MD-Update Issue 137

11VOLUME • #6 • 2021rECEMDbE ALSO IN THIS ISSUE CAMILLO CASTILLO, MD, UofL HEALTH/FRAZIER REHABILITATION DANESH MAZLOOMDOOST, MD, WELLWARD MEDICAL MEHYAR MEHRIZI, MD, BAPTIST HEALTH NEUROLOGY FRED ODAGO, MD, CHI SAINT JOSEPH HEALTH NEUROLOGY THE PAIN TREATMENT CENTER OF THE BLUEGRASS Stick To the Plan David Sun, MD, PhD, Inspires Collaboration and Communication at Norton Neuroscience Institute

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS 2022 Editorial Calendar Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com To participate, please contact ISSUE #138 (February) HEART, STROKE & LUNG HEALTH Cardiology, Cardiothoracic Medicine, Cardiovascular Medicine, Pulmonology, Sleep Medicine, Vascular Medicine, Bariatric Surgery, Wound Care ISSUE #139 (April) INTERNAL SYSTEMS Endocrinology, Gastroenterology, Geriatrics, Internal Medicine, Integrative & Regenerative Medicine, Infectious Diseases, Lifestyle Medicine, Nephrology, Urology ISSUE #140 (June) WOMEN’S & CHILDREN’S HEALTH OB/GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology, Travel Medicine ISSUE # 141 (September) MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, , Plastic Surgery, Physical Medicine & Rehabilitation, PT/OT ISSUE #142 (October) CANCER CARE Oncology, Plastic Surgery, Hematology, Radiation, Radiology ISSUE 143 (December) IT’S ALL IN YOUR HEAD Neurology, Neuroscience, Ophthalmology, Pain Medicine, ENT, Psychiatry, Mental Health Editorial topics and dates are subject to change

SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax Until next year, February 2022, Gil Editor/PublisherDunn MD-Update LETTEr FrOM THE EDITOr/PUbLISHEr

Welcome to the “It’s All in Your Head” Issue of MD-Update

Just like Mac, I’m still buying green bananas and planning to continue our conversations with Kentuckiana doctors in 2022. The MD-Update editorial calendar is on the preceding page, and I invite you to look for your specialty and contact me. I’m certain that you have a passion and purposeful interest in your medical practice. I’d like to hear about it and so would our readers.

The Mac Stone Story

Almost two years ago, January of 2020, in a brief conversation a physician friend said to me, “This Chinese virus could be a really bad thing.” I didn’t buy or sell any stocks or acquire massive amounts of toilet paper after his comments, but his words were so sentient and have stayed with me.

MD-Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials.

When I spoke with David Sun, MD, PhD, cranial neurosurgeon and director at the Norton Neuroscience Institute, for this issue’s cover story, I was very taken by his passion and commit ment to serve both the patients and his colleagues at NNI. “More eyes on the prize,” is how he puts it when describing the intense and purposeful emphasis on collaboration and communi cation between multiple subspecialists and patients. I think you’ll enjoy reading Dr. Sun’s story and meeting other members of the team at NNI, beginning on page 12.

The Big Surprise in 2022

Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502

These last two years have really been a blur for me. How has it been for you?

When I learned that Mac had colorectal cancer, I was stunned and saddened. From what I read in his story on page 10, he’s doing ok. Please take a few moments to enjoy his tale of discovery and repair. I also invite you to discover the joy and benefits of being a member of Elmwood Stock Farm’s organic food Community Supported Agriculture (CSA) membership program as I did 10+ years ago.

The Cover Story

2 MD-UPDATE MD-UPDATE MD-Update.com Volume 11, Number 6 ISSUE #137 PUBLISHER Gil Dunn gdunn@md-update.com GRAPHIC DESIGN Laura Doolittle, Provations Group COPY EDITOR Amanda Debord CONTRIBUTORS: Jan Anderson, PSYD, LPCC Chip AndrewDaltonDeSimone, Esq. Scott Neal, CPA, CFP Miriam Silman, MSW Mac Stone CONTACT US: ADVERTISING AND INTEGRATED PHYSICIAN MARKETING: Gil gdunn@md-update.comDunn

Mentelle Media, LLC 38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax

Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter. Thank Individualyou.copies of MD-Update are available for $9.95.

I’d prefer no more big surprises in 2022, but we know the “No Surprises Act” is coming. I invite you to read Chip Dalton’s detailed column on page 6 for a review of your practice’s prepa rations. Our financial columnist, Scott Neal, always prescient, delves into the causes and effects of inflation and says that “2022 could be your best year yet.”

My good friend Mac Stone is the 21st century personification of “a Good Farmer,” which David Farrell describes as “a systems thinker, able to perceive and understand the linkages between the farm’s productivity and the social and ecological dimensions of the farm; clear about what the farm depends upon and what its impacts are and how these need to be managed.”

Copyright 2021 Mentelle Media, LLC. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher.

MD-Update’s 2022 Editorial Calendar

ISSUE #137 3 PAIN MEDICINE • NEUrOLOGY • rEHAbILITATION • rEGENErATIVE MEDICINE ISSUE #137 16 PAIN MEDICINE 18 NEUROLOGY 20 SPINE REHABILITINJURYATION 22 NEUROLOGY 24 PAIN MEDICINE CONTENTS SPECIAL SECTIONS 4 HEADLINES 6 ACCOUNTING 7 FINANCE 8 LEGAL 10 OP/ED 12 COVER STORY SPECIAL SECTION: 16 PAIN MEDICINE 18 NEUROLOGY 20 SPINE INJURY REHABILITATION 22 NEUROLOGY 24 PAIN MEDICINE 26 MENTAL HEALTH 28 MENTAL WELLNESS 29 EVENTS 30 NEWS 12 Stick To the Plan David Sun, MD, PhD, Inspires Collaboration and Communication at Norton Neuroscience Institute COVEr PHOTOGrAPHY bY JAMIE rHODES

There was also a language barrier to overcome. “I told my wife the move was tem porary,” states Tsai. He had no idea that he would remain for more than 45 years, engaged in a very fulfilling and satisfying career.

LOUISVILLE/NEW ALBANY In the early 1970’s, Tsu-Min Tsai, MD, was a prominent surgeon with a flourishing career in Taiwan where he served as chief of surgery at Taipei City Hospital. But a chance meeting with Harold Kleinert, MD, and Joseph Kutz, MD, in 1974 would completely change his path.

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Tsu-MinMD-UPDATE

Impressed with his microsurgery research and his work in replantation, Kleinert invited him to come to Louisville. What followed was a move to a different continent with four more years of medical residency because despite the six years he had already done in Taiwan, the American medical societies didn’t recognize degrees from non-English speaking countries.

“notable” patients that would travel from all around the world for their hand and arm care during his tenure at Kleinert Kutz.

Working side by side with Drs. Kleinert and Kutz, Tsai has had his share of historical surgeries over his long career. While the first successful hand transplants are the most talked about, Tsai smiles as he recalls reattaching Neil Armstrong’s ring finger in 1978. “The first man to walk on the moon was flown to Jewish Hospital in Louisville for his replantation with our doctors,” says Tsai. This was one of many

“I will miss my patients and practice,” says Tsai, “but I will have more time for golf and time with my family.” He will also remain an active participant in the educa tion lecture series with the Christine M. Kleinert Institute. Tsai’s retirement was effec tive November 30, 2021.

Tsu-Min Tsai, MD, retires after more that 45 years practicing hand microsurgery andreplantation.Tsu-MinTsai, MD, with Harold Kleinert, MD, in 1990 in China.

A chance meeting led to 45 years of surgery in a world-renowned medical practice

Tsai, MD, Retires from Kleinert Kutz

4

2. There are no evidence-based treat ments for the biggest population of ED

1. Access to treatment is a challenge: Wait times are long, insurance usually doesn’t cover treatment, and the longer you wait, the less likely you are to recover. Levinson’s experiments with telehealth are proving to be just as effective as in-person treatment. This is especially good news for Kentucky residents, who have had to travel out of the area for treatment.

More information on the UofL Health Depression Center is at www.louisville.edu/depression and 502.813.6600.

Cheri Levinson, PhD, associate profes sor and director of UofL’s Eating Anxiety Treatment Laboratory, shared her team’s inno vative approaches to the three biggest challeng es in treating eating disorders (ED):

patients: Fifty percent of patients who seek treatment for ED symptoms do not meet all the diagnostic criteria for any major eating disorder, yet their symptoms cause significant distress. Particularly challenging is the wide variety of types of distress experienced. Levinson’s team has developed a per sonalized treatment approach, based on an innovative model targeting the top 2 distressors for each patient.

Barbara Rothbaum, PhD Cheri Levinson, PhD Maurizio Fava, MD

3. The relapse rate for EDs is high (60%). Levinson’s next step is a relapse-preven tion study based on her clinic’s compo nents of better access to personalized treatment. A mobile app version of the program is in development now.

Maurizio Fava, MD, psychiatrist-in-chief at Massachusetts General Hospital, outlined a series of approaches for treatment resis tant depression (TRD), including guidelines for switching medications, prescribing higher doses, and using augmentation drug therapies to enhance the effect of SSRIs. Fava also eval uated the effectiveness of various stimulants, nutriceuticals, and ketamine for TRD.

Annual UofL Depression Center conference addresses treatment of eating disorders, PTSD and treatment resistant depression.

ISSUE #137 5

PHOTOS PROVIDED BY UOFL HEaLTH DEPRESSION CENTER deandortonhealthcaresolutions.com Practice management and advisory services Medical billing and credentialing Revenue cycle management Compliance and risk management Interim practice management Accounting and financial outsourcing HumanTechnologyresourcesEmpowering physicians to focus solely on the demands of their clinical practice

HEaDLINES

Treatment of Mental Disorders: Practical Skills for Clinicians

BY JaN aNDERSON, PSYD, LPCC

Barbara Rothbaum, PhD, director of the Trauma and Anxiety Recovery Program at Emory University School of Medicine, described what’s new and what works in the treatment of PSTD. Rothbaum emphasized the use of biomark ers in diagnosis and treatment and demonstrated how virtu al prolonged exposure therapy (VRE) works to reduce PTSD symptoms. Rothbaum also noted how her clinic is finding telemedicine is equally effective in treating PTSD. Her clinic is also experimenting with the use of medications administered immedi ately before VRE to enhance its effectiveness.

LOUISVILLE The 2021 UofL Depression Center conference tackled some of the most chal lenging issues in mental health treatment. The online webinar on November 5 focused on skill-based approaches for treat ing eating disorders, PTSD, and treatment-resistant depression.

a) Does the patient access team have a new process to track consent forms, create good faith estimates, and apply the appropriate cost-sharing percentages?

6. Is your organization’s legal or risk manage ment team familiar with state and federal laws around balance and surprise billing?

BY CHIP DALTON, HEALTHCARE SERVICES ASSOCIATE MANAGER

• Continuity of care for patients. Continuing care patients will be required to be covered by a plan after being given a timely notice of any alteration in their participation. These services must be covered for the member for up to 90 days until a transition can occur.

Will You Be Surprised When the “No Surprises Act” Goes Into Effect Jan. 1, 2022?

Preparing for the No Surprises Act

ACCOuNTING

Surprise billing happens when a patient unknowingly receives care from a provider that is outside the patient’s health plan network. This scenario can occur for both emergent and non-emergent services. For example, if a patient is having imaging performed at an in-network hospital, the radiologist could be out-of-net work according to the member’s plan. If not prohibited by state law, the out-of-network provider can bill the patient for the difference between the billed charges and the amount paid by their insurance plan. This type of billing is known as “balance billing” and is prohibited by Medicare and Medicaid. The No Surprises Act will extend this similar protection to employ er-sponsored and commercial health plans.

• Determining cost shares calculation varies by state. The act requires a patient’s in-net

• Notice and consent exception. The only exception to the balance billing exclusion rule is for certain non-emergency services which the provider gives written notice at least 72 hours in advance and obtains the patient’s written consent.

Patients have never been more concerned and affected by the cost of their healthcare treatment, as medical debt continues to rise and consumers demand transparency from their medical pro viders. In December 2020, President Trump signed the No Surprises Act, which established patients’ protections against surprise medical bills, building on parts of the Affordable Care Act (ACA) that include similar protection.

1. Does your organization have a resource dedi cated to negotiating out-of-network bills with a strong understanding of contract networks, a process for determining allowances for out-

• Good faith estimates. Self-pay and unin sured individuals must be provided with a “good faith estimate” of expected charges for items and services that are rendered.

of-network services, and a rigorous appeal resolution process? Do you have a plan for creating contacts with out-of-network plans?

