THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #92
WOMEN’S HEALTH AND PEDIATRICS
THE PATIENT IS PARAMOUNT VOLUME 6•#3•MAY 2015
Baptist Health teams up with experienced gynecologic surgeons to provide minimally invasive techniques in the best interest of patients
ALSO IN THIS ISSUE OB/GYN AS PRIMARY CARE PROVIDER WOMEN’S HEALTH FROM ADOLESCENCE TO OLD AGE TECHNOLOGY & INNOVATION IN OB/GYN PRACTICE COMMUNITY HOSPITAL PARTNERS WITH MEDICAL CENTER PEDIATRIC OPHTHALMOLOGY ADOLESCENT EATING DISORDERS
let Healthy Lifestyle Centers help you live it well. The same health system that treats your heart now provides medically supervised exercise, nutrition counseling, stress management, and more, to help you get healthy and stay healthy. Unlike other fitness programs, ours is backed by KentuckyOne Health, with a team of nurses and exercise physiologists who work with your physician to prevent and treat heart disease, diabetes, cancer and obesity. Weâ€™re your one stop for wellness. You can join for not much more than the cost of a fitness club. Come by any of our new locations and let us help you get started. Visit KentuckyOneHealth.org/HealthyLifestyle or call 502.581.0110.
Medical Center Jewish Northeast 2401 Terra Crossing Blvd. Louisville, KY 40245
Sts. Mary and Elizabeth Hospital 1850 Bluegrass Avenue Louisville, KY 40215
Doctorâ€™s Office Building 250 East Liberty, Suite 102 Louisville, KY 40202
LETTER FROM THE PUBLISHER
Health is a personal choice, a freedom, and a responsibility When reading through the proofs of this issue of MD-UPDATE, I was drawn to two quotes by our featured physicians. “What I am most interested in is allowing people to take advantage of what they have control over, and that is their health,” says Suzanne Rashidian, DO, OB/GYN, One Health Obstetrics and Gynecology, part of Owensboro Health on page 15. “Healthcare is rapidly changing in the United States. People are now expected to take more responsibility for their own health,” says Deborah Ballard, MD, MPH, internal medicine specialist with KentuckyOne Health on page 7. I believe that health is a personal choice, a freedom, and a responsibility. I also understand that we don’t have complete and total control over every aspect of our health, but the Kentucky “uglies,” namely smoking, obesity, lack of exercise, and prescription drug abuse are lifestyle choices. Dr. David Bensema, KMA president and chief information officer at Baptist Health Kentucky, writes in a May 6, 2015 editorial in the Lexington Herald Leader that the health system, including payees and the state and federal government, contain “unnecessary roadblocks.” Bensema says, “We should take this opportunity to build a system for Kentucky that achieves the goals [set forth in the governor’s program ‘kyhealthnow’].” The problem, as I see it, is how do we do that? And who is “we?” Bensema, in a follow up conversation, says that every stakeholder needs to be involved: physicians, hospital groups, insurers, legislators, and any Kentuckian interested in their health. Insurers need to cover smoking cessation programs and other scientifically supported cancer screenings such as mammography and low-dose CT scanning for lung nodules. Kentucky’s colon cancer screening is a model for success. “We cannot fall back on the tendency to do what we’ve always done,” says Bensema. “That’s not working.” Now that CMS has moved to payment based on quality of care, Bensema believes “stakeholders need to move intentionally to a system that is not fee-for-service.” Feel free to comment or disagree.
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Volume 6, Number 3 ISSUE #92 PUBLISHER
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COVER STORY 3 LEGAL 5 FINANCE 6 PHYSICIAN VIEWPOINT 8 HEADLINES 9 COVER STORY 14 SPECIAL SECTION: WOMEN’S HEALTH 21 SPECIAL SECTION: PEDIATRICS Dr. Lori Warren
Dr. Rebecca Booth
25 COMPLEMENTARY CARE
THE PATIENT IS PARAMOUNT
SEXUAL HEALTH 27 COMPLEMENTARY CARE
Baptist Health teams up with experienced gynecologic surgeons to provide minimally invasive techniques in the best interest of patients
PHOTOGRAPHY BY BRIAN BOHANNON
BY JENNIFER S. NEWTON
SPECIAL SECTION WOMEN’S HEALTH
14 COMPLETE PATIENT CARE? THAT’S HER BABY!: OWENSBORO HEALTH 2 MD-UPDATE
16 FROM 10 TO 90: KENTUCKYONE HEALTH
SPECIAL SECTION PEDIATRICS
17 AHEAD OF THE CURVE: LEXINGTON CLINIC
19 GEORGETOWN PARTNERS WITH UK: GEORGETOWN COMMUNITY HOSPITAL
21 IMPROVING LIFELONG VISUAL POTENTIAL: KENTUCKYONE HEALTH
22 ADOLESCENTS AND EATING DISORDERS: UK HEALTHCARE
Help Me Help You
15 Ways to Play an Active Role in Your Legal Defense You have had a hectic day at the office. Several patients required more time than scheduled, your staff is stressed because there are patients waiting in the lobby, and your patients are getting antsy. To make matters worse, your practice manager just handed you an envelope from the local circuit court clerk’s office. It states: “Restricted Delivery – Signature Required.” You anxiously open the envelope to find … you’ve been served! Unfortunately, 75 to 91 percent of physicians will face at least one medical malpractice claim during their careers. If you are one of them, it is important that you play an active role in your legal defense. This article will provide you with practical advice on how to do that: 1. Do not contact the patient or the patient’s attorney. Anything that you say to the patient, the patient’s family, or the attorney can be used against you. 2. Notify your insurance carrier immediately of the lawsuit, the date you were served, and whether the complaint was accompanied by other documents such as “Interrogatories” or “Requests for Admissions.” Failure to timely notify your insurance carrier may result in denial of insurance coverage for the claim. If your practice group has also been named as a defendant, the practice group’s designated process agent must notify the group’s insurance carrier. 3. Your insurance carrier will assign
an attorney to defend you. If you are not comfortable with the attorney or law firm that is selected, tell your insurance carrier immediately. You may request that a certain attorney BY Donald P. Moloney, II defend your case. You must also determine whether you need “personal” counsel. In most cases, personal counsel is not necessary. However, if you have been placed on notice that there is some issue with insurance coverage, or the damages
include the medical chart, emails, correspondence to or from other medical providers regarding the patient, records received from the patient’s other medical providers, and billing records. Do not alter the records in any way. 5. Once counsel has been retained, he or she will set up an initial client meeting with you. Schedule the meeting to take place as soon as possible, allowing one to two hours with your attorney to discuss the allegations, your treatment of the patient, and the medical records. During the initial meeting, ask your attorney whether you should prepare a medical timeline or perform any medical research. Your notes and research can often be of great help to your attorney, but it must only be done at the request of
UNFORTUNATELY, 75 TO 91 PERCENT OF PHYSICIANS WILL FACE AT LEAST ONE MEDICAL MALPRACTICE CLAIM DURING THEIR CAREERS. claimed are expected to exceed your policy limits, then you may want to consider obtaining personal counsel. 4. While you are waiting to be contacted by legal counsel, gather and make a legible copy of the patient’s records. This should
your attorney in order to preserve attorneyclient privilege. 6. Exchange contact information with your attorney and discuss your communication preference. Create a folder in your email inbox for all email exchanges between
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Visit themortoncenter.org ISSUE#92 3
you and your attorney so that communication will not be inadvertently shared with unauthorized persons. Also let your attorney know if you prefer to receive mail at your home or at your office. 7. Make yourself readily available for subsequent meetings with your attorney. Attend at WomenFirst_2015_MDUpdate_FINAL.pdf least one meeting at your attor- 1
ney’s office so you can meet the members of your attorney’s staff who are involved in the defense of your case. If meetings must take place at your office, make sure to have a conference room available that is free of disruptions and distractions. 8. Ask your attorney to send you copies 4/26/15 9:07documents, PM of all relevant including written
Heartfelt care for women...by women. Above left to right, back row: Dr. Margarita Terrassa, Dr. Leigh Price, Dr. Kelli Miller, Dr. Holly Brown, Dr. Michele Johnson Front row: Dr. Lori Warren, Dr. Mollie Cartwright, Dr. Rebecca Terry, Dr. Ann Grider, Dr. Rebecca Booth Not pictured: Dr. Amanda Davenport
At Women First, we encourage our patients to take charge of their health care— and themselves. So we’re passionate about scheduling an annual wellness check as an important part of that care. We’ll look for physical changes and screen for breast, uterine, ovarian and colon cancers—and take the time to discuss their personal health concerns, too. Women First is proud to offer the most advanced healthcare options with the heartfelt and compassionate care that we’d expect for our own mothers and daughters, and ourselves. Refer a patient through our online new patient appointment request: womenfirstlouisville.com or call us at 502-891-8788. Visit us on Facebook or online: www.womenfirstlouisville.com Baptist Health Medical Pavilion • 3900 Kresge Way, Suite 30 • Louisville, KY
discovery, motions, deposition transcripts, and expert disclosures. 9. Help your attorney understand the medicine. If requested by your attorney, provide medical literature, including journals, textbooks, or anatomy charts that help explain the medical issues involved. 10. Be ready and willing to spend considerable time preparing for and giving your deposition. Many defense attorneys prefer more than one session to prepare you for your deposition, especially if you have never given one before. After you give your deposition, you have a right to review the transcript for accuracy. Although you cannot substantively change your answers, let your attorney know immediately if you have either misspoken or misunderstood a certain question asked of you. 11. Help your attorney come up with questions for the plaintiff ’s experts and offer to attend their depositions, even if it means having to travel. 12. Help your attorney select your defense experts, and offer to help your attorney prepare for meetings he or she will have with your experts. 13. Devote considerable time to prepare for your trial testimony. This may require multiple sessions with your attorney. 14. Do not discuss the patient, the nature of the lawsuit, or its merits with anyone other than your attorney, the insurance claims adjuster, your practice group risk manager (if applicable), or your spouse. 15. Be honest and forthcoming with your attorney. Disclose your involvement in any prior lawsuits – regardless of nature – and provide your attorney with copies of any court documents and depositions. Disclose all disciplinary actions against your medical license and all adverse employment actions. Disclose any information that may be perceived negatively by a jury. Donald P. Moloney, II, is a member of Sturgill, Turner, Barker & Moloney, PLLC, where he defends healthcare providers against claims of medical negligence. He can be reached at (859) 255-8581 and email@example.com. This article is intended as a summary of law and does not constitute legal advice. ◆
Maintaining Optionality We begin with a brief economics lesson and then move to how it affects investors. During periods of slow economic growth the Federal Reserve Bank usually lowers interest rates by reducing the rate it charges its member banks for loans (the Fed Funds rate). In theory at least, lower rates then trickle down to the other types of loans, such as mortgages and corporate debt. This rate reduction, known in economic circles as conventional monetary policy, is designed to foster growth because it is hoped that people and corporations will borrow and spend. In the wake of the financial crisis of 2008, the Fed actually adopted what has become known as a zero-interest rate policy (ZIRP, for short) and set a range for the Fed funds rate of 0.00 percent to 0.25 percent. The efficacy of ZIRP has been widely and vigorously debated. Arguably, ZIRP did not result in the robust growth that the central bank had hoped for, and they had to turn to non-conventional policy, e.g. quantita-
tive easing. That money has flowed into and driven up the prices of financial assets rather than spurring growth in the general economy because consumers and companies just aren’t borrowBY Scott Neal ing and spending like they did in the go-go years of the ‘90s. By the way, the Nestle Corporation recently issued bonds with negative interest rates. Yes, investors became content to pay the company to hold their money. As far as we know this is unprecedented. We will write more about this later. As you may be painfully aware, in the face of ZIRP, it is not uncommon to find money market rates at 0.10 percent or lower and five-year CDs that pay less than 2.0
percent. With the rise in the stock market, coupled with ZIRP, the temptation then is 1) to chase yield by investing in more risky assets, or 2) to invest ALL of one’s cash into stocks or real assets. Most investors and many advisors maintain just such a portfolio fully invested in an asset allocation completely devoid of cash or cash equivalents. We refer to this as a buy-hold-and-rebalance strategy. To invest in this way gives up the unique property of optionality. Nassim Taleb, author of best sellers The Black Swan and Antifragile, is frequently quoted in financial circles: “Optionaility is the property of asymmetric upside (preferably unlimited) with correspondingly limited downside (preferably tiny).” That’s an appropriate way to see cash in a portfolio. It is easy to become fixated on the interest rate (referred to as yield) that cash earns when compared to other types of investment. However, let’s be clear. The value of cash is not its earning potential, even when
FINANCE interest rates are high and let alone when they are near zero. The value of cash rests in the opportunities that it provides when, not if, the market turns unfavorable. That is the path followed by many legendary investors: buy when others are scared and sell when
who had invested $100 in the S&P 500 every month since 1929, compared to his counterpart who saved the $100 a month in a cash account and only invested when the market dropped by 20 percent. The latter wound up with 14 percent more money. The real beauty of dollarTHE BUCKET APPROACH OF ALLOCATING cost averaging is that it takes away the behavioral biases that YOUR RESOURCES ACCORDING TO most investors bring to the market. It is a discipline that works, SPECIFIC GOALS WOULD BE AN but perhaps not optimally. APPROPRIATE STRATEGY. Historically, a 20 percent decline in U.S. stocks has occurred once others are euphoric. every four years or so (the past four have Who is going to feel like borrowing, obviously been the exception). A 30 percent or have the ability to borrow, when stocks decline has historically occurred every decade. finally do go on sale? The only way to truly We are not advocating that you convert take advantage of a down market is to have your entire portfolio, or even a major porsome available cash when the time comes. tion of your portfolio, to cash at this point Furthermore, holding some cash while the in time. The bucket approach of allocating market is falling also feels pretty good. your resources according to specific goals Dollar-cost averaging new money into the would be an appropriate strategy. Assets set market is traditional advice offered by many aside for the funding of longer term goals advisors. One recent study looked at a can be invested more aggressively than those hypothetical dollar-cost averaging investor available for the short term.
