Ravi Sharma, MD, uses new cardiac technology at UofL Health to improve patient outcomes
ALSO IN THIS ISSUE
CARDIOTHORACIC SURGERY AT ARH
EP & PACEMAKERS AT BAPTIST HEALTH LOUISVILLE
RURAL CARDIOLOGY AT CHI SAINT JOSEPH HEALTH
CARDIAC IMAGING AT NORTON
HEART & VASCULAR INSTITUTE
SPORTS CARDIOLOGY AT UK GILL
HEART & VASCULAR INSTITUTE
ISSUE #157 (April)
INTERNAL & EXTERNAL SYSTEMS
Dermatology, Endocrinology, Gastroenterology, Geriatric Medicine, Internal Medicine, Integrative Medicine, Infectious Disease Medicine, Lifestyle Medicine, Nephrology, Plastic Surgery, Pulmonology, Urology
ISSUE #158 (June)
WOMEN & CHILDREN’S HEALTH
OB-GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology
ISSUE #159 (September)
MUSCULOSKELETAL HEALTH
Orthopedics, Physical Medicine & Rehabilitation, Sports Medicine, PT/OT
ISSUE #160 (October) CANCER CARE
Hematology, Oncology, Plastic Surgery, Radiology, Radiation
ISSUE #161 (December)
IT’S ALL IN YOUR HEAD
ENT, Mental Health, Neurology, Neuroscience, Ophthalmology, Pain Medicine, Psychiatry
Editorial topics and dates are subject to change
To participate, please contact Gil Dunn, Publisher
We have a big issue of MD-Update for you, the cardiology issue. We tried to cover multiple subspecialties: interventional cardiology, cardiac imaging, electrophysiology, heart surgery, sports cardiology, and general, non-interventional cardiology in rural Kentucky. I hope you enjoy reading what some of your colleagues are up to.
I want to thank Dr. Ravi Sharma for his time and participation in our cover story and for helping us photograph the UofL Health structural heart team in action. The cover story begins on page 10. Thanks also to Drs. James Shoptaw, Kevin Parrott, Cristina Cabral-Pauig, Arpit Agrawal, and Marc Paranzino, the cardiologists, surgeon, and electrophysiologist who made this issue of MD-Update possible.
“As technology continues to develop rapidly, so do cybersecurity threats…. Small and rural providers are targets for cyberattacks because they have limited resources,” writes Jamie Wilhite Dittert, Esq. on page 8. She explains the challenges and details the requirements of keeping cybersecurity protections in place for small and rural medical practices in upcoming HHS rule changes.
I invite you to read her column and consider your practice’s cybersecurity measures.
Can differences in politics crush a personal relationship? Absolutely, but not necessarily, says Dr. Jan Anderson in her mental wellness
column on page 28. Dr. Jan uses her personal experience to explain how to navigate the choppy waters of love, marriage, and politics. In a phrase, “it ain’t easy,” she says
If political differences abound in your personal relationships — and who doesn’t have that situation — Dr. Jan offers some insight and coping strategies inside this issue. It might save your relationship, and it’s free... what a bargain!
FeedSpot listed MD -Update among the top ten, at #8, in the Best Kentucky Magazines from thousands of magazines on the web ranked by relevancy, authority, social media followers & freshness.
“MD-Update is the place for Kentucky and Southern Indiana doctors and providers to connect—across specialties, across town, and the state. It’s a place for doctors to keep up with the latest trends and advancements in medicine in both their specialty and other specialties within their area,” said the review.
It’s nice to be noticed by outside sources, but I’d rather hear from you, our readers, the doctors of Kentuckiana. Drop me an email, or call if you have an idea for a story or an opinion that you want to share with your colleagues.
The 2025 MD-Update editorial calendar is on the preceeding page. When you see your specialty, contact me. If your specialty isn’t included, and you have a story to tell, that’s another reason to reach out to me. I’m looking forward to hearing from you.
MD-UPDATE
MD-Update.com
Volume 15, Number 1 ISSUE #156
EDITOR/PUBLISHER
Gil Dunn
gdunn@md-update.com
GRAPHIC DESIGN
Laura Doolittle, Provations Group
COPY EDITOR
Amanda Debord
CONTRIBUTORS:
Jan Anderson, PSyD, LPCC
Jamie W. Dittert, Esq.
Cody Hunt, KMA
Scott Neal, CPA, CFP
ADVERTISING AND INTEGRATED
PHYSICIAN MARKETING: Gil Dunn
gdunn@md-update.com
Mentelle Media, LLC 38 Mentelle Park Lexington Ky 40502 (859) 309-0720 phone and fax
Standard class mail paid in Lebanon Junction, Ky. Postmaster: Please send notices on Form 3579 to 38 Mentelle Park Lexington Ky 40502
MD-Update is peer reviewed for accuracy. However, we cannot warrant the facts supplied nor be held responsible for the opinions expressed in our published materials.
Copyright 2025 Mentelle Media, LLC. All rights reserved. No part of this publication may be reproduced, stored, or transmitted in any form or by any means-electronic, photocopying, recording or otherwise-without the prior written permission of the publisher.
Please contact Mentelle Media for rates to: purchase hardcopies of our articles to distribute to your colleagues or customers: to purchase digital reprints of our articles to host on your company or team websites and/or newsletter. Thank you.
Individual copies of MD-Update are available for $9.95.
Until next time, all the best, Gil Dunn Editor/Publisher MD-Update
SEND YOUR LETTERS TO THE EDITOR TO: Gil Dunn, Publisher gdunn@md-update.com, or 859.309.0720 phone and fax
Ravi
BY CODY HUNT, HEALTH POLICY DIRECTOR, KENTUCKY MEDICAL ASSOCIATION
The 2025 legislative session of the Kentucky General Assembly is upon us. This year’s legislative session is what’s known as the short session, or a 30-day non-budget session.
Lawmakers convened on January 7th and adjourned on January 10th, concluding Part I of the session. During this time, General Assembly members took their oaths of office, elected their respective caucus leadership, completed mandatory trainings, introduced legislation, and generally reacclimated themselves to Frankfort.
Despite the focus on organizational tasks during the first week, the General Assembly filed 201 bills in the House and 62 bills in the Senate. Notably, House Bill 1, which aims to lower the state personal income tax from 4% to 3.5% starting on January 1, 2026, has already been acted upon and passed out of the House. This bill is part of a multi-year, multistep effort by the legislature to phase out the personal income tax. We fully anticipate that the Senate will pass this bill early during Part II of the session and that the Governor will promptly sign it into law.
The General Assembly will reconvene for Part II on February 4th and remain in session until March 14th. This is when the bulk of the legislative work will take place, including numerous committee hearings, floor votes, and thousands of meetings with constituents and stakeholders. On March 14th, the General Assembly will adjourn for the veto recess and reconvene on March 27th to override any gubernatorial decisions that they disagree with. During this time, they will also finalize any pending legislation they wish to pass before the session’s adjournment. The General Assembly will conclude its legislative business on March 28th, with a mandatory adjournment by midnight.
In terms of healthcare legislation, the Kentucky Medical Association (KMA) anticipates an increased number of healthcare-related bills being filed. KMA will once again
advocate for prior authorization reform legislation, which would mandate insurers to offer an exemption program for physicians with a high volume of approved prior authorizations. Additionally, several non-physician providers
will seek to expand their scope of practice. For example, physical therapists are seeking the ability to order imaging and physician assistants are interested in expanding their prescriptive authority to include Schedule II medications.
Other anticipated healthcare-related legislation includes the establishment of freestanding birth centers, vaccine regulations, changes to fluoride requirements in public drinking water, tax relief for organ and bone marrow donors, and many other issues.
As in most legislative sessions, this year promises to be very active on the healthcare policy front, and I encourage you to lend your voice to the process by contacting your legislators to let them know where you stand on the issues that are important to you. Additionally, please feel free to reach out to us at the Kentucky Medical Association and utilize our resources at https://kyma.org/advocacy/.
Physician
Medical
35th
Golf
May
BY D. SCOTT NEAL, CPA, CFP®
If you are like the readers who write to me about what is bugging them, financially speaking, then you are likely to be a practicing physician with personal and/ or professional goals, only some of which are being achieved — and those only to a limited degree. Occasionally, I hear from the spouse of one of you who just happened upon the magazine and after reading one of my articles, thought he or she should reach out with a question or comment. I truly appreciate hearing from you, whoever you are, and I hope you keep sending me your comments and questions. One of my goals in writing this column is to be relevant to you, the reader.
This month I would like to take you on a short journey, the destination of which could well be the accomplishment of your goals. It can work, even if your goal is something big, like “complete financial independence,” or an intermediate goal, like obtaining a better mortgage rate or avoiding an underpayment penalty on your tax return.
People who know that I read a lot often ask me about some of the big ideas that have stood the test of time. Knowing that I have a seminary degree, some are theological or spiritual and are in the realm of being. Others, like what I am about to show you, tend to be in the realm of doing.
A little more than 25 years ago, my brother, Dan, recommended that I read The GOAL: A Process of Ongoing Improvement, a novel by Eliyahu Goldratt, an Israeli physicist turned author/consultant. Dan knew that I was a self-improvement junkie and would likely enjoy the book. I tried to get into it but failed miserably. I called my brother and told him, “This is about the most boring thing I’ve ever tried to read.”
“Did you get to Jonah?” he asked.
