Although an understanding of Parkinson’s disease dates back to at least the early 19th century, there is still much research to be done. Here is what you need to know about diagnosis and treatment options.

By Elena Acoba

Parkinson’s disease is confounding. The medical community doesn’t know what causes it. No two patients have the same symptoms or progress through the degenerative movement disorder in the same way. It’s hard to diagnose. There is no cure or way to slow its progression. And medical treatments lose their effectiveness over time.

But that doesn’t mean that someone with Parkinson’s can’t live a fulfilling life. “There are currently no treatments that delay the progression of Parkinson’s disease,” says Sarah Sullivan, D.O., a neuro-hospitalist with Northwest Medical Center and Oro Valley Hospital. “There are treatments, however, that improve a patient’s symptoms and quality of life, as well as decrease risks such as falls.”

About 60,000 Amer-icans are diagnosed with Parkinson’s disease every year. Around 10 to 20 percent of them have young onset, meaning they were diagnosed at age 50 or younger, says Rebecca Gilbert, M.D., Ph.D., vice president and chief scientific officer of the American Parkinson Disease Association. Some one million Americans live with the disease, including about 14,200 Arizonans.

It’s a difficult diagnosis for someone to receive.

“Patients often feel overwhelmed and anxious upon first hearing the words,” says Dr. Sullivan. “I review the medication and treatment options that we will consider in an effort to reassure patients that although we cannot cure the disease, there are many things we can do to manage it.”

Sarah Sullivan, D.O., a neuro-hospitalist with Northwest Medical Center and Oro Valley Hospital.

The first line of treatment for symptoms is the medication levodopa in various formulations and dosages. This drug allows the brain’s nerve cells to create dopamine, the neurotransmitter whose absence triggers Parkinson’s symptoms. The exact formula and dosage need continual adjustment taking into account the patient’s specific symptoms and disease progression.

The medication eventually no longer works, or its side effects become hard to tolerate. At that point, patients can consider deep brain stimulation (DBS). This could extend the relief of movement symptoms for 10 years or more, says Joseph Christiano, M.D., a neurosurgeon with Western Neuro.

In the procedure, two electrodes are placed in areas of the brain where Parkinson’s is disrupting movement control. These leads are connected to a battery pack that’s inserted under the skin of the chest. Electrical pulses adjusted to the patient’s specific needs are transmitted into the brain to help it control tremors and other movement symptoms.

“Ninety-plus percent of people see results,” says Dr. Christiano. “They can get significant improvement for various symptoms such as tremor, slowness and stiffness, gait issues and imbalance.”

With results like that, one might seek out the brain surgery as soon as possible. But, like a lot about Parkinson’s, it’s not that simple.

“Every patient’s Parkinson’s is slightly different,” Dr. Christiano says. “Medication often is very effective in the early stages and allows time for both the diagnosis and the trajectory of the disease to become clear. There are other disorders that appear similar to Parkinson’s disease, and it is important to clearly establish the right diagnosis.”

A typical Parkinson’s patient can consider DBS as early as three years after diagnosis, but this may depend on how fast the symptoms worsen.

“DBS is a well-studied, safe and effective treatment for Parkinson’s disease, and will be the next logical choice for many patients at some point in their disease,” says Dr. Christiano.

“There are other disorders that appear similar to Parkinson’s disease, and it is important to clearly establish the right diagnosis” – Joseph Christiano, M.D.

The Federal Drug Administration recently has approved the use of focused ultrasound to manage tremors. The nonsurgical procedure creates a lesion in the area of the brain where Parkinson’s has caused abnormal circuitry for movement.

Although medical options appear limited, many people can keep Parkinson’s symptoms at bay with lifestyle changes. This may be one benefit of having an early diagnosis even though there is no cure.

Rebecca Gilbert, M.D., Ph.D., vice president, chief scientific officer of the American Parkinson Disease Association. Photo by Abdulai Sesay.

“Some would argue that knowing that you have the disease is vital so that you can understand the changes that are happening in your body, increase exercise and plan for the future,” says Dr. Gilbert. “This should occur as early as possible.”

There are many ways to keep movement stable as long as possible.

Some physical therapy programs specific to Parkinson’s focus on exaggerating movements like arm swing and stride. Exercises that encourage loud speech help with maintaining vocal control.

Movement-dependent activities like video games, boxing, yoga, dance, swimming and tai chi help elevate mobility and mood. Any exercise is good, but doing them as intensely as possible shows more benefit.

Appropriate diets can address constipation, a common issue with Parkinson’s patients. Dr. Sullivan also suggests working with a doctor or dietician on the timing of eating certain foods, such as those high in protein, which can affect levodopa absorption.

An entire health team can respond to issues as they come up. Dr. Gilbert suggests a movement disorder specialist, primary care provider, rehabilitation specialists, nurse, nutritionist, neuropsychologist and social worker.

Research continues on many fronts: discovering genetic and environmental factors that cause the disease; detecting it before symptoms occur and brain damage becomes irreversible; and formulating treatments that can slow or stop its progression and for non-motor symptoms.

Joseph Christiano, M.D., a neurosurgeon with Western Neuro.

For Dr. Christiano, the way DBS is done — the procedure doesn’t change the brain structure — shows that the medical community has not given up.

“The key point,” he says, “is we are hopeful that somebody will come up with a cure for Parkinson’s, and since we didn’t change the brain cells, it might still be effective for DBS patients.”

PARKINSONISM

Some people who present with typical Parkinson’s symptoms also may show unrelated symptoms. This condition is known as Parkinsonism or Parkinson’s plus. Parkinsonism can appear in people with a history of stroke, head injuries or exposure to certain medications. It’s also evident in other diseases, such as Lewy body dementia and progressive supranuclear palsy.

“Because there is no single definitive test of Parkinson’s disease, these conditions sometimes are misdiagnosed as Parkinson’s early on,” says Dr. Sullivan.

Medications and therapies for classic Parkinson’s don’t work as well in these patients, and the disease may progress faster.

