Page 1

FOCUS TOPICS PEDIATRICS • ENDOCRINOLOGY • PAIN MANAGEMENT/ADDICTION

September 2019 >> $5

Ana Karabell Left Her Country, But Not her Dream While still a girl growing up in Caracas, Venezuela, she already knew what she wanted to do as an adult and although she left her native country she kept her dream and now delivers care in Memphis as a pediatric endocrinologist.

Story on page 3.

Options Grow For Addiction Treatment But So Does Debate As the treatment alternatives for addiction increase, so does the debate by healthcare professionals concerning the most effective ones.

Article on page 5.

Regional One Prepares For ‘What If ’ Moments

Mass Shootings Challenge Trauma Center to Respond Quickly By LAWRENCE BUSER Last November, Regional One Health (ROH) trauma surgeon Dr. Peter E. Fischer was driving to Jonesboro, Arkansas, when he heard news that almost literally stopped him in his tracks. A tour bus with 46 people headed to the casinos in Tunica had overturned on an icy highway near Byhalia in North Mississippi. Two were confirmed dead, while first responders were working frantically to determine the extent of injuries to the 44 others. “I did a quick turnaround on the highway to come back to Memphis and when I got back to the hospital the ER had been cleared out, we had six trauma bays ready for these patients, and we had our triage area set up,” Dr. Fischer recalled. “We actually didn’t receive any patients from the scene, but we were ready to go if we needed to. That was an unplanned drill, and I was extremely proud of our organization’s response.” Being prepared for disasters that could produce a medical surge of patients is an important part of being a Level 1 trauma care hospital, one with specialized physicians and Staffers at Regional One participate in a preparedness drill

(CONTINUED ON PAGE 4)

First Device Gets OK for Treatment Of Pediatric ADHD

HealthcareLeader

Le Bonheur’s New Leader: ‘We’re All in This Together’

NeuroSigma has received FDA clearance for the first device to treat pediatric ADHD, offering a new alternative to medication and now is preparing for the U.S. rollout.

By JUDY OTTO

Report on page 7. FOLLOW US

Michael Wiggins

ONLINE: MEMPHIS MEDICAL NEWS.COM

PHOTO COURTESY REGIONAL ONE

ON ROUNDS

“I can’t imagine a better reason to get out of bed than to go and do good things for children,” said Michael Wiggins, the new President and CEO of Le Bonheur, while reviewing the career path that led him from an early focus on engineering to leadership at what U.S. News & World Report lists as one of

the nation’s best children’s hospitals. Second thoughts while still an undergraduate at the University of Alabama-Birmingham moved Wiggins toward a bachelor’s degree with majors in quantitative methods and management of information systems. “Coming out of school I had two job offers: as a business analyst . . . or at a health(CONTINUED ON PAGE 11)

Who’s INCHARGE? ? ? ? ? ? Coming December 2019!! Please send your nominations for outstanding Memphis healthcare executives to: pamela@memphismedicalnews.com.

PRINTED ON RECYCLED PAPER

PRSRT STD U.S. POSTAGE PAID FRANKLIN, TN PERMIT NO.357


W I L L I A M S C H N A P P, M D ,

M O A C I R S C H N A P P, M D , R Y A N M C G A U G H E Y, M D ,

K I T S. M AYS, M D,

BETHANY OWENS, MD

World Class Pain Management Right here in the Mid-South As the premier comprehensive pain center in the Mid-South, Mays & Schnapp Pain Clinic and Rehabilitation Center offers advanced technology with physician practice, ambulatory surgery center and a physical therapy department at one location. We are the only CARF certified pain clinic in the Mid-South.

Patient referrals can be made at maysandschnapp.com or call 901-747-0040. 55 HUMPHREYS CENTER DRIVE, SUITE 200, MEMPHIS, TN

2

>

SEPTEMBER 2019

Pain Clinic Associates, P.C. is a licensed pain management clinic. License #PMC0000000690

memphismedicalnews

.com


PhysicianSpotlight

At 7 Ana Karabell Knew Her Life’s Calling ‘Always Wanted to Help Other People, Particularly Children’ MEMPHIS MEDICAL NEWS PHOTO BY GREG CAMPBELL

By LAWRENCE BUSER

  When Ana Helena de Luca Karabell, MD, was a young girl growing up in Caracas, the capital of Venezuela, she already knew what she wanted to do with her life. Her inspiration was right there under the same roof. “My father is a pediatrician and I spent a lot of time with him at the clinic and at the hospital,” she recalled. “I knew I would like to do that when I was 7 years old. He loved his profession and his patients. “He used to work in an area of very low income in Venezuela, and he never took any salary. He never turned anyone away if they could not afford to pay.  So I always wanted to be in a position where I could help other people, particularly children. I always knew I wanted to be a physician.” Today, Dr. Karabell is a member of Baptist Medical Group’s Endocrine Clinic and part of a national research team that is seek-

Ana Helena de Luca Karabell

ing to find the cause and a cure for Type 1 diabetes, or a way to slow the onset and better understand how the disease develops. She is the principal investigator in the National Institutes of Health’s TrialNet research study involving a blood test that can determine a person’s risk for developing Type 1 diabetes before the symptoms occur. The study is called “Pathways to Prevention” and involves more than 200 research participants worldwide. “In the United States, around 40,000 people are newly diagnosed with Type 1 diabetes every year, including almost half under the age of 20,” Dr. Karabell said.  “It’s not like diabetes Type 2, which is associated with family history, exercise, diet and weight. Type 1 is an autoimmune disease that can happen to anybody. They are very different diseases.” Approximately 30 million people have diabetes in the United States, with up to 95 percent being

Study Suggests Transplantation of Hepatitis-Infected Kidneys Is Safe Transplantation of kidneys from Hepatitis C-infected donors to uninfected recipients is safe and can be successfully implemented as a standard of care, according to an observational study by physicians at the University of Tennessee Health Science Center and the James D. Eason Transplant Institute at Methodist University Hospital. The practice, which has been tested in two smaller clinical trials, could expand the number of kidneys available for transplantation and reduce wait times for donors, said Miklos Z. Molnar, MD, PhD, FEBTM, FERA, FASN, associate professor of Medicine at UTHSC, transplant nephrologist at the James D. Eason Transplant Institute, and director of the Transplant Nephrology Fellowship program at UTHSC. Dr. Molnar is the principal author of the study published by the American Journal of Transplantation. In current practice, Hepatitis C-infected kidneys are transplanted only to patients already infected with the disease, Dr. Molnar said. The number of these available kidneys greatly exceeds the population of infected recipients. As a result, up to 1,000 or more Hepatitis C-infected kidneys are discarded annually. “Our thought was using these kidneys, which are usually pretty good, other than the Hepatitis C,” he said. memphismedicalnews

.com

The Memphis team began its study in March 2018. To date, more than 80 uninfected recipients have received Hepatitis C-infected kidneys. The paper cites 53 patients, since the remainder was done too soon after transplant to evaluate fully. All patients consented to the surgery in three separate steps, after being made aware that by receiving an infected kidney, they would be infected with Hepatitis C. All were successfully transplanted, and after receiving 12 weeks of antiviral therapy, show no signs of Hepatitis C and are considered cured. “We did not lose any patients, but there were some unexpected complications,” Dr. Molnar said. High volume of BK virus, common after transplantation and generally treatable, was evidenced in a number of the recipients. While this factor will demand further research, Dr. Molnar said the study results are positive for patients in need of transplant. “These people would not get this offering (a transplant) without these kidneys,” he said. “If you’re willing to accept these kidneys, the waiting time can go down by two years.”  The five-year survival rate on dialysis is 50 percent, Dr. Molnar said. “We are losing 10 percent of the patients every year on dialysis.” Dr. Molnar said the study indicates that transplantation of Hepatitis C-infected

kidneys to Hepatitis C-negative recipients has potential to become a standard of care in the United States. “Otherwise, the patients would be on dialysis and die,” he said. “These patients have good kidney graft function. The transplantation of Hep C-infected kidney to non-Hep C-infected recipients can be done and should be done.” James Eason, MD, director of the Transplant Institute said, “This is a landmark paper outlining a novel approach to using kidneys that would otherwise be discarded, to save more lives.”

$5 off

purchase of $50 or more.

Some restrictions apply. Offer expires July 31, 2019

$10 off

purchase of $100 or more.

