MD Update Issue 155

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #155 WWW.MD-UPDATE.COM

Treating Tremors

VOLUME 14 • #6 • December 2024

Abigail Rao, MD, uses deep brain stimulation and high-frequency focused ultrasound to treat essential tremor and Parkinson’s disease at Norton Neuroscience Institute

ALSO IN THIS ISSUE LUNG CANCER SCREENING AT KY DEPARTMENT FOR PUBLIC HEALTH INNOVATIVE SPINE SUGERY AT CHI SAINT JOSEPH HEALTH IN LONDON, KENTUCKY UofL HEALTH SPINE SURGEON BRINGS NEW TECHNIQUES TO PRACTICE SMOKING CESSTION PROGRAM FROM KY DEPARTMENT FOR PUBLIC HEALTH

Editorial Calendar

THE BUSINESS MAGAZINE OF KENTUCKIANA PHYSICIANS AND HEALTHCARE PROFESSIONALS

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, Plastic Surgery, Urology

ISSUE #158 (June) WOMEN & CHILDREN’S HEALTH OB-GYN, Women’s Cardiology, Oncology, Urology, Pediatrics, Radiology

ISSUE #159 (September) MUSCULOSKELETAL HEALTH Orthopedics, Physical Medicine & Rehabilitation, Sports Medicine, PT/OT

ISSUE #160 (October) CANCER CARE Hematology, Oncology, Plastic Surgery, Radiology, Radiation

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

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 “It’s All in Your Head” Issue of MD-Update We’ve wrapped up another year of MD-Update with a great issue for you including physician engagement, innovation, and exploration.

Our cover story on Dr. Abigail Rao at the Norton Neuroscience Institute leads the way with a new treatment for essential tremors brought on by Parkinson’s disease. Dr. Rao was very generous with her time speaking with us and sharing the results of the treatments for her patients. Her work gives her patients back the simple tasks of writing their names, feeding themselves or using their phones.

Spine surgeons Dr. Vincent DePalma and Dr. David Freeman are two young, fellowship-trained surgeons who came to Kentucky recently and have found a home here. Dr. DePalma is building a robust spine practice in London, Kentucky, with CHI Saint Joseph Health. Dr. Freeman joined UofL Health after completing training at University of Miami.

I invite you to read how both Drs. DePalma and Freeman are creating a new generation of spine surgeons serving patients in Kentuckiana, northern Tennessee, and West Virginia.

story is the high level of lung cancer screening and smoking cessation among Kentuckians that the KDPH’s work has achieved. MD-Update is very proud to help spread the word about these programs in this issue, among others. Our thanks to Ellen Cartmell, Nicole Key, Claire Weeks, and Nirvana Nawar for contributing to this issue of MD-Update.

The Public’s Health

Looking Ahead to 2025

Most of us have our work silos, our defined places, either physically or by area of interest and topics. The Kentucky Department for Public Health (KDPH) has no such boundaries or barriers. Its mission is “to improve the health and safety of people in Kentucky through prevention, promotion and protection.”

The KDPH’s patient population is 4.5 million+, all ages and every category. The KDPH, under the leadership of HFS Secretary Eric Friedlander and Commissioner Dr. Stephen Stack has nearly 150 different programs designed to help Kentuckians get healthier. One success

After 14 years and 155 successive columns, I want to thank Scott Neal for his continuing dedication to sharing wise, prudent financial advice through his columns in MD-Update. Be the road ahead rocky or smooth, Scott will keep his eyes on the road and hands on the wheel.

Read Scott’s outlook for 2025 on page 8.

The 2025 MD-Update editorial calendar is on the preceding 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.

Physician Engagement and Innovation The Kentucky Medical Association has a new president, Dr. Evelyn Montgomery Jones, and a new initiative, “Small STEPS, Big Impact.” The KMA and Dr. Jones have gathered a group of physician thought- leaders who will be community ambassadors, focusing on the messages of screening, ending tobacco use, exercise, and nutrition. Read more about it on page 4 and get involved if you can.

AI, whether you call it artificial or augmented intelligence, is here to stay. The Lexington Medical Society held a symposium and panel discussion recently. Dr. Danesh Mazloomdoost, a thought leader in the area of AI, gives us a recap and his thoughts on the benefits and challenges of AI on pages 30-31.

Until next time, all the best,

Gil Dunn Editor/Publisher MD-Update

2 MD-UPDATE

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

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ISSUE #155

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CONTRIBUTORS:

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10 T reating Tremors

Abigail Rao, MD, uses deep brain stimulation and high-frequency focused ultrasound to treat essential tremor and Parkinson’s disease at Norton Neuroscience Institute

CONTENTS

COVER PHOTOGRAPHY BY JAMIE RHODES

4 HEADLINES

SPECIAL SECTION:

6 ACCOUNTING

14 21 22 24

8 FINANCE 10 COVER STORY

14 NEUROSURGERY

NEUROSURGERY PUBLIC HEALTH EM/PSYCHIATRY PUBLIC HEALTH

18 NEUROSURGERY

26 MENTAL WELLNESS

ISSUE #155

28 NEWS 30 EVENTS

22 EM/PSYCHIATRY ISSUE #155 3

Headlines

The Journey to Better Health KMA launching “Small STEPS, Big Impact” Campaign

BY EMILY SCHOTT, KMA COMMUNICATIONS DIRECTOR

LOUISVILLE In January, the Kentucky Medical

Association (KMA) and the Kentucky Foundation for Medical Care (KFMC) will launch their latest public health campaign, “Small STEPS, Big Impact,” which will be led throughout 2025 by KMA President Evelyn Montgomery Jones, MD. Funded in part by the Kentucky Department for Public Health, the two-year campaign will focus on screenings, tobacco use, exercise and nutrition, physician visits, and stress.

While the steps may be “small,” the task at hand is large: improving the overall health of Kentuckians through straightforward solutions and support. According to the 2023 America’s Health Rankings Report, Kentucky ranks 41st in the country in overall health, including persistent challenges in areas like smoking rates, obesity, and mental health.

But tackling so many issues at once can be daunting for patients.

“We have many patients in our state who are suffering from multiple comorbidities.

They need to lose weight and quit smoking.

They are overdue for lots of screenings they qualify for, but they are so stressed about other things in their life they can’t even think about that. It’s overwhelming,” said Jones.

“We want to empower our patients to take control of their health little by little, which will add up to long-term success over time.”

Physicians, as leaders of the care team, will be walking beside their patients on the journey to better health. KMA has assembled a team of more than a dozen “Physician Ambassadors” who will serve as spokespersons for the campaign, alongside Dr. Jones and KMA President-Elect Jiapeng Huang, MD, who will lead the campaign in 2026, making this the first time two KMA presidents have combined their priorities into one.

“Our Physician Ambassadors have a passion for this project and for promoting healthier lifestyles,” said Jones. “They’re a talented and diverse group, both in their geographic loca4 MD-UPDATE

On Nov. 2, the Physician Ambassadors gathered for a session in Louisville for public speaking and media relations training.

tions across Kentucky and in their specialties, and we’re excited about the difference they will make through this campaign.”

On November 2, 2024, the Physician Ambassadors gathered for a session in Louisville for public speaking and media relations training. They even filmed public service announcements and digital ads on site, which will be utilized throughout the campaign.

In addition, Small STEPS, Big Impact will host a website with resources, distribute print and radio ads, and conduct multiple educational events.

The campaign will build on the success of KMA’s previous public health efforts, which have reached millions of Kentuckians over the last several years. Initiatives like Raise Your Guard, KY, Take It From Me, Breathe Better Kentucky, and Voices for Vaccination have centered on some of the state’s most pressing health issues and encouraged patients to talk to their physicians.

“We’re proud of what we’ve accomplished together, and I’m looking forward to what we will be able to do through the Small STEPS, Big Impact campaign,” said Jones.

“A Chinese proverb famously says, ‘The journey of a thousand miles begins with a single step.’ We’re taking our first steps towards better health together, and I know the destination will be more than worth the journey.”

PHOTO PROVIDED BY KMA

For more information on the KMA and KFMC’s Small STEPS, Big Impact campaign, visit www.SmallStepsKY.org.

“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

GETTING SCREENED IS EASY!

You smoked a pack of cigarettes a day for 20 years You currently smoke or quit smoking within the past 15 years

Scan the QR code or visit CHFS.ky.gov to learn more.

Lung Cancer Screening

Accounting

Medical Coders: Are You Using Total Time?

It may be the easiest way of all to increase practice revenues.

Here’s why medical coders need to take another look at total time.

BY BRANDY MONTGOMERY, HEALTHCARE CONSULTING MANAGER Our medical coding audits routinely reveal ways for practices to save more time, generate more revenue, and avoid more risk. In a previous article, we explored an opportunity many practices overlook: using prolonged services codes. Here we will look at a similar situation where small changes could potentially boost revenue in big ways.

