The woman chosen to be the next director of Arizona’s state parks once carved her name into a historic park’s property in southeastern Arizona.

She also helped recover thousands of acres of burned parks land in San Diego County and launched an innovative system to allow people to make campground reservations online.

The Arizona State Parks Board’s unanimous selection of Renée Bahl to take over the parks system next month has polarized state leaders.

Parks officials say she is a dynamic, experienced professional who will help lead the parks system out of a historic budget crisis.

Bahl, 40, is “a vigorous, intelligent, resourceful person who knows how to get through the most difficult of times,” said Bill Scalzo, who led the selection committee for the Arizona State Parks Board.

But at least one lawmaker says her selection as director is inappropriate given a vandalism incident that took place a decade ago.

Bahl, a former assistant state parks director, oversaw historic preservation at the San Rafael Ranch.

In 1999, another employee caught her etching her first name and the year into the wall of a historic adobe barn.

Bahl was disciplined but remained in her job until 2002, when she left to become director of parks and recreation for San Diego County in California.

State Rep. Daniel Patterson, D-Tucson, criticized the selection.

“Bahl should be fully questioned about her vandalism of state historic properties, and rejected as a poor choice for this important job,” Patterson wrote on his blog. “Someone as clueless as Bahl on protecting state treasures is clearly not appropriate to head state parks.”

Through a spokeswoman, Bahl declined to comment. Officials said they were impressed with Bahl’s education, which includes a bachelor’s degree in economics and a master’s degree in public administration with a focus on natural resource management.

Scalzo said Bahl brought up the vandalism incident during an interview and apologized for it, saying she had made a mistake.

“One thing I really appreciated is she brought that up,” Scalzo said. “She didn’t say, ‘I’ve had a perfect career I don’t make mistakes.’ ”

Bahl, who will make about $140,000 a year, will take over for Ken Travous, who is retiring after 23 years leading the parks system.

Lawmakers swept $36 million from parks coffers in the last year, prompting the closure of three parks and threatening several more with closure. The board is working to prevent further cuts proposed by the Legislature’s Republican leadership, which board members say would devastate the system.

Scalzo called criticism a distraction from the parks board’s most pressing problems.

“We need help; we don’t need criticism,” he said. “We need to have this new person come in here with everyone wishing her the best, because she’s going to need every bit of it.”

The death of a 13-year-old Tucson middle school student brings Arizona’s swine flu death toll to three, according to the Pima County Health Department.

Nationwide, it’s up to seven.

The most recent Arizona deaths were the Tucson teen who died Friday and a 57-year-old Pinal County woman who died earlier this week, according to the Health Department and the Associated Press.

Arizona’s confirmed cases have risen to 476, which adds to the more than 1,650 confirmed cases in the four states that border Mexico, according to the U.S. Centers for Disease Control.

Texas leads the border states with 556; California clocks in second with 553; and New Mexico has 68.

A total of 5,100 cases are confirmed nationwide.

The state with the most?

Illinois with 696, followed by Wisconsin at 616, according to a report in BizJournals.com.

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How are your protecting against swine flu?

Does anyone you know have swine flu?

Ginger, long used as a folk remedy for soothing tummyaches, helped tame one of the most dreaded side effects of cancer treatment – nausea from chemotherapy, the first large study to test the herb for this has found.

People who started taking ginger capsules several days before a chemo infusion had fewer and less severe bouts of nausea afterward than others who were given dummy capsules, the federally funded study found.

“We were slightly beside ourselves” to see how much it helped, said study leader Julie Ryan of the University of Rochester in New York.

Results were released Thursday by the American Society of Clinical Oncology and will be presented at the group’s annual meeting later this month.

But don’t reach for the ginger ale. Many sodas and cookies contain only flavoring – not real ginger, Ryan said. Her study tested a druglike ginger root extract, and it’s not known if people could get the same benefits from ginger teas or the powdered ginger sold as a spice.

The study involved 644 patients from cancer centers around the nation who had suffered nausea in a previous round of chemotherapy. Two-thirds had breast cancer and the rest, other forms of the disease. They were placed in four groups and given one of three doses of ginger (the equivalent of one-half, 1 or 1 1/2 grams of ginger per day) or dummy capsules in addition to standard anti-sickness medicines.

