ISSUE WWW.MD-UPDATE.COM#138 THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS 12VOLUME • #1 • 2022ryUAbrEF ALSO IN THIS ISSUE STEVEN J. HEATHERLY, MD, BAPTIST HEALTH LOUISVILLE HEART FAILURE & PULMONARY HYPERTENSION CLINIC MOSTAFA OSMAN EL REFAI, MD, NORTON HEART & VASCULAR INSTITUTE STEPHANIE MOORE, MD, UofL HEALTH – ADVANCED HEART THERAPIES PROGRAM RACHEL MATHIS, MD, CHI SAINT JOSEPH HEALTH – CENTER FOR WEIGHT LOSS SURGERY
Geniusof Data-Driven Decisions Help Interventional Cardiologist Nezar Falluji, MD, Prevent Strokes
Stroke
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 #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
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As one of our cardiologists said to me, “Cardiology is always innovating.” The specialty is also increasingly collaborative with cardiologists, interventionalists, electrophysiologists, structural heart and cardiothoracic surgeons, RNs, social workers, dieticians, social workers, and case managers.
CONTRIBUTORS: Samantha Albuquerque Jan Anderson, PSyD, LPCC Jeff LanceNatalieKoonceLittlefieldMann,CPA, CFE, CGMA Stephanie M. Wurdock, Esq. Scott Neal, CPA, CFP Mac Stone
2 MD-UPDATE
Upcoming Specialties in 2022
Volume 12, Number 1 ISSUE #138
Welcome to the Heart, Stroke and Bariatric Surgery Issue of MD-Update
Heart failure programs, structural heart surgery, and the benefits of bariatric surgery are some of the topics we have for you in this issue of MD-Update. We spoke with some of the Kentuckiana physicians who perform life-saving surgeries and advocate for life-changing behaviors every day.
Losing a Friend
The AMA adopted a policy in 2020 aimed at improving the safety of physicians and other healthcare providers and has developed specific best practices for effective violence prevention strategies both in and out of healthcare settings. Have you seen or experienced violence in your workplace? Please let us know.
“Violence has no place in the medical profession,” says Dr. Harmon, “and so we as individuals and as leaders in organized medicine have a responsibility to do whatever we can to prevent it from occurring inside and outside of the workplace.”
The first time I met Lara MacGregor, founder of Hope Scarves, was in 2016 at her organization’s signa ture event “Colors of Courage.” That night, and every time I saw Lara thereafter, she was full of energy and enthusiasm for her cause, her sisters in cancer care, and life in general. Her passing is a loss, but she gave us so much while she was with us. There’s more about Lara on page 32 and at www.hopescarves.org
EDITOR/PUBLISHER Gil Dunn gdunn@md-update.com
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I invite you to get to know some of your colleagues and their work better by reading their stories inside this issue.
Workplace Violence in Healthcare
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Dr. Gerald Harmon, current AMA president, recently wrote about the increasing level of work place violence in the healthcare environment. Workplace violence, says Dr. Harmon, has been on the rise across the U.S. for decades, but with the onset of COVID-19, it is now reaching healthcare “with healthcare workers five times more likely to experience workplace violence than workers in all other industries, according to the U.S. Bureau of Labor Statistics.”
Lara MacGregor at Colors of Courage, 2018
You’ll see the 2022 MD-Update editorial calendar on the preceeding page. I invite you to find your specialty and contact me so we can tell your story. If your specialty is not listed, that’s even more reason to reach out to us. I look forward to hearing from you. 859.309.0720
ISSUE #138 3 CArDIOLOGy • bArIATrIC SUrGEry ISSUE #138 16 CARDIOLOGY 18 CARDIOLOGY 22 CARDIOLOGY 24 BARIATRIC SURGERY CONTENTS SPECIAL SECTIONS 4 HEADLINES 5 ACCOUNTING 6 FINANCE 7 LEGAL 9 OP/ED 12 COVER STORY SPECIAL SECTIONS: 16 CARDIOLOGY 24 BARIATRIC SURGERY 26 PUBLIC HEALTH 28 MENTAL WELLNESS 30 NEWS 12 Stroke of Genius Data-Driven Decisions Help Interventional Cardiologist Nezar Falluji, MD, Prevent Strokes COVEr PHOTOGrAPHy by MArK MAHAN
Rahman, a graduate of Dow Medical College in Pakistan, completed the nephrolo gy residency program at the Baylor College of Medicine. He is a graduate of the University of Louisville’s MBA program. He joined Nephrology Associates of Lexington in 1994 and was appointed its president in 2015. He is the president of the medical staff at Saint
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The 2022 LMS leadership includes Angela Dearinger, MD, vice president, and Tina Fawns, MD, secretary treasurer. Lee Dossett, MD, is the president-elect, and Hope Cottrill, MD, is the vice president-elect.
Joseph Hospital in Lexington and on the Renal Physician Association Healthcare Practice Committee. Rahman, as LMS President, will focus on practice management education, retention of physicians, and rebuilding the relationship between the healthcare commu nity and the public.
Learn more about the Lexington Medical Society and its programs at lexingtondoctors.org.
The Lexington Medical Society is a non-prof it 501(c)(6) organization that supports physi cian members to improve the practice of med icine and the health of the community. The LMS, established in 1799, is one of the oldest medical societies in the country.
LEXINGTON Khalil Rahman, MD, a Lexington nephrologist, was installed as president of the Lexington Medical Society (LMS) on January 11, 2022, at a virtual ceremony attended by past Lexington Medical Society presidents, dating back to 1978. James Borders, MD, a Lexington internal medicine physician, was recognized for his outstanding leadership as the LMS president in 2021. Borders’ tenure started during the pandemic, and his focus was to communicate to the community throughout 2021 on the importance of COVID-19 vacci nations, masking, and social distancing.
PHOTO PROVIDED BY LEXINGTON MEDICAL SOCIETY
Lexington Medical Society Installs 2022 President
During a virtual induction, Dr. Khalil Rahman begins his term as president of the Lexington Medical Society.
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on allowable expenses and cannot be applied against lost revenue. Resources for allowable uses of these funds can be found at asbying-home-infection-control-distribution.gov/provider-relief/reporting-auditing/nurswww.hrsa.Thereisnograceperiodforsubmittingyourreportforperiod2.MakesureyouallocateasufficientamountoftimetocompleteyourreportingMarch31,2022.PleaseletDeanDortonknowifwecanhelpyouworkthroughreportingperiod2
New PRF Reporting Portal users must first register in the PRF Reporting Portal (https:// prfreporting.hrsa.gov/s/). If a reporting entity has previously reported, they may log into the
portal with their existing username, TIN, and password.HRSA has issued some new guidance for reporting period 2. Links for these new resources are detailed below.
Lance Mann, CPA, CFE, CGMA, assurance director, can be reached at 502.566.1005 and lmann@deandorton.com.
Provider Relief Fund Reporting Period 2
REPORTING PERIOD 2 FACT www.hrsa.gov/sites/default/files/hrsa/provider-relief/whats-new-in-rp2-fact-sheet.pdfSHEET:REPORTINGPERIOD2LOSTREVENUESGUIDE:www.hrsa.gov/sites/default/files/hrsa/provider-relief/prf-lost-revenues-guide-rp2.pdf
ACCOUNTING
BY LANCE MANN, CPA, CFE, CGMA, ASSURANCE DIRECTOR
This will also be the first time many recipi ents of the nursing home and infection control funds will be required to report on the use of these funds. One important thing to note about these funds is that they must be spent
The Provider Relief Funds Reporting Portal has opened for period 2. Providers who received one or more PRF payments exceeding $10,000, in the aggregate, during the second Payment Received Period (July 1, 2020 to December 31, 2020) must report on how these funds were used by March 31, 2022 in the PRF Reporting Portal. Payments received during this period must have been expended by December 31, 2021.
ISSUE #138 5
Drawdown risk. Because most people see the loss of capital, even if it’s only on paper, as their chief risk, most risk tolerance ques tionnaires ask the question, “How much drop in the value of your investments can you stomach before pulling the plug and going to cash?” A rational investor would not make an investment if he or she didn’t believe the investment was going to go up. Be that as it may, at times rational investors can be wrong. Their investments turn sour and drop in value. The chief risk control is to set a risk budget for each investment and for the port folio as a whole. Then set an alert on your smartphone to tell you if your investment hits that level and know ahead of time what you are going to do when the alert goes off. If you are right and the investment goes up in value, you can then move up the alert. Meanwhile, scale more money into winners and cut losses.
Risk of failing to achieve long term goals. We so often hear about people who sacrifice their long-term goals for a short-term promise of gain. Future regret is so hard for most of
Five Types of Risk and How To Deal With Them
Let’s look at four more different flavors of risk and what you might do to mitigate the impact of each one.
inflation by some margin. Some assets, such as commodities, precious metals, and real estate, are usually good hedges against inflation. Stocks, particularly the stocks of companies that are considered defensive stocks with good dividends, have consistently beaten inflation over longer periods. Short-term bonds or CDs are not inflation beaters. Additionally, inflation is the primary risk of most annuity payouts. Real estate works well against infla tion because a) property values are likely to increase, and b) investors can raise the rent to match inflation.
Investors face several types of risk, and I contend that it is a mistake to get so focused on just one that the others get short shrift. I often take an informal and unscientific poll to determine which risk is most prevalent in the minds of investors. Lately, because the U.S. stock market (as measured by the S&P 500) has dropped about 12% in the first 4 weeks of this year, a lot of investors found themselves scratching their heads and wondering what is coming next. They see the chief risk as losing their principal — or what I call drawdown.
BY SCOTT NEAL
6 MD-UPDATE
Scott Neal is president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Email your questions and or comments to scott@dsneal.com
Loss of purchasing power is experienced during periods of inflation. Inflation is insid ious and often goes unnoticed. I dealt with inflation rather extensively in the last issue and will not take up a lot of ink rehashing it here. (If you didn’t see that and you would like a copy, let us know.) Loss of purchasing power can generally be offset with assets that beat
Longevity risk. Perhaps I should have started with this one. Whenever we do financial planning for a client, we often run the numbers out to age 100 for both spouses. Actuarially, we know that most people won’t live that long, but you and I both know peo ple who have. Do you really want to take that risk? Running out of money before reaching such a ripe old age is rarely anybody’s goal, but it also isn’t something that any of us strive for. Most projections of smooth consumption, adjusted for inflation, show that to be broke at age 100 the asset values will likely peak at around age 92. That fact illustrates the impact of exceptional longevity and the rather large expense of our final years.
