The Journal of the Oklahoma Osteopathic Association
OKLAHOMA D.O.
May/June 2013 February 2014
Volume 78, No. 8
Oklahoma D.O. PAGE 1
Oklahoma D.O. | February 2014
WE KNOW OKLAHOMA HEALTHCARE AT PLICO, WE ARE HONORED TO INVEST IN OSTEOPATHIC EDUCATION AND COMMITTED TO PROTECTING YOU THROUGHOUT YOUR CAREER IN MEDICINE.
CALL US TODAY AND BEGIN EXPERIENCING THE DIFFERENCE THAT COMES WITH LOCAL SERVICE AND TRUSTED EXPERTISE.
“THROUGH THE PLICO BIOMEDICAL ETHICS FUND, PLICO PROVIDES A WONDERFUL RESOURCE FOR OUR COLLEGE OF OSTEOPATHIC MEDICINE. YOUR CONTINUED SUPPORT ALLOWS FOR THE APPOINTMENT OF AN ADJUNCT PROFESSOR TO DIRECT INSTRUCTIONAL ACTIVITIES RELATED TO THE MANY ETHICAL ISSUES SURROUNDING THE PRACTICE OF MEDICINE AND MEDICAL RESEARCH.”
Oklahoma D.O. PAGE 2
— KIRK JEWELL, PRESIDENT, OKLAHOMA STATE UNIVERSITY FOUNDATION
PLICO 405.815.4800 PLICO - OK.COM FINANCIAL STABILITY RATING ® OF A, EXCEPTIONAL Oklahoma D.O. | February 2014
The Journal of the Oklahoma Osteopathic Association
OKLAHOMA
May/June 2012 May/June 2013 February 2014
D.O.
Volume 78, No. 8
January 2012
Lynette C. McLain, Editor Marie Kadavy, Associate Editor
OOA Officers: Bret S. Langerman, DO, President (South Central District) Michael K. Cooper, DO, FACOFP, President-Elect (Northeastern District) C. Michael Ogle, DO, Vice President (Northwest District) Layne E. Subera, DO, FACOFP, Past President (Tulsa District) OOA Trustees: Kenneth E. Calabrese, DO, FACOI (Tulsa District) Dale Derby, DO (Tulsa District) Melissa A. Gastorf, DO (Southeastern District) Timothy J. Moser, DO, FACOFP (South Central District) Gabriel M. Pitman, DO (South Central District) Christopher A. Shearer, DO, FACOI (Northwest District) Kayse M. Shrum, DO, FACOP (Tulsa District) Ronald S. Stevens, DO (Eastern District) OOA Central Office Staff: Lynette C. McLain, Executive Director Lany Milner, Director of Operations and Education Matt Harney, MBA, Advocacy and Legislative Director Marie Kadavy, Director of Communications and Membership
The Oklahoma D.O. is published monthly from the Oklahoma Osteopathic Association Central Office: 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335. Marie Kadavy, Graphic Designer and Associate Editor
The OOA Website is located at www.okosteo.org
Oklahoma D.O. | February 2014
6
114th Annual Convention Program
13
114th Annual Convention Registration Form
14
“A Year of Achievement and Growth . . .” provided by Jamie Calkins, Marketing/Media Coordinator, OSU Medical Center
16
Legislative Report provided by Matt Harney, MBA
20
OOPAC Contribution Form
22 “Fanconi Syndrome and Nephrogenic Diabetes Insipidus in a Patient on Tenofovir-Didanosine Therapy” 26
“Clin-IQ Project Clinical Question: In adults with obstructive sleep apnea does continuous positive airway pressure (CPAP) treatment result in lower body mass index (BMI) compared to no CPAP treatment?”
provided by St. Anthony Family Medicine Residency
28
What DO’s Need To Know
29
2013-2014 OOA Directory Order Form
30
Bureau News
31
“Cortisol – The Stress Hormone to Keep in Check” provided by the American Osteopathic Association
32
February Birthdays
34 Classifieds 35
Calendar of Events
PAGE 3
For more information: 405.528.4848 or 800.522.8379 Fax: 405.528.6102 E-mail: ooa@okosteo.org
“We Value Your Input!” provided by Bret S. Langerman, DO, 2013-2014 President
Oklahoma D.O.
Copy deadline is the 10th of the month preceding publication. Advertising copy deadline is the 15th of the month preceding publication.
4
BRET S. LANGERMAN, DO President 2013 – 2014 oklahoma osteopathic association WE VALUE YOUR INPUT!
O Oklahoma D.O. PAGE 4
On Feb. 3, 2014, at the Oklahoma State Capitol, the flutter of legislative activity began as the Oklahoma legislative session officially opened. There was in excess of 2,200 pieces of legislation filed to be considered during this session. Of those 2,200 plus pieces of legislation, the Oklahoma Osteopathic Association (OOA) has identified just over 200 pieces of legislation that may have an impact on osteopathic medicine and what we do in our practices every day. With the help of our contract lobbyists, Gary Bastin and Mark Snyder, the OOA Bureau on Legislation under the leadership of LeRoy E. Young, DO, and Matt Harney, OOA director of advocacy and legislation, we will be watching and tracking these bills closely. As I have mentioned before, the OOA has been very successful at the Capitol with steering legislative in favor of us physicians.
I would like to thank those of you DOs who have signed up to participate in the Doctor of the Day program at the Capitol. There are still a few openings in March that we need to fill. If you are interested in helping with this, please contact Matt at the OOA office at matt@okosteo.org and he can assist you in signing up. As a reminder, please plan on attending the 114th Annual Convention sponsored by the Oklahoma Osteopathic Association. This will be held April 24-27, at the Embassy Suites Hotel and Conference Center in Norman, Okla. The event this year is being chaired by Michael K. Cooper, DO, and C. Michael Ogle, DO. There will be multiple specialty tracks available for CME and the social functions are sure to be outstanding. The OOA annual business meeting will be held on Thursday, April 24. DO OK
This success can only be attributed to the strength of the association and the grassroots efforts provided by YOU, the membership. As we identify issues we will need your help by contacting your local legislators and promoting the “physician point of view.” The OOA will keep you notified of the issues and when a call to action is needed. As you monitor session, if you identify issues of importance to osteopathic medicine, we would value your input and suggestions. It is only with your education of the issues and involvement in the process that we can remain a group of strength.
Oklahoma D.O. | February 2014
Get back to life faster. Sara Faccio Breast Cancer Patient
At Cancer Treatment Centers of America®, we can combine surgery and radiation into one procedure— so treatment time could be a lot shorter. When fighting cancer, every minute counts. That’s why we offer the Novac™7 Intraoperative Radiation Therapy (IORT) for breast cancer. With IORT, one precise, powerful dose of radiation is delivered to the tumor during surgery. Now one procedure could replace weeks of radiation treatments for some patients. One procedure. One time. And you’ll only find it at one place: Cancer Treatment Centers of America.
To discuss referring your patients, please call
800-261-1255 | cancercenter.com
Oklahoma D.O.
If you or a loved one is fighting breast cancer, you owe it to yourself to find out more.
PAGE 5
Scan to learn more about IORT Novac™7 Oklahoma D.O. | February 2014
©2012 Rising Tide
O
ER, D
114th
Annual
EN
NV
CO
N TIO
IL 24 APR , 2014 7 2 E: T DA
C
IR: HA
EL ICKA
M
OOP K. C
TING UES REQ 30-1A
MAN NOR BASSYS EM UITE N: S TIO
A
AO
TING UES REQ 30 DITS:
: ITS
D
E CR
E
CR
EL ICHA C. M LE, DO G :O
IR
HA
L C NA AM SIO GR ES PRO F O
CA
LO
FP
AA
PR
Y stival R A T N E M U C ilm fe O
Oklahoma D.O. PAGE 6
D family f
OKLAHOMA OSTEOPATHIC ASSOCIATION presents a ONE HUNDRED FOURTEENTH ANNUAL CONVENTION April 24-27, 2014 at the NORMAN EMBASSY SUITES-HOTEL AND CONFERENCE CENTER convention chair MICHAEL K. COOPER, DO, FACOFP professional program chair C. MICHAEL OGLE, DO the following PROFESSIONAL PROGRAM approval requested for 30 1A AOA CREDITS and program requested for 30 AAFP CREDITS from the AMERICAN ACADEMY OF FAMILY PHYSICIANS
G
GENERAL AUDIENCE ALL AGES AND PROFESSIONS ADMITTED
Oklahoma Osteopathic Association PRODUCTION
Oklahoma D.O. | February 2014
WEDNESDAY, APRIL 23 9:00 NOON5:00 8:3010:00
OOA/OEFOM Golf & Tennis Tournament Oak Tree Country Club, Edmond, Oklahoma Convention Registration: Norman Embassy Suites Presidential Reception Honoring OOA President Bret S. Langerman and First Lady DeLaine Langerman 8:009:00
114th Annual
s le track du e h c s IALTY
SPEC
THURSDAY, APRIL 24 11:00NOON NOON2:00
2:003:30
10:0011:00
OPENING SESSION: V. Burns Hargis, President, OSU LUNCH WITH EXHIBITORS OOA ANNUAL BUSINESS MEETING Presiding: Bret S. Langerman, DO
ACOFP UPDATE Presiding: Ryan Schafer, DO, President,
Oklahoma Society ACOFP Special Guest: Duane G. Koehler, DO, FACOFP, ACOFP Board of Governors
OKLAHOMA HOUSE OF DELEGATES MEETING
Oklahoma D.O. | March February 2014 2014
Oncology Track Importance of Integrative Oncology
Lorenzo Cohen, PhD (Professor and Director of the Integrative Medicine Program, Houston, TX)
Complementary Individual Medicine
Katherine Anderson, ND, FABNO (naturopathic medicine, Tulsa, OK)
PAGE 17
4:305:30
9:0010:00
Oklahoma D.O.
3:304:30
& 0 1 ICD ician Physrsement u b m i Re
Anesthesiology 114th Annual
s trackhedule Y sc
T SPECIAL
FRIDAY, APRIL 25
8:009:00 9:0010:00
10:0011:00
11:00NOON
NOON2:00 2:003:00
Oklahoma D.O. PAGE 28
3:004:00
4:005:00
Emergency Medicine
Internal Medicine
MORNING SESSION: “Interventional Pain Management: The Basics”
“Not Just for Kids Anymore! Intraosseous Vascular Access in the Emergency Department-Use of the Humeral IO in Adult Patients”
“Medical Certification of Airmen with Coronary Artery Disease, Valve Replacement and Atrial Fibrillation”
Larry D. McKenzie, DO (certified pain management, anesthesiology, Tulsa, OK)
Justin W. Fairless, DO, FAAEM (certified emergency medicine, Tulsa, OK)
Warren S. Silberman, DO, MPH (certified preventative medicine, internal medicine & aviation/ aerospace medicine, Oklahoma City, OK)
“Perioperative Diabetes Management: The Ups and Downs”
“Emergency Medicine in the Boonies”
“Asthma Update”
Neal W. Siex, DO (certified anesthesiology, Tulsa, OK)
Arthur G Wallace Jr., DO, MPH, FACEP (certified emergency medicine, Jenks, OK)
Thomas W. Allen, DO, MPH, FACP, FCCP (certified internal medicine, sports medicine & pulmonary medicine, Tulsa, OK)
“Post Pain Control By Use of Regional Blocks and Pain Pumps”
“The Freestanding Emergency Department: Fad or The Wave of the Future!”