A Quick Introduction to Total Time As of January 2021, practices can determine the level of office visit based on medical decision-making or based on the total time spent on the day of service. Since most coders were already accustomed to following medical decision-making, and the possible upsides of total time were not obvious, many haven’t made the switch. They do things now the same as before — and that may be a lost opportunity.

Let’s first highlight what activities count towards total time: • Preparing to see the patient: reviewing tests, old records, etc.

• Getting or reviewing separately obtained history • Doing the exam

• Counseling or educating the patient or the caregivers • Ordering meds, tests, procedures • Referring and communicating with other healthcare professionals (only when it’s not reported separately) • Documenting in the medical record • Independently interpreting results and giving those results to the patient or caregivers • Care coordination (when it’s not separately reported) Now let’s cover what cannot be included: • Staff time – Only the provider’s time counts, not any support staff.

• Day after – Only the day of service counts, so complete all notes on the same day.

• Medically unnecessary – Only justifiable time counts: A simple bug bite shouldn’t take an hour to examine.

Why Use Total Time?

Provided you follow these guidelines and get a little practice, coding by total time becomes second nature. So why haven’t more practices switched to this method yet?

In our experience, they see too much risk and not enough reward. Coders assume they will record the time incorrectly and cause problems with payers. And even if they got it right, this line of thinking goes, the revenue gains are minimal.

We have actually seen the opposite at practices that use total time. Rarely does it cause problems for providers or payers — or coders for that matter — and the extra revenue can be significant. We have seen practices make, on average, $20 more on each patient visit. If they average 30 visits each day, that’s an extra $600 per day, $3,000 per week, or $156,000 per year.

Should You Adopt Total Time?

The numbers above are hypothetical, but practices can get real estimates of how much total time would generate, along with plans to put those practices in place, by working with the coding experts at Dean Dorton. Let our team turn a change in process into an increase in profits. Contact us to learn more.

For more information contact bmontgomery@ ddafhealthcare.com or at 502.566.1037

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

Plotting the Course for 2025

BY D. SCOTT NEAL, CPA, CFP®

In the 2024 presidential election campaign, we heard from Donald Trump supporters and the “never-Trump” group. Both are now asking us the same question, “What now?”

Although you, dear reader, may not have been as focused on inflation at the gas pump or the grocery store, inflation became an election focal point this year. Recall that it was a mere two and half years ago that inflation jumped from 2% to 9%. The pain was evident around the country, but I fear that the cause (supply and demand) was widely misunderstood. Nevertheless, it appears most voters were convinced that Trump would do a better job of fighting inflation than the Democrats would. But take note: His announced policies of tariffs, extending the tax cuts from his 2017 Act, and exporting immigrants are all likely to be quite inflationary.

It is time to take stock. Here is a checklist of year-end items to consider:

for the purpose of risk reduction is usually a good idea.

Consider the Impact of Rising Interest Rates on Investments

Now is the time to make sure that you have taken full advantage of retirement plan contributions for this year. Review your year-to-date contributions to your retirement accounts i.e., 401(k), 403(b), and IRAs. For 2024, an individual may contribute up to $23,000 into their 401(k), $16,000 into a SIMPLE, and $7,000 into an IRA. If you are 50+, you may add an additional $7,500 for retirement plans, $1,000 for IRA accounts, or $3,500 for Simple IRAs. Hopefully, you have also taken advantage of the mega-Roth contribution if your employer’s plan permits. Please discuss this maneuver with our tax advisor if you are eligible or unsure.

While you should always be mindful of your portfolio, the year end is a great time to reassess where you stand and where want to go for the next year. Watch out for the bond vigilantes (those bond investors at very big firms). When they get tired of the dithering and never-ending spending by Congress, rates will be bid up, adding to market instability.

Every investor should re-evaluate his or her investment goals, risk tolerance, risk capacity, and asset allocation on an ongoing basis. At a minimum, do it once a year to determine whether the portfolio has deviated from its target allocation and whether your target, perhaps set years ago, needs to be altered due to changes in the economy or in your individual circumstance. The great temptation is to let winners continue to grow to the point that they become a concentrated risk. Taking gains 8 MD-UPDATE

Consider Tax-Loss and/or Capital Gain Harvesting If you invest in a diversified portfolio, you may have specific investments that have fallen from your purchase price, i.e., you have an unrealized capital loss. Look at individual investments and consider that the red ink spells “opportunity” to harvest those losses and offset capital gains that you might have booked earlier this year. Our caution is, do it with care.

One can only deduct $3,000 of net capital losses with any excess carried over to 2025.

Just remember the wash-sale rule says that to deduct the loss, you must wait at least 30 days before investing in that same company or when buying a substantially identical investment.

Maximize Retirement Contributions

Double Check RMDs If you are 73 or over, take care to ensure that you have taken your required minimum distribution (RMD) for this year. Also, even if you aren’t 73, but have an inherited IRA, you may need to take the RMD on that account.

The penalty for failure to distribute required

minimum distributions is onerous and can easily be avoided.

If you are at least 70 1/2 and interested in supporting charitable causes, taking a qualified charitable distribution (QCD) can avoid taxes on the distribution because it never gets treated as income in the first place.

As you consider your RMD, it is also a good time to look at your tax projection for this year.

Consider if the withholding on the RMD can help you avoid an underpayment penalty if you have not had enough withheld or have not paid estimates throughout the year. Withholdings made via your RMD are treated as having been paid ratably throughout the year.

Update Tax Projections for 2024 and 2025 We suggest that you always maintain a rolling two-year projection of both state and federal income taxes. Since you have filed your 2023 tax return, and you know most of your year-to-date amounts for 2024, you should use that data to prepare a projection for 2024 and 2025, looking for tax saving opportunities by shifting income and deductions from one year to the other.

Now is also the time to look at the liability side of your balance sheet, especially if you have variable rate or high-interest rate debt.

Remember, it’s okay to carry debt with an interest rate that is less than your portfolio return, but it might make sense to use some of the portfolio to pay off credit cards, home equity, or automobile loans.

With the potential for much higher inflation, the need for a watchful eye has perhaps never been greater. Don’t put this off. Plot your course for 2025!

Scott Neal, CPA, CFP® is the president of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville.

Email scott@dsneal.com or call 1-800-344-9098.

Cover Story

Treating Tremors

Abigail Rao, MD, uses deep brain stimulation and high-frequency focused ultrasound to treat essential tremor and Parkinson’s disease at Norton Neuroscience Institute

BY LIZ CAREY LOUISVILLE A new treatment procedure that

uses high-frequency ultrasound technology can help essential tremor and Parkinson’s patients control their tremors, says Abigail Rao, MD, a neurosurgeon with the Norton Neuroscience Institute (NNI), which is the first in Kentucky to use high-frequency, focused ultrasound waves (HiFU) to target specific areas of the brain to treat essential tremor and tremor-dominant Parkinson’s disease.

Starting this year, NNI is the first and only facility in Kentucky to offer the procedure. The treatment uses MRI-guided high-frequency focused ultrasound to create a lesion in the specific part of the brain

“It’s a new delivery system to create a precise and focused lesion in the brain without needing to put anything into the brain. These aren’t life-saving procedures, but they’re massively life altering.” — Abigail Rao, MD

Dr. Abigail Rao in front of the MRI scanner at Norton Brownsboro Hospital.

10 MD-UPDATE

important for hand tremors. Using pinpoint accuracy, neurosurgeons can target areas, within millimeters, to give immediate relief to a patient’s symptoms and provide them better movement control.

PHOTOS BY JAMIE RHODES

Cover Story LOUISVILLE Dr. Abigail Rao performed the HiFU procedure on multiple patients on November 21, 2024, at the Norton Neuroscience Institute. Her observations were as follows: MDU Did the procedures go as expected?

Anything unexpected?

Dr. Rao We did four surgeries today, and they went great! Nothing really unexpected. There will always be unexpected medical and workflow/ technical snafus periodically, in any process, but all four patients had smooth treatments, a great team to support them, and excellent clinical outcomes. All patients are very happy.

Dr. Abigail Rao performs a routine tremor check during final preprocedural walk through.

During the procedure, patients wear a helmet-like device filled with water that has more than 1,000 ultrasound transmitters while the surgeon tests the patient’s neurological and tremor function. “It’s a procedure where we very much want to see the patient’s tremors that we’re treating right then and there,” says Rao. “We need to be able to test their tremor so that we know if our treatment has been adequately efficacious, then we also need to be able to test their side effects.”

Choosing Functional Neurosurgery From a Wisconsin family of physicians, Rao came to Norton Neuroscience Institute in 2018 after completing her undergraduate work at the University of Wisconsin-Madison and a year of research at the National Institute of Health (NIH). During medical school at Warren Alpert Medical School at Brown University, Rao was mentored by Kim Burchiel, MD, during her neurosurgery residency. It was during Rao’s neurosurgery residency at Oregon Health & Science University in Portland, Oregon, that she developed her interest in functional neurosurgery as a sub-specialty.