Volatility risk. Most investors are quite confident that the stock market will go up over long periods of time. They are also keen ly aware that stocks don’t go up in a straight line. While the trend may be up over time, there are a lot of ups and downs in the price of stocks. That is volatility. It is widely accept ed in the investment community that asset allocation (i.e., putting your investment assets into several asset classes, some of which move counter-cyclically to others) is a way to deal with volatility. Volatility is typically measured by the standard deviation of the distribution of returns over multiple time periods. Rest assured that a broadly diversified portfolio will underperform the best performing asset or index. However, if you use asset allocation and re-balance the portfolio periodically, you will likely have lower volatility than your neighbor who simply buys and holds. If you have a portfolio with x% return and your neighbor has a portfolio with the exact same return, but you do it with less volatility, you will have more dollars in the future than your neighbor who has the same average return. It’s just the math of compounding.
us to appreciate in the present moment while considering an opportunity to invest. This most often gets manifested in taking on too much debt, buying too much house, boat, or car — or simply outliving your resources. To mitigate this risk, it is important to regularly update your financial plan to reflect current circumstances projected into the future using reasonable assumptions. Considering alter native future scenarios (especially worst-case and best-case) becomes very valuable when tradeoffs are present. It is important to con struct long-term goals and then break them down into current-year actions that move you closer to the objective. I often advise that if we string together a series of Best Years Yet, we will end up with a well-lived life. Speaking of which . . .
All these risks should be addressed in any well-developed financial plan. Talk to your advisor about them today.
FiNANCE
Ensuring Informed Consent
First, providers should make sure the informed consent discussion is conducted with the appro priate person. In most instances, it is the patient. However, if the patient is mentally incompetent, under the influence, or under duress such that the patient’s ability to understand might be impaired, consent may be properly obtained from a patient representative. Examples include a patient who is under anesthesia or other mind-altering medications. It could also include a patient who suffers from dementia or another condition impacting cognition or memory. It could include patients who are not proficient in reading or speaking English.
that the patient (or, if applicable, the patient’s representative or POA) appeared competent to understand the information provided.
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 LEgAL
Provider Guidelines
Kentucky’s Informed Consent Statute, KRS 304.40-320, was enacted in 1976. Pursuant to Kentucky law, healthcare providers have a duty to disclose certain information to patients when recommending a procedure or treatment. The provider must disclose the expected bene fits and “substantial” risks of the treatment as well as “acceptable” alternatives. This infor mation must be imparted in such a way that a non-medical person would understand it.
This information should be communicated in terms patients can understand. The aver age American reads and comprehends at the 7th- to 8th-grade level, and this is likely true of Kentucky’s patient population. This means
ISSUE #138 7
BY STEPHANIE M. WURDOCK
To avoid a claim for lack of informed con sent, providers should advise patients of two categories of risk: (1) the most common or likely risks of the procedure, and (2) the most severe complications that could occur, no matter how rare. Providers should also discuss the treatment’s success rate and describe what a realistic outcome might be given the patient factors at play.
Informed consent claims typically arise when a patient suffers a rare and/or significant com plication of a procedure or treatment without being told of the possibility of that outcome. Patients typically allege that had that risk been divulged, they would not have agreed to the procedure. While the pertinent information
Informed Consent: Not a Mere Formality
Basis for Informed Consent
varies by procedure, there are some general guidelines a provider can follow to protect themselves from informed consent claims.
Valid informed consent requires the infor mation to be conveyed in such a manner that it would provide a “reasonable individual” with an understanding of the “substantial risks and hazards inherent” as recognized by the medi cal community. Providers are not required to disclose every risk possible. Indeed, a provider must balance the duty to inform with the responsibility not to unreasonably dissuade patients from receiving necessary medical care.
Most healthcare malpractice claims allege a failure to properly diagnose or treat a medical condition, which is what most providers think of when attempting to reduce their litigation exposure. However, another important aspect of patient care—informed consent—can be an independent basis for a medical malprac tice lawsuit. It is important for providers to recognize that informed consent is an import ant component of care, not a mere formality.
If a provider doubts the patient’s ability to understand the information, she should con sider suggesting that the patient return with a trusted representative (e.g., a spouse, adult child, sibling, or parent) for a follow-up discus sion. If the patient has a designated Healthcare Power of Attorney, that individual should be included in the conversation. Providers should document who was present when the informed consent discussion(s) took place and
include the names of all persons present. It should also include a recitation of the specific risks disclosed. Providers should avoid generic statements such as “The risks and benefits of the procedure were discussed.” Instead, consid er the following: “The benefits and expected outcome of the procedure were discussed as well as the most common and severe risks, which include but are not limited to _______.”
Put our
Discussions between providers and patients constitute the informed consent process, and this exchange of information is the basis of an informed consent claim. The formal “Informed Consent” document patients typi cally sign upon the conclusion of that conver sation does not constitute informed consent; such documentation is merely evidence that informed consent took place.
Lack of informed consent claims can be brought regardless of whether the procedure itself is ultimately found to have complied with the standard of care. For this rea son, engaging in and documenting thor ough informed consent discussions is vitally important to a provider’s practice.
The suggestions
An “Informed Consent” form, such as those utilized by ambulatory surgery centers and hos pitals, can certainly be used to help memorial ize the consent process. However, these forms should not be the only documentation. These
providers must avoiding using complex med ical terminology. For example, if a procedure carries the risk of nerve damage, use that phrase instead of “neuropathy.” Instead of “dyspha gia,” explain that the procedure could result in some temporary difficulty swallowing.
Once the proposed treatment is described, providers must disclose what reasonable alter natives are available and the general risks and benefits of each.
There is one caveat to the above suggestions. This article assumes a non-emergency situation with a patient who has the capability of receiv ing, comprehending, and considering the risks and benefits of treatment. In an emergency, where informed consent cannot be reasonably obtained before providing care, it is not required.
Finally, the conversation must include an opportunity for the patient to ask questions.
If possible, this documentation should be done contemporaneous with the discussion. And, if practicable, a copy of the note should be printed, signed by the patient, and copied or scanned into the record. A copy should be given to the patient. Providers should ensure the informed consent note is entered into the record prior to the procedure.
forms are infrequently tailored to the specif ic procedure, provider, or patient. Therefore, where possible, information regarding the spe cific risks, benefits, and alternatives should be added to these forms, and reference should be made to the complete note (discussed above).
From the business health care compliance to litigation defense, Turner’s experienced health care attorneys comprehensive legal services health care providers, hospitals managed care organizations across the Commonwealth. experience
of
What Should Be Documented?
Providers should author a visit or progress note memorializing the discussion. This should
Stephanie M. Wurdock is a healthcare attorney who works closely with providers, insurers, and risk managers to defend claims of medical malpractice. She is a member at Sturgill, Turner, Barker & Moloney, PLLC in Lexington. She can be reached at swurdock@ sturgillturner.com or 859.255.8581.
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provide
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to work for you. YOU CARE FOR EVERYONE♦ WE TAKE CARE OF YOU♦ Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.LAW LEgAL
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The note should also reflect that reasonable alternatives were discussed and that the patient was given an opportunity to ask questions.
to
8 MD-UPDATE
While we have a long road ahead of us, the American Heart Association (AHA), an organization I’m proud to volunteer with, is funding research, educating the public, and providing resources to those in need in hopes of providing a better quality of life to people throughout the Commonwealth and beyond. February is American Heart Month, and the
A series of consumer surveys conducted by McKinsey Global Surveys in 2020 and 2021 revealed just how much of an impact the pandemic has made on our risk for heart disease and stroke, and the results are disheartening. One in five people reported lower physical wellness, while one in three reported lower emotional wellness. On top of that, over the past year, many of us have adopted unhealthy behaviors, like skipping exercise, eating unhealthy foods, drinking more alcohol, and using tobacco, which can all contribute to CVD.
Jeff Koonce
Central Kentucky Heart Ball Returns
I have served on the board of the Central Kentucky AHA for well over 10 years, becom ing a board trustee in 2021. During that time, I’ve chaired the Central Kentucky Heart Walk, served on numerous event committees and executive leadership teams, and have raised a significant amount of money to support the mission of the AHA. In 2022, my wife, Diana, and I are also proud to serve as the chair couple for the Central Kentucky Heart Ball coming up on Saturday, March 5, at the Central Bank Center in Lexington.
ISSUE #138 9
AHA is hard at work empowering individuals to take back control of their physical health and mental well-being. What better gift can you give someone than more time with the ones they love? That’s what the AHA does and why I am so proud to be involved.
To learn more or make a contribution, visit LexingtonHeartBall.heart.org.
and funds to ensure our work continues. Throughout our campaign we celebrate our milestones, we thank our sponsors, and we honor our survivors. We come together to achieve something bigger than ourselves. We Live Fierce and Stand for All. In 2022, the AHA has taken the campaign beyond the ballroom and onto the block. We are ensuring all Americans have an equal chance of living a healthier, longer life – no matter their ethnici ty, race, socioeconomic status, education level, or sexual orientation. From reducing blood pressure to ending tobacco and vaping use, to investing in COVID research and resources, to ensuring everyone has access to healthy foods, the AHA is working to improve and save lives every day.
NOW ONLINE
In addition to the overall decline of physical and emotional health that has resulted from living in a pandemic, contracting COVID-19 can cause a whole slew of other problems. The coronavirus can cause significant damage to the body, affecting not just the lungs, but the heart, brain, kidneys, and more. An estimated 10% of those who’ve tested positive, many of them without initial symptoms, are experienc ing long-term side effects, and the true impact of what many are calling long-haul COVID remains to be seen.
LEXINGTON Cardiovascular disease (CVD) has long been the leading cause of death, not just here in Kentucky, but around the world. Now, two years into the COVID-19 pandemic, the threat has only increased.
BY JEFF KOONCE, WESBANCO MARKET PRESIDENT, CO-CHAIR OF THE 2022 CENTRAL KENTUCKY HEART BALL
In over 150 communities across the coun try, Heart Ball supporters unite with a shared purpose to raise the critical awareness, action,
This year, we invite you to join us in cele brating the important work the AHA does by supporting the Central Kentucky Heart Ball. While we’re excited to be back in person this year, if you’re still not comfortable coming out, we hope that you’ll consider making a meaningful personal or corporate donation. After all, the work that this campaign funds may someday save your life or the life of a loved one.