“Considerations and Evaluation of the Preoperative Patient”
Dale Derby, DO (certified anesthesiology & family practice, Owasso, Oklahoma)
Chad E. Borin, DO (certified emergency medicine, Oklahoma City, OK)
Melinda R. Allen, DO, FACOI (certified internal medicine, Blackwell, OK)
LUNCH PROGRAM: “The Obese Anesthesia Patient and Obesity Surgery”
“Hypothermia Treatment Post Cardiac Arrest”
“Calcium Disorder”
Brian T. Harris, DO (certified anesthesiology, Tahlequah, OK)
Timothy A. Soult, DO (certified emergency medicine, Oklahoma City, OK)
Henry M. Allen, DO (certified internal medicine & nephrology, Oklahoma City, OK)
“PreOp Eval - What Anesthesia Wants to Know and Why. What’s It’s Worth to You”
“Alternative Airway Management”
“New Developments in Diabetes”
Daniel P. Kite, DO (certified emergency medicine, Oklahoma City, OK)
Kenan L. Kirkendall, DO (certified internal medicine, family medicine & pediatrics, Woodward, OK)
“Basic Perspectives on Disasters”
“Update on Adult Exercise Guidelines & Weight Management”
David E. Hogan, DO (certified emergency medicine, Oklahoma City, OK)
Stephanie J. Husen, DO (certified internal medicine, pediatrics & sport medicine, Edmond, OK)
Ronald S. Stevens, DO (certified anesthesiology, Muskogee, OK)
“Perioperative Evaluation and Treatment of the Cardiac Patient for Non-cardiac surgery” Jay D. Cunningham, DO (certified anesthesiology, Oklahoma City, OK)
Oklahoma D.O. | March February 2014 2014
OBGYN
Oncology
OMT
Neurology/ Psychiatry
Treating the Whole Patient with Trauma Osteopathically
Ronnie B. Martin, DO, FACOFP, dist (certified family practice, Blacksburg, VA); Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL); and Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL)
“Breast Cancer: Screening, Prevention, Diagnosis“
“Exercise Prescription for Low Back Pain”
“Clinical Neuro Anatomy Review for the Practicing Physician”
Marvin Williams, DO, FACOG (certified in Maternal Fetal Medicine and Obstetrics & Gynecology, Oklahoma City, OK)
Pamela Crilley, DO (certified Oncology & Internal Medicine, Philadelphia, PA)
Mark H. Thai, DO (certified OMM & family practice, Tulsa, OK)
Jay K. Johnson, DO (certified neurology, Tulsa, Oklahoma)
“Drop-in Prenatal Liability: Tag You’re It”
“Pulmonary Nodules”
“Basic Science for Alleviation of Chronic Musculoskeletal Pain”
“Migraine, Spells, & Medication Overuse”
Joseph R. Johnson, DO (certified obstetric & gynecological surgery, Tulsa, OK)
Daniel A. Nader, DO, FCCP, FACP (certified Pulmonary Medicine and Internal Medicine, Tulsa, OK)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
David Lee Gordon, MD, FAAN, FANA, FAHA (certified neurology & vascular neurology, Oklahoma City, OK)
“Abnormal Uterine Bleeding Associated with Ovulatory Dysfunction”
“Cervical / Ovarian Cancer “
“Basic Science for Alleviation of Chronic Musculoskeletal Pain Lab”
“Women’s Issues in Epilepsy”
Elizabeth K. Harris, DO (certified obstetrics & gynecology, Tahlequah, OK)
Tashanna K.N. Myers-Gibson, MD, FACOG, FAAHPM (certified obstetrics & gynecology, gynecologic oncology and hospice and palliative medicine, Springfield, Massachusetts)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
Andrea S. Hakimi, DO (certified neurology & clinical neurophysiology, Oklahoma City, OK)
AOA Update & MOL/OCC
Robert S. Juhasz, DO (certified internal medicine, Warrensville Heights, OH)
“Differential Diagnosis of Dementia”
Bryan C. Roehl, DO, FACOOG (certified obstetrics & gynecology, Ada, OK)
Timothy Holder, MD, FAAFP (Oncology & Internal Medicine, Tulsa, OK)
Kelley J. Joy, DO (certified OMM & family practice, Tulsa, OK)
Jimmie D. McAdams, Jr., DO (certified psychiatry, Tulsa, OK)
“An Overview of Quality Initiatives in Women’s Health: The Paradigm Shift from Fee for Service to Value Based Purchasing”
“Genetics”
“Practical OMT: Demonstrating High-Yield Techniques For a Busy Family Practice”
“Movement Disorders- When to Refer?
Guy W. Sneed, DO, MBA, FACOOG, C-HCQM (certified obstetric & gynecological surgery, Tulsa, OK)
Michael A. Kayser, DO, FACMG, John L. Owens, DO (certified FAAP (Certified Medical Genet- OMT & family practice, Pryor, ics & Pediatrics, Tulsa, OK) OK)
Cherian A. Karunapuzha, MD (certified neurology, Oklahoma City, OK)
Urinary incontinence”
“Precision Medicine”
“Clinical Applications of Transcranial Doppler Ultrasound”
Diane Evans, DO, MS, FACOOG, FACOG (certified obstetrics & gynecology Walnut, MS)
Maurie Markman, MD (certified Internal Medicine, Medical Oncology, Hematology, Philadelphia, PA)
OMT Workshop
Ryan K. Hakimi, DO (certified neurology , Oklahoma City, OK)
PAGE 39
“Making OMM Work in a Primary Care Setting”
Oklahoma D.O.
“Comorbidities and Cancer Management”
AFTERNOON SESSION
“What’s New in Prenatal Screening”
Oklahoma D.O. | March February 2014 2014
MORNING SESSION
“Amniotic Fluid Abnormalities”
Anesthesiology 8:009:00 9:0010:00
10:0011:00
11:00NOON
Oklahoma D.O. PAGE 410
SATURDAY, APRIL 26
114th Annual
SPECI
s trackhedule ALTY sc
3:004:00
4:005:00
Internal Medicine
MORNING SESSION: Anesthetic Considerations in Chronic Pain Patients”
“So When the DEA Calls.....”
“Incorporating Mental Health into Internal Primary Care”
Daniel G. Morris, DO (certified pain management, anesthesiology, Tulsa, OK)
Jerry C. Childs, Jr., DO (certified emergency medicine, Oklahoma City, OK)
Thomas D. Schneider, DO (certified internal medicine, Tahlequah, OK)
Labor Anesthesia”
“Sepsis-Presenting to the ER”
“Caution: DMARD Zone”
Michael J. Major, DO (certified anesthesiology, Oklahoma City, OK)
Billy R. Bryan, DO, FACEP (certified emergency medicine, Oklahoma City, OK)
Debbie A. Gladd, DO (certified internal medicine & Rheumatology, Tulsa, OK)
“Postop Cognitive Decline”
“Oklahoma’s Native Dangers”
“Pulmonary Evaluation Revisited”
Ty A. Martindale, DO (certified anesthesiology, Oklahoma City, OK)
Kristopher K. Hart, DO, FACOEM (certified emergency medicine, Oklahoma City, OK)
James S. Seebass, DO (certified pulmonary medicine & internal medicine, Tulsa, OK)
NOON1:30 1:302:00 2:003:00
Emergency Medicine
LUNCH PROGRAM: “What Are In Anesthesia Infuriation Management System and How do I get me one?”
“Forensic Medicine in the ER: Helping the Police Investigators”
“The Physicians Prescription for Nutrition”
Ronald S. Stevens, DO (certified anesthesiology, Muskogee, OK)
Larry T. Lovelace, DO, FACEP (certified emergency medicine, Oklahoma City, OK)
Michele L. Neil, DO (certified internal medicine & sports medicine, Tulsa, OK)
“Neuro Trauma”
“EHR’s in the ER, The Good, Bad, and Ugly”
“Chronic Kidney Disease”
John B. Hill, DO (certified anesthesiology Norman, OK)
Gregory H. Gray, DO (certified emergency medicine, Tulsa, OK)
Beverly J. Mathis, DO (certified nephrology & internal medicine, Tulsa, OK)
“Emergency Management of Atrial Fibrillation”
“New Cholesterol Updates”
James B. Williams, DO, FACOEP (certified emergency medicine, Oklahoma City, OK)
Natasha N. Bray, DO (certified internal medicine, Fort Lauderdale, FL)
Oklahoma D.O. | March February 2014 2014
OBGYN
Oncology
OMT
Neurology/ Pediatrics Psychiatry
Treating the Whole Patient with Trauma Osteopathically
“Recurrent Pregnancy Loss”
“Prostate Cancer “
“Foot Treatment”
Lecture Title
Diane Evans, DO, MS, FACOOG, FACOG (certified obstetrics & gynecology Walnut, MS)
Douglas Kelly, MD ( boardcertified radiation oncologist, Tulsa, OK)
Michael K. Cooper, DO, FACOFP (certified OMM & family practice, Tulsa, OK
Nicole M. Willis, DO (certified pediatric, Vinita, OK)
“The Short Cervix”
“Communicating with the Cancer Patient”
“OMT Practicum - Neck and Upper Thoracic Dysfunctions.”
“Apply Osteopathic Principles to the Structural Exam of a Developing Child”
“Office Based Evaluation and Management of Concussion”
Marvin Williams, DO, FACOG (certified in Maternal Fetal Medicine and Obstetrics & Gynecology, Oklahoma City, OK)
Carol Dillard, PhD, LPC, LMFT
Robin R. Dyer, DO (certified OMM & family practice, Tulsa, OK)
Lisa E. Hart, DO (certified pediatric, Tulsa, OK)
Gabriel M. Pitman (certified Neurology, Oklahoma City, OK)
OSU-COM UPDATE ALUMNI MEETINGS
“Child Abuse and Neglect”
“Psych 101: How to Address the Psychiatric Needs of Your Patients in an Family Practice Setting”
Jeffrey M. Hunt, DO (certified Internal Medicine, Tulsa, OK)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
Sarah J. Passmore, DO (certified pediatric, Tulsa, OK) and Michael A. Baxter, DO (certified pediatric, Tulsa, OK)
W. John Mallgren, DO (certified psychiatry, Claremore, OK)
“Method for Alleviation of Chronic Musculoskeletal Pain Lab”
Draion M. Burch, DO, FACOOG (certified obstetrics & gynecology, Pittsburgh, PA)
Robert Irvin, DO (certified OMM, Fort Worth, TX)
Lecture Title
“Making Sense of Clinical Osteopathy: Functional Pathways to Recognition of Disease”
“Pediatric Concussion Assessment & Management”
Jay M. Williamson, DO (certified obstetrics & gynecology, Tulsa, OK)
Barry S. Rodgers, DO (certified Neuromusculoskeletal medicine & OMM, Oklahoma City, OK)
Stephanie J. Husen, DO (certified pediatrics, internal medicine & sports medicine, Edmond, OK)
Oklahoma D.O. | March February 2014 2014
“Rural Psychiatry/Telepsychiatry and The Future”
Vincel R. Cordry, Jr., DO (certified psychiatry, Oklahoma City, OK) “A Review of the Newer Oral Anticoagulants and Reversal Strategies” Ryan K. Hakimi, DO (certified neurology and Neurosonology, Oklahoma City, OK)
PAGE 511
“The “L- Word”- Lesbian Health AND “T-Talk”-Transgender Health”
Oklahoma D.O.
