Vital Signs WINTER 2020 | VOLUME 85

FEATURE STORIES Health concerns about vaping Page 4 Q&A: Personalized care for cardiovascular disease Page 6 Cystic fibrosis Page 8 Community calendar Page 12

Genetic testing opens door to greater awareness of potential cancer risk As our understanding of the relationship between genetics and cancer increases, UCLA Health has expanded efforts to identify patients who could benefit from genetic screening specific for cancer risk, and to make testing and counseling services more broadly available. Beth Karlan, MD, vice chair of women’s health research in the UCLA Department of Obstetrics and Gynecology and director of cancer population genetics at the Jonsson Comprehensive Cancer Center, explains that patients who might benefit from cancer genetic tests include many cancer survivors, patients newly diagnosed with certain cancers and those whose ancestry places them at higher risk for carrying mutations Continued on page 5 Vital Signs WINTER 2020 | VOLUME 85

can stop colon cancer

In this issue UCLA Health aims to boost screening during Colon Cancer Awareness Month 2 What’s new at UCLA 3 In your community: Screening can help prevent and detect colon cancer, yet one-in-three Americans delay Hospitalists or refuse testing. To encourage more screening, UCLA Health and the Department of UCLA offers services and Medicine and divisions of gastroenterology and oncology are hosting a series of events support near you. — including lectures, webinars and informational sessions — during National Colorectal Vaping Cancer Awareness Month in March. 4 Two UCLA Health pulmonologists caution that beyond the immediate To learn more about Colon Cancer Awareness Month events, go to: concerns about illness, vaping poses uclahealth.org/colon-cancer-screening longer-term threats in the form of nicotine addiction and potential lung damage. Genetic screening for cancer risk 5 UCLA Health has expanded efforts to ensure that more patients can benefit Get UCLA Health information from genetic screening specific for cancer risk. on your phone 6 Q&A: Cardiovascular The UCLA Health app now is available for both iOS and Android users Genetics Clinic and allows you to search for a UCLA Health provider, get directions UCLA’s Cardiovascular Genetics Clinic and maps to more than 180 medical practice locations, access your provides personalized care to patients and families with inherited or genetic health records, find out about our medical services, find immediate forms of cardiovascular disease. care locations and view webinars and health education videos. You can also request an appointment and use our extensive health library. 8 Cystic fibrosis advances New therapies that target the genetic For more information and to download the UCLA Health app, go to: root of cystic fibrosis have been shown uclahealth.org/ucla-health-app to dramatically improve patients’ lung function and could benefit the vast Image: UCLA Health majority of patients with the disease. Cataract surgery 10 Advances in lens technology brighten outlook for patients with cataracts. In the “Zone” Knee replacement alternative UCLA Health is sponsoring a new, weekly radio show called 11 UCLA is among the first medical centers to offer a minimally invasive the UCLA Health Zone with Dr. Phil Cohen. The show airs alternative to knee replacement surgery. Saturdays, from 8 to 10 am, on AM570. Dr. Cohen is an internal and sports medicine specialist with the UCLA Health-Encino Community calendar 1 2 Health and wellness for the community. office; he is joined by station cohost Adam Ausland to discuss Photo: UCLA Health sports medicine-related issues for professional athletes and weekend warriors alike. Each show features guests and segments about nutrition, rehab or other health topics.

For more information or to access podcasts from previous shows, go to: uclahealth.org/ucla-health-zone-radio-and-podcast

UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) HOSPITALISTS

UCLA hospitalist care available at local hospitals in Greater Los Angeles region

As UCLA Health has expanded and opened communication with our patients’ primary primary and specialty care offices throughout care doctors,” Dr. Ramirez says. “This means Southern California, it has grown its hospital we can ensure continuity of care between the network and placed internists who specialize outpatient setting and the inpatient setting. in treating hospitalized patients, called Our patients feel more at ease knowing that hospitalists, into 17 community hospitals and the doctor taking care of them in the hospital counting. Forster Chhean, MD, a hospitalist also is connected to and in communication Photo: Getty Images at Ronald Reagan UCLA Medical Center, and with their primary care doctor.” Veronica Ramirez, MD, a UCLA hospitalist at California Hospital Medical Center, discuss How did this specialty develop? attend to individual patients, which can be a challenge in the outpatient setting,” the advantages of hospitalist care. The term hospitalist was coined in 1996. Dr. Chhean says. “We can take however The specialty developed as primary care What is a hospitalist? much time we feel is necessary with a patient physicians, juggling larger patient loads, or a family member to address their needs.” “A hospitalist is an internal medicine had difficulty keeping up with their patients physician who specializes in hospital in the hospital. Only available to see their How can I get care from a medicine and is available to take care of patients early in the morning or in the UCLA hospitalist? medical issues in real time in the hospital evening, they missed the opportunity to setting as they arise,” Dr. Chhean says. interact with many of the hospital team UCLA patients who know in advance “The hospitalist formulates the care plan members providing care, Dr. Ramirez that they will be hospitalized at a hospital and acts as the primary physician contact explains. In addition, patients who are covered by a UCLA hospitalist can have their for the other doctors, nurses and ancillary hospitalized today have more acute and primary care physician arrange for them to staff providing care to hospitalized patients.” complicated health situations. Hospitalists receive care from a UCLA hospitalist. Those have more expertise to oversee treatment of admitted from the Emergency Room can How will a hospitalist know these conditions in the hospital setting. show a UCLA hospitalist card (available at about my health history and primary care offices) or simply ask to see a communicate with my doctors? What are the advantages of UCLA Health provider upon admission. being treated by a hospitalist? “Because we’re an integrated health system, For more information about the Since they are based in the hospital, we have access to patients’ outpatient UCLA Hospitalist Program and to medical records, as well as maintaining close hospitalists are more available during the find locations near you, go to: day to speak with nurses, follow uclahealth.org/hospitalists up on tests and meet with patients and family members. They know the hospital’s policies and practices, as well as other hospital personnel. In addition to their connection with the patient’s other UCLA physicians, another advantage of having a UCLA hospitalist. “Hospital medicine affords us the time necessary to fully