• Balance billing is prohibited for out-ofnetwork emergency care, provider services at in-network facilities, and air ambulance services. Starting in 2022, out-of-network hospitals and emergency facilities are pro hibited from billing a patient more than they would pay for an in-network plan. Under this regulation, health plans must apply the member’s cost share for out-of-network care, cannot require a pre-authorization for outof-network emergency services, and must process a claim within thirty days of receiv ing an out-of-network claim.

3. Are your customer service, patient access, and billing staff prepared for the regulation change in 2022?

cdalton@ddafhealthcare.com |

• New arbitration and submission pro cess. Administrators and providers will be required to learn and follow the new guide lines for out-of-network payments. These will be paid in one of three methods: 1.) The initial payment the plan reimburses for out-of-network services; 2) The negotiated rate from the insurance plan to be com pleted in 30 days; or 3) Through the new independent dispute resolution process.

work co-insurance for out-of-network ser vices to be paid at the “recognized amount,” the rate paid for a service under the state’s medical billing law or “all payer” rate model. If a state does not have these established, the service is paid at the “qualifying amount.” This amount is defined as the median of con tracted rates for a specific service in the same geographic region within the same insurance market as of January 31, 2019. The rate will be adjusted per the Consumer Price Index for All Urban Consumers (CPI-U).

2. Does your organization have a team to create a process around the new dispute resolution process?

4. Current contracts for emergency and ancil lary providers need to be reviewed to deter mine any areas of concern or exposure?

5. Has any financial analysis been complet ed to understand how this new law may impact reimbursement overall and current oversight planning?

What is Surprise Billing?

As more clarification is released around the No Surprises Act, one concept is apparent: cur rent legislation is focusing on transparency for the patient. This new law may have a negative impact on a facility’s ability to obtain payments for services. Our experienced healthcare team can provide insights into the regulatory changes this law will require, aid in being complaint, and provide recommendations into processes to pre vent this change from hindering collections. 859.425.7683

6 MD-UPDATE

c) Can your customer service team address questions from patients that may arise from confusion about surprise billing or balance billing? Has the required regula tion of disclosure around this law been prepared to provide to patients?

b) Does the billing staff have new procedures for not billing patients for out-of-network costs and how to handle these outstanding balances?

The key provisions of the No Surprises Act to be cognizant of for providers:

So what is the cause of inflation? It is the result of shifts in the demand and supply curves. When the demand curve moves out faster than the supply curve, a rise in prices will occur. In our present case, the supply curve has moved backward while demand has increased dramatically, especially when compared to last year. This situation was quite predictable, but supply is largely ignored in most analysis, that is until it becomes a problem—like now. Anytime someone labels an action as inflationary, you should ask how that action will impact supply and demand. Only when you can answer that question will you know whether it is inflation ary. While we are on the subject, what do you suppose the infrastructure spending on bridges and roads will do for the profits of those com panies that build roads and bridges? Such an analysis could help you decide where to put your investment dollars.

FiNANCE

Let me ask you a question. With which are you more concerned, a) an increase in the price of goods and services, or b) an increase in the price of assets? It kind of depends on where you are in life and whether you already own the asset, doesn’t it? Rightfully, as we go about our daily lives most of us are more concerned with the rise in the price of goods and services. But we may also be concerned about the nearterm impact of inflation on our store of wealth in stocks, bonds, and other assets. Making a distinction between the flow of wealth and the store of wealth matters.

Time horizon becomes a very important factor in any planning scenario, and it takes on a more prominent role when the world is as uncertain as it is today. That’s why we plan ners stress the importance of time-dimensioned goals, and why long-range planning often needs a different set of assumptions and estimates than planning for more immediate goals. We see a lot of clients and other advisors who have used long-term averages that cover large popula tions for near-term planning. That is a mistake, in my opinion.

There appears to be a lot of misunderstanding about the nature and magnitude of inflation. Some people believe that the Fed can stop inflation by simply raising interest rates. They talk very wgenerically about interest rates, for getting that the Fed can only raise short term rates and can do very little to impact long term rates. Even buying up long term bonds in large quantities, i.e., quantitative easing (QE), did not raise inflation or interest rates coming out of the Great Recession. The bond market is in charge of long-term interest rates, and these are the rates that truly matter to our future financial security. If inflationary expectations continue to rise into 2022, and if worldwide growth recovers thanks to emergence from the pandemic, we should expect investors to demand a higher interest rate on long term bonds. Stocks are likely to fall in such an environment. As you start looking for safer long-term portfolio returns, remember that increases in yield (i.e., interest rates) result in a decline in the value of your bond investments. Long term bonds are not likely to produce the desired result.

Inflation: The Cause and Effect

ISSUE #137 7

had an average annual gain of 10.9% over the past 50 years.

I am out of space, but I soon want to take up the longer-term prospects for inflation. We could be entering a time of sustained inflation simply due to demographics (fewer workers in industries that serve senior adults while those seniors are living longer). Sorry to end on such a downer, but stay tuned. I firmly believe that 2022 could be your best year yet!

“Stay tuned . . . 2022 could be your best year yet!” — Scott Neal

Maybe you haven’t been paying attention, but that dreaded word, inflation, has made its way back into the regular broadcast of the news in one form or another. Even as they report the facts, the true impact of the rise from 1.75% inflation in Q4 2020 to 6.2% in October 2021 is largely ignored. Your financial advisor might have even started talking with you about the impact of sustained 6% inflation, raising the question, is it temporary or permanent? The result of 6% inflation, if sustained, is a dou bling of the cost of living in about 12 years. Just run the numbers. Due to compounding and a longer time horizon, inflation quickly gets scary when we think about the cost of almost any thing that we will purchase during retirement.

BY SCOTT NEAL

I remember my life as a teenager. I regularly visited the Chevy dealer and drooled over a brand new Z28 Camaro sitting on the show room floor. The year was 1969. Its cost was $1900. Today, a quick search pegs the cost of a similar brand-new model (now called a ZL1) at $72,900, an average annual increase of 7.4% over the 1969 price. By the way, the S&P 500

If you are the one in your family who fills up at the gas pump or shops at the grocery store, you have undoubtedly witnessed the rise of prices during the past few months. According to the U.S. Energy Information Administration, the average price of gasoline has risen from $2.248 per gallon in October 2020 to $3.384 in October 2021, an increase of 50.5%.

The ABCs of Inflation

Likewise, there is a lot of misunderstanding about the causes of inflation. Some believe that the deficits created by the spending bills winding their way through Congress are auto matically inflationary, and will therefore result in higher interest rates. That is not necessarily true. Remember that deficits of any size are financed by investors buying U.S. bonds. The bond market is likely to stay behind the deficit that funds projects with a positive rate of return. The problem is that Congress has no incentive to even calculate, much less reveal, the expected rate of return on its projects.

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.

difficult to defend and can carry with them sig nificant damage exposure. The cases are often emotionally charged and very sympathetic to the patient, especially if the patient has endured multiple hospitalizations, surgeries, radiation, and chemotherapy only to pass away eventually from the cancer. Almost all jurors will have a friend, loved one or family member who has suffered or passed away from cancer.

Delays in the diagnosis of cancer cases can be

past two years, which they anticipate has led to more delayed diagnoses and negative outcomes. While healthcare professionals have needed to focus on preventing the spread of the virus and maximizing their ability to treat COVID-19 patients, it is also important to ensure the stan dards of care for cancer diagnosis and treatment are being met in order to ensure better outcomes for both patients and healthcare professionals.

Defending Delay in Diagnosis Cases

Under the law, civil litigation is designed to return the party to his or her status quo before the injury occurred. In every case, this is accom plished through money. The jury decides, after

Critical Delays: The Importance of Meeting the Standard of Care for Cancer Diagnosis

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8 MD-UPDATE

The NIH findings show that cancer screening programs have been clearly interrupted over the

1 “Has COVID-19 Affected Cancer Screening Programs? A Systematic Review,” Frontiers in Oncology, Ibrahim Alkatout, Matthias Biebl, Zohre Momenimovahed, Edward Giovannucci, Fatemeh Hadavandsiri, Hamid Salehiniya, and Leila Allahqoli, 11: 675038, May 17, 2021.

One of the most common lawsuits in medical malpractice defense is a delay in diagnosis of cancer. According to the National Institutes of Health, the COVID-19 pandemic has affect ed healthcare services worldwide, including oncology services, and routine cancer screen ing and treatment have not yet returned to pre-pandemic levels.1 Not only were hospitals redirecting resources to treating COVID-19, patients have delayed screenings due to fear of contracting the virus in a medical setting.

BY ANDREW DESIMONE, ESQ.

is true. This is often defined as greater than 51%. Expert testimony on causation based upon a “possibility” or what “could” happen is insufficient to meet the legal causation standard. Thus, an opposing expert must testify that the delay in diagnosis of cancer, more likely than not, caused an injury, i.e., led to the patient’s death, or increased his or her morbidity (additional surgery, additional treatment, additional pain).

hearing all the evidence, how much value to award an injured individual for such things as pain and suffering, medical expenses, lost wages and, in some jurisdictions, a lost chance of survival. Medical malpractice cases are a subset of a general negligence claim, which requires the plaintiff to meet four elements: (1) duty; (2) breach; (3) causation; and (4) injury. Almost all medical providers have a duty toward their patient; the only excep tion being if the provider never entered a patient-physician relationship. Therefore, almost all medical malpractice cases are liti gated on the second and third prongs: did the physician breach of the standard of care and did that breach cause an injury.

The standard of care is defined as what a reasonably competent physician would do under the same or similar circumstanc es. In Kentucky, as in most jurisdictions, expert testimony is required to prove that the defendant physician breached the standard of care. Without this necessary expert proof, the defense may be entitled to a summary dismissal of the lawsuit. Furthermore, the Kentucky General Assembly recently passed a new law requiring a patient suing a physician to file a Certificate of Merit, which indicates that the patient has consulted with an expert who has looked at the case and who believes that a breach of the standard of care has occurred. Of course, there are general excep tions to the requirement of an expert witness: (1) when the negligence is apparent to a lay person (such as a wrong site surgery) or (2) when res ipsa loquitur applies (the very fact that an injury has occurred allows a jury to findCausationnegligence).–did the breach of the standard of care cause an injury? – must be proven within a reasonable degree of medical proba bility. Medical probability in the legal sense is much different than in a medical sense. A rea sonable degree of medical probability simply means that, more likely than not, something

2 “Changes in Newly Identified Cancer Among US Patients From Before COVID-19 Through the First Full Year of the Pandemic,” JAMA Network Open, Harvey W. Kaufman, MD; Zhen Chen, MS; Justin K. Niles, MA; et al, 2021;4(8):e2125681, Aug. 31, 2021.

Diagnostics in the Journal of the American Medical Association found a significant decline in newly identified patients with eight common types of cancer in the beginning of the pandemic. Although medical practices are back open, patient concerns remain. According to the study, “The impact of delayed diagnosis may vary with the type of cancer and the extent of delay but could lead to presentation at more advanced stages, with potentially poorer clinical outcomes.”2 Healthcare providers can protect themselves and their patients by ensuring they are familiar with the cancer diagnosis standards of care and meet or exceed them with every patient.

Andrew D. DeSimone is a medical malpractice defense attorney with Sturgill, Turner, Barker & Moloney, PLLC, and chair of the firm’s healthcare law practice group. He can be reached at adesimone@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.

ISSUE #137 9

Because of this causation defense, many states allow for a claim of lost or diminished chance of survival. In other words, because even an earlier diagnosis would not have saved a patient’s life within a reasonable degree of probability, the law allows a patient to recover damages for the reduction of the odds of recovery attributable to the delayed diagno sis, even if it is more likely than not that the patient would pass away regardless.

This is an “equitable” doctrine, and it attempts to provide some recourse for the patient. Equity stems from the old English court of chancery that allowed the courts to practice principles of justice when necessary. Although Kentucky does not follow the doc trine of lost chance, in jurisdictions that allow this type of claim, the expert testimony can be as generic as the patient’s chance of sur vival would have been significantly improved. However, when awarding damages, the jury must consider the percentage of lost surviv ability. In other words, if the patient had a reduction in survivability of 15%, this reduces a $100,000.00 total award to $15,000.00.

Because expert testimony is so important in the defense of medical malpractice claims, documentation remains one of the best means for reviewing experts to determine whether or not the physician has met the standard of care or caused injury. Although it seems clear at the time, it is difficult for both patients and providers to recall conversation details that can be very important in determining whether the provider sufficiently explained the diagnosis, prognosis, and next steps. It is always better to over-document than to under-document.AstudybyQuest

LEGAL

Importance of Documentation

Causation and the Standard of Care

will as it seemed a lot more important all of a sudden. I realized that careful thought needed to go into it, in hopes of minimizing the cussing among those who must clean up behind me. For example, not everyone would be happy to have a flock of heritage breed organic turkeys bequeathed to them.