Patients took the capsules for six days, beginning three days before chemo treatment. They rated their nausea symptoms on a seven-point scale.

Offer is good for a year, with restrictions

Sales of Lipitor hit $12.4 billion for Pfizer Inc. in 2008, making it the company's top-selling prescription drug.

TRENTON, N.J. – Pfizer Inc. says it will provide 70 of its most widely prescribed prescription drugs including Lipitor and Viagra for free to people who have lost their jobs and health insurance.

The world’s biggest drugmaker said Thursday it will give away the medicines for up to a year to Americans who lost jobs since Jan. 1 and have been on the Pfizer drug for three months or more.

The announcement comes amid massive job losses caused by the recession and a campaign in Washington to rein in health care costs and extend coverage. The move could earn Pfizer some goodwill in that debate after long being a target of critics of drug industry prices and sales practices.

The program also likely will help keep those patients loyal to Pfizer brands.

“Everybody knows now a neighbor, a relative who has lost their job and is losing their insurance. People are definitely hurting out there,” Dr. Jorge Puente, Pfizer’s head of pharmaceuticals outside the U.S. and Europe and a champion of the project, told The Associated Press in an exclusive interview Wednesday. “Our aim is to help people bridge this point.”

The idea for the program came just five weeks ago, at a leadership training meeting, as the workers discussed how many patients are struggling, Puente said.

He said he urged top management to approve the program, presenting a recent Associated Press article about how newly uninsured diabetics are suffering serious complications because they can no longer afford the medicines and testing supplies. Approval came quickly.

“It was my idea,” he said. “I floated it, and the reception it got was so dramatic that it very quickly became our idea.”

Colleagues suggested employees could donate to a fund to help support the effort, Puente said. He said some employees had tears in their eyes when discussing how they could help people who had lost jobs.

Officials for New York-based Pfizer said they don’t know how much the program will cost and haven’t put a cap on spending for it.

Applicants will have to sign a statement that they are suffering financial hardship and provide a “pink slip” or similar employer notice. Applications will be accepted through Dec. 31, with medication provided for up to 12 months after approval, or until the person becomes insured again.

Starting Thursday, patients can call a toll-free number, 866-706-2400, to sign up, and those whose drugs are not included in the program will be referred to other company aid programs. Starting July 1, patients can also apply through the Web site, www.PfizerHelpfulAnswers.com, which has information about the other Pfizer aid programs.

Pfizer and the rest of the drug industry are trying to have a voice in the debate over how to overhaul the U.S. health care system, partly by joining in a pledge this week to help hold down inflation of health costs.

Pfizer’s program comes at a time when many drugmakers, including Pfizer, have been raising prices on their drugs, partly to offset declines in revenue as the global recession reduces the number of prescriptions people can afford to fill.

The 70-plus drugs covered in the program include several diabetes drugs and some of Pfizer’s top money makers, from cholesterol fighter Lipitor and painkiller Celebrex to fibromyalgia treatment Lyrica and Viagra for impotence. Drugs from several other popular classes such as antibiotics, antidepressants, antifungal treatments, heart mediations, contraceptives and smoking cessation products also are included. Cheaper generic versions are available for quite a few of the drugs.

Pfizer said that from 2004 through 2008, its patient assistance programs helped 5.1 million people get 51 million Pfizer prescriptions for free or at reduced cost, with a total value of $4.8 billion.

ABOVE: Gabriel Baca (left), his brother Antonio Baca (center) and Jose Rivera enjoy the new sodded athletic field at St. John's Community Park, 3610 S. 12th Ave.

LEFT: Stephanie Prinzing's dogs Hopper (front) and Spike wait to get a drink from the dog water fountain at Jacinto Park, 2600 N. 15th Ave.

BELOW: Sandra Ramirez pushes daughter Natalia Navarro, 3, on a swing at Jacinto Park.

It was a long wait, but residents of the Miracle Manor Neighborhood finally have a park with amenities like other city parks.

“We’ve been asking, ‘Why can’t we have equipment in a park that is 60 years old?’ ” Jim Quinn, vice president of the Miracle Manor Neighborhood Association, said Thursday.