Forster Chhean, MD Veronica Ramirez, MD

Photos: UCLA Health

Vital Signs Winter 2020 Vol. 85 3 LAW PULMONARY MEDICINE Immediate health concerns about vaping are real but long-term effects are not yet fully understood

While the severe lung disease and related young adults,” Dr. Hamberger says. “Any that come in attractive, sleek designs that deaths that have been associated with the addictive substance that you inhale has the bear no resemblance to traditional cigarettes use of e-cigarettes give pause to some users, potential to cause harm.” and are easy to conceal. Dr. Hamberger says two UCLA Health pulmonologists caution Kathryn Melamed, MD, a UCLA adult too many teens and young adults believe the that beyond the immediate concerns about pulmonologist, points out that many of the habit to be relatively harmless. illness, vaping poses longer-term threats in health effects of e-cigarette use are yet to be “Comparing the safety of e-cigarettes and the form of nicotine addiction and potential determined. “Vaping is still relatively new, so traditional cigarettes makes sense when we’re lung damage. we don’t have data on the long-term risks,” talking about long-term adult smokers who Vaping involves heating a liquid — typically Dr. Melamed says. “It took decades before want to switch to something that’s probably containing nicotine or cannabis, as well we fully understood the effects of cigarettes, safer, but it’s not a useful comparison for a as flavorings and other substances and because cancer and lung-related illnesses child or teenager who isn’t a regular cigarette additives — to produce an aerosol that is such as emphysema and chronic obstructive smoker and isn’t trying to switch,” he says. inhaled through a battery-powered device. pulmonary disease develop over many years. “Kids today have access to more information E-cigarettes have grown into a multi-billion- It could be that the risks and long-term than any prior generation, and they’re smart dollar industry since hitting the U.S. market outcomes of e-cigarettes will be different about seeking it out. We need to do a better job in 2007, with a particular appeal to youth. from those of traditional cigarettes, but it’s of getting the word out that even if we don’t The U.S. Centers for Disease Control and too early to know.” know everything yet about long-term effects, Prevention (CDC) recently estimated that Dr. Melamed notes that e-cigarettes were there are many known reasons not to vape.” one-in-four high school students vape. initially seen as a potentially effective To view a #UCLAMDChat webinar By early November 2019, the CDC had smoking-cessation tool — a way to wean with Dr. Eric Hamberger received more than 2,000 reports from 49 smokers off their presumably more toxic about vaping, go to: states of vaping-associated lung injuries, as tobacco-cigarette habit. But the evidence tinyurl.com/e-cigarette- well as more than three-dozen confirmed on that point is mixed. A large clinical trial hamberger vaping-related deaths. The same month, published in 2019 found that smokers who the agency identified vitamin E acetate, switched to e-cigarettes were nearly twice a chemical additive in the production of as likely to remain off tobacco a year later e-cigarette products, as a likely culprit, as smokers who used traditional nicotine- though it warned that additional chemicals replacement products in their effort to quit. could also be involved. But the same study found that 80 percent Eric Hamberger, MD, a UCLA pediatric of the e-cigarette group was still vaping, pulmonologist, says he became concerned indicating they had traded one addiction about rising e-cigarette use among his for another. patients well before the recent rash of Whether e-cigarettes are safer than traditional illnesses. “Whether this outbreak turns cigarettes is beside the point for a generation out to be an isolated incident or continues of youths who have increasingly become indefinitely, we need to worry about the targets of e-cigarette marketing, with the long-term effects on the lungs of kids and multitude of appealing flavors and devices

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CANCER Continued from cover Genetic testing opens door to greater awareness of potential cancer risk

in genes related to cancer susceptibility. free breast cancer survivors, many of whom While many people could benefit from haven’t previously considered testing for cancer genetic services, “few are receiving BRCA1 and BRCA2 mutations, as well as them,” Dr. Karlan says. “We want these women with ancestries that put them at individuals to have conversations with greater risk, including women of Ashkenazi their health care providers about available Jewish descent, where the prevalence of the testing that could have implications for BRCA mutations is 2-to-3 percent. their own health and health care, as Risk from BRCA mutations is not limited well as for preventive opportunities for to women; men are at equal risk of carrying family members.” one of these mutations. A BRCA gene The U.S. Preventive Services Task Force mutation is associated with increased risk (USPSTF) recommends that primary care of several types of cancers, including breast clinicians conduct a risk assessment of their cancer in both men and women, prostate female patients who have either a family or cancer, ovarian cancer, pancreatic cancer personal history of breast, ovarian, tubal and melanoma, among others. or peritoneal cancer, or who have ancestry UCLA is part of a national multicenter associated with BRCA1 and/or BRCA2 gene research initiative to increase access to mutations, to determine whether or not they testing for BRCA. The BRCA Founder should be referred for genetic counseling Outreach (BFOR) initiative is open to men and, if indicated, genetic testing. Women and women ages 25 or older, with at least who test positive for a BRCA gene mutation one Ashkenazi Jewish grandparent, who have a substantially higher lifetime risk of haven’t previously been tested. Interested developing breast or ovarian cancer, and they participants complete an online consent and can work with their health care provider to are directed to a nearby laboratory to have manage that risk, as well as recommending their blood drawn. Their results are shared that first-degree relatives be tested. by their primary care provider. Inherited risk doesn’t recognize gender, and “Democratizing access to genetic testing an assessment of both women and men who provides knowledge that can reduce cancer have a personal/family history of cancer risks and improve outcomes for those with a ensures that all would benefit from genetic BRCA mutation,” Dr. Karlan says. counseling referral. Beyond the BFOR initiative, UCLA is “Thankfully, less than one percent of expanding its cancer genetic services women have these mutations, but for those to any UCLA Health patient who meets who are at risk, it’s very important that national guidelines for cancer genetic they get screened,” says Carol Mangione, testing — a group that includes many MD, MSPH, the Barbara A. Levey, MD, patients diagnosed with cancer, many cancer and Gerald S. Levey, MD, Endowed survivors and healthy individuals who Chair in Medicine and a member have never been diagnosed but are in high- of the USPSTF panel that issued risk groups. For people who are healthy, the recommendation. a positive genetic test can lead to more Dr. Mangione notes that the USPSTF frequent cancer screenings or, in some cases, guidelines, which were revised this past prophylactic or risk-reducing surgery. For summer, expand the population of women cancer patients, knowledge of a particular who should be assessed for potential BRCA1 mutation can influence the therapeutics and BRCA2 testing beyond the previous used in treatment. recommendation, which focused on women For more information or to enroll with a family history of breast or ovarian in the BRCA Founder Outreach cancer. The pool now also includes disease- initiative, go to: bforstudy.com Photo: Getty Images

