March 2012

Member saves member with new CPR Dr. Khaled Hadeli vs. Qaddafi

SOMBRERO••••••••••••P i m a C o u n t y M e d i c a l S o c i e t y • M a r c h 2 0 1 2

Home Medical Society of the 17th United States Surgeon-General

2 SOMBRERO – March 2012

With reimbursements shrinking and the integration of electronic medical records, treating your patients effectively and running a profi table practice has never been more diffi cult.

Mike Hannley understands this, and he has the expertise to provide solutions. Early in his career, he specialized in helping medical and dental practices meet their unique needs—and he’s never stopped, even as President of Bank of Tucson. Now he is making it a Bank of Tucson priority with its Professional Services Division to create individualized solutions for the growing challenges that face the healthcare community.

Visit Bank of Tucson or call Mike Hannley at 520-321-4500. Ask him about what Bank of Tucson is doing to help, and how you can focus on patient care without sacrifi cing the fi nancial health of your practice.

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SOMBRERO – March 2012 3

Official Publication of the Pima County Medical Society Vol. 45 No. 3

PublisherPima County Medical SocietySteve Nash, Executive Director5199 E. Farness Drive, Tucson, AZ 85712Phone: (520) 795-7985 Fax: (520) 323-9559E-MAIL: [email protected]: pimamedicalsociety.org

SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/ September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual sub- scription price is $30. Periodicals paid at Tucson,

Arizona. POSTMASTER: send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily represent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Officers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted.

Copyright © 2012, Pima County Medical Soci-ety. All rights reserved. Reproduction in whole or in part without permission is prohibited.

EditorStuart FaxonPhone: 883-0408E-mail: [email protected] do not submit PDFs as editorial copy.

AdvertisingBill FearneyhoughPhone: 795-7985Fax: 323-9559E-mail: [email protected]

Art DirectorAlene Randklev, Commercial Printers, Inc.Phone: 623-4775Fax: 622-8321E-mail: [email protected]

PrintingCommercial Printers, Inc., Andy CharlesPhone: 623-4775E-mail: [email protected]

Pima County Medical Society OfficersPresident Alan K. Rogers, MD

President-ElectCharles Katzenberg, MD

Vice-PresidentTimothy Marshall, MD

Secretary-TreasurerJohn Curtiss, MD

Past-President Timothy C. Fagan, MD

PCMS Board of DirectorsDiana V. Benenati, MDR. Mark Blew, MD

Neil Clements, MDMichael Connolly, DOBruce Coull, MD (UA College of Medicine)Alton “Hank” Hallum, MDEvan Kligman, MDMelissa D. Levine, MDLorraine L. Mackstaller, MDClifford Martin, MDKevin Moynahan, MDSoheila Nouri, MDJane M. Orient, MDGuruprassad Raju, MD Scott Weiss, MDVictor Sanders, MD (resident)Cambel Berk (student)Christopher Luckow (student)

Members at Large Kenneth Sandock, MDRichard Dale, MD

Board of MediationBennet E. Davis, MDThomas F. Griffin, MDCharles L. Krone, MDEdward J. Schwager, MDEric B. Whitacre, MD

Arizona Medical Association OfficersGary Figge, MD, past president

Thomas Rothe, MD, vice-presidentMichael F. Hamant, MD, secretary

At Large ArMA Board Ana Maria Lopez, MD,

Pima Directors to ArMATimothy C. Fagan, MDR. Screven Farmer, MD

Delegates to AMAWilliam J. Mangold, MDThomas H. Hicks, MDGary Figge, MD (alternate)

Madeline Friedman ABR, CRS, GRI Vice President 296-1956 888-296-1956

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5 D E P A R T M E N T S In Memoriam .................................18Members’ Classifieds ....................26

CONTENTS

20

22

26

14

8

6

On the Cover

This 1957 Maserati 3500 GT Berlinetta, on display at Phoenix’s Biltmore Resort & Spa, was sold in January by RM Auctions for $165,000. For the one-of-a-kind car that didn’t sell, see this month’s Behind the Lens (Dr. Hal Tretbar photo).

President’s Page What will polio eradication look like?

Executive Director’s Page A decade of the breakthrough that is PCAP.

PCMS News Dr. Norman Levine is still with us, thanks to Dr. Marcus Dill-Macky and the new CPR.

Behind the Lens Dr. Hal ‘Travelin’ ’ Tretbar travels to a Phoenix upscale car auction that is its own kind of gem show.

Reality Check Dr. Michael S. Smith on what to be aware of when “swimming with orcas.”

Medical Missions Tucson’s and Tripoli’s Dr. Khaled Hadeli and his year of living revolutionarily.

Conferences & Seminars Don’t forget TOMF’s 21st Annual Southwestern Conference on Medicine coming up in Tucson April 26-29.

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Could we do it again?One of the most significant medical

victories of all time is about to occur—a victory whose progress has spared count-less lives and reduced untold suffering while saving far more money than it cost to create. A program started in the 1930s has been so effective that the charitable organization spearheading it had to rein-vent itself.

The victory is over poliomyelitis, com-monly called polio. This acute viral dis-ease is characterized clinically by fever, sore throat, headache, and vomiting, often with stiffness of the neck and back. In the

minor illness, these may be the patient’s only symptoms. The major illness, which may or may not be preceded by the minor, is character-ized by involvement of the central nervous system, stiff neck, pleocy-tosis in the spinal fluid, and perhaps paralysis. There may be subse-quent atrophy of groups of muscles, ending in contraction and permanent deformity [1].

In the next few years polio will be declared extinct. On Jan. 13, India went an entire year without a single polio case. Its eradication in India is a monumental accomplishment that required untold numbers of dedi-cated healthcare workers and years of dedication. Now only Nigeria, Pakistan and Afghanistan remain as polio holdouts.

Polio has been endemic since ancient times. Egyptian pictographs show withered legs and crutches in the time of the pharaohs. Polio af-flicted many well-known people, from romance writer Sir Walter Scott to actor Alan Alda. Actress Mia Farrow spent time in an iron lung. Polio frequently strikes young children; it was once the worry of every parent. The peak polio epidemic in the U.S. occurred in 1952. I was born in 1954 and remember my mother worrying about polio. I had to nap every afternoon so I “would not get polio” and was forbid-den to swim in the lake near my home for fear of contracting polio. The neighborhood pool was dangerous because of lurking polio.

Ironically, polio epidemics began only when public sanitation and health measures improved in the 20th century. Most people contract-ing the virus do not get disease and afterward have immunity. Polio virus is spread by fecal oral route, so better sanitation left large groups naïve to the disease. Without herd immunity, polio began to attack vast numbers simultaneously.

Karl Landsteiner identified the poliomyelitis virus in in 1908. Hilary Koprowski developed the first vaccine in 1950. In 1952 came the more effective Jonas Salk version. The game changed, however, in 1958 when the National Institutes of Health chose Albert Sabin’s oral polio vaccine for world vaccination because of its low cost, ease of ad-ministration, and great effectiveness.

President Franklin D. Roosevelt founded the March of Dimes in 1938 to raise money to combat polio epidemics sweeping across Amer-ica. Widespread vaccination started in the 1960s was possibly due to government funding, but also because of effective public relations campaigns and political clarity. In a little more than three decades po-lio was gone from the Western Hemisphere. Vaccination programs were so effective that the March of Dimes was forced to find another cause, and changed to its mission to the prevention of birth defects.

A final push for world eradication started just 24 years ago by the combined efforts of the World Health Organization, UNICEF, and

Dr. Alan K. Rogers

the Rotary Foundation. I am proud to say I am a long-term Rotary member, and so I have contributed in a small way to polio’s defeat. Ro-tary has the unique advantage of being a worldwide NGO that is able to cross borders and sidestep Third World geopolitical issues.

Why are Nigeria, Pakistan, and Afghanistan still afflicted with po-lio? Clearly not the lack of scientific knowledge; we know how the vi-rus works and the vaccines are gloriously effective. It is not a lack of funding. Obstacles to vaccinating everyone in countries lacking infra-structure and education are daunting, but these obstacles have been overcome elsewhere.

So what is the problem? A major factor is political. Inadequate and corrupt governments block or fail to aid eradication efforts, and engage in political rivalries and warfare. Parts of the Third World have citizen lack of trust of healthcare workers’ intentions. Reported-ly, a 2005 Islamic fatwah issued in Nigeria declared polio vaccination to be a conspiracy of the United States and United Nations to steril-ize true believers. Total eradication will require overcoming political and cultural obstacles in the Third World more than more funding or a new scientific breakthrough.

But what about the United States? Could we accomplish a victory over polio again? Eradication efforts started in the 1960s, an era with-out our current trial lawyer/liability lawsuit industry. The public gener-ally trusted public officials and public health edicts. The lack of instant media made it hard for crackpots to make their views widely known.

Things have changed.Most Americans alive today do not know polio. Absence of with-

ered limbs and iron lungs have made us complacent. Rates of vaccina-tion for all childhood diseases have fallen due to apathy and cost.

Well-meaning but ignorant celebrities campaign against vaccina-tions for a variety of non-scientific reasons and create mistrust. MTV personality Jenny McCarthy comes to mind. (Reality check: measles vaccination does not cause autism. It just doesn’t. Measles is a serious disease with a significant death rate.)