There are multiple ways to deal with the situation of ZIRP and record highs in stocks. 1) If you remain fully invested, risk controls need to be in place to capture some cash as the market begins to fall—hopefully before small losses become large. 2) Determine an appropriate amount of cash and simply develop the patience to hold onto it. OR 3) Do some combination of both. Whatever you do, it is important to have a predetermined plan for your available cash and it is vital that you give this serious thought before the market turns down. Without a plan, fear will likely be too great to allow for new investment when the time is right. Also, should you decide that you will remain fully invested through the next major downturn, plan now to rebalance aggressively (meaning more frequently) and repeat often, “I will buy when others are scared.” 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, KY. Write him at firstname.lastname@example.org ◆
TESTIMONIALS “I was impressed with the feedback we received about our practice expansion into Louisville from the coverage in MD Update. While I expected to hear about it from colleagues, there was a great deal of response from friends and business associates who aren’t in medicine at all. Patients also love to see that their doctor is in a magazine.” --- Thomas Stone, MD Partner, Retina Associates of Kentucky
“MD Update provides me with the latest trends in medical services, practice management and cutting edge technology in the state. Reading it makes me feel like I am an active part of the regional healthcare community.” --- Darryl Kaelin, MD, Associate Professor, U of L, Medical Director Frazier Rehab Institute, Division of Physical Medicine & Rehab
A New Prescription for Health In the past, when a woman went to a doctor, she would likely leave with a prescription for pills or a referral to a surgeon. Today, she might instead receive a prescription for nutrition, exercise, massage, acupuncture, or meditation training. Healthcare is rapidly changing in the United States. People are now expected to take more responsibility for their own health. People who practice a healthy lifestyle and get preventive services are rewarded with lower insurance premiums. According to the United States Department of Labor, women make approximately 80 percent of healthcare decisions for their families and are more likely to be the caregivers when a family member falls ill. Women visit doctors and seek more preventive healthcare than men. Women use more alternative or complementary medicine than men. Integrative medicine offers a new pre-
scription for health that responds to womenâ€™s needs today. According to the Bravewell Collaborative: Integrative medicine is an approach to BY Deborah Ann Ballard, MD, MPH care that puts the patient at the center and addresses the full range of physical, emotional, mental, social, spiritual, and environmental influences that affect a personâ€™s health. Employing a personalized strategy that considers the patientâ€™s unique conditions, needs, and circumstances, integrative medicine uses the most appropriate interventions from an array of scientific disciplines to heal illness and disease and help
people regain and maintain optimal health. According to the Centers for Disease Control and Prevention (CDC), heart disease and cancer are responsible for almost 45 percent of all deaths among women. Poor diet, sedentary lifestyle, stress, and smoking are risk factors for both heart disease and cancer. The American Heart Association and the American Cancer Society recommend integrative strategies such as a plant-based whole food diet, regular physical activity, stress reduction, and tobacco avoidance to prevent disease. A growing body of scientific evidence supports using integrative therapies such as an anti-inflammatory diet, meditation, yoga, Tai Chi, massage, or acupuncture. These therapies can accelerate healing, reverse disease, reduce stress, and mitigate chronic pain without the risk of drug addiction or invasive procedures.
KentuckyOne Health currently offers The Lifestyle Medicine Program at its Healthy Lifestyle Centers. It is an individualized plan that includes nutrition, exercise, and stress reduction. The Lifestyle Medicine Program is indicated for almost all chronic
with chronic pain and stress. Patients should check with their health insurance company to verify coverage for integrative, preventive, and wellness services. Although many more people are now covered by health insurance as a result of the
A GROWING BODY OF SCIENTIFIC EVIDENCE SUPPORTS USING INTEGRATIVE THERAPIES SUCH AS AN ANTI-INFLAMMATORY DIET, MEDITATION, YOGA, TAI CHI, MASSAGE, OR ACUPUNCTURE. diseases, with the strongest scientific evidence showing benefit for heart disease, type 2 diabetes, hypertension, and obesity. Later in 2015, KentuckyOne Health will offer the Ornish Program, which has been proven to reverse heart disease. Medicare and some private insurance pay for the Ornish Program for persons with heart disease. The Healthy Lifestyle Centers also offer meditation, yoga, Tai Chi classes, and massage and acupuncture. These therapies are particularly helpful for people struggling
Affordable Care Act, they may have higher deductibles. If they have a high deductible health plan, they can set up a Health Savings Account (HSA). HSA dollars can be used for lifestyle medicine programs and integrative services if a physician prescribes them. Patients can learn how to set up a HSA through their employer or from the Internal Revenue Service at http://www.irs. gov/publications/p969/index.html. Women have more choices than ever before to help them live long, healthy,
happy lives. If your patients want help with living a healthier lifestyle, give them a lifestyle medicine prescription or call the KentuckyOne Health Healthy Lifestyle Centers at (502) 581-0110 or visit www. kentuckyonehealth.org/healthylifestyle. Deborah Ann Ballard, MD, MPH, is a an internal medicine specialist with KentuckyOne Health Primary Care Associates and is certified by the American Board of Integrative Holistic Medicine. â—†
Deborah Ballard, MD, MPH
KentuckyOne Health Integrated Medicine
250 E. Liberty Street, Suite 102 Louisville, KY 40202 To schedule an appointment, call 502.581.0110
Borders Named CMO for Baptist Health Lexington James L. Borders, MD, has been named chief medical officer for Baptist Health Lexington, effective Aug. 1, 2015. Borders will replace Stephen Toadvine, MD, who was recently promoted to serve as the chief medical officer of Baptist Health Medical Group. An internal medicine physician, Borders has been an active member of the Baptist Health Lexington medical LEXINGTON
staff since 1988. He also has served as a principal investigator with Central Kentucky Research Associates since
2005, working with more than 130 clinical trials. Borders has served as chairman of the Kentucky Medical Association Council for Continuing Medical Education since 1992 and KMA Scientific Program Chair since 1991. He also has served as chairman of the Baptist Health Lexington Continuing Education Committee since 1990 and Baptist Health Lexington Medical Ethics Committee since 1992. In his new role, Borders will be responsible for all medical staff services and physi-
cian relations for the hospital and its offsite facilities and will work closely with Timothy Jahn, MD, Baptist Health chief clinical officer, and the other CMOs throughout the system. Borders received his doctorate in medicine with distinction from the University of Kentucky. He completed his residency in internal medicine from Baylor University Medical Center in Dallas. Preston Nunnelley, MD, former Baptist Health Lexington CMO, will support Medical Staff Services in the interim. â—†
Dr. Lori Warren (CENTER) performs a total laparoscopic hysterectomy (TLH) with the assistance of Dr. Linda Shiber (LEFT), minimally invasive surgery fellow, and Liz Jewel (RIGHT), certified first assistant, at Baptist Health Louisville.
T H E PAT I E N T I S PA R A M O U N T
Baptist Health teams up with experienced gynecologic surgeons to provide minimally invasive techniques in the best interest of patients
Consumer-driven healthcare, a model of care that puts the patient at the center, has become the rallying cry across healthcare industries and organizations in the U.S. in response to the Affordable Care Act and the rapidly changing dynamics of medicine. The model is not just about putting decision-making power into patients’ hands. Equally as critical is providing services that are in the best interests of patients and educating patients on their choices. Baptist Health is one health system in Louisville that has teamed up with physicians to put this principle into practice – particularly when it comes to minimally invasive surgery (MIS) for women. LOUISVILLE
BY JENNIFER S. NEWTON
PHOTOGRAPHY BY BRIAN BOHANNON The HHS Office on Women’s Health cites hysterectomy as the second most common surgical procedure for women in the U.S. behind c-section. One in three women will have a hysterectomy by age 60, yet, it’s simply not something people talk about. Minimally invasive options for hysterectomy have been around for decades, but in 2008 it was estimated that 70 percent of hysterectomies were still done with a large abdominal incision. One partial cause for the lag may be reimbursement rates that are lower for MIS than open hysterectomy, even though advanced technology makes MIS technically more difficult. Says Rebecca Booth, MD,
gynecologist and co-managing partner of Women First of Louisville, PLLC, the largest OB/GYN group serving Baptist Health Louisville, “Nonetheless, we are devoted to these strategies and hope that the trend will be reversed in the future to encourage other surgeons to adopt these techniques.” The good news is the trends are changing.
Louisville on the Forefront
Until the late 1980s, surgical options were limited to open hysterectomy through an abdominal incision and transvaginal hysterectomy (TVH), the first minimally invasive approach. It was in 1989 that the first lapaISSUE#92 9
roscopic hysterectomy was published. “By 1991, when I started in my practice, we were offering laparoscopic-assisted vaginal hysterectomy (LAVH). I saw from early on in my surgical practice the advantage of how well patients do with minimally invasive surgery compared to open surgery,” says Lori Warren, MD, gynecologic surgeon with Women First. Warren has since become a champion of minimally invasive gynecologic surgery. In practice since 1991, she has for the past 10 years specialized in gynecology, specifically focusing on MIS techniques and treatment of prolapse and urinary incontinence. She is also the co-director of the minimally invasive gynecologic surgery fellowship program at the University of Louisville (U of L), which means, “Every time I’m in the OR, I have the opportunity to share MIS with other surgeons,” she says. Beyond the fellowship, she has been involved locally, nationally, and internationally with educational programs to help other doctors learn laparoscopic techniques. Last fall, she visited Saudi Arabia on the invitation of the Ministers of Health to teach MIS in a hospital in Riyadh.
Heath Brown, MD, OB/GYN with Baptist OB/GYN Associates, did his residency at U of L when TVH and LAVH were the only minimally invasive techniques available. “The problem with those procedures is that they were limited to women who anatomically had enough access to the uterus. Women who had not had children would often be precluded from those approaches,” Brown says. Brown, who grew up in Birmingham, Ala., put down roots in Louisville after his residency because he loved the community. He has been practicing OB/GYN for 20 years, and in fact, when he decided to add MIS techniques to his practice, he turned to Warren as a resource. “Warren has been instrumental in training not only new physicians but also seasoned ones in minimally invasive techniques, so they may adopt those practice for their own patients,” he says. Brown has been employed by Baptist Medical Associates for the last three years. His practice, Baptist OB/GYN Associates, has five providers and two main offices in According to Dr. Heath Brown, the harmonic scalpel has revolutionized minimally invasive gynecologic surgery.
