MD Update Issue 154

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #154 WWW.MD-UPDATE.COM

Oncology’s Holy Grail

VOLUME 14 • #5 • October/November 2024

UofL Health’s Goetz Kloecker, MD, has seen significant advancements in lung cancer treatment over the past 30 years

ALSO IN THIS ISSUE LUNG CANCER SCRREENING AT ARH A CAREER OF CAREGIVING BY OB-GYN AT WOMEN FIRST OF LOUISVILLE PERSONALIZING BREAST CANCER CARE AT NORTON HEALTHCARE WORLD TRAVELED ONCOLOGIST COMES TO CHI CANCER CARE CENTER IN BARDSTOWN SURGICAL ONCOLOGY AT ITS BEST AT UK HEALTHCARE

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THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS

Editorial Calendar

2024 ISSUE #155 (December) IT’S ALL IN YOUR HEAD ENT, Mental Health, Neurology, Neuroscience, Ophthalmology, Pain Medicine, Psychiatry

2025 ISSUE #156 (February) HEART & LUNG HEALTH Cardiology, Cardiothoracic Medicine, Cardiovascular Medicine, Pulmonology, Sleep Medicine, Vascular Medicine, Bariatric Surgery

ISSUE #157 (April) INTERNAL & EXTERNAL SYSTEMS Dermatology, Endocrinology, Gastroenterology, Geriatric Medicine, Internal Medicine, Integrative Medicine, Infectious Disease Medicine, Lifestyle Medicine, Nephrology, 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 To participate, please contact Gil Dunn, Publisher GDUNN@MD-UPDATE.COM 859.309.0720 (direct) • 859.608.8454 (cell) Send press releases to gdunn@md-update.com

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

LETTER FROM THE EDITOR/PUBLISHER

Welcome to the Cancer Care Issue of MD-Update The “War on Cancer” began with the National Cancer Act (NCA) of 1971, a federal law that was intended to “amend the Public Health Service Act to strengthen the National Cancer Institute in order the more effectively carry out the national effort against cancer.”

The NCA was signed into law by President Richard Nixon on December 23, 1971. “Moonshot 2.0” is the name given to President Joe Biden’s initiative to reduce cancer death by 50% over the next 25 years.

Death by cancer is still the second highest cause of death in the U.S. next to heart disease, according to the CDC. Kentucky has the unenviable position of second highest mortality rate by cancer at 176.1 per 100,000 persons, next to Mississippi at 178.8.

A recurring theme in this issue of MD-Update is the high value of clinical trials that propel advancement in cancer vaccines and the role of the immune system in remission. Those clinical trials, with national impact, are being held at the UK Markey Cancer Center, the UofL Health Brown Cancer Center, and the Norton Cancer Institute. The patients, the oncologists, and laboratory researchers in Kentucky will be instrumental in winning the war on cancer.

Bon Voyage to Dr. Rebecca Booth I’ve spoken with Dr. Rebecca Booth, OB-GYN, co-managing partner at Women First of Louisville, many times over the last 15 years of publishing MD-Update. Dr. Booth, as her patients and colleagues know, is passionate about women’s health. She is retiring from active medical practice at the end of 2024. She will not be idle, as she plans to continue writing, teaching, and speaking out on women’s health issues.

Our story on Dr. Booth begins on page 13. I invite you to enjoy reading about a doctor’s life well lived, serving others.

Biking to Beat Cancer Another of our physicians in this issue, Dr. Laila Agrawal with Norton Cancer Institute, is fighting against cancer on multiple fronts. Agrawal is a medical oncologist who specializes in breast cancer. She also works with women’s sexual health during and after treatment. An active woman with daughters and a physician husband, she takes her message across the country to conferences and is active in the local Louisville community.

Volume 14, Number 5

ISSUE #154

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Gil Dunn gdunn@md-update.com GRAPHIC DESIGN

Laura Doolittle, Provations Group COPY EDITOR

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Jan Anderson, PSYD, LPCC Brandy Montgomery Scott Neal, CPA, CFP Emily Schott, KMA Sarah Charles Wright, Esq

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Laila Agrawal, MD, and her husband, Arpit Agrawal, MD, with their two daughters rode in the Bike to Beat Cancer, an annual fundraiser supporting Norton Cancer Institute.

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 call me. I’m looking forward to hearing from you.

Until next time, all the best,

Gil Dunn Editor/Publisher MD-Update

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.

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Looking Ahead to 2025

2 MD-UPDATE

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ncology’s 10 O Holy Grail

UofL Health’s Goetz Kloecker, MD, has seen significant advancements in lung cancer treatment over the past 30 years COVER PHOTOGRAPHY BY JOHN LAIR

CONTENTS ISSUE #154

4 HEADLINES

SPECIAL SECTION:

26 MENTAL WELLNESS

6 ACCOUNTING

13 OB-GYN CANCER SCREENINGS 18 ONCOLOGY IN BARDSTOWN 20 ONCOLOGY/BREAST CANCER 22 PULMONOLOGY/LUNG CANCER SCREENING 24 SURGICAL ONCOLOGY

28 NEWS

7 FINANCE 8 LEGAL 10 COVER STORY

14 OB-GYN

18 ONCOLOGY

20 ONCOLOGY

22 PULMONOLOGY

31 EVENTS

24 SURGICAL ONCOLOGY

ISSUE #154 3

Headlines

Evelyn Montgomery Jones, MD, Steps in to the KMA Presidency

BY EMILY SCHOTT, KMA COMMUNICATIONS DIRECTOR LOUISVILLE You could say medicine “runs in

the family” for the newly inaugurated president of the Kentucky Medical Association (KMA), Evelyn Montgomery Jones, MD. Her father, Wally Olson Montgomery, MD, was a general surgeon and served as KMA president in 1985. Her husband, otolaryngologist Shawn Jones, MD, served as KMA president in 2011-2012. And the Joneses together have three children, one of whom has followed in their footsteps in pursuing medicine and another who works in health policy.

But while the path to the KMA presidency may have been familiar to Montgomery Jones, the Paducah dermatologist has been sure to blaze her own trail.

Evelyn Montgomery Jones, MD, KMA president 4 MD-UPDATE

Montgomery Jones admits she “sat on the sidelines” as a KMA member for many years, discouraged in part by the organization’s perceived lack of opportunity and overall diversity.

But in 2013, KMA underwent a strategic planning initiative that led to big changes to the organization’s board structure and programs, including a goal of diversifying its leadership and modernizing the more than century-old Association.

“I came home from the Annual Meeting that year and called KMA Executive Vice President Pat Padgett and just said, ‘I’m in.

Tell me what I can do,’” says Montgomery Jones. “I saw the Association was really trying to evolve, and support physicians and our patients in the ways we needed them to, and I felt confident that I could put my time and effort behind these ideals.”

One of the programs that developed out of the strategic planning process was the KMA’s Kentucky Physicians Leadership Institute (KPLI).

Now the premier leadership training program for physicians in Kentucky, the award-winning KPLI cultivates the next generation of physician leaders from across the state through a series of intense and tailored learning events. Montgomery Jones completed the program in 2021.

“I can’t say enough good things about KPLI. It really helped prepare me for leadership roles not only in the KMA, but in my practice and for opportunities in my community as well. And I think the results of the KPLI program speak for themselves,” she says.

PHOTO PROVIDED BY KMA

Currently, most of KMA’s leadership, as well as leadership within county and state specialty societies, are KPLI graduates. “I think you would be hard pressed to find a more diverse leadership group anywhere than KMA’s elected officers. They are diverse, from their specialties, to their geographic regions, to their race and ethnicity, gender, age, and backgrounds,” says Montgomery Jones. “I am so proud to work alongside them and am so proud of how far the KMA has come in that regard.”

Montgomery Jones has also hit the ground running as KMA president, with preparations for kicking off what will be a two-year public health initiative around overall health and wellness. “Small STEPS, Big Impact,” will build on the KMA’s recent public health success by encouraging patients to make long-term changes through taking simple steps that can add up to a big impact on their health. The campaign will focus on five key areas—screenings, tobacco use, exercise and nutrition, physician visits, and stress—and offer straightforward strategies and support for patients. The campaign, a partnership with the KMA’s charitable arm, the Kentucky Foundation for Medical Care (KFMC), will be funded by a grant from the Kentucky Department for Public Health.

“To our patients, making big changes to their health and lifestyle can be really overwhelming, so we want to encourage them and walk beside them in these efforts—we’re taking these small STEPS together!” says Montgomery Jones.

While she knows the path might not always be smooth, Montgomery Jones is looking forward to leading the KMA over the next year. “I have always believed that the value in the KMA is that physicians’ collective voice is more powerful than our voices as individuals,” she says, “and I am confident that Kentucky has some of the best physician voices in our choir. I can’t wait to see what all we can achieve together.”

“The low dose CT lung cancer screen saved my life. It found my lung cancer early enough so it could be treated and cured.”

-Teresa Daniels, Age 54

LUNG CANCER SCREENING You are eligible for screening if:

You are 50 to 80 years old

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Lung Cancer Screening

Accounting

Billing for Prolonged Services: An Untapped Opportunity

Are you using the codes for prolonged services and using them correctly? Here’s why every medical coder should start.

BY BRANDY MONTGOMERY, HEALTHCARE CONSULTING MANAGER Medical coders have incredible insight into their own way of doing things, but they may be less aware of how others in the industry work. Dean Dorton provides medical billing audits to providers of all shapes and sizes, so we have a unique perspective into how multiple offices operate. We can see trends and anomalies that others can’t—and we can call attention to opportunities and issues that may be overlooked.

A perfect example is billing for prolonged services.

One of our new clients was not in the habit of billing for prolonged services (e.g., services extending beyond the required time), and after doing some digging, some of our current clients are not either. They told us that payers do not reimburse for these codes, so they see no urgency to include them.

That’s understandable. From working with so many medical offices, however, we know that these codes are not only worth including but potentially an untapped source of significant revenue.

Why Bill for Prolonged Services?

Some payers don’t reimburse these codes, the most notable being Medicare, but others certainly do. They may be secondary payers, but whatever the source, they will only reimburse what has been coded into the bill. Omitting codes for prolonged services makes reimbursement impossible. Including the codes leaves the door open.

Furthermore, if more coders start including these codes, payers will begin to understand the extent to which prolonged services affect the time and revenues of providers.

