Nov/Dec 2024 Journal

NATIONAL PARK p. 22

TABLE OF CONTENTS

Drury

Nasal

Editor’s Note: All materials for the Journal must be submitted by the first of the month prior to publication.

Co-Editors:

Jim Blaine, MD

Minh-Thu Le, MD

Junior Co-Editor: Andrew K. Le

Managing Editor: Dalton Boyer

Editorial Committee:

Michael S. Clarke, MD

Frank Cornella, DDS, MD

Dalton Boyer

Andrew Le

Jean Harmison

Barbara Hover

Nancy Yoon, MD

Jana Wolfe

SOCIETY OFFICERS

James Rogers, MD

President

Vu Le, MD

Secretary

Jim Blaine, MD

Treasurer

Sanjay Havaldar, MD Immediate Past President

Council Members:

David Haustein, MD

Melissa Gaines, MD

Steven Gradney, MD

Keith LeFerriere, MD

Kyle John, MD

Jaya LaFontaine, MD

Nancy Yoon, MD

Managing Director: Jean Harmison

Executive Office: 4730 S. National Ave. Suite A1 Springfield, MO 65810 email: director@gcms.us www.gcms.us

All communications should be sent to the above address. Those marked for the attention of a particular officer will be referred.

EDITOR'S PAGE

by Jim Blaine, MD

I recently had the pleasure of interviewing the new President of Mercy Springfield Communities John Myers. We look forward to working with him to help improve the health in our community! Please check out John’s interview in this issue.

Cox President and CEO Max Buetow just returned from a trip to Zion National Park and Bryce Canyon in Utah. Max has written an article in this issue about the adventure with his brother and son. Max is a big fan of our National Parks, and visits them as frequently as possible.

John C. Hagan III, MD, FAAO, and Missouri Medicine Editor updates us on the science of Nasal Spray Timolol for migraine treatment.

I interviewed beloved retired gastroenterologist Dr. Bob Kipfer last week. Bob and his lovely wife Barb have been working almost 30 years to protect the nearby Bull Creek. Bob and his co-author and friend Loring Bullard wrote a wonderful book on the topic; it was released last Spring and entitled “Saving Bull Creek”. Limited copies are available at GCMS office.

My wife Barb and I spent a delightful day with Bob last week hiking some of his 400 acres. Bull Creek is the most pristine river I have ever seen; additionally, the entire area is steeped in Civil War history including an ancient cemetery.

Bre Tyger (SGCHD) and Kat Dull (Child Advocacy Center) have written articles summarizing the talks they gave at the recent GCMS CME event, “Child Abuse is Preventable”.

My son-in-law Karim Moukrime, Ed.D favors us with an article concerning the opportunities at Drury University.

Over the past few years we have witnessed the politicalization of medical science through misinformation (unintended) and disinformation (intended). The Greene County Medical Society has recently attempted to educate the public via TV and other media on COVID recommendations, dangers of more powerful marijuana, and prevention of child abuse. Current plans include developing specialist subcommittees in an effort to establish consensus on public health education as well as respond to any misinformation that surfaces in the media. The GCMS Executive Council would be very appreciative if you would consider contacting us at jimblaine@aol.com or (417 861-9286) to become a part of the GCMS subcommittee in your specialty. All specialties will be needed, but Infectious Disease, Immunology, Pediatrics, Addiction, Behavioral Medicine, Ob/Gyn, Surgery, and Family Practice are more urgent currently.

"Saving Bull Creek" painting by Jane Troup

PRESIDENT'S PAGE

by James Rogers, MD

To all of the Southwest Missouri regional area providers:

From the leadership of Greene County Medical Society, THANK YOU for providing excellent care to our patients and all Southwest Missouri. Your devotion and sacrifice is appreciated and cherished.

Thank you also for trusting and challenging us to "bring physicians together to improve the health of our community" as expressed in our mission statement.

I am proud to report that during the calendar year of 2024 GCMS Council has worked tirelessly with the Foundation, Alliance and community organizations for opportunities to bring us together and improve the health of our community.

We have sponsored several CME programs including traditional lectures, a focus conference on child abuse prevention, traveling CME to Breckenridge, Colorado, and current topics identified from the health department.

We collaborated with financial experts to cosponsor four events customized to physician groups (students/ residents, early, mid, and late career) that connected the evidence that a good fiscal plan leads to physical health and reduced physician burnout.

We have created working relationships with businesses that express and share the appreciation for the work you do. They continue to be supportive and offering opportunities for casual interaction, networking, and

professional relationship building outside of the workplace. This includes happy hours, family events at the Dickinson Park Zoo and family night at the Museum, and efforts to work closely with area organizations who are also dedicated to community health improvements.

We continue to find ways to support medical education in our region by encouraging voluntary faculty, and sponsoring lunches for the students. Our members also encourage medical students through mentoring.

As this season naturally inspires reflection, it is time for all of us to have a plan to answer the question, "What can I do to help this community that has given so much to me?"

To paraphrase Peter Parker, aka Spider-Man, "With great privilege comes great responsibility." I would like to offer a few suggestions:

Take the survey <GCMS.US> opinion survey tab and share your thoughts with us

Join the Greene County Medical Society <GCMS.US/Join> Challenge your family to write down three things that that they would like to see or do in 2025 to "improve the health of our community.”

Finally, thanks to all the readership of this wonderful publication, our GCMS Journal, for allowing me the privilege to report this evolving work and ask for your support for us to continue.

FAMILY CONNECTS IN OUR COMMUNITY

by Bre Tyger, BSN RN Community Alignment Specialist/Public Health Nurse Family Connects Springfield-Greene County

Family Connects International is committed to strengthening bonds for families with newborns and linking them directly to supportive community care resources through nurse home visiting. Family Connects is a universal approach to home visiting, enabling us to reach all families of newborns, including foster, adoptive, and bereaved parents. We offer a free, voluntary nurse visit to every family with a newborn that lives in Greene County. Family Connects Springfield-Greene County is the first Family Connects site in Missouri. We began implementation with our program in March 2024 at WIC locations throughout Greene county and in May 2024 we began visiting with families at the bedside in both Mercy and CoxHealth hospitals to introduce the program and offer to schedule their nurse visit around 3 weeks postpartum. We have now been working in the community for 6 months.

In a Family Connects visit, the nurse can spend however much time is needed with the family to provide education and support. We know this is something that can be difficult for providers in the limited time they have in their routine visits. Our nurses allow up to 2 hours per visit and cover domains of family support in the areas of health care, infant care, parental support, and home safety. They also can provide an assessment of the parent and infant that includes a physical exam and screening of postpartum depression, intimate partner violence, and substance use. Vital education is provided on topics such as infant feeding, safe sleep, post-birth warning signs, and normal infant crying and helpful soothing techniques. Lactation support

is another component of the Family Connects visit many families appreciate. Our nurses have undergone additional training to become Lactation Counselors, enabling them able to provide lactation support in the home.

Perhaps the most important part of the Family Connects visit is connecting families to valuable resources within our community that will provide continued support and education for the family in the years to come. Through the almost 200 completed visits, our nurses have placed close to 400 referrals to community resources!

Parents as Teachers is a wonderful program that also utilizes a universal approach and has been a valuable resource for our families. We have been excited to see families learn about and utilize the Imagination Library as well, which has become newly available across the state of Missouri. This program helps encourage positive parenting interaction through reading.

The number of nurse home visits completed each month has steadily increased. We have now completed 195 Family Connects visits in our community!

The Family Connects nurses have connected families to medical providers, including establishing the family with a Primary Care Physician or Pediatrician and ensuring the 6-week postpartum visit has been scheduled and that they understand the importance of attending.

Another exciting accomplishment in our work over the last 6 months has been connecting with the Hispanic community. We were fortunate to hire a bilingual nurse in May and we have seen her schedule steadily fill up over the last couple of months. A recent demographic report revealed that 14% of the families that have participated in Family Connects visits in our community indicated Spanish was their primary language. The families are able to reach out via text or phone call with questions or concerns before the visit, giving them an accessible source for information in their language during this critical period. This nurse has also helped bridge the gap for these families to valuable resources in our community that they either had no knowledge of previously or were unable to access on their own.

As of the month of August, we completed a nurse home visit with approximately 20% of the birth population in Greene County. We would love your help in reaching more families. We know that families that participate in Family Connects have improved outcomes. A randomized control trial from Family Connects International showed significant benefits for families that participated in a nurse home visit through Family Connects.

Families that participated in Family Connects had a 50% reduction in ED visits and hospitalizations in the first year.

This translated to a cost savings of $3 for every $1 spent due to the reduction of ED visits and hospitalizations alone

Due to the universal nature of Family Connects, there was shown to be a reduction in the disparity between black and white mothers, giving them more equitable access to resources in their community.

Family Connects increased community connections by 42%, and this was the highest among Hispanic and black families.

Positive parenting behaviors and safer home environments were noted by blinded observers at a four month follow-up visit.

