MD-Update Issue 138

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #138 WWW.MD-UPDATE.COM

Stroke of Genius

VOLUME 12 • #1 • February 2022

Data-Driven Decisions Help Interventional Cardiologist Nezar Falluji, MD, Prevent Strokes

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

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS

2022

Editorial Calendar

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

To participate, please contact Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com

LETTER FROM THE EDITOR/PUBLISHER

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.

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.

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 Dr. Gerald Harmon, current AMA president, recently wrote about the increasing level of workplace 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.”

“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 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.

Losing a Friend The first time I met Lara MacGregor, founder of Hope Scarves, was in 2016 at her organization’s signature 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

Upcoming Specialties in 2022

Gil Dunn Editor/Publisher MD-Update 2

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Volume 12, Number 1

ISSUE #138

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Gil Dunn gdunn@md-update.com GRAPHIC DESIGN

Laura Doolittle, Provations Group COPY EDITOR

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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.

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CONTENTS

ISSUE #138

troke of 12 S Genius Data-Driven Decisions Help Interventional Cardiologist Nezar Falluji, MD, Prevent Strokes 4 5 6 7 9 12

HEADLINES ACCOUNTING FINANCE LEGAL OP/ED COVER STORY

SPECIAL SECTIONS: 16 CARDIOLOGY 24 BARIATRIC SURGERY 26 PUBLIC HEALTH 28 MENTAL WELLNESS 30 NEWS COVER PHOTOGRAPHY BY MARK MAHAN

SPECIAL SECTIONS CARDIOLOGY • BARIATRIC SURGERY

16 CARDIOLOGY

18 CARDIOLOGY

22 CARDIOLOGY

24 BARIATRIC SURGERY ISSUE #138

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Headlines

Lexington Medical Society Installs 2022 President LEXINGTON Khalil Rahman, MD, a Lexington

During a virtual induction, Dr. Khalil Rahman begins his term as president of the Lexington Medical Society.

PHOTO PROVIDED BY LEXINGTON MEDICAL SOCIETY

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 vaccinations, masking, and social distancing.

Rahman, a graduate of Dow Medical College in Pakistan, completed the nephrology 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

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 community and the public.

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.

The Lexington Medical Society is a non-profit 501(c)(6) organization that supports physician members to improve the practice of medicine and the health of the community. The LMS, established in 1799, is one of the oldest medical societies in the country.

Learn more about the Lexington Medical Society and its programs at lexingtondoctors.org.

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Accounting

Provider Relief Fund Reporting Period 2

BY LANCE MANN, CPA, CFE, CGMA, ASSURANCE DIRECTOR

The Provider Relief Funds Reporting Portal has portal with their existing username, TIN, and on allowable expenses and cannot be applied opened for period 2. Providers who received password. against lost revenue. Resources for allowable HRSA has issued some new guidance for uses of these funds can be found at www.hrsa. one or more PRF payments exceeding $10,000, in the aggregate, during the second Payment reporting period 2. Links for these new gov/provider-relief/reporting-auditing/nursReceived Period (July 1, 2020 to December resources are detailed below. ing-home-infection-control-distribution.

31, 2020) must report on There is no grace periREPORTING PERIOD 2 FACT SHEET: how these funds were used od for submitting your www.hrsa.gov/sites/default/files/hrsa/provider-relief/whats-new-in-rp2-fact-sheet.pdf

by March 31, 2022 in report for period 2. Make the PRF Reporting Portal. sure you allocate a suffiREPORTING PERIOD 2 LOST REVENUES GUIDE: Payments received during cient amount of time to www.hrsa.gov/sites/default/files/hrsa/provider-relief/prf-lost-revenues-guide-rp2.pdf this period must have complete your reporting This will also be the first time many recipi- by March 31, 2022. been expended by December 31, 2021.

New PRF Reporting Portal users must first ents of the nursing home and infection control Please let Dean Dorton know if we can help register in the PRF Reporting Portal (https:// funds will be required to report on the use as you work through reporting period 2. prfreporting.hrsa.gov/s/). If a reporting entity of these funds. One important thing to note Lance Mann, CPA, CFE, CGMA, assurance director, can be has previously reported, they may log into the about these funds is that they must be spent reached at 502.566.1005 and lmann@deandorton.com.

ISSUE #138

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Finance

Five Types of Risk and How To Deal With Them

BY SCOTT NEAL

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.

