BACK IN THE GAME How Scripps Helped one Woman take Control of Prediabetes
PLUS GUIDE TO OPEN ENROLLMENT BLUE SPACES EXPANSION AT SCRIPPS MEMORIAL HOSPITAL ENCINITAS
FROM THE PRESIDENT
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;
AN DIEGO IS AN ACTIVE PLACE. Whether it’s the warmer days of spring and summer, or the shorter and cooler days of fall and winter, S A Healthy Place
Chief Development Officer, Scripps Health Foundation MANAGING EDITOR Laura Dennison
Health care, too, is fighting to get back to a healthier place. As you may have heard, health systems across the country are facing a confluence of challenges the likes of which we’ve never seen: supply and labor shortages, the higher costs of rising inflation, insufficient payments from government and commercial insurers, and a mandate that hospitals rebuild or close by 2030. Like our patients, we are focused on our goals, doing the work and making the tough decisions that will keep Scripps here and healthy for decades to come. You can read more about this “perfect storm” and how we’re weathering it on page 28. For 100 years, Scripps’ hospitals, clinics, doctors, nurses and thousands of health care professionals have been caring for San Diegans—patients like Nancy, Ariana, Brad—and maybe even you. As the seasons change and we welcome new beginnings, it’s a suitable time to reflect on what healthy means to us and the special people in our lives. Now and always, we hope you’ll choose Scripps to be your health care family.
Dennison.Laura@ScrippsHealth.org CONTRIBUTING PHOTOGRAPHERS Mark Dastrup, Bob Ross
we can find San Diegans of all ages out and active, enjoying and often improving their health. It’s true for retired biotech professional Nancy Butsumyo, who always enjoys a good game of pickleball. It’s true for Ariana Collopy, who likes to get in some exercise when she’s not busy with her interior design business. And it’s true for consulting firm CEO Brad Samuel, who has always enjoyed competing on the tennis court. All three have something else in common. They’re all Scripps patients. In this issue, you’ll read about how Scripps Whittier Diabetes Institute helped Nancy manage her prediabetes; how Ariana is now six months seizure- free after battling a life-altering epilepsy condition; and how Brad, through sheer will and determination, teamed up with his doctors to beat Hodgkin’s lymphoma. These are three of the thousands of patients who trust Scripps with their care. Each has their own story, their own challenges and their own Scripps health team helping them get back to a healthier place. It’s stories like theirs that get me up in the morning and make me proud of Scripps, its legacy and everyone who works here.
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Chris D. Van Gorder, FACHE Scripps President and Chief Executive Officer
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SAN DIEGO HEALTH | FALL 2023
Seizures forced Ariana Collopy to put her life on hold, but Scripps epilepsy specialists found a way to solve the medical mystery.
RECOVERY BY DESIGN How Scripps gave a woman a second chance at life seizure-free. Prevention Program at Scripps Whittier Diabetes Institute. 18 22 14 COMPETING IN THE GAME OF LIFE An innovative stem cell transplant and a positive attitude helped Brad Samuel win the fight against Hodgkin's lymphoma. A WEIGHT LIFTED A prediabetes patient gets healthy thanks to the Diabetes
3 HEALTHY LIFE
32 DOC OFF THE CLOCK Scripps Clinic family medicine physician Kosha Nathwani, MD, incorporates her lifelong love of yoga into her holistic clinical practice.
Your guide to open enrollment, how blue spaces benefit body and mind, new treatments for rotator cuff tears, plus a healthy taco recipe from Puesto.
Scripps breaks ground on the Lusardi Tower at Scripps Memorial Hospital Encinitas, health care's "perfect storm," and the 49th Annual Scripps Mercy Ball.
Siu Ming Geary, MD, Scripps Clinic
Discover what makes Scripps one of the leading health systems in San Diego—with convenient access to primary care physicians, specialists and state-of-the-art facilities—right here, close to your home or work. You’ll also appreciate the convenience of our MyScripps online patient portal where you can make in-person or virtual appointments, manage your medical records, access most test results, get prescription refills and more.
Switch to Scripps today and find out just how good health care can be. To find the primary care doctor who’s right for you and your family, call 858-281-2606 or visit Scripps.org/ForGood .
THE LATEST TIPS, ADVANCES AND ADVICE TO LIVE YOUR HEALTHIEST LIFE
The Season of Health For San Diegans, fall means shorter days, the start of a new school year and an end to the busy summer tourist season, but it's also a time to revisit your health care choices and reconsider whether they still meet your family's needs. We've dedicated many of the following pages to helping you make the most of open enrollment season, including how to find the right plan at any age and the benefits of finding a doctor who's part of a health care system. We also have a cold and flu season primer and some wise words on women's and kids' health, plus a healthy taco recipe sure to be a hit. Whatever your plans for fall, Scripps has you covered and will always keep your health a top priority.
