MD-Update Issue 142

Welcome to the Cancer Care issue of MD-Update

Screenings for early detection. New “smart” drugs developed from clinical trials. Advanced new technology for radiation treatment and surgery. A team of pathologists, cytologists, and lab techs working 24/7 to examine and diagnose biopsies for quicker response times. These are some of the ways that Kentuckiana doctors are providing cancer care. We have those stories and more for you in this issue of MD-Update

P&C Labs Cover Story

I’ve known Rick Lozano, MD, president of P&C Labs for 14 years. I remember meeting him at a holiday party at the UK Club at Spindletop Hall when we had just started MD-Update. I knew very little about pathology back then, but I recognized that Rick was someone to follow and stay in touch with, which we did throughout the years. I would occasionally see him at the YMCA and we’d chat about work, kids, and youth baseball.

He called me in August of this year to tell me that P&C Labs had just signed an agreement with Appalachian Regional Health to provide pathology services for the 13 Kentucky hospitals. “Would this be a story for MD-Update?” he asked. “Absolutely,” I replied, and that’s how we started this issue’s cover story. I learned a lot more about pathology in the next six weeks. I hope our readers will enjoy and benefit from the story of P&C Labs, how they’ve grown, what they do, and their commitment to serving Kentuckiana patients and doctors.

Lexington Medical Society Past Presidents

After a two-year hiatus, the Lexington Medical Society was able to meet again in person, just in time for the annual Past-Presidents Dinner. We were there and brought you some photos. My thanks to LMS executive VP/CEO Chris Hickey and Cindy Madison for the invitation. We’ll be there again in November to witness Dr. Steven Stack, commissioner of the Kentucky Department for Public Health, receive the Jack Trevey Community Service Award, an award most deserved for the commissioner.

2023 MD-Update Editorial Calendar

Included in this issue on the preceding page is the 2023 MD-Update editorial calendar. I invite you to look for your specialty and contact me. I’m sure you have a good story to tell.

Until December,

gdunn@md-update.com, or 859.309.0720 phone and fax

MD-UPDATE

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CONTRIBUTORS:

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Elizabeth

Scott

Emily

Adam

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Senate Bill 30 Goes Into Effect; Expands Organ Donor Registry and Education

SB 30 creates new ways to register to become an organ donor

LOUISVILLE, KY Senate Bill 30 goes into effect today, allowing the Kentucky Transportation Cabinet to add organ donation questions to the screen when individuals renew their car tags online. This will impact more than 30,000 people per month on average.

“On any given day, more than 100,000 Americans are waiting for a lifesaving organ transplant, and every 10 minutes, someone is added to the list. Sadly, 20 people die waiting every day. We had to find ways to grow the registry and help save lives, and this bill does that,” said Shelley Snyder, executive director, Donate Life KY.

Nearly 1,000 Kentuckians are currently waiting for a lifesaving organ transplant. With the state transitioning to an 8-year driver’s license cycle and many people registering to become organ donors during renewal, Senate Bill 30 will help by expanding the registry to help those requiring urgent transplant ser vices. Senate Bill 30 was filed by Sen. Brandon Storm on January 4, 2022.  It was passed unanimously by both the House and Senate and signed into law by Governor Beshear on March 10, 2022.

“This law going into effect means we have another tool to potentially double the number of people asked to join the donor registry and support this mission each year. One organ donor can save up to eight lives, and one tissue donor can heal more than 75 lives, so the impact cannot be overstated,” said Snyder.

Moving forward, during car tag renewal, individuals will be prompted to donate to the Kentucky Organ Donor Program. Next to that donation request is a picture of a pediatric heart recipient named Brynn from Georgetown. She is alive today because of the gift of life. Click here for Brynn’s story and more stories that touch on organ dona tion’s vital importance and impact. For more information about organ, tissue, and cornea donation or to register as a donor, please visit donatelifeky.org.

The mission of Trust For Life (TFL) is to educate and encourage Kentuckians to register as organ and tissue donors while obtaining a driver’s license and beyond. Trust For Life partners with Kentucky Organ Donor Affiliates in education and outreach and use the combined national Donate Life brand; learn more at www.donatelifeky.org

Workplace Factors Can Influence Employee Health

UofL research links workplace culture to chronic disease risk in employees

LOUISVILLE With employee burnout high and the Great Resignation being felt through out all employment sectors, pioneering new research from the University of Louisville demonstrates biological links between work place culture and human health.

The UofL study is believed to be the first to connect biomarkers for chronic disease risk to factors such as stress, employee capacity for work assigned, workplace physical and social environments, and whether work is regarded as meaningful to the person per forming it. The findings are published in the International Journal of Environmental Research and Public Health.

The study was conducted by Brad Shuck, EdD, professor of human resources and organizational development, UofL; Kandi Walker, PhD, professor, Department of Communication, UofL, and faculty affiliate, Christina Lee Brown Envirome Institute; Joy Hart, PhD, professor, Department of Communication, UofL, and faculty affiliate, Christina Lee Brown Envirome Institute; and Rachel Keith, PhD, APRN, associate profes sor of medicine, UofL.

These factors are part of a new “Work Determinants of Health” concept the UofL researchers have identified that they hope will become a model for both employers and employees to better understand the health impacts of workplace culture.

“For a long time, we’ve assumed that work place culture can impact our health,” said Brad Shuck, an author on the study and organiza tional culture researcher in UofL’s College of Education and Human Development. “This study shows, in biological terms, that assump tion is true and improving our understanding of these links could help both employees and employers make better, more informed deci sions that keep everyone healthy and happy in their work environments.”

In the study, conduct ed May to November in 2019, researchers asked participants to complete questionnaires on their well-being and work determinants of health factors, such as how engaged and positive or negative they felt about their work environment.

Local participants in a cardiovascular risk cohort were recruited electronically to com plete an electronic sur vey as part of a sub-study after completing and in-person visits where urine was collected for catecholamine measures.

The researchers then compared the survey results with biological samples that measure hormones signaling sympathetic nervous sys tem activity. When higher than normal over a long period, these hormones indicate chronic stress and increased risk of cardiovascular disease and other chronic health conditions.

The results showed participants who reported greater well-being, engagement, and positive feelings toward their work environ ment had lower levels of these stress-associ ated hormones, while the opposite was true for participants reporting poor well-being, isolation, and negative feelings toward work.

“Stress is fine in smaller, short-term doses, and may even help us to finish an important project or solve a big crisis,” Keith says. “But if our work culture puts us under constant stress, this study suggests it can affect our health and our risk for chronic conditions over time.”

Stress and related burnout remain a lead ing cause of employee resignation, especially among younger workers. In a recent survey

by Deloitte, about 46 percent of Gen Z and 45 percent of millennial workers reported feeling burned out by their work environ ments. Stress can negatively impact employee health – as the UofL study suggests – but it also can impact worker retention, as indi cated by a fair number of both Gen Z and millennials reporting that they hoped to leave their jobs within two years. Shuck said better understanding of work determinants of health could help reduce burnout and improve both employee retention and health.

The work determinants of health concept and model, along with Shuck’s previous work to measure employee engagement, are protect ed through the UofL Office of Research and Innovation and are licensed or optioned to OrgVitals, an organizational metrics company he co-founded.

“Understanding these cultural factors and what contributes to an employee’s health and engagement in their work environment is good for everyone,” he said. “By understand ing the work determinants of health, we can create better and healthier work environments that attract and retain great talent who want to be engaged.”

(l-r) Uofl researchers Joy Hart, Kandi Walker, Brad shuck, and Rachel Keith form a team that has demonstrated the link between work determinants of health and biomarkers for chronic disease risk.

What Are the Most Valuable Revenue Cycle Metrics to Measure?

BY ADAM SHEWMAKER, FHFMA, HEALTHCARE CONSULTING DIRECTOR

As the bridge between the clinical and busi ness side of healthcare, the RCM process is awash with metrics that can help administra tors get the most out of their cycles, including increased revenue stream, improved reputation, and enhanced “start to finish” quality of care.

Insurance denials are a revenue stream killer. Not only do they impact the current bottom line, they can lead to patient frustration that could affect future revenue as well.

Practices that monitor their RCM metrics ensure more effectiveness in planning for future expenses, including potential opportunities to embrace new technologies like telehealth and expanded services. They also put themselves in a position to identify possible weaknesses in their current process to correct — especially when navigating changing regulations in care, payer schedules, and even new COVID protocols.

Revenue Cycle Metrics to Monitor

Like with any business in the private sector, there are massive amounts of data to crunch to help track viability and long-term financial — and other — goals for healthcare organizations. Tracking key performance indicators (KPIs) can assist data-driven decision making and make it possible to benchmark the performance of the revenue cycle to measure success.

While the Healthcare Financial Management Association identifies as many as 29 possible standard metrics, here are a few key metrics to consider measuring consistently to determine how efficiently your RCM is operating.

RATE OF FIRST PASS PAYMENT

Also known as clean claims ratio (CCR), this is the rate billing claims are confirmed and paid without denials on the “first pass.”

Claims that need to be submitted a second or even third time are an inefficient waste of resources. Experts suggest that organizations should be aiming to experience 80% CCR

in order to ensure healthy billing practices.

By monitoring this KPI, healthcare pro viders can determine the quality of data being collected in the process as well as the amount of time it takes to resolve issues. This can help drive down the cost required to generate payments, adding up to millions or even billions in savings a year.

DAYS IN ACCOUNTS RECEIVABLE

One of the most important metrics for any practice to measure. The number of days in account receivable (A/R) represents the average length of time it takes for a claim to be paid. Potential cash flow issues or missed opportunities to invest and earn interest are just a couple results of practices waiting too long for payment. And accord ing to the Medical Group Management Association’s most recent poll, 49% of medical practice leaders say their time in A/R increased in 2021.

The ideal time for a claim in A/R is between 30-40 days with a goal of keeping it under 45. Once deadlines pass, it can be dif ficult to collect at all for the services rendered.

To calculate:

• Divide total current receivables by aver age daily charge amount

• Net the credits by subtracting the cur rent credit balance from the current total receivables

• Get the average daily charge amount by dividing total gross charges for the past 12 months by 365

NET COLLECTION RATE

More effective to track than gross collec tion rate, this is the percentage of the total amount an organization can realistically expect to collect for care and services.

Tracking this metric is key because it rep resents the efficiency of the RCM, the ability to mitigate missed payments, communicate with insurance payers and patients alike, and to submit clean claims in the first place.

While the COVID-19 pandemic has in part negatively impacted net collection rates, it’s commonly accepted that a good collec tion rate ranges between 98.5% to 99%.

CLAIM DENIAL RATE

It’s not enough to aim for a high rate of first pass payment (CCR); it’s also crucial to strive for a lower claims denial rate. Know the numbers to paint a better picture about what your revenue cycle is up against.

To calculate claim denial rate, divide the total dollar amount of claims denied by pay ers by the total amount submitted (within the given period). Claim denial rates above 10% indicate an unhealthy RCM process and financial flow. In this case, consider analyzing eligibility verification, coding, and credentialing functions.

BAD DEBT RATE

This is the reimbursement for services healthcare organizations have potentially written off. Calculate this KPI by dividing amounts written off by allowed charges.

Considering the growing amount of medical debt across the U.S., it’s critical to stay aware and ahead of this metric.

COLLECTION COST

Hospitals or clinics that are able to close claims quickly and reduce outside collection costs set themselves up to remain compet itive. Not only are they able to offer more cost-effective services, they free up resources to invest in other key areas such as patient experience and necessary infrastructure.

REFERRAL RATES

By accurately tracking referrals and new patient intake, organizations can get a clearer picture of the services provided as well as the required budgets. These referral rates can also provide insights on opportunities to improve service lines, which can in turn increase cash flow.

