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.”  

Gary Ong was well prepared for physical distancing and the other restrictions that came with the COVID-19 pandemic. Since 1999, he has lived on 6 acres of land on the outskirts of Mayer, Arizona, surrounded by National Forest and ranch land. “Everyone has acreage in my neighborhood,” he says. For Ong, being isolated is a part of every day life. However, when Ong’s 94 year-old mother broke her wrist, he made the journey to Phoenix to help care for her. This is how Ong’s experience with COVID-19 began. “I was there when she was discharged from rehab, and I stayed to help her settle back into her apartment,” Ong recalls. “I took her to doctor’s appointments and helped line her up with physical therapy.” “I got a call four days after I got home. It was Mom’s caregiver saying that Mom was not breathing well and needed to go back to the hospital. They tested her for COVID, and it was positive.” Ong immediately advised some of his good friends, whom he saw after he returned home, to get tested right away. Their tests turned out negative. “For a while, I was fine, but eventually I started to feel sick, and went for testing. It came back negative. I kept getting sicker, but even the second test I got was negative,” he says. “I finally called 911 because I was feeling worse. I warned them that I might have COVID so they could be prepared. They took me to YRMC and that’s where I tested positive.” Ong spent two weeks in the ICU at Yavapai Regional Medical Center (YRMC) West in Prescott. “My oxygen levels just weren’t where they wanted them to be. I was on 15 liters of oxygen for four or five days.” Ong was told that if his oxygen levels didn’t improve, he would be put on a ventilator. He was placed in a prone position, on his stomach, to improve oxygen flow. “Thankfully my oxygen levels started to improve. I guess I was oblivious to the fact that, for a while there, I was in pretty bad shape.” Different for Everyone Five other members of Ong’s family also tested positive for the Coronavirus. They are as certain as they can be that all of the cases trace back to Ong’s mother. What is less clear is why each of the family members had such different symptoms. While Ong’s mother is in a high-risk age bracket and has an underlying heart condition, her symptoms were relatively mild and she fully recovered. Some family members had a cough, some had a fever, and one family member spent three days in the hospital with fever, diarrhea and difficulty breathing. One family member is still recovering. Ong is working on weaning himself off of supplemental oxygen. The Message Ong’s experience led him to contact Yavapai Regional Medical Center so that he could tell his story. He is hoping to help others as they navigate the often-contradictory information circulating in the news and on social media. “I want people to know that symptoms can be very different for different people, like they were for my family,” he explains. “I want them to know that a negative test result doesn’t necessarily mean you’re virus free. It took three tests before I got a positive result, even though I was already feeling sick.” “I wasn’t feeling bad, even when I was in the ICU,” Ong says. “What changed my mind? It was only one step from my bed to the bathroom. For two days in a row, I tried to walk back from the bathroom. By the time I got to the bed, just one step, it felt like someone was standing on my chest. I was told my oxygen level went to almost zero.” Reference Points “On Saturdays, I like to go to the swap meet in Prescott Valley with some friends. I’m still unable to go, but when my friends go, they wear masks now,” Ong says. “My friend told me that he’s been asked why they’re wearing masks. His answer is simple. ‘You must not know anyone who has had COVID.’” “People who don’t think it’s real have no reference point,” says Ong. “They aren’t able to put a face to the health risk.” Ong believes that once a person experiences the real-life scare of being sick, or having a loved one sick with COVID-19, their perspective may change. “Luckily, our family has come out of this well, but I hope this will give some people some insight. I hate to see it downplayed.” Ong pauses. “This virus has the potential to affect your life and the lives of the people you love.” “The numbers are there. We aren’t out of the woods yet,” says Ong. “When I’m clear to go out in public again, you can bet I’ll be wearing a mask too.”

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.

People commonly experience changes in weight when life shifts dramatically, as can happen during big events like marriage, divorce, losses of any kind, retirement, and even sheltering at home! While some individuals lose weight during stressful times, the majority of us tend to gain. If this describes you, consider trying these proven, time-tested strategies that involve slowing down at meals, mindfulness, movement and, believe it or not, really enjoying food, to prevent weight gain when your life’s daily rhythm and routine change. Slowing Down at Meals The most important strategy for anyone experiencing weight challenges is simply to slow the pace of eating anything at anytime. Scientists discovered important links between eating speed and appetite, calorie burning, satiety, and weight gain decades ago. Simply put, it takes time for your brain to register satisfaction and fullness at meals!  After all, your brain is always working hard to make sure you get enough fuel, nutrition, and pleasure from food, and if your brain thinks you haven’t met those needs — it will tell you to eat more, even when your belly feels full. If you tend to eat meals quickly, or even while distracted by other activities, your brain won’t have enough time and attention to fully register what and how much you ate. By simply slowing down when you eat, and eating without distraction, you’ll likely discover that you are satisfied with less food. Slowing the pace of meals also increases your metabolism (the number of calories you burn throughout the day), because your brain knows that you are not starving and that you don’t have to store fuel as fat to use later on. Be Mindful Mindfulness is simply paying attention to what you are experiencing in the moment. Slowing down and really enjoying your food is a form of mindfulness. Noticing when you are going to the refrigerator to relieve stress is another type of mindfulness. If you find yourself turning to food to relieve boredom (which is a kind of stress), worries, or anxiety, try putting a name to that behavior. Recognizing stress eating for what it is actually gives you more choices and control! In other words, when you act out of fear and worry, your survival brain takes charge, and that part of the brain can’t make the best long-term decisions. The survival part of your brain is only concerned about keeping you safe and alive in the moment.  However, by simply naming a behavior, like ‘I’m eating because I am worried’, you start to hand the decision making over to the more logical part of your brain, which can come up with a bigger variety of options to help you feel better!  Remember, if you do decide to eat in reaction to stress, be kind to your self and eat slowly, in a mindful and pleasurable way, as best as you can. You will likely eat less and feel more in control as a result. Move Your Body Movement of any kind is another key strategy for increasing metabolism and managing stress-related eating. Sheltering at home might mean that you are moving less, due to not working at all, working from home, or not going to the gym. Even small losses of daily movement can result in weight gain, especially as we age. If you are able, take advantage of our local green spaces, parks, and trails, where you can walk, bike, hike, play catch or throw a Frisbee while easily maintaining safe social distancing. Some gyms, including the local YMCA, are offering their members online classes, and many workout routines for every level of ability are available on line for free!  Moving your body is also a time-tested strategy that’s guaranteed to shift your focus from food if you are stressed out or bored. Enjoy Eating Lastly, don’t forget the importance of enjoying meals, because pleasure is one of your primary stress-relieving tools! If you take the time to make, eat, and truly find joy in your meals, even if you are eating some kind of ‘comfort food’, you’ll likely consume less and avoid feeling deprived – which can actually prevent weight gain! Of course, be reasonable with the frequency of your indulgences, for no amount of mindful eating will likely make up for digging into pizza and ice cream every night!