San Diego Health - Spring 2024

Her path leads to purpose - A cancer survivor helps others heal

PATH PURPOSE Her leads to

A cancer survivor helps others heal

PLUS Women’s Health Through the Decades How Clinical Trials Advance Medicine 100th Anniversary of Scripps Health and more



Follow us @ScrippsHealth SCRIPPS CORPORATE LEADERSHIP Chris D. Van Gorder, FACHE President and Chief Executive Officer John B. Engle Corporate Senior Vice President, Marketing and Communications; Chief Development Officer, Scripps Health Foundation MANAGING EDITOR Laura Dennison COPY EDITOR Dave Flynn CONTRIBUTING PHOTOGRAPHERS Mark Dastrup, Bob Ross


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3 HEALTHY LIFE Tips to spring clean your wellness routine, how to stay healthy in your 30s, 40s, 50s and beyond, making fitness more fun, new options in virtual medicine and more. 23 SPOTLIGHT Looking back on Scripps’ 100-year history and reflections from longtime employees and volunteers.

3 0 CELEBRATING BY CANDLELIGHT Supporters celebrate the 92nd Annual Scripps Candlelight Ball. 3 2 DOC OFF THE CLOCK Scripps Clinic neurologist Leonard Sokol, MD, on the joys of fatherhood.

FINDING PURPOSE BEYOND BREAST CANCER A battle with breast cancer inspired a former tech executive to give back and help others facing a cancer diagnosis. 16


Your Care is Just a Click Away

At Scripps, we’re here for you and your family—with convenient in-person and virtual care. Now it’s easier than ever before to connect with the care you need, when you need it. We have a variety of options to schedule online and offer same-day, on-demand visits.

Same-Day Visits

Online Scheduling

Scripps offers several options for same- day care with on-demand video visits

You can also schedule your next appointment online. Most primary care doctors, as well as many specialists, now offer online scheduling using either or MyScripps.

New! Scripps now offers same-day, on-demand primary care video visits with Scripps Clinic and Scripps Coastal Medical Center providers. On-demand video visits with a primary care providers are a convenient and easy way to get health care for a variety of issues. Simply log in to MyScripps to start your visit. You will be assigned a provider based on availability—and your visit will begin in minutes.

Your MyScripps App Makes it Easy

All Scripps digital health options, including Online Scheduling, Video Visits, E-Visits

and Symptom Checker are available through MyScripps, our secure and convenient online patient portal.

Simply download the free MyScripps app to connect with your health using your mobile device

For minor illnesses and injuries, on-demand Scripps HealthExpress video visits are

also available seven days a week.*

*Always call 9-1-1 for life-threatening concerns.

To learn more about your options and to find a doctor who is right for you, call 858-358-6079 or visit


Spring into Good Health

Health is our greatest asset. Scripps is dedicated to improving the health of our community and empowering San Diegans to take charge of their own health and well-being. In this issue, you'll find dozens of expert tips to help you live your healthiest life well into the future.



Women’s Health

Through the Decades

For most women, life at 30 looks very different than it does at 50. Just as your life continually changes, so do your health care needs and concerns. Here, Scripps Clinic physicians address the most common health issues in your 30s, 40s, 50s and beyond.

30 s Your 30s In your 30s, preventive care is key. If you don’t already have a good relationship with a primary care physician—whether they are an internal medicine doctor, family physician or OB/GYN—now is the time to establish one. “Prevention is better than cure and is the heart of what we do in primary care,” says Dana Mourad, MD, internal medicine physician, Scripps Clinic, Carmel Valley. “Between the ages of 20 and 40, a lot of our focus is on investing in our health and trying to prevent disease as much as possible.” Diet and exercise are important at any age, but during your 30s, building healthy habits for a lifetime really comes into play. Quality sleep, stress management and strong social connections are also important components of good health. Make sure you’re up to date on recommended immunizations and preventive screenings, including an annual skin cancer check for any unusual spots. Pap tests for cervical cancer are recommended every three years unless you have had an abnormal result or risk factors. Another common concern in a woman’s 30s is family planning. Whether you're hoping to start a family, prevent pregnancy or have questions, your doctor can help you focus on your health. Pregnancy after age 35 is considered high-risk, so it’s especially important to understand the risk factors and any special care you might need. If your primary care doctor does not provide gynecologic care, schedule an annual visit with an OB/GYN also. “Even if you aren’t planning to get pregnant, the female anatomy is complex,” says Dina Fainman, MD, OB/GYN, Scripps Clinic. “We have expertise in a variety of womens' unique health issues.”

