ISSUE #17 SUMMER 2020 ADVANTAGE · ing and closing commerce and community are adjusted to control the spread. South ... feelings to trusted others, those who listen, reflect and do

ADVANTAGEHealthy Living Over 50

ISSUE #17 SUMMER 2020

COVER STORY

In this issue1 Cover Story:

Finding Normalcy

4 Coping With the Next Phase of the Pandemic

6 A New Balance: Making a Plant-Based Diet Work for Your Heart Health

8 Medicare Open Enrollment is On Its Way: A Checklist to Help You Make Best Choices

12 Stroke Doesn’t Have to Be Devastating When Expert Care is Close to Home

16 Your Doctor’s Office is Open: What You Need to Know

18 The Importance of Advanced Directives

“Besides regular physical activity, safe socializing,

healthy diets and regular rest,

individuals should resume annual checkups and doctor visits.”

Adapting to the Ups & Downs of COVID-19South Bay residents search for balance in the next normalWRITTEN BY MELISSA BEAN STERZICK

The success of the shelter-at-home measures in decreasing COVID-19 transmission rates is clear. However, a new stage of

the pandemic is developing. Cases of the virus are increasing while phases of open-ing and closing commerce and community are adjusted to control the spread. South

Bay residents are considering this reality and asking themselves what feels safe.

The activities outlined in each phase are a sensible guide, but every outing should include masks, social distancing, hand washing and common sense to keep rates of infection down. Every individual has the power to protect their health and the health

Continued on page 2

Seeking A New Normal in Uncertain Times

2 ADVANTAGE / Torrance Memorial, a Cedars-Sinai Affiliate

of those around them.“My biggest emphasis is the idea we should

try to get things open, but we have to understand while that means life is more normal, we still have to take certain precautions. If we do that, we can manage this with the least amount of people getting sick again,” says Dr. Eric Milefchik, a Torrance Memorial Physician Network infectious diseases specialist and chairman of infection control for the medical center.

Dr. Milefchik recommends individuals avoid be-ing around unmasked people within a 6-foot range or the “respiratory droplet zone.” Passing through a droplet zone is low risk, but staying in one for more than a few minutes could be dangerous.

“The more congested the location is, or the more time you are spending in a closed off area with less air circulating, or if somebody is not wearing a mask and you are exposed for a period of time, the more the risk,” he says.

Residents should feel comfortable going to stores, ordering take out, eating in restaurants where seating is limited and spending time outdoors. Wearing masks and reducing proximity are important precautions even outside, because droplet zones can be formed outdoors among large groups.

Parks, trails and beaches are low risk but can create chances for infection if crowds gather or people from different families share transporta-tion to those sites. Sitting in a closer environment like a car, with people from different families and talking while not wearing masks is not advised.

Besides regular physical activity, safe so-cializing, healthy diets and regular rest, indi-viduals should also resume annual checkups

Continued from Cover

Front-Line Heroes

F rom the time the pandemic began until most recent days, the medical community around the country, including Torrance

Memorial, has been manning the front lines carrying out treatment and research at the same time. What has been found so far, ac-cording to Dr. Eric Milefchik, Torrance Memorial infectious diseases specialist, is a treatment based on multimodalities is best.

“In this situation we share info with other centers. We look at the studies as they come out and we try to choose what is potentially helpful without causing harm,” he says.

High pressure oxygen techniques such as nasal cannulas and oxygen masks address respiratory distress. Proning - placing patients on their stomachs – also supports lung function. Different medications including immune modulating drugs and steroids are administered depending on the patient’s condition.

While COVID-19 has no proven treatment, plasma donated by those who have recovered (called convalescent plasma) may help patients fighting COVID-19. This is because the body develops antibodies against the virus. Historically, convalescent plasma has been successfully used to treat similar diseases such as the Spanish Flu, SARS, MERS and H1N1. Plasma donations are received through the American Red Cross (www.redcross.org) and San Diego Blood Bank (www.sandiegobloodbank.org).

Dr. Milefchik says the emergency department has been instrumental to successful COVID-19 management. Those providing patient direct care including nurses, respiratory thera-pists, phlebotomists, physical/occupational/speech therapists, hospitalists from each of the groups, pulmonary/critical care physicians, anesthesiologists and many other specialists have shown strong teamwork.

“Torrance Memorial nurses are smart, dedicated and have been the source of many of the innovations in care of patients,” he says. “Torrance Memorial administration has been quick to act, and great leadership has been demonstrated at all levels. They have listened to all players and enabled us to be well-prepared throughout this time.”

Issue #17 Summer 2020 3

and doctor visits. The hospital is a safe place to address medical needs, and the consequences of deferred care are high. Elective surgeries are now being done, and Torrance Memorial has reached full scheduling capability.

Dr. Milefchik says there is a lot of variability in the virus’ spread around the country and that variability will continue. Besides different conditions, transmission of the disease goes in stages – some plac-es are at the beginning of the spread and others at the end.

“The uniform thing is that testing is definitely better everywhere. Theoretical-ly, we have the ability to control it more by finding out where it is and quarantin-ing contacts better than we were in the beginning,” he says. “The key will be to identify those who are sick quickly and take measures to limit the spread.”

Although there has been an uptick in case numbers for Los Angeles county, it is still manageable in the South Bay. Many aspects of a return to normalcy are not known and will be made clear as weeks pass.

Torrance Memorial is preparing for a possible second wave by fine tuning its procedures. Testing processes will be im-proved by adding a third platform for rapid testing and gathering more supplies.

One thing that won’t change is the hospital’s triage system. Patients are separated at the door so all respiratory suspected COVID-19 cases go one way and the rest go the other way. Dr. Milef-chik says Torrance Memorial has not identified a single patient who caught COVID-19 at the hospital.

Every individual is adapting differently to the pandemic. As more businesses and venues open, there will be those who do and do not take precautions. Dr. Milefchik

says those who do not will be more likely to contract and spread the virus.

However, he says, it’s time to compare the risks and benefits of reopening. The pandemic has affected peoples’ health in ways that can’t be measured yet. Physical and mental health are both jeopardized by business closures and strict shelter-at-home measures. Anxiety is prevalent among those who have lost work or expe-rience isolation.