Vital Signs Winter 2020 Vol. 85 5 HEART DISEASE

New clinic provides personalized care for patients with inherited or genetic cardiovascular disease

UCLA Health’s recently established Cardiovascular Genetics Clinic provides personalized care to patients and families with inherited or genetic forms of cardiovascular disease. In addition to clinical evaluation and diagnostic assessment, including genetic testing, the program provides genetic counseling and subspecialty care designed to meet the unique needs of patients and families. Clinic director Jessica Wang, MD, PhD, genetic counselor Judy Fan and cardiologist Pritha Gupta, MD, PhD, talk about the program.

Photo: Getty Images

UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) What was the impetus for starting clear cut, and a negative result may not mean this clinic? their condition isn’t genetic. Part of pre-test counseling helps patients understand the Dr. Wang: Genetic or inherited possible test results and how that may affect cardiovascular diseases can run in families or their care and the care of their relatives. occur in isolation. Although family screening Patients sometimes have questions about the is recommended to prevent adverse outcomes impact of genetic testing on insurability, so and sudden death, it is not often emphasized we address these concerns as well. in a routine visit. Moreover, recent advances in technologies and the dramatic reduction in How might patients’ management be the cost of genetic testing have made genetic affected by genetic testing? evaluation both possible and feasible. We Jessica Wang, MD, PhD Dr. Wang: Whether tested positive or built our program to provide care to patients negative on genetic testing, patients and and their family members with these very their family members may still require specialized needs, to better assess risks and longitudinal clinical follow-up, which manage risks for sudden death, heart failure includes periodic clinical screening. For and related complications based on their example, patients with hypertrophic genetic profile. cardiomyopathy may require an What types of cases do you see? echocardiogram and ambulatory cardiac monitoring every year. Not-yet-affected Dr. Gupta: Some of the patients referred family members may require such screening here come with a clear-cut diagnosis based every one-to-five years, depending on on their clinical signs and symptoms. These their age and other risk factors. tend to fall into one of four categories: cardiomyopathies, arrhythmias, diseases In what other ways are patients better off of the aorta and familial high cholesterol. as a result of this type of a program? We also see familial cases in which there Dr. Gupta: Patients appreciate having is no diagnosis yet. For example, if there is answers to questions they might have had for a sudden cardiac death in the family and a long time — why their family member died, a cardiac condition such as arrhythmia or getting an explanation for a condition could be the cause, first-degree family that has been in their family for generations. members might be advised to obtain a Many patients also are concerned about the cardiac evaluation. Importantly, we provide Pritha Gupta, MD, PhD next generation, and they are hoping they genetic counseling to asymptomatic family can participate in research so that medical members who may not have a diagnosis, so care for that condition can improve in the they understand the implications of genetic future. And with family history taking, we testing, before they make an informed can identify other family members who choice about whether to proceed with might be at risk and allow those individuals genetic testing. to consider screening. What do you tell patients as part of their genetic counseling? For more information about the UCLA Cardiovascular Genetics Clinic, go to: Fan: We want them to make an informed uclahealth.org/heart/genetics decision, so we discuss both benefits and limitations of genetic testing and how that might affect them and their family members. Because many genetic heart conditions have guidelines for family screening, we want patients to be aware that some heritable cardiac conditions have an impact on the medical management of their relatives. The results of genetic testing are not necessarily

Judy Fan Photos: UCLA Health

Vital Signs Winter 2020 Vol. 85 7 CYSTIC FIBROSIS

targeted by the drug therapies. (More than New genetic therapies lead to 1,700 mutations in the CFTR gene have been identified, some of them common and others extremely rare.) major advances in treatment of Dr. Li notes that the CFTR modulator therapies have a beneficial impact on lung function, as well as decreasing pulmonary exacerbations and weight gains. “Previously, we had made large strides in life expectancy cystic fibrosis by mitigating the end-organ effects of CF. What’s exciting about these new therapies is that, for the first time, we are able to treat A new therapy for cystic fibrosis (CF) that though it occurs in all ethnicities. It is the underlying cause of the disease,” he says. targets the genetic root of the disease has been a progressive disease that results in the shown to dramatically improve patients’ lung buildup of thick mucus in the lungs, causing Elxacaftor/ivacaftor/tezacaftor was approved function and could benefit the vast majority persistent lung infections and limiting the for patients 12 years and older with the most of patients with the disease. Data from ability of patients to breathe. While the common CF mutation. Marlyn S. Woo, MD, clinical trials was so persuasive that the Food median survival for patients with CF has, codirector of the UCLA Cystic Fibrosis and Drug Administration approved the new over the decades, increased from 2 years to Center, and Dr. Li note that nearly half of three-drug combination therapy in October 47 years of age, there have, until recently, CF patients can benefit from one of the two 2019, five months earlier than expected. been no treatments that did more than earlier available CFTR modulator therapies alleviate symptoms. that target the malfunctioning protein “This is the closest therapy we have to a cure, encoded by the CF gene, which regulates and soon we hope to be able to successfully That is not the case with the new therapy, the flow of water and chloride in and out of treat all CF patients,” says Douglas Li, MD, elexacaftor/ivacaftor/tezacaftor, which is cells in the lungs and other organs. This new codirector of the UCLA Mattel Children’s part of a new class of drugs — cystic fibrosis medication expands the proportion of CF Hospital Cystic Fibrosis Center, which is transmembrane conductance regulator patients eligible for CFTR modulator therapy accredited as a Core Center by the Cystic (CFTR) modulator therapies — designed to approximately 90 percent. Fibrosis Foundation and includes both to correct the underlying defect that causes pediatric and adult programs. CF. While not cures, these drugs have “Before these CFTR modulator therapies, we dramatically improved the outlook for those could only symptomatically treat CF patients CF is the most common, life-limiting patients who have the specific mutations with drugs to help them with malabsorption recessive genetic disorder in Caucasians,