CHARACTERISTIC SYMPTOMS OF PARKINSON’S DISEASE

  • Tremors at rest
  • Decreased blinking
  • Handwriting that gets smaller
  • Small movements of the hands and feet
  • Arm, leg stiffness
  • Stooped posture
  • Decreased arm swing
  • Shuffling walk
  • Turning by taking several steps instead of pivoting
  • Changes in vocal quality There also are symptoms not related to movement, including
  • Loss of smell or reduced sensitivity to odors
  • Sleep problems
  • Depression, anxiety, psychosis
  • Gastrointestinal, urinary issues
  • Excessive sweating
  • Cognitive, personality changes

RESOURCES

April is Parkinson’s Disease Awareness Month, and Tucson has several resources to offer. Dr. Sullivan sees much interest among patients on how to live well with Parkinson’s.

“It’s something I see in Tucson a lot,” she says. “They are hungry for more information, more education. Many Tucson patients and winter visitors are intensely motivated to participate in their care. They want to stay young, vital, vibrant and active.”

Here are some locally based resources.

American Parkinson Disease Association Arizona runs three programs: a lecture series on the first Tuesday of the month; a support group for patients and caregivers every third Tuesday of the month; and for newly diagnosed patients, an eight-week class: “Parkinson’s Roadmap for Education and Support Services.” For more information: www.apdaparkinson.org or 326-5400.

The Parkinson and Movement Disorder Alliance lists several support group meetings and exercise classes, as well as online and streaming resources. The organization will hold an educational event July 25. For more information: www.pmdalliance.org or 800-256-0966.

Parkinson Wellness Recovery focuses on exercise and other ways for the brain to adapt to the effects of the disease. For more information: www.pwr4life.org or 591-5346.

This is the second year of “10 to try.” Although it’s hard to narrow down our staff’s favorites, we think you’ll find in these selections something that will make your own “best of ” list.

FROM THE STAFF OF TUCSON LIFESTYLE

Saffron Indian Bistro

MUST TRY: CHICKEN TIKKA MASALA

Although it’s the national dish of England, Tucsonans are crazy about Chicken Tikka Masala! According to server/bartender Aaron Wilson, this dish is the one most often requested at Saffron Indian Bistro, usually ordered with a side of garlic naan with which to sop up the delicious creamy, tomato-y sauce. The succulent chicken breast pieces are first marinated in yogurt blended with a number of traditional Indian spices such as cumin and coriander. The chicken then is added to a slow-simmered fresh tomato sauce with a hint of cream and zesty Indian herbs and spices. Basmati rice sprinkled with cumin seeds accompanies the saucy deliciousness.

Saffron offers most familiar Indian dishes, which are available in different levels of spiciness. Wilson notes that customers who like it hot can request additional spice levels, ranging from “spicy American,” “extra spicy,” and “Indian spicy” to a level so high the staff refers to it as “pet hospital”! Another notable factoid about Saffron: Owner Mintu Sareen offered furloughed Federal workers (with valid ID) free lunch buffets during the government shut-down — more than 700 were served!

7607 N. Oracle Rd., Suite 101, Oro Valley, 742-9100; tucsonindianrestaurant.com

Agustín Kitchen

MUST TRY: MEZZE PLATTER

If we learned nothing else from kindergarten, it’s that “sharing is caring,” and you can show your dining companion that you care very much by selecting the mezze platter at Agustín Kitchen. This Mediterranean-inspired dish offers plenty for two to share, and so many delicious and different tastes that it may be hard to decide what you like best.

Executive Chef Alex O’Neill explains how the dish evolved. “It started on a summer menu. We were trying to figure out something that was a little more economical, and more adventurous than the traditional chef board. Sally Kane, our operating manager, mentioned mezzes, and it piqued my interest with how dynamic they are. There are a plethora of ingredients that you can pull from to make a mezze platter, and it instantly became a staple on our menu. It’s one of those items that I think we would be met with torches and pick axes if we ever took it off!”

With ingredients that include beet-pickled eggs, hummus, flatbread, olives, sheep’s milk feta, falafel, and muhammara, it’s easy to taste why it’s so popular.

But it’s only one option on a menu that takes advantage of both locally sourced ingredients and O’Neill’s culinary wizardry. The restaurant not only has good relationships with many farmers and food producers in the region, the Mercado itself holds a farmers market every Thursday, and sometimes O’Neill will pick up something that seems especially inspiring.

“When I make the menu, there’s an unspoken tie that binds everything together,” says O’Neill. “Any time we put a dish on the menu, it has to speak to what the restaurant is and who our clientele are.”

That means the brunch, lunch and dinner menus can have everything from entrées with a Southwest flair (huevos rancheros), to Asian influences (tandoori pork loin), to classic French dishes (coq au vin), all created with a distinctive Agustín approach.

With bar dining that has a fun communal vibe, patio seating (with live music on the weekends), and a dining room that is elegant without being stuffy, there’s a spot for any dining mood.

100 S. Avenida del Convento #150, 398-5382; https://agustinkitchen.com.

Culinary Dropout

MUST TRY: BEER BATTERED FISH & CHIPS

Fish & Chips is a traditional dish that works well in casual eateries, so it’s no surprise to find it on the menu at Culinary Dropout. While developing the concept for the eatery, founder Sam Fox and Clint Woods, Fox Restaurant Concepts’ vice president of Culinary, created the dish to reflect classic comfort dishes for a gastro-pub style setting. Made with California Rockfish and beer-battered (using Stella Artois), the fish fillets are deep-fried to be crispy on the outside, tender on the inside. They are served with coleslaw, tartar sauce and fries.

Three days before opening the inaugural Culinary Dropout, Fox and Woods were still working on the menu, with a lot of ideas but no firm direction. “Nothing was working out,” Woods states. “So we starved ourselves for a day, and that’s how we came up with the ideas, like, ‘What are you hungry for right now?’ A little hung over, a little starved from the day before … that’s how the menu came about.”

The menu features many such pub food items that are enhanced in creative ways. The results are as varied as the eatery itself, with its many different dining areas, each with a different vibe.