OP/ED
Gala funds research, education, and resources to fight heart disease
GEORGETOWN Doctors and nurses know a lot. I imagine medical school to be a grueling, hazing onslaught of anatomy, physiology, endocrinology, with organic chemistry as a pre-requisite, to understand how the human body is supposed to work.
New knowledge is coming in at a break neck speed with advances in bio-mechanical technologies, genome coding (and altering), dialing in of pharmaceuticals, prosthetics, and even figuring out where our microbiome fits into the picture. The smiling dedication and the caring nature of medical professionals shines through. My hat is off to the doctors and nurses and technicians that take their work to heart and give us the courage to put our lives in their hands.
Mom and Dad had everything to do with our basic building blocks and a say in how we learned to use our bodies and our minds to become productive members of society. At some point, we each take over the daily deci sions that make us who we become. It seems to start with a positive attitude, which leads to better relationships, a thirst for knowledge, and concern for others. My one-time boss and major professor at UK once told me that success comes with eyes that see, a mind that works, and an action attitude. That advice stuck with me. The goal is to optimize the
OP/ED
things that keep us strong and minimize the factors that pull us down, to be ready when something bad happens, as it probably will.
The Body Is an Ecosystem
Success, when it comes to staying strong to fend off the common cold and grow old grace fully, is to stay mentally and physically active and eat the foods our bodies need. From my vantage point, focusing on a healthy diet sets the stage for feeling good enough to encourage the pursuits of life. Our bones need calcium, phosphorus, and a few hundred other things that doctors know about to stay strong. Our circulatory system needs red blood cells and white blood cells and inflammation fighters (and thousands more things doctors know about) to carry nutrients and oxygen to every single cell, and not for nothing, to carry away the old dead cells as we replenish ourselves. Brains are mostly fat; we need cholesterol to function. Our job is to be sure our cells have the tools they need to handle each situation.
The laws of nature tell us that the more diverse an ecosystem, the more stable it is. We see it in the biology of the oceans and wilder ness areas, in cultural exchange within a com munity, and in the foods we produce through our organic agrarianism. The preponderance of evidence points to a diet consisting of fruits
BY MAC STONE
The jury is in: We are what we eat
What they don’t know is us. What is it that each of our individual selves brings to them to fix? They know how the body assimilates amino acids and fats and sugars and calcium that we consume to make us who we are. The thing is, all 7+ billion of us on the planet have our own version of how those things work depending on our genetic predisposition, dietary habits, physical characteristics, support network of family and friends, aggressiveness of activity, cultural and spiritual beliefs, and emotional health—a reason for being, as it were. We are asking the medical community to utilize the preponderance of evidence, as they know it, to tailor a one-size-does-not-fit-all treatment plan to healing what ails every one of us. Our job is to bring them something good to work with.
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Preponderance of Evidence
Processed Food is Malnutrition
Ultra-processed foods and many fast foods are trojan horses sneaking all types of manmade products into our bodies. Never before encountered by our cellular selves, they are cloaked in the name of fast, cheap, and tasty. A minute on the lips, a lifetime on the hips,
As organic farmers, our job is to convert solar energy into edible human food to feed our cells. We know a lot, too (and there’s a whole lot we don’t.) One thing we do know is that plants store the solar energy that feeds us and feeds the soil. It lives in the carbon and nitrogen and calcium (and a bazillion other things that collect it), which allows the soil to store the energy to raise the next generation of plants. In our robust regenerative farming system, we work to build natural immunity, while debilitating plant diseases are kept at bay. Remember that in organic farming systems, microbes rule the world, and we too took an oath to do no harm.
Mac Stone
OP/ED
and vegetables, nuts, and cuts of properly raised unadulterated meats to provide the bal ance of amino acids to make the multitude of different proteins our muscles need, the types of fats our brains function on, the minerals for skeletal and cellular structure, and the sugars to propel us. Not so sexy, but emerging science is coming out about the relationship between gut health and immune health. It’s pretty exciting; we really are what we eat. The microbes in your stomach convert the food you eat into the cellular “you.” The doctors know what happens, but it is worthy of more study to understand how the magic happens when microbes rule the world.
The preponderance of evidence indicates that when we eat a balanced, nutritious diet, we are putting ourselves in a position for good things to happen. There’s nothing faster or tastier than a fresh green salad, some steamed or sauteed veggies, sliced fresh tomatoes, grilled corn on the cob, or a juicy grass-fed burger. Why put ourselves in harm’s way when eating good foods is so good for us, good for public health, and good for the envi ronment? We will feel better and have more time with family and friends, and our doctors will thank us for it in the long run.
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.
as they say. The rise in diet-related disease correlates closely with the rise in fast food con sumption, sugary soft drink intake, and with the proliferation of convenience foods pro cessed beyond recognition. Eating this way has become the norm, and at what cost? Kentucky ranks high in our incidence of diet-related dis eases like diabetes and hypertension, while cho
It seems likely that medical professionals want patients that come in for trauma repair or some insidious disease, like cancer, to be otherwise healthy. There seem to be many more options in the little black bag if we show up without a list of pharmaceuticals taken daily. Remember, that part of the job is to do no harm, and that’s tricky if our own bodily systems are all fouled up when we first present ourselves.
lesterol balances are out of whack, and obesity is endemic. Modern day malnutrition is shown in all its glory. Is not a proper diet the antidote to diet-related disease? We should all be grate ful to the medical community for keeping us alive while we learn to invest in ourselves and take diet-related disease off the table.
Sunshine and Rich Kentucky Dirt
ISSUE #138 11
Nezar Falluji, MD, MPH, serves as the director of the Structural Heart Program at CHI Saint Joseph Hospital
ISSUE #138 13
Erin Caldwell, RN, TAVR, MitraClip, WATCHMAN™ coordinator, with Nezar Falluji, MD
BY MARK
While all that is certainly true, Falluji admits that a different source of less-scientific informa tion now plays a significant role in the course of care for his patients. That source? The patients themselves, and their families. He finds that having a better understanding of the patients and their support system provides an insight into his patients’ lives and the impact different treatments might have on them.
“The specialty that I’m focused on – inter ventional and structural cardiovascular care – is procedural medicine, and it is focused on addressing particular conditions that affect either the valves of the heart, the coronary arteries, or the peripheral vascular arteries,” he says, noting that common patient presenta tions include chest pains, shortness of breath, palpitations, and stroke. “Most of the time these conditions could be reversed or at least repaired by these technologies. This is really the domain of structural and interventional cardiology. It’s procedural medicine.”
“Despite the fact that we work within very rigid guidelines, there is a uniqueness to every human being, their circumstances, their personality and their perception of their health,” Falluji says. “The biggest philosophi cal growth that I have had is that every patient is unique, though the conditions might look the same. The complexity of their illness is not restricted just to them. It’s complicated by many variables that affect their life and the lives of those around them. Involving the patient in the decision making has been the most important and rewarding realizations in my career. We have moved away from that authoritative, almost paternal approach in handling our patients. Now, you look the patient in the eye and you look at their family and you make that decision together.”
“Cardiologists frequently deal with critically ill and rather complicated patients,” says Falluji, who also is the director of the Structural Heart Program at Saint Joseph Hospital. “In cardiovascular care, we are data-driven, focused on science and innovation.”
Data-driven decisions help interventional cardiologist Nezar Falluji, MD, prevent strokes
Stroke of Genius
Approximately 70 percent of his time is spent on procedural medicine and the other 30 percent in the clinic or office. His patients tend to be older and present with co-morbid conditions, which complicate their care.
“Typically the majority of the consults that come my way are at a stage where the patient has become symptomatic,” Falluji says. “Our workup will help determine whether these symptoms are related to a cardiovascular condition, and if so, whether it warrants an intervention.”
Destined for Cardiology
“Cardiology is a field that struck me as having very unique characteristics,” he says. “From a very early stage it was an attractive field, not just for me but for a lot of people.”
BY JIM KELSEY
PHOTOS MAHAN
LEXINGTON Trusting the science comes nat urally to Nezar Falluji, MD, MPH. As an interventional cardiologist at CHI Saint Joseph Health – Cardiology in Lexington for 13 years, Falluji knows that treatment of complex, life-threatening conditions demands data-driven decision making.
COVER STORY
For Falluji, the decision to become a cardi ologist was a relatively easy one. He was drawn to the challenges of solving complicated cases with data, technology, and innovation.
While the majority of the conditions he treats require intervention, some can be treated in other ways. For example, Falluji notes that some cardiac rhythm problems can be managed by diet modification, exercise, and addressing sleep apnea. Determining which conditions are candidates for non-surgical options begins with bedside evaluation of the patient in the clinic or in the hospital setting complimented as needed with the use of non-invasive testing that helps determine how much of the condition is, and is not, cardiovascular in nature.
“Having atrial fibrillation places the patient at a five-fold higher risk of having a stroke,” FallujiFallujisays.explains that the heart’s left atrial appendage becomes the primary focus once a patient develops atrial fibrillation.
Most patients are eligible for the WATCHMAN™ or Amulet procedures, with very few exceptions due to anatomical or other“Thecontraindications.procedurecarries a very low risk of complications if done by experienced hands,” says Falluji, who began using the newest version of WATCHMAN™ in 2020 and performs the procedure in collaboration with his partner, Michael Schaeffer, MD. Falluji says it is import ant that his fellow medical professionals understand the benefits of the proce
PHOTOS BY MARK MAHAN
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“One of the most frustrating problems I face is the perception that older patients are beyond repair and that these ailments are considered to be part of the normal aging process,” he says. “We replace knees and hips in patients who are 80 and 90 years old, and that can give them another 5 to 10 years of mobility and quality of life. Yet there seems to be this perception that elderly patients are too old for interventional procedures. That mindset has to shift. Technology has provided us with opportunities to give heart patients a more productive and meaningful life without symptoms and without struggle.”
Ashley JosephCardiacNezartechnologist,Taylor, interventionalconferswithFalluji,MD,intheCathLabatSaintHospital.
“It’s unfortunate that we would miss oppor tunities on the premise that the patient is too old or that their condition is too complicat ed,” he says. “We need to continue to educate and communicate the great technological advances in cardiovascular medicine to pro vide our patients with the best quality care that they deserve”
For years, the Lariat® device was used to perform the left atrial appendage occlu sion (LAAO), but in very recent years the WATCHMAN™ and Amulet™ devices have gained prevalence due to being less invasive procedures. Falluji describes the WATCHMAN™ and Amulet devices as plugs that are placed inside the appendage.