New genetic therapies target mutations in the cystic Genetic variance in cystic fibrosis fibrosis transmembrane conductance regulatory protein. Deleted CTT nucleotide sequence results in a malfunctionning CFTR protein. Illustration: Monica Schroeder/Science Source

Chromosone 7

UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) HOW DOES TRIKAFTA™ WORK?

The underlying cause CF is caused by mutations in the CF gene. These mutations lead to defects in a specific protein called the cystic fibrosis transmembrane conductance regulator (CFTR) protein. As a result of these defects, the CFTR proteins don’t work the way they should. The most common mutation is the F508del mutation. The F508del mutation causes both defects illustratedHOW DOES below: TRIKAFTA™ WORK?

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Vital Signs Winter 2020 Vol. 85 9 OPHTHALMOLOGY

Photo: Getty Images

Advances in lens technology brighten outlook for cataracts patients

Cataracts — clouding of the normally The most common IOL used is a standard use in the United States in August. UCLA transparent lens of the eye — are the leading monofocal lens, which can only focus light is among the first academic institutions in cause of visual impairment. By age 65, more into one point in space; therefore, most the country to make the new technology than 90 percent of people have a cataract, patients will require glasses for the majority available to patients. and half of the people between the ages of of their tasks after cataract surgery. Newer There has been a trend toward seeking 75 and 85 have lost some vision due to a premium lenses like bifocal implants, which cataract surgery at an earlier age. “It’s not that cataract. A cataract cannot be removed with correct for both far and near vision, are people are necessarily developing cataracts eye drops; surgery is the only treatment to available and make people less dependent earlier, but their visual demands are greater,” remove the clouded lens and replace it with a on glasses. The choice to place a premium says UCLA cataract surgeon Shawn Lin, MD. plastic intraocular lens (IOL). Approximately IOL as opposed to a standard lens, however, “It used to be that cataract surgery was 3 million cataract surgeries are performed entails additional costs to the patient that simply aimed at allowing people to be able to annually in the United States, making the are not covered by insurance, and is dictated see, but the bar is higher with smart phones, procedure the most commonly performed by patient preference and preoperative computers and more active lifestyles.” outpatient surgery. clinical findings. The new trifocal lens, coupled with laser- Cataract surgery is indicated when patients As in most areas of medicine, technology that assisted cataract removal, which is designed are experiencing symptoms such as dimmed enhances benefits to patients is evolving. In for a gentler and more precise procedure, “is vision or glare with oncoming headlights the field of cataract surgery, the latest advance a major advance for the quality of life of our that are affecting their daily life, and these is a trifocal lens designed to allow cataract patients,” Dr. Lin says. symptoms are attributable to a cataract, patients to see well at all distances — near, explains Mitra Nejad, MD, a surgeon in the mid-range and far — while minimizing the For more information about eye care at Stein Eye Institute’s Division of Cataract and need for glasses. The lens has been available UCLA, go to: uclahealth.org/eye Refractive Surgery. internationally since 2015, but was approved by the Food and Drug Administration for

UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) INTERVENTIONAL RADIOLOGY Alternative to knee replacement offers potential relief for patients who have not been candidates for surgery

UCLA is among the first medical centers to Genicular artery embolization is performed offer a minimally invasive alternative to knee as an outpatient procedure and takes about replacement surgery, providing potential two hours under conscious sedation. Patients relief to individuals who are experiencing who smoke or have artery damage are not debilitating pain from knee arthritis but candidates. Through a small catheter under haven’t been candidates for surgery or were X-ray guidance, a small volume of particles, deterred by the lengthy recovery time. tinier than grains of sand, are injected into Osteoarthritis of the knee can cause enlarged arteries in the knee, reducing their significant pain and limit physical activity, size. Patients go home the same day and hindering quality of life. Most people can often can resume their usual activities by obtain relief from medications or injections the evening. of a steroid or hyaluronic acid, but the Dr. Padia notes that in Japan, where the benefits often are temporary and the effects procedure originated, approximately may diminish with repeated treatments. 80 percent of patients reported significant During the genicular artery embolization, Dr. Sid Padia uses an angiogram to identify the abnormal genicular artery that When these conservative approaches are pain relief and marked improvement in supplies the area of pain in the knee. inadequate, the only option has been knee their knee function. Many have been able Image: ABC7 replacement surgery. More than 600,000 to reduce or eliminate their need for pain people in the U.S. receive knee replacements medication, including narcotics. Dr. Padia each year, and the surgery produces excellent is equally encouraged by the results among overall outcomes with a relatively low the patients he has treated. complication rate. But many people are not “This fills in the gap for people who are not candidates, either because their advanced age being helped by conservative treatments and or other medical conditions that place them are either not ready or are poor candidates at high risk. Additionally, many people at a for knee replacement surgery,” Dr. Padia says. relatively young age may delay the operation, “Until now, there was no viable option for given the likelihood that they might need these patients.” a second replacement or revision after 15- Applications for this technology are in to-20 years. Others decide to live with their development for other joints, such as the discomfort rather than undergo a procedure shoulder for people with adhesive capsulitis that requires a prolonged period of recovery. (also known as frozen shoulder) and the UCLA now is offering a middle ground elbow for lateral epicondylitis (also known through a procedure called genicular artery as tennis elbow). embolization, a minimally invasive procedure that involves injection of a small volume of For more information about genicular tiny particles into the artery in the knee. artery embolization at UCLA, go to: “The goal is to reduce the inflammation that uclahealth.org/radiology/ir/gae causes the pain, which tends to be the result of abnormally increased blood flow to the area,” says UCLA interventional radiologist During the genicular artery embolization procedure, a 3D Sid Padia, MD. The procedure has previously reconstruction of the knee and the arteries helps identify been used to treat cancerous tumors and the genicular artery (blue), which is the target for the uterine fibroids. embolization procedure. Image: ABC7

Vital Signs Winter 2020 Vol. 85 11 Community Health Programs

JANUARY/FEBRUARY/MARCH 2020 COMMUNITY CALENDAR EVENTS UCLA Health offers community programs and events to help our neighbors lead healthier lives through wellness education. Go to connect.uclahealth.org/calendar for more information.

