M.D. Update Issue #79

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS ISSUE #79

SPECIAL SECTION

Orthopedics & Sports Medicine

The Power of

FOCUS

VOLUME 4, NUMBER 4

Louisville Orthopaedic Clinic cultivates success by pinpointing subspecialty expertise

ALSO IN THIS ISSUE  THE SHOULDER CENTER’S 16TH ANNUAL SYMPOSIUM  POLISHING THE PRACTICE: LEXINGTON CLINIC ORTHOPEDICS  CONCUSSIONS: MYTHS VS. FACTS  PEDIATRIC ORTHOPEDIC SURGEON EMBRACES SHRINERS TRADITION

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CONTENTS COVER STORY 3 HEADLINES 4 FINANCE

James Shambhu art@md-update.com

8 COVER STORY

CONTRIBUTORS:

18 COMPLEMENTARY CARE

Louisville Orthopaedic Clinic cultivates success by pinpointing subspecialty expertise

20 NEWS

BY JENNIFER S. NEWTON

24 EVENTS

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Andrew D. DeSimone Barbara Mackovic Scott Neal Calvin R. Rasey Kathryn Sandusky, AuD

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ORTHOPEDICS & SPORTS MEDICINE 13 POLISHING THE PRACTICE: LEXINGTON CLINIC ORTHOPEDICS 15 CONCUSSIONS: MYTHS VS. FACTS 19 PEDIATRIC ORTHOPEDIC SURGEON EMBRACES SHRINERS TRADITION

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7 INSURANCE

SPORTS MEDICINE

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5 LEGAL

 ORTHOPEDICS &

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Volume 4, Number 4 ISSUE #79

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HEADLINES

“I Will Not Live in Fear”

Louisville OB/GYN experiences Boston Marathon terror attack firsthand

BY GIL DUNN LOUISVILLE On April 15, 2013 Kelli Mudd Miller, MD, OB/GYN, was nearing the finish line of her third Boston Marathon when she heard what she thought was a loud firecracker explode a couple of hundred yards ahead of her near the finish line, but she kept on running. Moments later, a second blast occurred within 50 yards of Miller, and she immediately knew it was not fireworks but a bomb.

“My first thought was that there would be a third explosion and gunmen on the street and that I was going to die,” says Miller. “I thought of my three children and how I would never see them again.”

Miller recalls the paralyzing fear that rooted her in the middle of Boylston Street.

With smoke circling, the spectators, who moments earlier had been shouting encouragement, were now screaming with terror.

She vividly remembers the first responders dashing into the smoke and screams.

Fortunately her companion, had been waiting for her at the finish line on the right hand side of the street. “Somehow he found me and said, ‘We need to get out of here,’” says Miller. They climbed over the barricades and made it to the safe harbor of their nearby lodgings.

Miller is a member of the prestigious OB/GYN group Women First of Louisville, located at Baptist Health in St. Matthews.

She became a runner in 2006 for health benefits when her second child was a year old for the health benefits and is attracted to the endurance events, running an average of 20 miles a week. She has already run in 12 marathons. She qualified for the Boston Marathon by running in the Houston Marathon in 2012. Miller registered for the

Boston Marathon to run with and support her friend, Monica Murphy, who was running in her first Boston Marathon.

Running the 26.2 mile course is a long race says Miller, but on this Patriot’s Day, the weather was beautifully spring-like and the crowds were enthusiastic. “You feel like a rock star; people are waving and cheering for you.” She notes that she was running a little slower than her usual 3 ½ hour pace

suggested she take some time off, which she now acknowledges was the right thing to do. “I was having trouble sleeping. Loud noises startled me, and crowds bother me.”

Meditation and yoga have been helpful for Miller “getting the sights, the smells, and noises of that awful moment out of my head.” She eschewed anti-depressants for a holistic approach to healing, lean-

Kelli Miller, Boston, has competed in 12 marathons since taking up running in 2006; MIDDLE: with friend & co-marathoner Monica Murphy; RIGHT Dr. Kelli Mudd Miller, OB/GYN, Women’s First of Louisville

LEFT

because she was enjoying the day, talking with other runners, and high-fiving spectators and kids along the way. “When I turned onto Boylston Street and saw the finish line, I felt joy and excitement. It was a perfect day.”

The 26th mile had a memorial dedicated to the victims of the Newton massacre. Miller’s voice still quivers with emotion when she describes her feelings of sadness and anger over the twin acts of terror. “My heart is very sad,” she says. “Innocent lives have been altered forever.”

Miller’s original plan was to return to her practice on Wednesday, April 17, two days after the race. “I thought I could go back to work, business as usual,” she says. But that was not to be. Her partners

ing on friends, focusing on positives ,and starting to run again, though only 10 miles a week, not her normal 20. “I’ve been changed,” she says. “I take more time with myself, my family, my friends, my patients. I realize how fleeting life is. I am more in the present.”

“I feel like I have grown through this experience,” says Miller. “I feel stronger now, although I never felt so weak as I did when that bomb went off. I felt everything was out of my control. But now, I feel stronger because of the good that I saw in the aftermath, how people came together in community and because of the way that I am living my life now. I will not live in fear.” ◆

WHEN I TURNED ONTO BOYLSTON STREET AND SAW THE FINISH LINE, I FELT JOY AND EXCITEMENT. IT WAS A PERFECT DAY. ISSUE#79 3

FINANCIAL AFFAIRS

A Mid-Year Assessment Some of you may look at the outsized returns of the U.S. Stock Market for 2013 (S&P is up 15.1% year to date through May) and conclude that you have missed the boat by not having more money in the market. Others of you may be holding some investment in bonds, which have taken a hit in the past couple of months. The Barclays 10 Year Treasury Index lost 3.9% in May and is down 2.8% for the year. Recall that when interest rate yields rise, prices of bonds go down. Annual yields on the 10 year Treasury rose from 1.66% to 2.15% during the month of May. So the real question to ask is, “What can I do now?”

Your first task is to remember your goals. What, exactly, is the purpose of your investment portfolio? Why are you taking risks with your money in the first place?

Such an assessment will generally reveal your time horizon, which plays a significant role in investment strategy selection. Is your strategy matched to your goals?

Next, take an honest assessment of your current investments and the reasons for holding each one. Don’t be overly concerned with what you paid for an investment. That is largely irrelevant to your current analysis. What truly matters is where it stands today and your forecast for where it is likely to go from here. As much as we hate to say it, your forecast depends on the Fed and its policies and the spillover effect into the government’s fiscal policy. Policy risk was the subject of last month’s column – let me know if you didn’t see it and would like to.

Oh, did I mention making a forecast?

Our literature is replete with pronouncements that none of us have a crystal ball and thus do not know, indeed cannot know, where a market is going. Yet every investor makes particular bets with his or her dollars on which assets are likely to go up faster and farther than others. Surely those bets take into consideration an expectation of return that, even if not robust, is a forecast of sorts.

Why else would one make such a bet?

The problem with most forecasts is that they follow classical economic theory that assumes that the only way to forecast is by crunching historical data, such as returns and volatility, and then constructing an optimal port4 M.D. UPDATE

folio. However, the data can take the traditional analyst only so far because it assumes that the economy is stationary (i.e. devoid of structural changes).

Experience has told us otherwise,

BY Scott Neal that economies do structurally change over time. Upon that realization the assumption of “stationarity” goes out the window. Further analysis is needed.

The data can be used to discover long run averages that do exist, but nothing more.

The data cannot answer near term questions of when or how often cycles will go up and down or how large or small they will be.

This leaves the analyst with no choice but to consider other analyses, e.g. a subjective view of the structural changes. It is also possible that inferences can be drawn using evidencebased technical analysis. Apparently, this is all so brand new that few advisors even know of its existence, much less use it.

After looking at your individual holdings, you must then assess the effects of combining them into a portfolio. Traditional portfolio theory suggests that individual investments can be blended into an optimal portfolio that extracts the maximum return out of a unit of risk. The optimal allocations lie along what is called the efficient frontier.

Once again, traditional analysis suggests that a fairly wide band of short term volatility must be expected and accepted in order to get the long run average. A static asset allocation often becomes the response of those traditional analyses. There’s no real thought behind much of that analysis.

Is there any doubt that we are in the middle of huge structural change today brought on by the financial crisis at the very cusp of burgeoning boomer retirements.

Creative thinking is needed to fill the holes caused by such structural changes.

A more complete analysis actually begins in the same way as the traditional analysis: crunching the historical data. But it must also reflect a subjective analysis of

how things are different in a low-growth environment, the likes of which we have not witnessed in our lifetimes. This opens up a whole new set of questions.

Isn’t it logical that with the introduction of subjective and /or technical analysis that most investors will be wrong in their forecasts most of the time? Since most investors and their advisors will have different probabilistic forecasts of future events and prices, and since the one true forecast is known ex ante only to God, most investors will have been proven wrong most of the time. Some will be very wrong while others will be very right. These are mistakes in forecasting. Those mistakes generate what is known as endogenous risk.

Finally, you should challenge your advisor and his or her thinking. Is it merely traditional or is it post-modern? Your job of selecting an advisor is to discern which one is more likely to be less wrong most of the time or even very right, much of the time.

These will likely be advisors that:  Identify and exploit structural changes better than others.  Recognize and exploit endogenous risk through superior long term investing strategies and superior short term trading strategies.  Exploit a superior logic of portfolio optimization.

Speaking of portfolio optimization, aka asset allocation: we believe that a passive fixed asset allocation should not be used at all. This is what is often referred to as an “optimal portfolio.” Some advisors will suggest an alternative tactical allocation, but even that is usually revealed to be nothing more than a simple over- and under-weighting of particular asset classes. We prefer a technique known as “optimal policy” function that will cause an investor to stay heavily invested in the asset where high returns are being earned and largely disinvested in the other asset classes – both for fairly long periods of time on average. There is whole new world of thought out there. Take action now to improve your investment returns.

