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Central California Faculty Medical Group & University Centers of Excellence

New Study, New Outcomes, New Memories:
Amputation Patient Walks Seven Weeks After Surgery

 	 	

University	Centers ofExcellence

In affiliation with UCSF Fresno

Pulmonary Disease
Waqas Aslam, MD
University Pulmonary Associates

Hand Surgery
Lucas Seiler, MD
University Orthopaedic Associates

Vascular Surgery
Sammy Siada, DO
Valley Vascular Surgery Associates

ac) cmes were tested' m Iarge c1·m. icaI.tna Is.with
thousands of participants to ensure they meet safety standards.

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Afr ·	the vaccines were found to be greater than eventing COVID-19 illness. The vaccines

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has been studied for decades Sy researchers. The mR   ·	(' vaccines have strands of genetic material called mRNIA packaged in a special coating that helps it enter the immune cells near the site of vaccination.
The mRNA carries instructions for the cell it enters to
a harmless piece of what is called the "spike protei ," w 'ch is unique to the COVID-19 virus. This piece oft9e vir spike protein is then displayed on the cell's surface and is recogµ,ized by the  immune system. This then  triggers antibody production to fight off what the immune system thinks is a COVID-19 infection. The immune system is now trained and ready to protect against future infection from the virus. S ce

vaccine received. The first shot primes the immune system, helping it recognize the virus, and the second shot strengthens the immune response.

Because  the  supply  ofCOVID-19  vaccines in  the United States  is expected  to be limited  at first, the  initial  supply  of the vaccine is being allocated to health care personnel and long-term care  facility  residents.  As soon  as  large quantities of the vaccine are available, the goal is for everyone to be vaccinated. Until the pandemic is completely contained, social distancing and masking in public should still continue even

it does not contain  the actual  virus, it cannot cause C0  \1fD -19I	We're all in this together. When you get the call, roll up your

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illness. It is important to note that the mRNA strand never enters the cell's nucleus and does not affect genetic material.

From left to right: Raymond Whaley and daughter, Becca.
Photo courtesy of Sefra Kay Photography

When Leigh Ann O'Banion, MD, was completing her fellowship at the UCSF School of Medicine, she found that patients with a lower extremity amputation were spending almost a week in the hospital and taking six to eight months to begin walking independently again. When she became a physician at Valley Vascular Surgery Associates and UCSF faculty teaching at UCSF Fresno, she found a similar situation.

Convinced there was a way to improve patient outcomes,
Dr. O'Banion created a multidisciplinary team that included
all the resources a patient would need on their road to recovery. The team included health care professionals from Leon S. Peters Rehabilitation, San Joaquin Valley Rehabilitation, Community Regional Medical Center (CRMC), Hanger Prosthetics, peer counselors, social workers, and case managers.
A team approach is critical in providing information to patients before their operation and helps the patient understand and process what is happening and what to expect in terms of pain after their amputation. Including patients in the process from the very  beginning produces better  patient outcomes according to Dr. O'Banion.

With the team assembled, she began enrolling patients in the Lower Extremity Amputation Pathway (LEAP) study in March of 2019.

When Hanford  resident Raymond  Whaley  accidentally  stepped into a pothole and fractured his ankle on a chilly December night in 2019, he had no idea that he would become one of
Dr. O'Banion's LEAP study patients.

Through December and into January 2020, Raymond sought treatment for his ankle. When issues with his ankle worsened, he went to his podiatrist. His foot was swollen, discolored,
and extremely painful. As a diabetes patient, Raymond was concerned that doctors would have to amputate part of his leg. While he was somewhat mentally prepared to hear that news, his wife was not. Their youngest daughter was getting married in a few weeks, and, as many fathers dream of doing, Raymond was going to walk her down the aisle.
After examining his ankle, Raymond's podiatrist, Emmy Oji, DPM, of Valley Foot & Ankle Specialty Providers, called
Dr. O'Banion. They found that Raymond had adequate blood

From left to right: Raymond Whaley, Leigh Ann O'Banion, MD.

flow in the big arteries of his leg and thought Raymond would heal very well with a below-the-knee amputation.
Dr. Oji then sent Raymond directly  to the Emergency Department at CRMC. With the goal of walking his daughter down the aisle, his diabetes, and the type of amputation needed, Raymond was an ideal candidate for the LEAP study.

Members of the LEAP team met Raymond and his wife at CRMC. "I was in such pain that I was out of it, but I do remember that when I went in there ...

 	

 	

“ I’m just trying so hard because everything within me wants to walk my daughter down the aisle, and I promised her, and I can’t back down.”

