MD-Update Issue 143

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #143 WWW.MD-UPDATE.COM

Bringing the Brain Back to Former Function

VOLUME 12 • #6 • December 2022

Joseph Neimat, MD, chairman of UofL Health – Restorative Neuroscience focuses on restoration, research, and residency training ALSO IN THIS ISSUE PAIN TREATMENT CENTER ADDS ADDICITION MEDICINE SPINE SURGERY AT NORTON HEALTHCARE BEHAVIORAL HEALTH AT CHI SAINT JOSEPH HEALTH NEUROSCIENCE AT NORTON HEALTHCARE Q & A WITH KMA PRESIDENT ORTHOBIOLOGICS AT WELLWARD REGENERATIVE MEDICINE

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS World Class Hand Care

VOLUME 12 • #4 • SEPTEMbEr 2022

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

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

2023

Editorial Calendar

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

ISSUE #144 (February) HEART, STROKE & LUNG HEALTH Cardiology, Cardiothoracic Medicine, Cardiovascular Medicine, Pulmonology, Sleep Medicine, Vascular Medicine, Bariatric Surgery, Wound Care

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

ISSUE #145 (April) INTERNAL SYSTEMS

Endocrinology, Gastroenterology, Geriatrics, Internal Medicine, Integrative & Regenerative Medicine, Infectious World Class Hand Care Diseases, Lifestyle Medicine, Nephrology, Urology Legendary practice Kleinert Kutz continues the training and legacy of its founders

VOLUME 12 • #4 • SEPTEMbEr 2022

ISSUE #146 (June) WOMEN’S & CHILDREN’S HEALTH OB/GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology,

ALSO IN THIS ISSUE SPORTS MEDICINE AT UofL HEALTH & ATHLETICS TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE

ISSUE #147 (September) MUSCULOSKELETAL HEALTH SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH

NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

Orthopedics, Sports Medicine, Physical Medicine & Rehabilitation, PT/OT

ISSUE #148 (October) CANCER CARE World Class

Hand Care Oncology, Plastic Surgery, Hematology, Radiation, Radiology Legendary practice Kleinert Kutz continues the training and legacy of its founders

ISSUE #149 (December) IT’S ALL IN YOUR HEAD VOLUME 12 • #4 • SEPTEMbEr 2022

Neurology, Neuroscience, Ophthalmology, Pain Medicine, ENT, Psychiatry, Mental Health ALSO IN THIS ISSUE

SPORTS MEDICINE AT UofL HEALTH & ATHLETICS

TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

Editorial topics and dates are subject to change

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

To participate, please contact VOLUME 12 • #4 • SEPTEMbEr 2022

Gil Dunn, Publisher • GDUNN@MD-UPDATE.COM • 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com ALSO IN THIS ISSUE

SPORTS MEDICINE AT UofL HEALTH & ATHLETICS

TAKING THE PAIN OUT OF JOINT PAIN AT WELLWARD REGENERATIVE SPORTS MEDICINE AT CHI SAINT JOSEPH HEALTH NEW ORTHOPEDIC CENTER AT BAPTIST HEALTH LOUISVILLE

LETTER FROM THE EDITOR/PUBLISHER

Welcome to the Neurology, Neuroscience, Pain Medicine, and Mental Health issue of MD-Update Our December issue always has a wide variety of topics: neurology, neurosurgery, pain and regenerative medicine and mental health. You’ll find all of them here.

Our cover story on Dr. Joseph Neimat, chairman of the department of neurological surgery at UofL, takes us into the developing world of life-altering seizure treatments. Spine surgeon Kathryn McCarthy, MD, at the Norton Leatherman Spine Center, tells us how she alleviates pain and restores function for her patients. The Pain Treatment Center of the Bluegrass has added an addiction medicine specialist, and CHI Saint Joseph Health has added a behavioral medicine psychiatrist.

Virtual medicine is taking off at the Norton Neuroscience Institute with Drs. Abigail Rao and Justin Phillips interacting remotely with Parkinson’s patients. Regenerative medicine specialist Danesh Mazloomdoost, MD, at Wellward Medical, talks about the role of orthobiologics and joint pain relief.

Monalisa Tailor, MD, the new president of the Kentucky Medical Association, talks about her presidential platform.

Dr. Steven Stack At the Lexington Medical Society’s November 10th dinner meeting, Dr. Steven Stack, commissioner for the KY Department of Public Health, shared some interesting anecdotes that occurred during the COVID-19 pandemic. Among them: his transition from neckties to bow ties at the daily televised press conferences because he heard that some viewers were commenting on his neckwear; being recognized at McDonalds while eating with his children; and finding that being sued was part of the job (one that he preferred over armed insurrections and kidnapping).

We were so very fortunate to have a seasoned professional like Dr. Stack during a time of crisis in Kentucky.

A Stream to Follow Our friend Jess Wright, MD, internationally known psychiatrist, researcher, author, and professor at UofL has written his first novel, entitled A Stream to Follow. It tells the story of a WW1 veteran coming to grips with the psychological trauma of war and the joy of fly-fishing.

Copies are available through www.gosparkpress.com. If you like Hemingway, you’ll enjoy A Stream to Follow.

2023 We are working on 2023. The editorial calendar is on page 1 of this issue. I invite you to look for your specialty and contact me. If you don’t see your specialty listed, that’s even more reason to contact me.

I’m sure you have an interesting story to tell. I’m looking forward to hearing it.

Until next year, all the best,

Gil Dunn Editor/Publisher MD-Update

2 MD-UPDATE

SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax

MD-UPDATE MD-Update.com Volume 12, Number 6

ISSUE #143

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Jan Anderson, PSYD, LPCC Danielle Anderson, MD Jamie W.Dittert, Esq. Brandy Montgomery, CPC, CPMA, CPCO Scott Neal, CPA, CFP Colleen Ryan, MD Connie White, MD

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CONTENTS

ISSUE #143

ringing the 10 B Brain Back to Former Function

Joseph Neimat, MD, chairman of UofL Health - Restorative Neuroscience focuses on restoration, research, and residency training 4 6 7 8 10

HEADLINES ACCOUNTING LEGAL FINANCE COVER STORY

SPECIAL SECTIONS: 14 PAIN & ADDICTION MEDICINE 16 NEUROSURGERY 18 PSYCHIATRY/BEHAVIORAL HEALTH 20 NEUROSCIENCE 22 INTERNAL MEDICINE/ ORGANIZED MEDICINE 24 REGENERATIVE MEDICINE 26 COMPLEMENTARY CARE: PUBLIC HEALTH 28 MENTAL WELLNESS 30 NEWS 32 EVENTS

FEATURED

14 PAIN MEDICINE

COVER PHOTOGRAPHY BY JOHN LAIR

16 NEUROSURGERY

18 PSYCHIATRY

20 NEUROSCIENCE

22 INTERNAL MEDICINE

22 REGENERATIVE MEDICINE ISSUE #143 3

Headlines

Addiction Update 2022

Understanding contributing factors to addiction is crucial to treatment increase in initiates of alcohol use in that category occurred in the 16–17-year-old age group, but a LEXINGTON It may be years before larger percentage of the 14–15-yearwe know the full extent of the olds who did use over the past year COVID-19 pandemic’s impact were new users. Of females between on addiction treatment. We do ages 12 and 17 who used alcoknow that the disease of addiction hol in 2020, more were new users continues to claim lives, and that compared to males who used. It people who need treatment are isn’t clear what effect the pandemic not getting it. had on the increase in alcohol use Opioid use disorder has been among adolescents. According to in the spotlight because of the the 2019 NSDUH, about 7.3% of Colleen Ryan, MD Danielle Anderson, MD staggering number of associated adults who met criteria for AUD in overdoses, which only increased the past year got any treatment in during the pandemic. However, it is not the the gender specific thresholds for binge drink- that year. Less than 4% of people with AUD only addiction that has contributed to morbid- ing. People who consumed alcohol at twice were prescribed a medication approved by the ity and mortality in the U.S. population. The the threshold of gender specific binge drinking FDA for AUD. People suffering from substance importance of alcohol use disorder (AUD) as were 70 times more likely to have an ER visit use disorders may not receive treatment for seva major player in deaths related to addiction is than those who did not binge drink. People eral reasons including lack of perceived need of overlooked. Effects of alcohol use disorder are who consumed alcohol at 3 times the usual treatment, fear of stigma, and inability to access more subtle because the acute overdose scenar- threshold for binge drinking were 93 times evidence-based treatment. io seen with opioids is usually not the case with more likely to have an alcohol related ER visit. alcohol. Alcohol is the 3rd leading preventable The 2020 NSDUH (National Survey of At Risk Populations cause of death in the United States behind Drug Use in Households) estimated that There are some populations who may be tobacco, poor diet, and physical inactivity 712,000 adolescents between the ages of 12 more seriously at risk, for example seniors. according to the National Institute for Alcohol and 17 met DSM V criteria for AUD. The According to the 2020 NSDUH, in the 50 Abuse and Alcoholism (NIAAA). number of initiates (new users) of alcohol use in or older age category, 3,433,000 met criteria NIAAA reports that high-intensity drinking the 18–25-year-old age group went up in 2020 for illicit drug use disorders and 8,297,000 is an emerging trend. High intensity drinking compared to 2019 as did the percentage of past met criteria for AUD. Interestingly, of that is defined as consuming alcohol at 2-3 times year initiates of alcohol use generally. The largest group, the 65 and over group had the largest share of AUD as well as both AUD and illicit drug use disorders. People who previously did not meet criteria for AUD may increase their drinking and meet criteria even after 65.

Clinicians should be tuned in to this potential change. Alcohol screening can be useful here.

Another issue affecting seniors on MOUD (medication for opioid use disorder) is that of placement in nursing homes. Many nursing homes won’t accept patients on MOUD. So, what happens then?

People with co-occurring disorders are another at-risk group. In 2020, 2.7% of adolescents between 12 and 17 had a co-ocBY COLLEEN RYAN, MD, AND DANIELLE ANDERSON, MD

OVER 110,000 VISITS!

4 MD-UPDATE

curring MDE (major depressive episode) and SUD (substance use disorder). In 2020, 6.7% of adults 18 or older had any mental illness and an SUD and 2.2% had a co-occurring serious mental illness (such as schizophrenia or bipolar disorder) and SUD. Only 5.7% of adults with co-occurring SUD and any mental illness received both SUD and mental health treatment. Only 9.3% of adults with co-occurring serious mental illness and substance use disorder received both substance use and mental health treatment.

The American Academy of Addiction Psychiatry recommends that substance use disorders and psychiatric disorders be treated concurrently. Some of the more common mental health issues are depression, bipolar disorder, anxiety, and attention-deficit disorder, among others. If not addressed, these untreated disorders can lead to relapse and less engagement in treatment.

Those who are incarcerated constitute another vulnerable group. Very few prisons allow inmates to have controlled substances.

Therefore, when someone on suboxone or methadone is imprisoned, they can have significant withdrawal symptoms which may not be addressed. Often, their Medicaid insurance, if they had it to begin with, is stopped because of their imprisonment. Getting it restarted can take months. Frequently they are simply released to the street with no follow up. Since they do not have insurance, they can’t get back into treatment. Furthermore, the presence of an addiction which could be contributing to the inmate’s criminal activity, may not be detected while the person is incarcerated, so no treatment referrals are made at the time of release.

for substance use disorders. Patients are acutely aware of the attitudes of office staff and medical professionals towards them. The first step towards equitable care and access to SUD treatment is for the medical community to look at its own internal biases towards people with substances use disorders and why these exist. Only then can we understand how to exact change in the stigma and improve access to care for patients with SUD. REFERENCES: • Alcohol Facts and Statistics. NIAAA.nih.gov.

