12VOLUME • #3 • 2022EnUJ No inSufferingMoreSilence As a urogynecologist with Norton Women’s Care, Marjorie Pilkinton, MD, OB-GYN, FACOG, is giving voice to some seldom discussed gynecological issues. ALSO IN THIS ISSUE HANNAH HALL, MD, OB-GYN, CHI SAINT JOSEPH HEALTH MEDICAL GROUP EDWARD MILLER, MD, OB-GYN, UOFL HEALTH PHYSICIANS STEPHEN TAYLOR, MD, MEDICAL DIRECTOR, UOFL HEALTH – PEACE HOSPITAL
ISSUE
#142 (October) CANCER CARE Oncology, Plastic Surgery, Hematology, Radiation, Radiology
ISSUE
THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS 2022 Editorial Calendar Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com To participate, please contact ISSUE #141 MUSCULOSKELETAL(September)HEALTH Orthopedics, Sports Medicine, Plastic Surgery, Physical Medicine & Rehabilitation, PT/OT
ISSUE
#143 (December) IT’S ALL IN YOUR HEAD Neurology, Neuroscience, Ophthalmology, Pain Medicine, ENT, Psychiatry, Mental Health
#144 (February 2023) HEART & LUNG HEALTH Cardiology, Cardiothoracic Medicine, Cardiovascular Medicine, Pulmonology, Sleep Medicine, Vascular Medicine, Bariatric Surgery, Wound Care Editorial topics and dates are subject to change
Until next time, all the best, Gil
Shriners Children’s Lexington and Groundbreaking Infant Heart Surgery
Roe v. Wade
Mentelle Media, LLC
EDITOR/PUBLISHER Gil Dunn gdunn@md-update.com
GRAPHIC DESIGN Laura Doolittle, Provations Group
Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter.
Welcome to the Women and Children’s Health issue of MD-Update
Copyright 2022 Mentelle Media, LLC. All rights reserved. no part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher.
The majority of age restrictions are mandated by individual states, and Kentucky legislators need to take action directed at reducing murders committed by people using guns. The use of guns to kill innocent children and people is also a national problem which needs comprehensive, national action.
As always, many thanks to the doctors who gave us their time and shared their stories for this issue. Look for the MD-Update editorial calendar on the preceeding page. When you see your specialty, give us a call. I’d like to hear your story.
A five-year anniversary is something to celebrate, particularly after the past couple of years. We’re happy to share the news about Shriners Children’s Lexington as well as the incredible surgery performed at Norton Children’s Heart Institute. See details on pages 4 and 28.
You cannot get a driver’s license in Kentucky until you’re 16 years old. You cannot buy alco holic beverages or cigarettes until you’re 21. You cannot drive a car if you’re legally blind. There are many government-imposed restrictions on personal behaviors intended to protect the body politic. The age to buy a gun needs to be raised to at least 21.
THE EDITOR
CONTACT US:
Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington KY 40502
Volume 12, number 3 ISSUE #140
38 Mentelle Park Lexington KY 40502 (859) 309-0720 phone and fax
• Can research be done to determine if there is a link between psychotropic drugs and medicated teenagers who become homicidal?
COPY EDITOR Amanda DeBord
Thank Individualyou.copies of MD-Update are available for $9.95.
• Can Kentucky physicians use their voices to address this ongoing and escalating tragedy?
Abortion and a woman’s right to choose and decide what happens within her body is another difficult dilemma currently facing our nation and our medical community. I asked my friend Dr. Cameron Schaeffer, a board-certified pediatric urologist and plastic surgeon, to share his views on the topic. His thoughts are on page 10-11.
What we’ve been doing for the last 25 years is not working to reduce school shootings which are increasing in frequency and fatalities, with 27 so far in the first six months of 2022 accord ing to NPR. I ask:
2 MD-UPDATE
Editor/PublisherDunn MD-Update LETTER FROM THE EDITOR/PUBLISHER
• Can Kentucky doctors demand that more investment be directed towards mental health research and care, particularly for adolescents?
MD-Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials.
MD-UPDATE MD-Update.com
CONTRIBUTORS: Jan Anderson, PSYD, LPCC Brian Boisseau, CHFS, DPH, DPQI Scott neal, CPA, CFP Cameron Schaeffer, MD, FACS, FAAP Adam Shewmaker, CPA, FHFMA
ADVERTISING AND INTEGRATED PHYSICIAN MARKETING: Gil gdunn@md-update.comDunn
Women and children’s health is in the news right now for all the wrong reasons. Mass mur der shootings at elementary schools and other community locales are mind-numbing. How can mass shootings continue to happen in our communities, in our country, without our civic leaders acting to put in place deterrents to end, or reduce, the horrible violence created by the slaughter of innocent lives?
I am neither a hunter or gun owner. I know that some of our physician readers are either, or both. But I am the parent and grandparent of school age children and I am horrified by the thought that they, their classmates, or any child or teacher could be murdered at school or anywhere, by someone intentionally using a gun to maim or kill them.
SEND YOUR TO TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax
LETTERS
ISSUE #140 3 ISSUE #140 10 OP/ED 16 OB-GYN 18 OB-GYN 2O PSYCHIATRYPEDIATRIC 24 CHIROPRACTIC CARE CO n TE n TS FEATURED 4 HEADLINES 6 ACCOUNTING 8 FINANCE 10 OP/ED 12 COVER STORY SPECIAL SECTIONS: 16 OB-GYN 20 PEDIATRIC PSYCHIATRY 22 PEDIATRIC PUBLIC HEALTH 24 COMPLEMENTARY CARE: CHIROPRACTIC CARE 26 MENTAL WELLNESS 28 NEWS 30 EVENTS 12 No SufferingMore in Silence As a urogynecologist with Norton Women’s Care, Marjorie Pilkinton, MD,OB-GYN, FACOG, is giving voice to some seldom discussed gynecological issues. COVER PHOTOGRAPHY BY JAMIE RHODES
“In a complicated healthcare landscape, we’re able to provide care to thousands of children each year regardless of their ability to pay,” says Tony Lewgood, administrator for the Lexington medical center. “That allows us to get to the heart of healthcare, providing excep tional care to those who need it, thanks to our endowment and the generosity of our donors.
Shriners Children’s Lexington named among the Top 50 Best Hospitals for Pediatric Orthopedics
Shriners Children’s provides care for chil dren 18 and younger regardless of the families’ ability to pay. The healthcare system accepts insurance but will provide care for children with no insurance.
4 MD-UPDATE
Shriners Children’s Lexington has served children and families in five states for over 90 years. The first Lexington Shriners hospital opened on Richmond Road in 1926 with a newer hospital built nearby in the 1980s. The newest medical center opened in 2017.
Fulfilling a Dream and a Promise
More information about Shriners Children’s Lexington is at ShrinersLexington.org and 859.266.2101. For appointments, call 859.268.5675.
Lewgood says providers and families need to know that the Lexington medical center cares for a variety of patients. “It’s a long-held misconception that we only treat children with complex conditions, or only those with out insurance,” Lewgood says. “That is not the case. While we are fully capable of han dling more complex cases, we’re here to help every child with an orthopedic need, with some of the best physicians in the country.”
For two consecutive years, Shriners Children’s Lexington, in partnership with UK Healthcare’s Kentucky Children’s Hospital (KCH), has been named among the Top 50 Best Hospitals for Pediatric Orthopedics by U.S. News and World Report.
The 110,000 square-foot medical center fea tures two surgical suites, six pre- and post-sur gery rooms and a post-anesthesia care unit, a motion analysis laboratory, 20 patient exam rooms in an outpatient clinic, four infusion rooms, a radiology department that provides traditional and low-dose imaging, a rehabili tation gym and treatment rooms for physical and occupational therapy, an observation play ground, a research department, and a custom prosthetics and orthotics department.
Today, the pediatric outpatient surgical and rehabilitation center serves over 16,000 patients a year. The medical center is one of 20 Shriners Children’s facilities in the U.S. providing care for orthopedic conditions ranging from the rare to the routine.
National Acclaim
The physicians who practice at the Shriners medical center also practice at UK Healthcare, and many are professors at the UK College of Medicine. Consulting physicians from UK Healthcare also serve Shriners patients with anesthesia, rheumatology, sports medicine, and plastic surgery.
LEXINGTON Five years ago, Shriners Children’s Lexington opened a brand new, state-ofthe-art medical center across from the UK Healthcare campus. It had been more than a decade in the making.
“While we have a strong partnership with UK Healthcare, we are still separate enti ties,” Lewgood says. “The close proximity of Shriners and the KCH brings together Shriners’ pediatric orthopedic expertise and KCH’s specialty and subspecialty care for chil dren with complex conditions. It’s a partner ship that strengthens our mission of providing the most amazing care anywhere.”
Some of the pediatric specialties include clubfoot and other foot disorders, infan tile and adolescent hip disorders, hand and upper-extremity disorders, limb deficiencies and amputations, rheumatology, sports inju ries, fractures, scoliosis and other spinal defor mities, and orthopedic conditions related to cerebral palsy, spina bifida, osteogenesis imperfecta, and more.
Headlines
Start of claim - The revenue cycle process begins the moment a patient schedules an appointment. This is the point at which vital demographic information is gathered by the administrative side. The information will ultimately be used as part of the patient’s bill, or claim. Determining insurance eligibility early ensures any procedures that need pre-approval can be processed in a timely manner.
Republic Bank & Trust Company Loan Originator ID #402606 Choose a bank that keeps its finger on the pulse of your business. Let’s talk business. Call Private Banking Officer Emily Miller at (859) 266-3724. NMLS ID # 419242 ACCOUNTING
The healthcare revenue cycle encompasses all administrative and clinical functions that contribute to the capture, management, and collection of patient service revenue. Revenue Cycle Management (RCM) is how an organiza tion manages finances and associated processes as they relate to the full scope of patient care.
Claim submission - During the claim submission stage of the process, the clinical information from the patient’s
BY ADAM SHEWMAKER, FHFMA, HEALTHCARE CONSULTING DIRECTOR
6 MD-UPDATE
Revenue Cycle Management (RCM) in Healthcare: Part 2
Overview of the Revenue Cycle Process
There are many opportunities for process improvement throughout the revenue cycle. By better understanding how these functions
Editor’s Note: Part 1 of Revenue Cycle Management was published in MD-Update #139, April 2022. It is available online at www.md-update.com.