LENTY OF THINGS COME TO MIND when we think of fall, but it is also the time of year for open enrollment, which gives people the opportunity to reevaluate their health insurance plans, explore other options and ultimately, choose a plan that aligns with their health care needs. “Open enrollment is essentially your one chance to make sure that you’re covered the way you want to be covered,” says Anil Keswani, MD, chief medical officer, ambulatory and accountable care, Scripps Health. “It’s when people make decisions on which insurance plan and coverage they want, and oftentimes this impacts the ability to select a specific physician, medical group or health system.” Open enrollment periods can vary depending on what kind of coverage you have, but in general, fall between late October and early December for employer-sponsored coverage. Medicare beneficiaries can make changes between October 15 and December 7, and Covered California participants can review their plans from November 1 through January 31. Your health care needs change throughout your life, but regardless of age or stage, there are a few things you should consider when making your picks for the year ahead. Cost and coverage are usually at the top of the list, says Dr. Keswani. Each plan has different benefits, so pay attention to things like copays, coinsurance, prescription coverage and out-of- pocket maximums. Equally important, if not more so, is which groups or hospitals are included in the plan. Look for a health system like Scripps that has a reputation for medical excellence and top-quality care. “If someone’s picking a health plan, look for one that includes Scripps Health, an organization that has proven outcomes for quality, safety and patient experience,” says Dr. Keswani. “Our health is probably our most important thing. People think cost is important, but health really matters. It’s important to take a little more time, do the homework and pick a health plan that’s important to you and that meets your needs.” Open Enrollment: Make Sure Your Health Plan is Right for You P
YOUR HEALTH PLAN FIT TEST Tips to choose a health plan at any—and every—age
Choosing a health plan doesn’t have to be hard. Your health care needs change during different stages of life, and age can be a good place to start when deciding what type of health insurance you should have. Whether you are enrolling in coverage for the first time, thinking of starting a family or transitioning to Medicare, there is a right plan for you. These tips will help you evaluate your needs. 26+ Transitioning into adulthood comes with many big decisions, and insurance is one of them. Aging out of your parents’ plan means you’ll be shopping for a new one that caters to your needs as a young adult. Since people in this age group are likely just starting out in their careers, cost is a big concern. But it’s important to choose a plan that fits your budget and provides what you need in terms of taking care of your health. Your health is worth the investment. “Be proactive, not reactive, because things can happen at any age,” says Dr. Keswani. “I empathize with the importance of balancing your budget when you’re
4 SAN DIEGO HEALTH | FALL 2023
THE LATEST TIPS, ADVANCES AND ADVICE TO LIVE YOUR HEALTHIEST LIFE
sure the plan has prescription costs and deductibles that align with your budget. “Read the fine print,” says Dr. Keswani. “It is important to fully understand all the benefits available as part of your coverage.” TURNING 65 When you turn 65, you become eligible for Medicare. There are different types of Medicare coverage, known as Medicare Parts A, B, C and D. Part A covers hospital visits, skilled nursing and home health care; Part B covers outpatient care, preventive care, doctors’ appointments, testing and other medical necessities; Part C, also known as Medicare Advantage, is HMO or PPO plans offered through a private insurer that give participants access to a network of doctors and hospitals; and Part D covers prescription medication. Dr. Keswani says there are three main questions when switching to Medicare: Does your current doctor accept Medicare? Does the monthly cost of an Advantage plan fit within your budget? What benefits (medical, dental, prescription, etc.) do you need? Working with an advisor can help cut through some of the alphabet soup. “Each plan has a slightly different variation, and it’s important for people to understand what they’re picking and what the tradeoff is as well,” he says. “It’s a complicated conversation, but if someone picks a plan and they want to change it a year later, they still have the opportunity during the next Medicare open enrollment period.” To learn more, visit Scripps.org/SDOpenEnrollment. *Scripps La Jolla Hospitals and Clinics, 2023-2024.
into whether your would-be health system offers after-hours care and fast, convenient ways to get in touch with your provider, such as apps like MyScripps, the patient portal for Scripps, MyScrippsBaby and telemedicine options. “Time is a precious commodity. Technological advances are incredibly important, and the addition of virtual care provides more options and convenience,” says Dr. Keswani. MID-YEARS Don’t put your health plan on autopilot. Though you may be a little more experienced with health insurance by now, your 30s through 50s are prime time for new health concerns to arise and chronic conditions to develop. “Thirty through 55 is an interesting time. People think about wealth accumulation and retirement, but just as important is planning for the future, health-wise, and looking for the best preventive care,” says Dr. Keswani. This is also time to start thinking about specialty care. By now you’ve probably established a relationship with a primary care provider, but specialty care is also important (and will become more so in the future). If you have an HMO plan, your primary care physician will be the key to your specialty care and will be crucial in helping you manage your health. Look for an interconnected health system that includes specialty care, and in cases of chronic conditions, make
starting off in a career, but it’s important to also invest in insurance to ensure you have access to quality health care if you need it.” Convenience is also a factor. Flexibility and access points, such as virtual care, walk-in care and clinics with extended hours, can all prove beneficial for busy young professionals. If you’re not sure where to start, ask for recommendations from friends, family and co-workers and research online. “Picking your insurance plan for the first time is a rite of passage,” says Dr. Keswani. “You have a whole list of options available. That’s quite exciting and empowering for young adults.” PLANNING FOR A FAMILY If expanding your family is on the horizon, you’ll want to make sure your health care plan offers prenatal care, labor and delivery, postpartum care and pediatric care. Carefully review each available plan’s benefits statement to get a better idea of costs associated with pregnancy (health screenings, lab work, ultrasounds, birthing classes, etc.), giving birth and any complications that may arise. For instance, neonatal intensive care can be costly without the right insurance plan. Also, make sure the health care system you choose has OB-GYNs. Scripps has been recognized by U.S. News & World Report as one of the nation’s best for obstetrics and gynecology.* “First and foremost, I would say brand matters. When you’re picking a plan, make sure providers behind that plan are top quality,” says Dr. Keswani. Access is important, too. Pregnant people and new parents—especially first timers— tend to have a lot of questions, so look
MEDICARE ENROLLMENT comes with a unique benefit many participants may not be aware of: Medicare Wellness Visits. These preventive visits are different from annual physicals, and give Part B and Medicare Advantage patients an opportunity to meet with a primary care doctor and create a personalized plan for healthy aging that’s updated at each subsequent visit. Though your physician can do preventive care throughout the year, a wellness visit is an opportunity to delve into a range of issues that may be affecting your quality of life, such as depression, anxiety and memory loss, and discuss ways to stay healthy and avoid injury, illness and chronic conditions. Medicare Wellness Visits
“It’s one of the most amazing benefits that people have—the annual wellness visit is a preventive checkup,” says Dr. Keswani. “This is a great way to keep our seniors healthy, and oftentimes there isn’t any out-of-pocket cost.” Scripps operates Medicare Wellness Clinics at Scripps Clinic and Scripps Coastal Medical Center locations. The health system also reaches out to patients to remind them of the benefit, so they don’t miss out. To learn more about Medicare Wellness Visits and to schedule an appointment, visit Scripps.org/SDMedicare.