“No,” I had to admit.
“Well, do yourself a favor and get to the introduction of Jonah and then call me back.”
Jonah, introduced in chapter four as I recall, is a scientist who becomes a business consultant and coaches the main character, Alex Rogo, into turning around his failing business. He does it using the Socratic method — asking questions in such a way that the person comes to their own conclusion. When I got to Jonah, Dan was right. I devoured the book.
Goldratt, now deceased, was noted for developing the Theory of Constraints, an overall framework for helping organizations or individuals determine a) what to change, b) what to change to, and c) how to cause the change. He called it The Thinking Process. I found it applicable to so much of life, especially how we handle our money.
Let’s start by identifying what to change.
Too often we find those who are convinced that if every component of a system is working at optimum strength, then the entire system will be optimized. They reach for a small incremental change introduced by the latest hot tip of some financial publication or newsletter. Once that incremental change is implemented, they don’t understand why they move no closer to the goal. But local optima do not add up to global optimum.
Admit it. As a physician, you are very skilled at logical diagnosis, and you probably keep telling yourself that if you can diagnose a human illness, you can surely self-diagnose and address a money problem correctly. But it all starts with listening closely to what you are presently complaining about and drilling down until you get to the root cause. It is simple, but not easy.
One of my core beliefs is that we live in systems: family, work, the economy, the world — to name a few. Any system can be improved with clear thinking. But many people simply live by default, accepting the system as a circumstance that is beyond their control — without even entertaining an idea about what to change, much less about how to make the change that will have the most impact.
I have adapted Goldratt’s idea: “If you have a goal and aren’t achieving an infinite amount of it (whatever ‘it’ is), then there must be a constraint in your system somewhere. Find the core constraint, break it, and you will move closer to accomplishing your goal.”
Dan and I enrolled in a workshop that was to be Dr. Goldratt’s launch of a new book, Necessary, but Not Sufficient. That book was aimed at applying his theory of constraints to technological improvements. After I reg-
istered for the workshop, I got a call from what appeared to be a foreign number on the caller ID. It was well before spam was a thing, so I answered it. It was Dr. Goldratt himself, calling from Tel Aviv to ask me why a personal financial advisor had registered for his workshop in Chicago. I told him that I was interested in using his theory of constraints to help others to reach their goals, especially for those who had issues or constraints around money. He agreed that the workshop could be beneficial, and he let me in.
I later became certified as a Jonah, but that is a story for a different day.
Today, I want to ask you, “What is holding you back from achieving your most worthwhile goals?” Make a list of eight to ten items, called undesirable effects (UDEs), that are holding you back. Next, connect the dots. Ask if any one of these can cause one or more of
“What is holding you back from achieving your most worthwhile goals?” — Scott Neal
the other items on your list. Keep going until you find the core constraint. Make improvements there.
But wait — you don’t have clearly defined goals?
The financial planning process starts with identifying goals of the client. That means I’ve been through many goal-setting programs in my lifetime, and I haven’t found any better than Michael Hyatt’s Your Best Year Ever: A 5-Step Plan for Achieving Your Most Important Goals. One thing I like about Michael’s work is that he begins with an exercise in values clarification, because goals tied to your values are more likely to be achieved. He doesn’t impose a predetermined
set of values, nor do I. That’s left up to you, the goal setter.
Having been around goal setting since high school, I became very familiar with the concept of SMART goals: specific, measurable, achievable, realistic, and time-based. Hyatt changes that up a bit and adds a couple of elements to create what he calls SMARTER Goals: specific, measurable, actionable, risky, time-dimensioned, exciting (to you, that is), and relevant (to your station in life and to your other goals). Needless to say, that last one is very important if you have a spouse or significant other.
The application of these two major concepts is the key for giving direction to your life.
Scott Neal is president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. He welcomes your questions or comments and can be reached at 1-800344-9098 or scott@dsneal.com
From the business of health care to compliance to litigation defense, Sturgill Turner’s experienced health care and medical negligence defense attorneys provide comprehensive legal services to health care providers, hospitals and managed care organizations across the Commonwealth.
Put our experience to work for you.
Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.COM
BY JAMIE WILHITE DITTERT
As new threats to the security of information and patient data appear, the healthcare industry must adapt. Unfortunately, this requires regular investments of money, time, and attention from key staff members. As technology continues to develop rapidly, so do cybersecurity threats, which means a good security plan requires consistent revision and updates. Healthcare providers must make difficult resource allocation decisions when it comes to protecting electronically stored patient health information.
The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) is
the keystone for healthcare information privacy protection. Currently, HIPAA regulations concerning the security of electronic health information contain two types of controls:
1. “Required” or mandatory controls that must be to be put in place, and
2. “Addressable” controls that may or may not be implemented following a reasonable and documented risk analysis process for the provider.
The way a provider puts a control into place can be tailored to fit the entity’s size and capabilities, the cost of the measure, the effectiveness of current protections, and assessed
security risks. The flexibility in the regulations allows small providers to adjust security measures to fit their needs and resources but also creates a grey area of discretion that can make oversight and enforcement difficult.
On January 6, 2025, the Cabinet of Health and Human Services (HHS) issued notice of proposed rulemaking to tighten these security requirements. According to the notice, the discretion afforded under existing regulations has created vulnerabilities for providers with
Lexington
Patricia Morgeson (859) 519-3369
NMLS ID # 827418
Louisville
Gary Spence (502) 588-1595
NMLS ID # 1087080
When it comes to banking for physicians, we’re just what the doctor ordered.
Republic Bank specializes in personal and private practice banking solutions for physicians.
Here are just a few of the medical banking solutions we offer:
• Special Home Loan Programs Reduced closing costs* and exclusive financing options for Medical Residents and Physicians employed at participating programs**.
• Business Banking for Private Practices This includes lines of credit and equipment financing.
• Treasury Management Business on-site deposit and remote deposit capture, as well as lockboxes.
• Online Banking & Mobile Deposit** Because your time is too important to spend on a trip to the bank.
*Reduced closing costs is defined as $500 lender credit towards closing costs. To be eligible for the reduced closing costs applicants must have opened or open a primary checking account with Republic Bank and use this account on a regular basis until the Loan is paid in full and closed. To qualify as “Primary” checking account, the Account must be opened with a minimum of $50.00 and used on a “regular” basis. The term “regular” is defined by the following activity requirements: Minimum of one credit or deposit into the account per month through direct deposit or at any of Republic’s banking centers or ATMs; and establishing a recurring direct deposit within thirty (30) days of account opening if Borrower is employed at the time of the Loan closing or within thirty (30) days of Borrower’s employment start date, whichever may occur first; and Making five (5) or more payments or debits per month through the Account (this requirement may be met through ATM withdrawal, debit card usage, ACH or checks); and Borrower’s regular Loan payment must be withdrawn from the Account, in accordance with all terms set forth in the Authorization Agreement for Direct Deposits. For more detail, please ask about the Promotional Closing Cost Program Participation Agreement. ** To be eligible for the reduced closing costs Medical Residents and Physicians must have executed employment contract with one of the following programs: University of Louisville, University of Kentucky, University of Cincinnati, University of South Florida, Vanderbilt University, St. Elizabeth Medical Center, Children’s Hospital Cincinnati, Hospital Corporation of America, St. Thomas Hospital, Tri-Health Inc., Baycare Medical Group, The Christ Hospital Network.
fewer resources, particularly small and rural healthcare providers.
Based on revenue, HHS estimates that 90 percent of regulated healthcare providers are considered “small” and seven to eight percent are “rural.” Small and rural providers are targets for cyberattacks because they have limited resources and are more likely to decide against expensive and stringent security measures. The HHS notice proposes extensive regulatory changes to the HIPAA Security Regulations, including removing some of the discretion that has been afforded to providers when it comes to implementation.
Small and rural healthcare providers may be the most significantly impacted by these changes. The notice explicitly recognizes that these entities are the most likely to have difficulty finding and attracting qualified security experts and have tougher decisions regarding whether to invest in cyber security or other parts of their practice. It cites a study finding these providers are less likely to have personnel they can appoint to lead compliance and may not regularly update technology with security patches to ensure that programs are protected from newly discovered vulnerabilities.
HHS states that these providers are most susceptible to cyberattacks and may be those most in need of stronger protection. The notice contains several examples of rural providers whose practices were hamstrung or had to be closed altogether due to cybersecurity incidents. One provider could not submit health insurance claims due to a cybersecurity
incident. Another needed to allocate a single worker for a year to mitigate and remedy the impacts of a successful cyberattack.
The proposed rulemaking expressly states that small and rural healthcare providers must comply with more stringent security requirements. The new proposed regulations would remove the distinction between “required” and “addressable” protections. While providers would still be able to choose how to meet the specifications, the regulations add explicit details regarding what must be put into place and the documentation providers must maintain. Moreover, the proposal would require providers to continue to test and review their security measures on a regular basis, with modifications as appropriate.
The express requirements include the following:
• Maintaining an up-to-date written inventory of technology (e.g., hardware and software) and a “network map” of the electronic information systems that could affect how patient information is stored;
• A more detailed and robust written risk analysis of potential threats and vulnerabilities;
• Timely implementation of patches, updates, and upgrades consistent with cybersecurity alerts;
• A written risk management plan reviewed every 12 months;
• Standardized review of information system activity to identify ongoing inappropriate access to patient information;
• Implementing a written plan to address security incidents; and
• Performing a self-audit at least once a year. This proposed rulemaking acknowledges that this process may require small and rural providers to hire outside consultants to assist with compliance. It identifies several existing resources that have been published through the National Institute of Standards and Technology (NIST), including Cybersecurity Framework 2.0, HHS guidance and its Security Risk Assessment Tool, and a February 2024 NIST guide on risk analysis under the HIPAA Security Rule. None of these are definitive, but they are available to and may assist small and rural providers in this process.
