These days, many of us are looking for convenient, easy meal ideas, but we want to make sure they’re as healthy as possible. Rita Carey Rubin, Registered Dietician, Diabetes Educator and host of Yavapai Regional Medical Center’s Your Healthy Kitchen, says that wraps can be some of the best choices around. But, she says, you have to be careful about which wraps you choose. Tortillas are the most well-known wraps, especially here in the Southwest, but now there are lots of additional, and often healthier, options. Rita suggests looking for the word “whole” when reading the label, as in “whole wheat” or “whole spelt” which means that the entire grain is used, boosting the nutritional and fiber content. This is particularly beneficial to those who are diabetic, as whole grains tend to raise blood sugar less than refined grains. Counting the number of ingredients is also an easy way to judge the nutritional content of the wrap. “Typically, the less ingredients, the better,” Rita says, “Especially if some of those ingredients are hard to pronounce, which may indicate that there are additives.” Once you’ve chosen a healthy wrap, what do you fill it with? Rita has a three-step approach: Spread the inside of the wrap with a sauce, such as tzatziki (made with yogurt, garlic and cucumber), hummus, tapenade or pesto, which will give the wrap some moisture. Next, add your choice of protein, such as chicken, turkey, fish or grilled tofu. Finally, top it with some veggies, such as diced red peppers, onion and greens. Roll it up and you’re ready to enjoy a tasty, nutritious wrap! Your Healthy Kitchen is one of the many ways that Yavapai Regional Medical Center, your not-for-profit healthcare provider, delivers health education and support to the citizens of Yavapai County. You can also follow Rita on Facebook at YRMC’s Your Healthy Kitchen.

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.

Replacing damaged heart valves with transcatheter aortic valve replacement (TAVR) – a minimally invasive procedure – improves the quality of life for the critically ill people who undergo it, recent research reviews show. This is no surprise to Prescott Valley resident Nicholas “Red” Demino and his daughter, Lily Bergin, of Skull Valley. “My heart disease was so severe that I wasn’t a candidate for open heart surgery,” Demino said. Demino suffers from aortic stenosis – a narrowing of the aortic valve – a condition that tends to develop with age. The condition can lead to chest pain, fatigue, shortness of breath and heart failure. People with severe aortic stenosis at an advanced age, like Demino, are not eligible for traditional valve replacement surgery. Getting Ready for TAVR After speaking to Gwen Rhodes, RN, Patient Navigator for the James Family Heart Center at YRMC, and learning more about TAVR, Demino began preparing for TAVR. Rhodes arranged for Demino – a highly decorated Army and Air Force veteran – to undergo the series of tests required before TAVR. Dedicated to patient education, Rhodes also talked to Demino about how his heart works; provided a step-by-step overview of what happens before, during and after a TAVR procedure; and, most important to patients, discussed the pain and discomfort involved in the procedure (it’s minimal). Demino underwent TAVR in YRMC’s state-of-the-art Hybrid Operating Suite in April 2017. He was the Heart Center’s 12th TAVR patient, a number that now has grown to more than 70. “Everything went superbly,” said Bergin of her father’s experience. “They took great care of my Dad.” From Wheelchair to Weightlifting Following his TAVR, Demino joined Cardiac Rehabilitation at YRMC’s Pendleton Center West in Prescott. The 90-year-old’s exercise routine was supervised by one of the Center’s therapists. During sessions, he rode a stationary bicycle, worked out on an elliptical trainer, lifted weights from a chair, participated in resistance training and walked along a rail to build balance. “He went into Cardiac Rehabilitation in a wheelchair,” remembered Bergin. “Each day, we saw improvement. On the last day of Cardiac Rehabilitation, he stopped by to say thank you to Gwen and then walked out the door with his cane.” Today, Demino exercises on his own at home with a treadmill he purchased after he completed YRMC’s Cardiac Rehabilitation program. Lucky Number 12 Demino is proud he was among the Heart Center’s first group of patients. In fact, when he calls Rhodes to catch up or with a question, he enjoys teasing her by identifying himself as “number 12.” And research also shows that laughter improves your quality of life. For more information about TAVR and the James Family Heart Center at YRMC West, visit www.yrmc.org.

Willow Creek is normally a docile stream that winds its way through Prescott. But on September 23, 1983 – when 14.5 inches of rain soaked the Prescott area in a 24-hour period – Willow Creek was anything but passive. In fact, the creek was 800 feet wide in some sections. The torrents of water that rushed down Willow Creek and Skull Valley Road Wash upended cars, destroyed houses and left the community without water. The Prescott Courier’s front page headline – “Destruction” – summed up the situation. Below it, “Flooding leaves homeless, but no deaths” was like a sigh of relief given the destruction. Watch My Memories of YRMC: Gerry Turley on YouTube. Flood Strands YRMC Employees “I remember that flood and how it devastated Prescott,” said Gerry Turley, a 40-year employee of Yavapai Regional Medical Center (YRMC) who worked in the hospital’s Accounting, Accounts Payable, Payroll and other business operation divisions. YRMC was spared damage, but for days, hospital employees who were affected – including Harriet Mcqueary – struggled to get to work. But Mcqueary had a loyal and caring employee on her team who went out of her way for her supervisor. “I convinced my father that Harriet Mcqueary needed to be at work,” Turley said. “We drove the back roads to get to where she lived and get her back to work.” Turley and her father made that muddy trip as long as Willow Creek Road and Jack Drive were flooded. YRMC Staff Offers Support “Yavapai was a great place,” said Turley, who recalled the support she received on a number of occasions. “You knew you could depend on people and that’s still true.”