M.D. Update Issue #71

THE BUSINESS MAGAZINE OF KENTUCKY PHYSICIANS AND HEALTHCARE ADMINISTRATORS June 2012

Special Section

Orthopedics and Sports Medicne

Assembling an All-Star Lineup

Baptist Health launches Sports Medicine program in Louisville with a team of fellowship-trained physicians and a new functional rehab facility

also inside

Volume 3, Number 5



Pain Management for Sports Injury Rehabilitation  Organ Transplantation Researcher Establishes High Level of Chimerism  Notable Plastic Surgery Practices with Multispecialty Expertise

Better care is here.

Meet KentuckyOne Health. A new and unique partnership between two of Kentucky’s leading health providers—Jewish Hospital & St. Mary’s HealthCare and Saint Joseph Health System.

Together we are investing $320 million to bring the latest treatments to more people across the state. Learn more about KentuckyOne Health at KentuckyOneHealth.org.

Continuing Care Hospital Flaget Memorial Hospital Frazier Rehab Institute Jewish Hospital Jewish Hospital Outpatient Centers Jewish Hospital Shelbyville

Jewish Physician Group Our Lady of Peace Saint Joseph Berea Saint Joseph East Saint Joseph Hospital Saint Joseph Jessamine

Saint Joseph London Saint Joseph Martin Saint Joseph Mount Sterling Saint Joseph Physicians Sts. Mary & Elizabeth Hospital VNA Nazareth Home Care

Jewish Hospital Medical Centers: East, South, Southwest, Northeast The Women’s Hospital at Saint Joseph East

Contents Cover story

June 2012 Volume 3, number 5

2 letters 4 Finance 5 insurance 6 Physician ViewPoint>Pain management 8 research>organ transPlantation 10 Practical insights>Plastic surgery 12 Practical insights>hand and micro surgery 14 coordination oF care 16 coVer story 22 sPecial section ď ľ orthoPedics and sPorts medicine

24 allied health 26 news 32 arts

On the COver: BaCk rOw, LeFt tO rIght:

Sarah Crawford and Meghan Carrico of the assumption high School cross country team run through the ribbon at the opening festivities of the new Sports Medicine Center at Baptist eastpoint on June 15, 2012

Jeremy Statton, MD; kittie george, MD; Brennan McClure, MD; FrOnt rOw: william renda, MD; Stacie grossfeld, MD; J. Steven Smith, MD; Scott kuiper, MD, (not shown are ty richardson, MD; Christopher Pitcock, MD,; gregory Potts, MD and Mark Puckett.)

assemblingBaptist anHealth all-star lineup launches Sports Medicine program in Louisville with

a team of fellowship-trained physicians and a new functional rehab facility.

speCial seCtion

Story by Jennifer S. Newton page 16

orthopediCs and sports MediCne

19 Success Breeds Success

21 on the Field

22 Long Standing Practice Fulfills Its Mission

June 2012 1

Letters

Dispatch from Heidelberg Dear Physicians, I am sending my greetings from a cafeturned-sports bar in the 600 year old city of Heidelberg, Germany, typing out these words on my mobile while chatting with several other international journalists about what the future might hold for health and science media.

For me - and by extension M.D. Update - this entire year has been devoted to scholarship on the application of new media techniques that enhance patients access to and understanding of medicine’s peer-topeer knowledge base. The premise of my study being that if patients are going to turn to the web for answers to their healthcare problems, shouldn’t the web serve up some actual solutions instead of causing so many problems? And if it could serve up the right information, then it would serve up information on qualified local doctors who treat actual conditions, not prey on our latent hypochondria. And it would validate qualifications thru professional standards, not anonymous rankings.

I can be tad cynical, but after four months in the media capital of the world, collaborating with medtech and social media startups, I find it odd how few are the members of the medical startup world who actually spend their days talking to doctors.

And a bit of wisdom to boot- those who do are journalists.

Each month or two, another health app launches in a haze of hype, promising to be the app that will revolutionize healthcare.

A lot of VCs are buying it, but I caution providers to use discretion when deciding which digital and social media to be involved in. Scalability and rapid deploy-

ment give apps a stellar trajectory but are at inherent odds with medical practice.

D a n g e r o u s l y, some even propose to substitute for a genuine doctor-patient relaBY Megan Campbell Smith tionship.

Used well, social media can be a practice’s greatest ally in developing and nurturing strong patient relationships. I came upon a great example when covering the home birth and midwifery communities in NC last month. There, home birth families and their midwives collaborate in the exchange of valid health information, dispell rumors, and build rapport as a community of common interest. But gone awry, social media misuse not only spreads misinformation but threatens the provider with malpractice, inurement, or a dreadful reputation.

In the future of healthcare media, one thing is certain. Doctors have to take the lead and direct the tone and content of online discussion in accordance with the values and ethos of their profession. You have to go to the web as an extension of your practice, and you have to build this virtual community of trust just as you know it IRL (in real life).

TTYL, Megan

Megan Campbell Smith, Mentelle Media creative director and founder of Inside Health

Submit your Letter to the Editor to Jennifer S. Newton at jnewton@md-update.com 2 M.D. Update

Volume 3, Number 5 June 2012 Publishers

Gil Dunn Print gdunn@md-update.com Megan Campbell Smith Digital mcsmith@md-update.com Editor in Chief

Jennifer S. Newton jnewton@md-update.com Sales Manager

Bias Tilford bias.tilford@md-update.com Graphic Designer

James Shambhu art@md-update.com

Contributors: Bill Henkel Brenda Kocher Dr. Danesh Mazloomdoost Dr. Charles Metzker Scott Neal Seth Salomon

Contact us: Advertising:

Bias Tilford bias.tilford@md-update.com

Integrated Physician Marketing:

Gil Dunn gdunn@md-update.com

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June 2012 3

Finance

Is Retirement In Your Future?

Qualified retirement plan rules are changing once again. Later this summer, retirement plans must disclose to participants all the costs of the plan. This will shine a bright light on the true costs of maintaining the plans that you likely have in place or new plans that you may start. It’s time for a cost vs. benefit analysis.

Once upon a time, putting money aside in a tax-deferred retirement plan was as easy as making a deposit at the bank. Times have changed. Today, choosing the right retirement plan for a physician’s practice is a daunting task. First it requires developing a whole new lexicon: defined contribution, defined benefit, SIMPLE, IRA, safe-harbor and age-weighted are just a few of the terms.

Like most of the tax code from which they spring, the terms simply add complexity.

Doctors are not immune to complexity— you deal with it everyday, but do you really need to bring more complexity into your life than is absolutely necessary?

Adding to the problem of terminology is the need to make a good judgment for your family’s future benefit as well as that of your employees. This is often a balancing act. Through regulation, the government wants to hold you responsible as a fiduciary to your employees. This article will admittedly only scratch the surface of this very complex, bewildering assortment of choices that you face. Hopefully, the strategic view will be helpful as you weigh your options.

First comes the question of need. If you made it through medical school, you probably don’t need governmental coercion/assistance in forcing you to save for retirement. The tax-savings incentive built into formal retirement plans is usually high enough to make it worthwhile to most practicing physicians. For most people, it boils down to this question: is the tax deduction today (combined with tax-deferred growth) really worth the sometimes high cost of establishing and maintaining a qualified plan? Sooner or later, the tax man cometh.

And today it appears that if Congress is going to deal with some of our very real fiscal problems, the tax could be much higher in the future. There is not an easy answer to 4 M.D. Update

this question. It is a very individualized calculation and must be made with care, employing reasonable assumptions and sound judgment. Some take the stance that, even if the

BY Scott Neal costs are high, it is worth it for the qualitative reason that it compels us to save in the first place; and due to the penalties for early withdrawal, it keeps our hands off the money until we really need it to replace our income.

Okay, if analysis reveals that a taxadvantaged retirement plan is the right thing to do, the next question becomes: which plan should be considered for your particular practice, its doctors and employees? The most prevalent first plan is an IRA. If tax-deferred savings is appropriate for you, we encourage making an IRA contribution—even if it’s not tax deductible, and even if you are covered by another plan.

Next, up the scale of complexity is SEP and SIMPLE (which incidentally, is anything but). The SEP should be considered by an employer or self-employed person with a maximum IRA contribution and few, in any, employees; the SIMPLE, by a smaller employer with low income, or an employer with side income.

Continuing up the scale is the defined contribution (DC) plan. These come in various types and are usually referred to as profit sharing plans, pension plans, 401k, or 403b plans. Essentially DC means that you predefine the method to determine the amount of contribution that can be made for each participant after eligibility requirements have been met. Some plans may result in required contributions each year while others allow for annual discretion by the employer. Along with this complexity comes additional cost. There must be a plan document (usually drafted by an attorney) that has to be amended as the laws change. Compliance is not optional.

Disqualification of an existing plan’s tax benefits is a heavy price to pay. In addition to an attorney, you will likely hire an outside administrator and an investment manager.

Admittedly, many providers bundle these services, but it is rare to see excellence in each of these areas from a single provider.

Every employer should at least consider a 401k plan. In many markets, they have become de rigueur to remain competitive as an employer. In addition to the plain vanilla 401k, there are several options that should be considered. For example, the plan could be age-weighted if you are an older owner of a closely-held business. It can have new comparability provisions, which are appropriate if there are multiple owners of a closely-held company. A profit sharing component could be added to the 401k, and should be considered by an employer with variable income, higher turnover, and young employees.

Finally, a defined benefit (DB) plan should be considered, especially by those who are older with a stable income. A DB plan is one that defines what the participants benefits will be during retirement and requires an actuarial calculation of the amount of contribution necessary to fund that benefit. Because of the complexity the cost goes even higher, but the benefits can be huge. Many actuaries will make the initial calculation without any fee to determine the viability of the DB plan.

Obviously, there is much to consider in designing a retirement plan that is right for you and your practice. It requires specialized skill to make a good call. The benefits of making a good decision, as well as the costs of making a wrong decision, can be substantial. Even those with a plan should consider reviewing the plan to ensure that it is still the right plan for your specific goals and objectives.

Scott Neal is President of D. Scott Neal, Inc., a fee-only financial planning and investment advisory firm. Submit questions and comments to him at scott@dsneal.com or 800-344-9098. ◆

Insurance

Succession Planning – Why Now? According to the Social Security Administration, 1 in 4 of today’s 20 year olds will become disabled before reaching retirement age (3/11/2011), with 38% of these disabilities lasting longer than 5 years (CDA Personal Disability Quotient Calculator). Along with disability, the risk of a debilitating illness or death of a key executive must also be considered.

While these are not fun things to think about or make time for, they can have a big impact on a company that does not have a solid succession plan. A common misperception among business owners is that succession planning is for bigger businesses, when in fact each key member often plays a larger role in a smaller organization.