2543 E. Grant Rd., 203-0934; culinarydropout.com/locations/tucson-az

El Sur Restaurant

MUST TRY: CHICKEN TORTILLA SOUP

Visiting the 22nd Street location of El Sur Restaurant is like dropping into your grandmother’s house for dinner … if your grandmother is a fabulous cook from Sonora, Mexico. The aromas are enticing, the staff is welcoming, and the menu includes so many options that you’ll want to return for breakfast, lunch and dinner.

The chicken tortilla soup is a really good example of the care that goes into preparing each order. Isela Mejia, who owns the restaurant with her husband Luis, explains that they boil the chicken themselves, make their own broth, sauté tomatoes, onions and green chiles, and put it all together just before it goes out to your table. “We make everything when you order it, so the tortilla strips, the avocadoes, the goat cheese, nothing is cut and done until you order,” says Isela.

The recipes are those of Isela’s mom, who was from Sonora, as well as from El Sur’s cook, who likewise hails from that state. Whether you order the soup, shredded beef flautas, or cheese enchiladas, a server will come to your table and offer you steaming, freshly grilled onions and peppers to go with your meal. And fans of rice and beans will be pleased to know that they are prepared fresh several times throughout the day to keep up with the demand.

The 22nd Street location offers both interior and patio dining. The 29th Street store was recently remodeled, and is set up like a taco shop. “You order up at the front,” notes Isela, “and we have a salsa bar, a chip bar, and we make our corn tortillas for our street tacos by hand.”

The legions of fans of the 22nd Street location, who know how crowded the cozy dining room can get at peak lunch and dinner times, will be relieved to hear that plans are in the works to expand beyond the present boundaries. 5602 E. 22nd Street, 748-1032; 4602 E. 29th Street, 747-3313; www.elsurrestaurant.com

Beyond Bread

MUST TRY: CHOCOLATE BOMB

For many Tucsonans, Beyond Bread has become synonymous with delicious dessert items in addition to their amazing baked-on-the-premises breads. One treat that ranks as a Tucson Lifestyle favorite is the Chocolate Bomb. These orbs of chocolatey goodness come in three flavors: peanut butter, amaretto and the “chocolate lovers” version. It’s easy to find which is which, as the peanut butter has a hole in the chocolate shell to show off its peanutty inside; the amaretto has an almond attached to the shell; and the chocolate lovers features a white chocolate drizzle. Assistant Manager David Drazkowski, of BB’s Speedway location, notes that “The peanut butter seems to be the most popular, and it usually sells out first.”

Before indulging in your chocolate bomb, make sure to peruse Beyond Bread’s extensive menu. With its creative takes on sandwiches and salads, there is literally something for everyone in your party. The menu points out which options are vegetarian, vegan, and gluten-free, and also warns those with dental issues (via an adorable toothshaped icon) about crusty breads.

Monterey Village at Wilmot, 6260 E. Speedway Blvd., 747-7477; beyondbread.com

Bob’s Steak & Chop House

MUST TRY: PRIME FILET MIGNON

When you’ve got a fantastic product, there’s really no need to “gild the lily.” This is certainly true of the Prime Filet Mignon at Bob’s Steak & Chop House, which is available in 9-, 12- and 16-ounce portions. According to Bob’s General Manager Peter Prassas, their prime beef is chosen from the top two percent in the country, and is perfectly trimmed and expertly grilled. “With beef this great, there is no need for marinades — just salt and pepper, cooked and seared to perfection,” says Prassas. “The filet really is the best of the best — you’d be hard pressed to find a more tender piece of beef. Some guests prefer the ribeye, which is more marbleized. Each entrée — whether it is beef, vegetarian or seafood — is accompanied by our signature giant carrot, which is coated in a cinnamon glaze.” The carrot is a throwback to Bob’s grandmother, who used the vegetable to separate food items on his plate!

Bob’s Steak & Chop House’s dining room is charmingly old school, with hardwood floors, leather chairs, wooden beams and iron chandeliers. The main dining room seats 60, 30 on the patio, which looks onto the Catalina Course of the Omni Tucson National Resort. A private dining room is available for parties up to 50 guests, and boasts golf course views. The eatery is renowned for its hefty portions, big pours on drinks, and its attentive and knowledgeable staff. Omni Tucson National Resort, 2727 West Club Drive, 877-2377; bobs-steakandchop.com/Tucson

Dao’s Tai Pan Restaurant

MUST TRY: VEGETARIAN SPRING ROLLS

Long before most Americans learned what pho was (and subsequently fell in love with it), Cac Dao, owner of Dao’s Tai Pan Restaurant, was doing his best to introduce the cuisine of his native Vietnam to Tucson. A professor in UA’s Department of Civil and Architectural Engineering and Mechanics, he discovered some 20 years ago that he had to go to Phoenix for authentic Vietnamese food. He and his wife bought what was originally a Chinese restaurant, and went about slowly educating consumers. “The American public didn’t know that much about how to enjoy pho, banh mi and other dishes,” says Dao, “so we started a cooking class. We taught them how to make the spring rolls, and then they could eat what they made.”

The spring rolls are a little marvel: perfect for an appetizer, or even by themselves for lunch. Dao’s has the conventional variety, goi cuon tom thit, but also their own vegetarian version, goi cuon chay dau hu chien, with noodles, green onion, tofu and mint. “There’s no such thing as vegetarian spring rolls with tofu in Vietnam,” explains the owner. “We created it because of the needs of the customers. Traditionally spring rolls come with pork and shrimp. Someone said, ‘Why don’t you put tofu in and eliminate pork and shrimp?’ People have loved it. I debated whether to use fresh or fried tofu, and it depends on the customer. If they want fresh, we will do that.”

Likewise, Dao’s has both the type of pho one would find in Vietnam, as well as some rice noodle soups that are uncommon, such as pho rau dau hu with tofu and vegetables, or pho gar au, with chicken and vegetables. The chicken and vegetable soup was created for a regular customer, and has proved to be so popular that Dao says it’s their “signature dish.”