Drawdown risk. Because most people see the loss of capital, even if it’s only on paper, as their chief risk, most risk tolerance questionnaires 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 portfolio 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.

Let’s look at four more different flavors of risk and what you might do to mitigate the impact of each one.

Loss of purchasing power is experienced during periods of inflation. Inflation is insidious 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 6

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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 inflation because a) property values are likely to increase, and b) investors can raise the rent to match inflation.

Volatility risk. Most investors are quite confident that the stock market will go up over long periods of time. They are also keenly 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 accepted 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.

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

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 alternative future scenarios (especially worst-case and best-case) becomes very valuable when tradeoffs are present. It is important to construct 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 . . .

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 people 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.

All these risks should be addressed in any well-developed financial plan. Talk to your advisor about them today.

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

Legal

Informed Consent: Not a Mere Formality

BY STEPHANIE M. WURDOCK

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 malpractice lawsuit. It is important for providers to recognize that informed consent is an important component of care, not a mere formality.

Basis for Informed Consent 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 benefits and “substantial” risks of the treatment as well as “acceptable” alternatives. This information must be imparted in such a way that a non-medical person would understand it.

Informed consent claims typically arise when a patient suffers a rare and/or significant complication 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

varies by procedure, there are some general guidelines a provider can follow to protect themselves from informed consent claims.

Provider Guidelines First, providers should make sure the informed consent discussion is conducted with the appropriate 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.

If a provider doubts the patient’s ability to understand the information, she should consider suggesting that the patient return with a trusted representative (e.g., a spouse, adult child, sibling, or parent) for a follow-up discussion. 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

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

that the patient (or, if applicable, the patient’s representative or POA) appeared competent to understand the information provided.

Valid informed consent requires the information 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 medical 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.

Ensuring Informed Consent To avoid a claim for lack of informed consent, 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.

This information should be communicated in terms patients can understand. The average American reads and comprehends at the 7th- to 8th-grade level, and this is likely true of Kentucky’s patient population. This means

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providers must avoiding using complex medical terminology. For example, if a procedure carries the risk of nerve damage, use that phrase instead of “neuropathy.” Instead of “dysphagia,” explain that the procedure could result in some temporary difficulty swallowing.

Once the proposed treatment is described, providers must disclose what reasonable alternatives are available and the general risks and benefits of each.

Finally, the conversation must include an opportunity for the patient to ask questions.

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 typically sign upon the conclusion of that conversation does not constitute informed consent; such documentation is merely evidence that informed consent took place.

What Should Be Documented?

Providers should author a visit or progress note memorializing the discussion. This should 8

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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, consider 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 _______.”

The note should also reflect that reasonable alternatives were discussed and that the patient was given an opportunity 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.

An “Informed Consent” form, such as those utilized by ambulatory surgery centers and hospitals, can certainly be used to help memorialize the consent process. However, these forms should not be the only documentation. These

forms are infrequently tailored to the specific procedure, provider, or patient. Therefore, where possible, information regarding the specific risks, benefits, and alternatives should be added to these forms, and reference should be made to the complete note (discussed above).

There is one caveat to the above suggestions.

This article assumes a non-emergency situation with a patient who has the capability of receiving, 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.

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 reason, engaging in and documenting thorough informed consent discussions is vitally important to a provider’s practice.

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. The suggestions

Op/Ed

Central Kentucky Heart Ball Returns Gala funds research, education, and resources to fight heart disease

BY JEFF KOONCE, WESBANCO MARKET PRESIDENT, CO-CHAIR OF THE 2022 CENTRAL KENTUCKY HEART BALL 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.

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. 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 experiencing long-term side effects, and the true impact of what many are calling long-haul COVID remains to be seen.

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

Jeff Koonce

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.

I have served on the board of the Central Kentucky AHA for well over 10 years, becoming 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.

In over 150 communities across the country, Heart Ball supporters unite with a shared purpose to raise the critical awareness, action,

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 ethnicity, 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.

This year, we invite you to join us in celebrating 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.

To learn more or make a contribution, visit LexingtonHeartBall.heart.org.

NOW ONLINE

ISSUE #138

9

Op/Ed

Preponderance of Evidence The jury is in: We are what we eat

BY MAC STONE

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 breakneck 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.

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.

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 decisions 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

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 gracefully, 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 wilderness areas, in cultural exchange within a community, and in the foods we produce through our organic agrarianism. The preponderance of evidence points to a diet consisting of fruits

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Op/Ed

and vegetables, nuts, and cuts of properly raised unadulterated meats to provide the balance 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.