Although we attempt to meet with as many families as possible while they are still in the hospital, there are some families that are missed and others are not consenting to a visit when visiting with us initially. Often the conversation we have with the family at the bedside is the first time the family has heard of Family Connects. For providers working with families prenatally, this would be an ideal time to introduce the program to the family. Another important touch point is when the family is bringing their newborn in for their first visit days after coming home or around 2 weeks.

Referrals to Family Connects are quick and simple. We have rack cards that we have provided to all OB and Pediatric clinics at Mercy, Cox Health, and Jordan Valley Community Health Center that have a QR code that links directly to our website, www.familyconnects417.com. Filling out the referral takes only a matter of minutes to complete, or you can have the family refer themselves as well. If you are needing some of these rack cards, please reach out to me and I would be happy to bring them to you!

DRURY UNIVERSITY: AN EDUCATION LIKE NO OTHER

by Karim Moukrime, EdD, Director of Academic and Student Affairs-Drury University

“The key to ensuring positive outcomes in our world is leadership. Drury’s unique approach to education rooted in the liberal arts doesn’t just teach content, but also how to apply critical thinking, ethical decision-making, and respectful dialogue at every level of leadership.”— Kent Sunderland, The Sunderland Foundation, chairman

Hello! My name is Karim Moukrime, and I am the Director of Academic and Student Affairs in the College of Continuing and Professional Studies at Drury University. I have been working in higher education for 16 years. I am a strong advocate of student success and engaged learning. Some of my responsibilities are identifying and developing academic programs, ensuring academic standards and quality, contributing to academic advisors’ training and professional development and directing initiatives for student retention and success.

Drury offers great educational opportunities for both undergraduate and graduate students, transforming their lives through personalized education. Drury has a positive and visible impact on the community of Springfield and its surrounding regions. Students have the option to pursue their education while residing on campus or they can take online and evening courses that are offered throughout southwest and central Missouri. Synchronous, online, and blended courses are also available to students. Degree pathways vary from business and leadership to education, health, public safety, engineering, and the new physician assistant program.

Drury was proud of its first Physician Assistant White

Coat Ceremony that took place on September 14, 2024. “This is a landmark event for the Drury University PA Class of 2025 as they take their first steps to treat patients and serve the population of southwest Missouri, the surrounding communities and states, and across the country,” said Dr. Lawrence Herman, Clinical Professor and Program Director. “The Department of PA Medicine faculty, staff, and our university administration could not be prouder of this talented group of healthcare professionals and the incredible work that they will be performing.”

The academic journey of some Drury students starts early. Drury University offers its courses to Missouri high school students online in the fall, spring, and summer semesters. It also provides seated dual credit courses at the student’s high school during the day. Drury’s dual credit program currently serves approximately 120 high schools across the state of Missouri, providing seated dual credit classes to students in their high school. Students can also choose from more than 25 online courses.

It is important to mention Drury University’s guiding beliefs:

• Our students’ best interests come first.

• Our goal is to deliver a personalized education in a challenging yet supportive environment.

• We are inclusive of all people and perspectives, treating each other with respect of civility.

Drury University's Physician Assistant programs inagural class

• Student success is measured by the development of the whole person emphasizing academic achievement, critical thinking, and ethical behavior.

• We are creative, innovative problem-solvers eager to embrace and drive positive change.

• We aspire to achieve excellence in all things.

What is special about a Drury education is that people from all walks of life can find their niche of learning at this institution. It does not matter what age bracket a student is in to pursue a rewarding education. Everyone is welcome at any stage in their life at Drury.

Here is Drury’s vision for residential, evening and online, and graduate students:

Residential

Ensure that all students are extraordinarily well prepared for a productive career and a life well lived.

Evening & Online

Create a community of lifelong learners who gain the knowledge, skills, and values needed to better themselves and their communities.

Graduate Studies

Develop responsible leaders who aspire to thrive within their professions and service activities by fostering the integration of theoretical and practical knowledge.”

Drury faculty and staff help architect the structures that bolster and support student success. This means coordinating between various departments is essential, which allows students to focus on their education. For instance, I contribute to the academic advisor’s training and development, which serves our students better and keeps them on track. In addition, intervening quickly to solve problems and issues builds bridges and brings students closer to their goals.

I do my best every day to impart the message of this quote to Drury students. Persistence and tenacity are key attributes to achieving success. Serving evening and online students means equipping them with the resources and tools they need to be successful. Adult students often face challenging circumstances, such as being a full time or part-time worker, a returning student, or a single parent who started his or her education but never followed through and earned a degree. It’s impressive to see students, including first-generation college students, persevere and squeeze in the time to pursue their previously postponed dreams and educational plans. They work hard and put in the energy, focus, knowledge, and expertise to continue their education despite the financial hurdles and the work-life balance challenges.

The educational environment that Drury University offers is deeply rooted in the philosophies and psychologies of student development, care, and success. The wide selection of majors and minors, certificates, credentials, and pre-certification programs make up the unique Drury educational experience. Our programs utilize real-world experience curricula, pedagogies, and theoretical principles that shape the knowledge and skills of students. Drury students learn how to broaden their horizons through engaging in different activities, such as internships, group projects, and community service. They cultivate their imagination and ethical leadership so that they are ready to contribute positively to their communities while thriving in a demanding and changing world where education is continuously evolving to meet the needs of the community and the workforce.

Student success at Drury is a common goal that all departments strive to contribute to. Students are not alone on their journey. They have access to a myriad of resources including financial assistance. For example, The Drury Springfield Promise is the most recent initiative that makes a college education affordable and achievable for many students in the greater Springfield area. “If you thought you couldn’t afford to be at Drury, the Drury Springfield Promise will give you a reason to think again.”

Said Dr. Jeff Frederick President of Drury University.

Dr. Frederick stated in his most recent Campus Communication, “Now more than ever, a college education rooted in a dynamic student experience is the single most powerful predictor of future success economically, in cultural understanding of citizenship in a diverse, global society, and in uplifting individuals, families, neighborhoods, communities, states, and the nation. I believe in college as a critical and transformational opportunity to create lifelong learners that solve problems, think creatively and critically about their place in an interconnected society, and make informed decisions.”

I feel fortunate to be part of Drury University’s academic team. It’s great to work with smart and amazing staff and faculty who champion student success. My favorite time of the academic year is to attend the graduation ceremony. Graduates finally see the fruitful result of their hard work and persistence when they walk across the stage to receive their diplomas. This is a significant milestone filled with pride, accomplishment, and zeal for making a positive impact in their communities.

Many thanks to the Greene County Medical Society Foundation for publishing this article in the journal and for the care and engagement to keep our community members informed, safe, and healthy.

NASAL SPRAY TIMOLOL: THE NEW PARADIGM FOR ACUTE MIGRAINE?

by John C. Hagan III, MD, FAAO

The enormous neurological problem of migraine is often underappreciated. Consider these statistics. It is estimated that 40 million Americans and 1 billion persons world-wide suffer some form of migraine. Migraine disproportionally affects women more than men, 20% to 9%. Migraine is a disease of the young, most commonly between 18 and 50, but may also affect younger or older persons. Unusual for most diseases, migraine is more severe in the young and tends to mitigate with age. Given this demographic, migraine is one of the most common causes of missed work and school, inattentiveness, errors, subnormal performance and “out of service’ parents.

While there are many time-tested drugs and some remarkable new ones for migraine, 80% of treated patients would welcome a more effective medication to supplement or replace those they are on. What are the ideal parameters for such a medication? Well, it should be effective, safe when used properly, inexpensive and readily available. The beta blocker (BB) timolol in eyedrop liquid form, applied topically to normal eyes or best by nasal spray, in my opinion and other researchers around the world, may be that drug. It is available in the here and now. Timolol is FDA approved for migraine and glaucoma. I appreciate the Greene County Medical Journal giving me this opportunity to talk about my research and experience over the past 12 years. What is ‘new’ about this ‘old’ drug is administering it as a liquid rather than a solid pill.

Most of you use BBs on a regular basis. Beta blockers were invented by Sir James Black, MD in the mid-1960’s for cardio-

vascular (CV) indications. Even now, over a half century later, BBs remain 1 of the 10 most widely prescribed medications. So significant are BBs that Dr. Black was awarded the 1988 Nobel Prize for Medicine.

BBs have fortuitously been found to have a broad range of disparate applications. We shall discuss two treatments discovered fortuitously: migraine and glaucoma. Migraine patients put on oral BBs for CV indications often reported their headaches got better. Then neurologists tested oral BBs on migraine patients. In an intriguing paradox, timolol and propranolol pills, taken daily, prevented or reduced migraines in patients with the most frequent headaches. Taken orally, at first onset of a headache, both BBs failed to ameliorate acute migraines. This contradiction was accepted without study or explanation of the diametrically opposite clinical effects.