“Method for Alleviation of Chronic Musculoskeletal Pain”
AFTERNOON SESSION
“Colorectal”
MORNING SESSION
Ronnie B. Martin, DO, FACOFP, dist (certified family practice, Blacksburg, VA); Amanda D. Martin, DO (orthopedic surgery, Birmingham, AL); and Natasha Martin-Bray, DO (certified internal medicine, Fort Lauderdale, FL) “Endometriosis Treatment” “Skin Cancer” Buns of Steel “Childhood Obesity Buns of Still Identification and Treatment” “Puns of Still: Similes, Analogies, and Metaphors: Explanation of OMT Techniques for Patient “Prevention of Stroke: TreatUnderstanding and Enjoyment” ment of Acute Ischemic Stroke & Treatment of Hemorrhage/ R. Troy Lehman, DO, FACOOG Peter M. Knabel, DO Constance G. Honeycutt, Brian K. Lepley, DO (certified Aneurysm” (certified obstetrics & gynecolDO (certified OMM, addictive pediatric, Oklahoma City, OK) ogy, Woodward, OK) diseases & family practice, Glenpool, OK) Charles Morgan, MD
SUNDAY, APRIL 27 7:0010:00
10:0011:00
AOA CO*RE Rems Program
Thomas F. Jan, DO, FAOCPMR (certified physical medicine & rehab, Massa[equa, NY) & Daniel G. Williams, DO (certified Neuromusculoskeletal Medicine and Osteopathic Manipulation, Indianapolis, IN)
Opioid Prescribing Guidelines forOklahoma Health Care Providers in the Office-Based Setting Proper Prescribing Course-Sign in Required
Layne E. Subera, DO, FACOFP (certified family practice, Skiatook, OK)
11:00 1:00
Medical Protective Program
Gail Harris, Senior Risk Consultant (Clinical Risk Management, Vegas, NV)
annual convention activities
HOTEL RESERVATIONS
SeekingSitters
For hotel accommodations, please contact Wendy at Embassy Suites Norman - Hotel and Conference Center at 405-253-3547.
Oklahoma D.O. PAGE 612
Standard Suite is $145.00 a night. Check in: 3:00 pm/ Check out: 12 Noon. To avoid cancellation charges, reservations should be cancelled by 3:00 pm Room Cut-off is March 23, 2014 Room Amenities include: Two 32” televisions , Two phone lines with voicemail and data ports, Wireless Internet access, Hospitality center with microwave, refrigerator, and coffee maker. Don’t forget to mention you are with the OOA!
PRE-REGISTRATION is greatly appreciated! register online or on the convention form on page 13
Oklahoma D.O. | March February 2014 2014
Oklahoma Osteopathic Association’s 114th Annual Convention April 24-27, 2014 Embassy Suites Norman - Hotel and Conference Center 2501 Conference Drive, Norman, OK 73069 Full name: _____________________________________________________________________________________________________________________ Preferred Name / first name for name badge: __________________________________________________________________________________________ Office address: _________________________________________________________________________________________________________________ City: ____________________________________________________________________ State: ____________________ Zip: _____________________ Email: _______________________________________________________ Phone: ________________________________________________________ OTHER NAME BADGES NEEDED FOR:
check the box, if you plan to register this child in SeekingSitters
Spouse: ___________________________________________________________________________________ Guest(s): __________________________________________________________________________________ Children/Teens :
(age)
(age)
(age)
NOTE: All convention registrants, Teens, Children, and Guests MUST wear an OOA name badge to enter the exhibit hall. We suggest listing all of your guests above to save you time during the registration process.
On/Before April 17, 2014
DO Member Registration (or other AOA divisional society member) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 (Includes Sunday’s Proper Prescribing Lecture and Risk Management Program) Retired DO Member Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $300 DO Nonmember Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $1,090 Spouse/Guest/Exhibitor Events Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $220 MD and Non-Physician Clinicians Registration* . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $540 Osteopathic Medical Student: OMS-I OMS-II OMS-III OMS-IV . . . . . . . . . . . . . . . . . . . . .$0 Intern Resident Fellow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $0
After April 17, 2014
$565
$325 $1,115 $245 $565 $0 $0
Registration is complimentary for osteopathic students and physicians in postgraduate training. They are welcome to attend all programs and convention functions at no charge. Please make event ticket requests at the OOA Registration desk. Badge required.
DO Member Registration for Sunday Program Only** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $195 DO Nonmember Registration for Sunday Program Only** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $745 MD and Non-Physician Clinician Registration for Sunday Program Only** . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $195
$220 $770 $220
Non-registered OOA Members may purchase Banquet tickets. I would like to purchase ________ Banquet ticket(s). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $75 each
$100 each
TOTAL AMOUNT DUE:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $______________
$______________
Registration includes name badges(s), registration gift and all meals and social events unless otherwise noted. *Registration includes name badge, certificate, and registration gift. **Registration DOES NOT include registration gift or meal tickets.
Charge my VISA, MASTERCARD, AMEX, DISCOVER:
Card #: ________________________________________________________________________________________________ Exp. Date:______________ Name (as it appears on card): _______________________________________________________________________________________________________ Billing Address: __________________________________________________________________________________________________________________ City: _______________________________________________________________ State: ___________________________ Zip: _______________________
My check in the amount of $______________ is enclosed and made payable to the Oklahoma Osteopathic Association.
Mail this form and payment to: Oklahoma Osteopathic Association: 4848 N Lincoln Blvd, Oklahoma City, OK 73105-3335 or FAX: 405-528-6102 NOTE: Due to the number of specialty tracks, a print syllabus will not be offered. A digital syllabus will be sent to registrants in advance for those wishing to print their own. All DO attendees must be members in good standing with their respective state association in order to attend at the announced fees. Otherwise, a DO may attend the convention by paying an additional $550, which may be applied towards OOA membership dues with completed application. Students, interns, residents, and fellows are not required to pay a registration fee and are welcome to attend all convention functions at no charge. Requests for refunds must be received before April 17, 2014, and a $45 service fee will be charged. NO REFUNDS AFTER APRIL 17, 2014.
A Year of Achievement and Growth . . .
provided by Jamie Calkins, Marketing/Media Coordinator, OSU Medical Center
In 2014, OSUMC celebrates 70 years of operations, in addition 2013 was a busy year for Oklahoma State University Medical Center (OSUMC), filled with strategic initiatives placed in motion and completed. In December 2013, OSUMC was transferred to a state trust governed by the Oklahoma State University Medical Authority (OSUMA), an agency of the State of Oklahoma. With this transfer, OSUMC received state funding, which anchored osteopathic physician education and OSUMC’s sustainability.
As we celebrate 70 years of providing exceptional health care this year, we confidently look forward to our next chapter of securing a long term, management partner and advancing our mission of providing health care and training osteopathic physicians of tomorrow. OSUMC will continue its commitment for another seven decades and beyond to meet and exceed standards for quality patient care, every patient, every time.
Oklahoma D.O. PAGE 14
Building a team of primary care physicians was our foremost objective. This year we saw the opening of our south side clinic, Riverside Primary Care where Loring Barwick Jr., DO, practices. Fred M. Ingram, DO, and Patrick Allen, DO, joined our team in Collinsville, and we added an internal medicine doctor, John C. Hervert, DO, who is practicing in our physicians’ center next to the hospital. Our growth continues into 2014 with the addition of Nadim Daher, MD, a pulmonologist who joined our team in early February.
In addition to hiring the physicians that complement and further our mission, significant physical improvements to OSUMC began with the $2.3 million renovations to our Department of Maternal Child Health (MCH). With an anticipated opening date of early summer, MCH will have 15 multipurpose, energy-efficient rooms that will accommodate a woman during labor, delivery, recovery and postpartum (LDRP). The new, enlarged LDRP rooms will have ample space for a healthy newborn, family members and a medical team.
Oklahoma D.O. | February 2014
Oklahoma D.O. PAGE 15
Oklahoma D.O. | February 2014
LEGISLATIVE REPORT provided by Matt Harney, MBA
Coburn announces retirement from U.S. Senate, creates political cascade
Republican Sen. Tom Coburn, MD, announced his retirement from the U.S. Senate, effective at the end of the current congressional session. Coburn has been battling cancer in recent months.
Oklahoma D.O. PAGE 16
“This decision isn’t about my health, my prognosis or even my hopes and desires,” Coburn said in a statement. “As a citizen, I am now convinced that I can best serve my own children and grandchildren by shifting my focus elsewhere. In the meantime, I look forward to finishing this year strong.”
las announced her plans to run for the now-open 5th congressional district. Douglas was not the only Republican to announce their candidacy as former state legislators Steve Russell and Shane Jett also plan to run. Jett ran for congress in 2010 and finished 4th in a seven-way primary. Appropriations Committee Chairman and State Sen. Clark Jolley announced on Jan. 23 that he will run for the seat as well. Former University of Central Oklahoma professor Tom Guild, retired DHS child welfare worker Marilyn Rainwater, State Sen. Al McAffrey and Keith Davenport have announced their candidacy as Democratic candidates.
Even in retirement, Coburn is staying true to his small government principles. The special election will be timed in alignment with the regular election dates in Oklahoma. The primary election is June 24. A runoff election is slated for Aug. 26, in the event no candidate receives more than 50% of the vote in a primary. The general election is Nov. 4. Coburn’s seat will be up for election to a full-term in 2016.
On Feb. 3, Gov. Mary Fallin addressed the State of the State in front of a joint session at the state capitol. Fallin outlined her priorities for the upcoming year, largely steering clear of any specifics regarding health care reforms.
As members of the U.S. House face elections every two years, no current Oklahoma congressman will be able to run for this now-open U.S. Senate seat without sacrificing candidacy for their current position. The 2014 midterms also feature elections for statewide office in Oklahoma and those incumbents will face the same scenario of being forced to choose one position for which to run.
Regarding the Department of Mental Health and Substance Abuse Services, Fallin said, “We’ve offered increased resources for programs assisting those suffering from mental health issues, including drug abuse and addiction—helping people get the treatment they need to rejoin their families and communities as productive, happy members of society.”
Coburn served in the U.S. House of Representatives from 19952001 and has been in the U.S. Senate since 2005.
Fallin went on to express her intention to pursue Medicaid reform. “I look forward to continuing our work with private insurers, our healthcare industry and business to transform our ‘sick care system’—one that only helps people after they’ve fallen ill—into one that truly improves health outcomes by emphasizing preventative care and healthy living.”
