MD-UPDATE Issue #103

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #103 WWW.MD-UPDATE.COM

SPECIAL SECTION ONCOLOGY/HEMATOLOGY

Focal Point VOLUME 7 • #7 • OCTOBER 2016

First Urology pioneers high intensity focused ultrasound (HIFU) treatment for prostate cancer ALSO IN THIS ISSUE • PERSONAL EXPERIENCE SHAPES ONCOLOGY PRACTICE • ADVANCES IN HEMOPHILIA AND BLOOD CANCERS • INDIVIDUALIZED ONCOLOGY • CME PROGRAM TARGETS LUNG CANCER

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To learn more about treatment options available at the Brown Cancer Center go to BrownCancerCenter.org or call 502.562.HOPE (4673).

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LETTER FROM THE PUBLISHER

Louisville Mayor Inspires with Example of Giving and Equality Welcome to MD-UPDATE, the oncology and hematology issue.

I had the opportunity over 10 days in October to attend three events related to healthcare in Kentucky that, in my opinion, showed the best of people. I went as a participant and an observer to Colors of Courage, Yes, MAMM!, and The Doctors’ Ball. There are photographs for Colors of Courage in this issue, and we’ll have photos from Yes, MAMM! and The Doctor’s Ball in the next issue of MD-UPDATE. What I found so moving after this series of events that engaged thousands of Kentuckians, each of whom had a personal connection to the particular cause at hand, was the profoundly positive energy and optimism of those assembled.

Colors of Courage, presented by Hope Scarves, raises money for metastatic breast cancer research. Yes, MAMM!, presented

by KentuckyOne Health Saint Joseph Hospital Foundation, is a 5k race that raises money for mammograms for low income women. The Doctors’ Ball, presented by KentuckyOne Health Jewish Hospital & St. Mary’s Foundation, honors Louisville’s “finest physicians, medical, and civic leaders.” The Foundation has a long history of providing financial resources for multiple improvements in healthcare in the Greater Louisville area, the most recent being a $825,000 renovation to the Pulmonary Rehab Program at Frazier Rehab Institute.

At The Doctors’ Ball, Louisville Mayor Greg Fischer spoke of his parents, George and Mary Lee Fisher, who were honTo date, Hope Scarves has sent over ored as Community Leaders of the Year. Mayor Fisher recalled 6,000 scarves to those undergoing the example that his parents set when he was growing up. cancer treatment, reaching every “Treat everyone the same,” was his mother’s motto, he said. state in the US and nine foreign And, “If you see someone who needs help, give them a hand,” countries. The oldest recipient is 92 and the youngest is five. (See was Fisher’s memory of his father’s modus operandi. pg. 32 for more Hope Scarves and So simple and so powerful.

Colors of Courage photos.)

Sitting here mid-October, three weeks away from Election Tuesday, listening to Sunday morning news programs about an absurdly negative presidential campaign, I am heartened by the compassionate, uplifting spirit and actions of thousand of fellow Kentuckians who freely give of themselves and their resources to others.

I applaud each and everyone one who attended and participated in these events, as well as the thousands of providers who daily follow the example of George and Mary Lee Fisher: “Treat everyone the same, and if you see someone who needs help, give them a hand.”

All the Best,

Gil Dunn, Publisher Send your letters to the editor to: jnewton@md-update.com, or (502) 541-2666 mobile Gil Dunn, Publisher: gdunn@md-update.com or (859) 309-0720 phone and fax 2 MD-UPDATE

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CONTENTS

ISSUE #103

4

HEADLINES

5

FINANCE

6

ACCOUNTING

7

LEGAL

9

Q&A

10 Focal Point First Urology pioneers high intensity focused ultrasound (HIFU) treatment for prostate cancer 14 SPECIAL SECTION: ONCOLOGY/HEMATOLOGY 23 COMPLEMENTARY CARE 25 EDUCATION & ADVOCACY 28 NEWS

Pictured (l-r) John Jurige, MD, and John Eifler, MD.

31 EVENTS

SPECIAL SECTIONS ONCOLOGY/HEMATOLOGY

14 M ORE THAN A BENIGN INTEREST: OWENSBORO HEALTH

17 H EMOPHILIA, HODGKIN’S DISEASE, AND MULTIPLE MYELOMA: KENTUCKYONE HEALTH

19 N EW AND GROWING SUSTAINABLY: BAPTIST HEALTH LEXINGTON

21 T REATMENTS MAY VARY: BAPTIST HEALTH FLOYD

ISSUE #103 3

Headlines

Physicians at Baptist Health Lexington First in City to Implant Naturally Dissolving Heart Stent Physicians at Baptist Health Lexington were the first in Lexington to implant the recently approved coronary stent that slowly dissolves into a vessel. The new dissolving heart stent, called Absorb bioresorbable vascular scaffold, offers patients with coronary artery disease a new treatment option that opens a blocked vessel, helps to enhance blood flow, and then disappears over time.

Following federal Food and Drug Administration approval of the Absorb device July 5, physicians at Baptist Health Lexington implanted the hospital’s first Absorb stent in a Danville woman August 22. Its sister hospital, Baptist Health Louisville, was the first hospital in Louisville to treat a patient with the new stent July 26. Both hospitals participated in national clinical research trials that helped lead to FDA approval of the new stent. As of September 1, Baptist Health was the only hospital system in Kentucky currently implanting the new stents.

Stents are used to treat coronary artery disease by opening clogged vessels. Made of biodegradable polymer similar to what is used in dissolving stitches, Absorb naturally dissolves in about three years except for two pairs of tiny metallic markers that remain to enable a physician to see where the device was LEXINGTON

4 MD-UPDATE

The bioresorbable vascular scaffold (Absorb) was designed to provide scaffold support to the coronary artery needed directly after balloon angioplasty, but dissolves over time.

— Dr. Tyler Richmond

Tyler Richmond, MD, is an interventional cardiologist with Baptist Health Medical Group Lexington Cardiology.

placed. Conventional stents are mesh-like, made of metal, and the entire devices stay in a patient’s body for life.

The new Absorb stent, developed by Abbott Laboratories, promotes more natural healing of the treated area, explained interventional cardiologist Tyler Richmond, MD, with Baptist Health Medical Group

PHOTO PROVIDED BY BAPTIST HEALTH LEXINGTON

Lexington Cardiology.

“After a cardiologist opens a clogged artery with a balloon, there often is trauma to the artery, which requires scaffolding (a stent) to keep the artery open,” Richmond said. “After this trauma, the artery starts to remodel itself.

The bioresorbable vascular scaffold (Absorb) was designed to provide scaffold support to the coronary artery needed directly after balloon angioplasty, but dissolves over time to allow for this remodeling process and to allow the artery to pulse and flex like it naturally does.”

Coronary artery disease affects 15 million Americans and is a leading cause of death worldwide. About 850,000 patients in the United States are treated with conventional stents each year.

Finance

Will I Be Okay?

BY SCOTT NEAL

One of the key questions on the minds, if not the lips, of your patients is likely to be, “Am I going to be okay?” This has also become the most frequent question posed to us by our clients and friends. Of course, we deal in the realm of financial well-being, not one’s actual health.

We first must identify more precisely what our clients mean by “okay.” In less volatile times, most are referring simply to whether they will run the risk of running out of money while they are still alive. As the volatility of the market has picked up over the past 16 months and recollection of the Great Recession looms large in the memory of some, okay-ness has been more focused on the short run. What can I do to protect myself from the next downturn?

We even heard the corollary by one person, “How can we be prepared to make money in the next downturn of the market?” He had just seen the movie, “The Big Short.” In other words, people are now telling us, “I might feel good about the long run; right now it’s the short term that concerns me most.”

The traditional advisor deals with this by refocusing attention on the long term, usually 20 plus years. This totally ignores the important fact that losses in the near term are more costly to your long run scenario than losses that occur later in life. We call this return-sequence risk.

Recent studies call into question the effectiveness of a static asset allocation that remains the same over long periods. Such thinking defines risk as volatility. If risk were defined as the loss of capital, one antidote would be a trading plan coupled with strong risk management. Let’s explore some of the elements of such a plan.

Have a positive expectancy. Develop a system and select investments with a rational mathematical expectation of positive return.

Although you fully expect it to go up, decide ahead of time when you will get out if you are wrong and the market moves against you.

Place and move stops. When a trade is entered, a stop level should be set — that is the point at which you would accept a small loss and exit the position. If the position that you have purchased does go up, move up the stop.

This is called a trailing stop. We prefer soft stops (those without an actual order) that serve as alerts for further evaluation.

Set a maximum allowable risk for any trade. Some use two percent, we prefer a max of one percent. So let’s say that you have $500,000 in your account. This rule limits your maximum risk on any trade to $5,000.

Further, let’s say that you decide you are going to buy a stock valued at $80 and put a stop just below support at $75. That means that divid-

ing your maximum risk per position ($5,000) by the risk per share ($5) allows you to buy not more than 1000 shares.

Set a maximum monthly drawdown. Set a rule for the maximum loss that you will allow in your portfolio on a monthly basis.

We suggest six percent but that may vary with your tolerance for risk. This rule prohibits you from making any new trades for the rest of the month when the sum of your losses for the current month plus the risk of your open positions exceeds six percent of your account equity. Simply take a break from trading or find something to sell to reduce the risk currently in your portfolio.

Diversification is still a good idea, even in trading systems. Overconcentration of one security or one asset class can be ruinous.

Likewise, loading the portfolio with highly correlated securities that move in lockstep with each other should also be avoided.

If you would like to know more about these concepts, I suggest Dr. Alexander Elder’s book, The New Trading for a Living.

Scott Neal is president of D. Scott Neal, Inc. a fee-only financial planning and investment advisory firm with offices in Lexington and Louisville. Call 1-800-344-9098 or email to scott@dsneal.com.

2016 Editorial Opportunities

EDITORIAL TOPICS ARE SUBJECT TO CHANGE

Issue #104 (December)

Issue #105 (January 2017)

IT’S ALL IN YOUR HEAD

PRIMARY CARE AND PEDIATRICS

Neurology, Ophthalmology, Pain Medicine, Mental Health

Primary Care, Internal Medicine, Family Medicine, Pediatrics

TO PARTICIPATE CONTACT GIL DUNN, PUBLISHER | gdunn@md-update.com | 859.309.0720 JENNIFER S. NEWTON, EDITOR-IN-CHIEF | jnewton@md-update.com | 502.541.2666

SEND PRESS RELEASES TO: news@md-update.com ISSUE #103 5

Accounting

Changes to Provider-Based Reimbursement Rules and the Impact on Services

BY SHAWN STEVISON As Medicare has continued to tighten the reimbursement rates across all payment classifications, a spotlight has been placed on outpatient, off-campus provider-based clinics.

