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FOCUS TOPICS PEDIATRICS • PAIN MANAGEMENT • HEALTH LAW

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Improving on the Entire Spectrum of Care

New Chief of Pediatric Neurology at UAMS/ Arkansas Children’s looking to continue refining and improving access to care and services Freedom F. “Fred” Perkins, Jr., MD, has a background uniquely suited being the new chief of pediatric neurology of both Arkansas Children’s system and the University of Arkansas for Medical Sciences (UAMS).

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The Diagnosis and Treatment of Neuropathic Pain

AHLA Panel Looks at Current, Post-Pandemic Landscape  By CINDY SANDERS 

In the face of a global health crisis that called for limiting close, in-person contact, it’s not surprising telemedicine has enjoyed skyrocketing popularity in 2020. In addition to the practicality of such medical appointments, emergency orders loosening tight regulatory mandates around the field has made it possible for more providers to offer services to a larger patient population. Nothing, however, lasts forever. Turning an eye to a post-pandemic landscape, the Physician Organizations Practice Group of the American Health Law Association recently hosted a webinar looking at both legal and practical considerations of telemedicine now and moving forward. The regulatory changes currently in place are in effect throughout the public health emergency. When that designation is removed, rules and (CONTINUED ON PAGE 2)

Neuropathic pain is an important medical topic and the diagnosis of it should be understood by any medical provider regardless of their specialty. It is a condition that also presents in primary care but is often unrecognized.

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Legal & Practical Considerations for Telemedicine  

HealthcareLeader

A Foundation of “Service Before Self” Serves Well in Healthcare

Saline Health’s Michael Stewart committed to community By MELANIE KILGORE-HILL

Saline Health System CEO Michael Stewart is leading by example. Now in his second year at the Benton, Arkansas hospital, the seasoned executive is putting his military and professional experience to work for the rapidly

growing community of Saline County.

Starting out

Born in Gainesville, Florida, Stewart was a military kid who spent his childhood bouncing around the U.S., early adopting the Air (CONTINUED ON PAGE 4)

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Legal & Practical Considerations for Telemedicine, continued from page 1  

regulations revert to pre-pandemic status unless there is further action at the federal level.   

Public Health Emergency

On March 13 of this year, President Donald Trump made an emergency declaration in regard to the COVID-19 pandemic under the Stafford Act and the National Emergencies Act. That declaration of a public health emergency (PHE) set into motion authority for various federal agencies to issue waivers providing flexibility to meet the unique challenges of COVID-19.   Within days, changes went into effect

across Health and Human Services. The Office for Civil Rights (OCR) issued new HIPAA guidance allowing covered providers, “in good faith, (to) provide telehealth services to patients using remote communication technologies, such as commonly used apps – including FaceTime, Facebook Messenger, Google Hangouts, Zoom, or Skype – for telehealth services, even if the application does not fully comply with HIPAA rules.”   CMS issued a number of waivers making it easier for those enrolled in Medicare, Medicaid and the Children’s Health Insurance Program (CHIP) to access care through telehealth platforms

during the crisis. Changes have allowed providers to conduct telehealth visits with patients inside their homes and outside of designated rural areas. In many cases, providers could practice even across state lines. Telemedicine could be used for both established and new patients, and the appointments have been billable as if the visit was in person. Additional waivers specifically addressed Rural Health Clinics (RHCs) and Federally Qualified Health Centers (FQHCs), including easing  some  physician supervision requirements for nurse practitioners to the extent permitted by state law.    

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Transformation of Telemedicine

Ronnen Isakov  serves as  managing director of healthcare advisory services for Medic Management Group, which provides operational, management, financial and revenue services for practices. He noted CMS added 135 allowable services and CPT codes under the emergency orders, immediately doubling what had been available at the beginning of the year.   The healthcare industry, said Isakov, is notoriously slow-moving when it comes to transformation. “For our rules to change takes a long process,” he pointed out. “The pandemic kick-started the digitalization of healthcare.” Isakov added telehealth saw a decade of regulatory changes in a matter of a days and weeks.  Similarly, the medium saw an explosion in usage. Isakov said the normal number of telemedicine visits in March had been about 13,000 Medicare beneficiaries per week. “During the last week of April, in a six-week period, that number jumped to 1.7 million beneficiaries,” he noted. For those keeping score, that’s a 15,354 percent increase.  Isakov added that pre-pandemic, McKinsey estimated the total annual revenue of all American telehealth companies to be $3 billion. The company now estimates $250 billion of the nation’s health spend could ultimately be digitized. Similarly, Frost & Sullivan now predicts a sevenfold growth in telehealth by 2025.  From the operational viewpoint, Isakov said telehealth has focused on ease of access. “For our rural practices and facilities, it was an immediate way to solve some patient transportation issues,” he added of the relaxed RHC regulations.   On the flip side, Isakov noted, “There’s still a lot of perceived quality of care concerns.” He also said smaller practices continue to worry about the financial investment required long-term,  coupled with reimbursement uncertainty once temporary waivers expire. While it remains to be seen if payers continue to reimburse adequately, Isakov said there is a lot of pushback for expanded services to continue.   “We really believe it’s unlikely to see telehealth volumes go back to the preMarch numbers but that some form of telehealth is here to stay,” he concluded.   