The exciting innovations don’t stop with the appetizers and entrées, however. Dao has added his personal tastes and experience to the beverage selection. “When I was in Vietnam, I was a student, and I liked to enjoy fruit smoothies,” he says. “I actually helped my brother run a store selling them. Four or five years after we opened here in Tucson, we added these drinks with tapioca, which are originally from Taiwan. I came up with the recipes myself from my experience, and named them things like Tropical Storm, and Sensation of Vietnam.” For those who need a smooth and satisfying blast of caffeine, the restaurant also has sweetened iced coffee and Thai iced tea.

446 N. Wilmot Road, 722-0055; 4206 N. 1st Avenue, 888-2200

Shogun Japanese Restaurant & Sushi Bar

MUST TRY: CATERPILLAR ROLL

Although the Caterpillar Roll may look like its namesake insect, it does not contain any (thank God!). This “Americanized” sushi roll is unlikely to be found in Japan, but is super-popular in Tucson. It contains cooked fresh water eel (unagi) and cucumber, wrapped in a seaweed sheet (nori), and rice. The cucumber offers a hint of crispness. The exterior is layered with avocado, then drizzled with a thick, sweetened soy sauce that perfectly augments the eel’s slightly smoky flavor. According to Shogun’s Front-end Manager Chris San Jose, the Caterpillar Roll is half-price as a special on Wednesdays (each day features a different roll as the special). He notes that the restaurant primarily is known for its sushi and sashimi, and especially for its fresh, generous cuts of fish.

Shogun also serves traditional Japanese offerings such as teriyaki, sukiyaki, tempura fish and vegetables, Bento boxes filled with tasty items, and colorful “boats” laden with a variety of cooked items or sushi/sashimi assortments.

5036 N. Oracle Rd., 888-6646; shoguntucson.com

47 Scott and Scott & Co.

MUST TRY: GRILLED CHEESE STACK

Like the downtown scene itself, the menu at 47 Scott is always evolving. Manager Teodoro Lillard comments that, “It’s a menu with offerings for every individual. It constantly changes with the seasons, with creativity, and the availability of products.”

Although it’s not a huge menu, it’s finely curated so that whatever you’re in the mood for, you’re likely to find something that suits your tastes. Asked for her favorite item, Lillard names the scallops, which are served with a celery root risotto. She also singles out the handmade pasta options: a squash/wild mushroom/sage gnocchi for vegetarians, and a carbonara that includes house-made pancetta, prosciutto chips, and a 63-degree-cooked egg. “When you break the egg,” she explains, “you make your own sauce.”

But many long-time fans of this happening dinner spot choose the grilled cheese stack as their favorite item. Made on sourdough bread with a three-cheese blend, and served with a sweet-and-spicy dipping sauce, this delectable dish is definitely not the uninventive sandwich you remember from your childhood. And don’t be surprised if, by the time you read this magazine, there also is a new grilled cheese on the menu (although the traditional version will still be available).

Lillard says that one of the things the business is currently working on is creating a little better definition between 47 Scott, and Scott & Co., the bar that’s located in an adjoining room. “The bar is first come first served, more casual,” she says. “It’s more about socializing and interacting.”

Whichever area you choose, however, Lillard observes that the place is known for, “Friendly and approachable service, great and creative food, and a sense of community.” 47 N. Scott Avenue, 624-4747; www.47scott.com

5 Points Market & Restaurant

MUST TRY: THE PANCAKE

Adjacent to Cesar Chavez Park on South Stone is a little gem of a restaurant that brings a new sparkle to breakfast and lunch. The small but comfy space, staffed by folks who really seem to love their jobs, utilizes local food purveyors to offer a menu that co-owner Jasper Ludwig says is “small but diverse.”

Items include everything from a smoked salmon Benedict, to a breakfast salad (with butternut squash, argula and eggs), to a smoked beet sandwich. But those of us who fondly recall weekend mornings spent drizzling real maple syrup over a scrumptious, nearly dessert-like breakfast treat will gravitate to “The Pancake.” 

“It’s pretty basic as far as pancake recipes go, but it’s a good recipe,” says Ludwig. “I guess there’s something nostalgic about a really classic pancake. I think it’s a combination of quality organic ingredients, clarified butter that we brush on while it’s cooking, and putting cinnamon on the plate.”

Buying local is so important to the owners that they even give a shout out to many of their vendors on one wall of the restaurant. And they’ve taken the local connection a step further: “We’ve gone as far as creating our own farm, which we’re in our second season of growing now. That’s allowing us to play with even more rare, interesting heirloom seed varietals,” comments Ludwig.

Though 5 Points, which has interior dining, as well as a small, front patio, is only open for breakfast and lunch, and all the offerings are brunch-style foods, there’s such a span of choices that you can return again and again to sample new things. That goes for the beverage choices, too, which include all varieties of coffee drinks, about 10 hot or iced teas, and fresh juices.

756 S. Stone Avenue, 623-3888; www.5pointstucson.com

Despite being located in the desert, the Old Pueblo sports exemplary seafood in restaurants all over town.  Here is a tasty sampling of dishes at some popular spots.

Written by Kimberly Schmitz | Photography by Thomas Veneklasen

Firebirds Wood Fired Grill

Firebirds Wood Fired Grill offers boldly flavored wood-fired steak and seafood in a warm, modestly refined space at La Encantada.  For an appetizer or an excellent accompaniment to a signature martini, dip a chip in the luscious lobster spinach queso, featuring ample lobster, baby spinach, tomatoes, and pepper jack cheese.  As a starter to share or a meal, seafood lovers will enjoy the seared tuna superfoods salad, with seared sushi-grade red tuna over spinach, organic ancient grains, cucumbers, avocado, grilled corn, edamame and radish, tossed with avocado green goddess dressing.  Another good choice is the wood-grilled salmon salad with mixed greens, tomatoes, San Saba Farms

spiced pecans and cilantro-lime vinaigrette.  Bounty of the sea fans also will surely enjoy Firebirds’

signature wood grilled salmon basted in Key lime butter, and fresh vegetables, or the delectable sesame-encrusted salmon served with ginger mustard aioli, and fried spinach.  Diners interested in more turf than surf may enhance any cut of beef on the menu with a half-pound lobster tail or wood-fired shrimp.  Chef Mario Soto presents a new feature menu every few months.  Be sure to ask about the hottest new items.  2985 E. Skyline Drive,577-0747 www.tucson.firebirdsrestaurants.com

This shabby chic hotspot offers up its regional specialties with unexpected twists — and the fish offerings are no exception.