Prior to the Balanced Budget Act (BBA) of 2015, hospitals were free to purchase physician practices and convert the practices to hospital-based reimbursement. Under the hospital-based reimbursement structure, hospitals could bill for a facility fee, and physicians could bill for the professional fee, resulting in higher reimbursement than under the physician fee schedule (MPFS) structure.

The BBA changed the narrative. Effective November 1, 2015, hospitals could still purchase and operate clinics, but the clinics could no longer be established as provider-based and receive the reimbursement bump. All clinics established after November 1, 2015 instead can only be reimbursed based on the physician fee schedule. In addition, with the loss of the ability to treat new clinics as provider-based, hospitals are also losing the ability for those new locations to benefit from medications purchased under the 340(B) drug purchasing program.

In July 2016, Medicare issued the draft outpatient prospective payment system guidance (OPPS). In the draft guidance, Medicare is proposing that effective January 1, 2017 all off-campus provider-based departments

established after November 1, 2015 must bill and be paid under the appropriate reimbursement methodology, which Medicare indicates will likely be the Medicare physician fee schedule, unless licensed by hospital systems as ambulatory surgery centers.

In addition, Medicare also has proposed that existing provider-based clinics will maintain a grandfathered status as provider-based, unless the following occurs on or after November 1, 2015: • Change in services offered – the new services would not be covered under the provider-based status reimbursement and would instead need to be billed under the MPFS. • Change in physical location – A practice changing physical location will lose the grandfathered status will have to bill all services under the MPFS. The above information covers the regulation, but what does it mean to a physician?

In short, existing physician groups which were employed by a hospital and have provided services under a provider-based status prior to November 1, 2015 won’t see any changes at this time. Physicians who have become employees of a hospital subsequent to November 1, 2015 and are located in an off-campus location cannot bill under the provider-based status.

This restriction likely will result in the need to evaluate the appropriateness of co-locating physicians in the provider-based department going forward, as well as the billing complications that may ensue when trying to bill each physician appropriately under the regulation.

Additionally, those physicians practicing in a hospital-owned, provider-based department may find the ability to add additional services limited due to the inability to bill for the services under the provider-based reimbursement regulations. The new services would only be billable under the MPFS. Lastly, physicians will likely find themselves locked into their existing office space, as any attempt to move locations would result in the loss of the provider-based status for the clinics.

Physicians should begin the dialog with their hospital partners to understand where the hospitals stand on the current practice and what changes may be coming in the event that additional reimbursement changes are made to eliminate the provider-based reimbursement bump that makes owning physician practices so attractive to hospital systems, beyond the benefits of the continuity of the care continuum.

Shawn Stevison, CPA, CHC, CGMA, CRMA, is the manager of Healthcare Consulting Services at Dean Dorton. She can be reached at 502.566.1066 or sstevison@ddafhealthcare.com.

Focus on what matters most.

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• Revenue cycle assessment and • Reimbursement optimization management • Accounting and financial • Physician coding and documentation outsourcing improvement • Compliance and risk • Managed care contract negotiations management services 6 MD-UPDATE

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Legal

Radiology and Breast Cancer

BY STEPHANIE M. WURDOCK, ESQ., AND MATTHEW D. ZWICK, MD

Breast cancer affects one out of eight women in their lifetime. The primary tool physicians rely upon to detect, treat, and monitor breast cancer is radiology. In this month’s article, healthcare attorney Stephanie Wurdock and radiologist Dr. Matthew Zwick discuss advancements in the field of breast screening and liability issues unique to radiologists.

■■ What role does radiology play in diagnosing and/or treating breast cancer?

Normally, breast cancer is detected and monitored via mammogram, a traditional form of radiology that takes a highly detailed

X-ray image of the breasts. However, other imaging modalities can also be used to screen for, diagnose, and monitor the disease.

Magnetic resonance imaging (MRI) uses a magnetic field, radio waves, and a computer to scan the breast without radiation. MRI is more expensive and more accurate than other methods, and is often reserved for high-risk patients.

Ultrasound imaging uses sound waves to scan the breast without radiation. Ultrasound is not as accurate as a mammogram or MRI, but can be used in conjunction with mammogram screening, and is particularly suited for women under 40.

Digital breast tomosynthesis is the newest technology. By creating 3D images of the breasts, this modality overcomes many limitations of traditional mammogram. Its proponents claim that it is more effective and less painful than other breast screening techniques.

■■ When and how often should women be screened for breast cancer?

This depends on the woman’s risk for breast cancer. For women deemed to be at “average risk” for contracting the disease, the American Cancer Society currently recommends annual screenings from age 45 to 54, and every two years after that. The U.S. Preventive Services

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ISSUE #103 7

Task Force, on the other hand, only recommends screening every two years for women ages 50 to 74. That said, an overwhelming majority of Kentucky physicians recommend annual screening mammograms beginning at age 40. For women who are at a “high risk” of breast cancer, screening usually begins at age 35 (or even earlier), and takes place on a yearly basis.

■■ What liability issues are unique to radiologists?

The vast majority of lawsuits against radiologists involve allegations of missed or delayed diagnosis. Often, the radiologist is accused of failing to identify a lesion or other harmful condition, or failing to adequately communicate the significance of radiological findings to the ordering physician. Interventional radiologists may also be sued for sampling the “wrong” anatomical structure, failing to obtain an adequate sample, or injuring an adjacent structure. Often, the radiologist is only one of multiple defendants named in the lawsuit. The ordering physician, radiology practice group, and facility where the study takes place are frequently co-defendants.

■■ What can radiologists do to minimize their exposure to liability?

First, a radiologist can minimize exposure to liability by staying up-to-date with developments in the field. This is especially true of radiologists who specialize in reading film of a unique patient population or imaging modality. Next, radiologists should state their findings clearly, thoroughly, and as specifically as possible. Radiologists should also document if they have discussions with ordering physicians. Finally, radiologists should report their observations and impressions to the ordering physician in as timely a manner as possible and document that transmission.

■■ Does the patient have any responsibility for his or her medical care?

Under Kentucky law, all patients have a duty to act as a reasonable prudent person.

In general, this means a patient should follow medical advice, stay apprised of all test results, and attend all follow-up visits, if possible.

8 MD-UPDATE

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In terms of radiology, this means that a patient should be diligent in obtaining the results of his or her radiology studies. If a patient does not receive the results within two weeks of the study and a follow-up appointment is not scheduled, the patient should call the ordering physician to obtain the results. If further treatment is recommended, the patient should research, investigate, and weigh her treatment options to the best of her ability. To that end, patients are entitled to seek a second opinion regarding the outcome

of a radiology study or treatment recommendation, and to obtain one free copy of their medical records (which includes radiology reports and images).

Stephanie Wurdock is a healthcare law attorney at Sturgill, Turner, Barker & Moloney, PLLC, in Lexington. She can be reached at swurdock@ sturgillturner.com. Dr. Matthew Zwick is a board-certified radiologist at Central Kentucky Radiology, PLLC, in Lexington. He can be reached at 859.219.0542. This article does not constitute legal advice, nor is it intended to establish the medical standard of care.

Q&A

Q&A with Ronald Waldridge, II, MD KentuckyOne Health Physician Leadership Pathway

MD-UPDATE Editor-in-Chief Jennifer Newton talked with KentuckyOne Health Medical Group’s Physician Executive Ronald Waldridge, II, MD, to learn more about KentuckyOne’s Physician Leadership Pathway program (PLP), an intensive, experiential, eight-month program designed to prepare and support physicians in leadership positions.

Ronald Waldridge, II, MD, is a board-certified family practice physician with KentuckyOne Health Primary Care Associates, where he has been caring for patients in Shelby County for more than 20 years. In addition to his patient care responsibilities, Waldridge serves as KentuckyOne Health Medical Group’s physician executive. In this role, he chairs the Medical Group Board in “dyad” partnership with KentuckyOne Health Medical Group President Charles Powell. He is also the chief medical officer for Jewish Hospital and Our Lady of Peace, both in Louisville. In his spare time, he serves as medical director for Shelby County Emergency Services and is the Shelby County coroner.

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■■ MD-UPDATE: What is the Physician Leadership Pathway?

WALDRIGE: We started the Physician Leadership Pathway as a means of educating physicians about business topics related to the work they are doing in medicine. Why is this important? They need to understand business because medicine is changing from the small, independent practitioner model to one where doctors are often now working in larger systems where the level of complexity has increased exponentially.

We started to look at the tools doctors would need, such as understanding the basics of finance, human resource management, and safety. Our goal is to increase awareness and then provide doctors with the tools they need to take a more active role in leadership. We want to make physicians as comfortable in the board room as they are in operating room, ICU, or their clinics.

■■ What are the next steps?

We are starting phase two. We did eight courses last year and are going to do the same eight courses this year. Then we’re going to add another four courses on top of those, such as fundamentals of health law and advanced contract negotiations. The expectation is for participants to begin to use these tools in their own environment. So, for example, they will work closely with presidents and finance people when it comes to budgeting next year.

■■ When did the PLP program start?

We launched it about a year ago. We’ve graduated our first cohort of 21 doctors. We passed them through eight different modules, covering topics such as negotiations, human resource management, population health, leading the lean enterprise, finance, resolving conflict, communication, teamwork, and more. One of the first courses is “You’re Not Just a Doctor Anymore,” setting the tone for the need for them to expand their understanding of the world they’re working in.

■■ Who is eligible for the program?

Any physician who is an employee of KentuckyOne is eligible for the program.

Physicians are selected and nominated, and then we interview them to make sure they’re going to be committed toward the areas of physician leadership and management. We’re looking for inspired leaders.

■■ Was the program uniquely created for KentuckyOne and who teaches the courses?

The program was uniquely created for KentuckyOne Health in partnership with the American Association for Physician PHOTO PROVIDED BY KENTUCKYONE HEALTH

■■ With the transition to health system employment models, one physician concern has been maintaining a voice in decision-making and leadership.

Is this one of the ways KentuckyOne addresses that concern?

Absolutely. We need to make sure physicians not only have the vocabulary but they have the experience and the mindset needed to work in the board room and to be effective contributors to what’s going on in their environment. Without those bridging tools, we’re going to be at odds with the administration more than we’re going to find common ground. So, the focus of this program is to collapse that distance and make sure that physicians are working side by side with the administrative teams on the only thing that’s important here – and that’s the care of the patient.

■■ What measures of success have you seen so far?