Neighbors will gather at 9 a.m. Saturday at Jacinto Park, 2600 N. 15th Ave., to dedicate improvements that neighborhood residents had sought: a ramada, connecting sidewalks, a swing set with rubberized safety surfacing, a drinking fountain, picnic and game tables and a basketball half court.

Getting them was a chore since funds came from both the city and Pima County, said Marsha Quinn, the neighborhood association’s liaison with Tucson and Pima County.

The project’s $268,331 came from four sources: a $203,331 Pima County Neighborhood Reinvestment grant, $30,000 each from the Mayor’s Office and Ward 3 Back to Basics programs, and a $5,000 grant from PRO (People, Resources, Organizations) Neighborhoods.

St. John’s Community Park, 3610 S. 12th Ave., will be dedicated at 2 p.m. Wednesday and also will have new facilities.

The land is owned by St. John the Evangelist Catholic Church, which is leasing it to the city as a park site for 25 years.

Funds for the improvements came from grants from both the city and county, said Leslie Nixon, of the Pima County Neighborhood Reinvestment and Preservation Office.

A $500,000 Pima County grant funded construction of a skateboard facility at the park, Nixon said.

Other improvements include crushed stone paths, athletic field landscaping, a ramada, picnic tables and benches.

Misinformation serves as placebo rather than actually curing our health care system

The Senate Finance Committee held a hearing Tuesday on overhauling the heath care system. Among those testifying was Steven Wojcik (left), vice president of public policy for National Business Group Health.

The country is about to have a very frustrating debate over health care, characterized more by misdirection than an honest discussion of the alternatives.

A good illustration was provided by the Monday confab at the White House, in which health care executives committed to reduce expenditures by $2 trillion over the next decade.

Or did they?

President Obama, in his remarks, said that they did: “They are pledging to cut the rate of growth of national health care spending by 1.5 percentage points each year – an amount that’s equal to over $2 trillion.”

The actual letter signed by the executives, however, says something importantly different:

“We will do our part to achieve your administration’s goal of decreasing by 1.5 percentage points the annual health care spending growth rate – saving $2 trillion or more.”

“Our part” is much different, and far more ambiguous, than “we will do the whole thing.”

This is best seen as collusion by the health care industry and the Obama administration to misdirect the American people.

In the first place, what health care expenditures will be over the next 10 years is unknowable. So, the “pledge” is written on water.

More importantly, the commitment was made by trade associations that don’t actually deliver health care. What happens on the ground with health care costs is unaffected by press events held by politicians and lobbyists.

Most important, what happens on the ground already provides incentives for true economies. There are serious distortions in the health care marketplace, but market share can still be gained by reducing costs and prices.

The real significance of the press event wasn’t the phony pledge of cost savings. The event signaled the political capitulation of the health care industry. They will now accept whatever role in the health care system the politicians assign them.

The more substantive event that happened that day was the release of an “options” paper for health care reform by Senate Finance Chairman Max Baucus and Ranking Member Chuck Grassley.

But, again, “options” is a misnomer. This paper doesn’t really spell out fundamentally different approaches. Instead, the choices are all a variation on a single theme: a government-managed system of private health insurance.

Existing plans would be grandfathered in. But all future health insurance would have to be purchased through a government exchange.

The government would decide the benefit options insurers could offer, and insurers would have to offer all options. Pricing would be strictly circumscribed. Medical underwriting would be prohibited.

The fight over whether there would be a “public option,” a health plan actually administered by the government, is misplaced. If government controls the benefits and pricing of private plans, politicians and bureaucrats are in charge irrespective of whether there is a formal public plan.

The political need for action is driven by the uncertainty over coverage in the American system. The gaps in coverage are hugely worrisome even for those who currently have good insurance.

This uncertainty, however, is easily eliminated at no cost to the taxpayers. There already is a national health care plan, Medicaid for the low income. Universal access could be provided simply by allowing any legal resident to buy into Medicaid at the government’s cost.

The system as a whole, however, makes no sense. Obtaining health insurance through your employer is an artifact of World War II wage and price controls.

Some Republicans want to eliminate this dependence and stimulate a market for individual health insurance. That makes more sense, but the public is unlikely to be comfortable with such a radical restructuring without a government backstop, such as the ability to buy into Medicaid.