The notice of proposed rulemaking is only a proposal; comments to the rule are open through March 7, 2025. Likely, any final changes to the regulation would not be adopted until 2026; with the change in the administration, the approach taken by HHS may also change.
However, providers should take this opportunity to review their security measures now. These changes would require significant time and analysis if adopted; moreover, cybersecurity vulnerabilities are already present for providers and will continue to evolve. Addressing these issues now will keep providers of all sizes healthier in the long run.
Jamie W. Dittert is a partner practicing in torts, insurance, and medical negligence at Sturgill, Turner, Barker & Moloney, PLLC. She can be reached at jdittert@ sturgillturner.com or 859.255.8581.
Ravi Sharma, MD, uses new cardiac technology at UofL Health to improve patient outcomes
BY LIZ CAREY
LOUISVILLE Helping cardiac patients who have come to the end of their treatment options fuels Ravi Sharma, MD’s practice.
Sharma, interventional cardiologist and structural heart and valve disease expert with UofL Health, says his own experience with physicians after a car accident inspired him to make a difference in patients’ lives. Now, he uses his training to provide cutting-edge and innovative solutions to cardiac patients in the Kentuckiana region.
After attending Grant Medical College, a premier medical school in Mumbai, India, Sharma came to the U.S. as a visiting student at Harvard Medical School. He finished his residency at the University of Pittsburgh Medical Center and did a cardiovascular imaging and post-doctoral fellowship at Johns Hopkins University, in Baltimore. He then returned to Boston for a general cardiology fellowship at Beth Israel Deaconess Medical Center at Harvard Medical School. Sharma says his passion for advanced cardiovascular therapies led him to an interventional cardiology fellowship at Harvard, where he focused on structural heart diseases, valvular heart disorders, transcatheter treatments, and complex coronary interventions.
He found his calling for medicine from his own experience, he says.
“When I was 16, I had a motor vehicle accident with
multiple injuries and fractures. That was my first experience with physicians and physician teams,” he says. “The way they helped me during those difficult times to get me back on my feet, and then extensive rehab, was the one incident in my personal life that filled me with gratitude towards this noble profession. That was the reason why I chose to pursue medicine as my career.”
As a field, cardiology presents the opportunity to delve into many different aspects of science, he says.
“Cardiology has applications from basic fields of science like physics, chemistry, and pharmacology; everything is combined. You can actually provide more treatment options to the patient based on those backgrounds,” Sharma says. “I always related to the science. In my personal experience, during my training, I saw that with patients with cardiac diseases, you can provide relief to problems quite quickly and help save lives. It is an intense field, but the gratification of truly changing the course of someone’s ailment, or, for the matter, even life expectancy, was something that led me to gravitate towards cardiology.”
During his training, he met and married his wife, Natasha Jain, MD, a medical oncologist. The two moved to Kentucky when Sharma took the job with UofL Health in 2022. The move put them close to Sharma’s sister and sister-in-law who live in Evansville and Cincinnati.
“The transcatheter approach is the most minimally invasive way of heart repair. It does not involve open-heart surgery, so the recovery is much faster”-
“We have found a home in Louisville. It’s an amazing city, a combination of anything that you get in a major city, as well as the charm of being in a relatively smaller city. Being young professionals as well as raising a young family, this is the best place to be,” says Sharma.
At his Louisville medical practice, most of his time is spent doing procedures and in clinic with patients.
“Most of the time we do our minimally invasive approach, to fix the blockage in the heart,” he says. “With the rapidly evolving field of structural heart disease, we can either repair or replace the heart valve on any kind of structural heart conditions by transcatheter approach, which is the most minimally invasive way of doing it. It does not involve open-heart surgery so the recovery is much faster, the patient comfort is much better, and we can get equivalent results as an open- heart surgery.”
Sharma says being able to provide treatment options, like transcatheter aortic valve replacement and tricuspid and mitral valve repair and replacement procedures, among others, is one of the most rewarding aspects of his practice.
“In these cases, patients have been suffering for a long time with a gradually progressing disease. Many may not have an open-heart surgery as an option, so they think that they’re at the end of the road, without any options available. But now, thankfully, with a minimally invasive approach, we can offer a solution and patients who have basically no hope or no management plan or treatment options available to them, now feel better after the procedure.”
The remainder of his time is spent between inpatient rounds and collaborating with other physicians. While his patient population ranges from 18 to 100, most of his patients are between 50 and 90, where cardiovascular disease is much more common. With the younger patient population, cardiac issues tend to come with another underlying issue like congenital heart disease or cancer.
The lifestyle, genetics, and environment of the area come together to make the Kentuckiana region at high risk for cardiac issues. Sharma says he feels fortunate that his training allows him to provide state-of-the art care to patients in and around the Louisville region.
After evaluating the patient and looking at prior cardiovascular testing, Sharma says he will talk with the rest of the cardiac team to determine what the best treatment is moving forward.
“Once we have all the diagnostic testing available and we sit with the patient family, we devise a plan based on the needs of the patient,” he says. “We don’t only talk about what we need to do right now to fix their problems. We have lifetime management of the patient. We do not only need to provide short term relief of their symptoms, but we also need to make sure that we have a plan available for them so we can get them through the cardiovascular conditions for the remainder of their life expectancy.”
Giving patients a longer life expectancy sometimes means being involved in the development and implementation of new devices, he says.
With one patient, his procedures changed their life dramatically. The patient, an elderly woman, had previously been very active, but had noticed a decline in her energy levels. Fatigued and short of breath, the patient ended up on an oxygen tank.
She was diagnosed by a general cardiologist partner to have severe mitral valve regurgitation and was not a candidate for open heart surgery. She was, however, deemed a candidate for a transcather mitral valve repair, which involves the insertion of a small catheter to analyze the valve and then to repair it.
“The best thing about this case was that we did the procedure in the morning, the patient was recovered from anesthesia by afternoon, and the next morning, she was off oxygen and just walking the hallway without any limitations.” he says. “She was extremely excited because she got her quality of life back. When I saw her, she hugged me and said, ‘You really changed my life.’”
Currently, Sharma is involved in the study of new devices that can help further those life expectancies, he says. One study is the moderate aortic stenosis trial which will help with patients who have moderate narrowing of the aortic valve.
Data shows that patients who have moderate narrowing of aortic valve and are symptomatic, feel better once they get a valve replacement,” he says. “We are one of the few heart centers in the country where the trial is happening.”
The future of interventional cardiology, Sharma says, will rely on training the next generation of specialists.
“From the complex intervention perspective, I see that now is the time to start training this next generation of interventional cardiology specialists. I think the onus is going to be on us, the doctors who have worked with these devices, procedures, and techniques, to train the next generation of physicians so they can grow in the community and provide therapy options for the larger patient population,” he says.
New developments and devices on the forefront of valve replacement will be a key component of that future, and of that training.
“As in any medicine field, there will be newer, more refined devices, as well as a refinement of the techniques that will make the mitral and tricuspid valve repair or replacement more streamlined,” he says. “I would say it’s going to be a lot more reproducible, and it is going to be a lot more generalized, so this therapy can actually be provided to a larger patient population.”
MARK SLAUGHTER, MD
Cardiothoracic Transplant Surgeon
Welcome to UofL Health – Heart Hospital, an exciting chapter in the epic Jewish Hospital story. When you are searching for specialists to care for your patients, experience is key. With a history as one of the nation’s best hospitals for cardiology and heart surgery, this is home to over 40 medical heart firsts and is the area’s only Heart Hospital dedicated to comprehensive cardiovascular care. Our world-class network offers you a true partnership in the care of your patients. Here, patients with a wide spectrum of heart issues have exclusive access to a network of specialists that can heal, protect, revive, and even replace hearts. With every referral, we work hand in hand with our referring physicians to provide heart care that is truly life-changing for patients, and their families. Visit UofLHealth.org or call 502-587-4000.
BY LIZ CAREY
LONDON Despite medicine being her family’s occupation, Cristina Cabral-Pauig, MD, says her focus is to keep her rural patients in southeastern Kentucky out of the hospital. Pauig, a non-invasive cardiologist with CHI Saint Joseph Medical Group in London, Kentucky, comes from a long line of doctors. Both of her parents are doctors, as are her siblings and their spouses. While they, like her, were trained in the U.S., all the rest returned to practice in the Philippines.
Everything in her family, she says, revolves around healthcare. “Every day, there’s not a moment, there’s not a conversation, that’s not related to healthcare or patients and service,” she says. “My mom was the secretary of health in the Philippines, and everything in our family revolved around healthcare.”
It was in this framework that she picked cardiology as her specialty. Her mother was a cardiologist, and the field had always held a special interest to her. Born in the Philippines, Pauig went to medical school at the University of the Philippines before coming to America to obtain a Master of Public Health at the Harvard School of Public Health. She then did her residency in internal medicine at the University of Connecticut and a cardiology fellowship at the University of Florida in Jacksonville. Medicine, she says, is in her blood.
