When Cancer Can’t Hide

TRUSTEESMILES FISHERMiles Fisher is the founderand president of BixbyRoasting Co., which hefounded in 2016. Thecompany roasts andships specialty coffee tohouseholds and businessesacross the country. Fisherreceived his college degreefrom Harvard University andthen worked as an actoron TV shows and featurefilms. He serves on theboards of several nonprofitorganizations. An avid travelerand golfer, Fisher is a YoungLeader at the Milkin Instituteand is a director of the LosAngeles Fire DepartmentFoundation. He and wife,Lucy, have one daughter.recognized trial attorneyand partner in the Kirkland& Ellis firm in Los Angelesand San Francisco offices,serving in the CommercialLitigation Practice Group. Inthe last five years, Holscherhas obtained plaintiffsverdicts and settlementsof more than 1.1 billion.He received a bachelor’sdegree from the University ofCalifornia, Berkeley, followedby a law degree from theUC Berkeley School of Law.A former assistant UnitedStates Attorney, Holscheris a fellow in the AmericanCollege of Trial Lawyers andthe International Academyof Trial Lawyers. Since2008 he has been selectedevery year as one of the Top100 Lawyers in Californiaby the Daily Journal andhas been recognized inThe Legal 500 U.S.Mark Holscher is a nationallyLee S. Neibart is the chiefexecutive officer of HBSGlobal Properties, whichowns 83 flagship propertiesin the United Statesand Germany valued atapproximately 4.5 billion.In addition to pursuingattractive credit tenant,and the Lawyer-Pilots BarAssociation. He providespro bono work to ChristianLegal Aid of Los Angeles.Sampson is married toAlexis Amonic Sampson.EDWARD WHITEDANIEL S. SAMPSONLEE S. NEIBARTMARK HOLSCHERnet-leased and multi-tenantretail buildings in the UnitedStates and Europe, HBSGlobal Properties has amandate to explore similarinternational opportunities.Neibart is also the chairmanand senior partner of TrinityInvestments. He has heldleadership positions attop real estate investmentcompanies including ApolloReal Estate Advisors,NRDC Equity Partners andRobert Martin Company.He received a bachelor’sdegree from the University ofWisconsin and an MBA fromNew York University.Daniel S. Sampson is apersonal injury attorneyat Randolph & SampsonAssociations. He specializesin plaintiff’s personalinjury litigation, businesslitigation and aviationaccidents. Sampson earnedan undergraduate degreeat Loyola MarymountUniversity and a law degreefrom Southwestern LawSchool. He is a memberof many professionalorganizations, includingthe Association ofBusiness Trial LawyersEdward “Ed” White foundedEdward White & Co., LLP,certified public accountants,in 1976, representing highnet-worth individuals andgovernmental entities. Heholds an MBA from theUniversity of SouthernCalifornia and has beenaccepted as an expert bythe Superior Court and bythe United States FederalCourt. He was a professorof taxation at CaliforniaState University, Northridge,and lectured at USC. Whitehas served on the boardof directors of the UCLAComprehensive CancerCenter, the board of visitorsof the Graziadio School ofBusiness at Pepperdineand other nonprofitorganizations. White’s wife,Mary, is the director of theAngels of the ER programat Providence Saint John’sHealth Center. The couplehas three children and twograndchildren.SAINT JOHN'S MAGAZINE 7

HEALTH FOR A BETTER WORLDGET WELL, STAY WELLSaint John’s Physician Partners, anetwork of health professionalsaffiliated with Providence SaintJohn’s Health Center, has expandedto include almost 200 primary careand specialty care physicians,nurse practitioners and physicianassistants. The network, whichserves the Westside Los Angelescommunities, includes 10 medicalgroups that cover many types ofmedical needs including primarycare, pediatrics, geriatrics,orthopedics, neurosciencesand more. Recently the networklaunched a service to allow primarycare and obstetrics patients toschedule their appointments online.Advantages of usinga Saint John’s primarycare doctor:;; Many convenientlocations;; Easy referralto specialtycare within thenetwork;; Shared electronichealth recordsystem;; Scheduleappointmentsonline;; Extended hours,urgent careSAIN T J OH N ’S P H Y S I C I A N P A RT NERSSanta Monica Family Physicians has opened a new location in thethree-story building at 901 Wilshire that is home to 15 physicians.The office also offers urgent care and extended hours until 8:30p.m. weekdays and from 10 a.m. to 2:30 p.m. on weekends. Center for Hip and Knee Replacement Digestive Health Associates( formerly Southern California MedicalGastroenterology Group) Medical Doctors of Saint John’s Pacific Heart Institute Pacific Neuroscience Institute Providence Specialty Medical Group(includes individual specialists and other groups) Santa Monica Family Physicians Santa Monica Women’s Health Westside Internal Medicine8 SAINT JOHN'S MAGAZINE2 0 1 8 1952 0 1 7 18 62 0 1 6 1192 0 1 5 1102 0 1 4 662 0 1 3 4 92 0 1 2 4 92 0 1 1 4 9Saint John’sPhysicianPartners networkcontinues to grow