Adam Shewmaker can be reached at 502.566.1054 or ashewmaker@ddahealthcare.com

Preventive Care Mandates

They’re a core part of the ACA – but are they unconstitutional?

BY EMILY B. PENCE

On September 7, 2022, the U.S. District Court for the Northern District of Texas invalidated portions of the Affordable Care Act’s (ACA) pre ventive services benefit mandate. In Braidwood Management v. Becerra, (formerly  Kelley v. Becerra), six individuals and two businesses sued to eliminate the preventive services require ments, challenging the legality of the preventa tive care mandates under the Constitution and Religious Freedom Restoration Act (RFRA). The plaintiffs argued the benefits mandate violated their religious beliefs. The ACA’s preventive health benefits mandate requires health insurers to cover contraceptives and HIV pre-exposure prophylaxis (PrEP).

Of the six plaintiffs, the Court only addressed Braidwood Management’s RFRA claim. The Court reserved ruling on the remaining plaintiffs’ RFRA claims. Braidwood Management is a “Christian for-profit corpo ration” that provides health insurance for its approximately seventy employees through a self-insured plan. Braidwood’s owner, Steven Hotze, wished to provide health insurance for employees that excluded coverage of pre ventive care like contraceptives and PrEP drugs. In Braidwood Management’s self-in

sured plan, Hotze wants the option to impose copays or deductibles for preventive care.

To claim protection under RFRA, Braidwood Management had to show (1) the relevant reli gious exercise is grounded in a sincerely held religious belief and (2) the government’s action or policy substantially burdens that exercise. The government may substantially burden a person’s exercise of religion if it demonstrates the burden (1) is in the furtherance of a compelling gov ernmental interest and (2) is the least restrictive means of furthering that interest.

The Court held the PrEP mandate substan tially burdens Braidwood Management’s owner’s religious exercise. It further held the government did not have a “compelling interest in forcing private, religious corporations to cover PrEP drugs with no cost-sharing and no religious exemptions.” Finally, the Court held the PrEP mandate was not the least restrictive means for furthering the governmental interest. In making this decision, the Court suggested the govern ment could assume the cost of providing PrEP drugs to employees unable to get the drug due to an employer’s religious objection. This sug gestion is not novel, having first appeared in the Burwell v. Hobby Lobby Stores holding.

What happens next?

How this ruling will be applied has yet to be seen. The Court’s specific holding is that the PrEP mandate violated Braidwood Management’s rights under RFRA. The Court reserved ruling on whether the PrEP mandate violated the other plaintiffs’ rights under RFRA. The Court also reserved ruling on the appropriate remedy in light of its PrEP mandate decision. The Court has asked both sides to submit supplemental briefing on the scope of the relief and the claims relating to the contraceptive mandate. Until those issues are briefed and the Court renders its decision on those issues, the application of this ruling is unknown. To whom, and to what extent, the Braidwood Management case will be applied is currently uncertain. It will be important for healthcare providers and employers alike to keep an eye out for devel opments following this decision to ensure compliance.

Emily B. Pence is a healthcare and insurance law attorney with Sturgill, Turner, Barker & Moloney, PLLC. She can be reached at epence@sturgillturner.com or 859.255.8581. This article is intended to be a summary of state or federal law and does not constitute legal advice.

Change Is in the Air

BY SCOTT NEAL, CPA, CFP®

About a month ago, while visiting our college student in Chicago, my wife and I took a stroll down Michigan Avenue (one of my hobbies is people watching, not shopping) and I was surprised at how empty of custom ers all the high-end stores appeared to be. In pre-pandemic trips we saw those same stores bustling with shoppers. As we were leaving town, I thought we should top off our gas tank. Confronted with $5.99 a gallon, I remarked to my wife, “Can anybody really think this economy is secure?”

In the spring of this year, I expressed my opinion that the Federal Reserve leaders fell asleep at the wheel back in 2021. Their lack of action then has boxed them, and us, into a corner. I imagine it’s like you doctors having patients that simply avoid taking medicine, hoping things will get better. Now it appears that the Fed has every intent on increasing interest rates until they kill the economy. Speeches that contain phrases like, “We will do whatever it takes,” or, “The Federal Reserve is committed to our statutory mandate of sta ble prices and maximum employment,” are quite revealing. One thing seems sure at this juncture: change is in the air. And I am not talking about the fall Kentucky weather, as nice as it has been lately.

Alluding to recent turmoil in financial mar kets and growing evidence of stress in the world economy, the October 6th issue of The Economist probably said it best. “You might think that these are just normal signs of a bear market and a coming recession. But they also mark the painful emergence of a new regime in the world economy—a shift that may be as consequential as the rise of Keynesianism after the second world war, and the pivot to free markets and globalization in the 1990s.” The big question is what all this means to you and me.

seen that issue, I suggest you go back and read it now. If you did see it, re-read it. If anything, the situation has grown worse, not better, and the strategy is working.

Approaching year end, more than a few people just want to stick their heads in the sand and with all the turmoil, many just want to stick their entire portfolio into CDs. Those are usually not healthy choices. Instead, con sider doing these three things right now:

their entire portfolio into CDs.

In case you haven’t looked, global stocks have declined by more than 25% and gov ernment bonds may be looking at their worst year since 1949. The traditional 60% stock, 40% bond portfolio and a buy-hold-rebal ance strategy simply isn’t cutting it. In the last issue, #141, I addressed what we are calling a New Normal and outlined a strategy for deal ing with the present markets. If you haven’t

De-risk as much as possible. It’s about more than reducing volatility in your portfolio but that is a good place to start. There are better ways to do that than simply buying CDs. It also means reviewing your insurance policies and making sure that everything is up to date on life, disability, and even long-term care. We see so many mistakes made by people who wait until its too late to make sure that beneficiary designations and estate plans are what they want them to be. We recently saw a prospective client whose special-needs child inherited a sum of money outright from an aunt. It was just enough to knock the child out of some rather significant governmental benefits, but not enough to ensure the child’s long-term financial security.

• De-risking also considers whether your existing debt is appropriate for you now.

in

Variable rates are rising quickly, and some credit card interest is now 20%+. The terms of any new debt should be carefully considered. The amount of debt relative to assets is important, but so is the payment in relation to income. If your income were to come under attack or even be eliminat ed, how long would you be able to keep making the payments? These are important financial planning questions.

• Set goals for 2023. Remember SMARTER goals are Specific, Measurable, Actionable, Risky (but not too risky), Time-keyed, Exciting, and Relevant. As we approach the end of 2022, now is the time to be thinking about 2023 and what it will mean for you and your loved ones. These can be habit goals or achievement goals. In any event, it is important to identify the expected spending that it will take to achieve them. If you need help, I highly recommend Michael Hyatt’s book, Your Best Year Ever. If you need a coach, I can help. I think you

will find some renewed energy as you work through the process. It’s challenging, but not difficult.

• Focus on cash flow. There are five things, and only five things, to do with all the money that comes in from whatever source: 1) pay your taxes, 2) pay on debts, 3) save some, 4) give some, and 5) spend the rest. It’s an equation that always holds true. I will share our Excel-based cash flow mod eling tool with anyone who asks. Unlike most budgeting tools that ask you to build from the bottom up, ours starts with the big picture and then works down to the specifics. It works for all income levels and every stage of life, from student to elder.

For those who are nearing retirement, pay attention to maximizing retirement income, especially social security. I have produced a free video on that subject. You will find it at dscottneal.com/socialsecurity

The stakes for doing nothing about your finances (or the chance of making a significant

mistake) have perhaps never been higher, at least during our lifetime. If the Fed has to raise rates to the point of causing a recession, it will be painful. The outcry from job losses could result in even greater political upheaval that could, in turn, lead to further missteps at the highest levels of leadership.

Conversely, considering the potential for a major shift in global economies and a change in the Fed’s strategies (they are scheduled to reassess those in 2024) we are faced also with unprecedented opportunity for those who are prepared. Not to be discounted for you in the business of healthcare is that our aging popu lation is going to need more of your services than ever before. This is not a time to sit and see what will happen next. Now is the time to act.

Scott Neal is the president of the fee-only financial planning and investment advisory firm, D. Scott Neal, Inc. with offices in Lexington and Louisville. He can be reached via email at scott@dsneal.com or by calling 1-800-344-9098.

AT T ORNEY S

Y | TENNESSEE

Behind the Scenes No More

Pathology & Cytology Labs is well on its way to providing pathology service to all Kentuckians

BY GIL DUNN

LEXINGTON In September 2022, Appalachia Regional Health System (ARH) joined the Pathology & Cytology Labs (PCL) Pathology Network. All 13 of the ARH Kentucky hos pitals will be served through the main lab in Lexington and a hub in Hazard, including two additional pathologists. This affiliation is the only the most recent merger that has propelled PCL into a statewide pathology network serving hospitals, physicians, clinics, and healthcare systems.

According to its website, PCL and Chipps, Caffrey & Dubilier, PSC are “specialists in anatomic pathology, cytology, hematopathol ogy, neuropathology, GI pathology, clinical laboratory consultants, and laboratory medi cal directorships.” The practice was founded in 1967 and is accredited by the College of American Pathologists.

Rick Lozano, MD, FCAP, president of P&C Labs, LLC, vice-president of Chipps, Caffrey & Dubilier, PSC, and director of the histology lab says, “We are proud and excited to begin serving the ARH System and more of Appalachia.”

Fifty-Five Years and Counting

PCL has been serving Kentucky hospitals since 1967. Dr. H. Davis Chipps started P&C Labs at Central Baptist Hospital with the pathology and clinical labs at Medical Heights

on Nicholasville Road, now a grocery store. It grew slowly and, by 2003, the pathology practice was serving 14 hospitals in Central Kentucky. It now serves 48 hospitals in addi tion to surgery centers and over 500 medical offices across Kentucky. PCL has over 134 employees working three shifts to provide accurate and timely results. From couriers with specimen tracking to EPIC interfaced report

ing, PCL has provided professional and logis tical assistance to hospital pathology depart ments while maintaining turnaround-time and improving diagnostic capabilities.

PCL’s state of the art laboratory is strategical ly located in Lexington’s medical district, posi tioned for frequent courier runs to the three major hospitals of Central Baptist, Saint Joseph Hospital, and Saint Joseph East. The last five years has seen continual renovation and mod ernization combined with proactive equipment acquisition in order to yield increased capacity.

Can You Rush That?

Lozano recalls when recently one of the PCL pathologists had surgery at an outside facility and was told it would take 7-10 days to get pathology results. PCL’s goal is to pro vide results in 24–48 hours. Turnaround time is maintained by working three shifts daily. “Teamwork and innovative management help keep the tissue specimens advancing towards completion,” says Lozano. “Our team members are known to stay past their shift or drive back to a hospital in order to answer the call. Our customer service team receives special orders and follows the patient specimen through to the final report, ensuring that stat reports are not only sent, but also received,” he says.

Area hospital administrators have confi dence in PCL. Greg Giles, vice president of

PCL’s state of the art laboratory is strategically located in Lexington’s medical district.

operations at CHI Saint Joseph Health states that CHI Saint Joseph Health has been using PCL for three and a half years for anatomic pathology and clinical laboratory services with board-certified pathologists for clinical or technical consultation. “PCL provides lead ership and medical direction for our hospital and oncology center labs, ensuring we provide high quality care and meet regulatory require ments,” says Giles.

Giles continues, “PCL is a well-respected provider in Kentucky. Their experience serv ing institutions across the state provides valu able points of reference and expertise to help us maximize our potential and reduce costs. Their local connections and deep understand ing of the needs of our patient population help us stay focused on how we can best impact the health of our community. PCL has the resources available 24/7 to support our robust technical pathology needs, which has become a difficult skill to recruit in today’s tough job market.”

