Dr. Armen Chalian

National Doctor’s Day – Meet Dr. Armen Chalian

Posted on 03/29/19 by Allied Anesthesia

Armen Chalian Allied AnesthesiaMarch 30 is National Doctor’s Day, and to celebrate, we decided to interview Dr. Armen Chalian, one of the many incredible physicians we have here at Allied Anesthesia, about what made him want to become a doctor (in particular, an anesthesiologist).

Dr. Chalian joined Allied in 1993; since then, he has handled more than 20,000 cases with us. Dr. Chalian currently specializes in anesthesiology for pediatric, obstetric, neurology and orthopedic patients, as well as chronic pain management. Previously, he specialized in anesthesia for pediatric and adult open-heart surgery.

Here’s what he had to say.

 

Did you always know you wanted to be a doctor?

In high school, I really enjoyed the humanities—English and history. I wasn’t particularly interested in the sciences. I went to college at UCLA, and my dad told me to take a biology class just to try it. There were 600 students in the class, and I ended up being in the top 3. And I just kept going!

A little backstory here: My grandparents survived the Armenian genocide and escaped to the Middle East. Then my father similarly escaped war-torn Beirut to come here to the States. It was important for my dad and his siblings that their children become doctors, in part because doctors provide a critical service to others. And we did. Every single one of my cousins is a doctor or dentist.

 

What made you decide to get into anesthesiology?

That was an easy decision. Anesthesiology is the best and most exciting field in medicine—by far.

As an anesthesiologist, you have to be an expert in all fields of medicine—not just anesthesia—because administering anesthesia affects all organ systems. Anesthesiologists are the only doctors who need to have this broad base of knowledge and expertise.

It’s also the only field of medicine where, as a doctor, you have a cart full of medications and you can grab and administer them in real-time, which often ends up saving patients’ lives. I always tell people that if you had to pick one doctor to have around if you’re going to be very ill, it’s an anesthesiologist. We’re trained to spring into action, and our work depends on expertise across the medical spectrum.

 

What do you think is the biggest misconception about anesthesiology?

I think the biggest misconception is that anyone can administer anesthetic. And it’s not just a misconception on the part of patients. There are even doctors who think that!

But in reality, anesthesiology is not just pushing medicine in an IV and watching someone fall asleep. Every patient has unique things about them—age, general health, specific medical conditions, medications—and all of these characteristics factor into how anesthetic will affect them.

Another misconception is that anesthesiologists just administer anesthesia at the beginning of a procedure and then go home. You’re there the whole time, monitoring the patient, ensuring that they’re responding well to both the anesthesia and the procedure itself, and will wake up at the end of the procedure feeling better.

It’s an art form more than a medical practice. Everyone in my family knows that if they undergo a procedure, they have to demand to have an anesthesiologist present. Not a nurse anesthetist or a physician’s assistant, but an MD specializing in anesthesiology.

 

What do you like about working at Allied Anesthesia?

It’s been incredible to get to work in so many fields of anesthesia alongside such talented people. There are leadership opportunities here at Allied, and I’m not just a cog in an enormous healthcare machine. I’m practicing the kind of medicine I want to practice and have the freedom and support to be a true advocate for my patients. It’s the best job I can imagine.

Doctor and cancer patient look at data on computer

Can Anesthesia Impact Cancer Surgery Outcomes?

Posted on 03/07/19 by Allied Anesthesia

Many people think of an anesthesiologist’s role as limited to providing comfort during surgery—that our role begins and ends in the operating room. As our patients and their families know, anesthesiologists do much more. At Allied, we specialize in pediatric anesthesia, cardiac anesthesia, and chronic pain management. Other examples of anesthesiologist specialties are neuroanesthesia or anesthesia as apart of obstetrics or emergency care.

One of the most exciting parts of being a doctor, regardless of the specialty, is how the science of medicine is constantly advancing—as we learn more and more about certain diseases and treatments, our ability to help our patients gets better and better. Anesthesiology is no exception.

For example, a recent article published in JAMA Surgery suggests that modifying anesthetic techniques when operating on cancer patients could actually reduce the postoperative incidence of cancer metastasis, and therefore improve long-term survival.