Pauig says she was recruited to join Saint Joseph London nearly 15 years ago. “I was practicing on an island in the Philippines called Palawan, and a recruiter contacted me to see if I was interested in coming back to the U.S.,” she says. “Once I looked into it, I decided to take the job and I landed here in London.” When she came, her husband came with her. James Pauig, MD, was a neurosurgeon in the Philippines, but when the couple
moved to Kentucky, he retired so he could take care of the couple’s three children.
Rural Kentucky wasn’t too different from her home in Philippines, she says. “I’ve lived in the cities where I did my fellowship and residency, but London is similar to the island where I was working before I moved here. It’s an island, and there’s not much there except beaches. Not everything we need is here, but it’s close enough to the city that if we wanted to see or do something, we can go to Lexington.”
While a good number of her patients are over 60, she says, many are younger. For those who have primarily been sent to her by their primary care physician for complaints of chest pain, her goal is to be proactive.
“I might not be necessarily seeing them because of heart disease, but their primary care physician will want to rule out some heart-related illness,” she says. “My interest
with them is preventative cardiology. I do like to keep my patients out of the hospital.”
And her patients tend to be women more than men, she says.
“What I’m seeing is a lot more women coming in to be seen, which is not what we would normally expect,” she says. “Women do not seek treatment or help right away because they’re busy taking care of the other people in their lives. But when they do come, they could have heart disease.”
Pauig said women tend to come to her at later stages of the disease, and they want to talk to someone who is more knowledgeable about heart disease in women. More than just looking at a few charts, Pauig says she looks into her patients’ backgrounds before they even step foot into her office. Sometimes, she says, she’ll even go into old computer files to see if they have been to someone in the hospital years before. When they step in to see her, she says, she’s ready to ask questions about their symptoms and order some tests.
Checking their background is important because Pauig will often be treating multiple members of the same family. “If I’ve seen their parents, they they’ll come to see me,” she says. “They don’t always have the same disease. If the parent had coronary artery disease, the children may have AFib. What I do see run in a lot of families is high cholesterol. If the parents have high cholesterol, then the patients will have high cholesterol.”
“What I’m seeing is a lot more women coming in to be seen, which is not what we would normally expect.”
— Cristina Cabral-Pauig, MD
Diet, exercise, and habits also play an important part.
“There are a lot of issues that are genetic, but for sure the diet does not help,” she says. “And I think a lot of it is smoking and the lack of physical activity. People down here like to hunt, but that’s not necessarily exercise. They will say, ‘Oh, I walk up hills, you know, and I hunt.’ But once they get to the deer stand, they stay there for a while waiting. That’s not much activity after they walk up that hill.”
Getting patients to stop smoking is a key to her treatment. What she wants to do, she says, is stop that next event. “If they already do have cardiac disease, and have had a heart attack, or have stents, we try to prevent a next blockage or needing another stent,” she says. “I try to make sure that they are taking all the medicines they should be taking and that their diabetes is under control. And of course, I try to get them into a smoking cessation program when I can.”
“People
— Cristina Cabral-Pauig, MD
Sometimes, the most important thing is just talking to the patient about the importance of not smoking or of avoiding high fat foods. “Sometimes we think it’s common sense, but I’ve learned if I don’t say it, or when I say it, the patient will say, ‘Oh, I didn’t know that,’” she says. “Those are things they learn about in the conversations we have with them. And that’s important to keeping them healthy.”
And with rural populations, one other challenge is helping elderly patients who may live alone. “Sometimes when patients, especially the elderly, have no one to help them, it’s really hard for them in terms of medications, and even their diet,” she says. “I can advise them to do this or that, but if there’s no one day-to-
day helping them, then it’s hard for them to stay on top of it.”
Despite the challenges, Pauig says she loves being able to help her patients. “I love what I do and I think I help people by doing what I do,” she says. “If something is hurting, you want to help them, but I also want to help them stay out of the hospital and prevent any heart attacks. I really like what I do.”
Appalachian Regional Healthcare (ARH) Cardiology, where heart care meets the comfort of home. Our dedicated team of cardiologists brings world-class expertise to your communities, ensuring you receive the highest level of care without the need to travel far. ARH is committed to keeping your heart healthy and strong right here, close to home. Your heart matters to us. We want to ensure that you have a long and happy life. Trust your Heart to ARH.
To learn more about cardiology services at ARH visit arh.org/cardiology.
Join our team
• Great Base Pay with Signing Bonus
• Starting Bonus
• Student Loan and Relocation Assistance
• Collegial Work Environment
• Integrated Physician Lead Network
• Work Life Balance
To learn more about open cardiologist positions at ARH go to arhphysiciancareers.com
BY GIL DUNN
LOUISVILLE A good puzzle will have clues, some ambiguous, some easy to decipher. You can only solve the puzzle by putting all the pieces together, one at a time. Cardiac imaging, says Arpit Agrawal, MD, a cardiologist with a focus in cardiac imaging at Norton Heart & Vascular Institute in Louisville, is one piece of that puzzle.
“Cardiac imaging helps put the pieces of the puzzle together so we know how to treat the patient. Whether it’s with an echo or an MRI or a CT, it helps us paint the picture for that individual patient,” says Agrawal.
Agrawal was born at the downtown Norton Hospital and grew up in Louisville attending Louisville Collegiate through high school. He went to Washington University in St. Louis for his undergraduate degree and then came back to the University of Louisville for medical school. He did his internal medicine residency back at Washington University/Barnes Jewish Hospital, followed by a cardiology fellowship at Vanderbilt University Medical Center.
Agrawal was always drawn to cardiology because he was interested in engineering and cardiology was a perfect combination of the electrical activity and the pump function of the heart. “I always thought the physiology was very interesting, how the heart is a machine that works your whole life,” says Agrawal.
Agrawal joined Norton Heart & Vascular Institute in 2016. He and his wife Laila, a medical oncologist, moved back home from Nashville to be near family. “Norton Healthcare had a growth opportunity in general cardiology and in the cardiac imaging space. There was a pretty robust imaging program that has bloomed in the last several years,” he says.
Agrawal has a diverse work week that
includes seeing patients in the hospital or in clinic. He has dedicated time for cardiac imaging, which includes periprocedural imaging or structural imaging like transesophageal echocardiograms, which can help his interventional cardiologist colleagues during procedures such as the Watchman®, left atrial appendage occlusion, mitral clips, or transcatheter aortic valve replacements, aka TAVRs. Additionally, he spends time reading cardiac MRIs and cardiac CTs. “I like the variety I get on a day-today basis,” he says.
Heart disease can affect people of all ages, so Agrawal’s patients range from 18 years old to over 100 years old. “Heart disease affects all genders, males, females, transgender individuals. The presentations can vary. Sometimes it can be acute and dramatic presentations when they present with heart attacks, but it can also be slow and progressive such as valvular heart disease or heart failure. It can affect people no matter what stage of life they are in. Certainly, there’s a predilection to more elderly individuals, but we’re seeing younger patients with heart disease now,” he says.
“The bread and butter of cardiology around the world is echocardiography, which is ultrasounds of the heart. The imaging cardiologists often read CT scans of the heart, which allow us to look at the coronary arteries in more depth. It also allows us to look at the structure of the heart in a more static manner. We also do cardiac MRI, which is a unique way of characterizing the tissue of the heart. We can see if there’s scar in the heart and what caused the scar. It can also help us get a better idea about valvular heart disease, how severe is valvular narrowing or leakiness. It also helps us look at the cardiac structures a little more in depth than what we can with echo. And then nuclear medicine is another tool that we use to help characterize tissue looking for infiltrative heart diseases such as amyloidosis or sarcoidosis, as well as another way of assessing for coronary artery disease. It kind of runs a gamut from ultrasound, CT, MRI, and nuclear medicine to help put the pieces together for the patient.”
— Arpit Agrawal, MD
In Agrawal’s opinion, cardiac imaging is evolving and the technology is progressing quickly, particularly in coronary CT, when it’s used for evaluating patients with underlying coronary artery disease.
“There’s constant evolution in the scanner technology which reduces radiation doses while getting more precise diagnostic pictures. Recently we’ve contracted with HeartFlow® which helps us assess people’s coronaries
during coronary fatigue and do some secondary analysis, which can often prevent unnecessary procedures. It’s helped our diagnostic accuracy and that’s has really changed my practice quite a bit,” says Agrawal.
Agrawal states that improved imaging has helped give specialists more confidence in stating that a blockage doesn’t need more invasive testing and is something that can be managed non-invasively. “It gives us confidence that we don’t need to proceed with an invasive procedure because the blockage is not the driver for the patient’s symptoms,” he says.
“I think cardiac imaging allows us to get data on patients that we previously were only able to get with an invasive procedure. While many cardiac invasive procedures can be done safely, anytime you are doing an invasive pro-
cedure, there’s a risk of complications. Cardiac imaging allows us to get imaging and information on patients in a much safer manner than we could previously,” says Agrawal.
One of the roles of the cardiac imaging specialist is working with structural interventionalists on procedures including transcatheter aortic valve replacement, left atrial appendage occlusion, and transcatheter edgeto-edge repair.
“We do the transesophageal echo during the procedure to help guide the interventionalist to put the device in the right place and gauge the success of implanting the device. And then in that same role with left atrial appendage occlusion, when we insert a Watchman device, we help guide our interventional cardiologist, making sure the device is in the right position and making sure that there’s no complications from that,” says Agrawal.