Scott Neal is President of D. Scott Neal, Inc., a feeonly financial planning and investment advisory firm. He can be reached via email at scott@ dsneal.com or by phone 1-800-344-9098. ◆

LEGAL

Kentucky’s Amended Pill Mill Law Kentucky’s troubled history with the abuse of prescription medication is no secret.

Recent legislation hopes to reduce access to prescription pills while not interfering with legitimate medical care. Following the introduction of Kentucky’s first Pill Mill Laws in July 2012, physicians responded to the regulations with concerns about their ability to effectively treat patients under the guidelines. In light of those concerns, the General Assembly and the Kentucky Board of Medical Licensure amended the “Pill Mill Law.” Effective March 4, 2013, the amended statute and regulations balance the concerns of prescription drug abuse with the needs of physicians to prescribe controlled substances in their practice. See KRS 218A.172 and 201 KAR 9:260.

The new laws continue to explicitly regulate how controlled substances can be prescribed in Kentucky. Due to the lengthy nature of the laws, this article will present

highlights of the amended “Pill Mill Law.” The Kentucky Board of Medical Licensure’s web page contains additional information and material regarding the

BY Andrew D. DeSimone requirements of the new laws. Be advised that failure to follow these requirements may subject the physician to licensure inquiries before the KBML. The statute, KRS 218A.172, focuses only on the prescription of Schedule II controlled substances and Schedule III controlled substances with hydrocodone. The KBML regulations, as discussed below, are much broader and encompass Schedule III and Schedule IV substances as well.

Under KRS 218A.172, the General Assembly created minimum guidelines for the prescription of Schedule II substances and Schedule III substances with hydrocodone, but left to the regulating entity the task of implementing these minimum guidelines.

These include (1) obtaining a medical history and conducting a physical or mental examination “appropriate” to the complaint; (2) querying KASPER for the preceding 12month period; (3) creating a written plan listing the objectives of the treatment and potential diagnostic examinations; (4) discussing the risks (addiction) and benefits of the controlled substance; and (5) obtaining written consent for the treatment. Additionally, the practitioner must keep accurate and accessible medical records that explain the rationale for the prescription of these medications.

With regard to the prescription of Schedule II controlled substances and Schedule III controlled substances with hydrocodone to

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Ernest A. Eggers, M.D. Donald T. McAllister, M.D. Norman V. Lewis, M.D. Richard A. Sweet, M.D. Thomas R. Lehmann, M.D.

George E. Quill, M.D. Scott D. Kuiper, M.D. Ty E. Richardson, M.D. Robert A. Goodin, M.D. J. Steve Smith, M.D.

Lori L. Edmonds, APRN Melissa T. Parshall, PA-C Kate A. Hamilton, PA-C Christina L. Fields, APRN Carly O. Bell, PA-C

502-897-1794 4130 Dutchman’s Lane Louisville, KY 40207 www.louortho.com ISSUE#79 5

LEGAL a patient, the statute requires the KBML to enact regulations that require the physician to (1) review the plan of care and the patient’s needs at reasonable intervals; (2) modify the plan as appropriate; (3) query KASPER once every three months for the preceding 12month period; and (4) review the KASPER data before issuing new prescriptions.

Interestingly, the statute allows the regulating entity, like the KBML, to enact exemptions to the general prescribing rules for Schedule II controlled substances and Schedule III controlled substances with hydrocodone. Those potential exemptions include (1) prescribing the medicine prior to, during or 14 days after a surgery; (2) in an emergency situation; (3) by a pharmacist; (4) when the patient is in a hospital or long term care facility; (5) as part of hospice; (6) for cancer treatment; and (7) as a single dose to relieve anxiety when submitting to a diagnostic exam or other procedure. Finally, the regulating entity can create additional exemptions by providing notice to the Kentucky Office of Drug Control Policy, making a

factual finding based upon expert testimony, and submitting a report to the Governor and Legislative Research Commission.

The KBML guidelines implementing the controlled substances laws are intricate and are divided into two broad areas: (1) prescriptions of Schedule III (without hydrocodone) and IV substances and (2) prescriptions of Schedule II and III (with hydrocodone) substances. See 201 KAR 9:260. However, the typical exemptions apply to both: end of life; hospital inpatient; cancer treatment; long term care facility patient; during a mass disaster; or a single dose to ease anxiety before a procedure. The requirements to prescribe Schedule III (without hydrocodone) and IV substances on a short-term basis for pain are the same as the older version of the law, except it does not require verifying identity with a government issued ID, and the KASPER report only has to be reviewed for the 12 months preceding the prescription.

For long-term prescriptions (greater than three months) of Schedule III (without hydrocodone) and IV substances for pain, the

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6 M.D. UPDATE

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D S N E A L . C O M

restrictions are relaxed to allow partners in a single group practice to prescribe these medications if all of the prescribing partners follow the mandates of the regulation. See 201 KAR 9:260, Section 4. Be advised that the regulations continue to require a very strict chaperoning by the physician of those patients that require Schedule III (without hydrocodone) and IV substances for treatment of pain for longer than three months. The KBML has a summary of its controlled substances regulations on its web page to help the physician navigate these requirements.

As to Schedule II controlled substances and Schedule III controlled substances with hydrocodone, the baseline rule is that these substances can only be dispensed by a physician for a 48 hour supply unless the patient is part of a narcotic treatment program licensed by the Cabinet for Health and Family Services. Physicians cannot avoid this requirement by dispensing the substances on a consecutive or continuous basis. See 201 KAR 9:220.

When prescribing Schedule II controlled substances and Schedule III controlled substances with hydrocodone, the general standards from 201 KAR 9:260 apply as well as additional standards that the General Assembly has mandated in KRS 218A.172.

Physicians prescribing Schedule II or III with hydrocodone to patients near the end of life, suffering from cancer, in a hospital or long term care facility or receiving a single dose for procedure anxiety are exempt from the general and specific prescription requirements in the statute and the regulation. Finally, physicians can prescribe a 14-day supply of these medications without meeting the additional standards required in KRS 218A.172 prior to or following surgery. However, the general prescription requirements apply.

With these new laws and regulations, the Commonwealth of Kentucky has taken another step in preventing further escalation of prescription drug abuse.

Andrew D. DeSimone is a partner with Sturgill, Turner, Barker & Moloney, PLLC. Mr. DeSimone concentrates his practice in the areas of healthcare law and medical malpractice defense. He can be reached at adesimone@ sturgillturner.com or (859) 255-8581.

This article is intended as a summary of newly enacted state law and does not constitute legal advice. ◆

INSURANCE

THE ULTIMATE

“Pay your life insurance premiums pre-tax and keep the benefit tax free” Do you ever wish you could pay your life insurance premium with pre-tax dollars while keeping your benefit tax free? I am here to remind you that it can be achieved when purchasing life insurance inside a Qualified Retirement Plan (QRP). A qualified retirement plan is a plan that meets requirements as defined in the internal revenue code and as a result, such a plan is also eligible to receive certain tax benefits. These plans must be for the exclusive benefit of employees or their beneficiaries. A qualified plan is any sort of defined contribution or defined benefit plan, such as 401-k, profit sharing, traditional defined benefit or cash balance plan. IRA’s are not considered “qualified”; therefore life insurance is not a permitted investment in IRA’s The first step in implementing the strategy is to direct the QRP to purchase life insurance on the plan participant. If a plan is currently not available then an individual as a sole proprietor can establish his or her own profit sharing plan; to establish such a plan one must have earned income. Once a QRP is in place the assets can be invested in life insurance as long as the plan document authorizes the purchase and the death benefits are incidental to the plans principle purpose of providing retirement benefits.

The QRP pays premiums on the policy.

Those payments are a taxable event to the plan participant; however the amount subject to tax is not the amount of premium but the pure cost of the death benefit. This is called the “P.S. 58 cost” and is the amount the participant is required to include in gross income because of the plan held life insurance. This represents the annual cost of pure insurance protection and is used as “basis” for any purpose of the owner’s real expense. An owner employee does not want to treat that cost as an investment in the contract. Purchasing life insurance through a QRP leverages the amount spent on premiums. The main reason for the P.S. 58 cost is to maintain the distinction between the cash surrender value and the total amount of premiums paid, so when the insured dies and the policy proceeds are paid to beneficiaries, the death benefit will

not be subject to income tax.

As stated earlier, life insurance may not be purchased in a traditional IRA, but an IRA can be over-looked too because QRP assets can be

BY Calvin R. Rasey increased with IRA funds. IRA distributions made after 2001 can be rolled into a QRP without being subject to the incidental benefit test.

In theory, a taxpayer with an IRA, but who does not participate in a QRP, could still take advantage of this strategy by creating a business entity and establishing a QRP themselves.

The money available upon retirement of the insured depends upon which options chosen at that time for handling the funds.

Those options could include distributing the policy to him or her directly; surrendering the policy and having the cash value remain in the QRP, or purchase the policy from QRP. If the insured elects to have the plan distribute the policy, the policy value would be income to the insured, and the insured could reduce the taxable amount by its basis. Meaning if the cash value is $500,000, the insured’s basis is $25,000, the insured will include $475,000 in income in first retirement year. The tax is unavoidable, which makes surrendering the policy and having the cash value remain in the QRP possibly more attractive because immediate tax on the distribution could be avoided by rolling the distributed funds to an IRA. If the insured needs or wants the life insurance, he or she may elect to purchase the policy from the QRP. The insured will have to come up with the value of the policy. However if the insured purchases the plan, that could be interpreted as a prohibited transaction if the insured is an owner of the business. Fortunately a prohibited transaction exemption can be made available to the insured with the proper supporting documents.