Dr. Milefchik says the stress of the pan-demic and the challenges of isolation and unemployment have created an increase in mental health issues. An article by Moe Gelbart, PhD, on page 4, outlines ways individuals can protect their mental health as pandemic response evolves.

“There’s an unmeasured effect. People just want to see some good news after all of this. They want to know they can get out there safely,” Dr. Milefchik says. He thinks if residents of the South Bay do all they can to help keep the spread of the virus low, rates of infection can be controlled. Case numbers must be kept from rising exponentially to keep hospitals under their capacity lines.

Dr. Milefchik recognizes people can be confused by the information they read from different sources. For the South Bay community, he recommends Los Angeles County Department of Public Health and the Centers for Disease Control for straight-forward, digestible information about the virus, its treatment and containment.

“The faster we get things to move toward normalcy - and we’re talking an-other year before realistically things reach actual normalcy - the better,” he says. “We can’t ignore it. We have to respect certain measures and the better we can respect that, the better it will be for every-body’s health.” •

Erik Milefchik, MD, is a Torrance Memorial Physician Network infectious diseases specialist and chairman of infection control for Torrance Memorial. He practices at 2841 Lomita Boulevard, Suite 135 in Torrance. He can be reached at 310-784-6954.

#1 Ranked Hospital in the South BayTORRANCE MEMORIAL RANKED FIRST AMONG SOUTH BAY HOSPITALS BY NEWSWEEK AND U.S. NEWS & WORLD REPORT.When it comes to local expert care, it is important to know the facts. Torrance Memorial is leading the way in the South Bay for expert care, ranking among the best hospitals in California and the nation. TMFirst.org

Top 3% Hospital in

California- U.S. News & World Report

Ranked #48 in the Nation

- Newsweek

Ranked #10 in California

- Newsweek

CONGRATULATIONS on ranking

#1 in the

South Bay!


Coping With the Next Phase of the PandemicWRITTEN BY MOE GELBART, PHD, THE THELMA MCMILLEN RECOVERY CENTER

After more than four months of COVID-19, we are confronting new concerns relat-ed to the re-opening of our community and economy. With the early days of

COVID-19 came severe anxiety due to dealing with the unknown. Anxiety breeds on fear of the unknown, on uncertainty and on being confronted with things over which we have no control. When the consequences include possible illness and/or death of ourselves, our families and our loved ones, the anxiety can be overwhelming. What the past several months have shown us is we are resilient, and we have come to terms, to some degree, with this unknown enemy and a “new normal.” We have learned about social distancing, handwashing and face coverings -- all things to help us feel some sense of control. We (hopefully) follow the data and heed the guidance of our physicians and public health experts.

As the South Bay has begun to open up, we have a new set of concerns, again raising our fears and anxieties. Should we go to work? to the beach? to a restaurant? send our kids to school? go to the doctor? get a haircut? go to the gym? and all the other things which just over three months ago never caused us pause. Revisiting some of the coping mechanisms and strategies for handling stress may help us navigate through these decisions and shed some light on these dilemmas. Some things which help with this process include:

Thoughts and Feelings. We are motivated to ac-tion by our feelings. Fear and anxiety make us avoid an action. Desire will propel us towards something. Since feelings drive us, we need to understand the connections between thinking and feeling. Feelings are always accurate and correct, but they are the byproducts of thinking. Our thoughts are complex results of our history, experiences, perceptions, and even misinformation and distortions. The way to

understand our feelings is to be very clear about our thinking, and the meaning we give to things. The way to change our negative, painful and fearful thinking is to adjust how we think and how we perceive things. When it comes to making choices about stepping outside of our “comfort” zones, (like getting back to some activities), we have the nar-ratives in our heads which often create our feeling states. It can be of value to examine those narra-tives, and possibly come up with a new perspective. Often the narratives are indicative of absolute, all-or-none, black-white thinking which tends to cause unpleasant feeling states. If we can see things in more “gray” perspective, the intensity of our feel-ings lessen. In some ways, it is being able to see the proverbial glass as half full rather than half empty.

FEATURE

“As the South Bay has begun to open up, we have a new set of concerns, again raising fears and anxieties,” Moe Gelbart, PhD.


Accept and do not judge your feelings. When our inner voice judges our feelings, with nega-tive thoughts like we are wrong, dumb, insecure, inadequate or other negative judgments, it only deepens our shame and anxiety. Instead, when you hear yourself judging your emotions, feelings or reactions, learn to “speak” more kindly to yourself. I tell people to speak to themselves as they would to their children, which is always with kindness, understanding and an attempt to help. For example, when we feel afraid, we may hear ourselves say “what is wrong with you” or “there is nothing to be afraid of” or “you are weak.” If your child came to you with the same issue and same feelings, you would no doubt treat them with care and help guide them. This is something you can do for yourself as well and will enable you to come up with better outlooks and solutions.

Empower yourself with your strengths. We all experience ups and downs, achievements and failures, and we are often much stronger than we think. In stressful times our fears can lead to cata-strophic thinking, which often leads to anxiety and depression. If we head down the “what if” road to visions of disaster, we need to tell ourselves to stop and take inventory of our strengths and capabilities. We need to remind ourselves our worst fears are not very likely to occur, and even if they did, we are more capable of handling them than we think. It is almost impossible to deal with a monstrous scenario that has not occurred yet and is in our imagination, but we are able to feel a sense of control in dealing with things in our present.

Understand Risk-Reward Tradeoff. We are of-ten paralyzed when we try and determine whether actions are right/wrong, correct/incorrect. Many of our decisions have, in actuality, no right or wrong solution but are choices with benefits/rewards and positive/negative consequences. When we think about re-entering our activities, we need to be clear about the rewards offered, and the risks that need to

be taken. When we feel the benefit outweighs the risk, then we can proceed. We need to be certain to accept our feelings, understand the thoughts that produce them, and not judge or shame ourselves into an action we are not comfortable with. Be very careful of the danger-

ous internal thought known as “you should” and be able to replace it with “I want to.”

