THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #106 WWW.MD-UPDATE.COM
In It for the LONG HAUL KentuckyOne Health Endocrinology and Diabetes Associates embraces chronic care model for long-term treatment of patients
VOLUME 8 • #2 • March 2017
SPECIAL SECTIONS PAIN MEDICINE CHRONIC CONDITIONS ALSO IN THIS ISSUE • DISPELLING THE PAIN CLINIC MYTH • WHAT PROVIDERS NEED IN A TOX SCREENING • LEVERAGING DIABETES PREVENTION AND EDUCATION • A GASTROINTESTINAL MOTILITY CLINIC
Encouraging healthy lifestyles with Diabetes and Nutrition Care
KentuckyOne Health Diabetes and Nutrition Care is a place where you can learn about caring for your diabetes, as well as good nutrition and healthy eating. Since 1999, we have provided quality educational services using a team-based approach of certified diabetes educators (registered nurses and dietitians). Our program is recognized as a quality educational program by the American Association of Diabetes Educators. SERVICES PROVIDED (depending on location) • Irritable bowel syndrome • Comprehensive Group • Many others Diabetes Education: – Insulin administration – 3 weekly classes with a 4th – Insulin pump training follow up class 2 months later and follow-up – Morning, afternoon, and – Blood glucose testing evening classes available – Diabetes self-management • Individual Education Sessions: • Group or Individual – Nutritional Education Education Sessions: and Meal Planning – Gestational Diabetes Classes • Consistent carbohydrate • Pregnancy and • Heart healthy Diabetes Counseling • Weight change issues – Behavioral Goal Setting • Crohn’s disease – Diabetes Support and/ • Hyperlipidemia or Diabetes Refresher • Celiac disease – Pre-Diabetes • Renal (kidney)
Diabetes and Nutrition Care OUTPATIENT EDUCATION LOCATIONS CENTRAL/EASTERN AREA | 859.313.2393 or 859.313.2595 Saint Joseph Berea Saint Joseph East Saint Joseph Hospital Saint Joseph Jessamine Saint Joseph Mount Sterling LONDON AREA | 606.330.6868 Saint Joseph London LOUISVILLE AREA | 502.587.4465 or 502.587.4576 Sts. Mary & Elizabeth Hospital Healthy Lifestyle Center Medical Center Jewish Northeast Healthy Lifestyle Center Medical Plaza II Healthy Lifestyle Center Medical Center Jewish East Jewish Hospital Shelbyville Flaget Memorial Hospital KentuckyOneHealth.org
PHYSICIAN REFERRALS A physician referral is usually required in order to bill your insurance carrier. If you have questions about payment, please call your insurance provider. We can send a referral form to your physician. Once we receive the referral, we will call you to help you select the appropriate education session and time.
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LETTER FROM THE PUBLISHER MD-UPDATE MD-Update.com
Better Nutrition = Better Health
Volume 8, Number 2
ISSUE #106
Pain and chronic conditions, like diabetes, go hand and hand in Kentucky like heart and lung disease.
PUBLISHER
Our exploration into the physicians, providers, and clinicians who treat patients suffering with chronic pain and co-morbidities from poor health continues in this issue of MD-Update. What we found was a group of Kentucky and Southern Indiana physicians and providers who are meeting the challenge. I invite you to read their stories in the following pages.
EDITOR IN CHIEF
Nutrition & Health I’m a chronic shopper at the Lexington Farmer’s Market. No matter what the season, spring, summer, or fall, I go to the Farmer’s Market, whether I need to or not. In full disclosure, I have a Community Supported Agriculture (CSA) agreement with Elmwood Stock Farm. I’ve had one for at least five years and believe it was the best thing I’ve ever done for my family’s diet and health. To learn more about what a CSA is, please see Mac Stone’s column on page 27 in this issue.
In Memoriam Dr. David Stevens was the personification of the servant-leader-healer. He was an orthopedic surgeon in private practice for 20 years before serving as chief of staff at Shriners Hospital for Children in Lexington. He was a founding member and board chairman of the Central Kentucky Blood Center. He was a professor at the University of Kentucky College of Medicine; he served as president of the Lexington Medical Society; and he traveled to Eastern Kentucky with dermatologist Dr. Clifton Smith to provide a “skin and bones” clinic. Stevens was active on numerous Lexington community boards including three terms on the Lexington– Fayette Urban County Council. His accomplishments were many. Perhaps his most lasting impact will be his profound influence and leadership in 2003-04 that led to the region’s first smoking municipal ban. Stevens passed away unexpectedly on February 7, 2017. We’re always looking for good stories to tell. Take a look at the MD-Update editorial calendar and contact us. What’s your story? All the Best,
Gil Dunn gdunn@md-update.com Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGN
Laura Doolittle, Provations Group
CONTRIBUTORS:
Jan Anderson, PsyD, LPCC Lisa Meeker Scott Neal Jeff Ricketts Mac Stone Stephanie Wurdock
CONTACT US: ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:
Gil Dunn gdunn@md-update.com
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38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502 MD-Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials. Copyright 2017 Mentelle Media, LLC. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher. Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter. Thank you. Individual copies of MD-Update are available for $9.95.
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Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax 2 MD-UPDATE
CONTENTS
ISSUE #106
9 In it for the Long Haul
KentuckyOne Health Endocrinology and Diabetes Associates has embraced a chronic care model for the long-term treatment of their patients
s Dr. Mary Self, Dr. Fred Williams, and Dr. Lara Fakunle are boardcertified endocrinologists with KentuckyOne Health Endocrinology and Diabetes Associates
4
ACCOUNTING
5
FINANCE
7
LEGAL
COVER AND CONTENTS PHOTOS BY ROBERT DENSMORE
13 SPECIAL SECTION: PAIN MEDICINE
24 MENTAL WELLNESS
20 SPECIAL SECTION: CHRONIC CONDITIONS
28 NEWS
26 COMPLEMENTARY CARE
30 EVENTS
SPECIAL SECTIONS PAIN MEDICINE
14 DISPELLING THE PAIN CLINIC MYTH: BAPTIST HEALTH LOUISVILLE
CHRONIC CONDITIONS
16 W HAT PROVIDERS 17 I NNOVATION AND NEED IN A TOXICOLOGY INDIVIDUALIZATION: SCREENING: THE PAIN PREMIERTOX LAB INSTITUTE
19 A NEW ERA IN PAIN MANAGEMENT: KENTUCKYONE HEALTH PAIN CARE
20 D IABETES PREVENTION AND EDUCATION: JOSLIN DIABETES CENTER
21 A GUT FEELING: JEWISH HOSPITAL MOTILITY CLINIC ISSUE #106 3
Accounting
Are You Prepared for a Department of Labor Audit? BY JEFF RICKETTS
If you think you’re ready … think again! It is no secret that compliance requirements have been increasing over the last few years and will most likely continue to do so. Whether it is HIPAA compliance, OSHA/ facility compliance, or anything in between, organizations have to be forward thinking in regards to every action they take. Human Resource (HR) compliance is often a forgotten area, but should not be ignored in an overall compliance strategy. From ensuring legal compliance to management of compensation and benefits, the HR function represents a complex and important component of leading an organization and its people. Because of the changing regulatory requirements and criticality of the HR compliance function, Department of Labor (DOL) audits are on the rise. Here are some of the common compliance issues to review when preparing for a DOL audit.
Hiring Process Organizations can often times be inconsistent in their hiring practices – including completing reference checks on some candidates, but not all; retaining handwritten notes on resumes in personnel files; and missing key hiring documents, such as an application or resume. It is important to create a formal, defined process and train all hiring managers on the facilitation of the hiring process. It is also key to implement quality control measures to ensure legal compliance, consistency, and standards are met.
Employee Handbook/ Personnel Manual Surprisingly, it is not a legal requirement for an organization to have an employee handbook. However, it is recommended to have 4 MD-UPDATE
Because of the changing
Legal Compliance
regulatory requirements
Legal compliance is a wide umbrella of items, including required workplace posters (federal, state and local), the location of these posters, EEO-1 reporting, and compliance with Fair Labor Standards Act (FLSA) requirements. Legal compliance, on a majority of items, will vary based on industry, physical location, size of organization, etc. The recommendation for ensuring legal compliance is to conduct research on requirements based on your business and pay particular attention to industry, size (number of employees), and physical location.
and criticality of the HR compliance function, DOL audits are on the rise … The question today is when you will be audited, not if you will be audited. one. When reviewing your employee handbook, keep in mind some of the most common missed policies: Americans with Disabilities Act (ADA), lactation accommodations for nursing mothers, and meal and break periods. Also, it is important for your handbook to be easily accessible for all employees, which can include posting on your intranet or providing printed copies to every employee, including all amendments or changes.
File Management File management issues exist in multiple filing processes – employee files (active and terminated), manager desk files, I-9 filing, etc. The issues found within file management are usually human errors and miseducation. For example, did you know that I-9s are supposed to be retained separately from employee files? That any medical documentation from your employees needs to be filed in its own secure location? Also, that employee files retained at a manager’s desk will be subject to review under an audit? It is important for anyone maintaining employee files to understand and follow strict file management guidelines.
Benefits Love them or hate them, it’s not an area to disregard in terms of compliance. Organizations need to ensure they have all plan documents, are distributing required health and welfare notices (e.g., HIPAA), and are complying with current ACA reporting requirements. If you currently work with a benefits broker, they should be able to assist in assessing benefits compliance for your organization.
Still think you’re ready? Don’t assume you’ll never be audited. The question today is when you will be audited, not if you will be audited. You have the opportunity to be diligent and prepare for a potential audit. An initial HR audit can be overwhelming, especially while resources are already spread thin, but it can save you and your organization a future experience that could be costly. Jeff Ricketts, SHRM-CP, is a human resources consultant with Dean Dorton. He can be reached at jricketts@deandorton.com.