Mandatory vaccinations became required in the 1960s for school admittance. Would we be able to start mandatory school immuniza-tions today? Possibly not. Texas Gov. Rick Perry famously tried to make human papilloma virus vaccination mandatory but met a fire-storm of protest from conservatives right across to the liberal left. A re-cent bill before the Arizona Legislature would have allowed communi-ty colleges and private schools to opt out of vaccination requirements.

Our mission as physicians must be to overcome hysteria and fuzzy thinking with scientific fact and accurate PR campaigns. We must re-main politically active to combat poorly thought-out government policy. I call on all of us to aid in that effort.

What about the future? Once polio is extinct, vaccinating for it will not be necessary. But will the virus truly be gone? A sobering fact about another extinct disease: the last case of smallpox in the world occurred in a laboratory worker in England. Therefore stockpiles of smallpox virus exist in laboratories around the world. Within a gener-ation our immunity to smallpox will be gone and it will become a po-tent weapon. Could this occur with polio?

I will be interested to see the media coverage when polio is finally declared extinct. I suspect the eradication of polio will not get the at-tention it deserves.REFERENCE

[1] Dorland’s Illustrated Medical Dictionary 24th ed. WB Saunders Co. 1965.

PRESiDENT’S PagE


Steve Nash

The meaning of PCAPExECuTivE DiRECTOR’S PagE

Arizona had 100 candles on its cake Feb. 14, and all of us took a brief look back at a century of progress and hopes from when our state became the last ad-mitted to the union in the lower 48.

Throughout that time, Tucson physi-cians have made breakthrough contribu-tions in making Arizona a livable, attrac-tive place to take a stand. Over the last decade one contribution seems to bubble to the top: the Pima Community Access Program (PCAP).

Begun just after Arizona expanded AHCCCS eligibility to 100 percent of the federal poverty level, PCAP serves our Tucson neigh-bors who work, and earn between 100 and 250 percent of the federal poverty level. Although physicians and hospitals in the pro-gram offer substantially reduced fees, this is no “gimme.” Patients must pay their portion, and most are glad to do so because they want a hand up, not a handout.

Since 2001, PCAP has helped 41,426 Pima County residents. Medical bankruptcies have been prevented, and savings accounts preserved. For more information about the program, or to sign up, call Susa Frasquillo at 309.2931.

Here are the physicians who made this program possible since 2001.

Aiden Abidov, MD Thomas Abram, MDRodney Adam, MDIlana Addis, MDKaren Aderholt, MDPunit Aghera, MDJames Aguilar, MDGeoffrey Ahern, MDNorman Ahl, MDJamil Ahmed, MDTaro Aikawa, MDDavid Alberts, MDStephen Algeo, MDJoseph Alpert, MDTodd Altenbernd, MDRana Ammoury, MDQuinlan Amos, MDQuentin Anderson, MDEmil Annabi, MDRein Anton, MDEmmanuel Apostol, MDManuel Arreguin, MDVeronica Arteaga, MDBoyd Ashdown, MDMatthew Atlas, MDCatherine Azar, MDJohn Badal, MDPhilip Bain, DOMichael Baker, MDVirginia Baker, MDBrock Bakewell, MDFrank Bakke, MDColin Bamford, MDBhaskar Banerjee, MDBrent Barber, MDSteven Barker, MDMitzi Barmatz, MDJeffrey Baron, MDEric Barrett, MDRobert Bastron, MDCharles Bazzell, MDSusan Bazzell, MDJ. Bernardo Bebeil, MDPaul Bejarano, MDMichael Belin, MDMatthew Bell, MDJoseph Bellal, MDM. David Ben-Asher, MDPhilip Benedetti, MDRonnie Bergen, MDScott Berman, MDLynn Bianchi, MDMaria Bishop, MDJohn Bjelland, MDMelissa Bloch-Menschik, MDJohn Bloom, MDJoelle Boeve, MDJennifer Bogan, MDBradley Bohnert, MDDmitry Bolkhovets, MDJoseph Bonomolo, MDMichal Bookman, MDTroy Borboa, MDGuy Borders, MDMarisa Borders, MDSudeshna Bose, MDJohn Boulet, MD

Kevin Bowers, MDThomas Boyer, MDPatrick Boyle, MDRichard Boyle, MDCaryl Brailsford-Gorman, MDBradley Brainard, MDJohn Braunstein, MDWarren Breidenbach, MDDean Brick, MDJenny Brick, MDSteven Brick, MDSteven Brower, MDLansing Brown, MDMack Brown, MDMark Brown, MDThomas Brown, MDRosemary Browne, MDJared Browning, MDEdward Bryne-Quinn, MDAnnemarie Buadu, MDHarvey Buchsbaum, MDPooja Budhiraja, MDDariusz Bulczak, MDKimberly Burkholz, MDRobert Burman, MDKim Burroughs, MDJulien Caillet, MDCraig Cain, MDKaren Caldemeyer, MDDiego Calonje, MDBrian Cammarata, MDAndrew Campbell, MDMichael Capp, MDLigia Paulina Cardenas, MDCarlos Gerardo, MDAnn Carlson, MDKevin Carmichael, MDRaymond Carmody, MDJohn Carolan, MDGordon Edmund Carr, MDHarry Carrozza, MDColin Cavenaile, MDSetsuko Chambers, MDPong Chanvitayapongs, MDSongsiri Chanvitayapongs, MD Ang Chen, MDJohn Chen, MDJason Chesley, MDAnanthakrishna Chilukuri, MDMargaret Chilvers, MDStephanie Chin, MDAlexander Chiu, MDParina Cho, MDKenneth Choi, MDScott Clark, MDCathryn Cohen, MDRussell Cohen, MDAlan Cohn, MDJames Collins, MDBrenda Conners, MDBruce Coull, MDJaniel Cragun, MDLee Cranmer, MDBratu Cristian, MDChristopher Cunniff, MDJohn Cunningham, MDClara Curiel, MD

Stephen Curtin, MDDaines Cori, MDMichael Daines, MDSteven Dalbec, MDShawn Daley, MDMatthew Dang, MDMurray D’Angelo, MDJonathan Daniel, MDMark Davis, MDThomas Davis, MDIves De Chazal, MDMichale De Long, MDGregory De Silva, MDRajen Desai, MDSarah Desoky, MDMarcus Dill-Macky, MDHannah Dillon, MDMegan Dixon, MDLaurie Dodd, MDShona Dougherty, MDJeffrey Dowling, MDLeona Downey, MDTomislav Dragovich, MDKendra Drake, MDSarah Ducharme, MDCurtis Dunshee, MDElka Eisen, MDSean Elliott, MDEmad Elquza, MDDavid Emmerson, MDWilliam Erly, MDAudrey Erman, MDCarlos Escalante, MDLuis Esparza, MDMiguel Estevez, MDLois Estok, MDJames Evans, MDGordon Ewy, MDAmit Fadia, MDLionel Faitelson, MDR. Screven Farmer, MDRonnie Fass, MDJorge Favela, MDThomas Fay, MDSusan Feather, MDMark Feldman, MDRichard Feldman, MDPaul Fenster, MDJose Fernandez, MDDaniel Ferry, MDVictoria Fewell, MDMartha Fielder, MDTerry Fife, MDLisa Finch, MDWilliam Fishkind, MDKimberly Fitzpatrick, MDAmanda Fitzwater, MDGary Flacke, MDDonald Foley, MDStanley Foutz, MDStephen Fox, MDNicholas Fraley, MDIrwin Freundlich, MDArnold Friedman, MDRandall Friese, MDJoel Funk, MDJohn Funk, MD

John Galgiani, MDEric Gall, MDSteven Galper, MDCarlos Galvani, MDDietmar Gann, MDCharles Gannon, MDLinda Garland, MDRouba Garro, MDArnold Gee, MDBrenda Gentz, MDThomas Geron, MDFayez Ghishan, MDWendell Gibby, MDDorothy Gilbertson-Dahdal, MDKatherine Gillaspy, MDChris Glynn, MDCynthia Goldberg, MDSteve Goldschmid, MDGary Goldstein, MDStephen Goldstein, MDIsaac Gomez-Avraham, MDKeith Gonzalez, MDVictor Gonzalez, MDJoes Goode, MDMargaret Goodman, MDDhawal Goradia, MDKaoru (Kay) Goshima, MDRonald Gottlieb, MDRoni Grad, MDWilliam Grana, MDCheryl Grandone, MDRafael Grau, MDJohn Graziano, MDJerry Greenberg, MDMatthew Gretzer, MDKurt Griffin, MDArthur Groves, MDKristen Grubb, MDMarlon Guerrero, MDAlfredo Guevera, MDPuja Gupta, MDAndrew Gyorke, MDKai Haber, MDShahid Habid, MDDavid Hafner, MDStuart Hameroff, MDAaron Hammond, DOLaurence Hanelin, MDAngela Hanga-Roche, MDAileen Har, MDJolene Clark Hardy, MDApril Harris, MDJules Harris, MDHesham Hassan, MDKenneth Hatch, MDLisa Hazard, MDDavid Heaton, MDMichael Hecht, MDAmy Hellbusch, MDJeffrey Hellbusch, MDGary Henderson, MDMichelle Herman, MDAnnette Hernandez, MDMagdiel Trinidad Hernandez, MDEvan Hersh, MDJohn Hettiarachchy, MDRobert Heyer, MD

