Juliann Reiland, MD, FACS, a breast surgeon for the past two decades, has felt her fair share of breast cancers. To show women who ask what breast cancer feels like, Dr. Reiland, YRMC PhysicianCare Breast Surgery, carries a small, jagged, gravel rock in her pocket. Dr. Reiland carries this small rock with her to demonstrate for women what breast cancer feels like. While Dr. Reiland recommends annual screening mammograms and yearly clinical breast exams, she also advises patients to understand the usual look and feel of their own breasts, so they can report anything that feels abnormal. “The breast tissue under the skin is lumpy-bumpy stuff, similar to oatmeal or tapioca pudding,” Dr. Reiland explained. A lump that moves easily and feels smooth and round, like a pea, a grape, or even a Hot Tamale candy, is more likely to be a non-cancerous cyst or fibroadenoma. But a lump that feels like a hard rock, with jagged, irregular edges, and doesn’t move easily is more likely to be a cancer. “The stone I carry is one centimeter, smaller than the length of a dime. One centimeter is about the smallest cancer that can be felt with a breast exam.” Imitate a Mammogram Dr. Reiland advises that when women do a self-breast exam, they should try to imitate a mammogram as much as possible. Juliann Reiland MD, FACS, of YRMC PhysicianCare Breast Surgery. “A mammogram compresses or flattens out the breast tissue. Normal breast tissue, like oatmeal or tapioca, will flatten, but a cancer, like that rock, won’t flatten,” she said. Once a month, she recommends women lie flat on their back with their arm over their head, elbow close to their ear. “This allows the breast tissue to spread out and flatten. Then, keeping the fingers of the opposite hand close together to form a paddle, press down on the breast skin, trying to flatten the breast against the chest wall,” Dr. Reiland explained. “Your fingertips are more sensitive, and will feel all the normal lumps and bumps. It’s the action of trying to flatten out the breast tissue that helps abnormal lumps stand out.” The last part of your monthly self-breast exam, is to stand in front of a mirror to look at your breasts. Raise your arms over your head. (It’s normal to have one breast larger than the other). You are looking for dimples or puckering of the skin. Report any Changes Anything you believe is new or different should be reported to your healthcare provider. If you haven’t had a mammogram in a year, a diagnostic mammogram will be ordered. Often, ultrasound is used to look in the area of the lump you can feel. There are many tools used to identify breast cancer. Mammograms, the first tool, are excellent at seeing cancers too small to feel. This is why they are so important as a yearly screening. But even mammograms aren’t perfect, missing about eight to 15 percent of the breast cancer we can feel. So, even if your mammogram is normal and you feel a lump, you need to report it. There are other tests to look at breasts in different ways than mammograms. These are ultrasounds, MRI and contrast mammograms (CESM). “It’s important to use these tools when we are concerned a breast cancer is present,” Dr. Reiland said. “However, if a screening mammogram is normal, an exam in the clinic is normal, and a self-breast exam is normal, you most likely don’t have a breast cancer that has been missed.” For information about Dr. Reiland, please visit YRMC PhysicianCare Breast Surgery or contact us at (928) 442-8740. Screening mammography is available through the BreastCare Center at YRMC or Prescott Medical Imaging. Assistance is available for women unable to afford screening mammography through the Community BreastCare Fund.

