MD-UPDATE Issue #104

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #104 WWW.MD-UPDATE.COM

SPECIAL SECTIONS NEUROLOGY & NEUROSURGERY AUDIOLOGY MENTAL HEALTH

An Independent VOLUME 7 • #8 • DECEMBER 2016

VISIONARY

Georgetown ophthalmologist sees the future of his specialty and his practice through the lens of innovation and self-reliance ALSO IN THIS ISSUE • Q&A: OPIOIDS AND PAIN • MORE REFINED NEUROSURGERY OPTIONS • A MULTIDISCIPLINARY MOVEMENT DISORDERS CLINIC • RECONNECTING TO THE WORLD WITH SOUND

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LETTER FROM THE PUBLISHER

The Gift of Giving Back

MD-UPDATE MD-Update.com Volume 7, Number 8

The most enjoyable part of my job is meeting and talking with doctors. You are an amazing group of individuals. During interviews, I hear great stories about why you became doctors, what it means to you, the challenges, the rewards, the constant innovation, and what you give back to the community.

Recently I met Dr. Chip Richardson, an ophthalmologist in private practice in Georgetown, Ky. You’ll meet Dr. Richardson in this issue’s cover story.

In 2012, Richardson purchased 165 acres in Scott County, primarily because the tract held the remnants of the Choctaw Academy, which he wished to see preserved. The Academy has a complex history, but it remains a significant historical site. As Native American chiefs saw their peoples driven away from their home territories, they believed a way to stop this emigration was for their children to gain an education. This would allow the native peoples to compete for work and wages on an equal footing and provide the tribes with leadership knowledgeable in Euro-American, as well as Native American culture.

Richard Johnson, vice-preseident of the US in 1837, pushed to have the school built on his property in Scott County. This may be the first racially-integrated, federally-funded school in US History. The doors opened to Choctaw boys in 1825 and subsequently to members of 16 other tribes. The Academy closed its doors for good in 1845 after teaching nearly 600 students.

Richardson has been working with the Chip Richardson, MD, at the Choctaw Academy in Kentucky Heritage Council and the Choctaw Great Crossing in Scott County Nation on a conservation easement to allow for restoration fundraising, but progress is slow. Restoration is estimated at $200,000. Richardson hopes that Choctaw and other tribes will contribute financial support. He says, “This is a nationally significant building. Restoration could bring tourists to the historic community of Great Crossing as well as to the Academy itself. Things need to happen in a hurry because the remaining structures are disintegrating rapidly. It would be a shame to let this very historical site fade into the ground.”

To lend a hand, contact Richardson at 502.863.3112.

Happy Holidays,

ISSUE #104 PUBLISHER

Gil Dunn gdunn@md-update.com EDITOR IN CHIEF

Jennifer S. Newton jnewton@md-update.com GRAPHIC DESIGN

Laura Doolittle, Provations Group

CONTRIBUTORS:

Jan Anderson, PsyD, LPCC Andrew Desimone Steven Klipp Jason Miller Scott Neal Don Stacy, MD Jamie Wilhite Dittert

CONTACT US: ADVERTISING AND INTEGRATED PHYSICIAN MARKETING:

Gil Dunn gdunn@md-update.com

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CONTENTS

ISSUE #104 3

HEADLINES

5

FINANCE

7

ACCOUNTING

9

LEGAL

11 Q&A

13 An Independent Visionary Georgetown ophthalmologist sees the future of his specialty and his practice through the lens of innovation and self-reliance 16 SPECIAL SECTION: NEUROLOGY & NEUROSURGERY 20 SPECIAL SECTION: AUDIOLOGY 22 SPECIAL SECTION: MENTAL HEALTH 25 MENTAL WELLNESS

Dr. Chip Richardson and his wife Candy, office manager, built Georgetown Eye Care from the ground up.

27 ADVOCACY 28 NEWS 30 EVENTS

SPECIAL SECTIONS NEUROLOGY & NEUROSURGERY

AUDIOLOGY

MENTAL HEALTH

16 CONTINUAL REFINEMENT: BAPTIST HEALTH LOUISVILLE

20 H OW SWEET THE SOUND: BLUEGRASS HEARING CLINIC

22 B ODY AND MIND CONNECTION: BLUEGRASS HEALTH PSYCHOLOGY

2  MD-UPDATE

17 M OVING FORWARD: UOFL

24 T AKING RECOVERY ON THE ROAD: OUR LADY OF PEACE

Headlines

Kentucky Pain Society presents “Connecting Pain Professionals” LEXINGTON The Kentucky Pain Society (KPS),

Danesh Mazloomdoost, MD, Pain Medicine and Management, presented “Regenerative Medicine – Transforming Pain Management.”

a non-profit interdisciplinary group of healthcare providers treating chronic pain in the Commonwealth of Kentucky, met on Saturday November 12, 2016 at the Marriott Griffin Gate in Lexington.

The KPS consists of physicians, psychologists, dentists, physical therapists, occupational therapists, nurse practitioners, and nurses with a mission to provide education and advocacy for empirically based treatment of chronic pain.

The KPS started 13 years ago as a district of the Southern Pain Society, which is a region of the American Pain Society. KSP recently became its own entity. The November meeting, which was a combination of multiple aspects of pain including regenerative techniques for

Robert Klickovich, MD, president of Paradigm Pain and Spine Consultants and the Cardinal Hill Pain Institute, presented “Latest Advances in Interventional Pain Techniques.”

pain, chronic pelvic pain care, opioid problems with pain care, bipolar disorder and pain, sleep disorders and pain, physical therapy treatment of pain, and interventional treatment of pain.

Presenters were Danesh Mazloomdoost, MD, who presented “Regenerative Medicine – Transforming Pain Management”; Erica Adams, PhD, and Tracey LeGrand, PT, MPT, “Interdisciplinary Treatment for Chronic Pelvic Pain”; James Grider, DO, PhD, “Opioid Induced Hyperalgesia with Chronic Pain Patients”; Robert Pope, MD, “Sleep Disordered Breathing and Chronic Opioid Use”; Jonathan Cole, PhD, “The Effects of Bipolar Disorder on Chronic Pain”; Steve Marcum, PT, “Dry Needle Technique”; and Robert Klickovich, MD, “Latest Advances in Interventional Pain Techniques.”

(l-r) Robert Pope, MD, Owensboro Advanced Sleep Center, and Jonathan Cole, PhD, president of Bluegrass Health Psychology and the Kentucky Pain Society, both presented at the Kentucky Pain Society meeting.

PHOTOS BY GIL DUNN

ISSUE #104 3

Headlines — OP/ED

The Comeback Playbook

PremierTox Laboratory overhauls business operations and achieves CAP accreditation by providing fast, accurate, affordable drug testing services

BY STEVEN KLIPP RUSSELL SPRINGS Everyone loves a good come-

back story. Many patients making their own triumphant return from pain, addiction, or depression can immediately relate, and as their trusted physicians guiding them on the path of healing, you can most certainly sympathize: recovery can be arduous, but victory over trial is so sweet.

PremierTox Laboratory – a CAP-accredited, toxicology reference laboratory in Russell Springs, Ky. – is no stranger to turning wounds into wisdom since we made the local news a few years back for missteps by former leadership that ultimately led to a total overhaul of our business operations – including a complete change of ownership and management. Now, through a renewed commitment to quality testing processes, integrity in billing, and keeping our promises: PremierTox is back.

PremierTox’s journey comes right out of any experienced clinician’s playbook for recovery: getting back to the basics, fixing pain points with better processes, and bringing on the needed expertise to facilitate positive change.

For the last couple years, the long road of recovery meant looking inward first; developing in-house solutions for monitoring testing quality and timely results in the lab; bringing on exceptionally qualified expertise – including a chief laboratory officer, compliance officer, and new sales, billing, and operations leadership; and developing proprietary testing options that meet or exceed the standards put forth by Medicare/Medicaid. Ultimately, all this hard work culminated in national accreditation by CAP (College of American Pathologists) earlier this year, solidifying our standing amongst worldwide elite laboratories.

We’ve worked hard, and CAP accreditation is an endorsement of the impeccable quality of our services, our people, our integrity, and our highest standard of care for patients.

It is a belief echoed by our Chief Laboratory Officer James E. Meeker, PhD, who says, “Physicians, especially in this region, are hard hit by prescription drug abuse and need accurate drug tests in the shortest time possible to make the right decisions for the best possible outcomes. CAP accreditation reflects the intense attention our dedicated team gives every test, every detail. At PremierTox, it’s always more than a test result to us: it’s a patient; it’s the physician’s practice on the line. We’re focused on keeping promises to our customers.”

Plotting a New Course

Testing That Helps Improve Outcomes

When I became president of PremierTox Laboratory, we had inherited the seemingly impossible. But truly, this team, by the grace of God, has overcome what would have sunk any lesser company, any lesser lab. I couldn’t be prouder of where we are now.

PremierTox provides drugs of abuse testing services that help clinicians personalize medication therapy and treatment monitoring to improve patient outcomes. Powerful, addictive medications that are often vital for adequate treatment, potentially deadly drug-drug

4 MD-UPDATE

PHOTOS PROVIDED BY PREMIERTOX LABORATORY

interactions, and rampant illicit drug use in their communities are just a few of the reasons providers are finding themselves reluctantly on the front lines for identifying prescription abuse or diversion. Monitoring controlled drugs throughout the course of therapy with PremierTox testing services not only helps clinicians enhance medication therapy, but provides objective, clinically actionable data to inform their decision-making.

Industry-Leading Services CAP accreditation reflects the quality of our testing and proven accuracy. In addition to trusted results, PremierTox has been winning over providers in the region with our testing speed and reduced cost to the patient.

By getting results to our customers fast – typically the next business day – I believe that PremierTox equips providers in Kentucky and beyond with the information they need, when they need it. With all that’s going on in this area with drug misuse, having to wait threeto-five days for a complete toxicology result is often an inconvenience that physicians can’t accept these days. With PremierTox, you can rest assured that accurate results will be delivered quickly, at a low cost that isn’t a burden to your patients or the already financially strained healthcare system.

Clinicians Are Not Alone For many providers in our region, just knowing they have a partner in a local lab that’s been through it all, with wisdom from hard-fought experience, is often what makes the greatest difference. After all, recovery from any bottom isn’t a solo act; PremierTox intends on helping many more Kentucky patients in their own comeback story.

Please contact me if I can be of service to you.

Steven Klipp is president of PremierTox Laboratory.

He can be reached at 877.412.8330.

Finance

Trumponomics

BY SCOTT NEAL

It’s still a bit early to say much, but our ardent publisher has asked for a take on Trumponomics and what the results of the election might mean to your personal finances.

I think we can all probably agree with The Economist when it wrote in late November, “For the moment, the policy priorities of the Trump administration-in-waiting are a basket of unknowables.” To the extent that we can rely upon probability theory and early indications, we can make some pretty well-educated guesses about what could happen going forward. So here goes.

Campaign promises very often get sidelined by political realities once the candidate actually gets into office. However, tax cuts for the higher brackets and capital gains are likely to be early and easy victories for Trump given the Republican-controlled Congress. He has also indicated that he would like to do away completely with estate and gift taxes. On a note germane to this readership, congressional Republicans think that they are now more likely to be able to orchestrate a full replacement of the Affordable Care Act despite that fact that they lack the 60 votes needed to overcome a filibuster in the Senate. They would do that via a process called “budget reconciliation,” which permits a simple majority on tax and spending measures. The replacement, envisioned by Paul Ryan, would grant a tax credit to everybody based on age. Exactly how such changes will affect the demand for your services and reimbursement rates remains a question mark.