Expand your focus. We sometimes have a habit of thinking about things in only one way and not allow-ing ourselves to see things differently. This is known as selective inattention. In a well-known experiment (you can Google selective inattention gorilla), people were asked to view a group of teens in white t-shirts, and a group in black t-shirts, both passing a basket-ball. The viewer was asked to count how many times the group in white passed the ball. The interesting part was they were so focused on their task that the majority of the viewers did not even see a man dressed as a gorilla on the screen. I have tried this many times in talks I give, and shockingly, about 85% of the people do not see the gorilla until the video is rewound. The point is sometimes we need to take a step back from our way of thinking in order to see the bigger picture and options.

Express yourself. I have written about this before, and it bears repeating. Express your thoughts and feelings to trusted others, those who listen, reflect and do not judge. Often what you are looking for is a caring ear and not advice. This often lets you come to new ways of seeing things on your own.

As you have begun to confront getting back to “nor-mal” activities, remember to trust your feelings. Know your feelings come from your thoughts, that you can investigate your thinking and gain more clarity, and most decisions are not right or wrong, but are choices with positive and negative consequences. Trust most things will not be as bad as you fear, know you are stronger and more resilient than you give yourself credit for and be kind to yourself. •

Handwashing is one way to help us maintain

some sense of control over the current

situation.

Moe Gelbart, PhD, is Executive Director for the Thelma McMillen Recovery Center. He practices at 3333 Skypark Drive, Suite 200 in Torrance. He can be reached at 310-784-4879.


A New BalanceMaking a Plant-Based Diet Work for your Heart Health

WRITTEN BY MELISSA BEAN STERZICK

Trends in diet come and go, but the concept of a balanced diet is a constant. Everyone knows fruits and vegetables are healthful foods, however, the definition of what constitutes a balanced diet has changed. The emphasis on protein has been reduced and the

consumption of more plant-based foods recommended. A balanced diet still includes servings of all food groups, but it is now

defined to include many more servings of fruits, vegetables, grains and legumes than it does animal proteins such as meat, poultry and dairy.

An enormous amount of scientific data shows exactly how a plant-based diet supports good health. An area where it has irrefutable benefits is in the prevention of heart disease.

“Reducing any amount of animal product consumption is beneficial. Even if one doesn’t subscribe to a full vegan or vegetarian diet, minimizing the consumption of red meat, processed meats and dairy will reduce cardiovas-cular mortality in the long run,” says Torrance Memorial Cardiologist Victoria Shin, MD. “A plant-based diet reduces consumption of animal products and

high-sodium processed foods. This, in turn, reduces dietary cholesterol and salt, which in turn reduces risk of high cholesterol and high blood pressure - two well-known risk factors for heart disease.”

A “semi-vegetarian” or “flexitarian” diet reduces cholesterol and weight, and lowers the risk of devel-oping hypertension and heart disease. Both empha-size mostly plant-based foods while allowing meat and other animal products in moderation.

Shin says when compared to plant protein, the fol-lowing are associated with increased cardiovascular mortality rate when consumed: poultry and fish (6%), dairy (8%), unprocessed red meat (12%), eggs (19%) and processed meat (34%).

In contrast, plant protein was associated with a reduction in mortality rate of 10 percent.

“Plant-based and Mediterranean diets have been associated with lower risk of all-cause mortality in several observational studies, as well as a large ran-domized control study which showed a significant 41 percent mortality reduction in those who had a plant-based diet,” Dr. Shin says.

She emphasizes it is up to individuals to choose a diet that works with their lifestyles and can be accom-plished successfully. But reducing any amount of animal product consumption is beneficial.

“Dietary cholesterol is increased by consumption of animal products. The human body has the ability to remove the bad cholesterol from the body through re-ceptors in the liver,” she says. “However, if the dietary intake of cholesterol is significant, it overwhelms the system. The body can only do so much. And all that extra bad cholesterol floats around in the bloodstream depositing in arteries and forming plaque.”

Reducing sodium and cholesterol intake is one advantage of a plant-based diet that improves car-diovascular health, however there are key nutrients within a plant-based diet worth noting.

“A plant-based diet not only eliminates many foods high in saturated fat, but also is naturally high in fiber. Consuming adequate fiber and decreasing saturated fats can help lower our cholesterol levels and there-

Adapting to a plant-based diet supports good health. It can also help prevent heart disease and other health concerns from cholesterol to diabetes.

FEATURE


fore decrease the risk of developing heart disease,” says Dani Rodriguez-Brindicci, MS, RDN, Director of Clinical Nutrition at Torrance Memorial.

Plant-based diets can be practiced on a spectrum. It does not need to be an all-or-nothing approach. Individuals can choose to eat more plant-based foods and fewer animal products. They can also adopt flexi-tarian, vegetarian or vegan diets.

Rodriguez-Brindicci understands making changes to diet can be overwhelming.

She says some people hesitate to adopt plant-based diets because they think their food will be tasteless and boring. She also says cultural food practices can make embracing a plant-based diet difficult. If friends and family members are used to connecting over specific meals, they might pose a challenge to making changes in diet. And some indi-viduals might still believe they need animal proteins to be healthy.

“We don’t need as much animal protein as we thought we did. This has been a misconception, and the American diet has way more than we need of servings of these types of foods,” Rodriguez-Brindicci says. “You don’t have to have animal protein with every meal.”

She recommends starting slow. Begin by incorpo-rating more plant-based dishes and meals daily or weekly and generally eating animal foods in moder-ation. Get creative with ways to substitute plant foods for animal foods.

Meat Free Monday is a growing movement that can be a good place to start – it’s a campaign that chal-lenges people to be vegetarian one day a week.

Another idea is a regular visit to the farmer’s market. Experience food closer to its source and offered ac-cording to the season. Or try out plant-based foods at

a restaurant to get an idea what tastes good, Rodri-guez-Brindicci suggests.

“There has never been a better time in history for innovations in plant-based cuisine. I recommend people go out and try vegan restaurants. Whether it is Mexican food, pizza or desserts, there are many options to choose from,” she says.