To avoid any inclusion of the policy death proceeds in the insured’s estate it is necessary for the insured to pay tax on his/ her P.S. 58 cost and also have the beneficiary be a third party, such as using an irrevocable life insurance trust as the policy owner. If this is not done at the inception of the policy, it can be transferred at purchase or distribution, but there is a three year look back period that will be in effect. The insured’s estate should never be a beneficiary of the policy because the estate tax will inevitably come into play. In all cases the death benefit in excess of cash value is income tax free, but the amount attributable to the cash value minus basis in the policy is taxable income to the plan or beneficiary.

QRP funds should be recognized as another source of premium dollars, especially in today’s difficult economic environment. QRP’s are generally not viewed as available for day to day business expenses, and because of this inaccessibility for those expenses, QRP’s are a valuable asset for pretax payment of life insurance premiums.

The medical profession is being swamped with restrictions piled on top of restrictions.

Hours spent at the hospital seeing patients or doing procedures are on the rise, but the paycheck may not be. The tax leverage dictates one to consider using a QRP as a tool for today’s dollars as well as the extra value it could provide heirs. All retirement and estate planning requires a great deal of care when implementing, and purchasing life insurance in a QRP is no different. Proper planning can provide meaningful benefits today as well as in the future.

Calvin R. Rasey is president of Physicians Financial Services II, LLC. He can be reached at (502) 893-7001.

Securities Offered Through Securities America, INC.*Member FINRA/SIPC • Calvin R. Rasey • Registered Representative • Advisory Services offered through Securities America Advisors, INC. • A registered Investment Advisor Calvin R. Rasey • Investment Advisor Representative Securities America & its representatives do not provide tax or legal advice Physicians Financial Services II, LLC and Securities America Companies are NOT UNDER Common Ownership ◆

ISSUE#79 7

COVER STORY ????????

The Power of

FOCUS

Louisville Orthopaedic Clinic cultivates success by pinpointing subspecialty expertise

BY JENNIFER S. NEWTON PHOTOGRAPHS BY BRIAN BOHANNON

The human musculoskeletal system includes over 200 joints, 206 bones, 640 muscles, 900 ligaments, and approximately 4000 tendons. To any lay person, mastering the entire system seems a daunting task. So, how do physicians achieve an orthopedic practice that encompasses pinpoint expertise in each area of the musculoskeletal system? By selecting providers with an acute focus in a subspecialty area of interest and allow them the freedom to hone their focus to a razor-sharp edge.

For Louisville Orthopaedic Clinic, that is the formula that has allowed them to survive and thrive independently for 40 years.

A fixture in the St. Matthews’ area hospital corridor, and in their present location on Dutchmans Lane since 1980, Louisville Orthopaedic Clinic has flourished by being at the forefront not only of medical advancements but of operational ones as well. “We were the

LOUISVILLE

Dr. Ernest A. Eggers is a pioneer in the field of joint reconstruction.

8 M.D. UPDATE

first to own our own facility, to start physical therapy within our office, and to have an MRI within our office,” says founding partner Ernest A. Eggers, MD. Ty E. Richardson, MD, agrees that their business decisions have contributed to their practice’s success. “The fact that we own our own real estate gives us an advantage that will allow us to remain independent,” says Richardson. Each of the physicians shares a passion for remaining independent and the freedom to control one’s own path that provides.

The Clinic’s physical assets also include two fully accredited and licensed outpatient operating rooms and their own orthotics lab. Electronic Medical Records, which the Clinic has had since the late 1990s, make digital imaging available wherever the physicians need it.

Having most of the ancillary services they need at their fingertips allows Louisville Orthopaedic Clinic’s physicians to provide more timely and cost-effective care. “If I see someone that needs an MRI, I can get it done in 24 to 48 hours and not wait for the next opening at a hospital, which can take a week,” says Richardson.

The Clinic is currently undergoing renovations to realign the intake and checkout flow of the office, which had all been done through the same door, to better accommo-

the best of the best,” says Richard A. Sweet, MD, who specializes in total joint replacement.

George E. Quill, MD, foot and ankle specialist, agrees, “One of the things that attracted me to this practice is that everybody in the group, even in the late 1980s, had done a post-doctoral fellowship. Beyond four years of medical school and five years of orthopedic training, we all did another year or two in a subspecialty.”

The practice has grown to include 10 physicians and five mid-level practitioners. Their subspecialties range from foot Dr. George E. Quill is and ankle, to joint an expert in foot and replacement, to liga- ankle disorders. ment reconstruction, to hip and knee, to spine, to shoulder, to sports medicine and When Quill completed his orthopedic arthroscopic surgery. residency in 1989, he secured one of only Given their business acumen coupled eight foot and ankle fellowships in the with their advanced training, it is only country at the time. He began practicing in Louisville in 1990 and was the only orthopedic surgeon subspecializing in foot and ankle in Kentucky, southern Indiana, northern Tennessee, or southwest Ohio.

EACH OF OUR PHYSICIANS HAS A SPECIALTY NICHE WITHIN GENERAL ORTHOPEDICS AND THAT SETS US APART FROM OUR NEIGHBORS. date the volume of patients they see. “It’s a better freeway system,” says Eggers.

Focus on Subspecialties

From his passion for total joints, Eggers made the conscious decision to only recruit partners who had the same level of interest and expertise in a subspecialty of their own. “Each one of us has a subspecialty that we practice in, and every one of us has developed to the razor’s edge in their subspecialty and generally is recognized as

natural that they have a penchant to be on the cutting edge of medical advancements. In 1973, Eggers was one of the first orthopedic surgeons to do total hip and knee replacements in the Midwest, outside of the large orthopedic centers. “Since I was on the ground floor, I was in on all the research that went along with hip replacement surgery and all the different products and designs,” says Eggers. The key, he says, was including engineers as well as physicians in the development process.

Total Joint Replacements

For Eggers, a hip and knee replacement and custom joint replacement surgeon, the advent of cementless hip replacements in the early 1980s has been one of the most important advancements in hip replacement surgery. He was one of the pioneers in completely un-cemented hip and knee replacements. In 1996 Eggers was involved in an early study of metal-on-metal cementless hips. The titanium stem and chrome cobalt ball and socket may be the most advantageous implant in terms of longevity and durability. Additionally, metal on ISSUE#79 9

COVER STORY

metal articulations eliminate the concern of implant fracture and provide for greater design flexibility, allowing for a larger femoral head, which provides greater stability and less chance of dislocation. Pending more research on metal hips, the gold standard could revert back to ceramic on the new plastic liner in the socket.

There is some concern about the metal ions generated by metal implants, but research has yet to show any adverse health effects. In the event there are contraindications for metal, improved ceramic and polyethylene designs also allow for increased longevity.

Cement is still used when bone quality is poor, but in all cases, total hip replacements are lasting decades longer than early models.

“Ten years used to be the magic number,” says Eggers. “I have hips now well over 30 years that are still functioning.”

Sweet describes the advancements in knee replacement surgery over the last

decade as “evolutionary changes, not revolutionary changes.” These improvements are across the board from pain management, to surgical techniques, to enhanced biomaterials, to instruments, and better understanding of the ligament balance of the knee.

BIOLOGICS WILL BE THE NEXT GAME CHANGERS IN THE FIELDS OF SPORTS MEDICINE AND FOOT AND ANKLE CARE.

Pain management has evolved to better control pain in the 48 hours following surgery. Sweet uses nerve blocks and intraarticular injections to make the patient more comfortable post-op, which aids in rehabilitation.

While surgery may be heralded as minimally invasive, Sweet asserts, “There is no such thing as minimally invasive when you’re going to replace the whole joint … A better phrase would be ‘quadriceps sparing surgical approach.’” By avoiding cutting into the quadriceps muscle, the technique allows patients to regain quadriceps muscle function much quicker than traditional surgery.

Eggers concurs, “I think the technical improvement in how you put [knee replacements] in has made a big difference, and we are able to customize the knee to the joint of that individual patient.”

New MRI technology allows surgeons to customize a three dimensional surgical strategy based on each patient’s anatomy.

Orthopedic surgeons are also gaining a better understanding of the ligament balance of the knee post-operatively. Contrary to the work done by sports medicine specialists to repair and preserve the Dr. Ty E. Richardson anterior cruciate ligament (ACL), specializes in knee replacements require surorthopedic sports medicine and geons to sacrifice the ACL. “We arthroscopic surgery of have learned how to balance these the shoulder and knee. ligaments so that each is tensioned

10 M.D. UPDATE

appropriately to provide proper stability and combine that with implant design to make up for the loss of the anterior cruciate ligament,” says Sweet.

Where the goal of knee replacement used to be eliminating the pain of arthritis,

often at the expense of mobility, Sweet says, “Our goals are much grander than that now as we try not only to get rid of the pain of arthritis by replacing the surface but also to reestablish the function of the knee by reproducing normal stability.”

Lower Extremity Care

Perhaps, in part, as a result of the limited number of fellowship programs available focusing on foot and ankle treatment, care of the lower extremities was long neglected, laments Quill. Physicians and patients alike often dismiss problems as “just a foot” or “just an ankle sprain.” “The problem is the foot is so integral to everyday activity, if something is neglected, it’s hard to make it better down the line,” says Quill.

Common problems include heel pain, flat feet, tendon strains, ankle sprains, athletic injuries, arthritis, and bunions. A vast majority of patients do not require surgery and undergo nonoperative treatments.

Common surgical treatments include bunionectomy, ankle arthroscopy, fracture repair, and ligament reconstruction.