If your tax planning has been to assume that income tax and capital gains rates remain the same or go up over time, it is now time to reconsider the impact of declining rates. As we approach year end, deductions and exemptions are likely to mean more this year than they will next year. Even when rates are the same from one year to the next, income deferral has long

been a tax saving maneuver suggested by tax practitioners. It takes on added significance this year.

As you probably know, the stock market dropped precipitously as the returns came in on election night but bounced back to hit new highs shortly after the election. The stock market’s wild post-election ride seems to indicate an expectation that a return to the fiscal policies of Reagan might be in store. The big story is in the rapid rise of government bond yields. The bond market clearly expects for there to be bigger deficits, ramped-up growth, and higher inflation. If the past is any indica-

tor of the future, we can expect all of these to overshoot their targets – which could lead to our next recession.

The Economist points to three major concerns of a Trump administration using the Reagan playbook: 1) Financial instability (i.e., higher interest rates, defaults by emerging economies causing problems for banks at home); 2) A rapidly rising dollar that will make it difficult for the manufacturing sector to develop a current account surplus with our trading partners; and 3) The starting place (i.e., lower top tax brackets and higher inequality) that is much different than it was in the 80’s will make the

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ISSUE #104 5

Finance potential benefits of a stimulus much smaller than we saw then. This could all spur a new round of uncertainty, which, I probably don’t need to remind you, markets hate.

Interestingly enough we have a new tool to monitor economic policy uncertainty in the form of an index. It was formulated by three economists from Northwestern, Stanford, and Chicago and shows that increased uncertainty goes hand in hand with lower growth. So

The stock market’s wild post-election ride seems to indicate an expectation that a return to the fiscal policies of Reagan might be in store. despite the hoped-for stimulus promised by lower taxes and increased spending, there is enough uncertainty that sufficient growth is anything but a sure thing. The real question is where to look for the silver lining in these

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clouds.

If only the new administration is able to bring about infrastructure spending on projects with a high rate of return, the job market and the bond market will be delighted. The bond market would continue to fund the deficit without a huge rise in yields, which could lead to sustained growth and working Americans once again enjoying an improving living standard. If only he can negotiate a proper trade deal with China that will enforce free but fair trade, economies around the world will benefit. If only he can protect our shores without alienating our neighbors and partners, the economy needn’t suffer.

Other than the aforementioned tax planning, what can we do to contend with the new world that we all face in 2017? First of all, I point you back to last month’s article having to do with proactive risk controls in your portfolio that will even help make money in a volatile market while protecting capital. Just as importantly, we need to be alert for opportunities that this new environment brings.

The financial and healthcare sectors could benefit from reduced regulation. Technology is likely to do well because firms that depend on technology have a strong incentive to invest despite significant uncertainties just in order to stay ahead of their competition. If the protectionist strategies for stronger national defense fomented in the campaign actually play out, companies that support our defense are likely to do well. All in all, bonds are likely to underperform stocks in 2017 and lower than historical rates of return of securities of all types can reasonably be expected. Closer attention to the shifts in the market is key. Let us know how we can be of service.

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

Questions and comments are welcome at 800.344.9098 or by email to scott@dsneal.com.

Accounting

Outsourcing — The Key to Financial Health

BY JASON MILLER

The growth of healthcare organizations continues to trend upward in the industry as a result of key drivers such as federal mandates, market competition, tighter margins and the increasing need to do more with less.

Regardless of whether healthcare organizations expand because of consolidation or organic growth, the one challenge they all face is trying to gain visibility and transparency of information across the organization in order to better manage costs and link cost to outcomes and industry performance – without negatively impacting revenue and growth. One of the ways healthcare organizations can avoid over-investing in human and IT resources is to cost-effectively scale or outsource their IT systems, including their financial management systems.

As healthcare organizations strive to cost-effectively scale their business, cloud-based accounting solutions are being recognized as viable solutions. Small offices and mid-sized partnerships, practices with hundreds of specialists, plus laboratories, surgical and urgent care centers, and assisted living facilities are all looking for ways to increase revenues through faster and more accurate billing, reduce costs by automating manual processes, and make

better, faster business decisions by gaining realtime visibility into operational and financial data. Outsourcing the accounting function can be the key to financial health and an efficient solution for the accounting and administrative cycle that is vital to success.

Outsourced Accounting – Do what you do best and outsource the rest A good outsourced partner is comprised of experienced professionals that will evaluate your financial processes and controls, implement a secure, cloud-based software, and manage the accounting and reporting functions to provide you real-time results. However, the right partner also brings professionals with a deep understanding of the business of healthcare. Some of the benefits of a strong outsourcing relationship include: • A collaborative environment with improved visibility into an entity’s performance via dimension-based reporting (e.g., by physician, physician’s assistant, office location, service line / revenue stream, or other category); • Key financial information available on dashboards accessible from any device at

any time with an internet connection; • Strong internal controls and segregation of duties to minimize the potential of fraud; • Standardized, automated workflows and processes for accounts payable, employee expense reports, credit card transactions, payroll cycles, fixed asset tracking and bank reconciliations; • Integrations with other critical business applications to reduce time and costs involved in accounting operations; • Timely monthly reporting packages with variances to budgets and prior period results; and • An outsourced CFO, who understands the business of healthcare, that interprets financial information, performs profitability analysis, creates cash flow forecasts and adapts business processes to changes in the operations.

Real-Time Business Performance Insight Driving Agility Owners of medical practices that utilize strong outsourced accounting services experience many of the following benefits that allow them to move away from manual processes

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Accounting

and alternatively analyze key metrics instead of spending hours on computing: • More time to focus on operations, patient care, cost control measures, training and retention of employees, compliance with regulatory requirements, and other core processes essential to the success of the practice; • Lower investment in technology, software, and infrastructure; • Safeguarding of assets due to improved internal controls and segregation of duties; • Real-time visibility into key operational metrics and streamlined processes, eliminating manual data entry and Excel-based financial reporting • Predictable monthly cost of accounting services; and • Additional value in the overall business resulting from timely, quality financial information and sound financial practices (e.g., to potential lenders, to new investors or for merger and acquisition opportunities) Establishing streamlined, embedded processes also allows healthcare organizations to easily comply with auditors’ requirements for complete transparency. If you outsource pieces of your accounting functions with a qualified CPA partner, you should benefit from improved financial controls that are maintained right within the system and be able to centralize everything you are doing offline into one place.

With healthcare organizations required to report to several different stakeholders, including regulatory agencies and investors, visibility and transparency of data is critical.

Adapting your archaic mainframe accounting system to a more flexible system that meets your changing needs, provides better transparency, requires less manual data entry and IT resources, supports paperless workflows, and connects with your payroll and other integrated systems will be a necessity for healthcare organizations to continue growing and thriving in this era of healthcare transformation.

Jason Miller is the director of Business Consulting Services at Dean Dorton. He can be reached at jmiller@ddaftech.com.

8 MD-UPDATE

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Legal

Eighth Amendment Claims

BY ANDREW DESIMONE AND JAMIE WILHITE DITTERT

It is very rare for the Amendments to the United States Constitution to have any applicability to the practice of medicine. However, the treatment of inmates incarcerated in the prison system can implicate the Eighth Amendment, even when that treatment is rendered by a private physician.

The Eighth Amendment to the United States Constitution states “[e]xcessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.” (Emphasis added.) Federal courts have developed a considerable body of law related to prisoner lawsuits alleging an Eighth Amendment violation by medical providers, i.e., the medical care provided to the inmate was so poor it constitutes “cruel and unusual punishment.” With a large prison population in the United States, almost every medical provider will treat an inmate at some point in his or her career.

The Eighth Amendment applies to inmate medical treatment because it not only prohibits excessive force but also requires that prisoners be afforded “humane conditions of confinement,” so that prison officials “ensure that inmates receive adequate food, clothing,

shelter, and medical care.” Farmer v. Brennan, 511 U.S. 825, 832 (1994). While prison conditions are inherently “restrictive and even harsh,” adverse conditions should serve a corrective function. Id. (internal citations omitted). Eighth Amendment claims have a broader reach than the phrase “cruel and unusual punishment” suggests, and substandard medical care to a prison inmate may result in an Eighth Amendment claim.

When Does the Eighth Amendment Apply to a Medical Provider?

Generally, the Fourteenth Amendment to the United States Constitution makes the Eighth Amendment applicable to states.

Furman v. Georgia, 408 U.S. 238 (1972).

Under 42 U.S.C. § 1983, a claim can be made against the state or local governing body for an Eighth Amendment violation. Moreover, case law allows Eighth Amendment claims against private medical providers who have contracted with a state or local entity to provide medical care to those inmates, even where the private medical provider’s prison work is a small percentage of his practice. West v. Atkins, 487 U.S. 42 (1988). In West, the defendant ortho-

pedic physician had contracted with North Carolina to provide two clinics each week at the state prison, but he maintained a private practice outside of the prison system. The Supreme Court stated that the physician was acting under color of state law, such that he became a “state actor.” Id. at 55-56. Therefore, the physician could be liable to the inmate under the Eighth Amendment.

Finally, even consultants who see an inmate solely in a private practice setting and who have not contracted with the state or local prison system may be liable under the Eighth Amendment. The Seventh Circuit Court of Appeals (Indiana and Illinois) has held that “medical providers who have ‘only an incidental and transitory relationship’ with the penal system are generally not considered state actors.” Shields, 746 F.3d at 797-98. In contrast, the Fourth Circuit (Virginia and West Virginia) in Conner v. Donnelly, 42 F.3d 220 (4th Cir. 1994) found that a private physician, who only saw the inmate in his private office, and who did not have a contract with the Commonwealth of Virginia, could be liable under the Eighth Amendment, stating: Regardless of whether the private physi-

ISSUE #104 9

Legal cian has a contractual duty or simply treats a prisoner without a formal arrangement with the prison, the physician’s function within the state system is the same: the state authorizes the physician to provide medical care to the prisoner, and the prisoner has no choice but to accept the treatment offered by the physician. Even where a physician does not have a contractual relationship with the state, the physician can treat a prisoner only with the state’s authorization.

If a physician treating a prisoner-whether by contract or by referral-misuses his power by demonstrating deliberate indifference to the prisoner’s serious medical needs, the prisoner suffers a deprivation under color of state law Id. at 225 (emphasis added). Therefore, there is a good chance that anytime a medical provider treats an inmate, even in his or her private medical office, he or she can be liable under the Eighth Amendment.

Deliberate Indifference So what does the Eighth Amendment prohibit when a medical provider sees an inmate?

“A prison official is deliberately indifferent if she knows of and disregards a serious medical need or a substantial risk to an inmate’s safety.” Saylor v. Nebraska, 812 F.3d 637, 644 (8th Cir. 2016). Thus, the Eighth Amendment protects inmates when (1) those inmates have a serious medical need and (2) the medical provider is “deliberately indifferent” to that serious medical need.

Not every physical condition constitutes a serious medical need. “A serious medical need is one that has been diagnosed by a physician as mandating treatment or one that is so obvious that even a lay person would easily recognize the necessity for a doctor’s attention.” Youmans v. Gagnon, 626 F.3d 557, 564 (11th Cir. 2010). Unless being treated for a minor bruise, common cold or scrape, most medical conditions can be considered a serious medical need.

“Deliberate indifference” is less common.

The Eighth Amendment bars “obduracy and wantonness, not inadvertence or error in good faith.” Seiter, 501 U.S. at 299. This has been defined as “more than mere negligence,

but ‘something less than acts or omissions for the very purpose of causing harm or with knowledge that harm will result.’” Foy v. City of Berea, 58 F.3d 227, 232 (6th Cir. 1995).