Reimbursement could eventually become more common—but only if medical billers push the issue by including the codes.

How to Bill for Prolonged Services First of all, keep in mind that if you bill for prolonged services, you have to bill the primary e/m code based on time. For reference: Use 99417 for each 15 minutes beyond the required time of the primary outpatient service level. So use 99417 in conjunction with 99205, 99215, 99245, 99345, 99350, and 99483.

Use 99418 for each 15 minutes beyond the required time of the primary inpatient or observation service level. So use 99418 in conjunction with 99223, 99233, 99236, 99255, 99306, and 99310.

One exception is G2212, which designates a prolonged office or outpatient e/m service beyond the MAXIMUM required time of the primary procedure. And it’s only for Medicare claims unless otherwise directed.

Find the Other Untapped Opportunities There’s no doubt about it: Coders are leaving revenue on the table by not billing for prolonged services. This is one of the most common untapped opportunities we see...but it’s certainly not the only example.

What if increasing revenue, sometimes quite significantly, was as simple as making a few adjustments to billing and coding practices? Our audits regularly uncover exactly such opportunities while providing an objective analysis from coding experts with years of experience making billing better.

Contact bmontgomery@ddafhealthcare.com or 502.566.1037 for more information.

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

Health system solutions & advisory services

deandorton.com/healthcare 6 MD-UPDATE

Medical billing & credentialing Finance & revenue cycle management

Outsourced accounting, audit, & tax Risk management & compliance Technology & data analytics

Finance

Thoughts on Where We Stand Today

BY D. SCOTT NEAL, CPA, CFP

An occupational hazard for me is that I must pay attention when there is significant volatility, not only in the stock market, but in the mood of the country. Both have seen an uptick in volatility this fall. Much of the volatility in mood stems from the run-up to the election.

But anecdotally, this year the angst seems more pronounced than in the past and for a greater diversity of reasons.

It was just a couple of months ago that the jobs report was rather dismal (114,000 new jobs created in July). Unemployment had risen for the fourth straight month, coming in at 4.3%, the stock market suddenly dropped, and the fear of recession appeared to be the consensus.

Fast forward to October’s report of September data. The numbers show that 254,000 jobs were created, and unemployment fell to 4.1%.

Average hourly earnings increased 4% over those of a year ago. The Fed finally cut interest rates.

And at the time of this writing in early October, we have witnessed the stock market (defined by the S&P 500) surge by 10.9% since early August. Some people have a hard time separating what I have just described (the circumstances of our present condition) from their thoughts and feelings about it. But I want to warn you, financial well-being is derived from actions, or inaction, based on thoughts and feelings about those circumstances. Please pay attention.

With the U.S. stock market up 34% for the past year, some investors regret that they aren’t more heavily invested in the market and are frozen from acting. Others suffer FOMO, the fear of missing out, and are jumping in to follow the trend. Many academics would have us believe that trend following is just dumb, but I could point to some very learned economists who say it is totally rational. That’s a subject for a later column, if there is interest.

The one thing that appears to be a safe bet today is the U.S. consumer. I often reflect on how much better our living standard is

today than when my widowed grandmother, in 1933, bought some cows and chickens and started selling milk, butter, and eggs to provide for her and my father during the depression and beyond. The moral is that our living standard is built on our consumption of goods and services.

Our economy is consumer-based and much more a service economy today than ever before.

“But what does that have to do with anything?” you may ask. There is significant correlation between changes in GDP and changes in consumption, so these are numbers that everyone should pay attention to, but hardly anyone does. We consumers have little interest in consuming less. The important point is that the volatility of both measures has shrunk dramatically since my grandmother’s day.

There are three reasons for the drop in volatility: 1) the very significant rise of the service sector (that’s MDs and CFPs) which now accounts for 82% of the workforce; 2) the total lack of correlation between the traditional sectors of the economy; and 3) the willingness of governments (both federal and state) to soften the blow of downturns. Say what you will about the federal debt problem; as consumers we are a spoiled bunch and much of the debt is fueled by our desire to enjoy improved living standards. It is not all roses, however. There is always room for an exogenous shock that nobody can foresee. Let’s assess two major risks to economic stability as we see them today.

The possibility of World War III is not out of the question and paints a significant risk. Simply watching the nightly news and observing the destruction brought on by the regional conflicts, particularly in the Middle East, is gut-wrenching. Many of you are too young to recall the 1960 drills in elementary classrooms around the country. In what now seems rather absurd, we practiced crawling under our desks to protect ourselves from nuclear fallout. That was when

there existed two players, the U.S. and Russia.

What kept us from waging war against each other? Mutual assured destruction. The risk of escalation is much greater today simply because the number of regimes that can engage in all-out warfare has grown significantly.

A second risk (or opportunity, depending on your worldview) is the emergence of AI. It is still very early to properly assess the form and impact that AI is going to have. Full and broad scale adoption will, undoubtedly, bring about significant change. Every commentator appears to be obsessed with the impact on jobs and the unemployment rate, predicting that jobs will be lost, and unemployment will soar. While vast numbers of people will lose their job, unemployment is not likely to rise dramatically because new jobs in new industries will be created to take their place. The displaced workers will retire or retool. It is also very likely that the productivity gains of the new industries will be greater than those lost in the dying industries.

Isn’t life in these United States truly exciting? I don’t know about you, but I am looking forwarding to getting past the election and into 2025.

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

md-update.com YOUR RESOURCE FOR THE BEST IN KENTUCKY HEALTHCARE ISSUE #154 7

Legal

Certifying Patients for Medical Cannabis – It’s a Process

BY SARAH CHARLES WRIGHT

You likely know that medical cannabis becomes legal in Kentucky in January. What you may not know is that registration for physicians and advanced practice registered nurses (“practitioners”) who want to become medical cannabis practitioners (“MCPs”) began in July when the state opened the Medical Cannabis Practitioner Registration Portal (the “Registry”). The multi-step registration process to be an MCP will take time to complete, and practitioners who want to begin treating patients with medical cannabis in January should start that process soon.

STEP 1: Complete Medical Cannabis Continuing Education Hours.

To register as an MCP, a practitioner must first complete six hours of continuing medical education in (a) diagnosing “qualifying medical conditions” for medical cannabis treatment; (b) treating those qualifying conditions with medical cannabis, (c) the pharmacological characteristics of medicinal cannabis and possible drug interactions; and (d) indications of cannabis use disorder. Proof of completion of the six hours must be submitted with the practitioner’s MCP application.

STEP 2: Apply for Licensure Board MCP Authorization.

The State Medical Cannabis Program has delegated MCP authorization to the Kentucky Boards of Medical Licensure (KBML) and Nursing (KBN). Both boards are accepting applications for MCP authorization and have issued regulations establishing the professional standards for medical cannabis which detail the MCP authorization requirements for their respective licensees. Links to the regulations and each board’s MCP application are available on the practitioner webpage of the program website along with the link to 8 MD-UPDATE

the registry.

Physician and APRN eligibility requirements for MCP authorization are very similar, but not identical. In addition to the obvious need to have an active, unrestricted license in good standing with the KBML or KBN, they include: • Having current DEA and KASPER registrations. APRN registration certifications must be on file with the KBN; • No history of disciplinary action or license or permit denial or restriction imposed by any licensing entity in any jurisdiction or by the DEA in connection with inappropriate prescribing or other misconduct involving a controlled substance or other dangerous drug.

• No ownership or investment interest in or compensation agreement with a Kentucky licensed medical cannabis cultivator, dispensary, processor, producer, or safety compliance facility.

Exhaustive descriptions of all MCP eligibility and application requirements can be found in each board’s MCP regulations. The application review process described in the regulations is similar to the medical credentialing process, and it could take a month or longer for the KBML or KBN to review an application, and issue an authorization, a denial, or request more information.

Once granted, MCP authorizations are good for one year and must be renewed before they expire. During that time, the MCP will need to complete three more hours of medical cannabis CME to apply for renewal. Timing for authorization renewals will coincide with each board’s annual license renewal schedule.

STEP 3: R egister with the Medical Cannabis Program.

Once a practitioner receives their MCP authorization, they must register as an MCP

on the registration portal to file written certifications for patients to obtain medical cannabis.

STEP 4: Follow the KBML/KBN Professional Standards of Care Procedures to Certify Patients for Medical Cannabis.

The KBML and KBN professional standards for written certifications for medical cannabis include all the following. The MCP must • Establish a “bona fide practitioner-patient relationship” with the patient in person; • Document a comprehensive patient medical and psychiatric history, history of drug use and medication review in the patient’s medical record; • Perform a physical examination related to the patient’s medical condition, diagnose the patient with a “qualifying medical condition” (per KRS 218B.010); and • Obtain the patient’s signed informed consent, a KASPER report for the previous 12 months, a pregnancy test for female patients of child bearing potential and age, and a drug screen for patients with a history or evidence of substance abuse.

Legal

STEP 5: Determine the Appropriate Form, Dosage and Supply Limit to Recommend in the Written Certification.

Written certifications should follow program supply limits for a daily supply, uninterrupted 10-day supply, and uninterrupted 30-day supply which are published in 915 KAR 2:020.

For example, the daily supply limit a dispensary can dispense to a patient with a Medical Cannabis Program ID card is 3.75 grams of raw plant material, 1 gram of concentrate, or 130 milligrams of delta-9 THC infused into an edible, pill, capsule, oil, liquid, or tincture. An MCP can recommend greater than a 30-day supply if “they reasonably believe” and certify that a 30-day supply will be insufficient to give the patient uninterrupted relief. The regulation also establishes a four-step “potency equivalent formula” for determining the amount of raw plant material equivalent to the potency of a medical cannabis product.

STEP 6: Issue the Written Certification.

An MCP issuing an initial written certification to a patient is required to do it during an in-person exam. Certifications are only valid for 60 days. Subsequent certifications can be issued via telehealth. The MCP must record the certification online on the registry within 24 hours of issuing it. Certifications can be renewed before (but not after) they expire for three additional 60-day periods. After that, the MCP must perform an in-person or telehealth exam of the patient before issuing and recording a new certification.

Patients must have a registry ID card to get medical cannabis from a dispensary. The program will issue ID cards to patients who file a notarized application, meet eligibility criteria and have a current initial written certification from an MCP on the registry. The program website states that MCPs may begin recording certifications on the registry on December 1, 2024. However, the website also says ID

card applications will not be accepted before January 1. For this reason, filing a certification on the registry too early in December may not be practical if there is a chance the certification will expire before a patient is able to file a notarized ID card application.

