Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
OCTOBER 2014
Tucson Craycroft
2625 N. Craycroft Road, #200
Tucson 85712
TEL 520.324.2409
FAX 520.324.2454
Green Valley
1315 S. La Canada Drive
Green Valley 85614
TEL 520.625.6600
FAX 520.625.8467
Mariposa Community
Health (Satellite)
1852 N. Mastik Way
Nogales 85621
TEL 520.624.7445
FAX 520.623.6145
Western Avenue
(Satellite)
507 N. Western Avenue
Nogales 85621
TEL 520.624.7445
FAX 520.623.6145
Rita Ranch
(Satellite)
8290 S. Houghton Road
Tucson 85747
TEL 520.625.6600
FAX 520.625.8467
Safford
(Satellite)
2115 W. 16th Street
Safford 85546
TEL 520.624.7445
FAX 520.623.6145
Y. Haroon
Ahmad, MD
Guillermo
Gonzalez-Osete, MD
Robert J.
Brooks, MD
Manuel R.
Modiano, MD
Bruce W.
Porterfield, MD, PhD
Jonathan E.
Schwartz, MD
Natalie
Swansen, MD
Sombrero
Pima County Medical
Society Officers
Michael Connolly, DO
Michael Dean, MD
Howard Eisenberg, MD
Afshin Emami, MD
Randall Fehr, MD
Alton Hallum, MD
Evan Kligman, MD
Kevin Moynahan, MD
Soheila Nouri, MD
Wayne Peate, MD
Scott Weiss, MD
Leslie Willingham, MD
Gustavo Ortega, MD (Resident)
Snehal Patel, DO (Resident)
Joanna Holstein, DO (Resident)
Jeffrey Brown (Student)
Jamie Fleming (Student)
President
Timothy Marshall, MD
President-Elect
Melissa Levine, MD
Vice President
Steve Cohen, MD
Secretary-Treasurer
Guruprasad Raju, MD
Past-President
Charles Katzenberg, MD
Editor
Stuart Faxon
Phone: 883-0408
E-mail: tjjackal@comcast.net
Please do not submit PDFs as editorial copy.
Advertising
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Art Director
Alene Randklev, Commercial Printers, Inc.
Phone: 623-4775
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E-mail: alene@cptucson.com
$150,000
Members at Large
Vol. 47 No. 8
R. Screven Farmer, MD
Donald Green, MD
Veronica Pimienta, MD
Board of Mediation
Timothy Fagan, MD
Thomas Griffin, MD
George Makol, MD
Mark Mecikalski, MD
Edward Schwager, MD
Delegates to AMA
William J. Mangold, MD
Thomas H. Hicks, MD
Gary Figge, MD (alternate)
Arizona Medical
Association Officers
Thomas Rothe, MD
immediate past president
Michael F. Hamant, MD
secretary
Printing
Commercial Printers, Inc.
Phone: 623-4775
E-mail: andy@cptucson.com
Publisher
Pima County Medical Society
5199 E. Farness Dr., Tucson, AZ 85712
Phone: (520) 795-7985
Fax: (520) 323-9559
Website: pimamedicalsociety.org
$399,000
Madeline Friedman
ABR, CRS, GRI
Vice President
296-1956 888-296-1956
Inside
5 Dr. Timothy Marshall: Our HQ needs intensive
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care.
Letters: CHN CEO on Carondelets settlement
with Justice.
Milestones: Notes on three of our members.
Membership: Spotlighting Northwest Tucson
Emergency Physicians.
In Memoriam: Longtime Tucson dermatologist Dr.
Robert Friedman died in August.
Medical Missions: Sometimes a jaguar attack is
part of a regular days work for globetrotting
medical improviser Dr. Ken Iserson.
Behind the Lens: Dr. Hal Tretbar gets out his
Leica M3 and gets behind Cartier-Bressons lens.
PCMS News: A court victory for Dr. Rainer
Gruessner.
Arizona Medical Board News: AMB loses yet
another director.
Makols Call: Always listen to the patient
including that self-diagnosis.
CME: A new local conference tradition from
Tucson Osteopathic Medical Foundation
happens Nov. 1.
On the Cover
My Leica M3 was brand-new in 1958, photographer Dr. Hal Tretbar
says. To me the subject, lighting and composition in this image
from Germany looks like a French Impressionist painting. Even
though the German state of Hesse was considered a backwater of
West Germany, this was a rare scene of a couple plowing with cows.
Grandmas wore black with layered skirts. For another kind
of French pictorial heritage, see Dr. Tretbars homage to Henri
Cartier-Bresson in this issues Behind the Lens.