For example, a prisoner’s mere disagreement with his physician’s course of treatment is not deliberate indifference.

Conclusion The Eighth Amendment prohibits such acts as ignoring the serious medical condition or making the condition worse. So when treating an inmate, just remember to treat him or her like a normal patient. If you remember that one simple rule, the Eighth Amendment will not have an impact on you as a medical provider.

Andrew DeSimone and Jamie Wilhite Dittert are healthcare attorneys at Sturgill, Turner, Barker & Moloney, PLLC. They can be reached at 859.255.8581 or www. sturgillturner.com. This article is intended to be a summary of federal and state law and does not constitute legal advice.

WE’VE DONE THIS BEFORE. From health care transactions and compliance to litigation defense, Sturgill Turner’s health care team is committed to providing comprehensive legal services to health care providers, hospitals and managed care organizations.

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Q&A

Opioids and Pain

Q&A with Danesh Mazloomdoost, MD

LEXINGTON MD-UPDATE Publisher Gil Dunn recently sat down with pain medicine specialist Danesh Mazloomdoost, MD, to discuss the state of the opioid problem in Kentucky and trends in pain medicine.

Mazloomdoost is the medical director of Pain Management Medicine, a multidisciplinary practice begun by his parents in the 1990s, with locations in Lexington, Corbin, and Mt. Sterling. Mazloomdoost is currently the vice speaker of the Kentucky Medical Association (KMA), vice president of the Lexington Medical Society (LMS), and a board member of Physicians for Responsible Opioid Prescribing (PROP).

He is an advocate for a paradigm shift in healthcare to reduce its reliance on opioids and guides patients through rehabilitative and regenerative techniques to heal the underlying causes of pain.

■■ MD-UPDATE: Describe the current state of opioid use, abuse, misuse, and addiction in Kentucky.

MAZLOOMDOOST: Kentucky is consistently ranked in the top five for opioid abuse, misuse, and overdose. The problem is even worse in south and east Kentucky where 50 percent of the population has a friend or family member using opioids for non-medical purposes.

The indigent and Medicaid populations are most affected, where statistics show Medicaid recipients have a twofold greater opioid use and six times the overdose rate of the general population. This problem disproportionately affects young and middle-aged adults, where one in seven Kentuckians under the age of 30 have used an opioid. Opioid misuse and abuse in younger ages are of an even greater concern given the detrimental impact on brain development.

■■ Is the opioid problem unique to Kentucky, or unique to a particular region or population of Kentucky?

Kentucky is by no means unique in this problem, however, we have a substantial head start compared to many other regions of the country. The epicenter of the opioid epidemic is Appalachia, but, Kentucky’s also on the leading front to address this problem. This is a problem that does not discriminate across socioeconomic lines, demographics, or gender.

■■ Describe what you see regarding the opioid problem in your medical practice.

■■ What are the factors driving these conditions? Are there underlying causes for the opioid problem?

It is widely accepted now that misunderstandings, falsified information, and exaggerated study claims from the pharmaceutical industry drove this epidemic. As greater obligation was placed on providers to 100 percent eliminate pain (an unrealistic expectation), an illusion evolved that escalating doses of opioids was not only the solution but inhumane to even question. Use of these medications ballooned under the guise that tolerance was avoidable if used properly and addiction was rare. Certain adverse effects of opioids were never discussed – the CNS impact on affect and depression, the hormonal changes, decreasing immunity, tolerance, and physical dependency. The increasing rates of overdose and heroin use were interpreted as finding means to prescribe more safely and monitor compliance. Despite ample evidence showing lack of efficacy in long-term settings, ever growing numbers of patients were prescribed opioids without any further attention at fixing the underlying problem causing pain until a surgical option was unavoidable.

PHOTO BY JOHN LYNNER PETERSON

I am excellent at fixing a wide variety of orthopedic, neurologic, and degenerative pain problems, often circumventing the need for surgery. However, my colleagues often view my field and myself as the controlled substance manager for patients. This is a travesty, because when inundated with opioid maintenance it limits the time and resources I can offer the opioid-naïve patient who has a much better prognosis under my care than someone chronically maintained on opioids.

The vast majority of pain issues are treatable if opioids are avoided. Once introduced, however, the long-term prognosis drops rapidly and substantially.

■■ Is there any consensus among pain medicine physicians about what needs to be done?

Yes, there is consensus that medicine needs to re-evaluate how we view and use pain management as a specialty. While some view it primarily as palliative care for chronic conditions, the field is better suited in seeing patients at the front end of their pain problem. Using our focal diagnostic and workup skills, we are well-suited to diagnosing and isolating the specific origin of pain. In ISSUE #104 11

Q&A

doing so the goal then becomes to regenerate the damaged tissue through rehabilitation, correcting defects in the mechanical chain, improving the conditions for tissue healing, or moving into regenerative interventional techniques.

■■ Are there areas of disagreement among pain medicine doctors on the causes and options for dealing with the opioid problem?

The CDC guidelines provide a best-practices consensus but there is still some gray area where the literature does not have clear guidance. Like anything on a spectrum, some physicians and practices rely more heavily on opioids than others. For non-malignant pain patients in our practice, we consider opioids as a rescue therapy for intolerable episodes but an ineffective maintenance therapy if patients are opioid-exposed daily or around-the-clock. Another area that has some controversy but a growing body of evidence

12 MD-UPDATE

is in regenerative versus steroid-based techniques. We have gradually transitioned toward regenerative medicine and lessened our use of steroid-based injections with better outcomes.

but I believe that is mislabeling correlations.

Heroin was on the rise long before the legislative changes, and that trend is ongoing.

■■ What are the after-effects of legislation (SB2 and HB1) enacted in 2012 to change the reporting and prescribing of controlled substances in Kentucky?

We need to unify our messaging to patients. The onus cannot be just on pain specialists to educate the masses. While physicians have plenty to complain about as far as regulation and restrictions, we cannot blame the need to wean opioids on that. Patients need to be educated on the limits of opioids, such as the hypersensitivity that occurs with opioid use, the rebound pain when opioids wear off, or the fact that often pain for a chronic opioid recipient reflects withdrawal rather than physiologic pain. The message should be that opioids have a short-term benefit but a long-term harm and are not the only effective means for pain management.

HB1 was very controversial at the time, but it put Kentucky in the forefront of the opioid epidemic. At that time we were only one of four states in the country with progressive laws challenging the status quo of opioid management. These laws have had a beneficial impact on shutting down unscrupulous practices. There are still some elements of these laws that hinder care and warrant re-evaluation, particularly in rural regions, but overall it has been helpful for those challenging the opioid-driven messages. Some say that the increase in heroin is attributable to this,

■■ What needs to be done now?

Contact Dr. Mazloomdoost at 859.275 4878 or drdanesh@painmm.com.

Cover Story

Dr. William “Chip” Richardson and his wife Candy, office manager, built Georgetown Eye Care from the ground up. The thriving ophthalmology practice opened in 2007.

An Independent Visionary Georgetown ophthalmologist sees the future of his specialty and his practice through the lens of innovation and self-reliance Richardson it is easy to understand this loyalty.

He is passionate about this practice, and the GEORGETOWN Born into a family of engineers, practice is all about the patients. musicians, and optometrists, William Wallace Hard work and the delight in hard work “Chip” Richardson, MD, was nurtured in must be in Richardson’s DNA. He attended technology, performance, and a curiosity for Ohio State University’s Honors Program, but the eye and its abnormalities from childhood. was restless. When a professor there told him It is through the hard-working application of he was going to grade “Ivy League” tough, all of these skills that Richardson has been able Richardson said to himself, “Hmm, if I’m to do something almost unheard of in today’s going to be graded like Ivy League, I might medical environment – build and grow a solo as well go Ivy League,” so he transferred to ophthalmology practice in Central Kentucky, Cornell University and graduated with a BA in specifically in Georgetown. In medicine science. Cornell’s issuing an arts degree to a scitoday, almost all doctors, when they finish ence major is not an idiosyncrasy. They are telltheir residency or fellowship, join an estabing the world that their science grads are well lished large group or steeped in the humanare employed by a I thought, if I just keep working as hard as I can, it will happen. ities. Richardson hospital or healthcare shows the lasting — Dr. William Wallace “Chip” Richardson network. Richardson’s effects of this educastory is intriguing and tion in small ways, like complex, but he keeps coming back to one Currently, the practice sees about 80 patients keeping a book of poetry on his desk, and large mantra, “I thought, if I just keep working as a day. Richardson describes his established ways, like compassionate and personal care hard as I can, it will happen.” Well, he did, patient population as very loyal with some for every patient and dedication to restoration and it happened. former residents of Georgetown still returning of the Choctaw Academy, an historic Native Richardson, with his wife Candy as office for their annual visits from their new homes American school that operated in Scott County manager, now operates a thriving private prac- many states to the south. In conversation with from 1825-1848.

BY BOB BAKER

tice – Georgetown Eye Care. The practice employs a second ophthalmologist, James Gullett, MD, a graduate of the University of Kentucky ophthalmology residency; optometrist Stefanie Adams, OD, a graduate (cum laude) of the Illinois College of Optometry; and 12 office staff, including technicians and opticians. As a group, they provide eye care to a patient population of all ages from Georgetown and Scott County, including employees from the Toyota plant, as well as patients from surrounding areas such as Grant, Bourbon, and Harrison counties, and the stretch of land between Georgetown and the catchment area of the Cincinnati Eye Institute.

PHOTOS BY JOE OMIELAN

ISSUE #104 13

Cover Story Richardson returned to Ohio State for his medical degree. There, he did two years of cardiology research studying intravascular ultrasound. He committed to an internship in Columbus, followed by 2 years of NIHsponsored research at UK – studying the neural control of the muscles of facial expression.

An ophthalmology residency at UK marked the final phase of his formal training. During residency, Richardson distinguished himself as a dedicated fast learner and careful surgeon.

With time his colleagues discovered some of his other talents, such as, if a piece of equipment malfunctioned and manufacturer’s support was not available, Richardson fixed it. If IT support could not solve a computer issue, Richardson fixed it. It is no surprise then that as he built Georgetown Eye Care, there was no need to hire a network consultant to set up the computer network, and when a piece of biomicroscopy had an electrical failure, no one had to call the supplier and wait for help. Richardson took apart the circuit board, diagnosed the problem, fixed it, and corrected the design defect in all the other biomicroscopes as well. It is impossible to overstate what a valuable and unique set of skills Richardson brings to the development and maintenance of his practice.

Establishing a Solo Practice Richardson recollects choosing a location for his practice on the age-old adage – location, location, location. He wanted to be within walking distance of the hospital and in an area that was growing commercially. He found the ideal piece of land and bought it,

despite the seller emphasizing the location and setting the price accordingly. The property was excavated and the building completed in 2007. The next step was to purchase and set up the large number of complex and expensive pieces of equipment necessary to start an ophthalmology practice.

On the day the equipment was delivered but had not yet been installed, Richardson was concerned that his investment was sitting in crates with handles, far too easy a target for Jim Gullett, MD, joined Georgetown Eye Care in 2015 and performs theft. His solution was to cataract surgery at Georgetown Community Hospital. put an inflatable camping mat in an exam lane and spend the night on make it. “From then until now I have been the office floor. While that may seem a little confident. I could still manage a 20 percent bit over the top to some, to Richardson it’s increase in patient volume with my current staff just one of the little things he has to do as a and space. If and when I get more than that I solo practitioner. will take on more staff, hire another optomeSuccessfully establishing a patient population trist or perhaps another ophthalmologist, and I from scratch as a solo practitioner, Richardson will expand the space,” he adds, while stressing points to a couple of key networking philos- an integrated eye care team. ophies. “Very active involvement with area primary care physicians and a strong presence Advancements, Innovations, and in hospital affairs were crucial for me. I still Challenges thank the primary care doctors in this commuNot one to be intimidated by developments nity every day. What it really comes down to is in ophthalmology coming in the future, satisfied patients and word of mouth,” he says. Richardson says, “A number of my colleagues It took Richardson about 18 months in practice are looking for ways to block the advancement before he began to believe the practice would of telemedicine. The Kentucky Board of Georgetown Eye Care is within walking distance of Georgetown Community Hospital where Richardson is service chief of the Surgery Department. He often makes the trek there.