Both the WATCHMAN™ and Amulet proce dures take between 30-45 minutes, and patients are generally sent home on the same or the next day. After the procedure, some patients take oral anticoagulation medication for 45 days while the device heals and the seal is complete.
“Atrial fibrillation usually occurs as a conse quence of hypertension or valvular abnormal ities and is associated with old age and other chronic health conditions. These various con ditions can cause changes in the electrical and structural features of the left atrium and cause remodeling of the left atrium – remodeling might be good in your kitchen but not in your heart,” Falluji says. “These changes lead to atrial fibrillation, and once that happens the risk of stroke increases, mostly driven by the left atrial appendage which becomes a source of clot formation. Unless there is normal contraction – during atrial fibrillation there isn’t normal contraction – the blood stagnates in the appendage. Eventually clots are formed, and as they break down they get into the circulation and can occlude, acutely, an artery somewhere, frequently in the brain, causing a stroke”
A common condition in cardiovascular dis ease is atrial fibrillation, which affects nearly 6 million Americans. Falluji estimates that atrial fibrillation represents between one-third and one-half of the arrhythmia he sees.
The first line of treatment for patients at risk of stroke is long-term oral anticoagulation therapy. But patients who develop bleeding problems or have a lifestyle that puts them at a risk of bleeding or frequent falls become prime candidates for procedural intervention to isolate the appendage from the left atrium and the rest of the circulation.
Falluji says he and his team follow very strict protocols in determining which patients are candidates for the procedures. He esti mates that 90 percent of the patients benefit from these interventions.
dure and the low-risk, high-reward outcomes it can produce. He understands that many patients who would be good candidates for the procedure are likely not referred to him due to the patient’s advanced age.
In short, when you trust the patients, their families, and the science, and let the data be your guide, complex decisions become a little less difficult and the solutions can become reality.
The WATCHMAN™ manufactured by Boston Scientific, is used to occlude the left atrial append age in patients with atrial fibrillation.
COVER STORY
Atrial Fibrillation and the WATCHMAN™
“They isolate the appendage immediately,” he says. “Once they heal into the appendage, they limit clot formation inside the append age. Nothing gets in or out of the appendage, so these devices, as the evidence shows, would reduce the risk of stroke.”
Know A Good Doctor? We Do. YOUR RESOURCE FOR THE BEST IN KENTUCKY HEALTHCARE Now available online • 95,000+ visits! www.md-update.com .com
BY MENISA MARSHALL
Moore says, “I’d like to increase awareness about the importance of prompt referral to an advanced heart failure program or center.”
UofL Health – Advanced Heart Therapies Program continually assesses new and emerg ing information, technologies, and treat ments. Gene therapy and newer more innova tive heart pumps and pacemaker-like devices for example, stand to generate major changes.
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Moore, who is also UofL School of Medicine faculty, keeps a busy schedule but strives to practice what she preaches. Her day generally starts with a 6am workout at the gym or yoga studio. From there she’s off to the hospital for Morningsrounds.aretypically spent seeing patients whose treatments range from a transplant to an artificial pump or VAD, a ventricular assist device. Moore enjoys educating her patients about the need to combine lifestyle choices and changes with advanced medical therapeu ticHeroptions.central message is simple but critical: “Your number one aim should be to try to avoid heart disease.”
Typical transplant work teams include physicians, coordinators, nurses, pharma cists, dietitians, physical therapists, and social workers. These experts work together to max imize optimal outcomes for each patient.
In the meantime, stronger, improved med ications are making a big impact against familial hyper-cholesterolemia and heart fail ure. Less invasive cath lab procedures are improving the diagnosis and treatment of valve disease and often entail minimal need for inpatient admission.
Multidisciplinary teams make the care pro cess simpler and more effective. It’s common for patients at UofL Health to see a surgeon and cardiologist at the same time.
As a general rule, she suggests all patients hospitalized for heart failure should be assessed for referral to a heart failure center. Referral is definitely indicated if patients have an ejection fraction under 30 percent, have
Collaboration drives UofL Health – Advanced Heart Therapies Program
Recent figures from the Centers for Disease Control and Prevention peg heart disease as the leading cause of death for men and women nationwide. Moore notes that while significant progress is being made against coronary artery disease (CAD), heart failure is on the rise.
“You can refer a patient too late to an advanced heart failure center, but you can never refer someone too early,” she says.
Heart Disease Can Be Prevented
Familylife.”support is a critical part of the pro gram. Family members learn what patients should and shouldn’t do. If questions arise, nurses and transplant coordinators are just a phone call
“Our primary aim is for patients to keep their own hearts and have them function as maximally as possible,” Moore says. “If surgery is indicated, all related departments work together to get patients back to a good quality
“Supportaway.groups and transplant coordinators get to know one another well,” says Moore. “Caring about one another is a necessity.”
Collaboration Is Key
It’s no secret that Kentucky is part of a region known for a high incidence of heart disease. Beyond genetic factors, high smoking rates and poor dietary habits likely contribute to this.
“I urge everyone to invest in healthful life style choices,” says Moore. “Make sure you exercise, eat some vegetables, if you smoke try to quit, and get eight hours of sleep daily.”
“As a field, we’re at the forefront of some genetic therapies for cardiomyopathy or heart failure,” says Moore.
Collaboration is a hallmark of UofL Health –Advanced Heart Therapies Program. The program’s transplant clinic demonstrates the effectiveness of this approach.
She notes that recent news of a human transplant involving a genetically modified pig heart makes xenotransplantation “an exciting prospect.”
The mission of UofL Health – Advanced Heart Therapies Program shares certain simi larities with NASA. It aims for successful out comes. It is forward-looking and not daunted by tough challenges. And, its success is driven by collaborative teamwork
LOUISVILLE NASA control director Gene Kranz is often credited for saying, “Failure is not an option.” He claims those exact words were not said during Apollo 13’s failed 1970 lunar landing, however he did use them later to title his autobiography because they reflect ed NASA’s mission.
Stephanie Moore, MD, cardiologist and director of the program’s Heart Failure Clinic, says the program treats many conditions that stem from various causes. Because heart disease affects people of all ages, genders and ethnicities, having many tools in your toolbox is crucial.“Wehave lots of options, all the way from lifestyle changes and medications to a trans plant or heart pump,” says Moore. “Every day you learn about someone’s life. What is important to them. Then our team gets to work to help make our patients’ lives better.”
When Your Mission Is Healthy Hearts, Failure Is Not an Option
PHOTO PROVIDED BY UOFL HEALTH SPECIAL SECTION CARDIOLOgY
had one heart failure hospitalization, and can not climb a flight of stairs without stopping.
Promising New Treatment Options
Despite the effectiveness of advanced ther apies, Moore wants people to know that heart disease is largely preventable.
“I feel I’ve come full circle,” she says. “When you find something you love, you’re very lucky, even when the work might go from dawn to dusk.”
Transplant Cardiology Becomes a Professional and Personal Mission
SPECIAL SECTION CARDIOLOgY
She strives to remember that everyone she interacts with has loved ones and families. They’re important to their communities and deserve respect, dignity, and the best care possible.“Never underestimate the power of a posi tive outlook,” says Moore. “Hope is a power ful medicine.”
UofL Health’s heart program strives to be thorough and patient-centered. Moore says it reflects her personal philosophy to treat peo ple as if they are dear friends.
Moore, who is originally from northeast Ohio, did her undergraduate work at The Ohio State University. She became a phar macist and found she enjoyed working with patients. She was admitted to the University of Cincinnati College of Medicine and con tinued to work as a pharmacist part-time until she graduated in 1994.
After four years with Utah’s busy transplant program, Moore and her family relocated to the Boston area. Moore is a current member of faculty at Harvard Medical School and pre viously an associate physician at Massachusetts General Hospital. Twenty years later, with her boys in college, she had the opportunity to transfer to Louisville and help grow UofL Health – Advanced Heart Therapies Program while continuing her passion to serve patients with heart failure in Kentucky. She brings with her Midwest charm, compassion, and medical expertise in the field of heart failure, transplant and ventricular assist device.
She practiced internal medicine at the University of Cincinnati and soon fell in love with cardiology, which led to a fellowship at the University of Utah. During her seven years in Utah she met and married her husband, had two sons, and found her calling as a heart transplant cardiologist.
“Never underestimate the power of a positive outlook.”- Stephanie Moore, MD, cardiologist and director of the program’s Heart Failure Clinic.
LOUISVILLE Steven J. Heatherly, MD, PhD, FACC, is the system medical director for heart failure and pulmonary hypertension for Baptist Health’s Louisville Heart Failure (HF) and Pulmonary Hypertension (PH) Clinic.
What does a week in your professional life look like?
I grew up in rural North Carolina. When I was four, I told my parents I wanted to be a doctor, but my path to medical school was not linear. My undergraduate degree is from the Honor’s College of Western Carolina University in Cullowhee, North Carolina. I was a biblical studies/religion major and I ended up with a PhD in psychology. That’s when I decided to go to medical school at Eastern Virginia Medical School. I did my internship and residency in internal medicine at Wake Forest University Baptist Medical Center in Winston-Salem. I stayed on for one year as assistant chief of medicine. I then entered into my cardiovascular diseases fellowship at Wake Forest, as well. I also picked up a master’s in philosophy, so I have a varied background.
Heart Care Takes a Multidisciplinary Village
once. Some may also need to eventually con sider lung transplantation.
Heart failure is more common the older we become, so the average age of my patient is in their 60s. However, I see patients aged 18 plus. They include both females and males. Most of my patients have issues with fatigue, malaise, shortness of breath, and swelling. We have many prescription medications available for both HF and PAH. Some of my patients need implantable devices such as a special pacemaker known as “CRT-P,” and some need defibrillators, such as ICDs. Some of our patients also have an implantable pulmonary artery monitor (CardioMEMS). Some of my HF patients also need surgical procedures, such as CABG and valve replacement.
Kentucky has plenty of cardiovascular dis ease. At Baptist Health, we believe the best way to assist patients and their families is to focus on specialized areas for our patients. One example is the HF and PH clinic. One of the issues with both HF and PH is that the disease can enter into a flare state. Patients can suddenly have worsened breathing and swelling. We have same-day appointments for our patients, all with an eye toward preventing an ER visit or an admission. We can even offer them IV therapies in our clinic that is typical ly relegated to the ER. I like to think we meet our patients where they are.