Thomas Hicks, MDAdora-Marie Higgins, MDGeorge Hishaw, MDBradley Holt, MDCharles Hoo, MDCraig Hoover, MDSusan Hoover, MDHolli Horak, MDRobert Horvath, MDLawrence Housman, MDLori Hudson, MDJohn Hughes, MDDaniel Hughes, MDK. Rebecca Hunt, MDTim Hunter, MDTeh-Li Huo, MDCraig Hurst, MDJose Hurtado, MDMark Iannini, MDRehan Iftikar, MDJulia Indik, MDLindsey Inouye, MDAbraham Jacob, MDWayne Jacobson, MDLeslie Jacobson, MDMindy Jan, MDCameron Javid, MDSasanka Jayasuriya, MDDavid Jeck, MDTracy Jeck, MDJoanne Jeter, MDLalita Jha, MDAdam Johnson, MDDavid Johnson, MDR. Hill Johnson, MDLili Jordan, MDStephen Kaczynski, DOStella Kahn, MDBruce Kaplan, MDVal Kaplan, MDChristos Karabinas, MDPaul Kartchner, MDZane Kartchner, MDLawrence Kaskowitz, MDEmmanuel Katsanis, MDJay Katz, MDJeffrey Katz, MDCharles Katzenberg, MDFarhad Keliddari, MDKevin Kelly, MDKarl Kern, MDRobert Kersh, MDJohn Kettelle, MDKhalid Khan, MDToseef Khan, MDDavid Killion, MDByung Kim, MDJae Kim, MDSteven Kim, MDJay King, MDKim King, MDJames Klein, MDShayna Klein, MDScott Klewer, MDEvan Kligman, MDRobin Kloth, MDStephen Klotz, MD

James Knepler, MDSteve Knoper, MDKenneth Knox, MDSitara Kommareddi, MDLisa Kopp, DOTheresa Kramer, MDEdmund Krasinski, DOSarah Kratz, MDKerry Kreidel, MDVincent Kresha, MDRivitharan Krishnadasan, MDJoseph Kryc, MDHemant Kudrimoti, MDWendi Kulin, MDPhillip Kuo, MDBarry Kusman, MDJohn La Wall, MDGreg Labenz, MDDavid Labiner, MDMartha Laird, MDLareyenth Lancaster, MDClyde Lance, MDM. Peter Lance, MDLou Lancero, MDLisa Lane, MDJulie Lang, MDDavid Lapan, MDMark Lathen, DOLeonard Latt, MDAndrew Laurie, MDMichael Lavor, MDGregory Lawrence, MDDaniela Lax, MDJaime Ledesma, MDJong Lee, MDKwan Lee, MDJohn Anthony Lee, MDLaura Lee, MDHong Lei, MDGerald Lemole, MDJason Levine, MDNorman Levine, MDKai-Uwe Lewandrowski, MDPeter Lichtenthal, MDHoward Lien, MDMark Lin, MDBai Liqun, MDJeffrey Lisse, MDPerry Liu, MDRobert Livingston, MDRobert Loeb, MDJoy Logan, MDAna Maria Lopez, MDMichael Lopez, MDDavid Lorenz, MDPamela Lotke, MDKapildeo Lotum, MDAnthony Lucas, MDDavid Lucas, MDLayla Corral Lucas, MDRichard Lucio, MDUlrich Luft, MDPaul Lui, MDSahba Ma’Ani, MDJames Macdonald, MDMachaiah Madhrira, MDRebecca Madigan, DO


Rebecca Magno, MDDaruka Mahadevan, MDJedidiah Malan, MDJohn Maltry, MDJeff Maltzman, MDAnthony Manson, MDDonald Mar, MDEugene Mar, MDFrank Marcus, MDFernando Martinez, MDRyan Matika, MDMatthew Mazurek, MDAlan McBride, DOMark McClain, MDSean McCafferty, MDAnn McColgin, MDWendy McCurdy, MDN. Troy McDaniel, MDKevin McDonnell, MDKevin McGarvey, MDKimberly McLaughlin, MDShawn McManimon, MDJohn McNerney, MDJohn Medlen, MDLaura Meinke, MDMatthew Mendlick, MDDerek Merrill, MDWilliam Meyer, MDMichael Bracht, MDMargaret Miller, MDThomas Miller, MDTimothy Miller, MDJoseph Mills, MDAmy Mitchell, MDFrank E. Molls, MDGary Monash, MDNicholas Montalto, MDPatricia Montemayor, MDAdolben Montesclaros, MDDavid Moon, MDMonty Morales, MDFrank Morello, MDJessica Moreno, MDWayne Morgan, MDJohn Morrison, MDJeramy Mosburg, DOMichael Moulton, MDPoornima Mukerji, MDBrian Mulkerin, MDKim Mulligan, MDJames Myer, MDAnil Nabha, MDAbhilash Nair, MD

Sita Narayanan, MDNarong Kulvatunyou, MDGil Narvaez-Soto, MDGrant Nelson, MDValentine Nfonsam, MDMike Nguyen, MDNam Nguyen, MDBradley Nichols, MDGregory Nichols, MDJohn Nichols, MDBrian Nielsen, MDWallace Nogami, MDWayne Oakeson, MDSean O’Brien, MDMatthew Offerdahl, MDEdward Oh, MDPeter Oh, MDTerence O’Keeffe, MDJames Okoh, MDJason Oliphant, MDChristopher O’Neill, MDEvan Ong, MDKimball Orton, MDMaria Ospina, MDPeter Ott, MDCharles Otto, MDTheron Ovitt, MDFrancisco Pacheco, MDJeffrey Packer, MDSamata Paidy, MDCraig Palmer, MDBenjamin, Paras, MDMichael Parseghian, MDSairam Parthasarathy, MDChetanbabu Patel, MDJitesh Patel, MDPriti Patel, MDTushar Patel, MDMarc Paul, MDRanie Pendarvis, MDLisan Peng, MDDarren Peress, MDDaniel Persky, MDMark Peterson, MDTodd Peterson, MDRichard Petronella, MDJohn Pettit, MDTheodore Phillips, MDJeanette Pitts, MDGary Podolny, MD Donald Porter, MDJames Posever, MDRobert Poston, MD

William Prickett, MDCheryl Putman, MDRhoda Quick, MDThomas Quigley, MDWilliam Quinlan, MDEduardo Quinones, MDSantiago Ramirez, MDNicholas Ransom, MDTheodore Rasoumoff, MDRobert Rauch, MDYuval Raz, MDStephanie Reddick, MDDaniel Redford, MDHeather Reed, MDBruce Reiner, MDJennifer Reinhart, MDAnnette Revak, MDElson Revak, DOChristopher Reynolds, MDEdward Rhee, MDPeter Rhee, MDBirger Rhenman, MDJoshua Rieke, MDJose Rios, MDFranz Rischard, DOAlejandro Rivero, MDSergio Rivero, MDDonald Roach, MDMurray Robertson, MDHugo Rocha-Mendez, MDWilliam Roeske, MDDavid Rogers, MDLee Rogers, MDSteven Rosenfeld, MDRichard Rossin, MDThomas Rotkis, MDStephen Rowe, MDCreed Rucker, MDAdam Rulnick, MDRyan Barton, MDEgbert Saavedra, MDRizwan Safdar, MDGary Saito, MDJohan Samanta, MDJoseph Samson, MDRicardo Samson, MDO. Sang, DODonnie Sansom, DOSujata Sarkar, MDSam Sato, MDKatalin Scherer, MDMartin Schiff, MDHarry Schlosser, MD

Amy Schneider, MDJulie Schoeneman, MDKai Schoenhage, MDKatherine Schuppert, MDKent Scott, MD Philip Serlin, MDRageev Seth, MDGulshan Sethi, MDJulie Shaffrey, MDRajul Shah, MDSanjay Sharma, MDGary Sharp, MDScott Sheftel, MDZiad Shehab, MDDavid Sheinbein, MDJohn Shekleton, MDJoseph Sheppard, MDScott Sherman, MDScott Sherman, MDMohammed Sikder, MDJohn Siler, MDErica Simon, MDSteven Siwik, MDScott Slagis, MDJames Slattery, MDMarvin Slepian, MDJames Sligh, MDAllen Sloan, MDJoshua Smith, MDM. Christina Smith, MDLinda Snyder, MDMitchell Sokoloff, MDRodney Solgonick, MDBaldassarre Stea, MDThomas Stejskal, MDOtis Stephen, MDLawrence Stern, MDRobert Stern, MDBruce Stevens, MD Michael Stevens, MDBruce Stewart, MDLaiandrea Stewart, MDAlison Stopeck, MDPaul Strautman, MDDaniel Strifoc, MDBenjamin Strong, MDCraig Stump, MDAlbert Su, MDSreekumar Subramanian, MDKrista Sunderman, MDAmy Sussman, MDHarold Szerlip, MDMolly Szerlip, MD

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PCMS NEwS

Member saves memberAn old journalism maxim is that if a dog bites a man, that’s not

news, but if man bites dog, that’s news. On that scale, one PCMS member saving another’s life must be off the chart.

