MD Update Issue 135

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #135 WWW.MD-UPDATE.COM

Playing for the Home Team

VOLUME 11 • #4 • September 2021

After lengthy stints in the U.S. Navy, Anthony O’Daniel Jr., MD, is coming home to Louisville

ALSO IN THIS ISSUE JEFF SELBY, MD, CHAIR, UK DEPT. OF ORTHOPEDIC SURGERY & SPORTS MEDICINE FOOT & ANKLE REPLACEMENT, TODD HOCKENBURY, MD, UofL HEALTH TENDINITIS PAIN CAUSED BY SCAR TISSUE, DANESH MAZLOOMDOOST, MD, WELLWARD REGENERATIVE MEDICINE SHOULDER SPECIALIST KEVIN MAGONE, MD, CHI SAINT JOSEPH HEALTH - LONDON

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS

2021 Editorial Calendar & Opportunities To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM 859.309.0720 (direct) 859.608.8454 (cell)

Issue #136 (October)

CANCER

Oncology, Radiology, Hematology, Plastic Surgery

Issue #137 (December)

IT’S ALL IN YOUR HEAD

Neurology, Neuroscience, Ophthalmology, Pain Medicine, ENT, Psychiatry, Mental Health

*Editorial topics and dates are subject to change.

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LETTER FROM THE PUBLISHER

Talkin’ Sports and Baseball Greetings and welcome to the Orthopedic and Sports Medicine issue of MD-Update.

Our cover story on J. Anthony O’Daniel, Jr., MD, comes at a time when the tragic turmoil in Afghanistan is unfolding. Dr. O’Daniel served our country there, treating US soldiers as well as NATO and Afghani military and “civilians who were caught in the crossfire.” I invite you to read his story on page 10.

Signs that semi-normal life is returning to Kentucky include a return to high school and college sports. In conversations with many of our orthopedic and sports medicine doctors over the Chandler with Cal Ripken, 2011 years, I have noticed that an active role in athletics is a common theme. Many of them played some kind of sport. Some visited the orthopedic doctor with a broken bone or torn cartilage or tendon.

That experience often nurtured a goal of becoming the doctor who fixed up athletes.

Inside this issue, I invite you to read the stories of Drs. Anthony O’Daniel, a member of the karate team at the U.S. Naval Academy, Jeff Selby, who played soccer and pitched in baseball; Todd Hockenbury, gymnast; and Kevin Magone, a former quarterback.

Update on Chandler Dunn

As a Henry Clay Blue Devil, 2016

We’ve always been a baseball family. For as long as I can remember, back to 1955, we followed the Baltimore Orioles because our roots were in Baltimore and we grew up on the Eastern Shore of Maryland.

I’m very blessed that my son Chandler has a passion for baseball and I get to watch him play. As anyone who follows baseball knows, the game will break your heart as well as give you untold joy and exhilaration.

Chandler’s baseball journey was through the Cal Ripken Youth Baseball organization, ending with the Cal Ripken World Series in Aberdeen, Maryland. Then he played for Henry Clay Shoulder surgery, 2019 High School in Lexington.

Chandler had his own experience with orthopedic surgery and physical therapy in 2019 with a labrum repair, then in the spring of 2020, a PRP injection for a bicep tear.

I’m happy to report that one of the highlights of this summer was the Commonwealth Collegiate Baseball League All Star game.

In a Field of Dreams moment, Chandler hit a grand slam home run in the 9th inning with the score tied at 5-5 at Whitaker Ball Park.

I hope that every athlete and every athlete’s parent has felt the joy we felt at that moment. I’d be interested in hearing your story.

In 2021, after hitting a gamewinning grand slam home run!

Until October and the Cancer Care issue, all the best,

Gil Dunn Editor/Publisher MD-Update 2 MD-UPDATE

SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax

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CONTENTS

ISSUE #135

laying for the 10 P Home Team

After lengthy stints in the U.S. Navy, Anthony O’Daniel Jr., MD, is coming home to Louisville COVER PHOTOGRAPHY BY JAMIE RHODES, NORTON HEALTHCARE

4 5 6 8 10

HEADLINES ACCOUNTING FINANCE LEGAL COVER STORY

SPECIAL SECTION: 14 ORTHOPEDIC SURGERY & SPORTS MEDICINE AT UK 16 ANKLE & FOOT SURGERY AT UofL 20 SHOULDER SURGERY & SPORTS MEDICINE 22 JOINT PAIN AND REGENERATIVE MEDICINE 24 MENTAL WELLNESS 26 EVENTS 28 NEWS

SPECIAL SECTIONS ORTHOPEDICS • SPORTS MEDICINE • PAIN AND REGENERATIVE MEDICINE

14 ORTHOPEDICS & SPORTS MEDICINE

16 ORTHOPEDICS FOOT & ANKLE

20 ORTHOPEDICS & SPORTS MEDICINE

22 PAIN AND REGENERATIVE MEDICINE ISSUE #135 3

Headlines

W. Ben Kibler, MD, the Cy Young of Shoulder Surgeons Renowned orthopedic surgeon inducted into specialty society’s hall of fame LEXINGTON Long time Lexington Clinic

orthopedic and sports medicine surgeon W. Ben Kibler, MD, received the highest honor from his peers and his specialty’s society in July 2021 when he was inducted into the American Orthopedic Society for Sports Medicine’s (AOSSM) Hall of Fame.

Kibler retired from Lexington Clinic in June 2020 after 43 years of serving his patients and providing insights and education for his colleagues. He was widely acknowledged as a thought leader in shoulder surgery and the role of the scapula, establishing The Shoulder Center of Kentucky.

In addition to complex shoulder surgery, Kibler was accomplished in acute knee injury surgery, sports medicine, and arthroscopic surgeries of the knee, ankle, and elbow.

Before joining Lexington Clinic, Kibler did his residency in orthopedic surgery and completed a neuromuscular disease fellowship at Vanderbilt University. He received his medical degree from the Vanderbilt University School of Medicine.

According to a release from Lexington Clinic on his retirement, Kibler had multiple professional achievements such as: • Developing the first comprehensive sports medicine program in Kentucky • Being the first to provide athletic training services to area schools and sports organizations in Kentucky • Developing three Consensus Conferences on disorders of the scapula • Performing over 23,000 surgical procedures • Founding member of the Society for Tennis Medicine and Science • Head Team Physician for the Lexington 4 MD-UPDATE

Legends since 2001 Within the realm of medical innovations, Kibler: • Was the first to describe the kinetic chain in sports activities • Was the first to describe scapular kinematics and scapular dyskinesis • Wrote and co-edited the Mary Lloyd Ireland, MD, UK Healthcare orthopedic surgeon and chair first and only book on of the AOSSM Hall of Fame committee, with W. Ben Kibler, MD. scapular disorders • Developed concepts of core stability and research on the scapula and shoulder brought closed chain rehabilitation awareness to orthopedists of the importance • Developed protocols and programs that of the scapula in prevention of injury. He did set the basis for comprehensive shoulder significant work in this area, particularly in rehabilitation the sport of tennis,” she said.

• Developed and described three clinical Jed Kuhn, MD, director of orthopedic surexam tests for shoulder pathology gery at Vanderbilt School of Medicine, said • Developed and determined outcomes Kibler “is a kind, humble man of faith who for two operations for AC injury and has been given a unique way of looking at the scapular muscle detachment world. Instead of anatomy, he sees function.

• Developed the Personal Insight Program Instead of pathology, he sees dysfunction. to address issues of professional and perThis has led to a paradigm shift in the way sonal burnout. orthopedic surgeons think, considering the In his acceptance speech, Kibler thanked patient’s function to be paramount in our his “practice partners at Lexington Clinic approach to treatment.” who developed and maintained the highest According to their website, the AOSSM standards of excellence in Sports Medicine grew out of the American Academy of care.” He also acknowledged his mentors and Orthopaedic Surgeons Committee on Sports colleagues throughout his professional career, Medicine, first organized in 1964. In 1972, Betty, his wife of 51 years, and his sons. In 75 founding members created the AOSSM as closing he thanked “God, the creator of the a “scientific outlet for presentation and publiamazing human body, for giving him the skills cation of new ideas” in sports medicine. Every to heal.” year since 2001, AOSSM recognizes individMary Lloyd Ireland, MD, UK Healthcare uals who have made significant contributions orthopedic surgeon, presented the Hall of to orthopedic sports medicine and the society.

Fame plaque to Kibler. “Dr. Kibler dedicated The Hall of Fame is considered one of the time and money to research. His articles and highest honors given to a society member.

PHOTO PROVIDED BY AOSSM

Accounting

Outsourcing: The New Normal in Healthcare Accounting?

JUSTIN HUBBARD, ACCOUNTING & FINANCIAL OUTSOURCING DIRECTOR

The COVID-19 pandemic challenged every assumption in healthcare. Systems that were supposed to be redundant and resilient were pushed to the breaking point and beyond.

Problems that seem unthinkable became realities, one after another after another. No matter how the pandemic affected a healthcare provider, all of them think differently in the wake of it.

We can expect swift and sweeping changes as a result. Preventing a repeat of recent events will be the industry’s top priority. Every facet of healthcare will respond to this mandate in their own way, but none will ignore it. Continuing with the status quo represents too great a risk.

What will the new normal look like? Expect outsourcing to play a much greater role, especially in healthcare accounting and finance.

Why Outsourcing Makes the Most Sense Without receiving much notice, healthcare accounting teams were some of the hardest hit during the pandemic. They had to deal with a financial crisis that appeared out of nowhere while adapting to sudden remote work requirements and unpredictable staff shortages. Arguably, everything that could go wrong did go wrong.

Most teams adapted admirably and kept their organizations afloat through unprecedented difficulties. Nonetheless, it’s clear that most teams aren’t equipped for the next pandemic in terms of staff, technology, visibility, or expertise. Complicating matters even more, adding these missing pieces requires time, money, and other resources that are in short supply right now.

Outsourcing offers a shortcut between what healthcare accounting teams have and what they need. Outsourcing partners can introduce cloud-based accounting systems that facilitate remote work. Outsourcing partners offer professional accountants who are more skilled than the resources many healthcare organizations can hire on their own. Outsourcing partners can step up to handle routine accounting obligations whenever necessary or deliver specialized financial insights on demand. They can also free up the in-house accounting team to focus on strategic objectives or long-term initiatives.

The new normal calls for healthcare accounting teams to be agile, informed, and robust. Building out those capabilities in-house involves a huge cost and a complicated, time-intensive effort. But not with outsourcing. Any healthcare accounting team plus the right outsourcing partner equals an

Empowering physicians to focus solely on the demands of their clinical practice

elite unit prepared for whatever the future holds: good, bad, or unexpected.

Healthcare Accounting After Outsourcing The greatest argument for outsourcing, especially under the present circumstances, is that it insulates accounting teams from uncertainty.

Teams have the resources they need to keep the financial situation stable in the midst of chaos. They utilize technology that provides the information needed to make business decisions available from anywhere. And they have a partner to consult with on the most complicated and critical financial questions of the day.

A tidal wave of change was already headed towards the healthcare industry before the pandemic started. Outsourcing increasingly looks like the best – even only – way to say ahead of this transformation. Prepare for the new normal sooner rather than later by contacting Dean Dorton.