What are some of the new treatment plans and procedures for treating heart disease, both medical and surgical?
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Please tell us where you grew up, and your education and medical training.
What brought you to Baptist Health?
I keep a solid schedule. I have both clinical and administrative time, so I see patients in our heart failure and pulmonary hypertension clinic and I do procedures in the cardiac catheteriza tion lab. I also read echocardiograms through out my day. I have designated administrative time to oversee my division at our nine hospitals in Kentucky and Indiana. This can include significant time for meetings, including Zoom. I’ve been restricted because of COVID, but still able to visit each of our nine hospitals to assist with their heart failure programs. I am also the principal investigator for several randomized clinical heart failure trials, so I can often be in research meetings or doing data analysis.
Describe your patient population: age, gender, presentations, treatments.
Baptist Health was my first position after I finished my fellowship. I was looking for a hospital that wanted to launch a pulmo nary hypertension clinic. I first went to Madisonville, Kentucky and opened a PAH and HF clinic there. I recently transitioned to
Louisville to be the system medical director, as well as staff our heart failure clinic and open our new PAH clinic here.
When did cardiology become your primary focus?
Some patients may need to consider LVAD/ heart transplant. My patients with PAH need right heart catheterizations, often more than
We are also innovative as a health system because our nine hospitals currently partic ipate in over 200 clinical trials, so we are literally contributing to the knowledge to help care for patients in Kentucky and southern Indiana. We also offer remote patient mon itoring in our Heart Failure Clinic, so some of our patients are eligible to have Bluetooth and WiFi scales and monitors at home that monitor their vital signs. This information is conveyed directly to my office so we can monitor patients and improve their quality of life by helping them live at home, avoiding the ER and an inpatient hospital stay.
Kentucky is known for heart disease. How does the Baptist Heart Failure Clinic continue to innovate and address a common problem?
We have very exciting options for patients with heart disease. More and more we are see
SPECIAL SECTION CARDIOLOgY
MD-Update Q & A with Steven Heatherly, MD
I liked cardiology when I was in medical school. Later, while in residency, I fell in love with the field. There is a lot of physics in cardiology, which I have always loved. But my real passion developed when I fell in love with two big diseases: pulmonary arterial hyperten sion and heart failure.
ISSUE #138 19
PHOTO BY ALEXANDRA ROgERS
I always state up front that I often meet patients and their families on some of the worst days of their lives. HF and PH are scary diagnoses. I keep my initial appointments for one hour. And, I am typically in the room for that time, and often longer. I want to start with the patient and their family telling me what they know. I go through all of their med ical records, pulling up images in the exam room. I want us all on the same page: how we got to this exact moment in time. I will then solicit a patient’s values and goals. Then, I work to make that happen. That includes discussing diagnostic testing, procedures, and possible treatments.
Healthcare takes a village. No one physician or clinician can know it all. So, a multi-dis ciplinary approach is a necessity. Our HF patients, as an example, likely have a primary cardiologist, an electrophysiologist, and some of them will also need an interventional car diologist/structural heart disease specialist. Many of them will need to see cardiothoracic surgery and participate in cardiac and pulmo nary rehabilitation. They will depend on our medical assistants, nursing, case management, and social work. Our PAH patients will likely need to see sleep physicians and pul monologists. Some of them also need rheu
Steven J. Heatherly, MD, PhD, FACC, is the system medical director for heart failure and pulmonary hypertension for Baptist Health’s Louisville Heart Failure and Pulmonary Hypertension Clinic.
ing increasingly minimally invasive approaches. As an example, we have a robust structural heart program at Baptist. Some patients with aortic stenosis can undergo TAVR, which is a minimally invasive bioprosthetic valve replace ment. This procedure traditionally required open heart surgery. For patients with particular types of mitral regurgitation, our team also offer TMVR, which is transcatheter mitral valve repair, commonly called MitraCLIP. For patients with blood clots to the lungs, a pulmo nary embolism, our interventional cardiology team, in select patients, can do catheter-di rected thrombolysis, a catheter approach to addressing clots in the lungs. Baptist Health Louisville also has a robust mechanical cir culatory support (MCS) program including ECMO, of which we are very proud. And, for some of our PAH patients with a particular form of PH known as “CTEPH,” which is PH from chronic blood clots to the lung, there is a surgical procedure available that can be cura tive for some patients known as a pulmonary thromboendarterectomy (PTE) There are very
Talk about the collaborative team approach at Baptist Health Heart Failure Clinic in Louisville.
Describe your interaction with patients and their family, particularly the initial visit. Tell us about a unique patient experience.
matologists. So, I treasure the ability to have an extremely talented and diverse healthcare team here to depend upon.
few places in the world, and very few places in the United States, that can offer this. I am proud to say we have recruited Dr. Mariano Camporrotondo, a cardiothoracic surgeon, who can perform this procedure and we able to offer this to Kentucky and surrounding states.
What are the most common misconceptions among noncardiologists and the heart disease patient population that you want to address?
I have so many stories about unique patients and experiences, but I will summarize it by say ing I am so proud of our HF team in the clinic. We recently started a charitable fund so we can assist some of our patients with their medical financial needs. We can use those to even send an Uber for an appointment! Recently, we had a patient — who is always on time — fail to show up. I had two people who work in my office actually leave to drive down the road and go check on her. It turns out she had lost her phone, so she could’t use the Uber we had arranged. These two wonderful humans gave her a ride to my office and we were able to complete her visit. And, I have to tell you, that isn’t unusual behavior — at all! — on the part of our clinic staff. It’s such an honor.
PHOTO BY
ALEXANDRA ROgERS BAPTIST HEALTH LOUISVILLE HEART FAILURE CLINIC 4002 Kresge Way, Suite 110 Louisville, KY 40207 502.928.8700 BaptistHealth.com/Louisville SPECIAL SECTION CARDIOLOgY
What’s on the horizon of cardiology and cardiac surgery?
“At Baptist Health, we believe the best way to assist patients and their families is to focus on specialized areas for our patients.” – Steven Heatherly, MD
assessment and treatment strategy, but it is also true that national data indicates that up to 94% of the time a PAH-specialist will recommend additional testing/treatment, and one third of the time the patient will actually get a different diagnosis. For HF, about 10% of our patients will end up with AHF, advanced heart failure. And some of these patients will need to discuss LVADs and heart transplant. The misconcep tion with these therapies is that they should not be discussed with some patients, or some individuals have errors in thinking about hard age cut offs and things of that nature. We have a lot to offer every single patient. Period.
It is a line that comes out of the abdomen and is prone to infection. That line is required to power the battery, but I am anxiously hopeful the battery technology will improve to the point where an LVAD can be 100% contained inside a patient’s chest and charge much like you can do now with a magnet and a smartphone.
Training is intense. Wake Forest was an excellent proving ground, but it was challeng ing. I had a mentor who said, «We take care of patients; that’s what we do.” It was that idea of putting this other person in front of you before your desires, your sleepiness, your hunger. And, for me, it sums it up well for me. I, of course, want to be respectful, honest, open, and transparent, but at the end of the day I take care of patients and their families; that is what I do.
Yes, I am currently the principal investi gator here for two randomized clinical trials: STEP-HFpEF and STEP-HFpEF DM. These trials are investigating a medication known as semaglutide in patients with HF. We are looking at several outcomes such as change in KCCG, body weight, laboratory values, and even some echo changes. Overall, my priority as the system medical director is to expand our HF and PAH research here in Louisville, so I think we can expect to see a vast increase in our research here.
Let’s start with pulmonary hypertension. The biggest misconception is that “there is nothing do,” or, that it is “hopeless.” These patients now have longer life spans than ever. We are fortunate to have several PAH-specific medications for these patients. There is also this idea that “not all PH patients need to be seen in a PH clinic.” I disagree. It is true that a lot of the times I will concur with someone’s else
One thing we are seeing nationally is moving in-patient care to the out-patient arena. In the next decade many, many things that now require hospitalization will likely be treated in the out-patient arena. This means that the hospital will be reserved for sicker and sicker patients. So, we have to continue churning out excellent cardiovascular physicians in our training programs. This trend is something we are helping with actively in the HF clinic with same-day appointments and remote monitoring. I think we will also see vast improvements in our LVAD technology. Right now, one of the biggest limiting issues with LVADs is the driveline and battery technology.
Are you currently involved in any clinical trials?
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Describe your personal philosophy of care.
“My interest in heart disease actually came after medical school as I did my internal med icine training and rotated through cardiolo gy,” he says. “How interesting and complex it is and the variety of things that cardiovascular doctors take care of just piqued my interest.”
LOUISVILLE To borrow from Spider-Man, with great power comes great responsibility. Another way to say that is, just because you have the ability to do something, that does not always mean you should. For instance, modern medicine makes it possible to fix an arterial blockage, but that does not always make it the best option for the patient.
— Mostafa Osman El-Refai, MD, Norton Healthcare
“We have a lot of family friends that are physicians, and I volunteered at the VA and a couple of other hospitals when I was in high school,” he says. “I knew with my first expo sure to the medical world that I would want to be a physician.”
22 MD-UPDATE
“It’s my job to communicate,” he says. “I’ve modified the way I explain certain things. If I say a phrase that someone doesn’t understand,
Interventional cardiologist Mostafa Osman El-Refai takes patient care to heart
El-Refai admits that opting not to perform a procedure to fix the blockage is counter intuitive to his training as an interventional cardiologist, but the decision is all about what is best for the patient.
PHOTOS PROVIDED BY NORTON HEALTHCARE
El-Refai sees patients both in the clinic and the hospital and finds both environ ments rewarding. The hospital visits generally involve performing procedures on patients dealing with acute illness, such as heart attack, congestive heart failure, or arrhythmia. The outpatient clinic setting is naturally more casual and provides an opportunity to connect with“It’spatients.abusy and wide array of things that cardiologists do, which is why I love it so much. You never have a dull moment,” he says. “When we see patients in the clinic, it’s a very rewarding experience. Maybe someone had a heart attack and you put a stent in there, and now you’re seeing them in the clinic when they’re walking, and talking, and happy. So it gives you a nice perspective in the clinic. That’s where you really build good relationships.”
Knowledge Is Power
Born and raised in Louisville and a gradu ate of duPont Manual High School, El-Refai knew early on that he would become a physi cian but didn’t come to cardiology until well into his medical training.