Louisville and Shelbyville. Unlike Kentucky’s many poorly ranked disease states, Booth says, “Louisville has always been on the forefront of minimally invasive gynecologic surgery, and actually, the University of Louisville was a leader in training OB/GYN residents in these techniques in the mid-80s.” Since 1990, more advanced technology and instrumentation have paved the way for the advent of total laparoscopic hysterectomy (TLH), supracervical hysterectomy, and robotic hysterectomy. In 2008 Baptist Health Louisville acquired the da Vinci® robotic system which is used as another MIS approach to hysterectomy. The system may be of benefit in difficult cases and incidences of gynecologic cancer.
The MIS Advantage
As in other specialties, the benefits of gynecologic MIS are evident. “I very rarely have to open a patient,” says Warren. “The difference between seeing a patient after a vaginal hysterectomy or laparoscopic hysterectomy compared to open surgery is really paramount.” According to Booth, “Laparoscopic approaches allow the opportunity for much less post-operative pain and quicker recovery, generally less blood loss, and shorter hospital stays. This can translate to less time off work and lower rates of post-operative complications.” Booth is in her 26th year of practice, having started at Women First in 1989, one year after its inception. She has spent the 10 MD-UPDATE
last 10 years focused on gynecology with an interest in MIS and hormonal wellness. With 11 physicians and 11 physician extenders, Women First is an independent, full-service OB/GYN practice that sees an average of 350 patients a day. Baptist Health Louisville is currently the only major hospital they admit to. Brown posits the benefits of MIS can have additional implications for a woman’s future pelvic health. “When you perform a hysterectomy, depending on the method you choose, you degrade or compromise to a degree some of the supporting Dr. Rebecca Booth, gynecologist structures of the female anatomy,” with Women First of Louisville, he says. Open hysterectomy, TVH, says, “Louisville has always been on and LAVH require cutting through the forefront of minimally invasive the uterosacral ligaments to release gynecologic surgery.” the uterus. “The invention of minimally invasive techniques of late has given us the opportunity to preserve those upper structures and keep them intact to decrease the risk of vaginal prolapse down the road,” says Brown. Another rare complication of abdominal approaches is the shortening of the vagina, which can affect the quality and comfort of intercourse. “Minimally invasive techniques work at the highest possible margin for transecting the cervix so you preserve vaginal length as optimally as anyone can,” Brown says. All three of the physicians agree that the approach they choose depends upon the patient. Says Booth, “The approach is always individualized depending on the size of the uterus, the need for ovarian conservation, the patient’s habitus, and the patient’s preferences.” At Women First, physicians typically encourage women to conserve normal ovaThe earrings Dr. Lori Warren, gynecologic ries, unless there is a genetic history of cansurgeon with Women First of Louisville, cer or the ovaries are abnormal, until age 65, is wearing are a symbol of the non-profit at which point there is no proven benefit to organization, Pass the Pearls, she started ovarian conservation. to educate women on minimally invasive Removal of fallopian tubes and the cersurgical options. The metal circle represents the maximum size incisions should be in vix are also discussion points with patients. MIS. The pearls remind women to pass on Brown says bilateral salpingectomy was not pearls of wisdom about women’s health. common practice until a couple of years
Dr. Heath Brown, OB/GYN with Baptist OB/GYN Associates, says the invention of newer minimally invasive techniques has given surgeons the opportunity to preserve the uterosacral ligaments to decrease the future risk of prolapse. Photo courtesy of Baptist Health.
ago but has been widely adopted because of new studies suggesting cancers occurring in the abdomen of women later in life may frequently originate from the fallopian tubes rather than the ovaries. “It’s our common practice, even when ovaries stay behind, that we remove the tubes to increase women’s health and decrease the risk of malignancy later in life,” he says. The supracervical hysterectomy, preserving the cervix, provides quicker recovery and shorter hospital stays for patients who are at low risk for cervical cancer and dysplasia.
The Technology behind the Technique
As a vocal proponent of MIS, Warren keeps tabs on the nation’s progress. She estimates in 2008 only roughly 30 percent of hysterectomies were done using a MIS technique with 70 percent being open surgeries. Today, while exact numbers are hard to come ISSUE#92 11
by, she estimates those numbers have improved with 60 percent of procedures done with one of the minimally invasive approaches and 40 percent open. She credits the upward trend of MIS to the advent of robotic techniques and the resurgence of vaginal hysterectomy. One complication in the pursuit of optimizing MIS has been the controversy of morcellation. Surgeons used morcellation to cut tissue into smaller pieces so it could be removed through smaller incisions or the vagina. However, in November 2014, the FDA issued a warning against the use of power morcellators in laparoscopic hysterectomy and myomectomy for the treatment of fibroids. The concern is that uterine fibroids could contain an unsuspected sarcoma, and the use of a power morcellator could potentially spread the cancer. Brown says, “We try to do every hysterectomy now in a minimally invasive fashion.” However the FDA warning has decreased Baptist OB/GYN Associates laparoscopic rates from 90-95 percent several years ago to about 80 percent today because it precludes his practice from removing large fibroids minimally invasively using morcellation. Women First estimates 90 percent of their hysterectomies are still done laparoscopically. Warren is taking a very cautious but informed approach, and says Baptist Health is certainly following the warnings but has also been supportive in allowing doctors to use their best judgement based on the clinical picture of the patient. “If a patient would like to keep her cervix and is not having a hysterectomy for fibroids, I’m still offering a supracervical hysterectomy because the risk of sarcoma in a uterus that doesn’t have a fibroid is really zero,” says Warren. Baptist Health does ensure patients are well-informed and uses a special consent form in these cases. Warren believes the future for morcellation will be better devices that utilize the morcellator within a containment system inside the body so that cells are not spread. There are tools that have been pivotal in the development of newer MIS techniques 12 MD-UPDATE
Dr. Rebecca Booth (RIGHT), performing a total laparascopic hysterectomy (TLH) with the assistance of Dr. Leigh Price at Baptist Health Louisville, says the hospital has been their “partner all the way” in changing the dynamic of gynecologic surgery.
in a much less controversial way. “One of the biggest tools that revolutionized our basic minimally invasive interventions is the harmonic scalpel,” says Brown. Utilizing ultrasonic vibration to cut and cauterize tissue, the instrument can be introduced into the abdomen though a small five-millimeter incision where previous techniques required a large incision with clamps and suturing. While these surgeons agree minimally invasive techniques are usually in the best interest of the patient when surgery is warranted, the development of in-office techniques in the field mean that the best interest of the patient may be to avoid surgery altogether. “The use of IUDs, specifically the Mirena®, and endometrial ablations have significantly reduced the need for hysterectomy in patients,” says Booth. Women First is currently in an expansion to offer other procedures in-office, such as hysteroscopy, treatment of cervical lesions, and tubal sterilization procedures.
Women’s Services at Baptist Health Louisville
Minimally invasive hysterectomy is just one component in a comprehensive Baptist Health Louisville Women’s Services program, which also offers minimally invasive procedures for incontinence and heavy menstrual bleeding; women’s imaging services such as digital mammography and breast MRI; a lymphedema clinic; a Women’s Health Physical Therapy Program; and mother and baby care. “What they’ve really been able to do
with gynecology is team-building, where they have skilled nurses that are really familiar with gynecologic procedures, and that makes a big difference,” says Warren. Booth describes Baptist Health as “extremely cooperative with surgeons” and says, “Our practice has been on the forefront of changing this dynamic [toward MIS] for the last 26 years, and Baptist has been our partner all the way, which in this economic time is really unique.” Brown concurs, “Baptist is pretty good about procuring the latest tools for intervention. They have the routine armamentarium for performing MIS and have been receptive to acquiring new equipment.”
Pass the Pearls
As a champion of gynecologic MIS, Warren has started a nonprofit organization to educate women about their treatment options called Pass the Pearls. The organization’s website, www.passthepearls.com, includes a physician finder tool called “String of Surgeons,” where physicians across the country can add themselves to the directory if they perform MIS. Warren also works with HysterSisters, a woman-to-woman hysterectomy support organization. They have partnered together to create Hysterectomy Awareness Month in May and have set up the website www. hysterectomy.org to support the cause. “When you’re a surgeon, it’s a lifetime of learning,” says Warren. “If I did only the surgeries I trained with in residency, I wouldn’t have any surgeries to do. It’s been an exciting evolution for me and to get to share that with others is really gratifying. Most gratifying is to see the benefits to patient care. The surgeries I do today are much improved compared to the techniques I trained with in my residency.” In the end, that penchant for lifelong learning and educating others comes back full circle, and the beneficiary is clear – providing treatment options in the best interest of patients. ◆
WE’RE FULLY AWARE THAT WE’VE GOT YOUR WHOLE WORLD... IN OUR HANDS.
Quality OB/GYN care begins with outstanding physicians, and the One Health Obstetrics & Gynecology team offers some of the most trusted names in the region: Dr. Maria Smith, Dr. Chris Toler, Dr. Suzanne Rashidian, Dr. Eric Griffin and Dr. Amy Willcox, along with family practice APRN, Emily Clark.
Obstetrics & Gynecology Pleasant Valley Center 1301 Pleasant Valley Road, Suite #300 Owensboro, KY 42303 Main: 270-417-7700 OwensboroHealth.org/OneHealth
Our team has earned a reputation for clinical excellence, compassionate care, and expertise in robotic surgery and other minimally-invasive techniques.
TO SCHEDULE AN APPOINTMENT WITH OUR OBSTETRICS & GYNECOLOGY TEAM OR TO FIND A ONE HEALTH PROVIDER NEAR YOU, CALL 844-44-MY-ONE. ISSUE#92 13
SPECIAL SECTION WOMEN’S HEALTH
Complete Patient Care? That’s Her Baby! An OB/GYN who specializes in overall women’s health BY JIM KELSEY
For many women, a trip to the OB/GYN is much more than a visit to a specialist. For many, it is the only medical appointment they will keep all year. For some, it is an opportunity to discuss issues specific to women, medical or otherwise. “I feel we are their primary care physician,” says Suzanne Rashidian, DO, of One Health Obstetrics and Gynecology, part of Owensboro Health. “Patients often connect with me because they know I’m a working mother, I’m married, and I have three children. They can talk to me because they know I understand. Sometimes we don’t talk about obstetrics or gynecology. Instead, we might be talking about sleep, fatigue, stress, and the things that a woman does daily to maintain a household and a family. That’s why I love my job.” It’s a job that Rashidian has been doing for three years. A native of nearby Henderson, Ky., Rashidian joined Owensboro Health after attending the University of Pikeville’s OWENSBORO
titioner who brings an added level of patient care unique to most obstetric and gynecological clinics. Many practices have an OB/GYN-trained nurse practitioner, but Owensboro Health’s nurse practitioner Emily Clark, APRN, is a broader-based
Communicating and Selecting Options
“WHAT I AM MOST INTERESTED IN IS ALLOWING PEOPLE TO TAKE ADVANTAGE OF WHAT THEY HAVE CONTROL OVER, AND THAT IS THEIR HEALTH.” – Dr. Suzanne Rashidian College of Osteopathic Medicine and completing her residency at Botsford Hospital in Farmington Hills, Mich. She’s in a practice with five other physicians -- Maria Smith, MD, FACOG; Chris Toler, MD, FACOG; Eric Griffin, MD, FACOG; and Amy Willcox, DO. Together they specialize in a wide range of women’s healthcare, including routine prenatal care, annual screening, diagnostic screening, minimally invasive surgeries, weight loss, and overall women’s health. The practice also includes a nurse prac14 MD-UPDATE
PHOTO COURTESY OF OWENSBORO HEALTH
a better treatment plan and follow through due to everyone being in the same place.” Rashidian takes pride in relating to her patients and understands the trust they place in her, especially when it comes to dealing with pregnancies. “Having a child is a magnificent miracle and being allowed to be part of it is amazing,” she says. “I also enjoy assisting women in being healthy and aware of their gynecology.”