Dean Dorton offers an accounting team that specializes in the healthcare industry. Contact Dean Dorton to discuss your practice and opportunities to enhance your accounting function and to ensure continuity of business.

Justin Hubbard can be reached at 859.425.7604 and jhubbard@deandorton.com

Practice management and advisory services

Interim practice management

Medical billing and credentialing

Accounting and financial outsourcing

Revenue cycle management

Human resources

Compliance and risk management

Technology

deandortonhealthcaresolutions.com ISSUE #135 5

Finance

Get Ready for Post-COVID Investing

BY SCOTT NEAL

You’ve probably heard it said that the U.S. stock market average annual total return is about 10%. That’s widely publicized, so we wouldn’t fault you for holding that as your expected return. In days gone by, we even put the Ibbotson chart up on our wall that showed the value of stocks, bonds, bills and inflation over time since 1926. You can do an internet search and still find the chart that is conveniently updated each year (it still shows the long run average at around 10%).

We know that our readership can do arithmetic, so you can easily imagine how long it will take to move that very long-standing average away from the mean. You are likely to

“More than likely, your planning horizon is somewhere between five and twenty years.” — Scott Neal hear 10% being touted as the expected return of stocks for a long time. You also know, probably from experience, that the distribution of annual returns from stocks is rather wide.

So, the big question: is it reasonable to use a projection of 10% on stocks for your financial plan or to set your expectations? Mostly likely

it is not. Let’s explore why and delve into what to do about that.

First, let’s make sure that we know what makes up total return. Total return is equal to capital gains plus dividend yield. We can further break down capital gains into earnings per share growth times the change in the P/E (price earnings). When someone offers you a forecast of the market, you should be interested to know their assumptions for earnings growth, dividend yield, and changes to P/E if you want to test their forecast for reasonableness.

It’s very important to note that the 10% average return is for a very long and specific

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Finance

period: 1926 – present. It began at a time when P/Es were fairly low (those have doubled since then), and average inflation of 2.9%.

Your personal time horizon is very important to the success of your financial plan.

It is not likely that your time horizon for planning is anywhere near 95 years. More than likely, your planning horizon is somewhere between five and twenty years. So perhaps it would be instructive to break down the components even further and determine some direction, if not the magnitude of change in the stock market.

According to author Ed Easterling of Crestmont Research, fundamental principles, not randomness, drive each of the three components. Earnings per share (EPS) growth is inextricably linked to economic growth (GDP). That makes sense since GDP is the total of all sales of goods and services, and earnings emanate from sales. P/E expansion and contraction are closely correlated to the inflation rate, and the starting point of

“Inflation seems to be at the forefront of a lot of minds these days. The stock market likes stable inflation around 2 to 3%.” — Scott Neal the P/E ratio drives dividend yield. Periods starting with relatively high P/Es have low dividend yields.

For comparison, at the time of this writing (mid-August 2021) the current P/E ratio of the S&P 500 is estimated from the latest reported earnings and the current price of the index. It is about 35. The long run average is about 16. The Shiller CAPE (Cyclically Adjusted PE Ratio) is another common valuation metric and is based on average inflation-adjusted earnings from the previous 10 years. It stands at 38.5 as of this writing.

We like to test this against other measures of

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valuation. Hussman Strategic Advisors uses Market Capitalization to Corporate Gross Value Added (MktCap/GVA) as its preferred valuation metric. It is currently 3.6 times its historical norm. By almost any measure, the stock market is at an extreme valuation. It could remain over-valued indefinitely, but I wouldn’t count on it. It usually reverts to the mean at some point. In simple terms, a rising P/E adds to your capital gains, and a falling P/E takes them away.

A lot rides on inflation. Inflation seems to be at the forefront of a lot of minds these days. The stock market likes stable inflation around 2 to 3%. The latest numbers (those for July 2021) showed a change of 5.4% from one year ago. But remember what was going on last summer. We have expected this and the consensus view is that it will be temporary. There is significant speculation that the money pumped into the economy by the Fed and the Federal government will cause a permanent rise to inflation. A rather significant increase is likely, but for different reasons than the increase in the money supply.

There are structural changes going on in our economy that will probably lead to increased inflation compared to the preCOVID era. The primary determinant of inflation is a demand curve that moves out faster than the supply curve. We see it happening on a smaller scale today. Aggregate demand for goods and services (especially healthcare) is likely to expand for a very long time. Demographics will play a big part in this story. The number of elderly Americans who will demand that their benefits be paid is growing rapidly. Life expectancies are rising.

Couple this with a drop in the birth rate and you find a shrinking supply of labor. In short, the supply curve is moving out more slowly than the demand curve. That is inflationary.

What all this means for you is that you need to be on your financial toes. Paying attention to these issues is becoming more critical as time goes by—stay tuned.

Scott Neal is the president of D. Scott Neal, Inc., a feeonly financial planning and investment advisory firm with offices in Lexington and Louisville. He would love to hear from you at scott@dsneal.com or 1-800-344-9098.

ISSUE #135 7

Legal

Legal Liability During the COVID-19 Pandemic – What Do We Know?

BY DOUG STEPHAN

As of summer 2021, the U.S. counts over 35 million COVID-19 cases and more than 616,000 deaths. Nearly one-third of U.S. COVID-19 deaths are linked to nursing homes. According to the Centers for Disease Control and Prevention as of June 2021, 31% of all U.S. deaths (184,000) and 4% of all U.S. cases (1,383,000) were reported among residents and employees of long-term care facilities. In Kentucky, with 409 facilities, 33% of COVID-19 deaths (2,291) were linked to nursing homes out of 30,030 nursing home cases. These numbers have been trending down since the vaccine became available.

In the June 2020 issue of MD Update my

partner, Jamie W. Dittert, reviewed “COVID19 Immunity Protection for Health Care Professionals,” and in the February 2021 issue we reviewed “COVID-19 Vaccine” guidance. As pandemic circumstances continue to change, many issues remain as to COVID-19 vaccination, immunity and legal liability.

As of mid-August 2021, it is reported more than 80% of Americans over the age of 65 are fully vaccinated. Overall, about 189.9 million people or 59% of Americans have received at least one dose of vaccine (about 50% of the total population have now been fully vaccinated). In Kentucky 53% received one dose; 46% are fully vaccinated.

In 2020, long-term care providers began vaccinating patients, residents, and employees on a voluntary basis. Due to age and underlying health conditions, nursing home residents may be at greater risk of severe illness if they contract COVID-19. On August 18, due to lower vaccination rates and the rising number of COVID-19 cases attributed to the Delta variant, President Biden announced that nursing home and long-term care facilities must vaccinate their staff against COVID19 in order to receive federal Medicare and Medicaid funding.

During the summer of 2021 new cases have grown as the Delta variant spreads.

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Legal

The majority of people contracting the virus and being hospitalized are unvaccinated. The threat to patients may be reduced through universal staff vaccination, as findings from the June 2021 CDC “HEROES-RECOVER” study of health care workers, first responders, frontline workers, and other essential workers suggest that fully or partially vaccinated people who got COVID-19 might be less likely to spread the virus to others.

Some long-term care providers are now requiring mandatory vaccines for staff. As of July 2021, the healthcare industry has not endorsed a vaccination mandate but supported continued efforts to educate its workers.

Questions exist regarding whether employers can require a vaccination, applicable exceptions (union contracts, ADA and Title VII), who is responsible for COVID-19 in the workplace or at a business, and if there is immunity for business owners when there is a claim by an employee or customer. These issues give rise to the ongoing debate at the federal and state level over COVID-19 related lawsuits.

At the federal level, efforts were made in 2020 urging national COVID-19 civil liability immunity as a part of the “SAFE TO WORK” legislation. The federal bill proposed to provide broad liability immunity for businesses, healthcare facilities, educational institutions and local governments by preempting state laws, providing federal court jurisdiction, heightened pleading requirements, a medical causation affidavit, limited damages, limits on class actions, and to apply retroactively to all claims filed on or after December 1, 2019. The federal bill has not been passed.

At the state level, many legislatures have enacted immunity for businesses and employers against lawsuits claiming COVID-19 related liability. Of course, immunity from liability does not guarantee immunity from litigation and furthermore, there are insurance coverage issues for COVID-19 claims.

On April 11, 2021, Kentucky “Senate Bill 5” became law, purporting to afford immunity from COVID-19 based negligence litigation to healthcare providers and business owners (KRS 39A.280). The new Kentucky law attempts to protect businesses from law-

“On April 11, 2021, ‘KY Senate Bill 5’ became law, purporting to afford immunity from COVID-19 based negligence litigation to healthcare providers and business owners (KRS-39A.280)” — Doug Stephan suits that claim someone contracted COVID19 while at the place of business so long as the business did their best to follow COVID-19 guidelines. The April 2021 Kentucky law protects “essential service providers” who are also defined to include teachers, home healthcare workers and local government employees.

The 2021 Kentucky statute applies retroactively to March 6, 2020, and would end after December 31, 2024. This statutory immunity does not apply in cases of “gross negligence, wanton, willful malicious, or intentional misconduct.” Businesses must be in compliance with federal, state, local and industry guidelines. This statute also requires that COVID19 injury claims be filed within one year of the injury being discovered.

However, this new 2021 Kentucky law may not withstand a court challenge based on the Kentucky “jural rights doctrine.” Under the Kentucky constitution and case law, a person claiming an injury has a right of access to the courts. The constitutional provisions give the judicial branch the sole authority regarding personal injury claims. To enforce the 2021 statute may require amending the Kentucky Constitution. Despite immunity provisions, the potential for liability remains.

Even if a negligence lawsuit is filed, the plaintiff must meet their burden of proof.

First, the plaintiff must establish what standard of care applies during the pandemic and how the provider violated the standard of care.

This could be difficult because guidance from public health officials frequently changed.

Early in the crisis, a shortage of protective

equipment precluded staff from implementing COVID-19 protective measures.

Next, a plaintiff must prove that the acquired COVID-19 infection was caused by the negligent act or a failure to act by the business or employer. As a practical matter, most people infected with COVID-19 may not be able to confirm the source of their infection (with the possible exception of extended care at a hospital, long-term care facility or nursing home). It may be three to eleven days between infection and illness, and the inability to identify all the person’s contacts during the interval and limited testing to confirm the virus could present obstacles to establishing causation to any one business or healthcare provider.

Finally, if a lawsuit is filed and the case survives a motion to dismiss based on immunity, the plaintiff must identify an expert to establish standard of care and causation, which may be difficult to prove. If the case moves to trial, many of the potential jurors might now consider healthcare providers “heroes,” which could impact their willingness to find providers at fault.

In the meantime, businesses should continue to follow recognized COVID-19 safe practices. This includes hospitals, nursing homes, long-term care facilities, physicians, other healthcare personnel and providers.

E. Douglas Stephan is a medical malpractice defense attorney with Sturgill, Turner, Barker & Moloney, PLLC. He can be reached at dstephan@sturgillturner.com or 859.255.8581. This article is intended to be a summary of state or federal law and does not constitute legal advice.

