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WVSOM’S impact reaches past the hills, mountains of West Virginia
WVSOM’S impact reaches past the hills, mountains of West Virginia
Out-of-state alumni and students account for 75% of WVSOM’s demographic
The origin story has been shared many times. Four West Virginia doctors recognized a need for more physicians to serve rural communities throughout the state. Against all odds, they purchased the campus of a former military school and founded an osteopathic medical school in a small town in the southeastern part of the Mountain State.
While the goal of educating students to pursue careers as primary care physicians in rural and underserved areas still holds true to this day, the scope of that medical care extends much farther than the state’s borders.
WVSOM is the leading producer of physicians practicing in West Virginia, with alumni serving in 52 of 55 counties. For decades, the school has led the state in providing physicians for rural areas of West Virginia. However, there are WVSOM graduates practicing in every state in the U.S., totaling nearly 4,000 physicians from 1978 to 2020. Out-of-state alumni and students account for 75% of WVSOM’s demographic. And while it remains an important aspect of the school’s teaching model — educating bright minds to provide care to the state’s population — it is no surprise that the medical school has permeated communities outside the Appalachian region.
“While WVSOM is a state-supported medical school established to serve West Virginia, first and foremost, we have gotten to a point in our history where we are bigger than that,” said WVSOM President James W. Nemitz, Ph.D. “We have alumni in all 50 states and we accept students from every state in America. I am proud of our alums who are serving in West Virginia and throughout the country. And I care for and appreciate all our students, regardless of their state of origin.”
The 798 students enrolled at WVSOM during the 2023-24 academic year represent 36 states. Aside from West Virginia, the highest number of current students hail from Pennsylvania, followed by New York, Virginia, Michigan, Florida, Maryland, Ohio and New Jersey. Nemitz said it makes sense that many students are natives of mid-Atlantic states due to the school’s well-established, quality osteopathic education program and competitive price.
“I believe we have very good word of mouth, and our students and grads share their experiences with others who want to pursue a medical education,” he said. “Many students want to be close to their families, so if the student doesn’t get accepted in their home state, they look for quality schools that are close to home. One of WVSOM’s strengths is our incredible clinical education network, our Statewide Campus, which enables students from nearby states to be close to their loved ones during their medical school years.”
Josh Olmstead is a Class of 2027 student originally from a town in Northern California with a population of about 800 people. He has always been drawn more to small towns than large, urban areas, which is one of the reasons he selected WVSOM for his medical education.
“I chose to attend school in West Virginia because I saw this community as one that has conserved traditional American values,” he said.
Another reason Olmstead found WVSOM appealing was because it provides early clinical experiences for first-year students.
“The sooner we’re able to start developing our patient interaction skills, the sooner we develop the skills necessary for health care,” he said. “We could have all the knowledge of medicine in our back pocket, but if we don’t know how to have a human connection with our patients and earn their trust, it’s useless.”
Tapping into technology is a way Nemitz thinks WVSOM can continue to attract students from across the country and be a top option, especially with new osteopathic medical schools forming regularly.
“We need to explore ways we can create new markets for the school. This is important for our growth as new D.O. schools are established to grow the physician workforce. Innovative uses of social media, artificial intelligence and other technologies should help us establish new markets,” Nemitz said.
Finding students who are a good fit for WVSOM and want to be part of fulfilling the school’s mission will ultimately lead to alumni who maintain relationships with their alma mater.
Shannon Warren, WVSOM’s executive director of alumni relations, has worked to build alumni relationships at the medical school for 24 years. She said the best alumni are graduates who advocate for WVSOM, volunteer in the school’s programming, refer potential students and support the next generation of physicians.
“We have a tight community of graduates who want to stay connected to their alma mater, who want to be involved in some way because of the success they have gained from attending medical school at WVSOM and who are excited to see the school excel,” she said. “Our alumni have fond memories of their time in medical school and are proud to share those experiences with future students.”
Alumni who practice in West Virginia are certainly the most engaged with school events, Warren said. They represent the highest number of graduates from 1978 to 2020, with 873 physicians actively practicing in the state. Ohio, with 353 graduates, has the second highest number of alumni in practice, and areas such as Columbus, Dayton and Cuyahoga Falls have a higher concentration of WVSOM alumni because of the more prevalent and available osteopathic residency programs.