Practical Application

Kyle Sharp, interim associate vice president and executive director of OSU Physicians at Ohio State University, said the huge system utilized telemedicine for about 100 visits per month for a total of 0.04 percent of overall patient visits prior to COVID-19.   Looking at telehealth vs. in-person visits, Sharp said telehealth didn’t even register in the numbers pre-pandemic. By March, a little more than 13,000 visits were conducted remotely. In April and May, telehealth visits outnumbered inperson visits with 44,591 telehealth visits in April and 40,898 in May. “During the peak of the pandemic, 90 percent of our providers were using telehealth,” he said. At this (CONTINUED ON PAGE 4)

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PhysicianSpotlight

Improving on the Entire Spectrum of Care New Chief of Pediatric Neurology at UAMS/Arkansas Children’s looking to continue refining and improving access to care and services By BECKy GILLETTE

Freedom F. “Fred” Perkins, Jr., MD, has a background uniquely suited being the new chief of pediatric neurology of both Arkansas Children’s system and the University of Arkansas for Medical Sciences (UAMS). In addition to being a physician and researcher with an international reputation, he grew up helping care for a younger brother, Mikie, who developed significant permanent cognitive/intellectual delays, as well as epilepsy, as a result of a respiratory infection at age nine months. “Functionally, Mikie was autistic,” said Perkins, who shared a bedroom with Mikie for 20 years until Perkins entered medical school. “He was cognitively, speech and socially delayed. He had fixed-repetitive behaviors and a keen memory for details. He did not do well with changes in his routines. He has never been formally diagnosed with autism and his hypoxic brain injury is the main source of his difficulties. But this profoundly shaped my perceptions and empirical understanding of what children and families with developmental disabilities (however they are acquired) go through.” Perkins grew up in a military family that moved often. He had a natural affinity for drawing, an interest in design and a fascination with science. If not for having a brother so gravely ill, he might have been a designer, architect or engineer. As he grew up, encouraged by his family, he felt drawn to become a doctor. “I was the first one in my family to go to college, so none of us were totally clear on what we were in for,” Perkins said. “After high school, I entered St. Mary’s University in San Antonio. I spent my weekends working, the last couple of years in the physiology department at the University of Texas Health Science Center, San Antonio. From there I was fortunate to go to medical school at the University of Texas Medical Branch, Galveston, where I initially thought I would do adult neurology.” During his training, he found he was much happier in pediatrics and came to the conclusion that pediatric neurology was a better fit. He had a four-year military commitment to the Air Force which, at the time, had all the pediatric neurologists needed. So, after his intern year, he went on active duty as an aerospace medicine specialist, the primary care provider for the flight crew. ARKANSASMEDICALNEWS

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Perkins completed his fellowship in clinical neurophysiology/epilepsy at the University of Texas at Houston and went on to be program director at the University of Tennessee Health Science Center at Memphis Pediatric Neurology Residency Program. He joined Dell Children’s Medical Center in Austin, Texas, in 2012 and most recently was interim leader of the epilepsy program. His new job involves overseeing the child neurology section at UAMS/ Arkansas Children’s system, which has neurodevelopmental specialists whose work includes evaluating and treating children with autism spectrum disorders (ASD). They also coordinate care with other medical and developmental specialists. “We intend to continue refining and improving access to care and services in any way we can,” Perkins said. “A comprehensive approach works best. That means confirming or reaffirming the diagnosis of autism, performing appropriate diagnostic studies (i.e. genetic screening, EEG, etc.) and addressing some of the major co-morbidities that are observed in autism. These include sleep disorders, irritability, epilepsy, etc. We also wish to be strong advocates for speech, occupational and behavioral therapies–within the child’s local community, if possible. This can be very challenging.” Over the past 15 years, autism rates have increased. There is a lot of speculation as to the cause, but Perkins believes awareness and testing do play a role.

“Some evidence suggests environmental causes, epigenetics, etc.,” he said. “While very interesting, I don’t think there is a single cause that explains the numbers. Early intervention is crucial. Autism is broken down into different levels (I–III) from mild to severe. At its core, the main issues in autism spectrum disorders are the development of appropriate communication and social skills. Early recognition and subsequent deployment of therapy has been shown to have a profound positive impact of the child.” If a child isn’t speaking/communicating, they want to help the child develop that skill. If the child is speaking, is it at the appropriate level? Is the communication effective? If they aren’t interacting with peers very much, can they change that? If they are interacting, is it reciprocal, etc.? GI problems are very common in the ASD population. Some causes are not clear, but Perkins suspects a poor diet (i.e. starchy foods) and sensory processing issues (i.e. fear of the toilet; discomfort during a bowel movement) are contributing factors. Behavioral therapy can help most cases. “The brain-gut connection is not too well understood, but there seems to be growing evidence, not just in autism, that it is more complex than previously thought,” Perkins said. “This is an area for further research. Probiotics and fiber supplements can be helpful for some patients.” One reason Perkins was selected for the job was his clinical experience, particularly with surgical epilepsy and magnetoencephalography. Arkansas Children’s recently installed a magnetoencephalography system. “I visited, loved the hospital and met with an awesome team,” he said. “I thought, ‘What a great opportunity to work with a smart and enthusiastic faculty and staff! We could really do something special!’” There is also a lot going on with epilepsy care at UAMS/Arkansas Children’s. There are five pediatric epileptologists and a sixth person coming early in 2021. They have a National Association of Epilepsy Centers Level IV (highest acuity) epilepsy program at Arkansas Children’s. “We see and treat children, predominantly from Arkansas, but beyond state borders as well, with all forms of epilepsy,” Perkins said. “They have the most advanced diagnostic technology