Primary Care Matters The benefits of choosing a doctor who is part of a health care system
Plan Ahead for Cold and Flu Season Like clockwork, colds, influenza and other respiratory viruses tend to become more prevalent in the fall. However, many of us don’t take the time to prepare for when one of those pesky viruses strikes. “Generally, we start seeing cases start to pick up in November, peak around the first of the year, then generally go down after that,” says Mark D. Shalauta, MD, family medicine physician, Scripps Clinic, Rancho Bernardo. Dr. Shalauta has a few tips on how to get ready for cold and flu season. Get vaccinated. One of the most important things you can do to prepare is prevent infections in the first place. Get vaccinated against the flu (ideally before Halloween), get a COVID-19 booster, if applicable, and look into vaccines for respiratory syncytial virus (RSV), which have recently been approved for certain adults. Also, update your Tdap shot to protect against tetanus, diphtheria and pertussis, aka whooping cough, if it’s been more than 10 years since your last booster. Keep it clean. The lessons we learned during the pandemic will come in handy during cold and flu season, too. Wash your hands and sanitize often, avoid touching your eyes, nose and mouth, keep household surfaces clean and stay home when you’re sick. Masks, though optional, can still be used to filter out germs in public, and can be especially beneficial for people who are elderly or immunocompromised. Check your tech. Make sure to have access to a device capable of supporting a video visit with a health care provider. Stock up. Pick up pharmacy essentials just in case. Toss out any expired medications and stock your medicine cabinet with ibuprofen or acetaminophen, decongestants (if tolerated) and a general cough and cold medicine. Be sure to check with your doctor first if you have high blood pressure. A thermometer and at-home COVID tests are also good to have on hand, as is good old-fashioned chicken (or plant-based) soup. “Soup’s not really magical, but it definitely helps with hydration,” says Dr. Shalauta. “People with sore throats frequently don't drink enough fluids, and if they have a fever, they're getting even more dehydrated. Soup replenishes the salt and the fluid and makes your throat feel better.”
ON’T WAIT UNTIL YOU GET SICK or injured to find a doctor. Nearly half of adults ages 18 to 29 don’t have a primary care physician—and while that may seem OK if you’re healthy, having a primary doctor, and a supporting network of hospitals and
specialists on your side, will definitely pay off in the long run. Unlike retail health care services, such as those at retail pharmacies and online membership services, health care systems, such as Scripps, are patient- centered and the physicians are invested in patients’ health throughout the various stages of life. Patients build a trusting relationship with their primary care physician, which can lead to earlier detection of health issues via routine screenings and preventive care, and better health outcomes overall. “You want to be able to look at this as a partnership,” says Anthony Chong, MD, chief medical officer, Scripps Coastal Medical Center. “Primary care physicians focus on long-term health maintenance, prevention, wellness and health stabilization. Having a physician who understands and can work with you will set you up for success.” Doctors attached to a health care system also act as a point of contact to coordinate specialty care when needed, such as orthopedics, cardiology, allergy and asthma, among many other specialists who treat specific conditions. At Scripps, this also means access to nationally recognized specialty care at hospitals and clinics throughout the region. And since your primary and specialty care physicians all operate under the same network, they have access to your medical records to help ensure you receive seamless care. “It comes down to being part of a comprehensive network,” says Siu Ming Geary, MD, vice president, primary care, Scripps Clinic. “If your primary care doctor is part of a system, you have all the resources and the infrastructure behind it to really meet all of your health care needs. There are no gaps in care.” With a primary care doctor who is part of a health care system, you can be sure that you’re receiving expert, trusted information on health and wellness trends and quickly find out which are just hype (and could even be unsafe). Scripps requires continuing education for physicians, so patients can be sure their doctor has the most up-to-date information. Large health care systems, like Scripps, also practice diversity, equity, inclusion and belonging. They are committed to caring for everyone,
regardless of race, ethnicity, age, gender, location or socioeconomic status, and have the expertise to meet each individual’s health care needs. That can mean anything from offering
literature in several languages to having a diverse physician population to represent the variety of patients they serve. “We are committed to caring for everybody equally, with respect, dignity and compassion,” says Dr. Geary. To find a Scripps physician who is right for you, visit Scripps.org/SDDoctor.