NOW ONLINE

ISSUE #135 9

“I hold as one of my tenet philosophies, that every person on the team is a critical aspect of the team.” – Anthony O’Daniel, MD

Playing for the Home Team

After lengthy stints in the U.S. Navy, Anthony O’Daniel Jr., MD is coming home to Louisville

BY JIM KELSEY LOUISVILLE Be it high school or college, home-

coming is almost always held around a major school sporting event. There’s the big game, the reunion, the dance, and the memories. It’s a special event, as any homecoming should be.

It’s a reminder and celebration of community, family, school, and, yes, team.

For Joseph Anthony O’Daniel Jr., MD, homecoming might not include a dance or even a game, but it certainly involves a team. He has joined the team at Norton Healthcare in Louisville as an orthopedic surgeon. What makes the story all the sweeter is that O’Daniel, after 16 years, is returning to his “home team.” It’s the same city where he swam and ran track and field and cross country for Trinity High School. It’s where his 10 MD-UPDATE

family still lives, and where the family of his wife Andrea lives as well.

“One of the really attractive aspects of Norton Healthcare is that they emphasize that they are going to do what they can to provide for the team and support that team concept so that we can focus on providing the best surgeries and outcomes possible,” says O’Daniel, who is a fellow of the American Academy of Orthopedic Surgeons.

It is clear that the team atmosphere appealed to O’Daniel and was a key component of his decision to return to Louisville, as was the presence of extended family. “The opportunity to come home and to raise our three children around our parents and their cousins, we think is invaluable,” he says.

Invaluable, too, was the experience that O’Daniel gained when he went to the U.S. PHOTO BY JAMIE RHODES, NORTON HEALTHCARE

Naval Academy from 1992-96, immediately after graduating from high school. While there, he competed on the Academy’s karate team. “I spent a long time with my teammates there, and it was a very big part of my life,” O’Daniel says.

Upon graduation, he served five years as a line officer in the Navy. Then he was accepted to the University of Louisville School of Medicine, where he met his future wife Andrea, formerly Metten, who was also beginning her path to becoming a pediatrician. The Navy offered O’Daniel a military scholarship to attend medical school, which meant he returned to the Navy upon graduating from medical school.

What followed was 15 more years in the Navy.

“It provided an opportunity to train with surgeons from all over the United States and to have the newest and best technology at our

Cover Story

Dr. O’Daniel, left, in a mass casualty operation in Afghanistan.

fingertips to help veterans and our wounded warriors coming back from the wars in Iraq and Afghanistan,” says O’Daniel, who trained at Walter Reed National Military Medical Center in Bethesda, Maryland.

country. I did around 65 surgeries that were orthopedic specific. A lot of them were gunshot wounds to the extremities or blast injuries from IEDs. The majority of the patients that we took care of were Afghan locals that were either Serving in Afghani soldiers or Military civilians that were Healthcare injured in the crossAnthony O’Daniel, MD, orthopedic surgeon, Norton As a young line officer, Ensign Anthony O’Daniel O’Daniel was called Orthopedic Institute. PHOTO BY JAMIE RHODES was stationed in Okinawa and Sasebo in Japan. fire.” to serve in Iraq for O’Daniel returned seven months in 2007 and 2008 with a Navy “I deployed with a team that was responsible to the States in 2008 and completed his construction battalion of approximately 650 for manning the Level 1 hospital in Kandahar, residency in orthopedic surgery at the Walter sailors, aka The Seabees, who were skilled Afghanistan,” O’Daniel says. “The Navy was Reed National Military Medical Center in in construction, carpentry, and heavy equip- tasked with putting together a group of 16 2013. He spent the next seven years as an ment. They were deployed to support the healthcare professionals that ranged from orthopedic surgeon in the Navy and was marine and army infantry that were there, technicians, foremen, nurses, intensive care stationed just north of Chicago where Navy and O’Daniel, who had just been promoted nurses, physicians and surgeons, to provide recruits go through boot camp. He retired to Lieutenant Commander, served as the head healthcare for all of the NATO forces and from active duty in 2020 and took a oneof the medical department for the battalion. injured Afghanis in the southern half of the year fellowship in hip and knee arthroplasty PHOTOS PROVIDED BY ANTHONY O’DANIEL, MD

ISSUE #135 11

Cover Story

Not every minute was spent in the OR while Dr. O’Daniel was in Afghanistan.

at NorthShore University in Skokie, Illinois.

There, he was exposed to emerging technology, including robotic-assisted and computer-navigated arthroplasty surgeries.

“I think there could be a misconception that we are programming a robot and it actually does the surgery,” O’Daniel says. “What the combination of the computer and robot allows me to do is to preoperatively plan the surgery in finer detail. Before being exposed to robotic assisted surgery, I think a good surgeon would consistently put the total hip components within five to maybe 10 degrees in two different planes in the coronal and sagittal planes.

The emerging technology is allowing us to put it within one degree in two planes and within a millimeter in terms of depth. The computer and robot reinforce your instinct or training.”

A Change of Plans Nearing the completion of his fellowship at NorthShore, O’Daniel planned to go into 12 MD-UPDATE

private practice. It wasn’t long before he was approached by Norton Healthcare about joining them as a joint surgeon.

“From the first interaction with the senior recruiters, it was a wonderful experience,” O’Daniel says. “They explained to me the Norton Healthcare business model and what a large presence it has in Kentuckiana. I felt it was too good of an opportunity to let go.”

O’Daniel plans to focus on joint replacement, but will also treat orthopedic trauma as well as sports injuries. He feels his experience and training have prepared him for these challenging procedures and injuries.

“I believe that orthopedic care has advanced substantially and that we can treat the full gamut of types of injuries and disease,” he says.

“The opportunity to work with our military veteran population has given me a perspective of compassion that we all face struggles and we’re all trying to do the best that we can as we travel through life. It’s humbled me to realize PHOTOS PROVIDED BY ANTHONY O’DANIEL, MD

that I was very privileged to work with the military which was full of a very young and healthy population.”

Preparing for the New Challenge O’Daniel understands that his new patient population might not be quite as healthy outside of the military, and is bracing himself to face the challenges brought on by such risk factors as obesity, diabetes, and smoking. To do that, he will rely on his teammates and their expertise in helping to prepare the patient before surgery and rehabilitate the patient after. He anticipates working closely with other specialists such as internal medicine physicians, cardiologists, rheumatologists, dieticians, and physical therapists to provide the wide range of care these patients will require.

He also hopes to be able to help patients recover more quickly and successfully by getting them home as soon as possible after surgery.

Cover Story The US Navy surgical team on a tactical vehicle in Afghanistan.

“There is a trend towards minimizing patient stay postoperatively as much as possible,” he says. “Whereas perhaps a decade ago, the concept of outpatient surgery was a scary thought to a lot of patients. Now the thought of coming in for a major joint replacement and going home later that afternoon holds wonderful promise because it gets the patients back into their native environment sooner where they are likely most comfortable.”

In addition to a healthier patient mindset, the earlier return home helps avoid the risk of nosocomial infections from staying in the hospital. Of course, every patient and case is different. What might be the best course of action for one patient might not be the best fit for another. To that end, O’Daniel is committed to communication and teamwork with the patient and other medical providers on the team.

“I believe that care should be collaborative where, as a physician, I provide the best

Homecoming from Afghanistan for Anthony O’Daniel, MD, with wife Andrea and children William, Evelyn and Mary Grace and his father, Tony O’Daniel.

medical advice that I can and then work with the patient to collaboratively make the best decision for them as an individual,” he says.

“It could be surgery or it could be something entirely different to help meet their orthopedic needs. Treating every person with dignity and respect are some of the core tenets that I strive for.”

O’Daniel’s athletic and military background are evident in his words. He genuinely values what every team member brings to the table and understands that winning — be it on the playing field, battlefield, or in the operating room — takes a combined effort with every team member doing their part and every role being of equal importance.

“In the military it was emphasized that everyone’s role was to provide the best outcome possible,” he says. “I hold that as one of my tenet philosophies, that every person on the team is a critical aspect of the team. When we roll into the operating

room and perform a surgery, there’s so much work that goes in pre-operatively to get the patient ready. That’s from the medical technician, the x-ray technician, the radiologist, the patient’s internal medicine doctors, and often their cardiologist. Certainly, the nursing staff plays a critical role and the administration by supporting your plan.

Then, postoperatively, our internal medicine colleagues keeping the patient healthy and medically optimized after surgery. Physical therapists and occupational therapists that optimize as well. I think that if you took away any of those components you would have inferior outcomes.”

Even though he’s joining a new team, O’Daniel figures to be a quick and welcome fit. Ask any coach and they will surely tell you that a highly-skilled, well-trained, experienced player with a team-first attitude is always a welcome addition. Perhaps even worthy of a homecoming parade.

ISSUE #135 13

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Orthopedics/Sports Medicine

New Horizons in Orthopedic Medicine A Q&A with Jeffrey Brian Selby, MD

LEXINGTON Editor’s intro: Jeffrey Brian Selby,

size of the new UK Hospital, which is now ten years old, is responsible for that growth.

Just having the space to grow and the superb facilities has allowed all of the specialties to grow, ours included.

MD, has been chair of the UK Department of Orthopaedic Surgery and Sports Medicine since October 2020. He was interim chair for 2.5 years previously.

Dr. Selby, tell us some of your background.

(Selby) My family was originally from West Texas, but I grew up in Florida and Colorado.

I went to Vanderbilt for undergraduate, the Texas Tech School of Medicine, and did my residency at UK. I’m board certified in orthopedic surgery. I met my wife Lisbeth, a gastroenterologist, in medical school.

Both my father and grandfather were cardiothoracic surgeons, so I followed in their footsteps but took a slightly different path.

I’ve always been mechanical and like to build things. I first became interested in orthopedics when I took a summer job during college with an orthopedic surgeon in Missouri, Dr. Leo Whiteside. That’s where I first saw orthopedic research and surgery, and it enlightened me to the possibility of medically fixing things.

Was medical administration always one of your goals?

I have always had a tendency toward leadership. I have been the chief of orthopedics at the VA, medical director of orthopedic trauma at UK, and medical director of joint replacement at UK. Being vice-chair for several years prepared me for the business side of the department.

You are department chair, but you still see patients?

It was part of my agreement when becoming department chair that I could still see patients. My leadership style is to lead by example, and I can’t do that if I’m not seeing patients and still operating.

Describe your patient population for us.

I started out doing orthopedic trauma and 14 MD-UPDATE

There seems to be a trend in orthopedic surgeries, particularly with joint replacement, towards outpatient surgery or very short hospital stays.

What’s your view on that trend?

Jeffrey Brian Selby, MD, chair of the UK Department of Orthopaedic Surgery and Sports Medicine.

sports medicine procedures. My practice has now evolved to primarily older patients who need joint replacement, from simple joint replacement to the most complex revisions.

My more elderly patients need joint replacement from osteoarthritis or rheumatoid arthritis and other deterioration of the joints.

The field of orthopedics, orthopedic surgery and sports medicine has grown tremendously in the last few decades. Does the UK Department of Orthopaedics reflect that growth?