Livestock, crops, and customers naturally come first to food farmers. But clearly my perspective had changed. I determined there was no way I was going to get everything done anytime soon, so I needed to live a long time to at least get things in better shape than they are right now. I was planning on twenty or thirty years to get everything done I had on my list(s). At least I needed enough time to get some projects finished, not start anything that wasn’t already on the lists, and unload all the stuff left behind from thirty years of developing a regenerative organic food farm. Time to take it like a man, and fight like a girl.

Early August is a busy time on the farm. There are community supported agriculture shares to get out, veggies coming on strong, lots of planting going on for fall, turkeys getting rambunctious, pastures to mow. One fateful August morning, my day started with the dreaded ‘c’ word for colonoscopy, and I was ready to get it out of the way. A couple of hours later, my wife and I heard the second ‘c’ word:

Mac Stone

BY MAC STONE

GEORGETOWN My ’84 Chevy pick-up truck and I had similar experiences of late. We both went to the shop for a good going over. The previous owner(s) had been filling Old Blue with oil, and checking the gas for quite a while, so a ring and valve job was in order, along with whatever else my mechanic, Bernie, found. A rebuilt engine, some brake lines, and several belts and hoses later, she runs like a top. There are not many Bernies left in this world that can deconstruct a 35-year-old collection of greasy steel parts and pieces, and make it hum like the classic she still is today. I, on the other hand, checked myself in when I blew a gasket (aka inguinal hernia) only to find out my tail pipe had rusted off at the manifold (aka Stage II colo-rectal cancer). I was happy to find a whole team of Bernies at Markey Cancer Center, spe cial people that will keep me behind the wheel of my ’84 Chevy.

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cancer (aka—death sentence). We came home, checked on the farm crew and livestock, then sat down to cry. Through teary eyes it was quite evident that I, we, had a lifetime of stuff still to do and did not know how long we had to do it.

At Markey, the first thing they had me do was drink a clear liquid they called a dye, and then they also injected another type of dye that makes you feel like you wet yourself, but you don’t (and you’re not supposed to move around to check for yourself.) Next, I was swarmed by what felt like blood-sucking mosquitos wearing scrubs, and soon everyone there knew more about me than I knew about me. Going into the tubes and tunnels to check out my insides

10 MD-UPDATE

Doing My Part A Journey Through CRC from the View of an ’84 Chevy Truck

The first thing I did was clean out the fridge and run four or five loads of laundry through the wash, remembering my mother made sure we had on clean underwear every time we went out in the event we were in a car accident so as not to embarrass her. Over the next few days, I hauled stuff from the garage to the dumpster, did some plumbing projects and odd jobs I had been putting off—because I always thought we were getting along fine without them—until now. I dusted off the

Mac Stone and his family operate Elmwood Stock Farm in Scott County, Kentucky. He was executive marketing director for the Kentucky Department of Agriculture and chair of the U.S. Department of Agriculture National Organic Standards Board.

At this point halfway through my treatment plan, I am still buying green bananas, flossing

At our first consult we heard the third ‘c’ word: cure. The data and images informed the tumor team at Markey that the cancer had not spread to other organs and we had a shot at treatment that did not include surgery, it was up to me and my microbiome. Complications from surgery can go south pretty quickly down there, so that sounded like a plan I could live with. The tears welled up when we realized how lucky we were to catch it when we did, and to have a team of dedicated, smart people working with confidence to replace the bad parts with good parts, just like Bernie and my truck.

my teeth, although I’m not cutting the cords off appliances as they get pitched out like I used to. I’m eating whatever I want to, anything to keep my weight up because my new boss told me that was part of the job. This unexpected career change has given me a new perspective on life and living. I’ve been feeling pretty good and have time to work on fixing up things on the lists. Taking the time to enjoy being at home feels awesome, as the grass is pretty green right here. As a boy scout, we were taught to leave our campsite better than we found it. I’ve continued with that thought as an adult, but dang, there’s a lot to be done.

I realize that there is no time for asking “why me.” I have been tested many times before and will live to be tested again. The doctors will do their part to rid me of the alien inside me, but I must provide the building blocks to recon struct my vital organs. Thank you to Markey Cancer Center for giving me a shot at driving a rebuilt ’84 Chevy, and for the ability to work on my lifelong to-do list. Right now, I am so far behind I may never die. Godspeed.

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wasn’t so bad once I got to pick my own music; my advice is to just keep your eyes closed. All the while, I didn’t know how bad it was, as this was to help figure it out. Know that colonos copies are a walk in the park compared to the gauntlet you eventually run through. I view it as self-inflicted trauma from not getting scoped early and often enough.

The treatments are going as well as can be expected, with several more months ahead. The clinicians seemed skeptical when I told them I take no pharmaceuticals on a daily basis, as I’ve worked hard to avoid diet- related disease complications. The hard work of farm ing and the balance of nutrients in the food has put me in a position for good things to happen. No diabetes/heart conditions/choles

terol/liver(whew) to complicate the blitzkrieg of drugs now coursing through me. Not a position I was gunning for, but my family and our team of employees are affording me the time to make beating cancer my full-time job! The farm keeps me active and motivated, not to mention provides an abundance of wholesome, tasty food.

ISSUE #137 11

Norton Neuroscience Institute: A Study in Collaboration

A typical week for Sun begins on Monday

Perhaps partially influenced by his father who is a retired surgeon and his mother who is a nurse practitioner, Sun began to develop his plan as early as middle school. He was very interested in the brain, and he saw the passion that his father had for his career.

“We really wanted to create an experience for patients,” Sun says, noting that every detail was important, including the lighting and artwork. “We wanted patients to feel like they were in a place where the doctors and nurses and staff members who were going to care for them were truly dedicated and passionate about neuroscience care. We wanted to create a patient experience.”

In addition to the patients’ comfort level, the building is designed to enable effective communication and collaboration among the various healthcare professionals.

David Sun, MD, PhD, inspires collaboration and communication at Norton Neuroscience Institute

“At that young age I made the connection that if I love all these things related to the brain, and my dad loves his job as a general surgeon, I’ll become a brain surgeon,” says Sun, who grew up in Pennsville, New Jersey. “I had no idea at the time that was actually going to be what Implementationhappened.”ofPlanA began at the University of Pennsylvania where he studied biomedical engineering. From there, he attended the Medical College of Virginia before performing his internship, residency, and

The Path to NeuroscienceNortonInstitute

12 MD-UPDATE

CovEr StorY

“Patients will come in and see me, they’ll see the cancer doctor, they’ll see the physical therapist, they’ll see the speech therapist, they’ll see the behavior oncologist,” Sun says. “We all work together, we see patients, we intermingle, and we discuss patients all day long.”Tuesdays through Thursdays are typically surgery days for Sun, and on Fridays he returns to the clinic to see cases pertaining primarily to general cranial neurosurgery, such as epilepsy and hydrocephalus.

“I firmly believe that as a neurosurgeon, based on the nature of the job and the commitment to the job, that if you’re not passionate about it, you just can’t do it,” says Sun, who is also the executive medical director for the Norton Neuroscience Institute. “When I interact with medical students today that are interested in neurosurgery, I always will ask them, ‘What’s your plan B if you can’t do neurosurgery?’ And when they give me an answer, I immediately will say, ‘You may be better off just going to do that now,’ because for me as a neurosurgeon, it was, ‘That’s my Plan A. That’s my Plan B. That’s my Plan C. If I’m not going to do that, I probably am not going to be in the field of medicine.’”

fellowship at Vanderbilt. He received his PhD in neuroscience, studying how brain injuries and strokes can lead to seizures and epilepsy.

“What I use every single day is a brain that was trained by my biomedical engineering background, and it was trained by my graduate scientific background to look at problems a specific way,” he says. “A neurosurgeon who had an undergraduate degree in biology or an undergraduate degree in history and then went to medical school may just look at a problem slightly differently than the way my brain is trained to look at a problem. And it doesn’t mean in any way, shape, or form that one way is better than the other. It’s just different. All that training informs the way that I look at all kinds of problems.”

BY JIM KELSEY

Sun brought his problem-solving training skills to the Norton Neuroscience Institute in 2010, when the group was in its infancy behind chairman Chris Shields, MD, whom Sun credits with having “the vision of neurosurgeons, neurologists, neuropsychologists, therapists all working in this collaborative fashion.”

LOUISVILLE Many times in life we are advised to have a “Plan B” – an option in case Plan A fails. For David Sun, MD, PhD, a neurosurgeon at Norton Neuroscience Institute in Louisville, there was always just one plan. Plan B simply read: “See Plan A.”

The Norton Neuroscience Institute has a number of subspecialists, including neurosurgeons who focus specifically on degenerative neck and back pain, and others who focus specifically on cerebral aneurysms or vascular problems such as strokes. Sun’s particular focus is cranial neurosurgery, in which he treats patients with tumors in the brain, pituitary, and spinal cord. He also treats patients with medically refractory epilepsy.

Sun says that the Norton Neuroscience Institute office space was intentionally and uniquely designed to maximize communication and to enhance the patients’ overall care and comfort.

“To collaborate, you have to have open doors,” Sun says. “We wanted to create the

meeting with other members of the Norton Neuroscience Institute, including neurooncologists, neurosurgeons, radiation oncologists, neuro-pathologists, neuroradiologists, physical therapists, and cognitive speech therapists, to discuss the patients and determine the next step in their care plans. After that meeting, those same personnel hold a brain tumor center clinic in which they meet jointly with patients.

Stick To the Plan

ISSUE #137 13

David Sun, MD, a neurosurgeon and the director for the Norton Neuroscience Institute in Louisville.

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“I passionately believe in the new model where all those doctors are sitting together, and they’re talking to each other, and they’re brainstorming, and they’re problem solving together as a team.”

Greg Cooper, MD, chief of adult neurology and director of the Memory Center at Norton Neuroscience Institute.

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— David Sun, MD, Norton Neuroscience Institute

While Cooper focuses on the care and treatment of individuals with Alzheimer’s disease and related disorders, he has been active in research, serving as principal investigator on a number of clinical trials. He also has a strong interest in education and caregiver support.

Sun believes this model should and will become the new standard for medical facilities.

“I came to the Norton Neuroscience Institute to create and be part of an outstanding multidisciplinary memory disorders program to provide the highest possible level of care for patients with Alzheimer’s disease and related disorders and for their families. We intend to leverage the considerable commitment and resources of Norton Healthcare to be a resource for our entire region,” says Cooper.

Cooper says he was drawn to Norton Neuroscience Institute by the commitment to the highest quality, subspecialty neurological and neurosurgical care. “The level of collegiality is remarkable, and the opportunity for collaboration has become even greater with our move into the new Brownsboro facility. When patients come to us, they don’t just benefit from the expertise of one clinician, but from an entire team,” says Cooper.

“I passionately believe in the new model where all those doctors are sitting together, and they’re talking to each other, and they’re brainstorming, and they’re problem solving together as a team,” Sun says. “More eyes on the prize. More backgrounds and perspectives taking one person’s problem and developing an individualized care plan for

Cooper received his MD and PhD from the University of Kentucky before completing his residency in neurology and fellowship in behavioral neurology and cognitive neuroscience at the University of Iowa. He briefly directed the dementia clinic at the University of Iowa before joining the SandersBrown Center on Aging at the University of Kentucky, and later formed and directed the

“Since joining Norton Neuroscience Institute, I’ve come to realize that it is one of the best kept secrets in the region. I hope to communicate to the rest of the world the remarkable talent and resources we have here.”

space in such a way that the neurosurgeons, and the neurologists, and the neuropsychologists, and the therapists were all in the same space. Collaborative conversations can’t easily happen across buildings or across separate floors in a building space.”

Meet Ambica Tumkur, MD

Baptist Health Memory Care Program until joining Norton in 2021.

Ambica Tumkur, MD, is a neurologist and director of epilepsy at Norton Neuroscience Institute. She affirms that for patients with neurologic conditions, “Having all of their care in one location shows the patients that we truly work together as a team. We are in constant contact with our neurosurgical colleagues, and we are easily able to discuss

Meet Greg Cooper, MD, PhD

Cooper emphasizes that as the Norton Neuroscience Institute continues to recruit and grow, they now have increased access for new patient appointments, with relatively short wait times for most subspecialties. “We continue to recruit to better meet the needs of Kentucky and Southern Indiana, and expect our access to continue to improve,” says Cooper.

PHotoS BY JAMIE

Greg Cooper, MD, PhD, is chief of adult neurology and director of the Memory Center at Norton Neuroscience Institute.

that particular patient. That is what we’re trying to accomplish.”

rHoDES

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The surgery is performed with the assistance of robotic guidance, which allows precise placement of electrodes in the brain via tiny incisions that Sun describes “as small as a strand of spaghetti before you throw it in the pot.” The result is less tissue damage and a much quicker recovery.