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,

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 grateful 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

Mac Stone

as they say. The rise in diet-related disease correlates closely with the rise in fast food consumption, sugary soft drink intake, and with the proliferation of convenience foods processed beyond recognition. Eating this way has become the norm, and at what cost? Kentucky ranks high in our incidence of diet-related diseases like diabetes and hypertension, while cho-

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.

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.

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 environment? 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.

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Nezar Falluji, MD, MPH, serves as the director of the Structural Heart Program at CHI Saint Joseph Hospital

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Cover Story

Stroke of Genius

Data-driven decisions help interventional cardiologist Nezar Falluji, MD, prevent strokes

BY JIM KELSEY LEXINGTON Trusting the science comes naturally 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.

“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.”

While all that is certainly true, Falluji admits that a different source of less-scientific information 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.

“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 philosophical 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.”

Destined for Cardiology For Falluji, the decision to become a cardiologist was a relatively easy one. He was drawn to the challenges of solving complicated cases with data, technology, and innovation.

“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.”

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.

“The specialty that I’m focused on – interventional 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 presentations 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.”

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.

“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.”

Erin Caldwell, RN, TAVR, MitraClip, WATCHMAN™ coordinator, with Nezar Falluji, MD

PHOTOS BY MARK MAHAN

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Atrial Fibrillation and the WATCHMAN™ A common condition in cardiovascular disease 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.

“Having atrial fibrillation places the patient at a five-fold higher risk of having a stroke,” Falluji says.

Falluji explains that the heart’s left atrial appendage becomes the primary focus once a patient develops atrial fibrillation.

“Atrial fibrillation usually occurs as a consequence of hypertension or valvular abnormalities and is associated with old age and other chronic health conditions. These various conditions 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”

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.

For years, the Lariat® device was used to perform the left atrial appendage occlusion (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.

“They isolate the appendage immediately,” he says. “Once they heal into the appendage, they limit clot formation inside the appendage. Nothing gets in or out of the appendage, so these devices, as the evidence shows, would reduce the risk of stroke.”

Both the WATCHMAN™ and Amulet procedures 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.

Most patients are eligible for the WATCHMAN™ or Amulet procedures, with very few exceptions due to anatomical or other contraindications.

“The procedure carries 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 important that his fellow medical professionals understand the benefits of the proceAshley Taylor, interventional technologist, confers with Nezar Falluji, MD, in the Cardiac Cath Lab at Saint Joseph Hospital.

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PHOTOS BY MARK MAHAN

The WATCHMAN™ manufactured by Boston Scientific, is used to occlude the left atrial appendage in patients with atrial fibrillation.

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.

“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.”

Falluji says he and his team follow very strict protocols in determining which patients are candidates for the procedures. He estimates that 90 percent of the patients benefit from these interventions.

“It’s unfortunate that we would miss opportunities on the premise that the patient is too old or that their condition is too complicated,” he says. “We need to continue to educate and communicate the great technological advances in cardiovascular medicine to provide our patients with the best quality care that they deserve” 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.

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When Your Mission Is Healthy Hearts, Failure Is Not an Option

Collaboration drives UofL Health – Advanced Heart Therapies Program

BY MENISA MARSHALL 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 reflected NASA’s mission.

The mission of UofL Health – Advanced Heart Therapies Program shares certain similarities with NASA. It aims for successful outcomes. It is forward-looking and not daunted by tough challenges. And, its success is driven by collaborative teamwork 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.

“We have lots of options, all the way from lifestyle changes and medications to a transplant 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.”

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.

Moore says, “I’d like to increase awareness about the importance of prompt referral to an advanced heart failure program or center.”

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 16

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had one heart failure hospitalization, and cannot climb a flight of stairs without stopping.

“You can refer a patient too late to an advanced heart failure center, but you can never refer someone too early,” she says.

Collaboration Is Key Collaboration is a hallmark of UofL Health – Advanced Heart Therapies Program. The program’s transplant clinic demonstrates the effectiveness of this approach.

Typical transplant work teams include physicians, coordinators, nurses, pharmacists, dietitians, physical therapists, and social workers. These experts work together to maximize optimal outcomes for each patient.

Multidisciplinary teams make the care process simpler and more effective. It’s common for patients at UofL Health to see a surgeon and cardiologist at the same time.