TOP S IN ST R O KE C A R ET HIS D O ESN’T TASTELIK E HO SPIT AL FOODProvidence Saint John’s Health Centerhas received widespread recognition for First center in Southern Californiato be named a ThrombectomyCapable Certified facility Get With The Guidelines – Stroke GoldPlus Quality Achievement Award andTarget: Stroke Elite Plus Honor Roll from theAmerican Heart Association in recognition ofits success in implementing high standardsof stroke patient care meeting national,evidence-based recommendations Named an Emergency Medical Servicesdesignated comprehensive stroke center,which reflects the highest standards of careStrokes per year in U.S.:795,000 (610,000 are first strokes; 185,000 aresecond or subsequent strokes)Source: Centers for Disease Control and Prevention800,000795,000600,000total strokesper year610,000(first strokes)400,000200,000185,000 (subsequent strokes)12 MINUTESoutstanding stroke care services including:Defying the belief that hospital foodcan’t be delicious, Providence SaintJohn’s Health Center dietitians recentlyrevamped the hospital and cafeteriamenu to please every palate. Thenew menu is the first overhaul in 15years. Patients receive a menu withchoices, says Kari Ikemoto Exter,RD, clinical nutrition manager. “Ourstaff goes to each room with a tabletand takes an order. People like thechanges. They like the differentoptions. Food has the power to heal.”THE SAINT JOHN’SRECORD FOR TIMEELAPSED FROM APATIENT ENTERINGTHE ER TO THEADMINISTRATIONOF THE CLOTDISSOLVINGMEDICATION TISSUEPLASMINOGENACTIVATOR, WHICHCAN PREVENTLONG-TERM BRAINDAMAGE.SAINT JOHN'S MAGAZINE 9

UPCOMINGMARCH Y 4JWCI AuxiliaryLa OdiseaBeverly Hills HotelMAY 8Associates forBreast and ProstateCancer Studies(ABCs) Mother’s DayLuncheonFour SeasonsLos AngelesMAY 8Irene Dunne GuildGeneral Meeting andThink Pink EventUpper Bel Air Bay ClubFor more information onthese and other upcomingevents, please contact TessCsiszar at 310-829-8168 orTheresa.Csiszar@stjohns.org10 SAINT JOHN'S MAGAZINEA Homecoming forDr. RichardEssnerSurgical oncologistRichard Essner,MD, has joined theJohn Wayne CancerInstitute as professorof surgery, directorof surgical oncologyand co-director ofthe melanoma andcutaneous oncologyresearch program.Dr. Essner is nostranger to JWCI.He was a surgicaloncology fellow atthe Institute from 1992 to 1994 and served as an assistantdirector of surgical oncology from 1994 to 2007.During his first stint at the JWCI, Dr. Essner says hewas deeply influenced by Donald L. Morton, MD, therenowned melanoma researcher and co-founder of theJWCI.“The John Wayne Cancer Institute for many years ledthe world in innovation in cancer care with developmentof the sentinel lymph node biopsy technology and thecreation of vaccines and immunotherapy as primarytreatments of cancer,” he says. “For me, working in themelanoma field, it’s an honor to follow after Dr. Morton,who was my friend and mentor; not only for his skill asa cancer researcher but also as a surgeon and educatorof the oncology fellows. The work he did laid thegroundwork for the latest successes in oncology.”Dr. Essner’s practice is focused on complex surgicaloncology with a primary interest in caring for patientswith melanoma and other types of skin cancers as wellas head and neck diseases. His research focuses onimproving the quality of melanoma surgery to producebetter outcomes and cosmetic results. His research alsoincludes developing methods to reduce the incidenceof cancer using surgery with immunotherapy or targetedtherapy, allowing these other approaches to help whensurgery alone is not enough. Treatment of cancer israpidly changing throughout the world, but unfortunatelynot all patients are cured.“My goal at the John Wayne Cancer Institute is tocontinue the excellence in cancer research, surgicaloncology training and patient care and education,” hesays. “We have a superb team of oncologists, surgeonsand researchers who will ignite the next successes inoncology in the coming years.”