Another group of patients also benefited from going on BBs for CV indications. The intraocular pressure of migraineurs with glaucoma frequently dramatically dropped when put on oral timolol. Lowering the intraocular pressure is the goal of glaucoma therapy. In 1979, timolol was converted into eye drops and introduced in the US, becoming, and remaining, one of the most important glaucoma medications.

Carl V. Migliazzo, MD is a retired Kansas City glaucoma specialist. In the early 1980’s, he was told by his patients with migraines placed on timolol eyedrops that their migraines improved. He thoughtfully and empirically tried timolol 0.5% glaucoma eyedrops on family members, friends and staff with migraine and achieved extraordinarily good results. This remained an interesting adjunct to his practice until 2012. Carl is one of my golfing buddies and I knew that Carl’s wife had longstanding migraine. I told him that my two daughters had developed migraines. He recommended they try timolol eyedrops. Me being me, ever the pedant, I reminded him that taken daily BB pills worked for prevention but not for acute migraine. He went on to explain that he had used BB drops successfully for two decades. This struck me as a fascinating and important subject for further research.

When we treat glaucoma, we do not want high blood levels of BBs. Ophthalmologists know from studies that, placed on normal eyes, timolol eyedrops quickly pass through the tear duct into the nose and onto nasal mucosa. There absorption is ultra-fast approaching the rate of IV injection. Therapeutic levels of BBs are reached in 10-20 minutes. In ophthalmology this is a bad thing. To keep the drops in the eye and out of the blood, we have patients occlude the tear duct opening

with their fingertip, hold their eyelids shut and not blink for 5 minutes. Pharma made a gel-forming drop that is very slow to pass into the nose. Conversely oral BBs pass into the intestine and are slowly absorbed through the gut into the liver where first pass metabolism occurs. Only then do BBs enter the venous circulation to the heart then belatedly to the brain. Literally it is too little, too late.

In 2014, Carl and I published the first world literature report in Missouri Medicine on the successful treatment of acute migraine with BB eyedrops. Subsequently our research and success has been confirmed in placebo-controlled studies in 2018 JAMA Neurology, 2020 JAMA Ophthalmology, 2023 Mansoura Medical Journal (India). One study purported BBs were no more effective than placebo, that study has been discredited because of flawed methodology. Because eyedrops are difficult for many people to instill and certain eye/eyelid conditions preclude their use, we recommend a nasal spray.

Steve Kosa, MD is a neurologist that staffs a referral headache clinic at North Kansas City Hospital. I began a collaboration with him in 2022. With the help of a local compounding pharmacy, a nasal spray device was created. Each metered spray delivers 0.1 ml of timolol 0.5%, a dose of 0.5 mgs. Steve’s practice consists of refractory migraine patients who have failed standard therapy. Normal BB contraindications and monitoring apply. Patients are told to take one spray in each nostril as soon as possible at headache onset. If still symptomatic, at 10-15 minutes a second set of sprays is used but no more than 4 sprays in 24 hours. Other migraine drugs may be taken, and interactions have not been observed. If a patient is on BBs for any reason or has failed BB preventive therapy or had previous BB adverse reactions this treatment should be avoided.

Another first world literature report was published in the January/February 2024 Missouri Medicine. In a series of 16 refractory, unresponsive migraine patients referred to the Kosa Clinic, 9 or 62.5% were pleased with the nasal spray and added it to their preferred method of aborting acute migraines. There were no complications. These encouraging results were presented in a scientific poster at the 2024 American Headache Society meeting in San Diego. There was considerable interest on the part of attendees.

Multiple entreaties to pharma, including those that repurpose generics, have failed to develop interest. Usually cited is not enough profit potential and avoid producing an effective low-priced medication to compete with their much more expensive migraine product line. Currently a major state university is trying to finance a large, multi-center, placebocontrolled study.

The nasal spray BB is available now on prescription to O’ Brien Pharmacy. (913-322-0001 & https://obrienrx.com/) The

medication is mailed to patients. The cost is very modest, $74 for a 15 ml spray bottle that will treat multiple migraines.

The bottom line is that the timolol molecule has been approved for migraine, glaucoma and multiple CV indications for over 40 years with millions of people using it safely and effectively. In the here and now, for your acute migraine patients not responding satisfactorily to standard medications, nasal spray timolol 0.5% deserves your serious consideration.

Disclosure: I have no financial interest in this therapy. You may contact me at drjhagan3@gmail.com if you have any questions

Sources

1 Kosa SC, Hagan III JC. Nasally Delivered 0.5% Timolol Beta Blocker Successfully Treats Acute Migraine in a Referral Headache Clinic: A Case Series. Missouri Medicine 2024;121(1):33-36

2 Migliazzo CV, Hagan III JC. Beta Blocker Eye Drops for the Treatment of Acute Migraines. Missouri Medicine. 2014;111(4):284-289

3 Cossack M, Nabrinsky E, Turner H, Abraham A, Gratton S. Timolol Eyedrops in the Treatment of Acute Migraine Attacks: A Randomized Crossover Study. JAMA Neurol. doi: 10.1001/jamaneurol.2018.0970. Published online May 14, 2018.

4 Gratton S, Cossack M. Answering the Call: A Prospective Look at Timolol Eye Drops in the Treatment of Acute Migraine Attacks. Missouri Medicine 2018;115(6):520-521

5 Kurian A, Reghunadhan I, Thilak P, Soman A, Nair U. Short-term Efficacy and Safety of Topical β-Blockers (Timolol Maleate Ophthalmic Solution, 0.5%) in Acute Migraine: A Randomized Crossover Trial. JAMA Ophthalmology. 2020;138(11):1160-1166. doi:10.1001/jamaophthalmol.2020.3676

6 Elgamal S, Egila H, Kabbash I, Ansarey H, El Shafie M, El Shafie O. Timolol as a Migraine Acute Attack Therapy: Randomized, OTCs Control Study. Mansoura Med. J. 2023;52:1-6

7 Katz BJ. Put a Drop of Timolol into Each Eye and Call Me in the Morning. JAMA Ophthalmology. 2020;138(11):1166-1167. https://doi.org/10.1001/ jamaophthalmol.2020.3837

8 Aggarwal D, Heim AJ, Bittel B, et al. A Randomized, Double-Blind Placebo Controlled, Cross Over Study Evaluating the Efficacy and Safter of Timolol Ophthalmic Solution as an Acute Treatment of Migraine. Kansas Journal of Medicine 2020;13(supplement 2);2-5

9 Hagan JCIII. Letter to the Editor: A Randomized, Double-Blinded, Placebo-Controlled, Cross Over Study Evaluating the Efficacy and Safety of Timolol Ophthalmic Solution as an Acute Treatment of Migraine.” Kansas Journal of Medicine. Volume 13 (2020): KJM Supplement 2: Frontiers Edition. https://journals.ku.edu/kjm/article/view/15733

10 Hagan JCIII, Kosa SC, Chamberlain T. Acute Migraine Treatment with Timolol 0.5% Nasal Spray. International Journal of Pharmacy Compounding. 2024;28(4):286-290

CHILD ABUSE IS PREVENTABLE

by Katiina Dull, Executive Director, The Child Advocacy Center

The prevalence and pervasiveness of child abuse and neglect is staggering.

• 1 in 7 children experiences child abuse or neglect in the past year1

• 1,820 US children died of abuse and neglect in 20212

• 1 in 9 girls and 1 in 20 boys under the age of 18 experience sexual abuse or assault3

• 93% of child sexual abuse victims know their perpetrator4

Missouri and Greene County specifically have mixed outcomes when compared to national statistics.

While neglect is the leading cause of maltreatment nationwide, and is still the most prevalent form of maltreatment in Missouri and Greene County, the prevalence of physical and sexual abuse as a share of maltreatment is significantly higher than at the national level.

Understanding the causes behind these variances is difficult, but the point to make here is that child abuse often lives in the shadows. These are reported concerns, that have been investigated, and ended with a conclusion of victimization. Perhaps higher rates indicate that our community is doing better than the national average at identifying and responding to concerns of abuse and neglect?

At the recent Greene County Medical Society’s CME program at Cox Health, we discussed the multidisciplinary team

system response to child abuse and neglect allegations. The system response can seem overwhelming and inconsistent and this can at times lead mandated reporters to hesitate making a report – fear of being wrong or making a false accusation are common refrains we hear at the Child Advocacy Center. A paradigm shift is essential here. Making a report to the child abuse and neglect hotline it not the equivalent of making an accusation. It is a referral for services specific to the presenting symptoms. Understanding what happens after a hotline report can help mitigate these concerns and fears. The Child Advocacy Center encourages everyone to become educated on the multidisciplinary system response. As an example, did you know that in the state of Missouri, the only personnel who can take a child into protective custody are physicians, law enforcement personnel, juvenile officers, or when court ordered by a Judge? Children’s Division case workers can make a referral but can not independently take a child into protective custody. Reporting is an act of Intervention and is a critical component of reducing and preventing child abuse, but there is more we can do. The medical community is uniquely positioned as a front-line defense for both intervention and prevention efforts.