Rodriguez-Brindicci says it is easy to get caught up in trendy diets or skewed research. The Food Pyra-mid is outdated and the current model of a balanced diet is one that includes half of its calories from plant sources (vegetables and fruit), a quarter from whole grains. The last quarter should come from healthful proteins – with more plant-based proteins such as nuts and legumes and fewer animal products.

“If you really want to make a change, I want to encourage people to see a dietitian and examine health and goals,” she says. “Get good information from some-body who has a real understanding of it. Then find what works for you -- that’s the most important part.” •

Cauliflower has gone from trusted side dish

to the superhero of plant-based and low

carb replacements and everything in between.

Adopting a plant-based diet

Start with one meal each day being plant-based.

Look at plants as the entrée and meat as the condiment or side.

Pick a certain day or days of the week you will eat plant-based meals.

Make some of your favorite meat dishes vegetarian instead.

Shop at your local farmer’s market and see what’s in season.

Eat at a plant-based restaurant.

Start slow. It does not need to be an all or nothing approach.

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Victoria Shin, MD, is a Torrance Memorial Physician Network cardiologist. She practices at 2841 Lomita Boulevard, Suite 235 in Torrance. She can be reached at 310-517-8950

Dani Rodriguez-Brindicci, MS, RDN, is the Director of Clinical Nutrition at Torrance Memorial. To schedule an appointment with a registered dietitian nutritionist at the outpatient Medical Nutrition Therapy Office located in the Torrance Memorial Specialty Center, call 310-891-6707 or visit Torrance Memorial.org/nutrition.


Medicare Fall Open Enrollment is On Its Way Here is a Checklist to Help You Make the Best Choices

If you are a current Medicare recipient, you might know that every October you have the option to change your coverage during the Fall Open Enrollment Period (also referred to as the Annual Enrollment Period). This provides you the opportunity

to review your current benefits and how they might change in the coming year, according to independent insurance agent Vince Kelly. Here’s a checklist to get you prepared for open enrollment.

Are you ready for open enrollment?The 2021 enrollment period, as in prior years, runs from

October 15 to December 7. You can make as many changes as you wish, but your final selections submitted by December 7 will stand as your new plan and will start on January 1, 2021. You don’t have to make any changes. If no changes are made, your current plan will simply continue and roll over into 2021.

From January 1 through March 31, 2021, there is also a Medi-care Advantage Open Enrollment Period during which people in a Medicare Advantage Plan may make one change, which in turn will remain for the year. Kelly says this is unless you qualify for a Special Enrollment Period (SEP), in which case you may make a change during certain times of the year. One popular example of an SEP is moving out of the service area.

Have you reviewed your plan notices?Pay attention to your mail. As early as September 15,

Medicare Advantage recipients will be receiving their Annual

Notification of Change (ANOC) pamphlet from their current insur-ance company. The ANOC shows if the plan you currently have is changing, such as moving a prescription drug to a higher tier (which could make it more expensive) or adding benefits.

It pays to compare. “Most people don’t make any changes,” Kelly says, “and some see the pamphlet and get overwhelmed.” But they shouldn’t—all you really need to do is read the chart comparing the 2019, 2020 and 2021 columns. Confirm the things you like and have had in the past year will continue next year. If you’re happy with your current doctors, your health plan benefits and your coverage, open the ANOC and check for any changes between your 2019 benefits and the upcoming 2021 benefits.

Does your existing plan meet next year’s needs?During this enrollment period you may change or join

a Medicare Advantage HMO plan. The benefits of these plans are wide and they vary. Some of the most important factors are Medicare Advantage plans typically include a Part D prescription drug plan, urgent care visits and low or no copays or deductibles.

If you are not currently in a Medicare Advantage HMO, you can join during the Medicare Annual Enrollment Period. You also have the option to just change your stand-alone Part D prescrip-tion drug plan during Medicare Annual Enrollment Period only (unless you qualify for an SEP as noted previously.)

You might need a supplement plan. Individuals who decide to pay a premium and join a stand-alone Part D plan will return

Open Enrollment is coming and the more you understand about your specific needs ahead of time, the better prepared you will be when it is time to make important decisions about your Medicare benefits.HEALTHY LIVING


to their Original Medicare and should consider applying for and purchasing a Medicare Supplement insurance (also known as Medi-Gap). A Medicare Supplement policy helps pay the 20% not covered by Original Medicare.

Is this your first time enrolling?If you are a first-time Medicare applicant, your Initial En-

rollment Period (IEP) is the seven-month period surrounding the month you turn 65—three months before the month in which you turn 65, the month of your birthday and the three months following your 65th birthday. Once you’re eligible to apply, you have the choice of Original Medicare (the fee-for-service program run by the U.S. government) or a Medicare Advantage plan (a type of private insurance offering an HMO).

Do you need Medicare supplement insurance?Medicare Part A and Part B are considered Original Medi-

care and by design cover only basic services. Also there is a high hospital copayment charge with both. This is why consumers should consider adding a Medicare Supplement insurance plan to help cover costs not covered by Original Medicare.

The best time to get a Medicare Supplement plan is when you are new to Medicare because the premiums based on age and inflation will be the lowest they are ever going to be for you. Also, if you apply when you are first eligible, an insurance company can’t deny you a policy or place conditions on it. These situations include pre-existing conditions (they can’t deny you or charge you more) and moving or travel. “A supplement will also give you more control and freedom of choice,” adds Kelly. •

Go to medicare.gov and/or call the Torrance Memorial IPA Resource Center for more information: 310-257-7239; or health insurance counseling and advocacy expert Doris Herzog at 310-517-4666. Or, attend one of Torrance Memorial IPA’s complimentary Medicare 101 lectures. Visit torrancememorialIPA.org/Medicare101 to register.

Open Enrollment is just around the corner. Use this checklist to help guide you through the process.