In these days of uncertainties, parents of school-aged children can be sure of one thing: There is no cookie cutter approach to how their child’s school will operate during the 2020-21 academic year. Some schools are offering an entirely remote experience, at least for now. Some have scheduled a combination of remote and in-person learning. Whether the child is in a physical school setting or learning from home, Dr. Jennifer Tidroski, DO, YRMC PhysicianCare Ponderosa Pediatrics, provides her patients and their parents simple, useful and fun recommendations to keep them learning in the healthiest possible way. “I’ve been telling parents to talk through what some of the likely changes will be with their children,” says Tidroski. “For example, ‘Your classroom might look different – Your desks might be farther apart, and you will have to wear a mask all day.’” “Or, ‘You’re going to have to stay farther apart from your friends. You might have to eat lunch at your desk. You might not be able to use the playground.’” She points out that this will be more than one conversation and will help the child picture how things may be different when they return to school. Tidroski focuses on six important ways you can help your child stay safe and healthy: 1. Teach and practice proper handwashing. “Especially now, handwashing is the name of the game,” Tidroski says. “This is the number one way to prevent any disease forever and always.” Tidroski recommends researching fun online activities and other resources such as cartoons and child-appropriate YouTube videos on hand washing. “I’ve seen cute exercises where you cover your child’s hands with finger paint so that they can show you how they wash it away. Then you look for the spots that still have paint. It gives a good visual of the spots that need more attention.” This exercise can also help on other levels. While your child’s hands are covered in paint, point out that if they touch their face, the ‘germs’ can be transferred to their face as well. Singing the ABC song or the Happy Birthday song twice can help a child slow down so that they wash for the recommended 20 seconds. Make sure they are washing the backs of their hands, between their fingers and their thumbs too. “Draw a big X on your child’s hand with washable marker. They have to wash until the X is gone. This helps kids practice how long it really takes to get their hands clean,” says Tidroski. 2. Teach your child how to cough and sneeze properly. The best practice for smaller children is to sneeze or cough into the elbow, not the hand. ‘Dabbing’ is a fun way to show younger children how to sneeze properly. You can ‘dab’ your sneeze right into the crack of your elbow, then wash your hands. Older children can be taught to use a tissue to cover their face, then throw it away and wash their hands. 3. Practice not touching your face or mask. Tidroski warns that touching your face is the best way to put germs from the environment into your body. Many of us have no idea how frequently we are doing it. She suggests playing games with your child such as ‘spot mom touching her face’. In addition, “If kids are going to wear masks all day, it’s going to take practice to keep from fiddling with it, and inadvertently spreading germs to their face,” she says. “Practicing ahead of time will be very helpful.” Practice could include wearing masks at home together in short increments, such as 20 minutes at a time, then discussing how it felt. Talk about why the people you see at the grocery store are wearing masks and why there is tape on the ground. Measure how far 6 feet is, and practice standing at that distance, so your child becomes familiar with it. 4. Encourage your child not to share. This is difficult because we typically encourage kids to share. However, sharing things like eating utensils, cups and water bottles should be discouraged. Tidroski recommends a website called Asphalt Green. It has an extensive list of games and activities that require kids to be far apart, allowing for socially distanced interaction. You’ll even find popular old school games such as ‘Simon Says’ on the list. “My daughter and I like to play mirror games with each other,” says Tidroski. “We’ll stand six feet apart and one of us has to copy whatever the other one is doing. This is a great game where you can be close enough to interact but also stay about six feet apart.” In addition, you can help your child think of creative ways to show their friends they love them without a hug. For example, a Wi-Five is like an ‘air’ high five, without the physical contact. 