The August 2024 Clinical Report from the American Academy of Pediatrics, The Pediatrician's Role in Preventing Child Maltreatment, provides a road map. The Clinical Report explores how the utilization of relational health can minimize risk and increase resilience for children and families. It begins by recognizing that children do not exist in a bubble, they live in family units that also exist within communities. Within a family unit factors such as parental mental health, substance abuse, and domestic violence increase the risk for a child. At the community level factors such as poverty, transportation systems, affordable child care, and resource limitations increase the risk for a child. Pediatric Health Care Providers (HCP) can help minimize risk by anticipating, recognizing, and mitigating family and community stressors. The Clinical Report does caution that the implementation of relational health should take a universal approach and be used for all children and families. If not, the risk of bias enters the exam room, and rather than building trust and resiliency caregivers feel targeted and withdraw.

The practical application of relational health starts with going beyond the basics in gathering medical history. The Clinical Report recommends incorporating the social histories of the child, their family, and other primary caregivers in their

Chart 1: Children Confirmed by Child Protection Services as Victims of Maltreatment in 20225

lives. While there is a need to identify risk factors, there is also a need to ask about protective factors. This is where the Pediatric HCP can identify strengths to help build resiliency skills. A suggested tool is The Pediatric Intake Form in the Bright Futures health supervision guidelines published by the American Academy of Pediatrics. The initial intake process sets the tone and tenor for the relationship between the Pediatric HCP and the child and family, however, it is in the ongoing relationship where Pediatric HCPs can play a significant role in mitigating risk. At each well check-up asking about social information shows the child and family that you are interested and care about the factors influencing their health and well-being. An ongoing commitment to relational health allows Pediatric HCPs to better identify risks, resiliency factors, and meet the specific needs of the family from a position of understanding not assumption.

“Especially in early childhood, Pediatric HCPs observe and advise families at frequent intervals and can serve as trusted advisors who can facilitate referrals to community resources. The commitment of pediatric HCPs to assess risk and protective factors to promote resilience, although only a first step, can literally be lifesaving.”

The Clinical Report also addresses the importance of providing anticipatory guidance and targeted intervention for identified risks. Stressors and lack of understanding around child development can lead to inappropriate parental expectations of a child’s behaviors. The lack of understanding can lead to the utilization of disciplinary efforts that are too harsh, too frequent, or physically punitive. When we use anticipatory guidance and are proactive in discussing possible developmental and behaviors challenges children face, we are strengthening family resilience before abusive responses take hold. This is even more important for children with disabilities or special health care needs. Consider utilizing more frequent checkups for those children and families to further strengthen the relational healthbased trust between the Pediatric HCP and the family. Once a Pediatric HCP has developed an assessment of risk and protective factors seeking targeted intervention can be addressed both within the clinic setting and with referrals to community service providers with expertise in the identified areas of concern. Greene County has a deep pool of resources and service providers meeting a range of needs. Pediatric HCPs have a unique opportunity to connect families to these services thorugh direct referrals, by displaying resource

materials in waiting rooms, and by developing handouts to help families navigate available services.

The Clinical Report also addresses special topics in child abuse prevention, one of the most insidious being child sexual abuse. The vast majority of children who are sexually abused are done so by someone they know – a family member, a trusted caregiver, a coach, a religious leader, a neighbor, a peer. Here again Pediatric HCPs can support prevention practices by helping children and families understand the importance of body autonomy, age-appropriate sexual development education, and by destigmatizing the utilization of anatomic names for all body parts. Things to consider are:

• When we use words other than penis and vagina we signal to children that its not okay to talk about those body parts.

• When we touch children with out asking their permission first, even in healthy touch scenarios like a well-child exam, we send mixed messages about body autonomy and boundaries.

• When we ask or talk about “good touches and bad touches” we overlook that not all abusive touches feel bad or hurt. Touches should be discussed as appropriate/ comfortable or inappropriate/uncomfortable.

The overarching takeaway is that Pediatric HCPs are uniquely positioned to take a proactive role in reducing and preventing child abuse. There are certainly challenges – time being the biggest one – to implementing these efforts in daily pediatric and family care practice. But to quote Benjamin Franklin, “An ounce of prevention is worth a pound of cure.”

References

1. Finkelhor D, Turner HA, Shattuck A, Hamby SL. Prevalence of Childhood Exposure to Violence, Crime, and Abuse: Results from the National Survey of Children's Exposure to Violence. JAMA Pediatr. 2015;169(8):746–754. doi:10.1001/ jamapediatrics.2015.0676

2. U.S. Department of Health & Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children's Bureau. (2023). Child Maltreatment 2021. Available from https://www.acf.hhs.gov/cb/ data-research/child-maltreatment.

3. David Finkelhor, Anne Shattuck, Heather A. Turner, & Sherry L. Hamby, The Lifetime Prevalence of Child Sexual Abuse and Sexual Assault Assessed in Late Adolescence, 55 Journal of Adolescent Health 329, 329-333 (2014)

4. United States Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. Child Maltreatment Survey. Exhibit 5-2 Selected Maltreatment Types by Perpetrator’s Sex. Page 65. (2013).

5. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. National Child Abuse and Neglect Data System (NCANDS) Child File, FFY 2000–2022.

AN INTERVIEW WITH JOHN MYERS - PRESIDENT, MERCY SPRINGFIELD COMMUNITIES

by Jim Blaine, MD

Jim Blaine: Hello John, it is very nice to meet you! I heard that you are from Nebraska; please tell us about your days growing up there.

John Myers: Well, I grew up in central Nebraska on a large farm and ranch. It was an amazing way to grow up. Our town was 500 people, and the nearest town of a thousand was more than an hour away. Growing up on a farm in such a small town meant that I learned the importance of a strong work ethic at a young age, and I still think it was a great way to grow up.

Jim Blaine: What inspired you to pursue a career in healthcare?

John Myers: We had a small critical access hospital in town, and my mom was a nurse there. That’s how I got connected with a cardiologist who exposed me to the medical field. Until then, I had planned on staying on the farm and hadn’t considered healthcare as a career. I ended up getting my degree in nuclear medicine from South Dakota, and then I got my first job in Kansas City for a group of private practice oncologists who were managed by a national entity. That was when I realized I enjoyed leadership. I ended up working at their headquarters in Houston, Texas where I supported cancer centers throughout the United States. Jim Blaine: How did you develop a passion for Oncology?

John Myers: My grandfather and I were very close. In fact, my son Johnnie is named after him. But my grandfather was diagnosed with colorectal cancer and ended up passing away from it. He lived in a rural community where access to screening or just knowledge that you need to get screened was lacking. That's how I really got interested in oncology, and I really enjoyed my time at HCA where I oversaw the

cancer service line for several states in the Midwest. I did that for about four years, but I missed being connected with the operations of a large hospital. That's when I moved over to an HCA hospital called Research Medical Center in Kansas City. I moved over there as a chief operating officer and loved the work.

Jim Blaine: How did you find your way to Mercy?

John Myers: My wife’s parents live full-time at Lake of the Ozarks, and, l discovered, through a shared acquaintance with David Argueta, that Mercy Springfield was looking for a chief operating officer. My wife and kids are really close to her parents, and Mercy is well-known as a high-quality organization. It was a great opportunity for me and my family, so I threw my name in the hat and ended up getting the job. I was the COO for about a year and a half before moving into the role of president of Mercy Springfield Communities.

Jim Blaine: You’ve said before that David Argueta is a great leader and mentor. What did you value about his style of leadership?

John Myers: Yes, David was a great mentor to me and a visionary leader. I learned a lot from him. He did a great job aligning with the team and getting us all on board with changes that needed to be made and new goals that we set for our team. One thing that was really impressive was the fact that we were all new. David was new in his role as community president when I joined, and Marie Moore was a new chief nursing officer. So we had a new team, and we quickly realized that the physicians and leadership team at Mercy was fantastic, so once we had everybody in the right spot, we just took off.

Jim Blaine: Now that you’re the president of Mercy Springfield Communities, what do you hope to accomplish?

John Myers: I want to help Mercy become a Top Decile performing hospital, and I know we have the ability to accomplish that. That means we would be a leader in quality outcomes, patient experience and frictionless access. If a patient needs to be seen by a primary care physician or a specialist, we need to have the access to be able to get them in and take good care of them. We've made a lot of progress the past couple of years, and we're still working to get to where we know we can be. The thing I was most struck by is the passion and the engagements by our physicians. We have amazing physicians who want to be the best at what they do, and our job as leaders is to create the operating structure that helps them do what they are trained to do.

Jim Blaine: Is there anyway the community can help you?

John Myers, President, Mercy Springfield

John Myers: I think the one thing that we've been very focused on is being present in the community. Showing up to events to support the community, collaborating with Cox and Burrell, Jordan Valley and other healthcare providers on areas where community need is really relevant. It is important that we are at that table and that we're part of that conversation and part of the solution. So I would just encourage that continued collaboration. I think that is something that sets Springfield apart from other communities. There is a willingness here for traditional competitors to come together at a table and do what’s best for the community. Behavioral health is a great example of that. While we still have a lot of opportunity to improve behavioral support in this region, it's been great to see organizations like the Greene County Health Department, Burrell, and Missouri State take the lead on bringing us together so we can create a path forward.