Make sure you understand your options:

Medicare Part A (Hospital Insurance)Part A covers inpatient hospital stays, care in a skilled

nursing facility, hospice and some in-home health care. For most people, Medicare Part A has a $0 monthly cost because of what they have paid into Social Security taxes.Medicare Part B (Medical Insurance)

Part B covers certain doctor’s services, outpatient care, medical supplies and preventative services. For most services, Part B covers 80% of charges with no out-of-pocket maximum. There is a monthly cost for Part B, which is based on your income. For some, the state will subsidize, while high-income earners will pay more. Details can be found on the official Medicare website, medicare.gov.Medicare Part C (Medicare Advantage Plans)

Medicare Advantage plans are offered by private in-surance companies contracted by Medicare and include HMOs. Medicare Advantage plans cover everything that Original Medicare Parts A and B do and also offer pre-scription drug coverage, routine eye care, transportation and often acupuncture and other integrative treatments. Many also offer perks such as gym membership, dental discounts and allowance for over-the-counter items such as toothpaste, vitamins and skin care products. In addition, they offer several options for you to choose a medical group or an independent physician association (IPA) contracted with them, such as Torrance Memorial IPA, a division of Torrance Memorial. For information about Medicare Advantage Plans, you can attend Tor-rance Memorial IPA’s Medicare 101 educational events. Visit Torrance Memorial IPA.org/medicare101 to register.

The upside: These plans offer optimal coverage for just about anything that might arise in your life. There is great coordination of care within your IPA caregivers, and you can change your plan every year according to your needs.

One downside: You are typically limited to routine medical services within the network of your IPA or medical group.

Medicare Advantage Plans require you to choose an insurance company (such as Aetna, Anthem Blue Cross, Blue Shield of CA, Health Net, Humana, SCAN or AARP/United Healthcare) and a medical group such as nonprofit Torrance Memorial IPA or Healthcare Partners. The insur-ance companies, in turn, are contracted with the IPAs so you have plenty of choices. TorrancememorialIPA con-tracts with the HMO insurance companies listed above.


Welcome back to health

WE ARE SAFER TOGETHER. Thanks to our South Bay community for doing your part. Your efforts

have made it possible for us to take the next steps back to health and wellness. Getting the care you

need when you need it is essential. Timely treatments, testing and in-person visits offer the highest

level of care and success . Don’t put your hea lth on hold . Your sa fety and wel l -being are our

top priority at all times. Call your doctors and follow up on your regular screenings and treatments.

Learn more at TorranceMemorial.org


Welcome back to health

WE ARE SAFER TOGETHER. Thanks to our South Bay community for doing your part. Your efforts

have made it possible for us to take the next steps back to health and wellness. Getting the care you

need when you need it is essential. Timely treatments, testing and in-person visits offer the highest

level of care and success . Don’t put your hea lth on hold . Your sa fety and wel l -being are our

top priority at all times. Call your doctors and follow up on your regular screenings and treatments.

Learn more at TorranceMemorial.org


HEALTHY LIVING

Stroke Doesn’t Have to Be Devastating When Expert Care is Close to HomeTorrance Memorial earns Comprehensive Stroke Center certification and continues to offer advanced stroke care in the South Bay community

In January 2020, Torrance Me-morial Medical Center received its Comprehensive Stroke Center (CSC) certification from DNV GL, a national

healthcare accreditation organization. The CSC certification — the highest level of certification awarded by DNV GL — signifies Torrance Memorial’s commitment to offering the most ad-vanced stroke care for members of the South Bay community.

With the support of the Lundquist Neurosciences Institute and pro-gram-wide collaborative efforts, this significant milestone was achieved which will enhance critical stroke treatment in our community.

“The Comprehensive Stroke Center certification is a win-win for Torrance Memorial and Cedars-Sinai, as well as for the entire South Bay community,” said Shlee Song, MD, medical director

of the Comprehensive Stroke Center and Telestroke Program at Torrance Memorial and Cedars-Sinai. “South Bay residents now have access to a team of specialists who offer a full range of stroke treatments close to home, decreasing the time it takes for patients to receive expert stroke care and increasing the chances of a positive outcome.”

PH

OTO

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Our patients benefi t from our expert team off ering state-of-the-art minimally invasive treatments that help to eliminate or reduce the need for open heart surgery.

On theCuttingEdge ofCuttingLess

THE LUNDQUIST LURIE CARDIOVASCULAR INSTITUTE IS A LEADER IN ADVANCED CARDIOLOGY CARE.

Learn more at TorranceMemorial.org/Cardio

Brian Sherman, MD, Ed Nazarath, RN, Richard Krauthamer, MD, George So, MD, Derek Berz, Shlee Song, MD, Paula Eboli, MD, Eric Nakkim, MD, Marco Pech, RN

Source: U.S. Centers for Disease Control and Prevention

About 87 percent of all strokes are

ischemic strokes, in which blood flow to the brain is blocked.

87%Stroke is a leading

cause of serious long-term disability,

reducing mobility in more than half of stroke survivors age

65 and older.

65 yrs795KEvery year, more

than 795,000 people in the

United States have a stroke. About

610,000 of these are first or new

strokes.

Stroke Facts

40Seconds

Someone in the United States has a stroke every 40

seconds. Every four minutes, someone

dies of a stroke.

Neurosurgery ExpertiseThrough a partnership with

Cedars-Sinai established in 2016, Torrance Memorial Lundquist Neurosciences Institute now has specially-trained neurosurgeons on staff who can perform advanced minimally-invasive and open procedures to remove blood clots, treat brain aneurysms and control bleeding in the brain.

As part of the CSC certification process, Torrance Memorial was re-quired to demonstrate it is equipped to perform complex neurosurgical interventions to treat all types of strokes, including ischemic strokes that occur when the blood supply to the brain becomes blocked, as well as hemorrhagic strokes that occur when a blood vessel ruptures and causes bleeding in the brain. Tor-rance Memorial was also required to show hospital staff could provide expert treatment for brain aneurysm,

which is a bulge in a blood vessel in the brain that can cause a hemor-rhagic stroke if it ruptures.