Here are some ways company owners can protect themselves and their business from the unexpected:

Documentation & Development

While a crude notion, business strategists often use the “hit by the bus” scenario to explain the importance of succession planning. This implores business owners to think about what would happen to their business if one of their key executives was suddenly hit by a bus. Would the business stay strong or be irrevocably damaged?

While day-to-day issues can make long-term planning challenging, a business must minimize their dependence on any one person. Documenting key practices and institutional knowledge as well as grooming young talent can mitigate exposure to the unknown. Relationships with high-value clients should also not be dependent on or solely managed by any one executive.

Buy/Sell Agreement

Imagine a company has multiple owners and one suddenly dies or becomes disabled and a family member inherits their interest. Would their spouse or child be capable of managing their portion of the business?

Ideally the family member would recog-

nize their inability to do so, but if they did want to sell their interest, would the other owner(s) have the funds to buy them out? If so, how would they determine what the business’s value?

BY Seth Salomon A buy-sell agreement states that in the case of a death or disability how the other owner(s) can buy-out the family of that employee, it has a valuation built-in (which can be updated over the years to factor-in company growth), and is funded with life and/or disability insurance which provides the capital for the other owner(s) to purchase the stake of the business. This agreement also ensures that the family of the deceased or disabled owner is provided for in the case of these unfortunate circumstances.

While a buy/sell agreement provides capital to the owner’s family when a death or disability occurs, the costs to the other owners of keeping a business afloat while hiring, training, and integrating a new employee must also be considered (along with any interruption in business development). Key person insurance can provide a business with compensation in the event of a death or disability of a key employee and business overhead insurance can help pay for ongoing expenses during this time of flux.

Plan For Retirement

In Conclusion

Key Person & Business Overhead Insurance

Seth Salomon (seth@salomonco.com) specializes in corporate/personal finance, as well as small business operations and strategy.

Seth recently moved back to Lexington, KY after 14 years in Atlanta and New York City and has joined his father at Salomon & Co., a financial services organization serving small businesses and families for over 38 years (securities offered through LPL Financial, member FINRA/SIPC). ◆

Another common problem for business owners is their ownership comprises nearly 100% of their wealth. While a buy/ sell agreement provides for their families in-case of a death or disability, what happens should they reach retirement and a key employee or family member wants to buy them out but does not have the required capital? Or what if their business becomes worth drastically less in the years close to retirement?

In today’s environment, strong businesses can quickly be disrupted by emerging trends (e.g. Kodak and digital, Nokia and smart-phones/applications). Diversifying assets is therefore crucial for owners’ even if returns or elimination of market risk are never assured. For a planned buy-out, there are various products that can be set-up now to ultimately fund this transaction down the road.

Talk About It

While succession planning, a buy/sell agreement, and other strategies can mitigate the impact of a catastrophic event, ideally a business owner’s framework for addressing these issues does not come as a complete shock to the family members and key employees involved. Sharing succession strategies in advance with those ultimately affected can eliminate surprises and further confusion at a time of heightened emotions.

Many business owners do not anticipate that succession planning is something they need until they are in a situation where it is of the utmost importance. It can be difficult to make time for these considerations, but they can be crucial to a business’s longevity. While this is general information and not specific advice, a trusted wealth manager can explain how your business can best address succession planning. Once this is taken care of, you can focus on day-to-day issues, knowing that you have appropriately planned for the unexpected.

June 2012 5

Physician Viewpoint  Pain Management

Pain Management Complementary to Rehabilitation

By Dr. Danesh Mazloomdoost The most remarkable difference between a living being and a machine is the ability to heal. The steps necessary for efficient healing from a sports injury, however, are not always intuitive. Physical therapy and rehabilitation can help guide the body toward recovery, but it often requires stressing the injury, which in turn causes pain. While this pain serves a function by relaying feedback about an injury, it can become a limitation to rehabilitation. No one likes to intentionally hurt, and when the recovery exercises are coupled with discomfort, the motivation for getting better can be lost.

Acute pain management, however, can play an instrumental role in facilitating recovery from a sports injury. By controlling the pain, the therapies that guide func-

tional restoration become less burdensome and therefore easier to maintain. Whereas, pain medications have historically been the default treatment to ease rehabilitation, they are also associated with side-effects including nausea, disorientation, constipation, and opiate tolerance. Furthermore, the effects are diluted across the entire body rather than focusing at the point of injury.

Modern pain management techniques employ more than just medication management. The introduction of ultrasound-guided injections has enabled a wide variety of pain control modalities that were previously much more challenging. Focal injections, nerve blocks, and even stem cell therapy help control the pain and facilitate recovery.

Moreover, healing in certain conditions may even be accelerated through injections.

Trigger point injections and tendon sheath

Patients turn to social media for answers.

injections are local injections of numbing medicine with or without steroids. Traditionally they have been done without any image-guidance, but more recently, ultrasound guidance helps to both diagnose the specific cause of the injury in real-time and localize the distribution of medication to the primary source. Conditions treated with such injections include acute injuries such as tendon injury or muscle strains, but also more chronic conditions such as fibromyalgia and myofascial pain.

Peripheral nerve blocks are injections targeting nerves that carry pain signals from the injured site. When an injury takes place, the body responds by ramping up an inflammatory response often resulting in swelling. This inflammation also sensitizes peripheral nerves to respond more intensely and with a greater perception of pain. It is a defensive mechanism to protect the injured

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6 M.D. Update

Dr. Danesh Mazloomdoost

site. Peripheral nerve blocks are similar to a reset button and diminish the over-burdening sensitivity. These injections can last from hours to weeks depending on the condition and medications used. Ultrasound guidance is again very helpful in isolating the nerve to avoid affecting any other nerves or causing motor weakness. There are innumerable conditions treated with peripheral nerve blocks, and they include such conditions as post-operative joint pain, arthritis, or nerve injuries coincident with a sports injury.

Platelet-rich Protein (PRP) & Stem-cell therapy is a new arena in sports injury pain management. When an injury takes place, certain blood cells that come into contact with the injured

site act as the alarm and recruit other cells to help repair the damage. Because of their versatility and ability to adapt to any tissue type, they are called stem cells. These cells are always present in the bloodstream and can be isolated by using a special centrifuge to concentrate them. The solution of stem cells are then injected at the site of injury using ultrasound guidance to ensure the valuable concentration is directed into the injury. PRP can help accelerate healing of injured tendons and ligaments as well as chronic arthritis. Since it is a newer modality, however, insurance coverage of the procedure can be a barrier.

Dr. Danesh Mazloomdoost is a pain management specialist with Pain Management Medicine in Lexington, Corbin, and Winchester.

He can be reached at (859) 275-4878 or via his website, painmm.com. â—†

June 2012 7

Research  Organ Transplantation

A Paradigm-Shifting Discovery

Louisville researcher Dr. Suzanne T. Ildstad harnesses the multi-faceted power of stem cells to establish chimerism and induce tolerance in kidney transplant recipients

By Jennifer S. Newton LOUISVILLE Decades in the making, a recently published breakthrough study co-authored

by UofL researcher, Suzanne T. Ildstad, MD, demonstrates success in harnessing the renewal, differentiation, and mobilization powers of hematopoietic stem cells to establish donor chimerism and induce graft tolerance in kidney transplant patients. Published in Science Translational Medicine1 in March 2012, the FDAapproved phase 2 study utilizes a simultaneous approach to bone marrow and living donor kidney transplants in human leuko-

Suzanne T. Ildstad, MD director of the Institute of Cellular Therapeutics (ICT) at UofL

cyte antigen (HLA) mismatched patients, with the goal of eliminating immunosuppressant drug therapy at one year posttransplant. “It’s been known for over 50 years if you get bone marrow from the same donor to take, then the kidney is accepted without needing any drugs,” says Ildstad, director of the Institute of Cellular Therapeutics (ICT) at UofL. “And that has 8 M.D. Update

been the focus of our research for the past 15 years now.”

In 2008, 17,413 Americans underwent kidney transplants2. Subjected to an immunosuppressant drug regimen of 15 to 25 pills daily for the rest of their lives, recipients are at increased risk for kidney failure, diabetes, opportunistic infections, high blood pressure, cardiovascular disease, and cancer.

Establishing Chimerism

Achieving chimerism, the state in which cells of more than one genetic source coexist in a singular organism, in organ transplantation essentially establishes a dual immune system in the recipient, where their bodies accept the donor tissue as their own and do not attack it. “[The paper] is the report of the first eight subjects where we have been able to establish high levels of donor chimerism safely, without graft vs. host disease, without a syndrome called engraftment syndrome that some of our colleagues reported in a different study,” says Ildstad.

Cell Processing

Ildstad is seeking patents for the process ICT has developed for isolating hematopoietic stem cells (HSC) and a facilitating cell, which she discovered, and removing potentially harmful cells in the bone marrow. All of the cell processing occurs in Louisville at the ICT lab. At this time, all bone marrow and kidney transplants happen at Northwestern University in Chicago, which was chosen for its reputation and

high volume of kidney transplants. Joseph Leventhal, MD, at Northwestern is the principal investigator of the study and the first author on the paper.

Mary Jane Elliott, manager of ICT’s Bone Marrow Cell Processing Facility, supervises all of the cell processing, immunological testing, and facility maintenance.

The process begins when clinicians at Northwestern give subjects a drug that mobilizes stem cells into their bloodstream.

“Then they do an apheresis that collects all the blood, which includes the stem cells and the facilitating cells, and we receive the product fresh,” Elliott says. After 12 to 14 hours of cell processing and six to eight hours of quality assurance testing, the product is cryopreserved and shipped back to Chicago for infusion into the patient.

Conditioning and Immunosuppression

A critical component of the transplant process is conditioning with very low dose chemotherapy and total body irradiation to make space for the new bone marrow. Since phase 1 of the trial, they have had to gradually increase the conditioning until they achieved permanent take of the donor marrow. “Now we pretty reliably establish high levels of donor chimerism, and we manage the nadir, the decrease in white count, as an outpatient,” says Ildstad. Patient education is critical in managing the drop in white count, which usually lasts a week or less.

The benefit of conditioning is that it helps the bone marrow and donor kidney take.

Conditioning occurs five days before the kidney transplant, and the bone marrow transplant occurs one day after the kidney transplant. The patient goes home on day two after the surgery.

Patients start on a standard twodrug regimen of immunosuppression of Mycophenolate Mofetil (MMF) and Tacrilomus for the first six months, and then are slowly weaned. Immunosuppression is incrementally decreased at six and nine months post-transplant and stopped com-

Practical Insight  Plastic Surgery

Skill, Service, and Selection

Dr. T. Gerald O’Daniel banks on experience and intuition to align expectations with quality outcomes

By Jennifer Newton Louisville The basic principles of success in an independent medical practice are elementary, says plastic surgeon T. Gerald O’Daniel, MD, FACS. “Our basic philosophy can be distilled down very simply to any type of plan that you use for a business or service industry, which is a quality type of product with excellent customer service,” says O’Daniel. High quality work is essential in a field where outcomes are visible and insurance coverage is limited.