Your 40s In addition to Pap tests and skin checks, you’ll

likely have your first annual mammogram to screen for breast cancer at 40 and your first colonoscopy

for colon cancer screening at 45, if you are at average risk. Your doctor also may recommend cholesterol screening. If you’ve put off starting a family until now, talk to your doctor about the challenges associated with pregnancy later in life. “Women should recognize that fertility declines quite significantly after 40. Not only is it more difficult to become pregnant, but the risk of complications also rises,” says Dr. Fainman. “Still, I absolutely talk to these patients about contraception, because it is possible to become pregnant at this age.” Another concern is perimenopause, a transitional period before menopause when women experience hormonal changes. “The big talk that I have with my patients in their 40s is menopause awareness, because perimenopause starts one to five years before the official menopause transition,” says Dr. Mourad. “Menstrual changes, hot flashes, night sweats, sleep problems, vaginal dryness—these are all symptoms women may experience as part of the transition to menopause, and there are ways to help them navigate these changes and make them easier.”

40 s



5 Questions to Ask Your Primary Care Provider 1. What preventive care do I need? Immunizations, cancer screenings and preventive care can help ward off disease or detect it early. Your recommended preventive care depends on various factors including your age, medical history and lifestyle. Be honest with your doctor about your diet, exercise, alcohol or substance use and family medical history—these all help determine what is best for you. 2. Do I need to make any lifestyle changes? Again, being transparent with your doctor about your lifestyle is vital to optimal health. Downplaying your alcohol intake or glossing over feelings of depression or anxiety ultimately make it more difficult to get the appropriate care. Your doctor is there to help you, not judge you. 3. What are my biggest health risks? No one wants to think about potential health problems, but it is important to understand if you have an increased risk of any diseases and what to do about it. Heart disease, for example, is the leading cause of death among women; risk factors include age, high blood pressure, high cholesterol, smoking and early menopause. 4. Should I take supplements? Grocery and drug stores have entire aisles devoted to supplements for joint health, sleep, mood, weight loss, skin care—you name it. Ask your doctor if there are supplements you should be taking, such as calcium and vitamin D, to help prevent bone loss. 5. Should I be concerned about [fill in the blank]? Pain, weird skin spots, digestive issues, hair loss, painful sex—if something is “off” or you’re concerned about it, speak up early in the appointment, even if it seems minor. Where your health is concerned, there are no stupid questions!

Your 50s Plus The average age for menopause— defined as 12 months without a

menstrual period—is 52, but it can vary widely. Estrogen levels drop significantly after menopause, and this decline is associated with changes to weight, hair and

skin, as well as vaginal symptoms and more. “There is a misconception that weight gain in the 50s is related to menopause, but studies have shown this is not true,” says Dr. Mourad. “Midlife weight gain is related more to aging and lifestyle, whereas changes in body composition and fat distribution, such as more fat around the abdomen, are indicative of menopause." Production of collagen, which gives skin its elasticity, drops by about 30% in the first five years post-menopause and continues to fall over the next 20 years. Part of this is due to the decline in estrogen, but genetics, sun exposure, diet and the environment all play a role. “Genitourinary symptoms, including pain with sexual intercourse and more frequent urinary tract infections, affect one in every two women post-menopause,” says Dr. Fainman. “Often women don’t recognize how significant their symptoms are until they talk to me about it.” Estrogen also can affect bone density, so your doctor may recommend a bone density scan at age 65 (or sooner if you have a family history of osteoporosis). Vaccinations and preventive exams remain important into your 60s and 70s. You’ll continue to have Pap tests as recommended until age 65; mammograms and colonoscopies usually end around age 75. “Regardless of your age, if you have concerns about your health, don’t hesitate to talk to your doctor about them,” says Dr. Mourad. “We have a lot of options and, together, we can find ways to manage them.”

50 s+

To learn more and find a physician who is right for you, visit



into Health g


PRING IS THE PERFECT TIME to turn the focus back to you and take steps to improve your health. Th e natural world is in renewal mode; you can be, too.

Whether you’re currently in tip-top shape or have chronic conditions in need of management, there are numerous ways to steer yourself toward better health, says Stephen Shapero, MD, family medicine physician, Scripps Coastal Medical Center, Carlsbad. “Many of my patients—from adolescents to senior citizens—claim they plan to do something to improve their health ‘down the road,’” Dr. Shapero says. “I understand it’s human nature, but we all need to start today.” Spring clean your health and wellness routine with these tips from Dr. Shapero.

Schedule “Me” Time For Better Mental Health To improve physical health, take time to nurture mental health. Make it a priority to replenish yourself and relax. Find ways to manage stress and connect with friends and loved ones. Clean Up Your Diet Add more seasonal fruits and vegetables—aim to get at least fi ve servings daily—to your diet. Also, add in healthy fats (limit re fi ned oils or fried foods), whole grains, lean meats and low-fat dairy products. Stay Hydrated Hydration is always important—our bodies are roughly 60% water—but becomes even more so as the weather heats up and as we ramp up our exercise levels.