BONE HEALTH CANCER (CONTINUED) DIABETES

Osteoporosis Update Colon Cancer Prevention and Basic Diabetes Nutrition Group Class Learn what osteoporosis is, how to prevent it and Screening Update This two-hour ADA-certified class will teach how to treat it. Rimma Shaposhnikov, MD, UCLA gastroenterologist, you how to plan satisfying meals to maintain When: Tuesday, Jan 21 / 2 – 3:30 pm and Natalie Manitius, MPH, RDN, UCLA GI healthy blood-sugar levels. A physician referral is required. Covered by most medical Where: Belmont Village, 10475 Wilshire Bl Dietitian, will discuss screening modalities for colon cancer, how often you should be screened insurance policies. RSVP: connect.uclahealth.org/calendar and dietary tips to prevent colon cancer. Info: 310-794-1299 or or 800-516-5323 When: Monday, Mar 2 / 5:30 – 7 pm [email protected] Bone Health and Hyperparathyroidism Where: Cancer Support Community Valley/ When: Tuesdays, Feb 4, Mar 3 / 9 – 11 am Masha Livhits, MD, UCLA endocrinologist, will Ventura/Santa Barbara, 530 Hampshire Rd, Where: 2020 Santa Monica Bl, discuss hyperparathyroidism, how it contributes Westlake Village Conference Rm 2nd Fl to bone density loss and osteoporosis, and RSVP: connect.uclahealth.org/calendar treatments to help maintain bone health. or 800-516-5323 Living with Type 2 Diabetes When: Wednesday, Jan 29 / 10:30 am – Noon This ADA-certified self-care class will help you gain confidence to successfully manage your Where: Sunrise of Westlake Village, Healthy Breasts, Healthy U diabetes. A physician referral is required. 3101 Townsgate Rd Jeannie Shen, MD, UCLA breast surgeon, will discuss the factors that can increase a woman’s Covered by most medical insurance policies. RSVP: connect.uclahealth.org/calendar likelihood of developing breast cancer, plus Info: 310-794-1299 or or 800-516-5323 healthy lifestyle choices to lower your health risk. [email protected] Exercise for People with Arthritis When: Tuesday, Mar 17 / 6:30 – 8 pm Santa Monica Lauren Freid, MD, UCLA rheumatologist, Where: Cancer Support Community Pasadena, When: Jan 13 & 27, Feb 10 & 24, March 9 & 23 / will focus on osteoarthritis and the latest 76 East Del Mar Bl, #215 Time may vary by date recommendations on exercise and physical RSVP: connect.uclahealth.org/calendar Where: 2020 Santa Monica Bl, activity for people living with arthritis. or 800-516-5323 Conference Rm 2nd Fl When: Saturday, Feb 1 / 2:30 – 4 pm Porter Ranch Where: Belmont Village Burbank, Thyroid Disease When: Monday, Feb 10 / 8 am – 5 pm 455 E Angeleno Av James Wu, MD, UCLA endocrinologist, will Where: 19950 Rinaldi St, Ste 300 discuss the anatomy and function of the thyroid, RSVP: connect.uclahealth.org/calendar how thyroid blood tests are viewed, concerns or 800-516-5323 Learning to Manage about a thyroid nodule and when surgery Gestational Diabetes is necessary. This ADA-certified self-care class will help you CANCER When: Thursday, Mar 19 / Noon – 1:30 pm successfully manage your diabetes. A physician Where: Santa Monica Family YMCA, 1332 6th St referral is required. Covered by most medical Prostate Cancer Update RSVP: connect.uclahealth.org/calendar insurance policies. David Khan, MD, UCLA radiation oncologist, will or 800-516-5323 Info: 310-794-1299 or discuss current radiation therapy trends in the [email protected] treatment of prostate cancer. Colorectal Cancer Prevention Santa Monica When: Wednesday, Feb 5 / 5 – 6:30 pm Gobind Sharma, MD, UCLA gastroenterologist, When: Thursdays of each month / Time may Where: Cancer Support Community Redondo will give an overview on colorectal cancer, how vary by date Beach, 109 W Torrance Bl, Ste 100 and when to screen, screening options and Where: 2020 Santa Monica Bl, RSVP: connect.uclahealth.org/calendar simple steps one can take to prevent it. Conference Rm 2nd Fl or 800-516-5323 When: Friday, Mar 20 / Noon – 1:30 pm Where: Cancer Support Community Los Angeles, Integrative Medicine Class 1990 S Bundy Dr, Ste 100 This class will teach patients integrative RSVP: connect.uclahealth.org/calendar approaches to manage diabetes, including gentle or 800-516-5323 yoga, mindfulness and nutrition counseling. Info: 310-794-1299 or [email protected] When: Wednesdays in Jan & Feb, Tuesdays in March / Time may vary by date Where: 2020 Santa Monica Bl, Conference Rm 2nd Fl

UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) Community Health Programs JANUARY/FEBRUARY/MARCH 2020