Customer service is an equally important component, contends O’Daniel, because service sustains the business. He cites an obsessive-compulsive attention to detail and surrounding himself with people who do the same as keys to his success.

In a slow economic climate, internet merchants such as Groupon and Living Social have thrived, selling discounts on everything from hang-gliding to Medispa services. But O’Daniel says he has never advertised his services, relying instead on referrals and word-of-mouth. While discounted services are a blanketed approach to increasing volume, O’Daniel’s goal is to focus on a specific population that he can serve extremely well. “We can’t treat everybody, but when you come to our practice,

O’Daniel does approximately 400 facial procedures a year, including 150 to 200 face lifts. He performs surgeries at nearby Louisville Surgery Center, a nationally accredited and state-licensed multi-specialty surgery center in which he is a partner. While the surgery center covers services from ophthalmology to pain management, its largest volume of patients are plastic surgeries. The center, which has about 20 employees and accommodates 4,000 cases a year, is 100% physician owned, although nonowners also operate at the facility.

A benefit of maintaining a successful practice for 20 years is that you get to be selective about the services you offer. O’Daniel, who has been practicDr. T. Gerald O’Daniel is dual board-certified ing in Louisville since 1993, trained in in otolaryngology/head and neck surgery and ear, nose, and throat surgery and facial plastic surgery and fellowship-trained in facial nerve surgery. He continued his facial plastic surgery, pediatric plastic surgery, and surgery training with a plastic surgery craniofacial Surgery. residency and then completed pediatric plastic surgery and craniofacial surgery you’re going to get high-end quality out- fellowships. He is board certified in otocomes with unsurpassed customer service,” laryngology/head and neck surgery and he says. O’Daniel estimates his patient plastic surgery. “After nine years of surgery population is 60% local and 40% out of training, two board certifications, and two fellowships, I’ve kind of whittled my practown or out of state.

With an office staff of seven employees, tice down to doing a handful of operations,” two of whom have been with him 20 years, says O’Daniel. He used to do acute trauma

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

10 M.D. Update

and breast reconstruction, but the downside of a very successful practice was that he could not be readily available for acute cases and maintain a timely and accessible practice for his scheduled patients.

Focusing on facial procedures, O’Daniel’s cosmetic procedures include facial rejuvenation, rhinoplasty, and ear pinning in young children. Non-cosmetic procedures include cleft lip repair on children, cleft lip revisions on young adults and adults, nose revision on children with cleft lips, reconstruction after cancer removal, and post-traumatic reconstruction.

O’Daniel is also selective about his patients. Because his referrals are word-ofmouth, he feels his patient base is preselected and carries an inherent trust, but that trust must go both ways. “If I don’t feel like I can develop a relationship with the person that’s going to be amicable and understand-

ing and that’s going to be reasonable, then I don’t partake in the surgery,” says O’Daniel.

He also relies heavily on his office staff to look for red flags that might signal a patient that is impossible to please.

The doctor-patient relationship is criti-

tions with outcomes includes comparing photographs of them at 20 or 30 years old with current ones and discussing concerns, why things look the way they do, and what can be done to restore it. Patients also see pictures of what other patients looked like

The doctor-patient relationship is critical in aligning the patient’s expectations with what is surgically possible. “Really, I look at myself as being an educator,” says O’Daniel. If expectations are misunderstood or unrealistic, clients walk away unhappy. cal in aligning the patient’s expectations with what is surgically possible. “Really, I look at myself as being an educator,” says O’Daniel. If expectations are misunderstood or unrealistic, clients walk away unhappy. For the patient who wants to look more youthful, matching expecta-

an hour after surgery, a week after, a year, and ten years after to get an idea of their own recovery.

“We can make people feel really good about themselves, but if a person comes in for the wrong motivation, you’re going to end up a failure every time,” says O’Daniel. ◆

June 2012 11

Practical Insight  Hand And Micro Surgery

Christine M. Kleinert Institute

A mission of education and research, attracting surgeons, patients, and cutting-edge treatments to Kentucky

By Jennifer S. Newton Founded in 1986, the Christine M. Kleinert Institute for Hand and Micro Surgery (CMKI) has a dual mission: education and research. A 501(c)(3) independent organization funded by the Kleinert-Kutz Endowment for Education and Research in Hand and Micro Surgery, the Institute’s primary educational role is supporting the largest hand surgery fellowship program in the US and the only one to accept fellows from foreign countries. Having trained over 1,300 fellows from 58 countries, the fellowship’s faculty are primarily surgeons from Kleinert Kutz Hand Care Center, and the fellows are fully-trained plastic, orthopedic, and general surgeons. The fellowship is ACGME accredited and recently renewed its accreditation for five years with zero citations. This year there are 20 fellows in training from 10 different countries, including the United States, Italy, Spain, Columbia, China, Israel, Chile, Thailand, the Dominican Republic, and Egypt.

Hand and Upper Extremity Research

Christina Kaufman, PhD, executive director of CMKI, estimates she spends 50 percent of her time on the organization’s most well-known clinical trial – the Louisville Vascularized Composite Allograft (VCA) program, otherwise known as the hand transplant program. In addition, CMKI currently has 28 other active clinical studies in progress. Active trials include a biomechanical study on the amount of bone that can be removed in a broken arm before interfering with function and a trial focusing on patients with Dupytren’s syndrome or “Viking’s Disease.” Other studies include multiple trials on the distal radial ulnar joint (DRUJ), a very important joint where injuries can be severely debilitating. CMKI recently received Department of Defense 12 M.D. Update

Christina Kaufman, PhD, Executive Director of CMKI

(DoD) funding for a collaborative study with a University of Oregon researcher to measure and compare brain plasticity in amputees, replant patients, and hand transplant patients utilizing a functional MRI. Collaborating with the Louisville Cardiovascular Innovation Institute (CII), CMKI has proposed a number of grants utilizing the work of Stuart K. Williams, PhD, and James B. Hoying, PhD, with stromal vascular fraction (SVF) of adipose tissue, which contains stem cells and has anti-inflammatory, pro-healing, and potentially tolerance inducing properties. A grant submitted through the Armed Forces Institute for Regenerative Medicine (AFIRM) seeks to apply this work in hand transplants. CMKI is also the grateful recipient of a five-year grant from Kosair Charities for the establishment of a pediatric outreach clinic as well as basic science studies on nerve function in congenital defects and tolerance induction in pediatric patients using SVF cells.

Hand Transplant Program

Education and research integrate seamlessly in the VCA program. “Every [hand transplant] program in the country has come to Louisville to learn how we did it,” says Kaufman, as well as many programs from other countries. “I think our program is special in that we have always shared our experience, the good parts and the bad parts, because both happen,” she says.

Much like the multiple types of tissue involved in transplanting a hand, the VCA team comprises a vast group of professionals, including surgeons and researchers from Jewish Hospital (part of KentuckyOne Health), CMKI, Kleinert Kutz, and U of L. CMKI’s role includes administering the clinical trial, employing the research nurse, listing patients with KODA, completing regulatory paperwork, providing hand therapy for the first three months post-transplant (the revenue from which helps pay for the fellowship program), and setting up a mirror team in the patient’s

hometown. Kaufman refers to the surgeons of Kleinert Kutz as “the backbone” of the project, 15 to 20 of who participate in each case, and credits Jewish Hospital and U of L with providing infrastructure, transplant surgeons, and laboratory resources.

To date, the Louisville VCA team has transplanted hands on eight patients, most recently on Ronald Thurman in February 2012. In March 2012, the nation’s first hand transplant patient, Matthew Scott, returned to Louisville for his annual check-up. According to Joseph Kutz, MD, FACS, founding partner of the Kleinert Kutz Hand Care Center and president of the CMKI Board, “Matt is now 13 years out, and he’s got excellent function. He’s showing a regeneration of intrinsic muscles … which is giving him more dexterity in working better with his hand.” Scott’s strength, movements, and range of motion continue to improve.

controversial issues has been immunosuppression. Multiple studies going on across the country are exploring efforts to induce tolerance in organ transplant recipients and therefore minimize immunosuppression.

While Kaufman and Kutz agree their goal is always to use the least amount of immunosuppression necessary to maintain the graft, the SVF stem cell trial will be their first modification to address tolerance. “We are interested in the use of tolerance induction, but at this point it’s still an experimental study … because this is not a life-saving procedure, the bar of what you can accept for risk is a lot higher,” says Kaufman.

As the gatekeepers of the VCA program, the Institute walks prospective patients through an extensive screening process, which includes insurance coverage of immunosuppressants, a criterion

for the Louisville team. Hand transplant patients begin with a triple-drug regimen of Prednisone, Mycophenolate Mofetil (MMF) or Rapamycin, and Prograf. In some cases, Prednisone can be withdrawn as long as there are no problems, which helps to minimize harmful side effects.

Kutz looks forward to the day when hand transplants are no longer experimental treatments and are covered by insurance.

“The only difference between doing this and a replant of your own hand is the fact that you have to use the drugs to prevent rejection,” says Kutz. He counters ethical arguments with the degree to which hand transplants improve the quality of patients’ lives. “This means very much to the patients. This makes them feel like they’re whole again, makes them feel that they’re really living again,” he says. ◆

Evaluating Graft Vasculopathy

While they have had many successes, Kaufman cautions that chronic rejection still exists. Case in point is the program’s fourth patient, who experienced rejection in the form of vessel stenosis that was not detected in time because the screening tool they were using was not sensitive enough, resulting in removal of the hand.

Through their grant with the DoD, the team was able to find a technology that met their challenge – ultrasound biomicroscopy using the VEVO 2100. “This has a resolution of 30 microns, which is 1,000 to 3,000 times better than our current technology, and importantly, it’s non-invasive,” says Kaufman. The technology allows clinicians to look at vessels, including the radial and ulnar arteries as well as the digital arteries, and measure them directly. With it, they were able to detect and treat a thickening of the arterial walls in the sixth patient.

Fellows are also studying other potential uses of the technology.

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Coordination of Care

Joints in Motion Program Can Provide Patients Support, Accountability

By Brenda Kocher Physicians often see patients whose conditions cannot be treated with drugs or surgery. They have pain and other symptoms that often recur, and physical therapy is not always the answer. It is obvious that they need to make lifestyle changes that would promote better health, particularly better joint health.

A physician can suggest exercise and healthy eating, but many patients don’t know specific ways that they can incorporate those suggestions into their own lifestyle. A new program at Central Baptist Hospital, Joints in Motion, can create an individualized plan to get a patient moving, eating healthier and making other positive choices that will lead to better overall health.