Jim Blaine: Springfield is small enough that we all seem to know one another, and it sounds like you are very aware of that.

John Myers: That’s so true. Springfield, as large as it might be, is a tight-knit community and that's what Danielle and I find really appealing about raising our family here. Having grown up on a farm, I also appreciate the access to the outdoors that’s available here.

Jim Blaine: Tell me about your outdoor passion.

John Myers: That started at an early age and is something I haven’t let go of. My wife is the same way, and that’s the way we raised our kids. So, on weekends, we often go to local places and take a hike. My kids are also really into fishing. I love to fish, but for the last several years, I believe I do more baiting their hooks rather than my own.

Jim Blaine: Where do you like to fish?

John Myers: My wife's parents are at Lake of the Ozarks, so we’ve spent a lot of time there, but I took my daughter to White River to fly fish for the first time and had no idea that that existed in our backyard. It’s one of the best fly fishing rivers in the United States, so we have a blast doing that.

Jim Blaine: Is there anything you would like to communicate to local physicians?

John Myers: I would just want to tell our physicians how proud we are to have them on the team. Because of our depth of talent, we’re able to provide world-class care here in the Ozarks. I hope our physicians see that and share in our sense of pride. I also hope they feel supported by our leadership at Mercy. We are here to partner with them to create access for patients and develop programs to support the community. I think that this is an exciting time to be part of Mercy and also to be in the Ozarks right now. Our hiring and retention for nursing is at an all-time high. We're staffing in the OR space to a level that we haven't had in a long time, and we are recruiting even more specialists whether it's cardio-thoracic surgery, GI or other specialties. We want to make sure we have all those resources in place to allow the physicians to take care of their patients in the best way possible. When I look at the scope of care we’re able to offer patients in our region and know that we offer that care as the only Leapfrog A hospital in the area, I have endless pride in our team, and I just hope our physicians feel the same because we couldn’t do this without them.

Jim Blaine: Thanks John! Welcome to Springfield!

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"THROUGH THE DECADES: HIGHLIGHTS FROM THE GREENE COUNTY MEDICAL SOCIETY ARCHIVES"

by Melissa Gaines, MD, FACP, FAAHPM CoxHealth

10 years ago 2014

GCMS Community Flu Campaign

The journal highlights the collaborative effort of the Greene County Medical Society (GCMS) and the Springfield-Greene County Health Department in conducting the annual flu vaccination campaign. Initiated over 50 years ago, the campaign initially served high-risk individuals before expanding to all residents. In 2014, the campaign vaccinated an estimated 2,000-2,500 individuals. GCMS members and volunteers played crucial roles in setting up clinics, schools, businesses, and churches. We delivered vaccine supplies and managed administrative tasks and paperwork. We also conducted public awareness and outreach. The campaign ensures the widespread availability of flu vaccines, contributing to public health and disease prevention within the community. "The GCMS is very thankful for the recipients of these vaccinationsand the opportunity to work with our Coalition. The GCMS appreciates that the major health systems in the area set aside their collective egos and work together for the good of the community."

20 years ago 2004

Eighty Years of the GCMS Alliance: A Legacy of Community Service and Leadership

March 2004 GCMS Journal, celebrating eighty years of the Greene County Medical Society Alliance (GCMS). Founded in 1924 as the Greene County Medical Auxiliary, the organization's name evolved to reflect the growing participation of male spouses in 1992. The GCMS Alliance's core purpose focuses on improving community health through public health initiatives, supporting the medical profession, and staying abreast of advancements in medicine. The alliance's commitment to public health is demonstrated through initiatives like providing libraries for hospitals, contributing to the Hygeia magazine, and supporting the Visiting Nurse Association and home-health aide services. The alliance's strong support for the medical community is evident through their work during World War II, knitting sweaters and socks for deployed medical personnel. Our Alliance continues to be active and fruitful as it has over the past eighty years.

40 years ago 1984

Singing Doctors: A Brief History (1958-1983)

The Singing Doctors were comprised of physicians, and began in 1958 as an effort to raise funds for the Missouri Hospital Association. Their initial success led to an expanded schedule of approximately 25 engagements per year, including

appearances at medical conventions and community events. The group's popularity grew, leading to appearances on national television programs such as the "Today" show and "The Mike Douglas Show." The Singing Doctors released six albums, with proceeds going towards scholarships for medical students. Their charitable work raised an estimated $350,000 over 25 years, significantly supporting aspiring medical professionals. The final curtain fell on The Singing Doctors in 1983, leaving behind a legacy of musical entertainment and philanthropic contributions. Plans were in place to continue the group's legacy through a scholarship fund and potential future productions, ensuring the Singing Doctors' positive impact would continue. "When the final curtain fell at the Missouri Hospital Association convention in 1983, The Singing Doctors announced that they were accepting no further engagement dates. Thus ended a 25 year "institution" which had performed for an estimated quarter of a million people in that period of time. Some $350,000 has been raised and the monies used to establish grants to medical schools and loans to over 200 needy medical students."

80 years ago 1944

Greene County Medical Society Bulletin, 1944

Key themes and ideas from the October 1944 issue of the Greene County Medical Society Bulletin, specifically the editorial and minutes from the Missouri Medical Service, Inc. meeting. The editorial reflects on the third anniversary of the Bulletin, highlighting its role in disseminating information and fostering connection within the society. It acknowledges the challenges of reaching a geographically dispersed membership and welcomes constructive criticism for improvement. "This issue of the Bulletin brings to a close our third anniversary as Editor of the Bulletin for the Greene County Medical Society." "We might add that all our fan mail has not been complimentary. Criticism has played its part for a Bulletin." The minutes detail a meeting focused on establishing a pre-payment plan for medical services, specifically for pathologists, anesthesiologists, and radiologists. The goal is to standardize payment procedures and ensure fair compensation for these specialists. The proposed plan advocated for specialists to bill patients directly, with all bills on hospital stationery. It also emphasized the need for cooperation between participating specialists and hospitals to ensure smooth operation. The minutes conclude with a statement expressing concern that the proposed plan might face resistance from some within the medical community.

A Man, and Woman, for All Seasons

by Jim Blaine, MD

Last week I had the pleasure of interviewing Dr. Bob Kipfer and his wife Barb at their home in Springfield.

Jim Blaine: Bob, I know that you came to Springfield as a gastroenterologist in 1973, but I also know that, prior to that, you were on duty in Vietnam?

Bob Kipfer: Yes, at that time they were drafting everybody straight out of their residencies and I was getting ready to go to Mayo Clinic for of training. Since we had the likely prospect that I'd be drafted, I went ahead and signed up and was assigned to go to Vietnam as an infantry battalion surgeon and lived in the field with the guys, jumped out of perfectly good helicopters, went on long hikes, and dug a lot of holes. A year later I came back and spent a year at Fort Riley followed by reserve obligations. Vietnam was an interesting time and different kind of medicine.

I completed my gastroenterology training at Mayo’s and arrived in Springfield and Ferrell Duncan Clinic in 1973. During the latter part of my practice, the writing on the wall about what medicine was going to be like in the future was uncertain. We ended up in negotiations with Cox to decide what Ferrelll Duncan's relationship would be with Cox and that ended up with the program we have now. We needed to have somebody involved in the integration because Cox had a number of employed physicians and we were going to have a formal

relationship with Cox. Eventually we formed that relationship and it required having a medical director/ chairman of the JOC. I ended up doing that for the rest of my career. I was doing less gastroenterology and more administration right up until I retired. At that time, I was doing about 80% administration and 20% gastroenterology.

Jim Blaine: And then you retired.

Bob Kipfer: Well actually retirement was a lot easier from administration because it wasn't as satisfying as medicine. However, I worked with great people. I loved the work and loved the people, but it was good natural time to retire.

Jim Blaine: I suspect you were searching for another passion it seems that you found that in Bull Creek?

Bob Kipfer: In 1995 we were looking for the getaway place we never had and, by a series of coincidences, we ended up buying land on Bull Creek with an A-frame and 85 acres. We bought the land two years after the big 1993 flood and at that time there was a huge erosion of a bank right across from our A-frame. A proposed conservation department bank stabilization plan was going to require planting 120 trees and we were told that was for the Riparian. And we said "What's Riparian?" We didn’t have any background for this and and they explained the Riparian was the group of trees that holds the bank and shades the water and increases the oxygen and the health of the stream. We then realized that there was only one row of trees along most of the stream and so, rather than planting 120 seedlings, we ended up planting 1200 seedlings. After that the conservation department said “Hey we got a live one down here” and they started giving us other projects that included banks, warm season grass plots, and timber stand improvement. At the same time, the Master Naturalist started here. We joined that organization, and plunged deeply into conservation. We’ve had a ball it's been a great experience and we're still doing it and very actively involved!