“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 life.”

Family support is a critical part of the program. Family members learn what patients should and shouldn’t do. If questions arise, nurses and transplant coordinators are just a phone call away.

“Support groups and transplant coordinators get to know one another well,” says Moore.

“Caring about one another is a necessity.”

Promising New Treatment Options UofL Health – Advanced Heart Therapies Program continually assesses new and emerging information, technologies, and treatments. Gene therapy and newer more innovative heart pumps and pacemaker-like devices for example, stand to generate major changes.

PHOTO PROVIDED BY UOFL HEALTH

“As a field, we’re at the forefront of some genetic therapies for cardiomyopathy or heart failure,” says Moore.

She notes that recent news of a human transplant involving a genetically modified pig heart makes xenotransplantation “an exciting prospect.”

In the meantime, stronger, improved medications are making a big impact against familial hyper-cholesterolemia and heart failure. Less invasive cath lab procedures are improving the diagnosis and treatment of valve disease and often entail minimal need for inpatient admission.

Heart Disease Can Be Prevented Despite the effectiveness of advanced therapies, Moore wants people to know that heart disease is largely preventable.

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 lifestyle choices,” says Moore. “Make sure you exercise, eat some vegetables, if you smoke try to quit, and get eight hours of sleep daily.”

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 rounds.

Mornings are typically 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 therapeutic options.

Her central message is simple but critical: “Your number one aim should be to try to avoid heart disease.”

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Transplant Cardiology Becomes a Professional and Personal Mission Moore, who is originally from northeast Ohio, did her undergraduate work at The Ohio State University. She became a pharmacist and found she enjoyed working with patients. She was admitted to the University of Cincinnati College of Medicine and continued to work as a pharmacist part-time until she graduated in 1994.

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.

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 previously 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.

“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.”

UofL Health’s heart program strives to be thorough and patient-centered. Moore says it reflects her personal philosophy to treat people as if they are dear friends.

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 positive outlook,” says Moore. “Hope is a powerful medicine.”

“Never underestimate the power of a positive outlook.”- Stephanie Moore, MD, cardiologist and director of the program’s Heart Failure Clinic.

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Heart Care Takes a Multidisciplinary Village

MD-Update Q & A with Steven Heatherly, MD 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.

P lease tell us where you grew up, and your education and medical training.

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.

hen did cardiology become W your primary focus?

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 hypertension and heart failure.

hat brought you to W Baptist Health?

Baptist Health was my first position after I finished my fellowship. I was looking for a hospital that wanted to launch a pulmonary hypertension clinic. I first went to Madisonville, Kentucky and opened a PAH and HF clinic there. I recently transitioned to 18

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Louisville to be the system medical director, as well as staff our heart failure clinic and open our new PAH clinic here.

hat does a week in your W professional life look like?

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 catheterization lab. I also read echocardiograms throughout 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.

escribe your patient D population: age, gender, presentations, treatments.

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.

Some patients may need to consider LVAD/ heart transplant. My patients with PAH need right heart catheterizations, often more than

once. Some may also need to eventually consider lung transplantation.

entucky is known for heart K disease. How does the Baptist Heart Failure Clinic continue to innovate and address a common problem?

Kentucky has plenty of cardiovascular disease. 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 typically relegated to the ER. I like to think we meet our patients where they are.

We are also innovative as a health system because our nine hospitals currently participate 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 monitoring 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.

hat are some of the new W treatment plans and procedures for treating heart disease, both medical and surgical?

We have very exciting options for patients with heart disease. More and more we are see-

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 replacement. 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 pulmonary embolism, our interventional cardiology team, in select patients, can do catheter-directed thrombolysis, a catheter approach to addressing clots in the lungs. Baptist Health Louisville also has a robust mechanical circulatory 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 curative for some patients known as a pulmonary thromboendarterectomy (PTE) There are very

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.

T alk about the collaborative team approach at Baptist Health Heart Failure Clinic in Louisville.

Healthcare takes a village. No one physician or clinician can know it all. So, a multi-disciplinary 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 cardiologist/structural heart disease specialist.

Many of them will need to see cardiothoracic surgery and participate in cardiac and pulmonary 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 pulmonologists. Some of them also need rheuPHOTO BY ALEXANDRA ROGERS

matologists. So, I treasure the ability to have an extremely talented and diverse healthcare team here to depend upon.

escribe your interaction D with patients and their family, particularly the initial visit. Tell us about a unique patient experience.