including video EEG, neuropsychological assessment, brain imaging, magnetoencephalography, functional MRI, neuro-navigated transcranial magnetic stimulation, diet therapy and all forms of epilepsy surgery (including stereotactic EEG, focal thermal laser ablation therapy, and neuromodulation).” ACH has recently been admitted to the Pediatric Epilepsy Research Consortium joining many colleagues in collaboration around the country. They also have a number of ongoing investigational drug trials. “These things are intended to improve the diagnosis and treatment options of patients with epilepsy and most of all, improve their quality of life,” Perkins said. Perkins wants other healthcare providers in the state to know that their goal is to be the best care partners and advocates for patients and families. Perkins said UAMS and Arkansas Children’s share many of the same goals including patient care, community advocacy, training the next generation of medical providers, and pushing the research envelope. “Arkansas Children’s system provides the clinical venue and tons of support for faculty and staff,” Perkins said. “Without that, there is no program. UAMS provides critical academic structure, scientific support and collaboration. For me, they are really two halves of the same coin. Both are paramount in their own respect and each makes the other stronger.” In his free time, Perkins loves yard work, even mowing the grass, and growing native plants and vegetables. Perkins has been married to pediatrician Silvia Flores-Perkins, MD, for 24 years, and they have an 18-year-old, Jamie Perkins.

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Legal & Practical Considerations for Telemedicine, continued from page 2   point, Sharp added, they have had telehealth visits from 49 states, although the majority of remote visits have been in a four-state region.  As clinics slowly reopened and expanded services throughout the summer, Sharp said in-person visits began to rebound with total number of patient visits nearing pre-COVID projections. While telehealth visits have decreased, they have remained a significant percentage of overall visits. In August 2020, in-person visits accounted for 82,866 patient encounters, but telehealth added another 26,429 visits – a far cry from the 100 per month before the pandemic.   Coming out of COVID, Sharp said their ongoing telehealth targets are for about 30 percent of primary care, 20 percent of medical specialty and 10 percent of surgical visits to be conducted via telehealth. Sustaining momentum, he added, will require some additional patient education. “Our Medicare population did not resonate with our telehealth platforms as did our other populations,” he noted.    

Evolving Telehealth Law

Kate Hickner, a partner in the Cleveland office of  Brennan Manna & Diamond and chair of AHLA’s Physician Organizations Practice Group, noted telemedicine first came on the scene in 1997 as part of the Balanced Budget Act.  There have been multiple tweaks to the law, some quite significant, over the ensuing two decades.  Hickner said the Medicare Telehealth

Benefit is outlined in section 1834(m) of the Social Security Act, which includes specific geographic, location, service, technology and provider requirements, albeit with some exceptions. “Even though Medicare has implemented waivers, 1834(m) of the Social Security Act is still the law,” she pointed out.   Hickner said Congress will have to address the changes that have been put in place when the public health emergency declaration expires. She added there does seem to be a will to expand telehealth access. “There is a White House directive to CMS to look at telehealth efforts in rural health areas,” Hickner noted. She added the proposed 2021 physician fee schedule adds nine telehealth codes permanently, removes 74 at the end of the year in which the public health emergency declaration expires, and includes 13 codes to add to the list of telehealth services. However, she pointed out, any changes at this point are still in the proposed stage.  During the PHE, Hickner noted the HHS Office of the Inspector General (OIG) has created increased flexibility to allow providers to waive copays and deductibles for telehealth. Under normal circumstances, such a move to reduce or waive costs owed by federal healthcare program beneficiaries  could  be seen as inducement under the anti-kickback statute. However, OIG has said they will not enforce the statutes if providers choose to reduce or waive cost-sharing for telehealth during the COVID-19 emergency. 

