MD-Update Issue 141

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #141 WWW.MD-UPDATE.COM

World Class Hand Care

VOLUME 12 • #4 • September 2022

Legendary practice Kleinert Kutz continues the training and legacy of its founders

ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

Orthopedic relief.

Surgery not required.

CHI Saint Joseph Medical Group — Orthopedics

The experienced team at CHI Saint Joseph Medical Group — Orthopedics is here to help you get moving again. If your life has been affected by joint, muscle, or tendon disorder, Frank Taddeo, MD, is committed to offering non-surgical orthopedic options that could be right for you.

Call 859.264.9820 for more information or to schedule an appointment.

Non-Surgical Procedures • Ultrasound-guided diagnosis and injections for joint, tendon, and muscle injuries • Personalized physical therapy for muscle, tendon, and joint issues • Non-surgical treatment options for osteoarthritis from shoulders-to-toes • Bracing, booting, and casting for acute injuries • Platelet-rich plasma (PRP) injections • After surgery care

Three Convenient Locations Lexington 211 Fountain Court, Suite 320 Lexington, KY 40509 P 859.264.9820 Frank Taddeo, MD

Mount Sterling 624 N. Maysville Road, Suite A Mount Sterling, KY 40353 P 859.497.4144 Winchester 1850 Bypass Road Winchester, KY 40391 P 859.737.5188

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS

2022

Editorial Calendar

ISSUE #142 (October) CANCER CARE

Oncology, Plastic Surgery, Hematology, Radiation, Radiology

ISSUE #143 (December) IT’S ALL IN YOUR HEAD

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

ISSUE #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

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

LETTER FROM THE EDITOR/PUBLISHER MD-UPDATE MD-Update.com

Welcome to the Orthopedic and Sports Medicine issue of MD-Update I love summer. It’s my favorite season. I enjoy outdoor activities and have watched my son Chandler play baseball for 20 years. So, it’s a little bittersweet to publish the Orthopedic and Sports Medicine issue in September, because that means summer’s window is closing … again.

As you’ll read in our Special Section physician profiles, aspects of orthopedics and sports medicine meld together when doctors use multiple tools in their physician tool box to get their patients back into the game of life. Dr. Darryl Kaelin, physiatrist at the UofL Health - Frazier Institute told me several years ago that “[his] focus is on function. Getting people to do again what they’re not able to do now.”

Weekend warriors, college or high school athletes, and adults of all ages are turning to the new era of orthopedics and sports medicine doctors, pain and regenerative medicine physicians, and chiropractors.

Care for Children Gala The Shriners Children’s Lexington Medical Center was the beneficiary of a successful fundingraising event in August that we were fortunate to attend and bring you photographs of. We heard the stories of Shriners patients whose lives were touched by the skill and care of their pediatric surgeons and extenders. It’s a great day when you can help a child run, laugh, and play.

The International Medical Practice in Kentuckiana We should all feel proud of the Kleinert Kutz Hand Care Center and the Christine M. Kleinert Institute started here in Kentucky. It is impossible to measure the impact that Drs. Harold Kleinert and Joe Kutz have had on plastic surgery, plastic surgeons, and thousands of patients. A third generation of hand doctors is now carrying their work forward. I hope you enjoy reading their stories in this issue’s cover story beginning on page 10.

Jeff Murphy I felt profound sadness when I learned that Jeff Murphy, VP for Marketing and Communications at CHI Saint Joseph Health died. Jeff was a warm, joyful man and a friend.

I worked with Jeff and his colleague Stephanie Sarrantonio before I started MD-Update and for years after. It’s hard to believe that he is gone.

As always, I invite you to review the MD-Update editorial calendar and look for your specialty.

When you see it, contact me. I’m sure you have a good story to tell.

Volume 12, Number 4

ISSUE #141

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Gil Dunn gdunn@md-update.com GRAPHIC DESIGN

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CONTENTS

ISSUE #141

World Class Hand Care 12 Legendary practice Kleinert Kutz continues the training and legacy of its founders 4 5 6 8 10

HEADLINES ACCOUNTING FINANCE OP/ED COVER STORY

SPECIAL SECTIONS: 14 SPORTS MEDICINE/ ORTHOPEDICS 18 REGENERATIVE MEDICINE 20 ORTHOPEDICS 22 SPORTS MEDICINE

24 COMPLEMENTARY CARE: CHIROPRACTIC CARE 26 MENTAL WELLNESS 28 NEWS 31 EVENTS

GROUP PHOTO BY BRYAN BABB COVER PHOTO BY PAUL MARTIN

FEATURED

14 SPORTS MEDICINE

18 REGERATIVE MEDICINE

20 ORTHOPEDICS

22 SPORTS MEDICINE ISSUE #141 3

Headlines

Golf for Healthy Causes Lexington Medical Society Foundation donates to local health charities

LEXINGTON In May, the Lexington Medical

Society Foundation’s annual golf tournament raised over $20,000. At the August 15th LMS Foundation board meeting, grant requests were evaluated and over $20,000 was distributed among 15 non-profit health care organizations.

LMS Foundation president, John Collins, MD, affirmed the Foundation’s mission “to improve the health of our community through support of Lexington-area medically related, non-profit organizations, medical students and physician leadership and wellness programs.”

Organizations that received funds were: Baby Health Services, which provides medications and immunizations at no cost to uninsured children in Fayette and surrounding counties; Camp Horsin’ Around, a camp for children with compromised health or special needs; Children’s Advocacy Center, which provides comprehensive medical and mental health examinations for child victims of sexual abuse in Fayette County; Chrysalis House, which assists women recovering from substance abuse with residential aid and oral health programs; The Explorium, which provides educational activities for children while teaching about the human body; LMS Medical Student Emergency Relief Fund, which provides financial support for UK medical students who encounter unplanned life emergencies; LMS Physician Wellness Program, which provides counseling services for active LMS physicians, UK residents, and medical students; McDowell House Museum, which hosts a summer camp for children that teaches health and medical procedures; Radio Eye, which addresses the information needs of people who are blind or disabled by providing 24/7 audio services such as reading local and regional newspapers, health periodicals, magazines, and programs on health; Ronald McDonald House, which provides housing 4 MD-UPDATE

for families whose children are being treated in local medical facilities; Mission Health & Faith Pharmacy, which offers medical treatment such as insulin for low income and uninsured adults; Surgery on Sunday, which provides free outpatient surgery for uninsured or low income patients; Bluegrass Council of the Blind, which provides health services to the blind or visually impaired; Kidney Health Alliance of KY, which provides services to patients with kidney disease; and KY Diabetes Camp for Children, Camp Hendon, a summer camp for children with Type 1 diabetes.

LMS Foundation members include John Collins, MD, president, David J. Bensema, MD, vice president; John G. Roth, MD, secretary; Hunt Ray, treasurer; and board members Bill Farmer Jr., Gil Dunn, Jane Chiles, Alicia Jordan, and Khalil Rahman, MD, LMS president.

Stock Yards Bank & Trust was the 2022 presenting sponsor of the LMS Foundation’s Golf Tournament.

“The Lexington Medical Society Foundation seeks to help those who improve community health,” said Collins.

For information on the Lexington Medical Society Foundation visit www.lexingtondoctors.org.

For more information and to join the Lexington Medical Society, contact Chris Hickey, CEO, at 859-278-0569, or cmhickey@lexingtondoctors.org

VISIT LEXINGTONDOCTORS.ORG

Accounting

What Are Revenue Cycle Best Practices?

BY ADAM SHEWMAKER, FHFMA, HEALTHCARE CONSULTING DIRECTOR

For every physician, clinic, and healthcare organization, the first obligation is to deliver the best possible outcome for patients. Period.

But the truth is, the health of any organization itself is a key determining factor in how well they can care for others in the first place. Best outcomes are a full-circle proposition, from initial visit, through treatment, to communicating with insurance in the billing cycle. An effective revenue engine keeps organizations in the business of helping.

To ensure they receive reimbursement for care, manage denials, and work to increase revenue, healthcare organizations and practices of all sizes follow a process called revenue cycle management (RCM).

Of course, a fundamental truth is that you can’t manage what you don’t measure. Here we’ll discuss key revenue cycle management best practices to consider applying.

7 Revenue Cycle Management Best Practices When healthcare leaders were asked what they believed the “root cause” of claims denials for their organization was, the majority (36%) answered “missing information.”

Fact is, practices deal with insurance denials daily. But the weakest link in the revenue cycle can often be honest human error. Any number of clerical intake errors, duplicate claims, and lack of prior authorization can set the stage for difficult collection and reimbursement down the line.

While there’s no way to 100% bulletproof a healthcare organization from all claim denials, identifying root causes and having methods for quick resolutions is a great first step. To that end, here are some best practices to consider incorporating.

1. Understand payer fee schedules Because each payer has its own fee

schedule and billing requirements, practices must ensure patients are covered for services, provide proper patient information, and identify any necessary exceptions.

Since they account for much of a practice’s revenue, it’s important to monitor major payers routinely for underpayments. It’s also a good idea to ensure the practice is receiving contracted rates and is prepared to negotiate contracts as expiration dates approach.

2. Reduce claim denials Practices can work to reduce denials by confirming insurance and verifying eligibility and benefit coverage prior to service.

Be sure to get a copy of the front and back of the patient’s insurance cards for verification and to use valid procedure codes. It’s also important to stay current with new, changed, or deleted diagnosis codes.

3. Prioritize making corrections to existing claims Not only does correcting claims help the organization see at least some reimbursement for services, it can help create a streamlined process to identify common mistakes for future processing.

4. Be timely and transparent with collections Inform patients about payment policies prior to care when verifying insurance. If outstanding balances exist, inform patients of them routinely by phone or patient messaging applications.

5. Claim value-based reimbursements Delivering high-value, highly reim-

bursable services (such as Chronic Care Management) can improve patient outcomes and increase revenue as well.

As more practices move towards value-based care, it’s important to stay on top of billing requirements and other ways to improve processes.

6. Chronic Care Management (CCM) The Centers for Medicare & Medicaid Services (CMS) offers providers assistance in Chronic Care Management services. This is another way to potentially help increase value-based reimbursements for patients with two or more conditions expected to last at least 12 months.

7. Partner with an expert RCM system Consider partnering with an expert RCM service to help account managers better handle their day-to-day operations, quickly learn new regulations, and provide insightful analytics.

Vigilant Monitoring for Improved Care In the end, the task at hand for healthcare is to ensure the highest level of patient care with the most positive outcomes possible.

Those seeking care are often burdened with emotional or financial stresses.

By monitoring metrics within revenue cycle management processes, healthcare practices can take the next step to providing patients with more timely, transparent care — from initial visit, to treatment, to billing.

For more about revenue cycle management metrics and how Dean Dorton can help your practice assess their current process, connect with us today. ashewmaker@ddafhealthcare.com | 502.566.1054 ISSUE #141 5

Finance

Adapting to the New Normal

BY SCOTT NEAL, CPA, CFP®

I am sure that it goes without saying, but I will say it anyway: On so many fronts these are challenging times that we live in. But I would quickly add that they are also quite exciting, teeming with possibilities.

At the time of this writing (mid-August 2022), I just read that public pension funds and college endowments (some of the largest portfolios in the world) had their biggest losses since the financial crisis of ’08-’09. If your 401k is invested in what has been labeled a traditional portfolio (and most are), there is a good chance that it is in the tank as well.

Key word here is traditional. You might have heard the same mantra from your broker over and over again: “Simply invest in a broadly diversified portfolio of various asset classes, i.e., stocks, bonds, and some alternative, occasionally rebalance to the chosen allocation, hang on for the long term, and you will be fine.” And you will be . . . until you aren’t. We have not seen market conditions like this one for more than 40 years. But they aren’t totally unprecedented.