5. Encourage good nutrition and adequate sleep. Eating well and getting enough sleep contribute to overall good health, helping to keep our immune system strong. In addition, if we are adequately nourished and rested, we are better able to pay attention to things like avoiding touching our faces and other safety measures. Most 6 to 12 year olds require 9 to 12 hours of sleep per night. This can include naps. “An adequate amount of sleep allows your brain to convert short term memory into long term memory,” says Tidroski. For a school-aged child, this means that with a good night’s sleep, new information and skills learned in school will have the best chance of being retained and recalled the next day. In order to adjust from a loose summer schedule to the earlier mornings required during school, Tidroski recommends getting to bed 10 to 15 minutes earlier per week to gradually shift bedtime back to an appropriate time. When discussing nutrition with children, Tidroski uses a car analogy. “We talk about why a car needs gas. A full tank of gas gives the car more power and allows it to go farther.” “I explain that just like good quality fuel for a car, good quality food helps your body work better and stay stronger,” she continues. “If you let your tank run empty, the car doesn’t work right. It stops running or it makes bad noises and you can’t get where you want to go. The same is true for our bodies. That’s why we have to re-fuel throughout the day with a healthy breakfast, lunch and dinner.” Tidroski emphasizes that healthy nutrition is important for parents too. “They need to have a healthy diet because what they do will always count more than what they say. Modeling healthy eating and keeping healthy food in the house is important.” For information on healthy eating, Tidroski suggests visiting myplate.gov. She recommends that parents use the divided plate visual as a template for creating their own balanced meals. You’ll also find nutrition-based games and activities for children. 6. Make sure your children are up to date on their vaccines. “Get your flu shot when it comes out,” encourages Tidroski. “It’s going to be important to do what we can to prevent the preventable illnesses, especially in the face of so many unknowns.” For advice on a broader range of parenting topics, Tidroski regularly recommends that parents visit the Healthy Children website. The site is written and maintained by the American Academy of Pediatrics, which ensures that all of the information is reviewed and supported by pediatricians. And, of course, she says that your pediatrician is an excellent source of information and support. YRMC PhysicianCare Ponderosa Pediatrics is currently accepting new patients. The office is located at 2120 Centerpointe West Drive in Prescott. Visit our website for more information, or call (928)778-4581.

What does the phrase “destination healthcare” bring to mind? For a growing number of people in Arizona and the southwest it means heart care, patient blood management or both of these specialized programs, provided by Yavapai Regional Medical Center (YRMC). Cardiac specialists from the James Family Heart Center and leaders from YRMC’s Patient Blood Management program (PBM) joined a live-stream event on October 17, 2019 at Yavapai College Performing Arts Center to speak about both of these innovative programs. Over 600 participated in “YRMC – Your Destination for Cardiac Care and Blood Management” at Yavapai College and the live-stream the event online. YRMC – Your Destination for Cardiac Care and Blood Management featured exceptional cardiac specialists: a Cardiologist, Cardiac Electrophysiologist, Cardiothoracic Surgeon, and a Structural and Interventional Cardiologist. Patient Blood Management experts also took part in the event. Together, these professionals highlighted the services, technology and teamwork that are the hallmark of YRMC’s Heart Program and Patient Blood Management Program. “Neither of these programs existed 12 years ago,” said Pierre Tibi, MD, FACS, Medical Director of YRMC’s James Family Heart Center and Patient Blood Management Program. “Today, there is no other community hospital in Arizona or the southwest that offers what YRMC does. We