Tommy Haggard, CEO, Bourbon Community Hospital says that his hospital is “pleased to partner with P&C Labs for our pathology and cytology needs, covering the gamut from technical to consultative to onsite leadership. Those services include sur gical specimen workup and interpretations, assisting with laboratory policies and pro cedures, staff competencies, quality control, peer to peer discussions, and 24-hour call for blood bank and transfusions. PCL physicians also fully participate in physician leadership committees and hospital leadership to include board of trustee involvement. PCL is integral to Joint Commission readiness and actual survey participation,” says Haggard.

The critical need for pathology service is challenging for community hospitals. Haggard says, “It would be extremely diffi cult, if even possible, to maintain the full array of services offered by PCL independently for our facility. Where PCL excels is how they can tailor the full array of services they are capable of to meet the needs of the hospital. They provide and maintain equipment and supplies for specimen workup and assist with onsite procedures to ensure the testing is able to be completed in the one study such as fine needle

aspiration and thyroid biopsies for adequate margins. To provide the same level of service would be cost prohibitive for a facility of our size and scope. However, with PCL, we are able to receive the same level of pathological diagnosis of much larger facilities.”

Some of the Pathologists Behind the Microscope

„ Rick Lozano, MD, FCAP

After an internal medicine internship, on pathology residency at Emory University, Lozano completed his chief resident year and fellowship at UAB in Birmingham, Alabama. He was in private practice for seven years in Birmingham before joining PCL and the professional company Chipps, Caffrey & Dubilier, PSC.

Lozano says his fellowship and special inter est is cytopathology and gynecologic patholo gy, but he also has training in GI pathology. “I have definitely developed an interest in lab oratory management and business. We have the ability to bring our subspecialty brand of pathology service to Kentucky’s smallest hospitals. Our continued success is raising possibilities outside of Kentucky,” he says.

cialization in hematopathology, cytopathol ogy, dermatopathology, GI pathology, GU pathology, oral pathology, neuropathology, and molecular/IHC/flow cytometry expertise.

Clark received his undergraduate degree at the University of Indiana University; his med ical degree from Indiana University School of Medicine; pathology residency from Baylor University in Dallas; and cytopathology fel lowship graduation at University of North Carolina in Chapel Hill. He recognized that pathology was a natural fit for him in medical school. He joined PCL in 2012.

Clark serves as the medical director for CHI Saint Joseph East Hospital, Russell County Hospital, and Cornerstone Diagnostics, LLC. In addition, he provides anatomic pathology sign-out with a special interest in cytopathol ogy for 45 hospitals and hundreds of private offices across the state of Kentucky. “We provide on-site coverage of frozen section pro cedures and radiology adequacy,” says Clark.

“I see our practice continuing to grow throughout the state of Kentucky. We aim to one day grow enough to provide expert tissue and cytology diagnoses along with laboratory medical direction for every Kentuckian across the state,” says Clark.

„ Brad Gibson, MD, FCAP

From Knott County in Eastern Kentucky, Brad Gibson, MD, received his medical degree from the University of Kentucky College of Medicine. He recalls that he decided in his second year of medical school that pathology was one of his interests and chose the specialty in his third year. He did his anatomic and clinical pathology residency at the University of Louisville and a hematopathology fellow ship at Indiana University plus a combination general surgical pathology/gastrointestinal fel lowship at Brown University.

„ Jason Clark, MD, FCAP

Jason Clark, MD, is president of Chipps, Caffrey & Dubilier, PSC, a multi-specialty private practice pathology group comprising 21 pathologists, the majority owner of PCL, LLC. The group provides expert diagnoses across the entire field of pathology, with spe

Gibson interviewed with PCL during his first fellowship and says he knew he had found the place for him when he saw the desire to meet pathology needs across Kentucky, especially the rural areas, a desire which was evident by the number of maps in the laboratory. “Being from rural Kentucky, I understood how underserved many of these areas were and how many needs a growing

Jason Clark, MD, is president of Chipps, Caffrey & Dubilier, PSC, a multi-specialty private practice pathology group comprising 21 pathologists, the majority owner of PCL, LLC.

company like this could provide to our state. I accepted the PCL position and began the first weekday after my last fellowship had ended, and have been working here now for a little over three years,” say Gibson.

Gibson’s main interest is in leukemia and lymphoma diagnoses. He evaluates the hema tolymphoid cases from several dozen hospitals at PCL including bone marrows, lymph nodes, peripheral blood smears, and flow cytometry evaluation. He consults on gastrointestinal cases, occasionally evaluates general surgical pathology cases, and directs five laboratories across Kentucky and the immunohistochem istry section of the laboratory. Work begins around 7 a.m., prioritizing malignant and urgent cases, communicating with oncologists when critical diagnoses need to be delivered quickly, and arranging for ancillary testing.

“Discussing cases directly with physicians is particularly meaningful, as it helps us see the importance and impact of our diagnoses. I love to hear from our docs,” says Gibson.

Gibson is impressed by the breadth and volume of hematolymphoid neoplasia in his practice. He is working to expand the immu nohistochemistry test menu and PDL1 testing to make results available to clinicians with a short turnaround time.

„ Jessica Howard, DO, FCAP

A born-and-bred Kentuckian from Bowling Green, Jessica Howard, DO, completed her undergraduate studies at WKU with a major in biology and minor in chemistry; received

her Doctor of Osteopathy degree from the Kentucky College of Osteopathic Medicine; did her pathology residency at UK; and completed a surgical pathology fellowship fol lowed by a cytology fellowship, both at UK.

Originally, Howard planned to be a pedi atrician. However, while on her surgery rota tion she saw how pathology interacted with surgery when a biopsy of a tumor, taken bedside and hand delivered to the pathologist, allowed the surgeon to explain the situation to the patient. “After being impressed by the pathologist’s knowledge and workplace, I was able to get an elective rotation in pathology, and I loved it so much I never looked back,” says Howard. “Pathology suits me very well. I am able to provide doctors and patients with answers, and that makes me happy.”

Howard joined PCL in 2017. She says PCL leaders understand there’s a major learn ing curve between coming out of training and becoming an attending pathologist. That mindset and understanding of the more senior pathologists was something she appreciated when she started. “As with every new attend ing, I had some struggles at first, but the partners at PCL had my back, and after two years of hard work, I was invited to become a partner. That decision has paid off for me per sonally and professionally and I’m constantly trying to help grow the business because I want us to continuously evolve,” says Howard.

„ Sarah Williams, MD, FCAP

Sarah Williams, MD, attended both undergraduate and medical school in South Carolina. She grew up in Columbia, South Carolina, and spent the majority of her career working in Columbia and Charleston. Both her older sister and brother are pathologists, so she learned about pathology around the dinner table and it seemed like a natural fit.

Williams joined PCL in 2020. Her work ing day starts at 7 a.m. and usually involves traveling to outside facilities, with possible tumor board attendance and presentations in addition to reading cases out at the laboratory facility in Lexington.

Her area of interest is dermatopathology. “Although I am fortunate enough to look at a variety of specimens, dermatopathology is certainly my niche within the group,” says Williams.

„ Ed Tanous, Jr., MD, FCAP

Ed Tanous received his undergraduate BS in chemistry from Delta State University in Cleveland, Mississippi. He received his med ical degree from the University of Mississippi Medical Center in Jackson, Mississippi, and did his residency at the University of Kentucky Medical Center in Lexington.

He grew up in Greenwood, Mississippi, though home has been Lexington since his residency. He chose pathology in his fourth

PCL has over 134 employees, working three shifts to provide accurate and timely results.

Jessica Howard, DO, FCAP, is a born-and-bred Kentuckian from Bowling Green.

year of medical school after completing an elective month in pathology. He had not considered pathology until an internal medi cine resident invited him to review peripheral smears. He applied for an elective rotation in pathology the next day.

Tanous works at the Clark Regional Medical Center in Winchester, Kentucky. His special area of interest is GI pathology, review ing biopsies from the hospital’s endoscopy service. He also sees urologic, breast, skin, and gynecologic pathology, with a small amount of pulmonary and orthopedic pathology. His clinical path responsibilities include reviewing the occasional peripheral blood smear, review ing laboratory policies and procedures, over seeing the blood bank and serving as a con sultant for transfusion services, and serving as a liaison to the medical staff for the laboratory.

Tanous was in solo private practice before joined PCL in 2012. He says he feared losing independence and feared change.

“I’d been practicing solo for six years by that time, after my colleague of 14 years retired. I was comfortable where I was. Prior to joining PCL, I met many of the pathologists there in a moonlighting role, a helpful introduction to the group. That served to dispel much of the fear. Contract negotiations were not conten tious, and every objection was addressed open ly and honestly by the business manager and the president of the group. Once taking the plunge, I found that many of the frustrating aspects of work I’d been handling were taken away by PCL, as they had staff employed spe cifically to handle the pathology grossing, bill ing questions, supply logistics, IT frustrations, equipment maintenance, and bookkeeping. The responsibilities of running a business had been removed, and I’d gained access to a group of experienced and well-trained pathologists to consult on difficult cases. These things lifted a huge burden, to the extent that I really believe my career has been extended,” says Tanous.

In the future Tanous expects surgical pathology and cytopathology will move in the direction of molecular diagnostics, as medi cine is becoming more targeted in its therapy. “There is still great need for morphologic interpretation, and I doubt that will ever be replaced. PCL is a forward-thinking and nim

PCL has the complete package: seasoned veterans, motivated associates, and a trained technical staff.

ble business that I believe is positioning itself well to handle the new demands of this era of medical diagnosis,” says Tanous.

„ Harty Ashby, DO, FCAP Harty Ashby, DO, likes the mystery-solving that comes with being a pathologist. She feels she is at the central point in medicine, avail able to discuss the pathology with physicians and helping patients. “I love the challenge of looking at slides and solving daily tissue mys teries,” says Ashby.

After graduating from UK with a BS in biology, Ashby received her DO from the University of Pikeville School of Osteopathic Medicine. She followed that with an intern ship at Pikeville Medical Center, then an anatomic and clinical pathology residency and fellowship in dermatopathology at Tufts Medical Center in Boston.

Ashby says she has always had a strong interest in dermatology, spending time working with dermatologists during college and medical school. Dermatopathology was the best way to combine her interests. Her special areas of interest within the practice are melanocytic lesions, inflammatory skin diseases and cutane ous manifestations of systemic disease.

Ashby joined PCL in April 2019. With the diverse subspecialties within the practice, she can show cases to colleagues without sending out to other laboratories.

Other Members

Additional members of the practice are: Fred L. Picklesimer, Jr, MD, FCAP; Patrick C. Crowe, MD, FCAP; John F. Jansen, MD, FCAP; George Kim, MD, FCAP; Jason Mull, MD, FCAP; Douglas Damm, DDS; Craig Fowler, DDS; Christine Meece, MD, FCAP; Justine B. Sedlak, MD, FCAP; Filip G. Garrett, DO, FCAP; William J. Beuerlein, DO, FCAP; Keith Henry, MD, FCAP; and Autumn V. Hammonds, DFO, FCAP.

A Partnership Like No Other

While PCL is the machine that never sleeps, the pathologists are the driving force. PCL has the complete package: seasoned veterans, motivated associates, and a trained technical staff. The PCL leadership partners work the bench as well as manage, so they can oversee quality and consistency in their departments

PCL offers subspecialty service that rivals most university centers: seven cytopathol ogists, three hematopathologists, three oral pathologists, two dermatopathologists, one GI pathologist, one neuropathologist, one molecular pathologist, and special training in breast, GI, GU, and soft tissue.