The Department of Orthopaedics and Sports Medicine at UK has grown dramatically in the last 25 years. We started with a six-member faculty, and we now have 35. What started as a trauma center has developed into a trauma and sports medicine center with all of the subspecialties such as hand surgery, pediatric orthopedic surgery, shoulder and elbow surgery, tumor surgery, and of course joint replacement.

In your opinion, what’s driving the growth of orthopedics and sports medicine?

You would think that trauma would be constant, but it continues to increase. The biggest growth is in sports medicine and joint replacement. I think the rise in quality and PHOTO BY GIL DUNN

What use to be a four or five-day hospital stay, with one to two weeks at a rehabilitation facility, is now outpatient with the patient leaving the same day or the next day. Now that’s not appropriate for all patients. We have studies that show that for some elderly and more infirm patients, longer hospital stays are necessary and in rare occasions there’s a placement in rehabilitation facility. It all depends on the patient. Same day outpatient surgery is not for everyone, but most patients leave the day after surgery.

We’ve found that getting the patient back to their home environment quickly, in many cases, works much better.

Why do you say that?

We’ve gotten much better at post-operative pain management and physical therapy protocols so we’re able to get patients moving much faster than before. And that’s a good thing. People can sleep in their own beds and be comfortable the first evening.

But I want to emphasize that next day or outpatient surgery is not for everyone. People have to want that in-home care. We don’t force anyone to go home. Patients may be unsteady on their feet, and they need to have a qualified caregiving partner to assist them.

Another trend in orthopedic surgery is computer navigation and robotic surgery.

Do you employ those technologies for surgeries at UK for joint replacement?

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We’ve been using computer navigation and robotics for surgery at UK for several years now in joint replacement, but only if it improves patient outcomes. We’ve been using the robotic platform for joint replacement surgery for over a year and a half.

The benefits are not that a robotic arm makes a more accurate cut. The advantage is that we can place the implant in more exact alignment with the patient’s existing bone structure. The robotic-assisted computer allows us to combine the implant alignment with the patient’s soft tissue balance, which are the important elements of joint replacement surgery. It can also help us minimize cutting of soft tissue, such as ligaments and muscle, which aid in the patient’s recovery.

Talk about your department’s approach to pain management post-surgery.

It generally hurts to have orthopedic surgery. We’ve changed our pain management protocols over the years. In the past we used to give mostly narcotics to relieve the pain from surgery. Now we employ a multi-modal pain management approach where we attack pain pathways and use different medications for pain management, with narcotics as the solvent at the end. This approach allows us to reduce the amounts of narcotics used.

Some patients are concerned by this approach and are worried that we won’t give them enough pain medicine to control their pain. That’s simply not the case. Their pain will be controlled, but we’ve learned how to do it with far less narcotics than before.

What’s your opinion of protein-rich plasma injections for sports injuries or age-related soft tissue deterioration?

Protein-rich plasma injections are showing to be most effective in soft tissue, repetitive motion injuries, such as tennis elbow. Some people are using it in knees. As yet, the FDA has not approved it, so it’s not covered by insurance. The results are variable. It works for some people, for others it doesn’t. I have to follow the

FDA, so I’ll wait until we have more evidence of its efficacy and more clinical trials.

Are there any clinical trials going on at UK Department of Orthopaedics?

We have several trials going on now. One is focused on improving the patient’s overall recovery outcome and mental state after an orthopedic trauma. We can fix the bones and joints, but how can we optimize how the patient responds mentally?

We’re also doing some work on different new implants and a lot of work on cartilage restoration.

Talk to me about the collaborative team approach at the UK Department of Orthopaedics.

We have a team approach on several levels.

We have some super subspecialists, so we can collaborate on very complex surgeries where multiple bones and joints are involved. The team effort is really the whole department, our clinic team, our hospital team, our operating room team; all collaborate because each team is as important as the other.

We’ve had joint replacement optimization meetings where everyone involved was invited, over 50 to 60 people attended and each had something to do with the surgery. So, it’s definitely a team approach.

Talk about the department’s outreach beyond the UK campus.

Our Sports Medicine department covers multiple sports teams, Morehead State, Kentucky State University, Georgetown College, and of course UK. We also cover many high school teams around Lexington and in Danville and Lincoln County and other surrounding counties.

We have orthopedic surgeons at Med Center Health Orthopaedics and Sports Medicine in Bowling Green. They are very active with Western Kentucky University athletics. They were the first in our physician group to start using robotic surgery techniques. We started that about five years ago.

Orthopedics/Sports Medicine

What are some misconceptions about orthopedics that you want to address?

One that I hear from patients is that an MRI is necessary for everything. We order a lot of MRIs but not every orthopedic condition warrants an MRI. The second is that every orthopedic condition requires surgery. We spend a lot of time on non-operative techniques because we understand that there are risks and complications from surgery. Some patients may become frustrated and impatient that we don’t rush into surgery, but we feel that in some cases physical therapy and other medical options are suggested and have less overall risk for the patient.

What’s on the horizon for orthopedics and sports medicine that will be a game changer?

There are a lot of things coming. I believe biologics such as stem cell replacement and PRP will all continue to improve. Robotic surgery using artificial intelligence and computer navigation will improve for even more surgical accuracy. I’d like to see us be able to regrow cartilage on a larger scale. We can do it now, in some smaller locations, with younger sports medicine patients. I hope we can learn to regrow cartilage in larger areas of the joints in older patients with arthritis. That could eliminate the need for joint replacement with artificial joints with plastic and metal.

What’s your personal philosophy of care?

I treat all of my patients exactly as if they were my family. I would never recommend a treatment that I wouldn’t recommend for myself or my family. I think that makes people feel at ease, by keeping it simple.

What message do you want to share about the University of Kentucky Department of Orthopaedics with our readers?

We have the most widespread group of orthopedic subspecialists in the region. We have leading physicians of character who take great care of patients.

ISSUE #135 15

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Orthopedics/Sports Medicine

On Solid Footing

Ankle and foot specialist Todd Hockenbury, MD, brings a world of experience to his job as an orthopedic surgeon

BY PAT HENDERSON

LOUISVILLE To say it’s been a long, strange

trip for Todd Hockenbury, MD, might be an insult to long, strange trips. Hockenbury, who serves as the assistant clinical professor of orthopedic surgery at UofL School of Medicine and surgeon at UofL Health - Mary & Elizabeth Hospital and Medical Center East, has packed a lot into his 36 years in healthcare.

The Louisville native’s journey took him from the classrooms of Seneca High School and West Point to a medical career in the U.S. Army and a decision to become one of Kentucky’s earliest specialists in foot and ankle surgery. His time in the Army included a stint right after the Cold War ended in a 16 MD-UPDATE

United Nations’ MASH unit in the former Yugoslavia where he treated patients from more than 25 countries, including Russia and the Ukraine.

After he left the Army as a lieutenant colonel in 1997, he took a year-long foot and ankle fellowship in Cincinnati then returned to Louisville, where he was in private practice for a decade. In 2008, he was hired by Jewish Hospital, which became part of UofL Health, and he’s been there ever since.

Hockenbury’s ‘War’ Stories So, just how does a kid from Louisville wind up halfway around the world treating Soviet military officers?

PHOTO BY GIL DUNN

Todd Hockenbury, MD, did his first ankle replacement surgery in 1999 during a time when the procedure was relatively unknown. Since then, he has done more than 700 ankle replacements.

Well, when you are in the U.S. Army, you move around a lot, and Hockenbury was no exception. In the decade immediately after he finished at UofL School of Medicine, he had two stints at Fitzsimons Army Medical Center in Denver doing four years of orthopedic residency. That’s where he met his wife Dawn, who was a pediatric OR nurse at Denver Children’s Hospital. Then he spent a year at Fort Benning, Georgia, and worked overseas in Germany and Croatia.

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Orthopedics/Sports Medicine

Dr. Hockenbury was stationed with the 212th MASH in Zagreb, Croatia in 1992.

Since his unit was attached to the United Nations Protective Force, they wore blue berets.

Ankle Replacement Surgery

BY TODD HOCKENBURY, MD

“We were stationed in Zagreb, Croatia, with the 212th MASH unit, and I spent four months supporting the United Nations during the breakup of Yugoslavia,” says Hockenbury.

“It was quite an experience taking care of people from so many places—Russia, Ukraine, Poland, France, Argentina, Egypt and Nepal.

We had all these translators trying to help us communicate with these patients from 25 or so different countries. It was really fascinating, and I learned a lot about people and how much we are all alike.”

In his role with the MASH unit, Hockenbury did a lot of wound management and general orthopedics work, which included some amputations and fracture work. The unit didn’t receive soldiers right from the battlefield; rather the doctors saw patients a couple of days after they’d been stabilized at the battalion aid station.

“We were taking care of a lot of Russian and Ukrainian soldiers, who, just a few years earlier, we were at war with before the Iron Curtain came down,” says Hockenbury.

“These soldiers and their commanders were extremely grateful for the care we provided, and we had several Russian generals come and personally thank us.”

Getting His Footing in Orthopedics Hockenbury says choosing orthopedics as his specialty was heavily impacted by his days as a college gymnast.

“Like most orthopedic surgeons, I am a former athlete, and so I was interested in sports medicine,” he says. “With my engineering background at West Point, I think that was a natural fit to go into orthopedics.”

His decision to specialize in foot and ankle surgery traces back to his residency when he published a paper on Achilles tendon ruptures. As the paper gained traction, he was asked to present at different medical conferences where he got to know well-established foot and ankle surgeons, and he was hooked.

“At that time, 30 years ago, foot and ankle surgery were still in their infancy,” Hockenbury says. “It seemed like an opportunity to get in on the ground floor with a part of orthopedics that had been ignored for a long time.”

The focus of Hockenbury’s more recent work has been foot and reconstructive ankle surgery in adults. He routinely treats patients with plantar fasciitis, Achilles’ tendonitis and posterior tibial tendon tears that lead to flat PHOTOS PROVIDED BY TODD HOCKENBURY, MD

Ankle replacement relieves pain by removing the arthritic joint surfaces.

Ankle motion is maintained, leading to better walking ability and protection of adjacent joints against arthritic change over time.

In the top set of X-ray photos, the radiograph on the left shows the complete loss of tibiotalar joint space, which is indicative of ankle arthritis. In the ankle replacement procedure, the joint surfaces are removed with a saw and replaced by the tibial component above and the talar component below. A high-density polyethylene spacer articulates between the 2 metal components to allow ankle motion.

In the bottom set of radiographic photos, the preoperative radiograph on the left shows both loss of joint space and post-traumatic recurvatum deformity. Because of previous fracture malunions of the tibia and fibula, the foot is displaced anteriorly about 2 cm. This necessitated ankle replacement as well as medial malleolar and lateral malleolar osteotomies to shift the foot back into anatomic position under the tibia. Also shown are anteroposterior prep and postop views of the ankle showing the screws fixating the osteotomies.

ISSUE #135 17

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Orthopedics/Sports Medicine

Implant is the device Hockenbury has used the most.

“It has a big stem that goes up into the tibia with a lot more stability,” he says. “The software even makes patient-specific instruments that I use during the operation to reproduce exactly where the implant should be. That gives us a better chance of getting the implant right in the sweet spot where we want it so it can last for a long time.”