The goal is for everyone to have equal access and to be treated with the same level of care and expertise. Sun says that simply comes down to doing what he was trained to do – treat every patient like they are a member of his “I’mfamily.never going to recommend a procedure to a patient that I wouldn’t recommend for my own loved ones. And I’m never going to go into the operating room and operate on a patient without the passion, diligence, concentration, and effort that I would have if I was actually operating on my own loved one,” says Sun. “I tell my patients, ‘Whether you like it or not, you’re now part of the family.’

Sounds“ like a pretty good plan. Let’s call it Plan A … and there is no Plan B.

In addition to not discriminating by age, epilepsy does not discriminate by race, gender, or socio-economic status. Neither do other neurological disorders. Yet, Sun is well aware that the access to the type of care needed to treat these conditions may not be equally accessible to “Neurologicaleveryone.conditions do not necessarily declare gender, race, or socioeconomic biases,

but the access to care and the ability to care for those patients certainly suffer from it,” Sun says. “We’re very cognizant of that and we want to continue to develop care models and care plans that will give access to all patients in Kentucky and Southern Indiana.”

Every patient is evaluated to determine if they are a candidate for surgery, and the risks and benefits are discussed openly. When the surgery is warranted and successful, Sun says it is one of the most rewarding experiences he “Ihas.could see a patient six months after their surgery, and whereas they weren’t allowed to drive a car for the past 20 years, they’re now driving a car,” he says. “They weren’t able to go back to college or go back to school because of their seizures or they weren’t able to work, and now they’re able to do those things and they’ve gained this level of independence. When I see

Epilepsy Care and Neurosurgery

In addition to the big-picture aspects of his position as the institute’s medical director, Sun is acutely dialed into the daily care and treatment of his patients. One of the conditions he frequently treats is epilepsy, which affects people of all ages. Roughly onethird of all epilepsy patients are drug resistant, meaning their seizures cannot be controlled medically. Sun says any patient who has tried two medications without success should be evaluated in a comprehensive epilepsy center such as the Norton Neuroscience Institute, which is level four accredited.

those patients I will get goosebumps on my arms, every single time.”

“We make tiny little cuts on the skin and drill tiny little holes and pass tiny little wires into the brain to localize where the seizures are coming from,” Sun says. “In epilepsy, the name of the game is always identifying where the seizures are coming from.”

the best care and management for the patients we share,” says Tumkur.

Tumkur also says that the collegial and family atmosphere at Norton Neuroscience Institute allows staff to “work together to grow the program and provide the best treatment opportunities and care for the patients we serve.”Before joining the Norton Neuroscience Institute, Tumkur did a fellowship in clinical neurophysiology at Emory University, following her internship in internal medicine and her residency in neurology at Duke University. Tumkur received her medical degree from the University of Kentucky College of Medicine.

“When I got here 11 years ago, the first thing I said is, ‘I don’t want a single patient in Kentucky to feel like they need to leave Louisville to get comprehensive quality neuroscience care,’” Sun says. “I want them to know that they can have it at home.”

ISSUE #137 15

Ambica tumkur, MD, neurologist and director of epilepsy at Norton Neuroscience Institute.

The center and its mission, to manage or alleviate pain, started in the late 1980s with Peter’s father, Ballard Wright, MD, an anesthesiologist. In 1988, when he opened his physician practice, also known as The Pain Treatment Center of the Bluegrass, he became board certified in pain management. Eventually, in 1993, he obtained a license for a surgery center, The Pain Treatment Center, Inc. Stone Road Surgery Center.

the center’s physicians’ care plans have always utilized techniques from various specialties and modalities to diagnose and treat their patients, from interventional pro cedures and behavioral medicine to appro priate medications and physical therapy, the center has recently formed an affiliation with ApexNetwork Physical Therapy. Apex is both a national and local physical therapy group whose therapists are experts in the field.

Heather Wright, Esq., CEO

Furnishing outstanding medical care for the center and CHI Saint Joseph Health’s clinics are Karim Rasheed, MD, Ben Sloop, MD, Lauren Larson, MD, and Olivia Kelley, MD, who thoroughly evaluate and examine each patient’s pain complaint with dignity and compassion. Moreover, they have a staff of qualified mid-levels (advanced nurse prac titioners and physician assistants) who work alongside them to manage each patient’s plan of Whilecare.

Karim Rasheed, MD

all different kinds of pain and pain issues, whether the pain arises from an injury, illness, or disease,” says Peter Wright, medical director of The Pain Treatment Center of the Bluegrass. “If someone has acute or chronic pain and they are referred to us, we will work with them to manage or alleviate their pain.”

Growth and New Affiliation

LEXINGTON For some people, acute or chronic pain is a fact of life, but expert physicians and specialists can help manage pain with the right approach. The Pain Treatment Center of the Bluegrass specializes in pain management and helps patients cope with, and overcome, their“Wepain.treat

“The Pain Treatment Center of the Bluegrass is one of the oldest and largest private, mul tidisciplinary pain centers in the region and delivers comprehensive pain care to their patients. With our new partnership, The Pain Treatment Center of the Bluegrass will offer services as the preferred pain management provider for CHI Saint Joseph Health. We are proud of our affiliation and joint commit ment to providing outstanding medical care,” says Michelle Abrams, director of outpatient services at CHI Saint Joseph Health.

One such connection occurred at the begin ning of 2021, when the center became affiliat ed with CHI Saint Joseph Health’s network of hospitals and outpatient clinics. The center’s physicians became the preferred provider for all CHI Saint Joseph Health’s pain manage ment centers, providing physician services to multiple CHI Saint Joseph Health locations including Saint Joseph East in Lexington, Saint Joseph Berea, and Flaget Memorial Hospital in Bardstown. And, after a transfer of ownership of the Stone Road Surgery Center, the center’s physicians began performing their outpatient procedures at CHI Saint Joseph Health – Outpatient Surgery Center.

Legacy Pain Treatment Center of the Bluegrass enters a new era of collaboration and expanded care.

medicine and rehab doctors, internal and family medicine doctors, an addiction medi cine specialist, and a palliative care physician. All these different specialists work together to evaluate patients with the end goal of alleviat ing their chronic pain.”

BY DEBRA GREEN

As part of the center’s desire to help pain patients across the Commonwealth, it has grown its outreach by connecting with refer ring providers and healthcare institutions throughout the state.

16GenerationsMD-UPDATEofCare

PHOTOS PROVIDED BY THE PAIN TREATMENT CENTER SPECIAL SECTION PAIN MEDICINE

Patients generally come to the center upon referral from their primary care physician or another specialist. “The majority of our patients come because they have seen other providers who have not been able to manage or take care of their pain,” Heather says. “They realize they need a specialist in pain management.”

“In that time, we’ve expanded from the one building on the corner of Regency Road and Pasadena Drive to three buildings within this perimeter and a satellite clinic in Somerset, Kentucky,” says Heather Wright, CEO and daughter of Dr. Ballard Wright. “We have ten physicians from different specialties, most of whom are also board certified in pain manage ment, and they all practice pain medicine. We have anesthesiologists, neurologists, physical

New Staff and New Physical Therapy Partner

Apex’s physical therapists will work with the center’s providers to develop customized treat ment plans based on combined goals set with the center’s patient and provider. Like the center’s mission, its purpose is to provide relief from the aches and pains that keep patients from enjoying their lives.

Lauren Larson, MD

Ben Sloop, MD

ioral medicine specialists, compassionate staff, and partnerships with health care companies that have the same values, the center strives to meet Wright’s vision of exemplary pain practice. “There are many people out there who have pain and have legitimate reasons for needing to be seen by a pain specialist,” states Heather. Our goal at The Pain Treatment Center of the Bluegrass is to help alleviate or manage our patients’ pain and get them a better quality of life. That is our mission.”

For more information: Ballard Wright, MD, PSC aka The Pain Treatment Center of the Bluegrass 280 Pasadena Drive 2416 Regency Road 2201 Regency Road, Building 100 Lexington, KY 40503 Phone: 859.278.1316

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CEO Heather Wright. “For years, our physi cians have used a multi-specialty, multi-mo dality approach to treating our patients, and now we’ve partnered with two top-notch orga nizations to continue to serve the Kentucky community.”Throughthe employment of experienced, multi-specialty pain providers, skilled behav

Olivia Kelley, MD

Fax: (859) 276-3847 Website: www.pain-ptc.com

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“It’s an inspiring time at the center,” states

18 MD-UPDATE

The patient related how for the past two to three years he had been having sudden, uncontrollable episodes where he would throw things, scream profanities and yet not remember a thing about them. His wife was close to divorcing him because they couldn’t go out in public, not even church. “I’d start yelling out curse words in church during the sermon,” said the patient.

His medical practice consists of a diverse patient population, ages 18 to 96, from all dif ferent demographics and backgrounds. They present with different neurological disorders such as migraines, epilepsy, stroke, trigeminal neuralgia, essential tremors, and dementia.

Mehrizi says he was drawn to neurophysiology with epilepsy and migraines. “These are the two specific neurological disorders and conditions where I feel that I can improve the quality of life for my patients the most and make the most positive impact in terms of patient care and feel most comfortable treating based on my training.”

Neurophysiology is a broad combination of several medical disciplines. It includes testing nerve pathways using electroencephalography (EEG) and electromyography (EMG). It also includes somatosensory, auditory, and visu al evoked potential, testing the pathways of nerve stimulation, sending small shock waves throughout the nervous system to determine if the stimulus is captured by the brain. This can determine if there are lesions in the nervous system, blocking the impulses to the brain.

Neurophysiology also includes sleep medicine and surgical neurophysiology monitoring during brain surgery.

BY GIL DUNN

he studied under neuroanatomist Jeffery Winer, PhD, and then pediatric neurologist Elliott Sherr, MD, PhD, at UC San Francisco.

PHOTO PROVIDED BY BAPTIST HEALTH

Neurophysiology and Seizures

LOUISVILLE Every doctor has had an unusual case, right? A good story to tell. Mehyar Mehrizi, MD, FAAN, neurologist at Baptist Health Medical Group Neurology in Louisville has one that he tells to his neurology students at the UofL School of Medicine.

Mehyar Mehrizi, MD, FAAN

“I’m such a social creature and enjoy interaction with people. I chose to pursue a medical degree so I could work with people and not just lab mice.”

president. Working with Bill Robertson, MD, at UK confirmed his decision to pursue neurology, says Mehrizi. Following medical school, he pur sued a neurology residency at Indiana University School of Medicine followed by a subspecialty clinical neurophysiology fellowship, completed in Mehrizi2014.

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Searching for Answers

“I could have stayed in clinical research. I like research because on a grander scale your work will stay in the historical, scientific record and benefit many people, other doctors and their patients. I continue to do research with my students at UofL School of Medicine and will publish another paper soon on a case presenta tion on trigeminal neuralgia,” says Mehrizi.

He continues, “But I’m such a social creature and enjoy interaction with people. I chose to pursue a medical degree so I could work with people and not just lab mice.”

— Mehyar Mehrizi, MD

A Neurologist at an Early Age

Mehrizi became intrigued by human physiology during seventh grade at Morton Middle School in Lexington, Kentucky. He credits his biology teacher, Mrs. Jacobs, for sparking his interest. That led to science classes at Henry Clay High School, followed by his B.S. in neuroscience with honors from the University of California at Berkeley. There

is currently teaching medical students and serves as an adjunct clinical associate professor of neurology at Indiana University School of Medicine and is a member of the gratis clinical faculty at University of Louisville School of Medicine Department of Neurology. He is also a fellow of the American Academy of Neurology.

In the midst of the lengthy interview, with Mehrizi totally perplexed, they decided to order lunch from the hospital cafeteria. During the phone call to the cafeteria, the patient started yelling profanities and throwing the phone. Fortunately, he was hooked up to Mehrizi’s EEG. The patient’s brain activity spiked. Mehrizi saw a frontal lobe seizure on full display. Within 20 seconds, the seizure passed. Then the patient said, “Doctor, I’m hungry, can we get lunch?” He had no memory of the previous five minutes.

He was doing his subspecialty fellowship training in clinical neurophysiology in epilepsy at Indiana University Methodist Hospital when a well-spoken, middle-aged man sat down and said, “Doctor, you’re my last hope of finding out what’s wrong with me.”