A pathologist has four major roles in the hospital: directing the clinical lab, signing out pathology cases, performing on-site pro cedures, and serving on hospital committees. The post-COVID-19 era has seen pathologist shortages throughout Kentucky and the U.S. The change has been swift and the demand alarming. Without clinical lab direction, an entire hospital could shut down. Without pathology reports, treatments are delayed. Committees are often mandated and regulat ed. On-site procedures are a vestige of the past. Even some large hospital systems throughout the U.S. have had to extend their normal turnaround-time for anatomic pathology reports by several days or more. However, PCL has been able to maintain a consistent one- to two-day turnaround time throughout the COVID era.

“We strive to provide the standard of care service while looking towards clinical necessi ty and data-driven solutions. We are faithful, honest, hard-working and positioned to serve all of Kentucky,” says Lozano.

Cancer Care and Clinical Trials at Norton Cancer Institute

Don Stevens, MD, gives back to his community in many ways

BY GIL DUNN

LOUISVILLE Cancer care can be a long-term relationship between patient and physician. Don A. Stevens, MD, says, “Most of us in this field feel a connection with our patients and know that they’re going through a very horrible time and we’re doing what we can to make that better, hopefully having the opportunity to develop long-term relationships with them.”

Stevens also has a long-term relationship with his hometown of Louisville. He is a boardcertified hematologist/medical oncologist at Norton Healthcare and one of the founding members of the Norton Cancer Institute. He

grew up in the Highlands neighborhood of Louisville and graduated from Georgetown College in Georgetown, Kentucky and the University of Louisville School of Medicine. He followed that with a fellowship in medical oncology at the prestigious Johns Hopkins Hospital in Baltimore.

In 1994 Norton Healthcare had four oncologists, Thomas Woodcock, MD, Janell Seeger, MD, both now retired, plus John Hamm, MD, and Stevens.

Stevens recalls, “Before we actually used the words Cancer Institute, we had already

PHOTO BY JAMIE RHODES

grown to be multiple multidisciplinary providers that included radiation oncology, GYN oncology, and orthopedic oncology and more. Since then, we’ve added the treatment spectrum for all cancers, from prevention, genetic assessments, survivorship, all very inclusive and very expansive services for the community. It goes back to many years ago when the board of trustees at Norton Healthcare and the administrative leadership made a decision to put resources in and develop that program. Over $100 million in the first five years alone.”

Don Stevens, MD, director of Norton Cancer Institute hematologic cancer program. In 2020, he was inducted into the Kentucky Society of Clinical Oncology (KYSCO) Hall of Fame.

High Value in Clinical Trials

Kentucky has high rates of cancer, unfortunately leading the nation in many areas. Stevens says that’s one of the motivations for devoting resources to cancer care. In conjunction with treating patients, Stevens is currently the lead or sub investigator in around 65 clinical trials. He says that “until we are curing every patient, we need to continue to have clinical trials to advance cancer care.”

Some of the clinical trials that Stevens and his team are conducting include hematologic malignancies, with over three dozen active studies on Hodgkin lymphoma, nonHodgkin lymphoma, all of the subtypes of non-Hodgkin lymphoma, acute leukemia, and chronic leukemia.

“The most exciting thing that we’re doing now is using autologous cellular therapy, cells that come from the patient. The cells are harvested in a process called apheresis, similar to having platelets donated at the blood bank. We think of these cells as being drugs. We have helped some cellular therapies become FDA approved, and we can offer those now that the clinical trials are complete,” says Stevens.

“Because of clinical trials, we are treating cancer so much differently than we did when I started. And that’s a good thing,” he states.

Bench to Bedside

Leukemia and lymphoma are two cancers that Stevens specializes in. He’s conducting trials where a healthy patient’s cells are shipped to a laboratory where they are genetically engineered to fight the lymphoma or the leukemia cells and then returned for infusion into the patient. But even more exciting, says Stevens, is that they have several studies now using what are called allogeneic cells. “These are cells that come from a donor and some of them, but not all, are genetically engineered to fight specific proteins on the surface of

the cancer cell. We call these ‘just off the shelf cells’ because they’re really just out of the freezer. We go to the freezer, thaw the cells and infuse them into the patient. This allows us to treat more patients with cellular therapy. It also allows us to get the cells into the patient faster. And in some cases, it allows for re-dosing.”

Not all of the allogeneic cellular therapy that Stevens is working on is FDA-approved, but he has three or four studies open at any one time. He’s also continuing to look at very targeted therapies. For example, he is investigating a drug that specifically degrades a protein that’s important for the cancer cell to survive—a very targeted protein destruction.

Not only does Stevens see patients and conduct drug development trials, but he also has cooperative group trials with Hodgkin lymphoma. This is a trial that’s being done across the country that seeks to compare two different chemotherapy regimens or recipes that use different immunotherapy. And that’s exciting for Stevens because, as he says, “We can offer clinical trials to somebody in Boston, New York, or Miami, where they would have the same clinical trial option for their Hodgkin lymphoma as we do here at the Norton Cancer Institute.”

Most of Stevens’ research has to do with treatment. He says that continuing to exploit the information that he’s learned from studying the molecular biology of malignancy and translate that into very targeted therapies keeps him highly motivated. “The advantage of a targeted therapy is you don’t have all of the side effects that you would with something that’s not targeted. So literally for decades, the drugs that we’ve used have not been smart drugs. That’s why we have the side effects that some people associate with cancer treatment. We’re seeing fewer side effects, and we’re treating more patients, and we have more options because of clinical trials.”

The EMR Advantage in Clinical Trials

Electronic medical records, which are now a staple of hospital and medical offices, also enhance clinical trials, says Stevens. “It certainly helps us to follow patients more efficiently as they go through their trials and treatment.”

A prime example is next generation sequencing, explains Stevens. “We can send blood or a sample of a tumor and have it screened for literally hundreds of different mutations. And that’s what identifies the targets for therapy. We can take a few cancer cells and literally look for 400 or 500 different mutations that may be contributing. We can look at the ones that are there and that helps us choose what therapy or what clinical trial would be best for that patient.”

Stevens emphasizes that participating in clinical trials is important. It does several things that are positive. It frequently opens up treatment options for patients that would not have options. It allows clinical staff to become familiar with treatments and medications well in advance of FDA approval. “Our national guidelines state that clinical trial participation is encouraged for every patient, as long as the trial is appropriate for that patient,” says Stevens.

Team Approach

An important part of cancer care is the team approach. Stevens says it’s vital that Norton Cancer Institute has a caring, competent team in place for the patients, from the providers, to nursing staff, to the pharmacy staff. “We have to approach cancer care as a team. It’s about patient education, because knowledge is power. The more we can educate our patients, the better decisions they’re going to make, the less fear they’ll have, and the more confidence they’ll have in the decisions they’ve made.”

“In 1994 we started with four physicians and now we have over 30 oncologists including medical, radiation, gynecologic, orthopedic, and dermatologic. We continue to expand the depth and breadth of our research and care. I can’t praise Norton’s enough, from the board of trustees to our administrators, they recognized the need many years ago, and they have dedicated the resources to make this what it is today,” says Stevens.

“Until we are curing every patient, we need to continue to have clinical trials to advance cancer care.” — Don Stevens, MD

On the Front Lines of the Fight

Pulmonologist Hawa Edriss, MD, is working to improve lung cancer survival rates in the Bluegrass State through early screening and streamlined treatment.

BY DONNA ISON

LEXINGTON Kentucky is known as both the horse racing capital and bourbon capital of the United States. Unfortunately, our state holds the undesirable ranking as the lung cancer capital as well. According to the CDC, of all fifty states, Kentucky has the highest incidence of and mortality from this disease. In 2021, the rate of new lung cancer cases was 89/100,000; the average national rate is 58/100,000. In response, this July, Governor Andy Beshear signed House Bill 219, estab lishing a statewide lung cancer screening pro gram in the Kentucky Department for Public Health to aid in early detection.

As a pulmonary and critical care specialist with CHI Saint Joseph Health – Pulmonology and Critical Care Medicine, Hawa Edriss, MD, is on the front lines of the fight. She says, “I always wanted to be part of a change. I’m very, very interested in lung cancer and improving survival rates and improving delivery of care.”

One of the primary issues with lung cancer care in Kentucky is late detection. According to Edriss, “Unfortunately, the most common presentation is late stage—Stage 3 and even more often Stage 4, because lung cancer is asymptomatic; it becomes symptomatic at Stage 4. With Stage 1 lung cancer, approxi mately 90% of patients can expect to live at least five years following their diagnosis, so early screening is key.”

Edriss is especially proud of the CHI Saint Joseph Health lung care program, which takes a multidisciplinary approach to cancer care. It is headed by a lung cancer nurse-navigator whose sole job is to coordinate and streamline the care of patients with suspicious lung scans. After a pulmonary screening, if the navigator sees any cause for concern as identified in the scan reports by a CHI radiologist, the patient’s results are turned over to a board of pulmonologists, oncologists, interventional

radiologists, and surgeons who meet weekly to discuss cases and implement treatment plans. Edriss has been sitting on the board for three years. She says, “The benefit of this program is to expedite patient care and avoid any delay in a time-sensitive condition. For these patients, specifically those who are at risk for cancer, we get them scheduled within a week, sometimes the next day, to receive highly specialized care. I think this program is amazing.”

An Unlikely Route to Lexington

Edriss joined CHI Saint Joseph Health –Pulmonology and Critical Care Medical Group, a part of CommonSpirit Health, in 2018. Before, she received her Doctor of Medicine from Al Margeb University Faculty of Medicine in her native country of Libya, but kept her eye on an education in the U.S. Edriss explains, “Libya is one of the developing countries. I

always wanted to continue my training in a developed country and I knew America was the top for medical education and innovation. Luckily, I received scholarships while in medical school.” After moving to the U.S., she garnered a prestigious Master of Science in Clinical Research from Rush University Medical Center in Chicago, followed with a residency and fellowship at Texas Tech University Health Science Center in Lubbock, Texas.

Initially, Edriss was focused on becoming a cardiologist, but during residency rotations, she was introduced to her current specialty by Kenneth Nugent, MD, the pulmonary and critical care program director at Texas Tech, who became her mentor and guided her interest in research. “Our research and schol arly articles have been cited more than 700 times; these papers discuss both pulmonary and ICU diseases.” She loved the range of care

the field provided: “In critical care, you see acutely ill patients that you work really hard with, and then, after two days, see dramatic changes. With pulmonary patients, you deliv er care and get the chance to follow them for years and see long-term change. With pulmo nary, you deliver a wide spectrum of service, including preventive medicine, and get to communicate and know the family well. You also get to do a lot of different interventional procedures, such as bronchoscopies.”

During a typical week, Edriss will spend up to 50-60% of her time in inpatient ICU con sultations, evaluating and treating patients and performing procedures, such as intubation to place critically ill patients on mechanical ven tilation, central venous catheterization, arterial lines, chest tubes, and bronchoscopies. The rest of her time is spent focusing on pulmonology, both inpatient and outpatient clinics, analyzing scans, and performing an average of 1-3 bron choscopies a day. She sees all adult pulmonary consultations; her average patient population is over 50, with some patients being 90 and up.

Though Edriss is now an integral part of CHI Saint Joseph Health – Pulmonology and Critical Care Medicine, practicing in the U.S., much less Kentucky, was not her initial plan. After completing her education, Edriss planned to return home to Libya. “I honestly thought I would do some training and go back. But I feel that we never finish our training; we continue to grow and we continue to learn and there’s always more training, more innovation, and more technology. So, I decided to stay.”