Finance
Different Strokes BY SCOTT NEAL
Once upon a time, the most widely-used investment textbook was Graham and Dodd’s Security Analysis. Still relied upon, it was actually that book that my finance professor used for my MBA course in investments. Fundamental, value-oriented investing was the order of the day, and this was the tool. The mantra of investment professionals was buy-low when stocks are relatively cheap; sell when they are expensive. Many wise investors simply bought and held dividend-paying stocks when those stocks were selling at prices lower than the fair value calculated using those fundamental tools. In the early ’80s, in an effort to find continuing education that I thought to be both interesting and helpful, I attended a short course in technical analysis. I was immediately impressed with the idea that useful information could be gleaned solely from charts of stock prices and volume data alone. Contrary to all that I had been taught in school, there was absolutely no focus here on fundamentals. I immediately subscribed to monthly updates of point-andfigure (PnF) charts. Those are some of the strangest looking charts you can imagine: a column of X’s while prices are rising, reversing to O’s when prices are falling, all without regard to time. Of course, it is the reversal from one to the other that garners a trader’s attention. Buy when the trend shifts from O’s to X’s, and sell when the X’s reverse to O’s, and you can generally make money. Back in those days, technology to continuously monitor such charts on an ongoing basis was only available to a few large firms, if at all. Technical analysis was embraced by very few investors, and was often referred to as heretical by many professionals. A few short years later, Professor Markowitz, modern portfolio theory, and the efficient markets hypothesis became the order of the
day, and the mantra of investment professionals became buy-hold-and-rebalance. Simply put, one only had to determine the level of volatility that can be tolerated (how risk got defined), perform an optimization of risk and expected return, select the asset allocation for that optimal point on the efficient frontier, and then rebalance it periodically. One of the early proponents of Asset Allocation was Roger Gibson, who wrote the book of that title, now in its fifth edition. I was in the audience when Gibson spoke in the early ’90s. This theory was just getting off the ground, and I asked him how long it would
take to disprove it. He said that it would likely take about 400 years of data. After much debate about this concept, more recent research by Mordecai Kurz at Stanford concludes that it is not wrong, but incomplete. In fact, the Greater Recession of 2008 exposed many of the practical limitations of Modern Portfolio Theory. When it became clear that simply buying and rebalancing to a static asset allocation would not work to protect capital in the perfect storm, we shifted our focus back to a combination of fundamental and technical analysis. With the advent of the internet and fast personal com-
ISSUE #106 5
Finance
S&P 500 Index - Weekly Source: Stockcharts.com
puters, TA has evolved significantly over the 25 years since I bought my first monthly chart books. It is now taught in leading schools of finance, and we embrace it. One of the leading lights in technical analysis is Alexander Elder, MD (www.elder. com). He is a psychiatrist as well as a professional trader, and a teacher of traders. The accompanying chart of the S&P 500 is his construction, and provides a good illustration of what he calls The Impulse System. In short, this chart combines inertia, measured by the slope of the fast exponential moving average; and power, measured by the slope
of a histogram of another indicator, the moving average convergence divergence indicator, MACD. Stockcharts.com has made Elder’s chart style available in its paid subscription. Elder originally thought it could become an automated trading system; buy when green, short when red, and cash checks when blue. Rapid changes from red to green or vice-versa precluded that possibility. Instead, in a flash of insight, he concluded that it was not an automatic trading system at all, but a censorship system. It tells what NOT to do. No buying while red and no selling short when green. Either is okay when blue, but only with cau-
tion. Our firm’s trading plans are developed around a number of criteria, but we have found Elder’s chart to be quite useful, and we monitor it daily. We become very interested in buying when a red bar becomes blue, and take some interest in selling at the top of the range. The mantra of buy-low and sell-high still fits.
Scott Neal is the president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm, with offices in Lexington and Louisville. Send your questions via email to scott@ dsneal.com or call him at 1.800.344.9098.
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Legal
Legislative Update: SB4 – Medical Review Panels BY STEPHANIE WURDOCK
According to the National Practitioner Data Bank, Kentucky reported an average of 269 payments each year from 2011 through 2015. This number includes all payments arising out of written malpractice claims, including settlement payments and jury awards. To healthcare practitioners, these numbers are not insignificant, nor are they unique to the Commonwealth. Several states have enacted “tort reform” to stem the flow of medical malpractice claims. For example, Indiana enacted tort reform in 1975, instituting “medical review panels” and caps on damages. This year, members of the Kentucky Legislature propose that our state follow Indiana’s lead. Enter Senate Bill 4. Entitled “AN ACT relating to medical review panels,” SB4 is sponsored by Senator Ralph Alvarado, R-Winchester, who is a licensed internist. If enacted, the bill will establish “medical review panels” to evaluate the merits of proposed malpractice complaints before suit can be filed in court. This article provides a broad overview of SB4 as it is currently written. While changes to the bill may yet occur, its core provisions will likely remain the same. SB4 applies to all lawsuits arising out of healthcare or professional services that were, or should have been, provided by a healthcare provider to a patient. The bill defines the term “healthcare provider” to include individual providers, practice groups, hospitals, nursing homes, and agencies, as well as the administrators, officers, directors, agents, and employees of any healthcare practitioner or entity. The bill covers all causes of action arising out of the provision of medical care including negligence, wrongful death, informed consent, battery, breach of contract, and violation of a statute or regulation. Pursuant to SB4, a patient who wants to
Proponents of SB4 claim it is necessary to slow rising healthcare costs, prevent the practice of “defensive” medicine, and attract medical talent to Kentucky. Its opponents claim that the bill obstructs an injured patient’s path to justice. To be clear, SB4 does not prevent any patient from filing a lawsuit in the state court. sue for medical malpractice must first submit his case to a “medical review panel” for review on the merits. The parties can forego the panel process, but only if all parties to the proposed action agree. Claims governed by a valid Alternative Dispute Resolution agreement are exempt from the requirements of SB4. To institute a medical malpractice action under SB4, the patient must file a “proposed complaint” with the Commonwealth’s Cabinet for Health and Family Services. The parties must then appoint an attorney “chairperson” and a three-person voting panel. All healthcare providers who are licensed to practice in Kentucky are eligible to serve on the panel. When possible, the chosen panelists should practice in the same specialty as the defendants. However, that is not guaranteed. Chosen panelists may be dismissed upon a successful challenge, upon agreement of all parties, or for “good cause shown.” A panelist who fails to fulfill his duties may be removed and subjected to civil sanctions. Once the panel is set, the patient has 30
days to present his evidence. The provider then has 45 days to submit rebuttal evidence. These deadlines may be extended in the event of “extenuating circumstances.” The panel may request additional materials from the parties, perform its own research, and “consult with medical authorities.” Within 30 days of receiving the provider’s evidence, the panel must issue one of the following three “expert opinions” as to each of the providers: (1) the evidence supports the conclusion that the healthcare provider breached the applicable standard of care, and that breach was a substantial factor in producing a “negative outcome” for the patient; (2) the evidence supports a breach but not causation; or (3) the evidence does not support a breach. This opinion must be issued within 180 days of the panel’s formation. Thus, allowing three months for the panel to be formed, the entire process is designed to take less than one year from start to finish. However, given the relatively short (and unrealistic) timeframes given for the presentation of evidence, one could expect the process to take anywhere from one to two years. Anecdotal evidence from Indiana suggests the process could take as long as three years. Once the patient receives the “expert opinion,” he has 90 days to file a lawsuit – regardless of the “expert opinion” issued by the panel. However, if the matter proceeds in the circuit court, the panel’s opinion may be admissible as evidence. The panelists may also be called to testify as witnesses in the court matter. Each panelist may be paid up to $350 for all worked performed as a panel member (not including trial) plus reasonable travel expenses. SB4 does not appear to limit the number of times a healthcare provider can serve on a medical review panel. Proponents of SB4 claim it is necessary to ISSUE #106 7
Legal slow rising healthcare costs, prevent the practice of “defensive” medicine, and attract medical talent to Kentucky. Its opponents claim that the bill obstructs an injured patient’s path to justice. To be clear, SB4 does not prevent any patient from filing a lawsuit in the state court. Upon conclusion of the panel process, the patient may choose to file suit regardless of the experts’ opinion. What SB4 does do is essentially require patients to practice their cases for up to three years prior to filing suit. SB4 is not expected to significantly decrease
litigation costs. However, it is expected to “weed out” cases with questionable liability and increase the frequency of pre-trial settlements. For those cases that do proceed to trial, SB4 is expected to decrease the time from filing to trial. SB4 passed the Senate with a vote of 23-13 in early January. At the time this article was written, the bill was awaiting hearing in the House Committee. Assuming it completes the legislative process, SB4 will likely become effective in July 2017. It will only apply to claims
filed after it is signed into law. The full text of SB4 can be located at http://www.lrc.ky.gov/ record/17RS/SB4.htm. Editor’s note: As of press time, SB4 passed the House Health and Family Services Committee and is still waiting for a full House vote. Stephanie Wurdock is a healthcare litigation attorney at Sturgill, Turner, Barker & Moloney, PLLC in Lexington. Her biography and contact information is available at www.sturgillturner.com. This article does not, nor is it intended to, constitute legal advice.
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In It for the
LONG HAUL
KentuckyOne Health Endocrinology and Diabetes Associates has embraced a chronic care model for the long-term treatment of their patients BY JIM KELSEY LOUISVILLE As the Rolling Stones famously sang,
“You can’t always get what you want.” In medical care, everyone wants the issue to be fixed, healed, and cured. But there aren’t cures for every condition. Sometimes, long-term treatment is the only option. “The care model for managing acute conditions and chronic conditions is radically different,” says Fred Williams, MD, FACP, FACE. “Medicine in the past was built almost solely on an acute care model – healthcare reacted to whatever was wrong with the patient. Now, you have all of these chronic diseases and people are living much longer, which is great, but the old models don’t work.” Williams practices at KentuckyOne Health Endocrinology and Diabetes Associates in Louisville. There, they treat chronic conditions such as diabetes, pre-diabetes, obesity, thyroid disorders, pituitary disorders, and osteoporosis. Endocrinology and Diabetes Associates was established in 1993 and became part of KentuckyOne Health in 2015. At that time, Williams and his partners – Lara Fakunle, MD, 10 MD-UPDATE
Fred Williams, MD, FACP, FACE, estimates that 90 percent of the patients treated at KentuckyOne Health Endocrinology and Diabetes Associates suffer from chronic conditions related to diabetes or thyroid disorders.
FACE, and Mary Self, MD, CDE, all board certified in internal medicine and endocrinology and metabolism – had approximately 8,000 active patients, and the practice is completely outpatient. PHOTO BY GIL DUNN
Williams, who attended the University of Louisville School of Medicine and completed his residency and fellowship at the University of Virginia School of Medicine, estimates that they treat 50 to 60 percent of their patients for diabetes and closely related problems. Thyroidrelated issues make up the practice’s second-largest patient population. Virtually everything they treat is a chronic condition requiring long-term care. They see patients ages 18 and older. “Chronic health disease is no respecter of wealth, educational background, socioeconomic status or any other limiting factors,” says Fakunle. After attending Obafemi Awolowo University in Nigeria, Fakunle completed her residency program in internal medicine and a fellowship in endocrinology and metabolism at the University of South Carolina. While chronic illness can impact anyone, it can add additional stresses for those without the means to fully combat it. “Individuals frequently have deductible insurance plans that make needed outpatient testing out of reach for many,” Self says. “Often, insurers don’t cover programs that help with lifestyle change. Medication and
Cover Story
Medicine in the past was built almost solely on an acute care model – healthcare reacted to whatever was wrong with the patient. Now, you have all of these chronic diseases and people are living much longer, which is great, but the old models don’t work. — Dr. Fred Williams
(l-r) Dr. Mary Self, Dr. Fred Williams, and Dr. Lara Fakunle are board-certified endocrinologists with KentuckyOne Health Endocrinology and Diabetes Associates, which was established in 1993 and became part of the KentuckyOne Health network in 2015.
durable medical goods are expensive and frequently limit true choice of therapy. It is difficult for employed individuals to take time off work for appointments. The stress of all of these challenges can make it difficult for the most well intentioned patients to reach their goals.”