First, some background. In general, regardless of the health of the patient, the experience of surgery can have lasting effects on your physiology. Specifically, surgery can induce stress and inflammatory responses that have a measurable impact on cellular systems and can ultimately compromise a patient’s immune system. These changes don’t just occur during or immediately after the surgery—they can extend well beyond the actual event.

We know that reducing pain and inflammatory responses after surgery helps people heal faster and makes them less prone to infection. Is the same true for anesthesia?

In a recent Anesthesiology editorial, the authors note that clinical evidence suggests that there are three different anesthetic approaches that might reduce the risk of cancer recurrence:

  • Regional anesthesia, including nerve blocks
  • Anesthetic adjuvants to help prevent infection
  • Using propofol as a replacement for anesthesia

All three of these approaches are currently being evaluated, and we’re very much looking forward to the results.

At Allied, we’re committed to helping our patients before, during, and after surgery—so if there are anesthetic management changes we can make to help reduce the risk of recurrence in our patients living with cancer, we’ll be among the first to implement them.

Operating room team

The Year Ahead

Posted on 02/01/19 by Allied Anesthesia

2018 was a whirlwind at Allied Anesthesia and we’ve already hit the ground running in 2019. Our highlights for the year include:

  • Adding five surgery centers to our partners (we now provide anesthesia services at a total of 32 different locations)
  • Treating a record number of cases: about 111,000
  • Bringing on highly skilled new team members
  • Providing top-notch care to our patients across southern California (as always)

2018 also came with its challenges, in particular Assembly Bill 72. The bill, which the California legislature passed in September 2016, was designed to eliminate patients’ “surprise medical bills” for out-of-network care. For example, if a patient goes to an in-network facility for care but receives treatment from an out-of-network doctor, they could be billed later for that doctor’s fees.

Of course, we fully support the thinking behind this legislation. As a medical group that partners with many hospitals and ambulatory surgery centers, one of our highest priorities is ensuring that patients are not billed separately for our anesthesia services. We feel strongly that patients should not shoulder the burden for out-of-network services they receive as part of covered treatment.

Unfortunately, the implementation of this bill hasn’t been this straightforward—in fact, it’s been deeply flawed. It doesn’t just eliminate surprise bills for patients (which is undoubtedly a good thing)—it gives large insurance companies with lots of resources even more leeway to take advantage of small, specialty practices like Allied Anesthesia.

By allowing insurance companies to severely limit how much reimbursement they provide to specialized, out-of-network doctors, it’s no wonder that insurance companies fully supported AB 72—while our peers in the medical industry strongly opposed it.

One of our primary goals for 2019 is to work with the authors of AB 72 to make them aware of the unintended consequences of this legislation. Ultimately, we want to help them find a solution that protects patients from unexpected costs and enables us to continue bringing in exceptionally talented physicians to provide the highest quality care to our patients.

That’s just one of the many things we plan to accomplish in 2019:

  • Establish new partnerships. We currently work with many renowned hospitals and ambulatory surgery centers, including Hoag, CHOC Children’s, St. Jude’s, St. Joseph’s, and more. We’re look forward to collaborating with all of our existing partners and some new ones in the new year.
  • Continue to add to our team. We’re looking forward to another successful recruitment season where we can bring on 6-10 more talented doctors
  • Expand our role. We’re looking forward to expanding our role in the perioperative process as we use multimodal therapies to decrease cancellations and improve efficiency in the operating room.
  • Decrease opioid use. Opioids are extremely useful in treating severe pain, but they come with many complications. We’ll be limiting our use of opioids through intraoperative nerve blocks and administering other types of medications that affect pain pathways.
  • Continue to provide exceptional care to our adult and pediatric patients. It will come as no surprise to our patients that this is always our top priority.

 

Doctor talking to patient in hospital

Current Trends in Anesthesia

Posted on 01/24/19 by Allied Anesthesia

One of the most fascinating things about working in medicine, and anesthesiology in particular, are the near-constant advances in medical technology and their implications for our work. While there’s no telling exactly what medical breakthroughs will occur in the coming months and years, some of the developments we’ve encountered recently are excellent indicators about where we’re headed this year and beyond.

