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.

“Slow the spread” is a rallying cry for COVID-19. But, when it comes to information about testing for COVID-19, stopping the spread of misinformation is a challenge faced by public health leaders and healthcare providers. Two experts involved with Yavapai Regional Medical Center’s (YRMC’s) response to COVID-19 recently shared their knowledge about coronavirus testing and related topics. They are: William Lockwood, MD, Infectious Disease Specialist at YRMC PhysicianCare Pulmonology and Infectious Disease in Prescott Infectious disease specialists diagnose and treat diseases caused by microorganisms, including viruses and bacteria. Dr. Lockwood has more than 30 years’ experience treating people who suffer from immunodeficiency – when the body’s immune system is unable to fight infectious disease – and hard to diagnose infections. Rob Barth, III, RN, MSN, MBA, CEN, Director of Emergency Services at YRMC West in Prescott Mr. Barth’s experience in the nursing profession includes leadership roles in emergency medicine, disaster planning and trauma services. Since 2002, he has also served in the United States Air Force Reserve as the Deputy Commander/Chief Nurse of the 944th Medical Squadron. What types of tests are available for COVID-19? Dr. Lockwood: There are two types of COVID-19 tests that provide us with different information: a diagnostic test and an antibody test. Let’s start with diagnostic tests. These tests look for the presence of the virus’s genetic material – the DNA – in order to find out if someone has the virus that causes COVID-19. We collect that genetic material with a swab that is placed fairly far up the nasal passage and more recently using a saliva test. The second kind of test is an antibody test. When you get an infection, your body makes an antibody to that organism. We can check for the presence of an antibody with a blood test. This tells us if someone has had a disease in the past. It also gives us an idea of how immune people are to that particular infection. There’s still much to learn about antibody testing before it can be an effective tool in the fight against COVID-19. What needs to be learned about antibody testing before it can help fight COVID-19?  Dr. Lockwood: The main question being studied is: What does it mean to have immunity to COVID-19? Sometimes the presence of antibodies means that immunity is full and permanent and a person will never get that disease again. The measles are a good example of this. Once you have the measles, you have full immunity and you will never get them again. However, there are other illnesses – like chickenpox – where antibodies provide only partial immunity. When you get chickenpox, your body makes some antibodies and develops some immunity. But those antibodies are not 100 percent protective. The virus that causes chickenpox can remain dormant in your body for decades and return as shingles when you’re older. For this particular coronavirus, we do not know if the antibodies people are making provide full immunity from ever getting coronavirus again or if they give only partial protection. We also don’t know how long those antibodies will last. So, do you have complete protection for two months or three months or four months? Do the antibodies provide complete protection for your lifetime? Or, do coronavirus antibodies give partial protection for six months and then you’re back to being at risk again? We don’t have the answers to those questions yet. The bottom line is that antibody testing is still being developed so it is not widely available at this time. Who can get tested for COVID-19 at YRMC? Mr. Barth: First, if you’re experiencing severe symptoms, such as difficulty breathing or chest pains, you should call 9-1-1. If you’ve been in contact with someone who has COVID-19, or if you have mild symptoms, you should contact your healthcare provider or the Yavapai County Community Health Services COVID-19 Hotline (928-442-5103). The Centers for Disease Control and Prevention (CDC) established testing priorities for healthcare settings that YRMC has followed line and verse throughout the pandemic. So, when people arrive at either YRMC campus, we’re screening them for COVID-19 symptoms. We ask if they have a cough, a fever or difficulty breathing. We also take their temperature. If they have a fever or if they respond “yes” to any of the questions, they’re directed to one of our outdoor triage tents for further evaluation and possibly a COVID-19 test. Our triage tents are designed to reduce the chance of COVID-19 spreading in our hospitals. They keep our patients and staff safe and manage surge in our Emergency Departments. How are COVID-19 test kits prioritized for distribution to states and communities? Dr. Lockwood: Initially, that was done through the federal government and state