Some restrictions apply. Offer expires July 31, 2019

Type 2 in which the body does not use insulin properly. In Type 1 diabetes, the body does not produce insulin, the hormone that regulates the blood sugar that provides energy for the body. Once known as juvenile diabetes, Type 1 diabetes is found most commonly in people under age 40, although it can occur at any age. The immune system mistakenly attacks healthy, insulin-producing cells and destroys them. Genetics plays an important role in developing Type 1 diabetes. Dr. Karabell says family members of those with Type 1 diabetes are 15 times more likely to develop Type 1 diabetes compared to those without relatives with diabetes. “The NIH TrialNet study involves a free simple blood test for people with relatives who have Type 1 diabetes so we can detect a person’s risk of developing Type 1 diabetes before the symptoms appear,” Dr. Karabell said.  “Your participation will help the study and help us understand this disease, though not everyone wants to know the future.” She said TrialNet will stay in touch with those who participate in the study and keep them updated on advancements in treating Type 1 diabetes. “It will allow us to identify our patients earlier and to be attentive to them before they get sicker,” Dr. Karabell said. “That’s very important.” After graduating from medical school at the Universidad Central de Venezuela in 1993, and then completing an internship and residency in Caracas, she moved to the United States in 2000 with her husband, Keith, a Philadelphia native, and their young daughter, Sofia. Their son, Kenny, was born in Memphis. “Keith was studying music at Temple University in Philadelphia and was contracted as the principal clarinetist with the Orchestra Filarmonica Nacional de Venezuela in Caracas and we met through (CONTINUED ON PAGE 12)

Germantown Hardware & Paint

2083 S Germantown Road | Germantown, TN 38138 | 901-756-9522

SEPTEMBER 2019

>

3


Regional One Prepares For ‘What If ’ Moments, continued from page 1 nurses, high-tech equipment and specially trained support staff. ROH’s Elvis Presley Memorial Trauma Center, the only Level 1 trauma center within 150 miles of Memphis, treats up to 14,000 ER patients each year, including some 1,000 gunshot wounds. Training goes on constantly for the “what if” moments such as the Mississippi bus crash, but times are changing for hospitals in the era of increasingly common mass shootings, the worst being at a Las Vegas music concert in October 2017. On that night, a madman fired more than 1,000 shots in just 15 minutes, killing 58 and leaving more than 580 in need of emergency medical attention, according to the Nevada Hospital Association. Hospitals, EMS and law enforcement in Las Vegas were overwhelmed, and emergency providers elsewhere in the country have taken notice. “Ten or 15 years ago when we would think about disasters we would think about a building collapse or a plane crash, and that’s what we would practice for,” says Dr. Fischer. “In those scenarios, you don’t have a lot of time, but you do have 10 or 15 minutes for EMS to mobilize and for those patients to come to you. “A mass shooting is a little bit different in that the first patients you get are people who have literally been picked up by some-

body or who have run from the mass shooting to your hospital. With ROH being the regional trauma center and well known throughout the community, it’s important for us to be able to respond extremely quickly, and more quickly than we’ve ever had to do before.”

than we’ve had to in the past with different sorts of disasters. “We’ve changed our surge-capacity plan in the past three years with a collaborative effort to try to respond better to these types of events. The biggest part of that is to set up triage and then be able to clear out our emergency rooms very quickly so we can accept the new “Almost every surge of incoming patients and set up alternate treatment zones.” Friday and The triage process is crucial to an efficient use of medical Saturday night resources when every patient canwe’re going not be treated immediately. Dochave to determine the order through almost a tors and priority of emergency treatmini-drill to handle ment, as well as the destination of that patient. the mass surges.” “For example, the walking wounded are going to be the first — Dr. Peter E. Fischer patients you get and you can’t let those patients bog down your As an example, he points to the Pulse system,” Dr. Fischer said. “Those patients nightclub shooting in Orlando, Florida, would be sent to the cafeteria, which is set in 2016 that left 49 dead and 53 others up as an alternate treatment site so the wounded. The wounded began showing critical-care patients can be taken care of up unannounced almost immediately. in the critical-care staffed area. We’ve done “That shooting occurred only a mile a lot of work in the past three years to rearor mile and a half from the actual trauma range our plan so that we can adequately center, so they were getting patients within respond.” two minutes from when the actual shootIn addition to the hospital’s own drills, ing started because patients were getting in ROH participates in the annual masscars and driving right down the road to the casualty drill of the Mid-South emergency trauma center,” said Dr. Fischer. “So mass Planning Coalition, a partnership of hospishootings have changed our preparations tals across a three-state, six-county region, since we have to be ready even quicker the Shelby County Health Department’s Public Health Emergency Preparedness Program, and local fire Emergency Medical Services. “You can never plan for everything, and part of our drill is that the plan is usually destroyed in about the first 30 seconds,” said Dr. Fischer. “We have to be flexible and be able to respond as the situation changes. Almost every Friday and Saturday night we’re going through almost a mini-drill to handle the mass surges. It’s not uncommon for us to get a surge of six patients at a time. We are prepared for that, but six patients is one thing and 20 is another. “In a mass-casualty situation, the information can change dramatically, from ‘You’ve got 20 patients’ to ‘You’ve got two.’ Or there’s the worst-case scenario: ‘You’ve got two patients. No, you’ve actually got 20.’ How do you respond to that? That’s important. It has to be a true mobilization of the entire hospital, not just the ER, to be able to work at a high capacity for the next 24 to 48 hours.” Because emergency medical intervention within the first hour can mean the difference between life and death with trauma injuries, Dr. Fischer says he would like to see everyone become a first responder. “ROH and the American College of Surgeons are advocating the Stop the Bleed course (www.bleedingcontrol.org), which is how you stop life-threatening hemorrhaging at an accident scene or a shooting event,” he said. “A bystander at a scene can potentially help save the life of someone who’s been injured if, God forbid, one of these incidents ever happens here.”

901Ͳ683Ͳ8448 901-683-8448

DR.MOHAMMADASSAF DR. MOHAMMAD ASSAF ADULT NEUROLOGY ADULTNEUROLOGY

EEG,EMG/NCS,VNSPROGRAMMING EEG, EMG/NCS, VNS PROGRAMMING OFFERED IN OFFICE OFFEREDINOFFICE

MEMPHIS,TN&NEWALBANY,MS MEMPHIS, TN & NEW ALBANY, MS

WE ALL MAJOR MAJORINSURANCE INSURANCE WE ACCEPT ACCEPT ALL INCLUDING ANDTENNCARE TENNCARE INCLUDING MEDICARE MEDICARE AND 4

>

SEPTEMBER 2019

‘The People Make the Difference’ Just after 10 p.m. on Oct. 1, 2017, a gunman on the 32nd floor of a Las Vegas hotel sprayed a music concert crowd with non-stop gunfire for 15 minutes. More than 400 were wounded and 58 were killed by the gunman, who then killed himself. The wounded began arriving before the shooting had stopped. Hospitals were overwhelmed, as most patients arrived unannounced in private cars. In the months following the worst mass shooting in modern U.S. history, the Nevada Hospital Association prepared a 67-page case study – called “A Day Like No Other” – to share their experience with other hospitals and public health agencies. Some findings in the study include: * Most of the injured arrived by private cars, sometimes 10 to 15 at a time, creating traffic jams and leaving hospitals unable to know how many were coming; people used phone apps to find the closest hospital, resulting in trauma centers and community hospitals alike receiving patients in need of major emergency care. • Law enforcement received calls from multiple sites of the wounded, not knowing the injured were shot one place and called for help from another. The result of these “echo calls” was that officers responded as if there were active shooters at each place. • Las Vegas hospitals reported a total of 413 gunshot wounds that night; Sunrise Hospital, a Level II, initially received 200, while the University Medical Center-ER/ Trauma, a Level 1, received about 60. Triage was constant as new patients arrived every minute. • For every injured patient, there were four to six others who came with them, filling waiting rooms with hundreds of people all seeking medical information on loved ones; hospitals had different interpretations of what HIPAA regulations would allow them to release. A family assistance center was established the following day. • Hospitals ran low on supplies and medications, including clean linens, endo-tracheal and chest tubes; hospital crews had to clean blood from emergency rooms, waiting rooms and operating rooms as fast as possible to prepare for the next patients. “Lives were saved, and the impacts of these horrific injuries were minimized by the individuals who came together to take life-saving actions,” the report concluded. Training, exercises and police all help – but in the end it’s the people who make the difference.

memphismedicalnews

.com


Medical Community Debates Addiction Treatment

Which Option Is Best: Abstinence-based or Medication-assisted?      By BETH SIMKANIN