After Berkeley and UCSF, Mehrizi returned to Lexington to attend the University of Kentucky College of Medicine, graduating in 2009 as class

Neurophysiologist pursues his passion for understanding brain seizures

Epilepsy and Migraines are Treatable

“My personal philosophy of care is based on mutual respect between patient and physician,” says Mehrizi. “Baptist Health provides me the essential time needed to see my patients and care for them effectively and appropriately without feeling like we are rushed. I tell my patients we will have enough time to answer their questions, and they feel like they have been appropriately heard and leave my office with an understanding of their plan of care and what to expect for the future.”

The study of epilepsy goes back to ancient Egypt when holes were drilled into the head to release blood believed to contain the evil spirits that were thought to have possessed the epileptic person.

It’s hard to tell if epilepsy and migraines are increasing in the U.S. population, says Mehrizi, but there’s no doubt that reports of both are on the uptick, possibly because they are being diagnosed more. The medical knowledge of epilepsy has increased dramatically in the last 100 years and much more so in the last 10 to 20 years.

A new modification in the VNS has a cardiac monitor because research shows that when someone is having a seizure there’s a spike in the heart rate. The VNS sends a nerve stimulus to the brain to modify the length, frequency, and severity of the seizure.

“For patients with migraines and epilepsy there are plenty of options that can be near curative and for some, completely curative.” — Mehyar Mehrizi, MD

He continues, “The brain controls the rest of the systems that keep us alive: the nervous system, the skeleton and muscles, the cardiovascular system, the digestive system. When there’s a seizure and the brain malfunctions, all these other systems have a reaction. That’s how I first became interested in epilepsy and seizures.”

The responsive neurostimulator (RNS) is a newer device than the VNS. It records live electrical activity in the brain. Again, the purpose is to send a small electrical shock to the brain to either prevent the seizure or decrease the length and severity of it when detected.DBS, deep brain stimulators, along with neurosurgical procedures can assist with treatment of medically refractory epilepsy. There is also epileptic surgery, where neurosurgeons remove epileptogenic portions of the brain that are causing the seizures. There are also newer pharmaceutical medications such as Xcopri which can also assist with treatment of epilepsy along with a multitude of other FDA approved medications.

Advancements in Epilepsy and Migraine Treatment

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In the treatment of epilepsy specifically, there have been advancements in devices such as the vagal nerve stimulator (VNS), which Mehrizi uses frequently. The VNS is placed under the skin on the chest, and a wire is wrapped around the vagus nerve.

Mehrizi cites an example called “absence seizure,” typically in a teenager who seems “out of it,” just staring into space during school. This teenager can be misdiagnosed with ADD or ADHD and becomes an underperforming student when he’s really having multiple little absence seizures throughout the day. Undiagnosed, this can eventually lead to adult grand mal seizures. Primary generalized epilepsy, the category for absence seizures, responds very well to medical treatment, says Mehrizi. “But this is an example of the need for increased awareness and diagnosis of Thereepilepsy.”isa genetic component to epilepsies, specifically generalized epilepsy and certain focal epilepsy caused by tuberous sclerosis. Stroke is the most common reason for new onset of focal epilepsy in patients over the age of 50 years old. Head trauma, brain infections, and intracranial hemorrhage can also lead to focal epilepsies.

“The biggest question that I have yet to answer is: ‘What role does the brain play in consciousness? What is it about the human brain that allows us to have thoughts, to analyze, to make decisions?” says Mehrizi.

In treatment of migraines, there are newer anti-CGRP medications which are safe and very effective. Mehrizi performs Botox injections and occipital nerve blocks for further assistance with migraines and occipital neuralgia.

Are Epilepsy and Migraines Increasing?

There are many more triggers for migraines than in earlier generations, such as dietary ingredients, like MSG, artificial sweeteners, dark chocolate, and spicy foods. In addition, a lack of exercise and activity, stress, and computer screen time can contribute to migraine onset.

Mehrizi says that the most common misconception is that neurological disorders are not treatable. “When we think of stroke, presenting outside of IV tPA or thrombectomy window, or dementia or Parkinson’s disease, we may not be able to cure the patient of these neurological disorders. But for patients with migraines and epilepsy there are plenty of options that can be near curative and for some, completely curative.”

BAPTIST HEALTH MEDICAL GROUP NEUROLOGY 2400 Eastpoint Parkway Suite 430 Louisville, KY 40223 For appointments or referrals 502.253.6615 SPECIAL SECTION NEUROLOGY

Castillo said, “I’ve been doing this for 10 years, and I can tell you, it doesn’t get any easier. Obviously, the conversation is really, really tough. I usually hold their hand. I give them permission to grieve. I say, ‘You need to grieve. It’s okay to cry. It’s okay to be upset.’ It’s important for them to grieve the loss of function. Why? Because after that, I want them to see their new potential.”

Growing up, Castillo witnessed this level of compassion firsthand while watching his pediatrician father interact with patients in his native Colombia. “I always admired the love that he had for his patients. I was inspired because he was such a great doctor,” Castillo says. Though his father was killed in a car accident the day before Castillo’s eighth birth day, his influence still lives on today.

In addition to his work with UofL, Castillo serves as a member of the American Spinal Injury Association’s (ASIA) board of directors to help bring more attention to improving SCI care for those who need it the most, espe cially people living in very isolated areas. He has worked with ASIA in advocacy and com munication and is the “founder” of the ASIA’s Americas Committee targeting SCI education in Latin America.

He adds, “My goal for them is to see what is next. To say, ‘Yes, you may not be able to walk, but you will be able to do many other things that would help you regain your independence. You can get married and have kids. You will be able to be independent again because we can give you the support you need with the resources we have, including our rehabilitation technology.’”

Understanding Spinal Cord Injury

cord injury programs at UofL Health – Frazier Rehab Institute in UofL Physicians – Physical Medicine and Rehabilitation (PM&R) where he does inpatient and outpatient therapy along with research.

Of SCI, Castillo says, “This is a very chal lenging disease, very complex, affecting every organ in the body. And if you don’t know about it, you have us as an institution, we can help you understand it. The more under standing people have about this disease, the better for our patients.”

Camilo Castillo, MD, serves as the director of spinal cord injury programs at UofL Health – Frazier Rehab Institute in UofL Physicians – Physical Medicine and

LOUISVILLE Despite spending a decade as a physical medicine and rehabilitation doc tor specializing in spinal cord injury (SCI), Camilo Castillo, MD, still finds having that initial conversation around prognosis takes an emotional toll.

Castillo received his medical degree from the Foundation Universidad Juan N. Corpas in Colombia. He then went on to complete both a residency in physical medicine & rehabilitation and a fellowship in spinal cord injury medicine at Virginia Commonwealth University School of Medicine in Richmond, Virginia.

Currently, he serves as the director of spinal

RehabilitationPHOTOS

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At UofL Health – Frazier Rehab Institute, a combination of compassion, collaboration, and comprehensive care all factor into successful rehabilitation from life-altering spinal cord injuries

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20 MD-UPDATE

BY DONNA ISON

“When a patient arrives at Frazier Rehab, an interdisciplinary approach is essential.” - Camillo Castillo, MD

Finding Purpose After Prognosis

Spinal cord injury is a rare disorder, with only 17,800 cases occurring each year. Most patients with traumatic spinal cord inju

Castillo states, “On average, patients with cervical injuries receive inpatient care for about four weeks. We believe that the faster we get these patients mobilized, the better for them.

For thoracic injuries, the stay is about two weeks, which means patients spend a much longer time rehabilitating in an outpatient setting.

Castillo explains the protocol for SCI: “First, patients with suspected traumatic spi nal cord injury should be managed in an acute trauma center, such as UofL Health – UofL Hospital, equipped with specialized services. We know that care in those types of centers has been associated with decreased length of hospitalization, cost of care, and medical complications, including pressure injury. The rehabilitation process starts soon after the patient is stabilized and able to mobilize. As soon as the patient is medically stable and able to participate for 3 hours, the patient is moved to inpatient rehabilitation.”

To assist with the all-important transition from inpatient to outpatient therapy, UofL utilizes nurse navigators to ensure patients and their families have the appropriate resourc es to continue their rehab process. Because of common complications, including bowel issues, urinary tract infections, skin lesions, fractures, and obesity, it is imperative that pri mary care physicians and nurse practitioners are educated on the importance of continued rehabilitation.

Castillo’s main goal is increasing the level of care and accessibility for individuals with SCI. He states: “There is so much to do to enhance care access for our patients, and even more here in Kentucky, where we have a vast number of patients living in rural areas with only limited access to SCI equipment, resources, and SCI providers like me. Our department is unique with a coordinated mix between neurosurgery and PM&R. That, along with tremendous support from the university and UofL Health, has allowed me to build an SCI program that fits the population we serve.”

Isaac Hernandez jimenez, MD, from the University of Texas, Camillo Castillo, MD, UofL Health – Frazier Rehabilitation Institute, and Federico Montero, MD, from Costa Rica attended the annual physical medicine and rehabilitation meeting in Cordoba, Argentina. The three physicians presented on topics in spinal cord injury and promoted the Spanish translation of materials used by ASIA to train providers in the

Our bodies are not designed to be in a chair, to be in a bed. Our bodies are designed to move.”

Due to the complex nature of spinal cord injuries, it truly takes a network of individ uals working together to enhance a patient’s chance for

USA.SPECIAL

Accordingsuccess.toCastillo, “When a patient arrives at inpatient rehab, such as Frazier Rehab, an interdisciplinary approach is essential. Members of that team should include the rehabilitation physician and nurses; physical, occupational, speech, recreational, and vocational therapists; a psychologist; and the social worker or case manager. There are also other specialized areas such as orthotics, wheelchair experts, specialized navigators and educators, and often peer mentors. Most importantly, the patient and family are members of the team.”

The level of the injury often dictates the level of limb functionality and future difficul ties. With a cervical injury affecting mainly limb function from the neck down, the likeli hood of loss of control of the arms as well as legs is greater. The lower down on the spine that the injury occurs, the more limb func tionality is likely.

Protocol and Progress

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Severity is classified using an “ASIA exam,” which scores the level of injury from A through E, with A being the most severe and E being people with more residual function, including bowel and bladder. ASIA A indi cates no sensory or motor function has been preserved in the sacral segments. Castillo says,

SECTION SPINE INjURY & REHABILITATION

In Closing

“I tell patients, ‘You want to fail this test. You want to get a D, not an A. Because a D means you still have a lot of function going on in your body. And that will give you a better functional outcome.”

ries are between 17 and 40 years old and more often young males. Common causes are motor vehicle accidents, gunshot wounds, falls in the elderly, and sports.

It Takes a Village

Two factors affect the prognosis in spinal cord injuries: level and severity. Castillo states, “There are so many types of spinal cord injuries. You have cervical injuries, thoracic injuries, lower thoracic injuries, and each one of these levels has its unique challenges.”

22 MD-UPDATE

Neurology had interested Odago before medical school, and his interest piqued when he met and shadowed neurologist Dr. David

While it might seem that they spoke into existence his eventual interest in the medical field, the reality is that Odago took a long and unique path to his current position as a neu rologist at CHI Saint Joseph Medical Group in HisLexington.mother was a math teacher, which seemed to explain why he took an interest in science as a medical researcher. Odago came to the United States in 1998 to attend Berea College in Kentucky. Having no family in the United States, he relied on the resources provided by Berea College to help absorb the culture

Speak It Into Existence

These tests are intended to help reduce the risk of subsequent neurological disease. That is the type of work that Odago says makes neurology more important than is sometimes perceived.“There is a misconception that, when it comes to neurological conditions, we cannot do much,” Odago says. “There is the percep tion that these are conditions that patients will just have to deal with. I beg to differ with that impression of neurology. What we do as neu rologists has significant practical implications.”

Known as “Doc” as a child, Fred Odago is now a neurologist at CHI Saint Joseph Medical Group

Advances in Migraine, ALS, and Alzheimer’s

— Fred Odago, MD, CHI Saint Joseph Medical Group – Neurology

After graduating from Berea College, Odago did not immediately enter medical school. Instead he spent the next decade working in biotech companies and research labs at the University of Kentucky and Case Western University. He enrolled in biomed ical science courses and earned a master’s degree in toxicology before ultimately enroll ing in medical school at the UK College of Medicine. By the time he completed medical school in 2016, he was a father in his 30s. He performed research in neuroscience at UK for a year before returning to do his residency,

2021.PHOTO

BY GIL DUNN

“There is a misconception that, when it comes to neurological conditions, we cannot do much. There is the perception that these are conditions that patients will just have to deal with. I beg to differ with that impression of neurology.”

Mentorship Created a Career Path

come to the U.S. as a student you’re in the midst of an environment where you have to kind of figure things out,” Odago says. “I was very lucky at Berea College since they have a host family program. My American host family guided me through those initial phases in this country. That was invaluable in my transition to life in the U.S.”