Improving Sleep in Post-Operative Patients

If you’ve ever had major surgery, you know how difficult it can be to sleep immediately afterwards—especially if you’re in the hospital. Discomfort is a primary factor, but age, medication, anesthesia type, surgery type/method and environmental stress can also be factors. Trouble sleeping isn’t just an inconvenience—We need sleep to maintain our physical and mental health, and sleep is an important part of the healing and recovery process. A recent article in Current Opinion in Anesthesiology notes that there are pharmacological and nonpharmacological measures (like dim lighting, ear plugs, and eye masks) that can be used to promote sleep during recovery.

Using Data to Predict Outcomes

Doctors are scientists, and like all scientists, data is one of the most important aspects of our work. While vast medical databases have existed for years, only recently have nationwide databases been established especially for anesthesiologists’ use. The data collected by these databases help doctors document patterns across wide patient groups, enabling them to better predict outcomes in future cases. This data can also help healthcare providers identify rare but significant reactions or complications and respond to them appropriately. In order to be of real, lasting value, these databases will need to be consistently monitored for security and methodology, and the data itself must be validated, but their existence looks to be a promising one for the future of anesthesia.

Anesthesia Without Opioids

In an effort to minimize opioid use and the resulting complications, a movement around opioid-free anesthesia (OFA) is gaining traction. While opioids are incredibly important for pain management during and after surgery, they also have well-known adverse effects, including slowing down recovery and leading to long-term use or addiction. While comprehensive, multi-center studies are needed to better understand the risks and benefits associated with OFA, it’s definitely an avenue worth exploring.

Managing Chronic Pain

Chronic pain isn’t new, but given that more than 100 million adults live with it, it’s an important and ongoing focus in medicine. Defined as pain that lasts three months or longer, chronic pain limits your ability to work, sleep, relax, or eat. It also plays a huge role in mental health; studies show it is a prevalent factor in deaths by suicide. Most people know that anesthesiologists help manage pain before and after surgery, but many don’t realize that anesthesiologists specialize in the management of chronic pain. For example, at Allied, we have an award-winning pain management team that helps patients dealing with chronic neck and back pain.

 

Are there any recent medical advances you’re personally (or professionally) excited about? Let us know in the comments.

 

 

Man and woman working out in park - healthy lifestyle resolutions

The Best Resolutions You Can Make

Posted on 01/17/19 by Allied Anesthesia

Making New Year’s resolutions is easy, but keeping them? That’s another story.

If you’re hoping to make a resolution this year you can actually keep, try focusing on quality rather than quantity. In other words, instead of picking multiple resolutions, focus instead on one or two resolutions—clear, strong ones that will have a significant impact on your life and health.

1. Quit smoking.

This one might seem obvious, but there’s a reason for it—approximately 37.8 million American adults are still regular smokers, and more than 16 million Americans are living with a smoking-related disease. As any smoker knows, nicotine is highly addictive, and quitting is easier said than done. But there are a number of options for quitters, and the Mayo Clinic has a solid overview of them.

2. Eat healthy.

It’s hard not to indulge a little over the holidays, so it’s no wonder many people start off the New Year with a diet. But diets, and crash diets especially, can be difficult to follow (and easy to drop), so we recommend focusing on eating healthy, high-quality foods rather than restricting yourself to a rigid diet or completely eliminating certain foods or ingredients. Try to incorporate fruits and vegetables into every meal, limit animal products, and avoid sugars, fats, and processed foods as much as possible.

3. Develop an exercise routine.

Exercise doesn’t just give you a sense of accomplishment and increase your endorphins—It can lengthen your life expectancy, repair heart disease, and decrease your risk of getting cancer.

Experts recommend three to five hours of moderate physical activity (something that gets your heart rate up and makes you sweat) each week, or about 30-45 minutes a day, as well as two or three strength training weekly sessions.

4. Keep track of your BMI.

Your body mass index is your weight-to-height ratio and can be a good indicator of whether or not you’re overweight. Calculate your BMI and try to get to (and maintain) the “normal” range of 18.5-24.9.

5. Drink in moderation.

Some studies suggest drinking any amount of alcohol increases your cancer risk, while others show some alcohol consumption can help prevent cardiovascular disease. Either way, if you enjoy drinking, try to do so in moderation, which the CDC defines as up to 1 drink per day for women and up to 2 drinks per day for men.

 

Referred to as “intensive lifestyle change” by researchers, these resolutions may collectively seem prohibitively difficult. Try focusing on just one or two at a time, and remember that overall, each on its own will make a positive impact on your life—for this year and many to come.