“I think the nervous system is massively fascinating. So much is known, but so much is unknown, so the specialty has major potential for growth and change,” she says. “I trained under the chairmanship of one of the major pioneers in the field of functional neurosurgery, Dr. Kim Burchiel. Many trainees who

come in contact with him are inevitably influenced by seeing what he does. It was during my residency that I first came to understand what the subspecialty is about.”

While other specialties may focus on surgeries that are life-saving, functional neurosurgery focuses on procedures that improve a patient’s quality of life. Using surgical techniques like deep brain electrical stimulation (DBS), neuromodulation, and now focused ultrasound, Rao treats epilepsy, essential tremor, movement disorders, and chronic pain.

The specialty provides her with a broad range of patients in terms of both age and acuity and types of disorders. Rao says the combination of the patient profile and surgery on all parts of the nervous system drew her to the specialty.

“My medical practice involves taking care of patients who are acutely ill and are dying; and those who are not acutely ill, but impaired. It also involves taking care of patients who are about as healthy as they could possibly be, but they are still seeing me for some reason,” Rao says. “Sometimes, we may meet a patient once. Sometimes we may meet them many times over the course of years or decades, or effectively, their whole life.”

She says that she is also drawn to the subspecialty of functional neurosurgery because of its constantly changing nature. “The subspecialty is one of the most fascinating specialties of neurosurgery because it is one of the most rapidly expanding in terms of what we

MDU What were the immediate observed results?

Dr. Rao As expected, we could immediately notice, test, and quantify the clinical relief of tremor and also assess for side effects. The tremor relief in all patients was vast, and there were minimal side effects that were within what is expected.

MDU Any feedback from the patients?

Dr. Rao They are all very happy and grateful. They immediately started talking about all the activities they would do, like painting their nails, drinking coffee, writing a signature.

Many were showing off to family and looking at their treated hand in disbelief. Many also starting already plotting to have the other side treated. can do—the indications, the types of things we treat, how we treat them,” Rao says. “It’s ever changing, and it’s also very satisfying because the focus of it, from the patient care standpoint, is to improve their quality of life.”

A New Way to Treat Tremors Focused ultrasound goes by many names: fUS, MRI-guided focused ultrasound (MRgFUS), and high frequency focused ultrasound (HiFU). The treatment was first FDA approved in 2016 for essential tremor, followed

by FDA approval in 2018 for Parkinson’s tremor. That approval was expanded in 2021 to treat other symptoms of Parkinson’s such as stiffness or slowness, as well as dyskinesia, uncontrolled, involuntary movement.

ISSUE #155 11

Cover Story

At NNI, the treatment was initiated with the purchase of technology and equipment thanks to a $2.8 million grant from the Norton Healthcare Foundation. The high-frequency focused ultrasound treatment procedure became available and operational in fall 2024.

“This procedure is a game changer for our ability to treat patients with essential tremor and tremor-dominant Parkinson’s disease,” says Rao. “Acquiring this technology advances our mission of giving patients the best possible outcomes, while further establishing Norton Neuroscience Institute as the regional leader in advanced neurological care.”

Since its approval, the treatment has spread rapidly.

“Roughly about 75 treatment centers exist in the country,” says Rao. “It’s rapidly expanding, but It’s not just about buying a new instrument, it’s really about starting a whole new clinical program, because even though we, and other centers, have been treating patients with these diagnoses for a while, the work-flow and the surgery itself and the management are all very different for HiFU.”

Choosing the Right Patient for HiFU or DBS The treatment itself limits the patient base, Rao says.

“One aspect of candidacy is, can the patient participate with the testing? Do they have the cognitive capacity and willingness to do that?”

she says. “High-frequency focused ultrasound is MRI-guided, so MRI images and heat maps are used during the procedure to guide the treatment. That means the patient has to be willing and able to get an MRI.” Rao said HiFU and other treatments, like deep brain stimulation where wires implanted into each side of the brain deliver electrical pulses to change the movement circuitry of the brain to regulate control over movement, are similar in their results for essential tremor. Which treatment is right for a patient is between the patient and their doctor, Rao says.

“It’s not necessarily that there’s always clearcut candidacy, or that there’s a flow chart that says, ‘If this, do this, and if this, do the other,’ Rao says. “One big difference is that deep brain stimulation is programmable or modifiable, while in high-frequency focused ultrasound, we’re using the ultrasound to create a specific lesion in the brain.”

With DBS, doctors can use external controls of the implants to manage the treatment. With HiFU, that treatment is targeted and permanent. And while HiFU is all external, DBS does require anesthesia and a short hospital stay to implant the devices. If a patient is not capable of undergoing the MRI treatment, they may be a good candidate for DBS, while someone who doesn’t want to undergo traditional surgery may be a better candidate for HiFU. “For an individual patient, a lot of it boils down to understanding their goals, what they

Dr. Abigail Rao uses high-frequency focused ultrasound technology to analyze a patient brain scan.

12 MD-UPDATE

want to accomplish from the treatment, and what they want to see get better,” she says.

“Understanding that and talking about undergoing anesthesia, having an incision, having an implanted device that does require some maintenance over time, can help us narrow down what we might recommend.”

Rao expects HiFU use will be expanded in the future. “High-frequency focused ultrasound is a surgical system, a very technologically advanced surgical tool,” she says.

“It’s presently indicated for medically refractory essential tremor and medically refractory tremor-dominant Parkinson’s disease. Based on the growth we’ve seen in the past few years, we’ll continue to see those indications grow.

In a few years’ time, we’ll see it can be used for other diseases.”

As an example, HiFU has been used to treat prostate cancer for years.

While the effects of the procedure are immediate, the side effects are generally mild, Rao says. They can range from effects on walking or balance, to adverse effects on taste.

Other side effects can include feeling foggy or mentally slower, headaches, nausea, and dizziness, but those effects are not typically long-lasting, she says.

A New Treatment Option for Patients The first HiFU treatment for essential tremor at NNI took place in mid-November 2024. Rao and others at the NNI screened several potential patients to be that first HiFU treatment recipient. Their stories show just how impactful the treatment can be.

One patient, a woman in her late 70s, is very active, healthy, and independent, and wants to stay that way. Rao says the patient is “cognitively able to live on her own, but her tremors are preventing her from continuing to do so. The tremors are so strong she can no longer legibly write checks to pay bills.

The ability to use HiFU to change a patient’s quality of life, without having to open up their head, is a game changer.”

“It’s a new delivery system to create a precise and focused lesion in the brain without needing to put anything into the brain,” Rao says.

“These aren’t life-saving procedures, but they’re massively life altering.”

SPECIAL SECTION

Neurosurgery

Backing the Bluegrass Spine Surgeon Dr. Vincent DePalma moved to Kentucky to provide a needed service

BY JIM KELSEY LONDON Before he began planning to move

to London, Kentucky, in 2020, it’s probably safe to say that Vincent DePalma, DO, had given little thought to the Bluegrass state.

After all, he grew up in New Jersey, attended college, and completed his medical training in Philadelphia, New York, and Baltimore.

In those large metropolitan areas, however, he not only learned his craft as a spine surgeon, but he also learned that there was not a great deal of need for another spine surgeon.

“In New Jersey, there are 100 spine surgeons in a two-block radius, and they’re all doing small surgeries,” says DePalma. “My training included a lot of trauma in residency.

In fellowship, I was doing complex surgeries.

I wanted to go to an area where there was a huge need, where there was pathology ranging from scoliosis and severe deformity in 80-year-olds to younger people.”

DePalma researched rural areas in the southeast, including Kentucky, Tennessee, and South Carolina. He finally found the right place in London, Kentucky. Close but not quite close enough to Lexington and Knoxville, London’s proximity to rural southeastern Kentucky was an ideal choice.

“The biggest thing for me was being able to build a medical practice where there’s a big need,” says DePalma, whose patients come from communities such as London, Corbin, Berea, Richmond, Winchester, Mount Sterling, Hazard, Harlan, Hyden, Bowling Green, Pineville, northern Tennessee and even from Lexington. DePalma has patients travel from as far as West Virginia to receive his specialized care.

To say life in London is different from that of the Jersey Shore where DePalma grew up is an understatement. The youngest of four children, he grew up in a medical family. His father was a nephrologist in New Jersey. His 14 MD-UPDATE

siblings — two brothers and a sister — are also physicians.

DePalma initially chose a different route. He planned to go to law school and studied political science and interna- After growing up and training in the northeast, Dr. Vincent DePalma tional relations before his plans moved to London, Kentucky, in 2020 to serve the area’s rural population. changed abruptly.

“One of the biggest catalysts in deciding to become a doctor was my dad Learning the Craft of Spine Surgery passed away out of nowhere from a cardiac Throughout his medical training, DePalma’s arrhythmia,” says DePalma. “I was in my last plan was to learn from the best, to take on the year of college and I saw all the people he toughest challenges, to push himself to do affected and helped throughout his 30-year more. He has a natural competitive drive, career — thousands of people showed up at developed at least partially through his experihis funeral. I decided to go back and do med- ences playing football and baseball. Those lesicine at that time.” sons were put to the test during his residency DePalma attended medical school at the at Northwell Health.