Move Your Body, Preferably Outdoors Th e standard minimum recommended time of moderate-intensity physical activity is 150 minutes per week. You don’t need to become a marathon runner; walking or gardening will su ffi ce, as long as your muscles are activated. Exercising in the sunshine adds a mood-enhancing bene fi t. Protect Your Skin And Eyes From UV Rays Californians need to be even more vigilant with sunscreen. Wear sunglasses, wide-brimmed hats and garments with long sleeves and pants while outside. Th ough studies have shown daily sunscreen use has little e ff ect on vitamin D production, seniors may bene fi t from vitamin D supplements. Even with adequate sunshine, older skin does not produce enough. Stop Smoking And Vaping E-cigarettes are not a safe alternative to smoking. Both contain cancer-causing chemicals. Your physician can help you develop a cessation plan.

Get Adequate Sleep You’re too busy to “waste” time on sleep? Th ink again. Adults generally require at least seven hours nightly. Inadequate sleep can hinder your immune system and sense of well-being. It’s not a luxury; it’s a necessity. Address Springtime Allergies Outdoor and indoor allergens can both be disruptive. Changing home air fi lters can help, as well as avoiding outdoor activities on high pollen days and taking over-the-counter allergy medication. Schedule Annual Checkups Yearly physicals include screenings for cancer and heart disease, recommended immunizations and discussions with your doctor about family medical history. Don’t put o ff this important check-in.



New Options in Digital Health

“Digital health is here to stay. Having everyone online, being able to schedule online and having options where you can see physicians virtually, it’s all working very well together.” !"#$%&#"'()*(+*,-#."/#."0*&(1" /(#&0$-"&21,+/$)&,2",11&0(+." $/34-$),+5"656)(/6."60+&776" *($-)*."$2#"&2)(+2$-"/(#&0&2(" 7*56&0&$2."60+&776"0-&2&0 available at, allows patients to see wait times for all Scripps HealthExpress locations then notify their desired location that they are en route. Once notified, staff at the selected location place the patient in the queue. “On My Way is a great way to prepare for your visit and reduce your wait time,” says Dr. Wetherhold. “Imagine, you need to be seen and you go to a walk-in clinic and the line's out the door. This gives you an estimation of what kind of a wait to expect.” For those who are less tech-savvy or simply prefer to do things the traditional way, Dr. Wetherhold stresses that options for setting appointments over the phone and in-person doctor visits aren’t going anywhere. “Patients are loving telehealth, but in-person options are not going away,” he says. “We always enjoy seeing people face-to-face.” To learn more about Scripps' digital health options, visit

Convenient care options for Scripps patients are just a click away

 SCRIPPS PATIENTS HAVE MORE WAYS than ever to get connected to the care they need when they want it. In addition to the virtual care and telemedicine options patients embraced during the pandemic, Scripps now offers a variety of timesaving same-day, digital health options, including on-demand video visits with a primary care doctor, online appointment scheduling and a convenient way to check wait times at Scripps HealthExpress locations. “Digital health is here to stay,” says David Wetherhold, MD, chief medical information officer, ambulatory systems, Scripps Health, and internal medicine physician, Scripps Clinic. “We're seeing close to the 20% mark for our overall telehealth visits, which is pretty impressive, and we have about 85% of our patients on MyScripps online patient portal. Having everyone online, being able to schedule online and having options where you can see physicians virtually, it’s all working very well together.” Scripps’ convenient on-demand video visits with a primary care provider bring health care to patients. Scripps expanded its on-demand options to include primary care. The service is available to current Scripps Clinic and Scripps Coastal Medical Center patients who already have a Scripps primary care physician. It’s available Monday through Friday, 8 a.m. to 7 p.m., and weekends, 8 a.m. to 5 p.m. Wait times are generally around 10 minutes. “It may not be an on-demand visit with your primary physician, but it will be a Scripps provider who has access to all your records,” says Dr. Wetherhold. Patients who prefer to see their established doctor can now view all available appointment times and schedule their appointment online at Many Scripps Clinic and Scripps Coastal primary care physicians and specialists offer online scheduling, and more are adding the service. Other digital advances include On My Way for Scripps HealthExpress visits. This feature, also



How to tell if your child’s injury requires medical attention Know Where to Go

“It’s never the wrong answer to bring children in to be seen. Or if you’re not quite sure what you should do next, then it’s also never the wrong answer to call, and we can give guidance.” !"#$%&'())"$*(+,"-.,"#$&/00#"$'/+/$ “We see a lot of musculoskeletal injuries in children once they become mobile. Th at means things like ankle sprains or falls or tripping on things,” says Scarlett Chen, MD, pediatrician, Scripps Clinic, Rancho Bernardo. “We also sometimes see head injuries, especially when kids are learning to roll or move around, since they tend to be a bit more uncoordinated. In older kids, injuries can be caused by getting hit by objects during sports or other activities.” E VERY PARENT DREADS THE MOMENT their bundle of joy gets hurt. It’s bound to happen sooner or later, but there’s a big di ff erence between run-of-the-mill bumps, bruises and scrapes that can be treated with Band-Aids and booboo kisses and more serious injuries that require a visit to the doctor, an urgent care clinic or the emergency department.