Coburn’s announcement has created a major shakeup in Oklahoma politics. Oklahoma’s congressman from the 5th district, James Lankford, declared his candidacy for the open Senate seat within days of Coburn’s announcement. As of the end of September, Lankford had more than $450,000 in his campaign account, which can be transferred to the U.S. Senate race. Former Oklahoma Speaker of the House T.W. Shannon announced his candidacy on Jan. 29 in a three-city swing through Tulsa, Oklahoma City and Lawton. Oklahoma Attorney General Scott Pruitt, Congressman Tom Cole and Congressman Jim Bridenstine announced they will not run for the senate seat. Former State Sen. Randy Brogdon, a Republican, expressed his intention to run for U.S. Senate after initially announcing his candidacy for governor in December. Democrat Matt Silverstein announced his candidacy last summer and had raised more than $250,000 as of Dec. 31, 2013. Silverstein is a financial advisor and investment planner from Tulsa. Tulsa attorney Clark Brewster and state senator Connie Johnson both entered the race in mid-February as Democratic candidates. Democrats in Oklahoma have not won a U.S. Senate race since 1990. On Jan. 21, Oklahoma Corporation Commissioner Patrice Doug-
Fallin delivers State of the State Address
The governor went on to say, “We also need to continue to encourage access to appropriate levels of care. Far too many people with non-critical health problems are receiving expensive, unnecessary treatment in emergency rooms.” While many individuals seek care in emergency rooms when they do not have health insurance, Fallin alleged that expanding Medicaid in Oklahoma would make the problem worse. Fallin also touted Oklahoma’s low unemployment rate, the need for capitol repairs, and a Rainy Day Fund of more than $500 million among many other issues.
Rep. Joe Dorman announces plans to run for governor, Brogdon changes course
State Rep. Joe Dorman, D-Rush Springs, recently announced his intentions to explore a run for governor on the Democratic ticket in 2014. Dorman was first elected to the state house in 2002 and is Oklahoma D.O. | February 2014
term-limited. In an email announcement on Dec. 17, Dorman said, “I feel good about the odds with the exploratory committee.” Dorman made it official on Feb. 3 with an announcement at the Tulsa Press Club. Dorman said he was motivated to run after he organized a statewide initiative—Take Shelter Oklahoma—for a $500 million bond issue to pay for storm shelters in schools. Dorman says he plans to make education funding a top priority in a potential race against Fallin. On Christmas Day, former State Sen. Randy Brogdon announced on his website that he’s challenging incumbent Gov. Mary Fallin by seeking the Republican nomination in 2014. Brogdon served in the state senate from 2004-2010 and also ran for governor in the last midterm election cycle in 2010. Brogdon received 39.4% of the vote against Fallin in the Republican Primary Election, despite collecting only about one-fifth of the campaign funds raised by Fallin. Fallin kicked off her re-election campaign in October of 2013 and has more than $1.6 million in her campaign account.
Oklahoma House and Senate kick off legislative session
The legislative session began Monday, Feb. 3 following Gov. Mary Fallin’s State of the State Address. More than 2,200 bills and resolutions were filed in the House and Senate for the 2014 regular legislative session. More than a couple hundred bills possibly impacting the profession and public health have been filed and are being tracked by the Oklahoma Osteopathic Association and our lobbyists. An unprecedented number of shell bills (bills that have a title and list the section of law affected, but include little else) have been filed for 2014. The OOA Bureau on Legislation met Wednesday, Feb. 5 to review several bills for further action by the OOA Board of Trustees. The Board’s position is:
approved a motion from the Bureau on Legislation supporting any bill that bans nicotine sales to minors. The following is a listing of bills and subjects of just a few being tracked: • HB 2554-Requires Oklahoma Board of Nursing to administer certain compact; requires board to make certain determination regarding nursing license; requires Executive Director to enter into certain compact; promulgates certain rules. • HB 2589-Makes morphine, oxycodone, hydrocodone, and alprazolam applicable to the Trafficking in Illegal Drugs Act; adds penalties. (Trafficking in Illegal Drugs Act) • HB 2600-Relates to public health and safety; prohibits the practice of surgical technology in a health care facility unless certain requirements are met; provides exceptions. • HB 2791-An Act relating to professions and occupations; amending language which relates to the Physician Assistant Act. • HB 3030-Oklahoma Prescription Monitoring Program Reform Act of 2014 • HB 3045-Creates the Health Care Price Disclosure Act; requires health care professionals and health care facility to make available certain pricing information to the public. • HB 3107-Physical Therapy Practice Act modification of requirements • HB 3361-An Act relating to nurse practitioners; creating the Oklahoma Nurse Practitioners Act of 2014; providing for noncodification; and providing an effective date. • SB 1262-Relates to licensure of practical nurses; removes certain requirements for licensure. • SB 1365-Relates to mental health and substance abuse services; amending language which relates to health benefit plans; requiring health plans to provide for credentialing of certain entities and disclose certain information. • SB 1611-Clarifying language relating to optometry. • SB 1788-Relates to optometry; relates to practice by unauthorized persons; provides penalties for unlicensed practice of optometry; provides certain exceptions.
SB 1267-OPPOSE SB 1267 requires practitioners at pain management clinics to check PMP before prescribing, administering, or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol and requires pain management clinics to obtain OBN registration.
To remain current on legislation the OOA and our lobbyists are following, please check the OOA Touch Blog at http://okosteo.org/ displaycommon.cfm?an=1&subarticlenbr=120
SB 1275-OPPOSE SB 1275 allows the OBNDD to collect administrative costs associated with an investigation of a violation by an OBNDD registrant regarding controlled substances.
On Jan. 23, Gov. Mary Fallin informed reporters of her intentions to cut state income taxes for the top bracket. The comments were made at an impromptu with capitol reporters. Fallin confirmed her comments during her State of the State address, which kicked off the 2014 legislative session Feb. 3. Her income tax proposal would cost the state $136 million. The plan was announced despite a projected $171 million budget shortfall. The actual budget shortfall has been identified to be $189 million.
Relating to growth of e-cigarettes and vapor products, the Board also Oklahoma D.O. | February 2014
A group of Republican lawmakers recently introduced House and Senate bills cutting Oklahoma’s top income tax rate from 5.25% to 4% within four years. The top bracket for state income tax includes those making more than $14,900 for those filing as single and over $27,400 for married couples.
PAGE 17
SB 1789-OPPOSE SB 1789 allows for optometric prescriptions of hydrocodone in the event hydrocodone changes schedule.
Oklahoma D.O.
SB 1973-SUPPORT SB 1973 protects individuals calling for emergency assistance for self or another individual who reasonably appeared to be in need of emergency assistance due to a drug overdose.
Fallin pushes income tax cut
The Oklahoma Tax Commission defines income tax brackets and rates below. Annual Payroll (after subtracting withholding allowances) For individuals filing as single: Income:
$0-$6,200: $6,200-$7,200 $7,200-$8,700 $8,700-$9,950 $9,950-$11,100 $11,100-$13,400 $13,400-$14,900 $14,900 & above
Tax rates:
$0 $0 + (0.50% of the excess over $6,200) $5.00 + (1.00% of the excess over $7,200) $20.00 + (2.00% of the excess over $8,700) $45.00 + (3.00% of the excess over $9,950) $79.50 + (4.00% of the excess over $11,100) $ 171.50 + (5.00% of the excess over $13,400) $246.50 + (5.25% of the excess over $14,900)
For married couples: Income:
$0-$12,400 $12,400-$14,400 $14,400-$17,400 $17,400-$19,900 $19,900-$22,200 $22,200-$24,600 $24,600-$27,400 $27,400 & above
Tax rates:
$0 $0 + (0.50% of the excess over $12,400) $10.00 + (1.00% of the excess over $14,400) $40.00 + (2.00% of the excess over $17,400) $90.00 + (3.00% of the excess over $19,900) $159.00 + (4.00% of the excess over $22,200) $255.00 + (5.00% of the excess over $24,600) $395.00 + (5.25% of the excess over $27,400)
An analysis below by the Oklahoma Tax Commission shows the following financial impact of Fallin’s 0.25% state income tax cut for the top bracket. These are averages based on adjusted gross income. $0-$15,999: $16,000-$33,999: $34,000-$59,999: $60,000-$99,999: $100,000-$999,999: $1 million+:
No money back $1-$19 back $22-$59 back $70-$108 back $160-$718 back $1,377 back
Patients First Coalition meets, considers upcoming legislation
Oklahoma D.O. PAGE 18
The Patients First Coalition hosted a series of meetings regarding upcoming legislation that impacts physicians and the quality of patient care. Patients First works to ensure quality care by protecting patients against scope of practice overreaches. Gabriel M. Pitman, DO, and Irvin Yen, MD, serve as co-chairs of the Coalition. The Coalition met Dec. 17 to discuss potential legislation requiring certification of surgical technologists. Rep. Will Fourkiller, DStilwell, presented educational requirements, job tasks and surgical technologists certification information in other states. Surgical technologists are also known as scrub techs. Currently, scrub techs are the only member of the surgery team not required to meet minimum educational and certification requirements. The Coalition met again on Jan. 21 with members of Gov. Mary Fallin’s staff, Department of Health Commissioner Terry Cline, Com-
missioner of Mental Health & Substance Abuse Services Terri White and a representative from the office of the OBNDD. Each of the representatives spoke about possible PMP (Prescription Monitoring Program) changes that could arise in the upcoming legislative session. Oklahoma is one of the only states where PMP is monitored by law enforcement. On Feb. 11, the Coalition met to discuss SB 1789, which allows optometrists to continue prescribing hydrocodone if and when it’s reclassified as a Schedule II drug. The Patients First Coalition unanimously supported a motion to oppose SB 1789. The bill expands the prescribing pool at a time when the governor and others within legislative leadership are already considering more excessive PMP requirements. Rep. Doug Cox, MD, R-Grove, also attended the meeting and spoke on behalf of HB 2384, a bill he’s authoring proposing widespread Medicaid cuts. The bill: • Cuts provider rates from 96.75% to 95% for Medicaid-to-Medicare fees • Requires prior authorization for all controlled substances (with exceptions for minors with attention deficit disorder or autism spectrum disorder • Requires prior authorization for all nongeneric pharmaceuticals for Medicaid patients • Decreases monthly prescription limits for Medicaid recipients to five. For those in long-term care facilities, the limit is reduced from unlimited to eight. • Limits Medicaid recipients to six ER visits per calendar year • Implements a study to evaluate potential cost savings of a competitive bidding process for durable medical equipment and diabetic supplies. Dr. Cox says the bill will save the Oklahoma Health Care Authority $45 million. This bill includes cuts for everyone—physicians, hospitals, pharmaceutical companies, and the Medicaid recipient as well. Dr. Cox believes the savings contained within the bill should help oppose any future attempts to privatize the Oklahoma Health Care Authority. Also discussed was Fallin’s state income tax proposal. Her proposal cuts the top income tax bracket by 0.25%, creating a budget shortfall of $136 million. This proposal could worsen the overall budget picture and negatively affect the appropriation for OSU Medical Center. The Coalition was also updated on developments regarding possible changes to PMP requirements.
Health Insurance Marketplace enrollment soars to 3 million
As of Jan. 24, nearly 3 million Americans had enrolled in private health insurance via healthcare.gov as a result of the Affordable Care Act. The open enrollment period continues through March 31, 2014. The participation of young adults is important to sustain the program. The enrollment of young people into the program will help offset older enrollees and minimize rate increases from private insurOklahoma D.O. | February 2014
ers. A previous press release from the Department of Health and Human Services had reported 30% of all new enrollees were age 34 or younger. The Obama Administration has a goal of 38% of all new enrollment to include individuals 34 or younger. Earlier in January, the Obama Administration announced an increase in the number of people eligible for Medicaid and the CHIP (Children’s Health Insurance Program), as a result of the insurance enrollment effort. Both programs provide coverage to poverty-stricken individuals earning below the poverty level. Fifteen states and Washington D.C. operate their own marketplaces. Oklahoma has yet to create a state-run marketplace, rejecting a $54 million federal grant in 2011. According to the 2012 Census, Oklahoma has more than 685,000 uninsured individuals. Research indicates approximately 337,000 Oklahomans are eligible to receive premium assistance through the Health Insurance Marketplace.