Higher Smoking Merits Earlier Screening

While in fellowship reviewing lung cancer slides, Edriss met a pathologist who was a native of Kentucky and learned about the Appalachian region and how vast the under served population is in certain rural commu nities. This piqued her interest in the area. “I wanted to come here because of underserved communities with high smoking risk and therefore high cancer risk.”

A shocking 25-30% of Kentuckians smoke; according to Edriss, “Smoking is the num ber one risk factor for lung cancer; cigarette smoking is linked to 90% of lung cancer.” Due

to this statistic, the U.S. Preventative Service Task Force (USPSTF) has updated screening guidelines. The guideline now recommends lung cancer screening for adults aged 50 to 80 years who have a 20-pack-year smoking history or more which “is calculated by multiplying the numbers of packs of cigarettes smoked per day by the number of years the person has smoked.” For example, 1 pack-year is equal to smoking 1 pack per day for 1 year or 2 packs per day for half a year. This includes current smokers as well as those who have smoked that amount and quit in the past 15 years.

As for screening, Edriss has two pearls for primary care physicians. First, even if a patient is asymptomatic but falls within the criteria, set up a screening. Second, educate yourself on the basics to know when to reach out to a specialist. She urges, “Know features, criteria, and risk factors to know what needs interven tion and what does not need intervention, but requires observation. And if you are confused or if it’s concerning, refer to a pulmonologist.”

She points out that many reach out first to an oncologist, but a pulmonologist should be the first call, as it is their job to review scans, per form biopsies, and determine malignancies.

Most importantly, always remember, early identification is associated with increased sur vival, so when in doubt, screen and scan.

DR. HAWA EDRISS

CHI Saint Joseph Medical Group – Pulmonology and Critical Care Medicine

CHI

Joseph Health Office Park 1401 Harrodsburg Road, Suite C 405

Voice of Hope

Expertise offers hope to oral and throat cancer patients

BY JIM KELSEY

LOUISVILLE A common motivational phrase to drive someone to achieve a long-term goal is to “speak it into existence.” As a child growing up in Indianapolis, Melanie Townsend, MD, head and neck surgical oncologist at UofL Health, took that idea a step or two further. Playing the board game LIFE she always wanted her pro fession to be a doctor – admitting to manipu lating the cards to make sure she drew the right card to be a doctor in the game.

Her real-life journey to become a doc tor began by completing her undergraduate work at Denison University in Granville, Ohio before attending the Indiana University School of Medicine. She went on to com plete a head and neck surgery fellowship at the University of Miami and performed her residency in otolaryngology at Washington University School of Medicine in St. Louis.

“I saw an orthopedic total hip surgery in college and thought it was the coolest thing I had ever seen,” Townsend says, explaining her particular interest in a surgical profession. “In medical school, from the very beginning I was drawn to general surgery. Then I discovered ENT as a really nice specialty option. I specif ically liked the head and neck cancer side of things. The anatomy of the neck is very dense with nerves and muscles and blood vessels. Removing tumors while trying to preserve these structures was extremely interesting to me. Our face and our voice is kind of who we are. It’s a delicate place to have a cancer surgery on.”

Townsend spends a couple of days a week in the clinic and attends a weekly cancer conference at the UofL Health – Brown Cancer Center. The conference includes radiation oncologists, medical oncologists, and radiologists.

“We review each new cancer case, and we bring our patients in to meet the entire team,” says Townsend, who is also an assistant pro fessor in the University of Louisville School

of Medicine Department of Otolaryngology. “Generally, I’ll have another half day to full day of clinic in a week. The rest of the week I’m usually in surgery. A lot of those cases take all day long.”

Tumors and Trauma

Performing surgery on the head and neck is intricate and often involves not only the removal of the tumor, but also reconstruction as well. She also commonly removes benign tumors on the neck and salivary glands.

“We do overlap with other disciplines,” Townsend says. “For example, we deal with the structure of the upper and lower jaw. Oral maxillofacial surgeons similarly work with jaw structure, oral tumors, and the temporal man dibular joint. Where we overlap is when the tumors need larger removal and reconstruction. We also both manage facial traumas. Where we start to diverge is a lot of the oncology and the reconstruction after the bigger surgery.”

The most common risk factors for oral and throat cancer are tobacco and alcohol use. A large percentage of these patients are adults in their middle to latter ages. Townsend’s patients are often referred by another ENT who has done a biopsy, or by a primary care provider who has a suspicion, but not a diagnosis. Townsend says that they also welcome self-re ferrals for any concerns about lumps or bumps.

“The anatomy is so dense that time makes a big difference in functionality,” she says. “Throat cancers are generally found at advanced stages. The reason is, people don’t expect that it’s happening. It doesn’t take a large tumor to be considered advanced because the throat anatomy is so compact. One of the earliest signs are the lymph nodes in the neck or changes in voice and swallowing. For oral cancers, generally, the presentation is going to be a new spot in the mouth or a lump in the neck. Any new lump or bump in an adult’s neck is a good reason for a referral to ENT.”

Townsend says screenings play an important

role in early detection. Active smokers should be screened every time they see their dentist. “We encourage primary care to refer early for any chronic sore throat or voice chang es,” Townsend says. “The incidence is largely based on where it’s located. Even though the throat is all connected, the different areas of the throat are susceptible differently. The voice box, Adam’s apple, and right above it — the larynx and hypopharynx — those two areas are usually tobacco and alcohol use related.”

Another cause of throat cancer is the HPV virus, which Townsend says tends to present in younger people and is often a tonsil or back of the tongue tumor. It is significantly more prevalent in men than women, who are more apt to have cervical cancer from the HPV virus.

Once the patient has been diagnosed with any of these cancers of the throat or mouth, the case is reviewed in the weekly meeting at the Brown Cancer Center to determine the best course of treatment, which often means deciding between radiation and surgery.

“We have good data to show that multidis ciplinary care of any cancer is by far the best,” Townsend says. “We put all our heads togeth er at one time and review each case in detail. Cancer is complicated and unpredictable, and to have all our expertise is very helpful. We also bring in our speech pathologist and then we bring the patient in. We present the stan dard of care to the patient, what the literature and experience shows to be the best pathway for cure. Functional outcome is a huge part of all of our treatment choices. Loss of the voice box or loss of part of the tongue are major functional changes. Our speech therapists and dieticians get involved for that part. The patient is given all the possible choices, and then we make the decision together.”

Minimally Invasive Surgery in Tight Places

If surgery is the choice, Townsend uses minimally invasive techniques to remove ton

sil and tongue base cancers in particular. Minimally invasive techniques for thyroid nodules are also gaining traction as a way to avoid surgery in the right cases.

“Chemotherapy agents are in select cases able target tumors better than we could before,” Townsend says of another treatment option. “We have really nice responses from some of our patients where in the past we had no options at all.”

Townsend stresses that screening, early detection, and referral are essential to max imizing the options for the course of treat ment.

“We like to see them early because the voice box is one area of the body you can only radi ate one time. Most people respond well, but for those that don’t, then we end up having to do a very big surgery. Sometimes we have surgical options for them at the early stages.”

The primary goal of any course of treat ment is, of course, to remove the tumor. But Townsend also understands the importance of limiting the residual damage to the patient.

“I like my patients to have good cosmetic and functional outcomes. I’m very sensitive to that,” she says. “We also have plastic surgeons we work with closely in our department who specialize in scars and rehabilitation and rean imation. How we rebuild people’s tongues and jaws and throats has become increasingly perfected. We can remove sometimes up to half of the tongue and patients can be talking and eating after surgery.”

The passion to care for others that was so prevalent in Townsend as a child still burns bright in her as an adult. She might have “bent the rules” to make sure she became a doctor in the board game, but in the actual game of life, she knows there are no do-overs. The screenings, the science, and the expertise are the tools needed to win the game.

“I value human life. Life is sacred. We each get one, and it’s very important,” Townsend says. “When it comes to cancer, it’s a difficult road, it’s a long journey in this part of the body. I want to do the best surgery so the cancer doesn’t come back. I tell my patients we go by the sci ence that we have and I will be there with them through that journey as long as it takes.”

PHOTO BY JOHN LAIr

Melanie Townsend, MD, treats throat and oral cancers at UofL Health.

TrueBeam® Comes to Lexington Clinic

The most advanced radiation tool of its generation is now in Central Kentucky.

BY TIM CORKRAN

LEXINGTON What if the length of every can cer treatment could be reduced by 80%? What if every radia tion delivery device was fully program mable to adjust middose for movement? And what if they all worked equally well on all types of tumors? Such a perfect world for radiation oncolo gists and their patients is now the reali ty at Lexington Clinic. With the acquisition of Varian’s TrueBeam® radiotherapy system, Lexington Clinic has emerged as the region’s go-to facility for patient-centered cancer treat ment. Their radiation oncology department, staffed by Robert S. Lavey, MD, MPH and Falguni Amin-Zimmerman, MD, brought the new tool online last month, and with it the promise of dramatically more efficient, accu rate, and patient-friendly radiation courses.

TrueBeam is the most advanced radiation tool of its generation. It has several key advances that improve patient experience and outcome. It has a couch that has maximum flexibility with both pitch and roll axes and software that compensates for patient motion, relieving the patient of the stress of remaining still. Highly programmable leaves or gates substantially reduce radiation overspill into non-tumor tissue, leaving patients healthier. Dramatically shorter treatment times help patient morale and facility scheduling. As Lexington Clinic noted in a recent press release announcing the acquisition, “Simple treatments that once took 15 minutes or more can now be completed in less than two.”

TrueBeam improves the radiation oncologist’s experience as much as it improves the patient’s. Its capability to synchronize motion, imaging, and dosage allows for fast, efficient treatment, and its versatility means radiation oncologists need only learn one machine for all the tumors they are treating. As Amin-Zimmerman says, “TrueBeam enables us to treat even the most challenging cases with tremendous speed and precision.” The software is vast and the hard ware is supple, so fine adjustments, mid-course, are actualized immediately with no treatment time lost, at the same time minimizing the radi ation dose to adjacent tissues.

A Tool Is Only as Good as Its User

The capabilities of Lexington Clinic’s TrueBeam are already being maximized because it is in the hands of two very experienced radia tion oncologists, Lavey and Amin-Zimmerman. Lavey is board-certified in radiation oncology, having received his MD from Stanford and his MPH at Berkeley. He completed his radiation oncology residency at Duke University Medical Center and has published some 45 articles on cancer and led 15 group clinical trials on

innovations in cancer treatment

While new to Lexington, Lavey has been using the field’s best tools for years and has expertise in the most advanced radi ation therapy treat ment techniques. He has used TrueBeam in several other settings, including Moffitt in Tampa and Maurer in Ohio. In his expe rience, “Truebeam is the best machine in precision, reliability, speed and versatility, with the capability to treat any cancer in the body from head to toe.”

Lavey was drawn to Lexington Clinic because he sought a regional hospital setting and, he says, “Lexington Clinic matched my philosophy of how patients are to be cared for. Communication is easy, and coordina tion of care is comprehensive.” Securing the TrueBeam sealed the deal for Lavey. “We now have the most advanced linear accelerator in the world, and we’re able to offer patients the highest standard of treatment,” he says.

Amin-Zimmerman is a Lexington Clinic veteran of 15 years. A Transylvania University graduate, she received her medical degree from the University of Louisville School of Medicine. She is board certified in radiation oncology, and excited to see this latest evolution in her department. She has been integral to develop ing the program over the years and having had experience with the TrueBeam’s predecessors in other settings, is primed to take full advantage of its potential. In fact, her longitudinal under standing of the tools of her field informs her appreciation of the TrueBeam.

Robert S. Lavey, MD, MPH, joined Lexington Clinic in the summer of 2022.