The program regulations establishing the written certification and ID card application procedures are not yet final and may be further revised after the program gets underway.

It suffices to say the program is a work in progress and will likely be modified to some extent once officials have had the opportunity to evaluate how well those procedures work to accomplish their intended purpose.

Sarah Charles Wright is a healthcare law attorney at Sturgill, Turner, Barker & Moloney, PLLC. She may be reached at 859.255.8581 or swright@sturgillturner.com.

This article is intended to be a summary of state and/or federal law and does not constitute legal advice.

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Sturgill, Turner, Barker & Moloney, PLLC ♦ Lexington, Ky. ♦ 859.255.8581 ♦ STURGILLTURNER.COM ISSUE #154 9

Cover Story

Oncology’s Holy Grail UofL Health’s Goetz Kloecker, MD, has seen significant advancements in lung cancer treatment over the past 30 years

BY JIM KELSEY LOUISVILLE For Goetz Kloecker, MD, taking

the easy route is not his style. If it was, he wouldn’t have chosen to specialize in thoracic oncology. He might not have even come to the United States from Germany 30 years ago.

But growing up in Munich, Germany, the son of two physicians, he was always focused on helping people.

Kloecker’s medical journey began with completing his undergraduate work at the University of Regensburg in Regensburg, Germany, in 1986 and then obtaining his medical degree from the Technical University of Munich in 1990. That training also included time spent in Louisville as a senior medical student exchange.

“When I first came to the United States in the 1980s, it was for several months to get practical experience,” says Kloecker, who is the director of thoracic oncology at the UofL Health – Brown Cancer Center. “German medical training had been theoretically very good but practically somewhat limited. The strength of American medical training is the combination of bedside and book and interaction with the professor. Germany was mainly book learning and testing. So, I came here to get the practical aspect. Then later, in the 1990s, I came to become a teacher myself.”

Kloecker returned to the U.S. in 1994 to learn how to structure a residency program.

He intended to go back to Germany, but he met his wife, Mary Barry, MD, in Louisville, so he stayed. He completed an internship in internal medicine in 1995, followed by an internal medicine residency in 1997, both at UofL. For three years Kloecker practiced general internal medicine, primarily in the rural areas close to Louisville.

“When I was out in the community, I saw 10 MD-UPDATE

so much cancer in Kentucky,” says Kloecker.

“At that time, it was not easy to find oncologists, especially in the rural areas, so I had to do a lot as a primary care physician – diagnosis, pain control, palliative care, and direct where the patient went to get treated for cancer. When I started doing this in the community, I realized that this was a big problem.”

Seeing the need, Kloecker became interested in oncology, though he was well aware of the challenges it presented. When the Brown Cancer Center invited him to come back as a fellow, he jumped at the chance.

“I knew lung cancer was so common in Kentucky, and I told them I wanted to take care of lung cancer patients,” says Kloecker.

“Back then lung cancer was not a very sexy field. There was not much to offer. It was sometimes very sad because for many years, even decades, we had a limited number of treatment modalities. But in the last 15 years, things have boomed. Now thoracic oncology has become one of the sexier specialties because you can make a lot of difference in the patients’ lives.”

PHOTOS BY CHRIS WITZKE

Goetz Kloecker, MD is the fellowship program director at the UofL Health Brown Cancer Center and teaches graduate students, residents, fellowship, and subspecialty training.

Discovery and Innovation in Lung Cancer Treatment What has changed, says Kloecker, is an enhanced genetic understanding of cancer in the past 20 years and the discovery that certain mutations drive cancer cells.

Cover Story Dr. Goetz Kloecker with one of his patients. Thoracic oncology has grown in popularity as physicians embrace the enhanced opportunity for good outcomes.

is because smoking has become less common.

We are continuously dropping the incidence rate and the mortality rate. While we are more effective at finding cancer and treating cancer, there is a growing number of lung cancer survivors. So, the total number of lung cancer patients may be the same, or even increasing, because the patients survive their lung cancer longer. The survival rate of metastatic lung cancer has increased from two percent to close to 20 percent. We have fewer new patients and fewer patients dying from lung cancer but far more survivors.”

Thoracic Cancer: The Hot New Specialty

“The EGFR mutation drives up to 10 percent of lung cancers,” says Kloecker. “When we block this mutation, the cancer goes into remission and stops growing, and these remissions can last for a long time. That was the first revelation that we can turn the key of the cancer engine and shut it down. We now have at least 10 mutations that we can shut down with a simple pill.”

On the heels of that breakthrough discovery came another revelation pertaining to the role of the immune system in fighting cancer.

“Roughly 12 years ago, we learned that the immune system can be boosted and can help you put lung cancer in remission,” says Kloecker. “More than that, we can cure the cancer, even if it has spread and is metastatic.

By boosting the immune system, we can put many cancers in remission, and people are alive for years and years.”

Kloecker says that smaller but still significant recent advancements include blocking the blood vessels to cancer. Medicines to help control pain and side effects have helped make radiation therapy and chemotherapy

more effective and better tolerated. Enhanced diagnostics such as PET scans and MRIs, as well as blood tests to identify cancer genes, are helping to identify cancers in earlier, more treatable stages.

“There was a trial in 2011 where they used CAT scans with very little radiation and no contrast injection and found that you can find lung cancer early in patients at a certain age if they smoked a certain amount,” says Kloecker. “By finding it early, we can cure a lot of patients by using this screening test.”

Lung Cancer in Kentuckiana In men, 90 percent of lung cancers are related to smoking, versus 80 percent in women. Among the other causes of lung cancer are radon and air pollution. Kloecker notes that nationally the average age for a lung cancer patient is about 70, but in Kentucky, it is closer to 60 due to the higher prevalence of smoking at a younger age.

“In the United States, lung cancer rates have dropped significantly since the 1990s — more than 20 percent,” says Kloecker. “This

What was once a potentially depressing specialty, thoracic oncology, has grown in popularity as physicians embrace the enhanced opportunity for good outcomes. Kloecker, who is the fellowship program director, teaches graduate students, residents, fellowship, and subspecialty training. It makes for a busy schedule, balancing days in the clinic, conferences with fellows, hospital calls, and studying medical records and clinical trials.

“We have about 300 applicants for our positions here,” says Kloecker. “It’s often because of personal experience — often their family. They realize how serious this is. And it is an intellectual curiosity because in oncology, you have research, technology, genetics, radiology, social sciences — everything comes together.”

That doesn’t mean that every day is a good day, that every outcome is a positive one. The fear and reality of negative outcomes persist.

“Emotionally, it’s a different field from other fields because you see patients who are suffering and their family so close up,” says Kloecker. “It becomes emotionally very challenging. It is hard on fellows to see young people their own age suffering from cancer.”

The Impact of Clinical Trials Kloecker is optimistic that the suffering will continue to decline as more advancements are made in the prevention, detection, and treatment of thoracic cancers.

ISSUE #154 11

Cover Story

“In the next 10 years, I think our survival rates will not only get tenfold higher but probably reach 80 percent,” he says. “We need to send a message out about how important clinical trials are. The sad truth is that only five percent of people in the United States with a bad cancer like lung cancer get enrolled in clinical trials. Patients may think that they are used as guinea pigs. What people have to understand, however, is that clinical trials nowadays are the best chance to survive cancer, because not only do you get the newest treatment, but you also have more people looking at your cancer, your x-rays, and your chart, so you have many more people supporting you.”

Kloecker’s optimism extends to the classroom, where he encourages his students by showing them the amazing advancements in the past 20 years. He shows them a video of

the Wright brothers as an example of how quickly a small step can become a giant one.

“I show my students how the Wright brothers hopped with their airplane maybe the length of a football field and then sixty-six years later, we’re landing on the moon,” says Kloecker. “In cancer research, I think our jumps are longer now.”

Cancer Vaccine: The Holy Grail One potential giant leap for mankind is the possible development of a vaccine for cancer. What might seem unfathomable may not be so far out of reach.

“What I’m presently very excited about is a vaccine against cancer,” says Kloecker. “There are now more and more trials where we use the common cancer proteins and we can make a vaccine out of it, inject it — often with

immune therapy to boost the immune system — and then hopefully if the patient ever had a cancer, it will not come back. I imagine we may have cancer vaccines like we have now against measles or smallpox. That would be the holy grail of oncology to make cancers disappear altogether.”

In the meantime, Kloecker continues the work he started so many years ago, relying on science and optimism to get him through the bad days. He takes solace in the knowledge that he can help people, even on their worst days.

“There are still a lot of patients with lung cancer in Kentucky, and I know how much we can help them,” says Kloecker. “It’s the same motivation I had when I started — to help people. You learn a lot from the people and from your colleagues, and I think it makes life more valuable and worthwhile.”

“Clinical trials nowadays are the best chance to survive cancer,”- Dr. Goetz Kloecker with some of his clinical trial team 12 MD-UPDATE

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Gynecology

Putting Women First for Over Three Decades As she looks forward to her retirement, physician, author, and advocate Rebecca Booth, MD, also looks back, reflecting on thirty-five years of caring for Kentucky’s women

BY DONNA ISON

Rebecca Booth, MD, OB-GYN, FACOG, author, advocate, and co-managing partner at Women First of Louisville.

LOUISVILLE The one field of medicine Rebecca

Booth, MD, FACOG, did not want to enter was obstetrics and gynecology. According to Booth, “OB-GYN was the one thing I was sure I didn’t want to do. I really wanted to have what I thought would be a balanced lifestyle. I was very interested in having a family, and I felt that OB-GYN would be prohibitive.

So, I tried desperately to talk myself out of it.”

Booth could not escape her fascination with everything related to female health, however, and found herself captivated by each aspect— pathology, physiology, pharmacology, and surgery—of the specialty. She says, “I just had to get honest with myself; my energy flowed so naturally into OB-GYN that it was a calling stronger than anything I’d ever felt in my life.”

That calling led Booth to a thirty-six-year career in women’s health as an author, advocate, and co-managing partner at Women First of Louisville, an all-female medical practice with board-certified physicians who provide the most comprehensive and inno-

vative care to females of all ages. Now, in her “Goodbye Year” as she nears retirement, Booth looks back at the amazing journey that led her to this point.