OHIP Tobacco Use Prevention Workgroup set targets
The Oklahoma Health Improvement Plan (OHIP) Tobacco Use Prevention Workgroup met in December to update objectives, goals and progress. The Workgroup consists of representatives from the State Department of Health, State Department of Mental Health and Substance Abuse Services, Tobacco Settlement Endowment Trust, Oklahoma Hospital Association, Oklahoma City-County Health Department, Oklahoma Alzheimer’s Association and the Oklahoma Osteopathic Association among others.
Joint Committee meets to review e-cigarette regulation
On Jan. 22, the House Public Health Committee and Senate Health and Human Services Committee met to examine e-cigarettes and their role as a tobacco product. Many e-cigarettes contain nicotine, but not all. Many anticipate the Food and Drug Administration to quickly address regulation of e-cigarettes in the near future, especially regarding a ban on sales to minors. Lawmakers worked to understand both sides of the issue. Mike Shannon, vice president of external affairs for Lorillard Inc. said, “The most important thing to remember is that an e-cigarette is not a cigarette. It’s the heating of liquid. There is no combustion.” Sean Gore, representing the Oklahoma Vapor Advocacy League, told lawmakers e-cigarettes “should be subject to sales tax only,” and not an additional tobacco tax. The Chief Medical Officer for the American Cancer Society Leonard Lichtenfeld, MD, mentioned the impact of e-cigarettes is still being examined by scientists. He said, “We don’t know consistently from product to product that it’s the same thing” as combustible cigarettes. Sen. Brian Bingman, R-Tulsa, said the legislature is looking to understand e-cigarettes and how it relates to successful smoking cessation. Several bills impacting e-cigarettes have been filed for the upcoming legislative session.
The Workgroup is focused on three goals: 1. Protecting all Oklahomans from exposure to secondhand smoke. 2. Preventing initiation of tobacco use by youth and young adults. 3. Increasing the percentage of Oklahoma adults and youth who successfully quit tobacco use. For each of these three goals, the workgroup updated the result objective, target and actual completion dates, accountable parties, measures (legislation) and current progress.
On Feb. 6, the OOA Board of Trustees voted unanimously to support the OHIP legislative agenda after being moved forward from the Bureau on Legislation the previous day.
Oklahoma D.O. | February 2014
PAGE 19
OHIP came about as the result of a 2008 legislative mandate to the State Board of Health to prepare a report outlining “general improvement of the physical, social and mental wellbeing of all people in Oklahoma through a high-functioning public health system.” According to the State Department of Health website, OHIP “outlines numerous key priorities and outcomes that will support health improvement throughout the state.”
Oklahoma D.O.
Also discussed was the OHIP 2014 Legislative Agenda. It includes: 1. Prohibiting the sale of e-cigarettes to minors. 2. Requiring multi-unit housing to provide information about their smoking policies to prospective renters. 3. Provide a tax credit for the construction of residential storm shelters.
Support OOPAC in 2014! DO your part To protect and promote osteopathic medicine in Oklahoma. 2014 OOPAC Investment _____ My personal check made payable to “OOPAC� is enclosed [ ] $100
[ ] $250-$500 (PAC Partner)
[ ] $501-$1,000 (Premier PAC Partner)
[ ] $1,001-$2,499 (Executive PAC Partner)
[ ] $2,500+ (Platinum PAC Partner) _____ Yes! I commit to monthly contributions to OOPAC. Please charge my credit card: [ ] $2,508 ($209 per month)
[ ] $1,200 ($100 per month)
[ ] $1,008 ($84 per month)
[ ] $504 ($42 per month)
[ ] Visa
[ ] MasterCard
[ ] American Express
[ ] Discover
Account number: ____________________________________________ Expiration date: _______ Name as it appears on card: _______________________________________ CID: ______________ Address: __________________________________________________________________________________ City, State, Zip: ___________________________________________________________________________ Occupation: __________________________________ Employer: _______________________________
Oklahoma D.O. PAGE 20
Signature: ________________________________________________________________________________ I declare that this contribution is freely and voluntarily given from my personal property. I have not directly or indirectly been compensated or reimbursed for the contribution. This personal contribution is not deductible as a donation or business expense.
Please mail to: OOPAC, 4848 N. Lincoln Blvd., Oklahoma City, OK 73105-3335.
Oklahoma D.O. | February 2014
stability matters. If there is one thing to learn from the recent financial turmoil, knowing who to trust is paramount. Medical Protective, a proud member of Warren Buffett’s Berkshire Hathaway, has always believed that to provide our healthcare providers the best defense in the nation, our financial stability needs to be rock-solid, stronger than any other company. Stability even in the worst of times. Medical Protective is the only medical professional liability insurance company to protect their healthcare providers through all the business and economic cycles of the last 110 years, including the tough economic times of the Great Depression. We are also proud to have provided unmatched defense and stability during all the medmal crises.
We have received higher ratings from A.M. Best and S&P than any other carrier in the healthcare liability industry.
Trust Stability. Trust Medical Protective.
Oklahoma D.O.
Contact Scott Selman at Rich & Cartmill, Inc. today for a medmal insurance checkup and a FREE, no-obligation quote. Call: 800-725-8811
All products are underwritten by either The Medical Protective Company® or National Fire and Marine Insurance Company,® both Berkshire Hathaway businesses. Product availability varies based upon business and regulatory approval and may be offered on an admitted or non-admitted basis. ©2011 The Medical Protective Company.® All Rights Reserved.
Oklahoma D.O. | February 2014
OK_OsteoSoc_full_1c_7'375x9'75.indd 1
PAGE 21
Email: sselman@rcins.com Visit: www.rcins.com
3/28/11 11:05 AM
CENTER FOR HEALTH SCIENCES Mousumi Som, DO, FACOI, Editor Assistant Professor of Medicine Department of Internal Medicine Fanconi Syndrome and Nephrogenic Diabetes Insipidus in a Patient on Tenofovir-Didanosine Therapy Andrew Patchett, DO Internal Medicine Resident Oklahoma State University Medical Center Jeffrey S. Stroup, PharmD, BCPS Associate Professor of Medicine Oklahoma State University Center for Health Sciences Mousumi Som, DO Assistant Professor of Medicine Oklahoma State University Center for Health Sciences
Oklahoma D.O. PAGE 22
Johnny R. Stephens, PharmD Associate Professor of Medicine Oklahoma State University Center for Health Sciences
INTRODUCTION In the United States (US), as of 2009, approximately 1.1 million people were living with human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS) and another 50,000 are infected each year (1). HIV, the virus that causes AIDS, is a retrovirus that can be spread through exposure to blood, semen, or vaginal fluid. In epidemiologic reports provided by the Oklahoma State Department of Health (OSDH), Oklahoma and Tulsa County are identified as the cluster areas for positive tests of HIV (2). The OSDH estimates that 48% of Oklahomans who are known to be HIV positive have not made a primary medical care visit in the past year (2). More specifically, youth ages 13-19 who are living with HIV bear the greatest disproportion among the populations with the highest unmet need (2). In regards to trends of populations with HIV/AIDS in
Oklahoma State University Center for Health Sciences College of Osteopathic Medicine 1111 West 17th Street Tulsa, Oklahoma 74107-1998
the state, 22% of all HIV/AIDS cases are related to IV drug use (4924 with HIV/ AIDS and 980 reported IVDU related); there has been a 39% increase in HIV-only cases in females (28 cases in 2000 and 39 in 2009); African American females have an incidence rate eight times higher than Caucasian females; the majority of deaths related to HIV/AIDS are among African Americans (2009, all males, 70% African American and 30% Caucasian); HIV cases among Hispanics males increased by 125% over the past 10 years (12 new cases in 2000 and 27 new cases in 2009); and since 2000, heterosexual cases have increased 44% (19 new cases reported in 2000 and 44 reported in 2009) (2). Renal disease is a known complication of HIV infection and may occur as an adverse effect of highly active antiretroviral therapy (HAART). Tenofovir, a nucleotide reverse transcriptase inhibitor, is indicated in combination with other antiretroviral drugs in patients infected with HIV-1 (3). There is a known association between tenofovir and renal disease in patients with HIV infection (4). CASE PRESENTATION A 55 year old Caucasian female presented to the Emergency Department with fatigue and a 20 pound unintentional weight loss over the previous 8 months. Her past medical history was significant for HIV diagnosed in 1995 with a CD4 count of 400 cells/ÎźL and viral load of 40 copies/ mL, hypothyroidism, and avascular necrosis of the left hip. Four days prior to her hospitalization she was seen by her primary care physician where she stated that she had stopped taking all of her medications secondary to possible side effects. She stated at that visit that she had been feeling fatigued with increased thirst and frequent
urination. She denied any fever, chills, night sweats, melena, cough, chest pain, or shortness of breath. The patient’s medications at that time were didanosine 250mg daily, tenofovir 300mg daily, lopinavir/ritonavir 400/100mg twice daily, levothyroxine 100mcg daily, hydrocodone/APAP 7.5/500mg daily, vitamin D 50,000 units weekly, and alendronate 70mg weekly. She quit smoking about 22 years ago, with a non-contributory family history. Her baseline creatinine at her primary care office was 1.1mg/dL. She was started on intravenous fluids for volume depletion. Over the initial twenty-four hours of admission, she was noted to have about 8 liters of urine output. Labs were reviewed and she was noted to have a non-gapped metabolic acidosis with significant hypokalemia. In addition she was found to have a very dilute urine. Nephrology was consulted for a working diagnosis of nephrogenic diabetes insipidus with a proximal tubular cell renal wasting syndrome. A water deprivation test was initiated. She received a desmopression suppression test after water deprivation and her urine osmolality went from 165 mOsm/kg to 103 mOsm/kg. This confirmed the diagnosis of nephrogenic diabetes insipidus. While in the hospital she did have a peak of urine output of 12 liters in a 24 hour period. She improved throughout her stay in the hospital with IV hydration, cessation of medications, and electrolyte replacement therapy with citric acid/potassium citrate solution. She was discharged from the hospital with improved kidney function and close follow-up by her primary care physician and nephrologist. Her urine output
Oklahoma D.O. | February 2014
had begun to stabilize and she was able to maintain adequate intake to account for her urinary losses.
Oklahoma D.O. | February 2014
Increased concentrations of ritonavir and didanosine have been suggested to be secondary to an interaction at the level of the proximal renal tubules involving mechanisms of transport. Tenofovir is absorbed
PAGE 23
DISCUSSION Tenofovir excretion is primarily through the renal proximal tubules (3-5). In a series of case reports, Peyeiere and colleagues described renal tubular dysfunction associated with tenofovir (6). They described events of acute renal failure and also those
There has also been an observational increase in adverse renal events with patients receiving lopinavir/ritonavir therapy (3,7,8). Zimmerman and colleagues demonstrated an increased risk in proximal renal tubular dysfunction, specifically Fanconi Syndrome, when taking ritonavir with or without lopinavir in combination with tenofovir (5). Plasma concentrations of ritonavir have been shown to increase by greater than 30% when taken in combination with tenofovir (8-10).