6 SAN DIEGO HEALTH | FALL 2023
THE LATEST TIPS, ADVANCES AND ADVICE TO LIVE YOUR HEALTHIEST LIFE
A Bioengineering Breakthrough
Scripps researchers studying lab-grown
tendons to mend rotator cuff injuries
surgical options to explore novel biological approaches to repair rotator cuff tendons. Dr. D’Lima is the lead investigator for a Scripps research initiative in which rotator cuff tendons will be biologically engineered from pluripotent stem cells. “Pluripotent” means the cells have the potential to develop into many different types of cells or tissues in the body. The discovery phase of the research is supported by a recent $2.7 million grant from the state-funded California Institute for Regenerative Medicine. During the next three years, Dr. D’Lima and his team will develop tendon material in the lab, then test their concept on animal models in hopes of growing tissue that mimics the stretch and pull of healthy human tendons. “We’ve reached our limit on how much we can improve things mechanically and through surgical technique, so now we need to explore novel biological approaches,” he says. “Rotator cuff tears are a common injury, and as our population ages, there’s a pressing need to find new solutions.” Depending on the success of the research and future clinical phases, it could be a decade before the biologically engineered tendons are ready for use in patients. The Shiley Center for Orthopaedic Research and Education’s clinical trials are privately and publicly sponsored. The pre- discovery phase of the lab-grown tendon initiative was funded through philanthropy. To learn more, visit Scripps.org/SDScore.
GOLF, TENNIS, GETTING DRESSED
or even brushing your hair. A rotator cuff injury can make these routines uncomfortable, if not impossible. But, for some, hope may be on the horizon. Scripps researchers are exploring the gamut of rotator cuff treatment options, including the use of stem cells to grow new tendon tissue. The rotator cuff is a group of four muscles and their tendons that keep your shoulder in place and help you lift and move your arms. Unfortunately, it’s easy to injure a rotator cuff: degeneration with age, repetitive motion and falls can cause shoulder pain and weakness that limit range of motion and ultimately, affect quality of life. “Even small tears give rise to chronic pain. Patients have trouble sleeping because they can’t find a comfortable position and gradually give up activities,” says Darryl D’Lima, MD, PhD, director of orthopedic research, Shiley Center for Orthopaedic Research and Education (SCORE) at Scripps Clinic. The incidence of rotator cuff tears increases with age, Dr. D’Lima says. More than 25% of people over age 70 experience a full-thickness tear, in which a tendon has torn entirely through. Additionally, the failure rate for conventional repair surgery in older patients with significant rotator cuff tears is about 40%. “The available surgical options are not great for older patients with large tears that have been chronic,” he says. To find a solution, Scripps orthopedic researchers are looking beyond traditional
"Rotator cuff tears are a common injury, and as our population ages, there’s a pressing need to find new solutions." –DARRYL D’LIMA, MD, PhD
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PARENT ING Just Say NO
RIDING IN THE FRONT SEAT. The CDC recommends that kids age 12 and younger ride in the back seat of a vehicle and are properly secured with a seatbelt, car seat or booster seat, whichever is appropriate based on their age, height and weight. “Kids 12 and under should ride in the backseat,” says Dr.
Shleifer. “A lot of parents forget this once their kids get bigger.”
Four common activities one Scripps pediatrician says children should never be allowed to do
RIDING AN E-SCOOTER. A recent study found that over the past decade, the number of pediatric patients taken to hospitals for e-scooter injuries rose from 1 in 20 to 1 in 8. The average age of the patient was 11. Not only are e-scooters potentially dangerous, but your child could also be facing legal ramifications if they’re caught riding. In the state of California, it’s illegal for anyone under age 16 to operate an
KIDS DON’T ALWAYS HAVE the best judgment when it comes to balancing safety and fun. Though you can’t protect your children from everything, there are a few things that should be banned across the board for safety reasons, says Benjamin Shleifer, MD, pediatrician, Scripps Coastal Medical Center, Oceanside. “Summer doesn’t really end in September,” he says. “Even though kids are back in school, they still like adventures.” These are the four activities Dr. Shleifer says kids should avoid at all costs. The list isn’t comprehensive, he cautions, so when in doubt, look for recommendations from accredited agencies, such as the American Academy of Pediatrics (AAP) or the Centers for Disease Control and Prevention (CDC). 1
e-scooter and the driver must at least have a learner’s permit. “Children under 16 should not operate or ride on a motorized e-scooter,” Dr. Shleifer says.
RIDING ATVS. All-terrain vehicles have killed more than 3,000 children and sent nearly a million others to the emergency department, according to the AAP. The dire statistics prompted the AAP to issue a statement last year urging parents to keep children under 16 off ATVs because “youth do not have the physical, mental and cognitive maturity to operate ATVs safely.” “I've seen very bad accidents happen from kids riding ATVs that ended up sending them to the ICU,” says Dr. Shleifer. “ATVs should be off limits.” PLAYING AROUND WATER UNSUPERVISED. Safe Kids Worldwide recommends keeping kids within arm’s length around water and not allowing yourself to get distracted. “Water safety doesn't end in the summertime; it’s important year round,” Dr. Shleifer says.
Back-to-school stress could be behind
your child’s gastrointestinal issues TRESS AND ANXIETY have been linked to gastrointestinal (GI) issues in people of all ages, but for kids and teens, something like an upcoming test or uncomfortable social interaction can trigger severe abdominal pain and unpleasant symptoms like nausea, vomiting and diarrhea.