Treatment Challenges and Triumphs – Diabetes, Obesity, and Osteoporosis An example of this exists with diabetic patients. Williams points to the tremendous advancements in the medications to treat the disease and the increasingly high costs that accompany them. “We have the drugs and the know-how, but you have these insurance middle people that create problems with access to the medications,” he says. “Nevertheless, there are options out there, and our ability to achieve treatment goals PHOTO BY ROBERT DENSMORE
is tremendously better than even five years ago.” Another major development in the treatment of diabetes is the ability to identify patients with pre-diabetes. Patients with a fasting blood sugar between 101 and 126 and a hemoglobin A1C of 5.8 to 6.5 are considered to be pre-diabetic and, in most cases, will become diabetic without changes in diet and exercise. YMCAs and public health departments have become active participants in creating programs designed to help pre-diabetic patients make these lifestyle changes. Lifestyle changes have long been the primary ISSUE #106 11
Cover Story
treatment for another chronic condition – obesity. But when obesity was officially labeled a disease by the American Medical Association in 2013, it sparked some changes in treatment. “It forced the issue in terms of insurance companies and healthcare systems recognizing that not everybody who is obese just eats too much, that there is a whole complex physiology that’s involved that’s a lot broader than just people eating too many calories,” Williams says. “We do have medications that are FDA approved that are theoretically available for obese patients. The drugs are out there, and they work, but you can’t get people on them because the insurance companies won’t cover any obesity-related medication.” But insurance generally does cover bone density measurements every other year, which is great news for patients with osteoporosis. Referrals for osteoporosis have declined as many patients are treated by their primary physician or gynecologist, but KentuckyOne Health Endocrinology and Diabetes Associates has seen a dramatic increase in the number of referrals for patients with thyroid conditions. Thyroid issues include overactive or underactive thyroids, patients with goiters, and patients with nodules, which can be benign or malignant. “We are seeing a whole lot more of the patients with nodules, one, because doctors and nurse practitioners and PAs are looking for them, and two, because we now have ultrasound devices that are very sensitive in being able to pick them up,” Williams says. “The number of referrals we get for evaluation of thyroid nodules or tumors has skyrocketed. The incidence of thyroid cancer has increased, but no one knows if that’s a true increase or if we’re just more aware of patients having nodules.”
Making an Accurate Diagnosis – Thyroid Disorders and PCOS On the bright side, technology is making diagnosis of thyroid conditions easier and more definitive than ever before. “If I compare the pictures I have now to the ones I was looking at 15 years ago, it’s like an old black-and-white TV from the 1950s and a high definition TV now,” Williams says. While thyroid problems can be heredi12 MD-UPDATE
tary, Williams points to several recent studies that suggest environmental factors might be contributing to the surge in diagnoses. Some substances in plastics used for food packaging, for instance, have been shown to influence the function of various hormones. “There’s a lot of smoke,” Williams says, referring to the number of studies and theories suggesting the impact of environmental factors. “The whole issue of plastics and what is in them is going to be really big going forward. I believe there are some environmental factors involved, and it’s kind of scary.” Another issue with thyroid conditions is that they can sometimes mask other issues, Self says. There are so many symptoms affiliated with thyroid disease that can also be attributed to other conditions. “We frequently see individuals who are so focused on their thyroid being responsible for their symptoms, that many important medical conditions are overlooked,” Self says. Self, a board-certified endocrinologist, joined the practice in 1997. She attended the University of Louisville School of Medicine and completed her residency and fellowship there as well. “Many symptoms are listed under thyroid disease that are common with many medical conditions, including normal aging.” Another chronic condition frequently seen at KentuckyOne Health Endocrinology and Diabetes Associates is Polycystic Ovary Syndrome (PCOS). It too brings with it a host of affiliated health issues that are sometimes misdiagnosed. “PCOS is a metabolic and reproductive disorder,” Fakunle says, noting that she sees two-to-four PCOS cases per day. “Apart from the reproductive issues, attention should be paid to the other potential health issues such as heart disease, impaired glucose tolerance, diabetes mellitus, gestational diabetes mellitus, sleep apnea, hyperlipidemia, and obesity. There is also concern for under diagnosis. The longterm effects – including psychological effects – are probably under addressed.” Finding ways to identify and address the many needs of patients with chronic conditions is one of the challenges of the chronic care model. Physicians need to anticipate the patient’s upcoming needs, rather than simply reacting to their acute conditions. PHOTOS PROVIDED BY KENTUCKYONE HEALTH
Lara Fakunle, MD, FACE, attended medical school in Nigeria, then did her residency and fellowship at the University of South Carolina before relocating to Louisville in 1998.
Mary Self, MD, CDE, is a board-certified endocrinologist with a background in nursing and a passion for patient education.
“Today, a good medical office has a prepared proactive team and an informed, activated patient,” Williams says. He cites an article identifying the “5 C’s” of a chronic care model: contact, continuity, comprehensive care, coordination of care, and compassion. Notice that “cure” isn’t one of those “C’s.” It’s true you can’t always get what you want. But as practices like KentuckyOne Health Endocrinology and Diabetes Associates continue to implement and develop a chronic care model, you can get the expertise, treatment, and support needed to manage chronic illness.
SPECIAL SECTION
Pain Medicine
Dispelling the Pain Clinic Myth Kristal Wilson, MD, and the providers at the Baptist Center for Pain Control seek to educate patients and providers on the variety of non-narcotic chronic pain treatment options
BY JENNIFER S. NEWTON
On average we see people with chronic pain very late. If we treat their pain sooner rather than later, patients will have better outcomes. — Dr. Kristal Wilson
LOUISVILLE Unfortunately in the field of pain
management, there are still many misconceptions among both patients and healthcare providers. But, that is slowly changing with the efforts of specialists such as Kristal Wilson, MD, pain management physician with the Baptist Center for Pain Control at Baptist Eastpoint in Louisville. According to Wilson, two of the biggest misconceptions in the field are that pain clinics only provide chronic narcotic therapy, and that when narcotic therapy is ineffective, escalating the dose is the answer. At the Baptist Center for Pain Control, Wilson and her colleagues – Darel Barnett, MD, Brigid Buckman, APRN, and Jacqueline Dennis, APRN – do manage chronic narcotic therapy, but their main focus is on a “multimodal analgesic plan with conservative therapy, physical therapy, psychological therapy, moving all the way into interventional or surgical options,” says Wilson.
The Double Board-Certified Pain Physician For Wilson, dispelling the myth of pain clinics as narcotic dispensaries begins with the qualifications of its physicians. “In my opinion, one thing that sets pain management physicians apart is that we complete a fellowship and are double board-certified in both anesthesiology and chronic pain management,” she says. “This gives us more options to offer to patients, with more opportunities to help them.” Wilson completed medical school and residency in anesthesiology at the University of Louisville and took her fellowship in interventional chronic pain management at the University of Cincinnati. She
Dr. Kristal Wilson, with the Baptist Center for Pain Control, is double board-certified in anesthesiology and chronic pain management.
joined Baptist Health in August 2016. “The thing I like about pain management is that there is such a need for it. It is a very challenging but gratifying field, especially end of life palliative care, cancer care, and people with chronic conditions who think they have no hope or any other options,” says Wilson.
Multimodality Treatment Options The top complaint in Wilson’s office is back pain, closely followed by neck pain, knee pain, shoulder pain, and migraines. Many of their patients suffer from chronic pain post-surgery. Conservative therapy is always the first line of defense, including things like physical therapy, weight loss, and behavior modifications. If those fail, there are a variety of new technologies, interventions, and surgical options available, including steroid injection, radiofrequency ablation, and neurostimulation. Classic epidural steroid injections are appropriate for back or neck pain with radicPHOTO PROVIDED BY BAPTIST HEALTH
ulopathy symptoms (nerve compression or irritation in the spine). Radiofrequency ablation can be used on nerves from the head to the knees. Electrical currents are used to heat nerve tissue and decrease pain signals from that area for six months to a year, providing longer lasting pain relief. Neuromodulation treatment involves the implantation of a neurostimulator, much like a pacemaker, that stimulates the spinal cord or peripheral nerves to disrupt pain signals to the brain. Because the device is implanted, it must be trialed first in the patient, but Wilson says, “It has been very successful, especially in post-surgical patients.” If medications are a part of a patient’s treatment plan, Wilson never recommends narcotics first or on their own, opting for a multimodal analgesic plan. In addition to the array of medical, interventional, and surgical options, Wilson contends working closely with a pain psychologist is an important aspect of the program because of the anxiety, depression, and psychological issues that accompany chronic pain.
Education, Education, Education A large part of Wilson’s job is educating her audiences, both patients and physicians, as to what pain management is and what it ISSUE #106 13
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We’re not here to promote narcotic use in the community. If anything, we’re trying to decrease it and make sure these patients are highly regulated and monitored to decrease misuse in the community. — Dr. Kristal Wilson can do. “A lot of patients don’t know these options are available. What they’re familiar with is they hurt and there is a medication or pill they can take and feel better. So, they just think the more medication or pills they take, the better they will feel,” says Wilson. The problem is that’s not the case. “With narcotic therapy, continuing to escalate the dose when it’s not effective is not going to make it more effective. I tell patients, ‘If three Percocets don’t work, four is not the magic number,’” she says. For physicians and healthcare providers, particularly those who do not regularly work closely with pain management physicians, new recommendations have been slow to cir-
culate. “Older training in the specialty leaned towards high dose narcotics with no ceiling. The field has changed in the last 20 years. It has been proven that high dose narcotics are 1) not effective and 2) do come with harmful side effects. Now we’re dealing with addiction, tolerance, dependence, misuse, and abuse in the community. It’s a complete shift in the pain management field,” says Wilson. Her goal is to reach primary care physicians who “are the first line patients go to when they hurt.” It is those primary care physicians who are managing much of the chronic pain and chronic narcotic therapy. Wilson recommends that physicians start conservative therapy with their patients as they normally would
but schedule a consult with a pain physician as they are trying those therapies to see what other options are available. “On average we see people with chronic pain very late, later than we would like to. If we treat their pain sooner rather than later, patients will have better outcomes. A lot of our patient referrals we’re not seeing until they have chronic pain well over a year or a couple years, and they come to us as a last resort,” she says. Another advantage of sending patients to a pain clinic is they have the staff and resources to very closely monitor patients who are on narcotic therapy. They do so with urine drug screens, pill counts, KASPER reports, and frequent visits. “We’re not here to promote narcotic use in the community. If anything, we’re trying to decrease it and make sure these patients are highly regulated and monitored to decrease misuse in the community, to try to help control the narcotic epidemic that’s increased over the last 10 years,” concludes Wilson.
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What Do Providers Really Need in a Toxicology Screening?