I think it is unfortunate that over the past two and half decades, traditional asset allocation has become normative to most investors. It is an outgrowth of what is known

as Modern Portfolio Theory and the Efficient Market Hypothesis. It is fine as far as it goes.

I have often said it is not wrong, just incomplete. In other words, it is too simple for those of us who seek superior results. It is predicated on the principal that an investor should hold investment assets that are negatively correlated to each other, meaning that some will be going up while others are dropping. But what happens when the major asset classes all fall at the same time? That is what happened this spring to stocks and bonds. Those who thought they were protected by holding a higher percentage of bonds were surprised.

We heard more than one person say, “But I thought bonds were safe.” Remember, as interest rates go up, bond values come down.

Some of us can remember 1981 when interest rates were 22%. That was the Paul Volcker era at the Fed. I doubt seriously that we will see rates that high ever again, but I’ve also learned never to say “never.” The big story about our present-day milieu has been the easy money policy of the Fed. We believe that while it may continue to raise short term rates, the Fed will remain biased toward stimulus, i.e., easy money. They do this in concert with the U.S. Treasury’s eager deficit-spend-

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

ing. The Fed works by adjusting rates and buying bonds. Economic stimulus results in lower rates and economic tightening in higher rates. Typically, the Fed’s mission has been met by simply controlling short-term rates.

Over the years, I have often remarked that sooner or later everyone (including the Fed) will be reminded that it is the bond market that is truly in charge. I have had to reconsider that statement in the recent past as the Fed has become a major player in the bond market driving down interest rates on even the longest of long-term bonds and keeping them there for a protracted time frame.

Easy money results in more debt at almost all levels of borrowing. Worldwide debt to GDP has increased dramatically in the past few years. Just when we will reach a tipping point is anybody’s guess. But if/when we get there, rest assured it won’t be pretty.

So, what’s an investor to do? Let me explain where we have been and what we are doing now as we reach for excellence for all our clients.

Before Jerry Zimmerer and I merged our two practices in 2000, each of us pursued a quite traditional approach that embodied asset allocation. He added value by using a

Practice management and advisory services

Interim practice management

Medical billing and credentialing

Accounting and financial outsourcing

Revenue cycle management

Human resources

Compliance and risk management

Technology

deandortonhealthcaresolutions.com 6 MD-UPDATE

Finance

momentum style of investing, and there was a bias toward broad diversification using mutual funds invested in bonds, stocks (large and small, foreign and domestic), and real estate or precious metals but maintaining the allocation in an effort to control risk. We knew then, as we know now, that if two investors get the same average return but with different volatilities the one with less volatility will have more money at the end of the period. Asset allocation helped smooth the ride.

In the late ‘80s I subscribed to ChartBooks in my attempt to add value for our clients.

Those were thick books of point-and-figure charts (one company’s stock per page) that were updated every month. I became what is known as a technical analyst. Only when a favorable price pattern was discovered by reviewing the charts, did I dig into the company to find what it did and what its financial statements could tell me. The charts can be instructive, but not ultimately determinative, in my opinion. Thankfully, the computer

replaced the books, but I still get a kick out of reading the charts and finding value.

Fast forward to late 2007. I returned from a conference where I had heard Dr. Woody Brock tell us that we don’t have to be right in this investments business, but we must be “less wrong” than the crowd. He was introducing us to an entirely different way of thinking about and making investment decisions. It was predicated on the research of Dr. Mordecai Kurz at Stanford. From that work, our wealth preservation strategy was born in time to avoid the ’08 — ’09 market downturn. It combined the best elements of technical analysis, and its objective is to achieve a real rate of return above inflation that would enable an individual a better chance to achieve his or her goals.

The two strategies have worked independently through the years. Clients were steered into one strategy or the other depending on their goals, risk tolerance, risk capacity, and return need.

Recently, we made the discovery that the two strategies, momentum growth and wealth preservation, can work together to produce risk-adjusted returns that would not be achievable using either one alone. The allocation is not targeting a blend of asset classes as in traditional asset allocation, but it is a combination of the two strategies in measured proportions. More conservative investors get a bigger slice of wealth preservation and more aggressive types get more momentum growth.

Of course, as always, the accomplishment of particular investment goals is dependent upon getting the risk posture set correctly, developing a sound portfolio, establishing a discipline, and rolling with the punches that the market inevitably throws at you.

Scott Neal is the president of D. Scott Neal, Inc., a fee-only fiduciary advisor with offices in Lexington and Louisville. Comments and questions can be emailed to scott@dsneal.com or call him at 1-800-344-9098.

YOU CARE FOR EVERYONE♦ WE TAKE CARE OF YOU♦ 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.

Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.LAW ISSUE #141 7

Op/Ed

The Tale of the Fifth Vital Sign Opioid prescriptions decline but deaths from overdose rise

BY TUYEN T. TRAN, MD, MBA LEXINGTON The Centers for Disease Control

and Prevention (CDC) reported more than 100,000 people died of drug overdoses in the U.S. during the 12-month period ending April 2021. That’s a new record high!

Overdose deaths jumped nearly 29% from the same period a year earlier and nearly doubled over the past five years. Opioids continue to be the driving cause of the deaths, and synthetic opioids, primarily fentanyl and its analogs, caused about 64% of all drug overdose deaths in that same time period.

Although we have achieved tangible victories in our efforts to combat the opioid epidemic, it appears that we are losing the war. Opioid prescriptions have dramatically declined in every state for the last 10 consecutive years. Participation in state prescription drug monitoring programs (PDMPs) has increased in every state for the past five years.

Harm reduction and other community-based efforts distributed more than 3.7 million doses of naloxone between 2017-2020. Despite these measurable accomplishments, the nation’s overdose death rates related to opioids continue to worsen. Certainly, the physical isolation and financial insecurity caused by the COVID19 pandemic exacerbated the situation, but the rising trend in overdose deaths related to opioids predated the pandemic. What are we missing? What unintended consequences did we cause as the result of the implementation of these strategies to combat the opioid epidemic?

Many of us are familiar with the general story of how the recent opioid epidemic began. Doctors Hershel Jick and Jane Porter wrote a one paragraph editorial in 1980 to The New England Journal of Medicine reporting that after an analysis of 12,000 hospitalized patients who were given opioid analgesics, the risk of addiction was less than 1%. Companies like Purdue Pharma, the manufacturer of Oxycontin, aggressively promoted the idea that opioids were not 8 MD-UPDATE

Figure 1

addictive. Patient advocates and pain specialists convinced the medical community to raise its awareness that doctors were unresponsive to patients suffering from unnecessary pain. Federal regulators, doctors, and everyone persuaded by pharmaceutical companies demanded the assessment of pain as the “fifth vital sign.” The liberal prescription of opioid analgesics began, and the opioid epidemic followed shortly thereafter.

Once the opioid epidemic became apparent, the medical community reassessed the safety of opioids and discovered that they were not safe. In fact, opioids were tremendously addictive. We also realized that the liberal prescribing of opioids created an excessive supply. Many patients with addiction confided that their initial exposure to opioids was from someone else’s leftover prescription. As a result, the medical, regulatory, and legislative communities reacted with a 180-degree shift to essentially no opioid prescribing. There has been a steady decline in prescription opioids of about 44.4% from 257.9 million prescriptions in 2011 to 143.4 million in 2020.

Figure 2 shows that, despite our efforts to

decrease the amount of prescription opioids, the mortality associated with opioid overdoses continues to rise.

An immediate thought should be, if we decrease the supply of prescription opioids, what are these patients with addiction going to do? How are they going to resolve their withdrawal symptoms? Certainly, these patients can go to their local doctor for treatment. However, it’s probably much easier to simply find heroin, and Figure 1 clearly shows that in 2011, many patients did just that.

And as law enforcement cracked down on the heroin supply, we saw the rise in synthetic opioids — fentanyl and its many new and creative analogs.

There is another more concerning side effect of decreasing prescription opioids. When we adopted the 180-degree shift in our stance toward opioids, there were many patients with legitimate pain whose voices were essentially ignored. Patients were simply informed that there was not an indication for opioid analgesics with the rare exception of surgery or trauma. So how did we get from, “We must assess a patient’s pain and avoid unnecessary

Op/Ed

Figure 2

suffering,” to “Opioids will not help your pain”? In a very lengthy letter on June 16, 2020 to CDC doctor Deborah Dowell, MD, MPH, the AMA’s James Madara, MD, cites the data in Figure 2 and states, “We can no longer afford to view increasing drug-related mortality through a prescription opioid-myopic lens.”

He continues, “The nation’s opioid epidemic has never been just about prescription opioids, and we encourage CDC to take a broader view of how to help ensure patients have access to evidence-based comprehensive care…”

Later in the letter, Madara writes, “The CDC Guideline has harmed patients.” Patients suffering from pain view themselves as “collateral damage” from regulatory and legislative efforts to restrict opioid prescribing. The CDC has acknowledged its Guideline’s negative effect on patients with legitimate pain.

In addition to the dramatic change in how we view patients with pain, the regulatory restrictions have completely changed doctors’ practices. Doctors are very fearful of prescribing any opioids. As a result, patients are either abandoned, involuntarily tapered off their opioids, or referred to a pain management specialist who will face the same dilemma. A recent study (Sedney et al., 2022) interviewed 20 phyREFERENCES • Robinson, Amber, Aleta Christensen, and Sarah Bacon. “From the CDC: The Prevention for States Program: Preventing Opioid Overdose through Evidence-Based Intervention and Innovation.” Journal of Safety Research 68 (2019): 231–37. https://doi.org/10.1016/j.jsr.2018.10.011.

sicians in West Virginia regarding opioid prescribing and reported four general responses: 1) fear of disciplinary action, 2) exacerbation of opioid prescribing fear due to restrictive legislation, 3) care shifts and treatment gaps, and 4) conversion to illicit substances. Physicians feared that taking on patients who legitimately required opioid pain medications would jeopardize their career. Interestingly, several physicians confided that some of the patients who were seen for addiction related that their heroin and/or fentanyl addiction was directly related to being abandoned by their regular doctors.

Similar to the disappointment seen with rising overdose deaths despite decreases in prescription opioids, participation in PDMPs has not correlated with a decline in overdose deaths. The use of PDMPs has grown from 61.5 million in 2014 to 910.6 million in 2020 with over 2.7 billion queries. Many legislative and regulatory experts reported that the intent of PDMPs was to reduce the prescription of controlled medications. The registry is simply another tool to combat the opioid epidemic, but alone, it is not sufficient to win the war on opioid overdose deaths.

I certainly do not have the solutions to ending the opioid epidemic. However, I am • Sedney, Cara L., Treah Haggerty, Patricia Dekeseredy, Divine Nwafor, Martina Angela Caretta, Henry H. Brownstein, and Robin A. Pollini.

2022. “‘The DEA Would Come in and Destroy You’: A Qualitative Study of Fear and Unintended Consequences among Opioid Prescribers in WV.” Substance Abuse Treatment, Prevention, and Policy 17 (1). https://doi.org/10.1186/s13011-022-00447-5.

very happy to see that many of our academic colleagues are examining supply-demand mismatches. Simply removing the supply of prescription medications and/or illicit drugs will not cause a decrease in demand. As we have seen, patients with addiction will seek their medications elsewhere and the elsewhere may often not be very safe. We saw this with the shift to heroin when prescription opioids were forcibly removed. And when we aggressively eliminated heroin, fentanyl emerged. Thus, increasing access to proper evidence-based treatment is critical to ensure that the patients’ demands are met in a safe and controlled environment. More importantly, the addicted patients are often impulsive and volatile.