Philadelphia College of Osteopathic Medicine, “My residency was a rough one. We did graduating in 2014. He then completed an 52-hour shifts at times,” says DePalma, who orthopedic residency at Hofstra Northwell met his wife during his residency. “I fixed Health (2014–2019) and a spine surgery and nearly 400 hips as an intern and did thoureconstruction fellowship at Johns Hopkins sands of surgeries and cases at seven different University in Baltimore (2019–2020). He is a hospitals across Long Island, New York. We board-certified orthopedic surgeon specializ- worked like crazy as residents and I was appreing in spine surgery. He joined the CHI Saint ciative of that.”

Joseph Medical Group in London, Kentucky, That intense schedule prepared him for in 2020.

Johns Hopkins, where he learned from the Much like his decision to come to Kentucky, best spinal surgeons in the world, observing DePalma had a sound reason as to why he techniques and developing skills that would wanted to become an orthopedic surgeon. open doors almost anywhere. Yes, even in “I am a very goal-oriented person and rural Kentucky. outcome-driven,” he says. “I need to have a “We are treating Johns Hopkins-level project and fix it as quickly as possible. With patients here in a community hospital,” says orthopedics, you can identify a problem DePalma with understandable pride. He operquickly, then you can fix it and complete ates three or four days a week and averages 280 that task.” spine surgeries a year. Unfortunately, the small“I went into spine surgery because of the town region offers a large patient population. complexity of spine surgery and the breadth “I was surprised by the vast amount of and vast difference between different proce- spinal pathology in this region — things that dures and the workup,” he adds. “There’s a lot have gone on so long, and they have never had of thought process that goes into it as opposed treatment or never been diagnosed,” he says. to just fixing something. You work up a plan “The amount of patients we see is extraordiand execute that plan.” nary compared to the other areas where I was PHOTO BY GIL DUNN

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in the past. People have not had treatment for decades or forever until I came here.”

His patient population is equally divided between men and women, from teens to 90-year-olds. The most common surgery he performs is to correct severe spinal stenosis — pinching of the nerves, which results in leg or arm weakness and pain.

“Those surgeries do extremely well,” says DePalma. “It’s the only surgery where they are immediately out of leg or arm pain after the surgery. Some patients go home the same day or the next day.”

Surgery Is a Good Day DePalma enjoys surgery because it offers the opportunity for him to fix things by doing what he’s best at. He has the knowledge to identify the problem and the skill to fix it.

“Surgery is the easiest, best part of the day,” he says. “It doesn’t cause me stress. Neither does post-op care. The tiring days are the ones where I see 50+ patients in clinic and deal with insurance companies to get surgeries and imaging approved. It’s all the work to do the work that is exhausting.”

Despite his love for surgery, DePalma only performs surgery on about 10 percent of his patients. The joy he receives from surgeries is fixing the problem.

“There is a misconception that spinal fusion doesn’t work,” he says. “Ninety-five percent of my practice is doing spinal fusion and my success rates are over 95 percent.

You have to do the right surgery on the right pathology. You can’t take the easy way out. If you treat someone for spinal stenosis, your success rate is 100 percent if you do good patient selection, do the correct surgery, and do a good job at it.”

Surgery to just treat back pain is far less likely to have a successful outcome, says DePalma.

“If someone comes in with back pain, unless there is a fracture or instability there, I am not doing surgery. I am not going to do surgery and fuse your back for a degenerative disc. The outcomes are not going to be successful because the patient does not have much that is wrong with them. A lot of times, the back pain is just related to muscles and ligaments.”

Neurosurgery

A New Approach A unique surgical technique that DePalma is now offering to his patients is a Prone Transpsoas Lateral Interbody Fusion (PTP LIF). The traditional version of the surgery requires putting the patient on their side in the lateral position rather than an anatomical position. The PTP LIF surgery allows the patient to remain in the prone position. The outcomes are the same for either surgery, but the benefits to the patient are significantly different.

“The surgical time is cut down by an hour to an hour and a half, so the patients have less time under anesthetic, less surgical time, and less blood loss,” DePalma says. “Plus, the correction of the sagittal alignment is better.”

DePalma takes great pleasure from a successful surgery. He tells the story of one patient who came to him in a wheelchair, unable to walk. He had been misdiagnosed with arthritis.

DePalma correctly diagnosed spinal stenosis and corrected the issue via surgery, enabling the patient to walk once again pain free.

“I’m trained at doing something that allows me to help people who haven’t been treated for years,” says DePalma. “I tell them I can help them. I perform the surgery. I see them a few months after surgery and ask how they’re doing. They say great, nothing wrong, you fixed me. It’s pretty rewarding.”

Though other opportunities are no doubt available, he has no plans to leave London.

He feels a sense of purpose to serve what has long been an underserved patient population.

His goal is to establish a Spine Center of Excellence in eastern Kentucky. There’s no better way to show his patients that he has their back.

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ISSUE #155 15

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He’s Got Your Back

David Freeman, MD, PhD, performs endoscopic spine surgery to restore patients’ quality of life at UofL Health

BY JIM KELSEY LOUISVILLE “Spine-tingling” is generally used

to describe a movie, book, or event. It means exciting and thrilling, but also frightening. It represents a heightened state of alertness and sensitivity and is reflective of the vital role of the spine in human anatomy.

Anyone with chronic back pain or leg pain can speak to the importance of good spinal health. So can David Freeman, MD, PhD, director of endoscopic spine surgery at UofL Health.

“There is a misconception that if you need spine surgery, life is over and that you’re always going to have back pain or you’re going to need more surgery,” says Freeman, who is also an assistant professor of neurosurgery at the University of Louisville School of Medicine.

“Spine surgery done for the right reasons, in the right patients, is an incredibly powerful tool that can give people their lives back.”

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He recalls a recent case in which a patient had atlanto-occipital dislocation (AOD), a condition when the head is no longer connected to the neck.

“This lady had not had any significant trauma. This type of injury is most common in high-speed car accidents, but she had not had that,” Freeman says. “We stabilized her temporarily in a halo, an advanced neck brace, and we took her to surgery the next day. We put a plate on the back of her head, screws in the top of her neck, and connected them all. Everything went well. She had strength and dexterity back within five days, which was remarkable. If we had not intervened, she would have been a quadriplegic and would have needed a ventilator to help her breathe for the rest of her life.”

While that was an extreme case, it reflects why Freeman chose neurosurgery in the first place. After graduating from Augustana College in Illinois, the Chicago-area native PHOTOS BY GIL DUNN

attended medical school at the Loyola University of Chicago Stritch School of Medicine. For his PhD, he studied neurodegenerative diseases such as Parkinson’s disease.

The Road to Louisville Freeman was well on his way to becoming a neurologist until he found that neurosurgery was more appealing.

“I was very fortunate that one of the cases that I saw as a medical student in neurosurgery was a rare, bony septum that was sticking into a patient’s spine. We were able to remove that and, in the recovery area, she had significant immediate relief of her pain,” says Freeman. “It was sort of a landmark experience for me that made me want to continue down that path to neurosurgery.”

Freeman interned in neurosurgery at the University of Minnesota, where he also completed a neurosurgery residency. In 2023, he completed a minimally invasive spine fellow-

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ship at the University of Miami before joining UofL Health in Louisville.

“I was looking for a place that was interested in developing endoscopic spine surgery,” Freeman says. “I wanted to be able to teach residents and have a focus on some research as well. UofL Health has all of those things.”

Know the Patient First, Then Treatment A typical week for Freeman involves surgery on Mondays and Wednesdays and seeing patients in clinic on Tuesdays and Thursdays, while Fridays include research and administrative tasks. His typical spine patients are middle-aged or older, presenting with back, neck, arm, or leg pain.

“It spans the spectrum of clinical care because I get to take care of some patients in acute settings while treating others for a degenerative condition,” Freeman says.

In his initial consultation with patients, Freeman focuses on understanding the

Director of Endoscopic Spine Surgery Dr. David Freeman joined UofL Health in 2023.

patient’s symptoms, and completes a physical exam related to those symptoms. After any imaging is complete, he reviews them with

Neurosurgery

the patient, explaining the problem and the options for treatment.

“That’s how we establish a relationship and build trust,” Freeman says. “I try to be as truthful and frank as I can with the patients about the risk and benefits of surgery, and the risk and benefits of their condition. It is my job to be able to provide clarity and understanding of what the options are, what the risk and benefits are. Ultimately, I do not know what their symptoms feel like, and how they affect them on a daily basis. We need that input in order to make an informed decision together.”

Even though Freeman’s area of expertise is endoscopic spine surgery, it is the last resort for treatment. He often recommends conservative measures first, which may end up treating the symptoms without the need for surgery.

Those who do need surgery benefit from the minimally invasive endoscopic spine surgery, which results in a smaller incision and quicker recovery time.