PremierTox collaborates with providers to ensure it provides only the most appropriate, cost-effective toxicology screening BY BOB BAKER RUSSELL SPRINGS Unless you have just returned
from a very long isolation stay on the International Space Station, you are aware of the epidemic of opioid addiction. This is a national problem, but it disproportionately affects people who live in Kentucky. Everyone in healthcare is affected, but much of the burden of caring for this population has fallen on primary care providers and pain management specialists. A vital aspect of addiction management is determining what drugs the patient is taking and monitoring how much of a given drug is in the patient’s system. In response to this need, many toxicology labs have opened in the Commonwealth within the last decade. Competition for business and striving for a high gross-income-to-overhead-ratio has made an accurate description of the management and technical practices of some of these laboratories a difficult and unpleasant task. The exact opposite is true of PremierTox Laboratory in Russell Springs, Ky. Even a skeptical reviewer would be surprised and impressed at every turn in learning the corporate philosophy, the technical exactitude, and the constant attention to the long-term patient outcome through a dedicated partnership with care providers. Steve Klipp spent many years in the pharmaceutical and internal operations aspects of healthcare before coming to PremierTox in 2011. He was named president of the toxicology testing lab in early 2015. His guiding principle has been to provide a service that allows each physician to most efficiently and effectively personalize their treatment to every patient. This dedication remains primary at PremierTox today. Klipp states, “There are over 4,300 toxicology labs in the country
Steve Klipp has been president of PremierTox Laboratory since 2015.
PremierTox representatives proactively educate providers on medical necessity, and make routine consultative reviews available to equip them with the knowledge to determine which patient needs a full quantitative baseline panel and which would be more appropriately served with an individualized, focused analysis. today. Every one of them will give the provider a number on a piece of paper, but not every lab makes every effort for testing quality like PremierTox does to ensure that the result is accurate, and timely.” So, while the testing may be what is most profitable for other labs in the PHOTO PROVIDED BY PREMIERTOX LABORATORY
short run, it is not necessarily what the provider really needs. PremierTox takes a different approach by collaborating with providers to not only ensure that the result on the page is accurate, but also provide value-added services that will best aid the provider and support patient care. Instead of promoting test services that include running a full quantitative analysis of every drug possible on every visit, PremierTox representatives proactively educate providers on medical necessity, and make routine consultative reviews available to equip them with the knowledge to determine which patient needs a full quantitative baseline panel and which would be more appropriately served with an individualized, focused analysis. This will direct the provider’s attention where it needs to be and will be much more cost effective for the patient or third party payor. “We believe this kind of patient-centered testing will build long-term relationships that will be mutually beneficial,” says Klipp. Under Klipp and the Chief Laboratory Officer James E. Meeker, PhD, PremierTox has grown steadily in the past three years. Klipp projects that Premier Tox will perform nearly 200,000 drug tests in 2017. This growth is achieved in toxicology testing by implementing cutting-edge automation and by hiring clinical scientists who oversee quality control. PremierTox top scientists are made available for results interpretation assistance either remotely by telephone or by in-office consultation. Klipp says that these services are available for all PremierTox clients and provided at no cost to the practitioner or patient. “Automation doesn’t just reduce overall turnaround time of testing, it significantly reduces errors, the possibility for cross-contamination, and through bar-coding and tracking, keeps ISSUE #106 15
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our team informed of testing quality throughout the process. Our scientists still play an important role in overseeing every step,” says Meeker. “In addition, PremierTox is creating jobs in our client services sector so that we can continue to provide personalized support of physicians’ needs in all areas of what we do.” PremierTox has distinguished itself from other toxicology labs by attaining accreditation by the College of American Pathologists (CAP). This rigorous undertaking requires at least two years of documented precision and accuracy of test results and participation in ongoing proficiency monitoring: quarterly samples sent out by CAP with levels of substances that are known only to CAP. To maintain CAP accreditation, laboratories must report results on these proficiency tests that accurately reflect the drug and the level of the sample sent to them. “What sets us apart is the attention we pay to ensuring quality of testing and provider communication,” says Meeker. “Our proprietary sophisticated testing methodology, known
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as solid-phase extraction, allows us to correctly detect very low levels of drugs in multiple specimen types. We have daily monitors and continual quality management to ensure every result meets our stringent criteria prior to release.”
Patient-Centered Care in a Hard Hit Area Kim McKenna, APRN, is the owner/operator of One Cross Clinic in Campbellsville, Ky. She received her nursing and master’s degrees from UK College of Nursing and opened One Cross Clinic in 2015. She’s been a nurse and nurse practitioner for 25 years, serving the mostly rural Kentucky counties of Taylor, Casey, Adair, Green, and Russell. McKenna estimates that more than 10 percent of her patient population needs a drug screening for controlled substances. For new pain patients, after a complete review of their current medical usage and a KASPER report, she typically asks for a comprehensive panel for the first screening and then monthly for
PHOTO PROVIDED BY ONE CROSS CLINIC
Kim McKenna, APRN, is the owner/operator of One Cross Clinic in Campbellsville, Ky.
the next two or three subsequent tests. When her patient’s results are negative for any drugs not prescribed, the screenings can be quarterly and then possibly every six months, as long as the results are negative and in accordance with prescribed drugs. McKenna will ask for and receive a customized screening from PremierTox Laboratory after the comprehensive panels are validated and a patient’s history of usage is confirmed. “This is a great benefit to my patients because the customized panels are much more affordable than the comprehensive and unnecessary confirmatory panels. Patients cannot afford $1,000 for each drug screening, and they’re not necessary.” McKenna says she has found fraud in some toxicology labs that bill both Medicare and the patient for excessive testing. “Since I started using PremierTox, I have not had one issue with double billing or excessive testing.” The quick turnaround from PremierTox is an added benefit. “I’m not going to write a prescription for a controlled substance until I see the screen results. My patients are in pain, and every day that is delayed is hard on them,” she says. McKenna notes her desire to direct business to a local employer. PremierTox is certainly a substantial part of the economy of Russell County with over 100 employees, many of whom already lived in Russell County. As PremierTox grows toward its goal of becoming the first lab in the state to be certified to handle forensic testing, this number will grow, as will the company’s contribution to medical and legal professionals and the community as a whole.
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Innovation and Individualization
Brian Derhake, MD, uses customized pain management techniques to reverse the cycle of hopelessness and get patients back to their lives BY DONNA ISON LOUISVILLE With the rise in life expectancy,
stress, and obesity, pain is incredibly common. According to researchers at the National Institutes of Health, more than 25 million American adults reported having pain every day for the previous three months.1And, with chronic pain being linked to depression, sleep deprivation, and anxiety, it is imperative that the medical community find new and innovative ways to end the suffering. One physician dedicated to doing this is Brian Derhake, MD. Derhake, who is board certified in both pain management and anesthesiology, joined The Pain Institute in 2016 and also sees patients at the outpatient pain clinic at Jewish Hospital Shelbyville. He graduated medical school at the University of Louisville and completed a fellowship with the Cleveland Clinic, one of the premier pain clinics in the world. While there, he trained under many of the foremost experts in the field. The Pain Institute provides a wide range of therapeutic procedures, diagnostic and surgical recommendations, and non-opioid medications to help patients who have been sidelined by chronic pain. The most common culprits are lower back, neck, and the knee pain that often persists after total knee replacement surgery. Three of the most exciting innovations in treatment are the genicular nerve block, spinal cord stimulation, and ultrasound-guided procedures. During the genicular nerve block, radiofrequency lesioning is used to burn the nerves 1 Brady, Dennis. (August 11, 2015) “NIH: More than 1 in 10 American Adults Experience Chronic Pain.” Washington Post. https://www.washingtonpost.com/news/ to-your-health/wp/2015/08/11/nih-more-than-1-in-10american-adults-experience-chronic-pain/
Dr. Brian Derhake is board certified in anesthesiology and pain management. He practices with The Pain Institute and the pain clinic at Jewish Hospital Shelbyville.
I like to educate [patients] and come to a decision with them. I am both their doctor and their healthcare advocate. — Dr. Brian Derhake and break the neuropathway to the brain, leading to longer lasting relief than with traditional injections. Spinal cord stimulation can aid in the control of many conditions, including complex regional pain syndrome, a devastating disease process causing severe chronic pain. The use of ultrasound and x-ray guidance enables physicians to perform procedures with more confidence and accuracy. These, along with other breakthrough treatments, allow Derhake to meet his mission. “My goal is to help everybody get up off the couch and get back into living their
life,” he says. To accomplish this, he tailors the treatment plan to the individual patient. “I like to work with them and discuss what their goals are rather than just presenting a plan. I like to educate them and come to a decision with them. I am both their doctor and their healthcare advocate,” he states. Hence, Derhake prides himself on seeing, examining, and assessing each of his patients at The Pain Institute and Jewish Hospital Shelbyville. He also understands the importance of a strong referral network and working closely with spine and orthopedic surgeons as well as primary physicians to provide complete comprehensive pain care. A principal reason for customizing care is to curb the abuse of opioids. When asked about the prevalence of opioid-seeking patients, Derhake explains how the reputation of the clinic often deters these individuals because it is known that The Pain Institute ideally opts for other early interventional methods. Derhake also states that he, personally, is dedicated to “trying to decrease the opiate epidemic in our society and help people with alternative measures.” These alternative measures can often change the life of the patient, who, having exhausted all surgical options, opts for pain management. After receiving certain procedures or courses of treatment, many see a significant decrease in pain and can become much more active in their daily life and are able to return to work. He finds this to be the most rewarding aspect of the job. “The most exciting thing for me is seeing patients get back into their lives and out of the cycle of sitting around their house feeling depressed and feeling hopeless,” says Derhake. For this reason, he is committed to continuing to find cutting-edge answers to the pain problem. ISSUE #106 17
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A New Era in Pain Management is Brought on by New Technology
FDA approval pending for new device for complex regional pain syndrome The Progression of Pain Management
BY GIL DUNN LEXINGTON After nearly 25 years of medical train-
ing and practice, Karim Rasheed, MD, knows a game changer when he sees one. It’s the next generation of spinal cord stimulation (SCS), and it is just months away from FDA approval and being in the hands of interventional pain management physicians such as Rasheed. The new and exciting development for treating complex regional pain syndrome (CRPS), both I and II, is the Axium™ Neurostimulator System from St. Jude Medical, Inc. The device has passed clinical trials and is expecting final FDA approval within the next few months. The Axium radiates dorsal root ganglia (DRG), collections of sensory nerves that run alongside the spinal column. According to the St. Jude Medical website, “DRG stimulation is a first-of-its-kind therapeutic approach that provides pain relief to patients with neuropathic conditions underserved by traditional spinal cord stimulation.” While spinal cord stimulators have been the gold standard for years in treating neck and lower back pain, they are less effective when treating CRPS and certain areas of pain such as in the limbs. Research has found that the DRG is the specific region of the spinal cord that transmits the pain. The smaller and more precise leads are placed over the dorsal root ganglia, which affords more targeted pain blockage and control. “We have many patients who are waiting for this treatment and relief,” says Rasheed. Rasheed came to the University of Kentucky Medical Center in 1993 where he did his internship in internal medicine and took his residency in neurology and anesthesiology, followed by a fellowship in pain management. Then he spent several years in private practice, which included four years treating veterans at the VA Hospital in Lexington, where he says the “patients are so appreciative.” Rasheed joined KentuckyOne Health Pain 18 MD-UPDATE
Karim Rasheed, MD, board-certified in pain management and anesthesiology, joined KentuckyOne Health Pain Care at Saint Joseph Hospital in 2012.