Dr. Chen says the number one indicator as to whether an injury can be treated at home or requires medical attention is pain. Severe pain, worsening pain or pain that can’t be managed with over-the-counter medications, like ibuprofen, should be checked out by a doctor. So should any injury that comes with numbness, tingling or a weak pulse, or a head injury accompanied by vomiting, vision, hearing, speech or behavioral changes. In cases of sprains and strains, if your child can’t move or put weight on the a ff ected area without pain, have it evaluated. “If the child’s pain is mild and you’re able to manage it at home with over-the-counter medications, then give it a few days. If things are getting better, then we don’t necessarily need to see them. If things are getting worse or not improving, we would de fi nitely like to see them,” she says. So, should you wait for an appointment with your child’s pediatrician, fi nd an urgent care clinic or head to the hospital? Open wounds or an obvious deformity warrant an immediate trip to the emergency room, says Dr. Chen. Also, if you’re worried about blood fl ow to an area or are unable to move a joint, also head to the emergency room. For possible fractures where your child can still move and their pulse feels normal, urgent care or primary care are reasonable options for evaluation. Urgent care tends to have more immediate access to imaging, but some primary care physicians can also do imaging to evaluate for fractures or other abnormalities. Urgent care may also be the right destination for a minor wound that needs stitches. If you’re still unsure, err on the side of caution and seek help, Dr. Chen says. “It’s never the wrong answer to bring children in to be seen. Or if you’re not quite sure what you should do next, then it’s also never the wrong answer to call, and we can give guidance.”





Five ways to make getting and staying healthy more fun Radiating Health


BRING A BUDDY Everything’s more fun with a friend or family member by your side. If you’re working on fitness, try creating an obstacle course for you and your kids, taking a group class or setting your smart watch to participate in a group challenge. “By linking up, you keep each other on track and challenge each other,” Dr. Urbina says. “Friendly competition brings out a lot of good change in people.” Another suggestion: The next time a friend asks you out to dinner, spend the evening cooking together instead. Cooking for yourself is a much healthier option than eating out, Dr. Urbina says. Plus, cooking with others means more hands on deck when it’s time for dishes. SQUEEZE SOME HEALTH INTO DOWNTIME If you like listening to music or podcasts to relax, try doing so while going for a run or chopping vegetables. “You can even stream a show while prepping food,” Dr. Urbina says. “You’re still able to mentally shut off, but you’re also cooking, or doing something good for your body.” MAKE IT MANAGEABLE Deciding to transform your life overnight can be overwhelming.

 DOCTORS HAVE LONG KNOWN about the physical and mental health benefits of having fun. Things like laughing, playing and taking part in activities you enjoy have been linked to better heart health, lower stress levels, reduced risk of illnesses, better sleep and improved mood and energy levels. But what about the not-so-fun activities we do to stay healthy, like exercise or eating our veggies? Is it possible to up the fun factor and make these more enjoyable? Katherine “Kati” Urbina, DO, internal medicine physician, Scripps Coastal Medical Center, Hillcrest, says yes. “It’s not always easy to change your lifestyle, especially when it comes to being healthier. It can upend your schedules and routines and leave you really uncomfortable, but it is possible to improve your health and have some fun while doing it,” she says. These tips from Dr. Urbina will help make healthy activities more fun. BUY NEW GYM CLOTHES Looking good can help you feel good, too. Invest in workout clothes that you love. And while you’re at it, go take that gym selfie. “Why not show off a little bit? That’s going to help form the positive reinforcement that makes you want to go back to the gym again,” says Dr. Urbina.






And, according to Dr. Urbina, it also can be ineffective. “I recommend making one or two small changes every two weeks, and giving those new habits some time to get really locked in,” she says. “Over time, those small changes add up, and you’ll have made long- lasting improvements.”

If the gym isn’t your scene, you’ve come to the right city. “In San Diego, it’s so easy to get outside,” Dr. Urbina says. “Any activity that gets your heart rate up is a great option.” That could be running, biking, dancing or playing catch with friends. Adding ankle weights or moving at a quicker speed makes something as simple as walking also a great option.



Darryl D'Lima, MD, PhD, director, Orthopaedic Research Laboratories, SCORE, Scripps Clinic, is part of a team of physicians and scientists driving some of the most advanced orthopedic clinical studies.