“There are a number of reasons WVSOM graduates choose to practice in Ohio. We accept a higher number of Ohio residents compared with other states, we train a significant number of our students on the border between West Virginia and Ohio since three of our Statewide Campus regions border Ohio and partner with that state’s hospitals to help train our students in the third and fourth years,” Nemitz said. “Regardless of where I go across the country, I encounter WVSOM alums who are doing great work taking care of their patients, contributing in many other ways to their communities and are grateful for the education they received at WVSOM.”
Other states with active alumni participation include Pennsylvania, Virginia, Florida, North Carolina, Michigan, Georgia and Kentucky, though the WVSOM Alumni Association wants to explore more ways to engage with alumni in areas farther away from West Virginia.
“Connecting and maintaining relationships with alumni across the country is where we are looking to expand our engagement opportunities,” Warren said. “One alumnus mentioned that we need a West Coast WVSOM Alumni Association chapter.”
The alumni team has utilized digital efforts in the form of social media connections and email communications, as well as small alumni gatherings at national conferences and conventions, to connect with graduates throughout the country.
Nemitz said he would like to identify a “champion” in each of the areas where there are large groups of alumni and agreed he would like to see the establishment of regional alumni chapters.
“What I have been doing, in conjunction with the WVSOM Alumni Association, is visiting areas where we have concentrations of alums, such as Ohio and Florida, and have gatherings that include sharing a meal and updating alums on what is happening at their alma mater,” he said. “One of the benefits we have found with these visits is to connect the alums in a region to each other, which strengthens their relationship with the school.”
While WVSOM has excelled at producing primary care physicians who practice in rural and underserved areas, the reality is that WVSOM prepares its students to enter any residency of their choice. Nemitz said an important message to future students is that a D.O. degree doesn’t limit students’ choice of specialty.
“The number of WVSOM alumni in non-primary care specialties continues to grow,” he said. “These physicians are an extremely important contribution to the physician workforce, both for West Virginia and the rest of the country, as the current physician population ages.”
In the pages ahead, we’re profiling some WVSOM alumni who have entered specialties outside of primary care and in states throughout the country.
CAYTLIN DEERING, D.O. and CLINTON DEERING, D.O.
CAYTLIN DEERING, D.O.
Royal Oak, Mich.
Infectious Disease
CLINTON DEERING, D.O.
Clearwater, Fla. Psychiatry
Medical school may not have been the original plan for Caytlin Deering, D.O., Class of 2013, and Clinton Deering, D.O., Class of 2020. But the Michigan-raised siblings are happy that their paths ultimately brought them to WVSOM, and both are now physicians practicing in specialties that each of them finds rewarding.
Caytlin Deering is an infectious disease specialist and attending physician at William Beaumont Hospital in the Detroit suburb of Royal Oak, Mich. She planned to become a lawyer, and earned a bachelor’s degree in history from the University of Michigan — but having also completed pre-med courses and worked as a medical assistant, she decided to apply to medical school.
“Our parents are physicians — our father is a radiologist and our mother is in family medicine — and my goal was to not do that, because that was the question I was asked all the time: Are you going to be a doctor like your parents?” Caytlin said. “But during college I worked in a primary care office, and I learned that I liked talking with people and enjoyed the problem-solving aspect of health care.”
Clinton Deering is a psychiatrist who this summer joined the staff of Serenity Mental Health Centers in the company’s Clearwater, Fla., location. He earned a bachelor’s degree in zoology with a specialization in health promotion from Michigan State University, and worked first in medical research and then in politics, operating a campaign office in Michigan before feeling the pull of medicine.
“Medicine has provided me the opportunity to engage directly with others and see the results firsthand. I’m passionate about helping people who have struggled but are putting in the effort to get better,” he said.
The siblings’ father, James Deering, D.O., is a graduate of WVSOM’s Class of 1978, so Caytlin was familiar with the school when she began searching for a place to complete her medical education. A visit to Lewisburg cemented her decision.
“I came for an in-person interview, and I loved the campus, the community and the people I interviewed with,” she said. “The whole process went smoothly, from applications to travel, and it felt comfortable right from the start. It was just a good fit.”
Three years after Caytlin graduated, Clinton arrived at WVSOM. Having a sister who had already experienced medical school was beneficial, he said.