This 12-week program is offered in partnership with Central Baptist HealthwoRx Fitness & Wellness Center at Lexington Green Mall, a full-service fitness center staffed by certified personal trainers and fitness practitioners, registered dietitians and nurse health educators.

Patients enrolled in Joints in Motion start with an initial overall health assessment with a registered dietitian and a certified exercise physiologist/fitness practitioner.

These professionals will create a customized eating plan to help meet weight goals and an individualized exercise plan tailored to their abilities.

“The beauty of this program is that it is tailored to each individual,” said Dr. Mathew Nicholls, an orthopedic surgeon with Kentucky Orthopedic & Hand Surgeons who also serves as medical director of orthopedic services at Central Baptist Hospital. “This program can provide the extra support network, feedback and accountability that encourages patients to make lifestyle changes that can be difficult to make.”

Those enrolled in the program are asked to commit to exercise a minimum of three days a week. That exercise could be in the form of working out on fitness machines 14 M.D. Update

Joints in Motion, can create an individualized plan to get a patient moving, eating healthier and making other positive choices that will lead to better overall health. and using weights or taking a variety of group fitness classes offered at HealthwoRx. Patients may choose to participate in aquatic classes taught by a certified aquatic fitness instructor offered at an off-site location.

Joints in Motion patients will meet with a fitness practitioner once a week to assess their progress.

After the initial assessment, patients will meet with the dietitian every two weeks to

discuss dietary modifications that need to be made in order to achieve or maintain a healthy weight for joint health. The dietitian will help determine the recommended number of calories per day they need, create a customized eating plan and help them set measurable short- and long-term targeted goals.

At the midway point in the program (6-8 weeks) patients can meet with a physiatrist, who will design a treatment plan that will help alleviate pain and restore maximum function without surgery so that individuals can stay as active as possible regardless of age. The physiatrist, the fitness practitioner and the dietitian can each communicate with the patient’s physician at any point during the program at the patient’s request. ◆

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June 2012 15

cover Story

Back row, left to right:

Jeremy Statton, MD kittie george, MD Brennan Mcclure, MD front row: william renda, MD Stacie grossfeld, MD J. Steven Smith, MD Scott kuiper, MD, (not shown are ty richardson, MD christopher pitcock, MD gregory potts, MD and Mark puckett.)

ASSEmbLIng An ALL-StAr LInEUp Baptist Health launches Sports Medicine program in Louisville with a team of fellowship-trained physicians and a new functional rehab facility

By Jennifer S. newton PhotograPhy By Megan c. SMith

16 M.D. UpDate

LOUISVILLE Much like Babe Ruth himself, reportedly calling his shot in the 1932 World Series, Baptist Sports Medicine is swinging for the fences, behind a powerhouse team of experienced physicians and staff, a tradition of orthopedic care, and an integrated new facility at Baptist Eastpoint.

The sports medicine program is a natural springboard off the existing foundation of Baptist Health’s services. Baptist Hospital East has long been a leader in orthopedic care in Louisville with the highest volume of total joint replacement procedures in Kentucky and a rank of eighth nationally.

Baptist Hospital Northeast has been providing athletic training services to Oldham County schools for 12 years, and Baptist Eastpoint, the system’s newest outpatient center located off Old Henry Road in Louisville’s east end, already housed an Urgent Care center and physical therapy outreach clinic for the system.

Leading the sports medicine charge is board-certified orthopedic surgeon and Medical Director of Baptist Sports Medicine, J. Steve Smith, MD, who realized “Baptist had everything they needed to have a sports medicine department, but it just wasn’t organized into a cohesive unit.”

John Wortley, executive director of Baptist Health Community Services and the administrator overseeing the project, says, “A sports medicine

center in Louisville is something we have considered a couple of times over the past 10 years.” He attributes its coming to fruition now to the right staff at the right time.

A Line-Up of Independent and Employed Physicians

A native of Lawrenceburg, Kentucky, Smith played college baseball at Western Kentucky University and attended the UK College of Medicine. He pursued an orthopedic sports medicine fellowship at the KerlanJobe Orthopaedic Clinic in Los Angeles, California, and served on the medical staff of the LA Lakers, LA Dodgers, USC football team, and other teams before returning to the Bluegrass.

Opening its doors on Monday, June 18, the facility is functioning as a stand-alone sports medicine clinic staffed by two to three full-time primary care/sports medicine physicians with rotating coverage by six to

curs, “A partnership like this allows a private practice doctor to essentially enhance his or her practice without having to make drastic changes in their career … Both parties benefit directly from this situation with little risk.”

The foundation for Baptist Sports Medicine began at Baptist Hospital Northeast, which provides full-time athletic trainers to four local high schools – Oldham County, South Oldham, North Oldham, and Henry County. In addition to Oldham County, they also consult in Trimble County and work with Hardin Memorial Hospital through their management contract. The new program in Louisville has already signed the Kentucky Stickhorses professional lacrosse team as a client and plans to work with numerous public and private schools in Jefferson County, as well as local collegiate programs.

Beyond clinical and on-the-field experience, the program has the advantage of feeding off of the entire Baptist Health system. “It’s a nice avenue for the emergency room and Urgent Care centers,” says Smith. Additionally, “Baptist Medical Associates has close to 50 primary care doctors that now have a streamlined system within their own network.” Direct and easy access to myriad specialists is another benefit Baptist Sports Medicine serves up, including dentistry, OB/ GYN, neurology, neurosurgery, hand surgery, dermatology, and more.

Redefining “Athletes”

eight orthopedic surgeons, all fellowshiptrained in sports medicine. The starting line-up is a mix of independent and hospital-employed physicians, something Smith calls a novel approach. According to Wortley, “From our perspective as a system, employment is not the only option. We do everything to partner with physicians if they want to remain independent.” Smith con-

The average age of a typical orthopedic surgery patient may be closer to a retired major leaguer than a projected top draft pick, but the advantage of Baptist’s Sports Medicine program is that it is designed to treat athletes of any age at any level. “Part of our goal is also to give the weekend warrior the same access as high school and collegiate athletes,” says Wortley.

With other health systems entrenched in the high school and collegiate markets in Louisville, Baptist seeks to capitalize on recreational leagues, club sports, and anyone

(l to r) Medical Director of Baptist Sports Medicine Dr. J. Steve Smith, Director of Baptist Sports Medicine Gary Costelle, and Executive Director of Baptist Community Health Services John Wortley are the driving force behind the Baptist Health’s new sports medicine program and facility in Louisville.

participating in sports on any level.

Baptist’s services will “take the athlete through the full continuum of care,” says Gary Costelle, director of Baptist Sports Medicine, from injury evaluation and diagnosis, to acute treatment, to surgery, to rehab, to prevention and improving performance. The new 11,000-square-foot facility includes private treatment rooms, an extensive physical therapy gym, indoor turf field, portable pitching mound, rubberized running lane, and climbing wall.

It is designed as a one-stop shop for the injured athlete to increase efficiency and convenience. Physicians perform surgery at a number of nearby Baptist-affiliated surgical facilities.

Orthopedic Surgery

“Arthroscopy is the foundation of surgery in sports medicine,” says Smith. “With the use of a small camera and small instruments, small incisions are made, allowing quicker recovery, less pain, and less scarring.” While most sports medicine surgical procedures are done arthroscopically, open June 2012 17

cover Story

surgery is sometimes necessary to treat injuries that cannot be accessed with arthroscopy. Open procedures include arthroplasty of the shoulder and knee.

Evidencing his expertise in open shoulder techniques, Smith performs Reverse Total Shoulder Arthroplasty (RTSA) to treat arthritis in the shoulder when there is an associated rotator cuff tear. The shoulder is a ball and socket joint that resembles a golf ball resting on tee. A standard shoulder replacement consists of replacing the bones with a metal ball and a combination plastic/metal socket, which alleviates pain but does not solve the problem of torn muscles. RTSA puts the “ball on the socket and socket on the ball,” says Smith, reversing the components and altering the shoulder’s mechanics, allowing the larger

operative,” says Smith, who underlines the importance of physical therapy to the program. The center will have three therapists doing sports medicine exclusively and one therapist doing sports medicine plus general physical therapy, which will continue at Baptist Eastpoint.

An add-on benefit is the center’s functional rehab environment. Artificial turf, a rubber running lane, golf swing station, basketball court, and more allow patients to apply rehab to their everyday activities.

Because the sports medicine field is already well-populated in the Louisville area, “to make waves, we had to take things over the top,” says Costelle. In an effort to appeal to the community and attract healthy athletes as well as injured ones, Baptist included sports performance training and

(l to r) Administrator John Wortley, radiologist Dr. John Rothpletz, orthopedic surgeon Dr. Scott Kuiper, and family and sports medicine specialist Dr. Mark Puckett are representative of the diversity of experts and specialties that came together to form Baptist Sports Medicine.

flexibility, core stability, mobility, strength, speed, and power. Training is individualized in a small group setting and offered through specialized conditioning camps.

Strength training and conditioning are “the ultimate prevention,” says Sarantis.

Like preseason training, prevention and education are critical to athletic success.

Baptist Sports Medicine plans a series of

From our perspective as a system, employment is not the only option.

We do everything to partner with physicians if they want to remain independent.

–John Wortley, Executive Director of Baptist Community Health Services

Nick Sarantis, Baptist’s director of Sports Performance, says strength training and conditioning are “the ultimate prevention” of sports-related injuries.

muscles that surround the shoulder joint, namely the deltoid, to elevate the arm and increase both function and strength while eliminating pain.

Physical Therapy and Sports Performance Training

“A vast majority of sports medicine is not 18 M.D. Update

conditioning in its program.

Nick Sarantis, MS, ATC, CSCS, a certified athletic trainer and strength conditioning specialist and Baptist’s director of Sports Performance, says insurance only allows patients limited time in therapy. “I want to help them get back in shape after an injury, help determine what caused the injury in the first place, and build a bigger picture of looking at the whole athlete,” he says.

The next logical step in an athlete’s recovery, performance training focuses on

programs covering topics such as throwing mechanics, preventing ACL injuries, and evaluating concussions. It will seek to reach not only coaches, trainers, and players, but also to educate other physicians on current treatments.