Paula Eboli, MD, is a Cedars- Sinai endovascular neurosurgeon at Torrance Memorial who specializes in performing a range of complex endovascular procedures. Endovas-cular procedures treat problems with blood flow to the brain from inside the blood vessels themselves, using a catheter inserted through a small incision in the wrist or groin.

Dr. Eboli uses the latest brain and blood-vessel imaging technology to perform procedures not previously offered at Torrance Memorial, includ-ing clipping and percutaneous coil-ing to treat brain aneurysms, percu-taneous thrombectomies to remove blood clots that cause ischemic strokes, and carotid endarterectomy and stenting to remove blockages and prop the carotid arteries open.


“The partnership between Cedars-Sinai and Torrance Memorial brings the exper-tise of Cedars-Sinai neurosurgeons to the South Bay, allowing us to deliver a higher level of acute stroke care at Torrance Me-morial,” said Dr. Eboli.

Telestroke Technology In addition to being ready and able to

provide the most advanced surgical stroke treatments, Torrance Memorial Lundquist Neurosciences Institute is leveraging the latest Telestroke technology in partnership with Cedars-Sinai to deliver faster stroke diagnosis and treatment, which promotes improved outcomes for patients.

The Telestroke program provides phy-sicians at Torrance Memorial with 24/7 access to stroke specialists at Cedars-Si-nai. Using a specialized videoconferenc-ing system, Cedars-Sinai specialists can examine stroke patients, interpret brain images, confirm the diagnosis and provide treatment recommendations just as if they were at the patient’s bedside.

“Telestroke is enabling us to do every-thing so much faster when minutes count,” said Dr. Song. “With Telestroke, expert help is just minutes away.”

Neurointensive Care UnitAnother component of the CSC certifi-

cation was the establishment of Torrance Memorial’s Neurointensive Care Unit, which provides specialized care for pa-tients who have experienced a stroke.

The Neurointensive Care Unit is equipped with the latest monitoring tech-nology and staffed by a team of specially trained nurses, neurointensivist physicians and ancillary support professionals, such as respiratory therapists, physical thera-pists, nutritionists and pharmacists.

“When patients arrive in the Neuroin-tensive Care Unit after having a stroke, they are facing an uncertain — and sometimes grave — health situation. We help the patient and their family by surrounding them with a multidisciplinary team that works together to provide compassionate, seamless and excep-tional stroke care,” said Brian Sherman, MD, board certified Neurointensivist at Torrance Memorial. “It’s like a NASCAR pit crew — each staff member has a job to do, but everyone is communicating and working together in parallel.”

And at Torrance Memorial, the combi-nation of faster access to stroke care, the

HEALTHY LIVING

Source: U.S. Centers for Disease Control and Prevention

Stroke Facts

Recognizing the warning signs of a stroke using B.E.F.A.S.T. could save a life:

B BALANCE (Sudden loss of balance or un-steady on the feet?)

E EYES (Loss of vision in one or both eyes?)

F FACE DROOPING (Is one side of the face drooping or numb?)

A ARM WEAKNESS (Is one arm/leg weak or numb?)

S SPEECH (Is the person unable to speak, slurring words,

or hard to understand?)

T TIME TO CALL 911 (Note the time symp-toms first started and

call 911 immediately.)


Need to See aDoctor?

Offices located in: Torrance, Carson, Manhattan Beach,

Hermosa Beach and Palos VerdesAppointments scheduled

M-F, 8 a.m. to 5 p.m.

Hiva Bastanmehr, MDInternal Medicine602 Deep Valley Dr., Suite 300Rolling Hills Estates310-517-4692

Matthew Mejia, MDFamily/Sports MedicineComing Soon (Sept. 2020)

Hardeep Chohan, MDFamily Medicine855 Manhattan Beach Blvd.Suite 102, Manhattan Beach 310-939-7858Fereshteh Rajabi, MDInternal Medicine855 Manhattan Beach Blvd.Suite 201, Manhattan Beach 310-939-7848

Neda Rouhi, MDInternal Medicine3333 Skypark Dr., Suite 100Torrance 310-784-6300

Call Our Physician Referral Coordinator to

Schedule An Appointment.310-891-6717

TMPhysicianNetwork.org

Rumi Cader, MDInternal Medicine3701 Skypark Dr., Suite 100Torrance 310-378-2234

most advanced treatments, and special-ized, compassionate care for patients and families in the Neurointensive Care Unit often results in better outcomes and short-er hospital stays for patients.

“We shepherd our patients and their families through all aspects of stroke care, combining science-based treatment with compassion to make them feel truly cared for. It’s so satisfying for Torrance Memorial to have a Neurointensive Care Unit where a patient can be in a coma in the evening and wake up the next morning asking for an omelet,” said Dr. Sherman. “It reaffirms why we come to work every day.”

A Positive Community ImpactBefore Torrance Memorial became a

CSC, South Bay residents who required advanced stroke care had to be taken or transferred to another facility — some-times resulting in delayed treatment that placed patients at a higher risk of increased brain damage that could lead to physical or cognitive impairments.

Now, when seconds count, South Bay patients can receive faster access to ad-vanced stroke care right in their communi-ty, without having to go to a facility farther from home.

“When it comes to stroke care, time is brain — and the faster someone receives treatment, the better their chance of a positive outcome,” said Marco Pech, MSN, RN, SCRN, stroke program coordinator at Torrance Memorial Lundquist Neuro-sciences Institute. “It’s amazing to see patients leave Torrance Memorial defi-cit-free with their loved ones after having a serious stroke.”

“Being a Comprehensive Stroke Center is making a statement to our community that we offer the highest level of stroke care and have all of the systems in place to support patients and families through-out a neurological emergency,” said Dr. Sherman. “At Torrance Memorial, we

provide specialized stroke care from the emergency department through fol-low-up, and we anticipate each patient’s needs from day one.”

Additionally, having access to compre-hensive stroke care close to home means families do not have to travel long distanc-es to care for their loved ones.

“Having a patient transferred to a facility outside their community adds stress for the patient and family, especially during a lengthy hospital stay,” said Dr. Song. “Pro-viding care close to home helps patients recover, allows family members to visit, and eases stress.”