When they are ready for treatment, we need to quickly meet their needs then. Any delays in treatment such as prior authorizations may result in missed opportunities.

I embrace the AMA’s effort to combat the opioid epidemic and support their initiatives: Remove barriers to evidence-based care for patients with substance use disorder (SUD) such as prior authorization.

Remove barriers to medication for opioid use disorder (MOUD) for SUD and co-occurring mental illness in jails and prisons.

Protect families by focusing on increasing access to evidence-based care instead of punishment or threat of separation for persons who are pregnant, peripartum, postpartum and parenting.

Support patients with pain by rescinding arbitrary laws and policies focused on restricting access to multidisciplinary, multimodal pain care.

Tuyen Tran, MD, emigrated from South Vietnam after the war. He completed his undergraduate in biology/ chemistry and medical school at the University of Missouri – Kansas City. His is currently boarded in internal medicine and addiction medicine and current president of Kentucky Society of Addiction Medicine. He is a past president and executive board chairman of the Lexington Medical Society.

• IQVIA Institute Custom Xponent Opioid Dataset, Specialty View. For more information, IQVIA Institute Prescription Opioid Trends in the United States (December 16, 2020). Available at https://www.iqvia.com/en/insights/the-iqvia-institute/reports/ prescription-opioid-trends-in-the-united-states.

ISSUE #141 9

Cover Story

World Class Hand Care Legendary practice Kleinert Kutz continues the training, surgery, and legacy of its founders.

BY GIL DUNN

Margaret Napolitano, MD, FACS LOUISVILLE/ LEXINGTON/ NEW ALBANY When

a brand name like Xerox, Kleenex, Velcro or Google becomes so common that it is synonymous with the product or service itself, that’s called “genericization.”

Some celebrities and sport figures also rise to the level where one name is enough to encapsulate a unique legacy. Think LeBron, Jordan, Magic, Rupp. Or Elvis, Cher, Disney.

It’s not often that doctors reach that stature of brand recognition, but it’s fair to say the name Kleinert Kutz approximates that level of achievement when the names are synonymous with hand and upper extremity surgery, innovation, and advanced fellowship training in hand microsurgery.

The legacy medical practice that Harold Kleinert, MD, and Joseph Kutz, MD, began in Louisville in 1964 continues today and has spread through three generations and around the globe, signifying “world class hand care.”

According to its website, Kleinert Kutz Hand Care Center is the largest and oldest hand surgery practice in the United States.

Over 1,400 fellows from 58 countries have trained through the Christine M. Kleinert Institute (CMKI), a “nonprofit education and research organization dedicated to excellence in education and research in hand and microsurgery.” CMKI president Tuna Ozyurekoglu, MD, says, “Kleinert Kutz has touched the lives of countless surgeons from all over the world. The power of our institute comes from the principles set forth

by Dr. Harold E. Kleinert, which requires the students surpass their teachers.”

“Dr. Kleinert pioneered many ‘firsts,’ including the Zone II flexor tendon repair,” 10 MD-UPDATE

shared Huey Tien, MD. “He established techniques for those injuries that have been built upon by the team as the years have gone by.”

Meet the Kleinert Kutz Surgeons MARGARAET NAPOLITANO, MD, FACS Margaret Napolitano, MD, FACS, was born in Hollywood, Florida and attended Barry University in Miami and the University of Florida medical school. She did her general surgery residency at Saint Louis University in Missouri then returned to the University of Florida for a microsurgery and plastic surgery fellowship. She completed her fellowship training at CMKI and remained as a member of the staff.

“I was drawn to plastic and hand surgery because it allows me to work on a variety of structures such as bone, tendons, nerves, and blood vessels,” says Napolitano. Her patients are adults and children of all ages. She works in the satellite Lexington office and credits her staff and Wesley Lykins, PA, for expediting same-day care, especially for emergency hand surgeries.

“Wesley has an extensive background in several surgical specialties including orthopedics. He possesses a strong skill set and understands what types of injuries can be temporized and those injuries that cannot wait for surgery days later,” says Napolitano.

HUEY Y. TIEN, MD, FACS Huey Y. Tien, MD, FACS, is from Taipei, Taiwan and comes from a large family of doctors. He graduated from Chung Shan Medical University in Taiwan and completed orthopedic residency there. He did his clinical

hand surgery fellowship at CMKI and an additional general surgery residency at UofL School of Medicine.

Tien recalls that during childhood, a neighbor had a prosthesis for his amputated arm.

“He always showed me what he could and could not do due to amputation and what he needed to do to accommodate it. It drew my interest in how amazing a simple-looking hand could do and how much we lose without it.”

Tien sees the common presentations of nerve, joint, and vascular irregularities, but he has also had very challenging patients with rapid progression of loss of arm function without any known causes.

Advancement in arthritis and painful neuromas treatment is the future of the specialty, Tien believes, and he encourages other orthopedics or family practice doctors to refer patients. “We treat all conditions, from neck to fingertips, and we do more than people think we can do.”

TUNA OZYUREKOGLU, MD Born in Tarsus but growing up in Adana, Turkey, Dr. Tuna, as his peers and patients call him, was influenced by his uncle, a physician.

He attended the top medical school in Ankara, the Hacettepe University School of Medicine, where classes were taught in English for the sixyear degree which included internship. He says he learned early on of “the value of speaking well, being good at what you do, having good relationships with your peers.”

“I was mesmerized with the tendon transfers lecture for polio during my rotation in orthopedics. I loved the fact that there was a lot of action, and it did not sound like classic medicine or surgery. I felt happy; you fix people and you see the results immediately,” recalls

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Huey Y. Tien, MD, FACS

Ozyurekoglu.

While doing his residency in Denmark for his hand surgery rotation, he learned about the CMKI fellowship program “And that’s how I first heard of Louisville,” he says.

Ozyurekoglu’s patients commonly present with carpal tunnel, trigger finger, and arthritis of the thumb, fingers, wrist, and elbow.

His areas of focus are rheumatoid arthritis, Ehlers-Danlos syndrome, and wrist and elbow ligament injuries.

“Arthroscopy and endoscopy advanced my patient care significantly because they allow for minimally invasive procedures,” says Ozyurekoglu. “Mechanical hands and haptics, technology that stimulates senses of touch and motion, are advancing hand surgery and will be the ultimate treatment for amputations.”

“I treat my patients with respect and love. I inform them as much as possible, but I feel it’s my duty to guide them to the best treatment for themselves.”

RODRIGO MORENO, MD Rodrigo Moreno, MD, grew up in Bogota, Columbia, in a family of doctors with his father, a brother, and a sister being physicians and his mother and another sister as psychologists. He graduated from Colegio San Carlos, an American high school founded by Benedictine monks from North Dakota. He then received his medical degree and did his orthopedic residency at the Colombian School of Medicine at Bosque University including an exchange of clerkships in orthopedics and ophthalmology at Massachusetts General Hospital in Boston. He then entered CMKI for hand & microsurgery. He was drawn to the specialty because “We have to manage soft

Tuna Ozyurekoglu, MD

tissue, skeletal, and neurovascular pathology.

Hand anatomy is very complex, and returning the function of it is a challenge.”

Moreno’s typical patient presentations are humerus, forearm, distal radius, and hand fractures, elbow pathology, wrist instabilities, carpometacarpal and carpal osteoarthritis, carpal tunnel syndrome, trigger finger, and nerve entrapment pathology of the upper extremity.

Uncommon cases include thumb hypoplasia, absent thumbs due to congenital or traumatic conditions, malunion of distal radius fractures, and non-union of scaphoid.

Looking ahead, Moreno says, “Scarring around flexor tendon repairs is a problem in micro hand surgery. Further research and development of a treatment to diminish scarring while at the same time letting the tendon heal in normal timing will have a significant impact.”

When treating his patients, he recalls what his mentor, Dr. Kleinert, taught him: “Be available, be affable, and be able to help those who are in need of hand and upper extremity pathology.”

SUNIL THIRKANNAD, MD Sunil Thirkannad, MD, grew up in Bangalore, India, where an uncle and a cousin were doctors and the rest of his family were scientists and engineers.

He received his medical degree at the Bangalore Medical College, India. He is double board certified, with a masters in orthopedic surgery and a National Board Diploma from India. Additionally, he has two fellowships in hand surgery, one from the National University of Singapore and another from CMKI at UofL. A servant’s heart is at the core of Thirkannad’s mission to bring his surgical skills to patients in need. When he was a young doctor in India, PHOTOS PROVIDED BY BRYAN BABB

Rodrigo Moreno, MD

hand injuries typically happened to the working poor in factories and on farms. According to Thirkannad, access to competent plastic surgery for the poor and uninsured was minimal, at best. “I taught myself hand surgery, because there was no formal fellowship in hand surgery in India at the time. From 1998 to 2003, I dedicated myself to taking care of all hand injuries that arrived at our hospital. That meant I was on call 24/7/365 for hand injuries.”

That workload and dedication earned him a year’s worth of vacation which he took in the form of a sabbatical to enter the CMKI fellowship program.

He recalls, “I arrived in Louisville two weeks prior to my fellowship training. During that time, I was asked to write a chapter for a textbook as a co-author with Dr. Harold Kleinert. When Dr. Kleinert read a draft of chapter, he suggested that I consider joining Kleinert Kutz and Associates, which I accepted in all humility.”

Thirkannad’s special areas of interest are pediatric problems including deformities and injuries. Also, adult rheumatoid arthritis, wrist problems including fractures, ligament injuries, and arthritis, and tendon transfers for nerve problems. In addition, he sees common problems like carpal tunnel syndrome, cubital tunnel syndrome, ganglion cysts, and trigger finger.

His scientific and engineer’s sensibility helps when he encounters complex wrist problems that need reconstruction, or severe deformities due to rheumatoid arthritis. Another area of complex problems he sees are scaphoid fractures that have not healed or scaphoid fractures where the bone has lost its blood supply. In ISSUE #141 11

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Sunil Thirkannad, MD,

the latter case, the patient will require a vascular bone graft surgery to potentially save the scaphoid from dying.

Honesty, says Thirkannad, is his guiding principle. “If you are honest, you will always endeavor to make the correct diagnosis. If you are unable to make a definitive diagnosis, you will seek help from a colleague. If you are honest, you will always recommend only that mode of treatment which you believe is the best for your patient. And finally, if you are honest, you will be able to look back at each day’s work and feel a sense of fulfilment. That means, when you go home that night, you can lay your head on your pillow and sleep well.”

MICHELLE D. PALAZZO, MD Michelle D. Palazzo, MD, originally from Peoria, Illinois, went to the University of Illinois for her undergraduate and graduate degrees in engineering. Her medical degree came from Southern Illinois University, with residency at Saint Louis University in plastic surgery; then Georgetown University in Washington, DC, for a fellowship in aesthetic surgery and reconstruction of the breast; finally, CMKI fellowship in hand and microsurgery.

Among the Kleinert Kutz orthopedic and hand surgeons, Palazzo is unique in her dual practice focus on hand microsurgery and breast reconstruction.

She is aware of some minor areas of confusion. “Some patients cannot understand how I do both hand surgery and a wide variety of plastic surgery cases. Hand surgery is part of the training we receive as plastic surgeons.

I love being able to work on all parts of the body and in all age groups,” says Palazzo.

She is also on the go a lot, “I work out of 12 MD-UPDATE

Michelle Palazzo, MD

several different office locations and hospitals and surgery centers, so I am never in the same place two days in a row.”