Fred Odago, MD, joined CHI Saint Joseph Medical Group in Lexington as a neurologist on August 1,

Now, Odago is fully into his routine at CHI Saint Joseph Health. He drops his kids off at school in the mornings and is at work in the clinic by 8:30 AM. There he takes care of patients with neurological disorders such as migraines, epilepsy, multiple sclerosis, myas thenia gravis, amyotrophic lateral sclerosis (ALS), dementia, and stroke.

“Whenshock.you

which he completed in June 2021. He joined CHI Saint Joseph Medical Group on August 1, 2021, as a clinical neurologist.

Odago points to advances in migraine treat ment, which includes many new medications that are highly targeted to help reduce or even prevent the disabling impact of severe migraines.

LEXINGTON When he was a child growing up in Kenya, Fred Odago, MD, was never pres sured to become a physician, not even by his uncle, who was himself a doctor. Nonetheless, Odago’s family called him “Doc,” never knowing how prophetic the nickname would prove to be.

“I think migraines are starting to be rec ognized as a significant cause of disability,”

SPECIAL SECTION NEUrOLOGY

BY JIM KELSEY

Regarding stroke care, he notes that the clinic follow-up visit is essential in limiting the risk of further strokes. Odago says, “I want to make sure they don’t have a subsequent, even more catastrophic stroke. I do testing for heart conditions such as abnormal heart rhythm that needs to be addressed to prevent another stroke. Sometimes they have abnormal blood vessels and limited flow in the blood vessel that will need to be addressed via vascular surgery.”

Blake at Saint Joseph Hospital and Cardinal Hill Rehabilitation Hospital. “That was how neurology came to mind even before medical school,” says Odago, who also considered a career in internal medicine.

Alzheimer’s disease, there is active research on effective medication to prevent its progression, but also trying to identify patients who are at risk of getting dementia and prevent them from progressing down that path.”

KY

For patient referral or859.296.1922859.313.2255 SPECIAL SECTION NEUrOLOGY

“I need to meet the patient where they are,” he says. “It’s like a partnership. The patient has to be involved in the shared decision-mak ingSimilarly,process.” Odago stresses that neurologists must be seen and valued as an essential part of the patient’s health care team.

After all, it’s always good to have a “Doc” on your side.

Odago says. “In the past, people used to just find a way to live with it. Today, people are starting to appreciate how many options are available in migraine treatment.”

Patient-physician collaboration is an essen tial component of Odago’s philosophy of care.

Odago says advancement in identifying bio markers can help lead to early detection of risk and allow patients to work with their caregivers to develop a preventive plan. These biomarkers can also help assess treatment response and potentially guide future neurology research.

CHI Lexington, 40516

According to Odago, migraines can be trig gered in a variety of ways, including weather changes, particular smells or odors, menstrual cycles, or flashing lights. The treatment process can include, in select cases, obtaining head imaging (MRI) to rule out any underlying abnormalities. Once those abnormalities are ruled out, medication can help control the migraines and minimize the symptoms in manyOdagocases.says that major strides in neurology are leading to more effective treatment of MS, ALS, and Alzheimer’s.

“The role of a neurologist in the care of a patient cannot be overstated,” Odago says. “It is very critical. We help fill in the gaps to make

SAINT JOSEPH HEALTH MEDICAL GROUP - NEUROLOGY 1021 Majestic Drive Suite 200

ISSUE #137 23

“People think that when they develop neu rological conditions such as dementia, there’s nothing that can be done,” Odago says. “I believe in the next five years we will be address ing diseases such as Alzheimer’s and ALS dif ferently from how we’re looking at it today. In

sure the patient is getting the resources they need. The patient will be very happy to have us in their corner.”

LEXINGTON How does chronic pain change a patient? How can a patient change their relationship to chronic pain? If you are asking these questions, you will be excited to know that you have a valuable resource for answer ing them in Wellward Medical, Lexington’s most integrated and cutting-edge clinic for orthopedic, pain, and mental health problems. Wellward is focused on providing patients with answers to these two questions. Having arrived at a thoughtful, integrative response to the former question over the last few years, Wellward has now developed a comprehensive approach to the latter. Chronic pain suffer ers can soon enroll in a 24-session course that Danesh Mazloomdoost, MD, and his multi-disciplinary team have created to help alleviate the enduring physical and psycholog ical effects of chronic pain.

24 MD-UPDATE

Graduating from Chronic Pain: Every Patient’s Right

BY TIM CORKRAN

GIL DUNN

With the guidance of a diverse array of clinicians and the support of a cohort, the Wellward program patients will work their way to a deeper understanding of their relationship to chronic pain and to an empowerment to move beyond what has limited them. “The ultimate goal with our version of chronic pain treatment is to optimize the patient’s function and quality of life beyond even pre-injury baseline. By demystifying pain and increasing awareness of the biologic processes that led to injury, we look beyond treatment and toward prevention,” says Mazloomdoost.

Dr. Mazloomdoost conducts a comprehensive ultrasound as part of the pain mapping process to identify source of chronic pain.

Innovative new program is designed to HEAL chronic pain patients through group learning

PHOTO BY

Key to accomplishing this will be Wellward’s partnership with integrative services and abun dant, carefully orchestrated outsourcing and coordinating.

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ISSUE #137 25

Mazloomdoost’s work in recent years has focused on a deep respect for the potency of chronic pain and its ability to alter a patient’s sense of self. “Chronic pain can lead to an identity crisis,” he says. “Thus, the treatment must be psychological as well as physiological.” The Wellward answer combines psychological, physiological, kinesiological, and pharmaco logical elements in a longitudinal framework, neatly summarized in the acronym HEAL.

For some time, Wellward has guided individ ual chronic pain patients through the HEAL process in depth, over the course of several months, as each part has multiple elements, and each patient has a unique pain profile. From an observed initial success came the idea to scale a model that would leverage commonly held ideas of the value of cohort learning, reg ular meeting times, and published curriculum.

Much of each cohort’s work will go into the H and E steps of the HEAL process. Foremost is learning a vocabulary of pain to demystify it. Patients need to be able to say more than “It hurts.” Acknowledgement of the identity crisis that chronic pain compels is also an integral step. Moving forward into a fruitful reducedpain or pain-free life necessitates understanding just how identity-altering the discomfort and coping have been. Wellward has six clinicians involved in the process at this point. Some curricular segments will be led by a physical therapist as the group examines physiological elements of chronic pain. Some segments will be led by an MSW as relation ship issues are explored.

• Leveraging repair mechanisms, which includes an array of tools, from optimal physical reconditioning, to addressing socio-behavioral issues, to enhancing the biology of repair.

States Mazloomdoost, “The HEAL method ology is a transitioning of traditional pain man agement toward non-surgical repair of damage. Our philosophy relies on using pain as the tool to uncover the roadblocks preventing organic repair then facilitating it with a multi-disci plinary approach: mental health, biologics, and movement.” He refers to these three as “the trifecta of chronic pain.”

HEAL begins with pain mapping and diag nostic injections to isolate specific elements:

Scaling HEALing: The Development of a Curriculum

PHOTO

Mazloomdoost knows that some difficult emotional issues may arise for patients in the process, so a psy chiatrist is included in the “faculty.”Coordination and con tinuity will be crucial ele ments in the program’s suc cess. The multi-disciplinary team that is facilitating the process will communicate

The Wellward Understanding of Chronic Pain Treatment

explains. The result is a flexible model of onehour weekly meetings that will take place over about 6 months. At this point, the curriculum is developed, the workbooks are printed, and the syllabus is set. Mazloomdoost is excit ed, announcing “We are currently collecting cohorts and anticipate launch in early 2022.” There will even be a self-guided on-line version.

• Envisioning the ideal vision of life held by the patient;

• Alleviating symptoms, both medically and through therapy; and then

The structure is not unlike a graduate sem inar: weekly in-person sessions will include guest lecturers, breakout room conversations, and a group of like-minded individuals shar ing their evolving understanding of the topic.

“We consulted with many of our existing partners in PT and social-emotional learning to develop a comprehensive, multi-meeting pro gram that could be tailored to meet the needs of different demographics,” Mazloomdoost

PROVIDED BY WELLWARD MEDICAL SPECIAL SECTION PAIN MEDICINE

stretchingparticipatePatients/studentsinagroupexerciseclassconductedbyJamesEscaloni,PT,DC.

with each other as they pass their “students” onto the next clinician — to give continuity. “The curriculum helps take the patient through the steps of tuning up their entire system, so that patients do not end up experiencing the debilitating effects of more chronic pain in the future,” says Mazloomdoost’sMazloomdoost.workat Wellward Medical continues to push the boundaries of the health care industry’s limited understanding of diag nosing and treating chronic pain. His firm belief is that there is so much to learn about the patient experience with chronic pain, and so much room for enhancing the quality of life of its afflicted. He encourages healthcare professionals to embrace this discovery process and “Admit that we don’t know how much we don’t know about the experience of sufferers of chronicWellwardpain.”has created a program that aspires to help those sufferers evolve how they alleviate and grow beyond their pain. Mazloomdoost believes that as more healthcare professionals recognize its potential, Wellward Medical can graduate more patients to a life beyond chronic pain’s crippling grasp.

• Hearing the body’s message conveyed by pain;

Key will be the filling out of demographically aligned groups based on age, gender, and con dition. This will leverage the power of shared experience, which is so often crucial to efficient group-based learning.

BY MIRIAM SILMAN, MSW

To that end, regular and continuous screen ing is a must. Physicians and all healthcare professionals must be encouraged and expected to check in with themselves and one another as part of their practice. Staff meetings, huddles at the start or end of shifts, and one-on-one supervision should address not only patient needs but include a routine check-in with staff about the emotional impact of the work, how they are coping, and what they need. Casual conversations and relationship-build ing, critical for connection especially when PPE obscures our most human features, should be encouraged among staff. A number of validated screeners for burnout, compassion fatigue, secondary stress, depression, anxiety, and PTSD are available4 and should be offered and integrated into supervisory and staff meet ings and crisis response protocols to promote early detection and intervention and normalize the emotional toll of the work.

Screening is a Must

Public Awareness and Recognition

Miriam Silman, MSW

FRANKFORT The ferocity, duration, and unpre dictability of the current pandemic leave healthcare providers particularly vulnerable to negative psychosocial impacts: COVID-19 is an occupational hazard. This is no surprise: past pandemics have had similar effects, and healthcare workers have long suffered from burnout, compassion fatigue, and secondary traumatic stress, albeit to a lesser extent. This pandemic has exacerbated, not created, these stressors. But, the COVID-19 pandemic also offers an opportunity to address the toll of healthcare work in more effective and evi dence-informed ways to build and sustain a resilient workforce.

SPECIAL SECTION MENTAL HEALTH/PuBLIC HEALTH

mal limits. This should occur through regular information about normal stress responses and supportive resources provided at staff meetings and through regular staff communications in newsletters, email blasts, and other social media outreach. Past pandemics indicate that posting information for staff to access as needed is not enough when they are working long hours and experiencing pandemic-related additional stress; information must be actively, routinely, and repeatedly pushed out through personal and media communication channels.3

Mental Health Impact of COVID-19 on Healthcare Professionals: Occupational Hazard, Unique Opportunity

System Responsibility

Self-care must be reimagined from big escap ist activities to relax outside of work, to small, routine parts of even the busiest days that pro mote emotional self-regulation and well-being. This includes ensuring that staff have access to scheduled breaks and meals, healthy food, fresh

26 MD-UPDATEThe

Re-imagined Self Care

This starts with public awareness and rec ognition that, yes, it’s actually okay to not be okay, even among physicians. A robust body of literature concludes past pandemics created a plethora of negative psychosocial responses for healthcare professionals: depression, anxiety, symptoms of traumatic stress, sleep and appe tite disturbances, and somatic aches and pains.1 Emerging data confirm that this pandemic is no exception,2 with consistently elevated self-reports of depression, anxiety, traumatic stress, overwhelm, emotional exhaustion, and burnout noted across all healthcare profes sions, transcending geographical and cultural borders. Risk factors are also consistent with past pandemics: being female, younger, newer to the field, working as a nurse, working on the “front line,” and having any pre-pandemic mental health concerns increases vulnerability. And, not surprisingly, there is also a direct correlation to dose exposure from working with the sickest patients. Leaders, agencies, organizations, and professionals must normal ize the occupational hazard of COVID-19 for the mental health and well-being of workers; feeling even extreme stress is well within nor

First, it is critical to recognize this as a sys tem responsibility. For years, self-care has been promoted as an individual act, and suffering from burnout seen as indication that somehow you were not cut out for the job. We now understand how wrong-headed this view is. Organizational systems must create a culture that understands, recognizes, and actively seeks to prevent and mitigate burnout, secondary trauma, compassion fatigue, and moral distress in its staff. This level of transformative change requires clear understanding, buy-in, and engagement across all levels of healthcare, espe cially among leadership, to promote a multitiered system of supports integrated into the organizational structure and fabric of health care systems. This should include confidential mental health coverage and support through health insurance and EAP resources, including crisis response and a way for physicians and all staff to seek support for themselves and others. Resilience-building practices and policies must recognize staff well-being as a critical driver for a successful and sustainable healthcare system.