Booth joined Women First directly following her completion of a medical degree, residency, and internship at the University of Louisville School of Medicine. In Booth’s third year of residency, Christine Cook, MD, signed on as residency director. Cook was a pioneer in reproductive endocrinology, including in vitro fertilization (IVF), and a champion for other female physicians. To connect her residents to other women practicing in the community, Cook started a book club. It was there that Booth met Rebecca Terry, MD, who had the dream to start an all-female practice of “women for women” with the goal of helping the community overcome outdated fears and garner faith in females in medicine.

That dream became a reality with what is now Women First, which Terry cofounded PHOTO BY GIL DUNN

with Sarah Cox, MD. Shortly after its founding, Booth joined the practice with fellow resident Mollie Cartwright, MD. She states, “It was 1989, and we just started straight out of finishing residency. On the promise of the future growth of the practice, Molly and I took a very low competitive starting salary on the assumption that we would have an opportunity to grow, which we did. So, it took a leap of faith.”

Women First: The Early Years Success for Women First of Louisville, then named Terry, Cox, Booth, Cartwright, and Warren, started almost immediately, and they quickly grew, adding services such as in-office mammograms and ultrasound. Traditionally, most OB-GYN practices were focused primarily on obstetrics, instead of gynecology.

Booth explains, “The women in our community were attracted to an all-female OB-GYN practice, so I would say that unique factor was a big draw. And, once we were able to ISSUE #154 13

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Gynecology

add ancillary care, that expanded our practice and moved us into a situation where we were making it easier for women to get the preventive care they needed. This type of medicine as prevention was gaining steam in healthcare.”

Another feature that set Women First apart and aided with their expansion was their early adoption of advanced practitioners; they were one of the first practices in the region to hire a physician’s assistant. Currently, they have 13 advanced practitioners and nine physicians/ surgeons. Booth says, “When you begin to support the office flow with advanced practitioners, it allows the board-certified physicians to focus on non-office advancements, such as surgery or physiology, and to begin to develop niches that can enrich the overall practice.”

“We were one of the first in the region to bring mammography in-office, and we do it as part of our annual ‘well care’ exam. Our goal was to increase compliance with screening recommendations. And we see that compliance has markedly increased,” says Booth. “Our appointment staff facilitate scheduling. Most of our patients are very interested in being proactive with their breast cancer screening.”

“It’s been a real gift to me that we are able to offer this service to our patients,” says Booth.

Women First: Always Innovating Along with her burgeoning career, Booth was still committed to achieving a work-life balance that included having a family, as were all of the physicians at the practice. To accommodate this desire, the practice adopted a rotating call, which was highly unusual at the time. This meant that deliveries were performed by whichever physician was currently working, meaning patients had to accept that any of the doctors could be the one delivering their infant, depending on when they went into labor. “It was a very new concept at the time. The catch was that we had to be similar enough that our patients would feel comfortable with any one of us,” Booth states.

Booth continues, “The typical model was by far more common. If you had a patient as an OB-GYN and she went into labor, you went into the hospital and delivered her even if you had a waiting room full of patients. Our 14 MD-UPDATE

Dr. Rebecca Booth with a newborn she delivered in the 1990s.

patients have never had to wait because we’ve been rotating calls from the beginning.”

This approach also allowed for a more balanced lifestyle amongst the partners, with each of the doctors strategically organizing their work life and family planning. The result: the five original partners of the practice had 15 children between them in the span of seven years. However, once Booth had her own children, she began to think of long-term gynecological health maintenance and what the next phases of life would hold physiologically. This led to conversations with other women and additional research; the information gleaned became the basis for a book on the topic, The Venus Week: Discover the Powerful Secret of Your Cycle at Any Age.

The Metaphor of the Venus Week Originally published in 2008, but then updated and re-released in 2014, Booth’s book introduced the term “Venus Week,” which refers to the window of days each month when estrogen and testosterone are at their PHOTO PROVIDED BY WFOL

peak levels. It examines the hormonal fluctuations that occur throughout the month and how that influences the way women look, feel, and function. According to Booth, “The book came out organically from having multiple conversations with my patients who didn’t feel like they understood their hormones well, and also as an impetus for clinicians. Traditional medical school education was deficient in understanding and explaining the significance of female hormonal physiology.”

Both publishers and the medical community found the approach fresh and deemed it a breakthrough. Booth states. “We used a metaphor, the Venus Week, to explain what most women consider their best days hormonally in their cycle, to inform them of how to take charge of that dynamic, and how to apply it to their life every day.”

The book took Booth on a nationwide tour that involved stops at The Today Show, CBS.com, and SiriusXM Doctor Radio. In addition, she was quoted in various periodicals, including Shape, Glamour, Seventeen,

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Gynecology

Redbook, the Chicago Tribune, and Kentuckiana Healthy Woman. It has received praise from its wide readership as well. Booth has been surprised to find that some of her most positive reviews on Amazon have come from men who wanted to gain more insight into the physiology of the women in their lives.

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Looking to the Future When looking at the future of Women First of Louisville, advancements in reproductive health, and her own future, Booth has high hopes.

After years in senior leadership at the practice, Booth will remain dedicated to making certain Women First continues to grow and thrive. In her words, “I’m still very much immersed in making sure the legacy of our practice is well supported. We’re extremely fortunate at Women First that our younger GenXers and Millennials are willing and ready to carry on the legacy, and that has been the greatest gift. I know I’m leaving my patients…and all of our patients…in the hands of extremely talented women.”

This is imperative, as the field of OB-GYN is becoming even more vital with many women today receiving the most consistent medical care throughout their lifespan from their gynecologist. Women First of Louisville practices truly generational medicine. In Booth’s words, “The reason it’s relevant is because we’re on the precipice of an explosion in genetic medicine and since we, as OB-GYNs, see the mothers, daughters, sisters, infants, and even embryos, genetically, we have an opportunity to inform all of them with our medicine. OB-GYNs are in a very unique position to help with that mission.”

Despite the legislation now limiting the availability of women’s healthcare nationwide, Booth believes women have the potential to change the tide and take back their rights. She says, “We can look at this current time—and while very frightening with the fact that we have lost some reproductive freedoms—it is also an opportunity for women to speak through their votes about what they want for their bodies. And I am confident that the majority of women want reproductive freedom in this country, for all, in every state.”

Personally, Booth’s goal has always been to help women grasp that fertility and menopause coexist on the same biological clock. As most females are now living more years without ovarian function than with ovarian function, she wants women to embrace the importance of setting up an “ovarian retirement plan” in their twenties in order to reap the benefits throughout each stage of their life. “There hasn’t been enough work on metaphorical communication, in my opinion, to help provide anthropological explanations that are through the lens of natural selection, now that it is better understood,” Booth states. To remedy this, she intends to keep educating individuals through public speaking, writing, and employing other forms of media.

In closing, Booth says, “I’m hoping that I can continue to move the needle on helping women understand their physiology, because if it’s not understood, they cannot take charge. It is complicated, but it is understandable. That’s my passion…to generate tools to make female physiology understandable.”

ISSUE #154 15

Oncology servic

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Destination: Bardstown

Doctor’s experience at home and abroad colors cancer care

BY LIZ CAREY BARDSTOWN For Patrick Williams, MD, the

call to care for cancer patients started at home, but the experience he gained from his work around the country cultivated his mission.

Williams, hematologist/oncologist at the CHI Saint Joseph Health - Cancer Care Center in Bardstown, has seen cancer firsthand as he watched cancer take the lives of his grandfather and his aunt when he was a child, and later his mother and grandmother. His experience with caring for cancer patients and their caregivers helped enhance his oncology practice.

“I’m really thankful that I got to see what compassionate care looked like,” Williams says. “It’s been around me my whole life. My brother became a physician, a pediatric anesthesiologist. I’m married to a cancer nurse, and had the opportunity to actually practice with her and watch her as an incredibly compassionate nurse towards patients. I’m just really fortunate that my life has been kind of peppered with people who’ve been affected by cancer and people who treated cancer 18 MD-UPDATE

patients. That has blended itself into the way that I practice oncology care.”

A Career across the World Williams went to college at the University of Arizona, graduating with a degree in immunosuppression and a minor in chemistry. After medical school at the Uniformed Services University at the Navy National Medical Center in Bethesda, Maryland, he did his residency in internal medicine at the Eisenhower Army Medical Center. He then moved to San Antonio, Texas, for a composite combined fellowship at Wilford Hall Medical Center. After completing the fellowship, he took a position as assistant chief of oncology in Fort Lewis Tertiary Medical Center, and chief of oncology at Womak Army Medical Center before completing a tour of duty between 2003 and 2007 when he was deployed in Iraq. Since that time, he has held positions at the Norton Cancer Institute in Louisville, and a cancer care center in Billings, Montana, where he developed the program.

Williams states that his experiences with diverse backgrounds in various parts of the PHOTO BY GIL DUNN

country have influenced his quality of care.

Growing up, Williams’ dad worked as a steam pipe fitter on a travel card moving his family from job to job throughout the U.S. This led Williams to practice medicine all around the country, as well as while he was stationed overseas with the U.S. Army.

“I have been very fortunate to have opportunities to take care of people, literally from all around the world,” he says. “We used to talk about the disease that only occurs in the boards—when you take your oncology boards, and they say, ‘Well, you only see this disease on a board question.’ And I can honestly say there are many instances where the patient for me was one of those board questions. I have been fortunate enough to have gained that experience and to be able to bring that experience to each of the different places that I’ve practiced.”

Learning about diverse cultures and populations has given Williams an increase of knowledge, which allows him to more effectively communicate with and educate his patients, he says.

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“I understand that not every community receives information the same way, whether it’s good or bad news. Being acutely aware of some of those differences allows me to present patients with information that best helps them understand their situation,” he says.

“Sometimes, you have poor communication with the patient. When that does occur, because somebody may come from Uzbekistan, or you have somebody who is from a deeply spiritually Muslim country, understanding those issues as they relate to their current perception of the world helps you communicate much better and understand their goals much better.”

Bringing Big City Care to a Small City Despite his experiences in other places, Williams and his wife, Stacy Williams, an oncology floor nurse on the leukemia, lymphoma, and cell therapeutics floor of the Norton Women and Children’s Hospital, have chosen the small town of Bardstown as their home for their blended family. Being minutes away from

his practice allows him the time he needs to care for his own family, he says.