A patient-centered approach to billing can reduce that worry, improve overall patient experience, and shorten the revenue cycle of claims. Understanding the revenue cycle in healthcare is the first step toward creating a patient-centered, streamlined revenue system.
relate to each other, your RCM team can identify weak points and craft a strategy to eliminate them.
Revenue Cycle Management: What Is It?
As we stated earlier, healthcare profession als strive to deliver exceptional service and outcomes to their patients throughout every facet of care. A significant point of friction for patients is cost – both the uncertainty of expense and lack of clarity in terms of under standing medical billing.
the healthcare industry, there are challenges associated with implementing changes to an RCM strategy, though many of those chal lenges present opportunities for improved digital solutions and more efficient organiza tional structure.
Siloing data - Data silos create the potential for inflated administrative costs. Breaking down these silos is a matter of employing the right digital strategy, as well as training personnel to ensure accurate data flow between departments.
Invest Now for the Long Term
Challenges Opportunitiesandin RCM
Compliance - HIPAA has reduced administrative costs by setting rules for the security and portability of personal health information across medical systems. Any digital or outsourced services utilized by organizations for the RCM process must be HIPAA compliant. Investment in cybersecurity is a must for healthcare organizations.
Adam Shewmaker can be reached at ashewmaker@ddafhealthcare.com | 502.566.1054
Data analytics - Regularly analyzing the efficiency of each function of the RCM process is the best way to know what is working and what needs improvement. The digital tools used should include robust analytics to keep your organization on-pace for increased revenue.
With the changing pace of technology and the COVID-accelerated shift to more telehealth and digital care solutions, now is the time to invest in optimizing your RCM. There are qualified RCM professionals who can assist you in the process of sifting through all the available services to find the one that is right for your organization.
ISSUE #140 7
The RCM process involves a great many moving parts. Due to strict regulations within
Analytics and evaluation of results for improved functionalityAnalytics from each stage of the RCM process should be reviewed regularly by parties representing all relevant departments to ensure opportunities for improvement aren’t missed.
Patient statements and collectionsOnce the provider has received all eligible payments from insurers, the remaining balance of the claim is sent to the patient as a statement of financial obligation, or a bill. The patient collections stage may involve setting up a payment plan for larger bills. Any payments received are documented, and necessary action is taken when claims become past-due.
visit is transcribed and coded so the provider and insurers understand exactly what procedures and supplies are represented in the claim. Charge entry is the final task in this step, resulting in an itemized list of charges.
Billing and coding - Incorrect coding is a costly error. Reworking a claim costs, on average, $25 per claim. Half the time, denied claims aren’t even reworked, leaving potential payouts from insurers on the table. The goal of any RCM strategy should be submitting clean claims the first time.
from claims payments by insurers, as well as a wider pool of potential patients who carry that insurance.
Provider credentialing - Healthcare provider credentialing requires a great deal of data monitoring and reporting by both providers and insurers. Proper reporting is necessary for remaining on an insurer’s approved provider list. Being an approved provider increases opportunities for revenue
Patient-focused care - Healthcare professionals who provide direct services to patients should be freed up from as much administrative work as possible so they can remain patient-focused throughout the day. Automation and outsourcing of regular administrative tasks where feasible will improve patient care and experience.
Claims management - Claims management encompasses all steps involved with processing claims through insurers, including Medicaid. Claims are approved or denied by insurance, followed by rework and resubmission where applicable. When managed well, this stage has a significant impact on increasing revenue by reducing claims denials.
Just as it is important for healthcare profes sionals to connect with patients as individuals, it is important that changes of this size and nature are met with proactive training and education for administrators and clinicians throughout your organization.
deandortonhealthcaresolutions.com Practice management and advisory services Medical billing and credentialing Revenue cycle management Compliance and risk management Interim practice management Accounting and financial outsourcing HumanTechnologyresourcesEmpowering physicians to focus solely on the demands of their clinical practice ACCOUNTING
Investment Markets: Problem? or Opportunity?
8 MD-UPDATE
If you are feeling uneasy about your invest ments, rest assured that you are not alone.
I am sure that you probably think that the current market only presents a problem. However, we invite you to join us in seeing it as an opportunity. Please look at your portfolio performance (both the percentage return and the number of dollars gained or lost) for the trailing twelve months. Make an honest assessment of whether your portfolio is aligned with your objectives. There is still time in this market cycle to make adjustments.
There is a strong chance that traditional stock and bond losses will get worse before the markets turn around. If you are losing sleep now, just know that although not guaranteed, things can get worse and that you have a wonderful opportunity right now to accept or adjust your risk tolerance and thereby impact future performance. Now is a good time to assess your risk tolerance and to take steps to get it aligned to reality if you find the two are incongruent. Talk to a professional.
When it comes to investing, any inclination to “throw in the towel” or to “go all in” is usually a mistake.
The Problem
Perhaps you, like most investors and many professionals, follow the investment protocol popularized as asset allocation. You likely know the drill: own a basket of securities that contains traditional asset classes, usually cash, stocks, and bonds. Allocate the entire portfolio across those asset classes and then periodically rebalance the portfolio back to those prescribed allocations. “Wash, rinse, repeat, and your investment portfolio will be fine,” say it’s proponents. The portfolio objective of this strategy is to achieve marketlike returns within the particular asset classes while reducing volatility of the entire portfolio by holding securities that move countercyclically with each other. In other words, the theory assumes that volatility, not loss of capital, is the chief risk that we face. Won’t we accept, even desire, all the upside volatility we can find? It’s the downside that keeps us awake at night. But what happens when all the usual asset classes are all declining at the same time? Turn to cash?
FiNANCE
Thanks to Federal Reserve policy, the inter est rate on cash remains at nearly zero. With inflation running rampant at about 8%, hold ing cash while we wait for the markets to settle down means that purchasing power of those dollars is Rememberevaporating.thatthe Fed only controls short term interest rates. The bond market controls the rates of longer-term bonds. The interest rate on a bond is fixed at the time it is issued. The bond market fulfills its function by bidding up or down the price at which it is willing to buy bonds that pay a specific rate of interest. As interest rates increase, the price of the bond must fall to provide that rate.
At this writing the aggregate U.S. Bond market (AGG) is down nearly 9% year-todate, Treasury Inflation Protected Securities (TIP) down 6.4%, and U.S. stocks as mea sured by the S&P 500 (SPY) are down 18.1% and recently dipped temporarily into correc tion territory, defined as -20%.
The current economy, marked by the combination of high and rising inflation, low unemployment, and the near-zero interest rate policy by the Federal Reserve, is like nothing that we have experienced over the past 40+ years. The uncertainty of the situation has resulted in falling prices of both stocks and bonds at the same time—also a first in a very long time.
In 2007, we became aware of the work of Dr. Mordecai Kurz at Stanford University. Among other things, Dr. Kurz posited that most of the risk in the market is endogenous to the market and not to some outside forces. This discovery has far-reaching significance for portfolio managers. We asked our clients with which they were most concerned: a) failing to achieve market returns, or b) losing their capital. Many responded that they were more concerned with the latter. In response, we developed the Wealth Preservation Strategy just in time to prevent significant losses in the 2008 downturn for those clients who chose that strategy over the Momentum Growth Strategy. This strategy also worked very well to protect capital in the downturns of 2011 andOne2018.aspect of the Wealth Preservation Strategy has been the use of technical analysis to determine the entry point for adding new securities to the portfolio mix. Attention to risk controls for each individual security and position sizing are other aspects of the strategy designed to control drawdown. We did not allow small losses to turn into big ones. The strategy also usually carried a rather significant allocation to cash. This worked as long as
In 2002, while still attending to the tenets of traditional asset allocation, we began to select stock and bond mutual fund invest ments based, in part, on momentum. Each asset selected for the portfolio was growing at a faster rate than its peers. We likened our analysis to watching a horse race and seeing a particular horse moving through the pack toward becoming the leader. Initially, we invested in this way without imposing risk controls of selling those securities that lagged the others. We called it our Momentum Growth Strategy. This subjected the portfolio to drawdowns consistent with the market.
Our Solution
BY SCOTT NEAL
From the business of health care to compliance to litigation defense, Sturgill Turner’s experienced health care attorneys provide comprehensive legal services to health care providers, hospitals and managed care organizations across the Commonwealth. Put our experience to work for you. YOU CARE FOR EVERYONE♦ WE TAKE CARE OF YOU♦ Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.LAW FiNANCE
Regular rebalancing is also important and should be done quarterly or quantitatively when the total portfolio gets out of balance. The more risk tolerant you are, the more you will invest in a Growth strategy. Wealth Preservation will continue to protect from fur ther drawdowns. Risk tolerance can be assessed in many ways. We recommend using one that has been proven to be psychometrically valid.
As the markets’ access to “free” capital via the Fed’s zero interest rate policy kept driving up the stock market, it was quite normal for some investors to totally abandon Wealth Preservation for the sake of seeking higher returns.Attimes like the present, when all the usual asset classes are turning down, we instead hear investors clamoring for more Wealth Preservation. Rest assured, when it comes to investing, any inclination to “throw in the towel” or to “go all in” is usually a mistake.
an investor allocate a portion of assets to each of the two strategies. The amount to allocate to which strategy will solely depend on one’s risk profile. Do you detect a theme here?
A relatively new breed of ETFs is now readily available and can provide a way to hedge against further losses by placing some of your assets in those ETFs. They move in the opposite direction of a chosen index on a daily basis. Think of it as a way to short the market without selling short. Use them with extreme caution and close supervision. We hope that inverse ETFs, as they are called, or alternative investments, do not turn out to be long term holdings because they are expected to perform well while the market is going down and inflation/interest rates are rising. We can only hope that policy makers will soon get our economy back on track for sus tainable growth. Meanwhile, we must dance to the music we hear.
Going beyond allocating the portfolio to different strategies, we recommend that you choose specific assets that you believe will perform well in the current economic environ ment. Consequently, some of your traditional stocks or funds can be retained, but you might also consider ETFs that track commodities, pre cious metals, and real estate rather than exclu sively investing in traditional stocks and bonds.
inflation remained low or non-existent. Now we are at a different place and a different time.
ISSUE #140 9
Our present solution is to blend the two strategies in proportions that will attend to a particular investor’s tolerance for drawdowns while also attending to return needs that address particular investor objectives. Rather than mandate the allocation to particular asset classes i.e., stocks and bonds, we advocate that
So, what is a person to do?
Scott Neal is the president of D. Scott Neal, Inc., a fee only financial planning and SEC-registered investment advisor with offices in Lexington and Louisville. You may write to him at scott@dsneal.com or all 1-800-344-9098.