Quill has a particular interest in challenging cases such as late reconstruction after trauma, ankle sprains that do not get better, and tendon transfer after stroke or paraplegia. Treatments for late reconstruction can include making the foot flush to the ground, osteotomy, a fusion of arthritic joints, or ankle replacement, which few surgeons do.

“Even young people who don’t need a fusion or replacement are benefitted by cartilage transplant, which wasn’t available five to 10 years ago on a reliable basis,” says Quill.

Research Products and does research on cartilage regeneration and orthopedic implants. Additionally, he is currently involved in ortho biologic research, attempting to “harness the power of one’s own healing capacities.”

Sports Medicine

While the thought of sports medicine might conjure images of 20-something collegiate athletes, Richardson says his patient base is an average age of mid-to-late 40s and can often be described as the Dr. Richard A. Sweet is a specialist in total “weekend warrior.” A shouljoint replacement. der specialist, he actually sees about 50% sports injuries of the shoulder and 50% workCaring for these surgical cases has been related shoulder injuries. While his treatan uphill battle. Surgeons used to have to ments are similar, work-related injuries tend take a device designed for the neck or hand to be degenerative in nature after repetitive and adapt it to fit the foot. Fortunately, use whereas sports injuries can be due to thanks in part to the efforts of physicians a single event. Outcomes can be different like Quill, orthopedic equipment manufac- too. “The motivation of the patient appears turers are recognizing the unique challenges to determine the length of time it takes to and needs of the foot and are developing recover sometimes,” says Richardson, citing anatomic site specific fixation options for that workers compensation patients may drag out their recovery to get more time off work. tendon transfers and fracture work.

In some cases, Quill has developed his Weekend athletes, on the other hand, are own solutions to clinical problems. One of often anxious to get back to their normal those problems was treating patients with activities.

Two of the most common sports injuries a dead ankle bone after trauma or due to Richardson sees are a torn meniscus in the uncontrolled diabetes, patients whose only option was often amputation. Looking for a unique fixation device to span the dead bone and fuse the tibia to the calcaneus, “I adapted an intramedullary rod that had been used to fix long bones for use fusing an ankle,” says Quill. He now uses the device 30 to 40 times a year, and it is used all over the world.

Quill and his colleagues also developed a procedure for patients with painful defor- knee and rotator cuff in the shoulder. More mities due to tendon rupture, arthritis, or unusual conditions include Achilles’ tendon congenital defects to reorient the bone in rupture and bicep rupture. the operating room and fix it rigidly, resultRichardson currently uses a shoulder ing in less pain and swelling. replacement system by Biomet due to his In fact, Quill is so dedicated to research familiarity with the product and for its he formed his own LLC called Quill Clinical flexibility. “Whether I’m going to do a

total shoulder, a simple uni-shoulder, or a reverse total shoulder, I use the same surgical approach, the same set of instruments, the same implants. I can make changes at the last second and not have to worry about not having the correct equipment in the room,” he says.

When it comes to post-operative care, Richardson provides extensive physical therapy prescriptions for patients and sets limits on what they should do. “I think that attention to the details of a physical therapy regimen after surgery ensures that nothing is done to threaten the outcome,” says Richardson. For rotator cuff tears, the physicians have developed protocols in conjunction with the in-house physical therapy staff to address the different sizes and grades of tears. Any patient who goes to an outside physical therapist gets a hard copy protocol to take with them.

Much like the advancements in joint replacements, changes in arthroscopic shoulder techniques and equipment have been evolutionary modifications of existing technology. “I think the next big steps in sports medicine are going to involve biologic adjuncts to healing … I think in the future we’re going to see biologic structural grafts we’ll be able to use to replace an ACL or cartilage injuries or large rotator cuff injuries,” says Richardson. Research is currently underway and Richardson predicts effective products will become available for use in the next two to three years.

Louisville Orthopedic Clinic’s care is not

WE HAVE THE CAPABILITIES OF PHYSICIAN CONSULTATION, DIAGNOSTIC X-RAYS AND MRI, OUTPATIENT SURGERY, AND PHYSICAL THERAPY ALL IN ONE LOCATION. just limited to the office or the operating room but extends into the community as well. Richardson has been the team physician for Manual High School for eight years, and the Clinic also provides sideline care for St. Xavier High School, Ballard High School, and Kentucky Country Day. ◆ ISSUE#79 11

SPECIAL SECTION  ORTHOPEDICS & SPORTS MEDICINE

Quality of Care

Advancing the state of rotator cuff treatment at Lexington Clinic’s Shoulder Symposium BY TIM CORKRAN The 16th Annual Shoulder Symposium, no pain, others find the pain and dysfunction hosted by the Shoulder Center of Kentucky intolerable. Chances are there is more rotator at Lexington Clinic, July 26-27, will take cuff disease present than is being diagnosed, on the question “The Rotator Cuff: What and the significance of ignoring such patholare we really treating?” For Ben Kibler, MD, ogy is unknown. For Kibler, the symposium founder of the Lexington Clinic Orthopedics topic is relevant because, “We are trying to – Sports Medicine Center, figure out how to address the this means helping physicians different types of rotator cuff and physical therapists better tears. Our primary focus is understand shoulder biomedetermining which ones need chanics and pathophysiology, surgery and which ones can so they can provide the highimprove with therapy alone.” est quality surgical and theraDifferentiating between peutic care. “Recent studies surgical and non-surgical suggest the types of treatment pathology is a primary focus for rotator cuff injuries vary of the Shoulder Symposium quite a bit, and there is a lot this year. Consensus among of new information. We want orthopedic surgeons is that to try to focus the sympothere has been a tendency Ben Kibler, MD, is founder sium attendees’ thoughts on of the Lexington Clinic to over-treat rotator cuff best practices,” Kibler says. Orthopedics - Sports disease, so there is a growTo that end, the symposium Medicine Center. ing desire to utilize nonwill cover the basics of rotasurgical options first. For tor cuff injury, evaluation and treatment chronic tears, physical therapy or other options, and the foundations and applica- non-surgical treatment modalities may be tions for rotator cuff rehabilitation. satisfactory in many patients. Nationally The rotator cuff consists of four muscles recognized physical therapists will join the and their tendons that serve to stabilize Lexington Clinic physical therapy staff at the the top of the humerus against the shallow Shoulder Symposium to ensure that attendsocket of the scapula. The breadth of pathol- ees will receive the most current information ogy possible in the complex is considerable. on rotator cuff physical therapy. According Collectively referred to as rotator cuff disease, to Kibler, a recent development is that “you its causes and the ramifications for long term have to work on the shoulder blade as the shoulder health are numerous. While many base of rotator cuff exercises, rather than the people with rotator cuff disease experience arm. Therapeutic retraining of the muscles

to hold the ball and the socket is emerging as a viable solution in these cases.” Surgery remains inevitable in many cases. For more acute or massive tears, surgery may be needed more quickly. New surgical techniques and options will also be presented at the 2013 Shoulder Symposium.

The symposium will include lectures, didactic sessions, panel discussions, video case presentations, and hands-on rehabilitation workshops, and some of the leading practitioners on rotator cuff disease are on the symposium faculty. Kibler will present on retraining surrounding muscles following traumatic rotator cuff injury and his partner, Trevor Wilkes, MD, will discuss new diagnostic techniques. Guest lecturers include John Kuhn, MD, chief of shoulder surgery at Vanderbilt University; William Mallon, MD, editor-in-chief for the “Journal of Shoulder and Elbow Surgery” from Triangle Orthopedic Associates; Michael Schaffer, PT, ATC, clinical supervisor for sports rehabilitation at the University of Iowa; and Brian Leggin, DPT, ATC, of the University of Pennsylvania Presbyterian Medical Center.

Kibler is proud of this annual event because “It considers the most current, stateof-the-art thinking in the field.” Orthopedists and physical therapists from across the country are expected to gather in Lexington for the Symposium, with attendance projected to reach 200 people. For more information or to register, go to http://www.lexingtonclinic.com/shoulder/scseminars.html. ◆

2335 Sterlington Road, Suite 100 Lexington, Kentucky 40517 (859) 268-1040 Fax: (859) 268-6165 Email: lprober ts@barcpa.com www.barcpa.com

12 M.D. UPDATE

SPECIAL SECTION  ORTHOPEDICS & SPORTS MEDICINE

Polishing the Practice

Energetic professionalism, measured care, and thoughtful growth keep Lexington Clinic on top of the orthopedic game BY TIM CORKRAN LEXINGTON An orthopedic practice that performs over 1200 knee and hip replacements a year yet seeks to exhaust all nonsurgical options first, must have vision, discipline, and deep commitment to patient care. Lexington Clinic’s orthopedic unit, anchored by 10-year veteran Christian P. Christensen, MD, and including newcomer Tharun Karthikeyan, MD, has these in abundance. Both physicians are energized by the prospects of their collaboration and Lexington Clinic’s professionally supportive atmosphere. “A shared vision for excellent care for the community, tackling of complex cases, commitment to research, and tracking outcomes brought me Lexington Clinic to work with Dr. Christensen,” says Karthikeyan. Christensen adds, “The camaraderie of the physicians at Lexington Clinic is really impressive; we all hold each other to high standard.”

Across the country, orthopedic surgery is a boom industry. There are three basic factors for this: the number of people experiencing load-bearing joint arthritis increases with the obesity epidemic; advancements in replacement materials and rehabilitation rates eases surgery issues; and the dramatic degree of pain relief associated with joint replacement makes it appealing. As a result, Karthikeyan says osteoarthritis sufferers are more likely than ever to seek what they call “an arthritis surgeon.” Most patients in the Lexington Clinic practice are 40-80 years old, present with pain (often at night), noticeable stiffness or deformity (bowleggedness, for example), or are returning for a revision of a previously replaced joint.