Jim Blaine: Researching the Internet, I found that Larry Whitley has written an article in 2020 called “Conservation Pioneers; A Never Ending Love Story”. I suspect that that has something to do with Bull Creek as well?

Bob Kipfer: Yes! Larry had a cabin that overlooks our drive at Bull Creek. So, for a number of years, they had their weekend get

Dr. Kipfer in his A-frame cabin on Bull Creek

away there. We've done things with Larry for for a long period of time and of course Larry is an outdoor writer involved with bass pro and so that's that's why he wrote that article. It involved the Wolf School which we teach at and that was a major part of his article. At that time, the Wolf School was a fifth grade class with 46 students, two teachers, one parent, and a standard curriculum for the 5th grade in the Springfield public school choice program. It is the standard curriculum taught through the lens of nature and by that that means that they have field trips pretty much weekly. We have sessions on anything from insects to native plants. Barb and I initially did it once a week now we're doing it a little less frequently because we've been able to get other resources together which is important because right now at 83 I'm not going to be doing this forever and it's hard to find somebody that has the interest and knowledge and the time because you pretty much gotta be retired to do that. This project has been a full time patient and it's just been wonderful for both of us.

Jim Blaine: Do you still teach?

Bob Kipfer: We had a field trip last Friday! We had the Wolf School bring their bus down to the narrow lane and we we had sessions on the water and in the woods. We've been doing that ever since the wolf school started.

Jim Blaine: I also found on the Internet that Bob and Barb Kipfer were honored with the National Conservation Special Achievement award?

Bob Kipfer: Well, we have been very very fortunate in that these are people we've worked with and so we've had several opportunities to have awards made simply because we're both involved in it. We have been talking about me, but Barb is just as involved. She is a invasive species crusader fighting all kinds of invasive species and giving talks on that and she has planted over 90 species of native plants in her backyard. I say her backyard because she does all the work. Barb teaches classes on removing invasive species.

Jim Blaine: Do you pass these experiences on to your students at the at at the Wolf School?

Bob Kipfer: Yes! The Wolf school is located behind Bass Pro and we we bring in all kinds of natural things. You probably saw the acorns I have there on the ground in our backyard? If you throw the acorns in the water, some sink and some float; those that sink are living and those that float will have an insect in them and not germinate. That is part of their life cycle.

Jim Blaine: I have no idea how you guys do as much as you do. Circling back around to Bull Creek is Mike Kromrey involved?

(Watershed Committee of the Ozarks Executive Director).

Kipfer: Oh yeah he wrote the forward to Saving

book

Bob Kipfer: Yes! Loring Bullard is in charge of water quality in Greene County for a number of years; he owns the land with the source of water for Bull Creek, and Loring has had a passion about Bull Creek for years including floating it and canoeing it. He approached me about writing a book on Bull Creek. Loring is concerned because Bull Creek is an index stream and that makes it a stream against which all other streams are measured. Bull Creek is one of two or three streams in Missouri with the purest water. Unfortunately, the headwaters are near Ozark, Chadwick, and several other growing towns that have increased the number of people moving in, cutting down the woods, and putting in large mowed lawns with fertilizer that runs directly off into the Creek. These challenges and others can affect the future viability of the Creek. We are doing stream research on Bull Creek through MSU; they study the Hypo Reg zone; the Hypo Reg zone is when you're standing on a gravel bar 12 inches above the water level of the stream and burrow down 13 inches, in other words an inch below the water level, you'll find there is a lot of life there that lives just in that area and not out in the stream, but in that Hypo Reg zone insects (dragonflies larvae etc.) and a wide variety of other things that live in that wet gravel and then when they mature they come out and they fly off to do their thing (mate). One example of a new species found there was a frog biting midge. The frog biting midge larvae live in the stream for their entire life in that Hypo Reg zone until they come out when they mature. They then fly out and the female bites a frog to get the blood so that she can be impregnated and have have her babies and those babies go back into the gravel. The researchers pumped out this larva and they couldn't tell exactly what it was because, although it's a core thrilla, there's a large

Bob

Bull Creek

Jim Blaine: “Saving Bull Creek”?

Barbara Blaine on the bank of crystal clear Bull Creek.

number of core thrilla species. You have to have the adult to tell what the exact species is so they put a trap out over the gravel, and played the recording of a wood frog. The female then came out, fell into the trap, and they were able to identify it as a new species! They gave it the name Cortella kippari!

Jim Blaine: Wow!

Bob Kipfer: Yes! The researcher that was doing the identification became a good friend and it's the only known place in the world this species of a frog biting midge exists. Although we suspect it is probably in other places in the world, so far it's never been seen anywhere else so that's one more reason why it's important to protect Bull Creek and protect all streams because there's other cortellas out there unidentified. Important thing is once they’re gone you'll you never see them again. Currently we know that there are many animals and plants that are in danger of extinction due to the changes we are making in our environment, and we need to remain vigilant.

Jim Blaine: Does climate change play a part?

Bob Kipfer: Yes! Climate Change is a major part of it. Climate change and its effects have always gone on, but just never come on in this way. We've had ice ages that occurred over long periods of time so there was a time that certain animals came and went, but they had some time to adapt and smaller species could make it. Currently, it's happening so rapidly.

Jim Blaine: As a result we need an intervention?

Bob Kipfer: Yes! That's exactly right! We are aware of the things that we're doing with fossil fuel and you know we are constantly changing the land. I’m particular interested in the Bull Creek area with the history there because there has been a history of 12,000 years of Native Americans. We know that

12,000 years ago there were no humans here on the American continents and then the first ones that came over didn't cause any damage. We have lots and lots of artifacts including pointed projectiles and knives to document their existence with no harm to the land or creek. However, then we arrived and began cutting down trees and harvesting the forest for timber for railroad ties. The Chadwick area was a major supplier. Kansas didn't have railroad ties so we had to ship them there and by doing that we stripped those forests and stripped away the land. That allowed the erosion to the stream because people were raising cattle right up to the edge of Bull Creek and cutting down the Riparian trees that protected the stream. They totally eliminated the river cane which was dense when Henry Schoolcraft came through here in 1819. We have now completely changed the appearance of this area and that has had an effect on the stream.

Jim Blaine: It is amazing to me to see all that you and Barb have accomplished over the last few years in conservation and I think that our readers are really going to appreciate that.

Bob Kipfer: You can't protect nature unless you first learn to love it so that I think is a a major part of our our interest in what we've been doing since since we stumbled into this second career. I would say that it's not financially rewarding, but is very rewarding in every other way.

Jim Blaine: Gastroenterology and Bull Creek activism, how would you rank them?

Bob Kipfer: They're both Wonderful! Administrative duties and practicing medicine as a gastroenterologist were both rewarding. Both were doing good things as all of your readers know.They are doing things that make you feel good because you are contributing to the general health of the public. I hadn't thought of this before, but in some ways Barb and I are still doing that. It's just that we're practicing on nature rather than than directly on human beings.

Jim Blaine: Thanks to you both!

"Saving Bull Creek" co-author Loring Bullard

THE PERSONAL JOURNEY TO FIND BALANCE: LESSONS FROM THE GREAT OUTDOORS

by Max Buetow, President and CEO of CoxHealth

Getting into the great outdoors and doing something physical is a great way to hit the reset button and gain a fresh perspective.

As you may know, I am a big fan of our national parks. I believe they are an incredible gift and an unrivaled asset for our country, and we are blessed to have these treasures so accessible to anyone.

I recently took a weekend hiking trip to Utah, where I was reminded of the value of balance and focus across all areas of our lives.

I spent the weekend at Bryce Canyon and Zion National Park with my son, Jacob, and my brother, Luke.

On our first day, we arrived at Bryce Canyon at sunset. As so many hikers were on their way out, we put on our headlamps and headed down into the canyon for a night hike. Walking among the towering hoodoos in stillness of the night, we were blanketed in the peace of the moment. We capped off the experience by laying out on a wide section of the trail. Staring up at dark sky unpolluted by light, we took in the panorama of stars accented by the haze of the Milky Way. Without any significant conversation, we all felt close to one another and our Lord, who orchestrated that special moment.

Saturday was a day of transition and preparation, as we

shifted gears and focus for our upcoming, 22-mile hike of the narrows at Zion.

On Sunday morning, we were up at 3:30 a.m. and on the trail early. This was a different hike for all of us: We traded in the typical dirt trail for the less sure footing of river rocks as we tracked in and alongside the Virgin River.

As I often do while hiking, I thought of the ways you have to divide your focus – paying close attention to the slippery rocks beneath my feet, while also taking time to look around and observe the beauty of the moment. Nearly every step

required attention – none of us wanted to take an unnecessary bath in the 50 degree water. We also had to keep a sharp eye on the clock, because we needed to hit the finish line in less than 12 hours (the average time for those tackling the hike) in order to catch the last shuttle out of the park.