Didanosine has also been associated with Fanconi syndrome as described in a case review by Crowther and colleagues (9). Plasma concentrations of didanosine have been shown to increase by 30-60% when used in combination with tenofovir (11-12). Nephrogenic diabetes insipidus has also been diagnosed in patients that are taking combination HAART therapy with tenofovir and didanosine (5-8). Irizarry-Alavarado and colleagues described this process in three patients that received didanosine and tenofovir therapy (4). After cessation of tenofovir, both diabetes insipidus and Fanconi syndrome resolved (4).
Oklahoma D.O.
At her primary care follow-up, her basic metabolic panel was stable and her urine analysis improved with a specific gravity of 1.007, pH of 7.0, and 1+ glucose. Her HAART regimen was changed to abacavir/lamivudine and lopinavir/ritonavir. Her initial presenting symptom of thirst was improved and she had a significantly decreased urine output.
of Fanconi syndrome in patients on combination therapy with tenofovir (6). Renal disease associated with tenofovir is most likely multifactorial in nature with an increased risk due to combination therapy, specifically with didanosine or protease inhibitors (6-8).
from the plasma in the renal system by organic anion transport-1 (OAT1). Tenofovir, if accumulated in the cell, causes an increase in the production of mitochondrial DNA (mtDNA) in the proximal tubular renal cells (7). This may be the sign of early depletion of mtDNA production, leading to renal toxicity. The next process is that tenofovir effluxes into the urine via a multi-drug resistant protein type 4 (MRP4) (13). This was identified in a study by Kohler and colleagues in 2011, when etiologies of nephrotoxicity due to tenofovir were explored (7). Didanosine is transported into the proximal renal tubular cells via OAT1 transporter. However, there appears to be a compensatory mechanism for the transport of didanosine into the tubular cells in the absence of OAT1 (7). This compensatory mechanism shows an increase in mtDNA, leading to renal toxicity. Toxicity of tenofovir is shown to be secondary to an accumulation of tenofovir within the proximal tubular cells. This can happen through several different mechanisms that include: a) competitive inhibition of didanosine and tenofovir at the OAT1 transporter that leads to an upregulation of the didanosine alternate transporter and subsequent renal toxicity due to didanosine accumulation (7,9) and b) inhibition of the efflux mechanism by ritonavir which leads to the accumulation of tenofovir within the tubular cells (12).
Oklahoma D.O. PAGE 24
Initial treatment for this drug induced nephrotoxicity is removal of the offending agent. After removal of the agent, proper supplementation of electrolytes is advised with corrective fluid hydration. Patients typically respond dramatically to the cessation of tenofovir. Average recovery occurs over a 10 week period with a return of creatinine to baseline and correction of electrolyte abnormalities. Therapy with didanosine alone has not been shown to cause nephrogenic diabetes insipidus and fanconi’s syndrome. The combination with tenofovir is suspected to be the cause. The most common change in antiretroviral therapy is to abacavir/lamivudine and lopinavir/ritonavir. Resistance panels can be considered for more precise treatment regimens.
CONCLUSION HIV therapy with tenofovir is a very common regimen. However, it should be noted that tenofovir in combination with didanosine has an increased risk of side effects. The exact mechanism for why the increase in side effects is not well understood. If this therapy is absolutely necessary then regularly scheduled laboratory monitoring should be done. Patients need to be educated about possible symptoms of renal disease. Prescribing physicians should be aware of the symptomatology and abnormal laboratory that could suggest renal disease associated with therapy. Long term sequelae is not known to date, however continuation of medications can theoretically cause irreversible damage if not addressed in a timely manner.
Therapy, Report of 7 cases. J Acquir Immune Defic Syndr. 2004; 35:269-273.
7. Kohler JJ, Hosseini SH, Green E, et al. Tenofovir Renal Proximal tubular Toxicity Is Regulated by OAT1 and MRP4 Transporters. Lab Invest 2011; 91(6):852-858.
8. Rollot F, Nazal EM, Chauvelot- Moachon L, et al. Tenofovir- Related Fanconi Syndrome with Nephrogenic Diabetes Insipi- dus in a Patient with Acquired Immunodeficiency Syndrome: The Role Lopinavir-Ritonavir-Di- danosine. Clinical Infectious Dis- eases 2003; 37:e174-6.
REFERENCES 1. Centers for Disease Control (HIV/AIDS). Available at: http://- www.cdc.gov/hiv/basics/statistics.- html
9. Crowther MA, Calaghan W, Hodsman AB, et al. Dideoxyino- sine-associated nephrotoxicity. AIDS 2003; 7:131-132.
2. 2010 Oklahoma HIV/AIDS Comprehensive Epidemiologic Profile. Available at: http://- www.ok.gov/health2/documents/- HIV-2010EpiProfileUpdate.pdf
10. Schooley RT, Ruane P, My- ers RA, et al. Tenofovir DF in antiretroviral-experienced pa- tients: results from a 48-week, ran- domized, double-blind study. AIDS 2002; 16:1257-63.
3. Nelson MR, Katlama C, Montaner JS, et al. The safety of tenofovir disoproxil fumarate for the treatment of HIV infection in adults: the first 4 years. AIDS 2007; 21:1273-1281.
4. Irizarry-Alvarado JM, Dw- yer JP, Brumble LM, et al. Proxi- mal Tubular Dysfunction Associat- ed With Tenofovir and Didanosine Causing Fanconi Syndrome and Diabetes Insipidus. The AIDS Reader 2009;114-121.
5. Zimmerman AE, Pizzoferrato T, Bedford J, et al. Tenofovir-As- sociated Acute and Chronic Kidney Disease: A Case of Mul- tiple Drug Interactions. Clinical Infectious Disease 2006; 42:283- 90.
6. Peyriere H, Reynes J, Rouanet I, et al. Renal Tubular Dysfunc- tion Associated with Tenofovir
11. D’Ythurbide G, Goujard C, Mechai F, et al. Fanconi syn- drome and nephrogenic diabe- tes insipidus associated with didanosine therapy in HIV infec- tion: a case report and literature review. Nephrol Dial Transplant 2007; 22:3656-3659.
12. US Food and Drug admi- nistration. FDA report: back- ground package for NDA 21- 356: Viread 2001. Available at http://www.accessdata.- fda.gov/drugsatfda_docs/- label/2004/21356slr010_viread_- lbl.pdf.
13. Imaoka t, Kusuhara H, Ada- chi M, et al. Functional involve- ment of multi-drug resistance- associated protein 4 (MRP4/ ABCC4) in the renal elimination of the antiviral drugs adefovir and tenofovir. Mol Pharmacology 2007; 71(2):619-27. Oklahoma D.O. | February 2014
Oklahoma D.O. PAGE 25
Oklahoma D.O. | February 2014
In adults with obstructive sleep apnea does continuous positive airway pressure (CPAP) treatment result in lower body mass index (BMI) compared to no CPAP treatment? Jessica Booth, DO Family Medicine Resident, PGY-II Saint Anthony Residency Robin Gonzalez, MD Faculty Mentor Saint Anthony Residency
Oklahoma D.O. PAGE 26
Kalyanakrishnan Ramakrishnan, MD Faculty Mentor Saint Anthony Residency Answer: Yes, but insignificant Level of Evidence for the Answer: A Search Terms: obstructive sleep apnea (OSA), body mass index (BMI), and continuous positive airway pressure (CPAP) Date Search was conducted: September 2013 Inclusion and Exclusion Criteria: Inclusion Criteria: Systematic reviews published in the past 10 years comparing CPAP with other treatment or no treatment in obese human adults Exclusion Criteria: Obese children and adolescents, and obese adults without obstructive sleep apnea Summary of the Issues: Obstructive sleep apnea (OSA) is the most physiologically disruptive and dangerous of the sleep related diseases affecting one of every five adults (over 18 million Americans).1 This condition is being increasingly recognized though
the majority of patients still remain undiagnosed and untreated.2 Patients with OSA have diminished waking performance, increased risk of hypertension, cerebrovascular accidents, myocardial infarction, cor pulmonale, and motor vehicle accidents, contributing to decreased quality of life (QOL) and increased morbidity and mortality.1, 2 Most patients with sleep disturbances initiate evaluation and/or receive medical care in the primary care setting.2 Continuous positive airway pressure (CPAP) is the gold standard of treatment for all grades of OSA.2 Use of CPAP decreases risk of motor vehicle accidents and occupational injuries. CPAP can also improve hypertension; reduce hospitalization for cardiovascular and pulmonary disease, and decreases morbidity and mortality.1 Patients with OSA use health care resources at higher rates than control subjects for years before diagnosis.2 Recognition and treatment of OSA, when detected, should be part of the management of patients with diabetes, congestive heart failure, hypertension, or metabolic syndrome.2 OSA will become more prevalent as the population becomes more overweight and ages. Studies are ongoing to assess other benefits of CPAP including its effect on body mass index (BMI). Summary of the Evidence: One systematic review and meta-analysis of 12 studies (nine comparing similar interventions) in adults over 18 years of age with OSA (apnea-hypopnea index- AHI>5) systematically evaluated the impact of diet, exercise and lifestyle modification programs, and CPAP on
indices of obesity, OSA parameters, and quality of life.3 Diet and diet plus CPAP were compared in three studies (n=261). Intensive lifestyle programs were compared in six studies (n=483). Sample size ranged from 31-125, mean participant age from 49-54 years, and mean BMI from 29-43.8. The primary outcome was weight loss, and secondary outcomes included AHI, oxygen desaturation index (ODI), BMI, waist circumference, Epworth Sleepiness Scale and QOL. Dietary modification with CPAP therapy reduced weight by -2.64 kg (95% CI -3.98-1.30) compared with dietary modification alone. The benefit of CPAP therapy in addition to dietary modification on weight loss, though observed was thus not clinically significant. Lifestyle modification programs (involving caloric restriction and/or physical activity) were effective in reducing indices of obesity (weight by- 5.65 kg (96% CI -8.64, -2.96, BMI -2.33 kg/m2, 95% CI -3.41, -1.24) and improved severity of OSA (AHI -4.55 events/hour, 95% CI -7.12, -1.98). There was, however, a significant heterogeneity between included studies for some outcomes and the differences in the length of follow up between studies varied from 2 to 24 months. Pooled data was poorly representative of female sex. Weight was available in only two studies and publication bias was not assessed due to the small number of studies.3 Another meta-analysis of eight studies on non-diabetic patients with moderate to severe OSA (n= 170) evaluated the effect of CPAP (>4 hours/night) over 8-24 weeks on fasting plasma glucose (FPG), homeostasis model assessment insulin resistance (HOMA-IR) and BMI.4 All patients had newly diagnosed moderate Oklahoma D.O. | February 2014
St. Anthony Family Medicine Residency 1000 N. Lee Oklahoma City, OK 73101
to severe OSA (AHI>15), no prior treatment longer than 2 weeks, and without co-morbidities (diabetes mellitus, coronary artery disease, cerebrovascular accident, hepatic, endocrine, inflammatory or other chronic diseases). Effective CPAP was found to decrease HOMA-IR (-0.75; 90% CI 0.96, 0.53; p<0.001) but had no beneficial effect on FPG or BMI. Though the sample size was small, no publication bias was observed, study design AHI and other baseline characteristics were comparable between studies and similar duration of CPAP (4 hours/night) was used to quantify adherence to treatment. Large scale randomized controlled trials are needed to evaluate the benefits of longer treatment duration including effect on weight.