“My hope, as somebody who does cardiac
imaging, is that I can help our proceduralist do procedures on the patients, guide them to make their job easier, as well as to make sure that we’re doing the right procedure for the patient. There’s strong collaboration with our cardiac surgeons, with our interventional cardiologists, and with our structural cardiologists. One of the most important things is helping patients avoid going through those processes if they don’t need it,” says Agrawal.
At the Norton Heat & Vascular Institute there are typically two meetings a week that are multi-disciplinary with surgeons, imaging cardiologists, and interventional cardiologists. The structural heart meeting primarily focuses on valvular heart disease, and the team goes over all the cases under consideration for a structural heart procedure. They look at images together, including coronary angiograms, CT scans, and echocardiograms, and the multi-disciplinary team creates a comprehensive treatment plan.
PHOTO BY JAmIE rHODES
Arpit Agrawal, mD, cardiac imaging specialist at Norton Heart & Vascular Institute.
The other heart team meeting is driven by the interventional cardiologists as well as general cardiologists where they go over interesting cases that some of the cardiologists have had during the week. The cardiac surgeons are also there to provide input and discuss diagnostic and surgical dilemmas.
Solving a puzzle begins with the first piece. “I think the most important thing is listening to your patient and hearing what’s bothering them. You get so much out of hearing a patient’s story, their family history, their symptoms, how long they’ve been having symptoms. What they tell me will help guide the right diagnostic test for my patient. It also involves shared decision-making with my patient about the risks and benefits of testing and making sure that what I order aligns with how the patient and their family want to be cared for,” says Agrawal.
“Often patients and family members ask, ‘What would you do if this were your family member?’ I know that everyone’s goals are different. Some people want to live as long as they can. Some people want to just have a great quality of life for the time that they’re here. And at some point, patients’ goals change. So, when I get asked that question, it is hard to answer, unless I know exactly what the patient’s goals or their wants and needs are. What I do is get to know my patients and then recommend the test that I think that would help get them to those goals. Whether it’s an invasive test, or an imaging test, or whether it’s no test at all. Whether it’s medications, everyone’s got different goals and that’s the puzzle part about medicine: figure out what your patient’s goals are and doing what you can to align our treatment with those goals.”
“That’s one thing I enjoy doing and hope we will continue to be able to do over the course of my career,” says Agrawal.
BY JIM KELSEY
LEXINGTON Athletics and heart are synonymous. Just listen to any coach’s pep talk and you’ll hear phrases like “We showed a lot of heart out there” or “What he lacks in talent, he makes up for in heart.” They are clichés, but they are also true in the sense that a strong, healthy heart is essential for an athlete’s success and safety.
Because of their extensive exercise and training, athletes are generally assumed to be healthy and fit. The reality is, however, that athletes are susceptible to the same serious health conditions as anyone else. Even heart conditions.
“There’s this common misconception that athletes and fit people can’t have heart disease,” says Marc Paranzino, DO, who established the Sports Cardiology Program at UK HealthCare’s Gill Heart & Vascular Institute in the fall of 2023. “I realized that there was this need for high-level, athlete-specific cardiac care, particularly in this area.”
Paranzino’s awareness of heart health in athletes was born out of his own athletic experience. He grew up in Massachusetts, about 40 miles south of Boston, and spent much of his youth scuba diving, so much so that he planned to study marine science in college. He followed that path to Eckerd College in St. Petersburg, Florida, but was unfulfilled with his career.
He enrolled in medical school at Lincoln Memorial’s DeBusk College of Medicine in Harrogate, Tennessee. Following graduation he then completed his internal medicine residency and cardiovascular disease fellowship at UK. He and his wife Alisha, who is a plastic surgeon, moved to Boston for a year where she completed her fellowship. Paranzino took advantage of the time to gain additional experience in sports cardiology, which drew his interest after he developed a passion for endurance sports.
“Historically I had been involved in a lot of team sport activities, but when I found endurance sports, particularly running, I decided I was going to train for a marathon,” Paranzino says. “In doing so, I became fascinated with the physiologic adaptations that your body undergoes during training. I think that was the beginning of my path to cardiology and sports cardiology. When I got into medical school and started learning about the cardiovascular system and the diseases that can be associated with it, I knew that was it for me.”
“There’s this common misconception that athletes and fit people can’t have problems or can’t have heart disease.” — Dr. Marc Paranzino, University of Kentucky Gill Heart & Vascular Institute
Paranzino describes sports cardiology as general cardiology applied specifically to athletes and active individuals. He treats conditions ranging from those with known heart disease such as hypertrophic cardiomyopathy (HCM) or valvular dysfunction to athletes with symptoms concerning for heart disease including chest pain, syncope, or exercise intolerance. Paranzino notes “athletes can have training-related physiologic adaptations that often mimic pathologic conditions, and much of the specialty is focused on differentiating the two.” Paranzino has remained active in the endurance community, having completed multiple races including three Ironman triathlons. He was inspired by his fellow athletes and their questions about their heart
health. They would ask about their heart rate readings on their fitness devices and why they were out of breath.
“What I started to realize was that people had genuine questions,” Paranzino says. “I was disheartened by the fact that they would try to find these answers, and oftentimes, they were dismissed. When I was in fellowship training, I was reading a cardiology journal, and there was an article about the emergence of sports cardiology. I didn’t even know this specialty existed.”
The more he learned, the more he realized that not only was this a needed specialty, but one for which he was ideally suited. He developed the Sports Cardiology Program at UK with the assistance of his colleagues and mentors.
“One of my mentors at Gill Heart, Dr. David Booth, was seeing athletes long before I started this program,” Paranzino says. “He wasn’t doing it in the formalized setting, but he had already laid the groundwork, and we took it one step further and made it an official program.”
It is the only formalized sports cardiology program in Kentucky. Naturally, it has filled a significant need and, as such, has received the full support of the UK Gill Heart & Vascular Institute.
“Gill Heart has been so supportive in building this program,” Paranzino says. “They understand the value of being able to provide high-level, athlete-specific sports and cardiovascular care. I am fortunate to have such amazing colleagues here. We’ve now created this program of general cardiology and applied it to athletes.”
The sports cardiology program offers a multidisciplinary approach to treating athletes including advanced cardiac imaging (cardiac MRI, cardiac CT, and echocardiogram). It also includes specialists, such as electrophysiologists, congenital heart experts, and exercise physiologists.
Patients come to Paranzino via a variety of referrals, including from colleges and universities throughout Kentucky and surrounding states. “We are heavily involved in screening programs for college and professional athletes,” Paranzino says. “Maybe this is an athlete that had an abnormal pre-participation screen by an athletic trainer, sports medicine physician, or primary care physician. They are sending them to us for further evaluation.”
Paranzino’s first meeting with his patients involves compiling a detailed athlete-specific history, including information about their symptoms, training, family history, supplements, and medications.
“We do a deep dive into what testing they have had and try to understand if it was actually abnormal,” Paranzino says. “If it was abnormal, we determine if we need to do further testing such as advanced cardiac imaging or exercise testing. Or, if it was normal, we want the athlete to understand why it was normal.”
Most of Paranzino’s patients are 18 and over, though many referrals come from high
schools. In those cases, Paranzino works closely with the pediatric cardiology program at UK. Otherwise, most of his patients range from young elite college and professional level athletes to masters athletes in their 60s and older who are active and want to stay active safely.
Typically, Paranzino does two days of dedicated clinic during the week and one full day of cardiopulmonary exercise testing. He splits the rest of his time between on-site athlete screenings, research, diagnostic studies, and teaching activities with the residents and fellows.
“All too often, healthcare is practiced within the four walls of a hospital or a clinic,” Paranzino says. “One of the things I love about sports cardiology is the engagement in the community. That is my motivation. I can help educate race directors about how we can be prepared with an emergency action plan if something happens, or make sure we have the right AEDs in place at a swim meet. I can
build relationships with athletes, coaches, and trainers and see an athlete get back to doing what they love.”
Paranzino says that fear has hampered part of that process in the past. Horrific, highly visible incidents such as those suffered by Hank Gathers, a basketball player at the University of Maryland and Buffalo Bills football player Damar Hamlin, create understandable anxiety and caution.
“We were very afraid for a long time of athletes participating in sport with any question of heart disease,” Paranzino says. “There were so many times we would tell athletes they couldn’t play — not because we truly knew or had the data to support that, but out of fear. That has a big effect on people — telling someone who loves to be active that they cannot be active anymore. Having the ability to help move this field forward and not practice out of fear, but out of knowledge and evidence, motivates me to continue.”
Sometimes, it takes a lot of heart to be a doctor, too.
ARH cardiothoracic and vascular surgeon James Shoptaw, MD, feels the pulse of his community
BY GIL DUNN
HAZARD Like the population he has served for years, James Shoptaw, MD, cardiovascular and cardiothoracic surgeon at Appalachian Regional Health, ARH, says he works long and hard each day. He learned his craft starting in 1989 working as an intern for the renowned Michael Sekela, MD, chief of the division of cardiothoracic surgery at UK Healthcare. “We worked long, hard hours together. Dr. Sekela was always encouraging. I’ve worked with him for the last 20 years. Dr. Sekela is how I got to ARH,” says Shoptaw. Shoptaw describes his patients as people who “work long hours and unfortunately don’t have a lot of good things to eat. A lot them start smoking at a young age. They don’t have a lot of time away from work to take care of their health and exercise, so they generally develop obesity, diabetes, hypercholesterolemia, hyperlipidemia. All these are risk factors of atherosclerotic coronary artery disease and peripheral arterial disease. So that’s kind of where we are.”