14 MD-UPDATE

Optometry has already deterred their licensees from signing off on any telemedicine examinations or any refraction (assessment for glasses or contact lenses) not done face to face. I disagree with this stance. I am looking forward to finding out how we can use telemedicine in the future to deliver better eye care to everyone,” he says. Richardson does not deny the challenges of interstate licensing, the need for health maintenance exams, and determining reimbursement, but he points out that refractions are currently covered by very few third party payors, including Medicare.

When asked what one thing he would like to convey to the lay public about ophthalmology, Richardson says emphatically, “Ophthalmologists go to medical school.”

As medical doctors, ophthalmologists differ from optometrists and opticians in training and in their ability to perform surgery and diagnose and treat all eye diseases, as well as correcting vision. “Sadly, our legislators were careless in 2011 when expanding surgical privileges to optometrists. They especially need to understand the importance of medical school and the need for equivalent training for patient safety.”

For healthcare providers, Richardson describes recent advances in ophthalmology: “There are really two treatments that have undergone revolutionary development in the last five to 10 years. First, is that macular degeneration and diabetic retinopathy can now be treated very successfully and noninvasively.

Macular degeneration is no longer a certain

“Traditional examinations aided by spectral domain ocular tomography are the biggest advancement in ophthalmology in the last decade,” says Dr. Chip Richardson.

“Having a three-dimensional image of the retina, down to the micron level, is miraculous technology,” says Dr. Chip Richardson.

sentence to visual loss. Second, is the ability to correct refractive errors, such as astigmatism, at the time of cataract surgery thus minimizing the need to wear anything but reading glasses afterwards.” Richardson describes the ability to examine the retina with ocular coherence tomography as the biggest technical achievement in ophthalmology in the last decade.

“This piece of equipment, which I use in the office every day, gives us a three dimensional image of the retina down to the micron level, allowing the identification of abnormalities much earlier and more precisely. I would use the term miraculous to describe the capability of this technology,” he says.

Richardson believes the biggest challenges

facing ophthalmology in the next five to 10 years are the same ones facing all of medicine. “Despite clear cut evidence that organizing physicians into large groups does not save money, I anticipate further efforts to do so. My biggest concern is not the financial and lifestyle impact these changes will have on doctors, it is the impact these changes will have on patient care. These are huge challenges, my hope is that the medical profession will remain cohesive enough to face them together instead of lone voices calling out from the wilderness,” he says.

While his rallying cry may be for physicians to come together with one voice, Richardson is proving that physicians can be successful in a solo practice with enough hard work, determination, and a little technical know-how.

GENERAL OPHTHALMOLOGY AND FULL OPTICAL PROVIDING STATE-OF-THE-ART EYE CARE, DIAGNOSIS & TREATMENT

Cataract surgery Family Eye Care Pediatric Evaluations Laser Procedures Glaucoma Treatment Board Certified Ophthalmologists:

WILLIAM “CHIP” RICHARDSON, MD | JAMES GULLETT, MD

103 South Bradford Lane Georgetown KY 40324

FOR REFERRALS & APPOINTMENTS

502.863.3112

Diabetic Eye Conditions Retinal Disease Macular Degeneration Contact Lens Fitting Eye Glasses Optometrist:

STEFANIE ADAMS, OD

www.georgetowneyes.com Fax: 502.863.3113 ISSUE #104 15

SPECIAL SECTION

Neurology & Neurosurgery

Continual Refinement

Neurosurgeon John Cole, IV, MD, establishes an esoteric practice at Baptist Health that focuses on options and outcomes for patients

BY JENNIFER S. NEWTON LOUISVILLE Perhaps you could call his approach

tactical, as his military background might imply, or cerebral, as is the obvious neuro reference, but one thing is evident, John Cole, IV, MD, approaches his neurosurgery practice with a limitless enthusiasm for knowledge and experience that translates to more options for his patients.

A board-certified neurosurgeon, Cole attended medical school, internship, residency, and a spine fellowship at the University of Kentucky. But he didn’t set out to be a neurosurgeon. “When I went to medical school, I thought I was going to do primary care,” he says. It was mentorship from neurosurgical residents and preceptors that piqued his interest in neurosurgery.

That experience at UK’s Level I trauma center helped prepare Cole for what came next – four years in the Army treating active duty service members and veterans in San Antonio, Texas.

After four years in trauma, Cole was looking for a quieter role. He took a position in Elizabethtown, Ky., but it was a little too quiet. In search of a position that was more esoteric and broader in scope, Cole landed in Louisville at the Baptist Health Center for Advanced Neurosurgery in August 2014, joining the practice of Jonathan Hodes, MD. Describing himself as a general neurosurgeon, he says, “I tackle everything from entrapments to brain tumors. I enjoy that about my work, the fact that I get an opportunity to spread my wings a little bit and not just get pigeonholed into only doing spine work gives me some pleasure because I get to have a different day in the office every day.”

As a general neurosurgeon, Cole estimates his practice is like most – 75 percent spine-related disorders and 25 percent cranial work 16 MD-UPDATE

Dr. John Cole, IV, is a board-certified neurosurgeon with the Baptist Health Center for Advanced Neurosurgery.

or other procedures. However, he points to Kentucky’s high rate of smoking, which contributes to higher than average rates of malignancy in his patient population.

His patient mix is everything from young worker’s compensation patients to the elderly.

Given his attraction to the esoteric, Cole sees potential even in elderly patients where others do not. “One of the things I’ve come to appreciate in my new practice is there are patients I’ve seen who other people haven’t worked on based on the fact that they are elderly. But, elderly people have lives too,” says Cole. “You have to adjust and pivot and shift what you’re going to offer them in terms of an intervention and take into account their comorbidities.”

Cole sees the advances in neurosurgery over the last decade or two as an overall “continual refinement” of technique from aggressive, open dissection to minimally invasive surgery.

This is reflected in his treatment philosophy, where his enthusiasm is not focused on a particular technology or device, but rather on the PHOTO PROVIDED BY BAPTIST HEALTH

question he asks himself: “What good have I done today? It’s not so much one procedure; it’s a set of outcomes that charges my batteries,” he says.

Describing his practice as holistic, in the sense that he considers more than just the spine, the tumor, or the cranial problem at hand, Cole says, “I discuss smoking cessation with probably 90 percent of our patients. It’s odd for a neurosurgeon to focus on lifestyle issues, but we think it’s an important part of outcomes.”

The practice also takes a service-line, teambased approach in the case of cancer patients, incorporating neurosurgery, medical oncology, radiation oncology, pathology, etc.

Lifelong learning is not only part of the job for Cole but is part of his nature and a goal he has in common with his new practice. For instance, he recently attended training on a procedure for the ablation of metastatic spinal tumors. And, it’s a benefit to his patients.

While Baptist Health is not a Level I trauma center, because of his connections with and understanding of the military community, Cole still sees a fair amount of active duty personnel, and he will soon be spending a few days in North Carolina teaching non-neurosurgeons how to perform neurosurgery under exigent circumstances. “I still have my toe in the water in terms of giving back to my country. I value my country only after I value my family,” he says.

BAPTIST HEALTH CENTER FOR ADVANCED NEUROSURGERY 3900 Kresge Way, Suite 41 Louisville, KY 40207 For consults or appointments, call

502-896-1313

SPECIAL SECTION

Neurology & Neurosurgery

Moving Forward

The U of L Physicians Movement Disorders Clinic focuses on better quality of life for its patients we have many options for treatment available LOUISVILLE Kathrin and always strive to LaFaver, MD, has improve the quality always been amazed of life of patients in with the human our care” says LaFaver. brain. And now, as the Interventions include Raymond Lee Lebby medical management, chair of Parkinson’s botulinum toxin injecdisease research and tions, deep brain stimthe director of the ulation surgery, and U of L Physicians– other forms of invasive Parkinson’s Disease therapy for movement and Movement disorders.

Disorders Clinic, she The center has a is engrossed in it every multidisciplinary team day.

Kathrin LaFaver, MD Victoria Holiday, MD philosophy and works “To me it’s the most closely with physical fascinating thing, and it’s what makes us and occupational therapists, speech therapists, human – how individuals arrive at certain psychologists, and social workers. Just named Our mission is to be a conclusions and thought processes, how our a Center of Excellence for Huntington’s dispsychological makeup and specific influences ease, the clinic offers comprehensive care referral center for movement change people’s lives,” states LaFaver. “I have in treating the disorder, which is a genetic disorders in the region, to always been drawn to the field of neurology condition that often requires psychological and wanted to help people that are affected by and physical therapy in addition to medical provide the best clinical disorders of the brain.” treatments. “Our goal is to provide all patients LaFaver is most definitely living out with movement disorders with the best care care, offer opportunities to her dream by taking care of over 2,000 possible,” states LaFaver. “Our team is ready participate in research, and patients day in and day out who are fighting to listen to patients and families, determine against Parkinson’s disease, tremor, dystonia, their needs, and help them reach their treatprovide patient-centered Huntington’s disease, and other movement ment goals. Whatever the need may be, we disorders at the U of L Parkinson’s and will try to make it a reality.” educational opportunities.

Movement Disorders Clinic.

One of those reality makers is Diane StretzIt’s the trifecta of care.

LaFaver joined U of L in 2013 and became Thurmond, case manager and program coorthe director of the clinic last year. Her expedinator with Frazier Rehab Institute, part — Dr. Kathrin LaFaver rience is vast, including a neurology residency of KentuckyOne Health, which provides from Mayo Clinic, a movement disorders felrehab services as a partner in the Movement lowship from Beth Israel Deaconess Medical treated at the Movement Disorders Clinic Disorders Clinic. As a certified rehabilitation Center in Boston, and a two-year stint in suffer from Parkinson’s disease, but the center counselor with a master’s in educational psythe Human Motor Control lab at the NIH serves patients with a variety of movement chology and counseling from U of L, StretzClinical Center in Bethesda, Md., with Mark disorders including tremor, dystonia, chorea, Thurmond joined Frazier Rehab Institute Hallett, MD. tics, ataxia, and gait disorders. “The field in 2007 at the inception of the Movement The majority of patients evaluated and of movement disorders is exciting because Disorders Clinic and assists patients and their

BY MELISSA ZOELLER

PHOTOS BY ROBERT DENSMORE

ISSUE #104 17

SPECIAL SECTION

Neurology & Neurosurgery

families with a plethora of resources and support within the community.

“My main role is helping patients and their families navigate the healthcare system, and truly understand the social services available to them,” states Stretz-Thurmond. “I try to offer information and counseling, as well as provide the educational and psychological support needed in dealing with these life-changing chronic conditions.”

Stretz-Thurmond has just been named a social worker for the Huntington’s Disease Clinic, as well as the clinic coordinator for the Motor Reprogramming (MoRe) Clinic, which just opened this past January. The MoRe Clinic is an interdisciplinary, inpatient rehabilitation program for patients with functional movement disorders offered at Frazier Rehab Institute. Functional movement disorders may be caused by psychological stress or other adverse events in patients’ lives and can lead to chronic disability if not treated adequately. The program uses strategies aimed at improving patients’ motor symptoms, regaining control over abnormal movements, and

We provide a really wellrounded level of care, from the beginning to the end of a patient’s disease, and make an effort from a research perspective to not only help quality of life, but also help prolong life and slow the disease process down.