“Kids feel stressed just like adults do, and the start of the school year is a very common time to see it,” says Christopher Price, MD, pediatrician, Scripps Clinic, Rancho Bernardo. The GI tract, which is modulated by the nervous system, is very complex. Things like stress, anxiety and lack of sleep can affect the way the GI tract functions. Also, many of the neurotransmitters that control moods—the same ones that control pain and digestion—are produced in the gut. The first step to getting to the bottom of your child’s GI issues is acknowledging that their pain is real, though many children won’t bring it up because they’re afraid that you’ll think they're exaggerating or making it up. “When we're in states of stress our brain can inadvertently interpret signals coming from our GI tract as pain when there's really nothing there. That’s not to say they're making up the pain—they're truly feeling the pain, it's just that their brain is incorrectly
manifesting these signals as a perception of pain,” says Dr. Price. Not sure if it’s stress? Look for other signs, like changes in behavior and activity level, sleeping and eating more or less than usual and seeming withdrawn or down. You may not even realize there’s a problem until you start asking questions. If you feel that stress is affecting your child’s quality of life, consult their pediatrician. “It can be difficult, but you know your child best,” says Dr. Price.
8 SAN DIEGO HEALTH | FALL 2023
THE LATEST TIPS, ADVANCES AND ADVICE TO LIVE YOUR HEALTHIEST LIFE
Spending time in “blue spaces” benefits body and mind How the Blues Help You Feel Better
YOU’VE NO DOUBT HEARD that drinking eight glasses of water a day is good for your health. Now, researchers are finding that simply being near water—oceans, lakes, rivers, ponds and possibly even fountains—also benefits your health. “There are definite benefits to spending time in nature,” says Farida Valji, MD, family medicine physician, Scripps Coastal Medical Center, Oceanside. “It gets people outdoors, helps create a sense of community and well-being, and can lower stress and anxiety.” Outdoor spaces that include water, dubbed “blue spaces” by researchers, can be especially beneficial. Several studies conducted during the past decade confirm the positive effects of being near bodies of water: • A United Kingdom study that asked 20,000 smartphone users to track their environment and sense of well-being at random intervals found that people in marine or coastal areas were significantly happier than those in urban areas. • Another study found that people preferred photos of places that featured water over those that didn’t, even if the photos showed beautiful green spaces.
a mesmerizing effect on the water’s surface. Watery areas are often rich in soothing sounds created by waves and wildlife, and dipping your toes or trailing your fingers along the water’s edge creates a comforting physical connection with nature. • People who live near water or seek out blue spaces tend to be more physically active. Even if they don’t get in the water to swim or surf, they’re more likely to engage in activities like walking or cycling. In addition to boosting your physical health, exercise releases endorphins, the “feel good” hormones generated by activity. • Breathing in sea air is associated with better sleep. One study found that people sleep an average of 47 minutes longer at night after a seaside stroll. “You don’t have to live by water to get these benefits,” says Dr. Valji. “Even just being outdoors around decorative fountains, parks or yards with water features can have blue-space benefits. And don’t forget your sunscreen!”
• A 2020 review of more than 30 studies of blue spaces agreed that time spent near water in nature supports mental health and well-being. Moreover, family vacations to the beach or river may have benefits that last for decades. A 2022 international study that included California residents concluded that exposure to blue spaces during childhood may carry over into better health and well-being later in life. Why are blue spaces such powerful influences? Researchers believe they affect us in several ways: • Natural blue spaces typically go hand- in-hand with natural sunlight, fresh air and low levels of pollution, noise, traffic and crowds. These calmer, quieter environments promote feelings of peacefulness, help us disconnect from our day-to-day routines and pause the nonstop stream of thoughts running through our heads. • Being near water stimulates our senses, which can be psychologically healing. Gazing at a still lake, trickling stream or seemingly infinite ocean can be calming, and changes in light and wind can have
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Preparing for Perimenopause
Tips to stay well as hormone levels change
“Perimenopause is a threshold-lowering event for mental health,” explains Ronald Salzetti, MD, medical director, Scripps women’s services and OB/GYN, Scripps Clinic. “Hormonal changes can decrease your ability to cope with stress, and if there is a history of anxiety or depression, those symptoms become more prominent.” Get enough sleep. Counter sleep-disrupting hormonal changes with good “sleep hygiene.” Try to avoid screen time on phones, computers and tablets for an hour or two before bed. Instead, develop a relaxing routine to prepare for sleep and sleep in a dark, quiet and cool environment. Stay current with screening exams. Dr. Salzetti encourages women to keep up with their annual well-women visits and preventive screening exams to detect any concerns as early as possible. He notes that some of the guidelines have changed, so women should check with their doctors to determine when they need screenings. Women with risk factors may need more frequent or earlier exams. • Mammogram: The risk of breast cancer increases with age. Women between the ages of 40 and 44 have the option to start screening with a mammogram every year. • Pap smear: Women should continue to get Pap smears every three to five years to screen for cervical cancer. • Colonoscopy: Beginning at age 45, women should get a colonoscopy every 10 years to screen for colon cancer. • Cardiovascular screening: Blood pressure and cholesterol screenings should be part of an annual well-woman exam. “If you have questions about perimenopause, talk to your doctor,” says Dr. Salzetti. “We’re here to help you stay healthy and feel your best.”
Maintain a healthy diet. Dr. Theberge recommends a balanced diet built on plant-based whole foods, with plenty of fruits, vegetables, whole grains and foods high in calcium, since bone loss begins in a woman’s 40s; women also should talk to their doctor about taking a vitamin D supplement. Try to limit processed foods, sugar and alcohol, all of which can contribute to weight gain. Exercise regularly. Daily exercise helps to control weight and improve heart health. Strength training helps maintain bone density and reduces the risk of osteoporosis. Exercise also helps with managing stress, which can become more of a concern during perimenopause. Practice stress management. Along with exercise, stress management techniques, such as deep breathing, yoga, meditation and journaling can help reduce stress-related headaches and mood disorders. Spending time outdoors in nature is also proven to support mental well-being.