are now a destination program for Cardiac Care and PBM.” Defining PBM Until recently, prestigious organizations like the Society for the Advancement of Blood Management (SABM), the World Health Organization (WHO) and the American Association of Blood Banks (AABB), all mentioned blood transfusions in their PBM definitions. “They focused on thresholds for blood transfusion,” said Dr. Tibi, SABM’s Immediate Past President. “Today, the SABM definition states that PBM is a patient-centered approach that aims to improve patient outcomes.” At YRMC, this is accomplished by: Involving the patient in decision making Identifying anemia and other conditions early Managing conditions that can affect blood count Minimizing blood loss during hospitalization Embracing PBM tactics throughout the organization “We focus on taking care of the entire patient and keeping the patient as safe as possible before, during and after a procedure,” said Dale Black, Coordinator, Patient Blood Management, YRMC. “And one way to keep patients safe is to not subject them to possibly unnecessary blood transfusions.” YRMC: What Your Heart Needs John Amos, President and CEO, YRMC, recalled the beginning of YRMC’s heart services, which launched in 2004 with a single Cardiac Catheterization Lab at YRMC West in Prescott. “Even then, we envisioned a heart program that would bring together the latest services, exceptional specialists, unparalleled technology and compassionate caregivers,” said Amos. YRMC took a major step toward that goal in 2007 when Dr. Tibi – a highly regarded Cardiothoracic Surgeon from Phoenix – joined YRMC. Dr. Tibi brought open heart surgery to the community, launched YRMC’s Heart Program and introduced PBM. Under Dr. Tibi’s leadership, YRMC’s thriving, comprehensive Heart Program has grown to feature these services and exceptional cardiac specialists: Structural Heart Disease Services – Soundos Moualla, MD, FACC, FSCAI, Structural and Interventional Cardiologist, YRMC PhysicianCare, Prescott Mitral Valve Repair with MitraClip Paravalvular Leak Closure (PVL) Transcatheter Aortic Valve Replacement (TAVR) Transcatheter Mitral Valve Replacement (TMVR) WATCHMAN™/Left Atrial Appendage Closure (LAAC) Electrophysiology Services – Nisha Tung-Takher, MD, Cardiac Electrophysiologist, YRMC PhysicianCare, Prescott Curative Management and Ablation Procedures for Cardiac Arrhythmias (atrial fibrillation, atrial flutter, supraventricular tachycardia, atrial tachycardia, premature ventricular contractions and ventricular tachycardia) Device Implantations (pacemakers and defibrillators) Remote Monitoring (pacemakers, defibrillators and cardiac resynchronization therapy, CRT) Heart Failure Management Care with Compassion YRMC’s Heart Program and PBM Program combine science and service, according to George Rizk, MD, Invasive Cardiovascular Medicine, YRMC PhysicianCare in Prescott. “YRMC is doing what’s best for patients,” said Dr. Rizk, who presented during the live-stream event. “If you deliver the most scientifically advanced services without putting the patient’s interest first, you don’t get too far. YRMC’s team has a passion for helping patients.” One way that YRMC does what’s best for patients was described by Elizabeth Black, YRMC’s Patient Blood Management, Data Manager. In the tradition of healthcare and acronyms, she called it “KTBITP” or “keeping the blood in the patient.” Less than a decade ago, Black noted, blood transfusion was the most common procedure performed in U.S. hospitals. While some blood transfusions are deemed medically necessary, she said, they all come with risks. Those risks include increased infection rates, medical complications (kidney, lung and heart), and higher death rates. PBM strategies combine evidence-based medicine with good clinical practice to maximize the patient’s blood health and reduce exposure to risks associated with transfusion. A Field of Dreams Dr. Rizk remembers the opening of YRMC’s first Cath Lab as a “field of dreams” moment. “We thought: If we build it, they will come,” he said. “And, if you build it well, they will never leave.” These statements are even more relevant today as YRMC’s Heart and PBM Programs emerge as destination programs. To learn more about YRMC – Your Destination for Cardiac Care and Blood Management check out YRMC HealthConnect. For information about YRMC’s Heart Program and PBM Program, visit our website.