HEART HYPERTENSION FEATURED EVENT HEALTHY LIVING WITH DIABETES New Recommendations for Aspirin High Blood Pressure This free half-day event includes a health fair, Boris Arbit, MD, UCLA cardiologist, will present Rivkah Sevell, MD, UCLA internist, will discuss presentations on diabetes topics and breakout the latest research on the role of aspirin, fish high blood pressure (hypertension), associated sessions for type 1 and type 2 diabetes. oil and vitamin D to prevent heart attacks health risks, recent research data and lifestyle and strokes. modifications to achieve an ideal blood pressure. When: Saturday, Mar 7 / 8:30 am – 12:30 pm When: Thursday, Feb 6 / 2 – 3:30 pm When: Monday, Feb 3 / 10:30 am – Noon Where: UCLA Medical Center, Santa Monica, 1250 16th St, Conference Center Where: Belmont Village Encino, 15451 Ventura Bl Where: Kehillat Israel, 16019 W Sunset Bl, Pacific Palisades Info: uclahealth.org/endocrinology/diabetes RSVP: connect.uclahealth.org/calendar or 800-516-5323 RSVP: connect.uclahealth.org/calendar RSVP: 310-794-1299 or [email protected] or 800-516-5323 Coronary Artery Disease Discussion Timothy Canan, MD, UCLA cardiologist, will Is It a Stroke and What to Do discuss signs and symptoms of coronary artery Learn what a stroke is, the warning signs and disease, risk factors to avoid and the newest symptoms, and strategies to help if you think you GASTROINTESTINAL HEALTH treatments available. or someone else is experiencing a stroke. When: Tuesday, Feb 11 / 6 – 7:30 pm When: Tuesday, Mar 31 / 2 – 3:30 pm Healthy GI Tract Where: Camarillo Health Care District, Where: WISE & Healthy Aging, 1527 4th St, Anna Skay, MD, UCLA gastroenterologist, will 3639 E Las Posas Rd Santa Monica focus on prevention and management of RSVP: connect.uclahealth.org/calendar RSVP: connect.uclahealth.org/calendar constipation, diarrhea and reflux disease, plus or 800-516-5323 or 800-516-5323 the importance of screening for colon cancer. When: Monday, Feb 10 / 4 – 5:30 pm Heart Disease Prevention KIDNEY HEALTH Where: Brookdale Northridge, and Supplements 17650 Devonshire St Boris Arbit, MD, UCLA cardiologist, will Kidney Stones Update RSVP: connect.uclahealth.org/calendar discuss current evidence on over-the-counter or 800-516-5323 supplements for the prevention of heart disease. Ray Goshtaseb, MD, UCLA nephrologist, and Nishant Patel, MD, UCLA urologist, will discuss Take Action: Prevent Colon Cancer When: Thursday, Feb 13 / 10:30 am – Noon signs, symptoms, diagnosis and management of Where: ONEGeneration, 18255 Victory Bl, Reseda Join us at this free event to learn what you kidney stones. can do to prevent colon cancer – exhibits, RSVP: connect.uclahealth.org/calendar When: Thursday, Feb 6 / 2 – 3 pm information, resources, giveaways and a walk or 800-516-5323 Where: Beverly Hills Chamber of Commerce, through an inflatable colon! 9400 S Santa Monica Bl, 2nd Fl Heart Valve Disease When: Saturday, Mar 14 / 9:30 am – 12:30 pm RSVP: connect.uclahealth.org/calendar Olcay Aksoy, MD, UCLA interventional or 800-516-5323 Where: Pico Branch Library, 2201 Pico Bl cardiologist, will discuss the treatment of heart Info: 800-516-5323 conditions, such as mitral valve disease and aortic End-Stage Renal Disease Facts valve disease, with minimally invasive options that The Ins and Outs of Colonoscopy do not require surgery. Anjay Rastogi, MD, PhD, UCLA nephrologist, will discuss what you should know about ESRD, Adarsh Thaker, MD, UCLA interventional When: Tuesday, Feb 18 / 7 – 8:30 pm endoscopist, will discuss colonoscopy and other End Stage Renal Disease. Free blood-pressure Where: UCLA Medical Center, Santa Monica, screening options and the latest endoscopic tests and other educational resources 1250 16 St, Conference Rm 3 techniques for removing colon polyps before they also featured. develop into colon cancer. RSVP: connect.uclahealth.org/calendar When: Sunday, Mar 1 / 1 – 4 pm or 800-516-5323 When: Monday, Mar 30 / 6:30 – 8 pm Where: UCLA Medical Ctr, Santa Monica, 1250 16th St, Conference Ctr Where: Cancer Support Community Pasadena, Women’s Heart Health RSVP: 800-516-5323 76 East Del Mar Bl, #215 Megan Kamath, MD, UCLA cardiologist, will RSVP: connect.uclahealth.org/calendar discuss warning signs to know if you are at risk or 800-516-5323 of a heart attack and lifestyle changes to lower your cholesterol, blood pressure and health risk. FEATURED EVENT When: Wednesday, Feb 26 / 7 – 8:30 pm PLAY 4 KAY BREAST CANCER Where: Santa Monica Family YMCA, 1332 6th St AWARENESS GAME RSVP: connect.uclahealth.org/calendar UCLA Women’s Basketball hosts their 14th or 800-516-5323 annual Play 4 Kay Breast Cancer Awareness game versus Oregon, in conjunction with the Iris Cantor - UCLA Women’s Health Center, Revlon/ UCLA Breast Center and Santa Monica Breast Centers, Iris Cantor Center for Breast Imaging, Simms-Mann Center for Integrative Oncology, and UCLA Livestrong. Funds raised will support UCLA breast cancer research and services. When: Friday, Feb 14 / 8 pm Where: Pauley Pavilion, 301 Westwood Plz Info: uclabruins.com/tickets

Vital Signs Winter 2020 Vol. 85 13 Community Health Programs JANUARY/FEBRUARY/MARCH 2020