NOTES

Leaders, especially physicians, must recog nize the cumulative toll of exposure to trauma and consider how to reduce or manage high levels of exposure for themselves and their staff. Designating specific staff to COVID units permanently is not recommended; instead, creative rotating schedules to minimize the number of staff exposed while also ensuring that the highest risk and most grueling work is not falling on only a few individuals, is critical. While bonus pay and relying on volunteers may attract some, the organization and phy sician-leaders must still titrate exposure to the most stressful conditions to sustain the work force physically and psychologically. Resiliencepromoting supports to staff working in the highest-exposure areas are even more critical. They must be allowed and encouraged to take breaks and have access to nutritious food, and supervisors must monitor staff well-being through daily group check-ins, regular indi vidual supervision, and routine staff screening.

Mental Health American, (2021). The mental health of healthcare workers in COVID-19. Available at: workers:mentalRajasekaran,Stubbs,J.,S.,Prasad,covid-19mhanational.org/mental-health-healthcare-workers-https://A.,Civantos,A.M.,Byrnes,Y.,Chorath,K.,Poonia,Chang,C.,Graboyes,E.M.,Bur,M.,Thakkar,P.,Deng,Seth,R.,Trosman,S.,Wong,A.,Laitman,B.M.,Shah,J.,V.,Long,Q.,Choby,G.,Rassekh,C.H.,Thaler,E.R.,&K.,(2020).SnapshotimpactofCOVID-19onwellnessinnonphysicianotolaryngologyhealthcareAnationalstudy. OTO Open 4(3).

De Kock, J.H., Latham, H.A., Leslie. S.J., Grindle, M., Munoz, S-A, Ellis, L. Polson, R. & O’Malley, C.M. (2021). A rapid review of the impact of COVID-19 on the mental health of healthcare workers: Implications for supporting psychological well-being. BMC Public Health, 21(104).

Leadership must actively support and model care for worker well-being. Incorporating sup portive practices and policies to care for staff requires ongoing and public support and mod eling by leadership at all levels. As senior clinicians, physicians must acknowledge the

Salazar de Pablo, G., Vaquerizo-Serrano, J., Catalana, A., Arangob, C., Morenob, C., Ferred, F., Shine, J.I., Sullivan, S. Brondinog, N., Solmia,M., & Fusar-Poli, P. (2020). Impact of coronavirus syndromes on physical and mental health of health care workers: Systematic review and meta-analysis. Journal of Affective Disorders, 275.

ISSUE #137 27

toll of this pandemic, and shed the superhero, tough-upper-lip stance they have been taught, instead revealing their own humanity, exhaus tion, distress, and needs. Floor managers and clinic supervisors will only support staff if physicians and all top leadership do as well. Executive meetings and supervision should include check-ins, administrators should uti lize mindful minute strategies, and above all, leaders, including physicians, must acknowl edge the toll of pandemic work and regularly thank and affirm their staff individually and collectively. Leaders should promote a culture of engagement and participation and empower staff in creative and collaborative problem-solv ing, powerful antidotes to the profound sense of powerlessness endemic to the current uncer tainty of this pandemic. Leaders should also model and encourage collegial connection to reduce isolation and promote constructive sharing and support.

3 Evidence-informed guidelines for pandemic response including support to healthcare providers can be found at: thementalR.Miotto,pandemic_planning_and_response.pdffiles/evidence_informed_guidelines_for_child_focused_https://www.uky.edu/ctac/sites/www.uky.edu.ctac/K.,Sanford,J.,Brymer,M.J.,Bursch,B.,&Pynoos,S.(2020).ImplementinganemotionalsupportandhealthresponseplanforhealthcareworkersduringCOVID-19pandemic.

4 Psychometric screeners can be found at the uK Center on ctac/tier3screeningTraumaandChildrenWell@Workwebsite:https://www.uky.edu/

Finally, it is imperative to find hope and positivity. Although compassion fatigue and secondary traumatic stress may be inherent costs of caring for others, they are mitigated when providers also feel a sense of compassion satisfaction from their work – the sense that we are making a difference, that our work is valu able, and that there is meaning to our work. Physicians must share and celebrate the suc cesses, prize even small victories, and remind themselves and one another of their core values and their inspiration for choosing this “noble profession.”Thereisno doubt, the duration, severity and uncertainty of COVID-19 has had a deleteri ous impact on the mental health of healthcare professionals. There is also no doubt that it offers a unique opportunity to learn valuable lessons about resilience and transform health care practice to be more sustainable long after this pandemic has resolved. This must become a part of our work if we are going to be able to continue to do our work.

2 For current research and reviews of the literature to date on the mental health impact of the COVID-19 pandemic on healthcare providers see:

Miriam Silman, MSW, is Project AWARE/Trauma Informed Care Program administrator, Department for Behavioral Health, Developmental and Intellectual Disabilities, Cabinet for Health and Family Services.

air, and a supportive and affirmative leader who recognizes and thanks them for their efforts. Staff should be educated and encouraged to use short deep breathing and grounding strategies regularly between tasks throughout the day, to step outside for 5-10 minutes each shift, and to take care of their own bodily needs while at work. Staff meetings or shift huddles can start or end with three breaths, one-minute ground ing activities, or a short stretch.

Spoorthya,M.S., Pratapab, S.K. & Mahant, S. (2020). Mental health problems faced by healthcare workers due to the COVID-19 pandemic: A review. Asian Journal of Psychiatry, 51.

Model Leadership

Psychological Trauma: Theory, Research, Practice, and Policy. Advance online publication. Additionalhttp://dx.doi.org/10.1037/tra0000918informationandresourcescan be found at the university of Kentucky Center on Trauma and Children Well@ Work website: https://www.uky.edu/ctac/wellatwork

Shaukat, N., Mansoor Ali, D. & Razzak, J., (2020). Physical and mental health impacts of COVID-19 on healthcare workers: A scoping review. International Journal of Emergency Medicine, 13(40).

1 For information about the mental health impact of past pandemics see:

SPECIAL SECTION MENTAL HEALTH/PuBLIC HEALTH

Manage Exposure

AMA well-being resources are located here: https:// clinician.health/

Find Hope and Positivity

Braquehais, M.D., Varga-Cáceres, S., Gómez-Durán, E., Nieva, G., Valero, S. Casa, M. & Bruguera, E. (2020). The impact of COVID-19 pandemic on the mental health of healthcare professionals. QJM: An International Journal of Medicine, 1-5.

Søvold, L.E., Naslund, J.A., Kousoulis, A.A., Saxena, S., Qoronfleh, M.W., Grobler, C., & Münter, L. (2021). Prioritizing the mental health and well-being of healthcare workers: An urgent global public health priority. Frontiers in Public Health, 9.

Serrano-Ripoll, M.J., Meneses-Echavez, J.F., Ricci-Cabello, I., Fraile-Navarro, D., Fiol-deRoque, M.A., Pastor-Moreno, G., Castro, A., Ruiz-Perez, I., Zamanillo Campos, R., & Goncalves-Bradley, D.C. (2020). Impact of viral epidemic outbreaks on mental health of healthcare workers: A rapid systematic review and meta-analysis. Journal of Affective Disorders, 277, 347-57.

In the 1990s and 2000s, sociologists Sharon Hays and Annette Lareau began observing an all-out investment into children by their middle-class parents. Fueled by anxiety about the future of the American dream, parents were taking no chances to make sure their kids were able to compete for education and jobs — the keys to keeping their kids from falling through the middle-class cracks in the American economy.

Perhaps the most unanticipated downside to intensive parenting is adult-child estrange ment. I have spent the past ten years working with parents who have given up hobbies, sleep, and time with their friends to be the

The rules of family relationships are sud denly up for revision, without their input or awareness. Parents are dumbfounded to discover that their adult children’s perspec tives sound like something, not just from another generation but even from a differ ent planet. Here’s what I mean:

Going Through Hell? Keep Going

1. Don’t make things worse. So you have a chance to make things better.

It makes no sense to a parent who has always been there for their kids when an adult child suddenly cuts off contact. It feels terribly wrong. Yet, that’s what many parents are now experiencing. Almost one-third of my coun seling practice involves working with parents estranged from their adult children.

This hands-on parenting model is now the norm for American families, even for par ents who can’t afford the significant amount of time and money required to pull it off. “Intensive parenting” is now the aspirational ideal held by all races and classes in American society, according to researchers at Cornell University.Whether you view intensive parenting as careful and conscientious or anxious and overbearing, the research so far indicates (as expected) there are pros and cons to putting everything into raising your kids.

It’s devastating when the one thing you feel best about as a parent — being close to your children — suddenly turns sour. For many parents, it’s like a bad dream on an emotional rollercoaster, going from confusion and fear to shame and guilt to righteous indignation and helpless rage. Underneath it all is a profound sense of betrayal and abandonment.

The growing trend to cut ties with your parents is a major revision of the rules of American family life. Its roots trace back fifty years to a cultural shift emphasizing personal growth and happiness over family loyalty and duty. But who would have thought that a seemingly unrelated economic influence — the hollowing out of America’s middle class — would contribute to the unexpected side-effect of family estrangement?

best parent they could, assuming their child would naturally return the same degree of emotional closeness. University of Virginia sociologist Joseph E. Davis calls this expecta tion the “reciprocal bond of kinship.”

28 MD-UPDATE

How do you even begin to navigate this landscape?

Many parents’ reactions to being cut off by their adult children are entirely natural. Their initial responses are totally understandable, but they often don’t work and can make things worse. Even more confounding, many of the strategies that do work are counterintuitive. Estranged parents suddenly find themselves in unfa miliar territory.

Estrangement is a journey. It’s more like a marathon, so don’t try to sprint your way through the climate change of your relation ship with your adult child. Here are two ways to get started:

transferring our unrealistically high expecta tions of fulfillment from marriage onto what seemed like a safer bet — our kids.

Blinded by Estrangement: Can You Love Your Child Right Out of Your Life?

BY JAN ANDERSON, PSYD, LPCC

But the parental investment wasn’t just financial. It was also emotional, as children came to be seen as a primary source of happi ness and meaning. Some sociologists speculate this shift to a “child-centered” society was

Instead, many parents find themselves dematerialized from their children’s lives into the bewildering terrain of estrangement.

Abuse? Neglect? It’s easy to understand why an adult child decides to have nothing to do with a parent who subjected them to either. Loyalty test due to a bitter divorce? When kids are forced to choose sides, it’s no surprise that adult-child estrangement is an unfortunate consequence. But a close family with good kids? A single parent with a strong bond? No wonder parents are profoundly confused and caught off-guard when they find themselves in a spot normally reserved for “bad” parents.

MENtAL WELLNESS

• The “shift in power dynamics of your relationship” is a nice way of saying there’s a loss of status, power, and influence for you, the parent. It’s humbling, even humiliating, to be put in this position. No one likes to feel vulnerable — it’s like not having any skin — but denying the reality of your vulnerability is dangerous. Why? Because denial of reality will only make you more vulnerable. Here’s why dealing constructively with your very real vulnerability is safer, smarter, and saner:

To help clients reach their goals, each member of our team has been chosen for their unique talents: responsibility, strategic thinking, ideation, empathy, achiever, futuristic, analytical, intellection, maximizer, and discipline, just to name a few.

You’re interfering and meddlesome. I have some requirements for continuing to have a relationship with you.

Adult Child’s Perception

I’ve dedicated myself to your happiness. I’ve sacrificed for you. Doesn’t that mean anything to you?

filled with giant chunks of grief that test the strength and sanity of any loving parent. Offer yourself the support and self-compassion nec essary to get through it.

ISSUE #137 29

2. The pain of estrangement is unavoidable. Suffering is optional.

Estrangement liberates me from being responsible for your emotional needs.

There’s a saying that “it only takes one person to change a relationship.” There’s been a serious shift in the balance of power, but you may just be getting the memo. Here’s what it says:

EntitlementExpectations

Respect

3. You’re less likely to revert to passive/ aggressive, cold war tactics.

Estrangement is an act of empowerment. Estrangement is how I will set boundaries with you.

• Don’t expect your adult child to want to participate in or help you through this process. They will tend to see it as bur

So you’re still standing when the chance to reconnect presents itself.