In the areas of quality and safety, we’ve seen dramatic improvements. We’ve seen significant increases in our physician satisfaction scores. Also, we’ve seen the tenor of the conversations is beginning to change. Physicians are finding their own voices now, specifically in our KentuckyOne Medical Group. There’s much more sharing between physicians and their non-clinical colleagues.

ISSUE #103 9

Cover Story

Focal Point First Urology pioneers high intensity focused ultrasound (HIFU) treatment for prostate cancer

BY JENNIFER S. NEWTON LOUISVILLE When I think of Nassau, Bahamas,

and Cancun, Mexico, I picture white sand beaches, crystal blue waters, and vacation resorts. Perhaps the last thing on my mind would be a destination for medical treatment.

But for one group of local urologists, traveling to the Bahamas and Mexico, among other international locales, was the only way to provide their patients with leading-edge therapy for prostate cancer. Until now.

Prostate cancer is the most common cancer in men and affects one out of seven men during their lifetime. The incidence is higher in African-American men and in those with a family history of prostate cancer. The traditional treatments of radical prostatectomy and radiation therapy can be curative but may have life altering side effects, such as urinary incontinence and erectile dysfunction.

Now, a new treatment is available in Louisville for patients with early to intermediate prostate cancer – high intensity focused ultrasound (HIFU). Although it’s been in existence and performed around the world for 15+ years, HIFU was just approved by the FDA in October 2015. An outpatient procedure using ultrasound energy that converges at a focal point to ablate cancer cells and spare normal tissue, HIFU promises results equal to those of conventional treatments with fewer side effects. Thanks to the efforts of John Jurige, MD, and his colleagues at First Urology, Louisville boasts the first center in the US to perform HIFU.

International Training Ground John Jurige, MD, board-certified urologist with First Urology and Sonablate® HIFU 10 MD-UPDATE

John Jurige, MD, a Louisville native and graduate of the U of L School of Medicine, is a national expert in HIFU and the first urologist to perform HIFU in the US.

proctor, is a native Louisvillian who completed medical school and residency at the University of Louisville (U of L). He was drawn to urology because his father was a urologist but also because he enjoyed the varied patient mix, the balance of medical and surgical interventions, and the ever-evolving technologies. “I liked having something that PHOTOS BY ROBERT DENSMORE

had a beginning and an end, something that had a disease, a treatment, and an outcome,” says Jurige. After his training, he joined his father’s practice, and later recruited other physicians. In January of 2011, they merged with Metro Urology to form First Urology.

It was nine years ago that a few of Jurige’s patients brought the idea of HIFU to him.

Cover Story John Eifler, MD, joined First Urology in August 2015 and is the practice’s third HIFU surgeon.

began performing HIFU at international centers. “What really got me interested in HIFU was the fact that it was an outpatient procedure, it provided improvement in potential complications that the other treatment options had, and the data appeared to show that the results for local, confined prostate cancer were as good as the other techniques with less side effects,” says Jackson.

Jackson is also a graduate of the U of L School of Medicine and the urologic residency program at U of L. He practices general urology in adults and children with a special interest in stone disease and urologic oncology. “The one thing about urology is it provides the ability to take care of both children and adults. It allows you the opportunity to extend your practice to endeavor upon things such as kidney transplants. You can extend as far as you want,” he says.

As one of the first US urologists to adopt HIFU and one of the most prolific, Jurige was a natural fit to open the first HIFU treatment center in the US in Louisville.

The center, called HIFU Prostate Services (HPS) Kentucky, is a partnership between First Urology and HIFU Prostate Services, which provides administrative support to the practice.

Decoding Prostate Cancer

Brooks Jackson, MD, graduate of the U of L School of Medicine, began performing HIFU in 2010 at medical centers outside the US because it was an outpatient procedure that produced results comparable to traditional treatments with fewer side effects. PHOTO BY GIL DUNN

He diligently did his research and visited centers in the Bahamas, Mexico, and Canada to observe the procedure. “I was so impressed with the precision of the energy delivery and talking to patients I met on trips who had a quick recovery and minimal impact on quality of life issues,” says Jurige.

In February 2008, Jurige took his first

patient to Cancun to perform the procedure, and that favorable outcome set the future in motion. Jurige spent the next eight years traveling outside the US one or two weekends a month, primarily to Nassau and Cancun, to perform HIFU on his patients.

Around 2010, Jurige’s colleague, board-certified urologist Brooks Jackson, MD, also

Historically, early to intermediate prostate cancer has been treated with radical prostatectomy (removal of the prostate) or radiation therapy. Prostatectomy is very effective at curing cancer but carries side effects that hinder quality of life, primarily urinary incontinence and erectile dysfunction. With radiation therapy, the side effects are fewer but the cure rate is lower.

Research has led to a better understanding of the behavior of prostate cancer in recent years, which has opened up a variety of treatment options. One of those is active surveillance. “About 80 percent of prostate cancers that we find on biopsy take about three-tofour years to double in size. That’s the reason most patients won’t manifest a problem until 10 years out,” says Jackson. “However, there is a subset of prostate cancers that can grow much more aggressively, and as such, need to be detected and treated, even in the elderly ISSUE #103 11

Cover Story where aggressive prostate cancer may have a 30 percent mortality rate.”

Urologist John Eifler, MD, who joined First Urology in August 2015 and is the practice’s third HIFU surgeon, attributes prostate cancer’s slow-growth rates and long-term survival outlook to the advent of new techniques that look to preserve quality of life. “Often men diagnosed today may not die for 20 or 30 years, and as a result of that, we’ve started to focus more on not just curing cancer but making sure that after their treatment they not only live a long life but a good life with a functional treatment outcome.”

Eifler is also from Louisville and completed his undergraduate degree at the University of Kentucky. He attended medical school at Cornell University and then did a one-year research fellowship at the National Institutes of Health (NIH). He took his urology residency at Johns Hopkins University and pursued an oncology fellowship at Vanderbilt University.

“Very few people go into medical school and think they would like to be a urologist. It was the same for me,” says Eifler, who thought he wanted to be an ENT or orthopedic surgeon.

“After my electives, I loved urology.” He was drawn to the large, complex surgeries and the ability to cure a patient’s disease with surgery.

The Advantages of HIFU HPS Kentucky uses the Sonablate HIFU, the first device FDA approved for prostate ablation. The Sonablate HIFU utilizes a specialized ultrasound probe introduced rectally that provides three-dimensional imaging of the prostate and delivers the ultrasound energy. “As these ultrasound waves come off the transducer, they are unfocused and therefore low energy. As they move through the tissue, including the rectum, the waves all converge in a focal point. At that focal point, there’s a very intense thermal reaction where the tissue reaches 100 degrees Celsius. That’s incompatible with cellular life, so the tissue is ablated, vaporized, destroyed,” says Jurige. The technology allows physicians to avoid damaging the neurovascular bundles that regulate erectile function and the muscular sphincter that provides bladder control, therefore preserving erectile and bladder function.

The procedure is performed as an outpatient at the Louisville Surgery Center. The 12 MD-UPDATE

The Sonablate® HIFU utilizes a specialized ultrasound probe that provides three-dimensional imaging of the prostate and delivers the high intensity focused ultrasound energy in real time.

procedure does create a temporary swelling of the prostate, so patients go home with a catheter for five to seven days until normal urinary function returns. Most can resume normal activities within a week or two.

At this time, HIFU is not covered by most insurances because Medicare has yet to assign the First Urology was formed from the merger of Metro Urology and procedure a CPT code.

Allied Urology in January 2011 and is a partner in HIFU Prostate Of those eligible for the proServices (HPS) Kentucky, the first HIFU treatment center in the US. cedure, Jackson says, “The ideal candidate is a gentleman who has localized prostate cancer, has a small prostate Visualize, Localize, and Vaporize gland, and has pretty normal erectile function.

HIFU is not the only new tool in urologists’ There are some patients we have to be cau- toolbox when it comes to prostate cancer. tious of depending on comorbid problems, as Traditionally, prostate cancer screening has well as prostate size and a higher risk of having involved digital rectal exams and prostate spedisease that extends beyond the confines of cific antigen (PSA) blood tests. “Most cancers, the prostate.” when you diagnose them, you can perform an Patients may be eligible for HIFU if they imaging study to tell you exactly where the have low to intermediate risk prostate cancer cancer is. In prostate cancer, that has never and meet the following medical criteria: been the case. It’s not visible on CT scans. It’s • Prostate specific antigen not visible on ultrasound,” says Eifler. “With (PSA) score less than 15 newer, more powerful MRIs and MRI tech• Gleason score of 6 – 8 (The Gleason niques, we are now able to identify the highsystem is a microscopic assessment er-grade aggressive prostate cancers the majorof the aggressiveness of the cancer.) ity of the time.” Prior to MRI, patients with • Prostate size less than 40 grams a suspicion of prostate cancer would have an One of the advantages of HIFU is that it ultrasound and random biopsies, which could can be used before or after other treatments. miss the cancer completely or over diagnose it.

“One of the nice things about HIFU is that it First Urology is not only using MRI to doesn’t rule out other therapies,” says Eifler. screen for prostate cancer but also to pinpoint “Another thing to note is that patients who the exact location of cancerous cells within the have been treated with other forms of ther- prostate and provide more targeted treatment. apy in the past but have recurred can receive A technique called MRI/ultrasound fusion HIFU as an additional treatment option.” incorporates MRI imaging into the HIFU

Cover Story Tiffany Skees, medical assistant, holds the Sonablate® HIFU probe. Skees assists on HIFU procedures for all three surgeons at HIFU Prostate Services Kentucky.

software, essentially drawing a bullseye directly on cancer cells. Soon, the center will offer focal HIFU, which precisely targets only the cancer cells and surrounding margin rather than the entire prostate, for patients whose cancer is localized to one area. With focal HIFU, there are essentially no side effects, and patients go back to work the next day.

Because HIFU has been performed throughout the world for over 15 years, there is published long-term data, primarily from Europe and Japan. “What the data shows is that for stage T1 prostate cancer, the 10-year cancer free survival is 92 percent. That is about equiv-

alent with radical prostatectomy,” says Jurige.

“With more advanced stages of prostate cancer, survival changes. The probability of a cure rate when cancer is outside the capsule of the prostate is about 50 percent with surgery and 50 percent with HIFU. Those patients often need additional treatment down the road.”

MRI is not the only tool being used to provide more targeted cancer therapy. “One thing that I think our group has done a great job of spearheading is using biomarkers to really individualize prostate cancer risk,” says Eifler.