Surgeons washing their hands before surgery

Staying Healthy All Year

Posted on 01/07/19 by Allied Anesthesia

Winter isn’t all festive holiday cheer and new beginnings in the New Year—it’s also (unfortunately) synonymous with cold & flu season. But there are two things you can do during the winter months (and the rest of the year!) to stay as healthy as possible.

As anesthesiologists, handwashing is a critical part of our daily work. Whether it’s a complex surgery or a simple office visit, we always wash our hands before and after having direct contact with a patient. We also wash our hands after having any contact with blood, other body fluids, or medical equipment/objects in close proximity to our patients. We wash our hands after removing our gloves and, just like everyone else, after using the restroom or before eating.

For routine examinations and office visits, we follow the healthcare provider handwashing recommendations issued by the CDC, which are probably similar to the hand-washing you’re familiar with:

  1. Wet hands with water.
  2. Apply the amount of soap recommended by the manufacturer.
  3. Rub your hands together vigorously for at least 15 seconds, covering all surfaces of the hands and fingers.
  4. Rinse your hands with water and dry with disposable towels. Use the towel to turn off the faucet.

Surgery, however, is another story. Because surgery sites are prone to infection, there is a thorough surgical handwashing procedure that every doctor, nurse or technician in the surgery suite follows:

  1. Remove rings, watches, and bracelets—your fingers and wrists should be free of any jewelry.
  2. Wet hands.
  3. Apply antimicrobial soap.
  4. Choose one hand/arm to start on. Using a clean scrub brush, scrub each side of each finger, between the finger, and the back and front of the hand for two minutes.
  5. Next, move up the arm, keeping the hand upright so that water from the arm does not flow down to contaminate the clean hand.
  6. Wash each side of the arm, all the way up to three inches above the elbow, for one minute.
  7. Repeat on the other hand and arm. If the hand touches anything except the brush at any time, the scrub must be lengthened by one minute for every area that has been contaminated.
  8. Rinse hands and arms by passing them through the water in one direction only, from fingertips to elbow. Do not move the arm back and forth through the water.
  9. Proceed to the operating room suite holding hands above elbows.
  10. Once in the operating room suite, hands and arms should be dried using a sterile towel and aseptic technique before you don your gown and sterile gloves.

If that sounds a little overwhelming, don’t worry; the guidelines for handwashing for the general public are much less intensive—but just as important! Handwashing is one of the best methods people have to avoid getting sick or getting other people sick. In fact, handwashing can prevent 30% of diarrhea-related sicknesses and about 20% of respiratory infections.

When you wash your hands, follow these steps from the CDC:

  1. Wet hands with clean, running water, and then turn off the tap.
  2. Add soap to your hands and rub together, being sure not to overlook the backs of your hands, between your fingers and under your nails.
  3. Scrub your hands for at least 20 seconds—about as much time as it takes to sing the “Happy Birthday” song twice from beginning to end.
  4. Rinse your hands well under running water.
  5. Dry your hands with a clean towel or air dry them.

In terms of when to wash your hands, the CDC recommends washing them before, after, and during food preparation, before eating and before and after caring for someone who is sick or wounded (including yourself). It’s also important to wash your hands after using the bathroom, changing diapers, touching animals, handling animal food or waste or dealing with garbage.

One of the illnesses handwashing helps prevent is influenza (or the flu), a common virus that affected more than 48.8 million people in the 2017-2018 season. With symptoms that include fever, chills, body or muscle aches, headaches and fatigue, the flu is incredibly unpleasant—but for people with compromised immune systems, babies, and older adults, it can be deadly. That’s why it’s important to get a flu vaccination every year (in addition to washing your hands regularly).

While the effectiveness of the vaccine varies year to year, studies show that getting vaccinated can reduce the risk of getting the flu by 40% to 60%. For children, pregnant women, older adults and people with chronic conditions, the flu vaccine is especially important in staying healthy.

All of us here at Allied get vaccinated every year—and you should too.

 

Allied Anesthesia doctors at St. Joseph's 2018 Celebration Gala

Allied Members Celebrate 60 Years of St. Joseph Partnership at Annual Gala

Posted on 10/30/18 by Allied Anesthesia

On a recent evening in Anaheim, Allied Anesthesia doctors, along with many in the Orange County medical community, came together for St. Joseph Hospital’s annual Celebration gala. It was an extra-special event for a number of reasons, not the least of which was honoring Ron Moeller, a grateful patient and philanthropist of St. Joseph.

