If you are confused about the conflicting advice on breast screening (mammography) guidelines, you’re not alone. Women are asking: What’s the best age to begin breast screening? How often should I have breast screening? Is there a time that I’ll no longer need breast screening? “Most physicians, including myself, the radiologists at YRMC’s BreastCare Center and the American College of Radiology, recommend annual screening mammography starting at age 40,” said Michael G. Macon, MD, Breast Surgeon and Medical Director of the BreastCare Program at Yavapai Regional Medical Center (YRMC). At what age can annual breast screenings stop? That depends on the woman, according to the experts at YRMC’s BreastCare Program. “There are many women in their mid-70s who will live 15 to 20 more years,” Dr. Macon said. “If those women are going to act on the information from the mammogram, they should continue annual breast screenings. However, different organizations have different recommendations.” A Controversial Recommendation In January 2016, the U.S. Preventive Service Task Force (USPSTF) announced dramatic changes to its breast screening guidelines. The USPSTF – an independent group of preventive and evidence-based medicine experts – recommended that breast screening begin at age 50 and end when a woman reaches age 74. The group also recommended breast screening take place every two years, as opposed to annually. The USPSTF’s recommendations are based on statistics that show more women can be saved at lesser cost when breast screening begins later in life. As women age, they are more likely to be diagnosed with breast cancer. “The USPSTF is studying millions of women and making a recommendation based on data,” said Dr. Macon. “The difference is that physicians look at one woman at a time and ask: ‘What is best for this patient?’” Members of the medical community were alarmed by the USPSTF recommendations. They pointed out that breast screening mammography beginning at age 40 has been shown to reduce deaths due to breast cancer. Additionally, while breast cancer is more common as women get older, in younger women breast cancer tends to be more aggressive. Clinicians also argued that these more aggressive cancers need to be detected when the cancer is most treatable. Breast screening annually – rather than every two years as recommended by the USPSTF – would catch cancer earlier, when cure is most likely. Online Tools Assess Your Breast Cancer Risk  Breast screening recommendations are based on women at average risk for breast cancer. How can you learn your individual risk for breast cancer? You can start with an assessment tool. The Gail Model and Tyrer-Cuzick Model Breast Cancer Risk Evaluation Tool estimate the likelihood of a woman developing breast cancer within five or 10 years of her current age and during her lifetime. Take Action to Manage Your Health “It’s difficult for an organization in and of itself to make a nuanced recommendation on breast screening that works for all women,” said Dr. Macon. “Statistically, the USPSTF recommendations may make sense as a public health recommendation, but that doesn’t give a specific woman information on how she should act.”  

When Melody Gimlin crossed the finish line at the 2019 Whiskey Row Half Marathon in Prescott, she had fulfilled a very specific personal goal. It had to do with her plan to incorporate wellness into her everyday life. Gimlin had a baby in August and was experiencing the demands of parenthood and a full-time job. “I was stressed all the time. It was overwhelming.” She decided to discuss the issue with her doctor. “He recommended taking time every day for myself – just to read a book, have coffee outside, have my husband watch the baby for a while – to work on my wellbeing. What I’ve learned is that everyone needs their own time to find their own little happiness. For me, it was running.” Voted as one of the best half marathons in Arizona, the Whiskey Row Marathon sought out by residents and tourists alike who are looking for outdoor things to do in Prescott, AZ. Gimlin works as a Medical Assistant at the Yavapai Regional Medical Center (YRMC) PhysicianCare Internal Medicine office. She arrived at the decision to run the half marathon by chance. “I entered a raffle through the Human Resources Department at YRMC and won. The prize was free registration for the Whiskey Row Half Marathon. This was a sign that I needed to actually commit to it. So I started training right away.” This first step launched Gimlin’s wellness journey. The terms ‘wellness’ and ‘wellbeing’ seem to be everywhere these days, from hotels to juice advertisements to yoga apps. But what is wellness? Why is it important? And most importantly, should we strive, like Gimlin, to be more conscious of wellness in our own lives? Experts agree that wellness includes much more than physical fitness. In his presentation entitled The Wellbeing Imperative, Global Industry Analyst Josh Bersin lists six elements of a total wellbeing program. They are safety, physical health, mental fitness, financial fitness, community building and purpose/meaning. It might seem daunting to decide how to begin, but studies show that simple steps reap big benefits. A June, 2019 study published in Scientific Reports shows that spending two hours in nature a week can improve health and well-being. The results were equal whether the subjects spent a continuous two hours or broke up the time over the course of the week. Better still, the results were consistent across groups of older adults and people who have long-term health issues. Dana Blome, Cath Lab