Abortion was not something that was much discussed when I was a medical student. I remember a lecture in which a preening gyne cologist stated that he had advised a couple to abort their child who had a 25% chance of having a fatal autosomal recessive disease, and they had consented. The guy next to me whispered in my ear, “Why not deliver four of their pregnancies and kill the one baby with the disease? You’d get three instead of zero.”
After that “stroll along the jars” is per formed by the legislators and governors of the nation’s state houses through an updated prism of technology, ethics, neonatal care, and human embryology, the consensus moment of cellular-human transfiguration will likely be shifted earlier in the continuum of gestation. There will of course be noisy debates and arguments about the moment of conception, heart beats, and the perception of pain. One hopes that everyone talking remembers that we all sometimes need someone else.
Physicians and the Continuum of Life
Making that choice is of course impossible, as gestation is a continuum.
Values Count
Thoughts on embryology, abortion, and physicians
FEE-ONLY FINANCIAL PLANNING
One of the things we believe our clients appreciate most about D. Scott Neal, Inc. is our commitment to values we share with them:
absurdity of heroically resuscitating a 24-week baby in the NICU while aborting another 24-week baby in the clinic down the street.
Given the speed of change of medical infor mation, most of the books I accumulated as a medical student rapidly became worthless, the exceptions being those on anatomy and embry ology. To be a surgeon is to be an anatomist; to be a pediatric surgeon is to be an embryologist.
Lexington | Louisville | Cincinnati 800.344.9098 | DSNEAL.COM Call for our simplyassessmentcomplimentarytoolorscanthiscode. OP/ED
Even in StrategyInvestment
There is an interesting embryology exhibit at the Museum of Science and Industry in Chicago—a row of human fetuses in jars at every week of gestation. A good exercise is to walk down that row of jars, start to finish, and point to one and say: “Ah, this is no lon ger a clump of cells. This is a human being.”
At its core, elective abortion is the inten tional termination of a healthy biological process. In 1973, the nine clumps of cells oth erwise known as justices of the United States Supreme Court figuratively walked down that row of jars and arbitrarily pointed to a spot on the continuum and declared the moment at which life begins. The basis of their argu ment was viability which, not surprisingly, eventually collided with neonatal care, rather like Social Security colliding with longevity. Somehow those justices missed the moral
Revisiting the Abortion Debate
tive, a society ruled by judicial fiat, does not seem like a better alternative.
Abortion is not going away. Americans have a long tradition of compromise, and we will
We respect our clients’ individual values and we treat them as team members, informing them on strategy and the purpose of investment that fits their unique financial goals.
During my OB-GYN rotation, I watched a monstrous-looking, term anencephalic infant struggle to breathe and eventually die. I’m not sure if that baby suffered or not, but no one held it as it took its last breaths. Mom had refused an abortion. Abortion is a subject that certainly makes one think.
10 MD-UPDATE
BY CAMERON S. SCHAEFFER, MD, FACS, FAAP
After all, wealth without purpose is just numbers. At D. Scott Neal, we “walk the walk” when it comes to values –just one of the ways we try to distinguish ourselves from other financial planners.
Abortion is back in the news because it is back in the courts, and the nation awaits the Supreme Court’s latest take on the subject. A reversal of Roe v. Wade will not outlaw abor tion; it will merely return the rulemaking to the various states, taking the decision from the hands of nine judges with lifetime appoint ments and no accountability, and handing it to millions of citizens and their accountable representatives. Some people evidently do not trust the democratic process, but the alterna
Many people believe the Hippocratic Oath is silent about abortion and euthanasia. This is false. The oaths recited at modern medical
ISSUE #140 11
We have been seduced and corrupted by government money after buying into the notion that we are unique as service provid ers, and that our services should be paid by someone other than the recipient of those ser
Surgical facilities have rules and standards, as do professional surgical societies. To be a member in good standing of the American Society of Plastic Surgeons, one is required to use an accredited operating room to per form outpatient surgery and to have admitting privileges at a nearby hospital in the event of complications. There have been cases of women showing up in the emergency room, bleeding, after an office abortion performed by a physician without hospital privileges. Unless that physician has a coverage agreement with a gynecologist with full surgical privileges, such practice should not be permitted.
Physicians should remember that we are in the business of promoting life and health, and that our Oath, the real Oath, says it very clear ly. The assault on that Oath began with the eugenics movement one hundred years ago, which gave rise to a global century of forced sterilization and abortion, medical killing and the Holocaust, one child policies, ultra sound-driven sex-selective abortions, abortion clinics targeting poor neighborhoods, and the sale of fetal parts for commercial gain. It has been a project of dehumanization, fought by many and made difficult by ever-improving fetal ultrasound, which does not deceive.
Dr. Schaeffer practices pediatric urology and plastic surgery.
Judging by what one reads on social media, we are now hardly trusted by the public. The Covid pandemic has fully convinced many people that we physicians no longer put patients first, and that we have been completely captured by the medical industrial complex. The coming abortion debates give us the opportunity to redeem ourselves as the voice of those who are weak, and vulnerable, and voiceless.
We permitted our traditional and primary voice, the American Medical Association, to evolve into a medical coding business, fully captured and integrated into the medical industrial complex through its primary source of revenue, the monopoly CPT coding sys tem. According to its Code of Ethics, the AMA is on board with abortion, with lots of CPT codes from which to choose.
no doubt figure out the ground rules for abor tion. Many people will be unhappy. Assuming that Roe v. Wade is reversed, it is doubtful that the product of the legislature of Alabama will resemble that of California’s. To what extent will we physicians, as professionals, be involved in the rulemaking, or will we again be sheep among wolves, discussing the dinner menu? Physician opinion about abortion is as varied as that of the general population. The future rules will vary by state, and it is critical that physicians’ voices are heard during the debates over the regulation of abortion, a surgical procedure.
After over two millennia of Hippocratic medicine, physicians have not had a good run in recently memory. Aside from our partic ipation in the aforementioned programs of dehumanization and medical killing, we did not speak when insurance companies inserted themselves into the doctor-patient relation ship. We voluntarily surrendered control of the hospitals to administrators who do not take our Oath, and we said little as corpora tions gobbled up hospitals built by volunteers, nuns, and community bake sales.
Ethics and Surgical Boundaries
Cameron Schaeffer, MD, FACS, FAAP 1760 Nicholasville Rd., Suite 601 Lexington, KY 40503 859.275.KIDSFAX502.410.4700(5437)859.275.5434 Your Source for Graphic Design since 2003 GRAPHIC DESIGN • INTERACTIVE PUBLICATIONS • PROJECT MANAGEMENT and more... www.provationsgroup.com OP/ED
vices. Why, then, are we surprised when that coverage is followed by control, immiserating our working conditions with rules and docu mentation to prove that we have done what we say we have done?
When Will We Finally Speak?
school graduations have been edited and sanitized. After all, who wants to hear about poisons and pessaries on a warm spring day of celebration? In fact, the Oath, as written, is a profound celebration of the sanctity of life, and it is quite clear about abortion.
In an era when physician extenders are increasingly doing procedures and some physi cians are pushing the anatomical boundaries of their training and scope of practice, who will be the abortionists? Some states allow non-physi cians to perform abortions. Is this wise?
A large part of Pilkinton’s focus is on reconstructive surgery, which is very spe cific in the context of her practice. She states, “Reconstruction essentially means reconstructing prolapsed organs—fixing blad der and vagina prolapse along with rectal. Essentially, just placing a woman’s pelvic organs back where they’re supposed to be.”
No More Suffering in Silence
Initially, Pilkinton herself was not knowl edgeable of the field, much less focused on making it her life’s work. In college, during a work study program with Centre College’s athletic department, she homed in on pur suing either sports medicine or orthopedic surgery. Upon entering medical school at the University of Louisville School of Medicine, she was still single-minded and right on track. Then, third year clinicals began and changed everything. Pilkinton chose to complete the GYN rotation first, just to get it over and done with. She says, “I started with gynecol ogy thinking I would just get that done and move on, because that was the one rotation that I thought I would be least interested in.”
tively impacts quality of life. Pilkinton states, “There is this real opportunity here to offer a special type of care to patients, which is just how to live a happier, healthier, and more fulfillingPilkintonlife.”sees women of all ages with a wide range of complaints. Patients come to her through self- referral, primary care referral, and occasionally referral from their OB-GYN. Often, these are women in the per imenopausal period, which is typically around 50, when changes in hormones bring on other changes, many of which are uncomfortable and require surgical intervention. However, she has performed pelvic reconstructive sur gery on patients as young as 27.
BY DONNA ISON
12 MD-UPDATE
As a leading provider of urogynecology in Louisville and Southern Indiana, Norton Healthcare offers a wide range of services, including treatment for the scope of urinary disorders, uterine disorders, prolapse, pelvic floor disorders, sexual dysfunction, or voiding dysfunction. Each of these conditions nega
As a urogynecologist with Norton Women’s Care, Marjorie Pilkinton, MD, is giving voice to some seldom discussed gynecological issues.
Pilkinton also collaborates with oncologists for patients who have prolapses in conjunc tion with gynecological cancers. Patients are eager to have both surgeries at one time and moveAccordingon. to Pilkinton, “She’s thrilled to get it all done in one day. That’s all she want ed. She just wants to get better and not have to think about her vagina. I say that all the time in the office, ‘Let’s just get you better. So you don’t have to sit and think about this all the time; nobody wants to think about their vagina 24 hours a day.’”
So, upon receiving her medical degree from UofL, Pilkinton went on to a residency in OB-GYN at Mount Sinai West in New York City and a fellowship in urogynecology at Northwell Health, also in New York.
That all changed during her first day on general GYN service in the clinic when a woman in her 50s admitted that gynecological issues, not related to pregnancy, were domi nating her Pilkintonlife.explains, “She was a waitress, and she came in stating that she could no longer work her job because she had developed a large prolapse. And that was true. And to see her through her course of evaluation and
Four to six weeks after surgery, patients are assessed for their progression and degree of symptom relief. At this point, if there are lingering issues or if she believes it will aid in their recovery, pelvic floor physical therapy is recommended. According to Pilkinton, “It’s
Marjorie Pilkinton, MD
This encounter made Pilkinton realize there was “This whole other side of GYN beyond what I knew, which was your annual exam.”