Launching a program such as this one “takes expertise, talent, and reputation,” says Wortley. “Once you have the vision, you find the people. Execution, as with any service line, is the key to making these occur, as well as listening to your partners in the community,” he adds. ◆

Special Section Orthopedics and sports Medicine

Success Breeds Success

High Volume and Commitment to Positive Outcomes Lead the Way By gil Dunn Lexington Hip and knee replacement and to move to Lexington, Kentucky an easy one. revision surgeries are on the rise, increasBurandt joined Lexington Clinic in ing more than 3% nationally from 2009 2001 after completing a residency at the to 2010, according to a report published in Henry Ford Hospital in Detroit, Michigan Orthopedic Network News, July 2011. and a fellowship in knee and sports mediThe orthopedic and joint replace- cine at Baylor College of Medicine in Texas. ment specialists at the Lexington Clinic Derderian joined Lexington Clinic in Orthopedics – Sports Medicine Center 1983. He is board certified in orthopedic have seen this increase in volume first-hand. Christian Christensen, MD, David Burandt, MD, FACSM, and Harry Derderian, MD, who perform hip and knee replacement and revision surgeries, see nothing but increased volume in the future for their practices. There are a number of factors driving the demand for hip and knee replacement.

“Weight, weight, and weight are the number one, two, and three reasons that cause hips and knees to wear out early,” Christian Christensen, MD Christensen says. He also cites an ageing senior population that is living longer, baby boomers who want to live pain-free, active lifestyles, and advances in joint replacement systems.

In 2011, Christensen performed approximately 800 joint replacement surgeries including total hip and knee replacements, uni-compartmental knee replacements, and total knee and hip revisions. His surgery schedule is Monday, Wednesday, and Friday with up to five or six surgeries per day. “I feel that the volume of my work and the successful outcomes for my patients are the David Burandt, MD, FACSM result of my training and the support given to me by the Lexington Clinic partners and staff and the staff at Good Samaritan surgery and specializes in total knee and hip Hospital. When I came here, it was a great joint replacement and arthroscopic knee opportunity to develop a practice.” surgery. Dr. Derderian’s office is located at Christensen joined Lexington Clinic in the Lexington Clinic East facility.

2003 after completing specialist training at Duke University and a fellowship at New Anterior Approach in Hip England Baptist Hospital in Boston, where Replacement he trained under Drs. Dick Scott and Ben Christensen and Burandt have training in Bierbaum. The opportunity to practice in a the posterior, lateral, and anterior approaches physician owned practice and his wife Emily’s in hip replacement, but both now prefer the nearby family in Tennessee made his decision anterior approach. Christensen states that the

anterior approach gives him “clear and easy access to the hip joint without cutting through the muscle mass of the posterior approach.

Outcomes are clearly better with much less scarring and soft tissue trauma. Also the incisions are much smaller,” he says.

Patient recovery using the anterior approach is exponentially improved, Christensen says, and recovery is remarkably quicker. He recalls visiting a female patient less than 24 hours after her surgery.

When he asked her how she felt, she swung her legs out of the hospital bed, grabbed her walker and then walked across the room. She stopped, turned, and lifted the walker in the air. “’I feel pretty good,’ she said. I was amazed and thrilled for her,” Christensen says.

Christensen estimates that he now uses the anterior approach for most of his primary hip replacement surgeries. Burandt echoed his preference for the anterior approach and sees the use of the technique continuing to rise. Christensen emphasizes that he uses the posterior approach when the situation dictates, and notes that there are clinical factors that determine the approach.

“Having the anterior approach available has been a real positive for appropriate patients, however the more traditional approaches are still excellent techniques with a proven record of excellent outcomes,” says Christensen.

The patient population for hip replacement is varied, and “getting younger and is equally split between genders,” says Christensen. He now sees 40 year olds as well as the more traditional joint replacement candidate of 65 years and older. More women than men, 60%-40%, seek knee replacement.

Christensen and Burandt share a diagnostic philosophy that drives high positive outcomes. They counsel patients to exhaust alternatives before seeking joint replacement surgery, such as diet, exercise, physical therapy, and according to Christensen, “getting new and better shoes.”

Christensen says he dissuades possibly June 2012 19

Special Section Orthopedics and sports Medicine

75% of his clinical patients from joint replacement surgery because he doesn’t think that surgery will improve their condition to the patient’s, or his, level of expectation. “I have to be 99% convinced that I can improve my patient’s condition before I will operate on them,” he says, “because after I put in a new joint, there’s no returning to what they had before.”

Burandt also says that “managing patient expectations is a challenge.” Many patients have friends or relatives who have had joint replacement surgery, and expectations can be unrealistic. Burandt tells his patients that “recovery will be the hardest thing they’ve ever done, even more difficult than the pain they currently have.” If Burandt is not convinced that his patients will commit to the post op therapy regiment, he won’t proceed with the replacement surgery.

Improved Joint Systems and Technique

Advances in joint replacement systems are helping fuel the boom in joint replacement surgeries. Christensen and Burandt applaud the development of new metals, plastics, and the new lattice work designs that allow living bone material to graft itself onto the replacement parts. Both prefer the improved techniques of using non-cemented fastening of the joints which allow natural bone grafting, which previously did not occur because the cement was an impervious barrier.

“We don’t see the loosening of the joint and the resulting pain from the cement break down after a few years,” Burandt states.

Expanding the Team

To handle the projected increased volume

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20 M.D. Update

D S N E A L . C O M

and demand for joint replacement surgery, Lexington Clinic is adding a new orthopedic surgeon. Tharun Karthikeyan, MD, is completing his fellowship in joint replacement at OrthoCarolina, in Charlotte, North Carolina. Karthikeyan will join Lexington Clinic in August, 2012. ◆

For patient referrals, contact Drs. Christensen and Burandt at (859) 258-8561 or Dr. Derderian at (859) 258-5225.

For more information about Lexington Clinic OrthopedicsSports Medicine Center visit www.LexingtonClinic.com/sports.

Special Section Orthopedics and sports Medicine

On the Field

Experience Gives Hardin Orthopedist & Sports Medicine Doctor Insight By Gil Dunn ELIZABETHTOWN Having been a student athlete

who was injured while playing and underwent reconstructive surgery and extensive rehabilitation, Michael Krueger, MD, CSCS, has a unique perspective into the process of orthopedic surgery and rehab. “I was a two-sport athlete in college, football and track. I dislocated my shoulder 16 times.

I know what athletes go through when they are injured,” says Krueger, sole practitioner at Hardin Orthopedics & Sports Medicine in Elizabethtown, Kentucky.

“Being a former athlete gives me an equality and commonality with my patients,” says Krueger, regardless of whether the injury comes under the lights on Friday night or playing around the house or suffered on the job. “I have been through as much rehab as many of my patients. I know the process and the protocols first hand,” he says.

Krueger launched his solo practice in July 2011 after completing his sports medicine fellowship training at Sports Orthopedics & Spine in Jackson, Tennessee, following his residency in orthopedics at the University of Kentucky. Krueger credits his fellowship training and the Certified Strength and Conditioning Specialist (CSCS) certification he earned in residency for preparing

Being a former athlete gives me an equality and commonality with my patients. I have been through as much rehab as many of my patients.

I know the process and the protocols first hand.

– Dr. Michael Krueger him for the dual role of orthopedic surgeon and rehabilitation head coach.

“I view my practice as a team concept.

It’s me, the surgeon, with the referring physicians, the hospital OR and office staffs, the physical therapists, athletic trainers, and most importantly, the patient,” says Krueger.

Arthroscopic surgery is the majority of Krueger’s practice, encompassing 60 to 70%

Michael Krueger, MD, CSCS, sole practitioner at Hardin Orthopedics & Sports Medicine in Elizabethtown, Kentucky.

Dr. Michael Krueger is attending physician for many Hardin County athletic teams.

(Photo courtesy Michael Krueger, MD)

Below

of surgery volume. He comments on the advancements in arthroscopic surgical techniques such as allarthroscopic double-row rotator cuff repair, hip arthroscopy, and anatomic ACL reconstruction. “We are doing more advanced techniques today that we didn’t 20 years ago. That is a great plus for our patients.”

Pediatrics and Physical Therapy

Pediatric sport injuries for young athletes under 16 years old are a growing segment of the patient population at Hardin Orthopedics & Sports Medicine, which Krueger attributes to younger athletes training harder and pursuing one sport year round. Fractures and ligament tears require different techniques for pediatric patients, such as less use of x-ray and CT scanning as well as special instruments and implants in surgery to avoid growth plates. A physical exam, limited x-ray with or without an MRI is Krueger’s preferred diagnostic approach for pediatric patients.

Krueger has developed strength and conditioning protocols that he incorporates into his therapy regimens for rotator cuff and labral repair, ACL injury, and collateral ligament reconstructive elbow surgery – the “Tommy John” surgery. He borrows heavily from his mentors Dr. Darren Johnson at UK and Dr. Ben Kibler, Lexington Clinic, for their work on ACL reconstruction and

stabilizing the scapula, respectively.

Krueger communicates with his physical therapists regularly to keep apprised of his patient’s progress, and he clearly gives credit to physical therapists who “can make me look like a superstar, spending three to five hours a week for months with patients after my two or three hour surgery.” Krueger’s commitment to the benefits of physical therapy is evident when he recalls a former instructor who said, “It’s a scalpel, not a magic wand.”

Krueger is a fixture on the sidelines of many Hardin County athletic teams as an attending physician and un-abashed booster. “I still get a thrill being on the sidelines during a game,” he says. “I’d love to be back playing college ball again.” ◆

For patient referral, contact Hardin Orthopedics & Sports Medicine (270)735-1588 2407 Ring Rd, Suite 108, Elizabethtown, KY 42701 www.etownsportsdoc.com June 2012 21

Special Section Orthopedics and sports Medicine

Kentucky Orthopaedic and Hand Surgeons Long Standing Practice Fulfills Mission By Gil Dunn

Lexington In the era of consolidation and sub-specialists, Kentucky Orthopedics and Hand Surgeons (KOHS) remains successful by staying with its founding formula of specialists and general orthopedics.

KOHS was founded in 1981 by Dr. G.J. Sweeney, Jr. and Dr. David Stevens. The practice continues today after joining with three other Central Kentucky private orthopedic practices to form Ortho Kentucky. That four group merger occurred in July 2010 when KOHS joined Orthopaedic Consultants, Kentucky Bone & Joint Surgeons and Lexington Orthopaedic Associates. Ortho Kentucky was profiled in M.D. UPDATE, April 2011.

The mission of KOHS remains intact says senior partner Mark E. Einbecker, MD, “by providing outstanding patient care by fellowship trained sub-specialists and a general orthopedist who can handle everything and anything that comes our way.” Patients come to the Lexington office in Central Baptist’s medical campus from West Virginia, southern and northern Kentucky and west to Frankfort.

Einbecker says his commitment to a life of providing medical care began when he was a medic in the US Army Green Beret Special Forces, 1974-1977. “For a young man, with a little bit of college and no direction, it was a great experience and exposure to a lot of medicine,” recalls Einbecker.

Einbecker attended medical school at Northwestern University and took residency at the University of South Florida.