“Caytlin has been my biggest supporter,” he said. “She had been through it, so she was able to say, ‘Here’s the tough part of medical school.’ When I was on rotations and preceptors would ask about antibiotics, I was able to talk about things my peers hadn’t heard of because of Caytlin. And she helped me find places to interview for potential residency matches. She’s always played a pivotal role in helping me.”
Following medical school, Caytlin completed an internship and internal medicine residency at Advocate Lutheran General Hospital in Park Ridge, Ill., and an infectious disease and HIV medicine fellowship with Philadelphia’s Drexel University College of Medicine at Hahnemann University Hospital. She chose the subspecialty for the challenges it brings.
“It’s like solving a puzzle,” Caytlin said. “There are a lot of ways to answer the questions I’m faced with. Sometimes a patient will come in with a bacterial infection where the recommended therapy is a particular antibiotic. But maybe the patient is allergic to that antibiotic, so we have to find something else. Then it turns out the antibiotic is too expensive, so we have to try to find something else. It becomes a process of figuring out how to make people better without compromising their care.”
As with any specialty, being an infectious disease physician has advantages and drawbacks, she said.
“My work-life balance is great. I don’t want to say there are no emergencies; there are. But there aren’t a lot of reasons I have to get up and come to work in the middle of the night. Because we’re always researching new strategies and new antibiotics, it’s a field that’s going to see a lot of progress,” she said. “Things like the COVID-19 pandemic were hard. I worked at the University of Toledo’s COVID-19 hospital for six or seven months, and it was scary to see people frustrated and not knowing what was going to come next. I didn’t get sick, but a lot of providers did.”
Clinton discovered his passion for psychiatry during a rotation in the Central East Region of WVSOM’s Statewide Campus.
“I ended up working with a preceptor who thought I was a resident. He would quiz me on things I didn’t know, but I found that to be a good fit for my learning style. He gave me more autonomy than I’d had previously, and even when he found out I was a medical student, I kept the responsibilities. Being treated like a colleague motivated me,” he said.
Upon graduating, he entered a psychiatry residency at Unity Health in Searcy, Ark. Clinton said he has learned a lot by observing patients whose diagnoses turned out to be more complex than first imagined, and recommends that medical students who are considering becoming psychiatrists observe as many cases as possible.
“It’s important for students to explore every opportunity, because the cases you don’t think are going to be interesting — the ones where you say, ‘I’ve seen a hundred of these’ — are often curveballs. Psychiatry is also different from other specialties because we rely on our interactions with patients to get where we’re going. We don’t have, for example, blood tests for most problems we see.”
Clinton selected Serenity as his post-residency workplace for its location on Florida’s Gulf Coast, but more significantly for the organization’s emphasis on innovative techniques such as transcranial magnetic stimulation, in which magnetic fields are used to stimulate nerve cells in the brain, and ketamine therapy, which employs a psychotropic drug most commonly used as an anesthetic to treat conditions such as clinical depression that have proved resistant to other treatments.
“I’m interested in having the ability to rely on more than just the traditional pharmacological approaches of continuously adding more and more medication,” he said. “I’ll be seeing patients who have tried all the medications and have been to multiple clinics, who have struggled for a long time without relief. I was fortunate to have some training in these techniques during my residency, so I’m looking forward to doing interventional psychiatry at a practice that includes cutting-edge treatments.”
The Deering siblings have continued to maintain connections with WVSOM. Both have attended fundraising events; Caytlin has joined students on overseas service trips with DOCARE International, while Clinton has worked with WVSOM graduates who matched to Unity Health for residencies.
Caytlin said she especially appreciates the school’s ability to expose students to multiple locations and patient populations.
“I think the availability and diversity of the rotations help. Rotating throughout the state and out of state encourages students to find a good fit,” she said. “WVSOM certainly teaches students to be comfortable working in rural areas. But both of us, in our own ways, have found that West Virginia is not the only place with rural populations.”
BROOKE KANIA, D.O.
Bethesda, Md.
Hematology and Oncology
There may not be a cure for cancer, but physicians such as Brooke Kania, D.O., a WVSOM Class of 2021 graduate, are working to find treatment options for cancer patients that may help ease pain and improve comfort care.
And while hematology and oncology research can prove frustrating at times — doctors often invest years in studying different types of cancers only to hit roadblocks — Kania said it is worth it.