1. Epstein LJ, Kristo D, Strollo PJ Jr, Friedman N, Malhotra A, Patil SP, et al. Clinical guide- line for the evaluation, management and long-term care of obstructive sleep apnea in adults. J Clin Sleep Med 2009; 5(3):263-276. 2. Pagel JF. Obstructive sleep apnea (OSA) in primary care: evidence-based practice. J Am Board Fam Med 2007; 20(4):392-398. 3. Thomasouli MA, Brady EM, Davies MJ, Hall AP, Khunti K, Morris DH, et al. The impact of diet and lifestyle management strategies for obstructive sleep apnoea in adults: a systematic review and meta-analysis of ran- domised controlled trials. Sleep Breath 2013; 17(3):925-935. 4. Yang D, Liu Z, Yang H. The impact of ef- fective continuous positive airway pressure on homeostasis model assessment insulin resis- tance in non-diabetic patients with moderate to severe obstructive sleep apnea. Diabetes Metab Res Rev 2012; 28(6):499-504.
Oklahoma D.O.
Conclusion: Adults with OSA reduce BMI after 1 year of treatment with CPAP compared to no treatment, though the observed reduction is negligible. CPAP continues to be gold standard for treatment for OSA and should be recommended due to its manifold beneficial cardio-respiratory, metabolic and functional effects on patients with OSA. Patients at high risk for OSA should be screened using the Epworth Sleepiness Scale questionnaire and if they screen positive, should have a confirmatory sleep study and C-PAP titration. OSA will continue to become more prevalent due to increasing prevalence of obesity and the metabolic syndrome.
References:
PAGE 27
Oklahoma D.O. | February 2014
What DO’s Need To
KNOW
Important Payment Adjustment Information for Medicare EPs Eligible professionals (EPs) participating in the Medicare EHR Incentive Program may be subject to payment adjustments beginning on January 1, 2015. CMS will determine the payment adjustment based on meaningful use data submitted prior to the 2015 calendar year. EPs must demonstrate meaningful use prior to 2015 to avoid payment adjustments. Determine how your EHR Incentive Program participation start year will affect the 2015 payment adjustments: If you began in 2011 or 2012… If you first demonstrated meaningful use in 2011 or 2012, you must demonstrate meaningful use for a full year in 2013 to avoid the payment adjustment in 2015. If you began in 2013… If you first demonstrate meaningful use in 2013, you must demonstrate meaningful use for a 90-day reporting period in 2013 to avoid the payment adjustment in 2015. If you plan to begin in 2014… If you first demonstrate meaningful use in 2014, you must demonstrate meaningful use for a 90-day reporting period in 2014 to avoid the payment adjustment in 2015. This reporting period must occur in the first 9 months of calendar year 2014, and EPs must attest to meaningful use no later than October 1, 2014, to avoid the payment adjustment. Avoiding Payment Adjustments in the Future You must continue to demonstrate meaningful use every year to avoid payment adjustments in subsequent years. If you are eligible to participate in both the Medicare and Medicaid EHR Incentive Programs, you MUST demonstrate meaningful use to avoid the payment adjustments. You may demonstrate meaningful use under either Medicare or Medicaid. If you are only eligible to participate in the Medicaid EHR Incentive Program, you are not subject to these payment adjustments.
Oklahoma D.O. PAGE 28
Flu Activity is Widespread — Continue to Recommend and Offer Flu Vaccination As we move further into the influenza season, many people continue to experience severe flu illness, flu-related complications (like pneumonia), hospitalization, and, unfortunately, even death. The Centers for Disease Control and Prevention (CDC) urges people who still have not gotten vaccinated to do so now. The CDC recommends that everyone 6 months and older get an influenza vaccine each season. The predominant virus so far this season is H1N1. This is the H1N1 virus that emerged in 2009 to cause a pandemic. All flu vaccines this season are designed to protect against the H1N1 virus. This virus disproportionately affects young and middle-aged adults, especially those with medical conditions that put them at high risk for flu complications, as well as pregnant women and those who are morbidly obese. Influenza vaccination is especially important for people at high risk for serious flu complications, including: • People with chronic medical conditions such as asthma, diabetes, heart disease, or neurological conditions • Pregnant women • Those younger than 5 years or older than 65 years of age A full list of high risk factors is available on the CDC website. Influenza can be a serious illness for anyone, including previously healthy adults. If you have patients who haven’t yet been vaccinated, discuss the benefits and importance of flu vaccination. Offer to vaccinate or refer them to a vaccine provider. As a reminder, generally, Medicare Part B covers one influenza vaccination and its administration each influenza season for Medicare beneficiaries without co-pay or deductible. Note: The influenza vaccine is not a Part D-covered drug. Oklahoma D.O. | February 2014
The Journal of the Oklahoma Osteopathic Association
OKLAHOMA
May/June 2012 May/June 2013
D.O.
2013-2014 Directory Order Form I would liked to order______ copies of the 2014 directory @ $55 per directory. Shipping and Handling is not included in the price, please call for pricing (405) 528-4848 or (800) 522-8379 PAYMENT INFORMATION: 1 I have enclosed a check in amount of $__________. 1 Please bill my credit card
Check card type: ______VISA ______MC ______AMX ______ DSC_____
Card Number:_____________________________________________
Name on Credit Card: _______________ _______________________ Signature: ___________________________Exp. Date____________
BILLING INFORMATION:
Company: __________________________________________________________ Contact Person: _____________________________________________________
Address: ___________________________________________________________
City: _____________________________________ State: _______ Zip: _________
Phone: ________________________________ Email: _______________________
Please return form by mail or fax
Oklahoma D.O. | February 2014
FAX TO: (405) 528-6102
PAGE 29
Mail: 4848 N. Lincoln Blvd. Oklahoma City, OK 73105-3335
Oklahoma D.O.
Bureau News: Bureau on Membership The OOA Board of Trustees welcomes the following new members to the OOA family!
From the American Osteopathic Association Communications Department
Klaus P. Appel, DO Family Practice (Pawnee)
K. Eric Markert, DO Internal Medicine/Pediatrics (Tulsa)
Michael J. Boger, DO Family Practice/Emergency Medicine (Pauls Valley)
Timothy W. Teel, DO Otolaryngology (Lawton)
HEALTH FOR THE WHOLE FAMILY “Cortisol – The Stress Hormone to Keep in Check”
Kellie D. Van Tuyl, DO Family Practice (Coweta)
DOs consider the American Osteopathic Association’s “Health for the Whole Family” series a great way to promote the profession and educate patients about a variety of health topics.
Jonathan K. Bushman, DO Family Practice (Enid)
To use this month’s article, you have permisson to simply make copies of the article (see page 31) for use in your office waiting room to help educate your patients about current health care issues.
Jonathon D. Kirkland DO Radiology (Tulsa)
Oklahoma D.O. PAGE 30
When you need it. Medical professional liability insurance specialists providing a single-source solution
ProAssurance.com
Oklahoma D.O. | February 2014
Cortisol – The Stress Hormone to Keep in Check Who hasn’t dealt with stress? With approaching deadlines, frantic schedules, and a multitude of tasks that need to get done, stress has become an unavoidable part of our days and even our nights. While occasional stress may not affect your well-being, regular stressful episodes can eventually begin to take a toll on your health if not properly managed. Every time we become stressed, our body reacts by producing and releasing cortisol, also known as the stress hormone, into the bloodstream. Studies show that high levels of this hormone can produce serious health problems and increase the chances of dying from heart disease. Are you at risk? Craig M. Wax, DO, an AOA board-certified family physician from Mullica Hill, N.J., discusses the symptoms associated with increased cortisol levels and provides tips to help keep your stress and health in check. How can increased cortisol levels affect your health? If you have trouble sleeping during the night, difficulty recovering after exercise, or excessive cravings after 5 p.m., you might be experiencing the effects of high cortisol levels, which result when the body is under intense stress. Is cortisol completely bad for your health? “No,” says Dr. Wax. “A small rise in cortisol levels is normal. That is your body’s natural response to stress. In fact, normal cortisol levels actually help to strengthen the heart muscle and control blood pressure and blood sugar levels,” he notes. According to Dr. Wax, a normal cortisol level should peak in the morning hours between 3 a.m. and 7 a.m. and then steadily decline throughout the day. It becomes dangerous when the body experiences chronic stress, because over time, these levels increase above optimal range, and can put you at risk for developing sleeping, memory and digestive problems, as well as serious mental and physical problems. Symptoms may include: • Fatigue • Anxiety • Depression • Irritability • Weight gain • Increased blood pressure • Difficulty recovering from exercise If you suffer from these symptoms, Dr. Wax recommends visiting your physician for proper diagnosis and treatment. How can you keep your stress and cortisol levels at a healthy level? “It starts with proper nutrition, hydration, a balanced exercise routine, and plenty of sleep,” says Dr. Wax. To help regulate your body’s cortisol levels and maintain good health, Dr. Wax recommends: 1. Avoiding toxins such as cigarette smoke, chewing tobacco, and caffeinated beverages like coffee and tea. 2. Avoiding sugar and reducing starchy carbohydrates in your diet. 3. Routine daily exercise, which helps ultimately reduce resting cortisol levels; however, make sure to limit extreme heart activity, such as intense training exercise, to 40 minutes, since that’s when cortisol levels peak. 4. Implementing recovery based exercise, such as walking, Pilates or yoga to regulate cortisol output. 5. Getting around 6-8 hours of uninterrupted sleep a night, ideally from 10 p.m. to 6 a.m. 6. Practicing relaxation techniques, such as meditation. “If you’re suffering with stress symptoms on a daily basis, it is important to work with your physician to determine a stress management strategy, says Dr. Wax. “Most of the time, a few key lifestyle changes are all it takes to reduce stress and improve your health.”
Stress may be unavoidable, but it is not impossible to manage. “Taking steps to implement better nutrition, exercise, and lifestyle changes into your weekly schedule can help regulate your stress and cortisol levels,” says Dr. Wax. “Stress is a part of life, but with the guidance of your physician and stress management techniques, you can begin to take control of stress and your cortisol levels before they control you.”
Oklahoma D.O. | February 2014
PAGE 31
Preventive medicine is just one aspect of care osteopathic physicians (DOs) provide. DOs are fully licensed to prescribe medicine and practice in all specialty areas, including surgery. DOs are trained to consider the health of the whole person and use their hands to help diagnose and treat their patients.
Oklahoma D.O.