MULTIPLE SCLEROSIS PODIATRY FEATURED EVENT 2ND ACT WINTER EVENT REACH to Achieve Program (ongoing) Bunions and Bunion Surgery Alan Castel, UCLA Psychology professor, This weekly wellness program focuses on fitness, Bob Baravarian, DPM, will discuss bunions and discusses how selective memory takes shape memory, emotional well-being, recreation, and the latest surgical and nonsurgical treatments. in younger and older adults. Learn secrets nutrition and health education for individuals When: Tuesday, Jan 21 / 5:45 – 6:45 pm living with multiple sclerosis. that super-agers know about how to stay Where: 2121 Wilshire Bl, Santa Monica, Ste 101 Where: Marilyn Hilton MS Achievement Center sharp and to age gracefully. RSVP: 310-828-0011 When: Thursday, Mar 26 / 6 – 8 pm Info & Application: 310-267-4071 Heel and Ankle Pain Where: James West Alumni Center Beyond Diagnosis RSVP: [email protected] Gary Briskin, DPM, will discuss common causes An evening program for those newly diagnosed of heel and ankle pain, as well as surgical and with MS. Join MS professionals from the MS nonsurgical therapies. Achievement Center and the National MS Society When: Tuesday, Feb 18 / 5:45 – 6:45 pm in a conversation about the disease and wellness MEMORY practices to help you live your best life with MS. Where: 2121 Wilshire Bl, Santa Monica, Ste 101 Where: Marilyn Hilton MS Achievement Center RSVP: 310-828-0011 Optimizing Brain Health Info & Application: 310-481-1107 Ankle Arthritis and Ankle Replacement This seminar will focus on adopting changes in Bob Baravarian, DPM, will discuss the latest diet, exercise and other lifestyle habits to foster CogniFitness advances in treating foot and ankle arthritis, a brain-healthy life. A four-week program for those with MS who including injection joint lubrication, arthroscopic are experiencing mild cognitive problems. When: Wednesday, Jan 29 / 2 – 3:30 pm cleanup, joint-preservation surgery, fusion surgery Learn strategies to improve concentration, Where: WISE & Healthy Aging, 1527 4th St and ankle-replacement surgery. memory, organization, problem-solving and RSVP: connect.uclahealth.org/calendar critical-thinking skills. When: Tuesday, Mar 17 / 5:45 – 6:45 pm or 800-516-5323 Where: Marilyn Hilton MS Achievement Center Where: 2121 Wilshire Bl, Santa Monica, Ste 101 Alzheimer’s Disease Basics Info & Application: 310-481-1107 RSVP: 310-828-0011 Alzheimer’s Disease is the most common form of dementia, currently affecting 5.8 million Living Well TREMORS Americans. Learn more about this disease, This 12-week program helps those newly who it most commonly affects and the latest diagnosed with MS better understand MS and How to Shake the Shakes develop fitness and lifestyle practices to manage treatments and medical options. UCLA movement-disorders specialists will discuss symptoms and enhance well-being. When: Wednesday, Feb 12 / 10:30 am – Noon treatment options to cope with tremors, including Where: JFS Freda Mohr Center, Where: Marilyn Hilton MS Achievement Center medicines, surgery (deep-brain stimulation) and 6310 S San Vicente Bl, Ste 275 Info & Application: 310-481-1107 noninvasive therapies. RSVP: connect.uclahealth.org/calendar When: Saturday, Mar 28 / 9 am (registration), or 800-516-5323 ORTHOPAEDICS 9:30 am – Noon (lectures and Q&A) Where: Ronald Reagan UCLA Medical Ctr, Early-Onset Dementia (ongoing) Got Shoulder and Knee Pain? 757 Westwood Bl, Tamkin Auditorium, B level Memory Care is a weekly, three-hour program Joseph Burns, MD, and Ron Karzel, MD, will RSVP: 310-571-5741 or [email protected] for middle-aged dementia patients (age 65 and discuss treatment options for common shoulder younger) to support people with memory and knee pain. Topics will include non-surgical challenges and their caregivers. WALK WITH A DOC options, injections and surgical options. When: Thursdays, 1 – 4 pm When: Saturday, Feb 1 / 9 – 11 am Where: UCLA Longevity Center, 10945 Le Conte Ave Walk With a Doc Where: Southern California Orthopedic Institute, Join UCLA Health physicians for an informative, Info & Cost: Sherrie Goldfarb at 310-794-0680 or 6815 Noble Ave, Van Nuys brief discussion on a current health topic, [email protected] RSVP: [email protected], or 818-901-6600 x4301 followed by a refreshing stroll at your own pace. Topanga MINDFULNESS PEDIATRICS When: First Saturday of each month / 8 – 9 am Where: UCLA Health, The Village at Westfield Purpose and Connection: Speech and Language in Children Topanga, 6344 Topanga Canyon Bl, Ste 2040 A Mindfulness Approach Nicole Schussel, M.S., CCC-SLP, UCLA Speech- Van Nuys Katherine Sarkarati, LCSW, UCLA psychotherapist, Language Pathologist, will discuss speech and When: Second Sunday of each month / 9 – 10 am will discuss how to identify and connect with a language development in children, as well as Where: Lake Balboa, 6300 Balboa Bl sense of inner purpose and how to become a strategies for improving communication abilities Culver City more active participant in your own life. at home. Designed for parents and caregivers of When: Alternating 3rd Wednesday or 2nd Friday / When: Tuesday, Jan 28 / 2:30 – 4 pm children under the age of 5. 7:30 – 8:30 am Where: Collins & Katz Family YMCA, When: Monday, January 27, 6 - 8pm Where: UCLA Health Culver City, 1466 S Westgate Av Where: Ronald Reagan UCLA Medical Ctr, 757 6000 Sepulveda Bl, Ste 2660 RSVP: connect.uclahealth.org/calendar Westwood Bl, Conf Rm B124 A&B Info: uclahealth.org/walkwithadoc or 800-516-5323 RSVP: Please RSVP to [email protected] as seating is limited.