Wood-grilled salmon basted with Key lim butter, from Firebirds Wood Fired Grill.

The Parish’s grilled ruby red trout.


The Parish

Being the only Southern fusion gastropub game in town doesn’t mean The Parish’s coowners Steve Dunn, Bryce Zeakler, and Chef Travis Peters rest on their laurels.  This shabby chic hotspot offers up its regional specialties with unexpected twists — and the fish offerings are no exception.  Whether you’re looking for a simple nosh with a drink or to kick off a full Southern comfort meal in style, the Crawfish Hushpuppies — “sweet and spicy orbs of deepfried perfection”— won’t disappoint.  Guests looking to ride the crustacean train to the last stop will find the Burgundy angel hair pasta with lobster broth-bathed shrimp and crawfish, in saffron red pepper cream sauce an excellent choice.  Also not to be missed is the best seller shrimp and grits made heavenly with Creole barbecue cream sauce, white cheddar grit cake, and served with a side of greens.  Diners seeking a fresh water swimmer will thoroughly enjoy the pecan smoked ruby red trout served with roasted garlic, red onion marmalade, candied pecans and Creole mustard.  Guests may choose to wash down these delicacies with a selection from more than 40 craft beers, an assortment of unique seasonal cocktails or house-infused vodka, rum, tequila, gin or bourbon.

6453 N. Oracle Road, 797-1233www.theparishtucson.com

 

Dante’s Fire

Executive Chef and Owner Ken Foy delivers a no-holds-barred menu born of his East Coast classical training and a passion for regional flavors and ingredients.  His working philosophy of “food made from food” barely offers a glimpse into the gastronomic delights served until the wee hours at Dante’s Fire.

Dip your toes in the Fire’s waters with oysters Rockefeller.  The tasty little mollusks take their final swim in a thick, soupy reduction of Pernod, rendered bacon and heavy cream with spinach and asiago cheese and are topped with candied bacon.  Channel your inner Dante and try tequila-cured salmon gravlax paired with sliced olives, avocado, grapefruit, and Parmesan foam.  The salmon — vacuum sealed with lime, cilantro and tequila — is a modern, Tucson-twist on a Norwegian specialty, also known as “salmon from the grave” because it is traditionally buried to cure.  Diners interested in something sourced closer to home should try the ruby red trout — a sustainable, farm-raised Apache trout replica, pan seared, broiled and properly dressed in pesto and topped with crab meat and asparagus tomato succotash.  Choose a locally crafted beer or find the perfectly paired cocktail for any of these creations on the Pride, Lust, Heresy or Fraud cocktail lists.

2526 E. Grant Road, 382-9255 www.dantesfireaz.com

Wild Garlic Grill

For diners interested in taking an open sea culinary cruise with garlic as the co-captain, Wild Garlic Grill is a solid port stop.  Tucson native Chef Steven Schultz and his wife Maudi Gourdin treat guests like family at the recently relocated Foothills restaurant.  Chef creates a menu with California French accent cuisine, conceived after years of training under French, German, Austrian, and Swiss executive chefs.  For starters, it will be tough to choose between the grilled garlic shrimp with warm Brie, grilled vegetables and roasted corn salsa, in a beurre blanc sauce and the steamed Prince Edward Island mussels in white wine garlic tomato beurre blanc.  Choices don’t get easier for the entrée course, with treasures like herb-basted Alaskan cod fillet, oven-poached in white wine, with garlic, tomato fondue, basil beurre blanc; and San Francisco pier stew with white fish, shrimp, mussels and roasted peppers in a garlic, tomato basil, chardonnay broth.  There also are a slew of daily specials with dizzyingly complex flavor profiles and delectable fresh ingredients.  To accompany any choice, Chef Schultz personally selected over 90 sparkling, white, and red boutique wines from family owned vineyards as mainstays on the wine list.  Plaza Colonial, 2870 E. Skyline Drive, Suite 120, 206-0017 www.wildgarlicgrill.com

JPS Seafood Market and Restaurant

This southside hybrid has a dine-in/take-out menu that includes everything from soups, to tacos, to combo platters.  But if you’re a seafood- seeking foodie preferring to stay in, JPS has just what the home chef ordered.  A family owned and operated importer and distributor of fresh and frozen seafood, JPS specializes in bringing fresh product from Mexico’s Sea of Cortez harbors including Kino Bay, Guaymas, and Puerto Peñasco.  Pick up prepared family sized portions of breaded fish, breaded shrimp, chiles Marlin, with salad and corn tortillas to feed the home or office crew.  Or patrons may don the proverbial chef’s hat and choose a perfect cut of fresh or fresh-frozen trigger fish, cochito, shark, flounder, stingray, swai fish, tilapia, salmon, and shrimp to prepare themselves.  Any selection is sure to please even the most finicky fish fan at the table.  5550 S. 12th Ave., #100, 270-3600 www.jpsseafood.com

Valley fever can affect people, pets and livestock here in Southern Arizona, and can be hard to diagnose.

The University of Arizona’s Valley Fever Center for Excellence and Banner Health have created a tutorial to help local physicians speed up the process. Here’s what you need to know about this pervasive disease.