A recent collaboration between a Memphis hospital system and a team of physicians specializing in integrated addiction care has helped increase the number of new treatment options available to patients struggling with addiction in the Mid-South. However, with the growing number of treatment alternatives also comes a difference of opinion concerning the best methods to care for patients, especially when dealing with opioid addiction. This debate is occurring at both the national and local levels of the medical community, David M. Stern, MD, CEO of IAC Associates, a physicians group specializing in addiction treatment, says that some physicians and inpatient addiction treatment facilities use an abstinencebased strategy of no maintenance medication during a patient’s rehabilitation until after David M. Stern the patient goes through the process of detoxification. A different approach – one Dr. Stern said is becoming more accepted by the medical community – is medicationassisted treatment, with the patient given medication, in some cases for weeks or months, in combination with counseling and behavioral therapies, to provide a “whole patient” approach. Lucas Trautman, MD, a psychiatrist and chief medical director at Crestwyn Behavioral Health Hospital, said medication-assisted treatment became more prevalent during the past two decades as medical research revealed that patients, especially ones with an opioid use disorder, could benefit Lucas Trautman from it as a treatment option during recovery. “The (abstinence-based) 12-step program has been successful for addictions, such as alcohol, for a long time, but with opioids there is a physical change in the brain which requires medication-assisted treatment,” Dr. Trautman said. “It’s hard for patients to get off opioids. There are adaptive changes in the brain, which show craving and dependence, which weren’t there previously. We

are bridging the gap and saving patients’ lives with medication-assisted treatment. It decreases cravings for patients. You cut the death rate in half when a patient uses medications like Suboxone.” Suboxone is a brand name for a narcotic substance that is used to treat patients with opioid addiction. It contains buprenorphine, a partial opioid agonist, and naloxone, which are drugs that target brain receptors which respond to cravings. It’s commonly used because it can be administered orally and the patient can take it immediately during the detoxification process. Other medications, like naltrexone, which isn’t an opioid, must be injected and require the patient to completely go through the withdrawl process first. According to Dr. Stern and Shawn Hamm, MD, a fellowship-trained and board-certified physician in both family medicine and addiction medicine with IAC Associates, many patients with opioid use disorder are given buprenorphine at the start of treatment, and Shawn Hamm some continue to use it during treatment and recovery with counseling and behavioral therapies. “Our goal is to stabilize the patient,” Dr. Hamm said. “We treat the patient with medication first and then introduce other items of care so the patient can remain at home and continue working while incorporating treatment into their everyday lives. Everyone does treatment different. It’s a broad bracket, and we want to standardize care.” Dr. Stern, Dr. Hamm and another partner, Drew Blackstock, MD, founded IAC Associates in April. The practice, situated in Bartlett, Tenn., is devoted to what it calls “integrated, wraparound addiction care.” It incorporates behavioral health, physical health and case management in its treatment model. The practice employs a team of physicians, therapists and social workers to treat patients with addiction. In addition to its current location, IAC Associates plans to open a second clinic in Jackson, Tenn., next month. This past month, IAC Associates joined with Baptist Memorial Health Care in creating what the practice calls a center of excellence for addiction medicine. According to Dr. Hamm, many patients struggling with addiction end up in the emergency room because they seek help or medication for overdose.

Discover what true teamwork in healthcare looks like. At Humana, we understand how important the doctor-patient relationship is to your health and well-being. Humana is proud of its Humana Gold Plus® HMO network of clinics and physicians, including Consolidated Medical Practices of Memphis, PLLC.* 6.#0'#,!#'2$-07-301#*$ 7%#22',%2&# #,#i21 of a Humana Medicare Advantage plan today! Are you new to Medicare or turning 65 soon? Call a licensed sales agent.

1-877-239-2075 (TTY: 711) 8 a.m. - 8 p.m., Monday - Friday

*Provider may also accept/contract with other plans. Other providers are available in our network. Humana is a Medicare Advantage HMO organization with a Medicare contract. Enrollment in any Humana plan depends on contract renewal. At Humana, it is important you are treated fairly. Humana Inc. and its subsidiaries comply with applicable Federal civil rights laws and do not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity, or religion. English: ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-877-320-1235 (TTY: 711). Español (Spanish): ATENCIÓN: Si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-877-320-1235 (TTY: 711). 僐浣₼ 㠖 (Chinese): 㽷㎞᧶Ⱁ㨫㌷∎䞷僐浣₼㠖 ᧨㌷♾ⅴ⏜彊䘁㈦崭岏㚃┸ 㦜╨ᇭ嵚咃榊 1-877-320-1235 (TTY: 711) Y0040_GHHJPYFEN19v2_C

(CONTINUED ON PAGE 6)

19HMPT13499-1v2.indd 1 memphismedicalnews

.com

8/29/19 11:22 AM

SEPTEMBER 2019

>

5


20181620 #24337640.0 IRB Approved at the Protocol Level IDIOPATHIC HYPERSOMNIA: Apr 24, 2019 ARE YOUR DAYS FILLED WITH SLEEPINESS?

ERSOMNIA:

WITH SLEEPINESS?

20181620 #24337640.0 IRB Approved at the Protocol Level20181620 Apr 24, 2019 #24337640.0

RSOMNIA:

WITH SLEEPINESS?IRB Approved at the RSOMNIA: Protocol Level20181620 Apr 24, 2019 #24337640.0

WITH SLEEPINESS?IRB Approved at the RSOMNIA: Protocol Level

a.

e d re,

a.

e d al re,

a.

e d al re,

Help us research an investigational medication for idiopathic hypersomnia.

Apr 24, 2019

WITH SLEEPINESS?

The CHORDS Study is testing an investigational medication for people diagnosed with idiopathic hypersomnia (IH). There are currently no medications specifically approved for IH, and medications that are used do not work for everyone. Therefore, there Want to knowis more? a need to find additional treatment options for this unmet need. The CHORDS Study is a clinical research Want to know more? study that will help us learn more about how safe an Want to know more? investigational medication is and whether it works for excessive daytime sleepiness (EDS) in people who have IH. If you are interested in learning more about the CHORDS Study, please contact: If you are interested in learning more about the CHORDS Study, please contact: If you are interested in learning more about the CHORDS Study, please contact:

that al

We are looking for people 18–75 years of age who:

Want knowwith more? have been to diagnosed idiopathic hypersomnia

that

ed

sleep an average of 7 or more hours a night If you are interested in learning

ia.

that

ed

about the CHORDS Study, or take do more not have other medical conditions please contact: medications that cause EDS.

ed

re nd ore,

There are also some other requirements for taking part. The study will last for 44 to 46 weeks and will include up to18 study center visits and up to 7 phone calls. All study-related medication and care will be provided at no cost.

y nal

Want to know more? If you are interested in learning more about the CHORDS Study, please contact: Neurology Clinic, P.C. 901.507.3535 research@neuroclinic.org

s that

ated

6

>

SEPTEMBER 2019

Medical Community Debates Addiction Treatment, continued from page 5 “Patients may realize they need help but don’t know where to go so they go to the ER,” Dr. Hamm said. “ER physicians don’t know where to send these patients or how to care for them in some cases. Now patients in the ER at Baptist Memorial Hospital, Memphis, can get medicationassisted treatment right away to deal with withdrawal right in the emergency room.” Dr. Hamm says that a physician with the practice can consult with a patient either through telemedicine or face-toface in the emergency room to determine treatment, including authorizing medication, immediately. “This is a novel approach in Memphis but is being done in other parts of the country,” Dr. Stern said. “We can observe a patient, dispense medication, like buprenorphine, in the ER and set up an appointment with the patient the very next day. It’s imperative we stabilize the patient so they can get on with their everyday life. While patients are in recovery, they can perform their jobs and carry on with normal life.” Dr. Hamm said IAC Associates incorporates telemedicine throughout the practice to consult with patients while they are in treatment. He said this can be convenient for patients who live two or three hours away in some cases. Additionally, physicians with the practice can treat any co-occurring conditions at the same time. “It’s so common for patients to have co-occurring conditions with substance use disorder,” Dr. Hamm said. “We must get depression, anxiety and bipolar disorder under control. We may have to prescribe antidepressants to dampen the symptoms of anxiety. One physician is prescribing the medication and following their progress.” Dr. Stern said IAC Associates employs the only two fellowship-trained physicians in addiction medicine in the state of Tennessee. He says their approach to addiction isn’t taught in medical schools. “We’ve modeled this practice to treat addiction as a medical disease,” Dr. Stern said. “Physicians aren’t typically trained in addiction medicine. Doctors can become a part of the stigma to not treat an addict. There needs to be more education in our medical schools. We are learning more about medication and how it can assist in treatment.” Dr. Stern admits his passion to start IAC Associates stemmed from the loss of his son from a combination of mental health and substance use disorder. He wanted to give patients with addiction a treatment model that’s accessible and would have benefited his own son. He said Memphis is an underserved area for addiction, and he thinks the practice’s integrated care model will benefit patients with addiction. “There aren’t enough experts in Memphis,” Dr. Stern said. “It can be hard for a patient to access care. There aren’t enough places for patients to go to receive treatment. Many pain clinics only deal with cash. We take insurance including TennCare.”

Radwan Khuri, MD, a psychiatrist and medical director for Lakeside Landing Addiction Services, said he isn’t against the concept of what he calls opioid substitution therapy for opioid dependence, but he said it should only be used as a last resort when the patient has tried an abstinence-based treatment program multiple times and Radwan Khuri the treatment isn’t successful. He agrees that there are different approaches in the medical community, and he warns that patients can overuse Suboxone, which can cause additional problems. “There isn’t a quick cure for the disease,” Dr. Khuri said. “You don’t want to substitute one substance for another. We want to give the brain a chance to heal from addictive substances. It takes weeks or months for the addictive brain to heal.” Dr. Trautman said abstinence-based treatment is a model that has been so successful in the past that patients can have difficulty finding a sober living facility during the recovery process. “Some sober living houses won’t allow patients to live in them if they are on Suboxone,” Dr. Trautman said. “This can put the patient at risk for a relapse.” Research evidence on the long-term effectiveness of medication-assisted treatment for opioid addiction is ongoing, but findings from a clinical trial conducted through the National Drug Abuse Treatment Clinical Trials Network in 2016 concluded that patients who were engaged with opioid agonist therapy, like Suboxone, had markedly high odds of positive outcomes. Dr. Trautman said many non-drug cognitive behavioral therapies are also available to assist patients in their treatment for co-occurring disorders such as anxiety, including yoga, meditation techniques and biofeedback therapy, which is when patients learn to control bodily processes that are normally involuntary such as muscle tension, blood pressure or heart rate. No matter the treatment method, all addiction experts agree that physicians want the best outcomes for their patients. “It’s important to be empathetic, patient-centered and remove all judgment,” said Dr. Trautman.