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ISSUE #155 19

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Neurosurgery

“Endoscopic spine surgery introduces an endoscope into and around the spine, through which you can view the pathology directly,” Freeman says. “We also have instruments that allow us to do the surgery and take care of the problem there. The incision is usually about a centimeter. Anesthesia time can be significantly less and patients go home typically the same day.”

New Options for Spine Surgery and Recovery Freeman also utilizes single-position surgery, doing surgery in the lateral position.

“I’m interested in trying it and seeing what works for myself and the institution as well as

“If patients say they are feeling better than they were before surgery, that’s tremendously rewarding.” — David Freeman, MD, PhD, director of endoscopic spine surgery, UofL Health the patients,” Freeman said. “I’m excited to see where that approach goes. It is certainly a powerful approach that could be the most efficient and best type of surgery for certain patients.”

Freeman is also leading an application for institutional research approval for the use of FDA-approved composite beads.

“We can add antibiotics and pain medication to the beads and we can put them in the incision,” says Freeman, who

used the beads during his fellowship. “They dissolve over 45 to 60 days. Using them during my fellowship, we were able to reduce patients’ length of stay in the hospital, reduce the morphine or narcotic usage, and reduce surgical site infections.”

Seeing the result of such significant improvements and advancements is part of what fuels Freeman’s passion for his work.

Much like the rewarding story of the patient who recovered from AOD, the success stories, the positive outcomes, and the lives regained are the images and moments that hold a special place in Freeman’s mind and heart.

“If my patients say they are feeling better than they were before surgery, that’s tremendously rewarding. Those are the reasons I do spine surgery,” says Freeman. “I had an endoscopic case I did a couple of months ago. The patient had debilitating leg pain and was not able to golf or even walk. I just saw him for his three-month follow-up and cleared him for a golf tournament. He’s back to walking miles a day. He got his life back.”

Dr. Freeman views pre-operative MRI of the lumbar spine prior to scrubbing in to review the exact location of the pathology.

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Public Health

Lung Cancer Screening Is Primary Honoring Kentucky’s collective efforts and the role of primary care providers in early detection

BY NIRVANA NAWAR, MHA, LUNG CANCER SCREENING PROGRAM ADMINISTRATOR FRANKFORT November was Lung Cancer

Awareness Month, a time to spotlight the importance of early detection. In Kentucky, where lung cancer rates are among the highest in the U.S., this month highlights the state’s progress and ongoing efforts to increase screening access and improve patient outcomes. Though challenges remain, the commitment of healthcare providers, public health organizations, and community partners has resulted in significant strides.

Lung cancer is the leading cause of cancer death in Kentucky. However, early detection through low-dose computed tomography (LDCT) can significantly reduce mortality. Research, including findings from the National Lung Cancer Screening Trial, has shown that LDCT can decrease lung cancer deaths by 20% in high-risk individuals.

In recent years, Kentucky has seen steady improvements in lung cancer screening participation. Screening rates have risen, thanks to community outreach, mobile screening units, and partnerships between healthcare providers and public health organizations. While there is still work to be done, these efforts are making a meaningful impact.

Who Should Be Screened?

Lung cancer screening is recommended for individuals aged 50 to 80 who have a smoking history of 20 pack-years or more, and who are either current smokers or have quit within the past 15 years. This criterion, endorsed by the U.S. Preventive Services Task Force, ensures that those at the highest risk are identified and screened early. Kentucky’s healthcare providers have played a key role in educating patients about these guidelines and encouraging them to participate in screenings.

Despite the proven benefits, some individuals remain unaware of their eligibility for screening.

Primary care providers are crucial in addressing this gap by initiating conversations about lung cancer risk and screening options. Their proactive approach has led to increased participation in Kentucky’s screening programs.

Nationally, lung cancer screening rates also increased by over 50% between 2015 and 2020, according to the American Lung Association. Kentucky’s rising screening rates mirror this national trend, demonstrating that targeted outreach and education can drive improvements in early detection and reduce lung cancer mortality. In 2023 alone, the Commonwealth saw an 18% increase in the number of screenings compared to the previous year. This success is a direct result of initiatives such as mobile screening units that bring services to rural and underserved areas, as well as public education campaigns that emphasize the importance of early detection.

Healthcare providers are essential in increasing lung cancer screening rates. As the first point of contact for many patients, they are in a unique position to identify those at high risk and encourage screening. Studies show that when primary care providers discuss screening with eligible patients, the likelihood of participation increases significantly. In Kentucky, providers are working diligently to inform and educate their patients about lung cancer risks and screening options. These efforts have contributed to an upward trend in screenings and helped reduce the stigma surrounding lung cancer. By addressing patient concerns and offering support, providers are ensuring that more individuals take proactive steps toward their lung health.

Success Is a Team Effort Kentucky’s lung cancer screening successes can be attributed to collaboration between healthcare facilities, public health organiza-

tions, and local communities. The Kentucky Lung Cancer Screening Program has partnered with hospitals, clinics, and community groups to offer educational resources and increase access to screenings. This is a testament to the power of collaboration in improving public health outcomes. As Kentucky continues to work together to increase screening rates, more lives will be saved.

Looking ahead, there is reason for optimism. With continued collaboration, education, and outreach, Kentucky is poised to see even greater improvements in lung cancer screening rates. Healthcare providers will continue to play a pivotal role in ensuring that every eligible Kentuckian is screened. By proactively discussing screening options and educating patients, providers can help further reduce lung cancer mortality in the state.

Every step forward brings the state closer to its goal of reducing lung cancer deaths and improving the quality of life for its residents. Healthcare providers have a unique opportunity to continue this momentum by engaging with patients and ensuring that every eligible individual is screened. Together, we can reduce lung cancer mortality, improve outcomes, and build a healthier future for Kentuckians.

REFERENCES: Kentucky Department for Public Health. Kentucky Lung Cancer Screening Program. Accessed November 2024. https://chfs. ky.gov/agencies/dph/dmch/Pages/lungcancer.aspx American Lung Association. State of Lung Cancer Report 2020.

Available at: https://www.lung.org/research/state-of-lung-cancer.

Accessed November 12, 2024.

Centers for Disease Control and Prevention. National Lung Cancer Screening Trial Findings. Available at: https://www.cdc.gov/ cancer/lung/nlst.htm. Accessed November 12, 2024.

U.S. Preventive Services Task Force. Lung Cancer Screening: Recommendation Statement. JAMA. 2021;325(10):981-987. doi:10.1001/jama.2021.1440.

National Cancer Institute. Lung Cancer Screening Rates and Demographics in the U.S. Available at: https://www.cancer.gov/ about-cancer/causes-prevention/risk/smoking/lung-cancerscreening. Accessed November 12, 2024.

ISSUE #155 21

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EM/PSYCHIATRY

New Option for Emergency Psych Patients

UK HealthCare opens first psychiatric emergency unit in Kentucky

BY ALLISON PERRY LEXINGTON In July 2024, UK HealthCare

opened a new emergency unit dedicated to the treatment of patients experiencing a mental health crisis. The unit, known as EmPATH (emergency psychiatric assessment, treatment, and healing), is the first of its kind in Kentucky. The UK HealthCare EmPATH Psychiatric Unit is on the campus of Eastern State Hospital.

Currently, there are only about 30 EmPATH units in the U.S. UK HealthCare and New Vista have collaborated with leadership from the Kentucky’s Cabinet for Health and Family Services to bring this new model of emergency behavioral health care to Kentucky.

“The EmPATH model is a game-changer for mental health care, and we are proud to

be the first in the state to open this unit,” said Robert S. DiPaola, UK co-executive vice president for health affairs. “With EmPATH, we’re using a proven, evidence-based approach that allows our behavioral health team to provide fast, appropriate evaluation and care that’s easier for patients to access in an environment conducive to healing.”

EmPATH units are carefully designed physical environments that help patients experiencing an acute mental health issue receive immediate support. Instead of individual treatment rooms, the units are wide open spaces with comfortable seating. Upon arrival, individuals interact with supportive health care providers including psychiatrists, nurses, social workers, and even peer support specialists. Patients can stay in the unit for up to 23 hours.

Robert S. DiPaola, UK co-executive vice president for health affairs.

22 MD-UPDATE

Eastern State Chief Administration Officer and psychologist Lindsey Jasinski, PhD, says the peer support aspect is one of the chief factors that make this model successful. Patients can speak to others who have dealt with taking medication, receiving therapy, and participating in different programs.

At roughly 11,000 square feet, UK HealthCare’s EmPATH Psychiatric Unit has room for up to 12 patients at a time. Providers and support staff assess the individual’s symptoms and develop a care plan, which could include a treatment plan and discharge home with connection to appropriate outpatient services, or admittance as an inpatient for round-the-clock care. Nationally, studies show that 60-70% percent of individuals who come to an EmPATH unit are stabilized and sent home within 24 hours.