“Before we relied on what the pathologist sees under microscope and the PSA. Now, we

can get data on literally 1.4 million different genes within the prostate cancer cell to really fine tune how your cancer is going to behave and what is going to be the best treatment for you.”

It is also important to note that HIFU does not replace radiation therapy or surgery for prostate cancer in all cases. “Primarily for more advanced disease, we still recommend surgery and radiation therapy for the people with the highest risk,” says Eifler. While controversial in some specialties, robotic surgery for radical prostatectomy has become increasingly mainstream due to the increased visualization it provides. “The robot allows us an avenue to get great visualization both in the dissection and when reconstructing the urinary tract at the end of the case,” says Eifler.

Currently, HPS Kentucky is the only HIFU center in Kentucky, and Jurige is one of only three Sonablate proctors in the US certified to train other physicians in the procedure.

Soon, First Urology and HPS Kentucky will be extending their physician training within a 150-mile radius to include Lexington, Indianapolis, Columbus, and Cincinnati. In the meantime, HPS Kentucky has a concierge service that helps patients across the region with general HIFU information, travel accommodations, and more.

Whatever the tool, the new leading-edge technologies in the diagnosis and treatment of prostate cancer are allowing patients a choice and physicians a bevy of options to provide less-invasive treatment with fewer side effects and curative results.

WHY UROLOGISTS STILL RECOMMEND PSA SCREENING According to urologist Brooks Jackson, MD, the advent of prostate specific antigen (PSA) screening for prostate cancer brought about a dramatic increase in the detection of early cancers. “We found that before PSA and the combination of annual rectal examinations with PSA, about one-third of prostate cancer patients presented with metastatic disease. That number dropped to around five percent with the advent of PSA,” says Jackson. “The problem is that studies show that 30 percent of patients with prostate cancer are possibly being over treated.” This is related to the shortcomings of ultrasoundguided biopsy alone to determine cancer risk (see cover story) and the fact that the generally slow growth rate of prostate cancer means people often die of other causes.

The overtreatment statistics led the US Preventive Services Task Force to recommend against PSA screening in 2012. However, the recommendation has left urologists concerned that prostate cancers will not be caught early enough. The American Urological Association and the American Cancer Society recommend men discuss PSA screening benefits and risks with their doctor. “In the urology community, we still feel very strongly that the PSA and digital rectal examination complement each other to detect early prostate cancer,” says Jackson.

General screening guidelines include: • Baseline screening at age 50 for men at average risk • Screening beginning at age 40-45 for men at higher risk, including African-Americans and those with family history of the disease ISSUE #103 13

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Oncology/Hematology

More Than a Benign Interest Owensboro Health oncologist Jacob Hodskins, MD, MS, developed a passion for treating cancer at an early age

BY JIM KELSEY OWENSBORO You might call Jacob Hodskins,

MD, MS, a born problem-solver. Not because he has the solution to every problem, but because, as long as he can remember, he’s had a desire to find answers. And one of the first big questions he had was about why people got sick and how it could be prevented.

“My Papaw died of lung cancer when I was young,” Hodskins says. “I saw the deterioration and how it changed him mentally and physically. From that moment forward, cancer became the ultimate enigma. I started keeping scrapbooks of all the newspaper articles I could find pertaining to oncology and knew at a really young age, my life would involve caring for cancer patients in some form.”

Another event that piqued his interest came in his early teens when he developed a profound anemia. Multitudes of tests and numerous bone marrow biopsies revealed no answers. Blood transfusions became a way of life. The process continued for months. “They never could figure it out,” Hodskins says. “As talks of bone marrow transplant loomed, I naturally became invested in the hematology side of things. I had a great pediatric hematologist at Kosair who encouraged me to review my records and labs. I remember researching all that was happening. My parents always encouraged me to be inquisitive and involved throughout the entire process and were the catalyst behind my dedication to this field and patients like myself.”

What was going on was the forging of Hodskins’ career path. Raised in Owensboro, Hodskins attended Transylvania University, then went to graduate school at the University of Kentucky, receiving a master’s in molecular physiology, researching transcription factors in brain tumors. Afterward, he attended the UK College of Medicine. He further completed his residency in the UK Department 14 MD-UPDATE

Jacob Hodskins, MD, MS, Owensboro Health, is a member of the American Society of Clinical Oncology and the American Society of Hematology.

of Internal Medicine and then his fellowship at the UK Department of Hematology, Bone Marrow Transplantation, and Medical Oncology, serving as a chief fellow in 201516.

Hodskins has since returned to Owensboro, joining Owensboro Health in July 2016.

Specializing in hematology and oncology, Hodskins is now looking for solutions to patients’ blood and cancer problems every day.

One of the solutions that Hodskins finds encouraging is the increasing use and success of newer immunotherapy agents alongside chemotherapy. “For most oncologists, trying to manage cancer while avoiding the toxicity of chemotherapy is always an ambition,” he says. “Traditional chemotherapy can have significant short and long-term effects, even years after a cure. Additionally, many frail, elderly patients or those with concomitant medical conditions are often forced to forgo cancer treatment or receive sub-standard therapy due to poor tolerance and potential for PHOTO PROVIDED BY OWENSBORO HEALTH

toxicity. Immunotherapy is showing headway in restructuring not only how we think about cancer management, but also who we think is appropriate for treatment. It’s not that immunotherapy has no potential toxicity, but in general it’s better-tolerated than traditional chemotherapy. It’s a step in the right direction and with each step along the way, we’re extending survival or disease-free intervals in ways that we’ve never really seen for a number of cancers.”

Currently, immunotherapy is a viable treatment option with good results in a wide variety of cancers, including some hematologic malignancies and lung, genitourinary, and skin cancers, among others, according to Hodskins. As studies are conducted and more data is collected, Hodskins believes that immunotherapy will undoubtedly be used more widely. The newer immunotherapeutic drugs are mostly utilized in the chemotherapy refractory setting. However, innumerable ongoing clinical trials are reporting the benefit of earlier use in several situations, Hodskins noted.

Immunotherapy got its modern day jump start as a front line treatment for melanoma, where the results have been very encouraging. “We’ve seen some absolutely dramatic responses in the metastatic melanoma setting for example,” Hodskins says. “Witnessing patients, who have a disease that was until recently deemed ‘untreatable,’ show near complete responses to well tolerated drugs is very powerful and convincing.”

Another example highlighting the benefit of immunotherapy is in heavily pretreated Hodgkin’s lymphoma. A common treatment for refractory disease is autologous stem cell transplant. If that doesn’t work, further options have been lacking in the past. “Now these people are getting much longer survival and having really good response to the immunotherapy drugs when they fail transplant,”

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Hodskins says. “Before there was very little to offer the patient. Now you have something you can offer that has a beneficial outcome and a low toxicity profile, even in patients who have received a lot of chemotherapy.”

And Hodskins is also happy that other aspects of cancer management are expanding as well. “Oncology essentially pioneered the use of clinical trials to ascertain how and whom to treat with sufficient evidence to support your decision. The everyday problem is that if you look at the design of a clinical trial, you see a lot of times, the patients they select are not the typical patient who walks in my office,” Hodskins says. “It can be daunting to formulate a treatment plan, with confidence, for a patient population that wasn’t represented in clinical trials. All too often, the patients we see are ‘sicker’ or have other problems that would have excluded them from being treated on a given trial, making it hard to guarantee they will see the same type of outcome report-

It seems with each step along the way, we’re extending survival or extending disease-free intervals in ways that we’ve never really seen before.

— Dr. Jacob Hodskins ed from those studies. While the knowledge we gain from trials is absolutely paramount to the way cancer is treated, newer initiatives are finding a way around some of the pitfalls experienced in everyday care.”

For example, the American Society of Clinical Oncology (ASCO) has launched an initiative to help collect treatment data

She’s one reason Passport is the top-ranked Medicaid MCO in Kentucky.

Oncology/Hematology

and outcomes from everyday cancer patients in real world practice, off of clinical trials.

ASCO’s CancerLinq™ is a database through which medical information is being collected from hundreds of thousands of real life cancer patients. “The ultimate goal is that I can enter characteristics about a certain patient and immediately get information about how similar patients have been treated and what the outcome was with each successive line of therapy. Real-time ‘second opinions’ about how those patients fared will help us to better educate our patients about the expectations moving forward in their treatment. I think it may have an impact on all practicing oncologists and improve our understanding of cancer alongside clinical trials.”

Cancer had a big impact on Hodskins when he was young. Now, he’s having a big impact on the fight against it.

We can give you 23,483* more.

Passport Health Plan is the only providersponsored, community-based Medicaid plan operating within the commonwealth. So, it’s no coincidence that Passport has the highest NCQA (National Committee for Quality Assurance) ranking of any Medicaid MCO in Kentucky.

Our providers make the difference. *Passport’s growing network of providers now includes 3,720 primary care physicians, 14,014 specialists, 131 hospitals, and 5,619 other health care providers.

Ratings are compared to NCQA (National Committee for Quality Assurance) national averages and from information submitted by the health plans.

MARK-51677 | APP_11/16/2015

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5/2/16 2:59 PM ISSUE #103 15

One of western Kentucky’s largest medical groups, One Health, is proud to welcome Dr. Jacob Hodskins to their Hematology and Oncology team.

As a native of Daviess County, Kentucky, Dr. Hodskins knows the region. He has been a part the area for most of his life and is honored to be able to practice medicine in his hometown of Owensboro.

Early in his life, Dr. Hodskins experienced a blood-related illness of his own. The care he received helped inspire him to become a doctor—and taught him the importance of building relationships with his own patients. “I not only treat the disease, I take care of the person, I get to know my patients and stay with them through their treatments and beyond.” Dr. Hodskins said.

Today, Dr. Hodskins is serving Western Kentucky at the Mitchell Memorial Cancer Center—one of the area’s most advanced cancer treatment facilities.

His experience—and his passion for patients care—is helping One Health to build a healthier region.

Hematology & Oncology Breckenridge Center 1000 Breckenridge Street, Suite #200 Owensboro, KY 42303

FOR MORE INFORMATION OR TO SCHEDULE AN APPOINTMENT, CALL 270-688-3445.

www.owensborohealth.org/onehealth

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Oncology/Hematology

Hemophilia, Hodgkin’s Disease, and Multiple Myeloma

KentuckyOne Health centers in Louisville and Lexington focus on advanced treatments for blood disorders and cancers

BY BOB BAKER LOUISVILLE & LEXINGTON Bleeding disorders and

blood cancers are two areas in medicine where the dreams of a few years ago have come true in the form of better, safer, and more specific treatment protocols. The results for patients with these relatively rare conditions are better survival rates and a dramatic improvement in quality of life.