Follow us on to begin receiving West TN Medical News in print or on your tablet or smartphone @memphismednews for updates and breaking news www.WestTNMedicalNews.com

memphismedicalnews

.com


Another Option to Address Pediatric ADHD NeuroSigma Prepares U.S. Launch of First FDA-Cleared Device By CINDY SANDERS

The Centers for Disease Control and Prevention (CDC) estimate a little more than six million children in the United States have – or have had – Attention-Deficit/Hyperactivity Disorder (ADHD). The latest statistics, pulled from the 2016 National Survey of Children’s Health (NSCH), underscore how prevalent the disorder is with approximately 9.4 percent of children ages between 2 and 17 having been diagnosed with ADHD. Currently, treatment options for ADHD typically include behavioral therapy, medication or a combination of the two. While the CDC stated there is no single source of comprehensive data on ADHD treatment, parent reports and claims data provide some insight into therapy preferences. Of those ages two-17 with a diagnosis, the CDC estimates: • About 30 percent treated with medication alone, • About 15 percent received behavioral therapy alone, • About 32 percent received both

medication and behavioral therapy, and • About 23 percent of children with ADHD receive neither treatment option. In April, the U.S. Food and Drug Administration (FDA) cleared a new treatment option for pediatric ADHD – the Monarch® external Trigeminal Nerve Stimulation (eTNS®) System by NeuroSigma, Inc., a bioelectronics company based in Los Angeles. The Monarch eTNS System, the first medical device cleared to

treat pediatric ADHD, is a prescriptiononly device cleared for use in patients ages seven to 12 who are not currently taking prescription ADHD medications. “It provides non-invasive, transcutaneous stimulation of the trigeminal nerve through the forehead,” explained Colin Kealey, MD, vice president of Advanced Development & Medical Affairs for NeuroSigma. Used while children sleep at night,

Kealey noted the treatment allows users to go about their normal day without having to interrupt school or play time to take medicine. An electrical patch about the size of a large bandage is applied to the forehead before bedtime. The patch is connected to the handheld Monarch eTNS pulse generator, which is similar in size to a cell phone. “That generator creates a gentle electrical signal that stimulates the trigeminal nerve,” said Kealey. While the FDA release regarding the new device stated the exact mechanism of eTNS still isn’t fully understood, the federal agency pointed out neuroimaging studies have shown eTNS increases activity in certain brain regions. The Road to Clearance “We submitted our application for FDA clearance via the de novo pathway in 2018, and that clearance was granted in April 2019,” Kealey said. He added the de novo pathway is reserved for novel medical devices that are deemed low-to-moderate (CONTINUED ON PAGE 12)

CATARACT · RETINA · LASIK www.eyespecialtygroup.com | 901-685-2200

memphismedicalnews

.com

SEPTEMBER 2019

>

7


:MTMV\TM[[8I[[QWV\W+PIVOM 8I\QMV\+IZMQV)LLQK\QWV5MLQKQVM Ja,I^QL5;\MZV5,+-7+WNW]VLMZWN 1)+)[[WKQI\M[ I have a deep personal stake in addiction treatment. Our son Alan had []‫ٺ‬MZMLNZWUUMV\ITPMIT\PQ[[]M[IVL[]J[\IVKMIJ][MQVPQOP[KPWWTIVL KWTTMOM#_M\PW]OP\\PI\PM_I[¹W]\WN \PM_WWL[º_Q\P\PM[MXZWJTMU[ IVL[MMUML\WJMLWQVO_MTTQVTI_[KPWWT)N\MZ_MMS[WN ]V[]KKM[[N]TTa \ZaQVO\WIVITabMQVX]\NZWUU]T\QXTM*W[\WVXPa[QKQIV[)TIVLMKQLML\W KWUMPWUM)\\PM\QUM_MTQ^MLQV+QVKQVVI\Q_PMZM1_I[\PM,MIV WN \PM;KPWWTWN 5MLQKQVMIVL>QKM8ZM[QLMV\NWZ0MIT\P)‫ٺ‬IQZ[I\\PM =VQ^MZ[Q\aWN +QVKQVVI\Q?MLMLQKI\MLITTWN W]ZM‫ٺ‬WZ\\WKWV[\Z]K\QVO a treatment team that could help PQU1V\PMMVL_MNIQTML In a time and place not attuned \W[]J[\IVKM][MLQ[WZLMZIVLKW WKK]ZZQVO UMV\IT IVL XPa[QKIT PMIT\PQ[[]M[VWWVMKW]TLLM^Q[M \PM [a[\MU WN  KIZM \PI\ )TIV VMMLML \W OQ^M PQU \PM PWXM \PI\ \PMZM _I[ I _Ia W]\ WN  PQ[ []‫ٺ‬MZQVO ,M[XQ\M W]Z ^MZa JM[\ M‫ٺ‬WZ\[PMXI[[MLMTM^MVaMIZ[IOW ?MIZMIUWVOUIVaNIUQTQM[_PW PI^M []‫ٺ‬MZML []KP \ZIOMLa# UWZM \PIVUQTTQWVW\PMZNIUQTQM[PI^M JMMV[QUQTIZTaI‫ٺ‬MK\ML

8I\QMV\[ IZM IJTM \W ZMUIQV I\ PWUM IVL _WZS _PQTM QVKWZXWZI\QVO \ZMI\UMV\QV\W\PMQZLIQTaTQ^M[<PQ[IXXZWIKPQ[TMILQVO\WJM\\MZXI\QMV\ W]\KWUM[IKZW[[\PMKW]V\Za <PMKTQVQKIT\MIUPI[JMMVÃ&#x2026;TTMLW]\Ja\PMILLQ\QWVWN IVM`XMZQMVKML \PMZIXQ[\,Z2IUQM8M\\Q\I[WKQIT_WZSMZKI[MUIVIOMZ:W[[6IOTMZIVL IV]Z[MKIZMUIVIOMZ2IaVM/QX[WV:67]Z[\Iâ&#x20AC;«Ùºâ&#x20AC;¬N]VK\QWV[IKKWZLQVO \WIVQV\MOZI\MLUWLMTR][\TQSM\PMJM[\KIVKMZKIZM_PQKPZM[]T\[NZWU IKTW[MKWTTIJWZI\QWVWN UMLQKIT []ZOQKITIVLZILQI\QWVWVKWTWOQ[\[ 1V XI\QMV\[ _Q\P ;=,)=, QV\MOZI\QWV WKK]Z[ _Q\P QVX]\ NZWU \PM XI\QMV\ KIZM \MIU IVL \PMXI\QMV\\WJM\\MZUIVIOM\PM XPa[QKITUMV\ITMUW\QWVITIVL [WKQIT PMIT\P WN  \PM XI\QMV\ I[ _MTTI[JM\\MZKWUXTQIVKM_Q\P\PM \ZMI\UMV\ XTIV  +IZM XTIV[ IZM then developed and carried out QVIPQOPTaKWWZLQVI\MLUIVVMZ

Seeking help from providers who uniquely understand that addictions are chronic and complex brain disorders is the safest approach to recovery. A durable recovery plan must include the physical, mental, emotional, and social health of each patient, which our team provides for every patient.