“I meet patients today, women in their 60s, 50s, and even 40s, who think they just have to suffer in silence because no one is talking about these conditions. Women suffering incontinence, prolapse, or pain don’t realize they don’t have to live that way, that there are options,” says Pilkinton, a board- certified urogynecologist at Norton Medical Group.
LOUISVILLE The field of urogynecology is one of the lesser-known specialties—among both medical professionals and the general public—which means many of the women who need it most are unaware that help exists. Marjorie Pilkinton, MD, OB-GYN, FACOG, is on a mission to change that.
discuss with her how it negatively affected her quality of life and affected her job and affected how she felt as a woman. It was very insight ful. Nobody talked about these conditions.”
As for the field of urogynecology, Pilkinton states, “It broadly covers pelvic floor disorders that a woman may experience either related to, or completely unrelated to, childbirth. But childbirth tends to be a big factor in the development of a lot of these disorders. So, it can range from protruding organs, to fecal or urinary incontinence, to pain with the blad der, vagina, or rectum, to sexual dysfunction.”
“I meet patients today, women in their 60s, 50s, and even 40s, who think they just have to suffer in silence because no one is talking about these conditions.”
COver StOrY
The Scope of Urogynecology
One such device is the Medtronic InterStim™ sacral neuromodulation system, which improves urinary urgency and urinary incontinence as well as fecal incontinence through stimulation from a wire that is placed through an opening near the pelvic nerve that feeds the bladder and the pelvic floor. Pilkinton says, “We’ve seen great benefit in patients who actually struggle to urinate and for people who are retaining urine. This can actually improve their ability to urinate more normally. So, it’s a wonderful device. And it’s been around for several decades.”
‘Women suffering incontinence, prolapse, or pain don’t realize they don’t have to live that way, that there are options.”- Marjorie Pilkinton, MD, OB-GYN, FACOG
New Technology for Female Pelvic Health
Another innovation is Bulkamid®, a newly FDA-approved urethral bulking injection that treats stress urinary incontinence. This waterbased gel is in injected into the wall of the urethra to assist the sphincter, allowing it to close more naturally.
Just as many women are not aware of pelvic floor physical therapy or these latest advances, many are not attuned to the causes of pelvic floor problems. Issues can result from things as commonplace as constipation and consis tent straining during bowel movements. “It’s amazing how many people feel like having one bowel movement a week is a very normal
so commonplace to go to physical therapy after you get your knee replaced, or your shoulder operated on. It’s not so common for women to be aware of pelvic floor physical therapy for urinary, rectal, and vaginal issues.”
Technological advances have also led bet ter outcomes and better quality of life for women, specifically those struggling with urinary issues.
For women who want to avoid the issues that would lead them to Pilkinton’s office, she stresses awareness and early intervention with physical therapy soon after delivery. “It is important to understand that delivery does cause muscular damage, and potentially nerve damage as well, to the pelvic floor. I think the earlier the better, especially after delivery.”
However, the newest innovation is in bat tery life. The newest InterStim battery can last up to 15 years, with maintenance charging on the part of the patient.
PHOtO BY JAMIe rHODeS
Dr. Pilkinton uses Bulkamid®, a newly FDA-approved urethral bulking injection that treats stress urinary incontinence. this waterbased gel is in injected into the wall of the urethra to assist the sphincter, allowing it to close more naturally.
“I treat them and see them as if they were me, sitting in that chair, or my grandmother, my aunt, my mom.” - Marjorie Pilkinton, MD, OB-GYN, FACOG
PHOtOS BY rHODeS
of potential problems. She says, “If a patient can walk away from the visit understanding what they’re experiencing, versus me just throwing out different diagnoses, it hits home a lot better. So, education is a big part.”
Along with education, Pilkinton employs equal parts empowerment and empathy. With a firm focus on empowering the women she treats, Pilkinton takes a more collaborative and collegial approach, “I treat them and see them as if they were me, sitting in that chair, or my grandmother, my aunt, my mom. I try to remind the staff that this is somebody who could easily be you one day, because we’re all women in our office. I think our office does a great job of really trying to provide personal empatheticPilkintoncare.”often hears, “I just I don’t know why I waited so long. I just did not even realize how long I had been suffering.” These words are bittersweet. However, when this same patient can pinpoint different aspects of their life that have been positively impacted from treatment and voice how their confi dence and comfort have been renewed, it makes it all worth it.
thing, and even how much work it takes to have that one bowel movement. It may be their normal, but that’s not normal. And it does take a toll on the pelvic floor,” states Pilkinton.Another factor is obesity, which increases the risk for many issues and decreases the effectiveness of results from these surgical pro cedures. Pilkinton says, “We’re understanding more and more how weight can affect the pelvic floor as well, and, and how weight can impact the results of surgery.”
“There are not many groups educating women about their pelvic floor, but the majority of women are dealing with their pelvic floor to some degree, day in and day out. And the idea that you just have to suffer in silence, I don’t think has to be the way of life anymore.” Pilkinton makes it her personal mission to educate each of her patients on their bodies to help them become more aware
14 MD-UPDATE
When it comes to urogynecology, the big gest issue is lack of education on the topic.
Education, Empathy, and Empowerment
JAMIe
COver StOrY
completing her residency, she eyed a return to Louisville. Again, she was head ing the right direction, but her destination was CHI Saint Joseph Medical Group — Obstetrics and Gynecology in Bardstown, not Louisville.“Ialways liked the idea of being in a rural area,” says Hall, who lives on a small farm with her husband and their two daughters.
Hannah Hall, MD, FACOG, embraces the vital role she plays as an OB-GYN in a small town where patients have limited access to specialized care.
“One of the benefits of being in a rural area is that you treat families, not just individuals. I’ll see a woman and then her daughter, her sister, her cousin, and her best friend.”
BY JIM KELSEY
“The first time I delivered a baby, I had a smile on my face for a week,” says Hall, who did her residency at Saint Louis University. “When I did my OB rotation and couldn’t get enough. I think God put me where I needed to Afterbe.”
Hannah Hall, MD, helps ensure her small town patients have access to the care they need
BARDSTOWN A few people actually know what they want to be when they grow up. They dream about it and prepare for it their whole lives. Most people, however, figure it out as they go along, often starting down one path, then changing course a few times before the destination becomes clear.
Hall’s typical week includes three full days in the office, one day of surgery, and one flex day that includes meetings and administra tive work. Some weeks she is also on call at the hospital, which means she has to juggle her schedule and, if necessary, rely on her partner Carmen Folmar, MD, FACOG, to cover for her.
Hannah Hall, MD, FACOG, falls into the latter category. She grew up in Louisville, received her undergraduate degree from Murray State, and attended the University of Louisville School of Medicine, intending to be a pediatrician or pediatric oncologist. She was heading the right direction, but when she did her pediatric rotation, she didn’t enjoy it as much as expected. Then came the detour in the form of an obstetrics rotation.
16 MD-UPDATE
PHOTOS BY CHI SAINT JOSEPH HEALTH
PROVIDED
Hall admits that she was initially drawn to OB-GYN because of the obstetrics com ponent, but her experience in caring for women through all stages of their lives has helped her develop a strong appreciation for the gynecological aspect of her profession. She treats women of all ages, and her practice is nearly evenly split between obstetrics and gynecology, with pregnancy care, treatment of abnormal bleeding, and annual exams among her most common cases.
Adopting New Technology
delivery made her so happy. It is clear that she is right where she was meant to be, doing what she was meant to do.
“When you can work as a team, it becomes so helpful to figuring out what’s going on with patients, and providing timely care,” Hall says. “Having such a close-knit group of phy sicians allows us to reach out and get patients the appointments they need in a timely fash ion and skip some of the red tape that can hold you up in other situations.”
Treating the Whole Woman
Many women, for example, think that seeing their primary care physician is enough. While she encourages her patients to see their primary care physicians, Hall says it is imper ative that they keep their obstetrics appoint ments as well.
One way it is easier for new moms to keep their appointments is via telehealth. Hall says that telehealth visits help moms avoid the struggle of getting a newborn out of the house and exposing them to germs. The postpartum visits can be done via telehealth. Generally, those are done at 6 weeks, but Hall also does a 2- or 3-week visit with patients considered to be at risk for postpartum depression.
“I want to be an advocate for women’s health care,” she says. “One of the great ben efits of being in a small town is I’m able to see them through their pregnancies and when they are done having children, help them get through that menopausal transition. I want to take care of women in every aspect of their lives as much as I can.”
502.350.5800
SPECIALFACOGSECTION
Hall says that she and her colleagues often step outside their areas of focus to help fill a patient’s needs. For instance, there are no psychiatrists in Nelson County, so it’s not unusual for Hall’s patients to open up to her about personal issues not directly related to their obstetric or gynecological care. Hall understands that it is part of rural health care, and it’s a role she is happy to fill.
Hannah Hall, MD, OB/GYN 4359 New Shepherdsville Road Suite 255 Bardstown, KY 40004
OBSTETRICS & GYNECOLOGY
prioritized by a lot of different people, includ ing women themselves.”
“It’s a big problem because more and more primary care doctors are not doing breast and pelvic exams; they are not doing pap smears,” Hall says.
“I want to be an advocate for women’s health care.”-Hannah Hall, MD,
Other innovations in women’s health care include the use of nitrous oxide to help con trol labor pain. Hall says it can be particularly helpful for women who are too far along to have an epidural.
ISSUE #140 17
“Women’s health is affected not just by their physical health, but also their emotional health and their psychiatric health as well,” Hall says. “I have become so passionate about women’s health care and trying to help women through all the situations they are going through. Women really are a vulnerable population. Women’s health care is often not
“I can’t say enough about her,” Hall says of Folmar. “She’s wonderful. We work very well together, which really helps when it comes to being able to trade off. We rotate the OB patients between the two of us, so they get to know both of us and are comfortable with both of us for delivery.”
OB-GYN
Hall says that teamwork is seen across the entire Bardstown CHI Saint Joseph Medical Group, to the ultimate benefit of patients.
Hall says it is important not to dismiss those patient concerns that fall outside the usual parameters of her specialty and pro fession. She says women all too often ignore their own healthcare while they focus on their children and partners.
“What you see in a rural area is that we wind up doing a lot, because there aren’t as many specialists here,” she says. “When you’re taking care of people, you’re taking care of the whole person. Sometimes that means that we are addressing someone’s high blood pressure and sometimes that means we are addressing a patient with depression and anxiety.”