• The NSDUH Report. Office of Applied Studies, Substance Abuse and Mental Health Services Administration, Dept. of Health & Human Services.

ABOUT THE AUTHORS: Colleen Ryan, MD, received her MD from the UofL School of Medicine. She completed a psychiatric residency at the University of Michigan, Ann Arbor. Most of her career has focused on general psychiatry, both inpatient and outpatient. In January 2018, she became certified in addiction medicine through the American Board of Preventive Medicine. She retired from the UofL department of psychiatry in 2018 and is currently working part-time at 2nd Chance Center for Addiction Treatment and for Porter Starke Community Mental Health Center Danielle Anderson, MD, received her MD from the University of South Carolina. She completed her family medicine residency in the UK family medicine rural track in Morehead, Kentucky. She completed her addiction medicine fellowship at UK and is now an assistant professor in the psychiatry department. She works full time as an addiction specialist.

Stigma and Co-morbidities Patients suffering from addiction often have multiple medical co-morbidities. Stigma persists in the medical profession, unfortunately, and patients with substance use disorders often describe negative interactions with providers when disclosing information regarding their use of substances, even if they are currently in treatment. People suffering from addiction face unique barriers to receiving both routine medical care and treatment

For more information and to join the Lexington Medical Society, contact

CHRIS HICKEY, CEO (859) 278-0569 cmhickey@lexingtondoctors.org www.lexingtondoctors.org ISSUE #143 5

Accounting

Are You Ready for the 2023 E&M Code Changes?

BY BRANDY MONTGOMERY, CPC, CPMA, CPCO

Changes to in-patient evaluation and management (E & M) service codes for 2023 are coming. The changes will be effective January 1, 2023. These changes follow the outpatient service coding updates implemented on January 1, 2021. A recent AAPC review noted the following lessons from the 2021 implementation: 1. The change was harder than expected 2. Explaining the updates and changes was not as smooth as envisioned 3. There are still gray areas to be addressed 4. Applying the guidelines when reviewing notes is not as easy as counting elements 5. The changes were still an improvement and a good thing The updates align the method of assigning levels of service (LOS) for in-patient services with those introduced on January 1, 2021, in the outpatient setting. The history and physical exam components will be documented at the providers discretion, and will not be factors in assigning the final level of service. The

documentation must however support the medical necessity of the service.

We are mindful of the need to prepare physicians and non-physician practitioners for this change in the coding of their professional services. A clear understanding of these changes is imperative to avoid the possible compliance pitfalls that may lie ahead. While change is disruptive, this transition promises to provide greater ease for physicians with their billing practices.

The table below gives a brief snapshot of the pending changes for the respective in-patient service codes. The time thresholds for each code are displayed with the codes below. It is important to note that emergency department (ED) codes and guidelines have been revised.

No time thresholds apply to ED codes.

Deleted Codes Deleted codes include • the previous hospital observation codes (99217 to 99220).

• level one codes for consultations services (99241 and 99251).

• nursing facility code 99318, and • prolonged services codes 99354 to 99357.

New for 2023 The initial (99221-99223) and subsequent (99231-99233) in-patient service codes will also now be used for observation services. In addition, new prolonged services codes have been added for the in-patient and outpatient settings. Code 99417 was added for outpatient, home, or residence service encounters. Code 993X0 was added for inpatient, observation or nursing facility services encounters. The appropriate guidelines for all these services have been updated accordingly.

Dean Dorton has experts available to assist your practices in implementing an educational plan, and partnering with you to navigate these regulatory changes. Please do not hesitate to reach out to our experienced team. We are committed to serving any of your healthcare needs.

SOURCES: 1. Lessons learned from the E/M code changes. www. aapc.com/workshops/lessons-learned-from-emguideline-changes.aspx 2. Compliance Today; September 2021: A review of the impact of the 2021 E/M coding changes in the office and outpatient setting compliancecosmos.org/ review-impact-2021-em-coding-changes-office-andoutpatient-setting 3. AMA - 2023 Code changes and descriptors; www. ama-assn.org/system/files/2023-e-m-descriptorsguidelines.pdf Brandy Montgomery is Manager of Healthcare Consulting Services at Dean Dorton. She can be reached at bmontgomery@ddafhealthcare.com.

6 MD-UPDATE

Legal

Can’t We All Just Get Along?

Privacy and Substance Use Disorder Records

BY JAMIE W. DITTERT, ESQ. Privacy is paramount for all patient records.

Restrictions on how treatment records can be used and disclosed are more stringent, however, when it comes to particularly sensitive areas, like HIV and AIDS testing, mental health records, and substance use disorder (SUD) treatment records. While the reasons for protecting patient confidentiality are evident, the practical effect for health care providers is additional procedural and logistical hurdles as they navigate how to store, use, and disclose these records.

New Proposed Rules Regarding SUD Record Disclosure On November 28, 2022, the Department of Health and Human Services took a step forward in balancing the confidentiality of certain SUD records with promotion of the coordination of care. It issued a notice of proposed rulemaking that will change federal regulations restricting the use and disclosure of SUD treatment records from federally assisted SUD treatment programs. These higher-level protections are called “Part 2” requirements because they are found in 42 C.F.R., Part 2.

Generally, Part 2 providers can include any doctor with DEA authorization to prescribe controlled substances for the treatment of SUD. Historically, SUD records have been subject to these Part 2 requirements to allow patients to get necessary treatment without facing adverse consequences in other areas of their life, like employment and divorce.

However, these protections can make coordination of care between disciplines more difficult.

For example, under the current regulations, Part 2 providers cannot disclose any information that would identify a person as having a SUD without that person’s written consent to the patient’s other medical providers. So, if a patient receives SUD treatment through one provider at a facility that provides multidisciplinary treatment, any information identifying the patient as a recipient of SUD treat-

ment cannot be given to any other non-SUD treatment providers in the same facility or put into the general electronic medical record unless the patient has executed an appropriate authorization to release her SUD information to the facility and/or to other, individual providers within the facility.

Likewise, Part 2 has restrictions on “redisclosure” of information. Once SUD treatment information is disclosed, it cannot be disclosed again without another written authorization by the patient, unless one of a narrow set of exceptions applies. A valid authorization for the disclosure of SUD treatment records must include a specific statement that the information and records cannot be further disclosed. Other than when a few, limited exceptions apply, a new consent form is needed for each disclosure.

As part of the Coronavirus Aid, Relief, and Economic Security (CARES) Act of 2020, regulations were to be revised to align the more stringent Part 2 protections more closely with the privacy requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The November 28 notice of proposed rulemaking is in furtherance of that requirement and reflects several practical changes that will make care coordination more efficient without sacrificing the privacy protections that will help individuals with SUD feel more able to seek appropriate treatment.

Proposed Regulation Revisions • First, the proposed regulations allow a written consent for the disclosure of Part 2 records to apply to future uses and disclosures for treatment, payment, and health care operations. Redisclosure can occur without a new consent form, so long as the redisclosure is consistent with the HIPAA privacy rule and the recipients are also Part 2 programs or HIPAA covered entities like health care providers and health insurers. This would be

a significant shift from the existing prohibition on redisclosure without a new consent or applicable exception for each disclosure.

• Additionally, the changes will make it more difficult to use or disclose Part 2 records for civil and criminal legal proceedings without a court order or patient consent. For example, proposed regulations specifically address whether testimony conveying information from SUD treatment records is admissible in civil proceedings against patients, absent a court order or the patient’s consent.

• The changes will also add characteristics from HIPAA to Part 2, including a patient right to accounting of disclosures and a right to request restrictions on disclosures, a confidentiality notice requirement similar to a HIPAA notice of privacy practices, and a breach notification requirement for unauthorized disclosure of Part 2 records.

• Finally, the changes give more teeth to administrative enforcement of Part 2 protections.

They require a complaint process for violations, protect patients from adverse action for filing complaints, and prohibit Part 2 programs from conditioning treatment on a patient’s agreement to never make a complaint.

The proposed rules are available for comment as of December 2, 2022, and the comment period is open for 60 days. Ultimately, the aim appears to be to make it easier for healthcare professionals to provide proper care to patients with SUD, balancing care coordination with patient privacy by allowing easier disclosures for treatment, payment, and health care operations while shoring up complaint procedures, civil money penalties for violations, and breach notification requirements.

Jamie Wilhite Dittert is an award-winning healthcare law and torts & insurance member attorney at Sturgill, Turner, Barker & Moloney, PLLC. She may be reached at 859.255.8581, or jdittert@sturgillturner.com. This article is intended to be a summary of state and/or federal law and does not constitute legal advice.

ISSUE #143 7

Finance

Let’s Review 2022 and Peer into 2023

BY SCOTT NEAL, CPA, CFP®

Have you looked at your investment portfolio lately? I dare say that many of you don’t even want to go there. Rest assured that you are not alone. At the end of November 2022, for the trailing twelve months the S&P 500 Composite index had declined 13.6% and the tech-heavy NASDAQ 100 was down a whopping 29.3%. And get this— the Bloomberg Aggregate Government Bond Index was down 12.5% for the period.

The current market milieu is enough to cause a person to think about turning their portfolio into cash. For me, it called to mind a national conference that I attended in the early 90s. There, I heard Roger Gibson speak.

The first edition of his book, Asset Allocation, had just been published, and he was making rounds through the lecture circuit promoting the tenets of Modern Portfolio Theory and the efficient market hypothesis. If you have read anything at all about investing over the past 30 years, you probably have heard it many times: diversify your portfolio into several asset classes, perform periodic rebalancing, and enjoy a smooth ride to retirement. “Don’t put all your eggs in one basket” is the folk version that is hard to argue with on its face. Out of

The key is that asset allocation works, until it doesn’t. this theory, many, if not most, investment firms developed a typical “balanced portfolio” composed of around 40% bonds and 60% stocks. Let me do the math for you: the 40:60 portfolio lost 13.2% over the trailing twelve months mentioned above. Hardly comforting to most investors that I know.

Proponents of asset allocation usually advise that the bonds be spread among various maturities and/or various levels of credit quality. Stocks might get spread among companies of various sizes determined by capitalization of the company, i.e., large-cap, mid-cap, and small-cap. Some allocators will suggest adding some international companies and others will branch out into commodities and/or real estate. Having been taught the Benjamin Graham school of security analysis in grad school and perhaps being somewhat brash, I just had to put the question to Mr. Gibson, “How long before someone will be able to disprove this theory?” I recall that his

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

response was something like, “At a recent CFA gathering in New York, it was the consensus of attendees that it would likely take 400 years of data to approach such a proof.” In other words, the leaders of the investment community suggested to not bother trying.

With improvements in technology around the turn of the century, a whole flurry of software tools sprang up to enable investment advisors and even lay people to easily optimize their portfolio around a targeted level of volatility and expected return. This led most people, including the asset management industry, to benchmark their portfolio return to the historical average of the S&P or even the 40:60 portfolio, rather than to their ability to pay for a goal like retirement, college education, or a particularly desirable standard of living.