How Clinical Trials

Advance Medicine

Scripps researchers take new discoveries from the bench to the bedside


WHAT IS A CLINICAL TRIAL A clinical trial is a research study in which patients volunteer to help researchers test a new treatment, drug, procedure or technology. An investigator or company brings forward a new idea and compares its e ff ectiveness to that of existing treatments. Th is approach leads to incremental advances in the standard of care and, ultimately, better outcomes for patients; each step is with the perspective of the physician, patient and community in mind. Clinical trials also give patients access to therapies that may yield better results for them than more widely known treatments. Currently, around 90 clinical trials are underway at Scripps in such fi elds as cancer care, cardiology and orthopedics. “ Th e biggest impetus for clinical trials is when we have a disease or a condition that is not responding in all cases to our available traditional treatments. Th at’s when we know there’s a gap, and we need to fi ll that with science and innovation,” says Dr. Fortmann. “When we have clinical trials at Scripps Health, we give that patient one more option.”


happens separately from medicine. At Scripps, research is a critical part of the mission to provide the best care to patients. Many promising new treatments begin in clinical trials. Th e knowledge gained from these clinical studies helps advance the quality of care for people in San Diego and beyond. “Every single treatment, drug intervention and care item we deliver to our patients started with research,” says Addie Fortmann, PhD, Chief Research O ffi cer at Scripps. “When we go to the hospital, emergency room, primary care physician or a specialist visit, the care provided wouldn’t be delivered if it didn’t start with research. Research is really the foundation for medicine.”



THE PATH TO PATIENT USE Th ough the medications, devices or procedures being tested in a clinical trial are new, patients can rest assured that there’s a lot that goes on before it can be used on humans. When researchers make a new discovery, it’s fi rst tested under controlled conditions in the lab. “When it comes to complex human beings, there are a lot of di ff erent factors that can determine the outcome of a particular treatment. But in the laboratory, you’re able to isolate the mechanism of action of a particular new treatment, study it and show that it works,” says Th omas Buchholz, MD, C hief S cienti fi c Offi cer and medical director, Scripps Cancer Center, and radiation oncologist, Scripps Clinic. For new drugs, scientists may then move on to test for both the e ff ectiveness of the treatment and e ff ects on other organs in the body. Th e drug also undergoes a rigorous

Clinical trials can also focus on collecting patient data. For instance, Scripps made medical history with its development of a smart electronic knee implant for patients who needed knee replacements. Th e “e-knee” measured the distribution of forces on the implant from such activities as walking, exercising and climbing stairs, then transmitted that data to computers at Scripps Clinic’s Shiley Center for Orthopaedic Research and Education (SCORE) in real time via tranducers, a microtransmitter and an antenna. Not bad for the late ’90s and early 2000s, before Wi-Fi was widely available. Previously, designers of arti fi cial knees had to estimate force on the knee joint using force plates, cameras and computer modeling. Th eir calculations could vary greatly. “Knee replacements were failing a little more o ft en than we were comfortable with,” says

safety study to gauge potential toxicity. If everything checks out, researchers go to the Federal Drug Administration and apply for an investigational new drug license, which allows them to begin clinical trials. Clinical trials happen in phases. In Phase I, researchers test their new discovery in humans for the fi rst time. Researchers adjust dosages and watch for side e ff ects in a very small cohort of patients. In Phase II, the study is expanded to a larger patient population and researchers study safety and e ff ectiveness. For Phase III, the cohort is expanded even further. Some participants are given the new treatment and others, the standard treatment or a placebo. Dr. Buchholz notes that medical devices have a di ff erent pathway for FDA approval. “Medicine continues to advance all the time, and it’s exciting. And it does predominantly through clinical trials. Whenever there’s a new drug introduced for any type of disease, it has gone through a series of clinical studies to prove that it’s e ff ective,” says Dr. Buchholz. “It’s very important for an institution like Scripps to be involved in clinical trials.” If you’d like to learn more about clinical trials at Scripps, your primary care physician or specialist is a good place to start. Or your doctor may notify you if you’re part of a speci fi c patient population that’s eligible for an upcoming trial. Your physician may be initiating the trial or may be part of the investigative team. To learn more, visit

Darryl D’Lima, MD, PhD, director, Orthopaedic Research Laboratories, SCORE, Scripps Clinic. “We found that knee design was still stuck in the old way of designing components. It was a painful, laborious process, and most of the complications were related to excessive force.” Th e team also rethought their methods of collecting data. At the start of the study, they were observing a small number of patients in a controlled setting as they performed everyday tasks like walking, exercising or getting out of a chair. Th ey later took them on a hike at Torrey Pines State Natural Reserve and let them play sports like golf and doubles tennis. Th e researchers found that some movements, like a golf swing or even an accidental stumble, exerted much more force on one or both knees than originally thought. Dr. D’Lima notes that the team was having a hard time getting their research published—until pro golfer, Tiger Woods, sustained a stress fracture and strain to his leading knee. Th ey were then recognized with an award from Th e Knee Society, a prestigious membership organization for thought-leaders in knee arthroplasty. Results of the groundbreaking Scripps study gave scientists and engineers working on knee replacement the ability to design more e ffi cient and longer-lasting prostheses. It also helped establish what activities would be safe, moderately safe or risky for patients who have undergone a knee replacement surgery. An X-ray of the first electronic knee implant developed to measure force on the knee joint to design more efficient and longer-lasting prostheses.