This debate will be sad and frustrating.

And the end result will probably be neither fish nor fowl – a system that provides neither the certainty and security of a European-style national health care system, nor the choice and freedom of a vigorous individual health insurance market.

Robert Robb, an Arizona Republic columnist, writes about public policy and politics in Arizona. E-mail: robert.robb@arizonarepublic.com

GRAND CANYON NATIONAL PARK – The main roadway leading to the North Rim of the Grand Canyon is set to reopen on Friday morning for the summer season.

Grand Canyon National Park officials say all North Rim facilities, including the historic Grand Canyon Lodge North Rim, will also reopen on Friday.

Arizona State Route 67 leading to the North Rim was closed on Dec. 1 for the winter season. Most facilities closed on Oct. 15 and are set to close on Oct. 16 this year.

Rim operations also include camping, camper services, food services, groceries and a service station. Park rangers present daily programs.

The more popular South Rim of the canyon stays open year-round.

LONDON – As swine flu cases hit 6,500 worldwide, World Health Organization officials were meeting with vaccine manufacturers and other experts in Geneva on Thursday to discuss making a vaccine to fight the virus.

The meeting focused on the major questions surrounding a possible swine flu vaccine, such as how much should be produced, how it will be distributed and who should get it.

The expert group’s recommendations will be passed to WHO Director-General Margaret Chan, who will issue advice to vaccine manufacturers and the World Health Assembly next week.

But some experts feel the main decision has already been made.

“It’s a foregone conclusion,” said David Fedson, a vaccines expert and former professor of medicine at the University of Virginia. “If we don’t invest in an H1N1 (swine flu) vaccine, then possibly we could have a reappearance of this virus in a mild, moderate, or catastrophic form and we would have absolutely nothing.”

Flu vaccine companies can only make one vaccine at a time: seasonal flu vaccine or pandemic vaccine. Production takes months and it is impossible to switch halfway through if health officials make a mistake.

Vaccine makers can make limited amounts of both seasonal flu vaccine and pandemic vaccine — though not at the same time — but they cannot make massive quantities of both because that exceeds manufacturing capacity.

Seasonal flu kills up to 500,000 people a year. At the moment, health officials aren’t sure how deadly swine flu is, and whether they will need more seasonal flu vaccine or swine flu vaccine. And if the swine flu mutates, scientists aren’t sure how effective a vaccine made now from the current strain will remain.

WHO estimates that 1 to 2 billion doses of swine flu vaccine could be produced every year, though the first batches wouldn’t be available for 4 to 6 months.

The U.S. Centers for Disease Control and Prevention is currently working on a “seed stock” to make the vaccine, which should be ready in the next couple of weeks. That will be distributed to manufacturers worldwide so they can start producing the vaccine.

WHO is also negotiating with vaccine producers to save some of their swine flu vaccine for poorer nations. Many rich nations like Britain, Canada, Denmark, France, Switzerland and the United States signed deals with vaccine makers years ago to guarantee them pandemic vaccines as soon as they’re available.

As of Thursday, at least 33 countries reported nearly 6,500 cases of swine flu worldwide, with 65 deaths. According to WHO’s pandemic alert level, the world is at phase 5 — out of a possible 6 — meaning that a global outbreak is “imminent.”

“It’s a no-brainer,” Fedson said of the decision to make swine flu vaccine. “All that’s being discussed now is the details of how to make sure you have enough seasonal flu vaccine and the logistics of making the switch to H1N1 vaccine production.”

North America has been the hardest-hit continent. The United States has reported 3,352 laboratory-confirmed cases of swine flu, including three deaths. Mexico has 2,446 cases and 60 deaths, while Canada has 389 cases with one death, according to WHO figures.

Spain and Britain have the most cases in Europe, at 100 and 71 respectively.

In Central America, Costa Rica has eight cases and one death and Panama has 29 cases.

The Arizona Trail Association is requesting help in winning a $50,000 grant for a trail project in Saguaro National Park-Rincon Mountain District.

Through midnight May 31, citizens may vote twice daily among five national finalists for this Redwood Creek Greater Outdoors Project grant. Redwood Creek, a California winery, will give the money to the project receiving the most votes.