Other flexibilities around supervision, signature requirements, licensure, credentialling, prescribing and data privacy and security have all been temporarily implemented, as well. Medical documentation for a telehealth visit, she continued, is generally the same as for an in-person visit with two key distinctions: 1) consent to receive telehealth services and 2) notation of the state where the patient is located for the visit and specific location of the rendering provider.   “Regardless of the flexibility offered by CMS, we do need to consider state law,” Hickner reminded the audience. “The practice of medicine occurs where the patient is located at the time of service,” she continued. If a physician is in Tennessee but caring for a patient in Arkansas, then Arkansas’ rules and regulations govern the encounter.    Plan Now for Post-Pandemic 

For those who didn’t previously have a robust telehealth program in place, Greg Stein, IT and IP counsel for Cleveland Clinic, said now is the time to be thinking about how to move forward post-pandemic.   Currently, the type of technology that can be used has been greatly expanded to include any non-public facing remote communications product including Zoom, FaceTime, Microsoft Teams and other popular platforms. Similarly, private texting applications including Facebook Messenger, Jabber and iMessage are acceptable. However, cautioned Stein, using

public-facing technologies like TikTok, Facebook Live or Twitch are prohibited for telehealth.  While penalties aren’t being enforced right now for a hack related to the “good faith provision of a telehealth service,” Stein said a “bad faith provision” is still in play including an intentional invasion of privacy, use of personal health information (PHI) prohibited by the HIPAA Privacy Rule such as selling data or using PHI for marketing purposes without authorization, telehealth violations of state licensing laws or professional ethical standards, and for using public-facing remote communication products.  “At some point, this moratorium is not going to apply, so practices need to be thinking how telehealth will work within the framework of HIPAA,” he said of reverting back to more stringent rules. “With this enforcement discretion in place, it’s a really good opportunity to dig into details right now,” he continued.   Stein, who served as vice chair of the Data Privacy and Information Security Group as a partner at Ulmer & Berne LLP prior to joining Cleveland Clinic, suggested teaming up with someone who understands the technology  in play and the requirements to adequately protect privacy and security to meet stringent HIPAA requirements once the PHE expires. He recommended asking lots of questions or finding an advisor who knows what questions to consider when it comes to negotiating a telehealth agreement and analyzing risk.  

A Foundation of “Service Before Self” Serves Well, continued from page 1

Force motto, “Service before self.” After graduating with his Bachelor of Science in mechanical engineering from Texas A&M University, he served four years in the Air Force and rose to the rank of captain before pursuing his Master of Business Administration from McCombs School of Business at the University of Texas at Austin.

A passion for health care

Unbeknownst to Stewart, those military years were preparing him for a successful career in hospital administration. “Working as an Air Force engineer paralleled healthcare because I was responsible for base operations, and a base is a small city with a lot of different parts,” he said. Early in his career, Stewart also had a unique opportunity to experience hospital administration by shadowing a college friend who served as CEO at a Dallas hospital. “He explained the ins-and-outs and how it matched up to the military, and I knew this was where I wanted to be,” said Stewart, who soon accepted a residency position in a South Florida hospital and gained disaster preparedness experience courtesy of hurricanes Charley and Frances. From there he accepted a CEO position in the high desert of Southern California, and eventually relocated to Northwest Arkansas for a role as COO at Northwest Medical Center in Springdale. In 2014 he accepted a position as CEO of Navarro Regional Hospital in Corsicana, 4

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Texas, but eventually decided to return to the state where he met his wife - Arkansas. “As a Texas guy I really thought I’d end up there for the rest of my career, but I was fortunate this opportunity became available,” he said. “I met the fabulous team here which was made up of such good people, and I felt like what they needed, I could provide. Literally on the way back to Texas I called my wife and said, ‘start packing your bags, we’re moving to Arkansas.’”

A community with heart

Nestled in the heart of Central Arkansas, Saline County has experienced unprecedented growth, with the cities of Bryant and Benton growing nearly 40 percent in 15 years. Healthcare also is a selling point, since the region boasts 54 percent more physicians and 48 percent more hospital beds per capita than the U.S. average. Oncology specialist CARTI and Arkansas Heart Hospital are among the Little Rock providers who’ve opened satellite offices in Saline County. Only 30 minutes from Little Rock, Saline Memorial Hospital still faces some of the challenges common in rural medical centers. “My charge is to look at ways to deliver big city care in a rural setting, and while we may not have all the resources they do, we do have heart,” said Stewart, who was chosen to serve on the American Hospital Association’s Rural Healthcare Services Committee for 2021.

Leadership

Leading amidst a global pandemic, Stewart also is focused on disaster preparedness, tackling everything from viruses to tornadoes. “The challenge is that we don’t always know what’s coming, but we’re promoting an environment where we all work together to be able to handle whatever comes down the pipe,” he said. To that end, Stewart has adopted the Peach Tree Leadership Model, popularized by former Tyson Foods CEO Donnie Smith. “It’s my team’s job to be the roots and trunk of the tree, and to empower and support the branches, or frontline employees, and make sure we’re providing resources to support good fruit. Sometimes that’s more direct, and sometimes we may not see the fruit or leaves immediately but the trunk is still digging in to weather the storm.”

life, this isn’t it. But if they want to be able to practice their profession in a rural setting that respects clinicians tremendously, to be seen as a partner and attend church or PTA with the people they interact with at the clinic, we’re the place for them.” He also is prioritizing staff education, arming employees with knowledge of what today’s patients expect while ensuring the highest quality of care. “Short term, I want to make sure staff are educated and that we can get to where we want them to be, which is a top performing hospital,” Stewart said. “As an industry we have so many measures and agencies right now, so my job is to lay out expectations and provide resources to make sure we’re viable long-term, and that the decisions we make today put us on a path where we’re sustainable for community trust and viability.”