OR MOST WOMEN, menopause—the end of the menstrual cycle—happens in their late 40s or early 50s. However, a woman’s body begins preparing for menopause several years before her menstrual periods stop. This time, known as perimenopause, typically begins between 35 and 45 and is marked by changes in estrogen and progesterone levels. These female hormones not only regulate a woman’s menstrual cycle, but can affect many aspects of her physical and emotional health. “As hormonal production fluctuates, some women will experience lighter and shorter periods, while others may find their periods become heavier and last longer,” says Allison Theberge, MD, family medicine physician, Scripps Coastal Medical Center, Eastlake. “These fluctuations often cause other symptoms, including vaginal dryness, irritability and mood swings, headache, weight gain and problems sleeping.” Perimenopause symptoms vary widely among women and can range from mild to severe. By taking steps to maintain their health, women can successfully manage symptoms as their bodies prepare for the end of their reproductive years.
10 SAN DIEGO HEALTH | FALL 2023
THE LATEST TIPS, ADVANCES AND ADVICE TO LIVE YOUR HEALTHIEST LIFE
Behind the Label New rules mean more people can use nutrition data to eat healthier
“They’ve done a better job of bolding and highlighting the important information. But, of course, it still comes down to being mindful and paying attention to what you’re eating,” she says. “With a breakdown, you can see for yourself: ‘Even though I had salads all day, that bag of chips put me over my goal.’” Dr. Motazedi encourages people to read labels carefully and choose foods that align with the Mediterranean or DASH (Dietary Approaches to Stop Hypertension) diets, which emphasize whole foods, such as fruits, vegetables, whole grains and lean proteins. And when in doubt, cook from scratch.
It can be tricky to accurately track calories and nutrients for healthful eating—unclear serving sizes and hidden ingredients can derail even the best efforts. Poor diets can lead to chronic disease, and it’s
well documented that the majority of people in the U.S. eat too much saturated fat, salt and sugar and not enough fruits, vegetables, dairy and whole grains. The U.S. Food and Drug Administration (FDA) is making it easier to understand what’s in your meals by improving labels for prepared foods and beverages to better reflect the latest thinking on nutrition and healthy eating. It’s the first major revamp of the system in more than 20 years. The agency is also working to ensure that foods meet certain criteria for sodium, sugar and saturated fat content before being labeled as “healthy.” The FDA has recently pushed for easier-to-read nutrition labels: serving sizes and calories are in larger, bolder font, and labels now list more comprehensive data on added sugars. Labels are no longer required to list “calories from fat,” since the type of fat is more important than the amount. You’ll also no longer see Vitamins A and C content on packaging, since deficiencies of these vitamins are now rare. “The new rules can help people better control what they’re putting into their body and stick to their health goals, whether that’s weight loss, controlling sugar levels or managing blood pressure,” says Arame Motazedi, MD, family medicine physician, Scripps Coastal Medical Center, Carlsbad.
“If you’re able to identify every part of your meal, right down to the spices, that’s going to be the best way to know what you’re putting into your body,” she says. “Anything cooked at home or made at home is going to be better than outside food just because you are able to control your content and you know exactly what’s being used.”
ENTERTAINING Taco Takeover
Roasted cruciferous veggies and a smooth mole verde up the health factor of these tacos from Puesto.
A healthy take on one of San Diego’s favorite foods
OOD NEWS ALERT: Tacos can be healthy. Michelin-recognized Mexican food outpost Puesto has teamed up with Scripps Health, a
regional leader in expert, personalized care for people diagnosed with lymphoma and other types of cancer. During the next year, when you dine at Puesto, a portion of the proceeds will go to Scripps cancer care. In addition, Puesto has created a Scripps-inspired healthy taco, which will be on the eatery’s menu all September long. Culinary director Erik Aronow’s plant-based take on the foldable favorite features roasted cauliflower and broccoli, a spicy, veggie-forward mole verde, panela cheese and cilantro. An added bonus: You don't have to visit Puesto to try it. This restaurant- worthy dish is easy to make at home, so take your next Taco Tuesday to the next level with Puesto’s roasted cauliflower and broccoli tacos.
Watch chef Erik Aronow prepare this dish with help from San Diego Magazine publisher Troy Johnson at Scripps.org/SDHealthRecipes and look for more tasty, seasonal recipes in upcoming issues.
12 SAN DIEGO HEALTH | FALL 2023
THE LATEST TIPS, ADVANCES AND ADVICE TO LIVE YOUR HEALTHIEST LIFE
Puesto Roasted Cauliflower and Broccoli Taco with Broccoli & Kale Mole Verde, Panela Cheese and Cilantro
RECIPE SERVES 8
Mole verde delivers bright, complex flavor without the mile-long ingredient list and laborious process of, say, traditional black mole. These tacos are best served with your favorite smoky salsa, or amp up the wow-factor with Puesto's Flax Seed Salsa Macha . Find the recipe and more at Scripps.org/SDHealthRecipes .