Falguni Amin-Zimmerman, MD, radiation oncologist, has been with Lexington Clinic for 15 years

Radiation Oncology’s Evolution to this Powerful Tool

Amin-Zimmerman sees three recent stag es of evolution in radiation delivery. In the 1980s–1990s, radiation oncologists relied on traditional two-dimensional x-rays of an area to be treated from which they drew diagrams to plan their radiation targets. A lead block was then formed with that information and placed on the patient’s body to protect healthy

tissue from overflow during radiation delivery. This multi-stage process was cumbersome and inaccurate, not to mention potentially excruci ating for patients who had to remain still. The late 90s and early 2000s brought healthy-tis sue-protecting lead leaves. These were shaped based on the cat scan imaging in an electronic planning system. The computer would help build the needed beam shape, and the machine adjusted the leaves to work with that beam.

A period of rapid innovation followed that led to the current generation of tools. “IMRT gave us the ability to change the shape of the field because the computer plan adjusts the positioning of the leaves during treatment. This leads to a more homogeneous dose of radiation, with fewer hot or cold spots,” says Amin-Zimmerman. But it could still not simultaneously radiate and adjust, so nothing was happening for much of the treatment period. “To move to every individual angle, one at a time, the machines simply stopped radiating,” she explains, “leaving the patient waiting for 70–80% of the time, all the while remaining still.”

TrueBeam’s culminating innovations, then, are the ability to radiate throughout the adjustment process and to compensate for minor body motions. “The beam is arcing, and the leaves are adjusting—all at the same time. The programming allows us to tweak all these variables, yet be delivering radiation throughout,” says Amin-Zimmerman. As a result, for most treatments, the beam is on for 2-5 minutes.

In addition, Truebeam uses the latest tech nological advances to focus the radiation against cancer cells while minimizing the radiation of adjacent tissues. The built-in gates, or leaves, constantly adjust according to the repositioning of the beam and any internal organ motion. For his part, Lavey particularly appreciates this aspect, noting “What really stands out for the TrueBeam is improved pre cision and reduced overspill of radiation. As such, it reduces side effects.” They can even shoot and analyze an x-ray during radiation to monitor for any anticipated movement, allowing them to further adjust if needed.

Speed, accuracy, and versatility are the holy trinity of tool excellence, and Truebeam has them. With these, the radiation oncologist becomes even more capable and valuable. For Lavey, the art of radiation therapy is similar to surgery in that the same operation will be performed differently by different surgeons depending in part on their tools. He con cludes, “Just as people seek out the surgeons who have the best record, they should be seeking out radiation oncologists who can do the best job. TrueBeam puts us up there.”

The More You Know

Michele Johnson, MD, stresses patient education at Women First of Louisville

BY JIM KELSEY

LOUISVILLE It’s easy to imagine a “wellwoman” visit with Michele Johnson, MD, an obstetrics and gynecology specialist at Women First of Louisville, as a live version of “The More You Know,” the long-running NBC public service announcement series. Much like those short videos, Johnson offers words of wisdom and advice in concise, easy to understand language.

A native of Ohio, Johnson received her undergraduate degree from Xavier University before attending the University of Cincinnati College of Medicine. She also completed her residency there in 2000 and received her board certification in obstetrics and gynecology in 2003. She joined Women First of Louisville in 2000 and has been with the practice ever since.

The Women First team includes 12 OB-GYN physicians, eight nurse practitioners, and four physician assistants, plus additional clinical and support members. Together, they focus on providing women with comprehensive care in every stage of life.

One thing that Johnson’s thorough education, training, and experience has taught her is that two heads are better than one. An informed and engaged patient can be a key component of positive health outcomes.

“My personal philosophy is that I’m an educator,” Johnson says. “I want to make sure that I have explained things enough to my patient so that she understands herself, her body; what is normal, what is not normal. I like to individualize care for individual patients. No two patients are exactly the same. You have to look at the whole patient and her needs.”

At Women First, Johnson sees women of all ages. She is in the office two or three days a week, with one day a week set aside for operating either at the hospital or performing in-office procedures. One day a week is typically devoted to obstetrical call.

She was recruited to Women First by one of her former residency colleagues and current

co-worker, Ann Grider, MD, but she credits another physician with influencing her decision to become an OB-GYN in the first place.

“As a first-year medical student at the University of Cincinnati, we were given the opportunity to pick a specialty and we were then paired with a provider in the community to shadow that specialty,” Johnson says. “I chose obstetrics and gynecology and got paired with a wonderful physician out of Cincinnati named Dr. Ted Lum. His bedside manner with his patients was amazing to see and it is what made me want to do this field.”

A Lifelong Connection

Seeing how Lum interacted with his patients, Johnson was drawn to the opportunity that obstetrics and gynecology provided to build lifelong connection with patients.

“You take care of patients when they are young women in their teens and you get to see them yearly. Hopefully, you get to help them with pregnancy, and then you take care of them into their middle age and into their menopausal years,” she says. “I like having those connections and the variety of care I provide.”

Central to that care is the annual wellwoman visit. This exam includes obtaining and updating the comprehensive history of the patient, including any changes that have occurred since their last exam, such as surgeries, menstrual issues, or changes in their family health history.

“Some people perceive the well-woman visit as coming for their breast or pelvic exam or Pap smear, but we look at it as an opportunity to educate the patient about what might be pertinent at that time in their lives with regard to their health,” Johnson says. “We want to identify her particular health risks and needs.”

Johnson says the well-woman visit might be as short as 20 minutes, but that there is no time limit. “I try to not ever look at the clock,” she says. “I’m in the room for as long as that patient needs me. Everybody deserves our time.”

More than a Pap Smear

The annual well-woman visit does include many recommended screenings. Annual mammograms are recommended for all women beginning at age 40. At Women First, these patients have the opportunity to have a 3D tomosynthesis mammogram, which can improve breast cancer detection. These patients also have a breast cancer risk assessment calculated annually to identify those who might be at increased risk of breast cancer. Those at higher risk often benefit from the use of breast MRI as an additional screening tool.

Bone density screenings are recommended for every woman 65 or over, and younger post-menopausal women should have them if they have additional risk factors. Colon cancer screening is also recommended beginning at age 45. The HPV vaccine can begin as early as age 10 up to age 45.

Current updated cervical cancer screening recommendations for women who are considered low-risk and between the ages of 21 and 29 call for a Pap smear once every three years. For low-risk women between the ages of 30 and 65, there are three options: 1) a Pap smear every three years, 2) HPV testing every five years, or 3) HPV testing combined with a Pap smear every five years. Women considered at higher risk for cervical cancer should be screened every year.

While Johnson says the changes in the

“I try to not ever look at the clock. I’m in the room for as long as that patient needs me. Everybody deserves our time.” — Dr. Michele Johnson, Obstetrics and Gynecology, Women First of Louisville

various screening recommendations are good, they do create a potential problem with women assuming they don’t need their annual exam.

“Because so many women equate the annual exams with their Pap smear, they stop coming in once a year because they think they only need to come every three or five years,” Johnson says. “We want women to be aware that the Pap smear is only one facet of that exam. We want to see them yearly because there are other screenings that need to occur, or other health issues we need to intervene with.”

The Hidden Cancers

Johnson says the Pap smear screening is very effective for early detection of cervical cancer

and the yearly mammogram is particularly helpful in early detection of breast cancer. Other gynecologic cancers are uterine and ovarian cancer.

“We do not have any good screening strategies for early detection of either uterine or ovarian cancer,” Johnson says. “But when we see patients for their yearly exams, it does provide the opportunity to discuss any signs or symptoms that might be associated with these cancers. Uterine cancer often presents early because women will present with abnormal bleeding, such as changes in their menstrual cycle or bleeding after menopause. Most uterine cancers occur in women in their perimenopausal to post-menopausal ages. We can

PHOTO BY ALEXANDRA ROGERS

perform diagnostic procedures in the office to help identify if she might have uterine cancer or even a precursor to uterine cancer.

“Ovarian cancer continues to be the one we struggle to identify early,” Johnson continues. “There are some symptoms, although vague and most times not associated with ovarian cancer, that we do want patients to be aware of. If suddenly you’re starting to have a lot of abdominal bloating, pain, get full fast, or are having difficulty eating, come in and allow us to evaluate you with pelvic ultrasound, a lowrisk and non-invasive evaluation.”

In addition to educating her patients, Johnson wants to make sure that the primary care providers are aware of these changes in screening protocols and diagnostic capabilities that are offered so they can help communicate the importance of the annual well-woman visit. She also wants to inform non-OB-GYNs about recent changes in female sterilization. The procedure, which used to involve burning or removal of a portion of the fallopian tubes, is now a bilateral salpingectomy—removal of both fallopian tubes. Studies have shown that complete removal of the fallopian tubes reduces risk of ovarian cancer.

“For patients who may be considering sterilization and wondering whether they or their partner should undergo the procedure,” Johnson explains, “there are now some potential health benefits to a woman having the procedure done as current data suggests that ovarian cancers may actually originate in the fallopian tube.”

She also wishes to dispel some of the myths about post-menopausal hormone therapy. Past data suggested that hormone therapy increased risk of breast cancer and cardiovascular disease. But more recent data, Johnson says, suggests that for some women between the ages of 50 and 59, the use of hormone therapy may actually be beneficial and without significant risk.

“Have your patients come talk with us,” Johnson encourages her fellow healthcare providers. “We would like to have the opportunity to educate them about risks and benefits and individualize their care.”

After all, the more you know, the better, right?

Dr. Michele Johnson joined Women First of Louisville as an Obstetrics and Gynecology specialist in 2003.

New Program to Address Leading Cause of Cancer Death in Kentucky

BY ELIZABETH A. HOAGLAND, CHFS, DPH, DPQI

FRANKFORT While lung cancer is a daunting disease, early detection, new technologies, and therapies means survivability is increasing all the time. A key factor to increasing survivability is catching masses before they spread and metastasize. New guidelines from the US Preventive Task Force and a new program established at the Kentucky Department for Public Health will both work to increase lung cancer screening and reducing mortality.

Based on Kentucky’s smoking rates, over 600,000 Kentuckians are eligible for lung cancer screening – but only 15% are actually getting screened. Screening is import ant because the five year survivor rate for local lung cancers is 54%, compared to 5% at late stage or distant lung cancers. The evidence is clear that screening and early detection cause a clear increase in survivorship.

The majority of lung cancer cases are caused by tobacco smoking, including cig arettes, cigars and pipes. Radon gas is the second leading cause of lung cancer and multiplies the risk of cancer when combined with tobacco smoke. Kentucky has very high rates of radon, a clear, odorless radioactive gas commonly found in limestone bedrock.

The US Preventive Task Force Services recommends that anyone between the ages of 50 and 80, who has a 20-year pack smoking history and is currently smoking or has quit within the past 15 years should be screened for lung cancer using a low-dose CT scan (LDCT scan). Pack-years can be calculated by multiplying the number of packs of ciga rettes smoked per day by number of years the person has smoked. Eligible patients should be screened on an annual basis to monitor potential lung cancer lesions.

Kentucky has almost forty lung cancer screen ing centers recognized as Centers of Excellence.

These Centers meet high-quality requirements by the American College of Radiology, the National Comprehensive Cancer Network and the International Early Lung Cancer Action Program, which include shared decision-mak ing, comply with best practices for screening, and communication protocols between health care providers. Kentucky Screening Centers of Excellence can be found at https://go2founda tion.org.

Health care providers should have open and honest dialogues with patients about the benefits and risks of lung cancer screening. It’s important that patients realize that early detection significantly increases their odds of long turn survivorship. Patients may not realize that lung cancer screening should be annual, just like an annual checkup. For patients who are still using tobacco products, motivational interviewing and using the 5A’s may assist your patient to quit. At any point, quitting tobacco usage will be a benefit to their long-term health.