I’m interested in you. I want to be there for you. I’m concerned about you.

• Acknowledge that the thing you most want — to get past this awful thing that shouldn’t be happening, so things can get back to “normal” — is probably not going to happen, at least not in the way you envision it.

SayRelationshipWhaaat?IssueParent’s Perception

1. You’re less likely to collapse into a lose/lose victim position.

2. You’re less likely to overreact and go on the attack.

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Purpose/Objective of Estrangement

Responsibility You’re hurting me. Can’t you see what this is doing to me?

Respect my privacy. Stop “stalking” me on social media.

We’re a close family. It’s important that we spend time together.

You’re a part of this family, and you’re expected to be here for family events.

Thinking clearly. Caring deeply.

Cutting off contact with my parents is an act of strength and courage, a way to become an autonomous adult.

You’re a narcissist. It’s all about you and what you Stopwant.being so needy. You’re pathetic.

You’re demanding and controlling. You’re entitled.

RightsAssumptions

densome or manipulative. Seek the help of a therapist experienced in estrange ment and do your own work before pre maturely pushing family therapy. Finally, did I mention none of this is easy? Estrangement from an adult child is

You’re trying to manipulate me with guilt. Stop using other family members to try to influence me.

Estrangement is how I’ll become agentic and keep you from being controlling or manipulating me.

Beverly Smith, DO

Cleveland Clinic Foundation and complet ed her fellowship in cytopathology at the William Beaumont Hospital in Royal Oak, Michigan. Prior to coming to Baptist Health Floyd, she was senior vice president of clinical services at the University Health System in San Antonio and clinical assistant professor of pathology at the University of Texas Health Long School of Medicine.

She is certified by the American Academy of Nurse Practitioners and is a member of the Kentucky Association of Nurse Practitioners and Nurse-Midwives.

PHOTOS PROVIDED BY BAPTIST HEALTH

Valerie Breeding, APRN

Tara Smith, DO, Joins Baptist Health Family Medicine

LEXINGTON After serving as presi dent of Baptist Health Paducah, Chris Roty has been named chief operating officer at Baptist Lexington.HealthHe succeeds Karen Hill, who retired earlier this year. Matt Bailey, a 36-year healthcare veteran, will be the interim president at Baptist Health Paducah.Inthe new position, Roty, 57, will provide day-to-day leadership and management of the 434-bed hospital, including working with the hospital’s leadership, boards, and medical and nursing staffs to develop high-quality, cost-ef fective integrated programs and ensuring those services are efficiently designed to meet the needs of patients, physicians, employees and the Undercommunity.Roty’sleadership, the 373-bed Paducah hospital was given a Best Hospitals in Kentucky ranking from U.S. News & World Report in 2019 and an “A” in patient safety from the Leapfrog Group. The hospital was recently awarded the Heart Care Center of Excellence and the Transcatheter Valve Certification by the American College of Cardiology.Priorto the Paducah post, Roty served as president at Baptist Health La Grange. During his time there, the 120-bed hospital was named a Certified Stroke Center by The Joint Commission and earned Pathway to Excellence® designation, recognizing a positive work environment where nurses can excel. The hospital also assumed management of the Oldham County Emergency Medical Services.While at La Grange, Roty continued to serve as a vice president at Baptist Health Louisville with primary responsibility for car diovascular services. During that time, the Louisville hospital was named one of the nation’s Top 50 Cardiovascular Hospitals.

Baptist Health Floyd CMO Sworn in as President of College of American Pathologists

NEW ALBANY, IN Baptist Health Floyd Chief Medical Officer Emily Volk, MD, FCAP, is the 37th president of the College Pathologists.Americanof

Roty Named Chief Operating Officer at Baptist Health Lexington

30 MD-UPDATE News

Roty began his career with Baptist Health in 1994 as an assistant vice president for Baptist Hospital East, now Baptist Health Louisville, and was named a vice president in 1996.

LEXINGTON Beverly “Tara” Smith, DO, has joined Baptist Health Medical Group Family Medicine in uateSmithLexington.isagradoftheLincoln

Her services include everything from well visits and disease prevention to health mainte nance and care for urgent conditions.

The CAP, founded in 1946 with an esti mated 18,000 members, is the world’s largest organization of board-certified pathologists specializing in diagnostic pathology and lab oratory medicine, and a leading provider of laboratory accreditation and proficiency testing programs.

Valerie Breeding, APRN, Joins Baptist Health Internal Medicine & Pediatrics

LEXINGTON Valerie Breeding, APRN, has joined Baptist Health Medical Group Nicholasville.PediatricsMedicineInternal&inBreedinghasa

Chris Roty

“I am dedicated to provide leadership to drive successful execution of our core mission to serve patients, pathologists and the public by fostering and advocating excellence in the practice of pathology and laboratory medicine worldwide,” said Volk, who is also an associate professor of pathology at the University of Louisville School of Medicine.

Emily Volk, MD, FCAP

Master of Science in nursing, from East Tennessee State University and a BS in nurs ing from Virginia Commonwealth University.

Volk received her undergraduate and med ical degrees from the University of MissouriKansas City and her MBA from the University of Massachusetts. She completed her residen cy in anatomic and clinical pathology at the

Memorial University-DeBusk College of Osteopathic Medicine in Harrogate, Tennessee. She served her internal medicine residency at Johnston Memorial Hospital in Abingdon, Virginia.

Eric J. Kiltinen, MD

Antonio Lopez, MD

Lexington Clinic Welcomes Six New Physicians

Leslye Jones, DO, has joined Jessamine Medical and Diagnostics Center. Jones com pleted a residency in family medicine at Our Lady of Lourdes Memorial Hospital in Binghamton, New York, after receiving her medical degree from Kentucky College of Osteopathic Medicine. She provides general

Leslye Jones, DO

PHOTOS PROVIDED BY LEXINGTON CLINIC

Nessacare.Timoney, MD, received her med ical degree from Trinity College in Dublin, Ireland, and completed a residency in neuro surgery at UK. She provides consultation ser vices in cranial, spinal, and peripheral nerve surgery, including primary and metastatic brain tumors, vascular lesions, spinal tumors, deformative and degenerative spinal disease, and compressive neuropathies. Timoney’s pro fessional interests include minimally invasive spinal procedures, spinal fusions, neurosur gical oncology, and stereotactic radiosurgery

services for adults and children and travel medicine, as well as preventive and whole person

Sanjay Agarwala, MD

at UK. She provides services in urgent care and family medicine, including care for minor injury and illness. She is passionate about pre ventative health and can assist with smoking cessation, diabetes management and screening forAntoniodiseases.Lopez, MD, has joined Lexington Clinic Richmond. Lopez completed a resi dency in internal medicine and pediatrics at UK and received his medical degree from the University of Texas Southwestern Medical Center. He provides services in preventative medicine for adults and children, birth to geriatric age, primary care for acute and chronic medical conditions, well-child phys icals, ill-child care and child immunizations.

Katharine Freeman, MD, has joined Jessamine Medical and Diagnostics Center. Freeman received her medical degree and completed her residency in family medicine

Sanjay Agarwala, MD, has joined the Center for Breast Care and is located in the main South Broadway building. Agarwala is board certified in radiology and received his medical degree from Meharry Medical College in Nashville, Tennessee. He com pleted a residency in diagnostic radiology at Bronx Lebanon Hospital Center in New York City. Agarwala’s professional interests include radiology, breast imaging, breast cancer, dis ease of the breast, and women’s imaging.

Nessa Timoney, MD

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.

Katherine Freeman, MD

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com ISSUE #137 31

LEXINGTON Eric J. Kiltinen, MD, has joined Hospital Medicine based out of CHI Saint Joseph Health Office Park. Kiltinen received his medical degree from the UK College of Medicine. Kiltinen provides services and care for inpatients at CHI Saint Joseph Health. His clinical interests include inpatient medicine, hospice and palliative care, and geriatrics.

PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH AND UofL HEALTH

Siddiqui earned his medical degree in his home country of Hyderabad, India, at Gandhi Medical College. In 2013, he came to New York for his residency and fellowship at Staten Island University Hospital. Siddiqui gained experience serving patients across the nation, helping to make strides in the development of pulmonology treatment in San Antonio, Texas; New Orleans, Louisiana; Staten Island, New York; and Champaign and Urbana, Illinois.

Hejazi is a member of the American Thoracic Society, American College of Chest Physicians, American College of Physicians, American Medical Association and IranianAmerican Medical Association.

attended medical school at Shahid Beheshti Medical University (SBMU), in Tehran, Iran. After earning his medical degree, he completed three years of post-grad uate research work at the National Research Institute of Tuberculosis and Lung Diseases (NRITLD) a WHO tertiary referral center for lung disease in Iran where he helped treat ing patients suffering from end-stage lung disease and struggling for life.

Hejazi did his residency at University of Illinois at Chicago Louis A. Weiss Memorial Hospital and also completed three fellow ships: a geriatric medicine fellowship at Loyola University in Chicago, a pulmonary disease fellowship at Chicago Medical School, and most recently, a critical care medicine fellow ship at Inspira Health Network, a Cooper University affiliated hospital in New Jersey.

Both Drs. Kenari and Siddiqui will practice at 1025 Saint Joseph Lane in London.

Dunlapcancer.served as vice chair and professor of the Department of Radiation Oncology before accepting his new role. In addition, he serves as the residency program director for theDunlapdepartment.earned his medical degree from the University of Cincinnati College of Medicine. He completed his internship at University of Cincinnati’s University Hospital and his res idency at the University of Virginia Medical Center in Charlottesville.

Neal Dunlap, MDS. Kamran Hejazi Kenari, MD

LONDON S. Kamran Hejazi Kenari, MD, has joined CHI Saint Joseph Medical Group –Pulmonology and Critical Care Medicine in London.Hejazi

Siddiqui is board certified in critical care medicine, pulmonary disease and inter

Phyo Phyo Ye Kyaw, MD Abdul Hasan Siddiqui, MD, FACP

32 MD-UPDATE NEwS

LEXINGTON Phyo Phyo Ye Kyaw, MD, has joined CHI Saint Joseph Medical Group – Pulmonology in Lexington. As a first-gen eration physician, Kyaw practices with the belief that helping patients breathe easier is a privilege – a vital service as our communities experiences the second year of the global COVID-19

His research interests include the application of new treatment technologies in the treatment of lung, liver, and head and neck malignancies to improve outcomes and reduce side effects. He currently has investigator-initiated trials open for the re-treatment of lung cancers after previous radiation and evaluating of early radiationinduced lung injury with four-dimensional CT. He is currently the institutional principal investigator for multiple national cooperative group studies through NRG/RTOG in the treatment of lung and head and neck cancers and is a member of the American Society for Radiation Oncology.

Dunlap has served as a radiation oncologist with the department and Brown Cancer Center since 2011, where he is also associate director of the Head & Neck Multidisciplinary Team. He specializes in the multidisciplinary care of head and neck cancer, lung cancer, esophageal cancer, and liver

Kyaw will practice at 211 Fountain Court, Suite 210, Lexington, KY 40509.

LONDON Abdul Hasan Siddiqui, MD, FACP, has joined CHI Saint Joseph Medical Group –Pulmonology in London as a pulmonologist.

Kyaw receivedpandemic.her education in Burma from the University of Medicine 2, Myanmar, and completed her post-graduate trainings at Texas Tech University and Southern Illinois University. During her residency and fel lowship, Kyaw completed rotations within internal medicine, pulmonary consults, level 1 trauma, cardiac intensive care unit (ICU), and neuro ICU, among numerous others.

Neal Dunlap, MD, Named Chair of Radiation Oncology at UofL, UofL Health –Brown Cancer CenterLOUISVILLE Neal Dunlap, MD, has been named chair of the University of Louisville School of Medicine’s Department of Radiation Oncology and UofL Health –Brown Cancer Center.

Three Doctors Join CHI Saint Joseph Health

nal medicine by the American Board of Internal Medicine. He is also certified by the Educational Commission for Foreign Medical Graduates.

Norton Neuroscience Institute has opened the doors on a brand-new, state-of-the-art facility at our Norton Brownsboro Hospital campus.

A brand-new, comprehensive facility in the Norton neuroscience family.

It is also home to Norton Neuroscience Institute Memory Center, Cressman Parkinson’s & Movement Disorders Center and Cressman Neurological Rehabilitation, as well as outpatient care, diagnostics and testing for a wide range of neurological disorders.

To refer a patient to Norton Neuroscience Institute, visit NortonEpicLink.com or call (888) 4-U-Norton

Further expanding our existing network of neuroscience locations — and our role as the region’s leader in neurological care — this new location provides comprehensive, multidisciplinary neuroscience programs grounded in specialized expertise, technology, enhanced research and centralized collaboration.