Attracting providers

Looking forward

Physician recruitment is another priority for the CEO, who said Saline County is an ideal place for family-oriented clinicians who want to have an immediate impact in their community. Saline Health System currently boasts more than 180 active and consulting physicians, and continues to grow with the community. “Looking back over our lives we often find out we’re drawn to one thing but think we want another,” he said. “As we get to know physicians I ask them what is it that they want - because if they want big city

Looking forward, Stewart hopes to leave a legacy of impacting the communities he’s served, with a recognition that he gave it his all. But despite a myriad of professional accomplishments, Stewart said his greatest pride is his children, Nathaniel and Natalia. “If my wife and I can raise them as productive members of society, that will be my biggest accomplishment,” he said. “That is my goal: Making sure they’re able to contribute to society and see me as someone who has and continues to contribute to society in a positive way.” arkansasmedicalnews

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The Diagnosis and Treatment of Neuropathic Pain Neuropathic pain is an important medical topic and the diagnosis of it should be understood by any medical provider regardless of their specialty. It is a condition that also presents in primary care but is often unrecognized. When referring to neuropathic pain, it is important to understand the definitions that By JULIO OLAYA, MD have been evolving through time. In 1994 it was defined as “Pain initiated or caused by a primary lesion or dysfunction in the nervous system.” In 2008, the IASP (The International Association of Study of Pain) changed it to: “Pain arising as a direct consequence of a lesion or disease affecting the somatosensory system” giving it a broader connotation. The bottomline is that neuropathic pain is a complex entity that involves a multidisciplinary approach to diagnose and treat. Neuropathic pain, or nerve pain, is one of the most intense types of chronic pain, often described as sharp, stinging, or burning. The literature reports an overall prevalence of neuropathic pain in the population of up to 8 percent. Neuropathic pain can be peripheral or central. The etiologies are many: trauma, ischemia, infection, inflammation, cancer therapy, compression, etc. The following are some examples: Trauma: phantom limb pain and spinal cord injury, Ischemic: Post-stroke pain (central), diabetic neuropathy peripheral, Infection: Post-herpetic neuralgia (shingles) and HIV, Cancer drugs: Vinka alkaloids, monoclonal antibodies among others, Compression trigeminal neuralgia, and Multiple sclerosis without a clear cause but lately very well recognized as a real source of neuropathic pain. The first step in the diagnostic work up is no different from other areas of medicine; a meticulous collection of the medical history, focusing on exploring the onset of pain and the possible association with current diseases, trauma, surgery, etc. All neuropathic pains are perceived within the innervation territory of the damaged nerve or pathway due to the somatotopic organization of the primary somatosensory cortex. Symptoms of neuropathic pain include: • Severe pain, which may feel like shooting, throbbing, or burning • Electrical-like sensations • Numbness • A tingling sensation, or pins and needles • Reduced use of senses, such as difficulty sensing temperatures • Skin that appears mottled or red • Itchiness • Changes in pain associated with the weather. Neuropathic pain can also cause paarkansasmedicalnews

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tients to be overly sensitive to touch. For example, people may find that the slightest pressure or friction from clothing or a gentle touch can aggravate nerves and cause pain. (Allodynia). Neuropathic pain can occur at all time or come in spurts. Likewise, neuropathic pain can range in intensity from being mild and nagging to severe and disabling.

Treatment:

Treatment of neuropathic pain first entails addressing the underlying cause. For example, if a patient has neuropathic pain from diabetes, optimizing blood sugar (glucose) control is the critical first step. Even though an effective glucose control will not reverse the neuropathy, it will prevent it from getting worse. As another example, if a medication is causing debilitating nerve pain, removal or decrease in the dose of the offending drug may be all that is needed.

First line medications:

Along with treating the underlying disease, medication is often needed to manage the neuropathic pain. Antidepressant and antiseizure medications are used as the first line of treatment all come with a black-box warning about their ability to cause suicidal thoughts and behaviors.

Antidepressants:

Antidepressants have a well-established beneficial effect in various neuropathic pain states. These include: TCA’s (e.g., amitriptyline and imipramine) and the SNRI’s (duloxetine and venlafaxine), while the effect of the SSRI’s is lower. When we decide to prescribe these medications, we need to take into consideration their potential undesirable side effects, and we will have to tailor the medical plan considering the different co-morbidities that our patient might have. TCA’s have several side effects; the most important ones are cardiac conduction disturbances, dry mouth, urine retention, sedation, dizziness, and orthostatic hypotension. An electrocardiogram is mandatory before onset of treatment.

efficacy in neuropathic pain. Gabapentin and pregabalin are generally well tolerated and have no drug interactions but should be administered in smaller doses in patients with renal failure. The adverse side effects include dizziness, sedation, and occasionally, peripheral edema. Lamotrigine blocks voltage-dependent Na+ channels and inhibits Na+ influx-mediated release of excitatory amino acids from presynaptic neurons. In small trials, lamotrigine has shown efficacy in trigeminal neuralgia, HIV neuropathy, painful diabetic neuropathy, and central poststroke pain at doses of over 200 mg/ day. Lamotrigine is usually well tolerated. Side effects include rash, dizziness, and somnolence. Because of the rash, which in severe cases may progress to Stevens Johnson syndrome, the lamotrigine must be titrated slowly.