Care at Saint Joseph Hospital in 2012. According to Rasheed, the clinic sees the most common presentations of pain in the neck, back, lower back, shoulders, hips, knees, and ankles; also muscle and myofascial pain, headaches, some cancer pain patients, and injury to nerves in arms and legs. A rare occasion is oral-facial pain, when a patient is referred by their dentist. Rasheed’s practice is limited to adults, with slightly more male than female patients. Those under the age of 45 are more likely to have acute pain from trauma, while patients over 50 years old typically suffer from osteoarthritis and degeneration of the spine, joints, and other extremities. “We offer comprehensive pain care, which includes medical management, sometimes a mixture of opioid and non-opioid treatments, also interventional nerve blocks. We often see patients who have a ‘flare up’ of pain,” says Rasheed. “They tell us to treat the flare-up, and they can manage after that.” Rasheed still does some anesthesia in the OR but enjoys the patient interaction and both the challenges and rewards of pain management. His clinic also offers physical therapy to help patients become more functional.
To illustrate just how far pain management has come, Rasheed gives the example of pain relief in childbirth. “Fifty or sixty years ago it was thought that women had to have pain to deliver babies, that it was part of the process. Now we understand that women can give birth without extreme pain, and it’s better for both the baby and the mother because she is not so exhausted from the pain of labor contractions.” Another example of advancement is that of genicular nerve ablation. An ardent and early practitioner of the technique, possibly the first in the Central Kentucky area, Rasheed says the potential for genicular nerve ablation has been around for decades, but physicians only recently discovered its use. Genicular nerve ablation warms and de-sensitizes the nerve that transmits knee pain. The process can give patients pain relief for six months to a year. Rasheed’s success rate is 70-80 percent, which he considers “a great success.” Many patient referrals come from orthopedic surgeons, who want a conservative approach before partial or total knee replacement is engaged. “Genicular nerve ablation may postpone surgery for years,” says Rasheed, “and that is preferred by some patients and by their orthopedic surgeons. We test a patient’s response, one nerve at a time, to see what kind of results we get. Each patient and each knee is different.” The preferred candidate for genicular nerve ablation is a 40-65 year old with osteoarthritis or someone who has had knee replacement surgery or acute trauma but still has pain. Less optimal candidates suffer pain from damaged ligaments, muscular aches, or diffusion and swelling of the knee capsules. For back and neck pain, Rasheed notes that tremendous advancements are being made with radio frequency ablation and spinal cord stimulators, which act like a pacemaker for
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Pain Medicine
Dr. Rasheed performs genicular nerve ablation, which can postpone knee replacement surgery for years, at his clinic at Saint Joseph Hospital.
the brain and spinal cord. With an implanted spinal cord stimulator, a patient can control the amount of relief and the location of the pain. “Change the channel and increase or lower the volume, according to the location and the level of pain,” says Rasheed. “The patient is in control of the pain, rather than the pain being in control of the patient.”
Alternative Medicine and the Difficult Patient Pain medicine and management is a controversial specialty with many skeptics, Rasheed acknowledges. Some patients with some types of pain, typically myofascial, will respond to acupuncture. Rasheed is skeptical about over-the-counter herbal supplements because there is simply not enough scientific evidence or controlled dosage to demonstrate efficacy. “Some of my patients are resistant. I tell them, ‘I am the coach, but only the coach. You are the player who can win the game if we do this together.’” A difficult patient, says Rasheed, is one who hides his pain because of fear and shame
and is resistant to treatment. “I have to dig into that patient’s pain to help him using multiple modalities, such as anti-neuropathic medications, muscle relaxants, anti-depressants, injections, spinal cord stimulators, and physical therapy to get him functioning again in society.” All of Rasheed patients receive a psychological evaluation, and some receive therapy. “For some patients there is a stigma about going to a pain clinic. This is unfortunate because not all patients receive opioids at a pain clinic. In fact, we go out of our way not to prescribe narcotics,” he says. Multiple modalities are used such as injections of nerve blocks, spinal cord stimulators, a mixture of non-opioid medications, physical therapy, psychological counseling, and encouraging lifestyle modifications. Chronic pain is a disease that can lead to other morbidities such as hypertension, lowered immunity, chronic bowel syndrome, and depression, among other ailments. Anxiety and stress can manifest as pain. “Our job is to find patients who are ‘diamonds in the rough,’” says Rasheed. “Those are people who PHOTOS BY GIL DUNN
have pain but want to get back to work, to family, to functioning in life.” A new satellite KentuckyOne Health Pain Care clinic is opening this spring at Saint Joseph Jessamine.
PAIN CARE CLINIC 1401 Harrodsburg Road Suite C-315 Lexington, KY 40504
859.313.2212 Fax 859.313.3309 ISSUE #106 19
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Chronic Conditions
Diabetes Prevention and Education
The Joslin Diabetes Center Affiliate at Baptist Health Medical Group leverages new programs and technologies to improve outcomes and prevent complications BY MEGAN WHITMER NEW ALBANY, IN The Centers for Disease
Control and Prevention (CDC) reports that more than 29 million adults in the United States have diabetes, and nearly one-third has prediabetes. The CDC predicts that, without major changes, one in three US adults will have diabetes by the year 2050. The Joslin Diabetes Center Affiliate at Baptist Health Medical Group in New Albany, Ind., has worked since 1997 to turn this trend around. An affiliate of the Joslin Diabetes Center in Boston, Mass., New Albany’s Joslin Diabetes Center is the premiere diabetes center in the area, with a full team devoted to helping patients with diabetes. “We provide services in the entire spectrum of endocrinology, but our main focus is diabetes,” says Vasdev Lohano, MD, medical director of the Joslin Diabetes Center at Baptist Health Medical Group. “We have three endocrinologists, one nurse practitioner, two diabetes educators/dieticians, and one registered nurse/certified diabetes educator.” The medical staff at Joslin Diabetes Center stays on top of research and looks for opportunities to adapt new technology advancements and therapies into practice. “A lot of work has been done on the technology side of diabetes treatments,” says Lohano. “A new pump has just been approved that combines insulin pump technology with continuous glucose monitoring, and we hope to have this available for patients in the spring of 2017.”
Diabetes Prevention Program Education is a primary aspect of diabetes treatment at Joslin Diabetes Center, and Lohano believes their Diabetes Prevention Program (DPP) is what truly sets the practice apart. The DPP is based on research funded by 20 MD-UPDATE
Dr. Vasdev Lohano is the medical director of the Joslin Diabetes Center Affiliate at Baptist Health Medical Group in New Albany, Ind.
Empowering the patient to understand the disease process and how different activities and foods affect blood sugar is as crucial as taking medication. — Dr. Vasdev Lohano the National Institutes of Health and the CDC. The study found that eating healthier, increasing physical activity, and losing a small amount of weight can prevent or delay the onset of type 2 diabetes in a person with prediabetes by as much as 58 percent. Additionally, weight loss of six to seven percent was also seen in those who participated in the program. Program goals include reducing body weight by seven percent and increasing physical activity to 150 minutes per week. “We are offering this to the community, and everyone is welcome,” says Lohano. “It is a year-long educational program, with weekly PHOTO PROVIDED BY BAPTIST HEALTH FLOYD
classes for the first six months and monthly classes for the second six months. One group has just finished the program, and we are about to start a second. Our goal is to have one group start in the spring and a second group start in the fall, with 10 people in each session.” The cost of participation in the DPP is $375 for the year-long program, and can be paid for using a payment plan if necessary. “In comparison to the cost of treating diabetes, $375 is nothing,” says Lohano. “If you take one medicine for diabetes, that can be $500 a month. Whether that is paid for by the patient, insurance, or government, it all contributes to the high cost of healthcare. People are getting diagnosed with diabetes at a younger age, and it is a chronic disease. If you are diagnosed and expected to live another 30-40 years, the cost of medications is astronomical, and that is not even including the health complications that can accompany diabetes. Every bit you can prevent is useful, even if it is just one percent.” Apart from the DPP, the center also offers group and/or individual classes, depending on patient needs. When a physician or nurse practitioner orders diabetes education, the patient will go through a pre-assessment to determine the best course of action for their educational needs. Regardless of whether the patient receives one-on-one education or is in a group class, everyone gets individual attention and diabetes educators are available to provide whatever help the patient needs. This comprehensive education program covers the entire disease process, including therapies and medications, along with how treatments work in the body and possible side effects. “It is our belief that if patients understand how the medicines work, it will improve compliance and willingness to participate in therapies,” says Lohano.
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The Importance of Education Lohano believes that diabetes care involves two key components: the physician and diabetes education. “Diabetes is a chronic condition that the affects the patient 24-7,” he says. “Empowering the patient to understand the disease process and how different activities and foods affect blood sugar is as crucial as taking medication. It is a progressive disease. Even if you can control it today, there is no guarantee it will be under control in three or six months. After patients go through our DPP, our diabetes educators are available to them as a resource. If they have questions or issues, they have someone they can talk to who has seen them and knows them and can
Seeing patients sooner definitely helps, because once a complication — such as blindness, renal failure, or an amputation — occurs, we cannot reverse it. Prevention is key. — Dr. Vasdev Lohano address their particular issues. To me, that is invaluable.” Another piece of the diabetes treatment puzzle that Lohano finds particularly valuable is early treatment. Due to the amount
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Chronic Conditions
of information available on the internet and through social media, people are educating themselves and identifying themselves as at risk to develop diabetes. “We are getting more calls from people who come in for prediabetes at an earlier stage and demanding to see a specialist, whereas before we would not see a patient until much later in the disease process,” says Lohano. “Seeing patients sooner definitely helps, because once a complication – such as blindness, renal failure, or an amputation – occurs, we cannot reverse it. Prevention is key.” Lohano estimates that staff at the Joslin Diabetes Center sees 250-300 patients per week, but hopes to reach more. The center is open to any patients and physicians who wish to take advantage of the resources and services it has to offer, whether for diabetes or other endocrinology-related conditions. “We are happy to serve them,” states Lohano. “We are available however they want. If they just want to see educators, they do not have to be seen by a physician; they can just get the education and return to their own physician. I personally think we are fortunate to have this center in the area, and it should be utilized as fully as possible.”
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ISSUE #106 21
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Chronic Conditions
A Gut Feeling
Dr. Thomas Abell’s team at the Jewish Hospital Motility Clinic gets to the core of chronic illness BY JIM KELSEY LOUISVILLE “I’ve got this problem, and it won’t go
away.” Any physician dealing with chronic conditions has likely heard this statement hundreds of times. Through his work as medical director at the Jewish Hospital Motility Clinic, part of KentuckyOne Health in Louisville, Thomas Abell, MD, certainly has. Abell, who is employed by the University of Louisville Physicians group, has been practicing at the gastrointestinal Motility Clinic since its opening in the fall of 2012. There, he and the staff of 10 treat patients dealing with difficulties digesting food, whether it’s swallowing, nausea, vomiting, abdominal pain, constipation, or diarrhea. “Those illnesses are all common problems, but most of them are acute,” Abell says. “The problem is some people don’t get over it. Once it becomes a chronic condition – arbitrarily defined at about six months – treating those patients becomes a real problem for their primary doctors. That’s when they think about calling us.” Abell, who himself was a primary care physician earlier in his career, works closely with primary care doctors to help determine the
Dr. Thomas Abell, with U of L Physicians, is medical director of the Jewish Hospital Motility Clinic, part of KentuckyOne Health, and is trained in trauma medicine, family medicine, and gastroenterology.