Much has transpired over the years, but we still hear some version of this principal being trotted out as the panacea to market volatility. In fact, I recently visited an office of a brokerage firm and saw a sketch of the 40:60 portfolio illustrated on a white board. It is still alive and well. The key is that asset allocation works well, until it doesn’t. It is dependent on

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Finance

the lack of correlation between asset classes.

You know the old saying, “When the tide goes out, we find out who is swimming naked.”

So, what is an investor to do? Attempt to time the market? Hardly. Unless, of course, you are clairvoyant.

The answer is to think more deeply about the systemic risks facing the various markets, and indeed our world, and to act more responsibly in addressing those risks. It requires systems thinking. Authors Jon Lukomnik and James P. Hawley have addressed one aspect of this in their new book, Moving Beyond Modern Portfolio Theory: Investing that Matters.

The authors will be dismissed by many as simply offering a political statement, because of their emphasis on environmental, social, and governance issues, dealing with both individual stocks and the portfolio taken as a whole. Taking a systems approach requires that we look deeply at how value is created and destroyed over time and our participation as investors in such creation and destruction.

On the turning of the calendar to a new year, is there any doubt that we are living through a significant liminal moment? Perhaps that could be said of nearly any age, but this one seems rather poignant to me. (Maybe that is

because I am old enough to recall the details of a conference I attended 30 years ago.) If you haven’t already, it is high time to think outside the box and look beyond asset allocation as your investment strategy. Doing so an offer up a level of optimism that is hard to find this year. I have to say that I am truly looking forward to 2023 and I am optimistic that we can effectively deal with what comes next.

Scott Neal is president and CEO of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville, KY. He will respond to your question or comment sent to scott@ dsneal.com or 1-800-344-9098.

AT T O R N E Y S KENTUCKY | TENNESSEE

YOU CARE FOR EVERYONE♦ WE TAKE CARE OF YOU♦ From the business of health care to compliance to litigation defense, Sturgill Turner’s experienced health care attorneys provide comprehensive legal services to health care providers, hospitals and managed care organizations across the Commonwealth.

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Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.COM ISSUE #143 9

Bringing the Brain Back to Former Function

Joseph Neimat, MD, chairman of UofL Health – Restorative Neuroscience focuses on restoration, research, and residency training.

BY DONNA ISON LOUISVILLE For Joseph Neimat, MD, MS,

MBA, choosing the specialty of neurosurgery was a no-brainer. “Neuroscience is still a burgeoning field. There is so much that we’re just beginning to understand about how the brain works,” he explains.

“The fascinating part of neurosurgery is that you get to observe the brain firsthand and help restore its function or remove an impediment to function. It’s a tremendous privilege to do that.”

Taking on the role of chairman of the department of neurological surgery at the University of Louisville (UofL) required deeper consideration. Neimat was hesitant to leave his position at Vanderbilt Neurosurgery.

During his decade there, the program had grown into the largest DBS (deep brain stimulation) center in the nation. But, after delving deeper into UofL, he saw the building blocks for a tremendous program that combined research and clinical practice: “When I came to Louisville in person, I was tremendously impressed by the attitude the people in this department had regarding the translation of basic research into clinical scenarios.”

Rehabilitation and Research: Side by Side When Neimat took the helm in March of 2016, one of his first orders of business was to find a name that accurately represented the work of the team. He started by considering the various factions within the department and their goal; each shared the common mission of trying to restore the brain. Neimat said, “Our goal is to restore function and to restore people to what they were before their disease.” Thus, UofL Health – Restorative Neuroscience was born.

10 MD-UPDATE

There, on the 15th floor of the UofL Health – Frazier Rehabilitation Institute, neurosurgeons, researchers, basic scientists, and residents work side by side. This proximity encourages interactions that might not normally occur and offers an opportunity to “cross the cultural divide between researchers and clinicians.”

The center’s dual focus is diagnosing and treating neurological disorders and discovering new treatments for conditions such as spinal cord injury, epilepsy, brain tumors, aneurysms, stroke, Parkinson’s disease, brain malformations, and more. “The goal is to examine the very basic properties of neurological diseases and then translate that knowledge into clinical application that changes the way patients are treated,” says Neimat.

To this end, as chair, Neimat wears many hats. His week consists of performing a variety of operations and DBS surgeries, seeing patients in the clinic, heading up business and finance meetings, attending case conferences, leading grand rounds, teaching lectures, and co-directing an NIH-funded lab, where he reviews data and guides ongoing projects.

Significant time and energy also go into training future neurosurgeons through UofL’s residency program.

Residents: The Future of the Field When Neimat first joined the department, it was down to five residents. Now, 14 residents and several fellows are receiving top-notch training, with many passing on their knowledge by giving podium presentations at two yearly neurological meetings. This growth is a source of pride for Neimat. He states, “It’s been tremendously important to me to give residents and fellows a very thorough foundation so that they understand everything from fundamental

neuroanatomy to the most innovative new therapies and where the field is going. I, and all of my faculty, spend a lot of time thinking and working toward that. And in the end, that really is the future of our field.”

As for Neimat’s own education, he began undergraduate studies at Dartmouth University in New Hampshire as a music major but quickly realized his natural talents

Cover Story

lay in the sciences. He says, “Science came easy; music did not. I was not a very talented musician. As I went through my college experience, I realized science was where I would be making my contribution.”

Upon completing his bachelors, he went on to Duke University School of Medicine in Durham, North Carolina where he completed his medical degree as well as a masters in

neurobiology. Neimat found the mysteries of the brain intriguing and was drawn to surgery but had his misgivings.

Having grown up with a surgeon as a father, he was all too aware of the demands of that lifestyle. Then, during his second-year neurosurgery rotation, everything changed. He explains, “It was so exciting…so just absolutely fascinating. I remember one of the first cases I saw was PHOTO BY JEREMY COWART

an awake craniotomy. The scalp is numbed, so patients don’t feel the surgery, then you open the skull and wake them up in order to remove a brain tumor or part of the brain that is having seizures. And that was such a fascinating experience to be talking to somebody and watching their brain, which is in effect talking to you at the same time. I just got sucked in. After that, my mind was made up.”

ISSUE #142 11

Cover Story

Neimat then completed his residency and an internship at Massachusetts General Hospital, a Harvard program in Boston where he served as chief resident of neurosurgery. A fellowship at the University of Toronto in functional neurosurgery, which combines brain stimulators and other procedures in an aim to improve or restore brain function, followed.

Technology Offers New Solutions to Old Problems Now, as a practicing surgeon, Neimat specializes in treating epilepsy and movement disorders using the latest technologies and techniques. Neimat explains, “Traditionally, the simplest paradigm is to have patients come in for their epilepsy and you put electrodes in the brain. We keep them here in the hospital with wires coming out of the head, and connect them to a machine that 12 MD-UPDATE

is reading the seizures. And, when we figure out where the seizures are coming from, we go back and remove the seizure focus.”

He continued, “But more recently, we have devices that are implanted, so we can put in electrodes that stay and both record and stimulate. So, the electrodes tell you how

often a patient has a seizure and when those seizures occurred. They can also be used as a kind of defibrillator to stop the seizure after it has started.”

Many of his patients have suffered with seizures for years and tried multiple treatments prior to finding their way to UofL Health.

Cover Story

For example, the prior year, he saw a patient that had been treated at another center and equipped with electrodes but was still having seizures. Neimat and his colleagues reopened the skull and placed more than 160 electrodes on the brain to pinpoint the origin of the seizures. They identified that the source was in the temporal lobe near the language center.

He was able to map out the language center precisely so that it was left intact while the offending portion was removed. In addition, he placed responsive stimulation electrodes on the language center to detect and treat if a seizure did occur there. He referred to this as a “belt and suspenders” approach. The patient has been seizure-free since.

According to Neimat, “What I enjoy most are the challenging patients who have defied treatment in other places, and we’re getting

them here for something unique or different or hard to treat. I enjoy those challenges, those puzzles, to hopefully make progress when other people struggled.”

Advancements in technologies, like neuromodulation, have improved the field exponentially. Spine surgery is now being done robotically. Cranial surgery has been impacted by the frameless guidance systems that use remote technology to show surgeons exactly where they are in the brain. Aneurysm surgeries, which once required opening the head, can now be done with coils inserted through the blood vessels.

Despite the progress within the field, there are still misconceptions even within the medical community. According to Neimat, “I think among patients and perhaps some physicians there is a feeling that neurosurgery PHOTOS BY JEREMY COWART

is dangerous and must only be done as a last resort. There was probably a time when that was true, but today neurosurgery is tremendously safe.” He stresses that for many patients established neurosurgeries come with very little risk and high success rates and can offer life-changing results.

And, in the end, that is what it is all about— improving the lives of patients: “Today, in clinic, I saw a patient on whom we had done a surgery for epilepsy. It was a complicated surgery where we had to map out the location of the seizures. And we’ve been able to stop those seizures. That’s a significant restoration for somebody who before couldn’t drive, couldn’t work many jobs, couldn’t do things, and was always uncertain about when they might have the next seizure. That really is a form of restoration. And that is very gratifying.”

ISSUE #142 13

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Pain Medicine

Generations of Care

Legacy Pain Treatment Center of the Bluegrass enters a new era of expanded care

BY GIL DUNN LEXINGTON The Pain Treatment Center of the

Bluegrass has specialized in pain management since 1988 when Dr. Ballard Wright, board certified anesthesiologist and pain physician, opened his practice, Ballard Wright, MD, PSC, also known as The Pain Treatment Center of the Bluegrass.

Over the past three decades, the Center has expanded from one building on the corner of Regency Road and Pasadena Drive to three buildings in Lexington, a satellite clinic in Somerset, Kentucky, and now an affiliation with CHI/Saint Joseph’s Health System.

“We have ten pain physicians from different specialties. Those specialties are anesthesia, neurology, physical medicine and rehabilitation, family medicine, and palliative care.

All these different specialists work together to evaluate patients with the end goal of alleviating their pain,” says Heather Wright, CEO, and daughter of Dr. Ballard Wright.

“However, we realized one component was missing—helping patients who have pain but also have been abusing their opioid medications.”

Opioid Use Disorder While abuse of illicit drugs has always been an issue, the past decade has seen a steady rise of opioid addiction. According to the Substance Abuse and Mental Health Service Administration (SAMHSA), in 2020 3.4% of Americans 12 years or older, or 9.5 million people, misused prescription or illicit drugs. Of those 9.5 million, approximately 1.6 million had opioid use disorder. Opioid use disorder, also referred to as opioid addiction, is defined by the CDC as “a chronic and relapsing disease that affects the body and brain.” It can cause difficulties with tasks at work, school, or home, and can affect someone’s ability to maintain healthy relationships.

14 MD-UPDATE

Benjamin Sloop, MD, board-certified anesthesiologist and pain management physician.

It can even lead to overdose and death.

For individuals dealing with opioid abuse disorder, treatment is available through counseling and medication assisted treatment (MAT). Such MAT comes in the form of the following three medications: Buprenorphine/ naloxone (also known as Suboxone, Zubsolv, Subutex, Sublocade), Naltrexone (also known as Vivitrol, ReVia, Depade), or Methadone.

According to the CDC, these medications work to “normalize the brain chemistry, relieving cravings and in some cases preventing withdrawal.”