James
Shoptaw, MD, cardiovascular and cardiothoracic surgeon at Appalachian Regional Health
Shoptaw states that minimally invasive treatments for heart disease are increasing, so there are fewer people needing sternotomy and bypass surgery. “We can treat their occlusions and blockages with minimally invasive incisions and cannulations of arteries, treating the vessel blockages through the artery.”
“I do bypass surgeries, peripheral arterial surgeries, and some peripheral vascular interventions with balloons and stents. We treat some aneurysms with percutaneous approaches,” says Shoptaw.
In a deep, smooth baritone, Shoptaw says he grew up in Georgia and went to the Medical College of Georgia. From there he went to Baylor College of Medicine for residency, internship, and fellowship in general surgery. He is board certified by both the American Board of Surgery and by the American Board of Thoracic Surgery. After his training, he worked about five years in Macon, Georgia, then worked a brief stint in Texas before coming to Kentucky. “I’ve been here off and on for about 18 or 20 years, and I’ve been in Hazard about 10 years. It’s been good for me and my family,” he says.
In his experience, Shoptaw has observed
“I
and stents.”
– James Shoptaw, MD, ARH
that Eastern Kentucky patients start having issues with coronary artery disease as early as 20 years old. “Heart disease is younger here. People do not take care of themselves and make dietary choices that have a high risk for causing problems like drinking a lot of pop, like Mountain Dew, and eating a lot of food that is filled with calories that are mostly carbohydrates, not eating proteins, fats, and carbohydrates, in the proportions that are healthy,” he says.
Shoptaw’s typical patient wellness check is a complete history and physical exam. “We check the risk factors: Do they have diabetes? Do they smoke? Do they have hypertension? Do they have high cholesterol, triglycerides?
Do they have high sugar? What’s their hemoglobin A1c? Do they have a high BMI? What kind of lifestyle do they live? Are they sedentary? Are they active? Do they have an active exercise plan? Do they have a family history which would put them at great risk to have complications of coronaviruses, for cerebral vascular disease. And then, we talk about how to rectify the situation, get them back on the right track.”
Heredity is also a common factor, says Shoptaw.
“No question that the people that come into the world here in Hazard almost assuredly have a risk genetically for coronary heart disease. I see 25 patients a day, and I’d say 80% of those have brothers, sisters, mothers, fathers, aunts, and uncles with coronary artery disease, peripheral disease, cerebrovascular disease, strokes, heart attacks, and limb loss amputations from peripheral arterial complications,” Shoptaw says.
A lifelong student, Shoptaw is optimistic about the future. “We’re still trying to figure out what the perfect treatment for each patient is, and as we go to advanced artificial intelligence models, then hopefully we can plug in the demographics for a particular patient, and based on the best treatment plans across this country, we can figure out what’s right for each patient. And even further, we could look at their genetics and their propensity to be at risk for problems down the line and figure out what would be the best treatment,” he says.
“The new horizon is ventricular assist devices for people with advanced heart failure. Some people are living on devices for extended periods of time now, waiting to get a transplant,” says Shoptaw.
It is a known fact that the rural population in Kentucky, and elsewhere, is underserved. Shoptaw states, “There’s a big need. I remember when one of the men that worked with my dad came in one day and had an acute myocardial infarction. He was like family to me. I did CPR on him, and tried to resuscitate him, to no avail, and he passed away. He was about 40 years old, and that made me think, if I could help someone to avoid this, or kind of bail someone out that was having this kind of issue, then they get a few more days or months or years with their family. That would be a great gift,” he says.
Shoptaw continues, “To take care of the people in our area, you need to develop a team and a link. You’re never going to be able to do everything, but if you have a partner that does the advanced medicine that you don’t do, and develop a strong relationship with them, then the patients get excellent care wherever they are. If you can’t do it, you send them to the place where the can get the care they need and deserve. That’s why UK has been so helpful in supporting the rural healthcare mission of ARH.”
In conclusion, Shoptaw has one message, “Just to love God and love everyone, through your family, and if you do that, then you’ll never go wrong.”
Pacemakers are exciting again, says Kevin Parrott, MD,
BY GIL DUNN
LOUSIVILLE A history of the development of the modern pacemaker was written by O. Aquilna in the April 2006 issue of Images in Paediatric Cardiology. It states that “The first battery-operated, wearable pacemaker was created in 1957, by Earl E. Bakken, an electrical engineer, TV repairman, and co-founder of Medtronic Inc.”
The article goes on to state that Bakken and his brother-in-law, Palmer Hermundslie, co-founded Medtronic in 1949 in a garage in northeast Minneapolis. The company had existed as a repair service for hospital electrical equipment and a regional distributor for other manufacturers.
Medical historians regard Bakken’s pacemaker as one of the first successful
applications of transistor technology to medical devices, helping launch the new field of “medical electronics.” In the entire history of medicine before 1957, there had never been a partly or completely implantable electrical device.
The first totally implantable pacemaker was made in 1958, and the first long-term correction of heart block with a self-contained implantable pacemaker was achieved in 1960. The diameter and thickness of that pacemaker were approximately the same as a can of shoe polish.
Kevin Parrott, MD, is the director of electrophysiology at Baptist Health Louisville. He grew
up in London, Kentucky, in the southeastern part of the state. He went to Duke University for his undergraduate degree and the College of Medicine at the University of Kentucky for his medical degree. He returned to Duke for his medical residency and then back UK for a fellowship in cardiology and electrophysiology. He joined Baptist Health in Louisville in 2018.
“I chose cardiology early on in medical school because I liked the hybrid nature of it, the ability to be a proceduralist and also a medical doctor,” says Parrott.
When asked whether there is more atrial fibrillation in the current population than in previous decades, Parrott replies, “I think that there’s more awareness about certain conditions that I treat, and more knowledge that
there’s treatment available, like AFib ablation. Whether that represents a true increase in the prevalence of the disease is not clear to me. I think in the past, AFib was largely overlooked or just accepted. Patients weren’t really offered treatment, or they didn’t know about it. But due to changes in medical education, we’re seeing a lot more people with AFib in clinic.”
Parrott says that his patients range from 18 to 100 years old, with the majority being elderly, about 60% male versus 40% female. “Some patients are clearly symptomatic and they want relief. Some don’t have many symptoms, but they’re worried about the long-term consequences of AFib. We assess what the patient wants and focus on that. We talk about an ablation, or potentially a pacemaker implant, or alternatives such as anti-arrhythmic medications. I try to be very patient centric,” he says.
A very common, almost everyday question for Parrott is, “If this were your family member, what would you do?”
“I like my patients to have some input. Some people want to be directed; others say, ‘This is what I want.’ A lot of things that we deal with are semi-elective. The choice to get an ablation for a supraventricular tachycardia, an SVT, is going to vary from patient to patient, based on how much they are having it. How big a problem do they view it as, and what’s their fear of it, and what’s their fear of the procedure?”
“You really just have to kind of assess all those things,” says Parrott.
Parrott recalls that when he was in fellowship training, “Pacing was a little boring for electrophysiology. People had bradycardia or heart block, and they got a pacemaker. But over the last three or four years, pacing is really having a moment.”
That “moment” is conduction pacing, where the pacemaker is placed in the heart muscle. Parrott explains, “We specifically target the lead to capture the native conduction system. This gives us a very natural heartbeat with pacing, very close to the natural beat,
and it avoids some long-term complications with pacing therapy, such as a pacing-induced cardiomyopathy.”
“We’ve been real pioneers in that. My partner, Dr. John Mandrola, was doing his pacing, a form of conduction pacing before 2019, and we really started in earnest in 2020 doing conduction pacing from the left bundle location,” says Parrott. Since then, they have done hundreds of cases, and are now in a NIH-sponsored conduction-pacing trial.
Another innovation in pacemakers is the option for leadless pacing. “There are two leadless pacemakers on the market,” says Parrott, “MICRA made by Medtronic and the AVIER.”
In a traditional pacing system, a battery is placed externally to the chest cavity and heart under the skin on the chest wall. It is connected to the heart tissue with thin wires called leads running from the battery to the heart through veins. Leadless pacemakers are able to be implanted directly in the heart, eliminating any external evidence of a pacemaker or the need for leads to connect them to the heart.
“We’ve always known that the weakest point of a pacing system is the leads. They are the most failure-prone part of the system. By taking those out, we get a very reliable pacing system, a very long longevity of the pacemaker, up to 15–20, years, depending on the specific requirement to the patient, and we avoid some long-term complications like lead failure and infection,” says Parrott.
Another advantage is that new leadless pacemakers, such as the AVEIR, offer the ability to do true dual-chamber pacing, to pace in both the atrial and the ventricle, and to do atrial-only pacing. “Previously, all leadless pacemakers were for ventricular pacing only, so that limited the patient population that we could use them on. But now we basically have a leadless option that we can offer to almost any patient, depending on what condition they have,” says Parrott.
Parrott speculates that in the future he will have a leadless conduction pacing, the best of both worlds. “Those are in development. We’ll probably see those within five years, I hope,” he says.