Diane Stretz-Thurmond

— Dr. Victoria Holiday

learning better coping skills. The program has been successful for many patients in regaining normal motor control and is drawing patient referrals from several states outside of Kentucky.

Victoria Holiday, MD, also a member of the

Movement Disorders Clinic team, is a graduate of the University of Kentucky College of Medicine and underwent a movement disorders fellowship at Oregon Health & Sciences University in Portland, Ore. Holiday joined the practice recently as the medical director

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18 MD-UPDATE

SPECIAL SECTION of the deep brain stimulation program and to provide extra help for the clinic’s expanding patient volume.

Deep brain stimulation (DBS) surgery is a neurosurgical intervention used to treat complex patients with essential tremor, Parkinson’s disease, and some forms of dystonia. Joseph Neimat, MD, chairman of neurological surgery and specialty trained functional neurosurgeon, works with Holiday and the rest of the Movement Disorders Clinic, to provide state of the art care for patients in the area. DBS is a device implanted in the brain to manage neurological symptoms that have been difficult to manage with medication alone. U of L is one of just a few sites in the region that provide this type of service in an ever-evolving field of technological advancement.

“We try to address movement disorders from all angles,” states Holiday. “We make sure the patients have all the resources they need, aside from the medications that we prescribe, because it’s so much more than that in order to take care of a movement disorder patient.”

The clinic is also committed to research in the field of movement disorders and is a study site for the Parkinson’s and the Huntington’s study groups. Patients currently have the opportunity to be involved in potentially disease-slowing treatment trials for early stages of Parkinson’s and Huntington’s disease. With the research facilities on site, patients are able to be treated in the clinic as well as participate in research. The connection is the key.

“Our patients spend a lot more time in research because they have built strong relationships within the clinic and know these individuals are fighting to find a cure,” adds Stretz-Thurmond. “It’s so exciting, especially for folks that have children because that’s who they’re really here for.”

Clinical research nurse Annette Robinson, RN, has been conducting research studies in the U of L Neurology Department for seven years. Robinson is currently collaborating with

Annette Robinson, RN

U of L neurologist Robert Friedland, MD, on an investigator initiated study exploring the microbiota in the gut and nose in patients with Parkinson’s disease. The importance of a healthy bacteria flora in the gut has recently been recognized to be of importance for neurodegenerative disorders such as Parkinson’s disease, and U of L is hoping to contribute in unraveling some of the unknown factors influencing the development of the disease.

The Parkinson’s Buddy Program is another venture breaking new ground. A partnership between the Parkinson’s Support Center of Kentuckiana, U of L Medical School, and the Movement Disorders Clinic, the Parkinson’s Buddy Program pairs first year medical students with Parkinson’s patients over the course of one year for an in depth look into what it really means to suffer from a neurodegenerative disorder.

“The program gives a face to the disease, instead of just learning textbook knowledge,” states LaFaver. “I always tell students that no matter what specialty they’ll go into later, this is a good opportunity to learn how to create a connection with patients and be supportive of

Neurology & Neurosurgery

someone, not just be in charge of prescribing medications.”

And that’s just the beginning of new and exciting advances in the clinic. The Bill Collins Parkinson’s Education Center, located in the lobby of Frazier Rehab, is dedicated to enhancing education and outreach centered on Parkinson’s disease and related conditions.

Made possible by a large donation from the Bill Collins family through the Jewish Hospital & St. Mary’s Foundation, the center will offer a monthly speaker series, weekly exercise classes, and special events, all free of charge for patients and their families.

LaFaver makes it clear she wants to do what’s best for her patients and work hand-in-hand with providers in the community. “Referring a patient to us doesn’t have to mean losing a part of that patient’s care,” she says. “We’re happy to see someone for a second opinion just to confirm they’re on the right track or to make suggestions about what else can be done.

The goal is for the patient to receive the best treatment possible, and we will do whatever it takes for that to happen.”

Kathrin LaFaver, MD Victoria N. Holiday, MD Laura Dixon, DNP, APRN

FRAZIER REHAB HOSPITAL 220 Abraham Flexner Way Suite 606 Louisville, Kentucky 40202

P 502-582-7654 F 502-587-4117 UofLphysicians.com Email us at UofLPhysiciansMovement@ULP.org to sign up for our quarterly newsletter.

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ISSUE #104 19

SPECIAL SECTION

Audiology

How Sweet the Sound

Bluegrass Hearing Clinic helps patients reconnect with their world

BY JIM KELSEY LEXINGTON As the saying goes, sometimes you

don’t know what you’re missing. That is particularly true for many people who suffer from hearing loss. It might take place gradually, the degeneration so subtle that it is ignored or undetected for years. A tree falling in the forest does make a sound, but that doesn’t mean you can hear it.

The team of audiologists at Bluegrass Hearing Clinic sees it all the time. Someone comes in with hearing loss. They are skeptical, but try hearing aids. Suddenly, they are reconnected to a world they didn’t realize they had missed.

Stacey High, AuD, recounts the story of a patient who “was so hard of hearing that he didn’t really say anything. His wife was screaming at him in the waiting room, but he couldn’t hear.” High tested the man and found him to have severe hearing loss in both ears.

His wife was skeptical that hearing aids would help, but they tried anyway. The hearing aids worked. The couple was suddenly able to carry on a conversation. How long had they been unable to really communicate?

“His wife said, ‘You know, he’s always been part of the family, but he hasn’t really been part of the family for a very long time,’” High says. “She said, ‘He’s been isolated, physically there, but has not been involved.’ To see that man get his life back through better hearing, well, that’s why we do what we do.”

Bluegrass Hearing Clinic has been changing lives like that since 1997, when Deanna Frazier, AuD, founded the practice in Richmond, Ky. The practice has grown steadily since then, now consisting of 17 employees with locations in Bardstown, Cynthiana, Danville, Elizabethtown, Frankfort, Lexington, Manchester, Mount Sterling, Paris, and Richmond.

Frazier attended Eastern Kentucky University, received her master’s from the 20 MD-UPDATE

Deanna Frazier, AuD, is the founder and owner of Bluegrass Hearing Clinic.

Stacey High, AuD, completed her externship at Rady Children’s Hospital in San Diego.

University of Cincinnati and her doctorate from Arizona School of Health Sciences.

Initially, she was the lone audiologist at Bluegrass Hearing Clinic, but now the clinic has three other audiologists: High, Vanessa Ewert, AuD, and Daena Wilds, AuD. They work with patients who range from genetically deaf to those who have experienced hearing loss over time.

them realize or admit that their hearing has become a problem. “The typical person will wait about six years before they realize they are having problems and need to seek treatment,” Frazier says. “Often the “trigger event” is where they have missed out on something significant, been the butt of a joke, or they have an event coming up in the future that leads them to say, ‘Ok, it’s time to do something.’”

That something is often introducing the use of a hearing aid. And, like almost everything else, technology is rapidly changing the variety of options and the expected outcomes, with digital hearing aids offering advanced features over their analog counterparts.

“Analog is more of a one-to-one ratio when it comes to compressing sound,” Ewert says. “So what goes in, you give it this much amplification, and you get what comes out.

Now with digital they have compression of sound. So if a very loud sound comes in, they can compress it so it doesn’t sound so loud. It helps with loudness tolerance.”

Hearing aids are also being developed to work with smart phones with the Bluetooth technology, allowing sound from a television or cell phone to be streamed directly

We truly believe in letting our patients experience their world again.

— Vanessa Ewert, AuD “Hearing loss can be genetically recessive, so a mother and father can create a child with hearing loss even though they have normal hearing,” Wilds says. “We also see a lot of people who have noise-induced hearing loss from farming, working in a factory, or being in the military.”

Often times, such hearing loss develops gradually. It can take a “trigger event” to help PHOTOS BY GIL DUNN

Vanessa Ewert, AuD, was inspired to go into audiology by her grandmother, who lost most of her hearing when she was nine years old.

Daena Wilds, AuD, was on the swim team at the University of Tennessee.

to the hearing aid. That level of technology, however, comes with a learning curve for the patients.

But it’s time well spent to regain and restore quality of life. The impact of restored hearing can be immediate and dramatic. “As soon as we put the hearing aid on, you see the whole facial expression change,” Wilds says. “They go from this flat expression to being more engaged. They come back into the world and they come back into families.”

But the job of an audiologist is about more

than hearing aids. Bluegrass Hearing Clinic also does noise monitoring for industry, provides custom molds for noise protection and swimming, as well as all types of diagnostic testing.

They also treat tinnitus. “Patients that have a lot of noise-induced hearing loss are more likely to have tinnitus, but people that have normal hearing can have it too,” High says.

“Caffeine can contribute to it. Some herbal supplements can contribute to it. Even medicines can contribute to it.”

“I say we are auditory therapists,” Ewert says. “We are helping your auditory cortex through a similar rehabilitation that a patient with a knee or hip replacement would go through. New patients that are just starting to wear hearing aids don’t know what to expect.

My job is to help them transition through the process so they can figure out what the world sounds like again.”

“We truly believe in letting our patients experience their world again,” Ewert adds.

“We’re with them every step of the way.”

Our trusted Doctors of Audiology have been providing superior hearing health care since 1997.

1 (800) 470-4757

www.BluegrassHearing.com © 2016 Starkey. All Rights Reserved. 45434-16_5/16

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Bardstown | Cynthiana | Danville | Elizabethtown | Frankfort | Lexington | Manchester | Mt. Sterling | Paris | Richmond ISSUE #104 21

SPECIAL SECTION

Mental Health

Bluegrass Health Psychology

Making the Body and Mind Connection Work Better … Together

BY GIL DUNN LEXINGTON Since high school, Jonathan Cole,

PhD, ABPP, knew he wanted a career in psychiatry or psychology. His father David worked in mental health and his mother Becky was a nurse and became a nurse practitioner. Now as founder and president of Bluegrass Health Psychology (BHP) in Lexington, Cole’s dreams of working in his chosen field in his hometown are realized.

After taking his undergraduate degree at UK, Cole mastered in clinical psychology at Eastern Kentucky University (EKU) and received his PhD in clinical psychology at the Illinois Institute of Technology in Chicago. He then completed a fellowship in health psychology and pain management at Sun Coast Pain Management Center in Biloxi, Miss. Cole is married to Melody Cole, who is also from Lexington, so the decision to open his practice in the Bluegrass was easy.

Added to that happy circumstance is the satisfaction of seeing patients who need the special skills that Cole and his fellow health psychologists offer to patients dealing with chronic pain, headaches, migraines, gastrointestinal issues, insomnia, sleep apnea, dermatology problems, and bariatric surgery, to name the most common.

Medical health psychology, according to Cole, uses psychological techniques and training to treat people with medical conditions with the goal of improving their health.

“Bluegrass Health Psychology is the only fulltime health psychology private practice in Central Kentucky offering the full range of psychological treatment options for patients,” says Cole. BHP also is the only medical health psychology practice that is board certified in pain treatment and pre-bariatric surgery evaluation, states Cole.

Bluegrass Health Psychology usually does not treat patients with purely mental health illnesses such as bipolar disorder, schizophrenia, or 22 MD-UPDATE

Jonathan D. Cole, PhD, ABPP, founder of Bluegrass Health Psychology and Amanda Merchant, PhD, ABPP, who has been with BHP almost from the start.