Growth and New Care In order to help opioid use disorder patients across the Commonwealth, the Center has opened a new department for both its own high-risk patients and for patients referred to the Center. Benjamin Sloop, MD, and Kay Wilson, DNP, APRN, are the practitioners heading this high-risk/addiction department.

Both practitioners, as required under federal and state law, have obtained Buprenorphine Waiver Certificates in order to evaluate, treat, and prescribe the treatment medications.

Moreover, both Sloop and Wilson bring years

of experience to the Center. With such experience, they have seen firsthand the benefit of MAT, and such benefits are backed up by government studies. In a 2016 publication by the National institute on Drug Abuse (“NIDA”), researchers found that opioid use and opioid-related overdose deaths decreased when MAT was used on individuals with opioid use disorder. Thus, the reason to expand services and offer such care to not only the Center’s own high-risk patients, but also to individuals in the community.

“If you identify a patient with opioid use disorder, I will be happy to manage their care. As part of a comprehensive treatment program, your patient will be seen by myself and Kay Wilson, a DNP and APRN. We will evaluate the individual to determine that the patient is an appropriate candidate for medication assisted treatment,” states Sloop, a board-certified anesthesiologist and pain management physician.

Comprehensive Treatment Program As part of the Center’s comprehensive treatment program, the Center expects the patients to commit to two additional aspects of treatment besides MAT. First, the patient must undergo a behavioral health evaluation and, second, the patient is required to submit to routine urine drug monitoring.

“The patient’s care is coordinated with our behavioral medicine team to diagnose and treat any underlying mental health/addictive components. In addition, our laboratory technicians ensure the patient’s response to treatment is achieving desired outcomes,” states Wilson.

This coupling of drug monitoring, counseling, and MAT has shown to be the most effective means of treating opioid use disorder and ensure the patient’s road to recovery. In fact, in the 2016 NIDA article cited above, researchers found that patients stayed in ther-

PHOTOS PROVIDED BY THE PAIN TREATMENT CENTER OF THE BLUEGRASS

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apy longer and were more successful in their treatment when practitioners integrated MAT with psychological services. However, both Sloop and Wilson understand that patients may relapse, and/or misuse their medications or other illicit drugs.

“Part of our program is to treat the patient with dignity and to work with them to get back on track if they misstep. Opioid abuse is a long road and is not one that happens overnight,” says Sloop.

life, whether it is the result of pain and/or opioid abuse” states Ms. Wright.

Peter Wright, MD, the Center’s medical director, sums up the addition of this department to the Center, stating, “It’s an inspiring time at the Center. For years, our physicians have used a multi-specialty, multi-modality approach to alleviating pain. Now by opening this department, with these two top-notch providers, the Center will be able to help alleviate the number of individuals suffering from the abuse of opioids.”

Part of Their Mission Since Ballard Wright started his one office practice, his goal was to employ experienced, multi-specialty pain providers, skilled behavioral medicine specialists, and compassionate staff to offer exemplary treatment and care to the pain patients of Kentucky. “By adding the high risk-addiction component of care to the Center’s patients and to other

Pain Medicine

“If you identify a patient with opioid use disorder, I will be happy to manage their care.” - Kay Wilson, DNP APRN

Kentuckians suffering from opioid use disorder, the Center is fulfilling its mission to help provide Kentuckians with a better quality of

For more information: Ballard Wright, MD, PSC aka The Pain Treatment Center of the Bluegrass 280 Pasadena Drive 2416 Regency Road 2201 Regency Road, Building 100 Lexington, KY 40503 Phone: 859.278.1316 Fax: 859.276.3847 Website: www.pain-ptc.com

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Neuroscience Surgery

Welcome Back

Spine surgeon Kathryn McCarthy, MD, returns to Norton Leatherman Spine Center

“I want to make sure people understand that I’m new to Norton Leatherman Spine Center, I’m new to Louisville, but I’m not new to spine surgery.”

— Kathryn McCarthy, MD, Norton Leatherman Spine Center

BY JIM KELSEY LOUISVILLE The rhyme in the old kids’ game

goes “Step on a crack, break your mother’s back.” Much like the “floor is lava” game, no real harm came from any unfortunate missteps, but the thought of a broken back still sounds quite traumatic to young and old alike.

Fortunately, there are highly skilled surgeons such as Kathryn McCarthy, MD, spine surgeon at Norton Leatherman Spine Center in Louisville, who are trained to put even the most broken Humpty Dumpty back together again.

“It’s not always cookie cutter. There are multiple types of surgeries,” McCarthy says. “But by and large, spine surgeons think about things like, ‘How do we keep this person as functional as possible,’ recognizing that there’s got to be an intervention of some kind. So how do we leave the lowest footprint possible?”

McCarthy’s first steps toward becoming a surgeon began in Little Rock, Arkansas, where she was born and raised. McCarthy attended Notre Dame University for her undergraduate degree, then attended the University of Arkansas for Medical Sciences for her 16 MD-UPDATE

medical degree. She completed an internship and residency at the Northwestern University’s McGaw Medical Center, then accepted a fellowship at the Norton Leatherman Spine Center from 2011–12. For the next 10 years, she was back in Arkansas where she practiced at Ortho Arkansas.

Her father, Richard, is an orthopedic spine surgeon and her younger brother Michael is also a spine surgeon, but family influence wasn’t her only draw to the profession.

Personal experience and the ability to heal played a significant role as well.

“The treatments are diverse, minimally invasive techniques, mov“The power of a single inter- ing into the newer technological advancements that we have, also vention in terms of restoration employing some of the gold standard techniques that we’ve estabof health status,” she says is lished.” -- Kathryn McCarthy, MD, Norton Leatherman Spine Center what drew her to becoming a spine surgeon. “I myself have undergone a able to benefit from a surgical intervention that major cardiac procedure, having had a valve allowed me to maintain my functional status. replacement when I was a young woman. I was That’s point number one. Point number two is PHOTOS BY JAMIE RHODES

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that I had a built-in mentor who was passionate about what he did and shared that passion and joy of his own profession, which naturally bled into an interest.”

That interest became her profession. She and her husband, who is an anesthesiologist at Norton Audubon Hospital, have four children. They were settled and content in Arkansas, but when the opportunity to return to Norton Leatherman Spine Center came, they both knew it was an opportunity too special to pass up.

“When a place like Norton Leatherman Spine Center calls you and says, ‘We have an opportunity that we think might be a good fit,’ you don’t ignore the call,” McCarthy says.

“Furthermore, you start to really get in touch with some of those feelings of, ‘Wow, I could join something much bigger than myself—the idea of a mission and a systems approach that not only impacts the here and now of caring for patients in the year 2022 and during my career, but also impacts how we develop standards of spine care moving forward. So here I am, having moved my family of four small children and my husband because of that vision and the mission that has been so well established in that space.”

A Unique Place for Spine Surgery McCarthy says that Norton Leatherman is unique to the region.

“You have a research arm, an education arm, and a practice arm that all come together to provide patients an excellence in care that has not been duplicated in this region,” she says. “What has been created at the Norton Leatherman Center is a center steeped in tradition, steeped in excellence, and steeped in the pioneers of what’s driving what we do today. This is a space where things are evidence-driven. Doing things that are not founded in the evidence will never stand up in a space like this. It’s not just surgeons making decisions about surgery, it’s surgeons guiding people through the matrix of asking, what’s best for me and what’s best for the long-term function of my patient.”

McCarthy spends two days a week in the clinic where she sees both pre- and post-operative patients, as well as referrals and inpatient

consults. Norton Leatherman holds meetings of residents, fellows, and attendings on Mondays and Thursdays, which McCarthy also attends. She typically spends three days a week in the operating room. She sees a wide range of patients, from adolescents to older adults. Presentations include a wide range of conditions, including disc herniation and scoliosis.

“The treatments are diverse, inclusive of minimally invasive techniques, moving into some of the newer technological advancements that we have, but also employing some of the gold standard techniques that we’ve established as the main line of treatment,” McCarthy says.

“A lot of the focus in the world of spine surgery is about trying to maintain function while trying to alleviate pain.”

McCarthy points out that one successful procedure does not guarantee that other procedures won’t be needed in the future.

“Human backs are made to work like an accordion, not a hinge,” she says. “There’s been this misconception that it’s a failure if

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you have to go back in later and address a level above or below where you’ve already had a surgical intervention done. I try to outline for my patients that that’s not failure. I tell them that ‘You’ve gotten to live your life and you’ve used your back, and another level has now deteriorated.’ Thankfully, by and large, we have the capacity to address that.”

It is a capacity that she does not take lightly. Neither is she dismissive of her potential influence on future female spine surgeons.

“I think the question is, ‘Am I a female spine surgeon or am I a spine surgeon who happens to be female?’” McCarthy says. “Whether you are a man or a woman, to be employed at Norton Leatherman Spine, you are part of something much bigger than yourself. Perhaps I bring a little bit of a different flare or a longer set of hair, but I am honored and humbled and will carry the banner proudly to be a part of this space, in this center.”

None of this is a child’s game or silly rhyme.

It’s a profession. It’s a life. McCarthy is winning at both.

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Psychiatry

Behavioral Health: The New National Conversation Behavioral health is mental health acting out

Joining the Team

BY GIL DUNN LEXINGTON You hear it on the news

whenever there’s a mass shooting.

“We have a mental health problem in America.” Whether the cause is congenital, environmental, social media, video games, or teenagers on psychotropic drugs, the diagnosis is the same: mental health in America is not very healthy.

Behavioral health is the new frontier of mental health. Diagnosing and treating depression, anxiety, ADHD, and bipolar disorder are the bread and butter of psychiatrists and therapists.

Growing behavioral health treatment is a top priority for the CHI Saint Joseph Health ministry, says Carmel Jones, MBA, CPA, CMPE, president, CHI Saint Joseph Medical Group. “Mental health is such an important part of caring for the whole person. The impacts of COVID19, as well as the general stressors of the economy, inflation, et cetera, are real and need to be addressed. We feel strongly that investing in behavioral health is the right thing to do,” says Jones.

To further that priority, CHI Saint Joseph Medical Group currently has two physi-

“The mind and body are intricately connected.”

— Nicole Goodin, MD

cians, Brian Kelty, MD, and Nicole Goodin, MD, and Rick McClung, LCSW, caring for patients with behavioral health issues. “We are continuing to grow our internal team with plans to add more physicians and therapists.

We are also pursuing relationships with other partners who bring expertise and resources so that we can expand our offerings and increase our access,” states Jones.

Nicole Goodin, MD, recently joined the CHI Saint Joseph Medical Group – Behavioral Health team. Goodin is triple board certified in pediatrics, child and adolescent psychiatry, and adult psychiatry. She is originally from Lexington, went to Furman University in South Carolina for her BS in neuroscience, and received her medical degree from the UK College of Medicine. She was chief resident at Cincinnati’s Children’s Hospital and served as psychiatrist on duty at the Cincinnati Veterans Affairs Medical Center.

Goodin’s father is the late Theodore Ivanchak, MD, previously an emergency room physician in Louisville.

Nicole Goodin says she was interested in being a mental health practitioner as early as college. Her medical school rotation confirmed that for her. “The mind and body are intricately connected,” says Goodin.

“I consider all aspects of my patients; the biological, psychological, and social aspects are contributing factors when I formulate a treatment plan.”