Most of Parrott’s collaboration is with cardiac surgeons, because “we really take a strong interest in managing patients’ devices. We also do lead extraction, which is when we remove these leads if there’s an issue, like an infection or a problem with the lead. The cardiac surgeons back us up in those procedures,” he says.
“We also collaborate with the structural heart team if the patient needs a pacemaker after their surgery. We provide that for them, and we’re able to give them the option for different types of pacing therapy for the patients,” says Parrott.
Awareness of atrial fibrillation and getting patients referred to an electrophysiologist earlier in the course of their disease is important. Parrott feels that there’s good evidence that intervening earlier in atrial fibrillation is better because it tends to be a progressive disease. “What we often see is for patients that have AFib, it’s more of an annoyance for them. They have these intermittent episodes, and maybe they are hospitalized once and they are going in and out on their own. They just kind of live with it. Some patients never get referred to electrophysiology until they develop persistent AFib, where they’re in AFib all the time,” says Parrott.
“Treatment is available, and it’s better to do something earlier. That’s why our program is cutting edge. We practice the latest medicines in EP, we brought the new AFib ablation technology to Louisville with pulse field ablation, with conduction pacing, and we’re pioneers in lead extraction and lead management.
“I’m from Kentucky. I’m proud to be from here, and I like to provide the best possible treatment,” says Parrott. For patient referral, contact
3900 Kresge Way, Suite 60 Louisville, KY 40207
Cardiovascular disease (CVD) and stroke represent significant public health challenges in Kentucky and across the United States. Despite previous declines, recent trends since the onset of the pandemic have shown a troubling reversal, with projections indicating a substantial increase over the next three decades. By 2050, it’s estimated that up to 45 million U.S. adults will be affected by CVD, while stroke prevalence is expected to double. These estimations underscore the critical need for effective strategies to manage risk factors, particularly obesity, which is anticipated to impact over 60% of the population. While staggering, those projections don’t have to become a reality. When it comes to advancing cardiovascular health, the
American Heart Association plays a crucial role in driving significant advancements through research, advocacy and community impact efforts, in addition to collaborating with healthcare providers to improve the health of everyone, everywhere. This comprehensive approach aims to enhance care standards, improve patient outcomes and promote health equity in communities across the Commonwealth and beyond.
As the largest non-governmental funder of heart and stroke research, the American Heart Association has been instrumental in driving advancements in cardiovascular health since 1949, investing over $5.9 billion in research
funding, and currently supporting approximately 1,800 active awards totaling nearly $500 million. This funding is distributed through rigorous peer-reviewed processes to ensure that the most innovative ideas receive support. In Kentucky alone, the Association currently supports 30 active research grants totaling $6.8 million across leading institutions like the University of Kentucky, University of Louisville and University of Pikeville.
Beyond financial support, the Association actively fosters the careers of young researchers and scientists through specialized grants and mentorship programs. By nurturing talent and promoting diversity in research, the AHA contributes to the future of cardiovascular science and innovation.
To learn more about current research opportunities and how to apply, visit professional.heart.org.
In addition to working with other organizations to make a lasting impact by equipping communities with Hands-Only CPR skills, tools to control hypertension and more, the American Heart Association is a leading advocate for public policies that support its mission of longer, healthier lives for all. In Kentucky, the Association works tirelessly to influence legislation at federal, state and local levels, focusing on issues such as cardiac emergency response planning, hypertension prevention and improving access to healthcare.
During the 2024 Kentucky legislative session, the Association successfully advocated for the passage of legislation requiring Cardiac Emergency Response Plans and automated external defibrillators (AEDs) in all public schools – including elementary schools and at school-sanctioned sporting events – as well as a $2.5 million appropriation to ensure implementation and sustainability. Key priorities for 2025 include securing funding
to support the Kentucky Heart Disease and Stroke Program, expand the Cardiac Arrest Registry to Enhance Survival (CARES) and enforce the CPR training mandate for high school students. The Association also remains vigilant in defending against threats to essential programs like SNAP (food stamps) and Medicaid, recognizing their crucial role in improving the overall health of Kentuckians.
To support these advocacy efforts and stay informed about legislative developments, join the You’re the Cure network by texting KY to 46839. Members receive regular updates and opportunities to engage with elected officials in support of these critical initiatives.
The American Heart Association collaborates extensively with healthcare providers to improve patient care and outcomes through evidence-based guidelines and quality improvement initiatives. Programs like Get with The Guidelines® engage hospitals across Kentucky in continuous quality improvement efforts for heart failure, stroke and other cardiovascular conditions. By implementing these guidelines, hospitals can enhance patient care protocols and ultimately save lives.
Through Healthcare Business Solutions, the Association trains more than 23 million healthcare providers worldwide each year in CPR and first aid, equipping them with the skills necessary to respond effectively to emergencies. The Resuscitation Quality Improvement (RQI)® Program further supports healthcare providers by ensuring ongoing competency in CPR skills, improving the quality of resuscitation efforts and patient outcomes.
Additionally, initiatives like Target: BP™ and Check. Change. Control. Cholesterol™ provide clinical guidelines and resources to healthcare providers and patients alike, promoting better management of blood pressure and cholesterol levels. By connecting clinicians in Kentucky with nationwide networks engaged in similar efforts, the Association facilitates knowledge sharing and collaboration to maximize its impact and strengthen the health of communities.
Physician support is crucial in the ongoing fight against heart disease and stroke. Together, we can build a healthier Kentucky and work towards a future where CVDs are preventable and survivable for all. Join the American Heart Association in making a difference today.
To learn more about the Association’s local initiatives and how you can get involved, visit heart.org/kentucky or contact AHAKentucky@heart.org.
BY JAN ANDERSON, PSYD, LPCC
The last person you want to have political differences with is the person you share a bed with. Trust me, I know.
In my February 2023 column in MD-Update, “Can Love and Politics Mix?” I outlined my own personal struggles with loving someone who is my polar opposite politically. I recommend you read the whole article, but here’s the gist of it: It ain’t easy.
Political polarization is painful and can be poisonous to your relationships. It can ignite explosive conflict, create emotional distance, and even threaten the foundation of your relationship.
Families, even close ones, are more vulnerable to political polarization than ever before. A recent Harris poll found that one in two adults are estranged from a close relative, with politics being the primary cause in about 40% of cases.
Here’s a likely contributor: People today feel more free to treat those with differing political views with ridicule, contempt, and even aggression, according to a recent Stanford study.
Nevertheless, the poll noted that most family members estranged over politics are deeply distressed and long for reconciliation.
But how? What if I told you that your relationship can strengthen not because you agree on everything but because you can learn to disagree better?
Learning to navigate the treacherous terrain of political differences was the last thing I expected when I walked down the aisle with my husband over fifteen years ago. When his political side surfaced shortly after we married, I was totally apolitical and totally unprepared for the FGO (Freaking Growth Opportunity) awaiting me.
The journey has been long, difficult, and very messy. And meaningful.
Every time my husband and I recover from an inevitable political clash, I feel more confident in our ability to navigate conflict and come out on the other side more connected and understanding of one another.
My life experiences have always served as a crucible for informing, shaping, and strengthening my professional work. What I’ve learned on this journey is particularly potent, and I’m eager to share what I’ve learned with estranged family members and couples in conflict.
In my search for solutions, I took a deep dive into an unexpected and powerful synergy between neuroscience, emotion regulation practices, and business negotiating skills.
When political conflict triggers you, your rational brain takes a backseat—hijacked by raw emotion and the knee-jerk responses of your more primitive instincts. The neuroscience of regaining control is a two-step process—and the order matters.
When you’re flooded with emotion, trying to reason with yourself is like talking sense to a panicked child. Instead, start with the same simple steps you’d offer a freaked-out toddler, drawing on Dr. Kristin Neff’s research on the effectiveness of self-compassion:
1️. Acknowledge the Pain: “This feels awful. I hate this.”
2. Recognize Your Common Humanity: “I’m not alone. Others have felt this too.”
3. Do Something to Help Yourself. Do it right now.
The idea is to create a physical distraction that interrupts the negativity quickly. This allows your brain to reset and redirect the conversation from explosive to productive.
Here are some examples of how to set a neutral boundary for yourself and your partner to deescalate conflict:
• Break eye contact and look down for a moment. Don’t look up. It may look like an eye roll.
• Take a sip of water.
• Take a slow, deep breath through your nose, pause briefly, then exhale through your mouth.
• Put both feet on the floor and lightly press your palms into your thighs. When you’re emotionally flooded, it takes at least twenty minutes for your physiology to calm enough to re-engage with composure and clarity. Get good at reading your own physical and emotional arousal level so you give yourself the time and distance you need before re-engaging. You may need to take a break, take a walk, watch a movie, or call it a night.
This is how you take charge of your emotions—not by judging or suppressing them, but by working with them. Once your emotions settle, your brain’s rational, problem-solving, pro-social part comes back online. Now, you can respond rather than overreact or shut down.
Solution #1: Don’t Try to Solve the Problem. Learn to Manage the Problem.
Have you ever felt blissfully at one with your partner, only to wake up the next day wondering if they’re from another planet? That’s the paradox of relationships.
Marriage researcher John Gottman found that almost two-thirds of relationship conflicts are “perpetual.” These disagreements are based on fundamental personality and lifestyle differences — introvert vs. extrovert, night owl vs. early bird, thinker vs. feeler, risk-taker versus risk-averse, etc. Political disagreements
are often perpetual relationship problems. Each partner’s political stance is typically rooted in deep personal values and beliefs.