We heard in the February issue of Vistas, newsletter for mem-bers of Ventana Canyon Golf & Racquet Club, in a report by club CEO and General Manager George White, that he recommends the online video explaining the new life-saving cardiopulmonary resuscitation (CPR) technique developed at the UofA College Col-lege of Medicine, available at http://tinyurl.com/2fx8r59. And sub-sequently he had even more reason for the recommendation.

“If you view this video,” he wrote, “you will come away with enough information to assist in a situation where someone’s life is on the line. There is no better example of this than the recent inci-dent at the club where one of our tennis members, Dr. Marcus Dill-Macky, intervened to save the life of fellow member Dr. Norman Levine, by performing chest compressions immediately after Norm collapsed on the tennis court.” Both physicians are PCMS members.

“Dr. Dill-Macky continued compressions until the club’s Auto-matic External Defibrillator (AED) arrived,” White reported. “After several shocks, Norm regained consciousness. Then he was wheeled to a waiting ambulance and taken to TMC where he received triple bypass surgery the following day. I am happy to report that Norm is recovering and should be home from the hos-pital soon.

“Dr. Dill-Macky is the real hero here, thanks to his quick re-sponse and the use of the club’s AED. We hope to see Norm back on the courts playing tennis very soon.”

At PCMS we are equally happy to add that Dr. Levine went home on Feb. 2 and was reported to be doing well.

‘If you don’t vote for my candidate, you’re nuts!’

It’s a year for all things political, so Sombrero is opening it pages to members who have aligned themselves with candidates whom they feel worthy to be our next U.S. Senate member, House of Representatives member, state representative, or county supervisor.

Arizonans in abundant numbers have announced their inten-tions to run. Now it’s time to make your case, an opportunity to persuade your colleagues that the choice you’ve made is the right choice for them in the coming elections. So you are welcome to do it in Sombrero, or possibly a special election edition, for all to read, dissect, and digest.

It’s time for a robust discussion of candidates and we’re here to assist! Interested members willing and anxious to pen an op-ed piece on behalf of their candidate should reach Bill Fearneyhough at the society to talk deadlines and submission guidelines. E-mail [email protected], or call 795.7985.

Dr. Green new TSS presidentDonald “D.J.” Green, M.D.

has been named president of the Tucson Surgical Society, a 90- member, not-for-profit profes-sional organization of physician surgeons, TSS Administrative Coordinator Bill Fearney hough reported Jan. 24.

The 43-year-old board-cer-tified surgeon has practiced in Tucson since August 2011 and is currently with Trauma and General Surgery at University of Arizona Medical Center—University Campus, 1501 N. Campbell Ave., and UMC—South Campus, 2800 E. Ajo Way.

Dr. Green earned his M.D. at University of Washington at Seat-tle. He completed his GS residency at University of Arizona Affili-ated Hospitals, and a fellowship in Surgical Critical Care from the University of Southern California, Los Angeles. He served 10 years on active duty in the U.S. Navy.

He is a Fellow of the American College of Surgeons and a mem-ber of the Association for Surgical Education and the Special Oper-ations Medical Association.

Dr. Green replaces Charles A. Atkinson, M.D., who now serves as TSS past- president.

Dr. Gordon named chief of staffFamily practice physician

Paul Gordon, M.D., M.P.H. has been elected to a one-year term as chief of staff at Univer-sity of Arizona Medical Cen-ter—University Campus, the university reports. The appoint-ment took effect Jan. 1.

“Elected by the hospital’s medical staff, Dr. Gordon will be the chief administrative offi-cer for the more than 700 uni-versity and community physi-cians who practice at The University of Arizona Medical

Center—University Campus. He also will serve as chairman of the hospital’s Medical Executive Committee.

“Dr. Gordon, a professor in the University of Arizona Depart-ment of Family & Community Medicine, has been a board-certi-fied family practice physician in Arizona since 1986. He received his medical degree at Mount Sinai School of Medicine in New York


Creating value in Physician practice’s since 1987

and completed his internship and residency in family medicine at the University of Rochester. He also completed a faculty develop-ment fellowship and Master of Public Health degree at the UofA.

“Dr. Gordon practices full spectrum family practice, including care of hospitalized patients, maternity care and child care. His re-search interests include women’s health, delivering medical services to underserved populations, and education. As a College of Medi-cine professor he teaches and supervises family practice resident physicians and medical students.

“Dr. Gordon succeeds outgoing Chief of Staff Scott Klewer, M.D. Neurosurgeon G. Michael Lemole, M.D., is chief-of-staff-elect. Also elected to the hospital’s Medical Executive Committee are John A. Guisto, M.D., secretary-treasurer; and members-at-large Peter Rhee, M.D., Ana Maria Lopez, M.D., Bruce Kaplan, M.D., and David T. Hafner, M.D.

Dr. Iserson’s book out

Improvising medicine at the District Hospital in Kapiri-Mposhi, Zambia in 2011, Dr. Ken Iserson warms a post-resuscitation severe

preemie with a ‘lightbulb warmer’ (Photo courtesy Dr. Iserson).

Peripatetic and alphabetic Kenneth V. Iserson, M.D., M.B.A., F.A.C.E.P., F.A.A.E.M., Fellow of the International Federation of Emergency Medicine and UofA professor emeritus, reports that McGraw-Hill has just published his newest book, Improvised Medi-cine: Providing Care in Extreme Environments.

“The intended audience is all healthcare professionals who practice in the midst of disasters or other resource-poor settings,” Dr. Iserson said.

A more complete description of the book, including the publish-er’s short-term 20 percent discount offer, can be directly accessed at: h t t p : / / w w w. m h p r o f e s s i o n a l . c o m / p r o m o / i n d e x . p h p ? promocode=iserson&cat=39

The 6x9 578-page paperback retails for $54, or $42.50 with the offer. It is “full of practical clinical pearls and proven strategies” to show you “how to operate outside your comfort zone and devise ef-fective treatment solutions when the traditional tools (medications, equipment, and staff ) are unavailable—or when you need to pro-vide care outside of your specialty.” The publisher calls it “a must for anyone who plans to deliver healthcare under challenging field conditions in global, disaster or other resource-poor settings.”


You can learn how to:3 Make an endotracheal tube in seconds.3 Perform digital-oral and blind-nasotracheal intubations.3 Make plaster bandages for splints/casts.3 Give open-drop ether, ketamine drips, and halothane.3 Use subcutaneous/intraperitoneal rehydration/transfusion.3 Make ORS and standard nutrition formulas.3 Clean, disinfect, and sterilize equipment for re-use.3 Warm blood units in seconds inexpensively. 3 Take/view stereoscopic X-rays with standard equipment.3 Quickly and easily stop postpartum hemorrhage.3 Fashion surgical equipment from common items.3 Evacuate patients easily from high-rise hospitals.3 Make esophageal and precordial stethoscopes.3 Quickly improvise a saline lock.3 Make ECG electrode/defibrillator pads and ultrasound gel. Two Amazon.com reviewers gave the book five stars. J. Hop-

kins: “I highly recommend that it is on every M.D.’s shelf and any person interested in working in a disaster environment would do very well to have this book as well.”

Troy A. Lettieri: “This book does an excellent job of providing advance skills to layman and professional … I have read various books on emergency, primitive, survivalist and backcountry medi-cal care, and none have compared to this text.”

Huethers address kids and sunblock

Amy and Dr. Michael Huether (that’s pronounced “heater”), of Arizona Skin Cancer Surgery Center, P.C., have entered the juvenile fiction category with Ju Ju and the Sunblock.

“As a dermatologist and Mohs surgeon, I know personally how difficult it is to get kids to wear sunblock,” Dr. Huether said.

“My wife and I have six of them who resist it daily. In addition to treating thousands of skin cancer cases every year, I also have a very personal connection. My younger sister, Lisa, was diagnosed with melanoma last year. I am passionate about skin cancer prevention.” The book is dedicated to Auntie Lisa, all other skin cancer survi-vors, and to the memory of those who did not survive.

“This is why my wife Amy and I teamed up to write Ju Ju and the Sunblock. As parents, we recognize the importance of educating at an early age. Ju Ju is intended to be a fun and engaging way for parents to teach their children about protecting their skin from harmful UV radiation,” Dr. Huether said.

“Our goal is to get this tool into the hands of as many children and educators as possible. We hope it will be a message that stays with them for a lifetime. We believe that the more children and families we can reach, the lower their risk for developing skin can-cer later in life.”

Amy and Michael have been married for more than 20 years

and have six children, of whom Jude—Ju Ju—is youngest. Not only is Dr. Huether board-certified, but we’re told “he also knows that Mommy is always right.”

Dr. Huether practices at 5980 N. La Cholla Blvd. The practice’s website is www.azskincancer.com. For more information about the book, please log into www.meetjuju.com.

PCMS Walks With a Doc

This was a happy group of bipedal and quadrupedal walkers at PCMS’s Just Walk/Walk With a Doc event Feb. 11. Walk With a Dog is optional (Steve Nash photo).