A Never-ending Educational Process

Christmas in Croatia, 1992. Major Todd Hockenbury, MD, with Major Jeff Hrutkay, MD, orthopedic surgeon and West Point graduate.

foot deformities, as well as less common ailments such as ankle arthritis or severe, post-traumatic deformities and congenital foot conditions.

“I jumped on that when it was just making a comeback in orthopedics in the mid-1990s,” he says. “I’ve probably done over 700 ankle replacements, and now the implants we are putting in are much better than the ones from 22 years ago.”

As with many medical specialties, technology has played an ever-increasing role in ankle surgery. The Wright Medical INBONE

In his role as a professor, Hockenbury teaches both orthopedic residents and podiatry residents. While there is significant overlap between the two specialties, there is differentiation.

The professor starts with a history lesson: “Podiatrists exist because of the failure of orthopedic surgeons to take care of foot and ankle problems,” Hockenbury says. “Our refusal to take care of the people with foot and ankle issues has led to the development of podiatry programs.”

A big difference is the length of training, as a podiatry resident does three years after podiatry school and an orthopedic surgeon does five years of residency after medical school.

There are currently seven times as many podiatrists as there are foot and ankle orthopedic surgeons in the United States, and that gap means more patients choose to see podiatrists rather than waiting to get an appointment with an orthopedist. Hockenbury says the differences between the two disciplines can be very important.

“I think the training that podiatrists get now is superior to what they got in years past,” he says, “and most of the time, the podiatrist does a fine job. But sometimes the outcomes are less than perfect, and that’s when I see the patient and have to redo what’s already been done. That’s hard for the patient and complicated for the surgeon.”

And, when it comes to foot and ankle surgery, the specialty still has a bit of Rodney Dangerfield’s “I don’t get no respect” syndrome.

“There are so many knee replacements being done that everybody knows someone—a parent, a brother, a neighbor, an aunt—whose had one done,” he says. “Because they are 25 times more common than ankle replacements and ankle fusions combined, there just aren’t that many people you’ll know who have had an ankle replaced.”

He says he regularly runs across patients who have never heard of ankle replacement surgery and even some doctors who don’t know about it. While that can be tough for business, Hockenbury says the proof is in the healing.

“The way I get my patients is typically that one of my previous patients will see somebody limping and say, ‘If you have ankle pain, you should go see Dr. Hockenbury.’ That’s the absolute truth!” he says. “As more doctors become aware of what I do, I get referrals from other orthopedic surgeons and I get a lot of referrals from podiatrists. But most of my patients I get by word of mouth.”

Good footing and ankles are the foundation for proper orthopedic alignment and weightbearing for knees, hips, and lower back.

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Jerry Magone, MD, (left) with son Kevin who followed in his father’s footsteps in the family trade of orthopedics.

A Shoulder to Lean On

Orthopedic surgeon Kevin Magone, MD, is ready to treat surgical and non-surgical patients alike

BY JIM KELSEY LONDON The prospect of surgery is at the

least unsettling if not downright terrifying for many people. The questions whirl. How long will it take to recover? How much pain will I be in? How much risk is there? The combination of stress, anxiety, and pain can hinder focus and make the decision-making process that much more difficult.

Kevin Magone, MD, orthopedic surgeon at CHI Saint Joseph Medical Group in London, Kentucky, knows about handling stressful situations. In July 2020 he completed a fellowship in shoulder and elbow surgery at the NYU Langone Orthopedic Hospital in New York. He was ready to start his own practice. He and his wife, Ashley, were also ready to welcome their 20 MD-UPDATE

third child into the world. Both Magone and his wife are originally from the Cincinnati area and wanted to move closer to home and family, making the opportunity in London ideal.

Still, the stress and anxiety levels were high with the pending birth and the complexities of moving made all the more taxing by the COVID-19 pandemic. A hasty choice might have led to a poor result, but Magone credits CHI Saint Joseph Medical Group with making the decision an easy one.

“They were looking for someone to take over specifically work on the shoulder, which I had high interest in, and they needed somebody to do scope-related procedures, which I still have interest in doing,” Magone says.

“It was closer to Cincinnati and we wanted to be close to home. The two senior doctors

Kevin Magone, MD, joined CHI Saint Joseph Medical Group in London in the summer of 2020.

Jerry Magone, MD, (ret) orthopedic surgeon.

PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH AND KEVIN MAGONE, MD

Orthopedics/Sports Medicine

— Dr. Patrice Beliveau and Dr. Jean-Maurice Page — were just nice people, and you could tell they were going to treat you right when you come in as a junior person trying to get your practice going. They were so inviting.

We went to our recruitment dinner and when we left, the first thing my wife said was, ‘You have to come here because of them. You will be happy working with them.’ They’ve been great mentors entering practice.”

Magone says Beliveau and Page have guided him through the transition over the past year, and he and his family have eased comfortably into their new community. The past 12 months have reminded him of the importance of trusted guidance during times of stress, and he models this as he counsels his patients through their difficult healthcare decisions.

“The patient is in charge,” Magone says.

“I’m there to provide them information, to provide them with options and guidance.

They will get a strong push from me if I feel they will get a strong benefit from one course of treatment, which is not necessarily surgery.

But I will never make the decision for them.”

The Family Trade No one made Magone’s decision for him to become an orthopedic surgeon, but it was a natural for him to follow in the footsteps of his father, Jerry, who is a retired orthopedic surgeon who practiced at Middletown Regional Hospital, just north of Cincinnati.

Magone was further drawn to the profession because he likes to work with his hands and he had some experience in orthopedics as a

“We went to our recruitment dinner, and when we left the dinner, the first thing my wife said was, ‘You have to come here because of them. You will be happy working with them.’”

— Dr. Kevin Magone speaking about Dr. Beliveau and Dr. Page at CHI Saint Joseph Medical Group in London. high school athlete. He played football and basketball, and also participated in golf and swimming. He suffered an ACL injury and broke his hand in football, requiring surgery, and in basketball he re-tore his ACL. Magone survived his high school injuries and went on to attend Ohio State University for undergrad and then the Wright State University Boonshoft School of Medicine.

He did his residency at Michigan State University McLaren-Flint Regional Medical Center before the fellowship in New York.

Throughout that journey, his focus on orthopedic surgery remained steadfast.

“Orthopedic patients are generally healthy patients that have a discrete injury and you get them over their injury,” he says. “There is an intrinsic reward in trying to get them back to whatever they want to get back to.”

ries, meniscus tears, and elbow conditions such as arthritis and tendon injuries. Still, his particular interest remains the shoulder.

“The shoulder is the most complex joint in the body,” he says. “It’s a challenge in and out of the operating room. It is challenging to do these surgeries, but it’s also challenging to listen to a patient and figure out what their complaints are and correlate it to pain generators that are inside the shoulder.”

Among the procedures Magone performs are shoulder replacements. He uses navigation software to guide his work and increase the overall accuracy.

“What the computer allows me to do is not take out as much bone to replace the joint,” he says. “I can put the shoulder replacement in more accurately.”

He also enjoys working on elbow conditions, which are more often inflammation or tendinitis. “With the elbow, you have to think a little more outside the box,” he says. “A lot of problems with the elbow don’t necessarily lead to surgery.”

That, he says, is one of the misconceptions about the care he offers patients. Not all patients he sees are there to have surgery.

“With orthopedic care, you may or may not need surgery. You may or may not need physical therapy,” he says. “Go talk to the surgeon and see what your options are. At a minimum you’re gathering information to make a decision for your own healthcare. Just because you see me does not mean you need surgery.”

But it does mean you have a shoulder to lean on.

The Full Gamut of Orthopedics in London While Magone focuses primarily on shoulder and elbow surgery along with sports medicine of the knee, he and his colleague also cover calls at both the London and Corbin hospitals, which may result in Sports medicine came naturally to Kevin Magone, MD, seen here as hip or ankle surgeries as well. quarterback, #8, for the Middletown High Middies.

Magone also treats ACL inju-

KEVIN MAGONE, MD CHI Saint Joseph Health Medical Group - Orthopedics & Sports Medicine 160 London Mountain View Drive London, KY 40741

606.864.0770 ISSUE #135 21

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Pain & Regenerative Medicine

“It’s Just Scar Tissue, No Big Deal” Wrong!

Regenerative medicine specialist employs innovative approach to reducing tendinitis joint pain caused by scar tissue

Complex but Simple

BY TIM CORKRAN LEXINGTON The achy jointed

Percutaneous tenotweekend warriors and active omy is not widely perseniors of our modern culformed in Kentucky, and ture often need more than Mazloomdoost has worked physical therapists and ibuhard to master the techprofen to keep them moving niques and cultivate the comfortably. Fortunately, support systems to bring it Danesh Mazloomdoost, here. Using ultrasound to MD, has their backs—or diagnose inter-fiber scar tisrather, their hips, elbows, sue in tendons has involved shoulders and knees. His a steep learning curve, he use of percutaneous tenotsays. To discern the density omy to address micro-scar changes and tears that inditissue in tendons—a source cate what he should address of persistent pain for many requires recognition of the active or aging people—is patterns this insightful tool just another of the regencan provide. After this inierative treatments offered tial determination, he then at Wellward Regenerative performs the injections at Prior to a tenotomy, Dr. Danesh scans the joint with a diagnostic ultrasound Medicine, his medical pracone of two surgery centers, to map the tendon debridement. tice in Lexington. This outwhere has the option of patient procedure, accompanied by focused tenotomy is a method for ridding the tendon using a Tenex device, which uses ultra-sonic physical therapy, is giving his patients years of enough of that scar tissue to cause relief. waves, or the Tenjet device, which employees of comfortable movement. And like so many Percutaneous tenotomy relies on ultrasound high-pressure fluids. of Wellward’s services, it is an integrated, guidance to isolate a treatable area of a tendon Mazloomdoost leverages the minimally highly effective and minimally invasive proce- to which a needle is then applied. Ultrasonic invasive strengths of these evolving technoldure new to the Central Kentucky healthcare waves or high-pressure fluid vibrations are ogies and helps the patient do the rest. “The ecosystem. applied to a small area of tendon fibers, dis- tenotomy does not remove all the scar tissue; When we say we are experiencing joint rupting the scar tissue there. This single-treat- it is not going to fix it in and of itself,” he says, pain, it often means motion-limiting connec- ment, outpatient procedure has the effect of “but the rest will resolve with exercise.” The tive tissue swelling due to inter-fiber scaring. relieving constriction the length of the tendon. procedure is not a magic bullet, but he says, Non-arthritic joint pain is not typically a A four-to-six week physical therapy regimen is “It does give the patient a major boost forward problem where the bones meet, but a prob- also prescribed to make the most of the proce- with what the rehab needs to do.” lem with the ligaments and tendons that hold dure. Percutaneous tenotomy has been around Mazloomdoost also leverages his connecthose bones in place. Mazloomdoost says, for a number of years, with a high success rate tions within the physical therapy community.