This is gut failure. The good news is with the right diagnosis you can often times help people. — Dr. Thomas Abell problem, what treatments have been tried, and what diagnoses have been ruled out. “We really like to work with primary care
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doctors and have a partnership when we have a patient that is difficult to diagnosis,” he says. “It’s a team effort. We realize that the average primary care doctor has maybe seven minutes with a patient. We’re happy to try to help them and work with them.” Abell’s path to the Motility Clinic started at the Sanford School of Medicine of the University of South Dakota. He went on to complete residencies at Ohio State University College of Medicine and University of Tennessee College of Medicine and fellowships at Mayo Medical School and the University of Tennessee. He is trained in internal medicine, family medicine, and gastroenterology. At the Motility Clinic, Abell is joined by Abigail Stocker, MD, and Lindsay McElmurray, PA. Together, they received approximately 1,000 referrals and saw nearly 2,800 patients in 2016, including monitoring of approximately 100 home health patients. “The average person we see has been sick for several years,” Abell says. “When chronic illness people become very discouraged, depressed, they have financial stress, it affects the whole family. They often can’t eat. They’ve lost weight or they become overweight because they find that all they can eat is carbohydrates. Some of our patients only move their bowels every two
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weeks or they have diarrhea so bad that they can’t go out of their house. We spend a lot of time on the psychological aspects of chronic illness because you have to take care of the whole person.” That care begins with diagnosing the cause of the problem. Diabetes is the single most common cause for these digestive conditions, but that has often been diagnosed by the time the patient gets to the clinic. Many of the other causes are autoimmune. Abell says that nearly 80 percent of the patients are women. For some, it’s pregnancy-related nausea that never goes away. For others, chronic vomiting is a byproduct of a surgery to remove a tumor. Other causes might be genetic. A variety of tests are used to help with the diagnosis, including x-rays, endoscopy, barium studies, scans, specialized blood tests, and electrical recordings. “Instead of heart failure or kidney failure, this is gut failure,” Abell says. “A lot of these are systemic illnesses, and part of that is that their gut basically fails. The good news is with the right diagnosis you can often times help people. We don’t give up when we’re trying
to find out what’s wrong. Once we figure out what’s wrong, we can work on how to treat it.” In some cases, that treatment includes new drugs, administered through clinical trials. The clinic is part of the National Institutes of Health’s (NIH) Gastroparesis Clinical Research Consortium. This involvement in the consortium allows the clinic to follow patients over time and study the results of treatment. “We also offer some investigational therapies through the NIH – all free of charge through a grant through U of L,” Abell says. “People can get access to things that are only available a few places in the country. We’re very grateful for our ability to provide these. Our whole goal is to try to learn more about these disorders and then disseminate the information. That’s why the NIH Consortium is there, to try to impact patient care.” In addition to their involvement with the NIH, Abell and his staff have developed a number of strong relationships with other physicians and departments, enabling the patients to benefit from the knowledge and resources of a variety of specialists. “We have strong relationships with surgery (which is part of our
Chronic Conditions
clinic), and with endocrinology, psychology and psychiatry, rehabilitation medicine, pain management, and nutrition, among others,” Abell says. “We have access to a lot of resources to help our patients.” Support groups are another resource patients are encouraged to use. The feelings of hopelessness, discouragement, and despair can be overwhelming for patients dealing with years of chronic illness. There’s often frustration over the inability to understand and identify the root cause of the illness. The illness, ultimately, can become psychological as well as physical. Sharing those feelings with others who understand and are confronting many of the same issues can be a big part of the healing process. “Having one patient tell another patient about their experience is much more effective than me telling them,” Abell says. “You just can’t replace that.” There aren’t always cures and the symptoms can’t always be eliminated. But Abell believes in his gut that the Motility Clinic has the resources and expertise to help people. “I had this problem for a long time, but it finally went away.” ISSUE #106 23
Mental Wellness
The Art of Giving Selfishly BY JAN ANDERSON, PSYD, LPCC
What cranks your career? A sense of personal mission to help people heal and to be of service is what drives many of us in the healthcare profession. If you fit this career orientation or are in a relationship with someone who does, you know that making a difference is as important as making a living. After all, it’s called a helping profession for a reason. So I couldn’t help but be surprised when I heard Dr. Alex Gerrasimides mention that her husband, Louisville Mayor Greg Fischer, encountered some blowback when he signed a resolution committing to a multi-
Relationship and Life Strategist Counseling for Executives and Professionals Private, Discreet Setting No Sign, No Waiting Room Available for Speaking, Training & Workshops
502.426.1616 DrJanAnderson.com Jan Anderson, PsyD, LPCC
year Compassionate Louisville campaign on November 11, 2011. The objection? Pursuing the pledge to make Louisville a more caring city sounded “weak,” according to some concerned city leaders. Now is certainly not a time for Louisville to be perceived as weak – not when our business leaders are striving to accelerate business competitiveness, economic growth, and job creation to position Louisville in the top tier of American cities. After all, nice guys finish last, right? There’s solid evidence that suggests that statement is true. Just ask Adam Grant, the youngest tenured professor at the University of Pennsylvania Wharton School, who has studied over 30,000 people across dozens of industries around the world’s cultures. He’s looked at everything from medical students’ grades to engineers’ productivity to salespeople’s revenue. Not surprisingly, the worst performers in each of these jobs were ... the givers. “The engineers who got the least work done were the ones who did more favors than they got back. They were so busy doing other people’s jobs they literally ran out of time and energy to get their own work completed. In medical school, the lowest grades belong to the students who agree most strongly with statements like, ‘I love helping others,’ and in sales, too, the lowest revenue accrued in the most generous sales people.”
So Nice Guys Finish First After All… Here’s the twist, though: Grant says that in every job in every organization he’s ever studied the best results belong to ... again, the givers. Not the takers, who rise quickly but ultimately fall at the hands of what Grant calls
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“matchers,” those that give only as much as they get. A matcher’s “I’ll do something for you if you do something for me” approach to relationships may feel too transactional to the rest of us, but that insistence on equity comes in handy when it’s time to take down a taker. Givers go to both extremes – they are the best and worst performers of every performance metric that Grant has been able to track. Why? Because in the process of being taken advantage of, outmaneuvered, overtaken – and before they get totally burned out – givers make their organizations better. “We have a huge body of evidence … the more often people are helping and sharing their knowledge and providing mentoring, the better organizations do on every metric we can measure: higher profits, customer satisfaction, employee retention – even lower operating expenses,” according to Grant.
How Givers Get Ahead… Way Ahead So if you’re a giver, take heart. Now all you have to do is figure out how to move from the over-giver side of the scale to the successful end of the scale. Here’s how it works: • Think of “over-giving” as not so much a bad thing, but as too much of a good thing. Keep the big picture in mind: The goal isn’t to stop giving. It’s to protect yourself from being taken advantage of or getting burned out – so you can keep on giving and enjoying it. • Be aware that the problem with over-giving is that it doesn’t feel like over-giving. In fact, doing anything else would feel terribly wrong. In the mind of an over-giver, the absolute worst thing someone could say about you is that you’re selfish. You’re a taker – the kind of person we don’t hear from except when they want something
Mental Wellness
from us. Almost as bad as a matcher – someone who only gives to get. • Recovery from over-giving requires you to incorporate a small amount of the taker and matcher mentality. Whoa! Did I just suggest that you need to become a little more like the most odious people on earth? Yes. Here’s how it works: Takers feel entitled to take all and give little or nothing in return. A subclinical dose of that mentality is simply, “I count, too” – which translates into the rather matcher-like behavior of requiring more balance in the give/take dynamic. • A bonus: Along with handling the takers and matchers in your world much better, if you have any tendency to feel slightly self-righteous and superior to them (just a guess), you’ll also find yourself less reactive, less judgmental and spending a lot less time ruminating about them. • This is psychological work. (Translation: It will take some time, and you may need some help.) Here’s what it will look like when you make the shift to successful giver behavior:
You Give with Boundaries Three-time tech start-up CEO Adam Rifkin suggests, “Think of it as finding small ways to add large value to other people’s lives.” Your time is valuable, so focus on what Professor Grant calls five minute favors, as simple as “making an introduction between two people
who could benefit from knowing each other. It could be sharing your knowledge or giving a little bit of feedback. Or it might be even something as basic as saying, ‘You know, I’m going to try and figure out if I can recognize somebody whose work has gone unnoticed.’” For more involved favors, freelance writer Nadia Goodman asks herself, “If I’m going to spend a lot of time helping this person, is this something I can help with uniquely, or could someone else do it as well?”
You Know How to Receive Well Being a giver can be addictive. It feels strong, powerful, and darn good to always be the one that knows what to do, knows how to do it, and then does it. Yes, it’s slightly out of touch with reality, but what the heck – it’s whole lot more fun than bumping up against our limitations, our insecurities, and the annoying (and sometimes terrifying) truth that we’re frail and human. If you really suck at receiving well, here’s some good news: Paradoxically, your giving and receiving doesn’t have to be 50/50 to create a harmonious balance. One creative client took her first small step toward receiving well by requiring that a third party be the receiver of the quid-proquo. Another client simply practiced accepting compliments with, “Thanks! I appreciate that!” rather than his usual “So what do you want?” brush-off.
Successful givers are even good at asking for help. Sometimes they even see it as doing the other person a favor by letting them help!
You Practice Sustainable Giving “Giving is hard to sustain if it constantly feels like a chore,” Professor Grant says. In other words, it’s not selfish to give in ways that you enjoy and find meaningful. It’s smart and sustainable. For 15 years I was a volunteer facilitator of the Living Through Grief program at our local hospice organization. I loved doing grief counseling and always felt like I got even more than I gave. I observed that one of the most difficult experiences for a grieving person is that those around them are often uncomfortable about what to say to them – so they avoid them, or say nothing, or with all the best intentions say profoundly unhelpful things. These days I’ve found a way to convert my grief counseling skills into a five minute favor I can offer those I encounter in my everyday life who are grieving a death. It only takes a few moments to simply acknowledge the person’s loss and offer my condolences. Remember, the goal isn’t to stop giving. It’s to protect yourself from being taken advantage of or getting burned out – so you can keep on giving and enjoying it. Feel better now? I’m glad I could help. Now please pass this article along to someone who needs it.
ISSUE #106 25
Complementary Care
An Overlooked Complication Smart diabetes management includes routine hearing tests
BY LISA MEEKER
■■Use ear protection. Everyone is at risk of noise-induced hearing loss. But using ear protection is one of the best – and simplest – things you can do to preserve your hearing. Carry disposable earplugs with you, especially when you know you’ll be somewhere noisy. Use appropriate ear protection in loud work environments. Keep the volume on smartphones and other electronics low. Most of all, limit your time in noisy environments.