“Previously my professional life was waking up early in the morning, transitioning from Bardstown to Louisville, seeing anywhere from 25 to 35 patients a day, and really feeling that I didn’t have much energy left for my family or my personal life,” he says. “Now I travel eight minutes. I see fewer patients. I have more time to dedicate to them. It’s busy and it’s complicated. But my day-to-day is really taking care of a local population and providing them with big city care because we have the resources at Flaget we need to take care of them.”

Part of that “big city care” is bringing to his practice what he gained from his experience around the country and in Iraq. While his 26 years of experience gives him an edge when it comes to treating cancers, his contacts with providers in Kentucky who provide cancer-related services and the partnership with Cleveland Clinic Cancer Center helps to connect big city networks to his small town, he says.

“For instance, I had a patient who had a

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Oncology

very unusual negative breast cancer that did not carry all of the usual hormone signatures you would see on a common breast cancer,” he says. “I was able to reach out to a world expert because of my previous contact in the military.

Instead of wondering, ‘What do we do with this particular rare cancer?’ I can literally pick up the phone and have that patient seen within the week with that specialist. To me, that is what people hope for when they come to a doctor.”

That connection to patients is important to him. He says he’s honored to care for people he will see at local baseball games and in the grocery store.

“When I was in Louisville, patients who walked through the door could be from anywhere in the state,” he says. “Flaget is such a special place to be at, and I’m taking care of people within my community. There’s a more profound relationship in this community, and I feel like this was meant to be.”

The Future of Cancer Care With an eye on the past, Williams says the future of oncology care is in unlocking the potential of the human immune system and gene manipulation. From the progress he’s seen, he thinks it’s possible. As a child, he watched his grandfather die from metastatic melanoma. What his grandfather went through is unheard of today, Williams says.

“Every time I look at an old man with male pattern baldness and a mustache who is playing happily with his grandchildren, I think about my grandfather,” he says. “Now I get to be part of something where they don’t just have three months, they’ve got the rest of their life; where cancer has become a chronic disease, and the immune system, genetic knowledge, and manipulation all are going to probably be the final end to cancer.”

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502.350.5700 ISSUE #154 19

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Oncology

Personalizing the Treatment of Breast Cancer

At Norton Cancer Institute, Laila Agrawal’s drive to help patients on their breast cancer journey comes from a place of experience

BY LIZ CAREY LOUISVILLE As a child growing up in Urbana,

Illinois, Laila Agrawal, MD, medical oncologist at the Norton Cancer Institute in Louisville, experienced firsthand what a cancer diagnosis means to a family. Her mother was diagnosed with breast cancer at an early age.

“My mother was diagnosed with breast cancer in her 40s. I was a young child, but I still remember that experience, as well as the impact that it had on me and my family growing up,” she says. “Once I started medical school, from the very beginning, I sought out experiences in oncology. I really felt drawn to the relationship that I saw between the oncologist and their patients, and how impactful that relationship could be. I wanted to be able to provide to my patients.”

Agrawal received her medical degree from the Indiana University School of Medicine, then did her internal medicine internship and residency at Washington University in St. Louis at Barnes Jewish Hospital. After completing her residency there, she stayed for a year as a hospitalist, then she moved to Vanderbilt University for a hematology oncology fellowship.

Developing Her Style of Care Agrawal specializes in breast cancer and works to provide personalized care for her patients. She is part of the cancer care team at the Norton Cancer Institute with practices at both the Brownsboro and downtown Louisville locations.

Through a multidisciplinary clinic, the patient can meet with a medical oncologist like Agrawal, as well as with other specialists—a breast surgeon, a plastic surgeon, a radiation oncologist, and a genetic counselor—all on the same day. The multidisciplinary approach 20 MD-UPDATE

Laila Agrawal, MD, medical oncologist at the Norton Cancer Institute in Louisville

allows Agrawal to discuss all aspects of the patient’s case with other specialists, she says, to facilitate a very personalized treatment plan.

“We meet together and discuss the imaging with the radiologist. We discuss the pathology with the pathologist, and together, we’re able to design a comprehensive plan for each patient. This really facilitates very individualized care, and it expedites the patient’s care to have those conversations in real time.”

Providing that personalized care is important, she says, because no two cases are exactly alike. “With breast cancer care, there is a lot of research that leads to new treatments, and guidelines exist to establish the standard of care. But oftentimes, the cancer doesn’t read the textbook,’” she says. “It’s important we are able to provide state of the art care and equally important that we’re able to individualize care for each patient.”

The Patient Population Because she focuses mainly on breast cancer, Agrawal says her practice is primarily women, although she does have some male patients as well. Ranging in age from 20s to 90s, Agrawal says she sees all aspects of cancer care and can PHOTOS BY JONATHAN ROBERTS/NORTON HEALTHCARE

help patients in all stages of life—from helping older patients thrive and continue to do the things that are important to them, to helping younger patients who may be facing different challenges and circumstances—including concerns about fertility preservation, raising children, and impact to their careers. Agrawal says that rates of breast cancer are rising in younger women nationally.

“We’re seeing more breast cancer cases in women under age fifty,” she says. “There are likely multiple reasons for this, including lifestyle factors, family history, genetics, reproductive history, and environmental exposures.”

Lifestyle and Cancer In Kentuckiana, where high rates of diabetes, heart disease, lung cancer and obesity are present, those comorbidities can contribute to the increased risk of breast cancer. They can also contribute to the way patients should be treated for breast cancer.

“We know that many lifestyle factors, including exercise, nutrition, obesity, alcohol intake and other factors are tied to the risk of getting breast cancer,” says Agrawal. “In addition, if a person’s underlying health is compromised, then certain cancer treatments may be harder to tolerate or have greater risks. For example, some chemotherapy agents, immunotherapy, or targeted cancer treatments may have a chance of affecting the heart or the lungs. We factor all of those things in with our patient population here in Kentucky to really be able to pick the best treatment for each individual person.”

Bringing Clinical Trials to the Community Sometimes the best cancer care for a patient includes a clinical trial. Agrawal is the institutional principal investigator for numerous

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Oncology

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breast cancer clinical trials at Norton Cancer Institute working with Norton Research Institute. She says research on breast cancer treatments is advancing rapidly. “Being able to offer cutting-edge clinical trials to patients in Kentucky right here in our own community is so important.” She believes that access to innovative clinical trials should reach patients close to home. Some of the trials she has participated in have led to FDA approvals or new indications for cancer treatments. “Seeing the clinical trials we are able to offer to our patients lead to new treatments we can then offer to the next patient is so rewarding.”

Breaking Barriers to Sexual Health Care Oftentimes, part of that personalized treatment deals with a patient’s sexual health. After cancer treatment, Agrawal says that patients may experience decreased desire, vaginal dryness, dyspareunia, and body image and relationship concerns. As it is often viewed as a taboo topic, Agrawal says patients may

have nowhere to turn when dealing with the impact treatments may have on their sexual health. To help patients get care for sexual health symptoms, she founded the Norton Cancer Institute Sexual Health Program.

“I realized there was a huge gap in the standard medical training as it relates to women’s sexual health and what my patients needed.

I felt inspired by my patients to learn more and to be able to provide more for their care,” she says.

Agrawal sees women diagnosed with any type of cancer in the Sexual Health Program who are having concerns about sexuality after cancer treatment. After a bio-psychosocial assessment, Agrawal is able to provide patients with treatment recommendations and when needed, referrals to other professionals. The program helps patients deal with the physical, mental, and emotional factors and relationship concerns involved in a person’s experience with their sexuality after a cancer diagnosis.

“I work with other professionals, including mental health professionals such as psychoso-

cial counselors or sex therapists, pelvic floor physical therapists, gynecologists, urogynecologists, urologists, and GYN oncologists for pelvic health concerns as well. Caring for sexual health concerns is also really multidisciplinary as well.”

Lasting Relationships and Patient- Centered Care “My mother’s experience as a breast cancer survivor has shaped the way I approach my medical practice.” Agrawal strives to provide patient-centered care and build relationships to support patients not only during active cancer treatment, but for their overall well-being.

“One of the reasons I chose to specialize in oncology is that I wanted to really be able to help people in this very difficult. time in their lives,” she says. “I’ve been lucky to have some very long relationships with my patients and through their treatment. I think that’s one of the beautiful things about oncology; that we really have the opportunity to develop these meaningful relationships with our patients.”

ISSUE #154 21

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Pulmonology

Breathing Easier in Appalachia ARH pulmonologist Ashley Thompson, DO, serves her community with homegrown care

BY GIL DUNN HAZARD Hypertension is frequently called

“the silent killer” because the symptoms are often unrecognized and can go unrecognized for years. Ashley Thompson, DO, a pulmonologist at Appalachian Regional Healthcare (ARH) wants to add lung cancer to the list of preventable and possibly curable diseases that often “have no symptoms.”

“The largest misconception that I encounter regarding lung cancer is that a patient can’t have lung cancer without presenting symptoms. In reality, the vast majority of lung nodules or early lung cancers have absolutely no symptoms. By the time a patient develops direct symptoms related to lung cancer, it is often very advanced and treatment options may become much more limited. This emphasizes the absolute importance of lung cancer screening through low-dose CT scans for patients over the age of 50 with a significant smoking history. We want to detect lung cancer early to give patients the very best chance at a good outcome,” says Thompson.

Thompson’s familiarity with lung cancer comes from growing up in eastern Kentucky where genetics, environmental causes, high rates of smoking, and the working conditions for coal miners leads to various lung conditions, contributing to the CDC and the National Cancer Institute ranking Kentucky number one in deaths cause by lung cancer.

To combat the scourge of lung cancer mortality, the Kentucky Department for Public Health has aggressively promoted lung cancer screening programs. Kentucky now ranks second-highest in the USA at 10.6% of the at-risk population being screened, compared to the national average of 4.5%. Kentucky still has the unfortunate rank of number one in lung cancer incidence with 54.6%.

This makes for a patient-rich environment for Thompson and her colleagues at ARH. 22 MD-UPDATE

Ashley Thompson, DO, pulmonologist at Appalachian Regional Healthcare, ARH.