“For many patients, physical therapy and for patients who are not responding to conser- “We build relationships with physical therapy anti-inflammatories do not provide sufficient vative therapies. Outcomes appear as positive, providers so that we can optimize the comrelief, especially when there is micro-scar if not better, as that of surgical treatment, with bined approach.” In this way, percutaneous tissue that runs the length of an overused or more rapid recovery, less post-procedure pain tenotomy is a typical Wellward procedure: the long-ago traumatized tendon.” Percutaneous and lower overall costs. understanding of a complex process, the utili22 MD-UPDATE

PHOTO BY GIL DUNN

SPECIAL SECTION

zation of a subtle procedure, and the support of the patient in rehabilitation come together to yield an elegant outcome.

An Accessible Procedure with Broad Appeal Most of his patients are referred to him from physical therapists. “When they are not seeing a patient progress the way they should, we can get involved.” Very often, however, Mazloomdoost says that patients are coming with a misdiagnosis; what might be seen as bursitis, unrelated to connective tissue, is in fact tendon pain at the point that it passes around a bursa. “What you often see under ultrasound is instead a tendopathy. Left unchecked, it can result in bursitis, but not if we perform percutaneous tenotomy on that tendon.”

The hip, with the shoulder a close second, is the joint he most often performs tenotomy on. Sufferers of musculoskeletal conditions

such as tennis elbow, golfer’s elbow, jumper’s knee, plantar fasciitis, and pitcher’s and swimmer’s shoulder, are many of his patients.

All are experiencing chronic pain, which may have started with a traumatic injury that the body has compensated for, or that is the result of gradual wear and tear. He says, “The weekend warriors really respond well to this, because often it is just a small tether that once you release it the pain is gone and they are back to playing.”

He also has helped a lot of seniors who want to stay active—or just comfortable. He recently did a percutaneous tenotomy on a longtime patient, a 70-year-old woman who had been having lateral hip pain for years and was not responding to physical therapy. She had expressed hesitation about an even minimally invasive procedure, but her increased pain and the arrival of the Tenjet tool at the surgery center converged, and she elected the

Pain & Regenerative Medicine

procedure on her right hip. Halfway through her rehabilitation—one hour every other day for four weeks—she was able to sleep on her side for the first time in years, and she was requesting to have the procedure on her painful opposite hip.

Mazloomdoost sees percutaneous tenotomy as yet another way that Wellward is changing perception and practice of pain management in our region, and eventually beyond. He reflects, “I view our practice as a living laboratory for developing an entirely different approach and thought process towards pain.”

Wellward generates a registry of results in multiple areas that patients, physicians, and insurance providers can consider, and it may affect their choices—eventually. Aspirational, yes, but for now he is realistic about his potential reach. He concludes, “We want to develop the models and then be the open source for teaching others how to do it.”

ISSUE #135 23

Empathy 101 for A-holes: A Love Story

BY JAN ANDERSON, PSYD, LPCC

“The reason I’m here is my wife is unhappy with me. I’m worried about her because I think she’s really depressed. It’s not like her to lie around all the time. She’s still taking good care of the kids, but just about everything else has tanked.”

It wasn’t an unusual way for a counseling session to begin.

Me: What’s she unhappy about with you?

Client: She thinks I’m a total narcissist.

She says I have absolutely no empathy, that I’m unfeeling. She says, “It’s always a checklist. We never have a real conversation about anything.” She’s not even willing to come to counseling with me.

My first mistake was wondering to myself, “How bad can this guy be? He seems pretty emotionally intelligent to me. The wife isn’t here, so I can’t get a read on her.”

After a few sessions, he clued me in. “I don’t think you understand what an a-hole I am.”

So he gave me a few examples that took my breath and I got the picture. But he seemed so comfortable with his a-holeness.

Me: If she wasn’t so unhappy with you, would you even be here?

Client: Honestly, no. The problem is I’m not unhappy with myself. But I can’t really be happy if she’s so miserable.

No, You’re Not a Narcissist As we continued to work together, it became clear to me that Client wasn’t a narcissist. He described too many occasions of empathic responses, so he wasn’t missing the empathy microchip. The problem was he was only comfortable letting his Inner Empath out in an emergency or crisis situation, like an accident or a death in the family.

Me: I have good news for you. I don’t think you’re a narcissist. In fact, I think it would be better if we stopped pathologizing you with that label. Instead, let’s start exploring what it would take to make it pay to allow your Inner 24 MD-UPDATE

Wrong. Research shows that pretending nothing’s wrong raises heart rates for both of you. Having your feelings recognized and validated actually helps both you and your partner’s nervous system calm down, so you can both think more clearly.

The problem isn’t going into fix-it mode.

Most of us don’t want someone to “just listen.” We also want help. The problem is getting the cart before the horse. Feelings, first.

Solutions, second.

The Three Types of Empathy

Empathic Side out, just enough to connect better with your wife. We’re only talking about a very small shift, maybe 10%. I think that will be enough to reap big benefits, without freaking you out — or your wife.

By the way, you still get to keep your inner a-hole around. Because you never know when you might really need it. We’re not talking about a personality transplant, okay?

He seemed relieved and we knuckled down to work

Feelings First, Solutions Second.

Like many successful professionals, Client had a strong Rational Mind part of himself, so it was easy to jump to problem-solving with his wife when things got tense. Fix it — that’s the fastest way to make bad feelings go away as soon as possible, right?

Client: But my wife wants me to feel what she feels. Her modus operandi is 100% empathy for everyone, all the time. I’ll never feel empathy to the degree that my wife does.

Me: I’ve got good news for you. You don’t have to always feel what she feels in order to have a good connection and a good relationship. Yes, that’s what she says she wants, but there are two other alternatives that may be totally satisfying to her, without requiring you to feel what she feels. There are actually three types of empathy.

Client: How will that help? I don’t have any empathy of any kind. I’m an a-hole, remember?

Me: Hear me out. The Harvard Business Review series on emotional intelligence has identified three types of empathy. All of them are powerful and effective, but only one of them involves feeling what the other person is feeling. Here’s how it breaks down: 1. Emotional Empathy is the ability to feel what someone else feels.

2. Cognitive Empathy is the ability to understand another person’s perspective.

3. Empathic Concern is the ability to understand what the other person is feeling and what they need from you.

My advice? Don’t worry too much about trying to feel what she feels. Instead, just

Mental Wellness

let your natural curiosity fuel your cognitive empathy, so you get a better understanding of what she’s feeling and why, from her perspective. I have a feeling your empathic concern will kick in from there.

Client looked relieved and we forged ahead.

Operation Empathy Gets Underway — And It’s Bumpy.

Client’s first attempts at cognitive empathy and empathic concern didn’t go smoothly.

Me: How’d it go?

Client: Not so good, Doc. I got curious and started asking her questions. You know what she said? “It’s like you’re following a checklist and you want me to tell you if you did it right.

It’s more about whether you did a good job than how I feel. You make it more about you than about me!”

Me: So you were a bit clunky. It’s to be expected when you’re learning. Since a checklist approach appeals to you, may I make a suggestion? Let your natural curiosity include paying attention to your wife’s posture, gestures, facial expression, tone of voice and other signs of emotion, even when you don’t particularly want to. And look her in the eye when you’re talking. You’ll almost automatically feel more engaged. Then your questions are less likely to sound like a checklist.

Client Gets a Lucky Break.

Shortly after this interaction, Client got a lucky break, one of life’s ways of dropping something helpful into our laps. It involved a ”difficult” relative in the family. Usually Client’s wife experienced the brunt of it, but this time, like a ray of sunshine, Client’s wife saw her “unfeeling” husband lose it for a brief moment of utter exasperation. He felt exactly what Client’s wife had felt in similar interactions with Difficult Relative — and expressed it enough to validate her feelings in a spontaneous, genuine way. Voila! A brief moment of connection for the two of them.

The Turning Point I used this lucky break as an opportunity to suggest something counter-intuitive to Client.

Me: I’m going to take a big risk with you today. I’m going to suggest that rather than

always trying to read and respond to your wife’s emotions, that you also more closely tap into what you’re feeling when things get fraught — and maybe even share it with her.

Client: Isn’t that just being self-absorbed?

Making it all about me?

Me: Not necessarily. Let’s practice for a moment, so you can see what I mean.

Let’s say your wife has gone on at length about something bothering her that doesn’t involve the two of you. You’ve told me these problems are usually beyond your ability to help, but you feel responsible for helping her fix the problem. If you could say what you’re really feeling — just between you and me — at times like these, what would it be?

Client: I’d say something like “I’m getting worn out listening to this,” or, “Why are you asking me? I have no clue, or if I did, you wouldn’t listen to me.”

Me: Good. It’s a two-step process. First, tap into what you’re really feeling. Then — you’ll need some help with this part— translate it into something emotionally intelligent to say, like, “I want to help, but I don’t know what to say. I wish I did.” That’s honest — and empathic.

Me: Let’s try another one. Let’s raise the stakes and say it’s something bothering her that involves the two of you. If you could say what you’re really feeling in these situations, what would it be?

Client: I usually try to reason with her and say something like, “That’s not going to work, for the following reasons.” Then I’d tick them off. Then she’ll get ticked off.

Me: Okay, you can still be honest and translate it into something more emotionally intelligent to say, “I’m looking at this from a different angle,” or, “There’s another aspect to consider here and that’s XYZ.”

The Rubber Meets the Road Soon after, life presented an opportunity in the form of a family vacation. Day 1’s excursion at the amusement park went badly.

On the drive back to the hotel, Client sensed his wife’s bad mood, felt anxious and couldn’t help but go straight to problem-solving.

Client: Well, we could skip tomorrow at the park and do something else. (Continues

thinking aloud, listing several options and alternatives.)

Client’s Wife: Will you just stop it? The last thing I want to do is create more work and more stress for ourselves! I just want to get back to the hotel and forget about it!

Client (pausing and recovering nicely): You’re right. I went to my comfort zone and started contingency planning and problem solving, and you don’t like that. If I say the frivolous things I think you want me to say, you think I’m being fake. I’m at a loss. I don’t know what to do.

Client’s wife’s reaction? She seemed a bit taken aback and then got quiet. The mood was subdued, but not combustible. Later that evening they gingerly revisited the topic and decided to return to the park on Day 2, but do some things differently to make it more enjoyable.

Client seemed cautiously optimistic about the incident. I was, too.

Me: It’s important to note that this is your first win, not because you did it perfectly or it ended in some incredibly intimate moment.

It’s a win because it had the potential to go very badly and you defused it. You recovered and you kept it from getting worse. That’s big.

The Big Breakthrough Marriage researcher Dr. John Gottman describes a seemingly unlikely way for couples to overcome relationship gridlock. “No matter how seemingly insignificant the issue, gridlock is a sign that you each have dreams for your life that the other isn’t aware of, hasn’t acknowledged, or doesn’t respect. By dreams I mean the hopes, aspirations, and wishes that are part of your identity and give purpose and meaning to your life.”

That’s exactly what happened when Client eventually tapped into his wife’s dream to start a creative project, one that she couldn’t pull off without his help. Not only did he end up supporting her own efforts, he enthusiastically made his own unique contributions. It was lovely to see how the project unfolded and brought them together.

The best part? It was a win-win. Client didn’t have to feel what his wife was feeling in order to understand her feelings and give her what she most needed.