health departments. At that time, there was very limited testing. Everybody was waiting. Now, private companies are involved so test kits are much more available than they were. YRMC didn’t get more test kits in the beginning because we weren’t in a surge area. Arizona was not at the top of the list. When the private companies got more involved, that’s when the testing kits became more available. Now, the challenge is keeping up with the number of tests that need to be processed. It’s not so much having the swabs – which was a problem before – now it’s the volume of the tests to run at the labs. Mr. Barth: Yavapai County is very fortunate. We haven’t seen the surge here like other places around the state and country. YRMC has done a really good job with our inventory of COVID-19 test kits. We are in much better place than we were, but we’re still not in an ideal place to test asymptomatic people. And if you look at the CDC website, widespread community testing is listed on about the fourth tier as a non-priority. Is widespread testing an effective strategy for managing COVID-19 in a community? Dr. Lockwood: The answer to that is “yes” and “no.” Let’s say you could swab everybody on one day and get their results just as quickly. You might be able to say, for example, we have 50 people out there with the virus. Those 50 people need to go into isolation and that’s how you would address the virus in your community. The problem is, that is not an available test scenario for any community. We cannot get the results of all of those tests back fast enough for any one community. And, a test is only an indicator of where a person is on that particular day at that particular time. If you test someone on Tuesday and they’re negative, they may have acquired the virus by Friday. So, widespread testing would give you only limited information and it can’t be done fast enough to interrupt the entire chain of transmission. What happens to your COVID-19 test after you undergo it at YRMC? Dr. Lockwood: After you’re tested for COVID-19, the test kit goes to the YRMC Clinical Laboratory where it’s registered for tracking and then sent to a Mayo Clinic Reference Laboratory. YRMC transports tests to the Mayo Clinic Reference Lab daily. YRMC has partnered with the Mayo Clinic Reference Lab for several years. Because of our partnership, we’re able work with the Mayo Clinic Reference Lab as our best source for these tests. After the test kit arrives at the Mayo Clinic Reference Lab, its tested and the results are shared with YRMC via a secure computer. The patient’s physician is then notified of the test results. This process takes 12 to 48 hours, depending on the number of tests being processed on that particular day. Will there be a COVID-19 vaccine available in the future? Dr. Lockwood: A vaccine could potentially be a wonderful tool to stop the COVID-19 outbreak. The challenges we face with viruses and vaccines are the myriad steps before a vaccine can become available. First, you have to decide how the vaccine is going to be put together. There are several paths for developing a vaccine and you need to figure out which will work best. After that, the vaccine is developed in the laboratory where it undergoes many safety tests. Once it’s ready, the vaccine is tested on a small group of healthy volunteers to ensure there are no major side effects. Next, the vaccine is tested on a larger pool of volunteers to learn how much material the vaccine needs to make it effective. This is followed by more testing to determine the effectiveness of the vaccine and how long it will offer protection. While all of this is going on, you have to plan for how the vaccine will be manufactured and then distributed. So, when people say it’s going to be a year, 18 months, two years before a COVID-19 vaccine is available, they are probably very correct. It’s a great way of stopping an outbreak, but it takes time to develop. What is the best strategy for managing COVID-19 today? Dr. Lockwood: Social distancing is currently the best strategy for managing COVID-19. In other words, stay at least six feet away from other people. If you have been exposed to COVID-19 or you’re having symptoms, you should quarantine yourself in your home and stay out of public areas where you could transmit it. Of course, you should contact your healthcare provider or the Yavapai County Community Health Services COVID-19 Hotline. (The hotline is available between 8:00 am and 5:00 pm, Monday – Friday by calling 928-442-5103.) For the most accurate and up-to-date COVID-19 information, Dr. Lockwood and Mr. Barth recommend the following resources: Yavapai Regional Medical Center Centers for Disease Control and Prevention Yavapai County Community Health Services Arizona Department of Health Services Arizona Governor’s Office

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.