Andrew Cooley, MD, a UK HealthCare psychiatrist and CMO for Eastern State Hospital PHOTOS BY CARTER SKAGGS

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Patients treated in these units are also far more likely to continue their care. A study published in Academic Emergency Medicine showed that 60% of individuals in rural areas with suicidal thoughts or ideation sought follow-up care after their initial treatment in an EmPATH unit.

Reducing the Load on Traditional ERs The EmPATH unit will help reduce the load on traditional emergency departments. A 2020 study of mental health-related emergency room visits showed an increase from 6.6% to 10.9% between 2007-2016. The physician-owned partnership Vituity, which helps hospitals develop their own EmPATH units, estimate that currently 12-15% of emergency room visits are related to behavioral health.

While EDs can provide critical care to acute injuries, illnesses, and traumas, they often do not

have the resources or staffing to effectively treat individuals in a mental health crisis. EDs must prioritize patients with life-threatening issues.

Andrew Cooley, MD, is a UK HealthCare psychiatrist and has served as chief medical officer for Eastern State Hospital since 2013.

He stated, “Our emergency departments give amazing care and save countless lives every day. We know that patients who come in with a life-threatening injury will need to take priority, and patients experiencing a behavioral health crisis will be further down the list to receive treatment. EmPATH is the alternative to that – a patient shows up here, and we immediately greet them and begin care.”

Behavioral Health Has a Broad Patient Population UK HealthCare’s EmPATH Psychiatric Unit is open to adults age 18 and over who ae experiencing a behavioral health crisis, which has a

EM/PSYCHIATRY

broad definition: any mental health problem that impairs their ability to perform normal daily functions, take care of themselves, and keep themselves safe. That could include those seeking help for a substance use disorder, those experiencing depression and anxiety, someone who is thinking about self-harm or suicide, and more. Patients may be brought in through emergency medical services (EMS), or may self-refer and bring themselves there.

The EmPATH unit is part of UK HealthCare and will have its own separate entrance at Eastern State Hospital’s campus, on Bull Lea Road in Lexington. Eastern State Hospital is owned by the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities and managed by UK HealthCare. It operates 195 acute care beds and provides critical, recovery-focused psychiatric care for adults from a 50-county region of the state.

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PUBLIC HEALTH

Smoking Is Bad for More Than Your Heart and Lungs Improving patient well-being through tobacco cessation treatment

BY NICOLE KEY, MPH, CHES®, KENTUCKY TOBACCO PREVENTION & CESSATION COMMUNITY PARTNERSHIPS SPECIALIST; CLAIRE WEEKS, MS, KENTUCKY TOBACCO PREVENTION & CESSATION PROGRAM CESSATION ADMINISTRATOR; ELLEN H. CARTMELL, MPA, HEALTH PROMOTIONS SECTION SUPERVISOR FRANKFORT Smoking’s negative effects on the body

have been known for decades – but what about its effects on the mind? Patients dealing with stress, anxiety, depression, or other behavioral health conditions may not realize that nicotine addiction compounds and in some cases even causes those negative feelings.

This misbelief is particularly dangerous for young people, many of whom begin using nicotine products specifically to self-medicate for behavioral health issues. According to a 2021 survey by Truth Initiative, 81% of 15- to 24-year-olds reported started using e-cigarettes to manage feelings of anxiety, stress, or depression, believing that it will help them relax or boost their mood. Unfortunately, the truth is that nicotine disrupts the brain’s neurotransmitter systems, which can worsen mood regulation and increase feelings of anxiety and depression. This effect is especially pronounced in young people whose brains are still developing, making them more vulnerable to the long-term mental health effects of nicotine addiction.

The Effects of Nicotine People experiencing nicotine withdrawal can feel irritable, anxious, and depressed, all symptoms that are temporarily alleviated when they get the dose of nicotine their brains crave. This can create a self-reinforcing cycle: nicotine is used to cope with stress, but it ultimately causes more stress, intensifying both the addiction and the underlying mental health symptoms. As a result, research has shown 24 MD-UPDATE

that many mistakenly believe that tobacco products relieve stress and anxiety.

Healthcare providers are in a uniquely powerful position to help patients break free from nicotine addiction, improving both their physical and mental health. Integrating tobacco treatment into health care can offer long-term benefits including promoting overall wellbeing and enhancing recovery.

In adults, smoking cessation has been shown to reduce depression, anxiety, and stress, with benefits comparable to—or even greater than—the effects of antidepressant treatments for mood and anxiety disorders. Young people who quit vaping report feeling less stressed, anxious, or depressed compared to their peers who don’t quit. For individuals recovering from substance use disorders, quitting tobacco can also reduce cravings and improve the chances of long-term sobriety.

Tobacco Use and Mental Health Tobacco treatment should be a particular focus for people with diagnosed mental illnesses, who consume 40% of cigarettes in the United States despite being only about 25% of the population.

Research has shown that most people who smoke want to quit, and, in spite of misconceptions, that does include many people with behavioral health challenges. For instance, one survey found that more than 90% of psychiatrists at four community mental health centers patients said their patients who smoked were not interested in quitting. When asked, however, four out of five of those patients

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stated they were interested in decreasing or quitting smoking.

Patients of all ages who report interest in quitting tobacco products can be referred to 1-800-QUIT-NOW, known in Kentucky as Quit Now Kentucky. This is a confidential tobacco treatment service offered through the Kentucky Department for Public Health, 24 hours per day at no cost to the caller. Enrollees receive at least five calls from a quit coach with personalized tips on how to quit and stay quit successfully and how to access nicotine replacement therapy. Some participants may also qualify to receive nicotine replacement therapy such as patches, gum or lozenges shipped directly to their home. Using a quitline or nicotine replacement therapy can double a person’s chances of quitting smoking successfully.

Multiple Resources Quit Now Kentucky offers additional resources to the 57% of enrollees who report having a behavioral health condition. To

better support these individuals, the program offers a behavioral health protocol that includes seven telephone coaching sessions over three months. These sessions focus on stress management, coping skills, and creating a personalized quit plan. Enrollees in the Quit Now Kentucky behavioral health protocol also receive nicotine replacement therapy at no cost (if not contraindicated).

This tailored approach has proven effective for individuals with anxiety, depression, PTSD, ADHD, schizophrenia, and substance use disorders. Participants also receive a Welcome Package with educational materials and a workbook, My Quit Journey, to guide them through the quitting process.

Healthcare providers can refer patients to Quit Now Kentucky, helping them access the support they need to quit successfully. Web referral is available at QuitNowKentucky.org.

PUBLIC HEALTH

ing education credits to doctors, pharmacists and registered nurses interested in learning more about how tobacco treatment can help patients. Topics include the Medicaid cessation benefit, how to talk to patients about e-cigarettes and how to help patients with chronic conditions quit smoking. These resources are available at quitlogixeducation. org/kentucky.

By including a referral to Quit Now Kentucky as part of a comprehensive approach to tobacco treatment, providers can offer patients the possibility of reduced stress, anxiety, and depression, while also increasing their chances of long-term recovery and well-being.

With resources like Quit Now Kentucky, healthcare providers have the tools they need to guide patients on their journey to a tobacco-free life.

For more information, please visit QuitNowKentucky.org or contact the Kentucky Tobacco Prevention & Cessation Program at the Kentucky Department for Public Health at Ky.TobaccoFree@ky.gov.

Earn CME Credits Quit Now Kentucky also offers continu-

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ISSUE #155 25

Mental Wellness

The Surprising Secret to Breaking Free from Habit Loops and Unlocking Lasting Change Curiosity is more powerful than willpower

BY JAN ANDERSON, PSYD, LPCC

Do you ever feel trapped by your habits?

Stuck in stubborn behavior patterns that won’t budge or eventually resurface? Breaking free from habit loops — whether endless scrolling, stress eating, procrastination, or emotional outbursts — can feel impossible.

Your brain is wired to create and operate on habits. That’s what makes habits so tough to break once they’re formed. Yes, your brain is a habit-making machine. But what if you could hack into your brain’s reward center, reprogram, and take control?

Welcome to the world of habit hacking, where understanding how your brain works is the first step to lasting change.

Thanks to ground-breaking research about how your brain forms habits, we know behavior change requires more than willpower, substitution strategies, and avoiding temptation. It’s more about hacking into your brain’s reward center to overcome cravings, stop destructive behaviors, and create a life you love.

I took my first deep dive into habit hacking in October 2019 when I enrolled in a training program with one of the premier experts in habit change, Judson Brewer, MD, PhD. Brewer, a leading neuroscientist and addiction psychiatrist, appeared in 2018’s fourth mostwatched TED talk, A Simple Way to Break a Bad Habit. His groundbreaking research first gained prominence when his smoking cessation program (Craving to Quit) proved five times more effective than the gold-standard treatment. From there, he and his lab developed the first clinically proven apps for anxiety (Unwinding Anxiety) and craving-related eating (Eat Right Now).

The more I learn about the neuroscience of habit change, the less enchanted I am with forcing myself to adopt new behaviors and desperately trying to maintain them with 26 MD-UPDATE

willpower and motivational mind games. I’m learning that habit change is more about getting curious, staying present, and letting your brain learn naturally.