 	

 	

 	

 	

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“Our focus is always on Fresno and a population that can’t afford to have the newest medications. Our mission is to try and get those medications for our patients,” Dr. Simpson said.

Luis A. Dehesa, MD	Greg Simpson, MD

UCSF Fresno Liver Expo was a Potentially Life-Saving Event for Fresno Woman

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OUTPATIENT

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A patient may be admitted to the

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make up the entire trauma and	\_

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patient is seen in an inpatient

for by a CCFMG faculty physician. Our physicians provide services

cardiologist, gastroenterologist, pulmonologist, pediatrician, surgeon, or another specialist, they can be cared for by a CCFMG physician.

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What is a CCFMG Physician?

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A campus of Community Regional Medical Center

Other Affiliated Health Care Institutions and Training Sites:

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COMMUNITY BEHAVIORAL HEALTH

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Crystal Ives Tallman, MD, an Oregon native, fell in love with Fresno eight years ago during an Emergency Medicine (EM) residency at UCSF Fresno, and this summer  she  happily  returned  to assume a new faculty position as an Emergency Medicine/Intensivist.

Through a collaboration  between the UCSF Fresno Departments of Emergency Medicine and Internal Medicine, Dr. Tallman splits her teaching/training/patient care time between the Emergency Department and the Intensive Care Unit at
Community Regional Medical Center (CRMC). The hospital emergency department - one of the busiest in California - is staffed by UCSF Fresno Emergency Medicine physicians. With UCSF Fresno Critical Care specialists, the facility provides highly-skilled care for severely ill patients in the ICU.

Crysta l Ives Tallman, MD

Dr. Tallman is thrilled to be back working with colleagues at UCSF Fresno. "I knew I would be coming back to work with
just amazing people," Dr. Tallman said

Dr. Tallman is excited to be the first EM/Intensivist at UCSF Fresno. "I have a chance to bridge care between the ER and Critical Care," she said.
"UCSF Fresno is fortunate to have such high caliber physicians as Dr. Tallman bridging the intersection of emergency medicine and critical care," said UCSF Fresno Chief of Emergency Medicine James Comes, MD, FACEP. "Our community, our hospital, and training programs all stand to benefit," he said.

Dr. Tallman's return to UCSF Fresno comes during a pandemic that has stretched emergency and critical care resources, including the demand
for physicians who can care for ICU patients in need of extracorporeal membrane oxygenation (ECMO). An ECMO machine oxygenates blood outside of the body, taking over the function of the heart and lun gs. Dr. Tallman has expertise in ECMO.

She was introduced to the life-saving treatment in 2015 at a UCSF conference during her third year of EM residency at UCSF Fresno. "Her interests in critical care grew as she worked alongside expert clinicians and faculty educators in our medical ICUs," Dr. Comes said.

After residency, Dr. Tallman continued her training in a two-year Anesthesiology/ Critical Care fellowship at the University of Michigan, Ann Arbor in 2018-2020.
When used properly, ECMO is an amazing technology, Dr. Tallman said. "ECMO is a bridge to recovery or a bridge to transplant. So you're really providing something for those patients or they would not survive," she said. "You're really saving that person's life. I just find it such an amazing thing to be able to offer people."

She also is certified in ICU echocardiography, a test that uses sound waves to produce live images of the heart. This further adds to our Pulmonary Critical Care Fellowship program, said Vipul V. Jain, MD, MS, executive vice chair of the Department of Internal Medicine at UCSF Fresno and Interim Division Chief for Pulmonary and Critical Care Medicine. "We are very lucky to attract talented physicians like Dr. Ives Tallman to the Valley," Dr. Jain said.
Being at the intersection of Emergency Medicine and Critical Care makes for an

enriching academic environment,
Dr. Tallman said. 'Tm remarkably fortunate in this job," she said. "I work with EM residents and with Internal Medicine residents and Critical Care fellows. It's just really an incredibly rich academic opportunity for me to teach at various levels."
The position of EM/Intensivist is a unique chance to apply her teaching and patient care skills, but Dr. Tallman said it was only one of the reasons she returned to UCSF Fresno. "The biggest reason is
the people here are just a different breed and caliber of colleague. I am fortunate enough to work here with down-to-earth, collaborative, compassionate colleagues who truly care about the community.
They work together in a way that I feel sometimes bigger institutions are too 'siloed' to do."
UCSF Fresno was Dr. Tallman's first choice for residency after graduation from the University of Southern California, Keck School of Medicine in 2012.
She wanted to serve an underserved population, she said. "And I wanted a place that was very clinically challenging."