Pima County Medical Society, along with Carondelet Health Network and El Rio Health Centers, has joined the national orga-nization Just Walk/Walk With A Doc, and has started programs for patients to walk with a physician this year.

“All our missions involve improving public health,” PCMS Ex-ecutive Director Steve Nash said. “We want our neighbors all to be-come more active and one way to do that is to show them that they indeed can walk a mile.”

Beginning last month, PCMS, CHN and El Rio each began to host one walk on three different Saturdays every month through May, and probably will throughout the summer and into fall. Each walk will be led by a physician who will give a brief overview of the benefits of exercise, and answer general questions during the walk.

You can send your patients to any of the walks. Sample prescrip-tion pads were sent in our newsletter. Walks are open to anyone, and courses are generally flat with some small hills. Advise patients to wear comfortable shoes. They may bring a cane or walking stick, and a bottle of water.

“Patients should be advised that a monthly walk should not be their only physical activity,” Nash said. “They are free to come again, but we really just want to give them the confidence, and a safe place, to start walking.”

Walk schedules are posted at www.pimamedicalsociety.org . CMS and Carondelet use Rillito River Park. Have patients use the parking lot on the east side of Swan, just south of the bridge. The group meets at the ramada by the water fountain.

PCMS began Feb. 11 and will walk March 10, April 14, May 12, and June 9. For the March walk, please arrive between 7:30 and


7:50 a.m; it will begin at 8 a.m. April through June, please arrive between 6:30 and 6:50 a.m. Walks will begin at 7 a.m. For any questions, please call 795.7985.

Just Walk/Walk With a Doc is a program founded in 2005 by David Sabgir, M.D., a board-certified cardiologist in Columbus, Ohio, and now has 40 sites nationwide. Just Walk is a non-profit organization dedicated to encouraging healthy physical activities for people of all ages and fitness levels. For more information, the website is www.walkwithadoc.org.

Committee invites members, guests for SE AZ tour

PCMS members can join the PCMS History Committee on a jaunt to Southeast Arizona on Saturday, April 14, for a guided tour of Fairbank, Tombstone and (if there’s time) the jail/museum in Gleason.

There is no charge, you can drive or ride, and any PCMS mem-ber and guest are eligible to go. Please call 795.9484 to reserve your spot. The tour will leave from the PCMS parking lot at 7:30 a.m.

Seeking RR hospital historyThe committee has been considering subjects for its oral history

and lecture projects sponsored by the Southern Arizona Transpor-tation Museum, and considers that the history of the Southern Pa-cific Hospital, as told by the physicians who worked there, would be of interest to both the railroad-transportation community as well as the medical community, reports Dr. Ken Sandock, commit-tee member and director-at-large of the museum.

“We would like to identify and contact the doctors who trained and practiced at the SP Hospital, along with nurses and others who may have been associated with the hospital. We feel that this will be mutually beneficial.”

Please call Steve Nash or e-mail [email protected] if you can be of help to the History Committee in this effort.

PCMS 2012 meetingsThe ArMA Annual Meeting (delegates only) is June 1-2.Our coming Regular Membership Meetings are Tuesday Nov.

8, 7 p.m. including reading of the nominees slate, and Tuesday Dec. 11 after the Board of Directors meets, for ballot count and declaration of election winners.

Coming PCMS Board of Directors and Executive Committee (officers only) meetings are:BOARD: EXECS: Tues. March 27, 6:30 p.m. Tues. Mar 27, 5:30 p.m.Tues. April 24, 6:30 p.m. Tues. April 24, 5:30 p.m.Tues. May 22, 6:30 p.m. Tues. May 22 5:30 pm (Memorial Day May 30) Tues. June 26, 5:30 p.m.Tues. Aug. 28, 6:30 p.m. Tues. Aug. 28, 5:30 p.m.Mon. Sept. 24, 6:30 p.m. Mon. Sept. 24, 5:30 p.m. (Yom Kippur starts Sept. 25) Tues. Oct. 23, 6:30 p.m. Tues. Oct. 23, 5:30 p.m. Tues. Nov. 13, 5:30 p.m.Tues. Dec. 11, 6:30 p.m. Tues. Dec. 11, 5:30 p.m.

Pima County Medical Foundation schedules Evening

Speaker SeriesPima County Medical Foundation’s Evening Speaker Series

is on the second Tuesdays in February, March, April, May, June, September, October, and November, often including CME. Din-ner is at 6:30 p.m., speaker’s presentation at 7. Coming topics con-firmed as of this month are:

March 13: Compression-only CPR with Dr. Karl Kern.April 10: Bruce Parks, M.D., retired Pima County medical ex-

aminer, presents a forensic pathology lecture in honor of the late Dr. Richard Froede.

January monthly reportReferrals to physicians: 133Meeting rooms occupied: 28.5 percent (8 a.m.-10 p.m., seven

days per week)Executive Committee: PCMS President Alan Rogers MD pre-

sided Jan. 10, 5:40-6:15 p.m.The license revocation case involving a former Pima County

physician was discussed and the board will be asked to support a formal hearing request.

Several carryover items from the last board meeting were also discussed, and preparations made how to present them to the board.


Board of Directors: PCMS President Timothy Fagan MD pre-sided, then handed the meeting to new PCMS President Alan Rog-ers MD, Jan. 10, 6:35-7:35 p.m.

The new PCMS Board of Directors introduced themselves to one another, then got down to business, approving a letters to go out and a resolution for the ArMA meeting in June. The board ap-proved support for a former Pima County physician now appearing before the licensing board, and heard reports from AHCCCS and the UofA College of Medicine.

Housekeeping rules and policies were reviewed. Under a new schedule, the board does not meet again until March.

The Board of Mediation, Chairman Edward Schwager MD, did not meet in January.

Public Health Committee: Jane Orient MD presided Jan. 9, 12:18 -1:17 p.m.

Committee members met with state Rep. Matt Heinz MD (D-29-SE Tucson) to discuss his mental health reporting bill aimed at stopping incidents like the shooting of Rep. Gabby Giffords. It has gone from a notification action to a referral to a crisis line. He is also considering putting into statute the common law right that a gun owner has the right to refuse service to anyone. This will be sent to the PCMS Board of Directors to consider support.

A discussion was held about adjuvants added to vaccines and the possibility these might cause allergies.

The committee also looked at a supplement being offered to physicians to give to patients in Tucson.

Bioethics Committee: David Jaskar MD, chairman, presided Jan. 17, 12:39-1:10 p.m.

The committee made several important changes to the case being prepared for publish-ing in Sombrero. It also decided to take a look at the ethics surrounding triage and emergencies.

History Committee: Chairman James Klein MD.

The committee met on Jan. 10. No more details were available at press time.

Pima County Medical Foundation, Inc.: President James Klein MD.

The Foundation met on Jan. 17 and made sure the final details of the year’s Evening Speaker Series were done.

Regular Membership Meeting: The meet-ing on Jan. 10 coincided with the PCMS Board of Directors meeting and attendees were able to comment on plans the board was making for 2012.

Odds & Ends: PCMS joins Maricopa County Medical Society and the Arizona Med-ical Association in hosting a Legislative Recep-tion every year, and this year’s was abuzz about the resignation of Rep. Giffords and all the candidates gearing up to replace her. With the new congressional district for Arizona, Marico-pa legislators also were jockeying for position, making a fine stew of whispers and political thinking during a very interesting, low-key event Jan. 23.

PCMS was involved in a DEA hearing and learning the details of a Recovery Audit Con-tractor probe in January.

Planning continues for an Exercise is Medi-cine conference in March.

Alan Rogers MD and Tyna Callahan from the PCMS Alliance walked the PCMS course for Just Walk, a monthly effort by PCMS to get patients more active.

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From off a line to one of a kindWhen I grew up in a small

town in central Kansas during the 1930s and ’40s, there were always some old cars around. By old I mean aging Ford Mod-el As and Ts and an occasional Chevy. I do remember a run-down Chrysler limousine parked in someone’s yard that had mouse droppings on the seats. There were few that would draw your attention when they drove by, maybe a Buick from the local dealership.

There is one car that sticks in my mind. It belonged to Joy

Thompson, who had the local radio repair shop (remember when you had to replace burned-out tubes?). He had a garage in back of his shop where he kept his favorite auto. I remember sneaking in to look at it from time to time. It was a large, elegant sedan with the finest mohair upholstery. The dash was full of shiny instruments. But it was the headlights that set it apart. The car was a late 1920s

or early ’30s Pierce-Arrow with those bug-eye lights that flared into the swooping fenders. I can still picture it like it was yesterday.

In the last century America fell in love with the automobile, and the affair continues. There are major car collector auctions across the country throughout the year, from Las Vegas, Nev. to Florida. January 15-20 is a big week for Scottsdale and Phoenix for car auc-

tions. There are at least four major ones, and several lesser ones.