Behavioral Health at CHI Saint Joseph Health is part of their comprehensive care

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“It’s difficult to have good mental health without good behavioral health. Untreated mental health disorders can lead to behavioral health issues.”

— Nicole Goodin, MD

Brian Kelty, MD

Rick McClung, LCSW

model. “We prefer an integrated model between behavioral health and primary care,” says Jones. “We feel that this helps with any stigma and makes for better communication between caregivers. Right now, our referrals are limited to established patients of CHI Saint Joseph providers. As our care team expands, we hope to open up referring providers outside of CHI Saint Joseph Health.”

Though just starting with CHI Saint Joseph Medical Group in October 2022, Goodin has experience with mental health patients. “I’m new to Saint Joseph Health, but I’m not new to seeing patients,” she says.

The majority of behavioral health patients are referred by their primary care provider, or in the case of younger patients, their pediatrician. Presentations include depression, anxiety, ADHD, and bipolar disorder.

“Primary care doctors typically refer patients to me when patients are treatment-resistant to their initial medications and they need some diagnostic clarification,” says Goodin, who employs a combination of pharmaceutical treatment with therapy. Cognitive behavioral therapy, CBT, and dialectical behavioral therapy, DBT, are Goodin’s most used methods.

She also employs trauma therapy when need-

ed in the case of abuse, PTSD, or a specific traumatic event in her patient’s life.

Goodin states that mental health refers to a person’s emotional and psychological well-being. Behavioral health refers to the habits and behaviors that influence their overall well-being. So behavioral health could be an exercise routine, eating and drinking habits, and even addictions. Behavioral health and mental health are linked together. “It’s difficult to have good mental health without good behavioral health. Untreated mental health disorders can lead to behavioral health issues.

Likewise, behavioral health problems can worsen mental health disorders,” says Goodin.

Telehealth and Technology Advance Care “Psychiatry is one of the easier specialties to adapt to telehealth,” says Goodin, and

Psychiatry

she uses telehealth as often as appropriate.

Telehealth makes it easy for frequent consults with her patients, which she says are key in maintaining mental health. It’s also less stressful and time- consuming than a visit to a medical office. “Another advantage of telehealth I’ve found is being able to see a patient in their home environment.”

At the present, Behavioral Health practitioners are only located in Lexington, but telehealth allows for consults with patients from other areas of the state.

Transcranial magnetic stimulation, TMS, is a non-invasive form of brain stimulation in which a changing magnetic field is used to induce an electric current at a specific area of the brain through electromagnetic induction and is one of the ways in which technology is changing care for depression.

Pharmacogenetic tests to evaluate how certain psychiatric medications are metabolized are showing potential to help predict more effective treatment options.

Goodin urges patience when it comes to treating mental and behavioral health. “It can take a while to find the correct balance of medicine and therapy,” she says.

CHI Saint Joseph Health Behavioral Health can be reached at: 3581 Harrodsburg Road Suite 350 Lexington, KY 40513

859.313.6333

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ISSUE #143 19

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Neuroscience

New Technology Helps Parkinson’s Patients after Deep Brain Stimulation (DBS) Surgery Device allows doctors to make adjustments virtually

BY GIL DUNN LOUISVILLE Norton Neuroscience Institute is

using new technology so certain patients with Parkinson’s and other movement disorders can be treated without always having to go into the doctor’s office.

Some Parkinson’s patients undergo a procedure called deep brain stimulation (DBS). DBS surgery involves implanting wires to each side of the brain and connecting those wires to an implanted device in the chest. The device, like a defibrillator, generates electrical pulses that change the movement circuitry of the brain, helping regulate control over unwanted movement, such as hand shaking and tremors.

NeuroSphere Virtual Clinic, recently approved by the FDA, allows Norton physicians and specialists to interact with a patient’s implanted device remotely, via an app. The virtual clinic is designed to allow physicians to access the device, even hundreds of miles away.

This enables physicians to ensure the device is functioning properly, change settings, or even prescribe new treatment settings.

Changes made in the app are relayed directly to the patient’s compatible iOS smartphone or Apple iPod touch mobile device.

The goal of the virtual clinic is to make it easier for the patients who do not live close to necessary medical care and are unduly burdened by access to care. Additionally impacted are patients who are unable to get to the doctor’s office because of circumstances like the COVID-19 pandemic.

Abigail Rao, MD, neurosurgeon with Norton Neuroscience Institute, was the first in the Louisville area to use advanced techniques that do not require the patient to be awake during DBS surgery. This allows for greater patient comfort and lower surgical risks.

“DBS can help patients regain smoother, more normal movements, less slowness and less excessive movements that can develop

as a side effect or consequence of long-term medication use,” says Rao. “We often see very positive outcomes.”

“We’ve found the virtual clinic to be optimal for DBS patients who have challenges coming into the office, whether it be length of travel to logistics to mobility issues. It’s also an option for patients who feel safer and more comfortable staying at home.”

Rao continues, “The virtual clinic can be used for patients with essential tremor or any other diagnosis in which DBS is an option.

DBS also is FDA approved for dystonia, epilepsy, and OCD. The details of how the DBS is done—meaning what part of the brain is targeted by the surgeons with the leads—differ by the disease that is being treated.

Virtual Device Allows Remote Adjustments After DBS surgery, doctors may need to adjust the device for optimal stimulation. This responsibility belongs to the patient’s neurologist, such as Justin T. Phillips, MD, who is also the director of movement disorders with Norton Neuroscience Institute.

“We have collectively learned that, in many cases, remote care can be nearly equivalent to in- person care. Some research studies indicate non-inferiority of outcomes for remote care when it comes to Parkinson’s disease and other movement disorders,” says Phillips.

“As Parkinson’s progresses, patients have more challenges getting around. Being able to help patients in their own homes can make the experience better for them and their families,” says Phillips.

Justin T. Phillips, MD, director of movement disorders with Norton Neuroscience Institute, explains how a patient with Parkinson’s disease can monitor their symptoms.

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PHOTOS BY JAMIE RHODES

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Neuroscience

Abigail Rao, MD was the first in the Louisville area to use advanced techniques that do not require the patient to be awake during DBS surgery.

Save the Date Saturday • April 15, 2023

Abigail Rao, MD, neurosurgeon with Norton Neuroscience Institute.

The NeuroSphere Virtual Clinic is compatible with Abbott’s suite of neuromodulation technologies, including Infinity™ DBS System for patients with Parkinson’s disease or essential tremor of the upper extremities, Proclaim™ XR SCS System for patients living with chronic pain of the trunk and/or limbs, and Proclaim™ DRG Neurostimulation System for patients with chronic pain in the lower limbs caused by complex regional pain syndrome or causalgia.

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ISSUE #143 21

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KMA

Q & A with Monalisa Tailor, MD Norton Healthcare, KMA President 2022-2023

Editor’s note: We were interested in interviewing KMA President Monalisa Tailor, MD, a primary care physician with Norton Community Medical Associates–Barret

MDU What does a week in your

professional life look like?

I treat everything like a 30-minute appointment block. Four of my days I’m focused on patient care from 8 a.m. to 6 p.m. Thursday is my administrative day for my medical director meetings and that also includes review of KMA initiatives and meetings with staff. Evenings can sometimes include KMA meetings. I also take some Zoom meetings while going for a walk to get some physical activity in.

MDU P lease recap your education

and medical training, including where you grew up and when you decided to become a physician.

My parents immigrated to Bowling Green, Kentucky, from India around 1979 to be closer to my grandparents who were in Tennessee.

I grew up in Bowling Green and attended the University of Kentucky where I majored in political science with a minor in biology. I went to the University of Louisville School of Medicine for my medical degree. I did a oneyear internship at the University of Florida and returned to Louisville for my second and third years of residency in internal medicine. I did my chief resident year at UofL and stayed on for two years as faculty.

Immigrant families have similar aspirations for their children, regardless of where they come from. They want their kids to become doctors, lawyers, engineers. America allows that opportunity. My family is no different. I was told early on that I should be a doctor. I originally wanted to be a cardiologist, when in my senior year of high school my grandmother died following her coronary artery bypass surgery. It shook me and made me wonder why I would want to be involved in medicine. It took me some time and reflection.

I helped my grandfather following her passing with his medical conditions and managing his medications, his mental health, and taking care of him. It helped me see how medicine could make a difference in a positive way.

MDU A re there any other doctors or

healthcare providers in your family?

My family is composed of tailors. The whole family knows how to sew. My grandfather would sew and make clothing and furniture when in India. When we immigrated to America, you could say we diversified.

22 MD-UPDATE

MDU Describe your patient population:

age, presentations, and treatments.

Monalisa Tailor, MD, Norton Healthcare, KMA president 2022-2023

My uncle, Prayus Tailor, and his wife are physicians in Delaware. He was president of the Medical Society of Delaware a few years ago. I have cousins who are physicians that are within my generation. Another uncle is a dentist in Florida.

MDU What led you to pursue

internal medicine?

As a third-year medical student, internal medicine stood out to me because the internist could be Sherlock Holmes putting the pieces of the puzzle together and figuring out the diagnosis. That was most appealing to me.

MDU What brought you to

Norton Healthcare?

I went into internal medicine because I wanted to take care of patients on an ongoing basis with their chronic conditions. It was important to me to be able to establish a relationship and take care of the whole person. I was so impressed with the patient-centered focus when I interviewed with Norton Healthcare. The patient focus was present in every aspect of my interview, and that was the most important piece for me. That told me I had found the right spot.

PHOTO BY JAMIE RHODES

I see patients between 18–96 years of age.

They come in for their annual physicals, office visits to discuss chronic conditions, and sick visits. My favorite part is educating patients to better understand their condition.

MDU What motivated you to become

involved in the Kentucky Medical Association and its leadership?

In college, I saw the interplay of legislative decisions and healthcare firsthand. I was an intern for State Senator Brett Guthrie and got to see this interaction firsthand in Frankfort.

It was a natural fit to see that governmental decisions impacted us in healthcare. I wanted to be part of the conversation because that’s how positive change would occur.

I’ve been a member of KMA and organized medicine since 2006 in medical school.

Persistence helped me stay involved. I knew why this work was important, and I wanted to continue to play a part.

When I started out doing this, there were not a lot of people who looked like me. The conversations being had in those rooms were not always familiar to me. I persisted, formed relationships, and broadened the view of the others around me. I stayed involved, and that has helped me get to where I am today. It was most impactful at our recent Indian doctor meeting having physicians who immigrated

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here in the 1970s saying hello to me and being truly excited about having a physician that looked like them being represented within the KMA.

MDU What are the most common

MDU T ell us your agenda and plans for

As physicians, we are dedicated and focused on the care of our patients. A lot of physicians are employed these days, some are still in independent practice. It is easy to say, “We don’t have the time. This work is not important because it doesn’t directly impact day-to-day patient care in real time.” For physicians, this is our opportunity to impact the things that get bothersome in our world: prior authorization, expanding access to cancer screening, expanding access to tobacco cessation products for our patients. It is a way we can take some control back and be a part of the conversation to make things better.

I’ve referenced HB 529 from the 2022 Legislative Session to many of my colleagues because they know it; they have seen its

the next year at KMA. Is there a theme that you want to express?