Palazzo’s hand care practice covers the usual range of carpal tunnel syndrome, arthritis, and tendonitis. Her breast care practice includes mastectomies and reconstruction from breast cancer and skin cancer, and breast surgery for reduction and cosmetics.

“Advanced breast expanders, implants, fat harvesting tools and biologic materials help make breast reconstruction faster and less painful and with better results,” she says, emphasizing that she “treats her patients with respect and allows them to make well informed medical decisions in their health care treatment.”

ELKIN J. GALVIS, MD Elkin J. Galvis, MD, grew in Bogota, Colombia. He attended medical school at the Universidad Nacional de Colombia (National University of Colombia), obtaining his medical degree in 1999, followed by orthopedic residency at Javeriana University in 2004.

Impressed by the world class hand care and surgery training and the longevity of the Kleinert Kutz practice, he came to CMKI for fellowship training in 2010.

“I treat patients in all age groups, from early age to geriatric patients. I take care of multiple conditions, traumatic injuries and chronic conditions. I have a special interest and focus in peripheral nerve pathology and treatment with nerve or tendon transfer for different palsies, after stroke, and quadriplegia,” says Galvis.

The most common problems for Galvis’ patients are peripheral nerve compressions, carpal tunnel syndrome, and cubital tunnel

Elkin J. Galvis, MD

syndrome, followed by chronic arthritis, tendonitis, and tenosynovitis in different areas in the hand. “I have a special interest in nerve and tendon transfers after palsy and spinal cord injuries,” says Galvis.

Galvis believes that research in nerve healing and better understanding of the process and the possibility to enhance nerve regeneration are in the future for hand care. He’d also like to advance the idea that surgery can help patients with nerve compression and that neuroleptic medication does not have to be the first option for treatment.

“Protocols are important to guide care, but every patient is different. We need to adjust to the unique situation of each person. Patients need to take an active role in decisions about their health, and the physician is there to guide and advise,” he says.

“Life is motion,” says Galvis. “Orthopedic surgery on extremities keeps us moving.”

LAXMINARAYAN BHANDARI, MD Laxminarayan Bhandari, MD, grew up in Mangalore, India, the son of a father who was a pathologist and a mother who was a dentist.

He received his medical degree at the Kasturba Medical College of Mangalore and did his general surgery and plastic surgery residency at Calicut Medical College before entering CMKI for fellowship training in 2015.

Like many orthopedic and plastic surgeons, Bhandari enjoys the satisfaction of restoring the use of limbs to a patient and “giving patients back what they have lost,” he says. The name and legacy of Kleinert Kutz brought him to Louisville to perfect his skills and advance his training.

Bhandari sees patients from pediatrics

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Laxminarayan Bhandari, MD

through seniors, particularly hand trauma.

A newer member of the practice, he believes that advancements in hand prostheses and neuro integration will have significant impact in the future of upper extremity surgery and treatment.

“Always do what is best for the patient,” he says.

CLAUDE MURESAN, MD Claude Muresan, MD, grew up in Gaithersburg, Maryland. His brother, Horatiu Muresan, is a reconstructive plastic surgeon who practices in Myrtle Beach, South Carolina. Together the brothers graduated from the University of Maryland and the university’s School of Medicine in Baltimore.

He completed a fellowship at UofL in plastic surgery in 2019.

During his plastic surgery training, he was exposed to hand surgery and became fascinated with the field. He completed a fellowship in hand surgery at CMKI in 2020 and stayed on as faculty. He recalls how Palazzo arranged an additional rotation with Kleinert Kutz during his plastic surgery fellowship to gain extra exposure to the field. He was amazed at the clinical excellence, dedication to patient care, and complex cases that were being executed at the institute.

“It was love at first site, and I knew then that I wanted to join this cutting-edge group,” says Muresan.

Muresan treats people of all ages in a wide array of pathologies. His special interests include decompression of carpal tunnel, cubital tunnel, and other upper extremity neuropathies, upper extremity fracture fixation,

Claude Muresan, MD

thumb, hand, and wrist arthritis, as well as cosmetic plastic surgery and reconstructive plastic surgery.

Technology has been a game changer in Muresan’s practice. Initially he performed all open carpal and cubital tunnel surgeries with incisions of approximately 6 to 15cm. With advances in endoscopic equipment, he has transitioned to doing the same procedures through a 2cm and 4cm incision. This translates into a smaller scar, improved cosmesis, less postoperative pain, and a quicker return to normal use.

“I believe that new endoscopic and arthroscopic technology is changing the field.

Advances in cameras, nanotechnology, and optics are revolutionizing the type of incisions we utilize to perform the same operation. As this technology improves, we will see new devices and techniques developed that will allow for smaller, single-site incisions that will translate into less postoperative pain and a more rapid return of hand use and work,” say Muresan.

Muresan has a passion and dedication to patient care and continues to teach future surgeons. “It is an undeniable privilege and honor to use surgery to restore patients functionally,” he says.

HAIQIAO JIAO, MD Haiqiao Jiao, MD, was born in Beijing, China and immigrated to the United States in 1988 where his father pursued a PhD in chemistry and his mother was a teacher.

Growing up, education was always emphasized as well as empathy and compassion for others. It was with his strong family support

Haiqiao Jiao, MD

that he decided to devote himself to helping others in the most direct way possible and pursued a career in medicine.

Jiao received his undergraduate degree from Vanderbilt University and his medical degree from the University of Tennessee Health Science Center where he met two doctors who influenced his career in plastic surgery, Bill Hickerson, MD, and George Maish, MD. Jiao completed his residency in integrated plastic surgery at Louisiana State University in New Orleans, gaining experience in the breadth of plastic surgery. Under the tutelage of Kelly Babineaux, MD, he discovered hand surgery. “Dr. Babineaux showed me how you can restore someone’s life and livelihood,” says Jiao.

After completing his residency, Jiao joined the CMKI fellowship program. “I am honored to be a part of this world class hand center,” he says.

Jiao’s interests include hand surgery, fractures, nerve injuries and compression, tendon and soft tissue injuries, skin and nail lesions, microsurgery, and Dupuytren’s contracture.

Carrying on the Legacy “We have a group of physicians in our partnership – the more senior partners – we all had the benefit of training under Dr. Kleinert and Dr. Kutz. So that sets us apart as far as where our training came from. The younger physicians did not have that benefit, as our founders have passed. But we continue the legacy, we continue the vision to train hand surgeons and deliver hand care to patients. I think that Kleinert Kutz is one of those places – it’s a family, and we have the same mission and goal to continue and carry on the work that Kleinert Kutz started,” says Napolitano.

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Sports Medicine/Orthopedics

Treating Body and Mind: A Winning Game Plan

Jennifer Daily, MD, medical director of UofL Health – Sports Medicine, takes a holistic approach to make sure patients reach their goals, on and off the field.

BY DONNA ISON LOUISVILLE As a former coxswain on the

University of Kansas women’s rowing team, Jennifer Daily, MD, knows the physical and mental demands of being a college athlete. In her role as medical director of UofL Health – Sports Medicine, she uses this knowledge to ensure that not only elite athletes but all of her patients achieve peak performance.

According to Daily, “Sports medicine is primary care; it is keeping people active, so we see all walks of life. In our sports medi-

cine clinic, we see weekend warriors, young kids that have overuse injuries, 85-year-old patients who want to keep active and dancing and moving. So, it’s not just college athletes and high school athletes who we see, although those are a big part of it.” Many people do not realize that the field of sports medicine caters to patients all ages and encompasses counseling, non-surgical treatment, and diagnostics, including ultrasound and in-depth motion analysis utilizing the DARI system, which provides data on performance, mobility, alignment, force, and sway.

Misconceptions are understandable, as the field itself is a relatively new one. “The specialty overall is young; it’s not been around a very long time. Even our organization, the American Medical Society for Sports Medicine, is also very young, so it’s neat to see how it’s grown since when I was a fellow,” says Daily.

Daily completed her fellowship in primary care sports medicine at the University of Missouri-Kansas City (UMKC). Prior to that, the native of Reno, Nevada returned to her home state from KU to attend the University

In our sports medicine clinic, we see weekend warriors, young kids that have overuse injuries, 85-year-old patients who want to keep active. - Jennifer Daily MD

14 MD-UPDATE

PHOTOS BY ALEXANDRA ROGERS

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of Nevada School of Medicine. She followed up with a family medicine residency, also at UMKC.

An Offer She Couldn’t Refuse After her fellowship, Daily spent her early career in a private practice in Missouri, where the majority of her clinic time was spent on family medicine. She yearned to incorporate more sports medicine and work with athletes, so when the opportunity arose to join the team at UofL Health, she was extremely intrigued. After a visit to the city and encouragement from her husband, she took the position and is thrilled with that decision. Daily states, “My husband said, ‘Opportunities like this, to become a Division I team doc, just don’t come around; you have to take it.’ And, we both were like, ‘Yep, this just feels right.

We’ve got to do it.’ That was in 2014, and it was the best decision we ever made.”

Finding an opportunity to work alongside other women in the field is even rarer, but

Jennifer Daily, MD, medical director of UofL Health – Sports Medicine

when Daily joined UofL Health, the director was Jessica Stumbo, MD, also a woman. The specialness of the situation was not lost on Daily. She states, “Within our organization of sports medicine doctors, there’s only 25% who are women; we’re still the minority of sports medicine practitioners. So, I definitely

Sports Medicine/Orthopedics

recognize this [serving as medical director] is a big deal.”

Along with serving as director, Daily sees primary care patients two half-days and works in the sports medicine clinic two half-days as well. As a course director at UofL School of Medicine, she also has dedicated time to develop curriculum for Introduction to Clinical Medicine, a longitudinal course required for all first- and second-year medical students. In addition, she is program director of UofL’s fellowship program. Evenings and weekends, you can find Daily on the sidelines attending to the student athletes on the women’s soccer, women’s tennis, women’s rowing, men’s and women’s swimming and diving, and baseball teams.

Putting an Emphasis on the Mental as Well as the Physical As a team physician, Daily gets to know the athletes personally and is aware of the immense stress they can be under. With the latest NIL rulings enabling college athletes to

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ISSUE #141 15

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Sports Medicine/Orthopedics

garner financial gains from their name, image, or likeness, there is even more pressure to look and perform your best. Accelerated pressure can lead to anxiety, depression, eating disorders, sleep disruptions, and even substance abuse. This is why tending to the mental health of these students is as important as monitoring their physical well-being.

Daily explains, “A lot of our athletes identify as a person with how they perform, so if they’re performing well, then they have high self-worth and self-value. But if they aren’t meeting expectations, then self-doubt creeps in and they start viewing themselves as less and less and not worthy. These young adults can get in a pretty low space pretty quickly.”

This is where mental health guidance comes in with resiliency training, counseling to deal with past traumas, teaching positive self-talk, and providing different coping skills and emotional wellness strategies. “The mental health aspect of it cannot be understated—it is so huge and can impact not only how they perform now, but how they continue to grow and develop as they leave our universities,” Daily adds.

Daily takes a mind/body holistic approach with all of her patients by taking into consideration stress, nutrition, sleep, exercise, and then gaining as deep an understanding as she can about the person as a whole. She says, “They deserve my undivided attention and my full focus for the time I am with them.

They deserve to be heard and listened to. My goal and philosophy are to create a safe space where my patients can be vulnerable and honest, and where I can meet them where they’re at and give advice on what I think we should do. We’re on that journey together.”

In closing, it would be remiss not to mention that UofL Health was named as the official health care provider for the Louisville Cardinals. Along with sports health physicians, athletes have access to the many talented providers within the system, including cardiologists, orthopedic surgeons, neurologists, mental health professionals, and primary care doctors. Daily says, “I’m so proud to be part of this organization. We’re going to take great care of our athletes and our patients. It’s very, very exciting.”