The Path to Cardiology
BY JIM KELSEY
El-Refai credits his broad education with preparing him to build those relationships and connect with people of all backgrounds. Not only does that make the overall physi cian-patient experience more positive, but it also makes it more effective. With patients becoming increasingly involved in their own healthcare decisions, it is important that they understand their condition and their options.
Mostafa Osman El-Refai, MD
“That every blockage in the artery needs to be fixed is a very common misconception in terms of cardiovascular disease,” says Mostafa Osman El-Refai, MD, interventional cardiol ogist at Norton Heart & Vascular Institute in Louisville. “We have more and more data now that suggest that if you have a blockage that we would consider obstructive, that unless you’re having a heart attack or chest pain, we can actually treat that with medications for a long time. The only benefit you get out of fixing a blocked artery in a stable setting is improving chest pain. It is not to prevent heart attack, and it is not to prolong life.”
“The only benefit you get out of fixing a blocked artery in a stable setting is improving chest pain. It is not to prevent heart attack, and it is not to prolong life.”
“I do procedures, but I actually am more excited about the non-invasive things,” says El-Refai, who is also the medical director for quality at Norton Heart & Vascular Institute. “More and more we’re realizing that a lot of these things, if caught early, we can treat with medications and prevent people from needing procedures.”
He went to undergraduate and medical school at Ain Shams University in Egypt, then interned and did his residency at Henry Ford Hospital in Detroit. He served as the chief medical resident at Baylor College of Medicine in 2014 and completed a cardi ology fellowship at Baylor in 2017, then an interventional cardiology fellowship at Baylor in 2018. He then came back to Louisville and
In Clinic and the Cath Lab
joined Norton Heart & Vascular Institute. He also completed a master of science in clinical investigation sciences from the University of Louisville School of Public Health and Information Sciences.
A Diverse Patient Base
“We’re seeing a lot more people being invested in their health at a younger age and asking, ‘Are these symptoms normal? Should I be worried about my heart?’” says El-Refai, noting that sedentary lifestyle, diet, and smoking frequently play a role in heart issues in younger patients. “Information is so widely available online now that it triggers a lot of questions. But if you see a 33-year-old with chest pain, they are much less likely to have heart disease than a 65-year-old with chest pain. So the statistics are important, and perspective is important.”
Regardless of the age of the patient, El-Refai says that data, clinical research, and perspective are essential in helping determine the best course of care. That process results in the repet itive and consistent use of best practices for every patient to assure overall quality of care.
all that good clinical data into practice in a way that there are fail-safes in making sure every patient gets the outstanding care that theyEl-Refaideserve.”provides an example of stable angina patients on medical therapy that con tinue to have chest pain with exertion. These patients can often be treated with cardiac catheterization, which can often be scheduled as an outpatient procedure. He says that diagnostic procedures are becoming more patient-friendly as well.
it kind of triggers in my mind that maybe I need to reframe that. Houston has the larg est medical center in the world, and Baylor offered a wide variety of clinical experiences. We got to experience the VA, the county hospital, the Texas Heart Institute, as well as a private suburban hospital. Those unique experiences really made me more prepared to interact with a wide variety of patients no matter where I meet them.”
“There’s still a significant portion that get cardiac catheterization for both diagnostic and therapeutic purposes, but I think that’s going to move much more towards only for therapy, and the diagnostic portion will all be non-invasive, which probably is the right thing to do,” he says. “I really don’t want to do anything that doesn’t need to be done.”
ISSUE #138 23
Knowing how to do it is half the battle. The rest is knowing when to do it — or not.
SPECIAL SECTION CARDIOLOgY
After traveling abroad and within the U.S. to complete his medical training, Mostafa Osman El-Refai, MD, returned to his hometown of Louisville in 2018.
“Every human being is going to make a mistake,” he says. “So you have to put system atic processes in place to allow you to translate
Increasingly, some of those patients are younger than the expected 60+ year-old patient population. While most of his patients are in their 60–80s, El-Refai does see patients as young as 18. The number of heart attacks in younger patients has increased, he says, but largely the increase in these patients coming to a new Norton Heart & Vascular Institute Young Adult Cardiology Clinic is due to bet ter awareness.
In 2020, after two years within CHI Saint Joseph Health as a general surgeon, Mathis joined the Center for Weight Loss Surgery (CWLS) where she works alongside fellow
Though the benefits of these procedures are extensive and undisputable, as a nationwide average, only about 1% of patients who could qualify based on their BMI and their medical problems actually opt for weight loss surgery. Those who opt for surgery typically have only one regret. “The most common thing I hear from my patients that have bariatric surgery is that they wish they’d done it sooner. That it is lifechanging — not only in their size and their weight, but in the fact that they’re no longer on diabetes medications, blood pressure medi
Mathis states, “Bariatric surgery provides a very effective tool in the toolbox of treating these patients — for helping patients limit their portion sizes, helping control their sen sation of fullness after surgery, and helping induce hormonal effects on their insulin resistance. Just the dramatic weight loss that
“Bariatric surgery provides a very effective tool in the toolbox of treating these [morbidly obese] patients.” — Rachel Mathis, MD, FACS
PHOTO BY GIL DUNN
LEXINGTON How many surgeons can say their career began with a dare? Rachel Mathis, MD, FACS, can. While dissecting a fetal pig in 7th grade science, a classmate challenged Mathis to cut the pig’s brain out intact “without squishing it.” She did, and her success did not goMathisunnoticed.explains, “I couldn’t really turn down a dare and enjoyed it so much that my science teacher said, ‘You know, you might think about becoming a surgeon.’”
they can have with surgery — the extra weight that’s off their body — allows them to exercise more easily, have less joint pain and have less shortness of breath. So, it helps them get to the point where they can maintain their desired weight based on lifestyle.”
surgeon Alberto Zarak, MD, FACS, to pro vide a tool for patients, many of whom have been wrongly told that their only options are exercise and diet and that obesity is a personal failing and weakness on their part.
Benefits of Bariatric Surgery
At the CHI Saint Joseph Health – Center for Weight Loss Surgery, a dedicated team helps patients begin their journey to a healthier, happier, and longer life.
“The most common thing I hear from my patients that have bariatric surgery is that they wish they’d done it sooner.”- Rachel Mathis, MD, FACS
Though Mathis knew she wanted to pursue surgery, it wasn’t until a rotation in her third year of residency that she knew bariatrics was the specialty for her. Mathis states, “I think it’s very unique in surgical specialties, because you get the long-term follow-up with patients that you don’t generally get with very many other surgical specialties. And, you can see the impact surgery makes on their life.”
A graduate of Yale University with a BA in history of science and history of medicine, Mathis earned her medical degree from the Medical College of Georgia and then com pleted surgery residency training at Inova Fairfax Medical Center in northern Virginia, followed by a bariatric surgery fellowship at the prestigious Lahey Clinic in Boston.
A Lifetime Commitment for Both Doctor and Patient
SPECIAL SECTION BARIATRIC SURGERY
24 MD-UPDATE
BY DONNA ISON
This CWLS team consists of Mathis and Zarak along with Bariatric Program Director Karen Hillenmeyer, BS, PA-C, who boasts decades of bariatric experience, two certified bariatric nurses, a dietician, an exercise phys iologist and a psychologist — all working together to ensure the patient has the best chance for long-term success.
For Mathis, the gold standard of bariatric surgery is still the gastric bypass. However, over the last few years, the gastric sleeve has gained popularity, especially with patients.
One mitigating circumstance is severe acid reflux, which can be exacerbated by the gastric sleeve and even result in esophagitis. If at all possible, both surgeries are performed either laparoscopically or robotically.
Knowing how controversial bariatric sur gery can be, Mathis seeks to clear up two common misconceptions held by patients and physicians alike: Bariatric surgery should not be thought of as either a magic bullet or as a lastMathisresort.says, “I think, for the general public and potential bariatric patients, there’s a com mon misconception that surgery is a magic fix and is taking the easy way out. Bariatric surgery is certainly not easy. We think of it as a three-pronged approach; your surgery is your tool to help you maintain appropriate portion sizes and make appropriate food choices, but your diet and your exercise are the other corners of that triangle. So, it’s not a magic bullet. It’s not a magic fix. It requires a lifestyleMathischange.”alsourges doctors to look at bariat ric surgery as an option for qualifying patients sooner rather than later: “We’re continuing to reach out and try to let both patients and physicians know this is an excellent option. And this isn’t a last resort option for patients that are morbidly obese.”
For comorbidity resolution and weight loss, the bypass and the sleeve are, in general, equivalent to one another, so both surgical options are offered to patients unless there’s a compelling medical reason that one would be safer and more effective than the other.
A Lifetime Commitment
At the CHI Saint Joseph Health – Center for Weight Loss Surgery, the commitment to each patient lasts throughout their lifetime.
As an interesting side note, recent studies have shown that patients who’ve undergone weight loss surgery have fared much better after contracting COVID-19 than their mor bidly obese counterparts.
ISSUE #138 25
“We tell all of our patients that we are their team for life, whether they had their bypass yesterday or 10 or 20 years ago. It’s very important for them to follow up on a yearly basis, to have vitamin levels checked and to ensure that they’re doing well after their pro cedures,” says Mathis.
Each patient begins by attending a compre hensive bariatric seminar, which are currently being conducted virtually due to COVID, then an initial telemedicine consultation.
CENTER FOR WEIGHT LOSS SURGERY 160 N. Eagle Creek Drive Suite 201 Lexington, KY 40509 859.967.5520 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. Thinking clearly. Caring deeply. FEE-ONLY FINANCIAL PLANNING 800.344.9098 | DSNEAL.COM See how we think about money. dscottneal.com Do you know your next move? We can help! Retirement Goal Line? Where is your SPECIAL SECTION BARIATRIC SURGERY
During their first in-office visit, they meet with either a doctor or the program director for a full history and physical exam. An assess ment by the rest of the team follows. Once they are deemed suitable for surgery, the real journey begins. Post-surgery, patients have additional coaching and regular follow-ups to assess progress and determine problems. Follow-up visits not requiring lab work can be hosted via telehealth.
cations, and may not have to wear their CPAP for sleep apnea anymore. It can be completely life-changing for them.”
Major Misconceptions
4 Centers for Disease Control and Prevention. Self-Measured Blood Pressure Monitoring: Action Steps for Public Health Practitioners. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2013. Accessed at https:// millionhearts.hhs.gov/files/MH_SMBP.pdf.