In Louisville, the KentuckyOne Health Hemophilia Clinic at the James Graham Brown Cancer Center offers specialized, multidisciplinary treatment for the relatively small but significant population of patients suffering from the bleeding disorder hemophilia.

The clinic is led by medical oncologist/hematologist Vivek R. Sharma, MD, with U of L Physicians, who has been the clinic’s director for 15 years.

In Lexington, KentuckyOne Health medical oncologist/hematologist Jessica Croley, MD, treats bleeding disorders and blood cancers, specializing in Hodgkin’s disease and multiple myeloma.

A Multimodality Hemophilia Clinic Sharma took his interest in hemophilia to a very personal level when, during his hematology/oncology fellowship at the University of Louisville, he attended a summer camp for patients with the condition. This sensitivity to how patients cope with the condition day to day has kept Sharma pushing to deliver the very best medical care and comprehensive support the Hemophilia Clinic can possibly deliver. This includes making sure each patient is on the best prophylactic factor replacement regimen for them and has rapid access to an extended team of physiotherapists, orthopedic surgeons, infectious disease

Medical oncologist/hematologist Vivek R. Sharma, MD, with U of L Physicians, has been the director of the KentuckyOne Health Hemophilia Clinic at the James Graham Brown Cancer Center in Louisville for 15 years.

specialists, and the coordinating efforts of nurse practitioner Patricia Ashby, ARNP. Hemophilia is a bleeding disorder characterized by the absence of a clotting factor that allows blood to clot normally – factor VIII in hemophilia A and factor IX in hemophilia B. Sharma points out that 70 percent of hemophilia cases are hereditary, while 30 percent are spontaneous new mutations. The major complication in hemophilia patients is bleeding into a joint or soft tissue, such as muscle.

“Prior to effective treatment, these people were severely crippled by arthritis resulting from repeated, uncontrolled joint bleeds by the time they were teenagers,” said Sharma.

For decades, the standard treatment of these patients was to transfuse plasma when a bleed occurred. Subsequently, more purified forms of individual factors became available, but there was still a reliance on human plasma. This need for human blood products led PHOTOS PROVIDED BY KENTUCKYONE HEALTH

to the tragedy of the 1980s when, according to the National Hemophilia Foundation1, 50 percent of hemophilia patients in the United States contracted HIV from these transfusions and up to 90 percent were exposed to hepatitis C. Many of these people died before effective treatments became available. Sharma reinforces, “The fact that we still have some older patients with HIV and hepatitis C points out the need for the coordinated efforts of hematology, infectious disease, and hepatology as we have at the Hemophilia Clinic.”

The biggest revolution in management of hemophilia came with the commercial availability of specific clotting factor replacement produced from recombinant DNA, which is lab-created and not made from human blood products. With this infusion treatment, patients can be certain they will not get a transmittable disease, and the product can be stored at home with refrigeration and can be given in a preventative fashion. “Patients can be taught to administer the product intravenously at home several times a week if necessary and thus avoid a hospital stay,” says Croley. While IV infusions are short acting, says Sharma, “Even though the factor levels remain high for only a few hours after an infusion, it has been conclusively shown that patients who self-administer frequently at home have a significantly lower incidence of joint bleeds.”

The Future of Hemophilia Treatment “Two major directions of current research in the treatment of hemophilia that we are following closely are: the development of 1 National Hemophilia Foundation. (2016, October 3).

Blood Safety. Retrieved from National Hemophilia Foundation: www.hemophilia.org ISSUE #103 17

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Oncology/Hematology

Two major directions of current research in the treatment of hemophilia that we are following closely are: the development of long-acting factor replacement and human genetic engineering. – Dr. Vivek Sharma long-acting factor replacement and the very exciting but ethically controversial field of human genetic engineering,” says Sharma.

Currently, Sharma has adopted a wait and see posture on long-acting agents for factor replacement. “We will enter clinical trials in this area but with caution because we do not know what long-term complications may arise. We will ensure that our patients receive cutting-edge options, but we will pick the trials that look most promising to us,” he says.

Croley believes genetic engineering will start with attempts to prevent hemophilia from being passed from one generation to another. “I think the first thing we might see will involve ways to ensure that a known carrier female will not pass on the affected X chromosome,” she says.

As to other future work for the Hemophilia Clinic, Sharma looks to continue to strengthen the multidisciplinary, comprehensive support system, as this is the backbone of the clinic, and develop outreach clinics beyond the one now done every six months in Owensboro.

Sharma’s final word on the clinic is that no hemophilia patient should be denied any form of indicated treatment, including surgery, because of their hemophilia. “We are here to help anyone who has a question about a hemophilia patient. Someone will answer the call 24/7,” he says.

Advances in Blood Cancers Croley has a special interest in two kinds of blood cancer, Hodgkin’s disease and multiple myeloma. In the past, the mainstay of treatment for these conditions was cytotoxic antimetabolites. “Everyone is familiar with the hair loss, weight loss, and gastrointesti18 MD-UPDATE

nal complications of a cancer patient,” says Croley. “But now, after decades of research and refinement, we have effective immune therapy that is specific in targeting tumor cells and has very few side effects.”

Monoclonal antibodies (mAbs) were the much anticipated “silver bullet” that remained elusive for so long. Nivolumab is a targeted therapy that is available to Hodgkin’s patients who relapse in spite of multiple regimens of established therapy. In Hodgkin’s disease and several other tumors, the production of ligands to the PD-1 receptor on T cells is upregulated, thus inactivating T cell function and essentially turning off the body’s immune response to the cancer. Nivolumab binds to this receptor on T cells so the tumor-generated molecules cannot inactivate the immune cell. Compared to cytotoxic drugs, the side effects of nivolumab are usually mild, thus allowing an improved quality of life for the patient’s remaining years.

“Multiple myeloma is a blood cancer that is currently incurable, but we now have therapies that not only prolong survival but

KentuckyOne Health Lexington medical oncologist/ hematologist Jessica Croley, MD, has a special interest in Hodgkin’s disease and multiple myeloma.

provide an excellent quality of life while taking the medication. For instance, the patients can be on an oral therapy at home without the necessity of frequent trips to the hospital for intravenous infusions,” states Croley.

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Oncology/Hematology

New and Growing Sustainably Baptist Health Lexington Cancer Center

BY GIL DUNN LEXINGTON The new Baptist Health Lexington

Cancer Center sits on the lower two floors of the impressive new North Tower at the Lexington community hospital. Opened in February 2016, the Cancer Center has an array of amenities created with cancer patients and family members in mind, such as colorful artwork, an abundance of natural light, and a 31-foot wall of color-changing water extending from the first floor to the lower level. The facility has valet parking and a designated self-parking area on the lower level of the west deck.

A spacious waiting room and 26 patient rooms serve patients seeing medical oncology and gynecologic oncology providers. This area also is home to the center’s multidisciplinary oncology clinic and outpatient palliative care clinic. A lab and a retail pharmacy are located near the waiting area.

“The vision here is to grow sustainably, not lose our focus on community and patient.” says Greg Bodager, RN, BSN, OCN, executive director of Baptist Health Lexington Cancer Center.

The Infusion Center’s 24 treatment chairs and five private rooms offer patient privacy

yet allow them to socialize with their families during treatment. Physicians and patients have access to the cancer research staff for those patients interested in enrolling in clinical trials. Baptist Health Lexington currently has 32 open oncology clinical trials.

Offices for cancer support services staff including nurse navigators, oncology dietitians, clinical nurse specialists, genetic counselors, and an oncology social worker are located on the first floor. A wellness center, providing massage therapy services to patients, family members, and staff completes the attention to detail in patient and staff care.

Greg Bodager, RN, BSN, OCN, is the executive director of Baptist Health Lexington Cancer Center with a background in oncology nursing, administration, infusion, and survivorship nurse navigation, both inpatient and outpatient. Bodager says, “Every decision at Baptist Health Lexington is patient-centered, from the cafeteria to environmental services,

John Carloftis designed a wild, woodland appearance reminiscent of his mother’s Clay County roots and her strong, independent spirit.

PHOTOS BY GIL DUNN

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Oncology/Hematology

The Baptist name is highly respected as a community hospital, and yet we’re on the cutting-edge of cancer treatment.

— Greg Bodager “neat and clipped” look, instead opting for a wild, woodland appearance reminiscent of his mother’s Clay County roots and her strong, independent spirit.

Preserving the Feel of a Community Hospital and Growing Sustainably

A 31-foot wall of color-changing water extends from the first floor of the cancer center to its lower level.

and that includes taking care of the staff who take care of the patients.”

Latest Technology on the Cancer Center Lower Level In general terms, Bodager says cancer care at Baptist Health Lexington has three departments: medical oncology for a variety of cancers including lung, breast, colorectal, and multiple myeloma; gynecological for cervical, uterine and ovarian cancers; and radiation oncology, which often partners with medical oncology and urology. Pediatrics, acute leukemia and more specialized cancers are referred to larger academic institutions.

Radiation oncology has the Elekta Versa HD, which Bodager says is the latest version of the linear accelerator and is used for external beam radiation treatments with brain, prostate, lung, breast, gastrointestinal, gynecological, and head/neck being the primary sites treated.

Dr. Marta Hayne and Dr. Alan Beckman are 20 MD-UPDATE

the center’s radiation oncologists.

Bodager also says that the center has the Accuray CyberKnife M6 Series, the latest version of CyberKnife, a non-invasive alternative to surgery that delivers beams of high-dose radiation to tumors with extreme accuracy in the primary sites of brain, lung, and prostate.

“It is the only CyberKnife machine in Central and Eastern Kentucky,” says Bodager.

As a counter to the high-tech, state-of-theart treatment options on the inside, on the lower level outside is the Lucille B. Carloftis Garden, designed by award-winning garden designer Jon Carloftis to honor his mother, a cancer survivor treated at Baptist Health Lexington. Created for respite and relief, the garden can be appreciated from inside, or patients and family members may step outside to rest on surrounding benches and enjoy the scenery as well as the peaceful gurgle from three stone fountains.

Carloftis deviated from his customary PHOTO PROVIDED BY BAPTIST HEALTH LEXINGTON

According to Bodager, the patient population at the Baptist Health Lexington Cancer Center is 18 to 90+ years old and comes from Central and Eastern Kentucky. The Baptist Health cancer treatment network continues to grow with satellite locations in Frankfort, Richmond, and Corbin. Patient volume continues to meet expectations he says. “Electronic medical records allow us to communicate patient information across the entire Baptist Health community hospital network,” says Bodager.