16 MD-UPDATE

Dr. Jennifer Daily with student athlete Liz Dixon, member of the University of Louisville women’s basketball team, winners of the NCAA Elite 8 game (Women’s Wichita Regional Champions), Wichita, KS (3/28/22).

PHOTO PROVIDED BY JENNIFER DAILY, MD

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Regenerative Medicine

Redefining the Weekend Warrior’s Fight

At Wellward Regenerative Medicine, it’s a journey from joint degradation to healing.

BY TIM CORKRAN LEXINGTON Most people over 40 live with some

degree of joint pain, and the average physically active adult may consider arthritic joints an inevitable price of maintaining an active lifestyle. This may be endurable; anti-inflammatory drugs and analgesics get many of us through the next pick-up game or run. But an acute injury, such as a meniscal tear, sidelines these cherished activities. At Wellward Regenerative Medicine, Danesh Mazloomdoost, MD, and staff help patients understand the connection between the chronic arthritic state and the traumatic injury, and how to recover from the latter by attending to the former. By giving them the why of knee pain, Mazloomdoost helps patients avoid the next disrupting meniscal tear. Armed with an understanding of how to holistically heal and then maintain their joints, the Wellward patient can ensure that healing outpaces degradation and they can continue to enjoy an active lifestyle.

Mazloomdoost has two tenets that he imparts to joint pain sufferers that he believes help them refocus their efforts. Foremost, he employs a musical metaphor: “There is a concert of movement around each joint,” he explains. “Each participating tissue needs to be properly tuned to produce the most enduring piece of music.” Furthermore, arthritis occurs when that concert of movement is not happening the way it should. Such a joint is vulnerable to traumatic injury from something as simple as stepping oddly. As such, all the different components of knee usage should be addressed for enduring healing.

His second tenet is that inflammation is the mechanism of repair. Close attention to the sites of inflammation and the measured masking of it with anti-inflammatories are 18 MD-UPDATE

Dr. Danesh examining a patient’s knee prior to a regenerative procedure.

key to determining where the maladaptive motions—the out of tune instruments—have occurred. Mazloomdoost leads his patients to consider how to prepare for knee joint usage: “I want a knee user to know what they can do in the big picture to get the best longevity of that joint. Degradation is inevitable, but so is repair. The key is getting the repair to outpace the degradation,” he says.

A Common Diagnosis.

A New Prescription.

Consider the middle-aged jogger who has long relied on a morning endorphin rush and gross motor reset but might be carrying a little extra weight and feels some knee stiffness most days. Eventually a small ache on the inside of the knee is regularly felt at the end of jog. Heading into work one day, a minor slip like stepping off a curb happens, and now it is difficult to go up stairs. With a visit to the doctor, a medial meniscus tear is revealed. For Mazloomdoost, there is a causal chain here: the preexisting compromised knee was vulnerable to this low level “catastrophic event.”

After a medial meniscus tear is diagnosed through ultrasound or MRI, there are several common options with reliable outcomes.

Many people choose rest and eventual healing, but Mazloomdoost says this works only about 30% of the time. A meniscectomy has long been the preferred surgical procedure, followed by physical therapy. Over the years, however, higher rates of osteoarthritis down the line have been correlated. Mazloomdoost and Wellward Regenerative have a vision for a more successful and enduring course of healing, however.

Their approach integrates multiple variables for diagnosis and a holistic approach to reesPHOTO PROVIDED BY WELLWARD REGENERATIVE MEDICINE

tablishing joint health. Mazloomdoost says his course of treatment consistently results in good outcomes for his patients.

First Follow the Pain, Then Attend to the Lifestyle Mazloomdoost starts by following the pain.

For him it is the canary in the coal mine that will clarify the maladaptations in and around the joint. His focus is on understanding the biomechanics of joint pain. “I want to use a patient’s symptoms to understand what components might be failing and then reverse engineer that.” His diagnostic tools include a biomechanical assessment, diagnostic ultrasounds, and MRI. This is followed by an acute workup. He tactically alleviates pain with injections of local anesthetic that both numb and add volume to temporarily inflate ligaments or specific components to see where the pain originates. After this acute workup, he employs a generalized lifestyle evaluation to examine all the elements that contributed to this pain, so that there is longevity in the healing process.

For Mazloomdoost, osteo-arthritis is a preventable disease once the biomechanics have been understood. To remain active, his patients must be committed to addressing how the joint is being used, or misused. Minor joint pain must be understood as the indicator for adjusting behaviors. “Almost everyone has that small achiness. If we marginalize it, ignore it, and say, ‘I’ll just take some anti-inflammatories,’” Mazloomdoost says, “we are missing opportunities to reduce degradation.” Overuse of anti-inflammatories can obscure other indicators; these suppress the mechanism of repair.

“The better approach,” he says, “is to use the pain to figure out how we restore that normal

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function.” He has a useful analogy: “If the alignment on our car is off, we can still drive it.

The tires will start to wear unevenly as a result.

The uneven wear requires tire replacement sooner than necessary.” In similar fashion, taking care of joint alignment can spare a future joint replacement.

The Biodynamics of Meniscus Tear—and Healing It Our jogger’s medial meniscal tear may have manifested suddenly, but Wellward approaches it as a result of pre-existing instability.

Central to this is a stressed coronary ligament, whose function is to stabilize the menisci and limit rotation of the knee, which causes the other connective tissues of the knee to be misused. This puts an unnatural torsional stress on the knee due to uncoordinated movement.

The knee is primed for that tear because it has been weakened at many points.

There are several ways to begin the healing process. “To strengthen that coronary liga-

ment and alleviate strain on the meniscus, we use the connective tissues to stabilize and strengthen the area,” Mazloomdoost explains.

Focused exercising of the muscles, tendons, and ligaments that work together with some degrees of redundancy takes pressure off the coronary ligament. An additional approach could include the mortar and pestle effect that standard physical therapy provides: grinding down the tear to clean it up. There are also regenerative strategies such as injecting platelet rich plasma (PRP) or stem cell derived therapies directly into the tear that will accelerate the recovery.

Hopefully a patient leaving Wellward’s care knows how to prevent the problem thereafter and reduce the potential for arthritis.

Wellward can cure the disease and inform their patients about how to guard the health, but it is up to each patient to do it. They will know the exercises that are ideal for their body. Our jogger may need to incorporate other types of tissue strengthening exercises.

Regenerative Medicine

They will know the nutritional needs and the supplementing process, such as timing collagen and vitamin C supplements to aid with tissue repair prior to exercise. They will know their options for taping or bracing for the external stabilization that may be needed temporarily until structures are fully strengthened. They will know how to both reduce degradation and increase healing.

According to Mazloomdoost, the Wellward truisms for joint care are simple: • Joint degradation is inevitable.

• Pain tells us what to heal.

• There are multiple tools for healing.

• If healing outpaces degradation, we may avoid traumatic injury.

He concludes, “We are taking a holistic perspective to joint injury that results in preventive management of arthritis.” Patients leave Wellward with homework and a list of warning signs to watch for, and with the knowledge that can keep the pace of joint repair ahead of the pace of joint degradation.

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ISSUE #141 19

Dr. Fix It

Orthopedic surgeon Stephen P. Makk, MD, repairs the lifestyles of his patients

BY JIM KELSEY LOUISVILLE A connection on a matchmaking

app doesn’t always lead to marriage. A team with the highest payroll doesn’t always win the championship. And a hospital filled with all the latest state-of-the-art equipment and gadgets isn’t guaranteed to heal every patient.

The tools and the money and the data might all be in place, but ultimately, it still comes down to the people involved.

“It’s more the carpenters than the tools,” says Stephen Paul Makk, MD, MBA, an orthopedic surgeon at Baptist Health in Louisville.

“The tool doesn’t necessarily make you a better carpenter, but it can make you more accurate.

You still have to have the skill to use it, know when to use it, what the benefits are, and how to use it properly. I am proud to practice with the orthopedic team at Baptist Health.”

Makk finds reward in knowing that proper use of the tools at his disposal can often lead to successful patient outcomes in which a significant piece of a person’s life is improved or restored.

“With orthopedics you can fix lifestyles,” Makk says. “I like the hands-on things we can do to get people living better.”

Makk witnessed those capabilities firsthand as a high school senior at St. Xavier in 20 MD-UPDATE

Louisville. An all-around athlete, he swam, played tennis, and then tore his meniscus and ACL in his right knee playing football and had to have arthroscopic surgery, which was a new procedure at that time. Makk’s father, Laszlo, was a pathologist, and his brother, also named Laszlo, is a gastroenterologist, so Makk had a medical career in mind before his knee surgery.

But seeing how the procedure could repair his knee and restore his mobility inspired him to become an orthopedic surgeon.

That journey began at Tulane University, where he graduated with degrees in biology and economics. He went on to obtain his MBA from Northwestern University. He attended the University of Louisville School of Medicine, where he also completed his orthopedic residency. His wife, Cheryl, is an orthopedic nurse practitioner.

A New Day at Baptist Orthopedics Formerly a private practice, Makk’s practice, Louisville Bone and Joint Specialists, joined Baptist Health five years ago. It was a move that made a great deal of sense considering Makk’s practice had been located on the Baptist Health campus since it was founded.

“We had a very good working relationship with the hospital before we decided on employment to formalize that relationship,” he PHOTO BY ALEXANDRA ROGERS

says. “It just made good sense to join a large hospital system, and it’s been a nice working relationship for both organizations.” He enjoys the collaboration of the employed and private practice surgeons that are at Baptist Health.

Makk was recently involved in helping redesign Baptist Health’s orthopedic center’s operating rooms. The 12 operating rooms include 10 dedicated to orthopedic surgery, one for bariatric surgery, and one for general surgery.

Rather than the operating rooms needing to be changed over with new equipment and devices depending on the type of surgery being performed, the rooms are able to be prepared much more quickly and efficiently. The staff is largely focused on orthopedics, making their work more proficient as well.

“The team you’re working with can anticipate things, they learn the procedures well, and it makes the procedure go more quickly,” Makk says. “Sometimes when you’re in the OR you might not have all the equipment in there. You get ready to close and you don’t have the right suture or right dressing. The people who work with you every day know what you need.”

Additional efficiency built into the redesign is the positioning of the pre-op room very close to the operating room. The family can even wait in the pre-op room during the surgery.

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“It’s a premier center that’s focused largely around the orthopedic patient, which is a population that is greatly growing in needs, wants, and desires,” Makk says. “We can have two operating rooms where we can finish one operation and then start another. Total joint replacement is estimated to go up 300 to 400 percent in the next decade alone. We wanted to proactively have a premier center that was designed around the patient experience. The facility and infrastructure, not just the operating rooms, but the pre-op and post-op areas, physical therapy — are making that more and more possible.”

Makk’s surgery day is Tuesday. He does total hip and knee replacements. The center is complemented by the latest technology including computer navigation and surgical robotics.

“Like any procedure, you have to match the patient to how you do it,” says Makk.

Using the Procedure That Works For the Patient That matching process begins with determining the indication for surgery. Some patients can be treated with injection therapy, activity, or weight loss. Ultimately, Makk says, the indication for surgery is clear.

“The indication for surgery is very straightforward. It is pain that is not relieved by an adequate trial of non-operative therapies,” he says. “You want evidence-based treatments and therapies. If those fail, then your option becomes surgery. One of the big pushes over the last several years is having lower body mass indices for patients to have surgery. What we’ve found in orthopedics is that if your body mass is too high you have an exponentially increased chance of complications, including things like infection, blood clots, and other things you don’t want. We actually turn away people and tell them they have to lose some weight because the body mass is too high.”