Once patients are compliant _Q\P \PM \ZMI\UMV\ XTIV IVL [\IJTM QV \PMQZ ZMKW^MZa _M IZM IJTM \W \ZIV[Q\QWV IXXZWXZQI\M patients to telemedicine. It UISM[ KIZM UWZM IKKM[[QJTM IVL KWV^MVQMV\ NWZ XI\QMV\[   7]Z telemedicine patients can dial QV\W\PMQZIXXWQV\UMV\[][QVOIV 1V\MZVM\ MVIJTML LM^QKM []KP I[ I [UIZ\ XPWVM QV I XZQ^I\M IVL KWV^MVQMV\TWKI\QWV[]KPI[\PMQZ home. This is the care model \PI\ 1 PIL [W]OP\ NWZ )TIV IVL KW]TLVW\Ã&#x2026;VL

?PMV1KIUM\W5MUXPQ[I[ -`MK]\Q^M ,MIV WN  \PM +WTTMOM WN  5MLQKQVM I\ \PM =VQ^MZ[Q\a WN  <MVVM[[MM 1 _I[ LM\MZUQVML \W LM^MTWXXZWOZIU[\PI\_W]TLUISM ,I^QL;\MZV5, ILQâ&#x20AC;«Ùºâ&#x20AC;¬MZMVKM\W\PMKWUU]VQ\a\PI\ +W.W]VLMZ+-71V\MOZI\ML)LLQK\QWV+IZM _M[MZ^MLQVKT]LQVOIVILLQK\QWV UMLQKQVM XZWOZIU  1 KZMI\ML \PM +MV\MZ NWZ )LLQK\QWV ;KQMVKM I\ \PM=VQ^MZ[Q\a_Q\POZMI\PWXMIVL MV\P][QI[U  ;PWZ\Ta IN\MZ_IZL[ 1 _I[ QV^Q\ML \W I ?PQ\M 0W][M UMM\QVO QV ?I[PQVO\WV ,+ \W XZM[MV\ W]Z IXXZWIKP \W KIZQVO NWZ 7]Z[MZ^QKM[IZMMI[QTaIKKM[[QJTMIVLWN \PMPQOPM[\Y]ITQ\a"_MIZMWVMWN  XI\QMV\[_Q\PILLQK\QWV<PMZMIN\MZ_MZMKMQ^MLIVI_IZLI[I¹+MV\MZWN  WVTa\_W[\I\MTQKMV[MLWâ&#x20AC;«Ù»â&#x20AC;¬KMJI[MLWXQWQL\ZMI\UMV\KMV\MZ[7*7<[_M[\WN  -`KMTTMVKMºNZWU<PM)LLQK\QWV5MLQKQVM.W]VLI\QWV=VNWZ\]VI\MTaQ\ 2IKS[WV7]ZKIZMQ[M^QLMVKMJI[MLIVLXI\QMV\KMV\MZML<PQ[UMIV[° [WWVJMKIUMKTMIZ\PI\\PMUWLMT_M_IV\ML\WJ]QTLVMMLMLILQâ&#x20AC;«Ùºâ&#x20AC;¬MZMV\ [M\\QVO\WXZW[XMZ      1N  aW] IZM I PMIT\P KIZM XZW^QLMZ _M _W]TL TQSM \W JM aW]Z XIZ\VMZ QV KIZQVO NWZ aW]Z XI\QMV\[ _PW PI^M Q[[]M[ _Q\P ITKWPWT IVL ILLQK\Q^M      <PM \_W JM[\ ILLQK\QWV UMLQKQVM XPa[QKQIV[ _M PIL \ZIQVML I\ \PM []J[\IVKM[7]ZXPa[QKQIV[IZMI^IQTIJTMNWZKWV[]T\[W^MZ\PMXPWVMWZ^QI =VQ^MZ[Q\a ,Z[ ;PI_V 0IUU IVL ,ZM_ *TIKS[\WKS [M\ W]\ _Q\P UM \MTMUMLQKQVM1N aW]ZXI\QMV\Q[ZMILaNWZIVM^IT]I\QWV_M_QTT\ISMKIZM \WNWZUW]ZW_VXZIK\QKM"1)+1V\MOZI\ML)LLQK\QWV+IZM)[[WKQI\M[ WN \PMUY]QKSTa_Q\P_ITSQVPW]Z[IVL[IUMLIaVM`\LIaIXXWQV\UMV\[ 844+# JW\P LWK\WZ[ IZM NMTTW_[PQX \ZIQVML QV ILLQK\QWV UMLQKQVM ?M[PIZMaW]ZOWITWN I[[Q[\QVOaW]ZXI\QMV\[\WIKPQM^QVO\PMQZWX\QUIT IVL JWIZLML QV JW\P ILLQK\QWV IVL NIUQTa UMLQKQVM ,Z 0IUU ,Z PMIT\PIVL_MTTJMQVO *TIKS[\WKSIVL1IZMXIZ\VMZ[<PMXZQ^I\MXZIK\QKMQ[IXPa[QKQIVW_VML IVL TML W]\XI\QMV\ KTQVQK \ZMI\QVO XI\QMV\[ _Q\P []J[\IVKM ][MLQ[WZLMZ

8

>

SEPTEMBER 2019

memphismedicalnews

.com


No matter where you are in your recovery, we can help.

Our â&#x20AC;&#x153;come as you are careâ&#x20AC;? approach includes a team of medical professionals, social workers, and therapists who are dedicated to helping people with addictions - no matter where they are in their recovery. Working together with each patient, we create an individual plan to guide you to a stable life and durable recovery from substance and alcohol use disorders i.e. opioids, crystal meth, cocaine, crack, cannabis, heroin, benzos, etc.

Walk-Ins Welcome: M-F 8 am - 10 am Same Day/Next Day Appointments Available. Accepts Insurance, TennCare, Medicaid, Medicare Call us today and begin your durable recovery!

Phone: 901.746.9438

|

IACassociates.com

6630 Summer Knoll Circle Suite 101 Memphis TN 38134

memphismedicalnews

.com

SEPTEMBER 2019

>

9


Le Bonheur Team Achieves Voice Box Reconstruction Le Bonheur Children’s Hospital reports that Cooper Kilburn, a 2-year-old from Adamsville, Tennessee, is making an excellent recovery after doctor’s there successfully completed the reconstruction of an airway and voice box last month. It is believed to be the world’s first successful surgery of its kind. A team of pediatric experts, led by Le Bonheur and University of Tennessee Health Science Center otolaryngologist Jerome Thompson, MD, used a rib graft to create a voice box and establish a viable airway for Cooper. When his mother was 16 weeks pregnant with Cooper, she was in a car wreck that prompted her to visit the obstetrician for an ultrasound to check on her baby. The ultrasound revealed fluid was building in Cooper’s chest because of a rare condition – total laryngeal agenesis due to congenital high airway obstruction syndrome (CHAOS). Cooper had no airway, no larynx and therefore no voice or way to breathe outside the womb. Laryngeal agenesis occurs when larynx development is halted during pregnancy. The reasons for this condition are unknown. Larynx development begins in the fourth week of fetal growth. The windpipe starts as a solid tube and hollows out from the top and bottom to create an airway. About 50 documented cases of total laryngeal agenesis exist throughout history. Most babies do not survive to term due to lack of diagnosis.

PHOTOS COURTESY LE BONHEUR CHILDREN’S HOSPITAL

Believed World’s First Successful Surgery of Its Kind

Cooper Kilburn is the center of attention.

Diagnosis depends on the discovery of indirect problems – like Cooper’s fluid-filled lungs. A lack of airway is rarely identified in fetal screenings. Survival depends on immediate diagnosis in utero and a rapid tracheostomy at

Cooper Kilburn 10

>

SEPTEMBER 2019

birth to provide an airway. Le Bonheur Children’s Fetal Center, along with Dr. Thompson and his team, put together a plan for Cooper to survive the difficult delivery. As planned, Cooper was delivered next door to Le Bonheur at Regional One Health. During delivery, Dr. Thompson performed an ex utero intrapartum treatment (EXIT) procedure, a partial caesarean section that allowed Cooper to continue to receive oxygen via his mother’s placenta. While Brooke was recovering, he was transported to Le Bonheur’s Neonatal Intensive Care Unit (NICU) so he could continue treatment. Cooper stayed in Le Bonheur’s NICU for 324 days and had beaten the odds for survival. Once home, he still depended on help to breathe 24 hours a day. Any health issue would threaten his life. Two years and eight surgeries later, the Kilburn family was

back at Le Bonheur. Cooper had developed well and continued to follow developmental milestones, despite never being able to make a sound. According to Dr. Thompson, “our goal was to create an anatomical airway, get him off the trach and, possibly, give him a voice.” There have been only a handful of attempts to create an anatomical airway from scratch and all have been unsuccessful. The team at Le Bonheur included pediatric experts from ENT, neonatology, pulmonology, pediatric surgery and critical care. “We planned for this surgery from day one of Cooper’s life,” said Thompson. “Everyone from the nurses to surgery technicians to the neonatal team rose to the challenge and worked together for this surgery to be a success.” The four-hour surgery was conducted in tandem with pediatric surgeon Ying Weatherall, MD, and Dr. Thompson. Dr. Weatherall removed two of Cooper’s ribs to use to construct his new voice box. After navigating through complicated throat anatomy, Dr. Thompson and fellow otolaryngologist Jennifer McLevy, MD, began to create the new voice box. Dr. Thompson used the ribs to create the walls of a voice box. To learn more about Cooper’s journey, visit www.lebonheur.org/promise.