Program-Wide CollaborationTorrance Memorial Lundquist Neuro-

sciences Institute’s stroke program staff all agree the hospital’s long-awaited CSC certification was the result of a commit-ment to providing the best community stroke care and enhanced capabilities due to outstanding collaboration between Tor-rance Memorial staff, as well as between Torrance Memorial and Cedars-Sinai.

“The co-led program between Torrance Memorial and Cedars-Sinai allows us to combine our resources to treat patients at Torrance Memorial and if needed, expedite transfer to our partnered colleagues at Cedars-Sinai,” said Dr. Sherman. “Expert care can come to Torrance Memorial with our affiliation.”

“Our administration was strongly supportive of our efforts to obtain the CSC certification, including putting together local donor support — they were always coming from a place of ‘yes,’” said Dr. Song. “The Lundquist family has invest-ed in the idea of delivering expert care in the region.”

“It takes a village to have a successful stroke program,” said Pech. “Many people worked diligently to provide South Bay residents with this level of stroke care.” •


ASK THE DOCTOR

Your Doctor’s Office is Open: What You Need to Know

WRITTEN BY MELISSA BEAN STERZICK

As we have practiced isolation to decrease the transmission of COVID-19, many non-urgent doctor’s office visits have been

cancelled or delayed. Some individuals have postponed appointments or have avoided going to the doctor, but it is safe to go to the doctor’s office as urgent and many regular visits can be scheduled. Virtual appointments will continue and are a good option in some circumstances. Dr. Robert Glazer is the Medical Direc-tor for Torrance Memorial Physician Network. He answered a few questions about what doctor visits will look like in the days a ahead.

Q: Is it safe to visit my primary care physician?

A: Yes. During the ‘shelter in place’ order some offices were simply closed while others offered limited access. While emer-gency departments always remain open, and emergent surgeries performed, all elective visits, procedures and surgeries were cancelled or postponed. We are pro-gressing in our knowledge of mitigating risk to our patients and staff, and we now feel comfortable making the office more avail-able for face-to face encounters. Our offices have taken measures to ensure both patient and medical staff safety, such as taking temperatures upon entering an office, and

Speak with your doctor’s office to familiarize yourself with how you can prepare for your visit ahead of time. We are taking temperatures, limiting the number of people in waiting areas and requiring patients to wear face coverings for all appointments.


limiting the number of people in the re-ception, waiting and patient examination areas. All health care staff and patients must wear masks, and exam rooms are disinfected after each patient leaves.

Q: Is it a good idea to go to the doctor’s office or other medical service offices such as imaging centers or labs?

A: All outpatient centers on the Torrance Memorial campus are tak-ing the precautions listed above. The doctors are concerned that necessary ongoing and preventative care have been delayed or postponed because of the “sheltering at home” policy, and there can be unhealthy ramifi-cations because of this. We intend to help our patients catch back up in our offices and certain patients can go back to regular doctor visits.

Q: What about alternatives to face-to-face doctor visits?

A: Our clinics have instituted Tele-health, which are online, virtual visits. Most chronic health conditions, and some acute ones, can be addressed during these virtual discussions. Nothing can truly take the place of the face-to-face visit, but this has demon-strated to be an excellent substitute. We are using Telehealth to complete the very important Medicare Senior Annual Wellness Exams (even by telephone, for those without WiFi). Our mental health colleagues are finding Telehealth services particularly suited for emotional issues. Although, Tele-health cannot replace all visits, we will continue to integrate virtual visits as appropriate during this time. Routine appointments for annual screenings, mammograms, colonoscopies and oth-

er procedures are still advisable. Follow the advice of your physician.

Q: What types of regular checkups should patients schedule now?

A: All types of regular check-ups should be scheduled. Distancing requirements and the need to protect vulnerable groups, for now, necessi-tate some discretion as to who should come into the office at this time. For this reason, and to ensure the safe-ty of all, please follow the advice of your physician or physcian’s office on whether your appointment should be in person or a virtual Telehealth visit. Right now we are fully-operational, procedures and elective surgeries are currently being scheduled and we are allowing patients who require preoperative clearance into the offices. Also, since patients who are having significant pain or have had an injury need to be physically examined, these patients are being scheduled in the office. If there is a concern, the doctor’s office can speak with patients ahead of time to determine what would be in the patient’s best interest.

Q: When will there be open access to medical offices?

A: All essential services are current-ly available to all patients. Factors that will help us determine the safety of remaining open will be viral infection rates, advice from the public health entities, and of course recommen-dations from our infectious disease leaders at Torrance Memorial. The most important thing for our patients to remember is to not ignore or delay the care they need.

Q: What measures are being taken to ensure a face-to face doctor visit is safe?

A: Doctor’s offices already have strict protocols for hygiene and disin-fecting surfaces. In addition, they will be keeping up with new recommenda-tions offered by the CDC. Some offices will see fewer patients to create more space, and all offices have already rearranged their waiting areas. We are learning more about COVID-19 every week, and any new precautions will be added to our protocols accordingly.

Q: What can the patient do to make a visit to a doctor’s office safer?

A: Speak with your doctor’s office to familiarize yourself with how you can prepare for the visit ahead of time. Wear a mask, but if you don’t have a mask, one will be provided for you. If you are feeling any symptoms of COVID- 19 (fever, cough, shortness of breath or cold symptoms), call before your arrival and ask about the office’s policy and ability to accommodate you. If you need the assistance of a caretaker, or if the patient is a child, please bring only one caretaker. When you arrive at the doctor’s office, cooperate with entry procedures and answer all questions about your health, exposure and travel honestly. •

Note: If you are experiencing any symptoms of COVID-19 or need to speak with a doctor, please contact your Primary Care doctor or call our physician referral coordinator at 310-891-6717. Our Emergency De-partment is prepared and capable of safely handling ALL emergency needs during this time.

Robert Glazer, MD, is Medical Director for Torrance Memorial Physician Network. He practices at 3333 Skypark Drive, Suite 100 in Torrance. He can be reached at 310-784-6300.