Anyone may vote once a day online and once a day by text message. To vote online, visit www.blazethetrail.com/greatoutdoors/vote. Send text message votes to 39668 with the voting code “trail.”

The grant money would fund the Saguaro National Park Connector Trail, a five-mile stretch of the Arizona Trail into the park that must be constructed by hand due to its remoteness and the rugged landscape.

The trail would allow access into backcountry areas and protect a sensitive riparian area.

For more information, visit www.aztrail.org.

President Obama leaves the State Dining Room of the White House after speaking about health care reform Monday.

The White House trumpeted the news: health care providers taking a $2 trillion scalpel to their costs and pushing the U.S. toward Barack Obama’s vision of health coverage for all. But don’t line up yet for those insurance cards.

First, a reality check for the nation’s 50 million uninsured.

Medical providers have a long track record of avoiding fiscal constraints, as witnessed by the government’s efforts to tamp down Medicare costs.

And none of the groups that went to the White House can actually dictate prices to their members. Doctors in New York or hospitals in Los Angeles are free to charge what the market can bear.

There’s one more catch: Even if every penny of the promised savings shows up, not all of it would be used to help cover uninsured Americans. Actual savings to the government are all that can be counted as Congress tries to pay for subsidies that will be needed to help make health insurance affordable for everyone.

The medical groups’ pledge is “a very hopeful sign,” said economist Robert Reischauer, head of the Urban Institute. “But when we get down to hammering out the details, health care reform remains both complex and philosophically and politically difficult to accomplish.”

Costs could still turn out to be the greatest obstacle to Obama’s health care plan.

Outside experts estimate the taxpayers’ tab could total between $1.2 trillion and $1.5 trillion over 10 years. Some go as high as $1.7 trillion. Obama’s budget proposal includes a down payment that may cover less than half the bill.

Pledging restraint on costs Monday at the White House were groups representing hospitals, doctors, drug makers, medical device manufacturers and a major health care labor union – a who’s who of health care interests. The president posed proudly with them and called it “a watershed event.”

Obama wants to build on the current system in which most people get coverage through private insurers. But he wants to change the rules so the sick can’t be turned down. And he wants to provide subsidies to help low-wage workers and even some in the middle class afford their premiums.

House Republican leader John Boehner of Ohio isn’t impressed. “Today’s announcement promises savings with no concrete plan to achieve them and no enforcement mechanism if they don’t,” he said Monday.

Indeed, it’s too early to tell whether the White House meeting will be remembered as a turning point or as a political mirage. The administration is projecting an image of a new coalition for health care, with Obama and most of the health care industry and consumer interest groups claiming the political center.

Left out, for now, are conservative Republicans, who oppose Obama’s direction but have yet to articulate their own vision, and liberal Democrats who have been hoping to move toward a nationalized system like Medicare for all. As the debate heats up, the voices from both ends of the political divide will get louder – and the pressure on the center will increase.

Still, the sight of health care industry leaders volunteering to hold back spending is pretty unusual.

By joining Obama, providers are acknowledging at least some responsibility for a bloated and dysfunctional system that economists say is unaffordable.

In the 1990s, when President Bill Clinton attempted to overhaul health care, the battle lines quickly hardened. Obama, who has gone out of his way to woo the interest groups, praised their willingness to sacrifice on Monday.

The groups don’t just have the national interest in mind. Industry is worried that Congress will create a government health plan to compete with private insurers.

Such a plan would quickly become the biggest in the country and could use its power to set lower payment rates, driving costs down on the backs of medical providers.

“I think the reason all these groups want to actively participate in the process is they don’t want to see a blunt instrument used to get spending down,” said Mark McClellan, who ran Medicare for President George W. Bush. “This is an opportunity to get everyone behind a better approach to improve the way health care works.”

That’s just what the groups say they want to do. Their proposals include coordinating care for people with chronic illnesses, rewarding quality not quantity, and using technology to root out waste and prevent errors that get patients sicker.

But it’s hard to put numbers next to any of those ideas. For example, what if better care for chronically ill patients turns out to increase costs? None of the groups has set a target for how much its members should have to pony up.

Congress is going to need hard numbers to pass Obama’s plan this year.

Robert Laszewski, a former health insurance executive turned policy consultant, said he’s betting the consensus won’t last.