We have collectively been through a lot in the last two years. For healthcare workers, it has been difficult and traumatic. As we move forward in this stage of the pandemic, my theme for the next year is “Rejuvenate Medicine.” I want to remind us of what brought us to medicine to begin with, what keeps us going, and how we continue to sustain ourselves in this environment. This is a rewarding career, and we truly get to make a difference. I think we need a better understanding of trauma informed care and health inequities to help us better take care of ourselves and our patients.

misconceptions among physicians about the role and importance of physician-led organizations like KMA that you want to address?

KMA

impact on patients. We now have three days to contact our patients with sensitive results and discuss a plan with them; it has impacted our patients’ care. It allows my patient to not learn from their CT scan result that popped up on their device that they have pancreatic cancer and it gives me an opportunity to call them directly and come up with a plan.

MDU Describe your personal

philosophy of care.

I recognize as a physician that if the providers taking care of my grandmother had recognized the whole picture, she would have been cared for differently. She was a long-standing diabetic. She was in a level of renal failure. She was not a great surgical candidate. Her outcome could have been different with a holistic approach. I take care of patients the way I would want my family members to be taken care of by their medical providers.

ISSUE #143 23

SPECIAL SECTION

Pain & Regenerative Medicine

When Suppressing Inflammation Inhibits Healing Why we read pain to unlock the potential of regenerative medicine

BY TIM CORKRAN LEXINGTON Your caregiver’s instinct might

suggest that suppressing inflammation is an obligation. What if, in fact, you helped your patients by not limiting inflammation? The potential of regenerative medicine can be maximized by reconsidering pain and inflammation suppression, according to Danesh Mazloomdoost, MD, at Wellward Medical.

Regenerative medicine is targeted medicine, and for Mazloomdoost, “Without pain as a road map, the target cannot be narrowed sufficiently to take full advantage of regenerative medicine’s potential.” He advocates letting pain speak and lead as a way to enduring healing, through both regenerative medicine and physical therapy.

“Inflammation is the chemical process by which our body recognizes injury and initiates repair,” Mazloomdoost explains. As such, inflammation—and the pain it causes—should be understood not as the enemy of healing, but as a byproduct of the repair process. Unfortunately, Mazloomdoost feels,

Danesh Mazloomdoost, MD, medical director at Wellward Medical 24 MD-UPDATE

“The medical establishment’s goal is to mitigate the adverse effect of inflammation, which is pain—but it is, at the same time, ignoring the process by which the body initiates healing.” Clinicians miss important markers, he concludes, and healing is being put off, sometimes permanently. The Wellward team uses a broad range of targeted orthobiologics to initiate joint repair once the pain points have been specified. Their BLTNO (bone/joint, ligament, tendons/muscles, nerves, other soft tissue) approach guides practitioners as they search for the root cause of pain to optimize the body’s ability to heal through interventional, physical, and functional medicine.

Regenerative Medicine: Natural Products, Targeted Healing, Powerful Results Regenerative medicine is the process of healing the underlying causes of diseases through the use of native and bioengineered cells, assistive devices, and engineering platforms. It goes beyond disease management to focus on therapies that support the body in repairing, regenerating, and restoring itself to a healthy, fully functioning state. At Wellward, regenerative medicine starts with prolotherapy, a medication or chemical that induces an inflammatory response in order to instruct the body where strength or tissue remodeling is needed. This sets the table for the use of target orthobiologics.

One class of orthobiologics used at Wellward is the blood derived products. They include plasma, which is good for wound healing and non-healing ulcers, leukocyte rich plasma-rich protein (LR-PRP), known to be good for ligaments and tendons, leukocyte poor plasma-rich protein (LP-PRP), which ameliorates cartilage and joint erosion, and platelet lysate, which is used for nerves or for a PHOTOS BY GIL DUNN

pain reducing impact without as much repair.

Additionally, plasma protein isolates can be used for a variety of purposes, including as a glue for tears in tissue.

The other class of orthobiologics is stemcell derived products, which are understood to activate and recruit repair cells of the body to a site of injury. They include bone marrow aspirate concentrate (BMAC), which is effective when an accelerated process is needed or there is severe tissue damage and adipose derived stem cells that can act as a scaffold for tissue repair.

Some clinics dabble in these treatments, but at Wellward, they are central to the healing process. The science of orthobiologics is emerging, and though targeted use is ideal, Mazloomdoost knows that “we will always need a combination of orthobiologics to treat a given pain point.” Determining the right combination of orthobiologics to activate healing is a fundamental element of Wellward’s work.

The “How” of Regenerative Medicine at Wellward These powerful orthobiologics can only be used if you pay attention to the inflammation.

For Mazloomdoost, “Pain suppressed is pain unread. Damage, inflammation, and pain are three interrelated processes: damage causes inflammation, inflammation causes pain.”

Inflammation is the key: it is cells signaling; it is how your cells communicate. Pain is a byproduct of the signaling, not its primary purpose.

“Inflammation has anabolic (building up) and catabolic (breaking down) functions; it’s how the body coordinates repair efforts,” he says, “how it mobilizes resources.” He proposes we expand our understanding of inflammation, and as the negative conno-

SPECIAL SECTION

Pain & Regenerative Medicine

tations recede, we refine the use of inflammatory processes and use it as a tissue engineering tool. The main goal of inflammation is to shape or mold the body. Mazloomdoost says a way to understand this is working out: “Every time you exercise, you are doing controlled inflammatory processes to strengthen the body.”

Acknowledging this can also get patients off what he calls “the pain treadmill.” Suppressing pain indiscriminately with opioids leaves the patient more vulnerable to further damage by reinjuring the body over and over. If we constantly suppress pain with steroids and anti-inflammatories, we are defeating the purpose of anabolic inflammatory processes.

Then, an acute injury can evolve into chronic pain. He concludes, “The chronic inflammation of a former athlete’s joint is really the consequence of particular components breaking down.” – Danesh Mazloomdoost, MD “The reason you have chronic pain is because there is some bottleneck to your body repairing itself. If you suppress the Mazloomdoost explains that “PT is about block is palpable and inhibiting,” he laments. pain, the healing is suppressed also; the injury doing enough harm to mold the body—to The lesson for those young adults who and the pain will then remain, chronically.” direct it towards repair—but not pushing it suppress their pain—and contribute to their Consider the knee of a middle-aged past that limit where you are causing harm.” eventual osteoarthritis—is clear: today, with former athlete who suffered a meniscal tear the breadth of orthobiologics and their potenin his twenties. His knee hurts because there Not Suppressing the Pain tial for targeted usage, they can avoid disis damage; there is reason for the pain. Today; Better Joints Tomorrow ruptive joint pain later in life. Patients and He can take an anti-inflammatory and go Not getting off the pain treadmill has its practitioners who are open-minded about the about his business, but when he does, he is consequences. Mazloomdoost cites a Johns message of inflammation can mold the body compounding the problem and delaying the Hopkins study of over 1300 former medical back into shape and not end up in that state healing process. For such a case that suggests students for 36 years following their knee of degraded joints. cartilage erosion, Mazloomdoost talks about and hip injuries. It found those injured as his BLTNO approach. He breaks down young adults more than doubled their risk the joint into its component structures- its of osteoarthritis in those joints later in life. potential pain points- and considers each Suppressing the pain allows such people to separately. The pain guides him to the bone go back to normal activities, but it does not structure, the ligament structure, the tendons stop the damage—or the likely reliance on and muscles, the nerves, or other soft tissue. anti-inflammatories. He concludes, “If you “Cartilage erosion is a downstream effect of suppress the pain indefinitely, you will ignore For patient referrals problems in one or more of the stabilizing the symptoms, not seek treatment, and pro101 N. Eagle Creek Dr. structures of the knee,” he says. “The chronic long or even accelerate the damage.”

Lexington, KY 40509-1806 inflammation of the former athlete’s joint Mazloomdoost acknowledges the chalis really the consequence of particular lenge that re-understanding pain presents. It components breaking down.” The targeted requires a radically different understanding of orthobiologics are then applied as seen fit to body mechanics, joint repair, and pain, which Fax 859.276.5400 the BLTNO structures affecting the cartilage. can be overwhelming for any practitioner. wellwardmed.com Physical therapy is a necessity also because “This constitutes such a big paradigm shift it consists of controlled inflammation. for the medical community; the consequent

Wellward Regenerative Medicine

859.275.4878

ISSUE #143 25

Complementary Care

Viewing Patients Through a Different Lens Adverse childhood experiences and resilience

“…that non-compliant patient is driving me crazy…”

How many times have we said or thought something like that during our busy daily clinic?

Missing appointments, skipping medication doses, continuing ‘bad’ habits that clearly contribute to their poor health outcomes. Why can’t patients get it right?

BY CONNIE WHITE, MD, CHFS, MPH, DEPUTY COMMISSIONER OF CLINICAL AFFAIRS, KENTUCKY DEPARTMENT FOR PUBLIC HEALTH

Figure 1 – Three Types of Adverse Childhood Experiences (ACEs)

FRANKFORT During my 20-year OB-GYN

practice, I asked all patients at their annual visit if they were smokers. If the answer was ‘yes,’ I would review the medical harms that result from smoking. I wanted to be sure my patients were informed and knew the consequences.

One established patient responded that she continued to smoke despite my advice. When she told me that she started smoking at age 10, I questioned what prompted her to start so young. Her father, who hated the smell of cigarette smoke, would leave her alone at night in her bed if she smelled like cigarette smoke. She then told me tearfully that she had taught her eight-year-old sister to smoke. “I was a bad sister-wasn’t I?” In my zeal to stop her ‘bad’ habit, I had completely overlooked why she started smoking. Not only was I not helping her make an informed personal health decision on her smoking, but I was retraumatizing her annually for feeling she was a bad sister. I assured her she was the best sister anyone could want and applauded her skill to figure out how to protect herself and her sister at such a young age. My determination of her smoking as a ‘bad’ habit was actually an intelligent decision by a child to shield herself and her sister where adults had let her down.

Treating the Whole Patient The complexity of a patient’s life experiences, home situation, financial state, interpersonal relationships, and food insecurity all contribute to their behavior in our complex medical world. And sometimes we forget that every 26 MD-UPDATE

Source: Centers for Disease Control and Prevention Credit: Robert Wood Johnson Foundation

patient who enters our exam room with their list of medical symptoms also enters pulling behind them a little red wagon full of adverse childhood experiences that determine their reaction to our medical world and how they will respond to our best intentions to achieve a good health outcome. Adverse childhood experiences, or ACEs, are events that happen before age 18 years old that are a result of neglect, abuse, and household dysfunction and that change the trajectory of brain development as neuropathways are laid down before age two years (Figure 1). Incomplete neuro connections both across and within brain regions can limit the ability of functional areas such as empathy or ability to control impulses and emotions.

Continuous fight or flight experiences, leading to toxic stress resulting from a violent or unstable home life as a child, can cause an inflammatory response with high cortisol levels initiating chronic disease early in adulthood.

Coping with these childhood stresses can lead to health-risk behavioral choices that prompt social and emotional cognitive impairment, resulting in disease, disability, and social prob-

lems. Social-emotional development is based on secure attachment and becomes the foundation for cognitive development and a sense of self-identity. Lack of a stable nurturing relationship with a caregiver that is consistent and caring can influence a child’s health as an adult.

There is a risk response curve type reaction of ACE scores and chronic disease: diabetes, heart disease, cancer, alcoholism, stroke, COPD, depression, and suicide, with six or more ACEs resulting in a 20-year early death.