Opioids:

There is a misconception that neuropathic pain responds well to opioids, there is nothing further from the truth... opioids are the last option when treating neuropathic pain.

Topicals:

Lidocaine blocks the voltage gated sodium channels, and topical application is thought to silence ectopic discharges on small afferent fibers. Lidocaine patches are used in the treatment of postherpetic neuralgia and in

mixed peripheral focal neuropathy. Topical capsaicin. Topical applied capsaicin has shown a significant effect in diabetic neuropathy and in postherpetic neuralgia. The use of capsaicin is very limited because of the inconvenience of applying the cream to the painful area four times a day.

SUMMARY:

Damage or injury to the nerves can cause neuropathic pain. Symptoms can range from mild to severe. Neuropathic pain commonly presents in primary care and is underdiagnosed. Diagnosis is based on characteristic symptoms, altered sensations, and clinical history that matches a neuroanatomical or dermatomal pattern. Less than half of the patients achieve significant benefit with any single drug. Management includes making pain tolerable and maintaining emotional and physical functioning. Non-pharmacological approaches can be effective, but referral for specialist help is indicated if pain persists or remains uncontrolled. Some types of neuropathic pain may ease or resolve over time, while other types will require long-term pain management. Julio Olaya, MD is a board-certified anesthesiologist specializing in pain medicine at Arkansas Spine and Pain Center of Excellence.

Anticonvulsants:

Anticonvulsants drugs are primarily introduced for the treatment of epilepsy. They have several pharmacological actions that can interfere with processes involved in neuronal hyperexcitability, either by decreasing excitatory or increasing inhibitory transmission, thereby exerting a net neuronal depressant effect. Gabapentin is a structural analog to gamma-aminobutyric acid (GABA) that has no effect at GABAergic receptors but binds to the alfa2delta subunit of voltagedependent Ca++ channels therefore reducing the calcium influx into cells. Gabapentin has shown efficacy in painful diabetic neuropathy, postherpetic neuralgia, mixed neuropathic pain conditions, and phantom limb pain. Pregabalin is a GABA analogue related to gabapentin that has also shown

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GrandRounds Little Rock Allergy & Asthma Clinic Adds Physician LITTLE ROCK - Dr. Kim Jackson, MD, has joined the staff of Little Rock Allergy & Asthma Clinic. In her practice with the clinic, she will specialize in the treatment of pediatric and adult allergy, asthma and immunodeficiency disorders. Kim Jackson She earned her Bachelor of Science degree in biology from Arkansas Tech University, and holds a medical degree from the American University of the Caribbean. Dr. Jackson completed a three-year residency in internal medicine at Loui-

siana State University in Shreveport, after which she completed her fellowship training in allergy and immunology at the same institution. Dr. Jackson has been published within the fields of allergy, immunology, and internal medicine, and has made oral presentations at local and national professional conferences. She is board certified in Internal Medicine, and also maintains active membership with the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology. Dr. Jackson is now accepting new patients in the clinic’s Little Rock, North Little Rock, Benton, and Pine Bluff locations.

Conway Regional Health System Acquires Renaissance Women’s Center CONWAY - Conway Regional Health System has acquired Renaissance Women’s Center. The announcement brings together two organizations that are committed to providing comprehensive women’s services to central Arkansas and the River Valley. As of August 3, Conway Regional Health System began to manage and oversee all operations of Renaissance Women’s Center. The Providers who currently practice and who will remain at the location include Michael Wood, MD; Courtney Sick, MD; and Megan Moix, APRN. Kala Slayton, MD, has joined the practice as of August 10. No patient care or staffing changes are expected as a result of the transition. The staff and providers of the women’s center will join the staff of Conway Regional. The 9,350-square-foot Renaissance Women’s Center is located at 2300 Robinson Ave., next door to the Conway Regional Medical Center campus. The center offers obstetrics, gynecological, and in-office procedures with the physicians delivering babies and performing outpatient and inpatient surgical services at Conway Regional Medical Center. For more information about the Renaissance Women’s Center visit the website at www.rwcobgyn.com

Mercy Opens Unit Dedicated to Orthopedic and Spine Patients ROGERS – Mercy Hospital Northwest Arkansas has opened a 22-bed unit dedicated to the post-operative needs of patients undergoing orthopedic and spine surgeries. Mercy has also added an orthopedic service line coordinator and a nurse navigator who help guide joint replacement patients through treatment, from ensuring they have appointments booked correctly to escorting them through their surgery day and adding a layer of postsurgical checks on their progress. The unit includes 14 beds dedicated to inpatients who typically spend one day in the hospital after a surgery such as knee replacement. It also includes eight beds for outpatients who leave the hospital the same day as their surgery, including patients undergoing minimally invaJamie Moznabi, physical therapist assistant, helps sive hip replacement. patient Jerry Eagle during a therapy class after his The orthopedic/spine unit comknee replacement surgery. plements the services of Mercy Clinic Orthopedics – Rogers, whose team of seven surgeons and five physician assistants offers comprehensive orthopedics treatment and surgery, including knee and hip replacement, back and spine treatment and hand and wrist surgery.