Remote Receptionist
Appointment Scheduling
Order Taking
Se Habla Espaol
2434 N. Pantano
Medical Society
Exchange
790-2121
Established
1971
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Leers
Carondelet: Responsibility
program works
Editors note: This letter went out Aug. 19. to Carondelet
Community Partners after our last publication deadline.
Why choose
Desert Mountain Insurance?
see why our customers did...
Our physicians were so
COVERAGE INCLUDES
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Be well,
James K. Beckmann
President and CEO
Carondelet Health Network
Tucson
n
866.467.3627
866.467.3611 fax
info@desertmountaininsurance.com
www.desertmountaininsurance.com
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Outside of work, Dr. Tiwari loves to travel and spend time with
his family.
Milestones
STARonSthe
ve
bell A
Camp
AVENUE
PRESENTED BY THE
Pima County
Medical Society
Membership
Story and Photos by Dennis Carey
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In Memoriam
By Stuart Faxon
DESERT SUN
GASTROENTEROLOGY
Proudly welcomes
Piyush Tiwari, MD
7140 E. Rosewood Street
Tucson, AZ 85710
(520) 547-4900
www.dsgastro.com
Currently accepting new patients
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Medical Missions
By Kenneth V. Iserson, M.D., M.B.A., F.A.C.E.P., F.A.A.E.M.
Jaguar attack?
All in a days work
BUZZ
RING
BUZZ
RING
RINGING
HUMMINGGING
RIN
Your patients
deserve the
best hearing
care possible
ING
HUMM
USG
T
I
N
IN
IN
ING
G
N
I
R
BUZZING
BUZ
G
N
I
G
We offer
comprehensive
tinnitus
consultations.
TINNITUS
RINGING
TINNITUS
HUMMING
RINGING
BUZZING
HUMMING
TINN
ITUS
RINGIN
G
BU
HU ZZING
MM
ING
IN
Learn more about why we are a
R
preferred audiologistplease visit our website: www.arizonahearing.com
We are preferred providers
on most insurance plans.
520.742.2845
520.742.2845
520.648.3277
520.544.9890 | www.casahospice.com
Hospice services are paid for by Medicare
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physical and emotional comfort zone, and that you can afford. You
will also need to consider the cultural differences, living
arrangements, personal health needs, communication difficulties
(language and electronic), accommodations, local and international
travel arrangements, and required professional documents. For all
these other issues, The Global Healthcare Volunteers Handbook:
What You Need to Know Before You Go may be of help.3
That little girl mauled by a jaguar received rapid and thorough
assessment and treatment from our team, including
identification of a potentially lethal brain lesion resulting from
the big cats tooth penetrating her skull. After a craniotomy,
repair of the extensive soft-tissue injuries, and three weeks of
hospital care, she was discharged back to her home.
Months later, her only residual injuries were some large
lacerations that will take time to completely heal, and ptosis of
one eyelid. Success in this one case was awesome. But this
episode evoked even more pride in the sustainable educational
accomplishments our Vanderbilt University-based EM team has
provided over the past yearsand continues to providein
educating a new generation of Guyanese Emergency Physicians.
Dr. Iserson is a Fellow of the International Federation for
Emergency Medicine and Professor Emeritus, Department of
Emergency Medicine, The University of Arizona, Tucson. He is the
author of two recent books: The Global Healthcare Volunteers
Handbook: What You Need to Know Before You Go, Tucson, Ariz.:
Galen Press, Ltd.; (March 2014), and Improvised Medicine:
Providing Care in Extreme Environments, McGraw-Hill Publishing,
New York, N.Y. (December 2012).
Excellence In:
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ey man, a photographer
shouted from across the
courtyard behind Hotel
Congress, let me see that
Leica! He was getting ready to
record that nights musical
event. K.C., as he was called,
knew a classic when he saw one and thought my Leica M3
camera was really cool.
I was there to scout the layout for the Ho-Co Fest. Hotel Congress
has been putting on this musical party on Labor Day weekend to
celebrate the end of summer for 10 years. I had a plan to
photograph it in the traditional style of famous photojournalist
Henri Cartier-Bresson.
Cartier-Bresson (1908-2004) is considered the father of
photojurnalism and spontaneous street photography as art, and
one of the leading artistic forces of the last century. He was an early
adopter of the 35mm format. He photographed the famous such as
Mohandas Gandhi and Marilyn Monroe, and covered major world
events, but became best known for his candid photography, and his
1952 book The Decisive Moment.