Keeping the goal and destination top of mind, we also didn't want to get tunnel vision on the task and miss soaking in the scenery while enjoying the time together.

It’s incredible to me that even with many of these thoughts happening simultaneously, the experience can still be extremely peaceful and rejuvenating when the right balance is maintained. And I believe the same is true in work and in life.

But there is also perspective to be gained in the moments of challenge and growth. My son had never been on a hike as long as the narrows, and I know he was pushing hard in the last two hours. That’s when the legs and pack get heavy, and you’re forced to dig into your reserve of discipline and strength. I was proud to see him persevere through the challenge, and it was rewarding to push through it together.

It comes down to balancing these factors and experiences in a way that works for you. With the pace of work and family life, we all have to find ways to make the most of every moment. Balance does not come naturally. For many of us, it requires intentionality, and it can also mean different things to different people.

To some, tackling Bryce Canyon and Zion within the same weekend would not be considered “balanced,” which I completely understand. But for me, it was the perfect way to escape the pressures and chaos of the daily grind while I focused on the challenge of the opportunity, the beauty of God's creation, and the blessing of the time I got to share with the people I love.

All of that to say, I am no expert or example to follow of someone who has balance and focus figured out. But how great is it to have these God-given reminders – like the wonder of nature and the outdoors – to re-center us and remind us of what is important?

Taking that reminder home with me, it gave me renewed energy to focus on how I’m prioritizing things in work and

in life. Evaluating areas where I can push myself to be better for my colleagues, or take a step back from my professional responsibilities in order to prioritize my family.

Taking a close look at what balance means for you – both professionally and personally – and focusing your time and effort on working toward that balance is important for all of us.

As we all work to grow, innovate, and elevate the ways we serve our communities, I know I benefit from the lessons of the trail. I am grateful each day to be on the journey alongside all of our region’s health care professionals, and I hope you’ll all make plans to get outdoors soon!

PLEASE JOIN US FOR A HOLIDAY CELEBRATION

by Barbara Hover, President GCMS Alliance

The GCMS Alliance has our focus on Physician Wellness and strengthening the Family of Medicine. Our Zoo event in August and the Discovery center in February have been designed to offer quality family time and fellowship with others in the same profession. Socializing with those who understand the pressures of the job often relieves the stress for both the physician and spouse or partner. The Alliance is extending this project by offering more events and opportunities for couples and/or the spouses to socialize together. In October we brought back Wine Wednesday which was organized by Cybil True. November’s activity was a fun evening at the AR Workshop arranged by Megan Gradney. In December we will celebrate the holiday season with a Potluck Brunch to be held at Cooper Estates Club House on December 19 at 11 am. Please come and share your favorite holiday tradition. We will have fun surprises, good food and great fellowship. Barbara Blaine and Cathy Leiboult will be

our hostesses. There will be a short general membership meeting at which time we will install officers for 2025. We are excited to have Donna Corrado, Missouri State Medical Society Alliance President, in attendance. Registration is available online and we hope that Alliance members, prospective members and friends of the Alliance will attend. Renewal of dues in now available online. This will be our annual meeting and we hope to see you there. REMEMBER, YOU DO NOT NEED TO BE A MEMBER TO ATTEND OUR EVENTS. Friends are always welcome!

GCMSA would like to thank Jana Wolfe for her many years of service to the Alliance and their activities.

GCMS Alliance having fun at the AR Workshop Art Studio

GCMS Congratulates David Anderson, MD

Dr. David Anderson, a CoxHealth physician specializing in prostate cancer and robotic surgery, has been recognized by Newsweek Magazine as one of America’s Best Prostate Cancer Surgeons for 2024!

This distinction is awarded based on various performance measures, including peer surveys, certification considerations and more. Only 150 prostate cancer oncologists nationwide are recognized.

“If there’s anybody that this recognition should go to, it’s my entire team,” says Dr. Anderson. “I’ve got a great team that helps me manage all aspects of my practice. Nobody works in a silo in my field, so I’m very thankful for my incredible nurses, surgical staff, physician's assistants, anesthesiologists and more. We are giving patients an opportunity to get great care for prostate cancer right here at CoxHealth.”

Dr. Anderson has served CoxHealth patients for nearly 20 years.

“I like taking care of prostate cancer patients because it allows me to create a relationship with these patients not only at a time where their lives are stressful, but also to continue following these patients over the years with really good outcomes,” says Dr. Anderson.

Prostate cancer is the most commonly diagnosed cancer in men in the United States. Dr. Anderson encourages atrisk patients, including men over the age of 50, to talk with a health care provider about an annual rectal exam and a prostate-specific antigen (PSA) blood test.

GCMS Alliance enjoying a great night of fine wine at Vino Cellars.

GCMS LEGISLATIVE FORUM WITH LOCAL REPRESENTATIVES

by Jim Blaine, MD

Our GCMS Legislative Forum was held on Thursday, October 17, 2024 at the Jordan Valley Health Center. All State House and Senate candidates were invited and the event was well attended. As is our custom, the candidates were asked the same single question, and then given 5-10 minutes to address the GCMS members in attendance followed by Questions and Answers.

was 30% with the lion’s share going to research, treatment and prevention compared to 6% in Missouri with little to none going for research, treatment or prevention . The question posed to the candidates was, “Would you support a referendum to send an additional 24% on recreational marijuana?” All candidates stated that they would support such a

It was felt that, with this particular question, an explanation was necessary. The candidates were informed that several GCMS Executive Council members had studied the report “Colorado Division of CriminalJustice Report on Impacts of Marijuana Legalization in Colorado” that covered the previous ten years. They found that motor vehicle fatal crashes involving marijuana had increased 140%. Colorado recreational marijuana tax in Colorado

referendum (a referendum allows the legislature to send such a proposed amendment directly to the vote of the people without having to gather signatures for an Initiative Petition). Subsequently, following the November 5 election, Republican Representative Bill Owen, and Democratic Representative Betsy Fogle agreed to sponsor such a referendum in the House.

Left to Right:J.T. Rogers, MD, GCMS President, Derrick Nowlin, Rep. Betsy Fogle, Rep. Bill Owen, Rep. Melanie Stinnett, Rep. Stephanie Hein, MSMA Lobbyist Rachel Bauer, MSMA President Elect Brian Biggers, MD.

professional

To

Please Note: Changes to ads will be made quarterly and must be submitted in writing. H Denotes GCMS Membership “A” Denotes GCMS Applicant

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Statement

Dermatology, Procedural

MICHAEL H. SWANN, MD H

BRETT NEILL, MD

MICHAEL KREMER, MD

JOHN CANGELOSI, MD

AUTUMN BERTHOLDI, PA-C

PATSY DUGGAN, PA-C

LORI MILLER, NP-C

HANNAH LEE, FNP-BC

3850 S. National Ave, Suite 705 Springfield, MO 65807 (Located inside Hulston Cancer Building-7th floor)

1240 E. Independence Springfield, MO 65804

Phone: 417-888-0858 • Fax: 417-889-0476 www.swanndermatology.com

Hollister Location 590 Birch Rd, Ste 2c Hollister, MO 65672 PH. 417-690-3858 Fax 417-690-3862

Monett Satellite Location (Inside CoxHealth Urgent Care) 2200 E. Cleveland Ave Monett, MO 65708 Phone: 417-888-0858 • Fax: 417-889-0476

Direct Primary Care

ASCENT DIRECT PRIMARY CARE, LLC

MATTHEW GREEN, DO H

Family Medicine

www.ascentdpc.com 417-595-0956

413 N McCroskey, Ste 2 Nixa, MO 65714

Eye Surgery/Ophthalmology

EYE SURGEONS OF SPRINGFIELD, INC.