Born to Serve Others Thompson is a native of eastern Kentucky, growing up in Hindman, Kentucky, in Knott County. She received her undergraduate degree at Alice Llyod College in Pippa Passes, Kentucky, and completed medical school at the University of Pikeville Kentucky College of Osteopathic Medicine. She did her internship in Internal Medicine followed by a Pulmonary and Critical Care Medicine fellowship at the University of Kentucky Medical Center. Thompson joined ARH in April of this year.

Thompson’s passion and interest in healthcare and community is shared by her four siblings. Two of her sisters are physicians, one sister is an optometrist, and her brother is a pharmacist. “This can make for very interesting family discussions,” says Thompson, whose family includes “a long line of educators, musicians, and artists.”

“I attribute the primary reason I became a pulmonologist to the fact that I grew up in eastern Kentucky. This is the region of the country which is most disproportionalPHOTO PROVIDED BY ARH

ly afflicted by lung diseases, whether it be smoking related such as COPD, lung cancer, environmental, or genetic such as asthma or occupational lung conditions like coal worker’s pneumoconiosis. From the time I was a medical student, I saw a need for this specialty and saw the fulfillment of the pulmonologists who trained me. I knew this was the way I could best serve the people of my home region,” says Thompson.

Thompson states that patients throughout eastern Kentucky, as well as the greater Appalachian region are at a disadvantage not only due to baseline genetic and environmental factors, but there are also many socioeconomic and geographic barriers to ensuring adequate access to basic healthcare. This can result in many chronic medical conditions that may be sub-optimally treated, leading to increased risk of heart disease, diabetes, obesity, and pulmonary diseases. Thompson’s osteopathic training tells her that each organ of the body does not function in isolation.

“The human body is a complex entity that has to function in harmony for true health.

I understand that treatments for pulmonary conditions can sometimes have impacts on other organ systems such as the heart or a patient’s diabetes control. Therefore, it is critical for physicians to communicate with the patient’s primary care physician and other consultants to ensure a safe treatment regimen for each individual person we treat,” says Thompson.

A Diverse Patient Population A week in pulmonary and critical care medicine can be very diverse. Some days Thompson will be in the clinic treating patients with asthma or COPD. On other days she’s taking care of a critically ill patient on the ventilator in the ICU, or in the procedure suite performing a bronchoscopy to

SPECIAL SECTION

help diagnose lung cancer. Thompson says she feels fortunate to have the opportunity to interact with patients in different settings as well as with colleagues in almost every single specialty and that is a very rewarding piece of her career.

“I’m able to treat a vast patient population in my specialty, from young adults with asthma or cough to older adults with occupational lung disease or pulmonary fibrosis. I also see patients of various ages with nodules or abnormalities found on lung imaging that help further diagnosis for these conditions,” says Thompson.

The ARH system has developed an infrastructure for interdisciplinary collaboration to ensure timely and appropriate care for each patient. Medicine is not one size fits all, and every patient needs access to the best care plan to suit their needs. In pulmonology, Thompson says that she has the opportunity to directly interact each week with oncologists, radiation oncologists, thoracic surgeons, radiologists, pathologists, and primary care

providers to discuss specific complex patient conditions and needs to develop a tailored treatment plan for patients. This collaborative process can involve reviewing abnormal lung cancer screening CTs or incidental findings on imaging performed for other reasons or discussing a patient at tumor board.

“The ‘meeting of the minds’ provides the most comprehensive care to our region,” says Thompson.

Meeting Patients “Where They Are” During the first encounter with a new patient, Thompson says it is extremely important to meet that individual where they are, physically, emotionally, and psychologically. The patient may have been referred for a consult due to years of uncontrolled symptoms that are causing distress or may have received the fearful news of a “spot” on their chest X-ray or CT scan. This can result in significant anxiety for a patient. “I always try my best to empathize with each patient and explain conditions in the simplest way pos-

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Pulmonology

sible. Sometimes that may involve looking at imaging together or making simple drawings to help explain the situation,” says Thompson.

In pulmonology, the advancement in bronchoscopic technology has had a profound impact on expanding access to care for patients. Through expansion of endobronchial ultrasound (EBUS) at ARH as well as navigational bronchoscopy through the Ion Robotic Bronchoscopy system, pulmonologists like Thompson can further aid in the timely diagnosis and staging of conditions such as lung cancer for developing treatment plans with the oncologists and surgeons.

“These techniques are minimally invasive and many times we can even provide a preliminary diagnosis the same day,” says Thompson.

As an example of the benefits of early detection, Thompson recalls that one of her most memorable cases was a young patient she met in her first year as an attending physician.

The patient was not a smoker, had been treated for “pneumonia” multiple times without significant improvement, and was found to have a mass or tumor in the lower lung. She performed a navigational bronchoscopy and endobronchial ultrasound, which confirmed a lung cancer. The scope also confirmed it was an early-stage cancer and had not yet spread into any lymph nodes. She consulted with a thoracic surgery and the patient was able to undergo a resection of that portion of his lung.

“To my knowledge, at this time the patient is still completely in remission from the lung cancer and is living a happy and healthy life. Cases such as this are a reminder why prompt diagnosis is so important to ensuring the best outcomes for our patients,” says Thompson.

It’s that patient and many more cases like this that give Thompson her motivation for being a pulmonologist at ARH. It includes helping patients breathe easier and aiding with early detection and diagnosis of lung cancer in Appalachians to help improve outcomes.

“My overall career goal will always be to provide ‘more’ to the people of this region,” says Thompson.

ISSUE #154 23

World-Class Care Close to Home The University of Kentucky Markey Cancer Center is providing some of the most revolutionary treatments and sophisticated surgeries available to those with hepatobiliary cancers.

BY: DONNA ISON LEXINGTON During discussions of cancer, it is

often asked with optimism, “What if one day they developed a vaccine?” Now this concept is no longer just wishful thinking. An mRNA vaccine for pancreatic cancer, developed by BioNTech, recently entered Phase II trials. The vaccine, which is composed of individually sequenced RNA molecules, is not geared to prevent pancreatic cancer but rather induce a more effective response among patients by enabling their immune cells to recognize specific cancer cell neoantigens. And Lexington will prove a pivotal place in the testing process.

Pioneers in Pancreatic Cancer With Joseph Kim, MD, at the helm—as the chief of surgical oncology of the University of Kentucky (UK) Markey Cancer Center (MCC)—UK will be instrumental as one of hospitals chosen to participate in the clinical 24 MD-UPDATE

trials. After a stringent selection process, UK joined the ranks as one of only 17 institutions to conduct the trial. According to Kim, “We recruited our first patient in September for this clinical trial, and so we’re excited. I think it’s a reflection of how our program has grown and the excellence that it’s already achieved. We have grown a very large pancreatic cancer program. We have shown that we can successfully enroll and recruit patients.”

Kim recognizes that, even though the mRNA vaccine is one of the most revolutionary occurrences in recent medicine, many outside of the oncology specialty are still not aware of its existence. This is the case with many cancer breakthroughs. He points out, “The field of oncology is so fast moving. I would surmise most physicians who are not in the field of oncology wouldn’t know about the mRNA vaccines. And yet, they’ve been published in our biggest medical journal, the New England Journal of Medicine.”

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Providing revolutionary care is one of the hallmarks of the UK Markey Cancer Center.

One of Kim’s specialty surgeries is the HIPEC (hyperthermic intraperitoneal chemotherapy) also known as “hot chemotherapy.” HIPEC is most often performed to treat colon and appendiceal cancers. As a two-part surgery, it involves cytoreductive surgery to remove any existing tumors followed by the process of filling the abdominal cavity with the hot chemo.

Kim explains, “You’re going to set the clock back to zero. You’re going to remove all the disease and hope that if the clock starts running again, it will run really slowly. We give patients more time by resetting that clock.”

Because of their ability to perform surgeries like HIPEC, the MCC receives referrals from throughout the state of Kentucky—from Paducah to Pikeville. Due to UK’s innovative offerings, it is not uncommon to see patients from other states as well. Kim states, “We provide the most sophisticated, advanced

SPECIAL SECTION

therapies that are available at the best hospitals. Sometimes patients feel like they need to leave the state to get advanced therapies when it’s right here in their backyard.”

Surgeons Heal with Their Hands While studying at Loyola University’s Stritch School of Medicine in Chicago, Kim determined surgery was the proper path.

He states, “When I was in medical school, I decided that general surgery was the career I wanted because you could directly help and heal patients with your hands, rather than treating them with medications to heal them of their illnesses.”

After medical school, Kim entered a residency in general surgery at the University of Cincinnati, followed by a clinical and research fellowship in surgical oncology at the John Wayne Cancer Institute in Santa Monica, California. “Surgical oncology was technically challenging, fascinating, demanding, and I had great mentors. I think all of those together led me to this career path,” says Kim. Though surgical oncologists can specialize in several different areas—breast, skin, and soft tissue—Kim chose to focus on hepatobiliary surgery to treat disorders of the biliary system, which includes the liver, pancreas, gall bladder and bile duct.

Kim went on to hold surgical oncology leadership positions at the State University of New York at Stony Brook and City of Hope National Cancer Center outside Los Angeles, California before being recruited by the University of Kentucky to serve as chief in 2018.

All in a Day’s Work As chief, Kim oversees a broad range of administrative and leadership responsibilities, including identifying issues in the surgical oncology division, developing strategies for programmatic growth, facilitating meetings, participating in tumor boards, research, and outreach. To ensure the most comprehensive care for patients, UK takes a collaborative approach using a multidisciplinary model. Kim often works in tandem with a medical oncologist, radiation oncologist, and other relevant medical subspecialties.

Along with his above-mentioned duties, Kim still has one day of full clinic per week along with a minimum of one day of operating. His commitment to accommodating every clinic patient who requires an operation means that, on average, he spends two or three days in the surgical suite, which he relishes.

Kim says, “My love in medicine was surgery, I think it would be a vastly different position were I not able to do operations.”

Having the Difficult Conversations One of the more emotional aspects of Kim’s job is to inform patients of their diagnosis, especially when they have not been previously alerted that they have cancer. He elaborates, “It is sometimes difficult when patients are referred to us and the referring physicians are relying on us to break the news, because the patient is completely caught off guard.

They’re not prepared. When people receive the initial diagnosis of a cancer, they need time to process, to let it sink in, to go through the various emotions that everybody needs to go through.” Kim encounters a similar scenario with patients who have been prematurely told that surgery is an option for them, when further evaluation reveals it is not.