What do I like most about Brewer’s unique brand of habit change? He cleverly morphs his research findings into short, practical, smartphone-based applications. This format appeals to my clients: time-strapped, high-achieving executives, professionals, and two-career couples.

Why Are Habits So Hard to Break?

Habits are formed in the oldest, most primitive area of your brain and are part of your survival system. Habits are efficient shortcuts that save time and energy by helping you react automatically without thinking about it.

Habits are designed to free up your brain to focus on more important and interesting stuff.

The core of habit formation is rewardbased learning. If you’ve ever caught yourself reacting on autopilot — reaching mindlessly for food, a drink, or the “complete purchase” button — this simple three-step loop will feel familiar: 1. Trigger: A trigger can be almost anything — a situation, thought, or feeling, often outside your conscious control — that starts the habit.

2. Behavior: You act automatically in response to the trigger — grabbing a snack, checking your phone, or lashing out in frustration.

3. Reward: You feel a brief sense of relief, satisfaction, or pleasure.

Because our brains are so efficient, this loop quickly becomes so automatic that you barely notice it anymore.

Reward-based learning has kept humans alive for thousands of years. The downside?

Modern life is bombarded by artificial triggers

designed to exploit your brain’s reward-based learning system. Food, social media, and online shopping are engineered to give your brain quick dopamine hits. As you constantly trigger this reward system, it creates loops that trap you in behaviors you often don’t enjoy that much.

Everyday Addictions Are Everywhere.

Think addictions only apply to alcohol or drugs? Think again. Everyday addictions are everywhere: • Things: Shoes, snacks, gadgets.

• Behaviors: Binge-watching Netflix, doomscrolling, or gaming.

• Thoughts: Obsessing over the latest news, relationship drama, or diet disguised as a wellness plan.

These behaviors offer quick relief when you’re stressed, bored, or lonely. But the relief is short lived — and often followed by regret.

Mental Wellness

What Drives Everyday Addictions?

Modern life combines three subtle yet powerful forces that fuel everyday addictions: • Stress: Boredom, loneliness, frustration, or worry.

• Availability: Smartphones, streaming platforms, and online stores make everyday addictions all too easy to indulge.

• Intermittent Rewards: Sometimes you get what you’re craving. (One of the best examples of how intermittent reinforcement works is gambling. Sometimes you win.

That makes it harder to walk away.)

Why Willpower Alone Doesn’t Work What makes breaking habits so hard?

Most strategies, like willpower, rely on the brain’s decision-making center, the prefrontal cortex (PFC). Unfortunately, the PFC, a newer part of the brain, shuts down when you get overwhelmed, tired, or stressed. At the exact moment you need it most, your PFC goes offline.

Other common strategies, like substitution (swapping one habit for another) or avoidance (avoiding triggers), also fall short because they rely on the PFC. I’ve learned that Brewer’s approach to habit change targets both the old brain and the new brain, allowing them to work together and make it easier for you to recognize, reframe, and rewire.

1. Recognize: Turn off autopilot and become aware of what gets the habit loop started.

2. Reframe: Take a fresh look at how rewarding the habit behavior is so your brain can update its rewards system based on current, complete, and accurate data points.

3. Rewire: Test out potentially more rewarding behaviors that can replace old, less rewarding ones.

Curiosity Is Stronger Than Willpower What supercharges habit change is curiosity — particularly what scientists call interest curiosity — a wide-eyed, judgment-free interest in understanding yourself and your behavior. It’s different from deprivation curiosity, that itchy, nagging feeling of needing to know something (e.g., “Who just texted me?”)

I’ve found it’s a profoundly different feeling when you’re caught in a habit loop and infuse it with curiosity instead of criticism. And your old brain is really into feelings. Addressing your primitive brain’s need to feel something good helps it calm down and let the PFC come back online.

Who would have thought? By cultivating interest curiosity, you can disarm cravings and approach habit change with smarts and compassion instead of frustration.

The Science of Breaking Free The first step to rewire your brain’s reward system may surprise you because it doesn’t involve trying to change or stop the habit immediately.

It starts with switching off your brain’s autopilot and switching on fresh, present-moment awareness of your behaviors and curiosity about how rewarding they are.

A specific brain area, the orbitofrontal cortex (OFC), rapidly compares the relative reward value of different behaviors to determine what Brewer calls the bigger, better offer (BBO).

Hacking the Habit Loop: Brewer uses a simple analogy to explain how the habit change process works: gears on a bike.

Reverse: When you’re on autopilot, you’re stuck in reverse — repeating the same old behaviors without thinking.

As an example, you may be so used to beating yourself up that you don’t even realize how much of your daily headspace is hijacked by your inner critic. And how much living with a constant inner critic attack in your head is making you less effective, not to mention affecting your happiness and your peace.

First Gear: Awareness kicks in. You start to notice your triggers and how you respond to them.

“Hey, I feel like crap, and I don’t know why. I shouldn’t be feeling like this. I should be able to kickstart myself out of this funk right now… What’s wrong with me? Successful people don’t deal with BS like this...”

Second Gear: Let curiosity take over: Explore how the habit feels — what are its actual costs and rewards?

“So this is what an inner critic attack feels like — pissed at myself because I can’t figure out why I feel like crap, and I can’t shut it down or shake it off…”

“Is getting pissed at myself helping me get out of this mindset? No, but I don’t know what else to do…(yet).”

Third Gear: You experiment with a new behavior that’s more rewarding than the old habit.

“What might help more than beating up on myself? Well… I’d feel better if I stopped trying to force myself to feel good.

This is odd… It feels better to acknowledge that I feel bad, I don’t know why, and that I can go on with my day anyway…”

Interest curiosity intrinsically feels good.

That’s why curiosity can offer you some relief from an inner critic attack or the relentless pressure of your inner pusher. When your primitive brain takes in the feel-good chemicals generated by curiosity, it calms down and lets your PFC come back online. Now you can start problem-solving and help yourself out of the mindset funk.

Your Brain Is Ready for a Reboot. Are You? Habit change isn’t just about stopping the bad stuff. It’s also about automating positive routines, like exercising, journaling, or sleeping better. Regardless, I find this new brain/ old brain approach more effective and efficient than relying on willpower, substitution strategies, and motivational mind games.

But don’t take my word for it. Your inner critic may be (appropriately) skeptical when I say making habit change feel better makes it work better. Your inner pusher may be (appropriately) skeptical when I say making habit change feel better makes it work faster. Let these “Radical Dr. Jan” comments pique your interest and inspire you to test it yourself.

Honor your primitive brain’s need for a “show me the money,” felt sense that you can trust this new mindset.

If you’re curious about getting curious, staying present, and letting your brain learn naturally, please get in touch with me at www.

DrJanAnderson.com or 502.426.1616.

ISSUE #155 27

News

Two New Physicians Join Baptist Health Louisville LOUISVILLE Mohamed Jalloh, MD, has joined

the Baptist Health team to provide compassionate, patient-centered care. Jalloh specializes in diagnosing, treating, and managing diseases that affect the muscles, bones, and joints. In addition to musculoskeletal conditions, he treats autoimmune and inflammatory conditions.

He has a passion for preventive rheumatology and aims to not only treat existing rheumatologic conditions, but to engage in scholarly work focused on preclinical rheumatic diseases.

Jalloh received his medical degree at the University of Sierra Leone College of

Medicine and Allied Health Sciences and completed a residency at Howard University Hospital and a fellowship at MedStar Georgetown University Hospital in Washington, DC. Jalloh is board certified in internal medicine and board eligible in rheumatology.

Brandon Boyd, DO, internal medicine, has joined the Baptist Health team to offer services that include everything from well visits and disease prevention to health maintenance and care for urgent Mohamed Jalloh, MD Brandon Boyd, DO conditions.

He received professional training at Lake served a residency at Fairfield Medical Center Erie College of Osteopathic Medicine and in Lancaster, Ohio.

CHI Saint Joseph Health – Primary Care Opens New Location in Georgetown, Kentucky

NEW MARKET PRESIDENT FOR CHI SAINT JOSEPH HEALTH

GEORGETOWN CHI

LEXINGTON Matt Grimshaw, MBA, is the

Saint Joseph Health –Primary Care opened a new office in Georgetown, Kentucky. The new office at 150 Mount Vernon Drive will be staffed by Caresse Wesley, DO, and Nova White, DO. This expansion aims to provide compassionate health care services to the Georgetown community, furthering the mission of CHI Saint Joseph Health to enhance the well-being of Kentuckians.

“We are thrilled to extend our health care services to Georgetown and to have two exceptional physicians, Dr. Wesley and Dr. White, as the providers assisting local community members,” said Carmel Jones, president, CHI Saint Joseph Medical Group. “Their dedication to improving patient health aligns perfectly with our mission of delivering compassionate care to the communities we serve.”

Wesley is a Georgetown resident and family medicine physician who has been with CHI Saint Joseph Health since January 2013.