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Washington Regional Opens Integrative Gynecology Clinic FAYETTEVILLE – Washington Regional Integrative Gynecology Clinic, located at 3561 Johnson Mill Blvd., Ste. 102 in Johnson has begun serving patients. Kristin Markell M.D., earned her medical degree at the University of Arkansas Kristen Markell for Medical Sciences. She completed a residency in Obstetrics and Gynecology at UAMS where she served as Co-Chief Resident. She is a Fellow of the American Congress of Obstetrics and Gynecology. Dr. Markell practiced at Washington Regional HerHealth Clinic for 10 years before completing an Integrative Medicine fellowship in 2019 at the University of Arizona, Andrew Weil Center for Integrative Medicine. She specializes in integrative women’s health, focusing on preventive medicine and holistic health care for women. Dr. Markell is currently completing her 200-hour yoga teacher training at Arkansas Yoga and Therapy Center.

Baptist Health Opens Gastroenterology Center in Van Buren VAN BUREN – Thusha Nathan, MD, is now accepting patients at Baptist Health Gastroenterology Center-Van Buren at 209 Pointer Trail West, Suite C. Dr. Nathan provides comprehensive gastroenterology services, including treatment for Hepatitis B and C, management of liver disease and Thusha Nathan diagnostic colonoscopies and endoscopies. Many of the procedures are provided at Baptist HealthVan Buren, offering residents of Crawford County and Northwest Arkansas a shorter commute for specialty care. Dr. Nathan earned a medical degree from Ross University School of Medicine and completed a fellowship of Gastroenterology at Texas Tech University Health Sciences Center in Lubbock. It was there that Dr. Nathan says she developed a deep love for southern culture.

Baptist Health-Conway Names April Bennett, MSN, CHPF, RN, as New CNO CONWAY – Baptist Health-Conway recently welcomed April Bennett, MSN, CHPF, RN, as the hospital’s chief nursing officer. Bennett is an experienced nurse executive who comes to Baptist Health from Freeman Health System in Joplin, Missouri, where she served as the vice president of nursing services for

the past seven years. Her work at Freeman included serving as operations section chief for the 460-bed, three-hospital system’s Incident Command structure as part of its April Bennett COVID-19 pandemic response. Bennett received her Bachelor of Science in Nursing from Missouri Southern University and Master of Science in Nursing from the University of MissouriKansas City. Learn about the services that Baptist Health-Conway provides to Faulkner County and surrounding communities by visiting baptist-health.com, calling Baptist Health HealthLine at 1-888-BAPTIST or by downloading the myBaptistHealth app for iOS and Android devices.

PUBLISHER Pamela Z. Haskins pamela@arkansasmedicalnews.com EDITOR P L Jeter editor@arkansasmedicalnews.com ADVERTISING SALES 501.247.9189 pamela@arkansasmedicalnews.com CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Becky Gillette, Melanie Kilgore-Hill, Julio Olaya, MD, Cindy Sanders All editorial submissions and press releases should be sent to pamela@memphismedicalnews.com Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Arkansas Medical News is now privately owned by Ziggy Productions, LLC. P O Box 1842 Memphis, TN 38101- 1842 President: Pamela Z. Haskins Vice President: Patrick Rains Reproduction in whole or in part without written permission is prohibited. Arkansas Medical News will assume no responsibility for unsolicited materials. All letters sent to Arkansas Medical News will be considered the newspaper’s property and unconditionally assigned to Arkansas Medical News for publication and copyright purposes.

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GrandRounds Arkansas Children’s Names Mourani President of Arkansas Children’s Research Institute LITTLE ROCK – After an extensive national search, Arkansas Children’s has named Dr. Pete Mourani as president of Arkansas Children’s Research Institute (ACRI) and senior vice president and chief research officer for the state’s only pediatric Pete Mourani health system. He will serve as the fifth president of ACRI as the system pursues a vi-

sion to define and deliver unprecedented child health. Dr. Mourani, who will also hold the position of professor of Pediatrics and Pediatric Critical Care in the College of Medicine at the University of Arkansas for Medical Sciences (UAMS), joins Arkansas Children’s from the University of Colorado and Children’s Colorado Hospital where he served as a professor of pediatrics in the Section of Critical Care Medicine. Dr. Mourani, who is board-certified in pediatric pulmonary and critical care medicine, has been an influential leader at Colorado Children’s in development of child health research strategy and clinical research programs