Staying stress-free and healthy
Febr�ar� 1
Febr�ar� Bir�hdays
Matthew E. Brown, DO Andrew S. Crawford, DO Ryan S. Mandell, DO Sarah L. Shepherd, DO Jason W. Sims, DO Timothy W. Teske, DO
Febr�ar� 2
Febr�ar� 7
Arlen R. Foulks, DO Richard S. Harris, DO Stephen K. Martin, DO Deborah L. Nilson, DO Michael C. West, DO
Brian A. Allee, DO Harold L. Battenfield, DO Jerry J. Castleberry, DO Christopher S. DeLoache, DO Richard Drake, DO Monty J. Grugan, DO Michael D. McLaughlin, DO David W. Morris, DO Michael B. Shaw, DO LaToya T. Smith, DO Donald F. Swanson, DO
James Allen, DO Mark R. Damon, DO Kenneth E. Phillips, DO Moira A. RedCorn, DO Richard W. Schafer, DO
Febr�ar� 3
Febr�ar� 9
Jason W. Beaman, DO Derrick V. Freeman, DO David F. Grider, DO Gary W. Lambert, DO Paula K. McQueen, DO M. Susan Miller, DO Karlis I. Sloka, DO Erica R. Sun, DO
Oklahoma D.O. PAGE 32
Febr�ar� 6
Marc L. Abel, DO Kristin F. Earley, DO Guy L. Peterson, DO Daniel M. Studdard, DO E. Randal Williams, DO
Febr�ar� 4
Joseph A. Braden, DO Kevin C. Conatser,DO Christopher C. Conger, DO Kimberly Ann Dabbs, DO Tommy D. Foreman, DO John C. Jackson, DO Gary J. Lang, DO James S. Walker, DO
Febr�ar� 5
Robert Ellis Baker, DO William W. Davito, DO Angela M. McGuire, DO Francis E. Peluso, DO
Febr�ar� 8
Rod A. Kernes, DO Athena C. Mason, DO Rachel B. Ray, DO Johnny R. Rodriguez, DO Matthew D. Tucker, DO Dennis R. Whitehouse, DO
Febr�ar� 10
Elizabeth K. Dolin, DO Guy W. Sneed, DO
Febr�ar� 11
Victoria W. Bjornson, DO Larry A. Burns, DO Jerry W. Freed, DO John W. Goulart, DO Simeon Jaggernauth, DO Robert S. Lawson, DO Melissa Barnes Myers, DO Richard L. Myers, DO Marvin D. Rodgers, DO Jayna Shepherd, DO David A. Trent, DO Henry K. Upchurch, DO Thomas J. Whalen, DO
Oklahoma D.O. | February 2014
Febr�ar� 12
Robert C. Cobb, DO Hal H. Robbins, DO David A. Tilles, DO
Febr�ar� 13
Stephanie Aldret, DO George D. Andrews, DO Elizabeth M. Bader, DO Robert L. Chance, DO Bennett Troxler Gardner, DO Kacey L. Wallace, DO L. Wade Warren, DO
Febr�ar� 14
Sergio G. DeMier, DO Terrell R. Phillips, DO Max D. Yancy, DO
Febr�ar� 15
John C. Brand, DO Violet L. Cohen, DO Chris E. Manschreck, DO Saundra S. Spruiell, DO Susan C. Willard, DO
Febr�ar� 16
Kayci D. Lewis, DO Sean C. Ludlow, DO Tait D. Olaveson, DO Michelle D. O’Meara, DO S. Lynn Phillips, DO
Febr�ar� 17
Paul F. Benien, DO Laurie A. Kukas, DO John W. Seagraves, DO Oliver Seitz, DO
Febr�ar� 18
Corey S. Schoenewe, DO
Febr�ar� 19
Jason C. Emerson, DO Kathryn A. Hall, DO Tenia L. Skinner, DO
Febr�ar� 20
Tabitha D. Danley, DO Edward D. Glinski, DO Valerie B. Manning, DO Jesse M. Niederklein, DO Michael S. Reed, DO Zita Tripathy, DO Steven K. Watkins, DO
Febr�ar� 21
J. Martin Beal, DO Stanley E. Grogg, DO John P. Harris, DO Michael A. Kayser, DO John C. Ogle, DO
Febr�ar� 22
Ronnie B. Martin, DO Lisa Neff, DO Jay P. Reynolds, DO Thomas A. Schooley, DO
Febr�ar� 23
Angela D. Christy, DO Sean R. Hamlett, DO Jennifer C. Scoufos, DO Douglas W. Stewart, DO Lana D. Stout-Myers, DO Robert A. Wieck, DO
Febr�ar� 24
Gary A. Boyer, DO Michael B. Earls, DO Adam Mathew Karpman, DO Barbara A. Rygiel, DO Aaron S. Sizelove, DO Stephen K. Sparks, DO Thomas N. Truong, DO Kinion E. Whittington, DO
Febr�ar� 25
Richard C. Melin, DO Charles R. Mettry, DO John T. Romano, DO Robert A. Woodruff, DO
Febr�ar� 26
Deborah J. DeJarnett, DO James B. Harris, DO
Febr�ar� 27
Gayle D. Bounds, DO Robert L. Goodmon, DO Ronald J. Leckie, DO Joy A. Manning-Plain, DO Larry D. McKenzie, DO Lesley V. Vines, DO
Febr�ar� 28
David R. Anderson, DO Robin R. Dyer, DO Beth L. Leader, DO Temitayo B. Oyekan, DO Clell W. Pond, DO Paul M. Reed, DO
PAGE 33
Oklahoma D.O. | February 2014
Oklahoma D.O.
The OOA wishes a ver� happy bir�hday to all of our DOs who celebrate their bir�hday this month!
Classified Advertising OFFICE BUILDING FOR SALE: 6501 S. Western, OKC, OK 73139. Over 1 1/2 acres total size, 10,000 sq ft building divided into 3 doctors offices. 1200 sq foot private office upstairs with private bathroom and shower. 2 double sided fireplaces, over a dozen chandeliers, rough wood cathedral ceilings. Alarm and phone system in place, double glass doors in entrance, back patio with separate storage building. Larger office is fully equipped with exam tables, Pap table, chairs, medical instruments, QBC (CBC) machine, autoclave, medical supplies, and much more. For information contact: Captain David Simpson at (405) 820-5360.
Oklahoma D.O. PAGE 34
CLINIC FOR SALE: By owner. Fully equipped: LAB, XRAY, EKG. Well established clinic, near Integris Southwest Medical Center is available for sale. Clinic is well equipped and is ideal for one or more physician practice as well as a variety of specialties. Clinic has: waiting room with refrigerated water cooler, wheelchair accessible restroom, reception and staff work stations, Nurses station, 5 - 7 exam rooms with sinks and running water, large multipurpose procedure room, 3 private offices with built-in bookcases, (One Office with 3/4 Bath), additional staff and patient restrooms, large upstairs (currently used for storage) and variety of other medical equipment. Misys Medical Software. Large Parking Lot. “Must See Inside” the all steel building located at 2716 S.W. 44th St. in OKC to appreciate the effort placed upon providing convenient and up to date medical care. PRICE IS NEGOTIABLE. Doctor prefers to sell, but would consider leasing. If interested, please call: Evelyn Francis at (405) 249-6945. IMMEDIATE OKLAHOMA OPPORTUNITY with largest family medicine clinic in Muskogee, Ok. Excellent opportunity to assume a practice that is up and running. Senior physician of four physician group leaving to pursue new career opportunities. 2,000 active patients need a physician. Two physicians currently practice OB. Surgical OB experience a plus. On site x-ray and CLIA certified lab. Nursing and support staff in place. Income guarantee. Be your own boss, work hard and practice family medicine in its historical tradition with respect and loyalty of small town patients. Contact Evan Cole, DO, 918-869-2456, ecoledo@yahoo.com, Brad McIntosh, MD, 918-869-7356, drbamc@yahoo.com Jason Dansby, MD, 918-869-7387, jasonddansby@yahoo.com or Judy Oliver, RN, practice administrator, 918-869-7357. (leave a message if temporarily unavailable) Find us on the web at www.mfpclinic.com.
STAFF PHYSICIAN NEEDED: The Oklahoma Department of Corrections is seeking applicants for Staff Physician at our correctional facilities statewide. The state of Oklahoma offers a competitive salary and benefits package which includes health, dental, life and disability insurance, vision care, retirement plan, paid vacation, sick days, holidays and malpractice insurance coverage. For more information and a complete application packet contact: Becky Raines 2901 N. Classen Blvd., Suite 200 Oklahoma City, OK 73106-5438 (405) 962-6185 FAX (405) 962-6170 e-mail: braines@doc.state.ok.us DOCTORS WANTED: to perform physical exams for Social Security Disability. DO’s, MD’s, residents and retired. Set your own days and hours. Quality Medical Clinic-OKC, in business for 16 years. Call Jim or JoAnne at 405-632-5151. PHYSICIAN NEEDED: The practice of Terry L. Nickels, DO is currently seeking a part-time Family Physician with OMT Skills to help cover the office. If interested please contact Dr. Terry Nickels at (405) 301-6813. Family, Urgent Care, and Emergency Practitioners – Immediate Opportunities for FT/ PT and temp positions. Oklahoma physician owned placement company is hiring now. Offering top wage, flexible schedules, paid malpractice and travel expenses. Call Rachelle at 877-377-3627 or send CV to rwindholz@oklahomaoncall. com
Oklahoma D.O. | February 2014
E T A HE D
T E AV April 24-27, 2014
S
AEL
:
AIR
Annual
K MIC
UES
G TIN
G TIN UES : REQ 24 EDITS FP
AA
CR
AEL
Q -1A : ICH O N RE 24 REDITS MA C. MGLE, D TIO ORBASSYS AOA C EN N O V N IR: EMSUITEION: CO HA 4T L C CA IL 2 NA AM LO SIO OGR APR , 2014 S E R OF P 27 E: PR H NC
114th
earn up to 30 1-A AOA Credits including up to 12 hours of specialty credit in 8 specialty tracks
O
R, D
OPE
O K. C
T DA
Y tival R A T N E DOCUM film fes family
Anesthesiology | Emergency Medicine | Internal Medicine | Neurology/ Psychiatry | Neuromusculoskeletal Medicine | Obstetrics/Gynecology | Oncology | Pediatrics Calendar of Events April 10, 2014 Southwestern District Meeting/CME (Lawton, Okla.)
Oklahoma D.O.
April 23, 2014 FORE the LOVE of Osteopathic Medicine Golf & Tennis Tournament Oak Tree Country Club, Edmond, Okla.
April 24-27, 2014 114th Annual Convention Embassy Suites Norman Hotel & Conference Center
PAGE 35
Oklahoma D.O. | February 2014
Prsrt Std US Postage Paid Okla City OK Permit #209
OKLAHOMA OSTEOPATHIC ASSOCIATION 4848 N. Lincoln Blvd. Oklahoma City, Oklahoma 73105-3335
RELATIONSHIPS YOU CAN RELY ON PROTECTING YOUR MEDICAL PRACTICE FOR 83 YEARS
The Oklahoma Osteopathic Association has endorsed Rich & Cartmill, Inc. and Medical Protective since 1999 Please support your OOA and consider Rich & Cartmill, Inc. for your Professional Liability Insurance needs.
Oklahoma D.O. PAGE 36
For more information contact Scott Selman at 918-809-1461 or sselman@rcins.com
2738 E 51st Street, Suite 400 | Tulsa, OK 74105-6228 | 918.743.8811 | www.rcins.com
TULSA
OWASSO
OKLAHOMA CITY
SPRINGFIELD, MO Oklahoma D.O. | February 2014