During residency, Dr. Tallman received the "Smarty Pants" UCSF Fresno Emergency Medicine award for the highest in-service score in 2014 and 2016; the Borba Housestaff Resident Research

Award and the UCSF Fresno Emergency Medicine Research Award in 2016; and in 2016 she received the Bob Knopp Humanism in Medicine Award.

At the end of her UCSF Fresno residency, Dr. Tallman delayed starting her fellowship to stay in Fresno because she had unfinished business here - completing a black belt, the highest rank, in karate.
She began practicing American Kenpo Karate as a senior in high school and with the demands of medical school had not finished her black belt. "I was about six months away from finishing my black
belt and I knew ifl left, it would be the third time starting over, so I stayed here and worked as faculty in EM a couple of years," she said. "I was actually also working with the ECMO team at that time, doing ECMO consults with other
members of the ECMO team. That made me want to continue to be an intensivist and learn more about ECMO."
Dr. Tallman is thrilled  to be back working with colleagues at UCSF Fresno. "I knew I would be coming back to work with just amazing people," she said. "I am really excited about what we can develop at Community Regional and at UCSF Fresno. I'm looking forward to what we can build here."

M

Maria S.
University Dermatology Associates

From the first phone call to the end of our virtual appointment. We received top notch quality care! We are happy to have found this gem and have already scheduled our follow up appointment..

M

Maria A.
University Orthopaedic Associates

I had a wonderful experience with Dr. Charles and his staff. I was greeted at the front desk by Mayra who is just a sweetheart and all smiles, talked to me the whole time while getting my information and paperwork ready.

J

Janice T.
Valley Vascular Surgery Associates

The staff is very professional, and they’re kind.

CCFMG Faculty Physicians in the News

CCFMG's faculty physicians are the medical experts of the Central Valley. On a weekly basis, both local and national media outlets turn to our UCSF faculty practicing in Fresno for their expertise on trending health topics. In 2020, our physicians were interviewed by local media outlets like ABC 30, Fresno Bee, and GV Wire, as well as national media outlets like the Los Angeles Times and Wall Street Journal.

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"The reason I  was  initially drawn to the Valley is the same reason that I decided to stay. I want to care for the underserved
ispanic population and provide health education to those who are underserved and empower  them to take control  of th=ei'-"r'--_,,-~~ health care needs."
Ive t Garcia Renteria, MD - Becoming a pediat· mother-

happen "Help us
Eyad Almasri, M   -	've seen people di
Central Valley Hospitals, as many resist loc downs

"When you combine both together, I think you h  e a good chance to impr ve the outcome and reduce

out with a certain part of our clinical load without exposing our patients."
Lori Weichenthal, MD - We're sicker and have a doctor	•

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CCFMG Board of Directors

Jim Comes, MD , FACEP
Vice Chairman
Chief of Hmergency Medicine, UCSF Fresno

Iva n G omez, MD
Secretary
Chief of Family and Community Medicine,
UCSF Fresno
Vice Chair of Fami(y and Community Medicine, UCSF

Jam es Davi s, MD, FAC

Uzair Chaudhary, MD
Interim Chief of Medicine, UCSF Fresno Chief of Hl'matology/Oncology, UCSF Fresno
Yu-H ung Kuo, MD, PhD
Chief of Neurosurgery, UCSF Fresno

Carlos Sueldo, MD
Chilf of Obstt:trics and Gynecology, UCSF Fresno

Arm en Martirosian, MD

Christina Maser, MD, FACS
Medical Director, University Surgical Associates

R ichard Kiel, MD
Medical Director Advanced Heart Failure, UCSF Fresno

Haifaa Abdulhaq, MD
Director of Hematology, UCSF Fresno

Teresa Dan iele, MD , FACC

Joyce Fields-Keene, MPA, CMPE
Chief Executive Officer
Ex-( f)icio

Randall Stern, MD , FACS
Chairman/President Medical Direcro, Valley Vascular Surgery Associates

Treasurer
Chief of Su,gery, UCSF Fresno
Chief of Trauma Surgery, Community
N.egional Medical Center

Michael P eter son, MD
Associate Dean, UCSF Fresno Vice Chair of Med1dne, UCSF

Program Director of Orthopaedic Surgery Residency Program

John Moua , MD
Interim Chief of Pediatrics, UCSF Fresno

John Tran, MD, FAPA
Chief of Psychiatry, UCSF Fresno

Chief of Cardiology, UCSF Fresno

Craig Wagoner
Ex-Officio
Community Medical Centers

Central California Faculty Medical Group 2625 E Divisadero St.
Fresno, CA 93721