By Anne Kellogg | Photography by Kris Hanning

It can come on like the flu but may take weeks or months to run its course.  In rare cases, Valley fever can result in severe lung issues or meningitis.  Its symptoms mimic many other illnesses — such as rheumatism and even cancer — causing patients to undergo painful testing and unneeded treatment with antibiotics or steroids.  John Galgiani, M.D., director of the Valley Fever Center for Excellence, professor of medicine in the Divisions of Infectious Diseases at the UA Colleges of Medicine in Tucson and Phoenix, member of the UA BIO5 Institute and medical director of the Banner — University Medicine Valley Fever Program, has developed a way to assist physicians in the timely diagnosis of this challenging disease.

What is Valley Fever?

Have you experienced a fever, profuse sweating at night, chest pain and cough, muscle and joint aches — especially in the ankles and knees — loss of appetite, and a rash that resembles measles or hives?  You In Health may have thought you had the flu, but these symptoms also are those of Valley fever, which is caused by spores that live in the soil in Southern Arizona.  In addition to areas of our state, Valley fever can occur in semi-arid and arid soils of California, Nevada, Utah, New Mexico and Texas, as well as the states of Sonora and Chihuahua in Mexico, and Central and South America.

The corridor between Tucson and Phoenix is one of the most endemic regions for Valley fever, so the University of Arizona’s Valley Fever Center for Excellence (VFCE) was established by the Arizona Board of Regents in 1996 to promote education, research and care for this disease.  Dr. Galgiani explains that Valley fever is a difficult disease to detect and treat, frequently leading to misdiagnosis.

Its medical name, coccidioidomycosis, means fungal infection caused by the fungus Coccidioides . The name is often shortened to “Cocci” (pronounced “kok-see”).  This organism grows in the top six inches of soils in areas of low rainfall, high summer temperatures and Moderate winter temperatures.  In susceptible people or animals, infection occurs when a spore is inhaled.

Infection by the spores doesn’t always lead to detectable disease.  In nearly 60 percent of cases, the symptoms are so mild that individuals may not even realize they are infected.  In the remaining cases, symptoms may range from uncomfortable to miserable to even fatal.  It occasionally can develop into a severe, life-threatening form that may involve skin, bones, or other parts of the body, as well as the brain.  Overall statistics for Valley fever show about 150,000 infections per year, with only one-quarter of one percent contracting meningitis (i.e., roughly two cases per thousand), but increased numbers of cases cause a corresponding increase in serious disease.  Serious forms of the infection require anti fungal therapy.

The diagnosis of this disease is complicated because of the way the lungs respond to the inhaled spores.  Initially the infection causes a pneumonia, which sometimes can turn into a lung nodule or even a

The catheterization lab at Tucson Medical Center.

cavity.  Nodules are small, residual patches of infection that generally appear as single lesions (from one, to one and a half inches, in diameter).  If it is documented that the nodule is caused by Valley fever, no other treatment is required.  However, if the original Valley fever infection goes undiagnosed and the nodule is found on a chance X-ray, it looks no different fromfrom a lung cancer, and a physician may suggest biopsy or even removal.  Nodules caused by cocci can remain forever.  Those who had a mild case may have no symptoms or scarring.  Cavities occur in about 5 percent of patients, and may cause the patient to cough blood or have other chest symptoms.  For some patients, the best management is to have the cavity surgically removed.

In Arizona, infection is likely to occur from May to July and again following Monsoon season, from October to the end of December.  Those in occupations that involve disturbing the soil (such as construction, agriculture or archeology), as well as recreational gardeners, may be at greater risk of contracting the disease.

Two-thirds of all U.S. Valley fever infections occur in Arizona.  Roughly 75 percent occur in Maricopa county, with 20 percent or so occurring in Pima County.  According to Arizona Department of Health Statistics, those susceptible to the most serious consequences of Valley fever include people on chemotherapy, on immune suppression medications because of organ transplant, the elderly, or those with immunodeficiency, such as AIDS.

The Benefits of Early Diagnosis

A primary reason for diagnosing early is removing the patient’s fear of the unknown.  Patients suffering from these long-lasting Respiratory symptoms often undergo multiple diagnostic blood tests, chest X-rays, CT scans, PET scans, bronchoscopy, percutaneous fine-needle aspiration, and even thoracotomies.  They often are prescribed multiple courses of antibiotics from their primary care physicians.  In one study, 81 percent of patients with Valley fever pneumonia received at least one course, and 31 percent received multiple courses.  In addition to the cost, it can create antibiotic resistance.  Another issue is doctors prescribing corticosteroids for the rheumatologic complaints (a synonym for Valley fever is “desert rheumatism”).  The anti-inflammatory effects of corticosteroids may create adverse reactions in patients, as well as increasing the chances of Valley fever complications.

Developing the Tutorial

Out of the need to get Valley fever patients treated early and effectively, Dr. Galgiani and his cohorts at the VFCE teamed with Banner Health to help physicians.  “I am quite excited about this — it’s one of the most positive things to come out of the merger between Banner Health and the University of Arizona faculty medical group,” Dr. Galgiani enthuses.  “Banner Health has specific clinical practices that they share with all of their physicians, and the Valley Fever Center for Excellence developed this information for local and national dissemination.  This will help doctors in other states whose patients visited our area and now have respiratory symptoms associated with Valley fever.

“We spent last year in a planning process, where we designed and refined the ABCs of what a primary care physician should do to diagnose Valley fever early and manage it correctly.  This past September we held a webinar on the topic, and we’ll be training Banner physicians all year.  VFCE is a department of the University of Arizona, not part of Banner, so we’ve made all the tools we developed in this process publically available to any doctor who wants to do what we’re doing.”

The new approach for recognizing and treating a new Valley fever infection is centered around the acronym COCCI:

Consider the diagnosis
Order the right tests
Check for risk factors
Check for complications
Initiate management

Physicians are encouraged to consider Valley fever if any of the following indications are present:

  • Respiratory symptoms and at least one of the following:
    • more than one office visit
    • chest X-ray ordered
    • antibiotics prescribed
  • Two of the following have been present for a prolonged period: fever, fatigue and/or arthralgia (joint pain)
  • High numbers of eosinophils (a type of white blood cell) found in a blood sample
  • Skin rashes known as erythema nodosum or erythema multiforme

The tutorial and all the other resources created for the clinical practice training can be accessed online at https://vfce.arizona. edu/education/banner-valley-fever-clinical- practice-toolbox.