Einbecker was fellowship trained in hand and upper extremities at the Christine M. Kleinert Institute for Hand and Microsurgery in 1991 before joined KOHS. Today, Einbecker says the majority of his practice is “hand, elbow and wrist surgeries on working adults, who are too young to retire but whose aches and pains make working a daily challenge.” Repair and replace22 M.D. Update

Lisa T. DeGnore, MD

ment surgeries for tennis elbow, medial epicondilitis, nerve entrapment, Duputhren’s Contracture and, “the big one, carpel tunnel syndrome” keep Einbecker’s surgery schedule full, as well as consultations for his rheumatoid and osteo-arthritic patients.

Though hand transplant surgeries garner the media buzz, it’s the outpatient procedures that motivate Einbecker. “With an eight to 10 minute operation, we can relieve pain and preserve use and feeling in hands and fingers that might otherwise be lost through lack of awareness.”

As an example, Einbecker points to a common hand replacement procedure, arthritis at the base of the thumb joint. He replaces the arthritic joint with a pyro-carbon ball that restores mobility and pain-free use of the affected thumb joint. “It’s so simple and common that I carry the pyro-carbon ball in my pocket to show patients,” he says, pulling the ball out. It’s the size of a small gumball.

Foot and Ankle: Prevention and Replacement

Lisa T. DeGnore, MD, says she is “a tertiary sub-specialist known among referring physicians for salvaging and repairing foot surgeries that have previously failed.” Yet

prevention of diabetic foot disease is her most passionate cause.

Diabetic neuropathy interrupts the protective nature of pain sensation, states DeGnore. “Patients who suffer from diabetic neuropathy will walk around with a hole in their foot and not feel a thing,” she says, so prevention of diabetic ulcers is the key. DeGnore educates her patients on her four step prevention regimen: moisturize their feet every night to prevent the dryness that leads to cracking and infection; sand calluses every day; use custom inserts in shoes for problem feet; and no smoking, plus a tight rein on glucose in their diet.

DeGnore recommends that primary care physicians regularly examine their diabetic patient’s feet for warning signs of infection.

Ankle repair systems lag behind other joint replacement hardware in DeGnore’s view, so she is reluctant to use them on her patients, who are primarily middle age to early seniors and are heavy. The thin tibia and fibula struggle to withstand the intense downward pressure of walking when they are compromised with arthritis and the insertion of metal and plastic hardware, says DeGnore. When ankle surgery is needed, she prefers fusion over replacement.

Correcting rheumatoid foot deformities and straightening spastic foot deformities in stroke or head injury patients are the more gratifying surgical procedures that DeGnore performs because her “patients are free of pain and can walk again,” she says. Additionally DeGnore treats complex genetic foot deformity, Charcot –Marie Tooth disease, while her mainstay procedures are removing bunions and performing corrective toe surgery.

DeGnore graduated from the University

Mathew A. Nichols, MD

Mark E. Einbecker, MD

of Michigan’s six-year college and medical school program, took her residency at UNC Chapel Hill, a fellowship at Vanderbilt, and was on faculty for five years at UK before joining KOHS in 1998.

General Orthopedist: The Go to Guy

A graduate of the seven-year combined medical school and doctoral program in biochemistry at UK, plus a five-year orthopaedic residency and specialty at UK prepared Mathew A. Nichols, MD, for a career in academic medicine. But that was not to be.

Instead, Nicholls joined KOHS in 2004 and brought his interest in improving best practices for medicine and hospitals with him. Nicholls is widely published and works consistently within his specialty and hospitals to advance patient care. He stresses

pre-and post-operative patient education and processes. Among his efforts are a curriculum that educates patients on post operative expectations; modifying anesthesia for orthopedic patients for faster post-op recovery; and initiating physical therapy within hours of surgery whenever possible.

“Same day physical therapy shows definite improvement in reducing blood clots and allows the patient to leave the hospital faster,” says Nicholls.

As a general orthopedic surgeon, Nicholls is trained in the management of a wide array of operative and non-operative musculoskeletal problems from carpal tunnel syndrome to primary joint replacement and revision surgeries. He enjoys the challenge of staying up to date on the latest in treatment of the wide array of orthopedic problems. During any given week he may find himself operating on the shoulder, knee, ankle or any one of the joints in the upper or lower extremities.

Joint revision surgery intrigues Nicholls because it demands more pre-op planning and thought. The most important factor, he says, is determining why the primary surgery failed. Was it the result of infection, bone fracture, lack of proper therapy, or implant failure? Determining the reason

why an implant failed is critical in devising a solution that will work. “When you operate on a failed total joint, you may have to have a back-up plan and a back-up plan to the back-up plan,” he says.

Nicholls’ PhD in biochemistry included extensive study in the use of MRI. He continues to rely heavily on imaging in his orthopedic practice. He is a strong advocate for reading his patient’s MRIs himself in addition to simply reading the radiology report. “We use computers and cameras to make our surgeries smarter,” he says, this allows him to see the three dimensional fields and how joints and soft tissue align.

Addressing patient post-op expectation is part of the educational process that Nicholls embraces. He reminds patients that the replacement joint will not be as good as their God-given one. And joint replacement may relieve their pain, but may not allow them to do everything and anything they want to do. “Joint pain is sometimes your body’s way of telling you to do something different,” he says to his patients.

Doing the right surgery for the right problem is Nicholls’ mantra. “I frequently joke with my patients that I have plenty of surgeries that will make them worse off, but we are only going to find the one that will make them better. The more patients engage in the decision and post-op therapy process, the better they do.”

(Editor’s note: Dr. George Boucher, physiatrist joined KOHS in 2011. He specializes in the nonsurgical treatment of bone, joint and muscle pain associated with fibromyalgia and was profiled in MD Update, March 2012.) ◆

For patient referral, contact Kentucky Orthopaedic and Hand Surgeons at (859) 278 3481.

Located at 1780 Nicholasville Rd, Suite 501, Building B, Lexington KY 40504 www.kybones.com.

June 2012 23

Allied Health

Acupuncture And Chiropractic Synergistic choices for osteoarthritic joint pain

By Charles Metzker, DC, CAc Joint pain is a common and persistent reality in the lives of many suffering people. It is estimated that approximately 50% of adults over the age of 55 experience some type of mild to severe pain in various joints of the body. The most prevalent form of these pains is classified as osteoarthritic in nature.

This can occur in any and all joints of one’s musculoskeletal system. Osteoarthritis consists of pain, stiffness, swelling, crepitus, and limited range of motion within the joint. In my 32 years of active practice, I have found the synergistic application of chiropractic adjustments and acupuncture to be effective in alleviating acute and chronic pain in many of my patients. When a person asks for help in addressing their pain syndrome, I utilize both therapies within each appointment to create the best results possible for my client. Each session is time intensive with consideration given to providing a patient with the necessary experience to change their painful condition. Discussions of lifestyle, diet, exercise, and emotional support are necessary components of making acupuncture and chiropractic work as a synergistic experience.

There are several medical research facilities striving to better understand various techniques to aid the osteoarthritic patient.

A leading spinal surgeon, Dr. Vert Mooney of Del Mar, California, was a leading proponent of using acupuncture and chiropractic manipulation to decrease painful joint symptoms. It is not uncommon for physicians of all specialties to inquire about conservative modalities that can assist in the alleviation of joint pain. Acupuncture and chiropractic can be used in conjunction with traditional allopathic procedures to enable the body to recuperate from persistent painful conditions.

How do the individual and combined acupuncture and chiropractic methods work?

Acupuncture is a form of Chinese medical therapy that traces its roots as far back as 2500 years ago. It is being carefully studied in randomized laboratory settings 24 M.D. Update

According to Dr. Charles Metzer, acupuncture and chiropractic can be used in conjunction with traditional treatments to alleviate chronic pain.

to determine its efficacy. Western-based research regarding complementary therapies is rooted in discovering evidence-based outcomes. Most current acupuncture research is involved with discovering its consistency with named disease processes within the Western model. Acupuncture is thought to stimulate the central nervous system in three basic manners. These three postulates include the following: 1) The release of

Acupuncture is thought to stimulate the central nervous system in three basic manners.

opioid peptides. 2) The alteration in the secretion of neurotransmitters and neurohormones. 3) The stimulation of electromagnetic points in the body. Opioids have an analgesic effect on painful joints. The hypothalamus and pituitary gland secrete neurotransmitters and neurohormones that alter the manner in which the body expe-

riences pain. There is focus being given to the possible immune effect of these transmitters also. There are over 2000 acupuncture points as cataloged by Chinese texts. These are thought to be conductors of electromagnetic signals that cause a release of endorphins at painful sites. The increased flow of “Qi� or energy is central to the Chinese mode of treatment. These descriptive notions are well covered in several acupuncture and medical journals, the previous being reported by Paolo Zanardi AP at spine-health.com.

Chiropractic adjustments work on the theory that joint dysfunction is related to and composed of fixation and lack of mobility within the musculoskeletal system.

Mobilizing the spinal facets and articulations of the extremities results in increased range of motion and healthy joint function with stronger elasticity. The same principles related to endorphin release, opioid effect, neurotransmitter/neurohormone presence and electromagnetic conduction are thought to be part of the positive outcome from chiropractic adjustments. In the Journal of Manipulative and Physiological Therapeutics Vol. 27, results of a study

Photography courtesy of Josh Saxton

by Cramer and Fournier concluded that relevant in the practice of complementary “findings indicate that fixation (hypomobil- acupuncture and chiropractic. ity) results in time-dependent degenerative A recommendation by the University changes of the facets joints.” In other words, of Maryland Medical Center presented musculoskeletal manipulation is thought to within a collection of treatment suggestions increase joint mobility and decrease surface for osteoarthritic pain by the American degeneration of articular surfaces.

A landmark study reported in the Annals of Internal Medicine Vol. 141 on 12-21-2004 revealed the positive effect acupuncture treatment has in the improvement in function and pain relief as an adjunctive therapy for osteoarthritis of the knee. This was a study funded by the National Institute of Health (NIH). Direct encouragement and advice was provided from the National Institute of Arthritis and Musculoskeletal/ Skin Diseases. Another study of 3553 patients by Claudia Witt of the University Medical Center in Berlin, Germany, from 2001-2004 reported that “the present results show that Charles Metzer, DC, CAc in patients with chronic pain due to osteoarthritis of the knee or hip, addition Accreditation Healthcare Commission of acupuncture to the treatment regime (www.urac.org) suggests that acupuncture resulted in clinically relevant and persis- and chiropractic should be included as tent benefit.” It was further noted that an viable modalities in the relief of joint pain. acupuncturist’s experience was the most Thirty-two sources of research data were important factor in treatment outcome. included in this article of multidisciplinary Physicians and their patients frequently treatments. express the importance of sincere dialogue As a practical and descriptive note, I that comes from the depth of the therapist’s would like to share an interesting examexperience. This seems to be especially ple of how acupuncture and chiropractic

adjustments can act as synergistic agents.