CARE SMBP
2 Centers for Disease Control and Prevention, National Center for Health Statistics. Underlying Cause of Death 1999-2019 on CDC WONDER Online Database released in 2020. 2019. Accessed at D76;jsessionid=E76D448C9E254A592E53234C2E56.https://wonder.cdc.gov/controller/datarequest/
CARE SMBP combines SMBP with CARE Collaborative education to offer participants tools and resources to improve their blood pressure and overall health. CARE SMBP
3 Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Population Health. BRFSS Prevalence & Trends Data. 2019. Accessed at https://www.cdc.gov/brfss/brfssprevalence/.
dence has shown that SMBP plus additional support was more effective than usual care in lowering blood pressure among patients with hypertension. Additional support includes regular one-on-one counseling, web-based or telephonic support tools, and educational classes.4 Through regular out-of-office blood pressure measurements, participants are able to be a part of their treatment and care, pro viding reliable measurements back to their provider. Participants are trained, through the SMBP program, how to obtain accurate measurements that are reliable for treatment and maintenance decisions. Providers can be reimbursed for initial and continuing SMBP clinical services using CPT codes 99473 and 99474 respectively.
BY NATALIE LITTLEFIELD AND SAMANTHA ALBUQUERQUE
The CARE Collaborative is a free blood pressure education awareness program for Kentucky men and women over the age of eighteen years. CARE uses three color zones, green, yellow, and red, to indicate if the par ticipant’s blood pressure is normal, elevated, and high, respectively. Individuals document their blood pressure and choose lifestyle mod ification goals to lower their cardiovascular disease risk.
26 MD-UPDATE
can be used in any setting where a blood pressure is taken or can be taken. The CARE Collaborative is in use at community clinics, Federally Qualified Health Centers (FQHCs), health care systems, home visiting programs, and local health departments across the state. The program features a free blood pressure monitor, a trained CARE SMBP coach, and patient-centered education and resources.
FRANKFORT Hypertension or high blood pressure is a major risk factor for heart disease, stroke, chronic kidney disease, and dementia.1 Heart disease and stroke are the first and fifth leading causes of death in Kentucky, respectively,2 and approximately 38% of adults in Kentucky have hyper tension.3 The Kentucky Heart Disease and Stroke Prevention Program at the Kentucky Department for Public Health has created a program that combines self-measured blood pressure monitoring (SMBP) and simple hypertension education via the Cardiovascular Assessment, Risk-Reduction and Education (CARE) Collaborative. The program aims to increase participants’ engagement in their health and work towards improving their blood pressure to address the high burden of hypertension in Kentucky patients.
PHOTO PROVIDED BY UOFL HEALTH PUBLIC HEALTH
The CARE Collaborative and Self-Measured Blood Pressure Monitoring Program
1 Fuchs, F.D. & Whelton, P.K. (2020). High Blood Pressure and Cardiovascular Disease Hypertension 75 (2), 285-292 HYPERTENSIONAHA.119.14240Accessedhttps://doi.org/10.1161/HYPERTENSIONAHA.119.14240athttps://www.ahajournals.org/doi/epub/10.1161/onNov29,2021.
SMBP is defined as the regular measure ment of blood pressure by the patient out side the clinical setting, either at home or elsewhere. It is sometimes known as “home blood pressure monitoring.” Scientific evi
What is SMBP?
What is the CARE Collaborative?
CARE SMBP is an education and engagement program that enables participants to help control and manage their hypertension.
CARE SMBP coaches are healthcare pro viders or lay health professionals trained by the Heart Disease and Stroke Prevention Program to engage participants about their blood pressure. During the first CARE SMBP participant encounter, the participant is given a blood pressure monitor and instructed on how to properly use the device. The partic ipant then uses the teach back method to demonstrate understanding of proper use and cuff positioning to accurately capture their blood pressure. Next, the participant receives education on the CARE Collaborative. After
ISSUE #138 27
5 Ettehad, D., Emdin, C.A., Kiran, A., Anderson, S.G., Callendar, T., Emberson, J. et. al. (2016). Blood pressure lowering for prevention of cardiovascular disease and death: a systematic review and meta-analysis. Lancet, 387 (10022), 957-967.Accessed at https://doi.org/10.1016/S0140-6736(15)01225-8.
pants with high blood pressure in Kentucky. Although there is still much work to be done to reduce the burden of hypertension, we feel confident that the CARE SMBP program provides a way to minimize hypertension bur den and improve heart health of Kentuckians. Anyone interested in learning more about the CARE SMBP program is invited to con tact the Kentucky Heart Disease and Stroke Prevention Program at Khdsp@ky.gov or at 502.564.7996.
blood pressure. Patients enrolled in CARE SMBP at a clinical partner site demonstrated a mean reduction of 12 mm Hg in systolic blood pressure and 6 mm Hg in diastolic blood pressure. A meta-analysis on hyperten sion revealed that every 10 mm Hg reduction in systolic blood pressure lowers the risk of major cardiovascular disease events by 20%, coronary heart disease by 17%, stroke by 27%, heart failure by 28%, and death from all causes by 13%.5 Patient engagement and education is a crucial part of the CARE SMBP program. We measure success in this area by a participants’ ability to correctly identify their blood pressure zone according to colors. At the same CARE SMBP site, 90% of participants were able to identify their blood pressure zone correctly and 80% made improvements in their blood pressure. These findings show that CARE SMBP program is helping participants make the connection between their blood pressure number and the risk category they fall in. These positive outcomes show the CARE SMBP is making a difference for partici
Samantha Albuquerque, DrPH, is the epidemiologist with the KY Heart Disease and Stroke Prevention Program at the KY Department for Public Health. She has a DrPH in epidemiology and environmental health from the University of Kentucky, a MS in chemistry from Georgetown University, as well as a MS and BS in chemistry from the University of Mumbai. Prior to working in heart disease and stroke she carried out research in malaria, enteric viruses, occupational health, asthma, and COPD.
the participant’s blood pressure is measured, they are asked to identify which blood pres sure zone they fall in: normal (green), elevated (yellow), or high (red). This identification and ownership of their blood pressure zone is crucial for participants to become engaged in their health and begin healthy behaviors and/ or lifestyle modifications to reduce their blood pressure. The CARE SMBP coach then works with the participant to find one simple step they can take to reduce their blood pressure. Some examples of modifiable behaviors that a participant can focus on include taking their medication as directed, healthy eating, reduc ing tobacco use, increasing physical activity, reducing blood sugar, reducing cholesterol, and weight loss. At subsequent CARE SMBP encounters, the coach discusses any blood pressure changes since the previous visit and works with the participant to determine if additional healthy behaviors or lifestyle modi fications can be made. One of the main goals of the program is for participants to share their self-measured blood pressure readings with their healthcare providers, resulting in better informed clinical decision-making rel ative to CAREhypertension.SMBPpilot sites have shown reduc tions in participants’ systolic and diastolic
Natalie Littlefield is the CARE SMBP program director with the KY Heart Disease and Stroke Prevention Program at the KY Department for Public Health. She has an MPH in health behavior from the University of Kentucky and a BS in exercise science from Murray State University. Prior to working for the Department for Public Health she worked in community outreach and development with UnitedHealthcare and the American Heart Association.
So how did these couples manage to over come such serious obstacles and get happier? Focus group interviews with formerly unhap py spouses revealed three radically different approaches to turning things around:
Here’s the tricky part:
2. A commitment to solving problems.
• Stay together. Stay miserable.
Waite characterized this group as having a “marriage work ethic.” Rather than simply enduring the problems, these couples focused on solving the problems and got happier as a result. They used anything from date nights to marriage counseling to threatening divorce or consulting divorce attorneys to get the job done.
Here’s what I know now. Neuroscientists tell us that to bring the problem-solving, pro-social part of the brain online, it helps to consider more than two either/or alternatives. I’ve found that the act of simply acknowl edging the possibility of a third option can help struggling spouses start moving forward. Then the relationship has a chance to go where it naturally needs to go.
• Break up. Work on yourself. Find a new partner. Get happier.
I have to admit I labored under the same false assumption early in my counseling career. If you can’t find a way to fix it, you can’t just stay and put up with it, right? But the pressure of choosing between two extreme alternatives is immobilizing and can keep people seriously stuck.
You Don’t Have to Know Where You’re Going. Just Get Moving.
BY JAN ANDERSON, PSYD, LPCC
later. And there was plenty to be unhappy about: infidelity, alcoholism, emotional neglect, verbal abuse, depression, illness, and job loss.
When Is “Wait It Out” a Good Option?
• Determining whether your partner is capable of change.
There’s actually some research that suggests it is possible. More on that later, so stay tuned.
• Stay together. Work on yourselves. Work on the marriage. Get happier.
1. A commitment to stay married.
I like getting beyond the either/or mindset because it helps build distress tolerance. This coping skill enables you to ride out decision discomfort. It buys you time to test your assumptions, try out new behaviors, and gather the data you need before making one of the most consequential decisions of your life. Those consequences will affect not only you but also all those in your orbit.
Here’s one way to apply this thinking to an unhappy marriage and relieve some either/or pressure. From a “universe of all possibilities” mindset, generate an expanded list of all the real istic alternatives you can think of. For example:
• Stay together. Get happier yourself, regardless of the state of your marriage.
• Break up. Stay miserable, just in a different way or with a different person.
Waite characterized this group as having a “marriage endurance ethic.” In other words, these couples simply outlasted the problems.
Let’s focus on the stay together, get hap pier possibility. Sociologist Linda Waite and colleagues at the University of Chicago found that two-thirds of “unhappy” couples declared themselves “happy” when interviewed five years
28 MD-UPDATE
On top of those over-the-top expectations, marriage research reveals another faulty assump tion. Unhappy spouses in troubled marriages tend to see only two alternatives: 1) Stay and suffer, or 2) Get a divorce and get happy.
When Is “Work It Out” a Good Option?
Do both spouses demonstrate a growth mindset and a capacity for change? Then a solution-focused approach can be worth the effort it takes to work on your individual issues and the relationship to boot.
Dead Certain You’re Unhappy, But Dead Set Against Divorce?
That last one is a radical idea, isn’t it? It challenges our cultural assumption that you can’t be happy if your marriage is unhappy.
Miserable in your marriage? These days it’s easy to feel disappointed when a spouse doesn’t live up to our overload of expectations: best friend, workout buddy, hot sex partner, confidante, mentor, financial planner, and life coach all rolled into one.