If there is one challenge Bodager sees coming, it’s “maintaining the community hospital feel by growing sustainably.” Balancing the growth in patient volume and resources - such as social workers, dietitians, genetic counselors, clinical nurse specialists, and nurse navigators who bridge the gap between the specialists plus clinical trials and a patient library, is a task that Bodager says keeps his focus.

“The Baptist name is highly respected as a community hospital, and yet we’re on the cutting edge of cancer treatment,” says Bodager.

“We are a community hospital with some of the resources of a research hospital where providers can maintain direct contact with their patients. The emphasis is not on growth for growth’s sake. Rather, the vision here is to grow sustainably and not lose our focus on the community and patient.”

That sounds like a solid plan for growth.

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Oncology/Hematology

Treatments May Vary

Naveed Chowhan, MD, FACP, is happy to see that chemotherapy is no longer the one-size-fits-all cancer treatment It’s becoming more and more routine to perform genetic tests on most cancers to determine if there’s a targeted therapy available.

— Dr. Naveed Chowhan

BY JIM KELSEY NEW ALBANY, IND “Individual results may vary.”

We hear it so often as a disclaimer at the end of weight loss and supplement ads that the words have become white noise. But in the world of cancer treatment, a similar but significantly different phrase may soon be the norm: “Individual treatments may vary.”

That’s right, the disease that used to be synonymous with “chemotherapy” is on the verge of finding a new foe: individualized oncology.

Based on the genetics of the individual and the molecular makeup of the particular cancer they are battling, individualized oncology could become the approach that leads to more consistent results, even if the course of treatment varies from patient to patient.

Naveed Chowhan, MD, FACP, who practices at Baptist Health Floyd in New Albany, Ind., and is the director of Medical Oncology Services, is a believer in the benefits of these new procedures.

“It’s pretty exciting to use the molecular makeup of the cancer to come up with specific treatments that are more targeted therapies,” says Chowhan, who is board certified in oncology, hematology, and internal medicine.

“Chemotherapy is limited in what it can do, so these targeted treatments are the future.

They can target the cancer cells without impacting the normal cells, so they decrease the side effects. This is the future of cancer treatment.”

Immunotherapies started out as treatments for bladder cancer and melanoma. Successes there have led to expansion into other types of cancers. While many of the drugs are still in clinical trials, early studies have shown promise in helping identify treatments specific to patients based on the genetic makeup of their cancers.

Naveed Chowhan, MD, FACP, director of Medical Oncology Services for Baptist Health Floyd, is board certified in oncology, hematology, and internal medicine and also certified in acupuncture.

“Now we know that not all lung cancers are the same,” Chowhan says. “Molecularly, they are so diverse if you look at them under the microscope, so there can be different treatments for different lung cancers. It’s becoming more and more routine to perform genetic tests on most cancers to determine if there’s a targeted therapy available.”

For Chowhan, who has been practicing in New Albany since 1994, targeted cancer treatments aren’t the only significant improvement in his daily work. On October 1, 2016, Floyd Memorial Hospital and Health Services officially became part of Baptist Health. The new name – “Baptist Health Floyd” – is one part, but the more significant change, according to Chowhan, is the impact on patient care and convenience.

The additional services that are now accessible to Baptist Health Floyd patients mean less travel, less hassle, and less confusion for patients who already have plenty to deal with.

“We’ve tried to put everything all in one

PHOTO PROVIDED BY BAPTIST HEALTH FLOYD

place,” Chowhan says, noting that the cancers he treats most frequently are lung, breast, and colon. “Cancer patients, for example, are distraught and don’t need to be running from place to place. We try to make it as easy as possible for patients going through treatments.”

That level of patient care is important to Chowhan, who has always looked at big-picture ways to improve the patient experience during stressful and painful treatments. For instance, he saw the negative impact that high-level pain killers could have and decided to offer an alternative. “There are so many side effects from narcotic pain killers,” Chowhan says. “I wanted to offer a complementary form of pain relief.”

And that he does. Certified in acupuncture, Chowhan gives patients a choice, offering a viable, centuries-old alternative to narcotic pain killers. While pain killers might work just fine for some, others may have adverse side effects or be susceptible to addiction.

The treatment is the same; the results vary.

So, much like immunotherapy in cancer treatment, individualized pain treatment takes different paths toward the same destination.

It’s all part of treating not only the disease, but the patient as well.

“It is very exciting to be offering so many more choices to patients now than ever before,” Chowhan says. “This is the future of medical treatment and patient care.”

ISSUE #103 21

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Complementary Care

What To Do When Your Strengths Fail You

BY JAN ANDERSON, PSYD, LPCC

You’d think that most of the people I encounter come with a serious personal or professional crisis that’s blindsided them — a death, a divorce or family estrangement, or the loss of a job, partnership, or long-term friendship.

That’s actually not the case. More likely the person simply wakes up one day and says, “I can’t do this anymore.”

When I talk with a prospective client about working together, I often find that person’s life is going well in many ways, and they are often accomplished and successful in many areas.

But in some important area of life something isn’t working. Here are some ways I often hear it expressed: • “I’ve tried so hard. Why isn’t this working?”

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• “I’ve tried everything I know to do.

What am I missing?”

• “I don’t understand why this keeps happening.”

• “Am I wrong to be feeling this way?”

You’re At a Crossroads... And You’ve Already Taken The First Step.

What I’ve learned to recognize is that hidden in all that pain is where the hope is. What I mean is that the person sitting in front of me has reached a crossroads, and whether they realize it or not, they have already taken the first, and oftentimes hardest, step.

“It’s just too painful to keep going down this same path. It’s familiar, and at least I know what I’ve got, but somehow I’ve got to find another way — even though I have no idea where it will lead — because there’s got to be something better than this.”

Their reaching out for help tells me that they are already moving in a new direction. I can’t do that for them. My job is to help them keep the momentum going so they get the results they want. That’s where it gets tricky.

Yes, I Want Things To Change... But I Don’t Want To Do Anything Different.

Of course you don’t! I’ve decided it’s a mistake for people in my profession to classify this reaction as client “resistance.” Here’s why: There are some very good reasons why you’ve done things the way you have.

There’s more to it than that, of course, but if we don’t immediately address and factor in this basic truth, I’ve found it’s very hard to get unstuck and move forward.

You Did It Because It Worked.

Whatever you worked out between your DNA and your environment, we can assume it was an intelligent and adaptive response to your life situation. You figured out what you had to do to make yourself lovable enough (or

at least acceptable enough) to those around you and keep things safe enough that you made it to adulthood. You survived. Maybe those same behaviors even made you thrive and become the accomplished and successful person you are today.

There’s nothing intrinsically wrong with those original adaptive behaviors and with who you are as a person. The only problem facing you now is that your strengths and primary approach to life and relationships have some limitations.

But Now It’s Not Working...

It can be distressing to realize that the very same characteristics, traits, and attributes that got you where you are in life and to the degree of success that you’ve experienced – in other words, your strengths – can also be holding you back.

When we overuse and overdevelop certain parts of our personality, we can find ourselves stuck or sidetracked in our relationships or life. Think of your primary self and approach to life as a highly effective software program.

For example, QuickBooks is a great software system for accounting, but if you want to write a novel or a love letter or a eulogy, you’re going to have to install some additional software. It seems that the things that aren’t working in our lives are reality’s way of letting us know that it’s time to “up our game.”

Life and relationships are complex and challenging and if we’re going to be successful at them, we need the ability to reassess, adapt, and grow in order to stay relevant, vibrant, and to keep our edge.

How to Get It Working Again.

The trick is working with underdeveloped parts of our personality in a way that doesn’t feel fake, weird, wrong, unsafe, or unwise. Here are three essential components to the process: No Judgment. I find it important to remind my client that we’re not trying to get ISSUE #103 23

8/10/16 5:23 PM

Complementary Care rid of, fix, or change his or her primary self system and its strengths. This isn’t a personality transplant. You just want the freedom, choice, and balance to draw on other additional capabilities when you need them or want them. You still get to be you.

Make It Powerful. I like to create a feltsense experience that resonates for clients so they can see or feel a shift in their thinking, feeling, or behaving. The experience needs to resonate enough on a sensory level (not just an intellectual level) that it’s powerful, compelling, and empowering.

Keep It Safe. The goal is a breakthrough, not a breakdown. Although treading into unfamiliar territory is challenging, it needs to not be so unfamiliar or uncomfortable that it feels too vulnerable or fake, or violates your personal code of conduct. We’re not trying to turn you into someone that your friends, family, or coworkers won’t recognize or someone that you won’t like or respect.

That’s why we call it personal growth and professional development. It’s about how you hold on to who you are and become more of what you now want or need.

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24 MD-UPDATE

Education/Advocacy

Reducing Barriers

Kentucky CancerLink serves to connect uninsured and underinsured Kentuckians with appropriate cancer screening, diagnosis, and treatment

BY MELISSA KARRER LEXINGTON Kentucky has the highest rate of new cancers and the highest death rate for all cancers combined in the US. Kentucky ranks #1 in the US in the incidence and death rates from lung cancer, #1 in the incidence rate for colon cancer, and #4 in the death rate for colon cancer. The Appalachian region of the state has among the highest cancer incidence and mortality in the US, with rates especially high for lung, colorectal, and cervical cancers. “Patient navigators can help Kentuckians get screened for cancer – finding it early can save your life,” says CDC Director Tom Freiden, MD, MPH. Founded in 2008, Kentucky CancerLink is a 5013c not-for-profit whose mission is to provide support to Kentuckians by reducing and/or eliminating barriers to screening, diagnosis, and treatment for all cancers. Kentucky CancerLink (KCL) serves uninsured/underinsured or newly insured Kentuckians whose household income is at or below 250 percent of the federal poverty level guidelines. Many of the newly insured have obtained insurance through expanded Medicaid and they have little or no experience with medical facilities, their programs, and procedures.

Programs provided by KCL are: • Community outreach and education on the importance and availability of cancer screenings; • Assisting qualified patients in obtaining low-cost/no-cost cancer screenings; • Providing assistance to cancer survivors during and after completion of cancer treatment.

KCL’s certified patient navigators provide education and outreach at Kentucky health fairs and other community events in Kentucky to promote the value of early cancer detection. Patient referrals are received as a

Melissa Karrer, Kentucky CancerLink Community Relations

result of KCL outreach, patient self-referrals, and referrals from family members, friends, healthcare professionals, the KCL web site, and other communications.