She earned her undergraduate degree at Asbury University, completed medical school at Nova Southeastern University in Florida, and finished her residency at the University of Louisville. Wesley specializes in thyroid, hormone, and integrative and functional medicine.

28 MD-UPDATE

Caresse Wesley, DO

Nova White, DO

White grew up with a deep connection to holistic medicine and infuses an integrative approach to primary care. She earned her undergraduate degree at Eastern Kentucky University, completed medical school at Lincoln Memorial University DeBusk College of Osteopathic Medicine in Harrogate, Tennessee, and finished her residency in family and community medicine at the University of Kentucky.

Wesley and White will offer a full range of primary care services, including preventive care, wellness check-ups, chronic disease management, and treatment of acute illnesses.

PHOTOS PROVIDED BY BAPTIST HEALTH AND CHI SAINT JOSEPH HEALTH

new market president for CHI Joseph Health. He was formerly the market president of Trinity Health System in Steubenville, Ohio.

Both CHI Saint Joseph Health and Trinity Health System are a part of the South Region of CommonSpirit Health, which was created by the alignment of Catholic Health Initiatives and Dignity Health as a single ministry in 2019. It is one of the largest healthcare systems in the U.S., with 137 hospitals and more than 1,000 care centers across 21 states.

“I am humbled and honored to be selected for this position within the CommonSpirit South Region at Saint Joseph Health,” said Grimshaw. “I am excited to be joining the excellent team at Saint Joseph Health and to being a part of continuing their nearly 150-year legacy of providing quality healthcare in the region.”

Matt Grimshaw, MBA

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

Kentucky Physicians Take Leadership Training LOUISVILLE Kentucky physicians received advanced leadership training

through the Kentucky Medical Association’s award-winning Kentucky Physicians Leadership Institute (KPLI).

The KPLI is a top leadership training program for physicians in Kentucky. The KPLI selects a maximum of 15 physicians each year to engage in a year-long learning program to prepare the next generation of physician leaders.

According to the KMA, the four weekend events address many of the challenges facing the physician community. Physicians learn from guest speakers and study advocacy, business, communications, and personal aspects of leadership.

FRONT: Erica Courtney, MD, Trace Bratton, DO, Syed Haider Abbas, MD, Zubi Suleman, MD, Kelly Evans, DO, and Erin Moore, MD. BACK: Kevin O’Bryan, MD, Timothy Beacham, MD, Rinot Pancholi, MD, Robert Whitford, MD.

Erin Shumer, MD, and Drew Shirley, MD, during a KPLI work session.

md-update.com YOUR RESOURCE FOR THE BEST IN KENTUCKY HEALTHCARE

PHOTOS PROVIDED BY KMA

small STEPS big IMPACT ISSUE #155 29

Events

Symposium panel and moderator Dr. Angela Dearinger, Dr. Brent Oliver, Dr. Romil Chandra, Mitchell Denham, JD, and Michael Yared, CEO of Echo/Bind.

Dr. Bruce Koffler, Dr. Marian Bensema, and Gil Dunn, MD-Update.

Dr. Katrina Hood and Dr. Greg Hood.

Exploring AI in Medicine: Opportunities and Challenges Augmented Intelligence Symposium seeks to explore the future of AI in healthcare

BY DANESH MAZLOOMDOOST, MD

LEXINGTON Artificial intelligence (AI) is rapidly

transforming the medical landscape, offering both exciting possibilities and complex challenges. A November 7 panel discussion, hosted by the Lexington Medical Society and featuring Michael Yared, CEO of Echo/Bind; Romil Chadha, MD, CMIO of UK Healthcare; Michel Denham, JD; and Brett Oliver, MD, CMIO at Baptist Health, delved into this evolving field.

Unlocking AI’s Potential in Healthcare Michael Yared began by explaining how large language models (LLMs) function and highlighted current AI applications in medicine: • Radiology: AI algorithms enhance image recognition, leading to quicker and more accurate diagnoses, thereby reducing radiologists’ workloads.

• Predictive Medicine: AI analyzes vast datasets to predict disease outbreaks and patient 30 MD-UPDATE

risk factors, enabling proactive healthcare measures.

• Personalized Treatment: Tailored treatment plans are developed using AI by considering individual genetic, lifestyle, and environmental factors.

• Remote Patient Monitoring: Wearable devices combined with AI analytics allow for continuous health monitoring, crucial for chronic condition management.

• Infection Surveillance: Real-time tracking of infection patterns helps control disease spread, a need underscored by the COVID-19 pandemic.

Navigating Legal and Ethical Hurdles The integration of AI brings forth several concerns: • Business Associate Agreements (BAAs): These are imperative to protect all parties and ensure compliance with regulations like HIPAA. PHOTOS BY JOE OMIELAN

• Intellectual Property (IP) Concerns: Physicians contributing to AI model development question whether they will receive reimbursement or recognition for their expertise.

• Productivity Implications: There is apprehension that increased efficiency may lead administrators to demand higher patient volumes without proportional compensation, or that insurers might reduce payments.

Job Security and AI Integration Addressing fears about job displacement, Brett Oliver noted that technology rarely eliminates jobs entirely—citing elevator operators as a rare exception. The consensus is that AI aims to integrate seamlessly into healthcare, enhancing productivity without replacing providers.

Data Ownership and Interoperability A significant challenge is the control of data.

Events

Dr. David Kirn, Dr. Ahmed Al Bayati, and Houston Hall, Forcht Bank market president.

Industries may attempt to “close the door” behind them to own data and processes, selling access at high prices. Developers advocate for open systems to promote collaboration and innovation. The panel discussed how electronic medical records (EMRs) missed the opportunity for interoperability. AI could rectify this by converting unstructured data into structured formats, fostering a universal health language.

Preventative Medicine and Financial Hurdles While AI-powered apps for preventative medicine exist, their adoption is hindered by funding issues. The critical question is who will pay for these tools, as current reimbursement models are unclear.

Beverly Games, SVMIC, symposium cosponsor.

Dr. John Stewart and Dr. Angela Dearinger, LMS president.

models are crucial considerations. The goal is for AI to enhance healthcare so seamlessly that providers notice only the improved efficiency and patient outcomes.

Scott Pitts, Tucker Ballinger, Forcht Bank president, and Sarah Brock with Forcht Bank, symposium cosponsors.

The Augmented Intelligence Symposium was sponsored by Forcht Bank, SVMIC, and the UK Gatton College of Business and Economics.

LEXINGTON MEDICAL SOCIETY Physicians taking care of the community since 1799

Opportunities and Future Directions The panel highlighted the American Medical Association’s Physician Innovation Network as a platform for collaboration. They also discussed the advantages of proprietary AI models, which, despite higher costs, offer greater flexibility and do not require BAAs.

The principal voice & resource for Central Kentucky physicians Physician Wellness Program 24/7 Medical Call Center Legislative advocacy in partnership with the Kentucky Medical Association

Conclusion AI holds immense promise for advancing medical care but comes with challenges that need addressing. Legal protections, fair compensation, data ownership, and funding

For more information visit

lexingtondoctors.org

Jan. 21, 2025 Dinner Social LMS Presidential Transition KMA Legislative Update

or call (859) 278-0569

ISSUE #155 31

Events

SEATED: Drs. Lisle Dalton, Michael Lally, Mamata Majmundar, Gregory Osetinsky, Bruce Belin, Robert Belin, Allen Grimes, and Robert Granacher.

STANDING: Drs. David Bensema, Emery Wilson, John Collins, Charles Papp, Bruce Broudy, Tom Waid, Khalil Rahman, and Terrence Grimm.

Lexington Medical Society Past Presidents Dinner LEXINGTON Sixteen past presidents of the Lexington Medical Society came together on October 16, 2024, at

the Signature Club in Lexington for the annual Past Presidents Dinner. The meeting featured a presentation on personal finance by Andy Reynolds and John Boardman of Ballast, a financial management and planning company. ProAssurance, a professional insurance company, was an additional sponsor.

Dr. Tom Waid was presented with the Jack Trevey Award for Community Service. Dr. Waid is an LMS past- president and executive board chair.

Dr. Khalil Rahman.

Dr. Christine KO presents the Jack Trevey Award for Community Service to Dr. Tom Waid.

Dr. Danesh Mazloomdoost, Wellward Medical, and wife Shadi Talai.

Dr. Supriya Kohli and husband Dr. Ronak Jani, Baptist Health Neurology.

Dr. Amanda Foxx, Family Practice Associates, Rachel Belin, and Dr. Bruce Belin, CGSA.

Gil Dunn, MD-Update, and Miller DeWeese, ProAssurance & Professionals’ Insurance Agency

Andy Reynolds, Madeline Flynn, and John Boardman, Ballast.

Dr. Charles Papp and Dr. Mamata Majmundar.

Parisa Shamaeizadeh, third year UK medical student, and Mohammad Javad Mollakazemi.

32 MD-UPDATE

PHOTOS BY JOE OMIELAN

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