In 1954, Ernst Leitz GMBH Wetzlar, Germany, introduced the
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Leica M3 35mm film camera. Now they are celebrating the 60th
anniversary of the one of the best cameras ever made. It was a
marked change from previous Leicas that were a world standard.
The lens mount was bayonet rather than screw-in. The wide base
rangefinder was superimposed in the viewfinder. The outline of
the frame in the viewfinder changed when the lens was changed
from 50mm to 90mm to 150mm. There was a single-stroke film
advance lever.
The M3 became the camera of choice for most of the worlds
finest 35 mm photographersand for every other enthusiast.
About 220,000 were sold between 1954 and 1966. It is said that
Elvis used a Weston light meter for the best images with his M3.
SOMBRERO October 2014
It also happens to be the 60th anniversary of Kodaks 35mm blackand-white Tri X film. In the past there had been Super X and
Super XX sheet film with ASA (ISO) speeds of 50 and 100. When
the 400 speed film came out, it was named Tri X.
I decided to use the M3 with Tri X as Cartier-Bresson would have.
Cartier-Bresson always used Leica cameras. He said that shooting
with a Leica was like a long tender kiss. He liked a 50mm lens,
shot in black-and-white, and he crop his images when printing
them. People were not aware of being photographed with his
small, quiet camera, so the final prints showed spontaneity with
good composition.
For the Ho-Co Fest I wanted to follow his advice in the Oct/Sept
1997 American Photo: Avoid making a commotion, just as you
wouldnt stir up the water when fishing. Dont use a flash out of
respect for natural lighting, even when there isnt any. If these
rules arent followed, the photographer becomes unbearably
obtrusive.
First I did some street shooting. The couple at the bus stop was
oblivious to me while I was trying to get the best angle to show
their attention to eye care. I cropped this scene so they could be
compared. But when I shot the Ho-Co Fest at night it was full
All in all it was a delight to get back to basics and try to reach the
excellence of Cartier-Bresson. He said, Photography is, for me, a
spontaneous impulse coming from an ever-attentive eye which
captures the moment and its eternity.
n
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frame, hand held, black and white at 400 ISO. There was no light
meter and I exposed mostly at 1/15th-1/30th second at f1.8 to 2.4.
The Phoenix law firm Jaburg Wilk reported Aug. 25 that Dr. Rainer
W. Gruessner, renowned transplant surgeon and prior chair of
the Department of Surgery at the University of Arizona College of
Medicine was, cleared of all charges by an independent hearing
panel. The decision came just as the August-September Sombrero
went to press.
PCMS News
Conference focuses on
cardio-metabolic management
Tucson Osteopathic Medical Foundation reports that Eliot A.
Brinton, M.D. is flying down from Utah to present Lipid and
Cholesterol Management for the Cardio-Metabolic Patient at
the 3rd Annual Southwestern Conference on Medicine Primary
Care Update Nov. 1, 7:30 a.m. to 2:30 p.m. at the TOMF
Conference Center, 3182 N. Swan Rd. in Tucson.
Dr. Brinton is a practicing lipidologist and founding board
member of both the National Lipid Association and the American
Board of Clinical Lipidology, said Nicole Struck, program and
meetings manager at the Tucson Osteopathic Medical
Foundation, He is a thought leader in this field.
Other presenters and presentations during the conference include
Sander Zwart, M.D., F.A.C.P. on Diabetes and Insulin Resistance in
the Cardio-Metabolic Patient; Matthew P. Namanny D.O.,
F.A.C.O.S. on Managing Conditions Resulting From Untreated
Cardiometabolic Syndrome; Joy L. Logan, M.D. on Hypertension
and Renal Disease in the Cardiometabolic Patient; and Scott N.
Welle, D.O., F.A.C.O.S, F.A.C.S. on The Effects of Obesity and
Weight Loss Interventions in Cardio-Metabolic Syndrome. There
will also be a lecture on lifestyle modification, monitoring, and
intervention for these high-risk patients.
A continental breakfast and lunch will be provided. The
registration fee is $120. To register, please log onto http://www.
tomf.org/cme .
The Southwestern Conference on Medicine Primary Care Update
began as a means to fill the need for focused, convenient
educational opportunities for Southern Arizona osteopathic
physicians, Struck said, but in a very short time it evolved into
an event like its big sister, TOMFs Southwestern Conference on
Medicine, which has taken place every spring since 1991 and now
boasts an attendance of more than 400 medical professionals
from across the nation.