Christensen agrees with Karthikeyan, who says that, despite many patients’ preference, “Surgery is an option at the end of the line, not the beginning. In my practice, surgery is the last resort.” Clarity about real longterm solutions motivates this conservative approach for Christensen. “There are a lot of non-surgical alternatives for pain relief.

I see a lot of patients who want to jump into surgery not having tried the alternatives available, so we have the conversation that surgery is not the right magic bullet.”

He is frank with his patients, saying, “Let’s try rehabilitation. I know it’s going to be slower and the pain relief is going to be less complete, but it’s important for you because there is a greater risk of proceeding with more aggressive surgery.’”

Surgeries that Do Less Harm

Despite this approach, Christensen performed over 800 replacement surgeries in 2012 and has a waiting list of three months for his surgical services.

Karthikeyan expects to work up to this pace over the next five years. Both utilize direct anterior approaches for some 80% of their first time hip replacements.

are working with is unicompartmental knee replacement. Some knee pathologies are limited in scope, allowing the surgeon to remove only part of the joint. While only about one in 10 cases of debilitating knee osteoarthritis allow this, Christensen says, “It offers the patient the opportunity to have an operation which can provide great

Dr. Christian P. Christensen performed over 800 joint replacement surgeries in 2012.

Dr. Tharun Karthikeyan was attracted to the practice by its vision, complex caseload, and commitment to research.

This method has come into favor because “it is muscle sparing; you go between the muscles, which allows patients to get better faster,” Christensen explains. “Revision, however, is harder this way. With the traditional approach, you get better exposure when you extend your incision.”

Another orthopedic advancement they

pain relief and faster recovery, and it preserves more ligaments and bone.”

Both doctors are pleased with the decrease in rehabilitation time for these major surgeries. In 1986, a first time hip replacement patient could expect to spend six weeks on his back following surgery.

Today, that same patient would be out of the hospital in one or two days and rehabbing at home. Less invasive surgeries and proactive pain control, prior to and during surgery, is the key to this. Both doctors agree that the aggressive pain control allows patients to do more soon after surgery.

“They need aggressive pain control to try to gird themselves for the arduous rehabilitation they face,” says Christensen.

ISSUE#79 13

SPECIAL SECTION  ORTHOPEDICS & SPORTS MEDICINE

Challenges and Opportunities

There are both real and perceived challenges for orthopedic surgeons like Christensen and Karthikeyan. Christensen explains that, “The obesity epidemic is resulting in premature onset of load-bearing joint pain. Many of

joint gets replaced. Christensen says, “Knee replacement is not an operation that we do for pain that we do not understand. Arthritis is an obvious indicator for surgery.” He continues, “Someone who weighs too much, has a low pain tolerance, and no arthritis”

THAT’S WHY WE CALL IT A PRACTICE OF MEDICINE, BECAUSE EVERY DAY YOU ARE LEARNING, EVERY DAY YOU ARE REFINING. - DR. CHRISTIAN P. CHRISTENSEN these additional surgeries also have suboptimal outcomes because of obesity related complications.” In addition, revision rates increase as the average age of first time surgeries lowers. Both doctors also see patients who assume that their non-arthritic, undetermined knee pain will be relieved if the whole

should not be a candidate. He occasionally has to explain to a patient that weight or lifestyle could be causing the issue. “Not everything needs to be managed with surgery,” Karthikeyan concludes. “We are not dealing with a life-threatening condition here.”

It’s an exciting time to be in orthope-

dic surgery, especially at Lexington Clinic.

With advancements in surgical methods and replacement materials always coming, an attitude of committed, thoughtful progress pervades this practice. For Karthikeyan, innovation is a responsibility: “We get better at what we do by trying new technologies; we should not be too cautious to try something new, because that will keep us from getting answers.” For Christensen, refinement of surgeries is the medical practitioner’s calling: “That’s why we call it a practice of medicine, because every day you are learning, every day you are refining. We want to be great at what we are doing.” The next step for this practice is to increase sub-specialization – “It is the key to our growth,” Christensen says. Adding a foot and ankle specialist this fall and a shoulder replacement specialist in 2015 are the current plans. ◆

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THIS IS AN ADVERTISEMENT

SPECIAL SECTION  ORTHOPEDICS & SPORTS MEDICINE

Concussions: Myths vs. Facts

BY JENNIFER S. NEWTON LOUISVILLE A strong left hook in the boxing ring. A bone-crushing tackle on the football field. A windshield-cracking automobile accident. These may be the types of obvious injuries the term concussion brings to mind. However, the reality is concussions can result from circumstances much less severe and still have lasting neurological effects if ignored.

According to Tracy Eicher, MD, neurologist and concussion specialist with Baptist Neuroscience Associates in Louisville, “A concussion is any trauma that causes disruption of the brain’s function, even briefly.”

Contrary to common misconceptions, concussions do not require that the head strike another object or that the person lose consciousness. The jarring of the brain inside the cranium, as in the case of whiplash, is enough to cause a concussion.

Concussion is a type of traumatic brain injury with common symptoms including: headache, dizziness, nausea, blurred vision, fatigue, trouble sleeping, and cognitive disturbances, though not all of these symptoms will be present in every case.

It is true that most concussions do not need intervention. “Greater than ninetyfive percent of concussions will resolve within hours to days on their own without intervention,” says Eicher. However, she cautions, “If you’re still having symptoms two to three weeks after an injury, we may need to look at why you are not recovering.”

Trained in the Air Force, Eicher initiated a traumatic brain injury program at Wright-Patterson Medical Center in Ohio.

“The military injury of modern times is blast injury,” says Eicher, which became a big push in the military from 2007 to 2009.

Vestibular symptoms are also a high-levBaptist Health recruited Eicher to recreate that model in Louisville, assembling a el measure of whether an athlete is ready to team of vestibular, occupational, and speech return to play. Just because an athlete passes therapists, as well as physicians, and based traditional screening does not necessarily mean they are at Baptist Health’s new fully recovered.

Sports Medicine faciliIncorporating ty at Baptist Eastpoint. vestibular screenEicher joined ing and therapy Baptist Neuroscience with other tools, Associates in October such as the com2012. Baptist Health mercially availhas an existing infraable ImPACT structure of orthopetesting and neudists, neurologists, and rocognitive testsports medicine docing, provides a tors, as well as pedicomprehensive atric occupational and evaluation model. speech therapists, who “If they go back in are learning to treat before their vesadolescents. Eicher’s tibular issues are first step in building fully resolved … the concussion prothat’s where they gram has been to build get the next cona vestibular rehab procussion because gram, which is often Dr. Tracy Eicher is a neurologist and they’re not quite as crucial for concussion concussion specialist with Baptist Health in Louisville. visually and physirecovery. cally coordinated Vestibular Therapy is Key as they were,” says Eicher. A vestibular Eicher teaches using a mnemonic device to therapist and the right equipment can assess cover the common symptoms of concus- how well an athlete keeps focus while movsion: CHAD’S Moods, which stands for ing the head and body at a fast pace.

– Cognitive, HeadAche, Dizziness, Sleep, and Moods. Oftentimes vestibular and Tools and Treatments sleep disruptions act as barriers to recovery. The program’s specialized equipment Symptoms related to vestibular disturbances includes the SMART EquiTest® by include dizziness, nausea, blurred vision, NeuroCom that “will assess balance funcand fatigue. Nausea, for instance, can be tion as far as how well the sensory system, caused by an ocular motor dysfunction balance system, and vestibular system work where the eyes stop yoking together well. together,” says Eicher. It can also assess the speed and strategies patients use to keep and regain balance. To measure the speed and RATHER THAN KEEPING KIDS OUT OF SPORTS, WHAT WE WANT level at which patients can focus their vision while moving, Eicher uses sensory organizaTO DO IS GET THEM BACK QUICKLY BUT MORE SAFELY. tion and gaze stabilization testing. “Rather –DR. TRACY EICHER than keeping kids out of sports, what we want to do is get them back quicker and From there, Eicher transitioned her exper- This can cause a constant state of physio- more safely,” says Eicher.

According to Eicher, many medicatise to the private sector in Dayton, Ohio, logic challenge, which results in a feeling of where she set up a concussion program built fatigue. Sleep is critical to ensure the brain tions, such as analgesics or narcotics for headache, are a short-term band-aid that around a multidisciplinary team. Last year, gets the shutdown time it needs to heal.

ISSUE#79 15

 ORTHOPEDICS & SPORTS MEDICINE

can cause more problems in the long run.

When it comes to treatment, her main focuses are sleep and behavioral changes, and vestibular treatment when warranted.

Patients recovering from concussion need more than the average eight hours of sleep, especially adolescents who are still growing.

Avoiding alcohol and nicotine and limiting caffeine help prevent sleep interference.

“If I have to medicate, with adolescents I start with something as gentle as a tricyclic agent,” says Eicher. At low doses tricyclics work with the brain’s chemistry to enhance sleep, provide prophylactic headache relief, and lessen vestibular symptoms. When Eicher must prescribe analgesic medication for headaches, she educates patients about the detriment of long-term, frequent use.

Additionally, physical therapy to address cervical issues causing prolonged headache can be important. “What I do is try to take away the things that are barriers to the brain recovering on its own,” says Eicher.

Building Blocks

“A big part of running a concussion program is being in the community educating,” says Eicher. The community includes not only parents, coaches, and athletic trainers, but also family practice physicians, orthopedists, and other sports medicine physicians. For Eicher, educating athletic trainers is huge because they play a big part in safely returning athletes to play.

The most commonly used guidelines, the Zurich guidelines, state that if a player is symptom free for one week, they can return to graduated play, which means starting low and stepping up activity if the athlete remains symptom free.

In this regard, Eicher must trust the trainers to know what they are doing.