“It gives them something they can control, which I think is really a powerful thing — giving women control of their health care,” HallHall’ssays.passion for women’s health has led her to participate in the Woman and Infant Clinical Institute, a national organization which has recently been focusing on improv ing response to hypertension in pregnant women.“When a pregnant woman comes in and has severe high blood pressure, our goal is to get them treated with antihypertensives within 30 minutes and also make sure they get magnesium sulfate for seizure prevention.” Hall says. “We have made great strides, not just here but in facilities across the nation. These are the things we are doing that are real ly impacting maternal health care and trying to lower maternal morbidity and mortality in theHall’snation.”passion for her work proves she was right to follow the signs when that first baby
According to Miller, “Howard University changed everything. Howard University taught me to advocate. Howard University taught me how to get the most care with the least resources to the patient who needed it the most. And they shaped the physician that I want to be today.”
Miller finished up with fellowship at the University of California in San Francisco in maternal-fetal medicine, a field that was initially last on his list until his rotation in maternal-fetal medicine and high-risk obstet
LOUISVILLE The phrase “When one door clos es, another opens,” most definitely applies to Edward Miller, MD. Growing up in California playing sports, Miller’s goal was to become a college—and later a profession al—athlete. But, during his junior year of high school, a broken leg sidelined him and sent him through the door of an orthopedic surgeon who would alter this trajectory.
As the division director of maternal-fetal medicine at UofL Health, Edward Miller, MD, is focused on equity, education, and excellence in care.
BY DONNA ISON
Miller’s patients range from teenagers to women in their early fif ties, all with one thing in common—very high-risk pregnancies. Pregnancies
18 MD-UPDATEProviding the Highest Quality Care to the Highest Risk Pregnancies
High-risk Runs the Gamut
Miller, who is now the division director of maternal-fetal medicine at UofL Health in the UofL Physicians – OB/GYN & Women’s Health practice, states, “On my very last visit with my orthopedic surgeon, he said, ‘You seem like you really, really like medicine.’ I told him I thought I did. He said, ‘You can do this.’ And, then he walked out of the room. And, it was literally just a moment for him, but it completely changed my life.”
Disillusioned after a disappointing and difficult time in medical school at Wake Forest University in North Carolina, he began to wonder if he’d made the right decision. Luckily, Howard University in Washington D.C. was the next stop on his journey for residency and internship.
rics at medical school. After expe riencing the incredible relation ships that the providers had with their patients and their patients’ families, it quickly rose in the ranks. “It was a standard to which I held all other rotations and all other medical specialties when I rotated through them—and it was a stan dard that wasn’t met,”
MillerThissays.patient rela tionship is still what brings Miller the greatest satisfaction. He says, “I only get 3 to 10 months with the patient, but it is the most intense 10 months of the patient’s life and the most consequential. To be able to play a part in moments of such hap piness and also moments of profound sadness, is literally one of the most humbling experiences…and I get to experience it every day.”
PHOTOS PROVIDED BY UOFL HEALTH SPECIAL SECTION OB-GYN
ISSUE #140 19
As a physician at a referral center, Miller’s patient population is diverse, encompassing white, Black, and Latinx as well as a large immigrant population. Despite the diversity, the thing that unifies his patients is the fact that they are extremely highrisk and require frequent visits. This leads to an opportunity for education that will last far beyond their pregnancy, whether it is discussing insulin pump options with a 17-yearold Type 1 diabetic, lifestyle changes for a woman battling obesity, or counseling a mother battling addiction. Management of hyperten sion and diabetics makes up 40% of Miller’s practice. He stresses to patients that these chronic diseases need to be controlled, not just during pregnancy, but beyond.
Making Space for Everyone
As a physician to women, Miller sees first hand the disparities in healthcare with females in general and women of color in particular. He realizes that he is often the only doctor they have ever seen who “looks like them” and is willing to listen. He states, “My passion is in diversity and inclusion and equity work. My passion is eliminating barriers that are keeping certain populations sicker, disproportionately, and having disproportionate outcomes over the spectrum of medicine.”
Miller has also seen firsthand the ineq uitable treatment of those in the LGBTQ community. As an ally and advocate, Miller is committed to ensuring his transgender patients feel respected by everyone in the department and safe to openly discuss their entire health history. Miller adds, “The abil ity to provide a space for everyone is just so important. It’s a cornerstone to medicine.”
SPECIAL SECTION OB-GYN
As for the future of his field, Miller said, “Maternal-fetal medicine is one of the fastest changing fields of medicine in the world. The things that we’re doing today are just incredible.” Many of these are in the realm of advanced imaging, like 4D ultrasound and MRI, as well as in the fast-growing field of fetal intervention, where babies are treated for life-threatening conditions while still in utero.
As part of his care philosophy, Miller takes all this technology along with his training and experience, and personalizes it for each patient, keeping their desires at the forefront. He states, “As a maternal-fetal medicine doc tor, patients come to me for recommenda tions. My recommendation can’t be made just based on my facts. It’s a marriage of my facts, my patient’s wishes, and my patient’s values. I believe that as a physician, you can’t give a one-size-fits-all kind of approach. So, my philosophy is collaboration. The patient’s voice should always be the loudest voice in the room.”
To this end, the clinic refers patients to the proper specialist to continue care. He states, “Oftentimes patients are seeing me every week, so every week, I get an opportunity to leave an impact that will, hopefully, carry over outside of this pregnancy to help them get their high blood pressure or diabetes or thyroid disease under control.”
“My philosophy is collaboration. The patient’s voice should always be the loudest voice in the room.” Edward Miller, MD
can be classified as high-risk for a wide vari ety of reasons, including preexisting maternal conditions (e.g., diabetes, hypertension, lupus, renal disease), substance abuse, genetic syn dromes (e.g., sickle cell disease, cystic fibrosis, spinal muscular atrophy), multifetal gestation, or fetal anomalies, to name a few. Along with his time spent in clinic, counseling and mon itoring these patients, Miller reads up to 60 ultrasounds per day, consults with referring doctors from the greater Louisville area, and delivers an average of two infants per week, many requiring cesarean sections as well as pro cedures such as cordocentesis and intrauterine intravascular transfusions.
The university hospital shared this vision and named Miller the first chief diversity offi cer for UofL Health.
“There needs to be this interdisciplinary way of working with kids in order to really see them.”Stephen Taylor, MD, medical director at UofL Health – Peace Hospital
Taylor came to his field indirectly, and his education, life experiences, and personal philosophy have prepared him to effectively address the needs of post-pandemic youth. For Taylor, collaboration, integration, and conver sation underpin his approach to care. He sums up his holistic and deliberate view simply: “Try to see the whole picture—and don’t do some thing until you know something.”
PHOTO PROVIDED BY UOFL HEALTH
Eventually, Taylor sought to augment his medical practice through psychoanalytic training. He feels the connection between such therapy and music, particularly jazz. Both rely on the interplay of structure and freedom, he says. “Psychoanalytic work is like jazz,” Taylor believes. “Underlying structures are known, but there must be constant impro visation and reaction. There is a sense of what the whole body is doing that contributes to the total experience.”
20 MD-UPDATE
Taylor was named to his current role at Peace Hospital in June 2020 and also main tains a private practice. He came to psychiatry circuitously, having studied music in college. While practicing as a private music teacher, a physician adult student observed Taylor’s attentiveness to emotional and personal mat ters and told him he ought to train to be a psychiatrist. Through his medical training, Taylor never lost his musician’s sensibility; for him, therapy is always a dynamic, responsive combination of tools available. He strives to “combine a knowledge of the biology of mental illness with an understanding of the complexity of lived experience to bring a more holistic approach to treating mental illness.”
Adjusting Sails in Stormy Seas for Better Mental Health
An integrated approach to therapy serves adolescents well
LOUISVILLE Stephen Taylor, MD, medical direc tor at UofL Health – Peace Hospital, has a holis tic approach to mental and emotional wellness, integrating medication and therapy. Together with Peace Hospital’s Kosair Charities Children’s Peace Center, he feels that he is well suited to help the youth of our post-pandemic era.
Kids These Days…Need Integrated Care
Taylor’s patients range in age from 13-94, though most are in their 40s–60s. They come for psychoanalysis, medication, or therapy, or a combination of these. He advocates for the integration of medications and therapy, especially in these times. Depression and anx iety are the most common conditions that he treats, because, he says, “20 to 30 percent of our population is experiencing one of these at any given time.”
In the wake of the pandemic, adolescent depression and anxiety has broadened and
BY TIM CORKRAN
deepened. At the heart of this is isolation, Taylor feels, with 12–18 months of remote learning and tech-based communication replacing traditional face-to-face interaction for many kids. For all of us, Taylor says, “Going out into the world and forming new communities, building new relationships, is integral to our being human, and kids missed out on so much of this. Losing out on this for a year,” he continues, “has a much bigger impact on someone who has only begun this process than it does on adults, who have been doing it for decades.” That is why getting back to school was so significant for his patients: “School looks like utopia to kids who are stuck all day in their rooms,” he concludes. Similarly, while screen-based therapy was a valuable bridge, Taylor is so glad to be regu larly working with his young patients again. He feels strongly that “There is nothing that is quite as intimate or powerful or connecting as two people communicating in the same space. There is no substitute for this.” This helps him in another valued approach to working with young people; he needs to find their lan guage and use it to speak to them. This takes time, attention, and proximity, and some of his patients have needed more of this than they did Medicationpre-pandemic.playsakey role also, especially now. Some of his adolescent patients have needed their medication increased, and others have started medication for the first time. He has a favorite analogy that helps his young patients grasp their evolving treatments. He compares them to sailboats on the sea. He tells them, “We have different types of sails to use for different seas, especially when it gets stormy. To always keep the boat safe, we use different sails, different treatments.” He reminds them this does not mean they will not feel the storm, nor will it never be scary. He wants them to know that “Our goal is to keep the boat
Whom He Can Help and How
UofL Health – Peace Hospital’s popu lation and vision are similar to those of Taylor’s, though far more extensive. Their Kosair Charities Children’s Peace Center is the nation’s largest private provider of youth inpatient behavioral health services, and it prides itself on a comprehensive approach to working to meet young peoples’ behavioral and emotional needs. Peace Center serves children with intellectual or developmental disabilities, those with psychiatric needs, and the complex cases where both exist in a single patient. Like Taylor, the staff at Peace Center is committed to integrated treatment using a variety of medication and therapy methods.