Figure 2 shows the 11 questions in the ACE inquiries used by the Kentucky Behavioral Risk Factor Survey (KyBRFS). These questions were asked of a randomized group of Kentuckians during the annual survey in both 2015 and 2018. Kentucky’s results show one in four adult Kentuckians reported that as children they lived with a family member with mental health issues and were verbally abused as children. One in ten children lived with a family member that was incarcerated or jailed. Figure 3 gives a picture of the percent of patients in our offices that have from zero to five or more ACEs. Scores are also predictors of early age smoking, teen pregnancy, teen paternity, increased number of sexual partners, and sexually transmitted infections, along with multiple other health-risk behavioral choices resulting in patients with higher ACE scores having in higher outcomes of chronic disease.

Newer research shows that not only do these ACEs of childhood contribute to poor health outcomes and early death but the adverse community environments — racism, poor housing, violence, discrimination, poverty — add to these feelings of despair. These effects are seen more often in people living in poverty, marginalized communities, and

Complementary Care Figure 2 – ACE questions asked in the Kentucky Behavioral Risk Factor Survey (KyBRFS)

communities of color. The zip code where a patient lives affects life expectance more strongly than the genetic code.

Positive Childhood Experiences and Resilience Research Why does one patient with a complex history of historical and generational trauma develop into a person working in the healing community like you and me while another leads an unhealthy life with a poor social living situation and a shorter life expectancy?

Studies in the science of thriving, which look at the positive childhood experiences of patients, show us that a childhood with more positive experiences builds a balance for that patient. These experiences are called positive childhood experiences (PaCEs). Development of these nurturing trusting relationships build that sense of self-worth in the child — it may be a coach at school, a grandparent, a Sunday school teacher, a friend’s parent, a neighbor — someone who showed an interest in that child and showed them that they mattered and that they cared about them. These ideas are intuitive to many of us, but there is now hard science to support and expand our understanding of these positive experiences — the science of thriving — as a key to building that child.

Frederick Douglass told us, “It is easier to build strong children than to repair broken men.”

Figure 3 – Results of Kentucky ACE Scores in the 2018 KyBRFS

reliable transportation to come to your office or could face repercussions for missed work if they have no sick leave available.

Resilience, and how we achieve it, is discussed often in our society. The foundation of resilience is the combination of • Supportive nurturing relationships • Adaptive skill building • Positive experiences that reinforce self-efficacy, perceived control, and belonging The way we view our patients and the effects of their past experiences matter. With

Connie White, MD, CHFS, MPH, is deputy commissioner of clinical affairs at the Kentucky Department for Public Health.

Figures are available online at: CDC Adverse Childhood Experiences Study and Health Consequences www.youtube.com/watch?v=d-SSwYTe8TY

LEXINGTON MEDICAL SOCIETY Physicians taking care of the community since 1799

The Lexington Medical Society is the principal voice & resource for Central Kentucky physicians to enhance their professional lives & improve the health of the community • Physician Wellness Program – Take care of your patients by taking care of yourself.

Think ‘What Happened to You?’ Instead of ‘What’s Wrong with You?’ Patients who continuously miss appointments could fear disappointing the medical provider as they haven’t had funds to purchase their medications or transportation to get to the pharmacy. Many patients have a lack of

newer information from the science of thriving, we can help people to learn these skills and support their success instead of continuing to allow them to fail. Our support as trusted healthcare providers and staff can make a difference in the lives they can lead.

» 8 free counseling sessions per calendar year » Completely confidential and easy access » Call (800) 350-6438

For more information visit

lexingtondoctors.org or call

(859) 278-0569

• Credentialing • 24/7 Medical Call Center • Legislative advocacy in partnership with the Kentucky Medical Association • Events and programing throughout the year ISSUE #143 27

Mental Wellness

Self-Compassion Is The New Self-Esteem How to like yourself more — Or at least not dislike yourself so much: An introduction to self-compassion

BY JAN ANDERSON, PSYD, LPCC

This year I started asking my clients three questions at the end of every counseling session.

The effect of these simple questions on my clients — and me — has been dramatic enough that I make sure there’s time to cover them: 1. What’s your takeaway from today’s session? Did you have any “aha” moments that translate into a note to self or a headline?

2. Do you want to convert your takeaway into a call to action? Is there something actionable you want to do or try between now and our next session?

3. What’s your why? Why do you bother to show up for these counseling sessions? Why is it important to schedule the next appointment?

I’d Like To Let Myself Be Happier The English Language The answers I hear mirror the same ones Doesn’t Have a Word wthat originally drew me to counseling for for Self-Compassion myself: I want things to be better.

1. I want my relationships to be better.

2. I want to feel better about myself.

What’s poignant is that the people saying these things have generally done very well in life. They’ve accomplished so much and experienced success in so many ways.

On one level, they have a lot to feel good about and they know that. Here’s the rub: You can have plenty of self-esteem and still not feel that good about yourself or your relationships.

After decades of research, psychologists are finding that the ultimate marker of positive mental health is not self-esteem. It’s selfcompassion.

Self-Compassion: Here’s What It’s Not Self-compassion is the new kid on the block of mental health. It’s a foreign concept for most Americans. I find it’s easier to start out by saying what it’s not.

It’s not constantly telling yourself how great you are and it isn’t being so nice to yourself that you never get anything done. In fact, there’s now a large body of evidence (over 2500 studies) that shows that self-compassion doesn’t make you selfish. It actually makes you less self-absorbed and more prosocial. Self-compassion helps you carefully cultivate your self-image and not feel the need to constantly defend your ego.

Self-compassion doesn’t make you a slacker. Self-compassion actually gives you more motivation and take more responsibility for yourself. It has even been linked to practicing safer sex and a vast array of other benefits.

If it’s not self-confidence and it’s not self-esteem, what the heck is this gooey-sounding thing called self-compassion?

28 MD-UPDATE

No wonder we have such a hard time with what we rather lamely call “self-compassion.”

There is no direct English translation for this Buddhist concept.

Here are some of my clients’ reactions: Self-compassion? I think of self-pity.

Self-compassion? Sounds like a bunch of excuses for bad behavior.

Self-compassion? Does it mean you’re selfish or self-absorbed, like a narcissist?

Self-compassion? It sounds self-indulgent.

This exercise is one of the best descriptions of self-compassion I’ve found so far: 1. Imagine times when you felt a sense of friendliness, helpfulness, and goodwill toward someone, whether a stranger, a child, or someone you care about.

Whether you gave them a hand or simply wished them well, you extended goodwill toward that person.

2. Then imagine feeling and extending that same sense of friendliness, goodwill, and helpfulness toward yourself.

Don’t be surprised if you find this darn-near impossible to do for yourself, even though you do it every day for people around you.

Here’s another exercise that may give you a feel for self-compassion: When was the last time you were a recipient of some act of friendly helpfulness or goodwill?

I think of a recent encounter with fellow passengers in the Philadelphia airport. As is often the case, I was struggling to understand and operate a mechanical device. Noticing my confusion at the automated ticket kiosk — and overestimating my abilities — two fellow passengers in line began shouting instructions to me. When that failed, a passerby walked over and offered manual assistance.

All of them were complete strangers. No one was obligated to help. No one beat their chest over this everyday act of kindness. There was no group hug. They simply helped out and moved on.

I’m talking about the natural beneficence that’s the hallmark of most of humanity. If these random acts of kindness are the lubricant that turns the wheels of civilization, why is it so foreign and incredibly uncomfortable to offer it to ourselves?

On a practical level, all we’re talking about is how to like yourself a little more and treat yourself a little better.

Self-Compassion Is a Radical Act The practice of self-compassion is a radical act. Seriously. In our mainstream culture, self-compassion is quietly forbidden and secretly judged.

What makes the taboo so effective is that it’s passed along in the form of unspoken, unwritten rules: You’re just not supposed to go around liking yourself, wishing yourself well, and treating yourself with kindness. There’s something unseemly about it, even slightly subversive.

Something to be nipped in the bud.

If my mother were alive, I’m sure she’d be totally against self-compassion. I don’t want you to get the big head, I can hear her saying.

Even if you agree that you’d be happier if you disliked yourself less or maybe it would be a good idea to treat yourself a little better, how do you get started?

1. Let’s assume your first reaction is to recoil at the idea of feeling goodwill or acting with kindness toward yourself. The best strategy for getting past the negativity? Don’t fight it. Instead, be open and curious about any predictably negative reactions you may have. Fortunately, you have a committee member in your head who knows how to be open, curious, and non-judgmental. (Yes, you may just need some help getting in touch with it but trust me. It’s there.)

2. Anticipate some serious pushback from your Inner Critic. Of all the committee members in your head, the Inner Critic is the most fearful of self-kindness. So how

do you get internal permission to explore this forbidden topic? Oddly enough, I’ve found the Inner Critic a valuable ally in the journey to self-compassion. Taking its concerns and objections seriously is what safeguards us from going too far and falling prey to self-absorbed, self-indulgent narcissism (aka the big head).

3. If you find yourself “trying” to generate self-compassion, stop. Trying to think or will your way into self-compassion is exhausting, and it doesn’t work. Self-compassion is an embodied felt-sense experience. Since most of us live a short distance from our bodies, you’ll most likely need guidance, practice, and patience to get the hang of it.

4. Self-compassion is both tender and fierce.

Make no mistake: Self-compassion is not wimpy, and it’s not a pushover. Strangely enough, it’s self-compassion that empowers you to say no and set limits. It’s self-compassion that lights up that committee member in your head who knows how to kick butt — your own or someone else’s — when needed.

A Mindful Self-Compassion Exercise: How to Treat Yourself Better in Three Steps UT-Austin professor Kristin Neff ’s pioneering research on self-compassion identified three building blocks of self-compassion.

Here’s my take on how to use them as great place to start exploring self-compassion.

1. Acknowledge the pain.

Trying to distract, force, or talk ourselves out of emotional overwhelm doesn’t do much good. There’s something about naming the pain that takes away some of its power. Whether silently, out loud, or in writing, acknowledge the pain. Keep it short and simple.

EXAMPLES: This feels awful.

I hate this.

This scares me.

That hurt.

This is hard.

2. Acknowledge our common humanity.

I’m often astounded at how badly we

don’t want to be human. If we only could hold ourselves above the common human frailties of our species and the vicissitudes of life. When we feel isolated and alone in our pain, it has a way of increasing our suffering. Trying to be special or better than the rest of your fellow human beings doesn’t transcend or exempt you from pain. So let yourself join the human race.

EXAMPLES: Everyone has times like this… We all feel this way sometimes… It’s part of life.

We all have experiences like this… I’m not the only one… It’s part of being human.

3. Take action. Offer yourself some comfort, protection, or help.

I find it helps just to know there’s always something you can do, right now, to help yourself. No, you may not immediately solve the problem. But whether it’s generating self-compassion that’s tender or fierce or both, you’re supporting yourself emotionally and positioning yourself into a problem-solving mindset.

EXAMPLES: Get Grounded: I’m going to ground myself by (feeling the connection of my feet to the ground, or taking a sip of water, or lightly pressing my palms to the tops of my thighs, etc.)

Set Limits: I’m going to disengage by (breaking eye contact, or changing the subject, or leaving the room, etc.)

Offer Comfort: I’m going to comfort myself by (clasping my hands together, or resting my chin in my hand, or pressing my hand to my chest, etc.)