“When Congress comes up with mechanisms to reduce costs that actually take money out of the hands of doctors, hospitals and insurance companies,” he said, “that’s when we’re going to find out if things are really different this time.”

Ricardo Alonso-Zaldivar reports on health care policy for The Associated Press.

WASHINGTON – President Obama’s plan to provide medical insurance for all Americans took a big step toward becoming reality Sunday after leaders of the health care industry offered $2 trillion in spending reductions over 10 years to help pay for the program.

Hospitals, insurance companies, drug makers and doctors planned to tell Obama on Monday they’ll voluntarily slow their rate increases in coming years in a move that government economists say would create breathing room to help provide health insurance to an estimated 50 million Americans who now go without it.

With this move, Obama picks up key private-sector allies that fought former President Bill Clinton’s effort to overhaul health care. Although the offer from the industry groups doesn’t resolve thorny details of a new health care system, it does offer the prospect of freeing a large chunk of money to help pay for coverage. And it puts the private-sector groups in a good position to influence the bill Congress is writing.

Six major groups plan to deliver a letter to Obama and pledge to cut the growth rate for health care by 1.5 percentage points each year, senior administration officials said Sunday. They spoke on the condition of anonymity in order to sketch the offer before full details are revealed at a White House event scheduled for Monday.

Obama has offered an outline for overhauling the health care system, and he wants Congress to work out the details and pass legislation this year. His plan would build on the current system in which employers, government and individuals share responsibility for paying the cost and care is delivered privately. The government would play a stronger role by subsidizing coverage for many more people and spelling out stronger consumer protections.

“We cannot continue down the same dangerous road we’ve been traveling for so many years, with costs that are out of control, because reform is not a luxury that can be postponed, but a necessity that cannot wait,” Obama said in prepared remarks the White House released Sunday. “That is why these groups are voluntarily coming together to make an unprecedented commitment.”

The industry groups are trying to get on the administration bandwagon for expanded coverage now in the hope they can steer Congress away from legislation that would restrict their profitability in future years.

Insurers, for example, want to avoid the creation of a government health plan that would directly compete with them to enroll middle-class workers and their families.

Drug makers worry that in the future, new medications might have to pass a cost-benefit test before they can win approval. And hospitals and doctors are concerned the government could dictate what they get paid to care for any patient, not only the elderly and the poor.

A local church will hold a 10-mile walk/run Saturday to raise money for a mobile health clinic to serve the area’s needy population.

The event, organized by the Victory Worship Center and its student ministry, Elevate Youth Church, will take place on the University of Arizona Mall. Registration begins at 6 a.m. The run begins at 7 a.m.

The church’s aim is to raise $250,000 to buy the clinic and diagnostic equipment. The clinic would provide services at the church, 2561 W. Ruthrauff Road, and at other sites throughout town, according to a news release.

For more information about the fundraiser, go to www.elevate10mile.org or call the Victory Worship Center at 293-6386.

Hats on to the Arizona Cancer Center’s Skin Cancer Institute for putting a 12-minute video online to help people detect cancers.

(“Hats off” won’t prevent skin cancer, but “hats on” surely can.)

Early detection saves lives, and the quick spotting of skin cancers just became a whole lot easier thanks to the video that can be watched at www.azskincancerinstitute.org.

We denizens of the desert get plenty of sun exposure, so we need to indulge in sunblock, hats and other protection.

But spotting cancers promptly also is vitally important in the battle against skin cancer. Melanoma survival rates are 98 percent with early detection.

So check out the video now online, and follow the guidelines and instructions. The 12 minutes you spend now may provide you with many more years of life.

Tucsonan due to complete last leg of 800-mile walk

Tucsonan Sirena Dufault, who has fibromyalgia, plans to complete an 800-mile hike of the Arizona Trail on Tuesday.

When she set out to hike the 800-mile Arizona Trail last spring, Sirena Dufault worried that she might not finish.

The daunting trail stretches from Utah to the U.S.-Mexico border.

Tucsonan Dufault’s concern stemmed from her decade-long battle with fibromyalgia, a little-understood chronic pain disorder.

“I was a little hesitant to publicize it because I didn’t know how far I could go,” Dufault said this week. “Now I can comfortably do a 15-mile day with a big pack, no problem.”