There are two primary risks to lung cancer screening with a LDCT scan.

• The first is that false-positives may lead to invasive medical treatments that are not needed. Sometimes the wisest course of action is to monitor a suspicious spot

on the lungs, which can be emotion ally and mentally difficult for the patient and their family.

• The second risk is that LDCT scans do expose patients to radiation and should only be used if medically neces sary. For someone who meets eligibility guidelines for screening, the risks of LDCT are much less than the risks of untreated lung cancer.

Realizing the high burden of lung cancer in Kentucky, the legislature and Governor passed HB 219 in the 2022 legislative session. The Margaret M. Poore Lung Cancer Act, named for Rep. Kim Moser’s mother, establishes a Lung Cancer Screening Program at the Kentucky Department for Public Health and an Advisory Committee charged with ensuring the program has the data needed for health care providers to make evidence-based decisions. The program will strive to increase lung cancer screening in the state through partnerships with health care providers, health care systems and through patient education.

No one wants a lung cancer diagnosis, but with significant medical advances there is hope. Together we can screen appropriate patients and catch cancer early to reduce death.

For more information about the lung cancer screening program or the advisory committee, email LungCancer@ky.gov. To find the nearest lung cancer screening cen ters to you, go to the American College of Radiology finder at: Accredited Facility Search (acraccreditation.org).

Elizabeth Anderson-Hoagland is the supervisor in the Health Promotion Section at the Kentucky Department for Public Health. She was a policy analyst with the Kentucky Tobacco Prevention and Cessation Program for seven years. As part of her position, she focuses on a variety of issues related to youth tobacco use, including 100% Tobacco Free School policies and TRUST, a tobacco retailer underage sales training initiative.

Rick Lozano

Patrick  Crowe

Jessica Howard

Sarah Williams

Brad Gibson

Jason Clark

Lee Picklesimer

Jason Mull

George Kim

Filip Garrett

Estranged From Your Adult Child? Try These EvidenceBased Strategies

BY JAN ANDERSON, PSYD, LPCC

Do you have a close family member with whom you currently have no contact?

If you said yes, you’re not alone. Almost one-third of Americans (27% to be exact) are estranged from a close relative. Here’s how family estrangement currently breaks down in the United States:

• 10% are estranged from a parent or child

• 8% are estranged from a sibling

• 9% are estranged are other relatives

As a therapist specializing in family estrangement, there’s something not so obvi ous if you’re the one who’s been cut off: No matter what side of the estrangement equation you’re on, there’s pain. No one escapes it.

If you’re a parent estranged from your adult child, there’s usually an extra heaping of embarrassment and shame added to the stig ma. You’re dealing with rejection from the one person you thought would never reject you.

There’s Plenty of Pain To Go Around.

It’s easy to understand how painful it would be if your own kid cut ties with you completely and permanently. But I find that the person initiating the estrangement is often quite conflicted. It’s a different kind of pain, but I’ve noticed it’s no picnic for them, either.

But hey, they initiated the estrangement, right? They have the upper hand, don’t they? While that’s true, there is plenty of suffering on all sides of family estrangement. “I’m done” is often a last-resort attempt to stop the pain.

No wonder there’s a reluctance to acknowl edge family estrangement. No wonder researchers believe numbers are underestimat ed. No wonder almost every estranged family member I encounter shows up with a sense of isolation.

The sense of aloneness can be particularly profound for parents estranged from an adult child. You’re acutely aware that your life clock

is ticking, that it’s urgent to resolve the rup ture before it’s too late. Holidays are particu larly vulnerable times that can trigger intense emotions of confusion, rage, grief, and guilt.

Being ghosted can intensify an estranged parent’s desperation to relieve the uncertainty about the relationship. How do you begin to heal the rift if you’ve been cut off?

The Brain Science of Estrangement

If there’s one thing our brains don’t like, it’s uncertainty. I don’t understand why this is happening. When will this be over? Are things ever going to get back to normal — or at least get better? I don’t know how to make it better.

Being a tribal species, rejection quickly gets our survival brain’s attention. Being shunned elicits strong emotions that can overwhelm your physiology. That means your rational thinking brain goes offline and your survival brain takes over. Its instinctual hair-trigger reactions are a great help in life-and-death situations.

But relationship conflict with close fami ly members? Estrangement from your adult child? Not so much.

Your survival brain has no obvious blackand-white answers or quick fixes for dilemmas like the ones expressed by parents estranged from an adult child: When I retired, I thought I was going to be a grandmother. Now my daughter has cut off all contact with her and my grandchildren. Who am I now?

Recent Research on Estrangement

Fortunately, some light is now shining on the problem of family estrangement. The Cornell Family Reconciliation Project is the first largescale national survey on estrangement.

Researcher and Cornell sociologist Dr. Karl Pillemer’s groundbreaking research provides a blueprint of evidence-based ways estranged family members have navigated the choppy waters of reconciliation.

The study focused on 200 participants over

a ten-year period to identify:

• Study participants who reconciled with an estranged family member.

• The strategies the “reconcilers” used to overcome past hurts and build a new future with a relative.

• Science-based guidance and tools for reconciliation, based on the experience of those who have “been there.”

From Rejection to Reconciliation

The Cornell study revealed a surprising strat egy that almost all reconcilers adopted. I’ve bro ken it down into some simple dos and don’ts. First, here’s what the reconcilers didn’t do:

• Reconcilers didn’t require the estranged relative to accept their version of the past.

• Reconcilers didn’t require an apology from the estranged relative.

• Reconcilers didn’t try to change the estranged relative.

These strategies square with encounters like the mind-blowing exchange one mother had when her adult son called from out of the blue following four years of no contact:

Son: My wife asks me why I never want to call.

Mother: I figured it was because you thought I was too needy and desperate.

Son: Actually, I told her it’s because I thought you blamed me for everything that’s hap pened.

Mother: That’s the last thing I thought you would say! I’m so sorry it came across that way. It wasn’t my intention.

In that case, an apology wasn’t required, but its delivery was spontaneous and heartfelt and set the stage for Mother to learn more about how Son felt, which helped to move the process forward.

Instead, here’s what the reconcilers did do:

• The reconcilers focused on the present and future of the relationship.

• The reconcilers forged a new relationship based on more realistic expectations.

Here’s how one estranged mother handled this delicate transition:

Mother: I don’t want to jump to any conclu sions. Are you thinking you may want to have some kind of relationship?

Daughter: Yes… I want to have… some thing.

Mother: I know I want something… but what do you want?

Daughter: Well, one thing that I need is… I don’t want to talk about stuff from the past.

Mother (pauses): I can do that. I couldn’t have said that before… but now I think I understand.

From Rejection to Resilience: Get a Grip on Yourself

I like sharing the success stories because they can be inspiring, motivating, and create hope.

You’ll need that. Here’s why:

• Working your way through estrangement is not for the faint of heart.

• On top of that, you’ll need access to every ounce of your capacity for rational and prosocial thinking in the newer, more evolved part of your brain.

• And one more thing: You’ll have to learn some life skills you were probably never taught.

Yeah, it’s tough. Sometimes attempting reconciliation isn’t possible or even a good idea, especially in cases of violence or abuse. And there are no guarantees. Not everyone in the Cornell study made it. About half of the 200 participants were able to reconcile with an estranged family member. Not all the reconciliations were perfect, but most partic ipants reported they were glad it happened anyway. Even when reconciliation attempts were unsuccessful, some participants reported greater peace of mind for having tried.

Sometimes they end well. Like it did for a man who expressed his concern to a distant relative after a ten-year estrangement from his siblings:

Man: I’m not sure anyone would be inter ested in having contact with me.

Distant relative: I’ve spoken with your brothers, and they want you to know they would welcome you with open arms.

That’s why I want to be a part of it.

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Jacob Trapp, DO, Joins CHI Saint Joseph Medical Group in Lexington

LEXINGTON Jacob Trapp, DO, has joined CHI Saint Joseph Medical Group – Primary Care in the Palomar Center. Originally from Michigan, Trapp earned his doctorate in osteo pathic medicine at Michigan State University and completed his internships and residencies in Michigan, Pennsylvania and Ohio before moving to Lexington, where his fiancée is a pharmacist.

Jacob Trapp, DO

“The most important thing when it comes to patients is that you have to take them as a whole individual – not just medical problems, but also mind, body and spirit,” says Trapp. “My favorite experience is when I’m really able to help a patient and have done something to improve their lives, and they come back and say, ‘Dr. Trapp you’ve really made a difference.’”

Trapp’s residency training included a year of internship with Henry Ford Allegiance Health in Jackson, Michigan, one year of clinical anesthesiology with the University of Missouri in Columbia, Missouri, and three years of Family Medicine in New Richmond, Ohio; at The Wright Center for Graduate Medical Education, based in Scranton, Pennsylvania. Residents in the program do clinical training in needy communities across the United States.

Trapp is a member of the AMA and the American Osteopathic Association. A big fan of all things Disney, Trapp and his fiancée, Caroline Johnson, a hospital pharmacist at UK HealthCare, will be married at Walt Disney World Resort later this year.

Zaiba Khan, MD, Joins CHI

Saint Joseph Medical Group –Primary Care in Lexington

LEXINGTON Zaiba Khan, MD, has joined CHI Saint Joseph Medical Group – Primary Care in the Palomar Centre. Khan comes to CHI Saint Joseph Health after several years as a family medicine resident in the DeTar Family Medicine Residency Program at Texas A&M.

Khan completed her undergraduate edu cation at the University of California, Irvine. During that time, she changed her career path from journalism to medi cine after a trip to India where she worked with underserved community members.

Zaiba Khan, MD

“I encountered a girl who was the victim of abuse and could not communicate her needs,” Khan says. “I was able to get to know her personally because I was closer to her age. It made me realize that sometimes you need people in your life who will advocate and speak for you, which is how I became inter ested in medicine.”

Khan earned a bachelor’s degree in public health and continued her education at Atlantic University School of Medicine, where she graduated with her medical degree in 2017. She received her Educational Commission for Foreign Medical Graduates certification (ECFMG), which recognizes international medical graduates. Additionally, Khan is cer tified in family medicine, advanced cardio vascular life support (ACLS), basic life sup port (BLS), pediatric advanced life support (PALS), and is a member of the AAFP.

Amanda Vickers, DO, Joins

CHI Saint Joseph Health – Primary Care in Wilmore

father, uncle, and grandfather inspired her to join the service. She served at Dyess Air Force Base in Texas from 2014 to 2019 as a medical director, attending physician and family med icine allergy extender. In 2019, she moved to Missouri to work as an outpatient primary care physician and realized her passion for educating patients on the importance of pre ventive care.

“I’m the kind of doctor that teaches,” says Vickers. “I feel like my patients should know their medications, why they take them, and what it will do for them.” Vickers stresses a crit ical aspect of preventive care is women’s health. “As women, we neglect ourselves. Even though we are often the cornerstone of the family unit, we often forget our health care.” She says it’s crucial to stay up to date on preventive screen ings and educate yourself on your body and how to take care of it so you can self-heal.

After receiving her bachelor’s degree in chemistry, mathematics, and biology from the University of Arkansas at Monticello in 2007, Vickers attended medical school at Edward Via College of Osteopathic Medicine in Blacksburg, Virginia. She completed her residency in family medicine at the University of Missouri in 2014.

Vickers has received the Air Force Outstanding Unit Award, Meritorious Unit Award, Global War on Terrorism Service Medal, Air Force Training Ribbon, National Defense Service Medal, and the Meritorious Service Medal.