For the Broccoli Kale Mole Verde: (makes more than required for 8 servings) Ingredients • 1 organic onion
For the Roasted Cauliflower and Broccoli: Ingredients
• 1 organic potato (Yukon gold) • 1 bunch organic Italian kale • 2 cloves organic garlic, chopped • 2 poblano peppers, stems and seeds removed • 1 large head organic broccoli, cut into small florets with stem included • 1 bunch organic parsley chopped • 1 cup sunflower seeds • 1 tablespoon salt • 1 teaspoon pepper • 2 quarts vegetable broth/stock Step 1 In a medium-sized pot, add enough olive oil to coat the bottom, add in chopped onions, chopped kale, and chopped garlic. Cook until onions are translucent. Step 2 Dice potatoes into a ½ inch size for them to cook evenly, add your potatoes to the pot and continue to cook on medium heat for 4 minutes. Add 2 quarts of vegetable broth and bring mixture to a boil. Step 3 Once pot has come to a boil, add in the sunflower seeds, and cook mixture until the potatoes start to get tender. Once the potatoes are tender, add in your broccoli florets and cook for another 3 minutes. Step 4 Turn off the heat and add in parsley, salt, and pepper; it’s optional to season the mixture with some vinegar, if you would like some added acidity. This sauce also welcomes any dried spices or seasoning you would like to add. Step 5 It is always safest to let the mixture cool down just a little bit before blending, but once cooled, transfer to blender in batches and blend until smooth. Taste final product and adjust the seasoning with salt and pepper, if needed. Step 6 This sauce can be served both warm or cold depending on preference and can be stored in the refrigerator for up to 5 days or in the freezer for a month.
• 1 large head organic cauliflower • 1 large head organic broccoli • 2 tablespoons avocado oil • 1 teaspoon salt
• ¼ teaspoon chile powder • 1 organic lime, cut in half
Step 1 Cut broccoli and cauliflower into floret pieces about 1 inch or the size of your thumb, and add to a bowl. Season the cauliflower with avocado oil and salt. Transfer to a baking sheet and roast in the oven at 350 degrees for 15 minutes or until the cauliflower starts to turn golden brown. Step 2 Once the vegetables are cooked, remove from tray and toss in a bowl with chile powder and lime juice squeezed from your lime. Step 3 Vegetables are now ready to be used for taco assembly.
For the Taco Assembly: • 1 organic corn tortilla • 1 tablespoon of mole verde
• 2 tablespoons of roasted cauliflower & broccoli mix • 1 teaspoon of Puesto's Flax Seed Salsa Macha (or your favorite smoky salsa) • 1 teaspoon of shredded panela cheese • 3-6 leaves of organic cilantro • 1 squeeze of organic lime (optional) • ¼ teaspoon of flax seed, hemp seed mix (for added texture)
Layer in your tortilla and enjoy!
PUESTO ROASTED CAULIFLOWER AND BROCCOLI TACO NUTRITION FACTS: 1 Serving, Calories: 135.8, Fat: 6.9g, Saturated Fat: 1.4g, Cholesterol: 3.4mg, Sodium: 106.4mg, Carbohydrates: 17.1g, Fiber: 2.7g, Protein: 4g
14 SAN DIEGO HEALTH | FALL 2023
A prediabetes diagnosis came as a shock to 60-year-old Nancy Butsumyo, but a proactive response that included lifestyle changes and education led by the Diabetes Prevention Program at Scripps Whittier Diabetes Institute helped her get back in the game.
F E A T U R E
Learning healthy lifestyle changes with the Diabetes Prevention Program at Scripps Whittier Diabetes Institute
T AGE 60, NANCY BUTSUMYO WAS NO STRANGER to the perils of type 2 diabetes. The retired biotech industry professional’s father and brother both had
the chronic condition that affects the way the body processes sugar, or glucose, in the blood. She had struggled with her weight and had high A1C levels that didn’t budge with diet and regular exercise—she’s an avid pickleball player. But she was surprised when routine blood work during an annual visit with her primary care physician showed that her glucose levels were elevated, indicating prediabetes.
F E A T U R E
were still in place, so classes were held online. She liked the convenience of the virtual setting. It also helped that she had a great program facilitator, Jodie Block, a diabetes health educator and a registered dietitian. Butsumyo credits Block for her expertise with nutrition, the real-life examples she infused into her curriculum and her insistence that the process was a lifelong experience, not a quick fix. This, Butsumyo says, helped her stay with the program and make lifestyle changes necessary for long-term health. “I was worried going into the program that it was going to be hard for me because I’m a social eater,” she says. “Thanks to Jodie, I learned not to beat myself up about that. If I’m at a social gathering, I don’t have to eat something just because it’s offered to me. Or I can take something to be polite, but I don’t have to eat it. I can go out to restaurants and just look for healthier choices—not avoid the restaurant altogether. And even though I’m not a cook, Jodie and my other classmates all had suggestions for ways to eat healthy. The accountability to other people really helped.” Scripps’ Diabetes Prevention Program focuses on “baby steps,” small changes that patients are comfortable sustaining for the rest of their lives. Facilitators like Block work with each patient to establish an action plan that includes realistic ways to overcome any obstacle that may hinder progress. “Most people who join the program have been good at losing weight, but keeping that weight off is the problem,” Block says. “We know that when people lose weight and gain it back, they often gain even more than they lost, and they aren’t regaining the muscle that they also lost. That’s why I emphasize that this is not a diet, it’s a lifestyle.” Under Block’s instruction, no food is entirely off limits, but she counsels patients to avoid foods that are high in fat, sugar
make. Empowering them early on with all the resources we have available at Scripps can make a big difference. It’s not inevitable that the train is going to keep going down the track to diabetes.” Butsumyo, for one, was motivated to take the news of her prediabetes and run with it—directly to the Scripps Diabetes Prevention Program, a year-long program that is part of the National Diabetes Prevention Program. Using a curriculum developed by the CDC, the program has been shown to cut participants’ risk of developing diabetes by more than half. “I was surprised when Dr. Cheon told me I had prediabetes, even though I knew my weight had been creeping up,” Butsumyo says. “It was the wakeup call I needed. I tried to lose weight on my own, but three months later, my levels were still the same. That’s when I really started paying attention.” Usually, Scripps Diabetes Prevention Program groups meet with certified lifestyle coaches and registered dietitians weekly for the first four to six months, then twice a month for the remainder of the year to maintain
he normal range for fasting blood sugar is less than 100 mg/dl;
prediabetes is from 100 to 125 mg/dl; and diabetes is above 125 mg/dl, though several factors can influence these numbers, including genetics, weight and age, explains Athena Philis- Tsimikas, MD, medical director, Scripps Whittier Diabetes Institute, and an endocrinologist, Scripps Clinic. “Diabetes is a continuum, and prediabetes is one of the points on the diabetes spectrum,” she says. “People need to pay attention to the numbers creeping up. That’s an indicator that they’re heading in the direction of diabetes.” According to the Centers for Disease Control and Prevention (CDC), an estimated 96 million American adults—more than 1 in 3—have prediabetes. The vast majority are unaware they’re living with the condition. There are no telltale symptoms of prediabetes, so routine lab work is required to assess blood sugar levels. Fortunately for Butsumyo, her longtime primary care doctor, Isabel Cheon, MD, an internal medicine physician with Scripps Clinic, knows to screen for the condition. She uses a prediabetes diagnosis as a teaching moment to help her patients get on a path to good health.