We feel strongly that this will prove to be another high-quality
educational opportunity fitting the Southwestern Conference on
SOMBRERO October 2014
UA study researches
sarcoidosis
Sarcoidosis, the disease of unknown cause that leads to
inflammation and affects the bodys organs, is receiving state-ofthe-art research at the University of Arizona, reports Dr. Ana
Maria Lopez. professor of medicine and pathology at University
of Arizona Cancer Center.
Normally, your immune system defends your body against
foreign or harmful substances, Dr. Lopez said. For example, it
sends special cells to protect organs that are in danger. These cells
release chemicals that recruit other cells to isolate and destroy the
harmful substance. Inflammation occurs during this process. Once
the harmful substance is gone, the cells and the inflammation go
away. In people who have sarcoidosis, the inflammation doesnt go
away. Instead, some of the immune system cells cluster to form
granulomas in various organs in your body.
Dr. Joe G. Garcia, UA Senior VP for Health Sciences, is focusing
on sarcoidosis because though it is relatively rare, it is a
significant disease in Arizona.
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Steven J.
Blatchford,
MD
A. J. Emami,
MD, FACS
James D.
Gordon,
MD
(520) 792-2170
Adam D. Ray,
MD
Green Valley
Sierra Vista
Marana
David T.
Miyama
MD
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Makols Call
a lady who was hearing voices and music at night at home, but
not in the hospital, where she was admitted for observation. We
noticed that even in the hospital she wore large hair curlers at
night, and she told us she usually did the same at her home. She
described in detail the voices and music she was hearing, and it
sounded to me like the nightly show by Rick Shaw, Miamis most
popular DJ.
Back in the Marcus Welby days we actually did housecalls, so
my student partner and I drove out to her address nearby. We
noted that her bedroom faced north, and was almost directly
under a massive WQAM radio antenna, my favorite AM station.
Yes, that was all we had in those days; no Ipods, Sirius satellite
radio or Pandora music service. We only had oldies, but at the
time we did not know that was what they were, only that it was
what we listened to. Anyway, the ladys huge hair curlers were
acting as radio receivers and she was intermittently hearing what
the station was broadcasting. Needless to say, she was discharged
and advised to let her hair down!
This is certainly not to say that everyone who comes in thinking
that they know the etiology of their medical problem is correct,
or even close. Remember that close only counts in horseshoes
and hand grenades. As for medicine, Tyson Herrick wisely said,
Fashion in therapy can have some justification; fashion in
diagnosis has none.
And boy, do we have fashion in self-diagnosis!
A few years ago, almost everyone seemed to have TMJ, or
temporomandibular joint disease, and this was supposedly the
cause of their headaches, fatigue, poor marriages, and failure to
bag an elk when drawn in hunting season. Then, almost every
patient I saw for a while felt they had hypoglycemia, and it was
the cause of their headaches, fatigue, spousal problems, and
their sparse supply of elk jerky.
I dont know about each of you, but I am being bombarded with
patients who think they have celiac disease, wheat allergy, or
gluten sensitivity. I imagine that my colleagues in primary care,
gastroenterology, and allergy/immunology are having the same
experience.
The true incidence of celiac disease is in one person in 133. An
NPD Group poll of 1,000 respondents conducted in May 2014
revealed that about 30 percent, or nearly one in three, is trying to
cut back or avoid gluten in their diets. But being gluten-free does
not mean a certain food product is better for everyone. In fact,
The Wall Street Journal reports that, according to nutritional food
labels, many gluten-free foods contain fewer vitamins, less fiber,
and more sugar than the standard food products. The same
article, published this June 21, notes that manufacturers are
touting foods as gluten-free foods that never contained gluten
SOMBRERO October 2014
www.learnaboutwechv.com
25
CME
Oct. 14: Dermal Fillers and Fat Stem Cells in Plastic Surgery
presented by plastic surgeon John Pierce, M.D. A birthday cake
will be served in honor of Pima County Medical Societys 110th
anniversary Oct. 13.
Nov. 11: Newer Anticoagulants and their Role in A-Fib, DVT, and
Pulmonary Embolism presented by Timothy Fagan, M.D.
October
November
Members Classifieds
MEDICAL EQUIPMENT FOR SALE:
GYNEMED Colposcope. Good condition made by Medtronics with Japanese lenses,
no camera, $500.00 obo. MILEX Western Portable Office Suctions Machine. HandsFree pedal and variable speed with gauge. Good Condition. $50.00. Interested
parties should e-mail: houseofmontrose@msn.com
27
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(800) 352-0402
www.mica-insurance.com
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should not be relied on and may differ from actual MICA policy language. Coverage provided by MICA is always subject to the terms
and conditions of your policy, and MICA strongly encourages you to read your policy in its entirety.
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