C. BYRON FAULKNER, MD H Comprehensive Cataract Ophthalmology

JUDD L. McNAUGHTON, MD H Comprehensive Cataract Ophthalmology Diplomates, American Board of Ophthalmology

1330 E. Kingsley St. • Springfield, MO 65804 Phone 417-887-1965 • Fax 417-887-6499 417eyecare.com

Eye Surgery/Ophthalmology

MATTAX • NEU • PRATER EYE CENTER

JAMES B. MATTAX, JR., MD, FACS H American Board of Ophthalmology

LEO T. NEU III, MD, FACS H American Board of Ophthalmology

DAVID NASRAZADANI, MD

DREW A. YOUNG, MD

THOMAS PRATER, MD, FACS H American Board of Ophthalmology

JACOB K. THOMAS, FACS, MD H American Board of Ophthalmology

BENJAMIN P. HADEN, MD H American Board of Ophthalmology

MICHAEL S. ENGLEMAN, OD

MARLA C. SMITH, OD

MATTHEW T. SMITH, OD

1265 E. Primrose Springfield, MO 65804 417-886-3937 • 800-995-3180

Family Medicine

COXHEALTH

FAMILY MEDICINE RESIDENCY

FAMILY MEDICAL CARE CENTER

3800 S National Ste 700 Springfield, MO 65807 (417) 269-8817

AmericAn BoArd of fAmily medicine

Marc Carrigan, MD

Cameron Crymes, MD

Kristin Crymes, DO

Kristen Glover, MD

Kyle Griffin, MD

Shelby Hahn, MD

Laura Isaacson, DO

Evan Johnson, MD

Katie Davenport-Kabonic, DO

Michael Kabonic, DO

Jessica Standeford, MD

Gynecology

WOMAN’S CLINIC www.womansclinic.net

Leaders in Minimally Invasive Gynecology & Infertility

DONALD P. KRATZ, MD, FACOG H American Board of Obstetrics and Gynecology

AMY LINN, FNP-BC American Academy of Family Nurse Practitioners

VANESSA MCCONNELL, APRN, DNP, FNP-C

1135 E. Lakewood, Suite 112 Springfield, MO 65810

Located inside Tri-Lakes Family Care 1065 Hwy 248 Branson, MO 65616

Phone 417-887-5500 Fax 883-8964 or toll free 877-966-2607 Monday-Thursday 8am-4:30pm Friday 8am-12pm

Internal Medicine

MERCY CLINIC–INTERNAL MEDICINE WHITESIDE

RAJ ANAND, MD

JAMES T. ROGERS, JR. MD, FACP H

Board Certified in Internal Medicine

MARIA DELA ROSA, MD

NELSON DELA ROSA, MD

AMANDA MCALISTER, MD

ALEJANDRA ROA, MD

KELLY TRYGG, MD

GABBY BONNER, NP

STEVEN BOWLIN, MD

Board Certified in Internal Medicine

STEPHANIE HOVE, NP

CARRIE KUGLER, PA

COURTNEY WEATHERFORD, PA

JENNIFER WHITE, PA

VICTOR GOMEZ, MD

Board Certified in Internal Medicinee 2115 S. Fremont, Suite 2300 Springfield, MO 65804

Phone 417-820-5600 Fax 417-820-5606

Urology

MERCY CLINIC UROLOGY (FREMONT)

ERIC P. GUILLIAMS, MD, FACS H American Board of Urology

ROBERT D. JOHNSON, MD, FACS H American Board of Urology

TYRUN K RICHARDSON, MD

American Board of Urology

MARK J. WALTERSKIRCHEN, MD, FACS

American Board of Urology

Phone 417-820-0300

Fax 417-882-9645

1965 S Fremont, Ste. 370 Springfield, MO 65804

Internal Medicine

ADULT MEDICINE & ENDOCRINOLOGY

JONBEN D. SVOBODA, MD, FACE, ECNU

American Board of Endocrinology

JAMES T. BONUCCHI, DO, ECNU, FACE

American Board of Endocrinology

NICOLA W. GATHAIYA, MD, ECNU, FACE, CCD

American Board of Internal Medicine

American Board of Endocrinology

STEPHEN M. REEDER, MD, FACP

American Board of Internal Medicine

ANA MARCELLA RIVAS MEJIA, MD, CCD

American Board of Internal Medicine

American Board of Endocrinology

JACQUELINE L. COOK, FNP-BC, CDCES, CCD

KELLEY R. JENKINS, FNP-C, CDCES

ALINA CUMMINS, PA-C

STACY GHOLZ, FNP-C

SHELLEY L. CARTER, DNP

JESSICA A. CROUCH, FNP-C

Phone (417) 269-4450

960 E. Walnut Lawn, Suite 201 Springfield, MO 65807

Nephrology

SPRINGFIELD NEPHROLOGY ASSOCIATES, INC.

1911 South National, Suite 301 Springfield, MO 65804

Phone 417-886-5000 • Fax 417-886-1100 www.springfieldnephrology.com

STEPHEN E. GARCIA, MD H

American Board of Internal Medicine

American Board of Nephrology

ETHAN T. HOERSCHGEN, MD

American Board of Internal Medicine

American Board of Nephrology

GISELLE D. KOHLER, MD H

American Board of Internal Medicine

American Board of Nephrology

DAVID L. SOMMERFIELD, MD

American Board of Internal Medicine

American Board of Nephrology

SUSAN A. WOODY, DO H

American Board of Internal Medicine

American Board of Nephrology

Neurosurgery

SPRINGFIELD

NEUROLOGICAL AND SPINE INSTITUTE

CoxHealth Jared Neuroscience

West Tower • 3801 S National, Ste 700 Springfield, MO 65807 • 417-885-3888

Neurosurgery:

H. MARK CRABTREE, MD, FACS

EDWIN J. CUNNINGHAM, MD

MAYUR JAYARAO, MD

J. CHARLES MACE, MD, FACS H

CHAD J. MORGAN, MD

MICHAEL L. MUMERT, MD

SALIM RAHMAN, MD, FACS

ANGELA SPURGEON, DO

ROBERT STRANG, MD

Interventional Neuroradiology

MICHAEL J. WORKMAN, MD

Physiatry:

TED A. LENNARD, MD

KELLY OWN, MD

Physician Assistants:

JOSHUA BARBIERI, PA-C

MARK BROWN, PA-C

ERIC CHAVEZ, PA-C

BLAKE MARTIN, PA-C

HEATHER TACKETT, PA-C

Nurse Practitioner:

EMILY CROUSE, NP-C

BILL HAMPTON, ANP-BC

ROZLYN MCTEER, FNP

BRANDON RUBLE, ACNP-AG

ALYSSA CHASTAIN, FNP Obstetrics/Gynecology

COXHEALTH

PRIMROSE OB/GYN

MARCUS D. MCCORCLE, MD, FACOG

Diplomate, American Board of Obstetrics and Gynecology

THOMAS M. SHULTZ, MD, FACOG

Diplomate, American Board of Obstetrics and Gynecology

GREGORY S. STAMPS, MD, FACOG

Diplomate, American Board of Obstetrics and Gynecology

P. MICHAEL KIDDER, DO, FACOOG

Diplomate, American Osteopathic Board of Obstetrics & Gynecology

Phone 882-6900

1000 E. Primrose • Suite 270 Springfield, MO 65807

Obstetrics/Gynecology

SPRINGFIELD OB/GYN, LLC

MATTHEW H. TING, MD, FACOG H

American Board of Obstetrics & Gynecology 909 E. Montclair, Suite 120 Springfield, MO 65807

Phone 417/882-4466 • Fax 417/890-5631

Oncology/Hematology

ONCOLOGYHEMATOLOGY

ASSOCIATES OF SPRINGFIELD, MD, P.C.

WILLIAM F. CUNNINGHAM, MD, FACP

American Board of Internal Medicine

American Board of Medical Oncology

JIANTAO DING, MD H

American Board of Internal Medicine

American Board of Hematology

American Board of Medical Oncology

ROBERT J. ELLIS, MD, FACP

American Board of Internal Medicine

American Board of Hematology

American Board of Medical Oncology

BROOKE GILLETT, DO

American Board of Internal Medicine

American Board of Medical Oncology

V. ROGER HOLDEN, MD, PhD

American Board of Hematology

American Board of Medical Oncology

DUSHYANT VERMA, MD, FACP

American Board of Internal Medicine

American Board of Hematology

American Board of Medical Oncology

Springfield Clinic 3850 S. National, Ste. 600 Springfield, Missouri 65807

Monett Clinic 802 US Hwy 60 Monett, Missouri 65708

Phone 882-4880 Fax 882-7843

Visit our website: www.ohaclinic.com

Otolaryngology

MERCY CLINIC–EAR, NOSE & THROAT

BENJAMIN L. HODNETT, MD, PHD H

ERICH D. MERTENSMEYER, DO, FAOCOO

AARON R. MORRISON, MD

A. DANIEL PINHEIRO, MD, PhD, FACS H

RAJEEV MASSON, MD

MARK J. VAN ESS, DO, FAOCOO

Diplomates, American Board of Otolaryngology

SHELBY BRITT, PA

MELISSA COONS, FNP

TAHRA LOCK, NP

ELIZABETH (BETSY) MULLINGS, FNP

PAUL STRECKER, FNP

Audiology

JASON BOX, AuD, CCC-A

MAMIE JAYCOX, AuD, CCC-A

JENNIFER PLOCH, AUD

ALLISON WHITE, AUD, CCC-A

Phone 417-820-5750

Fax 417-820-5066

1229 E. Seminole, Ste. 520 Springfield, MO 65804

Plastic Surgery

MERCY CLINIC–FACIAL PLASTIC SURGERY

MATTHEW A. KIENSTRA, MD, FACS

American Board of Facial Plastic & Reconstructive Surgery

American Board of Otolaryngology

Phone 417-887-3223

1965 S. Fremont, Ste. 120 Springfield, MO 65804 facialplasticsurgeon.com

Psychiatry

JAMES E. BRIGHT, MD H Diplomate, American Board of Psychiatry & Neurology.

Practice Limited to: Adult Psychiatry

Phone 882-9002

1736 E. Sunshine, Ste. 400 Springfield, MO 65804

4730

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