“There are a lot of ups and downs with research. You have to struggle to achieve anything, but I have a lot of hope for the field. There are clinical trials that require FDA approvals, but patients could have more options and possibly a cure. That’s what keeps me going when I get discouraged,” she said.
Kania just completed a three-year internal medicine residency at Rutgers Robert Wood Johnson Medical School in New Brunswick, N.J. In July, she began a three-year hematology and oncology fellowship at the National Institutes of Health (NIH) in Bethesda, Md. She moved to Maryland with her husband, David McNamara, also a Class of 2021 graduate, who recently began work at Holy Cross Hospital as an emergency medicine physician.
“Oncology is something I’ve always been interested in. I had a family member with cancer. Seeing how the physicians interacted with and impacted my family, and the science behind it, sparked my interest to go into this specialty. Prior to medical school I completed three years of clinical research at Memorial Sloan Kettering Cancer Center and enjoyed the research aspect of oncology. And through my residency, that validated my interest,” she said.
During her work at the cancer center, Kania witnessed how clinical trials can advance medical knowledge and lead to more opportunities for patients seeking treatment. Years later, part of her work at NIH again focuses on patients in clinical trials, but the fellowship relies heavily on research. She is still determining what her research focus will be.
The New Jersey native is drawn to oncology more than hematology but plans to achieve board certification in both specialties. She’s also certain, because of some of her experiences in residency, that she would like to subspecialize in treating patients with bladder cancer or those with gastrointestinal malignancies or pancreatic cancer.
Kania said one patient interaction has stood out above all others as offering her a valuable lesson as a physician.
She remembered a patient with squamous cell carcinoma, a head and neck cancer, whose breathing was obstructed by a tumor. The patient had a clear knowledge of his cancer but expressed to medical professionals that he wanted to pursue comfort care rather than chemotherapy. His daughter witnessed him struggling to breathe and asked that he be brought to the intensive care unit, where he was intubated and a plan was created for invasive management.
“On the oncology side the team was advocating for aggressive treatment, and on the palliative and primary care side the teams were trying to respect his wishes. These teams weren’t on the same page, and it created such a burden for the daughter,” Kania recalled. “What I learned from that is how much a family can also be impacted by these decisions and how stressful it can be to make decisions about our loved ones. Physicians can contribute to that stress if they are not communicating with families. Since then, I have made an effort to overcommunicate with families and ensure all the providers taking care of the patient are on the same page, with a unified front. This helps reduce family members’ stress and hopefully eases their burden.”
That compassion and attention to patients and their families’ needs is one of the components WVSOM instills in students. Encouraging students to become engaged in the community is the best way to ensure that future physicians can understand patients and their backgrounds, Kania said.
“To be a good doctor you have to have a willingness to learn about others. We had incredible people in the Lewisburg community, and I wanted to be part of that,” she said. “Even though I’m in a non-primary care fellowship, I really enjoyed primary care. In order to be a good oncologist, you have to be a good internist. That was the main piece of advice every mentor would give: Become the best internal medicine physician you can, because you will apply a lot of that knowledge as an oncologist.”
DANIEL LOFGREN, D.O.
Nashville, Tenn.
Otolaryngology/Rhinology and Skull Base Surgery
Rhinology and skull base surgery is a subspecialty of otolaryngology that focuses on treating conditions in the sinuses or at the base of the skull. Daniel Lofgren, D.O., of WVSOM’s Class of 2019, is an ear, nose and throat specialist who has begun a one-year fellowship at Vanderbilt University in Nashville, Tenn., to learn this in-demand subspecialty.
Physicians in this field use endoscopic tools to examine and remove tumors or stop cerebrospinal fluid leaks. Lofgren said a childhood hobby may have helped him develop some of the skills needed to excel at this type of surgery.
“I played video games as a kid, so I have the hand-eye coordination required to look at a screen and do something that’s out of my field of vision. I liked using endoscopic cameras from the day I started using them,” he said. “It’s cool to have the ability to get into someone’s brain, take out a tumor and, because we go in through the nostrils, leave no residual scars.”
The son of a mother who was a nurse and businesswoman and a father who was a nurse anesthetist, Lofgren was interested in medicine for as long as he can remember. As a child growing up in Kirtland, Ohio, a suburb of Cleveland, he would try to help friends when they had minor injuries.