On the flipside are patients who find out their cancer is operable. Kim states, “When patients come to the office and know about their cancer diagnosis, everybody has the hope that we can do surgery. There’s elation…there’s joy, when I tell them, ‘This is removable with surgery.’”

Challenges of Comorbidities Joseph Kim, MD, chief of surgical oncology, UK Markey Cancer Center

The greatest challenge Kim has encountered since coming to UK is navigating the widespread comorbidities that exist among his

ONCOLOGY

“We provide the most sophisticated advanced therapies that are available at the best hospitals.”

— Joseph Kim, MD patient population, who are typically 70 and older. Unfortunately, in Kentucky, conditions such as obesity, heart disease, and diabetes are incredibly common and often coupled with effects of long-term smoking. According to Kim, “I feel the patient population here in Kentucky is more complicated than my patient populations in New York and Los Angeles because of the comorbidities.” Kim notes the reasons are multifactorial and involve genetics, diet, and environmental exposures, whether those be smoking or coal related.

He explains, “There are parts of Kentucky, especially in Appalachia, that have the highest rates of GI cancers in the country and some of the worst outcomes, and so we do have an extremely vulnerable population here in Kentucky.”

Despite his multitude of accomplishments, one of Kim’s greatest sources of satisfaction is in seeing complex patients with comorbidities and/or advanced age successfully undergo treatment and go back to their families and lives. He recently performed a pancreaticoduodenectomy—one of their most involved operations—on an 88-year-old patient with pancreatic cancer. The procedure, known as the Whipple, involves removing the head of the pancreas along with the first section of the small intestine, the bile duct, and the gallbladder. The results were surprisingly satisfactory.

Kim shares, “There’s a huge level of satisfaction that I get when I can successfully complete that operation, remove that tumor, and have the opportunity and ability to cure patients of their disease. So that is a tremendous level of satisfaction that’s hard to replicate in any facet of life.”

He adds, “From a physician standpoint, I feel like I have become a better surgeon being able to safely and effectively take care of all of these patients.”

ISSUE #154 25

Mental Wellness

Unlock the Power of a Great Apology An essential guide to healing your relationships

BY JAN ANDERSON, PSYD, LPCC Apologies matter whether you’re in a romantic relationship, navigating a family estrangement, or dealing with a workplace issue. As a therapist and executive life coach, I’ve witnessed firsthand how a well-delivered apology can make all the difference in repairing and saving relationships.

So why do most of us seriously suck at giving one?

When an apology doesn’t connect emotionally with the person you’re apologizing to, it won’t have the healing effect you intended. Apologies that come across as incomplete, insincere, or defensive can backfire and make things worse.

Client: “What if they don’t accept my apology?”

Dr. Jan: “Whether or not it changes their opinion or helps your public image, offering an apology can bring you emotional relief. You’re taking control by allowing yourself to clear your conscience and try to make things right.”

In other words, apologizing can have a surprisingly strengthening effect.

Common Obstacles to Apologizing

Feeling vulnerable is a key reason people resist apologizing, but vulnerability is also what makes an apology so powerful.

Client: “I don’t like feeling in a one-down position. Apologizing opens me up to attack or being taken advantage of.”

Dr. Jan: “An apology doesn’t mean putting yourself at the other person’s mercy.

When offered with confidence and sincerity, it becomes a powerful and subtle way to take control of the situation and strengthen the relationship.”

I often introduce safeguards and face-saving strategies that make vulnerability more manageable.

One of the most effective tools is the accusation audit, developed by former FBI hostage negotiator Chris Voss.

1. Inventory all the “accusations” you anticipate from the other person. What are their negative assumptions and judgments about you — before you even open your mouth?

2. Let the first words out of your mouth be naming and acknowledging those accusations. I’m probably the last person you want to hear from…

3. Immediately follow up with a strong request. But I’m going to ask you to hear me out…

The other person’s reaction lets you know you did something that bothered them.

They’re upset with you, and now you’re upset, too. Now what?

When you get clear about your motivation for offering an apology, it becomes easier to deliver one.

Dr. Jan: “What do you hope to accomplish with an apology?”

Client: “I want them to stop being upset with me. I want things to be okay and go back to normal.”

Research in motivation science shows that connecting with your emotions is crucial in turning intentions into actions. The promise of emotional relief and a stronger, stable relationship can inspire you to take that first step — to initiate a “repair attempt” that helps both parties feel understood, rebuild trust, and move forward.

Client: “But what if they need to apologize, too?”

Dr. Jan: “Sometimes being the first to apologize can disarm the other person and prompt them to own their part.

But there’s no guarantee. I don’t recommend making your apology conditional on receiving one in return.”

26 MD-UPDATE

From “Sorry” to Superpower: Safeguards and Face-Saving Strategies for Apologizing

4. Link it with a feeling of positive regard.

Because our relationship is important to me.

An accusation audit essentially beats them to the punch and shows that you understand their feelings. This can strengthen you and disarm them, reduce the tension, and create a more receptive atmosphere for your apology.

The Essential Elements of a Great Apology Many apologies fail because you’re too focused on making yourself feel better and not focused enough on the other person’s needs and feelings. The goal is to deliver genuine and empathic apologies from a place of strength. Let’s dive in: SAY “I’M SORRY.” Don’t say “I regret” or “I’m regretful.”

Better: “I’m sorry.”

Regret is about how you feel. Sorry is about how the other person feels.

Mental Wellness

SAY WHAT YOU DID. BE SPECIFIC. Generic apologies lack sincerity. Be clear and specific about what you’re apologizing for.

Don’t say: “Sorry about that.”

Better: “I’m sorry I didn’t tell you about this until now.”

Better: “I’m sorry I didn’t get back to you sooner.”

change.”

Better: “I’ve enrolled in an anger management class. I don’t want to lash out like this again.”

Don’t say: “The past is the past.”

Better: “I want to regain your trust.

I’m giving you the password to my phone.”

SAY HOW YOUR ACTIONS AFFECTED THE OTHER PERSON. This is the most important part of the apology. It’s crucial to show the other person that you understand how your actions affected them.

Don’t say: “I’m sorry that upset you.”

Better: “I’m sorry about what I said about your credentials. I can see how embarrassing it was for you.”

One of the most common “empathy mistakes” is focusing too much on your feelings and not enough on theirs. Focus on how it affected you only if the other person wants to hear it.

Don’t: Go on and on about how “terrible” you feel, how you couldn’t sleep, had to call your therapist, etc.

Do: “I feel terrible about how embarrassing that was for you, especially in front of the whole group.”

Empathy is an elusive but essential relationship skill to develop. It enables you to acknowledge the other person’s feelings, whether you agree or even understand them.

Using this Jedi mind trick can help you develop your empathy superpower: • You don’t have to agree with the other person’s feelings to be able to acknowledge them.

• You don’t have to feel their pain to acknowledge that your actions caused the other person pain.

• You don’t have to understand the other person’s pain to be moved by it and to help them ease it.

OFFER TO MAKE AMENDS WHERE APPROPRIATE. Taking tangible steps to repair the situation shows that your apology is more than just words.

Don’t say: “It was an accident. I didn’t mean to…“ Better: “I’m so sorry. Will you let me take care of the dry cleaning bill?”

Don’t say: “I was so busy, I just forgot.”

Better: “I’m so sorry. How can I make this right?”

SAY WHAT YOU’LL DO DIFFERENTLY. By offering a plan for change, you reassure the other person you’re serious about making amends.

Don’t say: “It won’t happen again. I’ll

LISTEN WITHOUT DEFENSIVENESS. Listening well in these moments is just as vital as offering the apology itself. It can be extremely challenging to listen without defensiveness. To help yourself emotionally regulate, nurture your curiosity with a growth mindset. Let the James Stephens quote “Curiosity will conquer fear even more than bravery will,” help you stay open, calm and engaged in the conversation.

Two Things to Leave out of an Apology Apologies that shift blame or offer excuses come off as insincere. It’s essential to show that you take responsibility for your actions and acknowledge their effect on the other person.

1. Avoid statements that imply it’s the other person’s fault.

Don’t say: “I’m sorry you took it that way.”

Better: “I’m sorry I offended you.”

2. Avoid statements that downplay your responsibility.

Don’t say: “I was so exhausted; that’s why I didn’t call.”

Better: “I was exhausted, but I should have called. There’s no excuse for not letting you know I wasn’t coming.”

Don’t Fake It. No apology is better than a fake apology.

1. The God has forgiven me (so there’s nothing more I need to do) apology.

“God has forgiven me. Why can’t you?”

If you’ve asked God for forgiveness, good for you. That’s between you and God. Now, ask the person you harmed for forgiveness.

That’s between you and them.

2. The I only did it for you (so it’s your fault) apology.

Shifting blame by saying you acted in the other person’s interest is a manipulation, not an apology.

“I only did it because… I didn’t want to hurt your feelings.” (You’re too sensitive.)

“I only did it because… I thought it would help you.” (You’re too dumb to figure this out for yourself.)

3. The Let’s forget about this as quickly as possible and never speak of it again apology.

Ignoring, distracting and avoiding without addressing the hurt won’t lead to genuine resolution.

“Problem? What problem?”

4. The eye-roll apology.

Saying the word “sorry” accompanied with a hostile tone, gestures or facial expression is not an apology. It’s a passive aggressive ploy.

“Okay, okay… I’m SORRY! Feel better now?”

“I’m SORRY (heavy sigh)… What else do you want from me?”

The Emotionally Intelligent Apology Mastering the art of an effective apology is an essential relationship skill. Whether it’s learning how to express empathy, taking responsibility, or crafting non-defensive responses, there’s a learning curve. If you’d like to enhance your apology skills, I’m here to help. Contact me at 502.426.1616 or LifeWise@DrJanAnderson.com Together, we can work through your specific challenges and tailor strategies to save and strengthen the relationships that matter most to you.

ISSUE #154 27

News

Baptist Welcomes New Physicians LOUISVILLE Aurora Cruz, MD, a specialist

in cerebrovascular and endovascular neurosurgery, has joined Baptist Health Medical Group.

Cruz is a fellowship trained cerebrovascular and endovascular neurosurgeon who uses both traditional and minimally invasive techniques to treat vascular disorders of the brain and spine, including stroke, intracranial hemorrhage, aneurysms, vascular malformations, and carotid artery stenosis.