PRIME TIME

Do you want a secure future? Of course; everyone feels a little better knowing the future is secure – but sometimes planning for a secure future can seem

like a full-time job. Do you know there’s a way to help make things easier for your family and ensure your own future care, comfort and peace of mind? Advance directives can do just that, with a little time and effort from you. Advantage spoke with estate planning, trust and probate at-torney Beti Tsai Bergman, a member of Torrance Memorial’s Professional Advisory Council, about the advantages of advance directives, so keep reading – we won’t ask you any more ques-tions, promise.

Advantage: Advance directives are sometimes called advance health care directives be-cause they specify a person’s preferences for medical treatment. How, legally, do advance directives work?

Beti Tsai Bergman (BTB): An advance direc-tive is a legal power of attorney. In addition to specifying health care and treatment prefer-ences for the individual, called the principal, the directive also names and empowers an agent – someone who can make medical treatment decisions for the principal. People should have that in place for when they can’t make decisions for themselves.

The Importance of Advanced DirectivesWRITTEN BY JOHN FERRARI

Working with a qualified legal professional on your own advanced directive now will clarify and help ease the burden of decision-making for your loved ones in the future.


The Lundqu is t Or thoped ic Institute offers one of the most advanced, minimally invasive o r thoped ic ca re p rograms i n S o u t h e r n C a l i f o r n i a , i n c l u d i n g M a k o ® r o b o t i c a r m - a s s i s t e d t e c h n o l o g y. TorranceMemorial.org/Ortho

New Hip.New Zip.

Advantage: Advance directives are used when the principal is unable to express his or her preferences for medical treatment, usually because a medical condition has rendered the person unconscious or oth-erwise unable to communicate, right?

BTB: There are two types of advance directive. Advance directives may spring into effect when the principal loses capac-ity, or they may be effective immediately. This is useful for people who want help planning their care. Some people have the capacity to make decisions but physically are limited, or they don’t want to deal with everything, and they’re comfortable with someone they trust making decisions for them. For example, an immediately effective advance directive can allow the principal’s grown son or daughter to speak with medical caregivers about medication and end-of-life decisions, or make deci-sions about care facilities, so the principal doesn’t have to do it all. Of course, that son or daughter has to be named an agent in the advance directive.

Advantage: What else can an advance directive do, besides specify the principal’s preferences regarding medical treatment?

BTB: Some people like to have very detailed instructions, including an assist-ed living facility, even their preferred diet. Besides the ability to make decisions about medical treatment, the health care agent can also be given a power of organ donation and burial.

Advantage: What are the limitations of advance directives?

BTB: The big one is people need to put it in place when they have capacity to put it in place. The principal has to prepare the directive. That’s why it’s important to have an advance directive before you really

need it. The other thing to remember is agents are not required or obligated to do the job. Advance directives give them the authority, but they’re not obligated, so it’s important to speak with anyone you’re thinking of naming as an agent, to make sure they understand what’s in it and what your preferences are, and they’re OK with being named your health care agent.

Advantage: What should people consider before completing an advance directive?

BTB: The main things are who you want to name as your agent, and to name as many successors as possible to back up your primary agent. You should also con-sider end-of-life decisions, like whether you want to be put on life support or not, your burial preferences, whether or not you’d like to be an organ donor, and what should happen if you need round-the-clock care.

Advantage: Can anyone prepare an ad-vance directive?

BTB: I would highly recommend that anyone who wants to put together an advance directive, by itself or as part of an estate plan, go to someone who’s qualified in this field. Even though the documents may be simple, a lot of law goes into them. It’s not as simple as filling out a form – there are different options, and it’s easy to miss something.

Advantage: What happens once someone completes an advance directive?

BTB: We have people name their pri-mary physicians, and we send copies to their doctors. We tell people to take copies to any hospitals they may be admitted to. The hospital will keep it on file as part of their medica record. It’s best to make sure their doctors have a copy, and to let their agent know. •

Beti Tsai Bergman is an estate planning, trust and probate attorney and member of Torrance Memorial’s Professional Advisory Council. She practices at Peninsula Law in Torrance and can be reached at 310-694-8703.

HELP PREVENT THE SPREAD OF RESPIRATORY VIRUSES SUCH AS CORONAVIRUS

• Stay home when you are sick

• Avoid close contact with people who are sick

• Wash your hands often with soap and water for at least 20 seconds

• Use an alcohol-based hand sanitizer that contains at least 70% alcohol if soap and water are not available

• Cover your cough or sneeze with a tissue, then discard

• Avoid touching your eyes, nose and mouth with unwashed hands

• Wear a mask or cloth face covering when in public spaces like the grocery store

• Clean and disinfect frequently touched objects and surfaces

Due to social distancing requirements currently in place, all our regularly scheduled classes and most support groups have been cancelled until further notice. Please check our website at torrancememorial.org/classes for updates. We hope to see you in class again soon!

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Torrance Memorial Medical Center310-325-9110 TorranceMemorial.org

ADVANTAGE Program Information310-517-4666Monday through Friday, 9 a.m. to 4:15 p.m.

Torrance Memorial IPALearn More: 310-257-7239 TorranceMemorialIPA.orgMembers: Toll-Free: 866-568-4472 TTY/TDD: 711 Monday through Friday, 8:30 a.m. to 5 p.m.

Torrance Memorial Physician Network310-891-6717 TMPhysicianNetwork.orgMonday through Friday, 7:30 a.m. to 4 p.m.

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Please note all information for articles published in this issue of Advantage were up-to-date at the time this maga-zine went to print. Because the status of COVID-19 remains fluid, some information may have changed since that time.

Published byVincent Rios Creative, Inc.vrioscreative.com

©2020 Torrance Memorial Medical Center. All rights reserved. Reproduction or use in whole or in part without written permission is prohibited.

This publication is for informational purposes only and should not be relied upon as medical advice. It has not been designed to replace a physician's medical assessment and medical judgment. Always consult first with your physician regarding anything related to your personal health.

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ISSUE #17 SUMMER 2020 ADVANTAGE · ing and closing commerce and community are adjusted to control the spread. South ... feelings to trusted others, those who listen, reflect and do