“I would carry a satchel filled with Band-Aids, gauze and other things on the playground. We’d run around and someone would get hurt, and I’d throw them some stuff and then go play again,” he said. “I thought it was amazing how immaculately the human body is put together. When I was learning basic anatomy in high school, I recall thinking how interesting humans are. That’s how I came to be an ENT specialist; the anatomy pushed me that way.”
Lofgren earned a bachelor’s degree in biochemistry from Washington & Jefferson College in Washington, Pa., before attending WVSOM, where he received the Statewide Campus Outstanding Student Award. After medical school, he entered an otolaryngology residency at McLaren Oakland Hospital in Pontiac, Mich., which he completed this summer. Lofgren explained that his rhinology and skull base surgery fellowship will give him options other ear, nose and throat specialists don’t have.
“Most ENT surgeons can do sinus surgeries after residency. Vanderbilt is a Level I trauma center that gets a lot of interesting pathology, so my fellowship will let me take on not only big sinus cases, but cases with bad polyps or cerebrospinal fluid leaks. My goal is to be able to treat head and neck cancer, fluid leaks and the harder sinus cases,” he said.
Even in his years as an otolaryngology resident, Lofgren had the opportunity to perform a variety of procedures.
“One day I might be putting ear tubes in a child, and the next I might be drilling the mastoid bone,” Lofgren said. “I could put in a cochlear implant and dig cancer out of the neck on the same day. Tonsillectomy, adenoidectomy and sinus surgery are all common procedures we do. I’ve even drilled along the brain and attempted a couple of repairs with my attending, which was really cool.”
The key to all surgical specialties lies in understanding anatomy, Lofgren said, and the osteopathic focus on the interconnectedness of structure and function he learned at WVSOM has been crucial to his success. Still, he knows that even his fellowship won’t be the end of his medical education.
“Structure and function is an integral part of how the body works. Knowing that is what drives any proceduralist,” he said. “WVSOM’s anatomy labs were great, and my physical exam skills were strengthened by the OSCEs and other work we did in medical school. But a lot of education is the drive to constantly be better, and that’s why we all have to be lifelong learners. I try to put that to the test every day.”
LISA ARNOLD, D.O.
Murray, Utah
Neuro-Oncology
As a neuro-oncologist, Lisa Arnold, D.O., treats patients who have brain tumors and works to mitigate the resulting neurological complications. In her position with Intermountain Medical Oncology in the Salt Lake City suburb of Murray, Utah, she manages chemotherapy for her patients and coordinates care from other physicians, including radiation oncologists, neurosurgeons and palliative care specialists.
Arnold’s education and career have taken her to all corners of the nation. An alumna of WVSOM’s Class of 2017, she was born in New London, Conn., and grew up in Carson City, Nev. She earned bachelor’s and master’s degrees in neuroscience from New Orleans’ Tulane University and chose WVSOM as her medical school after speaking with Deborah Schmidt, D.O., a longtime faculty member whose daughter was one of Arnold’s friends. She went on to complete a neurology residency at University of Vermont Medical Center and a neuro-oncology fellowship at the University of Utah’s Huntsman Cancer Institute.
Arnold said that because brain tumors aren’t as common as other types of cancer, neuro-oncologists tend to practice in large cities where there are plenty of patients. She chose the Salt Lake City area for the beauty of the Rocky Mountains, access to outdoor activities such as skiing and hiking, and its proximity to Nevada, where her family still lives. But Arnold also appreciates her organization’s commitment to promoting rural health.
“It’s nearly impossible to be a neuro-oncologist in a rural location,” she said. “Patients will travel to a big city for care, but it wouldn’t be possible to draw that kind of population to a rural area. Salt Lake City feels like a ‘smaller big city,’ and one thing I like about my job is that there’s an initiative to bring care closer to home. One way we accomplish that is by doing a lot of telehealth, which means I’m able to help patients who live in rural areas. They can go to the cancer center that’s closest to their home to get labs and infusions, and I can help them when they see me on video.”
The heterogeneity of brain tumors and their relative rarity means that less research exists compared with other forms of cancer, so the focus often is on extending life and maintaining its quality rather than curing disease. Arnold said that while she believes medical advances will be made during the course of her career, the profession currently has a long way to go in curing many of the types of tumors she sees.