ISSUE #140 21
PEDIATRIC PSYCHIATRY
Taylor readily employs another musical anal ogy, that just as music feels like it is alive inside the performer, psychoanalytic work is about becoming aware of what is alive down deep inside of us. Attending to this is key to completing the big picture. Through talk and observation, he contends, we can get as much of a story as possible before we decide anything. This is particularly important with young peo ple. Taylor concludes, “When we see kids from a multi-disciplinary perspective, we get a much better idea what is going on with them, and we have a much better chance of coming up with an effective way of treating them.”
SPECIALHospitalSECTION
them.” Among his diverse colleagues there, he concludes, “Collaborative work is such an important tool at Peace Center.”
True to his integrative nature, Taylor is concerned about isolation for mental health professionals also. He worries that his field suffers from a division between the psychi atric side and the general medical side, that many tend to be myopic, or have too much at stake in pushing for their perspective. “If we get caught up in this, we are going to miss the picture,” he says. “There needs to be this interdisciplinary way of working with kids in order to really see them.” Taylor feels that the pandemic has exacerbated this. “It has pushed
upright so that when the storm is over, we can get the other sails out and put away the storm gear. Our goal is to keep the boat in the water.”
us towards isolation professionally. We need to make a concerted effort to fight against isolation,” he pleads.
The Peace Center approach embodies Taylor’s concern for the attendance to the many parts of a patient’s experience and the integration of multiple treatment modali ties. In addition to the psychiatrists and nurse-practitioners, there are many interdis ciplinary resources for young patients, includ ing access to educational services through JCPS, art and horse therapy, and gyms and playgrounds. “To be able to see the kids from the multi-disciplinary perspective, we get a much better idea what is going on with them, and we have a much better chance of coming up with an effective way of treating
Integration Strengthens Broadly
Stephen Taylor, MD, medical director at UofL Health – Peace
2 is the number of hours spent on recre ational screen time. Two hours or less should be spent using Othertimeavoidmaygames.televisionsmartphones,computers,tablets,andvideoUsingatimerbeagoodstrategytoargumentsaboutspentondevices.engagingactivities
5-2-1-0 is a simple approach that can help our children develop better living patterns that can reduce the risks of obesity as they grow. Each number correlates with an action, and the combination of those actions can help prevent obesity and create a foundation for healthier living.
and just try some different things. It is their future, and we must be intentional to set the stage for their success. If one thing doesn’t seem to interest the child, it is OK to move on to something different. For more age-ap propriate guidance, the Society of Health and Physical Activity Educators (SHAPE) offers resources geared toward infants, toddlers and preschoolers at Kyshape.org and uphealthreductionChildrenallowingisthatCentersinobesityhealthandchildrenalongaddsorwithandTheseica.org/standards/guidelines/activestart.aspx.shapeamer0isforzerosugar-sweetenedbeverages.includesoda,fruitjuices,sportsdrinks,anybeveragethathasbeensweetenedsyrupssuchashigh-fructosecornsyrupsugar.Theconsumptionofthesebeveragesalotofexcesscaloriestoachild’sdiet,withariskofdentaldecay.Thisputsatincreasedriskfortype2diabetestoothloss,aswellasotherlong-termissuessuchasheartdisease.Childhoodcanleadtoarthritisandjointdamageadulthood.Itisimportanttoacknowledge,pertheU.S.forDiseaseControlandPrevention,thegoalforchildrenwhoareoverweighttoreducetherateofweightgainwhilenormalgrowthanddevelopment.shouldNOTbeplacedonaweightdietwithouttheconsultationofacareprovider.5-2-1-0isagreatstarttosettingchildrenforalifetimeofgoodhealth.Formoreinformationonhowtohelpchildrenmaintainahealthyweight,pleasevisitthefollowingCDCwebsite:cdc.gov/healthyweight/children/index.html.
Brian Boisseau is program manager for Physical Activity and Nutrition Program at the Kentucky Department for Public Health. He can be reached brian.boisseau@ky.gov.at
HealthyMD-UPDATE
FRANKFORT Today’s children are faced with many challenges that contribute to overweight and obesity. These include eating low amounts of fresh fruits and vegetables, spending too much time watching electronic screens (TV, computers, video games, smartphones), not getting enough physical activity, and drinking too many sugar-sweetened beverages.
22
like board games or discovering a fun hobby can reduce screen time. This can also be a time to engage in physical activity, which leads us to our next number.
BY BRIAN BOISSEAU, CHFS, DPH, DPQI
Numbers for Kentucky Children
SPECIAL SECTION PEDIATRIC PUBLIC HEALTH
Brian Boisseau, CHFS, DPH, DPQI
1 is the minimum number of hours spent on physical activity. Physical activity raises the heart rate above the resting rate and helps the body to develop lung capacity, muscle mass, and bone density. This can be achieved with structured play, such as organized sports or other planned physical activities. Free play should also be encouraged, allowing kids to explore what makes them want to move more, such as an impromptu game of tag or hide and seek. Not every child is able to participate in team sports, so it is important to see what type of activities the child is interested in
5 is the number of servings of fruits and veg etables children should be eating daily. Fruits and vegetables are a great way to get vitamins, minerals, fiber, and even water. The added fiber provides a feeling of satisfaction and fullness without the added calories. It is easy to incorporate fruits and vegetables at every meal and as a snack. For example, some fresh fruit with yogurt for breakfast or a fruit cup with no added sugar for a snack, are excellent ways to sneak some nutritious options in. Dinner can also be a time to add a salad or a couple of sides of vegetables to supplement the main course. Don’t worry if kids are not immediately excited about vegetables – keep offering them and modeling healthful eating patterns.
Program designed for setting children up for a lifetime of good health
(ICPA). Tamera Tolson, DC, DACBSP®, proprietor of Back Talk Chiropractic, is certified in the Webster Technique, having completed the training in 2020. Tolson also holds a certification of Diplomate American Chiropractic Board of Sports Medicine. Back Talk Chiropractic recently moved to its new, expanded location on Liberty Road in Lexington to handle its increased patient volume.
Sounds kind of far-fetched, but a pregnant woman’s body undergoes a similar transfor mation during gestation when the spine, sacrum, and pel vic bone structures coordinate with the soft connective tissue, cartilage, tendons, and liga ments to become elastic from her hormone-induced secre tions. The result is a walking balancing act that a woman carries off for nine months, hopefully culminating with a successful delivery.
LEXINGTON Imagine a fivetiered wedding cake with all the trimmings. Then imagine that in between the layers of cake are layers of Jell-O. Then imagine as a surprise, the baker inserts a seven-pound, almondshaped watermelon inside the cake layers. Finally, imagine turning the cake upside down and watching it walk down the aisle…in one piece!
BY GIL DUNN
PHOTOS BY GIL
the round ligament during the Webster protocol helps relieve groin pain during pregnancy.”Tamera Tolson, DC, DACBSP®
In 2000, a certification program was initiated to teach the Webster Technique through the International Chiropractic Pediatric Association
Expanding the Space for Babies In-Utero
24 MD-UPDATE
Tolson received her undergraduate degree from Morehead State University and took her doctorate in chiropractic medicine at Palmer College of Chiropractic in Port Orange, Florida.TheBack Talk Chiropractic patient popula tion is typically between 15 and 65 years old, with the common chiropractic presentations of neck and lower back pain from bulging and herniating discs. Additionally, because of her
Chiropractic technique helps women with pre-labor stability and muscle control
The Webster Technique is an adjustment protocol used by chiropractors to help women stabilize their spine, sacrum, and pelvis during pregnancy, to have the optimal delivery expe
A Full Service Practice
DUNN“Releasing
rience and lessen the probability of a breech birth. The Webster Technique is a proprietary method of care developed by Larry Webster, DC, in the 1980s when he was inspired by his daughter’s difficult birth. The technique is based on Webster’s theory of “uterine constraint” which restricts movement of the baby in utero. With gentle adjustments of a women’s pelvis, spine, sacrum, and associated muscle groups, Webster observed that babies had more room and they turned head down, avoiding the breech birth.
Back Talk Chiropractic is a full-service chiropractic prac tice serving Central Kentucky. Tolson also serves as the official chiropractor for the Lexington Legends baseball team. Tolson, a former Montgomery County High School athlete, was drawn to chiropractic medicine because of injuries she suffered play ing basketball. Instead of shoulder surgery, she opted for rehabilitation and chiropractic adjustments with positive results. “I wanted to do for other athletes what my chiropractor had done for me,” she says.
COmPLemeNTARY CARe
We know that the labor process becomes complicated when the fetus is not in the optimal vertex presentation of posterior facing and head down in the labor canal. Typically, the baby will naturally turn into the correct position in advance, but according to the ACOG website, in approximately 3-4 percent of births, the baby doesn’t turn, and the result is what is commonly known as a “breech birth,” feet-first delivery.
COmPLemeNTARY CARe
As more women become aware of the benefits of chiropractic care during their preg nancy, Tolson predicts more women will seek it out. “Since I have my Webster Technique certification, I’m seeing many more referrals from midwives,” says Tolson.
Tolson’s philosophy of care is that “The body is designed to work and heal itself. It can do that when the nervous system is open and the bones are in alignment and the muscles are intact. Chiropractors take the pressure off impinged nerves so the body can function properly. Address the body as a whole unit because every thing works together,” she says.
work with athletes, some of whom are teenag ers, Tolson has an interest in extremity work such as shoulders, hips, feet, ankles, rotator cuffs, and plantar fasciitis.
In an effort to better understand and assess her pregnant patients and to provide enhanced relief and care for the spinal compression their pregnancy brings on, Tolson pursued certifica tion in the Webster Technique. The results have been rewarding for both Tolson and her patients.
abdominal and pelvic areas to make room for the baby. “The sacrum, the pelvis, the muscle groups, and the tendons all have to work together, contracting and expanding in preparation for delivery,” says Tolson.
Her common treatment plans are adjust ments, stretching, E-stim (electrical stimula tion) for constricted muscle groups, decom pression, strength training, and dry needling for soft tissue trigger point release.
A misconception about the Webster Technique is that it is used to turn the babies inside the mother into the preferred vertex position. Tolson clarifies that the purpose of the Webster Technique is to give the baby the room to move around. “It’s about helping the mother have the flexibility and strength in her pelvic joints and muscles to make room for the natural, internal movements of the baby. By correctly aligning and balancing the pelvis, the sacrum and muscle groups of the mom, the baby does the work of getting into the correct position,” says Tolson.
The Webster Technique
Tamera Tolson, DC, DACBSP®, proprietor of Back Talk Chiropractic, is certified in the Webster Technique, having completed the training in 2020.