For those who are able to move forward with surgery, they are apt to find their hospital stay to be considerably shorter than it would have been a few years ago. What was commonly a three-to-five day stay a few years ago is now often considered outpatient with the patient going home the same day or next morning after the surgery. The shorter stays

are due to less invasive surgical techniques and better methods for blocking pain and rapid recovery pathways.

“The patients have to pass several criteria after the surgery,” Makk says. “We have to make sure they can eat, drink, use the bathroom safely, get up, and if they’re not doing well in any of those departments, we’ll keep them overnight.

Probably more than 90 percent are able to go home after a night in the hospital.”

Quality Measures Are Key To help ensure that the decisions that are best for the patient are being made, Baptist Health utilizes large quality committees to follow metrics and track patient outcomes.

“Quality is actually measuring details and data and seeing if there’s a difference from what is expected,” Makk says. “A big part of it is trying to standardize what we do based on evidence and not just surgical preference. We have been able to develop best practices by measuring quality indexes and then making

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changes in how we practice medicine based on that. That’s the future of medicine.”

He continues, “Our committees are composed of employed and private practice physicians who work together to maximize patient outcomes. This is unique in our community.”

Makk makes evidence-based decisions on how best to treat his patients but makes sure the patients are equally involved in the process to determine their course for care.

“I try to evaluate each patient as well as I can and to provide the best treatment recommendations that I can based on their needs, wants, and desires,” he says. “There are no guaranteed outcomes. You can practice great medicine and not get optimal outcomes. But you want to do the best you can within your skill set for each patient.”

While placing comprehensive data and quality tools in the mind and hands of a welltrained carpenter doesn’t guarantee success, it certainly measures up as a winning strategy for physician and patient alike.

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

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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.

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ISSUE #141 21

SPECIAL SECTION

Sports Medicine

Pain, Pain Go Away

Evolving subspecialty melds primary care and sports medicine to nix chronic pain it is not unusual for patients to have a normal nerve conduction LEXINGTON The work Frank study yet experience ongoing neuTaddeo, MD, does with CHI Saint ropathic type pain.

Joseph Health – Orthopedics can Pain after knee replacebe life changing. The outcomes ments can be a tricky challenge.

Taddeo and his team achieve for Sometimes after a joint has been patients who struggle with chronsuccessfully replaced it functions ic pain and nagging injuries are well, motion is good, and hardtrue game-changers. ware and alignment are right.

Their work is part of a relativeYet the patient suffers ongoing ly new subspecialty that melds pain months and years after the elements of primary care and procedure and completion of orthopedics. Many of Taddeo’s rehab. Taddeo recognizes this as a patients have already seen numercommon – and sometimes treatous physicians in their quest for able – problem typically caused as relief from chronic pain. healing begins and scar develops “These are usually patients around the nerves. who will see good results from Nerves do not like being the advanced, minimally invasive trapped or crowded. With ultrasound technology we special- “We’ll do an ultrasound diagnostic and see what’s going on while managing to advanced ultrasound, Taddeo can avoid an MRI.” - Frank Taddeo, MD, CHI Saint Joseph – Orthopedics ize in,” says Taddeo. see entrapped areas and put a specialized fluid channel around Bridging a Gap Between Surgery repair, yet several months later the patient the nerve. A special fluid with a touch of and Conservative Therapy still suffers with shoulder pain. The surgeon, steroid settles the inflammation and releases Taddeo’s team works to prevent certain who is reluctant to operate again, refers the the nerve away from the entrapment. painful conditions from progressing. Beyond patient to Taddeo. An ultrasound shows in “The result is almost immediate with lastrelieving pain, they can often fix problems great detail exactly what’s going on, especially ing pain relief,” he said. that cause the pain and even help patients when it comes to nerve entrapments and small Taddeo does many nerve blocks and preserve their general health. tendon injuries. hydro-dissection procedures to help address Advanced ultrasound technology is the key “We may be able to see that the problem is chronic entrapment from scar tissue. Steroids to his practice’s success. While ultrasound was a tear that may have developed during rehab can provide some relief temporarily, but invented in 1957, the last 10 years have marked or that just didn’t heal well post-surgery,” says hydro-dissection injections are far more effecdramatic improvements in software and screen Taddeo. “We can treat that tear with plasma tive for pain caused by scarring or narrowing resolution. Few are trained in this new clinical- rich platelets (PRP), and the results are pretty around the nerve from surrounding structures. ly based musculoskeletal ultrasound. remarkable: decreased pain and improvement PRP is an effective treatment for chronic “We started out being able to look at livers in range of motion/function. These treat- nagging tendonopathy and early osteoarthritis. and gallbladders and even babies. Now we ments are often how high-level professional PRP accounts for about 90% of the injections can look at tendons and nerves,” Taddeo says. athletes are able to return to play shortly after that Taddeo’s team performs. Though these “Today we can precisely guide a needle and place an injury. injections are not yet covered by insurance, treatments exactly where they need to be.” they are quite cost effective as they can often Taddeo describes how a typical care scenar- Solving Puzzling Pain Problems help the patient avoid surgery. These injections io might unfold. A person with shoulder pain Pinpointing the underlying causes of can help to repair some of the micro damages gets an MRI. Next comes a successful surgical chronic pain can be challenging. For example, that often lead to chronic discomfort.

BY MENISA MARSHALL

22 MD-UPDATE

PHOTO BY GIL DUNN

SPECIAL SECTION

Sports Medicine

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Additionally, Taddeo routinely receives referrals from surgeons whose patients are unable to have MRIs. “We’ll do a diagnostic ultrasound and further evaluate the underlying structures while managing to avoid a $2,000 MRI. The cost of an ultrasound is generally about one-tenth that of an MRI, and their insurance typically pays for it” says Taddeo.

Percutaneous tenotomy is another specialized minimally invasive procedure Taddeo uses to relieve chronic pain caused by partial tears and sometimes calcific tendons. It is done using a device Taddeo describes as “essentially a needle with a pressure washer on the end of it.”

“It washes away damaged tissue while leaving the healthy tendon intact, says Taddeo.

“The benefit of this procedure is that it does not use sedation anesthesia and only requires a ~1 cm incision. Everything is guided with the ultrasound, which allows for a minimally invasive approach. Patients can go home the same day with only a small bandage.”

One Triathlete’s Amazing Story One triathlete’s story shows the power of being able to pinpoint “problematic nerves.”

This athlete was an older competitive runner in good physical condition who suffered severe pain from periodic “ankle weakness.”

After the first mile of his run, his foot would suddenly give out.

Like most triathletes, he would continue running. The issue worsened and led him to Taddeo, who performed a diagnostic ultrasound evaluation. The area of concern was identified, and at the next visit a diagnostic injection was performed.

“Basically, his common peroneal nerve,

which wraps around the head of the fibula, had become trapped by some prominent musculature that developed as a consequence of how he strikes his foot,” Taddeo explains.

“We were able to release pressure on the nerve with an injection.”

After the injection the patient was put on a treadmill. He was able to run without foot drop. Soon after this, he ran a triathlon and finished first in his age group.

Aiming for Best Possible Outcomes Taddeo hails from Fort Lauderdale, Florida, and graduated from Florida State University.

He knew early on that he was called to medicine. After medical school at the University of Medicine and Health Sciences in St. Kitts, he did a family practice residency at Piedmont Columbus Regional in Georgia, then completed a sports fellowship at the University of North Dakota, Altru Health. When Taddeo and his wife, Darcy, now a physician assistant at UK HealthCare, were driving through Kentucky on their way to North Dakota, they were taken with the lush green landscape and rolling hills of central Kentucky. When the position for a primary care-sports medicine physician became available at CHI Saint Joseph Medical Group, he was eager to make the move to the Bluegrass.

Growing up, he played basketball and football, and ran track in high school. He credits that experience to understanding the mind of the athlete, which he feels led him to sports medicine. “The main thing about working with athletes is they want to get better and will do what that takes,” he says.

After dislocating his shoulder three times,

Taddeo can identify with those who suffer lingering pain after an injury. He acknowledges there are valid reasons for opioid-based pain management, yet cautions against assuming other effective treatments are not available.

“We want people who feel they’ve run out of options to know a new treatment modality is available that could potentially help them,” he says. “Whether it’s a partial tendon tear, early arthritis, or scarring around a nerve, we now have the ability to see that and create a personalized treatment regimen right here in our office.”

Taddeo focuses on each patient as a unique person. He reviews case histories and develops a broad range of potential diagnoses for new patients. He uses a phone anatomy simulation app to show patients what’s causing their pain.

“I use this app daily with patients,” Taddeo says. “I can point to the animated anatomy feature and say, ‘This is the reason you’re hurting and here’s how we move forward.’”

This approach sets an expectation for good results. It also reflects his team’s care philosophy.

“We aim for the best possible outcomes,” says Taddeo.

ORTHOPEDICS Lexington 211 Fountain Court, Suite 320

859.264.9820 Mount Sterling 624 N. Maysville Road, Suite 4

859.497.4144 ISSUE #141 23

Complementary Care

Batter Up! Play Ball!

Weekend warriors and professional athletes get the same treatment at Back Talk Chiropractic LEXINGTON Tamera Tolson, DC, DACBSP®,

Dr. Tolson works with Lexington Legends pitcher Jeff Johnson as part of regular stretching and spine/ hip alignment protocol.

Johnson played college ball at California Polytechnic and was drafted by the Cleveland Guardians organization.

proprietor of Back Talk Chiropractic, holds a certification from Diplomate American Chiropractic Board of Sports Medicine, the highest level of certification in chiropractic medicine.

Back Talk Chiropractic is a full-service chiropractic practice serving Central Kentucky.

Tolson also serves as the official chiropractor for the Lexington Legends and Wild Health Genomes professional baseball teams. Tolson, a former Montgomery County High School athlete, was drawn to chiropractic medicine because of injuries she suffered playing basketball.

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.

The Back Talk Chiropractic patient population 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 work with athletes, Tolson has an interest in extremity work such as shoulders, hips, feet, ankles, rotator cuffs, and plantar fasciitis.

Her common treatment plans are adjustments, stretching, e-stim (electrical stimulation) for constricted muscle groups, decompression, strength training, and dry needling for soft tissue trigger point release.

Back Talk Chiropractic recently moved to its expanded location on Liberty Road in Lexington to handle its increased patient volume.

A current theme is that sports medicine is also family medicine and preventative medicine. Do you agree?

Sports medicine does entail aspects of family medicine and preventative medicine where providers can suggest over the counter medication, provide wound care, give dietary 24 MD-UPDATE

PHOTO BY GIL DUNN

Complementary Care

advice, prescribe exercises/rehab, and provide emergency procedures. In general, sports medicine is not classified under family medicine. Family medicine encompasses the basic needs for treating heart disease, diabetes, infections, etc. Dependent upon the complexity of the condition, the patient will then be referred out to the appropriate source. I would agree that sports medicine is encompassed in preventative medicine. Functional movement assessments are a tool used to help identify dysfunctional movement patterns that can cause an athlete to become injured.

A rehabilitative program can then be created to strengthen the area or areas of deficit to prevent injury. Sport medicine providers can also suggest appropriate dietary concerns to individual athletes based upon their needs and goals. This also helps reduce risk of injury and reduce the risk of creating any nutritional deficits that could harm the athlete.

Do you see this in your practice?

I do. Family medicine provides for the basic needs for patients, and when more advanced conditions are apparent, a referral is made.