NARMC, CoxHealth Announce Collaboration to Expand Access to Care HARRISON – CoxHealth and North Arkansas Regional Medical Center (NARMC) are excited to announce a new collaboration that will expand health care access for residents of North Central Arkansas. In the coming months, the health systems will jointly open a new medical facility in Harrison so residents can continue to receive exceptional primary care while increasing access to specialists close to home. The facility will occupy the former Bear State Bank located at 1401 Hwy 65 North in Harrison. NARMC purchased the building and engaged CoxHealth to manage the renovations necessary to convert it to a medical office complex. When the project is completed, the building will house a variety of physician practices from both NARMC and CoxHealth. This venture will offer patients convenient access to complimentary services provided by both health systems. The mission, vision and values of CoxHealth and NARMC are closely aligned. This relationship will provide patients in the region specialty care without the need for travel. Their common goal is to strengthen the sustainability of the hospital and the provision of quality care in the region according to Vince Leist, President and CEO of North Arkansas Regional Medical Center. CoxHealth plans to expand the number of specialties it offers locally through the new facility. These services will be determined in cooperation with NARMC leadership to better understand the community’s needs. Additionally, CoxHealth Center Harrison, which opened in August 2020, will also relocate to the space. It is anticipated the facility will be open by Fall 2021.

Arkansas’ First Outpatient ROSA Robotic Knee Replacement Performed at OrthoArkansas LITTLE ROCK – Surgeons at OrthoArkansas in Little Rock, performed the state’s first robotic-assisted knee replacement with ROSA (robotic surgical assistant) technology in an outpatient surgery center on Aug. 6, 2020. Surgery assisted with ROSA technology is unique because the robot accurately uses data collected before, during, and after surgery to inform the surgeon of the many details related to a patient’s unique anatomy. OrthoArkansas performs close to 2300 knee replacements each year. By having total joint replacements done in outpatient surgery centers, it allows patients to have surgery in a more convenient environment and recover in the comfort of their own homes that evening. arkansasmedicalnews

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and infrastructure. He has served as medical director of the Children’s Hospital Clinical Research Organization (CCRO) and most recently as medical director of the Children’s Hospital Colorado Research Institute. Dr. Mourani, who will also hold the Ross and Mary Whipple Family Distinguished Research Scientist Endowed Chair at Arkansas Children’s, has maintained a consistent track record of NIH funding to support multi-center investigations focusing on pulmonary and pulmonary vascular disease in preterm infants, as well as projects investigating the pathogenesis and care of critically ill children with severe lower respiratory tract infection, including ventilator-associated pneumonia. Dr. Mourani is the site principal investigator and steering committee member for the prestigious eight-site National Institute of Child Health and Human Development (NICHD) supported Collaborative Pediatric Critical Care Research Network (CPCCRN), which performs impactful clinical research in the field of pediatric critical illness and

injury. ACRI will join the 24-site CPCCRN if a pending renewal application is accepted. He joins the Arkansas Children’s and UAMS health systems on Dec. 7.

Medical Center of South Arkansas Names Vince Xayasane as Chief Financial Officer EL DORADO - Vince Xayasane has been named Chief Financial Officer at Medical Center of South Arkansas. Xayasane, originally from Dumas, Texas has been working in the healthcare industry for over 21 years. He most recently served as Assistant CFO at Com- Vince Xayasane munity Health Systems affiliate hospital, Porter Regional Hospital in Valparaiso, Indiana. Xayasane was attracted to MCSA because of the friendly and positive culture and the vision of “Destination Healthcare.”

Arkansas Spine and Pain Names New Physician LITTLE ROCK -Amir Qureshi, MD, founder of Arkansas Spine and Pain welcomes Tatyana Stepanenko, MD, to the practice. Dr. Stepanenko received her medical degree from Minsk State Medical University in Minsk, Belarus. She completed her surgery internship at Mt. Sinai Hospital in Miami Beach, FL and did her residency program at Kingsbrook Jewish Medical Center in Brooklyn, NY, where she also served as Chief Resident in the Department of Physical Medicine. Dr. Stepanenko completed her fellowship program at the National Pain Institute in Winter Park, FL. She will practice in the Benton office.

Tatyana Stepanenko, MD, with Amir Qureshi, MD

Three Orthopedic Surgeons Join Arkansas Surgical Hospital NORTH LITTLE ROCK - Dr. Jesse Abeler, Dr. Kevin M. Goodson, and Dr. Nicholas B. Wilson are the three newest orthopedic surgeons to join the medical staff at Arkansas Surgical Hospital. Dr. Jesse Abeler specializes in treatment of the hand and arm, particularly in cases of trauma and dislocation. He has also studied and researched a wide range of treatments for traumatic injuries to various parts of the body, including the hand, wrist, elbow, shoulder, hip, and knee. Dr. Kevin M. Goodson specializes in treatment of the foot and ankle. His specialties include minimally invasive reconstruction surgery, bunion correction, and ankle replacement surgery. Dr. Nicholas Wilson focuses on total hip and knee joint replacement surgery. His research includes work on pain control in total knee arthroplasty. SEPTEMBER/OCTOBER 2020

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September-October 2020 Arkansas Medical News  

your primary source for professional healthcare news

September-October 2020 Arkansas Medical News  

your primary source for professional healthcare news