Recently I attended the upscale RM Auc-tion at the Biltmore Hotel Resort and Spa. On the Friday I was there, 75 cars were sold. A va-riety of highly desirable vehicles were first dis-played on the grassy lawn and then auctioned in the ballroom. All had been preserved or re-stored to as good as new condition and were fully drivable. Examples and final bids ranged from a 1914 Rolls-Royce Silver Ghost Lan-daulette ($550,000); a 1934 DeSoto Airflow Coupe ($52,250); a 1970 Ford Mustang Boss 429 Fastback ($170,500); a 1927 Isotta-Fra-schini Tipo 8A Boat-tail Tourer ($407,000); a

The body of this 1920 Pierce-Arrow is covered in 23-karat gold leaf. The hood and fenders are nickel-plated.

The Pierce-Arrow’s interior metal parts are silver-plated. The third passenger sits on a jump seat on the

left because the steering is on the right.


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2005 Porsche Carrera GT ($374,000); a 1903 Waverly Electric Surrey ($110,000); a 1957 Ferrari 410 Superamerica Coupe ($1,815,000); and finally a German 1964 Gogomobil TS400 Coupe ($27,000).

As I was making my way around the hotel grounds drooling over the marvelous machines, a glint of gold caught my eye and then my gaze lit on those wonderful prominent flared head-lights. A 1920 Pierce-Arrow glistened like a golden beacon in the sunlight, and what a story lay behind this singular treasure.

In 1920 a new Pierce-Arrow Model 48 2/3 Passenger Coupe was delivered to Emerson Carey of Hutchinson, Kan. He was the founder and owner of the nationally known Carey Salt Company. The auto had a 48hp six-cylinder engine, a three-speed gearbox, the solid front axle and the live rear axle had leaf springs, and was stopped by two-wheel mechanical brakes. Unusual for such a large car, it had seating for only three people, two in the main seat and one on a jump seat on the left. All Pierce-Arrows were right-hand drive until 1921.

It remained with the family in Hutchinson (40 miles from my home town of Stafford) un-til 1945 when it was sold to a wealthy collector

The Pierce-Arrow coupe is remarkably preserved after being restored 40 years ago. Here it is shown on the auction turntable.


This elegant 1914 Rolls-Royce 40/50 Silver Ghost Landaulette sold for $550,000.

.

in Great Bend, Kan., 30 miles from Stafford. You just never know where fascinating old cars might be hiding!

The new owner spent nearly 30 years restoring the car. He had decided to do something unusual and different, so he had skilled workers cover the aluminum body with 23-karat gold leaf! Then every inch of the chassis and engine was plated with either gold or nickel. All interior fittings were silver-plated. Black leather finished off the rest of the interior. Few people saw this car until it went on display in Denver in 1974.

Among the high-dollar cars a German import, this chummy 1964 Gogomobil Coupe, was a bargain when it sold for $27,500. It is one of only four in the U.S

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Remarkably preserved after nearly 40 years, this Pierce-Arrow is truly one of a kind, yet it was not sold at RM because it didn’t meet the reserve price of about $200,000.

The Pierce-Arrow Company, established in 1901, was always oriented to the upper-end market, and it closed in 1938 after fail-ing to survive the Great Depression.

Thanks to Amy Christie, public relations for RM Auctions, for the history of this marvelous Pierce-Arrow Coupe.


Dr. Gerald Giordano, 1943-2012iN MEMORiaM

Dr. Gerald F. “Jerry” Giorda-no, IM physician specializing in hematology and oncology, who joined PCMS in 1975, known as “Dr. G” and in his family as “Grandpa Bear,” died Feb. 8 at his Tucson home surrounded by his family, they reported in the Arizona Daily Star Feb. 16. He was 68.

Gerald Francis Giordano was born Feb. 20, 1943 in Phil-adelphia, where he earned his A.B. degree at LaSalle College. He earned his M.D. at Temple

University in 1968, including a summer research fellowship.He interned at Temple University Hospital in IM and Universi-

ty of Rochester (N.Y.) School of Medicine. He did residencies in hematology at Rochester and in oncology at Arizona Medical Cen-ter Division of Radiology Oncology. He also was a research assis-tant and instructor at Rochester.

He was a diplomate of the National Board of Medical Examin-

Dr. Gerald Giordano in 1984.

ers and the American Board of Internal Medicine, and a member of Alpha Epsilon Delta Honor Society, Babcock Surgical Honor Soci-ety, and Phi Rho Sigma Fraternity. He published on topics includ-ing marrow cell egress: central interaction of barrier port size and cell maturation; and effects of sulfhydryl inhibitors on granulocyte function.

He moved his family to Tucson in 1973 to start his practice, and he was on staff at St. Joseph’s Hospital and Tucson Medical Center. “He was a brilliant, compassionate, and dedicated physician,” his family said. “He was a remarkable man and dearly loved husband, father, brother, uncle, grandfather, and friend. We will miss and re-member him always.”

Dr. Giordano was a longtime supporter of PCMS and its mis-sion. In 1979-81 he served on the PCMS Board of Directors and as a delegate to ArMA. In 1982 he and Dr. Steven J. Ketchel added Dr. Robert J., Brooks to their IM-hematology-oncology practice on North Country Club Road. Also that year Dr. Giordano served on an AMA Council on Scientific Affairs national advisory panel on the use of aphaeresis in treatment of disease. At the time he was medical director of El Dorado’s Hospital’s Aphaeresis Unit.

In 1983 Dr. Giordano was honored by the 88-CRIME Board of Directors for his help in convicting a self-proclaimed cancer spe-

cialist of fraud. “Giordano testified as an expert witness in the trial in California of Vlastimil Milan Brych, 44,” the Arizona Daily Star re-ported Sept. 14, 1983. “The jury found Brych guilty of 12 felony counts involving defrauding cancer victims in California. Brych was given six years in prison.”

In 1985 Dr. Giordano chaired the PCMS Board of Mediation. In 1987 he was elected Professional Education Chairman of the Amer-ican Cancer Society. In 1897 he served on the medical staff of Sierra Vista Community Hos-pital. In 1989 he chaired the PCMS Group In-surance Committee. In 2001 he resumed his position as medical director for United Blood Services in Tucson

Dr. Giordano’s wife, Bev; sister Joy Galante and her sons Stephen, Robert and Richard; sons Jerry Jr. and Dave; daughter Kristin; step-son John Wallace; stepdaughter Nicole Pierce; and 11 grandchildren survive him.

A funeral Mass was celebrated Feb. 13 at The Church of St. Pius X in Tucson. The fami-ly requests that memorial donations in Dr. Giordano’s name be made to the St. Pius church, or the charity of the donor’s choice.

By Stuart Faxon

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Swimming with the orcas‘In nature there is no right or wrong, only consequences.’

REaliTY CHECK

Dr. Michael S. Smith

An Alaskan cruise ship happened upon several deer swimming across an inlet. Suddenly, several orcas appeared, attacking the deer, killing the whole group. The passengers screamed, begging the captain to “do something.”

There was, of course, nothing the cap-tain could do, or should have done. This is how nature works, predator and prey, sur-vival of the fittest. We may find such things horrifying, but deer feed other animals, as well as breeding and making more deer.

It is the way of the world.Unfortunately, I didn’t like the way of the world when lightning

caused Minnesota’s Pagami Creek Fire. It was monitored, because wilderness fires are beneficial to the ecosystem. Jack pine seeds can only open after a fire, and I’ve seen large forests of young jack pines 10 years after a major burn. Unfortunately, one day the fire explod-ed, running 12 miles, ultimately burning 92,000 acres. Re-growth has already begun, but I will never again wish to travel my favorite route to Lake Insula.

It is the way of the world.Large fires have burned huge swaths of Minnesota, the last big

one in 1918. That fact has not stopped many on the Iron Range from blaming the fire on the Forest Service or “radical environmen-talists” like me. Scientists know fire belongs; if there is anything “radical,” it is the idea that forests, like life itself, are immutable.

Often, many who decry big government are quick to ask where government is when there is a disaster. Wildland firefighters, who save so much property and risk their lives, are part of “big govern-ment.” A PCMS member once made a pejorative remark to me about “government doctors.” I think those of us who were medical officers, including the VA physicians who trained all of us, might feel differently. The previous vice-president, who never wore a uni-form, referred to those 16 percent of us against the Iraq invasion as traitors. I want every president to succeed, because if they fail, we are in big trouble. If being against a war is treason, wishing a presi-dent to fail borders on such, unless there is a double standard.

Alas, double standards are the way of the world.To many, government is inherently bad. But as long as we have

people with differing opinions on how they choose to live—and end—their lives, we need some form of government to regulate what each of us can and cannot do. This regulation costs money, and good regulation should be worth the money spent. If we as a collective society want certain benefits, like clean air and acid-free rain, which formerly were problems, or rivers that don’t catch fire, which Ohio’s Cuyahoga did, then we either have to pay for these changes through taxes or do without.

If millions of people can’t get medical care, then we as a people

need to decide whether it is worth paying for them to obtain such care. Each of us has a stand on an issue; sometimes we get our way, sometimes not. To me, the concept of drowning government in a bathtub would lead to anarchy, misery, and death for millions who are not well off, along with no national defense. I don’t want that.