In collaboration with healthcare providers throughout the state, KCL navigators assist patients in obtaining evidence-based cancer screenings such as breast, cervical, colon, and lung cancer screenings; and navigators follow up with patients after the completion of screenings. KCL activities vary depending upon the type of cancer, programs available, and collaborative partners. KCL navigators help reduce barriers for Kentucky cancer survivors who are receiving cancer treatment by providing assistance relating to transportation, childcare, health insurance, and other personal and financial issues. KCL also provides cancer-related supplies, such as mastectomy items, lymphedema garments, wigs, and headwear, to cancer survivors at no charge. Since 2008, KCL has served over

8,100 Kentuckians in all 120 counties. Types of patient navigation assistance provided to cancer patients varies based on the needs and situation of each patient.

KCL’s mission is unique. Our relationships with the clients and community partners are innovative, highly productive, and focused on improving health outcomes of Kentuckians. KCL certified patient navigators collaborate with the patient’s healthcare team, often working with physicians, nurses, physical therapists, social workers, case managers, health insurance companies, and a myriad of other resources as they guide the patient and family through a complex healthcare continuum.

KCL navigators have been certified through the Harold P. Freeman Patient Navigation Institute and the George Washington Cancer Institute. Patient navigators identify patients’ barriers to cancer screenings and cancer care.

They educate and advocate for their patients/ clients about issues that impact their healthcare, such as helping the patient find a medical home/family physician, obtain no-cost/lowcost medicines, provide assistance related to transportation to cancer screenings and treatment, childcare, and other relevant personal and financial issues. Navigators utilize KCL and external services and resources to help individuals become healthier and live longer, improving patients’ health outcomes while reducing healthcare costs for the population.

KCL has established patient referral systems and collaborative programs with healthcare organizations such as the UK Markey Cancer Center and its affiliates, KentuckyOne Health, Baptist Health, Kentucky Federally Qualified Health Centers, Kentucky free clinics, and others. Please visit our website, www.kycancerlink. org for additional information.

ISSUE #103 25

Goetz Kloecker, MD, MBA, MSPH, FACP, is co-principal investigator of the Kentucky LEADS Collaborative and the director of the Lung Cancer Multidisciplinary Clinic at the James Graham Brown Cancer Center.

Targeting Physician Education

The Kentucky LEADS Collaborative focuses on educating primary care providers to improve lung cancer outcomes in Kentucky

BY MEGAN WHITMER LOUISVILLE The mortality rate for lung cancer in Kentucky is 50 percent higher than the national average. The state ranks second in the nation in number of adult smokers, and first in teenage smokers and pregnant women who smoke.

Lung cancer is clearly a major health problem in Kentucky, and yet thousands of lung cancer patients are not pursuing treatment.

“The sad fact is 30 percent of lung cancer patients in Kentucky are not being treated for lung cancer,” says Goetz Kloecker, MD, MBA, MSPH, FACP, co-principal investigator of the Kentucky LEADS (Lung Cancer Education, Awareness, Detection, and Survivorship) Collaborative and director of the Lung Cancer Multidisciplinary Clinic at the James Graham Brown Cancer Center.

“That’s thousands of patients per year that are not being treated, and that includes early stage 26 MD-UPDATE

cancer, not just advanced cases.”

While some may argue that Kentucky residents in rural areas have a difficult time gaining access to appropriate treatment, Kloecker says the data does not support that theory. “What we’ve found from the cancer registry data, and this is very surprising, is that there is not a clear urban-rural split among patients who do and do not receive treatment,” he states.

“The Kentucky LEADS Collaborative is a statewide effort to reduce lung cancer mortality and morbidity in Kentucky. It is funded by a three-year, $7 million grant from the BristolMyers Squibb Foundation. Currently in its third year, the partnership of the University of Louisville, University of Kentucky, and the Lung Cancer Alliance includes a focus on the role primary care providers (PCPs) play in patients seeking screening and treatment.

The Collaborative has three major compo-

nents: provider education, prevention and early detection, and survivorship care.

Provider Education Kloecker believes that the main barriers to lung cancer care are mindset and information. That is where the Kentucky LEADS Collaborative comes in.

In March 2015 the LEADS Collaborative convened a Primary Care Task Force made up of 22 members representing multiple physician and advanced provider specialties, insurance providers, health systems, academic medicine, and state organizations to examine lung cancer care across the continuum and identify strategies for improvement. The Task Force created an action plan with five broad recommendations: tobacco cessation, lung cancer screening, management and treatment, survivorship, and continuing education.

Education/Advocacy The LEADS Provider Education Component, headed by Kloecker and Connie Sorrell, MPH, is a multi-pronged approach coordinated by the Kentucky Cancer Program at U of L that seeks to increase provider knowledge about lung cancer prevention, detection, treatment, and survivorship through a continuing education program.

The approach is threefold: delivery of practice toolkits to primary care offices (also known as academic detailing), group presentations, and a free interactive online CME/CE course (www.LungCancerinKentucky.org).

“The most exciting part to me is working to educate primary care physicians about lung cancer on a broad spectrum,” says Kloecker.

“We feel that if primary care physicians knew more about the treatment possibilities, the new treatments that are much more effective and much more easily tolerated, they would encourage their patients to do them.”

Early Detection The new standard of care in lung cancer detection is low-dose CT screening for patients at high-risk. The continuing education offerings of LEADS make PCPs aware of which patients are eligible and how to conduct the CMS-required shared decision testing testing cessation counmaking,testeing including smoking seling. After the screening, it is important that patients are screened annually, and that they are aware of the results of their screenings and follow up as necessary.

“The reason this is the new standard of care is because the National Lung Screening Trial showed twenty percent fewer lung cancer deaths for people screened with low-dose CT than a with chest x-ray,” states Kloecker. “If everyone follows the lung screening guidelines, you could actually cure many more patients because you would find the lung cancer early enough for the lung to be resected, or to perform radiation for those patients who cannot tolerate resection.”

and uncertainty, health effects of the cancer, and health effects of the treatment. The Kentucky LEADS CME offerings highlights these survivorship concerns and provides information about free patient resources.

Join the Effort While the CME offerings are geared toward primary care, any health care professional is welcome to participate. As LEADS continues its final year of the grant, the program is seeking to increase the number of physicians, nurse practitioners, and physician assistants participating in the online CME course, available in 20-minute individual segments, and to begin evaluating the effectiveness of the program’s interventions. “Now that we’re in our third year, we are looking to see the positive effects of our efforts,” Kloecker says. “We’re going back to healthcare institutions to see if the screening rates, treatment rates, and cessation rates have picked up, and we hope to see an improvement in the mortality rate over the next few years.”

Looking ahead, Kloecker and his team want to continue the work, saying, “We are

hopeful that the grant will go beyond three years. We’re also applying to other organizations for funding for related projects that can improve Kentucky’s lung cancer status.”

Lung Cancer in Kentucky Improving Patient Outcomes

A statewide effort to reduce the burden of lung cancer in Kentucky

Free CME/CE opportunities for primary care: ✓

www.LungCancerinKentucky.org* Interactive online learning; includes information on low-dose CT screening.

Free toolkit delivered to your office ✓ A cancer education specialist will review toolkit contents, provide exam room posters, and more.

(Until March 1, 2017) To request a toolkit or learn more: • Call 502-852-6318 • Email kyleads@louisville.edu • Visit www.KentuckyLEADS.org and click on Provider Education

Lung Cancer Survivorship “Fortunately, more and more patients survive lung cancer, and with screenings, we hope that number will grow exponentially,” says Kloecker. There are many issues to be faced by lung cancer survivors, such as general worries

The LEADS Provider Education Component includes messaging and tools designed to help PCPs: • Find lung cancer at an early, more treatable stage with new screening recommendations.

• Have more impact on smoking behavior in less time.

• Have better “Shared Decision Making” discussions.

• Enhance continuity of care by better information exchange with cancer specialists.

• Ensure that patients are offered opportunities for more effective, less invasive cancer treatment.

• Better address patient survivorship needs.

A partnership of

* This 1-2 hour online course and the toolkit delivery have been approved for CME credit. Also, this activity is approved for 2.0 contact hours of continuing education by the American Association of Nurse Practitioners.

Program ID 16072241. This activity was planned in accordance with AANP Standards and Policies.

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9/9/16 3:10 PM

ISSUE #103 27

News

KMA Elects 2016-2017 Officers

Nancy Swikert, MD

Maurice J. Oakley, MD

R. Brent Wright, MD

Linda H. Gleis, MD

Dale E. Toney, MD

Michael K. Kuduk, MD

Carolyn S. Watson, MD

J. Roger Potter, MD

PHOTOS PROVIDED BY KMA LOUISVILLE Nancy Swikert, MD, a Florence

family physician, was installed as president of the Kentucky Medical Association on Sept.

10 during the KMA’s Annual Meeting in Louisville. Swikert was also installed as president of the Kentucky Medical Association Alliance.

Swikert was trained at the University of Louisville School of Medicine and the St. Elizabeth Family Medicine Residency Program in Edgewood, Ky. She and her husband, Don, also a family physician, then started their own medical practice and worked together for 18 years in Florence. Afterward, Swikert worked for a large multi-specialty practice as lead physician of her office for over 15 years. Now, she works part time for St. Elizabeth Physicians and is a consultant for the Kentucky Board of Medical Licensure and Kentucky Department of Transportation.

During her address at the KMA Leadership Dinner, Swikert set forth three goals – to work to improve health outcomes for Kentuckians and to help develop a generation of physicians prepared to meet the needs of a 21st century healthcare system. “And most importantly,” she said, “to restore the joy in medicine and enable physicians to spend their time where it matters most – helping patients.”

Other officers elected by KMA members during the 2016 Annual Meeting include: President-Elect - Maurice J. Oakley, MD Vice President - R. Brent Wright, MD Secretary-Treasurer - Linda H. Gleis, MD Board Chair - Dale E. Toney, MD Vice Chair - Michael K. Kuduk, MD Trustee - Carolyn S. Watson, MD Trustee - J. Roger Potter, MD 28 MD-UPDATE

The association also presented its annual awards during the meeting.

Sen. Ralph Alvarado, MD, of Winchester received the KMA Community Service Award; Shawn Jones, MD, of Paducah received the KMA Distinguished Service Award; and Sheldon Bond, MD, of Louisville received the KMA Educational Achievement Award.

KMA recognized nine physicians who have completed the KMA Community Connector Leadership Program, which prepares and sup-

ports physicians in leadership roles and offers grants to nonprofit organizations. Members of this year’s class are David Ciochetty, MD, of Bowling Green, Evelyn Jones, MD, of Paducah, Shawn Jones, MD, of Paducah, Michael Kuduk, MD, of Winchester, Mamata Majmundar, MD, of Lexington, Maurice Oakley, MD, of Ashland, John Roberts, MD, of Louisville, Latonia Sweet, MD, of Lexington, and Monalisa Tailor, MD, of Louisville.