“Our knowledge just isn’t as advanced as with other types of cancer,” she said. “Also, the brain is a unique environment and the body does a lot to try to protect it, which makes it harder for treatments to penetrate. While we don’t have a cure for many of these cancers, we do have treatments that significantly prolong life, and that is valuable.”
WVSOM strives to instill in students the communication skills necessary to gain patients’ trust and help them feel comfortable. That’s especially critical in neuro-oncology, Arnold said.
“I see my patients regularly and get to know them as people, and I find it rewarding to help them navigate hard times. It does mean there are a lot of difficult conversations, which can be tough emotionally. WVSOM provided training with standardized patients where we talk about end of life, which was helpful — but bigger than that, the focus throughout medical school was on building relationships with patients. I feel grateful to have had such a good foundation going into residency, fellowship and my current position,” she said.
Arnold also appreciates the fact that neuro-oncologists work with other specialists in treating patients. But the collaborative approach means that this field of medicine isn’t for everyone, she said.
“The multidisciplinary approach is a great way to make sure the patient is getting the best care. If you’re a medical student who doesn’t like working with a team, this probably isn’t the specialty for you.”
JAMES BROCK, D.O.
Denver, Colo.
Pediatric Pulmonology
As the first person in his family to become a doctor, James Brock, D.O., is an example of how someone with fortitude can find success in their medical career.
Brock is a pediatric pulmonologist at National Jewish Health in Denver, Colo., where he has worked for more than three years. He is on the medical staff at five hospitals in the greater Denver area and is an assistant professor of clinical pediatrics with National Jewish Health and the University of Colorado School of Medicine.
The Colorado native didn’t know much about West Virginia or the osteopathic medical school tucked among its hills, but Brock knew WVSOM was the school for him from the time he visited the campus nearly 1,500 miles from his hometown.
“When I met the people at WVSOM and in the community, I thought it was an incredibly welcoming place. The hospitality was some of the best I’ve ever experienced. The anatomy lab was one of the best I saw during my interviews, and the facilities and grounds in general were gorgeous — it reminded me of an Ivy League school,” he said. “WVSOM is known for training incredible primary care physicians, but I chose to specialize. The outstanding foundational education I earned has made all the difference for me as a pediatric subspecialist. After all, I am a pediatrician, too.”
The WVSOM Class of 2012 graduate desired to become a pediatric surgeon, but although he didn’t match into a surgical residency program, he matched in general pediatrics, which allowed for specialization through additional fellowship training. He completed a general pediatrics residency program at University of California, San Francisco-Fresno, which opened opportunities to subspecialize in nearly anything nonsurgical.
“Pulmonary care was another avenue I was interested in because a pediatric pulmonologist is a proceduralist, so I get time in the pediatric operating room. That’s a special place to me, where all the providers are working together, focused on diagnosing and treating a child,” he said.
Brock’s patients range from premature babies and children to teenagers and young adults. He finds career satisfaction in working with the aerodigestive multidisciplinary team in which he and other pediatric subspecialists perform combined procedures to optimize patient outcomes. During triple endoscopies, for example, the pediatric pulmonologist, otolaryngologist and gastroenterologist provide three back-to-back procedures under a single round of anesthesia to minimize general anesthesia and to more effectively deliver therapy and evaluation.
He recalls an incident when a toddler was eventually referred to the aerodigestive team after experiencing chronic cough for more than six months. Medical therapy failed, and imaging was nonspecific and abnormal. During triple scope, the team found a 3-millimeter piece of clear plastic in the child’s lower airway. The team later learned that the child chewed on pacifiers and this fragmented foreign body had been aspirated.
“Following flexible bronchoscopy with bronchoalveolar lavage of pus and mucous, the pediatric ENT surgeon was able to use forceps to recover the foreign body. This child could have developed permanent lung damage known as bronchiectasis requiring potentially lifelong breathing treatments and airway clearance, but instead within four weeks he was totally clear to auscultation and imaging, and asymptomatic with no cough,” Brock said. “It’s amazing how much disease and dysfunction was averted because of our ability to work as a team, collaborate in the operating room and treat from each of our areas of expertise.”
Aside from providing pediatric care, Brock believes in advocating for early childhood literacy. He has written and illustrated two children’s books — Creatures of Nature, released in 2015 when he was a pediatric resident, and A Sudden Commotion in the Jungle!, published in 2023.