Casey Clark, MD, Joins CHI Saint Joseph Medical Group –Primary Care in Winchester

Amanda Vickers, DO

WILMORE Amanda Vickers, DO, has joined CHI Saint Joseph Health –Primary Care in Wilmore. Vickers comes to CHI Saint Joseph Health after sev eral years as a medical director and an attending physician at Dyess Air Force Base in Texas and two years as an attending physician in a family medical group in Jefferson City, Missouri.

Originally from a small town in Arkansas, Vickers grew up in a military household; her

WINCHESTER Casey Clark, MD, a Vanceburg, Kentucky, native with a passion for helping improve health care in his home state, has joined CHI Saint Joseph Medical Group – Primary Care in Winchester. Clark comes to CHI Saint Joseph Health after completing a residency in internal medicine and pediatrics with UK Healthcare.

Casey Clark, MD

Clark completed his undergraduate and medical education at UK. Clark says he grew up in an impoverished community and had never been exposed to the idea of practicing medicine, so he didn’t consider it a potential career path until he went to college.

“Because of my history and where I grew up, I’ve maintained an interest in rural health care,” Clark says. “I grew up in a family where no one was in medicine, but once I had this

Thoracic Surgeon Nabeel Gul, MD, Joins Baptist Health Medical Group

NEW ALBANY Thoracic surgeon Nabeel Gul, MD, has joined the Baptist Health Medical Group.

Gul is a board-certi fied general surgeon and fellowship trained in thoracic surgery, thoracic surgical oncology and critical care. He specializes in robotic and minimally inva sive surgical treatment for patients with disorders of the chest, including lung, esophagus, diaphragm and chest wall.

He is a graduate of Jinnah Sindh Medical University in Karachi, Pakistan and com pleted general surgery residency at Jinnah Postgraduate Medical Center, University of Minnesota and State University of New York at Buffalo. He completed surgical care fellowship at Washington University in St. Louis, thoracic surgery fellowship at Baylor College of Medicine, and thoracic robotic fellowship at the American Association for Thoracic Surgery.

Gul earned several honors including the Baylor Professional Educator Appreciation and Recognition award; Michael E. DeBakey VA Medical Center Best Catch award; Arnold P. Gold Humanism and Excellence in Teaching award; Worthington B. Schenk Resident Teacher of the Year award; SUNY Buffalo Best Overall General Surgery Resident; Louis A. and Ruth Siegel

exposure to science in, it was an immediate fit. I knew this is what I needed to be doing.”

Clark graduated from UK with a BS in biology, is a member of the university honors program and graduated magna cum laude. Upon entering medical school, he participat ed in UK’s Rural Health Scholars Program and Rural Physician Leadership Program. Both programs vet students interested in practicing in a rural area after they complete

Award for Excellence in Teaching; and was named to the Gold Humanism Honor Society in 2017.

To schedule an appointment with Dr. Gul, call 812.949.5575 or 502.895.2295. He has offices in both New Albany, 2125 State St., Suite 3; and Louisville, 3950 Kresge Way, Suite 402.

Baptist Health Leads the Way in Treating Atrial Fibrillation with New OCTARAY Technology

LEXINGTON In July, 2022 Gery Tomassoni, MD, an electrophysiologist at Baptist Health Lexington, was one of the first physi cians in the state to use an innovative new tool in the treatment of atrial fibrilla tion (AF) when he performed an ablation on a patient’s heart using the OCTARAY Mapping Catheter.

Traditionally, an additional mapping catheter (PENTARAY) is used to recon struct the heart anatomy and locate the cardiac sites for ablation. Now with the new OCTARAY technology, the time required to create the atrial anatomy is shorter and identification of the ablation sites is more accurate.

“OCTARAY technology provides addi tional catheter splines resulting in a higher number of electrodes that also have a shorter distance between them. In addi tion, the electrodes have a higher record ing fidelity. As a result, the electrical

their medical education and training. The selection process is competitive, and the pro gram allows students to complete multiple clinical rotations across Kentucky, depending on their specialty.

Clark has received awards, including being named Internal Medicine-Pediatrics Teacher of the Year and Graduate Medical Education Resident of the Month at the University of Kentucky.

signal quality is significantly improved,” explained Tomassoni.

“Electrical mapping of the chambers using OCTARAY technology is more effi cient resulting in a faster acquisition of both the electrical signals and reconstruction of the overall heart anatomy. Reduction in procedural time and enhancement of workflow efficiency can improve patient care. Less time in the procedure is better for the patient because you’re reducing the potential risks associated with longer procedures,” said Tomassoni.

Baptist Health Names New Chief Medical Officer

LEXINGTON Lee Dossett, MD, has been named chief medical officer at Baptist Health Lexington, effective Nov. 1.

Dossett has been with Baptist Health Lexington since 2009 and has served as a hospitalist and in many leadership roles, including director of hospital medicine, chair of the Department of Medicine, president of the medical staff, chair of the credentials committee, and vice chair of the hospitalist service line.

Lee Dossett, MD

He is also a Board of Health mem ber for Lexington-Fayette County and president-elect of the Lexington Medical Society. He received both his undergraduate degree and Doctor of Medicine from the University of Kentucky. He completed his residency at The Ohio State University.

Nabeel Gul, MD

Gery Tomassoni, MD

Lexington Clinic Welcomes New Physicians

LEXINGTON Lexington Clinic welcomes new physicians: Alexander Patterson, MD, Christian Warner, MD, Eric Schmidt, MD, Rebecca Adams, MD, Robert Lavey, MD, Matthew J. Zimmerman, MD, and Rebecca Geile, MD.

Alexander Patterson, MD, joined Lexington Clinic Allergy based out of the Lexington Clinic East location. Patterson completed his fellowship training in allergy and immunology at Washington University and Barnes Jewish Hospital, St. Louis, Missouri. He received his medical degree from the UK College of Medicine and also completed a combined Internal Medicine and Pediatrics residency there.

Patterson specializes in diagnosing and treating allergies, asthma, and immunologic disorders. His professional interests involve food allergy, rhinitis, urticaria, angioedema, drug allergy, and immunodeficiency in both adults and children.

Christian Warner, MD, joined the Lexington Clinic Ophthalmology at the Lexington Clinic East location. Warner received his medical degree from Marshall University Joan C. Edwards School of Medicine, Huntington, West Virginia. He completed an internship in internal medicine at Marshall University and a residency in ophthalmology at West Virginia University.

Warner provides services in comprehensive ophthalmology for adults and children; diagnosis, management, and surgical treatment of glaucoma; diagnosis, management and laser treatment of diabetic retinopathy; small incision cataract surgery; and diagnosis and surgical treatment of eyelid disorders.

Eric Schmidt, MD, joined the Lexington Clinic Neurosurgery at the CHI Saint Joseph Office Park location. Schmidt received his medical degree from the UK College of Medicine. He completed a residency in neurosurgery at the Cleveland Clinic in Ohio with fellowships in spine surgery and epilepsy surgery.

Schmidt provides consultation services in cranial, spinal and peripheral nerve surgery, including primary and metastatic brain tumors, vascular lesions, spinal tumors, deformative and degenerative spinal disease, medically-refractory epilepsy, pituitary tumors, Chiari malformations, and compressive neuropathies. Schmidt’s professional interests include complex spinal pathology, surgical management of intractable epilepsy, and neurosurgical oncology.

Rebecca Adams, DO, joined Lexington Clinic East. She received her DO degree from the University of Pikeville-Kentucky College of Osteopathic Medicine and completed her family medicine residency at St. Elizabeth Healthcare in Edgewood, Kentucky.

Adams is board-certified in family medicine and provides services in general family medicine, geriatric medicine, women, adolescent and children’s health issues, and preventive medicine. Her professional interests include patient education and patient centered care.

Robert Steven Lavey, MD, MPH, joined Lexington Clinic Radiation Oncology at the CHI Saint Joseph Office Park location. Lavey is board-certified in radiation oncology by the American Board of Radiology. He received his medical degree from Stanford University in California and his MPH in epidemiology from the University of California, Berkeley. He was chief resident and completed his radiation oncology residency at Duke University Medical Center, North Carolina.

Matthew J. Zimmerman, MD, MSPH, joined Lexington Clinic Cardiology. Zimmerman received his medical degree from the University of Louisville and completed a residency in Internal Medicine there as well. Zimmerman is fellowship trained in cardiology and interventional cardiology. Providing services in general cardiology, he performs stress tests, nuclear cardiology studies, trans-esophageal echocardiography, and vascular ultrasound.

Rebecca Geile, MD, joined Lexington Clinic in Richmond. Geile received her medical degree from the UK College of Medicine and completed her residency there as well. Geile provides general internal medicine services to adult patients, including management of acute and chronic health conditions.

Alexander Patterson, MD

Christian warner, MD

Eric Schmidt, MD

Rebecca Adams, DO

Robert Steven Lavey, MD, MPH

Matthew J. Zimmerman, MD, MSPH

Rebecca Geile, MD

WELCOME TO LEXINGTON CLINIC

Robert S. Lavey, MD, MPH

RADIATION ONCOLOGY

Dr. Robert Lavey is board-certi ed in Radiation Oncology by the American Board of Radiology. Dr. Lavey received his M.D. degree from Stanford University, CA, and his M.P.H. in Epidemiology from the University of California, Berkeley. He was Chief Resident and completed his Radiation Oncology residency at Duke University Medical Center, NC.

Dr. Lavey specializes in all types of external beam radiation treatment for cancer, including, but not limited to, lung cancer, breast cancer, prostate cancer, rectal cancer, head and neck cancer, brain tumors, esophageal cancer, pancreatic cancer, skin cancer, sarcomas, pediatric cancer and lymphoma. He is an expert in the most advanced radiation therapy treatment techniques.

To learn more about Dr. Lavey and our radiation oncology services, scan the QR Code or visit lexingtonclinic.com.

Radiation Oncology 1401 Harrodsburg Road Suite A-100 Lexington, KY 40504 P 859.258.6505 lexingtonclinic.com

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Lexington Medical Society Meets to Welcome Past Presidents

Tuyen Tran, MD, 10th District Trustee, gives KMA Update

LEXINGTON The Lexington Medical Society (LMS) held its Fall 2022 meeting, in-person for the first time since the COVID-19 pandemic. A full house, members and guests, were at the Signature Club in Lexington on October 12.

The event was co-sponsored by Professionals’ Insurance Agency, Inc. and Republic Bank.

LMS president Khalil U. Rahman, MD, presided, and Tuyen Tran, MD, gave the program address, highlighting accomplishments of the Kentucky Medical Association (KMA) during the 2022 KY legislative session.

Tran noted that three bills prioritized by the KMA were passed. One established the Lung Cancer Screening program; another created compassionate patient sup port; and the third created a Healthcare Worker Loan Relief program with $4 million in funding.

The 2023 initiatives for KMA will be scope of practice legislation and KY physician care.

The next LMS in-person dinner meeting is sched uled for Thursday, November 10, 2022 featuring Steven Stack, MD, MBA, FACEP, commissioner for the KY Department for Public Health and recipient of the Jack Trevey Community Service Award.

Lisle Dalton, MD, and wife Kathy.

Emily Chambers and Emily Miller, Republic Bank.

Killian Timoney, KY representative and recipient of the KMA Advocacy award for HB 529 with David Bensema, MD, former KMA president, and Corey Meadows, KMA deputy executive VP and director of advocacy.

Charles Papp, MD, and Khalil Rahman, MD.

John DeWeese, Professionals’ Insurance Agency, with John Collins, MD.

Tuyen Tran, MD, 10th District Trustee, gives KMA Update.

Tad Hughes, MD, Wanda Gonsalves, MD, David and Marian Bensema, MDs.