Cruz earned a distinction in service and in the arts and humanities University of California, Irvine School of Medicine and completed her neurosurgery residency at the University of Louisville, where she earned

several honors, including Resident of the Year.

She was also a member of the Neuroendovascular Surgery CAST fellowship at Geisinger Neuroscience Institute.

Cruz is certified in advanced and basic cardiac life support.

Jacob Meredith, DO, has joined Baptist Health to help patients identify and better manage mental and behavioral health concerns. Some of his areas of focus include depression, anxiety, and bipolar disorder.

Meredith is certified in NeuroStar® transcranial magnetic stimulation therapy and advanced cardiac life support. His professional training was at the University of Pikeville-

Aurora Cruz, MD

Jacob Meredith, DO

Kentucky College of Osteopathic Medicine with a psychiatry residency at the University of Kentucky College of Medicine.

Meredith is accepting new patients ages 13 and older. To schedule an appointment, call 502.928.1260 or visit Baptist Health Medical Group Behavioral Health, 6420 Dutchmans Parkway, Suite 195, Louisville, KY 40205.

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The Heart of the Matter Interventional Cardiologists Say the Human Connection Is Most Important

ALSO IN THIS ISSUE

THE WOMEN’S HEART HEALTH PROGRAM AT UOFL HEALTH ADVANCED CARDIAC IMAGING AT HARRISON MEMORIAL HOSPITAL, CYNTHIANA TREATMENT OPTIONS FOR AFIB AT NORTON HEART & VASCULAR INSTITUTE HYPERTENSION CLINIC GROWS AT BAPTIST HEALTH LEXINGTON

COLON CANCER SCREENING AT NORTON HEALTHCARE EATING DISORDERS COUNCIL & THE KPMA

CONTACT GIL DUNN (publisher/editor): 859.309.0720 • 859.608.8454 • gdunn@md-update.com

28 MD-UPDATE

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CHI Saint Joseph Medical Group Welcomes New Surgeon

general surgery residency at the University of Kentucky in Bowling Green.

LEXINGTON CHI

CHI Saint Joseph Health Welcomes New Pulmonologist & Critical Care Specialist

Saint Joseph Medical Group – Surgery welcomes Helena Do, DO, to its team of health care providers. Do earned Helena Do, DO her BS in biological sciences from the University of California, Irvine, and her Doctor of Osteopathic Medicine from the University of Pikeville – Kentucky College of Osteopathic Medicine. She completed her

LEXINGTON CHI Saint Joseph Health –

Pulmonology & Critical Care in Lexington is pleased to welcome Emhemmid Karem, MD, to its team of health care providers. Karem’s passion for medicine began in childhood, inspired by the care he received from doctors and their impact on his life.

Karem earned his medical degree from the University of Tripoli in Libya in 2008. He completed his internal medicine residency

You have never really lived until you have done something for someone who can never repay you. — Paul Bunyan

and Pulmonary Critical Care Fellowship at Marshall University in Huntington, West Virginia.

Karem specialEmhemmid Karem, MD izes in pulmonology and critical care, providing inpatient and outpatient care to his patients. His training in Huntington, West Virginia, gave him experience with a patient base similar to that in Kentucky, influencing his decision to practice in the region.

Karem brings extensive experience in treating patients with conditions related to black lung, a significant health concern in eastern Kentucky due to its history of coal mining.

CHI Saint Joseph Medical Group Welcomes New Oncologist BARDSTOWN CHI

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Saint Joseph Health – Cancer Care Center in Bardstown welcomes Patrick Williams, MD, to its team of health care providers.

Patrick Williams, MD Williams brings 26 years of oncology experience to the Cancer Care team, gained from international exposure.

Williams earned his BS in microbiology and immunology with a minor in chemistry, graduating with honors from the University of Arizona. He then pursued his medical degree at the Uniformed Services University of Health Sciences F. Edward Hébert School of Medicine.

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ISSUE #154 29

News

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

Lexington Clinic Welcomes Three New Physicians LEXINGTON Lexington Clinic welcomed three

new physicians to its family medicine, gynecology, and internal medicine specialties.

Elizabeth Case, MD, is a board certified member of the American Board of Obstetricians and Gynecologists and a certified NAMS provider. Case graduated from the UK College of Medicine and completed an internship in Obstetrics and Gynecology at Indiana University School of Medicine.

Case has more than 20 years of experience in gynecology and obstetrics.

Lexington Clinic Physician Moderates International HISA Presentation LEXINGTON Orthopedic

surgeon Peter Hester, MD, moderated a presentation at the Horseracing Integrity and Safety Authority’s (HISA) prestigious International Jockey Concussion, Safety and Wellness Conference on October 10, 2024, in Lexington.

HISA creates and regulates integrity and safety rules for Thoroughbred racing across the United States and is overseen by the Federal Trade Commission.

Benjamin McKenzie, MD, is board certified in internal medElizabeth Case, MD Benjamin McKenzie, MD John S. Reece, MD icine and provides services in primary and preventive American Academy of Family Physicians. care to adult patients. He received his med- Reece is a graduate of the Indiana University ical degree from Loyola University Chicago School of Medicine and has more than 40 Stritch School of Medicine. years of experience in family medicine.

John S. Reece, MD, is board certified Reece practices at Jessamine Medical and in family medicine and a member of the Diagnostics Center.

In addition to being a Lexington Clinic physician since 2002, Hester is HISA’s national medical director and is responsible for improving jockey health and welfare, minimizing their risk of injury, and helping athletes source healthcare insurance.

HISA’s conference is in partnership with the Jockeys’ Guild and featured industry and medical professionals from around the world to discuss safety and best practices within the horseracing industry.

Hester moderated the presentation, titled “How Equestrian and Other Sports Can Work Together on Concussion Prevention and Management,” before an international audience of attendees and participants.

Peter Hester, MD

Harrison Memorial Hospital Welcomes Nicholas Wiley, MHA, FACHE, as New Chief Operating Officer CYNTHIANA Harrison

Memorial Hospital (HMH) announced that Nicholas “Nick” Wiley, MHA, FACHE, has accepted the position of chief operating officer.

Wiley brings with him more than 17 years of healthcare experience in administration.

He earned an MHA from the University of Phoenix and a BS in international economics from the University of Kentucky.

His career includes roles such as executive director at Baptist Health Lexington/Baptist Health Hamburg, director of medical staff services at Baptist Health Lexington, patient advocate coordinator for patient experience at 30 MD-UPDATE

Baptist Health Lexington, emergency department patient access supervisor at Saint Joseph Hospital, and patient food and nutrition supervisor at Baptist Health Lexington.

At HMH, Wiley will oversee engineering and plant operations and support services, which includes dietary, environmental services, and rehabilitation services, in addition to supervising respiratory therapy, radiology, and laboratory.

Wiley is a member of the Commerce Lexington Emerging Leaders of the Bluegrass and board member for the March of Dimes Market.

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Nicholas Wiley, MHA, FACHE

Events

Hundreds of race participants ran to support free mammograms and cervical exams provided by CHI Saint Joseph Health Foundation

CHI Saint Joseph Health Foundation Holds Ninth Annual Yes, Mamm! Yes, Cerv! 5K NICHOLASVILLE The Saint Joseph Hospital

Foundation’s annual Yes, Mamm! Yes, Cerv!

5K was back for its ninth year, bringing together and celebrating local cancer survivors.

The race was held on Saturday, Oct. 12 at the RJ Corman Railroad Group Headquarters in Nicholasville. Funds raised from the race will

support local cancer survivors and patients.

The Yes, Mamm! Yes, Cerv! 5K, presented

by RJ Corman Railroad Group, was open to runners of all ages. Proceeds from the race will support Yes, Mamm! Yes, Cerv! programs statewide, providing free mammography and cervical cancer screenings, diagnostic test-

ing, and program support to thousands of underinsured and uninsured patients across Kentucky.

During the event CHI Saint Joseph Health Foundation hosted a family-friendly health expo with vendor, a kid’s zone, food truck and DJ.

Michelle Wiesner, PT, founder of Trillium Health & Restoration was part of the health expo. Trillium offers personalized health coaching blended with physical therapy in Lexington.

Friends Amy Scarboro, Leigh Annettoten, Jennie Campbell and JoEllen McComb ran to support the free mammograms and free cervical exams provided by Saint Joseph Health Foundation

Greg Bodager, Executive Director, CHI Saint Joseph Cancer Care Center and Benjamin Neltner, MD, CHI Saint Jospeh Health Primary Care took part in Yes MAMM! Yes CERV!

PHOTOS BY GIL DUNN

ISSUE #154 31

Events

Free Prostate Screenings for Men at the Kentucky State Fair

LOUISVILLE The Kentucky Prostate Cancer

Coalition was established in 2004. The officers were former Kentucky Lt. Governor Steve Henry, MD, serving as president, Vice President Don Lyman, and Secretary/Treasurer Greg Schell along with board members Heather French Henry and Connie Sorrell. The organization held their first free screening at the Kentucky State Fair the same year.

In 2024, 20 years after the coalition was founded, they continued the free prostate screenings. According to their website, the mission of the coalition is to “educate, increase awareness, and provide free prostate screening opportunities to men in Kentucky while advocating for healthier initiatives to reduce risk factors for prostate cancer.”

The coalition states that those risk factors include inactivity, obesity, poor diet, military service in Vietnam, African American heritage, and a family history of cancer.

For more information on the Kentucky Prostate Cancer Coalition, please visit www.kyprostatecancer.org.

Dr. Stephen Henry, prostate cancer survivor, Heather French Henry of the Kentucky Prostate Cancer Coalition, and Kentucky Cancer Program Director Connie Sorrel assist a patient regarding screening options for prostate cancer. This is the 20th year for the annual screenings at the Kentucky State Fair sponsored by the Lexington Cancer Foundation. Also helping are two medical students from UofL School of Medicine.

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32 MD-UPDATE

PHOTO PROVIDED BY THE KENTUCKY PROSTATE CANCER COALITION

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Kim L. Breast Cancer, 2019

Cancer

Free.

The Power of Teamwork At UofL Health – Brown Cancer Center, you’ll find inspiring stories like Kim’s, where being cancer-free is a reality thanks to our collaborative approach, early detection and pioneering treatments.

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To find Kim’s story THAT’S THE POWER OF U

and other survivor stories, visit UofLHealth.org/BCCStories.