The event also celebrated the 10th anniversary of the opening of the Center for Cancer Prevention and Treatment (CCPT), which has provided expert cancer care for thousands over the past decade. CCPT often employs the services of Allied Anesthesia physicians; and Allied doctors have partnered with St. Joseph for over 60 years, being a part of many medical triumphs over the decades, including the first open-heart surgery and pacemaker procedure in Orange County, the first-ever artificial hip replacement surgery and the first-ever knee replacement surgery, among many others.

“Allied is always grateful to be a part of the effort,” said Dr. Alex Ramirez, one of the many Allied members who attended the gala to support Allied’s fruitful and long-standing relationship with St. Joseph. “It was a great night for an incredible cause!”

It was also an opportunity for long-time Allied members to reflect on the progress that has been made, in no small part due to the groundbreaking work of St. Joseph and Allied Anesthesia medical innovators.

“As an anesthesiologist working in the Cancer Center, we often provide anesthesia services for adults with severe cancer pain, or pediatric cases from [Children’s Hospital of Orange County],” said Allied physician, Dr. Salomon Maya. “It’s amazing how far this technology has come! We’ve seen vast improvements in the outcomes of these cases, and I can’t think of a better cause to be a part of.”

But – let’s be honest – it was also a great party, truly worthy of the title, “Celebration!” Allied members were dazzled by the delicious dining options, silent and live auctions, and even a live musical performance by Postmodern Jukebox.

“The gala was so well organized and a truly excellent opportunity to raise money for a hospital that is especially important to the Allied family,” said Dr. Kishan Patel. “We loved it!”

We’re sad that we have to wait a whole year for the next Celebration gala, but we’re excited that Allied Anesthesia will be able to continue contributing to St. Joseph Hospital and the well-being of its grateful patients every day by providing high-quality, professional pain management support. Here’s to 60 more years of partnership and progress between St. Joseph Hospital and Allied Anesthesia!

 

Allied Anesthesia Choc Walk 2018 Disneyland group

Allied Walks for Kids at CHOC Walk in the Park at Disneyland

Posted on 10/03/18 by Allied Anesthesia

Allied Anesthesia was honored and thrilled to participate in the Children’s Hospital of Orange County (CHOC) Walk in the Park.  If you aren’t familiar with the CHOC Walk in the Park, it’s a fundraising event for the CHOC Children’s programs and services with the greatest needs, from mental health services to expanded neonatal intensive care units. And it’s held at The Happiest Place on Earth: Disneyland®.

It all started almost 30 years ago – on November 10, 1990 – when the entire Children’s Hospital (doctors, nurses, staff and patients) began the process of relocating from their original building, built in 1964, to a brand-new, six-story building a few miles away. The original walk began at the Main Place Mall in Santa Ana, passed by CHOC Children’s and wove its way through local neighborhoods before ending at the Disneyland parking lot. While the route changed a few times in its first decade, in 2002, it returned to its first home and became known as the CHOC Walk in the Park presented by Disneyland.

In the event’s 28-year history, it has raised more than $32 million for CHOC Children’s, and CHOC Children’s at Mission Hospital.

Tony Adkins of Choc Children's

Tony Adkins of CHOC

This year, we had an all-star team that included special guest Tony Adkins, a skilled CHOC physician assistant who has gone viral thanks to a special talent: using dancing as a way to cheer up and connect with his pediatric patients.

The Allied team also included Dr. Claudia Moreno and her family. “I wanted to participate in this event because I believe in providing the best possible care for our patients undergoing surgery at CHOC,” said Dr. Moreno. “I want parents to know that while their little one is in surgery, he/she becomes my little one, and that is the greatest honor and responsibility. My patients stay in my mind and heart.”

Dr. Rebecca Sanger and her family were there too. “The CHOC walk is an excellent opportunity for my own children to understand what I mean when I say I’m taking care of other people’s kids. It’s a chance for them to see other kids that have overcome and persevered through tough times with the help of doctors, nurses and so many wonderful staff members at CHOC.”

Learn more about the event and mark your calendars for next September … we’ll be there!