The spinal segments are frequently involved in facet dysfunction related to joint pain.

Along the spinal column there exist two acupuncture meridians or channels that accompany the osseous anatomy. These two channels are the Bladder (UB) Meridian and the Governing Vessel.

They are physically proximal to the spinal joints themselves. Prior to adjusting the painful articulations, I insert thin acupuncture needles to enhance endorphin release along the central nervous system. The Bladder Meridian is a unique channel in that it has “associated points” for every other organ of the body including itself. An acupuncture treatment of the Bladder Meridian brings a positive influence and relaxing effect to the entire body in this manner. After a few minutes of mild electro-stimulation to the inserted thin needles, the spine is much more able to respond positively to an adjustment that removes joint fixation. Increased mobility occurs within the joint and pain starts to subside.

The two techniques work cooperatively to enhance a patient’s health.

Dr. Charles Metzker is a licensed/certified chiropractor and acupuncturist. He can be reached at his Lexington practice, (859) 268-4111. ◆

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(859) 253-5353 June 2012 25

news  events  Arts

Boulanger named UK HealthCare CMO

LEXINGTON Dr. Bernard Boulanger has been named chief medical officer (CMO) for UK HealthCare effective June 12. He replaces Dr. Paul DePriest, who has accepted a position in Tennessee.

Working with his colleagues, Boulanger will be responsible for service quality, clinical outcomes, patient satisfaction, patient safety, and efficient practice – extending the excellent work begun

by DePriest.

To this role, he brings experience in supply chain manageBernard Boulanger ment, facilities planning, and enterprise operational management.

Boulanger’s undergraduate education, medical degree, internship, and general surgery residency were obtained at the University of Toronto. Further trauma surgery/critical care training was completed at the R. Adams Cowley Shock Trauma Center of the University of Maryland. Since 1998, Boulanger has been an attending trauma surgeon at UK. In 2005, he was named associate chief medical officer for UK HealthCare. In 2008, he became surgical director of perioperative services, and more recently, he took on additional responsibilities as a physician executive with UK Good Samaritan Hospital.

Dr. Ardis Dee Hoven Named AMA President-Elect

LEXINGTON Ardis Dee Hoven, MD, an internal medicine and infectious disease specialist in Lexington, Kentucky, has been elected president-elect of the American Medical Association (AMA. Following her year-long term as president-elect, Hoven will assume the office of AMA President in June 2013.

Hoven was first elected to the AMA Board of Trustees (BOT) in 2005. She initially served as secretary from 2008 to 2009, 26 M.D. Update

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and then as chair Marvin, MD, director of Transplantation from 2010-2011. at Jewish Hospital and associate professor Hoven has been of Surgery at the University of Louisville a member of the (UofL), and Mary AMA’s Group Eng, MD, a kidPractice Advisory ney/liver/pancreas Committee and transplant surcurrently serves geon with The Ardis Dee Hoven, MD on the Physician Transplant Center Consortium for at Jewish Hospital Performance Improvement, the National and an assistant Advisory Council for Healthcare Research professor of surand Quality, the National Quality Forum, gery at UofL, perand the Commission on Office Laboratory formed the surgery.

Accreditation Board of Directors.

Paired kidney Hoven was president of the Kentucky donation takes Medical Association (KMA) from 1993 to place when a donor Michael Marvin, MD 1994 and served as a delegate to the AMA who is incompatfrom Kentucky prior to her election to ible with their designated recipient promthe AMA BOT. She is also a fellow of the ises to donate their kidney to a stranger American College of Physicians and in order to enable their a member of the Infectious Disease designee to receive a Society of America. She is the recipicompatible kidney ent of many awards, including the from another stranger.

University of Kentucky College of An Elizabethtown, Medicine Distinguished Alumnus Kentucky, woman Award, and the KMA Distinguished received a kidney transService Award. plant in Louisville at Born in Cincinnati, Hoven Jewish Hospital on April received her undergraduate degree in 19, 2012 as a result of microbiology and her medical degree the paired donation. from the University of Kentucky. Mary Eng, MD Her husband donated a She completed her internal medikidney on May 1, 2012 cine and infectious disease training to help another individat the University of North Carolina, Chapel ual and continue the chain.

Hill. Since that time, Hoven has been in The chain began when a 31-year-old active practice. She is currently the medical Oklahoma woman altruistically donated her director of the Bluegrass Care Clinic, an kidney to a stranger in Greece. In return, infectious disease and HIV/AIDS practice the Greek recipient’s wife donated one of affiliated with the University of Kentucky her kidneys to another person in WilkesCollege of Medicine.

Barre, Pa., completing the first intercontinental exchange and opening a door that Jewish Transplant Center Part potentially can save thousands of American of First International Paired lives, as well as others throughout the Kidney Exchange in US world. A kidney from the donor in WilkesLouisville The Transplant Center at Jewish Barre, Pa. was flown to Jewish Hospital for Hospital, part of KentuckyOne Health, helped transplant, and thus the chain continues. make medical history on April 19, 2012 as To date, one Greek and four American lives part of the first international paired kidney have been saved and three more transplants donor exchange in America, with the help are expected within weeks as a result of the of the Alliance for Paired Donation. Michael first intercontinental kidney donor chain.

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Though paired exchanges have been taking place in the United States for over 10 years, the idea of enlarging the donor pool by including other nations, thereby getting more Americans transplanted, has been problematic due to the variability in national transplant laws.

Norton Healthcare Acquires LIFESCAN Louisville

LOUISVILLE Norton Healthcare has acquired LIFESCAN Louisville, an outpatient diagnostic imaging center located in the City of St. Matthews in eastern Louisville. The center provides PET/CT and CT services for cancer and cardiac patients, among others. Details of the transaction include: Norton Healthcare purchased the 4,200-square-foot facility, including the PET/CT and related equipment.

The facility, located at 4046 Dutchmans Lane, is temporarily closed for several weeks, effective June 18, 2012, for necessary renovations to mechanical and electrical systems.

When the facility reopens, the new imaging center will be named Norton Diagnostic Center – St. Matthews.

During this interim time, LIFESCAN patients can access the nearby Norton Diagnostic Center – Dupont, which offers PET/CT and CT services, among others.

Four LIFESCAN employees have joined Norton Healthcare.

When Norton Diagnostic Center – St. Matthews reopens, Norton Healthcare will offer five outpatient diagnostic imaging centers conveniently located around Greater Louisville: Norton Diagnostic Center – Dupont, Norton Diagnostic Center – Fern Creek, Norton Diagnostic Center

Healing Growth

– Brownsboro, Norton Cardiovascular Diagnostic Center – Dixie, and Norton Cardiovascular Diagnostic Center – Springs.

Norton Healthcare Accredited for Noninvasive Cardiovascular Diagnostics

Norton Healthcare recently achieved national accreditation through the Intersocietal Accreditation Commission (IAC) in all noninvasive cardiovascular diagnostic programs. This includes nuclear/ positron emission tomography (PET) scans, echocardiography, and noninvasive vascular testing. Norton Healthcare is the first hospital system in Louisville to be granted accreditation for all three noninvasive cardiovascular modalities.

In November 2011 the Norton Healthcare Cardiovascular Service Line

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winner of the 2012 landscaper of the year award June 2012 27

news

Advisory Committee unanimously approved a proposal to seek systemwide accreditation for noninvasive cardiology diagnostic services. The facilities underwent a thorough review of operational and technical components by a panel of experts in nuclear medicine. Accreditation is granted only to facilities providing quality patient care throughout a detailed case study review, which encompasses everything from department team members to physician participation.

Nuclear cardiology services went through a strenuous evaluation to ensure quality and subsequently received full accreditation from the IAC.

Shoulder Symposium Reaches 15 Year Milestone

Lexington The Shoulder Center of Kentucky and the Lexington Clinic OrthopedicsSports Medicine Center present the 15th Annual Shoulder Symposium at the Hilton Lexington in downtown Lexington, July 27-28, 2012.

The Shoulder Symposium is conducted each year by Dr. Ben Kibler, Medical Director of Lexington Clinic OrthopedicsSports Medicine Center and founder of the Shoulder Center of Kentucky, a nationally

Dr. Ben Kibler, Medical Director of Lexington Clinic Orthopedics-Sports Medicine Center and founder of the Shoulder Center of Kentucky

recognized expert on the shoulder mechanics, the scapula and biomechanics of tennis and throwing motion.

“Every 3 years or so, we have brought together some of the top scapula dyskinesis researchers and clinicians in a summit format, to try to improve understanding of this complex problem,” states Kibler. “This 28 M.D. Update

CMKI Celebrates 2011-2012 Fellows

LOUISVILLE Congratulations to the 2011-2012 class of Fellows that recently completed the Christine M. Kleinert Institute for Hand & Micro Surgery (CMKI) Fellowship Program. More than 1,200 physicians from 58 countries have received training in hand surgery as clinical fellows, research fellows, or residents since the program was started in 1960 by Harold Kleinert. Seated in front Row (left to right – all CMKI staff): Rodrigo Moreno, Huey Tien, Luis Scheker, Tsu-Min Tsai, Joseph Kutz, Thomas Wolff, Michelle Palazzo, Tuna Ozyurekoglu, and B. Thomas Harter, Jr. Back row (left to right): Yorell Manon-Matos (CMKI staff), Yong Yang, Joel Pessa, Jose Couceiro, Dong Han, Hongbin Sun, Blendi Cumani, John Kevin Bailey, Pobe Luangjarmekorn, Elkin Galvis, Saad Elrahmany, Amir Oron, Silvia Aviles, Luis Schnapp, John Papakonstantinou, Kenny Hanna, Lacey Rao, Antonio Rampazzo, Xueyuan Li, Bahar Bassiri, Amir-Kianoosh Fallahi, and Scott Ciaccia.

is our 4th summit and these meetings have progressed from simply defining scapular dyskinesis in a consistent way, to the development of a consensus statement on scapular function, dysfunction and evaluation. Since the publication of the consensus statements in 2009, clinical research has progressed and there now are considerable data associating scapular dyskinesis with various other shoulder pathologies. This year the summit will look at the clinical implications of that association along with treatment options and plans. This symposium is an opportunity to provide this information and cutting-edge thinking to a wider audience of clinicians,” says Kibler.

According to information provided by the Lexington Clinic Orthopedics – Sports Medicine Center, the 2012 Shoulder Symposium will present literature and on-going research on the conditions that involve “altered scapular mechanics,” such as shoulder and elbow injuries to the labral, rotator cuff, nerve impingement, MDI/ instability, clavicle/AC joint and scapula muscle detachment. Special attention will focus on baseball, tennis swimming and contact sports, the clinical exam, rehabilitation protocols and outcome research.