ISSUE #135 25

Events

Spencer Templin, Keystone Financial Group, and member of Corporate Council, with Tony Lewgood, administrator, Shriners Medical Center, and Karen Harbin, CEO, Commonwealth Credit Union, and event chair of Gala committee.

Kevin Bazner, CEO, A&W Restaurants, and chair of Shriners Hospital for Children Medical Center Corporate Council, wife Dawn Bazner, and Gil Dunn, publisher, MD-Update.

Jeff Koonce, market president, WesBanco, and Tony Lewgood, administrator, Shriners Medical Center.

Rebekah Leet, MD, non-surgical orthopedist at Shriners Medical Center, and husband Tyler Leet.

Vince Prusick, MD, and wife Kate. Dr. Prusick is a pediatric orthopedic surgeon at Shriners Medical Center.

Karen and Todd Ziegler, market president Republic Bank, and Emily Miller, vice president and private banking officer with Republic Bank.

26 MD-UPDATE

PHOTOS BY JOE OMIELAN

Susan and Vish Talwalkar, MD, pediatric orthopedic surgeon at Shriners Medical Center.

Henry Iwinski, MD, chief of staff, Shriners Medical Center, Janet Walker, MD, and Scott Riley, MD. All are pediatric orthopedic surgeons at Shriners Medical Center.

Events

Shriners Hospitals for Children Medical Center Gala Sets Record

Outpouring of donations follows a year of social distancing and canceled events

BY WHITNEY LEGGETT, MARKETING AND COMMUNICATIONS COORDINATOR, SHRINERS MEDICAL CENTER LEXINGTON Caring for children comes first for the Shriners Hospitals Claire and Ryan Muchow, MD, with Alycia and Ben Wilson, MD. Drs. Muchow and Wilson are pediatric orthopedic surgeons at Shriners Hospital for Children Medical Center.

Jennifer Schaeffer, PhD, pain psychologist at the VA Medical Center, and Cameron Schaeffer, MD, pediatric urologist and plastic surgeon.

Gil Dunn, publisher, MD-Update, and Angela Stamper.

Frazann Milbern, recreational therapist at Shriners Medical Center, with Jackie Dawson, philanthropy assistant at Shriners Medical Center.

for Children Medical Center — Lexington Corporate Council. Never was that more evident than Saturday, August 21, when the Council helped the medical center raise more than $200,000 toward its mission of providing world-class orthopedic care to children regardless of the families’ ability to pay.

The goal of the Corporate Council is to foster health care excellence for children through philanthropic support of the Lexington medical center.

The 2021 Care for Children Gala included an elegant dinner, cocktails, silent and live auctions and music and dancing with The Sensations. Bill Meck, chief meteorologist for WLEX 18, was the master of ceremonies for the event.

Olivia, a 13-year-old patient at SHCMC in Lexington, spoke about her experience at the medical center. Olivia, who has osteogenesis imperfecta, a genetic disorder that affects the bones, causing them to be brittle, break easily, and heal slowly, has broken 28 bones in her lifetime.

Despite the broken bones, casts, and surgeries, Olivia remains optimistic.

“Shriners has given me hope, happiness, and confidence,” Olivia said.

“Shriners feels like family to me.”

The Corporate Council’s generosity makes helping patients like Olivia and others at SHCMC possible.

“At Shriners Hospitals for Children Medical Center, our mission is to care for every child who needs it,” said Dale Wallenius, director of philanthropy for the medical center. “No child is ever turned away because of a family’s lack of money, having no health insurance, or having inadequate health insurance. That is made possible by the generosity of donors, like our incredible Corporate Council, who helped us raise hundreds of thousands of dollars to further our mission.”

This year’s gala raised approximately $220,000, a record high for the event and more than twice the event’s fundraising goal.

Tony Lewgood, administrator at Shriners Hospitals for Children Medical Center — Lexington, said the Corporate Council’s fundraising efforts will help the medical center reach more children than ever before.

“Each year, we are honored to care for more than 16,000 patients at our medical center,” Lewgood said. “It is our mission to provide the most amazing care anywhere to even more children from more places.

Corporate and individual support is vital to help accomplish this mission.

We are thrilled and humbled by the support shown at this year’s gala. We deeply appreciate the Corporate Council, and our patients do too.”

ISSUE #135 27

News Baptist Health Teams Up with Intuitive Health, Breaks Ground on Southern Indiana’s First Freestanding ER and Urgent Care

Louisville Student to Study Bahasa Indonesia on U.S. Department of State NSLI-Y Scholarship LOUISVILLE Sandhya Lohano, a high school

IMAGE PROVIDED BY BAPTIST HEALTH

JEFFERSONVILLE, IN It’s a $10.6 million part-

nership that is the first of its kind in Southern Indiana. Baptist Health has joined forces with Dallas-based Intuitive Health to bring the first hybrid emergency room and urgent care clinic to Southern Indiana. A formal groundbreaking was held July 21 and the facility is expected to open in spring 2022.

Baptist Health ER & Urgent Care will be located in the Jefferson Ridge development in Jeffersonville.

The full-service emergency room will be open 24 hours a day, while the urgent care will be open 7 am-9 pm, seven days a week.

Emergency room-licensed doctors will examine each patient upon arrival to determine the appropriate care and if it is emergent or urgent care. The patient will be billed accordingly. This new concept helps eliminate unnecessary emergency room visits.

“We are excited to partner with a leader in care innovation to bring this new facility to fruition,” said Michael Schroyer, president of Baptist Health Floyd. “There’s been tremendous growth in the River Ridge area and we want to establish this emergency and urgent care model to complement the primary care, occupational medicine and physical therapy location that we have located a few miles away. We want to bring the same level of quality patient care that our community has come 28 MD-UPDATE

to know from Baptist Health Floyd.”

Some of the features of Baptist Health ER & Urgent Care include: • On-site lab, a radiology suite and multislice CT scanners • Commitment to billing transparency.

• The facility will be in-network with most major insurance plans and accepts Medicare and Medicaid.

“This facility will be the first of its kind in Southern Indiana,” said Baptist Health CEO Gerard Colman. “That kind of innovation is something we’re proud of at Baptist Health, and something that Hoosier residents are fortunate to find close to home thanks to the level of care provided by our Baptist Health Floyd hospital.”

“The hybrid emergency room and urgent care clinic is just one example of the kind of ‘next-generation’ healthcare Baptist Health wants to bring to its communities,” said Baptist Health chief strategy and marketing officer Jody Prather, MD. “We never lose sight of what’s most important to our patients – in this instance, convenience and a great patient experience – combined with the quality of care our patients have come to expect.”

The model provides pediatric and adult patients access to care 365 days a year. Each location treats everything a hospital emergency room treats, from allergies to appendicitis.

student at Kentucky Country Day in Louisville and daughter of Vasdev Lohano, MD, a Baptist Health endocrinologist in New Albany IN, was awarded a National Security Language Initiative for Youth (NSLI-Y) Virtual Summer Intensive scholarship to study Bahasa Indonesia language for six weeks this past summer.

NSLI-Y is a program of the U.S. Department of State’s Bureau of Educational and Cultural Affairs (ECA) that promotes critical language learning among American youth. The 2021 Virtual Summer Intensive program is as an online alternative for NSLI-Y immersion programs that could not take place overseas due to the ongoing COVID-19 pandemic.

Sandhya was competitively selected from approximately 2,500 applicants from across the United States and is one of over 500 students who will study Arabic, Chinese, Hindi, Indonesian, Korean, Persian, Russian, or Turkish as part of the virtual exchange. The NSLI-Y Virtual Summer Intensive program provides robust language and cultural learning opportunities by virtually connecting the participants with overseas teachers, international peers, cultural organizations, and communities where the target language is spoken.

NSLI-Y is part of a multi-agency U.S. government initiative launched in 2006 to improve Americans’ ability to communicate in select critical languages, advance international dialogue, and provide Americans with jobs skills for the global economy.

Sandhya Lohano and Vasdev Lohano, MD PHOTO PROVIDED BY BAPTIST HEALTH

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Primary Stroke Centers Awarded Recertification from The Joint Commission

Values Count Even in Investment Strategy

LOUISVILLE UofL Health – Jewish Hospital

and UofL Health – Mary & Elizabeth Hospital have earned The Joint Commission’s Gold Seal Approval® and the American Stroke Association’s Heart-Check mark.

Jewish Hospital and Mary & Elizabeth Hospital both underwent a rigorous, unannounced onsite review. During the visit, The Joint Commission reviewers evaluated compliance with related certification standards including program management and delivering and facilitating clinical care. Joint Commission standards are developed in consultation with health care experts and providers, measurement experts and patients. The reviewers also conducted onsite observations and interviews.

“We are very pleased to have earned this approval for two of our hospitals. This clearly documents our dedication to stroke care throughout UofL Health,” said Kerri Remmel, MD, PhD, Director, UofL Health – Stroke.

“Our staff has been working together for months in preparation of this visit and with COVID-19 many of these preparations and meetings had to be carried out virtually and

One of the things we believe our clients appreciate most about D. Scott Neal, Inc. is our commitment to values we share with them: We respect our clients’ individual values and we treat them as team members, informing them on strategy and the purpose of investment that fits their unique financial goals.

After all, wealth without purpose is just numbers.

At D. Scott Neal, we “walk the walk” when it comes to values – just one of the ways we try to distinguish ourselves from other financial planners.

Call for our complimentary assessment tool or simply scan this code.

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with new approaches,” said Jason Stiles, executive director of UofL Health – Stroke. “It is a testament of our staff ’s desire to deliver expert stroke care to our patients no matter what that we have been awarded this certification

DSNEAL.COM

at both hospitals.”

In addition to Jewish Hospital and Mary & Elizabeth Hospital, UofL Health also has a Comprehensive Stroke Center at UofL Hospital.

UofL Health – Jewish Hospital Celebrates 1000th TAVR Procedure LOUISVILLE On July 22, 2021, UofL

Health – Jewish Hospital celebrated its 1000th transcatheter aortic valve replacement (TAVR) procedure. Brian Ganzel, MD, UofL Physicians – Cardiovascular and Thoracic Surgery performed the milestone minimally invasive heart procedure on Patricia Hendricks of Springfield, Kentucky.

“This is truly a team effort because there are so many people involved,” said Ganzel.

“Cardiologists, surgeons, anesthesiologists, nurses, technicians all come together to pull this off and provide good care for the patients. This also takes dedication from

the hospital administration because this is not a cheap endeavor.”

“I feel very lucky that I had Dr. Ganzel as my doctor, and I love his staff. I have another whole life to look forward to. I really feel that way now,” said Hendricks.

“If you have heart problems this is where you need to be.”

UofL Health – Jewish Hospital was the first in Kentucky to perform a transcatheter aortic-valve replacement, in 2011. UofL Health – Jewish Hospital is a national leader in advanced heart care,” said John Walsh, chief administrative officer of UofL Health – Jewish Hospital. “As an academic health

care system, we are committed to advancing minimally invasive heart procedures so patients can quickly return to their loved ones and resume their normal activities.”

Doctors at the Rudd Heart and Lung Center at UofL Health – Jewish Hospital perform cutting-edge treatments, and also train physicians from around the world on advanced techniques.