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 medical 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.

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I have so many stories about unique patients and experiences, but I will summarize it by saying 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.

hat are the most common W misconceptions among noncardiologists and the heart disease patient population that you want to address?

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

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 misconception 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.

hat’s on the horizon of W cardiology and cardiac surgery?

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.

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.

A re you currently involved in any clinical trials?

Yes, I am currently the principal investigator 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.

escribe your personal D philosophy of care.

Training is intense. Wake Forest was an excellent proving ground, but it was challenging. 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.

BAPTIST HEALTH LOUISVILLE HEART FAILURE CLINIC 4002 Kresge Way, Suite 110 Louisville, KY 40207 “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 20

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PHOTO BY ALEXANDRA ROGERS

502.928.8700 BaptistHealth.com/Louisville

Knowledge Is Power

Interventional cardiologist Mostafa Osman El-Refai takes patient care to heart 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.

“My interest in heart disease actually came after medical school as I did my internal medicine training and rotated through cardiology,” he says. “How interesting and complex it is and the variety of things that cardiovascular doctors take care of just piqued my interest.”

BY JIM KELSEY 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.

“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 cardiologist 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.”

El-Refai admits that opting not to perform a procedure to fix the blockage is counterintuitive to his training as an interventional cardiologist, but the decision is all about what is best for the patient.

“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.”

The Path to Cardiology Born and raised in Louisville and a graduate of duPont Manual High School, El-Refai knew early on that he would become a physician but didn’t come to cardiology until well into his medical training.

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In Clinic and the Cath Lab Mostafa Osman El-Refai, MD

“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.”

— 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 exposure to the medical world that I would want to be a physician.”

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 cardiology fellowship at Baylor in 2017, then an interventional cardiology fellowship at Baylor in 2018. He then came back to Louisville and PHOTOS PROVIDED BY NORTON HEALTHCARE

El-Refai sees patients both in the clinic and the hospital and finds both environments 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 patients.

“It’s a busy 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.”

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 physician-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.

“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,

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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.

it kind of triggers in my mind that maybe I need to reframe that. Houston has the largest 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.”

A Diverse Patient Base 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 better awareness.

“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 repetitive and consistent use of best practices for every patient to assure overall quality of care.

“Every human being is going to make a mistake,” he says. “So you have to put systematic processes in place to allow you to translate

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 they deserve.”

El-Refai provides an example of stable angina patients on medical therapy that continue 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.

“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.”

Knowing how to do it is half the battle. The rest is knowing when to do it — or not.

ISSUE #138

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SPECIAL SECTION

Bariatric Surgery

A Lifetime Commitment for Both Doctor and Patient

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.

BY DONNA ISON 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 go unnoticed.

Mathis 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.’”

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 completed surgery residency training at Inova Fairfax Medical Center in northern Virginia, followed by a bariatric surgery fellowship at the prestigious Lahey Clinic in Boston.

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.”

Benefits of Bariatric Surgery 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

“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

surgeon Alberto Zarak, MD, FACS, to provide 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.

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 sensation 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 24

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PHOTO BY GIL DUNN

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.”

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-

SPECIAL SECTION

cations, and may not have to wear their CPAP for sleep apnea anymore. It can be completely life-changing for them.”

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 morbidly obese counterparts.

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.

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.

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.

A Lifetime Commitment At the CHI Saint Joseph Health – Center for Weight Loss Surgery, the commitment to each patient lasts throughout their lifetime.

“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 procedures,” says Mathis.

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 physiologist and a psychologist — all working together to ensure the patient has the best chance for long-term success.

Each patient begins by attending a comprehensive bariatric seminar, which are currently being conducted virtually due to COVID, then an initial telemedicine consultation.

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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 assessment 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.

Major Misconceptions Knowing how controversial bariatric surgery 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 last resort.

Mathis says, “I think, for the general public and potential bariatric patients, there’s a common 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 lifestyle change.”

Mathis also urges doctors to look at bariatric 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.”

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Do you know your next move? We can help!

CENTER FOR WEIGHT LOSS SURGERY 160 N. Eagle Creek Drive Suite 201 Lexington, KY 40509

859.967.5520 ISSUE #138

25

Public Health

The CARE Collaborative and Self-Measured Blood Pressure Monitoring Program

CARE SMBP is an education and engagement program that enables participants to help control and manage their hypertension.