LEXINGTON Hearing loss is about twice as com-
mon in people with diabetes, yet hearing tests are frequently overlooked in routine diabetes care. In fact, some experts believe that hearing loss may be an under-recognized complication of diabetes. High blood glucose levels, over time, can damage the blood vessels and nerves of the inner ear, diminishing the ability to hear. Many times, hearing loss is prevalent among people with diabetes and has a strong association with peripheral neuropathy. Studies show that between the ages of 60 and 75, patients with well-controlled diabetes have better hearing than those whose diabetes was poorly controlled, shedding light on the importance of keeping diabetes under control to maintain healthy hearing. Deanna Frazier, AuD, of Bluegrass Hearing Clinic states: “We strongly encourage people with diabetes to include regular hearing tests as part of their routine diabetes care. Unaddressed hearing loss can interfere with good diabetes management, and untreated hearing loss is often associated with other significant physical, mental, and emotional health conditions.”
5 Habits for Healthier Hearing for People with Diabetes To help protect your hearing, be sure to follow these five healthy habits: ■■Get a thorough hearing exam every year and watch for signs of hearing loss. You do it for your eyes. Now do it for your ears. Be sure to see a hearing healthcare professional every year for a thorough hearing examination. If you notice a change in your ability to hear under certain conditions – like at a restaurant or on a conference call – go sooner. ■■Use hearing devices, if recommended. While hearing loss is not reversible, today’s hearing 26 MD-UPDATE
Deanna Frazier, AuD
devices can dramatically enhance your ability to hear and engage with others, which can make a tremendous difference in your overall quality of life. Hearing technology has advanced radically in recent years. Many hearing devices adjust to a variety of noise environments and pick up sound from all directions. Best of all, many include wireless connectivity. Today’s hearing technology can stream sound directly from your smartphone, home entertainment system, and other electronics into the hearing devices at volumes just right for you. ■■Keep your blood sugar under control. Just as your heart, eye, and nerve health are affected by your blood sugar levels, your hearing health may be as well. Work with your doctor to monitor your blood sugar and take appropriate medicines as prescribed. ■■Maintain a healthy lifestyle. Even for people without diabetes, a healthy lifestyle benefits hearing health. Not smoking, exercising, and maintaining a healthy diet all support your ability to hear. In fact, studies show that smoking and obesity may increase the risk of hearing loss, while regular physical activity seems to help protect against it.
Lisa Meeker is the marketing director of Bluegrass Hearing Clinic. She can be reached at 1.800.470.4757.
Our trusted Doctors of Audiology have been providing superior hearing health care since 1997.
1 (800) 470-4757
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Complementary Care
Common Wealth BY MAC STONE GEORGETOWN A trend among organic produce
farmers is to enter a contractual relationship with their customers known as Community Supported Agriculture (CSA). Basically, the customer makes a lump sum payment in the spring and the farmer agrees to deliver a box of fresh veggies every week, all summer long. By making the decision to pre-pay for your fresh, wholesome, organic food at the beginning of the farming season, you gain a sense of calm from making a wise investment, it puts you at ease with healthy eating, and ultimately, you have contributed to stabilizing the local food economy. As our family farm, Elmwood Stock Farm, began developing this business model, we have seen a symbiosis emerge. The relationship between the grower and CSA shareholder goes well beyond numbers on a spreadsheet. The true value is almost immeasurable.
To Start, an Investment The seasonality of cropping systems in Kentucky calls for large cash outlays in late winter and early spring to bring the greenhouses to life and for the fertile fields to bear fruit. Seeds, rhizomes, potting media, propane, diesel, irrigation supplies, and the willing hands to manage all the moving parts must be paid for long before the cash flow from vibrant farmers markets starts coming. Our CSA shareholders› investment in us provides firm financial footing to begin the season. With a strong CSA, not only do we avoid the interest payments of a loan, we avoid the hassle, documentation, and headaches of servicing that loan. Rather, we have a warm and transparent relationship with our shareholders. We grow the food with each of them in mind.
Our Food Responsibility With the awkward financial part out of the way, we can focus on growing food. We can get bulk discounts, we can lay in supplies ahead of the busy season, and we can be timely in our operations. We move through the day with pride and determination, our minds free to make clear decisions. The customer
gets to revel in the anticipation of what each week’s CSA share might bring. You know your kale and your tomatoes are being tended to, awaiting just the right time to be harvested and delivered to you. Chances are, you will be paying more attention to the weather since your little plants are out there in it. When you are a CSA shareholder, how food is grown is more prominent in your mind. CSA shareholders are often more seasonal eaters, look for organic first when shopping, enjoy experimenting with new recipes, and play with food. Over time CSA shareholders learn to keep it simple and let the freshness and flavors of the foods speak for themselves. The most valuable part of our contract with shareholders is the shared relationship with food for health. One reason people join the Elmwood Stock Farm CSA is to learn more about how food is grown, not just who their farmer is. By investing in us, you can avoid genetically modified organisms lurking in the picture-perfect sweet corn, squash, and zucchini, or avoid food grown with the release of toxic pesticides into the environment, much less those toxins being applied to the food itself. You can eat in peace because we are diligent about organic! Rarely does a weekend go by that a customer does not come to the farmers market and say, “My doctor told me to start eating what you have for sale.” Let the food be thy medicine. A recent University of Kentucky study shows CSA subscribers spend less time in a
doctor’s office and lots less on pharmaceuticals than the average Kentuckian. We partner with several companies and institutions that subsidize employees’ CSA shares with our organic farm to promote healthy eating and, by extension, a healthy lifestyle, figuring it will pay dividends in the long run. (Contact us if you’d like to talk about a voucher program or employer-sponsored health benefit for your employees.) Essentially, many of the top preventable causes of death are diet and lifestyle related. Be it sugar, bad fat, preservatives and additives, or residual toxins, you won’t find them in the food that Elmwood Stock Farm provides to you. Your CSA investment places a stake in the ground, literally and figuratively. By uniting with other investors, there can be a shift in the local food economy. Collectively voting with your food dollars this way spurs organic methods research, gives us access to equipment and supplies, and ultimately economies of scale kick in to produce food the way we do. The tentacles of your investment reach well beyond the farm gate. It is a self-fulfilling prophecy – a paradigm shift in the making.
Early Season Start-Up We have begun awakening the sleeping giant we call soil. Greenhouses are warm and starting to fill up with trays of seedlings. Boxes and bags of expensive organic seed are being delivered daily. The financial and moral support of our CSA members puts a little pep in our step. Our customers know those flavorful strawberries, tasty tomatoes, and the super sweet corn are waiting, a weekly birthday surprise, of sorts. Seems like a mutually beneficial, symbiotic relationship to us. Mac Stone, his wife, Ann Bell Stone, and extended family operate Elmwood Stock Farm in Scott County, Ky. Mac was the executive director of marketing for the KY Dept. of Agriculture, administering the Kentucky Proud program among many others. He is former chair of the U.S. Dept. of Agriculture’s National Organic Standards Board. His focus is on farming and marketing organic foods for the family and working with non-profit agriculture and food organizations. Mac can be reached at 859.621.0756. ISSUE #106 27
News
LEXINGTON CLINIC ANNOUNCES 2017 BOARD OF DIRECTORS
Umansky
Cecil
LEXINGTON At Lexington Clinic’s annual Board
of Directors meeting the following officers were elected to serve for the year: President – Stephen C. Umansky, MD Vice-President – Michael T. Cecil, MD Secretary – Kimberly A. Hudson, MD Treasurer – Andrew C. McGregor, MD Other members of the board include Haider Abbas, MD, Kyle Childers, MD,
Hudson
McGregor
Shailendra Chopra, MD, Robert Davenport, MD, Jamil Farooqui, MD, and Gregory Osetinsky, MD. Mr. Nick Rowe and Mr. Alan Stein were also added to this year’s board. They are the first non-physicians to sit on the Lexington Clinic’s Board of Directors and were selected because of their leadership roles in the community.
Mullett Receives ACS Quality of Life Award LEXINGTON The American Cancer Society
(ACS) recently honored University of Kentucky Markey Cancer Center surgeon Timothy W. Mullett, MD, FACS, with the Lane W. Adams Quality of Life Award. He was one of six recipients chosen for the national honor for his leadership in serving the complex needs of cancer patients and their families. The ACS Quality of Life Award honors persons who routinely excel in providing care to their patients experiencing cancer, going beyond the bounds of their duties. Lane W. Adams emphasized the importance of a “warm hand of service” during his vice presidency of the American Cancer Society. This award represents Adams’ credence to serve and enhance others being. Mullett has committed his time to lung screening and education by chartering Lung Screening Excellence in Kentucky and serving as co-investigator 28 MD-UPDATE
Morring Joins KentuckyOne Health Surgery Associates London LONDON D o n
Morring, MD, has joined KentuckyOne Health Surgery Associates, located at 1406 West 5th Street in London. Morring received Don Morring, MD his bachelor’s degree from Elizabeth City State University in North Carolina in 2005, and received his Doctor of Medicine degree from Meharry Medical College in Tennessee in 2010. In 2016, he graduated from Marshall University’s Department of Surgery in West Virginia. Morring has received honors and awards in research and academics throughout undergraduate and medical school, including the Excellence in Leadership award from the United States Marine Corps in 2001. He is certified in advanced cardiovascular life support (ACLS), advanced trauma life support (ATLS), and basic life support (BLS). He is a member of the American College of Surgeons.
Schmidt Receives NIH Grant to Study How Gut Microbiota Affects Malaria LOUISVILLE The
Dr. Tim Mullett accepting the Lane W. Adams Quality of Life Award at the ACS summit.
at Kentucky Lung Education Awareness Detection and Survivorship. As a stage 4 liver cancer survivor, he approaches patient care uniquely in comparison to his colleagues. Mullett is known for his devotion to providing availability to quality care for underrepresented citizens in Kentucky by working with nonprofit, government and medical groups. Mullett currently serves as medical director for both the Markey Cancer Center Affiliate and Research Networks. He has also served as a colonel in the Army Reserves, with deployments in 2004 and 2012.
bugs in our gut can help fight bugs from outside our bodies. N a t h a n Schmidt, PhD, has published research showing that Nathan Schmidt, PhD microbes in the gut of mice can affect the severity of illness suffered from infection with Plasmodium, the parasite that causes malaria. To pursue this research further, Schmidt, assistant professor in the Department of Microbiology and Immunology in the University of Louisville School of Medicine, has received a five-year research grant of $2.6 million from the National Institute of Allergy and Infectious Diseases, one of the National Institutes of Health. In his new research, Schmidt intends to determine which
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microbes are responsible for protecting against illness and to learn more about the mechanism behind that protection. “Now we are hoping to determine which bacteria or metabolites are interacting to determine the severity or lack of severity of illness in the individual,” Schmidt said. “If we can identify the bacteria, it raises hope that we can target those mechanisms to prevent severity of the disease, thereby reducing illness and death from malaria in sub-Saharan Africa.” Globally, malaria afflicts more than 200 million people and causes more than 400,000 deaths each year, with 90 percent of cases occurring in sub-Saharan Africa. However, many more individuals are infected with the Plasmodium parasite but do not become seriously ill. Schmidt’s research aims to learn more about why some people become seriously ill while others do not. In 2016, Schmidt published research in Proceedings of the National Academy of Sciences (PNAS) revealing that mice having one community of microbiota colonizing their gut were less susceptible to severe infection from Plasmodium than mice with a different community of microbiota. Schmidt is one of a growing number of researchers investigating links between gut microbiota and disease across the U of L Health Sciences Center campus.