nurse at YRMC West, joined a group of coworkers and friends this year to walk the Whiskey Row 10K. “It was a social event for me, a nice break from the norm, some fun physical activity and a chance to contribute to my community, all rolled into one event,” she says. “It made me feel more connected to my hometown and was very fulfilling.” “Working in cardiology, I see a lot of people who are sick,” says Landon Stribe, Physician Assistant at YRMC PhysicianCare Cardiology, “but it’s important to do what we can to prevent those conditions in the first place. A lot of my job is preventive medicine – teaching good habits, trying to lead by example. If my patients can see me being healthy, it has a much better foothold.” Stribe’s go-to stress reliever is mountain biking. He completed the Whiskey Off-Road Mountain Bike 30K in May, 2019. “It felt great to cross that finish line,” says Stribe. “It’s a tough race and I was very tired. You could tell by the look on everyone’s face that we all felt like we accomplished something big. And it was fun seeing YRMC staff coming together at the bike race to support this big community event. It really shows the strength of YRMC’s driving force in bettering our community.” In keeping with national trends, YRMC is on the leading edge of promoting wellness in the Quad Cities. Today’s focus in healthcare is shifting toward keeping people healthy through prevention and education. This enables people to take charge of managing their own health as much as possible, and ultimately avoiding emergency care. Wellness initiatives are offered to YRMC staff and employees as well. Financial fitness, community building and volunteer opportunities are always available. In addition, a wellness app helps employees track their activities, join contests and earn rewards for their efforts. “The YRMC MyHealth app from Virgin Pulse is a great way to bond with our coworkers, be active and relieve a bit of stress in the workplace,” says Brian DeVries, HR Manager, Employee Benefits and Wellness at YRMC. “Many of our staff and employees use it both at work and at home. So many folks report that the app enhances their work experience and helps them feel happier and healthier.” “Through the YRMC My Health app you can participate in challenges, share tips and recipes and get encouragement from your colleagues,” says Gimlin. “It’s definitely made me more aware of my health habits, and if you’re not in it alone, you’re more apt to stick with it.” Gimlin’s reflects on where her wellness journey may take her. “I try to think about the future – what I want to be like, what my level of health will be. I want to teach my kids and grandkids how to take care of themselves so that we can enjoy each other with the time we have.” This may seem like a lofty goal, but Gimlin is living proof that it starts with small steps, like completing the Whiskey Row Half Marathon. “I felt so proud of myself,” she says. “Even if I ended up in last place, I didn’t care. I just wanted to say that I did it.”

Science and history intersected during Patient Blood Management: Yesterday, Today and Tomorrow, Yavapai Regional Medical Center’s (YRMC’s) 6th Annual Patient Blood Management (PBM) Symposium. Approximately 350 people – PBM advocates from across the southwest, physicians, nurses, college students and more – gathered for the 2018 PBM Symposium at Yavapai College Performing Arts Center in Prescott. Throughout the world, even more streamed the Symposium live on laptops, smart phones and other devices. “It was the best of both worlds,” said Dale Black, Patient Blood Management Program Coordinator at YRMC. “Our guests enjoyed 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 Patient Blood Management.” Industry leaders who joined YRMC at the PBM Symposium include: 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.  #1 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, MD, 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. #2 Blood is one tough tissue. Daniel Beck, MD, 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 Dr. Beck. “The repairs range from paper cuts to broken bones and all of the way to heart attacks.” #3 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 Elizabeth Black, Data Manager and Administrative Assistant, YRMC’s PBM Program. “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.” #4 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 Elizabeth Black. “It is not the same quality as the fresh blood moving through our bodies or the blood that’s taken immediately before surgery.” #5 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, MD, FACC, FSCAI, 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.” #6 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 which are available at the James Family Heart Center at YRMC West. Left Atrial Appendage Closure (WATCHMAN) Mitral Valve Repair with MitraClip Paravalvular Leak Closure (PVL) Transcatheter Aortic Valve Replacement (TAVR) #7 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, PhD, 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. #8 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 Jared Head, AGACNP-BC, Hospitalist, NAZ Hospitalist. #9 PBM’s future is now. During the PBM Symposium, Dale Black, PBM Program Coordinator, spoke with Tucson resident Anthony Caballero about the extensive heart procedures he underwent at YRMC’s Heart Center, all using PBM principles. 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.” #10 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. For more information about YRMC’s Patient Blood Management Program, visit us here.