PTSD, among others. “We rarely see the patient with only mental illness,” says Cole. “The vast majority of our patients have a medical health condition that a physician believes has a psychological component such as migraines, chronic pain, irritable bowel syndrome, sleep issues, insomnia, plus diet and weight loss concerns related to bariatric surgery, diabetes, and even dermatological or cardiovascular disease.”

“The brain and the body are connected,” Cole continues. “We treat patients with medical conditions that are sensitive to stress and have a stress trigger. We’re impacting their medical health by treating their brain.”

As an example, Cole cites his success in treating insomnia. Treating patients with chronic pain and headaches often involved individuals with sleep problems, so he trained in sleep, helping people adjust to CPAP sensation. “I am most successful in treating insomnia using a procedure called ‘cognitive behavioral treatment for insomnia’ which has over a 90 percent success rate after four sessions. Basically, it’s sleep rehabilitation, addressing many aspects of sleep, going for quality versus quantity. Sleep heals the body. A good night’s sleep can help with many medical conditions.”

PHOTO BY GIL DUNN

Referral Patterns: Success Breeds Success Since opening Bluegrass Health Psychology in 2006, with himself as the sole provider, Cole has seen the practice grow steadily to the point where it now has four PhD psychologists and a licensed clinical social worker plus administrative staff. The reason for the growth, Cole believes, is the successful outcomes that referring physicians see. “Once a doctor sends a patient to us and the patient improves in their medical conditions, we typically see more referrals from that doctor’s office.”

Currently on staff at Bluegrass Health Psychology with Cole are: Amanda Merchant, PhD, ABPP; Erica Adams, PhD; Donald Crowe, PhD; and Susan Snyder, LCSW. The breadth of staff allows BHP to expand treatment beyond chronic pain patients.

Merchant is a board certified clinical health psychologist. She received her undergraduate degree in psychology from Boston University and her master’s and PhD in clinical psychology from Chicago Medical School. She completed a clinical and health psychology internship at the Cincinnati VA Medical Center and a postdoctoral fellowship in primary care psy-

SPECIAL SECTION

Mental Health

The brain and the body are connected. We treat patients with medical conditions that are sensitive to stress and have a stress trigger. — Jonathan Cole, PhD chology at the University of Massachusetts Medical Center. In addition to chronic pain patients, Merchant specializes in patients presenting with GI, sleep, cardiology, diabetes, anxiety, and dermatological disorders, pre-surgical spinal cord stimulators, intrathecal pain pumps, and bariatric surgery evaluations.

Merchant joined BHP shortly after it opened. She describes the work of the health psychologist as “working in the bio-psycho-social model, understanding a person’s health in the context of their medical issues, their social interactions, and their psychological conditions. We intervene at certain points to positively affect their health.”

Not a new specialty, health psychology is becoming more widely known and de-stigmatized as “chronic illnesses such as pain, psoriasis, cardiac disease, and diabetes are negatively affecting people’s quality of life,” says Merchant. “We don’t only treat depression. We provide coping strategies for people in their daily lives.”

Erica Adams, PhD, a licensed counseling and health psychologist took her undergraduate degree in psychology at UK, her master’s in clinical psychology from EKU and her PhD in counseling psychology from U of L. She completed an internship in clinical and health psychology at the Dayton VA Medical Center and a postdoctoral fellowship in pain at Tampa VA Medical Center.

In addition to chronic pain patients, Adams

specializes in pelvic pain, gastro-intestinal disorders, headache, sleep, cardiac rehab, bariatric, and pre-surgical spinal cord stimulator and intrathecal pain pump evaluations. Adams has been with BGH since 2013.

Adams herself was diagnosed with Crohn’s Disease at 18 years old, and she believes that influenced her career decision. “I did my dissertation on coping techniques for chronic GI disorders, which led me to chronic pelvic pain because they often overlap,” she says. She treats patients who have dysfunctional GI systems but with no organic disease pathology to explain it. “Treatment for chronic pelvic pain is complex, and treatment can last for months or years. What I try to accomplish is to instill hope in my patients. Hope that something can be done to get them feeling better.”

Donald Crowe, PhD, is a licensed clinical psychologist, having received his PhD from UK. He specializes in chronic pain and trauma issues related to health conditions.

Susan Snyder, MA, LCSW, specializes in treating depression and anxiety with both children and adults in addition to chronic pain, bariatric and sleep patients.

It’s Not All in Your Head …

Just Some of It Ironically, says Cole, the biggest misconception about medical health psychology comes not from physicians, but from the patients. “I tell my patients, ‘If your doctor thought your

problems were all in your head, you wouldn’t be here. You’re here because your doctor thinks your physical health issues are legitimate and can be helped with behavioral strategies.’”

Common contributing factors to a lack of progress in medical health are “behavioral compliance and risk assessment,” says Cole. Before prescribing opioids, some of BHP’s referring physicians ask for a risk assessment for addictive personality traits. Other issues involve the behavioral compliance of patients, such as diet control and blood sugar monitoring for diabetics, performing relaxation exercises for migraines and sleep problems, and even something as simple as not overdoing it for chronic pain patients.

“I’ve had patients with chronic pain, who’ve had a good day, so they went out the next day and overdid it,” says Cole. “And then they’re laid up for three days. We use cognitive behavioral therapy to get our patients to see the cause and effect of their behavior on their medical health.”

Pain has two parts, says Cole, “There’s the physical aspect, and then there’s the mental suffering that goes along with it. Pain management is not pain cessation.” Physicians and physical therapists reduce as much of the physical pain as they can. The psychologists at Bluegrass Health Psychology deal with whatever pain is left over. They help the patients accept the situation and move on.

“You can either hurt and be miserable, or you can hurt and be happy,” says Cole.

Healing through the

Body and Mind Connection

SPECIALIZING IN

chronic back & pelvic pain, headaches & migraines, bariatric surgery, cardiac, CPAP tolerance, cancer, diabetes, insomnia, gastrointestinal disorders and more

JONATHAN D. COLE, PH.D., ABPP, FOUNDER

AMANDA W. MERCHANT, PH.D., ABPP

ERICA ADAMS, PH.D

859.277.1008

859.277.1083

2560 Richmond Road, Suite 102 Lexington, KY 40509 bluegrasshealthpsychology.com

DONALD CROWE, PH.D.

SUSAN SNYDER, LCSW ISSUE #104 23

SPECIAL SECTION

Mental Health

Taking Recovery on the Road

Our Lady of Peace’s Peace Promises program is an intensive outpatient program that meets teenagers where they are, literally and figuratively

BY DONNA ISON LOUISVILLE Susan, a parent struggling with a son

on a downward spiral with alcohol, called the Peace Promises program, “An answer to prayer.

The best thing that could have happened to us.”

Peace Promises, offered through Our Lady of Peace, part of KentuckyOne Health, is an after-school, intensive outpatient program for high school students dealing with alcohol and drug use that travels to the teenager’s home county. The curriculum emphasizes the development of decision-making skills, finding healthy alternatives, and forming a solid support community. This innovative program currently serves residents of Jefferson, Bullitt, and Oldham counties.

Directed by Janine Dewey, MA, LCADC, Peace Promises was funded by a Kentucky Kids Recovery Grant issued by the Division of Behavioral Health. The grant helped Dewey establish five school sites to host the program and purchase five vans, which pick the participants up from their high school, drive them to their sessions, and take them home afterward.

Peace Promises is highly committed to providing transportation because, in the words of Dewey, “One of the biggest barriers in getting kids to treatment is getting kids to treatment.”

The students meet three times a week for a three-hour group session led by a program counselor who is either a clinical social worker or certified alcohol and drug counselor. In lieu of the traditional, adult-minded 12-step recovery model, Peace Promises utilizes The Seven Challenges®. Dewey explains, “The Seven Challenges is geared to meet kids where they are in their current decision-making mode.”

Therefore, each session starts with the counselor asking those taking part whether their goal for that day is to stop, cut down, or continue with their substance use. Knowing the prevailing dynamic of the group allows the counselor 24 MD-UPDATE

Janine Dewey, MA, LCADC, is the director of the Peace Promises program at Our Lady of Peace, part of KentuckyOne Health.

to adjust the focus, change the lesson plan, and address the most pressing issues. According to Dewey, “This program gives kids the opportunity to make a choice for the day, learn tools to get through that day, and come back for the next one.”

Another crucial component in the process is guided journaling. During each session, the attendees are asked to answer questions around a specific challenge. At the day’s conclusion, the counselor collects the journals. Later, in private, he or she reads the entries and makes individualized comments meant only for the eyes of the author. The journals are returned during the next meeting. Since this dialogue is shared exclusively between the teen and counselor, it creates a one-on-one bond. “The journals help so much to get to know our kids during a short time frame and build an amazing amount of trust,” says Dewey.

Children can be referred to this intensive outpatient program by parents, court designated workers, the juvenile justice system, teachers, school administrators, or their family physician. Dewey’s advice to medical practitioners PHOTO PROVIDED BY KENTUCKYONE HEALTH

assessing adolescents is to always perform a quick screen where you specifically ask about alcohol and drug use. She states, “Even though kids may get defensive at first, the more we get in the habit of asking what they’re doing, the more information we’re going to get.” However, she advises there are red flags that can also help in determining whether a teen may be abusing drugs or alcohol, including noticeable changes in sleeping or eating and extreme weight gain or weight loss. She also warns, “Heroin is happening to our kids. So, look for needle marks, and not just in the obvious places.”

So far, the Peace Promises program has helped 250 families. And, it continues to grow.

Our Lady of Peace also offers two additional alternatives that function in conjunction with Peace Promises, including Crossroads, a partial hospitalization program and an 11-bed rehabilitation program. Recently, after being approached by the Jefferson County school system, they also decided to launch an intensive outpatient program for middle schoolers, since the onset of first-use is now 11–12 years of age. “If we can focus on the sixth and seventh graders, we’ll be doing some good work,” says Dewey.

Dewey concludes with, “I really want parents to know there is help out there and how to find it. Reaching out is the first step, and it’s also the hardest step. But once they do, we’ll be there to guide them through the process.”

For information on Peace Promises, please call Janine at 502.479.4135 or visit KentuckyOneHealth.org/Our-Lady-of-Peace.

mental wellness

Building Resilience

How to get a grip, get back up, and go on

BY JAN ANDERSON, PSYD, LPCC

I recently had my first appointment with my new primary care physician. As she scanned the medical history of my parents, she paused when she got to the cause of death. “So... your father was … murdered?”

Most of the clients I encounter have experienced some kind of psychological trauma in their lives — but it’s generally not an acute, single-occurrence personal tragedy, or a catastrophic natural disaster or accident, or the actual experience of life-threatening physical or psychological harm.

That’s why I prefer not to use the word trauma —because it seems to imply that only the extreme, big, horrific stuff counts or has any lasting effect.

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502.426.1616 DrJanAnderson.com Jan Anderson, PsyD, LPCC

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I’ve come to think of trauma as another word for life, because most of us (70 percent of U.S. adults) have experienced some type of traumatic event at least once in our lives.

Trauma Messes With Your Mind Trauma results when the experience of an event, a series of events, or a set of circumstances overwhelms our ability to cope with what happened or process the emotions involved. A traumatic experience has lasting effects on our physical, social, emotional, or spiritual well-being. It affects our ability to function well in important areas of our lives.

In other words, trauma messes with your mind. It shakes your beliefs about the world, the people in it, and how life really works. It can leave you in a state of extreme confusion and insecurity.

Researchers like Janoff-Bulman and DePrince and Freyd found that trauma can shatter three of our basic assumptions about the world: 1. The world is benevolent.