Suzanne Rashidian, DO, of One Health Obstetrics and Gynecology, part of Owensboro Health, says she connects with patients as a married, working mother and often feels like their primary care physician.
family practice nurse practitioner. Rashidian is enthused about the extra level of care that a family practice nurse practitioner brings. “Often a patient has conditions such as hypertension, thyroid disease, diabetes or high cholesterol. We are able to coordinate care in the same practice, which allows for better communication, and
Rashidian stresses that her patients are aware of their options when it comes to procedures. She is trained in robotic surgery and is quick to point out the overall benefits to the patient. While some may be critical of the higher costs of robotic procedures, Rashidian weighs the overall costs, both financially and physically. “It is more expensive to operate robotically, but you have to think of the patient,” Rashidian says. “Most people return to work after robotic surgery in 10 days compared to an abdominal hysterectomy with a total recovery time of six to eight weeks. A hospital stay for a robotic surgery is an outpatient procedure. Patients can go home the same day versus a three-day hospital stay. A typical robotic surgery is an hour, so the operation room time is shorter using the robotic. Safety, operative time, blood loss, and recovery time are all things that make the benefits outweigh the cost.” Rashidian and her partners use the robot for a variety of procedures, including hysterectomies, ablative surgeries for endometriosis, extensive adhesive disease secondary to surgeries, ovarian cystectomies,
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patient, and she and her partners are able to perform a full range of hysterectomies. It’s a matter of evaluating each patient’s needs, conditions, and expected outcomes and determining the optimal course of action. For instance, a patient with suspected ovarian cancer is often best served with an open procedure. Or in the case of a morbidly obese patient, a robot might not be the best procedure due to anesthesia side effects and positioning. “Our practice excels in quality care, communication with the patient, and the minimally invasive program,” Rashidian says. “We try to take each patient individually and focus on their issue. “I am most interested in allowing people to take advantage of what they have control over, and that is their health,” she concludes. ◆
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difficult pelvic organ prolapse surgeries, and leiomyomatas. “Morcellation still is done,” Rashidian adds, “but there’s concern now that morcellating a uterus could potentially spread cancer. Now, a new procedure is being developed that would allow us to morcellate inside a surgical bag.” Hysterectomies are the biggest areas of impact for robotic surgery. “The gold standard used to be – and still is – a vaginal hysterectomy,” Rashidian says. “That is being debated now in terms of how the procedure is done. Where the ligaments are excised during the procedure can lead to subsequent pelvic organ prolapse. Minimally invasive procedures assist in diminishing those side effects.” While she sees the benefits of robotic surgery for many patients, Rashidian notes that it is not the best solution for every
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SPECIAL SECTION WOMEN’S HEALTH
From 10 to 90
Avis Carr, MD, OB/GYN with KentuckyOne Health Obstetrics and Gynecology Associates, delivers top-notch care to patients from ages 10 to over 90 BY JIM KELSEY When you go to visit Avis Carr, MD, at KentuckyOne Health Obstetrics and Gynecology Associates in Lexington, don’t expect to see her wearing pink. “On TV shows like ‘Grey’s Anatomy,’ the OB/GYNs get a bad rap,” Carr laughs. “They don’t even give them cool colored scrubs. They have to wear these light pink scrubs, and they consider them not real doctors. But I think in real life, everyone has respect for everyone.” Carr’s credentials certainly merit respect. A native of Rose Hill, N.C., she attended East Carolina University’s Brody School of Medicine and completed her residency in OB/GYN at Duke University in 2011. Immediately, she moved to Lexington and joined the KentuckyOne team. “I really fell in love with The Women’s Hospital at Saint Joseph East because it was relatively new and I just thought it was a great fit,” Carr says. She is part of a team that includes fellow OB/GYNs Dr. Elizabeth Elkinson and Dr. Anthony Smith, as well as perinatology provided by KentuckyOne High Risk Obstetrics Associates, that operates a clinic down the hall. Carr and her associates treat everything from obstetrics, such as prenatal care and pregnancy issues, to gynecological issues, such as abnormal uterine bleeding, endometriosis, pelvic prolapse, urinary incontinence, etc. LEXINGTON
Being an OB/GYN is second nature now for Carr, but initially she wanted to be a pediatrician, before leaning towards surgery. “I really liked the surgical aspects of everything,” she says. “When I did my OB/GYN courses after my general surgery courses, I realized that I was still able to do 16 MD-UPDATE
PHOTOS BY GIL DUNN
surgery, but you have a lot of continuity with patients. So, these are patients that you can potentially follow from adolescence to later on in their adult life. “I always wanted to be a pediatrician,
Dr. Avis Carr, OB/GYN with KentuckyOne Health Obstetrics and Gynecology Associates in Lexington, pursued a career in OB/GYN because she liked the surgical aspect and the ability to follow patients from adolescence to old age.
and then I learned in medical school that I didn’t want to be a pediatrician because I was always getting sick. I decided the next best thing would be to deliver babies. It’s been wonderful because they always come for their postpartum visits and always bring their babies with them. I get my baby fix that way.” Carr estimates that approximately 50 percent of the patients she and her associates see are pregnancy related. Those in need of high risk care – such as patients with abnormalities in the way their uterus developed or those having issues with thrombophilia – are referred to KentuckyOne High Risk Obstetrics Associates. Other conditions that
are referred out include oncology diagnoses and those with fertility issues. In the meantime, she stays busy with a patient population ranging in age from 10 to over 90. With a range that wide, there are a variety of issues, concerns and questions. “Sometimes adolescents will come in wanting to talk about the facts of life because the parents are uncomfortable with doing it, and they would prefer an OB/GYN to do it,” Carr says. “In adolescents who are sexually active, we talk about birth control, STD testing, and routine testing that needs to be done to make sure their reproductive health is good.” With her older patient population, Carr naturally sees many patients dealing with concerns related to menopause, including hot flashes, urinary frequency, and vaginal dryness. “We definitely talk about hormone replacement therapy, which I think is an excellent treatment for the symptoms that they usually experience,” Carr says. Regardless of the patient’s age or needs, Carr and her associates are determined to be as available as possible. They operate additional clinics in Jessamine County, Berea, and Richmond and hope to continue to grow. “We would like to spread out in the community to be more accessible to patients,” Carr says. ◆
Avis Carr, MD KentuckyOne Health Obstetrics and Gynecology 170 N. Eagle Creek Drive, Suite 104 Lexington, KY 40509 To schedule an appointment, call 859.967.5848.
SPECIAL SECTION WOMEN’S HEALTH
Ahead of the Curve
In the age of sub-specialization, Lexington Clinic’s OB/GYNs see the big picture of Women’s Health BY TIM CORKRAN The OB/GYN department at Lexington Clinic is always looking ahead. Collaboratively perceiving new ways to advance women’s health, three of its physicians, Tamara James, MD, Ramon Thomas, MD, and Tracy Arghavani, DO, each pursue what best suits them in availability and experience. Whether employing technologies like the da Vinci® surgical robot or InterStim®, or treating obscured pathologies LEXINGTON
on-call duties are easier; they have access to Lexington Clinic’s powerful electronic health records system; and they are part of a multi-specialty group, which gives them internal consultants at their fingertips. James says that these things in sum help her live up to Lexington Clinic’s vision – to be “great people providing great healthcare” – because, “It makes it easier to focus on medicine and the patient.”
endometriosis, removal of fibroids, and hysterectomies, but potential applications are always emerging. Thomas, excited about those applications, says, “I plan to do more advanced procedures, both urological and pelvic floor defect procedures.” Additionally, Thomas has developed a special niche within the department, providing the neurostimulator implant for urge incontinence. This “silent problem,” as he calls it, afflicts many aging women, but the implant can reduce the urge to urinate by 50 percent. Analogous to a pacemaker, the coin purse-sized neurostimulator is implanted in the upper buttock. The implant stabilizes the bladder and colon, helping patients who have experienced serious side effects from their incontinence medications. It also is effective for women who have developed fecal incontinence following birth lacerations.
Innovating to Meet the Needs of All Ages
Lexington Clinic OB-GYN Group –James, Thomas, and Arghavani work together to advance women’s health by reaching out to a younger group of women and adapting to the needs of the aging baby boomers. (L-R)
like urge incontinence and HPV, they are pushing the boundaries of the traditional OB/GYN practice. Creating new services and finding the right physician to treat patients in need of these services, these physicians are both reaching out to a younger group of women and adapting to the needs of the aging baby boomers. James, the department chair who began at Lexington Clinic in 2001, was joined by Thomas and Arghavani in January of 2014. Their collective strength benefits them and their patients. Each appreciates the economy of scale afforded them being part of Lexington Clinic’s multi-physician practice. As James says, “more physicians makes work and personal life more manageable.” The
Utilizing the Power of Technology
Within the operating room, advances in technology are helping all three physicians as they serve their patients outside of the office. The da Vinci surgical robot has been an integral part of the practice for a number of years. James, one of a few hundred “proctors” who consults on the development of the robot, and her colleagues, utilize it primarily for resection and treatment of
The practice is encouraging pediatricians in the Lexington Clinic network to get their female patients into the OB/GYN. James says getting 13-15 year-olds in for a meet and greet is invaluable “because there may be some issues they do not want to talk about with their pediatrician, or some information they have not shared with their parents.” Her goal is to educate young women on what the gynecologist will be for them throughout their lives. One way they are serving younger patients is through the provision of the HPV vaccine – now covering nine different viruses and further reducing incidences of cervical cancer. These advances empower James to promote this vaccine to other physicians, both for males and females, and encourage them to seek out the help of her and her colleagues when discussing the advantages of this vaccine with their young female patients. Outside of the clinical setting, the Lexington Clinic physicians have participated in school outreach programs, which Thomas heads up in conjunction with Fayette County Public Schools. His primary focus is on
PHOTOS BY STEPHANIE NORTHERN, LEXINGTON CLINIC
SPECIAL SECTION WOMEN’S HEALTH Arghavani handle many of the common pathologies associated with the aging of women. They regularly deal with pelvic organ prolapse, which James notes is “a natural part of the aging process.” This is resolved by procedures such as vaginal hysterectomies, repair of the bladder, and suspension of the vaginal vault. And Thomas’s work with urge incontinence patients is another form of service to the older patient population.
The Future of the OB/GYN Dr. Tamara James, Lexington Clinic OB/GYN, reads an ultrasound of a patient. TOP RIGHT: Dr. Tracy Arghavani, Lexington Clinic OB/GYN, consults with a patient in her office. BOTTOM: Dr. Ramon Thomas, Lexington Clinic OB/GYN, provides consultation for a patient. TOP LEFT:
minorities in healthcare, so he meets with underrepresented groups to “introduce more minorities to the breadth of possibilities in the healthcare profession, including physical therapy, dentistry, and pharmaceutical sales.” But their work doesn’t focus solely on the younger patient population. James and
Looking down the road, James sees most OB/GYNs becoming the primary care provider for their patients, as she has seen happen within her practice. She is at times a surgeon, a nutritionist, and a therapist. “We have become the primary care providers for women age 15-45 and are now working to meet more than just their obstetric and gynecological needs. We are striving to focus on the entire health of the women we serve,” says James. “A woman’s gynecologist can be the gatekeeper for all aspects of a woman’s health, and that is what we, at Lexington Clinic, are trying to do.” ◆
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SPECIAL SECTION WOMEN’S HEALTH
Georgetown Community Hospital Partners with UK to Bring OB/GYN Service to Local Community Combining academic excellence with community convenience benefits all
Georgetown Community Hospital (GCH) and UK Healthcare have been partnering on various service lines for several years. In 2010, a partnership between UK OB/GYN and GCH Women’s Health began when Joseph Haynes, MD, OB/GYN, started practicing at GCH exclusively. UK Healthcare is a natural partner in any service line, says William Haugh, CEO at GCH. “Georgetown Community Hospital is a community hospital, and we do an excellent job meeting the needs of the citizens in Georgetown and Scott County. There are service lines that do not make sense for us to provide, and that is where UK is a great partner. UK is a comprehensive, complex academic medical center that excels in providing highly specialized services throughout Kentucky and bordering states,” says Haugh. “When you look at OB/ GYN specifically, UK is a great partner because of the resources available through the expertise of their faculty, Kentucky Children’s Hospital, Chandler Hospital, UK Medical School, Kentucky Kids Crew, and their Level III NICU,” adds Haugh. GEORGETOWN
UK Physicians with Kentucky and Scott County Roots
Lauren Beaven, MD, OB/GYN, grew up in Georgetown from the age of seven, attending Scott County High School, then Georgetown College, and University of Kentucky College of Medicine. She completed her residency at the UK Chandler Medical Center. OB/GYN was the specialty that made her feel at home. “I was able to find everything I needed from a career in medicine, to be happy and successful. I love caring for women, educating them, helping them grow their families, and keeping
them healthy so they enjoy long productive lives,” says Beaven. “Being at UK offered me the opportunity to give the best care I am capable of while serving the community I grew up in,” says Beaven. Joseph Haynes, MD, OB/GYN, grew up in Kansas City, Missouri, attended the University of Missouri, Columbia, and medical school at the University of Kansas, Kansas City. During college Haynes says his mother was diagnosed with ovarian
Lauren Beaven, MD, and Joseph Haynes, MD are employed by UK Healthcare with their practice solely in Georgetown. “It’s a private practice feel with the resources of UK to support us,” says Haynes. (L-R)
cancer, leading to his interest in the field. “While she has passed, my ambition to improve the health of all women endures,” says Haynes. Haynes came to UK for residency. “My wife has an interest in horses, and we liked the area and people so well we didn’t want to leave. When the opportunity came up to develop a new practice in Georgetown about four years ago, with UK’s support, I went for it,” says Haynes. Beaven and Haynes are employed by
BY GIL DUNN
UK Healthcare with their practice solely in Georgetown delivering babies and performing surgery at GCH, providing general obstetrics and gynecology care. “It’s a private practice feel with the resources of UK to support us,” says Haynes. “Our foundation is on evidence-based medicine. We are a small practice that is growing rapidly. We expect to add a third partner in August 2015,” adds Beaven.