ISSUE #140 25
In recent years, some of her female athlete patients became pregnant and came to her for help with lower back pain. “A common miscon ception is that pregnant women can’t have spinal adjustments,” says Tolson. “That’s not true. We don’t twist and turn pregnant women, but they can have their spines adjusted to relieve pressure by using a different technique,” she states.
Optimally Tolson like to see her patients a couple of times per week starting at the middle of the second trimester, around 20 weeks, until the mother’s spine is stabilized. Treatment is then tapered off according to the need of the patient and continues through the delivery. “Using the Webster Technique early and often lessens the chances of mal-presenta tion at delivery,” says Tolson.
BACK TALK CHIROPRACTIC Tamera L Tolson, DC, DACBSP 1300 E. New Circle Rd., Suite 160 • Lexington, KY 40505 (859) 309-0377 backtalkchiro.com backtalkchiropractic@gmail.com When Your Back is Talking to You... TALK BACK! CHIROPRACTIC SPORTS MEDICINE FOCUSED Highest credentialing in the sports medicine realm for chiropractors CERTIFIEDWEBSTER Chiropractic specific technique designed for the pregnant patient DRYCERTIFIEDNEEDLING Soft tissue therapy utilization to break up scar tissue and adhesions for a variety of conditions
It’s more advantageous for the mother to start the Webster Technique early in the pregnancy, says Tolson, even coming in for an evaluation in the first trimester. Earlier in the pregnancy is better not only for assessment of the mother’s joint alignment, but also to maintain her joint stability and to relieve her lower back and pelvic pain.
Pregnancy changes a woman’s center of gravity, Tolson explains, and it puts tremen dous pressure on the lumbar 5 spinal column joint, sacrum, plus the pelvis and pubic areas. Pain from spinal compression is compound ed by the instability created by the muscle, tendon, and ligament laxity required in the
Think of it this way: Feelings first, solutions second.
There are amazingly simple ways to do this, but in our mind-worshipping culture, they’re easy to overlook.
Wife: It’s not that I don’t love you... Husband (interrupting): That makes no sense. How can you love someone and not want to be married to them anymore?
Wife: (taking her seat): I think I’m done.
don’t bother trying to download it. You’ll just get an error message.
To get started, instead of trying to ignore or shut down the feeling, meet it.
• Feel the connection of your feet to the ground.
Like most clients, she had the usual this feels weird, I don’t like it reaction to “woo woo” practices like these:
Wife (turning to me): This is why I can’t talk to him. I say how I feel and then he negates it.
Wife: If I try to talk to him about something that bothers me, I get one defensive maneuver after another and we get nowhere. But what’s even worse is when I feel like I’m talking to a brick wall. No reaction. Eventually, I start yelling, but even that’s not enough. I have to be yelling at the top of my lungs to get a reaction.
It’s scary because it’s a reminder that there’s an animal component to our human nature. The amygdala is the animal part of our brain, and it’s wired for only one thing: survival. We’re talking raw emotion, red alert reflexes, and hair-trigger instinct.
Wife: I need basic human connection and it hurts too much to not get it. I need to do something different… now.
The Classic Marital Impasse
Husband: That’s not true… Of course, it mat ters how you feel.
Wife (shrugs): I’m not planning on it. I just know I don’t want to live like this anymore.
Feelings First. Solutions Second.
Your amygdala is programmed to receive and process sensation, so give it something it can process and respond to. Giving yourself a vis ceral and calming experience will immediately register in your instinctual brain. It’s like when your mom held you when you fell down and skinned your knee. The physical contact (hold ing you) and emotional contact (comforting) helped you calm down and recover.
• Wiggle your toes and notice the sensation.
Avoiding or shutting down an “amygdala-hi jack” can be as simple as breaking eye contact, taking a drink of water, or leaving the room. The idea is to give yourself a chance to calm your body and reengage your rational mind.
Since your amygdala doesn’t have the circuit ry for reason, restraint, and problem-solving,
Husband: It worked at one time…
Wife: In the beginning it worked. I felt like I could talk to you and it mattered how I felt. But it stopped.
Do This to Save Your Marriage: How to Calm Down and Speak Non-Defensively
Eventually, only an emotional earthquake regis tered on Husband’s marital Richter scale.
Until now, this couple’s impasse took a common form. Like most marriages, the wife is more likely to sense when things are off and put it on the table. The husband often has more tolerance for putting up with stuff and sweeping things under the rug.
So, when Wife brought stuff up, Husband preferred not to deal with it. The less respon sive Husband became, the more reactive Wife got. What does it take to get your attention?
And yet, here was Wife demonstrating a newfound ability to self-administer the very antidote recommended by Dr. Gottman: Calm down and speak non-defensively.
26 MD-UPDATE
Several months earlier, I had introduced Wife to some simple ways to experiment with the calm down part of the marriage researcher’s mantra.
MENtAL WELLNESS
Wife: The marriage. I’m done with the mar riage… It’s not working.
BY JAN ANDERSON, PSYD, LPCC
1. Give your body something to feel.
Husband (after a long pause): What comes next? Are you moving out?
Wife is as stunned as Husband by her open ing comment. No one says anything for several moments.
Husband: (looking confused): With what?
Marriage researcher John Gottman calls it the “classic marital impasse” — A wife seeking connection from a withdrawn husband.
When the Body Relaxes, the Mind Tends to Follow
• Gently press your palms onto the tops of your thighs.
When Wife was crying hysterically or yell ing, we can be pretty sure that the prosocial, problem-solving part of her brain (the prefron tal cortex) had gone offline. That leaves control to the amygdala, an ancient, reptilian part of theAbrain.n“amygdala hijack” can be scary to witness in your partner. It’s also scary. There’s a tsunami of feelings in your body and your brain gets flooded with fight-or-flight chemicals.
Wife: When I’m upset, he ignores me. Here’s what happened the last time he saw me crying? He walked into the other room, went outside and started cutting the grass. Unless I’m crying hysterically, it doesn’t seem to register.
It’s not the way their counseling session usu ally began. Husband rarely gets reactive. What was different was Wife’s lack of reactivity.
Not that she wasn’t feeling anything. Wife’s emotion was palpable. She was containing her feelings and expressing them at the same time.
Your reptilian brain may not process thoughts very well, but it can process sensa tions. A simple grounding, felt-sense experi ence has the power to put your amygdala at ease and get your prefrontal cortex back online.
By making your happiness a priority, you go for it in an “I count, too” way. That may include sometimes going on anyway, even when you’d rather have your partner join you on the Doesjourney.leaning out put you at risk of moving
• Make a gentle fist. Gently cover and hold the fist with the other palm. Fortunately, she was game, probably out of sheer desperation. We tried several variations until she found ones she could “tolerate.” I let the results speak for themselves, and she was hooked.Itmay
Wife: Believe me, if I hadn’t trained myself to do that more, we wouldn’t have made it this far. Husband: So, what’s the problem?
Husband: Well, then that’s what you need to do…
If you’re in a committed relationship, sooner or later you will face the inevitable reckoning:
What You Can and Can’t Change in Your Partner
Renegotiating the Terms of the Relationship
In brain speak, experimenting with small moments of new behaviors grows new neural connections in the brain. And doing it many times reorganizes the neural circuitry so it becomes the new default mode network.
Husband: I don’t need to be asked. If you have something to say, why don’t you just speak up?
Once Wife had some grounding practices in place, she was better able to process the feeling without being overwhelmed by it. We added: identifying the feeling.
Coming to terms with what can and can’t be changed in your marriage.
Wife (continuing): It’s exhausting. I need you to do your part to balance out the talk time. Ask me what I think sometimes.
Wife (ruefully): I thought I could overcome it. I thought you’d change! (laughs).
ISSUE #140 27
Instead of moving out, you lean out.
As a couples’ counselor, my job is to help you figure out if you’re in a solvable state of gridlock or, if there isn’t much you can do about your differences, at least for now, or maybe ever.
That hurt. This feels awful. Keep it simple: This sucks. Use short phrases and feeling lan guage. I’m disappointed. This is painful. This internal noting process allows you to absorb the feeling, like a damp cloth soaks up a spill. Acknowledging the feeling gave Wife a way to hold it with a tiny bit of detachment. This ability to meet the feeling head-on without being overwhelmed by it, was comforting and empowering. It put her in a position to act with a better chance of being heard.
An often-overlooked option is a decision to look for personal happiness, regardless of a difficult or less than ideal marriage. It usually means developing more emotional indepen dence from your spouse.
Wife: The thing is, I’m not looking to always be entertained. I want someone I can talk to, have a give-and-take conversation with.
Husband: If you knew I was this way, why did you marry me?
By taking the risk of leaning out in some ways, you may discover other ways to lean in.
flip side: Going for happiness in ways that depend less on your spouse can take some pressure off a partner with limited capac ity for intimacy. You may feel less disappointed in your partner and, in turn, your partner may feel less put upon or defensive.
Wife’s decision to lean out didn’t take the form of becoming withdrawn and cold. No one moved out. Husband and Wife continued coming to counseling sessions.
Along with a focus on solving problems and getting happier, there’s the process of making peace with what’s not going to change — or starting to consider other options.
into parallel lives and therefore put the mar riage at risk? Yes, it can. I don’t recommend it as your opening move when your marriage is underHere’sstress.the
Wife had evidently learned enough about how her mind worked to translate it into doing something different, something better. Calming down made it easier to speak nondefensively.Anunanticipated side effect? It put pres sure on the marriage. Wife’s growth was now putting pressure on diamond-in-the-rough Husband to up his game. Could he catch up with her growth in social skills enough to make this work?
2. Unabashedly acknowledge the feeling.
Husband (grinning): I know…
sound simplistic or hokey, but research shows that a “small moments, many times” approach is the most effective way to retrain your brain to break bad habits and form better ones. Like calm down and speak non-defensively.
Husband (laughing): I see…
As the interaction continue to unfold, I couldn’t help but think, “You go, girl. You may just save this marriage. And your diamond-inthe-rough husband may just let you do it.”
MENtAL WELLNESS
Taking more control over creating your own happiness will be good for you. But it’s not entirely selfish. It may also be contagious. If you get happier, your partner may get happier, too.
Wife: A lot of our talk time is me being a good listener while you talk. If I didn’t elbow my way into a conversation…
Instead of Moving Out, Lean Out
Wife: Not everyone is like you… You’re very confident. You just march right into the room and start talking about whatever’s on your mind. You’re a really smart guy and your stories and observations are very interesting.