Family medicine is more of an entry point of care for patients. While working with sports medicine providers, they do focus on prevention when it is appropriate to the case and treatment.

oes regular chiropractic D treatment aid in prevention of sports or work injuries?

Chiropractic has many different benefits.

One of those benefits involves prevention of injuries, especially in the sports setting. In order to receive such benefit, chiropractic must be started in the off-season along with rehabilitative measures such as strength and conditioning. It is important for an athlete to come to the office to be checked structurally and functionally. Functionality can be checked through range of motion, balance, coordination, and functional movement patterns. Based upon those results, a plan can be created to help the deficits an athlete possesses, and they can be trained to reduce or eliminate those deficits, thus reducing injury pre-season and in-season.

When Your Back is Talking to You... TALK BACK!

CHIROPRACTIC SPORTS MEDICINE FOCUSED Highest credentialing in the sports medicine realm for chiropractors

WEBSTER CERTIFIED Chiropractic specific technique designed for the pregnant patient

DRY NEEDLING CERTIFIED Soft tissue therapy utilization to break up scar tissue and adhesions for a variety of conditions

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

OFFICIAL CHIROPRACTIC PROVIDER FOR LEXINGTON LEGENDS AND WILD HEALTH GENOMES

T alk about being the official chiropractic provider of the Legends and Genomes.

It has been an exciting year for Back Talk Chiropractic starting when we were announced as the official chiropractic provider for the Lexington Legends and Wild Health Genomes. What this entails is the athletes are exposed to and offered chiropractic services twice a week at the field of play. All the athletes have access to our expertise and treatment dependent upon their goal. This is the first time in the league’s history that they have a chiropractor available for the signed athletes.

hat does this mean to Back W Talk and to you personally?

All of us at Back Talk Chiropractic are extremely honored to have such an amazing opportunity to work with these athletes. The medical staff have been welcoming, and we work together as a team to provide the best care for the elite athletes. It is a dream in the

making, and this is just the beginning. We’re all looking forward to what the future may hold.

ow does working with H professional athletes differ from working with the rest of us?

For the most part, working with professional athletes is not all that different from working with the weekend warrior. Treatment options and protocols are very much the same. The big difference is the goal and time. When a professional athlete is injured, you have to provide the most effective treatment available to get the athlete back on the field. Time and performance are money. Professional athletes are paid to perform and to get results. You cannot tell a professional athlete to go easy or take time off. Quick recovery is essential. Goals are also important to professional athletes.

They already have a good idea of what they need because they have been through it already.

They are typically more eager to meeting goals because their career depends on it.

ISSUE #141 25

Mental Wellness

Do This to Save Your Marriage – Part 2: Learn to Complain Well

BY JAN ANDERSON, PSYD, LPCC

When was the last time you had a disagreement, an argument, or a big fight with your spouse or partner? Was it the same ongoing disagreement you’ve had over and over?

Marriage researcher John Gottman found that in the first three minutes of a disagreement, you can tell how it will end, no matter how long the argument goes on.

It’s based on a simple observation: When a conversation starts on a negative note, there’s a 96% chance it will end on a negative note, according to Gottman.

What do I mean by a negative note? You start the conversation by saying something critical, sarcastic, or insulting.

Duh, this isn’t hard to understand. And it’s not a new research finding.

So why do we keep doing it? What makes otherwise intelligent, accomplished partners routinely begin their interactions with what Gottman calls the harsh startup — inevitably followed by an unhappy ending?

Based on what I witness in my work every day with couples, as well as my “personal” research with arguments, here are some things I’ve noticed: 1. You don’t realize you’re doing anything wrong.

What if you grew up in a household like mine, where sarcasm was the norm?

I was in my early thirties with a BS in psychology well behind me before I realized there was anything wrong with communication laced with sarcasm. I just thought it was being funny.

2. You feel justified.

I doubt most of us start by intentionally saying something insulting to our partner. But the more frustrated we get when we’re not heard, and the more the problematic behavior continues, the more “direct” we tend to get. I tried being nice about this, and it’s not working. What does it take to get through to you?

26 MD-UPDATE

Our righteous indignation kicks in, and we suddenly have license to say just about anything.

3. You don’t know the difference between a complaint and a criticism.

This is where things get tricky. Because there’s a very thin line between a complaint and a criticism. Knowing the difference makes a big difference in how the first three minutes of the interaction go.

I realized this big time when I routinely started giving my clients a Gottman quiz entitled Complaint, Criticism, or Contempt: Do you know the difference?

I shouldn’t have been so stunned to see how many successful, savvy people score low on this seemingly simple quiz.

Nowadays, I’m stunned by how complaining well quickly clears the air about dumb stuff we argue about.

Knowing how to complain well is one of the best things you can do for your marriage.

Here’s why: Silent judgment corrodes your connection with your partner.

“A relationship can actually be strengthened because embedded in the complaint is the message that the complaining partner wants the relationship to get back on course so it can continue,” according to Gottman.

Even if you buy into what Dr. Gottman and I are saying, there’s still a problem. Our brains aren’t wired to value long-term gains as much as short-term gains — how something feels now, in the moment.

When we bring up something that may rock our relationship boat, it feels risky, and that doesn’t feel good to our physiology. No wonder most of us would do about anything to avoid those rocky conversations.

So how do you convince your pleasure-seeking brain to do this counterintuitive, uncomfortable thing?

Fortunately, our survival-minded, pleasure-seeking brains are also hard-wired for connection with others. Close, intimate relationships with others. Like the one you want to have with your partner.

There’s a catch to this need for connection, and it’s one of the most annoying parts of our human condition: If you want closeness, some conflict comes with the package. That’s the deal.

The good news is that you don’t have to like this reality to get good at dealing with it.

And there are some slick, simple ways to get skillful at complaining well.

The difference between complaining well and criticizing is tricky.

That’s because it’s a very short hop from a complaint to a criticism. Some of your complaints may go unheeded because you unknowingly express them as criticism.

In other words, part of the problem may be

that the way you complain sucks. Let’s face it — criticism comes pretty easily to many of us.

Learning to complain well will require some tweaking on your part.

Play around with this now and see for yourself. Which one of these statements feels better to you? A or B? A) You never say I love you anymore. B) You used to say I love you. I miss that.

A) You never initiate sex with me anymore.

B) You used to initiate sex with me. I miss that.

See what I mean?

The beauty of complaining well is that it focuses on specific behaviors.

Criticism tends to be personal. It’s usually a statement about your character or personality, not a complimentary one. You’re the type of person who always finds fault.

Complaining well is not a personal attack.

That’s why your partner is less likely to get defensive and more likely to hear you. It will help if you give me credit when I get it right.

To complain well, start with the first words out of your mouth.

1. There’s something about leading with the word “you” that tends to put people on the defensive.

If you want to stir the pot, start a complaint with you and link it with words like never, always, should, or why. Then envision yourself throwing gasoline on a fire. You’re always so negative. Why do you always jump to conclusions? You never consider my feelings.

Can you see how these criticisms feel personal, like there’s something wrong with you, with who you are as a person?

You should stop being so insecure. You always put yourself first.

It’s not that you have to eliminate the word you entirely from your complaints.

Just don’t make you the first word out of your mouth, especially when you’re upset. Not only will your partner be less reactive, but it can also help you calm yourself down.

So what do you say instead?

2. There’s something about leading with the word “I feel” that feels vulnerable.

You may have been told to lead with I feel ___ when you ___. If you’re comfortable with that, go for it. I’m upset that you didn’t talk to me about this first. I feel hurt when you don’t make time for me.

But I’ve noticed something. Leading with I may make you feel a bit too vulnerable. Especially when there’s strong feeling attached to it.

Leading with I may be received just fine by your partner. The problem is that you may feel too vulnerable to say it that way. I’m afraid you don’t love me anymore.

I’m worried about how much money you’re spending. I’m really angry that you started smoking again.

Here are some alternatives when leading with I feel is way too uncomfortable for you:

• Focus on the task or the behavior, not how you feel about it. We haven’t spent much time together lately. It’s been a long time since you told me you love me.

• Replace feeling words with thinking words. I thought we agreed to pay off our credit card balance every month. I didn’t know you started smoking again.

• Lead with It instead of I. It really upsets me when you don’t pick up after yourself. It really bothers me to see you smoking again.

• Lead with When ___ happens, I feel ___. When you say things like that, I feel really hurt. When I see our credit card bill, I worry about how we’re going to pay for all this stuff.

But don’t take my word for it — experiment with complaining well and see for yourself what happens. See if your next “discussion” ends better!

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• Credentialing • 24/7 Medical Call Center • Legislative advocacy in partnership with the Kentucky Medical Association • Events and programing throughout the year ISSUE #141 27

News

Jeff Murphy, Vice President for Marketing and Communications LEXINGTON CHI Saint Joseph Health announced the passing of Jeff Murphy, vice

president for marketing and communications for the Lexington-based health care system and southeast division vice president for CommonSpirit Health. Murphy died unexpectedly on August 13, 2022 in Lexington.

“Jeff greeted everyone with a smile, and his human kindness touched the lives of so many people across our ministry and community,” said Anthony A. Houston, EdD, FACHE, CEO, CHI Saint Joseph Health. “He mentored many marketing and communications professionals over his three decades of service. Our hearts are broken. He will be greatly missed.”

Murphy joined Saint Joseph in 1991 after graduating from the University of Kentucky. He served as director of marketing and communications for Saint Joseph Health Care in 1998; was promoted to regional director of marketing and communications for the former Saint Joseph Health System in 2008; and was system director and vice president for marketing and communications during the transition to and from KentuckyOne Health.

He played a key role as the ministry evolved and grew from the Lexington-based Saint Joseph Hospital and Saint Joseph East, as Saint Joseph London, Saint Joseph Mount Sterling, Saint Joseph Berea and Flaget Memorial Hospital joined the Saint Joseph Health System, and Saint Joseph Jessamine was built in Nicholasville.

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Roberto Cardarelli, DO, MHA, MPH, FAAFP, Named Chief Medical Officer for Saint Joseph Hospital and Saint Joseph East LEXINGTON Roberto Cardarelli, DO, MHA,

MPH, FAAFP, has been named chief medical officer (CMO) for Saint Joseph Hospital and Saint Joseph East. Cardarelli comes to CHI Saint Joseph Health from UK HealthCare, where he served as chief medical officer for Ambulatory Services and as professor and chair for the Department of Family & Community Medicine for the UK College of Medicine.

“We are pleased to welcome Dr. Cardarelli to CHI Saint Joseph Health,” said Dan Goulson, MD, senior VP/CMO for CHI Saint Joseph Health. “Dr. Cardarelli has held a range of leadership positions throughout his career and brings a wide breadth of experience in clinical care and health administration to this role. We are excited about what he has to offer Saint Joseph Hospital and Saint Joseph East.”

“Most of my career has been splitting my time among research, education, and patient care,” Cardarelli said. “I am excited to give 100

Brett Akers, DO, Joins CHI Saint Joseph Medical Group in London LONDON Brett Akers, DO, has joined CHI Saint Joseph Medical Group – Urology in London. With a passion for urology and a love for his home state, Akers is looking forward to sharAkers ing his extensive experience with patients in southeastern Kentucky.

“My father was a family physician, so I was always around medicine,” said Akers. “Ever since then, I knew I wanted to be a physician.

When I was in medical school, I decided I wanted to do something in surgery.”

Akers, who is originally from McDowell, Kentucky, obtained his undergraduate degree at Alice Lloyd College in Pippa Passes, Kentucky, and his medical degree from Des Moines

Roberto Cardarelli, DO, MHA, MPH, FAAFP

percent of my focus on high quality patient care and joining the great teams at Saint Joseph Hospital and Saint Joseph East, working with everyone toward the common mission of being

University College of Osteopathic Medicine & Surgery in Iowa. He completed a urological surgery residency through Michigan State University Garden City Hospital Campus in Garden City, Michigan, before beginning his medical career in Pikeville in 2001.