HEALTH BRIEFSMany patientsdon’t use all oftheir prescribedpain medicationWorrisome risein colorectalcancer inpeople under 50The nationwide opioid addictionepidemic has Americans thinkinghard about the value of takingopioids for pain relief and properlydisposing of any unused pills. Anew study suggests that manypatients don’t really need all of thepain pills their doctors prescribe.The study, published recently inthe journal JAMA Surgery, showedpatients used only about onefourth of the opioids prescribed tothem after a common operation.Researchers looked at pain pillusage in 2,392 patients who hadone of 12 common operations, suchas a hernia repair or appendectomy.The study is important becausepatients often have expectationsfor how much pain medicine theywill need depending on whatdoctors tell them about pain andhow many pills are prescribed.In the study, the number ofpills a patient received was thestrongest predictor of how manythey actually used. Other studiesshow the more opioid medicationa patient is prescribed, the higherthe risk of developing an addictionor overdosing.While colorectal cancerrates decline in olderadults, the incidence of thedisease in people youngerthan age 50 continuesto rise, according to newresearch. The trend mirrorsa rise in obesity. In 2016roughly 40 percent ofU.S. adults under age 50were obese. The studyalso showed increases ingastric cancer in peopleunder age 40. Gastriccancer is also linked toobesity.COLORECTAL BYCANCER TRENDS AGE2.51.8 0.8 1.250-1.25-1.5-2.5-2.8-3.75-4.6-5-3.9Age20–49. 1.8% increase (2002–2009)20–49. 0.8% increase (2009–2013)50–64. 1.5% decrease (2002–2013)65–74. 2.8% decrease (2002–2007)65–74 . 4.6% decrease (2007–2013)75 . 3.9% decrease (2002–2013)Source: The Ohio State University; SEER andNational Inpatient Sample dataAssessing Heart HealthNearly half of U.S. adults have someform of heart disease, according to newresearch. The study is a good reminder tobe aware of your heart health. The heartand vascular specialists at Providence SaintJohn’s Health Center provide a full range ofcardiovascular services as well as preventivecardiology assessment and advice. Formore information or to schedule anappointment with our expert heart careteam, call 888-HEALING (432-5464).ABOUTABOUT35% 1 IN 3 2,200OF T HE U.S.P OP ULAT ION HASSOM E FORM OFHEART D ISEASE.AM ERICANS WILLD IE FROM HEARTD ISEASE ORST ROKE.DEATHSEACH D AY IN T H E U . S.ARE AT TR IB U T AB L E T OHEART D ISE ASE .SAINT JOHN'S MAGAZINE 11

The Best in Breast CareDr. Janie Grumley becomesthe new director of the MargiePetersen Breast Center.BY SHARI ROANPHOTOGRAPHED BY KRISTIN ANDERSONIn September Providence Saint John’sHealth Center welcomed a new directorof the Comprehensive Breast Programat the Margie Petersen Breast Center.Janie Grumley, MD, was born in Taiwanand grew up in Edmonton, Canada,where she pursued a passion for figureskating. She studied sports medicine atPepperdine University and obtained hermedical degree from Keck School ofMedicine of USC, becoming a surgicalbreast oncologist. Prior to assuming herposition at Saint John’s, Dr. Grumleypracticed at Virginia Mason MedicalCenter in Seattle. We asked Dr. Grumleyabout her plans for the Breast Center.What drew you to Saint John’s?“All the people at Saint John’s havebeen wonderful. Their enthusiasm for thebreast program and desire to build on theamazing history of breast care drew me tothis program. I love the excitement aboutchange and desire to be on the forefront.Saint John’s Health Center is the perfectcombination of patient-centered care andinnovation, which are critical in cancercare. The partnership between physicians,staff, leadership and the Saint John’sHealth Center Foundation creates a uniqueenvironment for exceptional care. Theclose collaboration between physiciansand the foundation really impressed me.With such support from donors, it is nowonder the physicians at Saint John’s areable to reach new heights in patient care.”12 SAINT JOHN'S MAGAZINEYou are known as an advocate ofoncoplastic surgery. What is that?“Oncoplastic surgery is a novel approachto breast-conserving surgery. Oncoplasticsurgery combines breast cancer removalwith plastic surgery breast shapingtechniques to improve patient outcomes.Breast conserving surgery has beenperformed for many years and has beenshown to be an effective way to treatbreast cancer. Unfortunately, traditionaltechniques have often been limitedto small cancers due to the cosmeticdeformity that can result. Oncoplasticsurgery strategically removes areasof cancer using breast lift techniquesto minimize cosmetic deformity. Thisapproach allows for removal of largeramounts of tissue, decreasing the needfor multiple operations, which makes it abetter cancer operation while preservingthe appearance of the breast.”You also offer an innovative treatmentcalled intraoperative radiation therapy(IORT). What advantages does it offer?“Breast conserving treatment combinesa partial mastectomy or lumpectomywith radiation therapy. Most women whowant a partial mastectomy will requirethree to six weeks of radiation therapy aspart of their treatment. This one-size-fitsall approach can sometimes over-treatsome women with low-risk, early-stagebreast cancer. IORT delivers a singledose of radiation at the time of surgery,treating a small area around the tumorbed. This option has been shown to bejust as effective as whole breast radiationfor women who have low-risk cancers.Being able to effectively treat the site ofthe cancer while sparing other healthyareas like the rest of the breast, ribs,lungs and heart may have significantlong-term benefits. Some women canessentially be done with surgery andradiation therapy in one day, eliminatingthe need for prolonged treatments.”You started a multidisciplinary clinic.What is that?“At the Margie Petersen Breast Center,we provide twice-weekly multidisciplinarybreast cancer clinics where patientscan come and see a surgeon, medicaloncologist, radiation oncologist and,if applicable, geneticist all in one day.This gives the patients a good overviewof what treatment will be like and howdecisions need to be made. For mostpatients there is a sense of relief oncethey have had the opportunity to hearfrom all the different physicians and getan overview of what their treatment planwill be moving forward.”Is the kind of center you’re buildingunique?“In the last 10 years I have workedin academic, community and hybridbreast programs and have also had theopportunity to visit many breast centersacross the country as a breast programreviewer for the Society of SurgicalOncology Training Committee. There areso many programs out there with uniquestrengths. Some are great at clinical breastcancer care but lack innovative research,while some are great at research butlack compassionate, coordinated patientcare. Very few programs have been ableto provide a comprehensive programthat combines knowledgeable benignbreast care, coordinated cancer careand innovative research. We are buildinga program that provides excellence inall areas of breast care. We will be aprogram women will trust with their breastconcerns—benign or malignant. We willprovide the compassionate, patientcentered care Saint John’s Health Centeris known for while leading the charge ininnovation and breast cancer research,together with the JWCI.”