memphismedicalnews

.com


Le Bonheur’s New Leader, continued from page 1 care organization, working in their quality improvement department,” he said. “I really saw healthcare as something that had a larger community impact – almost a ministry aspect to it.” His early role as Quality Improvement Coordinator at Children’s of Alabama evolved rapidly into leadership positions there and at other health centers across the South, including Children’s Health System of Texas, where he served prior to accepting his current role at Le Bonheur in April. A brief departure to work in adult healthcare lasted just long enough for him to recognize that he wanted to resume his pediatric focus: “All healthcare providers are driven by altruism and the desire to do good things for the community, but that seems to reach an accelerated level in pediatrics.” Wiggins indicates, for example, the educational and research focus that typically characterizes children’s hospitals – especially Le Bonheur, with its strong partnerships with University of Tennessee Health Science Center (UTHSC), St. Jude Children’s Research Hospital, Campbell Clinic and Semmes Murphey Clinic, resulting in “some very robust research programs.” His quarter-century in the healthcare field has allowed him to witness some amazing advancements. “There are children now living into adulthood that, a generation ago, never would have survived,” he said. He points to premature infants weighing barely a pound in Le Bonheur’s neonatal intensive care unit and cites the recent ground-breaking success of a Le Bonheur surgeon who was the first to successfully create an anatomical airway and voice box for a patient with total laryngeal agenesis due to congenital high airway obstruction syndrome (CHAOS) identified in the womb. “They’re identifying these issues before the children are even born — so that they can be prepared truly, at birth, to begin to intervene. To be able to support what they’re doing is just incredibly rewarding,” he said. Wiggins acknowledges with gratitude his CEO/presidential predecessor, Meri Armour, during whose 13-year tenure Le Bonheur experienced increased funding and recruitment, and with a long list of accolades won. “I’m very fortunate that (she) left me with an organization that is very healthy and heading in the right direction.” In fact, being selected for that leadership role at Le Bonheur is one of his proudest achievements, which he compares to “that NFL coaching job” sports professionals dream of. His vision for Le Bonheur includes: • Improving the health status of all children — not just those receiving care at Le Bonheur. “We also want to be focused on the other things that are important to kids being healthy— strong, safe communities, good education, nutrition, things that impact their long-term success in life,” he explained. MEMPHISMEDICALNEWS

.COM

• Enhancing Le Bonheur training programs through its partnerships with UTHSC and continuing to build endowments to support research that elevates the quality of clinical programs. • Being advocates for children. “The majority of the children whom we take care of are Medicaid beneficiaries. As we see potential changes in Medicaid that are going to have a big impact on children, we’re going to continue . . . making sure they have good access to healthcare.” • Being good stewards of available resources and pursuing additional possibilities. “We’re trying to build elite clinical programs on a shoestring budget, so we continue to work with the community (whose members are) willing to invest in us from a philanthropic standpoint.” Because of the advances in clinical care, he sees many children living into adulthood with childhood diseases. Although children’s hospitals typically offer their services only to those 21 or younger, “there are certain childhood conditions that adult care providers are just not used to taking care of,” he said. Cystic fibrosis patients older than 30 may still receive care at some level, and patients with childhood heart conditions that were repaired surgically might also continue to receive care even into adulthood, on a case-by-case basis, he said. Reflecting on his past success, Wiggins notes that each community where he has served has its own culture. “But what I’ve found here in Memphis has been extraordinary. Even though all children’s hospitals are special places, the passion that our Le Bonheur team has for caring for children and their families is beyond even what I’ve experienced in other children’s hospitals. The level of collaboration with medical leadership and the physicians has been phenomenal, as well. To be in a community that so loves and reveres Le Bonheur as an institution has been so rewarding!” Being a parent (with Robin, his wife of 21 years) to three school-age children may have sensitized him to the stresses other parents face when a child is ill, he notes. “I think perhaps being a father helps me to be a better leader for a children’s hospital.” What has his career taught him to date? “We’re in this together. I’ve seen too many organizations struggle with an ‘us vs. them’ issue — whether ‘physicians vs. administration,’ ‘hospital vs. whomever.’ We’re all trying to accomplish the same thing – that is, to help our community be as healthy as it can possibly be. Finding ways to collaborate and work together will benefit all of us.”

Memphis Medical News Become a Fan on Facebook SEPTEMBER 2019

>

11


Another Option, continued from page 7 risk for patients. Even under the best circumstances, it may take years for a novel device to develop the data necessary to obtain marketing authorization from FDA. For NeuroSigma, the trek to FDA clearance began with an open label study enrolling 24 patients. That study yielded positive results that were published in 2015 and set the stage for a larger clinical trial, which was completed in 2017. “Based on those results (from the open label study), the principal investigator at UCLA – Dr. Jim McGough – was awarded a grant from the National Institutes of Health to do a blinded trial, and NeuroSigma provided the devices for that trial,” Kealey said. James McGough, MD, is a professor and child psychiatrist at the Jane & Terry Semel Institute for Neuroscience and Human Behavior at UCLA. The NIH-funded, randomized, double-blinded trial enrolled 62 children with moderate-to-severe ADHD to assess the Monarch eTNS System’s efficacy as a monotherapy to treat the disorder as compared to a placebo device. Kealey said the trial’s primary endpoint was improvement on the ADHD-RS-IV. The ADHD Rating Scale is commonly used to monitor the severity and frequency of symptoms for children diagnosed with the disorder. In addition, the trial also looked at changes to the Clinical Global Impression-1 (CGI-1) scale, which measures severity. Trial results were provided to the FDA last year and were published in the

12

>

SEPTEMBER 2019

April 2019 issue of the Journal of the American Academy of Child and Adolescent Psychiatry. Children were randomized to use the Monarch eTNS or a sham (placebo) device for four weeks while sleeping. Those in the active group of the trial had statistically significant improvement in ADHD symptoms compared to the placebo group. The active group’s average ADHD-RS score decreased from 34.1 points at baseline to 23.4 points (differential of 10.7 points) at the end of four weeks compared to a decrease in the placebo group from 33.7 to 27.5 (a 6.2-point differential). Similarly, between group comparison of the CGI-1 scores also favored the trial’s active group(p = .003). No serious adverse effects were observed with use of the device. The most common side effects were drowsiness, headache, trouble sleeping, fatigue, increased appetite and teeth clenching. Kealey said the eTNS has been approved in the European Union since 2012. “In all that time, there has never been a serious adverse event with the device that we’re aware of,” he said, adding it has a strong safety profile.

Next Steps

“We’re in the process of preparing for launch,” NeuroSigma President and CEO Leon Ekchian, PhD, said of the next steps. He added a pilot rollout will happen later this year, followed by a full market launch in 2020. “What is important in pediatric ADHD is to be able to offer different options to parents,” Ekchian said. “What we’re offering is a non-stimulant, non-drug treatment to improve a child’s ADHD symptoms.” He noted that at any given time, a little more than three million children are taking ADHD medication and that it is common to cycle on and off of drugs. “Our value proposition is we want to offer parents an alternative to the drugs. Of course, that’s a choice between physicians and parents, but we now have this alternative that has a strong safety profile and limited side effects.” Pointing to the broader field of neuromodulation, Ekchian continued, “We view this as part of a broader treatment paradigm. These approaches have the potential to provide an alternative to the use of medication and offer a more targeted treatment approach.” He said that while at this time the Monarch eTNS is only cleared in the US for pediatric ADHD, NeuroSigma plans to perform additional studies in the future to explore potential use in conditions such as PTSD, epilepsy, depression. However, he added, NeuroSigma is laser-focused on introducing the ADHD application to providers, patients and parents as the company prepares for the national rollout and partnering opportunities outside the US. “We think there’s a really compelling opportunity for our eTNS system because we believe it’s an alternative to medication with positive efficacy and a favorable safety profile,” Ekchian concluded.

GrandRounds Good Shepherd’s Network Now Tracking Drug Waste The Lebanese-American University School of Pharmacy in Byblos, Lebanon, has become the first blockchain node on foreign soil of what is now an international consortium of prescription repositories, health care organizations and higher education institutions to reclaim medications and track prescription waste – and in doing so eliminate the financial, environmental and accessibility problems it causes. The network, established by Good Shepherd Pharmacy in Memphis, utilizes RemediChain’s blockchain technology to track this waste across the United States and – now – the globe. “The consortium is already saving lives by decreasing the amount of high-value medication that is wasted and instead putting it in the hands of patients in need,” said Bedie Moran, chief strategy officer at RemediChain. “But the data is also priceless. We’ve never before been able to track prescription waste across state lines, much less in multiple countries. It presents an opportunity to radically improve health care globally by identifying where – and more importantly why – the medication isn’t reaching the patients who really need it. Once we know that, we can begin to address the problems.” “In the United States, medication is often wasted because someone passes away before they take their prescription or their treatment plan changes,” Moran said. “But there are plenty of rea-

sons for waste, which include ripple effects from counterfeit medications, corruption, or even crime in removing the drugs from the supply chain. Any or all of those things are in play globally. If we can identify where the waste is and why, we can work toward stopping it and putting the medication where it belongs.” Since October 2018, the RemediChain platform has received more than $2.2 million worth of donated high-value oral chemotherapy medication, some of which has already been verified and dispensed to patients with demonstrated financial need, including Tennessee.