We did canoe in Minnesota, just not where we had hoped. While the fire was beneficial, we are likely to see more of these as boreal rainfall patterns are changing to savannah-like ones with floods and droughts, rather than an even weather pattern, a change ascribed to climate change. The oceans are more acid, the Ksp (solubility prod-uct) of calcium and phosphate will now, with 30 percent more hy-drogen ions, cause deterioration in shell formation. This is a major concern, since the oceans are acidifying at a rate 100 times faster than ever recorded during the past 20 million years. Carbon dioxide + water=carbonic acid. Nearly every glacier is retreating, and the volume of cubic kilometers of fresh water entering the ocean will further change the climate. This isn’t bad, it just is, unless you are human, live on a coast, eat seafood, or get your water from a glacier, as do Peruvians and Indians, in which case it is a huge concern.

Every prediction of the future must quantify uncertainty; to do otherwise is unscientific. No argument I’ve heard against climate change has stated a p-value, confidence interval, or margin of error. The late New York Sen. Daniel Patrick Moynihan said, “You can choose your opinions, but not your facts.”

The International Panel on Climate Change is 95 percent confi-dent, which we statisticians consider high. Using a cold week or a record low as a counter-example shows an inability to distinguish between local weather and global climate, which is basic to under-standing climate change. For the record, Tucson temperatures have been above normal every year since 1984, and the normals have been raised three times. In Tucson there have been 6.5 times as many record highs than lows since 2001 (142/22). Our rainfall def-icit is 2.5 years in the last 15. These are facts.

No argument I’ve heard against climate change has been free of personal attacks. Ad hominem arguments have nothing to do with science, obscure the issue, and dilute and degrade the attacker’s the-sis. The subject is climate change, not what hikers wear. I have dis-cussed the science using statistics, which may be confirmed. To clarify, I have been to ANWR twice, hiked 120 miles in three of its major river valleys, including 1002, and I find it and Antarctica among the most beautiful places on Earth. I strongly disagree with those who disparage ANWR or deny climate change without hav-ing ever seen or understanding each respectively, and I have consid-erable knowledge of both topics.

Of course, some scientists, ever fewer, do not agree, but the vast majority of reputable scientists believe manmade climate change has occurred. Percent occupancy of the globe is statistical misuse. Fukushima is 0.0003% of Japan’s area, but radioactive Cesium contaminated 10% of the country.


It is the way of the world that as a statistician, I frequently see statistics misused (99.999996% of aircraft flights in the U.S. were not hijacked in 2001). Mankind has never encountered CO2 levels this high. We are running an uncontrolled experiment; worse, models are under-predicting the consequences. The average temperature has risen, weather patterns have changed over-all, huge amounts of fresh water are in the Arctic Ocean, and the higher sea level has already caused problems. These are facts.

It is the current way of this world, which like the forests, is not immutable.

When I was a neurologist, I often delivered bad news. I do so again as a scientist and writer. As a physician, I changed my patient management in the face of convincing evidence. I believe I have convincing evidence about the world’s climate. I believe if nobody speaks out against those who disagree, and I continue to be polite with my choice of verbs, misinformation will continue. I am call-ing them out; I will not be silent.

It is the way of my world.The voters who elected this Congress believe that they will ben-

efit from smaller government. Ironically, many of these voters will need SSI and Medicare, which may be cut. They are deer, and they actually want to swim with the orcas.

Sadly, it is the way of their world.

Sombrero columnist Dr. Mike Smith’s blog is http://michaelspinnersmith.com, where there are previous Reality Check columns, outdoor writing, descriptions and pictures of National Parks, Alaska hikes, eclipse-chasing, mental arithmetic, op-eds, and two non-technical neurology articles that physicians might enjoy.

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The year of living revolutionarilyBy Dr. Khaled O. Hadeli and Stuart Faxon

Dr. Khaled Hadeli had a helluva 2011. So did grandiloquent, near-mad Libyan dictator Muammar al-Qaddafi. Fortunately, the brute came out of it dead, while Dr. Hadeli merely got tired from nation building.

Dr. Hadeli, a native Tripolitan, is a partner with eight physicians in Tucson Pulmonology and has practiced here since 2003. Before that he was on the faculty of then-UPH/Kino Hospital.

He is a graduate of Libyan University Medical School, Tripoli, and did his IM residency at the UofA. He is fellowship-trained in pulmonary and critical care medicine.

To say the least, “It was a very busy year for me and my fami-ly,” Dr. Hadeli said. “It started in January at a quiet pace, re-volving mainly around the news of the ‘Arab Spring’ and the Tu-nis and Egypt revolutions.

“On Feb. 15 the news of revolt in Benghazi started to surface. On Feb. 20, Tripoli, my hometown, joined with peaceful pro-tests, calling for freedom and respect to the people in Benghazi. Both protests were dealt with in a violent way by Qaddafi’s forces.

“The entire country followed the movement and war erupt-ed over almost all of Libya. Since its beginning, it was as if were climbing on a roller coaster that, when it reached the top, came down at high speed for more than eight months, ending with the capture and killing of Qaddafi and one of his sons. The whole country was dragged into a war that ended 42 years of dictatorship. Libya was once an extremely wealthy country with low population, only 2.5 million as of 1969. During Qaddafi’s four-decade dictatorship Libya became a very poor and under-developed country with a bad reputation, having been one of the main sponsors of international terrorism.

“During the revolution I was involved in many projects; it was amazing I was able to keep my job!” Dr. Haedli said.

“The first could be called ‘Tucson to Zentan.’ Jo Samaha, a medical supply provider in Tucson, kindly donated tools and supplies worth almost $50,000. I made my request to him after I saw a spokesman from Zentan on the news, stating that a sur-geon had to amputate limbs using household tools to save fight-ers’ lives, due to lack of basic medical equipments. The supply was shipped to Zentan by help from Medical Teams Interna-tional of Portland, Ore.

“On March 21 I gave a talk, ‘Qaddafi’s 42 Years of Achieve-

ments,” as part of the UofA’s Near-Eeastern Studies panel discussion.

“In April North American Libyans had a meeting in Wash-ington, D.C., at which the Libyan community in North Ameri-ca attempted to organize itself to help the revolution in Libya. I took the role of medical relief coordinator/USA. This started many committees and coordinated at least some of the medical and humanitarian activities out of the USA.”

The National Transitional Council (NTC) is the interim high authority in Libya, Dr Hadeli said. “It was established on Feb. 25, a week after the crisis began, by Qaddafi Minister of Justice Mustafa Abduljalil. Recently the NTC formed the inter-im government, passed the executive duties, and retained the legislative high authority pending establishment, by election, of a national congress, at which time the NTC will have complet-ed its mission. The national congress will be the high authority empowered to write the constitution and oversee the first demo-cratic election of government and parliament.”

Late in April, Dr. Hadeli said, the minister of health for the NTC asked him to join an advisory committee to the minister. “I chaired this committee until the end of its existence. We had one-to-two-hour meetings, sometimes daily, for at least five months. This role enabled me and five other colleagues from Canada, the U.K., Qatar, and the U.A.E. to officially participate in humanitarian activities.”

Dr. Hadeli said that the “Medical Supply Containers to Lib-ya” project was a team effort that included Hesham Fallah, a Libyan oral surgeon from the San Francisco Bay Area. “He facil-itated communication with Medshare, a surplus medical con-sumable supply company that provided us with 42-foot con-tainers full of consumable medical supplies at fraction of what it would cost otherwise. Medwish, another supplier, also contrib-uted with some containers,” Dr. Hadeli said. “Hope Interna-tional Relief and Development of Columbus, Ohio took care of fund-raising and collection for this project. Thanks to Messrs Shwehdi and Huedi, the logistics part of this project was cov-ered with no problems. The estimated value of all containers was $3 million.

“In July, a trip to Tunis and Libya enabled me to meet with the Tunisian officials and the Tunisian head of Red Crescent to help facilitate transport of medical supply containers from Tuni-sian ports to Libya. I also met with my displaced family, who had to stay in Tunis for three months during the revolution.

“I attended the first medical relief multi-organization meeting

Dr. Khaled O. Hadeli


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On the Libyan-Tunisian southern border checkpoint, Dr. Hadeli shows a collection of Qaddafi’s ammunition for use on the Libyan people, captured by freedom fighters in early July 2011.

in Sfax. The highlight of this visit was the travel inside Libya with a small team of doctors, including the very active young Libyan physician Anas Baio, who was running the humanitarian medical relief in Tunis for a good part of the revolution. I traveled all the way to Gwalish, the last point, 2 kilometers from the fire line and 25 kilometers from Gerian, which was then a stronghold of Qad-dafi’s forces. We visited most hospitals in the region and held a large meeting with the heads of all hospitals and NTC health rep-resentatives from all cities in the western mountain area. We or-ganized medical evacuation protocols and treatment of wounded, and visited the front mobile unit at Gwalish.”

Dr. Hadeli made his third visit to Libya in October, which in-cluded evacuating wounded to the U.S. “Af-ter the capture of Tripoli by the revolutionar-ies and a week before the capture of Qaddafi, the minister of health asked me to attend a meeting with American Ambassador to Lib-ya Gene Cretz. I helped organize the evacua-tion of 26 Libyan wounded to Spaulding Hospital in Boston, and six critically wound-ed patients to a German hospital.