Both Beaven and Haynes trained in residency on the da Vinci Surgical System, and GCH has a new da Vinci robotic system with expectations to use the robot within a year for the more complicated laparoscopic procedures. Both are proficient with traditional laparoscopy and do most hysterectomy cases vaginally or with traditional laparoscopy, as indicated. However, with the rise in c-sections and obesity, those cases are becoming increasingly difficult. If there’s one theme or modus operandi at GCH Maternity & OB/GYN, it’s providing personalized care and patient involvement, say Beaven and Haynes. “We strive to educate our patients and accommodate any needs and wishes that are safe. We’re interested in new strategies for pre-term birth prevention, as well as prenatal diagnosis of genetic disorders with a simple blood test.” Beaven and Haynes strive to keep c-section rates as low as possible, while providing safe delivery, so they do not deliver electively before 39 weeks, unless it is medically indicated. They encourage breastfeeding and kangaroo care. “Most pregnancies are normal, but it is our job to identify problems before they become serious, if possible,” says Haynes. “Pregnancy is also a great time to improve overall health habits, such as eating habits or smoking,” adds Beaven.
PHOTOS COURTESY OF GEORGETOWN COMMUNITY HOSPITAL
SPECIAL SECTION WOMEN’S HEALTH
Emerging Trends: Balancing Traditional Care with New Technology
“I think the trend is getting back to basics, with a pull-back in some technologies,” says Haynes. With warnings about using mesh and the power morcellator, there is a continued effort to prevent bad outcomes for patients. With an interest in minimally invasive surgery, the vaginal approach is their first choice for hysterectomy. “We are interested in single-site hysterectomies at Georgetown Community Hospital,” says Beaven. “Some patients with fibroids and heavy bleeding may be able to avoid a hysterectomy altogether with devices like the Novosure and Myosure,” says Haynes. With the resources of UK, Beaven and Haynes have colleagues in Maternal Fetal Medicine, Urogynecology, Reproductive Endocrinology and Infertility, Pediatric and Adolescent GYN, Oncofertility, and GYN Oncology that they work with closely. “Having friends at the front lines of research
allows us to stay current healthiest,” says Haynes. on best practices,” says Haynes. The OB/GYN Younger patients are Misconception welcomed. Says Beaven, Every specialty has lin“We discuss available gering misconceptions birth control and preamong the profession venting sexually transand the public. “The mitted infections. We biggest misconception also educate about HPV “Georgetown Community Hospital from the general pubis a community hospital, and we do and the vaccine for it.” an excellent job meeting the needs lic is that we just deliver Pap smear screening is of the citizens in Georgetown and babies,” says Dr. Haynes. now recommended to Scott County. When you look at “Certainly we offer roustart at age 21 for most OB/GYN, UK is a great partner,” tine screenings, office proindividuals. Low-risk William Haugh, CEO. cedures, ultrasound serpatients may not need pap vices, and surgical options smears as often as before, but a yearly visit for gynecologic conditions. But the other is still important. As patients age, there are misconception is that our job is always more diseases to screen for. Cholesterol and so happy. Any woman that has suffered thyroid screening, mammograms, colonos- through a miscarriage, infertility, pelvic copies, and bone density testing all become pain, stillbirth, or a cancer diagnosis will important. Counseling on other issues like tell you that a compassionate and empasmoking, eating healthy, and exercising thetic physician can make a difference in a is also part of their routine. “We believe person’s life. We will be there in good times we can help women of all ages to be their and bad.”◆
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SPECIAL SECTION PEDIATRICS
Improving Lifelong Visual Potential
Palak Wall, MD, joins KentuckyOne Health to provide pediatric ophthalmology services at Saint Joseph Hospital East BY JILL DEBOLT Maximizing lifelong visual potential is the passion behind the pediatric ophthalmology practice of Palak Wall, MD. Wall joined KentuckyOne Health in November 2014 to fulfill a need for pediatric ophthalmology, according to Eric Gilliam, president of Saint Joseph Hospital East. The need was recognized based on feedback he received from pediatricians and other healthcare providers in the community. “Many of our premature babies in the neonatal intensive care unit (NICU) require care and follow up from pediatric ophthalmology, so Dr. Wall is a good fit for us,” Gilliam says. Wall was initially interested in pursuing general pediatrics, but a rotation in ophthalmology at The Ohio State University College of Medicine led her to the specialty of pediatric ophthalmology. “I saw how it could make a difference in the quality of life for a child,” she says. She also enjoyed the combination of medicine and surgery. Wall states she was fortunate to do her fellowship at the Cleveland Clinic where she received vigorous academic training and exposure to multiple eye-related diseases. LEXINGTON
Pediatrics to Adults
Wall’s pediatric patients come from central and eastern Kentucky. Her referrals come from pediatricians, neonatologists, and other eye care professionals. The presentations range from retinopathy of prematurity to normal visual screening. Wall also sees adult patients for strabismus, especially if they require surgical intervention. She works closely with many specialty providers stating, “I work with other pediatric subspecialties such as ENT and neurology on patients who have complex diseases that affect vision. I may identify an issue such as papilledema that requires referral to neurology.” Wall does take care of some plasticsrelated issues such as sties, nasolacrimal duct obstruction, eyelid lesions, and ptosis and works with oculoplastic and plastic surgeons to manage the visual issues related to more complex pathology. She performs surgery at the Lexington Surgery Center and Saint
Palak Wall, MD, joined Kentucky One Health in November 2014 to fulfill a need for pediatric ophthalmology in central and eastern Kentucky.
Joseph Hospital East.
Retinopathy of Prematurity
Advances in neonatal care have led to increased survival of extremely premature babies. These babies are at risk for retinopathy of prematurity (ROP) due to immaturity of retinal blood vessels and oxygen exposure leading to abnormal growth of retinal blood vessels that can lead to scarring and retinal detachment, says Wall. She performs retinal screening exams on all babies under 32 weeks gestation in the St. Joseph East NICU. According to Wall, the need for treatment depends on the stage of ROP, as the milder stages usually resolve on their own. She refers patients to retina specialists for laser treatment and/or Avastin injections for more severe cases. “I believe Avastin injections should be reserved for aggressive ROP due to the unknown long-term risks associated with systemic exposure to anti-VEGF drugs,” she says. Referral to a retinal specialist is also required for repair of retinal detachment, she adds. Wall envisions a role for telemedicine and further training on ROP for rural areas that may not have access to pediatric ophthalmology or retina services.
Scope of Practice
Other pediatric eye disorders Wall sees in her practice include:
Pediatric cataracts – uncommon, but can produce significant visual impairment if not removed. Infants can be screened by observing for red reflex on eye exam. Trauma - pediatric ophthalmology may be called for eye injuries such as corneal abrasions, hyphemas, or open globes. “Patients with open globes usually require surgery within 24 hours,” says Wall. A common injury in spring/summer is a baseball or tennis ball to the eye with the associated risk of bleeding. Wall encourages her patients to use eye protection. Amblyopia - decreased vision in one eye from multiple causes such as ptosis, strabismus, astigmatism, cataracts, etc. According to Wall, it can be treated by patching the good eye if it is asymmetric and treating the underlying cause. Nasolacrimal duct obstruction - Wall describes this as a common problem that usually resolves in the first year of life. It can be treated with massage of the lacrimal sac but may require surgery if it does not resolve. Genetic disorders - Wall has experience with many of the retinal dystrophies and eye abnormalities that occur with some genetic disorders. “I was lucky to train under Dr. Elias Traboulsi at the Cleveland Clinic, one of the top ocular geneticists in the country,” she says. From children to adults, Wall is providing a lifetime of vision for her patients. ◆
Palak Wall, MD Pediatric Ophthalmology A Department of Saint Joseph East 120 N. Eagle Creek Drive, Suite 104 Lexington, KY 40509 To schedule an appointment, call 859.967.5923.
PHOTO BY GIL DUNN
SPECIAL SECTION PEDIATRICS
Adolescents At Risk: Eating Disorders
UK Pediatric Psychiatrist Dr. Amy Meadows discusses the importance of early diagnosis and treatment for eating disorders. BY JILL DEBOLT Eating disorders are a complex syndrome of medical and psychiatric issues that most commonly appear in the adolescent population and have a mortality rate of five to 10 percent. According to Dr. Amy Meadows, assistant professor of Pediatrics and Psychiatry at the University of Kentucky Medical Center, “Onset often occurs around puberty as young teens, usually female, are influenced by cultural factors, social media, and family/peer pressure. These patients develop an abnormal body image.” Meadows treats both inpatients and outpatients with diagnoses such as anorexia, bulimia, and, occasionally, binge eating. However, she seldom sees binge eating in her pediatric population, saying, “This eating disorder, recently added by the American Psychiatric Association, usually occurs in young adulthood.” Her patients may present with physical symptoms, such as weight loss and electrolyte abnormalities, and behavioral symptoms, such as changes in eating patterns, pre-occupation with calories and nutrition, and control issues. LEXINGTON
Eating Disorder Diagnoses
The National Institute of Mental Health lists the following on their website(1): ANOREXIA NERVOSA - these individuals have a distorted body image and see themselves as overweight despite being dangerously thin. Eating, food, and weight control can become obsessions. They can lose large
"Family therapy is a big part of the recovery process for eating disorders including education on healthy eating and healthy body image and continued counseling," says Dr. Amy Meadows, assistant professor of Pediatrics and Psychiatry at the University of Kentucky Medical Center.
enamel. Heart attacks can occur from major electrolyte disturbances. BINGE EATING DISORDER - these individuals experience frequent episodes of out-ofcontrol eating but they do not purge. This
MEDICAL STABILIZATION IS THE FIRST PRIORITY INCLUDING TREATING DEHYDRATION, MALNOURISHMENT, AND ELECTROLYTE DISTURBANCES TO PREVENT CARDIAC AND RENAL COMPLICATIONS. amounts of weight and even starve to death. BULIMIA NERVOSA - these individuals eat excessive amounts, then purge their bodies of the food by using laxatives, enemas or diuretics, vomiting, or exercising. Bulimic behavior is done secretly because they feel disgusted or ashamed. Purging can lead to sore throat, acid reflux, and worn tooth 22 MD-UPDATE
PHOTO BY GIL DUNN
eating disorder affects men and women equally. Long-term complications can result from obesity.
Medical stabilization is the first priority of treatment according to Meadows. This includes treating dehydration, malnourish-
ment, and electrolyte disturbances. “It’s critical to prevent cardiac and renal complications,” she says. This is followed by intensive eating disorder treatment, which includes involvement of the healthcare team to normalize diet and provide psychiatric therapy. Mood stabilizers may be used to treat anxiety or depression. “One of the biggest challenges is getting the patient and/or family to acknowledge there is a problem,” says Meadows. She emphasizes family therapy as a big part of the recovery process including education on healthy eating and healthy body image and continued counseling. Barriers to treatment can include stigma associated with mental health treatment and acceptance of the need for treatment. Finding a compatible therapist and building rapport with patient/family can overcome these barriers, she says.