The agenda topics will include current

theories and techniques in the evaluation and rehabilitation of the kinetic chain, scapula and shoulder and will feature a national and international assemblage of speakers including: Ben Kibler, MD; Klaus Bak, MD, from Parkensprivat Hospital, Denmark; Peter Hester, MD, Lexington Clinic; David Dome, MD, ATC, Lexington Clinic; John (Jed) Kuhn, MD, Vanderbilt University and Sports Medicine Center; Augustus Mazzocca, MD, University of Connecticut; Trevor Wilkes, MD Lexington Clinic and numerous professors of physical therapy.

More information is available at (859) 258 8506 and online at ww.lexingtonclinic. com/ksportsmed.

Kosair Children’s Hospital’s Cancer Program Ranked by U.S. News & World Report

LOUISVILLE The cancer care program at Kosair Children’s Hospital was ranked No. 16 in the nation by U.S. News & World Report.

Kosair Children’s also was rated among the top 50 children’s hospitals in the nation, out of 178 hospitals eligible to participate in the survey, in six other specialties, according to U.S. News & World Report’s 2012-13 Best Children’s Hospitals rankings.

Kosair Children’s Hospital (the only

newS

full-service, free-standing children’s hospital in Kentucky and the only hospital with Level I pediatric trauma certification) ranked a full 29 places higher than last year’s cancer care ranking. The hospital also was ranked No. 24 in orthopedics, 24 in pulmonology, 29 in neurology and neurosurgery, 31 in urology, 38 in cardiology and heart surgery, and 49 in nephrology.

The Addison Jo Blair Cancer Center at Kosair Children’s Hospital is the country’s oldest continually accredited children’s oncology program by the American College of Surgeons’ Commission on Cancer (COC), holding accreditation since 1959. It is one of only 11 COC-accredited pediatric cancer programs in the country.

This year, U.S. News sent surveys to 178 pediatric centers to obtain hard data such as availability of key resources and ability to prevent complications and infections. The hospital survey made up 75 percent of the rankings. A separate reputational survey of 1,500 pediatric specialists – 150 in each spe-

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cialty – made up the remaining 25 percent.

Specialists were asked where they would send the sickest children in their specialty.

two kentuckyone health hospitals receive Quality awards from kha

LOUISVILLE AnD LExIngtOn Two KentuckyOne Health facilities were honored by the Kentucky Hospital Association (KHA) at the organization’s annual convention. Our Lady of Peace in Louisville and Continuing Care Hospital in Lexington both received the “KHA Quality Award,” Peace in the “Psychiatric” category and Continuing Care in the “Physical Rehabilitation or Long – Term Acute Care” category.

The awards recognize hospital leadership and innovation in quality, safety, and commitment in patient care. The hospitals were honored for patient safety and quality initiatives that have been integrated into the facilities’ culture, and for achieving quality goals.

Our Lady of Peace is the largest private

non-profit psychiatric hospital in the U.S. that provides care to children and adolescents. The facility’s Safety First initiative places patients’ and employees’ safety first in providing quality care. The program encourages the participation of families in the treatment process of the patient and in helping initiate and improve quality measures to promote safety. Daily safety huddles and a safety coach program are key components of the initiative.

Continuing Care Hospital is a general acute care hospital that addresses the unique and complicated physical, emotional, spiritual, nursing, and rehabilitation needs of the long-term acute care patient. The facility developed a Patient Safety Quality Improvement Committee that works to meet the core strategy of the organization, quality. The committee sets goals, reviews outcomes and evaluates the effectiveness of initiatives implemented, as well as makes recommendations for changes and improvements. Continuing Care Hospital also implemented a Safe Patient Handling and

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UK College of Public Health Part of MPROVE Study

LEXINGTON A new large-scale research project called MPROVE (Multi-Network Research Practice and Outcome Variation Examination), the first project to bring together the power of six public health practice-based research networks (PBRNs) from across the country, will look at how geography may play a role in the delivery of public health services that promote health and prevent disease and injury in communities.

Each of the six PBRNs has received a $50,000 MPROVE grant from the Robert Wood Johnson Foundation (RWJF) to participate in the study being coordinated by the PBRN National Coordinating Center (NCC), housed at the University of Kentucky College of Public Health. Each PBRN will collect data on the scope, intensity and quality of local public health ser-

vices delivered in the areas of communicable disease control, chronic disease prevention, and environmental health protection.

The results of MPROVE will help to identify why some communities receive more or better health services than others – and what health and economic impacts result from these differences. These findings will help public health practitioners and policy officials make better decisions about where best to invest new resources to maximize gains in population health, and where to cut resources during times of depleted funding to minimize the negative impact on people’s health.

Frazier Rehab Therapist Honored with U.S. President’s Council on Fitness, Sports & Nutrition Community Leadership Award

The U.S. President’s Council on Fitness, Sports & Nutrition (PCFSN) has select-

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ed Karey McDowell, MS, CTRS, to receive a 2012 PCFSN Community Leadership Award.

The award is given annually to individuals who improve the lives of others within their community by providing or enhancing opportunities to engage in sports, physical activities, fitness, or nutrition-related programs.

In her work at Frazier Rehab Institute, a part of KentuckyOne Health, McDowell has been instrumental to the development of the Frazier Community Fitness and Wellness Facility, a partnership with the Dana and Christopher Reeve Foundation, to provide a world-class fitness opportunity to the disabled community of Louisville and surrounding areas. The facility ensures that all patients have the utmost opportunity to improve the quality of their life, regardless of disabling conditions.

Jewish Hospital Receives Get With The Guidelines – Stroke Silver Plus Quality Achievement Award

Jewish Hospital, part of KentuckyOne Health, received the American Heart Association/American Stroke Association’s Get With The Guidelines®Stroke Silver Plus Quality Achievement Award. The award recognizes the facility’s commitment and success in implementing excellent care for stroke patients, according to evidence-based guidelines.

To receive the award, Jewish Hospital achieved an 85 percent or higher adherence to all Get With The Guidelines-Stroke Quality Achievement indicators for two or more consecutive 12-month intervals and achieved 75 percent or higher compliance with six of 10 Get With The GuidelinesStroke Quality Measures, which are reporting initiatives to measure quality of care.

These measures include aggressive use of

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medications, such as tPA, antithrombotics, anticoagulation therapy, DVT prophylaxis, cholesterol reducing drugs, and smoking cessation, all aimed at reducing death and disability and improving the lives of stroke patients.

Historic Cancer Research Project Seeking Greater Louisville Participants

Residents throughout Greater Louisville have an unprecedented opportunity to participate in a historic study that has the potential to change the face of cancer for future generations. Men and women between the ages of 30 and 65 who have never been diagnosed with cancer are needed to participate in the American Cancer Society’s Cancer Prevention Study-3 (CPS3). CPS-3 will enroll a diverse population of up to half a million people across the United States and Puerto Rico. The opportunity for local residents to enroll in CPS-3 is being made possible in partnership with Jewish Cancer Care, part of KentuckyOne Health, and the YMCA

LOUISVILLE

of Greater Louisville during August 7-11, 2012.

CPS-3 will help researchers better understand the lifestyle, environmental, and genetic factors that cause or prevent cancer.

To enroll in the study, individuals will be asked to read and sign an informed consent form; complete a comprehensive survey packet that asks for information on lifestyle, behavioral, and other factors related to your health; have your waist circumference measured; and give a small blood sample. Upon completion of this process, the Society will send periodic follow-up surveys to update your information and annual newsletters with study updates and results. The in-person enrollment process takes approximately an hour to complete. Periodic follow-up surveys of various lengths are expected to be sent every few years to individuals.

Researchers will use the data from CPS-3 to build on evidence from a series of American Cancer Society studies that began in the 1950s that collectively have

involved millions of volunteer participants.

The Hammond-Horn Study and previous Cancer Prevention Studies (CPS-I, and CPS-II) have played a major role in understanding cancer prevention and risk, and have contributed significantly to the scientific basis and development of public health guidelines and recommendations. Those studies confirmed the link between cigarette smoking and lung cancer, demonstrated the link between larger waist size and increased death rates from cancer and other causes, and showed the considerable impact of air pollution on heart and lung conditions. The current study, CPS-II, began in 1982 and is still ongoing. But changes in lifestyle and in the understanding of cancer in the more than two decades since its launch make it important to begin a new study.

For more information or to learn how to become involved with CPS-3, visit cps3kentucky.org, email cps3@cancer.org, or call toll-free 1-888-604-5888. ◆

June 2012 31

arts

Creating Restorative Gardens for Your Home

By Bill Henkel We are learning more and more daily about the healing and restorative qualities of nature. Healing gardens, as they are often referred to, are becoming much more of an integrated component of our medical facility designs. The value these gardens bring to improving patient, staff and faculty outcomes is powerful, real and measurable. So, why not have a restorative space where you spend most of your time away from your work – you own home?

Recognizing the need or desire to find such a restorative garden space is the first step in this process. Restorative gardens do not have a need for the obvious with a sign or a label. Often they are most effec-

tive if they simply exist with the proper combination of elements to tempt you to enter and explore the mystery.

Restorative gardens do not have to be comBY Bill Henkel plicated, large in scale or expensive to build. They do need to contain certain elements. These elements could be:  Quiet space, free from outside noise and daily interference  Protection from the sun, wind and rain  Comfortable place to sit or recline  Degree of privacy – to be alone with your thoughts  Feeling of safety  Interesting combination of plant materials with a variety of colors, textures, sizes and fragrances  Soft, quiet path to enter and leave on  Some element of water and its associated natural music  Any personal items you may want to contribute to the environment Restorative gardens are not limited to these elements alone, but should include most.

Finding the best possible location for this garden will be your next part of the challenge.

Remember, the size is not always important.

Large enough for one or two will usually suffice. Most of us have some small leftover spaces in our gardens that demand little attention. Some space, out of the way, perhaps in a far corner of the back yard. Side yards, often shady, can be easily developed into comfortable gardens to stroll through. An entry garden that connects the front door to your street can offer brief pause for a moment to refresh.

Often, a brief moment is all that is needed.

Phasing the installation of your garden can be fun and spreads the cost out over longer periods. Having new phases to look forward to and to think about is healthy and keeps you engaged in the garden’s development.

Lighting for your garden can be one of the most challenging and enjoyable for any garden development. Lights bring the garden to life at night and help to remove shadows. You may not use your garden at night, so having a view to this personal space may be all that you need. Night lighting can change a dark corner into an inviting vignette, bringing the outside in and extends the useable hours of restorative space. Soft, warm and indirect light is often preferred.

Landscape architects are the best choice for any garden design. They are educated and trained in the design and construction of gardens and people spaces. They will be the most qualified in delivering quality design for restorative and healing garden experiences.

Bill Henkel is owner and partner of Henkel Denmark of Lexington. He can be reached at (859) 455 9577 or bill@henkeldenmark.com. ◆

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32 M.D. Update