UCLAHEALTH.ORG 1-800-UCLA-MD1 (1-800-825-2631) Community Health Programs JANUARY/FEBRUARY/MARCH 2020 it begins with

UCLA HEALTH 50 PLUS IS A FREE MEMBERSHIP PROGRAM that offers individuals age 50 and older access to educational lectures, exercise opportunities, information on community and health resources, a free community flu-shot clinic and special events. Call 800-516-5323 or go touclahealth.org/50plus to sign up. To learn more about our 50 Plus program and events, subscribe to our Focus: 50 Plus e-newsletter by e-mailing us at [email protected]

Stay Active and Independent The Challenges of Aging Well Memory Training Course (quarterly) for Life (SAIL) This workshop will debunk myths in our culture Memory Training is an innovative, four-week Join the SAIL fitness and education program led about people age 65 and older and explore how educational program for improving memory by UCLA physical therapists, designed for healthy your physical and mental attitude and condition designed for people with mild memory concerns seniors. First-time participants must receive a can meet the challenges of aging. (not dementia). Participants will develop good physical therapy screening ahead of time. When: Thursday, Feb 20 / Noon – 1:30 pm memory habits and techniques to improve their memory. When: Mondays, 9 – 10 am / Thursdays, 10 – 11 am Where: Santa Monica Family YMCA, 1332 6th St When: Two hours per week, once a week, for Where: St Monica Catholic Church, RSVP: connect.uclahealth.org/calendar one month. Please call for next session date. 725 California Ave or 800-516-5323 Where: Locations vary Info: 424-259-7140 New Treatments for Knee Arthritis Info & Cost: Sherrie Goldfarb at 310-794-0680 or Cost: $40 per month Sid Padia, MD, UCLA interventional radiologist, [email protected] Tech Help for U will discuss new minimally invasive treatments designed for people with knee pain who are not Brain Booster (quarterly) UCLA undergraduate students offer free candidates for knee replacement surgery. Brain Boosters will provide information on healthy one-on-one coaching (30- to 45-minute sessions) aging research and exercises to enhance overall to UCLA Health 50 Plus members about When: Monday, Feb 24 / 1 – 2:30 pm cognitive function. Limited seating available. electronic devices. Bring your fully charged Where: Culver City Senior Center, Ninety minutes. smartphone, tablet, laptop or e-reader to have 4095 Overland Av When: Please call for next session date your questions answered. RSVP: connect.uclahealth.org/calendar When: Saturday, Feb 8 / 9 am – Noon or 800-516-5323 Where: UCLA Longevity Center, 10945 Le Conte Ave Where: UCLA Medical Center, Santa Monica, 1250 16th St, Conference Rm 3 Cardiovascular Health Info & Cost: Sherrie Goldfarb at 310-794-0680 or [email protected] RSVP: 800-516-5323 Learn about the symptoms, treatments and management of cardiovascular disease, as well Senior Scholars Hearing Loss as how to maintain cardiovascular health and prevent disease. The UCLA Longevity Center invites adults Megan Greenya, AuD, UCLA audiologist, will 50 years of age or older to audit undergraduate discuss different types of hearing loss, causes When: Tuesday, Mar 10 / 2 – 3:30 pm courses taught by UCLA’s distinguished professors. and treatment options, plus updates on current Where: Belmont Village, 10475 Wilshire Bl When: Spring 2020 classes begin March 30. hearing-aid technologies. RSVP: connect.uclahealth.org/calendar Applications will be accepted January 31 through When: Wednesday, Feb 12 / 2 – 3:30 pm or 800-516-5323 February 28. Where: WISE & Healthy Aging, 1527 4th St Finding Humor in Mental Health Where: Locations vary by UCLA campus RSVP: connect.uclahealth.org/calendar Info & Cost: semel.ucla.edu/longevity/srscholars or 800-516-5323 Ze’ev Korn, LCSW, UCLA psychotherapist, will explore ways to maintain, regain and keep your or [email protected] or 310-794-0679 Incontinence Update sense of humor to help your mental health. Brain Boot Camp Learn about the different types of incontinence When: Tuesday, Mar 24 / 2 – 3:30 pm This interactive educational program provides and treatment options. Where: Oasis Baldwin Hills, 4005 Crenshaw Bl, participants with lifestyle strategies and tools to inside Macy’s 3rd fl When: Tuesday, Feb 18, 2 – 3:30 pm keep their brains vital and healthy. RSVP: connect.uclahealth.org/calendar Where: Collins & Katz Family YMCA, When: Classes held monthly 1466 S Westgate Av or 800-516-5323 Where: UCLA Longevity Center, RSVP: connect.uclahealth.org/calendar 10945 Le Conte Ave or 800-516-5323 Info & Cost: Patricia Ramos at 310-794-6314 or [email protected]

Vital Signs Winter 2020 Vol. 85 15 nonprofit organization u.s. postage PAID 405 Hilgard Avenue ucla Box 956923 Los Angeles, CA 90095-6923

U.S. News & World Report’s Best Hospital Survey ranks UCLA No. 1 in California and No. 6 in the nation.

Vital Signs UCLA Health ranked WINTER 2020 | VOL. 85 # CHIEF OF COMMUNICATIONS 1 in California Rhonda Curry CHIEF OF MARKETING #6 in the Nation Tanya E. Andreadis EDITOR U.S. News & World Report David Greenwald CALENDAR EDITOR Michael Pollock MEDICAL EDITOR Robert Oye, md Putting U first keeps us first CONTRIBUTORS Dan Gordon At UCLA Health, we’re proud to be ranked #1. According to U.S. News & World Report’s Nancy Sokoler Steiner annual best hospital rankings, UCLA Health is #1 in L.A. and #1 in California. We also are ADVISORY BOARD Bernard Katz, md #6 in the nation. We know this comes from putting patients first, with a culture that Carlos Lerner, md Janet Pregler, md always strives to make health care the best it can be. With four hospitals and more than Gary Small, md 180 neighborhood locations, everything we do begins with U. DESIGN Donenfeld & Associates

Subscribe to Vital Signs & Health Tips for Parents electronically: @ uclahealth.org/enews Copyright © 2020 by UCLA Health. uclahealth.org/getsocial All rights reserved. For inquiries about Vital Signs, contact UCLA Health Marketing Communications, Box 956923 UCLA Health does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs Los Angeles, CA 90095-6923 and activities. / ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. uclahealth.org 注意：如果您使用繁體中文， 。 310-267-9113 (TTY: 310-267-3902) e-mail: [email protected]

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