that acupuncture also works at the brain level in areas, such as the limbic system, to reduce ampli fi cation of the pain caused by conditions that include migraine, fi bromyalgia and low back pain,” says Robert Bonakdar, MD, director of pain management, Scripps Center for Integrative Medicine, Scripps Clinic. Acupuncture can be used on its own to treat many forms of acute or chronic pain, but works best when combined with other therapies, such as medication or physical therapy. At Scripps Center for Integrative Medicine, doctors combine conventional Western medicine with evidence-based alternative therapies, such as acupuncture, to prevent, heal and reverse disease. “ Th ere’s very strong evidence supporting the use of acupuncture as a singular therapy, but it’s even more impactful when used as an adjunct therapy. It's something that can be personalized based on a patient’s needs,” says Sarah Dalhoumi, MD, integrative women’s health specialist with expertise in medical acupuncture, Scripps Center for Integrative Medicine, Scripps Clinic. “When we tackle pain through an interdisciplinary approach, using a lot of di ff erent treatments that work synergistically well together, we get the best outcome.” In addition to reducing pain, acupuncture has been found, in some studies, to also lessen a patient’s need for pain medication. But it’s not a quick fi x. Th e doctors note that while acupuncture is a safe and e ff ective way to help manage pain, it does require a trial period of at least six to eight treatments and must be continued regularly for ongoing bene fi ts. Most commercial insurance plans have covered acupuncture for some time, and in 2020, Medicare followed suit for Part B enrollees with lower back pain. Speak to your primary care physician or pain management specialist about any concerns you may have. “Keep an open mind. With any new treatment, you’re always going to assess the risk-to-bene fi t pro fi le, and with some standard treatments, like medications, the risks are greater than the bene fi ts,” says Dr. Dalhoumi. “When you're looking at acupuncture, there's great bene fi t to be had for many, and the risk is pretty negligible. Research supports the use, and if we're trying to treat from a whole-body approach with the best outcome and least side e ff ects possible, we need to be thinking about acupuncture as a mainstay treatment.”

WELLNESS Acupuncture and Pain Management

The practice may help chronic pain sufferers find relief


OR THOUSANDS OF YEARS, practitioners of traditional Chinese medicine have been using acupuncture to treat various conditions and relieve pain. Now, in an e ff ort to deal with increasing rates

of chronic pain, as well as ongoing issues related to the opioid epidemic, many people are turning to the practice for a natural approach to pain management without narcotics. Acupuncture is the relatively painless practice of inserting very thin sterile needles into strategic points on the body and leaving them in for a predetermined period of time. It’s thought that the therapy balances energy fl ow, stimulates the central nervous system, triggers the release of endorphins and activates the body’s natural healing abilities. Studies have shown that acupuncture can be e ff ective in treating chronic or recurring pain, such as migraine headaches and back injuries. “Acupuncture is an ideal option for those dealing with chronic pain, because we know that it can provide local relief by reducing muscle tension or tissue in fl ammation. What is less appreciated is




New Surgery Burns Away Back Pain

 Whether it’s a sharp, sudden pain or a constant dull ache, chances are you’ve experienced some type of lower back pain. One of the most common medical complaints in the U.S., back pain affects up to eight out of 10 people. In most cases, the pain goes away on its own with rest, physical therapy and medications.

For some, however, the pain becomes chronic, persisting for three months or more, and often interfering with everyday activities. Spinal injections may help temporarily, but the pain often returns. Spinal fusion surgery, which joins the affected segments of the spine to help reduce the pain, has variable success rates, as well as the risk of long-term complications. “Among our chronic back pain patients, a subset has historically been exceptionally difficult to treat,” says Kevin Barrette, MD, a Scripps Clinic physiatrist and interventional pain specialist. “These patients are likely not getting better because of what’s called vertebrogenic pain, caused by damage to their vertebral endplates.” Vertebral endplates are the protective barriers located between your vertebrae (the bones of your spine) and the soft disks that cushion them. Disk degeneration caused by injury or aging can damage the endplates and irritate the tiny basivertebral nerve that passes through each vertebra and branches off to the endplates. “Over the past decade, scientists have looked into why people are getting these very specific endplate changes, called modic changes, and what supplies sensation to them to cause pain,” explains Dr. Barrette. “Could we potentially get rid of these pain signals by killing the nerve that transmits them?” The answer is yes. A new minimally invasive procedure called basivertebral nerve ablation—or BVN ablation— essentially burns away the problem. While the patient is sedated, the surgeon creates a small incision in the back and, using tiny instruments, places an electrode over the basivertebral nerve, then heats it with radiofrequency energy. “It’s essentially like a root canal for your spine,” says Dr. Barrette, who has been involved with BVN ablation from its earliest stages. “We kill the nerve, which disrupts its ability to transmit pain signals from the endplates to the brain.” The procedure takes about 60 minutes; patients go home the same day. There is really no downtime, although Dr. Barrette advises his patients to take it easy for a week or so.