Once the device was in hand, the procedure to place the implant was completed over the course of a twohour open-heart surgery. The tiny device measures 1.16 by 0.65 by 0.38 inches and weighs 0.18 ounces.
Patient born at 28 weeks with slow heart rate and congenital heart disease receives never before used pacemaker implant
“It is remarkable how our team of pediatric specialists came together with the device company to offer a resolution for such a small patient weighing less than three pounds at the time of implant,” said Soham Dasgupta, MD, pediatric electrophysiologist, Norton Children’s Heart Institute and UofL assistant professor of pediatric cardiology. “This unique case is unlike any other and we are so pleased to see this patient thriving as a result of the innovative approach.”
“While the operative steps might be comparable to the usual pacemaker implantation surgery, this surgery was especially delicate due to the very small size of the baby,” said Bahaaldin Alsoufi, MD, chief of pediatric cardiothoracic surgery, co-director of Norton Children’s Heart Institute and UofL professor of cardiothoracic surgery. “This tiny pacemaker generator was positioned in the abdominal wall on the right side and was connected to the usual leads that were attached to the heart. This novel device will provide the necessary support that the baby currently needs. At time of repair of the patient’s congenital heart defect in the future, we will be able to utilize these same leads and likely connect them then to a traditional larger pacemaker generator.”
“In this instance, the patient was not of the optimal size and conservative medical management was unsuccessful, so a specially modified pediatric-sized pacemaker, also known as an implantable pulse generator (IPG), created by Medtronic was used,” DasguptaDasguptasaid.and his colleague, Christopher L. Johnsrude, MD, director of pediatric and adult congenital electrophysiology and UofL associate professor of pediatric cardiology, reviewed the relevant preclinical data from a procedure where a similar tiny pediatric
Once it was determined the pediatric IPG was potentially compatible with the patient at Norton Children’s, Dasgupta worked with Norton Children’s Research Institute, affiliated with the UofL School of Medicine, and the manufacturer, to obtain local Institutional Review Board approval and emergency authorization from the U.S. FDA.
A First for the United States:
PHOTOS PROVIDED
28 MD-UPDATE News
IPG had been implanted in an adult Yucatan miniature pig, an animal with a heart that resembles a child’s heart.
Norton Children’s Heart Institute Physicians
Sternotomy at the time of implantation of an epicardial single chamber pace maker in a premature infant with congenital complete atrio-ventricular block (head at the top). (A) Implantation of the cathode of the epicardial Medtronic 4968TM pacing lead on the left ventricular apex, and (B) anode implanted on the right ventricular free wall. (C) Post-operative chest radiograph demonstrat ing a bipolar ventricular epicardial lead connected to the abdominal pediatric implantable pulse generator pacemaker. BY NORTON HEALTHCARE
Approximately 1 in 22,000 infants are born with CCAVB. Untreated, the condition has a high incidence of prolonged illness or death. The usual treatment involves implantation of a pacemaker once the patient meets a minimum body size, typically 4 1/2 to 5 1/2 pounds, to accommodate the implantable device. Taking time for the baby to grow while being otherwise treated, is strongly preferred for this situation. With this patient, however, the traditional plan was not working.
LOUISVILLE On March 18, 2022 a multidisciplinary team within Norton Children’s Heart Institute, affiliated with the UofL School of Medicine, worked together to save the life of an infant born with congenital structural heart defects and complete atrioventricular block (CCAVB) that led to a slow heart rate. The patient was too small for the traditional path of care, driving the innovative team to perform the first known human implantation of a tiny pacemaker in a premature infant.
Implant Tiny Pacemaker, Saving Infant’s Life
Joseph Hospital, received a 2022 KHA Quality Award. It was the ninth time CCH has been recognized with the award. The facility was recognized for its ventilator weaning rates during FY19, FY20, and FY21.Additionally,
The KHA Quality Awards recognize the hospital leadership and employees for providing explementary care and commit ment to innovation and optimal patient services. The HANDS Awards are given to volunteers for particular projects making a difference within hospitals.
PHOTO
Christopher L. Johnsrude, MD, director of pediatric and adult congenital electrophysiology and UofL associate professor of pediatric cardiology
the Volunteer Guild at Saint Joseph Hospital and Saint Joseph East received a Helping Accomplish Noteworthy Duties Successfully (HANDS) Award for its marble maze fidgets project.
Continuing Care Hospital, a long-term acute care hospital located within Saint
PROVIDED BY CHI SAINT JOSEPH HEALTH ISSUE #140 29
Saint Joseph Hospital, Continuing Care Hospital Earn Kentucky Hospital Association Quality Awards; Hospital Volunteers Recognized for Maze Fidget Devices for Patients
LEXINGTON Saint Joseph Hospital, Continuing Care Hospital and the Volunteer Guild at Saint Joseph Hospital have all received awards from the Kentucky Hospital Association (KHA) for their com mitment to patient care and safety. The facilities and volunteers were recognized at the KHA Annual Convention on May 18,Saint2022.Joseph Hospital has received a 2022 KHA Quality Award, receiving a per fect score in KHA’s grading system. Saint Joseph Hospital was recognized for its use of a blood culture diversion device that helps decrease the rate of blood culture con tamination in the emergency department.
Soham Dasgupta, MD, pediatric electrophysiologist, Norton Children’s Heart Institute and UofL assistant professor of pediatric cardiology
Kentucky Hospital Association President Nancy Galvagni, left, and KHA Board Chair and CEO of Paintsville ARH Hospital Kathy Stumbo, right, presented Saint Joseph Hospital Emergency Department team members Shelly Potter, administrative assistant, Nathan Terry, ED technician, and Heather Lee, interim manager of Emergency Services, with a KHA Quality Award during the association’s annual convention on May 18.
SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com
Bahaaldin Alsoufi, MD, chief of pediatric cardiotho racic surgery, co-director of Norton Children’s Heart Institute and UofL professor of cardiothoracic surgery
Presenting sponsor Stock Yards Bank & Trust volunteers Selina Shepherd, Barbara Tilghman, and Alicia Jordan
Physicians and other medical community stakeholders answered the call. Under mostly sunny skies and breezy conditions, players “scrambled” their way to the finish. Over $25,000 was raised through players’ fees and corporate sponsorships.
Lexington Medical Society Foundation’s Golf Returns!Tournament
LEXINGTON On Wednesday May 23, 2022, the Lexington Medical Society Foundation’s (LMSF) 32nd Annual Golf Tournament roared back to life after a two-year pandemic induced hiatus. Twenty-three teams lined up for the starter’s call at the University of Kentucky Club on Leestown Road in Lexington.
The winning team of Jon Webb, Lee Webb, Walker Webb, and Ken Francke posted a gross shot total of 53 and handicapped total of 44. Second place team was Chris Wood, Frank Taddeo, MD, Chris Schmitt, and Tom Midkiff from Saint Joseph Medical Group. Third place was Tom Waid, MD, Dave Merrell, Bob Busch, and Rick Deglow, the UK Healthcare Transplant team.
30 MD-UPDATE
EvENTS
LMSF honors grants to Central Kentucky healthcare-oriented charities such as Baby Health Services, Bluegrass Council for the Blind, Radio Eye, Camp Horsin’ Around, Kidney Health Alliance of Kentucky, Ronald McDonald House, Surgery on Sunday, and more.Presenting sponsor of the 2022 tournament was Stock Yards Bank & Trust.
Stock Yards Bank & Trust team: Lucien Kinsolving, Michael Dodd, MD, Jason Ayers, Wade Lawson
Stock Yards Bank & Trust team: Kevin Lane, Erik Frey, Steve Scariot, Mac Fain
Stock Yards Bank & Trust team: W. Lisle Dalton, MD, Shane Foley, Marty Goins, David Stigers, MD
PHOTOS BY GIL DUNN
UK Healthcare team: Jon Webb, Lee Webb, Walker Webb, Ken Francke
George Dimeling, MD, Brandon Devers, MD, Kevin Donohue, MD, Joe Karpinsky, MD
Baptist Health Lexington team: Greg Repass, MD, Michael Kirk, MD, Justin Penticuff, MD, Tim Stark, MD
EvENTS
ISSUE #140 31
American Trust team: Kevin Avent, Jeff Smith, Kelly Ison, Josiah Henson
Dean Dorton team: Stefan Hendrickson, Jay Swacker, Matt Smith, Mike McCreary
ProAssurance team: John DeWeese, Cy Radford, Guy Huguelet III, Mark Wilson
UK Healthcare Transplant team: Tom Waid, MD, Dave Merrell, Bob Busch, Rick Deglow
CHI Saint Joseph Medical Foundation team: Larry Butler, Harry Lockstadt, MD, Jim Thompson MD, Thomas Greenlee, MD
Central Bank team: Mark Ruddell, Bruce Koffler, MD, Chris Thomason, Ryan Atkinson
Tanbark Rehab & Wellness Center team: J. J. Glover, Susan Devich
Xerox team: Michael Powell, John Hegeman, Chad Madison, Conway Smith
Jeff Foxx, MD, John Reesor, MD, Ed Rogers, MD, Randy Owen, MD
John Collins, MD, Ed Monroe, John Maher, Frank Buster
Saint Joseph Medical Group teams: (back, l-r) Chris Wood, Kathleen Martin, MD, Carmel Jones, Frank Taddeo, MD, Jillian Edwards, (front) Chris Schmitt, Katie Saylor, Tom Midkiff (not pictured)
PHOTOS BY GIL DUNN
EvENTS
UK Medical Students team: Alex Turner, MD, Max Boyle, MD, Wes Averill, MD, Corey Hughes, MD
32 MD-UPDATE
Arvinda Padmanabhan, MD, John Gohmann, MD, Shawn Peterson, MD, Evan Bennett, PA-C
CHI Saint Joseph Medical Group team: Bill George, Wilson Sebastian, Chip McGaughey, Gerald Leslie
Lexington ENT team: Tad Hughes, MD, Brent Morris, MD, Bert Laureano, MD, Greg Grau, MD (not pictured)
MD-Update team: Jarod Pierce, Ben Wilcoxson, Chandler Dunn, Turner Gentry
ANNUAL GOLF TOURNAMENT RAISED OVER $25,000 VISIT LEXINGTONDOCTORS.ORG TO JOIN University Club of Kentucky | 4850 Leestown Road, Lexington, KY Presented by All proceeds benefit medical non-profits in the Lexington area Congratulations and Thank You! CONTRIBUTING SPONSORS