I’ve found the “wait it out” approach can be a reasonable option for unhappy cou ples who have little appetite or capacity for change. Here’s an example: A thirty-something woman who suffered through her mother’s four divorces is firmly committed to staying in her marriage. Even when serious mental health problems surface in her husband four years into their marriage, she is determined to spare her two children the kind of pain she experienced.
Three Ways Unhappy Couples Stay Together and Get Happier.
MENtAL WELLNESS
Sometimes just making the decision to separate and actively planning it can cause an improvement in the marriage.
Focusing on your own personal happiness may be met with indifference, sabotage, or fur ther emotional distance from your partner. On the other hand, your emotional independence may have an unexpected consequence. It may make you more interesting or attractive to your partner or even win their grudging respect.
• Being apart gives you a chance to miss each other — or not.
Giving up on marital happiness doesn’t mean giving up on your personal happiness. It usually does mean developing more emotional independence from your spouse. Think of it this way: Instead of moving out, you lean out.
My job is to help you figure out if you’re in a solvable state of gridlock or if there really isn’t much that you can do about your differ ences, at least for now or maybe ever. If there’s not much wiggle room, my job is to help you make peace with that or start considering other options.
your partner may feel less put upon or defen sive and lean in a little.
• The distance may give you the space you need to emotionally regulate and become less likely to be easily triggered by your partner.
• Coming to terms with what you can and can’t change in your marriage.
Suppose you’ve given up on a happy mar riage and you’re not able to enjoy your life or protect your children from whatever is unsat isfying or difficult in your marriage. In that case, it may be time to consider a therapeutic separation.Here’show a concrete physical change like separation may be a catalyst for a change of mind or heart:
3. A commitment to personal happiness.
And most paradoxical of all, allowing your self to consider ending the marriage may be what enables and empowers you to save it.
MENtAL WELLNESS
Leaning out doesn’t mean you turn away or become withdrawn and cold. It means you think of yourself less as lovers and spouses and more as friends, roommates, or co-parents.
It’s always a good idea. Taking more control over creating your own happiness will defi nitely be good for you, especially if you tend to lose yourself in a relationship or have a his tory of trying too hard to save a relationship.
• Sometimes a separation allows you to reclaim an essential part of yourself that you lost or neglected in the marriage. Bringing “more of yourself” to the table may enable you to renegotiate the terms of your relationship from a position of strength. Reclaiming a lost or neglected part of yourself may also have a surprising effect: It may make you more interesting or attractive to your partner.
ISSUE #138 29
In other words, when you get happier, the marriage may get happier. It’s a good demon stration of the saying, “It only takes one per son to change a relationship.” So don’t sniff at small increases in happiness. Appreciate them, either as a short-term coping mechanism, a stepping stone to greater individual happiness, or — who knows? — marital satisfaction.
When Is “Moving Out” a Good Option?
It’s also possible that your partner may get happier, too. Getting more of your needs met elsewhere can take some pressure off a partner with limited capacity for intimacy. Finding your happiness elsewhere may mean you feel less disappointed in your partner. In turn,
• A separation may help you stop blaming everything on your partner. You may develop more insight into how you are contributing to the problems in your relationship.
• Determining if your anger and disappointment keep your partner so defensive that they feel too criticized to want to behave differently.
This group was committed to finding per sonal happiness, regardless of a difficult or less than ideal marriage. The ability to stay mar ried for the sake of your children, for religious reasons, or because you can’t afford it requires a very different mindset and strategy.
When Is It a Good Idea to Focus on Your Own Happiness?
• A separation may give you more awareness or appreciation of how much your partner positively contributes to the marriage.
PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH
CHI Saint Joseph Medical Group Recognizes 2021 Physician of the Year
BEREA Saint Joseph Berea rec ognized Donny Hardy, MD, as the 2021 Physician of the Year. Hardy, of Berea, practices with CHI Saint Joseph Medical Group – Internal Medicine in Berea.
30 MD-UPDATE News
Donny Hardy, MD
LEXINGTON Carmel Jones has been appointed presi dent of the CHI Saint Joseph Medical Group.
BARDSTOWN
Omaha, Nebraska. She is a certified public accountant, a certified medical practice exec utive and a member of the Medical Group Management Association and American Medical Group Association.
Aqeel Mandviwala, MD
Saint Joseph Berea Recognizes 2021 Physician of the Year
“Carmel’s list of accomplishments is long, including playing a key role in the growth of a high performing physician enterprise to ensure our communities and patients have access to high quality physicians and advanced practice providers across CHI Saint Joseph Health,” said CHI Saint Joseph Health CEO Anthony Houston, EdD.
Carmel Jones
“I am honored to lead such a wonderful team and am excited about expanding my role beyond operations to focus on strategic initiatives, growth, and partnerships with health care providers within the communi ties we serve,” Jones said. “One focus will be expanding access to quality care even further, particularly through primary care providers within our Medical Group.”
Jones began her health care career in 1995 at Saint Joseph London, then called Marymount Hospital. She most recently served as chief operating officer and market vice president of operations for the Medical Group, a position she held since 2012. She also previously served in finance leadership roles with Saint Joseph London, Saint Joseph Martin, Saint Joseph Berea, and the Saint Joseph Medical Foundation.
LEXINGTON The CHI Saint Joseph Medical Group recognized Aqeel Mandviwala, MD, as the 2021 Physician of the Year. Mandviwala, of Lexington, is a physician with CHI Saint Joseph Medical Group – Pulmonology in London and was instrumental in caring for COVID19 patients at Saint Joseph London during the recent delta Mandviwalasurge.was selected as the overall Physician of the Year among all physicians recognized by CHI Saint Joseph Health.
Jon Myers, MD
the physician of the year award,” said one of his colleagues. “He is known for his col laborative nature and wealth of radiology knowledge, is well respected by the medical staff and works very closely with our imaging technologists to assure the best care for our patients. On top of his very busy schedule, he performs numerous invasive procedures each week with skillful hands.”
Jones Named President of CHI Saint Joseph Medical Group
Flaget Memorial Hospital Recognizes 2021 Physician of the Year
veryofitsJonHealth,CHIHospital,MemorialFlagetpartofSaintJosephrecognizedMyers,MD,as2021PhysiciantheYear.“Dr.Myersisdeservingof
“Dr. Hardy is an asset to health care in the Berea community,” said a colleague who nominated him. “In his clinical practice setting, he provides excellent care to all of his patients. At Saint Joseph Berea, he provides coverage as a hospitalist on evenings and weekends. He also demonstrates our CommonSpirit core values in his interactions with everyone – both the patients he cares for and the nursing and ancillary staff he works alongside. He is well regarded by Saint Joseph Berea’s medical staff, as well as the hospital staff. You never see him without a smile – it is a pleasure and a privilege to serve alongside Dr. Hardy in Saint Joseph Berea’s health care ministry.”
A native of London, Jones is a graduate of Transylvania University with a BA in business administration with an emphasis in account ing. She earned an MBA with an emphasis in health care from Bellevue University in
• Treasurer – Robert A. Davenport, MD
Kyle Childers, MD
LEXINGTON Lexington Clinic announced new directors for 2022. They are:
SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com ISSUE #138 31
• President – Michael T. Cecil, MD
• Secretary – Shailendra Chopra, MD
Other members of the board include Haider Abbas, MD, David Alexander, MD, An-Yu Chen, MD, Jamil Farooqui, MD, Tharun Karthikeyan, MD, Jordan Prendergast, MD, Mr. Nick Rowe and Mr. AlanLexingtonStein.
The leadless pacemaker is a small self-con tained device implanted directly into the heart muscle. Traditional pacemakers require an external generator placed under the skin in the upper chest connected to leads, which are flexible insulated wires placed in the chamber of the heart. The device, about one-tenth the size of a traditional pacemaker, eliminates the need for wires, which can break or malfunc tion and create potential for infection.
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 spe cialties and has more than 25 locations throughout Central Kentucky.
• Vice-President – Kyle J. Childers, MD
John Abe, MD
Saint Joseph London Is First in the Area to Offer Leadless Pacemaker
FACC, FHRS, with CHI Saint Joseph Medical Group – Cardiology, performed the first leadless pacemaker implant at Saint
Shailendra Chopra, MD
“Some patients don’t qualify for the older pacemakers,” Abe says. “The new leadless pace
The procedure to implant a leadless pacemak er takes about 45 minutes, about half the time to install a traditional pacemaker. The device is installed using a catheter inserted into the femo ral vein through the groin. Patients are typically able to go home after about six hours.
PHOTOS PROVIDED BY LEXINGTON CLINIC
Robert A. Davenport, MD
Michael T. Cecil, MD
Joseph London, in December 2021 bringing new options for cardiac patients in the region.
maker can help patients who have had infections with a previous pacemaker or those whose veins are occluded. These patients may have been eligible for a pacemaker, but we had no way to implant it, other than through open heart sur gery. This new leadless device opens up a whole new option for treatment for these patients.”
Officers Announced for Lexington Clinic’s 2022 Board of Directors
Dr. John Abe implanted wireless heart device in December
LONDON Saint Joseph London became the first hospital in south eastern Kentucky to offer a Johntheirhelppatientspacemakerleadlessforwhoneedcontrollingheartbeat.Abe,MD,
More information on Hope Scarves is at www.hopescarves.org
LOUISVILLE Lara MacGregor, founder of Hope Scarves, died on January 18, 2022.
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After first being diagnosed with breast can cer in 2007, Lara was given a box of scarves with a note that read, “You can do this.” After her treatment, she then passed the same scarves on to another woman with words of encouragement. Hope Scarves was born.
Since its founding in 2012, Hope Scarves has sent more than 20,000 scarves to people, in every state and 29 countries, who are fac ing more than 90 different types of cancer. With the news of Lara’s metastatic diagnosis in 2014, Hope Scarves has also raised over $1.5 million to further metastatic breast can cer research. Lara continued inspiring others through A Hopeful Life, an extension of Hope Scarves, where she shared her journey through blog posts, a podcast, and more. In December 2021, she was named the “L’Oreal Paris Woman of Worth” by the cosmetics giant for her philanthropic work and service. She was 45 at the time of her death.
Lara MacGregor, Founder of Hope Scarves, Dies of Metastatic Breast Cancer
PHOTO PROVIDED BY HOPE SCARVES