“Our team’s expertise is helping save lives well beyond Kentucky and Southern Indiana,” said Debra Riley, UofL Health vice president of cardiovascular services.

“It’s an honor to work alongside people who truly make a difference.”

ISSUE #135 29

News

Stephen J. Behnke, MD, Named Chief Executive Officer of Lexington Clinic LEXINGTON The

Lexington Clinic board of directors has appointed Stephen J. Behnke, MD, MBA, as the organization’s new chief executive officer (CEO).

Behnke has assumed leadership responsibilities for the oldest and largest group practice, which includes 30+ specialties and has more than 25 locations throughout Central Kentucky.

“It is an honor to be chosen to lead such a prestigious organization like Lexington Clinic,” says Behnke. “I look forward to building on its rich history and foundation and working with our clinicians and employees across the organization as we continue to deliver the highest quality integrated health care to our patients.”

Prior to joining Lexington Clinic, Behnke has served as chief executive officer, president, medical director and as an attending physician at MedOne Hospital Physicians from 2005 onwards, where his broad understanding and knowledge of overall operations enabled him to play a pivotal role in the Ohiobased organization’s growth over the years.

As a seasoned healthcare executive with 14+ years of administrative experience, Behnke brings not only impressive experience, but also a new and energizing vision to Lexington Clinic. “Armed with my years of experience at MedOne, I hope to bring the same spirit of innovation, humility and excellence to the team, patients and community in Lexington,” says Behnke.

Behnke obtained his MD/MBA dual degree from University of Louisville and is board certified in internal medicine. He has also served as a clinical assistant professor of hospital 30 MD-UPDATE

medicine at the Ohio State University prior to joining MedOne Hospital Physicians.

Lexington Clinic was founded in 1920 and is Central Kentucky’s oldest and largest group practice. Lexington Clinic has more than 180 providers and serves more than 600,000 patients every year. Lexington Clinic has providers in 30+ different specialties and has more than 25 locations throughout Central Kentucky.

PHOTO PROVIDED BY LEXINGTON CLINIC

NOW ONLINE

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Franklin De La Cruz, MD, Joins CHI Saint Joseph Medical Group in Bardstown

Benjamin Neltner, MD, Joins CHI Saint Joseph Medical Group in Lexington

BARDSTOWN Franklin De La

LEXINGTON Benjamin

Cruz, MD, has joined CHI Saint Joseph Medical Group in Bardstown as an obstetrician and gynecologist. As a practicing physician who has worked in the field for De La Cruz decades, he’s now treating the second generation of mothers in the Bardstown area.

Raised in the Dominican Republic, De La Cruz first considered a career in general surgery and completed his undergraduate education at the Universidad Autónoma de Santo Domingo and earned his medical degree at Cetec University. Now, he cares for the patients that he helped deliver more than 20 years prior.

“It’s fulfilling to bring someone into life, and then continue to care for them and their offspring whenever they decide to start families,” says De La Cruz. “It’s a full-circle moment that allows me to feel like I’m part of the families I care for.”

Following medical school, De La Cruz gained experience at Pan American Hospital, Miami General Hospital, University of Miami and Westchester General Hospital, where he held various clerkships in internal medicine, surgery, pediatrics and obstetrics and gynecology. While in his obstetrics and gynecology residency programs in Puerto Rico, De La Cruz enrolled in the National Guard and served from 1989 to 1993, until he completed his program. He later moved to Kentucky to join the Kentucky National Guard and served in a variety of military leadership roles until he received honorable discharge from the Inactive Reserve in 2002. Professionally, he’s maintained an OB-GYN practice at the Bardstown Women’s Center since 1993 and served as the Chief of Medical Staff at the Surgical Center of Elizabethtown from 2004 to 2005.

De La Cruz is currently part of the Passport Health Plan Quality Medical Management Committee, serves as a member of the Kentucky Medical Association Community and Rural Health Committee, and is an associate professor at the University of Kentucky.

Neltner, MD, has joined CHI Saint Joseph Medical Group – Primary Care in Lexington. Born and raised just outside of Covington, Kentucky, Neltner is excitNeltner ed to return to his home state and treat the underserved populations across the commonwealth.

“The main reason I went into medicine was to serve,” says Neltner. “CHI Saint Joseph Health values taking care of the community and indigent populations, and I value serving the truly underserved.”

At 15, Neltner discovered his passion for medicine while volunteering at a hospice center in Northern Kentucky. “I saw the immense good that physicians can do for their patients, especially at the end of life – it was inspiring.”

Neltner’s mission to serve is evident through his years of volunteering at various hospice centers and clinics in Kentucky and Virginia, where he provided complimentary medical care to uninsured and underinsured patients.

His services included grief counseling and nursing assistance, as well as preventive care and chronic disease management. Neltner has many leadership experiences, including serving as a primary care provider to refugees at the University of Virginia International Family Medicine Clinic. He is also a member of the American Academy of Family Physicians and the American Medical Association, and he is board-certified in family medicine.

Now at CHI Saint Joseph Medical Group, Neltner is dedicated to providing primary care to the Lexington community through a “shared decision-making and research-based” philosophy.

“The decisions I make are only a small aspect of a patient’s overall health,” says Neltner. “It really takes a relationship with each patient that is built on trust to make decisions together and to fully treat them.”

Neltner attended UofL where he earned his BA in science and his medical degree. He met his wife, Caitlyn Neltner, MD, a Winchester, PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH

Kentucky native and pediatrician, while attending the UofL School of Medicine. Upon graduation, the couple moved to Charlottesville, Virginia, where Neltner completed his family medicine residency at the University of Virginia. He and his wife are excited to be back home in Kentucky and get to work.

“The biggest challenges facing Kentuckians right now is the lack of resources,” says Neltner. “CHI Saint Joseph Health is making a difference for our community by providing these resources through serving underserved patients, and I’m proud to be a part of this vision.”

George Dimeling, MD, Joins CHI Saint Joseph Medical Group in Lexington LEXINGTON George

Dimeling, MD, has joined CHI Saint Joseph Medical Group in Lexington as a cardiac surgeon – a field he has been passionate about since high school when he Dimeling had the opportunity to observe a heart transplant. The experience, which he called “life-changing,” has continued to motivate him throughout his life.

Dimeling and his wife recently moved to Kentucky from Cleveland, Ohio, to be closer to family. “I find the mission of CHI Saint Joseph Health to be in line with my personal goals,” said Dimeling. “My wife’s family is from the area, and we wanted to reconnect in the post COVID era.”

Before medical school, Dimeling enrolled in the U.S. Navy. He later attended the University of Virginia where he earned a BA degree; he earned a MS degree from Georgetown University, and later completed his medical degree at Drexel University. He completed an internship and residency at Stanford University Hospital and is currently pursuing his MBA. Since 2017, Dimeling has worked as an adult cardiac surgeon in the Norfolk, Virginia, and Cleveland, Ohio, areas. He is board-certified from the American Board of Thoracic Surgery.

Dimeling is a member of the Lexington ISSUE #135 31

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Medical Society, Kentucky Medical Association, Society of Thoracic Surgeons, Western Society of Thoracic Surgeons, and the Fellow of American College of Cardiology. In 2020, he also began serving as a board member for the American College of Cardiology – Ohio Chapter.

Bilal Aslam, MD, Joins CHI Saint Joseph Medical Group in Lexington Gastroenterologist brings years of experience to Lexington and surrounding communities LEXINGTON Bilal Aslam, MD, has joined

CHI Saint Joseph Medical Group – Gastroenterology in Lexington. Hailing from a family of physicians, Aslam set his sights on the medical field at a young age and never

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looked back. With his family as his support, Aslam adopted a medical philosophy that’s created close ties that span well beyond his bloodline.

“I try to treat all my patients like family,” says Aslam. “It’s caring for my patients, but also educating them to the point that they understand the risks and benefits of what you’re doing … this can be challenging, so ensuring I’ve established a familial type of relationship gives my patients a sense of ease and positivity during treatment.”

At age 12 Aslam’s family moved from New York City to Morehead, Kentucky. “Basically, I’ve been in Kentucky for the last 22 years,” says Aslam. He attended the UK for his undergraduate education and medical school, as well as his residency fellowship.

Aslam has also taught rising high school

seniors at the UK’s Area Health Education Center (AHEC), where he implemented an interactive, lab-based introductory physiology curriculum.

Aslam Aslam is fluent in both the Urdu and Punjabi languages, with career interests in advanced/therapeutic endoscopy, gastrointestinal bleeding, and systems-based practice.

“I’m very much looking forward to being part of the CHI Saint Joseph Health,” says Aslam. My kids were all born in Kentucky.

My sister is a resident at the UK, so my ties to this place are very strong.”

Aslam’s wife, Leslie, is a triple board-certified psychiatrist.

CHI Saint Joseph Health – Cancer Care Centers and Flaget Memorial Earn National Accreditation from the Commission on Cancer of the American College of Surgeons LEXINGTON The Commission on Cancer

(CoC), a quality program of the American College of Surgeons (ACS), has granted Three-Year Accreditation to the CHI Saint Joseph Health – Cancer Care Centers in Lexington and Flaget Memorial in Bardstown. To earn voluntary CoC accreditation, a cancer program must meet 34 CoC quality care standards, be evaluated every three years through a survey process, and maintain levels of excellence in the delivery of comprehensive patient-centered care.

As CoC-accredited cancer centers, CHI Saint Joseph Health - Cancer Care Centers and Flaget Memorial take a multidisciplinary approach to treating cancer as a complex group of diseases that requires consultation among surgeons, medical and radiation oncologists, diagnostic radiologists, pathologists, and other cancer specialists.

This multidisciplinary partnership results in improved patient care. The cancer care centers’ affiliation with Cleveland Clinic Cancer Care provides another layer of care for patients in Kentucky, including easier 32 MD-UPDATE

access to second opinions from highly specialized cancer providers.

“The re-accreditation of our cancer care centers is another reflection of our incredible team who work both behind the scenes and on the front lines,” said Tony Houston, CEO, CHI Saint Joseph Health. “Our employees are passionate about the work they do, and are committed to our vision of a healthier future for all. Every day, they provide excellent care to patients who turn to our cancer program for healing.”

“Our cancer center offers patients worldclass care close to home, and we are thrilled to receive this accreditation, which further PHOTO PROVIDED BY CHI SAINT JOSEPH HEALTH

demonstrates our commitment to providing the best care in Nelson County,” said Jennifer Nolan, president, Flaget Memorial Hospital. “We know the work being done through our cancer program is saving lives, and we are thankful to have such compassionate team members who are making a difference each day in patients’ lives.”

The CoC Accreditation Program provides the framework for CHI Saint Joseph Health — Cancer Care Centers to improve the quality of patient care through various cancer-related programs that focus on the full spectrum of cancer care including prevention, early diagnosis, cancer staging, optimal treatment, rehabilitation, life-long follow-up for recurrent disease, and endof-life care. When patients receive care at a CoC facility, they also have access to information on clinical trials and new treatments, genetic counseling, and patient centered services including psycho-social support, a patient navigation process, and a survivorship care plan that documents the care each patient receives and seeks to improve cancer survivors’ quality of life.

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