Tuesday – on national Fibromyalgia Awareness Day – the 35-year-old will make a final, eight-mile hike north of Oracle to complete the trail, trudging from the Tiger Mine Trail head to the American Flag Trail head.

Dufault kept an online journal throughout her trek, which she made mostly by herself in one- to five-day trips. Tuesday’s leg will mark the 80th day Dufault has spent on the trail.

Dufault said she hopes her success will inspire the 10 million Americans who suffer from the disorder. “There’s not a whole lot of positive information out there about people getting their lives back after fibromyalgia.”

Fibromyalgia’s symptoms include chronic, widespread body pain, according to the National Fibromyalgia Association. Symptoms can stem from an acute illness or injury, as in Dufault’s case. Her diagnosis came in 1998, a year after she was hit by a car as she crossed a street. For months afterward, even as her initial injuries healed, Dufault’s pain and fatigue worsened.

“I saw her probably at her worst,” said Angi Edge, a nurse and massage therapist who treated Dufault after her diagnosis and became a fast friend. “So many people give up on themselves. They become their disease. She was just not going to give up.”

Dufault’s pain has not flared up in a major way in the past three years, she said. “I attribute that to being very, very active.”

For her next big adventure, Dufault might hike the Tonto Trail in the Grand Canyon. She walked 25 miles of that 90-mile trail last winter.

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Read about Sirena Dufault’s experiences hiking the Arizona Trail in her online journal: www.aztrail4fms.org.

Connie Culp (left), before the injury to her face that would lead her to become the first face transplant patient in the U.S., and on Tuesday at the Cleveland Clinic in Cleveland after a series of surgeries.

CLEVELAND – Five years ago, a shotgun blast left a ghastly hole where the middle of her face had been. Five months ago, she received a new face from a dead woman.

Connie Culp stepped forward Tuesday to show off the results of the nation’s first face transplant, and her new look was a far cry from the puckered, noseless sight that made children run away in horror.

Culp’s expressions are still a bit wooden, but she can talk, smile, smell and taste her food again. Her speech is at times a little tough to understand. Her face is bloated and squarish, and her skin droops in big folds that doctors plan to pare away as her circulation improves and her nerves grow, animating her new muscles.

But Culp had nothing but praise for those who made her new face possible.

“I guess I’m the one you came to see today,” the 46-year-old Ohio woman said at a news conference at the Cleveland Clinic, where the groundbreaking operation was performed. But “I think it’s more important that you focus on the donor family that made it so I could have this person’s face.”

Up until Tuesday, Culp’s identity and how she came to be disfigured were a secret.

Culp’s husband, Thomas, shot her in 2004, then turned the gun on himself. He went to prison for seven years. His wife was left clinging to life. The blast shattered her nose, cheeks, the roof of her mouth and an eye. Hundreds of fragments of shotgun pellet and bone splinters were embedded in her face. She needed a tube into her windpipe to breathe. Only her upper eyelids, forehead, lower lip and chin were left.

A plastic surgeon at the Cleveland Clinic, Dr. Risal Djohan, got a look at her injuries two months later. “He told me he didn’t think, he wasn’t sure, if he could fix me, but he’d try,” Culp recalled.

She endured 30 operations to try to fix her face. Doctors took parts of her ribs to make cheekbones and fashioned an upper jaw from one of her leg bones. She had countless skin grafts from her thighs. Still, she was left unable to eat solid food, breathe on her own, or smell.

Then, on Dec. 10, in a 22-hour operation, Dr. Maria Siemionow led a team of doctors who replaced 80 percent of Culp’s face with bone, muscles, nerves, skin and blood vessels from another woman who had just died. It was the fourth face transplant in the world, though the others were not as extensive.

“Here I am, five years later. He did what he said – I got me my nose,” Culp said of Djohan, laughing.

In January, she was able to eat pizza, chicken and hamburgers for the first time in years. She loves to have cookies with a cup of coffee, Siemionow said.

No information has been released about the donor or how she died, but her family members were moved when they saw before-and-after pictures of Culp, Siemionow said.

Culp said she wants to help foster acceptance of those who have suffered burns and other disfiguring injuries.