Athena Philis-Tsimikas, MD, Medical Director, Scripps Whittier Diabetes Institute, Endocrinologist, Scripps Clinic
SCRIPPS HEALTH IS A NATIONALLY RECOGNIZED LEADER IN DIABETES CARE. Scripps’ specialists diagnose, treat and help patients learn to manage diabetes and prediabetes. Scripps also offers a comprehensive range of diabetes services, plus programs, such as the one Butsumyo participated in, to help people at risk of diabetes prevent the chronic condition from developing in the first place.
healthy lifestyle changes. Patients learn to eat healthy via nutritional counseling, increase their physical activity (like many people, Butsumyo’s activity level waned in the early days of the COVID-19 pandemic), manage stress and make healthy choices when eating out. Butsumyo began the Diabetes Prevention Program while pandemic-era precautions
“In general, when we do routine labs and people receive the prediabetes result, they’re surprised and upset, but I like to frame it as an opportunity to be proactive, to address the situation and improve their lifestyle so things don’t progress to diabetes,” Dr. Cheon says. “Often people are really motivated to make the changes they need to
16 SAN DIEGO HEALTH | FALL 2023
A WEIGHT LIFTED
like Scripps, a partnership between primary care physicians and specialty care providers, such as those of the Diabetes Prevention Program, can lead to more successful patient outcomes. “At the Scripps Whittier Diabetes Institute, we have a hub-and-spoke model,” says Dr. Philis-Tsimikas. “The core programs are developed centrally, and staff are dispersed throughout the Scripps Health system, so no matter where in the county you’re located, you have access to the same curricula and expertise,” she continues. “All programs are offered in English and Spanish, and research opportunities are interspersed as well. At any given time, there are multiple clinical research studies going on that offer innovations in diabetes care as we look toward the future. All of this occurs right here in the Scripps Health system, and it’s all integrated to lead to better outcomes.”
exercise I need. This program made it so that I had to do things, and that was really good for me. The increase in activity helped me drop another 10 pounds and get me to a place where my blood sugars are at a healthy level.” Block applauds Butsumyo’s commitment not only to the course, but to making the sustainable lifestyle changes that will keep her on a healthy path. “Nancy’s transformation was incredible,” Block says. “I kept encouraging her to find a way that she could eat for the rest of her life, and she totally got it. Plus, she really took to the activity. At the end of the year, her blood glucose levels went into normal range, and she felt it was effortless because she was eating more than before but was making healthy choices. She’s such a success story.” The Scripps Whittier Diabetes Institute is a leading center for diabetes care and research in Southern California. Founded in 1981, its mission is to improve the quality of life for people with diabetes through innovative programs, while pursuing prevention and a cure. In a collaborative health care system
and salt, in favor of those that are lower in fat and sugar and that are less processed. “A lifestyle change does not mean deprivation. I recognize that food is about so much more than just food. It’s about socializing, it’s about culture,” she says. “You don’t need to deprive yourself of food you like in order to make these changes,” Block continues. “Research shows that a 5% to 7% weight loss is all you need to reduce your risk of type 2 diabetes. All that requires is a little bit of awareness and making small changes and healthier choices. Over the long haul, those small choices are what’s going to make a big difference when it comes to diabetes.” For Butsumyo, it was these real-life lessons that made the biggest impact. In addition to the program’s focus on healthy eating, it also promotes physical activity, something she approached with gusto. “I loved the activity level that the program encouraged,” she says. “I enjoy doing active things, but sometimes I don’t make time for me, and I don’t do the
“I enjoy doing active things, but sometimes I don’t make time for me ... This program made it so that I had to do things, and that was really good for me.” —NANCY BUTSUMYO
For more information, visit Scripps.org/SDDiabetes.
With the help of her Scripps physician, lifestyle coach and dietitian, Butsumyo learned to make sustainable changes that helped her lose weight and get her blood sugars down to a healthy level.
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