Most of us are spending a lot more time at home these days, so why not use this opportunity to create great memories, strengthen family ties, and build life long healthy habits in the kitchen with your kids?  After all, kids love learning new skills, and teaching them how to prepare part or all of a meal will build self-confidence and even encourage picky eaters to try new foods.  A large variety of kid-friendly cookbooks and endless resources are available online (including YRMC’s Your Healthy Kitchen) to get you started! Kids really love to cook, even if they are simply stirring, measuring, or chopping a vegetable, and if your children take part in preparing meals, they’ll be more excited to eat them!  In addition, when kids help you with meal planning and grocery shopping, the buy-in is even greater.  Even simple, time-tested rituals, like lighting candles, setting the table, waiting for everyone to be seated before digging in, and expressing gratitude for the meal, builds life-long positive connections with family and food.  The folks at FamilyCook Productions – pioneers in culinary-focused nutrition education for all ages – have studied the benefits of cooking with kids for decades.  They encourage parents to involve kids in cooking as much as possible, from simply shaking up vinaigrette and tossing a salad, to chopping, grating, and more.  They offer parents three important tips to remember: Don’t worry about the mess Let go of perfection Enjoy the process and the results will be great! FamilyCook Productions offers wonderful resources online, including recipes and 8 Easy Tips to Move Beyond Nuggets and Mac ‘N’ Cheese!  They also published an easy cookbook called Get Your Family Eating Right, by Lynn Fredericks and Mercedes Sanchez, that features simple, family-friendly recipes; tips and words of wisdom about creating and enjoying family meals; and even a 30-day plan designed to get you and your kids in the kitchen more often. They advocate using mealtime as a way to explore the world from your kitchen, and to broaden the flavors and textures of food that your children accept and enjoy.  We sampled one of their recipes in this YRMC’s Your Healthy Kitchen episode back in 2016! Cooking with kids is also guaranteed to increase a child’s interest in, and willingness to try new foods.  For example, if you told your kids you were making cauliflower crust pizza tonight for dinner, they might just make a face!  But, if you invite them into the kitchen to make homemade pizza with you, chances are, the experience will be much different!  Need proof?  Check out this YRMC’s Your Healthy Kitchen episode with kids from Coyote Springs Elementary School – making cauliflower crust pizza with homemade pesto! Pesto-Pizza-with-Crispy-Cauliflower-Crust Another way to get your kids into cooking is to get into it yourself!  My 13-year old niece, Alayna Grace, says she got into cooking after “watching a lot of Chopped and Chopped Jr. shows” with her mom.   Alayna says, “My mom used to put a ‘Chopped’ challenge basket together for me and I would make a meal, snack or dessert out of the ingredients.  Mom and Dad were the judges, and of course, they loved everything, and I always won!”  These days, Alayna gets an idea for a food or a favorite restaurant meal she wants to cook at home and then looks up recipes online.  She also really likes the Unofficial Harry Potter Cookbook, by Dinah Bucholz.  Her favorite recipe: Pumpkin Pastis! Alayna shares her homemade pizza and Asian-style slaw   Remember, any time you invite your kids to help prepare a meal or snack is quality time with you.  After all, the main attraction of cooking for kids is being with you!  Toddlers can play with mixing bowls and measuring cups while you cook.  Younger children can add ingredients to a salad or mixing bowl while you stir. As they grow older, kids can start measuring and mixing on their own, and may use a butter knife to cut soft fruits and vegetables.  Teens can take over cooking pasta, chopping, baking and more!  Your own enthusiasm for cooking and eating will rub off on your kids, they will pass it on to their kids, and soon enough, you’ll belong to a tribe of healthy eaters! Some additional favorite resources for cooking with kids are listed below. Pretend Soup, and Other Real Recipes, a Cookbook for Preschoolers & UP, by Mollie Katzen Secrets of Feeding a Healthy Family: How to Eat, How to Raise Good Eaters, How to Cook, by Ellyn Satter The Family Cooks, by Laurie David Jamie Oliver Get Kids Cooking Blog. Check out the Toasted Popeye Bread!