2. Life is meaningful.

3. The self is worthy.

I can relate to that — I became acutely aware of two things through my experience of what happened to my father: 1. There is no absolute safety. If someone really wants to kill you, there’s no 100 percent guarantee that you can keep yourself safe.

2. Justice is not guaranteed. For me, the worst moment of the murder trial was waiting for the jury’s verdict and realizing that the man that killed my father might walk out of the courtroom that day a free man.

How to Get a Grip There’s a part of us that is deeply affected by trauma. However, I have found that rather

than trying to “fix” that traumatized part of us, recovery is more about accessing other, more resilient parts of ourselves — parts that are better able to integrate the emotions involved without being flooded by them and process the experience without being shattered by it.

When I was recently asked to speak at the Kentucky Counseling Association annual conference about how to treat and prevent trauma, I was thankful to be able to share research conducted since my family and I were struggling through our experience over 30 years ago.

What we now know, thanks to researchers like Matthew Tull, is that our ability to recover boils down to a combination of built-in resilient characteristics that we already have in place, further resiliency that we can develop within ourselves, and the resiliency that we can draw upon from those around us.

I can now look back and recognize that I eventually tapped into or cultivated many of these characteristics or resources in my own recovery journey: • Being resourceful • Being more likely to seek help • Holding the belief that there is something you can do to manage your feelings and cope • Self-disclosure of the trauma to a trusted confidante • Having an identity as a survivor, as opposed to a victim • Having social support and connection with others, such as family or friends • Good problem-solving skills • Effective coping skills to deal with stress • Spirituality • Helping others • Finding positive meaning in the trauma It’s hard to imagine someone like Sheryl Sandberg, COO of Facebook and author of ISSUE #104 25

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mental wellness the bestseller Lean In, having to deal with trauma. But it’s not so hard to think about anyone — no matter how powerful, affluent or accomplished — having to deal with life. After her 47-year-old husband suddenly dropped dead while they were on vacation last year, Sandberg was eventually ready to return to work, but struggling with how to manage it.

So she began posting updates to her Facebook page as a way to start the transition: “Many of my co-workers had a look fear in their eyes as I approached. I knew why — they wanted to help but weren’t sure how.

Should I mention it? Should I not mention it?

If I mention it, what the hell do I say?”

“I realized that to restore that closeness with my colleagues that has always been so import-

“You are not born with a fixed amount of resilience. Like a muscle, you can build it up, draw on it when you need it. In that process you will figure out who you really are — and you just might become the very best version of yourself.”

— Sheryl Sandberg, COO of Facebook, at UC Berkley 2016 commencement. ant to me, I needed to let them in. And that meant being more open and vulnerable than I ever wanted to be.”

Sandberg has continued to speak openly and candidly about dealing with her husband’s death, including a moving speech at the UC Berkley 2016 commencement. She recently confirmed that she is working on a new book that combines her personal story

along with others to focus on building resilience and finding meaning in the face of grief and adversity.

I’d call that a good example of self-disclosure, finding positive meaning in trauma, and helping others … and just about every other characteristic of resilience that we have identified. Sounds like something all of us experiencing “life” could use.

MD-Update.com is coming!

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

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.

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advocacy

The Case for Medical Cannabis

BY DON STACY, MD

The Alliance for Innovative Medicine (AIM) is a 501(c)(4) nonprofit organization that serves as the voice for professionals who believe that medical cannabis should be legalized in the Commonwealth of Kentucky. AIM’s diverse network of contributors includes healthcare, law enforcement, and legal professionals. The mission of AIM is to fuse the talents of likeminded professionals into a powerful advocacy effort to persuade Kentucky executive, legislative, and judicial branch leaders to legalize medical cannabis as soon as possible.

I volunteered as the medical liaison for AIM after a thorough review of the relevant social science and medical literature confirmed a scientific basis for the anecdotal positive benefits of cannabis reported by patients during my 10+ year radiation oncology career.

For example, medical cannabis has been proven effective in the treatment of a multitude of debilitating medical conditions (especially pain, decreased appetite, and nausea).1 Due to the national opioid epidemic, I was also pleased to learn that state medical cannabis laws have been correlated with an approximately 11 percent decrease in the annual number of daily opioid doses prescribed per physician.2 In addition, states that have legalized medical cannabis have an approximately 25 percent lower average opioid overdose death rate compared to states that have not legalized medical cannabis.3 Furthermore, emerging scientific evidence suggests that cannabis is an “exit” drug rather than a “gateway” drug, helping people decrease or eliminate their use of much more dangerous drugs such as opiates (and alcohol).4 And, unlike pre1 Institute of Medicine, Marijuana and Medicine: Assessing the Science Base (Washington, D.C.: National Academy Press, 1999), 159.

2 Bradford, A. and Bradford W., “Medical Marijuana Laws Reduce Prescription Medication Use in Medicare Part D,” Health Affairs 35, 2016: 1230-1236.

3 Bachhuber, M. et al., “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010,” JAMA Internal Medicine 174(10), 2014: 1668-1673.

4 Lucas, P. et al., “Cannabis as a Substitute for Alcohol

scription drugs (particularly opiates), cannabis has relatively minor negative side effects, does not increase or contribute to the likelihood of death, and is non-lethal.5 Allaying my concern that legalization of medical cannabis might increase teen abuse of cannabis, I discovered that, for persons aged 12-17 years between 2002 and 2013 (a time period during which 13 states enacted medical cannabis laws), the prevalence of cannabis use disorders fell by approximately 24 percent,6 the prevalence of past-year cannabis use fell by approximately 17 percent, the prevalence of past-month cannabis use fell by approximately 10 percent, the prevalence of daily or almost-daily past-year cannabis use fell by approximately 29 percent, the prevalence of daily or almost-daily past-month cannabis use fell by approximately 33 percent, and the prevalence of past-year cannabis initiation among persons at risk for initiation fell and Other Drugs: A Dispensary-Based Survey of Substitution Effect in Canadian Medical Cannabis Patients,” Addiction Research and Theory 21(5), 2013: 435-442.

by approximately 15 percent.7 Medical cannabis may save the lives of our patients in indirect ways also. For example, state legalization of medical cannabis has been associated with an approximately 11 percent reduction in the suicide rate of men aged 20-29 years and an approximately nine percent reduction in the suicide rate of men aged 30-39 years.8 And state legalization of medical cannabis has been correlated with an approximately 10 percent reduction in traffic fatalities the first full year after coming into effect.9 Finally, my research revealed unexpected economic benefits, for medical cannabis laws at the state level have been associated with statistically significant decreases in healthcare spending by the U.S. federal government and the relevant state governments.10 In conclusion, AIM is a nonprofit professional organization that advocates for the legalization of medical cannabis in the Commonwealth of Kentucky. Medical cannabis alleviates a variety of serious medical conditions without significant side effects and reduces opioid use and overdose death rates, state and national healthcare spending, traffic fatalities, teen cannabis initiation/use/ disorders, and male suicide rates. Join the movement!

Don Stacy, MD, dABR, is a physician-activist. He practices radiation oncology in Louisville, Ky., and Jeffersonville, Ind. He can be reached at 606.369.4246.

7 Azofeifa, A. et al., “National Estimates of Marijuana Use and Related Indicators – National Survey on Drug Use and Health, United States, 2002-2014,” MMWR Surveillance Summaries 65(No. SS-11), 2016: 1-25.

8 Anderson, D. et al., “Medical Marijuana Laws and Suicides by Gender and Age,” American Journal of Public Health 104(12), 2014: 2369-2376.

5 Sidney, S. et al., “Marijuana Use and Mortality,” American Journal of Public Health 87(4), 1997: 585-590.

9 Anderson, D. et al., “Medical Marijuana Laws, Traffic Fatalities, and Alcohol Consumption,” The Journal of Law and Economics 56(2), 2013: 333-369.

6 Grucza, R. et al., “Declining Prevalence of Marijuana Use Disorders Among Adolescents in the United States, 2002 to 2013,” Journal of the American Academy of Child & Adolescent Psychiatry 55(6), 2016: 487-494.

10 Bradford, A. and Bradford W., “The Association Between State Medical Marijuana Laws and Prescription Drug Use in Medicaid Suggests Rescheduling Marijuana,” currently in peer review.

PHOTO PROVIDED BY AIM

ISSUE #104 27

news

Courtney Joins Baptist Health Medical Group Neurology LEXINGTON Tre Courtney, MD, has joined Baptist Health Medical Group Neurology at Baptist Health Lexington.

Courtney earned a medical degree from Tre Courtney, MD the University of North Carolina. He completed an internship and residency at the University of Kentucky Albert B. Chandler Medical Center. He is a diplomat of the American Board of Psychiatry and Neurology and is a member of the American Board of Medical Specialties.

Bousamra Joins Baptist Health Floyd NEW ALBANY, IND. Baptist

Health Floyd is proud to welcome Michael Bousamra II, MD, to its growing Baptist Health Medical Group network. Bousamra, a board certified thoracic Michael Bousamra surgeon and director of II, MD thoracic surgery for Baptist Health Floyd, is perhaps most recognized for his extensive background and renowned research in the detection of lung cancer by breath analysis.

A team of developers created a silicon microchip that selectively traps cancer specific aldehydes and ketones from one’s breath. From a single breath, these compounds are concentrated on the microchip and analyzed. When three or four markers are elevated, cancer is highly likely. Bousamra currently leads a medical team focused on this continued research endeavor.

In addition to his commitment to providing quality patient care and continuing research focused on the detection of lung cancer, Bousamra also specializes in the following clinical areas: esophageal cancer, benign esophageal disorders, minimally invasive surgery and lung cancer surgery. Bousamra joins Dr. Robert Linker and Dr. Jonathan Kraut in serving the chest surgical needs of Kentuckiana within the 28 MD-UPDATE

Baptist Health System.

Bousamra received his medical degree from the University of Michigan Medical School and completed his residency in general surgery at the Medical College of Virginia Hospital in Richmond. He completed his cardiothoracic residency Washington University Medical Center in St. Louis. Bousamra is a member of the American Association for Thoracic Surgery and the Society of Thoracic Surgeons and was named the 2009 Brown Cancer Center Scientist of the Year for his metabolomic research. He received the 2012 Cardiothoracic Award of Excellence from the American Board of Cardiology and has been recognized multiple times as a “Top Doc” in Louisville Magazine.

Schapmire to Lead World’s Largest Oncology Social Work Group

Tara Schapmire, PhD LOUISVILLE A University of Louisville faculty

member has been tapped for leadership roles with the world’s largest organization of professionals who provide psychosocial services to people with cancer and their families and caregivers.

Tara Schapmire, PhD, has been elected president of the Association of Oncology Social Work. Her three-year term begins in January 2017 with one year as president-elect, followed by one year as president and the final year as past president.

Schapmire is an assistant professor at the University of Louisville School of Medicine in the Division of General Internal Medicine, Palliative Care and Medical Education of the Department of Medicine. She also is on the faculty of the Kent School of Social Work.

As a long-time oncology and palliative care social worker, Schapmire’s research interests include psychosocial care of cancer survivors and their families, gerontology, health disparities, communication and cancer, caregiver issues, palliative care, survivorship, end of life care, and interprofessional education.

Harkema, Angeli, and Rejc Win Grant to Develop Tethered Pelvic Assist Device LOUISVILLE Spinal cord

injury researchers at the University of Louisville pioneered activity-based interventions that have helped individuals with spinal cord injuSue Harkema, PhD ry (SCI) improve mobility. The addition of epidural stimulation to the lumbosacral spinal cord has allowed individuals with SCI to stand without assistance.