Akers is board certified by the American Osteopathic Board of Surgery in urological surgery.

Akers said his mission in returning to Eastern Kentucky is to address any issues that play a large role in urological health and notes that he sees patients at every stage in life. “Urology is a birth to the grave type of specialty. People throughout the whole spectrum need urologists for all sorts of reasons,” he said. “Eastern Kentucky is the middle of the ‘stone belt.’ There are a lot of issues with kidney stones in the area.”

“Our family is in Kentucky, and we like being in Kentucky,” said Akers. “If you’re from Eastern Kentucky, you have that connection. People there need help. The Good Lord puts you where He wants you.”

PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH

the provider of choice in the region.”

Cardarelli received his Doctor of Osteopathy and Master of Public Health degrees from University of North Texas Health Science Center at Fort Worth and his MHA from the University of Cincinnati. He completed a residency in family medicine and a fellowship in faculty development at Baylor College of Medicine, Houston. He was the founder of the North Texas Primary Care Practice-based research Network (NorTex) and immediate past director of the Kentucky Ambulatory Practice-based Research Network (KAN) that focused on helping primary care clinics in implementing QI models to improve care delivery.

Originally from San Francisco, Cardarelli has been in Lexington since 2013. His wife, Kathryn Cardarelli, PhD, is senior associate provost for administration and academic affairs at UK.

Robert Harris Joins Team at CHI Saint Joseph Medical Group – Orthopedics MOUNT STERLING Robert

Harris, PA-C, CNMT, has joined CHI Saint Joseph Medical Group – Orthopedics as an orthopedic physician assistant. Originally from Marion County, Harris Harris developed an interest in health care when his mother was diagnosed with diabetes. He says the experience of being young and feeling helpless in this situation drove him toward the medical field. After a longstanding history with sports and being in and out of orthopedic practices due to injury, he decided to pursue orthopedics.

“I played basketball and had a scholarship to play at Transylvania University but chronic knee problems ended basketball early for me,” said ISSUE #141 29

News

Harris. “So, I’ve been in and out of orthopedic practices, which piqued my interest — seeing how the physicians manage care and get you back to what you want to do. With orthopedics, you actually get to fix the issue and get patients back to the activities they enjoy without pain.”

Harris earned his bachelor’s degree in health science from Northern Kentucky University and his master’s degree in physician assistant studies at UK.

Brandi Botkin Joins CHI Saint Joseph Health – Cancer Care Center in Lexington LEXINGTON Brandi Botkin, APRN, FNPC, has joined CHI Saint Joseph Health – Cancer Care Center in Lexington in radiation oncology. Botkin found a passion for this posiBotkin tion after supporting her grandmother during her own cancer journey – as a three-time breast cancer survivor, Botkin’s grandmother also battled skin cancer and eventually succumbed to rectal cancer.

“Throughout my life, I watched my grandmother struggle with different types of cancer,” said Botkin. I felt I could help patients benefit because I have firsthand experience watching someone battle the disease.”

Botkin earned her associate degree in nursing from Jefferson Community and Technical College in Louisville in 2004; she earned her BS in nursing from Indiana Wesleyan University. After serving as a nurse for nearly 18 years, Botkin returned to school to pursue her nurse practitioner degree.

In 2018, Botkin earned her Master of Science in nursing and became certified as a family nurse practitioner from Indiana Wesleyan University. Throughout her 18-year career, Botkin has experience serving at facilities across Kentucky, including a stint at Saint Joseph Hospital from 2006 to 2018.

Botkin is board certified as a family nurse practitioner by the American Association of Nurse Practitioners and certified in basic life support by the American Heart Association.

30 MD-UPDATE

Danielle McPeak Joins CHI Saint Joseph Medical Group in Lexington LEXINGTON Danielle McPeak, DNP, APRN, has joined CHI Saint Joseph Medical Group – Behavioral Health in Lexington.

Originally from Michigan, McPeak McPeak earned her psychiatric mental health nurse practitioner degree in Kentucky and is looking forward to making the Commonwealth her home.

“My start in family practice began at two community mental health organizations,” said McPeak. “Since then, it’s taken me to various cities and practice settings. I’m very much looking forward to serving this community.

The patients are so appreciative and kind – there is a sense of genuineness here that I haven’t experienced elsewhere.”

McPeak most recently worked at the Cleveland Clinic with the multi-center ELEKT-D study and treatment resistant depression clinic. She earned three bachelor’s degrees from Wayne State University in Detroit, Michigan, in nursing, psychology, and biology. McPeak received her post-graduate training at UK, where she completed a doctorate in nursing practice in the family nurse practitioner track.

Additionally, McPeak received a post graduate certificate and completed her psychiatric mental health nurse practitioner studies at UK. She first practiced in various family nurse positions across Michigan and Kentucky before pivoting to psychiatric mental health care once completing her full post-graduate training.

“When I worked in primary care, there wasn’t enough time to analyze and accurately diagnose patients who needed care for their mental health,” said McPeak. “A patient may come in experiencing severe anxiety symptoms and receive a general anxiety disorder diagnosis when they’re actually suffering from an obsessive-compulsive disorder. While these two disorders may present similarly, they’re treated very differently.

Addressing mental health needs also helps to PHOTOS PROVIDED BY CHI SAINT JOSEPH HEALTH

improve other chronic health conditions. There are many different drivers of patient instability, and I work with patients to determine the root of their disorder.”

Jessica McMaine Joins CHI Saint Joseph Medical Group in Winchester WINCHESTER Jessica McMaine, APRN, has joined CHI Saint Joseph Medical Group – Primary Care in Winchester. Originally from Richmond, McMaine earned her McMaine associate and bachelor›s degrees at EKU and graduated with her MSN in May. As a certified diabetes educator, McMaine is looking forward to continuing specialized patient care and says she was inspired to work in health care after her own personal diabetes battle.

“I was diagnosed with Type 1 diabetes at age 11, and I knew at that point that when I grew up, I wanted to be a nurse,” said McMaine. “I knew I could positively impact patients’ lives throughout their continuum of care.”

McMaine will focus on primary care in Winchester. McMaine completed her final clinical rotation for her master’s degree with CHI Saint Joseph Medical Group and will reunite with some of her patients in this new role.

McMaine has practiced as a medical/surgical nurse at Saint Joseph Hospital and the University of Kentucky HealthCare in Lexington. Since 2019, McMaine worked at Baptist Health Richmond as a medical/surgical/telemetry nurse.

“My nursing philosophy is to treat patients holistically and look at them as a whole and individual person, and I also really enjoy preventive medicine,” said McMaine. “It never hurts to bring some compassion, too; that’s one of the biggest things I hope to bring to my new role.

I believe God called me to the field of nursing to provide love and compassion to all patients.”

In addition to primary care, preventive care, and diabetes education, McMaine is also interested in mental health care.

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New Leadership at Harrison Memorial Hospital

Kathy Tussey CYNTHIANA Kathy Tussey has been named

the new chief operating officer at Harrison Memorial Hospital.

As the COO, Tussey will join the HMH Senior Leadership team. She will oversee

the day-to-day planning and implementation of strategic initiatives for facilities, laboratory, radiology, rehabilitation services, and respiratory therapy.

“I am extremely pleased to have Kathy join the HMH Senior Management Team.

Her vast experience and knowledge will be invaluable to HMH, as we move through this transformational period in healthcare,” said Stephen Toadvine, MD, HMH chief executive officer.

Tussey is a native of Nicholasville, Kentucky. She received her Bachelors of Nursing degree from Midway College, Midway, Kentucky, and MNA from EKU. In May of 2023, she will complete her DNP. Tussey has more than 25 years of experience in healthcare. She began at Baptist Health in Lexington as a staff and charge

PHOTO PROVIDED BY HMH

nurse in the emergency department. In 2008, she became the director of the emergency department and interventional radiology, managing a department with 100 employees, including strategic planning, budgeting, and collaborating with other programs, overseeing polices and improvement projects.

Prior to joining HMH, Tussey served as the executive director of neuroscience and ambulance services at Baptist Health. In this role, she developed programming for the department and grew the service line in volumes and revenue.

“Being from a small town, I know how important quality healthcare is to a community. I am excited for the opportunity to be a part of Harrison Memorial Hospital to continue to provide these types of services close to home,” says Tussey.

ISSUE #141 31

Events

Republic Bank and Trust attendees were Dwayn and Emily Chambers, Todd and Karen Ziegler, and Lawrence Wetherby.

Vince Prusick, MD, pediatric orthopedic surgeon at Shriners Children’s Medical Center, with wife, Kate, and Leslie and Henry Iwinski, MD, chief of staff, Shriners Children’s Medical Center.

Shriners Children’s Lexington’s Care for Children Gala LEXINGTON Shriners Children’s Lexington’s annual

Bill Meck of WLEX was master of ceremonies.

Kevin Bazner, corporate council chair, Shriners Children’s Lexington Medical Center.

Jeff Koonce and wife, Diane, with Karen Harbin and daughter, Madison.

Gala committee members included Megan Lincavage, Karen Harbin, Ravin Marrs, and Abby Vaughn.

32 MD-UPDATE

Care for Children Gala, presented by Commonwealth Credit Union, was held Saturday, August 27, at the Central Bank Center. This year was the event’s second most successful year in terms of dollars and the largest attendance in terms of table sponsorships sold. Over 280 registered guests enjoyed the evening and heard from Shriners patients Grayson, 18, and Arlo, 4.

Shriners Children’s Lexington director of philanthropy Wesley Scott said, “Our local corporate council is a group of nearly 50 businesses that support patient care locally. While Shriners Children’s is an international organization, the Lexington corporate council works to fund our local facility. All funds raised locally stay local and support patients from Indiana, Ohio, West Virginia, Tennessee, and Kentucky. With the addition of this year’s funds, our corporate council has raised nearly $1.5M towards patient care since 2014, and the gala is one important source of those much-needed funds. The Lexington facility is funded 70% from philanthropic sources, so our budget relies on the generosity of our corporate and individual donors.”

MD-Update is a member of the Shriners Children’s Lexington corporate council.

Shriners Children Medical Center’s Shelby Watkins, Marla Harris, physician liaison, and Wesley Scott, director of philanthropy.

PHOTOS BY JOE OMIELAN

Jill Delair and Marc Cobane, Alpha Financial Partners and member of corporate council.

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

Susan and Vish Talwalker, MD, pediatric orthopedic surgeon at Shriners Children’s Medical Center.

LFUCG councilman James Brown and wife, Charmayne, with Wanda Gonsalves, MD, UK and KY State University.

“WITH NEW KNEES, I HAVE A NEW LEASE ON LIFE. I’M NOT LIMITED ANYMORE.” — Jon Thuerbach, Orthopedics Care Success Story

Jon Thuerbach has accepted that growing older is inevitable. But he doesn’t want his age to limit him from living life. After osteoarthritis pain caused him to give up sports, his family urged him to see a doctor. “It finally took its toll,” he said. “I was making groaning sounds every time I sat down.” Since having knee replacement surgery at Baptist Health Louisville, Thuerbach feels limitless. “It’s hard for me now to imagine that much pain 24 hours a day, seven days a week. Subconsciously, I would limit myself when I was in that pain.” he said. Instead, he’s back on the golf course and ready to travel the world with his wife, Kathy. Learn more about our advanced Orthopedics Care at BaptistHealth.com/Ortho.

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