BVN ablation is FDA-approved and covered by Medicare. Candidates should have pain that is only in the back (not down the leg), worsens with certain movements or sitting for a long period of time and has lasted at least six months. They should have tried rest, physical therapy, epidural injections and other nonsurgical treatments without relief. An MRI must show modic changes to vertebral endplates. Dr. Barrette estimates that 75% of patients who meet all these criteria will have at least a 50% improvement in pain. Most patients have multifactorial pain, meaning their pain is due to modic changes and other factors. Patients whose pain is caused solely by modic changes may have full relief. Like any surgical procedure, BVN ablation has some risks, but they are relatively minimal. Spinal nerve irritation can occur in up to 10% of patients and typically goes away within six weeks. “It’s really an incredible treatment that has changed the way we treat back pain patients, especially in younger patients who used to get spinal fusion surgery,” says Dr. Barrette. “And as far as we know, this nerve does not regenerate, so the relief is long-lasting.” To learn more about Scripps orthopedic services and spinal care, visit



Helping Those Who Hurt, Without Being Hurt Ourselves


doctors, nurses and other health care workers. Ongoing clinical training— a standard in health care—is now regularly augmented with training in violence de-escalation, self-defense and the proper completion of police reports. Special wristbands and door emblems help to identify patients who may be violent, and unique codes are called overhead for de- escalation assistance or help from security. Katrina Grossmann, RN, has been an emergency room nurse for 10 years. She worked at multiple hospitals in the U.S. before happily landing at Scripps Mercy Hospital, San Diego, last year. “At every emergency room I’ve worked in, sta ff have experienced some form of violence from a patient or family member on every single shi ft ,” says Grossmann, who recently witnessed a patient grab and physically threaten an emergency worker. “Sometimes it’s verbal and sometimes it’s physical, but it happens daily and it wears on everyone who experiences it.”

FROM HEROES TO VICTIMS During the COVID-19 pandemic, health care workers were heralded as heroes. Community members showed up at hospitals and clinics with signs, banners, meals and more to show their love and support. But a long pandemic saw tensions rise, and violence against health care workers spiked. Th e numbers are still rising. “Demeaning comments, verbal abuse and assaults now happen in all areas of hospitals and clinics, in addition to ERs, trauma centers and urgent cares,” says Scripps President and CEO Chris Van Gorder, a former police o ffi cer and volunteer reserve assistant sheri ff . “In San Diego and across the country, physicians, nurses and other health care professionals are concerned and frightened. Some are leaving their health care careers entirely rather than face this type of continued threat. “ Th is is a far broader issue than one hospital, one health system or one region,” Van Gorder adds. “As a community, we need to do better.” Van Gorder delivered the same message to San Diego law enforcement leaders last year. It

HE DOCTOR NEVER SAW IT COMING. Andrew Accardi, MD, was making his patient rounds in

the emergency department at Scripps Memorial Hospital Encinitas. His next patient sat in a nearby exam room—a 6-foot-5-inch muscular male, brought in by police for treatment, but in restraints. “As I entered the room, I took a quick assessment and, as usual, I asked the patient how he was doing,” says Dr. Accardi. “It was right then that he lunged straight at me from the bed. “It happened in a millisecond, so fast that I fell back as he swiped at me, but he missed,” he adds. “I’d intentionally le ft the door to the room open, so police ran in to catch me. Th ey then quickly wrestled him back onto the bed, but I’d say this was the closest I’ve ever felt to being prey.” Health care has become a dangerous job. According to the U.S. Bureau of Labor Statistics, 73% of non-fatal workplace violence victims in the United States are



San Diego’s Hospital Violence Task Force Since its first meeting last year, the San Diego Hospital Violence Task Force has continued to add new members from health care, law enforcement and the San Diego County District Attorney’s Office. The first two meetings were sobering, as health care staff and physicians shared stories of violence committed against them and those they work with. Now, a year later, there is better communication and policy alignment, regular site visits to hospitals by law enforcement, improved training and a renewed focus on prosecuting violent crimes against doctors, nurses and other health care workers. “I wanted to get law enforcement and health care leaders regularly talking with each other about these issues so there would be a better understanding on all sides,” says Chris Van Gorder, president and CEO of Scripps Health. “That’s the first step toward any solution, and we’re all committed to that purpose.” As violence in health care continues to rise across the country, the San Diego task force is becoming a model for other communities. “Without safety, nothing thrives,” says San Diego County District Attorney Summer Stephan, who started the group along with Van Gorder. “Reducing the threats and violence and preventing potential crimes that put health care workers in danger is critical to making our health system the best that it can be. This task force is already a positive step in that direction.”