Red Cross Names Vaughn Regional Director Laura Vaughn has been named development director with the Fund Development Department of the American Red Cross of the Tennessee Region. The Tennessee Region serves 95 counties in Tennessee along with Crittenden County in Arkansas and Desoto and Tunica counties in Mississippi. Vaughn is the most recent executive director for the Mid-South Chapter of the Red Cross in Memphis, has made numerous and significant accomplishments during her tenure as a director. During her tenure, she secured two new national partners and created the “Join the 1,000” campaign.  She has been part of nine disaster recovery operations while earning a master’s degree in Public Administration and Nonprofit Leadership from the University of Memphis. She will retain her office in Memphis.

At 7 Ana Karabell Knew, continued from page 3 a common friend on a blind date,” she recalled, adding that the political and social climate was going through upheaval in the late 1990s. “We knew things were not going to be good, and things started to deteriorate. We decided it was best to move to the United States. It was amazing how safe we felt when we got here. “Everyone knew about Memphis and St. Jude Children’s Research Hospital, and one of my father’s friends did an internship here.” In Memphis, pediatric endocrinologist Dr. George Burghen at Le Bonheur Children’s Hospital became her early mentor and friend. After a pediatrics residency and endocrinology fellowship at the University of Tennessee Health Science Center, she was hired as an associate at UTHSC, where Dr. Jay Cohen served as medical director.   Dr. Karabell joined The Endocrine Clinic in 2009 under Dr. Cohen. “I also did clinical research under Dr. Guillermo Umpierrez, Dr. Abbas Kitabchi and Dr. Samuel Dagogo-Jack, and I started truly loving endocrinology,” Dr. Karabell said. “But I also had a personal reason: Both of my grandmothers died very young from diabetes complications. Since I finished my fellowship and residency in 2008, the greatest change in my area has been the advances in technology that apply to diabetes Type 1.

This changes patients’ lives.” Dr. Karabell, who remains connected to diabetes programs in Venezuela, is the medical director for a free summer program for children called Camp Day2Day sponsored by Baptist Memorial Health Care, the American Diabetes Association and Church Health. She also is a volunteer for Hopewell Summer Camp in Oxford, Mississippi, for children with Type 1 diabetes. In fact, the Juvenile Diabetes Research Foundation – of which Dr. Karabell is a board member – is scheduled to hold its annual One Walk fundraiser at the Memphis Botanic Gardens on October 5. When not in the office, Dr. Karabell enjoys hiking, jogging and biking on the Memphis Greenline and at Shelby Farms with her family. Daughter Sofia is a junior and biology major at Rhodes College. Sofia is planning on becoming a veterinarian. Dr. Karabell’s son, Kenny, is a fourth-grader at Bornblum Jewish Community School. It’s a little early, but Kenny has rotating plans to become a scientist, singer or professional soccer player. “I love the outdoors and I feel like a Memphian now,” she said. “We are so lucky to be in a place that has a Greenline in the city and an amazing park like Shelby Farms. That’s very nice.” 

memphismedicalnews

.com


GrandRounds Philip Lammers Joins Baptist Cancer Center Dr. Philip Lammers, a board-certified medical oncologist and hematologist who specializes in breast cancer, has joined Baptist Cancer Center. Prior to joining Baptist, Dr. Lammers was on staff at Nashville General Hospital and served as an Philip Lammers assistant professor and the chief of hematology/oncology at Meharry Medical College in Nashville, Tennessee. Dr. Lammers leads the clinical trials committee at Baptist Cancer Center and serves as the medical director of clinical oncology research. He is a member of Baptist’s Mid-South Minority and Underserved National Cancer Institute Community Oncology Research Program, known as NCORP. Lammers also serves as an adjunct assistant clinical professor at Vanderbilt University Medical Center. Lammers earned his medical degree from Indiana University School of Medicine in 2006, and master’s degrees in cellular and integrative physiology and clinical investigation in 2003 and 2013, respectively. He completed Barnes-Jewish Hospital’s Internal Medicine Residency Program in St. Louis, Missouri, in 2009 and a hematology/ oncology clinical fellowship at VUMC in 2013.

UTHSC Hopes to Increase Availability of Dental Care The College of Dentistry at the University of Tennessee Health Science Center (UTHSC) is preparing to increase the number of registered dental hygienists and dental assistants it certifies to perform some restorative or prosthetic functions, including placement of fillings, temporaries for crowns, and making impressions for various fixed and removable dental procedures. UTHSC officials hope to increase availability and accessibility of dental care in the community and across the

Is the missing

state. The goal of the college is to double the number of participants it enrolls in the Expanded Functions for the Dental Auxiliary (EFDA) continuing education course, which trains dental hygienists and assistants to perform certain procedures currently done by licensed dentists. The college plans to increase enrollment up to 210 students in the EFDA restorative course, and 40 in the EFDA prosthetics course starting January 1, 2020. “The population in Tennessee has grown substantially in the last 15 years and a lot of areas in the state are in great need of improved access to dental care,” said Jerry McKinney, DDS, assistant professor in the Department of General Dentistry and Director of EFDA. “The dentists who are in those areas are overwhelmed and need help meeting the dental needs of the community. The EFDA program is one answer to getting help to these undeserved areas – both rural and urban areas, such as downtown Memphis or Nashville.”

Methodist Hospitals of Memphis Wins Top Ranking Methodist Hospitals of Memphis has been recognized as the Best Hospital in the Memphis Metropolitan Area by  U.S. News & World Report for the ninth consecutive year. Methodist Hospitals of Memphis is comprised of Methodist University Hospital, Methodist North Hospital, Methodist South Hospital and Methodist Le Bonheur Germantown Hospital. The annual  U.S. News  Best Hospitals rankings, now in its 30th year, recognizes hospitals that excel in treating the most challenging patients. Methodist Hospitals of Memphis also ranked in the top five best hospitals in Tennessee. U.S. News  publishes Best Hospitals to help guide patients who need a high level of care because they face a particularly difficult surgery, a challenging condition, or added risk because of other health problems or advanced age. Objective measures such as pa-

piece in

Jared L. Matthews, MD, Joins Hamilton Eye Institute Jared L. Matthews, MD, has joined the staff of the Hamilton Eye Institute at the University of Tennessee Health Science Center. Dr. Matthews specializes in laser vision correction, laser cataract surgery, cornea transplantation, complex cataract surgery and infectious and inflammatory corneal disease. Dr. Matthews, who comes to Memphis from The Eye Center in Fayetteville, Arkansas, earned his medical degree,  summa cum laude, from the University of Oklahoma College of Medicine. He completed a fellowship in ophthalmic pathology at Bascom Palmer Eye Institute and then transitional year internship at Presbyterian/ St. Luke’s Medical Center in Denver. After residency at the Yale University Department of Ophthalmology and Visual Science he returned to Bascom Palmer for a fellowship in cornea and refractive surgery.

Le Bonheur to Break Ground This Fall on Garden Le Bonheur Children’s Hospital announced plans to break ground this fall on Le Bonheur Green, an interactive outdoor space for children and families. Le Bonheur Green will fill the nearly 2-acre lawn facing Adams Street. Le Bonheur Green is designed to bring the therapeutic powers of nature – the sights, sounds and smells of the outdoors - to families and give them a place to gather to relax, share life and escape the emotional challenges of hospitalization. The $3 million project will be funded by donations. Le Bonheur Green design includes a prayer labyrinth, which is an ancient

practice used to facilitate prayer, meditation and spiritual transformation. A walking path in the shape of the heart is a nod to the Le Bonheur heart. A front porch gathering space encourages families to gather and an open green leaves space for children to run and play.

Sickle Cell Patients Hope to Improve Awareness at Memphis EDs As part of September’s National Sickle Cell Awareness Month experts planned to pop up at selected Memphis hospital emergency departments (ED) to offer popsicles and a view of sickle cell disease (SCD) as seen through patients’ eyes. Project “PopSickleCell” was planned to heighten awareness of pain management and the opioid epidemic. Qsource has partnered with three healthcare systems representing a total of 27 hospitals, along with two local SCD centers and national experts, to educate ED staffs. Local sickle cell patients were asked to share revealing photographs of their lives with support from Qsource, a healthcare quality improvement and innovation consultancy. The patients’ poignant photographs are intended to help ED clinicians better understand the potential stigma, challenges, and barriers to appropriate care for patients living with SCD, the most common genetic blood disorder in the United States. Popular Memphis frozen treat purveyor, Mempops, provided its treats for the PopSickleCell activation and will collect donations and tips in their three Memphis locations during September and donate those proceeds to The Sickle Cell Foundation of Tennessee. According to estimates from the Centers for Disease Control and Prevention (CDC), the disease occurs in approximately one out of every 365 African-American births. In Memphis and the Mid-South, the rate of disease is higher, at one in every 287 live births. Approximately 2,000 African-Americans in the Memphis area are affected by the disease.

G. Coble Caperton

your office?

• • • • • •

tient survival and safety data, nurse staffing levels and other data largely determined the rankings in most specialties. The specialty rankings and data were produced for U.S. News  by RTI International. The rankings have been published at  health.usnews.com/besthospitals.

Licensed Tennessee Attorney

37 years of experience

Former systems admin for UTHSC Over 17 years experience US Navy Network Security Microsoft Certified Networking services Security Specialist

Practicing in the following areas:

Let us help you keep your information safe!