“During this visit I also met with NTC leadership, the minister of health, the min-ister of war wounded, the head of Tripoli’s governing council, the acting president of Tripoli University, and the head of Tripoli Medical Center. All meetings revolved around wounded evacuation, medical sup-ply distribution, and health system devel-opment and structure for the new Libya. Along with local colleagues and my brother,

we founded the nongovernmental organization in Tripoli to facilitate supply distribution in Libya.”

Dr. Hadeli had what he calls “a minute of fame” when he did an interview with KUAT’s Ar-izona Illustrated that was aired on NPR. He also gave two talks at the UofA Eller College of Man-agement, on Libyan history and on medical hu-manitarian activities to Libya during the crisis.

“There were other events that took place in the 2011,” he said. “Some were good and some not. But thank God, all ended well. My youngest son Zackariya was born March 22. My mother-in-law visited us during the birth of my son. She had to undergo an emergent surgery that was complicated by heart failure, respiratory failure, kidney failure, and a 10-day stay in the ICU. I discharged her on the day I was traveling to Libya on my first visit.

“My parents visited in September and my father had to be admitted to the ICU for a tongue hemato-ma! I worked in ICU for 20 years but never saw one! This took place during my second visit to Libya.

“I was asked to submit my CV to be considered for Libyan min-ister of health in November, but I respectfully declined, as it was my recommendation that the MOH should be from among local Libyan doctors or health experts. Also, I ran out of energy by then!

“Finally, the boys missed out on vacations and annual trip. They did well during the events; Nizar donated all his savings during one of the local fund-raising events. Nader helped his mom with the baby and gave us less trouble than usual. So they were awarded an end of the year visit to Disneyland!

“I am grateful to my lovely wife for her support, especially taking care of Zack and our ailing parents. I am also grateful to


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my partners, associates, and Tucson Pulmonology staff for their support during my very hectic year. My colleagues at Tucson Pulmonology are doctors Neil Clem-ents, Sunil Natrajan, Brian Shon, James McCartan, Yuya Huang, Chuck Reilly, Annu Mallampalli, and Ubair Ahmed.

“I’m looking forward to a relaxing and quiet 2012!”

Two kilometers from the fire line at Gwalish, Dr. Hadeli and a group of doctors inspect signs leading to the field hospital.

Nation in transitionLibya is at high noon on the map of Africa,

bordered by Algeria and Tunisia to the west, the Mediterranean Sea to the north, Egypt to the east, Sudan to the southeast, and Chad and Ni-ger to the south.

With an area of almost 700,000 square miles, Libya is the fourth largest country in Africa by area, and the 17th largest in the world. The largest city, Tripoli, is home to 1.7 million of Libya’s 6.4 million people. The three traditional parts of the country are Tripolitania, Fezzan, and Cyrenaica.

In 2009 Libya had the fourth-highest GDP (PPP) in Africa, behind Seychelles, Equitorial Guinea and Gabon. Libya has the 10th-largest proven oil reserves of any country in the world, and the 17th-highest petroleum production.

As a result of the civil war of February to Oc-tober 2011, the Libyan Arab Jamahiriya, which had then existed for 34 years, collapsed, and Libya entered a period of governance by an ad-ministration called the National Transitional Council. The NTC has stated its intention to oversee the first phase of a transition to constitu-tional democracy, after which it claims it will dissolve in favor of a representative legislature.

Source: Wikipedia

Pima County Medical Society is…

THE PATIENT RESOURCE: More than 5,200 patients per year call for information about doctors. The only other places to call are the Arizona Medical Board and the managed care plans.

INFORMATION: Leaders, politicians, and regulators use PCMS’s nexus to spread the latest medical ideas, developments, and legislation.

ACTION: PCMS is connected through the state association and the AMA to get things done at the appropriate levels. It maintains con-tact for you, with the county board of supervi-sors, local state legislators, and Arizona’s con-gressional delegation.

VOICE: Strength and order are in numbers, rather than in the loudest and most recent out-burst. Through careful consideration of issues, the medical society is your voice to the public, media, government, hospitals, and managed care organizations.

LIAISON: PCMS has members serving on various boards and advisory panels throughout the community.

FRIENDSHIP: If you have a problem, we’re here to help. We respect and honor physi-cians and can get confidential answers to almost any concern. At PCMS, we’re colleagues, not competitors.

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Course targets pulmonary physicians, internists, hospitalists, and specialists in critical care medicine, bringing together a multidisciplinary faculty. “Lec-tures by leaders in pulmonary and critical care medicine, pulmonary pathology, and radiology provide a comprehensive approach to the current evaluation and management of various respiratory diseases.”

Course features “new and pertinent information regarding developments in respiratory and critical care medicine, including Pulmonary Literature Review and Critical Care Literature Review.” Program includes option to attend the American Board of Internal Medicine (ABIM) SEP Medical Knowledge mod-ule for Update in Pulmonary Disease and Update in Critical Care Medicine.

Contact: Lora Jacobson, Mayo School of Continuous Professional Devel-opment, [email protected]; phone 480.301.4580; fax 480.301.8323. Web-site: http://www.mayo.edu/cme/pulmonary-medicine-2012s495

April 26-29: Tucson Osteopathic Medical Foundation presents the 21st Annual Southwestern Conference on Medicine, offering CME for DOs, MDs, PAs, and NPs, at JW Marriott Star Pass Resort & Spa, Tucson.

CME: 26 AMA PRA Category 1 Credit; 26 AOA Category 1A; four more credit hours available with bonus workshops. Early registration: $500 for active physicians, $400 for retired physicians, NPs, and PAs. After March 31, $550 for active physicians, $450 for retired physicians, NPs, and PAs. Register online at www.tomf.org/cme, or call 520.299.4545 for more information.

AugustAug. 3-5: The Mayo Clinic Cardiology Update 2012 is at Enchantment Re-

sort, 525 Boynton Canyon Rd., Sedona 86336; phone 928.282.2900. CME cred-its to be determined.

Program covers a wide spectrum of topics in CHF/heart transplant, coro-nary artery diseases, cardiac arrhythmias, and adult congenital heart diseases, among others. “Participants will learn about the new anticoagulants available to use in patients with atrial fibrillation techniques, percutaneous aortic and pulmonic valve replacement, and new devices for the treatment of CHF.”

Course targets practitioners in adult cardiology, cardiovascular surgeons, cardiovascular trainees, general internists, and allied health personnel with a cardiovascular interests. Contact: Staci King, CME Dept., Mayo Clinic Scottsdale, 13400 E. Shea Blvd.; phone 480.301.4580; fax 480.301.8323. Website: www.mayo.edu/cme

SeptemberSept. 15: Mayo Clinic Acute and Chronic Leukemias 2012:

A Case-Based Discussion is at Mayo Clinic Education Center, 5777 E. Mayo Blvd., Phoenix 85254; phone 480.301.4580.

CME: 7.5 AMA PRA Category 1 credits. American Os-teopathic Association (AOA) 7.5 hours of Category 2-A cred-it. American Academy of Family Physicians (AAFP) credit pending.

This one-day comprehensive workshop designed for physi-cians, nurses, NPs and PAs presents attendees with a case-based analysis on the diagnosis, treatment, and challenging real-world scenarios with chronic myeloid leukemia, myelo-proliferative neoplasms, myelodysplastic syndromes. acute myeloid leukemia, chronic lymphoid leukemia, acute lympho-cytic leukemia, the role of stem cell transplant in 2012, and challenges to the nurse, NP, and physician in caring for leuke-mia patients.

Contact: Heather Langdon, Mayo School of Continuous Professional Development, Mayo Clinic, 13400 E. Shea Blvd., Scottsdale 85259; phone 480.301.4580; fax 480.301.8323. Website: http://www.mayo.edu/cme

Sept. 28-29: The Mayo Clinic Symposium on Concus-sion in Sport is at Mayo Clinic, 13400 E. Shea Blvd., Scotts-dale 85259; phone 480.301.4580. AMA, AOA, AAFP CME credits to be determined.

Concussion has become a major public health priority that transcends age, gender, and sport. The under-reporting and

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recognition of concussion, and the potential for short-term catastrophic conse-quences and disabling long-term neurological impairment from repeated con-cussions, has prompted passage of legislation in many states that requires im-mediate removal from play of an athlete suspected of having concussion, mandatory concussion education of all those who intersect with an athlete, and return-to-play clearance by a qualified healthcare provider.

Symposium highlights the epidemiology of concussion in sport and mili-tary combat; pathophysiology of concussion; sideline and outpatient clinical evaluation; standard and novel diagnostic strategies; and implementation of return-to-activity guidelines. Format includes platform lectures, small-group workshops, panel discussions, and live two-way remote audio/video concussion evaluations using robotic teleconcussion technology. Faculty are renowned sci-entific and clinical experts in concussion from Mayo Clinic and leading U.S. academic medical centers. Targets athletic trainers, athletic directors, allied health professionals, and physicians interested in evaluation and case manage-ment of people with concussion.

Contact: Jodi Lee Beert, Mayo School of Continuous Professional Devel-opment, [email protected]; phone 480.301.4580; fax 480.301.8323. Web-site: www.mayo.edu/cme/internal-medicine-and-subspecialties-2012s814.

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