes in health care. She works with mission-driven healthcare organizations, including hospitals, other healthcare providers and advocacy organizations. 

 

For more information about the Spine Center, visit YRMC’s website at YRMC.org and click on “Medical Services.” 

 

Dr. Spitalieri may be reached at the Spine Center, 1001 Division Street in Prescott, at (928) 445-4818.  

 

 

 

The Vein Center at Yavapai Regional Medical Center (YRMC) is the first provider in Northern Arizona to offer VenaSeal ablation therapy to treat varicose veins, spider veins and other symptoms of the vein disease, chronic venous insufficiency (CVI). 

“Patients are very happy with VenaSeal ablation therapy,” said Anil Kumar, M.D., FAAC, RPVI, medical director of the Vein Center at YRMC in Prescott Valley. “This new therapy does not require multiple injections to numb their legs, which can be painful or uncomfortable for people. Also, after VenaSeal ablation therapy, most people do not need to wear compression stockings.” 

CVI occurs when the valves in the veins of the lower leg no longer function properly. This makes blood flow backward, which leads to enlarged or varicose veins as well as other painful symptoms. 

“Chronic venous insufficiency can result in lifestyle-limiting lower leg pain, swelling, skin damage and ulcerations,” said Dr. Kumar. “It’s a serious condition that affects many people in our community.” 

During VenaSeal ablation therapy, Dr. Kumar places a small amount of VenaSeal – a medical adhesive – into the vein through a narrow catheter. Once VenaSeal closes the vein, blood is immediately re-routed through other healthy veins in the leg. 

“The procedure takes approximately one hour from the time the patient arrives at the Vein Center,” Dr. Kumar said. “Immediately following VenaSeal ablation therapy, the patient is ready to resume normal activities.” 

Depending on the extent of the CVI, the patient may need to undergo VenaSeal ablation therapy a number of times. 

“The good news is that VenaSeal ablation therapy works,” said Kumar, “and the patient is comfortable during and following the procedure.” 

For more information about VenaSeal ablation therapy, talk to your health care provider or contact the Vein Center at YRMC at 928-759-5890. The Vein Center at YRMC is located in the YRMC Del E. Webb Outpatient Building at 3262 N. Windsong Drive in Prescott Valley. QCBN 

 

By Bridget O’Gara 

Suggested Cutline: Anil Kumar, M.D., FACCP, RPVI, medical director of YRMC’s Vein Center 

 

 

Mark your calendars for a weekend of fitness, food and fun on Friday, March 2 and Saturday, March 3, courtesy of Yavapai Regional Medical Center (YRMC) in partnership with the Northern Arizona Suns and the Prescott Valley Event Center.

“We were delighted when the Prescott Valley Event Center approached us about holding YRMC’s Celebrate Life Health Expo 2018 – our community’s premier health festival – at the event center,” said Ken Boush, YRMC director of marketing and communications. “It was an easy choice because of our strong relationship with the folks at the Prescott Valley Event Center and the Northern Arizona Suns. It’s good for the community, too, since 2018 is YRMC’s 75^th anniversary.”

Join people from throughout the community:

7 p.m., Friday, March 2

Cheer for the Northern Arizona Suns as they take on the Memphis Hustle at the Prescott Valley Event Center. The NAZ Suns will salute YRMC for its 75 years of service during the game, which is designated as YRMC 75^th Anniversary Night. The Boys and Girls Club of Central Arizona (bgccaz.org) – the game’s designated local non-profit organization – also will be featured the same evening. Purchase game tickets at northernarizona.gleague.nba.com/schedule.

 

9 a.m.-1 p.m., Saturday, March 3

Explore these Celebrate Life Health Expo “neighborhoods” for fun activities, healthy living tips and tasty (and healthy) snacks.

• Kids and families
• Heart health
• Healthy living and wellness
• Nutrition
• Volunteer opportunities
• Community resources

Nearly 70 organizations will participate in the free Celebrate Life Health Expo 2018.

Watch the NAZ Suns Scrimmage; Help Your Community

On March 3, Expo guests will also get an inside look at professional basketball as the Northern Arizona Suns scrimmage at 11 a.m., during Celebrate Life Health Expo 2018.

“This year, we’re asking Expo guests to bring items to help out local non-profits doing great work in the community: Prescott Area Shelter Services (PASS), Prescott Valley Food Bank and Prescott Community Cupboard,” Boush said. “PASS is in need of household items and toiletries while the food banks need non-perishable food items.”

Below is a list of items you can choose from to bring to the Expo. It’s a good opportunity to help your neighbors in need:

Household Supply Drive for PASS

• Trash bags
• Toilet paper
• Paper towels
• Coffee
• Laundry detergent
• Dishwasher detergent
• Cleaning supplies

Food Drive for Prescott Valley Food Bank and Prescott Community Cupboard

• Canned meats, beans, nut butters
• Canned fruit 100 percent juice and unsweetened, dried fruit
• Canned vegetables, low sodium/no salt
• Boxed/flaked potatoes (no additives)
• Soups, stews
• Canned or boxed pastas and sauces
• Cereal cold/hot
• Shelf stable milk or rice milk, nut milks

Look for more information about YRMC’s Celebrate Life Health Expo 2018 at YRMC HealthConnect (yrmchealthconnect.org) or call 928-771-5738. QCBN

 

By Bridget O’Gara