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PHOTOS PROVIDED BY U OF L

Answering the Call for LGBTQ Health Equity

Michael Pendleton, MD, assistant professor and staff physician with U of L Campus Health Services LOUISVILLE On September 12, the University of

Louisville hosted an LGBTQ Health Summit, a day-long open forum to learn about LGBTQ health concerns through workshops and group discussions. More than 120 students, staff, physicians, and others from across the state attended the keynote session and other workshops during the day.

In the Medical Education Ground Rounds, Jennifer Potter, MD, advisory dean and director of the Castle Society at Harvard Medical School and an international expert on LGBTQ and women’s health, discussed patient-centered care for LGBTQ individuals.

In her talk, she cautioned against making assumptions about a patient that are influ-

Wallace Receives Ronald McDonald House Charities Award LEXINGTON The Ronald

McDonald House Charities of the Bluegrass (RMHC) recently honored Dr. Carmel Wallace, chair of the University of Kentucky Department of Pediatrics and physician-in-chief of Kentucky Children’s Hospital, with the 2016 Elizabeth Carey Nahra Legacy of Love Award.

(l-r) Adam Neff (MS3), Dustin Nowaskie, founder and president of OutCare, Jordan Nowaskie of OutCare, and keynote speaker Jennifer Potter, MD, advisory dean and director of the Castle Society at Harvard Medical School and an international expert on LGBTQ and women’s health

enced by unconscious bias.

Potter also proposed questions for clinicians that will reveal sources of stress and lay groundwork for helping the patient develop resiliency.

“We have to treat each patient individually, asking about life stressors and adaptive strategies, and make a commitment in our interactions with the patients to help people gradually increase their resilience over time,” asserts Potter.

By identifying previous trauma in a patient’s life, Potter said a physician may be able to understand the root of health problems. These events may be revealed by carefully asking the patient about his or her life. “In medicine we have been taught to think about a whole pathological way of categorizing patients.

‘What’s wrong with you; what is the disease?’

If we could switch from the pathological, ‘What’s wrong with you?’ and think about ‘What happened to you?’ it changes the whole paradigm. We don’t know what traumas a person has incurred until we ask,” she says.

At the summit, organizers also announced an online resource for providers and patients, OutCarehealth.org. The U of L School of Medicine is partnering with a consortium of three other LGBTQ Centers in Kentucky to populate this online database of LGBTQfriendly and competent providers. Providers sign themselves up for the database, pledging to provide a welcoming environment for LGBTQ individuals.

The award recognizes an organization or individual whose exceptional contributions or projects have enabled the Ronald McDonald House of the Bluegrass to assist families of children hospitalized at Kentucky Children’s Hospital (KCH). Wallace founded the Helping Hands Fund, which supplements family donations to cover the charity’s operational costs through scholarships. The fund contributes $20,000 annually to the RMHC. A native of Eastern Kentucky, Wallace has worked to ensure Eastern Kentucky families receive access to advanced pediatric care avail-

able at KCH. Through Wallace’s leadership, KCH has extended its presence in Eastern Kentucky by providing specialists and clinical services in rural communities.

Wallace accepted the award during the charity’s annual McDazzle Gala on Sept. 10.

Recipients of the award are selected by the family of Elizabeth Carey Nahra, an advocate and former director of the Ronald McDonald House who passed away in 2015. Past recipients include KCH, Children’s Charity Fund of the Bluegrass and KCH neonatologist Dr. Nirmala Desai.

ISSUE #103 29

News

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

Nationally-Recognized Pulmonary Physician Discusses Tobacco and Health LOUISVILLE Delivering a talk in a state with one

of the highest rates of cigarette smoking in the nation, Jonathan Samet, MD, MS, distinguished professor and Flora L. Thornton Chair, Department of Preventive Medicine at the University of Southern California Keck School of Medicine, and director of the USC Institute for Global Health, tackled the issue of tobacco and health at the University of Louisville’s School of Public Health and Information Sciences inaugural Woodson Lecture on Sept. 19.

Samet’s lecture covered a historical perspective on tobacco, addressing concerns over efforts of the tobacco industry to diminish the impact of emerging scientific evidence.

He outlined efforts to enhance tobacco and health policy over the last 50 years and demonstrated how solid research can drive gains in public health. Samet referenced the 2014 surgeon general’s report, The Health Consequences of Smoking – 50 Years of Progress.

30 MD-UPDATE

He also addressed the increasing use of electronic cigarettes and provided a clear balance of the benefits versus harms to the public, noting the potential for harm, especially to children.

There is an increased exposure to nicotine and greater initiation of conventional cigarettes linked with the marketing and use of electronic cigarettes with the potential for increased future disease risk.

The timely topic of the talk is a reminder of Kentucky’s dismal health statistics related to tobacco, such as facing the highest rate for cancer in the United States, especially lung cancer. In Kentucky, from 2009 through 2013, 118 men and 80 women out of every 100,000 individuals were diagnosed with lung

PHOTO PROVIDED BY UOFL

Dr. Jonathan Samet tackled the issue of tobacco and health at U of L’s inaugural Woodson Lecture on Sept. 19.

cancer compared to 75 men and 53 women per 100,000 nationally. The death rate for lung cancer is 70 per 100,000 in Kentucky compared to 46 per 100,000 nationally.

Death rates for other tobacco-related health problems such as heart disease, stroke, and non-cancer chronic lung disease also are higher in Kentucky than national averages.

Events

Construction on Schedule at Shriners Hospital for Children-Lexington LEXINGTON Construction on the new medical

PHOTOS BY GIL DUNN

The pedestrian pedway connecting the Shriners Hospital for ChildrenLexington to the parking garage of the University of Kentucky Albert B. Chandler Hospital is complete. (l-r) Buddy Hager, director of plant facilities, and Dale Wallenius, director of development for Shriners Hospitals for Children-Lexington, conducted a “dusty shoes” tour of the hospital’s new facility on the UK campus.

center for Shriners Hospitals for ChildrenLexington continues to be on schedule. The pedestrian pedway connecting the new hospital to the parking garage of the University of Kentucky Albert B. Chandler Hospital is complete. Additionally, the dichroic glass on the outside of the building is being installed.

Modern day dichroic (meaning two-colored) glass is available as a result of research conducted by NASA and contractors to protect the astronauts and equipment from harmful rays while in space. Its reflective appearance gives the impression that the glass is changing colors and provides a soothing effect.

Shriners Hospitals for Children-Lexington officials expect to begin treating patients at the new facility in April 2017.

OWENSBORO RESTAURANT SPONSORS ROCK’N ROLL TRIBUTE FOR CANCER SURVIVORS OWENSBORO On

a warm Friday night, expanded Medicaid, and they have little or September 23rd, PizzAroma in Owensboro, Ky., no experience with medical facilities, their sponsored the tribute band Hotel California, programs, and procedures.

Salute to the Eagles in an outdoor concert (l-r) Melissa Karrer, KCL community relations, Mary to benefit Kentucky CancerLink. PizzAroma Ann Leucht, PizzAroma owner and sponsor of the owners, Bob and Mary Ann Leucht, along party, with Vicki Blevins-Booth, KCL executive director.

PHOTOS PROVIDED BY KENTUCKY CANCERLINK with staff and many volunteers, hosted and catered to approximately 250 people in the community while raising funding for Kentucky cancer patients.

Founded in 2008, Kentucky CancerLink (KCL), is a 5013c notfor-profit, whose mission is to provide support to Kentuckians by reducing and/or eliminating barriers to screening, diagnosis, and treatment for all cancers.

KCL serves the uninsured, underinsured, or newly insured Kentuckians whose household income is at or below 250 percent of the Federal Poverty Level guidelines. Many of the newly Hotel California band with (4th from left) Vicki Blevins-Booth, KCL executive director, and Melissa Karrer (2nd insured have obtained insurance through from right), KCL community relations, and Blake Karrer (front).

ISSUE #103 31

Events

(l-r) Hope Scarves Founder Lara MacGregor and Pat Williams, MD, medical director Norton Cancer Institute, were happy to support the work of funding research for metastatic breast cancer.

COLORS OF COURAGE Hope Scarves Raises Funds for Metastatic Breast Cancer Research

LOUISVILLE The fifth annual Colors of

Courage, in honor of individuals affected by cancer and the community connected through Hope Scarves, was Friday, October 7, 2016 at the estate of Natalie and Reise Officer on La Grange Road in Anchorage, Ky. More than 500 people attended.

Live entertainment was provided by Porch Possums with a special guest appearance by Linkin’ Bridge, recent finalists on NBC’s “America’s Got Talent.”

The mission of Hope Scarves is to share scarves, stories, and hope with women facing cancer. When Founder Lara MacGregor was diagnosed with breast cancer, an acquaintance passed on the scarves she had worn in her cancer battle with an inspirational message that sparked the idea for MacGregor to pay it forward. Proceeds raised at Colors of Courage benefit Hope Scarves and provide funding for metastic cancer research.

Hope Scarves provides resources in three ways: 1. Patients, families or friends – those facing a cancer diagnosis who will lose their hair or just need support, can request a scarf, free of charge. Scarves come packaged with a cancer survivor’s story and tying instructions.

2. For hospitals and physicians’ offices – facilities can purchase scarf packages to distribute at the point of treatment so patients don’t have to seek them out themselves. The scarves are branded and customized with the hospital or facility logo and are available in quantities as small as 10. Promotional kits are also available for physician waiting rooms.

3. For survivors – cancer centers implementing survivorship programs can partner with Hope Scarves to collect scarves and stories to help survivors process, reflect on, and share their experiences.

For more information about the program or to request a scarf, visit hopescarves.org or call 502.333.9715.

32 MD-UPDATE

(l-r) Calvin Rasey, Physician Financial Services II, and wife Tara, Colors of Courage board member, are annual attendees of the Hope Scarves event.

(l-r) Attending Colors of Courage and supporting Hope Scarves were Janet Mart, family support liaison at Kentucky Organ Donor Association, Eric Davis, MD, transplant surgeon with University Surgical Associates, and Elizabeth Riley, MD, oncologist with U of L Physicians and the James Graham Brown Cancer Center, part of KentuckyOne Health.

Louisville performing artists Linkin’ Bridge entertained the audience at Colors of Courage with songs and personal tributes.

(l-r) Candace Green, Judy Semaria, and Dr. Jan Anderson, MD-UPDATE Mental Wellness columnist, attended Colors of Courage to support the cause of fighting breast cancer.

PHOTOS BY GIL DUNN

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