Susan Harkema, PhD, Claudia Angeli, PhD who leads this research at U of L, Claudia Angeli, PhD, Enrico Rejc, PhD, and Sunil Agrawal, PhD, an engineer at Columbia University, have won a $5 million grant to develop a robotic device that will aid Enrico Rejc, PhD individuals with SCI further by helping them regain balance. The Tethered Pelvic Assist Device (TPAD) will provide stimulation and feedback to aid in the recovery of balance, and will be integrated with activity-based training and epidural stimulation research at U of L. Harkema, Angeli, and Rejc, faculty members in the Department of Neurological Surgery at UofL, are working with Agrawal, professor of mechanical engineering and of rehabilitation and regenerative medicine at Columbia Engineering, to develop TPAD.

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Agrawal specializes in the development of novel robotic devices and interfaces that help patients retrain their movements.

The project has won a five-year, $5 million grant from the New York State Spinal Cord Injury Board. The project also includes Joel Stein, chair of the Department of Rehabilitation and Regenerative Medicine, and Ferne Pomerantz, MD, assistant professor in that department at Columbia University Medical Center.

TPAD is a wearable, lightweight cable-driven device that can be programmed to provide motion cues to the pelvis and corrective forces to stabilize it. It consists of a pelvic belt with multiple cables connected to motors, a realtime motion capture system, and a real-time controller to regulate the tensions in the cables. The U of L researchers will incorporate the device into the training of SCI patients during standing.

“Our stand and step training, combined with epidural stimulation, have shown success in enabling individuals with SCI regain the ability to stand. We hope the integration of the TPAD device will help these individuals with balance, further improving their functional ability and quality of life,” said Harkema, who also is director of research at Frazier Rehab Institute, part of KentuckyOne Health.

In their work with the Kentucky Spinal Cord Injury Research Center (KSCIRC), the U of L researchers have studied the effects of stand and step training along with epidural stimulation in adults with spinal cord injury. Epidural stimulation involves surgically implanting an electrode array over the lower spinal cord to activate the neural circuits.

Markey Cancer Center Launches Molecular Tumor Board

Pathologist Siva Theru Arumagam with Molecular Tumor Board co-director Jill Kolesar.

LEXINGTON The University of Kentucky Markey

Cancer Center recently launched its own Molecular Tumor Board, an approach to cancer care that uses genetic analysis to help oncologists choose cancer therapies tailored to each patient’s individual needs. The Molecular Tumor Board is the latest precision medicine initiative to come online at Markey.

“Oncology is now more genetic-based, whereas before it was based upon tumor types,” said Dr. Mark Evers, director of the UK Markey Cancer Center. “Through understanding the genetic makeup of our patients and their tumors, we can then help to direct their therapy.”

The Molecular Tumor Board is co-directed by clinical pharmacologist Jill Kolesar, PharmD, who recently joined Markey and the UK College of Pharmacy after starting a similar initiative at the University of WisconsinMadison, and Markey gynecologic oncologist Dr. Rachel Miller.

Currently, clinical trials often target tumors with certain molecular or genetic characteristics, then search for patients with tumors that matched those criteria — like looking for a

needle in a haystack. The information gleaned by the Molecular Tumor Board will instead allow researchers to develop clinical trials targeted to the needs of the patients Markey treats; in other words, it means starting with the needle, rather than the haystack.

Here’s how the Tumor Board process will work at Markey: when a patient undergoes a biopsy, the physician may choose to request a Molecular Tumor Board review of that case.

The patient’s tissue will then be sent to UK’s in-house pathology lab for genetic type testing.

Using technology known as Next Generation Sequencing, pathologists will run tests to compare the patient’s genes against a panel of 198 gene mutations that are associated with all types of cancer – 94 are for blood cancers and an additional 104 are added for solid tumors.

Once the sequencing is complete, the final report – containing the findings of any possible gene mutations – is sent to Molecular Tumor Board members. The report will be evaluated for three types of potential care: FDA-approved therapies for that patient’s cancer type, FDA-approved therapies in another tumor type (colloquially known as “off-label use”), and potential clinical trials.

The Tumor Board itself comprises a vast array of experts across both the UK medical and academic campuses, including oncologists, hematologists, surgeons, pharmacists, pathologists, biostaticians, basic scientists, and epidemiologists who meet on a regular basis to discuss each individual case together in person. Each brings their own expertise to discuss the available options and ultimately make a recommendation for the best course of care for that patient.

Join today and help AIM legalize Medical Cannabis in the Commonwealth of Kentucky!

Shannon Stacy RN

director@aimky.org

502-203-6253

aimky.org ISSUE #104 29

Events

s Dr. Ronald Levine (fourth from the left) received the Excellence in Education Award. He is pictured here with members of his family.

Doctor’s Ball Honors Louisville Physicians, Medical and Civic Leaders

Leslie Buddeke Smart, division VP of development for Jewish Hospital & St. Mary’s Foundation, with Gil Dunn, publisher of MD-UPDATE.

Encarnida and Manuel Grimaldi, MD, paused for a moment at The Doctor’s Ball where Dr. Grimaldi was honored with the Compassionate Physician Award.

LOUISVILLE The annual celebration of Louisville

doctors, medical and community leaders, known as The Doctor’s Ball, was held Saturday October 15, 2016 at the Marriott Louisville Downtown to benefit Jewish Hospital & St. Mary’s Foundation.

Over 700 guests enjoyed the event as Louisville Mayor Greg Fischer gave the keynote address while honoring his parents George and Mary Lee Fisher who were named Community Leaders of the Year.

Other honorees were Kelly McMasters, MD, PhD, – Ephraim McDowell Physician of the Year; Manuel Grimaldi, MD, – Compassionate Physician Award; Erica Sutton, MD, – Excellence in Community Service; Ronald Levine, MD, – Excellence in Education.

The Jewish Hospital & St. Mary’s 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.

30 MD-UPDATE

Dr. Kelly McMasters, surgical oncologist, was honored as the Ephraim McDowell Physician of the Year.

Phyllis and Joseph Banis, MD, with Jennifer Newton, MD-UPDATE editor-in-chief, at The Doctor’s Ball.

Dr. Jan Anderson, MD-UPDATE Mental Wellness columnist, and her husband Bill Elder attended The Doctor’s Ball to honor local physicians and medical leaders.

PHOTOS BY ROB DENSMORE

David Fannell (with his wife, Maura) is a member of the Foundation Board of Trustees, a recipient of a lung transplant, and is a former patient at the Frazier Rehab Institute, part of KentuckyOne Health.

Events

STARS Gala Sells Out nt u o m A d r o c Re ociates and Raofi48s0epeosple attended the STARS Ge alLexa (Sinaigtnont JoCseonphveAnsstion

th d er 29, 2016 at sell-out crow s in the turday Octob Sa on ose individual e) th ic e rv iz Se gn co ed n re d ow an ity for Ren to honor on commun crowd came d the Lexingt an Center. The em st r sy ie lth Hospital each for hea Saint Joseph ice and outr rv se fy li p who exem cipients are communities. the Year re of n ia ic his year 25 The Phys co-workers. T w llo fe r ei th Hospital nominated by Saint Joseph om fr ed at in ere nom ed through physicians w ,000 was rais 20 $2 r ve O ph East. and Saint Jose donations. lent auction si d an ip h rs sponso

LEXINGTON A

Physician of the Year at Saint Joseph Hospital was Dr. Samer Ksebi with wife Nazek.

Dr. Dan Goulsin and Gil Dunn, publisher of MD-UPDATE Physician of the Year at Saint Joseph East was Dr. Yasser Zohery with wife Amira.

Kitty and Dr. Andy Moore

Dr. Michael Schaeffer and wife Shannon

Dr. Eli Colon and wife Tracy, chair of the STARS committee

Dr. Tharun Karthikeyan and wife Jory with Cecilia and Dr. Joe Hill PHOTOS BY JOE OMIELAN

Dr. Robert Salley and wife Christy with Gil Dunn, MD-UPDATE

Dr. Sharon Napier and husband Dr. Robert Baker ISSUE #104 31

Events

YES, MAMM!

Annual 5K has Huge Turnout These smiling runners enjoyed a brisk run through the central Kentucky countryside to support breast care screenings.

All generations and genders joined together to help in the battle against breast cancer.

Moments before the start of Yes, MAMM! over 400 runners prepare.

NICHOLASVILLE The 2nd annual Yes, MAMM!

5K run/walk was Saturday, October 15, 2016 at the RJ Corman Railroad Group Headquarters in Nicholasville, Ky. Over 500 men, women, and children participated in the event, which raises money to provide breast cancer screenings for low income and underinsured women in 15 counties throughout central and southeastern Kentucky.

The Yes, MAMM! 5K is presented

by KentuckyOne Health Saint Joseph Hospital Foundation, a non-profit founded in 1989 that raises funds to support the core values of Saint Joseph Hospital. This year it is projected that over 500 mammograms will be funded for underinsured women.

Yvonne Edge, physician education coordinator at KentuckyOne Health, and her son Braxton took part in the effort to support breast cancer screenings in Kentucky.

Mothers, daughters, sisters, and friends participated in the Yes, MAMM! 5K. “It takes a real man to wear pink,” said this fellow as he neared the finish line in the Yes, MAMM! 5K.

On hand to support the runners and the mission of the 2nd Annual Yes, MAMM! 5K were: (l-r) Charles Kenney, MD, Richard Budde, MD, Bruce Tassin, president of Saint Joseph Hospital, Marta Kenney, MD, and John Strifling, MD. 32 MD-UPDATE

PHOTOS BY GIL DUNN

Leslie Hughes, RN, and her daughter Mackenzie shared the race and post-race party. Leslie works at KentuckyOne Health Weight Loss Surgery at Saint Joseph East.

2017 Editorial Opportunities Issue #105 l January 2017 PRIMARY CARE AND PEDIATRICS Primary Care, Internal Medicine, Family Medicine, Pediatrics Issue #106 l February HEART AND LUNG CARE Cardiology, Cardiac Surgery, Pulmonology, Sleep Medicine Issue #107 l March/April PAIN MEDICINE AND CHRONIC CONDITIONS Pain Medicine, Rheumatology, Endocrinology, Gastroenterology Issue #108 l May WOMEN’S HEALTH OB/GYN, Urology, Genetics, Prevention, and Wellness

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE PROFESSIONALS ISSUE #97

SPECIAL SECTIONS PRIMARY CARE & SENIOR HEALTH BARIATRIC SURGERY

Issue #109 l June/July MUSCULOSKELETAL HEALTH Orthopedics, Sports Medicine, Physical Medicine, and Rehab VOLUME 7•#1•JANUARY 2016

Issue #110 l August/September SKIN DEEP Dermatology, Plastic Surgery, Vascular Medicine

THE OPTIMAL AGING CAPITAL OF THE U.S.

The U of L Institute for Sustainable Health & Optimal Aging is leading the charge for innovation and transdisciplinary care of older adults

ALSO IN THIS ISSUE  PRACTICING DIRECT PRIMARY CARE  SPECIALIZING IN LAPBAND® AND

THE ORBERA™ BALLOON  THE COMPLETE BARIATRIC TOOLKIT  A COMPREHENSIVE WEIGHT LOSS PROGRAM

Issue #111 l October CANCER CARE Oncology, Hematology, Radiology Issue #112 l November IT’S ALL IN YOUR HEAD Neurology, Ophthalmology, Mental Health, Addiction Medicine Issue #113 l December 2017/January 2018 SENIOR HEALTH, PREVENTION, AND WELLNESS Primary Care, Senior Health, Family Medicine & Geriatrics, Bariatric Surgery, Alternative Medicine *Editorial topics are subject to change.

To participate, please 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

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