What Physicians Can Do
Meadows says that pediatricians and primary care providers should ask the right questions when they see young teens, for example: How do you feel about yourself? Tell me about your eating. A careful history and physical, along with weight loss or growth abnormalities, may indicate an eating disorder. She wants Kentucky physicians to know there are resources available. “Early treatment leads to better prognosis,” she says. As Chief of Psychiatric Consult Service at University of Kentucky Children’s Hospital, Meadows works with the healthcare team on continuous quality improvement to standardize treatment protocols and improve care for adolescents with eating disorders. FOOTNOTE 1. National Institute of Mental Health - Eating Disorders: About More Than Food, NIH Publication No. (TR 14-4901), Revised 2014. ◆
You Can Prevent or Reverse Type 2 Diabetes
KentuckyOne Healthy Lifestyle Centers has Lifestyle Medicine and Diabetes Education Programs that can help BY DEBORAH ANN BALLARD, MD, MPH, AND DANA GRAVES MSN, RN, CDE, MLDE, CPT Diabetes mellitus is diagnosed when a person has high levels of glucose (sugar) in the blood and urine. In Latin, diabetes means “go through” and mellitus means “sweet.” When too much sugar builds up in the blood, it goes through the kidneys and comes out as sugary urine. High levels of blood sugar make cells, especially those lining the blood vessels and nerves, sticky and unable to function properly. This is how diabetes causes heart disease, blindness, and neuropathy. High blood sugar also damages the fine membranes of the kidneys and makes them unable to efficiently filter toxins. About five percent of people with diaLOUISVILLE
salmon and albacore tuna, contain healthy fats called omega-3s and are good. Stress also sets us up for diabetes by raising our cortisol levels. High cortisol causes the body to need higher levels of insulin to metabolize food. More stress sets up a vicious cycle of cravings, higher blood sugars, higher insulin levels, and more weight gain and more cravings. So, if you eat healthy, are physically active, and lower your stress, you can prevent or reverse type 2 diabetes. It’s really that simple, but many people find it very hard to do these things. Fortunately, there is help readily available. KentuckyOne Healthy Lifestyle Centers
NINETY-FIVE PERCENT OF DIABETES IS TYPE 2, WHICH, UNDERSTOOD IN THE SIMPLEST WAY, IS A FORM OF FOOD POISONING. betes mellitus have type 1, an autoimmune disease that usually begins in childhood. We don’t yet know how to prevent this kind of diabetes, but it can be treated with insulin injections and a healthy diet. Ninety-five percent of diabetes is type 2, which, understood in the simplest way, is a form of food poisoning. A diet high in calories, sugar, and refined carbohydrates and fats overwhelms the body’s ability to produce enough insulin to keep blood sugar normal. This causes toxic levels of sugar to build up in the body, essentially poisoning it. The same wonderful food that helps you maintain a healthy body weight and avoid heart disease and cancer also prevents or reverses diabetes. This is mostly plantbased, whole food, with fish as the primary source of animal protein. It does not include added sugar, processed foods, artificial foods (especially artificial sweeteners and trans fats), and animal fats. Fatty fish, such as
has Lifestyle Medicine and Diabetes Education Programs that can help you break this cycle, reverse type 2 diabetes, and be happier and healthier. The American Association of Diabetes Educators (AADE) accredits the Diabetes and Nutrition Care Program. We provide quality educational services using a teambased approach of certified diabetes educators (registered nurses and dietitians). Educational services are provided depending on the type of education needed and the location. This includes the following, but is not limited to: Comprehensive Group Diabetes Education, which is a series of three classes once a week for three weeks followed by a fourth class two months later. Individual Nutrition Education sessions include: Nutritional Education & Meal Planning, carbohydrate count-
ing, heart healthy, celiac disease, weight change issues, renal, Crohn’s disease, irritable bowel syndrome, and hyperlipidemia. Individual classes on insulin administration, monitoring/ blood glucose testing, pre-diabetes, diabetes refresher, insulin pump training, and gestational diabetes. Our certified diabetes educators are also available for speaking engagements at churches, civic groups, schools, businesses, etc. Educational classes and individual sessions are provided across KentuckyOne Health in various locations in Louisville, Lexington, Shelbyville, Mount Sterling, Berea, and London. A physician referral is usually required in order to bill the insurance carrier. If you have questions about payment, please call your insurance provider. We can send a referral form to your physician. Once we receive the referral, we will call you to help you select the appropriate education session and time. Please visit our website at www.
kentuckyonehealth.org/healthylifestyle or call 502.581.0110 to start on your path to preventing or reversing type 2 diabetes.
Deborah Ann Ballard, MD, MPH, is a an internal medicine specialist with KentuckyOne Health Primary Care Associates. Dana Graves MSN, RN, CDE, MLDE, CPT, is program manager of Diabetes and Nutrition Care Program.
◆ PHOTOS COURTESY OF KENTUCKYONE HEALTH
Weighing in on Health
Floyd Memorial Weight Management and Bariatrics provides medical and surgical options to optimize weight loss and improve overall health BY JENNIFER S. NEWTON Diet and weight loss strategies are a ubiquitous part of American culture these days. While much of the media focus is on cosmetic outcomes, the underlying medical conditions and co-morbidities are wreaking havoc on our health. The Floyd Memorial Weight Management and Bariatrics Center is designed to provide comprehensive, safe, physician-supervised weight loss options to optimize an individual’s health. “Weight loss from our perspective is not a cosmetic thing. We’re trying to make people healthy,” says Vasdev Lohano, MD, medical director of the center. “We know that weight is a very important factor in cardio-metabolic issues. Addressing the weight in a healthy way will help those chronic cardiovascular risk factors.” A clinical endocrinologist who has been with Floyd Memorial for seven years and whose main focus is diabetes, Lohano also treats metabolic disorders and thyroid, adrenal, and pituitary issues. He became medical director of the Weight Management and Bariatrics Center on January 1, 2015. Lohano says, “I look forward to collaborating with all the physicians to see what is working, what is not, and where we can improve some of the processes.” His goal is to make the program a “one-stop shop,” where patients can be seen by nurse educators, dieticians, psychiatrists, and physicians to enhance their weight loss experience and improve overall health.
procedures. Patients undergo psychological screening prior to surgery to ensure they can be successful in losing weight and maintaining weight loss. The program has two physicians – Lanny Gore, MD, FACS, Floyd Memorial bariatric and board-certified general surgeon, and John S. Oldham, Jr., MD, FACS, FASMBS, board-certified general surgeon with Baptist Surgical Associates, a new addition to the team through a partnership with Baptist Health Louisville.
Medically Supervised Weight Management
As the name indicates, the Floyd Memorial Weight Management and Bariatrics Center has two arms – medical and surgical. The medical weight management program is open to anyone who needs to lose a significant amount of weight, and is not specific to diabetes or any medical diagnosis. The first visit with the program coordinator is free. Upon application, the patient is assessed with a medical exam and placed into one of three different groups – high 24 MD-UPDATE
The Weighty Burden for Women
Floyd Memorial endocrinologist Vasdev Lohano, MD, became medical director of the Floyd Memorial Weight Management and Bariatrics Center in January 2015.
risk, intermediate, or moderate – based on their medical co-morbidities and how much weight they need to lose. The program follows the HMR® (Health Management Resources) meal replacement plan. The number of calories and frequency of followup prescribed is based on the group participants are placed in. The weight management team includes clinical program director Joan Weston, RN, registered dietitian Amy Brown, RD, CES, CDE, a program coordinator, and several health educators. All participants are overseen by a physician throughout the program. Weekly meetings and support groups are crucial for keeping participants on track.
Bariatric surgery is another piece in the comprehensive puzzle for people who are obese and suffer from co-morbidities. Patients in this program are usually referred by their primary care physician. Currently the surgical program offers the gastric sleeve, the gastric band, and gastric bypass
PHOTO COURTESY OF FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES
Women in particular are more likely to be affected by societal pressures to be thin and look a certain way, and they also suffer from metabolic syndromes that affect their ability to maintain a healthy weight. Age is a factor in the issues women face. “In younger women, the most common condition that affects them is polycystic ovarian syndrome (PCOS),” says Lohano. PCOS is a genetic condition that can cause weight gain and infertility. Lohano contends that losing weight through medical means can help restore reproductive health and minimize the risk of long-term complications. As women grow older, they tend to experience metabolic disorders leading to cardiovascular complications – dyslipidemia, high blood pressure, diabetes, heart disease, and stroke. “Optimizing those through direct management of the disease or through management of weight loss obviously helps all those risk factors that are important to reduce the cardiovascular risk,” says Lohano. Regardless of the intervention, Lohano says having an endocrine program that goes hand-in-hand with the medical and surgical weight loss programs, and a team of specialized providers, gives patients a comprehensive approach to healthy weight loss. ◆
COMPLEMENTARY CARE MENTAL HEALTH
What You Need to Know About College Hookup Culture There’s been over a decade of solid research on “hooking up” — uncommitted sexual encounters that involve anything from kissing and touching to oral sex to penetrative sex — among college students. There’s a lot we know … and a lot we have to learn. LOUISVILLE
HOOKING UP HAS REPLACED DATING AS THE SOCIAL NORM ON COLLEGE CAMPUSES — BUT THAT DOESN’T MEAN THERE’S RAMPANT SEX EVERYWHERE.
Casual sex has always been a part of campus life, right? Yes, but it wasn’t the social norm. As sociologist Kathleen Bogle puts it, “Instead of dating that leads to sex, the sex comes first and may lead to a relationship.” In one survey, one-third of students revealed that their first time having intercourse was during a hookup. Two studies by evolutionary biologist Justin Garcia found that the majority of college students have some sort of casual sex experience. However, “no more than 20 percent of students hook up very often, a third abstain altogether from hooking up, and the remainder are occasional participants.” Sociology professor Lisa Wade found that the median number for college hookups for a graduating senior is seven. The strongest predictor of hookup behavior? A previous hookup. Those who have engaged in hookups that involve penetrative sex are 600 percent more likely to hookup again during the same semester. THE SEXUAL BEHAVIORS OF HOOKUP CULTURE ARE DIFFERENT.
Several studies indicate that rates of vaginal intercourse have declined significantly in the last decade, while rates of oral and anal sex have risen. According to Garcia, “Oral sex now precedes intercourse and is defined as not really sex.” However, men are the recipients of this increase — women are actually receiving significantly less oral sex. THE SEX ISN’T THAT GREAT, AT LEAST NOT FOR WOMEN.
Several studies reveal that much hook-
up sex is unpleasurable or coercive. There is a significant orgasm gap between men and women who hook up and a significantly greater likelihood of sexual for BY Jan Anderson, PsyD, LPCC assault women who participate in hookup culture. COLLEGE STUDENTS OVERSHARE STDS.
According to a Stanford study, one in four college students graduate with an STD along with their diploma. Hooking up involves more unplanned sexual encounters that are less likely to involve STD protection than planned sex. Many students apparently believe they have it covered — their use of condoms during vaginal intercourse has increased significantly. And yet STD transmission has increased during the past decade, likely due to unprotected oral and anal sex. Many students are unaware that oral sex carries a significant risk of infection.
well without being drunk.” Added one Penn student, “Guys assume that (when drinking is involved) the default answer is always yes.” THE “DOUBLE STANDARD” IS ALIVE AND WELL.
As Bogle notes, “The hookup culture definitely affects the genders differently. Women are far more likely than men to get a bad reputation for how they conduct themselves in hookup culture. Women can get a bad reputation for many different things, including how often they hook up, who they hook up with, how far they go sexually during a hookup, and how they dress when they go out on a night where hooking up may happen. Men who are very active in the hookup culture may be called a ‘player’; women, on the other hand, get labeled a ‘slut.’” One Penn student revealed, “I definitely wouldn’t say I’ve regretted any of my one-
THE MORE ALCOHOL, THE MORE LIKELY A HOOKUP WILL FOLLOW. AND BINGEDRINKING IS SIGNIFICANTLY UP FROM PREVIOUS DECADES, PARTICULARLY FOR WOMEN.