BY NATALIE LITTLEFIELD AND SAMANTHA ALBUQUERQUE 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 hypertension.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.

What is SMBP? SMBP is defined as the regular measurement of blood pressure by the patient outside the clinical setting, either at home or elsewhere. It is sometimes known as “home blood pressure monitoring.” Scientific evi1 Fuchs, F.D. & Whelton, P.K. (2020). High Blood Pressure and Cardiovascular Disease Hypertension 75 (2), 285-292. https://doi.org/10.1161/HYPERTENSIONAHA.119.14240 Accessed at https://www.ahajournals.org/doi/epub/10.1161/ HYPERTENSIONAHA.119.14240 on Nov 29, 2021.

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 https://wonder.cdc.gov/controller/datarequest/ D76;jsessionid=E76D448C9E254A592E53234C2E56.

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/.

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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, providing 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.

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.

What is the CARE Collaborative?

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 participant’s blood pressure is normal, elevated, and high, respectively. Individuals document their blood pressure and choose lifestyle modification goals to lower their cardiovascular disease risk.

CARE SMBP CARE SMBP combines SMBP with CARE Collaborative education to offer participants tools and resources to improve their blood pressure and overall health. CARE SMBP 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.

PHOTO PROVIDED BY UOFL HEALTH

CARE SMBP coaches are healthcare providers 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 participant 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

the participant’s blood pressure is measured, they are asked to identify which blood pressure 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, reducing 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 modifications 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 relative to hypertension.

CARE SMBP pilot sites have shown reductions in participants’ systolic and diastolic

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 hypertension 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 partici5 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 burden and improve heart health of Kentuckians.

Anyone interested in learning more about the CARE SMBP program is invited to contact the Kentucky Heart Disease and Stroke Prevention Program at Khdsp@ky.gov or at 502.564.7996.

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. 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.

ISSUE #138

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Mental Wellness

Dead Certain You’re Unhappy, But Dead Set Against Divorce?

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.

So how did these couples manage to overcome such serious obstacles and get happier?

Focus group interviews with formerly unhappy spouses revealed three radically different approaches to turning things around: 1. A commitment to stay married.

Waite characterized this group as having a “marriage endurance ethic.” In other words, these couples simply outlasted the problems.

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.

On top of those over-the-top expectations, marriage research reveals another faulty assumption. Unhappy spouses in troubled marriages tend to see only two alternatives: 1) Stay and suffer, or 2) Get a divorce and get happy.

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.

When Is “Wait It Out” a Good Option?

You Don’t Have to Know Where You’re Going. Just Get Moving.

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 acknowledging 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.

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 realistic alternatives you can think of. For example: 28

MD-UPDATE

• Stay together. Stay miserable.

• Break up. Stay miserable, just in a different way or with a different person.

• Break up. Work on yourself. Find a new partner. Get happier.

• Stay together. Work on yourselves.

Work on the marriage. Get happier.

• Stay together. Get happier yourself, regardless of the state of your marriage.

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.

There’s actually some research that suggests it is possible. More on that later, so stay tuned.

Three Ways Unhappy Couples Stay Together and Get Happier.

Let’s focus on the stay together, get happier 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

I’ve found the “wait it out” approach can be a reasonable option for unhappy couples 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.

2. A commitment to solving problems.

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.

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.

Here’s the tricky part: • Determining whether your partner is capable of change.

Mental Wellness your partner may feel less put upon or defensive and lean in a little.

In other words, when you get happier, the marriage may get happier. It’s a good demonstration of the saying, “It only takes one person 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?

• Determining if your anger and disappointment keep your partner so defensive that they feel too criticized to want to behave differently.

• Coming to terms with what you can and can’t change in your marriage.

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 differences, 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.

3. A commitment to personal happiness.

This group was committed to finding personal happiness, regardless of a difficult or less than ideal marriage. The ability to stay married for the sake of your children, for religious reasons, or because you can’t afford it requires a very different mindset and strategy.

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.

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.

When Is It a Good Idea to Focus on Your Own Happiness?

It’s always a good idea. Taking more control over creating your own happiness will definitely be good for you, especially if you tend to lose yourself in a relationship or have a history of trying too hard to save a relationship.

Focusing on your own personal happiness may be met with indifference, sabotage, or further 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.