For more information on the new UA/ Banner clinical practice protocols, see the Valley Fever Clinical Practice Toolbox at the VFCE website, which includes the webinar mentioned earlier.

The protocols were developed with assistance from David Valenzuela, M.D., a Phoenix-area family practice physician, clinical assistant professor at the UA College of Medicine — Phoe

nix and the physician executive who heads Banner Medical Group Primary Care.

As part of the effort, Dr. Galgiani and Fariba Donovan, M.D., Ph.D., another VFCE researcher and faculty physician with the UA Division of Infectious Diseases, are providing small group training sessions for six to 12 clinicians each at 39 Banner Health clinical sites across the State.

They completed about a half dozen sessions by the end of January.

I Want a New Drug…

“There have been no recent breakthroughs or changes in the antifungals that are used in Valley fever,” Dr. Galgiani notes.  “There are a lot of divergent opinions on whether to start patients on fluconazole … it depends on the patient’s clinical presentation.  The antifungal treatments don’t cure it — they can help, but only by suppressing it.  If the patient’s immune system doesn’t ‘step up to the challenge’ when the antifungal drugs are stopped, those who really needed treatment will relapse.”

Researchers at UA have been working on a drug called nikkomycin Z as a new treatment for fungal infections, particularly Cocci.  “It works by blocking an enzyme that is important in making the cell wall,” Dr. Galgiani explains.  “An key part of the cell wall is ‘chitin.’ Chitin is made by an enzyme called chitin synthase, and nikkomycin Z blocks that enzyme.  In that regard it’s similar to penicillin, which acts by blocking formation of the cell wall of a bacterium.”

Because this drug’s most important use would be for Valley fever here in the Southwest, which isn’t a worldwide disease, drug companies haven’t had a strong incentive to develop it.

“We’re trying very hard to get it back into clinical trials, and have been making progress, but the bottom line is that it needs more financial support than we’ve been able to get.  The National Institutes of Health has been very supportive, but they’re not a pharmaceutical company.

They want this drug to go forward, but we haven’t yet gotten the support to do it.  It’s frustrating … we hope to find a pharmaceutical company that would be willing to partner with us.”

When a medication or a vaccine is created for human use, it must go through many clinical trials and intense scrutiny by the Federal Drug Administration (FDA).  Drugs for dogs and other veterinary purposes also require FDA approval.  However, veterinary vaccines are cleared by the United States Department of Agriculture (USDA).  “Work on an effective vaccine for the prevention of Valley fever has been ongoing for decades,” says Dr. Galgiani.  “Currently, we have a vaccine candidate that shows excellent protection in mice.  We are proceeding through the steps to bring this Vaccine through USDA approval for use in our canine patients.  That itself would be a wonderful accomplishment.  Just as exciting, if our vaccine candidate is found to protect dogs from Valley fever, that will add to the evidence that a similar vaccine might ultimately be used to protect ourselves.”

Work on the vaccine is being coordinated through the following VFCE research partners: Marc Orbach, Ph.D., Jeffrey Frelinger, Ph.D., and Lisa Shubitz, DVM, at the University of Arizona; Colorado State University’s Richard Bowen, DVM, Ph.D.; and Anivive Lifesciences Inc., a Californiabased biotechnology company that licensed the vaccine in 2017 from the UA through Tech Launch Arizona, the university unit that helps commercialize innovations developed at UA.

Getting the Word Out

In addition to helping physicians diagnose Valley fever earlier, the Valley Fever Center for Excellence (VFCE) at the University of Arizona and the Arizona Department of Health Services (AzDHS) also are trying to educate the public.

For example, a billboard will go up this month in Phoenix with the words ““Pneumonia or flu for weeks? It could be Valley fever. Ask your doctor for the test.”

The campaign is being funded by a grant from IMMY, a Norman, Oklahoma-based firm that specializes in high-quality diagnostic tools for diseases caused by fungi such as Aspergillus, Blastomyces, Candida, Coccidioides, Cryptococcus and Histoplasma.

It’s coordinated through the VFCE; Kenneth Komatsu, M.P.H., state epidemiologist and chief of the Office of Infectious Diseases with the AzDHS Division of Public Health Preparedness; and Rebecca Sunenshine, M.D., a captain in the U.S. Public Health Service, epidemiology field officer for the U.S. Center for Disease Control and Prevention and medical director of disease control for Maricopa County Public Health.

Look for the billboard along Interstate 10 or the 202 Loop in Phoenix starting March 4.

From February 27th to March 3rd, PGA TOUR Champions will vie for the coveted Conquistadore Helmet trophy in the Cologuard Classic, and Southern Arizona’s kids will benefit.

By Joan Liess

Defending Cologuard Classic champ Steve Stricker describes Tucson as a “neat place” and a “great town” for good reason.  Stricker visited an aunt in Tucson for years.  “I’d come out to see her, play in some of the mini tour events and try to qualify for the Tucson Open.” Stricker eventually played in seven Tucson Open events from 1992 through 2001, and had some memorable moments.  “In 1994, I had a chance coming down the stretch.  Just needed to make a birdie on the back but finished

second,” he recalls.  “It’s a great feeling to finally put that helmet on.”

He will have stiff competition this year.  “We’re expecting, once again, to be one of the strongest fields on PGA TOUR Champions,” says Executive Director Judy McDermott.  The Conquistadores received commitments from World Golf Hall of Fame members, former champions, Charles Schwab Cup winners, and some of the top-ranked golfers on tour.

Steve Stricker.
Photo by J. Martin Harris.

Two-time US Open champion Retief Goosen is just one of those exceptional commitments.  The prolific South African golfer, wine maker and golf course designer just recently turned 50 and will compete on the Catalina Course for the first time.  He did, however, have a previous visit to Tucson.  Goosen played through the quarter finals in the World Golf Championships — Accenture Match Play Championship at Dove Mountain in 2010.