Knowledgeable primary care, sports medicine, and orthopedic physicians are important because they act as a gateway, determining who needs a referral to a neurologist. “It doesn’t all have to come to me, but it’s important to have the strong knowledge and education at all levels: athletic trainers, coaches, parents, and doctors,” says Eicher. ◆ 16 M.D. UPDATE

SPECIAL SECTION  ORTHOPEDICS & SPORTS MEDICINE

Pediatric Orthopedic Surgeon Embraces the Shriners Hospital Tradition Patient care, teaching, and research combine for the perfect job BY GIL DUNN

“It’s the perfect position for me, both sides of the coin,” says Todd Milbrandt, MD, pediatric orthopedic surgeon at Shriners Hospital for Children in Lexington and program director for the Department of Orthopaedic Surgery at the UK College of Medicine. “I can tend to the needs of children with orthopedic deformities, teach the next generation of orthopedic surgeons, and be involved in research that discovers biologic solutions to complex pediatric orthopedic problems.”

Milbrandt admits to “wearing several hats” throughout his busy week. As program director for UK’s Department of Orthopaedic Surgery he oversees 25 residents, (five residents per year for five years each) through their orthopedic rotations.

In addition to the “nuts and bolts of orthopedic rotations,” Milbrandt says he ensures that each resident has the training in “ethics, professionalism, and practice management to be not only a good orthopedic surgeon, but a good doctor as well.”

The ability to teach and train his residents is enhanced by the “protected teaching time” at Shriners Hospital. “It is my best case scenario,” says Milbrandt. “We see the acute cases at UK where the pressure is on to make an evaluation and treatment quickly due to trauma or infection. At Shriners, our decisions have a different timetable because the surgeries are elective.”

The Shriners experience, philanthropic care for all children with orthopedic problems, was the impetus for Milbrandt’s move to Lexington in 2005 after his pediatric orthopedic specialty training at Texas Scottish Rite Hospital in Dallas. Milbrandt received his medical degree from the University of Virginia School of Medicine with a secondary degree, MS in surgical research. He completed his residency in orthopaedics at the University of Virginia

LEXINGTON

Health Sciences Center.

Research is the creative part of his work week, says Milbrandt, “the time to think out of the box.”

“We have a continuing collaborative relationship with Dr. David Puleo, director of Biomedical Engineering at UK. We presented on scaffolding for regeneration

PHOTO COURTESY SHRINERS HOSPITAL

what’s causing you not to wear the brace?” says Milbrandt. And, “How can we help?”

A pain study for reducing pain response in children with spine deformities is another research interest for Milbrandt.

Funding for orthopedic research at Shriners comes from various sources, in addition to Shriners International, the hospital’s research efforts are largely supported by Kosair Charities in Louisville.

Additional funding comes from NIH grants, the Department of Defense, and the Pediatric Orthopaedic Society of North America (POSNA).

In recent years, the decision was made system-wide through Shriners Hospitals to accept payment for services through insurers. Shriners still provides philanthropic orthopedic and burn care to all children, regardless of ability to pay, but accepting insurance payment helps the economies of ABOVE Todd Milbrandt, MD, pediatric orthopedic surgeon and program director at UK Department healthcare, says Milbrandt, and of Orthopaedic Surgery allows Shriners to continue its RIGHT Milbrandt casting for club foot “any child, any time, mission.”

LEFT Shriners Hospital of Lexington physicians are Another change in the Shriners (l-r front) Vishwas Talwalkar, MD; Henry Iwinski, model is that referrals are not MD, Chief of Staff; Todd Milbrandt, MD; (rear) necessary; patients’ families may Kit Montgomery, MD; Janet Walker, MD. Not pictured Scott Riley, MD, and Ryan Muchow, MD. contact Shriners Hospital directly to schedule an evaluation by of growth plate tissue. We have two current an orthopedic specialist. clinical studies: one is an infection model There are five pediatric orthopedic which treats osteomyelitis with an injectable surgeons on staff at Shriners Hospital in and an injectable treatment for Legg-Calve- Lexington, which Milbrandt says is “very Perthes disease to restore blood flow to the rare for a city the size of Lexington, and head of the femur,” he says. each staff member has a particular area Shriners Hospitals has a long history of of specialty expertise.” Janet Walker, MD, pediatric orthopedic research, over 50 years specializes in limb lengthening surgeries. in Lexington from which Milbrandt and Vishwas Talwalkar, MD, specializes in early his colleagues can draw, “the biggest being onset scoliosis in infants. Ryan Muchow, clubfoot disease.” Milbrandt says they have MD, specializes in hip relocation and large developed a monitoring system to deter- hip procedures. Scott Riley, MD, is a conmine whether children are wearing their genital hand deformity specialist and comorthotics or braces. When data shows the plex hand trauma surgeon. Henry Iwinski, brace is not being worn, “Then we can ask, MD, chief of staff, is a spine expert. ◆ ISSUE#79 17

COMPLEMENTARY CARE

Frazier Rehab Institute Launches EMERGE

4 Mile Run

and 1.5 Mile Walk

Saturday, August 10 Run with ALL Your Hart and the Sarah Roberts Hart Fund was established in honor of Sarah's life and dedication to her family, faith, education, and to her profession as a pharmacist. The Fund will provide scholarships for area students pursuing careers in the fields of pharmacy and/or medicine.

An am�ing �perience the whole community gets behind!

Register today at www.runwithallyourhart.com Starting at the Russell County Auditorium in Russell Springs, KY at 8:00 AM (CT) on SAT AUG 10.

Cost is $20 before August 1, $25 before August 10, and $30 on Race Day. 18 M.D. UPDATE

Program to aid recovery of severe brain injury patients BY BARBARA MACKOVIC Frazier Rehab Institute, part of KentuckyOne consciousness, she began physical, occupaHealth, is now among one of few facilities tional, and speech therapy. in the nation to provide specialized care to Emily regained consciousness and while individuals with disorders of consciousness. she continues to recover from severe brain The renowned, comprehensive rehabilita- injury, she has made tremendous improvetion center recently launched a new pro- ments. Before going home to continue gram called EMERGE to help individuals outpatient therapy, she was able to respond with a disorder of consciousness emerge and verbally with yes or no responses and demregain capabilities. onstrate her sense of humor. Her memory When a traumatic or non-traumatic and balance continue to improve, and she injury to the brain causes a person to lose is more communicative. She can walk with consciousness, as the person comes out of a assistance and is slowly regaining many of coma, he or she may remain in a vegetative the skills she lost as a result of her injury. or minimally conscious state. This state is Emily is a prime example of why procalled a disorder of consciousness. grams like EMERGE are both necessary For many years, these individuals have and successful. been denied rehabilitation because it was The goals of the EMERGE program felt they would never recover or emerge are to: from this low level state.  Achieve medical stability “Historically, people in this state have  Increase the patient’s level of responoften been thought not to justify rehabilita- siveness to allow greater participation in rehab tion care and have been sent to a nursing  Train families to provide the care facility or home family care,” said Darryl needed for an eventual return home Kaelin, MD, medical direcPatients typically remain tor, Frazier Rehab Institute. in the program four to six “Research has demonstratweeks. Once they emerge to ed that aggressive medical a higher level of consciousand rehabilitation care can ness, they are transitioned improve both functional to the facility’s acute brain abilities and quality of life injury program. for these patients. At Frazier The EMERGE program Rehab, we’re seeing examples utilizes the Coma Recovery of just that.”

Scale (CRS) as a tool to The first patient admitmonitor improvements in ted to the program at Frazier patients with disorders of Rehab was Emily Holmes, Dr. Darryl Kaelin is the consciousness. The scale 20, from Fort Campbell, medical director of Frazier consists of 23 items addressKentucky. Emily suffered a Rehab Institute. ing auditory, visual, motor, traumatic brain injury during oromotor, communication a car accident in January 2013. After sev- and arousal functions that help physicians eral weeks of care at University of Louisville recognize even small changes in abilities.

Hospital, also part of KentuckyOne Health, One challenge is the ongoing education Emily could not walk or speak. of payors about the benefits and success of She was transferred to Frazier Rehab programs like EMERGE. Since it is not to begin rehabilitation therapy in the common, many insurance companies are EMERGE program. While being treated not familiar with this type program and with medications to help her regain full may be hesitant to provide coverage.

Many times, through education and outreach, providers will allow patients to be admitted for a limited time and monitor results closely to determine if it will cover continued care. “If we feel very optimistic, we will negotiate for smaller amounts of time and hope to see improvements that convince the insurance company to let us keep patients longer,” Kaelin said. The program is cost effective for payors in that it improves the patient’s ability to function and decreases caregiver burden. In the long term, this reduces costs for care.

According to Kaelin, historically, programs such as EMERGE at Frazier Rehab have a success rate of 60 to 70 percent. “That says a lot about this level of rehabilitation for the patient and the families,” Kaelin said. “With the right rehabilitation, you can take someone who otherwise was given no hope and give them the life they had before.” ◆

COMPLEMENTARY CARE

Emergency Treatment Needed for Sudden Hearing Loss

BY KATHRYN SANDUSKY, AUD Hearing loss, whether of gradual onset or sudden, is often dismissed as a non critical condition.

Granted, it is not a life or death matter, but hearing is our primary connection to the world around us.

And if it is missing, so is our ability to “connect” with family, friends, co-workers, etc. It is assumed by many professionals that “we all lose some hearing as we age, so it is just part of the process” and nothing is done to help these individuals.

Sudden hearing loss is particularly devastating. Patients’ lives are significantly affected by sudden hearing loss and overwhelming tinnitus.

Functional deficits can be catastrophic. Generally, these patients are initially treated with antibiotics for their hearing loss but not given an audiometric evaluation. Then they usually experience aural fullness that lasts for days to several weeks.