Rule 31 General Civil/Family Mediator

memphismedicalnews

.com

• • • • John Pantall, Microsoft Certified 901.466.6358

||

john@awesomepc123.com

Business and Commercial Law Family Law Personal Injury Contracts

901.526.6701 SEPTEMBER 2019

>

13


GrandRounds Integra LifeSciences Acquires Arkis Biosciences Innova Memphis, an early-stage venture capital firm based in Memphis, reports that its portfolio company, Arkis Biosciences, has been acquired by Integra LifeSciences Holding Corporation, a leading medical technology company. Arkis Biosciences is a neuro-surgical medical device company based in Knoxville. Financial terms were not disclosed. Innova was an early investor in Arkis and led the company’s Series A round in 2016.  An Integra news release reported, “The acquisition of Arkis Biosciences strengthens Integra’s offerings in neurocritical care and Integra’s position as the world leader in advanced catheter technology,”

Saint Francis Hospital Receives Stroke Certification Saint Francis Healthcare has earned the Advanced Thrombectomy-Capable Stroke Center certification from The Joint Commission, in collaboration with the American Heart Association/American Stroke Association (AHA/ASA). The certification signifies the hospital meets standards for performing mechanical endovascular thrombectomy (EVT), a specialized surgical procedure used to remove a blood clot from the brain during an ischemic stroke. To be eligible for the certification, the hospital was required to meet strict guidelines that included performing EVT on a minimum of 15 patients in the past year or 30 patients in the past two years, and the capability to perform EVT around the clock, seven days a week. The hospital’s primary neurointerventionalists – the physicians who routinely perform emergency mechanical thrombectomy – also must meet the highest standards of subspecialty training. “With the recent advances in endovascular therapies for acute ischemic stroke, it’s important to recognize hospitals which can perform this critical intervention safely and effectively, and we commend Saint Francis Hospital-Memphis on this designation,” said Edward C. Jauch, MD, chair of the American Heart

Association/American Stroke Association’s Hospital Accreditation Stroke Subcommittee. “The TSC certification helps pre-hospital providers better understand hospital stroke capabilities and assist in regional EMS triage of stroke patients so that the patient gets to the right hospital for the right treatment.”

Mississippi. It begins this fall, and will train doctor of nursing practice (DNP) students, who will commit to being health care providers in rural clinics and underserved areas. A commitment of three years will guarantee DNP students enrolled in the program free tuition, books, and a small stipend.

THA Selects Wendy Long Next President, CEO

Dharmesh Patel to Serve on Southeast AHA Board

Wendy Long, MD, MPH, has been selected by the Tennessee Hospital Association as its next president and CEO. Dr. Long will replace Craig A. Becker, who is retiring after 26 years of service. The announcement comes after a seven-month national search. Wendy Long Most recently Dr. Long served as director of the Metro Public Health Department for Nashville and Davidson County. She previously was deputy commissioner of the Tennessee Department of Finance and Administration (F&A), serving as director for the TennCare program. Dr. Long earned her undergraduate and medical degrees at Ohio State University and completed a preventive medicine residency and master of public health program at the University of South Carolina.

Stern Cardiovascular cardiologist, Dharmesh Patel, MD, will serve on the American Heart Association’s Southeast Affiliate Board of Directors for the 20182020 term. Dr. Patel has been involved with the American Heart Association for more Dharmesh Patel than a decade. Prior to joining the Southeast Affiliate Board, he served as a member and then president (2016-2018) of the Mid-South Board of Directors and will continue to as immediate past president. The Southeast Affiliate serves Alabama, Florida, Georgia, Louisiana, Mississippi, Tennessee, North Carolina, South Carolina, and Puerto Rico.

UTHSC College of Nursing Receives Rural Health Funding The University of Tennessee Health Science Center College of Nursing has received approximately $3 million in grant funding from the Health Resources and Services Administration (HRSA) to improve healthcare with an emphasis on maternal and obstetrical services for underserved and rural populations in the Delta region. The Advanced Nursing Education Workforce for Healthy Delta Moms and Babies program will educate the advanced nurse practitioner workforce to better meet the needs of mothers and babies in West Tennessee and northern

Bringing you interesting and flavorful coffees from around the world is a challenge that we greatly enjoy. At Dr. Bean’s Coffee Roasters, we source and taste the best beans discoverable before selecting a chosen few for presentation. Every bag of our coffee is roasted with care and attention to detail so you can taste the fruits of the farmer and the joy of our labor. Opening Soon in Downtown

Memphis!

409 South Main

14

>

SEPTEMBER 2019

UTHSC Opens New Youth Advocacy Center The University of Tennessee Health Science Center UTHSC) opened its new Youth Advocacy Center on August 30. Located at 66 North Pauline Street, Suite 233, on the UTHSC campus, the center is collaboration between the Shelby County Government Division of Community Services and UTHSC. The center will provide support and community-based resources for at-risk and justice-involved youth, ages 12-17, and their families by providing traumainformed screenings, individualized recommendations for referrals to community-based behavioral and trauma-related services, and follow-up. The center is voluntary, restraint-free, trauma-informed, family-centered, and independent from the juvenile court. Referrals can be made by the youth, parents, law enforcement, schools, and community members.

Ryan, Goan Promoted at SOMAVAC Memphis-based SOMAVAC Medical Solutions, Inc., a medical device company that creates solutions for the post-op recovery, announced two personnel changes as it prepares for commercialization of its flagship device the SOMAVAC 100  Sustained Vacuum System. Phil Ryan has been named vice president of operations and will focus on product development, quality management, vendor partnerships and purchasing. Ryan has 20 years of experience in electromechanical medical device development from design to manufacturing operations. Prior to SOMAVAC, Ryan

held executive roles at Olympus Corporation of America in Memphis. Joelle Goan has been named vice president of commercialization. Goan joined SOMAVAC as program manager earlier this year. Prior to joining SOMAVAC, Goan was in marketing, developing and launching new products at Olympus as a senior product manager. Before joining the firm, she held leadership roles in marketing at Hospira and Abbott Laboratories. The SOMAVAC® 100 is indicated for use in a range of surgeries which lead to large surgical flaps requiring drains, such as abdominal surgery, mastectomy, cosmetic surgery, hernia surgery, orthopedic procedures, etc.

PUBLISHER Pamela Z. Haskins pamela@memphismedicalnews.com EDITOR Bob Phillips editor@memphismedicalnews.com PHOTOGRAPHER Greg Campbell ADVERTISING INFORMATION 501.247.9189 Pamela Z. Haskins CREATIVE DIRECTOR Susan Graham sgraham@nashvillemedicalnews.com GRAPHIC DESIGNERS Susan Graham, Katy Barrett-Alley CONTRIBUTING WRITERS Lawrence Buser, Judy Otto Cindy Sanders, Beth Simkanin

All editorial submissions and press releases should be sent to editor@ memphismedicalnews.com

Subscription requests can be mailed to the address below or emailed to pamela@memphismedicalnews.com. Memphis Medical News is now privately and locally 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. Memphis Medical News will assume no responsibility for unsolicited materials. All letters sent to Memphis Medical News will be considered the newspaper’s property and unconditionally assigned to Memphis Medical News for publication and copyright purposes.

memphismedicalnews.com

memphismedicalnews

.com


Meet Sarah, age 15:

Wants to be an astronaut but hates geometry (and heights) Reads Where the Wild Things Are to her little brother every night

Listens to Joy Division and The Wombats

Loves the feeling of grass between her toes

Pets every dog she sees

Struggles with anxiety and depression Mental illness in teenagers is more common than you might think. In fact, 1 in 5 will need some form of mental health support. Recovery Academy offers a safe, proven treatment program where your teen can receive the care they need from experts in the field. We understand what your teen—and you—are going through, and we’re here to help. Talk with an understanding, trained professional today at 901.377.4733.

lakesidebhs.com

memphismedicalnews

.com

SEPTEMBER 2019

>

15


GIVE YOUR FINANCES THE SAME CARE AS YOU DO YOUR PATIENTS. In today’s uncertain markets, having a bank that tends to your financial health is vital. First Tennessee Medical Private Banking can help with today’s needs and tomorrow’s goals. Our Relationship Managers offer guidance and solutions tailored to medical professionals. So you can focus on your priority: your patients. To make an appointment with a Relationship Manager, please contact: Margaret Yancey Senior Vice President Medical Private Banking ph: 901-681-2526 email: myancey@ftb.com

Jeff McIlvain Vice President Medical Private Banking ph: 901-681-2555 email: jmcilvain@ftb.com

©2019 First Tennessee Bank National Association operating as First Tennessee Bank and Capital Bank. Member FDIC.

FTB_WEA_11676_2019_MPB_Print2_12319_10x13_4c_DocPatient_2_v2.indd 1

4/24/19 8:50 AM

Profile for Medical News

September 2019 MMN  

Memphis Medical News September 2019

September 2019 MMN  

Memphis Medical News September 2019