Allied Anesthesia Choc Walk 2018 Disneyland group Tony Adkins - Allied Anesthesia Choc Walk 2018 Disneyland Allied Anesthesia Choc Walk 2018 Disneyland

6 Reasons to Staff Your ASC With an All-Physician Anesthesia Group

Posted on 07/23/18 by Allied Anesthesia

Every ASC has several options when it comes to anesthesia staffing. You can hire anesthesiologists or nurse anesthetists directly, you can contract with them individually, you can contract with a large anesthesia group that operates on the care team model, or you can work with a specialized all-physician anesthesia group like Allied Anesthesia.

Here are six great reasons to consider bringing in a group like Allied to your surgery center this year.

#6 – Eliminate Cancellations From Coverage Issues

Many surgery centers don’t have the volume to employ a full-time anesthesia provider, and very few have the volume to support multiple providers.

Individual hires and contracts can lead to serious staffing issues. Are you willing to shut down your ASC because your anesthesia provider is sick or on vacation? Reschedule surgeries because they have a family emergency?

With a model like Allied’s, coverage issues are eliminated thanks to our pool of over 100 qualified physician anesthesiologists. Our anesthesiologists arrive on time, ready to deliver high quality care and won’t leave until patients are discharged from your ASC.

#5 – Benefit From Providers Who Are Ready for Anything

Variety isn’t just the spice of life – it’s also a helpful attribute in any profession. Medicine is no exception. Surgical care in an ASC setting is often routine and uneventful. But when the unexpected happens, you need a surgical team that can handle a curveball.

At Allied, all our anesthesiologists rotate through a variety of settings, from specialty outpatient surgical centers to fast-paced trauma centers and complex inpatient surgeries at some of California’s largest hospitals. That means that when your OR is staffed by an Allied anesthesiologist, it’s staffed by an anesthesiologist who’s ready for anything from the routine to the unexpected.

#4 – Improve Reimbursement

Appropriate and timely reimbursement is a big part of any successful outpatient surgery center. At Allied, our group has developed relationships and contracts with essentially every insurance company in our region. That not only ensures appropriate reimbursement for anesthesia services, it also lets you lean on our experience for help in negotiating reimbursement for all your ASC services. This ultimately leads to very happy patients that won’t receive unexpected medical bills and are more likely to return to your center for future procedures.

#3 – Keep Your Surgeons Happy

Surgeons prefer to work with anesthesiologists who have the same level of training and experience that they do. While there’s certainly a place for the care team model, our surgical satisfaction surveys have shown that most surgeons prefer to work with Allied’s physician anesthesiologists who can tailor an anesthetic plan to specific surgeon preferences. Allied anesthesiologists can also perform regionalized pain procedures that lead to lower pain scores after surgery which result in happier patients and surgeons.

#2 – Enjoy Customized Protocols

Despite what some large national anesthesia groups would have you believe, there is no one-size-fits-all in anesthesia. That’s why we develop customized protocols for every individual location and surgeon we work with. Whether it’s adapting the latest advanced procedures to an outpatient setting or accommodating individual preferences, our group works to deliver care in the right way for your ASC.

#1 – Improve Patient Care

Nothing is more important to our anesthesiologists than improving patient care, and we help our ASC partners reach that goal in a variety of ways: from implementing checklists and clinical decision pathways, to maintaining the safety of your ASC to helping to bring in new, advanced procedures and protocols to your facility. When you choose to work with a qualified anesthesia group like ours, you’re choosing a partner who’s always working toward the best for your patients.

Interested in learning what working with Allied could do for your outpatient surgery center? We’d love to hear from you.

St. Joseph Hospital Celebration 2017 Silent Auction

Allied Anesthesia Is Proud to Be a Silver-Level Sponsor of St. Joseph Hospital’s Celebration 2017 Benefit

Posted on 12/19/17 by Allied Anesthesia

On October 7, St. Joseph Hospital hosted Celebration 2017, an annual fundraising event whose proceeds benefit the St. Joseph Hospital Heart and Vascular Center. This year’s funds will go toward building a new, next-gen cardiac catheterization laboratory for technologically advanced procedures. The Celebration, which took place at the City National Grove of Anaheim, raised a record-breaking $450,000 for the center. Allied Anesthesia was proud to be one of the event’s sliver sponsors and a contributor to the event’s rare wine raffle. (more…)