Here’s the good news: Gottman found that relationships don’t require complete harmony to be stable and happy. He discovered that all couples — happy and unhappy — argue.
It turns out that relationships thrive not because you agree on everything. Your relationship thrives because you figure out how to disagree better.
The goal is to manage the problem rather than try to solve it. This involves making trade-offs, finding common ground, meeting halfway, or adjusting to accommodate each other so you can move forward together — despite your differences.
NOTE: Here’s what’s essential: Find a middle ground that doesn’t feel like a lose-lose.
At times, the tension over the presidential election grew so intense that we weren’t sure our marriage would survive the ferocity of our opposing views.
I credit my husband with negotiating a middle ground that honored his lifelong commitment to civic engagement and was rooted in respect for each other’s emotional boundaries. He offered not to vote for the presidential candidate and instead vote down ballot only. That was big, for him and for me. I’ve always felt like politics is more important to him than me. Maybe I was wrong. I offered not to vote for president either.
Then, my husband (wisely) suggested the need to “trust but verify.” We drove to the polling place together. After voting, we showed each other our ballots and then went to dinner together.
Some of my clients found more success with the opposite approach. Even though they vehemently disagreed, both partners felt the need to support each other’s right to vote. How does the approach make you feel? That’s what determines its success. We each gave up something. Was it disappointing? Yes. Did it feel lose-lose? No. Was it worth it? Absolutely.
We’re learning that not every political issue has to be a battleground. Saying “what everybody else is thinking but afraid to say” may play well on political talk shows, but it can tank your marriage’s Nielsen ratings.
Some conversations are better left unspoken, not out of avoidance but out of respect for each other’s emotional well-being.
My biggest takeaway about boundaries? Know my limits. I can overestimate my ability to actively listen, stay curious, and remain tolerant. Instead, I’m finding it better just to be human. Sometimes, it’s better just to walk away.
Even though the current political divide has deepened, the frequency, duration and intensity of our political dustups has decreased.
We have not changed our political beliefs or the passion with which we hold them.
So, what changed?
Both/And thinking is a game-changer when it comes to navigating differences. It’s like a Jedi mind trick that helps you recognize how seemingly opposing perspectives can both hold truth and have value.
This mindset shift expands your ability to see the validity and potential in all sides of an issue — fueling creativity rather than limiting choices.
Instead of feeling trapped in an Either/Or dilemma, you’re free to explore a “third way” — a solution that integrates the best elements of both perspectives.
This approach doesn’t just resolve conflict; it unlocks new possibilities that wouldn’t exist in a black-and-white framework.
When I first tried the Both/And examples below, I was surprised at how hard it was. My either/or wired brain wrestled with the cognitive dissonance:
• I can be deeply upset by my husband’s political beliefs, and I love my husband.
• My husband can hold political beliefs that are offensive to me and treat me with respect and consideration.
• My husband can support bad people and be a good person.
Both/And thinking forms new neural pathways in the brain, and practice will groove those pathways and make this mindset feel easier and more natural.
By working with your brain — not against it — you can stay in the driver’s seat, navigate intense emotions, and engage in problem-solving. The goal isn’t just to calm down. It’s to stay in control and at the table when it matters most.
If you are struggling or know someone struggling to get a foothold in treacherous political terrain, check out my many website blogs at www.DrJanAnderson.com If you want a personalized approach, schedule a free 1️5-minute consultation to see if I’m the right helping professional to support you.
Life is too short to live in a political divide from the people you care about most.
Trust me, I know.
LOUISVILLE Jonathan Weeks, MD, board certified in obstetrics and gynecology, has joined Baptist Health Medical Group.
Weeks focus is on maternal-fetal medicine care, from the assessment of fetal growth and wellbeing to the diagnosis and management of nonroutine pregnancy. His professional training began at the University of Kentucky College of Medicine. He completed a residency at Naval Hospital Oakland in California and a maternal-fetal medicine fellowship at the University of California Irvine and Long Beach Memorial Medical Center.
Weeks is a fellow of the ACOG and a member of the Society for Maternal-Fetal Medicine, the American Society of Addiction Medicine, the Greater Louisville Medical Society, the Kentucky Medical Association, and the American Institute of Ultrasound in Medicine.
LEXINGTON David Redinger, MD, has joined Baptist Health Medical Group Behavioral Health, at Baptist Hamburg. His areas of focus include depression, anxiety, and bipolar disorder.
Redinger is a graduate of the University of Louisville School of Medicine. He completed his psychiatry residency at the University of Florida and his addiction psychiatry fellowship at the University of Louisville School of Medicine. He is certified by the American Board of Psychiatry and Neurology, Addiction & Adult Psychiatry.
LEXINGTON Yuri Boyechko, MD, has joined Baptist Health Medical Group Cardiology. He provides comprehensive treatment for cardiovascular disorders, as well as preventive care and treatment for coronary artery disease.
Boyechko is a graduate of the University of Kentucky College of Medicine, where he completed his residency in internal medicine. He completed a cardiovascular disease fellowship at the University of Tennessee Erlanger Heart and Lung Institute. He has received national board certification in cardiovascular disease and internal medicine.
LOUISVILLE Baptist Health Louisville had a significant advancement in cardiac care with the successful implantation of the first leadless atrial pacemaker, AVEIR AR pacemaker by Abbott, performed by electrophysiologist Dr. Kevin Parrott.
Leadless pacemakers differ from traditional pacemakers in that they do not require pacing lead wires to run from a pacemaker generator battery implanted under the skin on the chest wall through blood vessels to the heart. Leadless pacemakers, instead, are placed directly into the heart tissue.
Eliminating the cardiac leads is associated with fewer long-term complications of pacing therapy such as system failure and infection. Parrott is enthusiastic about the procedure, “This new technology allows us to better tailor our approach to each patient’s unique needs, and completes our portfolio of options for our patients.”
The implantation took place at Baptist Health Louisville’s advanced cardiac care facility.
LEXINGTON Lexington Clinic announced that urologist Thomas Slabaugh, Jr., MD, has been recognized as an expert at treating bladder and bowel dysfunction with innovative Axonics Therapy. Slabaugh’s designation as an Axonics Center of Excellence recognizes his and Lexington Clinic Urology’s expertise with Axonics Therapy and dedication to improving the lives of patients with bladder and bowel dysfunction.
Axonics Therapy stimulates the sacral nerve through sacral neuromodulation, which restores normal communication between the brain and the bladder. Axonics Therapy has been clinically proven to provide rapid and long-lasting relief of symptoms associated with bladder and bowel dysfunction.
FRANKFORT Lexington Clinic welcomed Justin Hayes, MD, to its Orthopedics –Sports Medicine department. A graduate of University of Kentucky and the UK College of Medicine, Hayes is board certified in sports medicine and family medicine. He has significant experience covering athletic teams from high school to professional levels and offers specialized care for athletes and active individuals.
Hayes offers a wide variety of services, and specializes in diagnosis, treatment, and management of sports-related and general musculoskeletal conditions, including care for injuries and disorders of the muscles, bones, joints, tendons, and ligaments. He also offers ultrasound-guided procedures to relieve pain caused by musculoskeletal injuries and conditions, with a focus on providing effective care for arthritis with minimally invasive treatments.
Hayes will be based in Frankfort at Lexington Clinic Orthopedics – Sports Medicine office located at 101 Medical Heights Drive.
FRANKFORT Hope Cottrill, MD, is the new president of the Lexington Medical Society (LMS), having taken office at the January 21, 2025, dinner meeting. Christine Ko, MD, is the new president-elect. In her remarks, Cottrill referred to the influence of her mother, Carol Cottrill, MD, the first pediatric cardiology fellow at the University of Kentucky Medical Center.
President Cottrill also acknowledged two of her mentors, David Bensema, MD, past-pres-
ident of the LMS, and Elvis Donaldson, MD, for their guidance.
Outgoing president Angela Dearinger, MD, thanked the membership for its support during her tenure with a special mention of Chris Hickey, LMS EVP, who Dearinger said “is the backbone of the Lexington Medical Society.”
Cody Hunt, Kentucky Medical Association health policy manager, gave an update on possible legislative actions that could occur in the 2025 short session.
Winners of the LMS essay contest were announced. Danesh Mazloomdoost won the active physician category for his essay, “How AI Expands Our Vison in Medicine.” The resident essay winners were first place Jeff Spindel, DO, second place Chandra Kakarala, MD, and third place Fatai Akemokwe, MD. Winners in the medical school category were Bryant Reynolds in first place, Saadia Akhtar with second place, and Hassan Kashif third.
Norton Heart & Vascular Institute is recognized by the American College of Cardiology as a leader in care.
• First in Louisville to implant a dual-chamber leadless pacemaker
• First in Louisville to use PASCAL and MitraClip to replace and repair heart valves
• First health care system in Louisville to offer Cathworks FFRangio® System, a minimally invasive procedure used to treat clogged arteries and advanced heart disease
• Highest survival rate in the nation for ECMO interventions treating heart failure
• Among the highest survival rate in the nation for cardiogenic shock to treat heart failure
When it comes to heart and vascular care, we stop at nothing to get your patients the advanced care they need.
To make an appointment or refer a patient, call (502) 446-6484 (NHVI) or visit NortonEpicLink.com.