“Demeaning comments, verbal abuse and assaults now happen in all areas of hospitals and clinics. Physicians, nurses and other health care professionals are concerned and frightened.”

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was the catalyst behind San Diego’s new Hospital Violence Task Force, a group that includes senior representatives from local hospitals and health systems, law enforcement agencies and the San Diego County District Attorney’s O ffi ce (see sidebar). “ Th e task force is already making a di ff erence,” says Ghazala Sharie ff , MD, MBA, chief medical and operations o ffi cer for acute care, Scripps Health. “Group discussions have led to a better understanding of the issues on all sides, as well as law enforcement and DA visits with hospital sta ff , procedural changes and better connections between hospital security sta ff and law enforcement.” LET’S BE CAREFUL OUT THERE In the 1980s television series Hill Street Blues , a tough but caring police desk sergeant ended each morning’s brie fi ng with prudent advice for his o ffi cers: “Let’s be careful out there,” he’d say. It’s much the same for health care workers today. While security can continuously be enhanced, the fi rst defense against violence is prevention. Scripps’ de-escalation training helps sta ff recognize tense situations, set proper boundaries and maintain control of di ffi cult circumstances. Likewise, tools like electronic patient records o ff er ways for caregivers to silently alert other sta ff to potentially di ffi cult situations.

“If, despite these e ff orts, a person does become violent or threatening, our security teams quickly respond,” says Todd Walbridge, senior director of Scripps Health safety and security, and a former FBI agent. “In addition, we’ve created quick-response behavioral health teams, implemented high-tech metal detection where needed, limited building and elevator access and updated our camera monitoring systems. “We also work closely with local and regional law enforcement to align our processes and procedures when it comes to violent or potentially violent patients,” adds Walbridge. “We do whatever is possible to ensure the safety of our sta ff , patients and visitors without negatively impacting access to the care people need.” BE KIND Sometimes those e ff orts include reminding patients and visitors that they’re in a place of healing. “We recognize that some patients struggle with behavioral or addiction issues, but they account for just a fraction of violent incidents we see,” says Grossmann. “When someone is sick or hurting or scared, that’s a bad place to be and we’re going to help,” she says. “But there are often lots of other patients we’re helping, too. “I promise we’re doing our best. Please, be kind.”




A breast cancer diagnosis inspired Kelly O'Connor to rethink her priorities. The once busy executive turned her passion toward giving back and appreciating the simpler things, like spending time at home with her family and dogs.

Finding Purpose BEYOND BREAST CANCER A grateful patient finds her calling helping others facing a cancer diagnosis

Despite having a mammogram four months prior, O’Connor discovered a lump during a routine self-exam. She went to see her primary care physician, who told her it didn’t feel like breast cancer, but sent her for an ultrasound to be on the safe side. “Ultimately, it turned out to be stage 2 breast cancer,” she recalls. “ Th at’s what led me to Scripps.” A friend who had been through her own cancer journey spoke highly of the team at Scripps Cancer Center. From the fi rst moment O’Connor walked into the multidisciplinary clinic, she knew she had chosen the right place and had the right team in her corner. “ Th ey were brilliant the way they did it. I met my surgical oncologist, medical oncologist and radiation oncologist on the same day,” she says. “When I got my diagnosis, I was absolutely shocked. Th is was nothing I expected. But when I met with the Scripps team, they did everything to make me comfortable. Th ey gave me so much information and support that it helped me decide what I was going to do.” SHIFTING PERSPECTIVES and PRIORITIES Because every patient is unique, so is every patient’s path to wellness. Th at’s where Scripps’ stellar multidisciplinary team shines. Meeting with her team of physicians at the start meant O’Connor was able to fully understand her diagnosis and learn about her treatment options. Th is “dream team,” as O’Connor calls them—Louis Rivera, MD, a Scripps Clinic surgical oncologist; Carrie Costantini, MD, a Scripps Clinic medical oncologist; and Anuradha Koka, MD, a Scripps Clinic radiation oncologist—collaborated on a plan based on her individual needs and speci fi c type of breast cancer.


F YOU HAD ASKED KELLY O’CONNOR in 2022 about the big C in her life, you would have been referring to the C-suite. Then 45, O’Connor had a successful corporate career working with C-suite executives at a tech company. She was healthy, active, thriving both professionally and personally, in a loving relationship with her partner,

Jessica, and her two stepchildren. Then she received the diagnosis that no woman wants to hear. The other big C had entered her life, cancer. It came as a complete shock. “I’m a healthy girl,” she says. “I always go to my medical appointments. I get my mammograms and my annual physicals. I regularly have dermatology screenings, and I go to the gynecologist. I work out and eat well. I have always been very thoughtful about my health.”


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