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APLACEFORWOMENT H E R E I MAG INED B REASTC E N T E R PERSO NALIZ ESC A R E F O R EV ERY PAT IENT .BY SHARI ROAN / PHOTOGRAPHED BY KAREN HALBERT14 SAINT JOHN'S MAGAZINE

After receiving a diagnosis ofbreast cancer, Ingrid Nuberwas told by surgeons in herhometown of Nashville, Tennessee,that she would need a mastectomy.Nuber, 44, a cyber security manager,called her sister in Los Angeles to relaythe disheartening news.Nuber’s sister, who had receivedcare previously at Providence SaintJohn’s Health Center, convincedNuber to travel to Los Angeles to getsecond opinions from other breastsurgeons. Two surgeons agreedwith the Nashville surgeon that amastectomy was necessary. But thenNuber walked into the office of JanieGrumley, MD, the new director of theMargie Petersen Breast Center atProvidence Saint John’s Health Center.“The other surgeons said I wasn’t acandidate for a lumpectomy because itwould leave me disfigured,” Nuber says.“But Dr. Grumley brought an optionto the table that I didn’t know about.”The option was oncoplastic surgery(oncoplasty), a relatively new type ofbreast cancer surgery that combinesplastic surgery techniques with breastcancer surgery. With oncoplasty, thetumor is removed and the rest of thebreast and nipple are spared.”Nuber was stunned at the facts Dr.Grumley presented: The chancesof breast cancer survival withoncoplasty would be the same as withmastectomy, the complications withoncoplasty would be less than withmastectomy, and oncoplasty wouldnot be disfiguring. Nuber’s oncoplasticsurgery on October 8, 2018, wasenormously successful.“I have the chills speaking aboutit,” Nuber says. “I’m literally perfectand cancer-free. That is how lifealtering my experience was inmeeting Dr. Grumley. She is such anunbelievable doctor.”Oncoplastic surgery for breastcancer is just one of the advancedskills Dr. Grumley brings to SaintJohn’s, after assuming leadershipof the program in September 2018.SAINT JOHN'S MAGAZINE 15

Dr. Grumley is not only updating the Margie Peterson BreastCenter to usher in the latest approaches in breast health, sheis also setting the tone that patients like Nuber find extremelycomforting, says Donald Larsen, MD, chief medical officer atProvidence Saint John’s Health Center.“She was trained by the best,” Dr. Larsen says of Dr.Grumley’s education at the University of Southern CaliforniaKeck School of Medicine. “But she also demonstratescompassion for her patients and dedication to the field. Sheranks high on the likability scale. She’s very approachable.”The breast health clinicReimagining the program to include care for all kinds ofbreast health—not just cancer care—is part of Dr. Grumley’scommitment to creating a comprehensive center. At theBreast Health Clinic, Dr. Grumley and her colleagues seewomen with any type of breast issue, such as breasttenderness, nipple discharge and other conditions.Dr. Grumley and her team use a personalized approach,which tailors to the individual characteristics of each patient.Women can discuss a schedule for breast cancer screening,what type of screening to have and the conditions thatimpact screening, such as family history, risk factors andbreast density.“Our jobs as

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