Commonly, they experience psychological difficulties, depression that affects their very quality of life.

It is usually not until this point that an audiologist or ENT physician is consulted. By this time, the benefits of treatment can be limited or lost. Sudden hearing loss should be treated much more aggressively and immediately than current standards of practice. If treated promptly, hearing improvement, if not hearing recovery, and patient quality of life are possible.

If treated as an ENT/audiological emergency, early diagnostic testing (site of lesion), counseling, sound therapy, and tinnitus treatment can substantially reduce the effects of sudden hearing loss. In the case of sudden hearing loss, a referral should be made to an ENT physician within 24 to 48 hours.

With immediate action, a greater benefit and lessened burden will be seen for the patient.

Kathryn Sandusky, AuD, FAAA, is owner of Central Kentucky Audiology in Lexington. Reach her at (859) 277-5090. ◆

ISSUE#79 19

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NEWS  EVENTS  ARTS

Yson joins Baptist Medical Associates 

LOUISVILLE Angelino Yson, MD, endocrinology, has joined Baptist Medical Associates at 4003 Kresge Way, Ste. 400.

Yson is a 1982 graduate of the University of the Philippines College of Medicine. He completed an internal medicine internship at Philippine General Hospital in 1983. He completed his internal medicine residency at Atlantic City Medical Center in Atlantic City, New Jersey, in 1988. Yson completed an endocrinology fellowship at University of Connecticut Health Science Center in Farmington, Connecticut, in 1989, and an endocrinology fellowship at the University of Medicine and Dentistry of New Jersey in Newark, New Jersey, in 1990. He is board certified in internal medicine and endocrinology, diabetes, and metabolism.

Floyd Memorial Board of Trustees Welcomes Donn R. Chatham, MD 

The Floyd County Commissioners recently appointed Donn R.

NEW ALBANY, INDIANA

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Chatham, MD, to serve on Floyd Memorial Hospital and Health Services’ Board of Trustees. Chatham began his term on May 28, 2013. He replaces Stuart Eldridge, MD, who has served for over six years and made many significant contributions to Floyd Memorial during his tenure.

Chatham is a board-certified, fellowship-trained facial plastic and reconstructive surgeon with Chatham Facial Plastic Surgery and Medical Skin Care in New Albany and Louisville with over 28 years’ experience.

In addition to his practice, Chatham is also a clinical instructor of otolaryngology at the University of Louisville Medical School, has served on the board of directors of the Greater Louisville Medical Society, is a past president of the Floyd County Medical Society, a past chairman of the Floyd County Board of Health, and was a three-term board member and president of the American Academy of Facial Plastic and Reconstructive Surgery in 2008-2009.

Sts. Mary and Elizabeth, University of Louisville Hospitals recognized by KODA

LOUISVILLE Sts. Mary and Elizabeth Hospital and University of Louisville Hospital, part of KentuckyOne Health, have been awarded the 2012 “Tissue Donations Performance Award” by the Kentucky Organ Donor Affiliates (KODA).

The award is presented to a select group of hospitals that have achieved or exceeded a targeted conversion rate for tissue donation.

Due to these hospitals’ efforts, more tissues were available to enhance the lives of patients through the gift of tissue dona20 M.D. UPDATE

tion. Donated tissues may help renew sight through cornea transplantation, provide skin for burn victims, bone for spinal surgeries and cancer, veins for heart bypass surgery, and heart valve replacements for children and others.

Adamkin Elected President of Southeastern Association of Neonatologists

LOUISVILLE University of Louisville neonatologist David Adamkin, MD, has been elected president of the Southeastern Association of Neonatologists, a professional organization of 250 neonatologists. The mission of the organization is to provide for the betterment of the educational and professional objectives of individuals in the practice of neonatology in the Southeastern United States.

A professor of pediatrics, Adamkin is director of the Division of Neonatal Medicine, co-director of the Neonatal Fellowship Program, and director of Neonatal Nutrition Research at the University of Louisville Department of Pediatrics. Neonatal nutrition is his area of research interest. He has authored over 84 articles, 37 book chapters, 5 books, and 11 webinars dealing with methods and strategies to nourish premature infants.

Adamkin completed a neonatal

Congratulations to the 2012-2013 class of Fellows that recently completed the Christine M. Kleinert Institute for Hand & Micro Surgery (CMKI) ACGME accredited Fellowship Program in Louisville, KY. More than 1,274 physicians from 61 countries have received training in hand surgery as clinical fellows, research fellows, or residents since the program was started in 1960 by Harold Kleinert. Seated in front Row (left to right, all CMKI staff): Tuna Ozyurekoglu, Michelle Palazzo, Thomas Wolff, Joseph Kutz, Tsu-Min Tsai, Luis Scheker, Huey Tien, Yorell Manon-Matos. Second Row (left to right): Julia Mayberry, Camela Pokhrel, Anas Altamimi, Luis Latorre, Hagop Manushakian, Takehiko Takagi, Henry Calleja, Dong Han, Hua Tang, JiYin He. Third Row (left to right): David Graham, Jeffrey Williams, Shihheng Chen, Ari Mayerfield, Christiana Savvidou, Terence Tay, Elkin Galvis, Todd Ruiter, Leela Farr, Bahar Bassiri, Antonio Rampazzo, Horatiu Dancea, Carlos Lozano.

medicine fellowship at the University of Louisville after completing a pediatric residency at the State University of New York Upstate Medical School, where he also earned an MD.

pediatric disease in the areas of diabetes, neurobiology, and cancer.

Cai earned an M.D. in general medicine and Ph.D. in radiation medicine at Cai to Lead UofL Pediatric Norman Bethune University Research Institute of Medical Science, LOUISVILLE Lu Cai, MD, PhD, has been Changchun, China. A profesappointed to lead the University of sor of Pediatrics and Radiation Louisville Department of Pediatrics Kosair Oncology, he joined the Children’s Hospital Research Institute faculty of University of (KCHRI), which supports basic science Louisville in 1999. Cai has research programs dedicated to the discov- more than 130 peer-reviewed published ery of fundamental knowledge relevant to manuscripts in high-impact journals such

UofL Pediatricians Selected for AAP Committees

ident of the Kentucky Chapter of the American Academy of Pediatrics. He serves on the board of the Kentucky Two University of Louisville Pediatric Society Foundation pediatricians have been cho- and is the director of newborn sen to serve on prestigious screening programs at several national American Academy of local hospitals. Additionally, Pediatrics committees.

Stewart has Neonatologist worked internaDan L. Stewart, MD, tionally to prohas been selected to mote improveserve on the American ments to neoAcademy of Pediatrics natal care, Committee on the traveling to Fetus and Newborn countries such (COFN), which is as Romania, comprised of nine Moldova, members. This high- Dan L. Stewart, MD Russia, Poland, ly-selective commitG h a n a , tee studies issues and E c u a d o r, current advances in fetal and and Vietnam. He has been neonatal care; makes recom- the primary investigator on mendations regarding neona- numerous National Institutes tal practice; and collaborates of Health-funded pharmacolwith the American College of ogy studies as well as studies Obstetricians and Gynecologists. involving high frequency oscilStewart is assistant director latory ventilation, surfactant, of the Division of Neonatal and inhaled nitric oxide. He Medicine and director of has authored 70 peer-reviewed nurseries for Kosair Children’s publications and several book Hospital—the seventh larg- chapters. est NICU in the U.S.—and Stewart is board certified the University of Louisville in pediatrics and neonatalHospital. Stewart is a past pres- perinatal medicine, having

as Circulation, Journal of the American College of Cardiology, and Diabetes.

His research has been recognized nationally and internationally and he serves as an active member of both national and international diabetes foundations.

Cai’s research focuses on the cardiovascular complications of diabetes with an emphasis on novel mechanisms to protect the heart. His research team uncovered the first evidence that zinc may

completed a fellowship in interests center around invesneonatology at the University tigator-initiated studies, Phase of Louisville. He attended I-IV industry-sponsored clinithe University of Louisville cal trials and collaborations for medical school and the with other centers including Medical College of Virginia the NIH funded Pediatric and pediatrics residency.

Trials Network (Duke Clinical University of Louisville Research Institute). She has pediatrician Janice Sullivan, been the principal investigator MD, has been selected to serve or sub-investigator on over 200 on the American Academy clinical trials. She also mainof Pediatrics Committee on tains an active critical care pracDrugs. This national com- tice and has served as a member mittee reviews all aspects of of the University of Louisville pediatric pharmaBiomedical cology including Institutional drug indications, Review Board dosing, and use (HSPPO) since precautions. The 1998. She is the committee also author of 24 peeradvises the board reviewed publiof directors in matcations primarters related to drug ily in the areas of labeling, safety, and pediatric clinical efficacy for both Janice Sullivan, MD pharmacology and prescription and critical care. over-the-counter drugs; moniSullivan is board certified tors federal legislation related to in pediatrics, critical care, and the drug approval process; and clinical pharmacology. She promotes the need for expand- completed fellowships in pedied pediatric drug trials. atric pharmacology and critical Sullivan is the chief and care at Case Western Reserve medical director of the Kosair University/Rainbow Babies Charities Pediatric Clinical and Children’s Hospital in Research Unit. Her research Cleveland, Ohio.

ISSUE#79 21

NEWS

protect the heart from diabetes-induced dysfunction and are identifying the cellular mechanism that regulates this effect.

Serum zinc levels correlate with a spectrum of human diseases. Cai and UofL pediatric endocrinologist Kupper Wintergerst plan to investigate the role of zinc in insulindependent children with diabetes.

UK HealthCare to Add Cardiovascular Beds

LEXINGTON UK HealthCare has announced plans to open 64 more beds in Pavilion A of the University of Kentucky Albert B. Chandler Hospital subject to approval by the Board of Trustees.