The field also includes one of the world’s best known golfers — Northern Ireland’s Darren Clarke, making his Tucson debut.  The Ulsterman claims three PGA TOUR victories, including an Open Championship, 15 International wins and a plethora of national team successes.  The fun-loving Clarke has his priorities.  “When I had my choice of being on the golf course for my 50th birthday or being on the beach in the Bahamas, the beach sort of won that battle.”

Baseball hall of famer John Smoltz (Atlanta Braves) traded his pitcher’s glove for a golf glove a few years back.  Now, thanks to a sponsor’s exemption, he’s playing in the Cologuard Classic.  The workhorse right-hander said of his former career, “I literally gave everything I had every single time I went out there.” No doubt that sentiment applies to being on the links, too.

Fans also can count on three-time PGA TOUR Champion Jerry Kelly to be in the hunt for the helmet trophy.  Kelly shared second place with Gene Sauers and Scot Dunlap in 2018.  As a spokesperson for Exact Sciences, the manufacturer of Cologuard, Kelly also is raising the bar on his co

mpetitors when it comes to colon cancer screening.  “My wife is a cancer survivor,” he says.

“Everybody that we know has been touched by cancer in some way.  It feels like an opportunity to make more people aware of colorectal cancer and get them tested.”

Retief Goosen.
Photo by PGA Tour/Getty Images

TournamentSchedule

WEDNESDAY, FEB. 27
Jose Cuervo Pro-Am

Gates open at 7 a.m.

Country duo Chris Lucas and Preston Brust of LOCASH. Photo courtesy LOCASH.

THURSDAY, FEB. 28
Jose Cuervo Pro-Am

Gates open at 7 a.m

FRIDAY, MAR. 1
Cologuard Classic First Round

Gates open at 9 a.m
Opening Ceremony on First Tee 10 a.m.
After-Party Following Play, 19th Hole
Party Pavilion

SATURDAY, MAR. 2
Cologuard Classic Second Round
Dress in Blue Day

Gates open at 9 a.m
LOCASH Concert – Driving Range

SUNDAY, MAR. 3
Cologuard Classic Final Round

Gates open at 9 a.m
Awards Ceremony and Trophy
Presentation on 18th

Tickets and Information:
CologuardClassic.com; (800) 882-7660

Feels Like a Party

Saturday, Mar. 2, After the Last Putt Drops

LOCASH’s new country-rock single, Feels Like a Party, says it all.  This year’s shindig is going to be a rocking good time.  The party site is the big, beautiful Catalina Course Practice Range.

Preston Brust and Chris Lucas are the voices of LOCASH.  The duo has soldout concerts and tasted the top of the chart as Nashville’s quickest-rising singer-songwriters.  Georgia-born country singer Craig Campbell opens the show after the last putt drops.  Special guests include our men and women in uniform.  Get tickets on CologuardClassic.com.


John Daly with spectator. Photo by Chris Mooney.

Play Along

It’s typical to experience first-tee nerves when you’re playing a round with a PGA TOUR Champion legend.  The good news is you don’t have to play like a pro to have an unforgettable experience at the Jose Cuervo Pro-Am.

The evening before the first Pro-Am, amateurs and pros get to know each other at a pairings party.  This two-day golf event matches amateur players with a different PGA TOUR Champion each day.  Yes, it’s a once-in-a-lifetime experience and a guaranteed good deed — the real winners are local kids.

Proceeds from the Jose Cuervo Pro-Am and the tournament benefit youth athletic programs and charities.  “Since 1962, the Tucson Conquistadores have been raising money for youth sports in Southern Arizona,” says Conquistadores President Rob Draper.  “Tournament proceeds also will benefit the First Tee of Tucson, which uses the game of golf to prepare kids for life,” he adds.  “Now in our 57th year, the Conquistadores have raised more than $35 million.”

Proceeds from the Jose Cuervo Pro-Am and the tournament benefit youth athletic programs and charities.  “Since 1962, the Tucson Conquistadores have been raising money for youth sports in Southern Arizona,” says Conquistadores President Rob Draper.  “Tournament proceeds also will benefit the First Tee of Tucson, which uses the game of golf to prepare kids for life,” he adds.  “Now in our 57th year, the Conquistadores have raised more than $35 million.”

Smile, You’re on TV

Considering that the Cologuard Classic is a world-wide televised event, looking and acting your best is a smart move.  Fans know to plan for the weather, wear comfortable walking shoes and not leave home without sunscreen and sunglasses.  Fortunately for fans and players alike, navigating the Catalina course at Omni Tucson National Resort is a breeze.

The fan-friendly setup throughout the venue is a result of the Tucson Conquistadores’ 53 years of experience staging golf events, 35 of which were held at Omni Tucson National.  “Generations of Conquistadores have invested their time and talents to make this tournament the best it can be,” says Tournament Chairman Clint Buckelew.  “Our guys roll up their sleeves and get the job done.” Buckelew also praises the contributions of volunteers.  “This event requires service in more than 20 different areas on and off the course,” he observes.  “We couldn’t be successful without them.”

Special Events

Dress in Blue Day

SATURDAY, MAR. 2

March is National Colorectal Cancer Awareness Month.  Players, announcers and fans will wear blue to shine a spotlight on colon cancer, a disease that claims the lives of more than 50,000 Americans each year.  The first 10,000 fans will receive a free colon cancer awareness star pin.

50-50 Hole-In-One Challenge

SATURDAY, MAR. 2

Age 50 is when colon cancer screening is commonly recommended to begin.  The Cologuard Classic is marking that milestone with a special charitable connection.  If one of the pros makes a hole in one on the 16th hole on Saturday, $50,000 will be donated to the Colorectal Cancer Alliance and $50,000 to The First Tee of Tucson.

Celebrity Foursome

SATURDAY, MAR. 2

Golf fans are in for a big surprise.  The last group on the final nine holes on Saturday won’t be PGA TOUR Champions players.  Instead, a celebrity foursome will play a 9-hole scramble and meet you at the finish line.

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