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,

Suppose you’ve given up on a happy marriage and you’re not able to enjoy your life or protect your children from whatever is unsatisfying or difficult in your marriage. In that case, it may be time to consider a therapeutic separation.

Here’s how a concrete physical change like separation may be a catalyst for a change of mind or heart: • 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.

• 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.

• The distance may give you the space you need to emotionally regulate and become less likely to be easily triggered by your partner.

• A separation may give you more awareness or appreciation of how much your partner positively contributes to the marriage.

• Being apart gives you a chance to miss each other — or not.

Sometimes just making the decision to separate and actively planning it can cause an improvement in the marriage.

And most paradoxical of all, allowing yourself to consider ending the marriage may be what enables and empowers you to save it.

ISSUE #138

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News

Jones Named President of CHI Saint Joseph Medical Group LEXINGTON Carmel

Jones has been appointed president of the CHI Saint Joseph Medical Group.

Jones began her health care career in 1995 at Saint Joseph London, Carmel Jones 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.

“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. “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 communities we serve,” Jones said. “One focus will be expanding access to quality care even further, particularly through primary care providers within our Medical Group.”

A native of London, Jones is a graduate of Transylvania University with a BA in business administration with an emphasis in accounting. She earned an MBA with an emphasis in health care from Bellevue University in 30

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Omaha, Nebraska. She is a certified public accountant, a certified medical practice executive and a member of the Medical Group Management Association and American Medical Group Association.

CHI Saint Joseph Medical Group Recognizes 2021 Physician of the Year 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 Aqeel Mandviwala, MD CHI Saint Joseph Medical Group – Pulmonology in London and was instrumental in caring for COVID19 patients at Saint Joseph London during the recent delta surge.

Mandviwala was selected as the overall Physician of the Year among all physicians recognized by CHI Saint Joseph Health.

Flaget Memorial Hospital Recognizes 2021 Physician of the Year BARDSTOWN Flaget

Jon Myers, MD

M e m o r i a l Hospital, part of CHI Saint Joseph Health, recognized Jon Myers, MD, as its 2021 Physician of the Year.

“Dr. Myers is very deserving of

PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH

the physician of the year award,” said one of his colleagues. “He is known for his collaborative 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.”

Saint Joseph Berea Recognizes 2021 Physician of the Year BEREA Saint

Joseph Berea recognized Donny Hardy, MD, as the 2021 Physician of the Year. Hardy, of Berea, practices with CHI Saint Joseph Medical Group – Internal Donny Hardy, MD Medicine in Berea.

“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.”

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Saint Joseph London Is First in the Area to Offer Leadless Pacemaker Dr. John Abe implanted wireless heart device in December LONDON Saint Joseph London became the first hospital in southeastern Kentucky to offer a leadless pacemaker for patients who need help controlling John Abe, MD their heartbeat.

John Abe, MD, FACC, FHRS, with CHI Saint Joseph Medical Group – Cardiology, performed the first leadless pacemaker implant at Saint

Joseph London, in December 2021 bringing new options for cardiac patients in the region.

The leadless pacemaker is a small self-contained 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 malfunction and create potential for infection.

“Some patients don’t qualify for the older pacemakers,” Abe says. “The new leadless pace-

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 surgery. This new leadless device opens up a whole new option for treatment for these patients.”

The procedure to implant a leadless pacemaker takes about 45 minutes, about half the time to install a traditional pacemaker. The device is installed using a catheter inserted into the femoral vein through the groin. Patients are typically able to go home after about six hours.

Officers Announced for Lexington Clinic’s 2022 Board of Directors LEXINGTON Lexington Clinic announced

new directors for 2022. They are: • President – Michael T. Cecil, MD • Vice-President – Kyle J. Childers, MD • Secretary – Shailendra Chopra, MD • Treasurer – Robert A. Davenport, 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. Alan Stein.

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

Michael T. Cecil, MD

Kyle Childers, MD

Shailendra Chopra, MD

Robert A. Davenport, MD

PHOTOS PROVIDED BY LEXINGTON CLINIC ISSUE #138

31

News

Lara MacGregor, Founder of Hope Scarves, Dies of Metastatic Breast Cancer LOUISVILLE Lara MacGregor, founder of Hope

Scarves, died on January 18, 2022.

After first being diagnosed with breast cancer 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 facing 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 cancer 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.

More information on Hope Scarves is at www.hopescarves.org

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MD-UPDATE

PHOTO PROVIDED BY HOPE SCARVES