Hospice of the Bluegrass is Now Bluegrass Care Navigators LEXINGTON Hospice of the Bluegrass is now
Bluegrass Care Navigators, the company announced February 1. “Our organization was founded as Community Hospice of Lexington in 1978,” said Liz Fowler, CEO. “As we expanded our service regions to other parts of the state, we changed our name to Hospice of the Bluegrass in 1986,” Fowler added. “And that name has served us well, until now. Our company has grown to provide a wide range of services in addition to hospice care, including private nursing, case management, palliative care, and grief care.” The Lexington-based nonprofit, which provides services throughout Kentucky, chose the name Bluegrass Care Navigators because it
Williams Speaks at First International Conference of Hospital Medicine
(l-r) Chung-Liang Shih, Charles Liao, Mark V. Williams, Jerome C. Siy, Toru Yamada, and Hung-Bin Tsai. LEXINGTON During a recent trip to Taiwan,
Mark V. Williams, MD, director of the Center for Health Services Research (CHSR), had the opportunity to share his expertise as a hospitalist and researcher with colleagues in Taiwan. Williams was invited by Dr. Ming-Chin Yang, National Taiwan University’s associate dean of the College of Public Health, and Dr. Nin-Chieh Hsu, a practicing hospitalist in Taiwan, to speak at the January 7 forum of hospital medicine at the first International Conference of Hospital Medicine. Williams focused his presentation on the now guides and provides care to more people in more ways. The company’s service line names will include Bluegrass Extra Care, Bluegrass Transitional Care, Bluegrass Palliative Care, Bluegrass Hospice Care, and Bluegrass Grief Care.
Baptist Health Lexington Awarded Advanced Stroke Certification LEXINGTON Baptist Health Lexington has earned
Advanced Certification for Comprehensive Stroke Centers from The Joint Commission and the American Heart Association/ American Stroke Association. Baptist Health Lexington is one of only
evolution of hospital medicine and the roles hospitalists play now and the role they will play in the future. With the overall goal of inspiring the planning and implementation of hospital medicine in Taiwan, this conference focused on the challenges, opportunities, and future of the field. Williams has been the director of the Center for Health Services Research since 2014. He also serves as chief of the Division of Hospital Medicine at UK HealthCare. More than 50 hospitalists in the division care for more than 200 hospitalized patients per day at UK HealthCare four healthcare organizations in Kentucky to hold this certification. To be eligible, hospitals must demonstrate compliance with stroke-related standards as a Primary Stroke Center and meet additional requirements, including those related to advanced imaging capabilities, 24/7 availability of specialized treatments, and providing staff with the unique education and competencies to care for complex stroke patients. To earn this certification, Baptist Health Lexington underwent a rigorous onsite review, during which Joint Commission experts evaluated compliance with stroke-related standards and requirements. ISSUE #106 29
Events
Heart Ball 2017 Brings Out Business and Community Leaders and Physicians
Dr. Frederick deBeer, dean emeritus, UK College of Medicine, and wife Marcielle
Dr. Andy Henderson, president, Lexington Clinic, and wife Peggy
Gil Dunn, MD-Update, with Bill Sisson, president, Baptist Health Lexington
LEXINGTON  A sell-out crowd of
500+ turned out for the 29th annual Central Kentucky Heart Ball presented by the American Heart Association (AHA) at the Lexington Center on Friday, February 3, 2017. The guest of honor was Darby Turner, philanthropist and attorney with the firm of Bingham Greenebaum Doll, LLP. All proceeds from the Heart Ball support the AHA, which funds public and professional education, advocacy, and scientific research. Research funded by the Association has yielded important discoveries such as CPR, life-extending drugs, pacemakers, bypass surgery, surgical techniques to repair heart defects, and more. Advocacy efforts have also resulted in the passage of a CPR in schools law this past year.
Kay and Tucker Ballinger, CEO/president, Forcht Bank
(l-r) Heart Ball Honoree Darby Turner and wife Charlotte with Rev. Larry Gaither, who gave the invocation Chantel & Mark Stoops, UK head football coach
William Houck, CEO, Georgetown Community Hospital, and wife Brittany
Cassondra and Dan Koett, VP, community relations, Central Kentucky YMCA
(l-r) Dr. Jeremiah Cerel, KentuckyOne Health, Dr. Sylvia Cerel-Suhl, and Laura and Bob Babbage
Kristy and Dr. Robert Sallee, director of cardiac surgery, KentuckyOne Health
Ben Kauffman and Bill Lear, partner, Stoll Keenon Park, LLP
Jim Elliott, VP, Kentucky Bank, and wife Suzanne
Dr. Ted Wright, UK cardiothoracic surgeon, and wife Saskia
Gil Dunn, MD-Update, with Dr. Magdalene Karon and husband Dr. John Stewart, medical director, Stewart Home & School in Frankfort
30  MD-UPDATE
PHOTOS BY JOE OMIELAN
Noted landscape architect Bill Henkel and wife Dr. Mary Henkel with Gil Dunn, MD-Update
Events
Seventeen past presidents of the Lexington Medical Society gathered for the annual group photo.
Lexington Medical Society Past Presidents’ Dinner LEXINGTON The annual Past Presidents’ Dinner
on January 17, 2017 featured a gathering of 17 former presidents of the Lexington Medical Society, including David Stevens, MD, who passed away February 7, 2017. Robert P. Granacher, MD, began serving his term as president and presented a full agenda of goals for the LMS in 2017 including supporting the KMA effort to enact tort reform through the Kentucky legislature, protecting the confidentiality of peer review, and pursuing judgment interest rate and medical collateral service rule reforms. Granacher also cheered the KMA goal of smoking cessation. Cory Meadows, KMA director of advocacy and legal affairs gave an overview of healthcare topics scheduled for the February legislative short session and asked that all physicians support the efforts of their societies and association. PHOTOS BY GIL DUNN
Past Presidents Dr. John Collins and Dr. Michael Moore with wife Diana (middle).
LMS Executive Director Chris Hickey and Past President Dr. Thomas Waid spoke at the Past Presidents’ dinner on the night’s agenda.
DEMOGRAPHICALLY SPEAKING
Past presidents Dr. Emory Wilson (far left) and Dr. David Bensema (far right) with Lorna G. Patchen, director UK-U of L Executive MBA Education Center (middle).
Cory Meadows, KMA, gave an update and forecast on bills affecting health and patient care in the current Kentucky legislative session.
Current LMS President Robert Granacher Jr., MD, MBA, congratulates immediate past president Dr. Thomas Slaybaugh Jr. at the completion of his term.
PHOTOS BY JOE OMIELAN
A figurative exhibition draws a crowd to Lexington Art League LEXINGTON The
annual exhibit at the Lexington Art League that celebrates and explores the human body had its preview party on Jan. 13, 2017. The exhibit posed the question, “Whose stories are being
Dr. Robert Baker and wife Dr. Sharon Napier
told in the art world?” and included the human figure in various evocative poses and situations. The exhibit ran January 27-February 24, 2017. MD-Update was a sponsor of the preview party.
Dr. Brian Smith and Kyndra Martin
Dr. Chip Richardson and wife Candy
Gil Dunn, MD-Update, with Rona and Steve Kay, Lexington vice mayor, came to the preview party to support the arts in Lexington and catch up with friends.
Dr. Derek Weiss and Nasim Noorazar
Dr. Rick Lozano and wife Amy ISSUE #106 31
Events
Mardi Gras Gala in London Raises Money and Awareness LONDON, KY Saturday, February 3, 2017
was the night for the Saint Joseph London Foundation to celebrate and honor Dr. Aqeel Mandviwala as the Physician of the Year. Hundreds of London area business and community leaders enjoyed a Mardi Gras themed festive event. The gala raised over $26,000 through sponsorships, contributions and 68 silent auction items. Mandviwala has practiced in London and the surrounding counties of southeastern Kentucky for over 20 years. He immigrated to London, Ky., from his birthplace in Karachi, Pakistan, and was the first pulmonologist to practice in that part of the state.
Physicians from Saint Joseph London gathered at the Foundation’s Mardi Gras Gala. Pictured (l-r) are: Dr. Oluwole John Abe, cardiologist; Dr. Aqeel Mandviwala, pulmonologist and 2017 Physician of the Year; Dr. Don Morring, general surgeon; Dr. Krista Preston, OB/GYN; Dr. Shelley Stanko, chief medical officer; Dr. Nancy Morris, chief of staff; and Dr. David Keedy, cardiologist. PHOTO PROVIDED BY KENTUCKYONE HEALTH SAINT JOSEPH LONDON
Erika and Dr. Oluwole John Abe
Physician of the Year Dr. Aqeel Mandviwala with wife Shanaz
Ed and Dr. Shelley Stanko, chief medical officer, Saint Joseph London
32 MD-UPDATE
PHOTOS BY GIL DUNN
Steve Klipp, president of PremierTox Laboratory, and wife Christy
2017 Editorial Opportunities Issue #107 l April HEART AND LUNG CARE Cardiology, Cardiac Surgery, Pulmonology, Sleep Medicine Issue #108 l May WOMEN’S HEALTH OB/GYN, Urology, Genetics, Prevention, and Wellness Issue #109 l June/July MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine, and Rehab
THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #97
SPECIAL SECTIONS PRIMARY CARE & SENIOR HEALTH BARIATRIC SURGERY
Issue #110 l August/September SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine
THE OPTIMAL AGING CAPITAL OF THE U.S.
Issue #111 l October CANCER CARE Oncology, Hematology, Radiology Issue #112 l November IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, Mental Health, Addiction Medicine
VOLUME 7•#1•JANUARY 2016
The U of L Institute for Sustainable Health & Optimal Aging is leading the charge for innovation and transdisciplinary care of older adults
ALSO IN THIS ISSUE PRACTICING DIRECT PRIMARY CARE SPECIALIZING IN LAPBAND® AND
THE ORBERA™ BALLOON THE COMPLETE BARIATRIC TOOLKIT A COMPREHENSIVE WEIGHT LOSS PROGRAM
Issue #113 l December 2017/January 2018 SENIOR HEALTH, PREVENTION, AND WELLNESS Primary Care, Senior Health, Family Medicine & Geriatrics, Bariatric Surgery, Alternative Medicine *Editorial topics are subject to change.
To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM | 859.309.0720 Jennifer S. Newton, Editor-In-Chief JNEWTON@MD-UPDATE.COM | 502.541.2666 SEND PRESS RELEASES TO NEWS@MD-UPDATE.COM
Pikeville Medical Center is a different kind of place in a nice way. Find out why approximately 300 physicians have found a home at Pikeville Medical Center.
Contact Ashley McCoy Director, Physician Recruitment
606-794-8548 606-218-4915
ashley.mccoy@pikevillehospital.org