Did you know that early detection of lung cancer saves lives and that lung cancer screening services are available at YRMC?  To raise awareness of the vital role regular imaging plays in lung cancer survival, we invited Jennifer Harvey, Nurse Navigator, Lung Cancer Screening and Care at YRMC, onto the set at YRMC’s Your Healthy Kitchen!  Jennifer supports and guides individuals at risk for lung cancer through the screening process and offers support to those who are trying to quit smoking.  In the kitchen together, we talked about who might benefit from regular lung cancer screening, as well as strategies to help with the food and weight challenges people often face when they quit smoking.  Of course, we also made a delicious, nourishing meal, filled with flavorful ingredients that just happen to help our bodies heal and detoxify from nicotine! Lung cancer is the second leading cause of cancer-related deaths for men and women, according to the American Cancer Society.  In fact, more people die annually of lung cancer than cancer of the colon, breast and prostate combined.  While both smokers and non-smokers can develop lung cancer, the risks are much greater for past and present smokers.  Lung cancer screening is designed to catch cancer at its earliest stages, when survival is most likely, in those who are most at risk.  Join us as Jennifer explains the criteria that define high-risk individuals, talks about her role as a Nurse Navigator, and shares what inspires her at work, everyday. Recipe: Whole Grain Spanish Rice Statistics show that many people (but not all) do gain weight after smoking cessation.  However, the health risks of smoking far outweigh the downsides of weight gain — so don’t let the scale stop you from quitting!  Also, developing a healthy relationship with food, the stressors in your life, and your body can be some of the greatest gifts of smoking cessation. Simple tips that can reduce the amount of weight you might gain after saying goodbye to cigarettes include: When you eat, just eat. Taking time out for meals and snacks and eating them without distraction (i.e. no TV, work, computers, phones, etc.) will increase your sense of satisfaction and ‘fullness’ after eating, improve calorie burning, and reduce your cravings for sweets and snacks throughout the day and night. Instead of snacking on sweets or processed foods like chips or pretzels, consider creating snacks that resemble little meals. A small meal that includes fruit or vegetables, some protein (chicken, fish, meat, eggs, beans or nuts), carbohydrate (whole grain products, fruit, or beans) and healthy fat (avocado, nuts, seeds, or olive oil) will satisfy your taste buds as well as your belly and your brain.  Check out this episode of YRMC’s Your Healthy Kitchen for great snack ideas! Experiment and discover how physical activity helps you move through and reduce stress, fatigue, boredom and food cravings! It’s important to find a way to move your body that is enjoyable, not stressful.  Do you like walking in nature or around your neighborhood?  How about dancing, alone or with others?  Working in the yard or garden, going to a gym, taking gentle or vigorous exercise classes, doing yoga or Tai Chi, or even standing, stretching, and walking in place at regular intervals during the day qualifies as healthy movement that can reduce stress-related eating. Eat a larger meal in the middle of the day and a smaller meal at night. Most people burn more calories between noon and 2 pm, so it makes sense to eat more food at lunch! For other great tips on successfully navigating the challenges of smoking cessation, check out all of the resources available from the American Cancer Society and consider joining thousands of other Americans who have decided to quit on November 21st for The Great American Smokeout! Remember to also check out all of our informative videos and easy, delicious recipes at YRMC’s Your Healthy Kitchen!  Our site now includes an easy link to Your Healthy Kitchen’s YouTube Channel, where you can easily view and access our entire library!  You can access these at https://www.yrmchealthconnect.org/your-healthy-kitchen/.