I’ve worked as a dietician and cooking coach for almost three decades, and I know that with a little planning and creativity, anyone can prepare affordable, delicious meals with a few basic kitchen staples.  After all, that’s what home cooks around the world have been doing for centuries!  To get started, check out what I store in my pantry plus what a few of my favorite cooks stock in their kitchens. My staples include beans, grains, durable produce, fresh herbs, and flavor bombs! Traditional cooks around the world have based delicious, nourishing meals on basic starches, proteins, plants, herbs and spices for as long as there have been homes to cook in!  For example, consider any of the meals you enjoy with roots in South or Central America.  It’s likely that those meals feature rice, corn, or potatoes; chicken, meat, fish or beans; possibly some crumbly cheese; basic produce like onions, cabbage and tomatoes; and flavorings like chilies, cumin, cilantro, and lime.  While I don’t keep every possible essential ingredient in my kitchen all of the time, the list below includes those that show up on my shopping list on a regular basis. Starchy Foods: Pasta (different shapes and types, gluten free these days), Rice (brown, white and black), Beans (usually dried black, pinto, garbanzo and navy), French Green and Red Lentils, Corn or Gluten Free Tortillas, Polenta (coarse corn meal) Fats and Oils: Extra Virgin Olive Oil, plus Avocado Oil, Ghee (clarified butter) and Coconut Oil, for high heat cooking. Nuts and Seeds: Any and all kinds Nut Butter: Peanut Butter and Tahini (roasted sesame seed butter) Canned Goods: Tomatoes, Beans, Fish Flavor Bombs (to use in small amounts for bursts of color and flavor): Olives, Pesto, Hot Sauces, Red Thai Chili Paste, Anchovies, and Trader Joe’s Sundried Tomatoes in Olive Oil Miscellaneous Durable Fresh Produce: Onions, Garlic, Celery, Carrots, Cabbage, Winter Squash, Potatoes, Lemons, and Limes Cheese: Chao Brand Vegan Cheese, Kite Hill Vegan Cream Cheese, and Flavorful Real Cheese like Feta, Goat and Parmesan Frozen Items: Green Peas, Fruit, Cauliflower Pizza Crust, Almond Flour Pizza Crust Spices: Cumin, Coriander, Turmeric, Chilies, Salt, Pepper, Cinnamon, Mexican Oregano, Fennel Seeds, Bay Leaves Fresh Herbs: Parsley, Cilantro, Basil and Mint (when in season) Sweeteners: Stevia, Honey, Maple Syrup Additional kitchen staples in my kitchen include frozen peas, gluten free pizza crusts, tortillas, seasonal greens and spices likes cinnamon, chilies, cumin, coriander, oregano and peppercorns. Throw in fresh, seasonal vegetables and fruits, plus proteins like eggs, tofu, fish, poultry and grass-fed beef (my diet is mostly vegetarian but my husband feels better when he eats some animal protein), and you have the list of foods I work with nearly every day. Other Popular Kitchen Essentials Chef Molly Beverly, who has taught, cooked and catered locally for decades, keeps cooked beans in her freezer, a stash of popcorn in her pantry, and sturdy produce like apples, bananas, oranges, and potatoes handy.  Along with carrots and cabbage, she stocks fresh beets and seasonal produce in her fridge as well.  Molly shares her great ideas for healthy home cooking on Face Book at Chef Molly’s Cooking Class.  Chef Rebecca Katz, the renowned author of The Longevity Kitchen, The Cancer Fighting Kitchen and The Healthy Mind Cookbook, recommends stocking additional beans and grains like farro (an ancient form of wheat) and quinoa.  She also regularly uses canned goods like coconut milk, fish and chicken or vegetable broth.  Click on the links below to download our unique lists of kitchen essentials. Katz’s Pantry Chef Molly’s Pantry Rita’s Pantry Once you’ve stocked up on kitchen essentials, there are a million different recipes to sample and make your own.  First, check out our extensive collection of recipes and cooking/nutrition tutorials at YRMC’s Your Healthy Kitchen!  You can also follow me on Facebook, at YRMC’s Your Healthy Kitchen, to see what I make throughout the year at home, using a handful of kitchen staples and lots of seasonal produce. Chef Molly’s Cooking Class on Facebook and Rebecca Katz’s blog are also wonderful resources for simple, delicious meals.  Oldways Cultural Food Traditions, which features foods and recipes from traditional cuisine around the world, eBooks, grocery store lists, and more is another favorite site of mine.  Of course, don’t forget to ask your own favorite cooks what they regularly make at home!  My friend Shelley Stophlet stocks her kitchen with almost the same ingredients as I do, and she always impresses me with the easy, flavorful dishes she creates.  Click on the link below for one of her favorites! Black Bean Quinoa Chili with Sweet Potatoes Remember, you do not have to prepare something uniquely different for dinner every night of the week to have a healthy life and diet.  Once you find a handful of meals that are nourishing and enjoyable to you and your family, it’s OK to regularly rely on those. Make delicious meals.  Create your own traditional recipes.  Repeat.         .