Begin With the End in Mind I wish I’d let myself be happier. Of the Top Five Regrets of the Dying identified by hospice worker Bronnie Ware, I think this one packs the most punch.

And nine times out of ten, it’s echoed every time I ask at the end of a counseling session: Now remind me… Why are we doing these counseling sessions?

That’s why I plan to keep asking it.

ISSUE #143 29

News

New Doctors Join Baptist Health Medical Group LOUISVILLE Heidi Mahnken, MD, general sur-

geon, joins Baptist Health Medical Group to offer compassionate, patient-centered care.

Mahnken specializes in general surgery procedures, including reflux surgery, hiatal hernia surgery, and minimally invasive surgery, along with gallbladder surgery and hernia repair.

Mahnken graduated from the University of Oklahoma College of Medicine, completed a residency in general surgery at the University of Oklahoma College of Medicine, Department of Surgery as well as a fellowship in surgical critical care at the University of Texas Southwestern Medical Center/Parkland Hospital in Dallas, Texas.

Mahnken will be practicing at BHMG General Surgery located at 4001 Kresge Way, Suite 200, in Louisville.

SHELBYVILLE Enaam Alsoufi, MD, and David

Picklesimer, MD, have joined BHMG offering primary care for the entire family for residents of Shelbyville and the surrounding area at 60 Stonecrest Court, Suite 140 in Shelbyville.

Alsoufi and Picklesimer’s services include pediatric and adult well visits and preventive medicine, health maintenance, in-office procedures, and care for urgent conditions. They are both accepting new patients.

Alsoufi graduated from the University of Kalamoon in Dayr Atiyah, Syria, and completed a residency in family medicine at Geisinger Lewistown in Lewistown, Pennsylvania. He is board certified in family medicine by the American Board of Family Medicine.

Picklesimer graduated from the UofL School of Medicine and completed a residency in family medicine at Memorial Health System in Marietta, Ohio. He is board certified in family medicine and is certified in emergency medical technician training.

LA GRANGE BHMG La Grange welcomed three

new primary care physicians: Mary Manley, MD, Adam Neff, MD, and Ryan Russell, DO. All three physicians are accepting new patients.

Mary Manley, MD, joined BHMG Internal Medicine & Pediatrics at 1023 New Moody Lane, Suite 201 in La Grange. Manley enjoys taking care of entire families—from the brandnew baby all the way to the great grandma. She 30 MD-UPDATE

Heidi Mahnken, MD

Enaam Alsoufi, MD

David Picklesimer, MD

Mary Manley, MD

Adam Neff, MD

Ryan Russell, DO

Patrick Matthiessen, MD

Jonathan Lindner, MD

Thomas Edwards, DO

Cecelia Yeary, MHA

is passionate about helping people troubleshoot ways to make small diet and movement changes that can make a big difference in their health.

Adam Neff, MD, is board certified in internal medicine and pediatrics, joining Baptist Health Medical Group Primary Care at 7101 W. Highway 22 in Crestwood.

Ryan Russell, DO joined BHMG Primary Care, located at 1019 Commerce Parkway and sees patients of all ages. An Oldham County High School graduate, Russell is happy to practice in an area he considers home. As a DO, Russell offers some alternative treatments such as massage therapy, cupping, and osteopathic manipulative treatment (OMT).

neuropathy, and Parkinson’s disease and manages stroke patients.

LA GRANGE BHMG Outpatient Neurology

LA GRANGE Thomas Edwards, DO, joined the

is bringing neurology services to Oldham County with a new outpatient neurology practice at 1009 New Moody Lane in La Grange, offering treatment from board certified neurologist Patrick Matthiessen, MD, and support from a specialty pharmacist to oversee complex medications and offer medication counseling services.

Matthiessen is board certified by the American Board of Psychiatry and Neurology.

He treats patients with seizure and headache disorders, such as epilepsy and migraines. In addition, he sees patients with dementia, trigeminal neuralgia, essential tremors, peripheral PHOTOS PROVIDED BY BAPTIST HEALTH

LA GRANGE BHMG Orthopedics at 1023

New Moody Ln., Suite 102, welcomed Jonathon Lindner, MD, a UofL School of Medicine graduate. Lindner’s professional training includes an adult hip and knee reconstruction fellowship at Doctors Hospital in Coral Gables, Florida, and an orthopedic surgery residency at the University of Louisville.

Lindner specializes in orthopedic surgery involving diseases of the musculoskeletal system, including shoulder and elbow conditions, sports injuries, traumatic injuries, degenerative or congenital diseases.

BHMG OB/GYN team at 1023 New Moody Ln., Suite 103. His specialties include obstetrics and gynecology, and his professional training includes Lincoln Memorial University DeBusk College of Osteopathic Medicine and OB/GYN residency at the Naval Medical Center in Portsmouth, Virginia.

Edwards’ certifications include American Osteopathic Board of Obstetrics & Gynecology, American Heart Association Basic Life Support American College of Surgeons Trauma Evaluation and Management course, and American Academy of Family Physicians Advanced Life Support in Obstetrics course.

SEND YOUR NEWS ITEMS TO MD-UPDATE > news@md-update.com

LEXINGTON Cecelia Yeary, MHA, has been

named vice president of Cardiovascular and Oncology Services and Clinical Support at Baptist Health Lexington. Yeary has served in multiple leadership roles at UK HealthCare since 2011. Most recently she served as hospital operations integration director with oversight of healthcare security, workplace violence prevention, facilities management, and facilities planning.

Previous experience includes serving as administrative director for digestive health services, focusing on strategic growth and operations within the Division of Gastroenterology and Endoscopy. She served as preceptor for the UK HealthCare Administrative Fellowship and is on the board of advisors for the University of Kentucky MHA program.

Originally from Lebanon, Ohio, Yeary earned both a bachelor’s degree and a master’s in healthcare administration from the University of Kentucky.

Alexander Hernandez, MD, Joins CHI Saint Joseph Health – Primary Care in Lexington LEXINGTON Alexander Hernandez, MD, an enth-grade science

internal medicine and pediatrics physician, has joined CHI Saint Joseph Health – Primary Care in Lexington, where he looks forward to treating both English- and Spanish-speaking patients. Hernandez joins CHI Saint Joseph Health after completing a residency in internal medicine and pediatrics at the University of Kentucky.

Hernandez grew up in Florida and received his BS in molecular biology and microbiology at the University of Central Florida. He came Lexington for his residency program at UK after receiving his medical degree from Loyola University Chicago – Stritch School of Medicine, where he also earned his MS in medical physiology.

His father is also a physician and Hernandez credits him, along with his sev-

Saint Joseph Hospital Foundation Raises $33,500 at Yes, Mamm! Yes, Cerv! 5K LEXINGTON The

Saint Joseph Hospital supplied 4,500 screening mammograms, Foundation raised $33,500 during its Yes, 850 diagnostic mammograms, 900 ultraMamm! Yes, Cerv! 5K. This year’s race was sounds, and approximately $30,500 in held on Saturday, Oct. 15 at the RJ Corman transportation assistance to those in need.

Railroad Group race course and commemoThe Saint Joseph Hospital Foundation rated 10 years of the Yes, Mamm! program. launched the Yes, Cerv! program in The race returned during Breast Cancer 2021 as a cervical cancer screening Awareness Month for the first time since the initiative to provide screening for cerCOVID-19 pandemic. vical cancer. The program promotes “For the past 10 years, our Yes, Mamm! Pap smears and HPV vaccinations program has helped women and men access and provides cervical cancer screenlife-saving preventive screenings and resources ings, early-stage diagnoses and oncofor treatment. We are proud of the lasting logical pelvic treatment to uninsured impact it has left on our communities,” said and underinsured women.

Leslie Smart, CFRE, president, Saint Joseph Hospital Foundation.

Over the past 10 years, the Yes, Mamm! program has raised nearly $3.5 million to provide free mammography screenings, diagnostic testing and support to underinsured MD-Update is a sponsor of the Yes Mamm! and uninsured patients across Yes Cerv! program Kentucky. The program has PHOTOS BY GIL DUNN

teacher, for sparking an early interest in science and medicine.

Hernandez was a camp counselor and worked on mission trips, and says he wanted to work with kids, but his focus on becoming a “med-ped” was to make sure that the relationship doesn’t end when children turn 18, and they can still turn to him as a primary care doctor.

He speaks both Spanish and English and he hopes to connect with people who often face hurdles in obtaining health care.

Hernandez is accepting new patients and is practicing at CHI Saint Joseph Health – Primary Care in Lexington, located at 211 Fountain Court, Suite 120.

Jessica Croley, MD, medical director CHI Saint Joseph Health Cancer Care Center speaks to the crowd before the start of the YES MAMM, Yes Cerv!

5K run.

Marta Kenney, MD, radiologist, and Kelly Toponak, director of the CHI Saint joseph Health Breast Care Center, came out to support the Yes Mamm!

Yes Cerv! 5K run.

ISSUE #143 31

Events

Lexington Medical Society Presents Its Highest Award to Steven Stack, MD His calm and reassuring guidance saved lives during the COVID-19 pandemic LEXINGTON Steven Stack, MD, commissioner for Public

Health for Kentucky, was presented the Jack Trevey Award for Community Service by Khalil Rahman, MD, Lexington Medical Society (LMS) president, on November 10, 2022. This award is the society’s highest honor and is not presented every year, but only when a worthy recipient is selected. It is named after Dr. Jack Trevey, a true leader in the LMS as well as a servant for all Kentucky as a member of the Kentucky House of Representatives and Senate.

Rahman, during the award presentation, stated, “It is my privilege to present this award to Dr. Steven Stack for his leadership in guiding our state through the COVID-19 pandemic. Dr. Stack was no stranger to members of the society before the pandemic, having served as president of the American Medical Association, and now is no stranger to our fellow citizens, due to his nearly daily televised pandemic updates. I am sure Dr. Stack, through his long career as an emergency physician, saved many lives. Through the pandemic he remained a calm, reassuring presence to our citizens and a strong supporter of his colleagues.”

In his remarks Stack said that overall Kentucky responded well to the COVID-19 pandemic, particularly in the early days, pre-vaccination. He recounted that since his daily televised press conferences he has heard from many Kentuckians, including some who say, “Doc, I’m a Republican, but you did a good job.”

The November LMS dinner was sponsored by the U.S. Army and Stockyards Bank & Trust. The next LMS meeting is scheduled for January 10, 2023, at the Signature Club for the presidential transition.

UK third year medical students Katelyn Cox, Lucas Steele, and Taylor Bradley.

Gil Dunn, MD-Update publisher, with Patrick Padgett, KMA executive vice-president.

UK second year medical students Sydni Anderson, Brandley Firchow, and Katy Comer.

Alicia Jordan, Lucien Kinsolving, Kevin Lane, Stockyards Bank & Trust

Baptist Health Lexington physicians with their husbands, Jonathan Moore, Kara Beth Moore, MD, Christine Ko, MD, Stephen Mooney.

Steven Stack, MD, commissioner for KY Department for Public Health, Wanda Gonsalves, MD, and Gil Dunn.

U.S. Army Captain Jamie Gray and Sergeant 1st Class, Derrick Gentle.

32 MD-UPDATE

Steven Stack, MD, receives the Jack Trevey award from Khalil Rahman, MD, Lexington Medical Society president.

PHOTOS BY JOE OMIELAN

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