A majority of students said that their hookups occurred after drinking alcohol — on average, three drinks for women and five drinks for men. Physician and psychologist Leonard Sax notes that among college students who meet the clinical criteria for alcohol abuse, women now outnumber men — their rate of alcohol abuse has “roughly quadrupled” in the past 40 years. In her interview of University of Pennsylvania students, New York Times journalist Kate Taylor noted, “Women universally said that hookups could not exist without alcohol, because they were for the most part too uncomfortable to pair off with men they did not know ISSUE#92 25
COMP CARE MENTAL HEALTH
night stands.” At the same time, she didn’t want the number of people she had slept with printed and said it was important to keep her sexual life separate from her image as a leader at Penn. MANY MEN AND WOMEN EXPERIENCE HOOKUP REGRET.
Social psychologist Elaine Eshbaugh found in one study that 77 percent of students regretted their hookups and, in another, that 78 percent of women and 72 percent of men who had uncommitted vaginal, anal, and/or oral sex regretted the experience. Men were more likely to be sorry for having used another person, and women regretted the experience because they felt they had been used. Researchers Freitas and Campbell found that while women usually feel worse after a hookup than men do, 39 percent of men expressed extreme regret, shame, and frustration with themselves about their hookup experience. Let Us Introduce Our Financial Advisors: Richard Coles, Brad Fisher, Scott Neal, Jerry Zimmerer
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MANY MEN AND WOMEN HOPE THEIR HOOKUPS WILL RESULT IN A RELATIONSHIP.
Most young men and women appear to want emotional connection — and many of them are seeking it through hookups. Garcia found that both men and (slightly more) women report the potential to form a relationship as a main motivation for hooking up, and perhaps even more surprising, a majority of both men (63 percent) and women (83 percent) expressed a preference for a traditional romantic relationship as opposed to an uncommitted sexual relationship. “Without exception,” sex counselor Ian Kerner notes, students “discuss a long-term monogamous relationship as their desired end goal.” There are many forces driving hookup culture and many perspectives on how best to navigate it. Please visit my website blog at www.DrJanAnderson.com if you’d like to know more. ◆
COMPLEMENTARY CARE MENTAL HEALTH
Women and Substance Abuse
The Morton Center addresses gender differences in substance abuse and emphasizes family participation in recovery BY JENNIFER S. NEWTON Just as gender plays a role in risk factors for disease and medical treatment options, it also plays a role in substance abuse. Men have higher rates of addiction to illicit drugs and alcohol. However, women LOUISVILLE
Paula Porter, LCSW, clinical director of the Morton Center, specializes in trauma counseling for women and working with parents, spouses, and families to navigate recovery. RIGHT Priscilla McIntosh, Morton Center CEO, says their philosophy is about “getting individuals in the community back to their best.” ABOVE
are more likely to experience trauma, abuse, and the co-morbidities that increase the risks for substance abuse and make treatment more difficult. According to the National Survey on Drug Use and Health, in 2010, 11.2 percent of men and 6.8 percent of women ages 12 and older were illicit drug users. During that same period, 57.4 percent of men and 46.5 percent of women ages 12 and older were current drinkers. In 2007, the Office
of National Drug Control Policy estimated 32.3 percent of the 1.8 million admissions to drug/alcohol treatment in the US were women. Paula Porter, LCSW, clinical director of the Morton Center, says these statistics are realities they experience every day in their treatment of people with substance abuse issues. “Women tend to suffer more consequences earlier with their drinking and using, and they usually come into treatment with different priorities. A lot of what is unique with women are their caregiving roles and how that has a lot of stress and responsibility … Women are harder to keep in treatment because of these responsibilities,” says Porter. One of Porter’s areas of expertise is trauma, and the Morton Center has four
staff members trained in trauma counseling. For women, this can be childhood or sexual abuse or partner violence, but it can also be witnessing a traumatic event or growing up in an unstable home. One of the techniques they utilize is EMDR (Eye Movement Desensitization and Reprocessing). “Originally created to treat Vietnam veterans, EMDR has been proven to decrease the effects of trauma,” says Porter. The theory behind EMDR is that traumatic memories get lodged in our brain. The technique uses a bilateral eye movement or brain signal to help individuals process the trauma on through. The technique is used over several sessions until the disturbance goes down. Recognizing that the challenges and priorities of recovery are different based on gender, the Morton Center has created an ongoing recovery group just for women who have been in treatment, either at their center or elsewhere. “For women, the number one issue is relationships. They are barriers and assets for women getting and staying sober,” says Porter.
Whether family is a barrier or an asset in treatment, they are pivotal in the recovery process. At the Morton Center, all of their treatment is family-focused, providing services for the person struggling with abuse and their family, including spouses, children, even friends. “Nowhere else in the community has the family support we PHOTOS BY BRIAN BOHANNON
COMPLEMENTARY CARE MENTAL HEALTH do,” says Morton Center CEO Priscilla McIntosh. The Morton Center’s resource center fields incoming calls from anyone asking questions or seeking guidance. If the person is a loved one, they can schedule an appointment with a therapist. If it is the individual struggling with substance abuse, they will schedule an initial assessment. Porter says often it is a family member who contacts them first. Free educational programming for families at the Morton Center includes programs such as “Concerned Persons,” a 10-week program that provides an extensive education on addiction. To meet the needs of the community, the Morton Center has expanded the options of their intensive outpatient program for substance abusers, offering three different levels. Their most intensive treatment program is 60 hours – 12 hours a week for five weeks. While most programs engage family members only once a week, at the Morton Center family can participate in about 53 of those 60 hours. “We know that if we can get
the family engaged in our intensive program in at least two sessions out of 53 hours, the completion rate for the individual goes up by more than three times. That’s how significant family involvement is,” says Porter.
WOMEN ARE HARDER TO KEEP IN TREATMENT BECAUSE OF THEIR CAREGIVER RESPONSIBILITIES. Because children are not immune to the effects of substance abuse, the center has an art therapist and a social worker who work with children ages five and up. Often they work with the child while the mother or parent is undergoing treatment. “For every
four children, there is one who has some type of struggle with substance abuse in the home,” says McIntosh. With 97,000 students enrolled in Jefferson County, Kentucky schools, that means about 25,000 kids in Louisville alone are affected.
Adolescents and Addiction
The Morton Center has a full complement of adolescent treatment services for those starting to experiment, to full-blown substance abuse. Education is a key component of the program, particularly for the parent or guidance counselor who needs to know how to talk about these issues. Parents are a critical piece in the process, and siblings 13 and older are welcomed into the group to try and prevent the pattern from repeating. In the ages 19-26 population, the Morton Center has seen the effects of the crackdown on prescription drug abuse with an increase in heroin use. “Where it was $240 per day for prescription pills, now it’s $30 for the same high. That’s where we’ve seen an increase, especially in the younger age group,” says McIntosh. On average, an individual seeks treatment seven times for heroin addiction. With relapse rates so high and so deadly, the Morton Center has “heightened their responsiveness,” says Porter, and created additional avenues for people to seek treatment, such as the resource center and walkin hours. Their goal is to get people in for an initial assessment within a couple of days.
On the Lookout
According to Porter, there are things physicians can look for to help identify substance abuse problems in their patients. Blood pressure problems, indigestion, and gastrointestinal problems can be signs. She advises physicians to be vigilant for collateral information from family members who attend appointments and to be sure to ask questions directly – “What is your alcohol intake? Are you using any kind of illicit drugs?” The Morton Center is currently undergoing a rebranding effort. The new tagline – Restoring Self and Preserving Family – reflects their commitment to treating everyone affected by chemical dependency. In the end, McIntosh says it’s really about “getting individuals in the community back to their best.” ◆ 28 MD-UPDATE
NEWS EVENTS ARTS
Baptist Cardiac Surgery Welcomes Khan
Ahmad Khan, MD, cardiothoracic surgeon, recently joined Baptist Cardiac Surgery, a part of Baptist Health Medical Group. The practice also includes Samuel Pollock, Jr., MD, and Sebastian Pagni, MD. Khan received his medical degree at New York Medical College in 1999. He completed a cardiothoracic surgery clinical fellowship at Wayne State University/ Detroit Medical Center in Detroit, Mich. in 2005 and went on to complete a cardiothoracic surgery residency at SUNY in Brooklyn, N.Y., where he served as administrative chief cardiothoracic resident from July 2006 to June 2007. Baptist Cardiac Surgery is located at 3900 Kresge Way, Suite 46, Louisville and also has an office in New Albany at 136 E. Cottom Ave. LOUISVILLE
Ali Earns Senior Fellow in Hospital Medicine Designation
Ephraim McDowell Health announces that Amjad Ali, MD, medical director of the Team Health hospitalist service at Ephraim McDowell Regional Medical Center, has earned distinction as a Senior Fellow in Hospital Medicine (SFHM) from the Society of Hospital Medicine (SHM). This is a very elite honor for Ali as it is the highest degree in Hospital Medicine and very few physicians practicing in Hospital Medicine earn status as a Senior Fellow. The SFHM credential is a key component in professional development for hospitalists. To be designated as a Senior Fellow in Hospital Medicine, a hospitalist must: • Serve as a hospitalist for at least five years, • Be a member of SHM for at least five years, and DANVILLE
SEND YOUR NEWS ITEMS TO M.D UPDATE > firstname.lastname@example.org
• Demonstrate their dedication to quality and process improvement and commitment to organizational teamwork, leadership, and lifelong learning.
Williams Named UK HealthCare Chief Transformation and Learning Officer
Dr. Mark V. Williams has been named chief transformation and learning officer (CTLO) for UK HealthCare as well as co-director of the newly created Office for Value and Innovation in Healthcare Delivery (OVIHD). He will codirect OVIHD with Dr. Bernie Boulanger, chief medical officer, and foster innovative approaches to increasing the value of patient-centered care delivery. By leveraging UK HealthCare’s growing information technology expertise and performance improvement efforts, Williams intends to collaborate with staff and leaders throughout UK HealthCare to increase the effectiveness and efficiency of care delivery through standardization across the health system. His office will also work to optimize care coordination, fostering a population health strategy to deliver the most effective patient-centered care in the most appropriate setting. Working closely with co-director Boulanger, Williams will coordinate OVIHD efforts that use analytics to both evaluate implementation of evidence-based practices and foster applied health services research at UK HealthCare. The intent is to become a learning health system. Williams is a nationally recognized leader in quality and patient safety with 25 years of experience leading clinical enterprises ranging from a medical emergency clinic with 65,000 visits per year to hospital medicine programs with 100-plus staff members. He has conducted seminal research in the fields of care transitions, hospital medicine, care delivery and health literacy. LEXINGTON
Eichorn Recognized for Anesthesiology Article
Dr. John H. Eichhorn, professor of anesthesiology and Provost’s Distinguished Service Professor at the University of Kentucky College of Medicine, authored a paper earlier in his career titled, “Standards for Patient Monitoring During Anesthesia at Harvard Medical School,” which is named in the current issue of the prestigious journal, Anesthesia and Analgesia, as one of the top 20 most important articles in anesthesiology ever written. The Anesthesia and Analgesia review of the most important articles cites papers dating back to 1846 when the use of ether was first demonstrated (No. 1 on the list). Eichhorn’s report of the work of a committee he chaired starting in the mid-1980s at Harvard was published in the Journal of the American Medical Association. It describes the development and implementation of practice standards and protocols that ultimately changed the clinical behavior of an entire profession, and virtually eliminated intraoperative anesthesia catastrophes caused by human error. The landmark paper was ranked No. 10 on the review list and, as that article indicates, was a real “game changer,” the impact of which persists today around the world. As a result of career-long efforts to improve patient safety and quality of care in anesthesia, in 2011 Eichhorn received the John M. Eisenberg Patient Safety and Quality Award for Individual Achievement from the National Quality Forum (NQF) and the Joint Commission, the highest recognition there is in healthcare safety and quality. “It was an exciting time back then,” said Eichhorn. “Some serious lapses in anesthesia care had led to severe patient injuries, and my group was directed to find a remedy. The solution required changing behaviors while also greatly improving on human senses in the OR by using what were then brand-new sensitive electronic technologies to monitor patients under anesthesia.” LEXINGTON
Hoven Elected First Woman Chair of WMA
Kentucky physician Dr. Ardis Hoven, immediate past president of the American Medical Association, was elected the new chair of the World Medical Association on April 16, 2015. She was elected at the WMA’s 200th Council meeting in Oslo, Norway and takes over immediately as the WMA’s first woman chair. Hoven, who did her internship and residency at the University of North Carolina, Chapel Hill, is an internal medicine and infectious disease specialist in Lexington, Kentucky, and is Professor of Medicine at the University of Kentucky College of Medicine. She was president of the American Medical Association in 2013 and had been a member of the AMA Board of Trustees since 2005, becoming its secretary and then chair. For the past few years she has been the chair of the AMA delegation to the World Medical Association.