The eighth floor of the 12-story pavil-

24th Annual

BB&T/Lexington Medical Society Golf Outing

Wednesday, August 28, 2013 | 1:00 p.m.

University Golf Club of Kentucky Format: Shamble Tournament (Play best drive then own ball to the hole)

Teams: Put together own Foursome Or Committee will help form teams

Golf – Individual Players | $100.00/person Hole Sponsorship | $500.00

(includes signage & newsletter recognition)

Hole Sponsorship with 4 Players | $800.00 (includes signage & newsletter recognition) White Tee Sponsorship | $2,000.00

(includes banner recognition, newsletter recognition, hole sponsorship & four players)

Gold Tee Sponsorship | $6,000.00 BB&T Get your team together, sponsor a hole and register to play!

More information will be sent out soon. Please contact a committee member or call Jaime Verba at LMS office 859.278.0569 with questions or to sign up.

Committee Members John W. Collins, M.D., Chairman

James W. Baker, M.D.

Wendy G. Cropper, M.D.

W. Lisle Dalton, M.D.

Kenneth V. “Tad” Hughes, III, M.D.

John Maher, BB&T

David Smyth, Family Financial Partners

Jon H. Voss, M.D. Gil Dunn, M.D. Update

All proceeds to benefit the Lexington Medical Society Foundation.

MC-8820 4.8542x7.25 Golf Outing Save the Date.indd 1 22 M.D. UPDATE

4/22/13 11:38 AM

ion is targeted for completion in the fall of 2014, said Dr. Michael Karpf, UK executive vice president for health affairs.

The $30 million project includes 24 intensive care unit beds that will meet the sophisticated needs of UK HealthCare’s comprehensive cardiovascular program that includes patients with complex advanced subspecialty needs such as transplantation, artificial hearts, and ventricular assist devices.

Overall, construction and expansion of the new Pavilion A at UK Chandler Hospital is expected to support patient care for the next 100 years. Once fully fit out, the 1.2 million-square-foot facility will include 512 state-of-the-art private patient rooms. When combined with the Kentucky Children’s Hospital, the facility will have a total of 671 private rooms.

UK HealthCare Joins Eastern Kentucky Healthcare Coalition

UK HealthCare at the University of Kentucky and St. Mary’s Medical Center in Huntington, West Virginia, are now members of the Eastern Kentucky Healthcare Coalition. The two organizations join original members Highlands Regional Medical Center (Prestonsburg, Kentucky), Our Lady of Bellefonte Hospital (Ashland, Kentucky) and St. Claire Regional Medical Center (Morehead, Kentucky) in the coalition.

The mission of the Eastern Kentucky Healthcare Coalition, as written in the organization’s mission statement, is to “develop a clinically integrated network of healthcare providers to enhance the health status of our communities in an accountable and responsible manner.” In the coalition, each facility maintains its autonomy while working together on select projects that provide collective efficiencies for the hospitals (such as vendor contracts), improve patient access (through coordinated health events to provide greater patient access while eliminating duplication of efforts) and prepare for the reforms of the Affordable Care Act in addition to other integration.

LEXINGTON

NEWS

James Graham Brown Cancer Center Honored Among Select Few Continuously Accredited Cancer Centers

LOUISVILLE James Graham Brown Cancer Center, part of KentuckyOne Health, has been recognized as one of only 21 cancer programs across the nation, and the only cancer program in Kentucky, that has maintained their accreditation for at least 65 consecutive years (starting in 1948). The Commission on Cancer released a report in May that honors this milestone of consistent quality for cancer programs across the country.

CoC-accredited programs provide their community with high-quality, multidisciplinary patient-centered care. CoC programs evolve in response to new diagnostic treatments, quality assurance, and improvement initiatives, and the needs of cancer patients throughout the U.S. A facility receives a Three-Year Accreditation with Commendation following the onsite evaluation by a physician surveyor during which the facility demonstrates a Commendation level of compliance with one or more standards that represent the full scope of the cancer program (cancer committee leadership, cancer data management, clinical services, research, community outreach, and quality improvement). In addition a facility receives a compliance rating for all other standards.

Ephraim McDowell Regional Medical Center receives Quality Award from Kentucky Hospital Association

DANVILLE For the second time in just three years, Ephraim McDowell Regional Medical Center (EMRMC) has been recognized for the high quality of care given to knee & hip replacement patients and for spine and laminectomy surgical care.

On May 10, EMRMC received the 2013 Kentucky Hospital Association (KHA) Quality Award. The KHA Quality Award is presented to honor hospital leadership and innovation in quality, safety, and commitment in patient care.

“This award from the Kentucky Hospital Association further validates the four Gold

LEFT TO RIGHT Joyce Young, director of Surgical Services, Tonya Brady, director of OrthoSpine Center, Ron Barbato, director of Rehabilitation Services, and Harold C. Warman, Kentucky Hospital Association Board Chair.

Seals of Excellence previously awarded to EMRMC by The Joint Commission for providing such high quality care for our orthopedic and spinal patients,” says Vicki A. Darnell, president & CEO, Ephraim McDowell Health. “Our OrthoSpine Center of Excellence was joined by our physician champions of Danville Orthopedics and Dr. Robert Knetsche of the Central Kentucky Spine Center to achieve the level of teamwork, commitment, and dedication to earn this prestigious recognition.”

EMRMC previously won the KHA Quality Award in 2010 for excellence in our total knee and total hip replacement program.

University of Louisville Hospital Receives Kentucky Hospital Association Quality Award

LOUISVILLE University of Louisville Hospital, part of KentuckyOne Health, has been named a recipient of the 2013 Kentucky Hospital Association (KHA) Quality Award. The facility was recognized at the organization’s annual meeting, which was held on May 11.

The hospital was selected among facilities with 250+ beds and was chosen based on a program implemented in the Medical

Intensive Care Unit (MICU) to reduce the number of infections and pneumonia related to a central line or ventilator.

Through the use of educational campaigns, staff meetings, in-services, checklists, and changes to the patient care provided, the facility has seen sustained infection prevention since its implementation in 2009.

Floyd Memorial Cancer Center of Indiana Receives Susan G. Komen Foundation Grant

NEW ALBANY, INDIANA The Floyd Memorial Cancer Center of Indiana is pleased to announce the recent receipt of a $21,150 grant from the Louisville Affiliate of Susan G. Komen for the Cure®.

By receiving this grant the outreach portion of the Cancer Center of Indiana’s Breast Cancer Nurse Navigator Program will be able to continue to provide care and treatment in the community to underprivileged residents of the New Albany Housing Authority.

The goal of the program is to lessen the burden on breast cancer patients and their loved ones by providing them with a nurse navigator in charge of coordinating their care and treatment. This program helps to improve patient outcomes by insuring the early detection and treatment of breast cancer and well-coordinated communication between patients, physicians and the rest of the healthcare team. ◆ ISSUE#79 23

EVENTS

Go Red for Women Luncheon This year marked the 10th anniversary of the American Heart Association’s Go Red for Women Luncheon, which took place Friday, May 17, 2013, at the Kentucky International Convention Center. The program’s mission is to reduce heart disease in women and educate and empower women to make healthy choices and know their numbers, including cholesterol level, blood pressure, and body mass index. Since Go Red began 10 years ago, 21% fewer women are dying of heart disease and 23% more are aware that heart disease is the number one killer of women.

Approximately 900 women attended the event, which featured health screenings, wellness booths, and a survivor fashion show.

Norton Heart Care sponsored the event because their mission is closely aligned with that of Go Red for Women.

Janet Smith, MD, medical director of Norton Women’s Heart & Vascular Center, LOUISVILLE

Epidurals Facet Blocks

Intrathecal Pumps Vertebroplasty

says her goals are to identify and impact – identify risk factors and impact women’s health in a positive manner. One in every two women has some form of cardiovascular disease, and Kentucky’s high rates of smoking and obesity compound matters. Smith says Norton provides heart risk assessments to educate women about their risk factors and point them towards services when necessary.

Other services include group classes and one-on-one counseling on a healthy diet, the Circle of Hearts – a free monthly education series, and the Norton Weight Loss Center.

Charlotte Ipsan, RNC, MSN, NNPBC, is the president of Norton Women’s and Kosair Children’s Hospital. She says the partnership with Go Red is a natural extension of the services they already provide for women. “We do more deliveries than anyone in the state on our St. Matthews campus … well over 5,000 deliveries a year.

There are so many cardiovascular risks asso-

Dr. Janet Smith, medical director of Norton Women’s Heart & Vascular Center, and Charlotte Ipsan, RNC, MSN, NNP-BC, president of Norton Women’s and Kosair Children’s Hospital, were two of the speakers at the Go Red for Women Luncheon.

ciated with pregnancy,” says Ipsan. Those risks include: preeclampsia, gestational diabetes, pregnancy-induced hypertension, and babies small for gestational age, which doubles the risk for subsequent heart disease within the next five to 15 years.

Ipsan spoke to the Go Red for Women Luncheon audience about the obligation women have to help educate each other. “It really is our goal to take control of this and empower women to take their health to heart … We have to be open to listen and we have

Spinal Cord Stimulation Neurolytic & Sympatholytic Denervation

The Kentuckiana Go Red for Women Luncheon celebrated its 10th anniversary on Friday, May 17, 2013 at the Kentucky International Convention Center.

to be willing to do something about it,” says Ipsan.

The Norton Women’s Heart & Vascular Center is located on the Norton Suburban Hospital campus, which is currently being transformed into the Norton Women’s and Kosair Children’s Hospital, a $90 million construction project that will add 131,000 additional square feet of clinical space dedicated to women’s services. ◆ 24 M.D. UPDATE

© 2013 Baptist Health

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