Ephraim McDowell Health President/CEO Elected to AHA Regional Policy Walk with a Doc Board Events in Louisville DANVILLE Vicki A. Darnell, president and and Lexington Raise CEO, Ephraim McDowell Health, was Awareness for elected to serve on the American Hospital Parkinson’s Disease Association (AHA) Regional Policy Board 3 and has begun her three-year term. Regional Policy Board 3 represents six states including the District of Columbia, Delaware, Kentucky, Maryland, North Carolina, Virginia, and West Virginia. The Board meets three times a year to foster communication between the AHA, its members, and state hospital associations. They provide input on public policy issues considered by the Board of Trustees, serve as ad hoc policy development committees when appropriate, and identify needs unique to a region and assist in developing programs to meet those needs. ◆
Pollack Named 2015 Public Health Hero
Kentucky Children’s Hospital pediatrician and child safety researcher Dr. Susan Pollack was recently honored as one of the Lexington-Fayette County Health Department’s 2015 Public Health Heroes. The award is given annually to individuals who have demonstrated their dedication to improving the health of Lexington residents. Pollack has advocated for injury prevention and safety measures for children of all ages. Her areas of expertise include safe sleeping areas for infants, car seat safety, drowning and fire prevention, safe teen driving, and head protection for bicyclists, skateboarders and ATV riders. She frequently assists with the Child Care Health Consultant Program, which promotes healthy child development in safe environments. Pollack is the coordinator of the Pediatric and Adolescent Injury Prevention Program at the Kentucky Injury and Prevention Research Center, and an assistant professor in the UK Department of Pediatrics and the UK Department of Preventive Medicine. She serves on the Child Fatality Review committee in Fayette County and on the state level through the Department for Public Health. Pollack was selected for the (FROM LEFT:) Board of Health Chair honor with Marian Guinn, the Scott White and Commissioner CEO of God’s Pantry Food Bank. The two women of Health Dr. Rice Leach present were recognized during an April 13 meeting of the the 2015 Public Health Hero Awards to Dr. Susan Pollack and Lexington-Fayette County Board of Health. LEXINGTON
Marian F. Guinn. 30 MD-UPDATE
Walk with a Doc events are held monthly in Louisville and Lexington as part of a nationwide program that empowers people to improve their health through physical activity as they exercise side-by-side with their healthcare providers. Participants can also receive complimentary health screenings at the event.
KentuckyOne Health with the Parkinson Support Center of Kentuckiana and University of Louisville Physicians participated in Walk with a Doc events in Louisville to improve awareness of the disease. The first Louisville Walk with a Doc event was Saturday, April 11, 2015, at the Parklands of Floyds Fork Egg Lawn. Kathrin LaFaver, MD, a movement disorder specialist with U of L Physicians Neurology, led the walk while answering questions about Parkinson’s disease. A second Walk with a Doc event was Saturday, April 25, at Shawnee Park, led by Colleen Knoop, APRN, a clinician with U of L Physicians Neurology. According to the Parkinson Support Center of Kentuckiana, research indicates that over one million Americans are living with Parkinson’s disease. The average age of onset is 60, but people have been diagnosed as young as 18. LOUISVILLE
April was Parkinson’s Awareness Month, and on Saturday, April 18, 2015 KentuckyOne Health hosted its first Walk with a Doc event in Lexington with a focus on improving awareness of the disease. Warren Chumley, MD, KentuckyOne Health Neurology Associates, led the free walk around Shillito Park while answering questions about Parkinson’s disease. Walk with a Doc events will be held bi-monthly on the third Saturday of the month in Lexington as part of a nationwide program that empowers people to improve their health through physical activity as they exercise side-by-side with their healthcare providers. Participants can also receive free health screenings at the event. Community partners for the Walk with a Doc event include: Lexington-Fayette County Health Dept., Lexington Parks and Recreation, Passport Health Plan, and YMCA of Central Kentucky. ◆ LEXINGTON
Surgery on Sunday Grows and Adapts with New Patient Eligibility Criteria
On April 19, 2015 forty volunteers, including physicians, surgeons, and nurses, gave their time at the monthly surgery date for Surgery on Sunday. The physicians and surgeons volunteering their services included: LEXINGTON
Paul Kearney, MD, general surgeon with UK General Surgery, performs a laparoscopic cholecystectomy for a Surgery on Sunday patient.
Wayne Graff, MD; Phillip Hall, MD; Paul Kearney, MD; Andrew Moore, II, MD; Michael Moore, MD; and Levi Procter, MD. The surgeries performed included gallbladder removal, hernia repair and excision of a mass. The surgeries were performed at the Lexington Surgery Center at no cost for patients who were unable to pay for these essential outpatient procedures. Surgery on Sunday was founded in 2005 by plastic surgeon Dr. Andrew Moore, II, and provides essential outpatient surgical services for those who can-
not afford insurance, are not eligible for federal or state programs, and are within 250 percent of the federal poverty level. In response to the Affordable Care Act, the Surgery on Sunday Board voted in January 2015 to expand the eligibility criteria for the program. To meet the needs of those individuals that now have insurance, but that have high-deductible plans, Surgery on Sunday is accepting individuals whose deductible exceeds 10 percent of their income and are within 250 percent of the federal poverty level. Surgery on Sunday performs outpatient surgeries the third Sunday of each month at the Lexington S u r g e r y Center utilizWayne Graff, MD, anesthesiologist with ing volunteer Anesthesia Associates, p h y s i c i a n s , prepares a Surgery anesthesioloon Sunday patient for gists, nurses, surgery. social workers, and administrative personnel who have donated over 87,000 hours of volunteer service. To date, over 5,500 patients have been served. The 2015 summer schedule is May 17, June 14, July 19 and August 16. To learn more about Surgery on Sunday or to refer a patient, call Anna Taylor at (859) 246-0046 or visit www.surgeryonsunday.org. ◆
At the groundbreaking for Lexington Clinic Beaumont were (l-r) Andrew H. Henderson MD, Lexington Clinic CEO; Brett Setzer, Brett Construction Company; Robert L. Bratton, MD, Lexington Clinic chief medical officer; Stephen C. Umansky, MD, president of Lexington Clinic Board of Directors; Kimberly A. Hudson, MD, board member; and Nick Moran, Lexington Clinic director of facilities.
Lexington Clinic Breaks Ground on Lexington Clinic Beaumont
Lexington Clinic broke ground on March 13, 2015 on a new location – Lexington Clinic Beaumont. The new location will combine two of Lexington Clinic’s existing locations, Lexington Clinic Palomar Family Health Centre and First Choice Walk-In Urgent Care. Lexington Clinic Beaumont will provide family medicine and internal medicine/ pediatric services. In addition, walk-in care for minor injuries and illnesses, including sprains and strains, lab and X-ray services, general illnesses, lacerations, and work injuries, will be offered. "Lexington Clinic will offer the With over 11,800 square Beaumont area a feet of space, the new facil- complete family ity will be constructed to high care center energy efficiency standards, under one roof including the use of geothermal in the heart of HVAC and utilization of LED this community," lights throughout the facil- says Andrew H. ity. Completion is expected in Henderson MD, Lexington Clinic October 2015. ◆ LEXINGTON
2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober email@example.com www.barcpa.com
PHOTOS COURTESY OF SURGERY ON SUNDAY. COLUMN 3 PHOTOS BY STEPHANIE NORTHERN, LEXINGTON CLINIC
Jewish Hospital Live Streams and Tweets TAVR Procedure LOUISVILLE The
The Jewish Hospital Heart Valve Team performs a TAVR procedure on April 2, while U of L Cardiologist Dr. Lorrel Brown provides live updates on Twitter.
heart valve team at Jewish Hospital, part of KentuckyOne Health, performed a Transcatheter Aortic Valve Replacement (TAVR) on April 2, 2015 at 10:00 a.m., which was live streamed and tweeted for real-time updates throughout the duration of the procedure. The minimally invasive heart procedure was performed in Jewish Hospital’s stateof-the-art hybrid operating room, which opened last year. University of Louisville Assistant Professor of Cardiovascular and Thoracic Surgery Kendra Grubb, MD, and Interventional Cardiologist and Assistant Professor of Medicine Michael Flaherty, MD, performed the procedure, along with the U of L Assistant Jewish Hospital Heart Valve Team. Professor of University of Louisville Cardiologist Lorrel Cardiovascular and Brown, MD, an experienced heart specialist, providThoracic Surgery ed updates on Twitter @kyone_health and answered Dr. Kendra Grubb questions using the hashtag #KY1HeartCare. Brown and Interventional was not an active participant in the surgery. All three Cardiologist and Assistant Professor of doctors practice with U of L Physicians. Medicine Dr. Michael The TAVR procedure is usually performed using Flaherty lead the general anesthesia, but the Jewish Hospital Heart Heart Valve Team Valve Team uses conscious sedation without the use in performing the of a ventilator and breathing tube, which allows for procedure. quicker recovery times and shortened hospital stays. “TAVR requires a true team approach and showcases how the heart valve team works together to achieve the very best outcomes for our patients,” said Grubb. “Being able to watch live and follow updates is a unique opportunity for everyone from medical students to the general public to learn about this innovative procedure and see inside the hybrid operating room.” ◆
THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS
CALL FOR PARTICIPATION 2015 Editorial Opportunities *
The flowering gardens of summer make the Lawn Party a memorable experience.
Annual Lawn Party Celebrates Henry Clay’s Estate, Raises Funds and Awareness
Ashland, the Henry Clay estate, is a National Historic Landmark and a rare treasure in the heart of Lexington. Established in 1926, the Henry Clay Memorial Foundation, a 501c3 nonprofit organization, is dedicated to preserving Ashland and operating its educational center. Generous individuals and corporations make the conservation of Ashland, and sharing the legacy of the Great Compromiser, Henry Clay, possible. In support of the foundation and Ashland, the 19th Annual Lawn Party will be held on Saturday, June 27, 2015 beginning at 5:30 pm. There will George McGee, with Kentucky Chautauqua, presents Henry be cocktails, jazz, Clay to attendees at the Lawn dinner, and live and Party. silent auctions. ◆ LEXINGTON
Issue #93 June/July –MEN’S HEALTH, Dermatology, Plastic Surgery / Sports Medicine, Fitness Issue #94 August/September MUSCULOSKELETAL HEALTH Orthopedics, Physical Medicine, Rheumatology / Occupational Health Issue #95 October – SURVIVING CANCER, Oncology, Radiology, Imaging / Hospice, Home Health
Issue #96 November – IT’S ALL IN YOUR HEAD, Neurology, ENT, Pain Medicine / Mental Health, Smoking Cessation Issue #97 December/January 2016 PREVENTION AND SENIOR HEALTH, Internal Medicine (including Hospitalists and Concierge Medicine), Family Medicine & Geriatrics, Ophthalmology / Physician Extenders, Residential Care
TO PARTICIPATE CONTACT: Gil Dunn, Publisher • firstname.lastname@example.org/(859) 309-0720 Jennifer S. Newton, Editor-in-Chief • email@example.com/(502) 541-2666
*EDITORIAL TOPICS ARE SUBJECT TO CHANGE.
LEFT, PHOTOS COURTESY OF KENTUCKY ONE HEALTH. RIGHT PHOTOS COURTESY OF ASHLAND, THE HENRY CLAY ESTATE
ÂŠ2015 Baptist Health
NOTHING MINIMAL ABOUT THE RESULTS. BAPTIST HEALTH IS A RECOGNIZED LEADER IN MINIMALLY INVASIVE SURGERY. Baptist Health physicians provide healthier outcomes for your patients with more than 50 laparoscopic procedures for an array of cardiac, thoracic, urological, gynecological, gastric, bariatric, neurological and cancerous conditions. These minimally invasive surgeries mean less pain, reduced blood loss, faster recoveries, shorter hospital stays and less scarring and complications. For more, visit baptisthealthkentucky.com or call (502) 897-8131 for a specialist referral.